Tell Me All I Need to Know About Anxiety

You have questions about anxiety: What causes it? What treatments are best? Top doctors answer them here. Find peace—and plenty of solutions—to keep you moving forward. 

What Is Anxiety?

Who hasn’t occasionally tossed and turned worrying about the what-ifs in life—job security, health concerns, money woes, or relationship issues? Angst is a natural response to life’s ups, downs, twists, and turns.

“A certain amount of worry and hyper-vigilance can be considered normal and healthy reactions to life circumstances or immediate threats,” explains Marni Goldberg, LMFT, LPCC, whose San Diego, California-based practice, Mindful Matters Counseling, specializes in anxiety, sensitivity, and life transitions.

In fact, anxiety, that uneasy, unsettling feeling that something unwelcome or uncertain is about to happen, can even have some benefits. “Anxiety can help motivate you to work hard on important tasks, for example, or protect yourself against an immediate threat of violence when your fight-or-flight instinct kicks in,” she adds.

But anxiety can quickly take a turn from motivator to underminer when it brings along physical symptoms—your heart starts racing, you sweat or get chills, your chest tightens, or you have trouble focusing—and there are no immediate or dangerous threats present. Other symptoms can include shaking, stomachaches, excessive worrying, ruminating, or avoidance of certain places, activities, or even people.

Here’s the thing: anxiety by itself is not a disorder, says James Seymour, MD, director of the Chrysalis Program at Sierra Tucson, a residential treatment center for people struggling with a variety of depressive and mood disorders located in Tucson, Arizona.

“It’s a physical and emotional symptom that we all experience, and it can have value. It is a sign that something is wrong, physically or emotionally, or that we’re not safe in the environment or within ourselves,” he says. “Anxiety becomes problematic, however, when it affects functioning. When it’s not transient or fleeting, but static,” he adds. “That’s when it’s considered an anxiety disorder.”

What Is An Anxiety Disorder?

Anxiety disorder is an umbrella term that refers to a category of psychiatric conditions characterized by extreme fear or worry. According to the Anxiety and Depression Association of American (ADAA), anxiety disorders are the most common mental illness in the United States, affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.¹

In addition, according to the World Health Organization (WHO), globally, 1 in 13 people suffer from anxiety. In fact, WHO reports that anxiety disorders are the most common mental disorders worldwide with generalized anxiety disorder (GAD) topping the list followed by specific phobia, major depressive disorder, and social phobia.² In this 2017 study, researchers estimate that 792 million people live with a mental health disorder—slightly more than one in 10 people globally (10.7%).

The largest number of people had an anxiety disorder, estimated at around four percent of the population—that 284 million, a staggering number.

The Six Common Types of Anxiety Disorders

• #1. Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about everything. People with (GAD) may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry. They may worry more than what seems warranted about actual events or expect the worst, even when there is no apparent reason for concern.
• #2. Agoraphobia. Technically, this is defined by intense fear and anxiety of any place or situation where escape might be difficult. Agoraphobia involves avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area. You may think of it as people who are afraid to leave their houses.
• #3. Panic Disorder. People who experience spontaneous, seemingly out-of-the-blue panic attacks and are very preoccupied with the fear of a recurring attack. Panic attacks occur unexpectedly, sometimes even when waking up from sleep. It’s not like you’re necessarily thinking about something specific and the worry spirals into a panic attack.
• #4. Phobias are strong, irrational fear reactions in the presence or anticipation of a specific object, place, or situation. Fear of heights is an example.
• #5. Separation Anxiety Separation anxiety refers to excessive fear or worries about separation from home or someone very close to you.
• #6. Social Anxiety Disorder is a condition characterized by intense anxiety related to a fear of being judged, negatively evaluated, or rejected in a social or performance situation is also known as social anxiety disorder.

Generalized Anxiety Disorder (GAD): A Closer Look

According to ADAA, GAD affects 6.8 million adults, or 3.1% of the US population, in any given year, with women twice as likely to be affected. The disorder comes on gradually and can begin at any time, though the risk is highest between childhood and middle age. Although the exact cause of GAD is unknown, there is evidence that biological factors, family background, and life experiences, particularly stressful ones, play a role.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes GAD using the following criteria:

• Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance)
• Difficulty controlling the worry
• The anxiety and worry are associated with three (or more) of the following six symptoms (with some symptoms present more days than not during the past six months); only one item required in children:
  #1. Restlessness, feeling keyed up or on edge
  #2. Being easily fatigued
  #3. Difficulty concentrating or mind going blank
  #4. Irritability
  #5. Muscle tension
  #6. Sleep disturbance (insomnia or difficulty falling/staying asleep, or restless, unsatisfying sleep).
• The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not attributable to the physiological effects of a substance (e.g., drug abuse or a medication).
• The disturbance is not better explained by another medical disorder.

What Are The Symptoms of Generalized Anxiety Disorder (GAD)?

GAD is different from say having a phobia. People with phobias are fearful of something in particular – for example, spiders, heights, or speaking in public. If you have GAD, you have an uneasy feeling about life in general.

It’s often associated with feelings of dread or unease and you’re in a state of constant worry over everything. For example, if a friend doesn’t call you back within an hour, you may start to worry you did something wrong and the friend is upset with you. If you are waiting for someone to pick you up and he’s a few minutes late, you may start to fear the worst – that he was in an accident – instead of thinking that he simply got stuck in traffic.

The difference between worry and GAD is that people who are not suffering from GAD can rationalize their fears and resolve them. With GAD, there is no “off” switch. If you are suffering from GAD, you are experiencing a constant state of worry – and you can’t avoid it, because basically, just living is causing you anxiety.

GAD can manifest both mentally and physically. Here are some of the signs and symptoms to watch out for:

• Perpetual state of constant worry. Your brain is stuck in a “what-could-go-wrong” loop. In almost every situation, you’re scanning for potential problems.
• Inability to relax or enjoy quiet time. Like when you’re on vacation and it takes the first three or four days to unwind and really enjoy yourself.
• Feeling tense all the time. Quick test: Where are your shoulders right now? Pointing towards your ears and a little tight? That’s the tension we’re talking about. It’s like your body is always in a ready stance.
• Muscle tightness or body aches. This is similar to the above and might also include tightening your jaw or grinding your teeth.
• Avoidance of stressful situations. When you’re constantly running through the whole list of things that could go wrong, it’s not a surprise that you decide not to do some things. That danger ahead sign is always flashing.
• Difficulty concentrating. Worrying can make you jump around from one task to the next and that is bad for concentration. There may also be a physiological reason —  when you’re anxious, you breathe differently (breaths are more shallow) and it may impact the flow of oxygen to your brain, making you less able to focus.
• Inability to tolerate uncertainty. You need to know what is going to happen and how it is going to happen.
• Constant feelings of dread or apprehension. It’s not uncommon for people with anxiety to say things like, “I’ll be able to relax right after (fill in the blank).” The point is, there is always something out there on the horizon that you’re not looking forward to.
• Feeling constantly overwhelmed. For everything you have to do, there’s a whole list of worries that go along with it, and that can be pretty overwhelming.
• Intrusive thoughts of things that cause you to worry. Even when you try to stop thinking about things that are bothering you, they boomerang back.
• Not being able to sleep at all or to sleep well. This is because you are in a constant state of worry.
• Feeling jumpy, on edge, or restless. It’s almost like your whole body feels reactive.
• Stomach upset. This includes nausea and diarrhea and may be chronic.
• Fatiguing easily. You’re tired…All. The. Time.
• Heart palpitations. Feeling like your heart is racing.
• Trembles or shakes. Since you’re always anticipating something happening, you train your muscles to be ready for action, and this can lead to that shaky feeling.
• Sweating and dry mouth. Again, this is a response to that feeling that something is about to happen.
• Having difficulty breathing or a lump in your throat. It almost feels like you’re choking.
• Feeling lightheaded or dizzy. This might happen if you hyperventilate.
• Cold chills/hot flashes and or numbness or tingling sensations. As you prepare for a fight or flight response, blood rushes through your body and this brings on a lot of different sensations like hot or cold and tingling.
• Persistent irritability. Being on edge can make you cranky, too.

“The physical manifestations – chronic neck and back pain, headache, stomach and abdominal pain, irritable bowel syndrome – that can accompany anxiety disorder can be mild or severe,” Dr. Seymour explains. “Often anxiety is not the problem; it’s what manifests from it emotionally and physically.”

What Are The Risk Factors For Generalized Anxiety Disorder?

Real talk: All of us are likely to experience anxiety at some point, Dr. Seymour says. “But debilitating anxiety disorders are often seen in people who have depressive disorders, anxiety disorders, or other mood disorders in their genetic history. Additionally, people with depression often have anxiety, so they often exist in tandem.”

Anxiety does not discriminate: It can be experienced by anyone and may be present in varying degrees at different times in a person’s life, Goldberg says. “Anxiety disorders tend to be hereditary, and people often learn to worry a lot and distrust the world around them from observing this type of thinking from their primary caregivers as they’re growing up,” she explains. “People who have experienced any type of trauma can end up with anxiety. Also, those who have perfectionist qualities often experience anxiety – an underlying issue of anxiety is a fear of being out of control, so anyone who has a strong desire to be in control can be vulnerable to anxiety.”

What Triggers Anxiety?

“Each type of anxiety is triggered by different things,” Goldberg explains. For example, experiencing trauma and then subsequent reminders of the trauma, being predisposed to anxiety coupled with growing up in an environment that feels inconsistent or unsafe, whether physically or emotionally, or, going through a difficult experience such as a car accident can all trigger anxiety,” she says.

Anxiety can also be set off by having a strong need to succeed and putting a lot of pressure on oneself, by being in an abusive situation you feel you can’t escape, or even fears of recurrent panic attacks, Goldberg says. Major life events like divorce, a new job, a death in the family, or a move can also trigger anxiety.

What’s Going On In The Brain?

During a state of anxiety, the brain is affected by stress hormones such as cortisol and neurotransmitters such as norepinephrine, which can lead to difficulty regulating negative emotions, excessive negative thinking, and difficulty relaxing. Simultaneously, the amygdala, which is the emotion center of the brain, becomes overactive.

This can make it more difficult to calm down both mentally and physically. The amygdala constantly provides an assessment of threats to your environment. When it thinks there’s no danger, it does nothing and you feel calm. When it perceives danger, it warns you with anxiety, which is like its alarm system.

Anxiety In Kids And Teens

Anxiety disorders are not exclusively adult afflictions either — angst can strike even young kids. According to ADAA, one in eight children struggles with an anxiety disorder. The Centers For Disease Control and Prevention (CDC) says 7.1% of children age 13-18 have some type of diagnosed anxiety disorder.

Prevalence rates of anxiety tend to increase with age and this increase is thought to be a function of how our thought processes mature. That is, as our thinking develops it plays a considerable role in viewing stressors. This is observed early on when signs of separation anxiety may first be seen when younger children start school and struggle to adjust to leaving the comfort of their home and family. A teen’s perspective of their world and how their peers view them (e.g., being embarrassed, bullied, or other public humiliating experience) are key factors in the manifestation of social anxiety and its onset most often appears during puberty.

Getting a handle on anxiety during childhood is important. Research has shown that children and teens with untreated anxiety disorders are at higher risk of poor performance in school, social avoidance, and substance use, as well as comorbidities including eating disorders and ADHD. Therapy, medication in some cases, and familial support can help kids manage their anxiety, learn coping mechanisms early on, and lead healthy lives.

How Is Generalized Anxiety Disorder Diagnosed?

Because anxiety often manifests itself through physical symptoms, people tend to see their primary care physician first with complaints about headaches, chronic pain, or stomach issues, before seeing a therapist or psychiatrist. To be clinically diagnosed with GAD, you must meet the DSM-5 criteria more days than not, and for a period of at least six months.

What Is The Treatment For Generalized Anxiety Disorder?

Don’t worry (the last thing you need is to be anxious about your anxiety) anxiety disorders are highly treatable. Like other anxiety disorders, medications, and therapy are the most common treatment options for GAD. “Anxiety can be treated with many different types of therapeutic techniques as well as psychotropic medications, or alternative treatments,” Goldberg says. “I usually use cognitive behavioral therapy, mindfulness practices, and sometimes hypnotherapy.”

Goldberg focuses on awareness and changing thoughts and underlying beliefs, relaxation, and present-moment awareness/body awareness, as well as tapping into subconscious beliefs and old experiences that someone may be holding onto that no longer serve them.

Cognitive Behavioral Therapy is a common method of treatment that has shown great results for people living with GAD. This form of therapy is geared toward helping you recognize and understand your thoughts and the pattern of any negative thoughts you may experience. It focuses on teaching coping skills and mechanisms to help you return to normal functioning and ease your feelings of anxiety.

Dr. Seymour says that connections are key, as are stress-reducing skills. While stress and anxiety are not synonymous – stress relates to the external forces causing worry or fear, while anxiety comes from within – managing stress is critical to managing anxiety.

“The first step is to see a therapist when stresses build-up or you notice your anxiety increasing. A great way of dealing with anxiety is to find some way to connect with other people,” he says. “It’s not necessarily the psychotherapy that is most impactful; it’s the quality of the therapeutic relationship that is really the most healing aspect–the ability to connect right brain to right brain with another person,” Dr. Seymour says.

Other anti-anxiety methods Dr. Seymour finds helpful are deep breathing, guided meditation, yoga, and the good old power of positive thinking.

“If we look toward the positive and maintain a sense of humor, that can help relieve our anxiety,” he says. “We can choose what thoughts to attend to. We can’t choose how we feel or change our feelings, but we always have the ability to turn our attention toward the positive instead of the negative and maintain a sense of humor.”

Especially during difficult times, when anxiety seems to be running rampant in many people, positive thinking may seem extra challenging. But it can also be extra worth it. “As anxiety levels increase, it’s really helpful and important to recognize what we do have control over and try to accept and release the need to control the things that we really can’t,” Goldberg says.

“Focusing on what we’re grateful for – even the little things that we often overlook – can be positive and healing. Neuroscience backs up the belief that having a gratitude practice helps to rewire the brain. In addition, bringing yourself back into the present moment, rather than focusing on the future and the unpredictability of it, are helpful ways to deal with everything that’s going on around us,” she continues. “We really only have this moment anyway, so focusing all of our time and energy on the future is unproductive and stress-producing. Focusing on what you can control in your own life, connecting to others, spending your time doing simpler and satisfying tasks, and lowering your expectations of what the future ‘should’ look like will help tremendously in reducing anxiety levels.”

Other Types of Therapy That Can Be Helpful for Anxiety

Exposure Therapy

A form of CBT, exposure therapy is a process for reducing fear and anxiety responses. In therapy, a person is gradually exposed to a feared situation or object, learning to become less sensitive over time. This type of therapy is particularly effective for obsessive-compulsive disorder and phobias.

Acceptance and Commitment Therapy (ACT)

Also known as ACT, this type of therapy uses strategies of acceptance and mindfulness (living in the moment and experiencing things without judgment), along with commitment and behavior change, as a way to cope with unwanted thoughts, feelings, and sensations. ACT imparts skills to accept these experiences, place them in a different context, develop greater clarity about personal values, and commit to needed behavior change.

Dialectical Behavioral Therapy (DBT)

Integrating cognitive-behavioral techniques with concepts from Eastern meditation, dialectical behavioral therapy, or DBT, combines acceptance and change. DBT involves individual and group therapy to learn mindfulness and skills for interpersonal effectiveness, tolerating distress, and regulating emotions.

Interpersonal Therapy (IPT)

Often referred to as IPT, interpersonal therapy is a short-term supportive psychotherapy that addresses interpersonal issues of depression in adults, adolescents, and older adults. IPT usually involves 12 to 16 one-hour weekly sessions. The initial sessions are devoted to gathering information about the nature of a person’s depression and interpersonal experience.

Eye Movement Desensitization and Reprocessing (EMDR)

Under certain conditions, eye movements appear to reduce the intensity of disturbing thoughts. A treatment known as eye movement desensitization and reprocessing, or EMDR, seems to have a direct effect on the way that the brain processes information. Basically, it helps a person see disturbing material in a less distressing way.

EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Scientific research has established EMDR as effective for posttraumatic stress disorder. And clinicians also have reported success using it to treat panic attacks and phobias.

Other Ways to Treat Generalized Anxiety Disorder

Some people find that medication alone can be helpful in the treatment of GAD, while others are more likely to benefit from psychotherapy. Some find that the combination of psychotherapy and medication is the best course of action. Engaging in certain behaviors may also ease your anxiety and promote a healthier lifestyle. These include:

Daily exercise. Studies have shown that aerobic exercise can decrease overall levels of tension, elevate and stabilize mood, and improve sleep and self-esteem. As little as five minutes of daily exercise can have anti-anxiety effects.

Eating a healthy, well-balanced diet. A healthy diet can’t cure anxiety, but it can contribute to overall health and wellbeing. Eating breakfast high in protein, consuming foods high in complex carbohydrates, drinking water, avoiding caffeine and alcohol, and paying attention to food sensitivities can increase energy and motivation, reduce physical symptoms associated with anxiety, and improve mood overall.

Anxiety By The Numbers

6.8 million – the number of Americans with general anxiety disorder
17.7 million – the number of Americans with depression
4.7% — the percentage of the US adult population that will experience panic disorder sometime in their lives
2.3% — the percentage of adolescents age 13-18 that will experience panic disorder sometime in their lives
31 years – the average age of onset of anxiety disorders

Anxiety FAQs