What is anxiety?
Anxiety is a form of thinking linked to our physiological fear responses.
Healthy and adaptive anxiety helps us imagine and prepare for future danger. We know that some anxiety, like pressure from a deadline, improves performance. But too much anxiety destroys performance, and the line between is sharp and distinct.
Anxiety becomes unhealthy, and maladaptive is when it is detrimental to life functioning.
The degree to which it interferes with daily function determines whether we label it a 'problem' or an actual disorder.
Occasional anxiety is a normal part of life
You might feel anxious when faced with a problem at work, or before taking a test, or making a major decision.
Anxiety disorders involve more than temporary worry or fear.
For a person with an anxiety disorder, the anxiety does not go away and can worsen over time. The feelings interfere with daily activities such as job performance, schoolwork, and relationships.
There are several types of anxiety disorders like generalized anxiety disorder, panic disorder, and social anxiety disorder.
Learn specific anxiety relief techniques. Download our guide now.
Physiology of anxiety
The physiological stress response starts as soon as the senses perceive the stressor.
Your body alerts the brain, which signals to the autonomic nervous system, which signals the organs and hormone responses needed to gear up for action.
Anxiety tends to be a chronic activation of the stress response system rather than an acute, episodic response which is what causes the damage.
The nervous system and stress
Signals about that stimulus are sent to your brain when your body senses a stressor.
The hypothalamus is alerted to arouse the Autonomic Nervous System (ANS). The ANS is the system that controls the involuntary actions of the organs, glands, and blood vessels.
The ANS has two subsystems: the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS).
The SNS is the “action system that gears the body for fight/flight/freeze’ during a stressful situation.
The PNS is responsible for the healing mode of the body when it is relaxed.
Sympathetic nervous system (SNS) response to stress
Enhance the strength of your skeletal muscles
- Increase heart rate
- Increase sugar and fat levels
- Enhances mental activity
- Slows down blood clotting time
- Decreases intestinal movements
- Limits digestive secretions
- Dilates Pupils
- Constricts peripheral blood vessels
Hormonal response to stress
There are three major stress hormones:
- Adrenaline - Produces a surge of energy, heart rate increase, rapid breathing, muscle activation, focuses attention.
- Norepinephrine - Like adrenaline, but effects last longer, diverts blood flow from outer to inner, focuses attention, and awakens and keeps hyper-alert.
- Cortisol - Regulates fluid balance and blood pressure for action. Chronically elevated levels of cortisol are very damaging to the body.
Evaluation for an anxiety disorder often begins with a visit to a primary care provider or an emergency room.
Some physical health conditions, such as an overactive thyroid or low blood sugar, and taking certain medications, can imitate or worsen an anxiety disorder.
A thorough mental health evaluation is also helpful because anxiety disorders often co-exist with other related conditions, such as depression, eating disorders, addictions, obsessions, or compulsions.
Risk factors for anxiety disorders
Researchers are finding that genetic and environmental factors, frequently in interaction with one another, are risk factors for anxiety disorders. Specific factors include:
Shyness, or behavioral inhibition, in childhood
- Being female
- Having few economic resources
- Being divorced or widowed
- Exposure to stressful life events in childhood and adulthood
- Anxiety disorders in close biological relatives
- Parental history of mental disorders
- Elevated afternoon cortisol levels in the saliva (specifically for social anxiety disorder)
Signs and symptoms of anxiety disorders
Generalized Anxiety Disorder
People with generalized anxiety disorder display excessive anxiety or worry for extended periods and face several anxiety-related symptoms.
Generalized anxiety disorder symptoms include:
- Restlessness or feeling wound-up or on edge
- Being easily fatigued
- Difficulty concentrating or having their minds go blank
- Muscle tension
- Difficulty controlling the worry
- Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include:
- Palpitations, pounding heart, or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath, smothering, or choking
- Feelings of impending doom
People often go to the emergency room, thinking they’re experiencing a heart attack.
Panic disorder symptoms include:
- Sudden and repeated attacks of intense fear
- Feelings of being out of control during a panic attack
- Intense worries about when the next attack will happen
- Fear or avoidance of places where panic attacks have occurred in the past
Social Anxiety Disorder
People with a social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations. They expect to feel embarrassed, judged, rejected, or fearful of offending others.
Social anxiety disorder symptoms include:
- Feeling highly anxious about being with other people and having a tough time talking to them
- Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
- Being very afraid that other people will judge them
- Stressing for days or weeks before an event where other people will be
- Staying away from places where there are other people
- Having a challenging time making friends and keeping friends
- Blushing, sweating, or trembling around other people
- Feeling nauseous or sick to your stomach when other people are around
Treatments and therapies for anxiety
Psychotherapy and medications treat anxiety disorders. There is a growing trend to use stress management techniques, as well.
Psychotherapy or “talk therapy” can help people with anxiety disorders.
Psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs. A typical “side effect” of psychotherapy is temporary discomfort involved with thinking about confronting feared situations.
Medication does not cure anxiety disorders but often relieves symptoms.
Only medical doctors (such as a psychiatrist or a primary care provider) can prescribe medication. A few states allow psychologists to prescribe psychiatric medications.
Medications are sometimes used as the initial treatment of an anxiety disorder or are used if there is an insufficient response to a course of psychotherapy.
In research studies, it is common for patients treated with a combination of psychotherapy and medication to have better outcomes than those treated with only one or the other.
The most common medications used to combat anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Some medications are effective only if taken regularly, and symptoms may recur if the medication is stopped.
Antidepressants are used to treat depression, but they also help treat anxiety disorders.
They may take several weeks to start working and may cause side effects such as headache, nausea, or difficulty sleeping. The side effects are usually not a problem for most people, especially if the dose starts low and is increased slowly over time.
Anti-anxiety medications help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry.
The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines are first-line treatments for Panic Disorder.
For generalized anxiety disorder with panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind antidepressants.
Beta-blockers, such as propranolol and atenolol, are also helpful in treating the physical symptoms of anxiety, especially social anxiety.
Physicians prescribe them to control rapid heartbeat, shaking, trembling, and blushing in anxious situations.
Choosing the right medication, medication dose, and treatment plan should be based on a person’s needs and medical situation and done under an expert’s care.
Only an expert clinician can help you decide whether the medication’s ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
- How well medications are working or might work to improve your symptoms
- Benefits and side effects of each medication
- The risk of serious side effects based on your medical history
- The likelihood of the medications requiring lifestyle changes
- Costs of each medication
- Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment
- How the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
Stress management techniques will help people with anxiety disorders calm themselves and enhance the effects of therapy.
Diligent use of stress management techniques and therapy may allow you to avoid Rx medications.
- There is evidence that even very moderate exercise has a calming effect.
- Any drugs can affect anxiety levels. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.
- Many people are affected by specific foods/drinks. When you have sudden on-set symptoms, notice what you have had to eat or drink in the last few hours.
- Family support is essential in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms.
Learn more about Dr. Anne’s Anxiety and Trauma Relief class.