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Anxiety Disorders Back to Course Index


Occasional anxiety is a normal part of life. Someone might feel anxious when faced with a problem at work, before taking a test or making an important decision. Anxiety, in and of itself, is a feeling of alertness and concern that readies an individual to take some sort of action. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, schoolwork, and relationships. For some, the experience is persistent, seemingly uncontrollable, and overwhelming.

Anxiety can be mild, moderate, or severe and even escalate to panic. Mild anxiety is part of the tension of everyday life, and a person may actually see, hear, and comprehend more effectively when slightly anxious. Moderate anxiety causes an individual to focus on immediate concerns, selectively blocking out tangential information. A severely anxious person is so focused on specific details that he or she can’t think of anything else, and behavior becomes directed toward relieving the anxiety. Panic is associated with loss of control and a sense of dread, with increased motor activity, reduced ability to relate to others, and distorted perceptions.



Everyday Anxiety:
Worry about paying bills, landing a job, a romantic breakup, or the other important life event.

Anxiety Disorder:
Constant and unsubstantiated worry that causes significant distress and interferes with daily life


Everyday Anxiety:
Embarrassment or self-consciousness in an uncomfortable or awkward social situation

Anxiety Disorder:
Avoiding social situations for fear of being judged, embarrassed, or humiliated


Everyday Anxiety:
A case of nerves or sweating before a big test, business presentation, stage performance, or other significant events

Anxiety Disorder:
Seemingly out-of-the-blue panic attacks and the preoccupation with the fear of having another one


Everyday Anxiety:
Realistic fear of a dangerous object, place, or situation

Anxiety Disorder:
Irrational fear or avoidance of an object, place, or situation that poses little or no threat of danger


Everyday Anxiety:
Anxiety, sadness, or difficulty sleeping immediately after a traumatic event

Anxiety Disorder:
Recurring nightmares, flashbacks, or emotional numbing related to a traumatic event that occurred several months or years before


There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.


The five major types of anxiety disorders are:

Generalized Anxiety Disorder

Obsessive-Compulsive Disorder (OCD)

Panic Disorder

Post-Traumatic Stress Disorder (PTSD)

Phobia (Social or Specific)

Generalized Anxiety Disorders


Generalized anxiety disorder (GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, and GAD is different in that there are generally no panic attacks associated with it. Without panic attacks present, we may think we are “just worrying too much.” Our struggles of constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated.

When assessing for GAD, clinical professionals are looking for the following:

  1. The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is excessive.
  2. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.
  3. The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):
  • Edginess or restlessness
  • Tiring easily, more fatigued than usual.
  • Impaired concentration or feeling as though the mind goes blank
  • Irritability (which may or may not be observable to others)
  • Increased muscle aches or soreness
  • Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)


Obsessive-Compulsive Disorder

The DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3) is diagnosed  by:

A.  Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight:  The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.


Panic Disorder

Panic disorder is classified as an anxiety disorder in DSM-5. According to the guidelines, to be diagnosed with a panic disorder, someone must experience unexpected panic attacks regularly.

The diagnostic criteria for panic disorder are defined in the DSM-5 and also require that at least one attack is followed by one month or more of the person fearing that they will have more attacks. This causes them to change their behavior, which often includes avoiding situations that might induce an attack.

It’s important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack or what feels like one.

  • The attacks are not due to the direct physiological effects of a substance (such as drug use or medication) or a general medical condition.
  • The attacks are not better accounted for by another mental disorder. These may include a social phobia or another specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, or separation anxiety disorder

A panic attack is characterized by four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes
The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack.
Post Traumatic Stress Disorder (PTSD)
PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.  Below is specific to adults, adolescents, and children older than six years.   All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A: stressor (one required)

The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: intrusion symptoms (one required)

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: avoidance (one required)

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

Criterion D: negative alterations in cognitions and mood (two required)

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: alterations in arousal and reactivity

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F: Duration (required)

  • Symptoms last for more than one month.

Criterion G: functional significance (required)

  • Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion (required)

  • Symptoms are not due to medication, substance use, or other illness.

Two specifications:

  • Dissociative Specification In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
    • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
    • Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
  • Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.

Anxiety is as common among older adults as among the young. Generalized anxiety disorder (GAD) is the most common anxiety disorder among older adults. It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.

  • Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.
  • Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment.
  • People with an anxiety disorder are three to five times more likely to go to the doctor, and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
  • Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.


Phobia (specific and social)

Social phobia is a type of disorder involving discomfort around social interaction, and concern about being embarrassed and judged by others. This discomfort will be experienced as fear and anxiety and will be accompanied by autonomic arousal, including diaphoreses, apnea, tremors, tachycardia, and nausea. It can range in severity to discomfort, which can be circumvented and adapted, to a virtually disabling fear with infiltration into multiple areas of life. The discomfort that people with Social Anxiety Disorder experience can generalize to routine activities such as eating in front of others, or using a public bathroom. People with social phobia desire social contact and want to participate in social situations, but their anxiety can become unbearable.  Social anxiety can lead to isolation, and either the absence of development or stagnation of social skills, which can intensify existing social anxiety.

Social phobias are the most common type of fear.  Up to one in 20 people have a social phobia.

A specific phobia is a type of anxiety disorder defined as an extreme, irrational fear of or aversion to something.  These irrational fears can interfere with personal relationships, work, and school, and prevent you from enjoying life.

These common phobias typically involve the environment, animals, fears of injections and blood, as well as certain other situations.


Arachnophobia is the fear of spiders and other arachnids. The sight of a spider can trigger a fear response, but in some cases, simply an image of an arachnid or the thought of a spider can lead to feelings of overwhelming fear and panic.

So why are so many people terrified of arachnids? While there are an estimated 35,000 different spider species, only around a dozen pose any type of real threat to humans. One of the most common explanations for this and similar animal phobias is that such creatures once posed a considerable threat to our ancestors who lacked the medical know-how and technological tools to address injuries from animals and insects. As a result, evolution contributed to a predisposition to fear these creatures.



Ophidiophobia is the fear of snakes. This phobia is quite common and often attributed to evolutionary causes, personal experiences, or cultural influences. Some suggest that since snakes are sometimes poisonous, our ancestors who avoided such dangers were more likely to survive and pass down their genes.

Another theory suggests that the fear of snakes and similar animals might arise out of an inherent fear of disease and contamination.4 Studies have shown that these animals tend to provoke a disgust response, which might explain why snake phobias are so common yet people tend not to exhibit similar phobias of dangerous animals such as lions or bears.


Acrophobia, or the fear of heights, impacts more than 6% of people.5 This fear can lead to anxiety attacks and avoidance of high places. People who suffer from this phobia may go to great lengths to avoid high places such as bridges, towers, or tall buildings.

While, in some cases, this fear of heights may be the result of a traumatic experience, current thinking suggests that this fear may have evolved as an adaptation to an environment in which a fall from heights posed a significant danger. While it is common for people to have some degree of fear when encountering heights, the phobia involves a severe fear that can result in panic attacks and avoidance behaviors.



Aerophobia, or the fear of flying, affects between 10% and 40% of U.S. adults even though airplane accidents are very uncommon.6 Around 1 out of every three people have some level of fear of flying. Some of the common symptoms associated with this phobia include trembling, rapid heartbeat, and feeling disoriented.

The fear of flying sometimes causes people to avoid flying altogether. It is often treated using exposure therapy, in which the client is gradually and progressively introduced to flying.7 The individual may start by simply imagining themselves on a plane before slowly working up to actually sitting on a plane and finally sitting through a flight.


Cynophobia, or the fear of dogs, is often associated with specific personal experiences such as being bitten by a dog during childhood. Such events can be quite traumatic and can lead to fear responses that last well into adulthood.

This particular phobia can be quite common.

This phobia is not just a normal apprehension of unfamiliar canines; it is an irrational and excessive fear that can have a serious impact on a person’s life and functioning. For example, a person with this phobia might feel unable to walk down a certain street because they know that a dog is living in that neighborhood. This avoidance can impact the individual’s ability to function in their daily life and make it difficult to get to work, school, or other events outside of the home.


Astraphobia is a fear of thunder and lightning. People with this phobia experience overwhelming feelings of fear when they encounter such weather-related phenomena.

Symptoms of astraphobia are often similar to those of other phobias and include shaking, rapid heart rate, and increased respiration.4 During a thunder or lightning storm, people with this disorder may go to great lengths to take shelter or hide from the weather event such as hiding in bed under the covers or even ducking inside a closet or bathroom.

People with this phobia also tend to develop an excessive preoccupation with the weather. They may spend a great deal of time each day tracking the local and national weather to know when any type of storm might take place. In some instances, this phobia may even lead to agoraphobia in which people are so afraid of encountering lightning or thunder that they are unable to leave their homes.


Trypanophobia is the fear of injections, a condition that can sometimes cause people to avoid medical treatments and doctors. Like many phobias, this fear often goes untreated because people avoid the triggering object and situation. Estimates suggest that as many as 20% to 30% of adults are affected by this type of phobia.

When people with this phobia do have to have an injection, they may experience feelings of extreme dread and elevated heart rate leading up to the procedure. Some people even pass out during the injection. Because these symptoms can be so distressing, people with this phobia sometimes avoid doctors, dentists, and other medical professionals even when they have some type of physical or dental ailment that needs attention.

Social Phobia

Already noted, involves the fear of social situations and can be quite debilitating.  People with this phobia fear being watched or humiliated in front of others.  The most common form of social phobia is a fear of public speaking. 


Agoraphobia involves a fear of being alone in a situation or place where escape may be difficult. This type of phobia may include the fear of crowded areas, open spaces, or situations that are likely to trigger a panic attack. People will begin avoiding these trigger events, sometimes to the point that they cease leaving their homes entirely.

Approximately one-third of people with panic disorder develop agoraphobia.

Agoraphobia usually develops sometime between late adolescence and mid-30s. Two-thirds of people with agoraphobia are women.11 The disorder often begins as a spontaneous and unexpected panic attack, which then leads to anxiety over the possibility of another attack happening.


Mysophobia, or the excessive fear of germs and dirt, can lead people to engage in extreme cleaning, compulsive hand-washing, and even avoidance of things or situations perceived as dirty. In some instances, this phobia may be related to obsessive-compulsive disorder.


This common phobia can also result in people avoiding physical contact with other people out of fear of contamination, overuse of disinfectants, and excessive preoccupation with media reports about illness outbreaks. People with this phobia may also avoid areas where germs are more likely to be present such as doctor’s offices, airplanes, schools, and pharmacies.


What Causes Anxiety?

Severe anxiety can arise after trauma or injury or under persistent stress or extreme change. For example, a person recovering from a heart attack may have a level of anxiety that prevents successful rehabilitation if he or she is too fearful to begin exercise and resume normal activities. However, research seems to indicate that symptoms of anxiety may have a genetic or biochemical basis and that it can even arise without the presence of a major stressor. Recent research has focused on the amygdala, a part of the brain where a “harm avoidance” response may be etched. A disruption of neurotransmitters — norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), an inhibitor neurotransmitter — is thought to play a role in anxiety. Neuropeptide substance P (SP) and neurokinins, proteins, and receptors that function as co-transmitters for serotonin and GABA also contribute to anxiety.

Abnormalities in brain function or structure in such areas as the limbic system, the temporal lobe, and the brain stem have also been implicated in anxiety disorders. Magnetic resonance imaging (MRI) scans of the brain suggest a genetic susceptibility to anxiety as individuals with anxiety have been found to have less gray matter and weaker mood-regulating circuit connections. When anxiety symptoms appear suddenly and inexplicably, these patients can become extremely distressed.

Research has identified that poor working conditions, especially those that are psychologically demanding or limit individual decision-making abilities, are a source of stress that can contribute to the development of anxiety disorders.

The researchers discovered links between specific anxiety disorders in adulthood and childhood. For example, adults with posttraumatic stress disorder (PTSD) are more likely to have histories of extreme defiance and conduct disorders in childhood, and adults with obsessive-compulsive disorder are likely to have experienced delusional beliefs and hallucinations as children. Phobias diagnosed in adulthood tended to be linked to specific phobias that occurred during childhood.


Signs and Symptoms

Generalized Anxiety Disorder 

People with generalized anxiety disorder display excessive anxiety or worry for months 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
  • Irritability
  • Muscle tension
  • Difficulty controlling the worry
  • Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)


Panic Disorder

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; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feelings of impending doom.

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



Phobias are classified as either social or specific.

People with a social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which 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 hard time talking to them
  • Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, rejected, or fearful of offending others
  • Being very afraid that other people will judge them
  • Worrying for days or weeks before an event where other people will be
  • Staying away from places where there are other people
  • Having a hard 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


Specific phobias are intense, irrational fears of certain things or situations, such as cats, snakes, elevators, flying, or driving. Although some fears may seem fairly common, a phobia is present when the fear interferes with the person’s ability to function. Phobic individuals make every effort to avoid the situation or thing that causes such dread.


Post-traumatic Stress Disorder

Natural disasters, wars, terrible accidents, and crimes can all cause long-lasting emotional trauma in both witnesses and victims. Posttraumatic Stress Disorder (PTSD) occurs approximately 20% to 25% of the time when a person is exposed to a traumatic event that the person experienced or witnessed the event.

This disorder involves recurring intrusive memories of the event, troubling nightmares, and even flashbacks where the person feels that he or she is reliving the event.

Certain cues may set off intense distress, and the person tends to become hyper-alert and hyper-vigilant. For example, a veteran of combat might react to a sudden loud noise by dropping to the ground and trying to take cover.

The actual event could have occurred a week too many years ago. Individuals also talk about feeling emotionally numb, and some have difficulty with outbursts of anger. Flashbacks can be prolonged, and the individual can seem quite agitated for some time after. Symptoms tend to become worse when the individual is under stress.


Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder where individuals experience recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.

Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent, unwanted routines and behaviors are rigid, and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsive actions.

A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social, or other important functions. About 1.2 percent of Americans have OCD, and among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood.


Stress Vs. Anxiety

Stress and anxiety share many of the same physical symptoms, making it difficult to spot the differences between them. 

Both stress and anxiety can lead to sleepless nights, exhaustion, excessive worry, lack of focus, and irritability. Even physical symptoms – like rapid heart rate, muscle tension, and headaches – can impact both people experiencing stress and those diagnosed with an anxiety disorder. With symptoms that can appear interchangeable.  

In short, stress is the body’s reaction to a trigger and is generally a short-term experience. Stress can be positive or negative. When stress kicks in and helps someone pull off that deadline a person thought was a lost cause, it’s positive. When stress results in insomnia, poor concentration, and impaired ability to do the things someone normally does, it’s negative. Stress is a response to a threat in any given situation.

There are several emotional and physical disorders linked to stress, including depression, anxiety, heart attacks, strokes, gastrointestinal distress, obesity, and hypertension, to name a few. High levels of stress can wreak havoc on the mind and the body. While stress can manifest in many ways, it helps to know a few common symptoms:

  • Frequent headaches
  • Sleep disturbance
  • Back and/or neck pain
  • Feeling lightheaded, faint, or dizzy
  • Sweaty palms or feet
  • Difficulty swallowing
  • Frequent illness
  • Irritability
  • Gastrointestinal problems
  • Excessive worry
  • Rapid heart rate
  • Muscle tension
  • Feeling overwhelmed
  • Having difficulty quieting the mind
  • Poor concentration
  • Forgetfulness
  • Low energy
  • Loss of sexual desire

Symptoms of stress can vary and change over time.  Helping clients cope with stress can include teaching them the following techniques:

  • Relaxation breathing: The single best thing you can do when under stress is to engage in deep breathing. Practice this strategy when you’re calm so that you know how to use it when you’re under pressure. Inhale for a count of four, hold for four, and exhale for four. Repeat.
  • Practice mindfulness: Sure, there’s an app for that, but the best way to practice mindfulness is to disconnect from your digital world and reconnect with your natural world for a specific period each day. Take a walk outside and use the opportunity to notice your surroundings using all of your senses.
  • Get moving: Daily exercise releases feel-good chemicals in your brain. Making exercise a daily habit can buffer you from negative reactions to stressful events.
  • Keep a journal: Writing down your best and worst of the day helps you sort through the obstacles and focus on what went right. It’s normal to experience ups and downs on any given day.
  • Get creative: There’s a reason adult coloring books are so popular – they work. Whether you’re drawing, coloring, writing poetry, or throwing paint on a wall, engaging in a creative hobby gives your mind a chance to relax.
  • Crank up the tunes: Listening to slow, relaxing music decreases your stress response (just as fast-paced music pumps you up for a run.)

Anxiety, on the other hand, is a sustained mental health disorder that can be triggered by stress. Anxiety doesn’t fade into the distance once the threat is mediated. Anxiety hangs around for the long haul and can cause significant impairment in social, occupational, and other important areas of functioning.


Anxiety and Caffeine

Coffee, tea, or other forms of caffeine can cause anxious feelings and/or fuel anxiety.  

No drug is used more widely in the world than caffeine. The omnipresence of caffeine, however, sometimes makes people forget that it is a powerful stimulant. In addition to keeping someone alert and energized, caffeine has many suggested health benefits, but consuming too much of has its costs. Too much caffeine can lead to increased anxiety or complicate an existing anxiety disorder by increasing symptoms.

Anxiety is the body’s response to situations that we perceive as being worrisome or threatening, and it promotes the body’s “fight or flight” response. Caffeine also triggers this response, making someone overreact to situations that aren’t dangerous or troublesome. Too much caffeine can also make someone irritable and agitated in situations that normally wouldn’t affect them. And if they already have increased anxiety or suffer from panic attacks, caffeine can cause these symptoms to become worse.

The effects of caffeine can also include:

  • agitation
  • sleep problems
  • restlessness
  • twitching
  • dizziness
  • increased heart rate
  • nausea
  • diarrhea
  • changes in mood

 The Food and Drug Administration considers a daily intake of 400 mg of caffeine or less to be a safe amount for most adults (exceptions including pregnant women and others with special restrictions).  This amount is roughly 3 to 4 cups of the coffee someone would brew at home. Drinking more than this amount can cause “coffee intoxication,” and those who drink caffeine excessively and regularly and struggle to cut back may have a caffeine use disorder.


Risk Factors

Evaluation of an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions, such as an overactive thyroid or low blood sugar, as well as 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 or obsessive-compulsive disorder.

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)


Treatments and Therapies

The goal of treatment for clients with anxiety issues is to lower their anxiety levels and reduce the feelings and frequency of panic. For ongoing anxiety problems, goals should focus on helping clients learn how to tolerate a certain level of anxiety, as the expectation that patients can become completely free from anxiety may be unrealistic.

Some of the treatments used for anxiety disorders include biofeedback, cognitive behavioral therapy, EMDR, medications, or a combination of therapies. In therapy, patients should learn methods to control and manage anxiety.

Anxiety disorders are generally treated with psychotherapy, medication, or both.



Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, 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.


Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. For example, learning to remind themselves, “This is a panic attack symptom. I am not having a heart attack.” CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.

Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.

CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.


Self-Help or Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other, and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.


Stress-Management Techniques

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. While there is evidence that aerobic exercise has a calming effect, the quality of the studies is not strong enough to support its use as a treatment. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered.

The family can be important 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.



Medications do not cure anxiety disorders but often relieve symptoms.

Medications are sometimes used as the initial treatment of an anxiety disorder or are used only 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 classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Be aware that some medications are effective only if they are taken regularly, and those symptoms may recur if the medication is stopped.

Selective Serotonin Reuptake Inhibitors (SSRIs)–SSRIs improve mood by blocking the reabsorption of the neurotransmitter serotonin in the brain. SSRIs are not habit-forming and are frequently used to treat anxiety disorders, including obsessive-compulsive disorder (OCD). SSRIs do, however, sometimes cause side effects, which can include sleep problems, weight gain, and sexual issues. They also take several weeks to achieve their maximum effectiveness. Examples include citalopram, escitalopram, fluoxetine, paroxetine, and sertraline. SSRIs may increase the risk of suicidal thoughts in young people, so it’s important to monitor for this effect and notify your doctor if you experience any suicidal thoughts.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)–SNRIs increase both serotonin and norepinephrine and inhibit brain cells from reabsorbing them. SNRIs have similar side effects as SSRIs and also take several weeks to achieve their full effect. Examples include desvenlafaxine, duloxetine, and venlafaxine.

Benzodiazepines–Benzodiazepines are fast at reducing anxiety, but they are not usually considered the first course of treatment for anxiety. This is because patients can develop a tolerance to the drug and, in some cases, become addicted. People who discontinue the use of benzodiazepines may also experience powerful withdrawal symptoms. Sometimes these medications are prescribed with SSRIs until the SSRI reaches its full effect. For most people, benzodiazepines are not meant to be taken for the long term. Examples include alprazolam, clonazepam, diazepam, and lorazepam.


Antidepressants, such as imipramine (Tofranil), and MAO inhibitors such as phenelzine (Nardil), are used to treat depression, but they also help treat anxiety disorders. GAD responds quite well to venlafaxine (Effexor). The antidepressant clomipramine (Anafranil) has been effective in treating OCD. Selective serotonin reuptake inhibitors (SSRIs), especially sertraline (Zoloft) and paroxetine (Paxil) are becoming the first choice in treating panic disorders. They take several weeks to start working and may cause side effects such as headaches, 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.

While many antidepressant drugs can be highly effective in the management of anxiety disorders, the U.S. Food and Drug Administration (FDA) has issued an alert and required many of them to contain updated black-box warnings regarding increased risks of suicidal thinking and behavior, especially among young adults ages 18 to 24 during initial treatment (generally the first one to two months of drug use).

Anti-Anxiety Medications

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, such as alprazolam (Xanax), are first-line treatments for generalized anxiety disorder. With panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind antidepressants.

The side effect profile of these medications and their potential for addiction makes them a poor choice for long-term therapy. A nonbenzodiazepine, such as buspirone (BuSpar), is often helpful for long-term use for anxiety, especially with elderly patients, because it does not depress the central nervous system.


Beta-blockers, such as propranolol and atenolol, are also helpful in the treatment of 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.

Other medications–Other medications do not fit into the above categories that are sometimes prescribed to treat anxiety disorders. One example is buspirone, which has fewer sexual side effects associated with SSRIs. Gabapentin is a seizure medication that works quickly and is often preferred by prescribers over benzodiazepines. Hydroxyzine is also prescribed to treat anxiety because it works quickly and is non-habit forming.

Tool Box of Techniques To Teach Clients 

Positive Self-Talk “I am going to be OK” “I can and will get through this wave of anxiety.”

Focus on the brain. For example, have them touch each of their fingertips together as they count, “1,2,3,4,5,6,7, 8” then count back down, “8,7,6,5,4,3,2,1” touching their fingertips together with each number again.

Calm Breathing: This is a strategy that will help to reduce some of the physical symptoms experienced during a panic attack. Individuals tend to breathe faster when they are anxious, which can make them feel dizzy and lightheaded, which in turn can make them even more anxious. Calm breathing involves taking slow, regular breaths through

the nose. However, it is important to realize that the goal of calm breathing is not to stop a panic attack because it’s dangerous but to make it a little easier to “ride out” the feelings.

Muscle Relaxation: Another helpful strategy involves learning to relax the body. This technique involves tensing various muscles and then relaxing them, to help lower overall tension and stress levels, which can contribute to panic attacks.

Realistic thinking. The next tool involves learning to identify scary thoughts that can trigger and fuel physical feelings of panic. Clients should ask themselves,” what am I afraid will happen during a panic attack?” Examples include: “I will faint,” “It will go on forever,” “I’ll embarrass myself,” “I’ll have a heart attack,” or “I’ll die.” This will help them become aware of their specific fears.

Thoughts related to panic attacks can be grouped into two categories:

  1. Overestimating: This happens when we believe that something highly unlikely is about to happen; for example when we believe that we will faint or die as a result of a panic attack. This type of thinking is usually related to physical fears (such as fainting and hurting oneself, having a heart attack, going crazy, or dying)
  2. Catastrophizing: This is when we imagine the worst possible thing is about to happen and that we will not be able to cope. For example: “I’ll embarrass myself, and everyone will laugh” or “I’ll freak out, and no one will help.” This type of thinking is often related to social concerns (such as embarrassing oneself).

Once client identifies what they are most afraid of with a panic attack, they should ask themselves, “What would be so bad about that? What would that lead to? What would happen then?” Challenging overestimating: First, they need to realize that their thoughts are guesses about what will happen, not facts. Next, they should evaluate the evidence for or against their thoughts.

Individuals with panic disorder often confuse a possibility with a probability.



Approximately 70% of people with anxiety disorders go untreated each year. The good news is that the treatment of anxiety disorders is usually very successful. Medications can be useful, but research has also indicated that behavioral or cognitive-behavioral therapy alone or in combination with medication can be equally, if not more effective.


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