Medically reviewed by Dr. C.H. Weaver M.D. 2/2021
We’re all familiar with situations—important, stressful events, for example—that may cause anxiety. For most of us, this feeling soon passes and doesn’t interfere with our everyday lives. For people affected by anxiety disorders, however, a sense of fearfulness and uncertainty recurs often over an extended period (for at least six months).
According to the National Institute of Mental Health, approximately 40 million American adults are affected by anxiety disorders each year.
Types of Anxiety
Types of anxiety include panic disorder (also known as panic attacks), obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). (Phobias are also considered anxiety disorders and will be discussed later.)
Panic disorder involves panic attacks that come on suddenly. They’re associated with fear, a sense of unreality, or fear of losing control. It’s possible for a person to have a single panic attack and never experience one again or to experience isolated attacks; such individuals do not necessarily have panic disorder. If, however, repeated panic attacks begin to alter your life or become disabling—causing you to avoid situations and places that may trigger one, for example—you may have panic disorder.
Signs of a panic attack include:
- Pounding heart
- Feeling flush or chilled
- Tingling or numbness in hands
- Chest pain
- Smothering sensation
People affected by panic disorder can experience an attack at anytime, even during sleep, so worry about when another attack will occur can add to anxiety. If left untreated, panic disorder can progress to agoraphobia, a fear of open spaces; at this point, the disease becomes disabling, as it limits normal daily activities.
Obsessive compulsive disorder is characterized by persistent, upsetting thoughts (called obsessions) that cause anxiety; the affected individual responds to these obsessions by performing habitual, compulsive behaviors (compulsions). For example, an obsessive fear of germs and dirt may lead a person to wash his or her hands repeatedly, far beyond what is required for hygiene.
People affected by OCD don’t enjoy performing their rituals, and the compulsion to complete them can interfere with work and other activities of daily life.
Post-traumatic Stress Disorder
People affected by PTSD have experienced a major event that involved physical harm or the threat of harm to themselves or someone else. PTSD is often associated with war veterans but can affect anyone who has experienced a trauma such as rape, torture, assault, a natural disaster, kidnapping, or hostage situations or car, train, or plane crashes.
PTSD may cause an individual to startle easily, become emotionally numb, lose interest in things they once enjoyed, have trouble showing affection, and become irritable and aggressive. They may also have flashbacks or nightmares, during which they relive the traumatic event.
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is characterized by excess worry about common problems that lasts for at least six months. People affected by GAD may have intense concerns about issues related to health, money, or family—to an extent that they experience extreme tension; they may startle easily and have trouble concentrating and sleeping. Symptoms of GAD include muscle tension, fatigue, restlessness, difficulty sleeping, irritability, and gastrointestinal discomfort.
Phobias are also considered anxiety disorders. They include social phobia (also known as social anxiety disorder), specific phobias, and generalized anxiety disorder (GAD).
Social phobia, or social anxiety disorder, is characterized by an overwhelming feeling of anxiety and self-consciousness in everyday social situations. This excessive worry about being embarrassed in public or harshly judged by others can interfere with any activity requiring social interaction—work, school, celebrations, and everyday activities like grocery shopping.
People with social phobia may become intensely anxious before and during anticipated encounters. They may blush, sweat profusely, tremble, have trouble speaking, and feel nauseous.
An intense, irrational fear of a particular thing is considered a specific phobia. Examples of specific phobias include a fear of heights, tunnels, dogs, or closed-in places. When people who are affected by specific phobias must face—or even think about facing—the things they fear, they may experience a panic attack or severe anxiety.
Treatment for anxiety disorders is determined by individual preference, the nature of the disorder, and past treatment for anxiety disorders. Approaches to treatment include medication or psychotherapy or both. As well, your doctor will likely conduct a medical exam to make sure that the symptoms of anxiety are not related to a physical condition. And because anxiety disorders are sometimes accompanied by alcoholism or drug abuse, if present these issues must be addressed before treatment for the anxiety disorder can begin.
Alternatives to medical treatment may also be incorporated into the treatment plan for some anxiety disorders. Approaches including relaxation techniques, meditation, yoga, and exercise may help control anxiety and promote of feeling of calmness.
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Physicians may prescribe medications for anxiety disorders that are intended to keep anxiety under control; medication, however, cannot cure these disorders. Patients may take medication while undergoing psychotherapy for anxiety disorders.
Types of medications that may be prescribed to manage anxiety disorders include:
Antidepressants: Types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs). These drugs were developed to treat depression but can also be effective for anxiety disorders.
The type of antidepressant prescribed for an anxiety disorder will depend on the nature of the disorder, as certain drugs appear to be more effective for certain disorders. Your doctor can explain more about which medications may be appropriate for you. Your doctor will also take into account potential side effects associated with particular antidepressants when selecting medication.
Anti-anxiety drugs: Drugs used to treat anxiety are called benzodiazepines. They include: Klonopin® (clonazepam), used for social phobia and GAD; Ativan® (lorazepam), used for panic disorder; and Xanax® (alprazolam), used for panic disorder and GAD. Because anti-anxiety drugs may have to be prescribed at high doses to be effective, they’re generally prescribed for short periods (this is particularly important among people who have a history of drug or alcohol abuse or who may easily become dependent on medication). If you’ve been prescribed anti-anxiety medication, it’s important that you take the medication as prescribed and are monitored by your physician—especially when you begin tapering off your medication, as you may experience withdrawal symptoms.
Beta-blockers: These medications, which are used to treat heart conditions, are prescribed to control the physical symptoms of some anxiety disorders—social phobia, in particular.
Psychotherapy for treatment of an anxiety disorder involves talking with a trained mental health professional to try to determine the cause of an anxiety disorder and find ways to manage its symptoms. Examples of trained mental health professionals include psychiatrists, psychologists, social workers, and counselors.
Here are a few examples of types of psychotherapy used to treat anxiety disorders:
Cognitive behavioral therapy (CBT) is a two-part approach: the cognitive part aims to change thinking patterns that support fears, while the behavioral part focus on changing the way an individual reacts when he or she experiences anxiety. Your mental healthcare professional can further explain CBT, including examples of how this approach may be used.
Exposure therapy is a form of CBT in which a person is gradually exposed to the object or situation he or she fears. The goal is that with exposure, the person will learn to become less sensitive to his or her fear. Exposure therapy may be useful for OCD and phobias.
Acceptance and Commitment Therapy (ACT) is used to teach a person to accept experiences that create anxiety and establish, or commit to, behavioral changes to cope with them. The core of ACT is acceptance and mindfulness, or living in the moment and being open to experiences without judgment or unwanted thoughts and feelings.
Limit worry time to its scheduled time and watch worries disappear.
“In every life we have some trouble; when you worry, you make it double. Don’t worry, be happy…” The lyrics are not only catchy—they’re true. In fact, researchers have long known that worry can prolong stress and its associated physiological symptoms. Now new research indicates that scheduling worry—so that it is confined to a specific half-hour period each day—can help reduce anxiety. (3)
The tactic may sound counterintuitive, but it also makes sense—if worry is limited to a specific time period, it can’t overtake the rest of your day. The technique allows people to compartmentalize worry—meaning they set aside time to contemplate their worries and consider solutions and they also deliberately avoid thinking about those issues throughout the rest of the day. It’s a form of “stimulus control” called worry postponement and disengagement and Dutch researchers found that people who used the technique reduced their anxiety and depression significantly more than people who relied on traditional anxiety treatment.
There are four critical steps to worry reduction:
- Identify and realize that you are worrying.
- Set aside a time and a place to think about your worries.
- When you catch yourself worrying, postpone worrying and instead focus on the task at hand.
- Use your “worry time” to try to solve the issues that cause the worrying.
The researchers found that individuals who followed the four-step worry reduction technique significantly reduced anxiety and concern. Interestingly, even individuals who simply performed step one—identifying and realizing that they were worrying—experienced a reduction in anxiety.More research is needed to confirm the results of this small study, but the takeaway message is clear: postponing worry and confining it to a specific time and place may help limit the impact it has on your overall mental and emotional wellbeing. Put simply, if you’re overwhelmed with worry, consider scheduling daily “worry time.” It’s sort of like “tough love” for your brain.
- Anxiety Disorders. National Institute of Mental Health Web site. Available at: http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml. Accessed July 2020.
- Understanding Anxiety. Anxiety Disorders Association of America Web site. Available at: http://www.adaa.org/understanding-anxiety. Accessed July 2020.
- “Don’t Worry, Be Happy” by Bobby McFerrin
- Verkuil B, Brosschot JF, Korrelboom K, et al. Pretreatment of worry enhances the effects of stress management therapy: A randomized clinical trial. Journal of Psychotherapy and Psychosomatics. 2011;80:189-190.