Anxiety is a widespread mental health condition in which a person experiences extreme fear, unreasonable worry, and constant uneasiness. Anxiety disorders have a significant impact on people’s lives. It can lead to an inability to focus and experience physical symptoms such as rapid heartbeat and trembling.

Even though anxiety treatment has its difficulties, different therapies give hope for symptom management and an enhanced quality of life. It is important to realize that having anxiety is a prevalent thing that many people go through, and talking to a mental health professional can be very helpful as they can provide guidance and assistance with tackling anxiety problems.

 

Anxiety is a complicated emotion that is beyond the feeling of simple distress, nervousness, and fear regarding the future. Whether it's a help or a harm, it is an automatic response to stress, our bodies readying for perceived threats. On the other hand, anxiety is a normal reaction when it is useful to the situation, but, when it is excessive or disproportionality, it may cause a problem.

Historical Evolution of Anxiety Disorders

Anxiety disorders are one of the oldest mental illnesses as there is evidence of their existence from centuries ago. The indigenous communities of the past would often attribute anxiety to supernatural causes, or even interpret it as a symptom of weakness. Treatments differed a lot, ranging from the rituals of the religious ceremony to the herbal medicine.

As our mental health understanding was growing, the symptoms of anxiety disorders were being managed and treated. In the 20th century, psychoanalytical theories opened the door for a better understanding of the psychogenic nature of anxiety which led to the creation of psychotherapy as the primary treatment. Benzodiazepines were brought to the market as a class of medications in the mid-20th century, but they, too, soon revealed a double-edged nature, providing relief from the symptoms but also the risk of dependence and side effects [1].

In recent years, there has been a breakthrough in the field of neuroscience that has helped us understand the biological mechanisms behind anxiety. The knowledge gained from this research has informed the development of cognitive-behavioral therapy (CBT), which helps individuals acquire the skills for thought and behavior control that will support them in managing their anxiety.

What Anxiety Feels Like

Let’s now have a look at some examples of anxiety.

Think about yourself being jolted awake in the middle of the night, your heart pounding, and you can't catch a breath. At that moment your mind is uncontrollable, the fear is on a loop and you cannot help but be overpowered by every single thought. The tension in your body is so palpable that you feel your muscles could react like a coiled spring any moment. Such a situation is just a fragment of what an anxiety attack feels like [1].

When one is in the middle of an anxiety attack, this person might experience a mix of psychological, emotional, and cognitive symptoms such as rapid heart rate, difficulty breathing, sweating, trembling or shaking, fear of impending doom, worry, racing thoughts, and difficulty concentrating.

Who Gets Anxiety

Anxiety disorders can be identified among people of all ages, genders, and social milieu. However, certain demographics are more prone to developing anxiety disorders [1]:

  • Women are statistically more likely than men to be diagnosed with anxiety disorders which might have to do with the hormonal differences and the pressures of society.
  • Anxiety disorders are more likely to occur in people with a family history of anxiety disorders compared to the general population, suggesting a possible genetic link.
  • People who have gone through traumatic events or experienced severe life stress might have a higher risk of developing an anxiety disorder.
  • Certain medical problems, like thyroid disease for instance, or heart disease, can be responsible for the appearance of an anxious state.

Anxiety disorder is the most common mental health condition in the United States, with more than 31% of the country's population encountering this illness at some stage of their lives [2].

Women compared to men suffer from anxiety disorders twice as frequently.

A study reported that gender-nonconforming and transgender individuals are two times more likely to suffer from anxiety disorders than cisgender (gender-conforming) males, so the implication is that these people require particular attention from mental health professionals.

According to the research survey conducted in the period 2018 through 2019, 8.5% of youth aged 3 to 17 had been diagnosed with an anxiety condition. Generalized Anxiety Disorder (GAD) usually starts later in life than other anxiety disorders and the usual age of first appearance is about 35 years [2].

Social anxiety disorder can easily be considered the most common anxiety disorder in the US, affecting more than 12% of adults over their lifetimes.

It is also important to note that specific phobias are common, with 3-15% of the world population encountering them. Such phobias often encompass fear of animals and heights.

Approximately 5.7% of adults in the U.S. will have a Generalized Anxiety Disorder (GAD) at some point in their life. Even though GAD can be easily treated and most of the cases recover within two years of diagnosis and treatment, half of the people suffering from GAD wait two years before they get diagnosed and treated [2].

Anxiety disorders are not one-size-fits-all. They come in various forms, each with its own set of symptoms and challenges. Understanding these types and the specific symptoms of anxiety disorders can help individuals recognize their condition and seek appropriate support.

Let's explore the different types of anxiety disorders along with their symptoms[3]:

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is like having a constant worry companion. People with GAD feel anxious most of the time, even when there's no specific threat. They often struggle to control their worries and may experience physical symptoms like muscle tension, restlessness, and difficulty concentrating.

  • Persistent worrying about everyday concerns
  • Physical symptoms such as muscle tension and fatigue
  • Difficulty sleeping due to racing thoughts

Panic Disorder

Panic Disorder is like experiencing intense fear out of nowhere. Individuals with panic disorder have sudden and recurrent panic attacks, which are intense episodes of fear or discomfort. These attacks can be debilitating and may lead to avoidance of places or situations where panic attacks have occurred before.

  • Sudden onset of intense fear or discomfort
  • Physical symptoms like heart palpitations, sweating and trembling
  • Fear of losing control or dying during an attack

Social Anxiety Disorder

Social Anxiety Disorder is like feeling extremely self-conscious in social situations. People with social anxiety fear being judged or embarrassed in social settings, leading to avoidance of social interactions. This fear can significantly impact relationships, work, and everyday life.

  • Fear of social situations or performance situations
  • Avoidance of social interactions or public speaking
  • Physical symptoms such as blushing, sweating, or trembling in social settings

Separation Anxiety Disorder

Separation Anxiety Disorder resembles the feeling of being overly attached to a person or an object. It often shows up in kids but can also appear in adults. People who are suffering from separation anxiety are afraid of being away from loved ones or familiar surroundings and thus become distressed as soon as the separation happens.

  • Unbearable distress following the separation from attachment figures
  • Fear of oneself or family members getting into trouble during the time of separation.
  • Avoidance or refusal to go to school or work because of separation anxiety.

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a disorder that includes obsessions which are persistent and intrusive thoughts and compulsions which are repetitive behaviors or mental acts. Individuals with OCD may feel forced to perform these rituals to relieve the anxiety or avoid the perceived harm.

Symptoms of OCD include:

  • Undue fear of contamination or intrusive thoughts of harm.
  • Excessive hand washing, checking, or counting.
  • Impairment of everyday life or discomfort from obsessions and compulsions.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder may appear after a person has directly experienced or merely seen a traumatic event. People with PTSD may relive the trauma through intrusive memories or nightmares, avoid things that remind them of the trauma, and live with heightened arousal and reactivity.

Symptoms of PTSD include:

  • Recurrent flashbacks or unwanted memories of the traumatic event
  • Avoidance of trauma-related stimulators.
  • The development of negative mood or cognitive changes.
  • Hyperarousal, such as outbursts, being overly alert, or having a quick response to unexpected events.

Other Anxiety Disorders

Specific Phobias: Overwhelming anxiety towards a particular object or situation, for example, fear of heights, spiders, or flying.

Selective Mutism: Repetitive failure to speak in particular social situations, though speaking in other situations.

Agoraphobia: Irrational fear of being in places or situations where escape would be impossible or embarrassing, and avoidance of crowds or open places.

Anxiety disorders might have various origins, including biological, environmental, and psychological influences. Although the genesis of anxiety disorders may be different among individuals, unearthing the common background ideas can help to see why such conditions arise.

Biological Factors

Biological factors undoubtedly are the major contributors to the emergence of anxiety disorders.

These factors include:

Genetics: Studies indicate that genes could be responsible for the vulnerability to experiencing anxiety disorders. People with a family history of suffering from anxiety disorders are more susceptible to experiencing anxiety themselves, which indicates a genetic predisposition [3].

Brain Chemistry: Neurotransmitter imbalances, for instance, serotonin and dopamine, can impair mood control and be part of the anxiety symptoms. Some changes in the structure and function of the brain could contribute to the development of anxiety disorders as well.

Environmental Factors

Environmental factors may determine the level of risk someone has for developing anxiety disorders.

These factors include:

Traumatic Experiences: Prolonged exposure to traumatic events, such as being abused, assaulted, or being a victim of a natural disaster, can predispose individuals to anxiety disorders like Post-Traumatic Stress Disorder (PTSD). Trauma upsets the stress response system of the body which in turn leads to the condition of increased anxiety and hyper-vigilance [3].

Stressful Life Events: Transitions like relocation, money issues, relationship issues, or work-related stress can be the causes or worsening of anxiety. Chronic stress, in turn, can also undermine coping mechanisms, and thus people will be more prone to developing anxiety disorders.

Childhood Experiences: Adverse childhood experiences such as neglect, parental separation, or emotional abuse could be the primary causes of a person developing anxiety disorders in the future. First disturbances in attachment and social support may be the reason for poor emotional regulation and high anxiety sensitivity.

Psychological Factors

Psychological factors are definitely among the most powerful elements influencing the way a person feels and reacts in a state of anxiety. These factors include [3]:

Cognitive Patterns: These patterns of thinking, for example, catastrophizing or overestimating the possibility of harm, can evoke anxious symptoms. The distorted oneself, others, and the world view can create excessive fear and worry.

Personality Traits: The existence of specific personality traits, like perfectionism, neuroticism, and high sensitivity to threat, may be predisposing people to anxiety disorders. Individuals with perfectionism will face the problem of keeping unrealistically high standards for themselves, which in turn will result in chronic worrying and anxiety.

Learned Behavior: Sensing anxious behaviors from caregivers or receiving too many reassurance-seeking responses in childhood can be a factor that causes anxiety disorders to develop. In time, learned behaviors and the coping mechanisms developed in reaction to stress can become ingrained into the individual, and the symptoms of anxiety can keep recurring.

Medical Problems and Drug Abuse

Apart from the psychological factors, some medical conditions and substance use can also lead to the development and worsening of anxiety disorders. These include:

Chronic Illness: People with chronic diseases, e.g. cardiovascular problems, respiratory disorders, or long-term pain, are more likely to develop anxiety. The time spent on managing a chronic disease and the effect of this on daily functioning may lead to increased anxiety.

Substance Use: Substance use such as alcohol, drugs, and caffeine can aggravate anxiety symptoms or create anxiety disorders in some people. The brain chemistry can be disturbed and the anxiety disorder susceptibility of an individual increases, especially in the case of those who have a predisposition.

Anxiety is diagnosed through a thorough evaluation of the symptoms, medical background, and functional incapacity. Mental health specialists rely on a diversity of methods and procedures to provide patients with a correct diagnosis of anxiety disorders. Let's explore how anxiety is diagnosed.

Clinical Assessment

Clinical assessment is the first step in diagnosing anxiety when data about the characteristics of the symptoms, medical history, and psychosocial functioning of the individual who is being diagnosed is collected. Key components of a clinical assessment include [3,4]:

Symptom Evaluation: The doctor takes a complete history of the manifestations of anxiety, including the type, duration, and intensity of anxiety symptoms.

Medical History: The doctor takes information from the patient's medical history including previous medical conditions, medication use, or substance abuse.

Psychosocial History: The clinician examines the individual's psychosocial background, covering traumatic events in the past, the significant life events that occurred, and the family history of mental health issues.

Functional Assessment: The clinician determines the extent of functional impairment due to anxiety symptoms. This includes troubles in any field like work, school, relationships, or daily activities.

Diagnostic Criteria

Anxiety disorders fall in the category of mental disorders and this is diagnosed using specific diagnostic criteria, as they are mentioned in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The DSM-5 is a guide that provides standardized criteria, which physicians apply to diagnose patients with different mental health disorders, such as anxiety. Key criteria for diagnosing anxiety disorders include:

Presence of Excessive Anxiety or Worry: The person suffers from extreme anxiety and or fear about many situations and events that are in broader scope, the threats in nature of which are not in proportion.

Duration and Persistence: Symptoms of anxiety continue for a certain period (e.g. 6 months in case of Generalized Anxiety Disorder) and lead to substantial stress or trouble with social, work, or important areas of functionality.

Specific Symptom Criteria: The diagnostic criteria for each anxiety disorder are unique and require the presence of specific symptoms for the diagnosis to be made. For instance, a common symptom of Panic Disorder is recurrent panic attacks, whereas an individual with Social Anxiety Disorder would feel intense fear or anxiety in social situations.

Psychological Assessments

Self-report questionnaires and standardized rating scales may be employed in psychological evaluation to identify the intensity of anxiety symptoms and track treatment outcomes. These assessments allow for an understanding of the patient's personal view of anxiety and lead to treatment planning. Common psychological assessments for anxiety include:

Generalized Anxiety Disorder 7-item Scale (GAD-7): A self-report questionnaire consisting of items that rate the severity of generalized anxiety symptoms over the past two weeks.

Beck Anxiety Inventory (BAI): A self-report questionnaire that measures the severity of anxiety symptoms, such as physical symptoms, cognitive symptoms, and behavioral symptoms.

Hamilton Anxiety Rating Scale (HAM-A): A clinician-evaluated rating scale that measures the level of anxiety symptoms across different areas including anxious mood, tension, and physical symptoms.

Differential Diagnosis

In certain cases, anxiety symptoms can be similar to those of other mental health disorders or medical conditions which makes differential diagnosis instrumental. The clinician carefully evaluates the individual's symptoms and history to rule out other possible causes of anxiety, such as:

Other Mental Health Disorders: Anxiety and depression association has been a subject of research for many decades. Anxiety symptoms are often accompanied by other mental disorders including depression, bipolar disorder, and obsessive-compulsive disorders (OCD).

Medical Conditions: Some medical conditions, including thyroid disorders, cardiovascular disease, or neurological conditions, can be associated with symptoms of anxiety.

Substance Use: Substance abuse, including alcohol, illicit drugs, or medication, can be a cause for anxiety issues or they may aggravate them and should be considered during the diagnosis.

Dealing with anxiety is not an easy task, but many methods and skills are at the disposal of the persons who suffer from anxiety to cope with this, and hence, boost their well-being. From relaxation techniques to lifestyle adjustments, here are some tips to deal with anxiety [4]:

Practice Relaxation Techniques

Relaxation techniques possess the ability to induce relaxation, decreasing anxiety symptoms. Try incorporating the following relaxation techniques into your daily routine:

Deep Breathing: Try deep breathing techniques to decrease your breathing and consequently relax. Slowly take in the air through your nose, hold it for a few seconds, and then slowly exhale through your mouth.

Progressive Muscle Relaxation: Tense and relax each muscle group in your body, starting from your feet and working your way up to the top of your head. Emphasize tension release and relaxation of separate muscle groups.

Mindfulness Meditation: Try breathing exercises and mindfulness meditations to become more present in the moment and less stressed. Focus on your breathing or watch your thoughts and feelings without judgment.

Keep Yourself Physically Active Every Day

There are many benefits to exercising regularly, such as decreasing anxiety and boosting mood due to the release of endorphins which are the body's natural stress relievers. An objective should be to do at least 30 minutes of moderate-intensity exercise almost every day. Choose the activities that you like, for example, walking, running, yoga, or dancing.

Prioritize Self-Care

Looking after yourself is a vital part of anxiety control. Make self-care a priority by:

Getting Adequate Sleep: Try to get a good night’s sleep of 7-9 hours to keep your mental and emotional wellness steady.

Eating a Balanced Diet: Consume a balanced diet that consists of fruits, vegetables, whole grains, lean proteins, and healthy fats. It is better to refrain from drinking excessive amounts of caffeine or sugar, which will make your anxiety flare up.

Limiting Alcohol and Substance Use: Alcohol consumption should be in moderation and recreational drug use should be avoided since they may lead to the aggravation of anxiety symptoms.

Challenge Negative Thoughts

The reason for this is that a negative way of thinking can contribute to anxiety and even exacerbate the symptoms. Challenge negative thoughts by:

Identifying Negative Thoughts: Take note of when these negative thoughts occur and find out what these thoughts are based on, for example, their underlying beliefs or assumptions.

Questioning Negative Thoughts: Ponder if there is any fact to back up the negative thought process or if there are other explanations.

Replacing Negative Thoughts: Change negative feelings with thoughts that are more balanced and realistic. Work on strengths instead of weaknesses and drawbacks, and fight against catastrophizing and black-and-white thinking.

Adopt Healthy Coping Mechanisms

Problem-Solving Skills: Outline the problems into their small components and then create a plan to resolve them.

Seeking Support: Engage with your close ones, loved ones, or mental health experts for help and advice.

Engaging in Hobbies and Activities: Attend the events that you like. This should include hobbies, creative outlets, or volunteering activities. Engage in the activities that bring you to the fullest.

Practice Self-Compassion

It is crucial to be kind and compassionate, especially when going through tough periods.

Practice self-compassion by:

Treating Yourself with Kindness: Show yourself the same compassion and patience that you would use talking to your good friend going through a similar tribulation.

Acknowledging Your Feelings: Accept your emotions and recognize that you are not strange for experiencing fear in such a situation.

Practicing Acceptance: Realize that anxiety is a normal thing in life and put an emphasis on what you can manage here and now.

Effective treatment of anxiety typically involves implementing several evidence-based approaches, such as psychotherapy, lifestyle changes, and medication for some patients. Individualizing treatment strategies, depending on the peculiarity of anxiety, enables patients to control their symptoms and also enhance their life quality. Let's delve into the various treatment approaches for anxiety:

Psychotherapy

Psychotherapy (or talk therapy) is an effective tool that is used as a major method of anxiety treatment. Different types of psychotherapy can be effective for various forms of anxiety:

Cognitive-behavioral therapy (CBT): It is one of the most common techniques or methods that are used for anxiety disorders. It is directed toward pinpointing and breaking down the destructive belief patterns that are responsible for anxiety. Using this type of therapy, patients learn how to apply different techniques and strategies that would help them keep anxiety under control [4,5].

Exposure Therapy: Exposure therapy often involves the provocation of the individual by using feared objects, situations, or thoughts in a safe and regulated environment. With time, repetition will desensitize people from their specific trigger of anxiety and they will have less fearful responses [3].

Mindfulness-Based Therapies: These mindfulness-based therapies include mindfulness-based stress reduction (MBSR) and acceptance and commitment therapy (ACT) which stress on being in the moment and accepting the thoughts and feelings as they are. These therapies may aid people in building resilience and handling anxiety that plagued them more efficiently.

Medication

In some cases, anti-anxiety medications are administered to reduce the intensity of complex or persistent anxiety problems. Common medications used to treat anxiety disorders include [5]:

Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are a class of antidepressants that are responsible for regulating the serotonin levels in the brain and therefore they can help reduce the symptoms of anxiety. For instance, sertraline, fluoxetine, and escitalopram are all possible.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs are identical to SSRIs but in addition, these drugs affect the norepinephrine levels. For instance, venlafaxine, and duloxetine are examples.

Benzodiazepines: Benzodiazepines are fast-acting drugs that can quickly relieve anxiety symptoms and thus are used for the treatment of acute anxiety. On the other hand, they are mostly recommended for short-term use because of the risk of dependence and tolerance.

Support Groups

Through participating in support groups or going to therapy groups, those with anxiety can find connection, empathy, and anxiety awareness. Discussing experiences and coping strategies with other patients who have been through the same experience can be liberating and strengthening.

Alternative Therapies

Some individuals may find relief from anxiety symptoms through alternative therapies, such as Some individuals may find relief from anxiety symptoms through alternative therapies, such as:

Acupuncture: Acupuncture is a practice that consists of inserting tiny needles into specific points along the body to stimulate and release symptoms.

Yoga and Tai Chi: Performing yoga or tai chi can be an effective way of controlling stress and anxiety through the use of easy movements, deep breaths, and mindfulness methods.

Self-Help Resources

The use of self-help resources, including books, online programs, and mobile applications, can complement professional treatment and make people actively able to take charge of their anxiety. These may well become the basis for education, practical tools, and guided exercises for dealing with anxiety.

Inpatient Treatment

In situations where anxiety symptoms are severe and disrupt daily life so much that they impede normal function, inpatient care may be required. Inpatient treatment programs offer 24/7 care in a disciplined context. Components of inpatient treatment for anxiety may include:

Medication Management: Health professionals are responsible for the close supervision of medication regimens and they make changes to dosages if necessary to relieve symptoms and stabilize mood.

Therapeutic Interventions: The inpatient program provides a range of therapeutic approaches, such as individual therapy, group therapy, and experiential therapies like art therapy or recreational therapy.

Crisis Intervention: Inpatient facilities will have immediate access to suicide prevention and support persons for individuals who are having suicidal thoughts, acute anxiety attacks, or panic attacks.

Structured Routine: The inpatient treatment programs will give a scheduled daily routine that contains therapeutic activities, meal time, recreation opportunities, and resting times.

Aftercare Planning: The discharge plan for inpatient treatment normally involves comprehensive aftercare planning to allow the patient to successfully shift from institutional care to community-based services. This, in turn, may extend to linking people to outpatient therapy, counseling, and other resources that individuals would need to consolidate the progress they made.

1. Mayo Clinic. Anxiety Disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

2. Psych Central. Anxiety Facts: All You Need to Know. https://psychcentral.com/anxiety/anxiety-facts#10-facts

3. American Psychiatric Association. What are Anxiety Disorders? https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders

4. Cleveland Clinic. Anxiety Disorders. https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders

5. Medical News Today. What to know about anxiety. https://www.medicalnewstoday.com/articles/323454

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