Understanding Anxiety

A guide on the causes, types, and treatment for anxiety.

Anxiety can present in different ways. For some people, it comes as ruminating thoughts and worries. For others it’s a sick feeling in the stomach. Or, it might present as hypervigilance in public places.

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”

Like sadness or anger, anxiety can be perfectly normal. Everyone experiences anxiety from time to time. It often passes on its own, or can be managed until the cause of it subsides.

For example, a woman waiting on test results may feel anxious until she gets answers. It’s normal for the anxiety to last until the wait is over. Someone who is on a first date or in a job interview is likely to feel at least somewhat nervous.

However, when anxiety goes beyond the norm and begins to interfere with everyday life, it becomes a concerning disorder. It’s helpful to first understand the causes and types of anxiety conditions. Once the type of anxiety is identified, then the best treatments can be considered.

Causes of Anxiety

So why do some people develop extreme, chronic anxiety issues? There are at least a few factors involved.

  • Genetics. Some people are more likely to develop anxiety problems based on their genetic makeup. Those who have family members with anxiety are more likely to develop a general anxiety condition.
  • Environment. Those who experience higher levels of chronic stress, often based on life circumstances, are more prone to have anxiety issues.
  • Trauma history. Trauma may cause specific mental health issues, but can also make someone more vulnerable to broader conditions like depression and anxiety disorders.
  • Gender. Women are significantly more likely to suffer from anxiety. This may be at least partially relate to hormonal differences and influences

While anxiety itself can feel very similar, it does present in different ways. Here’s a look at the most common anxiety disorders people suffer with.

General Anxiety Disorder

General anxiety disorder (GAD) is one of the most commonly diagnosed mental health disorders. According to the National Institute of Mental Health, nearly 6% of people will experience GAD during their lifetimes.

Common symptoms of GAD that therapists look for include:

  • Feeling nervous or on edge
  • Ongoing worrying, or cyclical thoughts (sometimes called ruminating)
  • Worrying about different things (versus one particular issue)
  • Trouble with relaxing
  • Increased restlessness/problems sitting still
  • Fearing something awful may happen

GAD differs from other anxiety disorders because it relates to a variety of worries and anxiety in many situations. Other disorders are more specific, tied to specific fears or incidents.

Rather than being narrow, many people describe thoughts during GAD as being both broad and cyclical. For example, people might experience worries about losing their jobs, then about paying bills, then about how their family members will respond, then about how they will take care of the kids, then again about paying bills.

Those worries might become even more catastrophic, such as fear of a fatal accident or terminal illness, with no apparent risk or signs that such things are likely to happen. These thoughts occur daily, if not constantly.

Over time, the fears and worries get stronger and stronger. The act of worrying can become a habit that’s difficult to stop. The ruminating itself may be an effort by the brain to solve or prepare for potential problems. However, it ends up causing much more stress in the long run.

A recent study looked at what is happening in the brain during GAD. The researchers noted that some of the connections in the brain that regulate anxious response are weaker in such cases. Normally the anterior cingulate cortex (ACC) would be telling the amygdala and other emotional parts of the brain to calm down. This doesn’t work well in a brain with GAD.

While GAD is the most common disorder, it’s only one of several types of anxiety issues.

PTSD: Also an Anxiety Disorder

Another common disorder that relates to anxiety is post-traumatic stress disorder, or PTSD. Around 8 million people per year deal with PTSD. This disorder is caused by complications in healing following a trauma. The anxiety issues are specifically caused by fears related to the event.

Many of the symptoms of PTSD are similar to GAD, but there are key differences. Common anxiety-related symptoms include:

  • Feeling easily startled, or hypervigilant
  • Feeling frequently or occasionally on guard
  • Frequent feelings of anxiety/nervousness
  • High anxiety relating to certain triggers, such as in crowds, in social situations, or in places where there are reminders of the trauma

However, unlike with GAD or other anxiety disorders, those with PTSD may have all or many of the following symptoms as well:

  • Intrusive memories of a past trauma
  • Feeling as if one is reliving a past trauma
  • Disturbing dreams that may or may not be about the traumatic event itself
  • Feeling very upset when reminded of the trauma
  • Feelings similar to depression, such as hopelessness and a pattern of negative thoughts
  • Shame about what happened, or beliefs by survivors that the trauma was their fault

Similar to what’s been found with GAD, PTSD relates to a communication problem between parts of the brain. This may be why many of the symptoms of PTSD are similar to GAD. However, as the symptoms indicate, PTSD is a somewhat different disorder, because it specifically relates to one or more past trauma(s).

Social Anxiety Disorder

Another disorder with many similarities to GAD is social anxiety disorder, or social phobia. Around 7% of people have experienced this disorder in the past year.

As the name indicates, this type of anxiety specifically relates to social situations, and what others think of the person. This may lead to avoidance of social settings, which reinforces the fear and typically causes it to get worse over time.

Unfortunately, the isolation of social disorder can interfere with relationships, employment, and can make other disorders such as depression worse.

Obsessive Compulsive Disorder

Some people may not think of obsessive compulsive disorder (OCD) as an anxiety disorder, but it certainly includes a lot of fears. Two to three percent of the population suffers from OCD, which can present in different ways. Most people are familiar with behaviors such as obsessively checking that the stove is off, or flipping a light switch a certain number of times.

OCD can also present as obsessive thoughts relating to specific worries. While this is somewhat similar to GAD, it tends to be combined with compulsive ways to soothe the worries. For example, someone may ask a therapist or a friend to repeatedly reassure them about certain fears. At other times, this soothing presents as the compulsive behaviors such as repeatedly checking locks.

Other Anxiety Issues

While these are the most common related disorders, anxiety can present in many different ways. For example, someone might experience both PTSD and GAD. There are also several less common, but just as debilitating disorders, that relate to anxiety. These include the following:

  • Panic Disorder. This condition involves sudden feelings of overwhelming anxiety. This condition might look similar to PTSD. However, it would not include all of the broader symptoms of that trauma-related condition.
  • Agoraphobia. This disorder involves an overwhelming fear of being in an open space or not being able to access help. For example, some people may have extreme fear leaving the house.
  • Other specific phobias. There are many other, possibly unending, possibilities of specific phobias. Examples include a fear of heights, fear of animals, or fear of water.

Self-Help for Anxiety

If you are experiencing high anxiety symptoms, you can start with some basic steps to address the issue. You can also use these self-help skills while you’re looking for a therapist or waiting for a first appointment. Here are some ways that may work to decrease or manage feelings of anxiousness.

  1. Gradually face your fears. In many cases, the more a fear is avoided, the stronger it gets. For example, the longer someone with agoraphobia isolates inside, the more fearful they may be of leaving. Rather than continuing to avoid fears, you can gradually face your fears. Someone with agoraphobia might start by standing near an open door and work up from there.
  2. Practice mindfulness. Mindfulness is shown to improve all kinds of conditions, and can help with anxiety in both the short and long-term. Examples of mindfulness include meditation, yoga, or Tai chi. Many smartphone apps also include mindfulness activities.
  3. Exercise. Many people find, and studies indicate, that regular exercise can help decrease overall anxiety. It may also bring relief during immediate episodes.
  4. Use grounding techniques. Grounding exercises can help counter panic attacks and lower physiological symptoms of anxiety. For example, completing a body scan or noticing smells can be helpful.
  5. Deep breathing. Deep breaths in and very slow breaths out can often help decrease anxiety in the moment.
  6. Prioritize self care. Mental health symptoms tend to get worse with more stress. Setting boundaries on your time, making time for hobbies, and taking time to relax can be helpful.

Therapies for Anxiety

For more serious and ongoing anxiety, it may be important to seek professional care. Understanding the types of therapy for each disorder can be helpful in your decision making. Here’s a look at areas of treatment that may be helpful.

Exposure Therapies

Many treatments use exposure techniques to help people overcome anxiety symptoms. Therapies for general anxiety, OCD, and PTSD may all include exposure activities. While this can sound frightening, it’s found to be a highly effective and helpful strategy.

Here’s a look at types of treatment that include exposure techniques.

  1. Trauma-focused cognitive behavioral therapy (TF-CBT). This therapy is primarily used with children and teens. The exposure portion of the therapy, used if needed, includes creating a list of scary situations to face. For example, a teenager who is scared to drive after an accident may start by driving around a parking lot. Once this gets easier, the teen might move on to driving around the block.
  2. Prolonged exposure therapy. This therapy involves facing the memories, emotions, and situations that relate to the trauma. Like with TF-CBT, patients might face situations that are frightening. But they also repeatedly talk about the trauma until it no longer triggers them.
  3. Cognitive processing therapy. In this therapy, also used for trauma, patients write about the fears and often the memories of the trauma. This involves indirect exposure, that helps them face their fears and stop avoidance.
  4. Exposure and response prevention (ERP). This therapy is used for OCD, and guides patients in eliminating the compulsive behaviors of the condition. Rather than facing the fears of doing something, they practice not continuing the obsessive behaviors.

Cognitive Therapies

More basic forms of cognitive behavioral therapies (CBT) specifically address the thoughts relating to anxiety. Therapists may help their clients question the thoughts that reinforce anxieties and fears.

Sometimes fears are irrational, or misperceived, and working through the fears in talk therapy can make a difference. CBT therapies work with the basic premise that thoughts influence emotions. By challenging thoughts, feelings can change, especially over time.

As noted, several types of CBT therapies also include exposure techniques to face fears.

Somatic Therapies

In somatic therapies, the focus is primarily on the physical experience in the body, rather than the thoughts relating to anxiety. Following this theory, anxiety and trauma symptoms present mainly in the body, so should be addressed accordingly. Therapists may work with clients on noticing, movement, relaxation, and breathing.

Eye Movement Desensitization and Reprocessing (EMDR)

In this therapy, patients think about difficult situations while watching lights or tapping both sides of the body. In theory, activating both sides of the brain helps with healing and processing the distressing thoughts. Some also consider EMDR to be an exposure therapy, as it involves time thinking about and imagining difficult situations.

Moving Beyond Anxiety

Struggles with anxiety can be overwhelming and debilitating. It affects millions of Americans, as well as their loved ones. Fortunately, understanding the causes of anxiety and types of anxiety can help determine what may help.Self-help techniques for anxiety, along with professional treatment, can make the difference between continuing to suffer or finding relief.

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