Therapy for Anxiety Disorders
Cognitive behavioral therapy, exposure therapy, and other options
Do you struggle with anxiety? Here’s how to recognize the signs, symptoms, and different types of anxiety—and find the relief you need.
Anxiety is a normal reaction to danger, the body’s automatic fight-or-flight response that is triggered when you feel threatened, under pressure, or are facing a challenging situation, such as a job interview, exam, or first date. In moderation, anxiety isn’t necessarily a bad thing. It can help you to stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming—when worries and fears interfere with your relationships and daily life—you’ve likely crossed the line from normal anxiety into the territory of an anxiety disorder.
Since anxiety disorders are a group of related conditions rather than a single disorder, symptoms may vary from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything. But despite their different forms, all anxiety disorders illicit an intense fear or worry out of proportion to the situation at hand.
While having an anxiety disorder can be disabling, preventing you from living the life you want, it’s important to know that you’re not alone. Anxiety disorders are among the most common mental health issues—and are highly treatable. Once you understand your anxiety disorder, there are steps you can take to reduce the symptoms and regain control of your life.
“High-functioning anxiety” is a term you may have come across online. It’s not a clinical diagnosis but is sometimes used to describe a person who manages to cope with the demands of daily life despite having anxiety. Outwardly, they may seem unflappable. But beneath their calm demeanor, they’re plagued by anxious and negative thoughts.
If you have high-functioning anxiety, you might seem proactive, outgoing, organized, and achievement-oriented. You may even come off as a perfectionist or model student or employee. However, your underlying anxiety can still have health consequences, including irritability, insomnia, and muscle tension.
Different people experience anxiety symptoms in different ways. It’s important to remember that some people are dealing with struggles that aren’t always apparent.
If you identify with any of the following seven signs and symptoms, and they just won't go away, you may be suffering from an anxiety disorder:
In addition to the primary symptom of excessive and irrational fear and worry, other common emotional symptoms include:
But anxiety is more than just a feeling. As a product of the body's fight-or-flight response, it also involves a wide range of physical symptoms, including:
Because of these physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is finally recognized.
Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand-in-hand. Since depression makes anxiety worse (and vice versa), it's important to seek treatment for both conditions.
Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. They usually occur suddenly and without warning. Sometimes there's an obvious trigger—getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.
Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, you may experience terror so severe that you feel as if you're about to die or totally lose control. The physical symptoms are themselves so frightening that many people think they're having a heart attack. After an anxiety attack is over, you may worry about having another one, particularly in a public place where help isn't available or you can't easily escape.
It's important to seek help if you're starting to avoid certain situations because you're afraid of having a panic attack. The truth is that panic attacks are highly treatable. In fact, many people are panic free within just 5 to 8 treatment sessions.
Anxiety disorders and closely related conditions include:
If constant worries and fears distract you from your day-to-day activities, or you're troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. GAD often manifests in physical symptoms like insomnia, stomach upset, restlessness, and fatigue.
Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. Agoraphobia, the fear of being somewhere where escape or help would be difficult in the event of a panic attack, may also accompany a panic disorder. If you have agoraphobia, you are likely to avoid public places such as shopping malls, or confined spaces such as an airplane.
Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may feel troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.
Hoarding disorder is a chronic difficulty discarding possessions, accompanied by a dysfunctional attachment to even worthless items. It can lead to excessive accumulation of possessions (or animals) and a cluttered living space. You may attribute emotion to inanimate objects, have a strong sentimental attachment to items, or see the use in any object. These beliefs can make discarding items overwhelm you with feelings of anxiety, guilt, or sadness.
A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals (such as snakes and spiders), fear of flying, and fear of needles. In the case of a severe phobia, you might go to extreme lengths to avoid the object of your fear. Unfortunately, avoidance only strengthens the phobia.
If you have a debilitating fear of being viewed negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. It can be thought of as extreme shyness and in severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.
Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about the incident, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.
While separation anxiety is a normal stage of development, if anxieties intensify or are persistent enough to get in the way of school or other activities, your child may have separation anxiety disorder. They may become agitated at just the thought of being away from mom or dad and complain of sickness to avoid playing with friends or going to school.
Not everyone who worries a lot has an anxiety disorder. You may feel anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much caffeine. The bottom line is that if your lifestyle is unhealthy and stressful, you're more likely to feel anxious—whether or not you actually have an anxiety disorder.
These self-help tips can help to lower anxiety and manage symptoms of a disorder:
Connect with others. Loneliness and isolation can trigger or worsen anxiety, while talking about your worries face to face can often make them seem less overwhelming. Make it a point to regularly meet up with friends, join a self-help or support group, or share your worries and concerns with a trusted loved one. If you don't have anyone you can reach out to, it's never too late to build new friendships and a support network.
Manage stress. If your stress levels are through the roof, stress management can help. Look at your responsibilities and see if there are any you can give up, turn down, or delegate to others.
Practice relaxation techniques. When practiced regularly relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce anxiety symptoms and increase feelings of relaxation and emotional well-being.
Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days (broken up into short periods if that's easier). Rhythmic activities that require moving both your arms and legs are especially effective. Try walking, running, swimming, martial arts, or dancing.
Get enough sleep. A lack of sleep can exacerbate anxious thoughts and feelings, so try to get seven to nine hours of quality sleep a night.
Be smart about caffeine, alcohol, and nicotine. Caffeine and alcohol can make anxiety worse. And while it may seem like cigarettes are calming, nicotine is actually a powerful stimulant that leads to higher, not lower, levels of anxiety. For help kicking the habit, see How to Quit Smoking.
Put a stop to chronic worrying. Worrying is a mental habit you can learn how to break. Strategies such as creating a worry period, challenging anxious thoughts, and learning to accept uncertainty can significantly reduce worry and calm your anxious thoughts.
While self-help coping strategies can be very effective, if your worries, fears, or anxiety attacks have become so great that they're causing extreme distress or disrupting your daily routine, it's important to seek professional help.
If you're experiencing a lot of physical symptoms, you should start by getting a medical checkup. Your doctor can check to make sure that your anxiety isn't caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you're taking.
If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety disorders. The therapist will work with you to determine the cause and type of your disorder and devise a course of treatment.
Anxiety disorders respond very well to therapy—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most are treated with therapy, medication, or some combination of the two. Cognitive-behavioral therapy and exposure therapy are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. They can help with issues such as panic attacks, generalized anxiety, and phobias.
Cognitive-behavior therapy helps you identify and challenge the negative thinking patterns and irrational beliefs that fuel your anxiety.
Exposure therapy encourages you to confront your fears and anxieties in a safe, controlled environment. Through gradual exposure to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control. As you face your fear without being harmed, your anxiety will diminish.
If you have anxiety that's severe enough to interfere with your ability to function, medication may help relieve some symptoms. However, anxiety medications can be habit forming and cause unwanted or even dangerous side effects, so be sure to research your options carefully. Many people use anti-anxiety medication when therapy, exercise, or self-help strategies would work just as well or better—minus the side effects and safety concerns. It's important to weigh the benefits and risks of medication so you can make an informed decision.
NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)
Find a Therapist – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)
Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)
Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)
Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)
SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).
Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation).
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