Everyone feels anxious or nervous from time to time. Anxiety is the normal response to anticipating stressful situations, and it serves a useful purpose: motivating us to avoid danger and preparing us to act in times of need. However, for people with anxiety disorders, the body’s fight-or-flight response has become overactive. Worry reaches into areas of life that should be anxiety-free, such as social interactions with friends. The nervousness and accompanying distress can make simple tasks challenging.
If you have trouble with anxiety, you’re not alone. The American Psychiatric Association reports that over 25 million Americans live with anxiety disorders, making them the most common type of emotional disorder. The Merck Manual Home Health Handbook puts the number even higher, at 15 percent of the adult population (over 36 million people).
What Causes Anxiety Disorders?
The National Institute of Mental Health (NIMH) says that, just like cardiovascular disease, anxiety disorders come from a combination of many factors: genetics, environment, and development. Traumatic experiences in particular can contribute to heightened anxiety.
Scientists have used brain imaging technology and animal studies to investigate how anxiety disorders occur in the brain. Some of the brain regions involved include:
- The amygdala is a small structure in the limbic system, which is located deep inside the brain and responsible for producing many emotions. The amygdala’s job is to process incoming sensory information for frightening stimuli and to convey messages of fear to the forebrain. According to research published in Nature Reviews Neuroscience, in the case of anxiety disorders, the amygdala’s connections can overgrow or become overactive.
- The hippocampus is also part of the limbic system, and it has two primary jobs. One is to facilitate the formation of new memories, and the other is to regulate the body’s stress system, including the amygdala. In people with anxiety disorders, like post-traumatic stress disorder (PTSD), the hippocampus is often smaller and less active. This may also explain why anxiety makes some memories sharper and blurs other memories.
- The prefrontal cortex is the part of the brain’s executive center responsible for problem-solving, decision-making, and long-term planning. It’s also involved in emotional regulation, both receiving information from the limbic system and sending inhibitory signals back out to keep it in check. However, research published in BMC Psychiatry noted that, for people with anxiety disorders, the prefrontal cortex’s signals to the limbic system are weaker, limiting its ability to regulate the emotional centers.
What Are Symptoms of Anxiety Disorders?
Although there are different types of anxiety disorders, each with its own profile, they share a number of possible symptoms in common:
- Physical symptoms
- Racing heartbeat
- Shortness of breath
- Dizziness or lightheadedness
- Trembling or shaking
- Butterflies in the stomach
- Tightness in the chest
- Insomnia or difficulty sleeping
- Mental symptoms
- Intense anxiety, nervousness, or fear
- Panic attacks
- Dread of anxiety-triggering situations
- Feeling like situations are out of control
- Invasive feelings of worry
- Intrusive memories of painful past events
- Irritability or outbursts of anger
- Inability to stop thinking troublesome thoughts
- Uncontrollable racing thoughts
- Behavioral symptoms
- Avoiding situations, places, objects, or people that might trigger panic or anxiety
- Compulsively completing tasks to stave off feelings that something might go wrong (such as double-checking all the locks in the house before going to sleep at night)
Types of Anxiety Disorders
Generalized anxiety disorder (GAD) is severe, chronic anxiety that interferes with day-to-day life, lasting for at least six months. It can present as constant nervousness or worrying to the point of obsession. The fears might seem dominant or out of control. Worries might revolve around any number of things going on in a person’s life, like work or school obligations, money, family, health problems, errands, or chores. The anxiety can cause:
- Insomnia and difficulty sleeping
- Irritation or agitation
- Weakness or shakiness
- Muscle aches or tension
According to the Anxiety and Depression Association of America (ADAA), almost seven million adults will live with GAD in any given year.
Obsessive-compulsive disorder (OCD) causes people to experience persistent and unwanted thoughts that they just can’t manage to let go of, called obsessions. These obsessions can drive them to repeatedly perform specific routines or behaviors, called compulsions, in an attempt to soothe the anxiety. People with OCD know that their obsessions and compulsions might not make sense but feel like they have to act anyway. Other symptoms of OCD can include:
- Excess concern regarding hygiene, cleanliness, germs, dirt, or contamination
- Obsessive interest in order, symmetry, or completion
- Refusing to throw away minor objects of little value
- Preoccupation with others’ safety or worry of causing accidental harm to others
- Repeating certain phrases or actions
- Checking and re-checking
According to Dialogues in Clinical Neuroscience, about one to three percent of the adult population lives with OCD.
Post-traumatic stress disorder (PTSD) occurs after a person survives a traumatic event or series of events such as combat experience, sexual assault, the death of a loved one, or a natural disaster. Although it’s normal to have a stress response to trauma (such as having difficulty sleeping, anxiety about the topic of the trauma, distress, or depression), this response usually fades within a few weeks or months. If it doesn’t, the person may have PTSD. People with PTSD can experience:
- Recurring nightmares about the trauma
- Flashbacks (intrusive, overwhelming memories of the trauma)
- Panic attacks
- Emotional numbness or detachment
- Avoidance of people, places, or things associated with the trauma
- Difficulty sleeping or insomnia
- Difficulty concentrating or remembering details
- Irritation or agitation at little or no provocation
According to the ADAA, 7.7 million American adults live with PTSD, and women are twice as likely as men to develop the disorder. The Department of Veterans Affairs (VA) reports that 3.6 percent of men and 9.7 percent of women will develop PTSD within their lifetimes.
- Social anxiety disorder/social phobia is the fear of being judged, examined, or scrutinized by others in social situations. People with social anxiety disorder may be terrified of being embarrassed or humiliated. While most people are nervous about things like public speaking, social anxiety disorder can make it a real struggle to complete regular tasks such as going to work or school, interviewing for jobs, and maintaining friendships and relationships. The ADAA says that about 15 million Americans age 18 or older have social anxiety disorder, and that over a third of them live with their symptoms for over 10 years before they get help.
- Panic disorder can cause spontaneous, unwarranted panic attacks. People who experience panic attacks might develop a great deal of anxiety about the idea of getting a panic attack in public, such as at work or in front of friends. In the case of agoraphobia, this can cause the person to stop going places where they’ve previously had a panic attack, or to avoid public places without easy escape routes, like trains or arenas. They may find themselves living their lives along fixed paths or sticking to safe locations, frequently concerned about the next attack. According to the ADAA, six million American adults meet the criteria for panic disorder each year, and about a third of them also have agoraphobia.
- Specific phobias are excessive and irrational fears of specific things that trigger anxiety and panic attacks. Common phobias include fear of:
- Snakes, spiders, or dogs
- Enclosed spaces
- Blood or injections
- Dental procedures
- Travel (especially flying)
According to NIMH, 12.5 percent of adults experience a specific phobia in their lifetimes.
Treatment for Anxiety Disorders
Depending on the nature of the anxiety disorder, different types of therapy might be effective. For example, a war veteran with PTSD might find the peer support of group therapy helpful, while someone who is phobic of heights might get the most benefit from exposure therapy. When treating anxiety, it’s important to find a specialist who offers treatments that are right for you.
- Pharmacotherapy offers a range of medications that can help manage the symptoms of anxiety. Medications are best used in combination with psychotherapy, as they can stabilize a client and make him or her receptive to treatment.
- Selective serotonin reuptake inhibitors (SSRIs) are mainly known as antidepressants, but many of them also help reduce anxiety. Common SSRIs include Celexa (citalopram), Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Effexor (venlafaxine) and Cymbalta (duloxetine) are also effective.
- Tricyclic antidepressants also treat anxiety, but they are less commonly used due to unpleasant side effects. Tricyclics include Elavil (amitriptyline), Sensoval/Pamelor/Aventyl (nortriptyline), and Tofranil (imipramine).
- Benzodiazepines are also known as tranquilizers and have powerful sedating and relaxing effects. They’re useful for stopping a panic attack and can neutralize anxiety. However, using them in the long term builds up tolerance and can lead to dependence and abuse. Common benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam).
- Sleep aids like Ambien (zolpidem) and Lunesta (eszopiclone) can help treat insomnia.
- Beta-blockers like propranolol can prevent the body’s fight-or-flight system from kicking in, helping therapy to work better. A study published in Biological Psychology found that propranolol was useful for treating PTSD.
- Buspirone is an anti-anxiety medication that can help treat GAD, says an article in the American Family Physician. It can take three or four weeks to start taking effect.
- Cognitive-Behavioral Therapy (CBT) is the top recommended type of psychotherapy for anxiety disorders, according to NIMH and the American Psychological Association. The cognitive aspect helps people alter the thought patterns that support their worries and fears, cutting the feedback cycle, and the behavioral aspect helps people learn to deal with anxiety-provoking circumstances in new ways.
- Exposure therapy is a form of CBT that involves gradually exposing people to the things they’re afraid of so they can learn that their fears are unsubstantiated.
- For someone with a specific phobia of snakes, this might involve sessions of getting closer and closer to first pictures of snakes, then videos of snakes, and then a live snake.
- For someone with PTSD, this might mean writing down the story of a traumatic memory, then reading and rereading it to gradually become desensitized to it.
- For someone with OCD, this might mean spending increasing amounts of time after touching something dirty before washing their hands.
- For someone with social anxiety, this might mean entering into safe social situations and seeing how people react – usually, far less judgmentally than the person feared.
- Dialectical Behavioral Therapy (DBT) is a modified version of CBT that teaches people how to tolerate extreme or distressing emotions, such as self-criticism or the urge toward self-destructive behaviors.
- Cognitive processing/restructuring therapy (CPT/CRT) helps people with PTSD sort through their memories of traumatic events. People may blame themselves for what happened to them or feel stuck in their thoughts circling the trauma. CPT gives the person the opportunity to decide how they want to feel about their trauma, and then teaches the skills to change their beliefs to match. The VA reports that CPT is effective for PTSD.
- Eye-movement desensitization and reprocessing (EMDR) uses a series of induced eye movements, taps to the limbs, or auditory tones to disrupt the faulty neural circuitry underlying PTSD. This gives the person the opportunity to address and process their traumatic memories without fear circuitry activating and getting in the way of healing.
- Support groups or 12-Step groups offer people a supportive group of peers while they are getting other help to treat an anxiety disorder. It can be easier to deal with anxiety when you know you’re not alone.
- Complementary therapy consists of treatments that are not meant to replace medication or psychotherapy, but instead work alongside them.
- Mindfulness incorporates practices from Buddhism and yoga to teach “nonjudgmental awareness of the present,” according to a meta-analysis published in the Journal of Consulting and Clinical Psychology. It teaches the practitioner how to be aware of their sensations, thoughts, emotions, and feelings without being overwhelmed or controlled by them. These practices can help reduce the symptoms of anxiety, the analysis found.
- Exercise helps reduce anxiety, according to a review article in the Journal of Neural Transmission. It causes the brain to release chemicals that help regulate the body’s stress system, reducing the fight-or-flight reaction. Going outside to exercise can also act as a form of exposure therapy for people with panic disorder, PTSD, social anxiety, and other anxiety disorders with elements of avoiding the public.
- Dual Diagnosis treatment is appropriate for people who have been diagnosed with both an anxiety disorder and a substance abuse disorder. Many of the treatments for the two types of disorders are the same – for example, learning techniques to deal with stress in a healthy manner or building new behavior patterns that don’t provoke anxiety.
A Dual Diagnosis
When you consider how anxiety works in the brain, it can be easy to see why people with anxiety disorders might try to use substances to help feel better. Drugs like alcohol, benzodiazepines, opiates, and cigarettes all help soothe the body’s fight-or-flight system, which is overactive in anxious people. However, using substances to treat anxiety without a doctor’s recommendation can be dangerous and can lead to patterns of drug abuse.
A study in JAMA Psychiatry of over 43,000 people found that people with anxiety disorders were over twice as likely to have alcohol use disorder as well. A review in the American Journal on Addictions found that 30 to 59 percent of women who live with substance abuse disorder also had PTSD, about two or three times the prevalence seen among men. According to the VA, over 20 percent of veterans with PTSD also have substance use disorder, and almost a third of veterans who seek treatment for substance use disorders also have PTSD.
At Black Bear Lodge, our expert therapists specialize in treating Dual Diagnosis patients. We can work with you to develop a treatment program that addresses your unique needs. Fighting anxiety can be an incredible struggle, but hope is within reach. We can help – get in touch today to learn more.