Anxiety: When Worry Becomes a Problem and What Helps
Everyone feels anxious sometimes. A job interview, an exam or a medical test can make the heart race and the mind spin, and that response is normal and even useful. Anxiety becomes a problem when it is out of proportion to the situation, hard to control, lasts for weeks or months, and interferes with daily life. Anxiety disorders are among the most common mental health conditions and among the most treatable.
Types of anxiety disorder
- Generalised anxiety disorder (GAD): persistent, excessive worry about many everyday matters, often with restlessness, tension and poor sleep
- Panic disorder: sudden surges of intense fear, with palpitations, breathlessness, chest tightness, sweating, trembling and a sense of doom, often peaking within minutes
- Social anxiety disorder: intense fear of being judged or embarrassed in social or performance situations
- Specific phobias: marked fear of a particular object or situation, such as flying, heights or needles
- Agoraphobia: fear of places where escape may be difficult
- Separation anxiety and health anxiety
Obsessive-compulsive disorder and post-traumatic stress disorder are related conditions with their own features.
Symptoms in the body and mind
Anxiety is not only a thought; it is a whole-body state caused by the stress response, which releases adrenaline and prepares you to fight or flee.
Physical: a pounding heart, tight chest, shallow breathing, dizziness, sweating, tremor, dry mouth, stomach upset, muscle tension, headaches and fatigue.
Psychological: racing thoughts, constant worry, difficulty concentrating, irritability, feeling on edge and expecting the worst.
Behavioural: avoiding situations, seeking constant reassurance, procrastination and sleep disturbance.
Because the physical symptoms can mimic heart, thyroid or lung disease, a doctor may do an examination and a few tests to rule out other causes, particularly with first panic attacks.
What causes it
A mixture of genetics, temperament, stressful or traumatic life events, long-term illness, substance use and brain chemistry. Caffeine, alcohol, some medicines and stimulants can trigger or worsen symptoms. An overactive thyroid, anaemia and low blood sugar may also contribute.
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Treatments that work
Cognitive behavioural therapy (CBT) is the best-evidenced psychological treatment. It helps identify anxious thinking patterns, test predictions and gradually face feared situations instead of avoiding them. Exposure-based techniques are especially powerful for phobias, panic and social anxiety. Digital CBT programmes can be effective and accessible.
Medicines. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and escitalopram, and serotonin-noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine, are first-line. They take two to six weeks to work, and early side effects such as nausea or jitteriness usually settle. Do not stop suddenly. Pregabalin, buspirone and, rarely, short courses of beta-blockers for performance anxiety are other options. Benzodiazepines can relieve anxiety quickly but cause tolerance and dependence, so they are used sparingly and briefly.
Lifestyle. Regular aerobic exercise lowers baseline anxiety. Consistent sleep, less caffeine and alcohol, and balanced meals help. Mindfulness, yoga and progressive muscle relaxation all have supportive evidence.
Techniques you can use today
- Slow breathing: breathe in for four seconds, out for six to eight, for a few minutes. A longer exhale activates the calming branch of the nervous system.
- Grounding: name five things you can see, four you can touch, three you can hear, two you can smell and one you can taste.
- Scheduled worry time: set aside 15 minutes daily to write down worries, and postpone them the rest of the day.
- Question the thought: ask what evidence supports it, what a friend would say and what is the most likely outcome.
- Do the thing: avoidance feeds anxiety; taking small steps toward what you fear shrinks it.
Helping someone with anxiety
Listen without judging, avoid saying “just calm down,” encourage them to seek help and gently resist providing endless reassurance, which can reinforce the cycle.
When to seek help
Reach out to a doctor or mental health professional if anxiety has lasted several weeks, disrupts work, study or relationships, brings panic attacks, or leads you to rely on alcohol or drugs. If you ever have thoughts of harming yourself, contact emergency services or a crisis line straight away.
Outlook
With proper treatment, most people with anxiety disorders improve significantly. Seeking help is a sign of strength, and the sooner treatment begins, the quicker the recovery.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.