Understanding Anxiety

Increase Your Knowledge

People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

- Source: ADAA Anxiety and Depression Association of America -


"Good morning, let the stress begin." Everyone experiences stress at one point. From work challenges, academic pressures, financial strain, an overwhelming to-do list (There is never enough time in the day!) and even attending social engagements can bring on feelings of stress. Stress is our body's way of responding to demands placed upon it which can be caused by both positive and negative situations.

According to stress.org, there are about 50 common signs of stress including headaches, teeth grinding (jaw soreness), frequent illness (colds, cold sores, etc.), disturbed sleep and even increased anxiety. With stress producing anxiety how can you tell the difference?

Stress is a response to a threat in a situation. Anxiety is a reaction to stress.

It's true that anxiety can induce similar feelings to stress but it is different because anxiety is a reaction to stress. Stressful or anxious emotions increase your heart rate, trigger rapid breathing and cause muscle tension. The similarities diverge when anxiety gives way to a panic attack, which brings about chills, headaches, hot flashes and chest pains. Anxiety symptoms include stress that's out of proportion to the impact of the event, inability to set aside a worry, and an increasing sense of helplessness and restlessness.

With stress, you can manage it. The key to reducing stress is to understand what the causes are and putting together a stress management plan. Getting enough sleep, a proper diet, avoiding excess caffeine and other stimulants and taking time out to relax may help. Unmanaged stress or chronic stress can lead to adverse health effects including muscle tension which can lead to migraines, long term heart problems, digestion issues, and more.

When your worries become constant, non-specific, and you have a hard time controlling them, then you need to start thinking about them as clinical anxiety. Anxiety disorders are diagnosable mental illnesses, acute and chronic stresses are not.

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Types of Anxiety

Normal situations such as a move to a new town or meeting new people can make anyone feel anxious. An unfamiliar situation puts our body on alert. When facing a challenge you're going to feel something. Occasional anxiety is normal. Ongoing anxiety is cause for concern. When feelings of worry, anxiety or fear are strong enough to interfere with your daily activities it is considered a mental health disorder.

Many people with ongoing anxiety experience symptoms of more than one type of anxiety condition, and may experience depression as well. It's important to seek support early since symptoms can negatively impact your life if left untreated.

Common Types of Anxiety Disorders

There are many types of anxiety. The five major types of anxiety disorders as defined by the U.S. Department of Health & Humans Services are:
  • Generalized Anxiety Disorder
    Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
  • Obsessive-Compulsive Disorder (OCD)
    Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
  • Panic Disorder
    Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
  • Post-Traumatic Stress Disorder (PTSD)
    Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
  • Social Phobia (or Social Anxiety Disorder)
    Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation - such as a fear of speaking in formal or informal situations, or eating or drinking in front of others - or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.

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Source: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Impact on Health

What happens to the body when it is in a state of anxiety? Anxiety is our body's natural response to danger. The "fight or flight" response is triggered which involves two major parts of the brain - the amygdala and hippocampus. When faced with a stimulus, your emergency response kicks in before the rest of your brain has time to analyze the situation. Cortisol is released and your thinking and ability to problem solve slows and reverts to a protective response/evolutionary role. (Think primitive man running from a wild beast). Once the danger is over, our body returns to normal. In modern times, many of our dangers are physiological (financial strains, busy lifestyle, etc.) and ongoing, keeping our body in this heightened alert state which over time strains our body and leads to adverse health effects.

In a Scientific American article, Psychologist David H. Barlow of Boston University states that once a certain situation activates the fight or flight response, it becomes learned and can be triggered when the same situation happens again. Many individuals with anxiety disorders experience this. Once the neurological pathways get set for a panic attack or anxiety disorder the body will use begin to use that response. Early prevention and practice of coping skills is very important.

How does anxiety feel?
In general, those experiencing an anxiety disorder will have muscle tension, headaches, fatigue, difficulty sleeping, blood pressure and a raised heart rate long after experiencing an anxiety episode or a panic attack has ended.

It's important to note that anxiety can feel differently to different people. Watch this excerpt from our anxiety video to hear first hand experiences of what an anxiety attack feels like.

What are the health complications of untreated anxiety?
Overtime, if you have inadequately treated anxiety, a much more complicated picture occurs. Many times, anxiety cannot be overcome by willpower alone and requires support from a therapist or doctor. If left untreated, anxiety can cause serious issues such as:
  • Low self-esteem
  • Clinical depression
  • Suicidal thoughts
  • Impulsive behaviors
  • Aggression
  • Substance use
  • Sense of low self-worth

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Coping with Anxiety

Whether it is a fleeting case of anxiety or something more serious like Generalized Anxiety Disorder (GAD) there are things you can do to feel better and cope. There are many proven techniques to help you manage anxiety ranging from maintaining healthy lifestyle habits around exercise, sleep and eating, practicing mental wellness strategies like mindfulness, as well as medical support in various forms of therapy and, if needed, medication.

The Connection between Modern Lifestyle, Social Media and Anxiety
Awareness of triggers and an understanding of influences from our modern lifestyle are an important component to managing anxiety. Some societal influences include:
  • A cultural shift from an internal definition of success (how I feel about my achievements) to an external focus (do I look successful).
  • The pace of modern living and inadequate coping mechanisms.
  • Screen-based entertainment which stimulates the central nervous system and amplifies anxiety.
  • Social media use which has been linked with low moods and depression.
Millennials are the most impacted. According to the American Psychological Association (APA), millennials experience more stress and are less able to manage it than any other generation. A recent study on the addictive nature of smart phone use from Baylor University reports American students are on their phones an average of nine hours a day. Many college age social media users express a universal feeling of inadequacy about their lives and FOMO, the anxious feeling from the perception of missing out on a social event or experience learned through a social media post. Different life stages have different levels of stress/anxiety. All generations feel levels of anxiety but millennials have been coined "the anxious generation."

Coping Methods
Ongoing anxiety takes a toll on our bodies. If possible, it's best to start coping habits if you feel anxiety is a problem. Early intervention is not necessarily psychiatric medications or therapy. First, think if you can manage your stress effectively. If no, pause and look at what areas of life are overwhelming such as time, emotions, finances or social situations, and then come up with a plan. Replenish and reboot your state-of-mind by doing things you love and your emotional resilience will reboot too.

For those suffering from anxiety it is important to have a wellness routine in place that includes:

Exercise - Exercise works out all of the cortisol and adrenaline that builds up in the body during times of anxiety and stress. Exercise provides a natural release.

Nutrition - The cleaner your diet is, the better you are going to feel. Take out processed foods and stimulants. Removing sugar from your diet is the number one thing to help with stress and anxiety. Strip down your diet to the bare minimum, then start adding things in and see how you feel.

Hydration - Food and water are biological needs so anxiety naturally follows hunger and thirst. Drink at least the recommended eight glasses of water a day.

Resilience - When we are stressed and feeling strained, it is resilience which brings us back to center and a feeling of control. There are different paths for resilience such as listening to music, yoga, practicing mindfulness, spirituality and even connecting with family and friends.

Types of Therapy
For those experiencing clinical anxiety, therapy may be a necessary step. Therapy always starts with an evaluation identifying concerns and understanding what a patient's life has been like. A therapist may use a variety of methods such as cognitive behavioral therapy, biofeedback, basic skills training, distress tolerance and trauma expertise.

Cognitive Behavior Therapy (CBT) - CBT treats problems by modifying dysfunctional emotions, behaviors, and thoughts.

Mindfulness-Based Cognitive Therapy (MBCT) - MBCT combines cognitive therapy with meditative practices and attitudes based on the practice of mindfulness.

Psychodynamic Therapy - A form of therapy that helps clients understand their own psychic makeup such as triggers that they may not have known existed.

School counselors, especially on college campuses, are a great resource as well. There are also a few programs that have been very successful in helping people manage anxiety, they include:

Thrive Programme - This program, developed in the UK by a psychotherapist, teaches how to manage your thoughts, emotions and beliefs so you can be in control of your life. Often people who have phobia and anxiety very often have low self-esteem, social anxiety, and a need to control. The program teaches three supporting premises: Locus of control, self-confidence and self-esteem. Throughout the six to eight week program, participants learn to think differently, focus on the facts of the situation and practice working on social anxiety and self-esteem.

HeartMath Institute - The mission of the HeartMath Institute is to help people bring their physical, mental and emotional systems into alignment with their heart's intuitive guidance. A focus on the connection between the heart and deep breathing balances out important parts of nervous system and stimulates hormones released into the body to activate an uplifting emotion.

Medication for Anxiety
Medication is useful for alleviating the symptoms of anxiety disorders and is often prescribed in conjunction with other therapies. If experiencing any form of clinical anxiety, consult your doctor to see if medication may be right for you.

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Source: FutureHealth and Huffington Post

How to Help

When someone you care about suffers from anxiety you want to help but it can be overwhelming. What is the right thing to say? Does it change if you are a parent or a friend? Research supports that anxiety does run in families so what can be done to break the cycle? This section provides some tools and information to help you be the support your loved ones need.

How a Parent can Help a Child
Parenting becomes even more complicated when your child suffers from anxiety. As a parent you feel helpless. It's common for caregivers to try and protect a child from uncomfortable feelings to make them feel better. Unfortunately, it can do more harm than good. A parent's role is not to prevent anxiety; it's to help the child manage it. Child Mind Institute provides these tips:
  • Help your child manage anxiety. When children are encouraged to tolerate their anxiety, it lessens and may even dissipate over time.
  • Don't avoid things that make your child anxious. It could start a cycle of coping (escaping, avoidance) that is not helpful in the long run.
  • Express positive, yet realistic, expectations. You can't control how a situation will go (your child won't make a mistake, will make the team, won't get laughed at, etc.) but you can share your confidence in their ability to handle whatever happens. This vote of confidence will let your child know you believe they can handle it. Over time, they will start believing it too.
  • Respect feelings, but don't overpower. Validation is not always agreement so if your child expresses fear about something, listen, be empathetic, and help them understand what is causing the anxiety. Remind them they have the tools to handle it.
  • Don't ask leading questions. Avoid feeding the cycle. Don't ask questions like "Are you nervous about the first day of school?" Instead, ask open ended questions like "How are you feeling about the first day of school?"
  • Don't reinforce fears. Watch your body language and tone of voice when a situation comes up that previously caused anxiety. Even if your words are encouraging you don't want your body or voice to show you are nervous - kids will pick up on it.
  • Encourage tolerance of anxiety. Tell your child you appreciate their effort. Tolerance leads to eventually overcoming the stressor. It may take time, and it may not completely disappear, but it will be bearable.
  • Keep anticipatory timeframes short. The hardest time is the period before something we are nervous about happens. For instance, don't talk about a visit to the dentist days in advance, tell them that morning.
  • Help your child think it through. Talk in advance about what would happen if their worse fear comes true. A plan can help them feel prepared and reassure them it will be ok.
  • Model healthy ways to handle anxiety. Kids are perceptive. If they see you crumbling in the midst of stress - they will learn to handle it that way too. Don't pretend things are perfect but when you have a stressful or anxious situation show your kids how to manage it calmly, tolerating it and feeling good about getting through it.
For children with serious anxiety disorders, the Anxiety and Depression Association of American (ADAA) has additional tips for parents as well as siblings that may be affected. It's always important to consult a therapist or physician for the best way to support someone with clinical anxiety.

Helping a Friend
When helping a friend, it's important to remember that anxiety feels different to everyone. The best thing you can do is to try your best to understand their experience by starting with validation and empathy. Don't use language that will dismiss or blame them since it reinforces a sense of inadequacy. The Anxiety and Depression Association of America offers this advice:
  • Learn about the disorder since understanding what your friend is going through gives support but also keeps your worry in check.
  • Encourage treatment by offering to drive them to appointments and attend a therapy session with them.
  • Realize and accept that stressful periods will happen. Modify your expectation of how they should act and be extra supportive during difficult times.
  • Be tolerant, supportive and nonjudgmental. Even if you don't fully understand exactly how they are feeling, respect them.
  • Be encouraging and don't get discouraged. Give praise for small accomplishments and stay positive.
  • Ask how to help and listen carefully to the response.
  • Talk to someone so you have someone to support you too.
Interacting with someone with anxiety can be sensitive so to further help you provide the best support, below are a few ideas of what to say and what not to say?

What TO say ?
  • Can you tell me how you are feeling? Build up the sense they can cope with the situation. When a person feels in control and can start tolerating the discomfort of anxiety it will help them overcome it.
  • This must be hard for you. Empathy goes a long way.
  • Is there anything I can do to help? Support is always appreciated.
  • Silence. Sometimes just having someone to listen is enough.
What NOT to say?
  • You'll be okay. This is not an emphatic message and it can make it worse. It may create a wider communication gap and increase a feeling of isolation.
  • Don't worry. Worrying for someone with anxiety is a biological reaction, not a choice.
  • You need counseling. Avoid a language that has a dismissive and blaming component to it. Encouraging treatment by offering to drive them or go with them is more supportive.
For more insights into what someone with an anxiety disorder wants their friends to know, view the Future Health Understanding Anxiety Disorder video.

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There are many online resources and it's important to find trusted and reliable ones. Future Health composed the list below to help.

  • Anxiety and Depression Association of America (adaa.org) - ADAA is an international nonprofit dedicated to the prevention, treatment, & cure of anxiety and depression related disorders through education, practice, & research. www.adaa.org offers free educational info & resources, including find-a-therapist directory.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) - An agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
  • Worrywisekids.org - A service of the Children's Center for OCD and Anxiety in Plymouth Meeting, PA has a mission is to improve the quality of life for anxious children and their families by providing parents, educators and mental health professionals with comprehensive, user-friendly information on the full range of anxiety disorders.
  • Child Mind Institute (childmind.org) - An independent, non-profit dedicated to transforming the lives of children and their families suffering from mental health and learning disorders.
Online Communities

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