Most people feel anxious from time to time. However, anxiety can become abnormal if it interferes with your day-to-day activities. Anxiety is a symptom of various anxiety disorders. They can often be treated. Treatments include various talking treatments and medication.
What is anxiety?
When you are anxious you feel fearful and tense. In addition you may also have one or more unpleasant physical symptoms - for example, you might have:
- A fast heart rate.
- The sensation of having a 'thumping heart' (palpitations).
- A feeling of sickness (nausea).
- Shaking (tremor).
- Dry mouth.
- Chest pain.
- Fast breathing.
The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious. The nerve messages tend to make the heart, lungs and other parts of the body work faster. In addition, you release stress hormones, such as adrenaline (epinephrine), into the bloodstream when you are anxious. These can also act on the heart, muscles and other parts of the body to cause symptoms.
Anxiety is normal in stressful situations and can even be helpful. For example, most people will be anxious when threatened by an aggressive person, or before an important race. The burst of adrenaline (epinephrine) and nerve impulses which we have in response to stressful situations can encourage a 'fight or flight' response.
Anxiety is abnormal if it:
- Is out of proportion to the stressful situation; or
- Persists when a stressful situation has gone, or the stress is minor; or
- Appears for no apparent reason when there is no stressful situation.
What are anxiety disorders?
There are various conditions (disorders) where anxiety is a main symptom.
You may have an anxiety disorder if anxiety symptoms interfere with your normal day-to-day activities, or if worry about developing anxiety symptoms affects your life. About 1 in 20 people have an anxiety disorder at any one time.
The following is a brief overview of the main anxiety disorders. Some people have features of more than one type of disorder.
Anxiety can be one of a number of symptoms as a reaction to stressful situations. There are three common types of reaction disorders:
Acute reaction to stress (sometimes called acute stress reaction)
This sudden reaction - typically due to an unexpected life crisis - features anxiety, low mood, irritability and other symptoms. It usually settles quickly and sometimes occurs before the event takes place (this is known as situational anxiety). See the separate leaflet called Acute Stress Reaction.
This is similar to the above but symptoms develop days or weeks after a stressful situation such as a divorce or house move, as a reaction or adjustment to the problem. Symptoms are similar to acute reaction to stress but may include depression. The symptoms tend to improve over a few weeks or so.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) may follow a severe trauma such as a serious assault or a life-threatening accident. The main symptoms of PTSD are recurrent flashbacks about the trauma, avoidance of anything that can trigger thoughts of the trauma, emotional numbness, pessimism about the future and an increased state of irritability and arousal (for example, poor sleep, difficulty in concentrating). See the separate leaflet called Post-traumatic Stress Disorder.
Phobic anxiety disorders
A phobia is strong fear or dread of a thing or event. The fear is out of proportion to the reality of the situation. Coming near to or into contact with the feared situation causes anxiety. Sometimes even thinking of the feared situation causes anxiety. Therefore, you end up avoiding the feared situation, which can restrict your life and may cause distress.
Social anxiety disorder
Social anxiety disorder (also known as social phobia) is possibly the most common phobia. With social anxiety disorder you become very anxious about what other people may think of you, or how they may judge you. Therefore, you fear meeting people, or 'performing' in front of other people, especially strangers. You fear that you will act in an embarrassing way and that other people will think that you are stupid, inadequate, weak, foolish, crazy, etc. You avoid such situations as much as possible. If you go to the feared situation you become very anxious and distressed. See the separate leaflet called Social Anxiety Disorder.
This too is common. Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations. So, for example, you may have a fear of:
- Entering shops, crowds and public places.
- Travelling in trains, buses, or planes.
- Being on a bridge or in a lift.
- Being in a cinema, restaurant, etc, where there is no easy exit.
But they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home). When you are in a feared place you become very anxious and distressed and have an intense desire to get out. To avoid this anxiety many people with agoraphobia stay inside their home for most or all of the time. See the separate leaflet called Agoraphobia.
Other specific phobias
- Fear of confined spaces or of being trapped (claustrophobia).
- Fear of certain animals.
- Fear of injections.
- Fear of being sick (vomiting).
- Fear of being alone.
- Fear of choking.
But there are many more. See the separate leaflet called Phobias.
Other anxiety disorders
- Panic disorder.
- Generalised anxiety disorder (GAD).
- Mixed anxiety and depressive disorder.
- Obsessive-compulsive disorder (OCD).
Anxiety treatment - for disorders and phobias
The main aim of anxiety treatment is to help you to reduce symptoms so that anxiety no longer affects your day-to-day life.
The treatment options depend on what condition you have and how severely you are affected. They may include one or more of the following:
Understanding the cause of symptoms and talking things over with a friend, family member or health professional may help. In particular, some people worry that the physical symptoms of anxiety, such as a 'thumping heart' (palpitations), are due to a physical illness. This can make anxiety worse. Understanding that you have an anxiety disorder is unlikely to cure it but it often helps.
This may help some people with certain conditions. For example, counselling which focuses on problem-solving skills may help if you have GAD.
Anxiety management courses
These may be an option for some conditions, if courses are available in your area. The courses may include: learning how to relax, problem-solving skills, coping strategies and group support.
Cognitive behavioural therapy (CBT) for anxiety
This therapy, if available in your area, can work well for persisting anxiety disorders and phobias:
CBT is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them, which may help you to manage your anxiety. See the separate leaflet called Cognitive Behavioural Therapy (CBT).
There are various national groups which can help by giving information, advice and support. They, or your doctor or practice nurse, may also be able to put you in touch with a local group for face-to-face support.
You can also get leaflets, books, CDs, DVDs, MP3s, etc, on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress, help you to relax and possibly ease anxiety symptoms.
Selective serotonin reuptake inhibitors (SSRIs) are the group of antidepressants commonly used for anxiety disorders.
SSRIs often used for anxiety are:
These are commonly used to treat depression but also help to reduce the symptoms of anxiety even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms. Antidepressants are not tranquillisers and are not usually addictive.
Benzodiazepines such as diazepam used to be the most commonly prescribed anxiety treatment. They were known as the minor tranquilisers but they do have some serious known side-effects. They often work well to ease symptoms. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Now they are not used much for persistent anxiety conditions. A short course of up to two weeks may be an option for anxiety which is very severe and short-term, or now and then to help you over a bad spell if you have persistent anxiety symptoms.
Buspirone is sometimes prescribed to treat GAD. It is an anti-anxiety medicine but different to the benzodiazepines and is not thought to be addictive. It is not clear how it works. It is thought to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms.
A beta-blocker - for example, propranolol - can ease some of the physical symptoms such as trembling and a 'thumping heart' (palpitations). Beta-blocker medicines do not directly affect the mental symptoms such as worry. However, some people relax more easily if their physical symptoms are eased. These tend to work best in short-lived (acute) anxiety. For example, if you become more anxious before performing in a concert then a beta-blocker may help to ease 'the shakes'.
In some cases a combination of anxiety treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.
Alcohol and anxiety
Although alcohol may ease symptoms in the short term, don't be fooled that drinking helps to cure social anxiety. In the long run, it does not. Drinking alcohol to 'calm nerves' can lead to problem drinking and may make problems with social anxiety and depression worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease anxiety.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)
Anxiety disorders; NICE Quality Standards, Feb 2014