Insight-oriented psychotherapy. This type of talk therapy explores how past and current experiences may be contributing to anxiety. It helps people deal with unresolved conflicts in their lives to lessen feelings of anxiety.
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# Anxiety

Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Worried that you worry too much? Everyone worries or gets scared sometimes. But feeling extremely worried or afraid much of the time, or repeatedly feel panicky, may be signs of an anxiety disorder.

Anxiety is a normal reaction to stressful situations like taking a test or giving a presentation. Anxiety can be beneficial as it helps increase your focus and keeps you alert for danger when the situation warrants it. However, when feelings of fear or distress become overwhelming, their intensity is out of proportion to the situation, or they interfere with daily activities, it could indicate an anxiety disorder.

Anxiety is not a single condition but a spectrum of related disorders. While different anxiety disorders have distinct characteristics, they also share some common symptoms. Anxiety disorders tend to run in families.

Psychological therapy, medications, and self-help strategies can help manage anxiety disorders.

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## What are some different types of anxiety?

There are several types of anxiety disorders, and many people with one anxiety disorder also have another.

Phobias. Phobias are an exaggerated fear of a particular object, animal, or situation that does not pose a significant threat. Common phobias include fear of spiders, dentists, or flying on airplanes. Phobias are the most common type of anxiety disorder. A person with a phobia will develop anxiety symptoms, such as sweating, shaking, racing heart, and shortness of breath, upon encountering the source of their phobia. Many people with phobias will alter their behavior to avoid confronting their fear. More women than men are affected by phobias.

Generalized anxiety disorder (GAD). GAD causes excessive worry about different activities, events, and people. With GAD, the source of the worry changes, but the worry itself is present most of the time and is significant enough to interfere with the person’s ability to function normally. Most people with GAD wish they could stop worrying, but they feel powerless to do so.

Social anxiety disorder. With this type of anxiety, people feel uneasy and self-conscious in social situations. They often have a deep fear of humiliation or of being negatively judged by others. People with social anxiety might experience blushing, sweating, trembling, nausea, or even panic attacks when faced with speaking in a group or meeting new people. They might avoid social events to prevent these feelings. Early negative social experiences, such as bullying or teasing, can also contribute.

Stress disorders. Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are both are triggered by a traumatic event such as being in combat, a life-threatening event, a natural disaster, or an assault. They also share the same symptoms, including being easily startled, having recurrent flashbacks of the traumatic event, difficulty sleeping, nightmares, withdrawing from some people and particular events, and having intrusive thoughts about the event. Acute stress disorder is diagnosed when symptoms persist for three to 30 days after the traumatic event. PTSD is diagnosed when symptoms persist for more than one month; in some cases, PTSD symptoms do not begin until six months or more after the traumatic event.

Panic disorder. This condition causes periods of terror known as panic attacks, which often occur for no reason and without warning and typically last between five and 30 minutes. During a panic attack, a person might shake, sweat, have trouble breathing, and experience chest pains. These attacks can occur during stressful events or appear out of nowhere. They can even happen during sleep. Women are twice as likely as men to develop a panic disorder.

Obsessive-compulsive disorder****(OCD). Many people with anxiety also have OCD. People with OCD have persistent, involuntary thoughts, worries, or urges. OCD might occur because of genetics and structural differences in the brain. People who have had a brain injury also are at higher risk for OCD. Symptoms often are triggered by stressful experiences.

## What are the symptoms of anxiety?

Common symptoms of anxiety disorders include:

●Insomnia or sleeping too much

●Feeling restless, tense, or irritable

●Difficulty concentrating

●Racing heart

●Muscle tension

●Sweating, trembling, shaking

●Nausea

●Having a sense of dread

In addition, many people with anxiety disorders also experience symptoms of depression.

Some anxiety disorders have specific symptoms and behaviors. For example:

Social anxiety disorder. Symptoms may include shortness of breath, blushing, nausea, and feeling “tongue-tied” in social situations.

Panic disorder. Panic disorder is characterized by repeated panic attacks. Symptoms of a panic attack include shortness of breath, palpitations, chest pain, sweating, a smothering sensation, and feelings of going crazy or losing control.

Obsessive-compulsive disorder (OCD). A person with OCD has obsessive distressing and intrusive thoughts, worries, or urges and engages in compulsions, rituals, and behaviors in an attempt to manage those obsessions. For example, a person with OCD may excessively worry that they will become contaminated with germs and will repeatedly wash their hands. These obsessions and compulsions cause significant distress and interfere with the ability to concentrate or function normally.

## Psychological therapy for anxiety

Anxiety disorders can be treated with psychotherapy,medications, or a combination of the two. Common types of psychotherapy used to treat anxiety disorders include:

Cognitive behavioral therapy (CBT). The most common type of psychotherapy for anxiety disorders, CBT helps people learn to reframe negative thought patterns and to change their behaviors in situations that trigger anxiety.

Exposure therapy. This type of therapy involves slow, direct exposure to the object of a person’s fears. This can be done through role-playing or by imagining the feared object or situation. For example, people who are afraid of dogs might look at pictures of dogs and then imagine a dog across the room, then slowly coming closer. Feelings of anxiety should lessen with increasing exposure. This process can take days, weeks, or months.

Insight-oriented psychotherapy. This type of talk therapy explores how past and current experiences may be contributing to anxiety. It helps people deal with unresolved conflicts in their lives to lessen feelings of anxiety.

## Medication for anxiety

Antidepressant medications are the first-line medication treatment for anxiety disorders.

Selective serotonin reuptake inhibitors (SSRIs). Doctors prescribe SSRIs for generalized anxiety disorder, OCD, social anxiety disorder, panic disorder, and PTSD. They can take several weeks to start working. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and paroxetine (Paxil).

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also used to treat anxiety. Commonly prescribed SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

Other medications that may be prescribed for anxiety include:

- buspirone (Buspar), which has few side effects and is generally well tolerated
- pregabalin (Lyrica), an anticonvulsant medication
- hydroxyzine (Atarax), an antihistamine medication

In addition, beta blockers such as propranolol (Inderal) and benzodiazepines such as clonazepam (Klonopin) and lorazepam (Ativan) can provide short-term relief by slowing the heart rate and calming the nervous system. They may be taken as scheduled or as needed.

## Self-help for anxiety

Self-help techniques may help reduce the severity and frequency of anxiety symptoms and help manage attacks when they occur. For example:

Exercise. Research has found that people who exercise regularly have lower stress levels, improved mood, and sleep better — all of which can help reduce feelings of anxiety.

Mindfulness meditation. Mindfulness is the practice of focusing attention on what is happening in the present and accepting it without judgment. Mindfulness is often learned through meditation, a method of regulating your attention by focusing on your breathing, a phrase, or an image. The practice is used to treat generalized anxiety disorder, phobias, and OCD. Some experts believe that it works, in part, by calming the body’s stress response.

Relaxation techniques. Relaxation techniques , such as deep breathing exercises, visualization (also called guided imagery), and body scanning, can help you learn to relax your body when anxiety occurs.

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