Anxiety is an emotion that everyone experiences sometimes, whether it is about worrying if you will get a job, whether you can solve a work or a personal problem, or are afraid of a situation, type of person or thing. However, when your anxiety doesn’t go away, gets worse with time and interferes with your daily life, you may have an anxiety disorder.
If this describes you, you are not alone; more than 40 million Americans suffer from anxiety disorders and the incidence is growing. Almost 7.5% of children aged 3 to 17 have been diagnosed, up from 5.5% in 2007.
Types of Anxiety Disorders
There are three types of anxiety disorders: generalized anxiety disorder, panic disorder and phobia-related disorders. Each of these disorders has distinct anxiety symptoms.
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) are anxious most days for a period of at least six months. The topic of their anxiety can be anything, such as health, work, social relationships or finances. Anxiety symptoms that a person with GAD might exhibit include:
- Feeling and acting restless or tense
- Being irritable
- Feeling worn out
- Having muscle tension
- Difficulty concentrating
- Inability to control feelings of worry
- Sleep problems including difficulty falling or staying asleep
When a person has panic disorder, he or she has multiple, unexpected panic attacks. A panic attack, also called an anxiety attack, is when the individual suddenly feels an extremely strong and immobilizing fear that dissipates within a few minutes.
The cause of the panic attack may be a known trigger, or it may happen for no discernable reason at all. Because the panic attacks are so intense and unpleasant, people with panic disorder often worry about when their next anxiety attack will happen and might try to prevent them by avoiding known triggers. In extreme cases, it may result in agoraphobia, the fear of being in open spaces, in a crowd, outside the home or in enclosed spaces like on public transportation.
A phobia is an unreasonable and intense fear of specific things or situations that cause the person to radically change their behavior to avoid the thing they fear. Phobia-related disorders are broken down by what the person fears.
Phobia-related disorders include:
- Specific phobias like the fear of flying or fear of spiders
- Social anxiety disorder, the fear of social situations
- Agoraphobia, the fear of being in public
- Separation anxiety disorder, the fear of being parted from a person or people
The most common anxiety treatments involve a combination of psychotherapy and prescription medication. In conjunction with therapy and/or medication or more mild cases, stress management techniques such as yoga, exercise and meditation may be recommended.
Psychotherapy, also called “talk therapy” is when the person suffering from anxiety disorder talks to a therapist, psychologist or social worker to learn how to mitigate and cope with the anxiety. The mental health counselor may be in private practice, at a general psychiatric facility or at a specialized anxiety treatment center.
Most mental health professionals are trained on how to treat anxiety disorders, but some professionals are anxiety disorder specialists, dealing exclusively with this kind of disorder. To find an anxiety disorder specialist, search for mental health professionals on your insurance list or online and look at their qualifications and specialties listed on their profiles or websites.
The most effective types of anxiety counseling are:
- Cognitive behavioral therapy (CBT) – This is the most common therapy for anxiety and involves working together to identify triggers and develop coping skills and techniques to reduce anxiety. It also helps patients examine why they think or feel a certain way and then teaches them how to reframe their thinking so that the thing or situation does not produce so much anxiety.
- Exposure therapy – Exposure therapy is used most often with phobia-related disorders along with CBT. This therapy confronts the underlying fears and aims to eliminate or reduce them using relaxation exercises and/or imagery to desensitize the patient to the trigger.
- Group therapy – Some people with anxiety disorders benefit from joining group therapy or a support group. This is typically the most effective once the patient has made some progress with individual therapy.
Medications for anxiety reduce anxiety symptoms but do not cure the underlying problem, which is why they are often combined with psychotherapy. Anxiety medication is usually prescribed by a psychiatrist, who is a medical doctor specializing in mental health disorders. The psychiatrist would first meet with the patient and determine if an anxiety disorder is indeed present and medication is warranted. There are different types of medication for anxiety:
- Antidepressants – As the name implies, these drugs are prescribed for depression, but they are also effective at reducing anxiety by improving the way the brain uses certain chemicals that control mood or stress. Antidepressants usually take some time to accumulate inside the body and become effective. While each person may react to a medication differently, the most commonly prescribed antidepressants for anxiety disorders are:
- Fluoxetine (brand names Prozac or Sarafem)
- Citalopram (brand name Celexa)
- Sertraline (brand name Zoloft)
- Paroxetine (brand names Paxil, Paxeva or Brisdelle)
- Escitalopram (brand name Lexapro)
- Benzodiazepines (beta blockers) – This class of medications was the first used for anxiety disorder treatment. The advantage is that they work quickly, however, they are prone to abuse so are typically prescribed only for short-term use. They include:
- Chlordiazepoxide (brand name Librium)
- Alprazolam (brand name Xanax)
- Diazepam (brand name Valium)
- Clonazepam (brand name Klonopin)
- Estazolam (brand name Prosom)
- Triazolam (brand name Restoril)
- Buspirone – This drug is prescribed to help patients worry less, think more clearly and function better in daily activities and may also lessen anxiety symptoms like insomnia, sweating and pounding heartbeat.
- Esketamine (brand name SPRAVATO) – This is a new anxiety treatment, approved by the Federal Food and Drug Administration (FDA) in 2019. Unlike other anxiety medications which are taken in pill form, it is administered as a nasal spray. It has few reported side effects and little risk of abuse, making it revolutionary in the anxiety medication field.
- Hydroxyzine (brand name Vistaril) – Hydroxyzine is an antihistamine that is sometimes prescribed for short-term management (up to four months) of general anxiety disorder, but has not been shown to be effective for anxiety with long-term use. It also treats allergy symptoms.
Stress Management Techniques
Since anxiety is a form of stress, using stress management techniques such as yoga, guided imagery and exercise may help when used alongside psychotherapy and/or medication.
- Yoga – A scientific study compared the use of yoga to CBT and stress education to see what was the most effective. Yoga was less effective than CBT but more effective than the stress education course at reducing anxiety symptoms in people with GAD.
- Guided imagery – In this practice, a trained professional guides the patient in imagining a safe place and the sensory characteristics of that place and its feeling of relaxation. It has been used to successfully treat anxiety.
- Exercise – Some studies suggest that regular exercise can work as well as medication for some people with anxiety disorders.