What are the main types of anxiety disorders. How do symptoms of generalized anxiety differ from panic attacks. Can phobias significantly impact daily life. What are effective treatments for social anxiety disorder. How is agoraphobia different from other anxiety disorders. Are there ways to reduce anxiety naturally.

The Nature and Impact of Anxiety Disorders

Anxiety disorders are mental health conditions characterized by persistent and intense feelings of worry, fear, or unease that can significantly interfere with daily life. While occasional anxiety is a normal part of the human experience, anxiety disorders involve more than temporary concerns. For individuals grappling with these conditions, anxiety doesn’t simply dissipate and may worsen over time, affecting various aspects of life including work performance, academic achievement, and interpersonal relationships.

Anxiety disorders encompass a spectrum of conditions, each with its unique features and challenges. The most common types include generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and various phobia-related disorders. Understanding the nuances of each type is crucial for proper diagnosis and effective treatment.

The Prevalence of Anxiety Disorders

Anxiety disorders are among the most prevalent mental health conditions worldwide. According to recent studies, approximately 18% of adults in the United States experience an anxiety disorder in any given year. This translates to millions of individuals struggling with the debilitating effects of excessive worry and fear in their daily lives.

• Women are more likely than men to be diagnosed with an anxiety disorder
• Anxiety disorders often co-occur with other mental health conditions, such as depression
• The onset of anxiety disorders typically occurs during childhood or adolescence
• Genetic factors, environmental stressors, and brain chemistry all play a role in the development of anxiety disorders

Generalized Anxiety Disorder: More Than Just Worry

Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about various aspects of life. Unlike normal concern over stressful events, GAD involves a pervasive sense of anxiety that persists for months or even years. Individuals with GAD often find it challenging to control their worry, leading to significant distress and impairment in daily functioning.

Key Symptoms of Generalized Anxiety Disorder

Do you find yourself constantly on edge, unable to relax? This could be a sign of GAD. The symptoms of Generalized Anxiety Disorder extend beyond mental preoccupation and often manifest physically. Common indicators include:

• Feeling restless or on-edge
• Easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbances (difficulty falling or staying asleep)

These symptoms can vary in intensity and may fluctuate over time. However, for a diagnosis of GAD, symptoms must persist for at least six months and cause significant distress or impairment in social, occupational, or other important areas of functioning.

Panic Disorder: When Fear Strikes Unexpectedly

Panic disorder is characterized by recurrent, unexpected panic attacks. These intense episodes of fear or discomfort reach a peak within minutes and are accompanied by physical and cognitive symptoms. While not everyone who experiences a panic attack will develop panic disorder, those who do often live in fear of future attacks, which can lead to significant changes in behavior and quality of life.

Anatomy of a Panic Attack

What exactly happens during a panic attack? Panic attacks are sudden surges of overwhelming fear that come without warning and without any obvious trigger. They are far more intense than feelings of being “stressed out” or “very nervous.” During a panic attack, the body’s autonomic fight-or-flight response takes over. Physical symptoms can include:

• Pounding or racing heartbeat
• Sweating
• Trembling or shaking
• Shortness of breath or hyperventilation
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Feelings of unreality (derealization) or being detached from oneself (depersonalization)
• Fear of losing control or going crazy
• Fear of dying

The frequency of panic attacks can vary widely among individuals with panic disorder. Some may experience them several times a day, while others might have them only a few times a year. Regardless of frequency, the unpredictable nature of panic attacks can lead to significant anxiety between episodes and avoidance behaviors that can severely restrict a person’s life.

Social Anxiety Disorder: When Social Interactions Become Overwhelming

Social anxiety disorder, previously known as social phobia, is characterized by intense fear or anxiety in social situations. This fear stems from the belief that one will be negatively judged, embarrassed, humiliated, or rejected by others. The anxiety experienced in social situations is often disproportionate to the actual threat posed by the social situation.

The Impact of Social Anxiety on Daily Life

How does social anxiety affect everyday interactions? For individuals with social anxiety disorder, even routine social encounters can become sources of significant distress. Common situations that may trigger anxiety include:

• Public speaking
• Meeting new people
• Eating or drinking in public
• Using public restrooms
• Attending social gatherings
• Making phone calls
• Speaking up in meetings or classes

The fear associated with these situations can be so intense that it leads to avoidance behaviors. This avoidance can significantly impact a person’s personal and professional life, limiting opportunities for social connections, career advancement, and overall life satisfaction.

Physical Symptoms of Social Anxiety

Social anxiety is not just a psychological experience; it often manifests in physical symptoms that can be equally distressing. These may include:

• Blushing
• Excessive sweating
• Trembling or shaking
• Rapid heartbeat
• Nausea or stomach discomfort
• Difficulty speaking (feeling like your mind has gone blank)
• Rigid body posture or speaking with an overly soft voice

These physical symptoms can create a vicious cycle, increasing anxiety about social situations and reinforcing avoidance behaviors.

Phobia-Related Disorders: When Fear Becomes Irrational

Phobias are intense, irrational fears of specific objects or situations. While it’s normal to feel some degree of anxiety in certain circumstances, phobias involve a level of fear that is disproportionate to the actual danger posed by the object or situation. This excessive fear can lead to avoidance behaviors that significantly impact daily life.

Types of Phobias

Phobias can be broadly categorized into three main types:

1. Specific Phobias: These involve fear of particular objects or situations. Common examples include:
   • Acrophobia (fear of heights)
   • Arachnophobia (fear of spiders)
   • Claustrophobia (fear of enclosed spaces)
   • Aerophobia (fear of flying)
   • Hemophobia (fear of blood)
2. Social Phobia: Also known as social anxiety disorder, this involves fear of social situations and interactions.
3. Agoraphobia: This complex phobia involves fear of places or situations where escape might be difficult or help might not be available in the event of a panic attack.

The Physiology of Phobic Responses

What happens in the body during a phobic response? When confronted with the feared object or situation, individuals with phobias often experience an immediate and intense physiological reaction. This “fight-or-flight” response can include:

• Rapid heartbeat
• Shortness of breath
• Sweating
• Trembling
• Nausea
• Dizziness
• Chest pain or tightness

These physical symptoms reinforce the fear associated with the phobic stimulus, often leading to increased avoidance behaviors over time.

Agoraphobia: Fear of Open or Crowded Spaces

Agoraphobia is a complex anxiety disorder characterized by fear and avoidance of places or situations that might cause panic, helplessness, or embarrassment. Despite its name, which literally means “fear of open spaces,” agoraphobia is not simply a fear of open areas. It can involve a fear of leaving home, using public transportation, being in crowded or open spaces, standing in line, or being in enclosed spaces like elevators.

Key Features of Agoraphobia

What distinguishes agoraphobia from other anxiety disorders? The core feature of agoraphobia is the fear of being in situations where escape might be difficult or help might not be available in the event of developing panic-like symptoms. Individuals with agoraphobia often:

• Fear being alone outside the home
• Fear losing control in a public place
• Depend on others to accompany them to “safe” places
• Feel detached or estranged from others
• Feel helpless
• Have an exaggerated sense of danger in the world around them

In severe cases, agoraphobia can become so debilitating that a person may be unable to leave their home, a condition known as “housebound agoraphobia.”

Treatment Approaches for Anxiety Disorders

Anxiety disorders are highly treatable, and many individuals find significant relief from their symptoms with proper treatment. The most effective approaches often involve a combination of psychotherapy, medication, and lifestyle changes.

Psychotherapy for Anxiety Disorders

What types of therapy are most effective for treating anxiety? Cognitive-Behavioral Therapy (CBT) is widely considered the gold standard in psychotherapy for anxiety disorders. CBT helps individuals identify and change thought patterns and behaviors that contribute to their anxiety. Other effective forms of therapy include:

• Exposure Therapy: Gradually exposing individuals to feared situations or objects in a controlled environment
• Acceptance and Commitment Therapy (ACT): Focusing on accepting uncomfortable thoughts and feelings rather than fighting them
• Dialectical Behavior Therapy (DBT): Combining cognitive-behavioral techniques with mindfulness practices
• Interpersonal Therapy: Addressing interpersonal issues that may contribute to anxiety

Medications for Anxiety Disorders

Several types of medications have proven effective in managing anxiety symptoms. These include:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Often the first-line medication treatment for anxiety disorders
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Similar to SSRIs but affecting an additional neurotransmitter
• Benzodiazepines: Fast-acting anti-anxiety medications, typically used for short-term relief
• Beta-blockers: Can help manage physical symptoms of anxiety, particularly in performance situations

It’s important to note that medication should always be prescribed and monitored by a qualified healthcare professional, as they can have side effects and potential interactions with other medications.

Lifestyle Changes and Self-Help Strategies

In addition to professional treatment, various lifestyle changes and self-help strategies can significantly reduce anxiety symptoms. These include:

• Regular exercise: Physical activity can help reduce stress and improve mood
• Mindfulness and meditation: Practices that help focus on the present moment and reduce worry about the future
• Proper sleep hygiene: Ensuring adequate, quality sleep can help regulate mood and reduce anxiety
• Limiting caffeine and alcohol: Both substances can exacerbate anxiety symptoms
• Stress management techniques: Such as deep breathing exercises, progressive muscle relaxation, and time management strategies
• Support groups: Connecting with others who share similar experiences can provide valuable emotional support and coping strategies

While these self-help strategies can be beneficial, they are most effective when used in conjunction with professional treatment for anxiety disorders.

NIMH » Anxiety Disorders

What is anxiety?

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

What are the signs and symptoms of anxiety?

Generalized anxiety disorder

Generalized anxiety disorder (GAD) usually involves a persistent feeling of anxiety or dread, which can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

Symptoms of GAD include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating
• Being irritable
• Having headaches, muscle aches, stomachaches, or unexplained pains
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep

Panic disorder

People with panic disorder have frequent and unexpected panic attacks. Panic attacks are sudden periods of intense fear, discomfort, or sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

During a panic attack, a person may experience:

• Pounding or racing heart
• Sweating
• Trembling or tingling
• Chest pain
• Feelings of impending doom
• Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Social anxiety disorder

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. For people with social anxiety disorder, the fear of social situations may feel so intense that it seems beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things.

People with social anxiety disorder may experience:

• Blushing, sweating, or trembling
• Pounding or racing heart
• Stomachaches
• Rigid body posture or speaking with an overly soft voice
• Difficulty making eye contact or being around people they don’t know
• Feelings of self-consciousness or fear that people will judge them negatively

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

• May have an irrational or excessive worry about encountering the feared object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate intense anxiety upon encountering the feared object or situation
• Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

• Flying
• Heights
• Specific animals, such as spiders, dogs, or snakes
• Receiving injections
• Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with. However, adults can also be diagnosed with separation anxiety disorder. People with separation anxiety disorder fear being away from the people they are close to. They often worry that something bad might happen to their loved ones while they are not together. This fear makes them avoid being alone or away from their loved ones. They may have bad dreams about being separated or feel unwell when separation is about to happen.

Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

What are the risk factors for anxiety?

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder.

The risk factors for each type of anxiety disorder vary. However, some general risk factors include:

• Shyness or feeling distressed or nervous in new situations in childhood
• Exposure to stressful and negative life or environmental events
• A history of anxiety or other mental disorders in biological relatives

Anxiety symptoms can be produced or aggravated by:

• Some physical health conditions, such as thyroid problems or heart arrhythmia
• Caffeine or other substances/medications

If you think you may have an anxiety disorder, getting a physical examination from a health care provider may help them diagnose your symptoms and find the right treatment.

How is anxiety treated?

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and you should work with a health care provider to choose the best treatment for you.

Psychotherapy

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at your specific anxieties and tailored to your needs.

Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that is used to treat anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises.

Acceptance and commitment therapy

Another treatment option for some anxiety disorders is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts. It uses strategies such as mindfulness and goal setting to reduce discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness.

Medication

Medication does not cure anxiety disorders but can help relieve symptoms. Health care providers, such as a psychiatrist or primary care provider, can prescribe medication for anxiety. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety medications (such as benzodiazepines), and beta-blockers.

Antidepressants

Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects.

Antidepressants can take several weeks to start working so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a health care provider. Your provider can help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

In some cases, children, teenagers, and adults younger than 25 may experience increased suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, people of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Anti-anxiety medications

Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.

Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications. However, some people build up a tolerance to these medications and need higher and higher doses to get the same effect. Some people even become dependent on them.

To avoid these problems, health care providers usually prescribe benzodiazepines for short periods of time.

If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. Your provider can help you slowly and safely decrease your dose.

Beta-blockers

Although beta-blockers are most often used to treat high blood pressure, they can help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications can help people keep physical symptoms under control when taken for short periods. They can also be used “as needed” to reduce acute anxiety, including to prevent some predictable forms of performance anxieties.

Choosing the right medication

Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with a health care provider to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. People should talk with a health care provider, so they can learn which substances are safe and which to avoid.

Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your and your provider may try several medicines before finding the right one.

Support groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Stress management techniques

Stress management techniques, such as exercise, mindfulness, and meditation, also can reduce anxiety symptoms and enhance the effects of psychotherapy. You can learn more about how these techniques benefit your treatment by talking with a health care provider.

How can I find a clinical trial for anxiety?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage: Information about participating in clinical trials
• Clinicaltrials. gov: Current Studies on Anxiety Disorders: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
• Join a Study: Adults – Anxiety Disorders: List of studies being conducted on the NIH Campus in Bethesda, MD
• Join a Study: Children – Anxiety Disorders: List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about anxiety?

Free brochures and shareable resources

• Generalized Anxiety Disorder (GAD): When Worry Gets Out of Control: This brochure describes the signs, symptoms, and treatment of generalized anxiety disorder.
• I’m So Stressed Out!: This fact sheet intended for teens and young adults presents information about stress, anxiety, and ways to cope when feeling overwhelmed.
• Obsessive-Compulsive Disorder: When Unwanted Thoughts Take Over: This brochure describes the signs, symptoms, and treatment of OCD.
• Panic Disorder: When Fear Overwhelms: This brochure describes the signs, symptoms, and treatments of panic disorder.
• Social Anxiety Disorder: More Than Just Shyness: This brochure describes the signs, symptoms, and treatment of social anxiety disorder.
• Shareable Resources on Anxiety Disorders: Help support anxiety awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about anxiety disorders.

Multimedia 

• Mental Health Minute: Anxiety Disorders in Adults:Take a mental health minute to watch this video about anxiety disorders in adults.
• Mental Health Minute: Stress and Anxiety in Adolescents: Take a mental health minute to watch this video about stress and anxiety in adolescents.
• NIMH Expert Discusses Coping with the Pandemic and School Re-Entry Stress: Learn about the causes or triggers of stress and coping techniques to help reduce anxiety and improve the transition back to school.
• NIMH Expert Discusses Managing Stress and Anxiety: Learn about coping with stressful situations and when to seek help.
• GREAT: Learn helpful practices to manage stress and anxiety. GREAT was developed by Dr. Krystal Lewis, a licensed clinical psychologist at NIMH.
• Getting to Know Your Brain: Dealing with Stress: Test your knowledge about stress and the brain. Also learn how to create and use a “stress catcher” to practice strategies to deal with stress.
• Guided Visualization: Dealing with Stress: Learn how the brain handles stress and practice a guided visualization activity.
• Panic Disorder: The Symptoms: Learn about the signs and symptoms of panic disorder.

Federal resources

• Anxiety Disorders (MedlinePlus – also en español)

Research and statistics

• Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Statistics: Anxiety Disorder: This webpage provides information on the statistics currently available on the prevalence and treatment of anxiety among people in the U.S.

Last Reviewed: April 2023

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy the images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

When Worry Gets Out of Control

Do you often find yourself worrying about everyday issues for no obvious reason? Are you always waiting for disaster to strike or excessively worried about things such as health, money, family, work, or school?

If so, you may have a type of anxiety disorder called generalized anxiety disorder (GAD). GAD can make daily life feel like a constant state of worry, fear, and dread. The good news is GAD is treatable. Learn more about the symptoms of GAD and how to find help.

What is generalized anxiety disorder?

Occasional anxiety is a normal part of life. Many people may worry about things such as health, money, or family problems. But people with GAD feel extremely worried or nervous more frequently about these and other things—even when there is little or no reason to worry about them. GAD usually involves a persistent feeling of anxiety or dread that interferes with how you live your life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

GAD develops slowly. It often starts around age 30, although it can occur in childhood. The disorder is more common in women than in men.

What are the signs and symptoms of generalized anxiety disorder?

People with GAD may:

• Worry excessively about everyday things
• Have trouble controlling their worries or feelings of nervousness
• Know that they worry much more than they should
• Feel restless and have trouble relaxing
• Have a hard time concentrating
• Startle easily
• Have trouble falling asleep or staying asleep
• Tire easily or feel tired all the time
• Have headaches, muscle aches, stomachaches, or unexplained pains
• Have a hard time swallowing
• Tremble or twitch
• Feel irritable or “on edge”
• Sweat a lot, feel lightheaded, or feel out of breath
• Have to go to the bathroom frequently

Children and teens with GAD often worry excessively about:

• Their performance in activities such as school or sports
• Catastrophes, such as earthquakes or war
• The health of others, such as family members

Adults with GAD are often highly nervous about everyday circumstances, such as:

• Job security or performance
• Health
• Finances
• The health and well-being of their children or other family members
• Being late
• Completing household chores and other responsibilities

Both children and adults with GAD may experience physical symptoms such as pain, fatigue, or shortness of breath that make it hard to function and that interfere with daily life.

Symptoms may fluctuate over time and are often worse during times of stress—for example—with a physical illness, during school exams, or during a family or relationship conflict.

What causes generalized anxiety disorder?

Risk for GAD can run in families. Several parts of the brain and biological processes play a key role in fear and anxiety. By learning more about how the brain and body function in people with anxiety disorders, researchers may be able to develop better treatments. Researchers have also found that external causes, such as experiencing a traumatic event or being in a stressful environment, may put you at higher risk for developing GAD.

How is generalized anxiety disorder treated?

If you think you’re experiencing symptoms of GAD, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

GAD is generally treated with psychotherapy (sometimes called “talk therapy”), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat GAD. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and worried. CBT has been well studied and is the gold standard for psychotherapy.

Another treatment option for GAD is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts and uses strategies such as mindfulness and goal setting to reduce your discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness. However, different therapies work for different types of people, so it can be helpful to discuss what form of therapy may be right for you with a mental health professional.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Medication

Health care providers may prescribe medication to treat GAD. Different types of medication can be effective, including:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of GAD. They may take several weeks to start working. These medications also may cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Benzodiazepines, which are anti-anxiety sedative medications, also can be used to manage severe forms of GAD. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Buspirone is another anti-anxiety medication that can be helpful in treating GAD. Unlike benzodiazepines, buspirone is not a sedative and has less potential to be addictive. Buspirone needs to be taken for 3–4 weeks for it to be fully effective.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you.

For basic information about these and other mental health medications, visit NIMH’s Mental Health Medications webpage. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and information on newly approved medications. 

Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Healthy Habits

Practicing a healthy lifestyle also can help combat anxiety, although this alone cannot replace treatment. Researchers have found that implementing certain healthy choices in daily life—such as reducing caffeine intake and getting enough sleep—can reduce anxiety symptoms when paired with standard care—such as psychotherapy and medication.

Stress management techniques, such as exercise, mindfulness, and meditation, also can reduce anxiety symptoms and enhance the effects of psychotherapy. You can learn more about how these techniques benefit your treatment by talking with a health care provider.

To learn more ways to take care of your mental health, visit NIMH’s Caring for Your Mental Health webpage.

How can I support myself and others with generalized anxiety disorder?

Educate Yourself

A good way to help yourself or a loved one who may be struggling with GAD is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing GAD symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think that a friend or family member may be struggling with GAD, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as at school, at work, or with friends and family—it’s time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying generalized anxiety disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions—including GAD. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH’s clinical trials webpage.

Finding Help

Behavioral Health Treatment Services Locator

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA’s online Behavioral Health Treatment Services Locator. For additional resources, visit NIMH’s Help for Mental Illnesses webpage.

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider. For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website.

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 22-MH-8090
Revised 2022

What do we know about anxiety and depression?

Evgeniy Gennadievich Ilchenko, psychotherapist of the Department for the Treatment of Borderline Mental Disorders and Psychotherapy of the National Research Center for Psychiatry and Neurology. V.M. Bekhterev.
Anxiety, depression are conditions that are characteristic of disturbances in the state of the emotional sphere. Today, about 110 million people in the world suffer from depression. According to the World Health Organization, one in five women and one in fifteen men suffer from depression in major cities around the world. It is believed that by 2020 depression will take one of the first places among all diseases. Approximately 70% of depressed patients show suicidal tendencies, and depressed patients older than 75 have the highest rate of suicide.

I am suffering, I am afraid…
What is depression? Depression is a disease that can throw a person out of emotional balance for a long time and significantly impair the quality of his life. It can be difficult for you to concentrate, nothing is interesting, nothing pleases, doubts and fears are constantly overcome. Depression usually comes after a psychological trauma or negative event. Often it develops as if for no apparent reason. It can be caused by constant stress, accumulating fatigue, fears. Depression is more than just low mood. In this case, the work of the whole organism changes, as a person suffers from insomnia or early awakenings, he loses his appetite or begins to seize his anxiety, which leads to obesity and the development of metabolic syndrome, there is a hormonal imbalance. A person’s attitude towards others and himself changes.

Longing, apathy, anxiety…
How does depression manifest itself? The first symptoms include weakness, fatigue, unwillingness to do anything, strain once again, contact and communicate with people, go to work. Later, bodily symptoms may join these complaints – palpitations, sweating, trembling in the body, hot or cold flashes.
Three areas are involved in depression – emotional, mental and physical. At the emotional level, depression, melancholy, apathy, and anxiety are observed. On the mental level – thoughts about one’s guilt, self-accusations, a negative vision of the future, a feeling of hopelessness, that “no one will help me.” On the physical level – chronic pain, muscle tension, constipation, dizziness, heaviness in the head. And all these symptoms can constantly change: “Today my head hurts, and yesterday my joints hurt, the day before yesterday my heart hurt.”

Maybe it’s psychosomatics?
It is worth noting that there are different types of depression. According to the classification, depressions are diverse: major, minor, neurotic, autumnal, endogenous, psychogenic, reactive, etc. There is depression associated with the reproductive function of a woman, this is prenatal and postnatal. There is age-related depression associated with the physiological restructuring of the body, there is an obvious one that occurs with a sharply reduced mood, melancholy, and depression. There is a masked depression that hides under the guise of another disease. For example, chronic pain syndrome – pain in different parts of the body. There is depression, which is masked by gastrointestinal symptoms – diarrhea, constipation, stomach pain. Patients go to doctors for a long time and unsuccessfully, are treated by different specialists. But there is no improvement. At this stage, it is important to recognize psychosomatic disorders. It is worth looking, but what gives a person a disease? How is she good for him? It is quite possible that in this way a person attracts attention to himself, seeks location, manipulates loved ones and relatives.

How can I help?
Sometimes depressed patients try to alleviate their mental state through physical pain, inflicting injuries and injuries on themselves. This is definitely not an option. How can others help such patients? First of all, do not ignore or forbid complaining, do not try to cheer up the patient, do not appeal to conscience and faith, do not demand the adoption of any important decisions, but simply be there and listen patiently. As for direct treatment, there is no “magic” remedy for depression. Various methods are used here: psychotherapy, pharmacotherapy, electroconvulsive therapy, physiotherapy, aroma and color therapy, physical activity. If we talk about the prevention of depression, then this is a healthy lifestyle and a positive attitude, communication with nature.

Experiences about the future
Depression is a negative experience of past life events that we cannot change, and anxiety is an experience for the future, this is a vague, unpleasant emotional state characterized by the expectation of an unfavorable development of events, the presence of bad forebodings, tension and anxiety. It is directed to the future, it is the expectation of something indefinite. The state of anxiety is pointless, but anxiety is a personality trait of a person prone to experiencing anxiety, and constantly experiencing it. Most often, a person’s anxiety is associated with the expectation of the social consequences of his success or failure.
Risk factors for the development of anxiety include childhood trauma, stress, personality traits, genetic predisposition, alcohol and psychoactive substances. Anxiety can be normal or excessive. In pathological cases, anxiety becomes constant and harmful, appearing not only in stressful situations, but also for no apparent reason, and then anxiety not only does not help a person, but begins to interfere with his daily activities.

Panic attacks
The largest category of anxiety disorders are phobias, with about a hundred variants. Anxiety disorders include post-traumatic stress disorder, social anxiety, panic attacks, and separation anxiety. Speaking of anxiety, it is worth mentioning panic attacks separately. How do they appear? Unexpected internal tension, pointless fear, timidity, stiffness, feeling of danger, unreality of what is happening, “lump in the throat”, chills, sweating, heart palpitations, suffocation, nausea, diarrhea, dizziness, goosebumps, restlessness. What to do in such cases? It is necessary to focus on the real situation, to calm down, to be distracted, to understand that there is no real threat. Auto-training, progressive muscle relaxation, breathing techniques work great. But this must be learned. The state of a panic attack can be constantly repeated and the fear each time feels real. It is necessary to learn to understand and catch yourself in a state of “pre-panic”, not to let yourself breathe heavily and rapidly, try to say “I” on the inhale, and “calm” on the exhale.

Technology against anxiety: how to identify and reduce stress

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Many people are familiar with the feeling of anxiety. It may be due to family circumstances, exams, difficulties at work, an unstable situation around. Anxiety can escalate and become a serious problem. At the same time, anxiety can be overcome with the help of modern technologies.

Anxiety and its types

In 2022, according to VTsIOM, every fourth Russian has experienced stress several times a month. More than half of Russians experienced a sense of anxiety. A study by the Kaizer Family Foundation found that the number of people with symptoms of anxiety increased from 11% to 41% between summer 2019 and January 2021. Anxiety is a reaction to watch out for as it can lead to depression.

An anxiety attack cannot formally be classified as a clinical disease. People can talk about anxiety to describe a range of feelings, from butterflies in the stomach to panic. In order to understand how to classify the types of disorders, scientists have assessed and described the main types of anxiety.

• If it is necessary to go through a cycle of repetitive actions to feel better, such as pulling the doorknob three times before leaving, then we are talking about OCD (obsessive-compulsive disorder).

• Suddenly, the heartbeat quickens, shortness of breath, nausea, suffocation appear, an attack of panic fear sets in. This type of anxiety is referred to as panic disorder.

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How to distinguish between worry and anxiety

When worried, a person analyzes a difficult situation, makes a decision and starts to act. Anxiety directly affects health: poor sleep, migraines, weakness.

Here are the main differences between worry and anxiety:

How to get rid of anxiety

There are many treatment options for anxiety disorders. The most common is to independently determine the object of fear. A person may be afraid to speak in front of the public, but if you understand the issue, find life hacks of famous speakers and apply them, you can feel much more confident. You can go to a psychologist. In case of panic attacks or depression, it is better to immediately contact a specialist. But if you’re just worried, modern technology will help you calm down.

Applications of moods and habits. A person experiences negative and positive emotions throughout the day, whether at home, at work or on the road. There are handy apps to track your mood curve. For example, How Are You? throughout the day is interested in how the user is doing. For each answer, you can leave a small comment. As a result, a person receives a mood calendar and analyzes what events and situations preceded this or that emotion. Another interesting application was developed in the Behavioral Economics Laboratory at Duke University – Fabulous – Daily Routine Planner. The idea is to develop healthy habits through daily exercise. The service offers simple actions to help calm down, such as breathing, walking, exercising, or meditating. The apps are available on the App Store and Google Play.

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Virtual psychologist. In moments of severe anxiety, it is not always possible to seek help from a specialist or share your feelings with loved ones. In this case, special programs and virtual doctors come to the rescue. For example, the domestic project iCognito has developed a convenient self-help application with artificial intelligence. In moments of anxiety and stress, the user can start communicating with the chatbot, which will analyze the answers and offer different techniques, exercises to relieve stress or anxiety.

There are three areas: “Anti-depression”, “Anti-stress” and “Relationships”. The programs are developed by qualified psychologists and psychotherapists and can help in different situations. For example, “Anti-depression” includes theory and practice in a playful way. The bot helps to understand the causes of depression, work through them and return a person to a normal state. It uses techniques for analyzing negative thoughts, regulating emotions and awareness, self-compassion, and problem solving and communication. The Anti-stress program will teach users about positive thinking, emotional awareness and irritability management. To do this, the bot will offer simple exercises that will help you relax and concentrate on your inner feelings. “Relationships” – devoted to relationships in the family. The bot asks questions and, based on the answers, analyzes the microclimate in a couple. In addition, in the application, you can keep diaries of thoughts, gratitude and take audio courses. The mobile app is available on the App Store and Google Play.

You can fight anxiety even in Telegram channel . Clinical psychologist Daniil Danilov launched the Calm Bot project, where you can keep a diary of thoughts and practice mindfulness. Moreover, the application is absolutely free.

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VR fear fighting . Virtual reality technology reduces anxiety. This was confirmed by scientists from the Moscow State Psychological and Pedagogical University, who conducted an experiment. For 20 minutes, people used the Ocean Rift VR app. Under relaxing music, the subjects explored the underwater world. People with increased levels of anxiety noted an improvement in their condition. To use the app, you need to purchase a VR helmet or goggles. In addition to the underwater world, there are 11 more open places in the game, for example, an African safari. Detailing helped to make the virtual trip unforgettable: diving into the depths, for example, the user sees the outline of a swimming mask. You can download the application on the Steam platform.

Among the Russian developments is the XR Clinic project by Medviar. The developers have created special VR glasses. The user puts them and a pair of sensors on his hands and feet and finds himself in a virtual environment. Here he sees his body, sees other users, gets the effect of a highly realistic environment. With the help of glasses in the virtual world, a person can move, communicate. While the system automatically evaluates his actions as a psychologist and at the end of the session gives the results.

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Games as a help for disorders. Sandbox games to help develop creativity, create your own world and relax – Minecraft, Subnautica, Roblox, The Sims. Travel games are aimed at helping to relieve nervous tension and immerse yourself in another world. These include Journey, Dear Esther, Alto’s Adventure. You can download them on Steam or from the official websites of the developers.

In June 2022, among other things, the game Stray was released. In it, the user is invited to explore the open world by controlling a stray ginger cat. An unusual story, soothing music, the purring of a cat – all this will help you relax and calm down after a hard day. The game is available on PS4, PS5 and Steam. Another novelty of this year, Sifu, will help to let off steam. This is a third-person action game with colorful hand-to-hand combat. The game is available on the Epic Games platform.

The game DEEP will help you find peace, in which the user finds himself in a magical underwater world. It was developed jointly with the University of Nijmegen.