What is anxiety?

Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.

People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations and have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat.

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive, and persistent worry about everyday situations. Some people may experience repeated episodes of  sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. Anxiety disorders can start at any stage in life.

Types of anxiety disorders include:

• Agoraphobia is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless, or embarrassed.
• Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.
• Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.
• Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they’ve occurred.
• Social anxiety disorder (social phobia)involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.
• Specific phobias are characterized by major anxiety when you’re exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
• Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.
• Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive, including PTSD (post-traumatic stress disorder).

Patients can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Symptoms of anxiety
While anxiety symptoms vary from person to person, the body reacts in a very specific way to anxiety. When you feel anxious, your body goes on high alert, looking for possible danger and activating your fight or flight responses. As a result, some common symptoms of anxiety include:

• Feeling nervous, restless, or tense
• Having a sense of impending danger, panic, or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Causes of anxiety
The causes of anxiety disorders aren’t fully understood. Life experiences such as traumatic events appear to trigger them in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes
For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

• Heart disease
• Diabetes
• Thyroid problems, such as hyperthyroidism
• Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma
• Drug misuse or withdrawal
• Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
• Chronic pain or irritable bowel syndrome

Sometimes anxiety can be a side effect of certain medications.

How to treat anxiety
The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy
Psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you’ve avoided because of anxiety.

CBT may include exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.

Medications
Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. For example:

• Certain antidepressants and anxiolytics are also used to treat anxiety disorders.

Talk with your doctor about benefits, risks, and possible side effects of medications.

At-home anxiety treatments
While taking medication and talking with a therapist can help treat anxiety, coping with anxiety is a 24–7 task. Luckily, there are many simple lifestyle changes you can make at home to help further alleviate your anxiety.

• Get exercise.Setting up an exercise routine to follow most or all days of the week can help reduce your stress and anxiety. If you are normally sedentary, start off with just a few activities and continue adding more over time.
• Avoid alcohol and recreational drugs. Using alcohol or drugs can cause or increase your anxiety. If you have trouble quitting, see your doctor or look to a support group for help.
• Stop smoking and reduce or stop consuming caffeinated drinks. Nicotine in cigarettes and caffeinated beverages such as coffee, tea, and energy drinks can make anxiety worse.
• Try relaxation and stress management techniques.Taking meditation, repeating a mantra, practicing visualization techniques, and doing yoga can all promote relaxation and reduce anxiety.
• Get enough sleep. A lack of sleep can increase feelings of restlessness and anxiety. If you have trouble sleeping, see your doctor for help.
• Stick to a healthy diet.Eat plenty of fruits, vegetables, whole grains, and lean protein such as chicken and fish.

Coping and support
Coping with an anxiety disorder can be a challenge. Here are some things you can do to make it easier:

• Be knowledgeable.Learn as much as you can about your condition and what treatments are available to you so you can make appropriate decisions about your treatment.
• Be consistent.Follow the treatment plan your mental healthcare provider gives you, taking your medication as directed and attending all your therapy appointments. This will help keep your anxiety disorder symptoms away.
• Know yourself. Figure out what triggers your anxiety and practice the coping strategies you created with your mental healthcare provider so you can best deal with your anxiety when it’s triggered.
• Write it down. Keeping a journal of your feelings and experiences can help your mental healthcare provider determine the most appropriate treatment plan for you.
• Get support.Consider joining a support group where you can share your experiences and hear from others who deal with anxiety disorders. Associations such as the National Alliance on Mental Illness or the Anxiety and Depression Association of America can help you find an appropriate support group near you.
• Manage your time intelligently. This can help reduce your anxiety and help you make the most of your treatment.
• Be social.Isolating yourself from friends and family can make your anxiety worse. Make plans with people you like spending time with.
• Shake things up. Don’t let your anxiety take control of your life. If you feel overwhelmed, break up your day by taking a walk or doing something that will direct your mind away from your worries or fears.

Telehealth opens the door to better treatment
Telehealth may be the perfect solution for the older population that may be restricted by quarantine in a nursing home, health issues or transportation issues. Also called telemedicine, there are several ways that people with anxiety may benefit from telehealth. Additionally, telemedicine may be the most viable option for care for people who are struggling with anxiety and experiencing agoraphobia and social anxiety that may lead to them feeling uncomfortable leaving the house or participating in activities in the community.

Telehealth is Convenient
Telemedicine eliminates the hassles of securing transportation and traveling to the doctor’s office. This works because your appointment is made on your smartphone or laptop, so you can be anywhere in the world and still see your doctor. It also frees up more time to take care of other daily tasks and duties.

Telemedicine Increases Accessibility
Many people with anxiety must travel more than 10 miles to see their health care provider. This can be especially difficult for those who do not have a car as riding public transportation can be very time-consuming. Furthermore, those with mobility challenges do not have to worry about if the doctor’s office is accessible.

Telepsychiatry Offers More Privacy
Making your appointments online means more privacy because you can easily do them from the comfort of your home or workplace.

Insurance Should Cover the Cost
One of the positive outcomes of the pandemic is that insurance companies have been forced to cover the cost of telehealth appointments. If you are on Medicaid or Medicare, there is much more flexibility in getting your appointments covered than at any time in the past. Additionally, if you do not have access to insurance, you may find more opportunities to work with a clinic that has a sliding fee scale.

Telehealth Is More Comfortable
Most patients with anxiety report that they feel more comfortable seeing the doctor online because they are surrounded by their things and in their own space. This may help you dive deeper into the challenges you are facing to find workable solutions sooner.