Anxiety is defined as nervousness, apprehension, and self-doubt that may or may not be associated with real-life stressors. Everyone experiences some level of anxiety periodically, but when feelings of dread and worry are unfocused, overwhelming, recurring, and not directly linked to stressful events, anxiety may leave a person severely impaired. When anxiety interferes with daily function, the support of a qualified mental health professional can often be helpful.
Anxiety symptoms include obtrusive, obsessive, worried thoughts, confusion and difficulty concentrating, pacing or restlessness, irritability, frustration, and despair. A person with anxiety may feel tense, with uncomfortable physical sensations such as trembling, sweating, a racing heartbeat, nausea, and difficulty breathing. The severe and sudden onset of such symptoms is often indicative of a panic attack. Anxiety can also lead to headaches, insomnia, digestive problems, and lightheadedness.
Anxiety is at the root of many mental health conditions, including panic attacks and phobias, and it is often directly correlated with other conditions, such as obsessions and compulsions, posttraumatic stress, and depression. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5), lists the following mental health issues as anxiety disorders:
- Separation anxiety
- Selective mutism
- Specific phobias
- Social anxiety
- Medication/substance-induced anxiety
- Generalized anxiety
Anxiety, not unlike the fight, flight, or freeze response, is a survival mechanism that allows people to protect themselves in order to avoid suffering, but sometimes a person repeatedly and unnecessarily experiences extreme levels of the fear and worry associated with anxiety and feels helpless to alleviate the symptoms.
A person’s predisposition toward anxiety is based both in biology and environment. In other words, anxious behaviors may be inherited, learned, or both. For example, research demonstrates that anxious children are likely born to anxious parents, but those parents may also model anxious tendencies, such as avoiding or fearing potential threats, that then instill the same fear and avoidant behaviors in their children. Growing up in a stressful environment may also predispose someone to anxiety because anxiety becomes a way to anticipate danger and ensure safety.
Anxiety can also develop as a result of unresolved trauma that leaves a person in a heightened physiological state of arousal; when this is the case, certain experiences may reactivate the old trauma, as is common for people experiencing posttraumatic stress (PTSD).
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Free-floating anxiety, also known as generalized anxiety, is characterized by a chronic sense of unease, doom, and worry that is not directed toward any one thing in particular. Many people often feel anxiety about specific future events such as job interviews, dates, or financial concerns, but people experiencing flee-floating anxiety feel generalized anxiety about any number of issues or concerns for no obvious reason. In other words, the anxiety experienced may not be in proportion to the actual impact of a particular event.
The DSM-5 identifies generalized anxiety disorder (GAD) as excessive worry that impacts a person on an almost daily basis, lasts for six months or more, is difficult to control, and cannot be better explained by any other physical, medical, or mental health condition. A person diagnosed with GAD must also display at least three of the following symptoms:
- Frequent feelings of fatigue
- Restlessness, feeling tense or on edge
- Difficulty focusing, drawing a blank
- Sleep problems
- Muscle tension
There are many factors that can contribute to the development of free-floating anxiety. Living in stressful or abusive environments may produce chronic anxiety, and sometimes anxiety becomes a habit. When someone is accustomed to feeling anxiety about a specific event, they may continue feeling anxiety even after the event has occurred. Additionally, some psychologists have argued that the character of modern life subjects people to free-floating anxiety. Constant deadlines, the need for everything to occur quickly, and the ability to compare oneself to others via social networking, or otherwise, can cause chronic anxiety.
When a person cannot identify the source of anxiety, therapy can help that person develop coping skills for mitigating symptoms. Deep breathing techniques, meditation, exercise, effective planning, and assertive communication may each help some people cope with chronic anxiety.
Because anxiety can interfere with relationships, sleeping patterns, eating habits, work, school, and routine activities, anxiety is one of the most common reasons people seek therapy, and effective therapy can significantly reduce or eliminate symptoms associated with anxiety in a relatively short time, allowing a person to resume regular activities and regain a sense of control. Although people may not be able to identify the cause of their anxiety, after attending a few therapy sessions, many people are able to pinpoint the source and a therapist can help a person work on those deeper concerns.
The type of therapy that is most often recommended for the treatment of anxiety due to its demonstrated effectiveness is cognitive behavioral therapy, although most forms of therapy are well suited to addressing anxiety. Rather than treating symptoms alone, as medications do, psychotherapy aims to identify and address the source of the anxiety. The self-reflective process of therapy helps people to understand, unravel, and transform anxiety and learn self-soothing techniques to use if anxiety flares up again.
The therapist and client will collaborate on a treatment plan, which may include other therapy treatments and lifestyle adjustments to help relieve anxiety such as meditation, group therapy, stress-management and relaxation techniques, self-care, exercise, family therapy, and eliminating or reducing intake of stimulative substances like caffeine.
Psychotropic medications for anxiety are designed to treat the symptoms of anxiety and allow a person to function and feel better; they cannot, however, address the underlying emotional and psychological causes of anxiety or help a person learn to cope with future scenarios that may provoke an anxious response. Common medications for anxiety include antidepressants, such as Celexa, Lexapro, Prozac, and Zoloft, and anti-anxiety medications like Ativan, Xanax, and Klonopin.
Unwanted side effects are common, and each person will respond to medication differently, so it is important to track changes in mood, behavior, and other symptoms in order to select the right medication. For someone who is paralyzed with anxiety or who suffers intense panic, medication may be essential to leading a fulfilling life.
- Alcohol Abuse and Anxiety - Hayat, 23, experiences severe panic attacks whenever she fears she has failed at a task or angered a family member or coworker. Whenever she receives criticism, she begins to have trouble breathing, becomes sweaty, and may break out in hives. Her mind becomes completely focused on the offense she has committed, and she may cry, though she suppresses the tears and prevents catharsis. She drinks large quantities of alcohol to help numb herself to these feelings and may miss work for days, which furthers her anxiety, as she has little income.
- Social Anxiety - Benji, 45, is popular at work and very competent, but he feels highly anxious whenever he is out in public, especially around crowds. He races home each night, locks his door, and reads in bed, feeling fine once he is alone with the apartment secure. He cannot identify the cause of his anxiety, but in therapy, he discovers a great deal of repressed anger that may explain his fear of being in public—people trigger his rage, which he has avoided for years.
- "People-Pleasing” Anxiety - Anna, 26, comes to therapy because of intense anxiety. Anna has not experienced a panic attack, but is often on edge, worried, stressed, and has a difficult time sleeping through the night. In therapy, Anna discovers that although a part of her wants to marry her fiancé, Jeff, another part of herself, which she has suppressed, is not in love with him. Identifying this internal conflict temporarily intensifies Anna's anxiety, because now she has to face something she hasn't wanted face. Historically, Anna has been a people-pleaser. It's difficult for her to say "no" for fear of hurting others' feelings and then feeling her own guilt. Anna gains awareness about this, and through the process of unburdening her long-harbored guilt, Anna feels less anxiety over allowing others to feel pain. Although Anna hasn't yet decided what she's going to do about getting married, she feels less anxiety now that she is no longer suppressing her ambivalence and feels greater confidence about communicating how she really feels.
- American Psychological Association. (2009). APA concise dictionary of psychology. Washington, DC: American Psychological Association.
- Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Generalized Anxiety Disorder. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml
- Hudson, J. L., Dodd, H. F., & Bovopoulos, N. (2011). Temperament, family environment and anxiety in preschool children. Journal of Abnormal Child Psychology, 39(7), 939-51. doi:http://dx.doi.org/10.1007/s10802-011-9502-x
- Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
- Tyrer, P., & Baldwin, D. (2006). Generalised anxiety disorder. The Lancet, 368(9553), 2156-66. Retrieved from http://search.proquest.com/docview/199069841?accountid=1229