Anxiety: Symptoms and Treatment

What is anxiety, and how is it treated? “Anxiety” covers fear, worry, nervousness, apprehension and stress. Feeling anxious in daily life is completely normal, functional and even necessary. An anxiety disorder, however, is when the level of anxiety a person experiences starts to disrupt daily functioning instead of supporting it. In today’s world, many factors, such as financial pressures, dwindling natural resources, global warming, rising violence, technology and social media, are increasing rates of anxiety. Anxiety disorders make up a large part of psychiatric practice. Some of the main types are described below.

Before treatment: types of anxiety

Panic disorder

A panic attack and panic disorder are different things. A panic attack can happen to any healthy person or occur in many psychiatric disorders. Panic disorder involves panic attacks together with anticipatory anxiety, that is, an intense fear that attacks will recur, along with related thoughts and behaviours. Research suggests that there may be a genetic predisposition to panic disorder.

Around 4–5 people in every 100 have a panic attack at some point in their lives. It is an overwhelming fear, strong enough to make the person feel they are losing control: a sudden sense of terror, intense fear and dread, a feeling that something terrible is about to happen, together with symptoms involving breathing and circulation. Panic disorder is more common in women and usually begins between the ages of 20 and 30. Panic attacks often start after a stressful life event, such as the death of a loved one, a separation, moving house or starting a new job. People with panic attacks also tend to monitor their bodily sensations closely and interpret even trivial signals as signs of catastrophe.

A panic attack is really an exaggerated form of the body’s response to fear or stress. The body has an “alarm system” designed to respond to danger from inside or outside. When there is a threat, the “fight or flight” reflex produces the symptoms seen in a panic attack. The heart beats faster to carry blood more quickly to where it is needed, which is felt as palpitations. Breathing speeds up to bring oxygen to the muscles. Because much of the blood goes to the muscles, the person may feel discomfort in the stomach, tingling or paleness in the face, followed by other symptoms. In people with panic disorder, this system switches on more readily: noticing a minor bodily sensation increases fear and sets off the chain of symptoms.

Symptoms of a panic attack

• shortness of breath, or a feeling of choking
• fear of dying
• fear of losing control or going mad
• chest pain or tightness
• palpitations
• sweating and trembling
• nausea and abdominal pain
• dizziness or feeling faint
• chills or hot flushes
• numbness or tingling
• depersonalisation (feeling detached from oneself)
• derealisation (feeling that one’s surroundings are unreal)

Key features

• sudden, unbearable fear
• no specific, identifiable cause
• felt much more intensely than the distress of someone facing real stress
• accompanied by many physical and psychological symptoms

Treatment of anxiety

Cognitive behavioural therapy: works with modules such as relaxation exercises, breathing exercises and controlled breathing, and symptom induction, which brings on panic-like sensations so that the person learns to manage them.

Psychopharmacotherapy (medication): when needed, medicines with proven effectiveness are used alongside psychotherapy. Treatment algorithms are set by the Psychiatric Association of Türkiye (TPD).

Psychoanalytic group therapy (group analysis): carried out within a psychoanalytic frame (time, place) with 4–10 members and a conductor, usually in weekly sessions of an hour and a half. The group is open to new members and allows members to leave when they have reached their goals or a satisfying point in their personal process. The length of therapy varies with individual needs (on average 9 months to 3 years).

If you would like to learn about depression, see our article on depression treatment. Below is an article on anxiety and its treatment that includes the views of well-known theorists.

Anxiety disorders in modern psychiatry: aetiology, classification and holistic treatment strategies

Author: Prof. Dr. Ali Keyvan, Psychiatrist

Abstract

Anxiety is a universal, future-oriented human emotion characterised by the anticipation of danger. Within normal, adaptive limits it motivates survival and performance, but when it reaches a pathological level it turns into anxiety disorders that paralyse a person’s life and seriously impair functioning. This article aims to give a comprehensive account of the aetiology, clinical classification and evidence-based modern treatment of anxiety disorders. It covers the main aetiological perspectives: the neurobiological basis of anxiety (amygdala, prefrontal cortex, neurotransmitter systems), the psychoanalytic conceptualisation of unconscious conflict and signal anxiety, and especially the cognitive behavioural formulation built on catastrophic interpretation and avoidance. It describes the main diagnostic categories: generalised anxiety disorder, panic disorder, agoraphobia, social anxiety disorder and specific phobias. The treatment section discusses psychopharmacological approaches, with SSRIs and SNRIs as their foundation, and the role and risks of benzodiazepines. Under psychotherapy, it details the components of cognitive behavioural therapy (CBT), considered the “gold standard”, especially exposure-based techniques, as well as third-wave therapies such as mindfulness-based therapies and acceptance and commitment therapy (ACT). It concludes that the most effective treatment of anxiety disorders is a holistic strategy tailored to the individual, usually combining psychopharmacology and psychotherapy.

Keywords: anxiety disorders, panic attack, generalised anxiety disorder, cognitive behavioural therapy, exposure, SSRI, psychoanalysis, neurobiology.

1. Introduction: from normal worry to pathological anxiety

Everyone feels anxious. The tension before an important presentation, the racing heart when walking down a dangerous street or the worry when a loved one is late are part of an adaptive, protective mechanism. This normal anxiety is the body’s primitive “alarm system”, warning us of potential danger and motivating us to take precautions. But when the alarm keeps going off wrongly, with no real danger or out of proportion to it, we speak of anxiety disorders. Anxiety is then no longer a protective friend but an enemy that restricts a person’s life, narrows their choices and keeps them in constant fear and anticipation. According to World Health Organization data, anxiety disorders are the most common group of mental disorders worldwide and cause serious disability, lost working capacity and reduced quality of life. This article aims to shed light on the complex dynamics behind this common and painful experience and on the effective solutions modern psychiatry offers.

2. The nature and classification of anxiety

Anxiety has four main components: cognitive (catastrophic expectations, “what if?” thoughts), emotional (fear, dread, tension), physiological (palpitations, shortness of breath, sweating, trembling) and behavioural (escape, avoidance, safety-seeking). The pattern and triggers of these components determine how anxiety disorders are classified. According to DSM-5-TR, the main anxiety disorders are:

• Generalised anxiety disorder (GAD): excessive, uncontrollable worry about several areas, such as finances, health, family or work, lasting at least six months and affecting daily life. These patients can be described as people who “always think of the worst-case scenario”.

• Panic disorder: recurrent, unexpected panic attacks and intense anticipatory anxiety about further attacks (“fear of fear”). A panic attack is a sudden surge of intense fear that peaks within minutes, with symptoms such as palpitations, breathlessness, a choking sensation, dizziness and fear of dying or losing control.

• Agoraphobia: fear and avoidance of situations in which escape or help might be difficult if panic-like symptoms occur (public transport, open or enclosed spaces, crowds, leaving home alone).

• Social anxiety disorder (social phobia): intense anxiety in, and avoidance of, social situations for fear of being judged negatively, criticised or humiliated.

• Specific phobias: excessive, irrational fear of a particular object or situation, such as snakes, spiders, heights, enclosed spaces or flying, with active avoidance.

3. Aetiological perspectives: what causes anxiety?

The origin of anxiety gives the clearest answer to the question “nature or nurture?”: both.

• A. The neurobiological model: at the root of anxiety lies an overactive amygdala, the brain’s “danger detection centre”, and an underactive prefrontal cortex, the “reasoning and planning centre” that should silence the alarm. Dysfunction in the GABA system (the brain’s main calming neurotransmitter) and imbalances in other chemicals such as serotonin and noradrenaline contribute to this over-arousal. Genetic predisposition plays an important part in how sensitive these systems are.

• B. The psychoanalytic model: Freud saw anxiety as a “signal” from the ego in response to the threat of repressed sexual or aggressive drives (the id) breaking into consciousness. The ego senses the danger (fear of punishment) these unacceptable drives would create and, through signal anxiety, activates defence mechanisms (repression, displacement, projection and so on). In this model, phobias are seen as the “displacement” of the real unconscious fear (for example, an Oedipal conflict) onto a less threatening external object (for example, a horse).

• C. The cognitive behavioural model: this model revolutionised the understanding and treatment of anxiety disorders. According to CBT, what maintains anxiety is not the danger itself but the catastrophic misinterpretation of situations or bodily sensations. In panic disorder, for example, the patient interprets a normal palpitation as “I’m having a heart attack”, and this thought triggers a panic attack. A person with social phobia interprets a trembling hand during a presentation as “Everyone will think I’m incompetent, I’ll be humiliated”, which increases their anxiety. These catastrophic thoughts lead to avoidance: the person with a phobia avoids lifts, the person with social phobia avoids giving presentations. Avoidance brings short-term relief but, in the long run, keeps the fear alive and reinforces it, because the person never gets the chance to learn that what they fear is not really so dangerous.

4. Treatment strategies: holistic, evidence-based approaches

Anxiety disorders are among the most treatable mental health conditions today. The most effective approach usually combines two main methods.

A. Psychopharmacology (medication): especially in moderate and severe anxiety disorders, medication plays a critical role in controlling symptoms, making psychotherapy possible and restoring overall well-being.

• SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin–noradrenaline reuptake inhibitors): the first-choice medicines for anxiety disorders today. By regulating serotonin and/or noradrenaline levels in the brain, they calm the brain’s “alarm system”. They can take a few weeks to start working and are designed for long-term use.

• Benzodiazepines: medicines such as alprazolam and lorazepam relieve anxiety very quickly (within minutes) and are highly effective. However, they carry a high risk of dependence, and long-term use is not recommended. They are usually prescribed for short-term “crisis intervention”, for example to control severe panic attacks at the start of treatment before SSRIs have taken effect.

B. Psychotherapy: considered the “gold standard” for treating anxiety disorders and the route to lasting recovery.

• Cognitive behavioural therapy (CBT): the most strongly evidence-based school of therapy. Treatment focuses on changing faulty thinking patterns and avoidance behaviours. Its most powerful technique is exposure, often combined with response prevention. The therapist and patient build an “anxiety hierarchy” together, and the patient gradually and systematically faces feared situations or objects, from the least to the most anxiety-provoking. A patient with a fear of cats, for example, first looks at pictures of cats, then watches videos, then looks at a cat from a distance and finally touches one. At each step they wait for their anxiety to subside naturally, without escaping or using safety behaviours. This process allows the brain to reprogramme its “false alarm” and learn that the feared situation is not actually dangerous.

• Mindfulness-based therapies and acceptance and commitment therapy (ACT): rather than trying to change anxious thoughts, these “third-wave” therapies aim to change the person’s relationship with them. Patients learn to observe anxious thoughts and feelings without judgement, to recognise them as passing mental events and to keep living a meaningful life in line with their values despite these uncomfortable feelings.

5. Conclusion

Anxiety is part of being human. The aim of treatment is not to eliminate anxiety completely but to bring it down to a manageable level and help the person take back control of their life. Modern psychiatry offers a rich range of treatments for anxiety disorders, from effective medicines that act on the biology of the brain to powerful psychotherapy techniques that reprogramme how the mind works. With an accurate diagnosis and a holistic treatment plan tailored to the individual, it is entirely possible to break free from the grip of anxiety and live a free, functional and fulfilling life.

6. References

• Beck, A. T., & Emery, G. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. Basic Books.

• Barlow, D. H. (2002). Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press.

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th Ed., Text Revision (DSM-5-TR).

• Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge University Press.

• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. Guilford Press.

• Freud, S. (1926). Inhibitions, Symptoms and Anxiety. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. XX.