What anxiety is. Causes, types, symptoms, diagnosis and treatment
What anxiety is, how to tell it apart from normal fear and which treatments really work. Signs, causes and concrete steps, explained simply.
What is anxiety?
Anxiety is defined as a powerful emotional reaction marked by feelings of unease, fear and worry; it can range from passing states of restlessness to severe psychological disorders that affect a person's quality of life. It is one of the most widespread and complex mental disorders, affecting millions of people around the world.
The history of anxiety is a complex one that goes back to the earliest times, but the modern term "anxiety" and its understanding as a distinct disorder developed gradually over the centuries.
The concept of anxiety can be traced back to antiquity, when thinkers such as Hippocrates and Galen discussed symptoms like restlessness and fear. In those days anxiety was often attributed to imbalances of the humours and to physical disorders. During the Renaissance and the early modern period, anxiety began to be better understood from a medical perspective. The first attempts were made to classify and diagnose mental disorders, but the term "anxiety" was still not used in its modern sense.
The early nineteenth century brought greater attention to anxiety as a distinct clinical phenomenon. Psychiatrists such as Philippe Pinel and Jean-Étienne Esquirol contributed to a better understanding of mental disorders, anxiety among them. During the twentieth century, with the development of psychoanalysis and modern psychology, anxiety became the subject of deeper study. Greater emphasis was placed on its causes and treatment, and the term "anxiety" became increasingly widespread in the medical and psychological literature.
Anxiety was officially included in the classification system for mental disorders with the publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its various editions. In DSM-III (published in 1980) anxiety disorders were specifically classified and defined, and more precise diagnostic criteria were established.
Types of anxiety
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), published by the American Psychiatric Association, anxiety is classified into several distinct disorders, each with its own diagnostic criteria. Below we look at the diagnostic criteria for each type of anxiety disorder in turn:
Generalised anxiety disorder (GAD):
- A period of at least six months of excessive anxiety and worry that are difficult to control.
- The person experiences three or more of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension or sleep problems.
- The anxiety and its associated symptoms cause significant distress or difficulties in everyday life.
Panic disorder:
- The presence of unexpected, recurrent panic attacks, accompanied by an intense fear of experiencing further attacks.
- At least four symptoms from the following list: palpitations, sweating, trembling, a feeling of suffocation, chest pain, dizziness, fear of losing control or of dying, and so on.
- The panic attacks and the preoccupation with them cause significant changes in behaviour.
Social anxiety disorder:
- An intense, persistent fear of social or performance situations in which the person is afraid of being judged, humiliated or evaluated negatively.
- The experience of anxiety is linked to several kinds of social and performance situations.
- The social anxiety is persistent and causes significant distress or impairs social or professional functioning.
Separation anxiety disorder:
- Excessive, developmentally inappropriate anxiety about separation from an attachment figure or from familiar places, beyond what is expected at the child's stage of development.
- The anxiety is persistent and can be expressed as fear of loss, fear of being alone, excessive distress before separation or refusal to go to school or to leave the house.
Causes and risk factors for anxiety
Anxiety can be the result of a complex combination of factors, including genetic predisposition, life experience, stress and environmental factors. Here is a list of the causes and risk factors for anxiety:
- Genetic predisposition: there is a genetic component in the development of anxiety. People with family members who have anxiety disorders are more likely to develop such disorders themselves.
- Chemical imbalances in the brain: certain brain chemicals, such as serotonin and dopamine, can play a part in regulating mood and anxiety. Imbalances or deficiencies in these chemicals can contribute to the onset of anxiety.
- Traumatic events: past physical, emotional or psychological trauma, such as abuse, neglect, the loss of a loved one or other traumatic experiences, can increase the risk of developing anxiety disorders.
- Chronic stress: experiencing significant stress or prolonged stress can affect the functioning of the nervous system and contribute to the onset of anxiety. Situations such as pressure at work, financial problems or tension in personal relationships can trigger or aggravate anxiety.
- Environmental factors: certain environmental factors, such as exposure to toxic or dangerous surroundings, a lack of resources or of an active social life, or rapid changes in daily life, can contribute to the development of anxiety.
- Lifestyle and eating habits: excessive consumption of caffeine, nicotine or other stimulants can aggravate anxiety. An unhealthy lifestyle, with an unbalanced diet, lack of physical exercise and insufficient sleep, can also have a negative effect on mood and increase the risk of anxiety.
- Medical factors: certain medical conditions, such as hyperthyroidism, heart conditions, hormonal disorders or other health problems, can be associated with anxiety symptoms.
- Substance abuse: excessive use or abuse of substances such as alcohol, illegal drugs or prescription medicines can be linked to the onset or worsening of anxiety disorders.
It is important to understand that anxiety can be influenced by a wide range of factors and that every individual is unique in their experiences and sensitivities. Effective treatment for anxiety often involves a combination of approaches, including psychological therapy, medication and lifestyle changes. Seeking professional support is also essential for managing anxiety effectively.
The symptoms of anxiety
Anxiety can produce a wide range of symptoms, which vary from one person to another and may include physical and psychological symptoms, emotional manifestations and social behaviour. Here is a list of some common symptoms of anxiety:
Physical symptoms:
- Palpitations or a rapid heartbeat
- Laboured breathing or a feeling of suffocation
- Muscle tension or trembling
- Excessive sweating or a feeling of heat
- Digestive problems such as nausea, diarrhoea or abdominal discomfort
- Headaches or body aches
- Numbness or tingling in the hands and feet
Psychological and cognitive symptoms:
- Scattered thinking or difficulty concentrating
- Excessive restlessness and constant preoccupation
- Fear of losing control or of going mad
- A sense of disorientation or imbalance
- Anticipating disasters or negative events
- Difficulty making decisions or solving problems
- A tendency to overestimate dangers or to misread situations
Emotional symptoms:
- Intense fear or panic
- Increased irritability or nervousness
- Agitation or a feeling of restlessness
- Feelings of sadness or despair
- A lack of control over emotions
- Heightened sensitivity to stress and tense situations
Social symptoms:
- Isolation or avoidance of social interaction
- Fear of judgement, criticism or social rejection
- Difficulty communicating or expressing feelings
- A reduction in usual social or leisure activities
- A negative impact on personal or professional relationships
It is important to stress that each person may experience anxiety symptoms in their own way, and that the severity and frequency of those symptoms can vary depending on factors such as the type of anxiety, the level of stress and the individual's own coping resources. If you experience anxiety symptoms that are affecting your quality of life, it is advisable to seek professional help for proper assessment and treatment.
Diagnosing anxiety
Diagnosing anxiety usually involves assessing the patient's symptoms and medical history, as well as ruling out other medical conditions that could cause similar symptoms. A diagnosis of anxiety can be made by general practitioners, psychiatrists, clinical psychologists, licensed therapists or other mental health professionals. It is important that whoever makes the diagnosis has appropriate experience and training in the assessment and treatment of anxiety disorders. Below we present the various methods used in the process of diagnosing anxiety disorders:
- Clinical assessment: the diagnostic process usually involves a full clinical assessment, in which the health professional discusses with the patient their symptoms, medical history and any recent stressors or trauma. It is sometimes helpful to involve family members or other close contacts, who can provide additional information about the person's behaviour and symptoms.
- Clinical interviews: Structured or semi-structured clinical interviews are used to assess symptoms and to determine whether the criteria for a particular anxiety disorder are met according to diagnostic manuals such as DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, fifth edition).
- Psychological tests: standardised psychological tests are sometimes used as part of the assessment to measure levels of anxiety and other aspects of psychological functioning. Such tests may include questionnaires and rating scales for anxiety symptoms, as well as assessments of cognitive and emotional functioning.
- Ruling out other medical conditions: it is important to rule out other medical conditions that could cause or contribute to anxiety symptoms, such as physical health problems, thyroid disorders or sleep disorders. A medical assessment is usually carried out to exclude any medical causes of the symptoms.
Brain imaging techniques can also be used to investigate brain activity and the changes associated with anxiety disorders. Here are a few examples of the imaging techniques used for this purpose:
- BrainMap qEEG (the Brain Map): this method involves recording the brain's electrical activity using electrodes placed on the scalp. BrainMap qEEG provides a detailed analysis of these electrical signals, giving information about brain functioning in real time. The technique can be used to identify characteristic patterns of brain activity associated with anxiety disorders and can provide objective data for assessing and monitoring progress during treatment.
- Functional magnetic resonance imaging (fMRI): fMRI is an imaging method that measures changes in blood flow and oxygen in the brain while a person performs cognitive or emotional tasks. fMRI studies can be used to identify the brain regions involved in anxiety responses and to investigate how those regions interact with one another.
- Positron emission tomography (PET): PET uses radioactive substances to measure metabolic activity in different parts of the brain. This technique can be used to examine changes in the brain's chemical activity associated with anxiety disorders and to identify alterations in specific neurotransmitters and receptors.
- Structural magnetic resonance imaging (sMRI): sMRI is used to obtain detailed images of the brain's anatomical structure. sMRI studies can be used to examine the volume and shape of different brain regions and to identify structural abnormalities associated with anxiety disorders.
- Magnetic resonance spectroscopy (MRS): MRS is a technique that measures the concentrations of specific chemicals in the brain, such as neurotransmitters and metabolites. This method can be used to investigate the biochemical changes associated with anxiety disorders and to evaluate the effectiveness of pharmacological treatment.
These imaging techniques can provide important information about the biological basis of anxiety and can contribute to the development of more precise, more effective diagnostic and treatment strategies.
Complications associated with anxiety disorders
Anxiety disorders can have a significant impact on a person's physical and cognitive health. Here are some of the complications that people affected by these disorders may experience:
- Physical health problems: chronic anxiety can contribute to a range of physical health problems, including high blood pressure, gastrointestinal disorders (such as irritable bowel syndrome), chronic headaches and muscle pain, sleep disorders (insomnia, restless sleep), suppression of the immune system and an increased risk of cardiovascular disease.
- The impact on the central nervous system: anxiety disorders can affect the functioning of the central nervous system and contribute to changes in the structure and function of the brain. These changes can affect attention, memory, executive functions and other aspects of cognitive functioning.
- Difficulty concentrating and learning: people with anxiety may struggle to concentrate and learn, which can affect performance at school or at work and lead to feelings of frustration and lower self-confidence.
- A decline in quality of life: chronic anxiety can reduce a person's quality of life, affecting personal relationships, performance at work or school, participation in social activities and other aspects of everyday life.
- Depression and other mental disorders: people with anxiety disorders are often prone to developing depression and other mental health disorders, and these comorbid conditions can worsen the symptoms and make managing the anxiety more difficult.
- Self-medication and substance dependence: anxiety can lead some people to resort to self-medication or to substance use, such as alcohol or drugs, in order to cope with their symptoms. This can result in dependence and in further mental and physical health complications.
It is important to recognise and treat anxiety in order to prevent long-term physical and cognitive complications and to improve the person's quality of life. Treatment may involve psychological therapy, medication, stress management techniques and lifestyle changes that promote mental and physical health.
Treatment options for anxiety
Treatment for anxiety can involve a variety of approaches, which can be tailored to the patient's individual needs and to the severity of the symptoms. Here is a list of treatment options, neurofeedback therapy among them, and the types of anxiety disorder they suit best:
- Cognitive behavioural therapy (CBT): CBT is a form of psychological therapy that focuses on identifying and changing anxious thoughts and behaviours, teaching anxiety management techniques and using gradual exposure to feared situations.
- Suitable for: generalised anxiety disorder, panic disorder, social anxiety disorder, specific phobias.
- Medication (antidepressants, anxiolytics): Medicines such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines and others may be prescribed to reduce anxiety symptoms and improve daily functioning.
- Suitable for: all types of anxiety disorder.
- Exposure and response prevention therapy (ERP): ERP is a form of behavioural therapy that involves controlled exposure to objects or situations that provoke anxiety, together with learning techniques for managing the anxious response.
- Suitable for: generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder (OCD).
- Group therapy: Taking part in group therapy or support sessions can provide a safe, supportive setting in which to share experiences and anxiety management strategies with other people going through the same difficulties.
- Suitable for: all types of anxiety disorder.
- Neurofeedback therapy: Neurofeedback therapy is a form of biofeedback that uses technology to monitor brain activity and to teach the person to control and modify that activity by rewarding the brain's positive responses.
- Suitable for: all types of anxiety disorder.
Preventing anxiety disorders
There are certain strategies and methods that can reduce the risk of these conditions appearing or worsening. Here are a few preventive methods for anxiety disorders:
- Stress management: learning effective stress management techniques, such as deep breathing, meditation or progressive muscle relaxation exercises, can help lower the overall level of anxiety and prevent episodes of excessive anxiety.
- Adopting a healthy lifestyle: keeping a regular sleep schedule, eating a balanced diet, avoiding excessive caffeine and alcohol and exercising regularly can all contribute to better mental and emotional health.
- Limiting exposure to anxiety triggers: avoiding or limiting exposure to stressors and situations that can provoke anxiety can reduce the risk of triggering anxiety disorders. This may include avoiding certain substances or medicines that can aggravate anxiety, as well as spending less time in tense environments or situations.
- Counselling and therapy: attending counselling or therapy sessions can help you learn effective strategies for managing stress and anxiety and develop skills for coping with difficult situations. Cognitive or behavioural therapies can be particularly useful for learning healthy patterns of thinking and behaviour.
- Monitoring and managing emotions: learning to identify and handle negative emotions in a healthy way can help prevent anxiety from building up and help maintain emotional balance. Self-reflection practices, keeping an emotion journal and communicating openly with those close to you can all be useful here.
- Neurofeedback therapy: neurofeedback therapy can also be used preventively, helping to improve cognitive functioning and emotional regulation. By training the brain to regulate its own activity, neurofeedback therapy can help prevent or reduce anxiety symptoms before they become more severe.
It is important to stress that preventing anxiety disorders often calls for a multidisciplinary, personalised approach. Finding a balance between the various preventive methods and strategies can be beneficial for maintaining mental and emotional health in the long term. Consulting a qualified health professional can provide guidance and support in developing a prevention plan suited to each individual.
Anxiety remains one of the most prevalent and debilitating mental disorders in the world, with a significant impact on the physical, emotional and social health of millions of people. Although many treatment options are available, including psychological therapy and medication, recognising and integrating innovative, complementary approaches such as neurofeedback therapy may be the key to tackling anxiety holistically and effectively.
Neurofeedback therapy is a promising method that uses technology to train the brain to regulate its own activity, helping to reduce anxiety symptoms and improve cognitive and emotional functioning. It is non-invasive and free of the side effects associated with drug treatment. Although medication can be effective in managing anxiety symptoms, it can also carry adverse effects. Some possible side effects of anti-anxiety medicines include drowsiness and fatigue, gastrointestinal problems, an increase or decrease in appetite, agitation or insomnia and sexual difficulties.
To begin your journey towards a more balanced, healthier life, get to know neurofeedback therapy and book a free phone consultation with a specialist.
You can also pre-order the book "Antrenamente Cerebrale - Terapii Sinergice si Complementare pentru Vindecarea Anxietatii" (Brain Training - Synergistic and Complementary Therapies for Healing Anxiety, in Romanian) and discover 9 transformative stories of patients who treated their anxiety disorders through brain training.
References:
- Chen, C., Xiao, X., Abdelkader Nasreddine Belkacem, Lu, L., Wang, X., Yi, W., Li, P., Wang, C., Sha, S., Zhao, X. and Ming, D. (2021). Efficacy Evaluation of Neurofeedback-Based Anxiety Relief. Frontiers in Neuroscience, [online] 15. doi:https://doi.org/10.3389/fnins.2021.758068.
- Banerjee, S. and Argáez, C. (2017). Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of Clinical Effectiveness and Guidelines. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK531603/ .
🧠 How does your brain work?
Download the guide for FREE and find out what your brain map reveals.
📖 Our books - Real case studies with brain maps
📖 Vindecarea Depresiei (Healing Depression, in Romanian) - 29.00 RON
📖 Vindecarea Anxietatii (Healing Anxiety, in Romanian) - 29.00 RON
📖 Eliminarea Atacurilor de Panica (Ending Panic Attacks, in Romanian) - 29.00 RON
What panic attacks are
Panic attacks are intense episodes of fear or discomfort that come on suddenly and peak within minutes. They can be accompanied by physical symptoms such as palpitations, sweating, trembling, a choking sensation or dizziness.
In the history of diagnosis, the concept of a panic attack was first described under various names and interpretations, and the current term was introduced in DSM-III in 1980. In DSM-5, the diagnostic criteria for panic disorder, a condition of its own, include a number of unexpected panic attacks and persistent worry or behavioural change related to those attacks.
The difference between panic attacks and anxiety lies in their intensity and nature. While anxiety is a persistent state of unease or worry, panic attacks are short and intense episodes of fear.
Panic attack symptoms
Panic attacks are marked by a series of intense symptoms that appear suddenly and peak within minutes. These symptoms vary from person to person and can include the following:
- Palpitations or a racing heartbeat: the person may feel their heart pounding or beating irregularly.
- Excessive sweating: heavy sweating can appear even without intense physical effort.
- Trembling or a feeling of shaking: the person may feel that they are shaking or may show visible tremors in the hands or legs.
- A choking sensation or shortness of breath: it can feel as if breathing is not working properly or as if there is not enough air.
- Chest discomfort or pain: sometimes the symptoms are experienced as pain or pressure in the chest.
- Numbness or tingling: numbness or tingling can appear in various parts of the body, such as the hands or the face.
- Feeling of being smothered: the person may feel as if they are suffocating, even though there is no physical obstruction.
- Dizziness or feeling faint: dizziness or vertigo can appear, and sometimes the person feels they are about to faint.
- Feelings of losing control: the person may feel that they are losing control or that they are about to “go mad”.
- Intense fear of impending death: an overwhelming feeling of fear or anxiety can accompany the panic attack, and the person may feel they are going to die or completely lose control.
It is worth noting that not all of these symptoms have to be present for it to be a panic attack, and their intensity and combination can vary from person to person.
First aid during a panic attack
When someone is having a panic attack, first aid can make a real difference in helping them cope and get through that difficult moment. Here are a few techniques and strategies you can use in such situations:
- Stay calm: it is important to stay calm and to pass on a relaxing, reassuring energy to the person having the panic attack. Avoid showing your worry or becoming agitated, as this can heighten their anxiety.
- Provide a safe environment: help the person move to a quiet, safe place, away from anything that could trigger or worsen the panic attack. If possible, take them somewhere calm and comfortable, away from crowds or loud noise.
- Encourage deep, controlled breathing: help the person breathe deeply and steadily, focusing on slow, regular breaths in and out. You can guide them to breathe in slowly through the nose, count to four and then breathe out slowly through the mouth.
- Be empathetic: show your support and empathy. You can use encouraging, empathetic words such as: „I am sorry you are going through this, I am here for you and I will help you get through it” or „Breathe slowly and deeply, you are safe and this attack will pass”.
- Help them focus their attention: you can guide their attention towards something that draws it away from the anxiety and fear they feel during the panic attack. You can ask them to count backwards from 100 in threes or to describe an object in the room in detail.
- Be patient and encourage them to express their feelings: listen carefully and without judgement to what the person has to say about their experience and encourage them to express their feelings and fears in a safe, supportive setting.
- Reassure them that the attack is temporary and will pass: reassure them that the panic attack is temporary and will soon pass. It can help to remind them that they have been through such moments before and have got through them.
- Help set an action plan for future situations: once the panic attack is over, talk with the person about ways they can prepare for and better handle similar situations in the future. It can help to identify together stress management techniques and relaxation strategies that give them a sense of control and safety.
If you are the one going through a panic attack, it helps to have a few techniques at hand to settle your anxiety and calm yourself down. Here are some useful ones:
- Deep, controlled breathing: focus on your breath and try to breathe slowly and deeply. Breathe in through the nose for four seconds, hold for four seconds and then breathe out slowly through the mouth for four seconds. Repeat the cycle a few times until you feel the anxiety starting to ease.
- Use the 5-4-3-2-1 senses technique: this technique means turning your attention to your senses and to your surroundings in order to reconnect with the present and lower your anxiety. Start by naming five things you can see around you, then four things you can feel, three sounds you can hear, two things you can smell and one thing you can taste. It helps you step away from anxious thoughts and focus on the sensations of the present moment.
- Use positive affirmations: think of a few positive affirmations or mantras that make you feel safe and calm. Repeat them in your mind or even out loud to support a sense of well-being and calm.
- Practise mindfulness: focus on the present and on what you feel right now. Notice your body sensations, your breathing and your surroundings without judging or trying to change anything. Practising mindfulness can help you reduce anxiety and regain your emotional balance.
- Ground yourself with a calming object or activity: if you have an object or an activity that relaxes and calms you, such as a stress ball, a smooth stone or colouring, use it to help yourself through the panic attack.
These techniques can help you manage a panic attack and get your emotional balance back quickly. It is worth experimenting to see which ones work best for you and building them into a personal anxiety management plan. If panic attacks persist or become frequent, do not hesitate to ask for professional help from a therapist or a doctor specialised in mental health.
Frequently asked questions about panic attacks
How long does a panic attack last?
A panic attack comes on suddenly and peaks within just a few minutes. It is an intense, short episode of fear or discomfort, unlike anxiety, which is a more persistent state of unease. If the attacks become frequent or severe, it is best to ask for help from a mental health specialist.
What can you do during a panic attack?
Focus on deep, controlled breathing: breathe in slowly through the nose for four seconds, hold for four seconds and breathe out through the mouth for four seconds. You can also use the 5-4-3-2-1 senses technique (name five things you see, four you feel, three sounds, two smells and one taste), positive affirmations or an object that calms you, to bring your attention back to the present. These techniques help you get through the episode more easily; it is temporary and it will pass.
What is the difference between a panic attack and anxiety?
Anxiety is a persistent state of unease or worry, while a panic attack is a short, very intense episode of fear. The main difference is their intensity and nature: panic comes on suddenly and is overwhelming, anxiety settles in gradually and lasts longer. For a correct diagnosis, a specialist assessment is essential.
Are panic attacks dangerous?
The panic attack itself is temporary and passes on its own, but left untreated, panic disorder can come with complications: cardiovascular, gastrointestinal or respiratory problems, sleep disturbances, but also depression, social isolation and a lower quality of life. That is why the symptoms should not be ignored. A treatment plan set together with a specialist helps manage them and prevent complications.
Can panic attacks be prevented?
Panic attacks cannot be ruled out for good, but their risk can be lowered: by understanding the signs and triggers, managing stress, keeping a healthy lifestyle, avoiding too much caffeine and alcohol and working with negative thoughts. When the episodes are frequent or severe, cognitive behavioural therapy and the help of a specialist can go a long way in keeping them under control.
Do you want to understand what is happening in your brain?
Book a call with the BrainMap Institute's specialists and find out how a BrainMap and brain training can help you.