This article discusses the basics of various anxiety disorders as well as information on some evidence-based treatments and practical techniques to relieve symptoms. The purpose of this article is to give people who have anxiety or someone who knows someone with anxiety a place to start learning. At the end of this article, you will find links to helpful videos and articles about each topic discussed.
What Anxiety is and When It Becomes a Disorder
Anxiety is the fight, flight, or freeze response that informs you there might be a threat. However, this is not always based on facts. Anxiety does serve a purpose and can be useful at times but tends to run amuck if left unchecked. Knowing the difference between normal anxiety and anxiety disorder is important. We all feel anxious at times. For instance, right before an exam, getting called into the boss’s office, being late for an important meeting, and having to do our taxes. It is when the anxiety we feel is disproportionate to our experience and significantly hinders our daily life and ability to cope that it is classified as a disorder. Anxiety disorder can occur at any age. Interestingly, the average onset age for anxiety disorder is 31 years old (Durvasula, 2020). Also, it is the most common mental health disorder in the United States (Durvasula, 2020). According to the National Institute of Mental Health, 31.1% of the U.S population has experienced an anxiety disorder sometime in their life (Any anxiety disorder).
Types of Anxiety Disorders
There are a few types of anxiety disorders including generalized anxiety, social anxiety, separation anxiety, specific phobias, and agoraphobia which commonly cooccurs alongside panic disorder. The DSM V contains diagnostic criteria for each of these anxiety disorders. Additionally, there are assessment tools available in the online public domain. Briefly explained symptoms of generalized anxiety disorder include excessive and irrational worrying, intrusive thoughts, high startle response, intense frustration or irritability, and some physical symptoms such as headaches, fatigue, and muscle tension. This type of anxiety occurs in a wide variety of contexts without one specific trigger.
Social anxiety specifically has to do with feeling anxious in the context of relationships and being around other people. There is often a fear of making a fool of oneself, not knowing the correct thing to say, fearing rejection and abandonment, and avoiding certain triggers. For example, someone with social anxiety may not go to a party because there will be strangers and fear of how could they possibly fit in. Or they may skip class when they are required to give a presentation.
Someone with separation anxiety disorder feels an overwhelming need to stay close to their attachment figure and may become anxious if that person leaves. It can lead them to be afraid of abandonment. They may look for any sign a person will leave them and experience extreme distress because of this. Separation anxiety can be its own disorder or a symptom of another mental illness like dependent personality disorder and borderline personality disorder. (Stokes, 2022; What is dependent personality disorder (DPD)? 2022)
Next, there are specific phobias. Some of which include acrophobia (fear of heights), aerophobia (fear of flying), claustrophobia (fear of tight or crowded spaces), and mysophobia (fear of dirt or germs). Avoidance is a common way people deal with these phobias. People with agoraphobia avoid going out in public and may not leave their homes for months or even years. Durvasula (2020) explains this disorder by saying it is the fear of being somewhere without the ability to escape or receive help. She continues by stating it can also be because the person fears they will embarrass themselves. Ninety percent of people with agoraphobia also have a panic disorder which is another reason why they may refuse to venture outside their homes (Durvasula, 2020). They have an intense fear that another panic attack will happen. A panic attack is characterized by overwhelming terror and fears that something bad is about to happen when there is zero evidence to support this assumption. It seems to strike for no apparent reason. Several physical sensations are involved including headache, chest pains, pounding heart, dizziness, trembling, and shaking. It can literally feel to the person having the panic attack that they are having a heart attack and going to die. If the panic attacks occur two or more times without any evidence that they were in harm’s way, and they frequently worry about having another one, then the person should be assessed for panic disorder.
Treatment Methods and Grounding Techniques
Now that these anxiety disorders have been explained, I will briefly describe a few evidence-based treatments and practical ways to alleviate symptoms. Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT) have all been shown effective in treating anxiety disorders. In short, think of CBT as learning to confront distressing thoughts and emotions as well as recognize and reframe faulty thinking patterns. A therapist using DBT with clients may help them accept their present situation, teach them coping skills to deal with stressors, and help them change their emotional state. Mindfulness, emotional regulation, and opposite action are a few topics that will be included in DBT treatment. PE is very effective when treating phobias. With the support of a therapist, clients engage in different strategies to face their fears.
The American Psychological Association describes these strategies in their article titled “What is Exposure Therapy”. In vivo exposure is when a person directly interacts with a feared object, situation, or activity. Imaginal exposure is picturing the fear or trauma memory in one’s mind. Some therapists and clients may choose to start slow and work their way up to more intense fears whereas others may use a technique called flooding which requires exposure to the most intense fear first. Relaxation techniques are taught to help clients deal with any distress that may arise. Lastly, ACT, while not as common as other treatments, has been helpful in treating anxiety disorders. In ACT, clients are taught to accept their anxiety and let go of things outside their control. Clients learn to focus on how things are instead of getting caught up in the fear of what could happen. The goal of ACT is to become psychologically flexible (Depression and Anxiety with acceptance and commitment therapy 2021). If any of these seem helpful, check out the resources at the end of this article.
Some people are unable to go to therapy or simply aren’t interested in discussing their mental health. For anyone reading this article who wants free and low-cost grounding techniques to relieve stress and calm anxiety, I suggest the following:
Do some deep belly breathing where you inhale to the count of 4, hold 4 seconds, and exhale 4 seconds.
You can also try doing the physiological sigh, which is a long inhale through your nose, followed by a quick short inhale through the nose, and finish with a long exhale through your mouth. Do this about 3-5 times.
You can even do this 10 times, but only if your goal is to fall asleep. A video explaining why this pattern of breathing works to quickly alleviate stress and anxiety is linked at the end of this article.
You can also focus on your surroundings to get back to the present moment. Name 5 things you see, 4 things you hear, three things you can touch, 2 things you smell, and 1 thing you can taste.
Engage in progressive muscle relaxation by tightening any tense muscles and then slowly releasing them.
You can also distract yourself by holding an ice cube, taking a cold shower, taking a nature walk, exercising, smelling something soothing, listening to music, and doing an activity you enjoy.
Expressing gratitude and keeping a journal where you write positive things that happened might help as well. Something else that is very important to understand is how thoughts influence emotions. There are certain thinking patterns that make anxiety worse. These are called cognitive distortions. A few include catastrophizing, mind-reading, and all-or-nothing thinking. Perhaps I will delve deeper into these in a separate article. For now, I have included links in the resource section of this article. Finally, being aware of your triggers and retraining your brain to overcome the fear instead of avoiding it, will ultimately mitigate anxiety.
Learn more about how to effectively face your triggers by watching one of the videos included in the resource section.
ADAA-Anxiety. (2021, September 24). Depression and anxiety with acceptance and commitment therapy. YouTube. Retrieved April 13, 2023, from https://www.youtube.com/watch?v=X22cooCxdUQ
Peterson, T. J. (2015, October 22). Social Anxiety, Jumping to Conclusions, and Peace of Mind. HealthyPlace. Retrieved February 3, 2023, from https://www.healthyplace.com/blogs/anxiety-schmanxiety/2015/10/social-anxiety-jumping-to-conclusions-and-peace-of-mind
Stokes, V. (2022). Separation anxiety: Fall apart when it comes to time apart? Retrieved February 3, 2023, from https://www.harleytherapy.co.uk/counselling/separation-anxiety.htm
U.S. Department of Health and Human Services. (n.d.). Any anxiety disorder. National Institute of Mental Health. Retrieved February 3, 2023, from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
What is dependent personality disorder (DPD)? Florida Recovery Group. (2022, June 9). Retrieved February 3, 2023, from https://floridarecoverygroup.com/what-is-dependent-personality-disorder/
Resources for Further Learning
Separation anxiety: Fall apart when it comes to time apart
Dependent Personality Disorder
What is dependent personality disorder (DPD)?
Prolonged Exposure Therapy
Cognitive Distortion article and worksheets
Dialectical Behavioral Therapy
Acceptance and Commitment Therapy
Cognitive Behavioral Therapy
CBT worksheets and handouts
Videos for Continued Learning
Long-form videos (30+ minutes)
Tools for Managing Stress and Anxiety- Huberman Lab Podcast
Acceptance and Commitment Therapy Skills
Depression and Anxiety with Acceptance and Commitment Based Therapy
Anxiety Disorders in the DSM 5 TR- Symptoms and Diagnosis
Cognitive Behavioral Therapy for Abandonment Anxiety
Dialectical Behavioral Therapy Skills
Evidence-Based Practices for Anxiety Treatment
Short-Form Videos (Less than 30 minutes)
Anxiety and Triggers: Overcoming PTSD and Avoidance
Breathing Techniques to Reduce Stress and Anxiety- Dr. Andrew Huberman on the Physiological Sigh
How to Spot Normal Anxiety VS Anxiety Disorders-MedCircle
Mastering the Paradox of Acceptance and Change with Anxiety-Acceptance and Commitment Therapy
The Exposure Hierarchy: How to do Exposure Therapy for Anxiety: Anxiety Skills #20
What a Dialectical Behavior Therapy (DBT) Session Looks Like