Anxiety

It's a normal part of life to experience occasional anxiety.

But you may experience anxiety that is persistent, seemingly uncontrollable and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

Anxiety disorders are very real and serious medical conditions - just as real and serious as physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the United States. The term "anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD),  panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety and specific phobias.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.

Irritable Bowel Syndrome, also called IBS, is characterized by abdominal pain, cramping, bloating, gas, constipation, and diarrhea.

What is Anxiety?

What is Anxiety?

What is Anxiety (from ADAA's partner organization Anxiety.org) is an in-depth analysis and explanation of key anxiety disorders written by ADAA member experts.

Facts and Statistics

  • National prevalence data indicate that nearly 40 million people in the United States (18%) experience an anxiety disorder in any given year.
  • Approximately 8% of children and teenagers experience an anxiety disorder with most people developing symptoms before age 21.
  • Only about one-third of those suffering from an anxiety disorder receive treatment, even though the disorders are highly treatable.
  • In addition, according to the World Health Organization (WHO), 1 in 13 globally suffers from anxiety. The WHO reports that anxiety disorders are the most common mental disorders worldwide with specific phobia, major depressive disorder and social phobia being the most common anxiety disorders.

Treating anxiety disorders with therapy

Whether you’re suffering from panic attacks, obsessive thoughts, unrelenting worries or an incapacitating phobia, it’s important to know that you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is often the most effective option. That’s because anxiety therapy—unlike anxiety medication—treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder (OCD), for example, your treatment will be different from someone who needs help for anxiety attacks. The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

While many different types of therapy are used to treat anxiety, the leading approaches are cognitive behavioral therapy (CBT) and exposure therapy. Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems. But the goal is the same: to lower your anxiety levels, calm your mind, and overcome your fears.

Cognitive behavioral therapy (CBT) for anxiety

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.

Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Situation: A friend invites you to a big party

Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!

Emotions: Happy, excited

Thought #2: Parties aren’t my thing. I’d much rather stay in and watch a movie.

Emotions: Neutral

Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.

Emotions: Anxious, sad

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Thought challenging in CBT for anxiety

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

  1. Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
  2. Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear and determining the realistic chances that what you’re anxious about will actually happen.
  3. Replacing negative thoughts with realistic thoughts. Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.

Challenging Negative Thoughts:

Negative thought #1: What if I pass out on the subway? Cognitive distortion: Predicting the worst

More realistic thought: I’ve never passed out before, so it’s unlikely that I will on the subway.

Negative thought #2: If I pass out, it will be terrible! Cognitive distortion: Blowing things out of proportion

More realistic thought: If I faint, I’ll come to in a few moments. That’s not so terrible.

Negative thought #3: People will think I’m crazy. Cognitive distortion: Jumping to conclusions

More realistic thought: People are more likely to be concerned if I’m okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well. CBT may also include:

Learning to recognize when you’re anxious and what that feels like in the body

Learning coping skills and relaxation techniques to counteract anxiety and panic

Confronting your fears (either in your imagination or in real life)

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