Anxiety
What is anxiety?
Anxiety is a state of ongoing mental and physical tension that centers around anticipation—worrying about what might happen, what could go wrong, or what might be beyond your control. It often feels like your mind is constantly scanning for future threats, even when there is no immediate danger present. Someone experiencing anxiety may feel stuck in repetitive thoughts, unable to quiet their mind, and unable to feel settled in the present moment.
Some people describe it as “always being on edge” or “never being able to relax.” Others describe it as a constant internal tension, as if their body is bracing for something bad to happen. This prolonged state of worry can lead to indecision, avoidance, and self-doubt, and leave a person feeling exhausted.
What causes anxiety?
Researchers don’t yet know specific causes, but they do see links between certain factors. Neurologists have been able to study brain activity during heightened emotional states, and have identified areas of the brain that play a role in anxiety. In addition to those internal factors, researchers also notice that environmental factors and past experiences tend to affect the likelihood that someone will develop an anxiety disorder.
Brain function. It is theorized that an imbalance in the functioning of the limbic system (including the amygdala) and the prefrontal cortex contributes to disordered anxiety. Specialized psychotherapists use tools aimed at regulating these functions.
Neurotransmitters. It is also theorized that certain chemicals in the brain, like serotonin and norepinephrine, play strong roles in the regulation or dysregulation of fear responses. Medical providers can determine, based on your symptoms and history, if medication (SSRI, SNRI, etc.) can help reduce your distressing symptoms.
Family history. If a parent or sibling suffers from an anxiety disorder, you are more likely to develop one, too. This is not a guarantee, though. Most researchers agree that predisposition alone is not a causal factor.
Personal history. A significant number of people who suffer from anxiety disorder have experienced a traumatic event (a singular event, or an extended period of threat and harm). A therapist trained in acute and complex trauma (cPTSD) can incorporate trauma-informed tools into anxiety treatment.
Physical symptoms of anxiety:
Anxiety also affects the body. While it begins as worry in the mind, it often creates physical symptoms such as:
muscle tension,
restlessness,
fatigue,
upset stomach,
headaches,
increased heart rate, and
trouble sleeping
These symptoms happen because the body responds to perceived threat—even imagined future threat—by activating the nervous system. The body prepares for danger even when the “danger” may exist only in the person’s thoughts.
Different Types of Anxiety:
Separation anxiety is marked by intense distress at the thought of or after sepearation from a loved one. Seperation anxiety is an normal stage in early childhood development, but it can severely interrupt daily life when it occurs in adulthood. Commonly, separation anxiety follows a death, difficult change, or traumatic loss.
Panic disorder is a type of anxiety disorder that causes distressing, unexpected “attacks” of fear and panic response, usually lasting about 3-5 minutes. Multiple panic attacks are one criteria for panic disorder.
Social anxiety is marked by significant distress experienced in crowds and public places. Thoughts of negative judgment, criticism, or shame feel inescapable. Social anxiety often occurs alongside cPTSD.
General anxiety, phobias, and PTSD are more examples of types of anxiety. A medical provider or licensed mental health provider can discuss a diagnosis in depth after reviewing your symptoms and history.
Does anxiety get worse at night?
Because anxiety tends to intensify when external distractions quiet down, many people notice it most at night. During the day, responsibilities and stimulation can temporarily keep anxious thoughts in the background. But at night, when the body is supposed to rest, the mind may become louder. Thoughts begin to race, often jumping from one worst-case scenario to another. A person may replay conversations, imagine negative outcomes, question their decisions, or worry about things they cannot control. This can create a cycle where anxiety increases physical arousal—such as a racing heart—which then increases fear, making sleep difficult or impossible.
People often refer to moments of increased anxiety as “anxiety attacks,” but this term is not formally defined in the DSM-5-TR. In everyday language, an “anxiety attack” usually describes a period where anxiety spikes beyond its usual baseline. During this time, worry may intensify, physical symptoms may increase, and the person may feel emotionally overwhelmed. However, these episodes usually build gradually in connection with a stressor or a buildup of anxious thoughts. They may last for minutes, hours, or even much longer, depending on the situation and the person’s ability to regulate the distress.
A few quick tips:
When thoughts begin racing at night, and you’re struggling to fall asleep or go back to sleep, try these tips:
Speak your thoughts out loud. If your thoughts are exaggerated, you may be able to reason with yourself when you speak them. Our mouth and ears process words differently than our thoughts alone do.
Squeeze and relax muscle groups in your body. Start with your feet, then your calves, your hands, etc. This is a type of progressive relaxation. These motions connect your mind with your body and signal safety.
If you’ve been trying to fall asleep for more than half an hour, get out of bed and do something quietly productive, like read a chapter in a book or a magazine, or clean up a messy bathroom. This can help your mind get distracted and reset before you go back to bed.
How do you treat anxiety?
Psychotherapy (counseling)
Psychotherapy is a form of clinical treatment that addresses distorted thoughts (like catastrophization), repressed or overwhelmed emotions, and destructive or unhealthy behavior. The treatment of anxiety often involves looking into your history (or your present circumstances) to evaluate things that have been hurtful or threatening, and have caused your nervous system to be on constant alert. Many people with persistent anxiety have a history of trauma. Although this isn’t the only correlation to anxiety disorder, it is a common one.
Exposure therapy is an approach commonly used by psychotherapists to help someone break the cycle of constant avoidance, which often makes anxiety worse. Exposure to fear by talking about worst-case scenarios, reasonable outcomes, and alternative solutions, all within the safe, comfortable space of home or office, can help retrain the nervous system out of fight-or-flight mode and into a stable, reasonable new normal.
Cognitive therapy. With the skilled guidance of a therapist, a person suffering from anxiety will learn to reorganize their thoughts (cognitions) into more constructive patterns and teach their nervous system how to relax in the absence of threat.
Medication (or medically supervised alternatives)
A medical provider (psychiatric NP, DO, MD) can offer advice about different types of anxiety medications and alternative medical treatments that are shown to improve the distressing symptoms of anxiety attacks. This can be used in combination with psychotherapy to achieve noticeable progress.
How to calm anxiety quickly:
When your thoughts are racing, take a few seconds to write down a list of the things you’re worried about, or dictate a voice note. Connecting your brain to your hands or mouth by writing or speaking your thoughts can help stabilize your worry and ground your problem-solving skills.
Stand up and stretch. Allow the anxious energy to move through your body and feel a little less “stuck”.
Go for a walk and express emotion. Speak your thoughts aloud and create a list of priorities. What needs attention today? What can wait until tomorrow?
The good news is that both anxiety and panic are treatable. Learning how the body responds to fear can make symptoms less frightening. Therapy can help people identify thought patterns that fuel anxiety, learn grounding skills to regulate the body, and reduce fear of panic symptoms.
If you’ve been managing this on your own, consider this your invitation to take the next step. Whether that means scheduling a consultation with a therapist, speaking with your physician about symptoms, or simply learning more about your options—movement matters. You don’t have to keep navigating this alone.
Take the Next Step
https://pubmed.ncbi.nlm.nih.gov/11098410/
https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
The information provided in this article is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Reading this content does not establish a therapeutic relationship and should not be considered a substitute for professional mental health care, medical advice, diagnosis, or treatment from a qualified provider. Always seek the advice of your physician, therapist, or other licensed healthcare provider regarding any questions you may have about a medical or mental health condition.