Anxiety: Causes, Symptoms and Management

Disclaimer: The author, Sabbir Ahmed, is a registered psychotherapist (UKCP Reg: 2011164676). Sabbir has written this article for informational and educational purposes only, and referenced relevant sources when writing this article.

Reading this article, in and of itself, does not create a therapist–client relationship.

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Anxiety is a normal human psychological pattern in reaction to stress, generally triggered by the perception and thus identification of threats in the external environment.

However, when anxiety is persistent, overwhelming or otherwise gets in the way of daily living, though, this can point to an anxiety disorder, where anxiety becomes hard to rein in and thus diminishes quality of life (NIMH, 2022).

There are a few defining features of anxiety disorders in a clinical, psychological sense, which are as follows:

Experiencing worry which is disproportionate to the situation being worried about
Avoiding major life activities, including in-person activities such as hobbies, going to work and/or meeting friends; this can reduce overall quality of life
Physical signs, including elevated heartrate, sleeplessness or chest discomfort (MedlinePlus, 2023).

This article aims to provide an overview of anxiety, including its causes and symptoms, alongside its clinical subtypes, giving practical techniques to reduce anxiety effectively.

Why do we become anxious?

There are several reasons, including biological, environmental and psychological factors, that lead to the emergence and/or maintenance of anxiety as a psychological issue:

In terms of biological factors responsible for anxiety, researchers believe that there is an imbalance between neurotransmitters (brain chemicals), specifically the inhibitory gamma-aminobutyric acid (GABA; impaired function of, or deficiency in, GABA can cause or worsen anxiety disorders) and other excitatory neurotransmitters such as glutamate, dopamine, and norepinephrine (while these neurotransmitters are essential in cognitive function and alertness, excess or imbalance of activity of these neurotransmitters can lead to an anxiety disorder; Harvard Health Publishing, 2022)

Environmental and social factors contribute to anxiety disorders (ADAA, 2021) where evil living or working environments, psychologically damaging relationship dynamics, lack of social support or long-term isolation can all play a contributing factor.

Finally, psychological factors, such as traumatic or stress-inducing life changes (e.g., divorce, death of a beloved person), negative thought patterns, and/or low self-esteem can initiate or exacerbate anxiety symptoms (APA, 2021).

Knowing about these different contributing factors can therefore help customise anxiety disorder treatment.

Common Signs and Symptoms of Anxiety

There is no one-size-fits-all descriptor which describes everyone’s experience of anxiety, which differs from person to person. Some specific symptoms of anxiety can include:

Avoidance behaviours in the result to prevent potentially anxiety provocation situation of the daily life
Trouble sleeping (insomnia), which may manifest itself as restlessness, or being unable to take rest
Physical symptoms, such as:
A tight chest or heart palpitations
Sweating, trembling and/or difficulty breathing
Gastrointestinal issues including diarrhea, constipation and/or nausea.
Panic attacks (episodes of intense anxiety (panic), often with striking physical symptoms e.g. pain in the chest or dizziness; MedlinePlus, 2023)

Clinical Subtypes of Anxiety

Anxiety, however, is not a single condition, but rather can be considered an umbrella term for a group of conditions, clinically termed ‘anxiety disorders’.

Some common types of anxiety disorders include:

Social anxiety disorder (SAD) is defined (Cleveland Clinic, 2022) as an intense fear of social judgement (embarrassment), which can make social interaction in professional/occupational, public (speaking before an audience) and/or friendship contexts extremely difficult.
Generalised anxiety disorder, or GAD, is characterised (NIMH, 2022) by excessive worry or fear about a range of common day-to-day issues, such as money, health and/or work; the anxiety is often out of proportion to the severity or the nature of the actual event.
Specific phobias, such as claustrophobia (a fear of closed or confined spaces), arachnophobia (a fear of spiders) or acrophobia (a fear of heights) can provoke, in the person with the given phobia, an overwhelming fear of the subject of the phobia being the described phenomenon, object or situation) avoidance behaviours in an attempt to avoid the triggering stimuli, which can thereby lead to decreased quality of life via missing out on life experiences (ADAA, 2021).
Panic disorder is characterised by having frequent and recurrent (as opposed to standalone) panic attacks, frequently coupled with a negative fixation on when the next panic attack will occur. This can also result in avoidance behaviours, whereby the individual may not come in to work, or catch up with friends in order to avoid being in a setting which might trigger a panic attack (Cleveland Clinic, 2022).
Post-traumatic stress disorder (PTSD) is not classified strictly as an anxiety disorder per se by the present DSM-5, but shares many characteristics of anxiety and/or panic disorders. For example, symptoms of PTSD include flashbacks, hypervigilance (increased anticipation of danger/threat) and nightmares; thus, its symptoms arguably overlap with those of anxiety disorders (APA, 2021).

Strategies to Manage Anxiety

Anxiety is a treatable, manageable condition; people with the right tools and support can manage their anxiety, and there are multiple strategies which have clinical evidence for reducing anxiety symptoms, therefore improving life quality.

Here are a few of these strategies:

In anxiety therapy, or counselling for anxiety, a psychotherapist provides a safe space for individuals to explore their stressors and develop appropriate coping strategies (ADAA, 2021).
This approach often incorporates psychotherapeutic approaches such as CBT (cognitive behavioural therapy), which can help individuals to identify and therefore regulate their harmful, or self-limiting, thought patterns (APA, 2021).
Desensitisation, by controlled exposure to stimuli which elicit anxiety, gradually desensitises a subject to the offending stimulus and thus its potential to induce fear.
Some individuals may require pharmacotherapeutic treatment such as antidepressant and/or anxiolytic drugs.
When prescribed and supervised by a responsible medical professional, taking antidepressants and/or anxiolytics as prescribed can assist in establishing more balanced neurochemistry, thus reducing the symptoms and severity of anxiety (Harvard Health Publishing, 2022).
Support groups for individuals with anxiety and related issues can also be very beneficial (ADAA, 2021).

Some medicines prescribed for anxiety, such as benzodiazepines, may have side effects such as dizziness, drowsiness and/or impaired coordination (MedlinePlus, 2023); if you do experience these side effects while taking these medications, you should not drive, operate machinery or perform other functions that demand your full attention until you are aware of the effect the medicine has on you (ibid. 2023).

Always check with your doctor for potential side effects of medicines prescribed, such as antidepressants and/or any changes you may need to make in your lifestyle.

Making appropriate lifestyle adjustments to reduce anxiety can help you to establish an overall sense of wellbeing, alongside prioritising self-care in your daily routine.

The following lifestyle changes can be of benefit:

A balanced diet consisting of the three macronutrients (carbohydrates, proteins, and fats) is essential for both physical and mental health. Nuts and fish are rich in omega-3 fatty acids, which help brain function.
Mindfulness-based therapy encourages us to live in the present, reducing fear and overthinking. Mindfulness-based practices such as yoga, meditation and grounding exercises put people in the here and now, reducing anxiety (Harvard Health Publishing, 2022); breathing techniques, such as deep, slow breathing, can help calm the body when anxiety gets out of hand.
Engaging in regular exercise (such as moderate cardio and weight/resistance training) promotes physical and psychological wellbeing; exercise releases endorphins that elevate mood and reduce anxiety (Cleveland Clinic, 2022).
Alcohol and caffeine can aggravate anxiety symptoms (MedlinePlus, 2023); limiting alcohol and/or caffeine intake is recommended to reduce the occurrence of anxiety episodes.

Moreover, alcohol can cause adverse effects in its interactions with prescribed anti-anxiety drugs (e.g. antidepressants and/or anxiolytics). Both alcohol and benzodiazepines interact with the inhibitory neurotransmitter GABA and potentiate its activity; drinking while being prescribed a benzodiazepine anxiolytic (such as diazepam (Valium)) can increase the risk of addiction to both substances as well as leading to potentially life-threatening adverse effects such as respiratory depression (profoundly slowed breathing), unconsciousness (including blackouts/comas), memory loss, vomiting and multiple organ failure.

It is generally advisable to avoid drinking alcohol when taking prescribed anti-anxiety drugs, due to their potential for life-threatening adverse drug interactions.

Anxiety is a common, yet treatable, psychological condition, and you can overcome your anxiety through managing your symptoms via lifestyle changes, counselling/psychotherapy and medical support from qualified doctors and mental health professionals.

Conclusion:

In a nutshell, anxiety is a complex, although common, condition that has a number of different biological, environmental and psychological causes. Feeling anxious is a normal human response, but when anxiety is persistent or overwhelming, it can signal an underlying disorder that affects quality of life. As outlined above, awareness of the signs, knowledge of the clinical subtypes, and the use of a number of impact-reducing management techniques, from therapist-mediated interventions like CBT, to lifestyle, may play a critical role in reducing anxiety symptoms and improving general health and wellbeing (Harvard Health Publishing, 2022; NIMH, 2022). This piece serves as a reminder that the right support and treatment can go a long way in helping manage anxiety and help improve the quality of life significantly.

FAQ:

Q1: What distinguishes normal anxiety from an anxiety disorder?
A: Normal anxiety is a common response to stress or perceived threats, while an anxiety disorder involves constant or overpowering anxiety that disrupts daily activities and quality of life (MedlinePlus, 2023).

Q2: What are some common physical signs of anxiety?
A: Physical signs can include an elevated heart rate, chest discomfort, restlessness, insomnia, sweating, trembling, and digestive issues such as nausea or diarrhea (Harvard Health Publishing, 2022).

Q3: How do environmental factors contribute to anxiety?
A: Environmental factors such as stressful living or working conditions, damaging relationship dynamics, and lack of social support can all play a significant role in triggering or exacerbating anxiety symptoms (ADAA, 2021).

Q4: What are some common therapeutic approaches for managing anxiety?
A: As mentioned above, there are several therapeutic approaches and strategies for managing anxiety, including cognitive behavioural therapy (CBT), desensitisation techniques, counselling, and, where necessary, pharmacological treatments like antidepressants or anxiolytics (APA, 2021).

Q5: Can lifestyle changes really help manage anxiety?
A: Yes. Adopting a balanced diet, regular exercise, mindfulness practices, proper breathing techniques, and limiting alcohol and caffeine intake can all contribute to reducing anxiety symptoms and promoting overall mental wellbeing (Cleveland Clinic, 2022).

References:

American Psychological Association [APA] (2021) Anxiety. American Psychological Association. Available at: Anxiety (Accessed: 14/02/2025).

Anxiety and Depression Association of America [ADAA] (2021) Understanding Anxiety Disorders. Anxiety and Depression Association of America. Available at: https://adaa.org/understanding-anxiety (Accessed: 14/02/2025).

Cleveland Clinic (2022) Anxiety Disorders. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/12119-anxiety-disorders (Accessed: 14/02/2025).

Harvard Health Publishing (2022) What causes anxiety? Harvard Health Publishing. Available at: https://www.health.harvard.edu/mind-and-mood/what-causes-anxiety (Accessed: 14/02/2025).

MedlinePlus (2023) Anxiety Disorders. MedlinePlus. Available at: https://medlineplus.gov/anxiety.html (Accessed: 14/02/2025).

National Institute of Mental Health [NIMH] (2022) Anxiety Disorders. National Institute of Mental Health. Available at: https://www.nimh.nih.gov/health/topics/anxiety-disorders (Accessed: 14/02/2025).

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