We all experience anxiety in our daily lives, whether in work, family situations, or relationships.

Anxiety often manifests as feelings of fear or worry, accompanied by chest tightness and physical symptoms like sweating, trembling, and a rapid heartbeat. It is often triggered by changes in our lives that feel beyond our control—such as an upcoming important event, exam results, or an argument. It can also stem from more serious events like accidents, illness, or the death of a loved one. These feelings may persist for weeks or even months.

For most people, anxiety subsides once the problem is resolved. Sometimes, time alone helps.

However, for some individuals, anxiety lingers and becomes overwhelming—out of proportion to the situation. These individuals may suffer from an anxiety disorder, which can make daily activities either difficult or seemingly impossible.

Anxiety disorders are driven by irrational beliefs about the perceived danger of certain situations or events. Studies show that people with anxiety disorders tend to overestimate the risks of various situations. These conditions last at least six months and can worsen if left untreated. Anxiety disorders frequently co-occur with other issues, including alcohol or substance use, which can either mask or intensify the symptoms of anxiety.

There are six different types of anxiety disorders:

1. Panic Disorder
2. Obsessive-Compulsive Disorder (OCD)
3. Post-Traumatic Stress Disorder (PTSD)
4. Social Phobia (or Social Anxiety Disorder)
5. Specific Phobias
6. Generalized Anxiety Disorder (GAD)

Each anxiety disorder has its own set of symptoms, but they all share one key feature: overwhelming, irrational fear.

1. Panic Disorder

Panic disorders are characterized by sudden, unexpected panic attacks accompanied by intense fear, often paired with physical symptoms like sweating, rapid heartbeat, weakness, or dizziness.

During a panic attack, individuals may experience trembling, numbness, nausea, or chest pain. People with panic disorder often avoid situations or events for fear of triggering another attack. Since they cannot predict when or where the next attack will occur, this heightens their anxiety.

Panic attacks can happen anywhere, at any time, even during sleep. Although an attack typically lasts around 10 minutes, some symptoms may persist longer. Panic attacks are often associated with reduced quality of life and impaired psychosocial functioning.

The earlier someone seeks professional help, the better the recovery prospects. Cognitive Behavioral Therapy (CBT) is a structured, often brief therapy (usually between 10 and 20 sessions). It has clear goals, aiming to correct catastrophic thoughts and fears about physical sensations. This therapy may be combined with medication and involves techniques like psychoeducation, anxiety management (muscle relaxation, diaphragmatic breathing), cognitive restructuring, and gradual exposure to situations linked to panic attacks.

A study of 76 patients with panic disorder showed that combining cognitive techniques (psychoeducation, cognitive restructuring, problem-solving techniques) and behavioral techniques (exposure) significantly improves symptom reduction and maintains these improvements for up to six months after CBT.

2. Obsessive-Compulsive Disorder (OCD)

OCD is characterized by a cycle of obsessions and compulsions that cause significant distress, dysfunction, and fear. Obsessions are involuntary, repetitive, and unwanted thoughts that lead to feelings of anxiety or fear. Compulsive behaviors are performed in response to these obsessions, offering temporary relief from the anxiety. Over time, the urge to perform compulsive behaviors grows stronger.

If an initial compulsion becomes less effective at reducing anxiety, additional behaviors or more elaborate rituals may be added to seek relief. These behaviors can become extremely time-consuming, disrupting normal functioning.

Common obsessions in OCD include:

• Fear of germs or illness (e.g., herpes, HIV).
• Concerns about using household chemicals (e.g., cleaners, solvents).
• Preoccupation with precision and detail.
• Fear of being responsible for something terrible happening (e.g., fire, burglary).
• Forbidden or disturbing sexual thoughts or images.
• Intrusive thoughts about homosexuality or inappropriate sexual urges toward others or children.
• Superstitious thoughts.

Common compulsions include:

• Excessive handwashing or cleaning.
• Repeated checking to prevent a disaster or mistake.
• Ritualistic prayers to prevent harm.
• Avoidance of situations that trigger obsessions.

The most effective treatment for OCD typically involves one or more of the following:

1. Exposure and Response Prevention (CBT).
2. A therapist trained in behavioral therapy.
3. Medication (when needed).
4. Support from family and the social environment.

Studies show that, on average, 70% of people with OCD benefit from appropriate medication or CBT. Those who respond to medication see a 40–60% reduction in symptoms, while those who undergo CBT often report a 60–80% reduction in symptoms.

Unfortunately, 25% of OCD patients decline CBT, and 50% discontinue medication due to side effects or other reasons.

3. Post-Traumatic Stress Disorder (PTSD)

PTSD usually develops after a frightening experience that involves physical harm or threat. The person may have been harmed, witnessed harm to others, or been exposed to a traumatic event involving loved ones or strangers.

PTSD can result from various traumatic events, such as robbery, rape, torture, captivity, child abuse, car accidents, plane crashes, bombings, or natural disasters like floods or earthquakes.

People with PTSD often startle easily, become emotionally numb, lose interest in activities, have difficulty feeling affection, and may become irritable, aggressive, or even violent. They tend to avoid situations that remind them of the traumatic event, and anniversaries of the event can be particularly difficult.

Symptoms of PTSD worsen when the trauma was caused intentionally by another person (e.g., robbery or kidnapping). People with PTSD frequently relive the trauma through intrusive thoughts or nightmares. These "flashbacks" can be triggered by ordinary events and may cause the person to lose touch with reality, believing the traumatic event is happening again.

Symptoms usually begin within three months of the event but may appear years later. PTSD must persist for more than a month to be diagnosed. Some people recover within six months, while others experience chronic symptoms.

Certain medications and psychotherapy can effectively reduce PTSD symptoms.

4. Social Phobia (Social Anxiety Disorder)

Social phobia is characterized by intense fear of embarrassment or humiliation in social situations.

People with social phobia fear performance or interaction situations, such as public speaking, eating or drinking in public, using public restrooms, entering a crowded room, or speaking on the phone. Finding a partner, engaging in sexual activity, or even making eye contact may be difficult for those with social phobia.

Specialized CBT for social phobia focuses on reversing the processes described in the model. Since the model emphasizes self-focus, negative self-processing, and insecurity, therapy emphasizes reshaping thought processes to reduce these negative beliefs.

5. Specific Phobias

A specific phobia is an intense, irrational fear of something that poses little or no actual danger.

Common phobias include fear of heights, escalators, tunnels, driving on highways, enclosed spaces, dogs, spiders, and blood.

People with specific phobias might easily ski down the tallest mountains but be unable to ascend past the fifth floor of a building. While adults with phobias realize their fears are irrational, they often find them impossible to control, leading to panic or anxiety attacks.

Specific phobias are twice as common in women as in men and usually begin in childhood or adolescence, persisting into adulthood. The causes of specific phobias are not fully understood, but genetics may play a role.

If the fear is easily avoidable, people with specific phobias rarely seek help. But when avoidance interferes with their career or personal life, treatment is often sought and can be very effective.

Specific phobias respond well to targeted, structured behavioral therapies.

6. Generalized Anxiety Disorder (GAD)

People with GAD spend their days filled with excessive worry and tension, even when there is no apparent reason for it. They expect disaster and worry excessively about health, money, family, or work. Sometimes, simply thinking about the day ahead causes anxiety.

GAD is diagnosed when a person worries excessively about various daily issues for at least six months. People with GAD often cannot shake their concerns, even when they recognize that their anxiety is more intense than the situation warrants. They find it difficult to relax, are easily startled, and struggle with concentration. Sleep disturbances are common.

Physical symptoms often accompany GAD, including fatigue, headaches, muscle tension, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, dizziness, frequent urination, and hot flashes.

When anxiety levels are mild, people with GAD can function socially and carry out daily activities. However, when anxiety is severe, it can make it difficult to complete everyday tasks.

GAD develops gradually and can start at any point in life, though the highest risk is between childhood and middle age. There is evidence that genetics play a small role in the disorder's development.

Treatment for Anxiety Disorders

According to most scientific studies, Cognitive Behavioral Therapy (CBT) is the treatment of choice for anxiety disorders.

CBT focuses on the role of thoughts and behaviors and is the most scientifically validated psychotherapy for anxiety disorders.

The goals of therapy are symptom remission and prevention of future anxiety episodes.

A typical CBT program for anxiety disorders includes:

• Clinical and psychological evaluation & psychosocial history.
• Psychoeducation on the specific anxiety disorder.
• Learning the CBT model of anxiety disorders.
• Symptom and emotional fluctuation monitoring.
• Managing anxiety and stressful situations.
• Addressing dysfunctional thoughts, beliefs, and behaviors.
• Improving social and work functionality and emotional well-being.

The therapist and patient work together to achieve therapy goals, with an emphasis on collaboration. Sessions are typically held weekly, and patients are often assigned homework. The therapist teaches patients to track their thoughts and behaviors and monitor their anxiety symptoms. Various cognitive and behavioral interventions are used throughout therapy to deactivate the symptoms of the anxiety disorder.

‍

Scientific Editor:
Dr. Yanni Malliaris

‍