There are many types of psychotherapies used to treat anxiety. Unlike counseling, psychotherapy is more long-term and targets a broader range of issues such as patterns of behavior. The patient's particular anxiety diagnosis and personal preference guides what therapies would be best suited to treat them. The ultimate goal with any type of psychotherapy, is to help the patient regulate their emotions, manage stress, understand patterns in behavior that affect their interpersonal relationships. Evidenced-based therapies like Cognitive Behavioral Therapy (CBT), Prolonged Exposure Therapy (PE), and Dialectical Behavioral Therapy (DBT) are some of the most effective at treating anxiety.

Grants and Funding: We proudly support the research and programs of 501(c)(3) non-profit organizations and institutions such as: the Anxiety Disorders program of the Jane & Terry Semel Institute for Neuroscience & Human Behavior at the University of California, Los Angeles; the Pacific Institute of Medical Research; the International Foundation for Research and Education on Depression (iFred); and SchoolsForHope.org, an iFred educational project. Working with these partners enables Anxiety.org to extend its commitment to its mission. All the donations received, as well as 100% of Anxiety.org revenue in 2019, will be contributed to build, develop, and further the understanding, investigation, discovery, and treatment of the full spectrum of anxiety and related disorders.
Anxiety disorders are associated with chronic life stress. Unpredictable, unrelenting, unresolvable stressors chronically stimulate the stress hormone system and cardiovascular system, and lead to states of constant increased activity. Biologically, the body has evolved to deal with imminent and concrete danger in the environment, rather than continuous stressors. Under normal conditions where chronic stress is low, exposure to a sudden threat activates the autonomic nervous system, i.e. increased levels of adrenaline and faster breathing, and racing heart rate. These reactions in turn trigger activation of stress hormones, such as cortisol. One of the effects of these stress hormones is to increase glucose levels in the bloodstream in order to respond to the imminent threat, so that muscles can be activated for the flight or fight response. Another effect of stress hormones is to supress the immune system, since processes such as healing and repair can wait until after the threat subsides. However, in someone with an anxiety disorder, where there is constant activation of these responses to everyday stressors, the stress hormone system loses its ability to control immune function, thus contributing to heightened systemic inflammation that increases risk for cardiovascular and even autoimmune disorders. Neuroscience and clinical research continues to investigate how anxiety disorders increase individual risk for developing physical health co-morbidities in hopes of identifying new treatments that may alleviate suffering from and prevent the development of these whole-body disorders.

While the term "test anxiety" refers specifically to students,[33] many workers share the same experience with regard to their career or profession. The fear of failing at a task and being negatively evaluated for failure can have a similarly negative effect on the adult.[34] Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[33]


[2]DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.

If you’ve ever had a panic attack, you’ll know it can be both a terrifying experience and exhausting experience. Panic disorder is a diagnosis given to people who experience recurrent unexpected panic attacks—that is, the attack appears to occur from out of the blue. Panic attack symptoms include sweating, shaking, shortness of breath, feelings of choking, chest pain, and a fear of dying.
Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen.[1][2] The maximum degree of symptoms occurs within minutes.[2] Typically they last for about 30 minutes but the duration can vary from seconds to hours.[3] There may be a fear of losing control or chest pain.[2] Panic attacks themselves are not typically dangerous physically.[6][7]
In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.[50] There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.[50]
Everyone has probably experienced panic, or something like it, at least once in their lifetime: on a disturbingly turbulent plane, or before giving an important presentation, or after realizing you hit reply all when you really, really should not have. We all know the paralyzed feeling and the heightened physical sensations. But panic attacks and panic disorder take a different shape. Panic attacks have many physical symptoms and tend to peak around 10 minutes, and may last for 30. Panic disorder is diagnosed by the frequency of these attacks, and the presence of a fear of having them. 

A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and during which time a variety of psychological and physical symptoms occur. These symptoms include rapid heart rate, sweating, shaking, shortness of breath, hot flashes, and lightheadedness—as well as a sense of impending doom, chills, nausea, abdominal pain, chest pain, headache, and numbness or tingling.
Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.

If I might make a suggestion for another coping mechanism: go near someone you trust – a friend, family member, or spouse. There’s safety in numbers, and even your subconscious knows that. Being near someone you trust can be comforting, as you’ll be able to get their help if something really does happen. It doesn’t matter if you talk to them, if they’re paying attention to you, or even if they’re sleeping – them simply being nearby and available to call upon if something happens will dull your fear.


But over time, you may find yourself experiencing more panic attacks, in a variety of circumstances. Most of these will not be entirely unexpected. Most subsequent attacks occur in response to various cues such as entering a crowded area; a traffic jam; or simply worrying about having a panic attack. But there may still be some surprises: for instance, you might have a nocturnal panic attack, which wakes you out of a sound sleep. Or you might find yourself experiencing odd feelings of depersonalization as you kill some time with friends or colleagues.

Nevertheless, if you are struggling with symptoms of an anxiety disorder it is not uncommon to feel alone and misunderstood. Because the fear that people with an anxiety disorder have is not experienced by others, they may not understand why, for example, being in a crowd of people, not being able to wash your hands after meeting a new person, or driving through the street where you got in a car accident can be really anxiety-provoking for someone with an anxiety disorder. People may comment that "there is no reason to worry about it" or that you "should just let it go".


Carbonell compares the type of breathing you’ll need with the breathing of infants, whose bellies rise and fall with each inhale and exhale. When an anxiety attack starts, exhale deeply, loosen your shoulders, and focus on some longer, deeper inhales and exhales that let your belly rise and fall. Place one hand on your belly if you need to feel this happening.
Expected panic attacks are those which occur when you are exposed to one of your triggers. For example, if you have a fear of flying you may have a panic attack when you board a plane. Expected panic attacks are again broken down into two categories: situationally bound (cued) in which a person is anticipating exposure to a particular trigger (as with our flying example), or situationally predisposed, in which a panic attack does not always occur when exposed to the feared situation.
You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are strategies you can use to cope with the symptoms as well as effective treatments.
Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect more than 25 million Americans. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives.
This confusion is why potential therapy clients and other anxiety sufferers need to educate themselves or work with an anxiety specialist. If you don’t understand the terms and their differences, you might end up treating a panic disorder you don’t actually have. In the worst case scenario, you could become dependent on a medication you don’t need. That’s why it’s vital to seek out information about your specific condition and work with someone who is knowledgeable about the challenges that condition presents.
Most people have experienced fleeting symptoms associated with anxiety disorders at some point in their life. Such feelings — such as having a shortness of breath, feeling your heart pounding for no apparent reason, experiencing dizziness or tunnel vision — usually pass as quickly as they come and don’t readily return. But when they do return time and time again, that can be a sign that the fleeting feelings of anxiety have turned into an anxiety disorder.
[3]DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.

People with panic disorder have sudden and repeated attacks of fear that last for several minutes or longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.


If you think a friend or colleague at work is experiencing an anxiety disorder or other mental health difficulty, you should carefully consider how you react. Your actions in the workplace can have work-related and legal consequences. However, intervening early before an emergency situation arises can help prevent greater consequences for your colleague's career, health, and safety.
The causes of anxiety attacks are not well understood. Some traumatic life events can set off anxiety attacks if the person is prone to depression or anxiety disorders. Also, medical conditions and some medications may trigger anxiety attacks. Many believe anxiety attacks run in families with a genetic predisposition. In other words, if your mom and her sister had anxiety attacks, it’s likely you will, too.
People with panic attacks often report a fear of dying or heart attack, flashing vision, faintness or nausea, numbness throughout the body, heavy breathing and hyperventilation, or loss of body control. Some people also suffer from tunnel vision, mostly due to blood flow leaving the head to more critical parts of the body in defense. These feelings may provoke a strong urge to escape or flee the place where the attack began (a consequence of the "fight-or-flight response", in which the hormone causing this response is released in significant amounts). This response floods the body with hormones, particularly epinephrine (adrenaline), which aid it in defending against harm.[9]
Anxiety attacks usually peak within 10 minutes, and they rarely last more than 30 minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.
Neural circuitry involving the amygdala (which regulates emotions like anxiety and fear, stimulating the HPA Axis and sympathetic nervous system) and hippocampus (which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety.[55] People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.[56] Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.[57][58]
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/. For additional resources, visit www.nimh.nih.gov/findhelp.
To receive a diagnosis of panic disorder, the panic attacks must be unexpected and during the attack four or more of the above symptoms must occur. For panic attacks that are expected, meaning they might not be expected by the individual but are expected in relation to any phobia, anxiety or other mental health disorder, four or more symptoms must also occur.

Panic attacks (or anxiety attacks - the terms are interchangeable) are intense episodes of fear which are so powerful that they trick you into fearing that you are dying, going crazy, about to faint, or losing control of yourself in some vital way. The symptoms of a panic attack feel so powerful and threatening that they convince you that you're in terrible danger.
Don’t panic. That’s a phrase we hear countless times in a day. We hear it in conversation, on TV, in the movies. We say it to ourselves. Why? Because when we panic– experience an intense sensation of fear or anxiety in response to an actual danger—we are more likely to lose control and react to potentially unsafe even life-threatening events in a frantic or irrational way. Panic inhibits our ability to reason clearly or logically. Think about the explosion of fear, the borderline hysteria you felt the day you momentarily lost sight of your six-year-old in the mall. Or the time your car skidded violently on a rain-soaked road. Even before you registered what was happening, your body released adrenaline, cortisol and other hormones that signal danger. Those hormones cause physical reactions: heart pounding, shallow breathing, sweating and shivering, shaking, and other unpleasant physical sensations.
Panic disorder is a type of anxiety disorder that is characterized by fear and worry. One of the most salient symptoms is the experience of persistent and often unanticipated panic attacks. Panic attacks are typically experienced through a combination of frightening physical sensations and distressing thoughts and emotions. These attacks bring on severe apprehension and discomfort, despite a lack of actual threat or danger.
For me it stems from witnessing my mother unconscious after her successful suicide. I was 10 years old. Just about to turn 11. I went from a lively fearless child to an overcautious adult. Now well educated and on permanent disability. Anxiety over the recent elections had me frozen for a day. Then I burst into tears the next. These attacks are linked to the day she died. I have an excellent psychiatrist. Had a breakdown in 1996. I have improved since then. But these moments come up. I want to be normal. I have PTSD and bipolar disorder.

Panic disorder can greatly impact a person's quality of life, limiting your life, and causing you to miss out on many things, including anything beyond your door. That said, there are many effective treatments and strategies which can help people overcome panic attacks. You can learn to manage the symptoms of panic disorder and regain control over your life!
Paula had her first panic attack six months ago. She was in her office preparing for an important work presentation when, suddenly, she felt an intense wave of fear. Then the room started spinning and she felt like she was going to throw up. Her whole body was shaking, she couldn’t catch her breath, and her heart was pounding out of her chest. She gripped her desk until the episode passed, but it left her deeply shaken.
Fear and anxiety are part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful - it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. But for millions of people in the United States, the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders. Types include

I don’t know what to do any more I’ve had enough I’m suffering from severe anxiety it all started 10 years ago in Spain I was getting ready to go out one evening when I experienced tingling around my eyes thought nothing of it ten minutes later all my muscles contorted I fell in a heap the doctor came and seen me telling me I hyperventilated since then it’s like it’s messed my circuit board up I’ve had to finish work I cry everyday can’t cope with the attacks I’m crying out for help cant seem to get any I’m so depressed help
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used for diagnosis of mental health disorders, and is widely used by health care professionals around the world. For each disorder, the DSM has a description of symptoms and other criteria to diagnose the disorder. The DSM is important, because it allows different clinicians and/or researchers to use the same language when discussing mental health disorders. The first DSM was published in 1952 and has been updated several times after new research and knowledge became available. In 2013, the most recent version of the DSM, the DSM-5, was released. There are a few important differences with its predecessor DSM-IV regarding anxiety disorders. First, Obsessive Compulsive Disorder (OCD) is not part of the anxiety disorders any more, but now has its own category: Obsessive-Compulsive, Stereotypic and related disorders. Second, Post-Traumatic Stress Disorder (PTSD) now also has its own category: Trauma and Stressor-related Disorders.
According to the American Psychological Association, "most specialists agree that a combination of cognitive and behavioral therapies are the best treatment for panic disorder. Medication might also be appropriate in some cases."[50] The first part of therapy is largely informational; many people are greatly helped by simply understanding exactly what panic disorder is and how many others suffer from it. Many people who suffer from panic disorder are worried that their panic attacks mean they are "going crazy" or that the panic might induce a heart attack. Cognitive restructuring helps people replace those thoughts with more realistic, positive ways of viewing the attacks.[51] Avoidance behavior is one of the key aspects that prevent people with frequent panic attacks from functioning healthily.[14] Exposure therapy,[52] which includes repeated and prolonged confrontation with feared situations and body sensations, helps weaken anxiety responses to these external and internal stimuli and reinforce realistic ways of viewing panic symptoms.
ACT is a type of CBT that encourages patients to again in positive behaviors even in the presence of negative thoughts and behaviors. The goal is to improve daily functioning despire having the disorder. It is particularly useful for treatment-resistant Generalized Anxiety Disorder and Depression. The length of treatment varies depending on the severity of symptoms.
There are a number of things people do to help cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand better can also be helpful. Avoid caffeine, which can worsen symptoms, and check with your doctor about any medications.
Yes, panic attacks can feel awful, intense, and threatening. But they aren’t harmful and generally pass when the body calms down. And yes, they can range in number, intensity, and frequency with each person experiencing a unique set of panic attack symptoms. But panic attacks and their symptoms can be overcome for good by getting the right information, help, and support. We provide more detailed information in the Recovery Support area of our website.
Benzodiazepines, including alprazolam (Xanax) and lorazepam (Ativan), may be prescribed for patients to help with more acute symptoms of panic disorder. These drugs alleviate symptoms quickly and have fewer side effects other than drowsiness, but frequent use may lead to dependence on the medication. They are not recommended for patients who have alcohol or substance abuse issues.
According to a study published in Psychology Medicine1, people who suffer from panic attacks and panic disorder may be at higher risk of heart attack and heart disease later in life. While the link between panic disorder and heart disease remains controversial, the study found that compared to individuals without panic disorder, sufferers were found to have up to a 36% higher risk of heart attack and up to 47% higher risk of heart disease. If you suffer from panic attacks, seek attention for any chest pain symptoms in order to rule out any issues with heart health.
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