What is anxiety?

Anxiety is a feeling of fear, dread, and uneasiness. It might cause you to sweat, feel restless and tense, and have a rapid heartbeat. It can be a normal reaction to stress. For example, you might feel anxious when faced with a difficult problem at work, before taking a test, or before making an important decision. It can help you to cope. The anxiety may give you a boost of energy or help you focus. But for people with anxiety disorders, the fear is not temporary and can be overwhelming.

What are anxiety disorders?

Anxiety disorders are conditions in which you have anxiety that does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

What are the types of anxiety disorders?

There are several types of anxiety disorders, including:

• Generalized anxiety disorder (GAD).People with GAD worry about ordinary issues such as health, money, work, and family. But their worries are excessive, and they have them almost every day for at least 6 months.
• Panic disorder. People with panic disorder have panic attacks. These are sudden, repeated periods of intense fear when there is no danger. The attacks come on quickly and can last several minutes or more.
• Phobias. People with phobias have an intense fear of something that poses little or no actual danger. Their fear may be about spiders, flying, going to crowded places, or being in social situations (known as social anxiety).

What causes anxiety disorders?

The cause of anxiety is unknown. Factors such as genetics, brain biology and chemistry, stress, and your environment may play a role.

Who is at risk for anxiety disorders?

The risk factors for the different types of anxiety disorders can vary. For example, GAD and phobias are more common in women, but social anxiety affects men and women equally. There are some general risk factors for all types of anxiety disorders, including:

• Certain personality traits, such as being shy or withdrawn when you are in new situations or meeting new people
• Traumatic events in early childhood or adulthood
• Family history of anxiety or other mental disorders
• Some physical health conditions, such as thyroid problems or arrhythmia

What are the symptoms of anxiety disorders?

The different types of anxiety disorders can have different symptoms. But they all have a combination of:

• Anxious thoughts or beliefs that are hard to control. They make you feel restless and tense and interfere with your daily life. They do not go away and can get worse over time.
• Physical symptoms, such as a pounding or rapid heartbeat, unexplained aches and pains, dizziness, and shortness of breath
• Changes in behavior, such as avoiding everyday activities you used to do

Using caffeine, other substances, and certain medicines can make your symptoms worse.

How are anxiety disorders diagnosed?

To diagnose anxiety disorders, your health care provider will ask about your symptoms and medical history. You may also have a physical exam and lab tests to make sure that a different health problem is not the cause of your symptoms.

If you don't have another health problem, you will get a psychological evaluation. Your provider may do it, or you may be referred to a mental health professional to get one.

What are the treatments for anxiety disorders?

The main treatments for anxiety disorders are psychotherapy (talk therapy), medicines, or both:

• Cognitive behavioral therapy (CBT) is a type of psychotherapy that is often used to treat anxiety disorders. CBT teaches you different ways of thinking and behaving. It can help you change how you react to the things that cause you to feel fear and anxiety. It may include exposure therapy. This focuses on having you confront your fears so that you will be able to do the things that you had been avoiding.
• Medicines to treat anxiety disorders include anti-anxiety medicines and certain antidepressants. Some types of medicines may work better for specific types of anxiety disorders. You should work closely with your health care provider to identify which medicine is best for you. You may need to try more than one medicine before you can find the right one.

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

If you have an anxiety disorder, you’re not alone. Each year, tens of millions of Americans of all ages suffer from long-term anxiety. Among children, anxiety disorders are the most common form of mental illness—one they may carry into adulthood.

Anxiety is an uneasy feeling that something may harm you or a loved one. This feeling can be normal and sometimes even helpful. If you’re starting a new job or taking a test, it might make you more alert and ready for action. But sometimes anxiety can linger or become overwhelming. When it gets in the way of good health and peace of mind, it’s called an anxiety disorder.

“Everybody has anxiety,” says Dr. Daniel Pine, a psychiatrist and an NIH neuroscientist. “The tricky part is how to tell the difference between normal and abnormal anxiety.” For those with anxiety disorders, fears, worries, and anxieties can cause so much distress that they interfere with daily life. The anxiety grows out of proportion to the stressful situation or occurs when there is no real danger.

Anxiety activates the body’s stress response. Nearly all the cells, tissues, and organs in your body go on high alert. This stress response can wear your body down over time. People with chronic (long-term) anxiety have a higher risk of both physical and mental health problems. Some people visit their doctors because of headaches, racing heart, or other physical complaints without realizing that these symptoms may be connected to how anxious they feel.

NIH-funded researchers are working to learn more about anxiety disorders. They have discovered that these conditions are caused by some combination of your genes and your environment. However, the precise events that lead to anxiety disorders are still unknown. Scientists are also searching for better ways to diagnose, prevent, and treat these conditions.

Treatment for anxiety disorders usually includes both medication and cognitive behavioral therapy (CBT). CBT is a form of talk therapy. It helps people change both the thinking patterns that support their fears and the way they react to anxiety-provoking situations. Current treatments can be highly effective for most people.

Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your doctor.

Sometimes a physical evaluation is advisable to determine whether a person's anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of co-occurring symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety should wait until the coexisting conditions are brought under control.

If your doctor thinks you may have an anxiety disorder, the next step is usually seeing a mental health professional. It is advisable to seek help from professionals who have particular expertise in diagnosing and treating anxiety. Certain kinds of cognitive and behavioral therapy and certain medications have been found to be especially helpful for anxiety.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the type of disorder, the person's preference, and the expertise of the clinician.

Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out.

There are several kinds of anxiety disorders. The major types include:

• Generalized anxiety disorder (GAD). All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks.
• Panic disorder. People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last 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.
• Social anxiety disorder (social phobia). Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things. Everyone has felt anxious or embarrassed at one time or another. For example, meeting new people or giving a public speech can make anyone nervous. But people with social phobia worry about these and other things for weeks before they happen.

Closely related to anxiety disorders, but now considered categories of their own, are obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

• Obsessive-compulsive disorder. OCD is persistent, upsetting thoughts (obsessions) and repetitive rituals (compulsions), like hand washing, counting, checking, or cleaning. These behaviors are done in the hope of preventing the thoughts or making them go away.
• Post-traumatic stress disorder. PTSD is caused by trauma. This condition leads to flashbacks, nightmares, and insomnia. Often accompanied by depression or substance abuse, post-traumatic stress disorder can occur at any age, including childhood.

What medications are used to treat anxiety disorders?

Medication does not necessarily cure anxiety disorders, but it often reduces the symptoms. Medication typically must be prescribed by a doctor. A psychiatrist is a doctor who specializes in mental disorders. Many psychiatrists offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

Choosing the right medication, medication dose, and treatment plan should be based on a person's individual needs and medical situation, and done under an expert's care. Only an expert clinician can help you decide whether the medicine's ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one.

Antidepressants

Antidepressants were developed to treat depression, but they also help people with anxiety disorders. They are commonly prescribed for panic disorder, OCD, PTSD, and social anxiety disorder.

Some tricyclic antidepressants work well for anxiety. Monoamine oxidase inhibitors (MAOIs) are also used for anxiety disorders.

Benzodiazepines (anti-anxiety medications)

The anti-anxiety medications called benzodiazepines can start working more quickly than antidepressants.

Beta-blockers

Beta-blockers control some of the physical symptoms of anxiety, such as trembling and sweating.

Cognitive Behavioral Therapy (CBT)

CBT (sometimes called "talk therapy" or psychotherapy) involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand what caused an anxiety disorder and how to deal with it.

To be effective, therapy must be directed at the person's specific anxieties and must be tailored to his or her needs.

CBT can be useful in treating anxiety disorders. It can help people change the thinking patterns that support their fears and change the way they react to anxiety-provoking situations.

For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.

Exposure-based treatment has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Sometimes the therapist will accompany the person to a feared situation to provide support and guidance. Exposure exercises are undertaken once the patient decides he is ready for it and with his cooperation.

To be effective, therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. A typical "side effect" is temporary discomfort involved with thinking about confronting feared situations.

CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often "homework" is assigned for participants to complete between sessions. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.

Medication can be combined with psychotherapy for specific anxiety disorders, and combination treatment has been found to be the best approach for many people.

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.

The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one's symptoms. Family members should not trivialize the disorder or demand improvement without treatment.

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder.

The risk factors for each type of anxiety disorder vary. However, some general risk factors include:

• Shyness or feeling distressed or nervous in new situations in childhood
• Exposure to stressful and negative life or environmental events
• A history of anxiety or other mental disorders in biological relatives

Anxiety symptoms can be produced or aggravated by:

• Some physical health conditions, such as thyroid problems or heart arrhythmia
• Caffeine or other substances/medications

If you think you may have an anxiety disorder, getting a physical examination from a health care provider may help them diagnose your symptoms and find the right treatment.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) usually involves a persistent feeling of anxiety or dread, which can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

Symptoms of GAD include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating
• Being irritable
• Having headaches, muscle aches, stomachaches, or unexplained pains
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep

Panic disorder

People with panic disorder have frequent and unexpected panic attacks. Panic attacks are sudden periods of intense fear, discomfort, or sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

During a panic attack, a person may experience:

• Pounding or racing heart
• Sweating
• Trembling or tingling
• Chest pain
• Feelings of impending doom
• Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

Social anxiety disorder

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. For people with social anxiety disorder, the fear of social situations may feel so intense that it seems beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things.

People with social anxiety disorder may experience:

• Blushing, sweating, or trembling
• Pounding or racing heart
• Stomachaches
• Rigid body posture or speaking with an overly soft voice
• Difficulty making eye contact or being around people they don’t know
• Feelings of self-consciousness or fear that people will judge them negatively

Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

• May have an irrational or excessive worry about encountering the feared object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate intense anxiety upon encountering the feared object or situation
• Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

• Flying
• Heights
• Specific animals, such as spiders, dogs, or snakes
• Receiving injections
• Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

• Using public transportation
• Being in open spaces
• Being in enclosed spaces
• Standing in line or being in a crowd
• Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with. However, adults can also be diagnosed with separation anxiety disorder. People with separation anxiety disorder fear being away from the people they are close to. They often worry that something bad might happen to their loved ones while they are not together. This fear makes them avoid being alone or away from their loved ones. They may have bad dreams about being separated or feel unwell when separation is about to happen.

Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and you should work with a health care provider to choose the best treatment for you.

Psychotherapy

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at your specific anxieties and tailored to your needs.

Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that is used to treat anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises.

Acceptance and commitment therapy

Another treatment option for some anxiety disorders is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts. It uses strategies such as mindfulness and goal setting to reduce discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness.

Medication

Medication does not cure anxiety disorders but can help relieve symptoms. Health care providers, such as a psychiatrist or primary care provider, can prescribe medication for anxiety. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety medications (such as benzodiazepines), and beta-blockers.

Antidepressants

Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects.

Antidepressants can take several weeks to start working so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a health care provider. Your provider can help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

In some cases, children, teenagers, and adults younger than 25 may experience increased suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, people of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Anti-anxiety medications

Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.

Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications. However, some people build up a tolerance to these medications and need higher and higher doses to get the same effect. Some people even become dependent on them.

To avoid these problems, health care providers usually prescribe benzodiazepines for short periods of time.

If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. Your provider can help you slowly and safely decrease your dose.

Beta-blockers

Although beta-blockers are most often used to treat high blood pressure, they can help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications can help people keep physical symptoms under control when taken for short periods. They can also be used “as needed” to reduce acute anxiety, including to prevent some predictable forms of performance anxieties.

Choosing the right medication

Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with a health care provider to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. People should talk with a health care provider, so they can learn which substances are safe and which to avoid.

Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your and your provider may try several medicines before finding the right one.

Support groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Stress management techniques

Stress management techniques, such as exercise, mindfulness, and meditation, also can reduce anxiety symptoms and enhance the effects of psychotherapy. You can learn more about how these techniques benefit your treatment by talking with a health care provider.

Anxiety is a feeling of worry, nervousness, or fear about an event or situation. It’s normal for people to feel anxious in response to stress. Sometimes, however, anxiety becomes a severe, persistent problem that’s hard to control and affects day-to-day life; if you have this type of problem, you may have an anxiety disorder. About 19 percent of U.S. adults have an anxiety disorder in any given year, and an estimated 31 percent have an anxiety disorder at some time in their lives. Anxiety disorders are generally treated with psychotherapy, medication, or both. If you think you may have an anxiety disorder, talk with your health care provider.

Researchers are examining ways in which complementary and integrative approaches might reduce anxiety or help people cope with it. Some studies have focused on the anxiety that people experience in everyday life or during stressful situations, while others have focused on anxiety disorders.

What the Science Says

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

• Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
• Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
• Physical (e.g., acupuncture, massage, spinal manipulation).
• Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what the National Center for Complementary and Integrative Health (NCCIH) previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

Some complementary health approaches may help to relieve anxiety during stressful situations, such as medical procedures. Less is known about whether complementary health approaches can help to manage anxiety disorders.

Psychological and Physical Approaches

• Relaxation techniques may reduce anxiety in people with chronic medical problems and those who are having medical procedures. However, cognitive behavioral therapy (a type of psychotherapy) may be more helpful than relaxation techniques in treating at least some types of anxiety disorders.
• Although some studies suggest that acupuncture might reduce anxiety, the research is too limited to allow definite conclusions to be reached.
• Hypnosis has been studied for anxiety related to medical or dental procedures. Some studies have had promising results, but the overall evidence is not conclusive.
• In some studies in people with cancer or other medical conditions, massage therapy helped to reduce anxiety; however, other studies did not find a beneficial effect. Little research has been done on massage for anxiety disorders, and the studies that have been done have had conflicting results.
• Studies have looked at the effects of interventions involving mindfulness meditation on anxiety in various groups of people, including cancer patients, people with other chronic diseases, family caregivers, pregnant women, health care providers, employees, and students. Many but not all of these studies indicated that mindfulness was helpful for anxiety. There’s some evidence that Transcendental Meditation may have a beneficial effect on anxiety. There hasn’t been enough research to know whether mindfulness or other types of meditation are helpful for anxiety disorders.
• There is evidence that listening to music can reduce anxiety during illness or medical treatment.
• Studies suggest that meditative movement therapies (tai chi, qi gong, or yoga) might reduce anxiety, but the research is too limited to allow definite conclusions to be reached.
• Reiki and therapeutic touch have not been shown to be helpful for anxiety.

Nutritional Approaches

• Two studies, both supported by NCCIH, suggest that a chamomile extract might be helpful in managing generalized anxiety disorder, but the studies are preliminary, and their findings are not conclusive.
• Kava may have a beneficial effect on anxiety. However, the use of kava supplements has been linked to a risk of severe liver damage.
• Melatonin has been studied as a possible alternative to conventional anxiety-reducing drugs for patients who are about to have surgery, and the results have been promising.
• There isn’t enough evidence on passionflower or valerian for anxiety to allow any conclusions to be reached.

Other Complementary Approaches

• Aromatherapy and homeopathy haven’t been shown to be helpful for anxiety.

Side Effects and Risks

• Psychological and/or physical approaches are generally safe for healthy people if properly performed by a qualified practitioner or taught by a well-trained instructor. As with any physical activity, practices that involve movement, such as yoga, pose some risk of injury. People with health conditions and pregnant women should talk with their health care providers about any complementary health approaches they are considering and may need to modify or avoid some of them.
• Dietary supplements may have side effects and interact with medications.

If you have an anxiety disorder, you're not alone. Each year, tens of millions of Americans of all ages suffer from long-term anxiety. Among children, anxiety disorders are the most common form of mental illness—one they may carry into adulthood.

Anxiety is an uneasy feeling that something may harm you or a loved one. This feeling can be normal and sometimes even helpful. If you're starting a new job or taking a test, it might make you more alert and ready for action. But sometimes anxiety can linger or become overwhelming. When it gets in the way of good health and peace of mind, it's called an anxiety disorder.

"Everybody has anxiety," says Dr. Daniel Pine, a psychiatrist and an NIH neuroscientist. "The tricky part is how to tell the difference between normal and abnormal anxiety."

"For those with anxiety disorders, fears, worries, and anxieties can cause so much distress that they interfere with daily life. The anxiety grows out of proportion to the stressful situation or occurs when there is no real danger.

Anxiety activates the body's stress response. Nearly all the cells, tissues, and organs in your body go on high alert. This stress response can wear your body down over time. People with chronic (long-term) anxiety have a higher risk of both physical and mental health problems. Some people visit their doctors because of headaches, racing heart, or other physical complaints without realizing that these symptoms may be connected to how anxious they feel.

NIH-funded researchers are working to learn more about anxiety disorders. They have discovered that these conditions are caused by some combination of your genes and your environment. However, the precise events that lead to anxiety disorders are still unknown. Scientists are also searching for better ways to diagnose, prevent, and treat these conditions.

Treatment for anxiety disorders usually includes both medication and cognitive behavioral therapy (CBT). CBT is a form of talk therapy. It helps people change both the thinking patterns that support their fears and the way they react to anxiety-provoking situations. Current treatments can be highly effective for most people.

"These disorders put a huge burden on the individual, the family, and society," Bishop says. "Anxiety disorders are one of the most common reasons that people visit their primary healthcare provider."

Dr. Denise Chavira, a psychologist at the University of California, San Diego, works with anxious youth in underserved, rural areas. Her team is studying ways to make CBT more accessible to these children, who may have trouble getting to therapy sessions. To help make up for the lack of in-person contact, the researchers are examining telephone and self-help approaches that focus on teaching parents how to use CBT skills with their children.

In one study, the scientists are comparing CBT training delivered to parents by phone versus in-person CBT provided to anxious youth and their parents. With a therapist's help, parents and kids create lists of anxiety-producing situations. They learn how to face their fears gradually while using CBT coping skills. Both methods encourage parents to model brave behaviors for kids, and to let kids learn how to be independent.

NIH-funded researchers are also using advanced imaging tools to pinpoint the areas in the brain that underlie anxiety disorders. Still in its very early stages, this approach represents a major shift from how doctors usually diagnose mental illness, which is by looking at symptoms and behaviors. Using an imaging technique called functional MRI (fMRI), scientists are scanning the brain in action as it thinks, remembers, feels emotion, and regulates the body's reactions to things that cause anxiety.

Dr. Sonia Bishop of the University of California, Berkeley, uses fMRI to study people at high risk for anxiety disorders. Her team hopes to prevent anxiety disorders before patients enter a downward spiral. The researchers are working to develop a new type of CBT-related treatment that helps to retrain how patients regulate their emotions and attention.

"These disorders put a huge burden on the individual, the family, and society," Bishop says. "Anxiety disorders are one of the most common reasons that people visit their primary health care provider."

If you are troubled by anxiety, the first person to see is your family doctor or nurse practitioner. He or she can check for any underlying physical illness or a related condition. You may be referred to a mental health specialist, who might help to identify the specific type of anxiety disorder and the appropriate treatment. With proper care, most people with anxiety disorders can lead normal, fulfilling lives.

Anxiety — an overwhelming feeling of fear, dread, and worry — can make it hard for people to do everyday activities. Letting a friend or loved one with anxiety know that you support them can really help. Use these tips to start a conversation.

Show you care.

You can say:

• “How are you feeling? I’m here to listen and support you.”
• “I’m worried that you’ve been feeling anxious lately. Let me know if you want to talk.”
• “I care about you and want you to feel better. Do you want to grab lunch and talk about it?”

Remind them things can get better.

You can say:

• “Lots of people deal with anxiety — it’s nothing to be ashamed of. And it can get better with treatment.”
• “There are therapies and medicines for anxiety. Getting treatment is the best thing you can do.”
• “I know asking for help can be hard, but getting treatment can help you get back to your normal activities.”

Offer to help.

You can say:

• “I want to help you through this. Can I help you make an appointment with your doctor?”
• “How can I best support you?”
• “You can call or text me anytime if you need support — or if you just want to talk.”
• “Moving your body can help you manage your stress and feel better. Do you want to meet for a walk on Saturday?”
• “You might feel better if you talk to people who are going through the same things as you. Can I help you find a support group?”

Ask life-saving questions.

Many people who have anxiety also have depression. Check in on your friend or loved one with anxiety. For example, you might ask: “Do you feel safe?” or “Have you felt hopeless or thought about hurting yourself recently? I’m here for you. Let’s call or text the Suicide & Crisis Lifeline at 988.”