Anxiety Disorders and Stress

Anxiety is a symptom. People who feel anxiety experience muscle tension, restlessness, panic, or a sense of impending doom. They often also have anxious thoughts, such as fears of dying of a heart attack, fears of embarrassment or humiliation, or fears of something terrible happening. In addition, they often have uncomfortable physical sensations, including heart palpitations, sweating, dizziness, or shortness of breath. Some people with anxiety disorders perform certain rituals (checking door locks or handwashing) or avoid certain situations (bridges, freeways, airplanes, or social situations) in order to cope with anxiety.

In this section, we list several different anxiety disorders. If you are not sure which one you are looking for, we recommend you read the brief description provided for each disorder. Where possible, we provide a link to other websites that provide more complete information about each disorder. We also briefly discuss psychological treatments that have been scientifically evaluated and appear to be beneficial. Although some medications are also helpful for these disorders, we do not cover them. Of course, if you are having a problem with anxiety, we recommend a consultation with a mental health professional for an accurate diagnosis and discussion of various treatment options. When you meet with a professional, be sure to work together to establish clear treatment goals and to monitor progress toward those goals. Feel free to print this information and take it with you to discuss your treatment plan with your therapist.

For more information about anxiety disorders in general, check the following sites that provide descriptions of each disorder and, in some cases, specific research results related to treatment:

This site covers the following topics:


Agoraphobia

People who have panic attacks (see Panic Disorder below for discussion of panic attacks) sometimes become afraid of going places where they might be unable to get help or return home easily. Avoidance due to fear of panic attacks is called agoraphobia. Commonly avoided places include crowded stores, standing in line, driving, elevators, restaurants, church, or being far from home.

Cognitive behavior therapy (also used to treat panic disorder without agoraphobia) and exposure are both well-established as beneficial treatments for agoraphobia. In addition, some evidence suggests that couples communication training can increase the success of exposure in the treatment of agoraphobia. While other psychotherapies may be helpful for treatment of agoraphobia, they have not been evaluated scientifically in the same way as the treatments listed here.

For more information on Agoraphobia, please click on the Anxiety Disorders Association of America website. This site gives a good definition of agoraphobia and explains how panic and agoraphobia are related.


Generalized Anxiety Disorder

As the name implies, generalized anxiety disorder is characterized by a chronic high level of anxiety and is associated with a wide variety of physical signs of arousal including trembling, feeling keyed up or on edge, being easily startled, having difficulty sleeping, and being irritable. Along with this anxiety, the person worries excessively about bad things that might happen and finds it difficult to control this worry.

Cognitive behavior therapy is well-established as a beneficial treatment for generalized anxiety disorder. In addition, some evidence suggests that applied relaxation is useful for treatment of generalized anxiety disorder. While other psychotherapies may be helpful for treatment of generalized anxiety disorder, they have not been evaluated scientifically in the same way as the treatments listed here.

For more information on Generalized Anxiety Disorder (GAD), please see the National Institute of Mental Health Generalized Anxiety Disorder Page. This site gives a good definition of GAD.


Obsessive-Compulsive Disorder

Obsessions are repetitive intrusive thoughts. The thoughts might be of things like hurting someone you love without wanting to, making a horrible mistake, or being contaminated with dirt or germs. Compulsions are very strong urges to do something over and over again, often in connection with an obsession. Examples of compulsions might be washing your hands repeatedly, checking the stove or door locks, or saving things even though they have no sentimental or monetary value. People with obsessive-compulsive disorder have either obsessions or compulsions, and often both.

Exposure and response prevention is a combination of interventions that is well-established as a beneficial treatment for obsessive-compulsive disorder. In addition, some evidence suggests that cognitive therapy is useful for treatment of obsessive-compulsive disorder. Some evidence also suggests that a specific relapse prevention program may reduce the likelihood of the problem recurring after treatment. While other psychotherapies may be helpful for treatment of obsessive-compulsive disorder, they have not been evaluated scientifically in the same way as the treatments listed here.

For information on Obsessive-Compulsive Disorder (OCD), please see the Obsessive-Compulsive Foundation. This extremely informative site gives a good explanation of the symptoms of OCD, details about psychological treatment, and links to advice and support for families and friends of persons with OCD. The OC Foundation also provides referrals for scientifically supported treatment of OCD.


Panic Disorder

Panic attacks are sudden intense waves of fear. The attack involves several intense physical signs of anxiety, including racing heart, shortness of breath, dizziness, numbness or tingling, trembling, stomach upset, and hot flashes. During a panic attack, the person often feels afraid they might die or go crazy. Panic attacks can occur as a part of several different anxiety disorders, so an evaluation by a mental health professional is important. At least in the early stages of panic disorder, the attacks occur unexpectedly. Frequently, people with panic disorder have agoraphobia as well, although it is not always the case (see the section above on agoraphobia).

Cognitive behavior therapy is well-established as a beneficial treatment for panic disorder. In addition, some evidence suggests that applied relaxation is useful for treatment of panic disorder. While other psychotherapies may be helpful for treatment of panic disorder, they have not been evaluated scientifically in the same way as the treatments listed here.

For more information on Panic Disorder, please click on the Anxiety Disorders Association of America website. This site gives a good definition of panic attacks and explains how panic and agoraphobia are related. Another good site is maintained by the National Institute of Mental Health.


Post Traumatic Stress Disorder

Those who have been involved with a life-threatening event, either as a witness or a victim, often have some difficulty in recovering from the trauma. They may re-experience the event through nightmares or flashbacks, feel generally anxious and depressed, or feel numb and disconnected from life around them. If these effects continue beyond a typical period of readjustment after trauma, the person may be diagnosed with post traumatic stress disorder (PTSD).

Some evidence suggests that exposure therapy is useful for treatment of PTSD related to combat and civilian trauma. Some evidence also suggests eye movement desensitization and reprocessing is useful for treatment of PTSD related to civilian trauma (such as rape). While other psychotherapies may be helpful for treatment of PTSD, they have not been evaluated scientifically in the same way as the treatments listed here.

Click on David Baldwin's Trauma Information site for information about the experiential and physiological features of PTSD, along with information about risk factors and other resources for trauma victims and their loved ones. The National Institute of Mental Health PTSD Page also provides good definitional information about PTSD.


Specific Phobia

Specific phobias involve intense and irrational fear of specific situations or things, such as heights, thunderstorms, driving, seeing blood, certain animals or insects, or enclosed places. Although many people have fears of these things, we would not call them phobias unless they interfere with day-to-day functioning or the person is strongly bothered by having the fear.

Exposure or guided mastery is well-established as a beneficial treatment for specific phobia. In addition, some evidence suggests systematic desensitization, a related form of treatment, is useful for treatment of specific phobia. While other psychotherapies may be helpful for treatment of specific phobia, they have not been evaluated scientifically in the same way as the treatments listed here.

For more information on Specific Phobia, please see the Mental Health Matters page that provides a good definition of this problem.


Social Phobia and Public Speaking Anxiety

People with social phobia are extremely anxious in situations that involve the possibility of interaction with other people. For some, this fear is limited to public speaking or other specific situations. For others, the prospect of interacting with just one other person in any type of situation is frightening. People with social phobia often go to great lengths to avoid being in social situations.

Some evidence suggests several treatments are useful for treatment of social phobia, including exposure treatment, cognitive behavioral group therapy, and systematic desensitization. While other psychotherapies may be helpful for treatment of social phobia, they have not been evaluated scientifically in the same way as the treatments listed here.

For more information on Social Phobia, please see the NIMH Social Phobia Page.


Stressful Events

Coping with stressors like having a medical procedure performed or taking an important test can be difficult. People often feel anxious for several days ahead of time, and some even have trouble sleeping. Everyone feels the pressure of stressors like these, but some people have so much trouble coping that they are unable to continue to function normally.

Stress inoculation training is well-established as a beneficial treatment to aid in coping with stressors. While other psychotherapies may be helpful for coping with stressors, they have not been evaluated scientifically in the same way as the treatments listed here.


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