Anxiety: What it is, what to do

While anxiety symptoms vary widely, odds are good that at some point you've experienced occasional physical and emotional distress signals such as panicky breathing, your heart pounding in your chest, trouble sleeping, feelings of dread, or even loops of worry. That's normal.

By itself, anxiety isn't a problem. It anchors the protective biological response to danger that boosts heartbeat and breathing, pumping oxygenated blood to your muscles as your body prepares to fight or flee. A dollop of healthy anxiety can persuade you to get to work on time, push you to study hard for an exam, or discourage you from wandering dark streets alone.

"Experiencing anxiety is normal," says Dr. Gene Beresin, executive director of the Clay Center for Healthy Young Minds at Massachusetts General Hospital. "A certain amount of anxiety can even be helpful. The problem is that sometimes the systems underlying our anxiety responses get dysregulated, so that we overreact or react to the wrong situations."

What is an anxiety disorder?

Severity of symptoms and a person's ability to cope separate everyday worries or anxious moments from anxiety disorders. National surveys estimate nearly one in five Americans over 18, and one in three teens ages 13 to 18, had an anxiety disorder during the past year.

If anxiety is persistent, excessive, or routinely triggered by situations that aren't an actual threat, tell your doctor, who can discuss treatment options or refer you to an experienced mental health professional.

What kind of anxiety disorder do you have?

As with every health issue, an accurate diagnosis is essential. A few common anxiety disorders include:

• Generalized anxiety disorder: A pattern of excessive worry about a variety of issues on most days for at least six months, often accompanied by physical symptoms, such as muscle tension, a hammering heart, or dizziness.
• Social anxiety disorder: Feeling significant anxiety in social situations or when called on to perform in front of others, such as in public speaking.
• Phobias: A particular animal, insect, object, or situation causes substantial anxiety.
• Panic disorder: Panic attacks are sudden, intense episodes of heart-banging fear, breathlessness, and dread. "It's the feeling you'd have if you just missed being hit by a Mack truck — but for people with panic disorder there is no Mack truck," says Dr. Beresin.

The costs of anxiety

Constant anxiety levies a toll on health. For example, anxiety increases levels of the stress hormone cortisol, raising blood pressure, which contributes over time to heart problems, stroke, kidney disease, and sexual dysfunction. And a 2017 Lancet study using brain scans measured activity in an area called the amygdala, which mounts split-second responses to danger and encodes memories of frightening events. Greater activity in the amygdala correlated with higher risk for heart disease and stroke, possibly, the researchers speculated, by triggering immune system production of extra white cells to fight perceived threats. In people struggling with emotional stress, this might drive inflammation and plaque formation that leads to heart attacks and strokes.

Quality of life suffers, too. Intrusive thoughts, dread of panic attacks, intense self-consciousness and fear of rejection, and other hallmarks of anxiety disorders compel people to avoid anxiety-provoking situations. This interferes with relationships, work, school, and activities as people isolate themselves, turn down opportunities, and forgo possible joys in life.

There are effective treatments for anxiety

Treatment is tailored to the diagnosis. Effective options include:

• Lifestyle changes, such as skipping caffeine, exercising regularly, and avoiding medicines or substances that might cause anxiety symptoms.
• Mind-body approaches, such as deep breathing, meditation, mindfulness, and techniques to ease muscle tension and promote calm.
• Psychotherapy, such as cognitive behavioral therapy (CBT) and exposure therapy. CBT teaches people to challenge and reframe distorted or unhelpful anxious thinking, because thoughts influence feelings and actions. Exposure therapy helps people tolerate and calm anxiety by gradually exposing a person to feared situations or objects under guidance from a therapist.
• Medicines, such as short-acting drugs called benzodiazepines, which are taken as needed when anxiety spikes. Low doses of some antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), help relieve anxiety when taken daily.

Often, a combination of approaches is best. Relieving anxiety with medicine while using CBT or exposure therapy to strengthen coping skills and help retrain the brain can do much to make anxiety manageable.