Considering Anxiety: Overview and Treatment

Anxiety disorders are the most common group of mental health disorders in the world, with many individuals battling anxiety-related symptoms such as increased stress and hypertension. With various anxiety-inducing threats impacting our lives, health, and well-being, it can be beneficial to those suffering from an anxiety disorder to learn about the historical and current perception of anxiety, as well as the availability of effective treatments. 

Anxiety: a Short Definition

Anxiety is defined as a heightened level of adverse anticipation over a perceived threat. In essence, it is a primitive survival mechanism that has been kicked into hyperdrive: In the absence of anxiety, the mind and body begin to relax once a perceived threat (such as a tiger) disappears. However, an individual who suffers from anxiety will remain stressed, on edge, and fearful long after the threat is gone. It is this over-responsiveness to an intimidating stimulus, thought, or occurrence that makes anxiety a mental health disorder.

A melancholic woman staring at a street view

Statistical Data on Anxiety

Anxiety disorders are the most common group of mental health conditions in the world, with one in 13 individuals reportedly suffering from them. In the US, it is also the most common type of disorder, with 40 million adults, or 18.1% of the US adult population, battling an anxiety disorder.

Anxiety often coexists with other mental health conditions. This is particularly true with depression, as over 50% of those suffering from depression also contend with anxiety.

Differentiating Between Anxiety and Fear

Anxiety is similar to fear in that both involve an adverse, alert response to a perceived threat. To understand why anxiety, and not fear, is considered a disorder, it is important to take a closer look at both of these mental states.

The difference between fear and anxiety essentially comes down to two aspects:

  • Proportionality: While fear describes a measured and appropriate response to an actual threat (e.g. a large animal charging at you), anxiety is defined as a disorder due to its over-responsiveness to the possibility of a threat (e.g. becoming anxious when approaching the street where you were once bitten by a dog). 
  • Duration: Fear usually passes after the threat is averted, whereas anxiety tends to linger until it becomes a persistent source of distress in one’s life.

a lion chasing a boar

Anxiety and Depression: Two Central Themes of Mental Illness

Along with depression, anxiety is considered a central mental health symptom, with many of the mental health conditions including one or both as a defining feature.

Both anxiety and depression can evolve from facing the unknown. Depression is commonly linked to a vague sense of mourning, while anxiety is linked to a future threat, whose likelihood remains unclear.

They differ, however, in relation to an individual’s vitality or energy levels. Depression is characterized by a lack of energy as well as feelings of emptiness, sadness and longing. Anxiety, on the other hand, is seen as more of a system overload linked to having one’s energy diverted toward being adversely and overly concerned with perceived future threats, causing their attention to be hyper-focused on this aspect of their lives.

A tired man sitting, leaning head on his hand.

Anxiety Throughout History

From the Ancient World to present day, anxiety has gone through different conceptualizations and definitions, as society and individual thinkers strive to gain a better understanding of this disorder.

During the times of the ancient Greeks, anxiety was not yet considered its own disorder (unlike depression, which was already viewed as a distinct condition during this time period). Manifestations of anxiety, such as a hyper-sensitive and adverse focus on a perceived threat, were seen as an emotional problem that did not reflect a full-blown disorder. It was not until the Latin scholar, Cicero (106 BCE–43 BCE), came along that more chronic anxiety-like symptoms of adverse concern were differentiated from more temporary, adverse states, such as sadness.

The term “anxiety” stems from the Latin word “ango,” which means “to constrict.” It is also related to the word “angst,” which describes a feeling of being trapped, struggling to breathe, and optionless. All of the aforementioned sensations are known to be linked to anxiety.

Following the Classical period of the Greek and Roman empires came several centuries during which anxiety took a back seat, in terms of scholarly discussions and conceptualization. The next stage in its development came about in the 17 Century, when English scholar Robert Burton published The Anatomy of Melancholy, which offered an extensive review of an earlier incarnation of modern-day depression. Burton’s textbook also dealt with states of anxiety, describing them as a disquieting combination of fear and sorrow. 

19th Century German psychiatrist Emil Kraepelin added his own perspective to the examination of anxiety, describing it in 1913 as an inner tension that is part of several different mental health conditions. He spotted elements of anxiety in disorders such as manic depression, but refrained from identifying anxiety as a disorder in its own right.

With the publication of the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual (DSM) in 1952, anxiety was given a greater deal of attention, though initially it still was not seen as its own condition; instead, the DSM-I described it as a warning sign that an individual had repressed certain emotions or aggressive impulses. 

It was not until the 1980 publication of the DSM-III that anxiety disorders were granted an official section of their own. This edition included generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), all of which were seen as having anxiety as their central, defining feature.

More recently, the DSM-V (published in 2013) aimed to further define some of the aforementioned disorders, by separating OCD-related disorders and stress-related disorders (like PTSD) into their own sections.

Anxiety-Based Disorders

The DSM-V includes a number of anxiety-focused disorders, both within its own section and beyond it.

Anxiety Disorders

The DSM-V’s anxiety disorders section includes the following conditions: 

  • Separation anxiety disorder: increased, developmentally inappropriate distress over the thought of separating from an attachment figure. 
  • Generalized anxiety disorder: persistent and excessive worry about one or more life domains, such as school, the workplace or family life.
  • Panic disorder: acute, unexpected attacks of distress that bring on a fear of the next attack.
  • Specific phobia: fearing specific objects or situations.
  • Selective mutism: a failure to speak in public settings.
  • Social anxiety disorder: distress over social situations or interactions where one might be scrutinized.
  • Agoraphobia: a fear of open spaces, enclosed spaces, using public transport, being in a crowd or being outside and alone in specific situations.
  • Substance/medication-induced anxiety disorder: anxiety symptoms developed due to medication or substance abuse.

A child hugging their parent's leg

The above-mentioned disorders are listed within the DSM-V as part of the anxiety family. There are, however, two additional anxiety-centered disorder families included in this manual: obsessive-compulsive related disorders, and trauma and stress-related disorders.

Obsessive-Compulsive Related Disorders

The disorders included in this category pertain to obsessive thoughts and compulsive behaviors, both of which can induce anxiety. The central disorder within this section is obsessive-compulsive disorder (OCD), which is defined by obsessive, anxiety-inducing thoughts on a certain subject (such as cleanliness or fear of contamination). 

These thoughts initially cause the individual experiencing them to carry out a repetitive set of actions (such as repeated hand-washing), which is meant to assuage their anxiety. These actions eventually cease to effectively calm them down and instead become part of the ritualistic pattern of thoughts and behaviors that add to their anxiety. 

OCD and OCD-related disorders were eventually removed from the anxiety family and given their own section in the DSM. This was due to advances in research, which managed to uncover key neural pathways and structures that play a crucial role in the development of OCD. Additionally, certain treatments, such as SSRI medication and cognitive-behavioral therapy, were found to offer significant OCD symptom relief. Together, these breakthroughs helped distinguish OCD from other anxiety-based disorders, making the case for granting this condition a greater deal of focus.

Person washing hands

Trauma and Stress-Related Disorders

Trauma and stress-related disorders are believed to grow out from an acutely destabilizing occurrence. Certain disorders, such as post-traumatic stress disorder (PTSD), come about as a response to a fully traumatic event (e.g. witnessing or experiencing a physical/sexual attack or a natural disaster). Others, such as adjustment disorder, involve difficulty adapting to a stressful change in one’s life. 

Trauma and stress-related disorders were separated from the anxiety family due to increased focus on the central experiences of these conditions. Rather than always inducing anxiety, stress-related disorders were found to sometimes induce anhedonia (a lack of happiness), internalized or externally expressed anger or an asymptomatic disconnect from reality. Due to the variability in individuals’ pathological reactions to a stressful or traumatic event, it was decided to group them together in their own category, as trauma and stress-related disorders.

Effective Treatments for Anxiety

Several kinds of therapy have been shown to successfully alleviate symptoms of different anxiety-based conditions. They are:

  • Psychopharmacology
  • Psychotherapy
  • Deep TMS

Psychopharmacology

Certain types of medication have been shown to offer relief from several anxiety disorders. There are currently four groups of medication most commonly prescribed for these conditions:

Selective Serotonin Reuptake Inhibitors: Also known as SSRIs, these medications keep the neurotransmitter serotonin active for a longer stretch of time. Serotonin acts as a mood elevator and anxiolytic that decreases stress. Due to their effectiveness, SSRIs are considered a first-line treatment for anxiety. However, this group of medications can also create adverse side effectsת such as weight gain and sexual dysfunction, causing some patients to find this treatment course intolerable.

Serotonin and Norepinephrine Reuptake Inhibitors: A recent pharmacological development, SNRIs work by prolonging the activation period of both serotonin and norepinephrine. This treatment is generally considered to be as effective as SSRIs when treating anxiety disorders, with less severe side effects. That said, while SNRIs are a first-line treatment for disorders within the anxiety family, they are not considered a first-line treatment for OCD (SSRIs are a first-line treatment for this disorder).

Benzodiazepines: This group of drugs works as a sedative that quickly de-escalates feelings of increased stress and reduces muscle tension. Benzodiazepines’ powerful effect normally induces an enveloping sense of relaxation, with possible side effects including drowsiness or dizziness. Benzodiazepines are usually prescribed for more immediate short-term management of anxiety, and are not recommended for treating PTSD.

Tricyclics: This group of medications also works to prevent the reuptake of serotonin and norepinephrine, though at a different stage of their activation cycles. With the exception of social anxiety, tricyclics have been shown to effectively treat several anxiety disorders with well documented positive long-term effects. However, due to relatively severe side effects, such as hypotension, urinary retention and blurry vision, tricyclics have been found to be too adverse for many patients to continue on this medication.

a doctor prescribing medication for an elderly female patient

Psychotherapy

Out of the many different forms of talk therapy, two are more widely used when treating anxiety: cognitive-behavioral therapy and psychodynamics. 

Cognitive-Behavioral Therapy: CBT is a form of psychotherapy that helps patients break down and examine the thoughts, feelings, actions and physical sensations related to their source of anxiety. This type of therapy has been shown to effectively treat anxiety-based disorders due to a process that helps patients examine the different aspects of their condition. While in the company of a mental health professional, patients undergoing CBT gradually learn to acknowledge and withstand triggers they had previously found to be overwhelming.

Psychodynamics: Psychodynamic therapy assists patients battling anxiety by encouraging them to explore the experiences and relationships that led to the development of their disorder. As patient and therapist examine various components of the patient’s life story, they can begin to consider new alternatives, instead of the automatic responses they usually carry out when faced with a distressing trigger. Gradually, they are able to acknowledge the roots of their current struggles, relying on stabler and more well-balanced ways to face their anxiety.

Deep Transcranial Magnetic Stimulation

Deep TMS has been shown to offer symptomatic relief in certain cases of anxiety-based disorders. The treatment utilizes magnetic fields to safely and effectively regulate the neural activity of brain structures found to be associated with a number of mental health conditions.

Female patient being treated with BrainsWay's deep TMS

Deep TMS is an advancement of traditional TMS that addresses some of the shortcomings of its predecessor. Specifically, Deep TMS relies on its patented technology to reach wider areas of the brain and directly stimulate deeper brain regions. This helps avoid targeting issues while still adhering to strict safety guidelines.

As a non-invasive treatment, Deep TMS can be combined with other forms of treatment. It does not cause adverse or long-lasting side effects and does not necessitate the use of anesthesia, thereby allowing patients to continue with their daily routine following treatment.

Due to its proven efficacy and high safety standards, Deep TMS has been FDA-cleared to treat the anxiety-based disorder OCD, in addition to depression and smoking cessation.