Anxiety Treatment & Therapy
Philadelphia, PA

Anxiety is very common and can be helpful in small amounts, but it can also be very challenging and debilitating. Originally, the fight or flight response that is involved in anxiety was helpful for remembering whether certain foods were poisonous and other scenarios that involved identifying something as threatening/non-threatening.

Now, it is helpful for preparing for important life events such as interviews for jobs and presentations for work or school. Or, simply looking both ways before you cross the street. Without some anxiety, you may not prepare or show up for those important parts of your life. However, since most of us are no longer focused on basic survival by hunting and gathering food, anxiety can get in the way more often than not.

Anxiety can feel embarrassing because it can negatively impact the way you perform at work or in school. It can even impact your friendships and relationships with family members. By understanding common symptoms/signs of anxiety and understanding what anxiety disorders look like, you will be better at noticing anxiety in yourself and others. Similarly, there are ways to ease anxiety and reduce anxiety in your daily life that are helpful to know and try out! 

What is anxiety

Psychologically, anxiety is anticipatory unease about events in the future that activates the fight, flight, freeze, or fawn (F4) response, which are physical responses. When we become anxious, our sympathetic nervous system becomes activated. Our brain tells our body that we need to be prepared for something. Your body then starts to prepare- you feel like you have to go to the bathroom, your hands become cold/clammy, you feel your stomach go into knots (i.e., cortisol starts to be released into the body), etc. Your body wants to maintain a level of stability (i.e., homeostasis), so over time, your body will activate your parasympathetic nervous system, which will decrease F4 response and you’ll find yourself feeling more stabilized. 

Unfortunately, for some people, our body does not stabilize very easily. While there can be anxiety directed towards certain tasks such as work or school, anxiety can also seem to have no direct cause. People vary in the way that they experience anxiety, but there are many commonalities that define anxiety (e.g., racing thoughts, inability to complete a thought, reduction inability to make a decision, knot in our stomach, tightness in our chest, strain in our shoulder muscles).

Stress and anxiety are typically used interchangeably because of their ability to activate the F4 response, but they have some differences. Stress typically lasts for a short period of time and has a direct cause, while anxiety’s cause can be unknown and the symptoms can linger for a little while. An anxiety disorder can be described as symptoms of fear or anxiety that impair a person’s daily functioning. Anxiety tends to stem from fear. Fear is an intense emotional experience in response to a threatening situation. Many times, anxiety is not caused by threatening scenarios, but the fear of the possibility of a threatening situation due to uncertainty regarding future events. Additionally, many people who have experienced fearful events in their past have stored memories of these experiences. Commonly, these memories get brought to the forefront of our thoughts in times of uncertainty. Thus, causing us to be fearful of something that seems, to our brain, as something similar to the previous event, therefore experiencing anxiety about the future event. 

Symptoms of anxiety

Symptoms of anxiety usually consist of, but are not limited to:

  • Feelings of nervousness or worry
  • Racing thoughts 
  • Feelings of dread, panic, or impending doom
  • Restlessness 
  • Inability to concentrate 
  • Fatigue 
  • Difficulty falling asleep or staying asleep 
  • Irritability 
  • Constant vigilance 

Anxiety attack signs 

A person can experience some anxiety without having dealt with an anxiety attack. Anxiety attacks are short episodes of intense fear/anxiety based on a perceived threat.  

  • Intense worry/fear 
  • Rapid heart rate
  • Hyperventilating 
  • Sweating and/or chills 
  • Fatigue 
  • Diarrhea 
  • Nausea 
  • Sweating 
  • Difficulty focusing
  • Muscle tension 
  • Headache or lightheadedness 

Panic attack signs

An anxiety attack and a panic attack are very similar, but they are often distinguished from one another. A panic attack usually occurs without a trigger, while an anxiety attack occurs due to a specific threat. 

The following are the symptoms listed for a panic attack in the DSM-V…

  • Palpitations, pounding heart, or accelerated heart rate 
  • Sweating 
  • Trembling or shaking 
  • Sensations of shortness of breath or smothering 
  • Feelings of choking 
  • Chest pain or discomfort
  • Nausea or abdominal distress 
  • Feeling dizzy, lightheaded, or faint 
  • Chills or heat sensations 
  • Paresthesias (numbness or tingling sensations)
  • Derealization or depersonalization 
  • Fear of losing control or “going crazy” 
  • Fear of dying

To read more about the difference between panic attacks and anxiety, see this article from Healthline!

How to reduce anxiety:

Short term solutions (to help your body activate the parasympathetic nervous system)

  • Practice taking deep breaths 
    • Breathe in for one second and breathe out for one second. Continue this process until your breathing is back to normal and your other symptoms of anxiety are also gone or diminished. 
  • Write down your thoughts
    • Sometimes writing all of the negative thoughts you are having can help and it can help you realize which thoughts are dysfunctional. From there, you can point out which of your negative thoughts and fears are improbable. 
  • Avoid or limit certain substances that can trigger anxiety, such as caffeine, alcohol, drugs (even over-the-counter drugs like Sudafed PE or Allegra can make people more anxious)
  • Do yoga or meditate 
    • Both of these practices are ways of calming the body down and remaining in the present moment. 
  • Take a walk 
  • Use grounding techniques (e.g., listen to a specific song, put your feet on the ground and hands on your thighs while closing your eyes and taking deep breaths, dance/move your body, hold something that you can move around in your hands)

Long term solutions

  • Cognitive Behavioral Therapy (CBT)
    • Identify worrisome thoughts 
    • Discriminate between worries that are helpful to problem-solving and those that are not
    • Evaluate beliefs in order to figure out which beliefs due to the anxiety are helpful and which are not helpful
    • Challenge irrational thoughts and replace them with positive thoughts 
    • Practice muscle relaxation
  • Practice mindfulness
    • Mindfulness can be accomplished in all different ways but they all center on remaining in the present. Ways to practice mindfulness… 
      • Close your eyes or keep them open, depending on what you are comfortable with 
      • Notice anything you are sensing around you (reserve any judgment about anything you notice) 
        • What sounds do you hear?
        • What do you see around you (if your eyes are open)
        • What do you smell? 
      • Count your breaths 
        • Breathe in 1 and breathe out 1 until you reach 10 
        • Start over at 1 until you reach 10 if you want to 
      • If any thoughts come into your mind, simply acknowledge them and do not pass judgment 
  • Exposure Therapy
    • Identify the thing that you are fearful of (usually a phobia)
    • Work with a trained specialist to go through the steps to expose yourself to the very thing that you are fearful of
    • Learn to overcome the fear and trust yourself when exposed to the thing you are fearful of
  • Trauma-focused therapy
    • Identify life experiences that got stored as fear-based memories
    • Process and understand the past experiences
    • Experience safety in the therapeutic relationship to help minimize access to fear-based memory and maximize access to healthy, self-aware thoughts/feelings
  • A healthy body = a healthy mind 
    • Incorporate some healthy practices into your life such as… 
      • Going for walks or exercising a few times a week
      • Limit caffeine 
        • If you drink 2 cups of coffee try decreasing to 1 cup a day 
      • Eat a well-balanced diet 
        • What does this mean? A balanced diet includes eating some fruits, vegetables, grains, proteins, and dairy almost every day. It is important to avoid constantly eating processed foods, but once in a while, it is okay to treat yourself. 

Causes and risk factors of anxiety 

  • Caffeine 
  • Alcohol
  • Certain medications 
  • Stressful environments 
  • Driving
  • Bullying 
  • Genetics
  • Trauma 
  • Thyroid problems 
  • Poor nutrition
  • Lack of sleep
  • Irritable bowel syndrome (IBS) (Medical providers oftentimes diagnose IBS when it’s really anxiety)
  • Anxiety sensitivity: misinterpretation of bodily sensations and changes 
  • Other psychological disorders 

Reasons for being susceptible to anxiety 

The above causes and risk factors are ways that some people are more likely to develop anxiety or an anxiety disorder. To summarize, genetically based vulnerabilities, personality characteristics, life experiences, and attention to body sensations are all important in understanding how some people are more susceptible to anxiety. Certain social stressors and cultural norms can increase the likelihood of developing an anxiety disorder. 

What does anxiety feel like? How can I recognize anxiety as anxiety?

Anxiety can feel troublesome and the signs of an anxiety attack are physical and may be misinterpreted as a heart attack. While anxiety is psychological, the physical symptoms are very real and can be extremely uncomfortable. Anxiety feels different to different people, but most people experience an emotional sense of urgency and/or uncertainty, as well as the physical symptoms listed above. Since there is not always a direct cause for anxiety, it can be confusing. Some people might wonder why they are worrying so much if they do not have anything they are worried about. 

How to get rid of anxiety

By using the techniques described above (short-term and long-term solutions) an individual might be able to lessen their anxiety or completely overcome it. However, it takes time and practice to completely get rid of anxiety. Talk therapy can be especially beneficial to a person with anxiety because they can get guidance from a clinician as to what direction they need to use for the treatment of their anxiety. It can be difficult to take time for oneself and have no guide to practicing mindfulness and CBT. Therefore, a clinician can aid an individual with anxiety and try out different practices according to the individual’s preferences.

How to help someone with anxiety

Anxiety can be difficult to recognize in others because those who experience it may mask it, don’t see it as anxiety and therefore neither will you, or it may get the wrong label (e.g., anger, lack of focus because there are not many outward physical symptoms. Therefore, many people tend to not notice when their friends or family are experiencing intense anxiety or may not recognize it as a really difficult problem. 

  • Validate and understand their feelings 
    • Allow the person to express the feelings that are troubling them while you are listening to them. This can allow them to feel seen and heard as you listen without passing judgment. 
  • Speak to them in a calming voice and ask them what they need 
    • The best way to help a person is by asking them what they need rather than assuming what they need. 
  • Help them take deep breaths 
    • Due to some symptoms of anxiety and anxiety attacks such as racing thoughts, accelerated heart rate, and hyperventilation, it is beneficial to get the person to ease these symptoms. Steadying their heart rate and breathing by practicing deep breaths with them can also ease symptoms such as difficulty concentrating. By showing the individual how to breathe in and out normally, they can mimic you and ease some of the symptoms caused by their anxiety. 

What are disorders related to anxiety?

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) is characterized by persistent intense anxiety and excessive worry in different life circumstances. Most people with GAD are diagnosed around 30 years of age and women are twice as likely to be diagnosed with GAD. However, this could be due to more women going into therapy because there is less stigmatization for women to go into therapy. For a DSM-5 diagnosis of GAD the symptoms must be present on the majority of days for at least 6 months and cause significant distress or impairment in life activities. 

Diagnostic criteria 

  • Excessive anxiety or worry occurring more days than not for at least 6 months, about a number of events or activities 
  • The individual finds it difficult to control the worry 
  • The anxiety or worry are associated with three (or more) of the following symptoms (with at least some symptoms having been present for more days than not for the past 6 months)
    • Restlessness, or being keyed up or on edge 
    • Being easily fatigued 
    • Difficulty concentrating or mind going blank 
    • Irritability 
    • Muscle tension 
    • Sleep disturbance 
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning 
  • The disturbance cannot be attributed to a substance or a medical condition 
  • The individual’s symptoms cannot be better explained by another mental disorder 

Social Anxiety Disorder (SAD) 

SAD or Social Phobia is an intense fear of being critiqued and judged in social situations. The fear is out of proportion in regards to the context and can be chronic. There is general SAD, but also performance type. Performance type SAD is directed at performance activities in front of people such as public speaking. Social anxiety tends to get in the way of leading the social life we want to lead. You may find yourself cancelling at the last minute or saying no to something you actually want to go to. The interruption of your life is what makes social anxiety so destructive for people. 

Panic Disorder 

Panic Disorder is characterized by 1 or more months of recurrent panic attacks with worry about future panic attacks and avoidance of experiencing panic attacks. The individual with this disorder would experience recurrent unexpected panic attacks. The panic attacks would involve 4 or more of the symptoms listed under “Panic attack signs”. At least one panic attack would be followed by persistent concern or worry about more panic attacks, or a maladaptive change in behavior because of the panic attacks. 

Specific phobia

A specific phobia is an intense fear of an object or situation that causes an individual anxiety when presented with the object or situation. The object or situation almost always creates immediate fear and is typically avoided. The fear and anxiety is out of proportion for the actual object or situation. For example, while snakes are threatening because they can injure or kill you, a person with a phobia of snakes could not even look at a picture of a snake. A specific phobia must last for around 6 months and cause impairment to daily functioning. 

Selective mutism 

An individual with selective mutism consistently fails to speak in a setting that expects speaking/participating, but the individual speaks in other settings. Selective mutism affects either social, occupational, or educational success and lasts for at least 1 month. The lack of speaking is not due to lack of knowledge of the language being spoken in the setting and the mutism is not due to another disorder. 

Separation anxiety disorder 

Separation anxiety disorder involves excessive anxiety when separated from a person or place due to a strong emotional attachment. Separation anxiety disorder involves 3 of the following… 

  • Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
  • Persistent and excessive worry about losing major attachment figures about possible harm to them.
  • Persistent and excessive worry about experiencing an event that causes separation from a major attachment figure.
  • Persistent reluctance or refusal to go anywhere because of fear of separation.
  • Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  • Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  • Repeated nightmares involving the theme of separation.
  • Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated. 

The symptoms must last at least 4 weeks in children and adolescents, but 6 or more months in adults. The disorder causes distress or impairment in different areas of the individual’s life and cannot be better explained by other disorders. 

Anxiety disorder due to a medical condition or medication 

Certain medical conditions such as hyperthyroidism can cause symptoms of anxiety, but this anxiety is different from GAD because it is caused by a medical condition. Similarly, a medication-induced anxiety disorder is classified as its own disorder because the individual experiences the symptoms of an anxiety disorder, but it is due to a certain medication. 

Unspecified or other specified anxiety disorders 

This category is used to diagnose people who do not have all of the symptoms of an anxiety disorder but clearly demonstrate some of the symptoms. Similarly, if you do not experience symptoms more often than not for 6 months, you can still be diagnosed with an anxiety disorder. 

How do people develop GAD?

The multipath model of diagnosis includes biological, psychological, social, and sociocultural factors involved in the factors related to the onset of psychological disorders. Biological reasons include neurotransmitter abnormalities or overactivity of the brain that are linked to anxiety. On the psychological level, people with GAD tend to have intrusive, dysfunctional thoughts and beliefs. As discussed above, CBT is useful for GAD because it helps us recognize those thoughts and feelings are distorted and continue the anxiety response. Using CBT techniques, a person can reframe how they think, which will lead to a different, less anxious feeling. Also, an individual with GAD may experience constant worrying (intrusive thoughts) and has negative schemas about the world. A person may also experience different contextual issues in their environment such as being a victim of bullying, poverty or having parents who were less engaged. 

How to know if you have anxiety or GAD

While experiencing some anxiety is difficult to deal with, GAD is more frequent and interferes with one’s daily life. GAD is characterized by anxiety that occurs more often than not for 6 months. You may feel symptoms of anxiety from time to time (ie. once a week or once a month), but it might not impact or feel as if it is dictating your life. An important question to ask yourself is whether symptoms of anxiety are present almost every day and if that anxiety feels like it is more harmful than helpful. Experiencing some anxiety about weekly exams can allow you to prepare for your exam more than you would without the anxiety. However, anxiety or panic attacks are definitely more harmful to your success and wellbeing. Also, if your anxiety is only focused on one area of your life, it would not be considered GAD. This can help you to differentiate between anxiety and GAD. 

Anxiety can be difficult to deal with, but through using techniques such as CBT or mindfulness, it can become manageable and occur less frequently. Knowing the difference between certain disorders and understanding how anxiety plays a role in certain disorders is helpful. However all of this information can be hard to implement on your own, so The Better You Institute is here to help! Call our therapists in Philadelphia today and make an appointment at 267-495-4951. We understand that even the thought of seeing a therapist can give you anxiety, and for this reason, we have set up online anxiety therapy and treatment.