Understanding Anxiety: What It Is and How to Manage It

Normal anxiety versus an anxiety disorder

Anxiety is a normal evolutionary response — the fight-or-flight mechanism — that exists to help us respond to threats. Everyone experiences it. What distinguishes an anxiety disorder is persistence (the anxiety is present most of the time or is triggered by things that are not genuinely threatening), severity (the anxiety is disproportionate to the actual risk) and functional impact (it significantly disrupts work, relationships or daily activities).

The main types

Generalised anxiety disorder (GAD) involves persistent, excessive worry about a range of different things that is hard to control. Panic disorder involves recurrent, unexpected panic attacks — sudden surges of intense fear with physical symptoms including racing heart, chest tightness, shortness of breath and dizziness. Social anxiety disorder involves significant fear of social situations and the scrutiny of others.

What works

Cognitive behavioural therapy (CBT) is the best-evidenced psychological treatment for anxiety disorders. It works by identifying and challenging the thought patterns and avoidance behaviours that maintain anxiety. Typical treatment is 8-16 sessions. Exposure therapy — systematic, gradual exposure to feared situations — is particularly effective for phobias and social anxiety. SSRIs (selective serotonin reuptake inhibitors) are the first-line medication option and are effective for most anxiety disorder types, typically taking 4-6 weeks to show full effect.

Self-management strategies

Several evidence-supported self-management strategies complement formal treatment: regular aerobic exercise (which has a clinically meaningful effect on anxiety), limiting caffeine and alcohol, prioritising sleep, and practising relaxation techniques such as progressive muscle relaxation or diaphragmatic breathing.