Written by Claire Vu, (NAMI CC Crash Course 2026 Volunteer)
Anxiety is a normal response to stress and can help us prepare for danger or challenging
situations. An anxiety disorder, however, involves fear or worry that is difficult to control, persists
over time, and interferes with daily life. Anxiety disorders are common, treatable health
conditions—not signs of weakness or personal failure.
There are many types of anxiety disorders. Anxiety disorders include generalized anxiety
disorder (GAD), panic disorder, social anxiety disorder (SAD), specific phobias (i.e.
claustrophobia, arachnophobia), separation anxiety disorder, and agoraphobia (fear of specific
environments). Although symptoms vary, these conditions often involve excessive fear, physical
Common signs and symptoms
Anxiety can affect a person’s thoughts, emotions, body, and behavior. Common symptoms
include:
- Excessive worry or fear that is difficult to control
- Feeling restless, tense, irritable, or constantly “on edge”
- Expecting something bad to happen
- Difficulty concentrating or feeling as though the mind has gone blank
- Trouble falling or staying asleep
- Fatigue or feeling easily overwhelmed
- Racing heart, sweating, trembling, or shortness of breath
- Muscle tension, headaches, dizziness, nausea, or stomach problems
- Panic attacks involving sudden, intense fear and physical symptoms
- Avoiding people, places, activities, or responsibilities that trigger anxiety
- Frequently seeking reassurance or repeatedly checking for danger
Symptoms differ among anxiety disorders. Generalized anxiety disorder often involves
persistent worry about several areas of life. Panic disorder causes recurrent panic attacks and
fear of future attacks. Social anxiety disorder centers on fear of judgment or embarrassment,
while phobias involve intense fear of a particular object or situation. More information is
available from the National Institute of Mental Health [1].
What Anxiety Might Look and Sound Like
Family members and friends may notice changes such as:
- Excessive worry or fear: Repeatedly worrying about work, health, finances, relationships, or everyday decisions and saying, “I know I shouldn’t be this worried, but I can’t turn it off.”
- Restlessness, tension, or irritability: Pacing, fidgeting, becoming easily frustrated, or saying, “I feel like I can’t relax.”
- Expecting something bad to happen: Preparing for unlikely worst-case scenarios or saying, “I just have a feeling something is going to go wrong.”
- Difficulty concentrating: Struggling to follow conversations, rereading the same information, or saying, “My mind keeps going blank.”
- Difficulty sleeping: Lying awake while thinking through possible problems, waking frequently, or saying, “My thoughts start racing as soon as I try to sleep.”
- Fatigue or feeling overwhelmed: Appearing exhausted by ordinary responsibilities
- Racing heart, sweating, trembling, or shortness of breath: Appearing shaky, flushed, or out of breath and saying, “My heart is pounding,” or “I feel like I can’t breathe.”
- Muscle tension or other physical discomfort: Frequently reporting tight shoulders, headaches, dizziness, nausea, or stomach problems, especially during stressful periods.
- Panic attacks: Suddenly experiencing intense fear with symptoms such as chest discomfort, dizziness, trembling, or difficulty breathing and saying, “I thought I was dying,” or “I felt completely out of control.” Panic attacks can resemble medical emergencies such as a heart attack. New or severe chest pain, dizziness, fainting, or difficulty breathing should receive prompt medical evaluation rather than automatically being attributed to anxiety.
- Avoidance: Canceling plans, missing school or work, avoiding driving or crowded places.
- Reassurance-seeking or repeated checking: Frequently asking, “Are you sure everything is okay?” repeatedly checking locks, messages, or completed work, or repeatedly researching feared outcomes online.
Risk Factors and Protective Factors
Anxiety disorders usually develop through a combination of biological, psychological, and
environmental influences.
Risk factors may include
- A personal or family history of anxiety or another mental health condition
- A naturally cautious or shy temperament
- Trauma, abuse, discrimination, significant loss, or chronic stress
- Major life changes, relationship conflict, financial hardship, or caregiving demands
- Chronic illness, pain, or other medical conditions
- Social isolation or limited access to healthcare and support
- Heavy caffeine use or the use of alcohol, cannabis, stimulants, or other substances
Protective Factors
Protective factors include supportive relationships, access to healthcare, healthy sleep and
activity routines, effective coping skills, limiting substances that worsen anxiety, gradually facing
manageable fears, and seeking help early.
Risk factors do not guarantee that someone will develop an anxiety disorder, and anxiety can
occur without an obvious cause. Protective factors can support recovery but do not replace
professional treatment when anxiety interferes with daily life.
Established evidence-based treatment
Treatment depends on the type and severity of anxiety, the person’s medical history, and
individual preferences. Psychotherapy, medication, or a combination may be recommended.
Psychotherapy: Cognitive behavioral therapy (CBT) helps people recognize unhelpful thought
patterns, develop coping skills, and change behaviors that maintain anxiety. Exposure
therapy—a component of CBT—uses gradual, supported contact with feared situations or
sensations to reduce avoidance and build confidence. Other approaches, such as acceptance
and commitment therapy and mindfulness-based interventions, may also be helpful for some
people.
- Simple CBT practices for anxiety: These exercises introduce skills commonly used in CBT. They can support coping, but do not replace professional treatment.
- Check the thought: Pause. Write down the anxious thought and ask, “What evidence supports this? What evidence does not?” Then created a more balanced thought.
- Probability, not possibility: Instead of thinking about what could happen, ask how likely it is and what you could realistically do if it occurred.
- Practice slower breathing (box breathing): Slowly inhale for 4 seconds, hold for 4, exhale for 4, and hold for four. Repeat the cycle. [2]
■ 5 Minutes Box Breathing Relaxation Exercise
Medication: Selective serotonin re-uptake inhibitors (SSRI) and serotonin-norepinephrine
reuptake inhibitors (SNRI) are commonly used for several anxiety disorders. Though
SSRIs/SNRIs are commonly known as antidepressants, multiple clinical trials have shown
SSRIs/SNRIs can reduce symptoms of GAD, panic disorder, and other anxiety disorders
[3][4][5]. Buspirone may be considered for GAD. These medications generally take several
weeks to reach their full effect. Hydroxyzine is an approved medication for anxiety and has
some modest short-term evidence. Benzodiazepines can reduce anxiety rapidly but are usually
reserved for limited or carefully monitored use because they can cause sedation, tolerance,
dependence, and withdrawal. Medication choices should be discussed with a qualified
healthcare professional.
Supplements: Supplements commonly marketed for anxiety include ashwagandha, L-theanine,
kava, chamomile, lavender, passionflower, and valerian. Some studies suggest that certain
standardized preparations—particularly oral lavender and possibly ashwagandha—may
modestly improve anxiety or stress symptoms, but the overall evidence remains limited, and
products and doses vary considerably [6][7][8]. L-theanine may promote relaxation or reduce
stress in some people, but studies have not consistently demonstrated that it treats anxiety
disorders [9]. “Natural” does not always mean safe. Supplements may cause side effects,
interact with medications, or be with liver, thyroid, kidney, autoimmune conditions, or pregnancy.
Anyone considering a supplement should first discuss it with a physician and look for an
independently tested product. Supplements have not been shown to replace psychotherapy or
prescribed medication for an anxiety disorder.
Supportive health practices: Regular physical activity, sufficient sleep, balanced nutrition,
relaxation exercises, and reduced caffeine, alcohol, and substance use may help manage
symptoms. Other complementary approaches include mindfulness and meditation, relaxation
techniques, yoga, tai chi, massage, acupuncture, hypnosis, music therapy, and art therapy.
These may help reduce stress or anxiety symptoms, but the strength of evidence varies [6].
These practices work best as part of a broader treatment plan rather than as replacements for
evidence-based care.
Treatment often requires patience. Finding the right therapist, strategy, or medication may take
time, but anxiety disorders can improve significantly with appropriate care.
When to seek professional care
Consider speaking with a primary care clinician or mental health professional when anxiety:
- Persists, becomes difficult to control, or continues to worsen
- Interferes with work, school, relationships, sleep, or self-care
- Causes frequent panic attacks
- Leads to significant avoidance or isolation
- Results in increased alcohol or substance use
- Causes ongoing physical symptoms
- Occurs alongside depression, trauma symptoms, or disordered eating Sudden chest pain, fainting, severe shortness of breath, or other new physical symptoms should not automatically be assumed to be anxiety. Seek medical evaluation, particularly when symptoms are new, severe, or different from previous panic attacks. Seek urgent help if anxiety is accompanied by thoughts of suicide or self-harm, an inability to care for basic needs, severe confusion, or immediate danger. Call 911 or go to the nearest emergency department for a life-threatening emergency. In the United States, anyone experiencing emotional distress can call or text 988 or chat through the 988 Suicide & Crisis Lifeline. A person does not have to be suicidal to contact 988.
Supporting someone with anxiety
Listen without judgment and acknowledge that the distress feels real, even if the feared
outcome seems unlikely. Instead of saying, “Just calm down,” try:
- “I can see that this feels overwhelming.”
- “You are not alone.”
- “What would feel helpful right now?”
- “Would you like me to help you find professional support?”
Avoid repeatedly providing reassurance or taking over every anxiety-provoking responsibility,
because this can unintentionally reinforce the belief that the person cannot cope. Encourage
manageable steps and professional support while remaining patient and compassionate.
Community resources and support
- 988 Suicide & Crisis Lifeline: Call or text 988 for free, confidential emotional and crisis support available 24/7.
- Contra Costa A3 Crisis Response: Call 844-844-5544 for 24-hour behavioral health crisis support.
- Contra Costa Behavioral Health Access Line: Call 1-888-678-7277 for help accessing local mental health or substance-use services.
- Contra Costa Crisis Center: Call 211 or 1-800-833-2900, or text HOPE to 20121.
- NAMI: The National Alliance on Mental Illness provides education, peer support, family programs, and local resources. Visit NAMI to find an affiliate or support program.
- SAMHSA National Helpline: Call 1-800-662-HELP (4357) or visit FindTreatment.gov for mental health and substance-use treatment referrals.
- Primary care and community services: Primary care clinics, school counselors, student health centers, employee-assistance programs, and insurance directories can help connect individuals with appropriate care.
Anxiety disorders are common and treatable. Reaching out early can reduce suffering, prevent
avoidance from becoming more restrictive, and help a person return to the relationships and
activities that matter to them.
Sources
- https://www.nimh.nih.gov/health/topics/anxiety-disorders
- https://www.nature.com/articles/s41598-022-27247-y
- https://pubmed.ncbi.nlm.nih.gov/39880377/
- https://pubmed.ncbi.nlm.nih.gov/29620793/
- https://pubmed.ncbi.nlm.nih.gov/30479005/
- https://www.nccih.nih.gov/health/anxiety-and-complementary-health-approaches
- https://pubmed.ncbi.nlm.nih.gov/35378276/
- https://www.nccih.nih.gov/health/ashwagandha
- https://pubmed.ncbi.nlm.nih.gov/30580081/
NAMI Contra Costa Warm Line
(925) 942-0767
Contra Costa County Mental Health Services Access Line
1 (888) 678-7277
Info at www.cchealth.org/mentalhealth
Comprehensive List of Social Services Programs
For a comprehensive list of Social Services Programs available, including medical, food, housing, mental health, substance use, jobs, crisis lines, etc., please dial 2-1-1 from any phone.
Mental Health Financial Counselors
To reach Mental Health Financial Counselors, please call (925) 313-7750.
Crisis Hotlines
Contra Costa Crisis Center
The Contra Costa Crisis Center is a nonprofit organization committed to providing free 24/7 services to everyone in need.
Text ‘HOPE’ to 20121 to get in touch with one of their counselors.
988 National Suicide & Crisis Lifeline
The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.
988lifeline.org
Phone: 988
