Dr Zana Marovic, Phd

Clinical Psychologist, Johannesburg

Anxiety Disorders

Anxiety Disorders

It’s normal to worry and feel tense or scared when under pressure or facing a stressful situation. Anxiety is the body’s natural response to danger, an automatic alarm that goes off when we feel threatened.

Although it may be unpleasant, anxiety isn’t always a bad thing. In fact, anxiety can help us stay alert and focused, spur us to action, and motivate us to solve problems. But when anxiety is constant or overwhelming, when it interferes with your relationships and activities—that’s when you’ve crossed the line from normal anxiety into the territory of anxiety disorders.


Signs and symptoms of anxiety disorders

Because the anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party.

Someone else may struggle with a disabling fear of driving or uncontrollable, intrusive thoughts. Still another may live in a constant state of tension, worrying about anything and everything.

But despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:

  • Feelings of apprehension or dread
  • Trouble concentrating
  • Feeling tense and jumpy
  • Anticipating the worst
  • Irritability
  • Restlessness
  • Watching for signs of danger
  • Feeling like your mind’s gone blank
Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.

Common physical symptoms of anxiety include:

  • Pounding heart
  • Sweating
  • Stomach upset or dizziness
  • Frequent urination or diarrhea
  • Shortness of breath
  • Tremors and twitches
  • Muscle tension
  • Headaches
  • Fatigue
  • Insomnia

Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand in hand.

Since depression makes anxiety worse (and vice versa), it’s important to seek treatment for both conditions.


Types of anxiety disorders

There are six major types of anxiety disorders, each with their own distinct symptom profile: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, post-traumatic stress disorder, and social anxiety disorder.

Generalized anxiety disorder

If constant worries and fears distract you from your day-to-day activities or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety. People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over.

Panic disorder

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls or confined spaces such as an airplane.


A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia.

Post-traumatic stress disorder

Post-traumatic stress disorder is an anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event.

Social anxiety disorder

If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia.


When to seek professional help for anxiety

While self-help coping strategies for anxiety can be very effective, if your worries and fears have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.

If you’re experiencing a lot of physical anxiety symptoms, you should start by getting a medical checkup. Your doctor can check to make sure that your anxiety isn’t caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you’re taking.

If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety disorders. The therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.


Treatment for anxiety disorders

Anxiety disorders respond very well to treatment—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most anxiety disorders are treated with behavioral therapy, medication, or some combination of the two. New research has also revealed a number of beneficial complementary treatments for anxiety.

Cognitive-behavioral therapy and exposure therapy are two effective anxiety disorder treatments. Both are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. Behavioral therapy for anxiety usually takes between 5 and 20 sessions.

Medication for anxiety disorders

A variety of medications, including benzodiazepines and antidepressants, are used in the treatment of anxiety disorders. But medication is most effective when combined with behavioral therapy. When compared to those who use medication alone, anxiety sufferers treated with both therapy and medication benefit from a greater reduction in symptoms and a lower risk of relapse.

For certain types of anxiety disorders like phobias or social anxiety disorder, medication may only be needed from time to time, such as right before boarding an airplane or performing at a recital.

For other anxiety disorders, such as obsessive-compulsive disorder and generalized anxiety disorder, medication may be necessary for a longer period of treatment.

Medication may also be used in the short-term to relieve severe anxiety symptoms so that other forms of therapy can be pursued.

Complementary treatments for anxiety disorders

Several new anxiety treatments are showing promise as complements to both therapy and medication. In mild anxiety disorder cases, these treatments may provide sufficient relief on their own.

  • Exercise – Exercise is a natural stress buster and anxiety reliever. Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.
  • Relaxation techniques – When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing, and visualization can reduce anxiety and increase feelings of relaxation and emotional well-being.
  • Yoga – Recent medical studies have shown that a regular practice of yoga and meditation is effective at lowering levels of anxiety. Excessive anxiety can be alleviated through a slow, gentle yoga practice focusing on postures that calm the heart and the mind, balance the emotions, and release body tension. The following poses are known to be especially calming: child, shavasana, crocodile, seated forward bend, and seated head to knee. Pranayama (yogic breathing) and meditation will also be helpful to calm the mind and body, and to reduce stress and negative thinking. The breath plays a major role in many cases of excess anxiety. During feelings of anxiety, the breath becomes shallow, rapid and constricted, which in turn reinforces our nervous system’s state of anxiety. When practicing pranayama, yogic breathing exercises, the nervous system is naturally calmed and soothed. The practice of abdominal breathing with counting and Nadi Sodhana will be the most strongly calming to the body. Yoga Nidra is very helpful for anxiety and sleeping problems.
  • Abdominal Breathing Exercises – The abdominal yogic breath is one of the most potent relaxation tools. You can use your bed or floor to lie on your back with arms and legs apart. If you have back problem place a pillow under your knees. Start by observing your natural breath for ten rounds (one round is one inhalation and one exhalation). You will notice that as you inhale the abdomen rises and and as you exhale it falls. After ten rounds of following natural breath begin to count the lenght of each inhalation and exhalation. You should be able to count to three with each inhalation and exhalation. Do ten rounds counting lenght of three counts and then extend the count to four for both, inhaling and exhaling. Keep the count for inhalation and exhalation the same. Let the abdomen rise slowly as you inhale and at exhalation let it fall completely. During this entire process the only movement should be in the abdomen, and not in the chest area. Continue count of four for 10 rounds and then rest. As you practice abdominal breath on a regular base you should be able to extend the lenght of your breath one count each two weeks of practice. The slower the breath and the longer the count – the more relaxed you going to feel. Abdominal breathing is very useful for stress reduction, anxiety and sleeping difficulties.
  • Hypnosis – Hypnosis is sometimes used in combination with cognitive-behavioral therapy for anxiety. While in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help the client face fears and look at them in new ways.

Links and Resources

The South African Depression and Anxiety Group