Anxiety Guide

Published on Explorable.com (https://explorable.
com)
Anxiety Guide
Table of Contents
1 Why Learn about Fear & Anxiety?
2 What is Fear? What is Anxiety?
2.1 Theories of Emotion
2.2 A Brief History of Anxiety & Fear
2.3 Are Anxiety & Fear Bad Things?
3 Anxiety & Fear, Body & Mind

3.1 Fear, Anxiety & the Brain (Physiology)
3.2 The Physical & Psychological Risks of Anxiety
3.3 What about Genetics?
4 Common Anxiety Disorders

4.1 Generalized Anxiety Disorder (GAD)
4.2 Panic Disorder
4.3 Social Anxiety Disorders
4.4 Obsessive-Compulsive Disorder
4.5 Trauma Disorders & PTSD
4.6 Depressive Disorders
4.7 Phobias & Test Anxiety
5 Therapies for Anxiety

5.1 Cognitive Therapy
5.2 Behavioral Therapy & Exposure
5.3 Cognitive Behavioral Therapy (CBT)
5.4 Other Anxiety Therapies
5.5 Online Anxiety Treatment
5.6 Medication
6 Coping & Acceptance

6.1 Anxiety Tips: Diet & Exercise
6.2 Anxiety Tips: Social Strategies
6.3 Anxiety Tips: Mindfulness & Breathing
6.4 Embracing Uncertainty (Your "Negative Capability")
7 A New Appreciation
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1 Why Learn about Fear & Anxiety?
Fear and anxiety are natural emotional responses to life situations. They have both
positive and negative effects on our daily lives, and should be approached with
curiosity and openness.
"You gain strength, courage, and confidence by every experience in

which you really stop to look fear in the face. You must do the thing
which you think you cannot do."
—Eleanor Roosevelt
Fear is a primary ingredient of life; to feel fear is to feel life itself.
Fear keeps us safe from danger, motivates us to achieve, puts a wrench in our best-laid
plans, and brings in billions of dollars per year in movie sales. Depending on the
circumstance, a sense of fear may save your life or convince you to botch an opportunity.
Fear's close cousin, anxiety, also has a long history of helping and hindering the human race.
It goes without saying not everyone enjoys feeling scared or anxious. These are emotions,
after all, which convince us things are horribly wrong, or at the very least have a high
probability of going very wrong. They prime us to take action, to protect ourselves and our
interests. They convince us that stakes are always sky high, life-and-death.
Besides, who wants to show compassion toward an emotion that sets our heart racing, our
palms drenching, and sets off a mental hurricane of "What Ifs?"
What you may not realize is that there are many benefits to their alarms having a hand in our
lives, just as there are many inconveniences. When anxiety and fear take over, it can be
immensely difficult to recognize their positive aspects, the opportunities they give us to learn
about what scares us, and the window to react to anxiety-inducing situations with stronger
purpose and understanding.
The modern age is beset with high anxiety and fear. Our interconnected world has the
potential to bring doom to the doorsteps of countries and peoples on a massive scale and
quicker than you can imagine. Ecological disasters and extremist behavior have never been
so close to everyone on Earth. It can almost feel like the human race has a gun against its
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head!
Take some of these stats, for instance. They illustrate how anxious and fearful people around
the world are today:
Anxiety disorders are the most common mental disorders in the world. One study shows
7.3% of all people on earth (520 million people) suffer from an anxiety disorder.
As of 2015, the World Health Organization (WHO) is in the midst of collecting anxiety
data from 26 countries. In all but 1 of the first 14 countries surveyed, anxiety disorders
are routinely more prevalent than mood disorders and incidents of substance abuse.
In the United States, the average onset age for anxiety disorders is 11 years old, with
30% of 18 to 29-year olds and 35% of people aged 30-44 suffering from some condition.
40 million United States adults suffer from some form of anxiety and only 1/3 of them get
treatment.
The UK reports 1 in 6 people experience either an anxiety or depressive disorder each

year, affecting 3.3% of children and young adults. 1/5th of UK citizens with anxiety do
nothing to help themselves.
These number may surprise you, probably even frighten you. This is exactly why learning
about anxiety and fear—how they work, what conditions they spawn, and ways to cope and
accept them—is so vital. Our interconnectedness demands a nuanced and educated view of
the best and worst of what anxiety and fear have to offer our species. And the truth is, despite
the apocalyptic scenarios we imagine so easily, these emotions have a lot to add. Their
praises have gone unsung in a world rattled by global threats and everyday cries of
destruction, and their most extreme aspects have overshadowed rational debate or curiosity
about what they help us achieve.
Plus, as a person well-acquainted with how fear and anxiety influence your personal thoughts
and behaviors, you'll give yourself chance after chance to respect how these emotions protect
what matters most and how living alongside them fuels some of your best aspects.
Furthermore, a wide knowledge of fear and anxiety disorders helps you empathize with the
thousands of people diagnosed with these conditions every year. And investigating the
untapped power of the unknown may inspire you to think of fear and anxiety as the complex
tools they are—tools that you can cope with and use all throughout your life.
The goal of this course is to look at anxiety and fear from a number of biological and
psychological perspectives. We'll look at the difference between anxiety and fear, their pros
and cons, and the theories which explain how these emotions developed. From there we'll
explore the biological mechanisms driving them and the risks of prolonged fear and anxiety.
To learn the full scope of anxiety, we'll next discuss the most common anxiety disorders
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—from Generalized Anxiety Disorder (GAD) to PTSD and test anxiety. The final parts of the
course look at how best to treat and cope with anxiety in your life (offline and online therapies)
as well as the many reasons to be appreciative for the positive things these feelings allow you
to do.
The world is a scary place, but fearing fear is no cure for anxiety. Learning about the theories,
science, conditions, and treatments behind anxiety gives you tremendous insight and power
over the things that scare you and make you anxious.
No matter your culture or heritage, we're all citizens of anxiety and fear. The more we know
about these unsettling lands, the better we can cope with their pitfalls and dangers, and the
better we can use their resources to our advantage.
Let's begin!
How to cite this article:
Garrett Ray Harriman (Jun 26, 2015). Why Learn about Fear & Anxiety?. Retrieved from
Explorable.com: https://explorable.com/why-learn-about-fear-and-anxiety
5
2 What is Fear? What is Anxiety?
Fear is an emotion that helps protect us from immediate danger. Anxiety is an emotion
that helps us imagine and prepare for future danger. Both are integral to the human
experience.
Ever driven on an icy road? How about on an icy road during a particularly bad snowstorm?
Your mind and body were probably hyper-focused on your body and your environment. You
made sure to drive slow and were careful not to skid out. You checked your mirrors and
unfogged your windows. Even if you were confident that your tires were strong enough to take
on this excursion, and even if you were used to driving in this weather, fear kept you focused
and alert. Every motion of your body and thought in your mind likely existed in that moment to
help you survive this trip.
Now think back to a time in school when you had to present something in front of the class.
Your teacher or professor probably gave you ample time and resources to prepare in
advance. You were aware of the dates when all of the pieces were due, who your group
members were, and estimated how long certain tasks would take to complete. This pre-
planning and forethought is the domain of anxiety—to prevent future failure and the "danger"
of not completing the assignment, you prioritized your tasks and set deadlines for yourself.
Personality factors and life experiences may have led anxiety to take too many liberties with
your attention—you may have "stressed out" to a degree out of proportion with the task at
hand, catastrophizing and imagining all of the worst outcomes.
Even if these two scenarios have never directly applied to you, it's easy to relate to the
feelings they evoke. The first example highlights the emotion fear at work. It activates in the
present when your body and mind tell you that a dangerous situation is happening. It directs
your attention to the most vital actions and thoughts you need to put yourself at ease and
move out of harm's way.
The driver in this situation could have listened to and reacted to fear in any number of ways.
She could have pulled over to the side of the road in an effort to let the storm pass or to calm
herself down. Or she could have reminded herself that she was being cautious, that she had
driven in worse weather before, and let her fear dissipate into a guiding force.
In the moment, anxiety may feel very similar to fear. It activates many of the same chemical
systems and brain structures which come alive for fear. Many bodily sensations that
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accompany anxiety—racing heart, sweaty palms—also make an appearance with fear.
The major difference is one of time and perspective. Anxiety is always an emotional reaction
to stress, danger, or possible negative outcomes that exist in the future. Fear is present;
anxiety is past and future.
If there is no immediate way to explain your feelings of unease, if something is unknown or

out of your immediate control, anxiety is at work. You're not concerned with failing the
assignment in the moment—after all, it isn't yet due—but your actions are preparing you the
best they can to avoid the outcomes you imagine might happen should you fail the
assignment—bad grades, failed courses, ridicule from classmates. You may even take these
imagined scenarios to an extreme: "If I fail this assignment, I'll never pass this course! I'll flunk
out, have to abandon school, and join the circus!"
Fear and anxiety are both integral emotions to the human experience. They act in similar and
unique ways to keep our wits about us in situations where danger or failure is either a real or
untested possibility. They can also be exaggerated and taken much too far. And, as we'll see,
despite the uncomfortable ways they may make you think and behave, there are many
beneficial aspects to healthy senses of fear and anxiety in our lives.
This section of the course gives you a brief overview of what fear and anxiety are—
how these emotions likely came about in human development and what purpose they serve
us in the modern world. The section after this one exposes you to how anxiety and fear
manifest in the brain chemically, physically, and psychologically.
Remember: Fear is about the known present; anxiety is concerned with the unknowable
future.
Examining the history and usefulness of these emotions will bring you one step closer toward
understanding how they advocate for your survival and success every day. With these basics
firmly in mind, learning how these emotions cause so many people long-term psychological
pain will increase your sensitivity and awareness of how you react to these emotions in your
own life and how you may eventually cope with them more productively in the future.
Garrett Ray Harriman (Jun 26, 2015). What is Fear? What is Anxiety?. Retrieved from
Explorable.com: https://explorable.com/what-is-fear-and-anxiety
7
2.1 Theories of Emotion
Anxiety and fear are emotional states. A brief overview of what emotional states are
and how they work will prepare you to fully understand the specifics of fear and anxiety.
Fear and anxiety may feel similar in daily life. We may even talk about being fearful and
anxious as the same thing. As we'll see, these emotions share many biological similarities in
the mind but they are fundamentally different neurobiological experiences. They do, however,
share one very common thread: They are both emotions.
What Are Emotions?

As this course will talk at length about two specific emotions, it's a fine idea to have a basic
understanding of what emotions are and how they work. (For an intensive look into emotions,
click here, here, and here.)
You may be tempted to write off emotions as "feelings." After all, since most of us live under
the constant presence of emotions, it can be hard to define what they truly are. At their core,
emotions are our reactions to sensations and events in the world as well as our subjective
reactions to our own thoughts. Of course, these reactions aren't merely abstract—they are
usually followed by certain physiological sensations. Where fear and anxiety are concerned,
these could include increased heart rate, a rise in blood pressure, and sweaty hands and
palms.
Many theories have put emphasis on certain facets of emotions to explain them. The James-
Lange theory of emotion states that emotions are the biological outcome of our reactions to
stimuli (a basic cause/effect cycle). The Cannon-Bard theory posits that we experience
emotional arousal at the same time we interpret a stimulus. And the Schachter-Singer theory
emphasizes the cognitive (interpretive) role we introduce into emotional states. Emotional
states don't merely activate some biological series of events; it is our ability to interpret these
stimuli and give them context which colors and changes how we experience emotions.
These theories show the wide interest and many minds that have worked to understand
emotions since psychology's beginnings. Evidence and experiments will continue to test and
revise these theories, but one thing remains certain: Our emotions are both biological and
cognitive, and their interplay helps us feel the world with exquisite richness.
Evolutionary Theories
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The above theories may help us comprehend how emotions happen, but where did they first
come from? Evolutionary theory provides yet another explanation for emotions.
As we've seen, stimuli in the environment "arouse" certain emotional states. These states
then trigger a cascade of particular physiological reactions, and our cognitive (thinking) mind
further categorizes and shades these signals.
During early human development, many scientists believe that the emotions we experience
today—especially "primal" ones like anxiety and fear—were biologically "selected' for their
adaptive advantages and then transmitted through subsequent generations. These reactions
appeared under very specific situations that then generalized and grabbed a frim hold of our
evolutionary development.
For example, the fear response would activate if an early hominid was out hunting and came
across a fierce predator. This reaction alerted our distant ancestor that danger was present
and its life was in danger. It could decide to fight, run away (flight), or freeze in place to
survive another day.
By contrast, another hominid who paid no mind to its fear reaction would have been easy prey
indeed. Over generations, the sequence of arousal patterns and physiological reactions took
root in our early ancestors. All emotions—from guilt, compassion, anxiety, and fear—likely
have evolutionary origins akin to these. They all act to aid our survival, both socially and
physically.
It's amazing to think that all of our modern emotions have a common point of origin during our
species' emerging development. The same feelings that kept our ancestors alive and able to
reproduce flow in our bodies and minds, too. Regardless of the specifics, the function of
emotions, including the much-maligned fear and anxiety, solely exist to help us navigate and
survive our day-to-day lives. They do what they have always done - it is in many cases the
dangers (or imagined dangers) that have changed.
Garrett Ray Harriman (Jun 26, 2015). Theories of Emotion. Retrieved from Explorable.com:
https://explorable.com/theories-of-emotion
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2.2 A Brief History of Anxiety & Fear
Fear and anxiety have been thought about and explained in many different ways
throughout history. Our understanding of these emotions would be incomplete without
a brief look back at older theories of emotions and the roles of anxiety and fear.
The last section explored the general history of emotions and current theories surrounding
them. You now know that emotions are the results of both biological and cognitive processes
that allow us to respond to and interpret danger in our inner- and outer-environments.
But what about the "problem" emotions fear and anxiety? How have we come to understand
them specifically, and how do they aid our survival? These answers are integral to the history
of emotion itself. We'll cover the highlights of how people have thought about these emotions
in brief. You may even recognize some similar ideas about living a "balanced life" at work
today!
Theories of Fear and Anxiety

Fear and anxiety have long theoretical histories. Today, medical and psychological science
agree that fear and anxiety are emotional states accompanied by very specific bodily
sensations. But fear has fascinated many minds throughout history, and many explanations
were given to rationalize fear's origin and purpose.
Ancient Greeks
The ancient Greek philosophers had many ideas and explanations for the origins,
mechanisms, and outcomes of fear and anxiety. Though their scientific and medical
knowledge was limited, it is still fascinating to learn how inclusively they thought about fear.
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Aristotle felt that fear was the opposite of confidence. To him, the world was reducible to
pairs of opposites, (hot and cold, wet and dry). It was also from his school of thought that we
associate great men as those who suffer through fear and anxiety. Great men and women are
the ones who overcome fear's effects. The cure for fear was to act in virtuous ways, including
being courageous. Much in contrast to today's mantras, Aristotle did not advocate the pursuit
of "fearlessness." To be fearless was a sign of true "imbalance" of the opposite life pairs
discussed earlier. It was considered crazy to not fear the gods and the all-consuming
influence they had on the environment.
Aristotle believed fear worked in the body via body heat and blood. An angry person's blood,
for instance, was said to radiate away from their heart and cause their angry behaviors and
thoughts. Fear was the opposite: blood contracted toward the heart, making the body cold and
leading to many of the physical symptoms (trembling, sweating, urinating) that very fearful
people experience.
Epicurus was another great fear thinker for his time. Unlike Aristotle, he believed that it was
best to avoid and predict fear, not overcome it through virtuous acts. This perspective came
from his view that life was composed of tiny particles (atoms) and that the configurations of
these atoms in a person's body and soul led to unbalanced irreducibles. He felt that the mind,
body, and soul were all composed of these atomic sheets, which was why fearful thoughts
and acts could both feel so painful. He advocated that fearful people's best chance at avoiding
fear altogether was to adopt this atomic viewpoint, and thus take their fear away from the
power of the gods.
Galen, another Greek thinker, also agreed with the Aristotelean idea of "balances" of opposite
elements controlling thoughts and feelings. The goal of existence was to try to reach the ideal
"balance" of all these elements to live a fulfilling inner and outer life. To Galen, in cases of
extreme fear and anxiety, these balances were so off-kilter that some people suffered fears of
imaginary things. He was also very curious about explaining the physical symptoms of fear in
terms of these extreme imbalances. For instance, he felt trembling was caused by bearing too
heavy of an emotional burden.
Medieval Views & the Renaissance
You've seen that the Greeks' view of medicine and mental moods were intimately connected,
just as they are today. Schools of thought remained largely the same for centuries after. The
mechanism from the imbalances and interactions of the elements to imbalances and
interactions of atoms in the soul and body held true through the medieval period and the
Renaissance.
Medieval doctors and thinkers likewise believed that a person's health and wellness was
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dictated by their balance and imbalance of bodily fluids. This system stemmed from the
Greeks, specifically Hippocrates (460-370 BCE). In many ways an extension of the irreducible
elements of the Greeks, the concept of bodily humors dominated Medieval and parts of
Renaissance thinking. The body was thought to be composed of four "humors," or fluids, that
determined not only the mental and physical health of people's lives, but their entire
dispositions and personalities.
Like the Greek irreducibles, an "imbalance" of certain humors over others determined how
prone you were to certain temperaments and medical conditions. The four humors were black
bile (melancholic, sad or depressed), yellow/red bile (choleric, easily angered or disturbed)
blood (sanguine, optimistic and courageous), and phlegm (phlegmatic, calm and patient). We
still use these terms today when speaking in generaliteis of personality and disposition!
Based on this humoric approach, fear and anxiety, and their related consequences of mood
and body, were not interpreted as caused by life experiences or outside factors. You were
simply fearful or anxious because that was your temperament, you specific humoric
configuration. Doctors of the era prescribed changes in environment, diet, and even
bloodletting to try to restore the humor balance of people afflicted with an overabundance or
scarcity of a certain type.
Garrett Ray Harriman (Jun 26, 2015). A Brief History of Anxiety & Fear. Retrieved from
Explorable.com: https://explorable.com/history-of-anxiety-and-fear
12
2.3 Are Anxiety & Fear Bad Things?
When out of proportion with real threats, fear and anxiety have the power to disrupt
your life and your goals. At their cores, however, these emotions exist to keep you safe
and positively impact your well-being.
You've now learned some general information about anxiety and fear—their differences,
their theories, and their unique interperative histories. The elephant in the room is still
unanswered:
"Are anxiety and fear bad things?"
This question can be difficult to answer; it's tempting to speak in sweeping generalities. There
are instances in life when your body's fear response and your mind's anxious racing can
either get you into or out of trouble. Like all emotions, even though some may make us "feel
bad," the reason for their existence is deeply connected with preserving our mental and
physical well-being. Anxiety and fear are no exception.
Let's take a quick look at some outright positive experiences anxiety and fear permit us to be
a part of. Then you can decide for yourself if they are truly obstacles preventing your from
healthy living.
Survival
As previously explored, your fear response is a primal survival mechanism. Your mind
releases a swill of chemicals and neurotransmitters to many different brain centers (which
we'll look at in-depth here) which activate your "fight, flight, or freeze" response. If the danger
is immediate and has the potential to injure or kill you, your body and mind prep for whichever
option is most viable and likely to aid your survival. You can thank a long evolutionary chain of
choices for this protocol.
The thing to keep in mind, especially in today's "Age of Anxiety," is recognizing that this
evolutionarily-perfected danger alert system is still ticking away deep within us. For millions of
people, day-to-day survival no longer factors in predators or life-or-death struggles. All the
same, you may continually find yourself scared, truly terrified, in modern stressful situations or
be thrust into "fight, flight, or freeze" mode when facing modern problems. Money issues,
keeping appointments, relationship fallout—all of these scenarios and more may be perceived
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by your senses and interpreted by your brain as serious threats.
In other words, your fear response is not very adept at discerning modern threats (the non-
mortal kind) from threats of survival (a car accident). Depending on your arousal level and a
mix of genetic predispositions and life events, certain daily tasks may overwhelm your
thoughts and feelings, precipitating an exaggerated fear response to what might be a
stressful, but non-life-threatening, situation.
When people talk about fear as a "bad thing," this trigger-happy aspect of our fear system has
helped form that opinion. Later in this course, we'll look at ways to alleviate and cope with
your own personal fear responses and anxious thought cycles. For now, rest assured that
your fear response's main goal is to keep you safe. It may misinterpret its environmental and
cognitive cues, causing undue duress from time to time, but fear does its job to its full extent
whenever you truly need it. Fear is there for you through thick and thin.
Self-Control and Decision-Making

Fear is also a key factor in promoting a healthy sense of right and wrong and self-control. The
amygdala, the brain center responsible for the fear response, also inhibits other "impulses"
thanks to an evaluation of threat or risk. This flies counter to what you may believe:
"If only I didn't get afraid, I'd make great decisions all the time!"
There are times when unnecessary fear and risk assessment certainly help performance and
long-term goal achievement, but without fear's initial emotional evaluation, our self-reflective
cognitive processes wouldn't have a baseline of "acceptable" behavior. Fear helps keeps our
decision-making and self-control in check, especially where emotional content is concerned.
Read up on this case study for a particularly impactful example.
Interpretation is Everything
Research tells us that fear, anxiety, and stress are neither positive nor negative. Instead, it is
our reactions to these emotions, and the situations in which they're aroused, that seem to
"pick their path" in our minds.
Dr. Kelly McGonigal of Stanford University delivered a powerful talk about these findings. She
cites a study of 30,000 American adults who, if they believed that stress was not harmful to
them, had the lowest risk of dying compared to people who believed stress was harmful (43%
of whom died). Their physical stress responses (constricted heart blood vessels) also
changed for the better when they interpreted stress as challenge, not danger.
She also describes how the fear and anxiety we feel surrounding stress are more complex
than mere physical reactions: Stress turns off brain centers responsible for long-term
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planning, which is a big reason why prolonged fear and anxiety halt progress. It's also for this
reason that prolonged stress and cycles of fear and anxiety can be so devastating to the body
(more on that here).
Overall, believing that the mental and physical reactions of stress aren't signalling a failed
coping resonse, but instead telling you that you are physically and mentally preparing to meet
a challenge head-on, has profound effects on your reactions.
So are anxiety and fear "bad?" It all depends on your outlook, your reaction to these emotions
when they arise, and your ability to remember that fear and anxiety have helped humanity
reach where it sits today.
Garrett Ray Harriman (Jun 26, 2015). Are Anxiety & Fear Bad Things?. Retrieved from
Explorable.com: https://explorable.com/are-anxiety-fear-bad-things
15
3 Anxiety & Fear, Body & Mind
Like all emotions, anxiety and fear are the products of physiological and psychological
processes working together.
It's easy to forget that anxiety and fear are internal things, not external things. After all, we feel
scared at events that happen outside of our minds, and things we become anxious about feel
like physical places and events that our minds make real.
The truth to remember is that fear and anxiety are the products of our internal biological and
psychological assessments of things both inside and outside or our control. We may fear the
wolf that lunges toward us behind its cage at the zoo or become anxious about an upcoming
job interview in similar physiological ways.
Learning about the internal mechanisms, the chemicals and patterns of thought, that lead to a
fearful or anxious response can give you a wider perspective on these emotions at work.
Some people don't like acknowledging that the things they "feel" are the outcome of various
biological and chemical signals spurring them into action or defense. Feelings, some may
argue, should be divorced from the scientific ways they manifest themselves, as if
understanding the amazing processes that allow us to feel these things somehow undermines
the feelings themselves.
You are free to feel this way yourself, but this perspective has its limits. For starters, if you
constantly find yourself anxious about a certain situation—maybe walking in the woods and
imagining all the ways you could get lost—you externalize your own part in the design of
these emotions. You may even come to think of yourself as "just this way" and not try to
actively understand why you react as you do or what your body and mind are telling you about
these scenarios.
Although it may seem dry on the surface, the basic functions of our emotions and their
interplay of chemical messengers and physiological arousals give us a great chance to
introspect, to probe what ails u,s and go forward with plans to help alleviate our own fears and
anxieties. The truth is fear, as a response, is largely out of our conscious control. It has
evolved over millions of years of evolution to automatically trigger us to fight, flee, or freeze in
the face of dangerous odds or events.
Knowledge that this automatic response is also a feeling, a very powerful one at that, puts the
16
entire process into greater relief. Instead of resigning yourself to "always being afraid" or
"always being anxious" of certain situations, even a cursory understanding of how these
emotions affect your body and mind gives you many more avenues of thought and self-
compassion to travel down. You don't have to be a passive observer of your feelings or be
scared of why you're scared. Instead, you realize that your responses are natural, that
everyone experiences them through the same chemical processes, and therefore feeling
ashamed or embarrassed by anxious or fearful reactions won't stop them from happening.
Knowing exactly how fear and anxiety "happen" in the mind won't itself stop these feeling in
their tracks, but it will give you greater perspective on how and why you may be reacting and
feeling a certain way, to see patterns in your own thinking and behavior that you can work on
and learn to cope with better.
In this section, we'll look at the neurological processes behind anxiety and fear. How do these
emotions manifest in our bodies and minds, and how do these manifestations guide our
behavior and thinking? What are the risks of continuous anxiety, and what role does genetics
play?
Along the way, you'll find that there is a grand evolutionary design behind these often
troublesome emotions that connects you to every other human on the planet. And you'll be
able to use what you learn hear to increase your self-awareness and take the first steps you
need to approach what situations, real or imagined, put fear in your heart or anxiety in your
future.
Garrett Ray Harriman (Jun 26, 2015). Anxiety & Fear, Body & Mind. Retrieved from
Explorable.com: https://explorable.com/anxiety-fear-body-mind
17
3.1 Fear, Anxiety & the Brain (Physiology)
The brain structures and neurological mechanisms behind anxiety and fear are well-
known by science. To understand and cope with these emotions in your life, you must
first learn the basic physiological patterns that they follow.
With the theory, history, and a new view on the effectiveness of anxiety and fear now in mind,
it's time to map out exactly how these emotions manifest inside the brain. There are many
brain structures, chemicals, and processes at work in the brain during a fear- or anxiety-
arousing situation.
Luckily, the process always unfolds in the same fashion. Once you become familiar with the
neurophysiology of fear and anxiety, you'll gain the psychological resiliency to realize that your
own patterns of coping with these emotions are never up in the air. They have a firm biological
set of instructions to follow; know the pattern, and you will know that your own patterns of
interpretation are what count.
Emotion & Perception

We'll begin with the perception of fear. Sometimes it may appear that a feeling of fear or
anxiety comes out of the blue, that these emotions simply show up unannounced whenever
they feel like it. It's important to understand that emotions always follow perception. You
cannot feel an emotion without there first being some initial sensory input to prompt it.
Your five main senses—sight, hearing, taste, touch, and smell—absorb sensory information
from your environment, turn those chemical and nerve signals into electric signals, which then
activate and store inside different areas of the brain. If these signals are routinely interpreted
in a fearful or anxious light, the mere twinge of the sensation or of a half-remembered memory
can be enough to trigger these feelings again, even in the absence of direct sensory stimuli.
Consistent fear and anxiety are the product of unconscious stimuli/thought connections which
themselves have origins in initial sensory perception and interpretation. Much of the work of
coping with or "unlearning" your fears and anxieties involves making new associations
between sensation, perception, and cognition in a conscious way. We'll dive deeper into this
during a later lesson.
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Brain Structures
Your senses are sending signals of anxiety and fear to your brain—where exactly do these
signals go? And what do they do?
Here is a brief overview of the major brain structures responsible for creating and making
sense of anxiety and fear:
Adrenal Gland – Part of you endocrine system. It produces many kinds of hormones
that activate and regulate anxious, fearful, and stress responses. As the name suggests,
it is the brain's adrenaline factory.
Amygdala – The brain's emotional organizational center. The amygdala separates your
emotional responses into threatening or non-threatening camps and is the storehouse of
fearful memories and associations.
Hippocampus – A primary brain structure for memory. The hippocampus both files
away and recalls conscious memories and is one of the first-responders to give context
and meaning to sensations and stimuli.
Hypothalamus – This tiny structure is the seed of your "fight, flight, or freeze" response.
Pituitary Gland – Another endocrine structure. Together with the hypothalamus and
adrenal gland, it forms a feedback system that controls stress reactions, mood, and
emotion.
Sensory Cortex – The brain structure responsible for collecting uncontextualized

sensory information.
Thalamus – A junction box for sensory information. The thalamus reroutes specific
sensory information to other parts of the brain.
ACTH, Cortisol, Oxytocin, Epinephrine (Adrenaline), and Norepinephrine – A

sampling of the over 30 hormones and chemicals released during "flight, fight, or freeze"
responses. They are released by both your adrenal (bloodstream) and autonomic
nervous systems. Learn more specifics here and watch a video of the process here.
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The Autonomic Nervous System
These brain structures work in concert to interpret, contextualize, and store your sensory
reactions and emotional experiences, fear and anxiety included. They themselves are part of
a larger system called the autonomic nervous system, itself divided into the sympathetic and
parasympathetic systems. The sympathetic nervous system is the "arousal" side of your
nervous system. It regulates how your brain and body gears up to face stress and
emergencies, and ultimately causes the classic bodily symptoms of these emotions: increased
heart rate and blood pressure, widened eyes, and the shutting down of non-critical emergency
mode systems, such as digestion.
The parasympathetic nervous system essentially acts to reverse the effects of the
sympathetic nervous system—heart rate decreases, blood pressure levels off, and normal
function returns to all parts of the body. This system relaxes and soothes you.
Furthermore, remember that your fear responses are completely automatic and unconscious.
Any fear-eliciting situation always takes two simultaneous "paths" in the brain. The "low road"
(thalamus, amygdala, hypothalamus) sends an immediate uncontexutalized call to act on the
stimulus. The "high road" (thalamus, sensory cortex, hippocampus, amygdala, hypothalamus)
takes into account conscious interpretation—"Is this really something I need to be scared of?"
The trick is, your "low road" response always happens first—the body protects itself full-stop
and only later asks questions. Knowing this two-tiered system exists is itself a great
confidence booster--you are neither "weak" nor "childish" for reacting in accordancd with
fear's "low road" response.
How Anxiety and Fear Differ in the Brain

Anxiety and fear have quite a bit of overlap in terms of brain structures and chemical signaling
in the brain. Remember, however, that fear is a response to immediate, present danger;
anxiety is a response to unclear or imagined potentialities. Some researchers feel that
anxiety is a more "elaborate" form of fear. Others feel the difference is purely psychological.
Regardless, both responses make use of the brain's intricate emotional systems and prepare
the body and mind for potential threats of many different kinds.
Garrett Ray Harriman (Jun 26, 2015). Fear, Anxiety & the Brain (Physiology). Retrieved from
Explorable.com: https://explorable.com/fear-anxiety-the-brain-physiology
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3.2 The Physical & Psychological Risks of Anxiety
Our psychological health is affected by fear and anxiety. There are many long-term
consequences of ignoring symptoms of anxiety. This section highlights some of the
major ones for your consideration.
Physical Risks
It's well-known that prolonged anxiety and stress have negative effects on overall health. As
we've seen, stress and anxiety can have short-term benefits, but too much of anything is
detrimental to health. To read a little deeper into the "stress is bad" mantra, here are some
ways chronic anxiety and stress can wreak havoc on the body. Hopefully, this list motivates
you to take the small, cumulative steps and actions you need to acknowledge and manage
anxiety and fear's influence:
Inhibited Immune System – During normal stressful reactions to fear and anxiety, the
body produces white blood cells. These are the cells which fight infections. While
healthy white blood cell count is essential for health, chronic stress and anxiety lead to
the overproduction and eventual suppression of white blood cell activity. The result?
People living with constant anxiety and stress are more prone to infections of all kinds.
More Frequent Skin Conditions – Fear's activation of the stress response releases
many hormones which can negatively affect skin health. Psoriasis, hives, eczema, and
acne may all exacerbate under prolonged anxiety.
Cardiovascular Disorders – The fear response increases your heart rate and blood
pressure. It also increases your body's lipid (fat) levels. Over time, and through repeated
stress, these lipids may spike cholesterol levels and prompt atherosclerosis, a disease
where the heart's blood vessel's build up with fatty plaques, which may lead to heart
disease. The chemical cortisol, released during the stress/fear response, can also lead
to weight gain and diabetes. Lastly, certain "indirect" behaviors, such as coping through
alcohol, overeating, or substance abuse, also damages heart health.
Gastrointestinal Disorders – The stress response turns most digestive functions off to
better aid the "fight, flight, or freeze" response. As a result, people with anxiety tend to
experience diareha, excessive belching or gas, stomach cramps, and may even put
themselves at greater risk for developing Irritable Bowel Syndrome (IBS). Stress that is
chronic also affects appetite, which may lead to overeating, itself linked to everything
from diabetes, strokes, and heart disease.
Resperitory Disorders – Studies have shown that anxiety can exacerbate asthmatic
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symptoms. It has also been linked to chronic obstructive pulmonary disease (COPD),
with panic attacks reported alongside the condition. Though the relationship may not be
causal, anxiety symptoms decrease life quality for people already suffering from
respitory disorders.
Musculoskeletal System – When you are stressed or frightened, the muscles in your
body tighten and contract. People with chronic anxiety often report mild to severe
muscle aches and pains. Muscular spasms, migraines, and even joint dysfunction are
assoicated with chronic muscle tension.
Sexual Dysfunction – Both men and women's reproductive systems can be negatively
affected by chronic stress and anxiety. The stress hormones released can increase
menstrual disorders and discomfort, while men can experience erectile dysfunction.
Sexual desire can also dissipate for both sexes as a result of the chemical aftereffects of
anxiety.
Psychological/Lifestyle Risks
Later in the course, we will look at specific psychological risks connected with specific anxiety
disorders. For the time being, here is a brief look at some of the major areas in which anxiety,
if left unmanaged, can affect your psychological life:
Social Isolation/Lack of Support – Anxiety can cripple a person's social life. In an

effort to avoid feeling the physical or emotional results of anxiety, many people "cope"
by forgoing social interactions. Without proper outlets, it can seem all the more isolating
to the anxiety sufferer.
Missed Opportunities – Fear, anxiety, and stress can all infect the mind to convince
itself not to express itself or do the things it used to love. Hobbies and interests take a
back seat to the immediate need to protect oneself. As such, many anxiety sufferers
continually exclude themselves from wonderful opportunities, or even everyday activities
they used to love, in their fight to ignore or avoid feeling how they feel.
Dependence on Others – Social support is important for anxiety sufferers, but anxiety
can also cripple people's sense of self-efficacy. Depending on its severity, people may
stop going to work or providing for themselves because their fears are so great. This
puts strain on the people who take care of them and further reinforces their own sense
of helplessness.
Negative Self-Image – A chronically anxious person may feel they will never feel the
way they used to. They may start to wonder what the point of even trying is and
lack the confidence they need to make even small steps toward recovery. Negative self-
appraisal and low self-esteem are all-too-common tagalongs with fear and anxiety.
Develop Phobias – Phobias (discussed here) are fears of innocuous things that
develop over time. An anxious person may develop many phobias—social, medical,
physical—that they unwittingly provoke every time they avoid or demonize the situation.
Develop Anxiety Disorders – Anxiety, whether from an early age, a traumatic
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experience, or the cumulative effects of fear and stress, can break off into any number
of anxiety disorders. We'll discuss these disorders at length in the next section.
Suicide – By some reports, 70% or more of suicide victims suffered from an anxiety
disorder. The prevalence of suicide in anxious people should not be sugarcaoted and
cannot be overstated. Fortunately, suicide is always preventable and anxiety can be
properly treated before such drastic actions need be taken.
Garrett Ray Harriman (Jul 2, 2015). The Physical & Psychological Risks of Anxiety. Retrieved
from Explorable.com: https://explorable.com/physical-psychological-risks-of-anxiety
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3.3 What about Genetics?
There is always a "Nature/Nuture" debate in most psychological fields, and fear and
anxiety are no exception. Here we'll wade into what science says about the genetics of
these emotions.
Anxiety and a high arousal threshold for fear are certainly difficult conditions to live with. It can
be tempting to chock your anxious feelings up to genetics—"My father was anxious, so I'm
anxious too. It's just how I am"—but this breed of thinking hurts you in two major ways.
First, it erects a mental block to truly understanding your condition. Saying "This is how I am"
puts an inevitable spin on the anxiety you're feeling and your patterns of behavior. Believing in
the obdurate, unchanging nature of who you are is what psychologists call a "fixed mindset." If
you truly feel that your anxiety is integral to who you are as a person, you will be less inclined
to think that you can work to change how you approach your anxiety. You may resign yourself
to "suffer through it" or "just live with it." Anxiety is always negotiable.
Second, anxiety is an emotional reaction to imagined challenge or danger, where anxiety

disorders or chronic anxiety can take many forms. Thinking of anxiety as some monolithic
thing that controls your life is not just psychologically taxing, it actually does not align with
research into the heredity/genetics of anxiety.
Let's take a look at what science has to say about the nature/nurture debate surrounding
anxiety.
Is Anxiety Genetic?
The short answer is "No." As stated, anxiety is not a single measureable trait, but an umbrella
term for many kinds of disorders.
A distinction should be made here. Is the fear response (the "fight, flight, or freeze" cycle)
genetic? Yes. Our bodies have inherited this physiological response over millennia of
evolution. Every human being is coded to react to threats, real or imagined, in the same
neurobiological manner.
But can you inherit Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder
(OCD), or an above-average anxious disposition? Not directly. To understand this, we need
first to understand what genetic predispositions are and how they differ from simply
"receiving" a genetic disorder from your parents.
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An Anxious Predisposition
The distinction and relationship between what is "genetic" and what is "predisposed" is
essential, here. Consider a truly heritable genetic trait—attached or unattached earlobes.
The expression of this trait is entirely contingent on which specific genes you inherit from your
parents and which ultimately are activated (phoenotypically expressed) in your genetic code.
A predisposition is more the chance, the probabilty, that other genetic/heretiable traits you
have may make you more likely to experience certain conditions later in life. The complex
weave of other genetic traits you have, and the interplay of your environment on those traits,
leads to a higher risk for developing certain conditions. Anxiety disorders by and large fall into
this category—in other words, there is not a dominant "anxiety gene" that turns on or off in
people who develop anxiety disorders.
Currently, scientists are in the process of identifying certain genetic markers that may make
people more prone (predisposed) to acquire anxiety disorders. Thus far it appears that panic-
related disorders, agoraphobic tendencies (fear of public spaces), and a small group of
specific phobias are most closely linked to identifiable genetic configurations. It also appears
that perhaps 30% - 40% of a person's predisposition toward developing anxiety disorders can
be explained through genetic predispositions, the other 60% left to environmental risk factors.
The Role of Environment

Speaking of, what are "environmental risk factors?"
You've likely heard the term "Nature vs. Nurture." This refers to the notion that certain health-
and psychology-related conditions may be more the product of nature—your genetics—or of
nurture—the environment and experiences that have shaped you. These debates can
become maze-like and complex, and many positive and negative characteristics of personality
and behavior are a combination of these two concepts.
Where anxiety is concerned, there are many environmental risk factors that can work together
to evoke, or trigger, a person's predisposition toward stress or anxiety conditions. In a sense,
think of these risk factors as events that, if present and persistent in a person's life and
throughout their development, increase the risk that those complex predispositions activate
and make susceptibility to anxiety disorders more likely. It's not a one-to-one relationship the
way completely hereditary traits are, but a game of odds and circumstances.
Here is a short list of environmental risk factors that have been scientifically shown to increase
the odds of a person predisposed to anxiety developing a disorder:
Stress – Long-term and emotionally scarring stress, especially. Your reactions,

thoughts, and behaviors when under duress and their subsequent reinforcement.
25
Upbringing – Studies show that children who develop panic disorder before age 20 are
more likely to have parents who have the condition or another related anxiety disorders.
By no means an "anxiety sentence," evidence still suggests that anxiety disorders are
more common in people whose parents also suffer from them.
Trauma, Abuse, & Neglect – Early experiences with trauma, foul parenting, or lack of
strong, healthy social support increase the predispositional expression of anxiety.
People raised in low-income households and who lack healthy lifestyles are also more
vulnerable.
Other Anxiety Disorders – Panic attacks, depression, PTSD, and insomnia are all
debilitating and stressful anxious conditions. If you suffer from any one of them, you are
more likely to develop other anxiety disorders.
Garrett Ray Harriman (Jul 3, 2015). What about Genetics?. Retrieved from Explorable.com:
https://explorable.com/what-about-genetics
26
4 Common Anxiety Disorders
Anxiety takes many forms, from the everyday ways we imagine situations going wrong
or stressing us out, to debilitating, life-altering disorders. Here we'll explore the many
varieties of anxiety disorders, how they're diagnosed, and what challenges they
present to people who live with them.
Anxiety and fear have distinct evolutionary functions as emotions. Too much of either can
create mental and physical problems, and an excess of these problems may in turn lead to
diagnosable anxiety disorders.
This may come as a surprise to you—that someone can experience so much anxiety that
doctors and mental health professionals categorize their experiences as disorders. Then
again, you may be someone who has, or know someone who has, an anxiety disorder. No
matter which group you consider yourself part of, it's vital to understand what a "disorder"
entails as opposed to simply feeling anxious or scared a little more than normal.
Psychological disorders take on many forms. They can be cognitive in nature (how we think),
behavioral (the things we do), emotional- or mood-based, or personality-based. A mental
disorder is any combination of thinking and behavior that negatively and chronically affects a
person's life.
As we've learned, anxiety and fear are emotions that all people experience. Through a
combination of life experiences and genetic predispositions, some people may come to
experience anxiety and fear on such a continual basis that it impacts nearly every part of their
lives. Some anxiety disorders make it very difficult for people to approach and make
relationships with other people, for instance.
Other anxiety disorders stem from previous experiences of high-intensity fear and anxiety,
such as instances of combat or abuse. And there are also anxiety disorders that may be
harder to define—the person with Generalized Anxiety Disorder (GAD), for instance, may be
"put on edge" by a large variety of events that they interpret as stressful or cause them to feel
immediate fear. Other people in the same situations may feel nothing out of the ordinary.
As with other mental disorders, there are many factors to consider. One prevalent item to
keep in mind is that people with anxiety disorders do not choose to be more anxious than
other people. There are still unfortunately many demeaning stigmas surrounding anxiety and
27
fear that people outside the influence of these disorders misinterpret as "no big deal."
"Why don't you just get over it? It's only in your head!"
These attitudes likely come from a place of frustration, lack of personal experience, or
prejudice about fear and anxiety being "controllable" feelings or feelings with no real purpose
but to be overcome. For people living with anxiety disorders, the history of how they came to
develop them may be trying and dramatic, indeed, or it could be the cumulative outcome of a
lifetime of ignoring the physical, emotional, and environmental cues that caused them to
become anxious in the first place. They may never have had access to information and mental
health services in their community, and thus were not readily able to learn the ins-and-outs of
these emotions and how best to cope with their more extreme incarnations.
The important thing to remember for this section is that:
A person experiencing an anxiety disorder did not choose to become

this anxious and cannot just as easily choose to stop feeling this way.
Mental disorders puppetmaster the daily functions of the people who live through them.
Holding onto the belief that a person with a mental disorder can merely "get over it" is to
ignore and undermine the complex events that led them to that point. This point is especially
powerful to internalize, especially in our modern world where most nations' people suffer from
anxiety disorders above other debilitating conditions.
With an air of compassion and understanding in mind, this section outlines several of the most
common anxiety disorders as defined by the Diagnostic and Statsitical Manual for Mental
Disorders (DSM), though their equivalencies can be found in the ICD (International
Classification of Diseases). These disorders include Generalied Anxiety Disorder (GAD),
Social Anxiety Disorders, Panic Disorder, Obsessive-Compulsive Disorders, Trauma
Disorders and PTSD, Depressive Disorders, and Phobias and Test Anxiety. You'll learn how
these disorders come about, how they are diagnosed, and the ways they affect the lives of
people who endure them.
Garrett Ray Harriman (Jun 26, 2015). Common Anxiety Disorders. Retrieved from
Explorable.com: https://explorable.com/common-anxiety-disorders
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4.1 Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder (GAD) is a commonly diagnosed anxiety condition. Its

symptoms share much in common with typical, short-lived anxiety, so it is important to
understand exactly how it affects people's lives.
Anxiety is a part of life. You've learned that the fear/stress response is integral to the human
condition and has many positive effects on your life. However, there are times when the
temporary symptoms of anxiety stick around too long and a person's efforts to mitigate anxiety
grow more repetitive and irrational.
Generalized Anxiety Disorder (GAD) is the first anxiety disorder we'll look at. It's a good
place to start, especially to distinguish the fine line between healthy or understandable anxiety
and the threshold where anxiety crosses into disorders. Many of the symptoms and
techniques for managing GAD are shared by the other disorders we'll discuss. Understanding
GAD is a gateway to understanding how other anxiety disorders both share and deviate from
many of its qualities.
Definition/Exploration
Generalized Anxiety Disorder is diagnosed when a person experiences "persistent, excessive,
or unrealistic worry about everyday things." A person may have GAD if they constantly fret
and worry over the mundane, everyday details of their life. In the United States, 6.8 million
adults—a little over 3% of the population—are diagnosed with the condition every year. Like
most other anxiety conditions, women are twice as likely as men to experience GAD.
Symptoms
GAD's symptoms may sound familiar to most people. After all, everyone experiences anxiety,
even months of anxiety, during certain parts of their life. The difference is one of degree and
duration. According to the DSM, a person who experiences any of the following symptoms for
6 months or longer should schedule a doctor's appointment to rule out, or in favor of, a GAD
diagnosis. Symptoms include:
Headaches
Insomnia
Muscle tension/fatigue
Shortness of breath/hyperventilation
Irritability and/or a sense of edginess
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Trembling
Sweating
Lightheadedness
Find it hard to concentrate
Startle too easily
Find relaxing difficult
As you can see, these symptoms are all classic signs of normal anxiety and fear responses.
Sufferers of GAD, however, experience an excessive amount of these symptoms often when
there is no discernable stress or life situation warranting them. Everyday tasks and chores can
become painfully hard to perform under the weight of these sustained signs of anxiety.
Follow this link for a great side-by-side comparison of when normal signs of anxiety transition
into the realm of anxiety disorders, including GAD and the others in this course.
Case Study
To help you visualize what a person living with GAD goes through, here is a case study
excerpt of a 24-year-old man describing his thoughts and behaviors:
"He reported that he tends to overplan everything to prevent disaster,

which results in tension and frequent headaches...He said he has
always had trouble making decisions for fear of making mistakes and
upsetting others, and now worries a lot about what his supervisor will
think of him. However, he does not get anxious about engaging in social
situations.
"For the past several weeks he has begun to experience bouts of

fearfulness upon waking in the morning, and feels nervous, agitated,
light-headed, and his heart pounds. He finds it difficult to concentrate
on his study with his thoughts going "round and round like a record" -
thoughts from which he has difficulty distracting himself. He has
become frightened of going to university, worries about what
misfortunes might befall him, or becomes anxious if he feels he has
nothing planned for the day..."
Living with GAD

There are no direct causes of GAD. Like all other anxiety disorders, a combination of
temperament, predispositions to low-anxiety thresholds, and life experiences work in concert
to create Generalized Anxiety Disorder.
Researchers do know that GAD tends to develop over time. Unlike other anxious conditions (
PTSD
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) which may have roots in very specific instances of trauma or abuse, GAD is a culmination of
out-of-proportion stress and anxiety reactions to typical life events. Most people with GAD are
also able to maintain job positions and hold relationships together. In this regard, GAD can
seem more manageable than Social Anxiety Disorder, where people outright avoid interaction
in an effort to "protect" themselves. Nevertheless, GAD's prevelance and interference with
common, everyday tasks creates chronic tension and misery in the lives of people it affects.
People with GAD have many options when seeking treatment and symptom management.
The protocol for following through and seeing if you have an anxiety disorder is the same for
GAD as it is for the other conditions in this course. The basic outline looks like this:
See your family doctor for initial check-up and/or diagnosis

Seek a mental health professional whose methods (talked about here) and relationship
you can trust
Consider taking medication (discussed here) alongside your psychological treatment

Practice anxiety-reducing lifestyle changes, including exercise, healthy diet, and
mindfulness (more ideas discussed here and here)
Be willing to be curious about your symptoms, to experiment and personalize your

treatment, and to learn about the underlying mechanisms/cycles of anxiety and fear
GAD can be a debilitating but manageable anxiety disorder. Many of its symptoms overlap
with "normal" periods of anxiety and worry, but hopefully you see their exaggerated,
prolonged effect in contrast to normal periods of tension and worry. Keep these differences in
degree and severity of anxious symptoms in mind as you learn about other anxiety disorders.
Garrett Ray Harriman (Jun 26, 2015). Generalized Anxiety Disorder (GAD). Retrieved from
Explorable.com: https://explorable.com/general-anxiety-disorder
31
4.2 Panic Disorder
Panic Disorder produces very rapid physical sensations of fear. A person who suffers
from panic disorder can have these "panic attacks" so often that they interfere with
their life and livelihood.
It's a common enough expression—"I'm having a panic attack!"—that you may not realize it
refers to a larger anxiety condition. People who suffer from panic disorder don't think about
their "panic attacks" as just overblown stress (which panic is not). The physical feelings and
accompanying fearful thoughts of Panic Disorder can be debilitating and exhausting. Here,
we'll learn about the suddenness and severity of panic disorder and explain how these
"attacks" can be interpreted in a more beneficial cognitive light.
Panic Disorder is an anxiety disorder which involves experiencing sudden bursts of mental
and physical panic. A sufferer of panic disorder may live in perpetual fear that these "panic
attacks," often for which there are no immediate triggers, will happen time and again.
Panic attacks generally last between 15-30 minutes and are experienced as rapid and
terrifying physical symptoms of fear. Most anxiety disorders can include panic attacks in their
diagnosis and symptoms. Panic disorder specifically is diagnosed as its own condition if a
person experiences two or more unforeseen "out-of-the-blue" panic attacks on a consistent
basis and, after the initial attack, fears and believes another one is inevitable up to a month
later. Some people experience panic attacks on a daily, weekly, or monthly basis. A cycle of
panic attacks can either spawn from specific identifiable triggers or where none are involved.
About 6 million American adults are diagnosed with panic disorder per year. The condition is
almost twice as prevalent among women as it is for men. Most people will experience one or
two "full-blown" panic attacks in their lifetime and not develop the subsequent disorder.
Symptoms
As mentioned, panic attacks can be incredibly intense experiences. Many of the physical
symptoms of panic mimic those of breathing disorders, thyroid problems, and heart attacks.
Mentally, panic sufferers may feel completely out of control and even that they might go
insane from the seemingly random and sudden appearance of symptoms.
Panic disorder/attack symptoms include:
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Pounding heart and/or palpitations
Shortness of breath
Feeling like you are being smothered
Chest pain and tightness
Trembling, shaking, or numbing of the extremities
Stomach and/or abdominal pain
Derealization (feeling that things are unreal)
Depersonalization (feeling detached from one's body)
Fear of passing out
Fear of going crazy
Fear of dying
This list of mental and physical symptoms certainly sounds extreme. The important thing to
remember, however, is that the symptoms of panic, though exaggerated fear responses and
thought hey happen in a moment's notice, are neither dangerous nor deadly. In the moment
and without regular methods of treatment (see here), people with panic disorder may feel
embarrassed or ashamed of these events and start to isolate themselves from people or
situations they believe to be the "cause" of their panic.
Empirically at this time, the cause of panic is unknown, though it can be tied to very specific
panic-inducing situations and seems to be linked to family members. Oftentimes, a person
experiences their first panic attack in response to an obvious life event or stressor. Other
times a "connection" is made between the feelings of panic and certain scenarios. A person
will create false connections between cause and effect regarding panic attacks in a desperate
effort to peg its cause and thus eliminate its influence.
Unfortunately, by responding negatively to a "random" attack and seeking scapegoats, they

establish a cycle of bringing about subsequent panic. Some of the best coping methods for
Panic Disorder involve learning how to accept the short-lived but intense feelings they bring.
Mindfulness practices and Cogntive-Behavioral Therapy techniques help millions of people
rewire their thoughts about panic.
Furthermore, the psychological fallout of recurrent panic is mentally taxing. The experiences
are very draining and cause mental and bodily fatigue. People may become demoralized by
the seeming arbitrariness of panic's sudden dramatic entrance. In their frenzied search for a
cause, people inadvertently reinforce the idea that these attacks are dangerous and should be
avoided.
The good news is no "cause" need be found to treat panic disorder. What is most important is
retraining yourself to realize that these symptoms are short-lived and can be endured and
33
embraced. The more you think and react without enhancing your fear response, the more
readily your body will register symptoms of panic as minor annoyances. Remember also that
though panic attacks are discomforting and disconcerting, they are not life-threatening.
Myths & Agoraphobia

Sometimes, a person may lack the knowledge or support system they need to learn that panic
attacks are not dangerous, that situation shouldn't be avoided, and that the attacks
themselves always end. A person with panic disorder may come to restrict their lives and
behaviors to such an extent that they rarely leave their own house. 1 in 3 people with panic
disorder experience this string of isolationist behavior. They may feel that they can no longer
go places or do things they used to do because an "attack" might happen. They may
surrender independent tasks (going shopping, doing chores) unless a trusted loved one
accompanies them.
This extension of panic disorder is called agoraphobia and can be avoided if proper
intervention and behavioral techniques are learned. When panic disorder reaches this level,
there is also an increased risk of self-medicating (using alcohol or drugs) or developing other
anxiety/depressive disorders, which will all have to be treated separately.
There are also many myths people with and without panic disorder or agoraphobia believe
about their condition. Let's dispel some of them right now (you can find some others here):
Panic and anxiety/stress are not the same thing

You cannot pass out or die from a panic attack
Avoiding places/people/events is not the way to manage panic disorder; it only
reinforces that "something is wrong"
Case Study
Here is an illustrative example of what a panic attack feels like:
"I remember my first panic attack like it was yesterday...Suddenly this

thing just took me over. I got these pains in my chest and I couldn't
breathe. I was sure I was having a heart attack and was going to
die...Since the first time, I've had about a dozen attacks and each one
was terrifying. I've stopped going anywhere that I can't get out of easily
in case I have another one. No shopping centres. No cinemas. No
football games. No public transport. No crowded places. I left the navy
because I couldn't face going to sea again."
Garrett Ray Harriman (Jun 26, 2015). Panic Disorder. Retrieved from Explorable.com:
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https://explorable.com/panic-disorder
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4.3 Social Anxiety Disorders
Social Anxiety Disorder (aka SAD or social phobia) affects millions of people around
the world. SAD is not the same as shyness, is its own psychological condition, and
may develop (and be managed) at any age.
The previous section exposed you to Generalized Anxiety Disorder (GAD). The remainder of
the anxiety disorders in this course are more uniquely identifiable, starting with Social Anxiety
Disorder, or social phobia.
Social Anxiety Disorder (SAD) is characterized by an overwhelming fear of negative social
appraisal or public embarrassment. Embrassment and negative social evalutions happen
every day, of course, but those with SAD experience chronic worry and severe anxious
symptoms in the face of these situations. They lack the coping skills to grain perspective on
these isoloated incidents and believe they are in imminent danger during regular social
interactions.
Some people with SAD have lifelong struggles communicating with other people, developing
strong relationships, or expressing themselves for fear of negative social evaluation and the
accompanying physical sensations they experience.
Symptoms
A diagnosis of SAD includes these physical and behavioral symptoms:
Extreme self-consciousness in the presence of others

Extreme anxiety about meeting or speaking with other people
Excessive worry about social situations/encounters, often weeks or months in advance
Tendency to isolate themselves, not seek company
Avoid going out or trying new things
Devising excuses or "escape plans" when visiting/interacting with others
Difficulty making or keeping friends
Blushing, trembling, or sweating before and/or during social encounters
Feeling sick or dizzy
Rapid pulse
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Many people with SAD are aware that their fears of negative social appraisal or
embarrassment are wildly out of proportion to reality, yet feel powerless to change their
behaviors and thoughts. They may avoid or make excuses to not attend normal social
functions—seeing movies, attending birthday parties, using a public restroom, dating—and
some avoid eye contact all together.
Approximately 15 million Americans suffer from SAD every year. Most often, the condition
develops from early adolescence (13-years old) and affects men and women to nearly equal
degrees. Sadly, around 36% of people with the condition wait a minimum of 10 years before
seeking formal diagnosis or psychological treatment.
Generalized vs. Specific Social Phobia

Social phobias and SAD are diagnosed under two main types: Generalized and Specific.
Generalized social phobia is the most consistently debilitating form. People with this
condition fear almost all social situations with the same consistent level of fear and avoidance.
The sufferer had "generalized" their fear and conditioned themselves through patterns of
behavior and thought to react to all social situations with equal rushes of anxiety, doubt, and
fear. Luckily, this is also the form that most people seek treatment for. (Read about effective
anxiety therapies here).
Specific social phobia is the negative expectation and fear of social evaluation under very
particular circumstances or venues. Performance anxiety or giving speeches fall into this
category, but so too do places where a person experienced a painful and memorable
embrassing social situation. People with this type of SAD typically function well in most social
scenarios outside of the ones uniquely problematic for them.
SAD vs. Shyness

It's a common misconception that being shy is the same as being socially phobic, just as
many people believe being shy is the same as being introverted (they're not). Shyness is a
normal human emotion/disposition where people feel apprehensive or awkward during social
encounters. In comparison, SAD is a prolonged and severe belief that being evaluated
negatively in social situations is dangerous. Studies have shown that shyness and social
phobia are differentially diagnosable—that is, someone can have SAD and not be shy and
vice-versa.
Keeping shyness separate from SAD is a healthy way to respect people with diagnosable
social phobias and to not generalize about their condition.
Case Studies
It can be difficult for someone without social phobia to imagine how someone with the
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condition feels on a routine basis. If you are unclear about how SAD manifests itself and
changes a person's life, please read the following case study excerpts:
"Ms. M. is a 19 year old student. She decided not to attend her

university classes on the first day because she knows that in some
classes the professor will instruct them to go around the room and
introduce themselves...She knows she won't be able to think clearly
because her anxiety will be so high, and she is sure she will leave out
important details...
"Mrs. A., a 32 year mother of two kids hates to stand in line at a crowded
bus station because she's afraid that everyone is watching her. She
knows that it's not really true, but she can't shake the feeling. While she
is shopping, she is conscious of the fact that people might be staring at
her from the big mirrors on the inside front of the ceiling..."
"A 25 year old young man named Mr. R., an electrical engineer by
profession, wants to go to parties and other social events... indeed, he
is very, very lonely... but he never goes anywhere because he's very
nervous about meeting new people...The thought of meeting new people
scares him... will he know what to say? Will they stare at him and make
him feel even more insignificant? Will they reject him outright?"
Garrett Ray Harriman (Jun 26, 2015). Social Anxiety Disorders. Retrieved from
Explorable.com: https://explorable.com/social-anxiety-disorders
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4.4 Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is a well-known but little understood anxiety

disorder. This section will expose you to the realities and anxious underpinnings of
OCD.
People with Obsessive-Compulsive Disorder (OCD) live very anxious lives. Their condition
leads them to think and act in repetitious ways in order to stave off some hyper-inflated threat
or sense of balance in their world. Many people are under the belief that people with OCD
merely keep things meticulously tidy or count and organize their belongings, and thus see no
harm in that kind of behavior.
While OCD can manifest in these kinds of stereotypical behaviors, the psychological truth
behind the condition is one of chronic and debilitating anxiety. The patterns of thinking and
action are always unwanted for the OCD sufferer, and are often upsetting and horrific. Let's
take a closer look.
OCD is an anxiety disorder whose chief feature is the persistent thoughts (obsessions) and
actions (compulsions) which come to dictate small or large aspects of a person's life and
habits. People with this condition are preoccupied with patterns of thinking and behaving
which consume much of their time and energy. Rituals and routines are a key part in at least
half of OCD diagnoses. 2.2 million Americans are diagnosed with OCD every year, and it
affects men and women equally. It's most common age of onset is 19.
How does OCD operate? Essentially, some thought or anxiety about the present or future
refuses to leave a sufferer alone. The details and content of these thoughts can be graphic,
lewd, or unsavory. In an attempt to alleviate these interjecting and distressing thoughts, the
person invents and follows through with elaborate strings of action in the hopes of dismantling
or appeasing them. Worse still, most people with OCD realize the excess and futility of their
own compulsions, but their attempts to ignore these thoughts only increase their feelings of
anxiety.
You may have heard of Obsessive-Compulsive Personality, which is a separate concept from
OCD. This personality type is associated with traits of perfectionism, a strict adherence to
rules and regulations, inflexible ideals, and overly-conscientious (detail-oriented) thinking and
behavior. These traits are often the ones confused in the popular imagination with OCD.
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Research shows that people with OCD may or may not also have Obsessive-Compulsive
Personality traits. They are not the same condition.
As with certain other anxiety disorders we've discussed, there is no definitive cause for OCD.
Environmental and predispositional factors either develop the condition gradually or rapidly.
Symptoms
OCD symptoms are both general and specific to the Obsession and Compulsion sides of the
disorder. Let's break them down one at a time:
General Symptoms
Repeated images and/or thoughts. Topics can include (but are not limited to) germs,
tidiness, violence (toward self or others) and sexual acts
Perform the same rituals over and over again (locking doors, hoarding objects, counting)
An inability to combat, control, or suppress recurrent thoughts/images
Feel little or no pleasure completing the compulsive ritual, but temporarily relieve
anxious mindset through them
Spend 1 hour or more per day focused on these thoughts/behaviors
Obsessive Symptoms (Thoughts)
Ceaseless worrying about dirt and contamination

Constant worrying about order, organization, and/or symmetry
Concerned with accidently and violently hurting yourself, loved ones, or strangers
Hold onto exaggerated sense of responsibility for the well-being of others
Unwanted, ugly thoughts about religious or sexual imagery
Doubting that the things you think are irrational
Compulsion Symptoms (Rituals)
Cleaning (bathing, handwashing, scrubbing the bathtub multiple times a day)

Repetition (saying or thinking a name, thought, or phrase for hours; clicking a pen for
hours)
Checking (ensuring the lights are all off/on, that the thermostat hasn't changed, again
and again)
Hoarding (holding onto everything bought--every article of trash, every useless item)
Continually repeating an old conversation, a prayer, or "conjuring" good thoughts and
images in an effort to waylay anxious thoughts
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Treatment for OCD can take many forms, from Cognitive-Behavioral Therapy (see here) to
Psychotherapy (here) and medication (here). Often a combined approach is best, as is the
case for many anxiety disorders
Case Study
In an effort to empathize and visualize what OCD feels like, here are snippets taken from an
OCD sufferer's reflections on their experience:
"I couldn't do anything without rituals. They invaded every aspect of my

life. Counting really bogged me down. I would wash my hair three times
as opposed to once because three was a good luck number and one
wasn't. It took me longer to read because I'd count the lines in a
paragraph. When I set my alarm at night, I had to set it to a number that
wouldn't add up to a 'bad' number.
"Getting dressed in the morning was tough, because I had a routine,

and if I didn't follow the routine, I'd get anxious and would have to get
dressed again. I always worried that if I didn't do something, my parents
were going to die. I'd have these terrible thoughts of harming my
parents. I knew that was completely irrational, but the thoughts
triggered more anxiety and more senseless behavior. Because of the
time I spent on rituals, I was unable to do a lot of things that were
important to me.
"I knew the rituals didn't make sense, and I was deeply ashamed of
them, but I couldn't seem to overcome them until I got treatment."
Garrett Ray Harriman (Jun 26, 2015). Obsessive-Compulsive Disorder. Retrieved from
Explorable.com: https://explorable.com/obsessive-compulsive-disorders
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4.5 Trauma Disorders & PTSD
Traumatic experiences can have long-term consequences for people's psychological

health. Several anxiety disorders, including PTSD, are the result of such experiences.
Throughout life, extremely stressful and frightening experiences happen to us all. If we are
taught to respond to anxiety, fear, and stress with compassion and an educated mindset, and
if those around us react in healthy ways, we are more likely to retain our own helpful coping
mechanisms later in life.
There are extreme instances, however, when stress and anxiety happen so rapidly and
violently that we may become vulnerable to traumatic anxiety symptoms. In this section, we'll
learn how to define trauma and look at its effect on anxiety through the lens of PTSD.
Post-Traumatic Stress Disorder (PTSD) is an anxiety condition defined by "severe,
persistent emotional reaction[s] to a traumatic event that severely impairs one's life." The
major example most people think of is a soldier returning from war who experiences combat
flashbacks. He or she reacts with extreme horror or fear to memories of their experience or to
triggering sensory cues. Active experiences during combat certainly have affected, and will
continue to affect veterans. But PTSD is an anxiety disorder with a larger canvas of influence.
Before continuing, it's helpful to define exactly what trauma is and how it is related to anxiety.
Trauma is any strong negative emotional response to tragic, scary, or violent events. These
events can be performed directly to a person, happening to someone else the person cares
about, or could arise after witnessing a tragic/violent event happen to total strangers.
Any number of life experiences are capable of producing trauma, including:
Life-threatening events
Violence, lived or witnessed
Natural disasters
Sexual abuse
Accidents/Unexpected deaths
Vitally, not everyone who experiences a traumatic event develops some form of PTSD.
Equally vital is to be aware that traumatic events, whether on a large or personal scale, can
happen to anyone at any age. 60% of women and 50% of men will experience at least 1
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traumatic life event, though 20% of women develop PTSD symptoms overall. 5% of
adolescents meet PTSD diagnosis criteria, and a staggering 60% of children in foster care
suffer PTSD as a result of sexual mistreatment or abuse. It's estimated that 20% of soldiers
who have served in Iraq experience PTSD. Domestically (U.S.), nearly 20% of women report
a traumatic sexual experience, and 50% of all rape victims, male or female, are at serious risk
for developing PTSD. Worldwide, nearly 260 million people have experienced PTSD in the
previous year.
Clearly, trauma and PTSD are global conditions. But why is PTSD an anxiety disorder?
Symptoms
People living with PTSD have not only experienced highly stress- and anxiety-inducing
scenarios, but they continually re-experience these feelings in multiple ways. To be diagnosed
with PTSD, a person has to meet certain criteria for 3 months or longer:
1. A person has to have personally experienced or witnessed a traumatic event

2.
A person's reaction to the event is either with horror or intense fear, although children
may act "disorganized"
3.
The traumatic event serves as a triggering event. Unlike GAD or many instances of
Panic Disorder, PTSD is directly related to a specific traumatic event. These events are
generally outside everyday stress and anxiety typically experiences. They can be
instantaneous (an accident) or prolonged (war, sexual abuse)
From this point in symptomatology, without intervention or healthy coping, a person's thoughts
and behaviors significantly alter. The three main symptoms of PTSD are:
Re-experiencing – A person relives their traumatic experience through thoughts,

feeling, dreams, images, flashbacks, or, in the case of many children, continually
reenacting the event through play
Avoidance – A person may seek to completely avoid people, places, or sensory details
that remind them (trigger them) of the event. Many may seem dazed or distant and often
actively suppress details of their trauma
Increased Arousal - PTSD sufferers become "jumpy" or "edgy," vigilant about their
surroundings, and may experience insomnia and changes in mood (anger, irritability, or
depression). Like many other anxiety disorders, experiencing PTSD also increases the
risk of developing other anxiety disorders or negative coping habits such as drug or
substance abuse.
At this time, the causes of PTSD are thought to be very dynamic. There are of course the
triggering events themselves and genetic predispositions toward anxiety to consider, but
researchers have also made exciting headway in uncovering the brain structures and genes
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responsible for creating fear memories. These advances, coupled with advances in behavioral
extinction research, are paving the way for potential drug treatments to relieve PTSD sufferers
of their condition.
For now, the best interventions for helping PTSD patients are Psychotherapy (discussed here)
and medication (here). Preventive and resilience factors, as well as healthy coping habits, are
also encouraged.
Case Study
Here is a very personal example of how PTSD has affected someone's life--a prison security
guard who was beaten by several inmates:
"Over the next few months he experienced a significant number of

flashbacks to the incident, feeling the force of the blows to him and
experiencing the fear of dying. Many occurred at night, while in bed.
Every flashback was terrifying, and in the hour following them he had to
get out of bed and try and watch television or read a book to help him
calm down. He regularly had two or more flashbacks per night. As a
consequence he became increasingly exhausted. In addition, he spent
much of the day mulling over the causes and consequence of the
attack. He would spend many hours ('A day may disappear') looking out
of a house window dwelling on the attack..."
Garrett Ray Harriman (Jun 26, 2015). Trauma Disorders & PTSD. Retrieved from
Explorable.com: https://explorable.com/traumatic-stress-related-disorders
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4.6 Depressive Disorders
Depression is a serious condition which impacts the lives of millions of children and
adults around the world. Anxiety and depression have a complex relationship;
understanding one is a way of comprehending the other.
Depression is more than a temporary mood or state of mind. In its chronic medical form,
depression is a crippling mental illness which undermines a person's sense of motivation,
purpose, and self-worth. The disorder affects over 19 million Americans every year and can
affect anyone regardless of age, gender, or social status.
Anxiety has a complicated role to play where depression is concerned. Though there is not
direct evidence between anxiety causing depression or vice-versa, they both appear together
quite often (a term psychologists call co-morbidity). Let's investigate exactly what depression
is and the scope and nuances of its influence.
Most people are familiar with the feeling of depression. When you feel hopeless, apathetic,
unmotivated, or "down in the dumps," you're likely reacting to some external event or
circumstance which has temporarily (for less than 2 weeks) affected your mood and
motivation. The majority of people cope and rebound from slight bouts of depression.
If these depressive feelings persist, however, and beginning interfering with how you live,
work, and play, you are likely experiencing the onset of a clinical depressive episode. Without
intervention or treatment, most depressive episodes last between 8 and 9 months.
Unfortunately, around 85% of people who experience a depressive episode will experience
more in the future.
Symptoms
There are many signs that a person is suffering from depression. Here is a short list or
depressive symptoms:
Prolonged feelings of emptiness, sadness, anxiety, and/or pessimism

Feeling helpless, hopeless, irritable, and/or restless
Loss of pleasure or interest in things you used to enjoy (anhedonia)
Loss of energy, motivation, and concentration
Insomnia, bodily aches, and digestive problems
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Thoughts of or attempts at suicide
These symptoms can manifest and compound to form other sub-types of depression. Here
are a few to be aware of:
1. Major Depression – A person experiences 5 or more of the above symptoms for a

period of 2 weeks or more. These changes in thinking and mood negatively impact their
lives and relationships. Major depression can be short-lived but intense. Many suicide
attempts are connected to Major Depression.
2. Persistent Depressive Disorder (PDD) – Until recently called dysthymia, this is a less
intense manifestation of depression which encompasses the same symptoms of Major
Depression only extended for 2 years or more.
3. Bipolar Disorder – Another beast entirely, Bipolar Disorder is characterized by periods
of elation and mania followed by states of depression.
There are even more specific depressive subtypes, including Post-Partum Depression and
Seasonal Affective Disorder, which you can learn more about by clicking here.
Depression & Anxiety

As you read above, many of the symptoms of depression seem to overlap with anxiety--
restlessness, lack of concentration and interest, bodily aches--and anxiety is even a symptom
all on its own. (For the curious, there are many more connections listed here.) Despite these
similarities, these conditions are differentially diagnosable—they are separate from one
another and affect the brain and behavior in different ways.
A person suffering from depression, for instance, may come to develop symptoms or
disorders of anxiety in response to their depression. Likewise, someone who has long-
suffered from an anxiety disorder may experience depression as a consequence of the
duration and scope of their condition. One study showed this relationship starkly: 85% of
people who had Major Depression also had Generalized Anxiety Disorder (GAD), 35% of
whom also showed signs of Panic Disorder.
Some studies have shown suicide rates higher than 90% for people affected by both kinds of
disorders. Clinicians also agree that it takes longer to recover and cope with depression than
anxiety, a factor which should be discussed with doctors, therapists, and sufferers or
depression and anxiety. Follow this link for some ideas on how to begin seeking treatment,
and click these words to learn more about common schools of therapy.
Remember also that people who have both depression and an anxiety disorder experience
the symptoms of both to a greater degree than they would individually. These two kinds of
conditions feed into one another and can legitimately overwhelm, cognitively and emotionally,
the people they affect. Luckily, depression and anxiety are also similarly treated. Many people
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take the same medications or undergo the same therapies (click here) for both conditions,
with similar success and retention rates.
Case Study
Below is a quote from someone reflecting on how depression affected him. Do you recognize
these feelings as persistent presences in your own life or in the life of someone you care
about?
"It was really hard to get out of bed in the morning. I just wanted to hide
under the covers and not talk to anyone. I didn't feel much like eating
and I lost a lot of weight. Nothing seemed fun anymore. I was tired all
the time, and I wasn't sleeping well at night. But I knew I had to keep
going because I've got kids and a job. It just felt so impossible, like
nothing was going to change or get better."
Garrett Ray Harriman (Jun 26, 2015). Depressive Disorders. Retrieved from Explorable.com:
https://explorable.com/depressive-disorders
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4.7 Phobias & Test Anxiety
Phobias and Test Anxiety are two categories of anxiety disorders that should not be
overlooked. Whether you are a student who needs help during finals or someone who
lives with an irrational fear and want to alleviate it, this section is for you.
It probably doesn't take much effort to come up with the top 10 things you're scared of. Is it
the dark? Airborne illness? Maybe you feel shivers at the mention of spiders or sharks.
Everyone has fears specific and unique to them, and millions of people share the
same—often irrational—fears.
Or maybe your fear is more specific to a test setting. Are you a student who chokes and
trembles at the thought of studying for or taking a test? Perhaps your job includes
performance reviews or workplace assessments? In their many forms, tests tend to crop up
time and again in the lives of most people.
In this final section of anxiety disorders, we'll take a peek at the mechanisms behind your
phobias and test anxiety.
Phobias are persistent fears of specific objects or environments, the nature of which are
either non-threatening or the danger of which are statistically minimal. Phobias are different
than everyday fears or dislikes—a person who is phobic of something often has extreme
stressful, fearful, or anxious reactions to their perceived phobic threat. They may experience a
sudden flood of physical anxiety symptoms (think about panic symptoms) and may not be
able to function while their phobia is present or perceived to be present.
According to the National Institute of Mental Health (NIMH), upwards of 6.3 million people in
the United States alone have diagnosable phobias. For most people, phobias develop during
childhood or adolescence, and phobias disappear on their own in adulthood for around 20%
of people.
Test Anxiety is a type of performance anxiety, or an anxiety that is prompted by the very
specific action of performing a high-evaluative task. Like phobias, a person with test anxiety
may come to anticipate and respond to their next testing situation with strong physical and
mental sensations. Test anxiety can affect anyone (just as phobias can) and may be crippling
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for people in routinely performance- or merit-based positions--students, athletes, and
performers of every stripe.
Phobia Symptoms
There is virtually no end to the kinds of irrational fears that can become phobias. People can
come to be phobic of living and non-living things, specific places or songs, and just about
anything else imaginable.
Fortunately, most phobias consistently produce the same set of symptoms regardless of their
specific details. This uniformity of pattern can be of great comfort when beginning to treat
yourself from a phobia's influence. The symptoms include:
Feelings of tremendous panic or terror in the presence of phobia

The compulsive need to avoid your phobia at all costs
Sweating, trembling, or rapid heart rate
Psychological feeling that you can't cope/will lose all control
Extremely anxious thoughts; physical symptoms from even thinking about your phobia
Children with phobias may throw tantrums or cry
You may recognize many of these symptoms from previous anxiety disorders. Just like the
other disorders discussed in this course, phobias are highly treatable. In most cases,
medication is not needed. Phobic people respond best to certain Behavioral Therapy
techniques, such as densitization and incremental exposure. Essentially being present with a
phobia, little by little, and recording and assessing your thoughts along the way, is the best
antidote.
Common Phobias
For the curious, here were the top 10 phobias in America reported in 2014 by NIMH. You can
also watch a powerful news piece on phobias here.
1. Glossophobia – Fear of public speaking (74%)

2. Necrophobia – Fear of death (68%)
3. Arachnophobia – Fear of spiders (30.5%)
4. Myctophobia – Fear of darkness
5. Acrophobia – Fear of heights.
6. Sociophobia – Fear of speaking to others
7. Aerophobia – Fear of flying
8. Claustrophobia – Fear of confined spaces
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9. Agoraphobia – Fear of open spaces, places without "escape" (remember social
phobia?)
10. Brontophobia – Fear of thunder and lightning
Test Anxiety Symptoms
Many of the symptoms of test anxiety fall in line with phobic and panic reactions. Here is a
brief list:
1.
Physical symptoms – These can range from dizziness, nausea, sweating, racing heart,
dry mouth, and shortness of breath. Panic attacks are also commonly reported with test
anxiety
2.
Emotional symptoms – Feelings of shame, anger, disappointment, and/or
embarrassment
3.
Cognitive/Behavioral symptoms – Negative self-talk and social comparisons as well
as "stage fright" behaviors
The causes of test anxiety, similar to phobias, are a combination of predispostional reactions
to stress and anxiety, as well as episodes of exposure and negative mental associations
learned in the past. These reactions and behaviors can be unlearned and thought of in more
adaptive ways (click here for more).
The main thing to remember about test anxiety is that these reactions stem from a self-
appraisal that is wholly negative. A person may harbor a fear of failure, a perfectionistic
attitude, or may be trying to excessively meet the values and judgements of others.
A persistent belief in your own incompetence or inadequacy may also be a sign of

self-handicapping--that is, any behavior that lets you neatly dodge the bullets of criticism or
potentially negative feedback (i.e. test scores). You unwittingly but purposefully "set yourself
up for failure" either through lack of preparation or practice. In this way, you can be free from
personal blame should your performance not pan out. Cogntive restructuring and self-
confidence exercises can work wonders for chronic self-handicapping.
Some of the top things you can do to alleviate test anxiety include:
Improve study habits/routines

Learn relaxation techniques (click here)
Get rest; exercise and eat well
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Practice a positive outlook
Prepare
Seek counseling; don't ignore learning disabilities
There is also evidence showing that mentally restructuring how you approach test-taking (and
the anxious ways they make you feel) can help you perform better. Reframing your anxiety as
"excitement" rather than a negative reaction, and then practicing/preparing with that mindset,
helped test subjects in one study perform better on a speech.
Click here to learn more about Cognitive-Behavioral Therapy and how many of its techniques
can help you reframe your thoughts and reactions to anxiety. Then click here and here for
even more test anxiety reduction tips.
Garrett Ray Harriman (Jun 26, 2015). Phobias & Test Anxiety. Retrieved from
Explorable.com: https://explorable.com/phobias-test-anxiety
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5 Therapies for Anxiety
Many schools of therapy help people with fear and anxiety live more fulfilling lives.
Individually or in combination, therapies help people accept their feelings and develop
actionable plans to ease their fears and nerves.
The word "therapy" may ring some very clichéd bells in your head. Isn't therapy about lying
down on a couch, telling a pointy-bearded man with glasses all of your deepest darkest
secrets?
Thankfully, much of the stigma surrounding therapy has dissipated in the last three decades.
People understand that there are a wide variety of therapeutic treatments that they can try on.
Talk therapy (psychoanalysis) is still a viable option, but so are any number of behavioral and
cognitive therapies aimed at helping people break cycles of self-defeating thought and action.
This is particularly great news for people with anxiety disorders, or people who may only be
experiencing passing, but very stressful life events. Therapy exists for you to help yourself
discover the patterns of your own thinking and feeling. It is a relationship between you and
your therapist guided by your personal goals and vision of the future. If this vision includes
feeling less anxious and afraid, or maybe even uncovering some underlying reasons behind
your anxieties and fears, therapy can help you in the short-term and the long-term.
In this part of the course, we'll take a look at a handful of common, popular, and scientifically
effective therapy treatments that anxiety sufferers would do well to look into. Therapy has
become more ubiquitous and affordable for a large amount of people. Health insurance may
cover mental service costs up to a point, and if you are a college student your institution may
offer affordable therapy sessions. Some colleges give their students a set amount of free
consultations, which may be just enough time to express your concerns and develop a plan of
action on your own.
Therapy has also made its way onto the Internet. As we'll see, most schools of therapy are
offered as online courses. More and more studies are revealing that certain kinds of therapy,
whether in-person or across the Internet, produce nearly equal results for patients. And of
course, the main theories and exercises therapists of all schools use can be found online,
often with free worksheets and materials to help set you on a self-guided course.
Hopefully by now, you agree that fear and anxiety are necessary and natural emotions to feel.
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Life situations both in and out of your control may put you face-to-face with anxiety-inducing
challenges, and you may not always be able to cope. As there is no reason to be ashamed or
embarrassed by experiencing these emotions, so too is there no shame or guilt needed when
you decide to seek help for yourself or others. Most therapies conform to your goals and
wishes for the session. You and your therapist will work as a team to identify the anxious
thoughts or behaviors that may be keeping you from adequately relaxing or reaching your
potential. Then you'll narrow your focus onto putting what you learn during therapy into
everyday practice.
Remember that therapy is a commitment. While many of the core theories and practices of
therapies can be easily grasped, implementing them and setting up a system of support and
accountability are what are mostly needed to see solid results.
This section will introduce you to a number of therapies that may interest you, including
online therapies and the use of medication. Know that no matter which school of therapy you
decide to research more or find therapists for, you are taking the first step in a long but life-
changing road to living with fear and anxiety in a healthier way.
The self-knowledge you gain through therapy and the healthy mental habits you put to use in
your life can remain invaluable tools for fearful and anxiety-inducing situations you encounter
as the years roll on. Through therapy, you learn new ways to cope and new structures of
thinking and behaving which equip you to field life's stressful and anxious twists and turns.
Garrett Ray Harriman (Jun 26, 2015). Therapies for Anxiety. Retrieved from Explorable.com:
https://explorable.com/therapies-for-anxiety
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5.1 Cognitive Therapy
Cognitive therapy helps people with anxiety learn to recognize negative and self-
defeating thought patterns and gives them the tools to reverse these patterns. With
dedication and practice, many cognitive techniques can become second nature to
anxiety sufferers.
Anxiety takes many forms. Treatment for anxiety also takes many forms, including cognitive
therapy and cognitive techniques. Here you'll learn the basics of the cognitive school of
therapy and many cognitive exercises you can begin implementing into your daily life to
reduce anxiety.
Remember that help is available to you in person and online. Trained cognitive therapists can
further help you develop a cognitive restructuring program from the essentials presented in
this section.
What is Cognitive Therapy?

Cognitive therapy is a school of therapy concerned with how people's thinking affects their
behavior and sense of self. At its core, cognitive therapy holds that a person's
thinking—especially ongoing negative thoughts and self-talk—plays a major role in how they
self-identify, the ways they approach and avoid conflicts, and ultimately the ways they act in
response to negativity.
Cognitive therapists teach their clients that much of their thinking is counter-productive,
untrue, and exaggerated. Everyone is prone to looping negative thoughts, and cognitive
therapy gives people specific terms and techniques to help them label and experiment with
these patterns. Once such thoughts are seen for what they are—mental representations, not
stone-cold facts—people in cognitive therapy work with a therapist to apply their new
knowledge to their daily lives.
Cognitive theory also says that many of the most common psychological disorders, including
those on the anxiety spectrum, are exacerbated and given legs as a result of a person's
ingrained patterns of thinking and feeling. You also learn that your thinking affects the severity
of your anxiety symptoms.
Even if you feel that cognitive therapy is not the right fit for you, many of its ideas and
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exercises can be implemented individually outside of a therapeutic setting.
What does Cognitive Therapy Teach?

People in cognitive therapy for anxiety (and curious learners like yourself) learn many new
ways to strengthen and correct their own thinking. Here is a short list of the concepts a
cognitive therapist may help you understand:
Self-evaluation – Every minute of every day, people evaluate how they feel about who
they are, what they've done, and what they want to do. They ask themselves if they are
competent enough, handsome enough, successful enough, and so on. People with
anxiety evaluate themselves as incapable of coping with the symptoms and stressors of
life. These evaluations are constant and have a cumulative effect on an anxious
person's thought process.
Self-talk – Are you more likely to give yourself the benefit of the doubt or to blame
yourself for shortcomings? The ways you speak to and think about yourself and your
abilities greatly influences how you approach problems and solutions. This running
commentary provides you a ceaseless play-by-play of how you think and feel about
yourself and your abilities. A person adapted to negative self-talk ("I'm an anxious mess,
I'll never recover, I'm too dense to be helped") only reinforces further negative self-talk.
Automatic/Negative Thoughts – Over time, the ways a person self-evaluates and self-
talks can become automatic habits. People with anxiety disorders may come to believe
that their situation is hopeless as a result of weeks, months, even years of unflattering
and exaggerated negativity. Cognitive therapy gives people the space to realize their
current feelings are the product of long-standing patterns of thinking and feeling, not a
direct reflection of reality. A large part of cognitive therapy is working on bringing these
automatic, unconscious patterns into conscious focus to be manipulated and tweaked
for the better.
Irrational Beliefs – Just because you think and feel a certain way does not mean you or
your life truly are that way. A thought is irrational if it is always believed to be true ("I am
an anxious person and always will be") and if it is based on a false assumption ("I feel
anxious and don't deserve better"). Irrational thinking can take on many specific forms
called cognitive distortions.
What are Some Common Cognitive Distortions?

Cognitive distortions are specific ways of thinking, feeling, and evaluating your character,
worth, or situation. They are often negative, always exaggerated, and are easy to slip into,
especially if your anxious mind is already working overtime.
Here is a handful of common cognitive distortions—do you recognize any in your own mental
life?
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1.
Filtering – Focusing on the negative (or positive) of a situation only. For negative
thinking, this is often called the negativity bias
2.
Polarized (Black and White) Thinking – Believing that there are only two options for
any situation—a good option and a bad option. This limits nuanced and creative
problem-solving
3.
Overgeneralization – Believing a specific example of your behavior ("I embarrassed
myself at a party") will always happen in future situations ("I will always embarrass
myself at parties")
4.
Catastrophizing – Always expecting or imagining the absolute worst-case scenario;
never considering a neutral or positive outcome
5.
Personalization – Believing that the actions of others around you, or the situations that
arise, are always related to something you did/didn't do. You make yourself responsible
for everyone and everything
6.
Global Labelling – Calling yourself a loser, a coward, a hopeless case. Any
unexamined term you define yourself as colors and confines how you come to think and
evaluate yourself in the future.
Some of these cognitive distortions likely hit close to home--but don't get discouraged! After
you identify these and other distorted thought patterns, there are many ways you can retrain
yourself to think of them differently and better. Here are a few:
1.
Demand Evidence – Can you prove these distortions are true? Can you prove them
wrong with positive examples?
2.
Double-Standard Method – Talk to yourself and address your situation as you would to
a close friend or loved one. Give yourself the same self-compassion you reserve for
helping others
3.
Re-attribution – Regardless of how personally responsible you feel for a situation, think
up external factors that were likely at work
4.
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Survey Others – Feeling anxious about an event coming up? Ask other people if your
feelings are justified; get outside guidance and opinions
5.
Cost-Benefit Analysis – List out the pros and cons of thinking, feeling, or behaving the
way you do. Are your anxious tendencies really worth it? Do they produce results?
Garrett Ray Harriman (Jun 26, 2015). Cognitive Therapy. Retrieved from Explorable.com:
https://explorable.com/cognitive-therapy
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5.2 Behavioral Therapy & Exposure
Behavioral Therapy teaches people how their actions in the face of anxiety and fear
fuel their conditions. By changing your behavior, you change how you relate to and
recover from anxiety.
Cognitive therapy is concerned with how your thinking affects your anxiety condition.
Behavioral therapy focuses on how your anxieties and phobias have been learned through
repeated actions of avoidance, approach, and reward and punishment.
You've learned that fear is a natural human emotion and follows a predictable, closed circuit
biological path in the brain. Fear and anxiety are also learned responses: they happen as a
consequence of natural emotional processes as well as specific scenarios in life.
Behaviorists are interested in how a person's actions in the face of a threat (or imagined
threat) trains (conditions) them to react in the same predictable fashion time and again. By
changing your behavior, you use psychological principles of learning to decouple your fearful
or anxious reactions from a stimulus.
What is Behavioral Therapy?

Behavioral therapy is founded on the principles of biological learning. These principles are
present in all aspects of human life, including the behaviors that underlie anxiety.
There are two basic ways people learn. Once is through classical conditioning, the other
operant conditioning.
Classical conditioning occurs when an automatic response is triggered in the face of a

certain stimulus. The classic experimental example is a drooling dog. Experimenters ring a
bell and bring a dog a bowl of food. After repeatedly doing this, experimenters simply have to
ring the bell and the dog begins to drool. It has learned (been conditioned) to associate the
ringing of the bell (a neutral stimulus) with food, and this reaction happens automatically.
Operant conditioning is based on making new associations between cause and effect. Many
psychological experiments use mice to demonstrate this concept. In their cages, mice press a
lever to release food pellets. If they are positively reinforced with food every time (or more
times than not), they learn that their action has a positive consequence. Likewise, negative
reinforcement occurs when an action no longer happens. Mice may be in a cage whose floor
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shocks them whenever they stray into a certain corner. They come to learn that so long as
they stay away from that corner, they will not be shocked—the consequence is taken away
from the scenario.
Anxiety disorders function using both of these principles. For instance, a person who
experiences a panic attack for the first time may associate the particular place they had it with
the attacks themselves. They need only revisit or imagine the place to feel a wave of panic
(classical conditioning).
Later on, the same person may feel that bringing a lucky rabbit's foot around with them staves
off panic. They've been rewarded (positively reinforced) with a lack of panic whenever they
have the rabbit's foot with them—unaware that they don't panic because they are
systematically avoiding experiences where they think they will happen. The foot has nothing
to do with it!
Extinction & Learned Helplessness

Phobias, anxieties, and fear responses are acquired via these two learning methods.
Sometimes, more unseemly aspects of learning compound to keep an anxious person stuck
in trained (conditioned) loops of fear.
For instance, learned helplessness is the state of believing that no behavior you perform can
stave off a negative consequence or bring about a positive one. One famous experiment
demonstrated this with dogs and electric shocks. Three groups of dogs were kept in
harnesses—one group experienced no shocks, one group could stop the shocks by pressing
a lever, and the last group could do nothing to stop the shocks. The first two groups eventually
persisted and learned how to avoid the shocks; the third group eventually stopped trying to
help their situation.
This example illustrates that when events happen to us that seem out of our control,
we are more inclined to believe and behave in ways that exacerbate the problem. We
learn to rely on the notion that nothing we can do can help us. A person with social anxiety, for
instance, may become so debilitated by her previous experiences with social phobia that she
eventually comes to expect that recovery is out of her direct control, and so stops even
attempting to help herself.
Behavioral therapy helps anxious people come to terms with how learning operates and how
their own behavior may be inadvertently impeding their recovery. The goal of behavioral
therapy is to help clients "relearn" and make new associations between stimuli and their
environments (operant conditioning) and eventually let classically conditioned responses fade
away in lieu of consequences—a process called extinction.
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Exposure Programs & Systematic Desensitization
To facilitate new learning and the extinction of old fear/anxiety responses, behavioral
therapists work with clients to create exposure programs. In a safe and supportive setting, a
person comes to "expose" themselves to a feared situation. This can be done systematically
in small increments (systematic desensitization), all at once (flooding), and inside or outside of
the therapist's office. Panic Disorder, Social Anxiety Disorder, and phobic responses are three
states of anxiety which respond very well to the process of unlearning/re-association inherent
to exposure programs and behavioral therapy.
By being routinely exposed to a feared or avoided situation or stimulus, people learn that
there are no automatic negative consequences to many of the things they fear. Their
automatic fears go "extinct" without classical reinforcement. They learn that the very act of
avoiding or behaving in certain ways in the presence of imagined threats is what makes the
situation scary and anxiety-inducing in the first place.
Behavioral therapy helps millions of people cope with and recover from anxiety and fear.
Using the foundations of automatic and reinforced learning, therapists help clients make new
positive connections between behaviors and consequences.
Garrett Ray Harriman (Jun 26, 2015). Behavioral Therapy & Exposure. Retrieved from
Explorable.com: https://explorable.com/behavioral-therapy-exposure
60
5.3 Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is the leading form of therapy for helping people
overcome anxiety disorders. It combines theories and methods from both cognitive
and behavioral therapies.
People with anxiety disorders have many options to consider when they feel therapy is
needed in their lives. You've learned about the basic concepts and practices behind cognitive
therapy (your thought patterns exacerbate anxiety symptoms) and behavioral therapy (your
behaviors reinforce anxiety symptoms). CBT is an integrative therapy which combines
aspects of each of these therapeutic schools.
During CBT sessions, a person with anxiety will learn how to recognize and restructure his or
her thinking as well as techniques to alter approach/avoidance patterns of behavior. CBT has
been proven useful in addressing all of the anxiety disorders covered in this course. A typical
CBT program lasts between 12 and 16 weeks, though adapting many of its exercises and self-
reporting structures into your own life with anxiety can be a great step toward coping.
What to Expect from CBT

Cognitive Behavioral Therapy is a structured form of therapy that is generally divided into its
major components:
Cognitive component – A therapist works with clients to identify the self-defeating and
self-triggering cycles of thought, worry, and anxiety in their lives. Self-talk, self-
evaluation, and methods for dealing with cognitive distortions are typically addressed.
This phase of the therapy is called functional analysis.
Behavioral component – After teaching the cognitive aspects of anxiety, therapists

help people develop exposure and desensitization programs to repeatedly, both
mentally and in the real world, learn to cope and be present with the places and people
that upset them. The foundations of behavior change and learning paradigms are
brought to bear to a client's specific situation.
CBT argues that it is a person's typical and habitual patterns of thinking in conjunction with
their repeated approach/avoidance behaviors which predisposes them to heightened anxiety
and interferes with their powers to cope. Oftentimes simply being aware of a tendency or
problem behavior is not enough to cure it (see Obsessive-Compulsive Disorder). CBT
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interventions address this gap; negative thinking is first pegged and then followed-through
with everyday behavioral techniques.
Challenging Thoughts/Assumptions
We've already addressed the basics of cognitive therapy. Here is an extended breakdown of
what the thought identification and reversal process (called cognitive restructuring) might look
like for anxiety disorders:
I.D. Negative Thinking – Anxiety disorders often blind people to their own irrational
thoughts. A person with social phobia, for instance, may become used to imagining
social interactions as terrifying to the extent that this feels like the truth instead of a
distortion. CBT therapists help their patients bring these hidden thought patterns out into
the open.
Challenge Negative Thinking – Once the thought is out in the open, a CBT therapist
provides tools for questioning, analyzing, and testing these anxiety-prompting ideas.
We've gone over many of these techniques already, but some include purposefully
conducting thought experiments and weighing the pros and cons of holding onto a belief.
Replace Negative Thinking – The thought has now been exposed and challenged from
many angles—the last step is to completely replace it with a neutral or positive version.
This step may involve creating a short script of questions or directions to follow when the
negative thought rears again. Here are some brief examples of this 3-part cognitive
restructuring courtesy of HealthGuide.org:
Negative thought #1: What if I pass out on the subway?

Cognitive distortion: Predicting the worst
More realistic thought: I've never passed out before, so it's unlikely that
I will on the subway.
Negative thought #2: If I pass out, it will be terrible!

Cognitive distortion: Blowing things out of proportion
More realistic thought: If I faint, I'll come to in a few moments. That's not
so terrible.
Negative thought #3: People will think I'm crazy.
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Cognitive distortion: Jumping to conclusions
More realistic thought: People are more likely to be concerned if I'm
okay.
Creating an Exposure Hierarchy Program

Once you have practiced identifying, challenging, and replacing negative thinking, the
behavioral component of CBT begins to take shape. With a revised mental toolkit for picking
apart old habits of thought, you and your therapist may likely begin crafting an exposure
program. The situations, memories, or places which prompt your negative thoughts will need
to be approached either incrementally or all at once. The more you are exposed to the anxiety-
provoking scenario, the more chances you have to cope with the physical symptoms of
anxiety while actively addressing your thoughts in the moment.
Once common way to do this is through an anxiety hierarchy. If you suffer from Panic Disorder
, for instance, it can be helpful to list out the places/events which provoke the most debilitating
panic responses to the ones which provoke the least debilitating responses.
Gradually, you can begin to expose yourself to the least anxious situation, putting into practice
your cognitive tools while simultaneously retraining/unlearning your fear response. This may
begin with simple visualization exercises or even looking at pictures or videos. It could also
begin in the physical world.
Once you can successfully and routinely visit that low-listed place or scenario, you and your
therapist will move onto the next situation, and then the next. The great thing about
hierarchies is that you have a systematic record of success to look back on for
encouragement and support. Some CBT methods also advocate writing down your thoughts
and feelings before, during, and after an exposure session. The more ways you monitor your
progress, the more evidence you will have to prove your improvement.
The behavioral aspect of CBT may also involve secondary coping techniques such as
breathing exercises and mindfulness/relaxation techniques. We go over these strategies more
in-depth here.
Other CBT-based Therapies
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There are several other behavioral variations which CBT therapists may advocate, including
Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT). The
curious can follow this link for more about these alternative behavioral methods or this link for
other treatments described in this course.
Garrett Ray Harriman (Jun 26, 2015). Cognitive Behavioral Therapy (CBT). Retrieved from
Explorable.com: https://explorable.com/cognitive-behavioral-therapy
64
5.4 Other Anxiety Therapies
Cognitive and behavioral therapies are highly effective for treating a wide variety of
anxiety disorders. Because anxiety affects everyone in a unique way, however, there
are many other therapeutic options to consider when seeking professional help.
In the contemporary psychological world, the go-to therapies for anxiety treatment are
cognitive, behavioral, or cognitive-behavioral in nature, and for good reason. Multiple studies
have confirmed both of these approaches' short- and long-term effectiveness.
For any number of reasons (personal, financial, ideological), there may be times when
traditional CBT methodology is not the right fit for treating someone's specific anxiety. The
mechanisms and symptoms of fear and anxiety are universal, but the specific ways and
severities in which they manifest affect everyone to different degrees.
For those people seeking other psychological treatment methods, many more are at your
review and disposal. In this section, we'll list and describe other forms of psychotherapy which
differ from standard CBT methods and still work well for people committed to their teachings.
Acceptance & Commitment Therapy (ACT)

ACT Therapy is a mindfulness-based therapy which helps clients stay present-minded, accept
the necessity of negative or uncomfortable feelings as part of life, and choose to behave in
ways which validate their values and beliefs. Clients come to use cognitive defusion
techniques—letting thoughts and feelings happen without trying to erase or change them—to
give them distance and perspective on how they speak and evaluate themselves. Learn more
about the kinds of anxiety disorders ACT can help with here and follow through in this course
by learning some basic mindfulness techniques.
Dialectical Behavioral Therapy (DBT)

An offshoot of CBT, Dialectical Behavioral Therapy helps patients learn to accept the
uncomfortable thoughts and feelings they experience as their basis for recovery. The
emphasis is on validating and positively reinforcing attempts to strike a balance between
changing behavior and accepting feelings as they come. Through accepting the value of your
feelings, you become well equipped to make better emotional regulation decisions.
Like CBT, patients generally have "homework" assignments wherein they put their new
thinking and acceptance strategies into daily practice. This type of therapy was originally
developed to specifically address suicidal Borderline Personality Disorder patients, but has
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since shown wonderful results for helping all manner of mental disorders, including anxiety
disorders.
Eye Movement Densensitization & Reprocessing (EMDR)

EMDR is most specifically used to treat Post-Traumatic Stress Disorder (PTSD), but has been
shown to help panic sufferers, as well. This therapy is built on the foundation of dual
stimulation. The therapist guides patients to make repetitive eye movement patterns for 20-
30 seconds—this can be following a finger, a screen, or through audio cues—while
simultaneously triggering traumatic feelings and memories.
While the exact mechanisms are unknown (it's debated whether the mere exposure/elicitation
of PTSD memories is responsible for emotional recovery, the brain/eye stimulation, or both),
EMDR continues to help people suffering from traumatic episodes and anxiety link less
damaging emotional reactions to memories from their past.
Interpersonal Therapy
As the name implies, Interpersonal Therapy's focus is on improving how patients interact with
other people. Relationships and routine positive social interactions are the driving ideas
behind this therapy. The therapist works with patients to have them assess their patterns of
social behavior and thinking. Once identified, patients are taught how to rewrite many of their
negative social patterns—intimidation, trepidation, social isolation—to better prepare them to
create and sustain meaningful relationships. People with Social Anxiety Disorder and Panic
Disorder can benefit tremendously from this narrowly-focused school of therapy.
Psychodynamic Therapy
When people think of therapy, this is likely the immediate school that fills their minds.
Psychodynamic Therapy, made famous by Sigmund Freud, is a talk-centered therapy which
focuses on a person's past experiences as catalysts for their current mental health problems.
Through free association exercises ("Say the next word that comes to your mind") and open-
ended strings of questions, the therapist and patient work to untangle the negative life
experiences and thought patterns that may still have a hold on the patient's adult life.
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As discussed, many anxiety disorders can be treated without ever finding the "root" cause of
why they exist. In Panic Disorder, for instance, the origins of a person's panic, while
interesting to learn, are not necessarily integral to teaching new exposure and behavioral
techniques to treat it. That being said, and despite the school's shaky credibility,
Psychodynamic Therapy can provide valuable insight into entrenched patterns of thought
which may interfere with a person's ability to cope with trauma and anxiety. People with
clinical depression and many anxiety disorders can benefit from the insights gained during
psychodynamic sessions and can use such information as adjuncts to ongoing CBT or
medicated treatment.
Garrett Ray Harriman (Jun 26, 2015). Other Anxiety Therapies. Retrieved from
Explorable.com: https://explorable.com/psychotherapy
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5.5 Online Anxiety Treatment
Traditional in-person therapy sessions help millions of people with anxiety issues. The
new frontier of online therapy, however, has already proven itself a valid method for
anxiety treatment that delivers results comparable to other methods.
This course has made clear that a person struggling with the symptoms and stresses of
anxiety disorders has a wide range of treatment options to pursue. People seeking help for
anxiety disorders may be curious about the versatility and flexibility of online therapy and
treatment options.
Research (see below) has now demonstrated that, for certain disorders, online anxiety
treatment matches or rivals the results of traditional methods. It is a vehicle for the same
cognitive and behavioral principles taught during face-to-face sessions, and its record of long-
term symptom reduction is impressive. As a standalone treatment or a supplement to other
treatments, online anxiety therapy is as credible and viable an option as the others.
The convenience and ease of access online anxiety treatments offer make them an attractive
option for a wide swath of people. This section introduces you to the basic structure of online
anxiety treatment, what research says about its effectiveness, and ideas for choosing a
website or option that will work for you.
What Is Online Anxiety Therapy?

Online anxiety therapy is an offshoot of online counseling, itself the method of delivering
professional counselling services online. Online therapy goes by many names, including e-
counseling, e-therapy, and tele-counselling.
A typical online session lasts as long as traditional face-to-face counseling, between 30

minutes to an hour. The counselor and patient may communicate through various methods
including chat logs, video or Skype calls, forum posts, or telephone calls. As with in-person
counseling, professionals are free to choose their own rates and platforms. It's also important
to consider the benefits of online anxiety counseling (convenience, anonymity, versatility) with
its potential downsides (hardware issues, security, credentials).
What Does the Research Say?
Credibility online is an issue, and thus far online counselors are not accurately able to make
complete diagnoses in the absence of visual and body cues/behaviors. It's also worth
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remembering that online counseling has other limitations (it cannot yet benefit severe cases of
mental disorders).
Nevertheless, for people who have been professionally diagnosed with moderate cases of
anxiety disorders, following through with online counseling and treatment can produce
wonderful benefits alone or in conjunction with offline treatment. Preliminary and ongoing
research has begun to narrow down its positive outcomes, including:
Several recent studies demonstrate that online Cognitive-Behavioral Therapy (CBT)

interventions can be equally effective as in-person sessions
Meta-analyses—studies which pool and assess the results of many studies—also show
online therapy treatments for mild cases of depression and anxiety to be effective. More
research is needed to confidently confirm the scope and longevity of online mental
health interventions, but results are promising. One study in Zurich found that 57% of
people in their study who took online CBT therapy showed continued improvement after
three months compared to 42% of face-to-face CBT subjects
Mindfulness practices delivered online also lead to a reduction of clinical stress and
anxiety symptoms
Phone therapy (tele-therapy) has also been shown as effective as in-person therapy for
helping mild cases of depression and anxiety. The majority of 39,000 British adults
surveyed in one recent study reported less severe symptoms, and the cost was much
less expensive than traditional methods.
Online therapy has seen tremendous growth in popularity as well as scientific credibility.
Current science says it is an effective complementary treatment option for people with mild
cases of anxiety and depression and a great direction to take for people in financial difficulty.
(A reminder on expenses: Many companies and insurance policies cover the cost of therapy
sessions or supplement the cost of medication. A majority of private therapists also adopt
sliding scale payment plans to help people get the help they need, and colleges and
universities often provide a limited free number of sessions to their students, faculty, and
community members. Payment options likewise vary for online therapies and programs.)
How Do I Choose a Quality Online Program?

In most ways, the best practices for choosing an online program or counselor is to adhere to
the same criteria you would when choosing an offline therapist. Credentials, years of
experience, and methodological schools they use (psychoanalytic, CBT) should be vetted with
the same attention to detail.
To make this easier, many online counseling centers employ a roster of working mental health
professionals with profile descriptions and testimonials from previous clients. Just as
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important as credentials are how well the two of you will connect. Therapy is a relationship;
trust and comfort must be present in an online exchange for benefits to manifest themselves.
It is normal and acceptable to try working with any number of online therapists as needed until
you feel safe and secure enough to invest in the therapeutic process.
There are other treatment options besides counseling. Certain universities and organizations
operate free to cheap online courses which teach the basics of therapeutic techniques to treat
anxiety. While less personalized, the best of these courses are made widely available to
people and are spearheaded by mental health experts. Check university and mental health
organization websites to find these sources and know that, should you encounter a single
person's "anxiety cure" method, you are pursuing them at your own peril.
MoodGym is a wonderful example of an accredited and proven online course. It is an

Australian-based operation which covers Cognitive-Behavioral Therapy techniques, exercises,
and misconception reversal. Here is a brief list of quality cheap to free online anxiety
counseling services and courses available right now:
MoodGym
eCouch
eCentre Clinic – OCD Course
eCentre Clinic – Wellbeing Course
The Social Anxiety Institute's Online Courses
The Panic Center
Be Mindful Online
LivePerson Online Counseling (Presto Experts)
Healtheminds
Mindquire
Psychology Today's "Find a Therapist" Function
ADAA Therapist Search
Don't forget to check out these lists of great online anxiety resources and take the time to see
if Anxiety Social Net, an online anxiety community, might be a welcome addition to your
recovery program.
The bottom line: There are many online paths to take to receive quality anxiety treatment
which fit your budget and lifestyle.
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Garrett Ray Harriman (Jun 26, 2015). Online Anxiety Treatment. Retrieved from
Explorable.com: https://explorable.com/online-anxiety-treatment
71
5.6 Medication
Medication is available to help ease anxiety symptoms. Depending on the severity and
duration of an anxiety disorder, doctors and psychiatrists may recommend taking
medication in combination with certain forms of therapy for the best possible results.
For people contending with mild to severe forms of anxiety disorders, general anxiety-
reduction tips and therapy are great, research-backed starts on their road to recovery. When
combined with specific medications designed to further help reduce anxiety symptoms, this
two-pronged approach can also be highly effective.
It is worth noting that for most individuals with anxiety, medication is not needed nor helpful for
a successful treatment. Some medications frequently used for anxiety disorders, such as
Sobril, Valium, Xanax and other benzodiazepines/tranquilizers, usually reduce the effect of
other treatments and often trigger more anxiety in the long run. These medications are also
frequently known for high potential of substance abuse, and although it reduces anxiety fast, it
often also induce anxiety afterwards, which may lead to a vicious cycle.
You may be curious about what exactly medication does to help people with anxiety. This
section outlines the basics of how antidepressants and other psychopharmaceuticals work.
Remember, however, that if you or someone you know is considering starting medicinal
treatment for an anxiety condition, be sure to consult with a medical and mental health
professional first. Medication treatments require time, commitment, and involve their
own set of positives and negatives. Please seek professional diagnoses and opinions
before beginning an anxiety-reduction program that involves medication.
Medication & Treatment
SSRIs
Antianxiety and antidepressant medications have been in use for a number of decades. The
most commonly prescribed drugs for people with anxiety and depression are a class called
Selective Serotonin Reuptake Inhibitors (SSRIs). Brands you may have heard of include
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
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Sertraline (Zoloft)
Serotonin is a naturally occurring chemical in the brain (a neurotransmitter) which helps

regulate positive mood states. The chemical "fires" between neuron cells in the brain, where
its effects are felt, before being absorbed by the receiving neuron cell.
SSRIs work under the assumption and evidence that people with depression and anxiety are
unable to reabsorb (reuptake) a significant amount of serotonin, resulting in lowered mood or
more anxious states of mind. SSRIs block the reuptake of serotonin between neurons in an
effort to enhance and lengthen the amount of time serotonin affects your mood.
When SSRIs Work

While the classic explanation for this process and why it works is "an imbalance of serotonin
in the brain," science is discovering that anxiety and depression are more complex than a
simple imbalance. For some people, medication at clinical doses (50mg to 200mg) can have
tremendous positive effects on mood. Others may experience no change, heightened
arousal/depression/anxiety, or even anhedonia (loss of interest in once-loved things). There
is no baseline "perfect level" of neurotransmitters in the brain averaged across all of humanity;
think of this explanation as a metaphorical shorthand.
Thought the ultimate functional reasons SSRIs work for some people and not others is still
under debate, people suffering from severe symptoms of depression and/or anxiety may
benefit from a medication intervention. It is preferable to use medication in conjunction with
therapy, as medication without therapy is far less effective than a combined approach. (
Note: Medication does not "cure" anxiety and depression, but makes symptoms more
manageable.) Furthermore, antidepressants require daily usage between 4 to 6 weeks before
most people experience their effects.
It may take months or years of different dosages, brands, and therapeutic combinations to find
the right balance for your anxiety and/or depression. If you experience relief with medication,
and are dedicated enough to find this balance, you can join millions of other people have
found relief through continued use of SSRIs.
As with any psychopharmaceutical, there are risks to taking medication. SSRIs, because of
their duration and daily intake, cannot be discontinued all at once. Tapering is recommended
for extended use to avoid withdrawal symptoms (mood shifts, elevated anxiety, physical
effects). This information is not presented to deter you from seeking antidepressants to help
your condition, only to remind you that antidepressant use is a long-term process. When you
are ready to change or come off/reduce your dosage, the process is also gradual.
Medication by Disorder
The nuances of research for medication use with specific anxiety/depressive disorders is too
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extensive for this course. The more you know about the positive and negative sides of
medication use, the more informed your decisions will be and the greater security you and
your doctor/psychiatrist will feel as you continue exploring treatment options.
Garrett Ray Harriman (Jun 26, 2015). Medication. Retrieved from Explorable.com:
https://explorable.com/medication
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6 Coping & Acceptance
Fear and anxiety will be with you your entire life. Knowledge and therapy are great
ways to change your relationship with these emotions, but there are many other habits
and practices you can experiment with to ease the anxiety in your life.
You've just spent a decent amount of time exploring the ways anxiety and fear can get out of
hand, the ways they can adversely affect your health (mental and physical), and any number
of anxiety disorders and related therapies that exist to limit anxiety's negative and even
overwhelming influence.
But remember: At heart, fear and anxiety serve to keep us safe in a dangerous world,
and help us prepare for contingencies and success in the future. There will be times,
however, that remembering the virtues of anxiety and fear may prove difficult. If an
unexpected stress or tragedy happens in your life, or if you are diagnosed with an anxiety
disorder, it may feel that all you can do is react and "ride this wave out."
The good news is that you don't need to remember how fear and anxiety work at the chemical
level to rise above their weighty influence. In fact, it's best not to think of fear and anxiety as
antagonists at all—the notion of "facing your fears," for instance, only pits these
emotions as the bad guys, which they aren't. Life is full of anxieties and fears, small and
large. They are woven into the fabric of human experience and serve us well (for the most
part!)
Take a moment now to erase the idea of "facing your fears" out of your head. Your goal in life
is never to not experience fear and anxiety. Instead, it's too recognize when fear and anxiety
have overtaken your normal, healthy patterns of thinking and acting, and to realize that they
are doing their job—just a little too well.
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Psychologists call the ways we respond to negative situations in life as coping. There are
many coping strategies for all manner of temporary setbacks or long-term disorders, but they
all share one thing in common: They are ways of approaching what ails us with a sense of
optimism and acceptance. The more ways you have to creatively and effectively manage how
you react to fear and anxiety, the stronger your coping skills become. Coping strategies can
be used on-the-fly, and while their effects might not be immediate in some cases, the more
you practice them, the more naturally you will behave in those ways when future danger and
anxiety pay you a visit.
You'll recognize many of the coping strategies in this section as extensions of certain
therapeutic schools from the previous unit. Regardless if you first encounter these coping
strategies in a therapist's office or are just now learning about them, the ideas and behaviors
presented here are crucial for a healthy sense of balance and acceptance.
It bears repeating: You don't have to "overcome" or "defeat" your anxiety and fear! As
we've established, these emotions are central to who you are and usually have your best
interests at heart. They will be at your side your entire life. The trick is to accept their
presence, especially if they break away from you from time to time and temporarily blind you
from the less scary, less anxious way things used to be.
A large part of coping is routine. You'll find that implementing these thoughts and actions
during particularly stressful or frightening times may feel awkward, or that you are not making
much progress. Keeping a log of your plans and actions will give overtones of progress to
your coping so you don't always feel as if you're starting from square one. Consistency is key
to coping; the more consistently you think and act in ways that help ease your fear and
anxiety, the less need you'll have to forcefully fight against these feelings, and the more
accepting you'll be of their presence in your life.
It's inevitable that stressful and anxiety-inducing situations will be part of who you are. By
putting these easy-to-start coping strategies into play, you are making a pact with yourself to
consciously and bravely interpret fear and anxiety from a productive and respectful
point of view. These habits may be hard, even scary to begin, but keeping at them and
recording your progress helps you "in the moment" with things get scary or anxious, when
your thoughts or fears overtake your logic (which they are wont to do).
Give these coping strategies your time and attention, especially if you are currently
experiencing tremendous or unexpected anxiety in your life or are coming to terms with an
anxiety disorder. These habits are healthy even for people who normally don't react to stress
and negativity in an overly-anxious way. There are always better ways to cope with your
problems. In coping you accept, and in accepting you grow.
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Garrett Ray Harriman (Jun 26, 2015). Coping & Acceptance. Retrieved from Explorable.com:
https://explorable.com/coping-acceptance
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6.1 Anxiety Tips: Diet & Exercise
Anxiety is part of modern living and oftentimes cannot be avoided. Outside of

medication and therapy, daily coping techniques aid anxious acceptance and recovery
exponentially. This section describes several helpful ideas and habits to adopt when
living with anxiety.
At this point in the course, you have a wider understanding of the causes of fear and anxiety,
common anxiety disorders, and long-term anxiety interventions including therapy and
medication. Even if you do not personally suffer from an anxiety disorder, anxiety is and will
remain a presence in your life. It may arise gradually or suddenly; either way, you'll need a
powerful set of tools to cope with its influence, embrace its positive aspects, and avoid its
negative, lifelong effects.
The next three sections of the course are dedicated to the behaviors, lifestyle changes, and
positive mental habits you can begin incorporating into your life to reduce anxiety. Several of
these concepts have origins in the therapeutic schools previously discussed, but none of them
require extensive training or tremendous expense to implement. You can begin these
techniques today!
If you are ready to turn a new leaf in how you interpret and react to anxiety and the fear
response, these next sections are for you.
Exercise
The importance of exercise for reducing symptoms of mental disorders—not just anxiety and
depressive disorders—cannot be overstated. Exercise releases endorphins, chemicals which
help regulate energy levels and promote good sleep. More energy means less time for
rumination and worry and more time putting other anxiety-reduction plans into action. More
sleep means less stress overall. As little as 5 minutes of high-intensity aerobic exercise is
enough to improve motivation, self-esteem, and trigger anti-anxiety and immune system
chemicals.
For someone with depressive symptoms, 10 minutes of vigorous exercise has the same
positive mental effect as a longer 45-minute workout—temporary but hours-long
improvements in mood and concentration. Exercise also has a preventative role to play: One
study showed participants who exercised regularly were 25% less likely to develop an anxiety
or depressive disorder for a full 5 years. Another showed that a regimen of 30-40 minutes of
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exercise 3 times a week produced the same positive gains for Panic Disorder as did taking
the drug clomipramine in just 10 weeks.
What's more, the same neurons that are excited in the hippocampus (the brain's memory
center) during exercise seem to activate other inhibitive neurons. The more healthy
excitement neurons experience, the better prepared they are to counteract negative, stress-
or anxiety-related responses, and the more easily the hippocampus remembers to activate
them.
Aside from study specifics, regular exercise also promotes these overarching anti-anxiety
moods and mental conditions:
Gaining confidence
Meeting goals
Taking the mind off worries
More chances for social interaction/support
Reinforces more healthy coping strategies
Proper Diet
The food and nutrients you supply your body with affect your physical and mental well-being.
While most experts agree that the brain's biochemistry and one's life experiences acting on
predispositions to anxiety and stress are responsible for the majority or anxiety disorders,
there is mounting evidence that indirect links between nutrition and anxiety exist.
The unregulated market for homeopathic and supplemental cure-alls is rife with
misinformation about the role certain chemicals play when it comes to anxiety. (Many
combinations of natural supplements and psychopharmaceutical medications can actually be
deadly!) In an effort to combat these hucksters, here is a brief but scientifically-backed list of
foods and nutrients that affect—positively and negatively—anxiety:
Eat Omega-3 Fatty Acids – Commonly found in fish, these chemicals are severely
lacking in most modern diets. While the exact mechanism is still unknown, research has
found omega-3s reduce anxious reactions by restricting the concentration of cytokines,
proteins which carry out inflammatory cardiovascular roles during anxiety-inducing
situations. Less inflammation during bouts of anxiety means healthier stress reactions
on the body and heart. Diets high in omega-3s promote this reaction.
Eat Tryptophan – This amino acid (famously found in turkey) is the catalyst for the
production of serotonin, the mood-altering neurotransmitter the levels of which SSRIs
attempt to elevate. Controlled studies have shown increased serotonin production with
more tryptophan in the body, and a reduction of cortisol, a stress hormone.
Eat Complex Carbohydrates – Foods high in complex carbs—notably whole
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grains—may contribute to serotonin production more than simple carbs—foods high in
sugar and little nutrients.
Avoid Sugary Foods/Empty Calories – Speaking of, blood-sugar levels affect the
body's energy and mood levels. Spikes and drops in blood sugar can leave you more
vulnerable to stress and anxiety triggers. Eliminating simple carbs and sugars without
nutrients (have actual fruits and vegetables, not juices or concentrates) reduces
anxiety's preemptive appearance.
Avoid Alcohol & Caffeine – Alcohol is a depressant; its immediate effect on the body is
calming but once metabolized can increase feelings of edginess and interfere with
sleep. Caffeine is a stimulant; for people hypervigilant about sensations of danger and
anxiety, caffeine's effects on the body (shaky palms, sweating, racing heart) can be
confused with anxious symptoms and set off false panic alarms.
Garrett Ray Harriman (Jun 26, 2015). Anxiety Tips: Diet & Exercise. Retrieved from
Explorable.com: https://explorable.com/diet-and-exercise
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6.2 Anxiety Tips: Social Strategies
The experience of anxiety does not have to be weathered alone. Finding social outlets
is a key to coping with anxiety in a healthy fashion.
No anxiety disorder or bout of anxiety can be understood and corrected in isolation.

Connecting with other people has a two-fold effect on anxiety coping. First, it encourages
collaboration and resource-sharing. Asking for help, both online and off, increases your own
knowledge base and awareness of how anxiety affects your life and ways it can be managed.
Second, socialization spurs solidarity between people who may not know what anxiety
disorders are and between people who are suffering/have suffered through severe anxiety in
the past. Socializing is also a great opportunity to put into practice other cognitive methods
that research has shown effective against overwhelming anxious thoughts and feelings.
Here you'll discover information about the effectiveness of being social while in the midst of
severe anxiety. You'll also find a handful of ideas and methods for getting out of your own way
and connecting with others in-action.
Finding Social Support

Humans, as the saying goes, are social animals. Our best aspects as individuals are
facilitated through open and deep communication with other people, and our recovery from
mental hardships, including anxiety and anxiety disorders, depends on consistent socialization.
This advice may sound simple, but anyone dealing with high anxiety, fear, and stress knows
that these disorders prey on your self-confidence, motivation, and interject shame and doubt
into your ability to seek outside support. At its negative extreme, anxiety acts as a wedge
between needing help and isolating yourself from that help. People experiencing anxiety
become more ruminative, internalized, and prone to inner-dialogues of guilt, fear, and
hopelessness in response to the telltale physical and emotional symptoms of anxiety.
People with Social Anxiety Disorder, for instance, come to see even mundane social
interactions as cause for alarm. Studies also show that depression isolates people into self-
defeating routines, and only through novel pattern-breaking (new experiences, more
socialization) are these fixed tracks erased.
How Does Social Support Relieve Anxiety?

With all of these forces seemingly acting against people with anxiety, the positive benefits of
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social support are all the more necessary for acceptance and recovery. What are some of the
positive benefits of socializing while experiencing anxiety?
Biologically, socializing produces the hormone oxytocin which activates the

parasympathetic nervous system (the body's calming response). This hormone also
increases the need to seek social support and assistance when in crisis. People with
strong supportive networks of friends, family, or healthcare professionals receive more
of a "social boost" from the chemical and other-seeking nature of oxytocin.
Socializing takes the anxiety-sufferer out of his/her own head and problems to focus and
help other people. This alone reduces many classic isolationist and withdrawal anxiety
symptoms.
Volunteering and performing altruistic acts is a great way to escape your own head.
Helping those less fortunate than yourself gives you tremendous perspective not only on
your own condition, but the resources and strengths you have at your disposal. It is also
scientifically certified to help your self-confidence.
Being social helps you achieve some mental distance from your own distress. It also
promotes gratitude, a feeling itself linked to all manner of mental health benefits. Making
social connections and then reflecting on their value in your life and recovery initiates
the gratitude process.
Gratitude itself also increases self-esteem and –confidence, making it easier to navigate
and desire social connection.
How to Become More Social

If you're convinced that social support is a catalyst for anxiety recovery, your next question is
likely "What exactly can I do to get started?" As stated, the nature of negative stress and
anxiety make finding initial reserves of confidence and motivation to help yourself seek others
difficult, but not impossible.
Here is a short list of everyday ways you can begin being more social. Remember: Your
recovery and coping with anxiety depends on being social!
1.
Remember that social support involves many different relationships, so don't limit your
definition. Socioemotional support is the loving, sympathetic variety fostered between
family and friends. Tangible support can include money, resources, and a safe
supportive place to stay. And informational support includes feedback and advice given
by mentors and therapists. All of these kinds of social support facilitate better coping
skills and reduce the likelihood of severe anxious outcomes
2.
Your community itself is a support network. Churches, non-profits, and clubs all offer
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commaraderie and social bonding. Let your community bolster your self-worth and
reduce your anxious symptoms
3.
Join an online support community, forum, or website with people who are experiencing
the same anxieties as you. Use websites like MeetUp and Anxiety Social Net to find
people with similar interests and experiences with anxiety. There are many healthy
options to choose from, and scientific evidence agrees online social support can be
tremendously beneficial.
4.
Practice your communication skills by being more assertive and confident when
speaking and interacting with others. This involves paying attention to non-verbal cues
(body language), being an active listener (withholding judgement, providing feedback),
and keeping stress and anxiety at bay (making specific points, using calming
techniques). Here is a more detailed look at developing these skills.
5.
Engage in self-soothing strategies, especially when your anxiety symptoms overshadow
your will to follow through socially. Ask questions instead of assuming the thoughts and
reactions of others (mind-reading), list your anxiety-provoking thoughts, and keep ideas
of future social blunders out of the present moment
6.
Use psychologist Robert Ellis's ABC Model to reinterpret anxiety-causing events or
thoughts of social incompetence. The steps include:
A (Activating Event) – What was the situation itself? Look at the event objectively. ("I
didn't call my friend today.")
B (Beliefs) – How/Why did you feel this situation happened the way it did? Record your
reactions and thoughts to the event. ("I'm too anxious to make a phone call—I'm such a
fool!")
C (Consequence) – What is your emotional response to this belief? ("I'm depressed. I'm
never going to make a friend.")
The goal of the ABC Model is to recognize where your faults in logic lie between steps B and
C. Recognize and label the cognitive distortions at work in your initial belief, challenge these
negative beliefs bluntly and directly, and be aware of these ingrained belief patterns in the
future.
7. Keep a gratitude journal. This is another way to appreciate all the ways people in your
life help you gain perspective and motivate you to get better
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8. Practice mindfulness and breathing techniques, which we explore in-depth in the next
section
Garrett Ray Harriman (Jul 7, 2015). Anxiety Tips: Social Strategies. Retrieved from
Explorable.com: https://explorable.com/cognitive-social-strategies
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6.3 Anxiety Tips: Mindfulness & Breathing
Alleviating symptoms of anxiety can be achieved through mindfulness practices and

consciously changing your breathing habits. Science is continually discovering new
ways these two exercises benefit mental health.
The anxious mind is mired by repetitive concerns of future scenarios playing out in negative
ways. Daily worries about chores to be done, tasks to manage, and goals to meet distract us
from the immediate present of our thoughts, feelings, and reactions.
Anxiety disorders take the anticipatory nature of anxiety to its extremes. A person with
Social Anxiety Disorder might fret about making a fool of themselves in public three months
from now, while someone with Panic Disorder avoids new experiences because they foresee
disaster at every turn. This future-mindedness is a chronic byproduct of modern Western
living and a staple of the most common anxiety disorders.
You've already learned the negative results of a life filled with too much anxiety. You may
even be anxious about how long this section of the course will be because you really have
other things to do—things that can't wait, that must be managed and prepared for now!
If this sounds like you, if you find your anxious state is sucking the life and vigor out of your
present life, this section is of utmost importance. Over 40 years of research shows that
mindfulness and breathing exercises are supremely effective skills to cultivate, whether
dealing with the humdrum anxieties of everyday living or entrenched in the throes of an
anxiety disorder. These practices are designed to reacquaint you with the present
moment—your thoughts, feelings, and reactions here and now—and have become
integral coping mechanisms for many anxiety therapies.
Here we'll outline the basics of mindfulness and breathing and familiarize you with the ways
science says these practices positively affect our moods and calm our anxious proclivities.
What is Mindfulness?
Mindfulness is a state of intensely focusing on the present moment. To be mindful is to
acknowledge anxious-ridden fears and worries, let them "float" and pass through your
conscious awareness, and return your focus onto your present sensations and environment.
There are many varieties of mindfulness techniques. Some are linked with specific religious
traditions or beliefs, but secular mindfulness is the one routinely studied. At its core,
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mindfulness is the practice of letting the mind's constant barrage of worries and contingencies
play themselves out without reacting to them negatively. You come to realize these thoughts
for what they are—thoughts—not as harbingers of doom or visions of future failure.
To achieve this relaxed, accepting, and nonjudgmental frame of mind, there are several ways
to begin:
Focus on your immediate environment. What sensory stimuli are filling your
immediate space? Concentrating on these details invites you to step out of your own
anxious forecasting temporarily and gain perspective
Focus on your own bodily sensations. Notice the weight and position of your body,
any aches or pains. Perform a body scan to practice taking compassionate stock of
these sensations, acknowledging their presence, and then moving on down your body.
You are not trying to change how you feel, but learning to notice again and again how
you feel, not how you think
Guided meditation and visualization are further mindfulness techniques many

anxious people find helpful. Imagining a beautiful scene in full richness and
detail—senses included—usurps the hold your treadmill of anxious thoughts has on your
thinking
At first consideration, it may seem that you are distracting yourself from the symptoms and
thoughts of anxiety; in reality, the opposite is true. Your anxieties and worries are
distracting you from the immediate present! Learning to approach with compassion and
curiosity the ways you feel, accepting the thoughts that flicker through your mind's eye, and re-
engaging with the present moment (whether the environmental details, physical sensations, or
mental images) in both body and mind spare your limited concentration from ruminating. You
reinforce the skill of distancing yourself from anxious thinking and not surrendering your
precious conscious powers to a convincing, but overblown level or concern for future
outcomes.
There are many places online which detail the wide variety of mindfulness practices. As with
other coping strategies, mindfulness should be catered to the individual. Experiment with
multiple techniques until one feels right for you (i.e., helps guide your focus away from future
anxious worry). Some remedial places to start are right here; many of them give you
step-by-step instructions. These are all free resources and come highly recommended.
The important thing is to begin integrating mindfulness into your life as a daily habit. Reserve
time in your day (maybe right after you wake up, before going to bed, or while on lunch break)
to dedicate yourself to 20-30 minutes of concentrated mindfulness. Your resiliency and
reactions to anxious symptoms and situations can dramatically improve through habitual
mindfulness in as little as 8 weeks.
What about Breathing?
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In mindfulness practice, paying attention to your breathing is an inlet to that hallmark, hyper-
focused, and sympathetic state of nonjudgmental awareness. It's another physical focal point
to lead your thoughts back toward your body whenever anxious thoughts intrude and demand
your unbiased attention.
Biologically, deep breathing activates the body's parasympathetic nervous system to stop
producing fear and stress hormones, relieve muscle tension, and lower the heart rate—in
short, to relax. Cortisol levels have also been shown to reduce through routine
mindfulness/breathing practices.
The breath also plays a role in heightening the symptoms of many anxious conditions. The
fear/anxiety response causes hyperventilation, which precipitates other bodily reactions
(racing heart, sweaty palms) that anxious people may misinterpret as signs of immediate
danger. When you retrain how you breathe during panic- and anxiety-inducing situations, you
send a message to your mind that A) what's happening is not dangerous and B) you are in
control of how you choose to react. Many Cognitive-Behavioral therapists teach their clients
breathing techniques not only to help their mindfulness practice, but as a separate coping
mechanism to use "in the moment" when fear and anxiety symptoms strike.
Once of the most effective breathing techniques is practiced by American forces in active
combat. (You can imagine the very real, immediate threats they contend with.) It's called
tactical breathing and can be practiced as follows:
Breathe in for a count of 4

Hold your breath for a count of 4
Fully exhale to the count of 4
Pause between the next breath for a count of 4 (hold a "negative breath")
Repeat 3-5 times
To become even more familiar with your breathing patterns—and to start taking notice of how
integral and triggering shallow, scared breathing can be to symptoms of anxiety—schedule
time every day to focus on your breathing, re-center yourself, and move forward.
Garrett Ray Harriman (Jun 26, 2015). Anxiety Tips: Mindfulness & Breathing. Retrieved from
Explorable.com: https://explorable.com/mindfulness-breathing-exercise
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6.4 Embracing Uncertainty (Your "Negative
Capability")
Throughout this course, you've learned that anxiety is a natural emotion to feel in the
face of uncertainty (or presumed uncertainty). This final section leaves you with food
for thought: How psychologists have classified human reactions to uncertainty and the
concept of "Negative Capability" devised by poet John Keats.
''Do you not see how necessary a world of pains and troubles is to
school an intelligence and make it a soul?''
- John Keats (1819)
Anxiety, as you are now well aware, is a complex human emotion. It is the product of an
extended evolution of survival, a tool of imagination and forethought, and if not managed and
coped with, can lead to catastrophic thinking and often overwhelming anxiety disorders. The
emotion can be both a blessing and a curse for people living in today's harried world.
At heart, anxiety is a stress reaction to an unknowable or imagined event. Humanity's

capacity for planning, creating, and manufacturing visions of better living come designed with
a double edge. In our efforts to find patterns and rational explanations for arbitrary events, we
can knowingly (and often unwittingly) create anxiety out of thin air!
Uncertainty Management
Psychologists have been fascinated by uncertainty and how people manage their own fair
share. Three traditions in psychology have specific view of the usefulness and manifestation
of uncertainty and how people cope with unknowable potential:
Knowledge-Seekers are people who are curious and actively pursue new knowledge
and experiences. The act of seeking is an anxiety-mitigating endeavor, as any novel
knowledge gained is a buffer against all of life's uncertainties. This view originated from
psychoanalytic thinking.
Certainty-Maximizers believe that humans, through the biology and reinforcement of

learning principles, are natrually adapted to deal with the knowledge of uncertainty. By
focusing on the negative consequences of uncertainty, we are motivated to learn skills
to minimize uncertainty in our personal lives. Emotional and learning psychology
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traditions spawned this view.
Then there are the Intuitive Statistician-Economists. These people look at the
statistics and probabilities of unknowable events and seek to rationalize and reduce
uncertainty to its barest influence. They treat indecision and uncertainty with a
"cost/benefit" mindset, settling on the most rational course of action or thought. This idea
is the product of cognitive and perceptual psychology.
These categories are not hard-and-fast rules; many have fallen out of style in favor of newer
theories of anxiety and uncertainty management. You are familiar now with the emotional and
adaptive theories of anxiety, how human development and modern living demand reactions to
uncertainty to spawn motivation and survival. There are other modern twists psychologists
have brought into the uncertainty debate. Just a few are listed below:
Terror-Management Theory holds that all of human action—from small everyday acts of
kindness to the motivations for going to war—are motivated by a lifelong existential
dread. Our ability to speculate on our own mortality and to imagine a million potential
futures is at the core of the human experience. Quite a bit of research now supports this
overarching theory, most notably the famous hot sauce experiment.
In sociology, Uncertainty Reduction Theory attempts to explain the anxiety-reducing

steps strangers go through upon first meeting. As social creatures, we are always trying
to "figure out" the other person—what their motivations, thoughts, and intentions are. To
cope with the uncertainty of engaging with someone new, our behavior typically follows
three phases:
1.
Introductions (Entry Stage) – We exchange social greetings and culturally-specific
behavioral norms (small talk, eye contact or not, etc.)
2.
Detail-Sharing (Personal Phase) – Strangers take turns sharing more personal views
and values with each other. We probe one another to see where our values lie. If values
match up, more emotional connection and deeper sharing ensues
3.
Follow-Ups (Exit Phase) – At the end of the interaction, the strangers decide if they
want to continue developing their relationship. They either make plans to get together
again (exchange phone numbers, invite the other person out, etc.) or mutually decide
not to interact further
Psychologists believe heuristics (mental shortcuts/shorthands for thinking and

interpreting the world), biases (seeing the world through specific frameworks to the
ignorance of others), and even stereotypes (large group categories under shared trait
umbrellas) exist as cognitive tools we routinely use to save our mental energies from
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constantly acknowledging the "gray area" and ambiguities inherent to living.
All of this is to say that uncertainty occupies an enormous amount of human thought and
endeavor and, being the meaning-making creatures we are, we have many ways of managing
thoughts of the unknown.
Live like a Poet

There is another outlook to consider when facing the unknown, the vastness of the possible,
the infinite ways life can unfold. You can, little by little, begin living with uncertainty—accepting
it as a natural function of life itself which cannot be rationalized, controlled, or stopped.
To people with anxiety issues, this may strike a very horrific chord. When you stop to think
about it, however, the psychological principles and steps therapeutic approaches like
Cognitive-Behavioral and mindfulness-based schools take are about accepting that stress
and anxiety are inevitable. What matters is how you routinely assess and react to these
situations when they arise; efforts to completely eliminate or control all outcomes only
exacerbate anxious symptoms.
To embrace uncertainty, both in life and in art, is a concept beautifully encapsulated by

Romantic poet John Keats's term "negative capability." In his words:
"The concept of Negative Capability is the ability to contemplate

the world without the desire to try and reconcile contradictory
aspects or fit it into closed and rational systems....Negative
Capability, that is when man is capable of being in uncertainties,
Mysteries, doubts, without any irritable reaching after fact &
reason..."
To Keats, all of the contradictions, unknowables, and boundless potentialities that life
presents us are part and parcel of living. Uncertainty is another force—like gravity or
time—that must always be present, in fair or foul forms, for human ingenuity and efforts to
mean anything.
Consider the many ways uncertainty can bring joy, mystery, and an unquenchable fascination
to your own life. Consider how anxiety is both the impetus and impediment for human
connection and achievement. Last of all, from time to time, tune into your own "negative
capability." Seek to feel anxiety and fear in all of their forms, appreciate what these emotion
can do, and define your life alongside anxious thoughts, not in spite of them.
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Garrett Ray Harriman (Jun 26, 2015). Embracing Uncertainty (Your "Negative Capability").
Retrieved from Explorable.com: https://explorable.com/embracing-uncertainty-your-negative-
capability
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7 A New Appreciation
This course has presented the biology, mechanisms, outcomes, and therapies
surrounding anxiety and fear. It's now time to reflect on what you've learned and take
the necessary steps to rethink and cope with fear and anxiety in your own life.
Anxiety and fear are complex and fascinating emotions that govern so many aspects of our
lives, motivations, and futures. This course has given you ample evidence to think about and
respect fear and anxiety from points of view you may have never considered.
You now understand how these emotions manifest neurobiologically and the many positive
experiences a healthy level of these emotions can bring. You also understand the ways these
emotions may affect your health if you are not watchful and compassionate about exploring
them, as well as many anxiety disorders that hundreds of millions of people around the world
cope with every day. Lastly, you've learned an overview of the major therapeutic schools that
help people deal with short- and long-term anxiety issues in their lives, and may even have
begun establishing your own system of coping behaviors—mindfulness, exercise, and a
robust social support network.
It is our hope that this holistic look at fear and anxiety has given you more to think about and
be grateful for in terms of these emotions. Often it's difficult to realize that these emotions are
for our own benefit—some people never learn this and continually cast fear and anxiety as
"the bad guys" in their lives.
With just a little more awareness, however, these emotions can be seen as great allies for you
your whole life through. They can certainly be taken too far and can cause body and
heartaches in the lives of millions of people. But there are always ways, small, humble ways,
to remind yourself that these qualities serve you and can be lived with and cherished in
harmony.
92
Where does this leave you now? If you are someone who rarely experiences bouts of intense
fear or prolonged anxiety, the ideas and concepts we've covered have given you a wider
appreciation for people who may not be so prepared to deal with them. You now also have a
wealth of knowledge and resources to call upon if, in the future, an unexpected circumstance
thrusts the worst of these emotions into your life, or if someone you know begins experiencing
symptoms of fear, stress, and panic. You've become an empathetic guide for your own and
others' anxious tendencies.
Or maybe you're a person who has anxious and fearful tendencies. Learning about the
predictable ways these emotions manifest themselves, and the physicolgical hoops they
always make you jump through, will give you strength and courage to break their cycle in your
life. Couple this awareness with potential therapies to try out and foundational behaviors to
help you cope and you have all the tools you need to establish and practice your own "anxiety
reducing" and "fear appreciation" habits.
Lastly, if you are a person who is suffering from any of the debilitating anxiety disorders
covered in this course, you now know that there are many different therapies available to help
you return to a normal life—one where anxiety and fear don't predominate your thoughts or
inhibit your behaviors.
Remember: Anxiety and fear exist for your benefit. They have gotten the better of you for a
while now, but they are part of a predictable cycle of chemical and psychological reactions.
Medication and coping techniques can help you reclaim your sense of value and security.
Coping plans and behavioral changes are possible. Through them, you can reacquaint
yourself with the benefits of anxiety and fear, and lay the foundation for a better relationship
with the fears and anxieties that may affect you more than other people.
Thank you very much to all Explorable.com learners and readers out there. We hope you've
learned the value of anxiety and fear in your life and that, if you need help coping with or
understanding your own anxiety and fears, research and interventions exist to help you
reestablish a healthy relationship with these vital, if misunderstood, emotions.
Garrett Ray Harriman (Jun 26, 2015). A New Appreciation. Retrieved from Explorable.com:
https://explorable.com/a-new-appreciation
Thanks for reading!
93
Explorable.com Team
Explorable.com - Copyright © 2008-2015 All Rights Reserved.
94

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3 Anxiety & Fear, Body & Mind

4 Common Anxiety Disorders

5 Therapies for Anxiety

6 Coping & Acceptance

7 A New Appreciation

Cover design by Explorable / Gilli.me.

"You gain strength, courage, and confidence by every experience in

Fear is a primary ingredient of life; to feel fear is to feel life itself.

The UK reports 1 in 6 people experience either an anxiety or depressive disorder each

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If there is no immediate way to explain your feelings of unease, if something is unknown or

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What Are Emotions?

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Theories of Fear and Anxiety

Medieval Views & the Renaissance

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"Are anxiety and fear bad things?"

Self-Control and Decision-Making

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Emotion & Perception

Sensory Cortex – The brain structure responsible for collecting uncontextualized

ACTH, Cortisol, Oxytocin, Epinephrine (Adrenaline), and Norepinephrine – A

How Anxiety and Fear Differ in the Brain

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Social Isolation/Lack of Support – Anxiety can cripple a person's social life. In an

Develop Anxiety Disorders – Anxiety, whether from an early age, a traumatic

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Second, anxiety is an emotional reaction to imagined challenge or danger, where anxiety

The Role of Environment

Stress – Long-term and emotionally scarring stress, especially. Your reactions,

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The important thing to remember for this section is that:

A person experiencing an anxiety disorder did not choose to become

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Generalized Anxiety Disorder (GAD) is a commonly diagnosed anxiety condition. Its

"He reported that he tends to overplan everything to prevent disaster,

"For the past several weeks he has begun to experience bouts of

Living with GAD

See your family doctor for initial check-up and/or diagnosis

Consider taking medication (discussed here) alongside your psychological treatment

Be willing to be curious about your symptoms, to experiment and personalize your

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Panic disorder/attack symptoms include:

Unfortunately, by responding negatively to a "random" attack and seeking scapegoats, they

Myths & Agoraphobia

Panic and anxiety/stress are not the same thing

"I remember my first panic attack like it was yesterday...Suddenly this

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Extreme self-consciousness in the presence of others

Generalized vs. Specific Social Phobia

SAD vs. Shyness

"Ms. M. is a 19 year old student. She decided not to attend her

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Obsessive-Compulsive Disorder (OCD) is a well-known but little understood anxiety

Spend 1 hour or more per day focused on these thoughts/behaviors

Obsessive Symptoms (Thoughts)

Ceaseless worrying about dirt and contamination

Compulsion Symptoms (Rituals)

Cleaning (bathing, handwashing, scrubbing the bathtub multiple times a day)

"I couldn't do anything without rituals. They invaded every aspect of my