Understanding Anxiety

Because anxiety can interfere with relationships, sleeping patterns and day to day functioning, it is one of the most common reasons people seek therapy. Although general knowledge about mental health issues has increased in recent years, misunderstandings about anxiety remain common.

It’s important to understand the difference between ordinary anxiety and an anxiety disorder. It’s natural to feel nervous about an upcoming event such as a work presentation or a social affair. Some people can easily manage anticipatory nerves and shake off the tension when they are in an uncomfortable setting. But for others these situations can cause functional impairment. Anxiety can make it difficult to work, go to school or otherwise function. It can be overwhelming and disruptive to daily life.

A severe and sudden onset in certain settings is often indicative of a panic attack, while chronic and intense symptoms may be a type of phobia. But part of what makes anxiety so powerful is the fact that an individual can feel anxious with no apparent cause at all. It can strike out of nowhere. This generalized experience can feel especially mysterious and overwhelming.

Not everyone with anxiety behaves like a stereotypically nervous person. Many people do bite their nails, pace, or exhibit other commonly prevailed manifestations of anxious behavior. Others try to manage symptoms by withdrawing to deal with the discomfort. Anxiety isn’t always easy to see which can leave a person feeling isolated in their efforts to manage its symptoms. Whatever a person’s coping style, it can feel permanent and unmanageable.


Symptoms include worried and intrusive thoughts, rumination, difficulty concentrating, restlessness, irritability, frustration and despair. A person may feel tense with uncomfortable physical sensations such as trembling, sweating, a racing heartbeat, nausea, depersonalization and difficulty breathing. It can also lead to headaches, insomnia, digestive problems and lightheadedness.

Anxiety is at the root of many mental health conditions and is often directly correlated with other conditions such as obsessions and compulsions (OCD), posttraumatic stress disorder (PTSD) and depression.


A person’s predisposition to anxiety is based both in biology and environment. It may be inherited, learned or both. For example, anxious children are likely born to anxious parents, but those parents may also model anxious tendencies, such as avoiding or fearing potential threats, that then instill the same fear and avoidant behaviors in their children. Growing up in a stressful environment may also predispose someone to anxiety since it serves as a way to anticipate danger and ensure safety.

Anxiety can also develop as a result of unresolved environmental trauma that leaves a person in a heightened physiological state of arousal. When this is the case, certain experiences may reactivate the old trauma, as is common for people experiencing PTSD.


Deciding which treatment or combination of treatments depends on a careful interview and assessment of your goals and symptom-level. The outcome of treatment is determined by several factors, including the following:

Specific type of anxiety disorder
Severity of symptoms
Level of functioning prior to onset of symptoms
Degree of motivation for treatment
Level of support (e.g., family, friends, work, school)
Ability to comply to a therapeutic regimen

At Kachemak Counseling, my approach to treatment highlights the innate fight or flight response as the genesis of many mental health conditions. Like the fight or flight response, anxiety is a survival mechanism that allows people to protect themselves in order to avoid distress. However, sometimes a person experiences extreme levels of fear and worry that is disproportionate to the activating event.

Effective therapy can significantly reduce or eliminate symptoms, allowing clients to resume regular activities and regain a sense of control. Although clients may initially have difficulty identifying its origin, after attending a few therapy sessions, many are able to pinpoint the source of their anxiety and its deeper causative roots can then be addressed.


The type of therapy that I most often recommended for treatment due to its demonstrated effectiveness is Cognitive Behavioral Therapy (CBT). Rather than treating symptoms alone, as medications do, CBT aims to identify and address the source of anxiety. The self-reflective process of therapy helps clients to understand, unravel and reduce symptoms while learning self-soothing techniques to use if they flare up again.

CBT helps clients understand how automatic thoughts and cognitive distortions lead to exaggerated emotional responses that then cause secondary behavioral consequences. Cognitive behavioral techniques are used to change thinking patterns which results in reduced symptoms. Clients are also asked to collaborate on a treatment plan, which may include lifestyle adjustments. Therapy is a collaborative process where we work together to identify specific concerns and develop concrete skills and techniques for coping. It is important to be willing to practice new behaviors and monitor changes. These changes might include frequency and intensity of symptoms after therapy has started.


In addition to CBT, behavioral therapy sometimes involves a process where clients are sequentially exposed to anxiety-provoking stimuli. Over time, an individual becomes desensitized to the experience. “Systematic desensitization” relies heavily on classical conditioning. Clients are taught to replace a fear response with more relaxing and adaptive responses. Clients first learn calming techniques; once mastered they slowly expose themselves to their fear in gradually heightened doses while they practice these techniques. Clients may be asked to practice new skills outside of sessions to manage anxiety in situations that might make them uncomfortable. Over time this allows them to develop a healthier relationship with their environment. Clients are not encouraged into such scenarios until they are confident they have developed the skills they need to effectively confront their fears.

Behavioral therapy can be extremely effective. It has successfully been used to treat a large number of conditions but its techniques are most often used to treat anxiety. Many clients who participate in behavioral therapy with a competent therapist experience some benefits from treatment.


Conjunctive modalities include pharmacotherapy (medication management) in addition to psychotherapy. Cognitive and/or behavioral therapy can be used with pharmacotherapy. I sometimes refer clients to their primary care provider or a local medical professional if psychotherapy has proven insufficient. The combination approach of psychotherapy with pharmacotherapy sometimes provides results for clients who do not experience appreciable change from psychotherapy alone. However, there are dependency risks with many anti-anxiety medications such as benzodiazepines. I usually advise that clients try therapy before pursuing medication unless symptoms are causing severely impaired functioning or if a clients’ safety is at risk. In many cases anxiety can be treated with psychotherapy alone. Even if medication does reduce symptoms it is essential to participate in psychotherapy. Psychotherapy treats the core issues causing anxiety instead of temporarily masking its symptoms.

Other interventions such as mindfulness, relaxation therapy, and respiratory training have proven helpful. Mindfulness emphasizes the importance of discerning the difference between reacting and responding thoughtfully. When we react in ways that aren’t mindful, we often foster habits that cause or worsen symptoms. Consequently, these patterns of reactivity create further distress. Anxiety softens when we can create a space between ourselves and what we’re experiencing. When we become aware of the present moment, we gain access to resources we may not have had before. Like CBT, mindfulness relies on the evidence-based premise that we may not be able to change a situation, but can mindfully change our response to it.

Relaxation techniques can help reduce the intensity and frequency of symptoms. Using controlled breathing, respiratory training can help ward off anxiety and prevents hyperventilation during panic attacks. Diet and exercise also play a key role in reducing symptoms and improving overall well-being.

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