Pain of mind is worse than pain of body.

Latin Proverb

Fear and anxiety are a normal--even essential--part of life. They prepare us for danger, creating physiological changes that enable us to effectively respond to a threat. Fear is very straightforward. It arises in response to immediate danger, so it is usually unexpected, very intense, and limited to the situation at hand. Your response to the fear, such as jumping out of the path of an oncoming car, quickly resolves the situation.

Anxiety, on the other hand, is more general and complex. It is felt in anticipation of danger, and is associated with the ability to predict, prepare for, and adapt to change. Often, it lasts a long time, and its cause remains ill-defined. For example, someone uneasy about public speaking may experience a tightness in the stomach for days before a scheduled talk.

Both fear and anxiety send signals through the body that prepare all systems for possible danger. Hormones, such as adrenaline and catecholamine, are released in what is known as the "fight or flight" response. The sudden increase in hormone levels speeds up the heart and increases the amount of blood being pumped. At the same time, the muscles tighten, increasing the individual's ability to fight or flee from danger. The intensity of these physiological responses varies according to the seriousness of the event or thought that sparked the emotion, the strength of the individual's fear or anxiety, and his or her previous experience and genetic makeup.

Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment.

Stress management techniques and meditation may help you to calm yourself and enhance the effects of therapy, although there is as yet no scientific evidence to support the value of these "wellness" approaches to recovery from anxiety disorders. There is preliminary evidence that aerobic exercise may be of value, and it is known that caffeine, illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of an anxiety disorder. Check with your physician or pharmacist before taking any additional medicines.

Studies show that antidepressants have been effective in treating depression. A type of medicine called selective serotonin reuptake inhibitors (SSRIs) is most often prescribed by doctors. In "talk" therapy, the patient and therapist talk about the patient's experiences, relationships, events, and feelings. Two of the approaches found to be effective for treating depression are interpersonal therapy and cognitive- behavioral therapy.

Unrestrained anxiety can lead to any of several emotional disorders, all characterized by an unpleasant and overwhelming mental tension with no apparent identifiable cause. While most people with anxiety disorders are completely aware that their thoughts and behavior are irrational and inappropriate, this insight gives them no help in controlling their symptoms.

Faced by a threat, your body responds with a complex cascade of chemicals. The hypothalamus, alerted by the brain, pumps out a specialized hormone that ultimately prompts the two adrenal glands (perched atop the kidneys) to release the energizing hormone known as adrenaline. The result--faster pulse, higher blood pressure, sharpened awareness--is the "fight or flight" response to fear and anxiety.

Psychologists, social workers, and counselors sometimes work closely with a psychiatrist or other physician, who will prescribe medications when they are required. For some people, group therapy is a helpful part of treatment.

You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

Psychiatrists or other physicians can prescribe medications for anxiety disorders. These doctors often work closely with psychologists, social workers, or counselors who provide psychotherapy. Although medications won't cure an anxiety disorder, they can keep the symptoms under control and enable you to lead a normal, fulfilling life.

Although there are numerous chemicals that perform vital functions within the brain, three basic chemicals, or neurotransmitters, seem most critical in regulating this process and maintaining balance: serotonin, which is related to anxiety, depression, and aggression; dopamine, which affects reality perception and pleasurable experiences; and norepinephrine, which affects attention, concentration, and mood.

Many organizations today supports research into the causes, diagnosis, prevention, and treatment of anxiety disorders and other mental illnesses. Studies examine the genetic and environmental risks for major anxiety disorders, their course--both alone and when they occur along with other diseases such as depression--and their treatment. The ultimate goal is to be able to cure, and perhaps even to prevent, anxiety disorders.

Also, research indicates that other brain parts called the basal ganglia and striatum are involved in obsessive-compulsive disorder.

In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with post-traumatic stress disorder.

Scientists are also conducting clinical trials to find the most effective ways of treating anxiety disorders. For example, one trial is examining how well medication and behavioral therapies work together and separately in the treatment of obsessive-compulsive disorder. Another trial is assessing the safety and efficacy of medication treatments for anxiety disorders in children and adolescents with co-occurring attention deficit hyperactivity disorder. For more information about clinical trials, for example the National Library of Medicine's clinical trials database.

Biochemical theory suggests that biologic imbalances, perhaps among the neurotransmitters in the brain, may be the primary cause of anxiety disorders. Indeed, in one study researchers were able to trigger a panic attack in some people simply by infusing certain chemicals. Many scientists involved in anxiety research now argue that correcting biochemical imbalances with medication should be the first goal of treatment. Other studies suggest that biochemical changes can also be achieved through the psychological and behavioral changes produced by psychotherapy.

Learning theory views anxiety as a learned behavior that can be unlearned. This theory posits that a person's anxiety can be reduced by persistently confronting the feared situation or object. And some people do, in fact, change their thinking and experience significant relief without any medication.

Psychoanalytic theory holds that anxiety stems from unconscious conflict arising from discomfort or distress during childhood. Once the source of the anxiety is identified, it can be eliminated by resolving the underlying conflict. However, most studies find that people with anxiety disorders come from stable homes, with childhood backgrounds similar to those of people without anxiety disorders.

There's little doubt that all our thoughts and feelings are rooted in transmissions between nerve cells in the brain. These signals are passed from cell to cell by chemical neurotransmitters released at the synapse (tiny gap) between one cell and the next.

Terms used on this page

Anxiety

• A state of uneasiness and apprehension, as about future uncertainties.


• Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Anxiety disorder

• A psychiatric disorder involving the presence of anxiety that is so intense or so frequently present that it causes difficulty or distress for the individual.

Anxiety disorders

• Any of various disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object; they include obsessive-compulsive disorder and posttraumatic stress disorder.

Fear

• Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined.

Depression

• In psychiatry, a symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection.

Mental health

• A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.


• The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.

Stress

• A state of extreme difficulty, pressure, or strain.


• A physical and psychological response that results from being exposed to a demand or pressure.

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