Anxiety: when it is normal and when it is a disorder

• Anxiety disorders are the most common mental disorders worldwide.
• Signs of a disorder: excessive, long-lasting and interfering with daily life.
• Strongest evidence: CBT and SSRI/SNRI antidepressants.
• Relaxation and MBSR are effective complements.

Normal anxiety

Anxiety helps us prepare for danger. Feeling nervous before a job interview or a medical test is normal.

When it is a disorder

A review in The Lancet describes anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias, as the most prevalent mental disorders, often beginning in childhood or adolescence. Signs that anxiety has become a disorder include worry that is excessive, hard to control, persistent and disruptive to daily life (Penninx et al., 2021). Nearly a third of U.S. adults experience an anxiety disorder at some point.

What helps

• CBT has the strongest evidence among psychotherapies.
• Medications: SSRIs and SNRIs are first-line drug treatments.
• Mindfulness: in a randomized trial, an 8-week MBSR program was as effective as escitalopram for anxiety disorders (Hoge et al., 2023).
• Relaxation training reduces anxiety (Manzoni et al., 2008).

Self-help

• Regular physical activity.
• Limiting caffeine and alcohol.
• Breathing and relaxation exercises.
• Good sleep habits.
• Gradually facing feared situations rather than avoiding them.