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Anxiety: It's Causes, Symptoms, Types and Treatments

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Hard crashing waves, anxiety attack

Anxiety disorders are the most common mental illness in the US, affecting 40 million adults in the US over the age of 18. Nearly one in three adolescents (31.9%) will meet the criteria for an anxiety disorder by the age of 18.

With anxiety and anxiety disorders affecting so people of all ages and backgrounds, we here at doppel have pulled together some useful information about anxiety, plus a handful of ideas about how to manage anxiety naturally - all based on published peer-reviewed research from psychology and beyond. So we’ve made this post to help you better understand:

What is Anxiety?

What are the Causes of Anxiety?

How does Anxiety Affect You?

What are the Symptoms of Anxiety?

What are the Different Types of Anxiety?

Natural Remedies for Anxiety

Other Anxiety Treatments

What is Anxiety?

According to the American Psychological Association:

“Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.

People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.”

Angela Retano, RN, MS, PMHNP from New York University defines Anxiety as “a physiologic and emotional response to a threat that the brain perceives.”

What Causes Anxiety?

There are a range of causes of anxiety, but we’ve narrowed them down to the most common ones which lead to anxiety disorder in people. Whilst there are some clear links between our lives and the onset of bouts of anxiety, it is worth keeping in mind that there is believed to be a genetic component also.


A build up of stress in your life can trigger anxiety. Some causes of stress include:

  • Exhaustion
  • Work/ School pressures
  • Relationship issues
  • Financial troubles
  • Homelessness/Housing problems
  • Losing a loved one
  • Being out of work
  • Being the victim of bullying, harassment or abuse.

Source: Mind

Medication, Caffeine and Alcohol

Anxiety can be experienced by some people, as a side effect of certain medications they have been prescribed, particularly psychiatric medications. Anxiety is itself, also a symptom of some medical illnesses and conditions like hypoglycemia, heart attacks and heat stroke.

Coffee being poured into a cup steaming Caffeine Anxiety

Caffeine and alcohol have both been found to cause or worsen anxiety and panic attacks within people. Anxiety has been found to persist for up to two years as part of a post-acute withdrawal syndrome in about a quarter of people recovering from alcoholism.

Genetic Predisposition

While Generalized Anxiety Disorder runs in families and is six times more common in the children of an individual with the condition, currently experts believe that certain genes may modify your emotional responses in a way that may lead to anxiety.

Father and son walking on a wavey sunny beach shore genetics anxiety

More research needs to be done to confirm the exact strength of the role a person’s genetics may play, as to whether they are more likely to develop anxiety, however recent research suggests that when anxiety develops in an environment that has few or no risks; the onset of anxiety is likely due to an underlying genetic predisposition.

Lifestyle/ Environment

A person’s lifestyle and environment can affect whether they are more likely to experience anxiety.

cigarette stubs in an ashtray smoking anxiety

Smoking has also been found to cause anxiety symptoms and even make them worse. Contrary to what smokers believe about “smoking easing anxiety,” the nicotine within cigarettes actually only relieves their withdrawal symptoms.

Diets with high amounts of certain aged, fermented and cultured foods (Meat, wine, and cheeses to name a few) unfortunately contain histamine, which has been found to trigger anxiety in susceptible individuals when it is digested.

added spoonful of sugar anxiety energy levels crash

Added sugars are sadly  also a contributor to anxiety. Despite the rush of energy it can help to give, the inevitable crash in your energy levels is paired with a drop in mood and a spike in anxiety levels.

How does Anxiety Affect You?

Connection with the Fight or Flight response

Your brain responds identically to both real and unreal danger. This known as the ‘fight or flight’ response.

The ‘fight-or-flight response’ is the ultimate survival tool. It describes the instinctive physiological responses that all humans and most mammals experience when faced with a threatening situation.

tiger lying staring teeth growl fear fight or flight response anxiety

Historically, this ‘threatening situation’ could have easily been a tiger. And whilst it’s not amazingly likely to find yourself head on with a large predator on a day to day basis anymore, your body reacts in exactly the same way to anything it finds stressful. For the 25.3% of people who consider fear of public speaking their number one phobia, there’s next to no difference in how the body reacts.

So how does it work?

The fight-or-flight response begins in the brain

We are all constantly sensing. Our eyes, ears and other senses send information about our surroundings to the amygdala - an area of the brain involved with the experiencing of emotions. The amygdala interprets this information and when it perceives danger, it instantly sends a distress signal to the hypothalamus - the area of the brain, which communicates with the rest of the body through the autonomic nervous system.

Amygdala hypothalamus cortex anxiety fear fight or flight response

Source: Harvard Medical School

The autonomic nervous system is responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes. The autonomic nervous system has two components, the sympathetic nervous system and the parasympathetic nervous system.

“The sympathetic nervous system triggers the fight-or-flight response, providing the body with a burst of energy so that it can respond to perceived dangers. The parasympathetic nervous system promotes the rest-and-digest response that calms the body down after the danger has passed.” (Harvard Medical School)

So after the distress signal is sent, the hypothalamus activates the sympathetic nervous system by sending signals through the autonomic nerves to the adrenal glands. The adrenal glands respond by releasing the hormone epinephrine (also known as adrenaline) into the bloodstream. 

As adrenaline circulates through the body, it causes a number of physiological changes.

Adrenaline effects anxiety fear fight or flight response

Source: Psychology Tools

Fear in the Body and Mind

ECG heart rate monitor reading pulse anxiety heart rate

Have a think about this scenario:

It’s dark. You hear a noise. You begin to feel scared, and your heart starts pounding.

And now think about this one:

It’s dark. You hear a noise. Your heart starts pounding, and you begin to feel scared.

Which is true?

Well, in reality, both are true.

The body’s ‘fight-or-flight’ system reacts to the noise - for example you might ‘feel’ your stomach clench in fear as the body moves blood away from the gut towards the muscles in your arms and legs to prepare you to either face the danger or run away.

But your brain also reacts to your body’s responses and helps you to understand the emotion - that is, it helps you to understand that you ‘feel’ scared. For example, your brain notices that your heartbeat has sped up, and it knows that a pounding heart often happens when you’re scared, and so it tells you that you’re scared. This is one of the reasons why loud noises can make you feel on edge even if you know the noise isn’t scary - like when you’re watching fireworks.

Your brain and body are in a constant feedback loop. The loud noise triggers your fight-or-flight response, but your brain keeps the cycle going. This means that the physiological state of the body influences how we feel.

Understanding this feedback loop can be really useful as it gives you a wider range of tools to deal with a scary situation. Just as the brain understands your faster heart rate as fear, if you can slow your heartbeat down, it will help you feel more relaxed sooner.

Anxiety and Your Fear Response

The human brain responds identically to both real and unreal danger, thanks to the “fight or flight” response. When your brain is triggered by something, your brain must decide if the trigger is real or imagined. If it is real, it’ll then choose whether to fight or flee, and if it is unreal (like in a film, TV show or dream), the feeling of anxiety will occur, however in both cases, your body will likely experience a spike in your heart-rate, blood pressure and alertness of your senses as a result and a surge of adrenaline.

big Tiger mural concrete anxiety fight or flight response fear and reality

Angela Retano, RN, MS, PMHNP, explains:

 “In other words, anxiety and fear produce virtually identical physiologic responses. The difficulty is that your mind must make sense of the data. Over time, the mind learns how to distinguish between reality and unreality. However, it is never able to do this perfectly, because frightening experiences, whether real or imagined, automatically trigger the flight or fight response. 

An anxiety disorder results when the flight or fight response becomes triggered too easily and too frequently. Usually, this occurs after many events of any kind that are perceived as threatening from early childhood to the present or fewer extremely intense events that have left a strong impression of danger on the individual. As a result, the brain has learned to perceive the world as more dangerous than it actually is.”

What are the Symptoms of Anxiety?

anxious man sat down in the city looking down anxiety symptoms

Here are some of the most common symptoms experienced by people going through anxiety:

  • a churning feeling in your stomach
  • feeling light-headed or dizzy
  • pins and needles
  • feeling restless or unable to sit still
  • headaches, backache or other aches and pains
  • faster breathing
  • a fast, thumping or irregular heartbeat
  • sweating or hot flushes
  • problems sleeping
  • grinding your teeth, especially at night
  • nausea (feeling sick)
  • needing the toilet more or less often
  • changes in your sex drive
  • having panic attacks.

Source: Mind

Different types of anxiety disorder can lead to some other symptoms, like with certain phobias, and PTSD in particular.

What are the Different Types of Anxiety?

There are six main types of Anxiety Disorder. Below you’ll find what they are, and what they are typically characterized by.

Generalized Anxiety Disorder (GAD)

Generalised anxiety disorder nervous hands squeezing and clutching cloths

GAD is generally characterized by chronic, exaggerated worry about everyday routine life events and activities. In order to be diagnosed with GAD, according to the DSM-V, the worry and other symptoms need to have lasted for at least six months. Individuals with GAD almost always anticipate the worst even though there is little reason to expect it. Physical symptoms of GAD include but are not limited to fatigue, trembling, muscle tension, headaches and nausea.

Social Anxiety Disorder

social anxiety disorder, public road crossing fear isolated

Social anxiety disorder is characterized by a fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating, often times leading to avoidance of social situations and severe distress when participating in social situations that cannot be avoided

Obsessive-Compulsive Disorder (OCD)

Individuals with OCD have repeated, intrusive and unwanted thoughts or rituals that seem impossible to control. This is seen as a disorder as it can interfere and in many cases take over how a person lives their life on a daily basis. If a person does not adhere to their rituals or specific compulsions, they often experience crippling anxiety.

Panic Disorder

panic disorder lightning strike panic anxiety sudden fear

Characterized by panic attacks, sudden feelings of terror that strike repeatedly and without warning. Physical symptoms of panic disorder include chest pain, heart palpitations, shortness of breath, dizziness, abdominal discomfort, feelings of unreality, and a fear of dying.


Phobia, fear of heights, high mountain man standing on edge looking down anxiety

People with a specific or set of phobias tend to experience extreme, disabling and irrational fear of something that really poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives

Post-Traumatic Stress Disorder (PTSD)

PTSD occurs after experiencing a traumatic event such as war, rape, child abuse, natural disasters, or being taken hostage. Symptoms of PTSD can range from nightmares, flashbacks, numbing of emotions, depression, and feeling irritable and angry, to being  distracted and easily startled.

Source: Mental Health America

Anxiety disorders are diagnosed using the diagnostic criteria laid out in DSM-V, and by qualified and licensed physicians and healthcare professionals. If you think you may be affected by one of the disorders, seek a consultation by your general practitioner as soon as possible to receive help and guidance.

Natural Remedies for Anxiety

We’ve looked at the science behind anxiety and some of the research for how it can be treated. Here are the best natural treatments for anxiety, as supported by research.

Deep breathing

Breathing exercises are well known to reduce feelings of stress, anxiety and panic

When you breathe deeply, you’re mimicking the way you feel just before you fall asleep or when you first wake up - two of the moments when the body is most relaxed. Your brain responds to these physiological signals and your heart rate and blood pressure will begin to fall. It doesn’t matter that you’re not in bed, the feedback loop between your brain and body is an innate biological link and it will help you to calm down.

When we’re stressed, heart rate, breathing rate, and blood pressure all increase. And when we breathe deeply, we’re mimicking the way we feel just before we fall asleep or when we first wake up - two of the moments when our bodies are most relaxed. Our brains respond to these physical signals and our heart rate and blood pressure begins to fall, which in turn makes us feel less stressed.

Calm woman breathing deeply anxiety breathing

The link between heart rate and breathing rate is well known. In fact, we've already blogged about how choir singers (who breathe at the same rate because they are singing the same song) can synchronize their heart rate.

We’ve shared some tips on this previously in our post ‘Three breathing techniques to beat stress’.

Whilst you’ll get the most benefit if you do it regularly, deep breathing can also help you feel more calm on demand.

It’s not always easy to take a break and do breathing exercises - especially if you’re in the middle of something you find scary like giving an important presentation. But knowing that your body isn’t completely in charge and that you can ‘trick’ your brain to feel calmer might help you out the next time something scares you.

Walk Outside

Walk outside autumn red leaves on long path anxiety relief

When you’ve had a busy or stressful day, it can be tempting to relax in front of the TV, or even read a book, but according to Vybarr Cregan-Reid, Reader in Environmental Humanities, University of Kent in England and Author of 'Footnotes: How running makes us human', these actually aren’t the best activities for mental restoration - walking is.

Walking helps the brain to process the day without distraction. It allows your mind to wander and helps the brain to restore ‘directed attention’ (your ability to focus) quickly and effectively. And it’s even better if you can find some green space!

In the paper ‘The Cognitive Benefits of Interacting With Nature’ published in 2008 by researchers from the University of Michigan, it was observed that walkers in rural locations were more mentally restored and were able to tackle more complex cognitive tasks.

Dr Qing Li of the Nippon Medical School in Tokyo and author of Shinrin-Yoku: The Art and Science of Forest Bathing, also argues that the Japanese practice of shinrin-yoku - literally, forest bath - has the power to help with a number of health issues including depression, anxiety, stress and sleep. The practice of immersing yourself in nature (not necessarily in water), is even being recommended by GPs’ surgeries in the UK in an effort to boost well-being through non-medical therapies.

two women walking in the park on a sunny day anxiety remedy

A brisk walk which gets your heart rate up, can help you to feel less anxious and more calm afterwards. Studies have shown that it takes just 21 minutes for exercise to reliably reduce anxiety (give or take a minute).

Go Phone Free

Phone stress and notification anxiety

We’ve blogged before about increased stress levels for phone checkers. In the 2017 report “Stress in America”, the American Psychological Association found that US adults who report that they constantly or often check their email, texts and social media accounts are significantly more stressed than those who don’t check them as frequently.

Lifestyle Changes

Drink More Tea

Chamomile camomile green tea L-theanine anxiety remedy relief

Drinking a cup of chamomile tea can help to alleviate some of your anxiety symptoms. Some of the chemical compounds in chamomile tea have been found to bind to the same brain receptors as drugs like Valium, and thereby produce a similar result.

Green tea can also help you to feel relaxed thanks to an amino acid within called L-theanine. This amino acid has been found in a study to help curb a rising heart rate and blood pressure and help improve attention. In the study, anxiety-prone participants who took 200 milligrams of L-theanine before a task, were calmer and more focused during the task compared to participants given a placebo. You can get the same amount of L-theanine from between 5-20 cups of green tea (amount varies depending on the strength of the green tea).

Eat When You Are Hungry

Healthy snack hungry almonds cashews walnuts anxiety relief remedy

According to Dr Ramsey, co-author of The Happiness Diet:

“Almost universally, people get more anxious and irritable when they are hungry. When you get an anxiety attack, it may mean your blood sugar is dropping. The best thing to do is to have a quick sustaining snack, like a handful of walnuts, or a piece of dark chocolate, along with a glass of water or a nice cup of hot tea”

Stop Smoking

The struggle to quit smoking is incredibly intimidating, but the freedom from experiencing the withdrawal symptoms of nicotine can mean that you also will be free from the associated anxiety of not having smoked in so long.

Ask for Help

Helping hands holding hands reach out ask for help anxiety relief

You’re not alone. Talking about your anxiety with a friend or professional can be incredibly helpful. Don’t suffer in silence.

Join the Discussion

We have an awesome community where our doppelgängers are free to share their journeys and experiences living with mental health issues. If you'd like to read or engage with these experiences you can visit our community page here.

Other Anxiety Treatments

Visit Your Doctor

If you feel like you may be experiencing GAD or any of the other types of anxiety, you should book an appointment with your primary care physician as soon as possible. They will be best placed to understand and diagnose what it is you are experiencing, and offer you treatment options.

Typical options offered to individuals dealing with anxiety disorders include prescriptions for certain types of medications, and some form of counselling or therapy.


There are several options for medication to help manage anxiety including Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, Tricyclic Antidepressants and Benzodiazepines, however all have side effects, and work for some and not for others. If you think medication might be right for you, you should contact your doctor. Further details about these can be found at the link here.

For more information on each of these, please consult your primary care physician, general practitioner or pharmacist.

Counselling and Therapy

Counselling and therapy can help to address the thought patterns and perceptions that often lead to the onset of anxiety. They are often conducted in conjunction with some form of prescribed medication. This is done to allow someone with anxiety to focus on their therapy and help to nurture positive thought patterns.

Cognitive Behavioral Therapy (CBT)

CBT is one of the most effective treatments for many anxiety disorders including panic disorder, phobias, social anxiety disorder and GAD among others.

CBT works in two parts:

  1.  Cognitive Therapy explores how negative thoughts or cognitions, contribute to anxiety.
  2. Behaviour Therapy explores how you behave and react in situations that trigger anxiety.

The premise of CBT is that our thoughts affect how we feel, not external events. The focus of the therapy is on your perception of the situations that are causing your anxiety.

How does CBT work?

CBT for anxiety requires you to go through a process known as ‘thought challenging,’ (also known as cognitive restructuring). This involves you challenging the negative thinking patterns that contribute to your anxiety, and replacing them with more realistic and positive thoughts. This is done in three steps:

  1. Identify your Negative Thoughts: You and your therapist will start by going over what your perceptions are in different troubling situations, and will find out what your irrational fears are.
  2. Challenge your Negative Thoughts: The next step will involve your therapist teaching you how to evaluate your anxiety-provoking thoughts. Typically at this stage, you will question the evidence behind your negative beliefs/thoughts and testing out the reality of negative predictions. There are several strategies for challenging these negative patterns like conducting experiments, making pros and cons lists of worrying/avoiding a fear inducing situation, and determining the realistic chances of what you are anxious about actually affecting you.
  3. Replace Negative Thoughts with Realistic Thoughts: Having identified your negative cognitions, and the irrational predictions in your anxious thoughts, you can replace them with new thoughts which are more accurate and positive. Your therapist may also help you come up with calming statements for you to say to yourself, in anticipation of or during a situation which raises your anxiety levels

CBT is can be extremely helpful in removing or at least lowering the frequency and impact of cognitive distortions. Common distortions which are addressed through courses of CBT include:

  • Predicting the worst outcome
  • Exaggerating circumstances/Catastrophizing
  • Jumping to conclusions.

Many people find significant improvements in their anxiety levels within 8-10 therapy sessions. CBT is covered mostly if not entirely by insurance under psychotherapy or behavioral medicine. it can also be offered for free through some community clinics. CBT has even been found to be effective when deployed over the internet!

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a type of psychotherapy that was developed to help people deal with and heal from experiences that have caused emotional trauma. Despite only being developed in 1987, EMDR has become a more common treatment option for panic disorder and PTSD, and is a popular technique in treating other mental health disorders.

How does EMDR work?

In a typical EMDR treatment session, your therapist will ask you to focus on recalling a disturbing event or situation that causes you anxiety, and also focus on a positive or neutral thought at the same time. Whilst you do this, the therapist will have you follow their fingers as they move side to side in front of your face, and will guide you to shift your negative thoughts to more pleasant ones.

EMDR is theorized to work by replicating Rapid Eye Movements that occur when we are asleep (REM sleep). During this phase of sleep, the mind processes daily emotions and emotional experiences, and some evidence has been found to suggest that eye movements perform a similar function. Through focusing on the situation that causes anxiety or a traumatic event, and keeping a positive thought in mind whilst also tracking the therapists finger, the negative emotions around the event can be reprocessed. EMDR has been found to be effective after a single session, however there is some variation in the length and number of sessions required, depending on the complexity of the issues being dealt with. EMDR is regularly used in conjunction with cognitive therapy.

Other forms of therapy are available to help deal with anxiety. Please do seek guidance from your primary care physician or general practitioner, for more information on the options available to you and the best course of action to take.


Anxiety is a complex issue that can affect many people in similar ways, in a range of situations. It can progress and become an anxiety disorder for some, but there are many different causes for this and equally as many positive changes you can make to help lessen your anxiety. If you feel like you may suffer from anxiety, be sure to seek help from your primary care physician or general practitioner, before you take any medications. They will be able to provide you with even more options for support and help.

doppel Anxiety Testimonials

Some of our users have found that doppel has helped them manage their anxiety. You can read their stories and experiences using doppel here.

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