Anxiety is a natural emotional response to perceived threat or uncertainty. In moderate levels, it enhances alertness, concentration and preparedness. However, when anxiety becomes persistent, excessive and disproportionate to the situation, it may develop into a clinically significant anxiety disorder, affecting daily functioning, relationships and overall wellbeing. Drawing upon textbooks, peer-reviewed journal articles and reputable organisations such as the NHS, this article explores the symptoms, theoretical explanations and evidence-based treatments of anxiety using the Harvard referencing system and British spelling.
1.0 What Is Anxiety?
Clinical psychology textbooks define anxiety as a state characterised by anticipatory fear, physiological arousal and cognitive apprehension (Barlow and Durand, 2018). Unlike fear, which is a response to immediate danger, anxiety is typically future-oriented and linked to perceived threat.
According to the NHS (2023), anxiety disorders include:
- Generalised anxiety disorder (GAD)
- Panic disorder
- Social anxiety disorder
- Specific phobias
- Health anxiety
Anxiety disorders are among the most common mental health conditions worldwide. Rayner et al. (2019) estimate lifetime prevalence rates of approximately 17–30%. Within the UK, anxiety places substantial demand on NHS services (Cape et al., 2010).
2.0 Symptoms of Anxiety
Anxiety affects individuals across psychological, physical and behavioural domains. Symptoms may vary depending on the specific disorder but commonly include:
2.1 Psychological (Cognitive and Emotional) Symptoms
- Excessive, uncontrollable worry
- Persistent feelings of dread or impending doom
- Difficulty concentrating
- Irritability
- Overthinking and rumination
- Catastrophic thinking (“Something terrible will happen”)
For example, an individual with GAD may worry excessively about finances, health and family safety despite minimal objective risk.
2.2 Physical (Physiological) Symptoms
Anxiety activates the fight-or-flight response, leading to autonomic arousal (Barlow and Durand, 2018). Common physical symptoms include:
- Increased heart rate (palpitations)
- Sweating
- Trembling or shaking
- Shortness of breath
- Chest tightness
- Muscle tension
- Dizziness
- Gastrointestinal discomfort
- Sleep disturbance
During a panic attack, these symptoms may peak rapidly and feel overwhelming, often leading individuals to fear they are experiencing a medical emergency.
2.3 Behavioural Symptoms
- Avoidance of feared situations
- Social withdrawal
- Reassurance seeking
- Restlessness
- Procrastination
For instance, a person with social anxiety may avoid public speaking or social gatherings, which provides short-term relief but reinforces long-term fear.
3.0 Theoretical Explanations of Anxiety
3.1 Cognitive-Behavioural Model
The cognitive-behavioural model (CBT) proposes that anxiety is maintained by distorted thinking patterns and avoidance behaviour (Beck and Clark, 1997). Individuals may:
- Overestimate threat
- Underestimate coping ability
- Engage in safety behaviours
For example, someone afraid of flying may constantly check safety statistics and avoid air travel, reinforcing anxiety.
3.2 Biological Factors
Neurobiological research suggests that anxiety involves dysregulation in brain circuits associated with threat detection, particularly the amygdala and prefrontal cortex (Rayner et al., 2019). Genetic predisposition also influences vulnerability.
3.3 Learning Theory
Classical conditioning explains how phobias develop when a neutral stimulus becomes associated with fear. Operant conditioning maintains anxiety through negative reinforcement, as avoidance reduces distress temporarily (Barlow and Durand, 2018).
4.0 Evidence-Based Treatments for Anxiety
4.1 Cognitive Behavioural Therapy (CBT)
CBT is widely recognised as the gold standard treatment for anxiety disorders. A meta-review by Fordham, Sugavanam and Edwards (2021) concluded that CBT is effective across multiple conditions and populations. Twomey, O’Reilly and Byrne (2015) also found significant effectiveness of CBT in primary care settings.
Core components of CBT include:
- Cognitive restructuring
- Exposure therapy
- Behavioural experiments
- Relaxation techniques
For example, exposure therapy for social anxiety might involve gradually practising conversations in increasingly challenging social settings.
Cartwright-Hatton and Roberts (2004) found strong evidence supporting CBT for childhood and adolescent anxiety disorders.
4.2 Low-Intensity and Digital CBT
To increase accessibility, the NHS provides low-intensity CBT interventions, including guided self-help and online programmes. Powell et al. (2024) found that low-intensity CBT is effective for generalised anxiety disorder.
Simmonds-Buckley, Bennion and Kellett (2020) demonstrated that NHS-recommended digital therapies are acceptable and effective for anxiety and stress-related conditions.
For instance, a person with mild anxiety may complete structured online modules with brief weekly professional support.
4.3 Brief Psychological Therapies
Cape et al. (2010) demonstrated through meta-analysis that brief psychological therapies (often six sessions) produce meaningful reductions in anxiety symptoms in primary care.
4.4 Transdiagnostic Approaches
Transdiagnostic CBT targets common mechanisms underlying anxiety and depression. Andersen, Toner and Bland (2016) found that transdiagnostic interventions are effective and practical in routine services.
Cost-Effectiveness
Ophuis, Lokkerbol and Heemskerk (2017) concluded that CBT is generally cost-effective compared to usual care or medication alone, supporting its use within publicly funded healthcare systems such as the NHS.
5.0 Practical Coping Strategies
The NHS (2023) recommends practical strategies alongside therapy:
- Regular physical exercise
- Sleep hygiene
- Breathing exercises
- Reducing caffeine and alcohol
- Structured problem-solving
For example, diaphragmatic breathing can reduce physiological arousal before stressful events such as job interviews.
Anxiety is a common, multifaceted and treatable condition characterised by psychological, physical and behavioural symptoms. While occasional anxiety is normal, persistent and excessive symptoms may indicate an anxiety disorder requiring support.
Extensive evidence supports cognitive behavioural therapy as the most effective psychological treatment. Modern adaptations, including digital and low-intensity CBT, enhance accessibility while maintaining efficacy. With appropriate intervention, individuals can reduce avoidance behaviours, regulate physiological arousal and develop healthier thought patterns.
Anxiety should not be regarded as weakness but as a modifiable pattern of responses. With evidence-based treatment and practical coping strategies, recovery and improved quality of life are achievable.
References
Andersen, P., Toner, P. and Bland, M. (2016) ‘Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: A systematic review and meta-analysis’, Behavioural and Cognitive Psychotherapy, 44(6), pp. 673–690.
Barlow, D.H. and Durand, V.M. (2018) Abnormal Psychology: An Integrative Approach. 8th edn. Boston: Cengage Learning.
Beck, A.T. and Clark, D.A. (1997) ‘An information processing model of anxiety’, Behaviour Research and Therapy, 35(1), pp. 49–58.
Cape, J., Whittington, C., Buszewicz, M. and Wallace, P. (2010) ‘Brief psychological therapies for anxiety and depression in primary care: Meta-analysis and meta-regression’, BMC Medicine, 8, 38.
Cartwright-Hatton, S. and Roberts, C. (2004) ‘Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders’, British Journal of Clinical Psychology, 43(4), pp. 421–436.
Fordham, B., Sugavanam, T. and Edwards, K. (2021) ‘The evidence for cognitive behavioural therapy in any condition, population or context: A meta-review’, Psychological Medicine, 51(4), pp. 547–560.
NHS (2023) Anxiety disorders. Available at: https://www.nhs.uk/mental-health/conditions/anxiety/ (Accessed: 17 February 2026).
Ophuis, R.H., Lokkerbol, J. and Heemskerk, S.C.M. (2017) ‘Cost-effectiveness of interventions for treating anxiety disorders’, Journal of Affective Disorders, 210, pp. 1–13.
Powell, C.L.Y.M., Chiu, C.Y., Sun, X. and So, S.H. (2024) ‘Efficacy of low-intensity cognitive behavioural therapy for generalised anxiety disorder: A meta-analysis’, BMC Psychiatry, 24, 53.
Rayner, C., Coleman, J.R.I., Purves, K.L. and Hodsoll, J. (2019) ‘Genome-wide association meta-analysis of outcomes following CBT in anxiety disorders’, Translational Psychiatry, 9, 183.
Simmonds-Buckley, M., Bennion, M.R. and Kellett, S. (2020) ‘Acceptability and effectiveness of NHS-recommended e-therapies for depression, anxiety and stress’, Journal of Medical Internet Research, 22(10), e17049.
Twomey, C., O’Reilly, G. and Byrne, M. (2015) ‘Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: A meta-analysis’, Family Practice, 32(1), pp. 3–15.
