Understanding Anxiety Disorders: How Anxiety Works and When It Becomes a Problem
Written by Andrew Huber, LMFT #118700, a certified CBT Therapist
That familiar, suffocating feeling: the tight knot in your stomach, the sudden clamminess of your palms, the heart that feels like it’s trying to escape your chest. These aren’t just mental worries; they are powerful, physical experiences of anxiety.
This is your sympathetic nervous system kicking in. Anxiety, at its root, is a primal and core human emotion, designed to be a built-in alarm system. It’s the evolutionary mechanism meant to swiftly assess and prepare you for danger, keeping our ancestors safe from real, imminent threats.
But what happens when that alarm system is faulty: when it's blaring at full volume over a quiet dinner, a trip to the grocery store, or even just the thought of the week ahead? That’s often when anxiety crosses the line into a disorder.
At Sycamore Grove, we’ve worked with thousands of people whose lives have been profoundly impacted by anxiety. It's so much more than just being "stressed out." It's a complex, often debilitating condition, and yet, it’s also very treatable. My goal here is to help you understand the true nature of anxiety disorders, how they differ, and why they require professional attention.
What’s the difference between fear vs. anxiety?
To start, let’s first define a few terms. While we often use the terms interchangeably, fear and anxiety are distinct emotional states. (For simplicity's sake, I’m going to entirely dodge the “what are emotions?” debate for the moment, but this is still a helpful distinction.)
Fear Is a Response to an Immediate Threat
Fear is the emotional response to an immediate threat. Think of it as the "fight or flight" response. You see a car swerve toward you (a real, imminent threat), and your heart pounds, your muscles tense, and you slam on the brakes. This surge of autonomic arousal is your body preparing for immediate danger or escape.
Anxiety Is the Anticipation of a Future Threat
Anxiety is the anticipation of a future threat. It's the "what if." You're worried about giving a presentation next week, even though you’ve done a dozen before. Anxiety is characterized by muscle tension and vigilance—a constant state of preparedness—which often leads to cautious or avoidant behaviors. With anxiety, you might find yourself procrastinating by binging Netflix shows just as much a obsessively studying for an exam.
These two states are intertwined, but understanding the difference is key to understanding the various anxiety disorders.
When does anxiety become a disorder?
Anxiety, in its healthy and moderate form, is actually a good thing! It serves a powerful, adaptive purpose. That feeling of slight unease before a deadline or a performance is what we might call helpful anxiety.
It’s the energy that motivates you to study for the test, prepare for the presentation, not stand on a high rickety platform, or look both ways before crossing the street. It sharpens your focus and prompts necessary planning. Without internal drive of anxiety, we’d be less safe and less productive. If you felt no anxiety, you might never get out of bed!
It’s completely normal for a child to be nervous on the first day of school, or for an adult to feel anxious before a major job interview. So, how do clinicians determine that the natural feeling of anxiety has become a clinical disorder?
It is excessive: The level of fear or anxiety is far out of proportion to the actual risk posed by the situation. For example, thinking that talking to a cashier will lead to public humiliation.
It is persistent: The symptoms don’t just pass after a stressful event. They typically last for six months or more (though this can be shorter in children, depending on the disorder). It’s not a transient, stress-induced worry; it's a fixture of everyday life.
It interferes with life: The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. In many cases, this impairment is maintained by pervasive avoidance behaviors: the person stops driving, quits their job, or isolates themselves to reduce the feeling of anxiety.
It’s also important to note that most anxiety disorders develop in childhood and are diagnosed more frequently in females than in males (roughly a 2:1 ratio according to the DSM-5). In my personal opinion, I believe anxiety is underdiagnosed in males.
Anxiety attack vs panic attack
I often hear the question: "What's the difference between an anxiety attack and a panic attack?"
It's a tricky question because "anxiety attack" isn't a formal clinical phrase. It's a term people often use to describe a period of intense, sustained anxiety that slowly builds and then tapers off, often triggered by a stressful situation (like chronic work pressure or a relationship crisis).
A panic attack, however, is a specific, well-defined clinical event. It is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, usually within ten minutes, and then subsides. It can include terrifying physical and/or cognitive symptoms: a pounding heart, shortness of breath, dizziness, or the fear of "going crazy" or dying. Panic attacks feel like a sudden explosion.
While they are a feature of many anxiety disorders, panic attacks can occur in other mental health conditions, and they can be expected (triggered by a known phobia, like seeing a snake) or unexpected (occurring for no apparent reason, like just sitting at home).
The spectrum of anxiety disorders
While all anxiety disorders share the feature of excessive fear and anxiety, they are differentiated by what triggers the fear and what the person is thinking about the potential threat. This is why a close examination of the feared situation and the associated beliefs is crucial for diagnosis.
There are many different types of anxiety disorders; some range from highly specific, situationally-bound fears to chronic, pervasive worry.
Mental health professionals and researchers, particularly those who composed the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), established these categories to help understand disorders in order to aid in the development of helpful and effective treatment.
Anxiety disorders are highly comorbid, meaning an individual often meets the criteria for more than one diagnosis.
However, by pinpointing the specific cognitive ideation (the content of the accompanying thought, such as "I will be humiliated" in social anxiety versus "I will be trapped" in agoraphobia), we can select the most effective, disorder-specific intervention. The list below organizes these disorders to help illustrate this spectrum of anxiety.
Disorders rooted in avoidance and specific triggers
Specific Phobia: This is a focused, intense fear or anxiety about a very circumscribed object or situation. The fear is almost always immediately induced and is out of proportion to the actual danger. Examples of specific objects or situations include fear of spiders, fear of heights, or fear of flying.
Social Anxiety Disorder (Social Phobia): This involves intense fear of or anxiety about social situations where the person may be scrutinized or negatively evaluated by others. The core cognitive fear is of being embarrassed, humiliated, rejected, or offending others.
Agoraphobia: A distinct and often misunderstood disorder. It is defined by fear or anxiety about two or more specific situations (e.g., using public transport, being in open spaces, standing in line, or being outside the home alone). The fear is driven by the thought that escape might be difficult, or help might not be available if panic-like or embarrassing symptoms occur.
Disorders usually begin in childhood
Separation Anxiety Disorder: While normal in toddlers, this disorder involves developmentally inappropriate and excessive fear or anxiety about separation from major attachment figures. The worry centers on harm coming to the figure or events that could lead to loss. It can persist into adulthood.
Selective Mutism: A consistent failure to speak in specific social situations (like school or work) where there is an expectation to speak, despite speaking fine in other situations. It's often rooted in social anxiety and significantly impacts academic or social functioning.
Disorders focused on worry
Generalized Anxiety Disorder: The hallmark of generalized anxiety disorder is persistent, excessive anxiety and worry about a variety of things (work, school, health, finances) that the individual finds difficult to control. This chronic worry is accompanied by physical symptoms like restlessness, being easily fatigued, difficulty concentrating, muscle tension, and sleep disturbance. It is especially debilitating given how pervasive the anxiety and worry are.
Panic Disorder: Diagnosed when an individual experiences recurrent unexpected panic attacks and is persistently worried about having more attacks or changes their behavior in maladaptive ways (like avoiding exercise or unfamiliar places) to prevent future attacks.
Anxiety's role in other mental health disorders
It is important to understand that the intense, debilitating feeling of anxiety is not exclusive to the anxiety disorders listed above. Anxiety symptoms, often severe and chronic, frequently appear as a core feature of other mental health diagnoses, leading to a significant clinical overlap. The following is a small selection of some of those disorders:
Obsessive-Compulsive Disorder (OCD): While OCD is categorized separately in the DSM-5, the driving force behind the ritualistic compulsive behaviors (like checking door locks or excessive washing) is a profound and intolerable anxiety. The compulsion is performed solely as a temporary measure to reduce the fear and distress caused by an intrusive thought or urge, which is the obsession.
Depressive Disorders: Anxiety and depression are frequently found together. In depression, anxiety can manifest as agitation, restlessness, and physical tension, or it can take the form of persistent worry about the future, financial ruin, or failure, exacerbating the hopelessness of the depressive state.
Post-Traumatic Stress Disorder (PTSD): The state of hypervigilance, easy startling, and the fear-based avoidance behaviors central to PTSD are essentially chronic forms of anxiety resulting from past trauma.
In these cases, successful treatment requires addressing not just the anxiety symptoms but also the underlying diagnostic framework, like the obsessions in OCD or the mood dysregulation in depression, to achieve lasting relief. This is another reason why seeking professional help can be so necessary in dealing with these issues.
A note on faith and anxiety
For many people of faith who experience clinical anxiety, there can be a profound sense of guilt or spiritual failure. Those familiar with the Christian Bible often recall powerful verses from the Bible, such as: "Do not worry about your life" (Matthew 6:25) or "Do not be anxious about anything" (Philippians 4:6).
While these passages offer deep spiritual guidance and a call to trust in God’s provision, it is vital to understand how God meets us in our anxiety, anguish, or sorrow.
Clinical anxiety is a health condition, rooted in biological, genetic, and environmental factors; it is not simply a lack of faith. God does not condemn you for a physical or psychological health condition. Your anxiety does not mean you are a "bad" Christian.
In fact, many historical and contemporary figures of deep faith have openly struggled with depression and anxiety. This struggle is not new, even within the biblical narrative. While we do not apply clinical diagnoses retroactively, the Scriptures are clear about intense emotional suffering.
Consider the Apostle Peter, who, despite his fervent faith, was so overcome by fear during Jesus's trial that he publicly and repeatedly denied knowing him, a visceral reaction of panic and social fear. This same man, however, was later restored by God’s grace to become the foundational "rock" of the church.
The Apostle Paul, a man of unwavering conviction, spoke openly of his "daily pressure upon me of my anxiety for all the churches" (2 Corinthians 11:28). Even more profoundly, in the Garden of Gethsemane, Jesus himself experienced anguish so intense that he stated, "My soul is very sorrowful, even to death” (Matthew 26:38).
This acknowledgment of deep psychological distress by central figures of faith emphasizes that intense emotional suffering is a human reality, not a spiritual failing.
The Bible is full of reassurance, promising peace that transcends understanding. Seeking treatment, such as CBT or medication, is not a failure to trust God; it is wisely using the resources and knowledge He has given us to restore health and find the genuine peace that these verses describe.
Just as you would see a doctor for a broken bone, seeing a therapist for a pattern of anxiety is an act of responsible stewardship over the body and mind.
Finding the path forward
The good news, from my experience, is that we have powerful, evidence-based tools to help you learn to regulate your alarm system and reclaim your life from avoidance. Treatment for anxiety disorders is highly effective and often involves one or a combination of the following approaches:
Cognitive behavioral therapy (CBT)
CBT is widely considered a gold standard treatment for anxiety. It is a structured, short-term form of therapy that focuses on the connection between your thoughts, feelings, and behaviors. The core idea is that by identifying and changing the distorted thought patterns that fuel anxiety, the cognitive part, you can interrupt the cycle and change the resulting behavior.
You learn to challenge those catastrophic "what if" scenarios and replace them with more balanced, realistic perspectives.
In my practice, I use a particularly powerful and accelerated form of CBT called TEAM-CBT, developed by Dr. David Burns. TEAM is an acronym for Testing, Empathy, Agenda Setting, and Methods. This approach places extraordinary emphasis on building a strong, empathetic connection quickly, in order to rapidly transition to effective methods.
In TEAM-CBT, we have over 50 specific cognitive tools to quickly overcome the avoidance and negative thought patterns fueling the anxiety. When anxiety has held you captive for years, the idea of an accelerated, empathic approach can be tremendously reassuring, offering tangible hope that effective change can happen faster than you might think.
Exposure therapy
Often a core component of successful CBT, Exposure Therapy is gradually and systematically exposing yourself to the things you fear or avoid in a controlled environment. The goal is not to eliminate fear, but to teach your brain and body that the feared situation is not actually dangerous and that you can tolerate the anxiety until it naturally subsides.
This is traditionally done step-by-step, starting with the least anxiety-provoking situation and working your way up. It is the most effective way to dismantle avoidance behaviors.
Medication
For many people, medication can be a valuable tool, especially when anxiety symptoms are so severe that they prevent effective engagement in therapy. Commonly prescribed medications include Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptide Inhibitors (SNRIs).
These are not long-term solutions on their own, but they can help to manage the intense physical and emotional symptoms, giving you the space and capacity to do the deeper work of CBT and Exposure.
A final note
If you are reading this and recognizing yourself in any of these descriptions, please know this: you are not alone, and it is not a personal failure. Anxiety disorders are real, well-defined, and incredibly common.
If anxiety is excessive, persistent, and interfering with your life, the time to seek professional help is now.
You Are Not Broken—Your Alarm System Needs Support
Anxiety disorders develop when the brain’s alarm system stays activated long after danger has passed. This can lead to avoidance, exhaustion, and a shrinking sense of safety in daily life. With understanding and treatment, that system can be retrained rather than silenced.
For decades, Sycamore Grove Counseling has supported individuals navigating anxiety with care and clarity. Therapy honors both scientific understanding and the lived experience of faith and meaning. Healing is approached patiently, without shame, and with realistic hope.
If anxiety feels excessive, persistent, or life-limiting, reaching out is a wise next step. Professional help can restore confidence in your body, mind, and decision-making. You deserve support that helps you live fully rather than fearfully.