Generalized Anxiety-Causes, Symptoms and Treatment Approaches
- Nov 15, 2024
- 14 min read
Updated: 4 days ago
Generalized Anxiety: Causes, Symptoms, and Treatment Approaches
Anxiety can come from several sources. One is the world we’re living in: our environment is saturated with stress — from social and political tension to financial strain to environmental challenges — and it’s taking a real toll on both mental and physical health. The other is internal. For some people, anxiety isn’t only a reaction to what’s happening around them; it can also be intrinsic, or part of their natural temperament. When that built‑in sensitivity meets ongoing external stress, the body’s alarm system can become overactive, turning everyday worry into something more persistent and disruptive.
What Is Anxiety?
Anxiety is generally considered an exaggerated stress response — one that sometimes continues even after the perceived threat is gone. It often causes clinically significant distress, and the symptoms are NOT due to another condition, substance, or disorder.
The DSM-5 defines anxiety as “excessive worry and apprehension that occurs more days than not for at least six months about many events or activities.”
Moreover, the worry of anxiety is usually focused on future outcomes or concerns and is often tied to a sense of limited control or predictability. The trigger can be concrete (real), perceived (an imagined situation or source), or random and free‑floating (no known cause). Common features include uneasiness, tension, fear, or dread. Symptoms can range from mild to severe and debilitating.
Anxiety places both physical and mental demands on a person, resulting in mental anguish, often accompanied by physical manifestations.
Common Symptoms of Anxiety
Cognitive and Emotional Symptoms
Excessive worry
Irritability, feeling on edge
Trouble concentrating
Social withdrawal or isolation
Co-occurring depression and other mental health issues
Suicidal ideation or attempts (seek immediate help if this occurs
Substance abuse (self-treatment)
Avoidance of situations that trigger anxiety (e.g., panic and social anxiety)
Feeling detached
Racing thoughts
Difficulty making decisions
Physical Symptoms
Restlessness
Frequent headaches
Frequent urination
Weight gain or loss
Tense muscles
Unexplained stomach problems like pain or discomfort, nausea, and sometimes diarrhea
Hyperventilation (rapid breathing) or shortness of breath, numbness, and tingling of extremities
Excessive sweating
Chronic pain, including arthritis and fibromyalgia
Heart palpitations or racing heart
Psoriasis and other skin problems
Dizziness or light-headedness
Dry mouth
Understanding the Brain's Role in Anxiety: The Physiological and Neurological Response in Anxiety
If you are not interested in what happens to your brain during generalized anxiety, feel free to skip down to the section below, General Causes of Anxiety.
Like many mood problems, the “feeling” and symptoms of anxiety stem from neurochemical imbalances and impulses within the brain. Anxiety isn’t about lacking willpower — it’s about neurologic and chemical processes that have gone off‑track. You’ve probably seen this in a frustrating moment when you or someone else was deeply anxious. No matter how many times you say “buck up” or “pull yourself up by the bootstraps,” it doesn’t work — and it’s even more frustrating because the person truly cannot do that, no matter how hard they try. It may look like they have no backbone, but they do. The truth is simple: no one chooses to be anxious.
The following is a basic and brief discussion of current research about neurologic function in anxiety. This overview supports the broader topic of generalized anxiety: its causes, symptoms, and treatment approaches. The goal is to give you an elemental understanding of the complex processes involved in anxiety — the many ways things can go wrong in the brain to produce anxiety — and how therapies and modern medicine help target those problems.
Stress and anxiety responses are functions of the prefrontal cortex and the limbic system in the brain. Neurologic transmissions move from sensation to reaction through neurons (nerve cells) and neurotransmitters (the chemicals that allow neurons to communicate) in the following Basic steps:
1. Sensory input begins the process. Our senses — sight, smell, hearing, touch, and taste — initiate signals in the brain through nerve cells and neurotransmitters.
2. These signals travel to the thalamus and/or amygdala. Most sensory information goes first to the thalamus, which acts as a gatekeeper and sends the information either to the cerebral cortex (to think things through) or to the amygdala (the brain’s rapid “fight‑or‑flight” emotional processing center). Smell is the exception — it bypasses the thalamus and connects directly to brain regions involved in emotion, including the amygdala.
3. The brain chooses a pathway: thoughtful response or immediate reaction. If the signal goes to the cortex, a person can think through further action. If it is sent to the amygdala, the response is immediate — a fast fight-or-flight reaction — which then sends neuronal impulses to the hypothalamus. Sometimes the amygdala also sends signals to the prefrontal cortex so the brain can reassess the threat.
4. The hypothalamus activates the body. The hypothalamus alerts the thyroid and adrenal glands, which release a cascade of hormones and neurotransmitters (including epinephrine, norepinephrine, estrogen, and testosterone). These chemicals influence heart rate, blood pressure, glucose for energy, sleep, hunger, respiratory rate, and temperature, among other functions. This prepares the mind and body to respond to potential danger.
5. The hippocampus helps store and interpret the experience. Once processing is underway, both the amygdala and cortex send information to the hippocampus, which is responsible for memory, learning, and linking memories to emotion.
6. Other neurotransmitters help regulate the system. Serotonin (involved in mood regulation) and dopamine (which can be excitatory or inhibitory, depending on the pathway) also play roles in the amygdala's emotional regulation.
Considering all the pathways and responses in this complex process, it is not surprising that many points of alteration can occur. Numerous neurons and neurotransmitter pathways can go awry and contribute to anxiety. Problems may arise in the thalamus (the gatekeeper), the amygdala (the emotion center), the hippocampus (where memories are formed and linked to emotion), the hypothalamus (which triggers chemical release in the fight‑or‑flight response), and the cerebral cortex (where thoughts are processed). Issues can also occur in adrenal gland function, in the neurons themselves, or in the neurotransmitters that connect those neurons like bridges. Additionally, problems may develop with the release or concentration of hormones such as epinephrine and norepinephrine.
Overall, most researchers describe anxiety as an “overactive limbic system,” but many different factors can contribute to that overactivity. For example:
• Abnormal neuron structure. Neurons can be altered by neurodegenerative diseases, substance use, genetic mutations, and hormonal changes — including those related to nutritional deficiencies, pregnancy, menopause, and infection.
• Misdirection of neuronal impulses. Neurons, neurotransmitters, and certain hormones can misdirect or distort signals, causing impulses to go “off track.”
• Impaired communication between the amygdala and prefrontal cortex. If the amygdala sends a signal to the prefrontal cortex but the cortex cannot respond with appropriate judgment — due to damaged neurons or altered neurotransmission — the limbic system becomes dysregulated.
• Imbalances in calming and excitatory neurotransmitters. If there is not enough GABA (the brain’s primary calming neurotransmitter) in the amygdala, there is nothing to slow it down. Likewise, too much glutamate (an excitatory neurotransmitter) can heighten emotional reactivity and contribute to anxiety.
• Prefrontal cortex inhibition from chronic stress. Chronic stress can damage axons and disrupt neurotransmission in the prefrontal cortex. This reduces the brain’s ability to regulate emotions and “downshift” anxiety responses.
• Effects of chronic stress hormones. Long‑term elevation of stress hormones and catecholamines (such as epinephrine and norepinephrine) can impair the hippocampus. This can disrupt the development of new nerve cells, leading to learning and memory problems — both of which are known to influence mental health, including anxiety and depression.
• PTSD‑related structural and functional changes. In PTSD, research has shown decreased amygdala volume, increased amygdala excitability, and reduced medial prefrontal cortex volume — all of which contribute to heightened fear responses and difficulty regulating them.
Studies suggest that extreme or chronic stress can become a general anxiety disorder sometimes because perpetual or inordinate bombardment of stress hormones (cortisol, epinephrine, and norepinephrine) can actually damage the amygdala and disturb neurotransmission (change usual neural pathways). The result is generalized anxiety disorder and/or depression over time (as most people know, those who have one of these disorders- depression and anxiety, tend to go hand-in-hand). Amygdala dysfunction can cause several other mental health problems as well.
In essence, most researchers currently believe that anxiety is a disturbance of neurons and neurotransmitters within the limbic system (the area of the brain that processes emotions), and, to a lesser degree, the frontal cortex (the area of the brain that gives us reasoning). So next time you tell someone to "buck up," remember - it is not that easy.
Can We Train the Patterns of Our Neurotransmission to Go In More Functional Directions?
One of the newer and more exciting concepts in neuroscience and mental health is neuroplasticity. Through imaging studies such as MRI, it has become clear that we all develop certain neural pathways that become ingrained simply because we use them repeatedly. This has enormous implications for treatment: the brain can be rewired or retrained to take new, more functional pathways.
General Causes of Anxiety - Causes of Neurologic Disruption
Brain development. Deficiencies in vitamin B12, folic acid, and essential fatty acids may contribute to neurodevelopmental problems that increase anxiety risk later in life. Maternal stress can also alter neuronal development in the fetal limbic system.
Brain damage. Traumatic brain injury, Alzheimer’s disease, temporal lobe epilepsy, chronic stress, and lack of oxygen can all negatively impact neurons and neurotransmitters in the limbic system.
Diet. Vitamin B12 deficiency and severe vitamin D deficiency can contribute to psychiatric symptoms, including anxiety.
Genes. According to the NIH, anxiety has a genetic heritability of about 31.6%. Environmental factors can either increase vulnerability or offer protection.
Early family life. Many familial factors can affect the amygdala and other brain structures. Chronic conflict, communication problems, rigid expectations, financial stress, parental abuse or neglect, divorce or separation, sibling rivalry, trauma, major life transitions, inconsistent parenting, or over‑parenting can all contribute to neurologic changes that increase anxiety risk. Warmth, love, responsiveness, and consistency in early childhood play a critical role in the healthy development of the limbic system.
Social and relational environment. Bullying and mental or physical abuse can significantly affect emotional regulation and limbic system functioning.
Chronic stress or trauma. Long‑term stress can dysregulate neurotransmitters, hormones, and brain structures involved in anxiety.
Sleep Deprivation - Lack of sleep increases cortisol, which interferes with the prefrontal cortex’s ability to regulate the amygdala.
Substance Use and Abuse - Alcohol, stimulants, cannabis, and other substances can alter neurotransmission and increase anxiety.
Age (risk factor) - Age can be a risk factor, as brain structure, hormones, and stress responses change over time.
Toxic Environmental Issues - Toxins can disrupt neurotransmitters and neural pathways in the limbic system. Examples include carbon dioxide, chronic exposure to formaldehyde, lead, ozone, and organophosphate pesticides.
Anxiety: Treatments and Approaches
The fact that there are many different approaches to reducing anxiety is good because not everyone will respond to the same approach, and not everyone will like the same approach. In serious cases, medication along with therapy is the best way to go, but again, not all people want to do both. Luckily, there are options.
General Approaches to Anxiety
First, try to attack this early, especially if it is increasing.
Identify and acknowledge your feelings.
Relaxation, Mindfulness, and Body‑Based Techniques (click on links for more information)
Relaxation and meditation exercises play a major role in reducing feelings of stress and anxiety. It is hard to think of two things at once, so when you focus on your body, your mind often cannot drift into anxious thinking.
This helps release endorphins in your brain, which are "feel-good" hormones. It helps reduce cortisol levels, which, when high, can decrease coping. Deep breathing techniques are practiced by taking a deep breath through your mouth using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder, and upper chest muscles), pausing, and then releasing the breath through the mouth. Repeat this several times.
Progressive Muscle Relaxation Exercises
This is done by tightening muscle groups for eight seconds, then relaxing them for several seconds. Begin with facial muscles, with the face, moving to the scalp - tighten muscles for eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities, and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.
Mindfulness helps the fronto‑limbic areas of the brain (as shown in MRI studies). It involves focusing on the present moment with awareness and acceptance.
This includes traditional meditation, Analytical Meditation (focuses on one idea or object), Guided Imagery (Think of a relaxing situation or a place you have been and focus on only that - focusing on texture, smells, and visuals.), and Body Scanning (noticing sensations of warmth, relaxation, and release of tension).
Both combine movement, breath, and mindfulness, and can reduce anxiety and improve emotional regulation.
Try to stay in the present - anxiety is often based on thoughts of the future (events, imagined or known consequences, etc.)
Lifestyle Approaches That Help Decrease Anxiety (Support Neuroplasticity)
Eat a healthy diet and exercise.
Both support the development of new neural pathways — essential for “re‑forming” anxious thought patterns into more functional ones.
Get enough sleep
Sleep deprivation increases cortisol, which interferes with the prefrontal cortex’s ability to regulate the amygdala (the central part of the brain responsible for emotions and anxiety).
Avoid alcohol and drugs.
These are often used as self‑medication but can worsen anxiety and cause long‑term neurological effects.
Do things you enjoy — or used to enjoy
Pleasure, novelty, and engagement help shift neural pathways.
Do something different
Attend a concert, go to a ball game, try a new activity — novelty stimulates neuroplasticity.
Limit or avoid the news
A digital detox can reduce overstimulation and anxiety.
Cognitive and Emotional Approaches
Read self‑help books
These can provide insight and tools for managing anxiety.
Writing thoughts and feelings can promote emotional awareness and help process experiences.
Practice affirmations
Positive self‑statements can counter negative thought loops.
Set realistic goals
Start small and work through achievable steps. Tackle one thing at a time — especially if you’re not sure where your anxiety is coming from. Sometimes, simply taking action will uncover the source you haven’t been able to identify.
Recognize and celebrate small successes
This reinforces new, healthier neural pathways.
Use humor
Laughter can reduce stress hormones and shift emotional state.
Social Support
Find social support
Engage with family, friends, or groups — even online. Talking to someone who cares can be more helpful than you realize.
Therapeutic Approaches
Counseling and Therapy - These often help: Sometimes just being able to talk to someone can help more than you know. The best therapies all have one common bond: establishing a trusting relationship. If a counselor is good, they can work with you on different ways to cope and provide therapy that will suit your needs. Some of the more popular of these are mentioned below.
Cognitive Behavioral Therapy (CBT) - This is currently considered one of the best — if not the best — forms of therapy. There are several subtypes of CBT, but they all share the same core goal: helping people recognize and challenge the dysfunctional thought patterns that contribute to anxiety and depression.
CBT is one way people can intentionally promote neuroplasticity, the brain’s ability to change and adapt. Through this kind of therapy, neurons can be encouraged to send impulses down new, healthier pathways instead of relying on old, negative ones. The brain forms new neural connections (or strengthens existing positive ones) through purposeful learning, repetition, and practicing more constructive thought patterns and positive experiences. Essentially, it’s a form of “rewiring.”
This means you can train your brain to think differently and more positively — and that makes sense when you understand how adaptable the brain truly is.
Types of CBT
-Cognitive Restructuring - Cognitive restructuring helps a person change the way they think about a situation. Through this therapy, a person learns to identify and challenge their negative or irrational thought patterns and develop more constructive ways of thinking.
-Dialectic Behavioral Therapy (DBT) - Similar to CBT, but with DBT, a person works on validating or accepting uncomfortable thoughts, feelings, and behaviors instead of fighting them. It emphasizes acceptance and change.
-Mindfulness-Based Stress Reduction Therapy (MBSR) - MBSR helps people change their responses to depressing or intrusive thoughts by using mindfulness practices to reduce reactivity.
-Motivational Interviewing (MI) - MI helps people identify positive goals and the strengths or internal motivations that can help them work toward those goals.
-Acceptance and Commitment Therapy (ACT) - ACT helps people accept difficult feelings and develop tolerance for them while learning new coping mechanisms and committing to actions aligned with their values.
Note: CBT is also effective for those with other mental health problems like anxiety disorders, PTSD, OCD, insomnia, chronic pain, and others.
Non-CBT Therapy
Psychoanalysis - Psychoanalysis is an interpersonal therapy that explores a person’s past, looking for possible roots of depression and working through the associated thoughts and feelings. It aims to help a person develop alternative, more effective coping mechanisms.
Eye Movement Desensitization and Reprocessing (EMDR) - EMDR is a therapeutic technique used to treat traumatic memories and, in this context, depression related to trauma. The therapist guides the client to focus their eyes on an object as it moves back and forth. At the same time, the client processes negative traumatic memories and gradually shifts toward more adaptive, positive associations. This approach is effective for many people and involves changes in how the brain processes and stores traumatic information — essentially a form of “rewiring.”
Sometimes we get into a rut, and our brain keeps circulating the same anxious messages over and over. Counseling can help you “retrain” your brain to take new pathways and see things from a different perspective.
Common therapies include:
Note: One of the most important factors in effective therapy is a trusting relationship with the therapist.
Complementary and Holistic Approaches
Aromatherapy -- According to studies, aromatherapy (especially with massage) can be an adjunct in the treatment of anxiety and depression.
Massage - Studies show that massage has been shown to help with anxiety and depression.
Spirituality - Spirituality is believed to provide a sense of control, purpose, hope, and connection, which helps guide healing.
Reiki - A practice focused on channeling positive universal energy. Noted to promote mental and physical well‑being.
“Poetry in a Pill”
A creative, symbolic way to receive emotional comfort through curated poetry capsules.
Over‑the‑Counter Approaches
There are no true over‑the‑counter medications for anxiety, though a mildly sedating antihistamine (like diphenhydramine) may help some people feel more relaxed. Always follow the label or consult a pharmacist.
Focus on What You Can Do
Shift attention toward what is within your control rather than what is not. This helps reduce helplessness and supports emotional resilience.
Approaches to Anxiety: Alternative and Herbal
Kava kava
Aromatherapy (especially lavender, chamomile, and others)
5-HTP
Prescriptive Treatments for Anxiety
The following medications can work well alone, but usually work best if used in conjunction with therapy -
Barbiturates and benzodiazepines increase GABA, which calms activity in the amygdala (it also works in other areas of the brain, but the amygdala is the area of focus here). These work very well for significant episodes of anxiety but are also potentially very addictive and, because of this, should not be used on an ongoing or daily basis.
SSRIs - Selective serotonin reuptake inhibitors (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine). These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies). They help reduce excitation in the amygdala (the brain's emotion center).
SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine). These medications help decrease activity in the amygdala.
Other Medications for Anxiety - Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication actually causes greater production of serotonin in the brain. Buspar (buspirone) increases serotonin and decreases dopamine (an excitatory neurotransmitter in the amygdala).
There are many medications and approaches that help with anxiety. If your anxiety is making your life uncomfortable, if it is causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself out of that rut.
Problems With Anti-Anxiety Medications?
Are you having side effects? Many anti-anxiety and antidepressants can cause side effects, especially stomach symptoms in the beginning. Typically, these settle down. However, if your side effects are too bad, especially if you start feeling more anxiety or depression, talk to the person who prescribed them (ideally) or another healthcare provider.
The medications don't seem to be helping. It typically takes these medications about two to three weeks to start working well. Don't give up, and be sure not to skip any doses (you might end up on an emotional roller coaster!). If it remains ineffective, you may need an increased dose, an add-on medication, or a switch.
Do you feel blunted? "I don't want to take these medicines. I don't seem to feel any emotion". This is a fairly common complaint about antianxiety (and antidepressant) medications. If this is occurring, and you think the loss of feelings is worse than your anxiety, you can have your prescriber change your medication to one that works differently, or you can try some therapy instead.
"I feel great, I think I will come off my medications". Not a good idea. Don't just drop off your medication - it's probably helping. Speak to your prescriber about decreasing it slowly so you don't end up in "shock" (too much of an anxiety rebound). I have met a lot of people who just drop off their medications, and they realize how bad they feel without them.
