Anxiety
Overview
Anxiety (不安, anxiety) is an emotional state of tension, worry, and restlessness felt in response to a threat that has not yet occurred or is uncertain. Whereas fear is a response to a concrete, immediate danger, anxiety is distinguished by being anticipatory and diffuse, with an ambiguous object. An appropriate level of anxiety serves an adaptive function by enhancing performance and promoting avoidance of danger, but when excessive or prolonged, it can develop into an anxiety disorder that impairs daily functioning.
Main Content
Definition and Conceptual Distinctions
In psychology, anxiety is divided into 'state anxiety' and 'trait anxiety.' State anxiety is an emotional response that appears temporarily in a specific situation, while trait anxiety is a dispositional tendency that an individual possesses relatively stably. In psychoanalysis, Freud proposed the concept of anxiety as a signal, and in cognitive psychology, cognitive appraisal of uncontrollable threats is seen as mediating anxiety.
Types of Anxiety
- Normal anxiety: Temporary tension that appears before specific events such as exams, interviews, or presentations.
- Generalized anxiety disorder (GAD): A state in which excessive worry persists for more than six months without a specific object.
- Panic disorder: A condition in which unexpected panic attacks and fear of recurrence are repeated.
- Social anxiety disorder: Marked fear of being evaluated in social situations.
- Specific phobia: A strong avoidance response confined to a particular object or situation.
- Separation anxiety disorder: Excessive anxiety about separation from an attachment figure.
Neurobiological Mechanisms
The core neural circuitry of anxiety consists of the amygdala, the prefrontal cortex, and the hippocampus. The amygdala generates rapid warning signals in response to threatening stimuli, and the prefrontal cortex regulates these downward. When this regulatory function weakens, anxiety responses become excessive. In terms of neurotransmitters, GABA, serotonin, and norepinephrine are primarily involved, and reduced GABA function and amygdala hyperactivation are known as representative mechanisms of pathological anxiety. Chronic elevation of cortisol due to hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is also characteristic.
Symptoms
Psychological symptoms include worry, difficulty concentrating, restlessness, irritability, insomnia, and depersonalization. Physical symptoms are accompanied by autonomic nervous system hyperarousal, such as palpitations, chest tightness, shortness of breath, dizziness, sweating, tremor, indigestion, and muscle tension. When chronic, it can lead to headaches, chronic fatigue, and reduced immunity.
Causes
Anxiety arises not from a single cause but from a combination of genetic, temperamental, neurobiological, environmental, and psychosocial factors. Heritability is estimated at approximately 30–50%, and childhood adversity, overprotective or controlling parenting, chronic stress, use of caffeine, alcohol, or stimulants, and physical conditions such as hyperthyroidism can also be triggering factors.
Diagnosis and Assessment
Diagnostic criteria from the DSM-5 and ICD-11 are used, and self-report instruments such as the GAD-7, the Beck Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory (STAI) are utilized for screening. When diagnosing, physical causes such as thyroid disease, arrhythmia, hypoglycemia, and medication side effects must be ruled out.
Treatment
Cognitive behavioral therapy (CBT) is a representative psychotherapy that corrects distorted cognitive schemas and avoidance behaviors, and exposure therapy and mindfulness-based cognitive therapy (MBCT) have also accumulated evidence. For pharmacotherapy, SSRIs and SNRIs are first-line choices, while benzodiazepines are limited to short-term use. In terms of lifestyle, regular sleep, aerobic exercise, reduced caffeine intake, and breathing control training are effective.
Recent Trends
In 2024–2025, digital mental health interventions are rapidly spreading. Technologies that predict and intervene in anxiety by measuring heart rate variability (HRV) in real time with smartphone-based CBT apps and wearable devices are moving beyond the clinical research stage into commercialization. In addition, as the prevalence of anxiety among adolescents and young adults has remained high since COVID-19, social isolation and excessive SNS use have emerged as risk factors. Regulatory arrangements for telemedicine and AI chatbot counseling to improve access to mental health services are also underway in various countries. Precision medicine approaches combining brain imaging and genomic data, and clinical trials of psychedelic-assisted therapy (e.g., psilocybin) for anxiety treatment, are also drawing attention. Domestically, along with discussions on revising the Mental Health Welfare Act, early intervention policies such as the 'Mental Health Voucher' are expanding.
Related Topics
- [[Panic Disorder]]
- [[Depression]]
- [[Stress]]
- [[Cognitive Behavioral Therapy]]
- [[Amygdala]]
- [[Mental Health]]
- [[Mindfulness]]