Understanding Anxiety: From Everyday Worry to Panic Attacks

Have you ever found yourself lying awake at two in the morning with a loop of worry you could not switch off? Maybe it is that. Maybe it is the opposite, a heart that starts pounding out of nowhere in the car or standing in line at the store, frightening enough that for a few minutes you wonder whether something is wrong with your body. Those two experiences feel nothing alike, and they come from the same place.

I'm Charles Scribner, a psychiatric nurse practitioner in Brea, and some version of this is one of the most common reasons adults reach out to me. Here is how I think about anxiety, the different shapes it takes, and what actually helps over time.

How I think about anxiety

Most of what I do comes back to a simple idea. Anxiety is what happens when we spend too much time in the future.

That is not a criticism of the mind. It is close to a description of what the mind is for. We are built to look ahead, to picture what might go wrong, plan around it, and prepare. A person who could not do that would not last long. But the point of looking ahead is to come back. You scout the road, notice what might be difficult, and return to the present steadier and better informed, ready to meet it. Used that way, the future is a tool, and using it well is part of how we grow.

Anxiety is what happens when we go out to the future and do not come back. We keep building the scene, and the mind is very good at building, until we have a full storyline, usually more certain and more catastrophic than anything likely to happen. And then we believe it. The body cannot tell the difference between a threat we are imagining in detail and one that is in the room. It responds to the story as if it were true. The heart speeds up, the breath quickens, and everything readies itself to fight or run. That is the fight-or-flight response, and it is not a malfunction. It is protection, the same chemistry that would serve you well if the danger were real, switched on for a danger that lives, for now, only in the future.

So a good deal of the work is learning to come back. To notice, in the present moment, that you are safe, that you have what you need, and that you are capable, and that whatever is ahead of you, you can navigate it, and if you struggle with it you can learn from it. The goal is not to stop looking ahead. It is to stop living there.

What are the different types of anxiety?

Anxiety is less a single condition than a family of them. The National Institute of Mental Health groups the anxiety disorders into generalized anxiety disorder, panic disorder, social anxiety disorder, and the phobia-related disorders [1]. What they share is that root, a mind reaching into the future for a threat and a body mobilizing to keep you safe from it. What differs is the shape it takes.

Everyday worry is the quiet, running version. It is the low background hum of what-ifs, the planning that never quite lands back in the present. When worry becomes persistent, shows up across many situations, and is hard to control, it is what clinicians call generalized anxiety disorder [1].

Panic attacks are the acute version. The whole fight-or-flight response fires at once, within minutes, often with no storyline you can even name [2]. I have written a longer piece on what is actually happening during a panic attack, because it is the shape that frightens people most and the one that sends them looking for answers first.

Social anxiety is the same machinery pointed at being watched and judged, and the phobia-related disorders point it at one specific thing or situation [1].

Obsessions and compulsions, often called OCD, are another shape. A feared outcome will not let go, and rituals or mental checks are meant to buy back a feeling of safety. Clinicians now group OCD in its own category rather than with the anxiety disorders [3], but the felt experience shares the same root.

Across all of them the nervous system is trying to do one thing, which is to get back to safety, back to rest, back to the opposite of fight-or-flight. That common direction is part of why these problems are treatable, even when the surface looks very different from one person to the next.

What actually treats anxiety over time?

Anxiety is one of the more treatable things I see. For most people the plan has two parts, therapy and sometimes medication, and they tend to work best together.

Therapy is the foundation

I want to be plain about this. Therapy is not the optional half of the plan. It is the part that teaches your nervous system something new and lasting, and it holds up well after treatment ends. There are several forms that work, and the right one depends on the person.

Cognitive behavioral therapy (CBT) is the first-line treatment for panic and has held that position across a large body of research [4]. A lot of it is learning to catch the future-focused thinking, the catastrophizing and the negative thought patterns, and reframe it, and to slow down enough to notice where you actually are.

EMDR is often the better fit when trauma is driving the anxiety, helping the body finally file a past event as past. National treatment guidelines list it among the recommended therapies for post-traumatic stress disorder in adults [5].

Skills you can carry with you, including slow paced breathing, self-awareness, and the simple practice of returning to the present, are woven through all of it. A meta-analysis of randomized trials found breathwork associated with lower self-reported anxiety than control conditions [6].

Each of these is a way of learning to come back from the future and settle into the present.

Where medication fits

Medication can be a valuable part of the plan, especially when symptoms are intense, when anxiety comes alongside depression, or when someone is too overwhelmed to do the therapy work until the volume comes down a little.

The usual starting point is an SSRI, the class that includes sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac). SSRIs and the related SNRIs are both considered first-line medication treatment for panic disorder, generalized anxiety disorder, and social anxiety disorder [7]. They work gradually over a few weeks and act on the underlying anxiety rather than on any single moment of it.

There is also a different kind of option for some people, which is medication that works on the body rather than on the storyline. Propranolol is a beta blocker that blunts the effect of adrenaline, so it can quiet the pounding heart and the physical side of anxiety without touching the worrying thoughts themselves [8]. I go through how that works, and who it is and is not right for, in the panic attack article.

Which medication, and whether medication makes sense for you at all, is a conversation with a prescriber who knows your history. If you have tried medication before and had a rough time with it, that history is useful information rather than a dead end, and it is one of the reasons I sometimes look at how your body processes psychiatric medication.

A note on trauma

For some people the body's alarm was set by something that genuinely happened. When there is a history of trauma, the sentence "you are safe now" is truer than it feels but much harder to settle into, and anxiety and panic can be tangled up with it. That does not change the direction of the work, but it usually means the work needs its own careful, unhurried approach. It is worth naming early rather than working around.

How do I get help for anxiety in Brea, or anywhere in California?

I see adults at my office in Brea and by telehealth across California. A first visit is mostly conversation. We go through what your anxiety looks like, when it started, what you have already tried, and what your life has quietly reorganized around, and then we decide together what a reasonable plan looks like.

Questions I hear a lot

Is worry the same as a panic attack? No, though they are different shapes of the same underlying thing. Worry tends to be the slow, running version. A panic attack is the acute, all-at-once version. Both respond to treatment.

Which type of anxiety do I have? That is what an evaluation is for, and it is not something an article can tell you. Many adults carry more than one shape at the same time, which is common and does not make the plan more complicated than it needs to be.

Will I need medication forever? Not necessarily, and for many adults medication is not the whole plan or even the main part of it. Therapy has good durability after treatment ends.

Can this be treated over video? Yes, for most people. Anxiety responds well to structured work that translates to telehealth, and I see patients across California that way.

This article is education rather than medical advice, and it is not a recommendation for any specific treatment or medication. Please talk with your healthcare provider about your own situation. If you are in crisis, call or text 988 to reach the Suicide and Crisis Lifeline.

One small step

You do not have to decide about therapy or medication today. If you have been living braced for the next wave of it, the doable next step is putting words to it with someone who works with this regularly. Reach out through the contact form and we will talk through what has been happening.

References

1. National Institute of Mental Health. Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders
2. National Institute of Mental Health. Panic Disorder: When Fear Overwhelms. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms
3. National Institute of Mental Health. Obsessive-Compulsive Disorder (OCD). https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
4. Pompoli A, et al. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological Medicine, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137372/
5. American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2017. https://www.apa.org/ptsd-guideline/ptsd.pdf
6. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Scientific Reports, 2023. https://pubmed.ncbi.nlm.nih.gov/36624160/
7. Garakani A, et al. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in Psychiatry, 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7786299/
8. Farzam K, Jan A. Beta Blockers. StatPearls, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532906/