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Anxiety

Everyone worries sometimes. When fear or worry won’t ease, shows up in many situations and starts getting in the way of life, it may be an anxiety disorder — one of the most common and most treatable health conditions.

If you are in crisis or thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat online. It is free, confidential and open 24/7 (988 Lifeline). If a life is in immediate danger, call 911 or go to the nearest emergency room (NIMH).

Chest pain is never something to guess about. A panic attack can feel like a heart attack (NIMH), and a heart attack can itself cause anxiety, sweating and shortness of breath. Chest pain, pressure or tightness — especially if it spreads to the arm, shoulder, neck, jaw or back — is an emergency: call 911 right away, don’t wait and don’t drive yourself. Women, older adults and people with diabetes may have little or no chest pain, and feel short of breath, tired or weak instead (MedlinePlus). Let the emergency team decide whether it was panic.

When does worry become an anxiety disorder?

Feeling anxious now and then is a normal part of life, and some anxiety helps you stay alert and focused (NIMH, MedlinePlus). In an anxiety disorder, the anxiety doesn’t go away, turns up in many situations and can get worse over time, until it interferes with work, school or relationships (NIMH). Psychiatrists put it simply: fear is a reaction to a threat right now, while anxiety is about something that might happen (American Psychiatric Association).

Anxiety disorders are very common. About a third of U.S. teens and adults have one at some point in their lives (NIMH). A national survey (conducted 2001–2003) found that about 19% of adults had one in the past year — more women than men (NIMH statistics). Having one is nothing to be ashamed of, and many people improve with the right care (APA).

The main types

  • Generalized anxiety disorder (GAD): hard-to-control worry about everyday things, on most days for at least 6 months, with symptoms such as restlessness or feeling “on edge,” tiring easily, trouble concentrating, irritability, muscle tension and poor sleep. Headaches, stomachaches, trembling and sweating are common too (NIMH).
  • Panic disorder: repeated, unexpected panic attacks — sudden waves of fear with a pounding heart, chest pain, dizziness, shaking, tingling, sweating, trouble breathing or a sense of doom — plus worry about the next attack and avoiding places where attacks happened. Panic attacks themselves are not life-threatening (NIMH).
  • Social anxiety disorder: strong fear of being judged or embarrassed in social or performance situations, lasting at least 6 months. It often brings blushing, sweating, trembling or a racing heart, and usually starts in childhood or the teen years (NIMH).
  • Phobias: intense fear of something that poses little or no real danger (MedlinePlus), such as a specific animal or situation, or agoraphobia — fear of places where escape or help might be hard to get (APA).
  • In children: separation anxiety disorder and selective mutism are also anxiety disorders (APA). Anxious children may avoid school or complain of stomachaches and headaches (NIMH).

Causes and things to rule out

No single cause is known. Genes, brain biology, stress, traumatic experiences, a shy temperament and a family history of anxiety all play a part (MedlinePlus, NIMH). Some physical problems — such as thyroid disease or an irregular heartbeat — can cause or worsen anxiety-like symptoms, and caffeine, other substances and certain medicines can make symptoms worse (MedlinePlus). Alcohol can also trigger anxiety: anxious feelings can follow a single heavy drinking episode and rise during withdrawal (NIAAA). That’s why a check-up, and sometimes lab tests, usually comes first (MedlinePlus, APA).

Screening

The U.S. Preventive Services Task Force recommends screening adults aged 64 and younger for anxiety disorders, including during pregnancy and after birth. For adults 65 and older, it found too little evidence to recommend for or against routine screening (USPSTF, 2023). A primary care provider can do a first mental health screening and refer you on (NIMH).

When to get help: if worry or fear is hard to control, keeps coming back, or is getting in the way of work, school, sleep or relationships, talk with a health care provider (APA, NIMH). You don’t need to wait for a crisis — anxiety disorders are treatable.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A check-up to rule out physical causes, then talk therapy (especially cognitive behavioral therapy), medicine (most often SSRI or SNRI antidepressants), or both. Therapy commonly runs about $80–$200 a session at market rates; nonprofit sliding-scale networks offer $40–$70 sessions. Marketplace plans must cover mental health, and Medicare Part B covers therapy at 20% coinsurance after the deductible. 988 is free. CBT is considered the gold-standard therapy. Antidepressants usually take 4–8 weeks to work. Medicines don’t cure anxiety, but treatment brings meaningful relief for many people.
Chiropractic Being researched — coming soon.
Acupuncture A course of needle sessions, used alongside — not instead of — therapy or medicine. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Limited, mostly low-quality evidence. Some studies suggest it may ease anxiety before surgery; there isn’t enough evidence to recommend it for anxiety disorders.
Herbal medicine Kava, chamomile and lavender oil capsules are the herbs most studied for anxiety. Cost estimate being researched. Some small or preliminary studies, nothing conclusive. Kava has been linked to rare but serious liver injury; several herbs interact with medicines. Talk with your doctor or pharmacist first.
Massage therapy Relaxing hands-on bodywork as a complement to standard care. About $50–$90 for 45–60 minutes at clinics and spas; $60–$120 with an independent therapist. Some studies suggest it can ease anxious feelings for a while, but results are mixed and the evidence is weak. Low risk with a trained therapist.
MBHA Wellness Coach Exercise, sleep, cutting back on caffeine and alcohol, breathing and relaxation skills, mindfulness or yoga, a steady routine, and help finding a therapist and support. Cost estimate being researched. Healthy habits can ease symptoms and make therapy work better, but they don’t replace treatment for an anxiety disorder.

Approach 1 of 6

Conventional medicine (AMA)

The main treatments for anxiety disorders are psychotherapy (talk therapy), medicine, or both, and it can take some trial and error to find what works for you (MedlinePlus). Therapy alone may be enough for milder anxiety; medicine is often added for moderate to severe symptoms (APA).

1. Getting checked

A provider will ask about your symptoms and health history and may do a physical exam and lab tests to rule out other causes, such as thyroid problems, before a psychological evaluation (MedlinePlus). Panic symptoms can feel like a heart attack, so an exam is especially important then (NIMH).

2. Talk therapy

3. Medicines

Medicines don’t cure anxiety disorders, but they can bring real relief (APA). We describe them by type only — your prescriber will choose the medicine and dose.

Benzodiazepine safety. The FDA requires its strongest “boxed warning” on all benzodiazepines about the risks of misuse, addiction, physical dependence and withdrawal. Stopping suddenly after weeks or months of use can cause serious withdrawal, including seizures, and combining them with opioids, alcohol or other sedating drugs can slow breathing dangerously (FDA).

Never stop or change any prescribed medicine on your own, even if you feel better — make a plan with your prescriber (NIMH, FDA).

4. Support groups

Many people find support groups — in person or online — helpful, though advice from other members should be weighed carefully and isn’t a substitute for your provider’s (APA, NIMH).

What it costs

  • Therapy without insurance: the nonprofit Open Path Collective puts typical U.S. market rates at about $80–$200 a session. Its network of therapists offers sliding-scale sessions of $40–$70 after a one-time $65 membership fee, for people who lack insurance or adequate mental health coverage and can’t afford market rates (Open Path Collective).
  • Insurance and parity: all Health Insurance Marketplace plans cover mental health care, including psychotherapy and counseling, as an essential health benefit, and can’t refuse coverage for a pre-existing mental health condition (HealthCare.gov). Under the federal parity law, most plans can’t make copays, deductibles or visit limits for mental health care stricter than for medical care (U.S. Department of Labor, HealthCare.gov).
  • Medicare: Part B covers individual and group therapy, including by telehealth and at community mental health centers; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Medicaid is the largest payer for mental health services in the U.S. (Medicaid.gov).
  • Low-cost and free help: SAMHSA’s FindTreatment.gov locator lists mental health services near you; your county health department’s website lists local public services; and many employers offer a free, confidential Employee Assistance Program (NIMH). The 988 Lifeline is free (988 Lifeline).
  • Prescription medicines: MBHA cost estimate being researched.

How well it works — what to expect

Anxiety disorders are treatable, and many people improve meaningfully with the right care (APA). Ask a new therapist how long treatment usually takes (NIMH), and expect antidepressants to take several weeks to show their effect (NIMH).

Find a medical doctor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is sometimes tried for anxiety, but the research is thin. It should be used alongside — never instead of — proven treatment for an anxiety disorder.

What the research says

  • The NIH’s complementary health center says the evidence on acupuncture for anxiety is limited and the studies are of low quality (NCCIH).
  • A 2012 review of 32 studies found some positive results, but the generally poor quality of the research made firm conclusions difficult (NCCIH clinical digest).
  • For anxiety before surgery, a 2014 analysis of 14 studies (1,034 people) found acupuncture did better than placebo or no treatment, though the studies were small (NCCIH clinical digest).

In short: acupuncture may help some people feel calmer, especially around a medical procedure, but there isn’t enough good evidence to recommend it as a treatment for an anxiety disorder.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique, which can cause infections or, rarely, punctured organs. The FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH). Choose a licensed practitioner.

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics with shared rooms charge about $50–$90, and some use sliding scales (The Pricer). Medicare Part B covers acupuncture only for chronic low back pain, so check with your plan before counting on coverage (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Several herbs are sold for anxiety and stress. A few have small or early studies behind them, but none has strong proof, and “natural” doesn’t mean safe alongside other medicines. Psychiatrists advise starting supplements only after talking with a physician (APA). Dietary supplements are not approved by the FDA before they are sold (NCCIH).

Kava

Kava, a South Pacific plant, may have a small effect on anxiety, but it may need several weeks to work and doesn’t appear to help generalized anxiety disorder (NCCIH, NCCIH). Some trials suggested short-term benefit, but a 2018 review stressed it is not a replacement for longer-term anxiety treatment (NCCIH clinical digest).

Liver warning. Kava products have been linked to rare cases of liver injury, some serious or even fatal (NCCIH). In 2002 the FDA warned that kava supplements may be associated with severe liver injury, including hepatitis, cirrhosis and liver failure, with some people needing liver transplants. It advised anyone with liver problems, or taking medicines that affect the liver, to talk to a doctor first, and anyone with yellowing skin or eyes, brown urine, unusual tiredness or stomach pain to see a doctor (FDA consumer advisory, 2002 (archived)). Don’t combine kava with alcohol or sedatives such as benzodiazepines, and avoid it in pregnancy or while breastfeeding (NCCIH).

Chamomile

Some preliminary studies suggest a chamomile supplement might help generalized anxiety, but the findings aren’t conclusive (NCCIH, NCCIH). Chamomile can cause allergic reactions, especially in people allergic to ragweed, chrysanthemums, marigolds or daisies, and interactions with the blood thinner warfarin have been reported (NCCIH).

Lavender oil capsules (Silexan)

Studies of an oral lavender oil product called Silexan suggest it might help anxiety, but the research is small and has had little independent testing (NCCIH); NCCIH says no definite conclusions can be reached yet (NCCIH). It isn’t clear whether lavender aromatherapy helps. Oral lavender can cause diarrhea, headache, nausea and burping, and might add to the effect of sedating medicines (NCCIH).

St. John’s wort

St. John’s wort is promoted mainly for depression, not anxiety. It can interact in dangerous, sometimes life-threatening ways with many medicines — including some antidepressants, birth control pills and the blood thinner warfarin — and taking it with certain antidepressants may cause serious serotonin-related side effects (NCCIH). Never combine it with a prescribed antidepressant without your prescriber’s advice.

Others

There is too little research on passionflower or valerian to draw conclusions about anxiety (NCCIH).

Before you try any herb or supplement, talk with your doctor or pharmacist, especially if you take other medicines, are pregnant or breastfeeding, or are buying for a child (NCCIH, NCCIH). We don’t list doses here.

Approach 5 of 6

Massage therapy

Many people find massage relaxing, and it is low-risk. As a treatment for anxiety, though, the evidence is mixed: it may ease anxious feelings for a while, but it is a complement to care, not a replacement for it.

What the research says

  • NCCIH says some studies suggest massage may help anxiety, but more trials are needed before firm conclusions can be drawn (NCCIH).
  • In people with cancer, a 2016 review of 19 studies found some evidence of less pain and anxiety, but the evidence was of very low quality; a 2014 review of 18 trials in women with breast cancer found no significant effect on anxiety. Individual trials in people facing surgery have reported less anxiety (NCCIH clinical digest).
  • Small studies in people with HIV and an evaluation in fibromyalgia also suggest it may help anxiety (NCCIH).

Safety

The risk of harm appears to be low. Rare serious problems such as a blood clot, nerve injury or broken bone have occurred, sometimes with vigorous deep-tissue massage or in frail older adults. Forty-five states and the District of Columbia license or certify massage therapists (NCCIH). Don’t use massage to put off seeing a provider about a health problem (NCCIH).

What it costs

About $50–$90 for 45–60 minutes at gyms, clinics and spas, $60–$120 with an independent therapist, and $30–$40 an hour at massage schools (CostHelper). Ask your plan whether it covers any massage.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the everyday habits that calm the body and support therapy — and help you get connected to care. Healthy habits can ease anxiety, but they can’t replace treatment for an anxiety disorder (NIMH).

Move your body

A single session of moderate-to-vigorous activity can reduce short-term feelings of anxiety in adults, and regular activity lowers the risk of depression and anxiety and helps you sleep better (CDC). Exercise can also make therapy work better (NIMH).

Sleep, caffeine and alcohol

  • Getting enough sleep and cutting back on caffeine can reduce symptoms alongside standard care (NIMH, APA).
  • Alcohol may seem to calm anxiety in the short run, but heavy drinking and the “rebound” afterward can make anxiety worse over time (NIAAA). A coach can help you track how drinks and coffee affect how you feel.

Breathing and relaxation skills

Slow, deep (diaphragmatic) breathing, progressive muscle relaxation, guided imagery and biofeedback are all easy to learn. Reviews suggest relaxation therapy can reduce anxiety symptoms, though CBT may work better for some anxiety disorders. Relaxation is generally safe; occasionally it brings on more anxiety, so stop and tell your provider if that happens (NCCIH).

Mindfulness, meditation and yoga

Building a routine

A coach can help you set small, realistic goals — a daily walk, a regular bedtime, a few minutes of breathing practice — and keep track of what helps. If you are in CBT, a coach can also cheer you on as you practice the gradual “exposure” steps you and your therapist plan (NIMH).

Finding a therapist and support

Still being researched: Chiropractic. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Anxiety? Tell us.

Member stories

Living with Anxiety? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

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Which approaches have you tried?

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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