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When Anxiety Gets Physical

Anxiety often shows up physically in the body.

Key points

  • Anxiety often has physical manifestations.
  • People with anxiety disorder are at increased risk of heart disease, as well as mortality from heart disease.
  • Psychotherapy may have an impact on some of anxiety's physical effects.

A few years ago, I traveled to a nature area in Missouri called Johnson Shut Inns, a park featuring a river, slippery rocks to climb on, and hiking trails. It's beautiful. And just a little dangerous

As I swam and ventured across the boulders, I met a spot that dropped from well below my head to at least a foot or more over my head. I swim regularly, and so I did what I know to do when I get underwater: I put my hands up and out like wings and hoped to come back up.

But the water rushing off the rocks and the current together pushed me down, and it took maybe 30 seconds until I got a grip on a rock to lift myself from the water. In those 30 seconds, I thought, "Am I going to die?" And, of course, I didn't. I caught my breath, pulled myself out, and stopped shaking. That is what anxiety–and especially panic—is like.

Still, in truth, anxiety is no more or less intense than panic—but one is understood as terrifying, while people are quicker to judge or dismiss the other as something to get over. Like my semi-non-drowning deal, despite all its threats—anxiety can't hurt you.

When Anxiety Gets Physical

Physical signs of anxiety, like a racing heart, shortness of breath, and shaking, are often thought of as panic attacks. Yet, anxiety can present in several physical ways. Tightened muscles can result in neck pain and headaches, and anxious experiences can wreak havoc on the digestive system.

These physical issues are no less real than similar symptoms in non-anxious people.

Meta-analysis suggests that anxiety disorders are linked to higher instances of heart disease (Roest et al., 2010). Unfortunately, anxiety is also linked to increased mortality from heart events (Celano et al., 2015). Although the exact reason for this is unknown, the dismissal of physical symptoms in people with an anxiety disorder diagnosis could play a role.

A Bi-Directional Impact

Just as anxiety can influence physical symptoms, psychotherapy may also alter the course of physical symptoms in people with anxiety disorders. A meta-analysis found that cognitive behavioral therapy is linked to a decrease in heart rate in individuals diagnosed with conditions ranging from social anxiety to post-traumatic stress disorder (Gonçalves et al., 2015).

Some research also suggests that psychotherapeutic interventions may improve outcomes in individuals with heart disease (Biondi-Zoccai et al., 2016).


For individuals struggling with the physical effects of anxiety, help is available. Psychotherapy, coupled with evaluation by a medical professional and treatment as necessary, can assist.


Gonçalves, R., Rodrigues, H., Novaes, F., Arbol, J., Volchan, E., Coutinho, E. S. F., ... & Ventura, P. (2015). Listening to the heart: A meta-analysis of cognitive behavior therapy impact on the heart rate of patients with anxiety disorders. Journal of Affective Disorders, 172, 231-240.

Celano, C. M., Millstein, R. A., Bedoya, C. A., Healy, B. C., Roest, A. M., & Huffman, J. C. (2015). Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. American heart journal, 170(6), 1105-1115.

Roest, A. M., Martens, E. J., de Jonge, P., & Denollet, J. (2010). Anxiety and risk of incident coronary heart disease: a meta-analysis. Journal of the American College of Cardiology, 56(1), 38-46.

Biondi-Zoccai, G., Mazza, M., Roever, L., van Dixhoorn, J., Frati, G., & Abbate, A. (2016). Evidence-based psychotherapy in ischemic heart disease: Umbrella review and updated meta-analysis. Psychotherapy for Ischemic Heart Disease: An Evidence-based Clinical Approach, 131-158.

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