Anxiety Disorders Nursing CE Course for RNs and LPNs

Course preview

Anxiety Disorders for Nurses

Disclosure Statement

This course aims to provide an overview of anxiety disorders, including background epidemiology, clinical features, diagnosis, management, and treatment. The nurse should understand factors contributing to anxiety disorders and appropriate nursing interventions and treatment options.

At the conclusion of this activity, the learner will be able to:

• explore the epidemiology of anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD)
• review the pathophysiology of anxiety disorders, OCD, and PTSD
• discuss common risk and protective factors and appropriate nursing considerations
• understand the diagnosis of anxiety disorders, OCD, and PTSD
• explore the management of anxiety disorders, including pharmacologic treatment, nonpharmacologic and pharmacologic interventions, and nursing implications for anxiety disorders, OCD, and PTSD
• analyze future research and trends for anxiety disorders, OCD, and PTSD

Anxiety disorders are among the most common psychiatric disorders, comprised of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), phobias (i.e., an intense fear of places or situations that causes panic-like reactions), separation anxiety disorder, selective mutism, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In the United States, about 19% of adults have an anxiety disorder in any given year, and around 31% will experience one at some point in their lives. Globally, lifetime prevalence may approach one-third of the population. Adolescents are similarly affected, with approximately 32% experiencing lifetime anxiety and nearly 9% facing severe functional impairment. Many people experience episodes of anxiety that are manifested by sweating, heart palpations, and nervousness; all are considered expected physiologic responses when appropriately triggered and not maladaptive. Anxiety is a standard and primary emotion required for survival. Anxiety is considered an illness requiring treatment when these physiologic responses are triggered without a threat and when symptoms become debilitating or negatively impact an individual’s life (National Institute of Mental Health [NIMH], 2025a).

OCD and PTSD have been removed from the diagnostic category of anxiety disorders. They have been assigned independent categories in the latest edition of the DSM (DSM-5-TR) because OCD, PTSD, and anxiety disorders have unique causative and neurobiologic differences (American Psychiatric Association [APA], 2022). However, we will discuss those conditions as a collective today due to similar symptoms and treatments utilized.

Epidemiology and Risk Factors of Anxiety Disorders

Anxiety disorders are the most common mental health illness in the United States. Greater than 40 million, approximately 19% of adults aged 18 and older in the United States, have anxiety. Individuals with anxiety are at greater risk for hospitalization related to psychiatric disorders. Data indicates they are three to five times more likely to see a health care provider and six times more likely to be hospitalized compared to those without anxiety. People with anxiety disorders generally experience persistent concern and worry associated with nonspecific physical and psychological symptoms that impact their life negatively (Centers for Disease Control and Prevention [CDC], 2024; NIMH, 2025a).

Anxiety disorders can begin in childhood and have a median age of onset around 12 years old. Individuals assigned female at birth have increased rates of anxiety. Studies suggest that anxiety disorders appear more common in people with lower socioeconomic status and/or education level. They occur at higher rates among Black Americans than Americans of other ethnic backgrounds Additional risk factors for anxiety disorders consist of a family history of anxiety or other mental health illnesses; stressful or adverse life events; abuse and neglect (emotional or physical); sexual violence; chronic diseases; the death of significant others; financial difficulties; traumatic injury; being widowed, separated, or divorced; being middle-aged; having comorbid psychiatric disorders; and a history of substance use disorder (SUD). Medical conditions linked to anxiety disorders include endocrinologic disorders like hypo- and hyperthyroid states (APA, 2022; Barbek et al., 2024; Bie et al., 2024).

Some public health and safety occupations are at a higher risk of developing PD and PTSD. PTSD involves an emotional response (severe panic and worry) that can be triggered when reminded of past events. Individuals who are at increased risk of this disorder are people who have been sexually assaulted or raped, those who have been subjected to domestic violence or abuse, children who have witnessed domestic violence or abuse, war veterans, health care workers, and first responders.

Anatomy, Physiology, and Pathophysiology

The amygdala and the other components of the frontoamygdala are associated with neurophysiologic activity in individuals with anxiety disorders. The amygdala is the area of the brain responsible for processing fear and anxiety, and the prefrontal cortex regulates cognitive functions and impulse control. Individuals with anxiety disorders typically have increased activity within the amygdala and/or decreased prefrontal activity. The prefrontal cortex, amygdala, and hippocampus form a network responsible for receiving and expressing fear memories and are believed to be involved in the pathophysiology of PTSD. PTSD is caused by a traumatic life event. In addition to potential chemical imbalances and environmental factors, PTSD patients have been exposed to psychological trauma, which causes flashbacks, sleep disturbances, and intrusive thoughts. The areas of the brain involved in mediating the cognitive-affective impairments associated with OCD are the anterior cingulate, orbitofrontal cortex, and striatum (Bowen et al., 2021; Wang et al., 2021).

The neurotransmitters associated with anxiety disorders are gamma-aminobutyric acid (GABA), norepinephrine, serotonin, and dopamine. These neurotransmitters are activated when the body perceives stress, a fight or flight reaction. Depending on the magnitude of the response and the activation of these neurotransmitters, an imbalance can cause moderate anxiety symptoms. Therefore, anxiety symptoms may be related to disrupted modulation within the central nervous system due to low serotonin and elevated noradrenergic system activity. This explains why selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line agents for the treatment of anxiety. Neurotransmitters involved in OCD include serotonin, dopamine, GABA, and glutamate. Neurotransmitters implicated in PTSD are GABA, glutamate, serotonin, and neuropeptide Y. A decrease in GABA activity and an increase in glutamate result in dissociation and derealization (Armstrong et al., 2023; Hansen et al., 2022).

Signs, Symptoms, and Clinical Manifestations

ground:white;">Generalized Anxiety Disorder

GAD is characterized by excessive worry and anxiety about multiple events almost daily. The worry is problematic and associated with muscle tension, restlessness, irritability, lack of concentration, and difficulty sleeping. Even though excessive worry is the core of anxiety disorders, individuals may present with associated cognitive, physiologic, behavioral, and affective symptoms. Cognitive symptoms of anxiety can negatively affect an individual’s mood, concentration, perception, memory, and attention. Patients with anxiety can describe an intense fear of death, physical injury, or losing control and often feel like they are ‘going crazy’. Physiologic symptoms include chest pain, shortness of breath, tachycardia, diaphoresis, dizziness, paresthesia, gastrointestinal symptoms (nausea, vomiting, diarrhea), tremors, and dry mouth. Behavioral symptoms include irritability, agitation, restlessness, and an intense quest for safety. Affective symptoms include frustration, nervousness, jitteriness, and being on edge (APA, 2022; Munir & Takov, 2022).

Social Anxiety Disorder

SAD is an extreme, persistent fear that others are judging the individual and that everyone is always watching them. This fear is so intense and debilitating that it can affect going to school, work, or managing daily life. Symptoms associated with SAD include palpitations, diaphoresis, trembling, abdominal pain, body posture changes, decreased voice volume, and an inability to make eye contact, causing significant impairment or distress (APA, 2022; NIMH, 2025b).

Panic Disorder

PD consists of frequent and unexpected panic attacks. Panic attacks are sudden episodes of extreme fear associated with losing control, even without clear danger or a trigger. During a panic attack, an individual may experience the feeling of impending doom, as though they have no control. Patients with PD may experience shortness of breath, chest pain, palpitations, diaphoresis, trembling, and fear of ‘going crazy’ or dying. These symptoms may occur unexpectedly in the absence of a trigger. Individuals who experience a panic attack may not develop PD (APA, 2022; NIMH, 2025c).

Agoraphobia

Agoraphobia is a distinct anxiety disorder characterized by intense fear or avoidance of common situations, such as entering public places that are not confined, entering indoor spaces, entering an area with lots of people, or leaving the house without a support person. These fears often lead to significant distress or functional impairment. Individuals may experience panic-like symptoms such as palpitations, shortness of breath, dizziness, or fear of embarrassing outcomes like falling or incontinence, particularly in vulnerable populations (APA, 2022; Balaram & Marwaha, 2024).

Obsessive-Compulsive Disorder

OCD comprises a manifold of symptoms, including rituals, intrusive thoughts, preoccupations, and compulsions. Obsessions are intrusive and unwanted repetitive thoughts, urges, or impulses that can cause an increase in anxiety or distress. The onset of this chronic disorder usually occurs in early adulthood (late teens to early twenties) but can begin to manifest during the early teenage years as well. People with a family history have a higher risk of having the disorder as well as individuals assigned female at birth. There is not as much known about this disorder as others, but it is widely believed that genetic and environmental factors are involved in its development (APA, 2022; Strom et al., 2024).

Posttraumatic Stress Disorder

PTSD is a psychological disorder characterized by increased anxiety and stress after exposure to a traumatic or stressful event. Prominent symptoms can include intrusion symptoms, avoidance behaviors, negative alterations in cognition and mood, and arousal and reactivity changes. This includes flashbacks, sleep disturbances, depressed mood, nightmares, social isolation, and anxiety. Patients with PTSD may display irritability or have angry outbursts with little or no provocation. They may also have an exaggerated startle response. These symptoms must persist for more than one month and cause significant distress or functional impairment (APA, 2022).

Diagnosis

The US Preventive Services Task Force (2022, 2023) recommends (Grade B) screening for anxiety in patients age 8 to 65, but found insufficient evidence to recommend or discourage screening in adults over the age of 65 or children under age 8 (Grade I). The diagnostic criterion for GAD includes extreme concern or worry for 6 months or more with difficulty regulating these emotions, along with three or more of the following symptoms: feeling tired, feeling agitated, difficulty sustaining focus, poor sleep, tense muscles, and feeling fidgety. The symptoms must substantially affect the patient’s ability to function professionally or socially. The patient’s symptoms must not directly relate to the use of a substance, medication, or preexisting medical diagnosis or health concern, and the concern is not due to a more appropriate psychiatric condition such as panic attacks (i.e., PD), past trauma (i.e., PTSD), gaining weight (i.e., eating disorders), social interactions (i.e., SAD), separation from a loved one (i.e., separation anxiety disorder), physical symptoms (i.e., somatic symptom disorder), a specific trigger (i.e., specific phobia), or a recurrent thought (i.e., OCD; APA, 2022, p. 250; DeGeorge et al., 2022; Munir & Takov, 2022).

SAD is characterized by terror or significant concern about a certain environment that exposes the patient to potential judgment by the public or individuals. The fear/concern or active evasion of the environment leads to dysfunction (academic, professional, social, or otherwise) or substantial anguish. The patient’s symptoms are not directly related to the use of a substance, medication, or preexisting medical diagnosis or health concern, and the concern is not due to a more appropriate psychiatric condition such as autism spectrum disorder, panic attacks (i.e., PD), past trauma (i.e., PTSD), separation from a loved one (i.e., separation anxiety disorder), a specific trigger (i.e., specific phobia), physical judgment (i.e., body dysmorphic disorder), or a recurrent thought (i.e., obsessive-compulsive disorder). In pediatric patients, the fear/concern must be present when interacting with peers (not only grown-ups) and may present as dependence, immobility, mutism, outbursts, or fits. The fear/concern is disproportionate or unconnected in those with a physical attribute that causes discomfort (e.g., significant scars, facial or other obvious physical differences). A “performance only” specifier may be used if the fear is limited to public presentations or appearances (APA, 2022, p. 229; NIMH, 2025b).

Patients with PD will exhibit panic attacks or unanticipated and sudden experiences characterized by an upwelling of terror that crests quickly (i.e., minutes) and is accompanied by at least four associated sensations or physiologic reactions. Following at least one of the patient’s panic attacks, they reported at least 30 days of anxiety about or altered behavior to avoid another attack (APA, 2022, p. 235).

Agoraphobia is defined as terror or significant concern about at least two of the following conditions:

• entering public places that are not confined (e.g., parks/fields, vacant lots, etc.)
• entering indoor spaces (e.g., conference rooms, stores, etc.)
• entering an area with lots of people, or waiting in a queue
• public transport utilization
• leaving their house without anyone else, such as a companion or partner

If the patient also experiences panic attacks and meets the required characteristics of PD, the patient may be diagnosed with both (APA, 2022, p. 246).

OCD is characterized by obsessions: repeated and consistent ideations, contemplations, or visions that are invasive, unpleasant, and/or not desired, leading to intense concern or anguish. Compulsions are ritualistic physical or intellectual actions that the patient is compelled to complete due to a strict internal expectation or regulation, or related to an obsession, as defined above. There are several validated screening tools available for the assessment of OCD (APA, 2022, p. 265; Storch & Goodman, 2023).

PTSD is related to a prior experience of potential or genuine fatality, severe harm, or sexual assault. The patient may have been a participant, victim, or witness/bystander. The unwanted and unpleasant symptoms may include:

• recollections of the initial traumatizing experience
• significant psychological reactions to environmental or inner triggers
• significant physical responses to environmental or inner triggers
• flashbacks,
• repetitious nightmares

The patient consistently prevents exposure to internal or external triggers. The patient experiences a significant decline in disposition and mental function following the initial traumatizing experience. The patient experiences a significant change in responsiveness following the initial traumatizing experience. The symptoms cause substantial anguish or drastically affect the patient’s ability to function professionally and socially (APA, 2022, pp. 301–303; Burback et al., 2024).

In patients under age 6, the same five unwanted and unpleasant symptoms described previously begin after the initial traumatizing experience. In younger pediatric patients, recollections of the initial traumatizing experience may be displayed outwardly through play. The child consistently prevents exposure to external triggers or they experience a significant decline in disposition and mental function following the initial traumatizing experience. The child experiences a significant change in responsiveness following the initial traumatizing experience (APA, 2022, pp. 303–304).

The diagnosis of PTSD may be associated with dissociative symptoms. Validated screening tools available to assist in the assessment of PTSD are the PTSD Checklist for DSM-5 (PCL-5) and Trauma Symptom Checklist–40 (APA, 2022, p. 304; US Department of Veterans Affairs, 2025a).

Management

Nonpharmacological Treatment of Anxiety Disorders

Cognitive behavioral therapy (CBT) is an effective psychotherapy for individuals with many anxiety disorders. CBT teaches individuals methods of rethinking, responding, and reacting to situations to feel less anxious and fearful. CBT is the gold standard for psychotherapy. Exposure therapy is a form of CBT utilized to treat certain anxiety disorders. Exposure therapy enhances individuals’ ability to confront the fears underlying their anxiety disorder and reengage in activities they have been avoiding, as occurring with phobias. Virtual therapy uses computer programs to treat agoraphobia and SAD. Patients are provided with a virtual environment, like the environment responsible for their phobia. They identify with the specific avatars during multiple sessions until they can cope with the anxiety while preparing for exposure in real life. Additional nonpharmacologic treatments include lifestyle changes such as avoiding excessive amounts of caffeine, reducing or avoiding alcohol consumption, smoking cessation, and incorporating stress management techniques, such as meditation, exercise, and mindfulness, which can help reduce anxiety symptoms and complement the effects of psychotherapy (Bhattacharya et al., 2023; Malivoire et al., 2024).

Evidence shows that the combination of psychotherapy and pharmacotherapy is very effective for OCD management. ERP involves the patient being gradually exposed to anxiety-producing triggers while they refrain from engaging in compulsions or rituals. This slowly reduces anxiety over time. Another treatment option that is exceptionally successful in patients with OCD is deep brain stimulation (DBS), which involves placing electrodes in targeted areas of the brain. Impulses are then sent through the electrodes to help regulate brain activity. Encouraging patients to express and verbalize thoughts is essential when managing OCD, as well as developing a good rapport with the patient. Clinicians must work with the patient to reduce anxiety related to completing or not completing compulsions and increase coping mechanisms to interrupt or stop intrusive thoughts or compulsions (Nezgovorova et al., 2022; Reid et al., 2021; Roh et al., 2023).

Several therapies have been shown to have positive results for patients with PTSD. Trauma-focused cognitive-behavioral therapy (TFCBT) involves prolonged exposure (PE) therapy. PE focuses on reexperiencing the traumatic event through repeatedly engaging with the memories and everyday reminders/triggers instead of avoiding them. Eye movement desensitization and reprocessing therapy (EMDR) involves repeatedly recalling distressing images while receiving sensory inputs. Cognitive processing therapy (CPT) emphasizes correcting faulty attributions and posttraumatic overgeneralizing the world as dangerous and uncontrollable. Present-centered therapy (PCT) focuses on the current relationship and work challenges rather than the trauma. Psychodynamic psychotherapy may also be useful in the treatment of many patients with PTSD. PTSD is a trauma-related disorder, so it is not always comfortable for patients to communicate and openly express their feelings. Therefore, it is imperative for clinicians, nurses, and other healthcare professionals to be knowledgeable about the signs and symptoms of PTSD. Studies have shown that patients have a more favorable outcome with early detection and implementation of treatment (Stein & Norman, 2025; Wright et al., 2024).

The nurse should reference current clinical literature and use trauma-informed care frameworks when evaluating patients at risk who show signs of being abused. Additionally, they should follow proper facility protocol and make appropriate referrals to maintain the safety of the patient and their children. Particular attention should be given to the fact that these patients may have to maintain contact with their abuser if they have children together. The nurse should provide the patient with all the necessary resources and information to remain safe and continue to work toward recovering from the abuse and treating the resulting PTSD. Nurses should incorporate methods to develop a trusting relationship with the patient to communicate effectively. Patients with PTSD require a calm and therapeutic environment that encourages the expression of feelings and fears and incorporates different therapies to benefit the patient. The nurse can assist the patient in identifying triggers or situations that may cause recurrent memories or flashbacks, developing coping mechanisms and methods to help reduce intrusive thoughts or memories, encouraging group participation and therapy, and discussing ways to desensitize the patient from the traumatic event (Substance Abuse and Mental Health Services Administration, 2024).

Something that should be taken into consideration when working with victims of domestic violence is that when a victim decides to leave their abuser, the domestic relations court in many states often does not recognize witnessing abuse as a form of abuse. Research shows the harmful impact witnessing abuse can have on children and their brain development. Family courts may force the victim to remain in contact with their abuser if they share children or allow them to maintain some form of parental rights, which can have devastating effects on victims attempting to get treatment for PTSD (APA, 2022).

Pharmacologic Treatment for Anxiety Disorders

The first-line pharmacotherapy for GAD, PD, and SAD is SSRIs whose mechanism of action is selective inhibition of serotonin reuptake. These medications are generally well tolerated, with a very low risk of dependency. Commonly prescribed SSRIs are fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), paroxetine (Paxil), and escitalopram (Lexapro). Potential side effects of SSRIs include but are not limited to nausea, vomiting, diarrhea, headache, dizziness, dry mouth, drowsiness, insomnia, agitation, anxiety, sexual dysfunction, sweating, appetite/weight changes, and restlessness. It is essential to discuss with patients that many side effects are transient and will resolve within weeks. Patient education should include the importance of not abruptly stopping medications as this may result in serotonin discontinuation syndrome. Abruptly discontinuing an SSRI may cause disequilibrium, nausea, increased agitation, headache, flu-like symptoms, insomnia, diarrhea, and an increased feeling of being dissatisfied with life (Hirsch & Birnbaum, 2025; Kopcalic et al., 2025).

The nurse should assess for signs and symptoms of serotonin syndrome, excess serotonin in the brain that can be life-threatening. Symptoms of serotonin syndrome include restlessness, high fever, sweating, tremors, lack of coordination, delirium, rigidity, rapid changes in blood pressure, tachycardia, coma, and possible death (Boyer, 2024; Edinoff et al., 2021). SNRIs are also considered a first-line pharmacologic treatment for GAD; they function by inhibiting the reuptake of both serotonin and norepinephrine. The SNRIs venlafaxine (Effexor) and duloxetine (Cymbalta) are both approved by the FDA and are effective for anxiety (Nelson, 2025).

Benzodiazepines may be used short-term and as adjuncts to SSRIs/SNRIs during the initial treatment or stabilization phase of GAD. However, they should be avoided in individuals with a history of SUD or alcohol dependence due to the high risk of misuse and dependence (DeGeorge et al., 2022). Tricyclic antidepressants (TCAs) are generally reserved for treatment-resistant cases of anxiety (Moraczewski et al., 2023).

For performance-related social anxiety, β-blockers such as propranolol (Inderal) 10–20 mg can be helpful when taken shortly before the anxiety-inducing event but are not effective for generalized SAD (Stein & Taylor, 2024).

PD is treated with SSRIs and SNRIs as the first-line drug choice; TCAs and monoamine oxidase inhibitors (MAOIs) are adequate but not favored for use (Guaiana et al., 2023).

First-line therapy for agoraphobia is SSRIs. SNRIs, TCAs, or benzodiazepines may be considered as alternatives (Balaram & Marwaha, 2024).

In the past, the TCA clomipramine (Anafranil) was used as the first-line therapy for OCD; however, because of the significant side effects, the SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) are now the first-line treatment for OCD. Venlafaxine (Effexor) is also used off-label for this indication.   (Swierkosz-Lenart et al., 2023).

Patients with PTSD may be prescribed SSRIs, particularly sertraline (Zoloft) and paroxetine (Paxil). Other medications that have been effective in treating PTSD are the off-label SNRI venlafaxine (Effexor), the atypical antipsychotic risperidone (Risperdal), and the anticonvulsant topiramate (Topamax). Prazosin (Minipress) may help decrease or eliminate the nightmares associated with PTSD (US Department of Veterans Affairs, 2025b).

Nursing Considerations for Anxiety Disorders

Nurses should be able to apply the nursing process by understanding the symptoms, disease process, contributing factors, and treatment options for anxiety disorders. Nurses must identify ways to assist patients with coping skills to manage increased anxiety, nervousness, and panic levels. Nurses should remain nonjudgmental, be culturally sensitive and open-minded, and establish a good rapport with the patient. Nurses should be able to educate patients on coping mechanisms and ways to reduce anxiety, such as decreasing caffeine intake, incorporating physical exercise, and practicing deep breathing exercises. The nurse needs to ask the patient if they feel tense, nervous, fluttering in their abdomen, or any panic. The nurse needs to assess the autonomic nervous system by obtaining vital signs and observing for diaphoresis, tremors, or dry mouth (Munir et al., 2022).

Other essential factors in patient-centered care include supporting patients, acknowledging their feelings, and communicating using simple language while calm. Providing a calm environment while actively listening to the patient is an effective nursing intervention. Incorporating nonpharmacologic methods into the patient’s plan of care, educating the patient on the specific techniques, and utilizing less invasive and restrictive methods to assist patients in the identification and care of their condition can dramatically reduce anxiety and facilitate successful coping mechanisms (Bradshaw et al., 2022).

The clinician and nurse must review all the patient’s medications, including over-the-counter and herbal supplements. Effects of prescribed and over-the-counter medications, such as corticosteroids and herbal supplements, can mimic symptoms of GAD (Alturaymi et al., 2023; Baldwin, 2025).

Patients with anxiety disorders may have coexisting depression. Nurses need to assess patient safety by asking about suicidal thoughts using open-ended and closed questions. Once safety is determined, nurses can educate patients on recognizing anxiety, including triggers. It is also essential for nurses to review coping strategies such as meditation skills and mindfulness. Resources for support groups, mobile applications, books, and YouTube videos that explain and demonstrate meditation skills and mindfulness techniques should be provided (Gregory & Hardy, 2021).

Future Research/Directions

GAD is a chronic disorder that can be debilitating. Approximately half of the patients treated for GAD fail initial treatment, resulting in treatment-resistant (or refractory) GAD. Treatment–refractory GAD is characterized as failure to respond to at least one trial of a first-line pharmacologic agent. Studies are currently being conducted to examine the effectiveness of new medications that may result in additional options for treating anxiety. However, these newer medications may not replace current treatments but may be used as adjuncts. Researchers have noted the lack of efficient development of better biomarkers (Fagan & Baldwin, 2023).

Future research should incorporate more brain imaging, pharmacogenomic, and other neurobiochemical advances to further the advancement of treatment. Research should also be directed toward identifying the causes of anxiety and panic attacks and ways to reduce and treat symptoms related to anxiety disorders. The use of positive psychological interventions to reduce anxiety should be investigated; nonpharmacologic methods can often dramatically improve patient outcomes more than certain medications, especially short-term medications. CBT remains the first-line psychological treatment for most anxiety disorders and is effective with short- and long-term treatment plans. Emerging treatments that have shown to be effective when augmented with CBT are exposure therapy with virtual reality, augmentation with mindfulness, and emotional regulation strategies. There will continue to be a constant influx of new techniques for treating mental health illnesses. Clinicians, nurses, and healthcare professionals should remain open-minded about new treatments. When patients express interest in new treatments (whether FDA-approved or off-label), we are responsible for educating them about the risks, benefits, and limitations and openly evaluating the appropriateness of treatment as it relates specifically to the patient’s symptoms (Merkouris et al., 2025; Ren et al., 2024).

Conclusion

Anxiety disorders include GAD, SAD, PD, separation anxiety disorder, selective mutism, phobias, PTSD, and OCD; these are the 6th leading cause of disability and the most common mental health disorder worldwide. Anxiety disorders are chronic and can impair an individual’s ability to function and overall quality of life. Evidence-based practice has proven psychopharmacology and psychotherapy effective in treating anxiety disorders. The effectiveness of treatment may vary depending on the severity of the symptoms, leading to treatment-resistant anxiety. Research has also shown additional therapies, such as meditation, mindfulness, and yoga, to treat anxiety effectively. It is crucial for clinicians and nursing staff to be familiar with the signs and symptoms of anxiety, as some can manifest physically. It is equally important to educate patients about the different treatment options, both pharmacologic and nonpharmacologic. Psychiatric care is centered on developing a therapeutic relationship between the patient and the care provider. It is essential for nurses and other healthcare professionals to care for patients with GAD calmly and positively, promoting positive nurse–patient interactions (Tadros et al., 2025; World Health Organization, 2023).

References

Alturaymi, M. A., Almadhi, O. F., Alageel, Y. S., Bin Dayel, M., Alsubayyil, M. S., & Alkhateeb, B. F. (2023). The association between prolonged use of oral corticosteroids and mental disorders: Do steroids have a role in developing mental disorders? Cureus, 15(4), e37627. https://doi.org/10.7759/cureus.37627

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.) (DSM-5-TR). https://doi.org/10.1176/appi.books.9780890425787

Armstrong, J., Kurth, M. J., Watt, J., Fitzgerald, P., & Ruddock, M. W. (2023). Post-traumatic stress disorder: Sleep disturbances and biomarkers. International Journal of Brain Disorders and Treatment, 9, 045. https://doi.org/10.23937/2469-5866/1410045

Balaram, K., & Marwaha, R. (2024). Agoraphobia. In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK554387/

Baldwin, D. (2025). Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate. Retrieved August 1, 2025, from https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis

Barbek, R., Lüdecke, D., & von dem Knesebeck, O. (2024). Intersectional inequalities in health anxiety: Multilevel analysis of individual heterogeneity and discriminatory accuracy in the SOMA.SOC study. Frontiers in Public Health, 12, 1388773. https://doi.org/10.3389/fpubh.2024.1388773

Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2023). Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature. Current Psychiatry Reports, 25(1), 19–30. https://doi.org/10.1007/s11920-022-01402-8

Bie, F., Yan, X., Xing, J., Wang, L., Xu, Y., Wang, G., Wang, Q., Guo, J., Qiao, J., & Rao, Z. (2024). Rising global burden of anxiety disorders among adolescents and young adults: Trends, risk factors, and the impact of socioeconomic disparities and COVID-19 from 1990 to 2021. Frontiers in Psychiatry, 15, 1489427. https://doi.org/10.3389/fpsyt.2024.1489427

Bowen, Z., Changlian, T., Qian, L., Wanrong, P., Huihui, Y., Zhaoxia, L., Feng, L., Jinyu, L., Xiongzhao, Z., & Mingtian, Z. (2021). Gray matter abnormalities of orbitofrontal cortex and striatum in drug-naïve adult patients with obsessive-compulsive disorder. Frontiers in Psychiatry, 12, 674568. https://doi.org/10.3389/fpsyt.2021.674568

Boyer, E. W. (2024). Serotonin syndrome (serotonin toxicity). UpToDate. Retrieved August 1, 2025, from https://www.uptodate.com/contents/serotonin-syndrome-serotonin-toxicity

Bradshaw, J., Siddiqui, N., Greenfield, D., & Sharma, A. (2022). Kindness, listening, and connection: Patient and clinician key requirements for emotional support in chronic and complex care. Journal of Patient Experience, 9. https://doi.org/10.1177/23743735221092627

Burback, L., Brémault-Phillips, S., Nijdam, M., McFarlane, A., & Vermetten, E. (2024). Treatment of posttraumatic stress disorder: A state-of-the-art review. Current Neuropharmacology, 22(4), 557–635. https://doi.org/10.2174/1570159X21666230428091433

Centers for Disease Control and Prevention. (2024). Symptoms of anxiety and depression among adults: United States, 2019 and 2022. https://www.cdc.gov/nchs/data/nhsr/nhsr213.pdf

DeGeorge, K. C., Grover, M., & Streeter, G. S. (2022). Generalized anxiety disorder and panic disorder in adults. American Family Physician, 106(2), 157–164. https://www.aafp.org/pubs/afp/issues/2022/0800/generalized-anxiety-disorder-panic-disorder.html

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038

Fagan, H. A., & Baldwin, D. S. (2023). Pharmacological treatment of generalised anxiety disorder: Current practice and future directions. Expert Review of Neurotherapeutics, 23(6), 535–548. https://doi.org/10.1080/14737175.2023.2211767

Gregory, A., & Hardy, L. (2021). Anxiety in primary care: A primer for APRNs. https://www.myamericannurse.com/anxiety-disorders-in-primary-care/

Guaiana, G., Meader, N., Barbui, C., Davies, S. J., Furukawa, T. A., Imai, H., Dias, S., Caldwell, D. M., Koesters, M., Tajika, A., Bighelli, I., Pompoli, A., Cipriani, A., Dawson, S., & Robertson, L. (2023). Pharmacological treatments in panic disorder in adults: A network meta-analysis. The Cochrane Database of Systematic Reviews, 11(11). https://doi.org/10.1002/14651858.CD012729.pub3

Hansen, J. Y., Shafiei, G., Markello, R. D., Smart, K., Cox, S. M. L., Nørgaard, M., Beliveau, V., Wu, Y., Gallezot, J.-D., Aumont, É., Servaes, S., Scala, S. G., DuBois, J. M., Wainstein, G., Bezgin, G., Funck, T., Schmitz, T. W., Spreng, R. N., Galovic, M., . . . Misic, B. (2022). Mapping neurotransmitter systems to the structural and functional organization of the human neocortex. Nature Neuroscience, 25(11), 1569–1581. https://doi.org/10.1038/s41593-022-01186-3

Hirsch, M., & Birnbaum, R. J. (2025). Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. UpToDate. Retrieved August 1, 2025, from https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitors-pharmacology-administration-and-side-effects

Kopcalic, K., Arcaro, J., Pinto, A., Ali, S., Barbui, C., Curatoli, C., Martin, J., & Guaiana, G. (2025). Antidepressants versus placebo for generalised anxiety disorder (GAD). Cochrane Database of Systematic Reviews (1). https://doi.org/10.1002/14651858.CD012942.pub2

Malivoire, B. L., Stewart, K. E., Cameron, D., Rowa, K., & McCabe, R. E. (2024). Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting. Behavioural and Cognitive Psychotherapy, 52(4), 440–455. https://doi.org/10.1017/S1352465823000632

Merkouris, E., Brasinika, A., Patsiavoura, M., Siniosoglou, C., Tsiptsios, D., Triantafyllis, A. S., Mueller, C., Mpikou, I., Samara, M. T., Christodoulou, N., & Tsamakis, K. (2025). Molecular basis of anxiety: A comprehensive review of 2014–2024 clinical and preclinical studies. International Journal of Molecular Sciences, 26(11), 5417. https://doi.org/10.3390/ijms26115417

Moraczewski, J., Awosika, A., & Aedma, K. (2023). Tricyclic antidepressants. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557791/

Munir, S., & Takov, V. (2022). Generalized anxiety disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441870/

Munir, S., Takov, V., & Coletti, V. (2022). Generalized anxiety disorder (nursing). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK568696

National Institute of Mental Health. (2025a). Any anxiety disorder among adults [Data tables]. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

National Institute of Mental Health. (2025b). Social anxiety disorder. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness

National Institute of Mental Health. (2025c). Panic disorder. https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms

Nelson, C. (2025). Serotonin–norepinephrine reuptake inhibitors: Pharmacology, administration, and side effects. UpToDate. Retrieved July 31, 2025, from https://www.uptodate.com/contents/serotonin-norepinephrine-reuptake-inhibitors-pharmacology-administration-and-side-effects

Nezgovorova, V., Reid, J., Fineberg, N. A., & Hollander, E. (2022). Optimizing first line treatments for adults with OCD. Comprehensive Psychiatry, 115. https://doi.org/10.1016/j.comppsych.2022.152305

Reid, J., Laws, K., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 106. https://doi.org/10.1016/j.comppsych.2021.152223

Ren, L., Fan, Y., Wu, W., Qian, Y., He, M., Li, X., Wang, Y., Yang, Y., Wen, X., Zhang, R., Li, C., Chen, X., & Hu, J. (2024). Anxiety disorders: Treatments, models, and circuitry mechanisms. European Journal of Pharmacology, 983. https://doi.org/10.1016/j.ejphar.2024.176994

Roh, D., Jang, K. W., & Kim, C. H. (2023). Clinical advances in treatment strategies for obsessive-compulsive disorder in adults. Clinical Psychopharmacology and Neuroscience, 21(4), 676–685. https://doi.org/10.9758/cpn.23.1075

Stein, M., & Taylor, C. (2024). Social anxiety disorder in adults: Treatment overview. UpToDate. Retrieved August 1, 2025, from https://www.uptodate.com/contents/social-anxiety-disorder-in-adults-treatment-overview

Stein, M., & Norman, S. (2025). Posttraumatic stress disorder in adults: Psychotherapy and psychosocial intervention. UpToDate. Retrieved June 26, 2025, from https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-psychotherapy-and-psychosocial-interventions

Storch, E. A., & Goodman, W. K. (2023). Obsessive compulsive and related disorders. Psychiatric Clinics, 46(1), xiii–xv. https://doi.org/10.1016/j.psc.2022.11.006

Strom, N. I., Burton, C. L., Iyegbe, C., Silzer, T., Antonyan, L., Pool, R., Lemire, M., Crowley, J. J., Hottenga, J.-J., Ivanov, V. Z., Larsson, H., Lichtenstein, P., Magnusson, P., Rück, C., Schachar, R., Wu, H. M., Cath, D., Crosbie, J., Mataix-Cols, D., . . . Arnold, P. D. (2024). Genome-wide association study of obsessive-compulsive symptoms including 33,943 individuals from the general population. Molecular Psychiatry, 29(9), 2714–2723. https://doi.org/10.1038/s41380-024-02489-6

Substance Abuse and Mental Health Services Administration. (2024). Trauma informed approaches and programs. https://www.samhsa.gov/mental-health/trauma-violence/trauma-informed-approaches-programs

Swierkosz-Lenart, K., Dos Santos, J. F. A., Elowe, J., Clair, A. H., Bally, J. F., Riquier, F., Bloch, J., Draganski, B., Clerc, M. T., Pozuelo Moyano, B., von Gunten, A., & Mallet, L. (2023). Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1065812

Tadros, E., Keerthana, S., Padder, S., Totlani, J., Hirsch, D., Kaidbay, D. N., Contreras, L., Naqvi, A., Miles, S., Mercado, K., Meyer, A., Renteria, S., Pechnick, R. N., Danovitch, I., & IsHak, W. W. (2025). Anxiety disorders, PTSD and OCD: Systematic review of approved psychiatric medications (2008–2024) and pipeline phase III medications. Drugs in Context, 14. https://doi.org/10.7573/dic.2024-11-2

US Department of Veterans Affairs. (2025a). National center for PTSD: Assessment. https://www.ptsd.va.gov/professional/assessment/index.asp

US Department of Veterans Affairs. (2025b). National center for PTSD: Clinicians guide to medications for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/clinician_guide_meds.asp

US Preventive Services Task Force. (2022). Anxiety disorders in children and adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents

US Preventive Services Task Force. (2023). Anxiety disorders in adults: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening

Wang, M., Cao, L., Li, H., Xiao, H., Ma, Y., Liu, S., Zhu, H., Yuan, M., Qiu, C., & Huang, X. (2021). Dysfunction of resting-state functional connectivity of amygdala subregions in drug-naïve patients with generalized anxiety disorder. Frontiers in Psychiatry, 12, 758978. https://doi.org/10.3389/fpsyt.2021.758978

World Health Organization. (2023). Anxiety disorders. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders

Wright, S. L., Karyotaki, E., Cuijpers, P., Bisson, J., Papola, D., Witteveen, A., Suliman, S., Spies, G., Ahmadi, K., Capezzani, L., Carletto, S., Karatzias, T., Kullack, C., Laugharne, J., Lee, C. W., Nijdam, M. J., Olff, M., Ostacoli, L., Seedat, S., & Sijbrandij, M. (2024). EMDR v. other psychological therapies for PTSD: A systematic review and individual participant data meta-analysis. Psychological Medicine, 54(8), 1580–1588. https://doi.org/10.1017/S0033291723003446

Powered by Froala Editor