Anxiety: Symptoms, Physical Effects, and How to Manage It
Are you struggling with anxiety? You're not alone. Anxiety affects millions of people worldwide, and it can be a debilitating condition that impacts all aspects of your life — often in ways that aren't obvious at first. Many people experience real, sometimes alarming physical symptoms for months or years before connecting them to anxiety at all.
The good news: anxiety is highly treatable, and understanding what's happening in your body and mind is often the first step toward feeling better.
Types of Anxiety Disorders
Anxiety isn't a single, uniform experience. It shows up differently from person to person, and recognising which pattern fits you can help guide what kind of support is most useful.
Excessive, chronic, hard-to-control worry about everyday things (work, money, health, chores), often lasting months. Chronic body tension.
Recurrent, unexpected panic attacks — sudden intense fear with severe physical symptoms (pounding heart, chest pain, dizziness, sense of doom).
Intense fear of being watched, judged, rejected, or humiliated in social or performance situations. Leads to avoidance.
Excessive, persistent fear triggered by a specific object or situation (heights, spiders, flying, injections), leading to avoidance.
Intense fear and avoidance of places or situations where escape might be difficult or help unavailable (crowds, transport, open spaces).
Excessive fear or worry about being separated from people with whom one has a deep emotional attachment.
The Physical Symptoms of Anxiety
Many clients seek help for physical symptoms without ever connecting them to their underlying anxiety. The body's "fight, flight, or freeze" response is primitive and powerful, and when it's constantly triggered by worry, it can manifest in diverse ways that truly mimic medical conditions.
Below is an extended list of physical symptoms of anxiety, organised by body system — including some less commonly attributed to mental health.
Head & Sensory System
| Symptom | Description | Why Anxiety Causes It |
|---|---|---|
| Tension Headaches/Migraines | Persistent, dull ache or pressure (like a band around the head). | Chronic muscle tension in the neck, jaw, and shoulders due to hyperarousal. |
| Tinnitus | Ringing, buzzing, or whistling sounds in the ears. | May be due to muscle tension affecting the inner ear or heightened sensory perception. |
| Dizziness or Vertigo | Feeling faint, lightheaded, wobbly, or a spinning sensation. | Hyperventilation reduces CO₂ in the blood, leading to cerebral vasoconstriction. |
| Jaw Pain (Bruxism) | Clenched jaw, teeth grinding, pain mimicking TMJ disorder. | Unconscious tension and bracing of the jaw muscles. |
| Blurred/Tunnel Vision | Visual disturbances, "floaters," restricted field of vision. | Pupil dilation and blood flow changes as part of fight-or-flight. |
| Brain Fog | Difficulty concentrating, poor memory, mental sluggishness. | High cortisol and constant hypervigilance divert resources from cognition. |
Chest & Cardiovascular System
| Symptom | Description | Why Anxiety Causes It |
|---|---|---|
| Chest Pain/Pressure | A sharp, aching, or crushing feeling that can mimic a heart attack. | Muscle tension around the rib cage and esophagus, often with palpitations. |
| Shortness of Breath | Feeling like you can't get a satisfying breath, sighing, yawning. | Habitual shallow, rapid breathing throws off the O₂/CO₂ balance. |
| Palpitations/Skipped Beats | A noticeable fluttering, pounding, or racing of the heart. | Adrenaline floods the system, increasing heart rate and force. |
| Cold, Clammy Extremities | Hands and feet feeling unusually cold, sweaty, or numb. | Blood vessels constrict to shunt blood to core muscles. |
Gastrointestinal (GI) System
| Symptom | Description | Why Anxiety Causes It |
|---|---|---|
| Chronic Nausea or Vomiting | Persistent queasiness or sudden vomiting spells. | The gut connects to the brain via the enteric nervous system; stress hormones disrupt it. |
| IBS Symptoms | Alternating diarrhea, constipation, bloating, gas, cramping. | Stress hormones alter gut motility and increase pain sensitivity. |
| Difficulty Swallowing | A sensation of a "lump in the throat" or tight band around the neck. | Tension in throat and neck muscles used for swallowing. |
| Acid Reflux/Heartburn | Stomach acid backing up into the esophagus. | Increased stomach acid and relaxation of the esophageal sphincter due to stress. |
Musculoskeletal & Systemic
| Symptom | Description | Why Anxiety Causes It |
|---|---|---|
| Chronic Muscle Aches/Stiffness | Persistent pain in neck, shoulders, lower back — often mistaken for poor posture. | Muscles remain perpetually tensed and braced, leading to fatigue and inflammation. |
| Tremors or Shaking | Visible trembling or internal vibration, especially when resting. | Stress hormones overstimulate the nervous system and muscles. |
| Paresthesia | Pins and needles, tingling, or numbness in hands, feet, face, or lips. | Related to hyperventilation and resulting blood gas imbalance. |
| Fatigue/Exhaustion | Feeling perpetually drained, despite adequate sleep. | Constant hyperarousal is physically and mentally exhausting. |
| Unexplained Skin Issues | Itching, hives, rashes, or flare-ups of eczema/psoriasis. | The stress response releases inflammatory chemicals that irritate the skin. |
Sleep & Other
| Symptom | Description | Why Anxiety Causes It |
|---|---|---|
| Insomnia | Difficulty falling asleep, staying asleep, or waking unrefreshed. | The brain is too stimulated for the nervous system to settle. |
| Frequent Urination | Feeling the urge to urinate more often than normal. | Activation of the autonomic nervous system can stimulate the bladder. |
| Hot Flashes or Chills | Sudden, intense heat and sweating or extreme coldness. | Thermoregulation is disrupted by surges of adrenaline and cortisol. |
Self-Awareness Checklist: Recognising Your Anxiety Levels
The list below consists of common manifestations of anxiety, organised by intensity level. Some of these symptoms might also be caused by other health-related issues, so it's worth discussing persistent symptoms with a doctor as well.
It is normal to have some level of anxiety (the lower end) when excited or talking about emotional issues. This practice aims to help you become more aware of your own signs of anxiety — and, as a result, to regulate it better. Only with well-regulated anxiety is it possible to fully experience emotions and address emotional issues.
| Level | Manifestations & Symptoms |
|---|---|
| Low | Somatomotor manifestations: muscles of the hand (moving of the thumb), the mouth (rabbit-like movement), forearm (clenching the fist), tension in the upper arm, shoulders, neck, tension in the muscles of the face |
| Medium | Clenched jaws, tension in the vocal cords, tension in the intercostal muscles (frequent sighs), tension in the belly, tension in the lower muscles of the back, legs (tension or restless legs), tension from head to toe |
| High | Sympathetic reactions: dry mouth and throat, dry eyes, vaginal dryness, sweating in armpits, sweating of the palms, cold hands, blushing, acceleration of heart rate and force, shivering |
| Very High | Parasympathetic reactions: light-headedness, dizziness, fainting, constipation, diarrhea, urge to urinate, nausea, over-secretion of digestive hydrochloric acid, wobbly legs, weepiness. Cognitive/perceptual disturbances: incoherent, delayed, or accelerated thought processes; disorientation around time/place/persons; disturbances in perception (visual/auditory acuity, tunnel vision, tinnitus, hallucinations, dissociation) |
How to Manage Physical Symptoms of Anxiety
Physical symptoms of anxiety can be very debilitating. Psychotherapy can certainly help by working on the underlying issues that drive anxiety, but there are also things you can do on your own. Reducing anxiety is possible — though it requires that you take yourself seriously and take action.
The reason many people suffer from chronic anxiety is often self-neglect — they ignore their anxiety instead of trying to regulate it. Imagine consistently having a fever and never doing anything about it. There's a high chance you would get worse and worse. The same principle applies to anxiety.
Jacobson Progressive Muscle Relaxation: Why It Works
Jacobson progressive muscle relaxation (PMR) is one of the most well-researched, evidence-based tools for anxiety — and one of the few that works across all three levels of the anxiety pathway described above. Most clients who practice it consistently for at least 21 days report a significant reduction in symptoms.
How it works: PMR was developed by physician Edmund Jacobson in the 1920s, based on a simple but powerful observation: muscle tension and anxiety are directly linked, and learning to recognise and release physical tension can interrupt the anxiety cycle itself. The method involves deliberately tensing a muscle group for a few seconds, then abruptly releasing it — working systematically through the body. This contrast between tension and release teaches your nervous system what "letting go" actually feels like, often for the first time, since chronic anxiety tends to make low-grade muscle tension feel "normal" and invisible.
Why it works at every level:
– Level 1 (somatomotor): PMR directly targets the muscles where this level of anxiety lives — hands, jaw, shoulders, back, legs — by teaching the body a new default of release rather than bracing.
– Level 2 (autonomic): Releasing chronic muscle tension helps shift the nervous system from sympathetic ("accelerator") dominance toward parasympathetic ("brake") activation — the same vagus nerve pathway involved in slow exhalation. According to polyvagal theory, this shift moves the body from a threat-response state toward one that supports calm and social engagement, which can ease palpitations, sweating, and digestive symptoms.6
– Level 3 (cognitive-perceptual): By bringing overall arousal down, PMR can help restore the sense of groundedness and clarity that gets lost when anxiety reaches dissociation, brain fog, or racing thoughts — making it easier to think clearly and stay present.
What the Research Says
PMR is one of the most studied relaxation techniques in clinical psychology. A systematic review identified 21 separate studies supporting its effectiveness for anxiety, and 24 studies supporting its effectiveness for stress more broadly, either used alone or combined with other interventions.1 Reviews focused specifically on anxiety disorders have found abbreviated versions of Jacobson's original protocol to be effective for both generalized anxiety disorder (GAD) and panic disorder.2
One meta-analysis of psychotherapies for late-life anxiety found that PMR produced the largest reductions in anxiety symptoms compared with waitlist controls, supportive therapy, and other established approaches including cognitive behavioural therapy.3 More recent studies have also found PMR effective for improving sleep quality and reducing fatigue — including in high-stress groups such as nurses and people experiencing sleep disturbances.4 Research on its neurochemical basis suggests that regular practice may influence neurotransmitter systems involved in anxiety regulation, including GABA and serotonin pathways, which provides a biological explanation for why a primarily physical technique can have such a noticeable effect on mood and worry.5
Practicing PMR: Online or In-Person
One of the practical advantages of PMR is that it doesn't require any special equipment, a clinical setting, or even much space — which makes it equally suited to online and in-person therapy.
– Online: PMR can be guided over video call just as effectively as in person, since the therapist's voice and pacing are what matter most, not physical proximity. It also works well as a self-guided daily practice using a recording or app between sessions — try our Jakobson Training tool or this guided session.
– In-person: In the therapy room, PMR can be combined with real-time observation — a therapist can notice where you're holding tension that you might not be aware of, which can be useful information in itself, particularly within body-focused approaches like ISTDP.
Other Ways to Manage Symptoms
Breathing exercises. Even 5 minutes of intentional breathing helps: inhale slowly through your nose, exhale slowly through your mouth. Slower exhalation activates your parasympathetic nervous system via the vagus nerve.
Exercise regularly. Regular movement reduces stress and anxiety — exercise releases endorphins, natural mood-boosters that help alleviate symptoms. If motivation is hard, try short online classes (FitON is a good free option).
Decrease stimulants and improve sleep. Consider what caffeine, alcohol, nicotine, and poor sleep do to an already overstimulated body. If your use is well-established, think about reducing it — and prioritise restorative sleep.
Seek professional help. If you're experiencing chronic or severe anxiety symptoms, it's important to seek professional help. Chronic anxiety is a serious condition that should not be ignored.
How Therapy Helps
Treatment for anxiety is always different for each client. Why? Anxiety is a symptom, but the underlying cause can vary a lot. Think of anxiety as a fever: it tells us that something is happening inside of you, but there can be many different reasons for the fever — infection, inflammation, or something else entirely.
In therapy, we work to find the root causes. While doing this, we also help ease the symptoms with practical tools — like breathing exercises or cognitive restructuring. These tools are a bit like ibuprofen: they don't treat the underlying cause itself, but they can ease the discomfort and bring the "fever" down while the real work happens underneath.
Approaches like ISTDP are particularly effective for anxiety rooted in unconscious emotional conflict — where feelings that haven't been fully processed get converted into physical tension, worry, or somatic symptoms. A meta-analysis of ISTDP outcome research found large treatment effects for anxiety disorders, with improvements maintained at long-term follow-up.7
Get Support
If anxiety has been affecting your life and you'd like support working through it, online therapy is available with English-speaking therapists experienced in anxiety, ISTDP, and related approaches. You can also read more about couples therapy if anxiety is affecting your relationship, or learn more about our therapists and their backgrounds.
References
1. Khir, S. M., et al. (2024). Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychology Research and Behavior Management, 17, 345–359.
2. Conrad, A., & Roth, W. T. (2007). Muscle relaxation therapy for anxiety disorders: It works but how? Journal of Anxiety Disorders, 21(3), 243–264.
3. Thorp, S. R., et al. (2009). Meta-analysis of late-life anxiety psychotherapies, finding Progressive Muscle Relaxation produced the largest reductions in anxiety compared with waitlist controls, supportive therapy, and cognitive behavioural therapy.
4. Recent clinical studies on Progressive Muscle Relaxation for sleep quality and fatigue reduction in high-stress populations.
5. Research on the neurochemical basis of Progressive Muscle Relaxation, including effects on GABA and serotonin pathways involved in anxiety regulation.
6. Porges, S. W. (1995, 2022). Polyvagal Theory — a framework describing how the vagus nerve and autonomic nervous system regulate states of safety, threat (sympathetic "fight or flight"), and shutdown (parasympathetic), and how breathing and body-based techniques can help shift the nervous system toward a calmer, more regulated state.
7. Abbass, A., Town, J., & Driessen, E. (2012). Intensive Short-Term Dynamic Psychotherapy: A systematic review and meta-analysis of outcome research, finding large effects for ISTDP in the treatment of anxiety disorders, with gains maintained at long-term follow-up.
This article was written by Sylwia Latacz, psychologist and EFT couples therapist at Psychotherapy Lisbon. Read more about Sylwia and the rest of the team.
