Is Your Shortness of Breath Anxiety or Something More Serious?

Unpacking Anxiety Symptoms and What Can Help

• Anxiety and Fight-or-Flight|
• Common Symptoms of Anxiety|
• Is Your Shortness of Breath Anxiety?|
• Tips and Techniques for Anxiety|
• Know Your Power|

It’s understandable that there are a lot of reasons to be anxious these days, especially given the impact of the COVID-19 pandemic. You may be noticing that you and/or those around you have a heightened sense of anxiety or feelings of impending doom. You’re not alone in this. The World Health Organization (WHO) found that the “global prevalence of anxiety and depression increased by a massive 25%” as a result of the pandemic.

Shortness of breath, or dyspnea, is one of many potential symptoms of anxiety. It often coincides with rapid breathing, hyperventilation, rapid heart rate, chest pain/chest tightness, dizziness, and lightheadedness [1]. Knowing the difference between anxiety-related shortness of breath and something potentially more serious is really important for your physical and mental health. Shortness of breath may not only be a symptom of anxiety, but it could be the cause, especially considering that a key feature of the novel coronavirus is shortness of breath.

To better help you understand shortness of breath anxiety vs. other breathing problems, let’s look more closely at anxiety as a whole, potential symptoms, and which techniques might help you regain your breath, and ultimately, your calm.

Anxiety and Fight-or-Flight

To experience anxiety is to experience the fight-or-flight response, even if you haven’t had the words for it until right now. Under the influence of anxiety, your brain and body react by engaging your autonomic nervous system to get you through it. Part of your autonomic nervous system is the sympathetic nervous system, which manages your survival instincts and stress response [1].

This system is meant to help you stay alive in potentially threatening situations. Your brain sends a signal to your lungs to take in more oxygen. The oxygen is then sent to all the muscles in your limbs so you can move quickly to escape — in the event that “flight” is the right response — or spring into action to defend — in the event that “fight” is the right move [2].

Breath becomes shallow, you may experience chest pains or the feeling that you can’t get enough air, you become hypervigilant and fearful, your heart rate increases, and you may begin sweating [1]. These are all standard, healthy responses to a genuine threat (and also common symptoms of an anxiety attack). In the case of anxiety, however, the threat is almost never life-and-death, even if you perceive your fears to be rational ones. Unfortunately, having trouble breathing as a result of anxiety can exacerbate the anxiety, creating a vicious circle that may, in some cases, lead to a panic attack.

Situational anxiety is normal, healthy, and generally resolves on its own. But in the case of a clinical anxiety disorder, it may be hard to interrupt this cascade of the stress response, breathe normally, and come back to a state in which your nervous system can relax, and you can go about the rest of your life. We’ll go over some tools to help mitigate this cycle later in this article.

Common Symptoms of Anxiety

Anxiety and its effects range widely from person to person. Levels of severity can also vary. You may be diagnosed with generalized anxiety disorder (GAD) and panic disorder, in addition to a number of other forms of specific anxiety, such as social anxiety disorder, specific phobias, and separation anxiety [1]. Also, it’s worth keeping in mind that just because you experience anxiety sometimes doesn’t necessarily mean that you have an anxiety disorder.

Regardless of whether or not you have a diagnosis, any of the symptoms of anxiety we’ll outline may apply, especially in an acutely stressful situation.

Symptoms of anxiety can be cognitive, physical, emotional, or behavioral. They can range even within one person from day to day, and many are associated with a variety of anxiety disorders.

Symptoms may include:

• Cognitive Symptoms [1]
  • Fear of losing control, physical injury, death, going crazy, or negative judgment from others
  • Frightening thoughts, mental images, or memories
  • Derealization (perception that your surroundings aren’t real) or depersonalization (feeling that your thoughts and feelings don’t belong to you; loss of identity)
  • Poor concentration, confusion, distractibility
  • Narrowed attention, hypervigilance
  • Poor memory
  • Difficulty speaking
• Physical Symptoms [1]
  • Rapid heart rate or palpitations
  • Breathlessness or rapid breathing patterns
  • Chest pain or chest tightness
  • Sensation of choking
  • Shortness of breath (dyspnea) not related to effort, lung function diseases (like chronic obstructive pulmonary disease/COPD or lung cancer), or occasional sighs/yawns to fill the lungs [3]
  • Dizziness or lightheadedness
  • Sweating, hot flashes, or chills
  • Nausea, stomachache (or stomach cramps), or diarrhea
  • Trembling or shaking
  • Tingling or numbness in the arms and legs
  • Weakness, unsteadiness, or faintness
  • Muscle tension or feeling generally rigid
  • Dry mouth
• Behavioral Symptoms [1]
  • Avoiding real or imagined threats
  • Escapism or flight
  • Seeking safety and reassurance
  • Restlessness, agitation, or pacing
  • Hyperventilation (super-fast breathing — aka overbreathing — that causes you to lose too much carbon dioxide and become lightheaded and dizzy)
  • Freezing or motionlessness
  • Trouble speaking
• Emotional Symptoms [1]
  • Feeling nervous, tense, or wound up
  • Feeling frightened, fearful, or terrified
  • Feeling edgy, jumpy, jittery
  • Feeling impatient or frustrated

Nearly every form of anxiety disorder can manifest these symptoms, but it’s helpful to get a diagnosis for the particular form of anxiety you may be dealing with. It’s also helpful to know whether an underlying medical condition like sleep apnea, high blood pressure, chronic stress, chronic pain, or medications you may be taking could be causing or exacerbating your anxiety [1, 4, 5].

This isn’t to say that if you have one of these health conditions you’re doomed to have anxiety. But understanding both external and internal factors that may be affecting your mental health will give you the best chance of feeling better. It’s always good to see the big picture when making decisions about your mental health.

Is Your Shortness of Breath Anxiety?

Another really critical reason to have the big picture of your health in focus is to be able to tell the difference between anxiety-related shortness of breath and something potentially more serious or life-threatening, such as heart failure or lung disease. In addition to these two potential risks, the Mayo Clinic lists some of common or potential causes of shortness of breath as:

• COPD
• Asthma
• Heart attack
• Lung cancer
• Pulmonary hypertension
• Pulmonary edema
• Pulmonary embolism
• Pneumonia
• Choking or other airway constriction

Additionally, as we mentioned at the beginning, difficulty breathing and chest tightness are also symptoms of COVID-19, which creates all sorts of additional anxiety and can lead to a vicious cycle of shortness of breath anxiety, even if you haven’t tested positive.

Importantly, the length of time you’re feeling short of breath is a good indicator of whether or not you’re experiencing anxiety. Panic attacks and episodes of shortness of breath anxiety should never last longer than 30 minutes, while a more serious issue is more likely to persist.

Tips and Techniques for Anxiety-Related Shortness of Breath

The following techniques and strategies can help prevent or improve shortness of breath and other symptoms of anxiety.

Relaxation Techniques and Breathing Exercises

Relaxation techniques and diaphragmatic breathing techniques, especially when incorporated into more comprehensive psychotherapies such as cognitive behavioral therapy (CBT), are potential options to help you break the cycle of anxiety — or, at the very least, allow you to cope more effectively [6, 7]. Anxiety medications such as benzodiazepines can also be helpful for acute situations, but can be habit-forming if relied upon.

Cognitive Behavioral Therapy (CBT)

CBT has been studied extensively as a potential treatment for anxiety with results that include reducing symptoms of panic disorder, depression, and agoraphobia, in addition to improving quality of life overall for participants [8]. This type of improvement is possible with both in-person therapies and virtual/video conferencing/internet-based CBT [9].

Virtual Reality Exposure Therapy (VRET)

A type of exposure therapy (a technique that safely exposes a patient to their trigger in order to desensitize them to it over time) called Virtual Reality Exposure Therapy (VRET) was also shown to be an effective treatment for anxiety disorders, including panic disorder [10]. In this therapy, the patient wears a VR headset and is virtually exposed to potential triggers in a safe, clinical environment.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR), a type of therapy that allows the patient to recall a traumatizing experience while practicing specifically prescribed side-to-side eye movements or body tapping, has also had tremendous success with anxiety clinically. In a systematic review of 17 randomized controlled trials in 2020, researchers found that EMDR improved general anxiety, panic, phobia, and behavioral/somatic symptoms [11].

Address Your Gut Health to Improve Anxiety

The gut-brain axis is a well-studied topic in both functional medicine and the larger medical community as a whole [12]. Research supports the notion that improving gut health through diet and probiotics could positively impact mental health and well-being [13, 14].

Positive dietary changes may include temporarily eating a low FODMAP diet or vegetarian diet, adding in daily probiotics, and adding more fruit into the diet (especially for teens) [15, 16, 17].

Probiotics specifically have been studied for their potential impact on anxiety and depression and have performed well in a number of randomized controlled trials. In one 2021 study, adults taking probiotics for eight weeks showed significant improvements in depressive symptoms, anxiety, and sleep quality [18]. Other studies have demonstrated that taking probiotics can alleviate depression, anger, hostility, and anxiety, while also decreasing stress-hormone levels [19, 20].

Know Your Power

Unmitigated anxiety can be crippling, especially over the long-term. It can affect your sleep, your sense of well-being, and your ability to focus and communicate effectively.

Shortness of breath is one of many potential symptoms of anxiety that can exacerbate your overall anxiety. Having the full picture of your health can help your doctor best ascertain whether your breathing difficulties are a result of anxiety or something more dangerous, such as a heart or lung condition. This isn’t to say that chronic anxiety is harmless; it does have extensive negative effects on your well-being and should not be ignored.

By employing the right therapies, such as CBT or EMDR, and improving your gut health through diet and probiotics, you can begin to improve your mental health and find some relief from your anxiety. Slowing down, taking deep breaths, and learning CBT-based breathing exercises can help slow down your sympathetic nervous system and bring you calm. If you’re looking for help in this area, we’d love to hear from you. Reach out to our clinic at the Ruscio Institute for Functional Medicine to set up an appointment.

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