Anxiety is a thing we feel in our bodies.  It FEELS physical in nature.  Anxiety DISORDERS, however, are cognitive in nature.  They are not physical or body problems, despite the fact that anxiety is a thing we experience physically.  The distinction is important.  Understanding this is one of the keys to getting on the path to true and lasting recovery from your anxiety disorder.

You know what a panic attack feels like, and what anxiety feels like. We don’t really need to go over every panic symptom. But you do need to understand that there is a physical basis for all of it, be it general anxiety or full blown panic. There are specific biological processes  driving what you feel and what you think while in an anxious state. In every sense of the word, anxiety and panic are physical events.  We experience anxiety physically. I do not dispute this, nor would many others.

An anxiety disorder, on the other hand, is mental or cognitive in nature. A person may feel anxious every day, and might even panic on a regular basis,  without ever developing an anxiety disorder (i.e. panic disorder, agoraphobia, OCD, etc.). So, being anxious really isn’t the issue. It’s the cognitive reaction to that physical state that creates so many problems for so many people.  Your first panic attack is terrifying, but the attack itself isn’t what sends you into that downward spiral. The spiral is started by how you interpret your panic and anxiety symptoms, and how you react to them. Once you begin to worry about your anxiety, once you begin anticipating it and fearing the next attack, and most of all once you begin engineering your life to avoid those uncomfortable sensations, thoughts and situations, that’s when the wheels really start to fall off and you get into trouble.  That extreme avoidance reaction is what drives the progression from anxiety to anxiety disorder.

There are two cognitive processes that come into play.


It’s natural and common to initially interpret anxiety symptoms as dangerous and threatening, especially when they first surface. You experience intense, frightening sensations in your body, and these are accompanied by frightful thoughts about impending doom, certain death, or other serious incapacitation or disastrous outcome.  While there is actually no danger present – no actual threat to respond to – you interpret the sensations and thoughts themselves as dangerous.  You declare panic and anxiety to be nightmares that you hope to never revisit.

Fear and Avoidance

Your interpretation of anxiety and panic as dangerous drives the second important cognitive process – fear and avoidance.  You may find that significant amount of your time and energy is spent worrying about anxiety, thinking about it, and anticipating the next attack. In the worst case, lifestyle changes are made in an effort to avoid the places or situations that might trigger anxiety symptoms. Some people struggle to get out of the house and go to work. They might even quit their jobs. Students might drop out of school. Many people begin to avoid regular daily tasks like grocery shopping, or social events like going out to the movies or out to eat with friends. Focus turns inward at an extreme level, and there’s frequent or even constant scanning and checking of bodily sensations and thoughts. These people are always vigilant and braced for that next wave of anxiety. In the most severe cases, agoraphobia develops.  This can lead one to become stuck in the house or even in one room of the house.  When avoidance is left unchecked, life gets smaller and smaller as the fear of experiencing panic and anxiety drives one to eliminate one place, task or situation after another, leaving very little in the resulting “safe zone”.

So how do we know that anxiety disorders like panic disorder and agoraphobia are cognitive problems – not body problems?  The varying experiences of people that experience panic and anxiety illustrate this for us.

  1. Many people will experience panic attacks at least once or twice in their lives.  In most cases, a person experiences panic as an extremely unpleasant and frightening experience, but it remains simply an experience to them.  Not one they enjoy, but also not one they declare a total disaster that must never be repeated.  These people do not interpret panic or anxiety themselves as dangerous.  They do not develop anxiety disorders.
  2. Others will interpret panic or anxiety as dangerous, and will being going down the road of avoidance and fear.  This may last for days, or weeks, or even months. But for this group, the repeated experience of panic or anxiety with no actual disastrous outcome (other than being afraid) teaches them that while unpleasant, anxiety and panic are not to be feared.  They begin to change their interpretation or panic and anxiety, which then lessens the fear drive avoidance.  A life that was getting smaller begins to return to “normal”.
  3. A third group – regardless of how often they experience panic and anxiety with no actual harm done – continues to cling to the “danger interpretation”.  Logically, they can see this error, but they are powerless to correct it.  Fear and avoidance become the primary drivers of almost everything, and life continues to get smaller and smaller.  This group, unfortunately, develops full blown anxiety disorders that can dominate their lives.

Can you see that there is a common link between these three groups?  There is actually a common shared experience. That common link is the anxiety and panic themselves. The very same physical experience of anxiety and panic can lead down three very different paths. Same symptoms, same thoughts, but different interpretations and ability to change those interpretations based on actual experience. Shared common physical experience, vastly different cognitive/mental experiences.

Now do you understand why I say that anxiety is physical, but anxiety disorders are cogntive?

Understanding this concept and incorporating it into your approach to anxiety is an important step toward improvement.  If you’re still struggling with anxiety and panic, if you’re stuck in your house or afraid to venture out without your safe person, take heart.  The problem isn’t that your body is broken or defective.  The problem is that you’ve inadvertently created these learned avoidance and safety behaviors. Your anxiety disorder has trapped you in a cage that you have unintentionally created with your own thoughts and actions. You’ve accidentally learned to live the life that you’re living today.

The good news is that you can un-learn those things, and once you do, everything can change. We’ll talk about how this happens in future episodes.

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Podcast Intro/Outro Music: "Afterglow" by Ben Drake (With Permission)



Intro/Ending Music Credit: Title Autumn Day (Kevin MacLeod – incompetech.com) Licensed under Creative Commons: By Attribution 3.0 



Founder and host of The Anxious Truth podcast. Graduate student and therapist-in-training. Author and educator on the topic of anxiety disorders and anxiety recovery. Former anxious and depressed person.