Anxiety responds to therapy, medicine and exercise, and some calming herbs carry real risks

Key takeaways

• In a national survey run in 2001–2003, 19.1% of U.S. adults had an anxiety disorder in the past year, and only 11% of adults with one started treatment within a year of onset²⁶.
• In a 2015 Cochrane review of 30 trials, therapist-guided online cognitive behavioral therapy beat waiting lists and showed no significant difference from in-person therapy⁷.
• Big doses of caffeine set off panic attacks in about half of people with panic disorder in lab studies, but a 2025 trial of a smaller dose produced just one attack among 82 people¹.
• Lavender oil capsules, chamomile and L-theanine have promising but early evidence, while kava products were possibly linked to 11 liver transplants in a 2002 CDC report^1011121314.
• Crushing chest pain or pain that spreads to your jaw or arm means call 911, and thoughts of suicide mean call or text 988³¹⁵.

Researchers have tested what caffeine does to people with panic disorder by giving them a big dose and watching closely. Pooled together, those placebo-controlled experiments tell a striking story. At roughly 400 to 750 milligrams, which the researchers equate to four or five cups of coffee, about half of people with panic disorder had a panic attack. Only about 2% of people without the disorder did¹.

In 2025, a team at Uppsala University in Sweden tried a more ordinary amount¹. Their volunteers were 29 adults with panic disorder and 53 healthy adults, all light caffeine users. Each swallowed a 150-milligram caffeine capsule on one visit and an identical dummy capsule on another. Neither they nor the staff knew which was which¹.

Only one panic attack happened in the whole study. Caffeine didn’t raise how anxious people said they felt¹. It did nudge their bodies, raising a skin measure of arousal. It also made both groups more willing to give up points to avoid unpleasant pictures and sounds¹.

The trial was small, and about 7 in 10 volunteers were women¹. The authors concluded that telling people with panic disorder to quit caffeine should rest on higher doses and, ideally, on an individual assessment¹. Swedish research foundations paid for the trial, and the authors reported no conflicts of interest¹.

That trial captures the shape of good anxiety care. What you eat, drink and do matters, but the details matter more than blanket rules.

Anxiety disorders are common, and effective treatments exist³⁴. This is a map of what works, from daily habits to therapy and medicine, how calming herbs compare, and when worry needs a professional.

Worry is normal, but a disorder is fear that won’t stand down

Everyone worries about money, health or family. The U.S. Preventive Services Task Force (USPSTF) describes anxiety disorders as steady fear about ordinary life that is far bigger than the situation calls for⁶. The main types include generalized anxiety disorder, panic disorder, social anxiety disorder, agoraphobia and specific phobias⁶.

Generalized anxiety disorder (GAD) means worry that is hard to control on most days for at least six months³. It comes with at least three of these: restlessness, tiring easily, trouble concentrating, irritability, muscle tension or sleep problems³. The body often joins in, with headaches, stomachaches, trembling, sweating or shortness of breath, says the National Institute of Mental Health (NIMH)³.

Panic disorder means repeated, unexpected panic attacks⁴. An attack can bring a pounding heart, chest pain, trouble breathing, dizziness, tingling hands and a feeling of doom⁴. To meet the diagnosis, a person also spends at least a month worrying about the next attack or changing routines to avoid one⁴.

Social anxiety disorder is an intense fear of being judged by others. It often leads people to avoid social situations, and it lasts at least six months⁵. NIMH notes that it can look like extreme shyness, but the fear is hard to control and disrupts daily life⁵.

How common is all this? NIMH’s numbers come from the National Comorbidity Survey Replication, a Harvard-led survey run from 2001 to 2003. In it, 19.1% of adults had an anxiety disorder in the past year². The rate was 23.4% for women and 14.3% for men².

Anxiety disorders were much less common after 60, at 9.0%, than in younger age groups, where rates ran above 20%². About 22.8% of those affected had serious impairment². The figures are old, but they remain NIMH’s headline numbers.

Most people wait years for help, and a 2023 screening rule aims to change that

Here is a sobering fact. In research the USPSTF reviewed, only 11% of U.S. adults with an anxiety disorder started treatment in the first year, and the median wait was 23 years⁶. In one study of 965 primary care patients, only 41% of those with an anxiety disorder were being treated for it⁶.

In June 2023, the task force recommended that clinicians screen adults ages 19 to 64 for anxiety, including during pregnancy and after birth⁶. For adults 65 and older, it found too little evidence to recommend for or against screening⁶.

One tool the task force reviewed is the GAD-7, a short questionnaire about anxiety symptoms that you fill out yourself. At a score of 10 or more, it caught about 79% of people with generalized anxiety disorder and correctly cleared about 89% of people without it⁶.

A screening score is a flag, not a diagnosis. The task force says a positive result should lead to a full assessment and, if needed, a referral to proven care⁶. You don’t have to wait to be asked. If worry has been running your days, bring it up at your next visit.

Therapy and medicine have the strongest track record

NIMH calls cognitive behavioral therapy (CBT) the gold standard psychotherapy for generalized anxiety, panic and social anxiety disorders³⁴⁵. CBT teaches you to spot and question unhelpful thoughts and to change habits that keep fear going³.

For panic, CBT often includes interoceptive exposure: practicing the body sensations you fear, such as a racing heart, until they feel less frightening⁴. For social anxiety, it means facing avoided situations step by step⁵. Acceptance and commitment therapy, which builds mindfulness and goal setting, also has growing research behind it³.

You may not need to sit in an office. A 2015 Cochrane review of 30 trials with 2,181 adults found that therapist-guided online CBT beat being on a waiting list⁷. When it was compared head to head with face-to-face CBT, the review found no significant difference⁷.

Medicines are the other pillar. Britain’s National Institute for Health and Care Excellence (NICE) recommends offering an SSRI first when generalized anxiety needs medicine, with an SNRI as another option⁸. These antidepressants can take several weeks to work, and side effects such as headaches, nausea or sleep trouble are often mild³.

Benzodiazepines act fast, but tolerance and dependence can develop, so providers usually prescribe them only briefly³. NICE advises against them for panic disorder and limits them to short-term crises in generalized anxiety⁸. Buspirone carries less risk of addiction and takes three to four weeks³. Beta-blockers can ease the shaking and racing heart of performance anxiety⁵.

Which comes first, therapy or a pill? For generalized anxiety that seriously gets in the way of life, NICE found no evidence that either one beats the other, so your preference counts⁸. If a medicine works, NICE suggests staying on it for at least a year, because relapse is common⁸. Our guide to psychiatrists, psychologists and therapists explains who does what.

Coffee, a nightcap and the other everyday levers

NIMH says cutting back on caffeine and getting enough sleep, alongside standard care, can ease generalized anxiety³. The Swedish trial adds nuance: a modest dose didn’t trigger panic, but very large doses often do¹.

Cup sizes and brews vary, so milligrams are a surer guide than cups. If you have panic attacks, track your intake and how you feel. Then talk with your clinician before deciding caffeine is or isn’t the culprit. Our caffeine article covers timing and sleep.

Alcohol is trickier, because it can seem to help. Joshua Smith and Carrie Randall of the Medical University of South Carolina reviewed the evidence in a journal published by the National Institute on Alcohol Abuse and Alcoholism⁹.

In one large national survey, about 1 in 5 people with anxiety disorders said they drank to cope⁹. Among those who did, 34.5% had alcohol dependence, compared with 9.3% of anxious people who didn’t drink to cope⁹.

Lab evidence that alcohol lowers anxiety is inconclusive⁹. Withdrawal can mimic or worsen anxiety, and long-term heavy drinking may itself stir it up⁹. Before deciding whether panic or worry is a separate disorder, clinicians may need to see about four weeks without alcohol⁹.

Movement belongs in every plan. NIMH says exercise, mindfulness and meditation can reduce anxiety symptoms and may boost the effects of therapy, but these habits can’t replace treatment³. NICE suggests that clinicians discuss the benefits of exercise with people who have panic disorder⁸. Our articles on movement and on breath awareness cover the trials.

Your anxiety action ladder

This ladder is our own tool, built on the stepped-care model in the NICE guideline⁸. Start on the step that fits how much anxiety is disrupting your life. You don’t have to begin at the bottom.

Step	What it looks like	Move up a step if…
1. Self-help basics	Regular exercise, enough sleep, less caffeine, and a CBT-based self-help book or program worked through for at least six weeks38	Worry still shows up most days, or it’s hurting your work, schooling or relationships3
2. Guided self-help	CBT materials with a trained helper, often 5 to 7 sessions of 20 to 30 minutes; therapist-guided online CBT; or a six-week group class based on CBT78	You haven’t improved enough, or anxiety is causing marked trouble in daily life8
3. Therapy or medicine	CBT or applied relaxation, usually 12 to 15 weekly hour-long sessions, or an SSRI or SNRI8	Symptoms stay significant after two treatments, or anxiety is complex or severe8
4. Specialist care	A full reassessment and care plan from mental health specialists, sometimes with combined treatments8	Stay here until your team agrees on a step down

Go straight to help, not up a ladder, if: you have thoughts of suicide (call or text 988) or chest pain that could be your heart (call 911)³¹⁵.

The ladder fits a value many natural-health readers hold: begin with the gentlest option that has a fair chance of working, and add more only when needed. Stepped care is built the same way. It also says when to stop waiting, which matters just as much.

Calming supplements: promising, unproven and risky

Many people reach for an herb before a prescription. NICE’s first step for generalized anxiety includes a talk about over-the-counter products. They can interact with other drugs, and there’s little evidence on their safety⁸.

Kava shows why. Pacific Islanders have made ceremonial drinks from this pepper-family plant for thousands of years, and kava supplements are often promoted for anxiety¹⁰.

In 2002, the Centers for Disease Control and Prevention (CDC) reported 11 kava users in Germany, Switzerland and the U.S. whose livers failed badly enough to need a transplant, in cases possibly linked to kava¹¹. One was a 14-year-old girl¹¹. On March 25, 2002, the Food and Drug Administration issued a consumer advisory about kava and liver injury, and several countries restricted sales¹¹.

Most of the European cases involved alcohol or acetone extracts, but NCCIH, the federal center for complementary health, says liver injuries have also followed water-based drinks¹⁰¹¹. NCCIH says kava supplements may help anxiety in general, but kava doesn’t appear helpful for generalized anxiety disorder¹⁰. Never mix it with alcohol or sedatives such as benzodiazepines¹⁰.

Here is our safety-first summary. Ratings use our four-level evidence scale.

Product	What was tested	Evidence	Cautions	More in our library
Lavender oil capsules	An oral lavender oil product; NCCIH flags small studies and little independent funding or testing12	Promising but early	Burping, nausea, diarrhea, headache; may interact with sedatives; pregnancy safety unclear12	Our lavender article
Chamomile	Early studies of a chamomile supplement for generalized anxiety13	Promising but early	Allergy risk if you react to ragweed or daisies; reported warfarin interactions13	Our chamomile and herbal tea articles
L-theanine	Nine controlled studies; 200 to 400 mg a day may ease stress and anxiety in people under stressful conditions14	Promising but early	The review’s authors call for larger, longer trials before clinical use14	Our sleep-aid scorecard
Kava	May ease anxiety in general but doesn’t appear to help generalized anxiety disorder, per NCCIH10	Evidence says no, or unsafe (documented liver harm outweighs a possible benefit)	Liver failure, including transplants; never with alcohol or sedatives; pregnancy risks1011	Our sleep-aid scorecard
Ashwagandha and CBD	Covered in our sleep-aid scorecard	See scorecard	See scorecard	Our sleep-aid scorecard

Apply the same skepticism to every seller. NCCIH notes that lavender‘s evidence leans on products that weren’t independently funded or tested¹². If you try a supplement, tell your clinician and pharmacist, especially if you take a sedative, an antidepressant or a blood thinner.

What the evidence says about treatments and habits

Approach	Evidence level	What we know
CBT for generalized anxiety, panic and social anxiety	Strong evidence	NIMH’s leading psychotherapy for each345
Therapist-guided online CBT	Strong evidence	A Cochrane review of 30 trials: beat waiting lists (moderate-quality evidence) and showed no significant difference from in-person CBT7
SSRI or SNRI medicines	Strong evidence	NICE’s first-choice medicines; take weeks to work38
Regular exercise	Strong evidence as an add-on	Eases symptoms but can’t replace treatment, NIMH says; our movement article reviews the trials3
Cutting back on high caffeine intake	Promising but early	Large doses trigger panic often; a modest dose didn’t13
Drinking to calm nerves	Evidence says no, or unsafe	No clear calming effect; far higher rates of alcohol dependence9

When to get help

See a health care provider if:

• worry is hard to control on most days and has gone on for months³;
• anxiety keeps getting in the way of work, school or relationships, or symptoms won’t go away³;
• you’ve had repeated, unexpected panic attacks and fear the next one⁴;
• you avoid people, places or situations because of fear⁵;
• you find yourself drinking to cope with anxiety, a habit tied to much higher rates of alcohol dependence⁹;
• you scored high on a screening questionnaire like the GAD-7 and haven’t had a full assessment⁶.

To find care near you, NIMH points to SAMHSA’s FindTreatment.gov³.

If you are thinking about suicide or are in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat at 988lifeline.org. In a life-threatening emergency, call 911³.

Questions readers ask

The bottom line

Anxiety disorders are common, and most people wait far too long to get help. The best-proven options are CBT, which now works well online, and SSRI or SNRI medicines. Exercise, sleep and sensible caffeine and alcohol habits support either path.

Calming herbs sit lower on the evidence ladder. Lavender capsules, chamomile and L-theanine are promising but early, and kava’s liver record makes it a poor choice. Start with the gentlest step that fits, move up when the signs say so, and call 911 for chest pain or 988 in a crisis.

Related reading

• Worry gets louder at 3 a.m., and a few tested tricks can turn it down
• Moving can ease anxiety, though viral shaking and somatic workouts are less proven
• The sleep aid with the clearest warning is the drugstore antihistamine
• How to tell psychiatrists, psychologists and therapists apart
• What happens when you don’t tell your doctor about supplements

Sources

1. Hoppe JM, Björkstrand J, Vegelius J, Klevebrant L, Gingnell M, Frick A. “Acute effects of 150 mg caffeine on subjective, physiological, and behavioral components of anxiety in panic disorder and healthy controls – A randomized placebo-controlled crossover trial.” Journal of Psychopharmacology, 2025;39(8):836–846. pmc.ncbi.nlm.nih.gov
2. National Institute of Mental Health. “Any Anxiety Disorder” (statistics, National Comorbidity Survey Replication). NIH, accessed October 2026. nimh.nih.gov
3. National Institute of Mental Health. “Generalized Anxiety Disorder: When Worry Gets Out of Control.” NIH, revised 2025. nimh.nih.gov
4. National Institute of Mental Health. “Panic Disorder: When Fear Overwhelms.” NIH, revised 2025. nimh.nih.gov
5. National Institute of Mental Health. “Social Anxiety Disorder: More Than Just Shyness.” NIH, revised 2025. nimh.nih.gov
6. U.S. Preventive Services Task Force. “Anxiety Disorders in Adults: Screening.” Final recommendation statement, June 20, 2023. uspreventiveservicestaskforce.org
7. Dobbins MI, Bauk S, Albers J. “Therapist-Guided, Internet-Delivered Cognitive Behavior Therapy for Anxiety” (summarizing a 2015 Cochrane review). American Family Physician, 2018;98(7):459–460. aafp.org
8. National Institute for Health and Care Excellence. “Generalised anxiety disorder and panic disorder in adults: management” (CG113). Published January 2011, last updated June 2020. nice.org.uk
9. Smith JP, Randall CL. “Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations.” Alcohol Research: Current Reviews (NIAAA), pp. 414–428, undated PDF. arcr.niaaa.nih.gov
10. National Center for Complementary and Integrative Health. “Kava.” NIH, last updated April 2025. nccih.nih.gov
11. Centers for Disease Control and Prevention. “Hepatic Toxicity Possibly Associated with Kava-Containing Products: United States, Germany, and Switzerland, 1999–2002.” Morbidity and Mortality Weekly Report, 2002;51(47):1065. cdc.gov
12. National Center for Complementary and Integrative Health. “Lavender.” NIH, last updated February 2025. nccih.nih.gov
13. National Center for Complementary and Integrative Health. “Chamomile.” NIH, last updated November 2024. nccih.nih.gov
14. Williams JL, Everett JM, D’Cunha NM, et al. “The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review.” Plant Foods for Human Nutrition, 2020;75:12–23 (Aston University record). publications.aston.ac.uk
15. MedlinePlus. “Chest pain.” Medical Encyclopedia, National Library of Medicine, reviewed April 28, 2026. medlineplus.gov