Anxiety Case Study: Generalised Anxiety and Panic Attacks, Treatment and Recovery
Anxiety Case Study: Patient Background
This anxiety case study follows Riya (name changed), a composite example that reflects how generalised anxiety with panic attacks commonly develops and how it is assessed and treated at Calida Rehab. The details are illustrative and do not describe any one identifiable person.
Riya is a 27-year-old software engineer who lives alone in a rented flat in Pune. Her parents live in Nashik. For more than a year she had worried about almost everything: deadlines, performance reviews, her parents’ health, money and whether her life was on track. She described it as a mind that never switched off. Five months before she came to Calida Rehab, she had a sudden attack during a client call. Her heart pounded, her chest tightened, her hands tingled and she felt she could not breathe. Convinced she was having a heart attack, she went to the emergency room. Her ECG and blood tests were normal, and she was told it was just stress. It happened twice more over the next two months, and each time she went back to the emergency room and later saw a cardiologist, with the same normal results. By the time she came to Calida Rehab she was sleeping about four hours a night, drinking five or six cups of coffee or energy drinks a day to get through work, checking her pulse many times a day and avoiding meetings and long commutes. On bad nights she had begun taking a sedative tablet bought from a chemist without a prescription.
Before the case itself, a short note. Anxiety is a normal response to stress or danger. An anxiety disorder is different: the worry or fear is out of proportion to the situation, is hard to control, lasts for months and interferes with daily life. Generalised anxiety disorder (GAD) involves persistent, excessive worry about many everyday things. Panic attacks are sudden surges of intense fear that peak within minutes and can feel like a heart attack. The two often occur together, and both are common and treatable. For the full picture, read our pages on anxiety disorder, anxiety disorder treatment and panic disorder.
Symptoms: How Anxiety Showed Up
Anxiety shows up in the mind and in the body. In generalised anxiety disorder, the key feature is excessive worry on more days than not for at least six months, which the person finds hard to control. The signs below are common.
Worry and thinking
- Constant worry about many different things, such as work, health, money or family
- Expecting the worst, even when there is little reason to
- Difficulty switching off thoughts or tolerating uncertainty
- Trouble concentrating, or the mind going blank
Body symptoms
- Restlessness, or feeling keyed up and on edge
- Muscle tension, headaches, and aches in the neck, shoulders or back
- Getting tired easily
- Racing heart, sweating, trembling, dizziness or an upset stomach
- Trouble falling asleep or staying asleep
Panic attacks
- A sudden surge of intense fear that peaks within minutes
- Pounding heart, chest tightness, shortness of breath, tingling or light-headedness
- A feeling of losing control, or that something terrible is about to happen
- Worry about the next attack, and avoiding places or situations linked to earlier ones
Changes in behaviour
- Avoiding meetings, travel, crowds or tasks that set off worry
- Repeated checking or seeking reassurance, such as checking the pulse or asking family if everything is fine
- Using caffeine, alcohol or sedatives to cope
- Irritability and pulling away from friends
In this case: Riya worried about work most of the day and could not switch off even on weekends. She felt tense, with tight shoulders and frequent headaches, and got tired quickly yet could not sleep. Three times in five months she had sudden attacks with a pounding heart, chest tightness and tingling in her hands, each peaking within about ten minutes. After that she feared the next one. She began checking her pulse many times a day, avoided client calls and long commutes, and asked her colleagues to take her meetings. Coffee and energy drinks kept her going through the day, and a sedative tablet helped her fall asleep, which in turn left her groggy and more anxious the next day.
Doctors do not go by a single symptom. Under the DSM-5-TR criteria, generalised anxiety disorder is diagnosed when a person has excessive anxiety and worry about a number of events or activities, on more days than not for at least six months, finds the worry hard to control, and has three or more of six symptoms: restlessness, being easily tired, difficulty concentrating, irritability, muscle tension and disturbed sleep. The symptoms must cause significant distress or problems in daily life, and must not be better explained by a medical condition, a substance or another mental health disorder. Panic disorder is diagnosed separately, when a person has repeated unexpected panic attacks followed by at least a month of persistent worry about more attacks or a change in behaviour because of them.
Why Anxiety Often Goes Unnoticed
Many people with anxiety go without help for years. Worry is often seen as a personality trait or as overthinking, and people are told to relax, think positive or simply stop worrying. In a competitive workplace, constant worry can even be mistaken for being careful and driven. Families may not notice at all, because the person keeps working while struggling inside.
The picture is also easy to mistake. Because anxiety causes real body symptoms such as chest pain, breathlessness, dizziness, stomach upset and headaches, people often go from doctor to doctor looking for a physical cause. Each normal test brings brief relief and then more worry. Anxiety can also look like depression, a heart or thyroid problem, or acidity. Some people use caffeine, alcohol or sedatives from the chemist to cope, which hides the problem and can add dependence on top of it. Left untreated, anxiety can lead to repeated emergency visits, poor sleep, burnout, depression, substance use and avoiding work or relationships. The sooner it is recognised, the easier it is to treat. Our article on how anxiety can cause back pain and shortness of breath explains why the body reacts so strongly.
In this case: Riya was sure her symptoms meant a heart problem, and each normal ECG left her more confused than reassured. Friends told her to take a break and stop overthinking. Her parents did not know how bad things were, because she told them she was just busy. The turning point came when she missed an important client meeting after a panic attack in the office parking lot and could not enter the building for two days. A colleague who had been through something similar suggested she see a psychiatrist, and she came to Calida Rehab.
Diagnosis: How Anxiety Was Assessed at Calida Rehab
There is no blood test or scan that confirms an anxiety disorder. The diagnosis is made by a psychiatrist through a careful clinical assessment. At Calida Rehab this typically includes:
- A detailed clinical interview about the worries, any panic attacks, body symptoms and sleep, how long they have lasted and how they affect work and relationships
- Structured tools, such as the GAD-7 for anxiety and the PHQ-9 for depression. A GAD-7 score of 10 or above is commonly used as the cut-off for further evaluation.
- Screening for panic attacks and phobias, which often occur alongside generalised anxiety
- A physical and medical check, including a review of earlier ECG and test reports, and tests such as thyroid function, blood count and blood sugar where needed, to rule out other causes of the symptoms
- A review of caffeine, alcohol, tobacco and other substances, and of any medicines taken, including sedatives bought without a prescription
- A risk assessment for thoughts of self-harm or suicide
- Input from a family member, with the person’s consent
That wider check matters. Anxiety rarely comes alone. Depression, poor sleep and the use of alcohol or sedatives often sit alongside it, and treating only one leaves the person struggling. See our depression case study and PTSD case study to see how these conditions can overlap.
Result in this case: Riya was diagnosed with generalised anxiety disorder with panic attacks, of moderate to severe intensity, along with mild depressive symptoms, poor sleep and heavy caffeine use. Her thyroid function and other tests were normal. Her GAD-7 score was 18, in the severe range, and her PHQ-9 score was 8, in the mild range. She had no thoughts of self-harm. She was also found to be taking a sedative tablet two or three times a week without a prescription. Hearing that her chest tightness and breathlessness were real symptoms of anxiety, and that the condition was treatable, was the first real relief.
Treatment Plan for Anxiety
No single treatment suits everyone. At Calida Rehab the plan is built after the assessment, and the family is involved when the person agrees. Most plans combine the following.
Explaining the condition first. Understanding how anxiety and panic work, and why the body reacts so strongly, reduces the fear of the symptoms themselves.
Psychotherapy as the core of treatment. Cognitive Behavioral Therapy is the first-line talk therapy for generalised anxiety and panic disorder. It helps the person spot worry patterns, test anxious predictions and face feared situations step by step.
Medicines, when needed. A psychiatrist may prescribe an SSRI or SNRI antidepressant, which are first-line medicines for anxiety disorders. They usually take a few weeks to work, can cause mild side effects at the start, and are reviewed regularly. Benzodiazepine sedatives are generally used only for a short time, if at all, because they can lead to dependence. If someone has been taking them regularly, the dose is reduced slowly under medical supervision and not stopped suddenly.
Lifestyle changes. Less caffeine, fixed sleep and wake times, regular exercise and meals, and less screen time late at night help the body settle.
Treatment of other conditions. Depression, poor sleep and alcohol or sedative use are treated alongside anxiety. Where alcohol is part of the picture, see our alcohol use disorder page.
Family involvement. Families learn what anxiety is, how to stay calm during a panic attack and how to avoid feeding the cycle through constant reassurance.
In this case: Riya was treated as an outpatient at Calida Rehab. In the first two weeks she had weekly psychiatric reviews to start an SSRI, cut down caffeine in steps and begin a gradual, supervised reduction of the sedative tablet. She then had twelve sessions of Cognitive Behavioral Therapy over about twelve weeks, with short exercises to practise between sessions. Her parents joined one family session by video call in the first month. She kept working throughout, with a plan to limit late-night work and avoid back-to-back meetings.
Therapies Used in This Anxiety Case Study
The therapies below were part of Riya’s plan or were offered to her, and they are commonly used for anxiety.
- Cognitive Behavioral Therapy (CBT): helps the person notice anxious thoughts, test whether the feared outcome is likely and change the habits that keep worry going. This was Riya’s main therapy. Read more on our CBT page.
- Graded exposure: step-by-step practice of avoided situations such as meetings and commutes, and, for panic, of body sensations such as a fast heartbeat, until they lose their power to frighten
- Relaxation and breathing skills: slow breathing, muscle relaxation and grounding exercises to settle the body during a panic attack and at bedtime
- Acceptance and Commitment Therapy (ACT): helps the person make room for worry and anxious feelings without letting them make the decisions. See our ACT page.
- Behavioral therapy and routine building: structured steps for sleep, caffeine and daily activity. See our behavioral therapy page.
- Group and family therapy: sessions that reduce isolation and help families understand and support recovery. See our group therapy and family therapy pages.
Follow-Up Care After the First Phase
Anxiety can have ups and downs, so care does not end when the first phase of treatment ends. Follow-up usually includes:
- Regular counselling sessions, with more frequent sessions in the first months and wider gaps later
- Repeat symptom checks, for example with the GAD-7 and PHQ-9, to track progress
- Review of sleep, mood, anxiety and medicines, with the plan adjusted if needed. Antidepressants are usually continued for several months after symptoms settle and are then stopped slowly with medical advice.
- Booster sessions during stressful periods, such as appraisal season, tight deadlines or travel
- A graded return to avoided situations such as meetings, travel or crowded places
- Review of caffeine, alcohol and sedative use
- Continued involvement of the family, where the person agrees
A difficult phase does not mean treatment has failed. It is a signal to get support early. Our anxiety disorder treatment page and panic disorder treatment page explain what ongoing care looks like.
Outcome: What Recovery Looks Like With Anxiety
What changed for Riya over the first three months:
- Panic attacks: they fell from two or three a week at their worst to one mild episode in the third month, which she handled with breathing and grounding skills.
- Worry: constant worry eased. She could notice a worry, label it and let it pass without acting on it.
- Sleep: she went from about four hours a night to six or seven.
- Body symptoms: chest tightness, tingling and stomach upset eased. She stopped checking her pulse and had no further emergency room visits.
- Sedatives and caffeine: she stopped the sedative tablet under supervision and cut coffee to two cups a day.
- Work: she returned to client calls and meetings, and travelled to the office on most days.
- Family: her parents said her phone calls sounded relaxed again.
- Symptom scores: her GAD-7 score fell from 18 to 6 and her PHQ-9 score from 8 to 3.
It is worth being clear about what recovery means. It is not never feeling anxious again. Anxiety is a normal emotion, and everyone feels it before an exam or an important meeting. Recovery means the anxiety no longer runs daily life, the body does not sound a false alarm so often, and the person knows what to do when a hard day returns.
What the first six months of treatment usually look like
- Month 1: assessment, understanding the condition, cutting back caffeine, a sleep routine, and starting medicine if needed.
- Months 2 and 3: CBT does most of the work, with graded practice of avoided situations. Family sessions continue.
- Months 4 to 6: gains settle in, with booster sessions if needed and a review of the medicine plan.
This is a general guide. Every person moves at a different pace.
Key Takeaways from This Anxiety Case Study
- Anxiety disorders are real medical conditions, not weakness or overthinking.
- Anxiety causes real body symptoms such as chest tightness, breathlessness and dizziness. Heart and other physical causes should be checked first, and a normal test does not mean the symptoms are imaginary.
- Cognitive Behavioral Therapy is the first-line talk therapy, and SSRIs or SNRIs can support it.
- Caffeine, poor sleep and sedatives bought from a chemist can keep anxiety going and need attention.
- Recovery means anxiety stops running daily life, not that it never appears.
When Should You See a Doctor?
Please speak to a doctor if you or someone you know:
- Worries most days about many things, and finds it hard to stop, for several weeks or months
- Has sudden attacks of intense fear, a racing heart or breathlessness, or fears another attack
- Feels restless, tense, tired or unable to sleep because of worry
- Avoids work, travel, social events or other situations because of fear
- Keeps seeking tests or reassurance and still feels unwell after doctors find no physical cause
- Is using alcohol, caffeine, sleeping pills or sedatives to cope
- Finds work, studies or relationships suffering
If you have sudden chest pain, severe breathlessness or fainting, get emergency medical care first, because these symptoms can also have physical causes. If you or someone you know ever talks about hurting themselves, do not wait. Call 112 in an emergency, or Tele-MANAS on 14416. You can also call our 24-hour helpline for a confidential conversation.
Anxiety Case Study: Frequently Asked Questions
What is an anxiety disorder?
An anxiety disorder is a mental health condition in which worry or fear is out of proportion to the situation, is hard to control, lasts for months and interferes with daily life. Common types include generalised anxiety disorder, panic disorder and social anxiety disorder.
What are the symptoms of generalised anxiety disorder?
Common symptoms include excessive worry about many things, restlessness, feeling on edge, getting tired easily, trouble concentrating, irritability, muscle tension and poor sleep. The worry is present on more days than not for at least six months and is hard to control.
What is the difference between anxiety and a panic attack?
Anxiety is a longer-lasting state of worry and tension. A panic attack is a sudden surge of intense fear that peaks within minutes, with a pounding heart, chest tightness, breathlessness or tingling. A person can have generalised anxiety, panic attacks or both.
Can anxiety cause chest pain and breathlessness?
Yes. Anxiety can cause chest tightness, a racing heart and breathlessness. These symptoms can also come from heart, lung or other physical conditions, so a doctor should check them first, especially the first time they occur.
How is anxiety treated?
Treatment combines Cognitive Behavioral Therapy, graded exposure and relaxation skills, medicines such as SSRIs or SNRIs when needed, lifestyle changes such as less caffeine and better sleep, treatment of depression or substance use, and family involvement.
Can anxiety be cured?
Many people recover fully or have symptoms reduced so much that daily life is no longer affected. Anxiety can return at times of stress, which can be managed with the skills learned in therapy and with early support.
How long does anxiety treatment take?
It varies. Cognitive Behavioral Therapy for anxiety is often delivered over about 12 to 16 weekly sessions. Medicines usually take a few weeks to start working and are often continued for several months after symptoms settle.
Is my information kept private?
Yes. Assessment and treatment details are confidential and are shared with family or employers only with your consent.
Sources and Further Reading
This page is for information and is not a substitute for medical advice. The case described is a composite example, and details are illustrative. If you think you or someone you know may have an anxiety disorder, please see a doctor or psychiatrist for a full assessment.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.
- National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (NICE clinical guideline CG113). 2011.
- Spitzer R. L., Kroenke K., Williams J. B. W., Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097.
- Kroenke K., Spitzer R. L., Williams J. B. W. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613.
- World Health Organization. Anxiety disorders (fact sheet).