Why Do People With Anxiety Shake?

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Shaking or trembling of the hands or other parts of the body are common physical symptoms associated withsocial anxiety disorder(SAD) and other anxiety conditions.

“Anxiety is a complex mind-body experience involving both emotional and physical responses. A common physical manifestation of anxiety is shaking or trembling,” saysMona Potter, MD, the chief medical officer of InStride Health.

Feeling a lack of control over your body can not only increase the intensity of your shaking, but may also worsen other anxiety-related symptoms. This uncomfortable symptom may also be present in other anxiety disorders, such as panic disorder, specific phobias, and agoraphobia.

If you are experiencing shaking or trembling because of social anxiety disorder and/or another anxiety disorder, know that many treatment options are available.

What Are Anxiety Shivers?

What Causes Anxiety Shaking?

“Trembling happens when the sympathetic nervous system is activated; this is known as the “fight, flight, freeze” response,” explainsKathryn Boger, PhD, ABPP, the chief clinical officer of InStride Health.

Experiencing anxiety can trigger your body to go intofight-or-flight mode—an evolutionary response meant to keep you safe in times of perceived danger. Thisphysiological responseto threats in the environment increases your alertness and prepares your body to take immediate action.

This may then lead to the rapid contraction and relaxation of muscles, leading to a shaking, trembling sensation throughout the body, including the hands, legs, and voice.

While this might be uncomfortable or disconcerting when it happens, Boger says that it is both a natural and harmless response to stress.

You could think of it as the body’s attempt to restore equilibrium as it releases excess energy.—KATHRYN BOGER, PHD, ABPP, CHIEF CLINICAL OFFICER OF INSTRIDE HEALTH

You could think of it as the body’s attempt to restore equilibrium as it releases excess energy.

—KATHRYN BOGER, PHD, ABPP, CHIEF CLINICAL OFFICER OF INSTRIDE HEALTH

What Triggers Anxiety Shaking?

Potter notes that certain factors may cause people to be more susceptible to shaking when anxious. A genetic predisposition to anxiety and a more sensitive sympathetic nervous system may intensify a person’s fight-or-flight response.

Other factors contributing to shaking when anxious include underlying health conditions, high stress levels, poor sleep patterns, and excess caffeine intake. Some medications may also cause shaking as a side effect, she says.

In addition to shaking and trembling, facing a triggering situation can lead to sweating, rapid heart rate, feeling scared, nausea, andshortness of breath.

Anxiety shaking is one of the physical symptoms associated with anxiety disorders. While this symptom often occurs with conditions such as social anxiety disorder and panic disorder, it can also happen with other conditions such as post-traumatic stress disorder.

People can also experience this symptom when feeling anxious, even if they do not have a diagnosed anxiety condition. For example, you might shake during a presentation at work or a performance for school. While it can be unsettling, having this symptom does not necessarily mean that you have an anxiety disorder.

A visit to a doctor can help determine whether your shaking is due to an anxiety disorder, a medical condition, or both.

Impact of Anxiety Shaking

Shaking and other symptoms can also create a vicious cycle. Feeling fearful orthinking about being embarrassedabout shaking in public can also lead to even more shaking, either in the moment or in anticipation of it.

Because people fear shaking and other anxiety symptoms, they engage inavoidance copingto minimize the risk they experience such symptoms. This can lead to the avoidance of situations that trigger anxiety. While this may offer momentary or short-term relief, the reality is that avoidance worsens and prolongs anxiety symptoms.

RecapHaving your hands or legs tremble or shake during social situations or when you think about an upcoming social interaction may feel frustrating and embarrassing. Anticipating or worrying about shaking can lead to even more trembling, leaving you feeling out of control and uncomfortable.

Recap

Having your hands or legs tremble or shake during social situations or when you think about an upcoming social interaction may feel frustrating and embarrassing. Anticipating or worrying about shaking can lead to even more trembling, leaving you feeling out of control and uncomfortable.

Treatment for Anxiety Shaking

Anxiety-induced shaking or tremors, otherwise known as psychogenic tremors, are generally treated with psychotherapy, medication, or a combination of both. Which treatment option you choose is completely up to you and what you feel comfortable with.

Speaking with your doctor, psychiatrist, and/or therapist can help you make an informed decision about your treatment.

Psychotherapy

Talk therapies such ascognitive behavioral therapy(CBT) oracceptance and commitment therapy(ACT) may be effective treatment options for some experiencing shaking, tremors, and other symptoms associated with anxiety disorders.

Kathryn Boger, PhD, ABPP, chief clinical officer of InStride HealthCognitive Behavioral Therapy or “CBT” is a well-established therapeutic approach for anxiety. Through CBT, individuals can identify and challenge negative thought patterns that contribute to anxiety and learn strategies to more effectively respond to stress and anxiety-related physical symptoms.

Kathryn Boger, PhD, ABPP, chief clinical officer of InStride Health

Cognitive Behavioral Therapy or “CBT” is a well-established therapeutic approach for anxiety. Through CBT, individuals can identify and challenge negative thought patterns that contribute to anxiety and learn strategies to more effectively respond to stress and anxiety-related physical symptoms.

Exposure therapycan be a highly effective treatment for anxiety disorders. In this approach, people are gradually exposed to situations that trigger symptoms of anxiety. Over time, the anxiety response slowly fades.

The Best Online Anxiety Support Groups

Medications

Somemedicationsmay help reduce or alleviate shaking and tremors, as well as other anxiety-related symptoms. Keep in mind that medications may not work for everyone, and it’s best to speak with your doctor about the most appropriate course of action for your unique needs.

“If the physical symptoms of anxiety are debilitating and significantly impairing, you can talk to your doctor about potential short-term medication options to take the edge off the symptoms as you work on longer-term strategies for managing the symptoms,” Potter says.

If anxiety-induced shaking negatively impacts your quality of life,reach out to your doctor or therapistfor available treatment options.

Coping with Anxiety Shaking

There are manycoping methodsyou can try that may reduce the symptoms associated with social anxiety disorder, especially shaking and tremors. These techniques may be used in addition to psychotherapy and/or medication.

Keep in mind that, in general, most people out and about are likely not noticing your shaking or trembling, and are definitely less focused on it than you are.

Practice Tolerating Distress

Potter suggests that learning to sit with your anxiety symptoms can be helpful. Anxiety is a natural response, she explains, and learning that it is okay to have physical symptoms of anxiety is important.

Mona Potter, MD, chief medical officer, InStride HealthThe more you focus on the symptoms and try to make them go away, the more anxious you will feel, and the bigger the symptoms will get. Instead, practice making space for the symptoms and riding them out, like a wave that goes up and down.

Mona Potter, MD, chief medical officer, InStride Health

The more you focus on the symptoms and try to make them go away, the more anxious you will feel, and the bigger the symptoms will get. Instead, practice making space for the symptoms and riding them out, like a wave that goes up and down.

Exercise Regularly

Physical activityis a natural anxiety reliever. Exercise releases endorphins and decreases cortisol, resulting in stress hormone reduction and an increase in natural mood boosters.Research has found that exercise can significantly reduce symptoms of anxiety and may have a protective effect.

Avoid Certain Substances

An overabundance of substances likealcohol,caffeine, and nicotine may intensify anxiety-related symptoms, including shaking.

“Stimulants like caffeine and nicotine can exacerbate anxiety symptoms, including shaking. Reducing or eliminating their consumption can lead to a decrease in physical manifestations of anxiety,” Potter explains.

Practice Relaxation Techniques

When practiced regularly, relaxation techniques such asmindfulness meditation,progressive muscle relaxation, anddeep breathingmay help you feel more grounded and may reduce anxiety-related symptoms such as shaking.

Boger says that mindfulness and meditation practices can help people become more aware of their thoughts and feelings. With regular practice, these techniques can help reduce anxiety symptoms and improve emotional regulation.

Combining these practices with yoga can be particularly helpful. Research indicates that yoga, especially Hatha yoga, effectively reduces anxiety-related symptoms in various anxiety disorders, including social anxiety disorder.

If you or a loved one is struggling with activities of daily living because of an anxiety disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see theNational Helpline Database.

If you or a loved one is struggling with activities of daily living because of an anxiety disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see theNational Helpline Database.

Best Guided Meditations

11 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bighelli I, Castellazzi M, Cipriani A, et al.Antidepressants versus placebo for panic disorder in adults.Cochrane Database Syst Rev. 2018;4:CD010676. doi:10.1002/14651858.CD010676.pub2Smeltere L, Kuzņecovs V, Erts R.Depression and social phobia in essential tremor and Parkinson’s disease.Brain Behav. 2017;7(9):e00781. doi:10.1002/brb3.781National Institute of Neurological Disorders and Stroke.Tremor fact sheet.Witlox M, Garnefski N, Kraaij V, et al.Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: Pragmatic single-blind cluster randomized trial.J Med Internet Res. 2021;23(3):e24366. doi:10.2196/24366McGuire JF, Lewin AB, Storch EA.Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder.Expert Rev Neurother. 2014;14(8):893-910. doi:10.1586/14737175.2014.934677Anxiety & Depression Association of America.Clinical practice review for social anxiety disorder.Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A.Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis.J Psychopharmacol. 2016;30(2):128-139. doi:10.1177/0269881115612236Budde H, Machado S, Ribeiro P, Wegner M.The cortisol response to exercise in young adults.Front Behav Neurosci. 2015;9:13. doi:10.3389/fnbeh.2015.00013Kandola A, Stubbs B.Exercise and anxiety.Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23Toussaint L, Nguyen QA, Roettger C, et al.Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation.Evid Based Complement Alternat Med. 2021;2021:5924040. doi:10.1155/2021/5924040Hofmann SG, Andreoli G, Carpenter JK, Curtiss J.Effect of Hatha yoga on anxiety: A meta-analysis.Journal of Evidence-Based Medicine. 2016;9(3):116-124. doi:10.1111/jebm.12204

11 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bighelli I, Castellazzi M, Cipriani A, et al.Antidepressants versus placebo for panic disorder in adults.Cochrane Database Syst Rev. 2018;4:CD010676. doi:10.1002/14651858.CD010676.pub2Smeltere L, Kuzņecovs V, Erts R.Depression and social phobia in essential tremor and Parkinson’s disease.Brain Behav. 2017;7(9):e00781. doi:10.1002/brb3.781National Institute of Neurological Disorders and Stroke.Tremor fact sheet.Witlox M, Garnefski N, Kraaij V, et al.Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: Pragmatic single-blind cluster randomized trial.J Med Internet Res. 2021;23(3):e24366. doi:10.2196/24366McGuire JF, Lewin AB, Storch EA.Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder.Expert Rev Neurother. 2014;14(8):893-910. doi:10.1586/14737175.2014.934677Anxiety & Depression Association of America.Clinical practice review for social anxiety disorder.Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A.Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis.J Psychopharmacol. 2016;30(2):128-139. doi:10.1177/0269881115612236Budde H, Machado S, Ribeiro P, Wegner M.The cortisol response to exercise in young adults.Front Behav Neurosci. 2015;9:13. doi:10.3389/fnbeh.2015.00013Kandola A, Stubbs B.Exercise and anxiety.Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23Toussaint L, Nguyen QA, Roettger C, et al.Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation.Evid Based Complement Alternat Med. 2021;2021:5924040. doi:10.1155/2021/5924040Hofmann SG, Andreoli G, Carpenter JK, Curtiss J.Effect of Hatha yoga on anxiety: A meta-analysis.Journal of Evidence-Based Medicine. 2016;9(3):116-124. doi:10.1111/jebm.12204

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Bighelli I, Castellazzi M, Cipriani A, et al.Antidepressants versus placebo for panic disorder in adults.Cochrane Database Syst Rev. 2018;4:CD010676. doi:10.1002/14651858.CD010676.pub2Smeltere L, Kuzņecovs V, Erts R.Depression and social phobia in essential tremor and Parkinson’s disease.Brain Behav. 2017;7(9):e00781. doi:10.1002/brb3.781National Institute of Neurological Disorders and Stroke.Tremor fact sheet.Witlox M, Garnefski N, Kraaij V, et al.Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: Pragmatic single-blind cluster randomized trial.J Med Internet Res. 2021;23(3):e24366. doi:10.2196/24366McGuire JF, Lewin AB, Storch EA.Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder.Expert Rev Neurother. 2014;14(8):893-910. doi:10.1586/14737175.2014.934677Anxiety & Depression Association of America.Clinical practice review for social anxiety disorder.Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A.Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis.J Psychopharmacol. 2016;30(2):128-139. doi:10.1177/0269881115612236Budde H, Machado S, Ribeiro P, Wegner M.The cortisol response to exercise in young adults.Front Behav Neurosci. 2015;9:13. doi:10.3389/fnbeh.2015.00013Kandola A, Stubbs B.Exercise and anxiety.Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23Toussaint L, Nguyen QA, Roettger C, et al.Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation.Evid Based Complement Alternat Med. 2021;2021:5924040. doi:10.1155/2021/5924040Hofmann SG, Andreoli G, Carpenter JK, Curtiss J.Effect of Hatha yoga on anxiety: A meta-analysis.Journal of Evidence-Based Medicine. 2016;9(3):116-124. doi:10.1111/jebm.12204

Bighelli I, Castellazzi M, Cipriani A, et al.Antidepressants versus placebo for panic disorder in adults.Cochrane Database Syst Rev. 2018;4:CD010676. doi:10.1002/14651858.CD010676.pub2

Smeltere L, Kuzņecovs V, Erts R.Depression and social phobia in essential tremor and Parkinson’s disease.Brain Behav. 2017;7(9):e00781. doi:10.1002/brb3.781

National Institute of Neurological Disorders and Stroke.Tremor fact sheet.

Witlox M, Garnefski N, Kraaij V, et al.Blended acceptance and commitment therapy versus face-to-face cognitive behavioral therapy for older adults with anxiety symptoms in primary care: Pragmatic single-blind cluster randomized trial.J Med Internet Res. 2021;23(3):e24366. doi:10.2196/24366

McGuire JF, Lewin AB, Storch EA.Enhancing exposure therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder.Expert Rev Neurother. 2014;14(8):893-910. doi:10.1586/14737175.2014.934677

Anxiety & Depression Association of America.Clinical practice review for social anxiety disorder.

Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A.Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis.J Psychopharmacol. 2016;30(2):128-139. doi:10.1177/0269881115612236

Budde H, Machado S, Ribeiro P, Wegner M.The cortisol response to exercise in young adults.Front Behav Neurosci. 2015;9:13. doi:10.3389/fnbeh.2015.00013

Kandola A, Stubbs B.Exercise and anxiety.Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23

Toussaint L, Nguyen QA, Roettger C, et al.Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation.Evid Based Complement Alternat Med. 2021;2021:5924040. doi:10.1155/2021/5924040

Hofmann SG, Andreoli G, Carpenter JK, Curtiss J.Effect of Hatha yoga on anxiety: A meta-analysis.Journal of Evidence-Based Medicine. 2016;9(3):116-124. doi:10.1111/jebm.12204

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