It’s been a stressful couple of years (understatement of the century), and many of us, myself included, are struggling with anxiety more than ever. Last year, I sent myself into a tizzy over a slew of mysterious rashes that kept popping up all over my body. My anxiety got so severe that I had trouble breathing and needed to call 911 — it was hard to tell whether I was having a panic attack or going into anaphylactic shock. Luckily, everything was fine, but it was terrifying at the time. It turned out to be a good reminder that if I’m experiencing shortness of breath, sometimes it might be just my body’s response to stress levels. It did make me wonder, though, how to tell if shortness of breath is from anxiety — or something more serious.

It’s easy to go into a worry spiral just thinking about it, which could ironically lead to anxiety-induced shortness of breath. To help you avoid that, Scary Mommy asked Steve Carleton, LCSW, CACIII, a licensed clinical social worker and the executive clinical director at Gallus Detox, and Katie McLaughlin, a licensed professional clinical counselor and certified clinical anxiety treatment professional, for a little expert insight. So, if you’re like me and need as much reassurance as possible that you’re not *dying*, read on for more tips on recognizing when anxiety is behind your breathlessness.

How can you tell if shortness of breath is from anxiety?

“One of the critical signs that shortness of breath is from anxiety is that breathlessness worsens when in a state of emotional distress,” Carleton tells Scary Mommy. “Unlike a heart condition or other physical illness, which may cause a gradual increase in breathlessness during physical exertion, shortness of breath due to anxiety is often triggered by sudden stress or fear. Your body may be at rest, but you still feel as if you cannot take a full breath.”

What does shortness of breath from anxiety feel like?

According to McLaughlin, the easiest way to tell if shortness of breath is stemming from anxiety — rather than from a different medical condition — is to take stock of any other symptoms you may be experiencing, such as:

• Worry that is difficult to control
• Shakiness
• Feeling overwhelmed or panicked
• Fidgeting
• Muscle tension
• Headaches
• Irritability
• Sweating
• Lightheadedness
• Nausea
• Upset stomach or GI discomfort
• Frequent urination
• Fatigue
• Difficulty concentrating
• Unable to feel present with friends and loved ones
• Being easily startled
• Unable to relax

Why does anxiety cause shortness of breath?

My mind was flooded with worse-case scenarios about my rashes just before my panic attack. No wonder I started reacting the way I did. “People have shortness of breath when they are experiencing anxiety because the body’s natural fight or flight response is activated,” Carleton explains. “This triggers a cascade of physiological responses, such as increased heart rate, shallow breathing, and tightened chest muscles. The resulting physical symptoms can leave you feeling like you can’t catch your breath. In addition to this, the heightened emotional state can lead to an increased sense of panic, making it even harder to take a full breath.”

The good news, says Carleton, is that this feeling of shortness of breath is usually temporary and can be managed with relaxation techniques and exercise.

What are the treatment options?

It might sound simple, but being able to identify this change in breathing as a sign of anxiety can be pretty helpful, says McLaughlin.

“If we can name our experience, it often becomes much less frightening,” she explains. “Once we know what is happening and why our breathing pace has changed, practicing grounding techniques and breathing techniques to send calming signals to the body is the next step.”

The thing is, our brain doesn’t allow us to tell it that we are actually OK (it’s too smart, I guess), so McLaughlin recommends engaging in something called “bottom-up approaches.”

She explains, “These are techniques we can practice in the moment, but also in times when we are not experiencing any symptoms of anxiety. If we make the time to practice calming techniques outside of times of anxiety, we have a much higher chance of being able to remember them when we need them, and calming down more quickly and our breathing rate returning to normal.”

She suggests using the box breathing method. “This is where we breathe in to the count of four, hold our breath to the count of four, exhale to the count of four, and hold our breath to the count of four,” she explains. “Practicing this breathing pattern has the power to send out those calming signals to quickly decrease anxiety. It’s important to note that when I say ‘quickly,’ I mean within 15-20 minutes of actively coping. The body takes time to return to a calm state.”

Carleton recommends other helpful activities, including mindful meditation, progressive muscle relaxation, yoga, or a guided imagery exercise.

When should you call a doctor?

If you are experiencing shortness of breath without any other symptoms of anxiety, McLaughlin and Carleton both advise checking in with a medical professional.

“Shortness of breath can be a symptom of many different physical conditions and illnesses, such as asthma, COPD, heart disease, and lung cancer,” Carleton says. “Usually, the pain would worsen during physical activity or be accompanied by other symptoms such as chest pain, wheezing, coughing, and tightness in the chest. If you are experiencing any of these signs and symptoms, it is important to seek medical attention right away.”