Why Do People With Anxiety Shake?

Shaking or trembling of the hands or other parts of the body are common physical symptoms associated with social 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," says Mona Potter, MD, the chief medical officer of InStride Health.

It is caused by the body's stress response, which triggers the release of hormones such as cortisol and adrenaline. This increases physical tension and contributes to shaking and trembling.

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 Causes Anxiety Shaking?

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

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

Boger explains that when people feel anxious, the body prepares to deal with the problem by releasing stress hormones such as adrenaline and cortisol into the bloodstream. This results in heightened alertness as well as physical changes, such as increased muscle tension and nerve activity, as well as increased heart rate, blood pressure, and blood flow to your muscles.

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.

What Triggers Anxiety Shaking?

Anxiety-related shaking can be triggered by various circumstances. You may notice tremors or shakiness when you are:

• Anticipating an upcoming social interaction
• Attending parties or other social gatherings
• Eating or drinking in public
• Going on a date
• Joining a group conversation already in progress
• Making phone calls
• Meeting new people
• Performing on stage
• Speaking up in a meeting

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. 

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.

Impact of Anxiety Shaking

Shaking caused by social anxiety and other types of anxiety disorders can take a serious toll on a person's well-being. For some, high levels of stress and exhaustion may intensify tremors.

Shaking and other symptoms can also create a vicious cycle. Feeling fearful or thinking about being embarrassed about 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 in avoidance coping to 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.

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 as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) may be effective treatment options for some experiencing shaking, tremors, and other symptoms associated with anxiety disorders.

Exposure therapy can 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.

Medications

Some medications may 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.

• Antidepressants: These medications are typically the first line of treatment. Paxil (paroxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Effexor XR (venlafaxine extended-release) are FDA-approved for treating SAD.
• Benzodiazepines: Medications like Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) can begin working right away to reduce symptoms associated with anxiety, including shaking. However, the risk of dependence increases the longer you stay on these medications.
• Beta-blockers: By blocking the effect of adrenaline, beta-blockers such as Inderal (propranolol) can be used to cope with infrequent anxiety-provoking situations, such as speeches or performances. They are also able to help some individuals reduce tremors.

Coping with Anxiety Shaking

There are many coping methods you 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.

Exercise Regularly

Physical activity is 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 like alcohol, 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 as mindfulness meditation, progressive muscle relaxation, and deep breathing may 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.