Like much of the world, I spent a great deal of March in an anxious haze, walking aimlessly between my apartment’s three rooms because there was nowhere else to go. I have an anxiety disorder, and I was also, quite reasonably, afraid that I would get COVID-19. One common symptom of COVID-19 is chest tightness and shortness of breath. As it happens, chest tightness and shortness of breath are also common symptoms of anxiety. So when my chest felt tight for three days and I monitored my breath so closely that breathing started to feel unnatural, I worried, and worried some more.
Finally, on the third day of distress, I broke one of my Xanax pills into quarters and took one. (Because Xanax can be habit-forming, it’s not an easy medication to get — I had just 17 on hand, and no refills, so I did worry I’ll run out long before the pandemic ends.) Within an hour, the chest tightness was gone and I was able to think about something other than my own lungs for a while. It was a relief: For me, for now, that particular symptom only confirmed something I already knew — I’m anxious.
Still, there are countless months of this ahead, and I expect I will continue to worry that I am getting sick, even if I don’t have a fever or a cough. So I reached out to the Ross Center, a mental-health practice in New York, to ask their experts for help making the distinction between anxiety chest tightness and coronavirus chest tightness and what we can do to manage the former.
How do I know if my chest tightness is “just” anxiety?
There are several questions worth asking ourselves if we start experiencing chest tightness or shortness of breath, says Greta Hirsch, a psychologist and clinical director of the Ross Center. Firstly: Are you someone with a history of anxiety, and especially anxiety tied to health concerns? (Personally: yes and, uh, yes.) And if so, did your symptoms surface while reading news about the coronavirus? If so, these are likely indicators that your symptoms are tied to anxiety.
Some amount of anxiety is, of course, to be expected. “It makes sense to have some worry at the present — we all do,” says Hirsch. “That’s an adaptive response. But are you panicking? Are you finding it hard to focus on other things? Are you constantly checking the news to see what the numbers are?” If thoughts about your own health are intrusive and impossible to avoid, you’re likely experiencing above-average anxiety. And while it’s good for us to pay attention to our health and symptoms, paying too much attention is closer to what psychologists call “hypervigilance” and “body scanning,” which tend to be associated with anxiety.
Why does anxiety cause shortness of breath and chest tightness?
More broadly, anxiety can look like a lot of things, says Beth Salcedo, a psychiatrist and the Ross Center’s medical director. “The brain is very powerful. You can see a positive pregnancy test and immediately develop morning sickness when you didn’t have it two minutes ago.” Humans are suggestible, and the more anxious we are, the more suggestible we become. One of the reasons our anxiety might show up as shortness of breath right now is simply because we keep reading about shortness of breath.
But shortness of breath is also tied to the way anxious people breathe, says Salcedo. “People who are anxious tend to breathe a little too fast and a little too shallow, and they blow off too much CO2, which makes them feel dizzy and makes their chest feel tight, and then they begin to gasp for air,” she explains. “If they can relearn how to breathe by breathing in slowly through their nose, counting to four to five seconds and then breathing out just as slowly, and for a longer time, through pursed lips, that forces them to normalize their CO2 levels, which will then alleviate a lot of the symptoms.”
How do I relieve my anxiety-related chest tightness?
There are a number of grounding techniques we can use to slow down a rapid heart rate and/or quickened breathing, say Hirsch and Salcedo. “You can try focusing on something that’s immediately in your environment or count backwards out loud from 100 by threes, because that really gets you to focus and be in the moment,” says Hirsch. If you practice these techniques and your symptoms lessen or disappear, that’s a good sign it was anxiety, and not a physical illness. Another worthwhile technique is progressive muscle relaxation, an exercise that involves tensing and then releasing parts of the body one by one. Hirsch suggests practicing this technique for a few minutes each morning, midday, and night, not only when you’re anxious, so that you’re able to call upon it more readily when you are feeling panicked.
For those with access and prescriptions (taken at the recommended frequency and dose, of course), medication can also relieve symptoms and serve as a litmus test for anxiety versus physical illness. “People who have asthma will get anxious when they start to get short of breath, so they often will feel better if they take something like a Xanax,” says Salcedo. “Whatever is going on, the Xanax should help take the anxiety piece off the table so you can know what your physical symptoms are.”
What if I’m still worried I’m actually sick?
If you’re experiencing abnormal chest tightness, particularly if you think it might be a heart attack, you should not avoid going to the emergency room out of fear related to contracting COVID-19. Hospitals like Mount Sinai in New York are reporting lower-than-average ER visits, likely due to messaging that instructed patients with non-life-threatening symptoms to stay away during the height of the pandemic. But staying away could be very dangerous, particularly in the case of unusual chest tightness.
It’s important to recognize that it’s possible for a person to be both anxious and have a physical illness or condition, says Salcedo. I’ve often felt that doctors rule out all physical health concerns as soon as I tell them I have anxiety, and Salcedo says that kind of dismissal is common. “You have to be your own best advocate when you go to the doctor,” she says.
If your symptoms persist and you’re not sure whether they can be explained by anxiety, Salcedo suggests starting by calling your doctor. “The whole country right now is on high alert,” she says. “The last thing we want anyone to do is second-guess themselves.”
This post has been updated.