Therapies & Solutions

Somatic Anxiety - Treating the Body vs. the Mind

Micah Abraham, BSc

Written by

Micah Abraham, BSc

Last updated October 10, 2020

Somatic Anxiety - Treating the Body vs. the Mind

Somatic anxiety is a name for the physical, as opposed to “cognitive” or "mental" manifestations of anxiety. People who react to anxiety mainly in a physical manner experience primarily somatic anxiety, whereas people who react to it mainly mentally experience primarily cognitive anxiety.

This article will explore how cognitive symptoms of anxiety differ from somatic symptoms, how you can tell whether your anxiety is primarily somatic or primarily cognitive, and how to decrease your somatic manifestations of anxiety.

Somatic vs. Cognitive Anxiety Symptoms

Anxiety can be marked by somatic or cognitive symptoms, though both types of symptoms may be present. Physical symptoms often affect how easy your anxiety is to treat and possibly what is done to treat it.

The word “somatic” is derived from Greek and means “of the body,” and specifically the body which is distinct from the mind. Somatic illnesses are sicknesses of the body more so than they are of the mind, meaning that automatic physical responses are more a cause of anxiety than cognition or thinking in people whose anxiety is mainly somatic in its presentation.

Primarily somatic anxiety is marked by somatic events such as:

  • Stomach ache
  • Headache
  • Muscle tension
  • Muscle aches
  • Increased heart rate
  • Rapid breathing/Hyperventilation
  • Sweating
  • Shaking
  • Nausea

This is not an exhaustive list by any means, and the reality is that in some cases the anxiety can cause symptoms that are incredibly unusual, such as nerve symptoms, trouble swallowing, feelings of lumps, unusual pains, and more. Anxiety can have an intense effect on the body, possibly leading to issues that create further anxiety.

On the other hand, primarily cognitive anxiety implies that the above physical symptoms are present to a lesser degree and that mental symptoms of anxiety happen most often without concurrent physical effects. The cognitive symptoms of anxiety include:

  • Fear
  • Unease
  • Repetitive negative thoughts
  • Difficulty concentrating
  • Confusion
  • Depersonalization

Both types of symptoms may be present, but it is thought that in most cases one or the other type of symptom is predominant. Additionally, it should be noted that somatic symptoms can cause cognitive symptoms and vice versa. For example, an anxiety headache might lead to further negative thinking creating possible reasons why the headache is there in the first place. This can lead to further somatic symptoms such as sweating or shaking, causing a potential panic attack. For this reason, it is important to find out if your anxiety symptoms are primarily somatic or cognitive, and take measures to address them specifically.

The Cognitive-Somatic Anxiety Questionnaire (CSAQ)

When it was proposed that a given case of anxiety could be defined as either somatic or cognitive, the Cognitive-Somatic Anxiety Questionnaire or "CSAQ" was born. The CSAQ is a survey divided into two scales of 7 items that measure cognitive and somatic symptoms in order to conclude what type of treatment a person should receive.

However, it should be noted that there is conflicting evidence concerning the effectiveness of the questionnaire in measuring or differentiating the types of anxiety. One test of the CSAQ yielded results that challenged its validity, whereas another study wherein treatment of subjects was based upon the results of the questionnaire showed marked improvement. This will be discussed in the following section. It has been suggested that the questionnaire be expanded to better encompass the multidimensionality of anxiety as a disorder.

Somatic Anxiety Treatments

Treating anxiety based on whether it is primarily somatic or cognitive has been shown to have beneficial effects, especially because both types of anxiety involve different types of challenges.

In a test of the predictive validity of the cognitive vs. somatic anxiety distinction from the Pavlovian Journal of Biological Science, 24 subjects who were shown to have either predominantly somatic or cognitive anxiety were either given treatment that addressed or “matched” their primary mode of anxiety, or treatment that addressed the opposite mode. The 12 subjects who were given “matching” treatments reported significantly fewer anxiety symptoms than the 12 subjects who were given “mismatched” treatments, indicating that treatment based on the mode of anxiety can be more effective than treatment that disregards it.

Treating somatic anxiety symptoms can be difficult, and often involves some type of comprehensive strategy that focuses on what it is like to live with anxiety symptoms. The more physical the symptoms are, the less some of the cognitive treatments will work.

However, even small changes can make a big difference in your somatic symptoms. Some examples of changes you can do today include:

  • Massage Massages decrease somatic anxiety by relaxing muscles and relieving built up tension that can cause muscle aches. It also tends to put people in a more relaxed frame of mind, which helps to prevent cognitive anxiety symptoms from interacting with somatic anxiety symptoms and causing panic attacks.
  • Exercise Exercise decreases body based anxiety in that it alters the chemical composition of your body by causing your brain to release more of the chemical serotonin. Serotonin is a happy chemical that compensates for the hard work your body does when it exercises and makes you feel better in both body and mind.
  • A Healthy Diet Eating healthily keeps somatic anxiety at bay by helping you to maintain your ideal body weight and strengthening your heart, lungs, and muscles. This means that your body doesn’t have to work as hard when your blood pressure rises or your breathing rate increases so that your anxiety symptoms do not cause as much physical or mental distress.
  • Gentle Yoga Yoga is a particularly effective form of exercise for sufferers of primarily somatic anxiety in that gentle yoga keeps your heart rate fairly low while still stretching and flexing your muscles, keeping them loose, limber and ache free.
  • Zen Meditation You might think that meditation would only be good as a treatment for the cognitive symptoms of anxiety, but it is also beneficial in addressing somatic symptoms. This is because Zen meditation is largely focused on bodily discipline: teaching your body to do what you ask of it and learning to let go of any discomfort you might feel. Zen meditation also trains you to breathe steadily and evenly, which can help you to overcome the somatic anxiety symptom of rapid breathing or hyperventilation.
  • Healthy Sleeping Habits Healthy sleeping habits address somatic anxiety by giving your body time to fully relax, recharge, and replace old and tired cells with healthy new ones. To improve your sleeping habits, try going to bed at a regular time every day, and create a comforting bedtime ritual such as drinking a caffeine-free chamomile tea or listening to soothing nature sounds. Turn off all lights and electronics to ensure that you get the deepest sleep possible.

These are only the first steps in reducing anxiety, but f you can decrease your physical symptoms a small amount you may find that your overall anxiety levels become easier to control.

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

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Where can I go to learn more about Jacobson’s relaxation technique and other similar methods?

– Anonymous patient


You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process.

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