Shortness of Breath: Anxiety or COVID-19?

Here's how to tell — and what to do in either case.

By Amanda Capritto
woman with hand over chest

The range of COVID-19 symptoms is vast — patients have experienced fever, chills, body aches, pink eye, dry cough, digestive issues and even a loss of smell — but a few key symptoms have appeared in most patients. One of those ubiquitous symptoms is shortness of breath or chest tightness. 

Unless it's from a stunning view, losing your breath is not a great feeling. If you’ve experienced shortness of breath, chest tightness or both in the last few months, you may have wondered, rightfully so, if your symptom was indicative of anxiety or the novel coronavirus that’s swept the world. 

Here, two pulmonologists and a licensed therapist discuss the differences — and how to bring things down a notch when you’re experiencing anxiety.

Signs It’s More Than Anxiety

Unfortunately, it can be very difficult to distinguish the respiratory symptoms caused by anxiety from those caused by other medical conditions, says Ashley Losier, MD, pulmonologist and instructor at the Yale School of Medicine. 

The key sign: If you have other symptoms of COVID-19, such as fever, chills, loss of sense of smell or dry coughing, that’s an indication that you should call your doctor. (Find the CDC's full list of symptoms here.)

Another differentiating factor is if this is the first time you’ve experienced this kind of sensation. “If you are experiencing shortness of breath or chest tightness for the first time, you should contact your healthcare professional or a local urgent care center for advice immediately,” Losier tells THE WELL. 

Unusual, out-of-the-ordinary symptoms or symptoms that last longer than usual can also be a clue that’s something’s amiss. Patients with underlying pre-existing cardiopulmonary conditions, such as coronary artery disease, asthma or chronic obstructive lung disease (COPD), should contact their physicians to report any symptoms that seem different from their baseline, Losier says.

Signs It Might Be Anxiety

As you may know all too well, the COVID-19 pandemic is an understandable source of anxiety for most people, says Jennifer Possick, MD, a pulmonologist and associate professor at the Yale School of Medicine. And while anxiety manifests in a variety of physical symptoms, shortness of breath and chest tightness are commonly reported.

To pinpoint if your shortness of breath is indeed anxiety-induced, Lia Avellino, LCSW and Director of Head & Heart, at THE WELL, offers these tips:

  • Consider if you've had symptoms of anxiety or panic in the past, and if what you’re experiencing now feels similar. 
  • Identify if your shortness of breath coincides with other symptoms of anxiety or stands alone.
  • Notice when symptoms come on and if they dissipate: Do you notice you're excessively ruminating about COVID-19 when your breathing rhythm changes? Do symptoms come about while you're reading a news article? 

When we panic, Avellino says, our breathing becomes shallow and restricted. “Whether or not we are under a real or perceived threat, our body prepares for fighting against or fleeing from the threat as if it were real,” she explains. 

In other words, your anxiety is trying to help you survive. In the case of shortness of breath, your body is attempting to deliver more oxygen to your muscles so your body has enough energy to react to the perceived threat, Avellino says.

Possick points to the fight-or-flight response that occurs during episodes of acute anxiety: “As part of this, people often breathe more rapidly and more shallowly than usual,” she explains.  “The respiratory rate is faster than usual, and people can experience sensations of chest tightness and lightheadedness.”

Your anxiety is trying to help you survive.

Two Techniques to Relieve Anxiety-Induced Shortness of Breath

The overarching goal is to help your nervous system slow down enough for your brain to make rational decisions, Avellino says. If you’re experiencing anxiety-induced shortness of breath or chest tightness, Avellino recommends two main tactics: the “name-it-to-tame-it” strategy and grounding techniques. 

“Name it to tame it” is a psychological concept that involves identifying the deep fears underneath your anxiety and directly facing them. “Anxiety protects us from feeling our more painful and messy emotions, so facing those emotions may help reduce your anxiety,” Avellino explains. 

To fully allow yourself to face a fear, such as contracting COVID-19, spend some time noticing thoughts, sensations and emotions associated with your fear.

Grounding techniques take the opposite approach: The intention is to detach from your overwhelming feelings. “When we focus out on the external world, rather than what is going on within us in heightened moments of stress, we can temporarily detach ourselves to bring us back to the present moment,” Avellino notes.

Some examples of grounding strategies include:

  • Play a “categories” game with yourself. Try to think of types of dogs, classical musicians, state names, cars, TV shows, sports, songs or European cities.
  • Describe your environment using all your senses. Think of the color of the walls, the type of wood the table is made out of, the scent or aroma, the temperature, the lighting and the background noise.
  • Recite the alphabet backwards. 
  • Notice every part of your body, from your toes to your head, by slightly moving each part: Wiggle your toes, roll your ankles, bend your knees, etc. 

Avellino recommends practicing grounding strategies when you are not under stress so that they’ve already been integrated into your daily life and are more accessible to you when you’re under stress. (Note that if you can't breathe, even after trying one of these techniques, contact a healthcare provider ASAP.)

If you’re pretty certain that your chest tightness is anxiety — but anxiety is still new and foreign to you — Avellino emphasizes that anxiety is a normal response to an unusual situation, like the COVID-19 pandemic. "Anxiety is just our bodies' way of letting us know to pay attention to it,” she explains. “It doesn't always mean that something is wrong."

Looking for extra support during these trying times? Lia Avellino, LCSW, leads twice weekly digital Support Circles — "real talk" spaces that allow you to purposefully engage with others and work through issues that are meaningful to you — that are open to all. Learn more and sign up here.

PLEASE NOTE: If you are experiencing signs of a respiratory infection or COVID-19 (fever, cough, shortness of breath, and/or intense fatigue) please contact your primary care physician. If you have a fever above 102, difficulty breathing and confusion, or you are high-risk and develop any symptoms, call 911 or contact your nearest emergency room for safe arrival instructions.


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