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The Pain of Worry: The Anxious Brain

Anxiety occurs due to an imbalance between emotional and inhibitory brain parts.

Anxiety is excessive worry or concern. It gets the body ready for action to fight danger. But what if no danger exists? Then, anxiety compels the sufferer to keep running from an invisible monster to an unknown destination. If you are a champion in the anxiety marathon, you know how this makes you unfit in other aspects of your life such as work, school, and relationships. It is common to suffer from both anxiety and depression.

Anxiety is different from fear. Fear is directed towards a specific stimulus; when the stimulus is gone, so is the fear. Anxiety does not go away when the stimulus is gone because sometimes there is no stimulus! Particularly with the common generalized anxiety disorder, it is just a vague sense of intense worry and certainty that something dangerous will happen.

What is happening in the brain to magnify these infrequent threats? There seems to be an imbalance between the emotional and thinking inhibitory parts of the brain. Typically, the prefrontal cortex inhibits the emotional amygdala. The amygdala is a brain structure that is always on the lookout for threats so it can quickly react. You need it to be in full operation during a dangerous situation. However, in non-threatening situations, a healthy prefrontal cortex inhibits the lower parts and puts the brakes on the accelerated speed of the amygdala.

In the anxious brain, the amygdala is hypersensitive and the connections with the PFC become weaker. So, the amygdala generates too many false alarms such as perceiving a benign situation, comment, evaluation as very threatening. At the same time, the prefrontal cortex is ineffective at inhibiting the amygdala’s diarrhea of thoughts (see Inside the Thinking Maze of Anxious Minds). This process causes great pain as evidenced by activating brain pain areas such as the anterior cingulate cortex.

Anxiety also has detrimental effects on memory. Anxiety causes great stress to the sufferer and stress shrinks the hippocampus. This region is crucial for processing long-term and contextual memories. But here is the unfortunate part: All types of memories become limited except memories that support the anxiety, trauma, or stressor. In other words, the only memory files available for immediate conscious access are the ones of failure, threat, and danger. And the memories of success, certainty, and safety become inaccessible or buried deep in the basement.

Genetics and the environment interact to position the brain in this vulnerable position. Environment refers to early adverse childhood experiences such as abuse, a loss of a parent, or parents’ divorce. These painful experiences leave their mark for the rest of the child’s life. A horrible early experience convinces the brain to rewire and to tip the safety/danger ratio in favor of danger. Different brain areas are sensitive at different times of development: for example, the hippocampus is vulnerable much earlier than the PFC.

Research has also demonstrated the involvement of many genetic mechanisms. Anxiety disorders run in families and identical twins have a higher concordance rate than non-identical twins. Certain inherited personality types seem to be at a higher risk of developing anxiety such as Highly Sensitive Personality.

We know so much about how anxiety works and its psychobiological basis. The plethora of research led to discovering effective treatments for different anxiety disorders. For example, there are very effective treatments for phobias, social anxiety, and panic disorders. Anxiety pushes the sufferer to feel like life is a steep cliff, and they seem to be consistently standing at its edge.

If you know someone suffering from anxiety, let them know that they don’t need to live in psychological pain. Successful treatments save the person’s relationships, career, and self-confidence. Take the first step today!

More from Marwa Azab Ph.D.
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