Anxiety: a feeling of worry, nervousness, or unease about something with an uncertain outcome.
Click here for an excellent lecture by Alan Watts about worry or read the excerpt below or read this part of it below:
“The doctor tells you that you have to have an operation. And that has been set up so that automatically everybody worries about it. But since worrying takes away your appetite and your sleep, it’s not good for you. But you can’t stop worrying and therefore you get additionally worried that you are worrying.
And then furthermore because that is quite absurd and you're mad at yourself because you do it… you are worried because you worry because you worry. That is a vicious circle.”
Swap that first line of the above paragraph for either of the following:
You notice a symptom in your body and you think that you might have a disease.
You consider that doing something might kill you or a loved one.
You think something you have done (sometimes you can’t remember or are not aware of doing it) is going to make the people you love decide they don’t love you anymore.
You are just not good enough at something or everything.
You have an overwhelming feeling of panic and despair, with no single reason as to why.
And in my opinion, you have a pretty good definition of Generalised Anxiety Disorder (GAD). An increasingly common condition, GAD can cause both psychological (mental) and physical (felt in the body) symptoms.
An attack of anxiety is when you believe one of the above is true (although it may take different forms) and the thought (with all of the physical and emotional responses to having the thought) carries on repeatedly and often furiously in your head until you start to truly believe in some pretty awful scenarios. Often the end result of the scenario in your mind is your death, another person’s death, or doing something so unforgivable that you will have to take your own life.
Sometimes though anxiety is not so specific. It comes with an overwhelming feeling of panic and despair, with no single reason as to why. It’s the fear of losing control; the feeling of utter uncertainty in everything you do and even the fear of dying.
I sometimes refer to it as it being like a record that has gotten stuck: your mind keeps repeating the same thought over and over in a loop, but that thought is so frightening it makes it difficult to breath and difficult to do anything else.
Anxiety is a fear that cannot be located in space and time” – Dr John Kenworthy from his video – Your Brain on Stress and Anxiety
What is the brain up to?
3d rendering illustration of neurons.
In his article, The Neuroscience of Anxiety Disorders (1), Dr Mathew Mackinnon, MD explains what is actually happening in the brain when we are caught in the grip of GAD.
What is happening in the brain?
Dr Mackinnon describes a few characters that are involved in the brain when it experiences anxiety, which I have simplified further. Click here for a helpful diagram.
Amygdala – the radar gun
An emotional radar gun for internal and external experiences.
It takes in the events that are happening (inside and out) and it sends emotional messages to the other brain systems that then start physical responses such as heart rate, breathing and blood pressure and we experience conscious anxiety (anxiety that we are immediately aware of physically).
It has direct inputs and outputs to a large number of structures in the brain and so it has huge conscious, subconscious and unconscious control over our lives. It outputs messages to the brainstem and hypothalamus, both of which influence the heart rate, breathing and blood pressure.
The insula – the internal sensor
This structure processes the physical happenings in our body such as heartbeat, breath, gurgling stomach or full bladder.
The medial prefrontal cortex (mPFC) – the emotional sensor
It is turned on when we consciously or subconsciously (in other words whether we are aware of them or not) experience emotions, negative moods or when we look at our own thoughts and feelings.
The aneterior cingulate cortex (ACC) – the signaller
Manages how we focus our attention on our emotional (feelings), cognitive (understanding) and sensory (touch, hearing, sight) experiences. The ACC monitors and signals the need to exert conscious control over our emotional, cognitive and sensory experience.
The lateral prefontal cortex (IPFC) – the Manager
The lPFC is responsible for directing the mind to an object, conscious decision-making, and working memory. It allows us to remember a phone number long enough to dial or to follow a complicated set of directions.
Normal scenario
Dr Mackinnon gives the scenario of going on stage to speak to a large audience, which would make anyone feel anxious, even though it is unlikely you will be stoned to death for being awful.
Your radar gun (amygdala) takes in the sensory information about the crowd (you feel their presence, maybe smell their sweat, hear them talking and taking seats), this triggers sensory feedback (in the form of heart racing), which is sent to your internal sensor (insula). It is set off and starts sending out communications too. Your radar gun and your internal sensor are now shouting quite loudly to your emotional sensor (mPFC) and signaller (ACC). Your emotional sensor and signaller take these communications and decide whether to send the message on to your conscious mind for it to make a decision about how to react. If they decide that they should continue the message, they force the message out loudly through the gate from your unconscious mind to your conscious mind, and you start to consciously think about how things may go wrong (you forget what to say, you embarrass yourself, you can’t stop your face going red or your hands shaking, people will laugh). As you consider these options, your heart beats faster, you may begin to sweat and your fear increases.
The role of the conscious mind
Here is where your conscious mind can step in. If you know how to do it, you may take some deep breaths that allow your heart rate to come down and your other physical symptoms to lesson. By bringing your attention to your breath, the sound and feeling of the air coming in and out of your nose, to the feeling of your bum sitting on your chair, by looking out of the window and watching a tree moving instead, you take your experience away from the panic and fear, and back to the sensory experiences of your body to quieten the messages so that you can allow the Manager (IPFC) to assess the situation in a reasonable, calm way. You can recall memories of times when you were in a similar situation and it turned out ok, nobody died the last time you spoke in public and therefore it’s not likely that that will happen now, in fact, you may even remember the really positive feelings you’ve felt after being so brave in the past, like relief and pride.
The Manager uses understanding from events outside of the one you are experiencing now to judge how bad this situation is and whether it’s time to panic. If it decides that there is no need to panic, it sends messages to the emotional sensor and signaller to quieten them down. They listen to the manager and they use different methods of communication to tell the radar gun to stop sending so many messages about the current situation because it has been evaluated and all is under control by the Manager. Your heart slows down, your worry is under control and you are able to give your presentation (or go on the plane, or teach the class, or speak to the person you are having trouble with).
Anxiety disorder
“Patients suffering from a wide array of anxiety disorders demonstrate increased grey matter in the amygdala/Emoter.” (3)
Grey matter is composed of neurons that send electrical and chemical messages within the brain. This means that people suffering anxiety disorders have an overactive amygdala or radar gun. If you had it in childhood, it is likely to continue into adulthood and to develop into a disorder if there is no intervention.
Patients with anxiety disorders also consistently have hyperactive internal sensors or insulas (4) and decreased grey matter in the emotional sensor (mPFC) and signaller (ACC).
In the example above, you have used some basic mindfulness to overcome your anxiety by engaging the Manager in the discussion without panic. When you have an anxiety disorder, this may not be possible because of the following:
The overactive radar gun and the internal sensor are more sensitive to the sights and sounds of the audience and therefore, shout louder than normal, giving you a bigger fright. This loud message is delivered to a smaller than average emotional sensor and signaller. This creates a perfect environment for panic and chaos as the sensors make you feel more anxious and the signallers who could usually calm it all down are not loud enough to be heard.
One thing that is clear is that there is no decreased activity in the role of the Manager in a person with an anxiety disorder. This a positive thing because it means that no matter how extreme the feelings of anxiety are, the Manager can control it if it is given enough quiet to make an executive decision.
In a team full of emotional people, the Manager can be the voice of reason that makes the decision not to panic about a particular situation by properly assessing the danger and having the skills to quieten down the employees who are overreacting to the situation. However, the Manager can be given to panic if all of the team members are convincing enough and loud enough about the threat. As Dr Makinnon says, “It’s all a matter of magnitude.”
What can help?
Cognitive behavioural therapy (CBT), mindfulness, medications, and many other treatments can help to re-address the imbalance in communication within the brain.
CBT has been shown to increase the ability of the Manager, the emotional sensor and the signaller to stop the intensity of the feedback from the hyperactive radar gun and internal sensor. (5).
Selective serotonin reuptake inhibitors (SSRIs) are a first line treatment in anxiety disorders. Their use has been shown to decrease activation of the amygdala/Emoter during anxiety producing situations (6).
And finally, mindfulness meditation activates the Task-Positive Network (TPN) or the part of the mind that is active during the attention-demanding tasks (reading, classifying pictures, opening and closing their hands).
The TPN includes the Signaller and the Manager and is engaged during present-moment awareness tasks.
The positive effects of mindfulness meditation are thought to be a result of increased control over the radar gun and internal sensor hyper-reactivity. The cognitive (understanding) control over these anxiety-generating regions of the brain is believed to be from an increased collaboration between the Manager, Emotional Sensor, and Signaller. (7)
Just eight weeks of mindfulness-based stress reduction (MBSR) training can decrease the physical volume of the amygdala/Emoter (10).
Thus, mindfulness seems to work both at the source and at the control centres for anxiety processing.
So the next time you are feeling especially anxious, remember the lessons of the anxiety circuit. Take three deep breaths and engage your lPFC/Manager to reassess the situation. Do not look away from the worst-case scenarios. Instead, look deeply into them and examine your survival in spite of each one.
Communicate this knowledge of resilience (that you will survive and that nothing life-threatening will happen) to your mPFC/Emotional Sensor and ACC/Signaller and allow them to quiet the churning waters of your insula/Internal Sensor and amygdala/Emoter.
How do I learn how to do this?
You can see all of the treatment options that the NHS Scotland offers click here or at NHS Choices in England click here and your first port of call should always be your GP, particularly if you are concerned about physical symptoms or you are considering harming yourself.
There are many private CBT practitioners and therapists that you can find in your area – please make sure that the person is someone with a good reputation and who is a specially trained and accredited therapist.
Learn more about yoga, relaxation and meditation (sometimes referred to as mindfulness). Go to your local class, workshop or course and speak to your yoga teacher. Even if your class is mostly physical, most yoga teachers meditate every day and will be able to tell you about their practice. There are numerous mindfulness courses available online and in your local area.
There are many groups and websites that have self-management resources (including workbooks and telephone helplines). Click here for more information.
Talk to someone about it. It can be difficult to talk to your loved ones about what you are experiencing, but you may find some family members or friends also experience the same thing. It is best to speak to someone who has experienced anxiety and has developed ways of managing it or someone who is trained in CBT like a coach or mentor.
I sometimes personally write about my anxiety – I don’t know if I have a disorder, but all of this made sense to me and I have had times when I have been lost for a couple of months in the grip of an anxiety attack. The one thing that started getting me out of it the last time was talking to a couple of friends who I knew would understand. Strangely, and thankfully, a very close friend of mine suffered the same thing around the same time a couple of years ago and we were able to share what we were anxious about (sometimes it’s pretty specific, and weird and when you talk about it, you realise how unreal the thing you fear actually is.) The reason I write about it and talk about it is so that hopefully, it can help other people who have or are experiencing the same thing. It really helped me to understand what is happening in my brain.
Of course, yoga and meditation have been instrumental in helping me to manage my feelings of anxiety. I truly believe that my yoga practice (including physical asanas, meditation, self inquiry and taking action to be a better human being) is helping me to notice the signs when the record starts, press pause, have a little chat with all the above named characters and convince myself that the thing I am afraid of is not true and that I am a good person who deserves to be happy. I don’t know if it is because of awareness or not, but these days, instead of it being some sudden physical problem, my anxiety is much more clear cut – it’s about the things I am really afraid of – that I am not good enough at something or just in general. Sometimes a quick chat with someone I trust about what I am afraid of also helps to convince me that I’m doing just fine too. So if you haven’t heard it recently, or you haven’t said it to yourself, you are doing just fine, you’re a good person and you deserve to be happy.
Recommended books
Drive-Thru Succcess by Jenny Copeland – a book of practical exercises based on the best personal development programmes and philosophies in the world.
Living Your Yoga by Judith Hanson Lasater, PhD, PT
Joyful Wisdom by Yongey Mingyur Rinpoche – Buddhist scholar and teacher Yongey Mingyur Rinpoche explores the role of positive thinking and how to overcome anxiety in everyday life.
Meditations to Heal Your Life by Louise Hay – insights offering meditations and practical knowledge to apply to your day-to-day life.
Taming the Tiger by Akong Tulku Rinpoche – based on twenty years’ Buddhist teaching in the West, this book aims to help anyone seeking the truth about suffering and happiness and includes exercises, meditations and relaxation techniques for body and mind.
The Power of Now by Eckhart Tolle – Surrender to the present moment, where problems do not exist.
Silence: The Power of Quiet in a World Full of Noise by Thich Nhat Hanh – Buddhist monk and Nobel Peace Prize nominee Thich Nhat Hanh explains how mindfulness is the practice that stops the noise inside.
Apps
Pocket Yoga
Headspace
Audible
Yoga
References
2. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5.
3. Baur, V., Hänggi, J., Langer, N., & Jäncke, L. (2013). Resting-state functional and structural connectivity within an insula–amygdala route specifically index state and trait anxiety. Biological psychiatry, 73(1), 85-92.
4. 2. Etkin, A. (2010). Functional neuroanatomy of anxiety: a neural circuit perspective. In Behavioral neurobiology of anxiety and its treatment (pp. 251-277). Springer Berlin Heidelberg.
5. Carvalho, M. R. D., Rozenthal, M., & Nardi, A. E. (2010). The fear circuitry in panic disorder and its modulation by cognitive-behaviour therapy interventions. World Journal of Biological Psychiatry, 11(2_2), 188-198.
6. Arce, E., Simmons, A. N., Lovero, K. L., Stein, M. B., & Paulus, M. P. (2008). Escitalopram effects on insula and amygdala BOLD activation during emotional processing. Psychopharmacology, 196(4), 661-672.
7. Farb, N. A., Anderson, A. K., & Segal, Z. V. (2012). The mindful brain and emotion regulation in mood disorders. Canadian journal of psychiatry. 57(2), 70.