Understanding Anxiety

Understanding Anxiety, Neural Correlates, and Mitigating Processes

A few years ago, I received a phone call from my sister in France following the death of my father. The news she shared was not what I was hoping to hear. Blood raced to my head and my heart pounded in anger and frustration. After hanging up I felt like wanting to run or attack; better known as fight or flight. Anxiety, as I knew it, seemed to creep into my chest. No matter what I did, slowing down my breath, and focusing my thoughts on something more pleasant, I simply could not get rid of the feeling. My mind blurred and I could not think logically.

Hopes and expectations I had in helping my mother transition to a safer environment were sunk. I felt as if my world came crashing in on me. Plans I had made to see my mother spend the remainder of her life in the appropriate level of care were now going to be thwarted. My training in mindfulness and meditation (soft belly breathing, emptying the mind of thoughts through pointed concentration on emptiness, and entering a zone of deep relaxation) could not overcome the expressed feeling of desperation. I believed, “my survival is at stake here.”

What happened? Was this reaction a manifest of anxiety and where did it come from? The definition of anxiety is an emotional state characterized by marked negative affect and somatic symptoms in which a person apprehensively anticipates future danger or misfortune. It comes with a “what if” concern and because we can’t know what will happen, we prepare ourselves for the fight or flight to survive. In addition, it can create a storm of thoughts. Anxiety is a survival skill. It keeps humans and animals ready to respond to danger and to threats. Anxiety is a sense of apprehension that shares many of the same symptoms as fear, but it builds more slowly and lingers longer. Paulo Coelho suggested that “Anxiety was born at the very same moment as mankind. And since we will never be able to master it, we will have to learn to live with it just as we have learned to live with storms.” We need emotion to serve a purpose, even when that purpose is hand-wringing despair.

Anxiety will be experienced differently by every individual. There are psychological contributors such as trauma, and learned behaviors from both parental and environmental influences. Social contributions can include isolation, loneliness, a need to be perfect, and having control and certainty. Biological influences are often genetic to the point that researchers suggest that 30-50% of the variation in anxiety disorders occurs due to genetic differences. Anxiety can occur due to brain damage, and having an overactive amygdala that is part of our primitive brain’s alarm system.

I have studied anxiety, and meditation and could give advice to anyone on these subjects. But in the moment of my own dilemma, I was lost to these understandings. We know that thoughts, whether they be positive or negative, can produce a sense we call anxiety. Thoughts, no matter how rational, involve close causal relations and constitutive relations, to beliefs, or beliefs like states of mind, stories, judgments, and narratives of the past. Anyone who has experienced anxiety may know it does not take much to trigger anxiety. We live through images and impactful experiences that are transferred to the physical, behavioral, and cognitive parts of ourselves. In other words, we embody what happened to us and create patterns; mentally, emotionally, and physically.

Because of the experience of my sister’s phone call, my body felt like it was being distorted due to an emotional situation beyond my control. At the time I needed certainty — and there was none to be found. I had trained my mind to recognize different patterns of physical tension and emotion, but what I had learned was clearly not enough. Experience in mindfulness techniques and the relaxation response was not working in the heat of that moment. Even a carefully crafted short-term hedonic experience such as taking a hot bubbly bath, soft lights, incense, and entering a zone of deep relaxation while listening to Koyosan by Deuter would not do the trick.

Stories and conditions that surround us have relevance to what we perceive as threatening and are, subsequently, translated as mood-congruent information followed by activation of the relevant schema of phenomenological, behavioral, hormonal, and neurochemical processes. We organize stories about our past, present, and future. These stories are belief systems that perpetuate bodily and psychological relationships. Stories not only describe past and present life situations; they help us rehearse future actions. Stories coordinated with our memory system in the hippocampus, tell muscles to get ready and then signal them to begin to work. A story is an experience of organized bodily responses. It involves muscular patterns according to Stanley Keleman (1987).

The problem with anxiety is that once the schema or process is “triggered”, it is hard to “shut” off, similar to a broken spigot when the water keeps flowing. Once a leak, always a leak for some people with anxiety. Is it even feasible to imagine shutting the anxiety spigot off when the world around us seems to be falling apart due to a raging pandemic, a lagging performance at work, or a painful condition that does not seem to be letting up?

The malleability of emotions was first emphasized by William James (1884), who viewed emotions as response tendencies that could be modulated in a large number of ways (Cognition and Emotion, 2013). A basic understanding of why we feel what we feel and how we are driven by our emotions can allow us to better handle the toggle that drives us. Negative thoughts that feed our anxiety may linger on long after the initial assault on our emotional well-being. In turn, it is the emotional response to those triggers which causes us to suffer. Eventually, there is a point when anxiety will do us more harm than good.

In other words, emotions are not always helpful—sometimes they can work against us (Parrott, 1993), for example, if negative emotions occur with too forceful of intensity, are chronic, inappropriate, or happen at the most inopportune moments. In those instances, we may need to regulate our emotions, but the process must begin with full acknowledgment of what is happening at that moment.

When I hung the phone up my mind remained preoccupied with the dialogue, the heated exchange, and by my failure to mediate and come to a rightful conclusion. My thoughts were a morass of disorganization. Then there were intrusions of more debilitating ideas. I stayed home that day. The hours following my conversation with my sister ticked by. I had gone from a state of relative peace prior to the phone call to a state of anger, frustration, anxiety, and feeling pain and suffering in every pore of my body. Gradually the tension eased. My body started to feel more relaxed. I could now move freer with less tension. Mental images of doom and the negative feelings associated with those images gradually disappeared as my body became more supple. Finally, the tension dissolved. The important thing to note is I had no control over my recovery from feeling those negative emotions. The spigot was turning itself off on its own! I was able to pull myself back together literally, simply by being and allowing my body to take over.

Following the phone call, how could I resort back to continuing to live a relatively stress-free, meaningful, joyous life in spite of my mother not getting the care, I, as a Physical Therapist thought was best for my mother? What did I need to learn about my anxiety? And what does my past say about my present state of anxiety?

When I was younger I had difficulty transitioning from living in Aruba and then moving to Holland for college at 16. I struggled with Dutch and neuroanatomy. I saw numerous students expelled from the university due to poor academic performance. These were fight-and-flight situations at the time for which I had no solution. Was it possible that years later I was still being haunted by those negative emotional memories that were still playing out in my subconscious mind?

Finally, I resolved to put the phone call on the back burner and stop thinking about the conversation. I was able to restore a sense of feeling “normal” again. In other words, I returned to my “set point”. I experience this as a state of mind and body that I am used to being in every day. It feels familiar and offers me repose and ease in my ability to function optimally in an overall very eventful life. Later that day, I could think more logically without being in the “hot” state I was in earlier. I was now in a better place to be able to resolve the issues and clarify misunderstandings while also reconsidering my priorities and what was more important here; my sister’s emotional well-being. The fact was that she had already taken care of my mother, who had Alzheimer’s, for 3 years. This realization came after I had my initial reaction. Maybe this is a very natural occurrence. Maybe anxiety, for many, evolves into calm in its own time.

Brain and Behavior — What is Biological is also Psychological

The part of the brain that is most often associated with anxiety is the limbic system. (LeDoux, 2002, 2015). This system acts as a mediator between the brainstem and the cortex. Gray and McNaughton (2003) suggest the behavioral inhibiting system or BIS, is activated by signals from the brain stem of unexpected events that signal danger or threat. The danger signals in response descend from the cortex to the septal-hippocampal system. These signals receive a big boost from the amygdala according to LeDoux (1996). This manifests as our tendency to freeze, and experience anxiety, and we may begin to apprehensively assess the situation to confirm if the danger is real. A fight or flight reaction originates in the brain stem and travels through several midbrain structures, including the amygdala, the ventromedial nucleus of the hypothalamus, and the central gray matter.

Are there persons who are more sensitive to anxiety? Can this anxiety be linked to early learning experiences where a sense of control (or lack of it) develops that makes us more vulnerable to anxiety later in life? There is research that suggests we can have anxiety sensitivity. It is thought to be a personality trait that monitors how anxiety is experienced under stress. A strong fear response is thought to initially occur during extreme stress or a true sign of danger, and the emotional response becomes associated with a variety of external and internal cues. The cues act as a conditioned stimulus and provoke the fear response and an assumption of danger when there is none, thus a result in a conditioned response. Some researchers have noted these reactions are associated with differences in the size and nature of the amygdala and can be affected by psychoactive drugs.

Many points to an imbalance in Gamma-Aminobutyric acid (the main calming neurotransmitter) and deregulation of Glutamate, the brain’s main excitatory neurotransmitter responsible for parts of our learning and memory that create feelings of anxiety. GABA has been nicknamed the “brain police” so named for its regulatory purpose and calming effect. GABA reduces postsynaptic activity which, in turn, inhibits a variety of behaviors and emotions. Adequate GABA is known to help reduce anxiety. This is why drugs such as benzodiazepines, or mild tranquilizers reduce anxiety by making it easier for GABA molecules to attach themselves to the receptors of the neurons.

From a very theoretical neurotransmitter perspective, I was able to restore the Glutamate and GABA relationship while having learned to grasp “eudaimonia”, an Ancient Greek word meaning something like human flourishing or being happy-spirited. Lucky for me, my horrible state of anxiety did not last long. Maybe I am fortunate to have the disposition that I do.

You may not be able to change what happens around you, but how you can change what happens inside your body and brain to help regulate all those processes optimally? If we provide an environment conducive to optimal homeostasis such as getting eight hours of sleep, lots of exercise, and a healthy diet, for example, we end up creating healthier brains and bodies which are more likely to bring us back to our “cool” state. A state which is restorative and conducive to feeling joy, loving-kindness, empathy, deep relaxation, and balance.

Glutamate and GABA have a seesaw relationship where when one is high the other is low. Glutamate is also a precursor to the formation of GABA. Individuals with anxiety struggle with high glutamate and low GABA and can benefit from activities, foods, and supplements that improve the glutamate-to-GABA balance (verywellhealth.com).

In his book Looking for Spinosa: Joy, Sorrow, and the Feeling Brain, cognitive-neuroscientist Antonio Damasio describes how mind and body interact to establish an overall experience of physical and emotional well-being. He describes regulatory processes that maintain a stable, relatively constant internal environment called homeostasis which produces a positive outcome expressed by how we feel. The brain’s regulating mechanism is inherent in its ability to map out what is going on in the body (chemical and hormonal processes such as PH, temperature, blood sugar, etc).

Exercise can be used to decrease the physiological and experiential effects of certain emotions. A growing body of research suggests that aerobic exercise such as running can, in fact, rebalance those neurotransmitters.

Duke university philosopher Owen Flanagan mentions “My feelings and being are fully embodied and involve being in relation with the natural world and with other sentient beings. But my feeling and being in the world are in the world. Not in my head. If my life is only or even mostly in my head, there is a problem a psychosocial problem.”

The stress I experience has been relatively well managed. My life condition is not one of social isolation per the Covid pandemic. I get out into the world climb mountains and run ultra-marathons a few times per year. I have not lost my job or wondered where the next meal is coming from. These are extremely stressful situations that make controlling anxiety very difficult. What I have going for me is a pretty good success record of managing stress. If I get enough sleep, eat well, have control over many aspects of my job, and learn to delay gratification I have a better chance of not succumbing to stress-related anxiety. Stress and the regulation of stress reactions are both in and out of our control to some extent. This is a factor to be recognized and even normalized to the extent that we take a full inventory of our moments of anxiety first and foremost.

The stress response is likened to a cascade of falling parts. The pituitary gland releases a hormone that triggers the HPA Axis, or hypothalamic, pituitary, adrenal axis, and the sympathetic nervous system, and the cortisol-releasing factor or CRF directs our natural fight or flight response. Fear and repeated stressful experiences make our behavior more ridged and harder to change. Chronic activation of these circuits can lead to generalized anxiety and exaggerated fear responses, which in turn can result in negative physical changes in the body.

If the reason for anxiety is to alert us that something is wrong and to propel us to action then it is chronic anxiety that continues after the threat is gone which holds us back from positive action and establishing feelings of contentment. It would be better to have the anxiety end sooner rather than later so that we can suffer less and thrive more, in spite of what goes on around us. The antidote to some forms of anxiety is to encode and recall new experiences and to seek mood-congruent information in order to facilitate the relevant schema away from feeling anxious.

Accessing Your Space