Anxiety: How to Fight Your Own Brain

Anxiety is one of the most prevalent symptom clusters and disorders in the United States and elsewhere, especially following the COVID-19 lockdowns and mandates (Santomauro and colleagues, 2021). Santomauro and his team found a global prevalence rate of 4,802 diagnosed anxiety disorder cases per 100,000 people, an increase of 26 percent since the pandemic began. Daly and Robinson (2021) found that, at the height of the pandemic restrictions in April 2020, 21.4 percent of U.S. adults reported high levels of anxiety, and this rate remained above 8 percent until the end of that year. Adolescents and young adults are especially prone to anxiety (Hawes and colleagues, 2022), with nearly half of young American women surveyed during the lockdowns meeting the criteria for anxiety disorders.

Anxiety is caused by multiple factors, but neuroimaging studies indicate that anxious experiences are associated with increased activity in the amygdala—the brain region linked with strong emotions such as anger and fear (Rauch and colleagues, 2003). These neurological reactions may be associated with early childhood adversity and additional adverse experiences in adolescence (Sicorello and colleagues, 2021). Indeed, Sicorello and his team found that adverse events occurring during sensitive developmental periods— especially ages 3-4 and ages 16-17—are particularly associated with the type of chronic amygdala activation observed in anxiety and post-traumatic stress disorders. In essence, then, our experiences can help program our brains to be vulnerable to anxiety.

What does this mean for people dealing with anxiety problems? You are essentially fighting a battle against your own brain. Stimuli and events that would likely not cause stress for other people may create strong anxiety for you. You may panic when your account balance is low, when you cannot sleep, when someone cuts in front of you in traffic, or when a family member or close friend is angry with you. Your amygdala is so conditioned to be anxious that it habitually starts up in response to everyday events.

What do we do about this? There is some good news! In their meta-analysis, Cuijpers and colleagues (2014a) found that, compared to a waitlist control condition, cognitive-behavioral therapy reduced generalized anxiety symptoms by 84 percent of a standard deviation. Metacognitive therapies and other modalities addressing the intolerance of uncertainty may also reduce generalized anxiety (van der Heiden and colleagues, 2012). Adding psychiatric medication to psychotherapy has also been found to help reduce anxiety symptoms (Cuijpers and colleagues, 2014b).

It is also important to recognize that you are not crazy and no monster is hiding under your bed. Anxiety disorders are both experientially and biologically based, and regardless of the source of the problem, the manifestation involves chronic brain activation. The battle is between you and your brain, but it does not have to be one you must lose. Educating yourself on where anxiety comes from, and how it is activated and experienced, may help you deal with it successfully. Understanding your opponent—in this case, your brain—can help you to win the battle.

It is also essential that you not allow stigma associated with mental health treatment to prevent you from seeking care. Indeed, Corrigan and colleagues (2014) found that patients who endorsed such stigma more strongly were less likely to seek help. Psychotherapy is much more widely accepted today than it was 30 or 40 years ago, and the importance of mental health is much better understood than it was in earlier decades. There is no shame in taking medication for a mental health problem; mental health is just as important as physical health, and mental health problems are often associated with physical health symptoms. Not seeking help because of what you fear others might think is tantamount to giving up a key weapon in your battle against your anxiety symptoms and their experience in your brain.

Anxiety is associated with parts of the brain, and treating anxiety involves treating both the symptoms and the brain activation associated with them. You can win this battle as long as you are willing to use the available tools.