What happens in your brain when you are anxious?

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Calming yourself down is easier than you think.
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In last week’s column, I shared the four successive clinical stages of anxiety: a perceived threat, the feeling of fear and worry, the attempt at avoidance and the final long-term, ingrained anxiety disorder.

Today, I would like to describe what happens to our bodies and our brains when anxiety hits us. If last week’s column was the “why,” today’s column is the “how” of anxiety.

The human body has an excellent “fight or flight” response when confronted by a threat. I would add a third response: fight, flight or freeze, since anxiety can also make us become socially isolated and emotionally frozen.

The specific brain structure that determines that something is fearful and a threat is called the amygdala. It also interacts with the motor aspects of the periaqueductal area of the brain, telling us we should flee.

At the same time, parts of our endocrine hormone system (the hypothalamus, pituitary and adrenal glands) release cortisol, called the “stress hormone.” Continued activation of cortisol has negative short- and long-term effects. These include impaired cognitive functioning, increased blood pressure and a decreased life expectancy.

Anxiety disorders with a strong “worry” component, such as an obsessive-compulsive disorder, may have a slightly different brain circuit of action than other anxiety disorders.

It is interesting to note that the section for “obsessive-compulsive and related disorders” is separate from, and follows, the section on “anxiety disorders” in psychiatry’s latest edition of its diagnostic manual, the DSM-V. In everyday clinical practice, an anxiety disorder is often diagnosed with depression and/or a second anxiety disorder.

What are some of the brain’s neurotransmitters that are involved with anxiety?

GABA (gamma-aminobutyric acid) is an important neurotransmitter that inhibits and regulates the amygdala. GABA is also an important ingredient in medications, such as benzodiazepines, used to treat anxiety.

Benzodiazepines are used by 5 percent of the general population and by 10 percent of elderly females to calm the feelings of anxiety. They include such well-known drugs as Xanax, Klonopin, Valium and Ativan.

Anti-depressants are also used to reduce anxiety/fear symptoms in disorders as general anxiety disorder, panic disorder, social anxiety disorder and PTSD. Buspar, SSRI’s, such as Prozac and Luvox, and SNRI’s, such as Cymbalta, are commonly prescribed. Beta blockers, commonly used for hypertension, are also used for “stage fright,” and are often used by many professional musicians before a concert.

Psychotherapy and cognitive behavioral therapies are also used in conjunction with medication to treat anxiety disorders. Certain anxiety disorders, such as specific phobias, are best treated by cognitive behavioral therapy and exposure therapy, for more effective, long-term results. These treatment techniques are also used for individuals with social phobias and agoraphobia (a fear of public places and crowds).

In next week’s column, I will address what aspects of society and culture can make a person anxious.

Philip Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a post-doctoral degree in clinical psychopharmacology. His year-long internship in clinical psychology was served at The University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column for the Knoxville News Sentinel’s online website, knoxnews.com. He can be reached at (865) 330-3633.

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