Why Anxiety Is Not Always All In The Mind

Funnily enough, I am just doing a Case Review to help someone work out why they are suffering with quite severe anxiety, and then this pops up in my Inbox today. I thought I’d share it.

I often have to try and explain to patients that anxiety – and depression often come to that – is not always about external worries and circumstances, not even always about what’s going on in your mind. In fact, most times I would say it is biological, not psychological. Of course, psychology, trauma, circumstance, experience etc is going to come into it, but if it is chronic, what else might be going on? It pays to dig a bit deeper….

We all think of anxiety as one of the emotions, like joy or fear. But anxiety isn’t an emotion. It’s a sensation. Helping patients understand this can be transformative.

Anxiety is the sensation you feel when your sympathetic nervous system (SNS) turns on. The SNS can turn on for a whole variety of reasons, including your response to stimuli from the environment, changes in your body chemistry, or your response to your own troubling thoughts. The connection to our own thoughts is the connection we make most readily, but it’s not always the right connection to make. It’s important for us to understand the range of possibilities, so we don’t always connect the sensation of anxiety to our list of life concerns. That will just push us to worry more. Worry is an emotion, and not one that favors good clinical outcomes.

So, how does anxiety work? What should we (and our patients) do when we feel it?

In evolutionary terms, anxiety is the sensation that tells you to stop foraging for food, look around, and see if you’re about to be attacked by a predator. So it’s pretty important for survival. This is what you see herds of deer doing when you drive past a field where they’re grazing.

Both auditory and visual stimulation drive activation of the midbrain (mesencephlon), which drives the SNS response. Visual stimuli arrive at the superior colliculus of the midbrain. Auditory stimuli arrive at the inferior colliculus. These are essentially two bumps on the back of the midbrain. When you get a visual stimulus (you see movement in your peripheral visual field while you’re grazing) or an auditory stimulus (you hear a twig snap), these stimuli trigger the SNS. The signals stimulate your SNS before you’ve registered anything consciously. But you do feel the sensation of your SNS turning on. That’s anxiety. “I feel like I’m not safe. I’ll pick my head up and look around for a predator.”

The problem is that your SNS can be turned on by other factors, such as NFkB [NF Kappa B – an inflammatory chemical, Ed] in the CNS [central nervous system, Ed] driving corticotrophin releasing hormone (CRH) from the hypothalamus, which drives SNS activation. So, CNS inflammation can make you (and your patients) anxious, in a way that has nothing to do with cognitive or emotional content. It’s just neurochemistry. [In other words, neuroinflammation can be a cause of anxiety – Ed].

What do we typically do when we feel anxious? We connect the experience of anxiety to our list of cares and woes. We think we’re anxious “about something.” But much of the time, there is no “about.” When we assume anxiety is always anxiety about something, we confuse the sensation of anxiety with the emotion of worry. This mistake sends us in the direction of stirring the pot on our emotional content. Not a good idea. Keep your sensation of anxiety away from your emotional life. Putting them together doesn’t help either one.

The better approach would be to recognize that anxiety may be a signal about biology, rather than psychology. This directs us to a different set of questions and approaches to managing anxiety. We could get curious about food, sleep, stress chemistry driving inflammation [eg. high cortisol – Ed], lack of exercise, or other primarily biological mechanisms [hormones, nutrient deficiencies, neurotransmitter imbalances, histamine, pyroluria, for a few examples – Ed]. These questions are more likely to identify sources of biological upregulation of anxiety and therefore yield lines of inquiry that address and reduce the sensations of anxiety.

Helping your patients frame their anxiety in this way gives them an important tool for understanding, managing, and mastering their anxiety.

Dr Yanuck

2 Replies to “Why Anxiety Is Not Always All In The Mind”

  1. That’s actually a really great way of explaining it. I’d always thought of Anxiety as a an emotional feeling, not just a sensation. That’s actually quite interesting and like you say, could mean dealing with it a completely different way. And not always in our heads! As we so hate always being told that the problem stems from something internal that we can fix. We could discuss this for hours!

  2. Glad it made some sense for you. I am always explaining it. It’s just not always about how you ‘feel’ it’ can be physiological like a change of hormones or whatever. Makes it easier to think you can do something about it too, more hopeful!

Leave a Reply

%d bloggers like this: