One in five Americans has experienced an anxiety disorder in the past year. Given how very common anxiety disorders are, the discomfort they cause, and the degree to which they can impair quality of life, it’s not surprising that there has been a great deal of work in trying to understand where they come from, and what we can do about them.
In this article, we’ll look at our understanding of their causes.
Because anxiety affects so many parts of a person, including an experience of the mind as well as many physical processes such as heart rate, theories of anxiety range from the medical/biological to the psychological.
Let’s begin with some of the more biological views. Some focus on the anatomical aspects in the brain, while others are derived from understanding the chemical transmitters affected by medicines for anxiety.
Biological theories which focus on the role of chemicals and anxiety come from many sources, among them studies from the 1960s showing that infusing the chemical lactate intravenously could cause panic attacks and that people varied in their vulnerability to having this response.
Giving an antidepressant which blocked the breakdown of chemical transmitters known as norepinephrine and serotonin prevented the panic response. Findings such as these were among the first to show a connection between chemicals and the psychological experiences of anxiety and panic, and, along with later work, led to the use of some antidepressants, which increase norepinephrine and serotonin, as treatments for anxiety disorders.
Other studies have focused on GABA, a neurotransmitter which quiets the activity of neurons (brain cells). Some studies have found decreased numbers of receptors for GABA in persons with GAD. The benzodiazepines, or Valium-like tranquilizers, act by enhancing the activity of receptors for GABA.
The more anatomically oriented studies have pointed to high levels of activity in a portion of the brain known as the amygdala, which is crucial to regulating emotions, including fear and memories of anxiety-laden events. Others suggest a kind of dysfunction of coordination between the amygdala and the prefrontal cortex, a part of the brain involved in more cognitive processes such as organizing thoughts, thinking ahead to the future, and social behavior.
Many treatments for anxiety can be viewed as decreasing activity in the parts of the brain involved in becoming sensitized to fear, expression of fear, or memories of anxiety-producing events.
The medical view emphasizes that a number of medical illnesses can produce anxiety symptoms, which decrease when the condition is treated. Among these are abnormal heart rhythms, hyperthyroidism, asthma, and some forms of epilepsy. Since anxiety can arise from medical conditions, the implication may be that it has biological underpinnings.
The psychological understanding of anxiety has also been formulated several different ways, depending on whether the emphasis is on disordered thinking processes, learned behaviors, or processes of the mind envisioned in psychodynamic therapy.
In cognitive behavioral therapy, or CBT, which may be the most effective non-medicine approach, anxiety is thought to result in part from incorrect beliefs or ways of thinking. Among these are processing information selectively with excessive focus on threatening aspects of experiences. Others include inaccurately minimizing the degree to which one has control over feelings and situations.
Therapists work with a person with anxiety to re-think some of these assumptions and ways of seeing the world.
In behavioral theory, anxiety is considered to be what is known as an unconditioned response, that is, a built-in response to threats. (Other examples of unconditioned responses would be quickly pulling one’s hand away after touching a hot plate or jumping when suddenly startled.) These responses can, of course, be useful in the right context.
To behaviorists, anxiety, as an unconditioned response, has inadvertently become attached to non-threatening, neutral stimuli, and the goal is to break this inappropriate connection. One way of doing this is to repeatedly expose a person to the thing or situation which produces anxiety, either using imagery or in real life, so that they gradually become habituated to it, progressively decreasing the anxiety response.
In psychodynamic theories (based on the teachings of the Austrian father of psychoanalysis, Sigmund Freud, and others), anxiety is a message that there is an imbalance among the three facets of personality: the id, an unconscious part which harbors instinctive sexual and aggressive drives, the superego, which represents morality, and the ego, a more reality-based part which regulates these competing processes.
When conflicts arise between the id’s impulses for sexual or aggressive action and the superego’s moral strictures, the ego attempts to control it by using defense mechanisms such as repression.
Therapists use techniques such as free association (asking a person to say whatever comes to mind), dream interpretation, and examination of the relation of the person to the therapist as tools in understand the sources of the inner conflict which led to the anxiety.
In summary, anxiety can be seen many different ways, which makes it possible to treat it with a variety of approaches. These include ‘talking’ therapies, especially cognitive-behavioral therapy, which emphasizes behaviors and ways of thinking that may contribute to anxiety, and psychodynamic therapy which emphasizes emotional aspects and the influence of past experiences on the present.
More traditionally biological approaches include the use of medicines, which can have benefits but also limitations and possible side effects. The two are not incompatible, and can also be used successfully together. Lifestyle changes as described in other articles in The Daily Mind can also contribute to reducing anxiety. There are many things you can do, and the first step is learning about them so that you can make decisions that are best for you as an individual.
This article is excerpted from ‘Understanding Medicines for Anxiety’ by Wallace B. Mendelson MD, available as a Kindle eBook and paperback on Amazon.
Dr. Mendelson is currently in the clinical practice of psychiatry. He was formerly Professor of Psychiatry and Clinical Pharmacology, and director of the Sleep Research Laboratory, at the University of Chicago. Dr. Mendelson earned an MD degree from Washington University School of Medicine in St. Louis and completed a residency in psychiatry there as well. He has held professorships at Ohio State University and the State University of New York at Stony Brook, was Chief of the Section on Sleep Studies at the National Institute of Mental Health in Bethesda, MD, and Director of the Sleep Disorders Center at the Cleveland Clinic.
Dr. Mendelson is a past president of the Sleep Research Society. Among his honors is the William C. Dement Academic Achievement Award from the American Sleep Disorders Association/American Academy of Sleep Medicine as well as a Special Award in Sleep and Psychiatry from the National Sleep Foundation, and he is a distinguished fellow of the American Psychiatric Association. Dr. Mendelson has authored or co-authored seven books and numerous peer-reviewed papers on various aspects of sleep and general psychiatry. Among other recent books are ‘Understanding Antidepressants’ and ‘Understanding Sleeping Pills, both available on Amazon. His website, describing his interests, a blog devoted to literature, as well as a downloadable curriculum vitae, can be found at: www.zhibit.org/WallaceMendelson.