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How Anxiety Works: Using Neuroscience to Explain Anxiety

Article Summary:

Our in-depth guide to understanding how anxiety works using the latest research in Neuroscience - created to help you understand anxiety and the anxiety process...

Before we dive into this extensive and in-depth article, let us imagine a short scenario to understand better how anxiety works, the anxiety process, and how anxiety plays out in many circumstances.

You plan on shopping, so you hop in your car and head to the mall. As you approach the parking lot, you begin feeling anxious. By the time you park your car, your heart is thumping, and your stomach is in knots. Your mind begins to replay images of the last time you were here and how anxious you felt. You think, "It will happen again," "Why am I so afraid?" "What if I have to leave?" "What if everyone notices me freaking out?" By the time you walk from your car to the mall's front door, you're on the verge of a panic attack; thoughts racing, your heart pounding, your stomach churning, and your hands clammy as you reach for the door.

What is happening?

Why do you feel this way?

Anxiety can often seem unpredictable, uncontrollable, and even automatic at times.

Understanding the processes behind anxiety may seem complicated.

You might believe that understanding the anxiety process is limited to doctors or psychiatrists.

But you can better understand how anxiety works, the anxiety process and how and why you feel the way you do when you are anxious - and improve your life in the process.

To explain how anxiety works, I will use the latest scientific understanding of the brain – neuroscience – to explain the processes behind anxiety and answer the most common questions.

What happens when you are anxious?
How does your brain create anxiety?
What are the effects of anxiety on the brain and nervous system?
Which neurotransmitters are associated with or involved with anxiety?
Why do certain people, places, or things trigger anxiety?
What happens during the fight-or-flight response, and how does it relate to anxiety?

Understanding how anxiety works can illuminate an area where you might be in the dark.

By understanding how anxiety works, you can better understand why certain approaches and strategies reduce or eliminate anxiety.

When you understand the processes behind anxiety, you develop a clearer picture of the anxiety response and how it plays out in your life.

When you see that your brain is initially responsible for your anxiety response and your body is simply responding in the ways it is meant to respond, you can develop greater acceptance and less fear surrounding the feelings of anxiety.

So let's dive in and shine a light on anxiety and the brain using neuroscience as our guide.

Please note: this article is not meant to be taken as medical advice. The content provided is for informational purposes only. Consult with your doctor or healthcare provider before changing your diet, prescriptions, or making any other health-related changes.

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A Quick Note

I've intentionally simplified particular brain and body processes and avoided overly scientific terms wherever possible.

Hopefully, this makes the article not only easier to read but more enjoyable as well.

For example, we will use the term "cortex" throughout this article to describe the many processes of the cerebral cortex instead of stating the specific areas of the cortex, such as the anterior cingulate cortex or orbitofrontal cortex (which is a mouthful, to say the least).

Also, although the brain and bodily systems function as a whole to communicate, we will focus primarily on the areas directly associated with anxiety while ignoring others.

Overall, this should make the article easier to follow and understand without taking away from the information and the science behind it.

Neuroscience and Anxiety

The incredible progress in neuroscience over the past few decades has led to a vast increase in our collective knowledge of how the brain works.

As a result – we now have a greater understanding of anxiety, how the brain creates anxiety, and its resulting physical and emotional symptoms.

In fact, anxiety is the most well-understood of all the so-called "disorders."

We better understand the causes and treatments available for anxiety and potential future treatment options.

Neuroscientific research on the brain and anxiety centers around the brain's detection and response to threats and how we create and respond to fear.

According to the research, the brain detects and responds to threats through specific areas in the brain and physiological changes in the brain and body.

These changes include the infamous "fight-or-flight" response and the release of critical neurotransmitters and hormones.

The threats your brain detects and responds to can be physical, such as being in physical danger – or mental, such as thoughts and images related to a threatening event or experiencing a loss of your sense of homeostasis (mental or emotional balance).

These potential threats can be real or imagined.

Quite often, these potential threats are imagined or at least exaggerated out of proportion.

The brain and body respond to these imagined threats the same way as a real threat.

Research also shows the important role of stress in anxiety.

Intense, stressful experiences and prolonged stressful situations can often lead to symptoms of anxiety, physical and mental tension, and panic attacks.

The Latest Research

In this article, we will use the latest research in neuroscience to explain how the brain creates anxiety and what happens in your brain and body when you experience anxiety.

I have based the information in this article on the latest scientific research wherever possible.

As of today, as far as I am aware, this is the furthest understanding we have about the brain and anxiety.

But science is always pressing forward.

Our knowledge of ourselves, our brains, and our mental and emotional states is continually expanding.

I will do my best to update this information as it arrives.

The Brain and Anxiety

Anxiety can seem to originate from complex sources with a wide variety of symptoms.

Typical symptoms can include a fast-beating heart, fearful thoughts, obsessive thinking, sweating, worry, mental or physical tension, and panic – to name only a few.

Anxiety can also seem to come out of nowhere, occur automatically, or even feel like it comes from the outside in.

Your brain has evolved to take in information from experiences and surroundings while watching for potential threats or dangers.

While anxiety can seem to start in the body or even come from situations outside of yourself – in reality, all anxiety begins in the brain, regardless of where you think it started or what seemed to trigger it

There are key areas of the brain responsible for keeping you safe and avoiding potential danger.

These areas of the brain and nervous system also help to determine how you respond to threatening situations through your interpretations and actions.

While these areas have many essential roles – we will focus primarily on their direct relationship to anxiety, panic, and fear.

Below I will briefly summarize several essential areas of the brain.

Later we will discuss two in particular – the amygdala and the cortex – in more detail.

Areas of the Brain and Their Relationship to Anxiety

The Limbic System:

A system of closely related structures in the brain primarily responsible for emotions, memory and processing sensory input

Thalamus: like the grand central station of the brain, the thalamus takes sensory information and "passes" it to the proper channel in the limbic system or cortex
Hypothalamus: responds to stress from other parts of the limbic system (particularly the amygdala) by releasing stress hormones and activating the nervous system
Hippocampus: essential in the registering of details and facts and for the formation of memory
Amygdala: the key player in fear and anxiety, registers emotions with a strong focus on threatening or scary ones; works to avoid potential dangers based on past experiences; uses "triggers" to avoid certain people, places, or things; communicates with the hypothalamus to start the stress response

The Cortex:

Responsible for your thinking and perceiving – the cortex allows you to think, make plans, attach meaning, and interpret experiences.

The cortex also handles all the higher-level functioning of the brain – rational thinking, using logic, thinking about thinking, etc.

Considering how your thoughts and interpretations often create (or intensify) feelings of anxiety, understanding the cortex's role in anxiety should be easy to see.

There are four parts to the cortex, each with different roles, but all parts of the cortex work together.

For the sake of brevity and simplicity, I will refer to all the parts of the cortex simply as – the "cortex."

The Basal Ganglia:

The basal ganglia are responsible for many processes in the body.

Regarding anxiety, the basal ganglia are involved in the level of energy, arousal, and motivation felt.

Dopamine plays a large part in the motivation factor in the BG, while GABA keeps these energy levels in check.

High dopamine (and norepinephrine) and low GABA in the basal ganglia can cause physical and mental tension, perfectionism, and high drive.

This combination of tension, drive, and perfectionism often leads to burnout and high anxiety levels.

The basal ganglia are also responsible for the formation of habits.

The formation of habits is important, considering that many negative habits can cause or worsen anxiety.

Your habits can also keep anxiety in place and can be an important factor in overcoming anxiety.

The Two Pathways to Anxiety

There are two major pathways to anxiety.

One path to anxiety occurs when an external stimulus (or trigger) activates your amygdala – which activates the stress response (fight-or-flight response).

You will often experience this as a knee-jerk (automatic) anxiety/fear response, which may seem to occur for an unknown reason.

Another possible path to anxiety is when your cortex processes (thoughts, perceptions, or interpretations) trigger the amygdala – which starts the anxiety/stress response.

Cortex-based anxiety often occurs when you obsess, worry, or imagine threatening scenarios or interpret experiences in a threatening way.

The amygdala responds as if the thought or imagined situation were real.

Understanding how anxiety works in each pathway can help you recognize which area is causing you trouble.

Each path responds to different therapies and techniques.

Knowing the type of anxiety you are dealing with can be extremely valuable.

For example, if your anxiety is cortex-based (meaning your thoughts are the problem), then a thought-based therapy like CBT could work well.

If your anxiety is amygdala-based (meaning you have spontaneous fear/anxiety responses to situations or particular phobias – often without knowing why), then something like psychotherapy, trauma-based therapies, or body-based therapies such as MBSR and Yoga can be more helpful.

The amygdala kickstarts the fight-or-flight response and is the anxiety initiator – therefore, both pathways lead to the amygdala.

By understanding where your anxiety first begins (whether it's your thoughts/interpretations frightening the amygdala or an external trigger), you can determine the strategies that will be most effective for you.

Below we'll be diving more into each pathway.

The Amygdala

The amygdala is an almond-shaped structure within the brain.

Although there are two amygdalas (one on each side of the brain) – we will use the common term amygdala.

The amygdala is an essential part of the limbic system; the amygdala receives information from the outside world from the thalamus, forms memories with the hippocampus, and starts the stress response (fight-or-flight) with the hypothalamus.

Your conditioned fear responses, phobias, and anxiety triggers are directly associated with the amygdala.

The amygdala can become activated (become triggered or feel threatened) and lead the body to respond before you can even think about what is happening.

Unlike the cortex, which can take a second or two to think about something and respond – the amygdala can react almost immediately based on conditioned fear responses and external triggers your cortex may not even be aware of.

The amygdala takes only the most basic, "raw" data available and responds in fractions of a second - the cortex is usually left playing catch up

This nearly instant process is for a good purpose.

Think about when you are driving, and a car swerves over into your lane; the amygdala can instantly determine a potential threat, making your body respond and react by hitting the brakes or swerving out of the way before your thinking mind (cortex) has time to figure out what happened.

The Amygdala Playing Tricks

The amygdala isn't perfect and can play tricks on you.

Since the amygdala only takes in raw data, it can often mistake non-threatening things or situations for dangerous ones.

Let's use an example:

You get home alone late in the evening; the house is dark. You walk upstairs and through the darkened hallway, headed to the bathroom at the end of the hall. As you pass your bedroom, you believe you see someone out of the corner of your eye standing in your darkened room. You tense up and feel instant fear. Your cortex didn't get enough information to determine what it was you saw, but your amygdala is already preparing your body for fight or flight. Your palms begin to sweat; you feel fear and anxiety. At this point, you may use your cortex to rationalize the situation, thinking, "It was probably nothing," or the cortex could make it worse by imagining all kinds of scary scenarios. You decide to check it out. You walk into the bedroom and turn on the overhead light. It turns out it was only a floor lamp.

The Amygdala & The Stress Response

In the example above, your amygdala began activating the stress response based on very limited "data" – a fleeting image out of the corner of the eye.

Once the stress response is triggered, you will often feel anxiety, fear, and panic almost instantly.

The amygdala initiates the stress response – otherwise known as the fight-or-flight response.

The amygdala responds to threatening situations (real or imagined) by communicating to the hypothalamus to release certain hormones and neurotransmitters, starting the stress response.

The amygdala also activates the sympathetic nervous system, increasing blood flow, heart rate, and respiration, among other processes.

Both systems, initiated by the amygdala's response to a potential threat, prepare the body to fight or take flight (flee or run away).

We will discuss the stress response and the actions of the sympathetic nervous system in more detail later in this article.

Both are important factors for understanding how anxiety works.

The Role of the Amygdala in Anxiety & Fear

One of the primary roles of the amygdala is in the processing of emotional responses, such as anxiety, fear, and aggression.

The amygdala also plays a vital role in memory, especially emotional memory and trauma.

The amygdala has additional roles in processes such as sexual behavior and bonding, but we will only discuss the amygdala's primary role in fear and anxiety, its role in creating anxiety-producing memories, and its role in registering emotions.

One of the major roles of the amygdala is attaching emotional significance to objects, situations, or experiences. The amygdala "labels" experiences based on emotional responses to the particular experience and helps create memories with the labels it has prescribed.

While the amygdala registers all emotions – it focuses more on scary and threatening ones.

The amygdala places extra emphasis on the memories it has associated (labeled) with threatening emotions.

The amygdala does this to protect you and help you avoid potentially dangerous situations.

It does this based on things (events, people, objects, experiences) that scared you in the past or things it associates with threatening emotions.

You can think of the amygdala as your personal protector.

The amygdala's primary goal is to keep you safe.

Attaching extra emphasis on scary or threatening memories makes sense if you think about it.

If you are in a dangerous situation, such as driving carelessly on an icy road and you wreck your car and injure yourself – the amygdala will register your fear and stress based on the event.

Next time you drive on an icy road, the amygdala may increase your alertness (and stress) so you focus better and drive more carefully than you did the last time.

There can be issues with the amygdala's processing of threatening memories.

The amygdala doesn't "think" about or rationalize the situation – it responds emotionally.

Therefore, it can exaggerate the severity of a situation or place anxiety-producing significance on a seemingly mundane object or event.

A few years ago, I attended a "Neuroscience and Anxiety" seminar where the speaker discussed a patient with PTSD.

This patient was an Afghanistan war veteran.

The patient was doing well when he suddenly began experiencing intense anxiety in the morning.

He couldn't figure out what was causing the anxiety.

When he began examining his morning routine, he discovered the soap he had recently bought, and was using in the shower each morning, was the same soap he used while fighting in Afghanistan.

The smell of this soap triggered fear and anxiety based on his experiences in the war.

When he got rid of the soap, his anxiety went away.

Anxiety Triggers

The amygdala placed emotional significance on the soap in the story above because it associated it with a threatening situation – fighting in a war.

In other words – the soap became an anxiety trigger.

Anxiety triggers serve a purpose (to avoid danger), but the amygdala often places threatening significance on people/places/things that aren't dangerous in and of themselves – such as soap.

The amygdala pathway is closely associated with phobias.

Our fear/phobia of a particular person, place, or thing is directly related to these anxiety "triggers" created by the amygdala, often at an early age.

Someone who had a frightening or scary experience with a dog as a child may develop a phobia of dogs later in life.

This phobia of dogs would be caused by the amygdala "labeling" dogs as dangerous – thus becoming an anxiety trigger.

Anxiety triggers can be anything; smells, sounds, objects, places, people, or anything else - the amygdala responds emotionally, not rationally, so it can place emotional significance on anything associated with the threatening event

A woman sexually assaulted at a party while Led Zeppelin played on the stereo may have panic attacks afterward whenever she hears Led Zeppelin.

A young Army private home from war may become terrified of the sound of fireworks on the 4th of July that sounds eerily similar to the sound of explosions and gunfire.

In both cases, neither trigger is dangerous in the present context – it's the association created by the amygdala between the trigger and the threatening situation of the past that is causing fear and anxiety in the present.

The Amygdala & Trauma

The amygdala pathway to anxiety is closely linked to trauma and PTSD.

The amygdala's role in placing emotional significance on events and forming emotional (anxiety/fear-producing) memories is at the core of most trauma.

Trauma can link itself to particular memories and triggers.

If you've experienced trauma, you may be conscious (aware) of these memories and triggers, or they may be unconscious (you are unaware of them).

When you are aware of traumatic memories, you may consciously avoid situations and people related to the memory.

For example:

A man is physically assaulted while walking down a city street at night; in the following weeks or months, he may avoid that street or area, avoid walking alone or even avoid walking at all. This fear and anxiety related to the situation and avoidance of similar situations may last days, weeks, months, or even longer, depending on how he handles his experience and the resulting trauma.

If you are unaware of a traumatic memory and it remains in the unconscious (or subconscious) – you may respond to certain situations with anxiety and fear and not fully understand why.

Many people often repress trauma experienced in early childhood, and the trauma remains in the unconscious.

This repressed trauma can often lead to unconscious fears, phobias, and avoidance of particular people, places, or things later in life.

In either situation, the amygdala responds based on the emotional significance it has attached to the prior event and is functioning to help you avoid experiencing the same threatening/painful situation.

Retraining the Amygdala

The good news is you can retrain the amygdala.

You can teach the amygdala that the anxiety triggers it has created are not dangerous in the present experience.

You can also effectively process and integrate past traumas and traumatic memories so you are not encountering unconscious triggers throughout your life.

While a person may have experienced a traumatic event in their life, they need not continue reliving it or associate the present experience with the past.

Two powerful ways to retrain the amygdala and come to terms with phobias and traumas are psychotherapy (particularly trauma-focused therapy) and exposure therapy.

Psychotherapy can help uncover and integrate unresolved traumas and memories.

When a person uncovers (brings to awareness) unresolved traumas, they will no longer continue reliving past experiences or become fearful and anxious for unknown reasons.

The amygdala can then learn to let go of its intense association between past and present events, objects, people, and experiences.

Exposure can help people face what they are afraid of and create new (safer) experiences and memories.

Using the example of the fear of dogs above, a person could use exposure to face their fear of dogs by taking time to pet and play with a friendly Labrador.

They could retrain the amygdala to see that dogs can be loving and friendly and need not ignite anxiety.

Over time and with repeated exposure, the amygdala will no longer associate all dogs with threats.

The goal of retraining the amygdala is to show the amygdala you are safe now - what you are experiencing now is not the same as what you experienced in the past

A person may have experienced trauma as a child growing up in an abusive household – but they are safe NOW.

A person may have experienced a dog that scared them when they were young – but they can be safe petting a dog NOW.

A person may have experienced the traumas of war while in the military – but they are home and safe NOW.

The Cortex

The cortex – also known as the cerebral cortex – is the part of the brain you probably think of when you think of the brain.

The cortex is the area responsible for thinking and perceiving.

The cortex comprises several important structures, including the insular cortex (or insula), the cingulate cortex, the orbitofrontal cortex, and the prefrontal cortex.

For this article, we will use the generic term "cortex" to avoid confusion.

The cortex is involved in many essential mental and emotional processes:

Thinking and perceiving
Processing sensory information (information coming in from the outside world)
Attaching meaning to perceptions
Using logic and reasoning
Understanding and interpreting situations
Planning and responding to events and experiences
Using the imagination

The Cortex & Anxiety

If the cortex is responsible for your thinking and perceiving, then - the cortex is responsible for constructing your reality.

What you perceive, what you think, and what you think about what you perceive (how you interpret experiences/events) forms your construction of reality and the subjective (personal) reality you experience.

You use your cortex to think about and interpret experiences as they occur.

You think about, imagine, or remember experiences in the past or future.

You also create thoughts and images beyond your perceptions.

What you think about, how you interpret your experiences, and even what you picture and imagine – is your experience of reality. But... the reality you have constructed may not be accurate.

Your thoughts can be false – your interpretations can be misguided.

Let's use an example:

You've been with your boyfriend for six months. While at work one day, your boyfriend texts you: "We need to talk later." You text back, but he doesn't respond. Your thoughts and imagination (cortex) begin going wild with possibilities.

Does he want to break up with you?
Did he cheat on you and now wants to come clean?
Why did he say it like that?
Is he ignoring you now?

What makes you come to these scary conclusions based on five simple words?

These thoughts get the amygdala's attention, which sees the current situation as threatening (fear of being abandoned or betrayed) and starts the stress response – which turns into anxiety and, if it continues, panic.

Let's try a different example:

You've been struggling with social anxiety. You've been avoiding going out recently, but some friends have invited you to a concert at a local club. It's a band you like, so you decide to go. Hours before the show, you begin thinking about what could happen when you go.

What if you make a fool of yourself?
What if people can tell you're uncomfortable?
What if you want to leave but can't?
What if there are too many people there?
What if you panic?

Here you are again using scary thoughts with anxiety-producing mental images.

You imagine scary scenarios playing out.

Again the amygdala is activated by your thoughts and mental images – even if they are wholly imagined and have no basis in actual reality.

Again you become anxious.

If you continue down this path, you may cancel your plans altogether to avoid the anxiety.

These are just two examples, but the method behind creating anxiety is the same regardless of whether the situation is real or imagined.

Even if a real negative situation occurs – such as finding out you are getting laid off from your job in 2 weeks – your thoughts and interpretations can worsen the situation and spark intense anxiety.

You may think: "I'll never find another job," "How will I pay the bills?" "I'm going to be living on the streets," etc.

How the Cortex Anxiety Process Works

The cortex doesn't necessarily need actual experiences to activate the amygdala.

Thoughts and mental imagery unrelated to experience can be enough to activate the amygdala if the amygdala believes them to be threatening.

One crucial factor to remember is that the cortex can get anxiety started and worsen anxiety but cannot create anxiety on its own.

The amygdala causes the actual sensations and experiences of anxiety.

The amygdala is activated when the cortex pathway creates frightening thoughts, imaginings, and mental images.

The Cortex & Amygdala Connection

Your thoughts and interpretations from the cortex can create anxiety because of the cortex's connection with the amygdala.

The amygdala constantly monitors the cortex for potentially threatening interpretations.

The amygdala can also influence and take over the cortex by making the cortex focus on specific things in dangerous or threatening situations.

While the connection between the cortex and the amygdala goes both ways – the cortex has far fewer connections to influence the amygdala than the amygdala has to influence the cortex.

This limited influence of the cortex over the amygdala is why you typically can't think your way out of a panic attack or reduce your anxiety through thoughts alone during experiences of severe anxiety.

The amygdala responds to experiences faster than the cortex can process the information.

Once the amygdala is activated and the stress response begins, it is much harder to calm down than before the amygdala's activation.

This may sound like there isn't much you can do to keep the amygdala calm, but there is.

The key is what you focus on, think about, and how you interpret your experiences.

Creating Anxiety With Your Thinking

Cortex interpretations can either help the amygdala stay calm or worsen the amygdala's response to situations and experiences.

The amygdala can often become activated simply by scary negative thoughts.

If you were gifted a strong imagination, you could probably work yourself up with vivid images of every terrible thing you can think of, even when physically safe.

When the amygdala is only slightly activated based on your situation, the cortex can send the amygdala into panic mode.

For example, you are walking alone down a city street late at night, and you are already slightly on edge, but then you begin thinking thoughts such as: "What if someone attacks me?" "What if I get lost?" "What if I run into some bad people?"

The next thing you know, you're experiencing intense anxiety and fear.

This is entirely based on your thoughts/interpretations of the situation.

Therapies and techniques that focus on cognitive processes – thinking, interpretations, memory of experiences, and mental habits – are possible solutions to the anxiety created by the cortex pathway.

Cognitive Behavioral Therapy (CBT) is a popular form of cognitive therapy that has been shown effective for anxiety in particular.

Acceptance and Commitment Therapy (ACT) is another excellent option for cognitive-based anxiety (and one I like a lot).

Neurotransmitters and Anxiety

We now better understand the two major players involved in anxiety – the amygdala and the cortex.

So what about "neurotransmitters" and "chemical imbalances?"

These two terms are very often a doctor or psychiatrist's favorite to use when discussing anxiety with their patients.

While the "chemical imbalance" theory is often debated – there does seem to be some correlation between the availability (or lack thereof) of specific neurotransmitters in different parts of the brain and the level of anxiety, fear, tension, panic, negativity, and worry

Neuroscience also confirms that neurotransmitters can directly influence anxiety levels and is important to understanding how anxiety works.

There can be many reasons for having low or excessive amounts of certain neurotransmitters in the brain:

Trauma: experiencing physical, emotional, or mental trauma can lead to increases in stress hormones and a reduction in other neurotransmitters such as serotonin
Chronic Stress: similar to trauma, chronic stress can reduce key neurotransmitters
Nutrition/Diet: what you eat has a direct effect on how you feel and the health of your brain and body
Illness/Disease: many conditions can lead to an imbalance in different neurotransmitters
Poor Sleep: sleep is vital to the production of neurotransmitters and overall health
Genetics: some people are born with lower availability of specific neurotransmitters or may have fewer receptors in the brain, such as fewer serotonin receptors than the average person

Remember that an imbalance of neurotransmitters can cause anxiety – but the area in the brain where these neurotransmitters are low or excessive affects the type of anxiety experienced.

A person could also technically have an "imbalance," either more or less available than what is considered normal, and not experience any anxiety at all.

It is not an exact science, and saying that low serotonin is causing your anxiety is not always the truth.

Below are the neurotransmitters involved in anxiety in all of its forms.

For more on anxiety and chemical imbalances, check out our article:

Biological Causes of Anxiety: Root Causes of Anxiety Part 2

Serotonin

Serotonin is an important neurotransmitter that has a wide-ranging impact on anxiety.

Serotonin's essential function is to regulate the brain and bodily systems.

Besides playing a role in anxiety and stress, serotonin also regulates sleep, mood, and appetite.

It is believed that when less serotonin is available, a person will begin to lose much of this regulation.

Trouble sleeping, loss of appetite, an overly negative mood, or inability to pull oneself out of a depressed/dark mental state can all be symptoms of this dysregulation.

This loss of regulation due to low serotonin can also reduce one's ability to assess potential threats calmly and respond in a healthy way.

They may blow situations out of proportion, respond irrationally, or become overly sensitive and emotional.

When visiting the doctor for anxiety (or depression), they will often discuss a chemical imbalance – by this; they usually mean low serotonin.

Doctors typically prescribe an SSRI – such as Prozac, Zoloft, or Lexapro – as first-line treatment options.

SSRIs and similar drugs increase the amount of serotonin available in the brain.

Stating that a person has low serotonin doesn't describe the whole picture or serotonin's wide-ranging effects on anxiety.

Where serotonin is low in the brain determines the anxiety symptoms a person experiences.

While not as often discussed, excessive serotonin can also cause anxiety – particularly social anxiety and social phobia.

Excessive serotonin can also cause an imbalance in other neurotransmitters, such as Dopamine and Norepinephrine, leading to loss of motivation and drive and poor concentration and cognitive function.

Low Serotonin in the Limbic System

Worry
Negativity
Overly sensitive to possible threats

Low Serotonin in the Cortex

Irrational response to situations and events
Poor impulse control
Feeling stuck in negativity (having a "dark mood") or unable to see things positively
Inflexible attitudes and behaviors
Loss of emotional control
Constant underlying worry

High/Excessive Serotonin

Social anxiety and social phobia
Overall increases in anxiety and panic

Dopamine

Dopamine is a neurotransmitter that plays a role in many essential functions.

It is well known for its role in motivation, focus, and feelings of pleasure.

Low amounts of available dopamine in the brain can lead to cognitive issues such as trouble concentrating or scattered thoughts.

Low dopamine can also lead to an absence of good/positive feelings or a lack of pleasure.

Social anxiety, lack of interest in social interactions, social phobia, and social avoidance have been linked to low dopamine in the brain.

Symptoms of high/excessive dopamine levels can vary depending on where dopamine is high in the brain.

Overall, we associate high/excessive dopamine with perfectionism, panic attacks, and intense motivation that can eventually lead to burnout.

Chronically high dopamine (excessive dopamine in the brain for long periods) can lead to delusional states and even psychosis.

Trauma and periods of extreme stress can often increase dopamine levels in the brain, leading to anxiety and panic attacks.

Chronic drug use with drugs that affect dopamine directly, like cocaine and methamphetamine, can cause rapid and intense increases, followed by significant decreases in the levels of dopamine in the brain.

Dopamine can cause anxiety when it is too low or too high. The part of the brain where dopamine is low or high can determine the symptoms experienced.

High/Excessive Dopamine in the Basal Ganglia

Perfectionism
High drive
High motivation

Low Dopamine in the Basal Ganglia

Loss of interest in things, other people, activities, etc.
Lack of motivation
Low pleasure or complete loss of pleasure

High/Excessive Dopamine in the Cortex

Panic attacks
Anxiety
Overly focused on details
Long-term high dopamine in the cortex can lead to psychosis

Low Dopamine in the Cortex

Trouble focusing
Scattered thinking
Impulsive thinking and behaviors
Addiction

Norepinephrine

Norepinephrine is an important hormone and neurotransmitter responsible for many functions throughout the brain and body.

To describe every process norepinephrine is involved in would be an article in itself.

Norepinephrine's primary function is to prepare and mobilize the brain and body for action

In the brain, it does this by increasing alertness, focus, and mental vigilance.

In the body, it increases available energy and directly affects different bodily processes when needed.

Norepinephrine is the key player in the fight-or-flight response.

The sympathetic nervous system uses norepinephrine to prepare the body to fight or run (flee).

The sympathetic nervous system also uses norepinephrine to directly affect the body's organs, such as increasing the heart rate and blood pressure, redirecting blood flow to the extremities (muscles of the arms & legs), and producing more glucose for energy.

While the stress response process is necessary for survival – it's relatively easy to see how this could create problems.

Norepinephrine is an energizer and sets the tone for tension in the brain and body.

Those with anxiety are often already tense and overly stressed – it doesn't take much additional norepinephrine to send them over the edge into anxiety and panic.

Norepinephrine becomes a problem when there is too much – creating tension and anxiety.

Depending on where in the brain or nervous system there is too much norepinephrine will determine the symptoms.

Chronically high levels of Norepinephrine can stem from excessive stress, abuse or trauma, or lifestyle choices.

Low levels of norepinephrine can be an issue as well.

Like low dopamine, low norepinephrine can lead to many cognitive, energy, and motivation-related issues.

High Norepinephrine Throughout the Brain

Over-arousal
Mental and physical tension

High Norepinephrine in the Basal Ganglia

Feeling "wired"
Restlessness
Unable to relax

High Norepinephrine in the Cortex

Hypervigilance
Scattered thoughts
Chaotic thinking

High Norepinephrine in the Sympathetic Nervous System

Overall sense or feeling of "doom."
Panic attacks

GABA

Gamma-Aminobutyric acid (GABA ) is the primary inhibitor in the brain and nervous system, where it acts to slow or stop neurons from firing.

GABA reduces excitability throughout the nervous system.

GABA is often described metaphorically as the nervous system's "STOP" signal vs. glutamate's "GO" signal.

Low availability of GABA can lead to over-activity in the brain and nervous system – which can lead to anxiety, tension, restlessness, and panic

Low availability of GABA can also lead to an imbalance and an overall increase of excitatory neurotransmitters like glutamate and dopamine.

GABA is closely linked to anxiety and panic attacks, and many prescription anti-anxiety medications work by increasing the amount of available GABA in the brain and nervous system.

The most popular of these are Benzodiazepines, which include Xanax, Valium, and Ativan.

Most GABAergic drugs produce feelings of relaxation and anxiety reduction.

Other drugs such as sleeping pills, muscle relaxers, and anti-seizure medications also affect GABA, as do alcohol and herbs such as Kava and passionflower.

Insufficient GABA in the brain leads to an imbalance in other neurotransmitters.

Low GABA in the Brain

Anxiety
Agitation
Glutamate imbalance
Neurotransmitter imbalance (which can lead to other problems depending on which neurotransmitters are out of balance)

Low GABA in the Basal Ganglia

Panic attacks
Excessive energy/tension

The Autonomic Nervous System

The autonomic nervous system (ANS) is one of the body's control systems responsible for regulating the body's unconscious actions.

The ANS is the mechanism of the fight-or-flight response (or stress response). The ANS comprises two complementary parts: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PSNS).

The SNS and PSNS work together to regulate many of the body's reactions and responses during this period of fight-or-flight, including heart rate, digestion, breathing, energy production, and blood flow.

The SNS is the activator/initiator of the fight-or-flight response, directing the organs to respond and take action.

While the PSNS activates the opposite response, "rest and digest," and returns the body to calm and homeostasis after the stress response.

The sympathetic and parasympathetic nervous systems have opposing actions that complement each other.

For example, the SNS will increase heart rate and decrease digestive activity – while the PSNS will slow the heart rate (or return it to normal) and increase digestive activity.

While the actions of the autonomic nervous system are automatic and operate primarily without our control – we can take over control of the ANS using various techniques.

The Sympathetic Nervous System (SNS)

The sympathetic nervous system (SNS) originates in the spinal cord and is responsible for activating the changes that occur during the fight-or-flight response.

The SNS alters the functions of the organs such as the heart, liver, and lungs to prepare the body to act – either to fight or flight (run or flee).

The SNS is activated by the hypothalamus – which is activated by the amygdala (as we discussed above).

Once the SNS is activated, the pituitary and adrenal glands release hormones and brain chemicals (neurotransmitters) such as norepinephrine, epinephrine, and cortisol.

When you experience the physical symptoms of anxiety and panic, such as: shaking, sweating, fast and shallow breathing, or increased heart rate – you are experiencing the activation of the sympathetic nervous system (SNS)

When your heart is pounding, and your hands are shaking because of the fight-or-flight response – which is an intense activation of the SNS – you may become very anxious.

If you fear the sensations, you may experience a panic attack.

Panic attacks are often a fear reaction to the activation of the SNS – through the lens of fear, you may interpret a pounding heart as the beginning of a "heart attack" or the extra energy and adrenaline as "losing control."

Activation of the SNS: Physiological Changes

All the physiological changes that occur by the activation of the sympathetic nervous system serve a purpose – to give the body increased energy and strength to fight or run.

Specific bodily processes are accelerated while other functions are reduced/slowed to give primary importance to personal safety by preparing the body for fight or flight.

Below are some physiological changes that occur during the activation of the sympathetic nervous system, the purpose of the changes, and the possible symptoms you may experience based on your interpretation of the bodily sensation.

Physiological Change

accelerated heart rate and increased blood pressure

Purpose

increases blood flow and supplies extra energy

Possible Anxiety Symptom

pounding heart

blood flow is diverted away from the digestive system

blood is rerouted to the limbs and muscles

stomach pains/knots or nausea

more oxygen is taken into the lungs

allows for more oxygen exchange for energy

panic breaths/ lightheadedness

pupils dilate

allows more light to enter the eye for focused/far vision

tunnel vision

the liver produces extra glucose

supplies additional energy

headache/blurred vision/trouble thinking clearly

When you understand the purpose behind these physiological changes rationally, it makes sense and doesn't seem scary, but in the moment, your reaction and interpretation of these changes can lead to anxiety and panic.

If you can begin to understand how these processes work and why they happen, you can significantly reduce your fear of them and avoid escalating the experience into panic when it happens.

The Parasympathetic Nervous System (PSNS)

The parasympathetic nervous system (PSNS) originates in the brain stem (in the medulla in particular) and activates the "rest and digest" response.

The PSNS is responsible for returning the body to homeostasis (a calm resting state) after the fight-or-flight response

One of the primary nerves in the PSNS is the vagus nerve, which communicates between the brain and the body.

The vagus nerve can direct the function of the organs, such as the heart, lungs, and digestive system, to balance the activation of the sympathetic nervous system.

With the PSNS, the vagus nerve promotes normal (resting) function by calming action in the body started by the SNS.

This includes: reducing the heart rate, slowing breathing, and sending blood flow back to the stomach for digestion.

The PSNS is calm after the storm – but the calm doesn't happen immediately.

After the sympathetic nervous system has started the fight-or-flight response, it can take time before the parasympathetic nervous system brings everything back to normal – even if the danger (real or imagined) has passed.

There are actions you can take to improve the response of the parasympathetic nervous system after a stress response.

You can also control the PSNS by stimulating the vagus nerve, preventing the stress response before it starts.

Taking Control of the PSNS

Like the sympathetic nervous system – the parasympathetic nervous system functions automatically without your need to control it.

However, you can use several techniques and practices to activate the PSNS to reduce the time spent in the fight-or-flight response or prevent the response entirely.

We provide several guides showing you how to perform these techniques for stimulating the PSNS.

The techniques include; meditation, deep belly or diaphragmatic breathing, and relaxation techniques.

The fight-or-flight response is essential to human survival, but the response is not always necessary.

Through the practices mentioned above, you can take control of your ability to prevent exaggerated responses to non-threatening situations.

Fight or Flight Response (The Stress Response)

I've mentioned the fight-or-flight response – also known as the stress response – many times throughout this article with brief explanations so far.

Now we will go more in-depth into how the fight-or-flight response operates.

Understanding how the fight-or-flight response works is important to understanding how anxiety works.

The stress response is a system to get you energy when you need it. In most cases, this would be a dangerous or threatening situation – whether it is real or imagined.

The stress response can function for any length of time (although it will always end) depending on the situation and the response needed.

The stress response could occur for a short duration, such as in situations needing a quick reaction, or sustained periods, such as during extended stressful situations.

The amygdala is always the initiator of the fight-or-flight response (as discussed above).

The amygdala receives information from the outside world (through the thalamus), through memory (amygdala-based trauma), or through thoughts and mental images (the cortex).

When you encounter a situation that the amygdala has labeled as threatening, it signals to the hypothalamus to activate the stress response.

Once the amygdala detects a threat to your safety and activates the hypothalamus, many reactions and chemical processes occur.

Below I've provided a visual representation of the stress response to give you a better idea of what is happening.

Having a visual representation can make it easier to picture how something works.

The fight-or-flight response doesn't necessarily create anxiety in and of itself, but the continued release of adrenaline, cortisol, and other hormones can engender feelings of activation, stimulation, and tension.

The additional energy created can make one feel anxious, and the physical symptoms can be uncomfortable and misinterpreted.

Repeated stress responses can inevitably lead to symptoms of chronic stress, such as anxiety, fatigue, and illness.

The Effects of Chronic Stress on the Brain and Nervous System

The stress response described above provides the energy needed in dangerous or life-threatening situations.

This extra energy is received through the release of hormones and chemicals in the brain and body.

While this response is natural and vital to survival, chronic stress, and repeated fight-or-flight responses can lead to many issues, including anxiety, insomnia, fatigue, illness, weight gain or weight loss, and inflammation

One of the key players in the stress response is cortisol – often referred to as the "stress hormone."

Not only is cortisol released to help start the fight-or-flight response, but it also plays a role in stopping the stress response.

When cortisol is depleted through unrelenting stress, turning off the stress response becomes a problem.

Cortisol also suppresses the immune system.

Whenever someone is barraged with the release of cortisol over long periods, they may experience illness.

This is why people often catch a cold during periods of intense stress.

When cortisol is released for too long, it can also damage the hippocampus – leading to cognitive and memory issues.

It's not just cortisol that can wreak havoc on our brains and bodies.

The constant release of norepinephrine and epinephrine (adrenaline) and the dramatic increase and subsequent lowering of blood sugar levels also play a role in creating anxiety and health problems.

The fight-or-flight response alone isn't the issue.

When you respond this way repeatedly, the constant release of hormones causes problems.

A person might repeatedly trigger the fight-or-flight response for many reasons

Living in a dangerous or stressful environment
Suffering from an underlying illness
Having past trauma or unresolved psychological issues
Having an overly sensitive amygdala
Having less of the calming neurotransmitters such as GABA or serotonin available in the brain and nervous system

Regardless of the reasons for overactive fight-or-flight responses – once a person gets caught up in triggering this response regularly, they begin to deplete cortisol, making it harder to turn it off.

As it becomes harder to turn off, they prolong the response and set up a cycle of stress.

Just as significant (and essential to understanding how anxiety works) is that once you begin to repeat thoughts, actions, or responses, it becomes significantly easier to have these thoughts or reactions.

You create "anxiety pathways," setting yourself up for worry, anxiety, and panic on a regular basis.

Repetition: Creating Anxiety Pathways in the Brain

If you've been dealing with anxiety for any length of time, you've probably come to realize that once you get into the habit of worrying, catastrophizing, or responding to experiences with the fight-or-flight response – it becomes easier and easier to repeat these patterns and harder and harder to break away from them.

This habit of worry and anxiety response is due to physiological reasons just as much as psychological reasons.

The repetition of an action or thought increases the likelihood and ease of performing the action (such as having a panic attack) or thinking the worrying thought (such as "the world is unsafe").

In neuroscience, we understand that the brain recognizes repetition as an indicator of significance.

The brain literally changes its structure to help make that repetitive thought or action easier to perform.

Repetition of anxiety-producing actions, thoughts, worries, or mental images strengthens that particular mental or physical action.

The brain supports the neurons responsible for that particular action.

The neurons fire more efficiently through repetition, making it easier to keep performing the action.

Easy to get on, hard to get off.

Using panic attacks as an example, once we begin having panic attacks repeatedly, it becomes easier and easier to have panic attacks.

Activation of the panic response (the fight-or-flight response) occurs much more easily.

Techniques and therapies focused on reducing the duration and frequency of panic attacks can slow the activation of the response and make it harder to begin in the first place.

Therapies for worry and dealing with anxiety-producing thoughts – focus on managing repetitive thoughts and actions.

Cognitive Behavioral Therapy (CBT) is a perfect example of this.

CBT focuses on keeping track of cognitive processes (what we think about, focus on, worry about, how we interpret things, etc.) and then works to change the thoughts and strategies that don't serve us.

Whether you are dealing with worry, panic attacks, or any type of anxiety – by reducing the duration and frequency of particular actions, you will (over time) undo the pathway your brain created.

Allowing you to step off the path of anxiety.

It may be strange to hear, but this best sums it up: the less you worry or have anxiety-producing thoughts or actions, the easier it is not to worry or have anxiety-producing thoughts. The more you fall into the habit of worry, anxiety, and panic through repetition – the harder it is NOT to have these thoughts or responses.

Putting it All Together

If you've made it with me this far (and it's been a long journey, I know), you hopefully have a better understanding of how anxiety works and the processes involved.

We've discussed the limbic system, the amygdala, and its role in trauma – labeling potential threats and starting the fight-or-flight response.

We've talked about the cortex, where your thoughts and mental images are formed, which can often lead to anxiety or worsen your anxiety by activating the amygdala.

We reviewed the neurotransmitters and their role in anxiety, fear, tension, and panic.

We discussed the sympathetic and parasympathetic nervous systems and how the fight-or-flight response (stress response) works.

And we talked about repetition and falling into the habit of anxiety.

All the information we've reviewed is part of the anxiety process.

But let us bring it down to real-world, concrete examples to help clarify the entire process.

You can better understand how anxiety works in everyday life by seeing how these different parts function in a real-life example.

Let's take the scenario we used way back at the beginning of this article:

You plan on shopping, so you hop in your car and head to the mall. As you approach the parking lot, you begin feeling anxious. By the time you park your car, your heart is beating, and your stomach is in knots. Your mind begins to replay images of the last time you were here and how anxious you felt. You think, "It will happen again," "Why am I so afraid?" "What if I have to leave?" "What if everyone notices me freaking out?" By the time you walk from your car to the mall's front door, you're on the verge of a panic attack; thoughts racing, your heart pounding, your stomach churning, and your hands clammy as you reach for the door.

How do the different systems and processes we discussed play out in this example?

Let's break it down one piece at a time.

You plan on shopping, so you hop in your car and head to the mall. As you approach the parking lot, you begin feeling anxious.

The mall (public place/social engagement) seems to be an amygdala trigger (the amygdala has labeled it a threat), given that you are already anxious when you reach the parking lot.

You could have also had anxiety-producing thoughts on the drive over and not realized it (cortex), or seeing the mall itself could have triggered the amygdala and your anxiety.

By the time you park your car, your heart is beating, and your stomach is in knots. Your mind begins to replay images of the last time you were here and how anxious you felt.

The fight-or-flight response has already begun based on your physical symptoms.

The amygdala has been triggered by your memory of the last time you were here (remember, the amygdala focuses on strong emotions related to safety or potential threat).

The amygdala has activated the sympathetic nervous system; heart rate increased, digestion slowed, and blood moved away from the gut to the muscles and extremities.

You think, "It will happen again," "Why am I so afraid?" "What if I have to leave?" "What if everyone notices me freaking out?"

The cortex makes matters worse with fearful thoughts, making the fight-or-flight response more intense.

You worry about the sensations you are experiencing, possibly triggering a panic attack.

By the time you walk from your car to the front door, you're on the verge of a panic attack; thoughts racing, your heart pounding, your stomach churning, and your hands clammy as you reach for the door.

The fight-or-flight response is in full swing at this point.

If you continue to worry and fear your sensations, you may have a panic attack.

Otherwise, it will pass as the parasympathetic nervous system calms the response and returns you to homeostasis.

It always passes, no matter how bad it seems.

What about neurotransmitters?

Neurotransmitters play a significant role not only during anxiety but before and after.

Neurotransmitters play a part in the duration and intensity of anxiety, how you respond, and whether you go down the path of anxiety and panic in the first place.

You are not a robot governed solely by transmitters in your brain – but neurotransmitters play a decisive role in whether you tend to focus on negative thoughts and scenarios or healthy affirming ones (serotonin), the intensity of your anxiety (dopamine), the overactivity or calmness of your mind (GABA) and whether you over-respond to small stresses (norepinephrine).

Where does repetition fit into this scenario?

Repeating the behavior of worry, anxiety, and panic whenever you approach the mall makes it much easier to become anxious and panic whenever you are in the same situation.

In the example, I mentioned the memory of being anxious the last time you were at the mall, which kickstarted the anxiety and panic.

Repetition is already beginning to reinforce the panic response being triggered by the mall.

If the repetition continues, you will panic automatically whenever you go to the mall.

This repetition and reinforcement would need to be broken and moved away from in order to undo the automatic response you are experiencing.

Final Thoughts

I discovered much of this information over the course of many years while dealing with extreme anxiety and panic attacks.

While learning how anxiety works didn't cure my anxiety; it helped me to put things into perspective and understand what was happening when I was anxious or in the throes of panic.

Learning this information also helped to reduce my fear of the physical symptoms of anxiety and the fight-or-flight response.

My pounding heart wasn't a heart attack but simply an increased heart rate and blood flow.

The dizziness I felt didn't mean I was about to pass out – it was simply the release of different brain chemicals and a change in blood sugar levels.

Both were normal parts of the fight-or-flight response.

This information also helped me see how I was creating a lot of my anxiety (being anxious about anxiety) and making minor anxiety-producing situations much worse.

I have written this article to help you understand the processes behind anxiety so you can understand what happens when you experience anxiety.

Hopefully, it will help reduce your fears around anxiety and lead to a better understanding of the techniques and therapies you can use to handle the anxiety you are dealing with – as it did for me.

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