National Alliance on Mental Illness
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Anxiety and the Brain: Emerging Research and Treatment
by Brendan McLean, NAMI Communications Intern
Imagine yourself standing in the aisle of your local grocery store, the seven-foot shelves on either side overflowing with rainbow-colored jars of jelly, jam and preserves. All of this opportunity for choice sounds like a good thing, right? Actually, having so many choices can have an adverse effect in some people, setting off a series of reactions in the brain that make it more difficult to function in the grocery store and beyond.
“One of the hallmark cognitive problems in generalized anxiety disorder is choice overload,” says Hannah Snyder, one of the designers of a study examining decision making and anxiety. “A person with anxiety will go into a store to buy a birthday card, look at every single card in the store and then leave an hour later without having bought anything. It may seem trivial but it creates a lot of anxiety and has the potential to affect much more serious life decisions.” Even in people who do not live with clinical anxiety, research has found that when employees must choose from an increasing number of retirement plans, they are less likely to join any plan at all. Similarly, when physicians are asked to prescribe one of two similar pain medications they are less likely to give either.
There are multiple ways in which an anxiety disorder can affect an individual. Clinical anxiety, however, is not merely feeling anxious. Anxiety is an illness that impairs one’s ability to fully function on a day-to-day basis and should not be viewed any less seriously than other mental illnesses such as major depressive disorder, schizophrenia or bipolar disorder. Someone living with this kind of anxiety may find it difficult to face everyday situations or even leave the house. Scientists are working to untangle what may feel like an overwhelming wave of fear, pressure or dread for the person experiencing it, hoping to locate the brain’s anxiety centers.
The Neurotransmitter Building Blocks of Anxiety
One piece of the puzzle that continues to show up in the research behind mental illness is gamma-aminobutyric acid (GABA). Dysfunctions in the GABA system are may play a part in a variety of mood disorders including schizophrenia, bipolar disorder, depression and anxiety disorders. The fact that the symptoms of anxiety and depression respond to similar treatments—whether it be cognitive behavioral therapy or medication—supports the idea that there may be a common neurobiological dysfunction.
Dr. Mitsutoshi Munakata and her colleagues at the University of Colorado-Boulder released a study that looked closely at the role GABA relay neurons play in increasing an individual’s risk of developing anxiety. Studying the production of language, the team looked at the inhibitory dynamics caused by GABA-transmitting neurons and their prevalence within verb-generating tasks. GABA acts as the “stop signal.” If this neurotransmitter works too efficiently, or not efficiently enough, a person’s wellbeing will be affected. An individual with not enough GABA may exhibit signs of stress and anxiety and an individual with too much may be overly relaxed. Similarly, when individuals are shown to have decreased levels of neural inhibition, their ability to make a selection among options is impaired.
Benzodiazepines: Anxiety Now, Anxiety Later?
Conversely, increased GABA production leads to lower and shorter activation time among these competing choices. One way to improve GABA transmitting functions is to administer the GABA-triggering medication midazoplam, a benzodiazepine. Study participants who took the drug showed signs of improved selection ability.
Benzodiazepines are widely prescribed because they are generally well-tolerated and begin to show results quite rapidly. Although GABA triggers are prescribed to treat the affective symptoms of anxiety disorders, researchers believe that these medications may also be effective at controlling the underlying factors that ultimately give rise to these symptoms.
Despite the many positive benefits that have been found in benzodiazepine-type drugs, these drugs should still be taken with caution. Benzodiazepines, which are similar to older sedative/hypnotic types of drugs,( i.e., barbiturates), which act on the same GABA receptors, have recently been shown to have similar negative consequences. Multiple studies have revealed benzodiazepines to be addictive, with one study showing up to 70 percent of chronic benzodiazepine users experiencing withdrawal symptoms, and 60 percent of those individuals reporting post-treatment anxiety problems equal to or greater than those at pre-treatment. Individuals with previous drug or alcohol abuse are more likely to develop an abusive pattern.
Cognitive Strategies for Managing Anxiety
People weighing the pros and cons of anti-anxiety medication might want to read some of the latest studies weighing in on cognitive therapy. Much of the recent research has found that certain regions of the “anxious brain” respond differently to stimuli from the environment. Seeing the evidence on the brain scans doesn’t mean some people are simply destined to be anxious. Attention training, a cognitive technique that can help alter the perception of threats, appears to be effective for people living with anxiety. Working with a professional to help tailor cognitive approaches to anxiety-provoking situations can actually change the way the brain works. For example, someone who has a spider phobia can, through repetition, alter the way their brain habitually responds to an "eight-legged threat.”
Whether it’s triggered by something small like a spider, mundane like a trip to the grocery store or traumatic like combat stress-related PTSD, anxiety comes in all shapes and sizes. The severity of the reaction varies from person to person, with some experiencing more or less “invisible” anxiety while others go into full fight-or-flight mode in public. Regardless of what we think we know about the way someone “should” react to a given situation, it’s important to remember that everyone feels anxious sometimes. And for those whose brains process their environments differently enough to be diagnosed with clinical anxiety, there are multiple techniques and treatments that can help put overwhelming choices into perspective. Read more about anxiety on the NAMI website.