You’re driving to work one day when you suddenly wonder, Did I turn off the stove? You begin to mentally trace your steps from earlier that morning, but you still can’t remember turning it off. You probably did…but what if you didn’t? Your anxiety begins to build as the image of the stove catching on fire pops into your head. Just then, the person in the car in front of you slams on the brakes. You clutch the steering wheel tightly and hit your own brakes hard, stopping just in time. Your whole body is activated with a surge of energy and your heart is pounding, but you’re safe. You take some deep breaths. That was close!
Anxiety, it seems, is all around us. If you carefully consider the events in the scenario above, you’ll notice that they illustrate two very different ways that anxiety begins: through what we think about, and through reactions to our environment. This is because anxiety can be initiated by two very different areas of the human brain: the cortex and the amygdala. This understanding is the result of years of research in a field known as neuroscience, which is the science of the structure and function of the nervous system, including the brain.
The simple example above, involving both the imagined stove and the braking car, illustrates the underlying principle of this book: two separate pathways in the brain can give rise to anxiety, and each pathway needs to be understood and treated for maximum relief (Ochsner et al. 2009). In that example, anxiety was aroused in the cortex pathway by thoughts and images of the risks of leaving the stove on all day. And information from another anxiety-producing pathway, traveling more directly through the amygdala, ensured a quick reaction to avoid rear-ending another car.
Everyone is capable of experiencing anxiety through both pathways. Some people may find that their anxiety arises more frequently in one pathway than the other. As you’ll learn, recognizing the two pathways and handling each in the most effective manner is essential. The purpose of this book is to explain the differences between the two pathways, demonstrate how anxiety is created in each, and give you practical ways to modify circuits in each pathway in order to make anxiety less of a burden in your life. We’ll show you how you can actually change the pathways in your brain so that they’re less likely to create anxiety.
Anxiety is a complex emotional response that’s similar to fear. Both arise from similar brain processes and cause similar physiological and behavioral reactions; both originate in portions of the brain designed to help all animals deal with danger. Fear and anxiety differ, however, in that fear is typically associated with a clear, present, and identifiable threat, whereas anxiety occurs in the absence of immediate peril. In other words, we feel fear when we actually are in trouble - like when a truck crosses the center line and heads toward us. We feel anxiety when we have a sense of dread or discomfort but aren’t, at that moment, in danger.
Everyone experiences fear and anxiety. Events can cause us to feel in danger, such as when a severe storm shakes our house or when we see a strange dog bounding toward us. Anxiety arises when we worry about the safety of a loved one who’s far from home, when we hear a strange noise late at night, or when we contemplate everything we need to complete before an upcoming deadline at work or school. Many people feel anxious quite often, especially when under some kind of stress. Problems begin, however, when anxiety interferes with important aspects of our lives. In that case, we need to get a handle on our anxiety and regain control. We need to understand how to deal with it so it no longer limits our lives.
Anxiety can limit people’s lives in surprising ways - many of which may not seem to be due to anxiety. For example, while some people are plagued by worries that haunt every waking moment, others may find it difficult to fall asleep. Some may have a hard time leaving home, while for other individuals a fear of public speaking may threaten their job. A new mother may have to complete a series of rituals for hours each morning before she can leave her child with a sitter. A teenage boy may be haunted by nightmares and get suspended for fighting in school after his home has been destroyed by a tornado. A plumber’s anxiety about encountering large spiders may reduce his income to a level that won’t support his family. A child may be reluctant to attend school and unwilling to talk to her teachers, threatening her education.
Even though anxiety has the power to rob a person of the capacity to complete many of the basic activities of life, all of these individuals can return to fully engaging in life. They can understand the cause of their difficulties and begin to find confidence again. This understanding is possible thanks to a recent revolution in knowledge about the brain structures that create anxiety.
In the past two decades, research on the neurological underpinnings of anxiety has been conducted in a variety of laboratories around the world (Dias et al. 2013). Research on animals has uncovered new details about the neurological foundations of fear. Structures in the brain that detect threats and initiate protective responses have been identified. At the same time, new technologies like functional magnetic resonance imaging and positron emission tomography scans have provided detailed information about how the human brain responds in a variety of situations. When reviewed, analyzed, and combined, this emerging knowledge allows neuroscientists to make connections between animal research and human research. As a result, they are now able to assemble a clear picture of the causes of fear and anxiety, providing an understanding that surpasses our understanding of all other human emotions.
This research has revealed something very important: two fairly separate pathways in the brain can create anxiety. One path begins in the cerebral cortex, the large, convoluted, gray part of the brain, and involves our perceptions and thoughts about situations. The other travels more directly through the amygdalas (uh-MIG-dull-uhs), two small, almond-shaped structures, one on each side of the brain. The amygdala (generally referred to in the singular) triggers the ancient fight-or-flight response, which has been passed down virtually unchanged from the earliest vertebrates on earth.
Both pathways play a role in anxiety, although some types of anxiety are more associated with the cortex, while others can be directly attributed to the amygdala. In psychotherapy for anxiety, attention has typically been focused on the cortex pathway, using therapeutic approaches that involve changing thoughts and arguing logically against anxiety. However, a growing body of research suggests that the role of the amygdala must also be understood to develop a more complete picture of how anxiety is created and how it can be controlled. In this book, we’ll explore both pathways to give you a full picture of anxiety and how to change it, whatever its origin.
Chances are you’re already familiar with the cortex, the portion of the brain that fills the topmost part of the skull. It’s the thinking part of the brain, and some say it’s the portion of the brain that makes us human because it enables us to reason, create language, and engage in complicated thinking, such as logic and mathematics. Species that have a large cerebral cortex are often thought to be more intelligent than other animals.
Approaches to treating anxiety that target the cortex pathway are numerous and typically focus on cognitions, the psychological term for the mental processes that most people refer to as “thinking.” Thoughts originating in the cortex may be the cause of anxiety, or they may have the effect of increasing or decreasing anxiety. In many instances, changing our thoughts can help us prevent our cognitive processes from initiating or contributing to anxiety.
Until recently, treatments for anxiety were less likely to take the amygdala pathway into consideration. The amygdala is small, but it’s made up of thousands of circuits of cells dedicated to different purposes. These circuits influence love, bonding, sexual behavior, anger, aggression, and fear. The role of the amygdala is to attach emotional significance to situations or objects and to form emotional memories. Those emotions and emotional memories can be positive or negative. In this book, we’ll focus on the way the amygdala attaches anxiety to experiences and creates anxiety-producing memories. This will help you to understand the amygdala so you can learn how to change its circuitry to minimize anxiety.
We humans aren’t consciously aware of the way the amygdala attaches anxiety to situations or objects, just as we aren’t consciously aware of the liver aiding digestion. However, the amygdala’s emotional processing has profound effects on our behavior. As we’ll discuss in this book, the amygdala is at the very heart of where the anxiety response is produced. Although the cortex can initiate or contribute to anxiety, the amygdala is required to trigger the anxiety response. This is why a thorough approach to addressing anxiety requires dealing with both the cortex pathway and the amygdala pathway.
The chapters in part 1 of this book, “Anxious Brain Basics,” are dedicated to explaining the cortex and amygdala pathways. We’ll explain the different ways the pathways work, both separately and in conjunction with one another. Once you have a good foundation in how each pathway creates or enhances anxiety, we’ll teach you specific strategies to combat, interrupt, or inhibit your anxiety based upon what you’ve learned about the circuitry in your brain. We’ll describe strategies you can use to change the amygdala pathway in part 2, and strategies to change the cortex pathway in part 3. Then, in the conclusion, “Putting It All Together,” we’ll help you draw upon everything you’ve learned about changing your brain in order to live a more anxiety-resistant life.
In the past two decades, research has revealed that the brain has a surprising level of neuroplasticity, meaning an ability to change its structures and reorganize its patterns of reacting. Even parts of the brain that were once thought impossible to change in adults are capable of being modified, revealing that the brain actually has an amazing capacity to change (Pascual-Leone et al. 2005). For example, people whose brains are damaged by strokes can be taught to use different parts of the brain to move their arms (Taub et al. 2006). Under certain circumstances, circuits in the brain that are used for vision can develop the capacity to respond to sound in just a few days (Pascual-Leone and Hamilton 2001).
New connections in the brain often develop in surprisingly simple ways: Exercise has been shown to promote widespread growth in brain cells (Cotman and Berchtold 2002). In some research, just thinking about taking certain actions, like throwing a ball or playing a song on the piano, can cause changes in the area of the brain that controls those movements (Pascual-Leone et al. 2005). In addition, certain medications promote growth and changes in circuits of the brain (Drew and Hen 2007), especially when combined with psychotherapy. Also, psychotherapy alone has been shown to produce changes (Linden 2006), reducing activation in one area and increasing it in others.
Clearly, the brain isn’t fixed and unchangeable, as so many people, scientists included, once assumed. The circuits of your brain aren’t determined completely by genetics; they’re also shaped by your experiences and the way you think and behave. You can remodel your brain to respond differently, no matter what age you are. There are limits, but there’s also a surprising level of flexibility and potential for change in your brain, including changing its tendency to create problematic levels of anxiety.
We’ll help you use neuroplasticity, along with an understanding of how the cortex and amygdala pathways work, to make lasting changes in your brain. You can use this information to transform your brain’s circuitry so that it resists anxiety, rather than creating it.
We strongly recommend that you seek professional help, and specifically cognitive behavioral therapy, as you work on the strategies presented in this book. Cognitive behavioral therapists are trained in identifying anxiety-producing thoughts and other techniques in this book, including exposure therapy. Therapists in many disciplines have training in cognitive behavioral therapy, including social workers, for example. When choosing a therapist, it’s important to ask whether the therapist is knowledgeable about cognitive behavioral methods of treatment, especially exposure and cognitive restructuring.
If you take antianxiety medications, it’s important to use them wisely to support the process of modifying your anxiety. If a family practitioner prescribes your medications, we strongly suggest that you consult with a psychiatrist, who will have more experience with antianxiety medications, and the brain and how medications affect it. In addition, psychiatrists are more likely to be familiar with exposure and cognitive behavioral therapy in general.
That said, psychiatrists aren’t necessarily trained in the various amygdala-based and cortex-based strategies for reducing anxiety we outline in this book. Many people seeking treatment for anxiety expect a psychiatrist to provide therapy and are surprised when the psychiatrist instead focuses on medications. Remember, psychiatrists aren’t therapists; they’re physicians who are trained to treat psychological disorders, primarily through the use of medications.
If you speak with a psychiatrist about medications, be sure the two of you consider the distinction between medications that provide relief from anxiety on a short-term basis and those that can assist you in modifying your brain’s anxiety responses in a more lasting way. Also, explain the approaches you’re using to combat anxiety so that any medications you take support you in the process. And, of course, make sure to inform your psychiatrist about any medication side effects you experience. Good communication between you, your psychiatrist, and your therapist, if you have one, can be immensely helpful in facilitating the process of rewiring your anxious brain. Each of you can make important contributions in evaluating how a given medication is working and affecting the treatment process.
At its best, anxiety can help us stay alert and focused. It can get our hearts pounding and give us the extra adrenaline we need to, say, win a race. At its worst, however, it can wreak havoc with our lives and paralyze us to the point of inaction.
If you suffer from anxiety, especially an anxiety disorder, you know how disabling it can be. However, ridding yourself of all anxiety isn’t a realistic goal; and it is not only impossible but unnecessary. For some people, fear of flying severely limits their career, but others can easily avoid air travel for an entire lifetime with few consequences. If you focus your attention on the anxiety reactions that frequently or severely interfere with your ability to live your life in the way you desire, you’ll be on the right track.
Take some time right now to think of examples of how anxiety or avoidance interferes with your life. Write them down if that’s helpful. Think of potential goals that you have difficulty accomplishing due to anxiety. And because anxiety can extend its reach to influence future decisions, be sure to look beyond your daily life. Is anxiety keeping you from doing things like taking a trip, switching jobs, or confronting a problem?
Of course, you can’t tackle all of these situations at once. Several considerations are helpful in choosing which situations to focus on and which to focus on first. You could begin with the situations that you deal with most frequently, or you might want to start with situations that result in the highest levels of anxiety. In any case, it’s essential to focus on situations in which reducing anxiety will make a real difference in your life.
The central goal of this book is to give you the power to live your life in the manner you wish so that you can fulfill your own aspirations. Therefore, when deciding which anxiety responses you want to modify, carefully consider your personal objectives. What short-term and long-term goals do you have for yourself? To help you clarify this, complete the following sentences. For each sentence, try to imagine what you’d like to do if anxiety weren’t a limiting factor:
Keeping in mind the anxiety responses that most impact your life, you’re now ready to learn how to change those responses. So in chapter 1, we’ll begin by taking a look at the two pathways in the brain that create anxiety. Learning how the circuitry in these pathways functions, along with how you can potentially bypass, interrupt, or change that circuitry, is the first step to changing your life.
We want to start this chapter with a promise that everything that we tell you about the brain in this book is useful, practical information that will illuminate the causes of anxiety and help you understand how to change your brain to decrease your experience of anxiety. We won’t present detailed, technical descriptions of all the neurological processes involved; instead, we will provide a simplified, basic explanation of anxiety in the brain that can help you understand why certain strategies will help you control your anxiety.
If you don’t know what causes your anxiety, you’re at a disadvantage when you try to change it. Anxiety is created by the brain, and wouldn’t occur without the contributions of specific brain areas. And while the brain is a very complex, interconnected system, much of which remains a mystery, we can identify two general sources of anxiety in it. There are also techniques you can use to target these specific sources of anxiety that will help you be more effective in managing or preventing the anxiety you feel.
As mentioned in the introduction, the main sources of anxiety in the brain are two neural pathways that can initiate an anxiety response. The cortex pathway is the one most people think of when they consider the causes of anxiety. You’ll learn much more about the human cerebral cortex in the next section. For now, we’ll simply say that the cortex is the pathway of sensations, thoughts, logic, imagination, intuition, conscious memory, and planning. Anxiety treatment typically targets this pathway, probably because it’s a more conscious pathway, meaning that we tend to be more aware of what’s happening in this pathway and have more access to what this part of the brain is remembering and focusing on. If you find that your thoughts keep turning to ideas or images that increase your anxiety, or that you obsess over doubts, become preoccupied with worries, or get stuck in trying to think of solutions to problems, you’re probably experiencing cortex-based anxiety.
The amygdala pathway, on the other hand, can create the powerful physical effects that anxiety has on the body. The amygdala’s numerous connections to other parts of the brain allow it to mobilize a variety of bodily reactions very quickly. In less than a tenth of a second, the amygdala can provide a surge of adrenaline, increase blood pressure and heart rate, create muscle tension, and more. The amygdala pathway doesn’t produce thoughts that you’re aware of, and it operates more quickly than the cortex can. Therefore, it creates many aspects of an anxiety response without your conscious knowledge or control. If you feel like your anxiety has no apparent cause and doesn’t make logical sense, you’re usually experiencing the effects of anxiety arising from the amygdala pathway. Your awareness of the amygdala is likely to be based on your experience of its effects on you - namely bodily changes, nervousness, wanting to avoid a certain situation, or having aggressive impulses.
Therapists often don’t discuss the amygdala when treating anxiety disorders, which is surprising, given that most experiences of fear, anxiety, or panic arise due to involvement of the amygdala. Even when the cortex is the source of anxious thinking, it’s the amygdala that causes the physical sensations of anxiety to occur: pounding heart, perspiration, muscle tension, and so on. However, when family doctors and psychiatrists are prescribing medications to reduce anxiety, they’re often focused on the amygdala, even though they may not mention it by name. These medications, such as Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam), often have the effect of sedating the amygdala.
Such tranquilizing medications are very effective at quickly reducing anxiety. Unfortunately, they do nothing to change the circuitry of the amygdala. So while they reduce the anxiety response, they don’t help change the amygdala in ways that would be beneficial in the long term. (If you’re taking antianxiety medications or want to know how specific medications affect the process of treating anxiety, please visit http://www.newharbinger.com/31137, where you’ll find a bonus chapter, “Medications and Your Anxious Brain,” which is available for download. See the back of the book for information on how to access it.)
The amygdala has many functions that aren’t related to anxiety, and we won’t delve into them here. To understand the amygdala’s role in anxiety, it’s important to know that as you go about your day, the amygdala notices sounds, sights, and events even though you may not be consciously focused on them. The amygdala is on the lookout for anything that might indicate potential harm. If it detects potential danger, it sets off the fear response, an alarm in the body that protects us by preparing us to fight or flee.
Consider it this way: We are the descendants of frightened people. Early humans whose amygdala reacted to potential dangers and produced a strong fear response were most likely to behave in cautious ways and be protective of their children, which meant they were more likely to survive and pass their genes (and frightened amygdala) on to future generations. On the other hand, early humans who were too calm to worry about, say, whether a lion was nearby or whether a river looked like it would flood their dwelling were less likely to survive and pass on their genes. Through natural selection, humans living today are the descendants of people whose amygdalas produced very effective fear responses.
Having a protective, fear-producing amygdala is nearly universal among humans. It isn’t surprising, therefore, that anxiety disorders are the most common mental disorder people experience, affecting approximately forty million adults in the United States (Kessler et al. 2005). Given that the daily dangers in our lives have been reduced tremendously since prehistoric times, you may wonder why so many people are experiencing anxiety-based problems. Unfortunately, the amygdala is still operating on the lessons it learned in prehistoric times. It still considers us to be potential prey for other animals or humans. It assumes that the best response to danger is running, fighting, or freezing, and it prepares the body to initiate these responses whether they’re appropriate or not. But these fear responses don’t fit the twenty-first-century situations that most of us live in, and they don’t help us in the way they once did. For instance, people seem to be predisposed to fear snakes, spiders, and heights rather than cars, guns, and electrical outlets, even though the latter can be more deadly than the former. In addition, it also seems that some people’s brains are more susceptible to this fear response, whether due to genetics or living through traumatic experiences.
Neuroscience involves the study of the development, structure, and function of the nervous system, including the brain. In order to explain the neuroscience of anxiety, we need to provide you with a concise description of the anatomy of the brain, especially of the cortex and the amygdala. Having a grasp of how these important regions of the brain operate and the ways in which they relate to one another will help you understand what happens when the cortex or amygdala overreacts and creates anxiety. This basic knowledge of neuroscience will provide you with insight into how you can rewire your brain to resist anxiety.
We’ll start with the cortex pathway because when people talk about the brain, they usually picture the wrinkled, gray outer layer of the brain known as the cerebral cortex. The cortex is the source of many of the human race’s most impressive abilities. But, as we’ll explain, these abilities also result in the cortex being capable of creating a great deal of anxiety.
In humans, the cortex is larger and has more developed abilities than those of other animals. It’s divided into two halves: the left hemisphere and the right hemisphere. Furthermore, it’s divided into different sections, called lobes, that have different functions, such as processing vision, hearing, and other sensory information and putting it together to allow you to perceive the world. The cortex is the perceiving and thinking part of the brain - the part you’re using to read and understand this book.
In addition to providing sights, sounds, and other perceptions, the cortex also attaches meaning and memories to those perceptions. So you don’t just see an old man and hear his voice; rather, you recognize him as your grandfather and understand the specific meaning of the sounds he’s making. And beyond providing you with the ability to understand and interpret situations, the cortex allows you to use logic and reasoning, produce language, use your imagination, and plan ways of responding to situations.
The cortex can also contribute to changing your responses to threatening situations, which is key when dealing with anxiety. The cortex is capable of evaluating the usefulness of various responses to the dangers you face. Thanks to the influence of your cortex, you can decide not to physically fight your boss if you feel you’re in danger of being fired, or choose not to run away when you hear exploding fireworks. In fact, by reading this book, you’re doing the very same thing: actively using your cortex to find different ways to cope with anxiety.
The cortex pathway to anxiety begins with your sense organs. Your eyes, ears, nose, taste buds, and even your skin are all sources of information about the world. All of your knowledge of the world has come through your sense organs and been interpreted by different parts of your cortex. When information comes in through your sense organs, it’s directed to the thalamus, which is like the Grand Central Station of the brain (see figure 1). The thalamus is a central relay station that sends signals from your eyes, ears, and so on to the cortex. When information comes into the thalamus, it’s sent out to the various lobes to be processed and interpreted. Then the information travels to other parts of the brain, including the frontal lobes (behind the forehead), where the information is put together so that you can perceive and understand the world.
Figure 1. The human brain
The frontal lobes are one of the most important parts of the cortex to understand. Located directly behind the forehead and eyes, they’re the largest set of lobes in the human brain, and they’re much larger than the frontal lobes of most other animals. The frontal lobes receive information from all of the other lobes and put it together to allow us to respond to an integrated experience of the world. The frontal lobes are said to have executive functions, meaning that they are where the supervision of many brain processes occurs. The frontal lobes help us anticipate the results of situations, plan our actions, initiate responses, and use feedback from the world to stop or change our behaviors. Unfortunately, these impressive capacities also lay the groundwork for anxiety to develop.
The cortex pathway is often a source of anxiety because the frontal lobes anticipate and interpret situations, and anticipation and interpretations often lead to anxiety. For example, anticipation can lead to another common cortex based process that creates anxiety: worry. Because of our highly developed frontal lobes, humans have the ability to predict future events and imagine their consequences — unlike our pets, who seem to sleep peacefully without anticipating tomorrow’s problems. Worry is an outgrowth of anticipation of negative outcomes in a situation. It’s a cortex-based process that creates thoughts and images that provoke a great deal of fear and anxiety.
Some people have a cortex that’s masterful at worrying, taking any situation and imagining dozens of negative outcomes. In fact, some of the most creative people are also sometimes the most anxious because their creativity gives them the ability to dwell on extremely frightening thoughts and images.
A common imagined worry among parents who have teenagers who are late for curfew (and what teenagers are not?) is imagining their kids injured in an accident, bleeding and unable to call for help. This image is terrifying—and completely unnecessary to envision— but some people seem to end up repeatedly anticipating these kinds of negative events. If your pattern of worrying is serious enough that it interferes with your daily life, you may be diagnosed with generalized anxiety disorder.
Another kind of anxiety disorder, obsessive-compulsive disorder, can occur when the frontal lobes create obsessive thoughts—cognitions or doubts that won’t go away, to the point that people spend hours each day focused on them. Obsessions can sometimes lead a person to create elaborate rituals that must be carried out to reduce anxiety. Consider Jennifer, who thought obsessively about all of the germs in her house and spent hours washing her hands and cleaning certain areas of her home. Then, after she finished, she’d start over because she had doubts that led her to think that she might have touched something that contaminated everything that she’d cleaned. These kinds of obsessive thoughts may be due to a dysfunction in the cingulate cortex, an area in the frontal lobes just behind the eyes (Zurowski et al. 2012).
In summary, when we speak of the cortex pathway to anxiety, we’re generally focused on interpretations, images, and worries that the cortex creates, or on anticipatory thoughts that create anxiety when no danger is present. As mentioned, when therapists assist people with modifying their thoughts to reduce worry, they’re focused on the cortex pathway. Such cognitive approaches can be very effective at reducing cortex-initiated anxiety. However, as you now know, another neural pathway is also involved in the creation of anxiety, even when anxiety begins in the cortex.
The second pathway involves the amygdala. Although the cortex pathway to anxiety may be more familiar or understandable because we are often aware of the thoughts it produces, the amygdala initiates the physical experience of anxiety. Its strategic location and connections throughout the brain enable it to control the release of hormones and activate areas of the brain that create the physical symptoms of anxiety. In this way, the amygdala exerts powerful and immediate effects on the body, and these are crucial to understand.
The amygdala is located near the center of the brain (see figure 1). As previously stated, the brain actually has two amygdalas, one in the left hemisphere and one in the right; but it’s customary to refer to the amygdala as singular, so we’ll continue this practice. The position of your right amygdala can be estimated by pointing your left index finger at your right eye and your right index finger into your right ear canal. The point of intersection of the lines from your two fingers is about where your right amygdala is located. Because the amygdala is an almond-shaped structure, it gets its unusual name from the Greek word for almond.
The amygdala is the source of many of our emotional reactions, both positive and negative. When someone violates your personal space or gets in your face, it’s the amygdala that produces the rage you feel. On the other hand, when you meet someone who looks like your grandmother and you experience a warm feeling of affection for this lady you don’t even know, that’s also the amygdala, in this case accessing a pleasant emotional memory. The amygdala both forms and recalls emotional memories; and if you understand this, your emotional reactions will probably make much more sense to you.
The amygdala is divided into several sections, but we’ll focus mainly on two that play essential roles in creating emotional responses, including fear and anxiety. The lateral nucleus is the part of the amygdala that receives incoming messages from the senses. It constantly scans your experiences and is at the ready to respond to any indication of danger. Like a built-in alarm system, its job is to identify any threat you see, hear, smell, or feel and then send a danger signal. It gets its information directly from the thalamus. In fact, it receives information before the cortex does, and this is important to keep in mind.
The reason the lateral nucleus gets information so fast is because the amygdala pathway is the more direct route from our senses. The amygdala is wired to respond quickly enough to save your life. Its rapid response is possible because of a shortcut in brain wiring that allows information to get to the lateral nucleus of the amygdala directly (Armony et al. 1995). When our eyes, ears, nose, or finger-tips receive information, the information travels from these sense organs to the thalamus, and the thalamus sends this information directly to the amygdala. At the same time, the thalamus also sends the information to the appropriate areas of the cortex for higher-level processing. However, the amygdala receives information before the information can be processed by the various lobes in the cortex. This means the lateral nucleus of the amygdala can react to protect you from danger before your cortex even knows what the danger is.
See figure 2 for a simplified illustration of the pathways that allow the amygdala to react before the cortex can.
Figure 2. The two neural pathways to anxiety.
You can see the two pathways to anxiety in this illustration. Information goes directly from the thalamus to the amygdala, allowing the amygdala to react before you have time to use your cortex to think. While this may seem odd, if you consider your own experiences, you can probably recall some times when this has occurred. Have you ever been in a situation in which you reacted instinctively before you had time to know what you were reacting to? Consider Melinda, a ten-year-old girl who was looking for camping equipment in the basement of her home. She walked through a doorway and jumped back in fear. Her reaction was triggered by a coat hanging on a coat rack. Her amygdala responded to the shape of the coat, which could have been an intruder, and caused her to jump out of reach of the “intruder” before she even realized what she’d seen. As an evolution-based safety measure, the amygdala is wired to react before the cortex can.
The detail-focused cortex takes more time to process information from the thalamus. In Melinda’s case, the visual information needs to be sent to the occipital lobe at the back of the head, and from there it’s sent to the frontal lobes, where the information is integrated and informed choices arise. That’s why Melinda jumped back immediately but recovered in a moment and resumed looking for the camping equipment: it took a moment for her cortex to provide the information that the dark shape was a completely harmless coat. (You’ll find a step-by-step explanation, including a downloadable figure, that illustrates the two pathways at work in Melinda’s behavior at http://www.newharbinger.com/31137; see the back of the book for information on how to access it.)
The amygdala can accomplish its quick response because of the special properties of another nucleus within it: the central nucleus. This small but powerful cluster of neurons has connections with a number of highly influential structures in the brain, including the hypothalamus and the brain stem. This circuit can signal the sympathetic nervous system to activate the release of hormones into the bloodstream, increase respiration, and activate muscles — all in a fraction of a second.
The close connection of the central nucleus to elements of the sympathetic nervous system (SNS) provides the amygdala with a great deal of influence over the body. The SNS is made up of neurons in the spinal cord that connect with nearly every organ system in the body, which allows the SNS to influence dozens of responses, from pupil dilation to heart rate. The role of the SNS is to create the fight-or-flight response, an effect that is balanced by the influences of the parasympathetic nervous system (PNS), which allows us to “rest and digest.”
During fear-provoking situations, the lateral nucleus sends messages to the central nucleus to activate the SNS. At the same time, the central nucleus also activates the hypothalamus. (See figure 1 for the location of the hypothalamus.) The hypothalamus controls the release of cortisol and adrenaline, hormones that prepare the body for immediate action. These hormones are released from the adrenal glands, located atop your kidneys. Cortisol increases blood sugar levels, giving you the energy you need to use your muscles. Adrenaline (also called epinephrine) gives you an energetic feeling that heightens your senses, increases your heart rate and breathing, and can even keep you from experiencing pain. All of these responses come from the amygdala pathway.
Clearly, the amygdala wields a lot of power when it comes to initiating split-second physical reactions. In part, this is because the amygdala is strategically located in a central area of the brain, with immediate access to information from the senses and an advantageous position to influence parts of the brain that can change essential bodily functions very quickly. Being aware of how the amygdala functions is a crucial piece of the anxiety puzzle.
As you can see, one clear distinction between the amygdala and the cortex is that they operate on different timetables. The amygdala can cause you to act on information sooner than your cortex can process it, orchestrating a bodily response before the cortex has even finished organizing the information for you to perceive it. While this is beneficial in some situations, the fact that we have little control over the amygdala’s rapid responses means that we experience our fear and anxiety responses, rather than consciously controlling them.
The quick reaction that results from the amygdala pathway is typically called the fight-or-flight response. You’re probably familiar with this phenomenon, which prepares the body to react quickly in a dangerous situation. Most of us have experienced this response and can recall times we felt an adrenaline rush and reacted in an unthinking, immediate way to protect ourselves from a threat. How many people have been saved on the freeway by lightning-quick, instinctive reactions arising in the amygdala? The central nucleus of the amygdala is where the fight-or-flight response is initiated.
Being aware of these rapid responses initiated by the amygdala pathway can help you understand and cope with the physical experience of anxiety, including the most extreme anxiety reaction: a panic attack. People who have panic disorder and suffer from panic attacks find it useful to recognize that many aspects of a panic attack are related to the amygdala’s activation of the fight-or-flight response. Pounding heart, trembling, stomach distress, and hyperventilation are all related to the amygdala’s attempts to prepare the body for action. These symptoms often cause people to think they might be having a stroke or heart attack or are “going crazy.” When people understand that the roots of a panic attack often lie in the amygdala’s attempts to prepare the body to respond to an emergency, they’re less likely to be troubled by these concerns (Wilson 2009).
The reactions of fight or flight are the most familiar fear responses, but the amygdala can also produce another response to fear that’s less recognized: freezing, or becoming very still. In fact, we prefer the term fight, flight, or freeze response because so many people say they feel paralyzed when under extreme stress. As strange as it seems, for our ancestors the reaction of freezing may have been as helpful as fighting or fleeing in certain situations. Like a rabbit that remains motionless as you walk your dog past her nest, those who freeze sometimes find an advantage in remaining still when threatened.
When you’re experiencing the fight, flight, or freeze response, the amygdala is in the driver’s seat and you’re a passenger. That’s why, in emergency situations, you often feel as though you’re observing yourself responding rather than consciously controlling your response. There’s a reason why we don’t feel in control in these moments, or in control of our anxiety: the amygdala isn’t just faster—it also has the neurological capability to override other brain processes (LeDoux 1996). There are many connections from the amygdala to the cortex, allowing the amygdala to strongly influence the cortex’s responding on a variety of levels, while fewer connections travel from the cortex to the amygdala (LeDoux and Schiller 2009). Therefore, it’s literally true that you can’t think when the amygdala takes control. The thinking processes of the cortex are superseded and you’re under the influence of the amygdala.
Although you may question the usefulness of this arrangement, in some situations it’s crucial. Would it be wise for your brain to wait for the cortex to analyze the make, model, and color of a car crossing the center line toward you and consider details such as the facial expression of the driver before reacting? Clearly, the ability of the amygdala to override the cortex can literally save your life. In fact, it probably already has.
Being aware of the amygdala’s ability to take over is crucial for anyone who’s struggling with anxiety. It’s a reminder that the brain is hardwired to allow the amygdala to seize control in times of danger. And because of this wiring, it’s difficult to directly use reason-based thought processes arising in the higher levels of the cortex to control amygdala-based anxiety. You may have already recognized that your anxiety often doesn’t make sense to your cortex, and that your cortex can’t just reason it away.
In addition, the amygdala can also influence the cortex by causing the release of chemicals that influence the entire brain, including the cortex (LeDoux and Schiller 2009). These chemicals can literally change the way you think. Therefore, strategies for coping with amygdala-based anxiety are essential, even though cortex-focused approaches are more commonly offered in treatment. In part 2 of this book, you’ll learn techniques for controlling amygdala-based anxiety responses.
Based on what you’ve read thus far, you now know which parts of the brain are involved in different types of anxiety. You know that the cortex pathway produces worries, obsessions, and interpretations that create anxiety, and you know that the amygdala initiates bodily reactions that make up the fight, flight, or freeze response. Many people find some comfort in simply knowing where various symptoms are coming from, that their reactions make sense, and that they aren’t going crazy.
Now that you understand the parts of the brain that are involved in creating anxiety, you’re probably interested in how you can change the way these parts of the brain respond. In order to do so, you need to make changes in the brain’s circuitry. The brain is made up of billions of connected cells that form circuits that hold your memories, produce your feelings, and initiate all of your actions. These cells are called neurons, or nerve cells, and they’re the basic building blocks of the brain. They’re the reason that your brain has neuroplasticity: the ability to change itself and its responses. On the basis of your experiences, the neurons in your brain are capable of changing their structures and patterns of responding. Understanding how neurons function will help you learn strategies that will allow you to rewire the circuits in your brain that create anxiety. It will also help you understand the effects of antianxiety medications on the brain.
Figure 3. The anatomy of a neuron.
The space between an axon and dendrite is called a synapse (illustrated in figure 4). In this tiny space, communication between neurons occurs. At the end of the axon, called the axon terminal, tiny sacs hold neurotransmitters in preparation for sending chemical messages. Some neurotransmitters excite the next neuron, and others inhibit or quiet it.
Figure 4. A synapse between two neurons.
Neurotransmitters are called chemical messengers because when they cross the synaptic space, it’s as if they’re taking a message to the next neuron. Neurotransmitters connect to receptor sites on the dendrites of the next neuron and have an effect similar to that of putting a key in a lock. We won’t go into the specifics, but suffice it to say that when a neurotransmitter connects with the receptor site, it can cause the neuron to react by firing. Firing is when a positive charge travels from the receiving dendrites of a neuron, through the cell body, and all the way to axons at the other end. This causes the axon to release neurotransmitters from its axon terminals, transmitting the chemical message to yet another neuron, passing the message on.
Neurons operate on the basis of chemical messages between neurons and electrical charges within neurons. Every sensation you experience, from the sight of these words on the page to the sounds of birds singing in your yard, is processed in your brain by neurons. The sensations you experience, such as light waves that enter your eyes or vibrations in the air that impact your eardrums, get translated into electrical signals within neurons, and these signals are then communicated to other neurons via neurotransmitters. By means of these communication processes, the brain builds circuits of neurons that work together to store memories, create emotional reactions, initiate thought processes, and produce actions.
When scientists discovered that the messages sent between neurons were based on neurotransmitters sent from one neuron to the next, they began to develop medications that could target this process. Many of the medications most commonly used to treat anxiety, such as Lexapro (escitalopram), Zoloft (sertraline), Effexor (venlafaxine), and Cymbalta (duloxetine), were designed to increase the amount of neurotransmitters available in the synapse as a way of affecting circuits in certain areas of the brain. (The specific ways these medications affect neurons and how they influence anxiety are explained in “Medications and Your Anxious Brain,” a bonus chapter of this book available for download at http://www.newharbinger .com/31137.)
Why do you need to know how neurons operate? If you want to rewire the brain, it helps to understand the brain’s circuitry and its basis in connections formed between neurons. A Canadian psychologist named Donald Hebb (1949) proposed a theory of how neurons create circuitry that’s turned out to be very useful in explaining the process. His idea has since been distilled into this simple statement by neuroscientist Carla Shatz: “Neurons that fire together wire together” (Doidge 2007, 63). This statement offers clear insight into how you can change the wiring in your brain.
Basically, for neurons to build connections between themselves, one neuron needs to be firing at the same time another neuron is firing. When neurons fire together, a connection between them is strengthened, and eventually a pattern of circuitry develops in which activation of one neuron causes the other to activate as well. More neurons can be connected with these neurons in a similar way, and if they fire together, soon a whole set of connected neurons is created. Changing neural circuitry involves changing the activation patterns in the brain so that new connections develop between neurons and new circuits form. Changes in the brain, or learning, can occur as a result of neurons establishing new connections and circuitry.
Although our brains are programmed from birth to develop and organize themselves, they’re amazingly flexible and exquisitely responsive to the particular experiences of each individual. As neuroscientist Joseph LeDoux (2002, 3) explains it, “People don’t come preassembled, but are glued together by life.” The circuitry in your brain is shaped by the specific experiences you’ve had, and it can be changed as a result of your continuing experiences. For example, connections between particular neurons are strengthened when you use them. Some of us continue to use our memories of multiplication tables to calculate math equations, and those connections remain as strong as when we were in school. But some of us rely on calculators, so we don’t regularly use the brain circuits storing the multiplication tables, and our memory of these tables weakens.
The specific circuitry in your brain develops based on the experiences you have. Perhaps your brain came to associate horses with stables, grandfathers with cigars, the smell of popcorn with baseball, and so on. Although two people may share similar associations, each of us has uniquely formed brain circuits based on our own experiences. While one person may have circuitry that associates cows with cheese and Wisconsin, another person may have circuitry that associates cows with barns and milking machines.
Neurons make new connections and build new circuits in a variety of ways. Circuitry can be activated by certain deliberate thoughts, like those you have when you’re asked to remember your grandmother. Circuitry can be reorganized by changing your behavior, such as learning a new golf swing. Performing behaviors, like playing the piano or serving a volleyball, can cause new circuits to develop, and even imagining performing these behaviors can cause changes in circuitry. The brain remains flexible and capable of making changes throughout life.
If you want to change the anxiety you experience, you need to change the neural connections that lead to anxiety responses. Some of these connections are stored in the brain’s circuitry in the form of memories, and memories are formed in both the cortex and the amygdala.
Emotional memories are made by the lateral nucleus in the amygdala through the process of association, which we’ll discuss in chapter 2. These emotional memories come from experiences that your cortex may or may not remember. This is because the memory system in the cortex is completely separate from that in the amygdala. In fact, evidence suggests that amygdala-based memory is longer lasting than cortex-based memory (LeDoux 2000). In other words, the cortex is much more likely than the amygdala to forget information or have trouble retrieving it.
The existence of different memory systems explains why you can experience anxiety in a situation without any conscious memory (or understanding) of why the situation produces anxiety. Just because your amygdala has an emotional memory of an event doesn’t mean that your cortex remembers the same event. And if your cortex doesn’t remember the event, you’ll have difficulty remembering it because we humans rely on our cortex memory. This means we sometimes have emotional reactions that puzzle us, especially when it comes to anxiety. So you may not understand why crossing bridges is anxiety provoking, why you avoid sitting with your back to the door in a restaurant, or why the smell of tomato plants makes you tense.
The amygdala is capable of reacting on the basis of its own emotional memories and doesn’t need cortex-based memories. Research tracing the pathways in the brain that give rise to emotional responses has shown that emotional learning can occur without involvement of the cortex (LeDoux 1996). Here’s an example that will help illustrate this (from Claparede 1951).
A woman was hospitalized as a result of Korsakoff’s syndrome, a memory disorder often associated with chronic alcoholism. Her cortex couldn’t form memories of her experiences, so she couldn’t identify her doctor or the hospital, despite the fact that she’d been in the same hospital for years. She didn’t know the name of the nurse who had cared for her for months, and she couldn’t remember details of a story told to her only minutes before. But at the same time, her amygdala demonstrated the ability to create emotional memories without the aid of her cortex.
One day her physician performed a little experiment (one that wouldn’t be ethical by today’s standards). When he reached out to shake her hand, he stuck her hand with a pin he’d hidden in his palm. The next day, when the woman saw the doctor extend his hand, she quickly withdrew her hand in fear. When asked why she refused to shake his hand, she couldn’t offer an explanation. In addition, she reported that she had no memory of seeing the doctor before. She had no cortex-based memory of an event that would cause her to fear the doctor; but her amygdala had created an emotional memory, and her fear was the evidence of it.
If you fear a specific object or situation, you may be able to recall an experience in which your amygdala learned that fear. Alternatively, it may be difficult to uncover how an amygdala-based fear developed, since your cortex isn’t able to retrieve a memory related to that situation, even though the amygdala clearly does. The fact that the cortex can be left out of the loop is why people are often confused by their emotional responses.
Here’s an example to illustrate what this confusion is like: Lily recognized that she had social phobia when she learned about the symptoms of social phobia on an anxiety website. She knew that she felt uncomfortable in groups of people and that it was difficult for her to attend family gatherings, like Thanksgiving dinner or a sister-in-law’s baby shower. When her therapist told her that this anxiety was probably due to her amygdala, she had no idea why her amygdala had developed this emotional response. But after her therapist asked her to identify the specific characteristics of the gatherings that provoked anxiety, Lily said that being in a circle of people, even cheerful family members, was very distressing. She recognized that a circle of people was terrifying to her, especially when they all could look at her at once.
When the therapist asked Lily if she could think of an experience that could have taught her amygdala that a circle of people was dangerous, Lily recalled an event in second grade when she was in a circle of children reading aloud from their books. When it was her turn to read, she had difficulty, and the teacher treated her in a way that made her feel humiliated. The cortex-based memory of this experience finally came back to Lily, and she understood why her amygdala had created an emotional memory to try to protect her. Because of that memory, her amygdala responded to a circle of people as though they posed a danger.
Realizing that your amygdala stores emotional memories that your cortex has no knowledge of can help you better understand some of your emotional reactions. Sometimes the cortex has a complete lack of understanding of the origins or purposes of the emotional reactions created by the amygdala. But you can learn more about these processes, so in the next chapter we’ll help you and your cortex become more knowledgeable about the workings of the amygdala.
Two pathways can create anxiety. One pathway travels the detail-focused circuitry of the cortex and eventually sends information to the amygdala, which produces an anxiety response. The other pathway runs directly from the thalamus to the amygdala. Each pathway can cause the amygdala to create anxiety, but each is also constructed of circuitry, and certain aspects of that circuitry can be modified. If you understand how the circuitry works, you can rewire your anxious brain so that you experience less anxiety.
Don’t be fooled by the small size of your amygdala. Even though the largest and most developed portion of the human brain, the cortex, contributes to anxiety in many ways, the amygdala plays the most influential role because, as you learned in chapter 1, it’s involved in both the cortex pathway and the amygdala pathway to anxiety. Like the conductor of an orchestra, the amygdala controls many different reactions in both your brain and your body. In addition to relying on preprogrammed responses, it’s also exquisitely sensitive to what happens to you and responds to your specific experiences.
In this chapter, you’ll learn about the amygdala’s special “language” and its impact on your life. In evolutionary terms, the amygdala is an extremely ancient structure, and the human amygdala is quite similar to the amygdalas found in all other animals. Because the human amygdala is so similar to that in rats, dogs, and even fish, researchers have been able to study its functioning in depth and have learned a great deal about how it creates fear and anxiety.
When you’re born, your amygdala has preprogrammed responses that are ready to be put into action. But this ancient structure isn’t fixed; the amygdala is constantly learning and changing based on your day-to-day experiences. In fact, once you understand what we call the “language of the amygdala,” you’ll have more control over your anxiety responses because you’ll know how to influence the part of the brain that’s at the very root of fear.
To understand amygdala-based anxiety, it’s useful to think of the amygdala as your protector. Natural selection has given humans a fear-producing amygdala that has protection as a central goal. As you go about your day, the amygdala is vigilant for anything that might indicate potential harm. While the goal of protection is good, the amygdala can overreact, creating a fear response in situations that aren’t really dangerous.
Consider Fran, who’s about to give a speech. Her heart begins to pound and she starts to hyperventilate as soon as she stands in front of the group with everyone staring at her. What is her amygdala trying to protect her from? It seems as if it sees the situation of standing in front of an audience as dangerous.
Fran is not alone in experiencing this type of response. Studies have shown that fear of public speaking is the most commonly reported fear, surpassing fear of flying, fear of spiders, fear of heights, and fear of tightly enclosed spaces (Dwyer and Davidson 2012). What could account for this common response? Because the amygdala tries to prevent us from being prey to a predator, evolutionary scientists have suggested that we may be prone to interpreting eyes watching us as a potentially dangerous situation (Ohman 2007). Others have suggested that the risk of rejection by a group of observers comes from an ancient fear of being rejected by one’s clan (Croston 2012), which once meant being left on your own to fend for yourself and face roaming predators—a likely death sentence. In any case, it appears that the human amygdala reacts to protect us from being in the vulnerable situation of being observed by potentially hostile animals, including other humans.
Fran may not be aware of the evolutionary roots of her reaction and the amygdala’s role in it. Her cortex may be telling her that she’s afraid of being criticized, humiliated, or making a mistake, while her amygdala is operating from a more prehistoric perspective. The truth is, the cortex often comes up with reasons for our behaviors, which may or may not be accurate explanations. However, the concern here isn’t the accuracy of the cortex but its effects. The more Fran dwells on cortex-generated explanations for her amygdala- based anxiety, such as You’re worried that your boss will never be satisfied with this presentation, the more cortex-based anxiety she’ll create, adding to her problem. Looking in the cortex for the causes of amygdala-based anxiety is like looking in your refrigerator to understand why your car won’t start. You aren’t looking in the right place!
Instead, Fran needs to focus on her amygdala’s perspective. She needs to see that her amygdala is trying to protect her. Instead of using her cortex to seek explanations for her anxiety, she needs to use her cortex to apply her knowledge of the language of the amygdala. First, she needs to recognize that her pounding heart and increased rate of breathing, which would help her if she needed to run or fight, don’t indicate that she’s truly in danger. These responses are part of the amygdala’s reaction, and they aren’t helpful in the context of public speaking. Fran needs to understand that this isn’t a dangerous situation and that her amygdala is setting off an alarm unnecessarily. Even if the speech Fran is about to give is very important, perhaps for her career, it’s unlikely that this is the life-or-death situation that her amygdala seems to be preparing her for.
This underscores the importance of being aware of the amygdala’s role as protector. This is crucial in understanding and controlling your own anxiety responses. In many cases, the amygdala’s assumption that you need to be protected from danger is incorrect. Fortunately, you can remedy this by retraining your amygdala, and by not giving the amygdala more fuel for the fire by assuming that a fearful or anxious emotional reaction is a definite indication of danger. The protective amygdala reaction is often misguided, and you don’t want to let your cortex strengthen the reaction.
Lastly, it’s important to recognize that simply trying to use your cortex to convince yourself that the situation isn’t truly dangerous won’t always shut off the amygdala’s response. A more effective approach is using deep breathing techniques and strategies that retrain the amygdala, and we’ll outline this approach in part 2 of the book, Taking Control of Your Amygdala-Based Anxiety.
The human amygdala seems predisposed to respond to some stimuli as if they’re dangerous (Ohman and Mineka 2001). Fears of snakes, insects, animals, heights, angry facial expressions, and contamination seem to be biologically wired into the amygdala, because humans learn them with very little prompting. For example, few children have a car phobia, but many are afraid of insects. Although cars pose a much greater danger to children than insects, the fear of insects seems to be hardwired into the amygdala such that children develop this fear very easily. This is undoubtedly the result of thousands of years of evolution in which a fear of insects contributed in some way to survival. However, even fears that are programmed into the amygdala can be changed. If they couldn’t, it’s unlikely that so many of us would live with sharp-toothed animals like cats or dogs and treat them as part of our families.
On the other hand, many objects or situations aren’t naturally feared by the amygdala. Instead, the amygdala learns to fear them as a result of life experiences. The amygdala is constantly learning based on experience, and after certain negative experiences, it creates brain circuits that cause people to fear a previously unfeared object. For example, a child doesn’t naturally fear a flame and must be warned not to touch it. But after a child is burned by, say, a birth-day candle, the child’s amygdala learns to fear the sight of flames. In addition, the amygdala quickly adds various flaming objects to its list of dangerous things to avoid, so the child may also fear lighters, sparklers, and campfires. The amygdala retains lasting memories that identify the object and similar objects as dangerous. This is a very powerful and adaptive ability, because it allows for the creation of specialized neural circuitry that helps people avoid the specific dangers that occur in their lives. This has kept the amygdala useful and virtually unchanged for millions of years.
When we explain the two pathways to anxiety to people, they often ask if they could have inherited a sensitive amygdala. Understanding the Amygdala can definitely influence the amygdala and therefore your typical emotional reactions. For example, children who have a smaller left amygdala tend to have more anxiety difficulties than other children (Milham et al. 2005). The good news is, every amygdala is capable of learning and changing, and in later chapters you’ll learn how to train your amygdala to respond differently.
As discussed in chapter 1, the amygdala forms memories, but not in the way people typically think about memories. On the basis of your experiences, your amygdala creates emotional memories—both positive and negative—that you don’t necessarily have an awareness of. Positive emotional memories, such as the association of the smell of perfume with feelings of love for your partner, usually don’t cause much difficulty. Therefore, we’ll focus on negative emotional memories, especially those that result in fear and anxiety, because these memories can cause a great deal of amygdala-based anxiety.
As noted in chapter 1, the lateral nucleus of your amygdala creates emotional memories based on your experiences, and these memories can lead you to respond to certain objects or situations as if they’re dangerous. Because of these memories, you’re conscious of a feeling of discomfort, fear, or dread. However, you don’t realize that this feeling is due to an emotional memory because the memory isn’t stored as an image or verbal information. It isn’t like an old photograph or movie in your mind, as cortex-based memories can be.
Instead, you experience an amygdala-based memory directly, as an emotional state. You simply begin feeling a specific emotion. If this feeling is anxiety, it’s easy to assume that having a fearful or anxious feeling is an accurate reflection of the dangerousness of a situation—if you don’t understand the language of the amygdala. Consider Sam, who was in a car accident that severely injured his girlfriend, who was driving. To this day, when he rides in the passenger seat of a car, Sam has anxiety—an urgent feeling of danger that seems to result from the current situation in his environment.
Sam doesn’t experience a memory of the accident or reflect on the accident every time he experiences this amygdala-based anxiety. However, anytime he approaches the passenger seat, he has a strong feeling that he must avoid the situation, and he becomes extremely uncomfortable and almost panicky whenever he tries to ride with another driver. If he tries to put his feelings into words, he says it feels like something bad is going to happen if he rides in the passenger seat. He’s more comfortable driving himself, and for years he’s avoided being a passenger. Because his deeply felt emotional reaction is so real and persistent, he doesn’t consider whether he should question it. He would never describe it as a memory formed by his amygdala, and he doesn’t expect himself to change it or even realize that he can.
You may wonder what an amygdala-based memory feels like. Read through the list of experiences below and consider whether any of them are similar to something you’ve felt. Check any that apply to you:
All of the statements above reflect possible effects of memories formed in the lateral nucleus of the amygdala. If you’ve felt some of these reactions, you were probably experiencing the influence of an amygdala-based memory. Your amygdala may have stored these memories in an attempt to protect you from potential danger. When these memories are activated, it’s normal not to understand the reaction you’re having or not to feel in control of your responses. Furthermore, you may have come up with erroneous explanations for these reactions, which are based on your cortex’s desire to understand what’s happening.
As mentioned earlier, the amygdala’s central location in the brain places it in an advantageous position to influence other parts of the brain that can change essential bodily functions in a fraction of a second. When danger is detected, the amygdala can affect a number of highly influential structures in the brain, including the brain stem arousal systems, the hypothalamus, the hippocampus, and the nucleus accumbens. These direct connections allow the amygdala to instantly activate motor (movement) systems, energize the sympathetic nervous system, increase levels of neurotransmitters, and release hormones like adrenaline and cortisol into the bloodstream. This activation creates a cascade of changes in the body: heart rate increases, pupils dilate, blood flow is shifted away from the digestive tract to the extremities, muscles tense, and the body is energized and primed for action. In response to these physiological changes, you may feel trembling, a pounding heart, and stomach and bowel distress.
All of these changes are part of the fight, flight, or freeze response, and as noted previously, the central nucleus is the portion of the amygdala where the fight, flight, or freeze response is initiated. When this reaction is needed, we consider it a lifesaving event. But if the central nucleus overreacts, it can set off a full-blown panic attack when no logical reason for fear exists.
Once it initiates a panic attack, the central nucleus of the amygdala is in control and the cortex has very little influence. Some people respond very aggressively when they panic, some flee the situation, and others are immobilized. If you’re having a panic attack and people try to provide you with logical reasons why you shouldn’t be panicking, they’re essentially talking to a cortex that’s turned off. Strategies that directly target the amygdala, such as physical activity or deep breathing, will be more effective, and we’ll teach you these strategies in chapters 6 and 9.
Being aware of the amygdala’s ability to take charge is essential information for anyone who struggles with anxiety. It serves as a reminder that everyone’s brain is hardwired to allow the amygdala to seize control in times of danger. Countless lives (of humans and other animals) have been saved by the amygdala’s ability to quickly commandeer bodily reactions in dangerous situations. Examples include slamming on the brakes in traffic, ducking when a foul ball is headed your way, or leaving the room when the veins in your boss’s neck are bulging. All of these situations are instances when your amygdala is attempting to save you from perceived danger. But as we mentioned, sometimes the well-intentioned amygdala is itself the problem.
At this point, you’ve learned a great deal about how the amygdala creates anxiety. You understand that one of the main functions of the amygdala is to protect you. You also know that it can identify certain objects or situations as dangerous, usually because of a learning experience. You learned that the amygdala creates memories that you may not be aware of, but which you experience as emotions. Finally, you know that the amygdala has an immediate response system that can take over both your brain and your body when it feels that you’re in danger. This raises the question of how we can exercise control over the amygdala. To do so, we need to communicate new information to this small but powerful part of the brain, and the best way achieve this is by using the amygdala’s own language.
We use the word “language” here to describe the method of communication between the amygdala and the outside world. This particular language is not one of words or thoughts, but of emotions.
When it comes to anxiety, the language of the amygdala has a fairly narrow focus on danger and safety. It’s based on experience, and it’s a language of quick action and response. When you understand the specifics of this language, your experiences with amygdala-based anxiety will make more sense, and you’ll also be able to communicate new information to your amygdala in order to train it to respond differently.
As discussed in chapter 1, a central law underlying the neural circuits in the brain is “neurons that fire together wire together” (Doidge 2007, 63). The amygdala’s language is based on creating connections between neurons. When it comes to amygdala-based anxiety, connections between neurons are made when sensory information about an object or situation is being processed by neurons in the lateral nucleus of the amygdala at the same time that something threatening happens to excite the amygdala. In any threatening situation, the amygdala is working to identify any sight, sound, or other sensory information associated with danger. Therefore, association is an essential part of the language of the amygdala.
Psychologists have known about association-based learning, typically called classical conditioning, for over a century, but only in the past couple of decades have they recognized that some types of this learning occur in the amygdala. In this book, we make use of many findings from neuroscientist Joseph LeDoux (1996) and his team, who are researching the neurological basis of amygdala-based anxiety. The amygdala scans the sensory aspects of your life and responds in very specific ways when sensory information is associated with positive or negative events occurring at the same time. When sensations, objects, or situations have been associated with a negative event, memories are stored by the lateral nucleus in circuits that are wired to produce a negative emotion.
Imagine a person being confronted by a dog. The sights and sounds of the dog are processed through the thalamus and relayed directly to the lateral nucleus of the amygdala, which doesn’t automatically create a change in neural circuitry that will cause anxiety. Neurons in the lateral nucleus change in such a way that fear is learned only if sensory information about the dog is being processed in the lateral nucleus immediately before or at the same time as the occurrence of a negative experience, such as being threatened or bitten by the dog. Thus, if the dog behaves in a friendly or neutral manner, the lateral nucleus won’t create a negative emotional memory about the dog.
However, when a painful or negative experience such as a dog bite occurs, the neurons transmitting the sensory information about the bite create strong emotional excitation in the lateral nucleus. If this excitation is occurring at about the same time that the lateral nucleus is receiving sensory information about the dog, the lateral nucleus changes neural circuitry to respond negatively to dogs or similar animals in the future. In studies on rats, scientists have actually been able to observe that connections form in the amygdala when such pairings are experienced (Quirk, Repa, and LeDoux 1995).
An object or situation itself need not be harmful or threatening for fear or anxiety to be associated with it. Any object, even a teddy bear, can come to cause anxiety through association-based learning. For an association to develop, all that’s required is that the object be experienced at about the same time that some arousing or threatening event is activating the lateral nucleus. Remember, neurons become connected when they’re firing at the same time.
The association-based language of the amygdala is what creates many of the emotional reactions you experience; amygdala-based anxiety is only one example. In the case of anxiety, the lateral nucleus connects sensory information from a situation with the emotion of fear. After this connection has been created, you’ll feel anxious whenever the amygdala recognizes similar sensory information. The sights, sounds, or smells associated with the negative event become capable of activating the amygdala’s alarm system. The term trigger refers to anything—an event, object, sound, smell, and so on—that activates the amygdala’s alarm system as a result of association-based learning. In the example above, dogs become a trigger for anxiety. Triggers are an important aspect of the language of the amygdala.
It may seem surprising that any object can become a trigger if it’s processed when the amygdala is in an activated state. But amygdala-based anxiety is due to associations, not logic, so triggers need not make logical sense. Here’s an example that illustrates how association, not cause and effect, governs amygdala-based anxiety: Josefina was presenting a teddy bear to her grandson, who was running happily toward her. Then he suddenly fell and split his lip open on the driveway. Now he experiences amygdala-based anxiety whenever he sees a teddy bear. Because the perfectly harmless teddy bear was associated with the pain of the injury, the teddy bear became a trigger, leading to a fear of teddy bears.
The amygdala’s reaction may range from relatively weak to very strong depending on the experience. For example, you might have a mild dislike of a certain type of food that was associated with a negative experience, such as egg salad that you ate during a stressful family picnic. On the other hand, if you once ate pancakes when you had an illness that later caused you to throw up, you might find that, even years later, just the smell of pancakes makes you nauseous. Before you get the idea that you might be better off without your amygdala, remember that its role is to protect you. In addition, it produces positive emotions due to association-based learning. For example, if your special someone gives you a necklace as a gift, you’ll experience feelings of warmth and love for your partner. Later, when you see the necklace, the association formed between the necklace and the emotion of love will make you experience warm, affectionate feelings again. Had the necklace not been paired with a loved one, it would simply be another piece of jewelry. Many positive emotional reactions are produced by the amygdala, so you wouldn’t want to get rid of it.
In fact, if two people have had different experiences, they can have completely different reactions to the same object, thanks to the language of the amygdala. One of the authors (Catherine) has affectionate feelings for daddy longlegs because she frequently encountered them while picking her favorite red raspberries in her grandmother’s garden. She has been known to gently pick up daddy longlegs and take them out of her home, much to the horror of her coauthor (Elizabeth), whose amygdala reacts to daddy longlegs as though they’re frightful.
Can you think of harmless situations or objects that elicit amygdala-based anxiety as a result of the association-based language of your amygdala? Have you ever been puzzled by your reaction to something or someone you had no good reason to fear or dislike? Also consider whether you’ve ever experienced unexpected positive emotions in response to someone or something. These emotional responses could be a reflection of the language of the amygdala. On a separate piece of paper, list examples of both positive and negative reactions. Remember, the items you list for either category need not make logical sense. For example, you may have a negative emotional reaction to the scent of lilacs and a positive emotional reaction to lightning storms.
As you can see, amygdala-based emotions aren’t rational. They’re based on associations, not logic. Consider Beth, who was sexually assaulted while a specific Rolling Stones song was playing. After the assault, whenever Beth heard the song she felt intense anxiety. Obviously, the Rolling Stones song had nothing to do with the sexual assault; it was just a coincidence that it was playing when the assault occurred. Nonetheless, Beth’s amygdala responded to the association between the song and the assault, an extremely negative event. In this way, the amygdala transforms a neutral object or situation into something that creates an emotional reaction. To be more accurate, the object itself isn’t transformed; rather, it’s processed in a new or different way by the amygdala.
People experience the connection the amygdala makes between an object and fear, but they may not recognize or understand the connection. They may feel a strong emotional reaction to an object without realizing that a neural connection has been made or under- standing why the emotional reaction is occurring. This lack of awareness is completely normal and extends to all sorts of neural functions. For example, you don’t have to be consciously aware of the neural circuits that allow you to read this book, to sit upright, or to breathe. Thank goodness! That kind of awareness would be exhausting.
However, for people who suffer with anxiety, having an under-standing of the amygdala’s significant role in creating fear associations is helpful. It allows you to stop looking for logical explanations and start learning to use the language of the amygdala. We’ll use Don, a Vietnam veteran with post-traumatic stress disorder (PTSD) as an example of how having a grasp of the language of the amygdala can be helpful. Don used to experience panic attacks but then didn’t have one for many years. Suddenly, he started having a panic attack each morning for no apparent reason. When encouraged to investigate the situation, Don realized that his panic was closely associated with showering. After a few days of observing his anxiety build as he showered, Don realized that his wife had switched to the same brand of soap that he’d used in Vietnam. The smell of the soap was activating an amygdala response and creating panic attacks. In the language of the amygdala, the soap was a trigger associated with the war.
Recognizing that the soap was the reason for his panic attacks was a relief for Don. Knowing the language of the amygdala gave him a new understanding that helped him see that he wasn’t going crazy and that his PTSD wasn’t starting to take over his life again—something he was very concerned about. In Don’s case, understanding the language of the amygdala was helpful, even though it didn’t end his anxiety. He still felt anxious whenever he smelled the soap, despite knowing that the soap wasn’t dangerous; however, he could put an end to his morning panic attacks by switching to a different brand of soap.
For Don, avoiding that brand of soap had no costs. But sometimes the trigger is something more difficult, or impossible, to avoid. Consider a plumber who has a fear of spiders (which have a way of hiding under sinks), or an office manager who works on the twentieth floor and has panic attacks in elevators. In these cases, reducing or eliminating the fear or panic attacks requires retraining the amygdala. We’ll explain how to do this in part 2 of the book; for now, simply know that there are ways to change your emotional circuitry. This can be an enormous source of hope.
It may be that you aren’t sure where a certain emotional reaction came from. Fortunately, it isn’t necessary to know the original cause of amygdala-based anxiety in order to change the emotional circuitry. As you’ll see in chapter 7, once you recognize that a specific trigger is associated with an anxiety response, you can take steps to change the circuitry associated with that trigger, even if you don’t know the original cause of the emotional memory.
Many people believe that the symptoms of anxiety disorders, such as panic, worry, and avoidance of certain objects or situations, should be alleviated by rational argument. Well-meaning family members and friends, and sometimes even people struggling with anxiety, often think logic and reason should change the way the anxious person reacts. But, of course, the amygdala isn’t logical. For example, if a young boy fears dogs after being bit by one, you won’t get very far by saying, “Don’t worry about my dog Buddy. He’s never bitten anyone. He’s all bark and no bite.” Once you have a grasp of the language of the amygdala, it’s clear why logic-based interventions miss the mark. As you’ll see later in the book, many cortex-based anxiety symptoms do respond to logical arguments, but when it comes to amygdala-based anxiety, there’s only one sure way for the amygdala to learn: experience.
The amygdala’s reliance on experience for learning explains why hours of talk therapy or working through numerous self-help books may not help with anxiety: they may not be targeting the amygdala. If you want the amygdala to change its response to an object (for example, a mouse) or a situation (such as a noisy crowd), the amygdala needs experience with the object or situation for new learning to occur. Experience is most effective when the person interacts directly with the object or situation, although observing another person has also been shown to affect the amygdala (Olsson, Nearing, and Phelps 2007). You can reason with the amygdala for hours, but if you’re trying to change amygdala-based anxiety, that tactic won’t be as effective as a few minutes of direct experience will be.
So, to change your amygdala’s fear response to, say, a mouse, you must be in the presence of a mouse in order activate the memory circuits related to mice. Only then can new connections be made. Because the amygdala learns on the basis of associations or pairings, it must experience a change in these pairings for the circuitry to change. Not surprisingly, when your mouse-memory circuits are activated, you’re going to feel some anxiety.
Unfortunately, people typically try to avoid such experiences, and this avoidance prevents the amygdala from forming new connections. Returning to the example of the mouse, you may even try to avoid thinking about mice, because just the thought of a mouse can cause the amygdala to react, initiating an anxiety response. The amygdala tends to preserve learned emotional reactions by avoiding any exposure to the trigger, which decreases the likelihood of changing that emotional circuitry. Being the ultimate survivalist, the amygdala is purposely cautious, and its default setting is to organize responses that decrease your exposure to triggers. But again, amygdala-based anxiety responses won’t change if the amygdala is successful in avoiding triggers.
When you come to terms with the idea that you need to activate the amygdala’s circuits to generate new associations, you’ve learned an important lesson. We like the pithy phrase “activate to generate” as shorthand for this requirement, which is perhaps the most challenging lesson in the language of the amygdala. It’s challenging because it involves accepting the experience of anxiety as necessary for new learning to occur. By engaging in experiences that activate the amygdala’s memory of a specific object or situation, you communicate to the amygdala in its own language and put it in the best situation for new circuits to form and new learning to occur.
In this chapter, you’ve learned how the amygdala creates anxiety as a result of the associations it experiences. You’ve learned that one of the main functions of the amygdala is to protect you, and that the amygdala creates memories that you may not be aware of but experience instead as emotional reactions. The amygdala has an immediate response system that can take over both your brain and your body when it feels you’re in danger. But the amygdala can learn from its experiences, and you can use the amygdala’s own language of associations to make new connections. In chapters 7 and 8, you’ll learn how to rewire the amygdala so that it responds in a calm way. If you’ve suffered with the mysteries of amygdala-based anxiety for years, this will provide an amazing feeling of empowerment.
Although the amygdala pathway is very powerful in its ability to activate a variety of physical reactions instantly, anxiety can also have its origins in the cortex pathway. The cortex operates in a completely different way than the amygdala, but its responses and circuitry can prompt the amygdala to produce anxiety. Through this process, the cortex can create unnecessary anxiety and also worsen anxiety that originates in the amygdala. Once you understand how your cortex initiates or contributes to anxiety, you can see the possibilities for either interrupting or modifying cortex reactions to reduce your anxiety.
The cortex can initiate anxiety in two general ways. The first involves how the cortex processes sensory information, such as sights and sounds. As discussed, the thalamus directs sensory information to the cortex, as well as to the amygdala. As the cortex processes this information, it can interpret perfectly safe sensations as threatening. It then sends a message along to the amygdala that can produce anxiety. In this case, the cortex turns a rather neutral experience that wouldn’t naturally activate the amygdala into a threat, causing the amygdala to react by creating an anxiety response.
Here’s an example: A high school senior who had applied to several colleges looked at the mail and saw an envelope from one of the colleges he’d applied to. Imagining that it contained a rejection letter, he had a few very anxious moments before opening the envelope. As it turned out, he’d been admitted and had even been awarded a scholarship. Nevertheless, his cortex initiated an anxiety response by interpreting the sight of the envelope in a way that created distressing thoughts, and these thoughts activated his amygdala. This type of cortex-based anxiety depends on the cortex’s interpretation of the sensory information it receives.
The second general way the cortex can initiate an anxiety response occurs without the involvement of any specific external sensations. For example, when worries or distressing thoughts are produced in the cortex, this can activate the amygdala to produce an anxiety response even though the person hasn’t seen, heard, or felt anything that’s dangerous in any way. An example would be parents of an infant who leave their little boy with a babysitter to go out for dinner and suddenly begin to have concerns about their child’s safety. Even though the boy is perfectly safe, the parents imagine that he’s in distress or being neglected by the sitter. Thoughts and images like these can activate the amygdala even though there’s no sensory information indicating that the child is in danger.
Before we examine these two general ways in which the cortex creates anxiety, we want to address a process that can occur in both: cognitive fusion, or believing in the absolute truth of mere thoughts. It’s one of the biggest problems created in the cortex, which can produce a rigid belief that thoughts and emotions should be treated as though they reflect an ultimate reality that can’t be questioned. Both the high school senior and the worried parents in the examples above may have fallen victim to cognitive fusion by taking their negative thoughts and images too seriously.
Confusing a thought with reality is a very seductive process due to the cortex’s tendency to believe it possesses the real meaning of every thought, emotion, or physical sensation. Actually, the cortex is surprisingly prone to misinterpretations and errors. It’s common to have erroneous, unrealistic, or illogical thoughts or to experience emotions that don’t make much sense. In reality, you need not take every thought or emotion you have seriously. You can allow many thoughts and emotions to simply pass without undue attention or analysis. In chapter 11, we’ll discuss cognitive fusion in detail, help you assess whether you’re prone to cognitive fusion, and provide strategies to help you defuse from thoughts.
Now we’ll take a closer look at the different ways the cortex can initiate anxiety. First we’ll consider the type of anxiety that begins as thoughts or images produced by the cortex, without any information from your senses. There are actually two subcategories of this process, thought-based and imagery-based, and each typically arises in a different hemisphere of the cortex, with thought-based anxiety coming from the left hemisphere and imagery-based anxiety coming from the right. That said, these two types of cortex-induced anxiety aren’t mutually exclusive. In fact, they often occur together.
Distressing thoughts are more likely to come from the left side of the cortex, which is the dominant hemisphere for language in most people. Logical reasoning, which is produced in the left hemisphere, underlies both worry and verbal rumination (Engels et al. 2007). Worry is the process of envisioning negative outcomes for a situation. Rumination is a style of thinking that involves repetitively mulling over problems, relationships, or possible conflicts. In rumination, there’s an intense focus on the details and possible causes or effects of situations (Nolen-Hoeksema 2000). Although people may believe thinking processes like worry or rumination will lead to a solution, what actually happens is a strengthening of the circuitry in the cortex that produces anxiety. In addition, rumination has been shown to lead to depression (Nolen-Hoeksema 2000).
Whatever you devote a great deal of time to thinking about or think about in great detail is more likely to be strengthened in your cortex. The circuits in the brain operate on the principle of “survival of the busiest” (Schwartz and Begley 2003, 17), and whatever circuitry you use repetitively is likely to be very easily activated in the future. This means that instead of leading to solutions, the processes of worry and rumination create deep grooves in your thinking processes that make you tend to focus on these concerns in your left hemisphere. Sometimes people get lost in repeatedly analyzing situations, creating an experience called anxious apprehension (Engels et al. 2007). As these persistent, worrisome thoughts are rehearsed repeatedly in the mind, they become increasingly difficult to dismiss. This type of thinking is especially common among people with generalized anxiety disorder and obsessive-compulsive disorder.
The human ability to imagine situations in detail comes from the right hemisphere of the cortex, which approaches the world differently than the analytical, verbal left hemisphere. The right hemisphere is nonverbal and processes things in more holistic, integrated ways. It helps us see patterns, recognize faces, and identify and express emotions. It also provides us with visual images, imagination, daydreams, and intuition. Because of these capacities, it can contribute to anxiety based on imagination and visualization. When you visually imagine something frightening, you use your right hemisphere to do so. When you hear the critical tone of accusations in your imagination, your right hemisphere is involved. If you’re particularly good at using your imagination, you can expect your amygdala to respond. The amygdala can become highly activated when the right hemisphere creates frightening images.
Research suggests that the right hemisphere is strongly connected to anxiety symptoms (Keller et al. 2000). In fact, it’s more strongly associated than the left hemisphere with the kind of anxiety in which a person feels strong arousal and intense fear (Engels et al. 2007). For example, people with panic disorder are more likely to have right hemisphere–based anxiety (Nitschke, Heller, and Miller 2000). So when you’re feeling strong, arousing anxiety, as opposed to apprehensive or worry-based anxiety, the right side of your cortex is more likely to be activated. Vigilance, a general state of alertness in which the whole environment is scanned for indications of danger, is also based in the right hemisphere (Warm, Matthews, and Parasuraman 2009).
Now we’ll turn to the other type of cortex-based anxiety described at the beginning of the chapter: anxiety that arises from the cortex’s interpretations of otherwise neutral sensory information. Sometimes you may be in a situation that’s perfectly safe, but your cortex responds to sensory information as if it’s dangerous or upsetting. Information coming from your senses via the thalamus is given meaning by the way that the circuits in the cortex process and interpret that information. Let’s revisit the example of the high school student who thought he was being rejected by a college but was actually being offered a scholarship. His cortex had interpreted an envelope as a source of distressing news and turned it into a very frightening object.
The frontal lobes of the human cortex have a well-developed capacity to contemplate future events and imagine their consequences. This is often quite helpful, with the cortex producing interpretations that allow us to respond well to a variety of situations.
However, problems begin when the cortex repeatedly reacts in ways that produce anxiety. Whether due to certain learning experiences, specific physiological processes, or, most frequently, a combination of both, the circuitry in the cortex can respond in ways that promote worry, pessimism, and other negative interpretive processes. (We’ll discuss this in greater detail in part 3 of the book.)
If your cortex interprets a perfectly safe situation as threatening, you’ll feel anxiety. Consider Damon, who’s walking his dog in his neighborhood. He sees a fire truck heading in the direction of his house with its lights on and sirens blaring and interprets this to mean that his house is on fire. As a result, he starts to feel tremendous anxiety. The cause of his anxiety is his cortex’s interpretation of the meaning of the fire truck, not the fire truck itself. (Figure 5 illustrates this process.)
Figure 5. How the cortex’s interpretations can create anxiety.
Figure 5 makes it clear that the thoughts produced in Damon’s cortex, not the actual event of seeing the fire truck, are what created his anxiety. In fact, from Damon’s location it’s impossible to have information that confirms that his house, or anyone’s house, is on fire, so there’s no reason that seeing this fire truck should produce anxiety. It may be reasonable for his cortex to come to the conclusion that there could be a fire, but other explanations exist, such as an accident or medical emergency that has nothing to do with a fire or Damon’s house. But instead of considering these options, Damon imagines that his house is on fire. As a result, his left hemisphere gets to work considering the ways a fire could have started, thinking, I may have left the stove on or The wiring is so old. Maybe a short started a fire. Meanwhile, his right hemisphere is creating images of his kitchen engulfed in flames. His amygdala is likely to react to these kinds of thoughts and images, and in response, Damon may rush home in a panic, even though there’s no actual threat to his home. His interpretation is the source of his anxiety.
Because the human cortex has the ability to predict future events and imagine their consequences, we experience anticipation, which is both a blessing and a curse. Anticipation, which refers to expectations about what will occur, is based on the cortex’s ability to begin preparing for a future event by considering or visualizing it. It occurs primarily in the prefrontal cortex (which lies behind the forehead) on the left, more verbal side. The left prefrontal cortex is the part of the brain where we plan and execute actions, so it’s not surprising that anticipation arises here, as it’s about getting ready to act in some way. We can anticipate in positive ways and feel excited and eager about an upcoming event. However, we can also anticipate in negative ways, expecting and imagining negative or even dangerous events. This can lead to a great deal of distress.
The anticipation of negative situations creates threatening thoughts and images that can significantly increase anxiety. In fact, the experience of anticipation is often more distressing than the anticipated event itself! In many cases, the thoughts and images people have about an upcoming situation, such as a potential confrontation, an exam, or a task that must be completed, are much worse than the actual situation turns out to be.
As you can see, the cortex’s ability to use language, produce images, and imagine the future allows it to initiate an anxiety response in the amygdala even when no reason for anxiety exists. People usually find it easier to recognize the cortex’s role in creating anxiety than the amygdala’s role. This is because we’re more able to observe and understand the language of thoughts and images produced in the cortex. Some parts of the cortex are more directly under our control than the amygdala is, and we’re more able to interrupt and change cortex-created thoughts and images. That said, we don’t mean to suggest that controlling the cortex is easy. Your cortex has established certain patterns of responding, and once it has developed these habits, it can be challenging to interrupt and change them. But they can be changed, and we’ll explain how you can accomplish this in part 3 of the book.
Discussion of the cortex pathway isn’t complete until we address the role of the final component in the pathway: the amygdala. On its own, the cortex can’t produce an anxiety response; the amygdala and other parts of the brain are needed to accomplish that. In fact, people without a functioning amygdala, whether due to stroke, illness, or injury, don’t experience fear in the way most people do.
Consider the case of a woman whose amygdalas were both destroyed by a rare condition, Urbach-Wiethe disease (Feinstein et al. 2011). Her story offers a glimpse of what life is like without the amygdala’s fear response. She can be exposed to spiders or snakes or watch terrifying scenes from horror movies without experiencing fear. Even more remarkably, in the course of her daily life she was held up at gunpoint and also was almost killed during an assault but experienced no fear in either situation. In fact, she’s been the victim of a variety of crimes, probably because she lacks the caution that would arise from a functioning amygdala. Her experiences illustrate that the amygdala is the source of the fear response. No matter what thoughts, images, or expectations originate in the cortex, many of the emotional and physiological aspects of anxiety result only when the cortex activates the amygdala.
The amygdala responds to information passed on from the cortex. In fact, the amygdala may respond to what we imagine in much the same way that it responds to what’s actually happening. Information based on thoughts or images of potential danger travels the same pathways as information associated with actual perceptions and interpretations. As discussed earlier, the amygdala almost instantly processes information it receives directly from the senses via the thalamus. After a delay during which the cortex processes and interprets the information, the amygdala also receives information from the cortex. Neuroscientists don’t yet know exactly how the amygdala distinguishes whether the information it receives from the cortex is valid or based on an overactive imagination.
Let’s look at two examples of how the amygdala might respond to thoughts or images created in the cortex to examine how the amygdala’s reliance on the cortex can be either beneficial or problematic. In the first example, Charlotte is at home one evening when she hears the familiar sound of someone coming in the back door. She hears this noise every night when her husband comes home, so her amygdala doesn’t respond to the sound as a signal of danger. But Charlotte knows in her cortex that her husband is away on a fishing trip and that no one should be coming in the back door at this time. Her cortex produces thoughts of danger and an image of a stranger entering her home. These thoughts and images in Charlotte’s cortex influence her amygdala to initiate the fight, flight, or freeze response. Charlotte’s heart starts pounding and she stops what she’s doing. She becomes hypervigilant and focuses on getting herself to safety. If there is an intruder, these reactions could save her life.
Charlotte’s amygdala isn’t responding to the sound of the door. It’s responding to Charlotte’s thoughts that there may be a stranger in the house. Responding to information from the cortex allows the amygdala to guard against dangers it doesn’t recognize. The amygdala relies on the cortex to provide it with additional information.
But sometimes the amygdala’s reliance on the cortex leads to unnecessary anxiety, as in the next example.
In this scenario, Charlotte is once again alone at home while her husband is away. She doesn’t hear anything unusual, but she feels uneasy when she goes to bed. As she lies in bed listening to the quiet night, she imagines that someone is breaking into the house. She imagines an intruder walking around inside the house carrying a weapon, and her amygdala responds to these images in her cortex. Even though there’s no direct evidence that she’s in any danger, her amygdala still responds to the activity in her cortex by initiating the fight, flight, or freeze response. Suddenly, Charlotte feels a terrible sense of dread. Her breathing becomes shallow and she feels she should hide or seek help, even though she realizes that there’s no strong evidence of danger.
Charlotte’s amygdala is responding to the thoughts and images in her cortex as if they reflect actual danger, and it creates a very real fear response. As you can see from these two examples, what you think about and focus on in the cortex can definitely affect your level of anxiety. From the perspective of the amygdala, thoughts or images in the cortex may call for a response, even if the amygdala itself doesn’t detect danger from the sensory information it received more directly. In reacting to the cortex’s information, the amygdala may initiate the fight, flight, or freeze response. And once the amygdala gets involved, you begin to experience the physical sensations associated with anxiety.
Fortunately, a number of techniques can be used to interrupt and change cortex-based thoughts and images that may activate the amygdala. With practice, you can rewire your cortex to be less likely to activate your amygdala. The first step is to recognize when the cortex is producing thoughts or images that may lead to anxiety. When you become aware of these thoughts and their anxiety-inducing effects, you can begin to recognize the thoughts, identify when they occur, and take steps to change them.