Worry comes in all shapes and sizes and touches all of us in one form or another throughout our lives. We find ourselves wondering about routine decisions like what the best dinner option will be, or heftier concerns like how to afford tuition payments or manage a loved one’s health care. When all goes well in our brains, the concerns we face affect us for the time they are present: we work through options, follow a plan, and resolve the issue, allowing our worries to settle until the next problem presents itself. But for many-about 18% of neurotypicals and an estimated 40% of Autistic individuals-the brain finds itself unable to shut off the “worry” switch and instead wanders into the world of anxiety.
“It’s having your body reacting to a real emergency while your brain is wondering what the emergency is — because there is not one. But your body continues and you cannot turn off the alarm.” — Cathy W
“When you’re driving and see a cop car come out of nowhere and you get that rush of fear that you’ve done something wrong, when you haven’t and they are not there for you at all. But the feeling never leaves, even after the cop car has gone.” — Courtney D
The descriptions of anxiety are creative and diverse, but almost all have a common thread: anxiety feels chronic and ever present, to the point of interfering with living the life you intend. Why, then, would we even need it?
In our last blog, we touched on the idea of co-regulation in the brain- the medial prefrontal cortex helps us maintain emotional balance, and it develops most robustly when we see it in action in other people. In other words, people who are really good self-regulators are good at teaching other brains how to self-regulate. You can probably picture someone in your mind now-a parent, friend, spouse, etc.-who is a regulating presence for you, like the human version of the chill pill!
The thing is, as we talked about last time, these structures only developed in our recent evolutionary history: before this, other earlier brain structures ran the show and had the very important job of making sure we got to live another day. Sounds like a big responsibility, right? It’s a role that necessitates hyper vigilance for both danger and reward, and is the root of what we now call anxiety.
Though it seems like a pretty straightforward topic, it’s important to note the importance of interconnectivity in anxiety (and, really, anything to do with the brain!)-neural structures communicate with each other to process and respond to stimuli from our environment. Differences in the way the system interacts can lead to different expressions of anxiety-one person may have PTSD-like symptoms, another falls more into the category of generalized anxiety, and others may develop social anxiety disorder (SAD) or OCD. Brain imaging lets us know that these subtypes present themselves differently in terms of the brain areas activated, so it can be worthwhile to explore the specifics of any one type if it applies to you. However, there are some areas they have in common that can help us understand where anxiety of most types generally arises from.
This group of structures has existed for ourselves and our ancestors for literally millions of years-approximately 500 million, in fact! Known on the whole as the limbic system, this group of structures together allows us to feel emotions, and to learn from those emotions. Some of these lessons have been repeated so often that they’re ingrained in us as instincts – a feeling can lead us to an action or response we complete automatically!
The biggest players for most types of anxiety are the amygdala, the two almond-shaped structures sitting deep in the brain. They help us keep an eye out for danger, support reward learning, and determine the importance or salience of stimuli, especially in terms of emotional and social situations. In the “non-anxious” brain, the amygdala and limbic system communicate with and take direction from the regulating systems in the frontal lobe. The conversation might go something like this:
Amygdala: OMG OMG MORTAL DANGER!!
Frontal Lobe: It’s literally just our boss calling, we’re fine.
Amygdala: OMG ARE YOU SURE???
Frontal lobe: Yea it’s all good, I just have to answer the phone.
Amygdala: Ok…..I trust you
For people with anxiety, the amygdala and its compatriots have turned off their listening ears. Now the conversation is more like:
Amygdala: OMG OMG SOMETHING’S WRONG
Frontal Lobe: It’s literally just our boss calling, we’re fine.
Amygdala: WE SHALL PERISH!!!
Frontal Lobe: Dude, calm down, we will not die by answering the phone
Amygdala: HIGH ALERT EVERYONE HIGH ALERT
Frontal Lobe: No, the body does not need to sweat profusely and have a heart rate of 140! You have to stop!
Amygdala: PREPARE TO RUN
Frontal Lobe: OMG I give up.
These thoughts may seem controllable and “unreal”-after all, for non-anxious people, it can seem easy to flip the off switch. When we actually look at what’s happening in the brain, though, we can see these responses are due to very real activation of some key areas of what researchers call the “fear network”. In addition to our amygdala, this includes the dorsal anterior cingulate cortex (dACC) and the insula, both marked in yellow in the diagram below. Researchers believe and continue to explore the idea that other areas play a role as well, especially depending on the type of anxiety someone experiences. For our purposes today, we’ll focus on these two.
The dACC sits in our frontal lobe and plays a role in conflict monitoring and fear learning (i.e. learning lessons from “negative” situations). It receives signals from the amygdala and acts as an amplifier, helping us register in our conscious mind the feelings of fear or anxiety so we can decide what to do with them. The insula helps us take sensory information (already filtered through our thalamus) and use it to modulate any excess fear or worry-essentially monitoring and providing feedback from our internal body states. For people with anxiety, the dACC has a very loud voice that overwhelms the regulating feedback from cognitive centers in the frontal lobe like the ventromedial prefrontal cortex. The insula, too, is often over or under activated, meaning any sensory information we might use to calm ourselves doesn’t get through, or is amplified to an unhelpful degree. As Cathy and Courtney describe above, the feeling of danger and unease stays present even when we know no danger currently exists.
Experiencing and attempting to manage this sensation often requires a lot of energy on the part of the person with anxiety and can feel like a never-ending battle. The great news is that what is known can be addressed! We know that our brains are plastic and able to learn from new experiences. The fear network and anxiety may always exist, but they can be calmed and their regulatory partners strengthened through practices likeco-regulation, exercise, and purposeful engagement.
For more information on these, check out our other great blogs on co-regulation.
By Bryana Williams, M.S. CCC-SLP and Registered
I-ASC S2C Practitioner