What is Anxiety and Panic Disorder?
Anxiety and Panic Disorders
Everyone feels anxious sometimes. But when anxiety becomes a constant part of daily life, it may be an anxiety disorder. Anxiety disorders involve intense, excessive and persistent worry or fear about everyday situations. These feelings are hard to control, are out of proportion to what’s actually happening, and can get in the way of daily life, from caring for yourself and your family to going to work (1). Panic disorder is one type of anxiety disorder, marked by repeated, unexpected panic attacks.
If you are having thoughts of harming yourself or are in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.
How Common Are Anxiety Disorders?
The Anxiety and Depression Association of America estimates that about 40 million U.S. adults live with an anxiety disorder, yet only about 37% receive treatment (2). Symptoms often begin in childhood or the teen years and can continue into adulthood (1).
What Causes Anxiety Disorders?
The causes of anxiety disorders aren’t fully understood. Genetics, traumatic events and life experiences can all play a role (3). For some people, anxiety is linked to an underlying health condition, such as heart disease, diabetes, thyroid problems or chronic pain, or to side effects of medication (1). That’s one reason it’s important to have new or worsening anxiety checked by a medical provider.
What Are the Symptoms of Anxiety and Panic?
Anxiety can cause physical symptoms such as sweating, a racing heart and a constant sense of tension. People with anxiety disorders often feel tired or weak and may have trouble concentrating, sleeping or with digestion. It’s natural to want to avoid the things that trigger anxiety, and many people struggle to control their worry (1).
A panic attack is a sudden wave of intense fear. It can bring a pounding heart, trouble breathing, difficulty thinking and feelings of numbness or detachment. Panic attacks often come at unexpected times, with no clear cause. They are frightening and can affect quality of life. Because some panic symptoms, such as chest pain and shortness of breath, can also be signs of a heart attack or other emergency, call 911 if you aren’t sure what’s happening.
Anxiety disorders come in several forms, including generalized anxiety disorder, panic disorder, social anxiety disorder, separation anxiety and specific phobias (1).
How Do Anxiety Disorders Affect Your Life?
People with anxiety disorders tend to have higher healthcare costs than people without them (4). Anxiety disorders also often occur alongside other problems, including (1):
Depression
Substance misuse
Trouble sleeping (insomnia)
Digestive or bowel problems
Headaches
Chronic pain
Trouble focusing on tasks
Thoughts of suicide
Lower quality of life
What Happens in the Brain With Anxiety?
Several brain regions play key roles in anxiety, including the amygdala, hippocampus, orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex. These regions receive brain chemicals that help set their activity level from areas in the brainstem, including the locus coeruleus, raphe nuclei, periaqueductal gray and parabrachial nucleus. Key brain chemicals in anxiety include norepinephrine, dopamine and serotonin.
One helpful way to think about anxiety is as two overlapping types that involve different brain circuits. Fear-based anxiety includes panic attacks, worry about the next panic attack, and avoiding situations that might trigger one. It has been linked to a loop connecting the cortex, striatum and thalamus (5).
Worry-based anxiety includes constant apprehension, negative expectations and repetitive worried thoughts. It has been linked more to the amygdala, which may receive too much input from surrounding brain structures (6). One of those structures is the hippocampus, which is strongly involved in memory. Too much input from the hippocampus to the amygdala is thought to play a role in reliving traumatic memories, as in post-traumatic stress disorder (PTSD).
The amygdala also connects to areas that shape how your body reacts. Its connection to the periaqueductal gray is involved in the “fight, flight or freeze” response and in avoiding situations. Its connection to the parabrachial nucleus in the brainstem is involved in breathing changes, such as feeling short of breath. Its connection to the hypothalamus drives the body’s stress response.
The dorsolateral prefrontal cortex helps keep the amygdala in check. Research suggests that when this area is overactive, it may contribute to worry and getting stuck on the same thoughts. When it is underactive, it may be less able to calm the amygdala, which can lead to hypervigilance, or always being on alert for danger (7).
Anxiety and the Stress Response
Your body’s stress response runs through a loop called the hypothalamic-pituitary-adrenal (HPA) axis, which connects the hypothalamus and pituitary gland in the brain with the adrenal glands, which sit on top of the kidneys. The HPA axis also helps regulate your sleep-wake cycle, which is one reason sleep problems are common when it isn’t working well (8).
When you’re under stress, the hypothalamus releases a hormone called CRH, which signals the pituitary gland to release a hormone called ACTH. ACTH travels to the adrenal glands and triggers the release of stress hormones such as cortisol. These hormones act on the heart, blood vessels, muscles and fat, and they raise blood sugar to give you quick energy (9). Cortisol then signals back to the brain to turn the stress response off. The hippocampus also helps turn this loop off.
This system evolved to help our ancestors survive real danger, like running from a bear. Today’s stressors are usually less extreme, but they can trigger the same response. When the stress response is switched on too often, the brain may become less responsive to the “off” signal, and you can get stuck in a state of chronic stress. Research suggests long-term stress may also affect the hippocampus, which may contribute to memory problems.
Over time, chronic stress has been linked to higher blood sugar and reduced insulin sensitivity (8), heart and blood vessel problems (9), and sleep problems. Anxiety disorders can keep this stress response turned on, which is one more reason getting effective care for anxiety matters (10).
How Are Anxiety Disorders Usually Treated?
Anxiety disorders are diagnosed and treated by healthcare providers, most often with psychotherapy, medication or both. Cognitive behavioral therapy (CBT) is one of the best-studied forms of therapy for anxiety. It helps people recognize and redirect anxious, catastrophic thinking and gradually return to activities they’ve been avoiding (1). Medications prescribed by a medical or psychiatric provider can also be very helpful for many people.
How the NeuroRescue Program Can Help
Anxiety treatment is led by mental health professionals, and our care is designed to support that care, never replace it. Please continue any therapy and medications you’re receiving, and don’t make changes without talking with your prescriber.
Our chiropractic neurology care focuses on the neurological side of the picture. One of the brain’s most important jobs is figuring out where you are in the world. It uses your inner ear to sense where your head is in relation to gravity and how it’s moving, your muscles and joints to sense where your body is and what it’s doing, and your eyes to sense where you are in relation to everything around you. Your brain combines all of this into a picture of where you are, so you can respond to the world around you.
Some of the brain and brainstem regions involved in anxiety also help control eye movements, inner ear reflexes, balance and how the brain processes sensory information. Some people with anxiety also have difficulties in these areas, such as dizziness or feeling off balance, and our testing helps us find out whether that’s true for you.
Anxiety is rarely about simply having too much or too little of one brain chemical. It involves how many systems communicate and work together, including brain chemistry, thought patterns and the neurological pathways that connect them. That’s why we look at the whole picture.
Depending on your needs and test results, your program may include eye movement exercises (11); exercises that combine eye movements with inner ear input (12); vestibular rehabilitation, which has been studied for the links between the inner ear and anxiety (13); light therapy, also called photobiomodulation (14); and exercises in a virtual reality environment (15). Transcranial magnetic stimulation (TMS) is being studied for anxiety disorders (16). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you. The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to support the neurological systems that work alongside your mental health care, so you can feel calmer, steadier and more confident in daily life.
Your Next Step
Living with anxiety or panic can be exhausting, but effective help is available. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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