So anxiety is rooted in biology. It’s evolutionarily based in that we have our own fight or flight
responses. Some of it is very old and triggered from the deep part of our brain that is the
oldest part, the fight or flight response. And then some of it comes from the cortex
which evolved much later and that’s worry. And that might be 21st century anxiety because
there’s a lot we can find to worry about these days. Are we going to make enough money?
Are we going to get the right job? Are we going to provide for our families? Are we
going to do the right thing? What could go wrong in the world? So many things can trigger
anxiety just by walking through everyday life. But the good news is our systems are also
set up to handle it.
The beauty of anxiety and the system that we have of anxiety that’s all throughout our nervous system is that it evolved to protect us. So there’s two
components to it. The oldest being the amygdala which is deep in the brain in the reptilian
part of our brain signals whether we should fight something, flee something or freeze.
When it goes awry is when it’s perceiving immediate danger that really isn’t there.
Somebody’s heart starts to race and they think oh my goodness, is something wrong with
me? That’s panic and that can send somebody into a panic attack which is the clinical
manifestation of the fight or flight response. The other thing with anxiety is again as we
evolved and became thinking human beings and started building communities and cities and
civilizations is our brain evolved and there’s the cortex. It’s within the cortex that
we think. It’s within that system that we worry. And so we can worry ourselves into
states of anxiety where we are fraught in not knowing what to do and we actually get
stuck with anxiety and so we’re tense and irritable and upset. So what makes the difference
between everyday anxiety which we all experience – anxiety is perfectly normal. In any form
it’s perfectly normal. Having your heart racing because somebody is walking behind
you and you don’t know who it is is kind of normal. But if you let that happen to you
when you’re sitting alone at home and you start having panic then that gets out of control.
And worry about what to do in the future is normal for all of us. But if we can’t move
our minds off of that and onto what do I need to take care of here and let me enjoy my family
while we’re doing this thing and activity and I’ll problem solve that later then that
becomes a problem and that might become an anxiety issue.
What was great from the 1990s all the way through to now is it sort of was the age of anxiety in terms of mental health
treatment development. The 1990s opened up lots of treatment funded here in the United
States by the National Institutes of Mental Health. And then also in other countries did
similar things where cognitive behavioral therapy became the most tested and developed
treatment and found to be the most effective psychological or talk therapy for managing
anxiety. And managing anxiety of all kinds. Obsessive compulsive disorder, panic disorder,
generalized anxiety disorder and so forth. Social phobia, the number one anxiety disorder
in kids and adults. Cognitive behavioral therapy is great for that. So we put a lot of work
into developing these treatments and perfecting them. And then also there are great medications
actually that were developed through that time. The combination of the two treatments
works best for many people who are debilitated by anxiety.
But these treatments are excellent and they are available but not widespread. So this
is where again technology comes in because technology has allowed us to put some of the
skills training and some of the aspects of cognitive behavior therapy into apps, into
online programs and such that then can reach hard to reach individuals and people who don’t
have access to services.
There’s some very exciting work being done today throughout the country and around the world in terms of anxiety research looking at in different
ways what aspects of the brain are working with the amygdala and the cortex in terms
of turning anxiety on when it doesn’t need to, keeping it going. What are the triggers
for anxiety on all different levels from genetic all the way through to what’s in the environment.
And then helping to sharpen our treatments to direct themselves to those mechanisms and
tamp down those mechanisms so that can help a person probably earlier in the cycle of
anxiety, earlier in life in such and to manage. So neuroscience is coming on with all sorts
of ways of looking at what are some new technologies including different types of computer apps
and stuff that target anxiety processes. And then there are also ways of disseminating
treatments and reaching people that we are working with. So I think the big exciting
part of what we’re seeing over the next ten to 20 years is going to be much more dissemination
of more targeted and I think more effective treatments for people that are going to be
coming on board and going to be disseminated through many different means. Not just through
your local therapist like me but also through many different types of technologies that
are going to be made available.