Has anyone ever told you that your anxiety is just “all in your head?” People with anxiety are told this time and time again—that if they just relax, they wouldn’t suffer from constant worries or fears. But if this is true, why are so many people still struggling with anxiety? Research has found that diagnosed anxiety isn’t quite “all in your head” in the traditional sense. In fact, for those with generalized anxiety disorder (GAD), it’s all in the brain and the way the brain functions. This means that people with GAD experience anxiety due to biological differences in their brains that are distinct from the average person.
Can We Change how the Brain Works?
There currently exist effective treatments for GAD, such as medications and a form of psychotherapy known as Cognitive Behavioral Therapy, or CBT. CBT is a form of psychotherapy that focuses on changing thoughts, interpretations of experiences, and behaviors to promote reductions in anxiety. Yet, the big question remains: can these treatments alter the way our brains function? For those who prefer therapy over medication, this sets up a huge challenge. Can an hour in a therapist’s office every week make a dent in the way the brain experiences anxiety?
This was the dilemma that my colleagues and I set out to resolve. We wanted to see if CBT would be effective in altering the very function of the brain in adults with GAD.
Is Talking it out Enough?
To test this we examined the brains of 21 adults with GAD and a control group of adults without GAD. We had both groups complete a face processing paradigm, which is a trial in which participants are exposed to faces on a screen expressing different emotions such as fear, anger, and happiness. In our study, the participants’ brain reactions to these emotional faces were scanned and assessed both before and following CBT treatment.
We found that those who received CBT treatment showed different brain responses when performing this task than those who did not. More specifically, we found that CBT weakened responses to fearful and angry (threat-conveying) faces in a region of the brain known to be hyperactive in those with anxiety to stimuli in the environment that signal a potential threat—a change that was not observed in the control participants. This means that therapy does, in fact, have the capability to affect anxiety on a biological level, which is consistent with the clinical knowledge that therapy and medications are both effective treatments for GAD.
The Impact of CBT
So how is this relevant to the average person suffering from anxiety? First off, it’s helpful to realize that your worries or fears are not just “all in your head”—at least not purely in the conventional sense of the phrase. There’s a biological reason that you are feeling what you are feeling, and unfortunately it’s not something that can be switched on and off at will. We don’t yet know why one’s brain functions differently in those with anxiety, but there’s good evidence that genetics, environmental upbringing, and current stress levels can all play an important part.
The findings from our study tell us that people with GAD have the ability to make an impact on the very biology that might be driving their fear and anxiety. In collaboration with a trained and experienced mental health professional, it is possible to recover from generalized anxiety disorder or any other type of extreme anxiety. We have treatments that work, and the field of science is finally starting to recognize that exploring moods, emotions, and personal events through therapy can really make an impact. Cognitive Behavioral Therapy can help change the way you feel about things that would otherwise make you anxious—and your brain will follow suit.
Greg Fonzo, Ph.D., is a clinical psychologist and postdoctoral fellow at Stanford University School of Medicine. His research focuses on anxiety and traumatic stress disorders in the neurosciences. He received his Ph.D. from the University of California-San Diego and completed a clinical specialization at the VA San Diego Healthcare System. Fonzo is board certified in EMDR and Cognitive Processing Therapy. He is the recipient of several awards, including the Cota-Robles Fellowship and the Alan J. Jaworski Men in Science Award. He is an active member of the American Psychological Association.