Generalized anxiety disorder

Generalized anxiety disorder

Generalized anxiety seems to be less specific in terms of its source or the things that will trigger it. With social phobia all seems tied up with negative evaluations and with panic there is always some connection to some somatic symptom. Not so with generalized anxiety. However there is some more abstract marker in that pervasive worry seems to underlie this disorder. We all worry about pending dangers, but in the case of generalized anxiety, there seems to be a “wall-to-wall” pervasive tendency to always worry about what comes next and beyond. This had lead to a conceptualization of generalized anxiety that seems to explain most features and even suggest a path to recovery.

We would all like to reduce “our worries”, that is, we would all like to live in a situation, where we were safe from harm, be it physical, social or otherwise.

Worrying about expected scenarios is one way of actually preventing trouble, as it is one way of finding out what precautions are necessary and what steps to take to be safe.

In this light, worrying is anxiety reducing. But here is the conundrum: Worrying will enhance the salience of danger related topics. Because of this worrying is a double edged sword that will tend to hurt you in proportion to the degree that it helps you.

There is also the more global problem that worrying will change your “state”, that is, it will tend to activate brain regions that are relating to danger items. When your attention is focused on something that represent a danger, your amygdalae will swing into activity and do their business. Which is mainly to find danger related cues and clues in your field of attention. This is the intended course of worrying about something, we want to focus our attention on dangers and possible learn more about them, possibly even how to avoid them.

This is the process by which danger cues becomes more salient. But there are other consequences of this: Amygdala activity will tend enhance its effectiveness by recruiting other brain regions into this process and thereby to monopolize the brain for its purposes. This is done by direct stimulation along neural pathways, ei, propagation of signals along fibers and projections on the cellular level. This process is also supported in a more general way by stimulating excretion of brain hormones, such that the hormonal profile is better suited to a situation characterized by danger. This has effects in far regions of the body, where stress hormones will change a number of functions and prioritize here-and-now, fight-or-flight and postpone long term priorities like immune system function.

One important consequence of the global and the more specific activation by amygdala is that your appraisals will change in a general way. Specifically your appraisals of risk and danger will change, your brain will lower the bar for what is taken seriously as a risk or a danger. Not only will this make you more risk averse (and presumably more safe) but it does so by coloring our field of attention in way that enhances any hint of danger. Making you more risk averse will in general help keep you safer by making you less likely to do dangerous stuff on ladders, in darkness or with dogs and snakes. The price we pay for a greater chance of survival is that our quality of life is severely reduced by the saliency of dangers seemingly lurking everywhere we look. This is the effect of enhanced danger perception, triggered by amygdala activity. It leads to constant focus on dangers, on things to avoid and things to worry about. It is good for survival in nature, but it is not good for your quality of life. And for some people it tends to get out of control.

What seems to happen is this: A person with a fairly normal life in terms of dangers and worries (ei. “worry items”) will off couse worry about these. But for some reason this seems to get out of hand to a degree that said person will start worry about his or her cognitive style or even mental health. Perhaps not in any explicit way, but often in a vague and indeterminate way. “Something is wrong, im always worrying too much. It is getting out of hand”. This kind of thinking introduces another layer of risk perception: the worry process itself takes on quality of danger and is seen as something that could lead to a waste of time of energy and perhaps even insanity.

This is unfortunate for a number of reasons. One of them is the fact that the worry process is always going to be available as a target for worry whenever any more specific item of worry has been mulled over to a degree that makes it extinct and less anxiety provoking. Another is that it is really hard to find any solid footing for thinking anything about your own worry process unless you are an educated and trained psychologist. It will set you up for endless speculation with a strong flavor of danger when you try to sort out your own worry process.

A third problem is the inherent conflict with a general tendency driven by amygdala function and amygdala activation: A tendency to think that we dont worry enough about the pending dangers. This is core to what amygdala activation does to your brain and to your thinking: It drives danger perception up and it drives your focus of attention towards danger elements in your present situation. That is towards your present situation but with a large overrun into any relevant situation that you can think of that is in any way, shape of form a source of worry. A driving force for this process is an instinctive sense that we are perhaps something is missing from our thinking, something dangerous, something that could perhaps be avoided if we paid attention. “We need to worry more!” is the not so subtle message whenever amygdala is active.

This is perhaps a major benefits in terms of survival in nature. It probably have a genetic basis that was developed way before our biological ancestors

But in our modern world it does seem to result in some very anxious individuals with extremely poor quality of life. People for whom the benefits are almost non-existing, but whose daily life will be marred by anxiety that is all pervasive and for which there seems to be no cure.