Is Anxiety Biological?

By James M. Rochford

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We’ve already addressed the spiritual causes and cures for anxiety (see “Anxious for Nothing”). But does anxiety have a biological component as well? We believe so. As Collins writes, “Today it is generally recognized that anxiety is more than a purely psychological or purely physiological condition. It has elements of both, and both must be considered when anxiety is treated.”[1] Anxiety is surely a multifactorial issue, and as believers, we would do well to develop a robust view.

Biological causes of anxiety

We’re convinced that there are genetic factors that we’re born with that can predispose an individual to anxiety. But in addition, our lifestyle, behavior, and beliefs can wear down our brain chemicals (i.e. neurochemistry), thus creating biological reasons for anxiety. When we are stressed and anxious, our muscles use adrenalin. As a result, our body uses up neurochemicals like serotonin, dopamine, and norepinephrine. Psychologists Wehrenberg and Prinz writes, “Stress responses burn out the immune system, making one subject to illness, and can deplete the supply of neurotransmitters that keep the brain functioning in balance.”[2]

GABA (gamma-aminobutyric acid) transmitters are the most important calming neurotransmitters in the brain. They exist in abundance and serve as natural tranquilizers that control over-excitability, calm overzealous nerves, and help us feel at peace.[3]

Cortisol (a neurotransmitter similar to adrenaline) “is activated by stress. It gives us energy for survival and helps people cope. We need cortisol and can’t live without it. But when there is excessive and prolonged stress, the GABA is depleted.”[4]

Anxiety depletes our brain chemicals and make us more prone to anxiety. As we take proper steps to get out of anxiety, this chemistry returns to balance. But this takes time.

How does diet affect anxiety?

Diet plays a significant role in our anxiety. Psychologists usually tell patients to avoid CATS from our diet: caffeine, alcohol, tobacco, and sweeteners.[5]

Caffeine. Anxiety is due to an overactive brain. Caffeine is a stimulant and doesn’t help.

Alcohol. “Alcohol also has a connection to panic. When it is first ingested, it calms the brain down through its impact on GABA reception, but after the sedating effect wears off and before it is completely eliminated from the body, it leaves cells in the brain irritated, creating agitation… The more a person drinks and the more frequently, the greater the likelihood of anxiety stemming from alcohol use.”[6]

Tobacco. There is some debate on tobacco’s influence on anxiety. Smoking is a relaxing activity, but “smoking is linked to increased sensations of panic.”[7] But this should be a long-term goal. In the short term, quitting can make people more anxious. Honestly, while smoking is bad for us, it might be better to tackle one problem at a time.

Sweeteners. People with hypoglycemia will feel anxiety with spikes of sugar and low sugar levels: “The sweetener aspartame has been linked to increased anxiety among many other problems.”[8]

Self-control is one of the fruits of the Spirit (Gal. 5:23), so it shouldn’t surprise us that our diet would affect our mental health.

How does exercise affect anxiety?

When we are stressed, our adrenalin fires unnecessarily and too much. This is highly correlated with generalized anxiety and PD. Wehrenberg and Prinz write,

Physical activity dissipates the adrenalin released in the stress response. Exercise helps the body rid itself of toxins more quickly; the stress response releases cortisol, which is toxic to brain cells. Exercise uses up the fat and glucose released by the stress response. Exercise raises levels of neurochemicals that promote positive mood and energy.[9]

Aerobic exercise is the best because it is a great long-term relaxer, and it may help out at the moments when stress is high. Also, exercise increases blood flow to the brain and may help generate new neurons. Aerobic or anaerobic workouts discharge pent-up energy and cause neurochemistry changes. The vigorous activity uses up the adrenalin of the stress response and helps to rid the body of toxic cortisol.[10]

Therefore, exercise plays a major role in gaining control of anxiety. We should exercise:

-Five to seven days a week.

-Thirty to forty-five minutes a day.

-At 70% of maximum heart rate (i.e. if you have difficulty talking when exercising).

Of course, the first humans were very active (Gen. 2:15), so it shouldn’t surprise us that physical activity is important to our mental health. Paul tells us that physical exercise is of “little profit,” but he doesn’t say that it’s “no profit.” Moderate and even gentle exercise such as a brief walk can help here.[11]

How does sleep affect anxiety?

During sleep, our short term memory center (the hippocampus) dumps its information to the long term memory center (the prefrontal cortex). This is an incredibly important function, which is almost like a release on our brain. When the brain stores too much information, it overwhelms the individual. Good sleep can dump this information into the long term memory center and get us balanced. Adults need between 7 to 8 hours of sleep. Teens need between 9 to 10 hours. Much of teen depression and anxiety is due to a lack of good sleep.

When we sleep, make sure the room is dark and slightly cold. Stop using caffeine six hours or more before bed. Do not sleep with the television on, because this interrupts sleep function. Instead, use a timer on the television that will shut it off after you fall asleep. Individuals can also use a fan or noise maker if they need noise to fall asleep.

How important is relaxation?

Perfectionistic or highly driven people usually suffer from generalized anxiety disorder. Wehrenberg and Prinz write,

People with GAD almost always do more than is necessary, and they may end up paying for it. Others may see them as controlling or feel their own contributions are not valuable. Generalized anxiety disorder workaholics may push themselves to the point of exhaustion, which may negatively affect their health or relationships with friends and family. When people with GAD are blocked from working, they feel agitated. Lifestyle assessment and changes are intended to immediately calm and slow their pace.[12]

These sort of Type-A people fear that Christian counseling will turn them into a laid back and lazy person. However, this isn’t the case. Wehrenberg and Prinz distinguish between a Type-A hardy and a Type-A hostile temperament.[13] A Type-A hostile temperament is destructive, unhappy, and ultimately inefficient. A Type-A hardy temperament works hard and serves powerfully. But they also know when perfectionism is important and when it isn’t. For instance, when giving a big teaching, it is important to work hard. But when mowing the lawn or working on a project at home, it isn’t important and is actually destructive. Type-A hostiles cannot tell the difference between the two, and thus, they treat everything as a cause for hard work.

When should I consider using medication?

Medication does play a significant role for some people with anxiety. Antidepressants work for 35 to 45% of the depressed population, while more recent figures suggest as low as 30%.[14] We suspect that these figures are so low, because some people believe medication will cure them. It won’t. But it can help us get out of our hole and get other areas of our lives functioning better. Thus we should take a cumulative approach to anxiety, where we use all of the resources at our disposal—not just medication alone.

We should consider taking medication if we have already tried other spiritual disciplines and these aren’t working. If we have tried these basics to spiritual growth without change, it is worth investigating medicine as a viable way to help our problem. Consulting a physician or counselor is also important—although in our experience, physicians are often too quick to prescribe anxiety medication. Discernment is needed to know if this will really be helpful for you. There are a number of keys to using medication successfully:

First, medication doesn’t work right away. Anxiety medication “may take… 3 to 8 weeks before the effects are noticeable… Patients may notice that their anxiety or panic increases before it gets better. This is an important point to mention to patients, as they often get very frustrated when initiating treatment for PD. They should get a typical response of a 50% reduction of the intensity and severity of panic symptoms.”[15]

Second, anxiety medications have many side effects. Wehrenberg and Prinz write, “Lexapro has the fewest side effects, but Zoloft (sertraline) and Paxil (paroxetine) have excellent research results for reducing panic. Prozac (fluoxetine), in my opinion, is the most likely to cause agitation as a side effect.”[16] The doses of anxiety medications are as follows:

Zoloft 25-150 mg per day.

Paxil 10-60 mg per day.

Prozac 10-40 mg per day.

Lexapro 10-20 mg per day.

Third, we should go ON and OFF medication gradually. If a person goes on medication too quickly, it can make them sick. If they go off it too quickly, they can relapse back into anxiety. Be sure to talk closely with your doctor about your medication.

What is panic disorder?

Panic disorder (PD) is a form of anxiety that causes the individual to leap into a state of panic (e.g. rapid pulse, rapid breathing, sweating, etc.) for no good reason. Sometimes an individual will have a panic attack when they drive over a bridge on a highway, talk on the phone, or enter a large group of people at a party. After an individual has their first panic attack, they become incredibly afraid of having another one. Wehrenberg and Prinz write, “People with PD have three typical cognitions about the panic attack: ‘I’m dying’; ‘I’m losing control’; and ‘I’m going crazy.’”[17] This fear leads to more panic attacks, and this becomes a vicious cycle:

Panic attack. An individual might have their first panic attack at a party with friends. This is a terrifying experience. It has been likened to having a gun pointed to your head. But the problem is that you don’t know why you’re afraid! At least when someone has a gun to your head, you know the reason that you’re so afraid. But someone with PD doesn’t know why they feel this way. Panic disorder occurs when the brain triggers a fight or flight response, releasing adrenalin. Wehrenberg and Prinz write, “It is under this condition that people with panic deliberately look for reasons for the panic and often make incorrect and unhelpful interpretations of why they panicked.”[18]

Fear of panic. After a person’s first panic attack, they begin to fear having another. Wehrenberg and Prinz write, “Once people suffer a panic attack, they begin to worry about whether they will have another attack, and they will do just about anything not to experience it again. Part of the diagnostic criteria for PD involves worrying so much about future attacks that daily life is interrupted. Daily life may also be disrupted by the measures people take to avoid having the potential attack.”[19]

Hyper-vigilance. Because the person is constantly feeling fear of having another panic attack, they become hyper-vigilant to their feelings, wondering if another panic attack is coming on them. They might feel slightly nervous around a group of people, and they think, “I’m feeling nervous… I wonder if I’m having a panic attack… Yes, it’s getting worse… I’m having one!”

Increased sensation. When a person is in a state of hyper-vigilance, they ‘talk themselves into a panic attack.” The more they concentrate on their feelings, the more they have them. This becomes a vicious cycle.

Thus PD is a vicious cycle for those stuck in it.

What are cures for panic disorder?

It often surprises people with PD to hear, but this disorder is the easiest anxiety disorder to cure. Wehrenberg and Prinz write, “Panic disorder is among the easiest of all psychological disorders to treat… The most difficult aspect of treatment is gaining compliance, so teaching the reason for the techniques must be part of the program.”[20] Here are some of the steps that help people gain back control of their lives:

First, do not avoid activities associated with panic. This only reinforces your PD. Wehrenberg and Prinz write, “The more people avoid activities, the less able they are to ward off panic.”[21]

Second, study the brain chemistry associated with PD. Wehrenberg and Prinz write, “It can be a great relief to people who have this history of panic development to know it is just a neurochemical ‘glitch’ and not evidence that they are crazy or losing control.”[22] PD is associated with a portion of the brain called the Parasympathetic Nervous System. During a panic attack, this part of the brain generates signals of dangers. “Panic attacks are triggered when the basal ganglia (BG) generate a signal (for no good reason) that the person is in imminent danger.”[23]

Third, learn diaphragmatic breathing techniques. This isn’t a new age concept, where we breathe in “good energy” and breathe out “bad energy.” Instead, this is a medical and physiological concept, where our breathing communicates to our brain that everything is fine. This type of breathing triggers the parasympathetic nervous system to reduce physical arousal. This also stops the basal ganglia which triggered the panic in the first place. When your basal ganglia registers that your breathing is slow and controlled, it stops firing adrenaline into your system. Those with PD need to learn these techniques for when they initially sense their panic attack coming on, and they need to practice this sort of breathing throughout the day (e.g. in the car, standing in line at the grocery, on a break at work, etc.).

Fourth, get your thyroid checked. When thyroid function is low, it can result in depression. When it is too high, it can result in anxiety.

Fifth, change your thinking. As we have already argued (see “Anxious for Nothing”), it is necessary to change our thinking if we want to see victory over any form of anxiety. As we learn to change destructive thought patterns, this changes the physical structure of the brain. This is called neuroplasticity. It’s highly likely that we wore down our brain through negative and obsessive thinking, resulting in PD or generalized anxiety. As we take our thoughts captive (2 Cor. 10:3-5), this can change us back to normal, balanced state.

Conclusion

Anxiety is crippling for those plagued with it. Remember that God changes people. You cannot believe that lie that you will always feel this way for the rest of your life. Trust that God is going to change you gradually over time. Six months or a year from now, you’ll find that you can be an entirely different person, as you take steps to work through this issue.

Further Reading

Amen, Daniel G., and Lisa C. Routh. Healing Anxiety and Depression. New York: Putnam, 2003.

Burns, David D. When Panic Attacks: The New, Drug-free Anxiety Therapy That Can Change Your Life. New York: Morgan Road, 2006.

Hart, Archibald D. The Anxiety Cure: You Can Find Emotional Tranquility and Wholeness. Nashville, TN: Word Pub. 1999.

Leahy, Robert L., and Stephen J. Holland. Treatment Plans and Interventions for Depression and Anxiety Disorders. New York: Guilford, 2000.

McCallum, Dennis. “Cultivating a Tender Heart”

McCallum’s article addresses the plight of ministry pain and anxiety. We have read this over a dozen times, and each time, it speaks powerfully.

Schwartz, Jeffrey M.; Begley, Sharon. The Mind and the Brain. New York, NY: HarperCollins. 2009.

Dr. Jeffrey Schwartz is one of the leading psychiatrists in the world, who specializes in the field of neuro-plasticity (i.e. how the brain will physically change based on thought patterns). Schwartz specializes in working with OCD patients. Through his personally developed therapy, he found that OCD patients were able to change their thought-patterns. As a result, this changed the physical structure of the brain and its neural pathways. In his later book You Are Not Your Brain (2011), Schwartz explains how patients had the choice of medication or his therapy. He writes, “Much to our delight, we found that people who used our four step method had the same positive changes in their brains as the people who took medications to treat their OCD. These incredible brain changes occurred because of our minds’ ability to change our brains.” (see Introduction)

Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain: The Neurobiological Basis of Anxiety Disorders and How to Effectively Treat Them. New York, NY: W. W. Norton & Company, 2007.

Wehrenberg and Prinz are secular psychologists, but interestingly, they affirm the mind-body distinction (p.37). They utilize cognitive behavioral therapy (v.158), which we feel is closest to biblical principles. They explain the physical and biological components to anxiety, explain the proper use of SSRI medication, and strategies for battling panic disorder, social anxiety, and generalized anxiety.

Welch, Edward T. Running Scared: Fear, Worry, and the God of Rest. Greensboro, NC: New Growth, 2007.

 

[1] Collins, G. R. (2006). Christian counseling: a comprehensive guide (3rd ed., p. 143). Nashville, TN: Thomas Nelson Publishers.

[2] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 33.

[3] Collins, G. R. (2006). Christian counseling: a comprehensive guide (3rd ed., p. 146). Nashville, TN: Thomas Nelson Publishers.

[4] Collins, G. R. (2006). Christian counseling: a comprehensive guide (3rd ed., p. 147). Nashville, TN: Thomas Nelson Publishers.

[5] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 77.

[6] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 78.

[7] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 78.

[8] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 78.

[9] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 79.

[10] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 140-141.

[11] J Blumenthal et al., “Effects of Exercise Training on Older Patients With Major Depression,” Archives of Internal Medicine 1999, 159:2349-2356.

[12] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 149.

[13] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 150.

[14] NY Times article Antidepressants Lift Clouds, But Lose ‘Miracle Drug’ Label, June 2002.

[15] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 106.

[16] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 106.

[17] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 87.

[18] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 34.

[19] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 55.

[20] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 71.

[21] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 57.

[22] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 69.

[23] Wehrenberg, Margaret, Psy.D. Steven Prinz, M.D. The Anxious Brain. New York, NY: W. W. Norton & Company, 2007. 74.