I was having a cheerful day, eagerly anticipating a delivery from Amazon. Suddenly, a notification arrived: my item was marked delivered, but I couldn’t find it anywhere. I contacted Amazon, and they promised to investigate and resolve the issue within four days. My heart sank. The uncertainty triggered a wave of irritation and anxiety, churning in my mind like a broken record: “What if they don’t find it?” Another blow came later when someone who was supposed to move into my apartment as a tenant backed out. The day that started with such optimism was now shrouded in a cloud of anxiety and disappointment, my heart heavy and my nerves on edge.

What happens behind the scene?

Anxiety is a normal and adaptive response to perceived threats or challenges. It involves a complex interaction of brain regions, neurotransmitters, hormones, and bodily sensations. Anxiety can help us prepare for action, avoid danger, and cope with stress. However, when anxiety becomes excessive, persistent, or irrational, it can interfere with our daily functioning and well-being.

One of the key brain regions involved in anxiety is the amygdala, a small almond-shaped structure located in the temporal lobe. The amygdala is responsible for detecting and responding to potential threats, and activating the fight-or-flight response. The amygdala also communicates with other brain regions, such as the prefrontal cortex, the hippocampus, the hypothalamus, and the brainstem, to coordinate emotional, cognitive, and physiological aspects of anxiety.

When you experience anxiety, your amygdala sends signals to the hypothalamus, which in turn activates the sympathetic nervous system and the adrenal glands. This triggers the release of stress hormones, such as adrenaline and cortisol, into your bloodstream. These hormones increase your heart rate, blood pressure, breathing, and muscle tension, and prepare your body for action. They also affect your mood, memory, and attention.

At the same time, your amygdala also sends signals to the prefrontal cortex, the part of the brain that is involved in planning, reasoning, decision-making, and self-control. The prefrontal cortex helps you evaluate the situation, assess the level of threat, and choose an appropriate response. However, when the amygdala is overactive or the prefrontal cortex is underactive, your ability to think clearly and rationally may be impaired. You may experience negative thoughts, such as “What if they don’t find the item during the investigation?” or “What if I can’t find another tenant?”, that amplify your anxiety and make you feel helpless or hopeless.

Another brain region that plays a role in anxiety is the hippocampus, which is involved in memory formation and consolidation. The hippocampus helps you remember past experiences and learn from them. However, when you are anxious, your hippocampus may be affected by the high levels of stress hormones and the activity of the amygdala. You may have difficulty recalling positive or neutral memories, and instead focus on negative or threatening ones. You may also have trouble forming new memories or learning new information.

How do we cope with it?

CBT is a form of psychotherapy that aims to change your negative thoughts, beliefs, and behaviors that contribute to your anxiety. CBT can help you identify and challenge your cognitive distortions, such as catastrophizing, overgeneralizing, or jumping to conclusions, that make you perceive situations as more threatening or worse than they really are. CBT can also help you develop coping skills, such as relaxation techniques, problem-solving strategies, and exposure exercises, that can help you reduce your anxiety and improve your functioning.

Some of the CBT techniques that you can try are:

• Cognitive restructuring: This is a technique that helps you replace your irrational or unhelpful thoughts with more realistic or positive ones. For example, instead of thinking “What if they don’t find the item during the investigation?”, you can think “They will probably find the item during the investigation, or if not, they will refund me or send me a replacement”. Instead of thinking “What if I can’t find another tenant?”, you can think “I can find another tenant, or if not, I can look for other options to cover my expenses”. To practice cognitive restructuring, you can use a worksheet like this one¹ to write down your thoughts, emotions, and behaviors in different situations, and then challenge and modify your thoughts.
• Relaxation techniques: These are techniques that help you calm your body and mind when you are anxious. They can include deep breathing, progressive muscle relaxation, guided imagery, meditation, or yoga. You can practice these techniques regularly or whenever you feel anxious. To practice deep breathing, you can follow these steps²:
  • Sit comfortably or lie down on your back.
  • Place one hand on your chest and the other on your abdomen.
  • Breathe in slowly through your nose, filling your abdomen with air. You should feel your abdomen rise and your chest stay still.
  • Breathe out slowly through your mouth, emptying your abdomen of air. You should feel your abdomen fall and your chest stay still.
  • Repeat this cycle for several minutes, focusing on your breathing and keeping it slow and steady.
• Exposure therapy: This is a technique that helps you face your fears gradually and systematically, until you become less anxious or fearful of them. Exposure therapy can be done in vivo (in real life) or in vitro (in imagination). You can start with the least anxiety-provoking situation and work your way up to the most anxiety-provoking one, or you can start with the most anxiety-provoking one and work your way down to the least one. The goal is to expose yourself to the situation until your anxiety decreases or you feel more comfortable with it. To practice exposure therapy, you can use a worksheet like this one³ to create a hierarchy of your feared situations, rate your anxiety level for each one, and plan and record your exposure exercises.

I hope this helps you understand the brain changes and chemicals that are working behind your anxiety and how to deal with this situation using some CBT techniques.