When Anxiety Becomes Wired: A Brain-Based View of Anxiety Disorders

Anxiety disorders are the most common brain health disorders in the world, according to the World Health Organization (WHO). Despite their prevalence, only approximately one in four people receives treatment.¹ They are also the most prevalent mental health disorder in the U.S., affecting 40 million American adults (almost 20% of the population) each year.² Surveys suggest that approximately one-third of adults in the U.S. will struggle with debilitating anxiety at some point in their lives.³

Anxiety as a Disorder of Brain Network Dysregulation

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, panic disorder and complex anxiety presentations, are rooted in measurable patterns of brain-network dysregulation.⁴ In individuals with chronic anxiety, neuroimaging studies consistently demonstrate changes in brain function in individuals with chronic anxiety, highlighting dysfunction in the connectivity between brain areas that collaborate to regulate emotional responses.³ Research also indicates that the salience network, which determines what the brain pays attention to, becomes hypersensitive in anxiety disorders.^5,6 This heightened sensitivity can cause neutral experiences to feel threatening or urgent.

The amygdala also plays a central role. Mega-analysis shows that the amygdala becomes hyperresponsive to uncertain or ambiguous cues in anxiety disorders.⁷ Meanwhile, the prefrontal cortex must work harder to regulate these emotional responses, which can result in exhaustion, difficulty concentrating and persistent worry.

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Evaluating Anxiety Through a Whole-Brain Lens

Salma Health caregivers evaluate anxiety through a comprehensive lens that includes psychological assessment, medical contributors, and, when appropriate, neurological and biomarker data. This helps differentiate between GAD, trauma-related anxiety and complex anxiety patterns that involve overlapping circuits.

Care may involve evidence-based psychotherapy, including cognitive-behavioral or exposure-based approaches that help retrain the brain’s response to perceived threat. Medication support can assist with severe psychological symptoms, while neuromodulation treatment, such as transcranial magnetic stimulation (TMS), may help stabilize neural communication in people whose anxiety is tied to depression or trauma-related circuitry.

For people with overlapping depressive symptoms, rapid-acting therapies like SAINT® neuromodulation or Spravato® (esketamine) may help correct dysfunction in both emotional-regulation and cognitive-control networks, offering relief when anxiety has become entrenched.

Anxiety disorders are not character flaws. Instead, they are disruptions in the brain’s ability to regulate uncertainty, threat and attention.⁸ With targeted treatment and integrated support, the brain can relearn balance and people can reclaim control over their lives.

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<sup>1. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
2. https://www.nami.org/types-of-conditions/anxiety-disorders/
3. https://www.psychologytoday.com/us/basics/anxiety/the-causes-of-anxiety
4. https://doi.org/10.1016/j.pscychresns.2018.09.006
5. https://doi.org/10.3389/fnhum.2023.1133367
6. https://doi.org/10.1016/j.ijpsycho.2020.09.002
7. https://pubmed.ncbi.nlm.nih.gov/17425423/
8. doi: 10.1038/nrn3524</sup>