Disclaimer

Attention & Stress Unhinged: A Chronic Anxiety Story

Written by Michael Mantz, M.D.

Article Snapshot

• Your attention is the camera lens of your life – whatever object your attention focuses on automatically increases its salience and value.
• Your attentional capacity has limited bandwidth that can be readily overwhelmed.
• People with chronic anxiety (high-trait anxiety) usually develop an attentional bias that overvalues the likelihood and consequences of potential threats.
• Other key attentional issues in people with chronic anxiety are: increased distractibility, lowered capacity to concentrate, and decreased ability to disengage from perceived threats.
• You have 2 main stress response systems – the SAM axis and the HPA axis.
• Chronic anxiety can sensitize your entire nervous system, including your 2 main stress axes, to become hyperexcitable and harder to shut down.

NOTE: I will be giving a 2-Part Webinar on Anxiety on Feb 5th and Feb 26th, 2021. This article explores some of the major topics that I will be teaching during these webinars. It focuses on the most recent scientific knowledge on how chronic anxiety impacts your attentional and stress response systems.

If you are unfamiliar with the following terms: autonomic nervous system (ANS), sympathetic nervous system (SNS), and parasympathetic nervous system (PNS), then I suggest you read my article: Weakening the Storm – 6 Techniques to Help You When Anxiety Attacks first.

Attention: Brief Overview

Think of your attention as the camera lens of your life. Whatever you put your attention on – these words as you are reading them – is what your mind notices and automatically gives value to.

Your attention has limited bandwidth capacity – there is only some much information that you can pay attention to at any one time. The more cognitive load placed on your mind, the less room there is for new information to be attended to.

Side Bar 1: The limited bandwidth of your attentional systems can be used to your advantage when you are freaking out or panicking. A classic technique is to divert your attention away from jarring physical symptoms (rapid heartbeat, feelings that you can’t breathe, etc…) and redirect it towards & fill up on neutral/pleasant external stimuli in your environment.

One way to do this is to give yourself the task to scan your environment for all objects that are green and name them out loud. Once you have scanned the room, you then count how many green objects you have found. Then you move on to the next color.

By loading your attentional systems with naming and counting objects of a certain color, you fill up your attentional bandwidth and dramatically reduce any left over attentional capacity to focus on distressing somatic stimuli (and disturbing thoughts). This process gives your body time to regulate your intense emotional state and accompanying bodily sensations without your conscious attentional interference. 

Most of the time, your attention is split between what you are noticing in your external environment (sights, sounds,…) and what you are noticing in your internal environment (bodily sensations, thoughts,…).

Attention and Task Performance

When you are involved with a task, part of your attention is focused on the goal of the activity, part is focused on the thoughts and bodily sensations that are arising, and part is focused on the stimuli coming from your external environment.

For example when you check your email – part of your attention is focused on the goal of going through all of your unread emails in an optimal way, part of your attention is noticing aspects of your inner environment (shoulder tightness, lower back achiness, cranky thoughts), and part of your attention is noticing the external environment (computer screen, sounds in your room, warm cup of coffee).

Attention and the Chronically Anxious Person

People who have chronic anxiety attend preferentially to potential threat information, excessively prioritize threats, and demonstrate delayed disengagement (increased attentional stickiness) to possible threat stimuli.

For example, study participants with high trait anxiety, when given the task to read a paragraph and told not to let their attention sway – will demonstrate more eye movements toward threatening faces that are quickly displayed out in the periphery of their visual fields than people who do not have high trait anxiety. This tendency is enhanced when there is increased cognitive load placed on participants.

Side Bar 2: Cognitive load – the total amount of mental effort required to complete a task or group of tasks.

There are several explanations for this enhanced attentional bias towards perceived threats shown to occur in chronically anxious people:

Mood Congruency Effect – Your mind tends to pay attention to stimuli that are mood-congruent. Studies have demonstrated that when you are happy you are better at recognizing happy faces and when your mood is in the dumpster you become better at recognizing threatening and unhappy faces.

Negative Belief Filters – If you are a chronically anxious person, you are likely to have more elevated and prolonged stress responses than a non-anxious person. These elevated and prolonged stress states bias your thinking programs – increasing their tendency to think negatively towards yourself, others, and the world. Over time this increase in negative thinking develops into negative beliefs about life and your ability to cope with it.

These beliefs act like perceptual filters that have an increased propensity to block out “irrelevant” neutral or positive stimuli and magnify potential threatening stimuli. This is how one of the top 10 cognitive biases discussed in one the best-selling books on treating mood disorders, Feeling Good by David Burns is created. Dr. Burns called this tendency to dismiss positive stimuli and magnify negative stimuli the “binocular trick.” I prefer to call it the “Accentuate the negative, Eliminate the positive” bias.

Sensitization Effects Towards the Negative –  Neuroscientific studies have demonstrated how chronic anxiety can sensitize your amygdala – an important brain structure that processes novel stimuli – to get more efficient at picking up threat cues and broaden its range as to what it tags as threatening.

This “sensitization effect” is not only limited to your amygdala but is also present throughout your entire brain and nervous system. People with high trait anxiety have been shown to have heightened/more sensitive limbic reactivity and deficient cortical regulation.

Side Bar 3: Limbic system – area of the brain where a significant amount of your emotional processing occurs.

Cerebral Cortex (cortical) – the most evolved part of your brain that houses your executive control systems (attention, planning, decision making,…) and acts like the steering and braking system to your more ancient limbic system – helping to keep things in balance.

This combination of -> increased emotional reactivity + diminished executive control -> makes it more difficult for people with chronic anxiety to stay focused.  It’s like driving a car that has a sensitive gas pedal, a very powerful engine, poor steering, weak brakes and shocks. It’s a car that has a lot of power but is difficult to control given the overreactive gas pedal, poor steering, and brakes. The poor shocks make the bumps on the road more harsh and disturbing similar to how people with chronic anxiety can experience jarring effects from stimuli that were once much smoother to handle.

Thus, people with chronic anxiety have protracted intensified stress responses with less buffers and brakes to keep their attentional control systems in balance. This leads to an increase in distractibility and a reduced ability to concentrate.

Example: You start going through your emails and receive a distressing email that activates your anxiety to a high level of intensity. If you have high-trait anxiety, your cortical systems are less likely to be able to tame this rush of intense emotional energy from your more reactive limbic systems, This out-of-balance emotional energy can then destabilizes your attention systems making it harder to get through all of your emails in an efficient and effective manner.

Also, if you have chronic anxiety your attention systems are more likely to pay attention to task irrelevant cues, especially if they are perceived as potential threats. In addition, you are more likely to have a negative internal self-dialogue and an increased propensity to worry about your performance. All of these tendencies create more cognitive load for your attentional systems to process which has been demonstrated in studies to reduce task efficiency.

Thankfully, studies have demonstrated that task execution accuracy can remain intact if the anxiety intensity levels do not exceed moderate levels AND is not so protracted that it wears out your capacity to compensate for the extra cognitive load that it places on you mind.

Chronic Anxiety –  A Stress Sensitization Story

Sensitization can also occur within the two main stress axes in your body. The HPA axis or Hypothalamus – Pituitary – Adrenal axis and the SAM axis or Sympathetic – Adrenal – Medullary axis.

SAM gets trigger happy

During acute and sub-acute stress the body first responds with the SAM axis by first lifting the “Vagal brake” thereby increasing your heart rate. This is the first maneuver your SAM axis makes and shifts your autonomic nervous system (ANS) power away from the parasympathetic nervous system (PNS) and towards the sympathetic nervous system (SNS). Next the SNS directly stimulates your adrenal medulla (the inner core of your adrenals that produce and secrete both adrenaline and noradrenaline (aka epinephrine & norepinephrine)) to release adrenalin and noradrenalin to stimulate your body to prepare it to fight or flight.

Side Bar 4: Your Vagal Brake: Your heart’s natural pacemaker, the SA node, would beat your heart at 100-110 beats per minute without concurrent vagal inhibition slowing it down (the Vagal Brake) to an average range of 60-80 beats per minute. The release of some of this inhibition (“letting up on the brake”) is the first thing that occurs to increase your heart rate when you encounter a stressor. After that adrenalin comes in and stimulates the beta-receptors on your heart to make it pump faster and harder. 

Under chronic stress, the sympathetic nervous system’s trigger threshold becomes lower and enzymes inside the adrenal medulla that are used to make adrenalin and noradrenalin are upregulated increasing their production and amount released into your blood stream. Also CRH (corticotropin releasing hormone) is upregulated in the amygdala making it easier to stimulate noradrenalin release in your brain enhancing the fight or flight effect.

Side Bar 5: Noradrenalin (norepinephrine) is primarily produced in two areas of your body: 1) Adrenal Medulla 2) Locus Coeruleus (located inside your brain)

The HPA axis – The Secondary Stress Response Team

If someone cuts in front of you while you are driving – your SAM system kicks in first and initiates your body’s initial responses including increasing your heart and breathing rates. If you have a tendency for road rage and start tailgating the car that cut you off, your secondary stress response system the HPA axis springs into action.

Side Bar 6: Turning on your HPA axis – your hypothalamus secretes CRH which in turn initiates the release of ACTH (adrenocorticotropic hormone – say that 3x fast) from your Pituitary. ACTH then travels down to your adrenal cortex (cortex = bark (the outer layer)) and stimulates the release of cortisol. 

Cortisol impacts many bodily functions including increasing the power and impact of your adrenalin – increasing its potency. Once a stressor goes away, the cortisol that your adrenal cortex secreted, travels up to your Pituitary and Hypothalamus, and shuts down the production of both ACTH and CRH (this occurs once the cortisol level reaches a certain threshold concentration) which eventually brings your HPA stress response back to its baseline.

Side Bar 7: This is a classic example of a negative feedback loop where the substance that is stimulated and secreted reaches a certain threshold and shuts down its own production – keeping things in balance. 

Summarized: CRH -> + ACTH -> + Cortisol -> when Cortisol reaches a certain threshold it (-) CRH and ACTH -> which shuts down the increased stimulus to make more cortisol -> driving cortisol production back down to pre-stressor levels.

Under chronic stress, however, prolonged elevated cortisol can upregulate your adrenal’s adrenalin output -> shifting the balance of your ANS towards greater sympathetic (fight/flight) arousal. Persistently elevated cortisol levels can also cause your hypothalamus to become resistant to the normal negative feedback control that cortisol has on inhibiting CRH production. This unhinges your hypothalamus from the normal negative feedback loop which, in turn, allows your hypothalamus to continue secreting CRH unabated. These actions, catalyzed by chronic anxiety, begin to dysregulate your entire stress response system.

Subjectively, these hyper-sensitizing processes can shift your nervous system into a chronic condition where you begin to feel like you can’t relax. Life itself is perceived as more threatening, overwhelming and raw. This difficult situation often leads many people towards using intoxicating substances, especially alcohol, in an attempt to shut down their overactive/sensitized system. Unfortunately, this often leads to further dysregulation and bigger imbalances.

Good News: The Journey Back into Balance

The good news is that there are many ways to reverse the sensitization processes that occur with chronic anxiety and get your autonomic and stress response systems back into balance. One of the major strategies to do this is to strengthen your rest/digest/rejuvenation – parasympathetic nervous system (PNS) part of your ANS. You may want to check out my article: Weakening the Storm – 6 Techniques that can help You when Anxiety Attacks to learn some basic tools to help rebalance your ANS by using 6 techniques to strengthen you PNS.

For improving your attentional skillset, you may want to read – Get out of Your Mind and into Your Senses and Your 6th Sense: The Key to Mastering Your Emotions.

I will continue to add more powerful nervous system enhancing content to help those of you who suffer from chronic anxiety. I suggest you look through my other articles on DrMantz.com and check for new articles and videos coming out in 2021 that will empower you with the knowledge to create a more robust and resilient nervous system.

Lastly, a reminder that my 2 Part Webinar on ANXIETY will premier on Feb 5th and Feb 26th. It will provide you with the most up-to-date information from neuroscience on ANXIETY and give you a powerful framework to deeply understand the main issues regarding pathological anxiety and how to work with it skillfully.