Anxiety Disorders

Anxiety arises when the brain’s fear and worry networks—particularly the amygdala, prefrontal cortex, hippocampus, and cortico-striatal-thalamic-cortical (CSTC) loop—become overactive or dysregulated.

• Amygdala hyperactivation: Constant threat detection, even in safe situations.
• Prefrontal undercontrol: Impaired top-down regulation of fear and rumination.
• CSTC overexcitation: Persistent looping of worry and “what if” thinking.
• HPA axis dysregulation: Elevated cortisol and autonomic arousal that disrupt sleep, focus, and digestion.

This imbalance explains why anxiety feels both mental and physical—with symptoms like restlessness, muscle tension, fatigue, poor concentration, irritability, and insomnia.

Brain Networks and Anxiety: The Default Mode and Salience System

Your brain is constantly switching between different “modes” — internal reflection, external attention, and emotional alertness. Two key players in this process are the Default Mode Network (DMN) and the Salience Network (SN). Understanding how they interact helps explain why anxiety feels so persistent — and how modern therapies help restore balance.

🧠 The Default Mode Network (DMN)

The DMN is active when your mind turns inward — when you’re reflecting, remembering, or imagining the future. This network is active when your mind is wandering, thinking about yourself, or imagining the future. In anxiety disorders, especially Generalized Anxiety Disorder (GAD), the DMN can become overactive. This makes it easy to get stuck in cycles of worry, rumination, and “what if” thinking. It can also make it harder to focus on the present moment or shift your attention to other things. In a healthy balance, this network supports creativity, planning, and self-understanding.

When the DMN is dysregulated:

• The mind gets “stuck” in repetitive self-referential loops — excessive worrying, rumination, and “what-if” thinking.
• It becomes harder to shift focus to the present or to external tasks.
• Emotional regulation weakens, amplifying anxious thoughts.

⚡ The Salience Network (SN)

The salience network acts as the brain’s “switchboard.” It helps decide what deserves your attention — a threat, a thought, or a task — and toggles between internal (DMN) and external (executive control) networks.
When anxiety is high, this switching system becomes hypersensitive or inefficient:

• The brain stays “on alert” even when danger isn’t present.
• The salience network over-prioritizes internal worries as if they’re urgent threats.
• The DMN stays dominant too long, reinforcing cycles of worry.

🔄 Restoring Network Balance

Recent neuroimaging studies show that therapy and mindfulness retrain these networks:

• Mindfulness strengthens coordination between the DMN and SN, improving attention and emotional control.
• Neurofeedback devices can help you practice shifting your focus away from anxious thoughts and into a calmer state.
• Cognitive Behavioral Therapy (CBT) helps quiet DMN hyperactivity and re-engage control networks, normalizing brain patterns.
• SSRIs and other medications can modulate DMN connectivity, supporting calm and flexibility.
• Ketamine reduces anxiety symptoms in refractory cases, and its mechanism likely involves modulation of glutamatergic signaling and network-level rebalancing, including the DMN and SN.
• Transcranial magnetic stimulation can improve several varieties of anxiety disorders, including obsessive compulsive disorder.

Together, these findings suggest that effective anxiety treatments don’t just change thoughts — they rebalance the brain’s internal communication systems.

• Generalized Anxiety Disorder (GAD): Persistent, excessive worry about multiple life domains for at least 6 months, with difficulty controlling the worry and at least three associated symptoms (blank mind, easily fatigued, sleep disturbances, restlessness, irritability, muscle tension).
• Panic Disorder: Sudden surges of intense fear or discomfort with physical symptoms such as chest tightness, shortness of breath, or palpitations.
• Social Anxiety Disorder: Fear of scrutiny or judgment in social or performance settings.
• Obsessive-Compulsive Disorder (OCD): Intrusive thoughts and repetitive behaviors (rituals) aimed at reducing distress.
• Post-Traumatic Stress Disorder (PTSD): Persistent hyperarousal and intrusive recollections following trauma.
• Phobias and Health Anxiety: Specific or situational fears leading to avoidance and distress.

Anxiety frequently overlaps with depression, pain syndromes, hypertension, and gastrointestinal disorders—highlighting the mind-body connection.

📊 Epidemiology and Risk Factors

• Lifetime prevalence of GAD is 6–9%, with onset often in the 20s–40s.
• Women are 2–3× more likely to be affected than men.
• Temperamental factors (behavioral inhibition, harm avoidance, neuroticism) and adverse childhood experiences increase vulnerability.
• Chronic anxiety contributes to significant disability—over 110 million lost workdays per year in the U.S.

Treatment is individualized based on clinical presentation, prior response, and patient preference, but here are some of the common ways we treat anxiety disorders.

1. Psychotherapy

• Cognitive Behavioral Therapy (CBT): Identifies and restructures distorted thought patterns.
• Exposure-based and Acceptance-based therapies: Desensitize avoidance and fear responses.
• Mindfulness and Somatic Techniques: Reduce amygdala reactivity and restore interoceptive calm.
• Practicing relaxation techniques and coping mechanisms gives you real-world tools to face anxiety. You don’t want to train your brain that the response to anxiety is taking a pill. We’ll work on healthy adapative responses.

2. Pharmacotherapy

First-line monotherapy:

• SSRIs — escitalopram, sertraline, fluoxetine are helpful to many people
• There are some other medications we might use as well depending on how they might be helpful based on your story in particular.

Some second-line options:

• Buspirone, hydroxyzine, propranolol, guanfacine, clonidine, etc.

3. Neuromodulation and Advanced Treatments

When anxiety remains refractory to standard care:

• Neuromodulation: can shift brainwave patterns toward those associated with relaxation (e.g., alpha or theta frequencies), potentially reducing hyperactivity in anxiety-related networks and promoting a calmer mental state.
• Photobiomodulation (NIR/Red Light Therapy): Supports mitochondrial resilience and autonomic regulation. It’s very relaxing, and we can target treatment to anxiety centers of your brain (like the right dorsolateral prefrontal cortex).
• Brainwave entrainment: using pulsed NIR, isochronic tones, or binaural beats, we promote calm in your brain by matching your neural oscillations to a stimulus. This can be paired with other relaxation techniques like mindfulness or breathing exercises and used at home or on the go.
• Ketamine: Modulate glutamate and BDNF, promoting neuroplasticity and rapid relief from ruminative fear.
• Transcranial Magnetic Stimulation (TMS): Targets dorsolateral prefrontal cortex to reduce hyperarousal and strengthen executive control.

4. Lifestyle and Integrative Care

• Sleep optimization and structured exercise normalize circadian and cortisol rhythms.
• Nutritional psych: Support with omega-3s, magnesium glycinate, L-theanine, or saffron as appropriate.
• Breathwork and HRV biofeedback: Retrain the autonomic nervous system away from chronic “fight or flight.”

🔄 The Neuroplasticity Window

Effective treatment reopens the brain’s plasticity window—a state in which new learning and emotional regulation patterns can be encoded.
Interventions such as CBT, ketamine, and TMS work synergistically by reducing fear signaling while enhancing neural flexibility.
Integrating psychotherapy or behavioral practice within 72 hours of a neuroplastic intervention may consolidate lasting change.

🧭 Our Clinical Process

• Comprehensive diagnostic evaluation using validated scales
• Collaborative goal-setting and psychoeducation
• Stepwise treatment progression from least to most intensive
• Continuous monitoring of symptoms, side effects, and functioning
• Integration with therapy, coaching, and wellness services

We practice with precision—balancing science, empathy, and personalization.

🔬 Diagnosis and Screening

We will meet (in person or telehealth) for a semi-structured interview, and we’ll use validated tools to clarify your diagnosis and track your severity and progress over time:

• HHNY will send you a questionnaire about your symptoms
• Medical screening: lab tests (CBC, TSH, electrolytes, ECG, toxicology, etc.) are sometimes necessary when medical, somatic, or medication causes are possible.

🕊️ Outlook and Prognosis

Anxiety disorders can wax and wane over time, and full remission may be gradual—but with the right interventions, most patients achieve meaningful functional recovery and sustained reduction in distress.
Treatment aims not only to quiet anxiety, but to rebuild confidence, concentration, and a sense of safety in daily life.

• PRN / “as-needed” medications:
  PRN meds for anxiety teach your brain to resolve distress with a pill. This creates a maladaptive loop—your nervous system never learns that anxiety can rise and fall naturally, or that you have tools to bring it down yourself. We focus instead on durable regulation strategies that strengthen your brain’s resilience over time.
• Benzodiazepines (Xanax, Klonopin, Valium, etc.):
  These drugs are prescribed willy-nilly across the country by reckless providers, and it does a massive disservice to people who actually want to heal. Benzos don’t correct the underlying circuitry driving anxiety; they suppress it temporarily, often at the cost of cognitive sharpness, memory, and long-term mood stability. Dependence and withdrawal are common, and over time, your baseline anxiety can actually worsen. BZD dependence is the most difficult addiction to break. When we do Rx a BZD, it is not for a primary anxiety disorder.
• Avoiding anxiety triggers entirely:
  Avoidance provides immediate relief—but it’s a trap. The brain never learns that the feared situation is survivable. Over time, avoidance expands, and anxiety generalizes to more areas of life.
• Compulsive distraction (doom-scrolling, gaming, over-working):
  Anything that numbs discomfort in the moment can become a behavioral addiction. It delays emotional processing and prevents natural desensitization.
• Alcohol or cannabis “to take the edge off”:
  Both dampen anxiety temporarily but can dysregulate neurotransmitters (especially GABA and glutamate) and worsen anxiety rebound. Alcohol and cannabis withdrawal can feel identical to panic attacks.
• Over-intellectualizing or “fixing” feelings:
  Analyzing anxiety instead of feeling it can keep the nervous system in fight-or-flight. Healing often comes from tolerating discomfort, not solving it cognitively. Also constant optimization (biohacking, over-tracking, rigid routines) can become its own anxiety generator—replacing fear with control.