Anxiety and the Amygdala

Lily came in complaining of chest pains. After a thorough work-up produced negative findings, it was time for a face-to-face discussion of the problem. “At times, I get panicky and just can’t function. My mother did the same and so did my grandmother. I guess I just inherited it but I wanted to make sure nothing was wrong with my heart. At times it feels like it’s racing and I’m about to faint.” Even though she saw this as an inherited dysfunctional way to cope, her mother and grandmother grew old without psychotropic medication and she refused to take medicine for her condition because “it won’t help.”

The current trend in medical education is to explain Generalized Anxiety Disorder (GAD), Panic Disorder, Dysthymia, and Major Depressive Disorder as biochemical imbalances of the brain. This approach is to convert the problems into medical concerns, thereby suggesting to patients that medication is necessary to repair the imbalance. Unfortunately, many patients interpret this explanation of intense anxiety and severe depression as a life sentence which needs to be tolerated as their destiny. They and their family struggle through these troubling episodes of dysfunction without recognizing that through a combination of medication and behavioral intervention, they can live a more balanced life.

A study by the University of Wisconsin-Madison, using two types of brain imaging, found that in individuals with a diagnosis of GAD, the amygdala displayed “reduced white matter connections between the prefrontal and anterior cingulate cortex,” the center of emotional regulation, “and the amygdala,” that alerts the body to threats and initiates the fight-or-flight response. But the findings further suggested that cognitive-behavioral intervention “strengthened” the connection and helped reduce anxiety. This evidence supports the value of behavioral intervention as an important adjunct to medicine for healing the body both structurally and functionally. This study was published in the Archives of General Psychiatry.

For more details of the study, visit

Do you refer your patients with GAD for behavioral intervention?

Have you seen value in your patients’ outcomes by combining medication and behavioral intervention?