Conceptualizing anxiety as a neurobehavioral problem allows us to examine it from a different perspective.

What causes anxiety?

Anxiety can be a learned behavior pattern, as fearful events of the past become associated with other, previously neutral events. It can appear spontaneously and have no known event associated with it.

While many physiological correlates of anxiety have been studied (sympathetic nervous system response, the neurotransmitter GABA, there is not a known physiological cause for anxiety. Anxiety is a normal response to a dangerous situation. Perhaps 1-2% of us are nearly unable to experience anxiety, and because of this, may engage in dangerous behavior. Such people are known as psychopaths (about 20% of the prison population are psychopaths), a description of a behavior pattern that involves lack of conscience.

While many sufferers of anxiety feel that their thoughts cause the problem, thoughts we only associated with anxiety. In some cases, the physical anxiety response must be addressed first.

Treatment considerations

It may seem logical that if someone is anxious, just teach them to relax. But many anxiety clients will say, "relaxation is not relaxing for me." A more active approach is required, involving breathing and physical activity. Such approaches need to be taken slowly, for if activity is too aggressive, it can create more anxiety. If clients can gain control of some of the physical aspects of their symptoms, controlling the thoughts associated with anxiety becomes easier.

Is there a place for drugs?

Anti-anxiety drugs (e.g. Ativan, BuS par), anti-panics (e.g. Klonopin), and antidepressants (e.g. Prozac) are most often prescribed. 'While useful in severe and crisis situations, we believe they are over-prescribed, and that use of a neurobehavioral approach, as described here, results in more functional behavior. Drugs may suppress symptoms, but do not promote positive learning of behaviors that compete with anxiety.

Neurobehavioral Treatment for Anxiety

At the Center for Neurobehavioral Health, we take a multifaceted approach to anxiety:

1. The behavioral approach: If anxiety results from associative learning, then clients can unlearn anxiety responses with a variety of methods, including:
   • Identification of competing behaviors and developing methods of increasing such behaviors.
   • Exposure treatment that presents anxiety provoking stimuli gradually.
2. The physical approach: Addressing the actual physical responses of anxiety directly can either alleviate symptoms by themselves or allow clients to make better use of other techniques. Physical approaches include:
   • Breathing strategies that teach clients to gradually lengthen the pause between breaths that settle the body down and compete with sympathetic arousal.
   • Graduated aerobic exercise, that allows clients to increase their heart rate and relax at the same time.
   • Movement techniques that use physical activity as a competing behavior.
   • The cognitive approach addresses the self-defeating thoughts that accompany anxiety responses. Contrary to popular belief, such thoughts do not often cause anxiety, rather, they are associated with anxiety.

The effective management of anxiety involves a multitude of approaches. The client is taught to study their anxiety in some detail, and works with the therapist to find the approach that will yield the most effective results.