What is happening physiologically during severe anxiety?
The client shows evidence of hyperarousal i.e. there is an inundation of adrenaline and other stress hormones resulting in the client reacting confused and threatened. The brain structures mainly involved in rational thought and memory are short-circuited so to speak. The client’s sympathetic nervous system is in overdrive, presenting muscle tremors, a dry mouth and a pounding heart as a result. The limbic system, the hippocampus and the amygdala handle emotion and danger. The limbic system also is the mid brain area accountable for the initiation of the freeze, fight, flight response. The amygdala and the hippocampus are deeply involved in responding to perceived traumatic events too. The more rational outer layer of the brain, the cortex is where our ability to judge, deliberate, contrast and compare is seated as part of the thinking capacity. The hippocampus, amygdala and the cortex are in constant communication.

The amygdala is the early-warning system. Here emotion is processed even before the cortex is knowledgeable about the event. The amygdala on receipt of stimulus from the sensory nervous system, immediately generates an emotional response by releasing hormones that stimulate the visceral muscles of the autonomic nervous system, which are felt in the stomach or elsewhere. Then the amygdala initiates the accompanying somatic nervous system response (musco- skeletal) e.g. trembling legs.

The amygdala is unaffected by the effects of stress hormones and may continue to alert even when it is inappropriate. Meanwhile, the hippocampus is passing the information to the cortex, the seat of rational thought. Once this happens, the rational thought will take precedence in the decision for action or not as the case may be. However, this assumes that the hippocampus is able to function and is not being paralysed by large amounts of adrenaline and noradrenaline that would make it impossible for it to instruct the amygdala to stop sounding the alarm.