How Can Talk Therapy Help if I Have a “Mental Illness”? An Intro to the Biology of Stress and Anxiety
The term “mental illness” is widely used to discuss people’s emotional suffering, particularly when associated with significant distress or it interferes with relationships and day-to-day functioning. Although the term “illness” has arguably helped to reduce the stigma that has often accompanied mental health problems, it can also have the unfortunate effect of “over-medicalizing” normal human experience, and leave people wondering if and how, talk therapy can help. For example, it is common to hear people say that their mental health struggles are due to a “chemical imbalance”, and reason that only medication (i.e, a chemical intervention) can be effective in treating their symptoms. Although medication can indeed be helpful in many cases, it is important to understand that non-chemical treatments (i.e., talk therapy, such as Cognitive Behaviour Therapy [CBT]) can also be powerful and highly effective in alleviating emotional suffering, without the side effects that often result from medication use. The class of difficulties we call “anxiety disorders” are particularly responsive to CBT (Carpenter et al., 2018), and an examination of the interrelated components of anxiety may help to clarify how natural treatments such as CBT can help.
When we try to define the emotional experience of anxiety, we can think of it as having cognitive, behavioural, and physiological (i.e., biological) components.
While we may attribute anxious feelings to stressful situations in our life and/or worries that are present in our minds, there are also several biological factors that work to produce this anxiety. Looking at the biological contributors to anxiety, there are a variety of disturbances in our brain structures, hormones, and neurotransmitters that play a role in our experience of anxiety and stress. These disruptions in our brain’s natural balance lead to further dysfunction in our thinking and emotional centres, creating a compound effect. By way of analogy, our brains are like computers in many ways. Just as we ideally want all parts of a computer to function as they are supposed to so that we can use them with ease, our brains have an optimal way of functioning. However, if one of these parts gets “off track” or starts to communicate with the other parts in a different way, we see a change in the overall functioning of the computer (or brain), rather than solely in the malfunctioning part.
Research has shown that most of our emotional processing occurs in the limbic system; a part of the brain which includes the amygdala, hippocampus, thalamus, and hypothalamus. The limbic system is one of the most primitive areas in the human brain that has been vital to our survival as a species throughout history. This system helps to regulate our sensory (i.e., sight, hearing, taste, touch, smell), emotional, and thought processes, and has been implicated in our stress response and stress resiliency. This means that when we encounter a stressful situation, our limbic system (particularly the amygdala) is working hard to manage our sensory and emotional input to produce an adaptive response to perceived threat(s), as in the following illustration:
Imagine you are taking a walk in the woods and suddenly come across a bear. Since humans generally perceive bears as scary and a threat to safety, the limbic system kicks into action to produce an automatic behavioural response that helps keep us safe in that situation (e.g., escaping the situation or preparing to protect ourselves – also known as our “fight or flight” response).
The adaptive value of this response is fairly obvious, as people who fail to protect themselves by fighting or escaping the situation are more likely to be attacked, or even killed in these sorts of life-threatening situations. However, research has shown that people experiencing chronic anxiety tend to display persistent over-activity in these brain areas, causing them to remain on high alert despite the absence of an immediate realistic threat.
Unfortunately, this can lead to several problems that can reduce quality of life, including excessive worry and agitation / restlessness, decreased mood, muscle tension, irritability, sleep problems, fatigue, digestive issues, decreased concentration, and inability to remain engaged in the present moment (thus decreasing pleasure and interfering with relationships).
In addition to the effects outlined above, the limbic system’s stress response influences hormonal activity as well. In this context, the limbic system can be thought of as our personal automatic control centre that is responsible for rapidly sorting and evaluating all of the information that we receive from the outside world. Hormones, in turn, are the body’s chemical messengers that are responsible for regulating and maintaining our body and brain’s functions. You can think of hormones as instruments in an orchestra. When they are played together in an organized fashion they sound beautiful. But when one of the instruments starts to play randomly or out of tune, the music becomes less enjoyable and even unpleasant to listen to. Similarly, when hormones become imbalanced, this can contribute to the experience of anxiety-related symptoms such as increased heart rate, concentration difficulties, moodiness, unease, excessive worrying, and panic attacks. Two hormones of note that are released when we feel threatened, stressed or anxious (such as in the fight-or-flight response) are cortisol and adrenaline. In healthy doses, these hormones are beneficial to our well-being and safety. However, if there is excess or these hormones are released at inappropriate times (i.e., when you are not in danger) or over prolonged periods of time, anxiety and related symptoms can emerge. This can lead your brain to fall into a negative vicious cycle where the presence of excess stress hormones tricks your body into thinking you are under threat, triggering the release of even more stress hormones.
The good news is that there are many treatments available to individuals’ experiencing anxiety that help target these biological disturbances, both directly (i.e., medication) and indirectly (i.e., talk therapy). One of the most promising approaches is Cognitive Behavioural Therapy (CBT), which has been found to be highly effective in treating anxiety and related disorders.
Studies have shown that CBT can lead not only to feeling better and functioning more effectively, but also to altering the neural (i.e., brain) connections and hormonal functions that help with thought processes, emotional regulation, and the learning of new coping strategies. For example, several brain imaging studies have revealed that people who had engaged in CBT for anxiety demonstrated similar brain activation patterns to their healthy counterparts, suggesting a shift away from anxious thought processing (Paquette et al., 2003; Ribeiro et al., 2009; Jokić-Begić, 2010; Soravia et al., 2016). Overall, research suggests that CBT is an effective and natural approach with minimal risks for helping alleviate some of the biological disturbances that contribute to, and perpetuate anxiety, and establishing positive emotional coping strategies.
If you are struggling with anxiety and want to learn more about what we can offer at The Mindful Living Centre, please contact us today!
References:
Carpenter, J.K., Andrews, B.A., Witcraft, S.M., Powers, M.B., Smits, J., Hofmann, S.G. (2018). Cognitive behavioural therapy for anxiety and other related disorders: a meta-analysis of randomized placebo controlled trials. Depression Anxiety, 35, 502-514. DOI: 10.1002/da.22728
Jokić-Begić, N. (2010). Cognitive behavioural therapy and neuroscience: towards closer integration. Psychological Topis, 19 (2), 235-254.
Martin, E.I., Ressler, K.J., Binder, E., & Nemeroff. (2009). The neurobiology of anxiety disorders: Brain imaging, genetics, and psychoneuroendocrinology. Psychiatr Clin North Am. 32(3), 549-575. doi:10.1016/j.psc.2009.05.004.
Paquette, V., Levesque, J., Mesour, B., Leroux, J., Beaudion, G., Bourgouin, P., & Beauregard, M. (2003). Change the mind and you change the brain: effects of cognitive behaviour therapy on the neural correlates of spider phobia. Neuroimzge, 18, 401-409, DOI: 10.1016/s1053-8119(02)00030-7
Ribeiro, P., Oliviera, L., Mari, J., Volchan, E., Fuigiera, I., & Ventura, P. (2009). Does Cognitive Behavioural Therapy change the brain? A systematic review of neuroimaging in anxiety disorders. Journal of Neuropsychology in Clinical Neuroscience, 21(2), 114-125.
Soravia, L.M., Orosz, A., Schwab, S., Nakataki, M., Wiest, R., & Fiederspeil. (2016). CBT reduces CBF: cognitive behavioural therapy reduces cerebral blood flow in fear-relevant brain areas in spider phobia. Brain and Behavior, 6(9), https://doi.org/10.1002/brb3.510
Ms. Madeline Slack
Assistant Coordinator at Mindful Living Centre
Dr. Chris Parrish
Director of The Mindful Living Centre.
Please note: this article is for informational purposes only, and is not intended as a substitute for therapy or advice from a qualified professional.