Anxiety disorders are a group of mental health conditions characterized by feelings of worry, fear, and tension, distinct from the temporary, situational anxiety most people experience. To support traditional self-report tests for anxiety like clinical interviews, clinicians can use digital cognitive tests to help identify and understand the impact of anxiety on patients’ brain health. Anxiety has been found to stem from a multifaceted interplay of different brain regions, including the amygdala, known informally as the emotional brain, and the prefrontal cortex, an area primarily responsible for executive function.
Article Highlights
Anxiety disorders are a group of mental health conditions characterized by worry, fear, and tension, involving an interplay of brain regions including the amygdala and the prefrontal cortex.
- Generalized anxiety disorder is the most prevalent form, estimated at 3.1% to 6.1% of US adults, followed by specific phobia at 12.1% and social anxiety disorder at 7.4% over a 12-month period.
- Contributing factors include genetic predisposition, brain structure, neurotransmitter dysregulation, traumatic life events, and chronic stress.
- Anxiety commonly co-occurs with ADHD, OCD, depression, and substance use disorder, so distinguishing it from comorbid conditions is part of accurate assessment.
Among mental health concerns in the general population, anxiety stands out as one of the most common. According to recent estimates, social anxiety disorder has a 12-month prevalence of 7.4% in the US, agoraphobia has a rate of 2.5% over the same period, and specific phobia anxieties claim a prevalence rate of 12.1%. Generalized anxiety disorder has the highest rate, however, with some estimates placing prevalence at 20%, according to a StatPearls review.
With the pervasive nature of anxiety, clinicians have the challenging task of accurately pinpointing the contributing factors and causes of anxiety, made more difficult by disentangling situational anxieties, anxiety disorders, and their comorbid conditions.
This can be complemented by incorporating additional mental health assessment tools that provide both objective and subjective data to enhance the accuracy of anxiety diagnoses. By identifying changes in cognitive performance, healthcare providers can better understand the patient’s condition and tailor treatment strategies accordingly.
In this article, we’ll explore how anxiety affects cognitive function, how patients and physicians can recognize the symptoms, and what tools are available to screen for and manage anxiety disorders more effectively.
What are anxiety disorders?
It’s important for clinicians to support patients by distinguishing these symptoms from normal levels or temporary feelings of anxiety. Anxiety disorders come in various forms, each with unique characteristics, which we’ll outline in this section.
Generalized anxiety disorder (GAD)
Generalized anxiety disorder (GAD) may be likened to a background noise of excessive worry that never completely goes silent. It is characterized by persistent worry about various aspects of life.
The prevalence of GAD among adults in the United States is estimated to be between 3.1% and 6.1%, according to a CDC data brief. The Anxiety & Depression Association of America found that women are twice as likely to be affected by GAD compared to men. Additionally, GAD frequently co-occurs with major depression.
Panic disorder
Panic disorder is a type of anxiety disorder characterized by panic attacks, sudden and recurrent episodes of intense fear, often accompanied by physical symptoms like heart palpitations, shortness of breath, or dizziness. National Comorbidity Survey data estimates that 2.7% of U.S. adults experienced a panic disorder in a twelve-month period.
This disorder can be compared to a fear response that has gone off track, often related to heightened amygdala activity and hyperactivation in other limbic regions, provoking a state of severe anxiety even without any real threat.
Phobias
Phobias are characterized by persistent and excessive fear of specific objects, persons, or situations. Someone with a phobia will often go to great lengths to avoid what they fear, even if the fear is much greater than the actual danger.
Research findings also reveal that specific phobias have a worldwide lifetime prevalence ranging from 3% to 15%, with the most common fears centering on heights and animals. Additionally, phobias can endure for extended periods.
What causes anxiety in the brain?
There are many contributing factors that may relate to anxiety, though its exact causes are not yet fully understood. Risk factors range from genetic predispositions to environmental influences and personal experiences. Each of these elements can contribute to developing anxiety disorders and how they manifest. It can be valuable for healthcare professionals to understand the factors that can contribute to anxiety in order to better screen for anxiety and support patients in symptom management.
Genetic and environmental factors
Evidence suggests that genetic predisposition not only contributes to anxiety disorders in general but can also mean an increased risk for specific types of anxiety disorders. However, the genetic component of anxiety is incredibly complex, and the extent of it may be unclear.
Familial patterns reported by the National Institute of Mental Health do indicate a hereditary component in GAD. However, one study also described how parents with GAD may influence their children's perception of potential threats in the environment, perhaps by conveying direct or indirect messages that the world is unsafe, strong emotions are to be avoided, or that worry is a coping mechanism for dealing with uncertainty.
A therapist or healthcare provider might benefit from discussing family history with their patient to better understand the potential hereditary causes of their anxiety.
Brain structure
The brain’s structure is intricately linked with anxiety. Research on the brain and anxiety suggests that the brain's limbic system (which includes the hippocampus, amygdala, hypothalamus, and thalamus) is responsible for emotional processing, and people who experience anxiety disorders may exhibit heightened activity in these brain areas.
It’s not just about the individual brain structures but also about their function and interaction with each other. This communication between different brain regions can significantly influence the experience of anxiety.
Neurotransmitters
Neurotransmitters, the brain’s chemical messengers, play a vital role in anxiety. They convey information to the brain regarding emotional states, cognitive processes, and behaviors. The dysregulation of various neurotransmitters has been found to be involved in anxiety symptoms and processes and implicated in mood and anxiety disorders.
For example, glutamate has shown increased activity in patients with social anxiety disorder, while gamma-aminobutyric acid (GABA) has been found to be dysregulated in several anxiety disorders. Understanding the role that neurotransmitters and brain regions play can be useful to psychologists and physicians when communicating with patients.
Traumatic life events
Experiencing traumatic life events can be a significant trigger for anxiety disorders. These events may induce intense fear, horror, or helplessness and can lead to the development of disorders like panic disorder and specific phobias.
Exploring a patient’s personal history and traumatic life events is often integral to effective mental health care, especially in regard to treating anxiety.
Chronic stress
Chronic stress can be a significant contributor to anxiety. Stressors, whether daily hassles or major life events, can activate our body’s stress response, leading to a constant state of high alert, often described as “fight or flight.” Over time, this heightened state can give rise to anxiety disorders, as the brain may become overly sensitive to stress hormones and perceived threats.
The impact of chronic stress on mental health is far-reaching. It can lead to physical health issues for patients, like sleeplessness and muscle tension, as well as psychological symptoms, like difficulty concentrating. Chronic stress can also exacerbate existing anxiety disorders, making it even more challenging to manage anxiety symptoms.
Which conditions commonly co-occur with anxiety?
Anxiety often doesn’t exist in a vacuum. It can co-occur with a number of other conditions, like:
- Attention deficit hyperactivity disorder
- Obsessive-compulsive disorder (OCD)
- Depression
- Mood disorders
- Learning disorders
- Substance use disorder
- Bipolar disorder
Due to considerable symptom overlap between these conditions, finding the appropriate treatment to resolve comorbid symptoms might also reduce symptoms of anxiety at the same time. But this starts with having the proper tools to identify and address comorbid conditions, distinguishing them from anxiety, and understanding any interactions that may be occurring. Online tests to measure cognition and digitized questionnaires for psychological assessment can help clinicians get a fuller picture of patients’ brain health and cognitive ability.
Related factors: stress, fear, and the gut-brain axis
There are also a number of other factors that may be interrelated with a patient’s anxiety symptoms and that are valuable to both understand and distinguish in order to improve patient experience.
- Stress and anxiety: Stress (which is usually triggered by an external event) can exacerbate anxiety symptoms, and the chronic worry and tension characteristic of anxiety can, in turn, lead to more stress. Understanding the connection between stress and anxiety can be crucial in managing both effectively and supporting mental well-being.
- Fear and anxiety: Fear can trigger anxiety, activating parts of the brain like the amygdala. This activation can result in the experience of anxiety, making fear and anxiety closely connected in our brain’s response to perceived threats. For example, it’s useful to understand the difference between being scared of a snake present in the room with you (fear) and the constant worry of potentially encountering a snake (anxiety). Understanding this connection (and the differences) may help patients manage anxiety more effectively.
- Gut-brain axis and anxiety: The gut-brain axis, the bidirectional communication system between the gut and the brain, has been shown to play a role in anxiety. The brain sends signals to the gut, and the gut sends signals back to the brain. This communication can influence various aspects of health, as gastrointestinal diseases often involve psychological comorbidities. Disruptions in the gut microbiota, due to factors like diet or antibiotics, can potentially impact the gut-brain axis and contribute to anxiety.
With so many interrelated factors and possible comorbid conditions affecting a patient’s experiences and cognition, anxiety and anxiety disorders can be particularly difficult to diagnose. In this case, clinicians can turn to scientifically backed cognitive testing to see just how a patient’s cognition might be affected.
How is anxiety’s impact on cognition measured?
The influence that anxiety has on the function of limbic brain regions can relate to major residual effects on a patient’s cognitive ability. Therefore, it only makes sense to include cognitive tests for anxiety disorder as part of the tools used for anxiety screening.
Measuring the cognitive impacts of anxiety on the brain is a crucial step in understanding and treating anxiety disorders. Computerized cognitive assessments can serve as a complementary tool to subjective measures such as self-report questionnaires or interviews, providing a more comprehensive picture of anxiety’s objective effects on the brain and giving a deeper understanding of a patient’s cognitive ability.
Creyos Health provides a suite of cognitive assessments that helps clinicians measure anxiety and its role in other conditions, including behavioral health questionnaires and online cognitive tasks to test cognition.
There are a number of tools available through Creyos, like the GAD-7 and the Perceived Stress Scale (PSS), which can be used to evaluate patient health, track treatment progress, and substantiate treatment efficacy. These cognitive healthcare solutions can help healthcare providers to better understand their patients’ experiences, tailor treatment strategies, and monitor progress over time. They can also support patients in understanding their condition and feeling empowered in managing their anxiety.
The ability to combine standardized, subjective questionnaires with objective cognitive tests can make a huge difference in understanding and treating patients’ symptoms of anxiety through a number of factors and possible comorbid conditions. Understanding how a patient’s cognition and cognitive ability are affected is invaluable in the diagnosis and treatment of prevalent mental health concerns like anxiety disorders.
Benefits for patients with anxiety
- An engaging experience with gamified tasks where performance is linked to specific cognitive domains and brain regions
- Self-guided assessments that can be taken remotely and with minimal supervision, in-clinic or at the patient’s home
- Easy-to-understand results allow patients and families to be more proactive in their care
- Reimbursable evaluation under most insurance
Benefits for providers
- Reliable and scientifically validated cognitive assessments used in over 400 peer-reviewed research studies and a multitude of case studies
- Easy to administer using automated appointment scheduling
- Includes standard mental health questionnaires for many self-report measures
- Customizable to meet a variety of patient needs ranging from sound settings to time limits
Putting feelings of anxiety into words and data
Anxiety disorders, a complex interplay of genetics, brain structure, neurotransmitters, and environmental factors, go beyond the mere feeling of being anxious. This condition can significantly alter patients’ daily lives, influencing their thoughts, emotions, and interactions.
Grasping its influence on the brain, along with utilizing the tools available for measuring and identifying its causes, is vital for managing this widespread condition. With a variety of factors and comorbid conditions that can affect anxiety screening and diagnosis, having the ease and breadth of digital cognitive tasks and standardized questionnaires like those available at Creyos Health can make a huge difference in patient experience and care.
Reviewed by Sydni Paleczny, Staff Scientist at Creyos
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.