How to calm and reshape an anxious mind

"Between stimulus and response there is a space . . . in that space is our power to choose our response. In our response lies our growth and our freedom". – Viktor Frankl in Man's Search for Memory.

It's not often you finish reading a book and come away with a sense of having read something groundbreaking. I've just had that experience with Dr Harry Barry's new book, Flagging Anxiety and Panic: how to reshape your anxious mind and brain (Liberties Press).

Anxiety disorder is one of the most common mental health disorders; it is estimated that one in nine Irish people will experience a primary anxiety disorder during their lifetime.

While significant strides have been made in understanding depression in recent years, there was a sense of a missing link when it came to anxiety. And, in particular, there was a need to build a bridge between the clinical aspects of the condition and what exactly was going on in our anxious brains at a neuroscientific level.

Enter a part of the brain called the amygdala. It's a tiny structure buried deep in the limbic part of our brains. In evolutionary terms, it's been there forever and its job was to make you sense and to respond rapidly to danger. It fires the body's stress system and gets it to flood the body with adrenaline.

Which is fine if you meet a grizzly bear on a hike in the Canadian Rockies, but a bit over the top if you are feeling anxious in a social situation.

Barry has come up with a brilliant description of the amygdala’s unruly side. “It is also the gunslinger of the stress system – it shoots from the hip, often without thinking and does not really worry about the consequences. The gunslinger is not particularly smart, has a long memory, does not respond to regular talk therapies and regularly disregards instructions from head office, that is our logical brain.”

Meanwhile, the worry side of anxiety has been traced to the left prefrontal cortex of the brain while a tendency to catastrophise can be tracked to the right prefrontal cortex.

Neural pathways

These prefrontal cortices and the amygdala are all linked by neural pathways which also stretch to the adrenal glands from where our

"fight and flight" hormones

emerge.

Over time, the overactivity of these brain parts leads to actual functional change. Called neuroplasticity, this is the ability of the brain to adapt and change key pathways between its different parts.

So let’s say we have pathways formed in our past that are driving our anxiety. By using the cognitive behavioural therapy (CBT) and mindfulness techniques outlined in the book, we can literally alter our brains using the same neuroplasticity, in reverse, to block lifelong anxiety and panic.

Physical symptoms

This requires a reasonable amount of work on our part. You need to do some homework outside of one-to- one therapy sessions but the reward is to put the gunslinging amygdala back in its box. This reduces the physical symptoms of panic and anxiety. Similarly, reshaping pathways involving the left and right prefrontal cortices means we train our brains to deal with the worrying and catastrophising.

One of the reasons the book works so well is the extensive use of actual cases. As you read these you can see yourself sitting in front of the therapist, both looking in and participating in the interaction. You will see how patient and therapist work together to solve the specific anxiety in each case.

A general practitioner for almost 30 years with a long-standing interest in mental health, Barry saw a need to improve our understanding of the neuroscience of illnesses such as depression, anxiety and addiction. He is now part of an international group of researchers and thought leaders, looking to create new diagnostic tools in mental health.

If you or someone close to you suffers with any form of clinical anxiety then this book is a must read.

mhouston@irishtimes.com @muirishouston