Anxiety and stigma

I am mentally ill.

I say it that openly, and that bluntly, for a reason: mental illness still has a significant and entirely undeserved stigma in our society, a stigma shared by virtually no other group of illnesses.  I've never heard of someone ashamed to say they have bronchitis, high blood pressure, arthritis, heart disease, or cancer.  While no one would question the gravity of any of those or the impact on the patients and their families, none of those carry the same sense of shame -- the underlying feeling that somehow, it requires an apology, that it's the sufferer's fault for "not trying hard enough."

"Suck it up and deal."  "Just focus on the good things."  "Let go of the negatives."  All, perhaps, well meant, and all entirely useless.  Whatever the underlying cause of the anxiety and depression I've battled my entire life -- whether they're from a neurochemical imbalance, a genetic predisposition (there is good evidence that depression, at least, runs in both sides of my family), trauma from the emotional abuse I endured as a child, or all three -- what I experience is just as real as any symptoms coming from a purely physical illness.

I've gone to hell and back trying to find a medication that helps; none of the standard meds made much of a difference, and several gave me horrible side effects.  Right now the depression is reasonably well in check from the combination of the compassion and support of my family and friends and a set of coping mechanisms (exercise being top of the list).  The anxiety is tougher because it can come on without any warning, and is often triggered by activities that "should be positive" -- getting together with friends, engaging in creative pursuits, even leaving the house.

Edvard Munch, Anxiety (1894) [Image is in the Public Domain]

The reason this comes up is a pair of studies I ran into last week that resonated so strongly with my experience that I found myself saying, "Why didn't the researchers just ask me?  I coulda told them that."  The first, that appeared in the International Journal of Psychophysiology, investigated fear responses -- specifically, how quickly startle reactions ceased once a person realized something surprising wasn't actually a threat.  What they did was show test subjects photographs of two women, then suddenly substituted one with a photograph of a woman showing fear and accompanied it by the sound of a woman screaming at 95 decibels, delivered through headphones.  (I'm so sound-sensitive that just reading about this made me anxious.)  What was fascinating is that (of course) all the test subjects startled, but the ones without anxiety disorders very quickly learned that it wasn't a threat -- on repeated exposures to the same stimulus, they stopped reacting.  The people with anxiety disorders didn't.  Every time the photo changed and the scream came, they reacted, even when they knew it was coming.

This is all too familiar to me.  I once lamented to a therapist, "Exposure therapy doesn't work on me."  I have dreadful social anxiety; I take a long time to open up to people, and when I'm in a large group I tend to shut down completely.  I've been at parties where all night long, I've said exactly two sentences: "Hi, how are you this evening?" and "Good night, thanks for inviting me."  It doesn't seem to matter how many social gatherings I go to where nothing bad happens; I still get overwrought the next time, and spend the lead-up to the event hoping like hell there'll be a dog there to socialize with.

The second study, that appeared in the journal Behavioural and Cognitive Psychotherapy, looked at the ways that people with social anxiety cope, and found that those same "safety behaviors" -- such as rehearsing ahead of time what they'll say, avoiding eye contact, shying away physically if they feel like they're in the way, and not talking unless spoken to -- cause others to perceive them as less likable, more standoffish, aloof, and superior, and less authentic.

Which, of course, is the most vicious of vicious cycles.  I know I do all of those things, not to mention finding an excuse to leave early.  I also have a tendency to get tongue-tied when people do speak to me directly, which probably is why in short order they decide that they'd be better off finding someone else to chat with.

Both studies had me saying, "Yeah, exactly."  Even so, I'm glad these sorts of papers are appearing in well-respected journals.  All of it is a step not only toward finding out what underlies mental illness, but toward reducing the stigma.  Sufferers from disorders like depression and social anxiety aren't simply weird, and we're certainly not doing it for attention (something I was accused of pretty much continuously when I was a kid).  We're just struggling, in the same way that someone with a physical illness might struggle.

I have some hope that the stigma is diminishing.  I've been heartened by the support Senator John Fetterman of Pennsylvania has received following his revelation that he was entering the hospital for treatment for clinical depression.  We still have a long way to go -- there are still people who look at Fetterman's actions as evidence of weakness or instability -- but far more are responding with empathy, with an understanding that we sufferers from mental illness are every bit as deserving of compassionate care as someone dealing with any other kind of illness.

And while understanding that won't cure us, it certainly goes a long way to making us feel like we're not so alone.

(IMPORTANT NOTE: if you, or someone you know, are considering self-harm, please call the Suicide Hotline number now.  The number is 988, and there are people there who can help you and provide the emotional support you need.)

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The merry-go-round of self-blame

Depression is, at its heart, a completely irrational condition.

One of the (many) therapists I've seen during my life told me that the way to deal with depression and/or anxiety was to do a reality check.  Is this feeling I'm having right now consistent with what I know reality to be?  It sounds good, but in practice, it's extraordinarily difficult to do.  Depression and anxiety make it harder for you to be certain what reality is.  The problem is that the depressed and/or anxious response feels just as real as reality does.  You can analyze those feelings in as dispassionate a way as you want, but when the things you're trying to discern seem to be equally plausible, you're in trouble.

One good example is my continual fear of talking too much or calling attention to myself in social situations, especially when I've had a drink or two.  If I'm stone-cold sober there's usually no question, because I hardly ever say anything, much less too much or the wrong thing.  But the inhibition-releasing tendency of alcohol consumption blurs the ability to self-perceive accurately, and afterward, I'm always convinced that I said more than I should have or something I shouldn't have, and nearly every time I have to appeal to my wife to do my reality checking for me.

This is why my reaction to a piece of research that appeared last week in the Journal of Psychiatric Research made me say, "Well, duh."  Not, understand, that I am at all critical of research to support what are honestly anecdotal claims; more that what they found is essentially how I live.  A team at King's College London, led by clinical psychologist in mood disorders Roland Zahn, studied the reactions of a group of test subjects -- some of whom had a history of suffering from depression, and others who did not -- to various hypothetical social interactions, and had them identify what would be their most likely responses if it were a real situation.

[Image licensed under the Creative Commons Sander van der Wel from Netherlands, Depressed (4649749639), CC BY-SA 2.0]

What the team found was that people who have depression tend to blame unpleasant social interactions on themselves, even if the circumstances make it unlikely that they were at fault.  "Self-blaming feelings such as guilt, self-disgust and self-directed anger are key symptoms of depression and Freud is widely credited for pointing to the importance of excessive self-blame in depression," Zahn said, in an interview in PsyPost.  "Social psychologists have done research into these so-called ‘action tendencies’, i.e. implicit feelings of acting in a certain way, such as hiding or creating a distance from oneself, which are entailed in complex feelings.  This is why my PhD student Suqian Duan set out to investigate this question.  In this study, we investigated blame-related action tendencies for the first time systematically in people with depressive disorders."

The response Zahn describes is strikingly similar to my experience of clamming up completely in social situations.  "Many people with a history of major depression, despite having recovered from symptoms, showed an action tendency profile that was different from people who had never experienced major depression and are thus at a lower risk of depression overall," he said.  "They were more likely to feel like hiding, creating a distance from themselves and attacking themselves when faced with a hypothetical scenario of acting badly towards their friend whilst being less likely to apologize.  Interestingly, we showed that the label of the emotion did not map one-to-one on specific action tendencies as was often assumed but rarely tested.  Feeling like attacking oneself was specifically associated with self-disgust/contempt, a feeling which we had previously found to be the most common form of self-blaming feeling in depression."

Zahn points out (correctly) that one of the difficulties is there is such a thing as reasonable guilt.  Purging oneself of all guilt feelings shouldn't be the goal; sometimes we feel guilty for a very good reason, and those feelings can prompt us to make amends for mistakes we've made.  "There is... a controversy around how to measure and define healthy forms of guilt, which help us to apologize and try to repair the damage we might have done from unhealthy forms of self-blame, where we take responsibility for things that are out of our control and feel paralyzed by our guilt or sense of failure, so that we hide away from the situation," Zahn explains.

The trouble is, with depression and anxiety, the ability to discern between justified and unjustified guilt or self-blame gets blurred, and depression and toxic narcissism lead to opposite and equally damaging false conclusions; the former, that every negative interaction is our fault, the latter that none of them are.

It's hard to see, in the absence of someone like my wife to do an external reality check, what you could do to get off the self-blame merry-go-round.  When the heart of the problem is an inaccurate but compelling view of oneself and the situation, trying to do any kind of internal reality check is likely to meet with limited success.  That's certainly been my experience.  I can even go into a social situation with the mantra, "I know I don't talk too much, everything is going to be fine, I should loosen up and just chat with people," but afterwards the inclination to self-blame anyhow is awfully powerful.

No wonder we feel like hiding a lot of the time.

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Psychedelic uplift

In a study released last week by a team of psychologists working at the University of British Columbia, we find that in an extensive survey of 1,266 men from the ages of 16 to 70, guys who had used psychedelic drugs (specifically LSD or psilocybin) had a statistically significant lower likelihood of abusing their partners.

In "Psychedelic Use and Intimate Partner Violence: The Role of Emotion Regulation," by Michelle S. Thiessen, Zach Walsh, Brian M. Bird, and Adele Lafrance, the authors write:

Males reporting any experience using lysergic acid diethylamide and/or psilocybin mushrooms had decreased odds of perpetrating physical violence against their current partner (odds ratio=0.42, p<0.05).  Furthermore, our analyses revealed that male psychedelic users reported better emotion regulation when compared to males with no history of psychedelic use.  Better emotion regulation mediated the relationship between psychedelic use and lower perpetration of intimate partner violence.

Given the role of psychedelics in changing levels of activity of serotonin -- a major mood-regulating neurotransmitter -- it's unsurprising that this correlation exists.

[Image licensed under the Creative Commons: This image was created by user Caleb Brown (Joust) at Mushroom Observer, a source for mycological images.You can contact this user here., 2013-10-22 Psilocybe cyanescens Wakef 378614, CC BY-SA 3.0]

What is more surprising is that apparently, it only takes one use.  Consider, too, that one use of another psychedelic drug -- ketamine -- has been found to relieve many cases of intractable depression, acting in as little as thirty minutes and providing dramatic improvements that last for months.

If you've checked out the links, you may have noticed that none of these studies took place in the United States.  The first one was done (as I mentioned) in Canada; the research on ketamine was the result of two studies done in China.  Here in the United States it's extraordinarily difficult even for neuroscientists to obtain permission to experiment with psychotropic drugs, and there's been strong resistance to easing up these regulations by a group I can only describe as being the Morality Police.  Odd, isn't it, that alcohol -- a clearly mood-altering drug that is responsible for (by estimates from the National Institute of Health) 88,000 deaths yearly -- is legal.  Tobacco, which kills even more than that, is not only legal but is federally subsidized.

Psychedelics are unequivocally illegal in all fifty states.  At least some motion forward has happened with marijuana, which has been known for years not only to be effective for pain relief in terminal cancer patients, but has shown promise as an anti-anxiety medication.  The problem seems to be that marijuana and psychedelics have both become associated with recreational use, and I guess there's a sense that therapeutic agents shouldn't be fun.

I dunno.  Maybe there's a better reason, but if so I've never been able to figure it out.  It seems to me that careful administration of chemicals that can potentially alleviate depression and anxiety shouldn't be dependent on people moralizing about what amounts to this century's version of Demon Rum.

This is brought into sharper relief by the suicide last week of Kate Spade and Anthony Bourdain.  Depression is reaching epidemic proportions.  I use the word "epidemic" deliberately, and not as hyperbole.  Another study, released just three days ago by the US Center for Disease Control, has found that since 1999 there's been a thirty percent increase in suicides in the United States.  Only one state -- Nevada -- had a decrease, and that was by only one percent.  Twelve states had an increase of between 38% and 58%.  The result -- suicide has become the third highest cause of death, and is so frequent it's actually contributed to a statistically significant drop in American life expectancy.

This is a personal one for me.  As I've mentioned before in Skeptophilia, I've suffered from moderate to severe depression and serious social anxiety for as long as I can recall.  The depression is being controlled reasonably well by medication; the anxiety is still a work in progress.  But if I could knock out my depression -- potentially get off antidepressants permanently -- by one hit of ketamine, one use of LSD or psilocybin -- I'd do it in a heartbeat.  And I'd like to hear, if any of my readers are in the no-way-no-how column of the legalization controversy, a cogent argument about why I should not be allowed to do that.

Interestingly, I was asked that very question by one of my oldest friends, even before the tragic suicides of Kate Spade and Anthony Bourdain.  Would I be willing to try it?  Would I do so even before it was legalized?  My answer was an unequivocal yes.  Given a reasonable dosage, and friends to make sure I didn't do anything stupid while high, what exactly would be the risk?  Speaking perfectly honestly, if a 57-year-old middle-class science nerd with no social life had any access to the chemicals in question, I'd already have done it.

Perhaps we're waking up, though.  Like I said, there is an increasing push to legalize certain drugs, and that's encouraging.  (Nota bene: I'm not saying these drugs should be completely unregulated.  There are very good reasons for keeping them away from children, and for making sure that they're not used before someone gets behind the wheel of a car.  But if we can handle those challenges with alcohol, we can handle them with other chemicals.)  It's to be hoped that we'll see reason -- and potentially do something to alleviate the suffering of people whose illnesses have heretofore been essentially untreatable.

And maybe, in the process, reduce some of those suicide numbers, which are absolutely horrifying.

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This week's Skeptophilia book recommendation is a classic: the late Oliver Sacks's The Man Who Mistook His Wife for a Hat.  It's required reading for anyone who is interested in the inner workings of the human mind, and highlights how fragile our perceptual apparatus is -- and how even minor changes in our nervous systems can result in our interacting with the world in what appear from the outside to be completely bizarre ways.  Broken up into short vignettes about actual patients Sacks worked with, it's a quick and completely fascinating read.

Writing out your feelings

A paper in the journal Psychophysiology last week immediately caught my attention, as it linked a reduction in anxiety in chronic worriers with expressive writing.

The reason it piqued my interest is obvious to anyone who knows me; I'm a writer and a chronic worrier.  I always knew I felt good after meeting my writing goals, but I associated it with simple pleasure of accomplishment -- I never thought that the writing itself might be smoothing out some of my anxiety.

The paper was "The Effect of Expressive Writing on the Error-related Negativity Among Individuals with Chronic Worry," and was authored by Hans S. Schroder, Jason S. Moser, and Tim P. Moran, the first two part of the Department of Psychology at Michigan State University, and the last from Emory University in Atlanta, Georgia.  They write:

The relationship between anxiety and enlarged ERN [error-related negativity] has spurred interest in understanding potential therapeutic benefits of decreasing its amplitude within anxious individuals.  The current study used a tailored intervention—expressive writing—in an attempt to reduce the ERN among a sample of individuals with chronic worry.  Consistent with hypotheses, the ERN was reduced in the expressive writing group compared to an unrelated writing control group.  Findings provide experimental support that the ERN can be reduced among anxious individuals with tailored interventions.  Expressive writing may serve to “offload” worries from working memory, therefore relieving the distracting effects of worry on cognition as reflected in a decreased ERN.

"Expressive writing," the authors explain, "involves writing down one's deepest thoughts and feelings about a particular event," so it is expository writing and not storytelling; but it does make me wonder if writing fiction might serve the same purpose.  Of course, Hemingway would probably have disagreed:

As would Dorothy Parker:

Be that as it may, the results were striking.  The authors write:

Our findings also build upon previous studies demonstrating the positive impacts of expressive writing by showing for the first time that this intervention can also reduce neural processing of mistakes in those who typically show exaggerated error monitoring.  That the expressive writing group had reduced error monitoring but similar behavioral performance compared to the control group further suggests that it improved neural efficiency.  We therefore conclude that expressive writing shows promise for alleviating the interfering impact of worries on cognition—as reflected in reduced error monitoring and intact performance—for those who need it most.

I would be interested to see if the effect occurred in fiction writers, and (even more interestingly) if it held consistent across genres.  There are authors who write generally optimistic, upbeat stories, that leave you with a sigh of contentment and a warm feeling in your heart.  I, however, am not one of them.  In my current work-in-progress, I just finished a scene yesterday in which (1) a child is an accidental victim of a shootout, (2) the child's father was wounded, and (3) the father's wound becomes infected in a situation where there is almost no access to medical care, with the result that he begs his friends to shoot him as a mercy killing.  This leaves his three friends in the horrific situation of whether to kill the man to put him out of his misery, as per his wishes, or to let him continue in intense pain, with a condition that will almost certainly kill him anyhow.

Not cheerful stuff.  And yet... when I was done yesterday, I felt a real sense that I'd written a powerful scene, that (while not uplifting) would grab readers by the emotions and swing them around a little, all the while inducing them to empathize with all four of the characters in the scene.  Cathartic to the reader -- and to me as well.

So anyhow, that's an interesting step that Schroder et al. could take, apropos of the therapeutic value of emotional writing.  As for me, I'm going to wrap this up, because I've got more scenes to write, not to mention more characters to do really horrible things to.  Oh, well, it was their fault, after all.  They should have known what they were getting into, wandering into one of my novels.

Anxiety leakage

Following hard on the heels of a prominent athlete claiming that depression was basically self-inflicted and/or voluntary, we have a paper in Scientific Reports that unequivocally demonstrates the biological basis of anxiety.

The paper, entitled "Neural Circuitry Governing Anxious Individuals’ Mis-allocation of Working Memory to Threat," details research by Daniel M. Stout (of the University of California-San Diego), Alexander J. Shackman (of the University of Maryland), and Walker S. Pedersen, Tara A. Miskovich, and Christine L. Larson (of the University of Wisconsin).  The authors write:

Heightened levels of dispositional anxiety confer increased risk for the development of internalizing disorders, including anxiety and co-morbid depression.  These debilitating psychiatric disorders are common and existing treatments are inconsistently effective, underscoring the need to develop a deeper understanding of the mechanisms governing individual differences in risk... 

Building on prior behavioral and electrophysiological work, functional MRI (fMRI) was used in the present study to quantify neural activity while subjects performed a well-established emotional [working memory] task... The results of our mediation analyses suggest that the amygdala promotes the mis-allocation of [working memory] resources to threat-related distracters.  The amygdala is sensitive to a broad spectrum of emotionally salient stimuli, including threat-related facial expressions.  In addition, there is clear evidence that anxious individuals show amplified or prolonged amygdala responses to threat-related faces, even when they are task-irrelevant, consistent with our results.  Anatomically, the amygdala is well positioned to prioritize the short-term retention of threat-related cues...  

[I]t has become clear that information can enter [working memory] via either perceptual encoding or retrieval from long-term memory.  From this perspective, [working memory] reflects the temporary allocation of selective attention to recently perceived items or the temporary re-activation of representations stored in [long-term memory]...  This suggests that intrusive memories may reflect the mis-allocation of [working memory] resources to distressing material held in [long-term memory].

Put more simply, in anxious people, threat-related long-term memories "leak across" into the working memory, the short-term memory system we use to keep track of everyday occurrences.  This is mediated through increased activity in the amygdala, a part of the limbic system of the brain long known to have a connection to anxiety, stress, and obsessive behavior.  In an interview with PsyPost, study lead author Daniel M. Stout explained this in more detail:

Anxiety and depressive disorders are very common, challenging to treat, and pose an enormous burden on public health. Having an anxious personality is associated with developing future psychological disorders. 

We were interested in this topic because we do not fully understand why individuals with an anxious disposition, like those with an anxiety or depressive disorder, experience high levels of emotional distress in the absence of immediate threat, and spend an excessive amount of time thinking about potential dangers in objectively safe situations. 

These types of symptoms are particularly pernicious because they inflict their damage when we need to be focusing on the task-at-hand or at times when we don’t want them to (e.g., during a meeting at work, talking to loved ones, when trying to fall asleep at night).  If we can understand what underlies these symptoms, and the brain mechanisms involved, we may be better able to reduce the suffering that many people with high levels of anxiety report. 

Earlier work by our group using EEG technology suggested that this might reflect problems with how anxious individuals process threat-related information in working memory.  Working memory is a short-term memory system that guides on-going thoughts and behaviors.  It is the memory system involved in helping us remember things while we do a task, like remembering a phone number while dialing it. 

If threat-related information gains access to or ‘contaminates’ working memory, it can exert a negative influence on our thoughts and actions.  For instance, viewing an e-mail informing you that a bill is due can result in increased anxiety and intrusive thoughts about financial troubles; triggering a chain-reaction of uncontrolled worry that spans the entire day. 

One other important aspect of working memory is that its capacity is limited, so we can only hold a finite amount of information online in working memory at any given time.  So, if your working memory is ‘working’ on the worry-related thoughts, then less working memory capacity is available to attend to tasks important for your job or activities you are trying to complete.

Which certainly squares with my experience.  I have a good deal of social anxiety, and it doesn't seem to matter that I objectively, rationally know that I'm safe, that none of the people in the room are judging me or dislike me (or, honestly, are probably thinking about me at all).  The sensation is of having two brains; the rational one, that says, "These are your friends, there's no reason to freak out," and the emotional reptile brain that says, "I AM FREAKING OUT."

[image courtesy of the Wikimedia Commons]

The fact of Stout et al. showing the neurological underpinning of anxiety is a real step toward developing ways to manage it.  I'm lucky in that my anxiety is fairly mild, and hasn't impacted my day-to-day all that much (unless you count the fact that I basically have no social life).  For some people, anxiety is crippling, resulting in an inability to hold down a job, attend school, interact with anyone, and (in some cases) even get out of bed in the morning.

This fMRI study shows how such a disorder can occur, and what is happening in the brain during an anxiety attack -- allowing a much more targeted approach to treating it.  It's to be hoped that other researchers will take this study and run with it.  Because there's no other way to put it: anxiety sucks.

Anxiety shrinkage

I think one of the reasons I'm so interested in neuroscience is because there is still so much to be explored.  In my Intro Neuroscience class, I frequently have to answer questions students ask with the frustrating statement "That's unknown at this time."  Even such simple things as how memories are stored and recalled are poorly understood, although we are making significant progress in finding out how they work.

My friend and mentor Rita Calvo, Professor Emeritus of Human Genetics at Cornell University, once told me that we are currently at the point in understanding the brain that we were in understanding genetics in 1915.  We have some knowledge of what's happening, a lot of descriptive information, and little in the way of comprehension of the underlying mechanisms.  I still recall her telling me that if she were a college student in biology now, she'd go into neuroscience.

"The 20th century was the century of the gene," she said.  "The 21st will be the century of the brain."

So any time there's an advance, I'm pretty keen on finding out about it.  Which is why the article my wife sent me yesterday was such an eye-opener.  Entitled "Neuroplasticity in Response to Cognitive Behavior Therapy for Social Anxiety Disorder," this study (published this week in Translational Psychiatry) has found that social anxiety might be due to a hyperactive part of the brain called the amygdala, which has been known to be involved in fear, anxiety, and the fight-or-flight response.  More interesting still, they found that cognitive behavioral therapy can literally cause this hyperactive bit to shrink.

K. N. T. Månsson of Linköping University in Sweden, who led the group that did the study, writes:

[W]e demonstrate interrelated structural plasticity and altered neural responsivity, within the amygdala, after CBT for social anxiety.  Both GM volume and neural responsivity in the bilateral amygdala diminished after effective treatment.  Left amygdala GM volume was positively associated with symptom severity before treatment, and amygdala volume decreased significantly with CBT, correlating positively with symptom improvement in both hemispheres...  [O]ur results reinforce the notion that structural neuroplasticity in the amygdala is an important target for psychosocial treatments of anxiety, as previously suggested for pharmacological treatments of post-traumatic stress disorder.

Did you get that?  Cognitive behavioral therapy -- essentially, a kind of talk therapy -- actually had an equivalent result to anti-anxiety medication, and caused the part of the brain that was hyperactive to become physically smaller.

Are you amazed as I was at this result?  Because I read this with my mouth hanging agape.  The idea that cognitive behavioral therapy actually has a measurable result in the form of an anatomical change is absolutely mind-blowing.

Pun (lame though it is) intended.

I have another reason to find this result fascinating.  I have suffered for years from serious social anxiety, starting when I was in my mid-twenties and becoming progressively worse for the following thirty years.  Those of you who read Skeptophilia but don't know me personally might have a hard time picturing someone who is as verbose as I am being a social-phobe, but you'll have to take my word for it; in most social situations, I get myself a glass of wine and then hope like hell that the hosts have a dog I can interact with.  I have gone entire evenings at friends' houses, listening politely, laughing at the right times, and not saying a word.

Michelangelo Buonarroti, The Last Judgment (1541) [image courtesy of the Wikimedia Commons]

I've also been in cognitive behavioral therapy for about a year to try and deal with some of this, with guardedly positive results.  I'm not expecting such a deep-seated and pervasive problem to go away quickly; Rome, as they say, wasn't built in a day.  But the idea that by participating in CBT I am not only working toward alleviating my anxiety, but am causing long-lasting anatomical alterations in my brain -- that is amazing.

Because I have to say that living with an anxiety disorder is not particularly enjoyable.  Anything I can do to shrink that overactive left amygdala is fine by me.