Table Of Content“From fears to phobias and panic, this how-to guide unravels the
mysteries of worry, then delivers strategies that will lead you to a
resilient life.”
—Reid Wilson, PhD, author of Don’t Panic
“Fear, worry, anxiety, panic, and depression block individuals from
living fully. This book does an excellent job of unraveling the mys-
teries of the brain and how it causes anxiety, thus allowing individu-
als to take control of their symptoms and manage their lives more
effectively. I have used the concepts in this book in treating veterans
with PTSD and have seen people become much more functional.
Highly-recommended reading.”
—Susan Myers, RN, LCSW, BCD, holistic nurse and board
certified diplomate in clinical social work
“This is a unique contribution to a wide array of self-help books for
those who suffer with anxiety. The authors explain what we know
about the workings of the brain in a fluid style that neither talks
down to nor overwhelms the reader. This science becomes the foun-
dation for decreasing bewilderment, fear, and shame. There are
straightforward and logical recommendations for modifying patterns
of anxiety that originate from, and are maintained by, differing brain
circuitry.”
—Sally Winston PsyD, codirector of the Anxiety and Stress
Disorders Institute of Maryland
“Catherine Pittman, a trained behavioral scientist, brings her deep
scientific understanding of fear, anxiety, and learning to the world of
personal experiences. Few scientists can make this transition from
scientific communication to public communication. Pittman, along
with coauthor Elizabeth Karle, does this very well indeed. Readers
should not be put off by the early presentations of brain mechanisms,
because they are surprisingly readable and informative. Moreover, it
is information that provides a foundation for readers who have
anxiety challenges to use later as they develop effective coping strat-
egies. Readers should find the clear expositions of the where’s, why’s,
and how’s of anxiety and its management to be an anxiety-reducing
read.”
—J. Bruce Overmier, PhD, professor emeritus in the graduate
faculties of psychology, neuroscience, and cognitive science
at the University of Minnesota
Rewire
Anxious
Brain
Your
Catherine M. Pittman, PhD
Elizabeth M. Karle, MLIS
New Harbinger Publications, Inc.
how to use the
neuroscience of fear to end
anxiety, panic & worry
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychologi-
cal, financial, legal, or other professional services. If expert assistance or counseling is needed, the services
of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2015 by Catherine M. Pittman & Elizabeth M. Karle
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
http://www.newharbinger.com
Cover design by Amy Shoup
Acquired by Jess O’Brien
Edited by Jasmine Star
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
PDF ISBN: 9781626251144
This book is dedicated to all of the children and adults who
suffer from anxiety or panic, and who need daily courage to
find their way through the experience. We hope this book can
help them to live the lives they wish for themselves.
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction: The Pathways of Anxiety . . . . . . . . . . . . . 1
Part 1
Anxious Brain Basics
1
Anxiety in the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2
The Root of Anxiety: Understanding
the Amygdala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3
How the Cortex Creates Anxiety . . . . . . . . . . . . . . . . 51
4
Identifying the Basis of Your Anxiety:
Amygdala, Cortex, or Both? . . . . . . . . . . . . . . . . . . . . 63
Part 2
Taking Control of Your Amygdala-Based Anxiety
5
The Stress Response and Panic Attacks . . . . . . . . . . . 81
6
Reaping the Benefits of Relaxation . . . . . . . . . . . . . . . 95
Rewire Your Anxious Brain
vi
7
Understanding Triggers . . . . . . . . . . . . . . . . . . . . . . 113
8
Teaching Your Amygdala Through Experience . . . . 125
9
Exercise and Sleep Tips for Calming
Amygdala-Based Anxiety . . . . . . . . . . . . . . . . . . . . . 143
Part 3
Taking Control of Your Cortex-Based Anxiety
10
Thinking Patterns That Cause Anxiety . . . . . . . . . 157
11
How to Calm Your Cortex . . . . . . . . . . . . . . . . . . . 179
Conclusion: Putting It All Together to Live an
Anxiety-Resistant Life . . . . . . . . . . . . . . . . . . . . . . . . . 197
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Acknowledgments
My work on this book would not have been possible without the
assistance and support of many people in my life, and I would like to
thank them here.
First, of course, my coauthor and partner, Elizabeth (Lisa) Karle,
who has enriched my life in countless ways and accompanied me
into a variety of endeavors I could never have imagined without her.
She amazes me on a daily basis with her courage in the face of her
own anxiety, her patience with all that life requires of her, and her
determination to hold herself to high standards.
My daughters, Arrianna and Melinda, who have tolerated
months of me working on my laptop, not to mention years of discus-
sion of the amygdala and cortex. I hope they know how much I love
them despite many evenings of researching and writing.
My clients over the past thirty years, who have taught me so
much and inspired my respect and admiration as they’ve retrained
their brains, shaping their lives to follow their dreams. They haven’t
let their struggles with anxiety or brain injury keep them from
becoming who they were meant to be.
William (Bill) Youngs, neuropsychologist and dear friend, who
has provided a wealth of knowledge and encouragement during our
weekly lunches over the past twenty-five years, and who made many
valued observations and suggestions during the creation of this book.
Cathy Baumgartner, administrative assistant and friend, who’s
made the Psychology Department run smoothly while I’ve served as
chair and who made it possible for me to spend precious hours in the
Rewire Your Anxious Brain
viii
library during recent months. I feel so fortunate to have her compe-
tence and sense of fun in my life.
Samantha Marley, a psychology major at Saint Mary’s and
student assistant in the Psychology Department, who helped not
only by scoring exams but also by working on the many references
for this book. After her senior thesis, Sam produces perfectly format-
ted references in no time!
—Catherine
Having a mental illness of any kind is a challenge. Not only can it
affect daily living, but it can also alter the trajectory of one’s life
plans. Often it doesn’t stop there, as the ups and downs of anxiety
and other disorders impact family, friends, and coworkers as well. We
hope this book will provide insights and information that will help
our readers and their support systems weather these challenges. We
are grateful to the professionals at New Harbinger Publications for
giving us the opportunity to share our knowledge and experience
with you.
On a personal note, I’d like to thank the members of my own
support system for always being there: my parents and siblings, whose
love knows no bounds; Carol, who amazes me; Brother Sage, for his
daily wit and wisdom; Janet and my colleagues at Saint Mary’s
College, for their patience and assistance; Tonilynn, who under-
stands better than anyone else; Bill, the brain master; my ggf
Guiseppe Carpani, for being in the right place at the right time; and,
of course, Catherine, with whom I’ve shared both meaningful dreams
and madcap adventures.
Lastly, a special thank-you to my nieces and nephews, whose
limitless joy and affection make the sights and sounds of life more
rewarding. “To infinity and beyond!”
—Elizabeth
INTRODUCTION
The Pathways of Anxiety
You’re driving to work one day when you suddenly wonder, Did I turn
off the stove? You begin to mentally trace your steps from earlier that
morning, but you still can’t remember turning it off. You probably
did…but what if you didn’t? Your anxiety begins to build as the
image of the stove catching on fire pops into your head. Just then,
the person in the car in front of you slams on the brakes. You clutch
the steering wheel tightly and hit your own brakes hard, stopping
just in time. Your whole body is activated with a surge of energy and
your heart is pounding, but you’re safe. You take some deep breaths.
That was close!
Anxiety, it seems, is all around us. If you carefully consider the
events in the scenario above, you’ll notice that they illustrate two
very different ways that anxiety begins: through what we think
about, and through reactions to our environment. This is because
anxiety can be initiated by two very different areas of the human
brain: the cortex and the amygdala. This understanding is the result
of years of research in a field known as neuroscience, which is the
science of the structure and function of the nervous system, includ-
ing the brain.
The simple example above, involving both the imagined stove
and the braking car, illustrates the underlying principle of this book:
two separate pathways in the brain can give rise to anxiety, and each
pathway needs to be understood and treated for maximum relief
(Ochsner et al. 2009). In that example, anxiety was aroused in the
cortex pathway by thoughts and images of the risks of leaving the
stove on all day. And information from another anxiety-producing
Rewire Your Anxious Brain
2
pathway, traveling more directly through the amygdala, ensured a
quick reaction to avoid rear-ending another car.
Everyone is capable of experiencing anxiety through both path-
ways. Some people may find that their anxiety arises more frequently
in one pathway than the other. As you’ll learn, recognizing the two
pathways and handling each in the most effective manner is essen-
tial. The purpose of this book is to explain the differences between
the two pathways, demonstrate how anxiety is created in each, and
give you practical ways to modify circuits in each pathway in order to
make anxiety less of a burden in your life. We’ll show you how you
can actually change the pathways in your brain so that they’re less
likely to create anxiety.
Understanding Anxiety
Anxiety is a complex emotional response that’s similar to fear. Both
arise from similar brain processes and cause similar physiological
and behavioral reactions; both originate in portions of the brain
designed to help all animals deal with danger. Fear and anxiety
differ, however, in that fear is typically associated with a clear,
present, and identifiable threat, whereas anxiety occurs in the absence
of immediate peril. In other words, we feel fear when we actually are
in trouble—like when a truck crosses the center line and heads
toward us. We feel anxiety when we have a sense of dread or discom-
fort but aren’t, at that moment, in danger.
Everyone experiences fear and anxiety. Events can cause us to
feel in danger, such as when a severe storm shakes our house or when
we see a strange dog bounding toward us. Anxiety arises when we
worry about the safety of a loved one who’s far from home, when we
hear a strange noise late at night, or when we contemplate every-
thing we need to complete before an upcoming deadline at work or
school. Many people feel anxious quite often, especially when under
some kind of stress. Problems begin, however, when anxiety inter-
feres with important aspects of our lives. In that case, we need to get
The Pathways of Anxiety
3
a handle on our anxiety and regain control. We need to understand
how to deal with it so it no longer limits our lives.
Anxiety can limit people’s lives in surprising ways—many of
which may not seem to be due to anxiety. For example, while some
people are plagued by worries that haunt every waking moment,
others may find it difficult to fall asleep. Some may have a hard time
leaving home, while for other individuals a fear of public speaking
may threaten their job. A new mother may have to complete a series
of rituals for hours each morning before she can leave her child with
a sitter. A teenage boy may be haunted by nightmares and get sus-
pended for fighting in school after his home has been destroyed by a
tornado. A plumber’s anxiety about encountering large spiders may
reduce his income to a level that won’t support his family. A child
may be reluctant to attend school and unwilling to talk to her teach-
ers, threatening her education.
Even though anxiety has the power to rob a person of the capac-
ity to complete many of the basic activities of life, all of these indi-
viduals can return to fully engaging in life. They can understand the
cause of their difficulties and begin to find confidence again. This
understanding is possible thanks to a recent revolution in knowledge
about the brain structures that create anxiety.
In the past two decades, research on the neurological underpin-
nings of anxiety has been conducted in a variety of laboratories
around the world (Dias et al. 2013). Research on animals has uncov-
ered new details about the neurological foundations of fear. Structures
in the brain that detect threats and initiate protective responses
have been identified. At the same time, new technologies like func-
tional magnetic resonance imaging and positron emission tomogra-
phy scans have provided detailed information about how the human
brain responds in a variety of situations. When reviewed, analyzed,
and combined, this emerging knowledge allows neuroscientists to
make connections between animal research and human research.
As a result, they are now able to assemble a clear picture of the
causes of fear and anxiety, providing an understanding that sur-
passes our understanding of all other human emotions.
Rewire Your Anxious Brain
4
This research has revealed something very important: two fairly
separate pathways in the brain can create anxiety. One path begins
in the cerebral cortex, the large, convoluted, gray part of the brain,
and involves our perceptions and thoughts about situations. The
other travels more directly through the amygdalas (uh-MIG-dull-
uhs), two small, almond-shaped structures, one on each side of the
brain. The amygdala (generally referred to in the singular) triggers
the ancient fight-or-flight response, which has been passed down vir-
tually unchanged from the earliest vertebrates on earth.
Both pathways play a role in anxiety, although some types of
anxiety are more associated with the cortex, while others can be
directly attributed to the amygdala. In psychotherapy for anxiety,
attention has typically been focused on the cortex pathway, using
therapeutic approaches that involve changing thoughts and arguing
logically against anxiety. However, a growing body of research sug-
gests that the role of the amygdala must also be understood to
develop a more complete picture of how anxiety is created and how
it can be controlled. In this book, we’ll explore both pathways to give
you a full picture of anxiety and how to change it, whatever its origin.
The Cortex and the Amygdala
Chances are you’re already familiar with the cortex, the portion of
the brain that fills the topmost part of the skull. It’s the thinking
part of the brain, and some say it’s the portion of the brain that
makes us human because it enables us to reason, create language,
and engage in complicated thinking, such as logic and mathematics.
Species that have a large cerebral cortex are often thought to be
more intelligent than other animals.
Approaches to treating anxiety that target the cortex pathway
are numerous and typically focus on cognitions, the psychological
term for the mental processes that most people refer to as “thinking.”
Thoughts originating in the cortex may be the cause of anxiety, or
they may have the effect of increasing or decreasing anxiety. In many
