Pathways to Anxiety: The Cerebral Cortex

by Jerry Kennard, Ph.D. Medical Reviewer

In a previous post I outlined one of two main pathways to anxiety: the amygdala, a group of neurons located deep within the brain's temporal lobe. In this post, I’m looking at a second anxiety pathway, the cerebral cortex, and its role in both anticipating and interpreting anxiety.

The cerebral cortex

The cerebral cortex is the gray, squiggly outer layer of the brain. All our abilities to process sensations, thoughts, imagination, memories, logic, and planning are located here. But that’s not all. The meaning__s that we attach to these sensations, along with all the things we see, hear, feel, smell, and touch, are associated with the functions of the cerebral cortex.

Our brains allow us to imagine the future, and thus we are able to envision any number of negative outcomes. It’s our very ability to interpret, anticipate, and form images in our mind that creates anxiety when no actual threats exist. When, for example, a letter from the tax office arrives, your imagination might automatically assume that you owe money. You feel anxious as you tear open the letter, only to discover that it's a standard notice sent to all taxpayers. This is an example of cortex-based anxiety.

Cognitive fusion

The linking of thoughts to experiences is the result of something called cognitive fusion. An example of this might be the belief (the thought) that stepping into a busy shop will lead to a panic attack (the experience). Such thoughts are likely to activate the second anxiety pathway, the amygdala. This gives rise to the uncomfortable physical sensations associated with anxiety such as sweating, a pounding heart and rapid shallow breathing.

Cognitive fusion occurs when we misinterpret thoughts as facts. For example, if some of your thoughts scare you, or if you think things will get worse if you don’t worry about them, you are fusing thoughts with experiences. It’s very common and it’s one of the reasons psychologists (like me) stress the importance of questioning and challenging our own thoughts.

Pessimistic thinkers take note: Your thoughts don’t determine what actually happens to you.

Controlling the cortexThe amygdala responds to thoughts in the same way it does to actual events. This means we have a great deal of control over our anxiety simply by reducing the time spent thinking anxious thoughts. When people say, "don’t worry about it," the advice may sound clichéd but it makes sense. It’s the fact that we take these thoughts seriously and spend time on them that, for example, prevents the agoraphobic from stepping outside for fear of collapsing, panicking, or having a heart attack.

Acknowledging thoughts without necessarily buying into them requires that we develop a way to act as observers rather than believers when viewing our own thoughts. We call this technique cognitive restructuring. Learning to become suspicious of anxiety-generating thoughts and challenging them with evidence is key to this process. For this to work, it’s important to pay attention to biased thinking and identify recurring thoughts. Repeatedly replacing anxiety thoughts with different and more realistic thoughts will eventually pay dividends, because the circuitry of your brain will literally start to change.

Rewiring the brain

Let’s imagine you’re a brain. As you go about your business, a worry comes your way, so you fire up a few neurons to respond. But this and other worries go on and on, so you think, "hang on, this must be really important, I’d better commit more resources to it," and so you fire up a few more neurons. You start to make more robust and stable connections. Before too long, you’ve established a nice neural structure for worry.

Researchers used to think that our brains had little capacity to adapt and change as we got older. We now know this isn’t the case. In fact, it turns out that the brain is highly capable of adapting to new circumstances. This means we have a good amount of control over our anxiety -- if we choose to exercise it.

Jerry Kennard, Ph.D.
Meet Our Writer
Jerry Kennard, Ph.D.

Jerry Kennard, Ph.D., is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry’s work background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of