Anxiety isn’t necessarily the enemy: it’s a survival tool that misfires
STUDY: Herrera-Solís A et al, Progress in Neuropsychopharmacology & Biological Psychiatry 2026
STUDY TYPE: Review
FUNDING: Programa de Apoyo a Proyectos de Investigación e Innovación Tecnológica (PAPIIT), Universidad Nacional Autónoma de México; Hospital General Dr. Manuel Gea González, Secretaría de Salud, México
Background
Anxiety isn’t a flaw in the brain’s wiring. It’s a feature. This review from a Mexican neuroscience group examines anxiety as both an adaptive survival mechanism and a clinical disorder, tracing the brain circuitry involved and surveying new pharmacological and psychotherapeutic approaches.
Summary
Anxiety evolved to help humans plan ahead and avoid harm. The brain’s “defense system” includes the amygdala, bed nucleus of the stria terminalis, nucleus accumbens, cingulate cortex, and insular cortex. These structures drive two modes of threat response: a fast, reflexive system activated by immediate danger, and a slower, deliberate system that manages anticipated threats through planning.
This defense system turns into problematic anxiety when early adversity, social isolation, or chronic stress lowers its activation threshold. Children raised in orphanages show smaller prefrontal cortices and larger, more reactive amygdala. Loneliness is a particularly potent driver. Strong social connections predict longevity more reliably than exercise or not smoking.
Practice Implications
- Anxiety disorders are better described as phobias. The problem stems from efforts to avoid anxiety, not the anxiety itself. In therapy, the cure gradual exposure and reducing avoidance, which leads to more anxiety in the short-term and less in the long-term.
- Normal anxiety is a different experience from problematic anxiety. 30% of people have had panic attacks, but fewer than 5% have full panic disorder with the severe avoidance and phobia that involves.
- The goal of treatment is not to get rid of all anxiety, but to convert phobic anxiety to normal anxiety. Just as the goal of treating spider phobia is not to kill all spiders.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
