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Modulation of Anxiety

Anxiety often gets confused with "stressed". The truth is they are very different. "Stress" is usually situational and if the stressor is removed then the stress goes away. However , anxiety is usually chronic and ongoing involving excess anticipation, worry, and fear of about a future unknown outcome, event, or occurrence. So, Anxiety is very future oriented whereas stress is more tangible about here and now concerns. Anxiety has other related and more complex conditions like panic disorder, post-traumatic stress disorders, and obsessive compulsive disorders.


Anxiety also has many features of Attention Deficit and Hyperactivity Disorders. Meaning difficulty knowing what to focus on, what is a priority, what is important, as well as having a great deal of distractibility .


Anxiety involves many different checkpoints of the brain including the limbic system, the prefrontal cortex, basal ganglia, reticular activating system, insular cortex. These regions of the brain involve body sensations/regulation, planning , interoception, executive functioning, filtering information, hormone release, and more.


I recently did a Q& A on Anxiety and Heart Rate Variability (HRV) as a measurement of anxiety management. I have written at length about HRV biofeedback training before. Low HRV is largely associated with Anxiety and related disorder in a metanalysis of over 2000 patients.


Heart rate variability (HRV) is controlled by the autonomic nervous system. And, in anxiety disorder there is excessive corticotrophin releasing hormone and higher cortisol leading to sympathetic overdrive and underdrive of parasympathetic nervous system activity (called poor vagal tone) .Heart rate variability is defined as the the amount of time between your heartbeats. It is controlled unconsciously by the autonomic nervous system (which has a sympathetic branch and parasympathetic branch)


Heart rate variability is the variance in time between the beats of your heart. If your heart rate is 120 beats per minute; it does not mean that your heart is beating every .5 seconds. It may be beating 0.3 seconds between two beats, and then sometimes and .7 seconds between two others. The greater this variability ; then higher the HRV.


HRV can reflects how adaptable your body can be. People with high HRV are usually less stressed, less anxious, and happier.


Low heart rate variability is a sign of current or eminent health problems because it shows your body is becoming less resilient.


I am fascinated by the applications of HRV in anxiety. Because it can be regulated by breathing exercises, herbal and conventional medication, biofeedback devices, meditation, and psychotherapy. If we can increase HRV then anxiety is more manageable.


There are several tools that I like to help with measuring HRV.

. Many smartwatches have HRV applications such as GARMIN, Fitbit, and Apple watch. As do many Smart Rings like Oura Ring, Monavo, and Circular.

And there are many devices that give biofeedback and neurofeedback to effect your HRV like:


The inner-balance app by Heart Math

Sensate device

Alpha-stim


However, if you don't want to monitor it it would be smart to at least learn breathing methods such as coherent breathing, 4-7-8 breathing square, or methods discussed on the oxygen advantage.


For more in-depth discussion on HRV , please listen in on the interview I did with Marco Altinin, PhD on my podcast.





Since anxiety and related disorders are unique it may be helpful to look into genetic testing for mental health polymorphisms or neurotransmitter testing to identify ones unique neurotransmitter balance. Ther are validated questionnaires online that can determine the degree of depression, stress, or anxiety you have like the DASS-21 scale. As a functional medicine practitioner , I also use questionnaires like the HPA axis questionnaire that can also provide additional information.


From an herbal medicine perspective; I have accumulated some protocols that have herbs that help with raising serotonin, lowering glutamate, and raising GABA.


Some anxiety and stress is normal and adaptive; its when it is unchecked that life disruption, quality of life, and health effects may manifest.

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