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In the early 2000s, a group of brain researchers at the University of Iowa set out to frighten a woman. They never once managed it. They walked her through a pet shop full of snakes and tarantulas, and instead of flinching she had to be stopped from handling them. They sent her into one of those haunted houses where costumed actors leap out of dark corners; by the end she was the one startling the actors. Horror films that others could barely watch, she found simply gripping.
The woman, known in the literature for decades only as S. M., has the rare Urbach-Wiethe syndrome, which gradually destroyed both amygdalae in her brain, the very region responsible for processing fear. S. M. is, quite literally, unable to feel afraid. That would be enviable if it weren’t so dangerous. She has been mugged and threatened more than once, including with a knife to her throat, and said afterward that she felt no fear in any of those moments. She’s missing the early-warning system that makes most of us instinctively cross to the other side of the street. So she keeps walking straight in.
An honest story about anxiety has to start at this paradoxical spot. We treat it like a defect we’d love to switch off. S. M. shows what happens when that defect is genuinely fixed: a life of permanent defenselessness. Anxiety, at least in its basic version, is the reason most of us made it to adulthood at all.
In you and me, the very piece of brain S. M. lacks is hard at work. The amygdala, an almond-sized structure that exists once in each hemisphere, decides in fractions of a second between danger and no danger, long before the conscious mind has any idea what’s going on. For thousands of years that was a good deal. The trouble is that this ancient system has no concept of quarterly targets or unread emails, and responds to an unpleasant message with the same machinery once meant for genuine mortal danger. It can’t tell a real threat from a merely imagined one.
How common anxiety really is
S. M. is an extremely rare case. The widespread problem is the opposite: a system that fires too often and at the wrong moment. Anxiety disorders are among the most common mental health conditions there are. Estimates for Germany suggest that in a single year about fifteen percent of adults meet the criteria for an anxiety disorder, women roughly twice as often as men. And those are only the cases that would receive a diagnosis. The quiet, constant tension that so many people know, and head off to work with anyway, shows up in no statistic at all.
Not every bit of anxiety is a textbook case. Having a stomachache before an exam or feeling fear before an operation is perfectly healthy, and in fact rather useful. It only gets tricky when the anxiety stays even though the danger is long gone, when it no longer bears any relation to the situation and starts making your life narrower. The moment you take detours and pass up opportunities just to keep that queasy feeling away, the one-time lifesaver has tipped into its opposite.
Anxiety rarely looks like anxiety
The sneaky part is that it seldom shows up as what it is. In the body you can still catch it most easily: the heart beats faster for no reason, the breath goes shallow, the stomach pipes up. Some feel it as dizziness, others as a stiff neck or as a tiredness that no amount of sleep can touch.
It’s harder to pin down in the head, where it disguises itself as a carousel of thoughts that simply won’t switch off at night, or as that reliable knack for landing on the worst possible outcome before anything has even been decided.
But it hides best in behavior. There anxiety looks like procrastination, because even the thought of starting is unpleasant. Or like a bad mood, when someone blows up over a trifle. It dresses up as perfectionism, as the need to have absolutely everything under control, or as the kind of constant busyness that makes sure no quiet moment can ever arise. Sometimes it’s that quiet withdrawal, where you turn down invitations and tell yourself you just don’t have the time right now. Once you’ve learned to look behind these disguises, you start spotting anxiety in the unlikeliest places.
The body has a say
Anxiety is never purely a matter of the head. You see this most clearly with sleep. A sleepless night makes the amygdala noticeably touchier the next day; its alarm threshold drops, and suddenly a small thing is enough. Annoyingly, the anxiety in turn is what keeps you lying awake at night. So the two ramp each other up until, at some point, you can’t tell which came first.
Food has a say too, usually without you noticing. When blood sugar drops, it feels remarkably like anxiety, complete with trembling and a pounding heart. Caffeine piles on an extra helping of physical arousal and can practically stoke a panic. Alcohol soothes in the evening and gets its revenge a few hours later, when the nervous system overcorrects and leaves you wide awake and jittery in the middle of the night.
Then there’s the other side: movement burns off stress hormones, and through the breath you have a surprisingly direct remote control for your nervous system. None of this reduces anxiety to a question of sleep and coffee, of course. But the body stays a lever you can still reach even when your thoughts refuse to settle in the slightest.
What finally taught S. M. fear
S. M.’s story actually has a second act, and it’s almost more astonishing than the first. For years she was the woman nothing could frighten. Then, in 2013, the team around neuroscientist Justin Feinstein had her take a single deep breath from a mask delivering a mixture with 35 percent carbon dioxide. One breath of it briefly produces the bodily sensation of suffocating. S. M. tore the mask off her face, gasped for air, and cried that she couldn’t breathe. For the first time in decades, she experienced panic. Two other patients without amygdalae reacted the same way.
A decades-old certainty was gone. Fear, it turns out, doesn’t strictly need the amygdala. Threats from the outside, a spider or a dark parking lot, run through it. An alarm set off deep inside the body itself, such as the signal of too little air, finds an entirely different route into awareness. Anyone who has had a panic attack can sense why this is more than a lab curiosity. A panic attack is often exactly that: the body fires off the full alarm over some harmless internal signal, a quickened heartbeat perhaps or a brief spell of dizziness, and the mind supplies the frightening explanation only afterward. That’s also why panic can be reined back in through the body, through the breath for instance, which signals to the system that no one is actually suffocating.
What actually helps
The least spectacular trick first, because it works surprisingly well: name the anxiety. Telling yourself in the moment, “ah, this is just anxiety, nothing more,” wedges a small gap between you and the feeling. It seems almost too simple, yet it shows up even on a brain scan: merely labeling an emotion dampens its force.
Then the unglamorous basics that people love to skip because they sound like a health pamphlet: enough sleep, a bit of movement, and, honestly, a realistic look at how much coffee and wine are currently running through the day. For the breath, one rule is enough: exhale longer than you inhale. Spend a few minutes breathing in for about four seconds and out for six, and the arousal drops noticeably.
What helps most is, of all things, the most uncomfortable thing: pushing back against your own avoidance. Anxiety grows the more consistently you dodge it, because every dodge is proof to the brain that the danger must have been real. The way out runs in exactly the opposite direction, in tiny steps toward what feels unpleasant. It needn’t be anything big; the forever-postponed phone call, simply made for once, is already a start.
At some point, though, you reach the line where self-help no longer does the job. When the anxiety stays for weeks, visibly narrows your daily life, tips over into panic attacks, or has you building half your life around avoidance, professional help is worth it. Anxiety disorders respond well to treatment, and cognitive behavioral therapy in particular has a remarkably good track record here. Reaching out for support is one of the most sensible things you can do.
An exercise for the coming week
Grab a notebook or your notes app for a few days and observe your own anxiety like a curious reporter. Every time it comes up, jot down quickly: what did the body do? What thought was there just now? And note, in passing, the day’s easily overlooked basics: how you slept, what and when you ate, how much coffee was involved, whether you moved at all. And later, with a little distance: did the thing you dreaded actually come to pass?
You don’t have to therapize any of it away. It’s enough to gather material about yourself. After a few days, patterns surface: certain situations, recurring thoughts, and often enough a link to a short night, a skipped meal, or that third cup of coffee. And you’ll almost certainly notice how rarely the catastrophe your anxiety so urgently announces actually arrives. All of this is the raw material for recalibrating it bit by bit. You don’t want to get rid of it entirely anyway, you’ve seen where that led for S. M.
Sources
- Feinstein, J. S., Adolphs, R., Damasio, A. & Tranel, D. (2011): The Human Amygdala and the Induction and Experience of Fear. Current Biology 21 (1), 34–38. — The S. M. case study (University of Iowa).
- Feinstein, J. S., Buzza, C., Hurlemann, R. et al. (2013): Fear and Panic in Humans with Bilateral Amygdala Damage. Nature Neuroscience 16 (3), 270–272. — The CO2 experiment that triggered panic in S. M. for the first time in decades.
- Jacobi, F. et al. (2014): Mental Disorders in the General Population (DEGS1-MH), Robert Koch Institute. Der Nervenarzt 85 (1), 77–87. — 12-month prevalence of anxiety disorders: 15.3 % (women 21.3 %, men 9.3 %).
- Lieberman, M. D. et al. (2007): Putting Feelings into Words: Affect Labeling Disrupts Amygdala Activity in Response to Affective Stimuli. Psychological Science 18 (5), 421–428.
- Yoo, S. S., Gujar, N., Hu, P., Jolesz, F. A. & Walker, M. P. (2007): The Human Emotional Brain Without Sleep — a Prefrontal Amygdala Disconnect. Current Biology 17 (20), R877–R878.
- German S3 guideline “Behandlung von Angststörungen” (2021), AWMF reg. no. 051-028. — On the effectiveness of cognitive behavioral therapy.
