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We all experience anxiety sometimes—and chances are, we’re quite familiar with the way it manifests physically (think sweaty palms, a racing heart, sometimes even itchy hives). But have you ever wondered what’s actually going on in your brain when you have anxiety?

A lot of it comes down to chemicals. “Anxiety and stress cause the brain to release cortisol (the ‘stress hormone’), which can help manage the moment but which wears us down over time,” says licensed clinical psychologist Amy Marschall, PsyD. “Chronic stress is linked to all kinds of physical and mental health issues.”

Read on to learn more about the neuroscience behind anxiety, the long-term effects of anxiety on the brain, and how to cope with anxiety.

Brain Structures Involved in Anxiety

Our brains process anxiety and stress in what’s called the limbic system, which is made up of the hippocampus, the amygdala, the hypothalamus, and the thalamus. The limbic system is the part of our brain that connects to emotion and memory, as well as fear, stress, and motivation. It’s one part of the brain that regulates “autonomic” (what you might call automatic or unconscious) processes.

Hippocampus

The hippocampus is the part of the brain that consolidates information, and is associated with the different forms of memory: short-term, long-term, and spatial. The way your hippocampus processes and stores memories can affect anxiety if this part of your brain has made connections between your memories of stressful or anxiety-inducing events and how you respond to them.

Amygdala

The amygdala processes your emotional responses, especially fear. Aggression and anxiety also live in the amygdala, which processes memory and decision-making as well. This is another way for your brain to make connections between past experiences and the way you react to stressful stimuli.

Hypothalamus

The hypothalamus regulates the autonomic nervous system, and is one third of the hypothalamic-pituitary-adrenal (HPA) axis, which controls stress reactions and stress management. Overall, it coordinates the endocrine system, which also includes temperature regulation and appetite—two things that can be noticeably affected by anxiety and stress.

How These Structures Process Emotions and Stress

The limbic system—also called the emotional nervous system—made up of these four parts of the brain regulates memory, behavior, and emotions. Basically, every survival behavior, including how to react to your surroundings, when to eat and drink, and the need to reproduce, is produced by this system.

It’s also in charge of the way your body reacts to stress. Your heart rate, blood pressure, and body temperature are all a part of the autonomic nervous system that the limbic system manages. 

Your limbic system allows you to take in information, process that information, and react accordingly, learning from each experience and influencing the way you will react to similar experiences in the future. Using these four parts of the brain, this system regulates how you feel about stimuli, how you respond to those stimuli, and what effect those stimuli will have on you in the future.

Neurobiological Mechanisms of Anxiety

Chances are you’ve heard of the “fight or flight” response—but did you know that two other responses to stress have also been identified? It’s actually the “fight/flight/freeze/fawn” response, which sums up every common reaction to an anxiety-inducing situation.

“When the anxiety response is activated, the amygdala takes over—this is the fight/flight/freeze/fawn response,” explains Dr. Amy Marschall. “When you are in immediate danger, it can be the difference between life and death to act quickly in a way that eliminates the danger. However,” she notes, “the amygdala overrides the frontal lobe (the part of the brain that controls rational thought, language, and impulse control), so we can act out when we are experiencing anxiety in ways that would normally be out of character.”

So what happens in your body and your brain when you have one of these responses?

Fight

For people whose automatic response to stress is “fight,” they might have a tendency to get into fights or even physical altercations when faced with heightened stress. In fight mode, you’ll feel an adrenaline rush and intense anger, as well as physical responses like a higher heart rate and blood pressure. You might also respond with hypervigilence, like you’re tuned in at a higher level to the threat you are facing; you could also feel agitated and jumpy.

Flight

The “flight” response is characterized by the immense urge to flee, to physically escape the situation rather than to stay and try to resolve the problem. You’ll likely feel trapped, like the world is closing in on you; this could make you panic. In flight mode, you are more likely to perceive threats, both real and imaginary, and to try to avoid them at all costs.

Freeze

To “freeze” in response to stress is to completely shut down rather than have an “active” response (like fight or flight, which both require mental and physical activation). People freeze when fighting or fleeing isn’t possible. This stress response is highly associated with trauma and extreme anxiety. 

In freeze mode, you might dissociate (feel like you’re not connected to your body or like you’re mentally detaching from the present moment), feel emotionally numb or confused, or feel like you can’t make a decision or take action in this situation. You could also feel physical symptoms like numbness, holding your breath, or feeling like you can’t move. You might even lose the ability to speak. This stress reaction is one of terror.

Fawn

Sometimes, in a stressful situation, it feels safer to back down than to take action—this is where the “fawn” response kicks in. When you “fawn,” you’re showing submission to the person you fear; you’re trying to please this person instead of taking care of your own well-being. This reaction happens often in people-pleasers and those who have trouble setting boundaries. You might pretend to agree with the other person or do what they say no matter how it affects you. If you feel the need to fawn, your instinct is to be obedient to mitigate punishment.

The Impact of Anxiety on the Brain

Anxiety and its effects on the brain take place in the emotional regulation centers of the brain rather than the higher cognitive centers; this means that your unconscious, “emotional” brain is experiencing all the stress, changing the way you react to sources of anxiety.

There are many different types of anxiety disorders, with some symptoms that overlap. And consistently experiencing any or all of these anxiety disorders kick your brain’s limbic system into high gear. And with consistent high gear functioning comes constant stress on your nervous system.

Physical issues include high blood pressure, heart problems, weight gain, and even chronic illnesses like diabetes and cancer; mental health issues include anxiety disorders (as in, a consistent unhealthy and unhelpful response to stress) and depression.

“One consequence of prolonged anxiety on brain function is increased activation of the fight-or-flight system in the brain,” explains Dr. Romanoff. “Research has found that prolonged anxiety causes the amygdala to grow—which is the part of the brain responsible for responding to threatening stimuli and creating the fear response. This leads to intensified reactions to threatening stimuli—especially with regard to those that elicit fear and anger.” This change in your “fear” circuitry also negatively affects the way your hippocampus (through which you process information and memory) and your prefrontal cortex (where your “personality” lies) do their jobs.

Long-term anxiety also affects your cognitive functioning. “It disrupts rational decision-making, as the stressed mind is processing information through a ‘life or death’ lens,” says Dr. Romanoff, “which tends to lead to more extreme decisions and causes individuals to overestimate the likelihood of threat.”

Coping With Anxiety

So, you’ve got anxiety—now what?

“One of the best treatment options for anxiety is talk therapy, combined with medication (depending on the severity of symptoms),” advises Dr. Romanoff. “Medication can help bring the anxiety down to manageable levels so you can begin to work through and gain control over symptoms in talk therapy.”

Anxiety Medications

You’ve got options when it comes to medications for anxiety. 

Your doctor might prescribe an antidepressant, many of which are approved treatments for anxiety. SSRIs (selective serotonin reuptake inhibitors) like Zoloft, Lexapro, and Paxil, and SNRIs (serotonin and norepinephrine reuptake inhibitors) like Effexor and Cymbalta are commonly used to treat anxiety.

There are also anxiety-specific medications called anxiolytics, which are benzodiazepines. These include Ativan, Klonopin, and Xanax, and they act as tranquilizers. However, unlike antidepressants, benzodiazepines are habit-forming, and are only meant to be taken as-needed (as opposed to taking an antidepressant every day). 

Beta-blockers are also prescribed to treat anxiety, though this is an off-label use (a use for which the drug was not developed). Beta-blockers are helpful at relieving the physical symptoms of anxiety, such as a racing heartbeat and high blood pressure.

Therapy Approaches for Anxiety

The most common therapeutic treatment for anxiety is cognitive behavioral therapy, or CBT. This is an approach that targets negative thoughts and reactions and teaches you to respond to stressors in a different and more helpful way.

“CBT can be helpful to gain concrete behavioral intervention skills and clear strategies to implement to manage anxiety,” says Dr. Romanoff.  

She also recommends psychodynamic therapy, or therapy that is more focused on the experiences of your past and long-term solutions for deep-set problems, rather than the short-term and skills-focused approach of CBT. “Psychodynamic therapy can help with deeper and a more thorough analysis of longer standing anxiety symptoms that may be related to early life or more complex challenges,” she explains.

Exposure therapy can also be helpful when treating anxiety, especially for phobias. This is a subset of CBT that slowly introduces you to the triggers of your anxiety in a safe and contained way and teaches you, through practice, to react differently to those triggers.

ACT, or acceptance and commitment therapy, is also helpful when dealing with anxiety disorders. Rather than trying to change your thoughts and reactions like in CBT, ACT helps you accept your challenging thoughts and reactions as things that do not need “fixing” or “control;” instead, they are recognized as part of your emotional world, and you learn to live your life according to your values with the understanding that you might face—and conquer—certain problems along the way by being flexible and accepting of your anxiety and anxious responses.

Tackling Anxiety Outside of Therapy

Outside of therapy, there are plenty of exercises you can practice at home to fight your anxiety.

“If anxious throughout the day, practice grounding exercises,” proposes Dr. Romanoff. “This means engaging in strategies to ground you in the present moment. The easiest way to do this is to ground yourself through your senses. When you find your thoughts are racing, list 5 things you can see, 4 things you can touch, 3 things you can hear, and so on throughout your senses,” she suggests. “The theory is that your senses help you reconnect with the environment, pull you out of the chaos that has been created in your mind, and provide tangible evidence that the smoke detector in your mind pulled a false alarm. Basically, it’s an exercise proving that the lack of threat in the environment doesn’t match your high-anxiety reaction.”

This might involve developing better sleep hygiene, such as not looking at screens right before bed and going to bed and waking up at the same time each day, or incorporating an exercise routine into your week, since regular exercise has been proven effective in helping to manage anxiety. Meditation can also be useful, as it gives you time to reflect on what you are feeling and approach those feelings with respect and mindfulness; a diet that involves less processed foods, sugar, caffeine, or alcohol has also been shown to help manage anxiety symptoms.

Dr. Romanoff also speaks to the benefits of routine. “Research has found that your morning routine sets the tone for your emotional functioning and productivity for the rest of the day,” she advises. “It starts with small steps. For example: making your bed, doing a skincare routine, and eating a healthy breakfast. All of these tasks create a sense of accomplishment and generate momentum to continue to make additional achievements throughout the day.”

Why It’s Important to Address Your Anxiety

If you are living with anxiety, it’s very important to try to treat it—your mental health might depend on it. 

Not only does living in constant anxiety physically stress your brain, kicking your nervous system into overdrive, but the negative effects those stress reactions can have on your daily life can be at best disruptive and at worst debilitating. If left unchecked, your anxiety can make it difficult to work, to interact with people, and to enjoy things in your life that would otherwise make you happy.

If you’ve been dealing with untreated anxiety for a long time, you might not know or remember what life without anxiety would be like—but you don’t have to suffer in silence. 

Something we often hear a lot about, whether in the media or just conversations with friends, is sex addiction. But in an era of dating apps and hookups, what does that mean? 

There’s often a lot of confusion around sex addiction—there’s even some debate over sex addiction being a real diagnosable condition, as it’s not in the DSM-5 (the diagnostic standard for addiction and mental health disorders). But in essence, it’s a compulsive need to perform sexual acts to achieve a “fix,” similarly to how someone with a substance use disorder might feel a compulsive need to use substances to achieve a “fix.”

“It’s more than just being interested or enjoying sex or sexual activity,” says Michelle Herzog, a licensed marriage and family therapist and AASECT-certified sex therapist. “It involves persistent and recurrent thoughts and acts that seem beyond the individual’s control despite attempts to stop or reduce the behaviors or thoughts, causing significant distress and impairment.”

Sex addiction and high sex drive are sometimes used interchangeably, but they are not the same. Sex addiction is more than a high sex drive, and many people with a high sex drive can still enjoy a healthy sex life. People with sex addiction are more likely to have it negatively affecting their lives.

Ahead, I’ve spoken to sex coaches, educators, and therapists to explore what sex addiction actually is (and what it is not) and how one can manage their symptoms while maintaining an active sex life.

Understanding Sex Addiction

First of all, what are hypersexuality and compulsive sexual behavior? They’re the same thing, explains Gemma Nice, a sex and relationships coach. “It’s where you focus solely on fantasies or sexual urges which cannot be controlled, and where the normal sexual experiences take over and you want to do it obsessively.”

For example, you might enjoy masturbation. For some people, this could become an obsession that can’t be controlled, which turns into a behavior beyond their control. You might feel as if you need to act out certain fantasies every time you have sex or pay for sex or pornography.

Misconceptions and Myths

There are lots of misconceptions about sex addiction. “Some people may think that sex addicts are criminals or sex offenders,” says Nice. “This is not true. It can become an obsession where they are trying to find the high all the time and this affects their ability to live a normal life.”

It’s sometimes thought that people with the addiction will hide behind the “sex addict” label, but people who are addicted to sex often really want to stop.

Another misconception is that sex addicts don’t care about the people they have sex with—for example, their partners. They may not feel comfortable speaking openly about their addiction to their partner, perhaps because of past trauma, the stigma surrounding sex addiction, or just embarrassment. 

And while sex addiction is often associated with men, Herzog points out that people of other genders can experience sex addiction too. One study from 2018 indicated that around 7% of women experienced distress or impairment around controlling sexual behaviors and desires.

Symptoms of Sex Addiction

Sex addiction has several different symptoms and symptoms can differ from person to person. Generally, however, somebody with sex addiction will constantly think about sex to the point where it becomes obsessive and they can’t think about anything else.

The following can also be sex addiction symptoms:

• Excessive masturbation. This can lead to painful genitals or wanting to masturbate in inappropriate situations, such as in public settings.
• Feelings of shame, depression, anxiety, and potentially suicidal thoughts.
• Compulsive relations with multiple partners including strangers.
• Infidelity—however, not everyone with sex addiction will cheat.
• Putting themselves or others in danger due to their sexual behavior.
• Feelings of remorse or guilt after sex.
• Lying to cover their behaviors.
• An inability to stop or control sexual activity.

Impact of Sex Addiction

“The impact can be huge on someone’s life,” says Nice. “It can harm relationships and can often lead to breakups or divorce because the person has an unhealthy unrealistic thought of what sex should be like in a partnership or marriage.”

Sex addiction can also have an impact on your professional life if you’re focusing on sex rather than your work. “Even if you’re present, you may seem distracted and withdrawn so that your partner may feel upset or angry, and your boss may feel confused,” Dr. Buehler explains. “Relationships can come apart and a person may lose their job.”

Sex addicts may also experience financial issues if they spend money on sexual activities. Herzog adds that some people with sex addiction might experience legal issues, too. While this isn’t the case for everyone, some may engage in sexual behaviors illegal in their jurisdiction such as prostitution.

There can be physical effects as well. Frequent sexual activity can put a strain on the body, and increase the risk of sexually transmitted infections.

Causes and Risk Factors

Among the common risk factors for sex addiction are stress, loneliness, and depression. “Feelings of emptiness and low self-worth can lead a person to seek a way to self-soothe,” explains Dr. Buehler.

Often, people with sex addiction have past trauma that hasn’t healed, or they haven’t moved through the healing process. “The addiction isn’t really the whole thing,” says Nice. “It’s more of a process which has stemmed from trauma but it’s also a pain response or trigger for feeling a certain way for years.”

Nice adds that sex addicts can be chasing the “high” from other things, like substance abuse. “They can’t find the high in the substance anymore so turn to something else—for example, sex,” she explains.

Diagnosis and Treatment

With sex addiction not being part of the DSM-5, getting a diagnosis may be tricky. However, if you’re struggling, your doctor could refer you to a mental health professional for evaluation. 

It’s important to consider that many people who display compulsive sexual behavior may have another mental health condition, as sex addiction can often be rooted in things like stress, depression, and anxiety. Someone with compulsive sexual behavior may not necessarily have a sex addiction—they may just behave that way to cope with other stressors in life.

Medication can sometimes be a good fit, too. “There isn’t really a one-stop medication to be given,” explains Nice, however. “It’s based around how the person feels, so it could be anti-depressants or could be another form of a drug to boost the mood or stabilize the brain.”

Treatment Resources

Not sure where to get help or find treatment options in your area? The following resources are great starting points:

For more mental health resources, see our National Helpline Database.

Managing and Overcoming Sex Addiction

Nice recommends seeking professional help, support from loved ones (if you feel comfortable doing so), holistic therapy, and self-help group sessions. There’s also daily exercise and movement, like working out at the gym, cycling or swimming, or walking in nature. Activies like these help release serotonin and dopamine. 

She also recommends mindfulness practices like the tantra breathing technique, which she describes as moving sexual energy up and out of the body rather than keeping it down in the genital area. And if meditation isn’t your cup of tea, Nice suggests the Emotional Freedom Technique, or EFT Tapping, which is based on Chinese medicine and involves tapping on acupressure points to release negative and compulsive thoughts and balance energy.

Ultimately, a tried-and-true practice to managing your addiction is communicating your feelings with your loved ones and leaning on their support, says Dr. Buehler. It’s not easy, of course. And it can make you feel “uncomfortable and vulnerable,” she says. “But it will become easier with practice. By doing so, you can feel better connected and less lonely.”

Keep in Mind

Sex addiction can feel embarrassing or shameful, but there’s no shame in reaching out for help. From loved ones to mental health professionals, there are sources of support out there. If you recognize that you may be dealing with sex addiction or relate to the symptoms, contact a mental health professional or take a look at the resources below. In the meantime, know that you’re not alone.