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Dr. Albano received her Ph.D. from the University of Mississippi, and completed a postdoctoral fellowship at the Center for Stress and Anxiety Disorders at SUNY Albany. She is a fellow[…]

Big Think and the Mental Health Channel are proud to launch Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.

In our first video in the series, Dr. Anne Marie Albano, director of Columbia University Clinic for Anxiety and Related Disorders, traces the biological and evolutionary origins of anxiety, the unique features of anxiety in the 21st century, and the powerful research and tech-driven treatments that have emerged in recent decades.

Anne Marie Albano: So anxiety is rooted in biology. It’s evolutionarily based in that we have our own fight-or-flight responses. Some of it is very old and triggered from the deep part of our brain; that is the oldest part, the fight-or-flight response. And then some of it comes from the cortex, which evolved much later and that’s worry. And that might be 21st century anxiety because there’s a lot we can find to worry about these days. Are we going to make enough money? Are we going to get the right job? Are we going to provide for our families? Are we going to do the right thing? What could go wrong in the world? So many things can trigger anxiety just by walking through everyday life. But the good news is our systems are also set up to handle it. The beauty of anxiety and the system that we have of anxiety that’s all throughout our nervous system is that it evolved to protect us. So there’s two components to it. The oldest being the amygdala, which is deep in the brain in the reptilian part of our brain, signals whether we should fight something, flee something, or freeze. When it goes awry is when it’s perceiving immediate danger that really isn’t there. Somebody’s heart starts to race and they think, "Oh my goodness, is something wrong with me?" That’s panic and that can send somebody into a panic attack which is the clinical manifestation of the fight-or-flight response. The other thing with anxiety is again as we evolved and became thinking human beings and started building communities and cities and civilizations is our brain evolved and there’s the cortex. It’s within the cortex that we think. It’s within that system that we worry. And so we can worry ourselves into states of anxiety where we are fraught in not knowing what to do and we actually get stuck with anxiety and so we’re tense and irritable and upset. So what makes the difference between everyday anxiety, which we all experience – anxiety is perfectly normal. In any form it’s perfectly normal. Having your heart racing because somebody is walking behind you and you don’t know who it is, is kind of normal. But if you let that happen to you when you’re sitting alone at home and you start having panic then that gets out of control. And worry about what to do in the future is normal for all of us. But if we can’t move our minds off of that and onto what do I need to take care of here and let me enjoy my family while we’re doing this thing and activity and I’ll problem solve that later, then that becomes a problem and that might become an anxiety issue. What was great from the 1990s all the way through to now is it sort of was the age of anxiety in terms of mental health treatment development. The 1990s opened up lots of treatment funded here in the United States by the National Institutes of Mental Health. And then also in other countries did similar things where cognitive-behavioral therapy became the most tested and developed treatment and found to be the most effective psychological or talk therapy for managing anxiety. And managing anxiety of all kinds. Obsessive-compulsive disorder, panic disorder, generalized-anxiety disorder, and so forth. Social phobia, the number one anxiety disorder in kids and adults. Cognitive behavioral therapy is great for that. So we put a lot of work into developing these treatments and perfecting them. And then also there are great medications actually that were developed through that time. The combination of the two treatments works best for many people who are debilitated by anxiety. 

But these treatments are excellent and they are available, but not widespread. So this is where again technology comes in because technology has allowed us to put some of the skills training and some of the aspects of cognitive behavior therapy into apps, into online programs and such that then can reach hard-to-reach individuals and people who don’t have access to services. There’s some very exciting work being done today throughout the country and around the world in terms of anxiety research looking at, in different ways, what aspects of the brain are working with the amygdala and the cortex in terms of turning anxiety on when it doesn’t need to, keeping it going. What are the triggers for anxiety on all different levels from genetic all the way through to what’s in the environment? And then helping to sharpen our treatments to direct themselves to those mechanisms and tamp down those mechanisms so that can help a person probably earlier in the cycle of anxiety, earlier in life in such, and to manage. So neuroscience is coming on with all sorts of ways of looking at what are some new technologies including different types of computer apps and stuff that target anxiety processes. And then there are also ways of disseminating treatments and reaching people that we are working with. So I think the big exciting part of what we’re seeing over the next 10 to 20 years is going to be much more dissemination of more targeted and, I think, more effective treatments for people that are going to be coming on board and going to be disseminated through many different means. Not just through your local therapist like me, but also through many different types of technologies that are going to be made available.