Your Anxiety Isn't Just In Your Head

The role of the nervous system 

I've spent thirty years as a psychiatrist, and I've watched hundreds of smart, motivated people cycle through treatments that kind of help but never quite work. They take their medication. They show up to therapy. They practice their CBT skills. And still, something fundamental remains unhealed.

What took me years to understand is that most mental health treatment is missing something basic. It treats your symptoms as if they live in your thoughts, when they actually live in your body.

When you feel anxious, that's not just a ‘thinking’ problem. It's your heart racing, your breath shallow, your muscles tight, your gut churning. When you're depressed, that's not just a mood. It's fatigue in your cells, a heaviness in your chest, a nervous system that has shut down.

This has changed how I practice psychiatry.

Our Nervous System Has Three States

Our autonomic nervous system runs automatically, without us having to think about it. And it has three main operating modes:

• Safe and Social: This is our best state. When your nervous system feels safe, we are calm but alert. We can connect with others, think clearly, be creative, and feel our emotions without being overwhelmed. Our breathing is easy and full. This is where healing happens.

• Fight or Flight: When our nervous system detects threat (real or perceived), it mobilizes energy to help us fight or flee. Our heart rate increases, breathing gets shallow and rapid, muscles tense. This response is designed to be temporary. The problem arises when it becomes our baseline, when our nervous system becomes stuck scanning for threats, even when we're safe. This chronic activation is what we call anxiety or being "keyed up" all the time.

• Freeze or Shutdown: When fight or flight isn't possible, when the threat is too overwhelming or impossible to address, our nervous system has one more strategy: shutdown. This is an immobilization response where our system gives up trying to fight or flee and collapses inward to conserve energy and numb pain.

• Shutdown looks like: feeling numb or disconnected, severe fatigue, difficulty moving or speaking, emotional flatness, dissociation, and hopelessness. People describe it as "going through the motions" but not living. This is often what we call depression.

What This Means

We cannot think our way out of nervous system dysregulation. No amount of positive thinking, cognitive restructuring, or willpower can override a nervous system that perceives threat.

This is why so many therapies that focus only on changing thoughts have limited effectiveness. Our nervous system responds to cues of safety or danger based on patterns that were established years ago, often during childhood.

I see this constantly in my practice. Someone comes in with "anxiety." We try medication, we try CBT, and they get some relief. But they're still anxious. Why? Because we haven't addressed what's happening in their nervous system.

Their anxiety isn't just worried thoughts. It's a sympathetic nervous system stuck in activation because it never learned they're safe now.

Or someone comes in with "depression." They try multiple antidepressants. Some help a little, but the depression keeps coming back. Why? Because their depression might be dorsal shutdown, their nervous system's way of protecting them from overwhelm. You can't medicate your way out of that. You have to teach the nervous system that it's safe to come back online.

What You Can Do

If you've tried therapy and medication and still struggle, it might be because your treatment has been focused on your thoughts and symptoms, not on your nervous system.

Start paying attention to your body. Notice when you feel activated (heart racing, breath shallow, muscles tense). Notice when you feel shut down (numb, exhausted, disconnected). These aren't character flaws. These are your nervous system doing what it learned to do.

The first step in healing is recognizing what state you're in. You can't change what you can't see.

The good news is that your nervous system can learn new patterns. It's not fixed. But the work isn't just cognitive. It's learning to work with your body, not just your mind.

If this resonates with you, if you've felt like something is missing in your treatment, you're probably right. Your body has been trying to tell you something all along.

Start listening.

Yasin Choudry, MD

Holistic Psychiatry 

Yasin Choudry, MD Anxiety