Rewire Your Anxious Brain: Ultimate Book Summary

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I have to admit that the book “Rewire your Anxious Brain” from Catherine Pittman and Elizabeth Karle helped me a lot with understanding my own anxiety disorder.

But if you don’t want to spend hours reading this book, I’ve created a summary of everything I learned from this stunning book.

And here it is!

Rewire your anxious brain

Chapter 1: Anxiety in the brain

Fear and anxiety feel the same, but are actually quite different. Fear is associated with a clear and identifiable threat, whereas anxiety occurs in the absence of immediate danger. Anxiety happens when we feel dread, but aren’t in immediate danger. The anxiety is almost always caused by the amygdala. It has the task to attach emotional significance to situations or objects and to form emotional memories. 

In chapter 1 the author explains there are 2 pathways to anxiety. The first one is the Cortex based anxiety, and the second one is Amygdala based anxiety. People often try to use cortex-based strategies to ease their anxiety (the approach with logic), while all the time the amygdala could be responsible, which explains why their anxiety didn’t decrease.

When your mind thinks you are in immediate danger, there is no time to send the information to the cortex and therefore it sends it straight to the amygdala… which explains why anxiety often makes no sense. 

The Cortex is much more likely to forget information than the amygdala, which explains why your anxiety often seems to come out of nowhere and without an identifiable cause. The amygdala reacts to its own memories and doesn’t need the cortex for it. Its job is to create memories and to associate things or objects with experiences that are both positive or negative.

Chapter 2: The root of anxiety: understanding the amygdala

The amygdala is your protector and keeps you away from harm. But trying to influence it logically by the cortex doesn’t work and can make your anxiety even worse. The more you try to explain your anxiety, the more cortex-based anxiety you can create, adding to your problem.

Looking in the cortex for the causes of amygdala-based anxiety is like looking in your refrigerator to understand why your car won’t start. This is why convincing yourself to not be anxious doesn’t work, and being angry and frustrated makes it only worse.

The amygdala has some built-in “things” it is scared of, but most of the time the amygdala learns to fear things by experiences. Sometimes you don’t remember the negative memory of the amygdala, like how you can’t remember things in the cortex.

Also, once the amygdala is in control, the cortex has very little influence over your anxiety. If you’re having a panic attack and people try to provide you with logical reasons why you shouldn’t be panicking, they’re essentially talking to a cortex that’s turned off.

When it comes to anxiety, the language of the amygdala has a narrow focus on danger and safety. It’s based on experience and has a language of quick action and response. Therefore, association is an essential part of the language of the amygdala. The term trigger refers to anything (an event, object, sound, smell and on) that activates the amygdala’s alarm system as a result of association-based learning.

But amygdala-based anxiety is due to associations, not logic. Therefore, triggers sometimes make no logical sense. The way to help the amygdala understand that a trigger isn’t dangerous is by relearning only. And that means exposing yourself to your trigger that causes anxiety.

Chapter 3: How the Cortex Creates Anxiety

The cortex processes information that is sent by the thalamus. It can interpret perfectly safe sensations as threatening. If that happens, it sends that message to the amygdala which produces anxiety. The first way the cortex can create anxiety is by interpreting things as dangerous.

The second way is without any specific sensations. When worries or distressing thoughts are produced in the cortex, this can activate the amygdala to produce an anxiety response even though the person hasn’t seen, heard or felt anything that’s dangerous in any way. The author also talks about cognitive fusion, which is believing in the absolute truth of mere thoughts. 

We will take a look at how the cortex creates anxiety, without interpretation of sensations. There are two ways how this happens. Thought based anxiety comes from the left hemisphere (worry and rumination and anxious apprehension), and imagery-based anxiety comes from the right. If you struggle with panic disorders, you are more likely to have right hemisphere-based anxiety. 

The second way the cortex creates anxiety is by interpretation. Some neutral and safe stimuli are interpreted as danger. Now his mind creates a wide array of anxious thoughts and images to which his amygdala reacts to. Sometimes we anticipate an anxious event and our left hemisphere gets activated. 

But remember: the cortex can’t produce an anxiety response on its own.

Brain and anxiety

Chapter 4: Identifying the Basis of your Anxiety: Amygdala, Cortex or Both?

Anxiety can start in the amygdala, or in the cortex through anxious thoughts and images. Amygdala-based anxiety can often be identified by certain characteristics; for example, it seems to arise out of the blue, it creates strong psychological responses, and it seems out of proportion to the situation. 

But if your anxiety began in the cortex, the more effective approach is to change your thoughts and images to decrease the resulting amygdala activation. Thinking a lot and worrying is cortex-based anxiety. When you imagine things that give you anxiety, that is also cortex-based anxiety. 

Interpreting events, situations and other people’s responses can lead to anxiety. The cortex is creating unnecessary anxiety. The anxiety is being produced not by the situation, but by the way the cortex is interpreting the situation. Expecting things that cause anxiety is often also cortex-based anxiety.

Many people believe that certain situations are the cause of their anxiety, but anxiety always begins in the brain, not with the situation.

When people have repetitive, uncontrollable thoughts or compulsions, they are classified as behaviours that arise in the cortex but are fueled by the anxiety of the amygdala. Coping with obsessions and compulsions usually requires an approach that targets the amygdala as well as the cortex. 

To determine whether the amygdala or the cortex initiated a specific anxiety response, you need to consider what was happening before you began to experience anxiety. If you were focusing on specific thoughts or images, that suggests your anxiety began in the cortex.

If, on the other hand, you feel that a specific object, location, or situation immediately elicited an anxiety response, the amygdala is more likely to be the starting point. 

If your responses often seem over-the-top and out of proportion to the situation at hand, your amygdala is probably behind these patterns of extreme responding. 

Chapter 5: The Stress Response and Panic Attacks

The amygdala is always involved in creating an anxiety response, whether that response begins in the cortex or the amygdala. People often take their symptoms as a sign of danger, but it’s just the amygdala.

The central nucleus of the amygdala is like a switch. Once this tiny portion of the amygdala receives a signal from the lateral nucleus that indicates danger, it activates the stress response. Cortex based strategies won’t stop the activation of the stress response once it’s initiated. 

Panic attacks typically occur when the amygdala responds to a cue or trigger you may not even be aware of. Basically, a panic attack is your body launching into fight, flight or freeze response at an inappropriate time due to an overreaction by the amygdala, often in response to some sort of rigger that poses no real danger. 

The tendency to have panic attacks is partially due to genetics. In addition, panic attacks can also be caused by significant life changes or stresses, such as graduation, job changes, a death in the family, getting married or divorced and other transitional events.

If you’re suddenly in the midst of a panic attack, there are three amygdala based coping strategies that will work to calm you down: deep breathing, muscle relaxation and exercise. If you feel panicky, it’s very important to resist the strong urge to flee the situation. Why? Because a panic attack won’t hurt you, as it is just “chemical”… it’s a feeling.

Your cortex can’t directly create a panic attack. It takes the amygdala and other brain structures to set the process in motion. Before a panic attack sets in, understand that it’s just a feeling. Don’t focus on the panic attack and let go of the concerns about what others are thinking. If you use relaxation techniques, you’ll be surprised at how much more quickly your level of panic can decrease. 

Chapter 6: Reaping the Benefits of Relaxation

The cortex can’t reduce the stress response, for two reasons. The first is that the cortex doesn’t have many direct connections to the amygdala. Second, the initiator of the stress response is the amygdala. Therefore, interventions that target the amygdala are more effective in easing anxiety.

To ease your anxiety you have to activate the parasympathetic nervous system more often. You can do this by relaxation techniques, like muscle relaxation or deep breathing. Slow deep breathing is the opposite of how you would breathe if you’re anxious. You can also practice diaphragmatic breathing. This is belly breathing without much movement of the chest. 

Increased attention to breathing can increase anxiety in some people; especially those with asthma or other breathing difficulties. Those people might benefit more from muscle relaxation techniques.  

The most effective approach is reducing the activation of the amygdala and the Sympathetic Nervous System, in order to produce a Parasympathetic Nervous System response. You can do this by combining breathing-focused methods with muscle relaxation.

It is important to practice breathing in short breaks, in the morning or during other opportunities during the day.

Chapter 7: Understanding Triggers

The lateral nucleus is the decision-making portion of the amygdala, which determines whether the central nucleus should react to a particular sight or sound. It does so by scanning the sensory information it’s receiving and based on emotional memories, determining whether a threat exists.

The lateral nucleus also creates anxiety-related memories and changing those memories is essential in rewiring the amygdala. 

The language of the amygdala is based on associations. The lateral nucleus recognizes associations between events occurring in close proximity in time. We learn to fear triggers that are associated with negative events, whether or not a trigger actually causes a negative experience. When a trigger is paired with a negative event the amygdala is programmed to produce anxiety.

A trigger is an anxiety-provoking stimulus, such as a sensation, object or event, that was originally neutral, meaning it wouldn’t cause anxiety or fear for most people. When a negative event happens, it causes an emotional reaction and the trigger is now paired with the negative event. The language of the amygdala is not based on cause and effect, but on associations.

The fear response is a learned response and what’s learned can be changed. 

The goal is to modify anxiety reactions that interfere with your ability to live your life the way you wish.

Chapter 8: Teaching your Amygdala Through Experience

Although you can’t easily erase the emotional memories formed by the amygdala, you can develop new connections in the amygdala that compete with those that lead to fear and anxiety. To get the amygdala to create these new connections, you need to expose it to situations that contradict the association between a trigger and negative event.

If you show the amygdala new information that’s inconsistent with what it’s previously experienced, it will make new connections in response to this information and learn from the new experience.

You can overcome fears if you give your amygdala experiences that teach it to feel safe in anxiety-provoking situations. This is the power of exposure

You have 2 types of exposure: systematic desensitization and flooding. The amygdala must have particular experiences for rewiring to occur. During exposure, you need to experience the sights, sounds, and other stimuli that create anxiety in order to activate the exact neural circuity that holds the emotional memories you want to modify. Again, you must activate the neurons to generate these connections. You must experience fear or anxiety in order to conquer it. 

You can think of exposure as a way of providing exercises that will train your amygdala. You shouldn’t try exposure, until you’re confident you’ll follow through, because it’s possible to actually strengthen anxiety if you leave the exposure situation before your anxiety decreases.

Some medications can interfere with exposure, like benzodiazepines. On the other hand, medications like serotonin inhibitors can assist in exposure.

The more you experience anxiety and stay in the situation long enough for your fear to diminish, the stronger the new circuitry will become.

To practice with exposure follow the following steps:

  1. Pick a trigger you want to work on
  2. Decide the approach (flooded or gradual)
  3. Make a hierarchy (write down the most extreme and less intense and then the steps in between)
  4. Decide rewards
  5. Practice

Interoceptive exposure is when you use simulations such as intentional hyperventilation to become more accustomed to the physical symptoms of anxiety. 

During the exposure use deep breathing and relaxation techniques to cope with the anxiety during each session. If anxiety is high during exposure, this can speed up the process of change. You need to stay in the situation until the anxiety is decreased by half. There are always ups and downs, so don’t beat yourself up. Also, make a plan in advance and schedule your exposures. 

And again: never escape the situation during exposure, because then you train the amygdala that escape is the answer. Also, use helpful coping thoughts during the exposure and never rely on safety behaviours, because otherwise, the exposure has little effect.

Chapter 9: Exercise and sleep tips for calming amygdala-based anxiety

If your sympathetic nervous system is activated, try to make use of it. Instead of resisting it, you can work with the aroused energy and utilize your muscles in ways that will decrease the amygdala’s activation.

Exercise will lower levels of adrenaline and use up the glucose that is released into the bloodstream by the stress response. Aerobic exercise is very helpful to do this (walking, cycling, swimming and even dancing).

Reductions in anxiety are measurable after only 20 minutes of exercise. It can also serve as a form of exposure for people who are scared of the symptoms of sweating and a beating heart. Exercise results in decreased muscle tension for at least an hour and a half afterwards, and reductions in anxiety last from four to six hours.

Extended or intense workouts have been shown to cause the release of endorphins. These compounds can reduce pain and produce a sense of well-being through their effects on the brain. Regular exercise seems to make the receptors on the amygdala less active, resulting in a calmer amygdala that’s less likely to create an anxiety response. Last, exercise can stimulate the cortex in a manner that produces more positive feelings.

For optimal benefits, choose one or two types of exercise and use them three times a week for 30 minutes. 

Another way to calm amygdala-based anxiety is through sleep. Worries produced in the cortex compound to a sleep problem, because exposing yourself to distressing thoughts contribute to the amygdala’s activation of the SNS. If you don’t get enough sleep, you’ll be more irritated, have poorer health and find it harder to concentrate.

Studies have shown that the amygdala reacts more negatively to a lack of sleep than other parts of the brain. 

Chapter 10: Thinking patterns that cause anxiety

Cognitive therapists focus on identifying and changing thoughts that are self-defeating or dysfunctional, particularly thoughts that lead to increased levels of anxiety and depression. This approach is known as cognitive restructuring. In cognitive restructuring, the thoughts you think are used to rewire your brain. 

Because anxiety can occur automatically, without input from the cortex’s cognitive processing, changing thoughts can’t always prevent anxiety. However, when thoughts or images in the cortex have initiated the anxiety response, changing those thoughts and images can definitely ease or prevent anxiety.

Often, the cortex worsens anxiety initiated by the amygdala. But, rather than adding fuel to the fire, you can learn to control what you’re imagining, thinking or telling yourself and remain more even-keeled. 

Interpretation is also key in easing anxiety. Not the situations create anxiety, but your interpretations. By being aware of your interpretations during stressful situations and considering the possibility of modifying them, you can begin to take charge of the emotional reactions your cortex causes.

Also, when you’re optimistic you tend to be less anxious than if you’re pessimistic. Optimism is more associated with left hemisphere activation, whereas pessimism is associated with right hemisphere activation. 

Another thing that causes anxiety, is worry. Worry is a source of anxiety for many people, and the central difficulty for those with generalized anxiety disorder. It has the focus on problem-solving, designed to come up with responses to expected future difficulties. Worry largely arises in the orbitofrontal cortex, a portion of the frontal lobes that lie above and just behind the eyes. A second part of the prefrontal cortex, the anterior cingulate cortex, is also involved in creating worry.

Last, guilt and shame also contribute to anxiety. Guilt is focused on your evaluation of yourself, whereas shame involved imagining how others evaluate you. The amygdala seems to be more strongly activated by shame than guilt.

Chapter 11: How to calm your cortex

Fortunately, there is a huge difference between thoughts about events and the events themselves. Just because you think about or imagine something occurring, doesn’t mean it will occur. This difference between your thoughts and external reality is essential to remember, because your amygdala may not recognize the distinction. 

You gain a great deal of cortex-based control over your anxiety if you recognize the difference between thoughts about events and the events themselves. Therefore, it is essential to manage cortex-based anxiety. 

As explained, cognitive fusion is very common. We all tend to believe in our way of seeing the world. But sometimes we need to question our perspectives. When certain anxiety-igniting thoughts are combined with cognitive fusion, the risk of creating anxiety becomes greater. Cognitive defusion, on the other hand, involves taking a different stance toward your thoughts: being aware of them without getting caught up in them. 

Cognitive restructuring techniques give you the power to literally change your cortex. The key is to be sceptical of anxiety-igniting thoughts and dispute them with evidence, ignore them as if they don’t exist, or replace them with new, more adaptive thoughts, also known as coping thoughts. If you interrupt anxiety-provoking thoughts and images and repeatedly replace them with new cognitions, you can literally change the circuitry of your brain.

If you want to silence your thoughts, it’s not very effective. You should replace your thoughts. By replacing the anxiety-provoking thought with something else that engages your mind, you make it more likely that you won’t return to that thought. 

This also applies to worry. Instead of getting stuck in worrying or ruminating, plan! If you anticipate that a situation will actually arise, come up with possible solutions and then move on to other thoughts.


Even though this book summary of “Rewire your Anxious Brain” from Catherine Pittman and Elizabeth Karle, gave you many insights about how anxiety works and how you can overcome it… I still highly recommend that you read the entire book.

The theory and knowledge are easily understandable and a powerful asset in your toolbox to overcome anxiety.

By the way: have you already checked my FREE Limited Time Training? I’ll teach you the 3 biggest mistakes anxious people make and what to do instead.

See you there!

Wouter Manders Coach

Over Wouter

Wouter is een Nederlandse mindset coach. Voor enkele jaren heeft hij geworsteld met angst, paniek en depressie. Dit was zijn motivatie om anderen te helpen om ook angstgevoelens te overwinnen. Met meer dan 6000 blog bezoekers per maand helpt hij veel mensen in Nederland om van angstgevoelens af te komen.

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