Georgia Chiropractic Neurology Center

Brain Based Treatment for the 21st Century!

Written by Sophie Hose, DC, MS, DACNB, CCSP

Anxiety and dysautonomia frequently intersect in ways that amplify the challenges associated with  each condition. Dysautonomia refers to disorders of the autonomic nervous system (ANS)—the  system responsible for regulating involuntary functions like heart rate, blood pressure, and  digestion. One specific type of dysautonomia, postural orthostatic tachycardia syndrome (POTS),  causes a significant increase in heart rate upon standing, accompanied by symptoms like dizziness,  palpitations, fatigue, and often, anxiety. 

Anxiety, a mental health condition characterized by excessive worry or fear, can become entangled  with the symptoms of dysautonomia and POTS, creating a cycle of worsening symptoms. This  interconnectedness has implications not only for the physical but also the psychological well-being  of individuals who experience these conditions. From a chiropractic neurology standpoint,  understanding this relationship provides a foundation for integrative treatment approaches that  address both the neurological and physiological mechanisms underlying anxiety and POTS. 

What is Anxiety?

Anxiety is a natural, protective response to stress, designed to prepare the body for “fight or flight.”  When anxiety becomes chronic or excessive, it can disrupt daily life, causing a cascade of physical  symptoms like increased heart rate, muscle tension, and digestive issues. In people with POTS,  these symptoms can mimic or worsen autonomic dysfunction episodes, leading to heightened  anxiety. 

For individuals with POTS, the body’s stress response is often continuously active due to frequent  and unpredictable episodes of dizziness, rapid heartbeat, and fainting spells. The physical symptoms  that accompany POTS may lead to a form of “health anxiety,” where individuals become overly  focused on bodily sensations, further fueling the cycle of anxiety and autonomic dysregulation. 

Understanding Dysautonomia and POTS

Dysautonomia encompasses disorders of the ANS, where the body’s automatic processes, such as  temperature control and blood pressure regulation, become dysregulated. POTS, one of the more  common types of dysautonomia, is characterized by an abnormal increase in heart rate when  moving from a lying or sitting position to a standing position, without a corresponding change in  blood pressure. This leads to symptoms such as dizziness, palpitations, and fatigue, all of which can  create a sense of physical instability and emotional vulnerability. 

Individuals with POTS face unique challenges in daily life due to the sudden onset of symptoms  with even minor physical changes, like standing up or moving quickly. The unpredictable nature of  these symptoms means that those with POTS are often on high alert for signs of an impending  episode, which can lead to an increase in anxiety. 

How Anxiety and POTS Affect Daily Life

Physical Limitations

For individuals with POTS, even simple activities such as standing up, walking, or completing daily  tasks can become significant challenges. Many find themselves needing to modify their daily  routines by incorporating frequent rest breaks, using assistive devices, or avoiding activities that  could trigger symptoms. The physical strain and fatigue associated with POTS can make it difficult  to maintain an active lifestyle, leading to deconditioning, which further exacerbates symptoms. This  lack of physical capability can be frustrating and disheartening, especially for those who were once  active or have busy lifestyles.

Anxiety adds another layer to these physical limitations, often creating tension, headaches, and  fatigue, which intensify POTS symptoms. Anxiety may also cause hyperawareness of bodily  sensations, causing individuals to feel as though every increase in heart rate or sensation of  dizziness could lead to a more severe episode. This can result in both conditions feeding off each  other in a feedback loop of anxiety and physical symptoms, reducing physical independence and  quality of life. 

Emotional and Psychological Impact

Living with the dual challenges of POTS and anxiety creates significant psychological strain. The  unpredictability of symptoms can lead to feelings of helplessness, fear, and stress. Many individuals  with POTS may avoid public spaces or social situations for fear of experiencing symptoms,  resulting in social isolation and loneliness. This isolation, combined with the limitations imposed by  POTS, can contribute to feelings of depression or low self-worth, further affecting mental health. 

Anxiety compounds this psychological toll by creating worry around symptom management. For  someone with POTS, the fear of fainting, experiencing palpitations, or becoming lightheaded in  public can lead to hypervigilance. They may scan for symptoms and engage in “safety behaviors”— actions taken to avoid or minimize potential symptoms, like staying seated for long periods or  avoiding certain activities—which can make their world feel smaller and more restrictive over time. 

Social and Professional Life

POTS and anxiety can interfere with work, school, and social engagement. Due to the necessity of  frequent breaks, staying upright for long periods, or managing “brain fog” (cognitive impairment  often associated with POTS), those affected may find it difficult to complete tasks efficiently or stay  engaged in work and social settings. Anxiety further exacerbates this, as individuals may feel  nervous about symptoms occurring in professional or social settings, creating a sense of being  “different” or misunderstood by peers. 

In workplaces or schools that require a high degree of concentration or physical stamina,  individuals with POTS may struggle to keep up. Socially, they may feel uncomfortable in group  settings where they need to explain their limitations or deal with the stigma surrounding “invisible”  illnesses. This isolation and misunderstanding can impact career opportunities and personal  relationships, which, in turn, can lead to additional feelings of frustration and disconnection. 

The Chiropractic Neurology Perspective on Anxiety and POTS

Chiropractic neurology offers a unique perspective by focusing on how the nervous system can be  optimized to better regulate the autonomic responses affected in conditions like POTS and anxiety.  Chiropractic neurology aims to support neural pathways that control both the sympathetic (fight-or flight) and parasympathetic (rest-and-digest) branches of the ANS. Specific techniques and  exercises are designed to promote balance within these systems, potentially reducing both anxiety  and POTS symptoms. 

Key Neurological Mechanisms in Anxiety and POTS

  1. Sympathetic Overactivity

In POTS, the sympathetic nervous system is often overactive, leading to symptoms like  palpitations, sweating, and a heightened stress response. Chiropractic neurology  interventions, such as specific tilt table therapy, eye movement therapy, balance training and 

cognitive therapies can help reduce sympathetic dominance, which may relieve both the  physical symptoms of POTS and the associated anxiety. 

  1. Brainstem and Cerebellar Function

The brainstem and cerebellum are involved in autonomic regulation, including heart rate,  blood flow, and balance. Chiropractic neurology employs gentle therapies and balance  exercises to support brainstem and cerebellar function, which may help stabilize autonomic  function and reduce anxiety associated with POTS. 

  1. Neuroplasticity and Brain Retraining

By capitalizing on the brain’s natural ability to reorganize (neuroplasticity), chiropractic  neurology uses exercises that gradually expose the brain to positional changes, helping  retrain the ANS to respond appropriately to standing. This approach may reduce the  frequency and severity of POTS symptoms and improve the body’s tolerance to these  stressors, potentially alleviating both POTS and anxiety symptoms over time. 

Chiropractic Neurology Treatments for POTS and Anxiety

  1. Autonomic Stabilization Exercises

Autonomic stabilization exercises focus on calming the ANS through techniques like  balance training, biofeedback, and diaphragmatic breathing. These exercises aim to promote  parasympathetic activity, reducing the sympathetic overdrive commonly seen in POTS and  anxiety. 

  1. Myofascial Therapies

Myofascial work targeting the cervical spine influence the vagus nerve and the brain’s  perception of the body (proprioception), which play a major role in regulating the  parasympathetic response of the brainstem to different external stimuli. These treatments  can calm sympathetic overactivity, helping to reduce both POTS symptoms and anxiety. 

  1. Proprioceptive and Vestibular Training

Chiropractic neurology includes proprioceptive exercises, such as light resistance or balance  exercises, to help retrain the brain’s response to movement and positional changes.  Improving proprioception and balance may reduce dizziness, which can make POTS  symptoms and the accompanying anxiety more manageable. 

  1. Mindfulness and Relaxation Techniques

Incorporating relaxation techniques, such as guided relaxation, mindfulness, and  diaphragmatic breathing, helps calm the nervous system and reduce the “fight-or-flight”  response. These techniques work well alongside chiropractic care, reinforcing the brain’s  ability to regulate autonomic responses and manage anxiety. 

Anxiety and POTS are intertwined in a complex relationship that affects daily life on multiple  levels. From physical limitations to emotional strain, these conditions can create significant barriers  to maintaining a normal routine, forming relationships, and achieving personal goals. Chiropractic  neurology offers an integrative approach by addressing both the neurological and autonomic  imbalances that drive the symptoms of both anxiety and POTS. With interventions targeting the  autonomic nervous system, individuals can work toward improved stability, reducing both the  physical and psychological impact of these conditions. 

Understanding the effects of both anxiety and POTS and implementing comprehensive,  individualized treatments can empower individuals to manage their symptoms and improve their quality of life. By addressing these conditions in tandem, chiropractic neurology can offer hope to  those navigating the challenges of living with both POTS and anxiety. 

If you or someone you love is suffering from anxiety in combination with dysautonomia and you  would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic  Neurology Center today. We look forward to hearing from you. 

References 

  1. Raj, S. R., & Robertson, D. (2020). Postural tachycardia syndrome (POTS). Heart Rhythm,  17(1), 1-6. 
  2. Garland, E. L., et al. (2019). Mindfulness-Oriented Recovery Enhancement reduces pain, opioid  craving, and anxiety in chronic pain patients. Journal of Consulting and Clinical Psychology, 87(1),  79.
  3. Cortez, M. M., et al. (2022). Brainstem involvement in autonomic nervous system regulation:  implications for POTS. Autonomic Neuroscience: Basic and Clinical, 236, 102894. 4) Low, P. A., et al. (2021). The diagnosis and treatment of autonomic nervous system disorders.  Journal of Clinical Investigation, 131(1), e142947.