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
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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.
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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.
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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
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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.
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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.
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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.
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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
- Raj, S. R., & Robertson, D. (2020). Postural tachycardia syndrome (POTS). Heart Rhythm, 17(1), 1-6.
- 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.
- 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.