Anksiyete Her Zaman Kötü müdür? Anksiyetenin Çok Boyutlu İncelenmesi

Öz

Anksiyete, potansiyel tehditlere karşı gelişen ve evrimsel süreçte hayatta kalma olasılığını artıran temel bir tepkidir. Uygun şiddette ortaya çıktığında, dikkat, uyanıklık ve hızlı karar verme süreçlerini destekleyerek uyum sağlayıcı (adaptif) bir işlev görmektedir. Ancak bu sistem, yanlış ya da aşırı biçimde tetiklendiğinde, bireyin işlevselliğini bozabilen uyum bozucu (maladaptif) bir duruma dönüşebilmektedir. Bu derleme, anksiyetenin uyum sağlayıcı ve uyum bozucu boyutlarını, özellikle amigdala, prefrontal korteks ve ilişkili beyin bölgeleri arasındaki etkileşimlere odaklanarak nörobiyolojik temelleriyle incelemektedir. Mevcut bulgular, anksiyetenin düzeyi, süresi ve düzenleyici sistemlerle olan ilişkisine göre, hem uyum sağlayıcı hem de uyum bozucu sonuçlara yol açabileceğini ortaya koymaktadır. Uyum sağlayıcı ve uyum bozucu süreçlerin nörobiyolojik düzeyde ayırt edilmesi, klinik değerlendirmelerin hassasiyetini artırarak, daha hedefe yönelik ve bireyselleştirilmiş tedavi stratejilerinin geliştirilmesine katkı sağlayabilir.

Anahtar Kelimeler

• anksiyete
• adaptif
• maladaptif
• stres

Is Anxiety Always Maladaptive? A Multidimensional Perspective

Öz

Anxiety is a fundamental response to potential threats that has evolved to increase the likelihood of survival. When it occurs at an appropriate intensity, it serves an adaptive function by supporting processes such as attention, alertness, and rapid decision-making. However, when this system is triggered inappropriately or excessively, it can become maladaptive, impairing individual functioning. This review examines the adaptive and maladaptive dimensions of anxiety, focusing on its neurobiological underpinnings, particularly the interactions between the amygdala, the prefrontal cortex, and related brain regions. Current evidence indicates that the outcomes of anxiety—whether adaptive or maladaptive—depend on its intensity, duration, and interactions with regulatory systems. Distinguishing these processes at the neurobiological level may enhance the precision of clinical assessments and contribute to the development of more targeted and individualized treatment strategies.

Anahtar Kelimeler

• anxiety
• adaptive
• maladaptive
• stress

Kaynakça

1. 1. Barlow DH. Anxiety and its disorders: The nature and treatment of anxiety and panic, 2nd ed. New York, NY, US: The Guilford Press; 2002. xvi, 704-xvi, p.
2. 2. Meacham F, Bergstrom CT. Adaptive behavior can produce maladaptive anxiety due to individual differences in experience. Evol Med Public Health. 2016;2016(1):270-85.
3. 3. Nesse RM. The Smoke Detector Principle. Annals of the New York Academy of Sciences. 2006;935(1):75-85.
4. 4. Spielberger CD. Manual for the State-Trait Anxiety Inventory (self-evaluation questionnaire). (No Title). 1970.
5. 5. Lin H, Miltner WHR, Straube T. Trait anxiety predicts amygdalar responses during direct processing of threat-related pictures. Sci Rep. 2021;11(1):18469.
6. 6. Charpentier CJ, Hindocha C, Roiser JP, Robinson OJ. Anxiety promotes memory for mood-congruent faces but does not alter loss aversion. Sci Rep. 2016;6:24746.
7. 7. Chavanne AV, Robinson OJ. The Overlapping Neurobiology of Induced and Pathological Anxiety: A Meta-Analysis of Functional Neural Activation. Am J Psychiatry. 2021;178(2):156-64.
8. 8. Robinson OJ, Charney DR, Overstreet C, Vytal K, Grillon C. The adaptive threat bias in anxiety: amygdala-dorsomedial prefrontal cortex coupling and aversive amplification. Neuroimage. 2012;60(1):523-9.

9. 9. Türkiye Psikiyatri Derneği Yayınları. Anksiyete Bozukluklarının Psikofarmakolojisi2024.
10. 10. Gong W. Research progress on the neural circuits mechanisms of anxiety. Front Neural Circuits. 2025;19:1609145.
11. 11. Campeau S, Davis M. Involvement of the central nucleus and basolateral complex of the amygdala in fear conditioning measured with fear-potentiated startle in rats trained concurrently with auditory and visual conditioned stimuli. J Neurosci. 1995;15(3 Pt 2):2301-11.
12. 12. Davis M, Walker DL, Miles L, Grillon C. Phasic vs sustained fear in rats and humans: role of the extended amygdala in fear vs anxiety. Neuropsychopharmacology. 2010;35(1):105-35.
13. 13. Herman JP, Ostrander MM, Mueller NK, Figueiredo H. Limbic system mechanisms of stress regulation: hypothalamo-pituitary-adrenocortical axis. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(8):1201-13.
14. 14. Zorn JV, Schur RR, Boks MP, Kahn RS, Joels M, Vinkers CH. Cortisol stress reactivity across psychiatric disorders: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017;77:25-36.
15. 15. McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87(3):873-904.
16. 16. Milad MR, Quirk GJ. Neurons in medial prefrontal cortex signal memory for fear extinction. Nature. 2002;420(6911):70-4.
17. 17. Plas SL, Tuna T, Bayer H, Juliano VAL, Sweck SO, Arellano Perez AD, et al. Neural circuits for the adaptive regulation of fear and extinction memory. Front Behav Neurosci. 2024;18:1352797.
18. 18. Arnsten AF. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10(6):410-22.
19. 19. Henckens MJ, van Wingen GA, Joels M, Fernandez G. Time-dependent effects of cortisol on selective attention and emotional interference: a functional MRI study. Front Integr Neurosci. 2012;6:66.
20. 20. Lee BK, Glass TA, Wand GS, McAtee MJ, Bandeen-Roche K, Bolla KI, et al. Apolipoprotein e genotype, cortisol, and cognitive function in community-dwelling older adults. Am J Psychiatry. 2008;165(11):1456-64.
21. 21. James KA, Stromin JI, Steenkamp N, Combrinck MI. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front Endocrinol (Lausanne). 2023;14:1085950.
22. 22. Lukasik KM, Waris O, Soveri A, Lehtonen M, Laine M. The Relationship of Anxiety and Stress With Working Memory Performance in a Large Non-depressed Sample. Front Psychol. 2019;10:4.
23. 23. Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit‐formation. Journal of Comparative Neurology and Psychology. 2004;18(5):459-82.
24. 24. Dhabhar FS. The short-term stress response - Mother nature's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol. 2018;49:175-92.
25. 25. Degroote C, Schwaninger A, Heimgartner N, Hedinger P, Ehlert U, Wirtz PH. Acute Stress Improves Concentration Performance. Exp Psychol. 2020;67(2):88-98.
26. 26. Angelidis A, Solis E, Lautenbach F, van der Does W, Putman P. I'm going to fail! Acute cognitive performance anxiety increases threat-interference and impairs WM performance. PloS one. 2019;14(2):e0210824.
27. 27. 27. Robinson OJ, Vytal K, Cornwell BR, Grillon C. The impact of anxiety upon cognition: perspectives from human threat of shock studies. Front Hum Neurosci. 2013;7:203.
28. 28. Oshri A, Cui Z, Carvalho C, Liu S. Is perceived stress linked to enhanced cognitive functioning and reduced risk for psychopathology? Testing the hormesis hypothesis. Psychiatry Res. 2022;314:114644.
29. 29. Oshri A, Cui Z, Owens MM, Carvalho CA, Sweet L. Low-to-moderate level of perceived stress strengthens working memory: Testing the hormesis hypothesis through neural activation. Neuropsychologia.2022;176:108354.
30. 30. Norem JK, Cantor N. Defensive pessimism: harnessing anxiety as motivation. J Pers Soc Psychol. 1986;51(6):1208-17.
31. 31. Atta MHR, Rushdan EE, Elzohairy NW. The Relationship Between Defensive Pessimism, Goal Orientation, and Self-Esteem Among Nursing Students. SAGE Open Nurs. 2024;10:23779608241293662.
32. 32. Yamawaki N, Tschanz B, Feick D. Defensive pessimism, self-esteem instability, and goal strivings. Cogn Emot. 2004;18(2):233-49.
33. 33. Sarmiento LF, Lopes da Cunha P, Tabares S, Tafet G, Gouveia A, Jr. Decision-making under stress: A psychological and neurobiological integrative model. Brain Behav Immun Health. 2024;38:100766.
34. 34. Charpentier CJ, Aylward J, Roiser JP, Robinson OJ. Enhanced Risk Aversion, But Not Loss Aversion, in Unmedicated Pathological Anxiety. Biol Psychiatry. 2017;81(12):1014-22.
35. 35. APA. DSM - 5 - TR Tanı Ölçütleri Başvuru Elkitabı2023.
36. 36. 36. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897-910.
37. 37. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
38. 38. Global Burden of Disease Study Results. Global Health Data Exchange. Institute for Health Metrics and Evaluation (IHME) Seattle; 2019.
39. 39. Attridge DM, Pawlowski D. Understanding Anxiety, Work and the Impact of Mental Health Counseling and Coaching in 20,725 Employee Assistance Program Clients in United States: CuraLinc Healthcare 2022-2023. International Journal of Scientific and Research Publications. 2023;13(7).
40. 40. Mishra AK, Varma AR. A Comprehensive Review of the Generalized Anxiety Disorder. Cureus. 2023;15(9):e46115.
41. 41. Huffman JC, Pollack MH, Stern TA. Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Prim Care Companion J Clin Psychiatry. 2002;4(2):54-62.
42. 42. Aderka IM, Hofmann SG, Nickerson A, Hermesh H, Gilboa-Schechtman E, Marom S. Functional impairment in social anxiety disorder. J Anxiety Disord. 2012;26(3):393-400.
43. 43. Gautam S, Jain A, Gautam M, Vahia VN, Gautam A. Clinical Practice Guidelines for the Management of Generalised Anxiety Disorder (GAD) and Panic Disorder (PD). Indian J Psychiatry. 2017;59(Suppl 1):S67-S73.
44. 44. National Collaborating Centre for Mental H. National Institute for Health and Clinical Excellence: Guidance. Generalised Anxiety Disorder in Adults: Management in Primary, Secondary and Community Care. National Institute for Health and Clinical Excellence: Guidance. Leicester (UK): British Psychological Society Copyright © 2011, The British Psychological Society & The Royal College of Psychiatrists.; 2011.
45. 45. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012;36(5):427-40.
46. 46. McEvoy PM. Metacognitive Therapy for Anxiety Disorders: a Review of Recent Advances and Future Research Directions. Curr Psychiatry Rep. 2019;21(5):29.
47. 47. Hawken T, Turner-Cobb J, Barnett J. Coping and adjustment in caregivers: A systematic review. Health Psychol Open. 2018;5(2):2055102918810659.
48. 48. Domhardt M, Gesslein H, von Rezori RE, Baumeister H. Internet- and mobile-based interventions for anxiety disorders: A meta-analytic review of intervention components. Depress Anxiety. 2019;36(3):213-24.
49. 49. Lahousen T, Kapfhammer HP. [Anxiety disorders - clinical and neurobiological aspects]. Psychiatr Danub. 2018;30(4):479-90.
50. 50. Wells A. Metacognitive Therapy for Anxiety and Depression: Guilford Press; 2011 2011/03/14/. 337 p.