Is there a physical problem that could cause anxiety? I have problems expressing my thoughts to people, especially in a group. I get shaky and nervous and lose my train of thought. It is very obvious to others and embarrassing to me. One time when I was in college I had to give a speech, and a friend gave me a drug called Inderal that got me through this speech without the anxiety attack. Is this drug ever prescribed for this kind of anxiety? I cannot believe that this is only a mental problem. Do you have any insights on this problem?

--LouAnne

Asking if there is a physical problem that could cause anxiety is a little like asking the old question "which came first, the chicken or the egg?" The mind and body are so connected that what's going on in the mind affects the body, and what's going on in the body affects the mind.

There definitely are physical manifestations of anxiety (which can vary from person to person) -- shakiness, sweating, flushing or turning pale, among others. One common symptom is the heart beating faster in anticipation of danger. One theory is that the physical symptoms of anxiety and panic stem from the "fight-or-flight" (or, occasionally, "freeze") response any animal automatically goes into at the sign of danger, so it is ready to flee, defend itself, or play dead. Where humans are concerned, though, the perceived "danger" is usually not a marauding grizzly but a situation in which the feared outcome is embarrassment, rejection or failure of some kind.

The medication your friend gave you, Inderal (generic name propranolol) is one of a class of antiarrhythmic drugs known as beta-adrenergic blocking agents. It's prescribed for hypertension, heart rhythm disorders and sometimes other conditions such as anxiety and panic attacks. It probably addressed some of the physical manifestations of your fight-or-flight response. (By the way, please be cautious about taking Inderal or any other prescription medication that has not been specifically prescribed for you. These drugs may be dangerous for some people.)

So in answer to your question, yes, there is a physical aspect of anxiety, and Inderal is sometimes prescribed to treat the symptoms. But the mental or cognitive aspect of anxiety is equally, if not more, important.

Remember what I said about "perceived danger?" The key is "perceived" -- it's the mind, sometimes operating on a subconscious level, that evaluates a social situation and interprets it as being as dangerous as the hungry predator our fight-or-flight response developed to protect us from. It's also the mind that sometimes notices the heart-thumping and chest-tightening of anxiety or panic and reads that as a heart attack in the making -- which of course makes us only more anxious or panicked.

One of the ways in which therapy alleviates anxiety and panic attacks is by identifying and addressing the mind's role in anxiety ... retraining us to more accurately distinguish between a relatively harmless social occasion and a rampaging bear or other physical danger. In therapy we can also learn behavioral techniques, such as relaxation and deep breathing exercises, that can address the physical symptoms of anxiety.

So while you may want to ask a physician whether Inderal or another medication might address some of the physical aspects of your anxiety, please consider also consulting with a psychologist or other therapist to address the mental and behavioral aspects, too. Keep in mind that while medication targets physical symptoms, good psychological and behavioral treatment can address both mind and body.