Just over 19 percent of US adults experienced an anxiety disorder at some point last year (that figure jumps to nearly a quarter when looking at US women in particular) and over 12 percent of people suffer from social anxiety disorder at some point in their lives. So needless to say, quite a few present readers are about to get some bad news: it’s not just your retinue or lack thereof that’s feeling the consequences of sub-functional mental health. No matter how well you’ve co-opted your mental illness and colored it as an endearing eccentricity, if you’re still chronically distressed, impaired or both, then there’s a very high likelihood that nearly every cell in your body is losing the will to go on.
What does it look like when a cell reacts to your mood or anxiety disorders? While exact mechanisms are unclear, there’s an observable drop in two enzymes key for keeping your cells beautiful and long-replicating: one is essentially an antioxidant and the other serves to persuade your telomeres (those caps on the ends of chromosomes that degrade with each cell division, beckoning the inexorable march towards natural cell death) to not degrade so quickly. In 2015, one of the largest studies relating cell aging to mental disorders found that for among 1,200 participants, those suffering from anxiety disorders had consistently shorter telomere lengths than their non-anxious counterparts.1
For those learning about telomeres for the first time: If your chromosomes were like the drawstring on your favorite hoodie then your telomeres would be like the aglets on each end, and like aglets they’d gradually deteriorate as you incessantly chew your way through life. One day the caps holding together all those delicate threads of DNA will erode down to nothing, the threads will get splayed out and eventually lost behind the grommets, biological cell death, no further replication, the hoodie is off to Goodwill.
How can you quantify the cost of a disorder like social anxiety on your cellular health? A 2004 study found that women self-reporting higher levels of day-to-day stress showed higher levels of cellular oxidative stress, less protective enzyme activity and shorter telomeres, with the most stressed women showing telomeres shorter by a length equivalent to a decade of additional aging.2
Telomeres exist in the vast majority of your body’s cells, including blood cells, and so can be leisurely drawn from your body with all the associated enzymes, and then measured and tallied up to see if the numbers can tell us anything. Typically this would inform on the successes or failures or dangers of some pharmacological intervention, some pill. But a recent study in Sweden is unique for using blood-derived numbers to quantify the outcome of watching online videos and completing questionnaires, in other words a purely psychosocial intervention, and then using said data to qualify those individuals most likely to benefit from this brand of non-pharmaceutical intervention before it ever takes place.
The Swedish study is the first of its kind, demonstrating a positive link between the kind of improvements you can see in a blood sample, in this case the cellular output of a couple of enzymes, and improvements that were consciously experienced by 42 people who had previously felt socially anxious enough to adhere to 9 weeks of online cognitive behavioral therapy.3
By now there have been quite a few studies on internet-delivered cognitive-behavioral therapy and nearly all the research supports its basic equivalence to face-to-face treatment for a range of mental disorders. One particular study highlights the unique benefit of internet-delivered CBT for those suffering social anxiety disorders, noting that more favorable results “can be understood in light of the possibility that the therapist herself may be a phobic object. Hence, in face-to-face therapy, the patient’s self-focus will be heightened and, thus, his ability to fully concentrate on the therapy might be hampered.”4
So how strong is the link between a cognitive-behaviorally repaired mind and our cell’s keenness on keeping healthy and continuing its lineage? Not only did those benefiting most from CBT show the greatest increase in both enzymes, but people with the most inactive telomere-preserving enzymes to begin with were most likely to experience an improvement in symptoms of social anxiety following treatment.
Other studies have demonstrated increases in the activity of telomere-preserving enzymes following mindfulness training or increases in the physical activity of participants. While such practices often play a significant role within CBT, participants here were instructed not to change their baseline activity level so as not to confound the research results. For this particular study, participants worked through homework assignments, engaged in exposure exercises, traded weekly emails with a clinical psychologist, and took weekly multiple choice tests about CBT that they had to (eventually) ace to ensure compliance.
It should be noted that the Swedish study was not an RCT and of course 42 isn’t an overwhelming sample size. As previously stated, however, the effectiveness of the therapy used was never in question. Many studies have reproduced a general reduction in the symptoms of various mood disorders using internet-delivered CBT. The question was what effect this proven strategy would have on established biological markers, the well-trodden territory that typically lies far within the domain of pharmacological treatments.
Despite the effectiveness use of CBT and pharmaceutical treatments for social anxiety, nearly half the population remains treatment resistant.5 Perhaps the most important outcome of better understanding these biomarkers would then be a clinician’s ability to predetermine the best candidates for particular intervention strategies.
Further research into the unexplored complexities of cellular aging will uncover unexpected ways in which our thoughts and feelings shift the tiny enzymatic tides within our cells, not just those in our brains but in every cell of our body, and such knowledge will serve to redefine our understanding of psychiatric diseases through their existence outside the brain.
- Verhoeven, J. E. et al. Anxiety disorders and accelerated cellular ageing. Br. J. Psychiatry 206, 371–378 (2015).
- Epel, E. S. et al. Accelerated telomere shortening in response to life stress. Proc. Natl Acad. Sci. USA 101, 17312–17315 (2004).
- Månsson, K.N.T., Lindqvist, D., Yang, L.L. et al. Improvement in indices of cellular protection after psychological treatment for social anxiety disorder. Transl Psychiatry 9, 340 (2019)
- Carlbring, P., Andersson, G., Cuijpers, P., Riper, H. & Hedman-Lagerlöf, E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn. Behav. Ther. 47, 1–18 (2018).
- Mayo-Wilson, E. et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 1, 368–376 (2014).