Understanding the Anxiety and Depression Types—Type 4: Over-Focused Anxiety/Depression

Anxiety and Depression Types—Type 4: Over-Focused Anxiety/Depression

Type 4: Over-Focused Anxiety/Depression involves excessive activity in the brain and is associated with people who have trouble shifting attention and get locked into anxious and/or negative thoughts or behaviors. People with this type—which occurs more frequently in the children or grandchildren of alcoholics—tend to worry, hold grudges, and have problems with oppositional or argumentative behavior. Conditions that fit into this type include:

Type 4: Over-Focused Anxiety/Depression involves excessive activity in the brain and is associated with people who have trouble shifting attention and get locked into anxious and/or negative thoughts or behaviors. Click To Tweet


People with this type generally have 4 symptoms from Pure Anxiety (Type 1) and/or Pure Depression (Type 2) in addition to at least 4 “over-focused” symptoms.

Anxiety symptoms include:

  • Frequent feelings of nervousness or anxiety
  • Panic attacks
  • Avoidance of people or places due to a fear of having anxiety or panic attacks
  • Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor)
  • Periods of heart-pounding, nausea, or dizziness
  • The tendency to predict the worst
  • Multiple persistent fears or phobias (such as dying or doing something crazy)
  • Conflict avoidance
  • Excessive fear of being judged or scrutinized by others
  • Being easily startled or a tendency to freeze in anxiety-provoking or intense situations
  • Shyness, timidity, and getting easily embarrassed
  • Biting fingernails or picking skin

Depression symptoms include:

  • Persistent sad or “empty” mood
  • Loss of interest or pleasure in activities that are usually fun, including sex
  • Restlessness, irritability, or excessive crying
  • Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
  • Sleeping too much or too little, early-morning awakening
  • Loss of appetite and/or weight loss, or overeating and weight gain
  • Decreased energy fatigue, feeling “slowed down”
  • Thoughts of death or suicide, or suicide attempts
  • Difficulty concentrating, remembering, or making decisions
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
  • Persistent negativity or chronic low self-esteem
  • Persistent feeling of dissatisfaction or boredom

Over-Focused Symptoms

  • Excessive or senseless worrying
  • Upset when things are out of place or things don’t go the way you planned
  • The tendency to be oppositional or argumentative
  • The tendency to have repetitive negative or anxious thoughts
  • The tendency toward compulsive or addictive behaviors
  • Intense dislike for change
  • The tendency to hold grudges
  • Difficulty seeing options in situations
  • The tendency to hold onto own opinion and not listen to others
  • Needing to have things done a certain way or you become upset
  • Others complain you worry too much
  • The tendency to say “no” without first thinking about the question


Brain SPECT imaging findings associated with this type show excessive activity in the brain’s anterior cingulate gyrus, the basal ganglia, and/or the deep limbic system at rest and during concentration. Sometimes there is markedly increased activity in the anterior cingulate gyrus with concentration; other times it calms a bit with concentration.

  • Anterior cingulate gyrus (ACG): The ACG is the brain’s gear shifter. When there is too much activity in the ACG, people cannot shift their attention properly and end up stuck on negative thoughts or behaviors. When this is combined with excessive basal ganglia activity, people get stuck on anxious thoughts. When this is combined with too much activity in the deep limbic system, people get stuck on negative depressing thoughts. Many people get stuck on both anxiety-provoking and depressive thoughts. When ACG overactivity becomes worse with concentration, it usually means that as the person tried to focus on something, they become more anxious or more stuck on negative thoughts or behaviors. The more intensely they concentrate, the worse the problem becomes.
  • Basal ganglia: This set of large structures toward the center of the brain surround the limbic system. They are involved with integrating feelings, thoughts, and movement, along with helping to shift and smooth motor behavior. Research suggests the basal ganglia are involved in forming habits. At Amen Clinics, we’ve noticed they are also involved with setting the body’s anxiety level. In addition, the basal ganglia help to modulate motivation and are involved with feelings of pleasure and ecstasy (which is why drugs like cocaine and methamphetamines work in this part of the brain).
  • Deep limbic system: This system is one of the most interesting and critical parts of being human and is power-packed with functions, all of which are critical for human behavior and survival. The limbic system typically includes the thalamus (involved in relaying information), amygdala (fear center), hippocampus (memory center), hypothalamus (emotional center), and olfactory cortex (sense of smell).


This type is best treated with interventions that increase the neurotransmitter serotonin as well as strategies to help you get unstuck.

  • Diet: For many, eating a diet that is higher in complex carbohydrates (“smart carbs”) and lower in proteins is effective. Specifically, consume foods that are high in L-tryptophan, which is a building block of serotonin, such as sweet potatoes, hummus, salmon, turkey, eggs, nuts, and seeds.
  • Supplements: The nutraceuticals 5-HTP and saffron
  • Exercise: Burst training can be especially helpful for this type.
  • Stop your thoughts: Whenever you notice yourself getting stuck on negative or anxious thoughts, envision a red stop sign and think “STOP!”
  • Keep a journal for your thoughts: To help prevent anxious or negative thoughts from looping endlessly in your mind, write them down. This helps get them out of your head.
  • Consider options: Before automatically saying “No” to things, take a few moments to think about options. This helps you get unstuck and increases mental flexibility.

Depression, anxiety, OCD, PTSD, phobias, eating disorders, and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time.

At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. How are telemedicine sessions paid for??

    Comment by Julie Anderson — December 21, 2020 @ 3:12 AM

  2. I have suffered with anxiety all my life I am 82 . I’m healthy and active but I am having mcg more anxiety during this stressful times were in

    Comment by Diane Demola — December 21, 2020 @ 3:40 AM

  3. I feel like this article was literally written about me. When I got my brain scans done at your facility, my basal ganglia was on fire! Thank you for these articles. They are a nice refresher on what I can do to improve my situation.

    Comment by Sean W. — December 21, 2020 @ 4:40 AM

  4. Great advice.

    Comment by Susan sellers — December 21, 2020 @ 7:01 AM

  5. I feel like I have this type anxiety Iam so sick of it I feel likenot stole alot of years of my life and I just want to do live for Jesus, enjoy my marriage our kids etc withouth anxiety stealing my time with them. Do yall take medcaid ? I woulf love to.come.to yall clinic and get a scat scan

    Comment by Alexious Thomas — December 21, 2020 @ 9:10 AM

  6. Hello Alexious, thank you for reaching out. Amen Clinics is an out-of-network provider and we do not bill insurance. We do provide a superbill containing applicable diagnosis and billing codes, which can be submitted to insurance companies for possible reimbursement. Our doctors and therapists are not affiliated with any insurance plans or networks. Please check with your insurance provider for any mental health benefits. For additional information regarding your pricing, insurance, and financing options, please contact our Care Coordinators: https://amenclinics.com/schedule-visit/

    Comment by Amen Clinics — December 21, 2020 @ 7:24 PM

  7. Hello Julie, thank you for reaching out. For questions regarding cost and payment methods, please reach out to our Care Coordinators: https://amenclinics.com/schedule-visit/.

    Comment by Amen Clinics — December 21, 2020 @ 7:25 PM

  8. This is good stuff! This explain my symptoms better then any other traditional diagnosis. I tend to experience these episodes during times of high stress, little sleep, or post viral infections. The reoccurring somatic OCD like symptoms are brutal, but always eventually subside, and often go into remission for very long periods.

    Inositol is a good mediator supplement, also. I am going to make some of the diet changes and start getting a healthier dose of tryptophan in my diet, and adding saffron to my afternoon chai tea. I always felt like a million bucks after thanksgiving, so there must be some truth to this compound as it relates to the type 4 (over focus anxiety)

    Stay strong friends and keep your purpose on the front burner. My best years (I’m 43) we’re always those when I felt my purpose was strong. This almost solved the anxiety all by itself. When I tend to try and fix it, focus on it, it always gets the better of me.

    Definitely take Dr. Amen’s advice as this is the best research on mental health anywhere. Take the suggestions and move forward one step at a time until you’re really enjoying your life again.

    You got this 🙏❤️😎

    Comment by Danny M — June 29, 2022 @ 7:59 PM

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