A Different Way to Understand Chronic Anxiety
Imagine if the way we feel anxious did not begin in our thoughts but in our body. When you haven’t eaten all day, it becomes difficult to focus. When you are in pain, even small decisions can feel harder. These everyday experiences remind us how closely our body and mind interact. Recent studies are beginning to suggest that chronic anxiety might work in a similar way, where the body’s internal signals of stress arise before the mind even recognises them.
Research suggests that chronic anxiety may operate through similar body-first mechanisms — where subtle shifts in the body’s internal state, such as rising heart rate, hormonal stress signals, or even low-grade inflammation, can influence how the mind interprets the world around us. Inflammation, often triggered by stress or immune activation, can alter brain function and mood regulation, reinforcing feelings of tension or threat before we are consciously aware of them. This is the idea behind the Domain Loop Model, developed by Stephen Hartshorn and Michael O’Brien, who have studied the deep connections between physiology and anxiety, particularly among elite athletes with joint hypermobility.
Their work “When our physiology becomes our psychology”, published in The Psychologist, The British Psychological Society (BPS), suggests that anxiety is both a psychological and physiological experience, shaped by the body as much as the mind. It explores how the interaction between our internal signals, external environment, and inner narratives can create or resolve feelings of safety and chronic fear.
About the Researchers
In an article published by the BPS, researchers outline how physiology can become psychology, exploring links between interoception, hypermobility and anxiety. In over 20 years of working with various groups of athletes, they identified recurring physiological traits, particularly joint hypermobility, that appear linked with persistent anxiety and stress dysregulation.
Their observations align with growing scientific evidence linking joint hypermobility, autonomic nervous system sensitivity, and anxiety. For example, Eccles et al. (2022) found that connective-tissue variants (indexed by hypermobility) are associated with the emergence of anxiety and depression in adolescents, mediated by autonomic factors. Similarly, Sharp et al. (2021) reviewed how variant connective tissue (such as hypermobility) may impact emotional regulation via dysautonomia and altered interoceptive processing. More recently Kampoureli et al. (2025) reported that in individuals with hypermobility and anxiety, brain regions involved in threat processing (the amygdala) and awareness of bodily states (the insula) show altered responses. These findings suggest that internal signalling systems, including heart rate, gut activity, and other bodily sensations, may play a central role in shaping emotional experience.
The Domain Loop Model: Three Interconnected Domains
The model proposes that our lived experience is created through three continuously interacting domains.
Interoceptive Domain – Internal body signals
This domain includes heartbeat, gut sensations, muscle tension, and other physiological cues. The brain constantly monitors these signals to assess internal states, often subconsciously.
Exteroceptive Domain – External sensory input
This covers everything we see, hear, touch, smell, and taste. It helps us detect threats or cues of safety in our environment.
Narrator Domain – The internal storyteller
This is the conscious mind that interprets signals from the other two domains and constructs meaning, the “voice in your head” that explains what is happening.
While the physiological basis for these domains is well established, much of the existing research examines each factor in isolation. The Domain Loop Model differs by treating the three domains as an interconnected system rather than separate components. The narrator domain plays a central role by integrating bodily sensations and sensory input into coherent meaning, constructing our subjective reality through this continuous interplay.
These three domains form a dynamic feedback loop. When they are in sync, we experience clarity and coherence in our perception.When one domain sends distorted or heightened signals, such as the body being in distress while the environment appears calm, the brain may interpret this mismatch as anxiety.
From Flexible Joints to a Stressed Brain
Hartshorn and O’Brien highlight that people with joint hypermobility, common among gymnasts, dancers, and swimmers, may be up to sixteen times more likely to experience chronic anxiety (Eccles et al., 2022).
This link appears to stem from a biological chain of events. Some studies suggest that hypermobility may be associated with changes in gut integrity, potentially leading to increased intestinal permeability (‘leaky gut’) and immune activation. This allows unwanted particles into the bloodstream, triggering immune inflammation and oxidative stress.
These inflammatory signals activate the HPA axis, the body’s central stress response system, leading to elevated cortisol and a persistent state of “fight or flight.”
Over time, this disrupts interoceptive signals and causes the brain to misinterpret safety as danger, perpetuating anxiety even when there is no external threat. This biological sensitivity sets the stage for how the brain interprets bodily cues. When those signals are amplified or inconsistent, they may shape perception and emotion in ways that sustain anxiety.
When the Domains Fall Out of Sync
When your body signals danger but your senses detect no threat, your mind steps in to make sense of the mismatch. Often, it creates catastrophic explanations such as “I am having a heart attack” or “Something bad is about to happen.”
These thoughts then feed back into the body, increasing heart rate and stress hormones, locking all three domains into a self-reinforcing anxiety loop.
Expanding the Approach to Anxiety Treatment
Most anxiety treatments target the narrator domain, focusing on reframing thoughts or exposure to triggers.
Hartshorn and O’Brien argue that if the interoceptive system, meaning the body, continues to send alarm signals, thought-based therapies alone may not break the cycle.
Their model calls for a multi-domain approach:
- Interoceptive regulation: improve gut health, reduce inflammation, support sleep, and balance the nervous system.
- Exteroceptive grounding: engage the senses to reconnect with the present moment.
- Narrator awareness: identify false alarms and separate physical sensations from catastrophic interpretations.
This approach aligns with recent findings in psychophysiology and somatic therapy that emphasise bottom-up regulation, as described by Stephen Porges in his discussion of the Polyvagal Theory and the role of physiological safety (Frontiers in Integrative Neuroscience, 2022).
A Systems-Level Understanding of Anxiety
The Domain Loop Model shows that anxiety is not a flaw of willpower or mindset but a systems-level imbalance between physiology and perception. By treating body, environment, and cognition as an integrated ecosystem, we can create more effective and compassionate approaches to anxiety management.
As Hartshorn and O’Brien write, “Our physiology becomes our psychology.”
Understanding the loop between body and mind not only explains chronic anxiety but also points to new ways of restoring balance and resilience.
We would like to thank everyone in Swansea for welcoming us to your beautiful city and for the thoughtful conversations that deepened our understanding of how the body and mind are connected. One of the most memorable moments from our visit was when the researchers shared that in times they simply go for a walk, feeling the air, listening to the sounds around them, and noticing the scent of the sea. It was a perfect reminder of the Domain Loop in action, showing how tuning into our senses and our surroundings can help the body and mind return to harmony.
At LYEONS, we continue to study how supporting the body’s physiological responses to stress might create new ways to restore balance, improve focus, and strengthen emotional resilience. By exploring how sensory modulation and interoceptive feedback can influence the nervous system, we hope to contribute to approaches that help people feel calmer, safer, and more connected in their everyday lives.
References
Hartshorn, S., & O’Brien, M. (2024). When our physiology becomes our psychology. The Psychologist. The British Psychological Society.
Eccles, J. A., Owens, A. P., Mathias, C. J., & Critchley, H. D. (2022).
Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study
BMJ Open, 12(12), e066130. https://doi.org/10.1136/bmjopen-2022-066130
Sharp, H. E. C., Eccles, J. A., & Critchley, H. D. (2021).
Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression
World Journal of Psychiatry, 11(10), 805-820. https://pubmed.ncbi.nlm.nih.gov/34733643/
Kampoureli, C. N., Rae, C. L., Gould Van Praag, C., Harrison, N. A., Garfinkel, S. N., Critchley, H. D., & Eccles, J. A. (2025). Neural processes linking joint hypermobility and anxiety: Key roles for the amygdala and insular cortex. The British Journal of Psychiatry. https://doi.org/10.1192/bjp.2024.259
Porges, S. W. (2022). Polyvagal Theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227. https://doi.org/10.3389/fnint.2022.871227
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