Available online at:
https://cc.arcabc.ca/islandora/object/cc%3Apsycjournal

J Camosun Psyc Res. (2022). Vol. 4(1), pp. 191-222.
Submitted Fall 2021; accepted June 2022.

What Are the Biological Effects of Anxiety?
Authors: Ashley Pifer*, Lily Werner, Kennedy Guryn, Kimia Yousefian, Shweta Waddan, and
Anna Valente
Supervising Instructor: Michael Pollock, Psyc 215 (“Biological Psychology”)
Department of Psychology, Camosun College, 3100 Foul Bay Road, Victoria, BC, Canada V8P 5J2
*Corresponding author email: ashley.pifer23@gmail.com

ABSTRACT
In this paper, we sought to understand the biological effects of anxiety, especially in the return
of students to in-person classes. Previous research has shown that general anxiety is associated
with irritable bowel syndrome (IBS), increases in ambulation (movement), elevations in the
stress hormone cortisol, increased risk of inflammatory disease, hyperhidrosis (excessive
sweating), and increased amygdala size. In our correlational study, we tested the strength of
these relationships by examining naturalistic daily changes in their variables longitudinally over
a period of one week. We measured amygdala activity by increases of heart rate after watching
frightening videos, inflammation by measuring the circumference of the wrist, cortisol level by a
daily symptom questionnaire, IBS symptoms by an IBS symptoms questionnaire, locomotor
activity by step count tracking, hyperhidrosis symptoms by partially filling out the Hyperhidrosis
Quality of Life Index, and anxiety by the Hamilton Anxiety Rating Scale (HAM-A). Data
pooled across participants in our correlational study showed significant correlations only
between IBS and anxiety. Knowing that there is a correlation between IBS and anxiety can be
helpful in treatments of IBS patients by using anti-anxiety medications in some cases, especially
for patients with emotional distress.
1. Introduction
1.1 Research Problem
Anxiety can be debilitating for many, and
after a year of socially-distanced learning,
we would like to know how students are
being affected biologically. For example,
several of this paper’s authors suffer from
Generalized Anxiety Disorder and have
noticed a worsening of anxiety symptoms
with returning to campus after a long time
without socializing. We would like to gain a
more in-depth understanding of the
biological effects of anxiety, such as

digestion problems, stomach pain, excessive
sweating, and feelings of a racing heart.
Perhaps finding a solution to control the
biological effects resulting from anxiety can
help many people who are struggling with
this issue, as well as helping those who are
experiencing this type of anxiety for the first
time after returning to school.
1.2 Literature Review
One biological effect of anxiety
previously found was changes in the medial
temporal lobe of Generalized Anxiety
Disorder patients through neuroimaging
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using scans from an MRI. These scans found
significant grey matter and amygdala size
increase in patients suffering from anxiety.
For example, in an experimental study by
Suor et al. (2020), researchers asked
participants both youth and adult, to
complete a self-reported anxiety
questionnaire (Liebowitz Social Anxiety
Scale) followed by a resting MRI scan.
Based on these results, the researchers
suggested that there is a significant
volumetric increase in the amygdala in
patients suffering from Generalized Anxiety
Disorder. An increase in the amygdala can
potentially be used as a biomarker that
predicts anxiety, as well as creating a
different course of future treatment plans
based on these biomarkers to decrease
remission rates of anxiety.
Another biological effect of anxiety is
elevated inflammatory activity, which can
increase the risk of inflammatory disease.
For example, in a correlational study by
O’Donovan et al. (2010), 27 participants
were taken from a sample of those who
scored in the clinical range on the Hospital
Anxiety and Depression Scale, and 29
participants who scored low on the scale.
Blood was then collected in clot activator
tubes, to measure the levels of cytokine
interleukin-6. Based on their results, the
researchers suggested that those with higher
levels of anxiety had higher levels of the
proinflammatory hormone cytokine
interleukin-6 and were at a higher risk of
developing an inflammatory disease.
A third effect of anxiety is abnormalities
in stress hormones and inflammatory
markers. For example, in an experimental
study by Hoge et al. (2018) adults with
generalized anxiety disorder were put into
two different groups. One was a
mindfulness-based stress reduction group
and the other was an attention control class
group. The participants were put in either

group and took the trier social stress test
before and afterwards. It was shown that
adrenocorticotropic hormone (ACTH),
which produces the stress hormone cortisol,
decreased in the participants who were in the
mindfulness-based stress reduction group.
Based on these results, the researchers
suggested that meditation-based
interventions lower the stress hormone
cortisol in people with generalized anxiety
disorder. This shows that anxiety can have
biological effects and people with anxiety
tend to have higher stress hormones which
can lead to health issues. Using methods
such as mediation-based interventions can
help ease anxiety and lower the chances of
health issues due to anxiety.
Additionally, another effect of anxiety is
Irritable Bowel Syndrome (IBS). For
example, in a non-experimental study by
Drews & Hazlett-Stevens (2008),
researchers asked participants to complete a
series of questionnaires forms such as the
Generalized Anxiety Disorder Questionnaire
(GAD-Q-IV) for GAD diagnosis and ROME
II Diagnostic Criteria for Irritable Bowel
Syndrome (IBS). Based on the completed
forms, researchers found that 4.3% of
participants met the criteria for both IBS and
GAD, the majority of whom were women.
In fact, participants meeting the criteria for
IBS were more likely the ones who were
also diagnosed with GAD. Therefore,
researchers suggested that there was an
association between IBS and GAD since the
majority of people diagnosed with IBS were
also suffering from high trait anxiety.
A fifth biological effect of anxiety is the
change in ambulation in response to early
exposure to life’s adversity, such as
isolation. For example, in the experimental
study by Novoa et al. (2021), adolescent
male rats were either housed together or
housed separately and then were put in an
Open Field Test. An Open Field Test
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consists of activity chambers where the rat
was placed for 10 minutes and could roam
freely. Their activity was monitored by
infrared beams. When the beam was broken
the position of the rat was determined. Rats
that spent more time in the middle of the
cage were considered to be less anxious. The
socially isolated rats spent less time in the
middle and moved around the activity
chambers much more than the rats that were
group-housed. The rats that ambulated more
showed more anxiety. Based on these
results, the researcher suggested that
ambulation is increased in rats with anxiety
that have been socially isolated.
Lastly, a biological effect of anxiety is
hyperhidrosis, i.e., excessive sweating. For
example, in a correlational study by
Davidson et al. (2002), 375 participants,
who met the criteria of either the DSM IIIR
or the DSM IV for Social Anxiety Disorder
(SAD) filled-out the Brief Social Phobia
Scale (BSPS) and the Social Phobia
Inventory (SPI). On the BSPS, 93
participants reported having hyperhidrosis,
and on the SPI, only 88 did. When the 93
individuals with hyperhidrosis were
compared to the 166 who reported
experiencing either no or mild sweating in
the BSPS, the first group was shown to
score higher on the Sheehan Disability
Scale. When the 88 participants with
hyperhidrosis were compared with the 122
that reported no or minimal sweating in the
SPI, the first group scored higher rates of
social anxiety in the Liebowitz Social
Anxiety Scale. Based on the 25% of the
individuals in the sample that experienced
excessive sweating, the researchers found
that hyperhidrosis “was associated with
more severe social anxiety symptoms and
disability” (Davidson et al., 2002, p. 1331).
1.3 Hypotheses

Based on the above literature review, we
predicted the following hypotheses:
Hypothesis #1: If anxiety increases then
amygdala activity will increase.
Hypothesis #2: If anxiety increases then IBS
symptoms will increase.
Hypothesis #3: If anxiety increases then
locomotor activity will increase.
Hypothesis #4: If anxiety increases then the
stress hormones cortisol will increase.
Hypothesis #5: If anxiety increases then the
levels of cytokine interleukin-6 (proinflammatory hormone) will increase.
Hypothesis #6: If anxiety increases then
hyperhidrosis (excessive sweating) will
increase.
2. Methods
2.1 Participants
The six authors of this paper served as the
participants in its studies. The participants
ranged in age from 21-28 years old, with an
average age of 23.7 years, and included all
participants that identified as females. The
participants were all undergraduate students
at Camosun College who completed the
current studies as an assignment for Psyc
215 Biological Psychology and were
grouped together due to their mutual interest
in anxiety. All participants experience
different forms of social anxiety, and three
of them were clinically diagnosed with
Generalized Anxiety Disorder (GAD) and
one suffers from Irritable Bowel Syndrome
(IBS).
2.2 Correlational Study Methods
We first performed a correlational study
to test concurrently all of our hypotheses by
examining naturalistic daily changes in their
variables longitudinally. Each participant
kept a study journal with them at all times
over this study’s one-week period in order to
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record self-observations of the following
seven variables: (1) amygdala activity, (2)
levels of cytokine interleukin 6, (3) levels of
the stress hormone cortisol, (4) IBS
symptoms, (5) locomotor activity, (6)
hyperhidrosis symptoms, and (7) anxiety.
2.2.1 Levels of the Stress Hormone Cortisol
To measure high levels of the stress
hormone cortisol, each participant filled out
a cortisol questionnaire based on symptoms
that correlate with high levels of cortisol
(see Appendix D). The participants checked
which symptoms apply to them each
morning at the same time for seven
consecutive days. This questionnaire is
scored out of six because there are six main
symptoms and the higher the score the
participants have, the more likely it is
correlated with high levels of cortisol.
2.2.2 Levels of Cytokine Interleukin 6
To measure levels of cytokine interleukin
6, since it is known to produce
inflammation, participants measured it by
the circumference of the wrist. The
circumference was measured at 7 am every
day for 7 consecutive days. Each day
participants used a measuring tape to
measure wrist circumference and then
completed a table that includes the date,
time and measurement in cm (see Appendix
F).
2.2.3 Amygdala Activity
To measure amygdala activity,
participants monitored changes in their heart
rate levels in response to frightening events.
The participants recorded their heart rate
before and after watching a frightening
event using the finger and wrist test method.
There were 7 different frightening event
videos that were taken from youtube, each
one with a duration between 2 mins to 7
mins. Each video had a unique fear factor of
jump scares for each of the participants to
watch over the course of 7 days.
2.2.4 IBS Symptoms

To measure IBS symptoms, participants
completed the IBS Symptoms Evaluation
questionnaire (see Appendix B). This
questionnaire consists of 10 IBS symptoms
that each item scores on a scale of 0 (none)
to 3 (severe) with the total score of 0-30,
where <15 indicates the participant may not
be suffering from IBS, 15-24 indicates the
participant may be suffering from IBS and
25-30 indicates the participant is likely to be
suffering from IBS. Participants completed
this form daily (preferably before going to
bed) for a week.
2.2.5 Locomotor Activity
Locomotor activity was measured by a
fitness tracker or an application on their
phone. The fitness trackers used were
Fitbits. The phone applications used were
Apple Health and Samsung Health. The
participants recorded their results at the end
of the day for 7 consecutive days on the
forms provided by the experimenter (see
Appendix E).
2.2.6 Hyperhidrosis
To measure hyperhidrosis, 5 items from
the HidroQoL (Hyperhidrosis Quality of
Life Index) were presented to the
participants. They were: 1) “My choice of
clothing is affected [by my excessive
sweating]”; “I feel uncomfortable physically
expressing affection (e.g. hugging others)”;
3) “I worry about leaving sweat marks on
things”; 4) “My appearance is affected [e.g.:
face looking oily]”; and 5) “I think about
sweating” (see Appendix G). These
sentences were slightly altered in the
questionnaire, in order to better fit this
particular research. Instead of the verbs
being in the present, they were all
conjugated in the past tense. Also, at the
beginning of every sentence, the word
“today” was added, as participants were
supposed to reflect only on their experiences
throughout a given day. To answer each of
those questions, participants had three
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options, which were: “very much”, “a little”,
or “No, not at all”. The total possible score
in the full version of the questionnaire (with
18 items) is 36, and in this case, with only 5
items, the total possible score is 10.
2.2.7 Anxiety
To measure anxiety, all the participants
filled out the Hamilton Anxiety Rating Scale
(HAM-A) on a daily basis (see Appendix
A). The scale includes 14 broad items, for
instance, one item is called “fears”, which
includes “of dark, of strangers, of being left
alone, of animals, of traffic, of crowds”. For
each item, participants had to pick one out of
five options: 0 was equivalent to “not
present”, 1 to “mild”, 2 to “moderate”, 3 to
“severe”, and lastly, 4 to “very severe”. The
total possible score range is 0-56, where <17
indicates mild severity, 18-24 is mildmoderate severity, and 25-30 is moderate
severity. Based on the sum of each of these
numerical answers, one’s level of anxiety
was assessed.
3. Results
As shown in Table 1, IBS syndrome was
significantly correlated with anxiety
severity. In fact, it was statistically
significant for two of the participants (r =
.84, p = .015 and r = .88, p = .006) as well as
significantly correlated using pooled
standardized data (r = .46, p = .001; see
Figure 2), but IBS syndrome was not
significantly correlated with anxiety severity
using pooled raw data (r = .15, p = .333; see
Figure 1). In contrast, the correlation
between hyperhidrosis and anxiety severity
was only statistically significant for one
participant (r = -.84, p = .01). Another
participant data did not show any variation
in hyperhidrosis; therefore their data was not
considered in the final results. As for the rest
of the participants (all r ≤ .72, all p ≥ .07),
the pooled raw data (r = .24, p = 35; see

Figure 5) and the pooled standardized data (r
= .01, p = 0.96; see Figure 6), all showed no
significant correlation. Moreover, locomotor
activity and anxiety severity were not
significantly correlated in the pooled raw
data (r = -0.01, p = 0.93; see Figure 9) and
the pooled standardized data (r = 0.22, p =
0.16; see Figure 10) but there was one
participant that showed a significant
correlation (r = 0.89, p = 0.0039).
Furthermore, high cortisol levels and anxiety
severity was significantly correlated in the
pooled raw data (r = 0.32, p = 0.03; see
Figure 11), but not correlated in the pooled
standardized data (r = 0.10, p = 0.51; see
Figure 12), and one participant showed a
significant correlation (r = 0.86, p = 0.00).
Additionally, high levels of cytokine
interleukin 6 and anxiety severity were not
correlated in both the pooled raw data (r =
0.23, p = 0.25203; see Figure7) and the
pooled standardized data (r = 0.19, p =
0.2315; see Figure 8). Similarly, increased
amygdala activity and anxiety severity were
not correlated in both the pooled raw data (r
= 0.25, p = 0.106905; see Figure 3) and the
pooled standardized data (r = -0.22, p =
0.165128; see Figure 4). Therefore, based on
the comparison of the correlation
coefficients using pooled standardized data,
IBS symptoms showed the strongest
correlation with anxiety severity.
4. Discussion
4.1 Summary of Results
Based on previous research, we
hypothesized that increases in six biological
variables would follow an increase in
anxiety: amygdala activity (Hypothesis #1),
levels of cytokine interleukin 6 (Hypothesis
#2), levels of the stress hormone cortisol
(Hypothesis #3), irritable bowel syndrome
symptoms (Hypothesis #4), locomotor
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activity (Hypothesis #5), and hyperhidrosis
symptoms (Hypothesis #6). Data pooled
across participants in our correlational study
supported the predicted relationship of
irritable bowel syndrome symptoms with
anxiety (Hypothesis #4) but not with any of
the other 5 hypotheses listed.
4.2 Relation of Results to Past Research
Our correlational study indicated that
high cortisol levels and anxiety severity
were not correlated, which is not consistent
with previous research. Based on the study
done by Hoge et al. (2018), participants in
the mindfulness-based stress reduction had a
decrease in ACTH which produces the stress
hormone cortisol. This showed that
participants had high-stress hormone cortisol
due to anxiety levels and it decreased when
using mindfulness. The methodology of our
correlational study differed from that of
Hoge et al., (2018) study and this might be
why there was a difference in results. In
Hoge et al. (2018), Area-Under-the-Curve
(AUC) concentrations were calculated for
adrenocorticotropic hormone (ACTH)
whereas in our research the participants had
to fill out a questionnaire that consisted of
symptoms of high cortisol. Blood work is a
more accurate way of measuring cortisol
levels rather than a questionnaire. This could
be the reason that high cortisol levels and
anxiety severity were not correlated in our
research.
Our correlational study found that high
levels of cytokine interleukin 6 were not
correlated, which is not consistent with
previous research. According to the study
conducted by O’Donovan et al. (2010),
participants showed a correlation between
high levels of anxiety and higher levels of
cytokine interleukin 6. The methodology
used in this study differed from the methods
used in O’Donovan et al. (2010) and this is

potentially the cause of the differing results.
In O’Donovan et al. (2010) levels of
cytokine, interleukin 6 were measured by
collecting blood in clot activator vacutainer
tubes. In our research, participants recorded
the circumference of their wrist to measure
levels of cytokine interleukin 6 in
participants. In comparison with measuring
wrist circumference, blood tests are a more
precise and reliable way of collecting levels
of cytokine interleukin 6.
Our correlational study indicated that
amygdala and anxiety did not have a
significant correlation, which is not
consistent with previous research. According
to the study conducted by Suor et al. (2020),
Generalized Anxiety Disorder and amygdala
activity were significantly correlated. The
methodology used in this study differed
from the methods used in Suor et al., (2020),
as we did not have the proper technology
(fMRI) to accurately measure differences in
grey matter and amygdala sizes. In our
research, we measured amygdala activity by
heart rate. Participants measured their heart
rate before and after watching a frightening
scene and then it was measured alongside
the Hamilton Anxiety Scale. One of the
reasons this may not have been accurate is
due to the scenes provided, as everyone’s
fear tolerance can be different. Another
reason this may not have been accurate is
that we did not have proper technology for
measuring heart rates and it may have been
calculated incorrectly due to participant
error. Further studies should attempt to have
proper technology available to provide a
better chance at a more accurate correlation
between anxiety and amygdala activity.
Our correlational study indicates that
irritable bowel syndrome symptoms are
correlated with anxiety severity which is
consistent with the previous research.
According to the study conducted by Drews
and Hazlett-Stevens (2008), participants
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meeting criteria for IBS were more likely to
meet diagnostic criteria for generalized
anxiety disorder. Although in the previous
study sample, there were participants who
were diagnosed with IBS, in our study only
one participant was clinically diagnosed
with IBS and the rest only showed some of
the symptoms of IBS. However, both studies
despite having differences in terms of study
sample concluded that there is an association
between IBS and anxiety.
Our correlational study indicated that
hyperhidrosis and anxiety did not have a
significant correlation, which is not
consistent with previous research. According
to the study conducted by Davidson et al.
(2002), SAD and excessive sweating were
significantly correlated. Reasons, why no
correlation was found in the present study,
could be due to the different methodology
used, as in this paper, the HydroQoL
Questionnaire was the only hyperhidrosis
was measured, and in the study mentioned,
the participants answered four
questionnaires, and none of them was the
HydroQoL. Another fact is that not all
participants were diagnosed with SAD, as a
matter of fact, only one was, meanwhile in
Davidson’s study, all 375 participants
suffered from SAD. One last reason for the
discrepancy in our results could be due to
the transition of seasons (from Fall to Winter
during the time of our study), seeing that
with the lowering of temperatures, it could
be argued that participants noticed less of
their own sweating. Further studies should
attempt to understand how hyperhidrosis is
experienced at different times of the year,
and how its symptoms manifest in colder
temperatures.
Our correlation study indicated that
locomotor activity was not correlated with
anxiety severity, which is not consistent with
the previous research. Based on the study
conducted by Novoa et al. (2021), the rats

that ambulated more showed more severity
in their anxiety. The methodology of our
experimental study differed from that of
Novoa et al. (2021) study and this might
account for the discrepant results. First, a
difference between the studies is the type of
participants used. In Novoa et al. (2021),
they observed male rats as their subjects
while in our experimental study we used 6
female human subjects. Furthermore, Novoa
et al. (2021) used an Open Field Test to
observe the locomotor activity while we
used step count to track locomotor activity.
In our experiment, an anxiety questionnaire
was used to help participants assess their
level of anxiety each day, whereas in Novoa
et al. (2021) they concluded just by activity
level of the rats the severity of anxiety.
Further studies should examine whether
locomotor activity needs aerobic or
anaerobic activity to better predict the
severity of anxiety.
4.3 Implications of Results
Since the result indicates that there is an
association between IBS symptoms and
anxiety, this can be helpful in terms of
treatments and medication for IBS patients
who are struggling with anxiety. We
hypothesized that amygdala activity, IBS
symptoms, locomotor activity, stress
hormones cortisol and levels of cytokine-6
will increase if anxiety increases as well.
However, our finding only indicated that
there is a correlation between IBS symptoms
and anxiety. This study sought to understand
the biological effect of anxiety and found
that increasing IBS symptoms is one of the
many biological ways that anxiety affects
the body.

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References
Davidson, J. R. T., Foa, E. B., Connor, K.
M., & Churchill, L. E. (2002).
Hyperhidrosis in social anxiety disorder.
Progress in Neuro-Psychopharmacology
& Biological Psychiatry, 26(7–8), 1327–
1331. https://doi.org/10.1016/S02785846(02)00297-X
Drews, A., & Hazlett-Stevens, H. (2008).
Relationships between irritable bowel
syndrome, generalized anxiety disorder,
and worry-related constructs.
International Journal of Clinical Health
& Psychology, 8(2), 429–436.
Hodge, E., Bui, E., Palitz, S., Schwarz, N.,
Owens, M., Johnston, J., Pollack, M.,
Simon, N. (2018). The effect of
mindfulness meditation training on
biological acute stress responses in
generalized anxiety disorder. Psychiatry
Research, 262, 328-332. https://doiorg.libsecure.camosun.bc.ca:2443/10.101
6/j.psychres.2017.01.006
Novoa, J., Rivero, C. J., Pérez Cardona, E.
U., Freire Arvelo, J. A., Zegers, J., Yarur,
H. E., Santiago Marerro, I. G., Agosto

Rivera, J. L., GonzálezPérez, J. L.,
Gysling, K., & Segarra, A. C. (2021).
Social isolation of adolescent male rats
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accumbens: Role of CRF‐R1. European
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4905.
O’Donovan, A., Hughes, B. M., Slavich, G.
M., Lynch, L., Cronin, M.-T., O’Farrelly,
C., Malone, K. M. (2010). Clinical
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Evidence for specificity in emotion–
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https://doi.org/10.1016/j.bbi.2010.03.003
Suor, J., Jimmy J., Monk C., Phan K.,
Burkhouse K. (2020). Parsing differences
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05.027.

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Table 1
Correlation for Study Variables

Participant
#1
Variables

Participant
#2

Participant
#3

Participant
#4

Participant
#5

Participant
#6

Pooled
raw data

Pooled
standardized data

r

n

r

n

r

n

r

n

r

n

r

n

r

n

r

n

Amygdala
Activity
&
Anxiety
severity

-.51

7

-.30

7

.24

7

.19

7

-.51

7

-.43

7

0.25

7

-0.22

7

Cytokine
Interleuk
-in 6 &
Anxiety
severity

0.00

7

-.07

7

0.36

7

-0.05

7

0.44

7

0.45

7

0.23

7

.0.19

7

Cortisol
levels
and
Anxiety
Severity

-0.09

7

0.05

7

-0.26

7

*0.86

7

0.12

7

0.06

7

0.32
*

7

0.10

7

IBS &
Anxiety
Severity

.05

7

.84*

7

.31

7

.24

7

.88*

7

.45

7

.15

7

.46*

7

Locomotive
Activity
&
Anxiety
Severity

0.05

7

0.49

7

0.12

7

*0.89

7

0.02

7

0.23

7

-0.01

7

0.22

7

Hyperhidrosis &
Anxiety
Severity

-.84*

7

.22

7

.72

7

.30

7

-.35

7

-.20

7

.01

7

* p < .05.
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Figure 1
Association Between IBS Symptoms and Anxiety Severity Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 2
Association Between IBS Symptoms and Anxiety Severity Using Pooled Standardized Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 3
Association Between Amygdala Increase and Anxiety Increase Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 4
Association Between Amygdala Increase and Anxiety Increase Using Pooled Standardized Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 5
Association Between Hyperhidrosis Symptoms and Anxiety Severity Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 6
Association Between Hyperhidrosis Symptoms and Anxiety Severity Using Pooled Standardized
Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 7
Association Between High Cytokine Interleukin 6 and Anxiety Severity Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 8
Association Between High Cytokine Interleukin 6 and Anxiety Severity Using Pooled
Standardized Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 9
Association Between Locomotive Activity and Anxiety Severity Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 10
Association Between Locomotive Activity and Anxiety Severity Using Pooled Standardized Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 11
Association Between High Cortisol Symptoms and Anxiety Severity Using Pooled Standardized
Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Figure 12
Association Between High Cortisol Symptoms and Anxiety Severity Using Pooled Raw Data

Notes. Marker colour differentiates participants: red = participants #1, orange = participants #2,
yellow = participant #3, light green = participants #4, dark green = participants #5, light blue =
#6. Some data might not be visible in the figure due to overlapping markers.

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Appendix A

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Appendix B

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Appendix C
Heart rate vs Frightening Scene
Heart rate vs Frightening Scene:
Day 1:
⮚ Heart rate before=
https://youtu.be/mBYGUn6Q7tQ
⮚ Heart rate after=
Day 2:
⮚ Heart rate before=
https://youtu.be/S51jIrunYuY
⮚ Heart rate after=
Day 3:
⮚ Heart rate before=
https://youtu.be/OxRIWBoluzs
⮚ Heart rate after=
Day 4:
⮚ Heart rate before=
https://youtu.be/lTb-DIU9vj8
⮚ Heart rate after=
Day 5:
⮚ Heart rate before=
https://youtu.be/pfGEdmZyVyY
⮚ Heart rate after=
Day 6:
⮚ Heart rate before=
https://youtu.be/ck1NO9MyQsM
⮚ Heart rate after=
Day 7:
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⮚ Heart rate before=
https://youtu.be/nt9D55oZCnE
⮚ Heart rate after=

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Appendix D
High levels of cortisol questionnaire
Name:
Age:
Date:
Please check which symptoms you experienced on each day.

Symptoms: MON

TUES

WED

THURS

FRI

SAT

SUN

Rounding
of the face
(Weight
gain)
Acne
Fatigue

Headache
Flushed
face

Score:

/5

/5

/5

/5

/5

/5

/5

-The higher the score, the higher the chance that you are experiencing high levels of cortisol.

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Appendix E
Daily Step Count
Name:

Age:

Date

Sex:

Time

Step Count

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Appendix F
Daily Inflammation Measurement
Name:
Age:
Sex:

Date

Time

Measurement in cm

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Appendix G
Very much (2) A little (1) No, not at all (0)
Today, my choice of clothing was affected
[by my excessive sweating].

Today, I felt uncomfortable physically
expressing affection (e.g. hugging others).

Today, I worried about leaving sweat
marks on things.
Today, my appearance was affected [by my
excessive sweating].
Today, I thought about sweating.

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