View Full Version : "Varieties Of Anxiety In The MindBrain"


mildadhd
07-20-14, 02:28 PM
..In sum, there are many ways to monitor fearfulness in animals--from timid behaviors in large test arenas called "open fields" to "social interaction tests" to "elevated plus mazes" to "contextual freezing".

How these environments and behaviors all connect up to the FEAR system remains uncertain.

Overall though, at present, there is an enormous amount of work on fear-learning (as described in the next chapter) and very little work on the evolutionarily provided FEAR circuit of the brain.

So, while neuroscientists know a lot about the neurochemistries (e.g., glutamate synapses) that allow conditioned stimuli access to the FEAR system, they know comparatively little about the way that the FEAR system itself works.

Still during the past few decades, a few groups in Brazil have been intensively studing the various neurochemistries in the PAG that regulate defensive behaviors, and in our terminology the FEAR system (e.g., Brandao, et al., 2003, 2008; Del-Ben & Graeff, 2009).

Some of these details are difficult to summarize succinctly, but readers should be assured that the neurochemical understanding of this system will offer many possibilities for medicinal developments, including simple maneuvers such as reducing inflammatory cascades in the circuits that mediate a form of anxiety, perhaps feelings akin to social separation distress (see chapter 9) that are precipitated by morphine withdrawl following addiction (e.g.,Hao et al., 2010)


VARIETIES OF ANXIETY IN THE MINDBRAIN

Not every for of anxiety emerges from the FEAR system.

We use the word "anxiety" in several contexts, but we now know that "separation anxiety" is a very different kind of process in the brain than the various emotional trepidations we have described in this chapter so far.

It is important for psycholtherapists and scientific psychiatric experts to recognize that there are several distinct negative emotion systems in the brain and that more than one may be aroused at any given time.

How these systems interact is still unknown.

Successful therapy, however, may well rely on an understanding of which system is dominant in each patient.

For example, the PANIC/GRIEF system, detailed in Chapter 9, is probably more important for the often intense feelings of social insecurity and loss that people have when experiencing "panic attacks" than for the anticipatory anxiety that occurs in the response to scary nonsocial events.

We will devote and entire chapter to the PANIC/GRIEF system, but to expand on a comment made earlier, we note that there are two good reasons to distinguish the PANIC/GRIEF system from the FEAR system.

First they are supported by different brain chemistries and have different reactions to drugs.

As we have seen, BZ are generally effective in quelling FEAR, but they have little effect in eliminating the cries of distress that young animals make when they are separated from their parents.

The original BZ (Librium and Valium) also had little effect in quelling panic attacks in humans, even though some of the modern high-potency BZs, such as alprazolam, are quite effective.

On the other hand, the original tricyclic antidepressant imipramine can, at low doses, ameliorate panic disorder.

Indeed, imipramine was the first drug discovered to have clear antipanic effects in people and also to reduce separation cries in animals (Klein & Rabkin, 1981; J. Scott, 1974).


One can also distinguish between PANIC/GRIEF and FEAR on clinical grounds because they mobilize different automatic responses.

There are two major branches in the automatic nervous system.

The sympathetic branch readies an animal for an active response.

So, for example, the sympathetic nervous system may elevate heart rate and respiration, thereby providing oxygen for burning elevated levels of blood sugar that are necessary for taking flight.

It may likewise dilate pupils in order to increase vigilance.

The parasympathetic branch, on the other hand, takes over when animals are in a more passive state.

Under the influence of the parasympathetic nervous system, the heart rate slows, breathing is regular, and pupils remain undilated.

The parasympathetic nervous system is also sensitive to emotional changes, and it promotes tears, salivation, and sexual arousal.



Anticipatory anxiety (conditioned FEAR) is characterized by generalized apprehensive tension, with a tendency toward various symptoms stemming from the sympathetic arm of the automatic nervous system.

So symptoms like a rapid heartbeat, sweating, gastrointestinal upset, and increased muscle tension characterized FEAR.

Manifestations of PANIC/GRIEF, however, are accompanied by feelings of weakness and depressive lassitude, with more autonomic symptoms of a parasympathetic nature, such as a strong urge to cry, often accompanied by tightness in the chest and the feeling of having a lump in the throat.

While FEAR beckons one to escape from situations that intensify anxiety, PANIC/GRIEF prompts thoughts about lost objects of affection and impels one to seek the company of the people one loves.



Although there are distinct emotion systems, each characterized by specific affects and behaviors, they frequently interact in complicated ways.

There is an abundant psychotherapeutic literature on attachment disorders, which are manifestations of the PANIC/GRIEF system.

Children with severe attachment disorders are unable to trust, will reject feelings of dependency in themselves, and cannot empathize with others.

They are apt to be needy, greedy, and inappropriately demanding, often turning to drugs, especially opiates and alcohol, in adolescence and adulthood.



People with attachment disorders also frequently suffer from persistent fears, stemming from childhood experiences of neglect or abuse.

It is this complex picture that one often sees when examining the histories of young people in custodial penal institutions.

Such children grow up to be highly aggressive and are often antisocial.

At the same time, they often suffer from a sense of hopelessness about themselves.

Clearly they have problems with several basic emotional systems.

The complexity of their emotional needs and limitations render them difficult to rehabilitate.

A full understanding of the brain emotional systems involved in these behaviors is vitally necessary for the development of therapeutic techniques and effective medications to treat both the persistent fears and the attachment disorders of these unfortunate young people.


Post-traumatic Stress Disorder (PSTD) is another complex condition that involves several different emotion systems.

In addition to chronically overactive manifestations of the FEAR and PANIC/GRIEF systems, PSTD is a state of terror that is often accompanied by anger, which we mentioned in our opening vignette as a possible aftermath of repeated trauma (as soldiers experience during wartime).

An aspect of PTSD, distinct from straightforward PANIC/GRIEF or FEAR, lies in the fact that PTSD can be diminished with antiseizure medications such as carbamazepine, an agent that is not consistently effective in the control of either panic attacks or anticipatory anxiety (Berlin, 2007).

This suggests that there is an additional seizure-type process that can elaborate several negative emotions toward a full-blown PSTD state (Agrawal et al., 2006).

Although PTSD has not yet been unambiguously linked to an emotional anxiety-type system, like FEAR or PANIC/GRIEF, it appears to be another way that the brain can be traumatized, probably with several emotional systems participating, such as both FEAR and PANIC/GRIEF as well as RAGE.


Indeed, the vicissitudes of life being what they are, with each of us bombarded by a diverse set of emotional challenges, it will be next to impossible to prove that any emotional disorder is due to simply to a single emotional system, not to mention a single chemical imbalance.

Most people will reflect several emotional imbalances, explaining why the concept of "comorbidity" is so common in psychiatry.

This essentially means that more than one psychiatric syndrome occurs at the same time.

Take depression, which is often accompanied by excessive psychological pain, anxiety, angry irritability, as well as diminished urges to seek and pursue other life interests.

Indeed, the term "depression" is very ambiguous, implying both generalized malaise and sickness.

A more accurate description would need to address the emotional systems involved and the ways that their over- or underarousal contribute to the clinical symptoms, including increasing possibility that inflammatory cascades that characterize many types of sickness are overactive in depressed individuals (Dantzer et al., 2008).

We suspect that scientific psychiatrists, at some time in the future, may have little need for the diagnostic categories presently used, as we begin to undestand emotional problems in the terms of better descriptions of imbalanced brain emotional systems and an understanding of the many neurochemical changes that lead to affective distress.


We are just beginning to understand the massive complexities of the underlying neuroanatomies and neurochemistries.

A future biological psychiatry that works well along more specific affective psychotherapeutic interventions will probably be based on knowledge that more readily links to the actual emotional experiences of patients.

One reason this is not happening as rapidly as it could (and perhaps should) is because many investigators still believe that psychology is a soft science and that it is better to link psychiatric diagnostic categories directly to changes in brain facts, with no intervening emotional analysis.

The existence of distinct emotional systems in the brain may facilitate a more comprehensive psychobiological approach than currently exists (Panksepp, 2004, 2006a, 2009a, 2009b).



Panksepp/Biven, "The Archaeology of Mind", P 189-191


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