Anxious: Using the Brain to Understand and Treat Fear and Anxiety

The idea that we are rational decision makers is part of our folk psychology and leads people to believe that they are in charge of their behavior. In actuality, much research suggests that we lack direct knowledge of the processes and motivations underlying our decisions and behaviors and instead we often confabulate explanations for them after the fact, making them seem more rational than they are.

Our sense that our conscious minds are running the show is part fact and part fiction.

The amygdala can be thought of as the accelerator of defensive reactions, and the PFCvm as the brake to them.

As put by Ned Block, another leading consciousness philosopher at NYU, the hard problem is explaining why the physical basis of a given phenomenal or subjective experience is the basis of that experience and not of some other experience or of no experience at all.

Diagnostic categories based on clinical consensus fail to align with findings emerging from clinical neuroscience and genetics. The boundaries of these categories have not been predictive of treatment response. And, perhaps most important, these categories, based upon presenting signs and symptoms, may not capture the underlying mechanisms of dysfunction.

This led him to explore, with Andre Fenton (now a colleague at NYU), the role of PKMzeta in hippocampal-based memory. They found that ZIP, given long after learning, eliminated the conditioned memory. Many studies followed in the amygdala, neocortex, and other areas, confirming the effect.

an important feature of anxiety, as opposed to fear, is uncertainty about whether and when an impending danger will occur, how long it will last, and what actions should be taken in response to it.

Another brain area, the bed nucleus of the stria terminalis (BNST), which is part of what is called the extended amygdala has often been found to play a role in such tests. Studies in healthy humans have confirmed the role of the BNST in processing

consciousness is a result of the most advanced of its processing functions, a number of prominent psychologists and philosophers assume that a particular process called working memory plays a key role in consciousness.

the content of working memory is assumed to constitute the information about which we can be conscious.

So-called implicit memory does not require consciousness for either storage or retrieval

Such memory is typically expressed as behavior rather than by being accessed as conscious content.

You cannot teach these skills to another person in words. The other person's brain has to learn to do them.

The question is not so much about whether they have mental states, but instead whether they have mental state consciousness.

Hard data are sparse when it comes to this topic, because we can never truly know whether an animal consciously experiences what is going on inside its brain: We can measure information processing but not conscious content.

Although the same cortical areas are activated in both consciously seen emotionally neutral stimuli and consciously seen threats, the degree of cortical activation is greater for the latter. The net result is that a threat stands out in the conscious mind relative to neutral stimuli that are also vying for attention.

For example, in order to be conscious that you are being threatened, you have to know what a threat is (have the concept of a threat stored in your brain), knowledge that requires semantic memory. You also have to know that the particular stimulus present is an example of a threat (which also requires semantic memory). In addition, past personal experiences you've had with threats in general or with this particular threat are likely to be retrieved (which requires episodic memory).

The amygdala responses may therefore be affected by attention not because attention controls the amygdala but instead because it affects activity in cortical areas that connect with the amygdala.

Consciousness is an intrinsic feature of a neural network with unique information-representation capacities made possible by unique patterns of connectivity.

if your brain has detected a potential source of harm, and arousal has been triggered, through focused attention you begin to monitor the environment in search of other possible harmful things.

Through arousal and reentrant processing, their brains are on high alert. They are hyperaroused, thus hyperaware.

The labels "low road" and "high road" are best thought of as shorthand descriptions of sensory input routes to the amygdala from the thalamus and cortex, rather than ways of accounting for differences between nonconscious versus conscious processing of threats by the brain.

Anxious people typically have what is called trait anxiety, which is a chronic condition they want to be rid of.

the essence of anxiety is the unpleasant feeling--the apprehension, dread, anger, and worry--that one experiences when one perceives a loss of control in situations of uncertainty and risk. It is a by-product of our unique capacity to envision our future self and especially to anticipate unpleasant, or even catastrophic, scenarios regardless of their likelihood.

My restatement of Kierkegaard and Menand is that anxiety is the price humans pay for autonoetic consciousness.

People who suffer from panic attacks are especially sensitive to body sensations.

Anxiety, in short, is a conscious feeling.

President George W. Bush's science advisory board had a similar outlook, essentially declaring that memory is sacrosanct and should not be played with by scientists, even if the goal is to make people feel better.

This is another example of what these expectation violations, prediction errors trigger new learning.

Prolonged exposure therapy, a variant of flooding, attempts to maintain a high level of fear arousal, but its key premise is that all aspects of fear, as defined by Lang's three response systems (behavioral avoidance, physiological responses, and verbal behavior), have to be reduced in order for exposure to be effective.

On the whole, exposure approaches work fairly well, helping roughly 70 percent of those who are treated.

it was as if retrieval reopened the consolidation process, and in order for the memory to persist after retrieval it had to be restabilized or reconsolidated.