New study to help you treat fear and anxiety

Clearing misunderstanding of how certain parts of the brain function in terms of fear and anxiety disorders, a recent study offers new insights into neurological processes with the aim of overcoming existing barriers to drug development.

Professor Joseph LeDoux said, "Progress has stalled in treatment development for mental disorders. Promising new treatments either have not turned out to be useful when tested with patients or exhibit potential adverse effects that limit their applicability to severe disorders. We argue that this state of affairs reflects how fear and anxiety have been conceived, and we offer a new framework to address the problem."

The researchers observed it has long been assumed that advances in neuroscience would revolutionize treatment of psychiatric disorders.

Noting that discoveries about how the brain detects and responds to threats has guided research aimed at improving treatments for disorders that involve alerted threat processing, especially fear and anxiety disorders, the researchers added a misunderstanding of how the brain is wired with regard to both fear and anxiety has stymied the development of effective treatments.

In short, these efforts have assumed that emotions such as fear give rise to both the experience of "fear" (the feeling of being afraid of being harmed) and to behavioral and physiological symptoms that also occur.

LeDoux and Pine said that, contrary to existing views, the brain circuits that underlie conscious feelings are different from those that underlie behavioral and physiological responses.

While both sets of symptoms, the conscious and the behavioral/psychological, must be understood and treated, they must be addressed differently.

"Failure to recognize this difference has impeded understanding of fear and anxiety and their treatment. Going forward, recognition of this distinction should provide a more productive path for research and treatment," they said.

They also put forth a framework aimed at creating such a route that theorizes there is differences between processes that give rise to conscious feelings of fear or anxiety and the non-conscious processes that generate behavior and physiological responses that often occur with these feelings.

This two-track nature, the authors continue, means treatment must then move to a dual approach.

"Behavioral and physiological symptoms may be treatable with either medications or certain psychotherapies, such as cognitive behavior therapy, while conscious feelings may have to be addressed with psychotherapeutic treatments that are specifically designed to change these," they said.

Human research is essential for understanding conscious feelings in the brain while animal research is important for understanding the brain mechanisms that underlie the non-conscious processes that control behavioral and physiological responses.

"Our ability to understand the brain is only as good as our understanding of the psychological processes involved. If we have misunderstood what fear and anxiety are, it is not surprising that efforts to use research based on this misunderstanding to treat problems with fear and anxiety would have produced disappointing results," they concluded.

The study has been published in the American Journal of Psychiatry.