The Neurobiology of Anxiety
Emerging research from the field of affective neuroscience can improve our effectiveness with clients suffering from disabling anxiety. With brain scan technology, research provides fuller understanding of emotion. Informed by these recent findings, we can test our theories and explore new technical strategies to bring greater relief.
In The Emotional Brain, Joseph LeDoux presents his research on the neural circuits of the “fear system.” He discovered the crucial role of the amygdala, the alarm within the limbic system, which governs the body’s physiological equilibrium. The amygdala processes sensory information about potential danger unconsciously, a split second before the cerebral cortex becomes aware. This has survival value because it enables us to react instantaneously (e.g. “without thinking”), that is, to ‘jump’ out of harm’s way by sending a message to the body to get ready to fight or flee. However, the cerebral cortex and the hippocampus put information in context and can override the alarm when a second look suggests no real threat, thus sending a “relax and recover” directive to the body.
Our clients who have grown up with trauma, neglect, or disturbed attachment would have had to have very busy amygdalas. LeDoux tells us that fear has been conditioned in such people; the alarm is easily set off and in some, is constantly “on.” Secondly, other research indicates the hippocampus atrophies from chronic stress, leaving a client less able to “turn off” the alarm response and coping with a hypervigilant body/mind.
So the bad news is that chronic stress causes measurable brain damage. Many of our clients literally have less brain capacity to bring perspective to their sensitized amygdalas. But the good news is that there is increasing evidence the adult brain has the capacity to grow new neural connections (synaptic plasticity), especially in the hippocampus. As therapists, we may have a biological impact. In LeDoux’ words, “Psychotherapy is fundamentally a learning process for its patients, and as such, is a way to rewire the brain.”
We can educate our clients about the neurobiology of anxiety to normalize their experience and reduce defensiveness. Use of the term hypervigilance rather than anxiety may reduce shame, as it presumes there once was rational cause for fear. Clients are relieved to hear that their reactivity is typical of those with a traumatic past. Learning how sensory cues can set off flashbacks helps clients make sense of intense transference reactions. They can become more realistically hopeful and curious to discover their “triggers” and to learn how to turn off the now anachronistic alarm.
As clinicians knowledgeable about the modern science of anxiety, we can also teach strategies to help clients change their emotional states. In The Body Remembers, Babette Rothschild describes affect regulation tools which can help stabilize fragile clients and build safety for more exploratory work. Clients can also develop capacity for self-soothing outside therapy. For example, mindfulness meditation may strengthen the left prefrontal cortex to inhibit amygdala messages, according to neuroscientist Richard Davidson.
Working within this more medical model, a client of mine describes her “sirens going off” as she struggles to become more trusting. Now aware this danger signal is an understandable holdover from her abuse history, she is less likely to feel “crazy” or to blame herself. Shame about a rape has decreased as she has learned about the freeze response, a physiological strategy typical of trauma survivors. She works to learn new skills to ground herself in the present. Her symptoms improve with her increasing clarity and capacity to calm herself.
As therapists trained in older theories, it is challenging to integrate neurobiology into our clinical thinking and practice. Yet we are fortunate to have this resource and our clients stand to benefit from our fuller understanding.