Taming the Anxious Mind: Revisited

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Anxiety is an emotional trait that was, from an evolutionary standpoint, necessary for survival. When found in an unfamiliar or potentially unsafe environment, an animal’s anxiety would trigger a behavioral response, such as fight or flight, which would help ensure their well-being. While anxiety is still an important emotion for humans, it can manifest in overwhelming ways that interfere with a person’s ability to perform normally on a daily basis. This intense manifestation of anxiety raises the question of the neurological basis for the activation of anxiety as well as how to treat anxiety when it reaches an overwhelming level.

In our class discussion “Taming the Anxious Mind” we analyzed the presence of behavioral traits in infants that could indicate a potential onset of anxiety later in life as well as the high rate of diagnosis of anxiety in the elderly who live in nursing homes. We also discussed the different treatments available, namely Cognitive Behavioral Therapy (CBT) and the use of drugs such as Selective Serotonin Reuptake Inhibitors (SSRI’s), to determine the efficacy of anxiety treatments. Ultimately, we analyzed the role of consciousness and unconsciousness in the manifestation and treatment of anxiety.

The class discussion primarily focused on the New York Times article “Understanding the Anxious Mind” where we learn about Dr. Jerome Kagan’s major longitudinal study of temperament and its effects[1]. The article takes us through Dr. Kagan’s 20 years of research in which he initially observes if babies were upset easily. The babies that were upset easily were labeled as “high-reactive” babies and Kagan believed that they were more likely to be inhibited and anxious as they grew older. “Low-reactive” babies, Kagan hypothesized, were less likely to be shy and anxious as teenagers and adults.  Over the years as the subjects grew older they returned to Kagan’s lab where they were then interviewed and asked if they had any fears or anxieties. By age 7 many of the high-reactive babies showed higher levels of anxiety than the low or intermediate reactive babies. As the subjects got older and became teenagers, about two-thirds of the subjects who were high-reactive’s as infants were less anxious as adolescents. While many of the high-reactive subjects were able to successfully adapt to their environment, in doing so they were forced to internalize their anxieties. These findings support the belief that one can be born pre-disposed to be anxious.

The article goes on to discuss the physical differences in the brain that were found between high-reactive subjects and low-reactive subjects such as higher activity in the amygdala and thickening in the pre-frontal cortex for individuals who were high-reactors vs. low-reactors as infants. Several theories have stemmed from this finding, one being the possibility that since the pre-frontal cortex plays an inhibitory role on the amygdala there is thickening in the prefrontal cortex in high-reactive individuals that perhaps developed as a way to “dampen” the anxiogenic effects of the amygdala. Another theory is that the prefrontal cortex was thicker at early development and that resulted in an increase in anxiety from the amygdala compensating in its firing rates because of the thicker prefrontal cortex.

Scientists have collected significant evidence demonstrating that the amygdala plays a crucial role in the activation and expression of anxiety and conditioned fear[2]. The central nucleus of the amygdala has direct connections to the hypothalamus and brainstem, areas which appear to be involved in the activation of the sympathetic autonomic nervous system during fear and anxiety. Biologists have proven that stimulation of the amygdala in animal models alters heart rate and blood pressure, respiration, and cessation behavior. These behavioral and autonomic changes resemble a state of fear or anxiety. When researchers electrically stimulated the amygdala in humans, they evoked feelings of anxiety and autonomic reactions characteristic of fear in their subjects. In addition, scientists have shown that the prefrontal cortex while having a role in inhibition of the amygdala is perhaps not purely inhibitory[3]. There are other structures in the brain that play a role in inhibiting the amygdala along with the prefrontal cortex, such as the lateral septum. The clear role of the amygdala in anxiety, the presence of other inhibitory mechanisms, and lack of a purely inhibitory role perhaps suggest that the thickening of the prefrontal cortex is a result of an already over active amygdala and inhibition by the already present structures is not enough. Nevertheless, whatever the developmental and physiological neurological differences there are between high-reactive and low-reactive individuals, most high-reactive individuals seem to cope with their inborn anxiety.

In the end, the paper discusses the fact that even though individuals can be pre-disposed to developing anxiety at higher levels than others, there are ways to work around the anxiety. Subjects that had some form of activity or hobby that they were talented in, such as dancing ballet, brought the individuals a sense of comfort and control by doing something they enjoyed. They had a distraction from the everyday things and events that brought on their anxiety. Individuals born pre-disposed to anxiety can live normal successful lives, they are just required to perhaps work a little harder to adapt to their environment.

The other major topic of our discussion was on the over-prescription of anti-anxiety and anti-depressant medications to elderly individuals in nursing homes. Another New York Times article posted findings from a recent study by the University of South Miami where they found that 71% of Medicaid residents in Florida nursing homes were receiving psychoactive drugs while only 12% were receiving cognitive behavioral therapy[4]. These findings lead us to question the medical system and its increased diagnosis of mental illness and use of prescription medications on the elderly. Is there actually an increase in depression and anxiety in the elderly population in nursing homes? Perhaps the nursing homes are so terrible it is the institution itself that is increasing the rate of anxiety. Still, if there is an actual increase in anxiety why is there such a significantly higher usage of drugs such as SSRI’s compared to treatments like CBT?

SSRI’s have been proven to help treat anxiety disorders and depression by inhibiting the reuptake of serotonin into the presynaptic cell and therefore increasing the amount of extracellular serotonin available to bind to the postsynaptic cell. Conversely, patients who are treated with CBT meet with a therapist regularly who is capable of discussing and analyzing the patient’s anxiety and teaches them how to modify their behavior in order to inhibit or at least reduce the manifestation of their anxiety. This form of treatment takes a long time and requires active involvement from both the patient and care taker, but does not pose the same risk of side effects as SSRI’s.

Considering the active involvement required for behavioral therapy and the shortage of properly trained staff in the nursing homes, as stated by Dr. Molinari in the New York Times Wellness article, it is actually not terribly surprising that a high percentage of elderly in nursing homes are being prescribed psychoactive medications. This then leads us to question the differences in the state of consciousness the elderly (or anyone) being treated with anxiolytics experience compared to those receiving behavioral therapy. One possibility is that patients treated with medication are participating in an unconscious treatment of their anxiety while those undergoing CBT are involved in a conscious treatment of their anxiety. Furthermore, we can also question the consciousness of an anxious and non-anxious individual. Is there a difference in consciousness or unconsciousness when a person is anxious or not? One possibility is that an anxious individual is hyper-conscious of the world around them, which is part of what causes there constant feelings of anxiety. That could explain why enjoyable activities such as ballet or playing guitar help, at least temporarily, relieve an anxious individual of their anxiety. While engaged in their activity their anxieties are perhaps moved to an unconscious state and stay hidden there for a while. Similarly, perhaps individuals who are not terribly anxious are fortunate enough to usually have their anxieties stored in their unconscious.

The manifestation of anxiety is a complex subject which spreads from its physical core in the amygdala to the intangible clouds of the conscious and unconscious. How one behaves in response to potentially stressful situations in their environment is dependent on this tangled loop of physiological activation and mental interpretation. Hopefully one day researchers and doctors will be able to better understand the path of this loop in order to determine better treatments for individuals whose loop has gone awry causing their anxiety to be overwhelming. Fortunately, many people have figured out how to control and internalize their anxiety and lead successful and productive lives. Still, that’s not always the healthiest solution.