Image via WikipediaFear Extinction: The NYT has a good article about the causes of and treatments for anxiety-related disorders, including PTSD. There is some interesting work being done with a couple of medications that might enhance our contemporary therapies for PTSD. The author provides a nice synopsis of the brain mechanisms that underlie fearful responses:
"When mammals sense threat, at least two important brain circuits swing into action. One pathway runs through the frontal lobe of the cerebral cortex, the layer of the brain that regulates consciousness, thinking and decision-making functions.
The other circuit is more primal, running deep into the unconscious brain and through the amygdala, a pair of lozenge-sized nubs of neural tissue (one on each side of the brain) specialized to register threats. This unconscious circuit is “quick and dirty,” a primal survival instinct that increases blood pressure, heart rate and alertness well before the thinking cortex is fully aware of what is happening.
The difference between the two may be crucial to understanding how an irrational fear forms. The amygdala records sights and sounds associated with a harrowing memory, and it is capable of sending the body into high alert before a person consciously processes the stimuli."
So, if I have been hurt (emotionally or physically) by a person or a situation, my brain will be primed to respond fearfully to reminders of that hurtful incident. These reminders can come from within (memories that are voluntarily elicited, or triggered any number of other ways), or by a host of reminders that "bring it all back." For example, the mere thought of driving past the location where you were beaten and robbed might be accompanied by panic-type symptoms, and/or feelings of dread and fearfulness, all of which seem irrational, but are perfectly normal. These feelings exist because it is important for our brains to very quickly alert us when we are approaching places/situations that have been, within our own life history, dangerous. And our frontal lobes have a really hard time, sometimes, exerting a calming influence on our midbrains.
Psychologically, the key to calming down these distressing, and sometimes disabling, fear responses seems paradoxical: it consists of repeated exposure to that which is feared. The idea is that we make our fears worse by avoiding that which we fear; and we diminish our fearfulness by facing the feared object, repeatedly finding that it no longer represents a genuine danger to us.
This exposure can be live, in-person, or virtual/imaginal. One example: People who are being treated for a snake phobia are usually given gradually increasing exposure to images of snakes, and eventually to actual living snakes. All of this is done in a way that ensures that the person is not re-traumatized by the experience; otherwise, it certainly will not be effective.
Sometimes the best type of "therapeutic" exposure is within our own minds. Meditation practice is one type of mental activity that permits us to decide NOT to avoid certain distressing memories, thoughts, or sensations, as they spontaneously arise while we are sitting. We can gradually learn that our typical knee-jerk avoidance or aversion responses can be slowed down, calmed down, and that this can help us tremendously, in daily life, to see that not everything that frightens us is truly dangerous.
Mindfulness-based interventions are increasingly being used (with good results) for individuals with several of the anxiety-related disorders. There are researchers and clinicians currently working in VA hospitals who are bringing mindfulness practice to soldiers coming home from war with PTSD, and the early results are looking good. No doubt, there are various methods and modes of working with PTSD patients that can be effective; it's great to see positive results coming from various directions.
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