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Biology of anxiety<br />

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Biology of anxiety<br />Digby Tantam, Clinical Professor of Psychotherapy, Honorary Visiting Senior Fellow, University of Cambridge<br />slides can be downloaded from the Existential Academy at slideshare.net: <br />http://www.slideshare.net/djht2<br />www.existentialacademy.com<br />2<br />

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slides can be downloaded from the Existential Academy at slideshare.net: <br />http://www.slideshare.net/djht2<br />www.existentialacademy.com<br />3<br />

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www.existentialacademy.com<br />5<br />Anxiety<br />Stage fright<br />Fear<br />Shyness<br />Separation<br />Stress<br />Worry<br />

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Peripherally, many of the symptoms of anxiety and fear are the same<br />Biphasic response<br /> Fight or flight:<br /> Sympathetic: increased tone of sympathetic nervous system, increased secretion from adrenal medulla, increased heart rate and rise in BP<br />Cortisol: increased secretion from adrenal cortex<br /> Submission: sham death, freezing, ‘panic’: increased parasympathetic secretion, decrease in heart rate, fainting<br />But anxiety also includes:<br /> disgust<br /> neo-panic or hyperventilation syndrome<br />www.existentialacademy.com<br />6<br />

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1. Cognitive appraisal. Only events are judged or appraised to have significance for our goals, concerns, values, needs, preferences, or well-being elicit emotion.<br />2. Subjective feelings. The appraisal is accompanied by feelings that are good or bad, pleasant or unpleasant, calm or aroused.<br />3. Physiological arousal. Emotions are accompanied by autonomic nervous system activity.<br />4. Expressive behaviours. Emotion is communicated through facial and bodily expressions, postural and voice changes.<br />5. Action tendencies. Emotions carry behavioural intentions, and the readiness to act in certain ways <br />6. Sartrean transformation of the world: emotions change awareness, attention, perception, reappraisal<br />7. Characteristic brain substrates<br /> a. phasic<br />b. dispositional (‘personality’)<br />

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Fear and disgust are OF something<br />Panic is ABOUT something: being suffocated or just dying<br />Anxiety is FOR something: a future feeling, a preparedness for the worst <br />So anxiety is a disposition <br />Neurobiologically, a disposition is<br />A genetic endowment<br />Permanent change due to early experience<br />Memory<br />

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www.existentialacademy.com<br />9<br />Tantam, D. (2003). The flavour of emotions." PsycholPsychother. 76(Pt 1): 23-45.<br />Sacco, T. and B. Sacchetti (2010). "Role of Secondary Sensory Cortices in Emotional Memory Storage and Retrieval in Rats." Science 329(5992): 649-656.<br />

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Short-term memories need consolidation in hippocampus over 24 hours or more<br />Happens during SWS<br />May be disrupted in PTSD<br />Battle survivors, but not survivors of civilian disasters, may have reduced hippocampal volumes<br />www.existentialacademy.com<br />10<br />

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Amygdala<br />Poorly defined ‘nuclei’<br />Contain cortex<br />Respond to faces, and other external threats<br />Enable fear to be linked to new stimuli via conditioning<br />Orchestrate ‘arousal response’ may be fear/ anxiety or rage<br />www.existentialacademy.com<br />11<br />GABA ergic inhibitory interneurons, blocked by benzodiazepines<br /><br /><br />Endorphin signalling,<br />EtOH increases endorphins<br />

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www.existentialacademy.com<br />12<br />

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www.existentialacademy.com<br />13<br />Long-term memory blocked by Inhibitors of PKC (protein kinase C, or mitogen activate protein kinase<br /><br /><br />

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How do alcohol, opium, and diazepam work? <br />On endogenous opioid (endorphin) transmitters and on GABAergic inhibitory interneurons, respectively<br />However, both systems show considerable pharmacological tolerance presumably because of receptor number changes<br />How does propranolol work, peripherally (i.e. not much) and possibly by potentiating serotinergicanxiolytics<br />How do these work?<br />Probably on 5-HT1A receptor<br />But how?<br />And where?<br />?<br />slides can be downloaded from the Existential Academy at slideshare.net: <br />http://www.slideshare.net/djht2<br />www.existentialacademy.com<br />14<br />

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Attachment and the amygdala<br />Fear triggers attachment behaviour<br />Oxytocin reduces amygdala activation in a diazepam-like way via activation of GABAergic inhibitory interneurons<br />In people with generalized anxiety disorder shown frightened faces(Labuschagne, I., K. L. Phan, et al. (2010). "Oxytocin Attenuates Amygdala Reactivity to Fear in Generalized Social Anxiety Disorder." Neuropsychopharmacology. <br />More oxytocin receptors in women<br />Prairie voles bond<br />Oxytocin snuff makes men more woman-like in empathizing<br />Increases gaze at the eyes of other people, including angry people<br />Increase trust in ‘trust games’<br />15<br />

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The role of other peptides<br />Pentagastrin and orexin were both discovered as hormones active on the stomach and small bowel during digestion<br />Both stimulate the respiratory centre (as does acidosis) but also superior temporal cortex and hypothalamus: these might be associated with fears of death and experience of suffocation i.e. panic. <br />Orexin is linked to reward, and is involved in pleasure in the brain<br />16<br />

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Neo-panic<br />‘Shell shock’<br />Hyperventilation syndrome<br />Not clear whether hyperventilation increases pCO2 sensitivity in respiratory chemoreceptor<br />Or other way round<br />Hyperventilation produces hypocapnia and respiratory alkalosis and therefore hypocalcaemia<br />But vasoconstriction of cerebral arterioles and therefore cerebral hypoxia: so cautious about cognitive advice that you give<br />www.existentialacademy.com<br />17<br />

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www.existentialacademy.com<br />18<br />Self-conscious anxieties<br />Dysmorphophobia<br />OCD<br />Social phobia<br />

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Disgust, as well as fear contributes to anxiety. Disgust is response to internal threat: the primordium is ‘yukky’: what makes you vomit<br />www.existentialacademy.com<br />19<br />Miles on David Hume:<br />‘In attacking theoretical attempts to supply a rational basis for Christianity,<br />Kierkegaard found an unlikely ally in “the great Infidel”, David Hume (1711-76)’<br />Only in people <br /> ? Abstract disgust<br />Morality <br />

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Anxiety is the ‘dizziness of freedom’ <br />Because it motivates a ‘leap of faith’<br />www.existentialacademy.com<br />20<br />

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Psychoanalytic anxiety is two fold<br />Two factors influence distance from the parent, and emotional control (that lead to schizoid personality in extremis):<br />External threat (‘guilt’): produced by fear of punishment or loss of love<br />Internal threat (‘shame’) produced by parental disgust<br />Tantam, D. ‘Fairbairn’ 1996 150 Years of British Psychiatry, vol. 2 (eds. H. Freeman and G.E. Berrios)<br /> <br />www.existentialacademy.com<br />21<br />

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www.existentialacademy.com<br />22<br />Yuk. That’s gross<br />It’s a monster<br />Tak for Deresopmærksomhed<br />Let’s kill it<br />I don’t ever want to hear you say that again. And take this thing out of my sight, I never want to see anything like that again, either<br />The outline of my next but one book<br />