The powerful and often permanent impact of fear on the human brain was the focus of a major scientific symposium at the Anxiety Disorders Association of America (ADAA) 18th National Conference. In one of the first interdisciplinary meetings of the nation’s leading basic and clinical brain researchers, experts examined the latest findings on the biological and physiological nature of fear and trauma, and the potential for improved diagnosis and treatment of anxiety disorders. South African Psychiatrists and Psychologists were in attendance as was the Chairman of the South African Depression and Anxiety Support Group.
“This symposium has underscored the truly remarkable progress in our understanding of the basis of fear in the brain. It has been a major step in how we can use this information in the service of treating and. In particular, preventing anxiety disorders,” said Steven E. Hyman, M.D., PhD. Director of the National Institute of Mental Health and the meeting co-chair. Anxiety disorders include general anxiety disorder, panic disorder, phobia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
Greater understanding of fear and the brain could be used to help victims of such trauma, said meeting co-chair James C. Ballenger, M.D., Medical University of South Carolina and Chairman, ADAA Scientific Advisory Board.
“This conference is talking about what was going on in children’s brains at the time of a trauma,” Dr. Ballenger said. “We know that more that 20 percent of them are likely to develop post-traumatic stress disorder from this. The progress we are making in the basic and clinical areas can give us the tools to intervene earlier and offer better treatment for people who experience traumas.”
PTSD results from an abnormal, persistent response to fearful or traumatic stimuli – sometimes years after the event. Although the events may be long forgotten, the brain’s “emotional memory” recalls and reactivates their anxiety-producing physiological symptoms.
Throughout the day-long event, experts reviewed extensive data that reveal a confluence of chemical and hormonal brain responses immediately activated by a life-threatening or emotionally devastating event. According to researchers, most anxiety-related activity is centered in the part of the brain known as the amygdale, which regulates emotion, fear and memory. Upon exposure to a fearful event, the amygdale is the coordinating centre of the brain’s response, leading to a cascade of physical responses, including increased heart rate and blood pressure and hyperventilation. They also discussed how the stress hormones cortisol and norepinephrine released during a fearful event actually act on the brain to greatly increase the memory of that event.
“The field of emotion is maturing,” said Dr. Hyman, “and basic science can help determine where to look in the brain and can define and determine treatment.”
For example, the presenters discussed how basic research has uncovered significant gender differences with respect to the brain’s response to fear and anxiety. Moreover, research is emerging on the pivotal role of female hormones, including estrogen and cyclical hormonal changes, on how the female brain processes and adapts to fear and anxiety. Most participants emphasized the need for more gender-based research. The majority of anxiety disorder sufferers are women.
While many people never develop an anxiety-related disorder in response to a fear-inducing or emotionally disturbing event, others – genetically predisposed or more vulnerable from previous experiences – are left with lasting symptoms that interfere with daily life and function or limit social interaction or activity.
Some sufferers of generalized anxiety disorder, among the most common of anxiety disorders, may have lived with the disorder for more than 10 years before seeking treatment, according to Jonathan R.T. Davidson, M.D., Duke University Medical Centre, a symposium presenter.
Currently, the most effective anxiety treatment includes serotonergic agents, which serve as “parking brakes” in dampening fear-produced brain response, said the researchers.
“We are verging on the capacity to ‘see’ with neuroimaging, the circuits that mediate anxiety symptoms and disorders. The next step will be specific, novel, targeted therapeutics,” said Jerrold F. Rosenbaum, M.D., Massachusetts General Hospital.
Moreover, the symposium has furthered a critical dialogue between clinical and basic researchers on the nature and causes of anxiety disorders.
“There is still no consensus on the cause or causes of anxiety disorders, but today’s event showed how our understanding of anxiety disorders is deepening,” said Jerilyn Ross, M.A., L.I.C.S.W., president, ADAA.
South Africa was well represented at the Congress and 7 Psychiatrists and the Head of the local Support Group were in attendance. The mission of the South African Depression and Anxiety Support Group (DASG) is to promote awareness and education of anxiety disorders and to improve the lives of all people who suffer from them. Since 1995, by disseminating information, linking people who need treatment with those who can provide it, the DASG has made it possible for thousands of individuals to benefit from its services and publications. The group offers expert guidance for depression and anxiety sufferers.