Veenstra 170 - Anxiety Disorders Association of America

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Change 3: Why Do the Panic Feelings Become So Intense and Uncontrollable Old: Escalating panic is difficult to explain and difficult to turn off New: Panic is caused by an escalating feedback cycle Amygdala is monitoring internal feedback, so it will easily fire to an escalating heart rate But it fires sympathetic autonomic arousal that further increases heart rate Instead of reducing the fear stimuli, this actually amplifies it Vicious feedback cycle is set up that can only be terminated by the higher order safety signal Not understanding what is happening will further escalate the process because the amygdala responds to the possibility of danger So uncertainty and novel stimuli will tend to trigger amygdala arousal People often naively try to turn off the arousal by saying “Don’t be afraid” Unfortunately neocortically generated words do not communicate to the amygdala Does saying this to an infant do any good? Only the emotional feeling associated with the words communicates to the amygdala If “don’t be afraid” is communicated will with an angry tone or facial expression then the negative arousal will actually amplify the process And only positive calming feelings will activate the security signal The other problem with “don’t be afraid” is that it implies that being afraid is a problem A problem is a danger, so the amygdala will alarm Change 4: Why Does Accepting the Anxiety Make Sense Old: Accepting is advocated as a pragmatic solution New: Accepting makes sense given the understanding of the neural circuitry The explanations above suggest a useful three step strategy 1. Accept the anxiety as an old amygdala alarm Cannot head off the initial amygdala alarm – happens before higher level can respond Can only correct the feedback response So don’t fight the response, since this will only feed it Knowing what is happening removes the sense of uncertainty that could escalate the process Knowing that the amygdala response is only an “old alarm” reminds that it may not be a real danger 2. Thank the amygdala for doing its job Ignoring an emotional circuit will result in it escalating Recognizing that the amygdala has done its job terminates its need to continue Thankfulness is a positive emotion which is calming instead of aggravating Using the mindful approach of treating it as a distracting stimulus that is allowed to pass through 3. I will now use my thinking brain to assess what the problem really is Recognizing that the amygdala cannot reason, so don’t take its feeling as a reality Shift focus to higher level processing which can reason Use mindfulness to keep attention focused on the level that you can control Neuroscience Advances for Improving Anxiety Therapies © Glenn Veenstra 4
2. Improving Self-‐Talk Objective 2: Describe how to change dysfunctional self-‐talk using neuroscience challenges that supplement the usual CBT techniques. Change 1: Does Thinking Causing Feelings? Old: Classic cognitive model assumed that thinking caused feelings So by controlling and changing thinking a person could change and control feelings This was a top-‐down neurological model New: Emotional processes more often create thought processes Fear process begins with the amygdala triggering instinctive responses and autonomic arousal and its activation signal is sent up to the paleocortex Paleocortex translates activation signal into an emotion that is used for making emotional decisions and responses and sends this emotion up to the neocortex Emotional functioning is largely a right hemisphere process that develops most in first years of life Toddlers and dogs can make many decisions without the benefit of any higher level verbal processes Neocortex adds a verbal interpretation to these lower level responses Verbal functioning is largely a left hemisphere process that develops later in childhood Gazzinga’s research with split brains showed that the left makes its best guess at what the right is doing Ex: If right waves, then left assumes that saw a friend Read McGilchrist’s The Master and His Emissary for a fuller understanding of these processes In a typical panic attack, the amygdala activation produces an accelerated heart rate that the neocortex naively interprets as a heart attack The process is bottom-‐up. Emotional responses are producing thoughts. Once a thought has been produced it will be sent back down for an emotional appraisal The thought “I am having a heart attack” will produce a fear response in the paleocortex that will in turn further amplify the amygdala arosual of the cardiac system So thoughts can produce emotions, and correcting these thoughts does help control the fear But the linear assumption that this is how it happens will create problems in trying to do this It is actually a circular process and the bottom-‐up is usually more powerful than the top-‐down However, the top-‐down process is more easily changed so therapy will usually begin with it Self-‐talk changes are vitally important in directing the development of new emotional responses Change 2: Why Do Dysfunctional Thoughts Develop? Old: CBT identified common cognitive errors but did not explain why developed CBT never explicitly explained how distorted thinking developed Since it was a cognitive model, the implicit assumption that most people make is that they were not thinking wisely, i.e., they were thinking stupidly New: Common errors are naïve interpretations of amygdala decision making As explained before the amygdala makes decisions which are fed up to the neocortex which then interprets them Since the amygdala makes all-‐or-‐none decisions, it is understandable that they would be cognitively interpreted in the same way Neuroscience Advances for Improving Anxiety Therapies © Glenn Veenstra 5
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Veenstra 170 - Anxiety Disorders Association of America

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