Anxiety, Society, and the Brain

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The study and treatment of anxiety is a relatively broad topic in the fields of neurobiology and psychology. This is due partly to the inability to objectively examine and report one’s feelings. As we have mentioned in earlier class discussions, objectivity is something of a myth, even in the sciences. For this reason, we concluded in our earlier classes that there is, at least, some “shared subjectivity” in American culture/science. That is to say, there are fundamental ideas which we, as a society or a societal subgroup, commonly believe to be the closest approximations to truth. It is also hard to measure anxiety partly because the variation in human brains creates an obstacle to the process of generalizing brain function/behavior and its neurological underpinnings across a large sample of people. Various measures have been implemented in experiments to study anxiety. Some experiments measure physiological responses to stress-inducing situations, others use imaging techniques to monitor brain activity or brain structures to determine how anxiety is presented, what regions of the brain are chiefly associated with it, and what function it plays in life from an evolutionary viewpoint. Regardless of advances in imaging techniques, some questions surrounding anxiety remain unanswered. In class, we discussed several topics which have been presented as dilemmas to modern researchers. I will examine the role of consciousness and society in the manifestation of anxiety, how variation of the human brain could actually result in neural circuitry that predetermines elevated anxiety levels in certain people, and I will also discuss the positive and negative aspects of two popular treatments, psychotherapy and pharmacotherapy, and their implications to future diagnostic measures.

The topic of consciousness has resurfaced quite often in our class discussions. Consciousness has been hard to define in neurological settings, and in the broader realm of psychology, because of the variety of definitions commonly associated with the term “consciousness”. In an effort to simplify the aims of this paper, I will define “consciousness” here as an “awareness of the self”. I found the topic of consciousness, as it relates to anxiety, very intriguing. As Paul pointed out, one may or may not be conscious of the fact that they are experiencing symptoms of anxiety. Conversely, we could hypothesize that one is not actually experiencing anxiety until they are conscious of it. In a related manner, it could be that societal constraints project negative connotations onto a person who has been identified as having an anxiety disorder, which culminates in their (hyper-)consciousness of their own “disorder”. Thus, it could be further argued that people (at least, in the United States) only become conscious of their having an anxiety disorder in response to widely held societal beliefs that people who are not as “driven” to succeed as others (in keeping with the American capitalistic spirit) are somehow lacking necessary neural circuitry/experiencing a malfunction in that circuitry. When these beliefs are imposed on people, they are more apt to believe that they are indeed experiencing a malfunction in their neural wiring. Instead of becoming aware themselves that they might be experiencing relatively abnormal levels of anxiety, they are marked by American society as being different and therefore are assumed to be abnormal. Clearly, these issues represent just the tip of the iceberg, in terms of issues that plague neurobiologists and psychologists alike in the quest to understand anxiety and, more specifically, the roles that consciousness and society play in the manifestation of anxiety.

As we discussed in class, this consciousness may well result from the recognition of “two behavioral outcomes from the same brain state”, meaning that “[o]ne part of one's brain can be generating signals that result in bodily sensations of anxiety and another part can be experiencing those sensations and deciding how to act” (Grobstein in class forum on anxiety). In this case, it could be argued that this person is then conscious of the fact that they have “bodily sensations of anxiety” because they are directly experiencing their body’s own generation of these sensations. However, this scenario does not allow us to postulate about the role of society and how it influences people to become aware of their own feelings of anxiety. Society creates norms to which people are supposed to adhere. When someone’s behavior, or affect, falls outside of what is deemed acceptable by societal domains, they are made out to be different under the assumption that they, or their brains, are somehow abnormal.

There may actually be something to the assumption that anxious people have fundamentally different brain structures that result in this “abnormal” functioning. Two of the articles presented in class discussed the possibility that certain brain structures predispose people to eventually develop an anxiety disorder. For example, Koster, Crombez, Verschuere, and De Houwer (2006) reported that some people actually spend more time focusing on things that make them anxious. This hyper-awareness (perhaps requiring conscious effort) seems to act in tandem with neural circuitry that predisposes certain people to have anxious tendencies, which could ultimately culminate in the manifestation of an anxiety disorder. The authors state that “attentional biases towards threatening information in high trait anxious individuals play an important role in the maintenance of anxiety and may even cause the development of clinical anxiety disorders” (Koster, Crombez, Verschuere, & De Houwer, 2006). This information leads us to entertain the possibility that brain structure plays an important role not only in one’s mood and affect, but also in one’s likelihood to develop a mood disorder. This would imply that societal factors are less important than brain structure and neural organization in the manifestation of anxiety. This viewpoint supports the theory that brain structure determines function, or behavioral outcome. A question regarding consciousness that was raised in class still remains unanswered. Does this innate neural circuitry that makes one prone to experiencing anxiety imply that this anxiety stems from the unconscious brain? Or can people be conscious of the fact that their brain structure makes them more anxious than the average person?

Further evidence for the role that brain structures play in the manifestation of anxiety comes from another article discussed in class. The ScienceDirect article, by Quirk and Beer (2006), focused on the involvement of the ventromedial prefrontal cortex in the regulatory inhibition of the amygdala, which serves as the brain’s epicenter for the production of “bodily sensations” of anxiety. The authors explain that certain “processes of regulation of emotion trigger activation of the ventromedial prefrontal cortex and inhibition of the amygdala” (Quirk & Beer, 2006). Thus, the ventromedial prefrontal cortex regulates the experience and manifestation of anxiety by inhibiting amygdala activity, which creates sensations of anxiety. This information is useful because it implies that there are brain structures designed to also inhibit the manifestation of anxiety. We can even apply this to the New York Times article, Understanding the anxious mind; perhaps the high-reactors, or the people who are prone to experiencing feelings of anxiety, experience deficits in the mediation of anxiety because of faulty regulation by the ventromedial prefrontal cortex. We could entertain the notion that high-reactors have over-reactive brain structures that make them more attentive to threat and anxiogenic stimuli in addition to a less-than-normally-active ventromedial prefrontal cortex which ultimately allows sensations of anxiety to develop into anxiety disorders.

Given the evidence that brain structure plays a critical role in the experience of anxiety, various treatments have sought to target neurological structures to counteract anxiety. Prior to this class discussion, I believed that psychotherapeutic treatments were the best way to treat anxiety. More aptly, I believed that an individual undergoing a form of psychotherapy (like Cognitive Behavioral Therapy; hereafter CBT) would have a more positive outcome than someone taking prescription medicine because of the commitment and involvement required in talk therapy. However, this is not the case. There are certainly struggles to find the right prescription drug to treat anxiety, but when someone finds the right pharmacological agent, they can experience very successful outcomes, as well. There are positive and negative aspects to both psychotherapy and pharmacotherapy.

Pharmacotherapy has been vilified as a “quick-fix” for many disorders. Pharmacotherapy has the ability to interact directly with neurotransmitters in the brain, but usually effects are not noticeable until after at least three consecutive weeks of treatment. Similarly, it is hard to limit the interactions the drugs will have with other neurotransmitters in the brain. In other words, the effects of the drug can be generalized to multiple synapses, it is hard to localize the interaction of the drug in an effort to better manage the drugs’ positive effects. Sometimes people can experience negative side-effects from the drugs prescribed to them as treatment. This is usually due to the fact that localizing, or limiting, a drugs interactions is very difficult, as previously mentioned. Therefore, the drug interacts with various neurotransmitters and results in widespread changes in neurochemical levels, which is responsible for the negative side-effects. Although pharmacotherapy may take a while to become effective and there may be some negative side-effects associated with this type of treatment, it is still proven to be an effective treatment method and has the ability to work directly on endogenous neurotransmitters.

Various forms of psychotherapy, like CBT, has been found to be very effective, as well, however it requires more participation by the person undergoing treatment than simply taking a pill everyday. CBT is effective because it teaches training techniques and helps people learn to cope and change their own mentality. It also allows people to recognize that their previous outlook on life largely contributed to the manifestation of a mood disorder, in this case, anxiety. CBT has received positive praise because it often seems to be a better option than pharmacotherapy, especially in light of the high incidences of overmedication that have been reported in the media and the fact that people taking prescription medication tend to continue taking them for long periods of time. Both psychotherapy and pharmacotherapy have been found to be effective, but there are always some individuals who do not benefit from either therapy. Perhaps the future of diagnosis and treatment will bring about the advent of individualized treatment. This individualized treatment could combine multiple therapies to more effectively treat a person’s anxiety on an individual level. A special and individualized treatment method could help people who are predisposed to develop an anxiety disorder. Surely, people who are “wired to worry” would benefit from a therapy that differs from the therapy of someone who lacks an inherent neural basis for anxiety. A final theory from our class dicussion that intrigued me concerned consciousness again. Does the participation involved in psychotherapy imply that people undergoing this type of treatment are making a conscious effort to alleviate their symptoms of anxiety? Are people undergoing drug therapy participating in an unconscious process of treatment?

Consciousness is very strongly embedded in the current debates and popularly held beliefs about anxiety. Society also plays a critical role in the experience of anxiety. Due to the myriad differences in the individual structure and organization of the human brain, some people are actually more prone to worry and develop anxiety disorders. Current treatments for anxiety have been proven effective, but could possibly be more effective if they were tailored to each individual. This leaves us with one final question: is psychology/neurobiology prepared to provide individualized treatment or will this never be a possibility due to the immense variation amongst people and their individual experiences of anxiety?

References

Grobstein, P. (2010, February 28). Anxiety: Again culture, consciousness, and construction. Message posted /exchange/node/6210#comment-116272

Henig, R. M. (2009). Understanding the anxious mind. The New York Times. Retrieved from http://www.nytimes.com/2009/10/04/magazine/04anxiety-     t.html?_r=4&scp=3&sq=anxiety&st=cse

Koster, E. H. W., Crombez, G., Verschuere, B., & De Houwer, J. (2006). Attention to threat in anxiety-prone individuals: mechanisms underlying attentional bias. Cognitive Therapy and Research, 30, 635-643.

Quirk, G. J. & Beer, J. S. (2006). Prefrontal involvement in the regulation of emotion: convergence of rat and human studies. Current Opinion in Neurobiology, 16(6). Retrieved from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VS3-4M8779P-1&_user=400777&_coverDate=12%2F31%2F2006&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000018819&_version=1&_urlVersion=0&_userid=400777&md5=9cb7c0db7c05bdde80688ca183d6db80