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Mindful : December 2014
T he Bra in Tumor Epi- sode was not the first— or last—time I believed I was at risk of immi- nent death. Worries over nuclear wa r, fire, kidnapping, and tse-tse flies had all come before. In college, I found my way more tha n once to the emergency room, cer- tainIwasdyingofanMI.(Iwasupon the lingo for myocardial infa rction, aka heart attack, and many other conditions after spending countless hours watching doctor shows.) Inevitably, the ER doc would tell me I was having a panic attack a nd shoot me up with valium. I can’t remember a time when I wasn’t prone to a nxiety. I can’t remember a time when I haven’t wrestled with fear. In a sense, fear and anxiety have been my greatest teachers, moment by moment prompting me to come to grips with liv- ing in a body, living in the world. The Latin root of anxiety is angere, to choke or strangle—just the sort of sensa- tion felt during a pa nic attack. Accord- ing to the National Institute of Mental Health, anxiety disorders affect about 40 million American adults aged 18 years a nd older—about 18% of the population. Women are 60% more likely than men to experience an anxiety disorder over their lifetime, and a large national survey of adolescents reported that about 8% of teens ages 13-18 have a n anxiety disorder, with sy mptoms commonly emerging around age six (Hello!). And these are only the folks who get a formal diag nosis of a nxiety in one of its recognized forms: genera lized a nxiet y disorder, obses- sive-complusive disorder, social phobia and other phobias (snakes, airplanes, heights, you name it), panic disorder, a nd post-traumatic stress. But what about everybody else? The worried well, the high functioners plag ued by insecurity, dread, persistent stress, irrational fears? People without a formal diag nosis? People like me? “ When this many people have anxiety, is it really a disorder?” asks Phillippe Goldin, Ph.D., a n assistant professor at UC Davis who also directs the Clinically Applied Affective Neuroscience Research Group at Stanford University. A major thrust of Goldin’s research is the effect of mindfulness on clinical anxiety. “No,” he says, a nswering his own question. “Anxi- ety is normal in many, many cases. From an evolutionar y perspective, anxiety has been preserved in the human animal over millions of years. If everyone came in chilled out and calm, that would be the death of huma ns.” What is chang ing radically, though, is how psychologists and neuroscientists view not just a nxiety, but depression and other mood disorders as well. “The labels come from psychiatry, with the bless- ing of the pharmaceutical industry, but mounting evidence shows that the basic neural circuits are consistent across all these disorders,” Goldin explains. “The push now is to identify core psycho- biological mechanisms that help us understand what cuts across human experience without using these labels. What core mechanisms turn anxiety and distorted self-views from on to off?” Rema rkably, negative emotional states a nd self-perceptions can be seen clearly in functional MRIs of the brain. What’s more, Goldin says, “The common understanding is that the prefrontal cortex down-reg ulates the amygdala [i.e., it’s less aroused]. Anxiety reduces. That ’s oversimplistic. The data suggest that some people depend on the energy arousal of the amygdala for greater cognitive and emotional control, while in others the amygdala is overly aroused and needs to be quelled. What ’s really needed is individual and context-depen- dent modulation of brain circuitry.” The research sounds exciting. Still, I wonder, how might it help people whose brains aren’t being mapped by neuro- scientists? How do we form those new neural pathways we hear so much about? How do we, in Goldin’s terms, become Jedi masters of up- and down-regulation of our a mygdalae as needed? Not surprisingly, he says there’s no one-size-fits-all solution. “The Holy Grail now is treatment matching. There a re several potentially helpful components.” These include mindfulness meditation: either non-judgmental awareness of the present moment, or focused attention on an object, usually the breath. Mind- fulness-Based Stress Reduction (MBSR) has shown great promise in regulating mood states. So has Cognitive-Behav- ioral Therapy (CBT), in which clients learn how to identify and work directly with the thoughts that influence their emotions a nd behavior. Also in the tool- box are other forms of psychotherapy, medication, and aerobic exercise, as well as changes in diet and behavior. “ But we know that each of these interventions works for less tha n 50% of people studied,” says Goldin. “ What will amplify the effectiveness of any one or combination of treatments is creating an individualized lea rning experience that gets adjusted over time.” Still, he cautions, “To maintain the gains, you have to keep practicing.” Even if you do two months of MBSR, there will be longer term benefits if you stick with it. But for that to happen, you need the ongoing reinforcement of a teacher and a community.” Meditation troubles True confession: Although I’m power- fully drawn to mindfulness practice— and have done many retreats over the past 30 yea rs—I’ve often had trouble meditating. Times when I’ve been too anxious, too restless, my thoughts too rambunctious, my body too wired to sit quietly and follow my breath. This is my dirty little secret. I take comfort in knowing I’m not a total outlier. “ Everyone has to custom desig n their own pathway of soothing the nervous system,” says Tara Brach, Ph.D., a clinical psychologist and founding teacher of the Insight Meditation Community of Washington, DC. “There’s a reason it’s called a nervous system.” For people who have difficulty staying put on a → Anxiety disorders affect about 40 million Americans aged 18 and older—about 18% of the population. 40 million 38 mindful December 2014 mental health