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Mindful : April 2019
something that may go wrong. The part of the brain that worries about a future event we’re antic- ipating is the prefrontal cortex, and that’s where the second pathway to anxiety starts—the one that creates that flurry of anxious thoughts you can’t seem to control. Worried thoughts in the cortex trig- ger a stress response in the amygdala, which explains why we can freak out about things that aren’t even happening. “I think of the amygdala as sitting there watching cortex television,” says Catherine Pittman, a clinical psychologist and coauthor of Rewire Your Anxious Brain. “ You can be on your back porch, looking at the beautiful trees, but you’re thinking, ‘ How am I going to pay my mortgage with these medical bills? They’re going to take my house away!’ Your anxiety spikes even though nothing around you is dangerous.” It’s important to realize that the cortex can’t create anxiety on its own. It can only activate the stress response when it gets the amygdala involved. The amygdala, on the other hand, can bypass the cortex, detect threats in the envi- ronment, and react, quickly. When I swerved to avoid being hit by that car, my amygdala took over while my cortex was still figuring out what was happening. Similarly, when a veteran feels anxious at what sounds like g unfire, it’s because his amygdala has gone into overdrive. The amygdala is constantly sweeping the scene, comparing our current experiences with associations learned long ago and some that are prob- ably hard-wired. When it finds a match, it compels us to react, even if the current situation really isn’t all that threatening. The cortex is like a parent who intervenes to prevent a child from acting on his or her impulses. It acts as a check for when the amygdala overreacts, rec- ognizing, for instance, that what sounded like gunfire was actually a car backfir- ing and promptly tamping down the anxiety. Some- times, though, the amygda- la’s response is so overpow- ering that it drowns out the voice of the cortex. That’s anxiety in overdrive. The neuroscientist whose work led to the realization that anxiety arises from two distinct neural path- ways is Joseph LeDoux, the director of the Emotional Brain Institute at New York BECAUSE WE’RE SUCH IMAGINATIVE CREATURES, WE CAN GET STRESSED OUT BY SIMPLY THINKING ABOUT SOMETHING THAT MAY GO WRONG. University. His discovery of a direct neural pathway to the amygdala overturned the conventional wisdom that the cortex played the starring role in creating anxiety and instead placed the amygdala at center stage. This revolutionar y development has enor- mous implications for why some anxiety treatments work better than others— and for why mindfulness approaches are now getting so much attention. Getting to the Amygdala of the Problem In the 1960s, people who suffered from anxiety would have been advised, taking a cue from Freud, that they needed to uncover the unconscious forces driv- ing their fears. By the ’70s a more pragmatic approach had taken hold: Learn to change the thoughts and behaviors that lead to anx- iety. Cognitive therapy has proven successful in helping people interrogate the nega- tive thoughts underpinning their worries: Are people really judging me so harshly when I give a presentation? And what’s the worst that can happen if they are? Patients learn to question whether their thoughts are realistic or if they’re cata- strophizing based on scant evidence. → PHOTOGRAPHBYTIMFLACH/GETTYIMAGES April 2019 mindful 55 neuroscience