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Mindful : April 2019
Anxiety star ts in either the amyg- dala (via fight- or-flight physical sensations) or the cortex (via thoughts). Sen- sory signals of external stimulus (e.g. seeing a snake or a rope, hearing a loud sound, speak- ing in front of a crowd) go to the thalamus, which translates and sends out two messages: 1 Amygdala pathway One message goes directly from the thalamus to the amygdala, which reacts quickly and triggers a fight- or-flight response before the cortex realizes what’s happening. 2 Cortex pathway A more precise message goes to the cor tex, which determines if the external stimulus is a threat. If it is, the cortex signals the amygdala to activate a fight-or-flight response. If it isn’t, the cor tex tamps down the alert. EXAMPLES External stimulus may be a danger (e.g. a snake) Amygdala triggers fight-or- flight response quickly Cortex confirms external stimulus is a danger, signals amygdala to trigger fight-or- flight response Fight or flight = Healthy stress reaction Danger! Snake! Pathways to Anxiety Yes, danger! Snake! A Danger is real, amygdala reacts We now know that cog- nitive therapy is effective at tackling anxiety that origi- nates from thoughts in the cortex. But it does nothing to tackle anxiety that arises from reactions in the amyg- dala itself. “ Your thoughts can’t change the way the amygdala reacts through using logic or reasoning with it,” says Pittman, who is also a professor at Saint Mary’s College in Notre Dame, Indiana. “The amyg- dala only learns through experience.” So how do you target the amygdala directly? One way is through behav- ioral, or exposure therapy, which helps the amygdala “unlearn” associations it’s made between danger and particular experiences— like encountering strang- ers, loud voices, boarding a plane, or driving a car. Behavioral therapy uses the gradual, repeated expo- sure to whatever’s causing anxiety as a way to help the amygdala learn a more neu- tral association between the experience and our reaction to it. Another way to treat amygdala-based anxiety is to simply calm down that part of the brain. Medica- tions are one option. Xanax and its other incarnations are members of a class of drugs known as benzodiaz- epines. “They basically put the amygdala to sleep,” says Pittman. And that works. But if your goal is to lessen anxiety over the long haul, taking benzodiazepines will impede your progress. “What is learning?” asks Pittman. “It’s neurons fir- ing repeatedly so that new connections form. Neu- rons have to fire to rewire. So if you give someone a medicine that prevents neurons from firing, how is the amygdala going to learn?” Alternatively, the reason that another class of drugs—the selective serotonin reuptake inhibi- tors known as SSRIs—have proven helpful for anxiety is that they appear to help neurons form new con- nections. “SSRI’s promote more communication between neurons,” says Pittman. “People start to be able to think outside the box a little.” But drugs aren’t the only—or the best—way to calm down the amygdala. There’s also the so-called relaxation response. It’s the “rest and digest” antidote to “fight or flight.” Using MRIs, scientists can now see how, just as the amyg- dala revs up during stress, it calms down when people employ the deep breathing exercises that prompt the relaxation response. And that’s part of the reason that mindfulness shows so much promise for treating anxiety. Sitting quietly and focusing on DECOUPLING THE STRESS CENTER FROM THE LOGIC CENTER ALLOWED PEOPLE TO FEEL MORE DISTANCE FROM THEIR ANXIETY, WHICH MADE IT MORE MANAGEABLE. HOW IT WORKS 56 mindful April 2019 neuroscience