Novel Approaches Required for the Development of Drugs for Anxiety and Fear

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Highlights

• Fear and anxiety are adaptive responses that are protective against a challenge.
• Disorders occur when responses to fear or anxiety interfere with daily activities such as job performance, school work, and relationships.
• Treating anxiety disorders requires an understanding of the underlying processes responsible for them.

A recent analysis brings to light the misunderstanding that exists in the functioning of certain parts of the brain in relation to fear and anxiety. Researchers feel that this misunderstanding could be responsible for the failure in developing new medications that could effectively tackle fear and anxiety disorders.

Anxiety and fear are two emotions that affect the well being of a person. Though these terms are often used close to each other, a basic distinction exists between fear and anxiety.

‘Fear and anxiety can be momentary, but they can also last much longer and affect your health.’

Anxiety is a vague unpleasant emotional state where the patient experiences apprehension, dread, distress, and uneasiness that is object less. Anxiety is manifested in a person's thoughts (cognitively), in a person's actions (behaviorally), and in physiological reactions.

Fear is a natural response to a threat that can be either perceived or real. Fear differs from anxiety as it has a specific object. It is often associated with a strong flight or fright response to this object which may be something dangerous like a fire emergency in your house or a phobia.

Fear and anxiety can last for a short time and then pass, but they can also last much longer and affect your health.

"Our ability to understand the brain is only as good as our understanding of the psychological processes involved," state the authors Joseph LeDoux, a professor in New York University's Center for Neural Science, and Daniel Pine, who leads the Section on Development and Affective Neuroscience, at the National Institute of Mental Health's Intramural Research Program.

"If we have misunderstood what fear and anxiety are, it is not surprising that efforts to use research based on this misunderstanding to treat problems with fear and anxiety would have produced disappointing results."

"Going forward, recognition of this distinction should provide a more productive path for research and treatment."

The researchers observed that:

• Discoveries about how the brain detects and responds to threats have guided research aimed at improving treatments for fear and anxiety disorders.
• But many promising new treatments either have turned out to be not useful in patients or may cause adverse effects that limit their use to severe disorders.
• Contrary to existing views, the brain circuits that underlie the conscious feelings of fear and anxiety are different from those that underlie the behavioral and physiological responses associated with these feelings.
• Both sets of symptoms, the conscious and the behavioral/psychological, must be understood and treated but they must be addressed differently.

The researchers developed a framework which indicates that the processes that give rise to conscious feelings of fear or anxiety and the non-conscious processes that generate behavior and physiological responses have differences.

The authors also suggest that treatment must move towards a dual approach where:

• Behavioral and physiological symptoms are treated with either medications or certain psychotherapies, such as cognitive behavior therapy
• Conscious feelings are addressed with psycho-therapeutic treatments that are specifically designed.

The researchers feel that research in humans is essential to understand the conscious feelings in the brain while animal research is required to understand the brain mechanisms that underlie the non-conscious processes that control behavioral and physiological responses.

The analysis is published in the latest issue of the American Journal of Psychiatry.

Tips to combat Anxiety

• You cannot stop worrying, but you could try postponing it. Make a worry time. List out your worries during that worry time.
• Distinguish your worries into those that have solutions and those that require brainstorming.
• Do not label yourself as a failure or a loser.
• Be good to yourself; do not be strict with yourself.
• Be aware of your thoughts, don't resist them. Not resisting will help you get over them.
• There is no strict way of conduct of life. Consider yourself a work-in-progress and move ahead with positive thoughts.
• Try to be in the company of those that energize you and not with those that add to your worries. If that's not possible, keep the discussion of certain topics off limits.
• Accept uncertainty.

References:

1. LeDoux JE, Pine DS. Using Neuroscience to Help Understand Fear and Anxiety: A Two-System Framework. - (http://dx.doi.org/10.1176/appi.ajp.2016.16030353)
2. New York University. "Researchers outline barriers to treating fear, anxiety."
3. How to Stop Worrying - (http://www.helpguide.org/articles/anxiety/how-to-stop-worrying.htm)
4. Fear and Anxiety - (http://www.csun.edu/~vcpsy00h/students/fear.htm)

Source: Medindia

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