The science of fear.

This Discover article provides a nice overview of the biology of fear. It starts with early experiments by psychologists, e.g.:

In one of the most famous (and infamous) of these experiments, American psychologist John Watson decided to see if he could teach an 11-month-old baby named Albert to become scared of arbitrary things. He presented Albert with a rat, and every time the baby reached out to touch it, Watson hit a steel bar with a hammer, producing a horrendous clang. After several rounds with the rat and the bar, Watson then brought out the rat on its own. “The instant the rat was shown, the baby began to cry,” Watson wrote in a 1920 report. “Almost instantly he turned sharply to the left, fell over on his left side, raised himself on all fours and began to crawl away so rapidly that he was caught with difficulty before reaching the edge of the table.”

It looks at research revealing that there are variety of fear responses:

The first kind of behavior is a reaction to a potential threat, in which a predator isn’t visible but there is good reason to worry that it might be nearby. A rat might walk into a meadow that looks free of predators, for example, but that reeks of fresh cat urine. In such a case, a rat will generally explore the meadow cautiously, assessing the risk of staying there. A second, more concrete type of threat arises if a rat spots a cat at the other side of the meadow. The rat will freeze and then make a choice about what to do next. It may slink away, or it may remain immobile in hopes that the cat will eventually wander away without noticing it. Finally, the most active threat: The cat glances over, notices something, and walks toward the rat to investigate. At this point, the rat will flee if it has an escape route. If the cat gets close, the rat will choose either to fight or to run for its life.

It discusses research into whether humans exhibit similar fear responses, using a Pac Man-like video game in which study participants played the role of prey being pursued by predator:

This deceptively minimalist predator-prey game triggers some remarkably intense feelings. Mobbs measured the skin conductance of his players by rigging them up to a device similar to a lie detector. He found that when the predator was bearing down on players, they often experienced the same changes to their skin as those seen in people having panic attacks. Mobbs unleashed two kinds of predators on his players, a less adept one that was easy to escape, and a smarter one that was more likely to capture its victim. When people were chased by the better predator, they showed a stronger panic response in their skin, and they also crashed into the walls of the maze more often.

Meanwhile, striking changes were happening inside the brains of the players. The predators would first appear on the far side of the maze. While they remained at a distance, the same brain regions tended to become active in the players, a network that included parts of the amygdala as well as some other structures in the front of the brain. But when the predator was closing in, those brain regions shut down and a network of previously quiet regions farther back in the midbrain became active.

The bottom line is that fear is complicated:

...the amygdala and the periaqueductal gray are ancient parts of the brain, dating back hundreds of millions of years. Our small hominid ancestors probably faced the same kinds of threats that baboons do today from leopards, eagles, and other predators. Even after we evolved the ability to use weapons and became predators ourselves, this ancient brain circuit still offered a useful defense against members of our own species.

Unfortunately, our exquisitely sophisticated brains may make this predator-defense circuit vulnerable to misfiring. Instead of monitoring just the threats right in front of us, we can also imagine threats that do not exist. Feeding this imagination into the early-warning system may lead to crippling chronic anxiety. In other cases, people may not be able to keep their periaqueductal gray and other midbrain regions under control. As we perceive predators getting closer, our brains normally make the switch from the forebrain to the midbrain regions. People who suffer panic disorders may misjudge threats, seeing them as far more imminent than they really are.

 If you're interested in this stuff, you might like this and this.

Panic and anxiety stories from around the globe.

Lots of tales of people coping with anxiety and panic in blogs and newspapers in recent weeks. Like Irishwoman Caroline Revins:

It all began for Caroline with the first bombs in Talbot Street in 1974. She was at work nearby in Townsend Street at the Post Office...
"A lot of bomb scares followed, and I suppose that all fed my anxiety levels," she says.

"The first day back at work, a colleague told me that an old school friend of mine had committed suicide. I got a panic attack. My heart felt like it was going to explode in my chest. My hands were sweating and I was trying to get away and to act normally, even though my legs were shaking and I thought I was going to pass out. It was absolutely horrible."

From Vermont, there's equestrienne Barbara Ann Curcio and her story:

One of my major challenges with riding was to stay in the present. Having had more than my share of falls, I was convinced that it wasn’t a matter of if, but when my horses would misbehave. I obsessed about what they might spook or shy at around the next corner, and remembered all the places they had run away with or dumped me in the past–all of which distracted me from what they were actually doing now, even if they happened to be behaving. Once I began to breathe, I could actually feel what was happening without all the emotional baggage, projection and self-torture. Could I really expect my horse’s attention to be on me, if mine was not really on him? And since horses live in the moment, this is where they can be ridden most effectively.

Using a combination of therapy, yoga and mindfulness meditation, I turned my riding into a practice where the goal was not perfection, but feeling my body and the horse’s. With my husband’s support,
doing what amounted to exposure therapy–a physically and emotionally painful process–I learned to accept the anxiety and even ride with it.

From Scotland, there's the story of a woman whose panic resulted in some unusual, but understandable, behavior:

A desperate panic attack sufferer has been living in an NHS hospital car park for five months.
The 29-year-old woman is sleeping in her car outside an A&E unit - with the knowledge of doctors and police - since November.

She is severely agoraphobic and only feels safe in the car park where she is near doctors.

The woman said: "My life has been turned upside down. I no longer have much of a life being stuck here. "I'm a bit embarrassed about it because I know it's not a normal thing to do but I can't help it.

 Finally, there's New York-based comedienne Brooke Van Poppelen and her story:

Around age 21, I had scored a wonderful boyfriend whom I was pretty serious with. He'd successfully managed Type I diabetes since the age of 4. I often stayed the night, and one morning woke up to him convulsing and foaming at the mouth. He was having a diabetic seizure -- and I had no clue what to do. I frantically called 911 and fumbled through his fridge, looking for insulin and needles, ready to do something drastic if it took EMS too long to arrive. I didn't know that he didn't need insulin -- he needed sugar. Luckily, I simply stayed put, although it was terrifying to just stand there, unable to help. It haunted me to find out that nearly acting on my good intentions could have killed my boyfriend.

He recovered within two days, which is right around the time I had my first attack.

Remember, panic sufferers: You're not alone!

Panic, brain pH, and exercise.

As this Scientific American article discusses, a recent University of Iowa study suggests that panic may be related to the brain's pH level:

In general, the pH of our brain is carefully regulated. A large increase or decrease in brain acidity can seriously disrupt brain functioning. This new study indicates that pH can sometimes rise and fall in synapses, the points of communication between individual neurons in the brain. Some synapses include specialized proteins that "sense" acidity.  These proteins (called "'acid-sensing ion channels", or ASICs) stimulate neurons when increased acid is detected.

The Iowa study shows that genetically modified mice lacking these acid-sensing proteins have a greatly reduced capacity to show either instinctive or learned fear.  When the researchers restored the ASIC gene only in the amygdala of these genetically modified mice, they observed a normalization of fear behaviors. So their studies suggest that the ability to detect changes in synaptic pH in the amygdala is essential for normal fear behavior...

The Iowa findings might help explain the significance of another curious observation: patients with panic disorder tend to generate excess lactic acid in their brains. Scientists have long hypothesized that an abnormality affecting basic cellular metabolism or pH lay at the heart of the genetic vulnerability to panic disorder.  One of the products of glucose metabolism is lactic acid, or lactate. Lactate is constantly being produced and consumed during brain activity, but if it accumulates in the brain, it will make the brain more acidic.  Recent studies have shown that patients with panic disorder consistently build up excess lactate in their brains during ordinary mental activities. The results of the Iowa studies suggest that one of the triggers for “spontaneous” panic attacks in patients with panic disorder might be lactic acid accumulating in acid-sensitive fear circuits.

As of now, there's no magic pill you can take to lower your brain's lactic acid levels. There is something you can do, though -- something we've discussed before here on PANIC!:

...one of the many beneficial effects of aerobic exercise training (like running or cycling) is that metabolically active tissues (including the brain) become more efficient at consuming -- removing -- lactic acid. There is growing evidence that exercise training has powerful anti-anxiety and anti-panic effects. This invites the speculation that exercise training may reduce anxiety in part by improving the brain's ability to prevent excess acid accumulation in acid-sensitive brain regions involved in fear. If experiments support this idea, then specific exercise training regimens could be designed to take maximum advantage of this anti-anxiety mechanism.

Now go break a sweat.

Afraid to go to the dentist's office? Here's a possible solution.

The upside, if you can't make it to the dentist's office: More and more dentists will come to you. According to one recent article:

David Blende, a Tiburon resident and founder of the Blende Dental Group in San Francisco, has been doing house calls sporadically for the past two years, but he decided in July to launch a new division aimed at those confined to their homes due to dementia, obesity, agoraphobia or other ailments, said Amanda White, business manager for the practice.

The three dentists in the group were already known locally for doing dental work on patients with severe phobias or physical problems that required anesthesia for dental examinations, Blende said. But he said the new division is a Bay Area first because it focuses exclusively on house calls.

Bay Area House Call Dentists is another provider in the same region that will come to you.

Great news, right? As long as you're flush with cash, it is. According to the article:

Rates for the house calls begin at $375 for an initial appointment and then vary depending on treatment needed in follow-up appointments, White said. The practice does not accept dental insurance because rates are generally insufficient to cover costs for effective treatment, she said.

If you're like the many agoraphobics who can work only sporadically if at all, on the other hand, you may still be s**t out of luck.

The fear-prevention window of opportunity.

A January article in the U.K. Times provides a thorough, intelligent look at how researchers are finding success in preventing our fear memories from reconsolidating once we actively recall them. Here's how it works:

...traumatic memories are not written just once but every time we remember them. When we first record memories the presence of certain proteins strengthens connections between the synapses — the gaps between nerve cells — in the brain. However, every time we recall these memories subsequently the proteins break down and must be remade from scratch. During this period of reconsolidation our memory is vulnerable to reshaping.

The article mentions propanolol, a beta blocker, which regulates the heartbeat (and which I've discussed here on PANIC! in the past), as well as Tetris, which one researcher has used to block fear-memory reconsolidation (and which I've also discussed here on PANIC!). It also discusses other treatments being studied, most notably a therapy that interrupts the effectiveness of a specific brain protein in the fear memory-reconsolidation process:

...perhaps the most effective way of erasing memories was discovered a few years ago by Todd Sacktor, from the SUNY Downstate Medical Centre in New York. He believes that memories are strengthened by a protein called PKMzeta. This effectively acts as glue, turning up at specific synapses when we learn new things and doubling the strength of their connections.

Sacktor says that this discovery has prompted a “revolutionary change in how neuroscientists have thought about memory”. It suggests that our memory is a dynamic machine that needs the constant activity of PKMzeta to stand the test of time. With this power supply memories can last for years; without it they are lost. It is likely that the process of reconsolidation involves breaking down and remaking PKMzeta at specific synapses, and drugs such as propanolol work by obstructing this process.

In order to test his theory, Sacktor trained rats to avoid the taste of saccharin, an artificial sweetener. He then removed this aversion with a single injection of ZIP, a chemical that interferes with PKMzeta. The dose does not stop rats from laying down new memories, but it does erase existing ones, even if they are very strong and relatively recent. Even more dramatically, the process seems to be irreversible and universal. Sacktor says: “It applies to all parts of the brain that store different types of memory, like the amydgala that stores fear memories, the hippocampus that stores place memories, or motor memories in the motor strip. They’re all using PKMzeta.

"Deep Aftershocks": Fighting anxiety and depression in Haiti.

Earthquakes, hurricanes, tsunamis: Sometimes it seems the world has been experiencing more than its fair share of massively lethal acts of God in recent times. Among the most devastating: the 2010 Haiti earthquake, which killed some 300,000 people.

According to a recent L.A. Times article, the price imposed by that disaster goes beyond the death toll and the economic costs. For many Haitians, the price has been mental illness:

...The damage is still emerging months after many of the physical wounds were patched up.

An untold number of Port-au-Prince residents are suffering anxiety or feeling panic at the slightest movement that suggests the earth is shaking. Others have fallen into depression. For people who had underlying mental illnesses, the shock and grief have been severe enough to trigger a variety of disorders, including schizophrenia and mania, mental health workers say.

The poorest country in the Western Hemisphere was never an easy place to live. Recent months have poured more stress on families, many of which are living on the streets with no money, unsteady supplies of food and a future that on many days appears to be a fearsome void.

"People were pushed over the threshold," said Peter Hughes, a London psychiatrist who heads mental health efforts in Haiti for the Los Angeles-based International Medical Corps, which has three psychiatrists working here.

The article goes on to discuss good works being done to improve Haitians' mental health by groups like Partners in Health and the International Medical Corps:

For now, the task at hand is getting people like Jeanne Paul and James Dort through their personal crises. Paul, the woman chanting Psalms nonstop, had been treated for mental illness and had improved, her sister said. Since the earthquake, she's had a relapse.

Dort, 28, says that since Jan. 12, his heart often suddenly pounds furiously.

Hughes and a Haitian psychologist, Kettie Archer, guide Dort through a series of questions about his life, the earthquake, his feelings. They demonstrate a breathing exercise that can help him relax and invite him to a meeting for people with quake-related anxieties.

Hughes concludes with a diagnosis that is familiar these days.

"There are a lot of people who have their hearts going fast," he tells Dort. "What you have is not abnormal. You're not mad."

Reading this sent me back to January 1994 and the Northridge earthquake. I'd been dealing with panic for about seven years by that point, and had been managing pretty well after moving to L.A. from New York the previous year, largely thanks to an aggressive cycling regimen. The earthquake, an experience I'd describe as like being inside a giant washing machine, set me back vis-a-vis anxiety for the year or so that followed. I would have to battle panic much more regularly than had been the case in a while -- whenever I was stuck in traffic on the 10, or halfway up a crowded escalator in the Beverly Center, or at a red light beneath a highway overpass (I'd been to see one of the overpasses that had collapsed, in Hollywood; the force that had caused such damage had impressed me with its power).

I know that period was a challenge to me, even given my privileged socioeconomic position relative to most Haitians; I can only imagine the difficulties some folks there must be experiencing today.

Bill Murray does panic, OCD, agoraphobia, and much more.

What About Bob? is one of the better films out there built around a character with an anxiety disorder. (Others that come to mind: Analyze This, As Good As It Gets, Copycat, and Vertigo.) If you haven't seen it yet, or haven't seen it in a while, or have seen it recently but are a big fan, you should enjoy the above clip.

"What makes a hero a hero, and a coward a coward?''

This is the story of Andrew Pogany, Iraq War veteran. There, while facing the horrors of war firsthand, he panicked -- and was labeled a coward by his superiors:

He deployed to Iraq in September 2003, a 32-year-old staff sergeant trained in intelligence and interrogation. Based at Fort Carson in Colorado Springs, he volunteered to go to war with a team of Green Berets when another soldier couldn't.

Then, only a few days in-country, Pogany saw the shredded body of a gunned-down Iraqi. He had what he thought was a panic attack -- vomiting, hallucinations. A psychologist concluded he'd had a normal combat stress reaction and recommended rest, then back to duty.

Instead, Pogany's commanders shipped him back to Fort Carson, and he was charged with ''cowardly conduct as a result of fear,'' a crime punishable by death under the Uniform Code of Military Justice. The last such conviction in the Army occurred during the Vietnam War.

Alone, he tried to cope with his PTSD.

There were medical tests, treatment for Lariam toxicity and, eventually, sessions with a therapist, yoga classes, studies in Buddhism...

...He also learned what it meant to feel true despair, to sit alone in his bedroom, getting comfortable with the idea of shooting himself just to make it all end. And he discovered how vital it was to have someone to turn to in those times.

Now he advocates with the military for other soldiers who are undergoing similar travails. In the end, it seems, he's doing more than most to uphold those most venerable of military values, duty and honor:

''Those of us who have come home and have survived this war ... we have an obligation to help those who come home and struggle. We must help them, because if we don't ... not only are we breaking a sacred promise we've made to them, we're also dishonoring the memory of those who have not come home,'' Pogany says.