Bret S. Stetka, MD

Disclosures

June 10, 2014

In This Article

The Roots of Fear and Anxiety

On Tuesday, May 6, at New York City's cavernous Javitz Center, Dr. BJ Casey, PhD, took the stage to discuss why some of us are anxious -- how we develop fear and anxiety responses neurobiologically, that is. Dr. Casey, a professor of developmental psychobiology and Director of the Sackler Institute at Weill Cornell Medical College, was speaking to a large room of psychiatrists, psychologists, and researchers at the American Psychiatric Association's 167th Annual Meeting. "Thank you," she announced, "I hope you've had some coffee. It's a difficult time after lunch."

As many as 18% of US adults[1] and upwards of 30% of young people[2] suffer from some form of anxiety, making it the most prevalent mental health disorder in the country. Depending on the type of anxiety and time course of symptoms, adults with anxiety are typically treated with various combinations of fast-acting anxiolytics (namely, benzodiazepines); other pharmacotherapies, such as antidepressants, and psychotherapy, particularly cognitive-behavioral therapy (CBT).

Similar strategies are used in children and adolescents, with CBT being the primary evidence-based behavioral therapy used in this population. The idea is to identify the cause of the anxiety and replace associated negative behaviors and thinking patterns with positive ones. Exposure-based therapy, a type of CBT, is considered one of the more effective approaches to treating pediatric anxiety, though it still only carries a 50%-60% success rate.[3] The technique involves gradually and repeatedly exposing a patient to an anxiety- or fear-inducing stimulus or situation until they are able to overcome the negative associations and reactions -- in other words, attempting to desensitize them to anxiety-causing cues.

Anxiety often goes undiagnosed, and therefore untreated, in children and adolescents. Left untreated, it can lead to chronic and debilitating mental and physical illness. Casey and a number of her colleagues feel that patient outcomes can be improved, not only through improved recognition but also by personalizing treatment. If researchers can untangle the web of connections occurring in the developing brain, and how certain developmental patterns increase or decrease anxiety risk, clinicians would then be able to better determine which patients are more likely to respond to a particular treatment.

The adolescent brain is frantic with activity and influences. "Regional synaptic pruning and changes in myelination are occurring at a time when the brain is being marinated in gonadal hormones," Casey stated. She continued, "We also see peaks in neurotrophins and neurochemicals that are important to emotional and fear regulation." Neurotrophins are proteins that control neuronal development and function.

Casey then pointed out that although most brain imaging studies in adolescents have looked at the cortex, the deep, more primitive brain structures also play a key role in development, particularly in terms of learning the emotional significance of environmental cues. By the early 2000s, numerous laboratories were looking at how different brain regions, both primitive and cortical, interact with each other during development.

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