A new analysis by two neuroscientists asserts that there has been a misunderstanding of how certain parts of the brain function which has significantly hindered the development of new effective drugs for fear and anxiety.
The findings, published in the American Journal of Psychiatry, offer new insights into neurological processes with the aim of overcoming existing barriers to drug development.
“Progress has stalled in treatment development for mental disorders,” write Drs. 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.
“Promising new treatments either have not turned out to be useful when tested with patients or exhibit potential adverse effects that limit their applicability to severe disorders. We argue that this state of affairs reflects how fear and anxiety have been conceived, and we offer a new framework to address the problem.”
The researchers point out that discoveries about how the brain detects and responds to threats has been at the core of research aimed at improving treatments for fear and anxiety disorders. However, they say that a misunderstanding of how the brain is wired with regard to both fear and anxiety has stalled effective drug development.
In short, research efforts have assumed that emotions such as fear lead to both the experience of “fear” (the feeling of being afraid of being harmed) and to behavioral and physiological symptoms that also occur.
However, contrary to current theories, the researchers say that the brain circuits that underlie conscious feelings are different from those that underlie behavioral and physiological responses. So while both sets of symptoms — the conscious and the behavioral/psychological — must be understood and treated, they must be addressed differently.
“Failure to recognize this difference has impeded understanding of fear and anxiety and their treatment,” they argue. “Going forward, recognition of this distinction should provide a more productive path for research and treatment.”
LeDoux and Pine present a new framework aimed at creating such a route; one based on the theory that there are differences between the processes that give rise to conscious feelings of fear or anxiety and the non-conscious processes that affect behavior and physiological responses. New treatments must reflect this dual approach.
“Behavioral and physiological symptoms may be treatable with either medications or certain psychotherapies, such as cognitive-behavior therapy,” they note, “while conscious feelings may have to be addressed with psychotherapeutic treatments that are specifically designed to change these.”
More research on humans is necessary to fully understand conscious feelings in the brain, say the researchers, while animal research is needed to study the brain mechanisms that underlie the non-conscious processes that control behavioral and physiological responses.
“Our ability to understand the brain is only as good as our understanding of the psychological processes involved,” they conclude. “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.”
Source: New York University