Pepperdine University Pepperdine Digital Commons Theses and Dissertations 2016 The neuroscience of fear and anxiety: a primer for clinicians Lionel Lee Follow this and additional works at: https://digitalcommons.pepperdine.edu/etd Recommended Citation Lee, Lionel, "The neuroscience of fear and anxiety: a primer for clinicians" (2016). Theses and Dissertations. 1113. https://digitalcommons.pepperdine.edu/etd/1113 This Dissertation is brought to you for free and open access by Pepperdine Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Pepperdine Digital Commons. For more information, please contact [email protected], [email protected], [email protected]. Pepperdine University Graduate School of Education and Psychology THE NEUROSCIENCE OF FEAR AND ANXIETY: A PRIMER FOR CLINICIANS A clinical dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Psychology by Lionel Lee October, 2016 Louis Cozolino, Ph.D. – Dissertation Chairperson This clinical dissertation, written by Lionel Lee under the guidance of a Faculty Committee and approved by its members, has been submitted to and accepted by the Graduate Faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY Doctoral Committee: Louis Cozolino, Ph.D., Chairperson Robert deMayo, Ph.D. Joseph Turner, Psy.D. © Copyright by Lionel Lee (2016) All Rights Reserved TABLE OF CONTENTS Page LIST OF TABLES ......................................................................................................................... vi LIST OF FIGURES ...................................................................................................................... vii DEDICATION ............................................................................................................................. viii ACKNOWLEDGEMENTS ........................................................................................................... ix VITA ............................................................................................................................................... x ABSTRACT .................................................................................................................................. xv Chapter 1. Literature Review .......................................................................................................... 1 Epidemiology ...................................................................................................................... 1 Search for the Biology of Fear and Anxiety ....................................................................... 1 Adaptive Relationship Among Stress, Fear, and Anxiety .................................................. 5 Responding to Danger Through Phylogenetic Development ............................................. 7 Immediate and Preparatory Systems ................................................................................. 12 Neurochemistry of Fear and Anxiety ................................................................................ 15 Neuroanatomy of Fear and Anxiety .................................................................................. 18 Fear and Anxiety Circuitry ............................................................................................... 34 Development of Fear and Anxiety Disorders ................................................................... 40 Neuroscience of Unlearning Fear ..................................................................................... 48 Statement of the Problem and Research Proposal ............................................................ 51 Chapter 2. Methodology ............................................................................................................... 56 Databases and Dates of Publication .................................................................................. 56 Key Search Words ........................................................................................................... 56 Inclusion/Exclusion Criteria of Studies ........................................................................... 57 Consultation ...................................................................................................................... 57 Primary Methods of Research .......................................................................................... 57 Analysis of Data and Integration of Findings .................................................................. 58 Chapter 3. The Neuroscience Of Fear Vs. Anxiety: A Primer ..................................................... 61 Stress, Fear, and Anxiety: An Adaptive Relationship ...................................................... 62 Immediate and Preparatory Response Systems ................................................................ 64 Neuroanatomy of Fear and Anxiety .................................................................................. 67 Neurochemistry of Fear and Anxiety ................................................................................ 76 Fear and Anxiety Circuitry ............................................................................................... 77 v Chapter 4. Discussion ................................................................................................................... 84 Case Study ........................................................................................................................ 84 Background ....................................................................................................................... 84 In The Therapy Situation .................................................................................................. 85 Discussing War Experiences ............................................................................................. 85 Fear at Inappropriate Times .............................................................................................. 86 Flashback .......................................................................................................................... 88 Guidelines ......................................................................................................................... 89 Limitations and Recommendations ................................................................................... 91 REFERENCES ............................................................................................................................. 93 APPENDIX A: Davis - Mapping Fear and Anxiety ................................................................... 105 APPENDIX B: Implications of the Extended Amygdala ........................................................... 108 APPENDIX C: Davis – Paradigms for Measuring Fear and Anxiety ........................................ 111 APPENDIX D: BNST Outputs ................................................................................................... 114 vi LIST OF TABLES Page Table 1: Anxiety Disorders Through the DSM ................................................................................ 3 Table 2: Summary of Distinctions between Fear/Panic and Anxiety .............................................. 7 Table 3: The Triune Brain ................................................................................................................ 9 Table 4: Functions of the Amygdala .............................................................................................. 22 Table 5: CeA Targets and Physiological Responses ...................................................................... 24 Table 6: Hypothalamic Targets and Functions .............................................................................. 25 Table 7: Fear versus Anxiety ......................................................................................................... 63 vii LIST OF FIGURES Page Figure 1. BNST to HPA production of cortisol. ........................................................................... 26 Figure 2. LeDoux (1996) – The high road vs. the low road. ........................................................ 36 Figure 3. Fear pathway. ................................................................................................................ 39 Figure 4. Anxiety pathway. ........................................................................................................... 40 Figure 5. Fear and anxiety as stress responses. ............................................................................. 62 Figure 6. Sympathetic and HPA axis activation in the stress response. ....................................... 67 Figure 7. Fear pathway stage 1. .................................................................................................... 79 Figure 7. Fear pathway stage 2: Activation of anxiety and the HPA axis. ................................... 80 Figure 8. Anxiety alone pathway. ................................................................................................. 82 viii DEDICATION To Matthew Kenta Lee. ix ACKNOWLEDGEMENTS This journey could not have been accomplished without help. First, I would like to thank my committee members, Dr. Robert deMayo and Dr. Joseph Turner for removing my blinders and challenging me to see the bigger picture of this project to the field. To my chair and mentor, Lou Cozolino, thank you for