# Fear/anxiety research



## Ian (Apr 18, 1999)

Very interesting BBC Radio 4 programme a couple of evenings ago re. fear/anxiety response, areas of the brain involved, research using scanning techniques and treatments and new medications that could eventually target individuals' specific disorders.The main themes were (based on what I remember of the programme and a few notes):- Patients with phobias/anxiety states etc suffer from an overloaded fear response system - a constant state of 'low boil' / circuits constantly firing.- Part of bran involved is the 'amigdala' (sp?)- Negative emotions are uppermost and become part of fear memory. - Fear memory never goes away, but it is possible through CBT to break the cycle, to build an extiction memory to counteract the fear memory.- Through CBT rational part of brain will jump in and over ride negative thought patterns.- New research in London is discovering, through neural imaging, the celular mechanisms of the emotions, including anxiety and depression.- Chemical cyclocerine (sp?) is potential new medication, which along with CBT, could help build stronger extinction memories.- Future is treatments targeted to receptors in specific parts of brain to suit each individual. Sorry the above is just a remembered resume, but it did seem that fruitful research is underway and that there are scientific explanations for effectiveness of CBT and, so I thought, HT when seen as a means of over riding existing thought patterns.


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## BQ (May 22, 2000)

Thanks Ian. Sounds very promising doesn't it?Glad you shared this with us.







BQ


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## eric (Jul 8, 1999)

Ian, thanks for posting this and I can go over some of how this majorally relates to IBS for you if your interested.


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## Ian (Apr 18, 1999)

Eric,Yes, I'd be interested to read more on the IBS link.Although the programme only discussed CBT, I guess the ability to over-ride existing thought patterns could equally be achieved, albeit in a slighlty different way, via HT.Ian


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## eric (Jul 8, 1999)

Actually Ian, perhaps deeper with HT on the subconcious level where as the CBT is the concious level. Digestion works at the autonomic level and a lot of thoughts that trigger symptoms can be on the subconcious level in IBS.I will dig up the research for you on all this however.This is a good one to start with though although its a complex one. http://www.macmcm.com/pcp/pcp2000_01.htm The next one is seeking out emotions with pet scans. http://mentalhealth.about.com/library/rs/blpet.htm Also did you read this before. http://www.ibsgroup.org/other/usnews000403.htm Also Amygdala Circuitry and anxiety. http://www.nimh.nih.gov/events/pranxst.cfm


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## Ian (Apr 18, 1999)

Thanks Eric, very interesting reading - these articles give good indications of where research is heading. Ian


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## eric (Jul 8, 1999)

Ian, also read the fight or flight post I posted then I will come back to this some more, but that fits into the picture of IBS and I will go over that some more as it seems to be very important in IBS.


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## eric (Jul 8, 1999)

Ian, okay here we go somewhat.First they know serotonin regulation is a problem in IBS.Also, this"What would be an example of new understanding? Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or  "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. In fact, in people with IBS another area of the brain responds that is associated with anxiety. So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain." http://www.aboutibs.org/Publications/clinicalIssues.html So the neurotransmitters ( serotonin is very important here) leave the gut and travel up nerve fibers to the brain and then back to the gut. A " brain responds that is associated with anxiety" is turned up.More on the brain and IBS here and much more research is being done with all this. http://webpotential.com/falcon/uploadpic/ A part of the brain associated with releasing endorphines for digestion does not seem to be getting activated like it does in normal people.This was also part of some of the first studies on this. http://www.gastro.org/reuters/2000/May/22/...522clin003.html So the anxiety can already be turned up. Then you take the fight or flight response activated say when you have to find a restroom quickly. Some of this happens conciously and some subconciously. Then take that an apply it everyday to situations and thoughts. This alters the fight or flight responce and over the long term and continuously activates the fight or flight responce. It becomes unbalanced and the HPA axis is triggered constantly from chronic stressors. This releases adreline which in turn release histamine that in turn effects your gut function and can cause neurogenic inflammation on a microscopic cellular level. This is some new research gathering speed in IBS.There are some other things going on in the brain as well I will come back to.However, when you look at CBT and HT there are big reasons both physically and emotionally why these treatment are working on these issues and why they are shown effective in most people.


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## eric (Jul 8, 1999)

Here is some more on all this although they have had a year since this was written. http://www.iffgd.org/symposium2001.html


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## Ian (Apr 18, 1999)

Eric,Thanks again - very interesting and informative. The relationship of pain and increased anxiety/fight or flight response is intriguing, but must vary from individual to individual - some IBSers experience pain without the anxiety, others low pain but high anxiety. I guess general levels of anxiety/genetic disposition muist play a part as well.Ian


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## eric (Jul 8, 1999)

Ian," I guess general levels of anxiety/genetic disposition muist play a part as well."They do. Some people have low tolerence for pain from their genetic makeup. Other comorbid anxiety on top of IBS. Some people have physological issues that intensify pain experiences. It may also depend on the actual physical problem causing the IBS symptoms and how severe that maybe, also hormones regulation in each person.Here is some more info.IRRITABLE BOWEL SYNDROME: ALTEREDNEUROLOGICAL ACTIVITY Irritable bowel syndrome (IBS) is a common disorder ofthe intestines that leads to pain, intestinal gas, bloat-ing,and changes in bowel habits. People with IBS mayhave constipation or diarrhea and some people experi-enceboth. Other symptoms include the urge to movethe bowels but an inability to do so. The cause of IBS isnot known, and as yet there is no cure. IBS is classified asa functional disorder because there is no sign of diseasewhen the colon is examined. Although it does not causepermanent harm to the intestines and does not lead tointestinal bleeding of the bowel or to a serious diseasesuch as cancer, IBS patients suffer a great deal of discom-fortand distress.The underlying physiologic cause of IBS is unknown.Ordinary events such as eating and distention from gas orother material in the colon can cause the colon to overre-actin a person with IBS. Individuals with IBS seem tohave a colon that is more reactive and sensitive thanusual, so it responds strongly to stimuli that would notbother most people. Researchers have found that thecolon muscle of a person with IBS begins to spasm afteronly mild stimulation. Stress may also be a factor in themanifestation of disease symptoms.Patients with IBS also seem to have an enhanced aware-nessof and sensitivity to normal gastrointestinal events,such as muscle contractions and the filling of the viscerafollowing a meal. This has led some researchers to specu-latethat when the brains of persons with IBS receiveinformation from the visceral nerves in the intestines,they may process the information differently than personswithout IBS.To examine the possible role of information processingby the brain in causing IBS, researchers studied brainactivity in affected patients. In the experiment, the scien-tistsrecruited twelve people with IBS, as well as twelvehealthy volunteers, and inserted a catheter through therectum and into the volunteersï¿½ colons. Each cathetercontained two small balloons along its length that couldbe inflated to a precise pressure by the researchers.Inflation of balloons of this size is designed to producemild discomfort, but no serious pain or tissue damage.After the catheters were inserted and the patients had abrief recovery period, the researchers initiated a PositronEmission Tomography (PET) scan of the patientsï¿½ brains.This scan permitted researchers to see relative rates ofmetabolism based on energy usage and blood flow within specific regions of the brain. The researchers theninitiated a three-part experimental phase, in which theytold patients that the balloons would or would not beinflated, but did not consistently inflate the balloons inthe manner stated. This experimental design allowed theresearchers to see responses to no inflation (phase 1), anexpected and delivered inflation (phase 2), and anexpected but undelivered inflation (phase 3). During thisprocedure brain activity was monitored by PET scans.When the scientists analyzed the data generated by thePET scans, they found significant similarities between thenormal and IBS patients, but also noted important differ-ences.Brain regions activated by actual and simulatedballoon inflations were similar in both groups; however,differences in three important areas of the brain could bedetected. First, patients with IBS exhibited enhanced acti-vationof right prefrontal cortex in response to actual orexpected balloon inflation, whereas in normal patients,both sides of the brain reacted to a similar extent. Thisregion of the brain is thought to be very important forhigher cognitive functions, including concentration andjudgment. Second, within the anterior cingulate an areadeep within the brain thought to be involved in emotionssuch as sadness an enhanced reaction was seen in IBSpatients in a sub-region associated with the perception ofpain and unpleasantness. Third, the IBS patients demon-stratedan overall decreased activation of circuits in thebrain believed to activate fear and defense responses.All three of these observations indicate that IBSpatients show altered brain responses to rectal stimuli,regardless of whether these stimuli are actually deliveredor simply anticipated. This study provides solid evidenceof altered brain activity in patients suffering with this syndrome that is of unknown origin. To help fostermore research into the causes of IBS and its possibletreatmentsthe NIDDK is working with members of theIBS community to develop a conference on the topic offecal and urinary incontinence that is relevant to many ofthe quality of life issues that have an impact on peoplewith IBS.Naliboff BD, Derbyshire SWG, Munakata J, Berman S,Mandelkern M, Chang L, Mayer EA. Cerebral activation inpatients with irritable bowel syndrome and control subjectsduring rectosigmoid stimulation. Psychosomatic Med 63(3):365-375, 2001.


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## Ian (Apr 18, 1999)

Eric,'Third the IBS patients demonstated an overall decreased activation of circuits in the brain believed to activate fear and defence mechanisms'Some conflicting evidence here ?Whatever, the whole picture is, as these reports show, extremely complex.But, not withstanding CBT & HT, how far away do you think we are from targeted treatments based on individuals' specific physical symptoms and their scientifically evaluated psychological profiles?Ian


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## eric (Jul 8, 1999)

Ian, not really conflicting, that is the Amygdala. This acts as a gateway. The prefrontal cortex is also invovled in anxiety/emotions and in part pain. However it gets a lot more complex then this when you read how all these parts of the brain process information and the nerutransmitters signaling different areas."But, not withstanding CBT & HT, how far away do you think we are from targeted treatments based on individuals' specific physical symptoms and their scientifically evaluated psychological profiles?"These are really available today if I am reading this question right. CBT and HT for IBS work on these problems, hence why they are effective, however they will become more specific as they learn more about what is happening and the brain and IBS, but these things still are helping at some root levels of the condition. Also these treatments have specific biological reasons why they help people in basic science. Why they don't help absolutely everyone is also very complex, but for the majority they do.


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## eric (Jul 8, 1999)

Ian, if you have not read these three things fully. http://www.med.unc.edu/medicine/fgidc/relax.htm http://www.med.unc.edu/medicine/fgidc/hypnosis.htm and this sitewww.ibshypnosis.com


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## Ian (Apr 18, 1999)

Eric,I think what I was getting at was that although current treatment of IBS is say, using anti-spasmodics and/or anti-depressants and/or HT and/or CBT and reasonably good results can be obtained, the approach is still slightly 'broard brush' (although I do accept that in case of HT approach is fairly targeted, likewise CBT at a more conscious level).What I wonder, and what the original Radio programme hinted at, was how long until brain scans will be able to identify with certainty a patient's particular brain activity and for specific targeted treatments to be administered accordingly?Thanks for extra links - I'm away from computer for about a week, but appreciate your responses.Ian


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## Guest (Jun 2, 2002)

Just wanted to pop in and say that this is a very informational thread and thank you everyone who has posted here for all of the input.I suppose it's a pretty simplistic analogy.... but the way my sympathetic nervous system reacts to stress could be likened to swatting a fly with a mallot....







.... as in major overkill.Since my whole family has anxiety/depressive issues on some level, it has to be either genetic or familial or both..... else we all dropped off from the planet.... "Vaporola"... cuz we all also have some form of IBS !!


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