Anxious by Joseph LeDoux [Book Summary – Review]

Many people go through some type of anxiety in their day-to-day lives. The reason could be getting worried as a result of our rent or being worried about our social circumstances, it is a normal thing to feel anxious particularly in the unstable era we live in. 

However, at times, anxiety begins to take control of how we live and hinder the things we do. This is the period that individuals get diagnosed with anxiety disorder. In America, anxiety is one of the most predominant mental health concerns- presently, close to 40 million persons are living with anxiety. However, what is the meaning of having a disordered level of anxiety? Also, how does it occur?

This book will take a deeper look into these questions and look at the varieties of treatment choices that are available. By incorporating insights from psychoanalytic rites, cognitive behavioral therapy, as well as the latest advancements in the neuroscience field, they demonstrate how one can create approaches for effectively managing anxiety. 

In this book, you’ll discover

  • explore the mechanisms through which our brains endeavor to shield us from perilous dangers.;
  • the reason why anxiety was previously regarded as a positive feeling; and
  • how anxiety can be cured by wiping off some of our memories.

Chapter 1 – Anxiety was formerly considered an integral aspect of a human.

While current headlines may loudly proclaim the prevalence of anxiety disorders, they might give the impression that anxiety is a distinctly modern affliction. In truth, the term ‘anxiety’ has been in existence since centuries ago.

Its origin traces back to the ancient Greek term “angh,” signifying a sense of being “burdened” or “troubled.” References to anxiety can be found all through the New Testament, portraying worried sinners awaiting God’s punishment. In the year 1844, Søren Kierkegaard a Danish theologian wrote a book called “The Concept of Anxiety,” stating that anxiety is a result of human abilities to make choices, showing our knowledge of the strength as well as control of free choice.

This idea of anxiety being regarded as a normal and important feeling, had a great effect, motivating numerous existentialist theories from philosophers like Jean-Paul Sartre as well as Martin Heidegger. Sigmund Freud introduced a quite different meaning of anxiety at the beginning of the 20th century.

Freud claimed that anxiety played a central role in a variety of psychopathological conditions, serving as an indicator of our efforts to suppress traumatic as well as uncomfortable memories. These unaddressed problems would accumulate, turn into something toxic, and, consequently, make us become anxious neurotically. Freud’s psychoanalytic approaches entailed attempting to discover the root causes of this anxiety. He claimed that by addressing the suppressed trauma, the anxiety could be alleviated. This theory of Freud basically reshaped our understanding of anxiety, shifting it from a perception of normal human experience to a signal that something was wrong and required dealing with.

Freud’s concept of anxiety gained significant popularity following the Second World War. In the year 1947, poet W. H. Auden released his renowned work titled “The Age of Anxiety,” forging the slogan of the exact name, which has been embraced by subsequent generations. Filmmakers such as Woody Allen and Alfred Hitchcock began focusing on anxious roles in their films, and even The Rolling Stones began composing songs centered around housewives using Valium.

Currently, a basic search on Google for “anxiety” produces more than 42 million results. Therefore, obviously, anxiety disorders are something we discuss about often. We still have considerable confusion surrounding the actual meaning of anxiety. In the following chapter, we will delve into what sets an anxiety disorder apart from day-to-day concerns.

Chapter 2 – The standards for diagnosing anxiety disorders keep evolving

At what level does a “normal” range of anxiety become a disorder?

Typically, a psychiatrist or psychologist possesses the ability to diagnose an anxiety disorder. In order to know the process by which one got to such judgments, it is important to consider the Diagnostic and Statistical Manual (DSM). It was during the mid-twentieth century that the DSM was created by the American Psychiatric Association, and it has turned into a predominant reference for classifying people with psychiatric disorders.

In the first version of DSM, mental disorders were classified into states of psychosis and neurosis, with anxiety being classified as “anxiety neurosis.” In the third edition of the DSM that was published in the year 1980, this word was further divided into generalized anxiety disorder (GAD) as well as panic disorders. The following edition which was published in 1994 extended these varieties and included specific phobias and post-traumatic stress disorder (PTSD).

For diagnostic purposes, a psychologist assesses their client’s symptoms by comparing them to a checklist outlined in the DSM. If a specific number of symptoms correspond, an individual is categorized as having an anxiety disorder.

As demonstrated by this brief history, there is a spectrum of conditions falling within the category of anxiety disorders, and the criteria are continually evolving. The DSM has faced criticism for trying to put a highly complicated disorder into a very simple checklist and for likely attaching stigmatizing psychiatric labels to individuals. Likewise, it has allowed these diagnoses to be authorized, enabling individuals to have access to mental health services, file claims with their insurers, and seek assistance from their bosses and educators.

Therefore, what predisposes someone to have an anxiety disorder? What is the reason why some certain individuals experience traumatic situations apparently unaffected while other people have PTSD? Research has identified three factors that may be involved. Genetics is the first factor, as anxiety disorders can be hereditary,  passed from a parent, or even passed down through generations. The second factor relates to an individual’s general psychological disposition and their ability to cope with uncertainty. The third factor pertains to one’s learning experiences or the surroundings in which they were raised. In the subsequent chapter, we will learn more about how we acquire knowledge about threats.

Chapter 3 – Each of us possesses highly developed survival instincts to respond to dangers.

Wild animals are in a constant state of vigilance for potential threats, they need to be vigilant.  Even an easy quest for food can prove lethal if they cross paths with a predator.

During the beginning of the 20th century, Walter Cannon a physiologist formulated the well-known “fight or flight” theory. This theory talks about the survival techniques animals use when confronted with danger. When animals face a predator or some kind of threat, their options typically include freezing and feigning death, fleeing, or engaging in combat.

Human beings are made with similar survival instincts. Consider how you respond when confronted by a menacing, barking dog or when you feel endangered by a malicious coworker. Do you feel the urge to escape, or do you see yourself inclined to retaliate? These responses exemplify the manner in which survival mechanisms operate.

When we sense a threat, our sympathetic nervous system instantly gets activated, causing an increase in our breathing rate and heart rate. This leads to the supply of more energy into our muscles, as blood is forced away from our skin, gut, and extremities. Subsequently, during times of flight or when combating an attack, blood is pumped to the parts where it is most needed, and the adrenal medulla emits adrenaline into our bodies, giving us more energy.

The entire body participates in this survival reaction. However, how do we recognize what threat is made of? Our main means of identifying danger is via experience. For instance, let’s say a rabbit encounters an attack by a bobcat at a specific watering hole, she will associate both bobcats and that particular surrounding -with peril. The next time she finds herself at the watering hole, she will display defensive behavior, even if there is no threat there. 

Human beings possess particularly refined evolutionary survival mechanisms. Not only do we know about danger through the experiences we’ve had; but, we also possess the ability for observational learning. If we observe that someone is being attacked on a dark street corner, we can deduce that the exact spot may be a potential threat to us later in the future. Additionally, we can acquire knowledge regarding threats via verbal guidance. For instance, children are usually cautioned about potential dangers they will encounter in their lives, for example, fires or unreliable strangers. When they subsequently encounter such threats, their inborn survival instincts instantly activate.

These innate survival systems play a critical role in ensuring that we are alive. However, at times, they can become overly sensitive, seeing threats even in situations where there isn’t any threat.

Chapter 4 – Suffering from an anxiety disorder places you in a heightened state of vigilance for potential dangers.

Think about how frightening it could be walking to the corner store if you believed that every step you carry might trigger an invisible landmine. While others might just view it as a calm street, you perceive danger at each turn.

Individuals with anxiety disorders are extremely vigilant to potential dangers. In the case of certain phobias such as arachnophobia, this vigilance is concentrated on a specific thing—someone might view all the things they perceive or hear as related to spiders. On the other hand, social anxiety disorders keep individuals on high alert in social situations, turning what should be an enjoyable gathering into a minefield of potential embarrassment.

This extreme vigilance puts our survival mechanisms in a persistent state of regular vigilance, causing the sympathetic nervous system to become activated. This, eventually, activates the production of stress hormones, for instance, epinephrine and cortisol into the brain. Consequently, our bodies are now prepared to confront danger, and our minds become intently focused on identifying the roots of threats.

Individuals with anxiety disorders frequently encounter difficulty in discerning between actual and perceived threats, leading to exaggerated responses to circumstances that do not really endanger their survival. Additionally, they tend to overestimate the probability of unfavorable outcomes and underestimate their own capacity to manage such circumstances effectively if they actually happen.

These emotions can be really distressing, prompting those with anxiety disorders to go to extreme measures to evade likely circumstances that are uncomfortable. For instance, a person who is afraid of heights might steer clear away from tall buildings, and a person who has social anxiety might ensure they are always in the midst of people they are conversant with.

Individuals diagnosed with generalized anxiety disorder do not possess certain triggers or something they want to avoid. Rather, they go through a regular flow of anxious reasons encompassing a wide range of matters. However, this style of thinking is a type of avoidance behavior on its own. Worrying all the time makes our minds really preoccupied with a constant internal monologue, rendering us unable to objectively assess our own thoughts and subject them to scrutiny against reality.

Although evading likely anxiety triggers may provide momentary relief. However, it can also result in individuals with anxiety disorders gradually living more limited lives. As the fears remain unaddressed and unchallenged, they persistently grow more and more.

Chapter 5 – Fear as well as anxiety are emotions that human beings consciously experience and process.

Neuroscientists have gained quite a significant amount of their knowledge about the human brain through experiments using animals. Through the experiment of how creatures such as rats react to threats, valuable insights into the workings of human survival mechanisms have been learned.

In scientific publications, animals that react to dangers by either freezing or fighting have been characterized as demonstrating “fear responses.” This idea might make one infer that animals experience fear in a manner similar to that of human beings. However, this is a misunderstanding; an essential distinction exists between engaging in a defensive, survival reaction when facing a threat and the conscious experience of fear.

The survival reaction is directed by reflexive, unconscious cognitive circuits within our brains. And it is capable of activation without us knowing anything. On the other hand, fear as well as anxiety arise from deliberate cognitive processes.

Our conscious minds analyze our sensations as well as memories, constructing a narrative to comprehend what is unfolding around us. They develop understanding, giving meaning to the things we notice, perceive, hear, and go through on earth. Consider the sensation of fear, for instance. When we sense danger, for instance spotting a snake, our defense reaction will get activated. However, this is only the initial reaction. Our attention as well as working memory then guide us to the sensory input we are getting and how the bodies are responding.

Then, our semantic memory enables us to correctly pinpoint what we have observed – in this case, interpreting it as a poisonous snake. Simultaneously, our episodic memory fits the snake into a narrative, connecting the danger to our personal experiences. It might envision potential future outcomes say we get bitten or it might liken the snake to a previous encounter with a similar situation. At this point, our conscious mind will actively tag our emotional state as either “fear” or “anxiety.”

If researchers only rely on animal experimentation to understand anxiety, they will overlook a significant aspect: human feelings. As we will explore in the upcoming chapter, the differentiation between survival reactions as well as emotions becomes particularly crucial when attempting to devise treatments for anxiety.

Chapter 6 – In treating anxiety, cognitive-behavioral therapy methods have proven successful.

All of us are conversant with the setting of a therapist jotting down notes and touching his beard while their client reclines on a couch discussing their childhood experiences.

These familiar settings draw inspiration from the psychoanalysis era of Freud. Even though Freud was among the pioneers who brought about the notion of anxiety to psychology, contemporary therapeutic methods have evolved significantly. Freud utilized talk therapy to delve into the origins of psychological issues deeply embedded in a patient’s past. Nowadays, the majority of therapeutic treatments available for anxiety are grounded in cognitive-behavioral methods, and they place a greater emphasis on the individual’s present behaviors. These therapies focus on addressing symptoms rather than uncovering underlying causes.

Cognitive therapies strive to assist individuals in unraveling dysfunctional key beliefs that unnecessarily trigger instinctive avoidance and survival actions. Behavioral therapies target treating troublesome patterns of behavior directly. Both of these methods extensively incorporate exposure therapy.

You’re likely conversant with the traditional saying that advises getting back on the horse if you fall off from it. The concept is that by instantly changing a negative experience with a positive one, you can prevent having a dislike for horse riding. Exposure therapy operates based on a similar principle.

For instance, let’s say a patient is afraid of elevators, a therapist might begin the therapy by displaying elevator images to them or encouraging the patient to ponder on elevators. Subsequently, they would persuade the patient to visit an existing elevator and gradually begin going on it. These repeated exposures demonstrate to the patient that they can survive riding in an elevator without it causing any harm. Over time, their negative connections with elevators are gradually substituted with more neutral associations. In scientific terms, scientifically, this process is called “extinction.”

Likewise, exposure therapy can be helpful for persons living with generalized anxiety disorder (GAD) by giving them an opportunity to recognize certain anxiety triggers as well as the types of automatic concerns that occurs. Patients are taught how to objectively evaluate disastrous thoughts and generate more reasonable options. As they go deeply into their concerns and observe the extent of their exaggeration, these threats gradually begin to lose their strength. 

Chapter 7 -Exposure therapy is highly effective, although it comes with certain constraints

Exposure therapy boasts a 70% effectiveness rate, however, it still has some limitations. 

 Firstly, the end of negative associations is highly context-dependent; the skills acquired in a therapist’s office may not necessarily transfer to real-life situations. For instance, while you may have practiced entering an elevator virtually from the comfort of your therapist’s couch, you might still experience fear when faced with an actual elevator in the real world.

Furthermore and even more complicated, it is possible for the impacts of exposure therapy to be reversed which is usually as a result of a new traumatic occurrence. For instance, you might all of a sudden regain your fear of heights following a car accident. Additionally, old connections can resurface after a certain period, a phenomenon called spontaneous recovery.

Through the act of ringing a bell just before feeding his dogs, Ivan Pavlov the Russian physiologist trained his dogs to salivate in response to the bell’s sound. He later tried to erase this connection by constantly ringing the bell without giving them food. However, when Ivan rang the bell again after a hiatus, the dogs began salivating once more, as their brains had spontaneously returned to their previous connections.

Another issue associated with exposure therapy lies in its ability to only extinguish connections that are consciously remembered, despite the fact that most of our memories reside in the unconscious mind.

Fortunately, therapists can employ various methods to enhance the durability and effectiveness of exposure therapy. For instance, they can ensure that their clients undergo treatment in diverse ways, in order for the treatment to translate into various circumstances.

A substantial amount of cognitive processing occurs during the four to six hours following the time a client leaves a therapy session. If these hours are extremely preoccupied or stressed, it can potentially undermine the progress made in exposure therapy. This issue can be addressed with a basic solution, such as taking a nap at the end of a session as it is widely recognized that sleep enhances brain functioning.

In addition to these behavioral remedies, the combination of exposure therapy with short-term drug treatments has also demonstrated effectiveness. For instance, patients who received cortisol before therapy sessions reported reduced anxiety levels.

These approaches can enhance the effectiveness of the extinction process. However, what if there is an alternative answer? What if it is possible for us to totally delete damaging memories and connections from our brains?

Chapter 8 – Memories can be recalled and even enhanced by incorporating new details.

In the iconic movie titled  “Eternal Sunshine of the Spotless Mind,” a couple opts to forget one another from their memories following a painful separation. The remaining part of the movie revolves around their efforts to recover those lost memories. The message from that movie is that, even though eliminating hurtful experiences may provide comfort, it also entails sacrificing integral aspects of our identity.

The concept of erasing memories is extremely inconvenient for individuals and it is often regarded as unconventional in the realm of psychological treatment. Truthfully, when the author and his peers wrote a report revealing their finding of a means to delete dangerous memories in rodents, it brought about a controversy.

While doing the experiment, the rats were exposed to a loud noise, and afterward, they were exposed to an electric shock. After being trained to associate the sound with risk, the rats exhibited defensive reactions, such as freezing, when they heard the noise again. However, the researchers were able to eliminate the traumatic memory by injecting something that inhibits protein synthesis into a region of the brain known as the lateral amygdala. Subsequently, when the rats heard the noise once more, they displayed entirely normal behavior.

The researchers proposed that a related method could potentially be applied to humans; however, this research came with a lot of criticism. A psychologist claimed that removing hurtful memories from the brain could increase the likelihood of recurring occurrences such as the Holocaust. While memories of previous cruelty can be painful, they also serve as a crucial historical record.

Although the concept of our memories being manipulated can be unsettling, it’s important to recognize that many established psychological approaches already influence our memories to some extent. For example, psychoanalysis entails “recovering” suppressed memories, While cognitive therapy entails consulting and reinterpreting memories to facilitate a different perspective. It’s worth noting that memories are mutable; research has demonstrated that each time a memory is recalled, it can be reshaped with new detail.

This is fortunate for researchers as well as psychologists seeking means to assist individuals struggling with traumatic memories and connections. Nevertheless, even though memory is important,  completely erasing memories in humans is a challenging task. Powerful, and traumatic recollections, which remain quite stable even when protein synthesis in the brain is obstructed.

By overcoming our reservations about altering our memory, it is possible for us to discover that recent advances in neuroscience can go with more traditional therapeutic approaches, particularly when addressing trauma.

Chapter 9 – Engaging in active coping techniques can assist in managing and controlling your anxiety.

Countless individuals are living with anxiety disorders and, interestingly, many of them live fulfilling, exciting lives despite, or perhaps because of, the inconvenient emotions that anxiety can cause. George Bonanno’s research has demonstrated that individuals who can employ a variety of active coping approaches exhibit remarkable resilience when confronted with anxiety.

For instance, a person with social anxiety might address their unease at a social gathering by going to the bathroom frequently or stepping out to make a call. While this may appear as avoidant behavior, which is typically viewed negatively, it can be a valuable coping strategy. This proactive avoidance allows individuals the opportunity to strategize and return to the event without becoming overly overwhelmed.

At times, active coping may involve talking with others following a traumatic incident. For instance, days after the World Trade Center attacks, a lot of individuals found themselves in front of their TVs unable to move, entrapped by the ceaseless news coverage. Leaving their house and going outside to meet friends or returning to work served as a means to break free from that overwhelming sense of vulnerability.

In recent years, other active coping techniques have gained prominence, including breathing exercises and meditation routines aimed at alleviating anxiety. When we experience anxiety, our fight-or-flight response triggers rapid and shallow breathing. Taking a few deep conscious, slow breaths instantly induces a calm feeling.

Meditation is also strong. Practices such as focused attention enable individuals to redirect their thoughts away from frantic concerns and competing ideas and rather focus on specific bodily sensations or objects in their environment. Open monitoring, often referred to as mindfulness, teaches people to observe their environments, reflections, and emotions in a neutral and accepting manner. Significantly, meditation can instill a sense of “selflessness,” helping us detach from personal identification with our thoughts. This naturally diminishes the persuasiveness of anxiety since anxiety heavily relies on associating with a self that can potentially face humiliation, harm, or threats in future cases.

Effective coping strategies are highly subjective. What provides relief from anxiety for one person may be daunting and stressful for another. Active coping involves recognizing what is effective for you personally and ensuring you have a variety of these techniques readily available.

Anxious: Using the Brain to Understand and Treat Fear and Anxiety Joseph LeDoux Book Review

It is difficult to diagnose and treat anxiety disorders because it entails a lot of various types of processes in our brains. Individuals living with anxiety disorders maintain a heightened vigilance towards potential dangers, thereby keeping their innate survival mechanisms in a state of heightened readiness. However, anxiety is also an emotion we consciously process. Adequate treatment must encompass all the diverse forms that anxiety displays in both our bodies as well as minds.

When it comes to enhancing memory retention, consider taking a nap. 

When next you wish to recall something – say, for instance, a lecture, plan a nap immediately following it. Memories require about four and six hours in order for them to be completely developed in our minds. It’s essential to not only jot notes down during the lecture, but also to allocate some peaceful moments to reflect later on. Alternatively, opt for a nap. While you’re asleep, your brain diligently works to keep the memory of all the things you’ve grasped.

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Savaş Ateş

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