Infant Research & Neuroscience at Work in Psychotherapy by Judith Rustin

Author:Judith Rustin
Language: eng
Format: epub
Publisher: W. W. Norton & Company

CHAPTER FOUR

The Fear System

Working with Anxiety, Panic, and PTSD

OF ALL THE EMOTIONAL systems described in the previous chapter, the fear system is the most studied and researched. The fear system has particular relevance to psychotherapy as it is part of generalized anxiety disorders, phobias, trauma, and a variety of other relational and personal difficulties in which underlying anxiety contributes to the problem. In this chapter I discuss the fear system, as described by neuroscientists, from a subcortical perspective. Humans developed a higher brain system, the neocortex, which affords them better regulatory capacities to manage the fear system and to make decisions and judgments despite the fear(s). Nevertheless, the subcortical systems that become active in humans when they feel different forms of fear (anxiety, panic, etc.) operate in similar ways in other mammals. Understanding fear from the subcortical perspective alerts the clinician to the importance and nature of triggers, to many of the bodily changes that occur in fear, to its relationship to memory, and to its enduring nature. This understanding provides additional pathways for working with various permutations of anxiety, panic, and possibly trauma. Understanding the fear system is particularly important in understanding the relationship between trauma and memory.

I am on the subway deeply engrossed in a book when I become aware that the train has stopped between stations. I immediately break out into a cold sweat, my heart begins beating rapidly, and I become increasingly hypervigilant. In short, I am on high alert. The conductor announces train congestion ahead; we will be moving shortly. I don’t believe him. I fidget, tap my feet, and shake my fingers; my anxiety mounts. I don’t breathe easily again until the train starts moving. Then with every fit and start of the train I return to a hypervigilant, anxious state. If the delay is too long, my anxiety borders on panic. How could this happen to someone like me, a seasoned subway rider of over 45 years?

A year earlier, I was on the subway, also reading a book. The train halted. I thought nothing of it; business as usual on the NYC subway system. After 10 minutes, I became irritated and annoyed; I’ll be late for my meeting. Soon the announcements began. “We’ll be moving shortly.” No explanation. 10 minutes later, “There is someone ill in the train ahead.” 10 minutes later, “There is someone on the tracks; the track has to be cleared.” This sounds ominous and serious. These announcements go on for an hour, changing every 10 minutes. Periodically, the conductor strides through the car, ignoring all questions. The lights are dimmed and the air conditioning is reduced. Generators are now providing electricity. When the third rail is turned off (in this case, to remove a person from the tracks), generators take over. But, I know that once the third rail is turned off, rebooting the electrical system will take a long time. I become concerned that we might be stuck here for quite a while. I feel frustrated and irritated

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