Tuesday, October 06, 2009

Understanding the Anxious Mind

Interesting article from the New York Times - especially as someone who deals with social anxeity disorder. I tend to be a fan of Jerome Kagan, as well, so it's doubly good.

In my own case, however, I wasn't an anxious baby or child - it developed in adolescence, so in some ways I do not fit the mold Kagan was looking at here.

Understanding the Anxious Mind

Published: September 29, 2009

Jerome Kagan’s “Aha!” moment came with Baby 19. It was 1989, and Kagan, a professor of psychology at Harvard, had just begun a major longitudinal study of temperament and its effects. Temperament is a complex, multilayered thing, and for the sake of clarity, Kagan was tracking it along a single dimension: whether babies were easily upset when exposed to new things. He chose this characteristic both because it could be measured and because it seemed to explain much of normal human variation. He suspected, extrapolating from a study he had just completed on toddlers, that the most edgy infants were more likely to grow up to be inhibited, shy and anxious. Eager to take a peek at the early results, he grabbed the videotapes of the first babies in the study, looking for the irritable behavior he would later call high-reactive.

Mickey Duzyj

Mickey Duzyj

No high-reactors among the first 18. They gazed calmly at things that were unfamiliar. But the 19th baby was different. She was distressed by novelty — new sounds, new voices, new toys, new smells — and showed it by flailing her legs, arching her back and crying. Here was what Kagan was looking for but was not sure he would find: a baby who essentially fell apart when exposed to anything new.

Baby 19 grew up true to her temperament. This past summer, Kagan showed me a video of her from 2004, when she was 15. We sat in a screening room in Harvard’s William James Hall — a building named, coincidentally, for the 19th-century psychologist who described his own struggles with anxiety as “a horrible dread at the pit of my stomach ... a sense of the insecurity of life.” Kagan is elfin and spry, balding and bespectacled. He neither looks nor acts his age, which is 80. He is one of the most influential developmental psychologists of the 20th century.

On the monitor, Baby 19 is a plain-looking teenager, hiding behind her long, dark hair. The interview, the same one given to all 15-year-olds in the longitudinal study, begins with questions about school. She has very few extracurricular activities, she says in a small voice, but she does like writing and playing the violin. She fidgets almost constantly as she speaks, twirling her hair, touching her ear, jiggling her knee. “This is the overflow of her high-reactive nature,” Kagan told me, standing near the monitor so he could fast-forward to the good parts.

Here was a good part: The interviewer asks Baby 19 what she worries about.

“I don’t know,” Baby 19 says after a long pause, twirling her hair faster, touching her face, her knee. She smiles a little, shrugs. Another pause. And then the list of troubles spills out: “When I don’t quite know what to do and it’s really frustrating and I feel really uncomfortable, especially if other people around me know what they’re doing. I’m always thinking, Should I go here? Should I go there? Am I in someone’s way? ... I worry about things like getting projects done... I think, Will I get it done? How am I going to do it? ... If I’m going to be in a big crowd, it makes me nervous about what I’m going to do and say and what other people are going to do and say.” Baby 19 is wringing her hands now. “How I’m going to deal with the world when I’m grown. Or if I’m going to sort of do anything that really means anything.”

Her voice trails off. She wants to make a difference, she says, and worries about whether she will. “I can’t stop thinking about that.”

Watching this video again makes Kagan fairly vibrate with the thrill of rediscovery: here on camera is the young girl who, as an infant, first embodied for him what it meant to be wired to worry. He went on to find many more such children, and would watch a big chunk of them run into trouble with anxiety or other problems as they grew up.

The tenuousness of modern life can make anyone feel overwrought. And in societal moments like the one we are in — thousands losing jobs and homes, our futures threatened by everything from diminishing retirement funds to global warming — it often feels as if ours is the Age of Anxiety. But some people, no matter how robust their stock portfolios or how healthy their children, are always mentally preparing for doom. They are just born worriers, their brains forever anticipating the dropping of some dreaded other shoe. For the past 20 years, Kagan and his colleagues have been following hundreds of such people, beginning in infancy, to see what happens to those who start out primed to fret. Now that these infants are young adults, the studies are yielding new information about the anxious brain.

These psychologists have put the assumptions about innate temperament on firmer footing, and they have also demonstrated that some of us, like Baby 19, are born anxious — or, more accurately, born predisposed to be anxious. Four significant long-term longitudinal studies are now under way: two at Harvard that Kagan initiated, two more at the University of Maryland under the direction of Nathan Fox, a former graduate student of Kagan’s. With slight variations, they all have reached similar conclusions: that babies differ according to inborn temperament; that 15 to 20 percent of them will react strongly to novel people or situations; and that strongly reactive babies are more likely to grow up to be anxious.

They have also shown that while temperament persists, the behavior associated with it doesn’t always. Kagan often talks about the three ways to identify an emotion: the physiological brain state, the way an individual describes the feeling and the behavior the feeling leads to. Not every brain state sparks the same subjective experience; one person might describe a hyperaroused brain in a negative way, as feeling anxious or tense, while another might enjoy the sensation and instead uses a positive word like “alert.” Nor does every brain state spark the same behavior: some might repress the bad feelings and act normally; others might withdraw. But while the behavior and the subjective experience associated with an emotion like anxiety might be in a person’s conscious control, physiology usually is not. This is what Kagan calls “the long shadow of temperament.” The oldest high-reactive subjects in Kagan’s and Fox’s studies, like Baby 19, are in their 20s now, and for many of them, no matter how much they manage to avoid looking anxious to an outsider, fears still rattle in their skulls at 3 o’clock in the morning. They remain anxious just below the surface, their subconscious brains still twitchy, still hypervigilant, still unable to shift attention away from perceived threats that aren’t really there.

ANXIETY IS NOT fear, exactly, because fear is focused on something right in front of you, a real and objective danger. It is instead a kind of fear gone wild, a generalized sense of dread about something out there that seems menacing — but that in truth is not menacing, and may not even be out there. If you’re anxious, you find it difficult to talk yourself out of this foreboding; you become trapped in an endless loop of what-ifs.

“I was flesh bereft of spirit,” wrote the journalist Patricia Pearson in “A Brief History of Anxiety (Yours and Mine),” in a pitch-perfect description of this emotional morass, “a friable self, grotesque... I got an AIDS test. I had my moles checked. I grew suspicious of pains in my back. If I was nauseous, I worried about cancer and started reading up obsessively on symptoms. I lay in bed whenever I could, trying to shut up the clamor of terror with sleep.”

When the “clamor of terror” starts to interfere with functioning, as it did for Pearson when she was a crime reporter in her early 30s, worrying turns into a clinical anxiety disorder, of which there are several forms: panic, social anxiety, phobia, obsessive-compulsive, post-traumatic stress and a catch-all called generalized anxiety disorder. Taken together, they make anxiety the most common mental illness in America, affecting an estimated 40 million adults, according to the National Institute of Mental Health. And that figure doesn’t even count the far greater swath who are garden-variety worriers, people who fret when a child is late, who worry when they hear a siren headed toward home, who are sure that a phone call in the middle of the night means someone is dead.

In the brain, these thoughts can often be traced to overreactivity in the amygdala, a small site in the middle of the brain that, among its many other functions, responds to novelty and threat. When the amygdala works as it should, it orchestrates a physiological response to changes in the environment. That response includes heightened memory for emotional experiences and the familiar chest pounding of fight or flight. But in people born with a particular brain circuitry, the kind seen in Kagan’s high-reactive study subjects, the amygdala is hyperreactive, prickly as a haywire motion-detector light that turns on when nothing’s moving but the rain. Other physiological changes exist in children with this temperament, many of them also related to hyperreactivity in the amygdala. They have a tendency to more activity in the right hemisphere, the half of the brain associated with negative mood and anxiety; greater increases in heart rate and pupil dilation in response to stress; and on occasion higher levels of the stress hormones cortisol and norepinephrine.

But having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. “The brain state does not make it a disorder,” Kagan told me. “The brain state exists, and the statement ‘I’m anxious,’ exists, and the correlation is imperfect.” Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut. These variations also happen when someone grows up from an anxious infant to someone either fretful or tranquil. One aim of Kagan’s and Fox’s longitudinal studies is to watch how the life stories of these high-strung babies unfold.

The quintessential longitudinal study, the one often mentioned because it set the standard, is the Framingham Heart Study, which enshrined the idea of risk factors. It was through Framingham, for instance, that scientists learned that high blood pressure was a risk factor for cardiovascular disease, since it followed its subjects for long enough to detect that those who had high blood pressure in their 30s and 40s were more likely to have heart disease later in life.

But such studies draw conclusions about trends, not destinies. If someone with high blood pressure treats it early, the risk of heart disease can be reduced significantly. Similarly, if someone with an anxiety-prone temperament grows up in the right surroundings, he or she might never develop a full-blown anxiety disorder.

Kagan’s first exposure to longitudinal studies came shortly after he received his Ph.D. from Yale in 1954. He was working at the Fels Research Institute on the campus of Antioch College in Ohio, where a longitudinal study of middle-class children had been going on for nearly 30 years. He stumbled upon a gigantic room “loaded with prose summaries of what these children were like from the age of 1 month on,” he told me recently. He knew a treasure trove when he saw one.
This is a long article - read the rest here.

1 comment:

TheXaminers said...

I read your blog regarding the anxious mind and the article you cited. At http://www.synerid.com/ articles have been written regarding how the mind reacts to depression. This may be of interest to you.