https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2016.16030353
Joseph E. LeDoux, Ph.D., Daniel S. Pine, M.D.
Received: March 24, 2016
Accepted: June 28, 2016
Published online: September 09, 2016
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https://doi.org/10.1176/appi.ajp.2016.16030353
Tremendous
progress has been made in basic neuroscience in recent decades. One
area that has been especially successful is research on how the brain
detects and responds to threats. Such studies have demonstrated
comparable patterns of brain-behavior relationships underlying threat
processing across a range of mammalian species, including humans. This
would seem to be an ideal body of information for advancing our
understanding of disorders in which altered threat processing is a key
factor, namely, fear and anxiety disorders. But research on threat
processing has not led to significant improvements in clinical practice.
The authors propose that in order to take advantage of this progress
for clinical gain, a conceptual reframing is needed. Key to this
conceptual change is recognition of a distinction between circuits
underlying two classes of responses elicited by threats: 1) behavioral
responses and accompanying physiological changes in the brain and body
and 2) conscious feeling states reflected in self-reports of fear and
anxiety. This distinction leads to a “two systems” view of fear and
anxiety. The authors argue that failure to recognize and consistently
emphasize this distinction has impeded progress in understanding fear
and anxiety disorders and hindered attempts to develop more effective
pharmaceutical and psychological treatments. The two-system view
suggests a new way forward.
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