Anxious: Using the Brain to Understand and Treat Fear and Anxiety
Publisher: Penguin Books
ISBN 10: 0143109049
ISBN 13: 978-0143109044
“A rigorous, in-depth guide to the history, philosophy, and scientific exploration of this widespread emotional state . . . [LeDoux] offers a magisterial review of the role of mind and brain in the generation of unconscious defense responses and consciously expressed anxiety. . . . [His] charming personal asides give an impression of having a conversation with a world expert.” —Nature
A comprehensive and accessible exploration of anxiety, from a leading neuroscientist and the author of Synaptic Self
Collectively, anxiety disorders are our most prevalent psychiatric problem, affecting about forty million adults in the United States. In Anxious, Joseph LeDoux, whose NYU lab has been at the forefront of research efforts to understand and treat fear and anxiety, explains the range of these disorders, their origins, and discoveries that can restore sufferers to normalcy.
LeDoux’s groundbreaking premise is that we’ve been thinking about fear and anxiety in the wrong way. These are not innate states waiting to be unleashed from the brain, but experiences that we assemble cognitively. Treatment of these problems must address both their conscious manifestations and underlying non-conscious processes. While knowledge about how the brain works will help us discover new drugs, LeDoux argues that the greatest breakthroughs may come from using brain research to help reshape psychotherapy.
A major work on one of our most pressing mental health issues, Anxious explains the science behind fear and anxiety disorders.
Praise for Anxious:
“[Anxious] helps to explain and prevent the kinds of debilitating anxieties all of us face in this increasingly stressful world.” —Daniel J. Levitin, author of The Organized Mind and This Is Your Brain on Music
“A careful tour through the current neuroscience of fear and anxiety . . . [Anxious] will reward the informed reader.” —The Wall Street Journal
“An extraordinarily ambitious, provocative, challenging, and important book. Drawing on the latest research in neuroscience (including work in his own laboratory), LeDoux provides explanations of the origins, nature, and impact of fear and anxiety disorders.” —Psychology Today
“Every age believes itself to be the age of anxiety, as Auden’s famous poem first put it. But in his new book, Anxious, the neuroscientist and writer Joseph LeDoux suggests that that has never been a stronger claim to make than it is now . . . . If this is the age of anxiety, LeDoux is our Lewis and our Clark: It was LeDoux who laid down the first map of what is called the brain’s ‘fear circuit,’ the regions—centered on the amygdala and its adjacent structures—that together give rise to our ability to respond to threats and danger. But with his new book, he wants to redraw that map.”
—Casey Schwartz, New York Magazine
“Mr. LeDoux offers a careful tour through the current neuroscience of fear and anxiety. . . . [Anxious] will reward the informed reader.”
—Leonore Tiefer, The Wall Street Journal
“LeDoux presents a rigorous, in-depth guide to the history, philosophy and scientific exploration of this widespread emotional state. . . . Neuroscientists, psychologists, philosophers and psychiatrists will find this exquisitely referenced book particularly useful. It is also a must-read for young investigators, and anyone perusing the footnotes will be rewarded with an insider’s view of the state and evolution of anxiety research. LeDoux’s charming personal asides give an impression of having a conversation with a world expert. LeDoux ends on a high note, describing how cutting-edge research on the neural substrates of anxiety is being translated into new approaches for psychiatric treatment.”
—Susanne Ahmari, Nature
“LeDoux is not only a pioneer in the neurobiological analysis of fear in animals but also a scholarly and accessible writer. In Anxious, he systematically builds on his earlier works, covering with aplomb a vast literature on emotion, memory, attention, and consciousness. With that said, Anxious is a significant and important departure from the author’s earlier views on the neural underpinnings of fear. . . . In Anxious, LeDoux challenges the reader to think differently about the neural origins of fear and its disorders. In doing so, he offers a masterful synthesis of animal and human work and a novel roadmap for future work in both the laboratory and the clinic.”
—Stephen Maren, Science
“Anxious is an extraordinarily ambitious, provocative, challenging, and important book. Drawing on the latest research in neuro-science (including work in his own laboratory), LeDoux provides explanations of the origins, nature, and impact of fear and anxiety disorders.”
—Glenn Altschuler, Psychology Today
“Drawing on years of research, neuroscientist LeDoux delves into the subject of anxiety and fear, depicting both emotions as cognitive constructs. . . . [Anxious] will open up new worlds of thinking and feeling”
“Wonderfully erudite, informative, and splendidly well written. Helps to explain and prevent the kinds of debilitating anxieties all of us face in this increasingly stressful world. Any author who can weave Leonard Bernstein, W. H. Auden, The Rolling Stones, and Alfred E. Neuman into a single illustrative example is on my short list for favorite writers ever.”
—Daniel J. Levitin, author of The Organized Mind and This Is Your Brain On Music
“Joseph LeDoux [is] the William James of our era. . . . This marvelous book is science at its best. It traces the evolution of a key set of scientific insights based on progressively better empirical data, most of these derived from LeDoux’s brilliant studies, and applies these new insights to a family of clinically important phenomenon. Anxious is an absolute must read for clinicians and basic scientists as well as for anyone else interested in anxiety and its disorders.”
—Eric R. Kandel, Kavli Professor and University Professor, Columbia University; Senior Investigator, Howard Hughes Medical Institute; author of In Search of Memory and The Age of Insight; recipient of the 2000 Nobel Prize in Physiology or Medicine
“An exquisite and unique attempt to truly relate how neural cells lead to felt conscious states in the human mind—the toughest problem in all of science. LeDoux has thrown down the gauntlet and set the standard. I wish all of us working on the problem luck trying to beat this analysis.”
—Michael Gazzaniga, Professor of Psychology, University of California, Santa Barbara, and author of Tales from Both Sides of the Brain, Human, and The Social Brain
“Anxious is a profound, exciting and immensely useful work about one of our most troubling—and puzzling—emotions. Joseph LeDoux takes us behind the scenes of our own minds to show us not only how anxiety is constructed in the brain but how it can be deconstructed. This is neuroscience at its very best: helpful and hopeful without a hint of hyperbole.”
—Mark Epstein, M.D., author of Thoughts without a Thinker and The Trauma of Everyday Life
“In this tour de force, LeDoux artfully guides the reader from the unconscious defensive system, through attention and memory, to the conscious experience of fear and anxiety. His traverse from the unconscious to the conscious experience of emotion is rich in scientific detail and yet exquisitely readable. LeDoux completes his masterpiece with provocative discussions of therapies for anxiety. This book is a fascinating revelation of the evolution in LeDoux’s own scientific thinking and in the field at large and is a must read for any student of learning, memory or emotion.”
—Michelle G. Craske, Ph.D., Professor of Psychology and Director, Anxiety Disorders Research Center, UCLA
“LeDoux is a true leader in the field of cutting-edge neuroscience and psychology, yet he also has an uncanny ability to write beautifully and clearly. . . . A must-read for anyone interested in the intersection of the mind and brain, and how an understanding of psychology and neuroscience can change ourselves and the world around us!”
—Kerry J. Ressler, M.D., Ph.D., Professor of Psychiatry and Behavioral Sciences, Emory University; Scientific Council Chair, Anxiety and Depression Association of America; Investigator, Howard Hughes Medical Institute; Member, National Academy of Sciences
Praise for Synaptic Self
“Synaptic Self represents a brilliant manifesto at the cutting edge of psychology’s evolution into a brain science. Joseph LeDoux is one of the field's pre-eminent, most important thinkers.”
—Daniel Goleman, author of Emotional Intelligence and Primal Leadership
“A clear, up-to-date, and impressively fair-minded account of what neuroscience has established about human nature.”
—Howard Gardner, John H. and Elisabeth A. Hobbs Professor of Cognition and Education at Harvard University and author of Frames of Mind and Intelligence Reframed
“Synaptic Self is a wonderful tour of the brain circuitry behind some of the critical aspects of the mind. LeDoux is an expert tour guide and it is well worth listening. His perspective takes you deep into the cellular basis of what it is to be a thinking being.”
—Antonio R. Damasio, University Professor, David Dornsife Chair in Neuroscience and Professor of Psychology and Neurology, Director of the USC College Brain and Creativity Institute and author of The Feeling of What Happens and Descartes’ Error
“In this pathbreaking synthesis, Joseph LeDoux draws on dazzling insights from the cutting edge of neuroscience to generate a new conception of an enduring mystery: the nature of the self. Enlightening and engrossing, LeDoux's bold formulation will change the way you think about who you are”
—Daniel L. Schacter, William R. Kenan, Jr. Professor of Psychology at Harvard University, author of The Seven Sins of Memory and Searching for Memory
“Starting with a synopsis of the evolving nature of the "self" in philosophy, psychology, and physiology . . . [LeDoux] addresses that most unwieldy of subjects through the empirical divinations of neuroscience. The core of his argument rests on synapses, the empty gaps that neurons bridge to form circuits. LeDoux's remarkably accessible descriptions of the process crackle like the electrical storms that rain chemical ooze on the brain. . . . [Synaptic Self] goes a long way in ordaining the steps to humanity's timeless tango with tautology.”
—Andy Battaglia, A.V. Club
“[A]n important contribution.”
Praise for The Emotional Brain
“Highly accessible, a stimulating and thoughtful work [that] is essential reading for any serious student of human nature.”
—Raymond J. Dolan, Nature
“[The Emotional Brain] is vivid and convincing in its description of a central mechanism of emotion, and is directly applicable to understanding anxiety, the most common ingredient of emotional disorders. It's a terrifically good book.”
—Keith Oatley, New Scientist
“With clarity and convincing logic, The Emotional Brain presents a new view of emotion that is derived in large part from the author's own ground-breaking research. . . . LeDoux shows how the study of the brain leaves our understanding of emotion richer than it was before."
—Steven E. Hyman, M.D. Director, National Institute of Mental Health
“Engrossing and engaging.”
—Richard Restak, The New York Times Book Review
About the Author
Joseph LeDoux is the Henry and Lucy Moses Professor of Science at New York University, where he is a member of the Center for Neural Science and the Department of Psychology. He directs the Emotional Brain Institute at New York University and at the Nathan Kline Institute, and is the author of Synaptic Self and The Emotional Brain. A member of the National Academy of Sciences, LeDoux lives in Brooklyn, New York.
Excerpt. © Reprinted by permission. All rights reserved.
When I completed my previous book, Synaptic Self, which was published in 2002, I wasn’t certain I wanted to write another book for a general audience. I had gotten the idea that the way to really have an impact on the field was to write a textbook in my particular area, behavioral and cognitive neuroscience. My agents, John Brockman and Katinka Matson, urged me not to, as did my editor at Viking, Rick Kot, each of them warning me that I would regret it as a publishing experience. After struggling with the project for almost a decade, I had to admit that they were correct. I discovered that the textbook format was far too restrictive—it had to be fresh and innovative . . . so long as it was just like every other competing book. After each chapter was reviewed by a number of teachers from a mix of universities, colleges, and junior colleges around the country, I began to feel little connection to the edited text that was resulting and concluded that my role was more to be a name on the cover than to actually drive the content.
A few years ago I ran into Rick at a reading by our friend Rosanne Cash, who wrote Composed under his editorship, and he asked with a wry smile, “How’s that textbook going? I’ve been waiting for you to bail out of that and do another book with me.” I was thrilled that he was still interested in working with me, and I negotiated, with some help from Eric Rayman, my way out of the textbook and prepared a new proposal for Katinka. Anxious was the result. Rick loved the idea, and so here we are.
Anxious is different from my other books. While The Emotional Brain and Synaptic Self can be thought of as a series of connected essays that hang together around a single theme, in Anxious each successive chapter builds on the previous ones to argue for a new view of emotion, especially the emotions fear and anxiety. Although the book is called Anxious, fear and anxiety are complexly entwined, and must be understood both separately and together.
As an overview, here are the key points that Anxious addresses. First, the science of emotion, and especially the science of fear and anxiety, now finds itself at an impasse, dictated by the way we discuss emotions in relation to the brain. For example, researchers use words like “fear” to describe the brain mechanisms that cause rats to freeze when in danger, and also to describe the conscious feeling that humans experience if they think that they will be seriously harmed physically or psychologically. The general idea is that a fear circuit in the brain is responsible for the feeling of fear, and when it is activated, whether in a rat or a human, the feeling of fear occurs, along with responses characteristic of fear (such as freezing, facial expressions, changes in body physiology). The feeling of fear is often said to mediate between the threatening event and those responses. Because these circuits are conserved throughout mammals, including humans, we can study human fear by measuring freezing in rats. The key circuits crucially involve the amygdala, which is generally described as the seat of fear in the brain.
In fact, most of what I have just described is wrong. Because my work and writings are in part responsible for these misconceptions, I feel some responsibility to try to straighten out the story before it goes further off track. One of the main goals of this book is to provide a new view of fear and anxiety, one that more accurately distinguishes what we can learn from animals from what we can best learn from humans, and what fear itself really refers to in the context of the human brain.
Don’t get me wrong: I am not arguing that we have to study brain mechanisms related to emotions exclusively in humans. There is much we have learned, and can continue to learn, and can, in fact, only learn, from animal research. But we do need a rigorous conceptual framework for understanding what the animal work does and does not mean for understanding the human brain. I offer my view of such a framework, which I think provides a new perspective on fear and anxiety, and the disorders related to these states.
The suggestions I make in this book concern in part the words we use to describe certain phenomena, but my argument is not simply about semantics. Words have extended meanings that imply a great deal. For example, some researchers who study fear in rats by measuring freezing behavior say that they are not studying what most people think of as fear, but rather some nonsubjective physiological state that they call fear. While this scientific redefinition of fear makes it more tractable as a research problem, it has three disadvantages. First, using fear in a nonconventional way to describe a physiological state that connects threats with responses often leads researchers to write and talk about this state as if it was referring to the conscious feeling of fear. Second, even when the researchers adhere to that definition, everyone thinks that they are actually studying the feeling of fear. And third, we in fact do need to understand the feeling of fear, and ignoring it is not the solution.
As scientists we have an obligation to be precise in how we describe our research. This is especially important when the work is being used to conceptualize human problems—in this case, fear and anxiety disorders—and develop treatments for them. But because conscious feelings of fear and anxiety arise from circuits in the brain that differ from the circuits that control the expression of defensive behaviors like freezing, and are likely vulnerable to different factors, they need to be understood separately. Certainly the circuits that control defense responses and give rise to feelings of fear interact, but this does not mean that they are the same.
Failure to make such distinctions accounts for poor outcomes of studies that have attempted to develop new pharmacological treatments for fear and anxiety in animals, as the studies assess the effects of drugs on behavioral responses but then expect the drugs to actually make people feel less fearful or anxious. We have long known that there is discordance in how treatments affect the way people feel when threatened as opposed to the behavioral and physiological responses they express in such situations.
One of the key issues to point out is that people can be shown pictures of threats in such a way that they are not conscious of the stimulus, and have no conscious feeling of fear. But their amygdala is activated by the threat, and bodily responses, such as changes in perspiration, heart rate, or pupil size occur, showing that the detection and response to threat is independent of conscious awareness. If we don’t need conscious experience to control responses to threats in humans we should be cautious about concluding that conscious states cause rats to respond to threats. I am not saying that rats or other animals lack consciousness. All I am saying is that we should not simply assume that because they may respond the way we do when threatened they feel what we do. The problem is that scientific studies of animal consciousness are not easily performed.
Implied above is that fear and anxiety are conscious feelings. As such, we need to understand consciousness in order to understand fear and anxiety. Several chapters of Anxious are devoted to giving a progress report on the current state of our understanding of consciousness in neuroscience, psychology, and philosophy (at least from my perspective). Included is the controversial topic of animal consciousness, which, as I just mentioned, is extremely difficult to study scientifically. I suggest guidelines about how we might be more scientific in our approach to this subject.
My view of consciousness dates back to my graduate work on split-brain patients, which I conducted with my mentor, Michael Gazzaniga, at SUNY Stony Brook. We concluded that one important role of consciousness is to make sense of our complex brains. Much of what our brain does, it achieves nonconsciously. Our conscious minds then construct an explanation of what we experience. In this sense, consciousness is a self-narrative built from bits and pieces of information we have direct conscious access to (perceptions and memories) and also from the observable or “monitorable” consequences of nonconscious processes. Emotions are, as some now say, cognitive or psychological constructions.
Finally, I discuss issues related to therapy. One key argument I make is that contrary to popular opinion, the behavioral procedure called extinction is not the main process at work in exposure therapy. Extinction plays a role, but exposure therapy actually involves many more mechanisms, and it is possible they actually interfere with the ability to extinguish. Another principle I challenge is that avoidance is always a bad thing for people with anxiety, for I believe that a form of proactive avoidance can be very useful. These and a number of other ideas for improving psychotherapy come directly from animal research. The key is to know what we can and can’t learn from animals, and to not conflate the two.
• • •
I have dedicated this book to the many graduate students, postdoctoral, and technical researchers in my lab over the years who have contributed to the work with which I have been credited, for they deserve as much credit as I, and in some cases more. In alphabetical order they are:
Prin Amorapanth, John Apergis-Schoute, Annemieke Apergis-Schoute, Jorge Armony, Elizabeth Bauer, Hugh Tad Blair, Fabio Bordi, Nesha Burghardt, David Bush, Christopher Cain, Vincent Campese, Fernando Canadas-Perez, Diana Cardona-Mena, William Chang, June-Seek Choi, Piera Cicchetti, M. Christine Clugnet, Keith Corodimas, Kiriana Cowansage, Catarina Cunha, Jacek Debiec, Lorenzo Diaz-Mataix, Neot Doron, Valerie Doyere, Sevil Durvaci, Jeffrey Erlich, Claudia Farb, Ann Fink, Rosemary Gonzaga, Yiran Gu, Nikita Gupta, Hiroki Hamanaka, Mian Hou, Koichi Isogawa, Jiro Iwata, Joshua Johansen, O. Luke Johnson, JoAnna Klein, Kevin LaBar, Raphael Lamprecht, Enrique Lanuza, Gabriel Lazaro-Munoz, Stephanie Lazzaro, XingFang Li, Tamas Madarasz, Raquel Martinez, Kate Melia, Marta Moita, Marie Monfils, Maria Morgan, Justin Moscarello, Jeff Muller, Karim Nader, Paco Olucha, Linnaea Ostroff, Elizabeth Phelps, Russell Philips, Joseph Pick, Gregory Quirk, Franchesa Ramirez, J. Christopher Repa, Sarina Rodrigues, Michael Rogan, Liz Romanski, Svetlana Rosis, Akira Sakaguchi, Glenn Schafe, Hillary Schiff, Daniela Schiller, Robert Sears, Torfi Sigurdsson, Francisco Sotres-Bayon, Peter Sparks, Ruth Stornetta, G. Elizabeth Stutzmann, Gregory Sullivan, Marc Weisskopf, Mattis Wigestrand, Ann Wilensky, Walter Woodson, Andrew Xagoraris. Also included are Elizabeth Phelps, my long-standing collaborator, and her team at NYU, as they have done human versions of our rodent studies and verified that our findings apply to people.
For assistance with the ancient roots of the modern word “anxiety,” I am grateful to my son, Milo LeDoux, who was trained in classics at the University of Oxford, and is now a student at the University of Virginia School of Law, and Peter Meineck, clinical associate professor of classics at NYU and founder of the Aquila Theatre. The cognitive therapist Stefan Hofmann of Boston University helped me tremendously by providing key papers for me to read to help me better understand cognitive therapy and its relation to extinction. Isaac Galatzer-Levy, a colleague from the NYU Langone Medical Center Department of Psychiatry, read several chapters and made helpful comments.
I am also grateful to my illustrator, Robert Lee, for his patience in working through my various incomplete and sometimes incoherent rough drafts of the art.
Special thanks to William Chang, my longtime assistant, who has suffered graciously through many writing projects, and without whom completion of this project would have been far more onerous a task.
I have been continuously funded by the National Institute of Mental Health since 1986, and much of the research discussed here was made possible by its support. Recently, I have also been supported by the National Institute of Drug Abuse. In the past I have also received funding from the National Science Foundation. I am grateful to Robert Kanter and Jennifer Brour for their support.
In 1989 I joined the faculty of Arts and Sciences at NYU, where I have been a member of the Center for Neural Science and Department of Psychology. In recent years I have received appointments in psychiatry and in child and adolescent psychiatry at NYU Langone Medical School. NYU has been a loyal and generous friend to me and my research.
In 1997, through a collaboration between NYU and New York State, I was appointed as director of the Emotional Brain Institute. This is a multisite program with laboratories at NYU and at the Nathan Kline Institute for Psychiatric Research. Through support of this program by NYU and New York State we hope to make new gains in understanding fear and anxiety. Some of the studies described in this book have been conducted in this context.
John Brockman, Katinka Matson, and everyone at Brockman Inc. are incredible agents. I am grateful for all they have done for me over the years, starting with The Emotional Brain.
At Viking, I can’t lavish enough praise on Rick Kot. He was the editor of Synaptic Self as well, and I hope of future books that may be lurking deep down in the synaptic recesses of my brain. Rick’s assistant, Diego Núñez, has been terrific in helping navigate the end-of-book steps. And Colin Weber deserves special credit for designing such a compelling jacket image—so compelling, in fact, that it led to discussions about whether it might be too “scary” for anxious people.
I want to express my love and thanks to my brilliant and beautiful wife, Nancy Princenthal. Nancy and I were engaged in major book projects at the same time, both headed toward publication in the spring/summer of 2015. In spite of special challenges that she faced in completing her biography of the late artist Agnes Martin, she was a friend, companion, critic, and editor when each role was needed.
• • •
How did the title Anxious finally come about? In 2009 my band, The Amygdaloids, released an album titled Theory of My Mind on the Knock Out Noise label, on which Rosanne Cash sang two songs with me. One of the pieces that we recorded that didn’t make it onto the album was called “Anxious.” I always liked the song, and had been thinking of releasing it separately. That’s when the idea that the book should be called Anxious hit me. And it didn’t take long to make the next mental leap: Why not release both Anxious the book and Anxious the CD simultaneously, since my songs are related to the themes in the book? Colin Weber generously agreed to allow me to use the book jacket art for the CD cover. Below you will see a barcode that can be scanned for a onetime free download of the songs on Anxious.