Participating in NIMH’s recent panel on anxiety disorders were (from l) Dr. H. Blair Simpson, Dr. Elizabeth Phelps, Dr. Daniel Pine, NIMH director Dr. Thomas Insel, Dr. Ronald Kessler and Dr. Kerry Ressler.
Anxiety disorders, characterized by extreme anxiety or fear that makes daily life difficult, are among the most common mental disorders. About one in five people in the United States will be burdened by an anxiety disorder sometime
in their life. But 30 years of research and advocacy have led to improved understanding about the disorders and treatment options for those affected.
The results of that research were discussed at a recent symposium sponsored by the National Institute of Mental Health. The event was held in honor of the late Dr. Jerilyn Ross, one of the founders of the Anxiety Disorders Association of America and an advocate for anxiety disorders
research and treatment.
NIMH director Dr. Thomas Insel spurred discussion
about anxiety disorders from five panelists
who discussed studies prompted to a large degree by Ross’s accomplishments. They agreed that, like many mental disorders, anxiety disorders
tend to start in early life. “It can be hard to understand how crippling these disorders are if you don’t have one,” said Dr. H. Blair Simpson
of Columbia University, who is a clinician as well as a researcher.
“When you talk to adults with anxiety disorders,
most will say their problems started when they were kids,” said Dr. Daniel Pine, an NIMH intramural scientist who studies the neuroscience associated with anxiety disorders.
Although most children who have anxiety tend to grow out of it, the subset that does not will account for the majority of chronic anxiety problems in adults, he explained.
Determining who may grow out of it and who may not is “the $64,000 question right now,” he added. “Research has taught us that if you are exposed to your fears, you are better able to overcome them. Children with social anxiety
who are encouraged to interact with peers at school are often better able to overcome their anxiety.”
The group also discussed how neuroscience and the use of brain imaging technologies such as functional magnetic resonance imaging
(fMRI) have improved our understanding of brain disorders. Using fMRI, scientists have been able to pinpoint brain regions involved in developing fear and anxiety such as the amygdala,
a small area known as the “fear hub” situated deep inside the brain. In people with anxiety disorders, the amygdala may be overactive
Genetic studies are also helping identify certain genetic variations that confer risk or resilience in people. By combining our understanding of the neuropathways that mediate fear with our understanding of genetics, we hope to develop and target better treatments—“the sweet spot in the field,” noted Dr. Kerry Ressler of Emory University.
The panelists conveyed a collective sense of excitement about the future of anxiety disorder
research and treatment. Since Ross began her work in the 1980s, the stigma associated with the disorders has lessened. And psychotherapies,
especially cognitive behavioral therapy
and exposure therapy, have proven effective
for many people. Medications also help many sufferers.
Summing up the session, Insel noted that we now understand that an anxiety disorder likely
“has a biological basis, with a psychological
cure. It’s a very positive picture of how far we’ve come.”