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Citation : Perrotta G. Anxiety disorders: definitions, contexts, neural correlates and strategic therapy.
JJ Neur Neurosci 2019; 6(1): 042.
Review article
Anxiety Disorders: Denitions, Contexts, Neural Correlates And Strategic Therapy
Giulio Perrotta
*Corresponding author: Dr. Giulio Perrotta, UNIFEDER University, Department of Criminal Psychology, Italy,
Phone :( +39) 349 2108872; E-mail: info@giulioperrotta.it
Received Date: 03-12-2019
Accepted Date: 03-25-2019
Published Date: 03-29-2019
Copyright: © 2019 Giulio Perrotta
Jacobs Journal of Neurology and Neuroscience
Abstract
Starting from the concept of anxiety, we proceeded to separate the “physiological” form from the “pathological” forms,
distinguishing between fear, anguish, panic, phobia, fear, terror and stress, all terms often confused and overlapped in
the common jargon. Distinguishing the individual psychopathologies contained in DSM-V anxiety disorders, with a focus
pharmacological and psychotherapeutic approaches chosen to treat the morbid condition, paying particular attention to
the strategic model and the most important clinical techniques.
Keywords: Psychology; neuroscience; anxiety; panic; terror; anxiety disorders; panic attack; panic disorder; selective
mutism; phobia; agoraphobia; amygdala; prefrontal cortex; fear; anxiety; psychotherapy; psychopharmacology; benzodia-
zipines; antidepressants; strategic approach
Introduction
-
ety as the anticipated anticipation of a future danger or negative event, accompanied by feelings of dysphoria or physical
state with an unpleasant content, associated with a condition of alarm and fear that arises in the absence of danger real
However, the idea that it consists of a psychophysical state characterized by a feeling of apprehension, uncertainty,
fear and alarm towards events towards which the subject feels helpless and/or is univocal helpless. It involves a psychic
It represents an essential emotion for the correct functioning of our organism in response to external or internal
stimuli, allowing a functional adaptation to environmental demands. The related manifestations of anxiety have prevalence,
2
in the non-psychotic psychiatric population. The feeling
of anxiety, as well as, in an extremely polymorphous way,
is felt by every human being, is characterized by a vague,
widespread and unpleasant sense of apprehension, often
accompanied by somatic symptoms autonomous species
(palpitations, tachycardia, tremors, hyperhidrosis, etc.), but
also from psychic symptoms and behavioral manifestations
one’s existence; it becomes the source of a morbid condi-
tion if the management of it becomes uncontrollable, to the
point of undergoing a negative change in one’s lifestyle.
the normal response of our body that prepares to face what
it perceives as a danger. We have the feeling of being vulner-
able, even if sometimes we do not understand for sure why.
When our ancestors faced the threat of ferocious animals or
hostile peoples, the changes that took place in their bodies
are of a completely different nature, but faced with a situ-
ation that frightens us, or that we perceive as threatening,
the same changes occur in us at the time. When anxiety is
moderate it can be useful, because it puts us on the alert in
It can become a real problem when it is excessive compared
to the situation we are facing or lasts too long, to the point
the main constructs that cognitive theory associates with
-
Disproportionate fear of harm and tendency to neg-
as the tendency on the part of the subject anxious to
foresee a wider range of negative consequences than to
non-anxious subjects starting from everyday situations
and to conceiving the danger inherent in these negative
possibilities as essentially unavoidable, irresistible and
irreparable.
as the tendency to emphasize rather the errors and
imperfections present in the tasks performed than the
positive results, and to fear and foresee that these im-
perfections inevitably lead to negative and catastrophic
consequences.
to think of not being able to emotionally bear the fact
of not knowing perfectly all the possible future scenar-
ios and events, of not being able to bear the doubt that
among the possible future events there may be some
negative ones , even if this possibility is very low, or to
fear that, if there are negative possibilities in a certain
scenario, these will be those that inevitably or tenden-
tially occur (of course the negative developments are
predict catastrophic scenarios deriving directly from a
negative evaluation both of one’s own practical skills
(negative performance self-assessment) and of one’s
capacity for emotional self-control and recovery in situ-
of weakness, fragility).
search by the anxious subject of the illusion of absolute
certainty that he can prevent all the negative possibili-
ties that he himself continually feared and foreseen in
rumination through continuous monitoring and manip-
ulation some aspects and parameters of external and/
or internal reality (eg weight, food and/or fat in eating
disorders, intrusive thoughts or external order in ob-
sessive compulsive disorder, etc.). In our hypothesis, the
tendency to control constitutes the above-mentioned
and terminal level of the hierarchical architecture of
anxiety. This means that we believe that at the bottom
belief that things tend to go wrong and that a high de-
gree of knowledge and control of reality is necessary to
prevent things from going wrong. The other constructs
(fear of damage, fear of error, negative self-assessment
and fear of uncertainty) are subordinate and not all
always present, at least from the theoretical point of
view. Fear of damage and negative self-assessment are
3
whether they are organized hierarchically or refer to
different areas. Hypothetically it could be assumed that
the negative self-assessment is feared because it would
lead to damage, and therefore the fear of harm is the
terminal belief. Likewise, one might think that it is the
negative self-assessment of the central belief that fears
of harm is only a predicate. Or one might consider that
the two concepts are two different dimensions of a sin-
gle construct, and therefore they are mutually non-hier-
Distressing and stressful thoughts and sensations;
Physical symptoms, such as cardiovascular symptoms
(tachycardia, palpitations, extrasystolia, arrhythmia,
pain or discomfort in the chest, hypertension or pres-
sure drops, fainting), respiratory (breathlessness, chok-
ing sensation, sensation of a lump in the throat, asthma),
gastrointestinal (nausea, gastritis, gastroesophageal
-
cular (shaking sensation tremor, stiffness, paresthesia,
contractures, muscle tension, weakness and fatigue),
neurological (vertigo, feeling of “empty head” or light,
-
ical (hives, redness or pallor of the face, hyperhidrosis)
and urinary (sudden urge to urinate and pollachiuria).
appetite and avoidance of certain situations.
In summary, when physiological anxiety becomes
an abnormal reaction to a normal alarm situation, it then
takes on the pathological appearance of one of the anxiety
disorders described in the DSM-V and which we will see in
the next section. To be straightforward, physiological anx-
iety is the sensation of not being able to pass a university
exam; the pathological version consists in the choice not to
present ourselves at the exam session, despite the fact that
there is an intense study of several months behind.
“Healthy” anxiety, however, must also be distin-
guished from other feelings, often confused in the common
jargon in terms of terminology. We are talking about fear,
anguish, phobia, panic, fear, terror and stress.
-
ulus that evokes the answer. This difference is underlined
-
scribe anxiety as an emotion that anticipates the danger in
differentiates anxiety from fear, describing the former as a
state of increased vigilance and the latter as a consequent
emergency reaction to trigger factors. Fear can therefore be
-
mal, which allows automatic evaluation of a potential threat
or danger so perceived, while anxiety is, instead, a more
complex response system involving cognitive and emotional
factors. ,behavioral and physiological. On this basis, it seems
correct to state that anxiety and fear are physiological and
-
-
yond any doubt that anxiety states arise from an abnormal
control of fear; in particular, starting from the assumption
that anxiety is an adaptive state, anxiety disorders have a
genetic component and that the anxious disorders are dif-
-
gy, the researchers have concluded, also thanks to the use of
images of neurovisualization (fMRI), which in the states of
fear and anxiety, are called into question the neural circuits
that originate in the amygdala; indeed, the activation of the
amygdala was recorded in response to the presentation of a
stimulus that induces fear, not consciously perceived.
extreme essence of dysfunctional anxiety, where the inva-
siveness, the restlessness and the sense of catastrophe seen
and perceived, from a psychodynamic point of view, from
the Ego, such as to undermine the ego’s ability to control
and manage the pressures of the Super-ego and the id,
consisting of a painful emotional state in which there were
which embodies it in the sense of frustration and psycho-
4
physical malaise, a prelude to various pathologies, precisely
because this condition remains for a long time, in a subtle
and constant way. In the clinic, we tend to distinguish the
-
stance) from the “existential or chronic” form (due to the
lack of processing and maturation of the triggering condi-
tion).
The phobia is the pathological condition that is gen-
-
uation that is not really dangerous (or at least less danger-
ous than the subject feels); this because the phobia, unlike
fear, is not proportional to the risk to which one is aware of
being exposed or believed to be exposed. In essence, fear
phobic object that triggers the episode can be of any kind
1.
2.
3.
4. -
ing they cause. Often those suffering from this fear may
have the impression that mites have infected their skin.
5.
darkness. It is generally common in children and is re-
lated to the possible dangers it can hide.
6.
places.
7.
has an infantile origin and may be linked to a very loud
noise that has aroused fright.
8.
9.
discomfort and in some cases repulsion, towards physi-
cal contact (both given and received) perceived as a sort
of invasion of one’s own or another intimate area.
10.
environments, fearing he cannot control the situation
that leads him to desire an immediate escape route to a
place he considers safer. It can be associated with panic
attacks.
11. -
sistent fear of the proximity of cats, which can often
generate panic attacks.
12.
a certain means of transport, due to the direct involve-
ment or of loved ones in road accidents. It can be the
cause of panic attacks and can be particularly disabling
for professional and work life as it hinders travel.
13.
14. -
wards all that is English, in general it is the hostility ex-
pressed towards the culture and the English people.
15. -
tacts.
16.
even in photos, which can manifest itself in mild form
through disgust up to more serious forms such as repul-
sion and panic attacks with escape reactions.
17.
18.
19.
20. Ceraunophobia, is the fear of thunder and lightning, es-
pecially prevalent among children and pets. Even this
-
havior towards places where they can hide and feel pro-
tected.
21. Claustrophobia is the fear of closed and restricted plac-
es like dressing rooms, elevators, underground, under-
ground and all the narrow places where the subject
is considered encircled and devoid of spatial freedom
around him. It can manifest with or without panic at-
tacks.
5
22. Clinophobia is the fear of lying down and falling asleep
and detaching from reality, as they fear having night-
mares or bed wetting, they often remain awake and
develop insomnia. Some people in this fear associate
sleeping with death.
23. Coulrophobia corresponds to the fear of clowns and
clowns, very common among children and in some cas-
es in adolescents and adults.
24.
25. Dysmorphophobia is the phobia that arises from an ex-
cessive concern of one’s body image and one’s outward
appearance. See also somatoform disorders.
26. Disposophobia is an obsessive need to acquire (without
using or throw away) a considerable amount of goods,
even if useless, dangerous, or unhealthy. Compulsive
to essential activities such as moving, cooking, cleaning,
washing and sleeping.
27. Eisoptrophobia or spectrophobia is the persistent, irra-
in a mirror. People who suffer from this phobia feel an
undue anxiety looking in the mirror, while realizing that
their fears are irrational.
28. Emetophobia is the terror of vomiting caused basical-
ly by the inability to dominate and predict their own
retching. The idea of loss of control and anxiety not to
know the outcome that will have a feeling of nausea, are
the basis of this phobia. It often occurs at times when it
people close to him (eg, at the stadium, at the cinema or
more simply at a friend’s house, at work). Often a real
“psychological resistance” develops to the vomit that
prevents to put back even when the thing would really
29. Hemophobia is excessive repulsion for the blood.
30. Entomophobia or insettofobia is the abnormal and ir-
rational fear or aversion towards insects, mites and
spiders, which usually causes emotional reactions that
can range from mild forms of anxiety to severe panic
attacks.
31.
32.
33. Ergofobia or ergasiophobia refers to an irrational fear
of work or tasks and tasks, often hiding a fear of failing
in assigned tasks or socializing with colleagues, lead-
ing to experience a disproportionate anxiety about the
work environment.
34. Fagophobia consists in the fear of swallowing. It can
lead to fear of eating and subsequent malnutrition and
weight loss. In milder cases one affected by phagocytic
nourishes only with soft and liquid foods.
35.
abnormal fear of falling in love or loving a person, al-
though it provokes a sense of physical and moral attrac-
tion towards man or woman.
36. Phobophobia is a rare phobia that can be referred to as
fear of fear, but also as a fear of developing a phobia.
Phobophobia is related to problems of anxiety and pan-
ic attacks that are also connected with other types of
phobias, such as agoraphobia.
37. Phonophobia is the obsessive fear of noise. Unlike hy-
peracusis, it has psychological causes, often in sound
traumas.
38. -
ting old.
39. Ginophobia is an unnatural phobia of the woman.
40.
phobias.
41. Hydrophobia, is the anomalous and obsessive aversion
to liquids, in particular water and also refers to a fear of
swimming in deep water, or drowning.
42.
words and their use. For logophobia can also be under-
stood the fear of speaking in public.
6
43.
contact with foreign bodies, or through contact with
other human beings. It often leads to increasing the
hygiene precautions to the extent that they turn into a
separate disorder (to wash their hands obsessively).
44.
45.
disconnected from contact with the mobile telephone
network.
46.
snakes that leads to avoid walking in the high grass or
in any area where these animals can easily hide, even
in the regions where the presence of any species of any
species is absolutely excluded.
47. Homophobia is fear and irrational aversion to homosex-
uality, which involves the presence of aversive thoughts,
feelings and behavior towards gays, lesbians, bisexuals
and transsexuals (called transphobia), usually resulting
from prejudices and which can lead discriminating be-
haviors in society or in work, up to manifestations of
violent aggression.
48.
of getting sick.
49. Pediophobia is fear, present in some children or even
adults, in relation to certain dolls or puppets that are
generally larger than their parents and therefore a
scary enemy.
50. -
51. Rupophobia, is the obsessive fear of dirt that causes the
subject to repeatedly accomplish the act of cleaning up
on himself (for example the continuous washing of the
hands) or the environment that surrounds him (for ex-
ample the house).
52. Sessuophobia means the fear to face any action or
thought related to sexuality.
53. Siderodromophobia indicates a particular phobic con-
dition of the train journey, which can cause panic at-
tacks and is generally associated with claustrophobia.
54.
55. Tafophobia is the fear of being buried alive, as a result
of the erroneous observation of one’s own death, some-
times present in old people.
56.
57. Tocophobia is the fear of childbirth, usually present in
the primiparous, but it can also affect a woman in the
58.
59.
60. Urophobia is the phobia of urinating in public, in front
exposed urinals. The most serious subjects cannot uri-
nate even indoors, if nearby they feel the presence of
other people. In other words, the paruretic, although
not affected by a physiological disorder, in the presence
of other people is unable to urinate.
61. Xenophobia is the fear of what is distinct by nature,
race or species. Sometimes this attitude does not stop
at mere fear, but leads to a real intolerance and discrim-
ination against the object of one’s fear.
62.
Panic is an abnormal and uncontrolled reaction to
an initially neutral or mildly stressful situation. If, therefore,
pathological anxiety, in most cases, is due to the limits that
we impose ourselves for some form of fear, and the anguish
is the result of a false Self, of an identity that does not be-
long to us but that we consider ours and that we do not rec-
ognize as false, the panic attack is the clinical manifestation
of the result of a long-standing anxiety, to which we have
never left space for the elaboration and that, in a moment
often of apparent banality or serenity, while the ego’s de-
fenses are at a minimum, it hits the victim by paralyzing her.
It is not by chance that the main symptoms of a panic attack,
7
-
pnoea or suffocation, feeling of asphyxiation (lack of air),
chest pain or discomfort, abdominal discomfort, discom-
fort, instability, lightheaded or fainting, derealisation (feel-
ing of unreality) or depersonalization (being detached from
oneself), fear of losing control or going crazy, fear of dying,
paresthesia (sensations of numbness or tingling), chills or
however, should be distinguished the real panic disorder,
or the simultaneous presence of multiple, unexpected and
recurrent panic attacks and at least one of the attacks must
have been preceded by the persistent worry of having other
attacks or concerns about the implications of the attack or
its consequences (eg, losing control, having a heart attack,
-
ed to the attacks. The presence or absence of agoraphobia
fear can occur a harmful, painful or unpleasant event. It
arises when a situation that suggests a pleasant effect, joins
the possibility of suffering. One is afraid when the hypothe-
sis that the expected pleasure may not occur is considered,
however the hope is still present that pleasure comes and
covers the thoughts of different and painful hypotheses.
It’s the case of a person who waits for the beloved/or an
pleasure (loved one) may not arrive, together with the frus-
tration and sorrow (pain) that will ensue. When the person
arrives, a smile of contentment covers the previous fear
-
-
action is entirely inhibited. It arises in extreme danger or
body deactivates any sensation coming from the periphery
to limit the body’s sensitivity in the agony that precedes
death. It is a withdrawal inward, as in a state of shock. The
breath remains paralyzed in the exhalation phase. Terror
can precede fainting; in this case life is maintained by the
neuro-vegetative system through unconscious processes.
If the terror persists for a long period of time, the deper-
sonalization, dissociation of the ego perceived by the bodily
processes It can occur both on a conscious level and during
-
gon to indicate a state of nervousness and low-level anxiety,
often connected to the family or work environment. In the
psychophysical response of the organism to every request
Based on the duration of the stressful event it is
-
ulus occurs only once and has a limited duration, it is called
“acute stress”; if instead the source of stress persists over
time, the expression “chronic stress” is used. Furthermore,
according to the nature, the stressor (stressful events) is
distinguished in distress, as an event that lowers the im-
mune defenses (correlating it to frustration and anxiety),
and eustress, which is an event that fosters greater vitality.
The generally perceived symptoms depend on the
triggering event but can be summarized in physical-somat-
ic (headache, abdominal pain, muscle pain, sensory dis-
turbances, sexual disorders), emotional (tension, anxiety,
unhappiness, restlessness), behavioral (feeding impaired
sleep disorders, anger, substance abuse) and cognitive im-
-
lem solving and agitation).
-
ous psychopathological disorders. In other cases, it itself
becomes the predominant framework of the clinical context
disorders that share excessive fear and anxiety character-
istics; fear as an emotional response to an imminent threat,
not necessarily real, while anxiety as the anticipation of an
from each other by type, nature and symptomatology; the
Separation anxiety disorder consists of excessive fear
and anxiety concerning separation from home or from
8
-
mediately agitated and worried, experiencing a high
level of anxiety and agitation, even if only mentally an-
ticipating the removal from home or primary caregiv-
then they can experience mild levels of worry when
-
vironment, frequently returning to the parent, looking
for safety.
Selective mutism is the inability of the child to speak
and communicate effectively, in social contexts he se-
lects perceived as threatening (eg school). It is not by
chance that in the environments in which he experienc-
es the states of well-being, serenity and safety, the child
is always able to communicate and express himself
freely. Silences, however, should not be interpreted as
the child from speaking, paralyzing him.
often it is a disorder in comorbidity with other pathol-
ogies.
The social anxiety disorder (so-called social phobia)
consists in the intense and persistent fear of facing sit-
uations in which one is exposed to the presence and
judgment of others, for fear of being embarrassed, in-
capable, ridiculous or acting in inopportune and humil-
iating way. The immediate consequence of an exposure
is a state of anxiety that in some cases can reach the
then refers to one or two isolated situations, in which a
performance or activity is generally expected while be-
ing observed by others; in the case of generalized social
anxiety, however, one may be afraid of meeting acquain-
tances or strangers in any context, formal or informal.
The panic disorder, as already analyzed above, consists
in a chronicization of the single attacks, accompanied
by the thoughts of imminence of the attack itself. It is
severely disabling and often forces the subject to limit
himself. It can be in comorbidity with the agoraphobic
disorder that is the feeling of fear or serious discomfort
surroundings or in large open spaces, fearing he can-
an immediate escape route to a place that he considers
safer.
Generalized anxiety disorder is characterized by symp-
toms of persistent, pervasive, uncontrollable and gen-
eralist anxiety, induced by the excessive preoccupation
with respect to the feared event. Individuals suffering
from this disorder report feelings of anxiety and appre-
rumination and irritability.
From a strictly psychodynamic point of view, in the
Freudian model, anxiety corresponds to an ego affection,
which controls access to consciousness, leading to censor-
-
moved impulse can however be expressed in the form of a
symptom; then, depending on the defense mechanisms in-
volved, the hysterical rather than the phobic symptom will
be witnessed, with the compulsive symptom rather than the
-
scious) level, the anxiety that comes from the superego can
be understood in terms of torments of consciousness and
feelings of guilt, deriving precisely from the gap between
The brain systems that regulate the anxious re-
sponse are quite complex; among the regions that play a
the prefrontal cortex. The amygdala is the central nucleus
of the circuits of fear, as a very complex structure able to
respond promptly to the danger (be it potential or real), ac-
tivating a whole series of somatic responses (such as the
increase in heart rate and blood pressure, up to hyperventi-
-
9
The circuit in question takes into account anxiety,
as a physiological and functional measuring mechanism for
survival and evolution; however, if the critical threshold is
exceeded, anxiety turns from adaptive to maladaptive (and
therefore dysfunctional), leading to a worsening of perfor-
mance and reactions.
The relationship between anxiety level and performance (in
-
The relationship between anxiety level and per-
formance.
From a neuronal point of view, the anxiety-fear cir-
the sensory thalamus, which collects all the sensory percep-
tions of our body, transmits the stimuli to the lateral amyg-
daloid nucleus, which in turn transmits them back to the
central nucleus. From this last part stimulation of further
-
quency (due to the stimulation of the parabrachial nucleus),
the increase of the arterial pressure and of the heart rate
(due to an increase in the noradrenaline release induced by
stimulation of the locus ceruleus). Moreover, the activation
of the gray substance and of the paraventricular nucleus of
the hypothalamus will determine, respectively, the manifes-
tation of a defensive response of “block” and the activation
consequent increase in the adreno-corticoid. In the “long”
way, the sensory cortex, the insula and the prefrontal cor-
tex send the signal to the lateral amygdaloid nucleus. From
here the signal is sent to the brainstem and hypothalamus.
Central, in this way, unlike the short one, is the activation of
the prefrontal cortex whose function is to modulate anxiety
The thalamus performs a function of primary link
between the sensory systems exteroceptive (auditory, visu-
al, somatosensory), main afferents of the neuronal circuits
that determine anxiety and fear, and the primary sensory
areas of the cerebral cortex, which project the sensory input
to adjacent associative areas, for integrated stimulus pro-
cessing. The cortical associative areas then send projections
to various brain structures, such as amygdala, entorhinal
cortex, orbital-frontal cortex, and the cingulum gyrus. The
visceral afferences do not converge on the thalamus and ac-
tivate the locus coeruleus and the amygdala, either through
direct connections, or through pathways mediated by the
paragigantocellular nucleus and by the nucleus of the soli-
tary tract.
The fear response is particularly related to three of
receives the stimuli from the sensory thalamus and trans-
these areas signals are sent to the brainstem (BS) and to the
hypothalamus (HYP), to which the autonomic and behav-
ioral response of fear follows. The amygdala also receives
unprocessed information from the thalamus; it represents
the epicenter of the events involved in the modulation of
anxiety states, both in animals and in humans, with a wide
spectrum of reciprocal connections with the cortical and
limbic structures, implicated in the emotional, cognitive,
autonomic and endocrine response to stress. The neuronal
interactions between the amygdala and the other cortical
and subcortical regions allow the implementation of risk
reaction behaviors, dependent on multiple variables such
as the individual’s biological characteristics, his tempera-
ment, previous experiences, the contingent emotional situ-
10
ation, etc. In this sense, the importance of the stressful load
of an event is more related to the subjective evaluation of
an individual than to the objective reality of the event itself
-
ety-fear circuit trigger an autonomic response, which in-
volves the sympathetic and parasympathetic system. The
sympathetic activation, mediated by the stimulation of the
hypothalamus by amygdala and locus coeruleus, determines
an increase in blood pressure and heart rate, sweating, pilo-
erection and pupillary dilatation. Para-sympathetic activa-
tion, whose main projections are represented by the vague
and splanchnic nerves, mediated by the hypothalamus, the
paraventricular nucleus, the amygdala and the locus coeru-
leus, may be linked to visceral symptoms associated with
anxiety, such as disorders gastrointestinal and genito-uri-
the immune system through complex neuroendocrine and
immuno surveillance can, then, under certain conditions of
intense and protracted stress exposure, determine an organ
or system meiopragy, until the appearance of an organic
The amygdala plays a fundamental role in emotions.
Its functional coupling with the hippocampus and the
ventromedial prefrontal cortex extending to a portion
anxiogenesis and regulation of the hypothalamic-pi-
how functional connectivity centered on the amygdala
-
tisol in everyday life. Here, we investigate the relation-
ship between daily cortisol concentrations (dCOR) and
amygdala-centered HR during emotional processing in
forty-one healthy humans. FC analyzes revealed that a
higher dCOR predicts strengthened amygdala-centered
FC with the hippocampus and cerebellum, but inhibit-
ed FC with supramarginal rupture and a perigenal part
-
pared to neutral faces). In particular, the strength of
the amygdala-hippocampus FC mediated the positive
relationship between cortisol and anxiety, particularly
a presumptive neural indicator of emotional control. In-
dividuals with reduced connectivity between amygdala
vulnerable to anxiogenesis as it relates to higher circu-
lating levels of cortisol in everyday life. The individual
connectivity could provide a key to understanding the
complicated link between cortisol and anxiety-related
discrimination between an idea that predicts an ad-
verse result and a sure stimulus that provides for the
absence of that result. This impairment has been linked
to a spontaneous increase in fear after extinction; how-
ever it is not known whether there is a link between
discrimination and the return of fear in a new context
(i.e. the renewal of the context). It is also unknown if
the impaired discrimination mediates the relationship
between stroke anxiety and spontaneous recovery or
context renewal. The present study used a differential
fear conditioning paradigm to examine the relation-
ships between stroke anxiety, discriminant learning,
spontaneous recovery and context renewal in healthy
volunteers. Learning of fear was assessed using con-
tinuous assessments of US expectation and subjective
assessments of fear. Discrimination mediated the rela-
tionships between stroke anxiety and spontaneous re-
covery and context renewal in such a way that high trait
anxiety was associated with weaker discrimination,
which in turn was associated with an increase in fear
in the test phases. The results are discussed in terms
of genesis and maintenance of anxiety disorders (Sta-
establish the memory of fear are complex and involve a
dysregulation of these processes can manifest itself in
humans as a range of anxiety disorders related to fear
such as post-traumatic stress disorder (PTSD). In the
-
tal infralimbic cortex (IL-PFC) and prelimbal prefrontal
cortex (PL-PFC) of mPFC (medial prefrontal cortex) and
-
eral amygdala (CeL), centromedial amygdala (CeM) of
histone acetylation to the learning of fear and extinc-
tion. It has been found that the PL-PFC and IL-PFC to-
gether with the sub-regions of the amygdala have re-
sponded differently to learning and extinction of fear.
CeM and CeL and PL-PFC but not in IL-PFC compared
to naive control. Likewise, after learning the extinction,
CeL and IL-PFC but not in PL-PFC and CeM compared to
the naive control and the conditioned group. However,
-
-
region in the amygdala and in the PFC after learning of
fear and extinction, as evident from c-fos activation, has
-
sults suggest that histone differential acetylation in PFC
and amygdala subcores following learning and fear ex-
in the neuronal activation model resulting in greater
The polymorphisms of the OT receptor gene (OXTR)
have been implicated in gene-environment interactions
with style of attachment and child maltreatment and
-
terns of epigenetic OXTRs emerged as a link between
and neuroimaging correlations, highlighting them as
potential peripheral surrogates of the central oxytocin-
-
posed that integrates the dynamic nature of epigenetic
biomarkers and the synthesized genetic and peripheral
evidence. Finally, we emphasize the opportunities and
challenges of OT as a key node in the social interaction
network and we fear learning in social contexts. Coin-
ciding with multi-level surveys incorporating a dimen-
sional understanding of social belonging and avoidance
in anxiety spectrum disorders, these concepts will help
promote research for diagnostic, state, and OT response
biomarkers advancing towards indicated preventive
interventions and personalized treatment approaches
Pathological concern is a characteristic feature of gen-
-
functional emotional processing. The ventromedial
prefrontal cortex (vmPFC) is involved in the regulation
of these processes, but the link between the vmPFC
has not yet been examined. Objectives To study the as-
sociation between concern and vmPFC activity evoked
by the elaboration of the learned signs of security and
fear conditioning paradigm during functional magnet-
demonstrated reduced activation of vmPFCs to safety
signals and no differentiation of security threat pro-
cessing. This response was positively correlated with
-
ables showed a negative and weak correlation in HC.
The poor differentiation of the safety threat of vmPFC
-
difference based on the neuron between the health and
-
psychotherapy. The most used approach is undoubtedly
the cognitive-behavioral one, even if the protocol foreseen
patient, thus risking an incomplete resolution of the prob-
lems described in the anamnesis or worse a slippage of the
object towards another object, as it often happens for the
11
to continuous variations. However, it has been noted, in var-
if associated with pharmacological therapy, increases the
chances of maintaining the desired result longer and faster,
-
fective and well tolerated, are the antidepressants (in
serotonin);
For simple phobias, it is not recommended to combine
the pharmacological product with psychotherapy, while
for more complex and complex phobias and obsessive
compulsive disorder, it is also possible to combine an
antidepressant referred to in point a);
Benzodiazipines are used to deal more strongly with
anxiety, especially the generalized form, but often they
depress cognitive functions and create physical and
psychic dependence. For this reason, these categories
of psychiatric drugs are considered second choice,
antidepressants that need before giving the expected
effects of an initial period of administration equal to
some weeks), because of secondary effects from keep
in serious consideration.
Cognitive behavioral therapy (TCC) is based on the
assumption that our thoughts (and not external events) in-
-
tions not the situations but as we interpret and perceive the
experience is internalized and stored in memory in an orga-
have internalized certain cognitive patterns concerning the
potential danger of certain situations with respect to their
coping skills. The goal of TCC in the treatment of anxiety
disorders is to identify and correct dysfunctional thoughts
and beliefs, changing the behavior that causes the discom-
fort, also taking into account the factors of maintenance of
situation; b) the continuation of the underlying problem;
c) the automatic shift of attention to one’s anxious state
-
learn to recognize when you feel anxiety and how it mani-
fests at the body level; b) to learn coping skills and relax-
ation techniques to deal with anxiety and panic; c) to face
-
plying precisely the gradual or drastic exposure of the per-
son to feared situations and objects, allowing the person to
feel more and more in charge of the situation through the
ability to manage and lower anxiety levels; b) “systematic
desensitization”, with which the situations considered as
anxiety are progressively faced, according to a model con-
structed in three phases (learning of relaxation techniques,
creation of a hierarchy of disturbing situations, active inter-
vention).
anxiety, according to which the basic mechanism that pro-
-
vidual. The cognitive model then expands the conditioning
paradigm by suggesting that the initial automatic associa-
or situation results in the formation of patterns related to
-
strophic ruin every time the individual confronts the feared
and cognitive-behavioral model focused on conscious cog-
nitions, now the most recent hypotheses focused on uncon-
scious cognitive patterns, thus approaching the psychoana-
lytic, especially the more recent, which has shifted the focus
of the Self, and of the Self in relation to the other, as the main
The experiential approach focuses on the emotions
and the Greenberg model, linked to the concept of emotion-
consciousness that is often associated with the fear of be-
12
ing alone, the weight of individual responsibility, awareness
and acceptance of one’s death, the need to balance our ac-
tions and expressiveness than the socio-cultural demands,
the need to go through the painful process of deciding how
much freedom, autonomy and novelty we need in our ex-
perience of comfort, security and protection. Each of these
problems is involved in the struggle for self-esteem, and
this battle necessarily involves the experience of demean-
ing emotions, such as humiliation, guilt, shame, anger. De-
pression is lurking. The experiential perspective is the one
that most has to say about the role of emotions in the de-
velopment and maintenance of disorders. This view differs
from all others in the assumption that emotions are sources
of biologically adaptive information that individuals ignore
at their own risk. The problems derive from the learning
of erroneous cognitions regarding emotional expression,
The approach of the Self, according to Wolfe’s
approach. In an anxious individual anxiety is felt as a ba-
sic threat to deep beliefs about the Self. This experience
of self-impairment is characterized by a variety of states,
which include a sense of loss of control, lack of security and
impotence, and which push the individual to believe that
he is unable to avoid a traumatic experience, or extremely
painful, or humiliating. When people are in the middle of
this experience they automatically shift their attention from
the direct experience of anxiety to the thought of being anx-
ious and this inevitably increases the level of anxiety. When,
as happens in therapy, people manage to stay in touch with
their immediate anxious experience, they understand that
the experience of self-impairment represents a feared con-
only through this exploration of the implicit meaning of
anxiety that lasting healing can take place. Wolfe indicates
-
logically vulnerable Self (fear of extreme vulnerability to
diseases or physical impediments); b) the inadequate or in-
capable Self (fear of situations reminiscent of past failures
of a performance); c) the shameful, imperfect, humbled self;
-
values). There are many sources of wounds of the Self, most
emotional diseducation, ineffective responses to life’s exis-
factors, most of which have to do with protecting oneself
from the atrociously painful perception of the self. Instead
of confronting openly with the wounds of the Self, anxious
people generally implement these three strategies to keep
-
tential catastrophes, avoidance of anxiogenic situations,
negative circles of interpersonal behavior (those who see
themselves negatively involve so that others reinforce this
idea). These strategies result in a temporary reduction in
anxiety but at the high price of reinforcing the maladaptive
beliefs of one’s inability to manage the feared situations.
The three fundamental elements of anxiety disorders are
-
The emotional approach, linked to Bowlby’s think-
ing, is based on the concept of attachment. The child pre-
basis of the decoding, or interpretation, of which the parent
-
cation of facts and emotions that is, not corresponding to
the actual emotion that the child feels, it follows for him the
impossibility to accept all the experiences that on the con-
scious level When we cannot use our emotions, there is a
risk of psychopathological implications. The memories of
-
corporated into cognitive structures that will constitute the
convictions and expectations of the child and then of the
But without doubt, the most complete is the short
strategic approach. The strategic therapist has the task of
developing a series of intervention strategies capable of
producing effective, rapid and resolutive changes to the
13
strategic, suggestive and persuasive Chinese art to mod-
ern times, with Bateson, Watzlawick and other researchers
from the Mental Research Institute (known as the “Palo
the approach strategic has found its space ever more dom-
-
dividual should not be considered, but all the context and
relationships that bind the patient to all the components of
his mental and social universe, there is no objective reali-
ty and pathologies are the manifestation of discomfort, the
solution that does not work, if repeated, does not solve the
problem but complicates it, eg avoidance of the anxiogen-
ic situation in phobic disorder. It is therefore necessary to
block the attempted ineffective and pathological solutions
and to stimulate the experiences that change the perception
of the problem. The intervention that leads to change is the
provoking of concrete perceptive experiences that put the
person in a position to try something different in relation to
the reality to be changed. Strategic therapy is not a super-
as it aims at restructuring the ways through which each
one organizes the reality that then undergoes. Therapeutic
around her, have tried unsuccessfully to solve the problem,
or the attempted solutions that feed the problem; b) to ask
oneself not the why but how it is maintained and how to
change the negative experience in positive. In the hypoth-
esis of anxiety disorders, the suggested therapeutic strate-
to the situation avoided The strategic approach then pro-
ceeds by agreed objectives, pursues results and solutions
schemes, elevating the word spearhead of the therapist’s
tools, also thanks to the choice of the use of the criteria stra-
tegic operations, i.e. the logic of paradox, contradiction and
belief. The approach in question, using these logics, allows
you to quickly interrupt the vicious circles by offering the
patient the most effective maneuver (with respect to the
-
results; the effectiveness obtained in a short time; the use of
tools, guidelines and protocols already successfully tested;
Conclusions
The most decisive treatment for anxiety disorders
to the psychotherapeutic approach and to the pharmaco-
strategic approach seems to be the best in terms of healing,
as it provides the tools necessary for its resolution, drawing
on the cognitive-behavioral protocols extended with the
-
mic-relational school. Compared to the second element, on
the other hand, it certainly appears useful in two precise
as to prevent the patient from orienting himself favorably
-
management of his disorder, perhaps in the presence of a
biological or family vulnerability.
-
-
mento. Trattato italiano di psicoterapia cognitivo-com-
-
-
to italiano di psichiatria. Seconda Edizione – Edizione
14
di controllo, perfezionismo patologico, pensiero cata-
-
certezza. Studi Cognitivi, Milano. In Psicoterapia Cogni-
Colombo G. “Disturbi dell’affettività e dei sentimenti”.
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Bollati Boringhieri.
la terapia breve strategico.
Philadelphia.
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th’s, reading, Massachusetts.
Opere.
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In Opere.
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giche e correlazioni cliniche”, Pacini ed., Pisa.
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Erikson.
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alle Grazie.
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