The Search for Non-Pharmaceutical Courage
Fear, valor, and the neuroscience of feeling safe.
Posted Mar 18, 2009
I'm afraid. I'm afraid the savings will run out before the husband's start-up begins to make money. I'm afraid I'll get Alzheimer's just like my mom. I'm afraid of the too-fast, un-patrolled street my 2nd grader crosses on her way to school.
This fear is so tangible, so visceral. I fear a perceived threat-the 8th grade boy who was texting my 6th grade girl the other night at bedtime-and my brain sets off a general alarm, an involuntary reaction; my nervous and endocrine systems shift into high gear. This is presumably a self-preservation mechanism, and it might be helpful if I were being attacked by a bear. I'm flooded by stress hormones and neurotransmitters like adrenaline that increase my heart rate and blood pressure, constrict my blood vessels, and tighten my muscles; they wash over my amygdala, a little brain nubbin that processes emotions, and it promptly stores an imprint of my fear deep within its cells.
What to do? I could pop a valium to sleep, take some aspirin to thin my blood, and hope for the best. Or, if I wanted to rid myself of a particular bad memory, I could try erasing it. When we revisit a painful memory, there's a special period of neurobiological flexibility before the memory is placed back into long-term storage; during this critical window if a patient is given drugs that cause amnesia, the memory—and the fear and stress that accompany it—may be diminished, or even abolished. In one study just after patients' fearful memories had been reactivated, they were given beta blockers, which interfere with the action of stress hormones on the body and brain. In this case the patients' fearful emotions were diminished, while their memory of events remained intact. Trials are underway to test whether people suffering from Post Traumatic Stress Disorder (PTSD) might benefit from these kinds of treatment.
Although these findings are certainly exciting, the idea of memory erasure raises many ethical dilemmas. Besides, most of us are not suffering from severe PTSD; the ordeals we seek to overcome are much less extreme. And for people like me, drugs just create more fear: fear of the drugs' side effects; fear that I'll become dependent on chemicals for my emotional well-being. What if I want to feel better without chemical intervention?
Since childhood I have carried an image of the king's bravest soldier, stalwart, forging ahead in a land of peril. He walks through his fear, a-sparkle in his glory: not fearless, but courageous. That soldier is really living. I want to be like him. So maybe my fear won't go away; maybe I just need help getting through it. What can I take for that?
My answer might be a disappointment to people looking for a one-drug answer. I think we're often so focused on our search for the magic pharmaceutical bullet that we fail to consider the existing solutions. Courage may lie not in a drug, but in building up our belief that we can walk through fearful situations and remain intact-the old-fashioned way.
Therapy, support groups, and spiritual and religious community can help us feel safe to persist in the face of adversity. But do they literally change our minds? Can they can fix my brain, rewrite my amygdala's deep-seated fear-based memories, tip the balance of neurotransmitters in my circuits? I like empirical evidence; I'd like to see my soldier's courage on a hi-resolution brain scan. So I was happy to read about one recent data-packed study supporting the idea that "finding a safe place" emotionally has serious neurophysiologic consequences.
In this study mice were trained to associate safety or fear with specific electronic tones: for fear conditioning, a tone was paired with a shock to the foot, and for safety conditioning another tone signaled there would be no shock. Mice that had been trained to associate a tone with assured safety were found to be significantly more resilient under adverse conditions and less depressed by stressful situations than their cell mates with no learned safety training . In other words, when they knew there was a chance to be safe, they could return to their happy place. And these effects were discernable at a neurophyiological level.
In mice trained to feel safe, levels of a growth factor called BDNF increased, causing more neurons to be born in the dentate gyrus, a brain structure that contributes to new memories.These new cells were necessary for successful safety conditioning. In the amygdala, where fear memories are thought to be stored in the brain, learned safety also ramped up key dopamine neurotransmitter and neuropeptide systems that affect learning, thought and mood. In other words, this conditioning brought about unambiguous physical and chemical changes the brain.
I find this so gratifying. When my husband quietly reminds me that things are actually okay at the moment, or when I spend time with family and friends and think my happy thoughts, maybe I'm growing myself a new lawn of dentate gyrus cells and watering it with fresh BDNF; maybe a nice batch of neurotransmitter system components is brewing in my brain. Maybe these concrete biological changes will give me concrete, biological courage. In which case I can soldier on with confidence.