INTRODUCTION:

The behavioral intervention exposure therapy, in which anxiety patients expose to the fear-inducing object, subject, or situation, where the patient gains new experiences, which makes them less fearful. There is a significance in understanding the exposure therapy in the psychological intervention that is not only getting used to the fear stimuli; it also helps to retrains the brain to stop sending the fear signal when there is no real danger. Exposure therapy is a psychological treatment, which is beneficial for people who confront extreme fears in danger. [1] People fright against anxiety attacks and phobias because of their exaggerated fears. Their fear is irrational that has no intellectual base. It is difficult for people with phobic disorders to manage the fear; they try to come out of the fear remain unsuccessful and feel helpless. Also, their tries to avoid the fear ends up with strengthening it. The avoidance here is a defense mechanism, which helps them to reduce feelings of fear, but over the long term, the fear becomes even worse. [1]

The ‘Exposure Therapy’ in behavioral intervention is a behavioral technique, which helps the people with a phobia to retrain their part of brain amygdala to be free from disorders that include anxiety attacks, other forms of anxiety disorders, and conditioned fear responses. The pieces of evidence have demonstrated that exposure to the feared objects, in a safe environment aids to reduce fear and decrease the avoidance behaviour. [1]

For a better understanding regarding retraining of the amygdala, conceptualizing various related aspects such as fight or flight response, the role of the amygdala in conditioning fear response, and the behavioral technique exposure intervention is vital. The neurobiological bases of anxiety and fear processing are well learned, here functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), the imaging techniques are used to measures neural activity and cerebral blood flow in humans studies. The comparative studies with animal models are used to study imaging experiments, which are designed to study neural reactivity to fearful stimuli utilizes either conditioned fear paradigms. [1] There is an unconscious impact on understanding and processing of fear and anxiety cues, which are proved in one of the previous literature demonstrating masked stimuli, can elicit conditioned and unconditioned fear responses from human subjects. Studies have evidenced increased activity of the amygdala when responding to conditioned and unconditioned fearful objects, stimuli, and situations. The amygdalin responses to fearful stimuli are autonomous, not influenced by the individual’s awareness with the fear objects or stimulus. [2-4]

Fight or Flight Response

Individuals face situational stress that threatens them; the brain gets a signal of facing danger triggers an immediate response this is well known as Fight or Flight response. This response is triggered to release of hormones, which prepare the body to either contract with a threat or to run away to be safe. [5] This response alerts individuals to confront the danger stimuli as it appears so that they would react quickly and powerfully. In the current scenario, we live in the demanding biosphere that paves up to our adjustments that need to cope with emergencies, which alert the system to keep away from predators. [6] However, in many situations, individuals forced to make snap decisions when confronting danger. [7] Possibly, the part of your brain known as the amygdala, which involves in manages the threat confronted during fight or flight responses, which is different from the executive part of the brain. The role of the amygdala is seen in people with social anxiety and panic disorder who respond strongly to their amygdala. [8]

The Amygdala

The amygdala is a part of the limbic system, which makes snapshot decisions when confronted with the fight or flight situations. The amygdala makes decisions out of conscious awareness since the decisions of the amygdala are quick when confronted with threatening situations. The panic sensations and avoidance behavior is the effect of the amygdala as a bodily response when individuals confront the threat. Decision made in threatening situations, by the amygdala paves to two possible kinds of errors such as false positive and false negative. Irrational decisions made when there is no real threat and real threat. Previous researches on the subject group who does not have the disease evidenced neural correlates of anxiety are limited. [9] Studies have demonstrated that distinction among fear and anxiety not significant. Various fear processing studies demonstrate the relationship between trait anxiety and amygdala reactivity. [10]. Studies have evidenced the abnormalities in the amygdala were associated with increased trait anxiety and emotion deregulation. [11] The evidential studies proved that in healthy subjects, the reactivity of the amygdala is positively correlated with anticipatory anxiety even it is a forthcoming event. The amygdala activation demonstrated a positive correlation in varying degrees of trait anxiety. [12] The amygdala related responses are not conscious, thus individuals face repeated unnecessary fear responses try not to make any false negative mistakes. Individuals with phobia and anxiety attacks want to overcome them. That can be made possible with repeated exposure to fear and anxiety situations. The anxiety treatment that will retrain in part of the brain amygdala is the systematic exposure therapy.

The studies on college students have evidenced, the trait anxiety shows greater amygdala reactivity to emotional than normal, which suggests the anxiety-prone subjects have greater amygdala reactivity. [13]. The hyperactivity of the amygdala observed in trait anxiety individuals is noted with exhibiting anxiety when they exposed to unattended faces. This previous literature suggests that stimulus pave up to heightened amygdala activity there is no necessity of individual being aware of the stimuli to provoke anxiety. [14,15] Previous studies have differentiated the sub-regions of the amygdala, which prices activation of basolateral for masked emotional faces and the activation of dorsal/central amygdala for unmasked presentations. These pieces of evidence suggest that the sub-regions impact within the amygdala process unconscious and conscious fear stimuli. [15]

The current review study analyses the evidential facts that reveal the relationship between trait anxiety and amygdala reactivity seems to be influenced by perceived social support. The evidential study has proven a positive correlation between the degree of trait anxiety and amygdala reactivity to fearful faces among study participants. [17]

Another fact evidenced in providing a biological basis for the unconscious emotional attentiveness to an anxious behavior is a resource for examining the mechanisms for efficient treatment anxiety. When confronted with the anxiety-provoking stimulus, the unconscious processes are controlled activity that takes place only in the basolateral sub-region of the amygdala. On the other hand, conscious processing controlled activity takes place only in the dorsal amygdala, which is the central nucleus. [19]

Role of exposure therapy retrains amygdala.

The amygdala gets trained to response along with the experiences of an individual as they confront the anxiety and fear situations. When in the threatening situations, the amygdala gets activated and responds quickly, basing its memory association of the past. In the cases of individuals who experience phobias and anxiety attacks when they confront phobic stimuli, repeated experiences of which becomes part of their memory by conditioned learning. The experience and reaction faced in dangerous situations; result in learning the amygdala to react similarly in similar situations. The amygdala plays an inactive role, in checking the signs of danger when it is triggered with any danger signals, it responds immediately by fight or flight. This defense is helpful when the danger is real, but it becomes pathogenic when fear and danger are irrational. Pieces of evidence state that the neural substrates condition fears across species, but it is observed humans have more abstract representations of fear. [20]

When individuals confront apparent danger, the amygdala remains quiet and inactive. At the same time if individual confronts with previously stimuli that they are conditioned for fear, here amygdala react without any logic that it had learned by association. [21] Basically, the amygdala learns to react to the situation from an individual’s experience. If individuals flee when they confront the fearful situation and have an anxiety attack, the amygdala learns to run away from the fearful situation to be safer. The amygdala is not necessarily involved in attainment of the association between the shock and the signals seen in conditioned theory, though it has some influences performed behaviors of conditioned response. The acquisition of association between two stimuli that trigger long-term memories observed in Pavlovian fear conditioning. [21]

Previous studies have conceptualized that conditioned behaviors can be counter conditioned by substituting other behavioral actions. Thus individuals can learn to fight against the situation instead of fleeing. Here the amygdala learns new behavior in fear-inducing situations. Possibly, an individual has to be conditioned to believe that they can live better without being disrupted by phobias and anxiety attacks by repeating healthy substituted behavior and develop new memories and training their amygdala. [22]

The aversive learning such as fright expression of fear and anxiety among people though, normal and adaptive, occasionally leads to pathological behaviors of clinical disorders such as fear and anxiety. It’s important to understand the behavioral principles of the learning process and brain mechanisms of aversive learning. The review observes the piece of literature concerning the amygdala, which is a collection of nuclei located deeper part of the temporal lobe is involved in such aversive learning. [23]

Modulate amygdala in overcoming panic attacks.

Fear conditioning is a form of associative learning in which subjects come to express defense responses to a neutral conditioned stimulus that is paired with an aversive unconditioned fear stimulus. Evidential literature work suggests that critical neural changes facilitating the conditioned stimulus and unconditioned stimulus association take place in the lateral nucleus of the amygdala. Further, studies show that associative long-term eventual learning occurs in pathways that transmit the conditioning stimuli to the lateral amygdala and that drugs that interfere long-term increase in the strength of nerve impulses along pathways. Indeed, the disrupted behavior like fear conditioning, when instilled into the lateral amygdala, which suggests a long-term increase in the strength of nerve impulses along pathways in the lateral amygdala, which is a mechanism for storing memories of the conditioned stimulus and its association with unconditioned stimulus expressed as conditioned fear responses. [24]

The projections straight from auditory thalamus to lateral amygdala are an important connection in the circuitry, which controls behavioral responses for the fear stimuli. This take place during conditioned learning these neuronal processes can be changed to modify to bring plasticity in amygdala processing thus it can pave-up to counter conditioning of fear responses. [25]

Individuals confront to fear object panic symptoms appear, here one has to accept the symptoms, rather than resisting, that work as counter conditioning a powerful tool to overcome panic attacks.

Sport amygdala in overcoming panic attacks.

Working out with healthy mechanisms can change the unhealthy amygdala response to fear and anxiety situations using behavioral technique. Various healthy exposures can train the amygdala in overcoming panic attacks. Observing how the panic works, how a person responds to it so that people can unlearn unhealthy mechanisms.

Techniques like

Relaxing one’s breathing and muscles

If persons feel an attack coming on, simple breathing and relaxation techniques can help them feel more in control. Practicing them daily twice for 10 minutes at a time may make your panic attacks less frequent and easier to overcome.

Breathing relaxation

Put one hand on your upper-chest, and the other over your diaphragm

Take in a slow and deep breath through nose and count until five.

Observe the hand on the chest should stay still, the one over your diaphragm should upsurge with your breath, which helps one to know the breath is deep enough.

Start breathing mentally counting until five.

When reach the count of five, let the breath out slowly at the same rate or breath out is longer. Focusing on your hands and the counting will calm down persons and level of anxiety come to comfort level. One has to continue these breaths until they feel relaxed and comfortable.

Muscle relaxation:

Find a comfortable position to sit in (or lie down).

Close eyes and begin to focus on your toes. Flex them tightly for a count of five, squeezing the muscles together hard and then relax.

Next step focus on feet. Contract all of their muscles tightly for a count of five, and then relax.

Continue upward direction isolating each body muscle group (calves, thighs, buttocks, stomach, chest, shoulders, neck, fingers, hands, and arms) up to the face.

As we end up with contracting and relaxing face muscles we feel much calm and relaxed.

During an anxiety attack, persons need to make them a little more comfortable and wait for the attack to end. The techniques that patients have found particularly useful in overcoming panic attacks are exposure therapy, diaphragmatic breathing systematic desensitizing, and so on... These techniques play a powerful role in retraining the amygdala. The exposure that paired up with diaphragmatic breathing is a very powerful technique to overcome panic attacks. Though it sounds simple, the belly breathing is more descriptive, not practiced rightly by persons, they do not perform correctly, thus seen with poor results. [26]

Exposure Therapy - Behavioral Technique

A panic attack commonly sets abruptly in people when they imagine danger or threat happening in the future or experienced in the past. Individuals undergo intense fear or discomfort that reaches a peak within minutes. Literature review observes shreds of evidence reveal the panic attacks are associated with current and future Anxiety. [27] Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism. The symptom appears during flight and fight situations. Panic and anxiety symptoms of behaviors are defensive behaviors seen with physiological manipulations. The characterized pattern of panic and anxiety pave up to physiological manipulations of defensive behaviour during flight or fight evidenced in the animal study, which serve as a model for defense-related human psychopathology. [28]

Individuals develop panic symptoms such as palpitations, pounding heart, sweating, trembling, and sensations of shortness of breath. During this attack working with, what is around, and mindfully living in reality, helps individuals to reduce panic attacks. Confirmations from the previous research have proved the benefits of mindfulness used have part of dialectical behavioral therapy. [29, 30]

Therefore, persons in this situation need to get back to the activity which they engaged before the attack and connect themselves to people and objects around them. Experiencing this exposure several times, retrains the amygdala and with the outcome of conscious responses. Other types of behavioral training that reduce behavioral symptoms as well as retrain the amygdala, like relaxing the body parts during the panic attack, using the technique tensing, and then relaxing the various muscles of the body, top to bottom, or vice versa is found to be useful. Analysis of review reveals that robotically, norepinephrine performs to upsurge cellular excitability and increase synaptic plasticity inside an extinction-related neural circuitry. [31] Observations on literature demonstrate the drugs that modulate norepinephrine are used when confronted with a treat that leads to anxiety and panic symptoms now being tested adjuncts to extinction-based exposure therapy. [31]

CONCLUSION:

The current review brings out facts on brain-behavior in flight and fight response and its association with amygdala responses. In a nutshell, the article indicates that providing new experiences to the amygdala can bring new responses to fear and anxiety situations. The irrational fear responses which are learned through the conditioning process of learning are substituted by relearning. Thus, the amygdala exposure to new experiences can counter condition the anxiety and fear responses that are irrational. The implication can be useful in bringing out healthy wellbeing in humans.

CONFLICT OF INTEREST:

The authors affirm no conflict of interest.

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Received on 26.05.2020 Modified on 15.06.2020

Research J. Pharm. and Tech. 2020; 13(8):3987-3991.

DOI: 10.5958/0974-360X.2020.00705.2