Our Bodies, Our Fears

Anna-li Yaron will never forget the first time she heard the bomb siren go off. It happened in early February while she was sitting in class at Charles Smith High School for the Arts in Jerusalem. Her teacher had warned the class about the drill in advance, so there'd be no surprises. But when the high whine of the siren filled the air, Yaron, 16, found herself gripped by terror. "I froze," she recalls. A moment later, she panicked and screamed. "Everyone laughed at me," she says. "I even laughed at myself afterwards. But it wasn't funny."

Why would Yaron, safe and sound at school, react as though her life were in danger? The answer lies partly in Yaron's psyche--and also in the world around her. In recent weeks, Yaron's life has been filled with preparations for war. Her parents have been stocking up on masking tape, plastic sheeting, trash cans and tins of food in case a missile attack from Iraq forces them to remain indoors for days at a time. She and her classmates have practiced lining up in neat rows and filing down to the bomb shelter in the basement so many times, they cut the time it takes them to three minutes, from six. The media, meanwhile, continue to report heightened tensions on the West Bank, terrorist plots and war preparations in the Gulf. It's enough to make even the hardiest of souls anxious. "When you're scared of a monster under your bed, you turn on the light," says Yaron. "But what can I do about this? I feel so helpless."

Yaron and her compatriots aren't the only ones stressed out by what's going on in the world. In Japan, people worry about the country's poor economy and the threat from North Korea. In Britain and the United States, they worry about another 9-11-style attack. In Iraq, they worry about war. As Drs. Afton Hassett and Leonard Sigal of New Jersey's Robert Wood Johnson Medical School wrote recently, we're living in a "chronic heightened state of alertness and... helplessness," prompted by a "poorly defined... danger that could strike at any time in any form without warning."

Such feelings can be as unhealthy as they are unpleasant, impairing immunity, interrupting sleep and exacerbating everything from acne to ulcers. "The psychological state of fear affects us biologically," says psychiatrist Carole Lieberman. "People who are anxious drink and eat more. They have more accidents. They're more likely to get colds or suffer heart attacks." In short, as University of Michigan neuroscientist Stephen Maren puts it, a brain system designed to keep us from getting eaten is now "eating away at us."

Such is the paradox of fear. It is a response so fundamental to survival that we share it with rodents, fishes and fruit flies. Yet fear and anxiety can shackle us, diminish our lives, even kill us. Science is also showing us that it doesn't have to be so. There are a host of activities, from working out to going for a massage, that can temper anxiety. Many of these techniques have been used for decades, if not centuries, but recently scientists have been able to measure how much they can reduce the hormones associated with stress and even affect brain activity. The common trait: maintaining control over our emotions, and recognizing that our concerns are a natural response to the world we live in. "We're justified in having this fear," says Dr. Herbert Benson, president of the Mind/Body Medical Institute of Boston. "Life was stressful before 9-11. It's gotten progressively worse."

Until recently, no one knew how the brain generated feelings of fear or anxiety, or why they were so hard to will away. When New York University neuroscientist Joseph LeDoux started studying fear as a graduate student in the late 1970s, most experts believed it was beyond the reach of science. Since then, it has been elucidated more clearly than almost any aspect of the psyche.

The feelings inspired by vague threats are of course different from the ones you'd experience in a burning building or a hijacked airplane. But they're not entirely separate. Fear and anxiety exist on a continuum. They're rooted in the same physiology and can have similar consequences. To get at the essence of anxiety, you have to start with the anatomy of fear. The brain is not just a thinking machine. It's a biological adaptation, designed to promote survival in the environments where it evolved. The brain structures that handle that job evolved long before the neocortex (the seat of conscious awareness), and they easily override it. The "emotional brain," as LeDoux calls this web of ancient circuitry, is highly attuned to signs of potential danger.

When fear grips the body, it sets in motion a sequence of events that, repeated often enough over the long term, can have grave consequences for health. It starts when the amygdala, an almond-shaped structure near the brain's center, jolts the nearby hypothalamus into producing a hormone called corticotropin-releasing factor, or CRF. This in turn signals the pituitary and adrenal glands to flood the bloodstream with epinephrine (adrenaline), norepinephrine and cortisol. Those stress hormones shut down non-emergency services such as digestion and immunity, and direct the body's resources to fighting or fleeing. The heart pounds, the lungs pump and the muscles get an energizing blast of glucose.

As researchers learn more about the fear response, they're also learning more about the huge costs it imposes. "Norepinephrine is toxic to tissues--probably all tissues, but in particular the heart," says Harvard neurologist Martin Samuels. Israel recorded nearly 100 deaths during Saddam's 1991 Scud-missile attacks caused not by bomb injuries but by heart attacks presumably triggered by fear and stress. A recent study suggests that heart patients around New York City suffered life-threatening heart arrhythmias at more than twice the usual rate in the month following the World Trade Center attack. "Prolonged stress has physiological consequences," says Dr. Jonathan Steinberg, chief of cardiology at New York's St. Luke's-Roosevelt Hospital Center and the leader of the study. "These patients experienced potentially fatal events, even though many of them had trouble identifying themselves as unduly fearful."

In other words, acute fear is not the only kind that can hurt you. Constant, low-grade adrenaline baths may subtly damage the heart, raising the long-term risk of cardiovascular disease. Continuous exposure to cortisol can dampen the immune system, leaving stressed people more vulnerable to infections and possibly even cancer. Stress hormones can harm the brain, too, severing connections among neurons. In both human and animal studies, researchers have found that prolonged stress shrinks the hippocampus, a brain structure that plays a critical role in memory.

Even when it doesn't wreck the heart or the brain, prolonged stress can have countless subtler effects, including headaches, insomnia, back pain, neck pain and disorientation. Such complaints are common among worried people, and you don't have to be a hypochondriac to experience them. "Stress almost always comes out in a bodily symptom," says Afton Hassett, an expert in psychosomatic illness. Even at low levels, she says, anxiety causes muscle tension, which leads in turn to aches, pains and twitching eyes.

Children are especially vulnerable to fear and anxiety. They're also more likely than adults to experience their anxiety as a physical malaise, and emotional experiences have deeper effects on their still-developing brains. "Kids learn everything faster than adults," says Dr. Bruce Perry of the Child Trauma Academy in Texas. "If they have the stress response turned on a lot, their bodies say, 'I'm in a world where I need to use these systems a lot'." Genes and temperament make some kids less vulnerable than others. But when a susceptible child experiences too much fear, the consequences can extend beyond general anxiety to include phobias and posttraumatic stress disorder--conditions in which the amygdala hijacks the rest of the brain every time it encounters some cue. Like a rat in a conditioning experiment, the sufferer reacts as violently to a harmless stimulus as he or she would to a life-threatening emergency.

Millions of people, mostly women, suffer from phobias. Some are general, others specific, but they're all tenacious--for unlike names, our fears are never forgotten. What keeps most people from being paralyzed by them is not erasure but a phenomenon known as extinction, in which neurons in the cortex create new memories to compete with the visceral ones managed by the amygdala. Researchers have recently traced this fear-busting capacity to a particular part of the prefrontal cortex. In a recent study, stimulating this brain structure helped rats extinguish their conditioned fear responses more rapidly. Experts now hope that electromagnetic devices will help phobic people down the same path.

But in truth, the path is already open. "We can take people with very severe phobias and treat them in a day or two," says Dr. David Barlow of Boston University's Center for Anxiety and Related Disorders. The treatment has several components, but at its heart is an exercise that Barlow calls "talking to the amygdala." Instead of simply telling people that high places can be safe, he takes them to high places. By surviving the experience, and surviving it again, they form the new memories needed to temper the oppressive ones. The technique is as old as fear itself, but science has begun to show us why it works--and why avoiding what scares you is so futile.

There are plenty of things you can do to assuage stress. The first step is to identify it. Headaches, stomachaches, sleeplessness and rapid heartbeat are all symptoms of anxiety. Confront the emotion head-on by naming it, even saying, "I feel fear about this," says Saki Santorelli, executive director of the University of Massachusetts Medical School's Center for Mindfulness. Acknowledging anxiety makes us less passive, less vulnerable and, as a result, more able to cope.

One of the most efficient ways to reduce stress is to focus inward on one thing we can effectively control: our own breath. At the Mind/Body Medical Institute, participants focus on a "relaxation response," repeating a word--anything from "om" to "Hail Mary"--silently as they exhale. In numerous studies, Benson has found that the practice leads to lower blood pressure, slower breathing and an overall calm. Richard Davidson at the University of Wisconsin-Madison recently found that a form of meditative breathing pioneered at the Center for Mindfulness can affect the brain. In a small, soon-to-be- published study, Davidson took brain images of 25 members of a biotech firm who practiced meditation six days a week for eight weeks. He found increased activation in the left side of the prefrontal part of the brain, an area associated with lower anxiety, positive emotion and inhibition of the amygdala, the brain's fear center.

If sitting in one position for more than five minutes sounds impossible, you might try yoga. Concentrating on the physical intricacies of different poses forces you to filter out the "endless tape loops of chatter and fear," says Dr. Timothy McCall, medical editor of Yoga Journal, allowing you to be present in the moment. In so doing, you begin to clear the mind of future worries. You can also reduce angst by deliberately altering the way you perceive the world. Cognitive behavioral therapy, which focuses on identifying and changing destructive thinking, is the gold standard for treating anxiety disorders. Patients are encouraged to confront their worst fears--such as riding an elevator--to prove to themselves that they can and will survive. That experience helps get rid of distorted thinking, says Stanford University psychiatrist David Burns. If you find yourself feeling anxious, accept it, but don't let it control you. And certainly don't ruminate on it. "Anxiety feeds on itself," says Dr. Paul Appelbaum, president of the American Psychiatric Association, so talk to family and friends. "Sharing the concern with others can be enormously helpful."

Scientists are finding that it can help to get outside your head completely. In a study of 60 schoolchildren traumatized by Hurricane Andrew, Tiffany Field, director of the University of Miami's Touch Research Institute, found that depression dropped in kids who received 30 minutes of massage twice a week for a month; kids who watched a relaxing video showed no improvement. And cortisol levels, the body's marker for stress, declined significantly in the massage group compared with controls. If massage isn't your thing, go for a vigorous walk, swim or bike ride. Exercise is not only good at keeping you fit, it reduces anxiety and depression, too.

It may be difficult, but in troubled times, people need to take comfort from life's simplest pleasures. In a small study at the University of Rochester School of Medicine, Dr. O. J. Sahler found that bone-marrow transplant patients who listened to music reported less pain and nausea, and their transplants took less time to become functional. And, yes, laughter may be good medicine, too. Dr. Lee Berk, of the Loma Linda University School of Public Health, discovered that a group of students who watched a comic video for an hour had marked reductions in epinephrine and cortisol levels. "If fear is too great," says Berk, "send in the clowns." Laughter--now there's an essential item to stockpile in these anxious times.