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School of Medicine
Chemically anxious people differ in unexpected ways.
“People who lack anxiety usually get into trouble,” says psychiatrist Rudolf Hoehn-Saric. “A certain amount of it keeps us out of danger.” Hoehn-Saric pays little attention, then, to the devil-may-care among us, and his nod to people with healthy anxiety is mostly as a baseline. He has, however, devoted himself to helping those who suffer with phobias, obsessions and compulsions, panic attacks or more free-floating anxiety, spending some four decades in treating patients and clarifying the biology of anxiety and its reflective cousin, worry.
The light his collaborations have shed is revealing the disorders to the degree it will take to design precise therapies. “Rudy’s been a leader in measuring the physiological signs of anxiety,” says colleague Gerry Nestadt. And recently, with the help of Hopkins’ new abilities to image pea-size brain areas precisely and sample their metabolism, Hoehn-Saric’s research group is trying to show how general anxiety differs from, say, specific phobias. They’ve already found that worry may not be all bad.
Q. Didn’t your work begin, a bit, by default?
A. When I started in the 1960s, everyone was working on depression. I think fewer did anxiety research because—perhaps more than depression—anxiety was thought of as a sort of character weakness. And, because clinically anxious people are less likely to commit suicide, the urgency wasn’t the same. But these disorders can be every bit as disabling as depression or schizophrenia or more. And they’re chronic.
Q. We know you’ve measured reactions in long-anxious people. You’ve compared how they say
they’re feeling with what their bodies are telling you. And you’ve contrasted them with healthy control folk. Any surprises?
A. Yes. As you’d expect, people with snake phobias, for example, or general anxiety disorder (GAD) do have heightened heart rate, breathing, sweating, etc., when situations provoke their fears. But we didn’t realize how inaccurate they are in describing their response. Some people say, “my heart was beating out of my chest,” when the rate was only slightly increased. Others are just the opposite. Nonanxious people are far more accurate.
Q. Anything else?
A. We were really surprised that under everyday stresses like missing a bus, anxious people have less physiological change than the nonanxious. Healthy responses shoot up with a threat, then quickly drop when danger’s past. But in the anxious, EEG or adrenalin responses, for example, are blunted. They also linger longer. It’s a common theme.
What does that mean? We have an idea. We studied GAD patients and controls, exposing them to neutral sentences or to anxiety-provoking ones during a functional MRI scan. Then we treated them with an SSRI. Fortunately, they got better. But after they took the medicine, we were amazed at how tremendously their response to neutral statements decreased. So we believe anxious people overrespond to everything. They don’t discriminate. Medication helps them become properly selective.
Q. You found something intriguing about worry in healthy people.
A. Yes! This was our PET study. In essence, we asked nonanxious people to worry about something, for two minutes, that they’d normally worry about. We alternated that with having them mull over flower-arranging. When we looked at the brain’s response, we saw that worrying actually dampened activity in the amygdala, the part of the brain active during fear. Worrying, then, could have a calming effect.
Now we’d love to repeat the study with high-anxiety subjects. Can their brains calm themselves in the same way?