≫ Role of the Amygdala in Social Anxiety Disorder Free Essay Sample on Samploon.com

Abstract

This paper explores the anatomy, functions, and role of the amygdala in social anxiety disorder. The amygdala is a part of the limbic system that plays an essential role in developing and the expression of conditioned fear. Research shows that activation of the amygdala is evident in aggressive behavior and sexual arousal. Research proves that there is functional asymmetry of the amygdala. Each side of the structure has independent memory systems, but they work with each other to encode, store, and interpret emotion. Evidence has shown that the amygdala also plays a role in social anxiety disorder. Studies using magnetic resonance imaging has found that individuals with social anxiety have a hyperactive amygdala. Occupational therapy, in conjunction, with medications has been found to be beneficial in patients with social anxiety disorder.

Amygdala

The limbic system is the section of the brain that is involved in emotional responses and essential behaviors that we need to survive: reproduction, feeding, motivation, memory, and fight or flight responses (Queensland Brain Institute, 2018). This system is made up of multiple parts that work together, but it can be broken down into three main limbic structures: hippocampus, hypothalamus, and amygdala. Located within the medial temporal lobe is an almond shaped structure called the amygdala. The amygdala is primarily responsible for aspects of emotional memory and processing emotions such as fear/anxiety, pleasure, and anger (Taylor, 2018). It is important to thoroughly investigate the anatomical structures and diverse functions of the amygdala to understand its complex role.

Anatomy

There are four lobes that make up the cerebral hemispheres: parietal, occipital, frontal, and temporal. The amygdala is an almond shaped structure that is situated in the pole of the temporal lobe. It lies just below the cortex on the medial side (Bear, Connors, & Paradiso, 2016). This is under the temporal bone that is just behind the ear. Imagine an arrow being placed through your eye, and one place through your ear. The intersection of these two arrows is approximately where the amygdala is located (Ledoux, 2018).

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The Amygdaloid Complex

The human amygdaloid complex compromises approximately 13 nuclei, and it is structurally diverse. These nuclei are commonly divided into three groups: basolateral nuclei (largest), corticomedial nuclei, and the central nucleus (Sah, Faber, Armentia, & Power, 2003). Afferent nerve fiber signals from the neocortex in all lobes of the brain, in addition to the hippocampal and cingulate gyri, are received in the amygdala. All sensory stimuli feed into the basolateral nuclei portion. There are two major pathways that connect the amygdala to the hypothalamus: the stria terminalis and the ventral amygdalofugal pathway (Bear et al., 2016).

It has also been found that there are functional differences between the left and right amygdala. In one specific study, electrical stimulation of the right and left amygdala was used, and the patients reported the emotions they felt. Psychophysiological markers of emotions from skin conductance responses and electromygraphic responses were also documented (Lanteaume, Khalfa, Regis, Marquis, Chauvel, & Bartolomei, 2006). The results showed that electrical stimulations to the right amygdala induced negative emotions such as fear and sadness. The stimulations to the left amygdala induced pleasant emotions such as happiness or unpleasant emotions such as fear, anxiety, or sadness. These results show that there is functional asymmetry of the amygdala. Each side of the structure has independent memory systems, but they work with each other to encode, store, and interpret emotion (Lanteaume, 2006).

Functions

The amygdala plays an integrative role in vegetative, behavioral, and endocrine activities of animals and humans with their environments. It is involved in the emotional responses by integrating various input signals and initiating response to those stimuli (Rasia-Filho, Londero, Achaval, 2000). The amygdala plays a crucial role in the behavioral responses that are paramount to survival during stressful scenarios. It is active during the flight or fight response and fear conditioning (Bodytomy, 2018).

Fear and Related Events

It is said that through socialization or painful experiences, we learn to avoid certain behaviors because of the fear of being hurt. The amygdala is not the primary brain structure that is responsible for memory storage, but the synaptic changes that that occur in the amygdala appear to be a part of forming memories for emotional events (Bear et al., 2016). The amygdala is responsible for the integration of behaviors and physiological manifestations of defense reactions against perceived, learned threats (Rasia-Filho, 2000). When a person experiences a stressful event, the amygdala determines if the stimulus is threatening and sends out a type of distress signal to the hypothalamus. At this command center, communications are sent through the nervous system to the rest of the body to allow the person to fight or flight by releasing hormones (Harvard Health Publishing, 2018).

Aggression

The amygdala assists us in perceiving and responding to danger, and this may also lead us to aggress. Aggression is not a product of a single system in the brain, instead it is multifaceted. There are several lines of evidence that prove that the amygdala is involved in aggressive behaviors (Bear et al., 2016). Studies have found that individuals with higher aggression typically have smaller amygdalae (Matthies et al., 2012). In an amygdalectomy, this proved to have a calming/taming effect and reduced aggressive outbursts (Bear et al.,2016).

Sexual Arousal

Sexual desire is primarily mediated by emotion through the limbic system. The activation of the amygdala can invoke sexual feelings, memories of intercourse, orgasms and erections (Taylor, 2018). Through the use of magnetic resonance imaging, research has revealed that the amygdala activates in response to sexual stimuli. Processing these emotional stimuli can trigger sexual desire. The neurons in the amygdala fire in response to the perceived reward, and the dopamine that is released turns the individual’s attention and behavior towards the rewarding situation (sexual intercourse). Males were found to have a larger amount of amygdala activation then females when presented with a sexual stimulus. (Vignozzi, Corona, Forti, Jannini, & Maggi, 2010).

Social Anxiety Disorder

The DSM-IV describes social anxiety disorder (SAD), also known as social phobia, as the marked and persistent fear of social situations in which the individual is around unfamiliar people or vulnerable to scrutiny by others (Sladky, Hoflich, Kraus, Baldinger, Moser, & Windischberger, 2013). These situations are endured with high levels of intense anxiety and distress or avoided all together. Unlike everyday shyness, it will often lead to impairment of a normal social life. The individuals with social anxiety disorder often fear conversations, meeting new people, talking on telephone, parties, eating/drinking in front of others, speaking in front of groups, and expressing a controversial opinion or disagreement (Antony & Rowa, 2008).

Amygdala’s Role

The limbic system, the amygdala in particular, has been identified as a core hub for processing emotions, identification, and evaluation of the affective value of incoming stimuli (Sladky et al, 2013). The amygdala’s primary function is its role in determining and controlling the fear response. When compared to healthy individuals, people with social anxiety disorder have been found to show amygdalar hyperactivation in response to social cues that are conveying a perceived threat (fearful/angry faces, public speaking) (Labuschagne, Phan, Wood, Angstadt, Chua, Heinchs, Stout, & Nathan, 2010). Threat-related hyperactivity is the cardinal pathophysiological feature in individuals with social anxiety disorder. There have been several functional magnetic resonance imaging studies that have proven that GSAD subjects exhibited heightened activation of the amygdala when responding to social cues such as public speaking and emotional faces (Labuschagne et al., 2010).

Causes

The exact cause for social anxiety disorder is unknown. However according to a majority of the current available information and research, like numerous other mental health conditions, SAD likely is a result of interactions of environmental and biological factors (Atchison & Dirette, 2018). Anxiety disorders often seem to run in families. The research to date is unclear if this is from learned behavior or due to genetics. As mentioned in the previous paragraph, when the amygdala is overactive this leads to a stronger fear response which results in intensifies anxiety in social scenarios (Labuschagne et al., 2010).

Serotonin imbalances may be a contributor to social anxiety disorder. Also, the exposure or experiences of embarrassing/troublesome experiences in their environment may lead to the develop of this disorder. For example, excessive bullying, conflict within the family, or sexual abuse may lead to the development of social anxiety disorder. Classical conditioning or exposure to parental behaviors may evoke SAD in individuals (Atchison & Dirette, 2018).

Prognosis

The age of onset for individuals with SAD is adolescence or childhood. When left untreated, social anxiety disorder have a chronic, unremitting course. It is usually a precursor to the development of other psychological disorders, such depression and substance abuse (Antony & Rowa, 2008). Fortunately, there are a variety of interventions that have been found to positively affect the course and outcome of social anxiety disorder.

Medications

Medications that are used to treat anxiety disorders, social anxiety disorder specifically, include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and antidepressants (Mayo-Wilson, Dias, Mavranezouli, Kew, Clark, Ades, & Pilling, 2014). Selective serotonin reuptake inhibitors include Prozac, Zoloft, and Lexapro. SNRIs include Effexor and Cymbalta. The common antidepressants used for SAD are Norpramin, Adapin, and Tofranil (Mayo-Wilson et al., 2014).

The common benzodiapines that are prescribed to individuals with social anxiety disorder are Xanax, Klonopin, Ativan, and Valium. One must be cautious when working with patients that may have addiction concerns, because these medications are extremely addictive. Also, older individuals with balance issues need to be cautious while on benzodiapines because of the tendency for this type of drugs to negatively affect balance. Other side effects may include fatigue, sedation, memory/cognitive impairments, and hindering reaction time (Atchison & Dirette, 2018).

Psychotherapy Treatments

There are a variety of cognitive behavioral therapy (CBT) interventions that exist for this treatment of social anxiety disorder. Cognitive behavioral therapy is used to help patients detect cues that provoke anxiety and learn new coping methods such as behaving, thinking, and reacting to alleviate symptoms. These techniques may include breathing techniques for relaxation using breathing exercises or as simple as replacing negative thoughts with more positive ones (Davidson, 2009). Group therapy has been found to teach individuals with SAD new social skills by allowing them to interact with people in a social setting while participating in various activities. This will make them face their fears of social interaction and develop new skills by prohibiting them from avoiding social situations, also known as expose therapy (Stangier, 2011).

Plan of Care

Narrative

Clint is an 18-year-old male who lives with his parents. He has social anxiety disorder and attention deficit hyperactive disorder. He was diagnosed with both at the age of 10. He graduates this month, and he has been homeschooled after his diagnosis of SAD due to it interfering with his ability to feel comfortable while at school. Clint plans on attending a university next semester. Currently, he does not leave his parent’s house due to anxiety and fear of any type of social interaction. He occasionally rides with his mother pick up food, but she has to order for him due to his fear of interacting with the restaurant worker.

Clint avoids social settings at all costs. He fears being in situations with strangers, and he feels as if everyone is judging or criticizing him when he is in public. He has difficulty with communication skills and maintaining eye contact. He reports increased heart rate and difficulty breathing when around strangers. Clint and Clint’s family fear that his social anxiety disorder will hinder his ability to succeed at a public university.

Short Term Goals

Client will order his own food at a restaurant independently to decrease anxiety while interacting with others in 1 week.
In a group therapy session, client will be able to have a 5-minute conversation with a stranger to increase conversation skills and reduce anxiety in 2 weeks.
Client will accurately identify emotions and implement coping strategies or relaxation/breathing techniques in 3/5 activities when participating in group therapy to decrease anxiety in social setting in 2 weeks.
Client will carry on a conversation with a peer maintaining eye contact for 50% of the conversation to improve communication skills in 2 weeks.
Client will attend group therapy and interact appropriately with peers in 3/5 activities with minimum outbursts to increase social skills in 2 weeks.

Long Term Goals

In a group therapy session, client will be able to have a 15-minute conversation with a stranger to increase conversation skills and reduce anxiety in 6 weeks.
Client will accurately identify his anxiety and implement coping strategies or relaxation/breathing techniques in 5/5 activities when participating in group therapy to decrease anxiety in social setting in 6 weeks.
Client will carry on a conversation with a peer maintaining eye contact for 100% of the conversation to improve communication skills in 6 weeks.
Client will attend group therapy and interact appropriately with peers in 5/5 activities with minimum outbursts to increase social skills in 6 weeks.
Client will be able to attend a social gathering for one hour to decrease anxiety in a social setting to simulate sitting through a college class in 6 weeks.

Activities Used

Breathing techniques will be taught and practiced help reduce anxiety and control breathing while in social situations. Some examples are calming breathing (slow, through nose, out mouth), deep breathing, and pursed lip breathing. Client will attend and participate in group therapy sessions where various activities will be performed. These activities will focus on getting everyone in the group involved, so proper communication skills, eye contact, cooperation, and other social skills can be practiced. An example of a group activity may be, charades or a scavenger hunt in groups.

Discharge Plan

Client has received skilled occupational therapy 4 times a week for 6 weeks focusing on breathing techniques, coping strategies, reducing anxiety, communication skills, and developing social skills. During this time, Clint progressed well and has learned to manage his anxiety and anxiety symptoms. He developed communication skills and other social skills that will be essential for his success while attending a public university. He is currently able to interact with strangers and communicate using proper verbal skills and eye contact. Client will be discharged home to his parent’s house with a home exercise program to continue to work on his breathing techniques.

Conclusion

The amygdala is a small structure within the temporal lobe that has many functions that are essential in human survival. It is part of the limbic system in which it takes in sensory information and processes it to determine an appropriate response. The amygdala is associated with and makes contributions to processes dealing with fear, arousal, autonomic response, emotional response, and emotional memory (Rasia-Filho et al., 2000). It is absolutely necessary to understand how the amygdala functions in order to comprehend the many conditions that can occur when amygdala functioning is altered.

One of these conditions is social anxiety disorder. This is a disorder that often occurs when the amygdala is hyperactive (Labuschagne et al., 2010). Social anxiety disorder could hinder many areas of an individual’s client factors and occupational performance such as social roles, job performance, communication skills, self-esteem, and any other situations occurring in a social setting (Atchison & Dirette, 2018). This is why occupational therapy is essential in implementing interventions that may maximize these areas of functioning.

Role of the Amygdala in Social Anxiety Disorder