In Belgium, between 7 and 10% of the population suffers from anxiety disorder (AD). What exactly goes on in their minds?
There are different types of AD: phobias, OCDs, generalised anxiety disorder or panic disorder. Their common thread? Perceived threats that generate irrational, hard-to-control fear that on a daily basis can become crippling. Alexandre Heeren is a researcher at the UCL Psychological Sciences Research Institute. He studies the mechanism at work behind anxiety. Under the supervision of Prof. Pierre Philippot, his UCL mentor, Dr Heeren became interested first in attentional bias. ‘Anxiety is a defence mechanism that allows us to identify and locate threats in a hostile environment’, he says. ‘For example, you’re in an Amazonian forest, where you know there are poisonous spiders. So you’re on the lookout for this potential threat. That’s attentional bias: you pay attention to one specific thing to the detriment of everything else.’
Very (too) attentive and vigilant
The anxious person ‘over-detects’ threats, even when they’re minor or not imminent. For example, someone with a phobia of spiders will scan every room he enters. It’s beyond his control. It’s the same for all ADs. ‘AD sufferers all have attentional bias specific to that which makes them anxious and sustains the anxiety’, continues Dr Heeren. ‘Faced with these stimuli, they can’t sufficiently adapt and manage their attention. Anything sensed as threatening generates anxiety no matter where the sufferer is or what he or she is doing.’
Dr Heeren participated in creating attentional bias-reduction software. ‘In essence, it draws the patient’s attention toward something other than what “naturally” draws it. By repeating the exercise hundreds of times, we can reduce attentional bias and, in turn, the anxiety it provokes.’
In short, DA sufferers are hypervigilant concerning the cause of their anxiety. But this hypervigilance concerns other things, too. ‘It goes beyond that. Anxiety sufferers are also hypervigilant in other areas. For example, when confronted with anything aimed at distracting them from completing a task (and which has nothing to do with their anxieties), they fixate on it. It’s harder for them than for others to ignore it and concentrate on the task at hand.’
Anxiety and neuromodulation
These discoveries opened the way to an entire field of research, especially concerning treatment. Today, treating DA relies mainly on cognitive-behavioural therapies and, sometimes, anti-anxiety medication. The drawback is that they don’t work for everyone. As for the medication, which is not intended for long-term use, its use is relevant to only a small number of patients.
A third treatment path, easy to implement and free of side-effects, can be foreseen. ‘If you do a functional MRI scan of an anxiety sufferer,’ Dr Heeren explains, ‘you can see that certain areas of the brain, such as the prefrontal areas (which are involved in decision-making, self-control, etc.), are hyperactive. They don’t function as well as those of a non-anxious person.’
Neuromodulation can correct this. This non-invasive technique sends a weak electric current through the brain to improve brain function in targeted areas. ‘We recently discovered that when we send a weak electric current through these specific brain areas, some DA symptoms, such as hypervigilance, disappear. So we’re investigating whether complementary neuromodulation could improve on current treatments.’ It’s worth the effort, not only because anxiety disorders can ruin the lives of both sufferers and those around them. They also cost society. In 2011, DA treatments and socio-professional consequences cost an estimated €66 million.
Alexandre Heerens’s research is or has been funded mainly by the FNRS, the French-speaking Community of Belgium (Fédération Wallonie-Bruxelles) and several private foundations.
A Glance at Alexandre Heeren's bio
A Glance at Pierre Philippot'bio