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Fear and the Defense Cascade: Clinical Implications and Management.

Kozlowska K, Walker P, McLean L, Carrive P - Harv Rev Psychiatry (2015 Jul-Aug)

Bottom Line: Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei.Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions.Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state.

View Article: PubMed Central - PubMed

Affiliation: From the Disciplines of Psychiatry (Drs. Kozlowska and McLean) and of Paediatrics and Child Health (Dr. Kozlowska), University of Sydney Medical School; Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School (Dr. Kozlowska); The Children's Hospital at Westmead, Westmead, New South Wales (Dr. Kozlowska); Peter Walker & Associates, Randwick, New South Wales (Mr. Walker); Brain and Mind Research Institute, University of Sydney Medical School (Dr. McLean); Westmead Psychotherapy Program and Sydney West and Greater Southern Training Network, Western Sydney Local Health District (Dr. McLean); Department of Anatomy, School of Medical Sciences, University of New South Wales (Dr. Carrive) (all Australia).

ABSTRACT
Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei. Unlike animals, which generally are able to restore their standard mode of functioning once the danger is past, humans often are not, and they may find themselves locked into the same, recurring pattern of response tied in with the original danger or trauma. Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions. Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state. The process of shifting the neural pattern is the necessary first step in unlocking the patient's trauma response, in breaking the cycle of suffering, and in helping the patient to adapt to, and overcome, past trauma.

No MeSH data available.


Related in: MedlinePlus

Tonic immobility in a rat. The trunk and limbs are rigid and may be held in unusual or awkward postures. The body can often be manipulated (waxy flexibility). The eyes may be closed or open. If the latter, the rat will have a glassy, unfocused gaze. Because the animal has the appearance of being dead, tonic immobility is also known, following Darwin’s terminology, as feigning death.87
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Figure 4: Tonic immobility in a rat. The trunk and limbs are rigid and may be held in unusual or awkward postures. The body can often be manipulated (waxy flexibility). The eyes may be closed or open. If the latter, the rat will have a glassy, unfocused gaze. Because the animal has the appearance of being dead, tonic immobility is also known, following Darwin’s terminology, as feigning death.87

Mentions: Tonic immobility is a phylogenetically old defense response that occurs in a large number of species: insects, crustaceans, fish, amphibians, reptiles, birds, and mammals, including primates and humans.8,85 The long-held uncertainty about the nature of this defense response is reflected by the many different names used to describe it (see Supplemental Text Box 3, http://links.lww.com/HRP/A10). Tonic immobility is usually a terminal defense used when flight or fight has failed, and the animal has been caught by a predator. Its function is to deactivate the predator’s killing reflex or to discourage consumption, as many predators are reluctant to eat dead meat (see Figure 4).16,45,52,85 In some species or strains within species, however, tonic immobility may be the front-line defense response to extreme threat, even when the animal is not restrained.8,26,86 In laboratory settings, tonic immobility is elicited under conditions in which restraint and fear co-occur—for example, turning the animal upside down and restraining it until it stops struggling. Although the psychophysiological correlates of tonic immobility vary somewhat from one species to the next, the key clinical features are summarized in Supplemental Text Box 3, http://links.lww.com/HRP/A10.


Fear and the Defense Cascade: Clinical Implications and Management.

Kozlowska K, Walker P, McLean L, Carrive P - Harv Rev Psychiatry (2015 Jul-Aug)

Tonic immobility in a rat. The trunk and limbs are rigid and may be held in unusual or awkward postures. The body can often be manipulated (waxy flexibility). The eyes may be closed or open. If the latter, the rat will have a glassy, unfocused gaze. Because the animal has the appearance of being dead, tonic immobility is also known, following Darwin’s terminology, as feigning death.87
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495877&req=5

Figure 4: Tonic immobility in a rat. The trunk and limbs are rigid and may be held in unusual or awkward postures. The body can often be manipulated (waxy flexibility). The eyes may be closed or open. If the latter, the rat will have a glassy, unfocused gaze. Because the animal has the appearance of being dead, tonic immobility is also known, following Darwin’s terminology, as feigning death.87
Mentions: Tonic immobility is a phylogenetically old defense response that occurs in a large number of species: insects, crustaceans, fish, amphibians, reptiles, birds, and mammals, including primates and humans.8,85 The long-held uncertainty about the nature of this defense response is reflected by the many different names used to describe it (see Supplemental Text Box 3, http://links.lww.com/HRP/A10). Tonic immobility is usually a terminal defense used when flight or fight has failed, and the animal has been caught by a predator. Its function is to deactivate the predator’s killing reflex or to discourage consumption, as many predators are reluctant to eat dead meat (see Figure 4).16,45,52,85 In some species or strains within species, however, tonic immobility may be the front-line defense response to extreme threat, even when the animal is not restrained.8,26,86 In laboratory settings, tonic immobility is elicited under conditions in which restraint and fear co-occur—for example, turning the animal upside down and restraining it until it stops struggling. Although the psychophysiological correlates of tonic immobility vary somewhat from one species to the next, the key clinical features are summarized in Supplemental Text Box 3, http://links.lww.com/HRP/A10.

Bottom Line: Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei.Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions.Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state.

View Article: PubMed Central - PubMed

Affiliation: From the Disciplines of Psychiatry (Drs. Kozlowska and McLean) and of Paediatrics and Child Health (Dr. Kozlowska), University of Sydney Medical School; Brain Dynamics Centre, Westmead Millennium Institute for Medical Research and University of Sydney Medical School (Dr. Kozlowska); The Children's Hospital at Westmead, Westmead, New South Wales (Dr. Kozlowska); Peter Walker & Associates, Randwick, New South Wales (Mr. Walker); Brain and Mind Research Institute, University of Sydney Medical School (Dr. McLean); Westmead Psychotherapy Program and Sydney West and Greater Southern Training Network, Western Sydney Local Health District (Dr. McLean); Department of Anatomy, School of Medical Sciences, University of New South Wales (Dr. Carrive) (all Australia).

ABSTRACT
Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei. Unlike animals, which generally are able to restore their standard mode of functioning once the danger is past, humans often are not, and they may find themselves locked into the same, recurring pattern of response tied in with the original danger or trauma. Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions. Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state. The process of shifting the neural pattern is the necessary first step in unlocking the patient's trauma response, in breaking the cycle of suffering, and in helping the patient to adapt to, and overcome, past trauma.

No MeSH data available.


Related in: MedlinePlus