COVID-19 : Understanding how fear from such frightening events evolves into lifelong anxiety is critical for healing

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A deadly coronavirus pandemic, economic instability and civil unrest menace the mental well-being of millions. Understanding how, in vulnerable people, fear from such frightening events evolves into lifelong anxiety, is critical for healing.

A University of New Mexico research team led by Elaine L. Bearer, MD, PhD, the Harvey Family Professor in Pathology, and graduate student Taylor W. Uselman has identified for the first time brain-wide neural correlates of the transition from fear to anxiety.

“Until now, psychiatrists had little information about what goes on in the brain after a fearful experience, and why some people don’t easily recover and remain anxious, for even as long as the rest of their lives,” Bearer says.

Life-threatening fear frequently leads to post-traumatic stress syndrome (PTSD).

The goal is to shed light on the brain’s response to fear and why, in some cases, it can lead to prolonged anxiety states like PTSD.

While not feasible in human subjects, fear can be provoked in rodents by exposure to a scary smell, such as a product commonly used to protect our barbecues from mouse nesting.

This smell simulates a predator odor and scares mice away.

The UNM team used this trick to witness how the brain responds to scary events and discover how brain activity evolves from a scary feeling to anxiety.

In a paper published this week in the journal NeuroImage, they report a correlation of behavior with brain activity by watching behavior and capturing magnetic resonance images before, during and after exposure to non-scary and scary smells.

They created vulnerability to anxiety by manipulating the serotonin transporter (SERT), which is the major target of psychoactive drugs, like cocaine, and antidepressants, like Prozac.

Deletion of the SERT gene (SERT-KO) produces vulnerability to anxiety, and thus provides a unique model to learn how frightening experiences morph into anxiety.

The UNM researchers compared behavior and brain activity in normal versus SERT-KO to identify the neural correlates of anxiety – those regions active in anxious SERT-KOs and not in normal subjects.

To highlight active neurons, they used manganese, a non-toxic ion that lights up active neurons in magnetic resonance images.

Computational analyses of these brain-wide images yielded maps of activity throughout the brain before, immediately and long after brief exposure to the scary smell.

They identified differences in neural activity in 45 sub-regions throughout the brain. Some regions were activated by the scary smell, and some only came on later. Vulnerability to anxiety correlated with much more activity in many more regions.

The function of some of these regions, including the amygdala and hypothalamus, is at least partly understood, but others, such as the reward circuitry, were not previously known to be involved in anxiety.

In anxiety, the coordination between regions was altered, which may represent a brain-wide signature of anxiety, or signify a dis-coordination between brain regions, which is often experienced when we are frightened or anxious.

“We now know that brain activity in anxiety is not the same as in an acute fear response,” Bearer says. “With anxiety, neural activity is elevated across many specific regions of the brain, and normal coordination between regions is lost.”

What does this mean in the time of COVID?

The time lag for resilient or anxious outcomes suggests that early containment of fearful responses to surges in cases, protests and economic recession may reduce the likelihood of progression to anxiety.

The involvement of serotonin also suggests pharmacologic targets that could help in reducing the likelihood of anxiety. Meditation, music, poetry, exercise and other stress-reducing activities that engage the reward circuitry will also likely help. Early interventions will have lasting benefits.


Theories of emotion
While forming human behavior, emotion has a profound impact (Cherry, 2019). Cherry (2019) described emotion as ‘a complex state of feeling that results in physical and psychological changes that influence thought and behavior’.

Emotion is a complex set of processes that evolve with the passage of time as an evolutionary theory of emotion suggests (Cherry, 2019). Different researchers, psychologists and philosophers describe different forms of emotional aspects and theories, which plays a significant role to understand the behavioral outcome of human.

Among them, the James-Lange theory of emotion, Cannon-Bard theory of emotion, Schachter-Singer theory of emotion and Lazarus theory of emotion are some of the dominant theories of emotion.

The James-Lange theory postulates that persons’ emotional response is influenced by the physiological response, which means there shall be an event and that event impacted persons’ physiology and thus the emotion will work for that person (Walsh, 2013).

The Cannon-Bard’s theory raises some questions over the James-Lange theory and argued that, without building up emotion, the physiological response cannot be possible. So, this theory hypothesized that there shall be an event at the first place and then both the physiological response and the experience of emotion occurred simultaneously (Cherry, 2019; Walsh, 2013).

Again, the Schachter-Singer’s theory of emotion assumes that, after facing an event, the physiological stimulation happens first, then individuals have to identify the reason behind stimulation to experience and marked it as an emotion (Cherry, 2019; Walsh, 2013).

Finally, according to the Lazarus’s theory of emotion, there shall be an event and the person first labels (appraise) the event, and this leveling is basically done through a person’s personal experiences or shaped by culture, religion or other factors. Based on the labeling, one’s emotion will be formed and physiological response occurs almost instantaneously (Walsh, 2013).

Thus, all forms of emotional state (i.e., fear, anger, anxiety, depression, trauma, psychosis, panic, boredom, etc.) of humans can be linked with these prominent theories of emotion. The current study extends the theories of emotion by examining the impact of ‘Fear of COVID-19’ on future career anxiety and the mediating role of depression from COVID-19 in this relationship.

‘Fear of COVID-19’ and future career anxiety
Human emotion is a complex set of processes, where fear and anxiety play a great role independently. Based on phenomenology, behavioral expressiveness, psychometric and the level of neurobiology, the human emotion of fear and anxiety are essentially different from each other (Barlow, 2000, 2002; Barlow et al., 1996; Bouton et al., 2001).

From a theoretical viewpoint, fear has been considered as a primary form of emotion that is present commonly across ages, races, cultures and species. Beck and Emery (1979) defined fear as ‘awareness and appraisal of danger, and anxiety as the unpleasant feeling state and physiological reaction that occurs when fear is provoked’.

A new and fatal epidemic disease like COVID-19 can form fear, panic, anxiety and stigma very quickly among individuals worldwide (Ahorsu et al., 2020; Lee et al., 2018; Strong, 1990).

With access to real-time information, unauthentic pieces of information and upsurge of social media rumors somehow create a new breed of fear in this pandemic situation (Abramson, 2020; Lin, 2020; Rubin & Wessely, 2020).

With the presence of this fear and the uncertainty about the future, the human emotional system forms some kind of anxiety.

Anxiety is a state of human emotion which can be formed due to the perception of future threat (Dobson, 1985).

Epstein (1985) portraits anxiety as ‘threats to future happiness, threats to self-esteem, and threats to the individual’s ability to make sense of the data of his experience’. Izard (1977) identified anxiety as a fusion of different emotional statuses of the human mind, although fear remains a distinct part of that fusion.

Izard (1977) further argued that the blend of anxiety may be changed with the change of status quo and time. Uncertainty about the future career often impacted an individual’s present quality of life, resulting in some kind of anxiety (Mostert & Botha, 2013).

During the time of the global pandemic, career-related anxiety gets momentum particularly among the forthcoming university graduates who are going to face the job market in the near future.

According to the theory of career development, it is established that university students ages 23 to 25 years are forming their career expectations and career commitments (Super, 1980; Tsai et al., 2017).

But due to the outbreak of any unwanted global phenomenon the regular expectation level comes down and the situations like COVID-19 fear poses the greatest threat for those minds who are planning their future career (Tsai et al., 2017). T

hus, in this uncertain situation, the potential workforces’ fear turned toward career anxiety and they cannot make any fruitful decision about the future (Hornak & Gillingham, 1980; Kaplan & Brown, 1987). Hence, the researchers hypothesize as follows:

H1: There exists a significant relationship between ‘Fear of COVID-19’ and future workforces’ career anxiety.

The mediating role of depression from COVID-19
Fear, depression and anxiety, all are playing a significant role in the study of emotion. Barlow (2000) identified fear as the alarm system of human psychology, whereas most of the prominent philosophers and psychologists believe that the spectacle of anxiety and depression are deep-rooted on the fundamental concepts of human emotion (Barlow, 2002; Izard, 1971, 1977; Klerman, 1977; Plutchik, 1980).

Normally, fear occurs when people are directly threatened with a dangerous event (i.e., life-threatening), and anxiety is ‘a state of helplessness, because of a perceived inability to predict, control, or obtain desired results or outcomes in certain upcoming personally salient situations or contexts’ (Barlow, 2000).

However, depression is a psychological disorder which comprises a persistent feeling of sorrow and loss of interest (American Psychological Association, 2020a; Medical News Today, 2020b).

Some of the research studies conducted by Dobson (1985), Spielberger et al. (1970), Zung (1965) and others found that there exists a very close relationship between anxiety and depression.

Although some forms of differences exist by definition among the fear, anxiety and depression, different emotional and cognitive models, as well as psychometric-based literature, announce the empirical relationship among fear, anxiety and depression (Dobson, 1985; Izard, 1977).

Izard (1977) found a close connection among fear, anxiety and depression and further pointed out that fear is mostly concentrated with future emotions, whereas anxiety predicts the threat of future and depression related to the responses of past or imminent events (Dobson, 1985).

Due to the outbreak of COVID-19, the fear arises among the future workforce regarding their future career plan, which ultimately triggers career-related anxiety among them. An increasing number of job loss and the uncertain future job market grow depression among the future workforces’ mind as the virus may last longer and dries up the world’s economy more stronger than expected (Medical News Today, 2020a; Morath & Guilford, 2020; UN News, 2020; The Wall Street Journal, 2020).

Thus this research assumes that due to the COVID-19 pandemic, fear grows among the future workforce, ‘Fear of COVID-19’ has a direct influence on building career-related anxiety among the future workforces’ mind and depression from COVID-19 has a mediating role over that direct relationship (Figure 1) as the unknown long-term effect of COVID-19 fear threatening the future. Hence, this research hypothesized the following:

H2: Depression from COVID-19 mediates the relationship between ‘Fear of COVID-19’ and future workforces’ career anxiety.


                        figure
Figure 1. Proposed research model.

RESPONDING WITH FEAR IN THE FACE OF DANGER

Fear contagion is an evolutionarily old phenomenon that researchers observe in many animal species. It can serve a valuable survival function.

Imagine a herd of antelopes pasturing in the sunny African savanna. Suddenly, one senses a stalking lion. The antelope momentarily freezes. Then it quickly sets off an alarm call and runs away from the predator. In the blink of an eye, other antelopes follow.

Brains are hardwired to respond to threats in the environment. Sight, smell, or sound cues that signal the presence of the predator automatically triggered the first antelope’s survival responses: first immobility, then escape.

Then the amygdala forwards the signal to other brain areas, including the hypothalamus and brain stem areas, to further coordinate specific defense responses. The amygdala, a structure buried deep within the side of the head in the brain’s temporal lobe, is key for responding to threats. It receives sensory information and quickly detects stimuli associated with danger.

These outcomes are commonly known as fright, freeze, flight or fight. We human beings share these automatic, unconscious behaviors with other animal species.

RESPONDING WITH FEAR, ONE STEP REMOVED

That explains the direct fear the antelope felt when sniffing or spotting a lion nearby. But fear contagion goes one step further.

The antelopes’ run for their lives that followed one frightened group member was also automatic. Their escape, however, was not directly initiated by the lion’s attack but by the behavior of their terrified group member: momentarily freezing, sounding the alarm, and running away. The group as a whole picked up on the terror of the individual and acted accordingly.

Like other animals, people are also sensitive to panic or fear expressed by our kin. Human beings are exquisitely tuned to detect other people’s survival reactions.

Experimental studies have identified a brain structure called the anterior cingulate cortex (ACC) as vital for this ability. It surrounds the bundle of fibers that connect the left and right hemispheres of the brain. When you watch another person express fear, your ACC lights up. Studies in animals confirmed that the message about another’s fear travels from the ACC to the amygdala, where the defense responses are set off.

It makes sense why an automatic, unconscious fear contagion would have evolved in social animals. It can help prevent the demise of an entire group bound by kinship, protecting all their shared genes so they can be passed on to future generations.

Indeed, studies show that social transmission of fear is more robust between animals, including humans, that are related or belong to the same group as compared to between strangers.

Nevertheless, fear contagion is an effective way of transmitting defense responses not only between members of the same group or species but also across species. Many animals, through evolution, acquired an ability to recognize alarm calls of other species. For example, bird squawks are known to trigger defense responses in many mammals.

TRANSMITTING FEAR IN 2020

Fear contagion happens automatically and unconsciously, making it hard to really control.

This phenomenon explains mass panic attacks that can occur during music concerts, sports events, or other public gatherings. Once fear is triggered in the crowd–maybe someone thought they heard a gunshot–there is no time or opportunity to verify the sources of terror. People must rely on each other, just like antelopes do. The fear travels from one to the next, infecting each individual as it goes. Everyone starts running for their lives. Too often, these mass panics end up with tragedies.

Fear contagion does not require direct physical contact with others. Media distributing terrifying images and information can very effectively spread fear.

Moreover, while antelopes on the savanna stop running once they’re a safe distance from a predator, scary images on the news can keep you fearful. The feeling of immediate danger never subsides. Fear contagion didn’t evolve under the always-on conditions of Facebook, Twitter, and 24-hour news.

TEMPERING FEAR OTHERS TRANSMIT TO YOU

There’s no way to prevent fear contagion from kicking into gear–it’s automatic and unconscious, after all–but you can do something to mitigate it. Since it’s a social phenomenon, many rules that govern social behaviors apply.

In addition to information about fear, information about safety can be socially transferred, too. Studies have found that being in the presence of a calm and confident person may help overcome fear acquired through observation of others. For instance, a child terrified by a strange animal will calm down if a calm adult is present. This kind of safety modeling is especially effective when you have your eyes on someone close to you, or someone you depend on, such as a caretaker or an authority figure.

Also, actions matter more than words, and words and actions must match. For example, explaining to people that there’s no need for a healthy person to wear a protective face mask and at the same time showing images of presumably healthy COVID-19 screening personnel wearing hazmat suits is counterproductive. People will go and buy face masks because they see authority figures wearing them when confronting invisible danger.

But words do still matter. Information about danger and safety must be provided clearly with straightforward instructions on what to do. When you are under significant stress, it is harder to process details and nuances. Withholding important facts or lying increases uncertainty, and uncertainty augments fears and anxiety.

Evolution hardwired human beings to share threats and fears with others. But it also equipped us with the ability to cope with these threats together.


Source:
University of New Mexico

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