From the Center for Neural Science, the Department of Psychology, the Department Psychiatry, and the Department of Child and Adolescent Psychiatry, New York University, New York; the Nathan Kline Institute, Orangeburg, N.Y.; and the Section on Development and Affective Neuroscience, NIMH Intramural Research Program, Bethesda, Md.
Am J Psychiatry. 2016 Nov 1;173(11):1083-1093. doi: 10.1176/appi.ajp.2016.16030353. Epub 2016 Sep 9.
Tremendous progress has been made in basic neuroscience in recent decades. One area that has been especially successful is research on how the brain detects and responds to threats. Such studies have demonstrated comparable patterns of brain-behavior relationships underlying threat processing across a range of mammalian species, including humans. This would seem to be an ideal body of information for advancing our understanding of disorders in which altered threat processing is a key factor, namely, fear and anxiety disorders. But research on threat processing has not led to significant improvements in clinical practice. The authors propose that in order to take advantage of this progress for clinical gain, a conceptual reframing is needed. Key to this conceptual change is recognition of a distinction between circuits underlying two classes of responses elicited by threats: 1) behavioral responses and accompanying physiological changes in the brain and body and 2) conscious feeling states reflected in self-reports of fear and anxiety. This distinction leads to a "two systems" view of fear and anxiety. The authors argue that failure to recognize and consistently emphasize this distinction has impeded progress in understanding fear and anxiety disorders and hindered attempts to develop more effective pharmaceutical and psychological treatments. The two-system view suggests a new way forward.
近几十年来，基础神经科学取得了巨大的进展。其中一个特别成功的领域是研究大脑如何检测和应对威胁。这些研究表明，在包括人类在内的一系列哺乳动物物种中，威胁处理的大脑-行为关系存在着相似的模式。对于推进我们对改变威胁处理是关键因素的障碍的理解，如恐惧和焦虑障碍，这似乎是一个理想的信息库。但是，威胁处理的研究并没有导致临床实践的显著改善。作者提出，为了利用这一进展获得临床收益，需要进行概念上的重新构建。这种概念转变的关键是认识到威胁引起的两类反应背后的回路之间的区别：1）行为反应以及大脑和身体伴随的生理变化，2）通过恐惧和焦虑的自我报告反映的有意识的感觉状态。这种区别导致了对恐惧和焦虑的“双系统”观点。作者认为，未能认识到并始终强调这种区别，阻碍了对恐惧和焦虑障碍的理解，并阻碍了开发更有效的药物和心理治疗的尝试。双系统观点提出了一种新的前进方式。
