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John: Hi, this is John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Today I have a good friend of mine, Doctor Dotty Vacca. Dr. Vacca has had a wide variety of experiences. Dotty, will you tell us something about your training and your background. Dotty: I started my career as an elementary school teacher and most of my career has been in the public school system so I bring that as a backdrop to a number of the experiences I have had and the way I have looking at different disorders. I went from being a classroom teacher of 15 years to a school counselor to a school psychologist then I went on to become a licensed psychologist and a certified school psychologist. Recently I have been working at Northeastern University and at William James College and I am supervising psychology interns. John: That is a wide variety of experiences and certainly qualifies you to talk about anxiety disorders. Let me start off with my general first question: I see there being 8 kinds of anxiety, 4 of them have to do with the cerebral cortex, and those are separation anxiety, social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder. Those are all experiences that we can be aware of and they do respond to cognitive behavioral therapy (CBT), typically. The other 4 are much more likely to originate in the amygdala and although the cortex is involved, the amygdala pretty much controls them so they have really little response to discussions. Those are simple phobias, agoraphobia, panic disorders, and post-traumatic stress disorder (PTSD). How does that fit with what you understand? Dotty: I like the 8 categorizations because I think its a very useful way of looking at the many different kinds of anxiety. In addition to those areas of the brain that you mentioned, there are also other areas of the brain that are also affected with anxiety. For example, not too many people pay attention to the cerebellum, but at the brainstem for many of the anxiety disorders, if the brainstem happens to be overly sensitive, then there’s an abnormal brainstem regulation of things like the reduction of oxygen and it causes people to have quick panic responses so anxiety is a very complicated disorder. You use the biopsychosocial model which I think is a very important way of understanding how anxiety comes about because as a neuropsychologist and as a psychologist dealing with children and adults dealing with anxiety, almost every condition that I’ve worked with has an anxiety component to it. For example, with anxiety, usually in comorbid with depressive disorders, there is a belief that in conditions like bipolar disorder the anxiety of the manic phase of the disorder is a way to offset the depression that’s about to come so anxiety can be helpful in that way. But also some people have a genetic predisposition to anxiety and children can be born with the predisposition. John: You use the word “sensitive” before. I kind of think what you’re talking about right now is sensitivity, which is good because it makes one very responsive to the needs and feelings of others but it’s also bad because it makes us super, what we call, catastrophizing: ready to see catastrophe in everything. Dotty: Yes that isn’t quite what I was getting at in terms of the way the brain is organized when you have an abnormality in the brain stem in terms of regulation but there is the other component of anxiety where people are hypersensitive and are looking out to the environment for clues for what to do and so there’s a hyper-vigilance there and that can - as a result of that, they can misinterpret signals from the outside world. John: There’s no question about that. You’re absolutely right. Can you say anything more - do you think there’s some case where the biopsychosocial - those three factors, are pretty much equal or is there some, where one predominates over the other two. Dotty: Well for years we’ve talked about nurture versus nature and I think that’s an artificial way of looking at that. It helps with research and other things like that but I think over and over again the research has shown that the biological and the environmental are inextricably interwoven with each other. For example, if you have a seed, and that seed has the genetic composition to be a beautiful flower, but in order for that seed to flourish and become its full potential, it has to be planted in the right kind of soil, with the right kind of water and sunshine. If you don’t have those three components, then the seed won’t flourish. I feel the same way about a human being. A human being comes into the world with a certain genetic predisposition and that predisposition won’t flourish unless the environment supports it. John: There’s no question about it. In fact, I was reading recently about the fact that trees are not only psychological in the sense that they’re very sensitive to the environment, of course, they’re very biological, but they’re even social. They communicate through their roots about what’s going on in the area. Isn’t that amazing? Dotty: That is amazing. That’s absolutely amazing. If you have a child who has certain predispositions- let’s say you have a child who has a predisposition to anxiety, and that child is born into a family that’s very anxious, where the mother and father are very anxious, then the chances are very good that that child will develop some kind of an anxiety disorder. John: Yeah, you’re absolutely right about that. I’m reminded of a study that was done on how children develop at toilet training depending on how the mother fed the baby when it was just a baby. They found no difference whether the mother breastfed or bottle-fed and they found very little difference between whether the mother wanted the child or did not want the child, which is kind of amazing. But when they studied them together, they found out that breastfeeding mothers who wanted the child had the best results and breastfeeding mothers who did not want the child had the worst results. The other two - both bottle feeding - we’re kind of in the middle, which makes some sense when you think about it because breastfeeding seems to be much more emotionally close and the child can somehow tell how the mother feels towards it. Dotty: Right so the bonding is taking place and the child is picking up the feelings of the mother in a much more intimate way while being breastfed. Then the other thing, the child doesn’t know what’s happening to the mother’s milk if the mother is having hostile feelings towards the child. John: Oh that’s absolutely right. You’re referring here, it seems to me, to some extent, to bidirectionality, which is the concept we always talk about is it a good baby or a not good baby. And without thinking about what the baby is like, without thinking about what the mother is like, but of course, the mother reacts to the child just as well as the child reacting to the mother. So we have bidirectionality. Dotty: Absolutely. The child cannot grow and develop unless there’s an environment that’s inviting back to the child so there’s an interaction right from the get-go. Usually, there’s a mutual satisfaction that goes on between the two of them, so the child smiles the parent smiles back, the father smiles back, the grandparents smile back, and the child learns to have a social interaction with these people who care about the child and to feel good about him/herself and to grow and develop into a happy infant. John: You’re absolutely right. Dotty, I have only about 4 hours of questions but of course, I can’t ask them. I’m going to have to shut this off now because we try to keep them around 10 minutes. Would you come back and talk to us again sometime because you’re obviously very knowledgeable about this whole field. Dotty: I would be very happy to. John: Well thank you so much.