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.