The case of the fear-free brain

U. IOWA (US) — Spiders, snakes, and slasher flicks—even public speaking—failed to arouse feelings of terror in a woman whose amygdala was destroyed. She simply was unable to be afraid.

A case study of the patient—reported in the journal Current Biology—pinpoints the amygdala as fear central in the brain. The discovery could improve treatment of post-traumatic stress disorder (PTSD) and other anxiety conditions, say researchers.

“This finding points us to a specific brain area that might underlie PTSD,” says Daniel Tranel, professor of neurology and psychology at the University of Iowa. “Psychotherapy and medications are the current treatment options for PTSD and could be refined and further developed with the aim of targeting the amygdala.”

Studies in the past 50 years have shown the amygdala to play a central role in generating fear reactions in animals from rats to monkeys. This study confirms for the first time that the amygdala is also required for triggering a state of fear in humans. Previous studies with this patient confirmed she cannot recognize fear in facial expressions, but it was unknown until this study if she had the ability to experience fear herself.

PTSD affects more than 7.7 million Americans, according to the National Institute of Mental Health, and a 2008 analysis by the Rand Corporation predicted that 300,000 soldiers returning from combat in the Middle East would experience PTSD.


In these MRI scans of the patient’s brain, the arrows point to the amygdala, the region of the brain missing, as shown by the vacant black holes underneath the arrows. (Credit: University of Iowa)

Justin Feinstein, lead study author and a doctoral student studying clinical neuropsychology, says the findings suggest methods of safely and non-invasively dampening amygdala activity may help people with PTSD.

“This past year, I’ve been treating veterans returning home from Iraq and Afghanistan who suffer from PTSD. Their lives are marred by fear, and they are oftentimes unable to even leave their home due to the ever-present feeling of danger,” Feinstein says.

“In striking contrast, the patient in this study is immune to these states of fear and shows no symptoms of post-traumatic stress. The horrors of life are unable to penetrate her emotional core. In essence, traumatic events leave no emotional imprint on her brain.”

In examining the role of the amygdala, Feinstein observed and recorded the patient’s responses during exposure to snakes and spiders (two of the most commonly feared animals), during a visit to one of the world’s scariest haunted houses, and while watching a series of horror films.

Feinstein also measured the patient’s experience of fear with a large number of standardized questionnaires that probed different aspects of fear, ranging from the fear of death to the fear of public speaking. Additionally, over a three-month period, the patient carried a computerized emotion diary that randomly asked her to rate her current fear level throughout the day.

Across all of the scenarios, the patient failed to experience fear. Moreover, in everyday life, she has encountered numerous traumatic events that have threatened her very existence, yet, by her report, have caused no fear.

“Taken together, these findings suggest that the human amygdala is a pivotal area of the brain for triggering a state of fear,” Feinstein says. “While the patient is able to experience other emotions, such as happiness and sadness, she is unable to feel fear. This suggests that the brain is organized in such a way that a specific brain region—the amygdale—is specialized for processing a specific emotion: fear.”

For Feinstein and Tranel, the most surprising finding of the study was the patient’s behavior when exposed to snakes and spiders. The patient told the researchers that she hates snakes and spiders and tries to avoid them, yet she immediately started touching them at a pet store, stating that she was overcome with curiosity.

Antonio Damasio, professor of neuroscience at the University of Southern California and a longtime collaborator of Tranel, helped interpret the findings. The researchers say that the results suggest that our fear behavior is oftentimes controlled at a very instinctual, unconscious level.

“Without our amygdala, the alarm in our brain that pushes us to avoid danger is missing,” Feinstein says. “The patient approaches the very things she should be avoiding, yet, strikingly, appears to be totally aware of the fact that she should be avoiding these things. It is quite remarkable that she is still alive.”

Ralph Adolphs, professor of neuroscience and psychology at the California Institute of Technology, also collaborated on the project, which was supported by the National Institutes of Health and a National Science Foundation.

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