Anxious: Using the Brain to Understand and Treat Fear and Anxiety
by Joseph LeDoux
Viking, 2015 ($28.95)

Woody Allen's character in Annie Hall is not Hollywood's typical leading man. Alvy Singer may be charming and witty, but he is so preoccupied with the minutiae of his diet, past romantic debacles and the eventuality of his death that he ultimately drives away his girlfriend, Annie.

Allen was one of several cultural figures to embrace anxiety in the 1960s—it was “the centrifugal force of his cinematic humor,” according to LeDoux, a world-renowned expert on memory and emotion and professor at New York University. LeDoux reassures us that anxiety is a natural part of life, although, for many, it becomes pathological. The Anxiety and Depression Association of America estimates that 40 million U.S. adults suffer from an anxiety disorder.

In Anxious, LeDoux explores cutting-edge research on the biology, neuroscience, and psychology of anxiety and fear in an effort to unravel what anxiety is, how it can become a harmful, sometimes debilitating condition, and how we should treat it and related disorders. Contrary to popular belief, LeDoux argues that anxiety is not an innate response. Instead our life experiences seed its development over time. More specifically, he says, the physiological responses associated with anxiety—sweaty palms, tense muscles and heart palpitations, for instance—eventually change our brain chemistry.

LeDoux explains that fear and anxiety overlap in many ways, but they differ in a few key respects. Fear is triggered by a direct threat, whereas anxiety is much more insidious, arising in response to a perceived threat. We may become anxious when we think about a hypothetical future scenario or recall an unpleasant memory. In this way, anxiety holds great power over our minds and behaviors because it spans our past and future as well as our present.

Anxiety reaches the level of a disorder, LeDoux says, when a person has amassed a certain threshold of mental and physical symptoms that regularly influence his or her decisions and actions. Someone afraid of heights, for instance, may go through great pains to avoid taking an elevator, climbing stairs or even looking out a window.

The second half of the book focuses on current and future remedies. According to LeDoux, the drugs available to treat anxiety disorders fall short because they address only our overactive neural response, not the underlying associations. What we need, he argues, is a multipronged approach that can recondition our response to triggers. Current efforts focus on tweaking a person's neural environment—applying electrical stimulation or using hormones such as oxytocin—while he or she is feeling anxious in an effort to change bad associations into good or neutral ones.

Overall, LeDoux provides one of the most complete portraits of this complex emotion. Unfortunately, Anxious can read like a textbook—which is how it was originally conceived—making it challenging, at times, for a nonscientist to fully grasp the content. Still, LeDoux largely makes up for this shortfall by weaving in lighter moments—including fun narrative asides from his own life and intriguing forays into philosophy and animal psychology. These threads help to place anxiety and related disorders in a personal and historical framework, not just a clinical one. Anxious is a fascinating book with breadth that extends beyond its title.