Fear and the Defense Cascade: Clinical Implications and Management.
Fear and the Defense Cascade: Clinical Implications and Management.
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DOI：
10.1097/hrp.0000000000000065
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发表时间：
2015-07
影响因子：
3.8
通讯作者：
Carrive P
中科院分区：
文献类型：
--
作者：
Kozlowska K;Walker P;McLean L;Carrive P
补充的数字内容可在文本中找到。进化赋予了所有人类一种连续的先天的、天生的、自动激活的防御行为，称为防御级联。唤醒是激活防御级联的第一步；逃跑或战斗是应对威胁的主动防御反应；冻结是一种被搁置的“逃跑或战斗”反应；强直不动和崩溃不动是当主动防御反应失败时对不可避免的威胁的最后手段；静止不动是一种促进休息和愈合的静止状态。每一种防御反应都有独特的神经模式，由共同的神经通路介导：杏仁核、下丘脑、导水管周围灰质、交感神经和迷走神经核中特定功能成分的激活和抑制。与动物不同，一旦危险过去，动物通常能够恢复正常的功能模式，而人类往往不能，他们可能会发现自己被锁定在与最初的危险或创伤相关的相同的、反复出现的反应模式中。了解这些先天反应的特征模式——结合起来产生特定防御模式的特定成分——对开发治疗干预措施很重要。有效的干预旨在激活或停用特征神经模式的一个或多个组成部分，从而产生神经模式的转变，并随之产生身心状态的转变。改变神经模式的过程是释放病人创伤反应、打破痛苦循环、帮助病人适应和克服过去创伤的必要的第一步。
Supplemental digital content is available in the text. Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei. Unlike animals, which generally are able to restore their standard mode of functioning once the danger is past, humans often are not, and they may find themselves locked into the same, recurring pattern of response tied in with the original danger or trauma. Understanding the signature patterns of these innate responses—the particular components that combine to yield the given pattern of defense—is important for developing treatment interventions. Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state. The process of shifting the neural pattern is the necessary first step in unlocking the patient’s trauma response, in breaking the cycle of suffering, and in helping the patient to adapt to, and overcome, past trauma.