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  • Douglas Zimmerman

Fight or Flight

Sometimes it’s good to take flight. If you are walking down the sidewalk and an automobile is swerving off the road headed in your direction, for your survival, you would jump out of the way. A host of mechanisms are at play here: the optic nerve signaling the amygdala and activating the sympathetic nervous system. Your muscles become ready to run or fight. Again, a lot of things are happening– neurotransmitters and hormones are being released and thoughts and feelings are alerted. This is a case where nature has shown up perfectly to assist in our survival.


But there are times, and for a host of reasons, where nature may have gone awry (or at least rogue), and people become more susceptible to signals that are not meant to induce anxiety.

And herein comes the need for behavioral intervention. By behaving differently, over time, our brain chemistries change. It’s called neuroplasticity. We have a lot of control over how the feel-good chemicals, such as dopamine and serotonin, are released to our brains. The key component here is to change our behaviors to get the good chemistry on board!


I think it’s important to hold in mind, in part anyway, the inner workings of our brains, as it may help people take the risks and do exposures. If we know the reward is there, we are more apt to go for it (this negotiation involves the reward chemical, dopamine). The problem is the reward might not be immediate. In fact, usually it is not. ERP takes time. If it has taken a lifetime to wire your brain a certain way, it does not rewire overnight. However, many patients do feel hope, if not vigor, and a renewed sense of possibility after doing a couple of exposures without resorting to a ritual. And from there, motivation may not be as arduous. For some, thinking in terms of dopamine, serotonin, and the like, does nothing but confuse the situation and make it more abstract. But for others, it strikes a chord and excites the person. They can get behind the notion of neuroplasticity.


In review, and with further explanation – when a person’s nervous system is always on high alert and becomes shocked easily, or overstimulated, to a specific stressor, one can imagine that their brains are releasing a higher than is comfortable amount of norepinephrine and their bodies are releasing the hormones adrenalin and cortisol (and norepinephrine too – which when released by the adrenal gland is considered a hormone), and there are changes in the activity of key neurotransmitters such as glutamate and acetylcholine. With repeated approaches to the trigger/stressor/stimulus, less of the flight or fight chemicals will be released. In a sense our bodies return to a homeostatic state. There will be less stress and less of a need to be on high alert. Now it would be wrong to approach an oncoming car over and over to become habituated to this; indeed, some stressors are good, and one should be on alert while the stimuli, the danger, is present.


Regarding exposures, remember there is no ERP without the E + RP, so exposing oneself to a trigger is only part of the battle, but it’s a good start. After that, it’s important to not do the ritual (which is the Ritual Prevention)! When the E is combined with the RP, we begin to rewire our brains. Bad habits go away, and re-habituation occurs.


To summarize, I urge sufferers to fight their flight or fight habits. And then, the rewiring can occur. As I often mention to patients, this process is not a sadomasochistic one. The patient and therapist work together toward exposing the patient to various triggers a bit at a time and with varying degrees of intensity. And subsequently, the rituals are altered. One thing affects another, which affects another …


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