Anyone who knows me knows I am nerdy. Nerdy to the point of being annoying I fear. So of course when I heard recently in a class I was taking that a region of the brain called the anterior cingulate was implicated in Obsessive Compulsive Disorder (OCD) I decided to do some sleuthing.
The anterior cingulate is a region of the brain that basically is constantly receiving information from the lower (less sophisticated) regions of the brain and trying to make sense of that input. One of it's jobs is to try to predict behavior, so it is receiving information from areas like the amygdala (which looks for threat) and trying to predict what will happen. The lower, less evolved areas of our brain are VERY quick (much quicker than our more evolved, conscious functions) but they are also error-prone. Better to assume that what is coming at you is a saber-toothed tiger and run than to assume it is an over-sized bunny and get eaten by the (oops!) tiger. So the lower regions of the brain are sending signals to the higher areas, and some of those signals are wrong, and it's up to the higher regions to figure out what is true and what is error. The anterior cingulate tries to do this and it is doing it in the direction of predicting things so we can avoid making the same mistake twice. If you did manage to not get eaten by the saber-tooth tiger, even though you thought it was a very large bunny, you would not want to make that mistake again!
Our anterior cingulate is not only working to figure out which is a tiger and which is a bunny, and to make sure that we encode that information for future usage, but it is also looking at "dangers" like social criticism and feelings of shame or humiliation. Even though these are not physical threats the body/mind processes the pain from social gaffes in the same areas that it processes physical pain. So the brain is highly motivated to avoid emotional pain just as it is highly motivated to avoid physical pain.
So here your anterior cingulate is chugging along, trying to understand all of these signals and filter out the "bad data", and sometimes it makes mistakes. In fact, sometimes it gets over-active and is stuck "on" and keeps looking to predict bad things. So it starts making mistakes itself (in the present) in trying to help us avoid making mistakes in the future! Here is what this looks like: I am afraid to go to the office holiday party because I am thinking about a conversation that I had last week at the water cooler in which I greeted the new person in the office by the wrong name. I have replayed that conversation about a dozen times in the past week, cringing each time at the look on her face as I called her by the wrong name. I am sure that she has told everyone else in the office, who also probably thought I was a complete idiot. I am now sure that if I go to the office party everyone is going to be looking at me and thinking that I am an idiot who can't remember people's names. So I don't want to go.
This is a typical example of social phobia, a very common condition that can lead to lowered self-esteem, loneliness and depression. So that little area called the anterior cingulate can have a big impact on a person's life.
What is to be done, then? Since our experimentation with lobotomies in the 1940's through the 1970's (yes, they went on that long! for those with a macabre sense of curiosity, read My Lobotomy) was not very helpful to folks, it seems we are left with therapy and/or drugs. For a straightforward case of OCD I recommend CBT with an emphasis on "response resistance". But for more nuanced problems with the anterior cingulate a combination of response resistance with psychotherapy can be quite helpful. In terms of medication, which is also highly indicated in OCD and helpful in general with this brain region, the drug Effexor seems to work best. Effexor (venlafaxine) seems to target the anterior cingulate and calm it down some. If you think that you may want to try medication or make changes in your existing psychiatric medications I recommend that you consult a psychiatrist.
The future of psychology and psychiatry is very exciting due to all of the advances in linking specific brain regions with specific behaviors. The National Institute of Health initiative called BRAIN (Brain Research through Advancing Innovative Neurotechnologies) is urging scientists to target their investigations in this direction. Hopefully this will lead to more effective and specific treatments for things like OCD, depression, schizophrenia, bipolar disorder and many other forms of mental illness that currently effect millions. In the meantime I believe that by learning more about that squishy gray mass we all carry around between our ears that we can better choose from the existing treatments to improve our lives and help make us the best versions of ourself. Stay tuned for more nerdiness as science expands our understanding of what it means to be human. And feel free to send my your comments, questions or critiques.
Krista Jordan, Ph.D.
Dr. Jordan has been in private practice for 20 years in Texas. She is passionate about helping people to overcome hurts and obstacles from their past to find more happiness and health in their current lives.