Between Action and Emotional Survival During the COVID-19 era: Sensorimotor Pathways as Control Systems of Transdiagnostic Anxiety-Related Intolerance to Uncertainty.

Sari Goldstein Ferber,Gal Shoval,Gil Zalsman,Aron Weller,Mario Mikulincer

doi:10.3389/fpsyt.2021.680403

Abstract

Objectives: The COVID-19 pandemic and aligned social and physical distancing regulations increase the sense of uncertainty, intensifying the risk for psychopathology globally. Anxiety disorders are associated with intolerance to uncertainty. In this review we describe brain circuits and sensorimotor pathways involved in human reactions to uncertainty. We present the healthy mode of coping with uncertainty and discuss deviations from this mode.Methods: Literature search of PubMed and Google Scholar.Results: As manifestation of anxiety disorders includes peripheral reactions and negative cognitions, we suggest an integrative model of threat cognitions modulated by sensorimotor regions: “The Sensorimotor-Cognitive-Integration-Circuit.” The model emphasizes autonomic nervous system coupling with the cortex, addressing peripheral anxious reactions to uncertainty, pathways connecting cortical regions and cost-reward evaluation circuits to sensorimotor regions, filtered by the amygdala and basal ganglia. Of special interest are the ascending and descending tracts for sensory-motor crosstalk in healthy and pathological conditions. We include arguments regarding uncertainty in anxiety reactions to the pandemic and derive from our model treatment suggestions which are supported by scientific evidence. Our model is based on systematic control theories and emphasizes the role of goal conflict regulation in health and pathology. We also address anxiety reactions as a spectrum ranging from healthy to pathological coping with uncertainty, and present this spectrum as a transdiagnostic entity in accordance with recent claims and models.Conclusions: The human need for controllability and predictability suggests that anxiety disorders reactive to the pandemic's uncertainties reflect pathological disorganization of top-down bottom-up signaling and neural noise resulting from non-pathological human needs for coherence in life.

Highlights

IntroductionThe COVID-19 outbreak exposed the world to a prolonged uncertain situation which in turn poses a risk for increased psychopathology in the general population across ages and increased risk in individuals with pre-existing psychiatric disorders [2,3,4,5,6]
The human mind seeks coherence in life [1]
As emotional survival is threatened by the entire COVID-19 situation, we suggest that the threatened individual has “always something to do about something” meaning partial control in predictable situations and familiar human circles

Summary

Introduction

The COVID-19 outbreak exposed the world to a prolonged uncertain situation which in turn poses a risk for increased psychopathology in the general population across ages and increased risk in individuals with pre-existing psychiatric disorders [2,3,4,5,6]. A neglected aspect of this pandemic is the mental health suffering of the whole population (people who lost their relatives, out of jobs, familial economy crashes, people confined at home, elder people socially isolated and the worst, uncertainty about the future). Anxiety disorders are associated with intolerance of uncertainty [8, 9]. Anxiety disorders have the highest prevalence of all mental disorders, displaying compromised functioning with varied levels of prognosis and remission [12]. Treatment resistance or partial remission are prevalent [13, 14]

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Conclusion