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Fight-or-flight response

The fight-or-flight or the fight-flight-freeze-or-fawn[1] (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival.[2] It was first described by Walter Bradford Cannon.[a][3] His theory states that animals react to threats with a general discharge of the sympathetic nervous system, preparing the animal for fighting or fleeing.[4] More specifically, the adrenal medulla produces a hormonal cascade that results in the secretion of catecholamines, especially norepinephrine and epinephrine.[5] The hormones estrogen, testosterone, and cortisol, as well as the neurotransmitters dopamine and serotonin, also affect how organisms react to stress.[6] The hormone osteocalcin might also play a part.[7][8]

A dog and a cat expressing the fight (top) and flight (bottom) response simultaneously

This response is recognised as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms.[9]

Name edit

Originally understood as the "fight-or-flight" response in Cannon's research,[3] the state of hyperarousal results in several responses beyond fighting or fleeing. This has led people to calling it the "fight, flight, freeze" response, "fight-flight-freeze-fawn"[1][citation needed] or "fight-flight-faint-or-freeze", among other variants.[10] The wider array of responses, such as freezing, fainting, fleeing, or experiencing fright,[11] has led researchers to use more neutral or accommodating terminology such as "hyperarousal" or the "acute stress response".

Physiology edit

Autonomic nervous system edit

The autonomic nervous system is a control system that acts largely unconsciously and regulates heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response and its role is mediated by two different components: the sympathetic nervous system and the parasympathetic nervous system.[12]

Sympathetic nervous system edit

The sympathetic nervous system originates in the spinal cord and its main function is to activate the arousal responses that occur during the fight-or-flight response.[13] The sympathetic nervous system transfers signals from the dorsal hypothalamus, which activates the heart, increases vascular resistance, and increases blood flow, especially to the muscle, heart, and brain tissues.[14] It activates the adrenal medulla, releasing catecholamines that amplify the sympathetic response. Additionally, this component of the autonomic nervous system utilizes and activates the release of norepinephrine by the adrenal glands in the reaction.[15]

Parasympathetic nervous system edit

The parasympathetic nervous system originates in the sacral spinal cord and medulla, physically surrounding the sympathetic origin, and works in concert with the sympathetic nervous system. It is known as the calming portion of the autonomic nervous system.[16] While the sympathetic nervous system is activated, the parasympathetic nervous system decreases its response. Efferent vagal fibers originating from the nucleus ambiguous fire in parallel to the respiratory system, decreasing the vagal cardiac parasympathetic tone.[17] After the fight or flight response, the parasympathetic system's main function is to activate the "rest and digest" response and return the body to homeostasis. This system utilizes and activates the release of the neurotransmitter acetylcholine.[18]

Reaction edit

The reaction begins in the amygdala, which triggers a neural response in the hypothalamus. The initial reaction is followed by activation of the pituitary gland and secretion of the hormone ACTH.[19] The adrenal gland is activated almost simultaneously, via the sympathetic nervous system, and releases the hormone epinephrine. The release of chemical messengers results in the production of the hormone cortisol, which increases blood pressure, blood sugar, and suppresses the immune system.[20]

The initial response and subsequent reactions are triggered in an effort to create a boost of energy. This boost of energy is activated by epinephrine binding to liver cells and the subsequent production of glucose.[21] Additionally, the circulation of cortisol functions to turn fatty acids into available energy, which prepares muscles throughout the body for response.[22]

Catecholamine hormones, such as adrenaline (epinephrine) or noradrenaline (norepinephrine), facilitate immediate physical reactions associated with a preparation for violent muscular action and:[23]

Function of physiological changes edit

The physiological changes that occur during the fight or flight response are activated in order to give the body increased strength and speed in anticipation of fighting or running. Some of the specific physiological changes and their functions include:[24][25][26]

  • Increased blood flow to the muscles activated by diverting blood flow from other parts of the body to make taking quick action easier.
  • Increased blood pressure and heart rate enhance cardiac output in order to supply the body with more energy.
  • Increased blood sugar (glucose) and fats secreted by the liver to provide the body with extra fuel.
  • Increased respiration to supply the oxygen necessary to help burn the extra glucose.
  • The blood clotting function of the body speeds up in order to prevent excessive blood loss in the event of an injury sustained during the response.
  • Increased muscle tension in order to provide the body with extra speed and strength, which can result in trembling or shaking until the tension is released.
  • The pupils dilate to let in more light, allowing for better vision of the body's surroundings.

Emotional components edit

Emotion regulation edit

In the context of the fight or flight response, emotional regulation is used proactively to avoid threats of stress or to control the level of emotional arousal.[27][28]

Emotional reactivity edit

During the reaction, the intensity of emotion that is brought on by the stimulus will also determine the nature and intensity of the behavioral response.[29] Individuals with higher levels of emotional reactivity may be prone to anxiety and aggression, which illustrates the implications of appropriate emotional reaction in the fight or flight response.[30][31]

Cognitive components edit

Content specificity edit

The specific components of cognitions in the fight or flight response seem to be largely negative. These negative cognitions may be characterised by: attention to negative stimuli, the perception of ambiguous situations as negative, and the recurrence of recalling negative words.[32] There also may be specific negative thoughts associated with emotions commonly seen in the reaction.[33]

Perception of control edit

Perceived control relates to an individual's thoughts about control over situations and events.[34] Perceived control should be differentiated from actual control because an individual's beliefs about their abilities may not reflect their actual abilities. Therefore, overestimation or underestimation of perceived control can lead to anxiety and aggression.[35]

Social information processing edit

The social information processing model proposes a variety of factors that determine behavior in the context of social situations and preexisting thoughts.[36] The attribution of hostility, especially in ambiguous situations, seems to be one of the most important cognitive factors associated with the fight or flight response because of its implications towards aggression.[37]

Other animals edit

Evolutionary perspective edit

An evolutionary psychology explanation is that early animals had to react to threatening stimuli quickly and did not have time to psychologically and physically prepare themselves.[38] The fight or flight response provided them with the mechanisms to rapidly respond to threats against survival.[39][40]

Examples edit

A typical example of the stress response is a grazing zebra. If the zebra sees a lion closing in for the kill, the stress response is activated as a means to escape its predator. The escape requires intense muscular effort, supported by all of the body's systems. The sympathetic nervous system's activation provides for these needs. A similar example involving fight is of a cat about to be attacked by a dog. The cat shows accelerated heartbeat, piloerection (hair standing on end), and pupil dilation, all signs of sympathetic arousal.[23] Note that the zebra and cat still maintain homeostasis in all states.

In July 1992, Behavioral Ecology published experimental research conducted by biologist Lee A. Dugatkin where guppies were sorted into "bold", "ordinary", and "timid" groups based upon their reactions when confronted by a smallmouth bass (i.e. inspecting the predator, hiding, or swimming away) after which the guppies were left in a tank with the bass. After 60 hours, 40 percent of the timid guppies and 15 percent of the ordinary guppies survived while none of the bold guppies did.[41][42]

Varieties of responses edit

 
Bison hunted by dogs

Animals respond to threats in many complex ways. Rats, for instance, try to escape when threatened but will fight when cornered. Some animals stand perfectly still so that predators will not see them. Many animals freeze or play dead when touched in the hope that the predator will lose interest.

Other animals have alternative self-protection methods. Some species of cold-blooded animals change color swiftly to camouflage themselves.[43] These responses are triggered by the sympathetic nervous system, but, in order to fit the model of fight or flight, the idea of flight must be broadened to include escaping capture either in a physical or sensory way. Thus, flight can be disappearing to another location or just disappearing in place, and fight and flight are often combined in a given situation.[44]

The fight or flight actions also have polarity – the individual can either fight against or flee from something that is threatening, such as a hungry lion, or fight for or fly towards something that is needed, such as the safety of the shore from a raging river.

A threat from another animal does not always result in immediate fight or flight. There may be a period of heightened awareness, during which each animal interprets behavioral signals from the other. Signs such as paling, piloerection, immobility, sounds, and body language communicate the status and intentions of each animal. There may be a sort of negotiation, after which fight or flight may ensue, but which might also result in playing, mating, or nothing at all. An example of this is kittens playing: each kitten shows the signs of sympathetic arousal, but they never inflict real damage.

See also edit

Notes edit

  1. ^ Cannon referred to "the necessities of fighting or flight." in the first edition of Bodily Changes in Pain, Hunger, Fear and Rage (1915), p. 211. Some references say he first described the response in 1914 in The American Journal of Physiology.

References edit

  1. ^ a b Walker, Peter (2013). Complex PTSD: From Surviving to Thriving : a Guide and Map for Recovering from Childhood Trauma. An Azure Coyote Book. ISBN 978-1-4928-7184-2.
  2. ^ Cannon, Walter (1932). Wisdom of the Body. United States: W.W. Norton & Company. ISBN 978-0-393-00205-8.
  3. ^ a b Walter Bradford Cannon (1915). Bodily changes in pain, hunger, fear, and rage. New York: Appleton-Century-Crofts. p. 211.
  4. ^ Jansen, A; Nguyen, X; Karpitsky, V; Mettenleiter, M (27 October 1995). "Central Command Neurons of the Sympathetic Nervous System: Basis of the Fight-or-Flight Response". Science Magazine. 5236 (270): 644–6. Bibcode:1995Sci...270..644J. doi:10.1126/science.270.5236.644. PMID 7570024. S2CID 38807605.
  5. ^ Walter Bradford Cannon (1915). Bodily Changes in Pain, Hunger, Fear and Rage: An Account of Recent Researches into the Function of Emotional Excitement. Appleton-Century-Crofts.
  6. ^ "Adrenaline, Cortisol, Norepinephrine: The Three Major Stress Hormones, Explained". Huffington Post. April 19, 2014. Retrieved 16 August 2014.
  7. ^ Kwon, Diana. "Fight or Flight May Be in Our Bones". Scientific American. Retrieved 2020-06-22.
  8. ^ "Bone, not adrenaline, drives fight or flight response". phys.org. Retrieved 2020-06-22.
  9. ^ Gozhenko, A; Gurkalova, I.P.; Zukow, W; Kwasnik, Z (2009). PATHOLOGY – Theory. Medical Student's Library. Radom. pp. 270–275.
  10. ^ Donahue, J.J. (2020). "Fight-Flight-Freeze System". In Zeigler-Hill, V.; Shackelford, T.K. (eds.). Encyclopedia of Personality and Individual Differences. pp. 1590–1595. doi:10.1007/978-3-319-24612-3_751. ISBN 978-3-319-24610-9. S2CID 240856695.
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  14. ^ Kozlowska, Kasia; Walker, Peter; McLean, Loyola; Carrive, Pascal (2015). "Fear and the Defense Cascade: Clinical Implications and Management". Harvard Review of Psychiatry. 23 (4): 263–287. doi:10.1097/HRP.0000000000000065. ISSN 1067-3229. PMC 4495877. PMID 26062169.
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  35. ^ Brendgen, M; Vitaro F; Turgeon L; Poulin F; Wanner B (June 2004). "Is there a dark side of positive illusions? Overestimation of social competence and subsequent adjustment in aggressive and nonaggressive children". Journal of Abnormal Child Psychology. 32 (3): 305–320. doi:10.1023/B:JACP.0000026144.08470.cd. PMID 15228179. S2CID 11239252.
  36. ^ Crick, Nicki; Dodge, Kenneth (January 1994). "A review and reformulation of social information-processing mechanisms in children's social adjustment". Psychological Bulletin. 115 (1): 74–101. doi:10.1037/0033-2909.115.1.74.
  37. ^ Dodge, Kenneth (March 1980). "Social cognition and children's aggressive behavior". Journal of Child Development. 51 (1): 162–170. doi:10.2307/1129603. JSTOR 1129603. PMID 7363732.
  38. ^ Adamo, S. A. (2014-09-01). "The Effects of Stress Hormones on Immune Function May be Vital for the Adaptive Reconfiguration of the Immune System During Fight-or-Flight Behavior". Integrative and Comparative Biology. 54 (3): 419–426. doi:10.1093/icb/icu005. ISSN 1540-7063. PMID 24691569.
  39. ^ Grohol, John. . Archived from the original on 23 March 2013. Retrieved 18 April 2013.
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  41. ^ Dugatkin, Lee Alan (1992). "Tendency to inspect predators predicts mortality risk in the guppy (Poecilia reticulata)". Behavioral Ecology. 3 (2). Oxford University Press: 125–127. doi:10.1093/beheco/3.2.124. Retrieved September 9, 2020.
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  44. ^ Singh, J; Aballay, A (April 8, 2019). "Microbial Colonization Activates an Immune Fight-and-Flight Response via Neuroendocrine Signaling". Developmental Cell. 49 (1): 89–99. doi:10.1016/j.devcel.2019.02.001. PMC 6456415. PMID 30827896.

Further reading edit

External links edit

  •   Media related to Fight-or-Flight Response at Wikimedia Commons

fight, flight, response, fight, flight, redirects, here, other, uses, fight, flight, disambiguation, fight, flight, fight, flight, freeze, fawn, also, called, hyperarousal, acute, stress, response, physiological, reaction, that, occurs, response, perceived, ha. Fight or flight redirects here For other uses see Fight or flight disambiguation The fight or flight or the fight flight freeze or fawn 1 also called hyperarousal or the acute stress response is a physiological reaction that occurs in response to a perceived harmful event attack or threat to survival 2 It was first described by Walter Bradford Cannon a 3 His theory states that animals react to threats with a general discharge of the sympathetic nervous system preparing the animal for fighting or fleeing 4 More specifically the adrenal medulla produces a hormonal cascade that results in the secretion of catecholamines especially norepinephrine and epinephrine 5 The hormones estrogen testosterone and cortisol as well as the neurotransmitters dopamine and serotonin also affect how organisms react to stress 6 The hormone osteocalcin might also play a part 7 8 A dog and a cat expressing the fight top and flight bottom response simultaneously This response is recognised as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms 9 Contents 1 Name 2 Physiology 2 1 Autonomic nervous system 2 1 1 Sympathetic nervous system 2 1 2 Parasympathetic nervous system 2 2 Reaction 2 3 Function of physiological changes 3 Emotional components 3 1 Emotion regulation 3 2 Emotional reactivity 4 Cognitive components 4 1 Content specificity 4 2 Perception of control 4 3 Social information processing 5 Other animals 5 1 Evolutionary perspective 5 2 Examples 5 3 Varieties of responses 6 See also 7 Notes 8 References 9 Further reading 10 External linksName editOriginally understood as the fight or flight response in Cannon s research 3 the state of hyperarousal results in several responses beyond fighting or fleeing This has led people to calling it the fight flight freeze response fight flight freeze fawn 1 citation needed or fight flight faint or freeze among other variants 10 The wider array of responses such as freezing fainting fleeing or experiencing fright 11 has led researchers to use more neutral or accommodating terminology such as hyperarousal or the acute stress response Physiology editAutonomic nervous system edit See also Autonomic nervous system The autonomic nervous system is a control system that acts largely unconsciously and regulates heart rate digestion respiratory rate pupillary response urination and sexual arousal This system is the primary mechanism in control of the fight or flight response and its role is mediated by two different components the sympathetic nervous system and the parasympathetic nervous system 12 Sympathetic nervous system edit See also Sympathetic nervous system The sympathetic nervous system originates in the spinal cord and its main function is to activate the arousal responses that occur during the fight or flight response 13 The sympathetic nervous system transfers signals from the dorsal hypothalamus which activates the heart increases vascular resistance and increases blood flow especially to the muscle heart and brain tissues 14 It activates the adrenal medulla releasing catecholamines that amplify the sympathetic response Additionally this component of the autonomic nervous system utilizes and activates the release of norepinephrine by the adrenal glands in the reaction 15 Parasympathetic nervous system edit See also Parasympathetic nervous system The parasympathetic nervous system originates in the sacral spinal cord and medulla physically surrounding the sympathetic origin and works in concert with the sympathetic nervous system It is known as the calming portion of the autonomic nervous system 16 While the sympathetic nervous system is activated the parasympathetic nervous system decreases its response Efferent vagal fibers originating from the nucleus ambiguous fire in parallel to the respiratory system decreasing the vagal cardiac parasympathetic tone 17 After the fight or flight response the parasympathetic system s main function is to activate the rest and digest response and return the body to homeostasis This system utilizes and activates the release of the neurotransmitter acetylcholine 18 Reaction edit The reaction begins in the amygdala which triggers a neural response in the hypothalamus The initial reaction is followed by activation of the pituitary gland and secretion of the hormone ACTH 19 The adrenal gland is activated almost simultaneously via the sympathetic nervous system and releases the hormone epinephrine The release of chemical messengers results in the production of the hormone cortisol which increases blood pressure blood sugar and suppresses the immune system 20 The initial response and subsequent reactions are triggered in an effort to create a boost of energy This boost of energy is activated by epinephrine binding to liver cells and the subsequent production of glucose 21 Additionally the circulation of cortisol functions to turn fatty acids into available energy which prepares muscles throughout the body for response 22 Catecholamine hormones such as adrenaline epinephrine or noradrenaline norepinephrine facilitate immediate physical reactions associated with a preparation for violent muscular action and 23 Function of physiological changes edit The physiological changes that occur during the fight or flight response are activated in order to give the body increased strength and speed in anticipation of fighting or running Some of the specific physiological changes and their functions include 24 25 26 Increased blood flow to the muscles activated by diverting blood flow from other parts of the body to make taking quick action easier Increased blood pressure and heart rate enhance cardiac output in order to supply the body with more energy Increased blood sugar glucose and fats secreted by the liver to provide the body with extra fuel Increased respiration to supply the oxygen necessary to help burn the extra glucose The blood clotting function of the body speeds up in order to prevent excessive blood loss in the event of an injury sustained during the response Increased muscle tension in order to provide the body with extra speed and strength which can result in trembling or shaking until the tension is released The pupils dilate to let in more light allowing for better vision of the body s surroundings Emotional components editEmotion regulation edit See also Emotional self regulation In the context of the fight or flight response emotional regulation is used proactively to avoid threats of stress or to control the level of emotional arousal 27 28 Emotional reactivity edit During the reaction the intensity of emotion that is brought on by the stimulus will also determine the nature and intensity of the behavioral response 29 Individuals with higher levels of emotional reactivity may be prone to anxiety and aggression which illustrates the implications of appropriate emotional reaction in the fight or flight response 30 31 Cognitive components editContent specificity edit The specific components of cognitions in the fight or flight response seem to be largely negative These negative cognitions may be characterised by attention to negative stimuli the perception of ambiguous situations as negative and the recurrence of recalling negative words 32 There also may be specific negative thoughts associated with emotions commonly seen in the reaction 33 Perception of control edit See also Control psychology Perceived control relates to an individual s thoughts about control over situations and events 34 Perceived control should be differentiated from actual control because an individual s beliefs about their abilities may not reflect their actual abilities Therefore overestimation or underestimation of perceived control can lead to anxiety and aggression 35 Social information processing edit See also Social information processing cognition The social information processing model proposes a variety of factors that determine behavior in the context of social situations and preexisting thoughts 36 The attribution of hostility especially in ambiguous situations seems to be one of the most important cognitive factors associated with the fight or flight response because of its implications towards aggression 37 Other animals editEvolutionary perspective edit An evolutionary psychology explanation is that early animals had to react to threatening stimuli quickly and did not have time to psychologically and physically prepare themselves 38 The fight or flight response provided them with the mechanisms to rapidly respond to threats against survival 39 40 Examples edit A typical example of the stress response is a grazing zebra If the zebra sees a lion closing in for the kill the stress response is activated as a means to escape its predator The escape requires intense muscular effort supported by all of the body s systems The sympathetic nervous system s activation provides for these needs A similar example involving fight is of a cat about to be attacked by a dog The cat shows accelerated heartbeat piloerection hair standing on end and pupil dilation all signs of sympathetic arousal 23 Note that the zebra and cat still maintain homeostasis in all states In July 1992 Behavioral Ecology published experimental research conducted by biologist Lee A Dugatkin where guppies were sorted into bold ordinary and timid groups based upon their reactions when confronted by a smallmouth bass i e inspecting the predator hiding or swimming away after which the guppies were left in a tank with the bass After 60 hours 40 percent of the timid guppies and 15 percent of the ordinary guppies survived while none of the bold guppies did 41 42 Varieties of responses edit This section needs additional citations for verification Please help improve this article by adding citations to reliable sources in this section Unsourced material may be challenged and removed Find sources Fight or flight response news newspapers books scholar JSTOR October 2016 Learn how and when to remove this template message nbsp Bison hunted by dogs Animals respond to threats in many complex ways Rats for instance try to escape when threatened but will fight when cornered Some animals stand perfectly still so that predators will not see them Many animals freeze or play dead when touched in the hope that the predator will lose interest Other animals have alternative self protection methods Some species of cold blooded animals change color swiftly to camouflage themselves 43 These responses are triggered by the sympathetic nervous system but in order to fit the model of fight or flight the idea of flight must be broadened to include escaping capture either in a physical or sensory way Thus flight can be disappearing to another location or just disappearing in place and fight and flight are often combined in a given situation 44 The fight or flight actions also have polarity the individual can either fight against or flee from something that is threatening such as a hungry lion or fight for or fly towards something that is needed such as the safety of the shore from a raging river A threat from another animal does not always result in immediate fight or flight There may be a period of heightened awareness during which each animal interprets behavioral signals from the other Signs such as paling piloerection immobility sounds and body language communicate the status and intentions of each animal There may be a sort of negotiation after which fight or flight may ensue but which might also result in playing mating or nothing at all An example of this is kittens playing each kitten shows the signs of sympathetic arousal but they never inflict real damage See also editAcute stress reaction Anxiety Anxiety disorder Apparent death Body reactivity Coping psychology Defense physiology Domestication of the dog Emotional dysregulation Freezing behavior Generalized anxiety disorder Escape distance Hypothalamic pituitary adrenal axis Panic attack Phobia Rest and digest Social anxiety Social anxiety disorder Tend and befriend The Relaxation Response Vasoconstriction Yerkes Dodson law Reflex syncope HypervigilanceNotes edit Cannon referred to the necessities of fighting or flight in the first edition of Bodily Changes in Pain Hunger Fear and Rage 1915 p 211 Some references say he first described the response in 1914 in The American Journal of Physiology References edit a b Walker Peter 2013 Complex PTSD From Surviving to Thriving a Guide and Map for Recovering from Childhood Trauma An Azure Coyote Book ISBN 978 1 4928 7184 2 Cannon Walter 1932 Wisdom of the Body United States W W Norton amp Company ISBN 978 0 393 00205 8 a b Walter Bradford Cannon 1915 Bodily changes in pain hunger fear and rage New York Appleton Century Crofts p 211 Jansen A Nguyen X Karpitsky V Mettenleiter M 27 October 1995 Central Command Neurons of the Sympathetic Nervous System Basis of the Fight or Flight Response Science Magazine 5236 270 644 6 Bibcode 1995Sci 270 644J doi 10 1126 science 270 5236 644 PMID 7570024 S2CID 38807605 Walter Bradford Cannon 1915 Bodily Changes in Pain Hunger Fear and Rage An Account of Recent Researches into the Function of Emotional Excitement Appleton Century Crofts Adrenaline Cortisol Norepinephrine The Three Major Stress Hormones Explained Huffington Post April 19 2014 Retrieved 16 August 2014 Kwon Diana Fight or Flight May Be in Our Bones Scientific American Retrieved 2020 06 22 Bone not adrenaline drives fight or flight response phys org Retrieved 2020 06 22 Gozhenko A Gurkalova I P Zukow W Kwasnik Z 2009 PATHOLOGY Theory Medical Student s Library Radom pp 270 275 Donahue J J 2020 Fight Flight Freeze System In Zeigler Hill V Shackelford T K eds Encyclopedia of Personality and Individual Differences pp 1590 1595 doi 10 1007 978 3 319 24612 3 751 ISBN 978 3 319 24610 9 S2CID 240856695 Bracha H Stefan September 2004 Freeze Flight Fight Fright Faint Adaptationist Perspectives on the Acute Stress Response Spectrum PDF CNS Spectrums 9 9 679 685 doi 10 1017 S1092852900001954 PMID 15337864 S2CID 8430710 Retrieved 31 May 2021 Schmidt A Thews G 1989 Autonomic Nervous System In Janig W ed Human Physiology 2 ed New York NY Springer Verlag pp 333 370 Myers David G DeWall C Nathan 2021 Psychology 13 ed MacMillan Publishing p 422 Kozlowska Kasia Walker Peter McLean Loyola Carrive Pascal 2015 Fear and the Defense Cascade Clinical Implications and Management Harvard Review of Psychiatry 23 4 263 287 doi 10 1097 HRP 0000000000000065 ISSN 1067 3229 PMC 4495877 PMID 26062169 Chudler Eric Neuroscience For Kids University of Washington Retrieved 19 April 2013 Myers David G DeWall C Nathan 2021 Psychology 13 ed MacMillan Publishing p 422 Kozlowska Kasia Walker Peter McLean Loyola Carrive Pascal 2015 Fear and the Defense Cascade Clinical Implications and Management Harvard Review of Psychiatry 23 4 263 287 doi 10 1097 HRP 0000000000000065 ISSN 1067 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at Wikimedia Commons Retrieved from https en wikipedia org w index php title Fight or flight response amp oldid 1217659082, wikipedia, wiki, book, books, library,

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