Stressed mice perseverate. Stressed humans perseverate. Freud described in what I had feel was his only
true Ã¢ÂÂscience fiction thrillerÃ¢ÂÂ Ã¢ÂÂ Beyond the Pleasure Principle Ã¢ÂÂ how traumatized patients perseverated, that is they
persisted in repeating Ã¢ÂÂun pleasureÃ¢ÂÂ. It is I think rather unlikely that the Ã¢ÂÂDeath InstinctÃ¢ÂÂ is at the etiologic root of
these behaviors for either mice or for men. Rather it may be stress and neural circuits that favor the locus ceruleus,
the amygdala, and the dorsal striatum. And in order to impact these pathways, it may be necessary to intervene at
the moment of anxiety. This paper describes just such active interventions at moments of anxiety Ã¢ÂÂ interventions
informed by psychotherapy but very much expanding the boundaries of where and how psychotherapy should be
done. The work is described with two patients both of whom persisted in repeating Ã¢ÂÂunpleasureÃ¢ÂÂ.