The Dorsal Anterior Cingulate Cortex: What Is It and Why Does It Matter?

When I am at the store and the clerk clicks her tongue and sighs when I pull out my wad of coupons, I don’t slap her. Why not? Maybe a better question to start with is “Why would I?” Here’s why. When we perceive that we are being disapproved of, rejected, or left out, the dorsal anterior cingulate cortex (dACC) sends the exact same signal to the fight/flight center of the brain as it would if we were being attacked or threatened. That part of the brain cannot tell the difference. The part of the brain that can tell the difference is the prefrontal cortex (PFC). For someone whose PFC is functioning well, the PCF acts as an override mechanism. It stops the flight/flight center from taking over, and causing, as in this example, me to slap the clerk, or perhaps run out of the store crying. Behaviors we associate with flight or flight responses such as hitting, kicking, screaming, swearing, biting, hair pulling, crying, withdrawing and hiding, are healthy fight or flight responses. Besides operating as an override mechanism for flight/flight responses, the PCF also allows us to reason, put ourselves in other peoples’ shoes, plan and sequence, all helpful in giving us options for when the dACC triggers the fight/ flight response. Many people exhibit fight or flight behaviors when their PFC cannot differentiate feeling excluded from physical threats so their well-being.

You may be caring for someone who exhibits these behaviors “out of the blue” or “for no good reason.” That’s because your brain may be able to do reasoning in a different way than the brain of the person for whom you are caring. They may hit you when you try to wipe their face after a meal, or scream at you when you explain why they need to sign a document.

What is a caregiver to do??? Let’s again offer a counter-question. Let’s begin by asking what not to do. One thing we know that doesn’t work is to use logical reasoning with the person. It feels dignified to us, but when we are talking to the part of the brain that isn’t working very effectively we are actually excluding that person from the conversation because they are unable to understand and respond. Excluding the person (their brain’s perception) triggers the dACC which leads to fight or flight behaviors.

So going back to the example of wiping ones face, what might we do to help their brain know that the person is being included and is safe? Some things to try are: 1) use a soft, warm wash cloth, 2) use a pleasant smelling soap or essential oil blend, 3) offer the person a washcloth also, 4) be at the same level as the person, 5) move in slowly, 6) smile, 7) use a gentle, calm tone of voice, and 8) have palms up. Indicate with your mannerisms and tone of voice, not just your words, that you care. If you have to repeat yourself, use the same words again, so that they don’t have to start decoding the message all over again.

Some things to try when doing paperwork are 1) Keep it simple, 2) Give an emotional, rather that logical reason for the signing, 3) Compliment the handwriting, or willingness, 4) Assume compliance, 5) Show appreciation, and 6) Pick a time when the person is well rested, and not hungry or in pain.

I mentioned emotional reasoning. This is located a little further back in the brain, in the thalamic region which houses several key structures which tend to go undamaged from the ravages of diseases like Alzheimer’s for longer. By communicating with someone using emotional reasoning, we include them because their brain can do this, unlike logical reasoning, which may not be working as well as it has in the past. Again, when one feels included, the dACC does not activate the fight/ flight response.

Communicating with people where they are strong is the key to including the person which helps their brain know that they are safe. Exactly how this is done depends on the person and on the relationship. It can be fun and open doors for enjoyable interaction.