Select excerpts I can refer back to from How to Calm the Anxious Brain by Lawrence Yeo
- As I researched the structure of the human brain to prepare for this two-part series on anxiety disorders, it became strikingly clear to me why this struggle exists. It’s built right into the anatomy our brains.
- Robert Sapolsky, professor of biology and neuroscience at Stanford, sums up the entire role of the frontal cortex quite nicely: “the frontal cortex makes you do the harder thing when it’s the right thing to do.” It’s no surprise that it’s the most recently evolved brain region in humans, but is not fully formed in our primate cousins. Interestingly enough, the frontal cortex is the last part of the brain to fully mature and go online – this doesn’t happen until our mid-twenties, which explains a lot of the stupid shit we did in our younger days.
- since the connecting pathway to the PFC is literally longer, the amygdala gets thalamic input first.
- Whenever you’re in a fearful situation with high emotional arousal (“I’m scared I will die of a plane crash!”) and you’re able to use a cognitive response to calm it down (“The odds of dying in a plane crash are MUCH lower than if I were to get into a car, so it doesn’t make sense to feel this dread”), that’s the ACG allowing you to make that shift between emotion and cognition. The ACG is really important in the gradual unlearning of fear in anxiety disorders, and one of the keys to a healthy ACG is the neurotransmitter serotonin. the simplest way to think about serotonin is to equate it with regulation. It allows for smooth functioning of the anterior cingulate gyrus. The thing about the ACG is that if left unregulated, it has the tendency to spin around wildly, When this happens, emotionally-charged thoughts get caught in this constant loop …This is a prominent feature of people with Generalized Anxiety Disorder, where intense and destructive worry can result from unreasonable thoughts. For example, let’s say you were at work and you emailed a document to your boss that contained a minor error. The reasonable response would be to simply dismiss that error as a minor one and go about your day. However, for someone with intense generalized anxiety, he could think that the error would be a sign of his gross incompetence, leading his boss to fire him, leaving him without a means to support his family, which will ultimately end in destitution and eventual homelessness. As implausible as this sounds, this negative thought can continue to loop around and grow, causing deeply unpleasant cycles of worry and fear that just won’t go away.
- A healthy level of serotonin in the brain is crucial, and one reliable way to boost it naturally is through consistent exercise…However, just telling Sam to exercise more often is some pretty generic, unhelpful advice. Chances are that if you’re some form of human being, exercise is a good thing for you. Telling an anxiety-ridden person that exercise will make him feel better is just as helpful as telling a college student that studying will be a reliable way to get good grades.
What can I do to feel less anxious in way that lasts?
(1) cognitive behavioral therapy, and(2) exposure therapy.
CBT
His cognitive error constructed the false belief that people always found him boring. Correcting these cognitive errors allows for healthier and more realistic beliefs to take their place. This is the core thesis of cognitive behavioral therapy (abbreviated as “CBT”), which places false beliefs as the origin point for the emotional states of fear and anxiety. According to Aaron Beck, the founder of CBT, if these false beliefs can be properly identified and replaced, then the associated physiological sensations can change, and healthy behavioral shifts can follow accordingly.
CBT requires consistent, rigorous communication between the therapist and patient, and its efficacy relies upon the client’s ability to accurately self-report his situation. This is what is known as an explicit form of treatment, in which the client uses his conscious awareness and verbal reporting of emotional experiences to reappraise and change them. The client will have to consciously use working memory to identify false beliefs, replace them, and report these shifts (both to himself and to the therapist) as he’s making them. Since executive control and conscious processing are the working gears of explicit methods, the area of our brain that is targeted with CBT is that magical sage of ours: the prefrontal cortex (PFC).
What about the nonconscious processes that act as the origin points of fear and anxiety? Those uncomfortable physiological sensations like chest tension, sweating, flushing, etc. that happen before we are aware of them? Or the bombarding of thoughts that happen automatically once a stranger approaches us? What can we do to decrease the likelihood of these automatic reactions from arising in the first place? For that, we will turn to the second form of treatment: exposure therapy.
Exposure therapy
The CS-US association is housed in the amygdala, making it the trigger point for any of these fear responses. The ultimate goal of exposure therapy is to break this CS-US association, which is done through a process called extinction. Extinction happens when repeated exposure to the CS no longer elicits the arrival of the US (this is creatively known as a “CS-no US” memory). For Pavlov’s dog, extinction would occur if the buzzer (CS) was rung repeatedly without any food (US) showing up. The buzzer no longer indicated the arrival of food, so the old CS-US association is replaced by a “CS-no US” memory. As a result, the dog will stop salivating when the buzzer is rung.
For Sam, extinction would occur if repeated social encounters (CS) no longer produced the uncomfortable sensations (US) that would trigger the fear response. Since talking to someone no longer caused his heart rate to elevate and his face to flush, the emotions of fear and anxiety would have no reason to arise. While progress for cognitive behavioral therapy is determined by the client’s self-reporting of fear and anxiety, the efficacy of exposure therapy is determined by an actual reduction of physiological and behavioral responses. If Sam’s sweating decreases with each social encounter, that’s progress. If his face doesn’t flush as much as it used to, that’s progress.
Exposure therapy tries to close the door to anxiety by halting the rise of the uncomfortable sensations that start it in the first place. This is known as an implicit form of treatment, where we try to alter the nonconscious, automatic responses that are controlled by our nerve-wracked friend, the amygdala. By repeatedly exposing Sam to real and imagined social encounters, he can gradually learn that these situations are not dangerous, and the uncomfortable physiological sensations that would usually accompany them will start fading away. With each exposure, the surge of adrenaline and norepinephrine would lessen, and the CS-US link can be successfully broken
While all this sounds great, what is the neurobiological basis for extinction-based therapies like this? How does the age-old adage of “facing your fears” actually calm down the amygdala and reduce the freak-out capacity of the brain? [Kris: See original post for that as well as a list of specific types of exposure therapies]
While therapy is an incredible resource for the treatment of anxiety, sometimes it’s not easily accessible to the general public. Healthcare systems and stigmas around the world still have a long ways to go in the treatment of mental health disorders, so working with a therapist could be fiscally, culturally, and geographically unreachable for many people. Fortunately, our bodies and minds are equipped with some mechanisms that can help navigate us through anxiety-inducing situations without the usage of formal therapy as well. Let’s briefly touch two of these mechanisms that are inextricably connected with one another.
Breath and meditation
The DMN is what is active when you are lost in thought, or when you’re lost in what neuroscientists call “stimulus-independent thought.” Whenever your mind is wandering for no particular reason (scrolling through your social media feeds, daydreaming about a past event, etc.), your default-mode network is active; conversely, when you’re using attention to focus on external goal-oriented tasks, neural activity in the DMN slows down, which helps to induce those beloved experiences of flow states. Although much of the DMN is located in the Land of the Wise, it’s an area that isn’t very insightful a lot of the time. Studies have shown that a wandering mind is largely an unhappy one, and tends to focus obsessively on thoughts about oneself and his relationship with others. The wandering mind tends to conjure up thoughts about one’s past, one’s social standing in relation to others, reflections about one’s emotional status, visions of an imagined future, and all kinds of shit about the past and future. To put it simply, the DMN is the neurobiological epicenter for one’s sense of “self.”
When we are absorbed in mindless thought and are not aware of the states of our minds, the DMN is fully active and our sense of self is in full force. While feeling like you have a “self” and a distinct ego can seem comforting, the reality is that much of humanity’s problems come from the belief that we are the conscious authors of our lives. The feelings of anxiety and fear are no exception to this. Anxiety largely stems from an over-identification with the sense of self. Social anxiety’s roots lie in the erroneous beliefs of how others are perceiving your “self,” and generalized anxiety stems from worries about situations that can impact the well-being of your “self.”
It is through the constant belief in one’s distinct selfhood that we can fail to see our lives for what they really are: continuously changing pieces of the present moment.
If you’re scratching your head at this point, it’s totally understandable, as a lot of this stuff can sound pretty esoteric. If this whole “sense of self” section sounds a bit woo-woo to you, I get where you’re coming from, but there have been a number of fMRI imaging studies conducted on experienced meditators that shed some light on this. Daniel Goleman and Richard Davidson, leading researchers in this area, have found that the default-mode networks of seasoned meditators, many of which subscribe to the practice of “no self,” are substantially quieter than average levels. Additionally, studies have shown that the brains of long-term meditators have increased gray matter thickness, which is believed to protect age-related thinning of the cortex. LeDoux hypothesizes that meditation practices centered around “no self” prevents external stimuli from even entering working memory, thus isolating any memories about the self from one’s current experience. As a result, the practitioner is completely immersed in the present moment, as the brain is simply unable to take input from the external world.
Mindfulness practice can be invaluable to those suffering from anxiety disorders, as it allows discomforting physiological sensations to simply be observed for what they are: patterns of energy that ultimately have no real meaning. For Sam (our protagonist with social anxiety disorder), he can acutely feel the texture of his heart rate elevating, take a moment to study its character, experience it fully, then proceed to let it go as yet another appearance in consciousness. The elevated heart rate doesn’t have any particular meaning or lesson to convey; it simply arises and falls like everything else.
There’s a well-known quote attributed to Seneca that reads, “We often suffer more in imagination than in reality.”
Anxiety is the physical and emotional embodiment of that statement, and arises due to an unceremonious union of physiological sensations and erroneous beliefs. Concerns about a misinterpreted past and worries about an imagined future are the kindling for anxiety, and being aware of this can put out the proverbial fire before it even has the chance to start.
As we go on, living our lives in a world full of incessant change, it will be tempting for each successive generation to wonder if theirs is the defining era of fear and anxiety. Fortunately, the very thing that has created this exponential progress is also equipped with the ability to slow it down. The human brain, the product of a turbulent evolutionary process itself, can be used to amplify a false narrative about one’s anxiety, or it can take a moment to realize that this irrational tale can be rewritten.