This video will give you a thorough understanding of anxiety. It's about an hour long, and, if you'd like, you can skip it and go directly to the module by pressing ENTER.
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Remember the amygdala? It’s the core of the lower cortex; its job is to automatically detect when you're facing an opportunity or threat. When it detects something important (i.e., salient), it activates the fitting emotional response: when there's an opportunity for pleasure, it activates a craving; when there's a threat of pain, it activates anxiety and fear. The purpose of this module is to show you how the things you've been learning to deal with cravings also apply to dealing with anxiety.

It's a good question. Learning about anxiety sheds light on growing in self-control in two ways.

First, you will better understand how to handle cravings once you see how you can use the same approach to handle anxiety.

Second, you will learn how to thrive in the face of challenges that would before have made you anxious. Since people are more likely to seek out distractions (i.e., satisfy cravings) when they're stressed out and avoiding challenges, the approach of this module directly addresses the number one cause for relapse.

The amygdala does more than just sound an alarm when you face something it thinks is a threat; it also watches your response to the alarm it sounds. When it sees that you are avoiding the supposed threat, it will make sure to sound an even bigger alarm next time. When it sees you approach the supposed threat, it will decrease the alarm for next time. It's like everything has a "threat label," and that label gets increased by avoidance and decreased by approach. Let’s look at an example.

Imagine that a person living in Manhattan has an intense phobia of heights, and so she goes to a behavioral therapist for treatment. The therapist happens to work in a skyscraper and has an EXTREMELY high balcony -- perfect for doing exposure therapy! In the course of a session the therapist has the patient walk onto the balcony, and she feels terrified.

When she's feeling terrified, what urge would you expect her to have?

Well, it would be the right strategy for her to follow, as we'll discuss in a minute. But, even with a great deal of training, this would never be the URGE someone feels when he or she is afraid. Fear always urges us to flee the thing we fear.

You're joking, I'm sure. She would have an urge to do precisely the opposite. The urge you get when you're anxious is always to FLEE from the thing you fear. In this way it's the opposite of a craving, in which the urge is to APPROACH the thing you crave.

Exactly. Fear always urges us to flee from the thing we fear. Cravings always lead us to want to approach the thing we crave; in this way, a craving is a mirror image of a fear. This is why occasions of fear need to be approached eagerly, while occasions of cravings need to be avoided when possible (but yet, without fearing them).

What just happened is that her amygdala detected a threat, namely the extreme height, and sent her the classic Fight-or-Flight signal. Her initial desire is to run back inside and away from the balcony. But remember, her amygdala is watching closely how she reacts.

If she were to give in to her desire to flee and runs back inside the office, her anxiety would quickly stop. She would feel better in the short run, but, in the long run, high places would have an even greater threat label attached to them.

Take a look at the graph below, which shows how she developed the phobia of heights in the first place. At one point a high place made her scared and she avoided it; the next time, she feared a high place even more, and avoided it; and so on. Every time she avoids it, her amygdala increases the threat label for next time. After all -- this is the only way it knows that it was right to sound the alarm in the first place!

Our amygdalae always defer to our judgment as it is demonstrated in our behavior. We call the process that happens when we avoid things while the alarm is sounding threat learning or sensitization. 

An extreme version of threat learning is what happens during thwarted escape. This refers to a situation in which you try to flee from a feared object but CANNOT. Going back to the Manhattan office, this is what the woman would have faced if the therapist had (wickedly!) locked her out on the balcony. As long as she's trying to get inside, her escape behavior is powerfully confirming for her amygdala that the threat is real and must be desperately avoided. Take a look at the graph below.

Now let’s go back and see what happens if you chose not to flee from the balcony. You notice the extreme height, you feel the same anxiety rising within you, and you feel the urge to run back inside. But this time, you decide to stay out on the balcony and fully embrace your anxiety and fear.

Take a look at the graph this time. Notice that the anxiety level does not drop as steeply as it had when you decided to run back inside; instead it tapers off slowly. But this embrace of anxiety tells your amygdala that this the balcony is not a threat; if it were a threat, you’d be running away or you’d be dead! And by standing on the balcony and fully immersing yourself in the anxiety, you show your amygdala that it was a false alarm. The resulting process is known as safety learning or habituation.

The graph below shows what would happen over the course of five exposures. The difference between the successive peaks is called "between-session habituation," and it represents the stable safety learning taking place in your amygdala.

Remember the question I asked initially? Would running back inside help you deal with your anxiety more or would embracing it? Well now you understand that sensitizing yourself to the situation and fleeing would only bring immediate ease while habituation and embracing the anxiety would actually help you more in the long run, even if it takes more time in the moment.

Although we now know that habituation is far better than sensitization, what do you think is more common in everyday life?

You’re quite the optimist! This is definitely the more hopeful answer.

Unfortunately, this is probably much closer to the truth.

People often opt for sensitization over habituation because, in the moment that they are anxious, they prefer short-term comfort to long-term progress: sensitization dispenses with anxiety immediately, whereas habituation can take anywhere from 90 seconds to 90 minutes to process the anxiety.

90 minutes can seem like a long time, but that’s a worthy price to pay for overall progress. But I know you wouldn’t be satisfied with that, so I’ll tell you that there are ways to speed this up.

Before we discuss how to speed up safety learning, let me ease your worries. If you decide to embrace the anxiety, it will always tend to run its course. As long as you don’t run away or try to distract yourself, your anxiety will diminish, so you know ahead of time that you’re going to win the fight! But the length of time it takes to do that can vary.

The first piece of advice for speeding up habituation is to see the threat as an opportunity (remember when we talked about reframing? It all ties together!). If you view having anxiety as a chance to practice safety learning,  you’ll fare far better than if you kept seeing it as a threat! Remember that your brain detects threats and opportunities very differently (the amygdala and the appraisal center in your lower and upper cortices!). This simple frameshift in your perspective can drastically lower the time it takes to habituate.

The next piece of advice I have can sound strange at first: fully immerse yourself in your anxiety. That’s right. I’m telling you that trying to mentally increase your anxiety will actually help you lower it, while trying to avoid it and ignore it won’t. Let’s look at an example.

Imagine that the amygdala communicates with you through a series of pipes, and you can control how strong the signals are by opening or closing valves. If you’re standing on that high balcony, do you think it would be better to open the valve, allowing the amygdala to send signals to you, or would it be better to close it off?

I’ve already hinted that it’s best to open the valves and feel the anxiety, so now I’ll explain. If you were to close the valves by ignoring the anxiety or trying to distract yourself from it, the amygdala would continue to send the signal because it sees that you’re not receiving the message; soon the pressure would be too much and you would be flooded with anxiety when you’re not prepared for it.

If instead you decide to open the valves and let yourself become immersed in the flow of anxiety, you’d be releasing the tension. Remember the purpose of the amygdala: to make sure you notice threats and respond to them accordingly. By allowing yourself to feel the anxiety, you are telling the amygdala that you’ve received it’s message. And by calmly feeling the fear, you are telling it that this is, in fact, not a dangerous or threatening situation. Over time, the amygdala would stop sending the signal because it knows you’ve received them all.

Opening the valves is straightforward. Remember from the other modules that being completely aware of a situation you are in is known as mindfulness. A simple exercise of mindfulness will help you open the valves and feel the anxiety. When you feel the fear rise in you, focus on the tension in your chest (strong emotions can always be indicated by a tightening in the chest). Notice how it tightens as you breathe in, and relaxes as you breathe out. By being aware, or mindful, of this tension, you let your amygdala know you are receiving its signals.

So I’ve explained that opening the valves and immersing yourself in the anxiety will help you habituate to it, but let’s take it a step further. Which of these would be an even better step towards decreasing your anxiety in the long-term?

Both of these answers would help your anxiety in the long-term, but leaning over the balcony would actually help you even more! You’d be pushing your anxiety to the extreme and your desire to run inside would be much greater, but that actually helps you get over your fear even faster.

Remember reframing? Well this is that exercise pushed to the extreme. By leaning over the railing, you’re willingly increasing your anxiety and changing your mindset. Imagine what that’s telling your amygdala: “Not only was this not a threat, but it’s not even something that should cause mild discomfort!” By reframing the situation as an opportunity to grow rather than a threat, you’re actually lowering your anxiety faster. I’ve found that the phrase “Bring it on!” is a great way of reframing your mindset. Telling yourself that you want to feel this anxiety helps lower it.

An important detail to note is that safety learning only occurs while the amygdala is sounding the alarm. That means that you can’t teach your body how to deal with anxiety if you are not feeling anxiety at that moment. Psychiatrists help patients confront their fears and anxieties by placing them in controlled environments and helping them step-by-step — this is known as exposure therapy. The analogy of placing someone who fears heights on a high balcony is an example of this.

In order to get the most out of exposure therapy, you should focus on the three main steps that we’ve gone through in this module: first, view the model of anxiety as an opportunity for learning; second, fully immerse yourself in the sensation to the highest degree; and third, embrace the challenge with a “Bring it on!” mentality.

Your nervous system is split into two parts: the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS). Whereas the SNS is responsible for “fight or flight,” the PNS is responsible for “rest and digest” and "tend and befriend." For exposure therapy, you want to turn on your PNS rather than the threat mode of the SNS. You can do this by practicing mindfulness and also by exercising regularly and intensely. I’ve recommended it before in a previous module, but I’d like to mention Headspace again. Headspace gives useful advice and techniques to practice mindfulness daily, and I recommend it to all my patients.

So we’ve talked a lot about lowering anxiety, but I have another example to present to you. But first: do you think anxiety can hurt your performance?

Remember what you chose. Let's look at an example to answer that question fully.

A researcher at Harvard recently conducted an experiment with students who were about to take a practice GRE (Graduate Record Examination). This is an admissions requirement for most graduate schools in the US, and so a lot of the students were understandably nervous.

The researcher gave half the students a statement to read before they took the test:

“People think that feeling anxious while taking a standardized test will make them do poorly on the test. However, recent research suggests that arousal doesn’t hurt performance on these tests and can even help performance... people who feel anxious during a test might actually do better. This means that you shouldn’t feel concerned if you do feel anxious while taking today’s GRE test. If you find yourself feeling anxious, simply remind yourself that your arousal could be helping you do well.”

As it turned out, the researcher found that the statement had a noticeable impact on the scores.

On the practice test, those who read the statement had a score 54 points higher on the GRE than the controls.

On the actual exam, they found that their math score was, on average, 770 out of 800, while the control group scored 705 on average.

After those surprising results, you’re probably wondering how anxiety could possibly be helpful especially if we’ve been talking about ways to lower it this whole time. Well it’s important to remember that it’s not necessarily the anxiety that is hurting or helping us, but rather how we view our anxiety. In other words, it's all about reframing.

Researchers used to believe that having adrenaline would be helpful only if the adrenaline levels ("arousal") remained low. As the arousal increased, they believed that eventually the increase in arousal would hurt performance. This is called the Yerkes-Dodson law, and the graph looks like this:

Yerkes and Dodson did specify that the curve was intended for difficult tasks; easy tasks tended to be helped by adrenaline. The full Yerkes-Dodson graph looked like this:

Given the latest research in the field, we can update the graph of abilities vs. arousal. This research has shown that it is not the difficulty of the task that determines whether your abilities increase or decrease with arousal; rather, the graph is determined by your appraisal of the arousal. As long as you judge the arousal to be a good thing, it only helps your performance; if you at any time start judging it to be a bad thing ("too much"), it will then impede your performance. It's all up to you!

See Kelly McGonigal's book, "The Upside of Stress," for a fascinating review of the relevant literature.
Up through the 1990s, most forms of psychotherapy tried to help people who were feeling anxious or stressed by showing them ways of decreasing their arousal (e.g., relaxation training, deep breathing, etc). What effect does training people to reduce arousal have on their judgment of whether arousal is good or bad?

In fact, the answer can differ from person to person. The danger is that these kinds of older, anti-arousal behavior strategies could implicitly train people to see their arousal as a bad thing. This would especially be the case if a person tried an anxiety-reduction strategy and then found that it failed to help them; suddenly their anxiety would spike, as they came to see arousal as being very dangerous and uncontrollable.

In more mild cases, however, it might be that these strategies helped people to not be afraid of their arousal, thus changing their appraisal of it. All of the modern forms of behavioral therapy now aim at helping people change their appraisal of arousal, seeing it as an opportunity instead of a threat.

If you see adrenaline, or anxiety, as a threat, it hurts your performance, but if you view it as an opportunity, it actually helps you do even better than you could if you were calm and relaxed!

What does that mean for us? Be excited. Instead of worrying about your anxiety before a task, get excited about it. View it as an opportunity. And always keep hold of the “Bring it on!” mentality.

Good luck! I'm anxiously waiting to hear about your progress.

I'd appreciate any feedback you have to offer about this module. Thanks!