drawing on psychoanalytic traditions, cognitive behavioral therapy, and cutting-edge interventions in the field of neuroscience, they show how you can develop strategies to regulate anxiety.

anxiety was once seen as an essential part of being human.#

chapter 1 of 9.

with headlines blaring record numbers of anxiety disorders, it may seem like anxiety is something unique to our frenetic modern age.

but actually, the concept has been around for centuries.

the word originates from the ancient greek word, ang, meaning burdened or troubled.

there are references to it throughout the new testament, which describes anxious sinners awaiting for god's wrath to reign upon them.

in 1844, danish theologian søren kierkegaard published the concept of anxiety, where he argued that anxiety is a consequence of the human capacity to make decisions.

it shows we are aware of the power and responsibility of free choice.

the key message here is, anxiety was once seen as an essential part of being human.

this view of anxiety as a normal and even necessary emotion was very influential.

it inspired a wealth of theory by existentialist philosophers like martin heidegger and jean-paul sartre.

but then, in the early 20th century, sigmund freud presented a very different view of anxiety.

freud argued that anxiety is central to a host of psychopathological disorders and is a sign that we have been trying to repress trauma and unpleasant memories.

because we are not actively dealing with these issues, they become toxic and, as a result, make us neurotically anxious.

freud's psychoanalytic methods involved trying to find the underlying cause of the anxiety.

he believed that if the repressed trauma were dealt with, then the anxiety would disappear.

freud's theory fundamentally changed how we perceive anxiety.

it went from being seen as a normal part of being human to becoming a sign that something was wrong and needed to be fixed.

freud's idea of anxiety became especially popular after world war ii.

in 1947, poet w.h.

auden published his famous book the age of anxiety, coining a catchphrase of the same name.

it has been used liberally by every generation since.

filmmakers like alfred hitchcock and woody allen started featuring anxious characters in their films, while the rolling stones started writing songs about housewives using valium.

today, a simple google search for anxiety will yield over 42 million hits.

so clearly, anxiety disorders are something we talk about a lot.

but there is still tons of confusion about what it actually means to be anxious.

in the next chapter, we'll examine what distinguishes an anxiety disorder from everyday worries.

the criteria for diagnosing anxiety disorders are constantly changing.#

chapter 2 of 9.

at what point does a normal amount of anxiety cross over into a disorder?

the power to diagnose an anxiety disorder usually lies with the psychologist or psychiatrist.

to understand how they make those decisions, we need to take a look at the diagnostic and statistical manual, or dsm.

the dsm was released by the american psychiatric association in the mid-20th century and is now the leading guide used to classify psychiatric disorders.

the first edition of the dsm divided mental disorders into states of psychosis and neurosis.

anxiety fell under the latter, as anxiety neurosis.

in 1980, the third edition of the dsm subdivided this term into generalized anxiety disorder, or gad, and panic disorders.

the next edition, published in 1994, expanded on these categories and added post-traumatic stress disorder, or ptsd, and specific phobias.

the key message here is, the criteria for diagnosing anxiety disorders are constantly changing.

to make a diagnosis, a psychologist will evaluate their client's symptoms against a checklist provided by the dsm.

a certain number of matching symptoms classifies a person as having an anxiety disorder.

as this short history shows, there are a range of conditions that fall under the umbrella of an anxiety disorder, and the parameters are constantly changing.

the dsm has been criticized for attempting to fit a very complex disorder into a simplistic checklist, as well as for assigning potentially stigmatizing psychiatric labels to people.

but it has also made these diagnoses more legitimate, which allows people to access mental health services, make claims from their insurer, and seek support from employers and teachers.

so what makes someone susceptible to developing an anxiety disorder?

why do some people go through traumatic incidents seemingly unscathed, while others develop ptsd?

studies have revealed three factors that can come into play.

the first is genetics – anxiety disorders can be inherited from a parent or passed down through generations.

the second concerns people's general psychological disposition and the way they handle uncertainty.

and the third has to do with learning experiences or the environment you grew up in.

in the next chapter, we'll delve more deeply into how we learn about threats.

we all have well-developed survival instincts to counter threats.#

chapter 3 of 9 wild animals are constantly on the lookout for threats.

they have to be.

just a simple journey to forage for food can be fatal if they encounter a predator.

in the early 20th century, physiologist walter cannon developed the famous fight-or-flight theory.

the theory outlined the survival mechanisms animals employ when faced with a threat.

if animals are confronted by a predator or some other danger, they will either freeze and play dead, run away, or fight back.

humans are wired with the same survival instincts.

just think of how you react when you encounter a vicious barking dog or feel threatened by a hostile colleague.

do you want to run away?

or do you find yourself wanting to fight back?

these are the survival mechanisms at work.

the key message here is, we all have well-developed survival instincts to counter threats.

when we feel threatened, our sympathetic nervous system kicks into action.

we start to breathe more quickly and our hearts beat faster.

this delivers more energy to our muscles.

blood is directed away from our gut, skin, and limbs.

then when we're fleeing or fighting off an attack, it is pumped into the areas we need it most, and the adrenal medulla releases adrenaline into our bodies, filling us with energy.

our entire body is involved in the survival response.

but how do we know what constitutes a threat?

we primarily learn about danger through experience.

for example, if a rabbit is attacked by a bobcat at a particular watering hole, she will associate bobcats, as well as that particular environment, with danger.

next time she's at the watering hole, she'll behave defensively, even if no actual danger is present.

humans have especially sophisticated evolutionary survival mechanisms.

we don't only learn about danger through our own experiences, we also have the capacity for observational learning.

if we witness another person being mugged on a dark street corner, we will extrapolate that the same corner could pose a danger to us in the future.

we can also learn about threats through verbal instruction.

for example, children are often warned about the dangers they'll face in the world, like fires or untrustworthy strangers.

the next time they encounter such a threat, their survival instincts will automatically kick in.

our built-in survival systems are crucial.

they help keep us alive.

but sometimes they can kick into overdrive, perceiving threats where none exist.

having an anxiety disorder puts you on high alert for potential threats.#

chapter 4 of 9 imagine how terrifying it would be to walk to the corner store if you felt like each step you took could activate a hidden landmine.

other people just see a peaceful street, while you see danger at every turn.

people who have anxiety disorders are hypervigilant to possible threats.

with a specific phobia, like arachnophobia, this vigilance is directed toward a particular object.

a person might interpret everything they see or hear as being a spider.

and social anxiety disorders put people on high alert in social settings, meaning a fun gathering could instead feel like a minefield of potential humiliations.

the key message here is, having an anxiety disorder puts you on high alert for potential threats.

this hypervigilance keeps the survival systems in a state of constant high alert, which means that the sympathetic nervous system kicks into action.

this triggers stress hormones like epinephrine and cortisol to be released into the brain.

our bodies are now poised to deal with danger, and our minds become laser-focused on the source of the threats.

people who have anxiety disorders often have trouble distinguishing between real and imagined threats, which means they have disproportionate reactions to situations that aren't actually threatening their survival.

they also overestimate the likelihood that things will go wrong and underestimate their own ability to cope with the situation if it does transpire.

these feelings can be very distressing, so people with anxiety disorders often go to great lengths to avoid any potentially uncomfortable situation.

someone who is scared of heights might avoid all tall buildings, and someone with social anxiety could make sure to always surround themselves with people they know well.

people with generalized anxiety disorder don't have a specific trigger to avoid.

instead they experience a constant stream of anxious thoughts about anything and everything.

but this kind of thinking is in itself a form of avoidant behavior.

anxieties keep our minds so busy with an incessant internal monologue that we're no longer able to properly examine our own thoughts and test them against reality.

avoiding potential anxiety triggers can bring temporary relief, but it can also mean that people with anxiety disorders end up leading lives that become increasingly constricted.

since the fears are never confronted head-on, they just loom larger and larger.

fear and anxiety are feelings that humans process consciously.#

chapter 5 of 9 neuroscientists have learned a lot of what they know about human brains from experiments with animals.

by observing how animals like rats respond to threats, they've been able to glean important insights about how human survival systems work.

in scientific literature, animals who respond to a threat by freezing or attacking have been described as displaying fear responses.

that might lead us to conclude that animals feel fear just as humans do.

but this is a misconception.

there is a crucial difference between having a defensive survival response in the face of attack and consciously feeling fear.

the key message here is, fear and anxiety are feelings that humans process consciously.

the survival response is operated by instinctive, unconscious cognitive circuits in our brains.

we can swing into action without us feeling anything at all.

in contrast, fear and anxiety are created by conscious cognitive processes.

our conscious minds interpret our sensations and memories, and they piece together a story about what is happening.

they create meaning, making sense of what we see, hear, and experience in the world.

take the feeling of fear, for example.

when we perceive a threat, like seeing a snake, our defense response will kick into action.

but that's just the beginning.

our attention and working memory then direct us to the sensory information we're receiving, and to how our bodies are reacting.

our semantic memory allows us to identify precisely what we've seen, and to categorize it as a venomous snake.

our episodic memory inserts the snake into a story about how the threat relates to us personally.

perhaps it will imagine the future consequences if we were to be bitten, or it might relate the snake to a similar past incident.

at that stage, our mind will consciously label what we're feeling as fear or anxiety.

if researchers solely based their knowledge of anxiety on experiments with animals, they'll be missing a big piece of the puzzle—human emotions.

as we'll see in the next chapter, distinguishing between survival responses and emotions becomes especially important when we're trying to figure out how to treat anxiety.

cognitive-behavioral therapeutic approaches are effective in treating anxiety.#

chapter 6 of 9 we're all familiar with the scene of the therapist taking notes and stroking his beard while his client lies on a couch talking about her childhood.

these typical scenes are inspired by freud-era psychoanalysis.

but although freud was one of the first to introduce the concept of anxiety to psychology, current therapeutic approaches are very different.

freud used talk therapy to get to the root of psychological problems rooted in a patient's past.

today, most therapeutic treatments for anxiety are based on cognitive behavioral approaches, which are more concerned with how people behave in the present.

they explore the symptoms rather than the cause.

the key message here is, cognitive behavioral therapeutic approaches are effective in treating anxiety.

cognitive therapies aim to help people untangle dysfunctional core beliefs that needlessly kick instinctive avoidant and survival behaviors into action.

behavioral therapies aim to treat debilitating behavioral patterns themselves.

both approaches draw heavily on exposure therapy.

you're probably familiar with the old adage that if you fall off your horse, the best thing to do is get right back on.

the idea is that if you quickly replace that painful experience with a more positive one, then you won't develop an aversion to horse riding.

exposure therapy works along the same principle.

for example, if a patient is scared of elevators, a therapist might start by showing them photographs of or encouraging them to think about elevators.

then they'd encourage them to visit an actual elevator and start riding in it.

these repeated exposures show the patient that they can ride in an elevator and survive.

gradually, their negative associations with elevators are replaced by more neutral ones.

this process is known in scientific terms as extinction.

exposure therapy can also help people with gad by creating a space for them to identify anxiety triggers and the kinds of automatic worries that result.

patients are shown how to objectively assess catastrophic thinking and come up with more plausible alternatives.

by delving deep into the worries themselves and seeing how disproportionate they are, these threats start to lose their power.

exposure therapy is remarkably effective, but it has limitations.#

chapter 7 of 9 exposure therapy has proven to have a 70% rate of effectiveness, but there are some shortcomings.

for one, the extinction of negative associations is very context-specific.

something you learn in the therapist's office may not carry over to the real world.

you may have virtually practiced entering an elevator from the comfort of a couch, but still be scared of a physical elevator you encounter in real life.

even more problematically, the effects of exposure therapy can be reversed.

this is often because of a new traumatic event.

for example, you may suddenly find that you're scared of heights again after being in a car accident.

it's also possible for old associations to come back after some time has lapsed, in what is known as a spontaneous recovery.

the key message here is, exposure therapy is remarkably effective, but it has limitations.

by ringing a bell just before serving food, russian physiologist ivan pavlov trained his dogs to salivate when they heard the noise of a bell.

then he managed to extinguish that association by repeatedly ringing the bell without serving any food.

but when he rang the bell after a break, the dogs salivated once again.

their brains had spontaneously reverted to the earlier associations.

yet another challenge with exposure therapy is that you can only extinguish associations that you consciously remember, but the majority of our memories are buried in our unconscious.

luckily, there are strategies that therapists can take to make exposure therapy more lasting and effective.

for example, they can make sure to work with their clients in many different contexts so that the treatment translates into different situations.

a lot of processing happens in the four to six hours after clients leave a session.

if those hours are very busy or fraught, some of the important work of the exposure therapy can become undone.

this could be remedied by something as simple as taking a nap after a session.

it's well documented that sleep accelerates the work of the brain.

aside from these behavioral solutions, combining exposure therapy with a short-term drug treatment has also proven effective.

for example, patients who were given cortisol prior to therapy sessions reported experiencing less anxiety.

these methods can increase the success of extinction.

but what if there's another solution?

what if we could erase negative memories and associations from our brains altogether?

memories can be retrieved and updated with new information.#

point eight of nine.

in the cult film eternal sunshine of the spotless mind, a couple decide to erase each other from their memories after a painful breakup.

the rest of the film is spent trying to retrieve those memories.

the moral of the story is that while erasing painful memories might bring relief, it also involves losing vital parts of ourselves.

the idea of erasing memories makes people so uncomfortable that it's considered almost taboo as a psychological treatment.

in fact, when the author and his colleagues published a paper showing that they'd identified a way to erase traumatic memories in rats, it caused an uproar.

during the experiment, the rats were subjected to a loud noise followed by an electric shock.

having been conditioned to associate the tone with danger, the rats showed defensive responses, like freezing the next time they heard the noise.

but by injecting a substance that blocks the synthesis of protein into a part of the brain called the lateral amygdala, the researchers could erase the traumatic memory.

the next time they heard the noise, the rats behaved completely normally.

the researchers suggested that a similar procedure could be used on humans, but this finding attracted widespread condemnation.

one psychologist argued that erasing memories of trauma would make events like the holocaust more likely to happen again.

memories of past atrocities may be painful, but they also create a vital historical record.

while the idea of our memories being tampered with is scary, we need to acknowledge that most existing psychological methods already alter our memories in some way.

psychoanalysis involves recovering repressed memories.

cognitive therapy involves discussing and recontextualizing memories so that we might see them differently.

memories are mutable.

studies have shown that every time a memory is retrieved, it can be remolded with new information.

this is good news for researchers and psychologists looking for a way to help people who struggle with traumatic memories and associations.

but although memory is dynamic, it's actually very difficult to completely erase memories in humans.

strong traumatic memories are remarkably durable, even if protein synthesis is blocked in the brain.

if we can get over our squeamishness about interfering with memory, we might find that new neuroscientific research can complement more traditional therapeutic techniques, especially when dealing with trauma.

active coping strategies can help you to regulate your anxiety.#

blank nine of nine.

millions of people live with anxiety disorders.

they lead rich, full, adventurous lives in spite or maybe because of all the uncomfortable feelings that anxiety can bring.

research by george bonanno has shown that people who are able to draw on a range of active coping strategies are very resilient in the face of anxiety.

for example, a socially anxious person may cope with their discomfort at a party by taking lots of bathroom breaks or by stepping out to make a phone call.

this may seem like avoidant behavior, which we've defined as being negative, but proactive avoidance can be a useful coping strategy that allows people time to regroup and come back to the party without getting too overwhelmed.

the key message here is active coping strategies can help you to regulate your anxiety.

sometimes active coping can look like engaging with other people after a traumatic event.

for example, in the days following the attacks on the world trade center, many people were frozen in front of their televisions, trapped in the endless news cycle.

meeting friends outside or going to work were ways of breaking that sense of helplessness.

other active coping strategies that have become prominent in recent years involve breathing exercises and meditation practices that aim to diffuse anxiety.

when we become anxious, our emergency response causes our breathing to become fast and shallow.

justly taking a few deep, slow breaths immediately makes us feel calmer.

meditation is just as powerful.

techniques like focused attention can teach people to guide their minds away from frenetic worries and competing thoughts and instead focus on particular sensations in their bodies or on objects in the room.

open monitoring, also known as mindfulness, trains people to observe their surroundings, thoughts, and feelings in a neutral and accepting way.

most importantly, meditation can teach us to be selfless, that is, to stop taking our thoughts so personally.

this will automatically make anxiety less persuasive.

after all, anxiety depends very much on identification with the self that can be humiliated, harmed, or threatened in some future scenario.

active coping skills are very subjective.

what could be a bomb to one person's anxiety might feel overwhelming and stressful to you.

active coping is about identifying what works for you and keeping a range of these techniques at hand.

you've just listened to our chapters to anxious by joseph ledoux.

final summary#

Conclusion

the key message in these chapters is that anxiety disorders are complex to diagnose and to treat because anxiety involves so many different kinds of processes in our brains.

people with anxiety disorders are hypervigilant about danger and threats, meaning their automatic survival systems are on high alert.

but anxiety is also a feeling that we process consciously.

effective treatment will need to engage with all of these different ways that anxiety manifests in our bodies and minds.

here's another piece of actionable advice.

if you want to remember something, take a nap.

the next time you want to make sure you remember something, for example, a lecture, schedule in a nap right after it.

memories need between four and six hours to become fully formed in our minds.

it's important to not only take notes during the lecture, but also to set aside some peaceful time for reflection afterward.

or better yet, take a nap.

while you're sleeping, your brain will be hard at work preserving the memory of everything you've learned.

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