Created at: 2025-01-04
This book is foundational for anyone living in the modern era of anxiety.
There is a lot of incredible scientific and evidence-based advice in this book.
I won't spoil a potential reader with all the details, so below is my own summary of the techniques presented (but without their justifications; you have to read the book for that as they can be rather complex).
At the end I have included my highlights from the book to help paint a better picture of the most important information pieces I collected.
When feeling anxious, map the anxiety trigger, what behaviour showed up in response, and the resulting outcome.
For example:
Tips:
And pay attention to your body sensations, your feelings, emotions.
Tips
Curiosity is an example of this. Be curious about your feelings and emotions. Ask yourself "Hmmm.. What can I learn from this?".
Tips:
Useful when self-judging or doubting.
Residency was also the period when I started having my own panic attacks, fueled by lack of sleep and the feeling that I didn’t know anything, combined with the uncertainty of being on call and never knowing when my beeper was going to go off in the middle of the night and what train wreck was going to be on the other end when I called the nursing station. All of this took a collective toll on my psyche. Talk about being able to empathize with my anxious patients! Fortunately, my meditation practice helped here as well. I was able to use my mindfulness skills to ride out full-blown panic attacks that would wake me from sleep. Better yet, and I didn’t know why at the time, these skills helped me not to add fuel to the fire of panic: I learned to work with anxiety and panic so that I didn’t worry or freak out about having more panic attacks, which kept anxiety at bay and kept me from developing a true panic disorder. I also started to learn that I could teach people to become aware of uncomfortable feelings (rather than habitually avoiding them); I could give them a way to handle and work with their emotions that wasn’t simply prescribing them a pill.
Some people wake up with anxiety in the morning, that nervousness prodding them awake like a hungry cat, followed by unshakable worry that spins them more and more awake (no coffee needed) and builds throughout the day because they can’t figure out why they are anxious. This is the case for my patients with Generalized Anxiety Disorder (GAD), who wake up anxious, worry their way through the day, and then continue their binge-worrying late into the night, fueled by thoughts of Why can’t I get to sleep? Other folks have panic attacks that come out of the blue or (as happens with me) that wake them from sleep in the middle of the night. Still others worry about specific things or themes, yet oddly are unaffected by other events or categories
Some people wake up with anxiety in the morning, that nervousness prodding them awake like a hungry cat, followed by unshakable worry that spins them more and more awake (no coffee needed) and builds throughout the day because they can’t figure out why they are anxious. This is the case for my patients with Generalized Anxiety Disorder (GAD), who wake up anxious, worry their way through the day, and then continue their binge-worrying late into the night, fueled by thoughts of Why can’t I get to sleep? Other folks have panic attacks that come out of the blue or (as happens with me) that wake them from sleep in the middle of the night. Still others worry about specific things or themes, yet oddly are unaffected by other events or categories that one would think should drive them bonkers.
In a study that now seems ancient because the data were collected between 2001 and 2003, the National Institute of Mental Health reported that 31 percent of U.S. adults experience an anxiety disorder sometime in their lives, and that 19 percent of the population had an anxiety disorder within the past year.
In 2018, the American Psychological Association surveyed a thousand U.S. adults about their sources and levels of anxiety. The APA found that 39 percent of Americans reported being more anxious than they were in 2017,
In 2018, the American Psychological Association surveyed a thousand U.S. adults about their sources and levels of anxiety. The APA found that 39 percent of Americans reported being more anxious than they were in 2017, and an equal amount (39 percent) had the same level of anxiety as the last year. That’s nearly 80 percent of the population.
Large-scale disasters such as the COVID-19 pandemic are almost always accompanied by increases in a broad range of mental disorders, including substance use and anxiety. For example, nearly 25 percent of New Yorkers reported increasing their alcohol use after the 9/11 attack back in 2001, and six months after the 2016 Fort McMurray wildfire (the costliest disaster in Canadian history), area residents showed a spike to 19.8 percent in Generalized Anxiety Disorder symptoms.
Anxiety isn’t a loner. It tends to hang out with friends. That same JAMA study from 2017 found that 80 percent of people with GAD experienced another lifetime psychiatric disorder, most commonly depression. A recent study from my lab found something similar: 84 percent of individuals with GAD presented with comorbid disorders.
As a psychiatrist, I learned that anxiety and its close cousin, panic, are both born from fear. As a behavioral neuroscientist, I know that fear’s main evolutionary function is helping us survive. In fact, fear is the oldest survival mechanism we’ve got. Fear teaches us to avoid dangerous situations in the future through a brain process called negative reinforcement.
Anxiety is born when our PFCs don’t have enough information to accurately predict the future. We saw this with COVID-19, when it exploded onto the world stage in early 2020.
Importantly, like zebras who jump and kick, or dogs who shake their bodies after surviving stressful situations, you need to learn how to safely discharge the excess energy associated with that “I almost died” adrenaline surge, so that it doesn’t lead to chronic or post-traumatic stress and anxiety. Simply talking to someone doesn’t count here; you may really have to do something physical, like shout, shake, dance, or engage in some type of physical exercise.
When fear-based learning is paired with uncertainty, your well-intentioned PFC doesn’t wait for the rest of the ingredients (e.g., more information). Instead, it takes whatever it’s got in the moment, uses worry to whip it together, fires up the adrenaline oven, and bakes you a loaf of bread you didn’t ask for: a big hot loaf of anxiety. And in the process of making the loaf, your brain stores a bit of the dough—like sourdough starter—away for later. The next time you plan for something, your brain pulls that anxiety starter out of your mental pantry and adds it as an “essential ingredient” to the mix, to the point where that sour taste overpowers reason, patience, and the process of gathering more information.
Like COVID-19, anxiety is also contagious. In psychology, the spread of emotion from one person to another is aptly termed social contagion. Our own anxiety can be cued/triggered simply by talking to someone else who is anxious. Their fearful words are like a sneeze landing directly on our brain, emotionally infecting our PFC, and sending it out of control as we begin to worry about everything from whether our family members will get sick to how our jobs will be affected. Wall Street is a great example of social contagion.
How can we avoid panic? Too many times, I’ve seen my anxious clinic patients try to suppress or think themselves out of anxiety. Unfortunately, both willpower and reasoning rely on the PFC, which at these critical moments has shut down and isn’t available. Instead, I start by teaching them how their brains work so that they can understand how uncertainty weakens their brain’s ability to deal with stress, priming it for anxiety when fear hits.
And he said unto them, Go ye into all the world, and preach the gospel to the whole creation. 16 He that believeth and is baptized shall be saved; but he that disbelieveth shall be condemned.
This is a crucial moment, so please read this slowly: With the same brain mechanisms as that unnamed cave person, we modern geniuses have gone from learning to survive to literally killing ourselves with these habits. And it’s gotten exponentially worse in the last twenty years. Obesity and smoking are among the leading preventable causes of morbidity and mortality in the world. Undeterred by modern medicine, anxiety disorders top the charts as the most predominant psychiatric conditions.
When an animal is given a reward that isn’t on a regular schedule or one that seems random (intermittent), the dopamine neurons in the brain perk up more than usual. Think of a time when someone surprised you with a gift or party. I bet you can remember it, right? That’s because unexpected rewards fire off dopamine in your brain at a much higher rate than expected ones.
just enough times to keep us coming back for more. There’s plenty of research showing that anxiety gets perpetuated as a negatively reinforced habit loop. Over the past several decades, T. D. Borkovec, a researcher at Pennsylvania State University, wrote a number of scientific papers showing that anxiety can trigger worry. Back in 1983, Borkovec and his colleagues described worry as “a chain of thoughts and images, negatively affect-laden, and relatively uncontrollable,” representing an attempt to engage in mental problem-solving on an issue with an uncertain outcome. When worry gets triggered by a negative emotion (e.g., fear), it can also become reinforced as a way to avoid the unpleasantness of that emotion:
We found that before starting treatment, 60 percent of doctors in the study had moderate to severe anxiety, and over half of them reported feeling burned out from work at least a few times per week. We also found a strong correlation between anxiety and burnout (.71, where 0 is no correlation and 1 is a perfect correlation). After three months of using the app, physicians reported a whopping 57 percent reduction in anxiety scores (measured by the clinically validated Generalized Anxiety Disorder-7 questionnaire). And even though we hadn’t incorporated any specific anti-burnout teachings in the training (it was focused solely on helping reduce anxiety), we also found significant reductions in burnout, especially in the areas of cynicism (where people become more and more skeptical of the system), which can easily get perpetuated by anxiety: Trigger: Get another email about how behind I am on my RVUs Behavior: Think about how the system sucks and is only getting worse Result: Get more cynical, become burnt out
First Gear First gear is all about recognizing our habit loops and seeing the different components clearly: trigger, behavior, and reward. To be clear, reward is a brain term, as in it’s the result of the behavior that at some point was rewarding, that’s why the behavior got reinforced in the first place. The behavior might not seem that rewarding right now, so you can simply think of the habit loop as a trigger, a behavior, and a result.
Remember, our old brain is set up to help us survive. In addition to reward-based learning, it has another trick up its sleeve: it takes what it learns and moves the learning into “muscle” memory as soon as it can. In other words, our brains are set up to form habits so we can free up the brain space to learn new things.
recent research is calling into question some of the early ideas on willpower. Some of these studies have shown that willpower is genetically endowed for a lucky subset; still other studies have argued that willpower is itself a myth. Even studies that acknowledge willpower as real tended to find that people who exerted more self-control were not actually more successful in accomplishing their goals—in fact, the more effort they put in, the more depleted they felt. The short answer is that buckling down, gritting your teeth, or forcing yourself to “just do it” might be counterproductive strategies, possibly helping out in the short term (or at least making you feel like you are doing something) but not working in the long term, when it really counts.
If you have a craving for X, do Y instead. Like willpower, substitution relies on the new brain. This strategy is backed by a lot of science and is one of the go-to strategies in addiction psychiatry. For example, if you want to quit smoking but crave a cigarette, eat candy instead of lighting up. This works for a subset of folks (and was one of the approaches I was taught in residency training), but as research from my lab and others has shown, it may not uproot the craving itself. The habit loop stays intact, but the behavior is simply changed to something healthier. (Okay, okay, we can argue about how healthy candy is later, but you get the idea.) Since the habit loop is still there, this also makes it more likely that you will fall back into the old habit at some point in the future.
If you are tempted by ice cream, don’t keep cartons of it in the freezer. Again, this strategy involves the pesky new brain. Several labs studying priming an environment have found that people with good self-control tend to structure their lives in such a way that they don’t need to make self-control decisions in the first place. Getting into the habit of exercising every morning or buying healthy food at the grocery store makes staying fit and cooking nutritiously a routine, so it’s more likely to stick. There are two caveats here: (1) you have to actually get into a habit of doing the healthy thing; and (2) when you slip, because your brain has grooved your old habits much more deeply than your new ones, you’re prone to fall back into the old habit pattern and stay there. I see this all the time in my clinic.
Jon Kabat-Zinn is perhaps the most well-known Western mindfulness maven. While he was on a silent meditation retreat in the late 1970s, the idea to develop and test an eight-week mindfulness program that could be taught and researched in medical settings popped into his head. Thus mindfulness-based stress reduction (MBSR) was born. Over the next four decades, MBSR became the most well-known and studied mindfulness course on the planet.
Once you’re aware of your habit loops—when you’re on autopilot—you can then get curious about what is happening. Why am I doing this? What triggered the behavior? What reward am I really getting from this? Do I want to keep doing this?
my lab found that mindfulness training was key in helping smokers recognize habit loops and be able to decouple cravings from smoking. In other words, patients could notice a craving, get curious about what it felt like in their bodies (and minds), and ride it out, instead of habitually smoking. Breaking this habit loop led to five times greater quit rates than the current gold-standard treatment.
How rewarding a behavior is drives future behaviors, not the behavior itself. Another way of putting this is that the behavior itself is less important than the result of the behavior; if it were simply a matter of identifying the behavior and then telling someone to stop doing it, I’d happily be out of work. “Just stop doing it” never made it as a slogan for good reason. After years of research and clinical practice, I’m thoroughly convinced that willpower is more a myth than an actual mental muscle.
This notion that we must be at least a little anxious to perform well has also been romanticized in the research literature. Back in 1908, when the field of psychology was in its infancy, two animal behavior researchers at Harvard, Robert Yerkes and John Dodson, published a paper entitled “The Relation of Strength of Stimulus to Rapidity of Habit Formation.” In this manuscript, they described an interesting observation: that Japanese dancing mice learned a task more efficiently when they received a moderate shock as a negative reinforcer as compared to a mild or severe shock. They concluded that animals needed some level of arousal, but not too much, to learn best. This paper was referenced only ten times over the next half century, yet in four of the citing articles, these findings were described as a psychological law (now perhaps irrevocably imprinted on the Internet as the Yerkes-Dodson Law or the Yerkes-Dodson Curve).*
Fast-forward half a century, when a review of the psychological literature pertaining to stress and work performance established that only 4 percent of the papers supported the inverted U-shaped curve, while 46 percent found a negative linear relationship, which basically means that any level of stress inhibits performance. Despite these clear differences (data be damned!), the overgeneralized Yerkes-Dodson “Law” has become folklore, perhaps even reaching mythic status in modern day, evidenced by a seeming exponential growth in the number of citations (fewer than 10 in 1990, fewer than 100 in 2000, and greater than 1,000 a decade later).
As you move forward with changing any habit, anxiety or otherwise, don’t worry about finding all of the triggers. When mapping out habit loops, you can often get stuck focusing on the triggers and lose sight of what actually helps you change them. This usually occurs when people focus too much on figuring out why they started getting into this or that habit loop in the first place.
In fact, triggers are the least important part of the habit loop. Reward-based learning is based on rewards, not the triggers (hence the name).
a 2010 Harvard study showed that we get caught up in thinking (mind-wandering, to be exact) for about 50 percent of our waking lives. That’s a lot of time running on autopilot. Because this state of mind is so common, it can be measured in the brain. There is even a network of regions called the default mode network (DMN). The DMN was discovered by Marcus Raichle and his crew at Washington University in St. Louis. It was called the default mode network because this is what our minds go to whenever they are not engaged in a specific task. The DMN gets activated when our mind is wandering, thinking about things in the past or future, caught in repetitive thought patterns such as rumination, anxiety, or in other strong emotional states, and when we’re craving various substances. And for better or worse, we default to thoughts and memories about things that are related to us. We regret things that we’ve done in the past, worry about events coming up in the future, and so on.
Once you’ve mapped out your main habit loops, see how much you can zoom in throughout the day and count the number of times that they make it to the top of your brain’s “playlist.” Are there specific perseverative loops that you can map out? Can you count how many times they get played? Which ones make it to the top of the charts?
Being more in tune with the kind of person you are will also help you build on the strengths of your habitual tendencies. For example, a person displaying a predominantly approach type might do well at marketing or sales. One might give an avoid type an assignment requiring a high level of precision and attention to detail because such a person loves to focus in on figuring things out and thrives in those situations. And a go-with-the-flow type might be the best at coming up with creative ideas during a brainstorming session or the start of a large project.
Understanding your habitual tendencies will also help you grow as a person and avoid unnecessary heartaches. For example, if you are the approach type, you can map out all of the habits in your life where you tend to go overboard, where wanting too much of a good thing actually makes things worse (e.g., overeating, getting jealous in friendships, etc.). If you are the avoid type, you can pay attention to related behaviors such as being overly judgmental (of yourself and others) or overly focusing on accuracy to the detriment of the bigger picture. And if you are the go-with-the-flow type, you can focus on becoming aware of situations where you might step back from making decisions and agree with others for the sake of not causing friction.
Approach: You tend to be optimistic and affectionate and might even be popular. You are composed and quick thinking in everyday tasks. You’re more likely to be attracted to pleasant things. You put faith into what you believe, and your passionate nature makes you popular with other people. You have a confident posture (that is to say, you walk proudly). At times you might have the tendency to become a little greedy for success. You crave pleasant experiences and good company. Avoid: You tend to be clear-thinking and discerning. Your intellect allows you to see things logically and identify flaws in things. You are quick to understand concepts and tend to keep things organized and tidy while getting things done quickly. You pay attention to detail. You might even have a stiff posture (that is to say, you walk stiffly and hurriedly). At times you might notice that you are overly judgmental and critical. You may come across as a perfectionist. Go with the flow: You tend to be easygoing and tolerant. You are able to think about the future and speculate on what might happen. You think about things deeply and philosophically. At times you get caught up in your own thoughts or fantasies. As you daydream, sometimes you might become doubtful and worried about things. At times you might notice that you find yourself going along with what others suggest, perhaps becoming too easily persuaded. You might notice that you are less organized than others and can come across as dreamy.
One of my clinic patients put it nicely: when she was stuck in a habit loop of self-judgment (e.g., “That was stupid. Why did I do that?”), she would simply say to herself, Oh, that’s just my brain, which helped her not take things so personally.
This is important, so I’m going to repeat it: The more rewarding a behavior is, the stronger the habit. In fact, our brains set up a hierarchy of behaviors based on their reward value. The behavior with the bigger reward is the one our brains choose and the one we act out. From a neurobiological perspective, this probably has to do with the amount of dopamine that fires up our brain’s reward centers when we first learn the behavior. This goes all the way back to our caveman brains, which are set up to help us get the most calories we can so we can survive. For example, sugar and fat have a lot of calories, so when we eat cake, part of our brain thinks, Calories—survival! Hence we start to prefer cake over broccoli. A study from the Max Planck Institute recently found that our brains get two dopamine hits: the first comes when tasting food, and the second when the food hits our stomach. Depending on the caloric promise, our brains remember which foods are more rewarding (more calories = more reward), which is why our parents never served dessert at the same time as dinner. Given a choice, we’d fill up on cake before we ate our vegetables.
But it’s not just calories that count. Our brains also learn the reward value of people, places, and things. Think back to all of the birthday parties you went to as a kid. Your brain combines all of that information—the taste of the cake, as well as the fun you had with your friends—into a single composite reward value. Reward value has been mapped to a certain part of the brain called the orbitofrontal cortex (OFC). The OFC is a crossroads in the brain where emotional, sensory, and previous behavioral information gets integrated. The OFC takes all of this information, groups it together, and uses it to set that composite reward value of a behavior, so we can quickly retrieve it in the future as a “chunked” bit of information.
doesn’t. The only sustainable way to change a habit is to update its reward value. That’s why it’s called reward-based learning.
The only sustainable way to change a habit is to update its reward value. That’s why it’s called reward-based learning.
Here’s an example. I don’t have to tell my patients that they should force themselves to stop smoking or that smoking is bad for them—they know this already from watching their beloved Marlboro man get emphysema (in fact, no fewer than four Marlboro men have died from COPD). No patient of mine has ever marched into my office and asked me how to help them smoke more. Instead, I go to where the money is: direct experience. I teach people to pay attention when they smoke. Most people start smoking when they are teenagers, so they’ve laid down a strong reward value for cigarettes: being young and cool at school, rebelling against their parents, all of that. I have them pay attention when they smoke so they can see how rewarding smoking is to them right then and there. One woman who was doing the noticing reported that smoking “smells like stinky cheese and tastes like chemicals, YUCK.” Did you notice how she paid attention? She wasn’t thinking, Smoking is bad for me. Instead, she brought a curiosity and an awareness to her experience of smoking as she was smoking—noticing the smell and tasting the chemicals in cigarettes.
If you really pay careful and close attention—without making any assumptions or relying on past experience to guide you—and you see that a behavior is not rewarding right now, I promise you that you will start to get less excited about doing it again.
Once you’re fully aware that procrastinating puts the project even more behind schedule or inhaling a bag of your favorite chips will make your stomach feel bloated and will lead to a crappy emotional state, you can’t have a do-over and pretend you don’t feel what you feel.
Every time you pay attention to your actions, you become more aware of what you actually get from them. If you notice that potato chips make you feel crappy when you eat too many, you get less excited about eating the whole bag next time. Not because you have to force yourself to not eat them, but simply because you remember what happened last time (and the time before that, and the time before that, and the time before that). This also holds true for worry, procrastination, or any other anxiety habit loop that you’ve learned over the years.
When you have identified and mapped out your habit loops (first gear) and are ready to practice driving in second gear, ask yourself this simple question: What do I get from this behavior? Answering this question will require you to pay careful attention to the actual, visceral, embodied sensations, emotions, and thoughts that come as a result of the behavior in question. WARNING: This is not an intellectual training. Don’t fall into the trap of understanding how reward valuation works in the brain and then go trying to think your way out of your bad habits and into good ones.
While thinking is helpful for decision-making and planning, we often give the thinking part of our brain too much credit. Remember, it’s the weakest part of your brain, so you can’t trust it to do the heavy lifting. Let it do the fun, creative thinking. When it comes to actually changing behavior, leave that part to the heavyweights (the OFC and other reward-based learning parts of your brain). How do you get the big muscular guy to do your bidding? You hire someone to become the heavyweight’s coach or trainer.
So if your mind starts turning this into an intellectual exercise of thinking—trying to think your way out of worry, overeating, or another bad habit—simply notice and perhaps map that out as a habit loop (like the example above). Then ask yourself, What do I get from this? Don’t ask it in an intellectual way.
When you ask this question, put your thinking mind on hold for a few moments and then drop your awareness into observation mode and notice what is happening in your body. At this point it is pretty straightforward for awareness to coach your brain. Obviously, eating a whole bag of potato chips isn’t going to help you train for that marathon or lower your blood pressure. If you procrastinate, you aren’t going to get the project done—in fact quite the opposite, especially when it adds to the time pressure of a deadline. Awareness. That’s where the disenchantment presents are, waiting under the tree to be opened. You must be present to open them.
See if you can start driving in second gear now: map out a habit loop (anxiety or otherwise) to get you moving, then shift into second by focusing on the results of the behavior. Bring your awareness into your embodied experience and focus on the question What do I get from this? What does the result of that behavior feel like when you simply bring the behavior to mind?
simple. Keep going with the habit loop practice. Map out a habit loop (first gear); ask yourself, What do I get from this?; and pay attention to the body sensations, thoughts, and emotions that come as a result of the behavior (second gear). Repeat.
Keep going with the habit loop practice. Map out a habit loop (first gear); ask yourself, What do I get from this?; and pay attention to the body sensations, thoughts, and emotions that come as a result of the behavior (second gear). Repeat.
In her book, Mindset: The New Psychology of Success, Dweck advises, “If parents want to give their children a gift, the best thing they can do is to teach their children to love challenges, be intrigued by mistakes, seek new strategies, enjoy effort, and keep on learning. That way, their children don’t have to be slaves of praise. They will have a lifelong way to build and repair their own confidence.”
Bringing awareness to the results of your behaviors as a way to facilitate habit change goes beyond eating; it may also work with habits like worrying. One example would be planning for the future. Planning is like chocolate—a little tastes good, but too much of it can be counterproductive, as it can induce anxiety about what can go wrong.
Taking out the garbage is seldom seen as one of the highlights of our day. But let’s think about the role attitude plays in an action such as taking out the trash. If it is time to take out the garbage and you do so with a bad attitude, guess what? You’re learning to pair taking out the garbage with something that is bad or unpleasant. On the other hand, if you realize that you have to take the garbage out anyway and don’t see it as a big deal, you’ll learn that taking the garbage out isn’t a big deal. And it will be easier to do the next time and the next and so forth, even when it’s the middle of the winter or pouring rain. Changing your attitude toward even the simplest tasks can have a huge effect on your life.
Watch your thoughts. They become words. Watch your words. They become actions. Watch your actions. They become habits. Watch your habits. They become character. Watch your character. It becomes your destiny.
Instead of getting frustrated that you’re struggling or failing to make faster progress, get curious. Since the thought or emotion is already there, you can use it as a way to explore all the different ways that you react to it. Here’s an example. You notice that you are getting frustrated. Trigger: Start to feel frustrated Behavior: Notice the habitual reaction and ask, “What do I get from this?” Result: See how unrewarding the old habit is; get disenchanted with feeding the frustration (second gear) See if you can bring a kind, playfully curious attitude to your habit change process. If you notice you are getting afraid while you are working with a fear-based habit loop, or if mapping out an anxiety habit loop makes you anxious, see if you can distance yourself a little from the feeling. Take
Instead of getting frustrated that you’re struggling or failing to make faster progress, get curious. Since the thought or emotion is already there, you can use it as a way to explore all the different ways that you react to it. Here’s an example. You notice that you are getting frustrated. Trigger: Start to feel frustrated Behavior: Notice the habitual reaction and ask, “What do I get from this?” Result: See how unrewarding the old habit is; get disenchanted with feeding the frustration (second gear) See if you can bring a kind, playfully curious attitude to your habit change process. If you notice you are getting afraid while you are working with a fear-based habit loop, or if mapping out an anxiety habit loop makes you anxious, see if you can distance yourself a little from the feeling. Take a deep breath and remind yourself that this is your brain trying to be helpful and that it’s getting a little off track. If frustration or some other bad attitude arises, do you close down or get stuck in some fixed mindset habit loop? If so, take a moment to map that out and see what you get from it. The idea is to realize just how unrewarding that attitude is
Don’t trust your thoughts (especially the shoulds). Thoughts are just mental words and images that come and go and should be viewed with a healthy skepticism. This doesn’t mean that thinking is bad. Remember, planning, problem-solving, and being creative are part of what makes us uniquely human and helps us in life. Thinking trips us up when we get caught up in worry or self-judgmental habit loops (that is to say, shoulding—I should do this, I shouldn’t do that). Those types of thoughts, especially the ones that have strong opinions, are the ones to be on the lookout for, as they just make us feel bad about ourselves.
Our modern neural networks are still very much in hunter-gatherer (and not be hunted) mode. This means that reward-based learning shows up every time we smoke a cigarette, eat a cupcake, or check our email or news feed when we’re stressed: basically, each time we reach out for something to soothe ourselves, we reinforce the learning, to the point where it becomes automatic and habitual. This is how we end up stuck in anxiety (and other) loops. As just one example, by the time one of my patients came to me to help him quit his forty-year smoking habit, he had reinforced his learning pathway roughly 293,000 times. How can willpower possibly compete?
To break old habits and make new ones stick, you need to set up the necessary conditions. First, you need to make sure that reward value of the old habit is updated. That’s why you’ve been practicing second gear so much. Second, you need to find that BBO. For example, becoming clearly aware that smoking doesn’t taste good reduces the reward value of smoking cigarettes (second gear), but people don’t stand idly by on their smoke breaks doing nothing if they aren’t smoking. Idleness quickly gives way to boredom and restlessness, which themselves don’t feel particularly pleasant. In many paradigms for addiction treatment, the solution calls for a substitute behavior. Eating candy can occupy the time and satisfy a craving (to some degree), yet feeds the habitual process: triggered by a craving, one learns to eat candy instead of smoking, which sets up its own reward-based learning loop—and is the usual suspect for the average fifteen-pound weight gain that comes with quitting. Third, for lasting habit change, you must find a special type of BBO, not just any old BBO. You need to find a reward that is more rewarding and doesn’t feed the habit loop through mere substitution of a different behavior.
In 2006, the psychologists Jordan Litman and Paul Silvia itemized two main “flavors” of curiosity, which they dubbed I-curiosity and D-curiosity. The I in I-curiosity stands for interest, the pleasurable aspects of the hunger for knowledge, while the D in D-curiosity stands for deprivation, the idea that if we have a gap in information, we go into a restless, unpleasant, need-to-know state. In other words, curiosity—our drive for information—can either induce a pleasant state or reduce an aversive state.
Deprivation Curiosity, the Closed-Down, Restless, Need-to-Know Type: The Itch That Must Be Scratched Deprivation curiosity is driven by a lack of information, often a specific piece of information. For example, if you see a picture of a movie star or another famous person and you can’t remember her or his name, you might start racking your brain to remember who that is (“Oh, she was in that romantic comedy . . . the one where she . . . Urgh, what is her name?”). Trying to remember might even get you into a little bit of a contracted state, as though you are trying to squeeze that answer out of your brain. If the squeezing doesn’t work, you google the movie that you saw the person in so you can find the answer. When you see the name, you feel a sense of relief because you are no longer deprived of the information. This extends to texting and social media as well. If you are in a meeting or out to dinner, and you feel or hear a text come into your phone, you might notice that suddenly it is really hard to pay attention because not knowing what the text says makes you restless. It’s as though your phone starts burning a hole in your purse or your pocket. That fire of uncertainty is put out when you check your phone to see who texted you or read what the message says.
Interest Curiosity: The Opened-Up, Wide-Eyed Wonder of Discovery Interest curiosity is piqued when we become interested in learning more about something. Usually this isn’t a specific piece of information (like the movie star’s name), but a broader category. For example, did you know that there are animals who keep growing in size until they die? They are called indeterminate growers, and include sharks, lobsters, and even kangaroos. In fact, a twenty-pound lobster was discovered that is believed to be 140 years old, based on its size. That’s one big old lobster! Isn’t that fascinating? Interest curiosity is like diving into an Internet search and realizing hours later that you’ve learned a whole bunch of stuff and your thirst for knowledge has been quenched. It feels good to learn something new. This is different from filling a deficit, simply because there wasn’t a deficit there in the first place (that is, you didn’t know you didn’t know about big lobsters, but when you found out about them, you were intrigued and delighted). Unlike the D-curiosity—which is about destinations—the I-curiosity is more about the journey.
With deprivation curiosity, getting the answer is rewarding, but with interest curiosity, the process of being curious feels good. This is critical for two reasons. First, with interest curiosity, you don’t need something outside of yourself to get a reward—the curiosity is rewarding in and of itself—and second, because of its inherent nature, it doesn’t run out.
When they felt frustrated or stuck during a meditation practice, hmm seemed to help them explore what that felt like in their body and mind (instead of trying to fix or change it). When they got caught in a habit loop of worry or self-judgment, hmm could help them shift into third gear and step out of the loop. Instead of their minds spinning out of control and feeding more habitual self-judgment, they found that hmm could help them step back and see their habit loop component elements for what they were: thoughts and emotions.
Curiosity (the interest type, not the deprivation type) fits all of the third-gear conditions perfectly: it is an internally based (and thus always available) BBO behavior that enables us to step out of our old habit loops in a sustainable way.
Let’s walk through the curiosity exercise that I teach everyone on Day 1 in the Unwinding Anxiety app. This exercise works as a kind of “panic button” for when anxiety hits. It will take about two minutes. First, find a quiet comfortable place. You can be sitting, lying down, or even standing up; you just need to be able to concentrate without being distracted. Recall your most recent run-in or “incident” with a habit loop. See if you can remember the scene and shift right into retrospective second gear: focus in on the behavior itself. See if you can relive that experience, focusing on what you felt right at the time when you were about to act out the habitual behavior. What did that urge to go ahead and “do it” feel like? Now check in with your body. What sensation can you feel most strongly right now? Here’s a list of single words or phrases to choose from. Pick only one, the one you feel most strongly: ❑tightness ❑pressure ❑contraction ❑restlessness ❑shallow breath ❑burning ❑tension ❑clenching ❑heat ❑pit in stomach ❑buzzing/vibration Is it more on the right side or the left? In the front, middle, or back of your body? Where do you feel it most strongly? Now let out your inner hmm—is that hmm on the right side or the left? In the middle, front, or back of your body? Don’t worry about what area you picked. They are all perfect. Was there anything you noticed about being curious about what part of your body you felt the sensation in? Did being a little curious help with getting closer to this sensation? If the sensation is still there, see if you can get curious and notice what else is there. Are there other sensations you’re feeling? What happens when you get curious about them? Do they change? What happens when you get really curious about what they feel like? Follow them over the next thirty seconds, not trying to do anything to or about them, but simply observing them. Do they change at all when you observe them with an attitude of curiosity?
When we move out of our comfort zone, our survival brain starts warning us that we’re moving into parts unknown—there could be danger out there. If we see the world as either safe or unsafe, the only options are comfort or danger: we’re either in our comfort zone or in the danger zone (which many of my patients call the panic zone, because it feels so uncomfortable that they start panicking). That’s how Dave described it to me: not being anxious was making him anxious because it was unfamiliar to him. In other words, the discomfort of being in a new mental space, even if that new place was the garden of calm, was triggering his survival brain to look out for danger. Who knows, calm could be dangerous.
go. Curiosity is different from willpower or grit.
your breath is actually a great third-gear BBO: Your breath is always available. Paying attention to your breath helps you step out of your old habit loop. Breathing doesn’t feed the habit loop process itself. There are a bazillion instructions and entire books dedicated to teaching you how to pay attention to your breath as a way to “anchor” you in the present moment. Feel free to read them. (One of my favorites is Mindfulness in Plain English, by Bhante Henepola Gunaratana.)
Here’s the basic RAIN practice: First, RECOGNIZE that the stress is coming on and RELAX into it. Don’t grit your teeth and brace for impact! Just let go and feel it come on, since you have no control over it anyway. It’s even okay if you smile a little. Really. ALLOW and ACCEPT this wave as it is. Don’t try to push it away or ignore it. Don’t distract yourself or try to do something about it. This is your experience. Here it comes. To catch the wave of anxiety, you have to study it carefully, INVESTIGATING it as it builds. Be curious. Do this by asking, “What is going on in my body right now?” Don’t go looking for it. See what arises in your awareness most prominently. Let it come to you. Get curious. Where does the feeling originate in your body?
Here’s the basic RAIN practice: First, RECOGNIZE that the stress is coming on and RELAX into it. Don’t grit your teeth and brace for impact! Just let go and feel it come on, since you have no control over it anyway. It’s even okay if you smile a little. Really. ALLOW and ACCEPT this wave as it is. Don’t try to push it away or ignore it. Don’t distract yourself or try to do something about it. This is your experience. Here it comes. To catch the wave of anxiety, you have to study it carefully, INVESTIGATING it as it builds. Be curious. Do this by asking, “What is going on in my body right now?” Don’t go looking for it. See what arises in your awareness most prominently. Let it come to you. Get curious. Where does the feeling originate in your body? What does it really feel like?
Is it tightness in your chest? Is it a burning feeling in your belly? Is it a restlessness that urges you to do something—like run away? Finally, NOTE the experience. This keeps you here now, curious and focused, riding the wave. Keep it simple by using short phrases or single words. This helps you stay out of thinking or figuring-out mode, and instead will keep you in the direct experience of what is happening to you. For example, you might note clenching, rising, burning, heat, restlessness as the feelings come on and peak, and then vibration, tightness, tingling, lessening, relaxing, relief, and expanding as they subside. If thoughts arise, simply note “thinking” and don’t get caught up in analysis or fix-it mode! Note your actual experience. Follow that wave until it completely subsides. If you get distracted or your mind shifts to something else, simply return to the investigation. Be curious and ask, “What is going on in my body right now?” Ride the feeling until it is completely gone.
There are three parts to the loving kindness practice: The use of some loving kindness phrases to help you stay centered Seeing the image of the being to whom you are sending loving kindness Recognizing a feeling of kindness that arises in your body as you do the practice To begin with, sit in a comfortable position in a quiet place and let your mind just rest on the feeling of your body breathing. (As a reminder, no driving!)
Now—and as a contrast to loving kindness—bring to mind a situation that made you stressed or anxious recently. Notice what it feels like in your body. Does it feel contracted or expanded? Note the sensations that arise for a few moments. Now imagine a dear friend coming through the door—someone that you haven’t seen in a long time. What does this feel like? Notice any differences between this feeling and the feelings that arose when you remembered the situation that made you anxious. Which one feels more clenched or contracted? Which one feels more warm, open, or even expanded? Now bring to mind this dear friend again, or perhaps someone who has been a role model in your life, or someone who has been unconditionally loving, generous, or wise. This can even be a family pet; pets are really good at displaying unconditional love. Now think about their loving qualities and kindness toward you. Notice if there is a feeling that arises in your body. Warmth, expansion, perhaps in the chest/heart? (If you don’t notice anything immediately, that’s okay too—just keep checking in with your body as we do this exercise.) Now pick a few phrases of well-wishing to offer to this figure. Here are some suggestions (but be sure to pick phrases that really speak to you, or drop the phrases altogether and simply anchor in the feeling in your heart): “May you be happy,” breathe it in; “may you be happy,” breathe it throughout your body. “May you be heald"
Sadly kindle doesn't allow me to download the remaining highlights that I have!