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Kindle Notes & Highlights
by
Alex Korb
Read between
February 8 - February 12, 2021
People with depression are more likely to suffer from chronic pain and tend to worry more about getting sick.
Increased insula activity makes you hyperaware of any problems in your body, even if they’re small, which is how molehills turn into mountains. Calming insula activity can therefore help reduce both pain and worries about getting sick.
lead to delays in Denver or cancellations in Kansas City; similarly, in the brain increased emotional amygdala activity can change what the anterior cingulate focuses on, as well as the habits controlled by the dorsal striatum. And the neuroscience gets even more nuanced than that.
Similarly, the specific tuning of your decision-making circuit can contribute to your brain getting stuck in depression—as can the specific tuning of your habit circuit, your stress circuit, your social circuit, your memory circuit, and on and on—they can all potentially contribute to a downward spiral of depression, when the conditions are right.
It’s important to understand that if you have depression, your brain’s not damaged goods—we all have the same neural circuits, the same basic brain structure. However, the specific connections between neurons are different in every person, so the dynamic activity and communication that flow through your circuits is as unique as you are.
For example, depending on the excitability of the worrying circuit, some people worry more, and some worry less. And depending on the neural connections in the decision-making circuit, some people are more decisive than others.
My friend Janice doesn’t have a problem with loneliness or decision making—she has a different one. She needs to exercise every day, otherwise her mood plummets. That’s just how she’s wired. The problem is that when she feels down, she doesn’t feel like exercising. So she doesn’t and then feels even worse. Her brain has set her up for a downward spiral.
In addition to genetics, there are many factors that tune your brain’s circuitry. Your early childhood experiences, current life stress, and level of social support can influence your circuitry toward or away from depression.
So your genes can give you brain circuitry that is more likely to get depressed.
And given that the prefrontal cortex takes the longest to mature, it’s susceptible to stress for a long time. Stressful life events throughout childhood and adolescence can alter the development of neural circuits and change the levels of various neurotransmitters.
The third big factor that shapes the tuning of your circuits is the current stress level in your life. Are you working in a job you hate? Or are you unemployed? Is your mortgage looming over your head? Do you have health problems? Did your boyfriend just cheat on you?
The fourth factor is the amount of social support in your life. Humans are social animals. We need each other, and we’re meant to be around other people. Time and again, scientific studies have shown that close relationships help protect against depression. Note that it’s not the number of friends you have that matters, but the quality of those relationships.
turns out that just a little change can be enough to push you away from depression and up toward a happier state.
In the end, I managed to finish everything only fifteen minutes late, which meant I would have done everything perfectly but for the worrying. And in my distraction, I had missed my friends’ text message explaining they’d be half an hour late.
I was seeing everything that could go wrong. When I tried to think about my future, my heartbeat quickened, and I just felt overwhelmed. It was easier to not think about it, to ignore the fact that graduation was drifting closer and closer, which obviously only made things worse.
Whether a dinner party or my entire future, in each case, I was anticipating everything that could go wrong, and that made me think of more things that could go wrong, until I got stuck in a loop of worry, anxiety, and indecisiveness. It’s uncomfortable to feel the weight of the future pushing down on you, to be caught in the brief moment between the mistakes you made in the past and the mistakes you’re about to make in the future. Perhaps you understand the feeling.
cortex and the anterior cingulate. By comparison, anxiety is mediated by circuits within the limbic system. So there’s no reason to get upset with yourself for feeling anxious or worrying too much; it’s just a by-product of your brain’s evolution.
The circuits that helpfully allow us to plan, solve problems, and make decisions are the same circuits that lead to worrying. And the circuits that keep us out of danger are the same circuits that cause anxiety.
Make a decision. Anxiety and worrying are provoked by possibility, not certainty. In fact, many people are less happy when they have more choices, because they have more to worry about.1 When everything is up in the air, the amygdala becomes more reactive.2 So if you tend to worry, reduce your options and make quick decisions whenever possible. As soon as you make a decision, however small, everything starts to feel more manageable—we’ll discuss this more in chapter 6. One thing that makes humans
So what’s the difference between planning and worrying? The answer is really just the amount of emotional and self-oriented processing in the medial prefrontal cortex and anterior cingulate—how vigorously these regions react to potential future scenarios.
Worrying worsens your mood, and when your mood is worse, you worry more, which is a classic downward spiral.4
prefrontal cortex and the anterior cingulate.5 That illustrates that people with anxiety disorders have the same neural circuitry for worrying as “healthy” people. The difference between the two groups was simply that the people with anxiety problems got stuck in their worrying. Essentially, the communication circuit between the prefrontal cortex and anterior cingulate got stuck in the “on” position.
When you’re in a negative mood, almost all outcomes that your prefrontal cortex can calculate are tinged with a bit of negativity. Any choice you make feels like it’s going to lead you down the wrong path, and you quickly become inundated with all of the bad things that could happen to you.
Reflecting upon his life, he noted, “My life has been full of terrible misfortunes, most of which never happened.”
Worrying is mostly thought based, whereas anxiety has more to do with physical components like bodily sensations
In essence, worrying is thinking about a potential problem, and anxiety is feeling it.
Pay attention to what you can control. If the future were completely under our control—or at least predictable—there would be nothing to be anxious about. Feeling in control reduces anxiety, worrying, and even pain.7 These effects are mediated by the dorsolateral prefrontal cortex, so strengthening dorsolateral activity helps create an upward spiral.8 You can do this by simply paying more attention to what is in your control, which helps modulate your brain activity and quickly reduces anxiety.
When you’re using your planning and problem-solving circuitry to worry, you can’t use that part of your brain for more important things, like excelling at your job or organizing a dinner party.
As we briefly discussed above, anxiety depends on activation of the fear circuit—the same neural circuitry that keeps us out of danger. Fear activates the body’s stress response, readying you to either face the danger or run from it. This is mediated by the limbic system, mainly in connections between the amygdala and hypothalamus. The amygdala is responsible for recognizing dangerous situations, and the hypothalamus activates the fight-or-flight response (a.k.a. the sympathetic nervous system), triggering the release of stress hormones like cortisol and adrenaline.
Take a deep breath. Taking a slow, deep breath—inhaling and then exhaling slowly—actually calms down the sympathetic nervous system and reduces stress (as discussed in more depth in chapter 9).
Anxiety and fear activate the same stress response in brain and body, but anxiety is different from fear. The difference is between actual danger and potential danger. Fear is a response to actual danger that is right here, right now, while anxiety is concern for events that only might...
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And anxiety is connected to anticipation of danger, which is why some people avoid fields of grass altogether, because there might be a lion out there.
Go for good enough. Worrying is often triggered by wanting to make the perfect choice or by trying to maximize everything. When buying a used car, you want one that is cheap, reliable, safe, sexy, the right color, and fuel efficient. Unfortunately, no single option is likely to be the best in all those dimensions. If you try to have the best of everything, you’re likely to be paralyzed by indecision or dissatisfied with your choice. In fact, this kind of “maximizing” has been proven to increase depression.9 So don’t try to make the most amazing dinner; start out by just making a good dinner.
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Whenever something bad happens (like getting chased by a lion), the limbic system tries to figure out everything that led up to that event so that it can avoid it in the future. Your brain accomplishes this through communication between the amygdala and the hippocampus.
Anxiety doesn’t always have a conscious, thinking component; it can simply be a sensation, like an upset stomach or shortness of breath. Often when you think you’re sick, it’s actually the physical manifestation of anxiety.
Sometimes worry and anxiety can be useful. Your brain evolved that way to keep you alive. Worrying makes you think deeply about problems, rather than just taking the first answer that comes to mind, and anxiety helps keep you safe.
So don’t get too upset with yourself for being anxious. Your brain is trying to help you. Unfortunately, the specific tendencies of your anxiety and worrying circuits sometimes interfere with your ability to be happy.
Fortunately, recognizing how your brain works is a key step toward mindfulness and acceptance, which can help combat the worry and anxiety.
But they all follow the same basic pattern, and it’s as easy to remember as ABC.10 “A” stands for “alarm.” You make an observation that something seems wrong (for example, My heart is racing or That tuft of grass seems to be shaking strangely).
The beliefs are often subconscious; you’re not even aware of them. The limbic system deals with unconscious beliefs, while the ventromedial prefrontal cortex deals with conscious ones.11
Avoid catastrophizing. Anxiety is exacerbated by envisioning the worst possible scenario—a process known as “catastrophizing” (for example, your friend doesn’t call back immediately, so you conclude he or she doesn’t like you anymore). It usually starts with a perfectly reasonable worry, and then, through an incorrect assumption, it snowballs out of control. Well, you can’t control noticing the “alarm” in the first place, but you can reduce its negative impact. First, remind yourself of the more likely (and better) outcomes (“Maybe my friend is busy right now”). Second, whether or not the
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“C” stands for “coping.” Coping is whatever you do after the belief. Do you take a deep breath and tell yourself everything will be okay? Do you freak out? Yes, freaking out is a form of coping. But, while it gives you some semblance of control, it’s not the most effective response. Nor is eating ice cream and watching television.
A coworker once confided in me how much “benzos” helped her anxiety. Benzos (a.k.a. benzodiazepines) are a medication that enhances the inhibitory neurotransmitter GABA and suppresses amygdala activity.
The first step is simply to recognize your anxiety or worrying when it occurs. Becoming aware of your emotional state activates the prefrontal cortex and allows it to suppress the amygdala.
“Putting Feelings into Words,” participants viewed pictures of people with emotional facial expressions. Predictably, each participant’s amygdala activated to the emotions in the picture. But when they were asked to name the emotion, the ventrolateral prefrontal cortex activated and reduced the emotional amygdala reactivity.13 In other words, consciously recognizing the emotions reduced their impact.
Stay in the now. Pay attention to the things that are happening now, and don’t pay attention to the things that aren’t happening now. Focusing on the present helps reduce anxiety and worry, because it decreases emotional, self-focused processing in the ventromedial prefrontal cortex. Attention to the present also increases dorsolateral and ventrolateral prefrontal activity, allowing these regions to calm the amygdala.15 Improving your ability to stay present, a practice known as “mindfulness,” helps enhance these activations and leads to long-term improvements in anxiety and worrying.16
Putting emotions into words—however hokey that sounds—actually rewires your brain circuits and makes you feel better.
This is why Buddhist monks and yogis practice nonjudgmental awareness—the process of being aware of the present, without attaching emotional reactivity to it. This mindfulness practice cuts off worry and anxiety at the source.
Sometimes it seems like the whole world is conspiring against you, like life is full of disappointing events, missed opportunities, and harsh circumstances. Maybe, for you, it feels that way all the time. But guess what? It’s not some cosmic conspiracy, just a by-product of your brain circuitry.
Furthermore, some people’s brains automatically focus more on the negative, which puts them at a greater risk for depression. Their brains are biased toward pain, loss, and the emotional toll of mistakes, and they often distort memories of the past and expectations of the future.
