The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time

by Alex Korb

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.

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.

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.

Worrying is mostly thought based, whereas anxiety has more to do with physical components like bodily sensations (such as an upset stomach) or associated actions (like avoiding a situation). Worrying

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. Whatever

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

To combat pessimism, you can strengthen the brain circuits responsible for optimism. The first step is to simply imagine the possibility of positive future events. You don’t have to believe they will happen, just that they could happen.

Use the power of music. Whether playing an instrument or listening to the radio, music increases heart-rate variability, though making music has a stronger effect.4 Music engages most of the limbic system, including the hippocampus, anterior cingulate, and nucleus accumbens, which is why it can be motivating and enjoyable and can help regulate your emotions.5 It can also be soothing, lowering blood pressure6 and reducing stress. So sing along with the radio or just make a playlist of your favorite songs. Better yet, go dancing. Dancing combines music, exercise, and being social, so you get a triple boost to an upward spiral.

Think about the middle of your forehead, just above the center of your eyebrows. Is there tension there? Are you concerned about something? This muscle is the corrugator supercilii, and it pulls your eyebrows down and together, causing your forehead to wrinkle (in other words, it gets its name from the fact that it makes your skin corrugated). It helps express displeasure, anger, worry, and other negative emotions. But your furrowed brow is also a cause of consternation and discontent. In the same way that your brain thinks you’re happy when it senses that your “smile” muscles are flexed, your brain notices when your corrugator supercilii is flexed and thinks you’re upset or worried.

Wear sunglasses. On bright days, we often contract our corrugator supercilii while squinting to reduce glare from the sun. So while it might be a beautiful day, you’re sending signals to your brain that you’re slightly upset. Sunglasses reduce glare so you don’t have to squint. So they not only make you look cool, but also, thanks to facial feedback, they help you feel calmer.

Relax your jaw. Often, when stressed, we inadvertently clench our teeth, which increases overall tension. So let your jaw hang loose, wiggle it around, and then open wide. This may make you yawn, which will also increase your calmness.

Clench and relax. To remind your brain to relax your muscles, sometimes it’s helpful to clench them first. Take a deep breath in and then flex a tight muscle for a few seconds. After holding for a few seconds, exhale with a sigh and relax. The most important muscles to relax are your facial muscles, since those have the largest effect on emotion, but relaxing your hands, butt, and stomach are also important.

However, while some people find conversations relaxing, others require greater medial prefrontal processing during face-to-face conversations and may find them tiring.39 The more agreeable you are, the less prefrontal effort required. So if you find that talking to people feels effortful, try being more agreeable or supportive and less argumentative or judgmental.

Recognize that your lack of enjoyment is only a temporary situation and keep doing the things you used to enjoy, even if they don’t seem as fun.