Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind

by Judson Brewer MD PhD

84 percent of individuals with GAD presented with comorbid disorders. And anxiety doesn’t just come out of the blue. It is born.

definition of addiction: “continued use despite adverse consequences.”

That definition—and let’s hear it once again, in case we’re in any doubt: “continued use despite adverse consequences”—well, that could mean continued use of anything.

So I looked inward; and I also started asking friends and coworkers about their habits. Long story short: I found addiction everywhere. And this is what it looked like: Continued shopping despite adverse consequences. Continued pining away for that special someone despite adverse consequences. Continued computer gaming despite adverse consequences. Continued eating despite adverse consequences. Continued daydreaming despite adverse consequences. Continued social media checking despite adverse consequences. Continued worrying despite adverse consequences (yes, as you’ll see, worry does have significant adverse consequences). Addiction isn’t limited to the so-called hard drugs and addictive substances. It is everywhere. Is this new, or had we missed something?

In the name of convenience and efficiency, the modern world is increasingly designed to create addictive experiences.

Another feature of the “old brain” that I briefly touched on previously is what’s known as the reward-based learning system. Reward-based learning is based on positive and negative reinforcement. Put simply, you want to do more of the things that feel good (positively reinforcing) and less of the things that feel bad (negatively reinforcing).

When cave person got some sugar or fat, his or her brain not only connected nutrients with survival but also released a chemical called dopamine, a neurotransmitter essential for learning to pair places with behaviors. Dopamine acted like a primeval whiteboard, upon which was written: “Remember what you are eating and where you found it.”

Our modern brains say, Hey, you can use this dopamine thing for more than remembering where food is. In fact, the next time you feel bad, you can try eating something good, and you’ll feel better!

Feel good. Repeat. Trigger, behavior, reward. And each time you perform the behavior, you reinforce this brain pathway. Before you know it—because it’s not really a conscious occurrence—the way you deal with an emotion or to assuage stressors becomes a habit.

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.

Undeterred by modern medicine, anxiety disorders top the charts as the most predominant psychiatric conditions.

Trigger: Thought or emotion Behavior: Worrying Result/reward: Avoidance, overplanning, etc.

Our brains evolved to help us survive. When we were hungry cave people, we used reward-based learning to help us remember where to find food. Now this learning process can be leveraged to trigger cravings and evoke emotions . . . and create habits, compulsive behavior, and addictions.

First, the most crave-ogenic (that is to say, meant to make you crave) type of reinforcement learning is called intermittent reinforcement. 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.

The second everyday addiction maximizer in the modern world is immediate availability.

Time is critical for allowing all of that excitement to wash over us (oh, new shoes, how fun!), and importantly, go away. Time gives us, well, time to sober up, so that the sweet juiciness of the moment can fade into the reality of the need. In the modern world, however, you can take care of any need or desire almost instantly. Stressed out? No problem. Cupcakes are right around the corner. Bored? Check out the latest posts on Instagram.

Hate to also tell you this, but . . . your smartphone is nothing more than an advertising billboard in your pocket. What’s more, you pay for it to advertise to you constantly.

What are my top three habits and everyday addictions? What bad habits and unwanted behaviors do I keep doing, despite adverse consequences?

Nobody can go back and start a new beginning, but anyone can start today and make a new ending. —MARIA ROBINSON

Trigger: Anxiety in the late afternoon Behavior: Start drinking Reward: Numbing, forgetting, feeling intoxicated

Many people struggle with anxiety and drink alcohol to alleviate those feelings. How many of us were first introduced to drinking alcohol at high school parties and quickly learned that drinking made us feel less self-conscious and more at ease?

Trigger: Anxiety in the morning from seeing how much work he had to do Behavior: Procrastination Reward: Avoidance

(a shot of whiskey—his drink of choice—has over a hundred calories, so he was kicking back close to a thousand calories in alcohol alone each day)

I sent John home with the simple instructions to start mapping out all of his habit loops around anxiety.

But our work was not complete. John then worked on a set of new behaviors informed by his recent insights. So whenever his wife raised her voice excitedly, he would simply remind himself that his overreaction was out of habit, take a deep breath, and respond calmly. That anxiety bubble had burst.

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.

Mind-Mapping Exercise If you’re ready, try mapping out the TBR (T = trigger, B = behavior, R = result) components of your own anxiety (or other) habit loops over the next few days and see what clarity that brings. Don’t worry about changing them yet; learning how your mind works is the first step in this change. Don’t rush it. You can download a mind-mapping template from my website, www.drjud.com/mapmyhabit, or—as I did with John—take a blank piece of paper, write out the three components, and start mapping out your habit loops. Begin with the most obvious ones.

Trigger: Start to see habit loops clearly Behavior: Try to fix them using tools that you’ve tried in the past Result: (Surprise!) It doesn’t work

Knowing things intellectually or conceptually is just the first step. First gear is first gear: intellectually knowing how habits form and play out in your life builds speed and momentum so that later, when you have all of the tools in hand, you can change them.

You can’t read a book written by Bruce Lee and then walk outside and be Bruce Lee. Concepts don’t magically become wisdom with the wave of a wand. You actually have to do the work so the concepts translate into know-how through your own experience.

Trigger: See a new book about anxiety (or habit change) Behavior: Devour the book in one sitting Result: Understand the concepts, but fail to change the habit

You really have to get the mapping both conceptually and experientially before you can move on to changing them.

Repetition is king when it comes to forming habits, so I wanted them to repeat this phrase as many times as I could get them to in our short time together (while of course finishing the rest of the lecture). But there has got to be a better way to help people change habits! The point is, changing habits is hard work, but it doesn’t have to be dry, boring, or even painful. So repeat after me: “Changing habits is hard work but doesn’t have to be painful.”

Trigger: Tension Behavior: Hero’s journey involving struggle, etc. Result: Resolution

To change your own habits, you have to relate to the hero of the story (that’s easy, it’s you), the plot (whatever habits you have), the intrigue (why do you have to eat green M&M’s before brown ones?), the tension (can you do it?), and the resolution (yes, you can!).

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.

Your old brain functions in scarcity mode; it’s always worried about starvation. If you see a doughnut, your old brain impulsively tries to pounce on it, thinking, Calories! Survival! You might remember the odd runs on commodities—toilet paper, flour, pasta—at the grocery store at the beginning of the COVID-19 pandemic. If you’re at the store and you see someone’s cart piled high, you rush to grab whatever is left, even if you have plenty of it at home. In contrast, your new brain says to your old brain: “Hold off a minute. You just had lunch. This is not healthy, and you’re not even hungry!” or “We have plenty of toilet paper.

Anti-Habit Strategy 1: Willpower When you tap into your willpower reserve, your new brain is supposed to tell your older brain to take a hike and simply order the salad instead of the hamburger, right? If you’re anxious, you should be able to tell yourself to relax, and then be more relaxed. Willpower seems like it should work, but there are two big caveats.

First, 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.

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

Second, while willpower may be fine under normal conditions, when you get stressed (saber-toothed tiger, email from the boss, fight with a spouse, exhaustion, hunger), your old brain takes control and overrides your new brain, basically shutting the latter down until the stress is gone.

Think of the PFC this way: as the youngest and least evolutionarily developed part of the brain, it is also the weakest.

“You feel like you’re going to die, but you won’t. This is your brain playing games with you. You decide what happens next.” She’s one in a million, with a highly trained brain at her beck and call. If the rest of us found it easy when anxiety reared its ugly head just to tell ourselves to stop being anxious, I would happily be in another line of work. That’s not how our brains work, especially when stress and anxiety are shutting down the very parts that are supposed to be reasoning us through a tough spell. If you don’t believe me (or the data), try this: the next time you’re anxious, just tell yourself to calm down and see what happens.

Anti-Habit Strategy 2: Substitution 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.

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.

Anti-Habit Strategy 3: Prime Your Environment 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.

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.

How does priming your environment work for anxiety? You can’t not keep anxiety in your freezer or avoid the anxiety store so you aren’t tempted to pick one of its thirty-one flavors up on your way home from a hard day at work. As nice as an “anxiety-free zone” in your house sounds, even if you build it, the anxiety will come.

Anti-Habit Strategy 4: Mindfulness 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.

Kabat-Zinn’s definition of mindfulness is “the awareness that arises through paying attention in the present moment, on purpose, nonjudgmentally.” Basically, Kabat-Zinn is pointing to two aspects of experience: awareness and curiosity. Let’s unpack that a bit. Remember how our old brains react to positive and negative reinforcement to determine what to do, and then are really good at turning that behavior into habits? If you aren’t aware that you’re doing something habitually, you will continue to do it habitually. Kabat-Zinn describes this in terms of operating on autopilot.