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

by Judson Brewer MD PhD

You see, anxiety hides in people’s habits. It hides in their bodies as they learn to disconnect from these feelings through myriad different behaviors. Seeing this connection, I could now help my patients understand how they had formed habits around everything from drinking too much alcohol to stress-eating to procrastinating as a way to deal with anxiety. I could also help them see why they were struggling so much and failing to overcome both anxiety and their other habits.

One of the main things I’ve learned is that in psychiatry, the maxim “the less you know, the more you say” is applicable. In other words, the less you understand about a topic or situation, the more you fill that void with words.

The same APA poll found that 68 percent of respondents reported worries about health and safety made them somewhat or extremely anxious. Some 67 percent of folks reported finances as their source, followed by politics (56 percent) and interpersonal relationships (48 percent). In their “Stress in America” survey (2017), the APA found that 63 percent of Americans felt that the future of the nation was a large source of stress, and 59 percent checked the box that “the United States is at the lowest point they can remember in history.” Remember, this was back in 2017, three years before COVID-19 hit.

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.

Evolution made this really simple for us. So simple that we need only three elements in situations like this to learn: an environmental cue, a behavior, and a result. In this case, walking up to a busy street (the environmental cue) is our signal to look both ways before crossing (the behavior). Crossing the street uninjured (the result) teaches us to remember to repeat the action again in the future.

Even the sea slug, a creature with the most “primitive” nervous system known in science (twenty thousand neurons total, as opposed to roughly a hundred billion in the human brain), uses this same learning mechanism.

Anxiety is born when our PFCs don’t have enough information to accurately predict the future.

Notice how fear itself does not equal anxiety. Fear is an adaptive learning mechanism that helps us survive. Anxiety, on the other hand, is maladaptive; our thinking and planning brain spins out of control when it doesn’t have enough information.

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.

The PFC takes information from past experience and projects it into the future as a way to model and predict what might or could happen, so instead of constantly reacting to what is happening right now, you can plan for what’s next. This is all well and good as long as you have enough information to make a good prediction. The more certain you can be of what is about to happen, the more you can predict and plan ahead.

Like a seed needing fertile soil, the old survival brain creates the conditions for anxiety to sprout in your thinking brain (chronic). This is where anxiety is born. Fear + uncertainty = anxiety.

Alexander Chernev and his colleagues at the Kellogg School of Management at Northwestern University even identified three factors that significantly diminish our brain’s ability to make choices: higher levels of task difficulty, greater choice set complexity, and (surprise!) higher uncertainty.

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.

Wall Street even has something known as the Volatility Index (VIX), also known as the fear index, and I bet you won’t be surprised that it hit a ten-year high back in March of 2020, as stock traders started to realize what an unprecedented mess the world was in.

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.

Learning that uncertainty triggers anxiety, which in turn can lead to panic, allows them to be on the lookout. And simply knowing that this is their survival brain kicking into high gear (even if it is a little misguided because it doesn’t have enough information) helps put my patients a little more at ease.

To hack our brains and break the anxiety cycle, we must become aware of two things: that we are getting anxious and/or panicking and what results from anxiety/panicking. This helps us see if our behavior is actually helping us survive or in fact is moving us in the opposite direction.

Once we are aware of how unrewarding anxiety is, we can then bring in the bigger, better offer, or BBO (more on this in chapter 15). Since our brains will choose more rewarding behaviors simply because they feel better, we can practice replacing old habitual behaviors such as worry with those that are naturally more rewarding.

At times when your mind starts to spin out in your worry du jour, you can pause and take a deep breath while you wait for your PFC to come back online. Once it’s up and running again, you can then compare the feeling of anxiety to that of calmness and think clearly. To our brains, it’s a no-brainer. More important, once you are able to tap into your brain’s power to overcome anxiety, you can broaden your learning to work with other habitual tendencies as well.

Seeing what my patients were going through brought to life the otherwise dry definition of addiction: “continued use despite adverse consequences.”

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.

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.”

If you ever get caught up in a worry habit loop, you know what I mean: Trigger: Thought or emotion Behavior: Worrying Result/reward: Avoidance, overplanning, etc.

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Here, a thought or emotion triggers your brain to start worrying. This results in avoiding the negative thought or emotion, which feels more rewarding than the original thought or emotion.

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.

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: Trigger: Negative emotion (or thought) Behavior: Worry Result: Avoidance/distraction

Functionally, the act of worrying is a mental behavior that results in a feeling of anxiety (nervousness or unease). On top of this, the feeling of anxiety can trigger the behavior of worrying, which becomes cyclical: Trigger: Anxiety Behavior: Worry Result: Feel more anxious

This mental behavior of worry has to happen only a few times before our brain gets in the habit of trying it every time we’re anxious.

And here’s the kicker: even though worrying doesn’t work, our old brain keeps trying. Remember, our brain’s job is to help us survive, and because at some point it linked problem-solving with worrying, it thinks worrying is the best way to go. Our brain keeps pulling that worry slot machine lever hoping that it will hit the solution jackpot.

Even if you aren’t solving any problems—just spinning out of control by worrying more—that feeling of doing something can be rewarding in itself. Worrying is doing something, after all.

(A) Habit loop that starts the worry cycle: Unpleasant emotion triggers worry as a mental behavior to distract or feel in control; (B) When the “reward” of distraction diminishes, wears off, or fails to outweigh the combined negative qualities of the unpleasant emotion and worry, worry begins to trigger more anxiety (as an unpleasant emotion), which in turn triggers more worry and so on.

But there are two main downsides to worry. First, if the worrying mind doesn’t come up with a solution, worry triggers anxiety, which triggers more worry, and so on. Second, if worry is triggered by anxiety alone, there might not be something specific to worry about.

This anxious feeling throws their worrying into hyperdrive, as they try to figure out what they are supposed to worry about. When they can’t find anything specific, they start getting in the habit of worrying about just about any old darn thing in the future, whether it warrants worrying or not. This is the basis for Generalized Anxiety Disorder,

Our life of martyrdom was summed up by one of my surgery professors, who quipped, “See a doughnut, eat a doughnut; sleep when you can; and don’t f**k with the pancreas.”

The medical community has developed simple metrics, bullshit detectors of sorts, to gauge whether something is clinically significant—basically how big an effect a treatment provides. Of course, because it’s the medical community, their BS detector has an acronym: NNT, standing for Number Needed to Treat.

For example, the NNT of a class of gold-standard medications for anxiety (antidepressants, in this case) is 5.15. (That means you have to give just over five people the medication to see an effect in one of them.)