HOW WOULD YOU DEFINE THE TERMS ‘ANXIETY’ AND ‘STRESS’?
The difference between anxiety and stress is that stress tends to have a specific precipitant. When we alleviate whatever that precipitant is, then the stress goes away. So we say this deadline at work is stressing me out, compared to the deadline at work making me anxious. Anxiety often doesn’t have a specific trigger -it might be a trigger for worrying itself. And, anxiety might persist beyond that deadline being met, whereas the stress tends to go away.
WHAT IS ACTUALLY HAPPENING IN OUR BODIES WHEN WE’RE STRESSED OR ANXIOUS?
Physiologically, this traces back to our survival mechanisms. If we step out into a busy street and we see a car coming at us we jump back onto the sidewalk, then we have this stress response. Our hearts race, our breathing becomes more shallow and rapid. That’s our physiological flight or fight response that tells us that danger is there.
Anxiety shares a lot of those physiological reactions, but they’re happening at a very different timescale. If you think of the immediate jumping back on the sidewalk that happens before we’re even consciously aware of it. When we’re on the sidewalk, we start thinking “I should have looked both ways instead of looking at my phone”. It’s those fear reactions that actually help us learn.
That fear of the future is driven by the newer parts of our brain, which are trying to help us plan into the future. The best way to predict the future is to have accurate information and to
have stability in the signal so to speak. So the more uncertain the future is, the harder it is for us to actually predict it. That’s where anxiety comes in.
IN YOUR BOOK ON ‘UNWINDING ANXIETY’, YOU LIKEN ANXIETY TO ADDICTION – COULD YOU EXPAND ON THIS ANALOGY A LITTLE MORE?
This was probably the most important thing that I didn’t learn in medical school. The idea here is that habit formation is a part of our evolutionary process, to help us remember things so that we don’t have to relearn them every day. The way our brains do that is through a relatively simple process, with three key elements: a trigger, a behaviour, and a result.
It turns out that anxiety is driven like any other negatively reinforced behaviour. Worrying makes people feel like they’re in control. If a situation arises that they don’t have control over, their brain says, “well don’t just sit there, do something”, and what do they do? Worry. This drives anxiety which in turn reinforces worrisome behaviours.
WHY IS IT EASY TO FORM A HABIT OF THESE ANXIOUS BEHAVIOURS BUT SO DIFFICULT TO FORM ‘HEALTHY’ HABITS?
That is the million-dollar question. One thing that influences decision making is how easy something is to do. Let’s compare worrying or going for a run. You can worry immediately, whereas for running, you need to get changed, check the weather and warm-up. So if you just look at the time scale, one option is instantaneous while the other ‘healthy’ habit requires much more time and effort.
HOW CAN WE USE THAT KNOWLEDGE TO DRIVE HABIT CREATION THAT FACILITATES MEANINGFUL BEHAVIOUR CHANGE?
We’ve found behaviour change occurs based on two conditions; firstly you have to understand how unhelpful the old behaviour is, and secondly you need to recognise how rewarding the desired behaviour is.
We train people to change their behaviour by following a straightforward three-step process. The first stage is to map out a habit loop, which includes identifying the trigger, the action and the results of that behaviour. The second is really the critical piece that differs from the typical willpower-based approach and focuses instead on reward value. For example, let’s say that I have a certain reward value assigned to chocolate cake in my brain. I go to a new bakery, I eat the cake, and it’s the best cake I’ve ever had. Now I get what’s called a positive prediction error, which is another way of saying the experience exceeded expectation – reinforcing the behaviour. However, if I ate the cake, and it wasn’t as tasty as anticipated, my brain would get a negative prediction error and a message to stick with other bakeries.
Once we have these negative prediction errors associated with these old habits, we can apply that same principle to the new desired habits. I call this third third step, the bigger better offer. If, for example, worrying is the habit we are trying to change, we can first see how unrewarding worrying itself is–it only makes us more anxious–and then find intrinsic mental behaviours that are more rewarding than worrying.
IF WE CONSIDER FOR A MOMENT, WORKPLACE STRESS ASSOCIATED WITH RETURNING TO THE OFFICE. WHAT KIND OF BEHAVIOURS SHOULD WE BE AWARE OF AND ACTIVELY TRY TO AVOID?
Avoidance is interesting with respect to the workplace. If there is a toxic work culture it can be helpful to avoid it, however, we often can’t avoid our work environment as a whole.
Imagine going into a workplace where people are coughing and nobody is socially distancing. In this situation the likelihood of contracting COVID-19 increases. In the same way, in the workplace, we can catch what’s called social contagion. This is just the spread of emotion from one person to another. Yet, social contagion has no physical limits or boundaries. Even in a virtual meeting if someone is anxious that sense of unease spreads to others on the call. So, while it can be useful to avoid certain situations or behaviours, I would say it is more important to develop mental resilience so that we can cope with situations that are impossible to avoid.
HOW CAN WE RECOGNISE SYMPTOMS OF ANXIETY BEFORE WE START TO EXPERIENCE SERIOUS ADVERSE HEALTH EFFECTS WHICH MIGHT LEAD TO BURNOUT OR CHRONIC DISEASE?
Anxiety can present itself in a number of different ways for different people. You might feel tension in the jaw or shoulders, sometimes even behind the eyes, or even as gastrointestinal tract upset.
However, typically, anxiety manifests itself in the chest region. The most unifying sensation that informs someone that they are stressed or anxious is a feeling of contraction. Evolutionarily, this makes sense – if we are being cornered by a large predator, to increase our chance of survival we want to make ourselves as small a target as possible.
Physically, I would encourage people to be mindful and notice if feelings of contraction arise, whilst also mentally observing whether the mind is constantly focusing on the future with a tendency to catastrophize or dwell on the worst case scenario.
HAVE YOU GOT ANY ACTIONABLE TIPS THAT READERS COULD USE IN THEIR EVERYDAY LIVES TO HELP MANAGE FEELINGS OF ANXIETY?
Firstly, it is important to remember that you don’t have to go and meditate in a cave for 10 years to relieve anxiety. If we look at how habits are formed, raising awareness throughout the day and carrying out actions with a higher level of consciousness will kick start the shift in behaviour.
Just considering the level of reward you experience after the behaviour is carried out can inform you as to how strong your subconscious drive to engage in that habit is. If worrying is the habit we are trying to break, asking “what am I really getting from this?” can help to ground us in the present moment and recognise that worrying actually isn’t a rewarding behaviour.
Having effective tools in the toolbox that can bring us out of that survival state and back into the present, physical environment can help anchor ourselves and break the cycle of habitual worrying.
One of my favourite grounding techniques is this five finger breathing practice: take your index finger and place it at the base of your pinky on the other hand. As we breathe in, we’re going to pay attention to four things at once: 1) the physical sensations of one hand, 2) the physical sensations of the other hand, 3) visually seeing our hand and 4) our breath. As we inhale, just pay attention to what it feels like to trace the finger up the outside of the pinky. Feel the breath and notice as we exhale, the sensation of the finger down the inside of the pinky. Do four more and in five breaths, you’d trace from your pinky to your thumb.
The neuroscience behind this technique is that our working memory can’t hold much more than four pieces of information at once. This tool forces a reboot of our conscious awareness as we focus and pay attention to the four things outlined above. Any feelings of anxiety get ejected. If we do that for 10 breaths, you might notice a calming of the nervous system. One last simple technique, that anyone can do at any time, is feeling your feet. Often people don’t pay attention to their feet because they are rather a stress-free zone. Bringing awareness to our toes, getting curious about what wiggling them feels like and noticing the tingling sensation that follows can serve as a simple grounding practice to bring you back into the present moment.
Dr Judson Brewer is the Director of Research and Innovation at The Mindfulness Centre and associate professor in psychiatry at the School of Medicine at Brown University. A thought leader in the field of habit change he has founded his own apps for treating addiction and anxiety, is a New York Times bestseller as well as a renowned speaker – his TED Talk receiving over 17 million views.