Coping mechanisms: How to shift your mindset when anxiety arises

Health psychologist Kelly McGonigal discusses a three-step process to shift your mindset when anxiety creeps in.

Fear and anxiety disorders affect 20 percent of the American population, making these disorders the most prevalent psychiatric problem in the nation. While many understand anxiety as an overstimulated response system reacting to an uncertain environment, NYU Professor Joseph Ledoux believes this evolutionary argument is misguided.


We have not inherited feelings from our animal predecessors, he says, but rather inherited “mechanisms that detect and respond to threats." Consciousness plays a decisive role in how we translate messages we receive from our environment. In Anxious he writes,

When these threat-processing mechanisms are present in a brain that can be conscious of its own activities, conscious feelings of fear or anxiety are possible; otherwise threat processing mechanisms motivate behavior but do not necessarily result in or involve feelings of fear and anxiety.

Anne Marie Albano, Professor of Medical Psychology and Director of Columbia University Clinic for Anxiety and Related Disorders, works with anxiety, which is actually her advice as well—work with it, not against it. Sensations of anxiety evolved to protect us. This system, she says, goes awry when you perceive immediate danger that isn't really there.

An example: About a decade ago I had a severe panic attack in an East Village restaurant. I'm not certain of the trigger, but it caused me to rise from my seat to flee to the bathroom. I walked roughly ten feet and didn't wake up for nearly a minute, when I was cradled by a woman I apparently landed on.

(Turns out I walked twenty feet after blacking out, straight into a wall and then onto the poor woman. I only knew this because, unbeknownst to me, a woman I had recently met was seated nearby. Ironically, she is a neuroscience journalist who had just published a piece on the brain and anxiety.)

Two days later I had another attack at the Wall St subway station in which I nearly blacked out. Every subsequent time I entered that station an attack occurred. My workaround was walking a few blocks to City Hall and thereby increasing my commute time, which is always fun in a New York City winter. I didn't return to that restaurant for years.

As Albano phrases it, we envision an immediate danger that isn't there. We do it all the time. Research shows that roughly 50 percent of our day is spent thinking about something not in your immediate environment. Other research shows that we have thousands of daydreams every single day. How we fill that mental space can bring great pleasure to our lives, but it can also cripple us.

Albano differentiates between everyday anxiety (which we all have and is helpful as our brain evolved to cope with stress)—and chronic anxiety. That's creating a big problem, socially and economically: one study found that Americans lose 321 million work days every year due to anxiety and depression, which costs the economy $50 billion. More Americans head to the doctor for anxiety than for migraines or back pain. The World Health Organization claims anxiety disorder is the most common mental illness on the planet.

Cognitive behavioral therapy has been the most successful course of treatment, according to Albano. When combined with the right pharmaceutical treatment for anxiety she says symptoms can be alleviated. Of course, this is a challenging balancing act, given our pill overload. Cure-alls are impossible when anxiety is so individual and specific. Albano is hopeful; the cognitive and biological mechanisms behind anxiety are being discovered, which she believes will disrupt the chain between a trigger and attack. She also believes we'll soon be able to address the process in young sufferers to tamp down the process earlier in life.

While Albano is a fan of talk therapy and pharmaceutical interventions, health psychologist Kelly McGonigal discusses a three-step process to shifting your mindset when anxiety arises.

  • Acknowledge stress when you experience it
  • Welcome the stress by recognizing that it's a response to something you care about
  • Make use of the energy that stress gives you, instead of wasting that energy trying to manage your stress

Before I understood the depths of my disorder (which thankfully, I no longer suffer from) that third step was part of my arsenal. When an attack occurred I'd run around my neighborhood or jump on a treadmill. Anxiety is physiological as well as psychological; using your bodily systems to work with, instead of against, it is therapeutic.

Because anxiety can “create a state of concentrated attention," McGonigal suggests using that intense focus for something positive. Let's face it: triggers are everywhere. If one of every five people suffer from this disorder something cultural is happening. And when so many people are unwilling to talk about it, scared that it's “only in your head," as I was told for so long, we need to create supportive environments, which on a broad level we definitely are not. Given our current health care uncertainty, not everyone can afford the therapies Albano suggest, useful as they might be.

Your brain is wired for anxiety, as Albano suggests, as well as for dealing with it. Reframing your mindset is available to you at every moment. It's not easy, but it just might help you work with your mind instead of fighting it every step of the way.

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Derek's latest book, Whole Motion: Training Your Brain and Body For Optimal Health, is out now. He is based in Los Angeles. Stay in touch on Facebook and Twitter.

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An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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