A Three Part Plan for Anxiety | Dr. Luana Marques
Dr. Luana Marques, Associate Professor of Psychology at Harvard Medical School, discusses transforming anxiety into power using her 3-step plan: Shift, Approach, and Align. She shares her personal journey and emphasizes confronting discomfort and aligning actions with values for a more meaningful life.
Deep Dive Analysis
20 Topic Outline
Introduction to Authenticity and Dr. Luana Marques
Luana's Childhood in Brazil and Early Anxiety
Lessons from Grandmother and Mother: Early CBT Skills
Journey to Psychology and Specialization in Anxiety
Defining 'Bold Move' and Living Boldly
Understanding Psychological Avoidance and Its Three Forms
Personal Experiences with Avoidance and Workplace Challenges
Bold Move Step 1: Shift Your Perspective on Thoughts
Why Shifting is Difficult During Panic Attacks
The Brain as a Faulty Predictive Machine
Luana's Personal Transformation and Embracing Candor
Being Bold is Not the Same as Being Fearless
Bold Move Step 2: Approach Discomfort with Opposite Action
The Role of Social Support in Managing Anxiety
Bold Move Step 3: Align Your Actions with Your Values
Identifying Values by Examining Pain and Misalignment
Navigating Constraints and Finding Meaning in Difficult Situations
The Golden Circle: Starting with 'Why' for Life Planning
Balancing Multiple Motivations and Personal Goals
Being the Water, Not the Rock: Embracing Flexibility
9 Key Concepts
Psychological Avoidance
Any behavior aimed at quickly reducing emotional discomfort, but which ultimately leads to being stuck or worsening the long-term problem. It teaches the brain that the source of anxiety is truly dangerous and must be avoided.
Three R's of Avoidance
These are three common ways people avoid discomfort. 'React' involves aggressively moving towards a perceived threat to eliminate it, often impulsively. 'Retreat' means moving away from discomfort, often through rumination or inaction. 'Remaining' is freezing or staying stuck in an undesirable situation, like a deer in headlights.
Shift (Bold Move Step)
The first step in transforming anxiety, which involves pausing to examine one's thoughts and challenging them. It encourages recognizing that thoughts are not facts and reframing self-talk with kindness, compassion, and data-driven perspective, as if speaking to a best friend.
Brain as a Faulty Predictive Machine
The brain often predicts information based on past history and belief systems, frequently leading to worst-case scenarios or distorted views. It tends to minimize discomfort by creating narratives that are not always aligned with current reality, even turning positive events into perceived threats due to ingrained biases.
Approach (Bold Move Step)
The second step, which means moving towards discomfort instead of avoiding it. This often involves 'opposite action,' where one chooses a small, manageable step that goes against what anxiety is mandating, gradually training the brain that perceived fears are not actual dangers.
Opposite Action
A skill used in the 'Approach' step, where one identifies what anxiety is telling them to do (usually avoid) and then chooses one small, deliberate action that goes against that mandate. The key is to take baby steps that are manageable to avoid overwhelming the brain.
Align (Bold Move Step)
The third step, rooted in acceptance and commitment therapy, which involves identifying one's core values and ensuring daily actions are consistent with them. A misaligned life, where actions contradict values, can significantly magnify anxiety and stress.
Golden Circle
A framework for understanding and aligning one's life, starting with 'Why' (your core values and purpose), then moving to 'How' (your methods and processes), and finally 'What' (your specific actions or outcomes). It emphasizes clarity of purpose before action.
Being the Water, Not the Rock
A mental model for navigating life's obstacles and transitions with flexibility. Instead of being rigid and stuck like a rock when faced with adversity, one should be adaptable and flowing like water, finding ways to go around, underneath, or through challenges, embracing cognitive flexibility.
10 Questions Answered
Living boldly means showing up fully as yourself, being clear on what you want from life, and consistently taking steps towards those goals by moving towards discomfort rather than avoiding it. It can involve small, personal actions, not just grand gestures.
Psychological avoidance is any action taken to quickly reduce emotional discomfort, but which ultimately prevents long-term progress and keeps one stuck. It reinforces to the brain that the perceived threat is real and must be avoided, making anxiety worse over time.
The three R's of avoidance are React (aggressively confronting a threat to quickly reduce anxiety), Retreat (mentally or physically withdrawing from discomfort, often through rumination), and Remain (freezing or staying paralyzed in an undesirable situation).
During a panic attack, the brain's fear response (amygdala) is fully activated, overriding the thinking brain (prefrontal cortex). At this point, the brain's sole function is protection, making it impossible to rationally think one's way out of the panic; instead, one must experience the sensations to train the brain there is no real danger.
The brain is a faulty predictor because it bases its predictions on past history and ingrained belief systems, often leading to distorted, worst-case scenarios. It prioritizes minimizing discomfort (dissonance) and scans for threats, even when current situations are not actually dangerous, like turning a success into a perceived threat.
No, being bold is not the same as being fearless. It means acknowledging fear and anxiety but choosing to move forward towards your desired life despite those feelings. Fear can still be present daily, but it doesn't have to stop you from taking action.
Social support is the number one buffer against mental health problems, offering significant help in regulating anxiety. However, there's a fine line between supportive help and enabling avoidance; support should propel an individual towards their goals, not become another form of avoidance itself.
One way to identify core values is by looking at pain. When something causes significant emotional pain, it often indicates that a deeply held value has been violated or is being compromised. This pain serves as a signal for what truly matters to an individual.
It's important to acknowledge that multiple motivations, including financial ones, are valid. The key is flexibility and balance, choosing which value to prioritize in a given moment or season of life, rather than seeing them as mutually exclusive. It's about having a collection of values that collectively drive one's life.
Being the water, not the rock, means approaching life's obstacles, changes, and transitions with flexibility and adaptability. Instead of rigidly holding onto old views or freezing in place like a rock, one should flow around challenges, finding creative ways to navigate them, much like water shapes and moves around rocks.
46 Actionable Insights
1. Align Actions with Values
Identify your core values and consciously align your daily actions with them, as this practice is known to decrease anxiety, reduce stress, and foster a more meaningful life.
2. Identify Values Through Pain
To discover your true values, reflect on experiences of pain or hurt, as these emotions often indicate that something meaningful to you has been violated or is at risk.
3. Approach Anxious Emotions
When experiencing anxiety or distress, practice approaching these emotions directly rather than walking away or avoiding them, as this is a key emotion regulation skill.
4. Practice Opposite Action
When anxiety tells you to avoid, deliberately choose one small action that is the opposite of what the anxiety is mandating, to gradually move towards discomfort.
5. Reframe Inner Dialogue Kindly
Practice reframing your inner dialogue by speaking to yourself with the same kindness, compassion, and authenticity you would offer a best friend, seeking a more balanced and data-driven perspective.
6. Practice Cognitive Flexibility
When upset, ask yourself, “Is there a different way to think about this?” or “Can I see this from a different angle?” to develop cognitive flexibility and reframe your perspective.
7. Be Comfortably Uncomfortable
Accept that some anxiety and discomfort may always be present, and strive to become “comfortably uncomfortable” in challenging situations to reduce avoidance and live a more meaningful life.
8. Recognize Faulty Brain Predictions
Understand that your brain often makes predictions based on past experiences to minimize discomfort, which can result in a negativity bias and a distorted view of current reality.
9. Avoid Anxiety Avoidance
Do not run away from anxiety, as avoiding it only teaches your brain that the perceived threat is real and makes the anxiety worse and more persistent.
10. Choose Discomfort Over Avoidance
Consciously choose the temporary discomfort of approaching your fears over the prolonged suffering of living a small, avoidance-driven life, as avoidance ultimately leads to greater distress.
11. Live Boldly, Embrace Discomfort
To live boldly, be your authentic self, clarify your life goals, and take daily steps towards them, embracing discomfort and bringing anxiety along rather than avoiding it.
12. Strip Away Defenses
To foster good relationships, health, and happiness, actively work to strip away your fears, defenses, habits, and ancient storylines, allowing yourself to be real and spontaneous.
13. Start with “Why” (Values)
Before undertaking any action, begin by clarifying your fundamental “why” – your core values – to ensure your subsequent “how” and “what” are aligned with your deepest purpose.
14. Strategize Value-Driven Life
Strategize your life by carefully and incrementally planning how to align your daily actions with your core values, mirroring the careful approach used when confronting fears.
15. Schedule Value Alignment
Intentionally schedule activities that align with your values into your daily or weekly routine, understanding that meaningful pursuits require deliberate planning to manifest in your life.
16. Cultivate Social Support
Prioritize and actively cultivate strong social support networks, as robust social connections serve as the number one buffer against mental health problems.
17. Distinguish Support from Enabling
Carefully evaluate your social support to ensure it genuinely propels you towards your goals rather than enabling avoidance, recognizing the fine line between helpful support and detrimental enabling.
18. Act Immediately on Small Steps
To prevent anticipatory anxiety from escalating, identify one small, manageable step you can take now towards approaching a feared situation, rather than ruminating.
19. Gradual Exposure, Not White-Knuckling
When facing fears, use exposure therapy with slow, gradual steps rather than attempting to muscle through overwhelming situations, as this gentle approach is more effective for training your brain.
20. Stay With Your Edge
Once you identify the limit of your comfort zone, continue to engage with that level of discomfort to reinforce learning and prevent regression.
21. Experience Panic Sensations
When in a state of panic, do not attempt to rationalize your way out; instead, allow yourself to experience and approach the physical sensations to retrain your brain that there is no actual danger.
22. Examine Your Self-Talk
When experiencing anxiety, pause to examine your internal dialogue, recognizing that your thoughts are not always factual and can be distorted.
23. Challenge Anxious Thoughts
Actively challenge anxious thoughts by questioning if there’s an alternative perspective and reminding yourself that thoughts are not necessarily facts.
24. Acknowledge Anxiety, Show Up
Even with strategies like shifting and approaching, acknowledge that anxiety may persist, but commit to showing up fully in your life despite its presence.
25. Anxiety as Curiosity Signal
Consider reframing anxiety as a signal for curiosity, viewing it as an opportunity to explore what might be important or worthy of your attention.
26. Meditate to Observe Anxiety
Engage in meditation to practice sitting with and observing anxious sensations and thoughts without reacting or avoiding them, which is a powerful way to build resilience.
27. Pause, Communicate Hurt, Set Boundaries
When feeling threatened or hurt, pause before reacting impulsively; instead, clearly communicate your feelings and set boundaries, such as stating you are not ready to talk about it yet.
28. Break Avoidance Patterns
Identify your recurring patterns of avoidance and make a conscious decision to break them when they no longer serve you, as these habits can keep you stuck.
29. Identify Psychological Avoidance
Recognize any behavior whose primary function is to quickly lower emotional discomfort, as these actions constitute psychological avoidance and can lead to long-term stagnation.
30. Beware Impulsive Reacting
When feeling anxious, avoid reacting impulsively to eliminate the threat or discomfort, as this behavior is a form of avoidance that often lacks thoughtfulness and can lead to negative outcomes.
31. Avoid Anxious Retreating
Do not retreat from discomfort by overthinking or procrastinating, as this mental avoidance keeps you stuck in anxious patterns and prevents meaningful action.
32. Break Free From Remaining
Do not remain frozen or paralyzed in anxious situations like disliked jobs or relationships, as this form of avoidance prevents essential change and prolongs unhappiness.
33. Model Anxiety Coping for Kids
Parents should openly acknowledge their anxiety and model an approach-oriented mindset when facing fears, demonstrating to children that anxiety exists but can be managed.
34. Avoid Value Misalignment
Be aware that living a life that feels “wrong” or misaligned with your core values, whether professionally or personally, can significantly amplify anxiety and distress.
35. Gradually Align Trapped Situations
If you feel trapped in a situation, look for small, gradual ways to shift your actions from pure obligation towards activities that resonate more with your values, finding meaning even in difficult circumstances.
36. Envision Value-Driven Life
Regularly ask yourself, “What would my life look like if I did what mattered most to me?” to gain clarity on your deepest values and guide your life’s direction.
37. Embrace Multiple Motivations
Recognize that various motivations, such as financial stability or recognition, can coexist with and complement your core values, rather than polluting them.
38. Prioritize Values Flexibly
Maintain a diverse set of values and flexibly prioritize them according to the current season of your life, avoiding the narrow focus on a single driving value.
39. Include Self in Impact
Understand that “impact” encompasses positive change for yourself, as personal well-being and growth are crucial for effectively helping others and aligning with your values.
40. Apply Values to Self First
Begin by applying your values to your own life and well-being, as personal alignment is a prerequisite for effectively living those values for the benefit of others.
41. Prioritize Personal Health
Make your personal health and well-being a priority, as it serves as a fundamental step that enables you to pursue other values and make a broader impact.
42. Take Next Small Step
When experiencing pain or difficulty, focus on doing the next necessary thing to improve your situation, aligning your actions with your values and demonstrating a strong work ethic.
43. Be “The Water” (Flexible)
Cultivate flexibility and adaptability, like water, to navigate obstacles and challenges by finding alternative paths and shaping your approach rather than rigidly resisting.
44. Flow with Life’s Winding Path
Embrace cognitive flexibility and allow yourself to flow with the non-linear journey of life, understanding that aligning with your values is a winding path, which ultimately leads to greater well-being.
45. Avoid Being “The Rock”
During times of change or transition, avoid rigidity and clinging to old ways; instead, embrace flexibility to prevent being stuck and paralyzed between past and future.
46. Utilize Exposure Therapy
For anxiety and panic, exposure therapy is an effective method to gradually confront fears and train the brain that perceived threats are not real dangers.
9 Key Quotes
It is only when you strip away your fears, your defenses, your habits, your ancient storylines that you can be real and spontaneous. And that is the key to having good relationships with other people, which, of course, is the key to being healthy and happy.
Dan Harris
I was having panic attacks. They were not asthma attacks. They were always after a fight between my parents where there was a lot of domestic violence.
Dr. Luana Marques
Running away from anxiety doesn't work. It just comes along and runs faster.
Dr. Luana Marques
Thoughts are not facts. In fact, we would never say to our friends what we say to ourselves.
Dr. Luana Marques
There is no way to think yourself out of a panic. It just, it's impossible.
Dr. Luana Marques
Being bold is not being fearless. I'm scared every day.
Dr. Luana Marques
Social support is the number one buffer against any kind of mental health problems.
Dr. Luana Marques
Pain is only there because something that matters to us is getting hurt.
Dr. Luana Marques
I don't think you can live your values just for others. I think the first way to apply to yourself.
Dr. Luana Marques
1 Protocols
Bold Move: A 3-Step Plan to Transform Anxiety into Power
Dr. Luana Marques- Shift: Pause and examine your thoughts, challenging them with kindness and data-driven perspective, as if talking to a best friend.
- Approach: Identify what anxiety is telling you to do (usually avoid) and choose one small, manageable step (opposite action) that goes against that mandate, acting as soon as possible.
- Align: Identify your core values, often by looking at what causes you pain, and then strategically plan and schedule daily actions that are consistent with those values to create a meaningful life.