Anxiety, Explained | Luana Marques
Dr. Luana Marques, Associate Professor of Psychiatry at Harvard Medical School and ADAA President, delves into the science of anxiety, explaining the TEB Cycle and how our relationship to anxiety, not anxiety itself, is often the problem. She also covers the perils of avoidance and handling phobias.
Deep Dive Analysis
12 Topic Outline
Defining Anxiety and Its Brain Impact
Anxiety as a Positive Signal and Cognitive Distortions
Meditation's Role in Managing Anxiety
Distinguishing Real Anxiety from Self-Fulfilling Prophecies
Understanding the TEB Cycle for Anxiety Management
The Perils of Avoidance and Benefits of Approach
Practicing 'Comfortably Uncomfortable' Exposure Therapy
Navigating Anxiety During and After the Pandemic
Handling Anxiety Contagion in Relationships
The Link Between Anxiety and Depression
Long-Term Anxiety's Impact on Physical Health
Managing Anxiety Related to Medical Procedures
7 Key Concepts
Anxiety
Anxiety is defined as an overestimation of threat and an underestimation of one's ability to handle that threat. It is a prediction that one cannot cope with what is about to happen, affecting thoughts, emotions, and behaviors.
Amygdala Hijack
This occurs when the amygdala, often called the 'lizard brain,' becomes highly activated, preparing the body for fight, flight, or freeze. Simultaneously, the prefrontal cortex, responsible for rational thinking and planning, is dimmed, impairing the ability to think straight.
Cognitive Distortions
These are instances where the brain misinterprets information, jumps to conclusions, or imagines worst-case scenarios, often filtering thoughts through the lens of anxiety. People frequently believe these distorted thoughts are facts.
TEB Cycle (Thoughts, Emotions, Behavior)
A framework used to understand the interconnectedness of our internal dialogue (thoughts), our physical and emotional feelings (emotions), and our actions (behavior). Pausing to observe this cycle activates the prefrontal cortex, helping to slow down and break spinning anxiety cycles.
Avoidance
Avoidance provides a short-term benefit by temporarily reducing anxiety, but it teaches the brain that the only way to tolerate anxiety is by avoiding the feared situation. In the long term, this makes it increasingly difficult to approach the avoided situation and exacerbates anxiety.
Exposure Therapy
This therapeutic principle involves gradually approaching feared situations in a regulated manner. The goal is to stay with the discomfort long enough for the amygdala to learn that nothing bad will happen, leading to habituation and a reduction in fear.
Comfortably Uncomfortable
This refers to the optimal state in exposure therapy where an individual approaches a feared situation at a level of discomfort that is tolerable. This allows them to stay with the experience long enough for their brain to learn and habituate, without triggering a full fight-or-flight response.
9 Questions Answered
Anxiety often activates the amygdala (the 'lizard brain') for fight, flight, or freeze responses, while dimming the prefrontal cortex, which is responsible for rational thinking and planning, thereby impairing clear thought.
Yes, telling yourself 'I should be anxious because I'm an anxious person' can feed the anxiety cycle, activating the amygdala and making you feel worse by reinforcing the belief that something bad is happening.
By pausing and asking yourself, 'What am I saying to myself right now?' and 'Do I have data here?' This process activates the prefrontal cortex, allowing you to question if your thoughts are facts or filtered through emotion.
Listening to and observing bodily sensations without judgment helps create self-awareness and can slow down frantic engagement with the world. This allows for a calmer experience and a more fertile ground for challenging anxious thoughts.
While avoidance offers short-term relief, it teaches the brain that the only way to tolerate anxiety is by avoiding, preventing you from testing hypotheses about the feared situation and ultimately making the anxiety worse over time.
First, regulate your own anxiety, as you cannot help someone else if your own emotional brain is hijacked. If possible, negotiate boundaries beforehand and avoid feeding their anxiety cycle by stepping out of the way or not immediately trying to fix it.
Anxiety and depression are highly comorbid, often occurring together, and share common symptoms like sleep disturbance. While sometimes one can precede the other, it's often a 'chicken and egg' situation where a clear causal link is hard to establish, but the skills to treat both are often the same.
Research shows a strong association between anxiety disorders and physical illnesses, including GI troubles (like IBS), respiratory issues, and bone problems. Long-standing anxiety can affect the physical body due to being in a heightened state of arousal.
Expect some anxiety as it's normal. Instead of trying to cross-examine fears that have legitimate worst-case scenarios, face reality by acknowledging the situation without liking it, and try to minimize catastrophic thinking by focusing on what you can control or describing your immediate surroundings to activate your thinking brain.
15 Actionable Insights
1. Practice “Comfortably Uncomfortable” Exposure
Gradually approach feared situations in a regulated way, staying with the discomfort long enough for your brain to learn that nothing bad will happen. This habituates your brain and teaches you that you can handle even the worst-case scenario.
2. Challenge Anxious Thoughts as a Detective
When you feel bad or anxious, pause and ask yourself, “What am I saying to myself right now?” Then, act as a detective: question your thoughts, ask for data, and determine if they are facts or just filtered through anxiety.
3. Utilize the TEB Cycle to Break Spirals
Pause to identify your Thoughts, Emotions, and Behaviors in a moment of anxiety. Linking these elements helps you understand what’s happening in your brain, slowing down the limbic hijack and equipping you to add skills to break the spinning cycle.
4. Cultivate Self-Awareness Through Meditation
Practice meditation regularly to systematically engineer collisions with your inner voice, building the muscle of self-awareness. This allows your brain to operate at a slower speed, creating a fertile ground to challenge anxious thoughts and engage with the world more calmly.
5. Approach Feared Situations, Don’t Avoid
Actively identify what you are avoiding due to anxiety and choose to approach it, slowly and steadily. Avoiding only teaches your brain that the only way to tolerate anxiety is by escaping, preventing you from testing your hypotheses about feared outcomes.
6. Reframe Physical Sensations of Anxiety
When you notice physical symptoms like a pounding heart, observe them without adding a negative narrative. Recognize that these sensations can accompany excitement or exercise, not just threat, allowing you to change your relationship with anxiety and prevent it from escalating.
7. Regulate Your Own Anxiety First
When someone around you is anxious, prioritize getting your own anxiety in check first. You cannot effectively help others if your own emotional brain is hijacked; instead, regulate yourself to avoid feeding their anxiety spiral.
8. Listen and Validate Before Offering Solutions
When someone shares their anxiety, resist the urge to immediately fix or solve their problem, as this can be a subtle form of avoiding your own discomfort. Instead, listen, validate their feelings, and ask what would be helpful to them in that moment.
9. Practice Unitasking to Reduce Frenzy
Focus on doing one thing at a time, as research indicates that this practice can decrease anxiety. Multitasking often leads to a frenzied state because our brains are not equipped to handle many things simultaneously.
10. Set Daily Reminders for Self-Inquiry
Create moments of curiosity by setting a daily reminder, such as a phone alarm, to pause and ask yourself, “What was I thinking about right now?” This simple act helps activate your prefrontal cortex and build awareness of your thought patterns.
11. Journal Your Thoughts to Slow Down
Write down your thoughts, ideally with pen and paper, to slow down your brain’s processing. This physical act makes it impossible to write as fast as cognitive distortions occur, inherently engaging your prefrontal cortex and aiding self-reflection.
12. Face Reality in High-Stakes Uncertainty
In situations of high uncertainty where worst-case scenarios are plausible (e.g., medical diagnoses), face reality without necessarily liking it. Focus on what you can control and use reassuring self-talk, such as “We’re doing everything we can,” to minimize catastrophic thinking.
13. Seek Professional Help for Impairment
If anxiety significantly interferes with your life, consider seeking treatment from a mental health professional. While self-help skills are valuable, persistent or severe impairment indicates a need for expert guidance.
14. Activate Thinking Brain by Describing Surroundings
When caught in anticipatory anxiety about uncertain high-stakes outcomes, activate your thinking brain by describing your immediate surroundings to yourself. This helps you stay present and prevents your mind from feeding worst-case scenario thoughts.
15. Explore Dr. Luana Marquez’s Resources
Visit drluana.com for more information, including a free “Mental Health for All” course available in multiple languages, and consider reading her book “Almost Anxious” for skills based on cognitive behavioral therapy.
7 Key Quotes
Anxiety is almost never thrown around as a positive thing. That word is never thrown around in a positive sense. But it is trying to serve us, right? It is trying to protect the organism.
Dan Harris
Often, when we're anxious, we believe that thoughts are facts. But the reality is, our thoughts at that point are really being filtered through the lens of anxiety.
Dr. Luana Marques
Avoiding has a short-term benefit. The problem is, is teaching your brain the opposite of what we want to teach. Is teaching it the only way you can tolerate anxiety is by avoiding.
Dr. Luana Marques
We can't help somebody to manage any of their anxiety if our anxiety is not in check. And it's as simple as that.
Dr. Luana Marques
The louder they get, the cooler you want to get. And you want to slow it down and you want to bring your rational brain.
Dr. Luana Marques
Most of us need to be heard first before we get solution.
Dr. Luana Marques
Facing reality does not mean you like reality. It's being able to sort of look at the data and sit with it for a little bit.
Dr. Luana Marques
2 Protocols
Addressing Cognitive Distortions
Dr. Luana Marques- Create a pause button: Develop curiosity about what's going on in your brain and literally pause for a second.
- Ask yourself: 'What am I saying to myself right now?' without judgment or correction.
- Become a detective: Ask, 'Do I have data here?' to question whether your thoughts are facts.
- Evaluate helpfulness: Ask, 'Is it helpful?' to re-examine negative thoughts and find a more balanced view, especially if they are not serving you.
- Journal: Write down your thoughts, especially with pen and paper, to slow down your brain and activate your prefrontal cortex.
Using the TEB Cycle in a Moment of Anxiety
Dr. Luana Marques- Pause: Take a moment to literally go, 'Wait a minute, what's going on here?'
- Identify the situation: Recognize the external trigger (e.g., a text from your boss).
- Identify Thoughts: Observe what you are saying to yourself (e.g., 'She's going to fire me').
- Identify Emotions: Notice what you are feeling in your body and heart (e.g., chest tightening, discomfort).
- Identify Behaviors: Become aware of what you are doing in response (e.g., calling too fast, avoiding).
- Link them: Understand the interconnected picture of your thoughts, emotions, and behaviors in that moment to slow down your brain before reacting.