So, heightened anxiety triggers alternate emotional regulation, with traits like pro-avoidance behavior.
To me this is not necessarily dysfunctional. It may also go hand-in-hand with motivating heightened deliberation. I can see how one can fall into regressive patterns like distracting ourselves away from critical path actions, especially if a particular person only uses one of two strategies, 1) try going on as before or 2) try forgetting we need to go this way.
I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of.
They show that even mild emotional challenges can saturate FPl neural range, which to me is simply a greater sensitivity that can be easily overloaded (like when you put the voltmeter on a more sensitive setting).
Exposure Therapy is a methodical, deliberate, routine heavy strategy. ET doesn’t simply get us to re-engage, it gets us to re-engage with new and different behavior, which may be essential to success.
The paper suggests rTMS to disrupt the disruptive activities.
The emotional challenge in this study was that you had a joystick and sometimes you pulled that joystick towards you when you saw an unhappy face. That's what was paralysing emotional challenge was for highly anxious people. Meaning it's unlikely their PFl could have any control in real life scenarios. It's important to note that in both anxious and non-anxious people the PFl was highly excitable. It's the pattern of its activity that makes a difference.
Cognition is hard work and the truth is you can't reason about your entire life and expect much success. Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on. Imagine if every time you got in you had less intuition about how to drive.
Think of the absence of fpi as a lack of intuition you get once you learn to drive.
CBT +/- an SSRI for 6months is a small price to pay to regain intuition.
> “Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on.”
This reminded me of starting to ride a motorcycle (again) in 2021. Lots of anxiety and stress.
Two years later I’m not as stressed. But, each near-accident I’ve had was following not paying attention.
Thinking about this on a ride over the weekend, I mused about solo-jet fighter pilots and Olympians. I recalled breathing exercises are supposed to help.
Reading the abstract, I’m reminded of awkward social situations and inexperience in primary school. I’m thinking the biggest lesson was trying, and realizing failure is not life threatening. But it didn’t stop me from developing some bad habits for cheating on tests, and waiting until the last 48 hours to write my papers.
I think getting a job at 16 helped a lot. It was at a comic book shop. I held that job for seven years.
Failure in this case ranges from life-altering disabilities or death outright. The emotional toll on your friends and family. The waste of medical resources on you.
Yeah, people should have a healthy amount of fear for needlessly dangerous things.
?? There’s nothing unethical about riding a motorcycle.
I ride within 80% of my abilities. I wear full PPE all year round. My moto is maintained to a high standard. I drive defensively. I have taken safety courses, and continued my motorcycle safety training both in and out of the classroom. I am not careless about my life or the lives of others. I drive like everyone is out to kill me, and I’m a gentleman. Want to pass, go ahead.
Morally— I’m not needlessly risking my life or the lives of others. If it becomes necessary, god forbid, that I need life saving medical care, I trust I’m worthy of it, if, for no other reason than I take great care when I’m driving any motorized vehicle.
Are you fit to ride? And not in a relative-manner (“I’m the least drunk here!”), but in your own objective sense. If you’re not, then don’t start. If you started, then you should stop—sort of thing.
I think we might each be talking to different ends of the extreme here.
> recruitment of FPl when controlling emotional behavior fails in patients with emotional disorders
I won’t comment on people who have emotional disorders, or who have operated in this modality for very long periods of time. I’m more interested in it as a transient mechanism in people without disorders.
Ah I'm not sure you can extend this study to high anxiety circumstances in otherwise non-anxious people.
The executive functions that highly anxious people need to engage are precisely the functions that high stress levels disrupt.
This is about low stress situations in anxious people.
Not high stress situations in non-anxious people.
It's not likely that we can extrapolate between the two. And it's likely under those scenarios a third or more mechanism comes into play (flight, fight, freeze).
Not to mention the control were all men so we do need better sample for replication before we consider extrapolation.
It’s hard to say where the boundary of application lies, I believe. The paper is naturally concise, and experiments typically select potent examples to clarify the phenomena, economically. Without the authors’ clarifying contextual anecdotes, I believe there is a lot of room to interpret.
One potential problem with this approach is that a person might not actually fear driving a car but dying in general, and this fear spills over into all parts of life. I don’t think you can CBT your way out of it.
I think it’s a “if all you have is a hammer” situation. In my experience and from talking to different therapists CBT is ill-equipped to deal with existential problems because it doesn’t embrace them or helps patients learn from them. Existential therapy or other forms of psychoanalysis is better suited, in my opinion.
I agree with your take on CBT and existential problems (although CBT is incredible for many other types of issues). Do you have more details on therapies that are useful for existential types of problems?
One of the first things that some reading on psychology gives you is the realisation that the “real self” is an illusion. You’re a bundle of competing drives and narratives. Even you don’t know why you do stuff most of the time, and you make up justifications after the fact. So if one way of looking at things makes you stay home and cry, while another leads to going out and making the world a better place, maybe training yourself to pick the latter interpretation is a good thing.
Interestingly, Internal Family Systems therapy, which applies techniques from family systems therapy to the internal world, treats this as a "both-and." You do have a core Self, but one of the primary things it does is lead and direct and serve as the primary attachment figure for all the other parts of you, which are conceptualized as individual, separate characters with their own history, needs, desires, wounds, and fears.
I've found this to be an immensely helpful way to work through my own struggles and maladaptive behaviors. Trying to get myself to do something challenging is more like leading a group, some of whom are gung ho and others who are terrified because something about it reminds them of something that went very badly for them back when we were younger.
When it feels like some negative attitude is overriding the whole system, it's said that a part has "blended" with the Self, and the way forward is to help it unblend, to step back or aside so you, as the Self, can be in relationship with it, can listen to it and understand it (which goes a long way in its own right), but then also help meet the need or protect from the scary thing. The part never has access to all the resources you do as the Self, and the part is often a young child trying to take on something that should be overwhelming for a child.
I have no idea whatsoever if this is the case, but it wouldn't surprise me to find that what's actually happening inside the brain in these cases is an energy shift away from, for example, this over-excited anxious part of the brain to one with more control and executive function. It might be a way of training the mind to direct the activation of the brain, not unlike training for any other sort of skill.
I think it’s the other way around, CBT and SSRIs is not the last resort but the first. These techniques can help acquire the basic life skills of operating in anxious situations, but they’re a prosthesis.
You can use this prosthesis to tackle the underlying deeper issues.
But I do agree reliance on CBT and SSRIs as the be-all and end-all of therapy is bad and inhumane. They’re the most commodifiable techniques, but they’re Pavlovian and reduce human beings to machines you can train through a chat bot (really?).
As far as I can tell, CBT is the gold standard for psychotherapy in much the same way that agile is the gold standard for software development. There's compelling evidence that some implementations can be remarkably effective at least some of the time, and a vague consensus that it's good and proven. However, there's also widespread disagreement and confusion about what it means to actually do it, how to evaluate whether it's a poor fit as opposed to the practitioner or client "doing it wrong", and the extent to which it meaningfully outperforms other approaches across a variety of real-world situations.
It’s not really different from asking people to remember how things didn’t go wrong in earlier situations though. It’s weird how giving it a specific name and repeating it often enough in a variety of different ways makes it actually work.
“I know you are afraid of walking through a crowd of people, but think of how many people do that every day. Think of all those times when you were 15 when you did it without any problem.”
E.g. your problem isn’t real, it’s all in your mind. Which of course it is, that’s kind of the point :)
No not really. Gaslighting has an intent to deceive someone to pull them away from reality. CBT starts with the assumption by both people that the patient is away from reality and gives them tools to bring them closer. Gaslighting is like trying to convince a healthy person they’re fat (and giving them an eating disorder in the process) while CBT is like giving a fat person practices to manage appetite.
I believe OP is trying to suggest that if you're well adjusted to the current world, you're the one who is deluded. And therefore, any method to change your perspective is forcing a delusion. Gas lighting.
The fat person in your metaphor is actually fit, surrounded by unhealthy skinny people who have been convinced they are fit.
From the outside, it's easy to dismiss an anxious individuals fears as nothing more than thoughts in their head that are (sometimes, but not always) completely removed from reality. But from the perspective of the anxious person whose sympathetic nervous system is causing elevated heart rates, shaky sweaty hands and feet, heart palpitations and chest pain, pressure headaches, and brain fog, the problem may seem a tad bit more serious than something that's "all in your mind".
Look, I understand what you're trying to say, but as someone who deals with all of the physical symptoms of anxiety listed above and has been told by loved ones countless times "your problem isn't real, so just don't stress about it", it doesn't help, and it's frankly infuriating to hear.
Agreed, and I think GP mostly agrees with you too, their phrasing was just confusing.
As a bipolar person I have come to semi-ironically embrace the "it's all in your mind" mindset, but with the understanding that literally EVERYTHING is in our minds, and there is no clean distinction between physical and mental symptoms. Mental and physical illness are one and the same, because our body feeds our brain and our brain runs our body.
Simple example: a stomachache involves your brain noticing and reacting to something going on in your stomach. Is it your brain's fault for telling you your stomach is upset, or your stomach's fault for having the conditions to be upset, or your brain's fault for leading your stomach to have the conditions to be upset, or your stomach's fault for altering your brai chemistry so that it has the conditions to lead your stomach to.... etc, you can understand how fuzzy it all is.
Yeah, sorry. My comment was meant to agree, but illustrate that to people without anxiety (or disinclined to trust the medical establishment) CBT might come across as little different from “it’s all in your head”.
I suffer from the same, and after CBT, it’s actually kind of worse to hear “it isn’t real, so don’t worry”, because I know it (on the balance of probability) isn’t real, but somehow that doesn’t make me feel any better.
EDIT: Sorry, I misunderstood your comment, I thought you were GGP saying that "it's all in your head" is better than CBT. Leaving my original response below.
Sure, but someone with crippling anxiety could easily counter your with any of these:
* I was assaulted when I was 17 so of course I could do things more easily when I was 15.
* I feel physical symptoms of anxiety when I am around others so it's not just in my mind.
* I am a fundamentally worse person than average and do not deserve to be around other people.
* I don't care about what others can do, I would rather die than walk through a crowd.
CBT tries to meet people where they are, acknowledge them, and then give them the tools to move in a healty direction. Kinda like this:
"I know you are afraid of walking through a crowd of people. I want you to imagine walking through the crowd, and tell me what you think and feel.
OK, so you feel physically ill, and you feel like there are bugs on your skin, and you imagine people around you are talking about you. Let's acknowledge that's how you feel.
Now, let's look at this logically. Do you accept that it's unlikely that anyone is actually talking about you? Can you touch your skin, confirm there are no bugs? And, finally, do you understand that your nausea, whilst real, is likely a physical symptom of anxiety following from the other two things, so if we work on the anxiety then the nausea will subside too?
Great. So we've acknowledged how you feel, and we've acknowledged that what you are feeling is driven by anxiety moreso than reality, and we agree that it's possible for you to overcome. It's OK if that doesn't immediately resolve your fear, but next time you are near a crowd, I want you to think about what we talked about before you decide to avoid the crowd."
This is proven to be more likely to help people. If your smug "IT'S ALL IN YOUR HEAD" solution worked, then plenty of kids with mental issues would have been magically cured when their parents said that exact phrase to them.
One’s beliefs and feelings won’t be rational but the overall functioning of your brain is mostly reasonable when you know enough about your self, your past, and your brain. The task of building a fulfilling life with the nervous system you actually have is not trivial but also not impossible.
If it wasn’t dysfunctional, it wouldn’t be a diagnosed with mental health condition to begin with.
I think this is a concept that is getting lost in mainstream mental health discourse: There is a big difference between anxiety the emotion and anxiety the mental health disorder. Similar story for depression and concentration struggles.
It’s normal to feel anxious at times. It’s not healthy when anxiety becomes so dominant as to interfere with normal activities of life, manifesting as the type of pervasive avoidance behavior described in this study.
This is becoming a huge problem among the young people I’ve mentored recently; They will go through phases where they become convinced, often by TikTok or Reddit, that they have ADHD, anxiety, and/or depression because they aren’t perfect robots who do marathon study sessions with a smile every day. I feel like I’m always explaining to them that it’s normal and healthy to feel some discomfort as they learn and grow. It’s not reasonable to expect everything in life to come easy. Of course, there are students who struggle with mental health issues as well, but the difference between someone struggling with lifelong ADHD and someone who just learned about ADHD through a serious of TikToks a few weeks ago and now thinks they have it is obvious when you’ve been working with them both for a long time.
> I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of.
The study doesn’t say that this is “best medicated out of”. It specifically highlights exposure therapy as being effective in normalizing this in individuals who respond to it:
> and exposure therapy has been shown to restore frontopolar function in those PTSD patients that benefit from treatment.
I think this is another issue permeating pop culture discussion of mental health issues: The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications, but patients often arrive convinced that they need medication. If the provider recommends therapy or lifestyle interventions they often get angry that at the perception that the provider is being dismissive or not taking their problem seriously.
I've shared my experience in being diagnosed as ADHD as an adult already[1][2], but in this context, the net is that I fought even the concept of going on any kind of medication for a long time. I wanted to go hard on lifestyle interventions and all kinds of different "tricks" for working around my constant reshifting to different priorities.
Ironically, while I love my therapist still, my psych has been an absolute pill pusher. I've routinely told her that I'm not interested in _also_ being prescribed Xanax because I'm having some anxiety after a long, shitty breakup. That discomfort is part of the human experience. But she is SO eager to throw more Rx at me...it's been kind of eye opening how easy it could be to abuse prescription meds.
I think it would be wise to disassociate your concept of yourself and your psych.
Are you on adderall, have you tested if it works for you?
If you are now medicated for ADHD which everyone with symptoms should at least experience. Knowing it even exists and that you can feel that way is extremely grounding.
If you are concerned with abuse, do some research and on the drugs they are recommending. I am hypersensitive to some drugs, so I tell anyone prescribing me the drug that I am going to ramp and if they have a problem with that. Most of the time they are and they like someone engaged in their own outcomes.
You probably need a combination of a lot of things, therapist, life changes, deliberate drug use, etc.
Yeah, I've been getting regular therapy for years, that's all a part of it. I allude to it in the links, but I've gone hard on going into the gym, building better routines, etc.
I've also taken plenty of steps backwards, but I'd like to hope that's part of the process...
> They will go through phases where they become convinced, often by TikTok or Reddit, that they have ADHD, anxiety, and/or depression because they aren’t perfect robots who do marathon study sessions with a smile every day.
I was struggling to put a name to this phenomenon but I recently learned about the term "semantic contagion" as coined by Ian Hacking. There is an article I found interesting that speculates the rise of a rare disorder with the proliferation of the Internet in the 1990s.
I think the idea that an influx of readily available information can confuse people with tempting theories or misinterpretation is more relevant than ever today.
> The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications
Moreover, these two aspects nearly always coincide: Every credible institution will require you to engage in therapy in tandem with commencing medication. Often, once your condition improves, the discourse shifts towards the possibility of gradually decreasing your medication (though this is obviously a conversation, not a mandate).
This is the wrong approach imo. Therapy, lifestyle changes, learning to cope with it without meds should always be the first line treatment. More and more, you see the approach of just handing out meds like candy with a small mention that you should also seek therapy AFTER you get the meds. You can go to a general doctor and they'll write you up a prescription for an SSRI with hardly and convincing at all, there is no requirement for therapy so I'm not sure where you're getting that from.
The side effects of meds for anxiety issues are far too downplayed imo. Benzos, ssri's etc. all have very detrimental side effects and are very difficult to get off of.
Preface: I'm speaking as someone who is diagnosed with OCD and generalized anxiety disorder, and I will be speaking about my experiences.
When my mental health took a turn for the worse a few years ago, I was strongly encouraged by my therapist to start taking medication. I was admittedly skeptical upon hearing. I had never taken psychiatric medications before as I held many misconceptions of their side effects, and besides, I figured therapy was supposed to "fix me," so why should I need meds?
When I inquired as to why they wanted me to become medicated, their response was that patients tend to only reach out for help AFTER their mental health becomes severe enough that "learning to cope without meds" is not an option. When a provider is faced with such a case, they are trained to treat it with as much aggression as reasonably possible in order to prevent the patient from becoming even more despondent. This means medication.
From the perspective of the patient, it appears that they're being funneled into taking meds, but from the perspective of the provider they recognize the trajectory the patient is on, and suggest taking drastic actions before things get worse.
As I mentioned before, reputable establishments typically mandate concurrent therapy, particularly when dealing with conditions like depression and anxiety. Your therapist and psychiatrist will often work together and share notes to better treat you. Reputable psychiatrists will often ask if you want to try therapy alone first: The good ones have no lack of patients, so it’s not in their interest to even take you on immediately especially if you’re not committed to getting better through therapeutic means.
Sure: Just as you can unquestionably locate primary care physicians who readily prescribe large quantities of Vicodin, naturally, you can also come across psychiatrists and PCPs who readily prescribe SSRIs without much supervision.
"As I mentioned before, reputable establishments typically mandate concurrent therapy"
But, this is objectively false. Are you trying to say a GD is not "reputable"? Like I said, you can go directly to a GD almost anywhere in this country and they will give you an SSRI with no requirement or mandate to get therapy at all. They will all mention it but there's nothing that requires you to attend therapy.
In the capacity of a psychiatrist? No, a primary care physician is not a trustworthy substitute for a psychiatrist. Mental health disorders should not be addressed by a PCP, even if they have the ability to prescribe you medication for it. You should seek treatment from mental health clinics that almost always have both psychiatrists and therapists on staff or work closely with other clinics that do.
Furthermore, once more: Numerous primary care physicians excessively prescribed opioids like candy. Acquiring a medical license does not automatically equate to being reputable in all fields.
Whether they should or shouldn't be addressed by a GD is irrelevant. They are addressed by a GP in many circumstances. There are not enough psychiatrists around to cover everyone.
Your point is moot. The system is not set up to push therapy, it's set up to push drugs first. You mentioning that "reputable" psychiatrists wouldn't do that is irrelevant. Your ignoring the issue by marking everyone disagree with as not reputable.
I also see that some of these types of people you mention wear this (imagined or not) ADHD “status” as some kind of badge of honor, so that they may feel superior to or more special than “normal” people. Weird times.
I think it's always been that way to some extent. There's some element of being human, where we seek empathy from others or pity if you will to a degree. I know I've done it, where I made justifications for something I have difficulty in.
It's just now there's a lot more of it, where there is a lot more awareness of disabilities, and empathy rightfully but also means more people are inclined to maybe take the easy way out through diagnoses or taking medication to cover for some emotional issues. If there is no other way, then you should seek out meds,etc. But it is part of being human, to understand and overcome some difficulties through perseverance, resilience, or emotional work.
> I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of.
Is it possible for an individual to do ET, or indeed other therapy in combination with medication, to study the change in this response? I tend to agree that we (collectively) should not look at these results and immediately look for a drug to change it; after all, that’s how we arrive at a popular culture that thinks depression is a chemical imbalance (it’s not), so it would be nice to be able to use these findings in conjunction with therapies that focus on a person’s ability to change their own mind.
We're afraid to approach people, afraid to ask for help, afraid that someone might react in the worst possible way or something really bad might happen.
But obviously, it never happens the way we imagine. Reality is 100% of the time, different from our imagination and yet, many of us still fail to remember that.
Every good opportunity that I ever got, was from me coming out of my comfort zone and avoiding to avoid situations.
It's important to remember, anxiety is a useful defense mechanism, but not 99% of the time.
As an anxious person with people-pleasing tendencies, something I've been trying to focus on is reframing the situation and removing fear entirely. For me, fundamentally the fear of social interactions comes from the fear I'm going to do something wrong, that person will react badly, and I'll feel bad about myself. I've realised this entire calculus is broken, because you feel good or bad based on people's reactions which is something you cannot control.
Instead, I'm trying to focus on feeling good or bad based on my intentions, and seeing people's reactions as merely a feedback loop to better align my actions with my intentions. It has been difficult but I think it is slowly working.
>I've realised this entire calculus is broken, because you feel good or bad based on people's reactions which is something you cannot control.
Yes. A thousand times this. It has taken me years to create a situational intuition around this. Another thing that I have had to learn is that people aren’t thinking about you nearly as much as you think they are. Like, take whatever amount of time that you think someone is thinking about you in any social situation, and divide that by 10. That’s still more than they are thinking about you.
> Instead, I'm trying to focus on feeling good or bad based on my intentions, and seeing people's reactions as merely a feedback loop to better align my actions with my intentions.
This is the way. People might disagree, but I've noticed that our intentions really do influence the outcomes because our intentions affect the way we approach problems (Kinda like Wave function collapse). My world is a mere reflection of who I really am, what I really think and what I meditate upon.
Yes, I completely agree. Instead of being upset with outcomes (like how people react to me in interactions), there's three things I've been trying to instead focus on: Am I at peace with my core values? Do my intentions align with those values? And finally, do my actions align with those intentions. If something bad has happened, and those three questions are a 'yes', then you have no reason to feel bad because you've been completely true to yourself and this occurence is something outside your control. If it's a 'no', then you probably need to do some reflection and figure out where in that chain something is going wrong.
If you say something unpleasant to a boss or someone else with the power to hurt you in life, even if it is aligned with your values (like enforcing boundaries or refusing unethical tasks), you may get fired, lose your income and destabilize your future safety, and have every reason to feel bad about your situation.
I see your point but I’d argue that if you feel bad about this it means your core value is actually financial stability over sticking to your principles at any cost, and in that case your actions and intentions didn’t align with what you truly value.
I'm not disagreeing with you at all. If you value financial stability over taking a stand about things you might disagree with, then lying for survival is aligned with your values. Using the ideas I described above, this would be completely acceptable for the person doing that.
Epictetus would add that you need to act in accordance with "nature", by which he meant the world as it is, including human behaviour, not as we want it to be. In this case "nature" would include the behaviour of the boss and you can act accordingly, knowing that if you challenge them you may suffer repercussions.
I've been doing this too, but saying to myself "you are off the hook altogether" with the reasoning that the harm from not attempting something is just so much worse than any typical consequence from saying or doing something dumb in the moment, to the point it needn't even be a consideration. But I like this approach of focussing on intention, to rationalize it.
But your actions may have good intentions but still end up getting a bad reaction. Think codependency; you may have good intentions dealing with the other person's bad behaviour, but you're still encouraging the bad behaviour that way, and you may still resent your own actions despite your good intentions.
That's the idea though, if your intentions are sound but you're not getting the reactions you expect, then you need to re-evaluate how you're acting. The important part is not to beat yourself up about it - bad reactions are just a way for you to learn and correct your actions, fundamentally you are still the person you think you think you are.
They key thing here is that what you’re describing can be interpreted several ways.
One could be maladaptive (long term) and is the easy approach (or may be necessary to survive short term) - ‘oh, I need to be nicer or give more’, or ‘oh, I need to manipulate them or make them be okay with this’ which is the codependent approach.
The other is to step back, realize perhaps you’re already giving too much, and it’s time to leave (safely) or deal with more blowback at the moment to set a boundary even at the risk of real problems.
That takes courage and a wider view, exactly what is hard to do when in these situations though.
I've weirdly noticed a type of analagous mechanism in relation to anxiety where I castastrophize or engage in worst-outcome thinking and when things inevitably turn out ok, the relief from the incongruity has a somewhat "euphoric" and calming effect. I feel like it might be somewhat maladaptive and "addictive"
I don’t know if it’s always this way, but I create emergencies and catastrophes because I otherwise have no motivation to do anything. My back has to be against the wall to get me to act. It’s been a lifelong issue, I’ve tried to kill myself several times because of it, and I learned it was ADHD in the last month. 100% of my issues are explained by this. I never would have guessed.
Definitely sounds like not a good thing, even though it ties in with pithy sayings like "expect the worst but hope for the best" or "Don't get your hopes up and you'll never be disappointed".
I think "meaning" plays a huge role and when you can get yourself to buy into a productive/growth mindset-type narrative, it does seem to help immunize against trauma or at the very least, to help integrate it to the point the negative effect is attenuated
This was first attributed to Mark Twain in a Singapore newspaper 13 years after his death, so was probably not actually said by him. It looks like it's just one of those things people say:
Spot on. This hit me a few weeks ago when I was considering a long workout class ln Peloton. I was hesitant to hit the start button because it was late, I was tired, etc. Then I realized that it was genuinely harder to hit play than to actually do the class.
Literally I've done thousands of workouts and have never regretted one, yet every time there's this negotiation to not do it. I am connecting that to your "reality is different 100% of the time" point.
This book by David Burns [1] taught me that ACTION comes first, AND THEN motivation arrives. If you lay there and wait to be motivated, it will never happen. Specifically:
1. Action
2. Results
3. Motivation
4. Repeat!
Anti-pattern:
1. Motivation
2. Action
3. Results
4. Does not work
When I notice myself using self-talk like "ugh, I just don't feel like it" I thing of A-R-M and it helps.
Action and discipline (the habit of doing the same action) beat motivation everytime. And yet you will find people on HN that will fight to death that motivation is enough or that motivation is the moving force of discipline. Up to redefining words if needed. I think it's because of the warped guilt trip of the saying "you didn't do it/achieve it because you weren't motivated enough" and the "entrepreneuship" spirit of the audience who needs to believe that they can succeed no matter what and motivation is the main factor because it's something fuzzy enough they can say they had it or hadn't when they fail/succeed and ignore the hard unpleasant things like hard work, luck, skills, talent, etc.
I think a big part of the difficulty here is that "motivation" is a very broad term, and people often mix up different aspects of it (both intentionally and unintentionally). It pretty much covers the "full stack" of goal-oriented behavior: everything from the neurological factors that balance action vs. inaction generally to the most abstract meta-goals toward which actions are ultimately directed. When people say they "lack motivation", the experience they're describing might involve any mixture of deficiency in the biological foundations of attention and behavior, lack of identifiable goals, or lack of belief/understanding in the connections between actions and goals. An aphorism like "discipline beats motivation" can't possibly come close to engaging that full spectrum, so even if there's value in the underlying idea, there will probably always be people who feel that someone saying it is misunderstanding or ignoring their difficulties.
Furthermore, I think what people are sometimes confronting when they discuss motivation is personal belief in markedly different goals than society promotes. In such cases they're not really expressing a lack of motivation generally, but rather frustration with a disconnect between the goals they actually believe in and the goals that they've been told to pursue (typically with according extrinsic reward/punishment). Telling such people that they just need to develop discipline is probably about as useful as telling atheists that they just need to go to church.
I am assuing this is in the context of some kind of mental health issue? Because this reads and feels backwards to me. Maybe it is a recipe for people without motivation, and that is fine. But I, for one, am mostly driven by motivation. I dont do things just because they are written on a list, or because someone told me it is supposedly good. I do things because I am intrinsically motivated to do so, or not. Just performing an action in hope of positive affirmation to boost motivation feels like the algorithm to drive a robot, not a human.
> I am assuing this is in the context of some kind of mental health issue?
Yes, if you are already 'self-actualized', you don't need to be thinking about behavior modification frameworks, your behaviors are already serving you.
Some people have circumstances and long-lived reactions and behaviors for those circumstances that make it very difficult to change course, even if they have a real desire to. This 'disconnectedness' between lived experience and personal goals and values can lead to a lot of anguish. In those cases, following a framework, even though it can feel 'weird', can lead to the positive sparks required for change.
It's not necessarily a "mental health issue", it's just fairly common procrastination.
Also, there's motivation and there's (self-) discipline. You get up in the morning or do things either because you feel like it, or because you have to. Of course it feels better if you feel like it (you're motivated), but if you're not motivated then discipline has to take over.
It's sort of a meme but I experience this pretty frequently with running. I've been a distance runner for over 30 years now but when I have a long run and I wake up and I'm just not feeling it, I will stare at my running shoes with pure hatred for a while before finding the courage to lace up and move. It's always the right decision, I always feel incredible once I get going, but it's sometimes very hard to summon the motivation at the onset.
Yes most of human behavior is about fear - just that we mostly aren’t aware of it. Almost everything is a coping strategy for fear - some constructive, others destructive.
Some people end up with more of the constructive ones, others with more of the destructive ones.
The way to have some control over this is mindfulness, to practice being aware of the fear whenever it comes, and then of the habitual response. And then to practice responding differently if one doesn’t find one’s habitual response constructive.
At the same time, as someone very prone to this kind of behavior, with siblings with similar issues to talk to, we've all found that few attempts at helping are more frustrating than being told "just remember that you don't need to be anxious". The entire point is that in the moment that just doesn't work. It's kind of like telling a person with ADHD to just pay attention.
This 100%. But the only time where I do have the courage to step out of that comfort zone is when I have that don't-give-a-shit attitude usually triggered by a specific life situation for e.g divorce made me not give a shit about being self-conscious about going to the gym or I'm pretty bad at asking people for help but had to approach someone at immigration to get help with my passport in front of everyone there.
I wish it comes easy like with the people I know for e.g no worries or issues at all with questioning a contractor regarding the price of remodelling a kitchen, sending back dishes due to some quality issues..etc
A little anxiety is a good thing. It’s the nagging feeling that maybe you should complete that pre-flight checklist.
I forecast a lot of doom, but try to bother only with the dooms I can prevent or mitigate. This is useful for going “I should replace that pipe before it bursts” or “I should fill up on gas here as it’s 300km to the next station”.
Where it goes wrong is doom we either cannot control at all, or cannot control without inflicting greater dooms - what someone else might think, whether the sun will rise tomorrow.
I feel we are trained (thanks, marketing. Thanks, social animals) to sensitise ourselves to a great many fears, most of which are beyond our control, and it does us little good.
Case in point: a little over a week ago I was having apoplectic paroxysms over the amount of stuff I have to do at home before winter - foundations to dig, brush to clear, firewood to gather. Then, a forest fire ripped through our land, which was somewhere in my mind as “definitely one day, probably not today, don’t sweat it, but have a plan”. The former anxiety I was letting grow out of all proportion - so fucking what if I don’t dig foundations this year? No deck. Boo hoo.
The latter, if I’m honest, occasionally kept me up at night, and occasionally hovered around the edge of my field of imaginary view, like a particularly irritating fly, but after I would reassure myself that we had go-bags packed, that we had the ability to run without hesitation, it would subside. It’s that whole agency thing - being able to take what actions you can to alleviate an anxiety. If there’s no meaningful action to be taken, it’s a useless anxiety, best forgotten.
If anything, more positives have emerged than negatives - the fire service fixed our road, which we’d been begging the council to do for years, the flammable brush is cleared, and we discovered we have a great many friends.
Sometimes it takes the manifestation of one of our anxieties to remind us what is and what isn’t worth worrying about. Watching a friend or family die also has the desired effect - but unfortunately from experience, it isn’t permanent, and we (I mean I) seem to need a slap in the face from time to time to remind us what matters.
Always comes back to uncertainty. The things we avoid have somewhat unpredictable outcomes. Fear of calling someone: who will answer, will they resent the interruption. Fear of submitting work: is it what they wanted, is it good enough. Avoiding starting a creative job for a client: am I taking the right tack, am I wasting my time?
My personal flavor of social anxiety is quite a bit different. I don't expect to have a negative social interaction (I almost never do), and when it does happen, it doesn't actually bother me that much (I find it very easy to roll my eyes and dismiss assholes).
My anxiety stems from the fear that the interaction will be exhausting. And that fear is almost always realized.
The only thing I've found that reduces my anxiety is to ensure that I am feeling very energetic (e.g., getting a good night's sleep and giving myself an extra strong dose of caffeine), to make sure the interaction happens in an easier and less tiring format (e.g., face-to-face where I can read their face and body language, as opposed to something like a phone call where I have to work extra hard to process what they are saying), and to make sure my schedule is clear for the next few days for recovery. When I can do these things, I find myself actively looking forward to social interactions and enjoying them a great deal. I can even manage to be downright outgoing and charming.
So I'm not really sure what a good solution is here. Life requires more social interactions than I can properly prepare for, and assorted necessary interactions sap all my energy for more fulfilling interactions. It creates this conundrum where I crave more interactions with my friends, but I simultaneously avoid them; even receiving a text from a friend fills me with dread.
Anxiety is maladapted for the modern world. Everyday situations in our ancestral past were legitimately dangerous so in that context it paid to be excessively cautious.
Yes, but we are one proverbial red button away from nuclear hell on Earth no ancestor could have prepared for, where a lot of anxiety will translate into a lot of lives being saved. So we’re not too far from being adapted to the modern world.
It’s just that temporarily things are going well - there are no famines, no lawlessness, and no wars. As soon as we return to chaos even a bit, all those thrifty genes and anxious genes won’t be so maladaptive.
There doesn’t even need to be a world-ending scenario. Just go live outside an urban center, among wild animals, and all these genes will help you.
Its honestly getting to that point though, and, depending on the robustness of your support network and economic situation, it can actually get that bad or worse.
> "Reality is 100% of the time, different from our imagination"
A bit of a hyperbole:
100%? So never ever we can predict reality? I think, if we focus on the core details, we are better than always wrong, perhaps even much better.
That's what I meant. Even if you imagine a scenario you can successfully predict (a cashier handing you your change, for example), how it plays out in experience is always different.
Anxiety causes you to imagine how a scenario would play out, in detail. Flashes of things going wrong, something breaking apart and all the terrible things that a horror movie director could imagine.
The thing is, if you really know it's just a fear, it's much easier to name it and overcome it. I know from myself that the worst thing that can be is anxiety of unknown origin.
So from my understanding. Anxious people are so anxious that they overload the part of the brain that typical deals with anxiety so the brain routes it to another part of the brain to deal with it and that part of the brain isn't what you want dealing with it so it cause problems.
So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.
I could be wrong, but that my understanding of it.
> doing things you are fearing to do so that you no longer fear doing it.
Careful with that assumption. I can see it completely backfiring. Doing the thing repeatedly can end up increasing the anxiety. If this route is taken, then "the thing" must be introduced very gradually and from a place of security.
As an example, for an arachnophobe, it would starting with something like "draw a dot. Draw a line coming out of the dot. Keep drawing lines up until 8. Pay attention to your anxiety levels and remind yourself that this is not a real spider, only a drawing. You are in control, you are safe". Then progressing to pictures of cartoon spiders, then the first picture of the most cute realistic spider that one can find, and so forth. It would be a process that takes months and it's not guaranteed to work. For example, a realistic depiction of a spider might be too much to handle even with a gradual approach.
On the other hand, if you tell that person "Close your eyes and open your hand. There, I put a tarantula in your hand, you see, it's innocuous!" that person is going to be scared of spiders for life.
I'm exaggerating, but hopefully it sends the point across.
Graded exposure can be a more manageable way to get to the end result (fear extinction), but reminding yourself that the threat isn’t real is a fear-neutralizing behavior that will limit the effectiveness of the treatment. The point of exposure therapy is to feel the fear and to do nothing about it other than let the feeling (eventually) climax and dissipate. (In fact, “lean in harder” can be even better than “do nothing”.)
[Edit: I want to emphasize this point for others who may find this post: if you are doing exposure work or you’re supporting someone who is, please don’t reassure yourself/them that the exposure isn’t dangerous. At best it undermines the treatment; at worst it reinforces the fear. When you violate your anxiety by facing a feared situation or idea, it will and should feel like you are doing something bad and dangerous.]
Second, graded exposure isn’t always necessary - flooding (direct exposure to the high level fear situation) works too, and can work a lot faster.
But I think most people with anxiety disorders have a number of fears not just a single isolated phobia - and they’re connected in a network of sorts. It’s often helpful for the person to experience success in extinguishing a low-moderate grade fear first, to grok the process and build confidence to approach their worst fears successfully.
In my experience, over-exposure to terrifying situations leads me to full-blown panic attacks, emotional dysregulation, crying, sometimes being trapped in a situation miles from safety with no way to get back, and being traumatized for days afterwards and (very rationally) avoiding the situation in the future. The people who want me to put myself into fearful situations are people who want to hurt me.
I’ve been there, and I get it. But if you’re on the path to extinguishing Big Fears, this is simply what the process entails. It’s really uncomfortable - until it isn’t.
> sometimes being trapped in a situation miles from safety with no way to get back
I’m not sure what you mean by this part. If you’re referring to the symptoms above (panic attacks, crying, dysregulation), I think you’d be better served to refrain from thinking of these symptoms as a loss of “safety”. They’re feelings of intense discomfort - but not danger. And they’re temporary.
> being traumatized for days afterwards and (very rationally) avoiding the situation in the future
Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.
This is not the pattern you went to be in. If you’re finding it too difficult to resist this, it might be a good idea to begin with smaller steps. That means doing less intimidating exposures so that you can be more successful in sticking with it until the fear comes down.
> The people who want me to put myself into fearful situations are people who want to hurt me
This is absolutely not true. No one gets sadistic pleasure out of the temporary pain that anxiety treatment brings. It’s just the price of getting better: to conquer your fears, you have to go all the way through them. By analogy, you can’t get physically fit without first going though some soreness and discomfort.
Based on what you wrote, I’d highly recommend finding a therapist who has expertise in exposure with response prevention. They will know, from having treated many others in your situation, how to design a treatment program that meets your needs and that you can succeed in.
The specific situation was trying to bike to a doctor's office late in the afternoon after being unable to go earlier due to non-24 sleep disorder and executive dysfunction and struggling to pack and get out of the door. After being slowed down beyond my plans by unpaved roads, traffic lights, and parking lots, I got turned away from the door when the office closed, and did not have a safe way to get back home, since the sun was setting, I was not prepared for the cold weather, and I could neither safely stay outdoors at night in an office park without food or shelter, nor safely bike home while crying, and did not have a ride arranged.
Growing up, my parents punished and traumatized me for not getting straight As in classes and cramming for extracurriculars, judged my worth based on academic performance and following their orders, fed me stories about how not getting into a top college would turn me into a burger-flipper, then forced me to the most difficult computer science program in the country, which together pushed me into burnout, dropping out, and a years-long CPTSD mental breakdown. They tried to force me to become their idea of a top student, ignoring the existential harm they caused.
Similarly, other people ignore the harm they cause (regardless if they want to hurt me or not) when they want me to put myself into unpleasant situations which have hurt me in the past for little gain (for example failing driving exams time and time again, the above-mentioned biking trip, rude and disrespectful doctors delaying care for an hour and then complaining when I asked questions and couldn't make decisions quickly enough, and psychiatrists who refuse care when I go nonverbal and want to communicate over text), and blame and accuse me of being "self-destructive" when I refuse to do as told.
> Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.
It is perfectly rational for me to not harm myself further by seeking out situations which (promise benefits, cause substantial harm, and the benefits fail to materialize as expected), and for me to avoid people who pressure me to do so. If I find a route to doing things which benefits me more than it hurts, then I will start doing it.
I’m very sorry you’ve had bad experiences and difficult circumstances. Of course, no one can make you follow a treatment protocol: you have to want the freedom that comes with conquering your fear, and be willing to go through some discomfort to get there. It’s a very personal choice.
I will say again that if you’re inclined, you might consider starting with something that seems like a small challenge. Even a small victory can really boost your confidence and motivation. Finally, you might consider working with a therapist. Telehealth is a nice option that works well for many people.
> So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.
I gave this advice in the past, but I know people with social anxiety disorder for whom this approach does not work.
I have social anxiety and pushing myself to get out there leads to massive fatigue which makes me not want to go out and do that again, it can lead to a vicious cycle.
Exposure Therapy is a great method to deal with this in my humble experience, it has to be set up with sensible realistic boundaries though, and maybe start small, like doing an imagination ET, or taking medication to overcome the initial anxiety.
Reframing this as a challenge with concrete goals rather than a problem helps too.
I'm no expert though, and I advise you to talk to a professional that can help with this.
Don't forget that this is not a problem but just another part of you, and love yourself :)
Oh yes, I've tried, and I think there may be other reasons behind why it's not right - but at the moment ET isn't working for me, I just don't have the energy to spare.
20 years ago though yes, definitely, I learned to embraced the chaos (vs needing everything pre-planned) and put myself out there.
Im also responding to the "do the things you fear" bit: I think you are right. As to why this works for some and worsens it for others, I think that depends on how you approach this.
In my experience these confrontational situations need to strike a certain place between "too easy" and "too hard". It hardly helps to throw people into situations they can't handle again and again. A more gradual approach via small wins is the way to go IMHO, with a focus on avoiding the learned avoidance patterns, heh. There's also the aspect of the perception: one needs to be able to accept small victories and see them as the improvement that they are.
But all of this is way easier said than done, especially if you have to deal with it all by yourself.
So while I think that you are technically right, I think it's easy to misunderstand for people as "just toughen up" (not implying that's what you meant, but there is this to many people unknown middle part of it that I wrote about).
IMO, the ‘just toughen up’ advice is people kind of giving up.
It’s not wrong per-se - just useless. If they could do that, they wouldn’t be in the situation! Like telling someone with PTSD to ‘just calm down’, or someone with an eating disorder to ‘eat normally’. If they could, they wouldn’t have the problem!
As a life long anxiety sufferer, I identify with your interpretation.
My anxiety devolves into panic attacks if I try to deal with it consciously - self talk, rumination, avoidance. But it goes into a dormant state when I don't engage with it consciously and just let it be.
Yeah I had a couple rough years with panic attacks, high anxiety state (always been anxious but not to that level). What you start to realize is that you are actually scared of the anxiety itself, not the situations so much. So, you sort of get caught in loop of being scared of your own emotions. The treatment is simple, but takes work and a lot of habit forming through time... but essentially you just stop thinking of the anxiety as an emotion you shouldn't have or should fear.
Like you said, just let it be and stop caring about it. Anxiety can be a good thing, it's a normal emotion. Any attempt to stop it or control it will end in disaster. Let your body/mind do it's thing. Emotions are fleeting and they will always come and go. Over time you sort "re-wire" your brain to stop panicking every-time it feels a fleeting anxious feeling.
> So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.
Which is pretty much the go-to advise for a lot of people with anxiety as far as I'm aware.
I believe this is done in supervised fashion in Exposure and Response Prevention, and also CBT. Some say ERP violates the Hippocratic Oath part about 'do no harm'.
I found the mockery of it in GTA SA quite entertaining [1]. In my own experience, it's probably best to talk to a therapist before forcing yourself into doing things you are fearing.
Physiatrists and psychologists don't take the Hippocratic oath in most cases. I don't think it's even that common for doctors to take it - definitely not in it's original "do no harm" form.
Fear is an immediate, emotional response to a known or definite threat.
Anxiety is a more prolonged emotion that arises from an anticipated or potential threat or a situation that's uncertain. Unlike fear, the source of anxiety might not be real or immediate.
- fear is transient, you feel it in the moment and then it goes away. You can then remember "boy I was scared" and feel the memory of fear but not fear itself. You can project and imagine a situation where you'd be scared.
- anxiety is a persistent state of stressful anguish. There are peaks and troughs. During peaks it can be overwhelming and look like, trigger, or mix with fear. During troughs anxiety is still there somewhere deep, it merely takes a backseat to other emotions. In every moment it biases every process your mind undertakes.
Fear is a response to a perceived threat. For example, in a panic attack you fear dying, but you are in no more danger than anyone else.
Anxiety is a kind of fuzzy term because it encompasses an overall pattern and cycle as well as the associated feelings. But a useful distinction is that anxiety is driven by avoidance of fear of some uncertainty, and exposure and acclimation to that fear (without avoidance) is what extinguishes the anxiety.
Avoidance can take almost any form, but common examples include worry and rumination, procrastination, compulsive rituals like hand-washing or internet research, self-medicating, and superstitious behaviors. And of course, literal avoidance.
I think this splits hairs. Yes, fear means "perceived" threat. You could be acculturated to handling venomous snakes, but that doesn't male the average modern society dweller pathologically fearful of the same snakes. Anxiety is about the distorted anticipation of a threat. E.g., the snake handler has been doing this his whole life, but after seeing his brother accidentally step on one, get bitten, and die, he starts fearing that every one of his future interactions with snakes will be so likely to entail that outcome that he refuses to touch them anymore, and can't avoid a panic attack if he's in the room with one, despite all his past skill.
I was responding to a suggestion that fear occurs when the trigger is a “real” threat. But of course, the feeling is the same regardless of whether the hazard is real.
Also, since I’ve already been accused of hair-splitting, I might as well point out:
> can't avoid a panic attack
There’s no need to avoid a panic attack. In fact, trying to avoid a panic attack feeds the panic.
If your interpretation is correct, it seems that there could be some truth to the old wisdom of (gradually and willingly) facing our fears in order to develop more courage.
For those who didn't read any of it: anxious people's brains use a different area when regulating emotions. Unfortunately the connection to this area may be more easily saturated during high emotional states.
So, over stressed/anxious brains appear to have a different routing setup than everyone else. Very interesting find!
> Unfortunately the connection to (*the usual area = FPl, that's a L not an i) may be more easily saturated during high emotional states.
I do wonder if the FPl is overactive and needs to be slowed down like the article suggests (which hurts behavior in non-anxious people), or if the amygdala is jamming the FPl with excessive signalling (and needs to be slowed down).
Yeah, I was thinking about the treatment possibilities while reading. My wife has very high anxiety, which cannabis edibles mitigates pretty well, so I wonder if the pot is affecting those areas.
If you suffer from serious anxiety, I highly recommend you work on any health issues you have. Low blood sugar in particular is known to promote anxiety by increasing the amount of adrenaline in your system.
I used to suffer a lot of anxiety. Getting physically healthier helped mitigate that enormously.
Proviso: n=1, "anecdata" and the usual dismissals that random internet strangers desperately try to apply as if I somehow misrepresented myself and claimed it was from a large scale study.
health issues can both directly and indirectly make your psychological issues worse (or even be the direct cause of it)
and also the other way around
I think many of the "dismissal" (assuming non troll) comments come from with health issues people being feed up with getting the force feed the same advice they long time now every time their health comes up without the person giving their advice understanding their health issues. (e.g. not you because you just wrote what helped you in a neutral way).
For example some absurd examples I have seen repeatedly:
- a person with serve enough clinical depression to just be a step away from getting suicidal getting told "just do sports it will help" for the thousands time in a situation where they frequently have issues to even eat because their brain just stopped caring about being hungry
- or a person with motion sickness from certain games being again and again told the same set of well known and years ago tried advice, potentially combined with "you must never try VR" even through they did try VR and depending on the title it's not an issue as long as movement in VR is done through motion tracking
- or a person which had to stop their masters degree because of sever depression and anxiety being told "oh it's you could have done the masters because I was able to do so" when that other person just had a mild depressive phase due to overwork
- or people which had Vitamin-D deficit (which is really good at making other health issues worse) now insisting that every time they meat a "sick" person they should take Vitamin D supplements because sure their trauma induced psychological issues are just a Vitamin D deficiency.
Just to be clear I appreciate your your post, this is not trying to dismiss it in any way. In different to many of the examples I listed you bothered to formulate it neutral in a "this helped me, fixing health issues can help, here is why it helped me if you thing this could apply to you why not try it" way instead of a "this helped me so it 'must' help you too way". Through the line between both formulation is thin, and not seldom a matter of tone which is often lost in writing.
Eat regularly, do physical exercise, go to bed at the same time, etc etc. All good advice of course, but when you're in that situation they're not easy. It takes self-discipline.
Also: Not necessarily the best means to work on your health. Sometimes you need dietary changes or to ferret out an unrecognized allergy -- allergy being another thing that promotes adrenaline -- and/or other changes to figure out what went wrong and how to walk it back.
have agoraphobia pretty bad. I've spent so much time trying to work on exposure, but then I'll have a huge panic attack, I don't have access to my frontal cortex to reason through it, during this time I'm feeling the immensity of the universe, I feel electricity running through my body, at the end of it all when I get somewhere "safe" I'm not able to think straight or sleep well for months. So yeah the impulse to avoid those feelings is pretty strong. I'll push myself once again in the future but the risk reward ratio is pretty bad. Thanks brain wiring!
Extreme agoraphobia probably requires more than just simple exposure to improve. I'd recommend working with a therapist. But one thing I am curious about: during exposure, you don't have access to your frontal cortex, that makes sense. But after exposure, do you spend any time reflecting, and reminding yourself that nothing bad actually happened to you? It might be that exercising your frontal cortex afterward could help you learn to cope with the situation in the future. At least, that's what I've done with social anxiety and it seems to help.
Not a psychologist, but you might need to build exposure more slowly, and maybe check for other issues (such as generalized anxiety disorder, avoidant personality disorder, hypochondria) because a panic attack should not take months to recover from.
> Agoraphobia involves fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed. You may fear an actual or upcoming situation. For example, you may fear using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.
Wait, do I have agoraphobia now?
I thought we were still supposed to be avoiding indoor spaces and crowds on account of the highly infectious disease propagating the globe.
We're supposed to be comfortable sharing air with others again?
I wouldn't say avoiding others during a pandemic is agoraphobia, it's a rational response. But after a society has largely resumed dense public activities, it's only possibly a phobia if you've formed a personal preference to partake based on your own risk/reward tolerance yet find yourself anxious to do so.
There is a coherent argument to be made that the problem of misplaced anxiety is so prevalent/fundamental to the species, that dreaming is a built in mechanism for diagnosing it.
A summary of the paper is:
Anxious states involve: The default mode ("imagination") network, high levels of the fight-or-flight neurotransmitter norepinephrine, and an active amygdala.
REM dreaming states involve: The default mode ("imagination") network, extremely low levels of the fight-or-flight neurotransmitter norepinephrine (80% below base levels), and (surprisingly) an inactive amygdala.
The content of dreams can be viewed as inverse anxious mind wandering, where situations we find ourselves in actually encourage confrontational behaviour, however we are able to observe our avoidant behaviour with clarity that is not so present in waking life. (This also indicates that anxious structures are not really associated to the neurological state, as in we still seem to follow our anxious patterns even when norepinephrine levels are low, implying that the structures that represent them in our brain are not affected by different levels of norepinephrine/must exist outside of something so variable.)
It's a great study. I would welcome if they did the same experiment and analysis on groups of people who had an anxiety disorder diagnosed and got healed, preferrably with CBT or other non-pharmacological methods alone, and a healthy population. It would be interesting to see the effects of therapy on this mechanism and whether an higher excitable FPI stays activated in the healed cohort or it's exitability is less, or the amygdala activation is again the root of all of this. It's notable that some healthy individuals had high FPI excitability but were not anxious.
I wonder if this shift of processing areas is behind the the "detachment" or "depersonalisation" (feeling like you're in autopilot, or not being you) that seems to be a common response to high anxiety.
The language of this is challenging for me to read and understand.
Is there any clarity on whether high anxiety leads to this different routing, or whether there has been some event in the past leading to this routing which then leads to high anxiety?
And is there any indication whether exposure to feared situations will lessen anxiety after this difference in routing is in place?
According to the paper avoidance begets avoidance.
Avoidance and success in anxiety inducing situations both lead to relief. Most of us have plenty of experience of both leading to balanced future responses.
My understanding of this is illuminated by (stay with me here...) blockchains.
Most blockchains use a kind of time-traveling/holographic data structure where a given tree root can be used to lookup state values in a big trie, for some block in the past. Different root, potentially different value for the state you're interested in.
The brain seems to be operating a similar data structure where the answer to your query depends on some sort of "neural net root" value. This value seems to come from primitive structures (HPA?) and depends on basic things like fight/flight anxious/relaxed.
The upshot is that people can believe/think/know different things depending on their current emotional state.
"Anxious individuals consistently fail in controlling emotional behavior, leading to excessive avoidance, a trait that prevents learning through exposure."
This is just tedious. The electro-chemical map of the brain that is built and used to study it, is so primitive.
Almost certainly, "the brain" tunes itself to its environment and inner states from a preformed inner structure through evolution. A lot of what is in the brain, is not actually to be found in the brain, or by studying it materially. The "formwork" that formed it, is lost in evolutionary time.
Unfortunately there is no way to impute the formwork from the form, like say it would be possible to (mostly accurately) impute what formwork created a square column or cast a piece of iron.
"The brain" is not in any way shaped like a physical object, and the formwork that formed it is infinitely complex.
> A lot of what is in the brain, is not actually to be found in the brain, or by studying it materially.
You are talking about consciousness (and perhaps the non-conscious processing that the brain does as well). That is indeed a non-physical phenomenon, but it still has physical underpinnings.
> The "formwork" that formed it, is lost in evolutionary time.
You can't lose something that you never had in the first place :). It will take that as a figure of speech.
The good news are: we are very familiar with some things that "exist" but don't have a physical presence. On this forum, "software" is the most obvious one. "Math" is probably the second. There's many others, like all the emotions, entropy, and so forth. We can, to a certain degree, reverse-engineer some of these processes by looking at the physical imprint that they leave. It's true that we never get a full picture - the same way that just looking at the source code might not give you a good idea of how the RAM will look like when the program is executing. But it can give you some insight. And then, if you are lucky, you may be able to fill in the gaps.
The bad news: this is the most imbricated and complex piece of "code" that the humanity has ever faced. Our brains might simply not be capable of understanding their own complexity by themselves. Most of us have a "cache" of 7 items, after all. Barely good enough to swing to the next tree branch.
But then again some good news: the complexity is definitely not infinite- just very big. And we keep improving our tools. The same way some of them expand the limits of what we can physically do with our bodies, some of them expand what we can mentally do with our brains. Wether or not that will be enough for us to understand ourselves, to a certain definition of "understand", is still up in the air as far as I'm concerned. I'm agnostic about it.
"The brain" is not physical like columns or iron. Those are simple objects. The kind physics likes to deal with. Things that are easily measured to describe its properties quantitatively and the relations of these properties as a placeholder for qualitative aspects (equations). Physics can't deal with the brain. No equation can be written.
If a bud's seeds were to sprout in place, instead of in the ground, you would have every single ancestor plant in a very long chain. Every brain is the result of this kind of structure. A mother buds and sprouts a new human. If the umbilical cords remain attached, we have a very similar kind of long chain of human brains. Not like any other physical object.
Physics is inadequate at studying "the brain". So, "the brain" is not a physical object.
> Physics can't deal with the brain. No equation can be written.
There are many many many physics simulations out there that cannot be "written with an equation". Climate Modelling, for example. You cannot write a single equation to model all that. You need a big complex piece of software, made of many equations, a lot of hardware, and a lot of processing time. Any of those was simply inconceivable mere decades ago.
It's possible that it's as you say, and the brain is inscrutable if we attack the problem from the physics point of view alone.
I think that you may be right. With what we have now. But decades from now? I'm not so sure.
All climate models are based on mathematical physics models. I don't know the specifics, so I asked chatGPT and here is what it said:
'''
Climate modeling is a multifaceted field rooted in physics that relies on a complex set of equations to describe various atmospheric, oceanic, and terrestrial processes. Here's an overview of the key equations that form the foundation of climate models:
Navier-Stokes Equations: Governing the flow of fluids like the atmosphere and oceans, these equations capture how the velocity of a fluid changes over time.
Radiative Transfer Equations: Essential for understanding how sunlight and other forms of radiation interact with the atmosphere, including scattering, absorption, and emission.
Energy Balance Models: These equations describe the balance between incoming solar energy and outgoing heat, fundamental for capturing the planet's energy dynamics.
Equations of State: Linking density, pressure, and temperature, these equations are critical for understanding the behavior of the atmosphere and ocean.
Continuity Equations: Representing the conservation of mass in the atmosphere and oceans.
Moist Processes Equations: Capturing phase changes between water vapor, liquid water, and ice, along with latent heat exchange.
Boundary Layer Equations: Describing the complex dynamics near Earth's surface where the atmosphere interacts with the land or ocean.
Chemical and Aerosol Equations: Governing the reactions and interactions between different chemical species and particles, which can affect both weather and climate.
Sea Ice and Glacial Equations: Modeling the flow and melting of ice, essential for understanding the cryosphere.
These equations are solved numerically using computer algorithms, often over a grid representing the Earth's surface and atmosphere. Together, they form an interconnected system that allows scientists to simulate and analyze the climate system's behavior. This intricate mathematical framework underscores how the study of climate is fundamentally rooted in mathematical and physical principles.
In the context of human behavior, consciousness and neurology, what are the mathematical equations that are relevant in order to model how a human brain works? Please highlight any equation that involves Physics in particular
ChatGPT:
Modeling the human brain is an extremely complex task, and it involves various levels of abstraction and different mathematical and computational approaches. While there are no specific equations that fully capture the intricacies of the brain's function, several mathematical and physics-related principles can be applied at different levels of analysis. Here are some relevant equations and concepts:
Neuron Modeling:
Hodgkin-Huxley Equations: These equations describe the behavior of ion channels in neuron membranes and are fundamental to understanding how neurons generate action potentials.
Integrate-and-Fire Models: Simpler models like the Leaky Integrate-and-Fire model can describe the basic firing behavior of neurons using differential equations.
Neural Networks:
Backpropagation:
This is a fundamental algorithm for training artificial neural networks. It involves the chain rule from calculus to update weights during training.
Activation Functions: Functions like the sigmoid, ReLU (Rectified Linear Unit), and softmax are used to model the activation of neurons in artificial neural networks.
Synaptic Plasticity:
Hebbian Learning:
Often described as "cells that fire together wire together," it's a principle used to model how synaptic connections strengthen or weaken based on correlated firing patterns.
Diffusion Equations:
Fick's Law of Diffusion: Relevant for modeling the diffusion of neurotransmitters across synapses.
Information Theory:
Shannon's Information Theory:
While not an equation per se, concepts like entropy and mutual information are used to quantify information flow and coding in neural systems.
Quantum Mechanics:
While not directly related to classical neuroscience, there's ongoing research into whether quantum effects play a role in brain function. This would involve quantum mechanics equations such as the Schrödinger equation and the equations describing quantum states.
Connectome Modeling:
Graph Theory:
Modeling the brain as a network involves concepts from graph theory, like adjacency matrices and graph algorithms. While not a direct physics equation, it's relevant for understanding brain connectivity.
Functional Imaging:
Techniques like Functional Magnetic Resonance Imaging (fMRI) rely on physics equations related to magnetism and nuclear magnetic resonance to measure brain activity indirectly.
Biomechanics:
Equations from mechanics can be used to model the physical properties of the brain, like deformation during injury or the propagation of mechanical waves in brain tissue.
Electroencephalography (EEG):
Maxwell's Equations: EEG measures electrical potentials on the scalp, and the interpretation of these signals relies on Maxwell's equations describing the behavior of electric fields.
It's important to note that modeling the human brain is still an active area of research, and there's no single mathematical framework that fully explains all aspects of brain function. Instead, a multi-disciplinary approach is used, combining mathematics, physics, biology, and computer science to gain a better understanding of the brain's complexity at various scales, from individual neurons to large-scale brain networks.
Yes but resolution and coherence matters. A map that says "here be dragons" is not high resolution. A map that misidentifies or misses parts is incoherent. The brain is not physical (as explained above), and cannot be captured in a sufficiently high resolution map that only studies substance and its interactions. Since we have no access to the formwork, we will always have missing data, that hampers our ability to create such a coherent map.
Thank you for staying engaged, it's helping me see my position more clearly.
Don't understand the downvotes because I get exactly what you're saying -- it's like poking around in the data for an LLM and expecting to find a written language algorithm. Taking things further -- I think it's unlikely that much of the brain's operating software came via DNA. It's mostly machine learned from the environment and other humans. We call this child development.
> It's mostly machine learned from the environment and other humans. We call this child development.
Yes, exactly. The software lies in humanity collectively. Not inside us, but in between us.
Which is why it cannot lie entirely in the brain. At least not entirely in one brain.
A new node born into the network, learns the network. Individual nodes perish, and new ones replace them. But the network doesn't go down. Or it hasn't yet.
Much of conscious experience is the network. Isolation is painful because it deregulates the connection to the network.
But even on the "hardware" side, there must be so many kinds of developments that must occur simultaneously. Some of it is as you say, environment based child development. Others that we may not quite be aware of, say patterns of neural firing, or growth patterns. Such developments probably get passed on in shape (DNA or X) to the next generation.
When a vortex forms in a pool of water, it is formed by the complex interplay of water, the pond made up of earth, rock, plants, its undulations perturbing the water, the wind etc.
The vortex appears and vanishes as conditions change. But is the vortex, the water? Is the water no longer water once the vortex dissipates?
Is the vortex the same as any physical object? Or it’s a form taken up by water?
What if the brain is just the form. And what if the water is itself just a river fed by ocean currents millions of miles away?
Standing by the river, you only experience the form, not the formwork, the substrate, or even the shaping force in time.
I may have made this a worse explanation… hard to tell.
Wish I could give you an npm package for that, but best I can do is a process:
[0] keep a log / journal
[1] make a change
[2] observe the result
[3] iterate
[0] is to raise awareness and detect cause and effect. Keep it minimalist. I once went overboard with a whole spreadsheet. Plain text turned out better. What to track? Inputs (food, media, activities) and outputs (physical and psychological state).
[1] Try eating better, exercise, changing media exposure, time outside. If you go down the supplement rabbit hole, start with simple things like magnesium. Attach new, better habits to your existing routine.
[2] Watch out for delayed reactions. For instance, what I ate 48 hours ago has significance.
[3] while(true)
Random bonus: if there is something that negatively affects you, seek out its polar positive opposite. I'm very easy bothered by sounds. Leaf blowers shall die. But this also means sounds have a strong positive leverage on my mental state:
https://youtu.be/gKdFbdrk-58
the results of this study can, in combination with other studies over time, potentially, lead to better treatment methods. Weather that's better assistant medication, better ways to apply treatments or a better understanding of some of the unusual treatment methods.
But what is described in the paper seems to me to be a fundamental mechanism of the brain to cope with anxiety overload. And that we can't fix, because it isn't really broken. I mean compare it to a bit far fetched example: Water spill ways. Especially on a larger scale they always come with drawbacks and you can't fix that. What you can change is stuff like how you wire up the spill way (e.g. when and which gates opens when) or e.g. how likely they need to be engaged (by upstream changing things), or how well you (as a city) cope with whatever drawbacks the specific water spill way has. For all of this properly understanding the underlying mechanics is important. And this is what the paper is about, properly understanding the mechanics so that we can provide better treatment.
If you suffer from anxiety, and haven't tried any of the following yet, worth giving a go: escitalopram (with medical supervision, also 10mg did nothing for me, 20mg was life changing), ingesting silexan / lavendar oil, L-Theanine with your coffee, less coffee, less alcohol, propanalol (see a dr) instead of benzos for break-through anxiety, ashwagandha.
I personally have tried and agree with L-Theanine to reduce coffee anxiety without killing its alertness power, and anxiety certainly spikes a day after a night out drinking. But I think we are missing here the most important levers; 1) a steady regimen of well-scheduled exercises and injury-preventing recovery work, 2) a well-scheduled nutritionally balanced diet free of inflammatory products. Julia Ross’s The Mood Cure goes into specifics for the latter, for example sufficient L-Tryptophan is important for a feeling of well-being. I think scheduling is key because stress increases with energy unpredictability.
I think I'm not qualified to talk about other people's mental health, but I haven't noticed much of a difference between periods when I exercise consistently and those where I don't. I'd always recommend people throw everything they can at chronic anxiety though, and consistent exercise is a win in its own right.
The devil is in the details with exercise, just as it is for nutrition. There are so many ways to do exercise that ultimately increase anxiety; over the years I've had exercise regimens that made sleep difficult, or created increased inflammation (through oxidation, brief injuries or by being more careless with food/drink), or by increased muscle tightness, or lead to me not getting ahead at work because of time spent exercising. I find I have to be very clear on my exercise objective. Six Ironmen and many marathons later, I see I easily get caught up in athletic targets that are not helpful to my life goals.
It's really a roll of the dice. My mother was scared of me getting on Escitalopram because it gave her panic attacks but it was literally a silver bullet from me. 10mg a day turns me from a broken brain to a mostly normal human brain. It's such a lightswitch effect that sometimes I wonder if I'm overselling it to myself, and then I forget to get my prescription refilled for a couple days and I can feel that anxiety creeping back in from the edges, trying to make it's insidious way back into my life, and then I remember why I take it.
My understanding is that each SSRI type med has a roughly 30% chance of working for you, though the odds are slightly connected for SSRIs that are similar.
Completely anecdotally it seems to be much, much more effective for GAD than depression. I did have a panic attack on the 3rd or 4th day of taking it (and interestingly the only one I've ever had), but I kept going. 10mg to 20mg was the light-switch for me: I was on 10mg for about 3 months with no noticeable difference, and then 15mg (climbing to 20mg) was exceptional. I have a graph from the time when I was recording my mood 10-30 times a day, and it goes from being all over the place to just being in a relaxed state.
Also: "Escitalopram was well tolerated and only 7% patients withdrew, due to adverse events in the escitalopram group, versus 8% in the placebo group" -- people with anxiety disorders have panic attacks when they start lexapro at about the same rate as people who think they're on lexapro but aren't!
Also I do recommend trying any/all of the others things I mentioned as an adjunct, they've all got some decent science behind them, and defense in depth seems like a good idea to me.
To me this is not necessarily dysfunctional. It may also go hand-in-hand with motivating heightened deliberation. I can see how one can fall into regressive patterns like distracting ourselves away from critical path actions, especially if a particular person only uses one of two strategies, 1) try going on as before or 2) try forgetting we need to go this way.
I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. They show that even mild emotional challenges can saturate FPl neural range, which to me is simply a greater sensitivity that can be easily overloaded (like when you put the voltmeter on a more sensitive setting). Exposure Therapy is a methodical, deliberate, routine heavy strategy. ET doesn’t simply get us to re-engage, it gets us to re-engage with new and different behavior, which may be essential to success.