Anxiety Really Sucks!

We’d all like to believe that we think  in an objective, rational manner. Unfortunately, our minds are hardwired to see the world in an egocentric frame of reference, and thus information tends to get distorted, lost, or invented. Over the course of evolution, the human brain has evolved many mechanisms for extracting the most relevant information out of the surrounding environment without having to overload its senses.

One broad category of such mechanisms is the cognitive bias. Cognitive biases have evolved to speed up judgment times and make decisions easier to come by. However, by decreasing judgment time, your brain often sacrifices objectivity and precision. Decision-making mechanisms that speed up reaction time (while sacrificing accuracy) are referred to as heuristics, and there have been many identified in cognitive psychology. Cognition can also be persuaded by goals or motivational states (we often perceive things as we’d like to see them).

Cognitive biases not only interfere with your day-to-day perception of the world, but can also affect the way you see your illness and when you choose to seek treatment. In today’s post, I want to go over four basic cognitive biases that could be hindering your anxiety treatment plan.

Confirmation Bias. 

What is it? Humans have an overwhelming tendency to confirm their own beliefs. Hence, it shouldn’t come as a surprise that we’re hardwired to do just that. The confirmation bias is the tendency to collect information from our surroundings that supports ideas or beliefs that we have already formulated.  It’s hard to think objectively when your brain is constantly searching for information that validates your beliefs.

How can it disrupt treatment? If you think that your biggest anxiety trigger is the smell of perfume, then you’ll notice every time you feel anxious around someone wearing a heavy scent. Unfortunately, the confirmation bias may lead you to miss other obvious triggers. The confirmation bias will make it difficult for you to pinpoint your anxiety triggers because you will likely already have an idea of what’s causing your anxiety. Overcoming the confirmation bias is an essential part of cognitive therapy.

Hindsight Bias. 

What is it? The hindsight bias is closely related to the confirmation bias; both are examples of how overconfident we can be in our own thoughts and beliefs. The hindsight bias is the tendency to overestimate how predictable something was after it has occurred (“I knew it all along!”). For example, when you get an A on a midterm, you “knew” it would happen because you studied so hard.   Cognitive biases like the hindsight bias probably derive from cognitive dissonance: the discomfort we feel when we hold two or more conflicting ideas. “I thought I was going to get an A on that midterm, but I got a B.” These two conflicting thoughts make you feel quite uncomfortable; so you rectify them. “Well, it wasn’t a fair exam. I have an unfair professor.” Hindsight bias is one of the many ways we can reduce the amount of cognitive dissonance we feel. Obviously, when I’m right I knew it all along. When I’m wrong, something happened that was completely out of my control.

How can it disrupt treatment? You may find yourself overly confident in your ability to predict panic attacks or sudden onset of anxiety. Over time, you may become so confident in your ability to predict your panic attacks that you stop following your treatment plan. The ability to predict when we’ll feel anxious is falsely comforting, sometimes encouraging us to think we’ve “conquered” our illness. From time to time, I’ve found that I become so confident in my ability to deal with and predict my anxiety that I stop doing the things that keep me calm. Eventually, falling off my treatment plan comes back to bite me, and the anxiety gets worse again.

Availability Heuristic. 

What is it? The availability heuristic occurs when we make decisions or judgments based on how easily information comes to mind. For example, if you’re out buying a new car, and you remember your uncle telling you about how much he loves his new Honda, you may be persuaded to buy a Honda. When memories are available to us, they can be quite persuasive. Many students unknowingly use this tactic to answer multiple choice questions; read the question, and whatever comes to mind is probably the right answer. Professors can take advantage of this mental short-cut to trip up their students and make misleading questions. This heuristic can be used to make a lot of false assumptions, and can enhance the effects of an illusory correlation (a situation where two things seem related, but are not). For example, say you have two friends from Belgium. Both of them happen to be fans of the show Friends. If asked whether most Belgian people like the show Friends, you’ll probably say yes. Hopefully you can see how irrational that is; two individuals are hardly a representative sample of a population of 11 million. We use the availability heuristic in many different areas of our lives to make decisions, both trivial and important.

How can it disrupt treatment? Like the confirmation bias, the availability heuristic can distort the way you see your anxiety triggers. If the last time you felt anxious happened to be while giving a presentation in class, you may become convinced that presentations are your biggest problem, while this may not be the case. This can lead you to start solving problems that aren’t really problematic – while ignoring problems that are severely impacting your life.

Anchoring Effect. 

What is it? Anchoring occurs when we base decisions on deviations from a set piece of information we’re given. For example, if you’re told a watch normally costs $100, but you can get the watch for $80, it will sound like you’re getting a deal – even if the watch is only worth $50. The first piece of information we receive surrounding a decision will anchor how we approach that decision.

How can it disrupt treatment? Labels can act as anchors to disrupt your perception of your illness. If you’re initially told you may be suffering from obsessive compulsive disorder, that label will act as an anchor to guide the way you see your illness, and can influence the treatment you decide to undergo. The anchor may dissuade you from exploring alternative diagnoses like post-traumatic stress disorder or generalized anxiety disorder.

The human brain is an incredible organ, capable of astounding feats that (as of yet) are not reproducible in the lab. We are constantly being bombarded with a daunting amount of sensory information, and it’s a wonder that any of us can make it out the door in the morning without being overwhelmed. Our brains do their best to keep us living happy, healthy lives free of decision fatigue, sensory overload, and debilitating stress. But sometimes, the very mechanisms our brains use to lighten our cognitive loads can also be those obstacles preventing us from overcoming illness. Being more aware of the various cognitive biases that plague the human race can have a noticeable impact on your treatment outcomes.

What cognitive biases are affecting you? Leave me a comment if you have stories of your own cognitive bias.

You may be asking yourself, “How could I possibly be breathing incorrectly? I’ve been breathing since I was born, how could I screw it up?” Well, for those of us who have joined the anxiety club, breathing may be something that we just can’t get right. It has been known for a long time that anxiety sufferers tend to hyperventilate more often than the average person (see, for example, this scholarly article or this one). While researchers haven’t really distinguished the directionality of the association (does anxiety cause hyperventilation, or vice versa?), it is clear that a frantic state of breathing exacerbates underlying anxiety.

Let’s go into a brief explanation of what hyperventilation does to you. When you breathe faster than normal, you are expelling carbon dioxide at a much quicker rate, which would be okay if you were running a marathon and creating more carbon dioxide than usual, but chances are that’s not the case. What happens is that the concentration of CO2 in your blood falls drastically, sending you into a state of respiratory alkalosis – where your blood is more basic (less acidic) than it should be. This increase in pH is interpreted as a signal that you have too much oxygen in your blood (which isn’t true), so your blood vessels constrict and less oxygen makes it to your brain. Low oxygen levels in your brain give you the characteristic symptoms of labored breathing: numbness/tingling, lightheadedness, dizziness, headache and fainting. You might notice that these symptoms sound a bit like a panic attack. Cue the “Aha!” moment.

So how can you avoid hyperventilation, you might ask? Here are some simple steps you can take to reduce your anxiety through proper breathing techniques.

• Monitor your breathing during periods of increased anxiousness. Make the effort to start noticing your breathing patterns – do you hyperventilate more when you’re anxious? If you don’t, then maybe you are already breathing correctly. Chances are that either way, you’ll benefit from learning proper technique.
  
• Does your stomach expand or retract when you breathe? If your stomach is expanding, then you’re breathing correctly. If not, then you need to work on your technique. Correct, deep breathing is about expanding your diaphragm to get the most air you can. Slow, deep breathing will actually activate your parasympathetic nervous system (the so-called “rest and digest” system) that will calm you down. Incorrect “chest” breathing will not help.
• Try some breathing exercises every day. Make room in your day for 10 minutes of deep breathing. You can train your body to breathe more effectively if you just take the time to do so. Here is a resource that I found helpful when I was learning proper breathing technique.
• Take deep breaths when you feel anxiety coming on. Remember that deep breathing will calm you down. It certainly won’t eliminate all of your anxiety, but I’ve generally found that if I focus on my breathing when I feel a panic attack coming on, I can calm myself down in time to get through whatever situation I’m stuck in.

Diaphragmatic breathing is an important tool for anyone suffering from anxiety or high stress levels. Deep breathing even feels calmer, and sometimes the difference between labored breathing and calm breathing can be all it takes to ward off panic attacks or drag you out of a state of prolonged anxiousness.

Picture yourself riding a wave when you’re accepting your panic attack.

For many of you, the most troubling aspect of your anxiety is the thought that it might strike when you can’t take the time to deal with it. Maybe you’re sitting in a meeting. Maybe you’re in the middle of a final exam. Maybe you’re at a party with some friends that don’t know you very well. Whatever the situation, it puts you on edge to think that a panic attack could overwhelm you at any moment. 

In today’s post, I want to go over some simple ways that you can reduce the acute fear that surrounds panic attacks, and how you can deal with panic attacks when they happen.

Before the panic attack:

• Accept that a panic attack could strike. Let go of the notion that having a panic attack in public would be the end of the world. Come to terms with the fact that you could panic in an inconvenient situation. What’s the worst that could happen? Maybe you have a panic attack during a meeting, and you have to step out to the bathroom for a little while. Maybe you have to head home to take a sick day.
• Remember that a panic attack can’t kill you. You are in no danger of dying, having a heart attack, suffocating, or being harmed in any other way. Panic attacks are certainly real, but the physical sensations they cause are not. Another good thing to remember is that the typical panic attack will reach its peak in about 10 minutes, so if it does happen, it won’t last as long as you think.
• Ignore other people’s perceptions. For many of you, your real fear is that people will judge you. From my experience, most people are quite understanding when it comes to panic attacks. Reaching out and telling someone you are at risk of having a panic attack may actually do more good than you’d think. If you’re not comfortable talking about your anxiety, that’s okay too. Just tell others you’re not feeling great and asked to be excused. Think about how concerned you are with other people’s perceptions of you, and then imagine that everyone else is thinking the same thing. Most people are so concerned with what other people are thinking that they don’t take the time to notice what others are doing.
• Think calming thoughts. If you feel a panic attack on its way, there’s no point building it up in your head. Try to think calmly and positively about it. When I feel a panic attack coming on, oftentimes I’ll start laughing to myself. I find it funny that my brain is still convinced that a rising heart rate is a sign of danger, so I laugh at myself. Maybe you’re not at the point of humor, but at least you can try to avoid the catastrophic thinking. “I feel a panic attack coming on, but I know I’ll be okay.” “I only have to sit through 10 minutes of panic, and then I’ll start to feel better.”

During the panic attack:

• Accept that it’s happening. There’s no point trying to ignore it – chemicals have started coursing through your blood, readying your body for action. You can’t hide from a panic attack.
  
• Think coping thoughts, ignore negative ones.  Like I mentioned before, try not to build the panic attack up in your head. Think things like “This will be over soon” or “I’m going to be okay, nothing bad can happen to me.”
• Take deep breaths. Diaphragmatic breathing is very important here – take in deep breaths, making sure your stomach is expanding (not retracting), and let them out slowly. You want to signal to your body that there’s no danger. Slow, deep breathing is a way of activating the relaxing mechanisms in your body to override the panic attack. Hyperventilation, which is the default panic state for most, decreases the carbon dioxide concentration in your blood, which triggers mechanisms that reduce the amount of oxygen flowing to your brain – increasing your anxiety.
• Distraction. Once you’ve accepted that the panic attack is happening, you may want to keep your mind engaged. I find that doing mental arithmetic helps keep my brain focused on something other than the anxiety. I keep doubling numbers until I can’t keep track anymore (2, 4, 8, 16, 32, and so on).
• Feel new sensations. Exposing your senses to new stimuli can be a powerful force to combat your anxiety. However, everyone has different triggers, so there isn’t one way to accomplish this. Sometimes I want to see a familiar face or be hugged by someone I feel close to, other times I want everyone to get the hell away from me .  Sometimes I find that smelling lavender oil helps, but other times it gives me a headache which just makes me feel worse. It takes some time to figure out what sensations can help you while you’re panicking, so don’t use this as a first line of defense.
• Advanced tip: Stay put. When you have a panic attack, I know the first thing that comes to mind is: “Get me the hell outta here!” It’s hard to stay put during a panic attack, but there’s an important reason for it. Anxiety is largely a result of faulty learning: instead of learning that a tiger or bear is a sign of danger, you’ve learned that a phone call or a group presentation is a sign of danger. Avoiding the things that make you panic is like telling your brain “Yes, you’re right, sitting through a meeting could kill me.” Once you’ve found your anxiety triggers, you will want to try to expose yourself to them without running away.

Panic attacks really sucks, huh? If there’s any take-home message I can emphasize here, it’s to learn to accept the panic. Don’t let it rule your life, or you’ll end up housebound. If you’re new to this whole anxiety stuff, then take the time to deal with it now before it gets any worse. The longer you leave your anxiety unacknowledged, the harder it will be to overcome later on.

How do you survive your panic? I’d love to hear from you. Leave a comment below!

Are crowded places making you anxious?

You’re sitting on a crowded bus, and suddenly your heart rate spikes, your breathing becomes irregular, and you get an overwhelming sense of dread. You’re going for a nice long run, and then suddenly you feel like the world is closing in around you and you can’t breathe. You’re at a party having fun, and then your ex walks in and you feel your hands trembling, your palms sweating, and your temperature spiking.

In all of these cases, you are experiencing some form of anxiety. It seems like the anxiety came out of the blue, but something must have caused it, right? Most certainly. Anxiety triggers will be very different for most of you. If you have social anxiety, you might get anxious when you have to give a presentation or when you’re forced to be assertive. If you’re a panicker like me, you may get anxious when your heart rate rises or your breathing becomes irregular. If you’re obsessive-compulsive, you might find that intrusive thoughts are causing anxiety.

Here is a simple step-by-step guide to help you identify your anxiety triggers. I suggest that you keep a small journal handy to document your experiences.

1. Be vigilant. Stay focused on your feelings, and try to pinpoint exactly when a wave of anxiety starts. Note your heart rate, your breathing, your trembling, and your emotions. The first step to identify your anxiety triggers is to notice the exact moment when your anxiety starts (this can be harder than it sounds).
   
2. Record your surroundings. Have a journal or notebook handy. Write down everything you can about your physical environment. Where are you? What are you doing? Are you alone or with friends? Are you in public?  Be as objective as you can.
3. Record your thoughts. Much of your anxiety comes from your false beliefs and assumptions. Take some time to write down what you’re thinking about when the anxiety starts. Are you having negative thoughts? Are you worrying about a future event? Are you overly conscious of other people around you? Try to figure out what it is that’s making you fear the situation.
4. Keep recording for a week. Every time you start feeling anxious for the next week, record everything you can about the situation (remember to look internally as well!). The biggest obstacle you’ll face here is hypothesis myopia: you will start to develop an idea of what’s causing your anxiety, and only notice evidence that supports your hypothesis (this is called a confirmation bias – we’ll talk more about that later). Keep being objective! Record everything, not just what you think is important.
5. Go back and analyze your records. Remember to start looking at your findings without a prior hypothesis. Sometimes, I’m surprised to see that every time I get anxious, I happen to be thinking about something I never imagined could be a trigger. Look for commonalities in your journal: were most of your anxious episodes surrounding public transportation? Was a certain person around? Were you having recurring, intrusive thoughts? Was it a smell, a particular sensation, a bright light? Triggers can be very general (like open areas) or incredibly specific (like the smell of pine needles on a cold day in the dark). You may be surprised by what seems to be causing your anxiety.
6. Take note of your triggers. This isn’t an exact science (well, it’s not really science at all), so you may not be able to find all your triggers. You may have some triggers that you rarely come across (I’m terrified of heights, but I’m not usually dangling over the side of a building so I don’t think about it very often). You may even have some triggers that you never experience anymore because you’re avoiding something (I hate answering the phone, so I avoid it at any cost). The more triggers you can identify, the more control you will develop over your symptoms. The scariest part of anxiety is the not knowing; the times when the anxiety strikes for no apparent reason. Develop a list of your triggers, and see whether or not they persist over time. The ones that do persist are probably the ones closer to the root of your problem.

To give you an example to get you started, I will describe a recent anxiety-provoking situation of my own. I was down in my basement running on the treadmill, and I suddenly noticed I was panicking. I’m certainly not new to this whole anxiety-tracking business, so I took note of everything around me and everything I was thinking and feeling. I realized that there were two main things causing the panic: superficially, it was the strained breathing signalling to my brain that I was under stress; but really, the trigger was my own negative thinking. I was worrying that because my breathing was becoming strained after only 10 minutes of running, I was severely out of shape and I would never build up the endurance I wanted to. My thoughts wandered over to Failureland, that part of your mind that loves to tell you that you’re failing at something. Over the past two years, I’ve realized that most of my triggers surround my perfectionism.

Keep in mind that your triggers will probably change over time. If you’re anywhere near as suggestible as I am, you may find that reading about other people’s triggers will cause you to develop new triggers. The biggest step you can make in your journey to recovery is to identify what is making you anxious. Then, you can take the steps to figure out why a particular situation, thought, or feeling is making you that way. We are really trying to get to the why. There’s a reason we’re anxious. I hope that in finding that reason, it will help us get better.

Leave me a comment! I would love to hear what your triggers are. If you have any questions for me, feel free to leave them below! I love answering questions (seriously).