3 Steps of Anxiety Overload — and How You Can Take Back Control | Lisa Damour | TED

80,847 views ・ 2023-02-14

TED


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00:04
So the most important thing to know about anxiety straight out of the gate,
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is that it has gotten an unnecessarily bad rap,
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as has happened for a lot of negative emotions.
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But you should know that psychologists have long understood
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that anxiety has both healthy forms and unhealthy forms.
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And a lot of the anxiety we experience in the day-to-day is healthy.
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OK, so what makes anxiety healthy?
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Anxiety is healthy when it is serving as an alarm system
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that lets us know that something's not right,
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that it gets our attention and helps us to keep ourselves safe.
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So if you're driving and somebody swerves and cuts you off
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and you have a surge of anxiety, that's a good thing.
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It will focus your attention,
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it will help you be safe around that driver,
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maybe take evasive maneuvers.
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But it's good for you to respond.
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If you're entirely indifferent or relaxed in that setting,
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it's not as safe.
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So we look for anxiety to be of help to us, to guide us
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and to let us know what we're supposed to be doing and not doing.
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I care for a lot of teenagers clinically, and, you know, I will say to them,
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if you walk into a party that you thought was going to be a little get-together,
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and it turns out it's kind of, you know, wild and you feel anxious,
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pay attention to that reaction.
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Like, that's telling you something,
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that's indicating that you may not be as safe
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as you thought you were going to be.
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So that's healthy anxiety.
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The only time we consider anxiety to cross the line
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from healthy to unhealthy
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is under two conditions, actually.
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One is when we have anxiety, but there’s no threat,
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that there's nothing wrong.
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So if it's, you know, a lovely Sunday morning and you're taking a drive
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and there's no traffic nearby,
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you shouldn't be having an anxiety response in that moment.
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And if you do, we would consider that grounds for concern.
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The other time we pay attention to anxiety
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and consider it to be unhealthy
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is if the anxiety response is way too big for what's happened,
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out of proportion to events.
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So if somebody swerves and cut you off
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and you have a panic attack in that moment,
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that is not healthy anxiety, it is not helping you.
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And we would address that clinically.
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Other than that, we really see anxiety as largely normal, protective,
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healthy and useful in our lives.
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OK, all the same, it feels terrible, right?
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I mean, I think one of the things that's so true about anxiety
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is it doesn't feel good
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even if it's actually serving a useful purpose.
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And so whether the anxiety is healthy or unhealthy,
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it's really great to know how to get it in check if you want to.
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And that's what I'm going to teach you now.
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And you may be surprised to hear me say,
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"Oh, let me just teach you how to do this,"
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because our experience of anxiety is that it's kind of out of control,
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that it sort of takes over.
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But despite that,
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the reality is that anxiety is probably the most systematic human emotion.
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It unfolds in a very stepwise fashion,
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it's actually a one-two-three process when it really goes off the rails.
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And so I'm going to walk you through the one-two-three
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of how anxiety unfolds for all of us.
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And then we're going to come back
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and I'm going to show you how at every step of the way
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there are things you can do to bring that anxiety back under control.
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OK, so the first thing that happens when we have an anxiety response
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is our bodies react.
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There's actually just a physical reaction that we have,
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and it's pretty universal and it's very familiar to all of us.
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Your heart rate accelerates,
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your breathing gets really quick and shallow.
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It feels uncomfortable,
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there's other stuff happening in our bodies, too, at the same time.
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But that activated heart,
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that kind of hyperventilating sense of breathing,
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everybody knows that feeling.
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OK, what's happening here?
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The sympathetic nervous system,
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which is the part of our nervous system
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that is paying attention to the environment,
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is sympathetic to what's around us,
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is kicking off some degree of the fight or flight response, right?
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That ancient response that we all know about.
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And in the fight or flight response,
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what we want to do is get ready to run or attack.
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And so our sympathetic nervous system is taking measures
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to send a whole lot of heavily oxygenated blood
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out to our large muscle groups for that purpose.
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That's why the heart accelerates, that's why breathing changes.
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And I, you know, especially in caring for people
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who have not ever heard any of this before,
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it can be really helpful to understand that as strange as this reaction is,
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it has a sort of ancient logic to it, may not fit the moment,
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but it definitely makes sense.
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And it's not something going, you know,
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kind of, out of whack when our heart and our lungs accelerate.
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So that's the first thing that happens.
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The second thing that happens is we notice that change in our body
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and we come to the conclusion that we're going to call it anxiety.
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We decide to use that label.
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This is often an arbitrary decision.
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We can call it something else,
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but we can sometimes default, unhelpfully, to calling it anxiety.
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And then the third thing that happens,
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and this is where things really do go off the rails,
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is we engage in catastrophic thinking.
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And the definition of catastrophic thinking is actually very straightforward.
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It's when we overestimate the risks
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and we underestimate our ability to manage the risks.
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That's it.
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So if your body reacts, you're like, "I must be anxious,
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oh, my gosh, this situation is completely out of control
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and there's nothing I can do to stop it."
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That's when anxiety really becomes miserable.
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And that's the one-two-three.
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Alright, so knowing that,
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let's go back and hit every one of these in terms of how we can work against them.
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So the first one, the body reacting.
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OK, so one of the most powerful ways to get the body to calm down,
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is through controlled breathing.
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And I will tell you,
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if you're having like, this, "Uh, really, breathing?
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Like, you're going to go to breathing?"
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I totally get it.
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For years, I was like, "Oh, that's so woo woo.
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That's not that technical. It's not that scientific."
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Ok, I was wrong.
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I learned I was wrong.
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And in fact, breathing is this really biological intervention.
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And what it does is it kickstarts
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the parasympathetic part of our nervous system.
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And the parasympathetic nervous system,
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its job is to reset the body to its resting state.
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OK, here's how this works, it's kind of amazing.
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So just as the brain can signal to the heart and lungs
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like, "go into overdrive,"
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you know, "we might have to do something here,"
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we're also of a mind that the lungs can communicate back to the brain.
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So when we’re anxious, we’re breathing quickly and ... shallowly.
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And if we override that,
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if we deliberately deepen and slow our breathing,
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what we think we're doing,
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this is sort of the understood science,
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is that we are hacking into a set of nerves
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on the surface of our lungs
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that are stretch receptors.
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And all day, every day,
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those nerves are paying attention to our breathing
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to keep us safe.
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And they notice that we have slowed our breathing
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and things have gotten calmer
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and they read that as evidence of safety
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because we only breathe deeply and slowly when we're safe.
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And they send that message up to the brain saying,
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"you're kind of having a reaction that doesn't make sense
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because the nerves on the lungs are telling us that we must be safe."
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And that's how anxiety comes under control.
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That's step one.
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Step two, if we want to, need to,
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is to consider whether anxiety is the right name for what's happening.
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That we have a kind of activated response all the time.
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So it might be like, I was excited for this presentation.
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And before this presentation, I kind of felt a little bit of a rev.
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I could have said, "I must be anxious."
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But instead I said, "No, I think I'm really excited."
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And that shift in thinking actually makes a huge difference
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in terms of how we feel about what we're engaging.
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The third thing we want to watch out for
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is anxiety going off the rails with catastrophic thinking.
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And again, that's overestimating risk,
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underestimating our ability to handle it.
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So if something is feeling really, really scary to you,
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really, really anxiety-provoking,
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key questions to ask yourself are,
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"Am I imagining this to be worse than it might really be?"
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So you're going to try to bring that estimation of risk down.
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And also, "Do I have more say in how this is going to go
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than I'm giving myself credit for?"
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"Are there things I can do to actually increase my sense of control,
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not feel as helpless as I do right now?"
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So you're not trying to get rid of the anxiety entirely,
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but you're trying to sort of get it in the narrower band
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of not overestimating risk
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and not underestimating your own powers.
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So I'm going to start to wrap up, but here is the bottom line.
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Most of the time,
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we don't need to feel anxious about feeling anxious.
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It really is there to help us out.
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And whether we want it there or not, or whether it's helping us or not,
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if we want to get it under control,
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knowing the basics of how it unfolds
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really does put you in the driver's seat
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of knowing how to calm yourself when you feel anxious.
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And so you don't have to feel
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like it's something that you are at the mercy of.
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David Biello: You spoke about breathing
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and how you were skeptical in the early days.
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Do you have the particular breathing practice you like?
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Lisa Damour: I do.
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Once I got over my snobbery about breathing,
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I use something called square breathing or box breathing.
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And, you know, people have often heard of this.
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And it's really simple.
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It’s where you breathe in on a count of three,
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so one, two, three, in --
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and I'm actually going to walk us through it as a group.
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Then you hold it for a count of three: one, two, three.
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Then you exhale slowly on a count of three: one, two, three.
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And then you wait, one, two, three.
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So, one, two, three, in.
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One, two, three, hold.
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One, two, three, exhale.
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One, two, three, wait.
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OK, so let's all do it together.
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But here is my instruction to you.
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If you really want this to work,
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picture the nerves on the surface of your lungs getting the message.
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You're not just breathing to breathe, right?
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You're breathing because you are hacking into this system
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and using those nerves to communicate to your brain that everything's OK, right?
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So everybody, like, (Exhales) blow out breath a little bit, ready?
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Breathe in slowly.
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One, two, three.
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Hold it.
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One, two, three.
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Exhale slowly, one, two, three.
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Now, pause.
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One, two, three.
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That’s it. (Laughs)
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And you can do it a few times.
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If you get really anxious a lot,
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you should be practicing this when you're not anxious
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so that you can slip right into that groove.
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But it is powerful.
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It is really powerful.
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And I am a little embarrassed
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about how long it took me to get on the breathing train.
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DB: I mean, it's actually incredible because just doing that with you,
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you know, the little ball of whatever, excitement in my stomach
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just sort of dissipates.
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So breathing, people, it's real.
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It's important.
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So we already have some questions flooding in.
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And I want to make this useful for the members.
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Let's get right to them.
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First up, Gordon wants to know about helping other people.
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How can we help if we notice
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that a friend or a family member is experiencing excessive anxiety?
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LD: OK, I love this question.
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So the first thing I would say just by being generally useful,
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is, we'll get to the excessive piece,
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but just, people need validation that anxiety makes sense
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most of the time.
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And one of the real hazards
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of anxiety being talked about as though it's everywhere
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and always pathological
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is that people experience normal anxiety
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and then they think, "Oh, I'm having anxiety.
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Oh, no, there's something really wrong."
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And so one quick thing you can do to say [to] somebody who’s anxious
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if they’re like, “Oh my gosh, I have a big talk tomorrow and I’m anxious,”
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you can say, “You’re having the right reaction ...
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That's going to give you energy and juice.
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There's nothing wrong with being anxious about a talk"
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or "there's nothing wrong with having to go tell your boss
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something they don't want to hear.
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And that making you anxious,
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that's evidence that you work perfectly."
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So that alone reassures people a lot.
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And then I think the next step you can do is to say,
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"If it gets uneasy,
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if it gets to be too much more anxiety than is helpful to you, right?” --
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Even framing it is like, “This should help you out until it doesn’t.” --
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“You can actually dial it back.”
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So walk them through why breathing works.
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Everybody knows they're supposed to breathe.
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Very few people know why.
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And so that's why people won't do it.
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And so when I'm caring for people, I will say,
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think about your anxiety being on a dial, right?
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And if it's a zero to 10 dial,
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two to three, you actually tend to do a better job
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with whatever you're needing to do
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if you have a little energy, a little rev.
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Once it gets into four, five, six, seven, you start to be in trouble.
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And so I teach people to use the breathing to actually turn down the dial.
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But that idea of like, you're not at the mercy of this.
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You can be in the driver's seat on this
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and you can use breathing or reframing
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or questioning your own thinking,
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is really helpful because there is a general sense of like,
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we're helpless in the face of anxiety, and we're really not.
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DB: So Catarina describes an anxiety that leads them to avoid things.
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So meeting new people because it’s scary.
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Do you --
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What do you recommend for that kind of avoidance tactic around anxiety?
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LD: Oh, Catarina, I'm so glad you brought up avoidance.
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This is actually the most important thing we need to say
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when it gets to talking about anxiety.
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So, when we're frightened of something,
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our instincts are like,
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"Get away."
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And if that is a tiger or a bad driver,
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those are really good instincts.
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And so when we remain frightened of something that's in our everyday lives,
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we can actually feel very compelled to avoid it.
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Here is, if you remember anything from what we talk about today,
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these are the three words I want you to remember most.
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Avoidance feeds anxiety.
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So here's the process.
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It's actually a wonderfully -- I think it's fascinating science on this.
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So say, Catarina, you're thinking about going to a party.
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You've been invited to a party and you're like, OK,
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"I'm going to try to go to this party."
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And then it's time to go to the party
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and you feel your anxiety starting to bubble up
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and you're like, "Forget it. I'm going to cancel."
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OK, here's what's going to happen.
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You'll go from feeling very, very anxious
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to suddenly feeling much, much better.
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So this is the first helping of how avoidance feeds anxiety,
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which is that it feels good.
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That, we call it a reinforcing experience.
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You felt bad, you avoided, you feel better.
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So you're like, avoidance is kind of fun.
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Or not fun, but it solves the problem.
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Here comes the second helping.
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Because you haven't gone to the party,
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nothing challenges your beliefs about how frightening that party is.
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The party remains whatever you have pictured in your mind --
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people not talking to you, you know, people, you know, whatever.
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Like whatever you have imagined about what makes that party scary
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goes unchallenged.
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If you actually go to the party,
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you often find it's a little bit, if not a lot, better than you expected.
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But if you don't go, it remains very frightening.
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So that is how avoidance actually entrenches anxiety over time.
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It feels good to do it and it actually doesn't give us any competing data.
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So when you go see a clinician for treatment of anxiety,
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often we will start by asking about what are you avoiding
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as a result of your anxiety?
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And we will work with you
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on -- we call it graduated exposure, which is like basically baby steps --
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getting you in there, right?
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So we'll say, OK,
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could you go to a small thing with a couple people?
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Could you use your breathing to make that bearable?
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And it would just sort of work you into it very, very slowly,
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because the solution to anxiety is often what we call exposure,
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making yourself do it.
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But you are not alone in this sense of like, you know,
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why not just not go?
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It feels better to not go.
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And that's something that we, as clinicians, work really hard on.
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And I will tell you, you know, the pandemic and kids and school,
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you know that, and, you know,
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we've always known if this child is frightened of school,
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the solution is get them to school.
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Even if they sit in the teacher’s ... back office for the day.
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Physically being at school is better than being home
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if it's otherwise safe for them to be there.
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DB: So another ...
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Area of anxiety that's popping up in the chat
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is dealing with it in our sort of, children.
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Robert wants to know what,
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or are there any differences between words like
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anxiety and worry or fear
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as it might pertain to how a teenager is describing
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or trying to put a name to what they're feeling?
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LD: I think it means for the kid whatever it means.
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But I will say teenagers use the term anxiety a lot,
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and they use it very broadly.
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And I've been practicing for a very long time.
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And then in the last I'd say 10 years, I started to notice,
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like, kids use this term a lot
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and I wasn't quite sure what to make of it.
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And then I was actually rereading "Jane Eyre" --
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no, it was "Pride and Prejudice."
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And Mrs. Bennet, I don't know if you remember her,
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she's like, the kind of piece of work mom in that book.
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There is a line in the book that was,
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"Whenever Mrs. Bennet was discontented, she fancied herself to be nervous."
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And I thought, Oh, I think that's often what I'm seeing with teenagers,
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is they'll say, "I feel anxious" when they usually mean not calm.
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"I don't feel calm."
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And so the first thing I would do if a teenager says
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"I feel anxious" is to say, "Tell me what's going on."
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And they might say, you know, “I’ve got a big try out tomorrow”
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or, you know, “This concert is happening
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that I’m going to with my friends.”
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And listen for the possibility that it’s something besides anxiety.
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It could be they're excited, they're amped, they're apprehensive.
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So try to make more granular
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their description of what is causing the stirred-up feeling.
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And sometimes they are anxious.
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And that's when there's a threat, right?
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Like, "I'm feeling anxious because I have my driver's test tomorrow
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and I am not ready."
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That is anxiety.
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There is a threat, they could fail that driver's test, right?
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So listen for a threat and then ...
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if they’re anxious about something, be like, “Yeah, of course you’re anxious.
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That's kind of scary.
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Let's see what we can do to reduce your sense of risk,
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18:38
increase your sense of control."
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But often it's very important that we help them
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18:47
bring more nuance to the language they use
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around a sort of sense of being stirred up.
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And what's so nice is that act of a teenager saying or a kid saying,
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18:56
“I feel really anxious about school tomorrow.” --
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“What’s making you anxious?” --
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"New classroom, new kids, don't know where things are going to be."
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You say, "Yeah, you should feel apprehensive,
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there's a lot there,
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and also maybe a little excited."
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If you can get in there with words that are more accurate
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than the big generic of anxiety,
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that act is in and of itself therapeutic.
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Kids are like, "Yes, I am apprehensive and also excited."
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That they feel heard, they feel better,
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and they have a better language.
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So what I watch for especially,
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is kids saying, "I have anxiety."
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I like to say, “You’re feeling anxious.”
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Because I think, there is this sense of, “I have anxiety,”
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I think there's very much among adolescents a sense of like,
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"I have anxiety,"
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but I try not to say, well, everybody has anxiety at some level
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19:48
because I don't want to be dismissive,
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but to really help them make that distinction
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between a feeling that comes and goes,
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and a diagnosis they would need to be concerned about.
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DB: Several folks want to know how can they tell when to seek help,
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when anxiety has become too crippling?
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LD: This is a great place to wrap up. This is a perfect place to wrap up.
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So mostly this has been an ad for anxiety.
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Like, don't be frightened of it.
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Be curious about it.
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Trust that it’s trying to tell you something.
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If it feels too uncomfortable,
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try these strategies to get it under control.
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But two conditions.
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Let's go back to them.
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If you feel like your anxiety is showing up
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and there's no reason, like, there's no threat,
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there's nothing to be worried about,
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that would be a great time to seek out support.
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The other is if your anxiety like, well, there's a threat,
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but like my anxiety is off the charts and making me miserable
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or getting in the way of my life,
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that's a good time to seek support.
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So, you know,
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pretty straightforward in terms of how we define
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what we consider concerning.
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But I really want you to know,
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most anxiety does not need to make you feel anxious about its own presence.
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About this website

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