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Authors: PhD Friedemann MD Schaub

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Usually it’s not fear and anxiety but experience, common sense, and wise choices that keep us safe. This is also true for our productivity, which may initially spike because of anxiety, but eventually decreases as ongoing stress and worry drain our energy and wear us down. Aren’t joy, purpose, and fulfillment much better motivators for improving our performance and helping us sustain a highly productive level?

How much fear is actually safe? Chronic fear and anxiety exhaust you mentally and emotionally, cloud your judgment, and eventually make you feel insecure and powerless. Physiologically, even low-grade fear, experienced continuously, causes great strain on your body that can lead to severe health challenges such as high blood pressure, chronic pain, obesity, heart disease, diabetes, autoimmune disease, and even cancer. These stress-related illnesses are the most common causes of death in our modern society. Even in situations
where fear may appear completely appropriate, it can paralyze you, leaving you like a deer in headlights: unable to make a decision or even physically move, which is obviously not a very safe position to be in.

When I was nineteen years old, a friend and I bicycled on our own Tour de France to the south of France. On a warm but rather stormy day, we decided to swim and body surf on the large waves of the Atlantic Ocean. We enjoyed the thrill of being tossed around by the surf so much that we didn’t realize that the current was pulling us farther and farther out to the open sea. We tried to swim back to shore, but soon noticed that despite our greatest efforts, we couldn’t make any progress. I was getting concerned. I didn’t want to alarm my friend, but I couldn’t help asking, “What if we can’t make it back? There’s nobody out here and nobody on the beach to help us.”

My friend appeared calm, which in turn calmed me down, and I figured there was probably nothing to worry about. But then I looked at him and saw the panic in his eyes. Either my fear was contagious or he’d realized our dire situation on his own. All of a sudden, he started waving his arms wildly and screaming, “Help! Help!”

That did it for me. My sense of safety was gone because if he was scared, we must be in deep trouble. I felt the heat of fear rising inside, almost taking my breath away, as I joined my buddy in desperate shouts for help. After only a few moments, the panic had completely overtaken me. My heart was pounding. I couldn’t focus my eyes; it was as if a dark curtain had been pulled in front of them. I started frantically paddling with my arms and legs, desperately trying to keep my head above water. Then two gigantic waves rolled over me in short sequence, pushing me with all their force deep underwater. After what had seemed an eternity, I came back to the surface, coughing, gagging, and spitting out saltwater. Gasping for air, I felt completely helpless and paralyzed by fear.

It’s interesting what strange thoughts pop up in those moments of despair. As I struggled for my life, I contemplated how my obituary in my hometown newspaper would read and wondered how many people would show up to my funeral. Somehow, surrendering to the fact that my obituary was as good as in press, I became very calm. Then a clear message rose from somewhere deep inside: “Remember, panic is just a waste of your energy.”

Good advice. I stopped shouting and fighting the elements and began instead focusing on working my way toward the shore, inch by inch. Calmer, I could access a mental and physical strength that I’m certain saved my life—and
possibly that of my friend, as well, as he picked up on the shift in my energy. When we both finally crashed onto some sharp rocks, badly cutting our legs and hands, the enormous relief of recognizing that we were back on land made this one of our happiest moments ever.

This experience taught me the paralyzing limitations of fear and anxiety. While these feelings may be effective in alerting us to potential danger, when their intensity escalates, the consequences can be devastating.

THE REALITY OF ANXIETY

You are awakened in the middle of the night by a muffled noise, and you just know that somebody has broken into your house. You hear about burglaries every day on the news, so you know it can happen to you. The phone is downstairs, so you can’t call the police. Your heart is pounding, and your mind is racing as you envision the possible horrific outcomes of a robbery. Holding your breath, you slip out of bed and grab a lamp, a fire poker, a baseball bat—whatever is heavy and nearby. You’re determined to fend off the intruder if he or she should dare to enter your bedroom. After what seems like hours of agonizing anxiety, you tiptoe downstairs—and discover that the intruder turns out to be your cat, which has knocked over a vase.

Like most medical students who immerse themselves in the study of diseases, I went through a phase of suffering from devastating afflictions, all of which had two things in common: I’d just learned about their specific symptoms, and they all mysteriously disappeared as quickly as they came. Because of the Internet, this phenomenon seems to be no longer limited to medical schools. Many of my clients report having sleepless nights after consulting “Dr. Google” and “finding out” they have an incurable disease.

Mark Twain said, “I have experienced many catastrophes in my life—most of which never happened.” It is our active imagination that turns cats into burglars and an upset stomach into cancer. If just a tiny fraction of people’s anxieties were to come true, Planet Earth would have ceased to exist a long time ago.

Remember, fear is supposed to function as the inner alarm signal, a little red warning light that gives you a heads up if there is something you need to be aware of. However, if you’ve been dealing with fear and anxiety for an extended period of time, this warning system often becomes too sensitive and is then set off by even the slightest detail. For example, you might interpret a frown on
your boss’s forehead as a sign that you’re one step away from being fired. Or you might believe your spouse’s purchase of a new pair of sunglasses means you’re doomed to financial ruin. If friends don’t call you over the weekend, it’s a sure sign they’ve stopped caring about you or that you’ve done something terrible to upset them. Over time, you may become so used to these constant warnings that they feel completely normal to you.

You may be thinking, “But how do I decide if a situation is truly dangerous or just a frightening interpretation of my mind? How can I know whether my
what ifs
are founded in reality or in fantasy?” In other words, how can you know if the alarm is real or not?

You can’t tell—at least not right away. At first you need to reset your internal alarm system so it will respond appropriately. And then you need to do a bit of relearning and build a new inner foundation of confidence and true self-empowerment. While this may sound like a long and complicated process, it isn’t if you know how to work directly with the source of fear and anxiety: your subconscious mind.

Before we probe deeper into working with the subconscious, let’s have a look inside your brain to give your intellectual side something to chew on.

WHAT HAPPENS IN OUR BRAIN?

Although anxiety is often based on nothing but our imagination, the feeling of anxiety is always real to our minds and bodies. To better understand why, we need to delve a little bit into the neuro-physiological pathway of fear and anxiety.

Imagine you’re walking in the forest on a warm summer day. Suddenly you spot a long, thin object hanging from a branch that stretches right above the trail. Your eyes direct this visual information to the optic nerve, which sends it to the thalamus region, one of the most important relay stations of the brain (see
Figure 1
). The thalamus sends signals to the amygdalae, almond-shaped groups of cells that are part of the brain’s limbic system and play a significant role in emotional responses and long-term memory.

The amygdalae evaluate the input by determining whether the image of the long, thin object has any emotional relevance. Could this object mean danger or pleasure? Another part of the limbic system, the hippocampus region, becomes involved. It helps scan the cortex, or outer part of your brain, for memories that may provide further information about what this long, thin thing might be. The resulting thought: it could be a snake!

Figure 1
Brain pathways associated with fear and anxiety

Now your brain considers the situation potentially dangerous. The hypothalamus and the pituitary gland stimulate the release of stress hormones, such as adrenaline and cortisol, which increase your heart rate, breathing, perspiration, and blood circulation to the peripheral muscles—all of which prepare your body for an appropriate flight-flight-or-freeze response. At the same time, the cortex tries to develop a master plan for dealing with this potential threat.
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What is especially fascinating about this fear pathway is that only after the stress responses have been set in motion does the visual information finally reach the occipital part of the brain. This visual processing center provides an accurate analysis of the object: It’s only an old rope hanging from a branch. All systems can return to normal.

Why does the fear come faster than the awareness? Why does our nervous system cry wolf rather than wait for the facts? From a survival point of view, it makes sense that evolution has favored this better-safe-than-sorry response. It was a matter of survival to be able to spot and instantly react to any potential threat—and as I mentioned before, our ancestors had to face plenty of threats on a daily basis.

The problem with this system is that the more often you activate this stress-response loop, the more likely you will react anxiously to changes in your environment and unexpected circumstances. The amygdalae function like an
anxiety switch: when they are turned on, we feel anxious; when they are turned off, we don’t. If you’ve been dealing with stress and anxiety for a long period of time, this anxiety switch can be triggered very easily or even become stuck in the “on” position, and it can activate the fight-flight-or-freeze response in situations (such as driving, flying, or spotting an elongated object hanging from a branch) where most people would experience moderate nervousness at the most.

So what can you do about this anxiety switch? How can you gain access or control over it without just getting rid of the amygdalae (which you can’t and shouldn’t want to do)? Does pharmacology have the answers?

IS ANXIETY A BIOCHEMICAL PROBLEM REQUIRING A BIOCHEMICAL SOLUTION?

Medical research has focused largely on a physiological solution to emotional problems such as anxiety and depression. The most prescribed antianxiety drugs are either benzodiazepines (such as Valium and Xanax), which are often used for anxiety, or selective serotonin reuptake inhibitors (SSRIs, such as Zoloft and Prozac), which are more commonly used for depression. While benzodiazepines directly affect the amygdalae by reducing their activity, SSRIs increase the level of serotonin in the brain, which is associated with mood improvement.

The good news is that using prescription drugs to alter the brain’s physiology and chemistry can indeed successfully dampen fear and anxiety and make these emotions more manageable. However, this improvement often comes with a price. One of the challenges with antianxiety medications—besides their common side effects, such as drowsiness, nausea, constipation, and lower sex drive—is that they potentially lead to physical addiction, and you must wean yourself carefully when you want to stop taking them.

Many of the clients I have worked with complained that their medication not only reduced their anxiety, it also dulled or even turned off their emotions in general. It appeared to my clients as if their minds had been wrapped in cotton or a lid had been placed on their ability to feel anything. But what still hadn’t vanished were their deep-seated insecurities and the limiting core beliefs they had struggled with for a long time. Beliefs such as “I’m not good enough” or “The world is not a safe place” still remained a part of their mind-set, even though they didn’t have the same emotional impact. As a client put
it, “I basically still have the same issues, but I don’t feel them as intensely. They seem to be further out of reach. It’s a relief, but not really a resolution.”

Unfortunately, the development of effective pharmaceutical treatments fostered the belief that emotional challenges are mainly caused by neurotransmitter imbalances in the brain and are therefore more a biochemical than a psychological problem. More and more people subscribe to a “let’s get it fixed” attitude, which has been reflected in the fact that the use of antidepressant drugs in the United States doubled between 1996 and 2005. At the same time, the number of people who visited psychotherapists declined.
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There is no doubt that changes in the brain chemistry are connected to different emotional states. There is also no doubt that antianxiety medications have helped countless people disrupt the downward spiral of fear and anxiety and escape a state of emotional paralysis and entrapment. But what came first—the chicken or the egg? Are neurotransmitter imbalances in the brain the root cause of fear and anxiety, or are they a consequence, a biochemical symptom of our emotions? If the latter is true, does restoring the biochemical balance really address the root causes of fear and anxiety?

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