As the electrodes are placed on your head, you wonder what the sensation of electricity running through your brain will feel like. You’re in a bare room that resembles a doctor’s office, but instead of blood pressure cuffs and stethoscopes, there are wires that run from your head to a box that will be transmitting electricity in just a few moments.
No, you aren’t in the electric chair about to be punished for your crimes, but instead, you are about to undergo Transcranial Direct Current Stimulation (tDCS) to see if you can capture one of its many possible benefits. While this may seem like a fringe, woo-woo treatment only dabbled in by extreme brain biohackers, there have actually been over 3,000 studies done on tDCS .
What Is Transcranial Direct Current Stimulation?
Before we go any further, it would be helpful to know what tDCS is. In short, the therapy involves attaching up to 20 electrodes to various parts of the head depending on which areas of the brain you are trying to target. These electrodes will then emit a weak (.28-.8 mA/cm2) current of electricity across your brain. Sessions typically last between 10-30 minutes and many studies have patients complete around 10 sessions within a two-week period.
As we know, neurons and synapses rely on electricity to pass information to one another, so introducing new electricity can alter this process . This electrical stimulation travels through the brain, modifying connections along the way, the changes sustainable long after treatment. It’s interesting learning about how it works, but you’re probably wondering “why even bother with it?”
Transcranial Direct Current Stimulation Can Help You
tDCS For Mental Health
As far-out as tDCS may seem, there are many studies showing a variety of different benefits. First, research has found tDCS to work well for a variety of different psychiatric disorders. A review by Bennabi and Haffen displayed many interesting studies that investigated the effect tDCS had on conditions such as major depressive disorder (MDD).
Worldwide, around 7% of people experience MDD, but many patients fail to see positive results from common pharmaceutical treatment options. However, we know that certain parts of the brain (left prefrontal cortex, for example) in people with MDD aren’t as active as they should be, so in theory, stimulating them with tDCS could help their condition.
Studies On The Effect tDCS Has Regarding Mental Health
In one randomized controlled study, 40 participants with major depression were subjected to 1mA of electricity for 10 minutes over 10 sessions and some promising results followed. After being evaluated using the Hamilton Depression Rating Scale and the Beck Depression Inventory, depression was lowered significantly when compared to the control group. A few more studies were carried out by the same scientists and depression was lowered by an average of 40.4% in the tDCS group versus 10.4% for the control.
It has also been found that a combination of tDCS and traditional pharmaceutical treatment worked better than tDCS by itself. However, it hasn’t really been investigated if tDCS and other natural depression treatments like Cognitive Behavioral Therapy, meditation, or journaling would have a synergistic effect.
From my own research, I know that alternative therapies like the ones I mentioned have been proven to help with anxiety and depression, so I assume combining it with something like tDCS would only enhance its effects. In the US, tDCS remains an experimental treatment for depression but has been adopted in many parts of Europe as a legitimate treatment option.
“this technique has gained renewed interest as a practical tool for the modulation of cortical excitability and the treatment of psychiatric disorders”
tDCS For Boosting Brain Power
tDCS for cognitive enhancement is where you need to be careful as many companies are trying to make a quick buck by claiming that you can strap their device to your head, flick the switch and increase IQ by 50% or something of the sort. While some of these statements are just a money-making scheme, there has been real research showing that tDCS can, in fact, lead to cognitive improvements.
The cognitive enhancing effects have been promising enough for the US Department of Defense to take notice. They even performed their own single-blind study where participants were subjected to 2.0 mA of tDCS for 30 minutes. Electrodes were attached in areas that would stimulate the right frontal and parietal cortex which are involved in learning.
They then underwent a real-world virtual training exercise where participants identify threat-related objects that are concealed in a natural environment. The results? There was a significant improvement in the experimental group’s ability to identify the objects. fMRI also showed increased activity in the brain regions of interest .
“the application of anodal tDCS over these regions can greatly increase learning, resulting in one of the largest effects on learning yet reported. The methods developed here may be useful to decrease the time required to attain expertise in a variety of settings.”
Other studies done in ‘healthy’ people suggest that tDCS can improve working memory, attentional control, decision making, and creativity .
Is Transcranial Direct Current Stimulation For You?
All of the positive research surrounding tDCS means that you should definitely go buy a set for yourself, right? Well, it is a bit more nuanced than that. First, despite a majority of research showing that tDCS does work, it would be disingenuous not to mention that there are a handful of studies in every category showing tDCS has no effect at all.
Furthermore, a lot of research has concluded that the effectiveness of tDCS may heavily rely on individual factors such as personality, genetics, age, and skull thickness. In addition to this, there really are no standard operating procedures when it comes to variables like the number of electrodes, placement of electrodes, electrical current strength, and duration of each session. Much more research needs to be done to solidify these aspects of tDCS.
The Main Takeaway
Although we do need more definitive research, I believe that based on current evidence tDCS can work for many people and serves as a relatively cheap and safe way to improve depression symptoms and cognitive function especially if you are looking for a different therapy route.
Don’t hesitate to do your own research on the therapy and treatment options available to you. Whether you decide to try a DIY tDCS device or consult a therapy center is up to you, but either way, make sure to consult your primary care physician first. All in all, keep an open mind and don’t be afraid to try something new.
A video of tDCS self-administration (skip to 1:56):
Deep down it’s as if we know reading is good for us, yet the majority of us don’t read books very often. In fact, about a quarter of American adults said they haven’t touched a book in the last year. Reading is one of the absolute best techniques to learn, hands down. When you make reading a habit, you constantly expose yourself to new information. This isn’t always a good thing, the constant influx of media thrown our away can be overwhelming and harm our concentration. Then again, this is where reading becomes crucial; when you read books you not only accumulate knowledge and information but also improve your attention span. The benefits of picking up a bo\ok don’t stop here.
Reading & Stress
We live in a stressful world, good thing we have books! Those who have become lost within the pages of a fascinating narrative will understand how books can provide powerful stress relief. Researchers at the University of Sussex in England found that reading was the most effective stress reduction technique. Stress was measured by heart rate as well as muscle tension. After reading for just six minutes, on average the participant’s stress levels dropped by 68 percent. I could have just titled this article “How to cut your stress in half with only 5 minutes of your precious time”, but that wouldn’t give the habit of reading enough credit.
Reading & Memory Decline
Reading offers benefits beyond childhood and well into adulthood. In a study of nearly 300 people, those who engaged in mentally stimulating activities such as reading had slower memory decline than those who didn’t.³ Cognitive decline can creep in as early as the late twenties for some adults. As we age, our brains shrink in volume and our cortex begins thinning. In the study, engaging in a mentally enriching activity such as reading was associated with a 32 percent lower rate of mental decline versus those who didn’t. This is a good indication of how reading can actually preserve the structure of the brain and serve as a potent anti-aging mechanism. In addition, other research identifies a strong association between the habit of reading and being less likely to have Alzheimer’s.
Reading & Empathy
I like to think of empathy as a skill in understanding our world and the people around you. Imagine a time where you felt alone or grossly misunderstood, perhaps by a friend or spouse. You were probably in need of empathy, or being heard and understood. This is a basic human need and functions as our emotional support system. It is critical to the interconnectivity of our species. What’s better? Empathy can be learned and practiced.
Authors Maia Szalavitz and Bruce D. Perry, MD, Ph.D. describe empathy: “The essence of empathy is the ability to stand in another’s shoes, to feel what it’s like there. Your primary feelings are more related to the other person’s situation than your own.”
One study showed that by reading fiction we not only decrease our stress levels but we increase our empathy towards fellow humans. The study authors stated, “In two experimental studies, we were able to show that self-reported empathic skills significantly changed over the course of one week for readers of a fictional story by fiction authors Arthur Conan Doyle or José Saramago.” These feelings of empathy go along way and are worth cultivating for a variety of reasons. Being able to see the world as others see it without judgment and communicating your understanding of those person’s feelings can make all the difference to them.
It’s important to note a distinction here. This is a rather subtle and hard difference for some to grasp but empathy is not the same as sympathy. Most people will feel as if they’re being empathetic to someone because they feel sorry for them, but this is sympathy. With empathy, we can build a bridge of understanding by listening without judgment, putting ourselves in their shoes, and relating to them without giving biased or unwarranted advice.
As L. Frank Baum put it “No thief, however skillful, can rob one of knowledge, and that is why knowledge is the best and safest treasure to acquire.” Learning new things is one of the best investments we can make. Reading books is one of the most profound techniques to learn new things. Let’s set aside the fact that we can learn just about any skill, hobby, or profession by reading about it and focus on the reading itself. Just the act of reading allows us to learn new words and thereby increase our vocabulary. Children are exposed to greater than 50 percent more words while reading than watching prime time T.V. This is true even when compared to the child listening to a conversation between college graduates according to a paper published by the University of California, Berkeley. Sure, obviously reading more will help you learn new words and improve your vocabulary, but those who read also score higher on general intelligence tests too! I don’t know about you, but reading seems like the smart thing to do. Nonetheless, cultivating a reading habit can be challenging. I’ve failed many times, so I thought I’d share some of the tips I’ve picked up along the way.
Cultivating a Lifelong Reading Habit
Start small read during certain segments in the day. It helps to have 10-15 minute chunks where you know you can read. Make it a habit and do it every day during those certain and short time periods.
Just bring a book with. Going to the beach? Bring the book. It doesn’t hurt to bring your book even if you only read a few pages. Maybe keep one in the car. Make books more available and accessible to you.
Keep a list of books you hear about and are curious to read. Keep it wherever you like but just having a list can inspire you to read more.
Find good books. This may be one of the most important tips. Some books may bore the crap out of you, but that’s okay. Move on; find one that really compels you. A good book will seriously make you want to read.
Lastly, make reading as fun as you can. Maybe that’s cuddling up on a blanket with hot chocolate or it’s going to watch the sunset. Either way, by giving yourself something pleasurable while reading you may grow to enjoy it more.
Lewis, D. (2009), Galaxy Stress Research, Mindlab International, Sussex University, UK
Life-span cognitive activity, neuropathologic burden, and cognitive aging
4. Robert S. Wilson, Patricia A. Boyle, Lei Yu, Lisa L. Barnes, Julie A.Schneider, David A. Bennett Neurology Jul 2013, 81 (4) 314-321; DOI:10.1212/WNL.0b013e31829c5e8a
I enjoy time in my apartment; it’s safe and has everything I need to be comfortable. However, as I peer out the window at a small grouping of trees that leads to a larger nature reserve, something draws me towards it. As I walk on a small trail past the edge of the canopy, the outside urban environment slowly fades away into something that feels much more natural. My home is back in my apartment, but something about this little forest feels like home as well.
How Our Ancestors Saw Nature
Not too long ago, our nomadic ancestors called the endless forests, plains, deserts, and hills ‘home’. Their days were spent listening and experiencing nature, searching for food and places to take shelter. They had no concept of urbanization and the wonders it would hold. They couldn’t imagine what it would be like to leave the office and drive to the grocery store. Permanent housing that is always kept at 70 degrees despite the season would seem a bit foreign as well to say the least. These, along with all the other conveniences of modern urban life, have revolutionized the way we live.
This new way of life that 50% of humans (70% by 2050) globally experience and benefit from has a darker side that, until recently, has gone largely unaddressed. The wanderers of the past would likely panic at the sound of a blaring car horn. Crossing a road with 2000lb metal machines whizzing past might have been their demise. Although I enjoy my apartment, they might feel claustrophobic and trapped if they were limited to one bedroom and a small living area.
The moral of the story is that humans are becoming more and more urbanized because of the true benefits that can improve life but there are also many ways that cities are harming our mental health. One of these harms is that we are becoming increasingly disconnected with nature which is not as trivial as one may think.
The Link Between Nature and Mental Health
Nature Walks and Wellbeing
Luckily for us, scientists have been studying the link between nature and our mental health because the issue is becoming more evident. We as humans are connected to nature and can utilize that connection to decrease stress and anxiety and improve psychological well-being .
In one study, participants walked for just 15 minutes through a forest completely devoid of any signs of urbanization while another group walked in an urban environment. The result was that the forest walkers had a strong response in their parasympathetic state (relaxed) while the urban walkers experienced the opposite; a sympathetic response (fight or flight) .
Because of this, the forest group had lower heart rates, lower blood pressure, and a questionnaire showed that they were more relaxed and had lower stress and anxiety than when they started. Unfortunately, the urban walkers did not see these same benefits and many of them actually were worse off than when they started in terms of mental health. While I believe that taking a walk and getting exercise is extremely beneficial wherever it may be, try to make it a nature walk whenever possible.
“Participants [in the forest group] experienced less negative mood states such as tension-anxiety, anger-hostility, fatigue, and confusion and felt more comfortable, natural, soothed, and refreshed after forest walking.”
How Nature Can Change the Brain
Another study took place in an urban nature center like the one across the street from me. Interestingly, participants who walked in the nature center showed a decrease in subgenual prefrontal cortex activity. This part of the brain is associated with much of the negative rumination that is associated with anxiety and depression. In addition to this, they also experienced less rumination which was expected after the brain activity findings. Another group took a stroll through city streets which yielded no change in brain activity or rumination .
“accessible natural areas within urban contexts may be a critical resource for mental health in our rapidly urbanizing world.”
While walking through small plots of nature in urban environments and parks is both convenient and great for mental health, researchers found that the larger the nature reserve is, the more benefit there is to be had . It seems as if our brains can’t be tricked into thinking we are in our natural environments by walking around small patches of city trees. We need to completely detach from the concrete jungle if we want a full reset and all of the mental health benefits that come with it.
Time Spent in Nature Increases Vitality
Another aspect of having good mental health is the amount of vitality a person has. Are they vibrant? Is the person full of life and energy or do they look like a wilted flower that hasn’t been watered or seen the sun for a few days? Experiencing true nature is to us like water and sunshine is to a flower.
When study participants went for just a 15-minute silent walk outside, researchers found that there was a statistically significant increase in self-reported vitality (determined from an in-depth questionnaire) . I bet you can guess what happened to the group who went for a 15-minute walk indoors: a slight decrease in vitality.
“individuals walking outdoors reported a greater change in vitality compared with indoor walkers, controlling for social and physical activity”
This same group also did another much simpler study which was interesting nonetheless. They found that just being shown images of nature for two minutes and then imagining that you were there led to an increase in vitality while a photo of an urban environment proved to do the opposite. We as humans are so hungry for nature that we can feel more alive by just imagining that we are in a place free from buildings, streets, and cars.
How You Can Get These Benefits As Well
In terms of you as an individual, your situation may make it easy for you to find nature or you may be far, far away from it. Either way, if you can find just 15 minutes to reconnect with the environment of our ancestors, do it. This is a must if you wish to improve your vitality and decrease anxiety. Make it a habit to detach from city life just a couple times a week. Your mental health is worth it.
Staying focused on a task you know needs to be completed should be easy, right? It’s on the to-do list and once you are able to cross it off, you will feel a wonderful sense of accomplishment. Well, for most of us it’s not that easy. My phone has a little light that blinks at me when I get a notification. It’s like an eye that stares until I cave into the pressure.
Maybe what you’re doing is important, but something you’d rather not be doing at the moment. In school, this was an everyday reality. Luckily, there are many ways that we can increase our ability to pay attention to the task at hand.
One of these has been heavily studied and is an interesting, round-about way to increase focus that I had never heard of it until I was doing research for another article. What I am referring to is mindfulness-based stress reduction (MBSR).
Mindfulness-Based Stress Reduction
MBSR pulls tactics from many ancient practices but was largely brought to the Western world by Jon Kabat-Zinn in 1979 at the University of Massachusetts. In short, MBSR was developed to help people live happier, healthier and more adaptive lives  through helping people live in the present, utilizing exercises such as meditation, yoga, and other practices . The goal is for you to be fully “awake” and in control of your life rather than aimlessly wandering about.
“The consequence of enhanced mindfulness is a shift from non-awareness and automatic, habitual behaviors and stress responses to conscious awareness and effective, deliberate action”
We will go more in-depth on specific practices later, but let’s first explore some of the research. Early studies showed that it did what it was intended for; reducing stress, anxiety, and depression while also improving overall well-being . The benefits that meditation can have on our psyche are very well known (head here for more information on mindfulness meditation), however, further research started producing some more unique results.
MSBR and attentional control
Researchers started to test the effects that the training had on other aspects of our day-to-day life, one of which was focus, otherwise known as attentional control. The results were stunning. Immediately after MBSR training, older adults were found to have made significant improvements in visual attentional control as well as executive control, especially when performing complex tasks. Executive control can be thought of as your brain’s flexibility and processing power.
These results aren’t limited to older adults. Another study showed the same amazing results among young and middle-aged participants as well . Across the board, it seems as if MBSR can significantly help to increase your attentional control and strengthen your mind.
“MBSR improved the ability to orient attention, and direct and focus attention on relevant inputs”
Let’s put MBSR to the test
We now know that this training can help people of all ages, but if you’re still not convinced, let’s see how MBSR holds up to a bit more of an extreme environment. One of the most stressful activities that I can think of is being in live combat. You have tremendously taxing training and the enemy is actively trying to take your life all while you are separated from your loved ones by thousands of miles.
Researchers showed that without any mindfulness training, active-duty military members had a gradual and significant decrease of working memory capacity throughout their enlistment. However, personnel who actively participated in MBSR actually saw an increase in working memory capacity .
“ mindfulness training was associated with an increase in working memory capacity, defined as the capacity to selectively sustain and manipulate task-relevant information without becoming distracted by irrelevant information.”
Working memory capacity can be broadly defined as your ability to focus attention along with your cognitive processing power. This is important for everyone especially military members or really anyone who is looking for peak cognitive performance.
How does MBSR change us?
Besides the common benefits that meditation has on our psyche and wellbeing, how does MBSR specifically help us to increase our focus and brain power? Well, there are two interesting routes we can examine: physical changes to the brain and mentality changes.
Let’s start with how MBSR has been studied to change us emotionally. One group of researchers found that in addition to enhanced focus and the ability to control where attention is directed, patients became more mindful and, like the name implies, saw a reduction in their stress .
As a result of being more mindful, I would imagine that priorities would become much more clear which might be followed by a realization on how futile it is to check your social media in the middle of an important task. It has also been hypothesized that simply relieving your mind of stress and anxiety allows the brain to function properly, allowing the ability to enhance focus and mind power.
In addition to this, MBSR has been shown to increase activity in regions of the brain associated with positive emotions and general emotional control .
The physiological changes to the brain amazed me when I first read the research. This is where things really get interesting. Scientists found that after just 8 weeks of MBSR, grey matter in the brain increased significantly in the left hippocampus among a few other regions .
Grey matter contains neurons located near the surface of the brain and is responsible for processing information from the central nervous system. It also contains glial cells which transport nutrients and energy molecules to neurons. The hippocampus is the emotional processing plant in our brains along with regulating wakefulness, vigilance, muscle response and heart rate.
“The adult nervous system has the capacity for plasticity, and the structure of the brain can change in response to training… [and] such increases represent enduring changes in brain structure that could support improved mental functioning.”
Just practicing MBSR for 8 weeks actually changed the shape and composition of the brain in an extremely significant way.
Start Doing MBSR!
By this point, I am sure you are 100% ready to embark on your mindfulness-based stress reduction journey. Let’s go into the details on how you can participate in the practice and see some of the same results.
First off, it would be disingenuous of me to act like you can significantly enhance your focus and change the physical composition of your brain with an “easy 5-minute MBSR hack” or something of the sort. This practice is fairly intense and will take some of your time every day.
However, I am hoping that the proven results will serve as motivation to push you through it and hopefully it will become something you enjoy as many do. There are many in-person or online courses that you can participate in to help guide you through, but if that isn’t what you’re looking for or if you don’t have access, I’ll give you some ways to try this at home.
MBSR on your own
Practicing MBSR is very flexible and there are many different methods you can use. Below are some of the most common techniques, though you can find many more through a quick search of the internet. Everyone is different, so choose what works for you and do it. Dedicating 30 minutes to an hour is about the amount of time you should be spending on this if you want to mimic what the methods used in many of the studies.
Mindfulness Meditation: View your thoughts and observe what is happening in your mind. Try to keep a clear mind an not to think about the past or future; the goal is to stay in the present moment as much as possible. Sometimes it is helpful to view your thoughts as an observer, realizing that they are there and what they are rather than analyzing them.
Controlled Diaphragmatic Breathing: Most of us use our upper chest to do most of the work when we breathe. However, breathing with our diaphragm is very beneficial for helping us to be calm. To do this, try to fill the lower part of your lungs with air using inner abdominal/diaphragm muscles. Put one hand on your belly and one on your chest, inhale for a slow count of 5, pause, exhale for a slow count of 5, pause and repeat. Your upper hand shouldn’t move throughout the process. You are sort of filling your “belly” with air. Make sure to focus on every breath and try not to let outside thoughts into your mind.
Body Scan: Lie down and mentally scan different parts of your body, noticing any sensations or feelings that occur. Start at your feet and work your way up, relaxing every muscle on the way. As with the other methods, try to maintain your focus on the body part and banish outside thoughts.
Object Meditation: Hold an object that is special or interesting and focus all of your senses on it. Notice all of the different visual features, how it feels, and how it smells. Do this until you feel that the object is fully examined.
Mindful Eating: Many of us spend our time eating in front of some sort of a screen. While this is entertaining, it is certainly not productive. Practicing mindful eating will help you gain a deeper connection to your food and also will regulate how much you eat. To do this, focus on the feel, look, and taste of the food. If your mind wanders, just bring it back to the food you’re eating. I like doing this with healthy food since I often begin contemplating the effect that it will have on my body.
Walking Meditation: Go for a walk in a safe place at a normal pace, noticing sensations you feel with every step along with viewing all of your surroundings. For example, make note of the colors of the trees and sky, the shape of the path, and the people you see without wondering where the people are going or what they may think of you.
Mindful Stretching: Most people are extremely bound up and tight from a lack of movement and stretching. Mindful stretching fixes this along with helping you maintain your mind in the present. Get your yoga mat and start stretching out your body. Try to balance out your stretching between body parts, feeling your muscles the entire time. Focus on the tension in your muscles and the relief afterward.
Yoga: Yoga is very similar to mindful stretching, but it is more structured. Try to find a yoga routine that incorporates a meditation aspect as well. If it doesn’t, that’s ok, just try to focus on your body and movements, dispelling and outside thoughts.
Exercise: Lifting weights or doing cardio are great ways to keep your body and mind healthy. When you perform either, focus on your movements and how your body feels during them.
This list incorporates just a few of your many options to practice MBSR. My favorites are walking meditation, mindful stretching, and lifting weights. These are easy to incorporate into my day and give the added benefit of staying fit and flexible. Just remember to stay in the present moment within any activity you choose and stay consistent. These are the two biggest factors for success.
In addition to these two important reminders, there are a few other principles that are universally true to make MBSR successful:
Treat the experience as a challenge rather than a chore. This is your journey to becoming more aware, awake, and in the present rather than something you ‘have’ to do. Remember that you are doing this to make yourself better.
Stay disciplined and practice for at least 30 minutes daily. Missing a session out of necessity is fine, but don’t make it a habit if you want to be successful.
Practicing long-term, though not necessarily as consistent as when you first start, has been shown to be necessary to maintain the positive effects on enhanced attentional control . You will likely find that the way these make you feel is something you deeply enjoy and choose to do willingly.
This will probably be difficult at first (at least it was for me), so treat it as an educational experience. You are learning how to be in the present moment which may not come naturally right away.
Try to bring yourself to the present moment throughout the day even outside of your training. Maybe on your commute to work, just focus on the sensation of the road, your current surroundings and the colors of the cars around you, for example.
It’s hard to do this on your own, so find a partner or an online community to interact with if possible.
Stay flexible with your practice. Don’t skip something just because it is hard, but if something really doesn’t work for you, there are many other practices that can be chosen from.
And finally, here are some attitudes for success from Jon Kabat-Zinn himself:
Be free of judgment for yourself and others.
Have patience, give yourself time and space to grow.
You must BELIEVE that your mindset can be changed.
You must be willing to learn. The quickest way to stop learning is to have the belief that you know everything. Learning is integral to the human experience and is how we grow to become better.
Don’t have a set goal to strive for. This isn’t a competition, but rather a continuous bout of personal growth.
Let go of your control and let the mindfulness take over.
Practice self-compassion. It’s easy to be hard on yourself if you aren’t seeing progress, but you need to be kind and love yourself. The whole purpose of this exercise is to be more stress-free, happier, and healthier.
Begin your journey to superpower your focus
With everything that has been said, I hope that you will be willing to at least try MBSR to see what it can do for you. The risk is low, but the potential for a stronger mind and improving well-being is high. So, pick a few practices that sound enjoyable and doable and get after it.
If you’ve ever experienced a panic attack, one thing is for certain: you never want to have one again. However, it’s not as easy as saying ‘wow, I’m never going to do that again.’ Panic attacks are a bit mysterious in their nature which can make them even more tormenting for those who experience them.
Not knowing why it occurred, what symptoms or bodily sensations lead up to a panic attack, and what happens during one can actually make them worse, leading to a downward spiral. Luckily, many mental health experts have outlined just about everything science currently knows. So, let’s learn about them.
What Are Panic Attacks?
Panic attacks are different for everybody including what causes them, how you feel during one, and how you treat your relationship with them. Broadly, panic attacks revolve around a sudden feeling of intense anxiety and impending doom that can occur almost instantaneously .
During a panic attack there are many abnormal physical sensations such as breathlessness, palpitations, chest pain, choking, dizziness, tingling, hot/cold flashes, sweating, faintness and trembling. If you have had any combinations of these along with feeling like you are in danger or the world is coming to an end, we can consider it a panic attack.
Experiencing a panic attack is not an anomaly, and in fact, panic disorder affects up to 5% of the population. Statistically speaking, in a room of 100 people, 5 of them are likely to have this disorder. Keep this in mind when you think that you are the only one suffering from panic attacks; you are not alone.
Panic disorder means that instead of a one-time experience, the attacks are recurrent. This is also accompanied by anxiety about future panic attacks, phobic avoidance (staying away from places you fear will trigger a panic attack), or really any other change in behavior due to the attacks . If you haven’t noticed, the criteria are fairly broad which shows how much it can vary from person to person.
Having this condition is often accompanied by other psychological disorders such as bipolar disorder, depression, general anxiety disorder and so on. In general, being in a poor state of mental health puts you much more at risk for panic attacks and panic disorder.
What Causes Panic Attacks?
This leads us to think about what exactly causes panic attacks. There are a number of things that can cause them and there are likely many more triggers that we aren’t even aware of, so I will go over some of the most common.
Many people experience panic attacks as the result of early-life trauma and PTSD. We become afraid that whatever caused the trauma will occur again. When we enter a situation that we believe will cause that traumatic event to happen again, a panic attack may be triggered .
Stress and Anxiety
Another common cause is having an overbearing amount of stress and anxiety in day-to-day life which can lead to a mental breakdown or attack. Related to this, the amount to which someone is sensitive to anxiety can alter the occurrence of attacks . Someone who has developed an anxiety disorder may be much more sensitive to anxiety and experience more panic attacks.
Panic attacks most often happen outside of the home in a place that we feel is unsafe. This is exacerbated by loud noises and entrapment that might be experienced on a plane or bus. We may also feel unsafe in situations where we are being judged such as in a job evaluation . Changes in bodily sensations (sudden warmth, heart rate increase, etc) may also be misinterpreted as ‘unsafe’ to your body and could lead to an attack.
Interestingly, having parents with panic disorder also makes you much more likely to experience this yourself . Some other general lifestyle and health-related risk factors include stimulant/substance abuse, smoking, hypothyroidism, respiratory difficulty and hearing loss.
Trouble Assessing Threats
The main psychological reason underlying why we get panic attacks is that our brains have trouble assessing true threats . This is especially true if the attack arises from a source of trauma but can also occur from fears out of the blue as well. Our brains determine that something poses a direct threat and we are in danger, setting off our fight-or-flight response.
However, the problem is unsolvable in the moment, resulting in a rush of anxiety that leads to a panic/anxiety attack . Aside from being unsolvable, it is also unlikely that the situation we are in poses any real danger. Most panic attacks arise from either misinterpreting our environment or bodily sensations as a threat to our safety.
Fear of Future Panic Attacks
Unfortunately, simply having a panic attack can make you more susceptible to future panic attacks. It can be such a terrible experience, especially if it happens in a public place, that attacks themselves become what you’re afraid of instead of the initial trigger. This is called a fear of fear , where you become afraid of the anxiety that causes panic attacks.
Ways To Overcome Panic Attacks
Now that we know a bit about panic attacks and their causes, let’s get to the most important part: overcoming them. They can seem to creep up anytime, leaving you without control, but rest assured that there are ways that you can limit their occurrence or possibly eliminate them completely.
Consistent practice of various panic control therapies has been shown to be 70-80% effective and can last for up to two years . With that said, if you suffer from panic attacks or panic disorder you should try to remain vigilant with your therapy and not test how long it will last.
Gaining the ability to stop panic attacks is crucial not only because of their inconvenience and unpleasant nature but also because how you react to them can make other parts of your mental health suffer as well. If you start changing your habits and avoiding situations that may cause an attack, you will likely become more and more isolated which could lead to heightened anxiety and other problems such as depression. This will only make your condition worse.
The best option to gain control is to work with a good mental health expert and have them walk you through therapy, but that is not always an option. Because of this, I will summarize (in no particular order) what the experts believe to be the best ways to stop panic attacks in a way that you can implement on your own.
There are typically three routes you can take: therapy alone, medication alone, or a combination of the two. The question of whether or not to medicate to reduce anxiety and panic attacks should be taken seriously. Medications DO have some value in therapy especially if anxiety is blocking you from even attempting therapy.
Studies have shown that taking medication alone will help to stop panic attacks and reduce anxiety, but the patients never actually solved the underlying issues and there was a high risk of negative side effects or abusive behavior relating to the drugs .
“pharmacological treatments have short-term effects, and improvements do not persist after the end of the therapy. On the other hand, therapy has a long-term effect”
A combination of therapy and medication was shown to work best to help individuals lower anxiety and then overcome the underlying problems causing their panic attacks. However, after the risk of abuse and side effects of the drugs are factored in, some experts in mental health concluded that strict therapy led to the best outcomes .
Unfortunately though, taking a drug to overcome the problem is the ‘easiest’ route and is what most people follow, at least in the USA.
“Although the nature of the evidence [for behavioral therapy] is robust, such approaches are underused in the USA, compared with drug treatment”
So, now that we know that therapy is the best option, what do we mean by therapy?
Cognitive Behavioral Therapy
The most popular form of therapy for overcoming panic attacks and anxiety in general is cognitive behavioral therapy (CBT). CBT focuses on reversing misunderstandings (false interpretations of threat) you may have about your environment along with changing how you act in environments that seem ‘unsafe’ .
“CBT is the most widely studied and validated psychotherapeutic treatment for panic disorder”
Education About Panic Attacks
The actual therapy is very in-depth, so for time’s sake, I will give a general outline and let you decide if it is appealing enough to do more research on the how-to. The first step for CBT is educating yourself about panic attacks including what happens to your body and mind and what causes them . This education includes correcting misconceptions about fear (how unlikely it is to occur) and correcting distortions you may have in how you think about them.
Controlling Behavior and Emotions
The next step is controlling how you act and think in situations when you are prone to panic attacks. One of the main techniques is becoming more present and gaining control of your body. This is done through attentional focus training where you try to gain the ability to focus on your surroundings as objects rather than abstract fears. For example, if you hear a loud noise on a bus, you just acknowledge that a loud noise occurred and move on rather than think about all of the terrible things that may have caused the noise.
Another purpose of CBT is to allow you to view your thoughts objectively and acknowledge the presence of negative thoughts, but don’t allow them to control you. You will also focus on how the negative thoughts affect you, thinking about advantages and disadvantages of keeping those thoughts. Often times you will realize that the negative thoughts harm you much more than they help.
In addition to this, you are encouraged to think objectively about bodily sensations that may have previously pushed you into a panic attack. For example, an increase in heart rate happens naturally many times throughout the day and doesn’t mean you will have a heart attack.
Sometimes you may not know what causes panic attacks, but if you can pinpoint the source, fear exposure therapy has been shown to be an effective option. In our minds, we have deeply rooted fear networks that tell us what we are afraid of and how to act. This occurs even if we know it is irrational .
Because of this, if we want to reduce panic attacks, the fear networks must be restructured. Experts in psychology have laid out the groundwork for doing this through exposure techniques. Facing your fears is no easy task and in the beginning it will likely be difficult, but with time and consistency, you will be able to overcome it.
“We have found that patients with comorbid panic attacks are generally successful in quickly reducing their fear”
Education About Your Fear
In order to reduce fear, two conditions must be met. The first is that you must become educated about your fear and begin to think about it in a way that is different than when you were afraid. Learn as much about your fear as possible so that when you experience it again there will be as few surprises as possible. This is much easier with the power of the internet where you can read and watch almost anything.
View the fear from all angles including how you think about it and the chances that your perceived negative outcome will occur. In reality, most of the things we are afraid of will never actually harm us and hopefully, you will come to that conclusion through learning. As a part of this process, try to watch videos of people interacting calmly around your fear or in the situation that you fear. Keep what you learned in your tool belt for the next step of the process.
Facing Your Fear
The second condition is that you must become more familiar with your fear in person, starting small and then working up to facing your fear. Thankfully, this part isn’t very technical but remember to stay safe. You don’t want to try facing your fear in its entirety right off the bat because failure means that your fear will only be strengthened.
Instead, take small steps logical steps that lead up to facing your fear. For example, if you’re afraid of being with large groups of people, start by hanging out with a couple friends. Do this a few times until you’re comfortable in that situation and then go a bit bigger, but not too much bigger.
Maybe hang out with a couple friends and a few of their friends that you aren’t as acquainted with. Repeat this building up over and over until you are to the point where you are facing initial fear. In the beginning, this would’ve seemed impossible, but now it is just another step like all the others you have conquered. Not all types of fear are this straightforward, but just try your best to implement the basic outline of the therapy.
Throughout the process, one of the best ways to remain calm is to practice breathing with your diaphragm. It may seem trivial, but this can have an enormous impact on taking you out of the fight-or-flight state of mind and into the calm. Briefly, breathing with your diaphragm means that instead of inhaling with chest muscles (how many of us breathe normally), you use your diaphragm and fill your lungs around your abdomen. I like to take about 4 seconds on my inhale, pause, and then 4 seconds on the exhale, repeating this cycle until I feel calm.
While CBT and fear exposure therapy were the two methods written about the most in the primary literature, there are also many other steps that can be taken to overcome panic attacks. Since panic attacks include a sudden onset of heavy anxiety and may also be caused by anxiety, techniques that reduce anxiety will only help us out.
One of my favorite methods for reducing anxiety is journaling. Again, this method has been deeply researched and proven to help with anxiety. Here is a compilation of what has been shown to work.
Before you begin writing, think about something that makes you happy for as long as you like. Then, write about some troubling thoughts you may be having, but try to incorporate how the negative experience could benefit you. This may be difficult, but it is almost always possible to see some sort of silver lining.
In addition to this, take some time to write about a few things you are grateful for and why. I also like to write about goals and track progress. Completing goals is ultra-fulfilling and just makes you feel good. Doing this on a blank sheet of paper works, but if you want to check out a guided journal we made for reducing anxiety that is explained in more depth, head here.
[Check out an in-depth article on journaling]
We saw earlier that a main focus of CBT is viewing thoughts objectively which also serves as a large part of mindfulness meditation. Meditation is also completely free and easy to implement if you have a few minutes of spare time. To do this, sit in a stable, comfortable position, keeping a clear mind and trying to remain in the present moment.
Once you feel that you have control of your thoughts, begin to notice your surroundings and any thoughts that come into your mind. Think about everything objectively and try not to think about the past or future. This has been shown by many studies to work wonders for reducing anxiety.
If you suffer from panic attacks, it might seem like you are alone without control. However, we now know that neither of those are true. Many people experience panic attacks and mental health experts have found ways for us to overcome them. Once again, if you have access to a therapist, take that option. If you are taking any type of medication, keep taking it and discuss your alternative options with a healthcare professional.
The methods listed above are some of the best according to the scientific literature, but I’m sure that there are many more that could work for you as well. The most important thing is that you have to be willing to try and practice consistently if you truly want to overcome your panic attacks.
 Clark, D. M. (1986). A cognitive model of panic. Behavior Research and Therapy, 24, 461−470.
 Byrne, Peter Roy, et al. “Panic Disorder.” The Lancet, vol. 368, no. 9149, Sept. 2006, pp. 1023–1032., doi:10.1016/s0140-6736(05)74897-2.
 Craske, Michelle G., and David H. Barlow. “Mastery of Your Anxiety and Panic: Therapist Guide.” Oxford University Press, 2006, doi:10.1093/med:psych/9780195311402.001.0001.
 Ehlers, Anke, et al. “Selective Processing of Threat Cues in Subjects with Panic Attacks.” Cognition & Emotion, vol. 2, no. 3, 1988, pp. 201–219., doi:10.1080/02699938808410924.
 Fava, Leonardo, and John Morton. “Causal Modeling of Panic Disorder Theories.” Clinical Psychology Review, vol. 29, no. 7, 2009, pp. 623–637., doi:10.1016/j.cpr.2009.08.002.
 Falsetti, S.A., & Resnick, H.S. (2000). Cognitive-behavioral treatment for PTSD with panic attacks. Journal of Contemporary Psychotherapy, 30, 163–179.
When fear comes into our lives, we can either face it and overcome it or pretend it doesn’t exist through avoidance. The former allows us to maintain all regular activities while at the same time strengthens our confidence for the next time a fearful situation arises. However, the latter limits the scope of what we are able to accomplish and weakens us for any future adverse situations.
Crippling fear can be extremely disabling, reducing your ability to function which will inevitably lead to a decrease in your quality of life. For example, maybe you experienced heavy turbulence while on an airplane; in that moment you truly worried that you might go down in a fiery wreck. This led to other thoughts about airplanes such as the height you are flying at, the absurd amount of mechanical errors that could occur, and how hard it must be to land especially if it is windy. These thoughts ruminate in your mind and manifest as a sort of monster that comes out whenever the thought of an airplane pops into your mind.
Now there is no way that you can ride a plane without experiencing a panic attack or debilitating anxiety so it seems easier to avoid the situation altogether. However, this decision makes any long-distance travel out of the picture. This is fine if you enjoy long road trips or don’t mind isolation, but more than likely it will have vast undesired effects on your life. This could include never being able to travel to dream destinations overseas, not being able to see loved ones who live far away, missing job opportunities that require travel and many more.
False interpretations of fear
When in a worrisome state, we are most likely falsely interpreting something in our environment as being a threat . This activates our sympathetic nervous system, more commonly known as a “fight-or-flight” state. We try to escape to avoid getting injured, and what easier way is there to escape than avoiding the situation altogether? The main issue here is a constant anxious feeling that arises from knowing our fear still exists along with the regret of missing out important parts of life because of our avoidance. The constant worry about non-existent threats forces us into living our lives as a sort of illusion.
Whatever your fear may be, the result of avoiding them will almost certainly have more drastic consequences than the reason you are avoiding the fear in the first place. Facing your fears head on is no easy task, but it is crucial to conquering them. Exposure therapy may seem like you are just using brute force to solve the problem and while it may not be easy, it remains as one of the most effective strategies you can use to reduce fear.
There is a lot of practical information buried in the scientific primary literature regarding specific techniques and practices regarding exposure therapy. Some of the most useful that I will describe come from two papers, one authored by Falsetti and Resnick and the other by Foa and Kozak. While many of these methods can be practiced at home, if your fear is too overpowering don’t hesitate to see a trained therapist to help you overcome them.
Using exposure therapy to overcome fear
Of the many aspects involved in conquering fear, two stand out as the most important. The first is that relevant information must be presented about the fear to give you a better understanding of what it is you’re are trying to overcome. Then, you must create a new relationship with the fear and integrate it into your existing fear structure. In other words, you must become acquainted with your fear and realize that facing it will not harm you. The first part focuses on making steps towards breaking through the barrier that your fear has constructed. This sets you up for the second part which involves a realization that you can conquer your fears using exposure techniques.
Learning about your fear
The first step to overcoming fear might seem a bit obvious, but many miss it. You must learn about your fear before you face it. By educating yourself, you can see the thing you fear from all angles which eliminates as many surprises as possible. Objective information also helps diminish the power you have attributed to your fear through constant rumination. Throughout the process, pick your top three fears and make a diary of all your findings and new things you have learned.
You need to learn facts and statistics about whatever is causing your fear. This is made much easier with the internet. Going back to our airplane example, the first step would be to search for general facts about how planes take off, gets to altitude, maintains altitude, lands, etc. Watch videos of airplane operation including sounds that you might hear and sights that are to be expected. Get as many insights as possible so that you won’t get thrown into a downward spiral (pun intended) when you feel a jolt or unexpected noises the next time you embark on a flight.
Try to learn as much as you possibly can about the background and then move into statistics. Statistics don’t always help, but they do allow us to achieve a baseline understanding of how irrational our fears may be. Thousands of flights are completed successfully every day with almost no incidence of failure.
Expanding to other types of fear
While airplanes serve as a straightforward example, there are many other types of fear that may not have such a clear way of learning about them. For example, let’s say you suffer from social anxiety and you’re afraid of going to dinner in large groups. You may not know exactly what you’re afraid of. For these types, do your best to determine what it is. After examining your thoughts, you may find that the fear of others judging you is the root cause of your anxiety in a group setting. For this, there aren’t really statistics to help you out.
In this example, change your research to focus on the location and place you will be meeting along with who will be there. Maybe determine a few people that you can rely on throughout the experience to give you comfort. It is also helpful to search for other articles outlining the underlying causes for your specific fear so that you can better understand why you are feeling the way you are. For the statistics part, just think about the likelihood of your fear occurring. More often than not, most people aren’t going to spend the whole night judging you and you probably won’t spill your drink all over yourself. Whatever it may be, think about how unlikely it is to happen.
How is this fear affecting you?
Once you have a grasp on some of the background information, it’s time to switch over to thinking about how holding onto the fear is affecting your everyday life. Write down the advantages and disadvantages of holding onto your beliefs, focusing on the disadvantages. Hopefully, you will see that the disadvantages far outweigh the advantages. This should encourage you to move towards overcoming the fear after you see the consequences of remaining a victim.
Avoiding going out to eat with large groups of people will mean you never have to worry about people thinking negatively of you, which is an advantage. However, staying away from these types of gatherings means that you will become more isolated, miss out on important events, and miss opportunities to make relationships with new people. The disadvantages will hurt you much more in the long run, so you might as well take the steps necessary to overcome that fear.
Exposure therapy and tips for success
It’s very difficult to successfully overcome fear without having exposure to it. Because of this, many mental health experts have written about effective exposure therapy practices in the primary literature. I will go over some of the most helpful aspects of the therapy that I think anyone can implement to start chipping away at the mountain your fear has become.
In short, exposure therapy focuses on having you do things that you are afraid of so that you will get used to them. Using the same three fears from above, pick the one that you are least afraid of and would like to resume. This will hopefully allow you to build confidence in your ability to face your larger fears. Don’t worry though, the experts make sure that you work up to your fear so that you won’t ever be overwhelmed.
The worst thing that can happen is to jump off the deep end with your fear and fail, making you more afraid than you were in the first place. Because of this, we are going to start small to get you more acquainted with what the fearful activity feels like. Pick an activity that is related to your fear and feasible to do without failure, doing it a few times until you get comfortable with it. With our group social anxiety example, it would be a good idea to start off small by just getting coffee with a friend. It may be uncomfortable at first but knowing that it will get better makes it a bit more doable at first.
You will eventually become comfortable with the smaller activity that you chose which will be very encouraging. However, there is still more work to do before achieving your end goal of being free from fear. It’s time to pick a larger activity that pushes closer to your actual fear. This could possibly be going to lunch with a few close friends. Again, do this until you feel comfortable. Keep pushing farther and farther using the same technique.
In addition to the building up phase, visualization of your fear has been shown to be successful as well. This is a bit like meditating on your fear. The exercise won’t be particularly pleasurable, but it will help you along your journey to overcome your fear. Focus on visualizing what you are afraid of including specific aspects that are particularly frightful. Block out at least 25 minutes for this. Watching videos of people calmly interacting with what you are afraid of has been shown to be effective and can serve as a part of your visualization. Like all of the treatment, doing this often and consistently will yield the best results. Another benefit of visualization is that it can be done often and anywhere.
[To learn how meditation can help with anxiety, read more here.]
Facing your fear
This is the part of exposure therapy that we have been building up to. By now, this is just another step like all the others. You should have worked up to something in the build-up phase that is not far behind what your fear may be. Facing the actual fear may be a daunting task, but with the confidence you have built from the previous training it is something you can accomplish. The first time will be the hardest, but as you do it more and more it will become easier, even to the point where you are comfortable with it. You can now resume the activity and avoid the disadvantages that came from not facing your fear.
This method of overcoming fears is synonymous with watching a scary movie but much more practical and beneficial in your daily life. Imagine flipping the channel to a particularly scary and disturbing movie. You watch it for a while but decide it is too fear-inducing so you change the channel (avoidance). Yet, despite changing the channel, the scenes from the movie are still in the back of your mind where they will stay unless you intervene. If you change the channel back, the scary movie will still be there waiting for you.
Now, if you force yourself to watch the whole movie and then repeat it a few times, the horror will likely fade and the movie may even become boring. The same happens with fearful and traumatic experiences. Ignoring it is like changing the channel; you have avoided the exact cause in the moment, but the fear remains. Fear exposure therapy allows you to habituate the fear and the experience becomes less frightful.
Tips for success
Breathing with your diaphragm
When we acquire an acute fear of something, our body and mind are most likely misinterpreting a threat that in reality won’t harm us. We instinctively go into “fight-or-flight” mode, activating the sympathetic nervous system. This activation works great if we are in the jungle being chased by a tiger, but in our everyday lives it can make things difficult.
Luckily, we can manage our bodies response through a few different techniques, one of which is diaphragmatic breathing. Put a bit more simply, this is what people mean when they say to ‘take slow, deep breaths’. However, more detail than that is needed to calm yourself effectively. Although breathing deeply and slowly will help to calm you down, it doesn’t quite capture all that can be done to when you are afraid and experience anxiety.
The title ‘diaphragmatic breathing’ encapsulates what you are actually doing, which is using your diaphragm to do the work of breathing. In other words, using your abdominal muscles rather than chest muscles to fill your lungs with air. This method of breathing holds a few other benefits such as strengthening your diaphragm, decreasing the effort needed to breathe, slowing heart rate, and decreasing your body’s demand for oxygen . It also helps us transition from the sympathetic fight-or-flight state to a parasympathetic calm state.
How to breathe with your diaphragm
It is best to practice this at home before you embark on your fear exposure journey. Start by laying on your back with your knees slightly bent and head supported. Place one hand on your chest and another just below your ribcage so that you can feel where the inhaled air is being stored. Then, breathe in slowly through your nose using your abs to do the work. Instead of pushing out your chest as you breathe, your belly should push out against your lower hand. Try to not allow your chest to move which can be felt by the upper hand .
When you exhale, use the muscles in your belly. Your lower hand should move down as air exits and your upper hand should remain still. This may be a bit difficult at first since most of us naturally breathe with our chest muscles and have underdeveloped muscles that control the diaphragm. Practice 3-5 times per day for about five minutes at a time. Then move to sitting and standing once you feel more comfortable with the technique.
It is best to follow some sort of cadence when you are doing the breathing. For me, I like slowly counting to 4 on the inhale, pause, slowly counting to 4 on the exhale, pausing again and then repeating. Whenever you feel anxiety and fear coming on, start breathing using this technique to help calm yourself. While diaphragmatic breathing can be used all day, it is hard to always be mindful of how you are taking in air.
More tips: Journaling practices
Writing has already been done as a crucial step throughout the process, but there are additional in-depth techniques that may be helpful. Broadly, write about the event or situation that causes your fear including what happened and why you are still afraid of it. More specifically, write down the emotions you feel around the fear and think about how it is just a memory and not an event that is reoccurring or one that will reoccur.
Identify which parts of the experience caused the most pain and trauma through your writing. As a part of this, identify distortions in your perceptions of your fear that were found through research. Allow yourself to let go of some self-blame that often occurs as trauma. It’s hard to accept this as a reality, but sometimes bad things do randomly happen to good people. Blaming yourself or others may just be a coping mechanism to make you feel safe, but again, sometimes negative events do happen randomly and likely won’t occur again. With that said, write about how you can prevent events that cause the fear or trauma from happening in the future as well. Both of these are meant to empower you over your fear.
Read what you have written daily and continue writing with this method as many times as you like. The more you do it, the more helpful it will be. Your first writing therapy session will likely be the most difficult, but like the scary movie example above, it will become easier and help you better understand your fear every time you do it. Although what happened may have been random, there is a reason and you are not completely helpless.
[If you’re interested in the benefits journaling can have for general anxiety, check out Journaling for Anxiety.]
Utilize thought restructuring
Thought restructuring is a practice that branches from cognitive behavioral therapy. In short, the purpose is to restructure your thinking patterns to allow you the ability to view your fearful thoughts objectively. When you do this, you gain the ability to realize that what you are afraid of doesn’t warrant the fear you have attributed to it. Instead of restating how to go about thought restructuring, it would be more useful to head here to read an in-depth article about it on our blog.
Other useful info about exposure therapy
Depending on your fear, the time it takes to overcome it will vary along with the difficulty. If it doesn’t work at first, the worst thing you can do for your wellbeing is give up. Go at it again in a safe manner, using as many techniques as possible to stay relaxed throughout the process. Also, as you do this try to weaken the link in your mind between the activity or situation and perceived harm. If you constantly have thoughts running through your mind that you will be harmed, you will stay in fight-or-flight mode which makes it almost impossible to reduce your fear.
While mental health experts have shown that exposure therapy can help many conquer their fears and achieve a higher quality of life, it won’t work for everybody depending on the type and severity of your specific fear. The above technique is great if you are comfortable with doing the training on your own or don’t have access to a therapist, but I would recommend seeing a therapist if you have the ability. With that said, I believe that with persistence you will be able to find success in reducing your fear and living the life you desire.
Have any experiences with thought restructuring? Comment Below!
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 Borkovec, T.D. (2002). Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9, 76–80
 Clevland clinic diaphragm breathing.
 Falsetti, S.A., & Resnick, H.S. (2000). Cognitive-behavioral treatment for PTSD with panic attacks. Journal of Contemporary Psychotherapy, 30, 163–179.
 Emotional processing. Foa, Edna B., and Michael J. Kozak. “Emotional Processing of Fear: Exposure to Corrective Information.” Psychological Bulletin, vol. 99, no. 1, 1986, pp. 20–35., doi:10.1037//0033-2909.99.1.20.
Fears in everyday life can range from minor disturbances that we breeze past to crippling events that cause us to avoid certain situations completely. For example, imagine riding a public bus. Everything seems normal at first, but you then see someone cough and realize how close you are to them. What if they have tuberculosis? Could you catch it? You then notice the driver runs over the curb while driving. The driver surely isn’t competent and the trip will inevitably lead to a rollover accident at some point. In the meantime, you smell something that vaguely resembles smoke. You decide that you no longer need to worry about the rollover because the bus is going to start on fire before that happens with you trapped inside, perishing to a fiery demise.
Because of that experience and the fears that arose, it would be much easier to just skip riding the bus altogether, right? The fear is avoided and the problem is solved, but now you have just extremely limited your range of travel and exposure to the outside world. We can see through this story that the fears experienced on the bus are a bit irrational and are very unlikely to happen, despite how real they felt.
What really happened?
Let’s look at an alternate scenario. The person coughing? They simply swallowed a gulp of water down the wrong pipe and are completely healthy. The driver was forced to hit the curb in an attempt to avoid a near collision with another vehicle. Their competence was actually the thing keeping you safe. Oh, and the smell of smoke? The wind changed when you were at a stoplight, pushing some of the exhaust through an open window behind you.
Unfortunately, when we have a fear, our minds often take it the foreseen consequences to level 10. Conjuring the worst-case scenario is a protective mechanism that we have evolved throughout time to keep us safe. Imagine when our ancestors traveling in the jungle. If a twig snaps, you better be ready for a tiger to leap at you even though it was probably just a squirrel (do they have squirrels in the jungle?) hopping to a different tree because it was scared of you. When these fears manifest in our everyday lives, they can take control of our minds, making it difficult to tell our minds to ease up a bit.
How do we begin controlling our fears?
Luckily, this is something that experts in psychology have been deeply invested in. Below, I will detail some of the best information I found in the scientific literature to restructure your fear networks. The methods largely pull from some cognitive behavioral therapy (CBT) techniques discussed by Wells and Papageorgiou in a paper they wrote in 2004 along with a few other scholarly articles. Before the methods, it is important to say that if you have access to a therapist who can walk you through CBT, definitely take that route. However, many people don’t have the time or means to access this resource or may be afraid to go to a therapist. If you are in any of these categories, read on. If not, you may still find added benefit from a different point of view, so read on as well.
For most of us, fear comes from having trouble assessing true threats coupled with poor coping mechanisms for when this happens. Because of this, we may have lingering negative thoughts that can affect our lives on a daily basis. We may ruminate about these thoughts and hold onto the fear which will inevitably decrease our state of mental health and quality of life in general. To solve this, here are some techniques from mental health experts to decrease your fear through cognitive restructuring.
Educate yourself about the fear at hand
One of the biggest components that can cultivate fear is the unknown. Going back to the bus example, you probably didn’t know how unlikely it is to come across someone with tuberculosis or even how it is spread for that matter. Furthermore, your bus route only follows residential streets, so unless something catastrophic happened it would be practically impossible for the bus to roll over. Also, do you even know what a bus on fire smells like?
Correcting misconceptions we have about our fear is the first step to overcoming it . Referring back to the example, when we think about it rationally, the distortions in the thought process become much more clear, showing us that the fear we have is actually very unlikely to occur. However, holding onto the fear will end up harming us much more than it will help us. Once we realize this, we can begin to overcome fear.
“negative thoughts are seen merely as events in the mind that should be treated as objects, and efforts should be devoted to changing one’s relationship with them”
Correcting misconceptions about the fear
Write down your top fears and begin to make a list of what makes you afraid of them. With the bus, being afraid of coughing comes from a fear that you could contract a disease that would severely diminish your quality of life. The rollover is scary because it could lead to serious injury.
Then, write down the advantages and disadvantages of holding onto that fear. An advantage would be self-preservation for the one in a gazillion chance that the negative outcome occurs. Don’t get me wrong, self-preservation is great! Well, except when it comes to disadvantages having consequences that also impact your life negatively, which is what you were trying to avoid in the first place. Think about the disadvantages of not confronting your fear. Not being able to travel outside of walking distance because you are unwilling to take public transportation will have a direct effect on your life. Completing basic errands, socializing, and finding any enjoyment outside of the home will become much more difficult. Ultimately, you will realize that dwelling on and giving in to your fear will not help you.
Once this is done, come back to the possibilities of each advantage or disadvantage occurring and write them down. Sure, you could contract a disease, have a rollover accident or be trapped in a fiery abyss, but are those likely in the slightest sense? No. Statistics don’t make the fear go away, but they can help to establish a baseline of objective thinking. Then write about the likelihood that avoiding your fear will harm you. More often than not, avoidance will impact your life immediately. Since the goal is to overcome the fear, it is ok to be a bit biased towards the negative impacts, though you may not need to be. Review this writing at least once daily and contemplate it.
Enhancing control over thinking
Wouldn’t it be great to have control in the moment and not take your assumptions about the fear to the extreme? With attentional training, this may be possible. If it doesn’t completely allow you to take control of your thinking, it will at least help. The main overview of the training is to allow you to keep your thinking in the present. It helps you think about your thoughts more objectively rather than extrapolate what you are sensing to an immediate reaction to fear which leads to the negative consequences you wrote down from the previous exercise. Obtaining a high amount of control won’t happen overnight. In a clinical setting, a therapist will guide patients through the training a couple days a week for many weeks. If you stay consistent and truly put in an effort, you too can acquire some of the benefits and control how you handle fear
Training your mind
The initial training is a bit abstract and has some deep similarities to mindfulness meditation, though it is more applied. To begin, find a comfortable place in your home and focus intensely on individual sounds, sights, smells and bodily sensations. Begin by focusing on a specific sound for a few minutes. If there is ticking from a clock, focus on that sound and try your hardest to not stray. If you do, that is ok, simply bring your attention back to the ticking.
“attentional training, which promotes external focus, can eliminate fear” -Adrian Wells
Once you have done this, switch your attention to looking at something, using the same intensity. Examine every part of the object. If it is a clock, notice the shape of the clock and the markings. Watch the movement of the hands. Take in all of the different colors. Again, for about three minutes the only thoughts in your mind should be of how the clock looks. Follow this same technique for smells. For bodily sensations, focus on each of your limbs one at a time. Notice anything you feel and how the feelings change. Imagine that there is a heavy weight attached to each limb and then imagine it being removed. Then, imagine that each limb suddenly becomes warm. Spend about a minute on each leg and each arm.
Try to pick different sources to focus on for each different training session. You will notice yourself becoming better and better at maintaining your focus. As stated earlier, this may take some time, but consistent training will pay off. After you feel yourself become more proficient, add about 3 minutes at the end (if you don’t have time, shave a minute off of the longer focus periods) where you rapidly change your focus between different sources. Quickly switch from sound to sound, still focusing intently on each . Try to divide this time evenly between sounds, sights, and bodily sensations. Skip smells as it may be difficult to differentiate between them.
Increasing the difficulty
Once you’ve mastered this part of your training, go to a safe, public place and follow the same routine. Pick a place with more distractions to raise the difficulty. In today’s world, our attention spans are becoming shorter and shorter. This hurts us when it comes to fear because instead of being able to focus on and objectively analyze individual thoughts, we bounce from negative moment to negative moment. Not only does this cause the fear to linger in our minds, but it also increases our anxiety about the situation.
Another helpful technique is to utilize mental imaging. Think about an image such as a tree and examine it just as you would with the sights from above. Notice everything about the image and maintain this for a few minutes, bringing yourself back to the image if your mind wanders. You may begin this whenever you feel comfortable but eventually, this should become a main staple of your training.
Once you feel comfortable with mental imaging, shift the focus from images to thoughts using the same process. Instead of trying to process the thoughts that come into your mind, just observe them sort of like the objects from earlier in your training. Maybe examine how that thought makes you feel without letting yourself bring emotions into it. Explore the thought like you explored different parts of the clock. Instead of consciously picking a specific thought, allow your mind to wander and see what thoughts come into your mind.
Connecting the training to your thoughts
While it may not seem directly evident, the point of this attentional training is to increase your ability to be in the present moment and notice your feelings more objectively. When you notice the early negative thoughts arising from your fear, just observe them as you did the sights, sounds, smells, and bodily sensations earlier. Thinking “I am afraid of X” turns into “I am having thoughts about being afraid of X”. When this happens, you are no longer controlled by the emotions that would’ve followed before the training. You have the ability to monitor the thoughts and decide what to do with them. With this, you can think rationally and apply the list of disadvantages and the consequences of those disadvantages to hopefully change your mind about the nature of the fear and its importance.
Another method that has been found to be helpful with your newly acquired attentional control is to implement a “fearful thought ban”. Again, this one won’t be easy, but it has been shown to help. You can probably guess what it is from the title. The ban essentially means that when a fearful thought arises, you won’t try to understand it, find a coping mechanism, or fix it like you normally would before. Instead, you observe them like discussed earlier and tell yourself the reasons that you don’t need to be afraid. To enhance the benefits this can yield, make a log of when fearful thoughts come up in a journal and also write down how successful you were at overcoming them and what helped/didn’t help.
By doing this, you are further altering the cognitive fear networks, telling the mind to objectively engage in negative thoughts without simply covering them up or avoiding them. In order to conquer your fears, it is important to emphasize the confrontation of fearful thoughts. Otherwise, they will always remain in the back of your mind subconsciously. Another overarching goal of this process is to realize that you can actively modify your thoughts and beliefs rather than being a slave to them. The idea that you can’t change your thoughts or the way you think is common among people but erroneous. This is compounded by the fact that often there isn’t a path to change thought processes, but this training changes the game.
“patients believe erroneously that rumination is uncontrollable”
Overview of the process
Determine your top fears and write them down in a journal format. Then, ponder the advantages and disadvantages of holding onto that fear. Write down the positive and negative impacts that ruminating and acting upon the fear will yield. Then, think about the likelihood of each advantage or disadvantage actually occurring and write that down as well, acknowledging that the disadvantages are far more likely to occur. Look over this list at least once a day.
Enhance your ability to remain in the present:
Begin to train your ability to control your thoughts and remain in the present moment. In your home, intensely focus on and examine a sight, sound, smell and bodily sensation. If your attention strays, just bring yourself back into the exercise. Try to spend about 3 minutes per day on each category. Once you become better at this, add an additional 3 minutes at the end where you rapidly switch between sources of focus while maintaining the same intensity. To increase the difficulty and further your training, practice this in a safe, public space with more distractions.
Practice monitoring your thoughts:
Now that you have increased your ability to think objectively and stay in the present moment for an extended period, it’s time to move inside your mind. Using the same sort of process as before, create a mental image and focus on examining it for a few minutes, noticing distinct features and how it changes. Once adept at this, shift the focus from images to thoughts that enter your mind. Spend a couple minutes observing a single thought in your mind. Examine the features just as you did with mental imaging: notice you are having it, where it came from, how it makes you feel all without emotion or analyzing the thought itself.
Implement a “fearful thought ban”:
Now that you have trained yourself to view thoughts objectively and can notice their features, it’s time to begin reducing your fear. The fearful thought ban means that whenever a fearful thought comes to mind, simply take notice of it and realize that it is there rather than freaking out and trying to cope or cover it up. Instead of thinking “I am afraid of X right now. What should I do?”, you will now think “I am having thoughts about being afraid of X. Why am I having a fearful thought in this situation? Is the thought justified? How is acting on this thought going to hurt me more than benefit me? Ok, I no longer need this thought and can continue with my day”. Make a journal entry every time a fearful thought comes into your mind, detailing what it arose from and how successful you were with not falling to it. This ban brings all the training together and puts it to work.
While these techniques are supported by psychological experts and real-world examples of success, they may not work for everyone. Because of this, it may be useful to try multiple different techniques to tackle your fear and anxiety. This goes without saying, but if you are on any medications or participate in a program with a therapist, don’t discontinue treatment unless you have discussed it with a medical professional. While I have spent many hours researching these techniques, I myself am not a mental health expert. My intent is simply to convey the information put out by experts in the scientific literature in practical and understandable.
By training yourself to think objectively about your thoughts, you can begin to chip away at the underlying cognitive framework that causes you to hold onto fears. You will begin to see them as irrational and unneeded, causing more damage than benefit. Fear itself can be scary when there is not a clear way to manage and reduce it. Through consistent and proper implementation of these techniques, hopefully you too can find the fear reducing benefit that many others have. Once you start, you will finally be on the path to conquering your fears.
Have any experiences with thought restructuring? Comment Below!
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 Byrne, Peter Roy, et al. “Panic Disorder.” The Lancet, vol. 368, no. 9149, Sept. 2006, pp. 1023–1032., doi:10.1016/s0140-6736(05)74897-2.
 Ehlers, Anke, et al. “Selective Processing of Threat Cues in Subjects with Panic Attacks.” Cognition & Emotion, vol. 2, no. 3, 1988, pp. 201–219., doi:10.1080/02699938808410924.
 Wells, A., & Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination; Nature, theory, and treatment (pp. 259–273). West Sussex, England: Wiley
 Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21, 273–280.
We all get anxiety, and when it seems like it’s getting out of control we may not know where to look for a solution. Maybe, going to the doctor would seem like a fix to your problem. While many times prescriptions given out for medication can work, all too often it leads to abuse, dependence, or adverse side effects. Unbeknown to most, there are many supplements and herbal remedies that have been shown by science to be effective ways to reduce anxiety while avoiding the negative side effects of pharmaceuticals.
I used to work in a supplement shop, so I know how intimidating walking into one can be. The walls seem like they go on infinitely with millions of different colored bottles lined on the shelves. You read the nearest label, and it may say “Cat’s Claw”, “Pycnogenol”, or some other obscure name that you probably didn’t even know existed. Out of the corner of your eye, something no short of a monster makes you freeze with fear.
Luckily for you, it was just a poster of a muscular behemoth humanoid with the headline “GAIN 60 POUNDS OF MUSCLE IN 10 DAYS GUARANTEED!!” Where do you even start looking for something that may help with your anxiety?
Don’t worry, leave the searching part for me. I’ve spent a long time sifting through the research that is out there and found some legitimate candidates that have been shown to reduce anxiety and depression. Unfortunately, many of the studies I read didn’t survive my scrutiny. I tried to pick only double-blind placebo studies. These present some of the most unbiased research and relatively trustable results. If your favorite supplement that you’ve been taking for years didn’t make the list, keep taking it. The research for the various supplements and herbal remedies was just the most convincing that I found.
Herbal Remedies for Anxiety
Of all the herbal remedies out there, Kava has the most conclusive research resulting in anxiety relief. Traditionally, Kava would be taken as a drink in tea form, but the studies that tested it utilized kava extract form. A summary of a few studies concluded that 70-100mg of extract a day taken for at least 8 weeks led to the most benefit . While Kava may be effective for anxiety, be careful not to exceed 400mg of extract a day. This has been shown to be harmful to the liver and kidneys and led to it being banned in a few countries. We are trying to fix anxiety, not give you more with kidney and liver issues!
Passionflower (specifically Passiflora Incarnate) comes in a close second place when it comes to clinical research done on its use as a treatment for anxiety. Three different double-blind placebo studies all resulted in a significant self-reported reduction in anxiety . One of these studies tested Passionflower against oxazepam, a pharmaceutical anti-depressant. Amazingly, Passionflower extract was just as effective and avoided all of the negative side effects ! Between 1970 and 1990, Passionflower was even listed as an official plant drug for anxiety and depression. Once in the body, an increase in important neurotransmitters may be the reason it works so well.
St. John’s Wort
Unfortunately, St. John’s Wort didn’t have any well-conducted studies that made me believe it belonged on this list of anxiety-reducing herbs. However, it gets an honorable mention because it does have a pile of evidence showing it may be effective in treating mild to moderate depression. Some researchers put it to the test against an antidepressant medication and a placebo group. Their conclusion was that “St. John’s wort was significantly effective when compared with placebo” . St. John’s Wort is also one of the most popular ones out there which must mean something, right?
While there are many other documented uses for Rhodiola, the research is less clear when it comes to anxiety. However, there was one very thorough double-blind placebo study that found 170g of extract twice daily produced significant reductions in both anxiety and depression . The specific extract utilized was rhizome so if you happen to find some laying around or get a good deal, take it.
“ standardized extract SHR-5 from [Rhodiola] possesses a clear and significant anti-depressive activity in patients suffering from mild to moderate depression”
Chamomile has been known as just a bedtime tea for far too long! While there isn’t a ton of research regarding its specific role in reducing anxiety, one double-blind placebo revealed promising results. After the subjects took extract capsules for an extended period of time, “analysis found a significantly greater reduction over time in the mean total HAM-A (anxiety measurement) score for chamomile versus placebo” . Break away from the norm and maybe give the extract a try.
Ginkgo biloba is well-known for its ability to increase mental performance, but what about its ability to improve mental health? Well, among participants who took 480mg of extract per day, changes in anxiety were found to be significant . Like many of the other herbal supplements above, this one may be worth a try. Also like many of the others, in addition to the possibility of reducing anxiety, you may also be able to obtain some of the other benefits as well.
Other Supplements for Anxiety
L-lysine and L-arginine
These are two very useful amino acids that can be found almost anywhere. When the two are taken together (about 2.5g of each per day) for just a week, there was already significant reductions in anxiety . This may partially be due to the fact that L-lysine can act as a serotonin reuptake inhibitor. Another study found similar results, with patients taking the combination finding an increased ability to manage higher cortisol levels and therefore anxiety .
“A week-long treatment with L-lysine and L-arginine decreased trait anxiety [and] blocked stress-induced state anxiety”
Low levels of magnesium are consistently correlated with increased inflammation which is also associated with anxiety and depression. Magnesium deficiency itself has also been associated with depression. So, it makes sense that supplementing with magnesium may be a good idea if you are deficient, which will be the case unless your diet is very healthy. It makes even more sense after examining a study that showed a statistically significant reduction in depression and a general drop in anxiety after supplementation . 300-400mg daily of a high-quality magnesium should do the trick. If it comes in smaller capsules, start off by taking lower doses to feel out how it affects you and then work your way up. Aside from reduced inflammation, magnesium may also play an important role in cell function and enhances communication between cells. Some researchers found that increasing the amount of magnesium given to mice enhanced their ability to deal with anxiety and lowered anxiety related biomarkers .
We all know (I hope) that B-vitamins are crucial to brain health, and inositol is one of them. In a study comparing it against fluvoxamine, a common SSRI given for anxiety, 18g/day ofinositol given for one month was actually more effective in reducing panic attacks . This is strongly related because many panic attacks result from uncontrollable anxiety. Unfortunately, most B-complex supplements have a minuscule amount of inositol, so if you want to try it, opt for a bottle of the powder.
Folate (Folic Acid) and B12
Proving the importance of B-vitamins again, another recent study revealed some fascinating ways that folate (B9) and B12 are related to anxiety and depression. The link is homocysteine, a molecule that causes inflammation . This mechanism digs into biochemistry a bit, but it is interesting to know how it works. I think this is interesting, but if you aren’t curious in the slightest about the pathway, just skip to the last paragraph in this section.
In the diagram, there are a few important things we need to focus on. First, for our purposes we can consider THF to be folate. If we follow the arrows, we see that our bodies eventually turn folate into a product that is used for neurotransmitters. Second, B12 is used to convert homocysteine (Hcy) into SAM, another building block for our central nervous system .
So what does this all mean? Well, supplementation of both folate and B12 have been correlated with lower amounts of homocysteine within certain populations, which is also associated with lower anxiety and depression. With folate, high doses had the most success, but with B12, moderate doses showed the best results . Many B-complex supplements will have adequate doses of the two.
Look back to the top of the diagram above. SAM is the molecule made after the long process involving B12 and can be supplemented directly. The problem is that SAMe supplements are very expensive, but we will see that they may be worth the price. A large review of the literature found that many double-blind placebo studies achieved significantly lowered depression and a correlation with lower anxiety when 1g was taken per day . If the other supplements don’t work for you, this one may be worth a try. Alternatively, SAMe’s alter ego is a superhero who fights for the joints of people everywhere. Taking it for anxiety or depression may also give you the added benefits of stronger joints. Almost every supplement on this list has other known uses such as this.
Omega-3 Fatty Acids
Omega-3 supplements are becoming more and more popular because of their (you guessed it) anti-inflammatory properties along with general muscle maintenance and brain health. Most of the supplements come from fish oil and are taken because not enough is obtained from the typical western diet. So what can more omega-3 do for anxiety and possibly depression?
Well, a lot actually. The recurring relationship between inflammation, brain health and anxiety/depression still holds true here. Omega-3 supplements can be broken down into two main parts: EPA and DHA. EPA is the part responsible for knocking down inflammation while DHA helps our brains out. A review of a few double-blind placebo studies found that taking 6g/ day (this is a lot!) led to significant reductions in depression . Relating back to anxiety, one specific study found that 3g of omega-3 supplementation per day led to a 20% reduction in anxiety symptoms and inflammatory biomarkers among medical school students . Medical school students are under a hefty amount of stress and anxiety, so if it can help them, maybe you can benefit as well.
“the [omega-3] supplemented group had 20% lower geometric mean anxiety scores post-randomization, adjusting for baseline anxiety scores, study visit, and gender”
What Should You Do?
What you choose to do with this information is completely up to you. Start with one or two supplements at a time and switch them out if you didn’t get the results you were hoping for. I would suggest starting with a good omega-3 (contains >750mg of omega-3 per serving), a B-Complex that has B12 and folic acid among others, and passionflower if you can find it. If you have the budget, feel free to expand and try others on the list. If you are currently taking any sort of prescribed medication, SPEAK TO YOUR HEALTH CARE PRACTIONER BEFORE TAKING SUPPLEMENTS as they may interfere with your treatment.
Are there other supplements out there that may work for you but aren’t on this list? Probably. These are simply supplements that had solid methods that resulted in convincing data. There is also practically no risk associated if you stay within the recommended dosage, so why not give it a try? Since everyone’s body is unique, you are sort of your own experiment when it comes to supplementation. Put some to the test and see what they can do for you!
What has your experience been while supplementing for anxiety?
Any other comments, questions, or suggestions?
Feel free to contact us or leave them below.
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