Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind

In Part 0, Dr. Brewer provides the reader with the neuroscience of how the brain produces anxiety, and how it can inadvertently become a habit. Unlike other disorders, anxiety can produce a huge array of symptoms in different people, making it more difficult to diagnose. Brewer recalls his own early experience with anxiety in university, where he began experiencing severe digestive issues. At the time, Brewer was in denial about how anxious he was feeling and insisted that he had a bacterial infection. Now he realizes that his anxiety about school and his extracurricular pursuits was causing his body to become dysregulated. Some people experience anxiety as part of their everyday state of mind, as they chronically worry about any part of their lives. This condition is called “Generalized Anxiety Disorder.” The author posits that labels are generally only diagnostically or bureaucratically helpful; in reality, people’s minds are changeable and disorders do not have to be permanent.

The author shares anecdotes that reveal the range of symptoms anxiety can produce. His wife, Mahri, experiences generalized anxiety in which her brain identifies uncertainty and begins to worry or overplan about it. While she appears calm to others, she often finds herself feeling nervous about upcoming events, and she tries to plan them out in detail to feel more in control.

Meanwhile, Brewer’s friend Emily experienced anxiety in a completely different form: panic attacks. While a law student, Emily endured a difficult internship, her parents’ divorce, and preparing for the bar exam all at once. During this stressful period, she began having panic attacks that would make her wake up gasping for air with her heart pounding. Emily learned that these episodes were caused by anxiety, and she learned to become mindful of her body’s reactions and reassert control over her anxious thoughts during her episodes. The author contrasts these two very different forms of anxiety: the “slow burn” of Mahri’s generalized anxiety and the boiling “tea kettle” of Emily’s panic attacks (10).

According to the American Psychological Association, stress and anxiety are increasing in America. The author attributes recent spikes in anxiety levels to the COVID-19 pandemic, pointing out that anxiety and other mental health issues tend to worsen after major traumatic events, such as 9/11. Unfortunately, depression is a common twin illness that coexists with anxiety. Brewer concludes that anxiety does not randomly occur, it is “born” out of one’s circumstantial and personal conditions.

Anxiety and panic are byproducts of fear. Our brains evolved the ability to feel fear in order to protect us from threats. People are wired for fear to inform their behavior in three steps: a cue from their environment, which prompts them toward a certain behavior, which produces a particular result. For instance, kids are taught to fear moving cars (cue), and this lesson teaches them to wait on the sidewalk (behavior), which keeps them safe (result). Our ability to feel fear is rooted in the oldest systems in our brains, making it possible for us to have instant, subconscious reactions to threats that bypass our ability to think. For instance, if a car races toward us, we could jump out of the way without even realizing it until afterward. It is this system that produces the fight, flight, or freeze responses.

Meanwhile, the prefrontal cortex, or PFC, is the most recently evolved part of the human brain. This region is essential for creativity and planning, and as such can imagine future events and create simulations about possible outcomes. Ideally, the old system and PFC work well together, with the PFC committing different fear experiences to memory so people can learn to remember and avoid threats.

While fear is “adaptive” and helps us avoid danger, anxiety is maladaptive: It harms us more than helps us. Instead of using the PFC to respond to useful information and avoid threats, anxiety sends it spinning out of control, seeking out more and more information to generate simulations that can become detached from reality. The more we worry, the more likely it is that the PFC’s ability to rationalize will shut down, and our nervous thoughts will trigger physiological fear responses from the older brain system.

The author argues that the best way to deal with this tendency is to develop awareness of every part of the cycle, beginning with what kinds of uncertainty or events trigger anxiety. Then, people should become aware of the outcome of their anxiety—whether it was helpful or harmful to their survival. If it had hurt more than helped, people should recognize this brain behavior as ultimately “unrewarding,” and try to divert this habit into something more constructive. For example, if someone was worried about getting sick, they could use this panic to consider when they had last washed their hands. This strategy engages the brain’s rationality by giving it a constructive, pragmatic action to take, rather than engaging in speculative worry, stopping the cycle of unhelpful anxious thoughts.

Brewer argues that addiction is ubiquitous in modern society. While most people think of addiction as something that affects cigarette and drug addicts and alcoholics, in fact, everyone is addicted to something. Addictions are merely habits that have adverse consequences. People form addictive behaviors around everyday activities such as shopping, gaming, eating, and more. Humans have evolved to learn and form habitual behaviors through positive and negative reinforcement. For instance, a hungry cave person would receive the positive reinforcement of a powerful hit of dopamine, a feel-good hormone, when they ate some food. This would help them remember what the food was and where they found it, aiding their survival. In modern life, this brain wiring can be negatively hijacked by the availability of so many resources. For instance, when a person feels sad, they might be triggered to eat ice cream and momentarily feel better, thereby entrenching themselves in a cycle of positive reinforcement that leads to adverse long-term consequences. Even these everyday addictions can be very consequential; for instance, habits such as overeating and smoking have terrible effects on people’s health.

Indeed, modern life fosters addiction by introducing “addiction maximizers.” The first is Intermittent Reinforcement (when people experience an inconsistent reward, their dopamine spikes higher), and the second is Immediate Availability (being able to buy or eat something right away, which increases impulsive behavior). According to Brewer, this creates a “dangerous formula,” making addictive behavior difficult to identify and manage. Brewer believes that because anxiety is an uncomfortable feeling, people avoid it by pursuing feel-good experiences, thereby leaving their anxiety unmanaged and forming destructive habits. He contends that the best way to manage anxiety is to begin from the “bottom up” by considering one’s own habits that are creating adverse consequences.

The human brain is wired to respond fearfully to uncertainty. At a primal level, our brains cannot be assured of our basic safety and survivability if something feels uncertain. Uncertainty prompts people into action in an attempt to make the future more concrete or resolve a problem. Sometimes real solutions are found, giving people a sense of relief. However, when uncertainty triggers negative emotions, such as fear, it can prompt people to worry, thinking endlessly of possible outcomes and solutions. They may then avoid their uncomfortable feelings and worries by pursuing comforting distractions.

Even though worrying or avoidant behavior does not provide a real solution to the problem, the brain registers it as a kind of “reward,” since it feels productive. This cycle of trigger, behavior, and reward is part of how anxiety becomes a habit loop. People may even believe that worrying is a helpful and productive behavior—even if it never helps them produce a concrete positive result.

Anxiety is a cornerstone of burnout culture. Rather than coaching people to understand and manage their emotions, many workplaces encourage people to ignore stress and continue working. As a medical student, Brewer’s instructors explicitly taught him and his peers to sacrifice their own mental and physical health to focus on their patients. Brewer attributes this approach to the high rate of burnout amongst physicians. In Brewer’s own study on doctors, he found that mindfulness techniques dramatically reduced worry and anxiety, thereby decreasing cynicism and other symptoms of burnout. In fact, the mindfulness app Brewer designed was more effective at reducing anxiety than antidepressants.

The author concludes his chapter by explaining that forming an intellectual understanding of anxiety as a habit loop is merely the first step toward solving the problem. He explains that he will use a bicycle analogy to explain the rest of his solutions in Parts 1-3. In “first gear,” the reader will map their own anxiety loops, in “second gear,” the reader will understand their brain’s reward system, and in “third gear,” the reader will learn how to retire old habits and develop new, positive ones (49).