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Wide awake at 4am? It's an anxiety epidemic


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Joseph Ledoux

Joseph Ledoux


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It takes three messages, six missed calls and two ring-backs before the neuroscientist Joseph LeDoux and I make contact. We have a tense laugh; we're supposed to be discussing his book, Anxious: The Modern Mind in the Age of Anxiety.

"Every generation feels it is the most anxious," says LeDoux, but to me, the episode merely reaffirms that a tight feeling in your chest - a sense of rising panic coupled with woeful visions of personal catastrophe - is the modern malaise. Rare is the 21st-century adult who has never lurched awake at 4am in a cold sweat of worry.

However, if anyone can help us in our fretful predicament, it's LeDoux - renowned anxiety expert, professor of psychology at New York University and director of the Emotional Brain Institute, which aims to understand how emotions affect mind and behaviour.

His laboratory's remarkable research into how our brains work suggests that many of our assumptions about anxiety are wrong. His findings have the potential to revolutionise the way anxiety is professionally treated, but he believes we can all learn to calm our minds ourselves, four-year-olds included.

"There are 37 words in the English language for variations of fear or anxiety," says LeDoux. This reflects a long-standing obsession - he notes in Anxious that googling "anxiety" returns more than 42 million hits. And while the New Testament states "You cannot add any time to your life by worrying about it", popular culture offers a closer reflection of reality: in Alan J Pakula's film Starting Over, the main character has a panic attack in Bloomingdale's and his brother appeals for a Valium. Everyone in the vicinity produces a pill bottle.

We assume our anxiety is innate, says LeDoux. He believes it is an emotion formed of non-emotional ingredients: a feeling we think ourselves into as a result of instinctive warning signals from the body and brain. Walking home at night, we might sense a presence, feel our fast-beating heart, then spot a figure walking towards us. Our memories of personal experience and factual knowledge, and physiological signals such as our racing pulse, converge to form a template. We recognise the situation as a potential threat. Is it? Then we feel anxious.

LeDoux says: "There's no way that we have in our brain a fear centre, an anxiety centre, a trepidation centre, a consternation centre, a panic centre, a terror centre, a horror centre. We apply those labels to our experiences, but those labels do not reflect hard-wired states in the brain, they reflect our cultural understanding of what those words mean and the concepts underlying them."

Worrying might not be hard-wired, but it is essential. "If you're a student preparing for an exam, if you don't give a damn, don't prepare, you probably won't do as well," he says. "You need that anxious, stressed edge."

The trick is to find the "optimum level" without focusing so much on the possible consequences of uncertainties that "they become all-consuming and take over".

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We might tell ourselves that once the mortgage is paid and the kids at college we'll stop fretting, but for most of us anxiety is a fairly stable personality trait: "We each have a set point of worry. If we get rid of one worry, it makes room for another." You can be a born worrier: the hereditability of anxiety is estimated at between 30 and 40pc, although LeDoux says, "the environment will regulate the degree to which a gene is expressed".

We all know anxious parents whose children suffer from nerves, but it's easily caught, as anyone trapped next to a nervous flyer will know - "in general, emotions are contagious," says LeDoux. Our behaviour, however, not our mindset (LeDoux remarks that the two don't always correspond) most powerfully affects those around us.

I'm reminded of hearing Judith Kerr discuss When Hitler Stole Pink Rabbit, her fictionalised account of her well-to-do family fleeing Nazi Germany and living as impoverished refugees in France. Aged nine, she wasn't scared, she said, because her parents acted as if it were a thrilling adventure.

LeDoux reminds us that anxiety is a practice we engage in: "We develop habits of mind as well as habits of behaviour, whether bad like smoking or biting your fingernails, or good habits: say, you walk to work, you figure out a route, it's the best route, so you don't think about it, your brain knows the route, it just does it.

"It's the same with mental habits in certain situations - the way we persevere to solve a problem, despite having a worry. Some people can't persevere because the worry is dominant; it becomes a well-worn path. It's not as if you make a choice: 'I'm going to worry'."

However, like most habits, it can be broken. I could do with LeDoux's help on this. I recently shrugged on my dressing gown in front of the bathroom mirror and became vaguely aware of a spindly alien crawling on my shoulder. I tore off the dressing gown and saw a fat black spider plop on to the bathroom floor.

LeDoux dissects my trauma into its component parts. Two separate brain systems were at work: "The unconscious systems in your brain detected that threat, led you to act in a certain way - to react to that creepiness, the thing crawling on your shoulder - and then you consciously realised what was happening. Then you experienced fear. Then you started to worry: you started to transition from fear of the actual spider to the worry about what the spider could have done. That's when you become anxious."

When you're in a blind panic, it's hard to grasp the separation between the "quick and dirty" alert of your brain and body to a potential threat and reacting before you consciously see it: a longer, slower process.

LeDoux explains: "All these signals coming up non-consciously, like arousal [and] memory, come together and we begin to consciously construct an interpretation of what it is we are experiencing together with these memory templates about past emotions and the present experience. Perception, memory, arousal [and] body feedback, come together and then compel us to feel fearful, anxious or happy."

LeDoux is not a therapist - which doesn't stop people contacting him for advice - but hopes his findings could improve the professional treatment of anxiety. For instance, my spider phobia would benefit from a two-pronged approach: counselling to deal with the conscious fear and separate "exposure therapy" to extinguish the unconscious fear. (Ignore one fear and it's likely to reactivate the other.) Ideally, LeDoux imagines, I'd sit in the therapist's office and be exposed to spider pictures subliminally for 30 milliseconds.

This theory is based on the psychologist Ivan Pavlov's discovery, as part of his bell and salivation experiments with dogs, that when you ring a bell repeatedly without the dog getting any meat, it stops salivating to the bell - this is called extinction. The spider images, says LeDoux, would enter "the brain and cause your heart to race, but because [the exposure] is so brief, it doesn't have time to cause the tension, the cognition - you aren't aware of what the stimulus is. It would directly extinguish the non-conscious threat-detection system."

Meanwhile, there is a simple way to can tackle our own anxiety - which LeDoux uses himself. "When you breathe in the proper way - something the yoga masters figured out centuries ago - it calms the conscious mind."

This, he says, is because the respiratory system is connected with the parasympathetic nervous system, one of two systems that regulate our internal organs. The other is the sympathetic nervous system, which sets the body off into the fight-flight mode to mobilise its energy resources, to help you to face a present challenge, such as a predator. "If you escape, or it goes away, you need to calm down and that's the job of the parasympathetic nervous system. It reduces that flood of chemicals that keeps the brain wired to get you out of the dangerous situation. When you breathe in the proper way, you naturally engage the PNS and shut down the fight-flight system."

If there's no threat present, says LeDoux, "all you have to do is calm the mind. By breathing in this way you allow the mind to be more peaceful, which is why meditation is so important." He believes children would cope far better with pressure if they were taught to breathe properly before encountering "playground stress or test anxiety in the classroom". Eventually, it would "become a habit to calm yourself in a dangerous situation or when there's no danger but you're just worried".

We have been talking, internationally, for an hour, on his dime (because of the phone trouble), and I'm aware that he's on holiday. I start to worry about trying his patience, but one last question: how does he deal with anxiety?

LeDoux laughs: "Like everyone else - poorly!" Somehow, I don't quite believe him.

Everyday anxiety

1. You worry about paying bills, getting a job and other important life events

2. You feel embarrassed or self-conscious in an awkward social situation

3. You feel nervous or sweaty before an exam, presentation, performance or other significant event

4. You worry about an actual dangerous object, place, or situation

5. You make sure you are healthy and living in a safe environment

6. You experience anxiety, sadness or trouble sleeping, immediately after a traumatic event

Anxiety disorder

1. Constant, unsubstantiated worry that causes you significant distress and interferes with daily life

2. You avoid social situations for fear of being judged, embarrassed, or humiliated

3. You have panic attacks, apparently out of the blue, and are preoccupied with fear of another

4. You experience irrational worry about, and avoid, an object, place or situation that poses little or no threat

5. You perform uncontrollable repetitive actions such as excessive cleaning or checking, touching or arranging

6. You have recurring nightmares, flashbacks, or feel emotionally numb, relating to a traumatic event that occurred months or years ago

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