part0013

W hen people struggle with anxiety they often can’t see a way out, thinking life will always be this way. It may be because the anxiety has been a part of their lives for so long, or they believe it’s a fixed personality trait and change is impossible. While genetics can predispose us to anxiety, it’s our experiences, lifestyle, and behaviour patterns that determine whether we ‘switch on’ the genes. So there is much we can do help ourselves.

Short-term strategies may help us to ‘get by’ and overcome certain situations, but sufferers often can’t imagine a life free from every day debilitating anxiety. Whilst we will never eliminate anxiety - neither should we want to - it is possible to change our relationship with it in a fundamental way.

Acceptance of who we are and how we feel is important, but before we identify with too strongly with our anxiety and label ourselves as lifelong members of the anxiety club, we should consider the possibilities that a change of mindset can bring.

Later we will look at the importance of having a growth mindset - a set of beliefs that change is possible through learning and action - as opposed to a fixed mindset - the belief that our traits and abilities are fixed - but first we will focus on the evidence demonstrating the powerful impact our beliefs can have on our body, brain, and behaviour.

Recent research investigating the effect of mindset on health has showed how beliefs and attitudes can change the way the body responds to physical and mental threats and have a direct impact on our wellbeing. Studies by Harvard University psychologists Alia Crum and Ellen Langer, highlighted in Kelly McGonigal’s excellent book The Upside of Stress , 9 have demonstrated that changing the way we think about an experience can change the way our bodies react to it.

The research is both remarkable and surprising, and will make you think twice about your beliefs. When I first discovered the research it changed the way I thought about my anxiety. We’ll first take a brief look at how mindset can affect physical health and hunger, before focusing on stress and anxiety.

Crum and Langer’s research first came to my attention when I was preparing a health psychology module for undergraduate students in 2007. The findings of their first mindset study made me scratch my head in disbelief.

The researchers recruited hotel maids to investigate if a change in mindset could lead to a change in physical health.10 Before starting the intervention they found that two thirds of the maids believed they weren’t exercising regularly. Measurements of their physical health reflected this belief: the maids’ blood pressure, body weight, and waist-to-hip ratio matched those of people who were sedentary. This puzzled Crum and Langer because the work the maids were doing was strenuous, burning over 300 calories an hour (in comparison, the average office worker burns only 100 calories an hour) .

So they divided the hotel maids into two groups; an experimental mindset group and a control group. The mindset group attended a talk and were given an information sheet explaining the work they were doing each day was demanding physical exercise that exceeded the Surgeon General’s recommendations for an active lifestyle: pushing carts loaded with linen, lifting heavy mattresses, vacuuming, and walking from room to room. They also put posters around the group’s workplace detailing how many calories they burned while doing each activity.

The maids in the control group were only given information about how important physical exercise is for health, but weren't told their work qualified as exercise.

At the end of the study, four weeks later, the hotel maids in the mindset group had shown some remarkable improvements in their physical health; the group’s blood pressure had dropped, they had lost weight, and reduced their body fat. These changes happened with no extra physical exercise being completed inside or outside of their work and no change in diet. The control group showed no changes in physical health over the same four week period.

So the study appeared to indicate that our expectations and beliefs about our behaviour — our mindset — can influence physical outcomes, or put another way, ‘the effect you expect is the effect you get.’

To test these mindset findings further, Crum and colleagues designed a study to test if people's perceptions of how calorific a certain food is can affect their levels of fullness and hunger.11 They gave participants two different milkshakes; one was described as an indulgent treat, high in calories and fat, and the other was described as a healthy diet shake with low calories and low fat. However, in reality the milkshakes were exactly the same, they were just labelled differently. The researchers also measured the changes in the participants’ blood levels of ghrelin — a hormone associated with hunger. When blood levels of ghrelin go down, we feel full and sated, when they rise we feel hungry.

The measurements found that when the participants believed they had drank an indulgent high calorie shake, their ghrelin levels dropped three times as much as when they thought they were drinking a low calorie shake. Remember, when ghrelin levels go down, we feel full. The participants also reported feeling more full and less hungry after the high calorie shake. So the findings weren’t just based on self-reported perceptions, the different perceptions resulted in hormonal changes. So their expectations altered the levels of their hormones.

In both studies — the hotel maid study and the milkshake study — the participants’ body responses changed when their mindset — their perceptions — changed. A change in mindset resulted in the body reacting in an adaptive, or more helpful way. Perceiving physical work as exercise helped the body experience the benefits of being active and viewing a milkshake as a high calorific indulgence helped the body produce signals of fullness.

However, it is their latest study, published in 2015, that interested me the most. Knowing stress can be both beneficial and harmful, Crum and colleagues wondered if changing the way people thought about stress would change the way the body responded. Can mindset affect how the body experiences stress? To examine this question, they manipulated people’s views of stress and then measured how their bodies reacted to a stressful situation.12

Again, they divided participants into two groups. One group watched a three minute video that presented research outlining the benefits of stress: how it can improve performance, make us more focused, alert, and competitive. The other group watched a three minute video presenting research outlining the negative and debilitating aspects of stress .

Both videos were based on real research because stress can be both helpful and unhelpful. However, the videos were also designed to prime the perceptions of the participants into a positive or negative mindset. After watching the video both groups were subjected to tough mock interviews, with interviewers trained to give negative and critical feedback to the participants throughout.

Samples of two stress hormones were also taken from both groups before and after intervention. The hormones measured were cortisol and dehydroepiandrosterone (DHEA). Cortisol turns sugar and fat into energy and directs the body to use that energy when stressed, while also suppressing some biological functions, such as digestion and reproduction. DHEA is a neurosteroid — a hormone that helps brain grow stronger from stressful experiences. It also counters some of the effects of cortisol, as well as speeding up the repair of wounds, and improving immune function.

We need both hormones when experiencing stress. Each has an important part to play, so neither can be categorically stated as good or bad. However, the ratio between the hormones can influence the long-term impact of stress, especially when stress is chronic: long lasting and consistently occurring over time.

High levels of cortisol over long periods have been linked with weakened immune function and depression, but high levels of DHEA are associated with reductions in anxiety, depression, heart disease, and other diseases we associate with stress. The ratio of DHEA to cortisol is called the growth index of a stress response, and the more DHEA present, the higher the growth index. High growth indexes have been shown to help people flourish under stress; increasing resilience and helping recovery.

So summarising, a greater ratio of DHEA to cortisol in the stress response creates a higher growth index, and a higher growth index is beneficial for the body, reducing the impact of the stress response and protecting the body from many of the diseases associated with stress.1 3

The preliminary results of the study indicated the type of video a participant watched had no effect on cortisol; this rose in both groups during the mock interview. However, there were higher levels of DHEA, and therefore a higher growth index, in the group that watched the video informing them stress was beneficial. So the results suggested viewing stress as helpful created a different biological reality, again demonstrating expectations can alter hormones and help the body to become more adaptive.

The next steps in the research were to discover if these changes in mindset were long lasting, or if they only had a temporary effect.

Further studies by Crum and colleagues have showed that changing a person’s mindset has a long-lasting impact on their lives and is not just specific to one event. So altering an individual’s mindset about stress doesn’t just help them cope with the stress of a one time mock interview, but influences their beliefs and physical reactions to stress in other stressful situations over a longer time.

The research has also demonstrated that people who believe stress can be beneficial have fewer health problems and cope better with challenges than those who see stress as harmful. It’s not that they are less stressed, the research shows they are in fact just as stressed as the people who don’t cope as well, but they interpret the stress response differently and can manage it more effectively.

Stress mindsets are powerful because they affect not just how we think, but how we act too. If we think stress is harmful, we are also more likely to become anxious and distract ourselves from dealing with stressful and problematic situations, rather than tackling them and sorting them out. So instead of dealing with the source of the anxious feelings, we focus on getting rid of them, and we sometimes do this in maladaptive ways, like avoidance, turning to food, alcohol, or other substances.

On the other hand, when we see stress as beneficial, or enhancing, we don’t try to distract ourselves from feeling anxious or try to avoid it, but accept it’s real, and plan a strategy for dealing with the situation. People with this mindset often seek help or advice, and take steps to tackle the source of the anxiety, viewing it as an opportunity to grow and improve. So mindset changes can be thought of as catalysts; they put processes into motion that create and maintain positive changes over time.

People have difficulty accepting brief interventions can change a mindset because they believe meaningful problems are deep rooted and difficult to change. However, changing a mindset isn’t some magical manipulation, it’s about educating people and showing them they have a choice about what to believe. The most successful interventions designed to change mindset have three stages:14

So in the case of changing an individual’s mindset about stress; firstly they would learn the benefits of feeling stressed, then they would be given a chance to adopt the new mindset in a stressful situation, and finally they would be encouraged to share and explain their new mindset with others. This is exactly what happened in Crum and Langer’s stress study. So in what way can anxiety and stress be beneficial ?

We will consider when and how social anxiety can be problematic and debilitating over the next few chapters. We will also discuss the stress response in greater detail throughout the book, but having discussed how important mindset is — our beliefs about anxiety — let’s first talk about how anxiety and stress can be beneficial.

The stress response is also referred to as the emergency arousal system, and the fight, flight, or freeze response. It’s vital to our survival, our management of challenging situations, and how we relate to other people (more of this later). So we should see it as our friend and appreciate it. Its intention is to keep us safe from danger and help us to perform at our best when we are challenged. The stress response can be initiated by anxiety about a potentially threatening situation as well as a reaction to being in an actual threatening situation.

Not every response we have to anxiety-inducing situations is an all-or-nothing fight-or-flight response. We have understandable stress responses when important things are at stake, but there is some nuance in our stress response. When there is a real threat to our survival we will experience the full fight, flight or freeze response, along with strong biological changes. However, when the situation is less threatening, we tend to experience a challenge response. The muscles and brain get more energy, heart rate increases, and adrenaline is released. All of these changes are there to help us perform better under pressure and in stressful situations: giving us a detailed focus of attention, more energy, heightened senses, and greater motivation.

An often overlooked hormone released in the stress response is oxytocin. When oxytocin is released into the bloodstream, it motivates us to seek out social connection, while also raising our levels empathy, trust, and intuition. This is why, when we feel challenged or stressed, we often seek out other people to talk to or be with. Recent research has shown that contrary to most people’s expectations, when people are caught up in traumatic events, such as a terror attack, they are more likely to help each other rather than act only in their best interests.15 However, more than just seeking out social connection, oxytocin also dampens the fear response in the brain: increasing courage and suppressing the urge to fight or flee.

Experiencing a stress response also prepares us for similar future stressful situations and expecting to learn from stressful situations can give us a type of stress inoculation — just like vaccinations protect or inoculate us from future illness by stimulating our immune systems to develop immunity. The brain does this by using the previously mentioned DHEA, along with nerve growth factor — which is released in the stress response to increase the brain’s ability to learn and change. These hormones also speed up physical and mental recovery, helping us to bounce back from challenging situations.

This is often why, for several hours after a stressful event, we go over it in our minds — time and time again — considering how we responded, what actions we did, and what thought processes we used. We talk to others about it and experience intense emotions of relief, shock, joy, and anger. All of this makes the experience more memorable, allowing it to change the brain in order to be better equipped to respond to similar situations in the future .

This is the reason many professionals are encouraged to practise skills, techniques, and actions in stressful situations. Footballers practise penalty kicks in front of crowds, emergency service responders practise procedures in challenging environments. Going through a stressful situation can make us better at responding in similar challenging situations. If we can see anxiety-inducing situations as opportunities to improve, grow, and become better at challenges, we are less likely to avoid or distract ourselves from them.

We’ve made the case that anxiety and stress can be beneficial in certain circumstances, not that the way we experience it is always helpful and we should just accept it as it is and do nothing about it. As we will find out, it also can be debilitating and overwhelming, especially when our anxiety triggers a full fight, flight, or freeze response when it’s not needed.

If you suffer from anxiety in this way, or are often troubled by anxious thoughts that make life difficult, the idea of anxiety being beneficial may sound ridiculous, and the suffering you’ve endured over time may have left you feeling hopeless.

However, it isn’t suffering that leads to hopelessness, it’s suffering you think you can’t control. The exercises in this book will provide you with hope. Not a magical positive thinking type of hope, but a real and practical hope. So it’s important you approach the following chapters with an understanding that: