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Comment by impulser_ | Hacker News Reader

So from my understanding. Anxious people are so anxious that they overload the part of the brain that typical deals with anxiety so the brain routes it to another part of the brain to deal with it and that part of the brain isn't what you want dealing with it so it cause problems.

So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.

I could be wrong, but that my understanding of it.

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> doing things you are fearing to do so that you no longer fear doing it.

Careful with that assumption. I can see it completely backfiring. Doing the thing repeatedly can end up increasing the anxiety. If this route is taken, then "the thing" must be introduced very gradually and from a place of security.

As an example, for an arachnophobe, it would starting with something like "draw a dot. Draw a line coming out of the dot. Keep drawing lines up until 8. Pay attention to your anxiety levels and remind yourself that this is not a real spider, only a drawing. You are in control, you are safe". Then progressing to pictures of cartoon spiders, then the first picture of the most cute realistic spider that one can find, and so forth. It would be a process that takes months and it's not guaranteed to work. For example, a realistic depiction of a spider might be too much to handle even with a gradual approach.

On the other hand, if you tell that person "Close your eyes and open your hand. There, I put a tarantula in your hand, you see, it's innocuous!" that person is going to be scared of spiders for life.

I'm exaggerating, but hopefully it sends the point across.

This isn’t quite accurate.

Graded exposure can be a more manageable way to get to the end result (fear extinction), but reminding yourself that the threat isn’t real is a fear-neutralizing behavior that will limit the effectiveness of the treatment. The point of exposure therapy is to feel the fear and to do nothing about it other than let the feeling (eventually) climax and dissipate. (In fact, “lean in harder” can be even better than “do nothing”.)

[Edit: I want to emphasize this point for others who may find this post: if you are doing exposure work or you’re supporting someone who is, please don’t reassure yourself/them that the exposure isn’t dangerous. At best it undermines the treatment; at worst it reinforces the fear. When you violate your anxiety by facing a feared situation or idea, it will and should feel like you are doing something bad and dangerous.]

Second, graded exposure isn’t always necessary - flooding (direct exposure to the high level fear situation) works too, and can work a lot faster.

But I think most people with anxiety disorders have a number of fears not just a single isolated phobia - and they’re connected in a network of sorts. It’s often helpful for the person to experience success in extinguishing a low-moderate grade fear first, to grok the process and build confidence to approach their worst fears successfully.

Only I will remain.

In my experience, over-exposure to terrifying situations leads me to full-blown panic attacks, emotional dysregulation, crying, sometimes being trapped in a situation miles from safety with no way to get back, and being traumatized for days afterwards and (very rationally) avoiding the situation in the future. The people who want me to put myself into fearful situations are people who want to hurt me.

> full-blown panic attacks, emotional dysregulation, crying

I’ve been there, and I get it. But if you’re on the path to extinguishing Big Fears, this is simply what the process entails. It’s really uncomfortable - until it isn’t.

> sometimes being trapped in a situation miles from safety with no way to get back

I’m not sure what you mean by this part. If you’re referring to the symptoms above (panic attacks, crying, dysregulation), I think you’d be better served to refrain from thinking of these symptoms as a loss of “safety”. They’re feelings of intense discomfort - but not danger. And they’re temporary.

> being traumatized for days afterwards and (very rationally) avoiding the situation in the future

Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.

This is not the pattern you went to be in. If you’re finding it too difficult to resist this, it might be a good idea to begin with smaller steps. That means doing less intimidating exposures so that you can be more successful in sticking with it until the fear comes down.

> The people who want me to put myself into fearful situations are people who want to hurt me

This is absolutely not true. No one gets sadistic pleasure out of the temporary pain that anxiety treatment brings. It’s just the price of getting better: to conquer your fears, you have to go all the way through them. By analogy, you can’t get physically fit without first going though some soreness and discomfort.

Based on what you wrote, I’d highly recommend finding a therapist who has expertise in exposure with response prevention. They will know, from having treated many others in your situation, how to design a treatment program that meets your needs and that you can succeed in.

The specific situation was trying to bike to a doctor's office late in the afternoon after being unable to go earlier due to non-24 sleep disorder and executive dysfunction and struggling to pack and get out of the door. After being slowed down beyond my plans by unpaved roads, traffic lights, and parking lots, I got turned away from the door when the office closed, and did not have a safe way to get back home, since the sun was setting, I was not prepared for the cold weather, and I could neither safely stay outdoors at night in an office park without food or shelter, nor safely bike home while crying, and did not have a ride arranged.

Growing up, my parents punished and traumatized me for not getting straight As in classes and cramming for extracurriculars, judged my worth based on academic performance and following their orders, fed me stories about how not getting into a top college would turn me into a burger-flipper, then forced me to the most difficult computer science program in the country, which together pushed me into burnout, dropping out, and a years-long CPTSD mental breakdown. They tried to force me to become their idea of a top student, ignoring the existential harm they caused.

Similarly, other people ignore the harm they cause (regardless if they want to hurt me or not) when they want me to put myself into unpleasant situations which have hurt me in the past for little gain (for example failing driving exams time and time again, the above-mentioned biking trip, rude and disrespectful doctors delaying care for an hour and then complaining when I asked questions and couldn't make decisions quickly enough, and psychiatrists who refuse care when I go nonverbal and want to communicate over text), and blame and accuse me of being "self-destructive" when I refuse to do as told.

> Avoiding the situation post-exposure unfortunately “un-does” much of the benefit of the exposure: it reinforces the neural pathways that make you feel a sense of danger in the first place.

It is perfectly rational for me to not harm myself further by seeking out situations which (promise benefits, cause substantial harm, and the benefits fail to materialize as expected), and for me to avoid people who pressure me to do so. If I find a route to doing things which benefits me more than it hurts, then I will start doing it.

I’m very sorry you’ve had bad experiences and difficult circumstances. Of course, no one can make you follow a treatment protocol: you have to want the freedom that comes with conquering your fear, and be willing to go through some discomfort to get there. It’s a very personal choice.

I will say again that if you’re inclined, you might consider starting with something that seems like a small challenge. Even a small victory can really boost your confidence and motivation. Finally, you might consider working with a therapist. Telehealth is a nice option that works well for many people.

Actually seeing a tarantula made them a lot less scary. Hard to be afraid of something so fluffy.

From my experience, cold-turkey forced exposure simply works.

> So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.

I gave this advice in the past, but I know people with social anxiety disorder for whom this approach does not work.

I have social anxiety and pushing myself to get out there leads to massive fatigue which makes me not want to go out and do that again, it can lead to a vicious cycle.

Exposure Therapy is a great method to deal with this in my humble experience, it has to be set up with sensible realistic boundaries though, and maybe start small, like doing an imagination ET, or taking medication to overcome the initial anxiety.

Reframing this as a challenge with concrete goals rather than a problem helps too.

I'm no expert though, and I advise you to talk to a professional that can help with this.

Don't forget that this is not a problem but just another part of you, and love yourself :)

Oh yes, I've tried, and I think there may be other reasons behind why it's not right - but at the moment ET isn't working for me, I just don't have the energy to spare.

20 years ago though yes, definitely, I learned to embraced the chaos (vs needing everything pre-planned) and put myself out there.

Has two parts: Meeting with people, interacting with people. One step at a time, a couple of people, for a specific timeframe.

The issue comes when/if the people trigger real issues - like fear of being manipulated , or safety concerns.

Right now mental health is a huge problem overall in society, and therapists and Psychiatrists are no except to the rule unfortunately.

It’s gotten very predatory out there.

Im also responding to the "do the things you fear" bit: I think you are right. As to why this works for some and worsens it for others, I think that depends on how you approach this.

In my experience these confrontational situations need to strike a certain place between "too easy" and "too hard". It hardly helps to throw people into situations they can't handle again and again. A more gradual approach via small wins is the way to go IMHO, with a focus on avoiding the learned avoidance patterns, heh. There's also the aspect of the perception: one needs to be able to accept small victories and see them as the improvement that they are.

But all of this is way easier said than done, especially if you have to deal with it all by yourself.

So while I think that you are technically right, I think it's easy to misunderstand for people as "just toughen up" (not implying that's what you meant, but there is this to many people unknown middle part of it that I wrote about).

IMO, the ‘just toughen up’ advice is people kind of giving up.

It’s not wrong per-se - just useless. If they could do that, they wouldn’t be in the situation! Like telling someone with PTSD to ‘just calm down’, or someone with an eating disorder to ‘eat normally’. If they could, they wouldn’t have the problem!

More accurately multiple parts of the brain are activated when considering anxious situations.

In anxious people the FPI is unable to override the avoidance behaviours.

The key is not to limit overload you don't have much choice there, it's to use other mechanisms to make your seek exposure and not continue avoidance.

CBT is all about teaching those skills the paper mentions TMS.

As a life long anxiety sufferer, I identify with your interpretation.

My anxiety devolves into panic attacks if I try to deal with it consciously - self talk, rumination, avoidance. But it goes into a dormant state when I don't engage with it consciously and just let it be.

Yeah I had a couple rough years with panic attacks, high anxiety state (always been anxious but not to that level). What you start to realize is that you are actually scared of the anxiety itself, not the situations so much. So, you sort of get caught in loop of being scared of your own emotions. The treatment is simple, but takes work and a lot of habit forming through time... but essentially you just stop thinking of the anxiety as an emotion you shouldn't have or should fear.

Like you said, just let it be and stop caring about it. Anxiety can be a good thing, it's a normal emotion. Any attempt to stop it or control it will end in disaster. Let your body/mind do it's thing. Emotions are fleeting and they will always come and go. Over time you sort "re-wire" your brain to stop panicking every-time it feels a fleeting anxious feeling.

> So the key is too limit overloading the part of the brain that deals with anxiety, which probably means doing things you are fearing to do so that you no longer fear doing it.

Which is pretty much the go-to advise for a lot of people with anxiety as far as I'm aware.

> doing things

I believe this is done in supervised fashion in Exposure and Response Prevention, and also CBT. Some say ERP violates the Hippocratic Oath part about 'do no harm'.

I found the mockery of it in GTA SA quite entertaining [1]. In my own experience, it's probably best to talk to a therapist before forcing yourself into doing things you are fearing.

[1] https://gta.fandom.com/wiki/Inversion_Therapy

It violates the Hippocratic oath as much as cutting somone open for surgery does. That is to say, it doesn't at all.

Physiatrists and psychologists don't take the Hippocratic oath in most cases. I don't think it's even that common for doctors to take it - definitely not in it's original "do no harm" form.

You're assuming the region in question will undergo desensitization rather than reinforcement learning. That may or may not be the case.

What if there are things we are fearing to do but shouldn’t be doing also?

Then usually you shouldnt have a need to do them, and if you feel like you do, that might be the problem to address.

Fear and anxiety are very different

How so?

Fear is an immediate, emotional response to a known or definite threat.

Anxiety is a more prolonged emotion that arises from an anticipated or potential threat or a situation that's uncertain. Unlike fear, the source of anxiety might not be real or immediate.

From my experience, the way I'd describe it is:

- fear is transient, you feel it in the moment and then it goes away. You can then remember "boy I was scared" and feel the memory of fear but not fear itself. You can project and imagine a situation where you'd be scared.

- anxiety is a persistent state of stressful anguish. There are peaks and troughs. During peaks it can be overwhelming and look like, trigger, or mix with fear. During troughs anxiety is still there somewhere deep, it merely takes a backseat to other emotions. In every moment it biases every process your mind undertakes.

Fear is a response to a perceived threat. For example, in a panic attack you fear dying, but you are in no more danger than anyone else.

Anxiety is a kind of fuzzy term because it encompasses an overall pattern and cycle as well as the associated feelings. But a useful distinction is that anxiety is driven by avoidance of fear of some uncertainty, and exposure and acclimation to that fear (without avoidance) is what extinguishes the anxiety.

Avoidance can take almost any form, but common examples include worry and rumination, procrastination, compulsive rituals like hand-washing or internet research, self-medicating, and superstitious behaviors. And of course, literal avoidance.

I think this splits hairs. Yes, fear means "perceived" threat. You could be acculturated to handling venomous snakes, but that doesn't male the average modern society dweller pathologically fearful of the same snakes. Anxiety is about the distorted anticipation of a threat. E.g., the snake handler has been doing this his whole life, but after seeing his brother accidentally step on one, get bitten, and die, he starts fearing that every one of his future interactions with snakes will be so likely to entail that outcome that he refuses to touch them anymore, and can't avoid a panic attack if he's in the room with one, despite all his past skill.

I was responding to a suggestion that fear occurs when the trigger is a “real” threat. But of course, the feeling is the same regardless of whether the hazard is real.

Also, since I’ve already been accused of hair-splitting, I might as well point out:

> can't avoid a panic attack

There’s no need to avoid a panic attack. In fact, trying to avoid a panic attack feeds the panic.

If your interpretation is correct, it seems that there could be some truth to the old wisdom of (gradually and willingly) facing our fears in order to develop more courage.

> anxiety so the brain routes it to another part of the brain to deal with it

In a sense, anxiety is like a malignant cancer? That explains a lot.

So in a way anxiety prevents learning a.k.a moving past "undesired" behaviours.

It’s a maladaptive response, yes.

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