In the year before and months after MAY CAUSE SIDE EFFECTS released, I didn’t read a single book. I’d just finished writing one, and reading other people’s work did nothing but invite comparison and insecurity. But something shifted when we flipped the page to 2023, and I’m back to devouring books at all hours of the day.

Among the stack I’ve recently finished is Dr. Ellen Vora’s The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response.

Ellen is a Yale and Columbia University educated, board-certified psychiatrist who speaks openly about antidepressant withdrawal and the overprescription epidemic. Though Ellen and I haven’t ever met, we’re in occasional contact since she’s one of the few working psychiatrists with the balls to speak out about the pill for every ill “strategy” that seems to be doing more harm than good. Also an acupuncturist and yoga teacher, she practices from a functional-medicine foundation, meaning she believes most (if not all) mental health issues are caused not by disease or a chemical imbalance but by everything from unresolved trauma to lifestyle choices to blood sugar crashes.

The perk of this approach is that unresolved trauma, lifestyle choices, and blood sugar crashes are all things we have the power to fix. What a concept!

The conventional theory of anxiety is that it exists in the head and causes downstream, emotional and physical effects. In The Anatomy of Anxiety, Ellen argues that anxiety begins in the body, and that it’s the physiological stress response that causes mental anguish. Said another way, our brain chemistry changes as a result of an imbalance in the body, not the other way around. This is good news, she says, because this anxiety is both preventable and responsive to basic adjustments to habits, diet, and lifestyle.

Just as I did with Johann Hari’s Stolen Focus, I’ve compiled what I think are the 10 most important and interesting ideas from Ellen’s book. One caveat: The Anatomy of Anxiety is an outstanding starting point for those beginning to explore the mind-body connection and the basic science of anxiety. For those of you who spend a lot of time in this space, you’ll likely recognize much of the content. I worry that my familiarity with the topic means I’ve skimmed over obvious lightbulb moments. Thus, if you’re someone who struggles with anxiety and you don’t spend your free time nerding out over the science like I do, I highly recommend you take my word for it and get a copy for yourself. Understanding how your body works and why it reacts the way it does is a key first step in managing and healing anxiety.

Onward to the good stuff! (Bold emphasis mine.)

Ellen likes to differentiate from “true anxiety” and “false anxiety” in order to help her patients understand what is anxiety they can control (false), and what is anxiety that’s baked into human existence (true)

“False anxiety is the body communicating that there is a physiological imbalance, usually through a stress response, whereas true anxiety is the body communicating an essential message about our lives. In false anxiety, the stress response transmits signals up to our brain telling us, something is not right. And our brain, in turn, offers a narrative for why we feel uneasy…this type of anxiety is not here to tell you something meaningful about your deeper self; rather, it’s offering a more fundamental message about your body. When we recognize that we are experiencing anxiety precipitated by a physiological stress response, we can address the problem at the level of the body, by altering our diet or getting more sunshine or sleep. In other words, false anxiety is common, it causes immense suffering, and it’s mostly avoidable.”

True anxiety arises from having strayed from a vital sense of purpose and meaning. This anxiety is what it means to be human—to know the inherent vulnerability of walking this earth, that we can lose the people we love and that we too, will one day die…it is essentially a guide for how to make our lives as full as they can be.

Between 2019 and 2021, the Kaiser Family Foundation estimated that rates of anxiety and depression skyrocketed by 270 percent.

Genes simply don’t adapt that quickly, which punctures quite the hole in the theory of anxiety as a genetic disorder. (Never mind the fact that an “anxiety gene” has never been identified.”

Ellen says: “These rates would not have risen so precipitously if these disorders had a predominantly genetic basis—which was our presiding understanding over the last several decades. Our genes cannot adapt so quickly as to account for our recent catapult into anxiety. It stands to reason that we are increasingly anxious because of the new pressures and exposures of modern life—such as chronic stress, inflammation, and social isolation. So, odd as it may sound, this recent acceleration is actually good news because it means there are straightforward changes we can make.”

Though we have the same stress response as we did thousands of years ago—when stress meant running from a saber-tooth tiger or finding consistent food supply—modern life gives us a very different set of circumstances to cope with. Rarely are we in life or death situations and instead experience regular, low-grade stressors like a bloated email inbox or road rage.

Still, “with our modern diets and habits—which frequently trigger stress responses in our bodies—many of us live in a near constant state of feeling under siege. Your blood sugar is crashing after eating something sweet? The body interprets this as a mild threat to survival. You stay dup too late doom scrolling on your phone? The body feels surrounded by danger. Sleep deprivation, chronic inflammation from eating foods you don’t tolerate, and the comment section on Twitter—these are all, from your body’s perspective, indications that your environment is not safe. So, the body releases stress hormones into your bloodstream, and this invisible chemical cascade manifests as the feelings and sensations of false anxiety.”

Because false anxiety is often caused by outside stressors, it’s also manageable if you know what to look for. The book goes into the science behind each of these bullet points, but as a starting point, here are Ellen’s recommendations for “pausing in the midst of turmoil” in order to understand the particular false anxiety that’s occurring as well as how to address it:

“I’m anxious, and I’m not sure why. Am I…

• Hungry? (eat something)
• Sugar-crashing or having a chemical comedown? (Did I just eat something sweet, processed, or laden with food coloring or preservatives? Have a snack and focus on making different choices next time.
• Overcaffeinated? (Perhaps this jittery anxiety is really caffeine sensitivity; tomorrow, drink less caffeine.)
• Undercaffeinated? (I drank less caffeine today than usual; dose up and aim for consistent daily caffeine consumption going forward)
• Tired? (Take a nap; prioritize an earlier bedtime tonight.)
• Dehydrated? (Drink some water.)
• Feeling sluggish? (Take a quick walk outside; dance.)
• Dysregulated? (Did I just engage in an internet rabbit hole or social media binge? Dance or go outside to rest the nervous system.)
• Drunk or hungover? (File this away to help inform future choices around alcohol.)
• Due for a dose of psychiatric medication? (Right before the next dose, I’m at the pharmacological nadir—or the point where the level of medication in my bloodstream is at its lowest, and this can affect mood. Time to take meds.)

(A note from Brooke in bold: I’d argue that the last bullet point could also include, “Time to take meds or if coming off meds, recognize this as a sign of psychiatric drug withdrawal and be kind to yourself.” )

True anxiety serves a purpose in society, as demonstrated by this fascinating 1980s study of primates:

“Studies of primates show that some members of the tribe are more anxious than others—these are the ones that tend to hang back, gathering the peripheries of the main group. In the 1980s, the late zoologist Dian Fossey decided to remove these more sensitive members of one group of chimpanzees to see how it would affect the rest of the community. Six months later, all the chimps were dead. ‘It was suggested that the anxious chimps were pivotal for survival,’ Sarah Wilson writes compellingly of this experiment in her book First, We Make the Beast Beautiful. ‘Outsiders, they were the ones who were sleeping in the trees on the edge, on the border, on the boundary of the community. Hyper-sensitive and vigilant, the smallest noise freaked them out and disturbed them, so they were awake much of the night anyway. We label such symptoms anxiety, but back when we were in trees, they were the early warning system for the troop. They were the first to scream, “Look out! Look out!”’”

(Side note, I’ve never used that many quotation marks before. My 10th grade English teacher Mrs. Utter would be proud.)

Though this study was on monkeys, the same can be said about more sensitive and anxious folks in the world. They alert everyone else to potential problems and dangers. (I.E., climate activists.)

The most positive (and counterintuitive) change I ever made to my sleep hygiene was when I started eating a hefty portion of starchy carbs at dinner.

Prior to this directive—which came from a high performance nutritionist and professor of muscle science at Cal Fullerton—I’d often skimp on starchy carbs at dinner in order to rationalize dessert, or go low-carb all together in a misguided attempt to cut calories and stay lean. My shitty sleep, I assumed, was unrelated.

As it turned out, this strategy was causing blood sugar spikes and crashes (with dessert) or causing overall low blood sugar (low-carb) that disturbed my sleep. When I added about a cup of cooked white rice or potatoes to the meal, my sleep issues evaporated. What happened?

Ellen explains: “If you typically get ‘hangry’—angry and irritable when you’re hungry—at 3pm, the overnight equivalent is waking up at 3am with racing thoughts, unable to fall back asleep. This typically happens when your blood sugar crashes overnight and your body counters with a stress response…a stress response can make your sleep more superficial, shunting you out of the deeper stages of sleep and making it more likely you’ll be jolted awake.”

The solution is to stabilize blood sugar throughout the night. I do this with a big, starchy carb heavy (but low sugar) meal. Ellen likes to eat a spoonful of almond butter before bed, and eats another spoonful if she wakes up jittery and anxious.

“Our bodies are increasingly bombarded with unrecognizable chemicals and food—ranging from pesticides to phthalates to Pop-Tarts (essentially, foreign agents our bodies didn’t evolve to deal with)—that provoke the immune system in much the same way a genuine infection would. A daily ingestion of Doritos, for instance, leaves the immune system belligerent and confused. It keeps fighting, thinking it stands a chance at killing off the ‘infection’ of Doritos, but our immune system isn’t build to defeat chips—not to mention that we get ‘reinfected’ with every snack. Over time, a consistently inflammatory diet can result in a dysregulated, hyper-vigilant immune system, an inflamed body, and sustained feelings of depression or anxiety.”

“The body is hardwired for survival,” Ellen says, “not for feeling calm.”

She’s says this in the chapter about psychiatric drug withdrawal, specifically in relation to benzodiazepines. But what I find most interesting about the statement is that we’re all walking around under the assumption that calm should be the norm and anxiety a pathogen to eradicate.

In reality, a part of our body is always looking out for dangers. It’s why we startle when we hear an unfamiliar thunk. Debilitating anxiety needs to be dealt with, of course, but bouts of it is just the body doing its job of trying to stay alive.

“We’re taught from a young age that when something is difficult, it is necessary to distract ourselves. When a child has a tantrum, we think, How can I make the crying stop? We know that if we hand the kid some sugar or a screen, they’ll probably be satisfied. Problem solved, right? Well, actually, now we’ve taught the kid: I can’t handle your big emotions, you can’t handle your big emotions, and should ever feel big emotions in your future life, quickly find something that will distract you, offer you a hit of dopamine, or numb you out. It’s no wonder even we adults turn to our phones or emotional eating when in fact we just need to feel our feelings and let our tantrums run their course.”

This is where true anxiety comes into play. Safety is an illusion. All our effort put into keeping our kids “safe,” building equity, or eating clean could be undone in a matter of moments. We do these things to bring a sense of order into our lives, but trying to white-knuckle our way to control often creates the exact anxiety we’re trying to prevent.

“We are anxious and exhausted because wee are fighting with reality, beliving things are supposed to go a certain way. Instead of showing us where we need more control, anxiety actually alerts us to where we need to let go; when we need to take a breath and patiently, courageously see where our particular path will take us.”

When I began Happiness Is A Skill early in the pandemic, I imagined it as a space where I could freely share my tips and strategies for recovering from depression and antidepressant withdrawal. Sixty-eight issues later, I’ve decided it’s time to bring in other voices. As much as I’d love to pretend I have all the answers for everyone on the planet, the truth is that the first step to becoming a great teacher is being a great learner.

Happiness isn’t like riding a bike. You don’t learn it once and know it forever. It requires maintenance, and without practice, can slip away. When you return to it, weeks or years later, it can feel like you never learned it at all. I am deeply curious about how other people learned happiness, what techniques they’ve developed to keep themselves on track, and how they know they’re sliding off track in the first place.

I’ve reached out to a slew of people from all sorts of backgrounds. Even though we’re all in different situations, at the heart of it, I believe that depression and anxiety feels roughly the same for each individual, with varying degrees. If you’ve experienced either one, you know what it’s like to feel like your body is made of lead or for your heart to jump into your throat. You know what it’s like to lack motivation and curiosity, for the world to literally lose its color. You may not know how to recognize early patterns that signal an incoming bout of mania or melancholy, but learning to recognize those signals early is part of the practice.

This week, Jenny Blake (@jenny_blake), international keynote speaker and author shares her strategy for managing overwhelm—a feeling she is all too familiar with. After launching in 2016 as the top career pick by Axiom Best Business Books, Pivot: The Only Move That Matters Is Your Next One, by Jenny is now the go-to career development framework for forward-thinking organizations, pivoters, and entrepreneurs. Her next book, Free Time: Lose The Busywork, Love Your Business, tackles all that creates overwhelm in work and life: hustle culture, busywork, and overly-complicated systems.When asked to share a strategy to manage difficult or stressful times, Jenny said:

“As a highly sensitive introvert, sometimes the basics of family life—on top of running my own business—overwhelm me. I check my energy gauge to see if I feel like I’m drowning (as I did recently), treading water, or gliding and in flow. As much as I wish I could consistently be a good partner to my husband and dog mama to my two-year-old German shepherd within the constraints of my day-to-day and our WFH-household, sometimes I just need an escape. Booking a 3-night “staycation” or “workcation” in the city (I live in Manhattan) recharges me like nothing else. I know it’s not always financially feasible for everyone, and it can certainly feel like an excessive luxury (at first) to spend on room-and-board in one’s own city. But if I go into the trip with clear intentions (either deep rest, or deep work), I always come out with a renewed sense of self, feeling like it was a priceless investment.I got this idea from Cheryl Strayed and Maya Angelou, who said it was integral to their writing process.”

Two things stick out to me. First, Jenny stops to check in with herself before making any decision. Is she drowning, treading water, or gliding in the flow? Drowning signals a need to escape. Treading water is manageable, but it could also be a warning that an escape may be needed in the future. Gliding in the flow is calm, easy. All is well.

If she decides she’s drowning, she books a staycation and sets an intention. It’s not enough to mindlessly book a hotel and hope it works out. She creates a plan and sticks to it. After all, we can’t know if we’ve succeeded unless we’ve created parameters for success.

How could you take Jenny’s strategy and apply it to your own life? If a staycation isn’t on the menu, how about a solo hike or an overnight camping trip? Perhaps it’s about asking those around you for an hour a day, away from the kids. Or hiring someone to help you complete a project that’s been weighing on you, like cleaning the house or organizing the garage. Maybe the first step is simply asking for help.

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Related resources: 

This week, I wanted to draw attention to the work of Andrew Huberman, an American neuroscientist and tenured professor in the Department of Neurobiology at the Stanford University School of Medicine.

Huberman specializes in the visual system and how it affects brain development, neuroplasticity, and neural regeneration and repair. Our eyes, as it turns out, have two functions. In addition to helping us read, see colors, and identify objects, our eyes are one of two primary systems (respiration is the other) that help tell our brain whether to be relaxed or alert.

The most obvious example of this is how we use our eyes to communicate the time of day. Our eyes perceive changes in light and therefore, our brain tells our body to awaken or become sleepy through an “aggregation of neurons” that dictate things like metabolism (are you hungry?) and movement (do you want to be lying down?) This is why sleep experts recommend shutting off harsh lights and avoiding screens toward the end of the day. When your eyes perceive the light, it triggers wakefulness in the body instead of sleepiness.

The eyes also have a direct impact on our inner state. Our pupils contract when we’re relaxed and dialate when we’re focused or under any kind of stress, good or bad. For example, when you’re staring out over a beautiful coast or vista, your pupils get smaller in order to let you take in the breadth of your surroundings. This panoramic vision opens our window to the world, literally making it look bigger, which leads to stress reduction. This is one of the reasons why we feel so good in nature.

Conversely, our pupils dilate when we’re focused or stressed. Now we see the world through straws, the peripheral fields of our vision narrowed. When the visual field shrinks, according to Huberman, it triggers an increase in alertness. In a negative experience, that alertness is called stress, anxiety, or fear. In a positive experience, it might be called flow, excitement, or infatuation.

Like breathing, this is usually autonomic. Or rather, we don’t have to think about how our pupils adjust to see, just like we don’t have to think about breathing to stay alive. But just like we can hijack respiration and use breathing to our advantage, either because we’re blowing up balloons or because we’re practicing breathwork techniques in order to manage stress, we can also direct our gaze to influence our state of mind.

When we’re in a state of anxiety or negative stress, we can cue our brain to calm down by forcing ourselves to expand our field of view, to literally see the bigger picture.

Huberman said in a recent podcast, “If you look forward and you expand your field of view, so you kind of relax your eyes so that you can see as much of your environment around you as possible to the point where you can see yourself in that environment, what you are doing is turning off the attentional and, believe it or not, the stress mechanisms that drive your internal state towards stress.”

In short, to help keep stress levels down throughout the day, look around. Take breaks from staring at your computer to look out a window or check out the patterns in your ceiling. And if you’re having a bout of anxiety, force yourself to see a literal, bigger world.

After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on September 6, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

In a day and age when information travels at warp speed and lives can be irrevocably changed by one photo or a single tweet, there was something poetic about the speed of the 2020 federal election. All the bandwidth and technology in the world couldn’t move it along any faster than it was going to go. The outcome was too precarious and the stakes were too high for anyone to make an honest call. And so we waited, and waited, for more information to come in.

It is moments like this that pierced through my own fourth wall and grabbed me tight around the chin, forcing me to face the greater collective storyline and apply it to my own. While the United States idled at a crossroads that led us toward two very different futures, I also stood at a major junction. There were two choices, and I needed to choose one. Each somehow felt both beautiful and awful, and yet the rest of my life hinged on this choice.

It was too close to call.

But life imitates life. For all the faults of that election and the missteps of all the people involved, there was one thing huge lesson to learn from it: when a decision remains unclear, it is because all the information has not yet arrived.

We have conditioned ourselves to think that when we are presented with a choice, our only options are to pick one or the other and to do it fast. But there is an ever-present third choice that often holds the most power — the choice to wait.

Waiting is itchy. It prickles at you like a stiff wool sweater on a frozen winter night. But to rip it off too soon is to expose yourself to the elements without having first found shelter. If only you could wait until dawn when the sun rises to light the way. Life might look a little different then, the two paths now illuminated, obstacles in clearer view.

So we waited. And I waited, itchy and squeamish, for the information to come in. Because the outcome was too precarious. The stakes were too high.

It was too close to call.

No fate is worse for those with anxiety than the act of doing nothing. But there is one tool you were born with that can help calm your mind and body when the weight of a situation becomes too much: your breath.

I am an XPT certified breathwork coach. Often, with my clients going through antidepressant withdrawal, I use my training to teach them how to breathe through the unpleasant side effects. But the techniques are relevant to anyone who suffers from anxiety, and yet little attention is paid to our breath.

Though breath is the single most important life-force on the planet, studies suggest that breathing dysfunction occurs in up to 83% of anxiety sufferers. Breathing dysfunction can negatively impact the body in a number of ways, including reduced blood flow to the brain, and sleep apnea, and higher instances of stress and anxiety.

Anxiety is the body’s way of alerting you to potential danger. It’s that “fight or flight” response that historically, motivated our ancestors to get scared and run away from a hungry tiger. But these days, most people aren’t being chased by a tiger (or its metaphorical equivalent.) Instead, anxiety is created in our minds.

Just because anxiety is created in the mind doesn’t mean it isn’t real. Physiologically, the body doesn’t know the difference between anxiety created because of a physical source and one created in our head. Think of a nightmare, for example. Even though we are safe in our beds without any physical threats, the situation created in our mind can shoot us up out of bed, drenched in sweat, and panting as if the dream was as real as the mattress underneath us.

The breath is like a remote control for the mind, and learning how to harness its power can mitigate the body’s stress response. Several studies have shown that deep breathing, specifically belly breathing that activates the vagus nerve, significantly reduces the stress response in the body. The vagus nerve runs from your brain all the way down to the belly, with branches that extend into your throat, heart, and lungs. When properly stimulated through deep breathing, the nerve regulates the nervous system’s response by turning down the intensity of stress and anxiety.

By breathing with intention, each of us has the power to operate our internal remote control, thereby gaining some authority over the anxiety. With an undetermined future ahead, there’s no better time to gather tools to manage our new uncertain world. You’re going to need every edge we can get, so let’s start with the one you were born with: your breath.

Designed to keep you mindful of your breath while also helping your body to kick into a parasympathetic (calm) state, cadence breathing is an ideal breath pattern to ground yourself first thing in the morning.

To begin, sit in a comfortable upright position, either crossed-legged or in a chair. Take a moment to become aware of your breath. Actually look at it. Can you see your belly going out and in? Or maybe your chest moves up and down? Are your lips parted, allowing you to take in air through your mouth? Or is your jaw clamped down tight?

No matter how you typically breathe, commit to spending the next 10–15 minutes breathing only in and out through your nose and into your belly. Keep one hand on your stomach for a tactile reminder, and feel that hand rising and falling with each breath.

Begin with a cadence tempo of 2:2:4:2. That means you’ll inhale through your nose for an honest count of two (one one thousand, two one thousand…), hold your breath for a count of two, exhale through your nose for a count of four, and hold your breath at the bottom of the exhale for two. The crux of cadence breathing is to keep your exhale twice as long as your inhale, so if you’re comfortable at 2:2:4:2, increase the tempo to 3:3:6:3 or even 4:4:8:4. The slower and deeper your breath, the more the vagus nerve is stimulated to lower overall stress.

If you find yourself on the verge of panic and you don’t have 15 minutes to step away and collect yourself, the 4:7:8 breathing pattern can knock anxiety down in just a handful of breaths.

Simply breathe in the nose for four seconds, hold your breath at the top of the inhale for seven seconds, and exhale audibly out your mouth for eight seconds. This is one breath cycle.

Repeat the breath cycle three more times.

If you find the 4:7:8 too challenging, simply speed up your counting while keeping the inhale:hold: exhale ratio the same.

Though humming has long been a staple of yogic breathing and meditation, science has only recently revealed the potential reasons why. Our paranasal sinuses are the main producers of nitric oxide, a gas that plays an important role in vasoregulation (opening and closing our blood vessels) as well as neurotransmission, immune defense, and respiration. When we hum, our nasal passages produce nitric oxide up to fifteen-fold in comparison with quiet exhalation, which leads to lowered blood pressure, heart rate, reduced anxiety, and a grounding feeling of calm that can lull us off to sleep.

Know that there’s a high chance of falling asleep during this exercise, so make sure you’re ready for bed before you begin.

Lying on your back with your head in a comfortable position, simply close your eyes and inhale through your nose, taking in a big breath into your belly. When you’ve taken in a full breath, begin humming and slowly exhale out all your air. Keep the hum deep and low and long, with the vibration coming from the back of your throat rather than your head. Repeat the humming breath for 10 minutes, or until you fall asleep.