anxiety disorder
the brain's disaster rehearsal
three in the morning
you wake up
not startled awake by a nightmare
but woken by a single thought
will tomorrow's presentation go wrong
that test result last month was a little high
could it be some serious illness
the kid's grades have been slipping lately
will they fail to get into a good school
then these thoughts start flooding your mind like a barrage
one after another
faster and faster
denser and denser
you tell yourself to calm down
but your body won't listen
your heart races
your palms sweat
your chest feels like a stone is pressing on it
you toss and turn
until dawn
this isn't occasional nervousness
this is an inner war playing out every single day
more than three hundred and fifty million people worldwide are fighting this battle
according to World Health Organization data from twenty twenty one
anxiety disorder is the most common mental disorder on earth
bar none
more common than depression
and only one in four patients receives any form of treatment
hello
everyone
I'm Wang Lijie
I once did an episode about depression
called I once thought about ending it all
that episode was about the brain's energy being drained away
serotonin crashing dopamine shutting down cognition narrowing into a tunnel
a person trapped in darkness unable to see a way out
then there was another episode on panic attacks
about the brain suddenly sounding a nuclear alarm
the whole body entering life or death mode within minutes
the anxiety disorder we're talking about today
is different from both of those
depression is like your power plant shutting down
the whole person sinking into darkness
a panic attack is like a sudden explosion
it hits hard and passes fast
but anxiety disorder
it's not a blackout
and it's not an explosion
it's an alarm in your brain that can never be turned off
buzzing away twenty four hours a day
not too loud not too soft
not enough to break you down
but just loud enough to keep you from ever finding peace
this is the most insidious thing about anxiety disorder
it doesn't knock you down all at once the way a panic attack does
it drains you slowly steadily and without pause
like a faucet that isn't fully closed
dripping drop by drop
every day you feel something is off
but you can't quite say what's wrong
you still function
you can still go to work
you can still socialize
but the background noise inside you never stops
now let me show you
this alarm that can't be turned off
what's really going on with it
deep in your brain there's an amygdala
this thing is about the size of an almond
tucked inside the medial temporal lobe
it's the oldest threat detection system humans have
hundreds of millions of years ago
when our ancestors were still small mammals
this system was already in place
its job is extremely simple scan the environment
detect danger
sound the alarm
the key thing is
it's so fast it bypasses your consciousness
in two thousand eight the Monk team
published a study in the Archives of General Psychiatry that found
even when a threatening face flashes by for just seventeen milliseconds
too fast for you to even make it out
the amygdala of an anxiety patient still lights up instantly
what does seventeen milliseconds even mean
a single blink takes you three to four hundred milliseconds
in other words
a face you haven't even had time to make out
your amygdala has already completed a threat assessment for you
and this study found something even more crucial
faced with this kind of fleeting threat
the amygdala of an anxiety patient reacts far more strongly than in ordinary people
in a normal person the prefrontal cortex hits the brakes after the amygdala fires
pressing the signal back down
but in an anxiety patient this braking system
is clearly weaker
the amygdala slams the gas
the prefrontal cortex only taps the brakes lightly
you can picture it as a car
in a normal brain
the gas and the brakes work well together
speed up when there's danger
slow down once the danger's gone
but in an anxiety patient's car
the gas pedal is stuck
and the brake pads are worn thin
so it just keeps accelerating
even when there's nothing on the road
in twenty twenty one the Kenwood team
published a review in Neuropsychopharmacology
that explained this mechanism even more clearly
they said
the prefrontal cortex of primates expanded greatly over evolution
originally to add a layer of rational control over the anxiety response
but if certain pathways in the prefrontal cortex go wrong
it not only fails to suppress the amygdala's output
it actually produces a negative bias
meaning you become more likely to notice threat signals
harder to pull out of an anxious state
and start avoiding every situation that might trigger discomfort
this is the core neural circuit of anxiety disorder
it's not that something's wrong with your personality
it's not that you're too sensitive
it's not that you overthink
it's that between the gas and the brakes in your brain
there's a hardware level imbalance
but the story isn't over yet
just having an overactive amygdala
isn't enough to create an anxiety disorder
what really turns anxiety into a chronic condition
is another system your stress hormone axis
in medicine it's called the hypothalamic pituitary adrenal axis
you can think of it as the body's emergency mobilization system
under normal circumstances
when you meet a real danger
this system kicks in
releasing cortisol
helping you focus mobilize energy and prepare to fight or flee
once the danger passes
cortisol comes back down
the system resets
but in an anxiety patient the stress hormone axis doesn't reset properly
in twenty nineteen the Fiksdal team's research found
the more severe a person's anxiety symptoms
the flatter their cortisol recovery curve after a stress test
what does that mean
it means other people's alarm shuts off quickly after it goes off
yours keeps buzzing there long after it's gone off
slowly and reluctantly dragging its feet before it quiets down
and the twenty fourteen Dieleman team's research on childhood anxiety is even more startling
they found
children with chronic anxiety
actually have lower baseline cortisol levels
this seems contradictory
but it actually points to exactly one thing
the system has been chronically drained to near exhaustion
it's like a fire brigade
if it's called out by false alarms twenty times a day
over time
the firefighters burn out
and when there's a real fire they can't respond
this is the fundamental difference between anxiety disorder and occasional nervousness
occasional nervousness is a normal alarm
anxiety disorder is the alarm system itself breaking down
either it won't stop ringing
or it rings until it can't ring anymore
alright
now we come to the most crucial part
this faulty alarm system
what exactly is it warning about
the answer is
the future
this is the most essential difference between anxiety and depression
the core of depression is despair over the past and the present
what has already happened crushes you
you can't see a way out
but the core of anxiety is fear of the future things that haven't happened yet
your brain has already started rehearsing disaster
modern neuroscience has a brilliant framework to explain this
it's called predictive coding
your brain is essentially a prediction machine
it doesn't passively receive information from the outside world
it actively generates predictions about the world a second from now
then compares the actual input against those predictions
if they match
nothing happens
if they don't match
the brain produces a signal called prediction error
to correct the model
in twenty twenty five the Ballal team proposed an integrated model
it's really elegant
they said
the problem in anxiety patients lies in precision weighting
what is precision weighting
it's the level of trust the brain assigns to different signals
a normal brain adjusts flexibly according to context in a safe environment
it lowers its sensitivity to threat signals
in a dangerous environment
it raises the sensitivity
but the brain of an anxiety patient
sets the weight on uncertain signals from inside the body far too high
the heartbeat speeds up a little
read as the warning sign of a heart attack
the stomach feels a bit off
read as a sign of cancer
the breathing gets slightly rapid
read as being about to suffocate
their computer simulations show
once this weighting bias forms
the system reinforces itself
getting more and more rigid
harder and harder to return to a normal state
anxiety creates more physical discomfort
physical discomfort gets read under high weighting as a bigger threat
a bigger threat creates more anxiety
this is a self locking loop
so now you understand
anxiety patients aren't worrying over nothing
their brains really are seeing evidence that the sky is falling
it's just that this evidence is manufactured by the brain itself
it's like a security checkpoint turned up to its highest sensitivity
a normal checkpoint
knives guns and explosives can't get through
a keychain gets waved through
but an anxiety patient's checkpoint
a single paper clip can trigger a full airport evacuation
and what's worse
every evacuation makes the system think see
there really was a threat
then it turns the sensitivity up another notch
so you might ask
if this system breaks down so easily
why didn't evolution weed it out
the answer is
it's not a malfunction
it's an outdated feature
on the African savanna a hundred thousand years ago
your ancestors needed this system
an odd rustle in the bushes
the amygdala responds in zero point zero one seven seconds
making you leap up at once ready to run for your life
in that era
the anxious types lived longer
nine times out of ten a rustle in the grass is just the wind
but the tenth time it's a leopard
the cost of those nine false alarms is low
just a few extra steps
but the cost of missing the tenth is death
so evolution chose a strategy of better a false alarm than one missed
the problem is
you no longer live on the savanna
you live in a world with no leopards
but your amygdala still runs on the savanna's parameters
it treats an email from your boss as a leopard
it treats silence at a social gathering as a sign of being cast out of the tribe
it treats one arrow on a medical report as the footsteps of approaching death
your hardware is a hundred thousand years old
but your environment is the twenty first century
the mismatch between hardware and environment
is the underlying reason anxiety disorder erupts on a massive scale in modern society
at this point
I want to turn our perspective back to the East
Buddhism has a very precise concept called restlessness
restlessness is one of the five hindrances
the five hindrances are the five main obstacles on the path of practice
sensory desire ill will sloth restlessness and doubt
restlessness means a mind that is unsettled scattered and agitated
if you look closely at the definition of restlessness
you'll find it maps almost perfectly onto the anxiety disorder modern neuroscience describes
restlessness isn't a great storm
it's the constant little ripples on the water's surface
never able to settle
the Buddha observed this state twenty five hundred years ago
and ranked it alongside greed anger and sloth as an obstacle of equal magnitude
what does this tell us
it tells us anxiety isn't an invention of modern people
it's a built in trap in the structure of the human mind
it's just that in ancient times
people had more ways to burn off their excess vigilance energy
physical labor rising with the sun and resting at sunset
close knit community bonds
but modern people sit in offices
the body barely moves
the brain runs around the clock
social relationships are fragmented
every floodgate that could help you release the pressure
is blocked up
so what do we do
I'm not going to repeat the help seeking advice from the last depression episode
today I'll just add one point unique to anxiety disorder
and it's the one I find most practically valuable
the essence of anxiety is an inability to tolerate uncertainty
in clinical psychology this concept is called intolerance of uncertainty
in twenty twenty two the Zemestani team
studied nearly seven hundred children and adolescents and found
intolerance of uncertainty is the thing that cuts across every anxiety subtype
the core risk factor
whether it's generalized anxiety social anxiety separation anxiety or panic disorder
the same thing is driving all of them underneath
you can't stand not knowing how things will turn out
to put it the other way
if you can raise your tolerance for uncertainty
every type of anxiety drops in step
this lines up strikingly with what the Buddha taught
the Buddha said
the root of suffering is attachment
and the core of attachment is wanting to control what cannot be controlled
you cling to a certain future
but the future is never certain
the harder you try to grasp it
the more it slips through your fingers
and the more anxious you become
so
every effective anxiety intervention whether it's cognitive behavioral therapy
or mindfulness training
or exposure therapy they're all essentially doing the same thing
training you to coexist with uncertainty
not to eliminate uncertainty
because that's impossible
but to change your relationship with it
from I must know the outcome to I can not know the outcome
and still live just fine
this shift
can't be achieved by thinking alone
it takes practice
just as a muscle needs training
your capacity to bear uncertainty also needs to be built time after time
experienced endured and discovered in real situations
uncertainty didn't kill me after all
you know what
what does Buddhism call the steadiness cultivated in practice
it's called forbearance
not the enduring kind of forbearance
it's resting in discomfort without running away
the opposite of forbearance
is precisely restlessness
you think you're fighting anxiety
but really you're practicing forbearance
every time you choose to stay in that discomfort one second longer
instead of instantly grabbing your phone or hitting a search engine
or repeatedly asking the people around you am I okay
you're recalibrating that faulty security scanner
finally I want to say one thing
the sentence anxiety patients hear most is you think too much
this is well meaning
but it's wrong
anxiety disorder isn't overthinking
it's a parameter error in the brain's threat detection circuit
the precision weighting has shifted
the reset mechanism of the stress hormone axis has grown sluggish
these are all things that can be scientifically measured
changes with a neurobiological basis
you wouldn't tell a nearsighted person just look more carefully and you'll be fine
nearsightedness is a problem in the eye's refractive system
it needs glasses or surgery
by the same logic
anxiety disorder is a problem in the brain's threat assessment system
it needs professional intervention
if you're going through persistent anxiety that affects your life
please see a psychiatrist or a mental health professional
this isn't weakness
it's the smartest decision you could make
in that earlier depression episode I said a line that isn't you
that's the illness
today I'll say it again
in a different version
you're not weak
you're not being dramatic
you're not overthinking
your brain is fitted with a warning system from a hundred thousand years ago
and now it's frantically sounding alarms in a world with no leopards
this isn't your fault
but you can learn to recalibrate it
do you think anxiety is the baseline color of our generation
if you've had experience living alongside anxiety
whether good or bad
tell me in the comments
I'm Wang Lijie
see you next time