The Real Happy Pill

by Anders Hansen

  Exercise your anxiety away

  It’s often difficult to separate stress from anxiety. After all, it’s all part of the same system (including the HPA-axis and the amygdala), which is active in both stress and anxiety. Physical training, as you have seen earlier, has an amazing effect on stress, which is why training is also a great way to treat anxiety.

  When American students suffering from anxiety drew lots to either walk or run for twenty minutes a few times a week over the course of two weeks—hardly a grueling training regimen either way—it showed that anxiety levels fell for both the walkers and the runners. The anxiety wasn’t just lowered after the exercise, it stayed low over next twenty-four hours, and the effect lasted an entire week. Who experienced the highest impact on their anxiety levels? The runners did. More effort is obviously better if you wish to lower your anxiety.

  This isn’t surprising, if you think about it. Anxiety is caused by over-activity of the brain’s stress response and an amygdala that signals danger where there is none. Training strengthens the brain’s brake pedals against worry, and the frontal lobe and hippocampus become better at calming the amygdala, thereby preventing anxiety.

  Anxiety—a learning problem

  In principle, everyone would experience high anxiety if they were exposed to a life-threatening situation; on the other hand, not everyone becomes overwhelmed by anxiety when stepping onto a subway train. I once had a patient who suffered a severe panic attack, complete with a racing heart and trouble breathing, in the subway. Her terror was so strong that she was convinced she was going to die. If you’ve experienced this, you know that it’d be common to feel anxious about riding the subway again. That’s what happened to this woman, who, since her attack, has chosen to travel exclusively by bus. It isn’t that she didn’t understand that subway cars aren’t dangerous, it’s that her brain misinterpreted the situation. The mechanisms that misread the event were so powerful that they overrode her “thinking brain.”

  The amygdala, as you have seen, is so powerful that it can overrule the brain. Moreover, it is excellent at making sure we remember threatening situations very well. If you’ve had a panic attack in the subway once, you will remember it very clearly. This is logical from the point of view of survival. We are programmed to distinctly remember what turned out to be unpleasant and/or dangerous so we can avoid it in the future. From an evolutionary perspective, it’s not as critical to remember the five beautiful clearings in the woods as it is to remember where the wolf charged at us. Because of this, negative memories take precedence.

  Memories that are connected to fear are so vivid that they can become a hindrance when you wish to treat anxiety disorders such as panic attacks. For anyone who has experienced a panic attack on a subway train, walking past a subway entrance can be enough to tell the amygdala to trigger the stress response and the HPA-axis. Even if this person eventually overcomes his or her fear and dares to ride the train again, it can take a long time before he or she feels okay or at peace doing so. The unpleasant memory is so strong that it blanks out all the memories of uneventful subway trips without panic attacks.

  Considered this way, you can view anxiety disorders as a learned behavior problem. The brain can’t learn that something is not dangerous. However, if it is programmed to clearly retain the memory of what is threatening, how can we ever be free of anxiety and worry? Well, the solution is to slowly and patiently build up new memories where, for example, a subway ride is not full of panic or apprehension. This is exactly what takes place during CBT (Cognitive Behavioral Therapy), during which a patient is gradually introduced to more of what causes his or her anxiety in order to relearn that it isn’t dangerous. This memory slowly morphs from an anxiety-inducing misinterpretation to something the brain considers neutral and nonthreatening.

  Increased heart rate doesn’t have to mean anxiety

  This leads us to another reason why training is so beneficial in treating anxiety. Heart rate and blood pressure increase in tandem with symptoms of high anxiety. The heart beats faster and harder, and the body goes into fight-or-flight mode, prepared for something negative to take place. But remember, the heart also beats faster and harder if you are out jogging, without your training session ending in some kind of unpleasant episode. Instead, you feel calm when the run is over, and you’re rewarded with surges of endorphins and dopamine. Exercise teaches the brain that a raised heart rate and blood pressure don’t mean anxiety and panic, but rather that positive feelings will ensue.

  This is exactly what was observed in the anxiety-ridden American students who were asked to walk and run. Those who ran were no longer nervous about their heightened heart rate. When before they had equated a racing heart with an imminent anxiety attack, their body had since made the adjustment that an elevated rate was not a threat but the opposite—it could be a positive thing. This effect was not seen in those who walked—their brains still appeared to be misinterpreting the quicker heart rate as dangerous. This underscores the importance of moving more intensely if you wish to overcome anxiety and worry.

  It was once believed that those experiencing a lot of anxiety and worry should avoid physical activity. Today we know that nothing could be further from the truth. However, I must warn that it’s important to start out carefully if you have ever suffered a panic attack. Intense training can be risky, because it could be misinterpreted by the body as an impending crisis and cause an attack in someone who isn’t ready. For that reason, it’s better to start out slowly and ramp up the effort gradually.

  Exercise is the opposite of stress

  When you look closely at research on physical activity and stress, a clear pattern emerges: stress and physical training seem to have almost opposing effects on the brain. Increased stress (i.e., having high levels of the stress hormone cortisol) impedes brain cells’ ability to communicate with one another, whereas training boosts that ability. Stress decreases the brain’s ability to change (its plasticity), while training increases it. Higher stress applies the brake on the change from short-term memory to long-term memory, while training releases it, and so on. In area after area, it appears that stress and training yield the exact opposite effects. This literally makes exercise and physical activity an antidote to stress and anxiety!

  TRAIN AND PREVENT PANIC ATTACKS

  There are some who will do just about anything to help advance the cause of research. I would like to introduce the twelve bravest test subjects I know. They all agreed to receive an injection of the substance CCK4 (Cholecystokinin tetrapeptid 4). CCK4 has an extremely nasty side effect: it can bring on a panic attack, complete with breathing difficulties and a racing heart. The feeling is so strong that some believe they’re going to die. This is what happened to six of the twelve participants: they broke out in a cold sweat, had trouble breathing, and were overcome by paralyzing fear, even though none of them had ever suffered panic attacks before.

  This test was then repeated—amazingly, the test subjects agreed to volunteer again—but with a big difference: the participants exercised quite intensely (at 70 percent of maximum capacity) for thirty minutes prior to getting their CCK4 injection. At this point, something extraordinary happened: only one test subject experienced a panic attack. Evidently the training showed immediate results and decreased the likelihood of having such episodes.

  Agreeing to be injected with a panic-inducing substance is undeniably brave, but another test group showed even more guts. This group had experienced panic attacks before and knew how horrible they could be. And yet they consented to go through yet another one, by administering CCK4. Despite only getting half a dose compared to the healthy group, nine people in the test group had a panic attack. But, as with the healthy group, the number of panic attacks declined when the test subjects were authorized to exercise beforehand. Only four out of the twelve subjects experienced a panic attack; furthermore, they felt that the event was less severe than those they had experienced before.

  Thus, train
ing has a preventive effect on panic attacks, both in prior sufferers and in those who have never experienced one. If exercise works on such severe cases of anxiety, it should definitely help with the “garden variety” anxiety that so many of us grapple with today.

  THE RIGHT PRESCRIPTION TO RID YOURSELF OF STRESS AND ANXIETY

  Realistically, which is the best way to train to rid yourself of stress and anxiety? Based on research, there is no custom program that specifies how intensely or how long you should move to lower your stress level and prevent anxiety; everyone responds differently to exercise, which is why no such systematic comparisons have been undertaken. However, even though there isn’t one single, definite program that works for everyone, there are some concrete tips based on scientific research, that you can follow.

  Focus on cardiovascular training at the outset. It appears that aerobic training is more beneficial than weight training from a stress-relief standpoint. Work out for at least twenty minutes; try to make it thirty to forty-five minutes if you have the stamina.

  Make training into a habit because the results will only get better as you go along. It takes time before the hippocampus and the frontal lobe—two of the brain’s stress brakes— become stronger.

  Try to get your heart rate up at least two to three times a week. Your body will then learn that a faster heartbeat is not a cause for fear, but a state of being that brings about positive changes. This is especially important if you suffer from more serious anxiety problems and panic attacks.

  Aim to reach the point of fatigue once a week—with interval training, for example. There are many indications that this is extremely effective in combating anxiety. However, start out carefully and build up slowly if you have suffered panic attacks or serious bouts of worry in the past; otherwise, you could bring on an anxious reaction if you start out too gung-ho.

  If for some reason you can’t or won’t raise your heart rate, just go for a walk. This also has an anxiety-suppressing effect, though not quite as strong as if you were to move more briskly.

  3. IMPROVED CONCENTRATION

  Strength of mind is exercise, not rest.

  ALEXANDER POPE

  Do you sometimes find it hard to concentrate? If so, welcome to the club to which almost all of us belong. In today’s world of information overload, where cell phones and computers jostle for our attention, it’s virtually impossible to not get distracted. Being engrossed by a task and captivated by it to the point where time stands still is so rare—for me at least—that I almost consider it a luxury.

  Fixing our flagging attention has become big business. There is a steady stream of self-help books, food supplements, and home remedies that are supposed to improve our powers of concentration, most of them having no proven merit whatsoever.

  In truth, there is a remedy that not only helps but also makes a big difference; it is, once again, physical activity. It is only over the past few years that we’ve become able to show that we become more focused—and otherwise more alert—through exercise, as well as knowledgeable about what takes place inside the brain.

  FOCUS ON ONE THING

  Let’s go back and start from the beginning. To see if anything can boost our powers of concentration, we must be able to measure this power. But how can it be done? Is it enough to simply ask someone if they’re feeling focused? In science, you would want to have a more objective measure. Enter the Eriksen Flanker test, which consists of an exercise using five arrows on a monitor. The task is to indicate which direction the middle arrow points to, as quickly as possible. Occasionally all the arrows go in the same direction (<<<<<), which makes things easy. But sometimes the middle arrow points in one direction and the others go in the other direction (>><>>), so the trick is to ignore all the arrows except the middle one. The test is fast-paced; the arrows are only shown for two seconds. To quickly single out and focus on only part of what you see and ignore the rest of the information—in this case, the surrounding arrows—the brain needs to block out irrelevant information. This is called selective attention.

  This type of test might seem pretty ordinary, but it is in fact an accurate indication of our ability to zero in on one thing and not become distracted by our surroundings. Selective attention is an important part of our ability to concentrate and a valuable trait in today’s world. Imagine a day at the office: You’re on the computer while two of your colleagues are chatting away, and someone else is running the printer. The phone pings at incoming texts and emails. You’re trying to get your work done amid all of this, so it’s important that you concentrate and not be sidetracked by all the buzz around you. This is selective attention, which is what the Eriksen Flanker test aims to measure.

  The notion that exercise could affect selective attention and concentration became obvious when a group of people were given the Eriksen Flanker test. The participants’ physical fitness levels were tested at the same time. It indicated that the participants who were fit did better on the test (i.e., they had better selective attention). But it doesn’t end there. The test subjects’ brains were also examined by MRI during the test, and it was noted that areas of the parietal lobe (in the middle of the skull) and the frontal lobe—parts of the brain that are vital to our ability to be and remain focused—were more active in the subjects who were in good shape. Activity in the areas important for concentration was higher in that sample of testers.

  Be that as it may, we can’t make too much of this information since we cannot say for sure that better selective attention is due to people’s fitness. It could be the case that people who can concentrate harder tend to enjoy exercise and are therefore fitter, rather than the other way around. Consequently, the next step was to look at new test subjects, who were training to increase their fitness, to see if this would improve their selective attention. The participants were split into two groups: one group met three times a week to walk on a treadmill for forty-five minutes; the other group performed low-impact stretching exercises. They did this as many times and for the same duration as the walking group, with one key difference: they did not raise their heart rate.

  Six months later, it was time to see if either group had improved at the Eriksen Flanker test and to check for any noticeable differences in the subjects’ brains. And sure enough, there were differences! The walkers had not only improved their selective attention and did better on the test, but the activity in the areas of the frontal and parietal lobes responsible for selective attention ability showed changes, too. This effect was only seen in the participants who walked. Engaging in physical activity as simple and uncomplicated as regular walking for six months didn’t simply improve selective attention; it produced a measurable effect on the brain.

  Why is this the case? One possible explanation is that walking might have increased the amount of connections between brain cells in the frontal lobe, which made it easier for the brain to recruit additional mental capacity in these areas when the intellectual load became high. Like a car shifting into a higher gear, the brain makes use of an extra “focus gear” to stay on track when there are a lot of distractions around. We become more adept at filtering out what is unimportant. The study’s authors could not have been any clearer when they stated that the end results showed “a brain that is more efficient, has better plasticity, and better adaptive capacity.”

  But how does training achieve this effect, and how can you exercise to improve your concentration? In this instance, the test subjects walked; but is running, biking, or swimming better? And for how long? The answers can be found in research that shows how physical training affects a specific condition, one in which the ability to concentrate is the issue itself. It’s a diagnosis that has mushroomed over the past few years; we all see traces of it in ourselves to a lesser or greater degree: Attention-deficit/hyperactivity disorder (ADHD).

  The ADHD epidemic

  A Google search for the four letters ADHD, the acronym for attention-deficit/hyperactivity disorder, brings up fifty-three mil
lion results. ADHD has become our era’s most recognized and discussed medical problem. It is also the diagnosis that has risen the most, by a wide margin. Time magazine warned around the turn of the millennium that too many children were being prescribed medication for ADHD and put the controversial question “Do we drug our children?” out there. At the time, between 4 and 5 percent of all American children and adolescents had been diagnosed with ADHD. Now, fifteen years later, these numbers look tame. We now estimate that 12 percent of the country’s children and teenagers—over six million kids—have been diagnosed with ADHD.

  This increase has been so explosive that, for a period, it was hard to find ADHD medication in the United States. The demand was so huge that pharmaceutical companies couldn’t keep their production levels up.

  We’re all somewhere along the ADHD spectrum

  A diagnosis of ADHD is built on the presumption that you have issues in three areas: concentration, impulsivity, and hyperactivity. Like the boy in class who could never sit still, who bounced around like a pinball, and who paid attention to everything except for what the teacher was writing on the blackboard. He acted on every little whim. There’s no doubt that he had trouble concentrating and that he was impulsive and hyperactive—he ticked the three boxes for an ADHD diagnosis. But do we have to be like him to suffer from ADHD? We all have difficulty focusing from time to time, but that doesn’t mean that we all have ADHD. Concentration is affected by different elements, such as sleep, stress, the time of day, and what’s in our environment. Furthermore, concentration can vary over long periods of time; the same goes for impulsivity and hyperactivity. So, where do we draw the line between what are run-of-the-mill concentration problems and what is ADHD? To put it mildly, that’s not easy to figure out.