A (4:57)

That's a really nice quote that you start one of the chapters with in the attention fix. I don't have it to hand now, but it was something like, it's a surprise that more of us are not mentally ill, given how alien our current environments are.

B (5:15)

Exactly.

A (5:16)

And I think what you've just said really speaks to that.

B (5:18)

Exactly. And the world that we think is so natural, with cars and computers and refrigerators and tinders, whatever, that's actually a very, very strange world for humans. Almost all previous generations have lived as hunter gatherers or as farmers. So you may be a doctor or a cab driver or a nurse or a teacher, but biologically speaking, we are all hunters and gatherers. That is what we have adapted for. And those instincts that helped us survive in a world of scarcity and a dangerous world, those instincts don't help us become happy in a world of overabundance.

A (5:58)

Yeah, I think that's a really nice rephrasing for your patients with anxiety that actually there's nothing wrong with You. Your brain is doing what it's meant to do.

B (6:07)

Exactly. So anxiety is both natural and hell at the same time. I don't want to downplay how horrible anxiety can be, because it devastates lives, it costs lives. But it's important to understand that you are not broken, you are not damaged goods. And this is something that can be fixed by therapy, by exercise, and if it's really bad, by medication. And you cannot get rid of all of your anxiety. But even if you just lower it a bit, you will feel a lot better. But I think the perspective on looking at it as an evolutionary defense mechanism, that makes you less afraid of the anxiety itself, because you. There's something which is basically fear of fear. You're afraid of your anxiety, and you're afraid that you will get anxious in the future, and that might be. Cause as much harm as the anxiety in itself, so to speak. You see, patients with panic attacks, they start avoiding things to avoid those possible attacks. And I told the patient once that a panic attack is often a sign that your brain is functioning normally. Because if we assume that we are living on the savannah, which 99.9% of all humans did, and there's a rustle in the wind, then you could think that, okay, that's probably nothing, and then you don't do anything. If it's just the wind and you run away, what do you lose then? Would you lose 200 calories? That's what your body uses when you run away. If it's a lion, what you lose then, well, then you lose 200,000 calories. That's what the lion will get. When he eats you, you lose your life. So from a pure calorie perspective, we should not be surprised that the brain is calibrated in a way that it accepts 1,000 false alarms to not miss the one time your life depended on it. So this really gives an understanding that most panic attacks are false alarms. That shows that you are functioning normally. And when I say that to patients, I've had many of them who say, okay, so it's okay to have a panic attack. And when he realized that in this case it was a he, those attacks came less often.

A (8:14)

I mean, it's really powerful, Anders. It's really powerful. That sort of reframe.

B (8:18)

Exactly.

A (8:18)

Because so many patients think they're broken. They think there's something wrong. Why is my brain doing this? My partner's brain doesn't do this. There's something wrong with me. And so I think you just been able to validate their Experience and say, wait a minute. Your brain's doing what it's supposed to.

B (8:34)

Do, and you are not damaged, but you suffer. And we can fix that, and that's fine. But you should not look at yourself as someone who is broken. That's very important. How you contextualize an experience of anxiety or depression is very, very important of how you will experience it. And also, if you learn the biology of the brain, you realize that feelings are short term. They will pass. Because the goal of feelings is not that we should have a rich inner life. It's to push us against behaviors that helped us survive in our past. And if feelings were not short term, you know, that we would not. We need to change behaviors all the time.

A (9:16)

So a feeling is there, in your view, to help us change our behavior?

B (9:21)

Exactly. That's what they're doing.

A (9:22)

That's the only reason.

B (9:23)

That's the only reason. So in every moment of our lives, the brain takes information from the body and from the surroundings, and it creates a summary of all that. And that summary is a feeling. And it's supposed to tilt you to behave in certain ways. If your energy levels is low, well, that feeling might be hunger to take care of your nutritional need. If your feeling is lonely, it's telling you to take care of your social needs. So feelings are there to help us do the things that help to survive. Not the things that help us survive today, but the things that helped humans survive in our past. And I would like to see. I almost see feelings as whispers from previous generations of humans who have, against all odds, survived.

A (10:11)

Yeah, there's a beautiful poeticism sort of philosophy behind what you said about ancestral whispers. But there's also kind of a change to our physiology. We're seeing lots of research, aren't we, about transgenerational trauma being passed on.

B (10:31)

Right.

A (10:31)

We see in certain families, if, you know, we see this in Northern Ireland, Iraq, all kinds of countries where there's been significant trauma in the recent history. We see that the kids or the grandkids, even though they didn't experience it, they didn't directly experience the trauma. They have imprints of that trauma within them. Their stress response is set differently. So that idea of whispers from the past, I think it works poetically and physiologically it does.

B (11:03)

And, you know, you could see this as a smoke detector principle. If you have a smoke detector in your kitchen, it's okay if that smoke detector sometimes alarms when you burn, because it has to alarm when there is a fire. So you accept false alarms, and that's the way you should see anxiety, most of it is false alarms. If you grow up in a world where there's a lot of danger, where no one is really taking care of you, if you have traumas, severe traumas in your families, then the brain thinks that I'm gonna live in a very, very dangerous world. And the sensitivity of the smoke detector rises even more, not because you are broken, but because your brain is trying to help you to survive.

A (11:48)

So the smoke alarm going off is our anxiety. Right. So we can either look at the smoke alarm and go, that's irritating. How annoying. I wish I never put it here. So ignore it. See it as a negative. Or we could reframe it and go, okay, slightly frustrating, but it's a good job that it's working. You know, I'll be a bit more careful with checking the toast, maybe putting the setting down on my toaster. Whatever it might be, you're looking at it as a positive thing. Thank God it's working. So that if ever, in the middle of the night it goes off, I know it's gonna save our lives. Is that almost how you want your patients to approach anxiety and go, thank God it's working? It's a good thing?

B (12:33)

Yeah, I think so. And when I hear patients saying things like, okay, so now I get it. A panic attack is just a false alarm that shows some functioning normally. I think of a scene in a movie called wizard of Oz, from the late 30s, I think. And in this scene, the protagonist, Dorothy, is afraid of a really powerful wizard. And in the end of this movie, the curtain where the wizard is behind is withdrawn by Dorothy's dogs. And she sees that it's just a phony. It's just a phony who's pulling levers and pushing buttons. And the same thing goes for anxiety. When you realize what it is, when you realize what kind of buttons and levers that are being pulled in your brain, it becomes less frightening. And if you go in therapy, a big part of any therapy is to sort of see yourself at a distance. And that's very, very difficult to do that. It's very difficult to take a helicopter perspective on yourself. But you could use the brain for doing that. You could say, it's just my brain who wants me to be afraid, and so on. So I think this perspective can be therapeutic. But having said all of this, we must remember that anxiety is incredibly powerful.

A (13:47)

Yeah.

B (13:48)

If we could just think, you know, trick anxiety away by thinking, think positive things or be happy or choose happiness or anything, then, you know, anxiety would not exist at all. It is extremely powerful because it's going to motivate us to take care of danger. So these are very, very, very powerful things and they will not just get easily tricked. So if you suffer from this, you should definitely seek help. There's no point at all in suffering in vain.

A (14:20)

So I think first step is you're trying to explain to us and your patients that, look, this is a normal phenomenon, okay? Doesn't mean it's easy to deal with. Yes, it can be frustrating, yes, it can have a massively negative impact on your life currently. But it's your brain doing what it's supposed to do. Right? So patients are obviously going to feel better when they hear that, oh, I'm not broken, okay? There's nothing actually properly wrong with me. Now the next step is, well, what can I do about it? Now, you said one of the goals of therapy is to try and get that helicopter view. And in the Happiness Cure, you've got a nice little section on anxiety. There's a nice little box out. Two brain tricks to combat anxiety. You talk about breathing and writing things down. I wonder if you could explain how they might help here.

B (15:11)

Right. Well, first of all, there's a part of your nervous system called the autonomic nervous system, and that is something that you can't control and that it takes care of the organs in your body, how they work and so on. And there's two parts of this autonomic system. One is called the sympathetic system, and then the parasympathetic system. And these two work at the same time. And the parasympathetic system is digestion of food, being calm, at ease. The sympathetic system is stress. That's fight or flight. And it's a balance between the system. You go from digestion to fight or flight, back to digestion and so on and so forth. And it turns out that your breathing actually affects these systems. When you inhale, you amp up the sympathetic system. So inhaling is fight or flight. Exhaling is digestion.

A (16:09)

Calm.

B (16:10)

And you could use this by breathing in for four seconds and breathing out for six seconds. It's longer than one feels normal. And by doing so, you pushes the activity in your autonomic nervous system away from fight and flight. And that is very effective. Breathe in four seconds, breathe out six seconds, repeat that a couple of times, and that's very, very efficient. And another thing that you could do is to put words on what you're experiencing and try to be a bit nuanced, not just saying, I Feel bad, but try to describe it in a job more objective way.

A (16:45)

In a journal.

B (16:46)

In a journal. Or say it out loud, or just think it, but try to try to explain it and see it from the distance, because that. That activates certain parts in your prefrontal cortex that calms your amygdala. An amygdala is a part of the brain that is very active in detecting threats and connecting to anxiety.

A (17:05)

I mean, it's really interesting, isn't it? I think many people don't realize the power of slow, intentional breathing. When your out breath is longer than your in breath, you are literally changing your biology. You're changing the signals to your brain. Right. We understand it. We've been conditioned by taking a pill. That's gonna have a big effect. But actually, I think some of us don't realize just how powerful. Finding a breathing practice that works for you. I mean, my experience has been that, you know, I've been teaching my patients for years something called the three, four, five breath, where you breathe in for three, you hold for four, and you breathe out for five. Right. Again, similar principle. But I always say to patients, listen, that's one breath. Anders is talking about the four, six breath. Andrew Wilde talks about the four, seven, eight breath. There's box breathing. Right. Find a breathing practice that works for you, that you resonate with, and could you perhaps share some patient stories whereby they had bad anxiety and actually breathing was massively useful?

B (18:11)

I've had one guy who said it was incredibly important for him. And he actually learned it from you in your books. Yeah. And he had tried a lot of things, and for him it was very important. He said this one patient case that I never will forget, and that's a guy in his 20s who came up to me at an airport, and he said that he read a book I wrote about physical activity and the brain and how physical activity reduces anxiety. And he decided to try running. And he had a very, very, very bad upbringing. He was a child soldier. So he had severe post traumatic distress. And he had tried everything and nothing had worked. And he had started drinking. So he had developed a severe alcohol problem as well. And then he started to run, and from running, his anxiety was reduced. And then he could cut down his alcohol intake. And he did not know whether it was the running or the reduced alcohol. That, in the end was the most important. But he said if I had not started to run, I could never have cut down my alcohol. And he said that he wished that I had written this book 10 years before. So exercise is incredibly important for mood regulation. And that goes back to the things that we talked earlier, that the brain doesn't create feelings based on sensory input, it creates feeling based on sensory input and the input from your body. So your body's state is incredibly important for the. When the brain creates your emotional state, and if you exercise well, then the whole of the body becomes in better shape and then the brain gets better signals and that increases the chances that it will create positive feelings instead of negative.

A (19:52)

I think there was a cycle test you referenced and how it can predict depression in a few years.

B (19:59)

Right, exactly. That was done in the uk. And if you were to cycle for six minutes as fast as you can on a cycle and then squeeze a handle as hard as you can, do you think that could say anything of your risk of being depressed from now until 2029?

A (20:19)

No, you wouldn't think so, would you?

B (20:20)

No, you wouldn't. I, I, I wouldn't. At least I would think that if I become depressed, that, that, that would be if someone would get sick in my family or if I lose my job or something. This was studied on more than 100,000 individuals. They did this cycling test. They squeezed this handle as hard as they could and they were followed for six years. And it turns out that the ones who were in good shape, they had lower prevalence. There were fewer of them who were depressed after six years. And then one thought, the researchers thought that maybe this is because they are more healthy in general, maybe they eat better, maybe they sleep more, maybe they don't smoke as much. So they excluded all of these factors in the data and it turned out that exercise was still protective. And then they thought, well, depression is not just black and white, it's sort of on a spectrum. You could be having mild depression, you could have a severe depression. But no matter where they put this cutoff of what is a depression and what isn't, exercise protected against it. So it's incredibly important that we move. We will not get immune to depressions, but we lower the risk of it. And I say to my patients who have had several depressions and who really, really want to avoid a new one, most of them want to continue having antidepressant medication because they want to be protected against the new depression. And to them, I say that the most important thing, probably even more important than continuing with medication is, is that they exercise to avoid a new depression.

A (21:46)

Yeah, it's absolutely incredible. And you've outlined so much research on exercise. I'd like to think anyone reading your books is going to be convinced if they're not already that. Exercise daily exercise daily movement, whatever you want to call it, is an absolute must. It's not really an optional extra. It's who we are.

B (22:10)

My aim with these books has been to present knowledge in a way that everyone can relate to and they have to decide for themselves, but they can make that decision on a level where they are more informed. What I really remind myself of every day, and what I remind my patients of, is that the brain is an organ and like the other organs, it has not evolved the way it did by chance. It doesn't show the world as it is. It shows the world as we had to see, the world to survive, which was often filled with danger. The brain doesn't show ourselves as we are, it shows ourselves as we had to see ourselves to survive. So the brain is not a passive middle step that you could skip if you want to understand yourself. If you want to understand yourself, even if you want to understand human nature, you should start with the brain. And this is an incredible time to live in because we have for the first time been able to look inside and see what's happening in our brain when we do certain things. And that means that we are studying the machinery of the soul. For the first time in our species history, we can do that. Some of the discoveries are actually pretty new and interesting, and one of these discoveries is how extremely important exercise is for the brain. And the ones who are to benefit the most are the ones who don't exercise at all. So it's when someone who don't do anything start walking to school or taking the bike to school, that's where the really big effects come in.

A (23:43)

Hope you enjoyed that bite sized clip. Do spread the love by sharing this episode with your friends and family. And if you want more, why not go back and listen to the original full conversation with my guest. If you enjoyed this episode, I think you will really enjoy my bike Sized Friday email. It's called the Friday five and each week I share things that I do not share on social media. It contains five short doses of positivity, articles or books that I'm reading, quotes that I'm thinking about, exciting research I've come across and so much more. I really think you're going to love it. The goal is for it to be a small yet powerful dose of feel good. To get you ready for the weekend, you can sign up for it free of charge@drchatterjee.com Friday 5 Hope you have a wonderful weekend. Make sure you have pressed subscribe and I'll be back next week with my long form conversational Wednesday and the latest episode of Bite Science next Friday.