When you are afraid, you start going into fight or flight mode. Your body starts prioritising what is needed for immediate survival - screw routine body functions, if you don't make it past the next few moments there won't be a routine to return to. You stop digesting food. Cell repair slows or stops. You stop producing saliva, which is why your mouth goes dry when you're nervous just before making a speech or going into a difficult conversation. Your heart rate and breathing increase to ensure better blood flow. A cocktail of hormones like epinephrine and oxytocin are cued up and produced, which amplifies your body's ability to act (and remarkably, in the case of oxytocin, reminds you to seek help).
Don't be mistaken about what happens when you feel fear. Your body is readying itself to help you face what you fear in the way it knows how.
What causes us to feel fear?
1) Fear occurs to us unconsciously. Do you pause to think, hey, very angry looking snake! Maybe I should be scared. Of course not, it would be too late! Fear becomes much clearer when we examine what happens inside your brain. When you are afraid, the fear/anger/aggression/anxiety centre of your brain - the amygdalas (get used to this name, it's gonna keep popping up) lights up. And we've covered all the changes that happen in your body: your blood pressure, your hormones, your heart-rate. But remember how amygdala is like a train interchange with direct routes to different parts of your brain? There is a direct neural link between our amygdala and your pre-frontal cortex, the rational thinking part of your brain. And if we look closely enough or we think things through, sometimes we realise, argh! it's not an angry snake, it's just a prank toy that your annoying friend had thrown at you. Or if you've handled angry snakes enough times, your amygdala does not light as much. Your blood pressure and your heart rate do not increase as much, you realise what you need to do is to stay calm and slowly back away.
Finally, notice how fear, anger, aggression, and anxiety are processed by the same part of the brain, the amygdala. This is no coincidence. These 4 emotions are closely tied to one another; aggression maybe triggered because one is nervous, angry, or fearful. Being fearful may cause one to react angrily, as a self-defense mechanism. Fear, like all our emotions, happens to us. Mostly, we can't control how it originates. But we can control how it develops by understanding what exactly is causing fear and by choosing the response that dispels it
2) We fear what we are unconfident or uncertain about. Think back on your ancestors doing something they weren't confident or certain off - hunting a massive animal without a weapon, or eating a berry they've never seen before. Doing so would mean a very high chance of seriously harming themselves. Today, after many cycles of evolution, we have been wired based on these experiences.
Think about it. Are you ever fearful of something you've done before, and are good? Brushing your teeth, putting on your clothes, indulging in your favourite hobby (whatever it is)? Of course not. You know you can perform these functions easily. You are confident.
But many of us would have felt fearful and anxious the first time we ventured into something new: using a pair of chopsticks, riding a bicycle, swimming, going on a first date. We were uncertain about these functions, and we were not confident about performing them. However, once we have demonstrated to ourselves that we are able to perform these tasks, we are no longer afraid. The same applies to more challenging tasks. Some of us struggle with: public speaking, starting a business, having a very difficult conversation with the CEO... You are uncertain and unconfident if you can succeed. But once you have proven to yourself you are able to do it, even for the more challenging tasks, you are no longer afraid. People might start off feeling scared about public speaking, but after speech 3797, you're pro The catch, of course, is that sometimes, we are too scared to start.
Even if we were certain of something OR confident about something, many of us will still feel some amount of fear. We might be theoretically certain how we should use a pair of chopsticks, but if we have never succeeded in using them properly, we remain unconfident and will still feel nervous if we had to use them, especially when others are observing. You might also be confident about
3) we fear what is painful. Boxer. climbing 100 flights of stairs or doing 100 burpees. But pain is not just physical but mental. Failure is painful. Being judged is painful.
This is why you procrastinate. You either fear what you have to do bevause you don't know how to do it (you don't fear brushing your teeth for example), or you fear doing something becaue you know it will be effortful
4) we fear what we cannot control
Learn more about your amygdala, the amygdala hijack, the thalamus, the pre-frontal cortex, and how your brain works here.
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Summary:
- Fear and anxiety (and anger + aggression) are always
Forget about health, I take medicine because of the lottery
What could be more important than... our lives?
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Yet, amazingly we often see examples of people putting themselves in danger:
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We have doctors who are morbidly obese
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People who do not wear seat belts despite cars being installed with reminder beepers
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And most recently, even with more than 15 million infected and close to 625 thousand casualties due to Covid-19, people still reject keep safe distancing and wearing masks, even if it is meant to save their lives. Read more about this here.
In addressing such issues, our normal response is to tell people what the right thing to do is. But this is clearly not an effective strategy. Do people really not know that putting on a seatbelt or not eating too much is bad for them? We know what the right thing to do is. We just can't bring ourselves to do it.
So, changing the behaviour of people has to extend beyond giving them information. Instead, we have to explore creative and sometimes counter-intuitive solutions that get people to do what they otherwise wouldn't.
These could mean reducing the friction of taking action (for example, just pressing one button, or free delivery, or automation where you only need to decide once) or increasing the attractiveness of doing something (for example, putting in incentives or coupling the action that needs to be taken with another action that people enjoy).
And one area where a large amount of creativity has been generated is how we can get people to take their medication on time.
Yes. Even though life is precious, and medication saves lives,
people still need to be convinced to take it on time.
Psychologists have worked with medical teams to design all sorts of interventions - rewards, fines, reminders, notifying loved ones that you have not taken your meds.. everything you can think of.
2 of the most prominent psychologists in this area - Kevin Volpp and George Lowenstein - went one step further. They were working with patients who had previously suffered from a stroke. These patients had to take a medication - warfarin - on a strict schedule.
Volpp and Lowenstein conducted two pilot studies to try and improve warfarin adherence.. with the introduction of.... a lottery.
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Patients were given their pills in an automated pill-box, which enters their name into a lottery if it is opened at the right time each day.
Did this work?
In the first pilot, the adherence rate of taking the pills went up from 65% to 87.8%. Btw, it's also worth noting that once the lottery experiment ended, adherence rates fell to 58% (lower than original) - we will come back to this point later. On top of this, the number of incorrect pills taken, traditionally at about 22% dropped to just 2.3%.
In the second pilot, the results were replicated. Adherence rates of the second group went up from just 35% to 59.6%. The proportion of incorrect pills taken fell to just 1.6%. You can read the full paper here.
Why does this happen? Why do we need rewards to save our own lives? And why do lotteries work so well?
The answers come in 2 particular features of our brains:
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We value the short term over the long term.
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A simple and classic example: say you have a craving for chocolate. And someone offers you: would you like half a bar of chocolate now or 1 bar of chocolate in one week's time? Or substitute chocolate for any other reward. What comes immediately feels more valuable.
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In much the same way, health is long term. We don't become unhealthy overnight. Even for stroke patients, a relapse is very unlikely just because the patient misses one or two days of medication. Conversely, good health is difficult to observe, if at all. We don't feel the value of good health because we have made a correct decision today to take our medication on time.
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There is actually neurobiological wiring behind this. Our brain's reward system does support short-term pleasure more. If you're interested, you can check out our page on dopamine (dopamine - which is often misrepresented by psychologists and thought leaders in popular media)
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We try to avoid pain because, in the past, it has a higher chance of causing us harm.​
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Again, it's not difficult to identify examples of this in real life:
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Diet starts tomorrow!
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I really want to work out but I'm just really tired today; I promise to make up for it tomorrow
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I'll have that difficult conversation with this other person tomorrow. I can't do it today
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For much of human existence, anything painful usually means danger. Think about your ancestors in the past - pain from a plant, an animal, a fall, a fight, a climb - could all easily lead to their demise. Over many cycles of evolution, our brains became wired to avoid pain to ensure our survival. Today, the nature of pain has shifted considerably away from physical to mental pain - very few things threaten our survival these days, but the wiring of our brains has already been set, as seen in the examples above. If you're interested, you can check out our chapter on pain here.
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Taking medication contains elements of pain. At a simpler level, it is the pain of inconvenience, of constantly having to worry about taking medication on time; at a deeper level, it is the pain of being reminded you are not well, and you need this schedule of drugs to keep you ticking.
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This is where the lottery system comes in. It provides an immediate reward (and if you read the chapter on dopamine, it provides an uncertain reward, which is even more effective). And this reward causes us to forget the pain patients might experience otherwise.
A similar and fascinating example happened with a group of Hepatitis C patients, who had to take mediation which caused considerable discomfort, but which would save their lives. Only 1 patient managed to finish his course of medication, and he did so by introducing his own reward on the days he had to inject himself. Read more here.
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