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
What affects the doctor' prescription?
The world of commercial medicine is fascinating, in that it is really simple and complicated at the same time. I'll write a little more about this in the future, but for now, let's take a look at this example.
For many common ailments, generic (i.e. no brand medications) are no different from branded medication. Think about a normal and a branded T-shirt - in most cases really not much difference besides the brand. Doctors, of course, are aware of this.
However, researchers at the Perelman School of Medicine at the University of Pennsylvania noticed that the doctors at the UPenn health system tend to prescribe branded drugs instead of generic drugs (to be clear, there is no financial incentive for them to peddle more expensive drugs - these doctors do not get a cut from sales). This meant greater costs for both patient and the health care system, and studies actually show that branded drugs have a lower rate of adherence (it's expensive, so people tend to default).
In other words, there is no benefit for branded drugs to be prescribed when generic drugs were just as good and cheaper*. The researchers wanted to change such behaviour, and so they thought about the default system that was so useful in changing behaviour for organ donation.
Organ donation rates upon death for many countries was barely in double-digits when the default was not to donate (i.e. you had to specifically indicate that you wanted to opt-in to donate your organs). When the default was changed to donate (i.e. your organs will be donated upon death unless you specifically indicated you wanted to opt-out), the donation rates were in the high 90%.
One argument against this though (terribly bad one but the world is full of bad arguments) is that people aren't experts on organ donation. They don't know if they should donate their organs upon death or not, because it's not a question people think about. So they simply follow the default option.
But will the default option be as effective for experts - the doctors? What do you think? if we try out the effectiveness of the default option on experts?
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*(In a blog post, I supported the theory that just branding and making the same medication more expensive leads to a placebo effect where people actually felt it was more effective. In this case, there is no placebo effect because patients have nothing to compare to - they don't know the prices of drugs other than what they were prescribed)
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Image Credit: David Asch, "Why it's so hard to make healthy decisions", TedMED 2018
The default option was introduced in mid-November, where doctors defaulted all prescriptions to an equivalent generic, if available. If they wanted to prescribe a brand name, physicians had to opt-out by checking a box labelled "dispense as written."
And was it effective? Look at the graph above (click to magnify). Every line on the graph represents a type of drug choice. Before the default, the generic drug was chosen between 20% to 100% of the time, an average of about 75%. With a simple change to the default option being the prescription of generic drugs - the rate rose to 98% across all drugs.
This study, like many others shared on this page, affirms how our decisions can be changed even though the decision factors remain exactly the same, merely with simple modifications to how the options are presented. This happens without us really realising it. For example, even though the doctors were now prescribing almost exclusively generic drugs, they would formulate a logical reason to explain their decision, perhaps that generic drugs were just as good. But we know for a fact that this explanation is falsely manufactured - if they truly believed as such, why did they do so only after we changed the way choice was presented using the default option?
As humans, we are not rational, we have innate inclinations and biases which most of the time we are not even aware of. This is not news. We all know this. But because we are irrational in predictable ways, we can leverage on our biases to instead guide ourselves to making better decisions.
Read the full paper here.
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