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Tag: Anxiety

Living with Anxiety: Turning the Mind’s What If Into a What Now

Anxiety is a universal human experience. It’s not just the 30% of people who will meet criteria for an anxiety disorder in their lifetime (Bandelow & Michaelis, 2015). It’s the friend who can’t sleep before a big meeting, the parent who mentally runs through a dozen worst-case scenarios before their child even leaves the driveway, or the student who rewrites a text message three times before pressing send.

Our brains evolved to anticipate. This remarkable ability to look ahead has kept humans alive for millennia—it’s why early hunter-gatherers carried tools before they needed them and why we pack an umbrella when the forecast calls for rain. But the same foresight that allows us to prepare can also trap us in mental simulations of disaster, living in the tension of problems that haven’t happened yet—and may never happen at all.

From Story to Narrative—and Back Again

I hear the same underlying struggles in my recent therapy sessions with patients. One worries that a partner’s habits might shape their child’s future in harmful ways. Another lay awake imagining a tragic bike accident before their child even left the house.

Both situations were rooted in what I call the difference between story and narrative:

  • The story is what is actually happening right now.
  • The narrative is the version of events our mind constructs, often based on fear, assumption, or incomplete information.

When we mistake the narrative for the story, we start responding emotionally to a movie in our head rather than the facts in front of us. That’s where anxiety thrives.

What Science Says About Why We Worry

Modern research tells us anxiety is shaped by multiple forces—biological, cognitive, and environmental.

  • Trait vs. state anxiety (Spielberger, 1983) explains why some people tend to feel anxious across many situations, while others experience it only under specific stressors.
  • Reinforcement sensitivity theory (Gray & McNaughton, 2000) describes how an overactive “behavioral inhibition system” makes us extra alert to potential threats.
  • The tripartite model (Clark & Watson, 1991) helps explain why anxiety often overlaps with depression, highlighting shared features like negative mood and unique features like physiological arousal.
  • Recent neuroscience adds another layer: stress can actually alter gene expression through epigenetic mechanisms, potentially making us more sensitive to anxiety triggers over time (Zannas & West, 2014).

What these theories have in common is the recognition that anxiety isn’t just “in your head”—it’s a complex interaction between brain, body, and lived experience.

Worrying vs. Planning: A Crucial Distinction

Here’s the important part: worrying is never a requirement for effective action.

  • Worrying is imagining the future as if it’s already gone wrong, then reacting to that imagined outcome.
  • Planning is choosing an action in the present, without demanding that the future turn out a certain way.

Both are future-oriented, but only planning moves you forward. Worry burns energy; planning invests it.

What Works: From Therapy Room to Daily Life

In those sessions, the shift came from turning worry into intention. The process looked like this:

  1. Catch it early — Recognize, “This is worry.” Naming it interrupts the spiral.
  2. Anchor in the present — Ask, “What needs my attention right now?”
  3. Plan without prediction — Choose one next step without adding “and it must work out this way.”
  4. Use external supports — Reminders, notes, or scheduled check-ins to keep you aligned with action rather than rumination.
  5. Reframe the narrative — Replace “This will go badly” with “I’ll handle whatever comes.”

These strategies echo what research shows works best for anxiety: cognitive-behavioral methods to challenge distorted thoughts (Beck & Clark, 1997), mindfulness to stay in the present (Hofmann et al., 2010), and acceptance-based approaches that allow worry to exist without letting it steer the wheel (Hayes et al., 2006).

Try This Today

If you find yourself caught in “what if” thinking:

  • Pause and label it: “This is a narrative, not the story.”
  • Shift to a “what now” mindset: “What’s the smallest action I can take in the next 10 minutes?”
  • Ground yourself in sensory details—the sound of a kettle, the texture of your desk, the feel of your feet on the floor.
  • Close the loop by acting on your plan, no matter how small.

Final Thought

The challenge is not to silence our worries completely but to respond skillfully, using it as a prompt to plan instead of a trap and a downward spiral. When we can move from “what if” to “what now,” we reclaim the energy that worry steals and put it toward a present moment that we actually want to live in.

Read more from Rizaldy R. Ferrer, Ph.D.


References

Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.

Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49–58.

Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression. Journal of Abnormal Psychology, 100(3), 316–336.

Gray, J. A., & McNaughton, N. (2000). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford University Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2006). Acceptance and Commitment Therapy: An experiential approach to behavior change. Guilford Press.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press.

Zannas, A. S., & West, A. E. (2014). Epigenetics and the regulation of stress vulnerability and resilience. Neuroscience, 264, 157–170.

The Neuroscience of Overthinking and Decision Paralysis

Overthinking and decision paralysis happen when certain parts of the brain become too active, especially the prefrontal cortex, amygdala, and basal ganglia. The prefrontal cortex helps with thinking and decision-making, but when there are too many choices, it gets overwhelmed, making decisions harder. The amygdala, which controls emotions, becomes too active under stress, making people feel anxious and unsure. Scientists found that people who overthink have extra activity in the dorsolateral prefrontal cortex (DLPFC), which helps with memory and planning (Gillett & Glannon, 2023). This overactivity creates a loop—more stress leads to more overthinking, making choices even more difficult.

Another part of the brain, the basal ganglia, helps with habits and making choices. If it doesn’t work properly, people struggle to take action (Brahmacari, 2018). The anterior cingulate cortex, which helps solve conflicts and spot mistakes, can become overactive, making people second-guess their decisions (Chachane & Jagtap, 2024). But there is good news—scientists say the brain can change and adapt. Mindfulness, neurofeedback, and simple mental exercises can help people break free from overthinking (Capanna-Hodge, 2024).

Ways to Stop Overthinking and Make Decisions Faster

  1. Use the “5-Second Rule” – If you feel stuck, count 5-4-3-2-1 and make a small move toward a decision. This helps stop hesitation.
  2. Set a Time Limit – Give yourself a set time to decide (e.g., “I will choose in 10 minutes”). This prevents endless thinking.
  3. Limit Choices – Too many options create stress. Narrow choices to two or three for easier decisions.
  4. Use Pros and Cons, Then Trust Your Gut – Write a simple list, but also listen to how you feel about the choice.
  5. Take Action Quickly – Even a small step in one direction helps break decision paralysis. Action builds confidence.
  6. Try Deep Breathing or Mindfulness – Breathing slowly calms the amygdala, reducing anxiety and helping clear your mind.
  7. Ask: “Will this matter in 5 years?” – This helps you see if a decision is really important or just feels urgent.
  8. Accept That No Choice is Perfect – Every decision has risks, but moving forward is better than staying stuck.

These simple strategies help the brain stay balanced, reduce stress, and make decisions with more confidence.

References

Brahmacari, D. (2018). Navigating the shadows of society modern woes: Insights and solutions. SSRN. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4808110

Capanna-Hodge, R. (2024). Neurofeedback for OCD: Overcoming compulsiveness. Retrieved from https://drroseann.com/neurofeedback-for-ocd/

Chachane, L., & Jagtap, S. (2024). Assisting overthinkers to reframe cognitive processes. Journal of Engineering. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=23492473&AN=177982964

Gillett, G., & Glannon, W. (2023). Neurodynamics and adaptive behaviour. Springer. Retrieved from https://link.springer.com/chapter/10.1007/978-3-031-44951-2_2

Creating vs. Fixing

When faced with life challenges, many of us default to “fixing” the difficulties because we assume that they are “broken,” rather than just are inevitable parts of life. Fixing may be an attempt to control every possible outcome in hopes of avoiding discomfort. While this may feel productive, it often fuels anxiety and distances us from the present moment. In contrast, the philosophy of “Creating vs. Fixing” encourages us to shift our focus to proactive, intentional actions that promote well-being in the now. Drawing on mindfulness, cognitive-behavioral practices, and existential psychology, this approach teaches us to live fully in the present while navigating life’s challenges. Let’s explore this transformative mindset through the lens of a therapy session between Cathy and I, a patient preparing for childbirth.

Cathy: I’d like to get some help with my pending childbirth and the fears I have about it. That’s at the top of my mind right now. I’ve mentioned to you before that childbirth has always been something I feared most of my life. And now, any day now, it’s happening. I’m already emotional about it. I’ve been trying not to dwell on it or think too much about it because it genuinely frightens me. I just want to ease that fear because it’s going to happen. If I go into it feeling afraid, I think it will make the experience worse. I want to own as much of the experience as possible because I believe it can be beautiful. But there are so many decisions and unknowns—it’s overwhelming.

Cathy proceeded with how she had been planning about her childbirth.

Dr. Ferrer: You seem to be overanalyzing your childbirth preparation—whether to drink the tea, do yoga stretches, eat the dates or even to determine how much epidural injections should you get. But all those are still making you anxious because you want a guarantee that they will make the process easier and also eliminate the fear you are experiencing recently. What if we shifted the focus from ensuring future success to asking, “What can I create right now that benefits me?”

Cathy: I feel stuck. I keep thinking, if I do all these things and they don’t make childbirth easier, what’s the point of even doing them? It feels like I’m setting myself up for disappointment even more.

Dr. Ferrer: That’s the mindset of “fixing”—doing something now purely to control a future outcome. Instead, let’s ask, “Does this action improve how I feel or function in this moment?” If drinking tea or stretching is better than worrying, then it’s worthwhile, regardless of what happens later.


Understanding the Problem: Fixing the Uncontrollable

The tendency to “fix” is natural. Fixing involves trying to solve or prevent future problems through meticulous analysis and planning. While this approach can be effective for practical tasks, it becomes problematic when applied to situations outside our control. Cathy’s fixation on childbirth preparation, for instance, stems from a desire to control an inherently unpredictable process. This overanalysis not only increases her anxiety but also consumes mental energy that could be used to enhance her current well-being.

The issue with fixing lies in its transactional nature—it’s tied to a specific desired outcome. If the outcome doesn’t align with expectations, the effort feels wasted. This mindset often leads to a cycle of disappointment, self-doubt, and paralysis.

The Alternative: Creating in the Present

In contrast, the argument of “creating” focuses on intentional actions that enhance the present moment, independent of future outcomes. By shifting her focus from controlling childbirth to engaging in meaningful activities, Cathy can redirect her energy toward actions that bring immediate value. Whether it’s deep cleaning her coffee maker, practicing gratitude meditation, or savoring her morning coffee, these acts of creation foster a sense of accomplishment and presence.

Creating isn’t just about productivity; it’s about cultivating a mindset of mindfulness and generativity. For Cathy, stretching or walking doesn’t have to guarantee an easier labor—it’s enough that these activities help her feel grounded and healthy now.

Why Creating Works: A Theoretical Perspective

  1. Mindfulness Theory (Kabat-Zinn, 1990): Creating aligns with mindfulness by anchoring individuals in the present. Mindful actions like gratitude meditations or sensory awareness reduce mental clutter and help individuals step out of anxiety cycles.
  2. Flow Theory (Csikszentmihalyi, 1990): By engaging in meaningful tasks, individuals enter a “flow state,” characterized by deep focus and enjoyment. Cleaning, walking, or stretching can be flow-inducing, helping Cathy feel accomplished and calm.
  3. Cognitive Behavioral Therapy (Beck, 1976): Fixing often reflects cognitive distortions like catastrophizing or fortune telling. Creating, on the other hand, aligns with CBT principles by emphasizing actionable, positive behaviors that counter negative thought spirals.
  4. Existential Psychology (Frankl, 1946): Creating connects to the existential idea that meaning arises from proactive engagement with life’s challenges. By focusing on what she can create, Cathy finds purpose in the journey, not just the outcome.

Practical Steps to Shift from Fixing to Creating

To adopt the mindset of creating, consider these practical steps:

  1. Ask, “What can I do now?” Instead of worrying about outcomes, focus on actions that enhance your present.
  2. Engage your senses. Activities like smelling coffee beans or feeling the texture of your sheets can ground you in the moment.
  3. Practice gratitude. Start your day by identifying things you’re thankful for, then immerse yourself in those thoughts.
  4. Create daily intentions. Set achievable, well-being-promoting goals for the day, such as taking a walk or meditating.

A Transformative Perspective

By embracing the philosophy of “Creating vs. Fixing,” Cathy—and anyone grappling with uncertainty—may hopefully reduce anxiety, increase self-efficacy, and find joy in the process of living. This principle doesn’t negate the value of preparation but reframes it as a means to cultivate presence and intention. Life is unpredictable, but our ability to create meaning in the moment is always within our control.

Read more from Rizaldy R. Ferrer, Ph.D.


References:

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. Harper & Row.

Frankl, V. E. (1984). Man’s search for meaning (Rev. ed.). Washington Square Press. (Original work published 1946)

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press.


Disclaimer: The information provided in this newsletter is not intended to be a substitute for professional medical or mental health advice. If you are experiencing any mental health issues, please seek professional help. The author of this blog is not liable for any damages or injuries that may result from the use of the information provided here.

When applicable, the names, gender identification, location and/or other identifiable characteristics have been modified to maintain privacy and confidentiality; whilst, still maintaining the integrity of their stories and narratives.

What is Serotonin and How is it Related to Our Mental Health?

Serotonin, or 5-hydroxytryptamine (5-HT), is a neurotransmitter—a chemical messenger that helps transmit signals in the brain and throughout the nervous system. It is primarily known for its role in regulating mood, but it also influences sleep, appetite, digestion, memory, and even social behavior. The majority of the body’s serotonin, about 90%, is produced in the gut, while the rest is synthesized in the brain. Once released, serotonin interacts with specific receptors to produce various effects, depending on where it acts in the body or brain. This neurotransmitter has a complex role, and its levels and functionality are influenced by genetics, diet, stress, and physical health (Berger et al., 2009).

In terms of mental health, serotonin is widely associated with conditions like depression and anxiety. Low serotonin levels are thought to contribute to mood disorders, which is why many antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), are designed to increase serotonin activity in the brain. SSRIs work by preventing serotonin from being reabsorbed into neurons, thereby allowing it to remain in the synaptic gap longer and enhance communication between nerve cells. However, while serotonin plays a significant role, mental health conditions are typically influenced by a combination of genetic, environmental, and psychological factors. Recent research has even questioned the simplistic “low serotonin equals depression” theory, suggesting that the relationship between serotonin and mental health is more complex than once believed (Moncrieff et al., 2022).

Understanding serotonin’s impact on mental health highlights the importance of a holistic approach to treatment. This includes addressing physical health, stress management, and other factors that influence neurotransmitter function. While serotonin is not the sole factor driving mental health, its role in mood regulation and emotional stability makes it a critical area of study for understanding and treating conditions like depression and anxiety.

References:

Berger, M., Gray, J. A., & Roth, B. L. (2009). The expanded biology of serotonin. Annual Review of Medicine, 60(1), 355-366.

Moncrieff, J., Cooper, R. E., Stockmann, T., et al. (2022). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 27, 2404–2414. https://doi.org/10.1038/s41380-022-01661-0

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