Fighting anxiety with science

For Dr Olivia Remes, the fight with anxiety is both professional and personal. She’s a renowned mental health researcher at Cambridge whose talks have been viewed by millions around the world. But in the midst of a global pandemic, she is also having to cope with the stress of supporting her loved ones through the hardest of situations.

“My mother’s cancer recently returned for a second time,” Remes explains.

This has been a very difficult time for Remes’ mother and for the entire family. To help her family and many others to deal with such circumstances, Remes has just published The Instant Mood Fix, a book that brings together research on mental health and her personal drive to figure out the science of wellbeing.

In recent years, science has begun to explore the relationship between self-control and wellbeing, and has shown how important this relationship is for our mental health. Remes saw a need to bring this new research to a wider audience – to empower people in the fight against anxiety.

“The Instant Mood Fix is based on my experience with my mother and what I was going through, as well as people's life stories and related science. The book teaches people ways that they can cope with difficult life situations, and how they can become more optimistic, more decisive, more confident, and take charge of the lives that they want.”

Remes first arrived at Cambridge via the Institute of Public Health, where she examined the risk factors of anxiety and depression, focusing on the incidence of these conditions at a societal level. While her work still focuses on mental health – she is now looking at depression in young people – she has made the unusual transition to the Department of Engineering.

While this might seem counterintuitive, engineering approaches can actually help select and prioritise innovations in the treatment of depression, she explains. Engineering concerns itself with the design of different structures, using specialised mathematical models to test potential solutions to a given problem. By focusing on the effectiveness of mental health innovations across disparate parts of society, engineering methods can help identify interventions that prevent people becoming depressed in the first place.

Over the past few years, Remes’ pursuit of the science of wellbeing has taken her beyond academia. She’s headed seminars with hundreds of people at the University and around the world. She’s started her own radio show to have conversations with people experiencing mental health issues. And she’s spoken at mental health conferences and TED , where her talks have been viewed millions of times online.

Remes’ far-flung conversations form the basis of her book, which distils scientific findings on anxiety into practical steps for a better life. But in order to navigate anxiety, she says, we first need a map.

Recognising the signs of anxiety

“The core of anxiety is fear and restlessness,” Remes says. “An example is excessive worrying. If you worry so much that you start to have muscle tension, or if it interferes with your sleep, relationships or work – that’s when you might have an anxiety disorder.”

Separating anxious emotions from anxiety disorders can be tough. Indeed, being appropriately anxious is a good thing. If you come across a wild animal, you’re going to experience a surge of adrenaline and your heart will beat faster. Here, anxiety is normal – it protects you and helps you get out of dangerous situations. It is when anxiety starts to appear in situations that are not threatening, or interferes with your life in detrimental ways, that it can become problematic.

Anxiety can manifest in many different ways, she says. “You could feel like you’re lacking a sense of control. You could also feel indecisive. People everywhere, including students at Cambridge, struggle with procrastination, low motivation and feeling overwhelmed when they are stressed.”

Researchers look at scenarios such as these and others to inform their understanding of anxiety. By measuring someone’s mental state with questionnaires, they can begin to ask the important questions: How can we become resilient against anxiety? What do people who conquer anxiety have in common? One of Remes’ studies might just point to the answers.

A quest for coherence

When a family or community goes through a tough time, some people are able to bounce back quicker than others. Why is it that some people are able to maintain their wellbeing in adverse circumstances, while others cannot?

In a study of over 20,000 people, Remes found that a feeling of control over one’s life was a key aspect of mental health – and in her study, a feeling of control was linked to low anxiety levels in women.

“One of our studies showed that living in disadvantaged areas was linked to anxiety in women, which made sense," she says. "But when we looked deeper, we found that if women living in disadvantaged areas had a certain set of resources or traits, then they had a reduced risk of anxiety.”

In Remes’ study, these resources fall under the umbrella term, ‘sense of coherence’. People with a ‘strong sense of coherence’ tend to view the world as manageable and meaningful, and see challenges as worthy of investing effort in. Viewing the world in this way can give you a greater feeling of control.

“In our study, a strong sense of coherence was associated with reduced risk of anxiety disorder among women in disadvantaged circumstances. When we looked at other studies of people going through tough times, they seemed to reach similar conclusions. People exposed to difficult circumstances who have certain traits, ways of viewing the world or coping mechanisms may be protected from spiralling downwards.”

So how does someone develop helpful coping mechanisms? Often, the roots of these can be found in childhood: the way we were raised, our early environment, and the role models we had around us growing up. Personality traits may also play a role in our emotional states. But Remes is keen to stress that our mind-sets and the way we view the world are not set in stone – the way we cope can be changed.

“It is my firm belief that no matter the hand you’ve been dealt in life, you can take charge and really become a version of yourself that helps get you closer to the life you want.”

The thought of teaching people coping strategies, of helping people feel more in control of their lives and therefore reducing their risk of developing anxiety, was a eureka moment for Remes’ journey into the science of wellbeing. Along the way, she found scientifically-verified nuggets of advice for all to make use of.

Exercise your self-control muscle

One of the key coping strategies Remes identified was the training of self-control.

“Self-control is like a muscle,” she says. “The more you use it, the stronger it gets.”

A surprising benefit of self-control is its spill-over effects: exercising self-control to form one good habit – convincing yourself to go on a walk every day, for example – can lead to improvements in unrelated elements of your life. After you’ve walked every day for two weeks, you might find it easier to work on a pet project or cook healthier meals.

Remes highlights a study in The Instant Mood Fix that shows what happens when our self-control becomes depleted. In the study, participants were told to place their favourite alcoholic drink next to them, but they were not allowed to take a sip. Then they were asked to do a set of tasks. When participants saw the alcohol but couldn’t indulge, they used up valuable energy in self-restraint – as a consequence, they performed more poorly on the given tasks. Interestingly, in the same study, when these participants had to alternatively sniff water, they ended up doing better on the tasks. So one of the aspects coming out of this study is that practising self-control – in this case, resisting the temptation to drink – can be taxing.

This study is a neat demonstration of how self-control takes effort. To get better at longer stretches of self-control, we need to practice: just like we would when seeking to lift heavier weights, or run longer distances. Luckily for us, the modern world gives us plenty of opportunities to practice self-control.

Set boundaries

Remes advises us to set clear boundaries around potentially distracting sources of information. Take her advice on listening to the news: “Only listen to the beginning of the programme, just enough so that you get the gist and the headlines, and then turn it off before they go for the in-depth discussion.”

This might seem counterintuitive, but the balance between being informed and paralysed by a constant stream of bad news is particularly important for our wellbeing. If we can set boundaries for ourselves to reduce the amount of time we spend on social media, or listening to news reports that rehash and sensationalise negative stories, then we decrease our chances of feeling anxious. Setting time-limits on our devices could be a good way to mitigate this risk.

This boundary-setting can be applied to any habit. “Whenever you’re feeling compelled into a temptation – another mug of coffee, the need to check your phone – wait 10 minutes before you give in,” says Remes. “Doing so will often make your brain see the object of temptation as less tempting.”

To avoid temptation altogether, we should remove distractions from our environment. For example, simply moving your phone into another room, or hiding it behind your laptop, could significantly reduce the likelihood of you procrastinating.

“When we do things like this, our environment supports us. This way, we don’t have to use up all our energies to control what’s going on around us,” Remes says.

Embrace the environment

The natural world can be a powerful way of relieving anxiety. Researchers have shown that even just viewing representations of nature can have a de-stressing effect on our brains. Accordingly, changing your desktop background to one rooted in nature, or putting up posters and pieces of art that depict a natural scene, could boost your wellbeing.

To fully feel nature’s positive effects, though, Remes emphasises the importance of getting back to basics: “Go outside, collect leaves and rocks, feel the smooth texture of a leaf crinkling in your hand. It’s an important contrast to our daily lives, where everything we touch is manufactured by humans.

“For a feeling unlike any other, I’d really encourage people to walk barefoot on grass. Being grounded in this way helps you feel present. It’s a fresh feeling that can give you a reliable sense of joy.”

Give your mind some room

One day, when Remes was walking through Cambridge, she saw a flyer for a meditation class at Robinson College. Why not, she thought, and signed up for the class.

“I really thought the class was life-changing. It added another dimension to my life. From the first time I went, I didn’t miss a week until the course was over. By the end, all the stress I had been feeling had gone way.”

Recent studies have confirmed many positive effects of meditation: from lowering your blood pressure to thickening your brain (in a good way), from reducing stress to increasing our compassion. Meditation can also form a key part of coping strategies for anxiety and stress. Its emphasis on being mindful, of appreciating the present moment from a place of stillness, allows our busy minds to settle and provides clarity in our thinking.

It is very easy to feel overwhelmed by the world around us – by our relationships, our work, our financial situation, not to mention the ongoing pandemic and climate crisis – but ultimately, Remes’ book urges us to focus on what we can control, to be realistic about the changes we can make in our situation. Only then, she says, will we find a reliable source of fulfilment.

“When you're faced with uncontrollable events, all you can do is focus on the things that you can control and let everything else fall to the wayside. It turns out that when you do that, you become happier and you start to feel like you're in charge of your life.”