Physiology First: A New and Necessary Approach to Stress and Anxiety Education

By David J Bidler

(David J Bidler presenting the science of stress and anxiety management at a professional development training for teachers in Hoboken, New Jersey.)

Imagine this…

A new line of autonomous cars is released into the marketplace. They are running smoothly-at first.

Suddenly, several models experience a glitch.

Before long, over a quarter of these A.I powered automobiles are experiencing the same technical problem.

Engineers are dispatched onto the scene. They walk around the vehicles, kick the tires a few times, and visually scan every inch of surface area.

Unfortunately-no one knows how to pop open the hood.

A cursory glimpse into the compartment which contains the motor might reveal a number of obvious causes for the disruption.

Perhaps there’s a squirrel in there…

Going a step further and examining the computer that runs the software that directs the vehicle would produce infinitely more data than we retrieved from kicking the tires and giving the vehicle a good old-fashioned “once over.”

Complex machines require complex analysis.

Any diagnosis lacking the requisite information to accurately trace the symptoms of the glitch to its most likely source must be updated the moment that we gain new insights into its underlying mechanisms.

When it comes to understanding our mental health, we’ve been kicking the proverbial tires for centuries.

It’s time to look under the hood.

It’s time to examine the motherboard.

It’s time to apply new methods to solve old problems.

Nearly a quarter of the youth in the United States have a been diagnosed with a “mental health disorder.”

20% of U.S adults (47.6 million people) experienced mental illness prior to the COVID-19 pandemic-and these numbers have shot up to new heights in the past six months.

We are facing an unprecedented mental health epidemic with no clear definition of the term “mental health” and no mental health education program in place.

When a quarter of the populace is suddenly experiencing an ambiguous series of disorders with no clear diagnostic parameters we must take a deeper look at the diagnostic process itself.

When we do this the following becomes clear-we desperately need to take a new approach to stress and anxiety education

We Are Not Self Driving Cars. We Are Far More Complex.

Photo by Michael Dziedzic on Unsplash

The inspiration behind many of the greatest technologies produced by Silicon Valley is the mother of all operating systems-the human brain and nervous system. Our perception of the world around us is the result of more than 84 billion neurons communicating with over 7 trillion nerves through a sensory network so complex that is puts self driving cars to shame.

We are so complex that attempting to understanding ourselves is one of the greatest challenges that each of us will experience in our lifetimes.

Herein lies the problem with an observational approach to mental health in which one human being attempts to understand another with limited data.

When a clinician asks a person who is experiencing chronic stress, anxiety, or depression to explain their internal experience they are asking them to describe the expression of an extremely nuanced and interconnected set of physiological processes that are taking place “underneath the hood” of conscious awareness.

The common response is a familiar emotional descriptor such as “I just feel anxious and I can’t shake it.”

Through a decade of working with students, educational administrators, workplace leaders, and athletes I can confidently sat the following answer is less common.

“I’m experiencing the inevitable result of exhaustion, too much caffeine, a week of missed gym sessions, and an ongoing breathing pattern disorder that leads to chronic hyperventilation.”

If we were to pull some basic data from a fitness tracker, or simply perform a baseline physiological assessment, we would find that this answer is often far more accurate-and far more actionable than “I feel anxious.”

(The author (L) and pioneering neuroscientist, Dr. Jose Herrero. (R) Dr. Herrero studies the effect of breathing on the brain through his work with epileptic patients in New York City.)

Prior to recent breakthroughs in neuroscience, clinicians were reliant on “kicking the tire” and taking their best guess at what a person is experiencing through the limited lens of psychology, with no insight into the underlying physiology which drives all of human behavior.

Fortunately, we can now assess physiology.

What’s even better is that we can do this first.

When we fail to assess the physiological prerequisites that make mental well-being possible, we risk locking ourselves out of the solution to one of our most important problems-the declining mental health of our nation.

We are currently in the midst of a mental health epidemic. We are also entering a new era in which the language used to describe a particular mental state is being drawn out of the shadows, and into the light of science.

This has the potential to lead us to a self-directed plan of action aimed at creating the foundational grounds for optimal mental health.

Mental Health by the Numbers: An incomplete picture of a fast growing crisis.

1 in 5 U.S. adults experience mental illness each year

1 in 25 U.S. adults experience serious mental illness each year

1 in 6 U.S. youth aged 6–17 experience a mental health disorder each year

50% of all lifetime mental illness begins by age 14, and 75% by age 24

Suicide is the 2nd leading cause of death among people aged 10–35

These statistics reflect both the size and scope of the problem.

They also reflect the ambiguity that results from a diagnostic process which emerged in an era lacking the necessary data to accurately diagnose the source of a patient’s symptoms.

We don’t leave a hospital with a diagnosis of “stomach illness.” We have gastroenterologists who specialize in diseases affecting the gastrointestinal tract who can provide insight into what, exactly, is causing our pain or discomfort and propose an action plan to address it.

We would not be satisfied to find out that our low back pain is the result of “low back disorder.” We have digital imaging technology capable of ruling out disk herniations, detecting abnormalities of the vertebrae and spinal cord, and checking for tumors that may need to be removed.

We have made some incredible process in understanding the heart, the kidneys, the lungs, and the liver-yet, when it comes to the one organ with the capacity for self directed change and the responsibility for regulating the function of all others we are operating dangerously in the dark.

The diagnostic process itself desperately needs an update if we are going to solve the epidemic currently described as “mental illness.”

If our work at Physiology First is successful many manifestations of psychological distress will be separated in the categories of autonomic dysfunction, purely psychological phenomena, or underlying neurological abnormalities-described in specific terms-that would suggest an illness or disorder related to the human brain. (People suffering from schizophrenia, for example, have up to 25% less volume of grey matter in their brains, specifically in the temporal and frontal lobe. These regions are know to be important to coordination, cognitions, and judgement. When someone experiences anxiety there is heightened activity of the amygdala, the brain region responsible for threat assessment, yet there is no abnormality in the structure of the brain. The amygdala is doing exactly what it was designed to do, and it is performing this task exceptionally well.)

The New Science of Stress and Anxiety

Of the four key terms that we are dealing with in this section-stress, anxiety, mind, and brain-only one has a common definition that most people could point to if put on the spot.

I know this from experience, as I’ve polled countless people during our presentations over the years.

What is stress?

What is anxiety?

What is depression?

What is the mind?

What is the brain?

I’ve asked this question in presentations to schools, companies, and teams and it is only the last item on the list-the 3 pound supercomputer in our skulls-that is even attempted in most instances.

Although “stress” may be used as a catch-all term culturally it has several working definitions that can be helpful in tracing the experience of chronic stress back to tangible, physiological processes as well as actionable steps that an individual can take to reduce, or increase, her or his stress response.

“Stress is the non-specific response of the body to any demand for change.” Hans Selye, 1936

More than 90 years after Selye’s definition which lacked the advantage of modern medical technology we could likely add the following without objection from the famed endocrinologist: Stress is the response of the body to any demand for change as characterized by an increase in glucocorticoid levels within the body.

A demanding workout is an example of applying a deliberate stress to the body in order to self initiate a physiological adaptation.

An email delivering bad news unexpectedly is an example of an unexpected stress.

A dissatisfying job in which you are under appreciated and mistreated can be a source of chronic stress.

In all three cases glucocorticoids (a class of “stress hormones” such as cortisol and epinephrine) are released from the hypothalamus, a small region located at the base of the brain.

Suddenly, we have two tangible things to examine.

1.) The hypothalamus.

2.) The class of stress hormones knows collectively as glucocorticoids.

Whether the hypothalamus is functioning properly is a question that can be answered through the lens of neuroscience.

Whether the particular stress hormones being released are appropriate for the environment that unconsciously promoted their cascade from the adrenal glands into the bloodstream is a question that we can answer for ourselves.

Cortisol, for example, is a welcome addition to the bloodstream from a performance perspective. However, it is an unwanted long term guest, especially when prompted by an environment in which you spend 40+ hours per week.

A surge of cortisol is ideal as you head into the gym for a challenging training session. It is not ideal as lie under the covers trying to get to sleep after a taxing day.

Anxiety, another commonly used but seldom defined term, can be described as a state of heightened arousal initiated by the sympathetic branch of the autonomic nervous system. When this stare of arousal feels desirable we call it excitement. When it feels undesirable we tend to refer to it as anxiety. Yet, both responses run through the same physiological channels. The major difference is in our perception of the experience.

This branch of your nervous system responds to threat and over-stimulation similarly-by preparing your body for action.

This leads to increases in respiration rate, heart rate, skin temperature, and a dilation of the pupils. It causes a heightened ability to focus (narrowing of attention) along with a reduced ability to concentrate (depth of attention.)

Creating a state of hyper vigilance in order to respond to a threat of danger is one of evolutionary biology’s simplest and most important moves.

Much like the object-sensing technology in our autonomous car-your nervous system is objectively scanning for danger and preparing us to avoid collisions whenever possible.

The natural physiological responses listed above mirror the symptoms described by those diagnosed with “anxiety disorders.”

When this is described as autonomic dysfunction we have the mechanisms of the nervous system to study and attempt to understand.

When it is described as “mental illness” we have nearly impossible to define or quantify “mind” to attempt to decode.

If we begin with what we can objectively study and attempt to understand we may gain new insights into the human mind. We may initiate a new approach to helping those who suffer from chronic stress or anxiety achieve physiological resonance and access desired their mental states through the process.

As anxiety rates climb in the face of technological advancements that undeniably shift nervous system time towards the sympathetic we must ask one of the important questions in mental health:

What if Anxiety Isn’t A Disorder?

“Autonomic dysfunction is the clinical condition for people who have trouble managing stress. In people with anxiety disorders the sympathetic nervous system is stuck. Originally, it was thought that if we just brought down the sympathetic nervous system we could relax. However, what we learned in the past twenty years is that it’s actually the braking system (parasympathetic) that you want to train in order to bring you back to homeostasis.”

-Dr. Leah Lagos

To understand whether anxiety, for example, is a disorder or a perfectly natural response to a given environment we must examine the evolutionary role of increased sympathetic nervous system tone, or, anxiety.

Anxiety is not a punishment, it is a prompt for action.

Our brain is preparing our body for a highly focused task which may have including fighting, fleeing, competing, mating, or any other environment in which sleepy and relaxed is a suboptimal state.

We must also examine both the objective and subjective nature of a given environment,

To obtain the greatest clarity we need to begin from the perspective of the human brain and nervous system within the context of both the internal and external environment that a person inhabits.

A classroom, for example, may seem perfectly safe to an outside observer.

Yet, without understanding the internal environment of a student (glucocorticoid levels, neurotransmitter activity, hormone levels, nutrient deficiency, breathing pattern disorders, sleep quality) it is impossible to assess whether the student should feel at ease in her or his body and whether a sense of anxiety is or isn’t an obvious prompt for action.

A disorder is only a disorder if it is in contrast to a natural physiological mechanism operating as it was designed to. This is the very definition of the term “disorder.”

The brain and nervous system prompting changes that increase the health and resilience of the body is far from a disorder. Labeling this natural, evolutionary mechanism as a mental health disorder or “mental illness” without a thorough assessment of a person’s physiological state may result in the prescription of drugs which have been shown to down regulate the brain regions responsible for self regulation, leading to an inevitable dependence on these drugs in order to calm down.

This article from Yale University explains how medications used to treat anxiety have the potential to create an epidemic of addiction.

For arguments sake, let’s that the student feeling anxious in their classroom was in a state of physiological resonance. Imagine that their sleep quality, nutrition, exercise levels, and breathing rate and volume were all optimal. We then have to examine the internal environment from a focal standpoint. Every one of us has taken shelter in the safety of our bedroom while simultaneously inhabiting a digital world of social media comments, direct messages, emails, and never ending advertisements.

This world may be “safe” but it’s certainly stimulating from a visual and auditory perspective.

A certain level of digital stimulation creates an inevitable shift in our nervous system signaling increased sympathetic tone.

If you are living in America in the 21st century you have undoubtedly experienced the subtle, yet powerful, impact of highly sophisticated technologies on a comparatively primitive mammalian brain and nervous system.

Technological exposure has a significant impact on the functioning of the brain, and, as a result, the body.

The chemical messenger dopamine, for example, is commonly described as the pleasure chemical. It is one of the prime drivers of human behavior-and it is extremely addictive.

Part of this addiction is due to the relationship between dopamine secretion and the reward mechanism in our brains. When a behavior produces a spike in dopamine we are more likely to engage in that behavior again.

When the behavior “might” produce a spike in dopamine we are far more likely to engage in this behavior again.

One of the most powerful pleasure and reward mechanisms known to human beings is centered around the mechanisms of a slot machine.

Pull a lever or poke a button. Wait, and see…

This is why casinos built slot machines.

(A little known fact: Slot machines replaced levers with touch screen buttons to keep the players hand in contact with the screen, thereby decreasing the likelihood that they would simply pull away from the bright lights and potential reward that one more “pull” might bring. Today, everything from most laptops to our smartphones operates on touchscreen technology.)

It is also why technology companies design algorithms based on increasing the the unexpected nature of the next “click.”

Whether it is Instagram, Facebook, YouTube, Netflix, or your Gmail inbox that serves as our modern day, digital hunting grounds what we’re on the prowl for is dopamine, whether we realize it or not.

Dopamine fatigue and it’s relationship to depression must also be part of the diagnostic process when determining whether someone is experiencing a mental health disorder or simply responding appropriately to the internal and external stimulus that they are exposed to.

In the clip below Stanford professor Robert Sapolsky describes the massive increase in dopamine that a familiar activity produces an unexpected response. Think of checking your email inbox or social media notifications (which the average person does roughly 100 times per day) for example.

How to Hack a Human: Human engineering, algorithms, and how technology impacts mental health.

“For the first time in history human beings have become hackable animals.”

-Yuval Noah Harari, author of Sapiens: A Brief History of Humankind.

The past decade has seen the rise of powerful information technologies powered by big data algorithms. In order to bring a viable digital product, app, or new social media platform onto the scene in the 21st century data acquisition is a requirment for marketplace survival. This results is data mining competition in which our most personal information is the digital goldmine. Understanding our favorite colors, clothing brands, musicians, and political opinions is only the tip of the spear. Knowing our fears, vulnerabilities, and deepest insecurities is the skeleton key to customer acquisition in 2020 and beyond.

What does this mean for our mental health?

The answer to this question depends on how well we understand the algorithms.

Two examples:

First, imagine that you are a 15 year old female preparing to send out an Instagram post announcing your sweet sixteen party. You nervously hit “post.” Then, you wait. Your posts usually get around 100 “likes”- but this one is special. You stare at the notifications button, but nothing happens.

If you feel that your important birthday notice is being ignored you may begin to experience the natural physiological cascade which occurs when we humans feel emotionally slighted or de-prioritized by our tribe.

If you understand that an Instagram algorithm may not have even shown the post to the majority of your contacts in order to keep you staring at, and returning to, the platform you may feel annoyed at Instagram as opposed to let down emotionally by your closest friends.

These are two very different outcomes to the same event.

Algorithms will often space out how our posts are distributed. If you were expecting 100 likes (and secretly hoping for 150) and you got 160 likes within one minute of posting you would have no reason to return to Instagram other than to say “Thanks! See you there!

Another reason that algorithms distribute content in this manner is as follows: Dopamine is increased when initial dejection is followed by a slow stream validation of your initial projection.

In Sapolsky’s example from the video clip above-the juice is even better when you didn’t think you were going to get it at all.

160 likes “eventually” is more addictive than 160 likes “all at once”-despite, or, more accurately, due to the emotional strain associated.

The second scenario involves a game that you can play, if you’re up for it.

Swap your phone with a friend for a day. This works even better if you have a diversity of opinion regarding politics or any emotionally evocative social issue.

You may be blown away by the result of this experiment.

Our news feeds, advertisements, and social media landscapes are built based on what we’ve clicked on previously. As a result, they become the very definition of confirmation bias. The world that we want to see is simply sold back to us through our smartphones with just enough opposing opinion to keep things interesting. The result? A reduced ability to empathize with others and consider alternate viewpoints as valid alternatives to our own thinking.

I include this in an article about physiology because these technologies fundamentally alter our brain chemistry and change how we view the world at large, as well as our place within it.

If we do not educate our youth about the nature of the technologies that they will invariably interface with we leave them vulnerable to an altered physiological state that is biased towards depression, anxiety, and an altered sense of self worth and interconnectedness.

In the same way that we now teach students to use computers in the classroom we must teach them how to avoid allowing these computers to use us.

What is a Physiology First approach to education?

In the face of a 21st Century mental health crisis that severely impacts our youth we need to ensure the following:

  1. That we understand the difference between psychology and physiology. If you were to engage in a 7 day experiment in which sleep was limited to 2 hours per night, 80 ounces of caffeine per day was mandatory, the only available food were Pop Tarts, and your movement was restricted to sitting at a desk or lying in bed, it is not difficult to project your mental state at the end of the experiment. You would have disrupted physiological resonance to the point that an accurate psychological perception of the works around you was impossible. Yet, you would not have a acquired a “mental disorder.”
  2. Education about the stress and anxiety response must become part of core educational curriculum. Our lifestyle directly affect our mental state-and every student deserves to know “how” this process works. They deserve to look under the hood of their mental and physical experience.

21st Century Skills and the Breathe to Perform Curriculum.

Our goal at Physiology First is to collaborate with industry experts specializing in neuroscience, sleep management, nutritional science, exercise science, and a host of valuable skills which we can scale to students through a 21st century skills curriculum.

We focus on stress and anxiety management as an entry point to a larger conversation on human behavior, emotional state management, and self leadership in the digital age.

Attention, focus, memory, and learning are all compromised when students feel stressed and anxious. Attempting to teach a student whose brain and body is working them is a losing battle.

When we focus on stress and anxiety management “first” we open to the doors to the optimal neurological grounds for learning while giving the students tools to succeed academically and beyond.

When designing a stress and anxiety management curriculum for classrooms we put our focus on the greatest toggle for state management that every student and educator already has access to-their breath.

Breath education crosses language barriers, cultural barriers, and economic barriers while serving as the foundation for a larger conversation about the science of stress management and, ultimately, peak personal performance.

Given the current respiratory pandemic education regarding the respiratory system is also incredibly timely from a mental wellbeing perspective as well as a public safety standpoint.

Breathing exercises can influence physiological state in less than one minute.

These simple shifts in breath rate and volume have been scientifically shown to reduce the signs of stress and anxiety on the spot.

The way that we breathe can also improve memory, focus, and attention based on unique research on the impact of nasal breathing and brain activity.

Much attention has been lent to the use of breathing exercises to reduce stress and anxiety.

A lesser know fact is that breathing pattern dysfunction can cause stress and anxiety-and breathing dysfunction is extremely common.

This alone can create an internal environment in which anxiety is increased from a purely physiological perspective.

Chronic hyperventilation is often overlooked as a contributor to generalized anxiety-a classic example of our ability to miss a critical piece of information that makes an accurate psychological diagnoses possible.

You are not likely to meet someone living in a state of chronic hyperventilation who is not prone to heightened states of anxiety. You are, however, likely to find countless individuals suffering from chronic hyperventilation due to underlying breathing dysfunction.

Breathing assessments must become part of the standard diagnostic process if we want to move toward an accurate diagnosis of the physiological state of anyone undergoing a psychological analysis.

We can not apply a psychological solution to a respiratory problem and hope for a successful outcome.

As we enter a new era of understanding human physiology we must apply the lessons learned to one of the greatest healthcare crises of our time.

If we can identify the physiological prerequisites for mental well-being we can increase the accuracy of a myriad of mental health related diagnostic processes.

Our level of accuracy is critical as we shape the future.

Our willingness to upgrade our previous assessments based on new information is essential.

Our investment in securing an accurate analysis of the physiological prerequisites that make 21st century mental health possible is a necessary contribution to the future-and to the students who are soon to lead it.

If we can provide the leaders of tomorrow with the skills and tools that they need today, we take a step toward solving one of the greatest problems that any civilization can face: We work to prevent the declining mental health of our next generation of problem solvers.

When the problems of the world seem insurmountable, we must overcome the inevitable inertia that results from staring at a mountain with numerous trails to the summit and feeling paralyzed by the inability to simply “start.”

We must start somewhere.

If we begin by focusing on the mental well-being of our next generation of problem solvers we are making the greatest investment that a society can make in its own future.

If we are truly prepared to address the needs of our future leaders we can further overcome the existing inertia by learning to address physiology, first.

When Labels Become Lives: A closing note on the consequence of applying outdated models to our current analysis of physiological resonance and mental wellbeing.

Accidentally diagnosing someone with appendicitis will not result in them developing appendicitis.

Accidentally diagnosing someone with a “mental illness” can have devastating, long term effects which dramatically alter self perception within a critical developmental window.

Neuroplasticity-or brain change-is extraordinarily high between the ages of 12–25.

An inaccurate diagnosis of a mental health condition can become a self fulfilling prophecy due to the plasticity of the human brain and its immense capacity for change.

(The number of students that I meet and work with who define themselves through the lens of a “mental health disorder” is extraordinary. In a recent seminar at a local high school one student raised her hand and said “I just got diagnosed with anxiety-and I want to die.” Later in the seminar, I asked if anyone in the room, students, staff, and counselors including, could take a crack at defining the term “anxiety.” The room went silent, as it had every time that I’ve posed this question.)

We are attempting to tackle a physiological response of the autonomic nervous system without a thorough understanding of its underlying, evolutionary, mechanisms as manifested in a new, technologically enhanced, environment.

As a result, the diagnosis of “generalized anxiety disorder” grows daily.

Currently, more than 275 million people on a global scale have been labeled “disordered” without a common, scientific, understanding of what the normal function of the human nervous system in a modern, technologically driven society, actually is.

When we give students the requisite information to shape their brains and regulate their nervous system deliberately, we give them the capacity to develop their lives intentionally.

This is, perhaps, the greatest gift that one generation can give to another.

Introducing physiologically informed stress and anxiety education to the classrooms of the 21st century is the first major step that we can take to passing this gift along.

David J Bidler is the President of Physiology First, a nonprofit organization dedicated to providing stress and anxiety solutions to students and the larger community that supports them.

David is the co-founder of Breathe to Perform and author of the new book, Breathe to Perform: 3 Simple Breathing Exercises to Reduce Stress, Improve Energy, and Peak Athletic Performance.

Breathe to Perform helps to improve health, fitness, and performance through better breathing. Professional development services for workplaces and teams.