The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time
Alex Korb, 2015
Why is it so hard to do even the things that would surely help, when you are in a bad patch? Neuroscientist Alex Korb explains depression as a spiral in which thoughts, feelings and habits drag each other down. You will learn which circuits of the brain are involved, and why a small change can turn the spiral upward: a walk, a decision, sleep, gratitude and other people.
Who it is for
For those who are stuck in a bad patch and keep telling themselves that nothing will help. And for anyone curious about how anxiety, habits and mood work in the brain itself.
Even a small shift can change the sound of the entire system.
The Hand That Calms the Brain
Picture an experiment that Korb describes. A woman lies in a scanner that shows brain activity. She is told that at any moment a faint electric shock may follow. Her brain does what it is designed to do: the circuits of alarm and danger become more active. Then her husband simply takes her hand. The shock is still possible, but on the scan those circuits calm down noticeably. One small circumstance has changed, and the brain already works differently.
Alex Korb is a neuroscientist whose dissertation focused on depression. His central claim sounds unexpected: in depression, something fundamentally wrong does not usually happen in the brain. Korb explains it this way. If you bring a microphone too close to a speaker, a piercing squeal erupts. Neither the microphone nor the speaker is broken: the squeal is born from how they act on each other. So it is with depression. The whole matter lies in how the brain's circuits are tuned and how they interact. Above all there are two areas. The prefrontal cortex, the thinking part of the brain, should help manage the feeling part, which is called the limbic system. In depression, the cortex struggles to do this.
That is the image that gives the book its name. A downward spiral begins when events and decisions change how the brain works, and the altered brain pushes toward new decisions that pull you down again. Such a spiral does not just lower you, it keeps you low. But the connection works both ways, and then an upward spiral appears. In Korb's account, the brain runs on positive feedback: the result reinforces itself, and often a tiny change is enough to make a noticeable shift.
Ahead lie the reasons an anxious brain clings to the bad, why a habit fires before your intention does, what a walk does to the brain, why a decision that is good enough matters, how the body and sleep signal to the brain, and why gratitude and other people count so much. Along the way Korb shows how the chemicals that nerve cells use to send signals take part in all this, and why one small step changes several of them at once. This is not a treatment plan. It is a map of circuits and small steps. Let us begin.
Anxiety Feeds on the Word “What If”
Picture Olya. It is Sunday evening, and tomorrow there is an ordinary meeting. Nothing bad has happened, but a voice keeps going: what if the boss is unhappy, what if the project gets cancelled, what if I have to look for a new job? Olya runs through the options, looks for the best answer to each, and by midnight she feels worn out, though she has decided nothing. Olya is invented for the example, but Korb describes exactly this mechanism.
Worry and anxiety, according to Korb, are both signs of depression and causes of it. Worry consists mostly of thoughts, while anxiety is more tied to the body: the stomach tightens, the heart speeds up. Both are fuelled not by uncertainty but by possibility. Something bad that has already happened often frightens us less than something bad that might still happen.
Why is the brain built this way? Korb's answer is evolution. Circuits that make us expect trouble in advance helped our ancestors survive. In depression, however, the prefrontal cortex, Korb says, is responsible for worry, guilt, shame, difficulty thinking clearly and indecision. A useful tool starts working against its owner.
The most interesting point is that worry is produced by the same circuits that help us plan and solve problems. The difference between a plan and a worry, Korb explains, lies in how strongly the emotional areas of the prefrontal cortex and the anterior cingulate cortex respond to an imagined future. In people prone to anxiety this circuit seems to get stuck in the on position. It is like a satnav that keeps recalculating the route while the car stays parked. The comparison is Livria's own, but it captures Korb's idea: worry resembles work, but it goes nowhere.
There is a second trap too. When mood is low, almost all the outcomes that the prefrontal cortex calculates are tinged with negativity. The brain is not lying on purpose. It is simply looking at the future through dark glass.
What can you do about it? Korb advises, to start, naming the feeling in words. He cites studies showing that when people name an unpleasant emotion, the prefrontal cortex engages and the amygdala, which sets off the alarm, calms down. Second, the sense that you control at least something reduces anxiety, worry and even pain. And third, Korb advises returning to the present and noticing what is happening now rather than what might happen. Attention to the present, he says, reduces both anxiety and worry.
About the author
Alex Korb is a neuroscientist who earned his PhD in neuroscience at the University of California, Los Angeles, where he studied depression, and who works there in the psychiatry department. For many years he coached the university's women's ultimate frisbee team.
All books by this author: Alex Korb
Terms from the book
- limbic system
- amygdala
- prefrontal cortex
- Dopamine
- Oxytocin
- serotonin
- melatonin
- Downward spiral
- Striatum
- Endorphins
- Sleep hygiene
- Upward spiral: An image from the book: a small change for the better makes the next one easier, and the changes start to support one another.
- Positive feedback: A property of a system in which the result reinforces itself. It is what makes a squeal when a microphone is held near a speaker.
- Anterior cingulate cortex: A region deep in the frontal lobe. It takes part in attention, in noticing mistakes and in experiencing pain, including emotional pain.
- Noradrenaline: A chemical through which nerve cells send signals. It helps focus and cope with stress.
- Biofeedback: The influence of the body's signals, such as breathing, muscle tension and facial expression, on the brain's work and on mood.
- Insula: A region of the cortex deep in the brain that registers bodily sensations, including pain and unpleasant feelings.
All terms
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