If you feel like you may harm yourself, please, please call a crisis hotline. They're free, confidential, and 24/7:

US: National Suicide Prevention Lifeline – 1-800-273-8255
US: The Trevor Project (for LGBTQ youth) – 1-866-488-7386
UK: Samaritans – 116 123
For all other countries, see Wikipedia's list.

For mental health advice from official sources, rather than a random internet person like me, check out these lists from the Mental Health Foundation & National Health Service.

・・・

This article is a mix of personal story, the science of mental health, and practical tips. It's a 22-minute read in full, but you can just skip to the practical tips:

  1. An Old Friend (story)
  2. Therapies I Tried (story + theory)
  3. The Purpose of Pain, the Function of Feelings (theory)
  4. Habits 101 (theory + practical)
  5. 9 Evidence-Based Mental Health Habits (💥the actually useful part💥)
  6. TL;DR (summary of everything above)
  7. Me & My Wolf (story)
  8. Extra Resources (practical)

Fan-translations: Deutsch(make your own?)


An Old Friend

I remember my first panic attack. I was at the bus stop. I'd just moved to a new city, and the bus never showed up. So the little wolf in my brain said to me:

🐺 We're in a new place, and we can't even figure out how busses here work?

🐺 That means we won't be able to make friends! Or get home safely! Or buy things we need to survive!

🐺 Wait, why is our heart pounding? Why can't we breathe?! Aren't heart attacks in our family medical history?!?! Oh my god is this it?!?!?!

🐺 AAAAAHHHHH

In 4 mental steps, a no-show bus had me 100% convinced I was going to die.

So, that's why I never trusted the saying, "trust your gut." Or, "your feelings are valid." Imagine this scene:

Friend, to you: I feel worthless. I feel like a burden to everyone. I feel that deep down I'm an irredeemably broken, evil person.

You, to friend: Your feelings are valid! :D

Thus, I trusted those other platitudes: "Emotions are irrational." "The only thing to fear is fear itself." "Don't worry, be happy!"

So, I looked for ways to shut my fear up.

It worked! I used random hookups and risky sex to drown out the sounds of my brain screaming. Finally, now that I paid no attention at all to my fear... I walked straight into several abusive and dangerous situations.

(FUN FACT: In 1994, neuroscientists found a woman with both her amygdala destroyed. She was the woman with no fear. No anxiety. No worries at all. That's why she's been victimized, mugged, and almost murdered several times.)

Thankfully, my friends were afraid for me, when I was too afraid to let myself be afraid. (The only thing to fear is fear itself, right?) My pals helped me realize my situation was abusive, and got me out of it.

A few months later, I heard the familiar voice of an old friend:

🐺 AAAAAHHHHH


Therapies I Tried

If this was a movie, that should've been the point I realized the value of fear.

Nope. I learnt nothing.

It did, however, inspire me to finally try psychotherapy. I first tried Cognitive Behavioral Therapy (CBT), which meta-analyses have shown is as good or better than medications for depression & anxiety. The therapy recommends "challenging your thoughts" by pointing out all the irrational "cognitive distortions" in your fears. (🤓 “Well, Actually...”)

CBT helped me a lot, but I quickly hit a plateau. My problem was I used CBT as a weapon against my fear. I still thought of fear as my enemy.

Next, I tried a mindfulness-based therapy – specifically, Acceptance & Commitment Therapy – which recommends not fighting your thoughts, but just letting your feelings pass by. (Metaphor I was told: anxiety's like quicksand – the more you struggle, the quicker you sink. Therefore: don't struggle.)

Again, I used mindfulness as just another way to ignore my fear. Fear was still my enemy.

It took me a decade to finally figure it out, but fear is––

Hang on, my wolf wants to say something:

🐺 Nicky, CBT and mindfulness have helped millions of people, and are backed by hundreds of studies. Who are we to poop all over what saves peoples' lives?!

Thanks, wolf! That's a very good concern you've brought up.

I want to clarify: CBT and mindfulness does help people. They helped me immensely.

But no technique will fully work if you believe that fear is an enemy to be "overcome" or "conquered". Or an annoying thing to "mindfully" put up with. As I was saying earlier: it took me a decade to finally figure it out, but fear is not an enemy.

Fear is a friend.


The Purpose of Pain, The Function of Feelings

"Fear is a friend"?! That sounds stupid – even morally offensive – to someone with near-daily panic attacks. So why am I, someone who knows this pain, saying something like that?

To understand this, imagine putting your hand on a lit stove.

🔥👋😰

Obviously: it would hurt.

Less obvious: it's a good thing that it would hurt.

Pain is an alarm system. It tells you when things are bad, which is good.

(FUN FACT: There's a rare condition called congenital insensitivity to pain, where people can't feel pain. As a result, adults with the condition have lots of wounds, burns, and broken bones. They're the lucky ones – the rest are dead.)

However, you'd also want an alarm system to go off before harm is done. This alarm system is called "fear". It's an alarm that predicts – and tries to protect you from – future harm.

Harm to what? Your fundamental human needs:

  1. Physical Needs – survival, health, safety
    (When threatened: 🐺 “We're in danger!”)
  2. Social Needs – friends, family, lovers
    (When threatened: 🐺 “Nobody likes us!”)
  3. "Becoming A Better Person" Needs – learning, character growth, doing good for others
    (When threatened: 🐺 “We're a bad person!”)

(This list of needs is something I pulled out my bum a condensed version of Maslow's hierarchy + Self-Determination Theory [pdf])

Here's my conjecture. It's not original, hundreds have said it before, but it still took me forever to learn:

🚨 ALL FEELINGS ARE IMPERFECT SIGNALS ABOUT MET & UNMET NEEDS. 🚨

This is the functionalist view of emotions. But, what do I mean by "signal"?

Imagine a cafe. When a customer arrives, the bell above the entrance door gives a ding signal.

Likewise, when a body/mind need is met – or is about to – we feel a Pleasure signal: joy, anticipation, curiosity, the "Aha!" moment, pride.

Imagine a cafe's smoke alarm. When something in the kitchen is burning, it gives a BEEP BEEP BEEP signal.

Likewise, when a body/mind need is not being met – or is being threatened – we feel a Pain signal: fear, loneliness, frustration, guilt, grief.

But wait, isn't this just the same as "your feelings are always valid"? No, because all signals can have false alarms. Thus, negative feelings aren't always valid, but they aren't always irrational either. They're clues – not to be taken as 100% literal truth, but not to be thrown out entirely either. (Have an over-sensitive alarm? We'll see how to "re-calibrate" your signals with Habits, in the next section)

All my life, I thought mentally healthy people were just better at "coping" with "negative" emotions. The very vocabulary of this idea is wrong. The mentally healthy don't "cope" with emotions, they collaborate with them. They know how to listen to, act on, and re-calibrate the signals.

When the smoke alarm goes off:

Once I understood feelings = alarms & signals, I realized a lot of what I thought were emotions' bugs were actually features! "Negative" emotions turn on by themselves and you can't turn them off at will – this is a good feature for an automatic smoke detector. "Positive" emotions never last, they always re-adjust themselves to your new normal – this is a good feature for smart thermostats.

A good life is not about minimizing Pain and maximizing Pleasure. That's like a cafe whose goal to minimize alarms & maximize entrance-bell-ringing. Feelings are NOT the ends, they are the means to the ends: a fulfilling life.

So that's why I claim "fear is not an enemy, it's a friend." But what kind of friend is fear? The "Man's [sic] Best Friend" kind. In a sentence:

🐺 FEAR IS A GUARD DOG FOR YOUR NEEDS. 🐺

When it yaps “nobody likes us!” it's trying (however badly) to protect your need for belonging. When it yaps “we're bad people!” it's trying (very poorly) to protect your need for personal growth.

(The idea of a sub-agent in your mind isn't as wacky as it sounds – this thought's popped up independently in several fields: "System 1 and System 2" in behavioral economics, "The Elephant & The Rider" in social psychology, "The Society of Mind" in cognitive science, etc)

However, maybe you have a hyperactive dog that barks at shadows. It's not the dog's fault. Maybe in the past, it's been abused or neglected. But the dog genuinely wants to help you! That's its literal evolved function!

It yaps because it's a battered shelter dog, and it needs you to help it heal.

Sadly, many people's first response to the loud dog – including mine – was to lash out at it. But you can't beat the meanness out of a dog, or scare the fear out of it. (Note: this is also true for literal dog-training [pdf].)

So... how do you train your dog?


Habits 101

To train a dog, first: don't beat the dog. Don't fear fear itself.

So, what then, are you supposed to buy one of those clickers and train your own mind with operant conditioning?

Well... yeah! Okay, dog clicker is optional. But, we have a word for when humans do operant conditioning on themselves:

Habits.

Here's a quick summary of the science of forming habits, paraphrased from the British Journal of General Practice [pdf]:

  1. Habit = When X, Then Y.
    X is the "cue", Y is the "routine". Example: "when I come out of the shower, then I will floss my teeth."

  2. To build a habit, have a consistent When.
    Example: if you're trying to eat healthier, don't just say "I'll eat more fruits". Give yourself a specific time and/or place, like, "after I have lunch at home I will have a piece of fruit". (Also known in psychology as an Implementation Intention. [pdf])

  3. To build a habit, have a simple Then.
    Example: if you're new to meditation, don't start with "meditate for 30 minutes a day." Start with "meditate for 2 minutes a day." Once 2 minutes becomes habit, then you can increase it.

  4. To break a habit, change the When or Then:
    Example: to stop myself from procrastinating, I use apps to block tempting websites. (Odysseus tied himself to the mast to resist the sirens' song.)

  5. Track your progress.
    Personally: for each day I successfully do my When→Then plan, I draw an ⭕ on a calendar. If I fail, I draw an ❌.

  6. Do NOT try building more than one habit at a time.

  7. It takes 66 days (on average) for a habit to become automatic.
    Be patient! Mind-training takes time, but it's worth it.

Hang on, my guard dog wants to say something:

🐺 We just spent 1800+ words and we haven't actually given the reader any practical mental health tips! We're wasting their time!

That's a good concern! I'll add a link at the top to let readers skip to the Mental Health Habits sections. Speaking of which:


9 Evidence-Based Mental Health Habits

This list is to help you start improving your mental health today. Nine sounds overwhelming, so just pick one habit from the list below, make a small, simple When→Then plan, and track your progress for 66 days or until it becomes automatic. Then come back, pick another habit, repeat.

Habits to get to know your wolf better

😌 Meditation:

Yeah it's a cliché at this point, but meditation's been shown in meta-analyses to improve anxiety & depression.

However, there's one cliché about meditation worth dispelling: the goal is NOT "clear your mind". Classic beginner mistake! The goal is to observe your mind, like a scientist: non-judgmentally. When the wolf starts howling – and it will – don't fear fear. Just listen. Observe.

Though I was critiquing "mindfulness" earlier (or my mis-implementation of it), meditation actually is profoundly helpful to my life.

Example When→Then plan: “After brushing my teeth in the morning, I will go to the living room and set a timer to meditate for 2 minutes.”

Recommended: this 2-minute animated intro to meditation.

📓 Journaling:

Another cliché, but writing about your emotions has been shown to moderately improve psychological and physical health [pdf]. Though, you have to write about your emotions and try to understand them. Expressing emotions without cognitive sense-making seems to not help [pdf].

Not sure how to begin journaling to understand your emotions? Here's a simple template:

"Today when [event], I felt [feeling] because it seemed to fulfill/challenge my need for [need]. Next time, I'll try [experiments around that need]."

Example: "Today when my friends all chatted without me, I felt insecure because it seemed to challenge my need for belonging. Next time, I'll try to fulfill my need for belonging either by speaking up more, or practicing being comfortable listening to my pals, actively and wholly, without needing to pipe up to prove my existence."

(As much as I criticized "challenging your thoughts" earlier, this is where CBT shines. Knowing common cognitive distortions and how to reframe them does help you make sense of the Pain signals. Just don't approach it like Debate Club, where the point of the game is to "win" by Well, Actually-ing your fear. The goal should be to help your fear be a better helper. Help it help you.)

Example When→Then plan: “Before going to sleep, I will write/draw about my feelings for 10 minutes.”

・・・

Remember, fear is a guard dog for your needs. If you hear it barking "we're in danger!" but with no specific cause, it's likely your general physical needs are not being fully met. To reassure your inner dog, you can take care of those needs:

Habits to protect your physical needs:

Imagine if popsci magazines wrote, "Wow! Getting your computer's hardware wet can affect how well the software runs." Or "Wow! Having a lot of intensive software running can make the hardware hot!"

That's how I feel about articles acting surprised that physical health affects mental health & vice versa.

😴 Sleep:

If natural selection decided to knock you out unconscious for a third of your life, you'd better bet there's a huge benefit to make that cost/benefit analysis work out.

And it does. As the director of UC Berkeley’s Center for Human Sleep Science explains in his book, a good night's sleep reduces your risk for heart disease, cancer, Alzheimer's, depression, anxiety, and more. As a best-selling children's author once said, “Go The F**k To Sleep.”

Example When→Then plan: “When it's 10pm, I will turn off all my devices, and put them on charger, outside the bedroom, in a trash can, where they belong.”

Recommended: F.lux. It's an app that changes your screens' lights in evenings, because blue light messes up your sleep cycle.

🏃‍♀️ Exercise:

Jog. Hike. Play Frisbee. Just half an hour of moderate exercise a day is enough to give great benefits to your physical and mental health. A recent meta-analysis shows that exercise reduces depression as much as than psychotherapy or medication!

Example When→Then plan: “After getting home in the evening, I'll go for a 10 minute stroll.” (Remember: you can always increase duration/intensity of a habit later)

🍆 Eat:

Your gut bacteria makes 90% of your body's serotonin. So: you keep your microbes happy, they keep you happy, capiche? (See: this Mental Health Foundation report)

There's a zillion diets out there, but most of them aren't based on science... and the science is full of failed replications and p-hacking. Personally, I go with Michael Pollan's anti-diet diet: Eat food, not too much, mostly plants.

Example When→Then plan: “Before grocery shopping, I'll eat a fruit so I'm not hungry and won't get tempted to buy chocolate-flavored Cheetos. Again.”

・・・

Our physical needs are essential, but we're not just animals, we're social animals. So, if your guard dog barks "nobody likes us!" you can reassure it with these habits:

Habits to protect your social needs:

High-quality social connections, not surprisingly, reduces depression and anxiety [pdf]. And "surprisingly", it even reduces your risk of an early death by 50%. (Again, it shouldn't still be surprising that hardware affects software and software affects hardware)

👯‍♂️ Talk To Friends

Some anecdote-not-data advice:

  1. Whenever possible: Real-Life Face-To-Face > Videochat > Phone Call > Text/Email.
  2. Meet with friends outside your usual context. Examples: meet a friend from work outside work, go with housemates out to a movie. Otherwise, you'll probably lose touch after leaving the job or house.
  3. Because everyone's a busy bee who lives in a rectangular beehive called a calendar, regularly schedule friend-hangouts. Make friendship a habit, for both of you!

Also, talk about your thoughts & feelings with pals! Besides strengthening the friendship, I suspect sharing your feelings with another person improves your mental health the same way journaling does: explaining your emotions makes you understand your own emotions.

Example When→Then plan: “Every first Monday of the month, I'll video-call my good friend who's in the distant, faraway land of New Haven, CT.”

🎳 Make New Friends

Option 1: Ask friends to introduce you to their friends. (e.g: you all go to a movie together)

Option 2: Join a class or volunteer group or bowling league on Meetup.com. (They're not paying me to say this.) I work independently and just moved to a new city, so it could've been super lonely, but Meetup helped me make new friends fast! Just remember to also meet your new friends outside of the meetup.

Example When→Then plan: “Every Thursday evening, I'll go to the French Meetup pour pratiquer mon terrible français.”

・・・

Finally – our physical and social needs are essential, but we're not just social animals, we're persons. So, if your dog barks "we're terrible, evil, broken!", you can reassure it with these habits:

Habits to protect your "becoming a better person" needs:

The last decade of "the science of happiness" has been all about how happiness is not enough.

Researchers now identify two kinds of well-being [pdf]Hedonia, which is pleasure & fun, and Eudaimonia, which is purpose & fulfillment. The two aren't opposed, but they are different. And of course, eudamonia predicts better psychological & physical health [pdf].

So, how do you find the meaning of life? Dunno, that's a question for philosophers. However, you can find many meaning(s) in life, like being a good friend, raising a child, volunteering for a cause... and pushing yourself to your fullest human potential, with habits like:

💭 Learning

Draw on the right side of your brain. Play your ukelele. Understand quantum computing. Flirt in French. Split apples in half with your bare hands. Make plushies. Learn Morse code. Try a new team sport on Meetup.com. Make chiptunes. Learn Python programming. Play "explorable explanations" about game theory, music composition, fourier transforms, and more. Cook.

Just pick something and set aside a day of the week (or hour of the day) to read a book, or deliberately practice a skill.

Example When→Then plan: “Every Sunday evening, I'll try cooking a new recipe.”

Recommended: Spaced Repetition ("flashcards on steroids") to help you remember what you learn. See this 7-minute video or this 80-minute long essay.

😇 “It Builds Character”

Benjamin Franklin was the first lifehacker. In-between experimenting with lightning and fighting to abolish slavery, he also strived to improve his moral character with the help of... index cards. As described in his autobiography: he carried a card with 7 columns – one for each day of the week – and 13 rows – one for each Virtue he wanted to work on. At the end of each day, he'd draw a dot for each Virtue he'd successfully practiced that day. He failed a lot. But over time, he got the crooked timbre of his human nature a little less crooked.

I think we all can, too. You don't have to use Franklin's exact method. In fact, I recommend being more specific than "practice Humilty", and have a specific When→Then plan, like:

Example When→Then plan: “When I'm about to post something angry on the internet, I will wait one hour before hitting Send.”

“Be the change you want to see in the world” etc etc.

・・・

Know your wolf.
Physical needs.
Social needs.
Becoming a better person.

What helps you meet all of these at the same time: making fear your friend. Building a healthier collaboration with your fear (know the wolf) will help you get better at protecting yourself (physical needs), be more vulnerable with trusted friends (social needs), and let you improve your moral character ("becoming a better person" needs).

Hang on, my friend wants to say something:

🐺 Gah! We've blabbered on for 3500+ words! How's a reader supposed to remember any of this?!

Good point! Let's refresh the reader's memory with a summary:


TL;DR


Me & My Wolf

If this was a movie, I should've learnt to befriend my wolf in a shocking moment of catharsis, with explosions in the background. That would have made a good story.

Instead, I only learnt to befriend my wolf while trying to make a good story.

When I started writing my game Adventures With Anxiety, I planned it to be a bunch of CBT & mindfulness lessons wrapped up in a narrative. Two problems: 1) The story felt inauthentic. 2) I couldn't make the Anxiety character's dialogue come out naturally.

But then I realized an obvious solution for Problem #2: I shouldn't write the Anxiety character, my anxiety should write the Anxiety character.

Thus began a weird collaboration.

Strange side effect: I started liking my anxiety. Because now, whenever my anxiety went on a thought-spiral like:

🐺 What can we even do that matters in the grand scheme of things? Contribute to humanity? All great works decay like Ozymandias. Love? Death always does it part. And how much death there is! We'll die, our loved ones will die, the 2nd Law of Thermodynamics means even the universe will die! LIFE HAS NO MEANING, DEATH HAS NO MEANING, AND EVEN MEANING HAS NO MEANI–

I would think:

1) holy s*** that's terrifying
2) this is incredible writing material! Thanks, wolf!

This also solved Problem #1: the reason the story felt forced was because I never gave the Anxiety character a real motivation. It was just a Skeletor-like "evil for the sake of being evil" enemy. But when I just asked my anxiety what its motivation was, it told me:

🐺 I want you to be safe.

And with that core motivation, Adventures With Anxiety basically wrote itself. Not only that, I learnt that why CBT & mindfulness plateaued out for me: because I was still thinking of fear as my enemy.

Until you realize fear is (trying to be) your guard-dog, you will still fear fear itself.

And the more my battered shelter dog and I collaborated on the game, the more we collaborated in the rest of our life. I'd hear it bark "they hate us!", I'd see the Pain signal below the mere words, and we'd try an experiment to fulfill the unmet need. Together. As a team.

Alright, I think I'll let my friend have the final say. Wolf?

🐺 Okay this article is still too long. It's 4000+ words! Or maybe it's not long enough, you didn't even cover other therapies like psychodynamic or humanist or logotherapy, let alone the Dodo Bird controversy: recent meta-analyses show that all the main psychotherapies are equivalent, with CBT maybe sliiiiightly better in the short-run! Speaking of which, what about the infamous meta-analysis that shows psychiatric medication may be up to 75% placebo? Heck, what with the replication crisis, how do we know anything in this 4000+ word monster is scientifically accurate?! Also we're writing this on the 15th, and you promised the game to come out on the 17th, so please shut up and stop writing.

Fair enough! It's good in science to be skeptical, though I'd like to say: even if all therapies have been proven equivalent, they've been proven equivalently good, and much better than lack of therapy (self-help or professional). And even if meds are only 25% better than placebo, being 25% better at saving lives is still a lot. Also, science is a process of learning from mistakes, and gratefully, scientists are learning from the replication crisis.

Still, thanks for the constructive criticism, and protecting my need for intellectual honesty!

🐺 You're welcome. And, hey, thanks for finally being patient and understanding with me... instead of drowning me out with risky behaviors and "Well, Actually"s.

Of course! Any final words?

🐺 Yes. Just one.

Yeah?

🐺 AAAAAHHHHH


Extra Resources:

More mental health tips from: Mental Health Foundation & National Health Service

Feeling Good, the classic 1980 book that popularized CBT.
Man's Search for Meaning, a 1946 book written by a Holocaust survivor & psychotherapist.
Meditation 101, a 2-minute animation.

・・・

This essay is the "companion piece" for my interactive story/game, Adventures With Anxiety. If you'd like to help me make more free, educational words+games, you can throw coins at me on Patreon!

Huge thanks to these folks for gifting feedback on this essay: Glen Chiacchieri, Lexi Lockwell, Spacie. Any problematic words remaining are my own.

Finally, thank you for reading! Whoever you are: Stay determined. Good luck.

<3,
~ Nicky Case