When you are afraid, you start going into fight or flight mode. Your body starts prioritising what is needed for immediate survival - screw routine body functions, if you don't make it past the next few moments there won't be a routine to return to. You stop digesting food. Cell repair slows or stops. You stop producing saliva, which is why your mouth goes dry when you're nervous just before making a speech or going into a difficult conversation. Your heart rate and breathing increase to ensure better blood flow. A cocktail of hormones like epinephrine and oxytocin are cued up and produced, which amplifies your body's ability to act (and remarkably, in the case of oxytocin, reminds you to seek help).
Don't be mistaken about what happens when you feel fear. Your body is readying itself to help you face what you fear in the way it knows how.
What causes us to feel fear?
1) Fear occurs to us unconsciously. Do you pause to think, hey, very angry looking snake! Maybe I should be scared. Of course not, it would be too late! Fear becomes much clearer when we examine what happens inside your brain. When you are afraid, the fear/anger/aggression/anxiety centre of your brain - the amygdalas (get used to this name, it's gonna keep popping up) lights up. And we've covered all the changes that happen in your body: your blood pressure, your hormones, your heart-rate. But remember how amygdala is like a train interchange with direct routes to different parts of your brain? There is a direct neural link between our amygdala and your pre-frontal cortex, the rational thinking part of your brain. And if we look closely enough or we think things through, sometimes we realise, argh! it's not an angry snake, it's just a prank toy that your annoying friend had thrown at you. Or if you've handled angry snakes enough times, your amygdala does not light as much. Your blood pressure and your heart rate do not increase as much, you realise what you need to do is to stay calm and slowly back away.
Finally, notice how fear, anger, aggression, and anxiety are processed by the same part of the brain, the amygdala. This is no coincidence. These 4 emotions are closely tied to one another; aggression maybe triggered because one is nervous, angry, or fearful. Being fearful may cause one to react angrily, as a self-defense mechanism. Fear, like all our emotions, happens to us. Mostly, we can't control how it originates. But we can control how it develops by understanding what exactly is causing fear and by choosing the response that dispels it
2) We fear what we are unconfident or uncertain about. Think back on your ancestors doing something they weren't confident or certain off - hunting a massive animal without a weapon, or eating a berry they've never seen before. Doing so would mean a very high chance of seriously harming themselves. Today, after many cycles of evolution, we have been wired based on these experiences.
Think about it. Are you ever fearful of something you've done before, and are good? Brushing your teeth, putting on your clothes, indulging in your favourite hobby (whatever it is)? Of course not. You know you can perform these functions easily. You are confident.
But many of us would have felt fearful and anxious the first time we ventured into something new: using a pair of chopsticks, riding a bicycle, swimming, going on a first date. We were uncertain about these functions, and we were not confident about performing them. However, once we have demonstrated to ourselves that we are able to perform these tasks, we are no longer afraid. The same applies to more challenging tasks. Some of us struggle with: public speaking, starting a business, having a very difficult conversation with the CEO... You are uncertain and unconfident if you can succeed. But once you have proven to yourself you are able to do it, even for the more challenging tasks, you are no longer afraid. People might start off feeling scared about public speaking, but after speech 3797, you're pro The catch, of course, is that sometimes, we are too scared to start.
Even if we were certain of something OR confident about something, many of us will still feel some amount of fear. We might be theoretically certain how we should use a pair of chopsticks, but if we have never succeeded in using them properly, we remain unconfident and will still feel nervous if we had to use them, especially when others are observing. You might also be confident about
3) we fear what is painful. Boxer. climbing 100 flights of stairs or doing 100 burpees. But pain is not just physical but mental. Failure is painful. Being judged is painful.
This is why you procrastinate. You either fear what you have to do bevause you don't know how to do it (you don't fear brushing your teeth for example), or you fear doing something becaue you know it will be effortful
4) we fear what we cannot control
Learn more about your amygdala, the amygdala hijack, the thalamus, the pre-frontal cortex, and how your brain works here.
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Summary:
- Fear and anxiety (and anger + aggression) are always
Jon Corzine did not have a knowledge deficit, he had a behavior deficit. It's not that he didn't know better. He knew better. It's that he didn't do better.
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Instead, I think the mind is a high-resistance pathway. Changing someone's mind with information is hard enough. Changing their behavior with information is harder still. The only way we're going to make substantial improvements in health and health care is to make substantial improvements in the behavior of health and health care.
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If you hit my patellar tendon with a reflex hammer, my leg is going to jerk forward, and it's going to jerk forward a lot faster and a lot more predictably than if I had to think about it myself. It's a reflex. We need to look for the equivalent behavioral reflexes and hitch our health care wagon to those. Turns out, though, that most conventional approaches to human motivation are based on the idea of education. We assume that if people don't behave as they should, it's because they didn't know any better. "If only people knew that smoking was dangerous, they wouldn't smoke." Or, we think about economics. The assumption there is that we're all constantly calculating the costs and benefits of every one of our actions and optimizing that to make the perfectly right, rational decision. if ths was the case, everything would work out prfectly all the time.
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A better approach lies in behavioral economics. Behavioral economists recognize that we are irrational. Our decisions are based on emotion, or they're sensitive to framing or to social context. We don't always do what's in our own long-term best interests. But the key contribution to behavioral economics is not in recognizing that we are irrational; it's recognizing that we are irrational in highly predictable ways. In fact, it's the predictability of our psychological foibles that allows us to design strategies to overcome them. Forewarned is forearmed. In fact, behavioral economists often use precisely the same behavioral reflexes that get us into trouble and turn them around to help us, rather than to hurt us.
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Hard work pays off in the future, but laziness pays off right now."
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And patients also have present bias. If you have high blood pressure, even if you would desperately like to avoid a stroke, and you know that taking your antihypertensive medications is one of the best ways to reduce that risk, the stroke you avoid is far in the future and taking medications is right now. Almost half of the patients who are prescribed high blood pressure pills stop taking them within a year. Think of how many lives we could save if we could solve just that one problem.
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We also tend to overestimate the value of small probabilities. This actually explains why state lotteries are so popular, even though they return pennies on the dollar. Now, some of you may buy lottery tickets -- it's fun, there's the chance you might strike it rich ... But let's face it: this would be a horrible way to invest your retirement savings. "State lotteries are a special tax on people who can't do math."
It's not that we can't do the math, it's that we can't feel the math. And we also pay much too much attention to regret. We all hate the feeling of missing out.
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recent lottery, a mega-jackpot lottery, Everyone in my office is pooling money to buy lottery tickets, and I'm not having any of this. There I am, like, swaggering around the office, "Lotteries are a special tax on people who can't do math."
And then it hits me: uh oh. What if they win?
Now, it's not that I didn't want my colleagues to win. I just didn't want them to win without me. Now, it would have been easier if I had just taken my 20-dollar bill and put it into the office shredder, and the results would have been the same. Even though I knew I shouldn't participate, I handed over my $20 bill, and I never saw it again.
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We've done a bunch of experiments with patients in which we give them these electronic pill bottles so we can tell whether they're taking their medication or not. And we reward them with a lottery. They get prizes. But they only get prizes if they had taken their medication the day before. If not, they get a message that says something like, "You would have won a hundred dollars, but you didn't take your medicine yesterday, so you don't get it."
07:20
Well, it turns out, patients hate that. They hate the sense of missing out, and because they can anticipate that feeling of regret and they'd like to avoid it, they're much more likely to take their medications. Harnessing that sense of hating regret works. And it leads to the more general point, which is: once you recognize how people are irrational, you're in a much better position to help them.
The fly in the urinal helps men pee. a black fly etched into the urinals at Schiphol Airport in Holland had the effect of, shall we say, improving the accuracy of men’s aim by 80%.
We had a problem in our hospital in which the physicians were prescribing brand-name drugs when a generic drug was available. Each one of the lines on this graph represents a different drug. And they're listed according to how often they're prescribed as generic medications. Those are the top are prescribed as generics 100 percent of the time. Those down at the bottom are prescribed as generics less than 20 percent of the time. And we'd have meetings with clinicians and all sorts of education sessions, and nothing worked -- all the lines are pretty much horizontal. Until, someone installed a little piece of software in the electronic health record that defaulted the prescriptions to generic medications instead of the brand-name drugs. Now, it doesn't take a statistician to see that this problem was solved overnight, and it has stayed solved ever since. In fact, in the two and a half years since this program started, our hospital has saved 32 million dollars. Let me say that again: 32 million dollars. And all we did was make it easier for the doctors to do what they fundamentally wanted to do all along.
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We did this with a contest to help people walk more. We wanted everyone to walk at least 7,000 steps, and we measured their step count with the accelerometer on their cell phone. Group A, the control group, just got told whether they had walked 7,000 steps or not. Group B got a financial incentive. We gave them $1.40 for every day they walked 7,000 steps. Group C got the same financial incentive, but it was framed as a loss rather than a gain: $1.40 a day is 42 dollars a month, so we gave these participants 42 dollars at the beginning of each month in a virtual account that they could see, and we took away $1.40 for every day they didn't walk 7,000 steps. we're much more motivated to avoid a $1.40 loss than we are motivated to achieve a $1.40 gain. And that's exactly what happened. Those in the group that received $1.40 for every day they walked 7,000 steps were no more likely to meet their goal than the control group. The financial incentive didn't work. But those who had a loss-framed incentive met their goal 50 percent more of the time.
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Money can be a motivator. We all know that. But it's far more influential when it's paired with psychology. And money, of course, has its own disadvantages. My favorite example of this involves a daycare program. The greatest sin you can commit in daycare is picking up your kids late. No one is happy. Your kids are crying because you don't love them. The teachers are unhappy because they leave work late. And you feel terribly guilty. This daycare program in Israel decided they wanted to stop this problem, and they did something that many daycare programs in the US do, which is they installed a fine for late pickups. And the fine they chose was 10 shekels, which is about three bucks. And guess what happened? Late pickups increased. And if you think about it, it makes perfect sense. What a deal! For 10 shekels. They took a perfectly strong intrinsic motivation not to be late, and they cheapened it. What's worse, when they realized their mistake and they took away the financial incentive, the late pickups still stayed at the high level. They had already poisoned the social contract.
Financial incentives can help, but we shouldn't expect money in health care to do all of the heavy lifting. Instead, perhaps the most powerful influencers of health behavior are our social interactions. Social engagement works in health care, and it works in two directions.
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nd so one of the most powerful ways to change our behavior is to make our activities witnessable to others. We behave differently when we're being observed than when we're not. I've been to some restaurants that don't have sinks in the bathrooms. Instead, when you step out, the sink is outside in the main part of the restaurant, where everyone can see whether you wash your hands or not. Now, I don't know for sure, but I am convinced that handwashing is much greater in those particular settings. We are always on our best behavior when we're being observed.
Write out a new page:
Amazing study that was done in an intensive care unit in a Florida hospital. The handwashing rates were very low, which is dangerous, of course, because it can spread infection. And so some researchers pasted a picture of someone's eyes over the sink. It wasn't a real person, it was just a photograph. In fact, it wasn't even their whole face, it was just their eyes looking at you. Handwashing rates more than doubled. It seems we care so much what other people think of us that our behavior improves even if we merely imagine that we're being observed.
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Doctors use antibiotics more appropriately when they see how other doctors use them. So social influence works in health care. So does tying it to notions of regret or to loss aversion. We would never think of using these tools if we thought that everyone was rational all the time.
