Overcoming Depression: An In-Depth Interview Dr. Alex Korb

In this article, I’m excited to sit down (virtually!) with Dr. Alex Korb, acclaimed neuroscientist and author of “The Upward Spiral”.

In this intimate discussion, Alex candidly shares his journey to a PhD in neuroscience, while seeking answers to his own mental health questions.

We’ll explore his perspective on the roots of depression and anxiety, the power of positive habits, and his daily routine.

Through his compassionate lens, we’ll learn the strategies we can employ for positive change, as well as emerging developments in the field of psychology.

Enjoy!

Find Alex on his website or Instagram.

Alex Korb Interview

1. Can you share a little of your background and how you became interested in mental health?

I’ve always been interested in how things work, including how my own mind worked.

In college I took a neuroscience class and realized that neuroscience explained so many of the questions about myself that I was interested in.

I’ve struggled at times with feelings of anxiety or depression, and I found it validating and comforting that mental health challenges could be explained by what’s happening in the brain.

Eventually I wanted to commit to understanding these things on a deeper level so that I could help more people, and that’s what led me to get a PhD in neuroscience.

2. Much has been written on the potential origins of mental health issues – but what causes depression and anxiety?

People often think there’s something “wrong” with their brain if they have depression or anxiety, but that’s not really the case.

There’s no brain scan or EEG or lab test you can take that will diagnose someone with depression.

And yet these issues originate from what’s happening in the brain.

However, it’s not a part of the brain that’s malfunctioning or broken, it’s an issue with the dynamic communication and tuning of numerous brain circuits.

It’s a problem with how the thinking, feeling, habit, and reward circuits are communicating with and regulating each other.

3. You’ve written a book on depression that has resonated with many readers. Can you provide a brief summary of “The Upward Spiral”?

The Upward Spiral can be summarized in a couple main points.

1. There’s nothing “wrong” with the brain in depression, but it is caused by the tuning of particular brain circuits. Specifically there’s a problem with how the thinking, feeling, and action circuits are communicating with and regulating each other.

2. Small positive life changes – in thinking, actions, etc – cause small brain changes – in its electrical activity and chemical composition. In short you can change the tuning of key brain circuits. And those small brain changes make it easier to make further positive life changes.

4. It seems that forming incremental habits is crucial in mitigating depression. Can you share what this looks like in practice and the science behind it?

Habits are mediated by a brain region called the dorsal striatum, and they all share the same basic structure whether they are “good” or “bad” habits.

The dorsal striatum doesn’t make a distinction.

To start, a habit is triggered by something – an external event, another habit, a thought, an emotion, etc.

That makes you do the habit, which benefits you in some way.

And because it benefits you, the neural connections that caused you to do the habit get strengthened.

That means each time you repeat an action in a certain situation it makes it more likely that you’ll do that action again in the future.

So the goal is to recognize the bad habits you’re stuck in and figure out how to stop triggering them or stop strengthening them.

And part of that is to figure out how to start triggering more positive habits and strengthening those.

5. What does your own daily routine look like?

My daily routine isn’t magical.

And one of the keys I emphasize in coaching people is that you can’t just hope to copy someone else’s routine, because your brain is unique, and your circumstances, goals, and values are also unique.

You just need to make sure that your routine helps your brain function optimally.

1. I wake up around 6:45, read a bit, play with my kids and then take them to school.
2. I usually go for a 10-minute walk in the morning before starting work.
3. Throughout the day I take frequent breaks to relax and refocus and move my body.
4. In the afternoon I usually go for another 10-minute walk or sometimes a run (you don’t really need as much intense exercise as most people think).
5. I don’t have a big mindfulness or gratitude practice, but instead practice small bits throughout the day – though that usually only works when things are mostly habitual.
6. Family time and reading and family dinner in the evenings.
7. And most nights after the kids go to bed my wife and I watch TV we’re excited to watch (as opposed to just watching TV for the sake of watching TV).
8. Bedtime around 10:30PM.

6. I love your quote, “We don’t just choose the things we like; we also like the things we choose.” People with depression are often reported to have difficulty making decisions – how can they become more decisive?

People can become more decisive by listening to what their emotions are telling them about what’s truly important to them.

From there it’s important to be compassionate towards yourself and accept that you don’t have full control over everything, nor do you have complete information.

It’s also helpful to stop trying to make the perfect decision or the “best” decision, and just make a good decision.

Often you don’t have enough information to know what the “best” decision is.

But usually there are tons of good decisions available to you that are all better than sitting there doing nothing but worrying about making the “wrong” (i.e. not “best”) decision.

7. Goal-setting is often discussed as an essential part of mental health. If someone feels stuck, how do they know which goals are worth pursuing?

When you’re really stuck you usually can’t know which goals are worth pursuing.

Though if you do know, then great! Pursue them!

To see if you already know, start by thinking about your ideal future without worrying about whether it’s “realistic.”

In other words, what do you dream about?

That’s a good hint at where you should start setting goals.

But if you don’t know which goals are worth pursuing, that’s fine.

In that case you just have to take your best guess and get going.

In other words, pick a goal and start taking action.

Once you start moving somewhere you gain more information about yourself and you can adjust or pick a different goal entirely.

Think of it like an experiment.

You don’t know the answer before you start.

You just have a hypothesis and you test it out.

And then incorporate that new information into a new hypothesis and keep going.

8. You’ve said that “Positive life changes, even very small ones, lead to positive brain changes”. How do self-belief and developing a positive self-image affect mental health?

When you start with the assumption that you’re broken and irreparable, it’s very hard to take positive action, because your brain often interprets everything through a negative lens.

It’s much more useful to treat yourself with compassion at stop getting in your own way by calling yourself “broken.”

That’s not to say that everything is perfect, just that you’re aren’t broken or damaged.

From there it’s helpful to adopt a growth mindset – the belief that through hard work you can change (and it’s also a more accurate description of your biology).

So when you start from the assumption that it’s possible to change your brain and strengthen your mental resilience, then it becomes much easier to change.

9. What is the relationship between happiness and depression – does one emerge naturally in the absence of the other?

Happiness and depression have a complex relationship.

In depression there’s often a dearth of happiness, but it can still show up (sometimes making the depression more painful by contrast).

Happiness can also help combat depression, but simply eliminating depression does not guarantee happiness.

It is more helpful to think of both as processes as opposed to fixed states.

10. “The Upward Spiral” emphasizes the role of social connections in mental health. How can someone, who has a tendency to withdraw, start engaging with others and maintaining relationships?

Three tools are very helpful:

• Practicing self-compassion. Because the brain circuits we use to understand other people’s motivations (the medial prefrontal cortex) are the same ones we use to understand ourselves, that presents a great opportunity. By treating yourself with more kindness and less criticism it becomes easier to expect and accept kindness from others.
• Practicing gratitude. Focusing on and expressing what you’re grateful for helps increase our sense of connection with others, even if you’re by yourself.
• Notice when your tendency to withdraw is getting in your way and take steps to reduce your isolation. That doesn’t mean you need to have deep conversations with people, or meet new people, or even talk to anyone at all. Just be around people more. Do activities with others.

11. Are there any common misconceptions about depression and anxiety that you encounter in your work?

People often have a stigma against depression and anxiety, particularly depression.

They also have stigmas against particular treatments, like medication, because they think it confirms that there’s something “wrong” with them.

But there’s nothing “wrong” with the brain in depression or anxiety, and it does not mean you’re weak or a bad person.

In fact, many of the characteristics that make someone smart, successful, and purpose-driven are also the same characteristics that increase the likelihood of getting stuck in depression or anxiety.

12. Your books and advice have been extremely well-received by readers. Are there any reader stories that you’ve been particularly moved or inspired by?

Every so often I get an email or message from someone saying how The Upward Spiral helped save them.

I remember one guy I knew a while ago recently reached out and shared how he had had a specific plan to take his own life.

But he fortunately made a different decision and wanted to let me know how The Upward Spiral had helped save his life.

I am incredibly grateful that I’ve been able to share all this amazing science with the world and that it’s had such a profound impact on so many people’s lives.

13. What are your favorite books you recommend to everyone, and why?

The book I recommend most often is Difficult Conversations.

It’s so incredibly insightful and useful in reducing stress and improving communication and connection with friends, colleagues, bosses, and spouses.

I also often recommend Man’s Search for Meaning to help people understand the importance of meaningfulness and purpose in life.

But it’s also just a really moving story.

14. Do you have any favorite quotes?

Here are a few of my favorite quotes:

• “In the depth of winter, I finally learned that within me there lay an invincible summer.” – Albert Camus
• “My life has been full of terrible misfortunes most of which never happened.” – Michel de Montaigne
• “Truth out of season bears no fruit.” – Meng-tzu

15. What are the most promising areas of research or potential treatments in neuroscience that could revolutionize how we approach mental health in the future?

The most promising treatments for anxiety and depression are coming from research into psychedelics.

These are not traditional medicines, in that it’s not simply the chemical that creates a therapeutic effect.

The chemical is simply a reliable way to create a transformational experience, and the experience is what has the therapeutic effect.

There’s a lot of cool high-tech stuff too, on various neuromodulation techniques, some of which I’ve been a part of.

But while neuroscientists should keep searching for better treatments, no amount of research will entirely solve the inherent challenges of having a human brain.

People who want to improve their mental health should better utilize the neuroscience we already have to empower themselves.

Conclusion

✍️ There is nothing inherently “wrong” with the brain in cases of depression or anxiety. Instead, these conditions originate from issues with the dynamic communication and tuning of various brain circuits.
✍️ Small positive life changes can lead to small but significant changes in the brain’s electrical activity and chemical composition, promoting a positive cycle of change. This includes cultivating beneficial habits and practicing self-compassion and gratitude.
✍️Personal routines should be tailored to an individual’s unique brain, circumstances, goals, and values. For Dr. Korb, this includes frequent breaks throughout the day, physical movement, and mindful moments.
✍️Taking action towards your goals, even without complete information or certainty, can help individuals struggling with indecision. Treat decisions as experiments to gather more information and adjust as necessary.
✍️Emerging research into psychedelics and neuromodulation techniques hold promise for future treatments in mental health, but existing neuroscience can be used more effectively to empower individuals in their mental health journey.