The Cholera Lesson: Why Managing Anxiety Fails (And What Actually Works Instead)

In the summer of 1854, people were dying in a small neighbourhood in London’s Soho district.

Within days, the streets around Broad Street had become a death zone.

Hundreds of people had died and entire families were wiped out.

Doctors worked frantically, trying everything they knew: bloodletting, opium, castor oil, bed rest. They eased suffering where they could, slowed dehydration, and fought to keep people alive once the illness had taken hold.

But they were losing the battle.

One doctor, John Snow, took a diametrically different approach. Instead of focusing on how to treat cholera, he got curious about what was causing people to get cholera in the first place.

He mapped the location of every death, and a pattern emerged:

Almost all cases clustered around a single water pump on Broad Street.

Realising this, Snow removed the pump handle.

Within days, the outbreak collapsed.

Not because cholera had been cured.

Not because symptoms were better managed.

But because the source of the problem had been eliminated.

Like those well-intentioned doctors in 1854 London, most change approaches still focus on managing, coping with, or eliminating “symptoms”¹:

Calming breathing exercises, grounding techniques, mindfulness used to ride out distress, cognitive diffusion techniques, debating or challenging “irrational” thoughts, reframing interpretations in the heat of the moment, positive self-talk, reassurance, distraction, relaxation training, progressive muscle relaxation, guided imagery used to dampen arousal, emotion-regulation skill sets, distress-tolerance tools, urge-surfing, journaling to process feelings, acceptance strategies applied during spikes of emotion, and the list goes on.

Occasionally, prioritising these tools is the best we can do.

Sometimes, these tools backfire and maintain or worsen the problem long-term (for example, see my Panic Free TV series).

But in every case, they share one thing in common:

They focus on what to do to try to regain control after an unwanted response has already been set in motion.

What if we took a fundamentally different approach, like John Snow did?

What if, instead of trying to manage reactions after they’ve already erupted, we could transform how your brain responds to those triggers² so they automatically elicit the response you want instead?

When your response to the trigger changes, the entire downstream pattern effortlessly changes with it.

There’s nothing left to cope with.

There’s nothing left to manage.

The solution is as effortless and automatic as the problem once was.

For a concrete example of what this looks like in practice, see When Change Happens Fast: A Real Case of Automatic Change.

Footnotes for the Scientifically Curious

1. I use the word “symptoms” here simply because it is the language most people are familiar with. Medical terms for mental and emotional suffering (such as “mental illness”, “disorder”, or “symptoms”) are best understood as frames—one way of organising experience—rather than empirically discovered truths. Research shows that strongly medicalised framings of psychological distress tend to increase pessimism, stigma, and perceived lack of control. Throughout this article, “symptoms” refers to learned, patterned responses, not evidence that you are broken or ill. ↩︎
2. I use the word “trigger” as a colloquial term. Emotions aren’t mechanically triggered by external events; they’re constructed, based on predictions the brain generates as result of past learning, context, current body signals, and other factors. ↩︎