Default Mode Network

I think of a patient, a composite drawn from several people I’ve seen with this presentation. The air seemed to tighten when she walked into the room; her breathing was faster than it should have been, not laboured but fast, and as she sat, I could see a fine tremor in her hands whilst her fingers constantly fidgeted in her lap.

It was anxiety that had driven her to see me. Her sleep was fretful, her concentration was poor, she’d been getting annoyed with people around her, and recently she’d been getting full-blown panic attacks. The last one necessitated an ambulance trip to the local emergency department.

In hospital, they’d systematically ruled everything out — ECGs, blood tests, a chest X-ray, arterial blood gases. Not a heart attack, not an abnormal heart rhythm, not a blood clot on the lung, not any of the genuinely dangerous conditions that could present with similar symptoms.

She looked at me, confused and frustrated. It can’t be a panic attack, she said. I wasn’t doing anything stressful.

With that phrase, she’d inadvertently hit the nail on the head. Part of where the problem lay, and part of where a solution existed, was in something called her Default Mode Network.

What Your Brain Does When You’re Doing Nothing

The Default Mode Network (DMN) refers to the parts of your brain that are active during your default state, when you are not engaged in a specific task. These areas fire when you’re busy doing nothing. Researchers believe that during inactivity, your brain reviews, replays and remembers past experience, and plans future action — and that this same network underlies a good deal of spontaneous, wandering, and creative thought.

Sounds useful, doesn’t it? A system that helps you plan, review experience, and think creatively. What could go wrong?

Quite a lot, as it turns out.

When Your Default Mode Goes Wrong

The trouble is, the Default Mode Network can overdo it. Left to its own devices, it can get stuck replaying negative memories, driving rumination over negative thoughts and experiences. Its creative element can conjure worst-case scenarios, surrounding you with a world of imagined catastrophe.

Research using brain imaging shows that the DMN is overactive in a range of conditions, including anxiety, depression, ADHD, PTSD, and chronic pain. An overactive DMN isn’t necessarily the cause of these conditions, but that doesn’t mean we can’t look at how turning it down might help with managing them.

My patient wasn’t doing anything stressful when her panic attack hit. That was precisely the problem. She was sitting at home, relaxing, or trying to, doing nothing. Her Default Mode Network kicked in, and instead of helpful planning or creative thinking, it started replaying every stressful thing that had happened that week, every worry about the future, every catastrophic possibility her brain could conjure.

Within minutes, she was hyperventilating. Her heart was racing. She was convinced she was dying. This is the pattern psychologists call the catastrophic misinterpretation of bodily sensations, first described by the psychologist David Clark: her heart rate rose, she noticed it and interpreted it as a sign of a heart attack, which raised her heart rate further, which confirmed the fear, and the cycle escalated into a full panic attack. Her body responded to her brain’s catastrophic thoughts as if they were real threats, because to her nervous system, they were.

The Task Positive Network

Here’s where it gets interesting. The part of your brain that you use when you’re actively doing something is called the Task Positive Network (TPN). When you’re engaged in a task, the TPN lights up, and the DMN reduces its activity. They’re inversely related. When one’s active, the other quiets down.

There’s a condition called a flow state, when you’re totally engrossed in a semi-complex task. In a flow state, the TPN is fully engaged, and the DMN has effectively shut down. You don’t have to reach a flow state to know that sometimes keeping busy is the only way to take your mind off your worries.

Studies on cognitive engagement repeatedly show this pattern. When people are actively engaged in tasks requiring attention, their anxiety decreases, rumination stops, and mood improves — not because the problems disappeared, but because attention shifted from internal catastrophising to external engagement.

The Anxiety Paradox

This brings us to what’s called the anxiety paradox. Your mind is more likely to relax if you’re doing something, when the TPN is predominant and the DMN switches off, rather than when you’re doing nothing, when the DMN becomes overactive.

Think about that for a moment. You’re more relaxed when you’re busy than when you’re trying to relax. Your anxiety decreases when you’re engaged in tasks, and increases when you’re sitting quietly doing nothing.

This is counterintuitive. We’re told to relax, to take time for ourselves, to just sit and be. And for some people, that works beautifully. But for many people, particularly those with overactive Default Mode Networks, doing nothing is the worst possible strategy, because doing nothing is when their brain starts catastrophising.

I explained this to my patient. Her homework wasn’t to relax more. It was to recognise when her DMN was spinning up and actively engage her TPN. When she felt anxiety building, she needed to do something — clean the kitchen, organise a drawer, solve a puzzle, call a friend. Not to avoid her problems, but to shift which network was dominant in her brain.

Training Your Brain

As well as staying busy, you can train your brain to turn down your Default Mode Network. Mindfulness-Based Cognitive Therapy is the correct name for one well-evidenced structured approach to this, and it’s specifically a manualised programme developed for relapse prevention in recurrent depression, not a general label for meditative practice. In recent years, research has repeatedly shown that the brains of people who practise meditation function differently from those who don’t.

Meditative practice appears to turn down the DMN. The TPN engages. Awareness shifts from the past or the future back into the present. This is one of the ways mindfulness can help with an overactive DMN and the negative moods that ruminate from it.

Research on long-term meditators shows changes in brain function consistent with this: the Default Mode Network becomes less reactive, and the connections between the DMN and areas responsible for emotional regulation appear to strengthen. Cognitive behavioural therapy, which is NICE-recommended and has one of the strongest evidence bases in psychological medicine, can also help retrain unhelpful thought patterns over time.

The Medication Question

Perhaps not everyone’s open to the thought of starting a meditative practice or seeing a therapist. Most people, however, are open to simple lifestyle advice and stress management techniques. Some people want a quicker route, and clinicians commonly prescribe medication to treat anxiety.

Research comparing psychological therapy with medication suggests comparable efficacy for many people with mild to moderate anxiety and depression, though the picture is more mixed at greater severity, and adding psychological therapy to medication tends to improve outcomes further.

I’m not anti-medication. Sometimes medication is absolutely necessary and appropriate. But I’ve seen too many people prescribed medication as a first-line treatment without any discussion of lifestyle changes, cognitive therapy, or mindfulness practices. We’re sometimes medicating overactive Default Mode Networks when we could also be training them.

‘Have you tried therapy?’ I often ask.

‘It doesn’t work, Doc,’ is often the reply.

It’s worth being honest that therapy fails people for lots of reasons that have nothing to do with effort — the wrong approach for the problem, too few sessions, a therapist who wasn’t the right fit, or simply not enough time for it to take hold. ‘It didn’t work’ is very often ‘that particular attempt didn’t work’, and it’s worth trying again, differently, before concluding therapy isn’t for you.

What Happens When You Do Nothing

Take a few minutes to ask yourself what happens when you’re doing nothing. Where does your mind wander? Where do your daydreams take you?

If you’re like most people with overactive DMNs, your mind doesn’t wander to pleasant places. It wanders to problems, to worries, to regretting the past and imagining catastrophes about the future. You ruminate. You replay conversations. You imagine worst-case scenarios.

My patient started practising mindfulness — ten minutes daily, focusing on her breath, bringing her attention back to the present when it wandered. She also started recognising when her DMN was spinning up and actively engaging in tasks when it did. Within a month, her panic attacks stopped. Within three months, her anxiety had decreased significantly.

Her Default Mode Network hadn’t disappeared. It was still there, still active during rest. But she’d trained it. She’d learned to recognise when it was becoming problematic and shift her attention deliberately. She’d taken some control over which network dominated at any given time.

The Practical Application

Here’s what you need to understand. Your brain has two primary modes: active mode, the Task Positive Network, and default mode, the Default Mode Network. In active mode, you’re engaged with the world, focused on tasks, present in the moment. In default mode, your brain reviews, plans, and often catastrophises.

For some people, the default mode is helpful. Creative insights emerge. Problems get solved. For others, particularly those prone to anxiety or depression, the DMN becomes a place of rumination and worry.

If you’re in the second category, the solution isn’t to never be in your default mode — that’s impossible. The solution is to recognise when your default mode is becoming problematic and deliberately shift into active mode. Engage your Task Positive Network. Do something, anything. And if you want a more lasting change, train your Default Mode Network through mindfulness practice or a structured therapy such as CBT. Teach your brain that when it’s left to its own devices, it doesn’t need to catastrophise. It can rest without torturing you.

If panic attacks are a regular part of this picture for you, it’s worth knowing that they respond very well to treatment. Cognitive behavioural therapy for panic is a NICE first-line treatment with strong evidence behind it, and in England you can refer yourself to NHS Talking Therapies without needing to see your GP first.

Remember what my patient said: it can’t be a panic attack, I wasn’t doing anything stressful. That was the problem. She wasn’t doing anything. Her Default Mode Network was. And until she learned to manage it, doing nothing was the most stressful thing she could do.

Further reading

1. Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., & Shulman, G. L. (2001). A default mode of brain function. Proceedings of the National Academy of Sciences, 98(2), 676–682.
2. Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. (2008). The brain’s default network: Anatomy, function, and relevance to disease. Annals of the New York Academy of Sciences, 1124, 1–38.
3. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-Based Cognitive Therapy for Depression (2nd ed.). Guilford Press.
4. Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang, Y. Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity. Proceedings of the National Academy of Sciences, 108(50), 20254–20259.
5. Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. Harper & Row.