The Art of Manliness - #396： How to Deal With Anxiety

00:00:00.000 Hello, Brett here. Before we get to today's show, got a quick favor to ask of you. If you've been

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00:00:52.540 $20 off your first custom shirt today. Brett McKay here, and welcome to another edition of

00:01:11.460 the Art of Manliness podcast. Recent surveys have shown that rates of anxiety are up, especially among

00:01:16.160 young people. What's going on? And if you're someone of any age who struggles with anxiety,

00:01:19.820 what can you do about it? Those are just a few of the questions I asked my guest today. His name

00:01:23.620 is Kevin Ashworth, and he's the clinical director at the Northwest Anxiety Institute. Today on the

00:01:27.640 show, Kevin and I discuss the difference between regular old worrying and anxiety disorders, the

00:01:31.280 ill effects of anxiety, and its causes. Kevin then explains some of the different ways anxiety

00:01:35.480 manifests itself in men and women, and some of the theories out there as to why it's been on the

00:01:39.940 uptick in recent years. We end our conversation with some research-backed ways to get a handle on your

00:01:43.960 anxious feelings. After the show's over, check out the show notes at aom.is slash anxiety.

00:01:48.520 And Kevin joins me now via clearcast.io.

00:02:03.380 All right, Kevin Ashworth, welcome to the show. Thank you very much. Happy to be here.

00:02:11.260 So you're a psychologist. I read about you in the New York Times because you also are the director of

00:02:16.000 the Northwest Anxiety Institute, and that's based in Oregon, correct?

00:02:20.420 That's right. We're in Portland, Oregon. I'm actually a licensed professional counselor

00:02:24.200 and the clinical director of Northwest Anxiety Institute.

00:02:27.320 So what got you into focusing on clients or patients or people, individuals who have anxiety

00:02:34.320 problems?

00:02:35.700 You know, my interest in psychology, I kind of got there by, I don't want to say by mistake,

00:02:41.680 but I initially started working with adjudicated youth, realizing I need graduate training.

00:02:47.340 Once I got into grad school, I met a professor that he really was an anxiety guru. He had published

00:02:52.240 on anxiety and really taught me how to do exposure therapy, which is the kind of work that I do.

00:02:58.280 It's a type of cognitive behavioral therapy. And since meeting him and reflecting on my own life,

00:03:04.440 I realized that I was a much more anxious kid than I thought I was.

00:03:07.200 And I really saw this passion of working with people that, one, you could actually help get

00:03:12.220 better. Anxiety is very, very treatable. And do it with a type of therapy that is very hands-on,

00:03:18.980 very matter-of-fact. And I love the idea of helping people build tolerance to distress versus

00:03:24.240 helping them just layer their life with extra coping skills, which we already know how to do.

00:03:29.840 So let's talk about what is an anxiety disorder. I think all of us have experienced worry at some

00:03:35.560 point. When does worry transition to like, okay, this is actually an anxiety disorder?

00:03:41.700 Good question. We look at two things. We look at impairment and distress. You're right. We all

00:03:47.600 worry and we should. If there's anything that's important in our lives, we have some interest or

00:03:53.120 some investment in anything, whether that's going on a date or having a job interview or passing a class

00:03:58.300 or whatever it is, we should have some anticipatory concern that we're going to do well.

00:04:02.840 And that's pretty standard. It becomes problematic when that level of worry or that level of anxiety

00:04:09.480 stops you from functioning. And that doesn't mean complete functioning, like you're not going to

00:04:13.320 work or anything like that, but you're not enjoying work because you can't focus on your daily tasks

00:04:19.080 because you're constantly living in the future. You're anticipating every worst case scenario,

00:04:23.240 or you're having panic attacks where you start really questioning whether you should leave your

00:04:28.360 house when, especially in this day and age, when you can order everything to your home,

00:04:31.620 it becomes really easy to avoid. So the difference between angst and general concern and worry versus

00:04:38.680 an anxiety disorder is we're looking at like pathological levels of distress and impairment.

00:04:44.540 And can individuals be anxious about certain types of things, like maybe, but like not others,

00:04:49.920 right? Oh, absolutely. Yeah. I mean, one of the reasons I love doing this work is I work with

00:04:54.900 really, really intelligent, logical, high functioning individuals that are anxious about the strangest

00:05:01.820 things. And that's partly why they're so anxious is because they've got such an awesome brain that

00:05:06.320 allows them to think about stuff too much. And so I can be obsessed with this irrational fear of

00:05:13.420 contracting AIDS, let's say from walking down the street, or that I'm going to be judged at an interview

00:05:19.000 for a podcast and then have absolutely no concern about public speaking or no concern about skydiving

00:05:24.860 or any other kind of normal or abnormal or extreme life events or behavior. So anxious individual or a

00:05:32.060 warrior do not necessarily worry about everything. Gotcha. And besides, I mean, you've talked about

00:05:38.020 what constitutes anxiety disorder, like you worry to the point where it impairs you in some way. I mean,

00:05:43.800 besides the impairment where your work isn't going great or whatever, how else can anxiety

00:05:50.060 debilitate people? The number one way that most people try and cope with their anxiety is through

00:05:56.660 avoidance. And so this is probably the most clear sign that individuals are starting to suffer from

00:06:04.040 anxiety. Ultimately, I ask people, are you making decisions throughout your day based on preference or

00:06:08.400 fear? And avoidance doesn't have to be, you know, extreme avoidance. It's really insidious. It could

00:06:14.180 be, it could be the difference between sitting at a coffee shop facing the wall or not. And if you do

00:06:20.080 that based on, I don't want people to notice me because I'm sitting alone and that makes me worried.

00:06:24.520 Now you're making a decision based on fear. Or it could be, you know, the student that's not going

00:06:28.560 to school because they're, and avoidance shows us that they're anxious, but we don't know yet why.

00:06:33.520 That could be because of the school that the grades, the academics, that could be because of

00:06:38.600 the public speaking component. That could be because of the social component, but avoidance is

00:06:42.580 for sure the best way to identify anxiety in individuals. And do people with anxiety disorders

00:06:49.180 often try to self-medicate in detrimental ways? Yeah. Well, anxiety is a lot about just not wanting

00:06:54.860 to feel bad. And so this comes back to that question about how do you make your decisions? You know,

00:07:00.420 I enjoy whiskey. I enjoy bourbon a lot. And there's a big difference if I get off work and

00:07:05.800 have a bourbon versus if I feel bad, I have a bourbon. Now the difference is, is one's developing

00:07:12.020 a functional relationship. And so every time I have a drink, I feel less anxious. Now my brain is

00:07:17.360 learning pretty quickly that that's really helpful. And so whether it's that, or I smoke a joint, or I do

00:07:23.500 any other kind of substance, I quickly, my brain quickly learns that I actually feel less bad and

00:07:30.980 I don't have to tolerate these worrisome thoughts or these awful physical symptoms. And so my goal is

00:07:36.700 helping people enjoy whatever recreational substance you may enjoy. And of course, that's not my role is

00:07:45.360 to judge people on how they make decisions, but it's more of what's the relationship you have with

00:07:49.740 that. But we know pretty quickly that, you know, alcohol is a depressant. So anxiety is about being

00:07:54.820 too activated. So it helps. Marijuana, on the other hand, can make people actually more anxious because

00:08:01.080 you're messing with your physiology in ways that you're not quite sure how. Alcohol is pretty consistent

00:08:05.680 in how it does that. I'm curious, you know, with you mentioned depression, the research has shown

00:08:11.020 there is, there's a genetic component to it. It's something that's inheritable that you might have a

00:08:14.940 tendency or temperament towards depression. Is it the same thing with anxiety? Are some people more

00:08:19.100 prone to having anxiety disorders? Yes, absolutely. And again, it's similar to depression that we don't

00:08:24.840 exactly know why or how much, but we know there's genetic loading. We know that anxious parents

00:08:29.740 typically have some anxious children. And again, it's hard to pair out there is that because they've

00:08:34.200 kind of modeled anxious behaviors, but there is definitely more of a vulnerability to the reactivity

00:08:42.780 of thinking too much and worrying too much and also being just sensitive to your physiological

00:08:48.220 reactivity. I'm a pretty, I'm pretty sensitive to my body. You know, my stomach hurts and my heart

00:08:54.100 skips a beat. I'm aware of it where my wife, for example, I think she just thinks less or cares less 0.81

00:08:59.800 about those things because she's just not wired that way. And so if I start behaving very differently

00:09:05.180 because of my changes in my body or anxious thoughts, then I can quite quickly develop an anxiety

00:09:10.820 issue. And besides that, you just mentioned that there could be an environmental component.

00:09:15.380 So maybe you grew up around anxious parents and you caught that vibe from them and that's,

00:09:20.540 you learned how, that's how you cope with life is just by worrying about it excessively.

00:09:25.020 Yeah. And so the story I tell people is when I was in graduate school, I had never had a panic

00:09:32.100 attack before, but I got stuck in an elevator and I never thought I was claustrophobic or particularly

00:09:37.440 an anxious individual. So this is an environmental stimulus. I got stuck in an elevator. My body just said,

00:09:42.920 no way to get me out of here. I felt extremely anxious, felt like I was panicking, got out of

00:09:47.900 the elevator. Of course, that's the process of classical conditioning. My brain pairs this neutral

00:09:52.820 stimulus of the elevator with the sphered stimulus and they become wedded. When I left class that day,

00:09:58.200 I walked up to the elevator and my brain triggered that same response without me even getting on.

00:10:02.700 So I took the stairs, which is avoidance. That's how an anxiety disorder is born. I start making

00:10:07.920 decisions based on feeling and there may or may not have been a genetic loading there or not for

00:10:13.500 any individual. But if you make those decisions based on feeling bad, you can quickly get in that

00:10:18.800 loop. So there's been recent research. I've been reading articles about this past few years is that

00:10:24.440 anxiety disorders are on the rise, particularly amongst young people, like teenagers and young

00:10:30.720 20 somethings. Have you noticed that in your own practice? And what do you think's going on there?

00:10:36.480 Yeah, there's a few things I think to account for that one is we are just getting better at having

00:10:42.360 conversations about what anxiety is. You know, 40 years ago, 50 years ago, you know, we called it

00:10:47.680 things like nervous breakdowns and we had different names for it. And our diagnostic criteria has gotten

00:10:53.400 better for kind of understanding it. So that definitely has a component, I would say. But we are also

00:10:59.360 parenting shifted in the 70s and 80s. And, you know, with the baby boomers having children,

00:11:05.000 they started parenting quite differently. And I think a big component is, we went away from helping

00:11:10.660 teach children how to tolerate distress. And we started helping them really to soothe. And I think

00:11:16.820 the job of parents went from child raising to basically how successful my kiddo is, is a reflection

00:11:24.380 of how I am as a parent. So parents started doing everything for kids. So now we've got kids in their

00:11:29.040 20s, who parents have been the ones that registered them for college. And they're the ones that probably still

00:11:33.900 do their laundry. And they're the ones that when they feel the stress, bail them out. And so over

00:11:38.060 time, you really reduce your tolerance for feeling bad. And I think that has a huge component.

00:11:43.160 So yeah, so the kids today haven't exercised that muscle tolerance, right?

00:11:48.500 Yeah, exactly.

00:11:49.640 I'm curious, you mentioned depression. Is anxiety often linked with depression? Or can you

00:11:55.560 be anxious and not depressed? Or do you often see the two come together?

00:11:59.160 We do see them together a lot. There's a high, we call comorbidity rate between anxiety and

00:12:05.020 depression. But there's plenty of individuals that suffer from an anxiety disorder and are not

00:12:09.520 depressed. You know, the age old chicken or egg question becomes with this, but anxiety is very,

00:12:15.080 very prevalent. And we're talking, you know, 25 plus in childhood percentage. That's a lot of people.

00:12:21.920 And if you've ever experienced distress, or intense anxiety, you feel pretty hopeless. And that often

00:12:28.040 turns into a feeling of demoralization, which looks just like depression. And the question that the

00:12:34.260 test, the litmus test that I asked my clients is, if your anxiety disappeared tonight, no more worry,

00:12:41.640 no more panic attacks, no more obsessive thoughts, would you still feel depressed? And they often say

00:12:47.100 no, they don't think so. But the truth is, is if their depression went away, would you still be anxious

00:12:52.180 and have obsessive thoughts and panic attacks? And the answer is yes. So we know there's plenty of

00:12:56.800 people that suffer from depression that don't have an anxiety disorder. And there's plenty of

00:13:00.480 people that are anxious that aren't depressed. But I think often depression is misdiagnosed when

00:13:05.020 anxiety is the cause. So this is the Art of Manly's podcast. Most of our audience are men. And I know

00:13:09.800 we've had guests on the podcast talking about depression, how depression often manifests itself

00:13:14.500 differently in men than in women. That's why it's often hard to find. So I guess men, when they're

00:13:20.120 depressed, they'll often get angry. You know, they're not, they don't look sad. They act angry.

00:13:24.220 I'm curious. Is there another, is there something similar with anxiety? Do men express anxiety

00:13:28.380 differently than women? Yeah. Men are, men are very good at avoiding and emotionally that looks 1.00

00:13:33.980 like just shutting down. Right. And so if I distract phones, video games, magazines, bars, alcohol,

00:13:40.500 whatever it is, the gym, right. If I pour my attention into something else, I'm trying to relieve any kind

00:13:48.180 of distress that I have related to anxiety. So the difference is, is, you know, we know the rates of

00:13:53.180 anxiety are higher in women, but that's most likely because women are reporting it more. Yeah. It's

00:13:58.860 just, culturally, it's just, it's safer for women to say, Hey, I'm suffering from anxiety. It's really

00:14:03.380 hard for, for guys who admit that because it is really owned as a sense of like weakness or

00:14:09.080 vulnerability is not good or not to talk about it. And I see a lot of men in my practice

00:14:13.180 that has taken them, you know, some serious work and time just to even call in and make the,

00:14:18.640 make the initial intake appointment. So, but you're right, you know, things like agitation,

00:14:23.100 when I see angry or agitated men, usually there's an anxiety beneath there that they haven't ever

00:14:28.640 processed or haven't really ever been able to even identify. And if I can say a little bit more,

00:14:34.220 I think, you know, many times what I, what I tell people is most of us remember the first time we

00:14:42.500 ever saw our dads cry. And if ever, and the fact that that's like a pivotal event that you can

00:14:48.780 remember speaks to how poorly our culture allows men to express emotion. That's not the first time

00:14:55.120 your dad was sad. I can promise you that, but usually that's either dumped behind closed doors

00:15:00.280 or they have learned very quickly, like don't express sadness. So as we grow up as men, we have

00:15:06.460 never really been modeled how to manage negative emotion. We know how to behave when we're happy or

00:15:11.660 surprised or excited, but now we have no practice or modeling on what to do with these really

00:15:17.040 hard feelings. And I think that's a big component of why guys then express that in other ways.

00:15:24.200 So let's get into sort of the specifics of the faulty thinking that goes on with anxiety problems.

00:15:30.360 So you mentioned when you have an anxiety problem, you're making decisions based on fear. That fear

00:15:35.940 must be irrational. So how, what happens in our brain to like kickstart that irrational thinking

00:15:42.680 where you mentioned the elevator thing, like, okay, you got stuck in an elevator, then you started

00:15:47.440 avoiding elevators. Cause you thought next time I get in that elevator, I'm gonna get stuck again.

00:15:50.620 Well, that's irrational. So what, what goes on that sort of perpetuates that, that faulty thinking?

00:15:57.200 Yeah. You know, our brain is, our brain is developed and it's evolved over time to, to make sure that

00:16:02.280 we're alive, to make sure that we're safe. And so when there's anything that is potentially even

00:16:07.420 dangerous, our brain wants us to protect ourselves. So to give a non, non-anxiety example, most of us

00:16:14.980 have experienced food poisoning. And what happens after we've had food poisoning is most of us stop

00:16:20.280 eating that thing that got us sick, right? Despite logic and knowledge, knowing that, Hey, I've had an egg

00:16:26.220 salad sandwich 600 times in my life. The chances of me getting sick from another one is pretty minimal,

00:16:30.960 but your brain prevents you from having any more, whether that's with a disgust factor or whether

00:16:35.720 that's, it's irrational. If you use logic, anxiety works the same way. So when we're, when we experience

00:16:41.580 distress, one thing that we do is look for meaning. And sometimes it's not there, but we start making

00:16:48.320 association connections with things that are scary. So our brain then through this process of classical

00:16:54.880 conditioning and negative reinforcement works really hard to make us feel better.

00:16:59.260 And then we associate whatever we've done in that time with feeling better and we avoid

00:17:05.000 everything else. So it's, it's this fight or flight response. Anxiety is, is the anticipation of

00:17:12.500 something bad happening, but it's not actually dangerous, right? We don't use the, we don't use

00:17:17.060 vocabulary related to anxiety for actually dangerous events. People don't get T-boned, you know,

00:17:23.400 in a crosswalk and say, I was hit by the car and I went into a panic attack, or, you know,

00:17:27.920 I was really scared with the explosion that occurred and I had all these intrusive thoughts.

00:17:31.780 These are actually dangerous events that people don't even use words to describe like anxiety.

00:17:36.540 But if you anticipate driving and that you may get in an accident at some point, the feelings

00:17:42.140 associated with that, the brain says, Hey, you're feeling bad about that. You should probably

00:17:46.320 shouldn't do it. And so they are irrational. They don't, they don't make logical sense, but we make

00:17:51.640 a lot of emotional based decisions. Like if I feel bad, then it must be true. Does that make sense?

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00:19:53.800 And now back to the show. Yeah, yeah, that makes sense. And another thing I've seen in my own life

00:19:59.020 when it comes to sort of like, at least with worrying, is you make these conclusions that

00:20:05.980 are illogical, right? But the way you get there and the way it makes sense is you make small steps,

00:20:12.460 right? I remember when I was in law school, every time I took an exam, it was,

00:20:16.420 I failed, oh my gosh, I failed that exam. Since I failed that exam, I'm not going to get on law

00:20:20.940 review. And if I'm not going to get on law review, it means I'm not going to get an internship. And if

00:20:24.180 I don't get an internship, I'm not going to have a job and I'm going to be unemployed and have all

00:20:26.980 this law school debt, which, you know, that conclusion is illogical, but it made sense because

00:20:31.040 I made these like small little incremental steps there. Yeah. And we call that, you know,

00:20:35.940 catastrophic thinking, right? Like you're worried about one exam that may or may not impact your

00:20:40.680 future and your brain is helping you get there. And for sometimes that's really rewarding. So if

00:20:47.660 that makes you then study harder for your next exam, you're, there's many processes that are going

00:20:53.800 to reinforce that behavior. Like, look, I actually don't feel distressed after I studied really,

00:20:59.400 really hard. So that's good for me. The problem is, is people that worry like that often, they worry

00:21:04.380 like that over everything. They worry like that over their exams. They worry like that over their

00:21:09.060 friendships that, you know, Johnny hasn't called me back. What's up with Johnny? Why hasn't he

00:21:12.880 called me back? That's weird. I wonder if it's, oh man, you know, I guess I didn't respond to his

00:21:16.860 message last time. I wonder if he's not talking to me and we can go all the way down that catastrophic

00:21:21.360 until we bump into Johnny and he's like, Hey, what's up, man? I haven't heard from you. And we're

00:21:25.020 like, Oh yeah, right. You hadn't thought twice about this. And so we can do that with finances.

00:21:30.680 We can do that with romantic relationships. And that follows a pattern of what we would call

00:21:35.700 generalized anxiety disorder, which is this excessive worry about things that you actually

00:21:40.480 don't have any control over in the moment. And what do you, what can you do if you, I mean,

00:21:45.360 first you have to recognize that you're experiencing this faulty thing, but what do you do once you

00:21:49.000 recognize, are there's actions you can take to like stop it in its tracks?

00:21:54.100 Helping people change the way that they, helping people get better from anxiety is,

00:21:59.120 is analogous to managing one's health. It is not a coping skill that I can say, you know,

00:22:05.440 if you do X, Y, Z, you're going to feel better. That would be like saying, you know,

00:22:08.680 every time you feel fat, do a pushup, you might help right there. You'll probably distract yourself

00:22:14.800 from your thought of being overweight, but, you know, being healthy physically is a hundred

00:22:18.860 decisions a day, you know, from fries to a salad to, you know, walking down the stairs versus taking

00:22:24.980 the elevator. And that's the same with anxiety. So we have to help people change their relationship

00:22:29.460 with their thoughts. It's not about trying to push their thoughts away. It's not about trying to

00:22:33.780 disagree with their thoughts. In fact, if you've ever had an anxious thought and you try and push

00:22:39.780 it away, you know, that thing just gets bigger and bigger and bigger. And that's why lots of people

00:22:43.660 struggle to fall asleep at night with their worry is that just they've distracted themselves all day.

00:22:48.240 And then once they lay down, they're hit with all these thoughts that they just don't have the

00:22:51.440 cognitive resources to keep away anymore. So the strategy that takes time is I think kind of

00:22:59.340 having this dance with your anxious thoughts and actually agreeing with them. And so when my brain

00:23:03.940 tells me something that's scary, like, you know, Hey, Kevin, something might happen to your daughter

00:23:08.360 today. I don't know that that's true or not. It's a very irrational thought, but if I tell myself,

00:23:13.080 no, she's safe, she's home. She's probably with my wife. They're probably driving safely.

00:23:17.840 That actually reinforces that I should be concerned. If I'm a little bit more provocative with those

00:23:23.020 thoughts and I say things like, yep, yep. Something might happen to her today. I'm really just kind of

00:23:27.760 saying this thought carries no weight. It's like how you, it's like how you teach kids to manage

00:23:31.700 someone that's teasing you or bullying you. So there's some, some cognitive behavioral

00:23:35.480 therapy things you can do like that. But you mentioned at the beginning that your, your approach

00:23:40.320 and I guess, I mean, maybe the research says this is the best ways is, is, is exposure therapy. So

00:23:44.760 correct. Tell us what exposure therapy is exactly. And what does the research say about that when it

00:23:49.880 comes to anxiety? Yeah. So, so exposure is known to be the gold standard treatment and that's,

00:23:54.800 that's both looking at the national Institute of mental health and exposure is a type of cognitive

00:23:59.540 behavioral therapy. And essentially what it is, it's helping people move towards the things that

00:24:05.540 are scary to demonstrate in real time that the worries, the end, that the potential threat

00:24:11.360 doesn't actually exist. So how do we know there's actually no danger? If I have a thought right now

00:24:17.620 that, you know, in your studio, there's 10 people behind you listening to me, mocking me right now,

00:24:23.140 right? If I think that that's going to make me pretty anxious, although I don't know that to be

00:24:27.260 true exposure. So the best way to manage that would be to change the way that I'm speaking,

00:24:31.880 be very careful about what I say, or in fact, just hang up would be the best way to protect myself.

00:24:37.820 But to manage that thought and exposure thought would be to say, yeah, well, I hope that they are,

00:24:42.560 I hope that they are. And I'm just going to be myself because what happens is the anxiety kind of

00:24:46.560 builds. And then once there's no actual danger, it resolves itself. So to give a very concrete

00:24:52.100 example, if someone is scared of dogs, which is a very basic example, you can't be better,

00:24:58.460 you can't be more comfortable about being around dogs or know that you're not going to be bit every

00:25:02.680 time you're around a dog by avoiding dogs, turning off commercials with dogs, not watching movies with

00:25:08.560 dogs. And you can't buy a coping skill with a long stick that you can pet a dog from afar. What we would

00:25:14.600 do with that individual is depending on their level of fear is we would help them be around dogs

00:25:19.900 until their body relaxes. So that fight or flight system, that brain system that we talked about

00:25:24.800 before we activated on purpose. So we say, let's get a dog, let's activate that. And then let's just

00:25:30.020 sit here. And what happens is your brain goes fight or fight, fight or flight, fight or flight,

00:25:35.180 danger, danger. Oh, nothing's happening. Let's turn off this system, which turns on this parasympathetic

00:25:41.120 nervous system and relaxes an individual or calms them from their distressed state. And then the brain

00:25:47.320 learns very quickly that I don't have to respond with anxiety when I'm around the stimuli. And it

00:25:52.340 doesn't matter if it's a dog or anything else because I'm not actually in danger. Now, if the

00:25:58.120 dog walks in and I leave every single time, I'm actually proving to my brain that is potentially

00:26:02.800 dangerous. I haven't been bit because I haven't been around the dog. Well, that's true. And so that

00:26:07.440 becomes, that's why avoidance works so well for people because they're, even though they're enduring

00:26:12.160 the distress, nothing bad is happening, but they have no tolerance now for managing it.

00:26:17.620 And how long does exposure therapy take? Does it just depend on the person? Is it different?

00:26:21.400 Yeah, it really depends on the person. Some things like phobias, phobias, we actually have a lot of

00:26:26.780 success in treating in one day. And so I've treated individuals with fear of heights, fear of needles,

00:26:32.640 what are some of the other fears that, but there's a, there's a protocol that is a six hour

00:26:36.680 prolonged exposure protocol that has been proven to be very effective. And so

00:26:40.940 you're essentially just recreating the feared stimulus over and over and over until the brain

00:26:45.320 says, Oh yeah, that's true. I got this. And, but for most people they're in therapy about,

00:26:51.780 it depends. They have about 16 to 20 weeks. We have a Northwest anxiety. We have an intensive

00:26:57.460 outpatient program. And so we have a three week program where people come three hours a day,

00:27:01.780 every day for three weeks, well, five days a week. And that's very effective because it's not,

00:27:05.980 therapy is not set. The way that we do therapy is I don't need you to go home and just experience

00:27:12.140 life to come back and have a chat about it. You know, if you're here for a specific anxiety issue,

00:27:16.500 whether I see you every day in a row or not, we need to work on that issue. So the frequency is

00:27:20.540 really, really important. What about like more, not a phobia, but say you're a college student

00:27:25.700 and you're just anxious about failing out of college or you're, you're out in the job market and

00:27:32.020 you're anxious about not being able to find a job and it's just causing you a lot of anxiety

00:27:37.360 because it's not, you're not able to pay the bills. How does exposure therapy work for things

00:27:40.900 like that? Yeah. Typically exposure then becomes a conversation about what you can control. So those

00:27:48.260 kinds of anxieties usually load on uncertainty, right? Most people would be actually okay if they

00:27:54.440 had the cert, even if they had the certainty, you're not going to get a job with the degree that

00:27:58.060 you've got. And you know that now 100%, then they can shift their focus or you may, but, but that I

00:28:04.040 don't know if I'm going to, or I don't know if I'm going to be successful is a normal anxiety response,

00:28:09.260 but exposure then is about helping people learn to tolerate that feeling of uncertainty. And so

00:28:15.960 sometimes we're just looking at, you know, what's realistic, how much of, you know, you graduating

00:28:20.900 college and looking for a job, can you actually control, right? There's only so much of looking for a

00:28:26.460 job you can control. You can, you know, prepare your resume, print it out, apply to jobs. Other

00:28:30.380 than that, there's very little, you can network, you can do lots of things, but anxious individuals

00:28:34.900 worry far past that. And part of the issue is anxiety is a very future oriented problem.

00:28:40.940 So even when people that are anxious or in the middle of a job interview, they're focused on

00:28:45.420 failing it, or they're focused on the next interview, or what if I don't make it to the second round of

00:28:49.180 interviews, which disallows them to be present and actually successful at doing well in that,

00:28:53.660 that interview. And so the goal is helping them be present at the same time. And sometimes we can

00:29:00.040 do exposures around just things that are uncertain. Things like I, we ask people to do things like see

00:29:06.100 a movie that you've never seen a preview for, or eat at a restaurant that you haven't read the Yelp

00:29:10.040 review. People require certainty so much that are anxious that they won't eat anywhere unless they've

00:29:15.960 asked 10 people or read 10 things about something, or they know exactly what the food is and they

00:29:20.220 don't do spontaneous things. So for those kinds of things, developing exposures around being

00:29:25.980 spontaneous, managing uncertainty can be really helpful.

00:29:29.060 Yeah. That reminds me, I heard about this guy, he did a Ted talk about, he called it rejection

00:29:33.740 therapy where he, he just wouldn't ask people just ludicrous things. Cause he was just super,

00:29:38.740 he was super high strung.

00:29:40.340 Right.

00:29:40.600 So he'd ask people things like he forced himself to ask, like he went to a burger restaurant and

00:29:44.820 asked for a burger refill.

00:29:46.440 Yeah.

00:29:47.600 Like, you know, you would a soda refill and he got rejected most of the time, but he learned that,

00:29:52.180 Oh, nothing, nothing really bad happened.

00:29:54.760 Right. And that's exactly what I do with our clients that have social anxiety, right? I'm going

00:29:59.560 to do something that's going to make me look so foolish. So if I walk around and I have people ask 0.98

00:30:04.180 questions like that or ask them, you know, there's a big stadium here where the Portland Timbers play and

00:30:08.860 we'll walk around out front there and I'll have people ask strangers, excuse me, um, where do the

00:30:12.880 Timbers play? And people will go right there after about five or six times of doing that. They don't

00:30:18.980 care anymore. And if you can tolerate that, then you can have small talk with the person on the

00:30:23.980 train in the morning. If you can ask the person on the train, 20 questions in the morning. Now,

00:30:28.940 when you sit in your first freshman class in college, it's pretty easy to lean over and say,

00:30:33.260 what's up.

00:30:34.000 Yeah. Yeah. And does, so is this, this exposure therapy towards more towards general

00:30:38.780 anxiety, does it transfer over? I mean, so say like you, you, you get a handle on uncertainty

00:30:44.860 in social situations. Does that transfer over to being able to handle uncertainty and say the job

00:30:50.920 market, or do you have to like actually be specific about handling?

00:30:55.180 No, it really does translate over because actually the content. So whether it's, you know, social

00:30:59.900 situations or job market or whatever it is, or, or, you know, a dog, the content is different,

00:31:05.860 but the process is the same. And so we care less about the content, you know, people that come to

00:31:10.360 therapy care a lot about the content, of course, but the process is helping you feel bad and tolerated

00:31:15.920 anyway. So if I know that I can manage this awful feeling of distress and it actually goes away

00:31:21.340 and I get some mastery with that, a lot of confidence comes from that. And so now if I go and

00:31:27.620 apply to a job and I get the job, and now of course, there's lots of things that are anxiety provoking

00:31:31.840 deadlines and things like that, I now trust that I can tolerate my own distress. And so it really does

00:31:37.540 translate well into other areas. All right. So it's all about, again, exposing yourself,

00:31:42.000 letting that, I guess, what do we call it? Resilience muscle to grow with inside you.

00:31:46.960 I know we have a lot of parents who listen to the show. What if you're a parent and you notice your kid

00:31:52.600 has a tendency to be anxious? What, what can parents do to help their kids manage that or,

00:31:59.680 or, you know, confront that and reduce that anxiety? Yeah. I would say one of the things

00:32:05.660 that parents do the most with great intention, but becomes really problematic is they, they feel

00:32:11.360 bad that their kids are struggling. They feel bad that their kids are anxious. And when they feel bad,

00:32:17.560 now they're working on managing their own stuff by helping their kids. It becomes less about the

00:32:23.180 kids. And so some of the earliest signs that we know kids are anxious is there's often a lot of

00:32:29.520 reassurance seeking. And that looks like things like asking the same question over and over

00:32:33.380 because they're looking for that certainty, even though it doesn't exist. And so helping parents

00:32:39.200 learn that not answering those reassurance questions are not accommodating the anxiety. And so

00:32:44.840 what's really helpful is helping parents identify what decisions are my kids making based on anxiety?

00:32:51.200 And then how am I accommodating those anxieties? So, you know, obviously a big issue for anxious

00:32:57.180 kids is not going to school and parents work really, really hard to make sure their kids are

00:33:01.240 comfortable. And so when kids don't have to go to school and they get, you know, work brought home

00:33:07.660 or they're online or they're doing these different things, they may feel better in the moment, but

00:33:12.560 they're not building that resilience muscle. They're not building that tolerance over time. And so, and then

00:33:17.620 parents realize that they're doing everything to manage their kids' anxiety. They're checking in

00:33:21.600 with their kids. Have you eaten? Are you up on time? Are you okay? Do you need anything? And they're

00:33:26.600 really working hard to make sure the kids never feel distressed and they have to feel distressed.

00:33:31.980 And so some of the most helpful things parents can do is actually dial back a lot of the

00:33:37.740 accommodations that they're making for their kids' anxiety, not for their kids. We want parents to

00:33:42.460 make every accommodation they can for their kids. They're lovely, I'm sure, but not for their

00:33:46.980 kids' anxiety. And so that just maintains the anxiety over time.

00:33:51.720 So that looks like, so if your kid's asking you for reassurance, you just, what do you do to say,

00:33:57.020 well, we're not, I'm not going there. What do you, what do you, what does that look like?

00:34:00.060 Yeah, I would say, hey, that sounds like, that sounds like something your anxiety wants me to say.

00:34:03.560 I've already answered that. It's not that you're not giving information. And so, you know,

00:34:07.300 if a kid says, you know, I got invited over to Sarah's house tonight. Do you know who's going to be

00:34:11.520 there? No, honey, I don't, I don't know who's going to be there. Mom, do you know who's going

00:34:15.040 to be there? I've already answered that. I feel like that's an anxiety thought that wants to answer

00:34:19.480 that. Because now what you're saying is, I hear you and I validate that you have a concern,

00:34:23.660 but I'm just going to let you sit there and tolerate that. But what many parents will do

00:34:28.900 is they'll say, well, I don't know, let's find out. And they'll call and they'll ask,

00:34:32.600 call Sarah's mom and they'll figure out who's there. And now this kid is not learning how to develop

00:34:37.060 any of those skills of tolerating. I guess I'll just have to figure out who's there

00:34:41.440 when I show up. Because the truth is finding out who's there or not actually doesn't change

00:34:47.060 whether the person's going to go or not. It just changes their level of distress walking

00:34:50.960 into the situation. And we want them to be confident walking in, not knowing.

00:34:55.540 Right. Yeah. I mean, it sounds like the internet can just exacerbate that because, you know,

00:34:58.660 if your kid has a worry, you know, you can answer like, let me check Google on my phone

00:35:02.780 here really quick. And here's an answer for you.

00:35:04.300 All day long. Google is the, Google is very, very challenging for anxious individuals because

00:35:09.340 now we can look up everything, you know, from a physical ailment to a question of,

00:35:14.420 you know, infidelity to any kind of worry. We ask Google.

00:35:18.080 Yeah. And then just, and then, yeah, we've all, everyone's been down that route of, you know,

00:35:21.960 checking Web and D and I have a pain in my arm and now I have cancer.

00:35:27.200 Yep.

00:35:28.240 Right.

00:35:28.720 Exactly.

00:35:29.400 Don't go down that path. Well, Kevin, this has been a great conversation. Where can people

00:35:33.720 go to learn more about your work?

00:35:35.280 Yeah. So I have a YouTube channel and it's under fighting fear with Kevin Ashworth.

00:35:39.840 We have a website. It's nwanxiety.com. And people are certainly actually welcome to send

00:35:46.320 me an email at Kevin at nwnorthwestanxiety.com. So Kevin at nwanxiety.com. And we're in the

00:35:53.080 process, our website's up. We're in the process of getting our new website redesigned. It should

00:35:57.080 be launched here by the end of the month. And then check out the YouTube channel. And I have

00:36:01.380 some blogs on the website.

00:36:02.960 Fantastic. Well, Kevin Ashworth, thank you so much for your time. It's been a pleasure.

00:36:05.400 My pleasure. Thanks so much.

00:36:06.680 My guest today was Kevin Ashworth. He's the clinical director of the Northwest Anxiety

00:36:10.220 Institute. You can find more information about his work at nwanxiety.com. Also check out his

00:36:15.340 YouTube channel, Fighting Fear with Kevin Ashworth, where he's got lots of videos on some of the

00:36:19.220 things we've talked about and goes more in depth. Again, Fighting Fear with Kevin Ashworth. Also check

00:36:23.040 out our show notes at aom.is slash anxiety, where you can find links to resources, where you delve

00:36:27.560 deeper into this topic.

00:36:35.280 Well, that wraps up another edition of the Art of Manliness podcast. For more manly tips

00:36:44.500 and advice, make sure to check out the Art of Manliness website at artofmanliness.com.

00:36:47.880 And if you enjoy the show, I'd appreciate it if you give us a review on iTunes or Stitcher.

00:36:51.220 Helps out a lot. And if you've done that already, thank you. Please consider sharing the show

00:36:54.540 with a friend or family member. As always, thank you for your continued support. Until next time,

00:36:58.520 this is Brett McKay telling you to stay manly.

The Art of Manliness - April 12, 2018

#396： How to Deal With Anxiety

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