#396： How to Deal With Anxiety
Episode Stats
Summary
Kevin Ashworth is the Clinical Director at the Northwest Anxiety Institute in Portland, Oregon. He discusses the difference between regular old worrying and anxiety disorders, the ill effects of anxiety, and some of the theories as to why anxiety is on the rise among young people.
Transcript
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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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$20 off your first custom shirt today. Brett McKay here, and welcome to another edition of
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the Art of Manliness podcast. Recent surveys have shown that rates of anxiety are up, especially among
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young people. What's going on? And if you're someone of any age who struggles with anxiety,
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what can you do about it? Those are just a few of the questions I asked my guest today. His name
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is Kevin Ashworth, and he's the clinical director at the Northwest Anxiety Institute. Today on the
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show, Kevin and I discuss the difference between regular old worrying and anxiety disorders, the
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ill effects of anxiety, and its causes. Kevin then explains some of the different ways anxiety
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manifests itself in men and women, and some of the theories out there as to why it's been on the
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uptick in recent years. We end our conversation with some research-backed ways to get a handle on your
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anxious feelings. After the show's over, check out the show notes at aom.is slash anxiety.
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All right, Kevin Ashworth, welcome to the show. Thank you very much. Happy to be here.
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So you're a psychologist. I read about you in the New York Times because you also are the director of
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the Northwest Anxiety Institute, and that's based in Oregon, correct?
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That's right. We're in Portland, Oregon. I'm actually a licensed professional counselor
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and the clinical director of Northwest Anxiety Institute.
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So what got you into focusing on clients or patients or people, individuals who have anxiety
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You know, my interest in psychology, I kind of got there by, I don't want to say by mistake,
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but I initially started working with adjudicated youth, realizing I need graduate training.
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Once I got into grad school, I met a professor that he really was an anxiety guru. He had published
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on anxiety and really taught me how to do exposure therapy, which is the kind of work that I do.
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It's a type of cognitive behavioral therapy. And since meeting him and reflecting on my own life,
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I realized that I was a much more anxious kid than I thought I was.
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And I really saw this passion of working with people that, one, you could actually help get
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better. Anxiety is very, very treatable. And do it with a type of therapy that is very hands-on,
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very matter-of-fact. And I love the idea of helping people build tolerance to distress versus
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helping them just layer their life with extra coping skills, which we already know how to do.
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So let's talk about what is an anxiety disorder. I think all of us have experienced worry at some
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point. When does worry transition to like, okay, this is actually an anxiety disorder?
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Good question. We look at two things. We look at impairment and distress. You're right. We all
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worry and we should. If there's anything that's important in our lives, we have some interest or
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some investment in anything, whether that's going on a date or having a job interview or passing a class
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or whatever it is, we should have some anticipatory concern that we're going to do well.
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And that's pretty standard. It becomes problematic when that level of worry or that level of anxiety
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stops you from functioning. And that doesn't mean complete functioning, like you're not going to
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work or anything like that, but you're not enjoying work because you can't focus on your daily tasks
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because you're constantly living in the future. You're anticipating every worst case scenario,
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or you're having panic attacks where you start really questioning whether you should leave your
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house when, especially in this day and age, when you can order everything to your home,
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it becomes really easy to avoid. So the difference between angst and general concern and worry versus
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an anxiety disorder is we're looking at like pathological levels of distress and impairment.
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And can individuals be anxious about certain types of things, like maybe, but like not others,
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right? Oh, absolutely. Yeah. I mean, one of the reasons I love doing this work is I work with
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really, really intelligent, logical, high functioning individuals that are anxious about the strangest
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things. And that's partly why they're so anxious is because they've got such an awesome brain that
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allows them to think about stuff too much. And so I can be obsessed with this irrational fear of
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contracting AIDS, let's say from walking down the street, or that I'm going to be judged at an interview
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for a podcast and then have absolutely no concern about public speaking or no concern about skydiving
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or any other kind of normal or abnormal or extreme life events or behavior. So anxious individual or a
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warrior do not necessarily worry about everything. Gotcha. And besides, I mean, you've talked about
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what constitutes anxiety disorder, like you worry to the point where it impairs you in some way. I mean,
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besides the impairment where your work isn't going great or whatever, how else can anxiety
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debilitate people? The number one way that most people try and cope with their anxiety is through
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avoidance. And so this is probably the most clear sign that individuals are starting to suffer from
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anxiety. Ultimately, I ask people, are you making decisions throughout your day based on preference or
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fear? And avoidance doesn't have to be, you know, extreme avoidance. It's really insidious. It could
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be, it could be the difference between sitting at a coffee shop facing the wall or not. And if you do
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that based on, I don't want people to notice me because I'm sitting alone and that makes me worried.
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Now you're making a decision based on fear. Or it could be, you know, the student that's not going
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to school because they're, and avoidance shows us that they're anxious, but we don't know yet why.
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That could be because of the school that the grades, the academics, that could be because of
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the public speaking component. That could be because of the social component, but avoidance is
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for sure the best way to identify anxiety in individuals. And do people with anxiety disorders
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often try to self-medicate in detrimental ways? Yeah. Well, anxiety is a lot about just not wanting
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to feel bad. And so this comes back to that question about how do you make your decisions? You know,
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I enjoy whiskey. I enjoy bourbon a lot. And there's a big difference if I get off work and
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have a bourbon versus if I feel bad, I have a bourbon. Now the difference is, is one's developing
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a functional relationship. And so every time I have a drink, I feel less anxious. Now my brain is
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learning pretty quickly that that's really helpful. And so whether it's that, or I smoke a joint, or I do
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any other kind of substance, I quickly, my brain quickly learns that I actually feel less bad and
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I don't have to tolerate these worrisome thoughts or these awful physical symptoms. And so my goal is
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helping people enjoy whatever recreational substance you may enjoy. And of course, that's not my role is
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to judge people on how they make decisions, but it's more of what's the relationship you have with
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that. But we know pretty quickly that, you know, alcohol is a depressant. So anxiety is about being
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too activated. So it helps. Marijuana, on the other hand, can make people actually more anxious because
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you're messing with your physiology in ways that you're not quite sure how. Alcohol is pretty consistent
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in how it does that. I'm curious, you know, with you mentioned depression, the research has shown
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there is, there's a genetic component to it. It's something that's inheritable that you might have a
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tendency or temperament towards depression. Is it the same thing with anxiety? Are some people more
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prone to having anxiety disorders? Yes, absolutely. And again, it's similar to depression that we don't
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exactly know why or how much, but we know there's genetic loading. We know that anxious parents
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typically have some anxious children. And again, it's hard to pair out there is that because they've
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kind of modeled anxious behaviors, but there is definitely more of a vulnerability to the reactivity
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of thinking too much and worrying too much and also being just sensitive to your physiological
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reactivity. I'm a pretty, I'm pretty sensitive to my body. You know, my stomach hurts and my heart
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skips a beat. I'm aware of it where my wife, for example, I think she just thinks less or cares less
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about those things because she's just not wired that way. And so if I start behaving very differently
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because of my changes in my body or anxious thoughts, then I can quite quickly develop an anxiety
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issue. And besides that, you just mentioned that there could be an environmental component.
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So maybe you grew up around anxious parents and you caught that vibe from them and that's,
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you learned how, that's how you cope with life is just by worrying about it excessively.
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Yeah. And so the story I tell people is when I was in graduate school, I had never had a panic
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attack before, but I got stuck in an elevator and I never thought I was claustrophobic or particularly
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an anxious individual. So this is an environmental stimulus. I got stuck in an elevator. My body just said,
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no way to get me out of here. I felt extremely anxious, felt like I was panicking, got out of
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the elevator. Of course, that's the process of classical conditioning. My brain pairs this neutral
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stimulus of the elevator with the sphered stimulus and they become wedded. When I left class that day,
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I walked up to the elevator and my brain triggered that same response without me even getting on.
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So I took the stairs, which is avoidance. That's how an anxiety disorder is born. I start making
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decisions based on feeling and there may or may not have been a genetic loading there or not for
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any individual. But if you make those decisions based on feeling bad, you can quickly get in that
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loop. So there's been recent research. I've been reading articles about this past few years is that
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anxiety disorders are on the rise, particularly amongst young people, like teenagers and young
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20 somethings. Have you noticed that in your own practice? And what do you think's going on there?
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Yeah, there's a few things I think to account for that one is we are just getting better at having
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conversations about what anxiety is. You know, 40 years ago, 50 years ago, you know, we called it
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things like nervous breakdowns and we had different names for it. And our diagnostic criteria has gotten
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better for kind of understanding it. So that definitely has a component, I would say. But we are also
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parenting shifted in the 70s and 80s. And, you know, with the baby boomers having children,
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they started parenting quite differently. And I think a big component is, we went away from helping
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teach children how to tolerate distress. And we started helping them really to soothe. And I think
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the job of parents went from child raising to basically how successful my kiddo is, is a reflection
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of how I am as a parent. So parents started doing everything for kids. So now we've got kids in their
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20s, who parents have been the ones that registered them for college. And they're the ones that probably still
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do their laundry. And they're the ones that when they feel the stress, bail them out. And so over
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time, you really reduce your tolerance for feeling bad. And I think that has a huge component.
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So yeah, so the kids today haven't exercised that muscle tolerance, right?
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I'm curious, you mentioned depression. Is anxiety often linked with depression? Or can you
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be anxious and not depressed? Or do you often see the two come together?
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We do see them together a lot. There's a high, we call comorbidity rate between anxiety and
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depression. But there's plenty of individuals that suffer from an anxiety disorder and are not
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depressed. You know, the age old chicken or egg question becomes with this, but anxiety is very,
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very prevalent. And we're talking, you know, 25 plus in childhood percentage. That's a lot of people.
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And if you've ever experienced distress, or intense anxiety, you feel pretty hopeless. And that often
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turns into a feeling of demoralization, which looks just like depression. And the question that the
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test, the litmus test that I asked my clients is, if your anxiety disappeared tonight, no more worry,
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no more panic attacks, no more obsessive thoughts, would you still feel depressed? And they often say
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no, they don't think so. But the truth is, is if their depression went away, would you still be anxious
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and have obsessive thoughts and panic attacks? And the answer is yes. So we know there's plenty of
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people that suffer from depression that don't have an anxiety disorder. And there's plenty of
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people that are anxious that aren't depressed. But I think often depression is misdiagnosed when
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anxiety is the cause. So this is the Art of Manly's podcast. Most of our audience are men. And I know
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we've had guests on the podcast talking about depression, how depression often manifests itself
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differently in men than in women. That's why it's often hard to find. So I guess men, when they're
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depressed, they'll often get angry. You know, they're not, they don't look sad. They act angry.
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I'm curious. Is there another, is there something similar with anxiety? Do men express anxiety
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differently than women? Yeah. Men are, men are very good at avoiding and emotionally that looks
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like just shutting down. Right. And so if I distract phones, video games, magazines, bars, alcohol,
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whatever it is, the gym, right. If I pour my attention into something else, I'm trying to relieve any kind
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of distress that I have related to anxiety. So the difference is, is, you know, we know the rates of
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anxiety are higher in women, but that's most likely because women are reporting it more. Yeah. It's
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just, culturally, it's just, it's safer for women to say, Hey, I'm suffering from anxiety. It's really
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hard for, for guys who admit that because it is really owned as a sense of like weakness or
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vulnerability is not good or not to talk about it. And I see a lot of men in my practice
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that has taken them, you know, some serious work and time just to even call in and make the,
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make the initial intake appointment. So, but you're right, you know, things like agitation,
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when I see angry or agitated men, usually there's an anxiety beneath there that they haven't ever
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processed or haven't really ever been able to even identify. And if I can say a little bit more,
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I think, you know, many times what I, what I tell people is most of us remember the first time we
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ever saw our dads cry. And if ever, and the fact that that's like a pivotal event that you can
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remember speaks to how poorly our culture allows men to express emotion. That's not the first time
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your dad was sad. I can promise you that, but usually that's either dumped behind closed doors
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or they have learned very quickly, like don't express sadness. So as we grow up as men, we have
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never really been modeled how to manage negative emotion. We know how to behave when we're happy or
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surprised or excited, but now we have no practice or modeling on what to do with these really
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hard feelings. And I think that's a big component of why guys then express that in other ways.
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So let's get into sort of the specifics of the faulty thinking that goes on with anxiety problems.
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So you mentioned when you have an anxiety problem, you're making decisions based on fear. That fear
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must be irrational. So how, what happens in our brain to like kickstart that irrational thinking
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where you mentioned the elevator thing, like, okay, you got stuck in an elevator, then you started
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avoiding elevators. Cause you thought next time I get in that elevator, I'm gonna get stuck again.
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Well, that's irrational. So what, what goes on that sort of perpetuates that, that faulty thinking?
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Yeah. You know, our brain is, our brain is developed and it's evolved over time to, to make sure that
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we're alive, to make sure that we're safe. And so when there's anything that is potentially even
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dangerous, our brain wants us to protect ourselves. So to give a non, non-anxiety example, most of us
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have experienced food poisoning. And what happens after we've had food poisoning is most of us stop
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eating that thing that got us sick, right? Despite logic and knowledge, knowing that, Hey, I've had an egg
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salad sandwich 600 times in my life. The chances of me getting sick from another one is pretty minimal,
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but your brain prevents you from having any more, whether that's with a disgust factor or whether
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that's, it's irrational. If you use logic, anxiety works the same way. So when we're, when we experience
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distress, one thing that we do is look for meaning. And sometimes it's not there, but we start making
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association connections with things that are scary. So our brain then through this process of classical
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conditioning and negative reinforcement works really hard to make us feel better.
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And then we associate whatever we've done in that time with feeling better and we avoid
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everything else. So it's, it's this fight or flight response. Anxiety is, is the anticipation of
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something bad happening, but it's not actually dangerous, right? We don't use the, we don't use
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vocabulary related to anxiety for actually dangerous events. People don't get T-boned, you know,
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in a crosswalk and say, I was hit by the car and I went into a panic attack, or, you know,
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I was really scared with the explosion that occurred and I had all these intrusive thoughts.
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These are actually dangerous events that people don't even use words to describe like anxiety.
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But if you anticipate driving and that you may get in an accident at some point, the feelings
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associated with that, the brain says, Hey, you're feeling bad about that. You should probably
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shouldn't do it. And so they are irrational. They don't, they don't make logical sense, but we make
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a lot of emotional based decisions. Like if I feel bad, then it must be true. Does that make sense?
00:17:56.580
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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
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are illogical, right? But the way you get there and the way it makes sense is you make small steps,
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right? I remember when I was in law school, every time I took an exam, it was,
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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
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I don't get an internship, I'm not going to have a job and I'm going to be unemployed and have all
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this law school debt, which, you know, that conclusion is illogical, but it made sense because
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I made these like small little incremental steps there. Yeah. And we call that, you know,
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catastrophic thinking, right? Like you're worried about one exam that may or may not impact your
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future and your brain is helping you get there. And for sometimes that's really rewarding. So if
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that makes you then study harder for your next exam, you're, there's many processes that are going
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to reinforce that behavior. Like, look, I actually don't feel distressed after I studied really,
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really hard. So that's good for me. The problem is, is people that worry like that often, they worry
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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.
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We can do that with romantic relationships. And that follows a pattern of what we would call
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generalized anxiety disorder, which is this excessive worry about things that you actually
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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,
00:29:40.600
So he'd ask people things like he forced himself to ask, like he went to a burger restaurant and
00:29:47.600
Like, you know, you would a soda refill and he got rejected most of the time, but he learned that,
00:29:54.760
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
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,
00:30:34.000
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.
00:35:29.400
Don't go down that path. Well, Kevin, this has been a great conversation. Where can people
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
00:36:02.960
Fantastic. Well, Kevin Ashworth, thank you so much for your time. It's been a pleasure.
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
00:36:35.280
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
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