The Art of Manliness - #497： The Meaning, Manifestations, and Treatments for Anxiety

00:00:00.000 Brett McKay here and welcome to another edition of the Art of Manliness podcast. According to

00:00:11.540 recent statistics, the number of Americans dealing with anxiety disorders is over 40 million and

00:00:15.960 that number is increasing. My guest today is one of those Americans who suffered from bouts of

00:00:20.020 anxiety all of his life. He's also a successful journalist, so he decided to use his journalistic

00:00:24.200 chops to explore the history of anxiety and how he treated in the hopes he could gain more insight

00:00:28.760 about the mental disorder that has plagued him since his youth. His name is Scott Stossel. He's

00:00:32.800 an editor at The Atlantic and the author of My Age of Anxiety, Fear, Hope, Dread, and the Search for

00:00:37.660 Peace of Mind. We begin our conversation discussing Scott's experience with anxiety that began as a

00:00:41.900 child, what anxiety feels like, and how he's treated it throughout his life. We then dig into the history

00:00:47.020 of anxiety, looking at how it's been viewed differently through time, and at what point

00:00:50.360 psychologists classified it as a mental disorder. Scott then walks us through the different theories

00:00:54.620 about what causes anxiety and what the research says about the best ways to treat it, and we

00:00:58.520 in our conversation discussing the state of Scott's anxiety today and whether he thinks he'll ever

00:01:02.540 be cured. After the show's over, check out our show notes at aom.is slash ageofanxiety. Scott joins me

00:01:08.340 now via clearcast.io. All right, Scott Stossel, welcome to the show. Thanks so much for having me.

00:01:22.100 So you wrote a book, My Age of Anxiety, which is a cultural history, a scientific history of anxiety,

00:01:29.920 which is something that a lot more Americans are struggling with, they are reporting struggling

00:01:34.840 with. But not only is this a history, it's a narrative of your own struggle with anxiety

00:01:40.120 throughout your life. So let's start there. How long have you been struggling and dealing with

00:01:44.860 anxiety? It's honestly been pretty much a lifelong struggle from a very young age. I mean, the earliest

00:01:52.800 I can remember, I had terrible acute separation anxiety when I was a little kid. Anytime I was

00:01:58.140 away from my parents, I was convinced that they were dead or had died in a car crash or that they were

00:02:02.960 actually robots and I was part of some experiment. And then by the time I got to school, I would have

00:02:09.800 anxious stomach aches and anxious headaches. And I didn't always end up in the nurse's office.

00:02:14.780 I would worry incessantly about all kinds of things. So really from the time I was, my earliest

00:02:21.060 memories, I remember being worried about things. So I have, I think, a temperamental tendency towards

00:02:26.940 anxiety and worry that manifested itself at a very, very young age. And did it manifest itself

00:02:31.640 differently over the years as you got older? Yeah. I mean, the separation anxiety, and that's

00:02:37.340 sort of a classic early manifestation of people who grew up to develop what's clinically called

00:02:42.100 anxiety disorders. But over time, I sort of developed specific phobias, fear of heights,

00:02:47.680 fear of enclosed spaces, fear of cheese, and fear of vomiting, fear of flying, which was a pretty

00:02:53.520 acute one that still plagues me today. I also, as I got older, started developing and sort of having

00:02:58.880 panic attacks, which anyone who's experienced them knows are awful. And when they recur with any

00:03:04.180 frequency over a period of time, that becomes clinically known as panic disorder. So I had

00:03:08.680 that. And then when I got to middle school and high school, I had all kinds of social anxiety where

00:03:14.120 I'd worry about interacting with other people, particularly performing in public. I was in the

00:03:19.240 school play in sixth grade and it was humiliating. I had to walk off stage because I lost the ability

00:03:22.760 to speak. And then I carried all that with me into adulthood. Basically, these anxieties were

00:03:30.000 unfortunately additive, not substituting. I wasn't switching one for the other. It was just every time

00:03:34.220 I got a new anxiety, I would just add that to the ones I already had. And so by the time I got to

00:03:40.060 high school and then young adulthood, I was not all the time, but pretty constantly struggling with

00:03:45.420 some collection of fears about going to school, traveling, getting sick, dealing with other people.

00:03:51.560 And the strain of dealing with that would lead to depression. So it was a pretty toxic stew of

00:03:58.160 negative emotions I was dealing with by the time I was a young adult.

00:04:00.900 Right. One, two punch. And I imagine, I mean, you're still, I mean, we'll talk about it. You're

00:04:04.820 still working with this stuff today, but like you're, you know, you're a public, you're a writer

00:04:08.740 for, you know, the Atlantic. I mean, you're a public figure. I mean, has that, I mean, is it still

00:04:14.040 something you struggle with? And then like the fact that you have to do speaking engagements or things

00:04:17.800 like that, is that something you have to manage as well?

00:04:20.200 It is. And, you know, I'm, I'm what they call, you know, I'm a high functioning person with anxieties.

00:04:25.640 Or, I mean, there's some people who get so anxious that they, you know, they're what's

00:04:30.780 called agoraphobia where they're, you know, their panic disorder gets so bad that, you know,

00:04:34.280 the range of things they can do gets smaller and smaller. And eventually there are people who are,

00:04:38.520 you know, confined to their houses or even confined to one room in their house and can't

00:04:41.800 do anything for years at a time. And I've had periods like that, fortunately short periods where

00:04:45.760 I could feel the world closing in on me. But for the most part, with a combination of

00:04:50.760 medication, other kinds of therapy, just, you know, sort of force of will sometimes have managed

00:04:57.220 to, you know, mostly manage to, you know, live a normal life and, and, and have a career,

00:05:02.840 you know, and there are ways in which, and I talk about this in the book in which, you know,

00:05:06.940 anxiety has its benefits, or at least it's, it's connected to temperamental traits that are,

00:05:13.380 that are good. So if you're super anxious about things, you know, you're kind of hypervigilant,

00:05:17.220 which makes you, you know, good at scanning the environment and being aware of your social

00:05:21.980 situations or being able to read social cues. I mean, people with social anxiety probably

00:05:25.380 overread them, but it can be a useful skill. You know, preparing, worrying a lot can be

00:05:30.380 debilitating if it's excessive, but it also helps you to plan for different eventualities.

00:05:35.220 You can kind of look ahead. You know, I think that just the, the struggles I've had with,

00:05:39.600 with my mental health have made me more empathetic towards other people who have those struggles

00:05:43.180 and even to people who don't have those struggles. So I think it helps with communication.

00:05:47.060 So there are a lot of ways in which, even though I hate my anxiety when it's, you know,

00:05:51.020 flaring up, it's probably propelled me along and it just, it makes me conscientious because

00:05:54.940 I'm afraid of screwing up. I'm afraid of looking bad. And that becomes kind of a motivator.

00:05:59.920 So, you know, a lot of times I feel like I'm kind of patched together or barely holding it

00:06:03.580 together because my anxiety is so bad or, you know, I'm, I'm sort of pharmaceutically

00:06:08.460 armored against, against my anxiety and that's how I've, I've struggled through. But yeah,

00:06:13.340 and it's, and I still struggle with it today a lot. And we can talk about that more later if you want.

00:06:17.060 But I, I've been fortunate enough to manage to, you know, mostly be a productive member of,

00:06:21.460 of society.

00:06:22.420 Well, this book came out 2014. So it's been five years. You're seeing all these reports come out,

00:06:27.320 you know, week after week about how Americans, particularly young Americans and, you know,

00:06:31.860 young Westerners, right. In general are increasingly feeling like they're anxious or they're suffering

00:06:37.040 from anxiety. What are the numbers? Like how many Americans do we know, like have a reporting

00:06:41.720 and being anxious?

00:06:43.200 They're, they're really high. And there was a study, a couple, it was before my book came out,

00:06:48.700 but, but some years ago that talked about how, you know, the average level of anxiety for a typical

00:06:53.460 high school student now self-rated report of anxiety is the same as it was for inpatient,

00:06:59.480 you know, psychiatric patients in the 1950s. So basically, you know, the average kid today

00:07:03.860 is as anxious and neurotic and miserable as people who are in, you know, in, in psychiatric

00:07:08.760 hospitals, uh, a couple of generations ago. And then there's all kinds of other, you know,

00:07:12.940 statistics that just show levels of stress, worry, anxiety, anxiety disorder, diagnoses,

00:07:18.240 you know, are much, much higher in young people, you know, pretty much across all Western countries,

00:07:23.360 you know, particularly there's a lot of data about Europe and the United States in the U S I think,

00:07:29.820 I mean, there's so much data that, that there is, you know, that this is something real.

00:07:33.220 I think part of it is our definitions of what constitutes, you know, a clinical anxiety disorder

00:07:39.840 have expanded and become a little bit more elastic probably because we know more about

00:07:43.740 these disorders. And so people now can identify them partly because you've got now drugs that

00:07:48.460 have been approved to treat them. So you've got kind of the marketing imperatives of the drug

00:07:51.780 companies, you know, the, the, the broader you can define more broadly, you can define an anxiety

00:07:56.120 disorder, the more people you have, um, that you're able to prescribe it to. So, so partly this is

00:08:00.260 inflation of a diagnostic category. I think in any society, there's a, you know, some compliment of

00:08:05.380 people who will be anxious, you know, under many circumstances. But I also think that there are a

00:08:10.580 lot of factors about the culture and the society right now that are driving people and particularly

00:08:15.140 young people to be more anxious. And, you know, at the largest kind of societal level, it's, you know,

00:08:20.000 we're in a long period really going all the way back to the industrial, dawn of the industrial

00:08:23.620 revolution, but, you know, accelerating now in the internet age of just, you know, rapid change,

00:08:28.240 economic dislocation, all kinds of transitions. There's just a lot, you know, the pace of life

00:08:34.020 because of the internet, the way people, you know, select themselves into tribes, the pressure to

00:08:39.520 create your own personal brand on the internet. There are just so many sort of countervailing

00:08:44.400 pressures that confuse young people about what their identity is. And, you know, in, in, in centuries

00:08:49.900 past, you, you're kind of born into your role. You, your, your family had a status in the tribe or in the

00:08:56.220 medieval village you lived in, or even, you know, in, in your, you know, farm village in the, in the

00:09:01.520 19th century America. Now, you know, you, who are you, you know, what's your, you can choose your

00:09:06.440 gender. You can choose your sexual preference. You can choose your group, the groups you affiliate

00:09:11.180 with socially. And all of this creates a lot of stress. And then the last factor I would say is just,

00:09:16.220 there's been a lot written about this, you know, particularly people in the millennial generation and

00:09:20.380 younger, there's so much, you know, helicopter parenting and your parents are super involved

00:09:25.020 and, you know, driven and trying to make their kids succeed. But the combination of like over

00:09:31.180 protectiveness and trying to, you know, and, and, and pressure to achieve is really toxic because on

00:09:36.180 the one hand, these kids feel all this pressure to succeed and do better than their parents and get

00:09:39.920 into good colleges or, or do whatever. And at the same time, the parents are doing things for them

00:09:44.160 that parents of previous generations wouldn't, it sort of robs them of their feeling of autonomy

00:09:48.980 and resilience. And it's really sort of an epidemic thing. And I've talked to a lot of

00:09:53.620 psychiatrists, you know, both for the book, but then also just, you know, people I've come to know

00:09:57.400 who are now friends who are psychiatrists or therapists, and they, and they see this as just

00:10:01.320 kind of an epidemic phenomenon. So all those factors kind of combined to create soaring levels of anxiety.

00:10:08.520 So let's talk, you mentioned, you know, there's sort of a cultural component to anxiety. It's not that

00:10:12.160 like it's a, you know, anxiety is a cultural construct, right? Like it exists, it's biology,

00:10:16.820 it's rooted in biology, but like the culture has an influence, you know, for example,

00:10:20.120 you know, the diagnostic of anxiety disorder didn't exist 35 years ago. Like I'm older than

00:10:26.180 that, right? I'm 37, 30, how old am I? 36. I forgot how old, at some point you stop counting

00:10:31.860 how old you are. That's right. Yeah. It becomes a defense mechanism. Right. But that doesn't mean

00:10:35.480 that people weren't anxious. So like, what did we call anxiety, like say like 2000 years ago or a hundred

00:10:40.600 years ago, or even 50 years ago? Yeah, no good question. And it's been called all different

00:10:45.060 things. I mean, obviously the emotion that we feel or the set of emotional and physical

00:10:50.500 experiences you have in your body, when you are feeling what we now call anxiety, you know,

00:10:56.900 have humans have experienced since there were humans, you know, what did they call it before

00:11:00.980 there were, you know, in preliterate times when they were cavemen, you know, they made it

00:11:04.280 out of, they didn't have a concept of anxiety, but when they went out of the cave and they were

00:11:07.480 worried about getting eaten by a saber tooth tiger, you know, their palms would sweat, their hair

00:11:11.480 would stand on end, their stomachs would hurt. Like that is anxiety. Even in animals, you know,

00:11:15.520 the fight or flight response is a sort of evolutionary, you know, programmed instinct

00:11:21.120 to help keep species alive. So what we call anxiety today sort of, you know, emanates from

00:11:26.660 that deeply rooted evolutionary biological reality. But over the years, you know, different cultures

00:11:34.480 have, and, you know, science has called it all kinds of different things. So, you know, for many

00:11:39.440 years, you know, in the Renaissance, they would group anxiety, what we now call anxiety and

00:11:43.240 depression together under, you know, melancholy. If you were, if you, if you suffered from what,

00:11:47.900 you know, you were, you were worried about things or you were, had depressed, you were called

00:11:51.000 melancholy. You know, once you get into the 19th century in Europe and America, they would

00:11:57.140 call it asthenia. And it was meant to describe, this described a kind of set of traits that was

00:12:01.660 a combination of physical things. And it could be like dizziness, sweats, you know, gastrointestinal

00:12:06.320 problems and emotional things, you know, phobias, worry, a whole, and basically could encompass

00:12:11.520 anything because, you know, your anxiety is, you experience it in your brain, but it has

00:12:15.640 effect throughout your body. So neurasthenia is what they call it. You know, getting into

00:12:19.040 the Freudian age, you know, Freud became very influential through the, through the 20th

00:12:23.160 century, particularly into the mid, mid 20th century. And, you know, he would, he, he talked

00:12:26.960 about what we today call anxiety as neurosis. And it really, that was just sort of a, I mean,

00:12:31.060 he had a different theory of what caused it, you know, childhood sexual, you know, repressed

00:12:36.960 sexual desire, conflict with your parents, the Oedipal complex, which a lot of which has

00:12:41.980 sort of been debunked now, but, but as a kind of cultural idiom, the idea of neurosis

00:12:47.120 became very prominent in the culture. So that was kind of through, you know, World War II

00:12:51.160 up until, really until 1980, when the Diagnostic and Statistical Manual, which is the Bible of

00:12:56.340 the psychiatric profession, they redefined the neuroses as anxiety. So technically anxiety

00:13:02.880 disorders didn't exist when you were born and they didn't exist when I was a little

00:13:06.060 kid. I'm 49 now. So, you know, for the first 10 years of my life and I was starting to get

00:13:10.360 taken to psychiatrists, they would say, I have, you know, childhood neurosis or something like

00:13:14.300 that. It's now been redefined as anxiety. So the labels we put on this do kind of inflect

00:13:20.120 how we think about them and how we treat them, but it is the same underlying set of, you

00:13:25.440 know, you, you and I, or I speaking for myself, I would be feeling the same set of unpleasant

00:13:30.140 thoughts, emotions, and physical sensations, whatever age I was in and whatever we choose

00:13:35.800 to call it. It's just now we, we, we classify them as anxiety disorders.

00:13:39.140 Right. And the way we describe it and the way we talk about it has changed. Like, for example,

00:13:42.280 in the Renaissance melancholia, like, yeah, you were sort of depressed and anxious, but like

00:13:46.020 it was sort of romantic too, right? Like it was like, well, you're just like ponderous

00:13:49.660 romantic person who's thinking about big thoughts. And so it was actually, there was like a

00:13:54.620 positive spin on it, but then like Freud kind of saying, no, neurosis is bad. We got

00:13:59.360 to, you know, solve your neurosis by sitting on a couch and talking to a therapist over

00:14:02.720 and over again until you, you solve it. So there's that sort of swing back and forth

00:14:06.600 between, yeah, there's some good and bad, but then it's all bad.

00:14:09.620 Yeah. And there, there's, there's often been, you referenced the Renaissance era, you know,

00:14:13.920 this sense that, you know, having melancholy is attached to having an artistic or refined

00:14:19.260 or sophisticated sensibility. And it was actually seen to be sort of a desirable trait. You

00:14:23.020 know, if you were melancholic, that meant you are creative and artistic and must be very

00:14:27.360 smart. And sometimes that, you know, they're, they're, this is contested, you know, among

00:14:31.220 actual experts about whether is there a link between mental illness of various kinds, including

00:14:35.560 anxiety and depression and creativity. You know, so many famous writers, for instance,

00:14:40.760 and artists have had, you know, very prominent psychiatric disorders or, or alcoholism or things

00:14:46.200 like that. You know, is that, is there an alliance between the things that make you anxious

00:14:50.860 and depressed and the things that give you a kind of artistic sensibility? Maybe there's,

00:14:55.620 like I say, different, different people dispute that. And you're right that the, the sort of

00:14:59.380 cultural interpretation we put on anxiety changes. And, you know, one thing in particular, you

00:15:04.920 know, as a man, you know, that this has been changing recently, but there's a lot of shame

00:15:08.560 associated with, you know, is anxiety cowardice, you know, and is, and cowardice is shameful.

00:15:14.160 You know, there's not no, almost no worse epithet you can sling at a, at a man than being

00:15:17.880 a coward or whatever. And yet, and it's, but suppressing this stuff or not treating it can

00:15:22.880 be very dangerous. And so, you know, instead of going to a therapist, a lot of people turn

00:15:26.800 to alcohol or drugs and, and, and, and basically try to manage their anxiety in very unhealthy

00:15:31.280 ways that can be quite dangerous. And we'll, we'll get into that a little bit more because

00:15:35.000 I'd like to talk about stuff like Navy SEALs and neuropeptide wide and whatever. But, you know,

00:15:39.560 talking about the current diagnosis of anxiety, I thought it was interesting. You explore the DSM

00:15:45.620 and how they kind of came up with it. And we've talked about some other people when we talked

00:15:49.040 about, you know, depression, how a lot of this stuff, it's sort of like ad hoc. Like it was,

00:15:54.280 there was like this when I threw spaghetti at the wall, or sometimes there's like dinners and they're

00:15:57.340 like, well, here are the five things that we think that you can use to diagnose anxiety. Like it

00:16:02.160 often seems very arbitrary sometimes. It's, it's often completely arbitrary. I mean, I was fascinated

00:16:08.020 when doing research for this book and hearing some of these people talk, like, so the people who did

00:16:11.860 the last edition, a previous edition of the DSM, you know, every, every, you know, 10 or 20, 30 years,

00:16:17.520 they, they reissue a new one. And they were, when they introduced all the anxiety disorders for the

00:16:22.100 first time, that was in 1980 with the DSM three, the third edition. And yeah, that, you know, I would

00:16:27.720 hear people who are part of the committee that, that came up with the categories and yeah, they'd be

00:16:31.340 like sitting around and they would have come up with, you know, a definition for like panic

00:16:35.400 disorder, but even that was arbitrary. They'd say, well, if you have, you know, it's, it's,

00:16:39.200 if you have six, I'm trying to remember if you have, you know, X number of panic attacks

00:16:42.520 over a period of six months, well, then you have panic disorder. Well, why did they choose

00:16:45.760 six months? Like instead of, you know, a year or two months and why X number of panic attacks

00:16:49.740 instead of why? And the more interesting one was then they were talking about, well, we've

00:16:52.840 got all these different kinds of anxieties categorized into discrete disorders. So you've

00:16:58.420 got, you know, phobias, which is fear of specific things. You've got social anxiety, which

00:17:02.940 is fear of social situations. We've got panic disorder, which is panic attacks. You've

00:17:07.240 got OCD, which is obsessive compulsive disorder. But then what about, so they're at this dinner

00:17:11.160 and they're like, well, what about our colleague, you know, Joe, he's just sort of generally anxious

00:17:15.220 and they're like, oh, well, let's come up with something called generalized anxiety disorder.

00:17:19.420 And so they wrote that into the third edition of the DSM. And then once it exists as a real

00:17:23.640 category, then researchers and drug companies start to treat it as a real thing. And they, you

00:17:29.240 know, do studies based on the sets of symptoms that you're supposed to have to be, to be

00:17:34.480 characterized with that disease. And it starts to become sort of reified into, you know, like,

00:17:38.460 well, you're testing for a thing that you made up in the first place. And again, it's not that

00:17:44.360 the underlying suffering is not real and not there, but is generalized anxiety disorder really

00:17:49.440 its own separate disorder? Or is it, as some people now think, just a subset of depression,

00:17:55.100 you know, or depression with anxiety? People who are depressed often worry a lot and get sort of

00:17:59.160 sucked up into their own head. Well, that's what people with generalized anxiety disorder do.

00:18:03.140 They just worry incessantly and kind of spin in circles in their head. Being very anxious can be

00:18:09.120 depressing. So, you know, no wonder that anxiety and depression are so often, you know, co-occur in

00:18:13.840 people. And then many people with depression experience anxiety. So it's unclear how these

00:18:18.560 things really, you know, in the DSM, they're very neatly cleaved from one another. So, you know,

00:18:24.340 this disorder is distinct from that disorder. A lot of people are now starting to think maybe,

00:18:29.480 especially as they start to look at the neuroscience of this, which is still in early stages, but maybe

00:18:33.680 this is all kind of variants of the same thing. I imagine like a hundred years from now when

00:18:38.520 scientists look back, they may think that our categorizations of these things are pretty crude,

00:18:42.820 but they're the best we have right now.

00:18:44.120 Right. Like when we think about how people talk about neurostenia, right? Well, that's kind of silly.

00:18:49.180 Or hysteria, you know, hysteria, you know, it was a sort of, you know, particularly for women,

00:18:54.340 but it was, there was some, you know, what was that? Was that a cultural phenomenon? Was it a

00:18:58.120 medical phenomenon? It was kind of both. And these things always intersect. That's always interesting

00:19:02.000 to me. Like how to, when you have a real biological thing that gets interpreted culturally,

00:19:07.600 that's fascinating and really does change how we treat and think about people who have these disorders.

00:19:14.160 We're going to take a quick break for your word from our sponsors. And now back to the show.

00:19:19.740 And I imagine it can cause a lot of confusion and frustration for people struggling with it.

00:19:24.040 They're going to help and they're getting inconsistent diagnoses from different, like,

00:19:28.080 because like, you know, one therapist was like, well, you have this, but not this. So you're this.

00:19:33.060 And it's like, well, what am I like? What am I supposed to be doing with what I,

00:19:36.460 how am I supposed to go after what I have?

00:19:38.260 Yeah. After my book came out, I had a lot of people say that, or, you know, versions of that,

00:19:44.160 that they, you know, struggled a lot. But in general, I would say, you know, most therapists,

00:19:47.220 that there's a lot of agreement and it may change, but, you know, there are certain things

00:19:51.600 that there's emerging data about what works for kind of all these things or many of these things.

00:19:57.160 So for instance, there's a form of therapy called cognitive behavioral therapy,

00:20:00.780 which is basically a combination of, you know, helping people to change their thoughts to make them

00:20:08.120 less maladaptive, you know, break the cycle of negative thinking and sort of reality test in a

00:20:12.900 better way. You know, people are worried about things who have, you know, generalized anxiety

00:20:16.160 disorder. They always see the worst case scenario. And cognitive behavioral therapy helps you restructure

00:20:20.660 your way of thinking so you can see things in a more realistic way and then help you change your

00:20:25.300 behavior and exposing yourself to the things, you know, if you have anxiety, exposing yourself to the

00:20:29.620 things you're afraid of to kind of decondition you from the fear. There's a lot of evidence over now,

00:20:35.660 you know, more than a decade that that kind of therapy can work for all kinds of anxiety disorder,

00:20:40.440 for obsessive compulsive disorder, for depression. So there are things that work. And then there are

00:20:44.460 certain medications. I mean, medication is, you know, we may talk about that. That's a whole complex

00:20:48.840 stew where my sense is medications can work, but there is a great mystery about how they work,

00:20:54.280 when they work, who they work for, what the downsides are. But there are some studies and a lot

00:20:59.240 of evidence that suggests that for some people, certain medications can help them with their anxiety,

00:21:02.800 their depression. So even though we're still kind of groping around for, you know, proper definitions and

00:21:06.880 everything is kind of, these categories are messy. There are things that, that are generally believed

00:21:11.800 to, to, to work. And we'll, we'll talk about medications. That's interesting as well. Cause

00:21:15.560 that's, again, it's like the coming with the, how we define and diagnose anxiety. A lot of the,

00:21:21.580 the medication developed were very ad hoc and we'll talk about it because it's really interesting as

00:21:25.300 well. But let's talk about like what causes anxiety because like some people will look at it,

00:21:29.360 well, it's just like a choice. Like it's a, you can just snap out of it. Like, you know,

00:21:33.440 get, get your, get yourself together. But there's also evidence that says, no, there's,

00:21:37.500 there's a genetic component to it. So what's going on when, what, what causes anxiety?

00:21:41.520 There are, it's, it's, there are multiple causes, but there is a very strong, you know,

00:21:45.880 there's tons of evidence that there is a strong genetic component, you know, and just about

00:21:49.440 everybody has some adaptive predisposition to experience, you know, have a fight or flight

00:21:54.940 response, to have a fear response. But there are some people who, because of their genes

00:21:58.640 are born with, you know, what psychologists call a temperament that is more highly reactive.

00:22:03.220 And so it's literally, you know, the, the, the genes in their, you know, their, their DNA

00:22:07.920 and codes for a physiology that is more high reactive. And so those people, you know, just,

00:22:13.520 and you can detect it in babies, you know, you can often tell the ones that are going to grow up to

00:22:17.640 have, you know, anxiety disorders because they have a more exaggerated, what's called startle

00:22:21.640 responses. You know, if you, if you make a loud noise or flash a light at them, you know,

00:22:25.840 you can see their, their heart rate increases more, they sweat more, they have, you know,

00:22:29.640 electric conductance in their skin is greater. So it literally is at some level you can't control

00:22:34.720 it. It's, it's, it's deeply, deeply wired in and, you know, scientists are starting to look

00:22:39.640 at the various, you know, clusters of genes that, that lead to that. So some people are just born

00:22:44.380 with a ready press predisposition to be anxious. But then on top of that, there's kind of the

00:22:49.580 environmental factor. And there's also tons of evidence that, you know, and this is where Freud

00:22:54.500 wasn't wrong. You know, early childhood experiences have a profound impact on your psychology and your

00:23:00.340 sort of mental resilience, psychological resilience for the rest of your life. So people, kids and

00:23:05.100 adults who are exposed to trauma, you know, it changes your brain chemistry and even your brain

00:23:09.240 structure in such a way that, you know, this is what PTSD is. You're, you're now much more prone

00:23:13.480 to anxiety and depression, you know, panic attacks. So, you know, it's, it's a gene environment

00:23:18.840 interaction. And there are some people who are born with such an anxious predisposition that even

00:23:25.560 small stressors are going to send them into spiraling anxiety or depression and make them

00:23:30.780 develop a disorder. There are other people who are going to be much more resistant to it, but,

00:23:35.360 you know, even those people, most of them, many of them anyway, if exposed to enough trauma, you know,

00:23:41.000 war or, you know, something horrific in childhood will develop the elements of an anxiety disorder.

00:23:47.400 And then overlaid on top of that, as we were talking about earlier, they're kind of the

00:23:50.160 cultural and social level stuff, you know, are there certain cultures or periods of history that

00:23:57.140 are more anxiety causing than others? And I think the evidence suggests that, that there are,

00:24:02.080 but I think the strongest contributor by far is, is your genes. You know, there are some people who

00:24:06.680 are just have the misfortune to be born highly anxious and some people who are born sort of more

00:24:10.740 serene, but, you know, as with all human traits, then environment plays a role too. So.

00:24:16.000 Yeah. Well, you talk about even your own family, anxiety seems to run, run in your family.

00:24:21.040 Yeah. So, you know, when I was both in my therapy, but as I was researching the book,

00:24:25.900 you know, I was trying to figure out, well, what is the source of my own anxiety? And, you know,

00:24:28.820 my mom, you know, super high worrier, had a lot of phobias, which I got from her, you know, 1.00

00:24:33.960 and did I get them from her by watching her? Did I learn them from her, from environmental or is it,

00:24:39.340 you know, genetically encoded? And then her, you know, parents, you know, both had kind of elements of,

00:24:45.060 you know, had worrying personality traits. Her grandfather, my great grandfather,

00:24:49.200 you know, had struggled terribly with what they then called anxiety neurosis and was

00:24:52.520 institutionalized in psychiatric hospitals, you know, many times. Again, he had a very successful

00:24:56.960 career, was a smart, accomplished guy, but then would just get completely incapacitated

00:25:00.320 by his anxiety, would have to go to the mental hospital and get electroshock therapy to kind

00:25:04.880 of get his brain reset. And then, you know, I've got other relatives who struggle with this.

00:25:10.240 So, and then, and then studies show that once you have, you know, some number of anxious people

00:25:14.480 in a family, it just, you'll find many, many more. And, you know, is that transmitted by

00:25:20.540 environment? You know, did I learn it from my mom, from watching my mom, from watching my

00:25:23.940 grandparents? Maybe. Or was it transmitted through my genes? Well, probably that too. And

00:25:28.600 you can never, you know, completely disentangle them.

00:25:31.640 Well, yeah, going back to that idea that some, that you brought up that, you know, for men,

00:25:36.020 anxiety can be like a slap in the face. Cause like, look, if you have it, like you're a coward, 0.93

00:25:40.460 but like, you know, we were talking about Navy SEALs. Like some people are born with a predisposition 0.75

00:25:45.240 to be very anxious, but some are born with just like, they're just, just water off a duck's back,

00:25:50.080 right? Like Navy SEALs, they've done research on them where they found like they're actually

00:25:53.840 have a genetic predisposition to be hyper resilient, even in super stressful situations.

00:25:59.260 Exactly. I was fascinated by that study. So, I mean, Navy SEALs are really interesting to study

00:26:04.520 because they're such extreme like human specimens, you know, and to get to the point where you,

00:26:09.000 you know, get through Navy SEAL training, it's like, you must be, you know, incredibly physically

00:26:12.320 fit. And then they put you through these physical hardships, like sleep deprivation and, you know,

00:26:16.480 incredible hardship. And, you know, the physical part is hard enough, but these guys, you know,

00:26:21.080 they're able to withstand almost like a form of, you know, torture that would cause, you know,

00:26:26.920 me or many other people to just kind of break down. And so there's a guy at Yale who was

00:26:32.360 studying, you know, what, what is it that makes these guys so resilient? And he was actually

00:26:36.020 looking, you know, he would take, I think it was from their blood samples, you know,

00:26:39.680 measuring different neurotransmitters in their brain. And he found that the Navy SEALs who succeeded

00:26:44.940 in doing the Navy SEAL training had unusually high levels of something called neuropeptide Y.

00:26:51.520 And, you know, basically if you have a high level of, and they could actually predict in advance

00:26:55.260 to try to determine cause and effect, like, is it, you know, finishing the course that like gives

00:26:59.200 you a boost of confidence or something that causes your neuropeptide Y to rise, or do you have

00:27:02.860 kind of a natural baseline level of it? When you, when they looked at these people in advance,

00:27:08.360 they could almost predict how they would do on the test by their levels of a neuropeptide Y in

00:27:12.740 advance. And there are other studies that show that neuropeptide Y, you know, your levels of that

00:27:16.900 are kind of genetically determined, or at least partly genetically determined, which, you know,

00:27:21.660 to me is powerful evidence that your level of psychological resilience is, you know, conferred by your

00:27:26.620 genes, which, you know, allows you to produce this neurotransmitter that makes you unusually

00:27:31.180 psychologically resilient. But what psychologists now are really interested in studying, and in the

00:27:35.880 military too, is, you know, how can you cultivate this in non-genetic ways? You know, many of us would

00:27:40.920 benefit from being more resilient. So are there things that we can do through therapy or through

00:27:45.480 life experiences that boost our levels of neuropeptide Y, or that create the kind of psychological

00:27:50.980 structures in our head that are associated with neuropeptide Y, and that make us resilient and

00:27:55.540 resistant to anxiety, traumatic stress, that kind of thing. And it's a really promising area of

00:28:00.660 research. You know, it's basically taking, focusing on the people who are the least anxious and figure

00:28:04.760 out how can we use what they have going for them, both in terms of how they think and what's in their

00:28:09.140 brain, to treat people who, you know, are particularly non-resilient or highly anxious.

00:28:14.440 Well, let's talk about sort of the history of treating anxiety. So you mentioned earlier,

00:28:17.920 right now, there's a lot of promising research and, you know, studies have shown that cognitive behavior

00:28:22.900 therapy can help mitigate or help people manage their anxiety. But besides that, what are some

00:28:27.480 of the other ways, as far as therapy goes, and we've used to try to treat anxiety disorders?

00:28:32.400 Well, so these days, there's cognitive behavioral therapy. There's more traditional talk therapy.

00:28:37.560 I mean, CBT is kind of a form of talk therapy, but, you know, more of what you think of from the

00:28:41.300 movies, which is, you know, just talking to a psychiatrist or a psychologist or a social worker

00:28:46.660 or a therapist or some other kind, you know, psychodynamic therapy, that's called. And there's a lot of

00:28:50.700 evidence that just, you know, talking to someone who listens sympathetically to your problems has

00:28:56.060 some training in, you know, both helping you solve basic life challenges, but also, you know,

00:29:01.520 helping you resolve childhood issues. There's some evidence that that works. And then there's

00:29:06.820 medication. And, you know, going back really millennia, I mean, you know, if you read, you know,

00:29:12.600 the ancient Greeks or, you know, even Hippocrates, you know, the sort of original,

00:29:16.580 you know, most famous doctor in history, you know, talks about, you know, how wine can treat

00:29:21.900 anxiety. And, you know, for years, people have been using alcohol and opium and things like that

00:29:27.420 to medicate anxiety. But, you know, just going back a hundred and some years, there've been sort

00:29:32.400 of waves of different things that have been used to treat, you know, particular anxiety and then

00:29:36.220 anxiety and depression. You know, way back at the turn of the 20th century, you had kind of

00:29:40.740 barbiturates and other sedatives that were used to treat anxiety. Then around mid-century,

00:29:46.500 you had the dawn of what are called the benzodiazepines. So it's Valium and Librium.

00:29:52.300 And these days you have Klonopin, Xanax, Ativan, even Ambien that work on your, you know,

00:29:58.700 set of neurotransmitters in your brain called GABA that basically calms your brain down. And that can

00:30:03.760 be very effective in treating anxiety, but very dangerous too, in terms of its addictive potential

00:30:08.760 and, you know, the tendency to form, you know, habit and dependency. For depression,

00:30:13.600 you know, there've been different waves of drugs. There was the, you know, wave of what they call

00:30:17.280 the tricyclic antidepressants. Tricyclic just describes the structure of the molecule that,

00:30:22.200 these were things like imipramine, dezipramine. And then in the 80s, you had the first, what's

00:30:26.920 called the SSRI, serotonin, selective serotonin reuptake inhibitors. And the first one and most famous

00:30:31.800 one is Prozac. But these days you've got Prozac and Paxil and Zoloft and Celexa and Lexapro and a whole

00:30:37.840 bunch of others in that category and related ones too that affect serotonin and norepinephrine.

00:30:42.940 And basically all these drugs work on different sets of neurotransmitters to kind of, you know,

00:30:47.420 augment their levels in the brain in ways that we still don't fully understand how they work,

00:30:52.300 but seem to have some efficacy in reducing anxiety and reducing depression. And I've taken a lot of

00:30:59.560 these drugs myself and some of them seem to work and some of them don't. Some of them have terrible

00:31:03.020 side effects. The depressing thing about a lot of this is that, you know, a lot of treatment just

00:31:10.660 doesn't work. You know, it takes a lot of trial and error. You know, therapy can be effective and

00:31:14.480 I would encourage anyone who's suffering with these things to, you know, seek out treatment because

00:31:18.340 it can be a lifesaver. But it can sometimes, sometimes it takes a few tries to find a therapist

00:31:22.900 that you like or a medication that works. And if you look at the long-term evidence, you know,

00:31:26.840 really it's like a third to a half or something of any treatment works. And it's not always clear

00:31:31.760 why the thing that's working is working. And that's why CBT is probably the best evidence,

00:31:36.740 has the best evidence in its favor. And it also has in its favor, since it's not a drug,

00:31:41.660 it's not addictive, it's not dependency forming, it doesn't, you know, and ideally you can kind of

00:31:45.320 learn the skills from CBT and take them with you through your life, you know, and keep practicing.

00:31:50.960 Unlike, you know, if you're on a drug and it works, what happens if you go off the drug?

00:31:54.300 Like sometimes, you know, have, you know, withdrawal issues.

00:31:57.280 Yeah. So, I mean, I think you brought up an interesting point that anxiety sounds like

00:32:01.700 it's something that you can't really, you're never going to be cured of it, right? Like

00:32:04.900 you're always going to have to just, just manage it for most of your life.

00:32:08.600 I would love to be able to be cured of it. And I still, you know, some of the time with,

00:32:13.500 you know, 10% of my brain hope that I could be, you know, to achieve like complete serenity.

00:32:18.380 And not that there won't be things that scare me or that I don't, you know, worry about

00:32:21.280 legitimately, but it's not something that plagues me. And I think,

00:32:24.140 you know, some people, they get really, the one thing I didn't mention is, is, you know,

00:32:27.520 mindfulness practice. These days, there's tons of evidence that the, you know, various meditation

00:32:32.480 skills and practices and, and, and other forms of mindfulness really can help confer the kind of,

00:32:38.900 you know, resiliency and calm that say neuropeptide Y does in these Navy, Navy seals. And, you know,

00:32:44.280 so I, in my therapy, I've tried, you know, a combination of CBT with trying to do meditation stuff.

00:32:48.980 So, so I think it is, and you're not cured. You're, you're always going to have your underlying

00:32:52.900 genetics. So if you're a high reactive person, someone who is prone to be nervous about things,

00:32:58.360 that's probably always going to be the case, but you can reduce, you know, the amount of it. And

00:33:02.140 you, as you say, you can learn to, to manage it with different sets of skills from whatever kind

00:33:06.520 of therapy you're using or to manage it with medication or to, you know, sort of adjust your

00:33:10.880 lifestyle. I mean, sometimes if you're anxious or depressed, that's your body and your brain

00:33:15.120 telling you something's not right in your life and you need to, you know, make some changes and

00:33:19.340 sometimes having a better lifestyle and all this obvious cliche and stuff that people tell you is

00:33:23.160 true. You know, it's really important to get sleep. You know, for me, if I'm, if I'm underslept,

00:33:27.640 my anxiety goes to the roof. It's for me also, and tons of studies support this regular exercise. I

00:33:32.520 mean, these are basic things that don't cost anything. You don't need insurance for, but in

00:33:36.460 modern life, it's sometimes hard to work out regularly. It's hard to get a good night's sleep when

00:33:39.860 you've got deadlines. So all these things, you know, if you, if you do them all, you can

00:33:44.160 actually minimize the effect that anxiety has on your life. And there's always going to be,

00:33:49.040 I mean, for me, you know, there's things that erupt that cause my anxiety to spike,

00:33:52.200 but when I'm doing well, I can both have those spikes be fewer and farther between. And also

00:33:59.260 when they happen, manage them better and not have them, you know, send me spiraling off the rails or,

00:34:03.920 or, you know, sort of over-medicating myself. So there's a long-winded way of saying, yes,

00:34:08.380 you know, if one can learn to, to, to manage them and if, and if you can do that, then you can live a

00:34:12.240 pretty, you know, fulfilling and rewarding life. That's not, you know, the constant misery that

00:34:15.900 anxiety can sometimes be. Right. I think that's hopeful because I mean, if there's a strong

00:34:20.020 genetic component to anxiety, you know, people who have that problem, they're listening, they're

00:34:23.340 like, well, crap, I'm, I'm hosed. Yeah. That's, that could be the approach or it could be like, 0.79

00:34:27.680 well, okay, this is the thing. I got to work with it. It's not great, but I can manage it. There's

00:34:32.920 things I can do. Yeah. And I mean, I, when I, I remember talking to my therapist when I was sort of

00:34:36.760 learning about my great grandfather and all the terrible troubles that he had had and then

00:34:41.760 multiple, you know, hospitalizations. And I was like, God, you know, he reminds me so much of

00:34:45.460 myself and I have, you know, his genes and this, I'm doomed to this. And my therapist was like,

00:34:49.260 first of all, he's your great grandfather. You have like a tiny fraction of his genes.

00:34:52.760 And second of all, you know, there's medications we have now that he didn't have access to that can

00:34:59.140 help you. And, you know, there, there, there's just lots of stuff that you can do. You're not,

00:35:03.000 yes, genetics is powerful, but you're not doomed to your genetic fate and we can learn to cultivate

00:35:08.760 resilience. And a lot of the therapies that are effective, like I say, you know, kind of behavioral

00:35:12.900 therapy, but just in general, you know, facing your fears and I'm, you know, it's easy for me to say

00:35:17.820 this and sometimes hard for me to do, but the more you, you know, if you have specific phobias like

00:35:22.080 fear of flying or fear of public speaking, the more you do it, the easier it gets. And that's sort of a,

00:35:27.540 you know, simple lesson, but it's, it's, it's true. It's just, you know, for me,

00:35:31.200 sometimes those things can be so anxiety producing that I can't do them. And then I feel like it's

00:35:35.560 a setback and my anxiety gets worse. But what my therapist always tell me is, you know, get up,

00:35:39.380 persist, do it again, and you will get better. So.

00:35:42.200 Right. Exposure therapy. I think that's what that is.

00:35:43.760 Exposure therapy. Exactly. Yeah. So if you have fear of heights, they'll take you up on higher and

00:35:46.960 higher buildings. I mean, you know, sometimes these treatments sound kind of extreme. Like if you

00:35:50.900 have severe claustrophobia, there's actually therapists who will put you in like a coffin and, you know,

00:35:55.260 you have a horrible anxiety, but then you just wait it out and you realize I didn't die. You know,

00:35:58.960 I'm okay. I can manage it. It was just a really unpleasant emotion, you know, for,

00:36:03.380 for people who have flying phobia, there are pilots who will take you up. A lot of airports have

00:36:07.780 programs where you can go and, you know, get walked around the plane by a pilot who explains how the

00:36:12.840 whole thing works, you know, and basically little by little expose yourself, you know, sit in the

00:36:16.520 plane, then go on a short plane ride. And eventually, hopefully you can be flying to Europe without

00:36:20.040 being completely miserable as I've sometimes been on, on international flights.

00:36:24.380 And I think that's an important point for parents who might have children who are,

00:36:26.880 you know, hypersensitive or super anxious. You know, oftentimes when you're a parent,

00:36:29.880 you're like, well, I just don't want my kid to freak out. So I'll just avoid the thing that,

00:36:33.980 you know, causes them lots of anxiety and gets them worked up. Rather, the better approach might

00:36:38.420 be, well, just sort of slowly introduce that thing over and over again. So they don't get scared.

00:36:43.060 They're not scared of it or doesn't worry them anymore.

00:36:45.400 That's absolutely right. And I think that's really important. And what I'm about to say may sort of

00:36:49.340 sound paradoxical, but it's not, you know, if you think that there's all kinds of evidence that

00:36:53.800 suggests that if you think your kid might be developing, you know, unusual level of anxiety,

00:36:57.980 you know, what could be a clinical level anxiety, the evidence says, you know, if you, the earlier

00:37:02.100 you can get help and get them therapy, the better, the better outcome they'll have, the less likely

00:37:06.520 they'll be to, you know, suffer anxiety disorders as an adult. So early intervention is key, but early

00:37:12.260 intervention doesn't mean sparing them from anxiety. And, you know, what almost any therapist

00:37:16.280 they would tell you is actually, you know, don't, and this is where, you know, it's the antidote to

00:37:20.300 helicopter parenting. Don't try to do everything for your kids. Don't try to spare them the unpleasant

00:37:26.780 experience or the thing that's making them nervous, you know, particularly if it's being, you know,

00:37:30.020 anxious about going to school. And I know how hard that is, you know, both having been, you know,

00:37:33.820 a very anxious kid and now being a parent who has anxious kids, you know, it's incredibly painful

00:37:39.780 and hard to watch your child, you know, suffering and feeling nervous. And everything in my body wants

00:37:43.720 to be, I just want to take him out of that situation so he's not nervous. But what, you know,

00:37:48.360 their therapists, every therapist, you know, I've ever seen says, no, no, you have to let them,

00:37:53.440 within reason, experience the anxiety and learn that they can overcome it. And that's how they

00:37:57.180 develop resilience. Don't do it for them. That's how you, you know, you'll helicopter your parent,

00:38:01.540 your kid into being kind of a helpless, neurotic, you know, 22-year-old who can't make his own dinner.

00:38:06.720 Right. So what's the state of your anxiety today? So you've said you're doing cognitive behavioral

00:38:10.780 therapy, some mindfulness meditation. Are you taking medication?

00:38:13.360 I am. So I'm still really bad at the mindfulness. And I think it's one of these catch-22s that like

00:38:19.340 the more, the people who need, who benefit from like mindfulness and yoga and that kind of thing,

00:38:24.180 meditation the most are the ones who are worst at it because, you know, I'm just,

00:38:27.260 my thoughts are always racing. I have a hard time sitting still, but I'm trying that,

00:38:31.180 doing CBT with a really good therapist and that's helped doing exposure therapy, which is

00:38:34.840 really unpleasant, but I think does help. And then, yeah, I am currently on Lexapro,

00:38:40.540 which is one of these SSRI medications. And then around the, I take a medication called

00:38:45.760 gabapentin, which was originally a anti-seizure medication and a medication for pain, but has

00:38:51.760 shown some effectiveness in treating anxiety. And then, you know, I've, I used to take a lot of

00:38:57.600 benzodiazepines. I've now tried not to, they work incredibly well for me. You know, for me,

00:39:03.140 that was always like my magic bullet. If I was, you know, I knew I could always survive if I could

00:39:06.540 have access to, you know, enough, enough Xanax. The problem is it worked a little too well.

00:39:12.040 And, you know, the danger is I, you know, I started to become too dependent on it. And,

00:39:16.340 you know, you, the more of it you take, the more you need to take in order to get the same effect.

00:39:20.200 And it can be very dangerous and people become dependent on it. So I'm trying not

00:39:23.720 to use that now. And, you know, it's pretty widely prescribed by both psychiatrists and...

00:39:30.320 Just family doctors.

00:39:31.400 Just family doctors, because it is so effective. But there's also, you know, a pretty big school of

00:39:35.380 thought out there that it's like, they really shouldn't be prescribing it so wildly because

00:39:38.380 it can be, in certain people, very addictive and dependency forming.

00:39:42.660 And so I imagine it's like, and also you're doing the things like getting enough sleep,

00:39:45.760 exercising, managing stress, reducing that when you can, et cetera.

00:39:51.040 Yeah. I mean, I don't know why this is the case, but for me, you know, getting, you know,

00:39:55.340 regular exercise is, it's like night and day. And my wife can even tell, you know, if at the end of

00:40:00.660 the day I'm on the phone with her, she'll be like, why don't you go work out? And I'm like,

00:40:03.620 how can you, she's like, I can just tell in your voice that you haven't. And it's like,

00:40:06.060 my personality changes somehow. And, you know, not, you know, you don't always feel like working

00:40:10.340 out. There's some people who just don't exercise at all. And, but for me, forcing myself to work

00:40:14.720 out, even when I'm, don't feel like it, you know, just is so good for my state of mind and good for

00:40:19.480 my physical health as well. And that's true for just about everyone.

00:40:23.400 Right. Well, and I imagine if there's someone who's listening to this podcast, they're struggling

00:40:27.360 with anxiety, best advice, go get help, go talk to somebody. There's things you can do to help

00:40:32.280 manage it. So you have a flourishing, productive life like yourself. Like you said, like, yeah,

00:40:35.860 you've, you've struggled with your entire life, but you have a good career and you're doing a lot

00:40:39.600 of great things. Yeah. And there, there are a lot of ways you can get help. I mean, there's,

00:40:43.420 I'm forgetting what it stands for, but NAMI, it's like the National Alliance of Mental Health

00:40:47.760 Initiative or something like that can help you find, even if you don't have insurance or, you know,

00:40:52.200 help you find access to, you know, individual therapy or group therapy or just resources in your area.

00:40:57.260 If you have anxiety in particular, there's an organization, nonprofit organization called

00:41:01.340 the Anxiety and Depression Association of America. It's the ADAA. And if you go on their website,

00:41:06.900 you know, they have lists of therapists in your area and you can always just go to your

00:41:12.040 primary care physician and they, they can help refer you. You know, if any, any city that has a

00:41:19.020 university will often have like an anxiety disorders clinic. So there's lots of help available out

00:41:24.280 there. Well, Scott, is there some place people can go to learn more about your work?

00:41:27.280 You can go to my website. I'm embarrassed. I'm blanking on now what the...

00:41:31.940 Is it scottstossel.com?

00:41:33.440 scottstossel.com. Yes. Thank you. I never go to it.

00:41:38.100 Right. Well, hey, Scott, this has been a great conversation. Thanks so much for your time.

00:41:43.040 Thanks so much, Brad. I really appreciate it.

00:41:44.760 My guest today was Scott Stossel. He's the author of the book, My Age of Anxiety. It's

00:41:48.500 available on amazon.com and bookstores everywhere. You can also check out our show notes at

00:41:51.880 aom.is slash age of anxiety, where you can find links to resources,

00:41:55.580 where you can delve deeper into this topic.

00:42:03.180 Well, that wraps up another edition of the AOM podcast. Check out our website at

00:42:07.360 artofmanliness.com, where you can see our podcast archives. We're coming up on 500 episodes here

00:42:11.740 pretty soon. You can see them all there. While you're there, check out our articles we've written.

00:42:15.140 We've got a couple thousand there about just about anything. Depression, how to manage that,

00:42:19.220 personal finances, how to be a better husband, better father. Check it out. And if you haven't

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00:42:30.380 member. You would think we get something out of it. As always, thank you for the continued support.

00:42:34.280 Until next time, this is Brett McCary. Remind you not only to listen to the AOM podcast,

00:42:37.540 but put what you've heard into action.

The Art of Manliness - April 08, 2019

#497： The Meaning, Manifestations, and Treatments for Anxiety

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