Turn Your Anxiety Into a Strength
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Summary
Dr. David Rosemarin is an associate professor at Harvard Medical School, the founder of the Center for Anxiety, and the author of Thriving with Anxiety: Nine Tools to Make Your Anxiety Work For You. He explains why the prevalence of anxiety has risen while the reasons to feel anxious have fallen, and what the increase in anxiety has to do with our growing intolerance for uncertainty and uncontrollability.
Transcript
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Brett McKay here, and welcome to another edition of the Art of Manliness podcast.
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Anxiety is typically thought of as a disease or a disorder. My guest has a very different
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way of looking at it. It says that rather than being a burden, anxiety can actually
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become a benefit and even a strength. Dr. David Rosemarin is an associate professor
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at Harvard Medical School, the founder of the Center for Anxiety, and the author of
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Thriving with Anxiety, Nine Tools to Make Your Anxiety Work for You. Today on the show,
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David explains why the prevalence of anxiety has risen while the reasons to feel anxious
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have fallen, and what the increase in anxiety has to do with our growing intolerance for
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uncertainty and uncontrollability. We discuss how the perception of anxiety is a big part
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of the problem that has made anxiety a problem. Now you can change your relationship with anxiety,
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transforming it from something that hinders your life to something that helps you develop
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greater self-awareness, reach your goals, make needed changes, connect better with others,
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and build your overall resilience. After the show's over, check out our show notes at
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All right, David Rosemarin, welcome to the show.
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So you are a clinical psychologist and you founded the Center for Anxiety to help people who are
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struggling with anxiety problems. I know a lot of people have that issue. We also got a new book
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out called Thriving with Anxiety, Nine Tools to Make Your Anxiety Work for You. We walk readers
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through the tools you give your clients or patients on how to manage their anxiety. Not only manage,
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but like thrive with it. That's the whole point of this. I'm curious, what led you to specialize in
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Yeah. When I was getting into clinical psychology, you know, I really wanted to do something that was
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evidence-based. And there are lots of different areas to focus in. Anxiety was definitely the most
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well-researched, well-understood in terms of how to do it. And that appealed to me, the scientific
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approach. And that's sort of the first part about it. Little did I know that getting into this field,
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I would learn a lot about myself, a lot about the world, a lot about my patients. And it's been
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So let's talk about definitions first. How do you define anxiety? Because I think it's a word now that's
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become part of the popular culture. Everyone's talking about it. There's songs about anxiety.
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So anxiety is the same as fear. It shares the same brain circuitry,
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shares the same physiology, and it's the fight or flight system, which we all know where your heart
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starts beating and your breathing gets constricted and your muscles get tense and your stomach might
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get upset and you might feel even a little dizzy because your pupils are dilating. And fear,
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you have to start with understanding fear before you define anxiety. Fear is an adaptive, healthy
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thing. It keeps you safe. It's the fight or flight system that if you need it, that's going to come
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into play and you'll either fight or flee from some threat. Now, anxiety is the same exact thing,
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but there's one small difference. It's actually a large difference, which is that there's no actual
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threat present. You're having all the feelings of the fight or flight system, but you're not actually
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experiencing a real threat in front of you at the time.
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Okay. So fear would be you see a bear on the trail in front of you when you're out backpacking,
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and then you're experiencing that fight or flight response. Then in that situation,
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that would be an appropriate fear response. Anxiety would be experiencing that same sort of
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physiological reaction to thinking about going to a party and socializing. In that situation,
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like the worst thing that could happen to you is, you know, you feel awkward or uncomfortable,
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but I mean, you're not under actual threat in that situation. So, you know, what's interesting
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then is that, you know, despite us living in the safest, most prosperous time in human history,
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where there's not a lot of threats out there, anxiety keeps increasing. You know, more and more
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people have or report having anxiety than ever before. So what's going on there? Like, why are
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we more anxious despite not having any real threats to be afraid of?
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Yeah, it's a great question. It's at the core of my new book. I actually think it's because we are in
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one of the most safe and prosperous times in human history that we have the highest levels of anxiety.
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And I'll explain that one. You know, if you look at high-income countries, they have twice as much
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anxiety as middle-income countries. And middle-income countries have twice as much anxiety as low-income
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countries. And as things have become more prosperous and more safe in our society with more safeguards
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and more information, which we're presented with, our anxiety is actually increasing substantially.
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And this is objective. I mean, look at the suicide rate. If you look at the levels of disability,
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it's not just people reporting it. So we have a big problem. The question is why, I think.
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And we expect to be in control all the time. We expect that things are going to go well.
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We expect that if we start a business right away, things are going to be hopping. We expect that we
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can get the medical care that we need, that our technology is not going to fail us. And because of that,
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we are not resilient. We are actually very unresilient to anxiety. And when we experience it,
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even low levels, all of a sudden, boom, that cascades into a massive amount of anxiety. And I
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think that's what we're seeing en masse. Our expectations are just unrealistic.
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Well, here's a perfect example of that I've seen in my own life. The expectation that you shouldn't be
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able to be in touch with your loved ones and know where they are at all times thanks to cell phones
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has made a lot of people anxious. Because now whenever you call your spouse or you text your
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kid and they don't respond, you're like, oh my gosh, something terrible happened. They're in a car
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wreck. But I grew up before cell phones and I would leave at seven o'clock in the evening and go out and
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hang out with my friends and not come home until midnight. And I don't think my mom ever freaked out
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about it. Yeah, I think it's a perfect example. Like you see, hey, they read it. Or like, hey,
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they're around the corner. I can see on the GPS. But like, why aren't they calling? Why aren't they
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doing this? Where are they? You know, it's almost like the more information we have and the better
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things are going day to day, the less, like I said, resilient we are. And that's a big problem.
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Okay, so the more in control we feel with our life, thanks to technology and all the things we have
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in our life, the more anxious that we can potentially feel. Yeah. And you mentioned the
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word control and that's exactly what it's about. In reality, we're not in control. We're like,
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let's acknowledge it. There's so much less that we can control than we really think day to day,
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even with the information, even with the technology, even with the medical systems and financial systems
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we have in place. But we don't like to live on the edge. We don't take risks. We don't like to feel
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uncomfortable. We assume that even feeling uncomfortable is a disease. It's not. It's
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called being human. And I think we've really forgotten how to be emotionally resilient and
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to learn how to thrive with difficult emotions, which are part of life.
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Well, that's another point in the book that stood out to me was this idea that even feeling
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anxiety, like people can feel anxious about that. They feel bad that they feel bad, which
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just causes even more anxiety. Yeah. The minute you feel anxious today,
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you don't say, oh yeah, of course, I'm working really hard. Or, oh yeah, that's because there's
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this news, which is really, really tough for me to stomach. Or it's because I didn't know that
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something was happening. Instead, we say, oh my God, I have a disease. Something's wrong with me.
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Now, if you perceive your anxiety as a disease, you're going to trigger your fight or flight system
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more. You're literally going to dump adrenaline more into your system and create a cascade of
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anxiety. So, we've created this monster and the effects are really quite problematic.
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Yeah. I think that's one of the big problems with the popularization of psychology of people
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reading psychological books or consuming psychological content like lay people and then
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diagnosing themselves. Well, I have anxiety. And as soon as they make that self-diagnosis,
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they've made this normal feeling of feeling nervous because of uncertainty into a bigger
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problem than it needs to be. And then it can become debilitating.
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I would agree. But unfortunately, I think the medical field has played into this as well.
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This last summer, there was a panel of federally funded, in fact, physicians across the United States
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who made a recommendation to use a very brief measure at all PCPs visits, any primary care visit.
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And the net result of that was that if you report any level of worry or any level of anxiety at a
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visit, it flags you for diagnosis and potential treatment of an anxiety disorder. Now, let me ask
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you, how many people have you seen this week who had no anxiety and no worry at all in the last two
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Zero. There's nobody because it's a normal human emotion. So, I think that it's not only the,
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yes, popularization of psychology, a hundred percent, no question. But the medical field,
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I would even say the pharmaceutical industry, has played into this myth of having perfect emotions all
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the time. And in doing so, has greatly disrupted our capacity for well-being and for flourishing.
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And something you do with your work, you're working with people who have varying levels of anxiety. You
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have people who, they're, you know, mostly well-functioning, but they might experience just
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like, ah, I feel nervous all the time and I like to get a handle on that. But then there's also to
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the point where that anxiety becomes a problem. And it's something you, actually, there's a clinical
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diagnosis. Like at what level, at what point do you as a clinician diagnose someone with anxiety
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Yeah. I mean, the, you know, the simple answer to that question is when it causes significant
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distress or impairment. And that's a very subjective call, to be perfectly honest. Like
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there's no lab test to say you have anxiety and an anxiety disorder or you do not. There's
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no, you know, clear physiological, neurobiological markers of these. And there's some indications
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of, you know, pathology, what we call it, but, but not really. It's not, you can't, you can't
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use those as diagnostic for each person. So to me, it's less about whether a person has
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a clinical level or a subclinical level and more about what do we do when we feel anxious?
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How do we change our relationship with anxiety? That it's not an indication that something's
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wrong with us. It's not the end of our happiness and wellbeing. It's just considered to be part
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of life and something that actually can make us stronger and even thrive better.
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Well, yeah, that's the big argument in your book. This book's called Thriving with
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Anxiety. You make the case that anxiety can be used as a strength in our lives. How can
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this thing that we see as a disorder and everyone's trying to get rid of actually be a blessing?
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Yeah, it's really simple. A really solid workout in the gym. You don't feel good at the moment,
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right? You're sweating, you're uncomfortable, you're feeling a burn in your muscles. I mean,
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if you're increasing, you know, you're lifting, you know, you're lifting heavy stones or whatever
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it is that you got going. And it's uncomfortable. It burns. It feels like death at one point. And if
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you have a trainer or someone standing over you, they're like, keep going, keep going. It looks
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like torture. I mean, you know, if you're filming it from the outside, it would be, you didn't know
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what was going on. You'd be like, why is that person torturing them? But they're not. And the
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person who's doing it is actually voluntarily going through that pain in order to develop their muscle
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tone, to develop their reaction time, to develop their cardiovascular health. And emotional health
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is no different. It's no different. Going through anxiety can enhance our emotional and neural strength
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and make us more resilient and more capable of handling difficult situations, which, by the way,
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are going to come up, especially if you're pursuing your dreams and your goals in life.
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If you're taking the easy road, maybe not. But if you're doing something that's out there
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and you're, you know, being a man, so to speak, and, you know, really out there on a limb and
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pushing yourself to the max, you're going to feel stressed. You're going to feel anxious. That's the
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way it's going to be. And can we use anxiety to build that resilience in order to propel us forward
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in our goals and dreams? I think the answer is yes. Okay. And I hope throughout this conversation,
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we can discuss some of the tools you've come up with and use with your clients and patients
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on how to turn their anxiety into something that can be used as a strength instead of a
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liability. But one of the first things you do when you have someone that comes in to see you saying,
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oh, I've got so much anxiety, is you talk to them like, well, are you, do you really have anxiety?
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Because you highlight the fact that a lot of times people confuse being stressed out with being
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anxious. So what's the difference between stress and anxiety? And why is that difference important?
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Yeah, great question. First, I'll just mention that people only ask this question if they're feeling
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anxious, that they're feeling uncomfortable. So here we already see how anxiety can help you to
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thrive because it helps you to become more self-aware. And you're going to hopefully start
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to ask yourself questions. Am I just stressed out by situations in my life? Or is there an imbalance
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between my demands and my resources, between the number of things I have to do and the amount of time,
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money, whatever it is that I have to accomplish, all that stuff? That would be called stress.
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Or is my anxiety really a misfire, if you will, of my fear system, in which case I need to take a
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different approach? That would be the difference between stress and anxiety. Stress is the imbalance
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between demands and resources. And anxiety is, again, that fear response, which is not in response
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to an actual threat. It's in response to something which is really in your mind.
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Okay. So you can just be stressed when there's an imbalance in your life between
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your demands and your resources. But then you can also feel anxiety about that stress because you're
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like, oh my gosh, this is going to crush me. My life's going to fall apart. But that anxiety you're
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feeling about your stress, I mean, it could be helpful sometimes because it can help you recognize,
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okay, I've got a problem here that I need to do something about.
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Yeah. Anxiety helps you to unpack all of this. If you're stressed out, like super stressed and
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chronically stressed, because there's just way too much to do in your life, the structure is such
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that you never have enough time, never have enough money, never have enough capacity to handle
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whatever's coming your way, then your body's going to get anxious and feel uncomfortable as a sign to
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tell you, hey, let's check, let's recalibrate, let's rebalance, let's maybe do something and make some
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different choices here. And that's actually a healthy thing. So leaning into the anxiety, letting you
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experience it can help you to be more self-aware.
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And so when you have a patient that comes to you like, okay, I'm anxious. They're like, well,
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let's take a look at your life. It looks like you have a lot of stress in your life. What do you tell
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My go-to is when someone's stressed out, number one is going to be sleep. And I kid you not,
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I've had many patients come to me. I have them go through an exercise of sleeping for eight hours a
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night for two weeks. And two weeks later, they have no symptoms of anxiety.
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They are really restored. They're rejuvenated. And basically their body was telling them,
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please, please put me to bed. And finally, when they listened, then their symptoms went away. Now
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it doesn't happen all the time, but that is going to be my go-to for dealing with stress.
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Gotcha. And then you also talk about exercise is an important one.
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Getting out in nature, ideally, can help out a lot. And then doing things, I think a lot of people
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these days, they feel overwhelmed with the amount of news and social media they're consuming. That
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Yeah. I like to think about social media and even the news that we have as the greatest
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social psychology experiment of all time. And it does not seem to be going well.
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Never before in history have you had a generation with unfettered access
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to international news at this order of magnitude. It's incredible what we can look up in 10 seconds
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on our phones. And we have to be mindful of the effects of that. That can be intense.
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Yeah. Okay. So if you're feeling anxious, first question to ask, well, maybe I'm stressed out.
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Look at that and do an inventory. And then if you are, get some extra sleep. I know I've noticed
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in my own life with sleep. I'm sure everyone else has experienced this as well. Is it nighttime?
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That's when you start ruminating and you start going down this dark place. Like, oh my gosh,
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my life's terrible. I've got all this stuff going on. And oh, this problem, there's just
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something about being tired and it's dark outside. And then it's usually at that point, it's like,
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I got to go to bed. If I just go to bed, all the problems go away for at least eight hours.
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And then I wake up and then I see those things that I thought were problems. They're not actually
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Sounds like you're also not your best self when you're super tired late at night. Hey, we got that in
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Right. Yeah. It's like, you know, sometimes we're grownups are just big babies. Like, okay,
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baby, you know, is the baby crying because it needs sleep and it's hungry, et cetera. And like,
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usually the same things can apply to grown humans as well.
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So one of the things you talk about is let's say someone gets triggered by anxiety and they start
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feeling that anxiousness starting to percolate in their body. That feeling can be okay. It can be a
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signal that something's off and that you need to explore something. But you talk about how people
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can get on this anxiety spiral that takes them to a not so great place. So what's the anxiety spiral?
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Yep. That's definitely the key here. And I think this relates to what we were saying before.
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To me, the anxiety spiral is the reason why we have an anxiety epidemic today.
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The minute we start to feel a little uncomfortable, our first perception is what's wrong with me?
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Something's not right here. And we start to judge ourselves and say, oh, I'm diseased. Oh,
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everyone else feels fine. Why do I feel this way? You know? And we start to get upset about the fact
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that we're anxious. Okay. The second thing we do is we catastrophize. I can't handle this anxiety.
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This will kill me. This will make me a weak person. This will make it impossible for me to function.
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And by the way, none of that is true. People actually function better when they're anxious,
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surprisingly. Often people function better when they're anxious. But those two horsemen, if you
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will, horsemen of the apocalypse, the first one, the judgment of oneself, and the second one
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is the catastrophizing, may actually physiologically increase the intensity of your anxiety symptoms
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because you're going to have a dump of adrenaline into your system. And around and around we go.
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That creates the anxiety spiral or the cascade, as I like to call it. Because the initial experience
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of anxiety met with judgment, met with catastrophizing, leads to greater levels of
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anxiety. And that's what's happening in our society en masse.
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What's an example of the anxiety spiral? Like a very concrete example you might see in your practice.
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Let's say someone has, they say, I've got an anxiety problem around, let's say socializing. I have a
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social anxiety. What would that anxiety spiral look like in that situation?
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Great. Okay. So you're in a social situation. You're walking into a party. You don't
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know too many people. And you're worried about making small talk. So you start to feel a little
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bit panicky, a little bit of a flutter in your heart. Start to feel a little bit of a pit in your
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stomach. You feel the cotton mouth coming on. And then immediately start to think, oh no,
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other people are going to see I'm anxious. Oh no, why do I feel this way? I'm weak. I can't really
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handle this. So at that point, there are a couple of things that happen. People either leave the party
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or they start drinking or they can take a bold, bold move, which is what I'm recommending,
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which is to weather the storm and to say, no, I'm not feeling uncomfortable because something's
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wrong with me. This is just part of a new territory for me. I'm not the most social guy. I'm not the
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most, I'm a little bit shy. Okay, fine. So I'm going to learn how to do this. I'm going to build the
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resilience. I'm going to build that capacity and then I'm going to move through. And that choice of
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going into the anxiety spiral or what I call the positive spiral makes all the difference in the
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world when we're dealing with anxiety in the moment. Well, yeah, let's talk about that positive
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spiral. That's the antidote to the anxiety spiral. What does the positive spiral look like?
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Yeah, the positive spiral is when we accept I'm going to feel anxious sometimes. Okay. Some people
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just aren't that social. In social situations, when they're meeting new people or when they're having
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conversations with, I don't know, superiors at work or whatever it is, they're going to feel
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awkward. They're going to feel uncomfortable and that's okay. There's no judgment.
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There's actually self-compassion. There's an understanding, okay, this is just my makeup and
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I have to build my resilience and build my connection. And these opportunities, you know
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what? I'm going to do it once a week. I'm going to go into an uncomfortable situation and I'm going
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to build that muscle just like I would in the gym once a week, a couple times a week in order to
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make the anxiety a catalyst towards thriving and growth as opposed to something that gets me down
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and then I get upset about. Okay. So for someone who has maybe social anxiety,
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you're in that social situation. You have to make small talk at a party. You're feeling that
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moment. You're like, oh my gosh, I'm starting to feel a little anxious, feeling tight in the chest.
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The positive spiral would be like, just, okay, I'm just going to experience this. I'm not going to
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try to fight it. You're not going to try to convince yourself there's nothing to be afraid of.
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You're just going to allow yourself to feel that tightness. And then usually what ends up
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happening by just allowing it, it usually just washes over you pretty fast. And oftentimes the
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anxiety just stops after a few minutes. It does. A couple of years ago, this happened to me. I was
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giving a talk for an audience and I was not expecting to feel anxious at all. I don't usually get
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anxious giving public lectures as a public speaker. It happens all the time that I probably give
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30, 40 lectures a year at this point. But I was in this situation and all of a sudden I started to
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feel anxious and I'm like, okay, great. We're going to build our resilience. I looked at my watch and
00:22:05.360
120 seconds later, the anxiety symptoms were gone.
00:22:09.240
Yeah. And this reminds me a lot of acceptance and commitment therapy from Stephen Hayes. We've
00:22:14.300
had Stephen Hayes on the podcast before. His whole thing is instead of fighting these negative emotions,
00:22:19.660
just sit with them for a bit and maybe even explore them. Like what's going on there? Why am I feeling
00:22:25.060
that tightness in my chest? And counterintuitively by really leaning into those negative feelings or
00:22:34.180
Yeah. Steve is a bit of a mentor of mine, in fact. And he actually wrote an approbation of
00:22:39.260
a previous book that I wrote. So he definitely has had a huge influence on my work. I think
00:22:44.400
acceptance is the starting point. The question is, can you actually use anxiety in a positive
00:22:49.980
way in your life to increase your relationships with others, your connection with yourself to
00:22:55.940
start to really parlay that into pursuing higher goals and dreams? That's really where
00:23:02.080
ACT is the sort of foundation point for my approach.
00:23:07.240
Well, something I've done as I've coached flag football for my son and his friends for the past
00:23:12.960
couple of years. And there's a few boys who get really anxious before a game and they'll be like,
00:23:18.400
oh my gosh, I just have a lot of anxiety. And you can see them starting to go down that
00:23:23.500
anxiety spiral where they're going through this catastrophizing, like, what if I do this
00:23:29.180
during the game? And then they start beating themselves up like, oh, why do I feel like
00:23:34.340
What's going on? And I have to stop and be like, hey, hey, you know, look, it's perfectly
00:23:38.400
normal to feel nervous or anxious before a big game because it means it's important to
00:23:43.400
you. Like you want to do well. That's great. It's okay. Just feel it. It's going to go away.
00:23:48.080
And then I also try to reframe it. I say, hey, you know, that feeling of anxiety, that's
00:23:52.900
just your body's way of getting ready to take on this challenge. And it seems to help
00:23:57.380
reframing it. It's like, hey, you can use that energy to do well on the football field.
00:24:03.000
Yeah, it's exactly what teachers and mentors need to be doing these days. And unfortunately,
00:24:06.580
it doesn't happen nearly enough. Usually it's like, oh, you feel anxious? Oh, something's
00:24:11.260
really wrong. Like, that's a problem. You should really speak to someone about that.
00:24:15.180
And it just reinforces the sense that we can't function in an anxious way. Sometimes people
00:24:21.460
play their best game when they're anxious. Comedians. I can't tell you how many comedians
00:24:25.840
I've had who've come into the Center for Anxiety offices. Often plagued with anxiety, hilariously
00:24:31.240
funny, and plagued with anxiety because you've got to be on. You're doing improv. You have to
00:24:36.560
be on in order to do comedy in front of hundreds of people. And if a joke fails, you've got to
00:24:41.640
be able to recover quickly. I mean, it's really anxiety provoking. And that's good. That actually
00:24:46.860
is part of the strength of comedy is that it's predicated on being on your game.
00:24:53.900
Right. You could fall flat on your face. That's what makes it exciting.
00:24:57.920
And you also highlight there's a lot of athletes who have a ritual. Some of them just throw up
00:25:03.100
before a game. And that's what they do. That's how they get ready for it. Because it means
00:25:09.040
that the game's important to them. If they don't do that, if they don't have that, I'm
00:25:12.560
feeling nervous, I'm throwing up, they often play worse because they don't have that edge
00:25:17.520
Yeah. We often misinterpret today, unfortunately, our anxiety that something's wrong as opposed
00:25:22.080
to recognizing that, oh, hey, this is actually, you know, my adrenaline is starting to flow
00:25:27.680
through my body here. And that's preparing me for actually a higher level of performance.
00:25:32.740
Like it is often amping you up and keeping you on your game.
00:25:37.820
We're going to take a quick break for a word from our sponsors.
00:25:44.140
Okay. So if you feel those feelings of anxiety, don't go down the anxiety spiral. Don't catastrophize.
00:25:50.380
Don't beat yourself up. Don't say this is a big problem because that'll just make things
00:25:54.320
worse. Antidote is the positivity spiral, the positive spiral. And you can do that by
00:26:00.040
do you feel those negative, anxious feelings, just sit with them. And then also you maybe
00:26:05.500
do some reframing like, well, how can I use this to allow me to excel whatever task I'm
00:26:11.080
about to do or my relationships? We'll talk more about the relationship aspect of anxiety
00:26:14.860
because I thought that was really interesting. So you mentioned that most people don't respond
00:26:18.440
with the positivity spiral. So what are the counterproductive ways in which we try to
00:26:26.460
Yeah. Your number one counterproductive way is by avoiding it and by shutting it off,
00:26:31.300
by squelching it, by trying to reduce the amount of distress. That's kind of the equivalent of going
00:26:37.920
to the gym, starting to do your workout and being like, oh, you know what? This is uncomfortable.
00:26:42.800
I'm not going to do this. You're not going to build your muscles. It's just the way it is.
00:26:46.640
If you avoid it, if you avoid all the distress. Now, I'm not saying we need to be facing a nine
00:26:51.800
out of 10 on the anxiety scale on a daily basis. Obviously, that's too much. That's going to lead
00:26:57.340
to the equivalent in the gym would be whatever, however many hundreds of pounds of barbells you're
00:27:03.120
lifting, which is beyond whatever your current capacity is. But I definitely think we should be
00:27:08.640
moving into the area of a four or a five, even on a daily basis. When I'm pursuing a big dream and a
00:27:15.440
big goal, I'm feeling uncomfortable. My stress level is high. I'm facing it. I get it in my chest.
00:27:22.060
It's an uncomfortable thing. And that's good. That's an indication that I'm on the right track.
00:27:28.680
So I think we need to flip into a completely different relationship with our anxiety compared
00:27:34.800
to the way we currently see it, which is as a disorder and a disease and something's wrong.
00:27:38.980
Okay. So the person with social anxiety, the way they might manage the anxieties,
00:27:43.840
they just avoid social situations completely because they don't want to feel that.
00:27:48.240
Yeah. And people who are afraid of heights won't go in elevators or they won't go up in a plane.
00:27:52.380
And people who have panic attacks are going to avoid any situation that might lead them to panic.
00:27:57.140
I've had patients who stopped riding the subway because they didn't want to panic when they
00:28:00.280
were underground. I've had patients who stopped going over bridges, stopped going through tunnels,
00:28:06.460
stopped traveling completely. I had a patient who stopped going to the supermarket.
00:28:09.440
She would not leave her house because she was so terrified that she might have a panic attack and
00:28:15.520
die. And these are real life situations that the anxiety, if it leads into avoidance, it can just
00:28:23.860
take over your life as opposed to being like, whoa, hold on. I got to actually face this and get that
00:28:29.300
opportunity to build that inner strength. And once they do that by facing it through what we call
00:28:33.300
exposure therapy, that can be a huge catalyst for bravery, for really moving oneself forward
00:28:42.500
Well, let's talk about exposure therapy. How does that look in a clinical setting? And then
00:28:45.800
can people do this? Let's say someone has mild anxiety with social situations. Could they do this
00:28:53.140
Okay. Two great questions. I'll tell you what it looks like first. It looks a little bit like death.
00:28:57.420
And what I mean by that is people face their specific anxiety head on in a structured way.
00:29:05.820
So if you're afraid of spiders, then yes, I do have the name of a spider wrangler that I can call
00:29:11.160
and he will bring over tarantulas to my office. Now, of course, we don't start off with live
00:29:15.360
tarantulas. It's usually videos, it's pictures, it's maybe going to a zoo or some sort of a museum of
00:29:22.580
natural history kind of deal. But eventually, yeah, you're playing with spiders in the office
00:29:27.660
and it's very uncomfortable and the person's, you know, has super high levels of anxiety. And I kid
00:29:33.500
you not, two to three hours later, two to three hours later is often all it takes, they are able
00:29:40.360
to actually tolerate the anxiety that they have been avoiding sometimes for years. In terms of doing
00:29:46.220
it at home, you know, we like to say don't try this at home, kids. But in all seriousness,
00:29:50.980
you can try a little bit, like I might, you know, just approach some of these things, like if something
00:29:56.960
makes you uncomfortable to watch on the screen, you know, I would stay in that a little bit longer
00:30:02.920
than pulling away from it. But, you know, it's not a bad idea to have a coach when you're training
00:30:08.200
for something big. And it's not a bad idea to have a therapist when you're trying to train for the anxiety
00:30:15.680
Okay, so you've got some serious anxiety. A coach therapist would be really helpful
00:30:20.740
to guide you through this exposure therapy. Another way people often avoid anxiety, or it
00:30:27.360
allows them to do the thing that makes them anxious, but not be there mentally or kind of
00:30:34.060
checked out is substances. How have you seen your patients use different substances?
00:30:39.100
Yeah, so we were speaking a lot about social anxiety beforehand. Social anxiety and alcohol abuse
00:30:43.920
are like brother and sister, you know. Very common, especially among college students,
00:30:48.600
especially among males, I'll add, although females as well, where people feel socially anxious
00:30:54.040
and, you know, they got to get their liquor courage, as they say. You know, that's really
00:31:00.000
kind of dangerous territory. Firstly, it can clearly lead to substance abuse and alcohol abuse and
00:31:05.720
alcohol dependence and all sorts of other issues there. But the other thing is that, you know,
00:31:09.940
if you need a drink in order to be in a social situation, you're never going to learn how to
00:31:14.780
feel truly comfortable and how to develop closer relationships with people. And that's a skill
00:31:19.460
that can leave, I mean, I should say without that skill, you can feel pretty lonely and pretty
00:31:24.680
disconnected. And I think ultimately we all want that, you know, level of, you want to call it
00:31:29.800
emotional intimacy or connection or, you know, whatever language you want to use. And being able to lead
00:31:34.780
into the anxiety actually can help us to get there. So that's one way that they're related.
00:31:40.120
You talk about another response people have whenever they go down that anxiety spiral,
00:31:44.160
start going down, it is worrying. How is worrying different from anxiety?
00:31:49.500
Yeah, it's a great question. So the clinical science on worry is really interesting.
00:31:52.740
People who worry a lot tend to have low levels of anxiety almost forever. And the reason why is
00:31:59.900
because the worry, believe it or not, it's a behavior that people engage in, in order to keep
00:32:05.020
their anxiety at a low level without actually facing the truth that there's so much that we can't control
00:32:11.920
in life. And there's so much that we can't know. You know, when we worry, we're like, what if I got
00:32:16.780
sick? What if I lost money? But it's not like really what if that were to happen? People don't actually
00:32:23.500
face the real possibility of those terrible situations, which is genuinely terrifying.
00:32:32.620
It is genuinely terrifying and perilous. But that leaning into the real anxiety beneath the worry
00:32:41.540
Okay. So worrying is kind of a superficial anxiety.
00:32:45.660
Okay. So if you're a worrier and you find yourself on that worrying cycle, anything,
00:32:53.300
Yeah, this is a tough one. And this is one where therapist intervention is probably going
00:32:56.560
to be even harder because it's just, it's a little bit amorphous. It's a little bit harder
00:33:00.560
to actually do. You know, if you're afraid in exposure therapy, if you're afraid of, like
00:33:04.500
I said, spiders before, you're afraid of heights. So, okay, you can physically get into an elevator
00:33:08.960
and look out the window. It's hard, but you know what you got to do. With worry, you got
00:33:13.880
to actually sit and imagine the worst case scenario. And to do it for five minutes a day,
00:33:20.400
worry at a specific period of time and to really delve into the depths of your worry. You know,
00:33:26.240
that can be harder to do. People can do it on their own. I've seen it. But that's the kind
00:33:30.260
of thing where it's usually, you need a little more guidance and someone to give you a little
00:33:33.700
bit more of a push from the outside because it's so mental. It's really in your head.
00:33:37.200
So just to clarify, what's the positive version of worrying? So worrying is kind of productive
00:33:41.860
because it's not actually causing you to confront the thing that's actually making you anxious.
00:33:52.080
The flip side of that is actually becoming brave and learning to accept and to tolerate
00:33:58.840
how little is within the scope of our knowledge and control because we're human beings.
00:34:04.660
We can only know so much. We can only control so much. And actually coming to peace, coming
00:34:10.860
to terms. The analogy I'll give you is like this. I have this exercise I do when I get
00:34:16.340
on a plane where I look at this aluminum box that I'm about to enter and I touch the outside
00:34:21.920
of the plane and I walk in over the threshold. I sit down and I buckle my seatbelt and I say
00:34:28.240
to myself, David, you are not in charge for the next however long. Let's say it's a two-hour
00:34:33.700
flight. You are not in charge for the next two hours. You're not going to fly the plane.
00:34:36.920
You're not going to know where it's going. You can look on the screen, but at the end
00:34:40.380
of the day, you don't know. And we have to learn to be okay with that and to embrace
00:34:45.460
the unknown, to embrace the lack of control, and to sort of man up along those lines.
00:34:53.340
My experience with worrying, going on the lines that it's a superficial anxiety,
00:34:57.500
I think one of the problems with worry that I've seen is that it makes you feel like you're
00:35:01.640
doing something, but you're not really doing anything.
00:35:04.200
That's well put. It's an attempt to convince yourself that you have control that you really
00:35:10.280
Right. So you're just constantly thinking, you're going through all these different
00:35:13.760
situations. I could do this. I could do that. And you find yourself eventually just going
00:35:17.260
through the same two or three things over and over again. And you realize, okay, this
00:35:22.040
is actually not doing anything. I just have to accept that I don't know what's going to
00:35:25.320
happen. There are certain actions I could take, but I don't have control over the outcomes
00:35:32.060
No, you're just going to do the best you can. And the rest, you just got to give it
00:35:35.460
up. Like it might work, it might not work. And therein lies the challenge, but therein
00:35:40.300
lies the opportunity to be more emotionally resilient and to accept the limits of our control.
00:35:47.840
Okay. So anxiety in relation to ourselves, our anxiety can kind of, I like the idea that
00:35:52.920
the anxiety can be a signal to what's important to us in life or a signal to how we can excel
00:35:59.540
or where our strengths might lie, but we might be afraid to embrace that. And we've talked
00:36:04.480
about some tools you can do, avoiding the anxiety spiral, embrace the positive spiral. I like
00:36:10.480
this idea in the book you had about how anxiety can either disconnect us or connect us to others.
00:36:17.360
So how can anxiety lead us to be disconnected from others?
00:36:23.020
Yeah. I think, so men in particular, I think are pretty bad at this in our culture. And the
00:36:28.380
reason why is because, you know, when we feel anxious and we're human, so we're going to feel
00:36:33.280
anxious sometimes. Like let's acknowledge it. Your fight or flight system is going to get triggered
00:36:36.920
every once in a while, erroneously with the anxiety spike. What do you do? Do we actually
00:36:42.500
acknowledge that and say, hey, I'm feeling kind of uncomfortable right now? Now it seems like
00:36:46.760
not like the most guy thing to do, but if you want to develop emotional connection, you know,
00:36:53.180
I would say, you know, generally speaking, especially with females, it's gold. It's just gold.
00:36:59.500
It's the best way to open up and to show that feeling. There's a vulnerability that comes with it.
00:37:06.320
And I think it can really truly enhance our connection with others. And it allows people
00:37:10.760
to drop their guard around us and to actually be with us and connect with us on a different plane.
00:37:17.660
But, you know, it's, it's gutsy. It's a gutsy move, you know, to put it out there and to say,
00:37:22.660
hey, I'm feeling, you know, I'm feeling anxious. I'm having a hard time.
00:37:25.800
It's something you talk about in the book is that some people who are really anxious about
00:37:30.960
relationships, they might see that as a weakness, right? But you actually, this idea that the anxiety
00:37:37.940
can be a strength. Those people who are really anxious about relationships, whether like, okay,
00:37:42.460
how's my marriage? Does this guy, does my boss think I'm a loser or not? They're constantly
00:37:48.540
thinking about that. These individuals, they can like, they can read people better because
00:37:53.120
they're more, more attuned to like what people are thinking, feeling, doing, et cetera.
00:37:57.840
That's definitely the case. There are these categories of people and people who are flourishing.
00:38:02.140
Everything's going well for them. They got a great business. They got a really nice car.
00:38:06.880
They've got a great house. They've got everything flying for them.
00:38:09.680
People often are misreading the emotions of others around them. Typically, that's the most hated boss,
00:38:16.900
you know, because he like doesn't pick up on how other people are really feeling and people don't
00:38:22.560
like them. The kids usually hate them. I've seen this a lot in the clinical setting. But if you look
00:38:29.580
at like the anxious guys, people who are a little more, you know, more likely to feel uncomfortable
00:38:35.660
in certain situations and they actually care about what other people think. They're more in tune with
00:38:39.960
other people's emotions. Their relationships are often closer and better. And that can predict
00:38:45.720
people's happiness as we age to a much greater extent than our level of success.
00:38:50.660
But just as there's like an anxiety spiral with ourselves, right? We experience those feelings of
00:38:56.640
anxiety and then we can go down that, okay, catastrophize and then self-judgment. This can happen in a
00:39:02.800
relationship. So someone might be in a relationship with, let's say, you know, some guys dating a woman,
00:39:09.420
but he's anxious about the state of the relationship. And he starts going down this
00:39:13.860
spiral of like checking in and kind of becoming needy and like, oh, are you okay? What do you think
00:39:18.980
about our relationship? Or I'm really sorry. Like, and then it becomes like, it's coming from a good
00:39:23.980
place because like the guy really wants to make the thing work, but he becomes so obsessed with it that
00:39:29.760
it becomes off-putting. Yeah. And sometimes it destroys the relationship.
00:39:33.440
It destroys the relationship, right? They become overly needy and attached.
00:39:36.540
Yeah. Or angry, by the way. People sometimes they, oh, what do you mean? Why'd you say that?
00:39:42.700
And they, cause they're taking it personally when like, she didn't mean it personally. Like she was
00:39:46.880
just saying what she said. And, but he, he's emotionally reactive because he's not aware of his feelings.
00:39:53.100
It's sort of the fight response or the flight response. Like the clinginess is one side of it and
00:39:57.380
the other side is getting angry. And yeah, both of those responses are maladaptive and not going to
00:40:03.220
build your, your connection. And if you care about her, then well, that's, I think be honest and be
00:40:09.720
open instead and embrace the anxiety and say, hey, you know, I've been thinking about our relationship.
00:40:13.840
Like, I really like this and I like where it's going. I'm wondering where you stand. And it's hard to
00:40:19.500
put yourself out there and to sort of, you know, and if she's like, no, I'm not so sure. Oh, that's,
00:40:24.580
that's too bad. You know, I, I really kind of like this thing and I hope that changes in the
00:40:29.600
meantime, you know, whatever, whatever your plan is, but it's hard to like embrace your anxiety and
00:40:34.480
actually put it out there, but it really builds connection. Right. You have to put it out there
00:40:38.660
and then again, accept that you have no control of the outcome. No, she might say no. She might say
00:40:43.520
yes. Who knows? It's not up to you. And I think this is why, you know, one of the factors that might be
00:40:48.540
contributing to you, you read a lot about young people having a hard time with relationships these
00:40:52.460
days. And I think it goes back to this idea of a sense of control. Like we feel like we can control
00:40:57.140
every aspect of our lives, including our relationships. So we want our dating life to
00:41:01.640
be perfect, our marriage life to be perfect. And so we try to do all these little tactics to like
00:41:08.060
control everything, but that just makes us more anxious about those relationships, which just makes
00:41:14.460
it harder to have those positive relationships. Yeah, definitely. I mean, all relationships are real
00:41:20.460
relationships and great relationships are messy. They're just messy. You know, people have
00:41:25.060
miscommunications and misunderstandings. They, you know, they rub each other the wrong way. They
00:41:30.300
have these interactions, which are problematic and these patterns, you know, that often stem from
00:41:35.220
childhood and butt up against each other. And, and, you know, therein lies the opportunity to actually
00:41:40.160
create real connection. I think it's a lost art in our society, the art of, the art of love,
00:41:45.580
if you will. I think it's a lost art and not, not to our, not in our favor.
00:41:50.800
So you mentioned anger. How can anxiety be a source of our anger?
00:41:56.360
Now, when I see angry people, almost always, almost always the root of it is anxiety, but
00:42:04.120
they're not expressing it. And sometimes they're not even aware of it. And it's amazing. We talked
00:42:08.060
about this at the beginning that the anxiety response is based on fear, which is called the
00:42:12.260
fight or flight response. Remember fight? So fight is anger. And that's often what happens.
00:42:18.160
When you're, when somebody does something that makes you anxious, you have a choice. You can say
00:42:21.760
to them, hey, what you're doing is making me uncomfortable. Or, I mean, some sort of language
00:42:25.500
around that. Or you can just say like, you jerk, like stop doing that. What's wrong with you? You know,
00:42:30.040
and blaming them as opposed to sharing how you feel. And that blame, that anger is the exact
00:42:36.380
opposite. That's leaning away from your anxiety. That's, um, covering it up, making it harder to
00:42:43.160
connect with others and, uh, usually pushes people away.
00:42:47.560
Okay. So if you have an anger problem, maybe you look at, okay, what am I, what am I potentially
00:42:54.540
Yeah, definitely. It's hard to get there because anger is usually a way of avoiding the feelings
00:43:00.580
of anxiety. Um, so you might need a therapist to actually probe, you know, the depths of that.
00:43:06.520
We call it a secondary emotion anger because it's a response to the primary emotion of anxiety.
00:43:12.380
Sometimes sadness, but often it's anxiety. Most often.
00:43:16.120
Gotcha. So with anxiety, there's either the flight, fight, uh, response, right? Fight or flight. So anger
00:43:21.680
is the fight response. Like I'm going to get really angry about this. I'm going to do something about it.
00:43:25.920
The flight response would be, I'm going to avoid the situation completely.
00:43:29.660
You're arguing that if you really want to thrive with anxiety, that's like the third way. You just
00:43:33.620
kind of have to sit with it and be okay with it.
00:43:35.820
Sit with it, tolerate it, and then find a positive way to do it, which might mean expressing it and
00:43:40.880
saying, Hey, I'm really having a hard time right now. I'm having, you know, an anxious moment. Um,
00:43:46.540
and if you can't do that in a romantic relationship, then at least doing that with a friend,
00:43:50.780
um, or with a therapist for that matter, you know, just being able to get it off your chest is
00:43:54.460
really, really critical and something that, uh, we have to learn how to do as humans.
00:43:59.840
Something you do with your practice is you bring in spiritual traditions from around,
00:44:04.380
around the world to help people with their anxiety. How have you done that with your work?
00:44:08.640
Yeah. Well, first of all, I want to say it's dependent on the patient and, you know,
00:44:11.720
this is only for people who want it. You know, when I was writing this book, um, uh, the publisher,
00:44:17.120
Harper Collins, they said, well, we want, you know, a third of the book to be devoted to this
00:44:20.860
subject. Cause we think that people in general are going to, are going to want spiritual approaches.
00:44:25.160
And I said, sure, like, I'm very happy to do it. And I try to use really accessible language,
00:44:29.500
which comes across different religious traditions. I say it's for people with, um, any faith or none
00:44:35.220
at all. And, uh, I stand by that. I think the spiritual concepts in the book are very broadly
00:44:40.060
applicable. So just that sort of a preamble from a faith perspective or from a spiritual perspective,
00:44:45.980
I should say, what's wrong with anxiety? You know, it's a very, uh, biomedical materialistic,
00:44:52.440
uh, reductionistic approach to say that human beings should never feel anxious, should never
00:44:57.560
feel uncomfortable, should never have any pain. And I just think when we take that approach and
00:45:02.080
we apply it to our emotions, you know, the spiritual lens is that, well, maybe there's a
00:45:06.960
higher purpose. Maybe there's something greater in our lives. Maybe we're here to self-actualize and
00:45:11.500
to bring out our potential in this world. Maybe we're here to build connection with each other.
00:45:16.480
And emotional distress can enhance every single one of those processes, every one of those
00:45:21.860
processes. So here's a place where I think the spiritual traditions approach anxiety so much
00:45:27.720
better than the current biomedical model. Um, so what are some practices that you've done
00:45:32.220
with your patients to incorporate the spiritual aspect? You know, one of them is understanding
00:45:37.180
that, and I talk about this in the book, what are your biggest goals? What are your biggest dreams?
00:45:43.320
What do you really want to be doing? You know, is your current job, is your current
00:45:48.320
day-to-day life reflective of your core values of what you really truly want to do? And if
00:45:56.560
the answer is no, usually anxiety is involved because it's scary to pursue your deepest dreams
00:46:04.380
and to try to bring out your latent potential in the world. Even to think about it can be really
00:46:10.740
terrifying because what if I fail? What if I fail? What if I can't quantify my results?
00:46:15.880
So what if it has to be some sort of qualitative, complicated way of evaluating whether I really
00:46:21.660
achieved it? And I won't even know. Nobody will know. So it gets, you know, it gets anxiety
00:46:26.660
provoking. And, uh, but I think from a spiritual perspective that that's the case. Anxiety can
00:46:32.000
actually enhance, um, our spiritual growth and our self-actualization because it's part and parcel
00:46:37.600
of self-expression. Right. And I also, you talk about just looking at spiritual traditions from
00:46:43.840
history and around the world, all of them usually have a tenet about human beings. They don't control
00:46:49.780
the world. Like you, you are not the center of the universe and your goal in life is just to figure
00:46:54.420
out how to navigate the world in which you have no control. At the center, and clinical science has
00:46:59.840
borne this out, at the center, at the core of anxiety is an intolerance of uncertainty and
00:47:06.040
intolerance of uncontrollability. If you need to know and you need to be in control, you will feel
00:47:11.460
anxious. I promise you are going to feel anxious. And I think spiritual traditions teach us that
00:47:16.540
there are human limits. There just are human limits. And whether you believe in something greater
00:47:21.920
or even if you don't, I think all of us can understand that, you know, we didn't choose
00:47:27.560
whether to be born, when to be born, where to be born, and a zillion other factors that are,
00:47:32.700
have a colossal impact on our day-to-day, there's so much that we don't know, so much that we can't
00:47:38.780
control. And can we come to a place of acceptance of those terms? I think spirituality can enhance
00:47:44.780
our acceptance and our awareness of our human limits.
00:47:49.640
So there's a few books that I've read during my lifetime that have hit on this idea that humans,
00:47:54.980
the limitations of humans and your inability to control everything. Bhagavad Gita,
00:47:59.280
really big one. I get the opening scene. You have Arjuna basically having anxiety attack,
00:48:06.880
right? He's about to see, he sees this great war unfolding before him. And he says,
00:48:11.320
my limbs sink, my mouth is parched, my body trembles, the hair bristles on my flesh,
00:48:16.360
the magic bow slips from my hand, my skin burns, I cannot stand still, my mind reels. And then he
00:48:21.800
gets a lesson from Krishna saying, yeah, you don't have control of everything. You don't,
00:48:26.500
you can't control the outcomes. Book of Job, another good one that I like to read. I know
00:48:32.740
Abraham Lincoln loved to read the Book of Job, particularly during the Civil War. The Odyssey
00:48:38.480
of Homer, another one where character doesn't have any control over the outcomes. And then another one
00:48:45.100
that I really like is Lonesome Dove. People who've listened to this podcast a lot know I'm a big fan of
00:48:49.980
Lonesome Dove. But I think that novel, one of the themes is just how life is constantly changing and
00:48:55.080
you don't know what the outcomes are going to be, but you just have to deal with it. You just kind
00:48:58.380
of have to live with it and accept whatever outcomes come your way. So those are some,
00:49:02.720
like, I guess we can call them spiritual books that have helped me out.
00:49:05.620
I love that. Sounds like a great collection. And it sounds like something that's also missing from
00:49:09.720
the education of many young people today to our detriment. You know, we live in a society that
00:49:15.860
prizes itself on predictability, on controllability, on quantitative measures,
00:49:21.920
as opposed to really embracing the limits of our humanity.
00:49:27.280
And another one, you talk about this one in the book, one of my other favorite books,
00:49:33.600
Yeah, Viktor Frankl, I mean, you know, his whole story was incredible and really having to accept
00:49:40.100
really incredibly trying horrific circumstances and finding meaning despite that, or maybe even
00:49:47.700
So we've talked about a lot in this conversation. Let's say someone's listening to this podcast and
00:49:52.580
they've got an issue with anxiety, right? It's a problem in their lives. What's like one thing
00:49:57.980
that someone could start doing today to start turning their anxiety into a strength?
00:50:02.740
The one thing that I would say is do something that makes you anxious once a week. It doesn't
00:50:07.820
have to be a huge thing. It doesn't have to get you to an eight or a nine on a scale of
00:50:11.860
zero to 10 of anxiety, but try to do something that's going to get you to a four or a five.
00:50:17.140
And when you feel anxious, when you feel anxious in response to that, instead of squelching
00:50:21.880
it, allow yourself to experience it. Take a look at your watch, see how long it's going
00:50:26.380
to last. And if you don't fight it, I'd be shocked if it lasts more than five minutes.
00:50:32.520
I love that. And I think that that goes back, what you just said goes back to our, the beginning
00:50:36.620
of our conversation, right? Like each time you do that, you know, it's like you're going
00:50:40.820
to the gym and doing a workout. I mean, you're building your bravery and your resilience
00:50:45.700
muscle. Well, David, where can people go to learn more about the book and your work?
00:50:49.960
Sure. So my author's website, which actually is a free giveaway of a 12 page guide that
00:50:54.860
people can use, whether or not they buy the book, which is based on the nine tools. So
00:51:00.000
people are welcome to check me out at dhrossmarin.com. The book's available wherever books are sold,
00:51:07.140
including Audible. Um, and, uh, even on Spotify, I actually saw it. So the audio book is available
00:51:13.420
and I love to hear from people about, uh, the topic of anxiety and about the book and I can
00:51:19.560
Fantastic. Well, David Rosemarin, thanks for your time. It's been a pleasure.
00:51:22.140
Hey, thanks for the great chat. Really appreciate you having me on your show.
00:51:25.180
My guest here is Dr. David Rosemarin. He's the author of the book, Thriving with Anxiety. It's
00:51:29.260
available on amazon.com and bookstores everywhere. You can find more information about his work at his
00:51:33.120
website, dhrosmarin.com. Also check out our show notes at aom.is slash thriving with anxiety.
00:51:38.740
We can find links to resources. We delve deeper into this topic.
00:51:48.280
Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at
00:51:52.440
artofmanliness.com. We find our podcast archives, as well as thousands of articles that we've written
00:51:56.700
over the years about pretty much anything you think of. And if you haven't done this already,
00:51:59.720
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00:52:09.780
thank you for the continued support. Until next time, it's Brett McKay. Reminder you to listen to
00:52:13.360
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