Latest / The Lila Rose Show / E26: Overcoming Crippling Anxiety with Dr. Aaron Kheriaty

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E26: Overcoming Crippling Anxiety with Dr. Aaron Kheriaty · The Lila Rose Show

0:00
So Doctor K, we're here back at the studio again.
0:03
Hey everybody. And today we're going to talk
0:05
about. Anxiety.
0:08
Anxiety. Feeling a little anxious?
0:11
Who hasn't experienced anxiety? I know, I know.
0:15
I sometimes am experiencing anxiety and I don't realize that
0:18
I am until afterwards, which I think is.
0:20
It's very common. Common.
0:21
Absolutely. And then I'm like, I had a
0:23
headache. I feel stressed.
0:26
I I don't feel well right now. It's hard to think straight and
0:29
then I realize I'm anxious. I'm feeling very, very stressed
0:32
out. That's right.
0:33
No, It can take many forms, right?
0:35
It could be just holding tension in certain parts of your body.
0:38
It can be an upset stomach, butterflies in your stomach,
0:43
tightness in your chest where becomes harder to breathe.
0:46
You have rapid, shallow breathing that can make you
0:49
lightheaded, spinning out of control and keep, you know,
0:53
continuing down that path becomes a full blown panic
0:55
attack. Or it could just be more sort of
0:57
worries rummaging through your mind, more cognitive, right?
1:01
So this is something that a lot of people are facing right now.
1:04
Absolutely. And I think in the years that as
1:07
years go by, the rates of anxiety reported clinical
1:10
anxiety, which we're going to talk about the difference
1:12
between anxiety and clinical anxiety because they're not the
1:15
same. It's increasing.
1:18
And The Atlantic just had an article out a couple weeks ago
1:21
and the title was, well, this is this is CNN right here.
1:25
But there was one in the Atlantic too.
1:26
But why today's girls are so anxious?
1:30
And The Atlantic's article was something similar, like the
1:32
teen. Oh, the tragic mystery of
1:34
teenage anxiety. So this was last week, but from
1:36
The Atlantic, and it talked about a survey that was just
1:39
completed. You've probably heard of the
1:41
survey that reports record numbers of sadness.
1:44
A record number of adolescent girls are experiencing sadness
1:47
and violence, which is not good. So let's start there and then
1:54
we'll zoom into the details of anxiety.
1:56
Just on a general level, why do you think we're here and and
1:59
have you noticed this in your practice?
2:01
Oh, absolutely, without a doubt. What?
2:03
Does that look like? Well, we're, we're seeing more
2:05
and more young people presenting for clinical treatment of
2:08
anxiety and a level of anxiety that impairs their daily
2:12
functioning, that gets in the way of school, that gets in the
2:15
way of work, that gets in the way of relationships.
2:18
You know, their parents are noticing, sometimes their peers
2:21
are noticing. They're, they know something is
2:23
wrong. I don't feel right with anxiety.
2:27
People's world can become progressively smaller, right?
2:31
Because they, they begin to avoid triggers, they begin to
2:33
avoid things that tend to make them anxious.
2:37
And you know, one of the key things in terms of understanding
2:40
anxiety and how to treat it is that almost all different forms
2:44
of anxiety result behaviorally in a tendency to want to avoid
2:49
things that would make you more. That's natural.
2:52
Natural, right? If I'm, if I'm sort of
2:54
uncomfortable in an enclosed space and I don't really like
2:57
elevators for that reason, I might avoid getting on the
3:00
elevator. But the problem with avoidance
3:02
is that in the moment it can make anxiety better, but in the
3:06
long term, avoidance always makes anxiety worse.
3:10
So go back to the elevator example.
3:13
Let's suppose that, you know, you started avoiding getting on
3:16
an elevator because you notice that you become slightly anxious
3:19
when those doors close. You know, while you're going up
3:21
before it opens again, it it can trigger some anxiety for
3:25
whatever reason. And so you just start taking the
3:28
stairs and maybe your office is on the second or third floor and
3:30
that's not a problem. Well, let's suppose you have an
3:34
interview now in the skyscraper on the 50th floor that starts in
3:38
5 minutes and you know you're not going to be taking the
3:40
stairs and you're facing down that elevator.
3:42
If you've only avoided getting on an elevator for a week, you
3:45
could probably get on that elevator and you're going to
3:47
experience some anxiety, but you're going to be OK.
3:50
But if you've avoided getting on elevators for an entire year,
3:54
every time you engage in that avoidant behavior, you kind of
3:58
confirm in your own mind that that situation, elevators are
4:02
actually threatening. They are actually anxiety
4:05
provoking. There's something to be avoided
4:08
because they're going to somehow harm me.
4:10
Now you're, you're not necessarily telling yourself
4:12
that consciously, but just the act of, you know, continuing to
4:15
engage in that avoiding behavior kind of conditions your mind
4:19
into into thinking this thing is a bigger threat than it actually
4:24
is. Do you think that phenomenon,
4:27
which it's, I mean, it's the general adage of face your
4:30
fears, you're going to face your fears, overcome your fears in
4:33
order to be healthy and free and all of this that right now,
4:37
because I think in our society there's coddling is a strong
4:41
word, But it, there's some of that happening where, you know,
4:45
the safe spaces thing on you, you know, universities create
4:48
the safe space where you're not going to get triggered and
4:51
people expect to feel comfortable and safe.
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They think that's a societal what they're owed by society.
4:58
And so if something is making them feel anxious, that
5:01
something must be bad and in the wrong, and therefore they have
5:04
the right to reject it or leave it.
5:06
Exactly so safe spaces are the opposite of what good behavioral
5:11
therapy would do for someone who's dealing with anxiety.
5:15
They actually make the problem worse for exactly the reason.
5:18
Yeah, there there's there was a book published a couple years
5:21
ago about universities called The Coddling of the American
5:23
Mind. Greg Lukyanov, and I'm
5:26
forgetting his co-authors name. And they talked about precisely
5:29
this. They they looked at this whole
5:31
social phenomenon. They're social scientists.
5:34
They described it and so forth. They critiqued it, but they also
5:36
brought in cognitive behavioral therapy and said, you know, from
5:40
the point of view of treating anxiety, this is the this is
5:44
actually the opposite of what you should do.
5:47
This doesn't create a more resilient person.
5:52
This doesn't create a less anxious person.
5:55
This ends up creating a more fragile person who has to avoid
5:58
more and more and more things, whose world becomes
6:00
progressively smaller. And particularly once they're
6:04
off campus and they no longer have this constant coddling on
6:08
the part of the administration, they have to face the rough
6:12
edges of real life. They can't manage.
6:14
They're not equipped. They're not prepared.
6:16
So for these adolescents that you say are presenting
6:18
themselves more your practice and you know, all these media
6:21
groups are reporting on the surveys that are being done that
6:23
show that teenage anxiety is spiking and it's kind of spiking
6:28
across groups. It looks like it.
6:29
Some groups are affected more than others, but everybody,
6:33
largely speaking, is affected. Most racist socioeconomic
6:35
backgrounds, not one is completely an outlier to the
6:39
others. I mean, do you think there's,
6:42
what is the safe space that we're making for is, is there
6:46
kind of an equivalent for the high school kid or the junior
6:48
high kid that's suffering from anxiety in our culture right
6:51
now? What does that look like?
6:52
So everyone needs a home base. Everyone needs a place where
6:56
they can let their hair down, be more comfortable, be more
6:59
relaxed. For most people, that's home and
7:01
family life. But if they don't have that.
7:03
If they don't have that, I think it's very important for us to
7:05
find ways to try to create something close to that for AS.
7:09
Many people, that's why there's so much anxiety, more anxiety
7:12
happening today because there isn't a a home base that they
7:15
feel safe in. Yeah, yeah, absolutely.
7:18
If you look at if you look at research on early attachments, a
7:24
secure relationship with usually one's parents, right or another
7:29
attachment figure. This starts like in the first
7:32
year of life and there's a famous experiment that divides
7:36
and classifieds different attachment styles.
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It basically involves mom is in in a room with baby and the
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experimenter observes how baby interacts with mom and if baby
7:48
has a strong securely attached relationship with mom, What
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happens is the baby will seek solace and comfort from mom,
7:56
maybe go sit in mom's lap for a few minutes, but then you notice
8:00
the baby can actually venture out into the room and play with
8:03
the toys or explore things. And maybe every few minutes, you
8:07
know, the one year old's going to come back and check in with
8:09
mom, you know, make sure she's still there, get a pat on the
8:12
head or a kiss or whatever and then venture out again.
8:15
And that safe, secure home base allows the child to venture out
8:20
into the world, into the unknown, knowing that if I run
8:24
into trouble, there's a place I can go where I will be consoled
8:28
and comforted. And then there's there's cases
8:31
in which the experimenters noticed that's not how baby
8:34
behaves. So there's insecure forms of
8:35
attachment. You can have a kind of clinging,
8:38
anxious attachment where the baby doesn't venture out from
8:43
mom because I'm. Afraid.
8:44
They'll be left they're they're afraid is mom going to be there?
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Am I going to get what I need if I venture away?
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Is, is this attachment figure constant and available and ready
8:53
to receive me if I need help? Then oftentimes neglectful
8:59
parents will produce a situation in which you have what's called
9:02
an avoidant attachment where the baby doesn't seek solace or
9:06
consolation from mom as a safe home base.
9:10
It's just out there doing its own thing and doesn't seem to
9:13
have a strong emotional connection with mom that creates
9:15
its own set of problems later in life that, you know, we could
9:19
probably talk about in another episode.
9:21
But do you think a lot of the anxiety today is rooted in that
9:24
not having secure attachments to one or both or any kind of
9:28
caretaker or? I, I do the, the best context
9:33
for developing secure attachments is an intact family
9:36
where ideally the person's own mother and father are available
9:41
and caring for, you know, for the person in those early
9:44
critical years. And so we are seeing more and
9:48
more problems that have their roots in early attachment,
9:53
unhealthy patterns of attachment.
9:55
And that's certainly going to make people more prone to all
9:58
kinds of different troubles later in life, including
10:01
depression, including anxiety. But it says, according to the
10:05
study that it's increased really in the last five years, is my
10:09
understanding. And so this is not like, I mean
10:12
it actually it is actually increasing over the last couple
10:14
of decades as well, but it's continuing to increase in the
10:16
last five years. Is that correlated to broken
10:20
families? Because it seems like broken
10:22
families. I haven't read the studies in
10:23
the last five years, if there are any.
10:25
Are there more broken families in the last five years than five
10:28
years prior? No, there are not.
10:30
I mean, one of the positive things, Well, yes and no, I
10:34
should say. One of the positive things that
10:35
we've seen in the last 10 to 20 years is a slight decline in the
10:39
rate of divorce. But on the other hand, we've
10:42
seen an increase in the rate of parents who never get married in
10:45
the. 1st place it's a decline in even getting married.
10:47
Exactly. That's why divorce.
10:49
Is so there's that, but I would actually say that the rise in
10:52
the last five years probably has more to do with the rise of
10:56
social media. You think about the timing of
10:58
this Lila, the iPhone was invented in 2007.
11:02
So the the generation born, you know, let's say 2000 and four
11:08
2005, who are now going to be in their teenage years.
11:12
This is the first generation that didn't have any experience
11:17
of a world without the smartphone.
11:20
It's crazy. Right.
11:21
So the teenagers we're seeing now are the, the 1st of this
11:25
sort of like zero generation post smartphone where their
11:31
whole life they didn't, you know, this wasn't introduced
11:33
while they were in high school or while they were in college.
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This was already a pervasive part of growing up for for them,
11:40
when they got into their teenage years, social media was probably
11:44
one of the main ways in which they interacted with peers.
11:47
And one of the downsides of this, especially for teenage
11:49
girls. You think about if you do, if
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you pull people and you ask them what are you most afraid of?
11:55
What situations are most anxiety provoking?
11:57
Almost everyone talks about performance, public speaking,
12:00
right? Getting up in front of people,
12:02
having everyone looking at me and potentially judging me and
12:05
making a mistake. In that context, I have to give
12:07
a presentation in front of the class or I'm supposed to give a
12:09
speech. They're supposed to read
12:11
something at church in front of the congregation or whatever.
12:13
This is terrifying to many people.
12:16
In some cases, you know, if you believe the survey's more
12:18
terrifying than death. Which is why a lot of
12:20
entertainers are bipolar, because they're like they get a
12:23
thrill from. It there's yeah, there's there's
12:26
some people who are just built for that, obviously, and they
12:28
get a thrill from it, but for many, many people that.
12:30
Is and by the way, you can still get a thrill from it and not be
12:33
bipolar or be good. At it and not be bipolar but
12:35
this is true well social media kind of turns a teenager's
12:41
entire world into a constant performance in some sense you're
12:46
you always have to be on because at any given moment one of your
12:49
peers might be snapping a photo of you that could be post you
12:53
know not just handed to a few friends as happened when you and
12:57
I were growing up with something like a photograph but that could
13:00
be shared so widely that literally anyone in the world
13:03
could see it I I think well. And you see social opportunities
13:09
as opportunities for social media.
13:12
And I think that's the other problem is everything is through
13:14
the lens of that photo you're getting for social media.
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And that robs the safety, you know, to use the word we're
13:22
using from the experience. And it also just makes the
13:24
experience less about the people and being present to them and
13:26
more about this photo and appearances.
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I mean, 20 years ago, going out with three or four friends to
13:32
get ice cream or go to a movie, it was kind of an an intimate,
13:36
private experience. It was wholesome 20 years ago.
13:38
Now it's a. Now it's how am I dressed and my
13:42
makeup and it because, you know, even if I'm not interested in
13:46
taking a selfie with my ice cream sundae or whatever I'm
13:48
doing, one of my friends might do that.
13:51
So I, I think there's probably a pervasive level of literally of.
13:56
Performance makes me nerve. It feels nerve nerve wracking
13:59
just to think about that. Like be pretending.
14:02
I mean, thankfully my people I hang out with the most are my 2
14:05
toddlers, you know? So like, they're not taking any
14:08
selfies, thank God. But yeah, if that's the life of
14:11
a teen girl today that anytime she physically gets to hang out
14:14
with her friends, it's all around.
14:17
What are we going to post on social media?
14:18
Or somebody might post something on social media or, you know,
14:21
oh, I'm not on social media right now.
14:23
What do I do? That's that's that sounds very
14:27
anxiety inducing. I think I think it is the idea
14:31
that you know, what I do at a party or a mistake I make at a
14:34
party might cost me getting into college because somebody may
14:39
post about it. I may make an off color joke
14:42
because I drank too much or whatever.
14:45
I'm not up with the latest rules of the cancel culture and that
14:50
could come back to bite me. Those, that's a level of, I'm
14:54
going to call it performance anxiety that our generation
14:57
never had to deal with at the pre digital generation, pre
15:01
smartphone generation didn't really have to deal with, at
15:04
least not anywhere near to the same degree.
15:07
So I think that that's a major factor.
15:10
I there's a line from the Netflix series 13 Reasons Why
15:14
and I have a critique of that series.
15:15
I don't like the way in which it glorified and presented suicide,
15:18
but there's a very interesting line in season 1 of 13 Reasons
15:21
Why where the narrator, the main character, says basically, you
15:26
know when everyone is following everyone else.
15:29
We've become a Society of stalkers, This this idea that
15:34
any given moment I could turn around and somebody could snap a
15:37
photo or be taking a video. Of oh, and this is the fact that
15:39
you can learn so much about someone by going to their
15:43
Instagram profile or their TikTok and the voyeurism that
15:47
that invites. So this, you know, obsessive
15:49
curiosity in other people's lives that you really should not
15:52
need to know. And it actually can be harmful
15:54
to know those details of their life, in no small part because
15:57
it takes you out of the details of your own life.
15:59
That's right. Or it makes you toxically
16:00
compare their life to your life. Or you just shouldn't be in
16:04
their business and you're you're meditating on something that is
16:07
not for you to think about. And then it will help make you,
16:10
you know, view your own stuff in the wrong way.
16:13
I mean, it's just, it's all problematic.
16:16
And if you look. At can be anxiety inducing.
16:19
The issue of comparison which you mentioned is also really
16:21
important, I think contributes to a lot of anxiety, especially
16:25
among adolescents. I would say maybe particularly
16:27
among adolescent girls because you think of how people self
16:30
present on social media. People don't typically post on
16:35
Instagram or, you know, or, or Tiktok.
16:40
My parents are going through a divorce.
16:42
Oh, here's a selfie of me with a divorce lawyer.
16:45
You know, in the mediation section, right?
16:48
They don't post that. Oh man, I got AD on my algebra
16:52
test yesterday and you know, or. Struggling, feeling really
16:56
lonely and I have no friends exactly.
17:00
Or hanging out with me right now or oh, I'm I that guy that I
17:03
wanted to date. He's not interested in me.
17:06
Yeah. He would not post that on social
17:07
media. You know, they post the
17:08
airbrushed best version of themselves that's somewhat
17:12
staged. You know, it's interesting to
17:14
see adolescents out in public, you know, preparing for the
17:18
school dance or going out to a dinner or whatever.
17:20
They, they spend a lot of time staging photos and, you know,
17:24
getting the best angle and taking the photos and the guys
17:27
are usually standing around, you know, staring at the, at the
17:30
ceiling. But the girls are very into sort
17:32
of the, I love the studio staging process of capturing
17:36
this amazing fun that I'm having with my friends at this fancy
17:40
restaurant. So when you go on social media,
17:42
that's what you see. You see the awesome vacation
17:45
that this person at school took. You see the beautiful date that
17:49
so and so landed with that guy that you know, turned me down or
17:53
whatever. You don't see their whole life.
17:56
You don't see those very same people whose parents are going
18:00
through a divorce, you got AD on a test who are struggling with
18:04
insecurity or loneliness and probably many of the same things
18:07
that you are. And so whenever you're comparing
18:11
yourself to anything that you see online on social media, it's
18:14
always an unfair comparison, right?
18:17
It's bad enough to compare yourself to real people.
18:20
That's not really fair either because you don't know their
18:22
background and their circumstances and just whatever
18:24
their different God-given gifts. But in this case, you're not
18:27
even comparing yourself to real peers.
18:29
You're comparing yourself to partial, airbrushed, staged,
18:35
theatrical version of your peers.
18:37
That is not their reality. And then it only takes one
18:41
person, the outlier who's maybe very, very photogenic and
18:45
naturally is in those situations that opt for good photos because
18:49
they're maybe very wealthy and, you know, they do have the like
18:52
perfect Pottery Barn home and and they so their pictures maybe
18:56
are authentic, you know, are more authentic than the next
18:59
person's. But you're going to spend your
19:01
whole life comparing yourself to this one person.
19:04
And at the end of the day, you know, back to the statistic or
19:07
back to the studies that are out now, people are not happier
19:11
because of all. Of yeah.
19:12
And even then, if they're presenting aspects of their real
19:15
wealthy, privileged life, one thing I've learned, Lila, being
19:18
a psychiatrist, is you never really know what's going on in
19:23
another person's life. And you know what they display
19:27
publicly and what is known publicly and what you imagine
19:31
this person's life might be like because they have wealth, power,
19:34
money, prestige, professional success.
19:38
Some of the people I've dealt with who who suffer more
19:43
intensely than than anyone else are people who from the outside,
19:48
their friends, their families, sometimes even their spouse,
19:52
would never imagine that they're dealing with this issue of
19:57
childhood trauma or severe depression or what have you.
20:01
So the, the whole comparison game is always dangerous because
20:06
you, you never have. The one thing I've learned as a
20:09
psychiatrist is you almost never have the full story.
20:12
You know, people disclose to me things that they've never
20:14
disclosed to another human being and including the person they've
20:17
been married to for decades. How does?
20:20
That make you feel as a psychiatrist to receive that.
20:23
Well, it's a great privilege to do this work, to be let into
20:26
someone's intimate life and someone's secrets and that you
20:30
know the corners of their soul that they they don't.
20:33
Does it weigh? Does it weigh on you?
20:35
It does. It does.
20:36
There's also an emotional burden that you carry doing this kind.
20:39
Of and you can't share what they tell you with your wife, Jen, or
20:43
you know, with someone else. So you have to hold it yourself.
20:46
That's right. Kind of like a Catholic priest
20:47
in the confessional. Very similar to a Catholic
20:49
priest in in a confessional. And so, you know, I think so.
20:52
What do you do? What do you do to kind of deal
20:54
with that? Well, I have to take care of
20:56
myself physically and spiritually.
20:58
That's really important and I have to notice when I'm taking
21:04
on too much. So early in my early in my
21:07
career, I did a lot of psychotherapy.
21:10
In my first couple of years in academic medicine, I think I was
21:13
doing 30, sometimes 35 hours a week of intense psycho
21:20
psychotherapy. And there were times where I was
21:22
driving home from work and for reasons that I didn't understand
21:25
and couldn't put my finger on, I would just burst into tears and
21:28
start sobbing and soak my necktie with, with tears.
21:32
And I, I, I knew that I'm carrying a lot of emotional
21:37
baggage. And in that moment, for whatever
21:39
reason, I just needed to discharge it.
21:41
But I also recognized after a year or two of that, I need to
21:44
find more balance in my professional work too.
21:47
I needed to dial back to 1520 hours a week of psychotherapy
21:51
and take on other things, teaching, research, writing and,
21:56
and you know, maybe different forms of clinical work other
22:00
than psychotherapy that didn't, didn't have the same emotional
22:04
toll. So even for me, and I think I'm
22:07
very well suited to this work, not everyone, not everyone has
22:10
the personality or sort of just the the Constitution.
22:13
And you think you're well suited because you're, when you say
22:16
your personality, what does, what kind of personality does is
22:19
well suited? I don't think there's one magic
22:22
formula, but I think, you know, you have to, on the one hand, be
22:26
able to maintain some level of emotional distance from what's
22:30
going on. But that has to be balanced with
22:32
a level of empathy and ability to communicate and ability to
22:37
connect with the patient or the client.
22:40
And then you have to be able to have some way to process the
22:44
emotional contagion. And for me, it had to do with
22:48
other sort of health related practices, but also just making
22:53
sure I didn't take on literally too many hours of this a week.
22:57
There was a sweet spot that I had to find.
23:00
And so I think there's people with other temperaments and
23:02
other personalities that also make very good psychotherapists
23:05
in their own way. I don't claim that I have sort
23:07
of the magic formula for that, but I think you.
23:11
Know you're Myers Briggs. Are.
23:13
You INTJI. Think I'm an INTJ.
23:15
It's been a while since I yeah, I'm more of a Big 5 guy, Myers
23:19
Briggs guy. We could talk about personality
23:21
assessments. Maybe another another time.
23:23
Another episode. No, I mean, I'm definitely more
23:26
introverted, more sort of melancholic in in the
23:30
traditional temperament sense sense of the word.
23:33
So that's all very, I mean, what, what do you do to process
23:38
other people's pain in a way on the anxiety front with these
23:43
girls and these adolescents that you're describing coming into
23:45
your office? And I think we've sort of
23:48
narrowed it down to social media as a big reason for that.
23:51
Broken families as well. Anything else we're missing on
23:55
the list? The top top three, top four
23:57
things? What else?
23:58
Do we add to that? Relationships are just very hard
24:00
for adolescents. For any adolescents, it's a
24:03
period of your life where you're shifting from more of a
24:07
primarily parental influence in your life to a peer influence.
24:10
You're struggling with issues of identity.
24:12
Who am I? Where do I fit?
24:13
What am I good at? Where do I belong?
24:17
And again, we need institutions of civil society and, you know,
24:22
local institutions that that help Orient young people to a
24:28
sense of meaning and purpose, a sense of direction in life, a
24:30
sense of belonging. And that has to involve face to
24:37
face encounters, face to face relationships.
24:40
That has to involve sort of a realm in my life where I connect
24:46
with people in real, tangible, tactile, personal ways, and not
24:51
just from behind a screen. And you think there's less?
24:54
I mean, certainly the pandemic made it difficult to do that in
24:57
person. Absolutely.
24:59
The pandemic made it difficult. So we had three years of
25:02
virtually none of that or very little of that for many people,
25:06
but also. Was the pandemic 3 years?
25:09
Well. Was it 3?
25:10
We're still living under a state of emergency in California and
25:13
at the federal level. So technically, yeah, there
25:16
still are places where there are, you know, mask mandates and
25:20
other restrictions on interaction.
25:22
There's a lot of people still working from home that used to
25:25
go to the office. That has its own pros and cons,
25:28
But we're interacting from behind screens a lot more.
25:31
And if you just look at the number of hours a week that
25:35
adolescents spend on social media or on their devices, it's
25:40
obvious that that leave that leaves much less time for face.
25:44
To face encounters. Face to face interactions and
25:47
navigating those things. Young people are not good at
25:50
talking on the phone, right? They texting is easier.
25:53
It keeps other people at a safe distance.
25:55
It's highly controlled. I don't have to learn to
25:58
navigate awkward silences in the conversation or, you know, tone
26:03
of voice or all the subtleties that happened when you have to
26:06
speak with someone either face to face, which is the most
26:11
complicated and subtle form of communication.
26:14
But even even over the phone where you just have the audio,
26:16
you're not, you're not seeing, you know, non verbal visual cues
26:20
and body posture and so forth. Even that has become fraught and
26:26
intimidating for a lot of young people.
26:29
So it's easier just to text message, send an emoji, kind of
26:33
keep things at the superficial level of communication and
26:38
emotional expression that an emoji can allow.
26:41
So for folks listening who I think they might feel OK, I know
26:46
anxiety, it's bad, I don't like it or I feel like it's just
26:49
sometimes what is the difference between just feeling anxiety and
26:53
this might be clinical anxiety? I've heard folks say the kind of
26:58
through line is, is it preventing getting in the way of
27:01
your everyday activities, your work, your relationships, and
27:05
any kind of significant way? If it is, you should probably
27:08
get it checked out if you're feeling anxious once in a while.
27:11
That's normal. That's being a human being.
27:13
That's right. Now I think that's a, that's,
27:15
that's a good shorthand is to look at how's this impacting my
27:18
daily functioning in these different domains of life.
27:22
All of us experience anxiety. Our brains are hardwired, you
27:26
know, our limbic system, our amygdala, these deep structures
27:29
in the brain are hardwired to be very sensitive to danger and to
27:34
trigger a fear response or a fight or fight response when
27:38
there is something in the environment, something in my
27:40
world that could potentially be threatening to me.
27:42
That's normal, right? If you didn't feel, if you never
27:46
felt any fear, if you never had any anxiety triggered you, you
27:52
know you're not a well constituted human being.
27:54
You're probably a sociopath. And that's probably another
27:57
conversation for another day. But also, you're, you've said
28:00
earlier, this is a teaser for another day that the society
28:04
right now is designed to traumatize people because it's
28:06
triggering fear. And there's good reason to be
28:09
afraid, but you can't live in a compensate of fear.
28:12
That's right. But I wonder if that's true for
28:14
the teen girls or for the teenagers too, Because I mean,
28:18
school shootings as an example, climate change paranoia as
28:22
another example, these things that we're told to fear.
28:26
And on social media, it's the new news media, social media,
28:29
right? And they're consuming reports of
28:32
the latest shooting, the latest catastrophe, economic
28:36
environmental catastrophe. And I think that's triggering
28:40
fear in people on an everyday basis.
28:42
Absolutely. That probably increases clinical
28:45
anxiety. Do you think that's the case?
28:46
Without a doubt, without a doubt.
28:48
I just saw a mother posting on Twitter the other day describing
28:52
that, you know, her kids at school had a shooter drill, an
28:56
active shooter drill. What happens when you know,
28:59
shooter? And they were showing the kids
29:01
how to line up in that case. And they put the taller kids in
29:05
front of the shorter kids and told the taller kids, OK, part
29:08
of your job is to protect the smaller kids.
29:12
Now to be human Shields for the. Human Shields, but and all of
29:17
these people are still children. I mean, these was might be a
29:19
little older, a little more mature, you know, the 8th
29:22
graders versus the second graders in the school, but we
29:25
should not be doing this to young people.
29:28
Well, what? Should we?
29:29
What should we be doing? What is the?
29:30
Solution. I mean, we should be telling
29:32
young people that unexpected things can happen, but we can't
29:38
live in fear and this school is a safe place that that you can.
29:43
Come so you don't. So are you against shooter
29:46
drills? I.
29:53
As far as I've seen the research on this, there are a limited
29:57
number of things that can be taught that might actually
30:00
enhance the safety. Might get under the desk.
30:03
People during a shooting. So I'm not absolutely opposed to
30:07
shooter drills, but I think we have to think very carefully
30:10
about how we do these things, how often we do them, whether
30:14
there's actually any evidence that drilling it before it
30:17
happens improves the outcomes when it happens, right?
30:22
Maybe we just need to train the teachers and then the teachers
30:25
instruct the students what to do in the case of the shooter.
30:28
Like it doesn't take a lot of practice to learn how to get
30:30
under your desk or to learn how to go do a certain corner of the
30:33
room that's further away from the window or whatever.
30:37
So I, I think we've done this in a way that's not very thoughtful
30:42
on the pretense that, you know, every, every school kid is, is
30:46
in danger from a shooter and which is not true.
30:50
These kids are at much higher risk of, you know, dying in an
30:53
automobile accident or drowning in the swimming pool over the
30:56
summer than they are of being a victim.
30:58
That is, that is amazing to me when I think about phobias, you
31:02
know, everyday phobias that we have or we're told to have, that
31:06
getting into the physical act of getting into your car, turning
31:10
it on or getting into the car of someone else and just being
31:12
their passenger you is the most likely thing to kill you more
31:17
than any other thing you're going to read about in the news
31:19
media. Certainly among teenagers, yeah.
31:22
And we just do it mostly fearlessly.
31:25
Some people are not, you know, are not, are scared by it, but
31:29
mostly fearlessly, right. So, so if OK, so that's the
31:33
difference between clinical anxiety and everyday anxiety is,
31:35
is it interfering? And more and more people, it
31:37
sounds like it's interfering with their lives, especially
31:39
these younger people. It can enhance your functioning
31:42
so like everyday. Anxiety.
31:43
Tell me about that. How does it?
31:44
Enhance your a mile so a a limited focused form of stress
31:52
that will trigger some low level of anxiety can make you more.
31:55
Productive. I'm feeling a little bit anxious
31:58
about the exam tomorrow I'm going to be a little more
32:00
motivated to study because I'm under a deadline.
32:02
Or you you could. Think so?
32:03
It's a good stress. Some stress is good stress.
32:05
Yep. Yeah, yeah.
32:06
There's distress, the bad stress, which is chronic,
32:09
ongoing, pervasive. It's happening when there's not
32:14
actually an acute danger. And there's good stress.
32:16
You stress which is, you know, self limited focused.
32:20
You know, you think of a deadline at work.
32:22
If you're working in a team, probably everyone's had this
32:24
experience where, OK, we're working under pressure, we got
32:27
to finish this project by a deadline.
32:29
It's important. We're all invested in it and
32:31
we're really productive, right? That's good once or twice a year
32:35
at work. But if you start, if that
32:37
becomes what happens every week, then the people will start
32:41
getting worn down. Over well, that's an interesting
32:43
point because adrenaline junkie style working is a thing.
32:48
So people at least because I kind of live action is sort of
32:52
the media world and activism. And there's sort of like this
32:56
intensity, these waves of intensity that kind of break
32:59
frequently around work where you're just like doing this push
33:02
through and it's like very controversial and maybe there's
33:05
an all nighter involved and that kind of happens regularly.
33:08
And you're saying sounds like what you're saying is that
33:10
that's going to lead to burnout. You can't too.
33:12
Much of that is a recipe. For.
33:13
But what if you just do some of it?
33:14
How often? How much can?
33:15
You some of it, some of it can be productive.
33:17
It can be energetic. How many times and how?
33:19
Many times a. Month.
33:20
Oh gosh, I would. I would think no more than than
33:24
four times a year. OK, so 4 * a year is when you do
33:27
those really intense push through projects.
33:29
Yeah, and they have to be followed by a period of respite,
33:32
by a kind of Sabbath rest. OK, here's another question.
33:34
How often in order to combat the unprecedented levels,
33:39
unprecedented levels of anxiety in our culture.
33:41
And it's, by the way, not just young girls, it's across the
33:43
board. My understanding is anxiety
33:45
spiking. What does that mean for people,
33:48
professional people? Because a lot of jobs today, and
33:51
that's why I think the gig economy is so popular, You know,
33:53
freelancing, working for oneself, because you could take
33:56
those respite. You can take those pauses and
33:59
you're not going to get in trouble with the big bad boss or
34:01
you're not going to, you know, miss the deadline or the metric
34:03
in your, you know, corporation. But certain profession
34:06
professions, the medical profession is 1, but
34:08
particularly in the law legal profession, having these
34:12
intensive long stretches of work that really are unrelenting.
34:16
They just keep going and then maybe you get 2 weeks off of a
34:20
year, but those two weeks off for the public holidays that you
34:22
would probably end up working on anyways.
34:25
I mean. So the not everything is or can
34:31
be or should be framed as a crisis.
34:33
And one of my worries about contemporary society,
34:37
contemporary models of governance, involve utilizing
34:42
one crisis after the next, from the COVID crisis to the climate
34:46
crisis to, you know, whatever the next real or manufactured
34:50
crisis is, to exercise greater and greater control over
34:53
people's lives and to get people to do what the governing
34:57
authorities want them to do. But you can see this in business
35:00
and corporate life. Definitely.
35:02
Right, where everything becomes a crisis and everything becomes
35:05
and you know, you could see managers that have this sort of
35:08
management style where I'm, you know, I'm going to just kill my
35:12
team to get stuff done. The 3:00 PM call on the Friday
35:15
This has to get done. Exactly.
35:17
And again, 2-3, maybe 4 * a year in certain industries that
35:22
really actually require that. OK.
35:25
Well, what about the public relations world?
35:27
Because you don't control when the story breaks.
35:30
No, you don't. But I mean, we also have to
35:33
recognize that this is a, this is a great question.
35:38
I was at a gathering of a new nonprofit involving scholars and
35:43
people doing work in the public health space.
35:46
And this was a kind of an insider gathering.
35:48
It wasn't a public facing gathering.
35:49
We are having a very interesting conversation about public
35:52
relations because, you know, this new institute that started
35:57
the year and a half ago has been very successful.
35:59
It's been influential. It started to impact public
36:01
policy. And people who disagree with our
36:04
public policy stance have, you know, they don't like what we're
36:07
doing. So they're going to write up
36:09
opinion pieces and stuff with, you know, nonsensical criticisms
36:14
and trying to pain us in a bad light.
36:16
And so people were really worried about this, like, you
36:19
know, this, this article is going to come out in this
36:21
newspaper from this person, and we know they're going to say bad
36:24
things about us that aren't true.
36:26
How do we fix the public perceptions?
36:28
And my intervention in that conversation was, OK, we do
36:32
what's reasonable, we do what we can from a public relations
36:36
standpoint. But at the same time, we're
36:38
going to waste a lot of time and energy trying to respond to
36:42
critics that will be wasted, right?
36:46
Either we believe in the power of the truth and the power of
36:49
what we're doing ultimately in the long term to be compelling,
36:53
or we don't, right? Or we have to engage in spin
36:56
doctoring to convince people of things that otherwise they
36:59
wouldn't be convinced of. And so I think we can spend a
37:03
lot of time throwing stones and sticks at the dogs barking at us
37:08
from the side of the road. Whereas in some cases we just
37:11
need to ignore those people. That's going to be a flash in
37:14
the pan. We can't control what they say.
37:17
If they publish, you know, something publicly, We if we try
37:21
to reason with them, they're, they're not going to care
37:22
because they, they have an agenda, they have an axe to
37:24
grind. So let's just keep doing our
37:26
work and not worry too much about that stuff and not create
37:30
unnecessary crises for things that are outside of our control.
37:35
I think that's a really good assessment of, I mean, the
37:39
manufactured crises of your opponents and how they try to
37:42
throw you off course because people actually do that.
37:44
Maybe this nonprofit or this institute, their enemies would
37:47
love to do that to them on a Friday afternoon.
37:49
So that's that's a really good perspective.
37:51
And it's a good perspective for individuals too, who just are
37:54
worried about what people are think about them or say about
37:56
them. Even forget separate from media,
37:59
just in personal relationships that you got to let it sit, you
38:01
know, and and live your life at the end of the day.
38:04
But I'm saying, what about if you are in news media creation
38:08
and so many social media creators are, and your job is to
38:12
be the first to the story? Because a lot of people have
38:16
become influencers or creators who need to be on top of the
38:20
trend, on top of the story. And I think that's a driver.
38:23
I I, I would venture that's a driver of a lot of the anxiety.
38:26
I think it is. I think it's oftentimes a driver
38:29
for bad premature information. It's true.
38:33
So, you know, my advice to those people might be, OK, think about
38:38
carving out a niche within that space where it's not every other
38:42
day that you have to be rushing to throw together your whatever
38:46
it is, your Twitter space or whatever.
38:48
You know, when a story comes out on this topic where you've
38:50
cultivated expertise, Yeah, from time to time you need to jump on
38:54
and be first out of the gate with your, with your commentary
38:57
or your analysis or, or whatever.
39:00
But if you try to be that and do that for everything all the
39:02
time, you know, you're going to, you're going to be just be
39:05
running here and there and, and, and doing probably shallow work.
39:12
I mean, some some analysis requires time and sifting.
39:17
I got away from reading newspapers a couple of years ago
39:20
and went more toward monthly or quarterly publications because I
39:25
just found that they had they had more depth.
39:28
What are? Your favorite monthly and
39:29
quarterly? Oh gosh, there's, there's a lot.
39:31
There's a new magazine called Compact that I really like and
39:35
they're they're mostly online, so they publish one or two
39:39
articles a day. I don't think they have a print
39:42
edition. There's a you feel it's a more
39:45
in depth forum. It's a more in depth forum.
39:47
There's people on the right and on the left that write for.
39:50
They have interesting authors. They're not trying to be.
39:53
They're trying to do social and cultural commentary and
39:56
analysis, but they're not necessarily trying to be the
39:59
first to the story. Well, see, it's interesting with
40:02
the the design of social media because it rewards the people
40:06
first to the story. It rewards the people that are
40:09
the most aggressive. Yeah, the hot takes.
40:13
It rewards the inflammatory and the sensational.
40:16
And I mean, you, you kind of like up against the machine.
40:21
What do you do in the face of that when all of these things
40:23
are inducing anxiety? I think the research is proving
40:27
to us that it induces anxiety in the people that consume it and I
40:31
sounds like in the people that create it.
40:33
Yeah, right. Well.
40:35
I so I've seen influencers on social media that don't take
40:38
that tack. What tack did they take?
40:41
Well, I think there are people that are more thoughtful and
40:46
GTP. And Lyler and Aaron Curiotti
40:49
have you heard of? Him if.
40:55
You've. Cultivated a niche on social
40:58
media where you can actually look at look at the latest news
41:02
in the moment, size it up quickly and say something
41:05
thoughtful and intelligent, then go ahead and do it.
41:08
Do you think anyone's doing that well today?
41:11
I think there are a few people doing that well for narrowly
41:14
defined topics where they really have a lot of expertise.
41:17
They've done the reading, they've done the background,
41:19
they've followed that topic so closely that they're able to do
41:22
that well, but they're not able to be a Jack of all trades.
41:26
They're not able to do that with every issue that comes down the
41:29
Pike. So I think a lot of social media
41:31
influencers feel like they have to say something about
41:34
everything, right? But OK, maybe you need to just
41:37
cultivate a smaller plot of land here where you do a deeper dive.
41:41
You actually read the read the long form articles, you read the
41:45
books, you read the the stuff that comes out, you sort of more
41:49
slowly and drills down more deep.
41:51
Why do you think people are so spreading themselves so thin?
41:57
I think I, I think the I, I think the media itself creates
42:04
incentives in that direction. Financial incentives.
42:06
Financial incentives, dopamine hit incentives, right?
42:11
I mean, one of the things that one of the reasons that
42:14
Instagram and and Twitter are very powerful and I think TikTok
42:18
I'm not, I don't engage with TikTok.
42:19
So I, I know that platform less well.
42:22
One of the things I think they're, you know, that that
42:25
accounts for their sort of maybe addictive quality is pretty
42:29
instantaneous feedback, right? How many likes did I get in the
42:33
1st 5 minutes? How many likes did I get in 30
42:35
minutes? How, how many likes did I get in
42:37
an hour? You know, if, if you publish an
42:40
article in a print journal, you don't really know what people
42:43
thought about it. You know, there might be one or
42:45
two letters to the editor they publish.
42:47
But first of all, you're waiting weeks before you see it in
42:49
print. Maybe it's a newspaper article
42:51
and you're you're waiting a shorter period of time.
42:54
But even then, there's a lag between when you finalize it and
42:57
submit it and when you actually see it in print or see it
43:00
online. People might write comments and
43:03
you know, in the comments section below, often times
43:06
that's trolls. So you have to take that with a
43:08
grain of salt. But the social media gives you
43:11
instant feedback. I share an idea that just popped
43:13
in my head and I can see within minutes kind of how people are
43:17
reacting to that, how people are engaging with that.
43:21
And the combination of either the short term pleasure from a
43:24
positive reaction or the short term feeling of anxiety from a
43:29
negative reaction or disappointment from no reaction
43:33
altogether, even the positive experience reaction of pleasure
43:37
lends to clinical anxiety ultimately.
43:41
I think it lends to a form of frantic engagement, OK with that
43:46
social media that tends to exacerbate or cultivate anxiety.
43:50
OK, and there and then there you have it.
43:53
There's the the perfect cocktail.
43:55
OK, so treatments of the thing. I mean, we can talk about turn
43:58
off your phone at, you know, don't look at your phone an hour
44:00
before bed. Don't eat any seed oils.
44:05
I mean, what do you think about seed oils?
44:07
So, OK, diet can play a role. And yeah, there's been a lot on
44:12
seed oils. There's been a lot on sort of
44:15
corporate manufactured foods in the way in which that's
44:17
negatively playing into our health.
44:20
You know, we eat way too much sugar, way too much high
44:22
fructose corn syrup, because corn is a subsidized crop in the
44:26
United States. So we have all this excess crop
44:29
that you know it. Is crazy I in high school debate
44:36
like over a decade, you know, decade and a half ago.
44:38
I one of our our resolutions was to substantially change the
44:42
agricultural policy and all of us kids were the case was, you
44:48
know, remove the subsidies on corn, you know, on on corn
44:52
because now corn syrup is in everything and it's making
44:54
America fat and you know sick and hard to use.
44:57
But it's incredible how a government policy and transform
45:02
an industry and and have such a huge impact on people's everyday
45:05
lives. And it it's easier to say eat
45:08
real food, eat natural food, eat organic, stay away from, you
45:14
know, seed oils if you're a middle upper middle class
45:18
individual. What most people don't realize
45:20
is that lower class working class families bad food is
45:25
cheaper. Well, I would say just look at a
45:27
food pantry and if you're, you know, going to the House of
45:31
worship and they have a food pantry, what are people dropping
45:33
off in that food pantry? It's usually not going to be
45:36
organic lettuce. Yeah.
45:39
It's going to be canned, processed foods.
45:42
I mean, a lot of families routinely eat at McDonald's not
45:47
because it necessarily is their favorite food, but because it's
45:52
it's a cost effective way to get a meal for a whole family, even
45:57
though it's highly processed, highly manufactured.
45:59
But you're saying these processed foods and seed oils
46:02
can let can help create anxiety? Yeah, they they well, they
46:06
create physiological problems that set the stage for bodily
46:11
forms of stress, which contributes to anxiety,
46:14
inflammation. We now know inflammation can
46:17
contribute to depression and anxiety.
46:20
So yeah, a healthy diet is is a good place to start.
46:25
I would say if you heavily engage with social media, start
46:27
with an assessment of the problem, right?
46:30
Most of these smartphone software now can tell you if you
46:33
set it up that way, how many hours a week are you spending on
46:35
this app or that app? Just begin with that.
46:38
What's my two week average, right?
46:40
And then put in some concrete things in place to cut that in
46:44
half. Maybe you have to get to the
46:48
point where you need a a total break from it for a month.
46:51
It's hard for most. It's hard for most people
46:53
because it for most people, it's connected to their job.
46:56
So it makes it extra hard. What about I've noticed a lot of
47:00
people saying I'm having a panic attack or I had a panic attack
47:04
or almost, you know, I was, I was about to have a panic
47:06
attack. And I think a lot of that's
47:08
true. I think also maybe people
47:10
misunderstand what a panic attack is.
47:12
What's a panic attack? So a panic attack is the most
47:15
severe and acute form of anxiety.
47:18
When people experience a panic attack, very often they don't
47:21
present to a psychologist or a psychiatrist's office.
47:23
They go to the emergency room. The reason they go to the
47:26
emergency room is they feel like they're dying.
47:28
They feel this impending sense of doom.
47:31
They will say things like I can't breathe or my heart is
47:34
racing, or I'm having a heart attack, or maybe I'm having an
47:37
asthma attack. They think something
47:39
catastrophic is happening to them and so they end up
47:42
presenting the emergency room. They may get a cardiac work up
47:46
an EKG. So is there always elevated
47:48
heart rate with a? Yeah, typically.
47:50
So when anxiety levels are really high, you're going to get
47:52
an elevated heart rate, elevated blood pressure, You're going to
47:55
get muscle tension, including in your muscles of respiration,
47:59
your breathing muscles, in your chest, in your diaphragm.
48:02
That can create rapid shallow breathing which doesn't
48:06
oxygenate your organs very well, so you can get numbness and
48:10
tingling in your hands and feet, which feels like maybe a
48:12
neurological problem. Am I having a stroke?
48:15
It can also create light headedness and dizziness because
48:18
you're not getting enough oxygen.
48:20
And your brain. None of this is actually helping
48:22
you flee danger. No it.
48:25
So this is. It creates A vicious cycle.
48:27
So the first thing to do when you're having a panic attack is
48:31
to tell yourself I'm having a panic attack.
48:34
Because what a lot of people tell themselves is I can't
48:37
breathe or something's wrong with my heart, or I'm about to
48:42
die. They catastrophize because
48:44
they're having very profound physical, physiological
48:48
symptoms. They don't feel right.
48:51
I'm lightheaded. I feel like I can't breathe.
48:54
It's extremely uncomfortable. It's very distressing.
48:58
It's not just a high level of anxiety, it's an overwhelming
49:00
level of anxiety, but that that can create a vicious circle
49:05
because the thought I can't breathe or the thought, what if
49:08
something is wrong with my heart?
49:10
What is that thought going to do to most people?
49:11
It's going to increase your level of anxiety.
49:14
I think that's such a powerful point that it can't be
49:18
overemphasized that your thoughts can influence your
49:21
emotions. Can.
49:22
Influence yourself physiologically, your
49:25
physicality being influenced. Because a lot of people think,
49:28
you know, or they even say like, I feel that you were mean to me
49:32
or, you know, in a conversation. It's like, no, you thought this
49:35
thing about the person which made you feel something.
49:38
And maybe you shortcut the thought because you're so
49:39
ingrained in the habit of the feeling that the experience just
49:42
immediately triggers the feeling.
49:43
It misses the thought, but so you're saying you have to think.
49:47
If you're having a panic attack, the first step is to actually
49:49
think about what is happening to me because that's the only way
49:52
to ultimately master the feeling.
49:53
Yeah, in, in the moment when you're having a panic attack,
49:56
you don't necessarily need to figure out why am I having the
49:58
panic attack, what triggered it. Sometimes you can't identify
50:01
that. Maybe afterwards you can dig in
50:03
and figure out triggers, but in the moment, what you need to
50:06
tell yourself is I'm having a panic attack.
50:10
This is very uncomfortable. This is a very high level of
50:13
anxiety, but I'm not dying. I can still breathe.
50:18
There's nothing wrong with my heart, there's nothing wrong
50:21
with my lungs. It's just, you know, anxiety can
50:23
present with these severe physical or.
50:26
Somatic and do what? Should you seek help in that
50:29
moment? So what?
50:30
What usually happens after the first time when someone goes to
50:33
the ER and then then I try to educate them on, OK, let's look
50:38
back at what happened. Go through all these symptoms
50:40
like like we just did and remind them that this is what a panic
50:45
attack feels like. And often times that vicious
50:48
cycle between the, the negative thoughts that something
50:51
catastrophic is happening to be physically that which worsens
50:55
the anxiety, which amplifies that thought, which worsens that
50:58
you get into this very rapid spiral downwards.
51:02
That spiral can be interrupted just by telling yourself, I'm
51:06
having anxiety. It's uncomfortable.
51:09
I can't and shouldn't necessarily try to completely
51:11
control the anxiety in the moment because then you're just
51:15
going to get frustrated because I, you know, I can't control it.
51:17
I can't make it stop. I'm telling myself nice
51:19
thoughts. You don't have to tell yourself
51:20
nice thoughts, but you do have to tell yourself I'm not dying.
51:24
There's nothing wrong with my heart.
51:25
There's nothing wrong with my lungs, nothing catastrophic is
51:29
going to happen and this will pass.
51:31
I may not be able to completely control the symptoms now in the
51:34
moment, but the symptoms will subside.
51:37
And when you introduce that line of thinking, that's typically
51:41
the beginning of getting out of that cycle and the and the
51:43
calming of the anxiety. So the first thing to do when
51:47
you're having a panic attack is literally to tell yourself
51:49
you're having a panic attack and to remind yourself that anxiety
51:53
is uncomfortable. It's very unpleasant, but it's
51:56
not going to kill me. It's not going to harm me
51:58
physically. It's I'm, I'm not going to
52:01
literally fall apart because of these symptoms.
52:05
I'm gonna be OK and this will pass.
52:07
And that's so I, I think that message is for really most
52:12
difficult things we go through in life.
52:14
That's right. And anxiety attack being this
52:16
very extreme case of it exactly can hit people, but to kind of
52:20
talk yourself through it, like I am feeling this way and because
52:26
you know, this is what's happening to me and it's
52:28
triggering to kind of explain yourself to yourself helps you
52:32
be more in command of what's happening and and navigate
52:34
what's. Happening.
52:35
And once you start doing what's, once people start doing that,
52:39
they can begin to recognize those symptoms when they're more
52:42
subtle, panic attacks feel like they come out of the blue.
52:44
They come out of nowhere and they can spiral within minutes.
52:48
But as you become more adapted, noticing, OK, one of my symptoms
52:52
of anxiety is tightness in my chest or another one of the
52:55
symptoms of anxiety for me is clammy, sweaty palms or, you
53:01
know, butterflies in my stomach. When those symptoms are more
53:04
subtle, you can start to notice them.
53:06
And just by noticing them again, not controlling, noticing and
53:10
labeling that, oh, I'm experiencing a little bit of
53:12
anxiety right now. OK, I wonder what's going on.
53:15
And maybe I'm in a situation in which I need to, you know,
53:21
remove myself temporarily. Well, no right not to.
53:24
Avoid it entirely. Don't go to the safe space, but
53:27
you're scared of the elevator. Get on it.
53:29
I mean, how much of that is real though?
53:31
I mean, we were just talking earlier about if you're feeling
53:34
a phobia or or anxiety about something and you continue to
53:38
run from it or or move away from it, you might make it bigger and
53:42
harder to overcome. Oh yeah, it's it's very real.
53:45
So if you remove yourself from the space, it should only be for
53:50
a minute or two to. Allow.
53:51
Yourself to collect your thoughts.
53:53
Collect the thoughts because I think it's also then.
53:55
You got to face your fears. Right, well, and it's in
53:57
relationships too. And I know we have to wrap soon
54:01
and I want to do a call out for people's questions for future
54:04
topics here too. But I think, and we're going to
54:07
get to relationship stuff more in the future.
54:08
But if you're, I think a lot of times anxiety is triggered in a
54:12
relationship, not just the situation, but in a relationship
54:15
or a conversation that you're having with someone.
54:17
And so they're, you know, I think a good therapist will will
54:21
usually say remove yourself, especially if it's an
54:22
overwhelming emotion, remove yourself from the situation.
54:26
But then what? But you remove yourself so that
54:28
you can go back into it equipped to deal with it.
54:32
And sometimes it help has a you know, it helps to have a
54:34
therapist who acts like a bit a bit of a coach to help you
54:38
structure the process of overcoming your fear or your
54:41
phobia. I'll use a simple example.
54:43
Let's say I'm dealing with a patient who has a fear of
54:46
heights. In one of my sessions, I might
54:50
walk out to the parking structure across the street with
54:53
a patient and say, OK, we're not going to go to the top of the
54:56
parking structure today. We're going to take a stepwise
54:58
approach to this problem. We're going to go to the second
55:00
floor of the parking structure, walk up the stairs, maybe lean
55:04
over the railing, look, you know, 15 feet down to the ground
55:08
below. And that's going to trigger
55:09
some. Level of.
55:10
Anxiety. Yeah, exactly.
55:12
What about Bob? Approach.
55:13
Baby steps. Have you actually done that with
55:17
with patients? Oh, yeah, yeah.
55:18
We have interesting patients that have OCD, germ phobia.
55:22
I have them bring things into the session that they're afraid
55:26
to touch, you know, and you begin by, OK, touch your elbow
55:30
on this. That's going to trigger a one
55:31
out of 10 anxiety and you're going to have an impulse to want
55:35
to remove it or, you know, go wash it or something like that.
55:37
And then we move to the back of your hand.
55:39
And then, you know, step by step, you get to the point
55:42
where, you know, first they're touching the table, then they're
55:44
touching the floor, then they're putting their, you know, head on
55:48
the side of the toilet and doing things that most people would
55:50
find anxiety. That's actually part of the
55:53
therapy. I mean, depends on how far you
55:54
want to go, right? So.
55:58
Aaron's like. Those are the fun sessions.
56:01
So yeah, no, it it, it helps to have someone who can coach you
56:04
and push you through it, right, Because you can give homework
56:07
and people can do some of these things.
56:09
See, I always. Thought, what about Bob?
56:10
That was just a crazy, hilarious movie, and that wasn't like real
56:14
therapy, but it sounds like it actually kind of.
56:16
No, there was there was an element.
56:17
I mean, it was, it was humor and you know, kind of can't be
56:21
situations. But no exposure therapy means is
56:25
a fancy way of saying face your fears.
56:28
But you, you, you might want to do that in a kind of structured,
56:31
systematic, proactive way. A lot of people have a fear of
56:36
flying. And it's hard to put yourself in
56:39
a situation where you're on a plane.
56:40
You can expose yourself to that without actually taking off and
56:43
going somewhere that may be too overwhelming for some people.
56:46
So there are place, there's a place in Orange County where
56:48
there's a kind of like plane simulator, really.
56:52
It looks like you're on a commercial flight and you go and
56:54
you sit there. Just for anxious people.
56:56
Just for anxious people. It's a behavioral therapy place
56:58
to help people overcome their fear of flying.
57:01
You can do maybe if real exposure is too anxiety
57:04
provoking, you start with imaginal exposure.
57:07
OK, let's stand in front of the elevator and now let's, you
57:10
know, imagine what it looks like.
57:12
Look, see what it looks like inside.
57:13
Now close your, close your eyes and imagine you just got on that
57:16
elevator and the door closed. And sometimes just the imaginal
57:19
exposure is the first step. It's, it's mildly anxiety
57:22
provoking, but it's, it's not as bad as getting on the elevator.
57:25
So you start with that and then you move a little closer to the
57:28
elevator and maybe get on the elevator and go one floor, you
57:31
know, And then a few days later you go 2 floors and then you
57:33
know, you, you work your way up. To another topic for another one
57:37
is EMDR. Oh yeah, and your your theory on
57:40
or your opinion on? EMDR can be powerful.
57:43
For that, I want to, I want to hear about that.
57:45
That's, that's very interesting. So for anxiety then, and for
57:49
someone who's listening, who wants more resources on this,
57:53
and maybe they're not going to a therapist or they're not sure
57:56
they need to ask for someone that they love, what's a good
57:58
primer? Yeah, so there's some good
58:00
cognitive behavioral therapy workbooks out there.
58:03
The one that I used to use to teach and also recommend to
58:07
patients is called Mind Over Mood, written by Dennis
58:11
Greenberger. He was the guy who taught me
58:13
cognitive behavioral therapy when I when I was in residency.
58:16
So that's a very good resource. That's an Amazon.com.
58:18
Yeah, you can order it. It's sold the bazillion copies.
58:20
It's a very popular CBT workbook and there's, there's there's an
58:25
introductory couple of chapters in there just on the basic
58:28
principles of behavioral therapy and cognitive therapy.
58:31
And then there's chapters on specific issues.
58:33
So, you know, somewhat for anxiety, I would recommend, OK,
58:36
read the initial chapters in the book, then go to the chapter on
58:39
anxiety and work, work through the written exercises in there
58:44
that he offers a structured sort of way to deal with some of
58:48
these things that involves homework exercises and writing
58:52
and sort of behavioral exercises.
58:54
So that's one. There are many other good CBTCBT
58:58
workbooks out there, but what what I've described as exposure
59:02
therapy is a common behavioral therapy for anxiety disorders.
59:06
So mind over mood, mind. I like that.
59:08
And we'll link other top other books or resources that folks
59:13
recommend. And are you you're, you're
59:15
practicing right, Aaron? I am Doctor K, so you can also
59:18
go see call up Doctor K's office if you need to see a great
59:22
shrink. Don't have time for more
59:23
patients but I do. Not taking new patients.
59:25
Aaroncuriaty.com I. Have Aaron Curiaty.
59:27
Dot com referral list in Southern.
59:29
California and you also wrote a great book on depression.
59:31
I did it's it's called the Catholic Guide to Depression.
59:34
So it brings in the spiritual domest attention as well.
59:37
And you know, my my own sort of knowledge of the, the Catholic
59:42
faith and the way in which the embrace of the faith.
59:45
But I think the book would be certainly be applicable to
59:48
Protestant and Orthodox Christians.
59:50
As well. I've had non Christians read the
59:52
book and you know, find it beneficial.
59:54
Just, you know, thinking about looking at depression from
59:58
multiple perspectives. So addressing the biological,
1:00:02
addressing the psychological, relational, social, but also the
1:00:05
spiritual factors that can play a role in, in, you know,
1:00:09
contributing to the illness or recovering from the illness.
1:00:12
Awesome, thanks Aaron, this is good.
1:00:15
Hopefully folks listening can feel a little bit more equipped
1:00:18
to understand anxiety and deal with anxiety in our ever anxious
1:00:22
world. There's a lot of people can do
1:00:25
that's that's empowering and proactive.
1:00:28
You know, there's something kind of bracing and proactive about
1:00:30
facing your fears in a, in a structured step wise way.
1:00:34
You don't have to do the, the flooding, jump in and swim.
1:00:37
You can do that. Some people do, but usually the
1:00:40
more the the more gradual approach is really helpful.
1:00:43
People can measure their progress, right?
1:00:46
I have a fear of driving and you know, last week I went one exit
1:00:49
on the freeway and this week I went three exits on the freeway
1:00:53
and next week I'm going to try to go 6 exits.
1:00:55
It's good on the freeway. So to do it in that way and to
1:00:58
be able to measure and see progress is very empowering for
1:01:00
people. That's great.
1:01:02
So folks listening can send questions.
1:01:05
So we, if you were, you're hearing Doctor K talk and we
1:01:08
want to do something, people want to do something on some
1:01:10
other mental health issue, relationship issues, questions,
1:01:15
We want to hear them, send them. And I think the next time we're
1:01:18
going to do something on trauma. So anything trauma related, very
1:01:22
important to send them over because lots to say about that.
1:01:25
Like anxiety traumas everywhere. Yep, awesome.
1:01:28
Thanks, Lila. Thanks, Doctor K that's good.