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The Most Common Anxiety Disorder May Never Walk Into Your Clinic — But We Still Need to Recognize It · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back
• 0:06
  my
• 0:06
  friends
• 0:06
  to
• 0:07
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:09
  Npz.
• 0:10
  Here
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:11
  pocket,
• 0:12
  your
• 0:12
  go
• 0:12
  to
• 0:12
  place
• 0:13
  for
• 0:13
  pearls
• 0:13
  that
• 0:14
  prep
• 0:14
  you
• 0:14
  to
• 0:14
  practice.
• 0:16
  My
• 0:16
  friends,
• 0:16
  this
• 0:17
  is
• 0:17
  probably
• 0:17
  the
• 0:18
  juiciest
• 0:18
  pearl
• 0:19
  drop
• 0:20
  that
• 0:21
  I
• 0:21
  have
• 0:22
  ever
• 0:22
  shared
• 0:22
  with
• 0:22
  you
• 0:23
  and
• 0:23
  it
• 0:23
  is
• 0:23
  my
• 0:24
  privilege
• 0:24
  to
• 0:24
  be
• 0:24
  here.
• 0:25
  My
• 0:25
  goal
• 0:25
  is
• 0:25
  to
• 0:26
  do
• 0:26
  what
• 0:26
  I
• 0:26
  call
• 0:26
  pearl
• 0:27
  dives
• 0:27
  on
• 0:27
  my
• 0:27
  off
• 0:28
  time.
• 0:28
  Right?
• 0:28
  Pearl
• 0:29
  dives
• 0:29
  are
• 0:30
  me
• 0:30
  just
• 0:31
  scouring
• 0:31
  through
• 0:32
  the
• 0:32
  depths
• 0:32
  of
• 0:32
  all
• 0:32
  of
• 0:32
  the
• 0:33
  psychiatric
• 0:33
  literature
• 0:34
  and
• 0:34
  trying
• 0:34
  to
• 0:34
  find
• 0:35
  the
• 0:35
  big
• 0:35
  shiny
• 0:35
  thing,
• 0:36
  the
• 0:36
  big
• 0:36
  shiny
• 0:37
  pearl
• 0:38
  that
• 0:39
  is
• 0:39
  going
• 0:39
  to
• 0:40
  transformationally
• 0:41
  change
• 0:41
  the
• 0:41
  way
• 0:42
  you
• 0:42
  practice
• 0:44
  and
• 0:44
  the
• 0:44
  way
• 0:44
  you
• 0:44
  look
• 0:45
  at
• 0:45
  psychiatry.
• 0:46
  And
• 0:47
  I
• 0:47
  want
• 0:47
  it
• 0:47
  to
• 0:47
  be
• 0:47
  high
• 0:48
  yield
• 0:48
  and
• 0:48
  practical
• 0:49
  also.
• 0:49
  And
• 0:49
  this
• 0:50
  one
• 0:50
  might
• 0:50
  be
• 0:50
  one
• 0:50
  of
• 0:50
  my
• 0:51
  favorites.
• 0:51
  And
• 0:51
  it
• 0:51
  starts
• 0:52
  off
• 0:52
  with
• 0:52
  a
• 0:52
  very
• 0:52
  simple
• 0:53
  question.
• 0:54
  And
• 0:54
  the
• 0:54
  question
• 0:54
  is
• 0:54
  this.
• 0:55
  What
• 0:55
  is
• 0:55
  the
• 0:55
  most
• 0:55
  common
• 0:55
  anxiety
• 0:56
  disorder?
• 0:57
  What
• 0:58
  is
• 0:58
  the
• 0:58
  most
• 0:58
  common
• 0:59
  anxiety
• 0:59
  disorder?
• 1:00
  Is
• 1:01
  it
• 1:01
  A,
• 1:01
  generalized
• 1:02
  anxiety
• 1:02
  disorder?
• 1:03
  Is
• 1:03
  it
• 1:03
  B,
• 1:04
  social
• 1:04
  anxiety
• 1:05
  disorder?
• 1:05
  Is
• 1:06
  it
• 1:06
  C,
• 1:06
  panic
• 1:07
  disorder?
• 1:08
  Is
• 1:08
  it
• 1:08
  D,
• 1:09
  specific
• 1:09
  phobia,
• 1:10
  or
• 1:10
  is
• 1:10
  it
• 1:11
  E,
• 1:11
  agoraphobia?
• 1:12
  Now
• 1:13
  if
• 1:13
  you
• 1:13
  asked
• 1:13
  me
• 1:13
  this,
• 1:14
  I'll
• 1:14
  be
• 1:14
  honest,
• 1:15
  I
• 1:15
  would
• 1:15
  say
• 1:16
  generalized
• 1:16
  anxiety
• 1:17
  disorder.
• 1:17
  It
• 1:17
  seems
• 1:18
  like
• 1:18
  everybody
• 1:19
  who
• 1:19
  comes
• 1:19
  into
• 1:20
  any
• 1:21
  outpatient
• 1:21
  clinic
• 1:22
  anywhere
• 1:23
  is
• 1:23
  coming
• 1:24
  with
• 1:25
  some
• 1:25
  form
• 1:25
  of
• 1:25
  generalized
• 1:26
  anxiety
• 1:27
  disorder.
• 1:27
  They
• 1:28
  are
• 1:28
  worried
• 1:29
  about
• 1:29
  everything.
• 1:29
  It's
• 1:30
  an
• 1:30
  ongoing
• 1:30
  day
• 1:30
  to
• 1:31
  day
• 1:31
  struggle.
• 1:31
  It's
• 1:31
  very
• 1:32
  hard
• 1:32
  to
• 1:32
  control
• 1:32
  their
• 1:32
  worry.
• 1:33
  It's
• 1:33
  affecting
• 1:33
  their
• 1:34
  sleep,
• 1:34
  it's
• 1:35
  affecting
• 1:35
  their
• 1:36
  ability
• 1:36
  to
• 1:36
  concentrate
• 1:37
  because
• 1:38
  they
• 1:38
  just
• 1:38
  can't
• 1:38
  shut
• 1:38
  their
• 1:39
  mind
• 1:39
  off
• 1:39
  from
• 1:39
  worrying
• 1:40
  about
• 1:40
  things
• 1:40
  they
• 1:40
  know
• 1:40
  are
• 1:41
  irrational,
• 1:41
  but
• 1:41
  they
• 1:41
  can't
• 1:42
  stop
• 1:42
  worrying
• 1:42
  about
• 1:43
  them
• 1:43
  anyway.
• 1:43
  That
• 1:44
  seems
• 1:45
  to
• 1:45
  be
• 1:45
  the
• 1:45
  peanut
• 1:46
  butter
• 1:46
  and
• 1:46
  jelly
• 1:47
  of
• 1:47
  all
• 1:47
  any
• 1:48
  outpatient
• 1:48
  practice.
• 1:48
  Right.
• 1:49
  It's
• 1:49
  like
• 1:49
  depression
• 1:50
  and
• 1:50
  gad.
• 1:51
  Okay,
• 1:52
  so
• 1:52
  that
• 1:52
  would
• 1:52
  be
• 1:53
  the
• 1:54
  very
• 1:54
  first
• 1:54
  guess
• 1:55
  if
• 1:55
  I
• 1:55
  was
• 1:56
  looking
• 1:56
  at
• 1:56
  this.
• 1:57
  If
• 1:57
  we're
• 1:57
  talking
• 1:58
  about
• 1:58
  outpatient
• 1:59
  psychiatry.
• 2:00
  Now,
• 2:00
  we
• 2:00
  all
• 2:01
  know
• 2:01
  that
• 2:02
  public
• 2:02
  speaking
• 2:02
  is
• 2:03
  feared
• 2:04
  more
• 2:05
  than
• 2:05
  death
• 2:06
  by
• 2:06
  most
• 2:07
  Americans.
• 2:08
  So
• 2:09
  social
• 2:09
  anxiety
• 2:10
  also,
• 2:10
  also
• 2:10
  is
• 2:11
  a
• 2:11
  very
• 2:11
  appealing
• 2:12
  choice
• 2:12
  here.
• 2:13
  Now,
• 2:13
  I
• 2:13
  do
• 2:13
  not
• 2:13
  see
• 2:13
  social
• 2:14
  anxiety
• 2:14
  as
• 2:15
  often
• 2:15
  as
• 2:15
  gad,
• 2:15
  although
• 2:16
  I
• 2:16
  will
• 2:16
  tell
• 2:16
  you
• 2:16
  it's
• 2:17
  one
• 2:17
  of
• 2:17
  those
• 2:17
  diagnoses
• 2:18
  that
• 2:18
  if
• 2:18
  you
• 2:19
  ask
• 2:19
  for
• 2:19
  it,
• 2:19
  you
• 2:20
  will
• 2:20
  find
• 2:20
  it
• 2:20
  a
• 2:20
  lot
• 2:21
  more
• 2:21
  if
• 2:21
  you
• 2:21
  intentionally
• 2:22
  go
• 2:22
  out
• 2:22
  of
• 2:22
  your
• 2:22
  way.
• 2:23
  And
• 2:23
  you
• 2:23
  should.
• 2:24
  To
• 2:24
  ask
• 2:24
  about
• 2:25
  social
• 2:25
  anxiety,
• 2:26
  ask
• 2:26
  about
• 2:27
  if
• 2:28
  people
• 2:28
  are
• 2:28
  avoiding
• 2:29
  promotion
• 2:30
  opportunities
• 2:30
  or
• 2:31
  specific
• 2:31
  gigs
• 2:32
  or
• 2:33
  events,
• 2:34
  networking
• 2:36
  opportunities.
• 2:37
  Right.
• 2:38
  You
• 2:38
  want
• 2:38
  to
• 2:38
  really
• 2:39
  flesh
• 2:39
  that
• 2:39
  out
• 2:40
  because
• 2:40
  it's
• 2:41
  one
• 2:41
  of
• 2:41
  those
• 2:41
  diagnoses
• 2:42
  that
• 2:42
  I
• 2:42
  find
• 2:43
  are
• 2:43
  very
• 2:44
  easy
• 2:44
  to
• 2:44
  sniff
• 2:44
  out.
• 2:45
  And
• 2:46
  it's
• 2:46
  actually
• 2:47
  a
• 2:47
  lot
• 2:47
  more
• 2:47
  common
• 2:48
  if
• 2:48
  you
• 2:48
  just
• 2:48
  ask
• 2:49
  the
• 2:49
  question.
• 2:49
  It's
• 2:50
  kind
• 2:50
  of
• 2:50
  like
• 2:50
  eating
• 2:50
  disorders.
• 2:51
  I
• 2:51
  find
• 2:51
  that
• 2:51
  the
• 2:51
  same
• 2:52
  thing
• 2:52
  is
• 2:52
  true
• 2:52
  with
• 2:52
  like
• 2:53
  Binge
• 2:53
  eating
• 2:53
  disorders
• 2:54
  when
• 2:54
  you
• 2:54
  ask
• 2:54
  about
• 2:54
  it.
• 2:55
  And
• 2:55
  again,
• 2:55
  you
• 2:55
  should
• 2:55
  ask
• 2:56
  about
• 2:56
  it
• 2:56
  at
• 2:56
  every
• 2:57
  new
• 2:57
  evaluation.
• 2:58
  Binge
• 2:58
  eating
• 2:59
  disorders,
• 2:59
  social
• 2:59
  anxiety
• 3:00
  disorder,
• 3:00
  these
• 3:01
  are
• 3:01
  pretty
• 3:02
  common
• 3:02
  when
• 3:03
  you
• 3:03
  ask
• 3:03
  about
• 3:03
  them.
• 3:04
  OCD
• 3:04
  also
• 3:05
  seems
• 3:05
  a
• 3:05
  little
• 3:05
  more
• 3:06
  common
• 3:06
  when
• 3:07
  you
• 3:07
  ask
• 3:07
  about
• 3:07
  it.
• 3:08
  And
• 3:08
  you
• 3:08
  know,
• 3:08
  because
• 3:09
  patients
• 3:09
  don't
• 3:09
  really
• 3:09
  volunteer
• 3:10
  any
• 3:10
  one
• 3:11
  of
• 3:11
  those
• 3:11
  diagnoses
• 3:11
  to
• 3:12
  you,
• 3:12
  they
• 3:12
  all
• 3:12
  have
• 3:12
  kind
• 3:13
  of
• 3:13
  a
• 3:13
  stigma
• 3:13
  attached
• 3:14
  to
• 3:14
  them.
• 3:14
  So
• 3:15
  I
• 3:15
  do
• 3:15
  think
• 3:16
  that
• 3:16
  they're
• 3:16
  probably
• 3:17
  underdiagnosed
• 3:18
  because
• 3:18
  patients
• 3:18
  don't
• 3:19
  volunteer
• 3:19
  them.
• 3:19
  They
• 3:20
  don't
• 3:20
  really
• 3:20
  anchor
• 3:21
  their
• 3:21
  chief
• 3:21
  complaints
• 3:22
  in
• 3:22
  the
• 3:22
  language
• 3:23
  of
• 3:23
  social
• 3:23
  anxiety
• 3:24
  or
• 3:24
  binge
• 3:24
  eating.
• 3:25
  Panic
• 3:25
  is
• 3:25
  pretty
• 3:26
  common,
• 3:26
  I
• 3:26
  will
• 3:27
  say,
• 3:27
  maybe
• 3:27
  not
• 3:28
  the
• 3:28
  most
• 3:28
  common,
• 3:28
  but
• 3:29
  panic
• 3:29
  attacks
• 3:30
  and
• 3:30
  panic
• 3:30
  disorder,
• 3:32
  you
• 3:32
  will
• 3:32
  see
• 3:32
  it
• 3:33
  in
• 3:33
  the
• 3:33
  outpatient
• 3:34
  space
• 3:34
  quite
• 3:35
  frequently.
• 3:35
  It's
• 3:36
  hard
• 3:36
  to
• 3:36
  put
• 3:36
  a
• 3:36
  number
• 3:36
  on
• 3:37
  it.
• 3:37
  I
• 3:37
  would
• 3:37
  say
• 3:37
  maybe
• 3:38
  1
• 3:38
  in
• 3:38
  30
• 3:38
  of
• 3:39
  my
• 3:39
  patients
• 3:39
  in
• 3:39
  the
• 3:39
  outpatient
• 3:40
  space
• 3:40
  may
• 3:41
  deal
• 3:41
  with
• 3:42
  either
• 3:42
  panic
• 3:42
  attacks
• 3:43
  or
• 3:43
  something
• 3:43
  very
• 3:44
  suspiciously
• 3:44
  close
• 3:45
  to
• 3:45
  panic
• 3:45
  disorder.
• 3:46
  Of
• 3:46
  course
• 3:46
  that's
• 3:46
  going
• 3:46
  to
• 3:46
  vary
• 3:47
  clinic
• 3:47
  to
• 3:47
  clinic,
• 3:47
  but
• 3:47
  it
• 3:48
  is
• 3:48
  quite
• 3:48
  common
• 3:48
  and
• 3:48
  we
• 3:49
  need
• 3:49
  to
• 3:49
  be
• 3:49
  prepared
• 3:49
  for
• 3:49
  it.
• 3:50
  And
• 3:50
  we
• 3:50
  need
• 3:50
  to
• 3:50
  be
• 3:51
  prepared
• 3:51
  for
• 3:51
  the
• 3:51
  fact
• 3:51
  that
• 3:52
  panic
• 3:52
  attack
• 3:52
  specifiers
• 3:53
  are
• 3:53
  fundamentally
• 3:54
  different
• 3:54
  than
• 3:54
  panic
• 3:55
  disorder.
• 3:56
  Right.
• 3:56
  There's
• 3:56
  a
• 3:56
  lot
• 3:56
  of
• 3:56
  DSM
• 3:57
  5
• 3:57
  diagnoses
• 3:58
  where
• 3:58
  panic
• 3:59
  attacks
• 4:00
  are
• 4:00
  a
• 4:00
  specified,
• 4:01
  a
• 4:01
  specifier
• 4:02
  to
• 4:02
  the
• 4:02
  syndrome.
• 4:03
  But
• 4:04
  that
• 4:04
  is
• 4:04
  qualitatively
• 4:05
  different
• 4:05
  than
• 4:05
  panic
• 4:06
  disorder.
• 4:07
  Okay.
• 4:07
  Where
• 4:07
  your
• 4:07
  life
• 4:08
  is
• 4:08
  kind
• 4:08
  of
• 4:08
  being
• 4:08
  rearranged
• 4:09
  in
• 4:10
  out
• 4:10
  of
• 4:10
  a
• 4:10
  sense
• 4:11
  of
• 4:11
  avoidance
• 4:11
  to
• 4:12
  experience
• 4:12
  the
• 4:13
  next
• 4:13
  attack.
• 4:13
  And
• 4:13
  it
• 4:14
  comes
• 4:14
  with
• 4:14
  a
• 4:14
  constellation
• 4:15
  of
• 4:15
  symptoms
• 4:16
  that
• 4:16
  are,
• 4:16
  that
• 4:17
  don't
• 4:17
  seem
• 4:17
  to
• 4:17
  have
• 4:18
  a
• 4:18
  trigger
• 4:18
  attached
• 4:18
  to
• 4:19
  that.
• 4:19
  Agoraphobia
• 4:20
  is
• 4:20
  pretty
• 4:20
  darn
• 4:21
  uncommon.
• 4:21
  I
• 4:22
  definitely
• 4:22
  have
• 4:22
  seen
• 4:22
  it.
• 4:23
  There's
• 4:23
  usually
• 4:24
  a
• 4:24
  trauma
• 4:24
  component,
• 4:25
  in
• 4:25
  my
• 4:25
  experience,
• 4:25
  attached
• 4:26
  to
• 4:26
  that.
• 4:26
  The
• 4:26
  reason
• 4:27
  why
• 4:27
  people
• 4:27
  don't
• 4:27
  go
• 4:27
  outside.
• 4:28
  But
• 4:28
  that's
• 4:29
  another
• 4:29
  story.
• 4:29
  That's
• 4:30
  another
• 4:30
  day,
• 4:30
  my
• 4:30
  friends.
• 4:31
  The
• 4:31
  most
• 4:32
  common
• 4:32
  anxiety
• 4:33
  disorder,
• 4:33
  this
• 4:34
  is
• 4:34
  shocking
• 4:34
  to
• 4:34
  me,
• 4:35
  is
• 4:35
  a
• 4:35
  specific
• 4:36
  phobia.
• 4:37
  I
• 4:37
  had
• 4:38
  no
• 4:38
  idea.
• 4:39
  And
• 4:39
  that
• 4:39
  blows
• 4:40
  my
• 4:40
  mind.
• 4:40
  It
• 4:41
  has
• 4:41
  a
• 4:41
  6
• 4:42
  to
• 4:42
  12%,
• 4:42
  12
• 4:43
  month
• 4:43
  prevalence,
• 4:44
  roughly.
• 4:45
  Some
• 4:46
  evidence
• 4:46
  shows,
• 4:46
  okay,
• 4:47
  that's
• 4:47
  extraordinary.
• 4:48
  That's
• 4:49
  anywhere
• 4:49
  from
• 4:49
  like
• 4:49
  1
• 4:50
  out
• 4:50
  of
• 4:50
  10
• 4:50
  people
• 4:51
  you
• 4:51
  go
• 4:51
  to
• 4:51
  the
• 4:52
  grocery
• 4:52
  store
• 4:53
  and
• 4:53
  1
• 4:53
  out
• 4:53
  of
• 4:54
  every
• 4:54
  10
• 4:54
  people
• 4:55
  that
• 4:55
  you
• 4:55
  see
• 4:56
  in
• 4:56
  all
• 4:56
  those
• 4:56
  aisles
• 4:57
  may
• 4:57
  be
• 4:58
  suffering
• 4:58
  from
• 4:58
  a
• 4:58
  specific
• 4:59
  phobia.
• 5:00
  And
• 5:00
  the
• 5:01
  reason
• 5:01
  you
• 5:01
  don't
• 5:01
  see
• 5:02
  it
• 5:02
  in
• 5:02
  outpatient
• 5:03
  practice,
• 5:03
  and
• 5:03
  therefore
• 5:04
  you
• 5:04
  might
• 5:04
  be
• 5:04
  caught
• 5:05
  off
• 5:05
  guard
• 5:05
  that
• 5:05
  this
• 5:06
  is
• 5:06
  the
• 5:06
  most
• 5:07
  prevalent
• 5:07
  anxiety
• 5:08
  disorder,
• 5:09
  is
• 5:09
  because
• 5:09
  people
• 5:10
  usually
• 5:10
  are
• 5:11
  really
• 5:11
  good
• 5:11
  at
• 5:12
  avoiding
• 5:12
  the
• 5:12
  stimulus
• 5:13
  that
• 5:13
  provokes
• 5:13
  the
• 5:14
  phobia.
• 5:14
  Pretty
• 5:15
  straightforward,
• 5:15
  right?
• 5:16
  If
• 5:16
  you
• 5:16
  are
• 5:18
  deathly
• 5:19
  afraid
• 5:19
  of
• 5:19
  spiders,
• 5:20
  you're
• 5:21
  probably
• 5:21
  not
• 5:22
  going
• 5:23
  to
• 5:23
  work
• 5:23
  in
• 5:24
  Australia,
• 5:25
  as
• 5:25
  in
• 5:25
  some
• 5:26
  kind
• 5:26
  of
• 5:26
  tarantula
• 5:27
  sanctuary.
• 5:27
  Right.
• 5:27
  You're
• 5:28
  going
• 5:28
  to
• 5:28
  be
• 5:28
  an
• 5:29
  insurance
• 5:29
  salesman
• 5:30
  or
• 5:30
  you're
• 5:31
  going
• 5:31
  to
• 5:31
  sell
• 5:31
  hot
• 5:31
  dogs
• 5:32
  at
• 5:32
  a
• 5:32
  baseball
• 5:33
  stadium.
• 5:33
  It's
• 5:34
  really
• 5:35
  unlikely
• 5:35
  that
• 5:36
  if
• 5:36
  you
• 5:36
  have
• 5:36
  a
• 5:36
  spider
• 5:36
  phobia,
• 5:37
  you're
• 5:38
  going
• 5:38
  to
• 5:38
  want
• 5:38
  to
• 5:38
  work
• 5:38
  in,
• 5:39
  like,
• 5:40
  the
• 5:40
  insect
• 5:41
  reptile
• 5:41
  house
• 5:41
  at
• 5:42
  the
• 5:42
  zoo,
• 5:42
  right?
• 5:42
  You're
• 5:43
  pretty
• 5:43
  good
• 5:43
  at
• 5:43
  avoiding
• 5:44
  that.
• 5:44
  Same
• 5:44
  thing
• 5:44
  goes
• 5:45
  with
• 5:45
  blood
• 5:45
  draws.
• 5:45
  People
• 5:46
  are
• 5:46
  petrified
• 5:46
  of
• 5:46
  blood.
• 5:47
  Okay.
• 5:47
  Well,
• 5:48
  they're
• 5:48
  not
• 5:48
  likely
• 5:48
  to
• 5:49
  become
• 5:49
  nurses
• 5:49
  or
• 5:50
  cardiothoracic
• 5:51
  surgeons.
• 5:52
  They're
• 5:52
  just
• 5:53
  going
• 5:53
  to
• 5:53
  build
• 5:53
  their
• 5:54
  life
• 5:54
  away
• 5:55
  from
• 5:55
  the
• 5:55
  phobia.
• 5:56
  And
• 5:56
  when
• 5:56
  they
• 5:56
  do
• 5:56
  that
• 5:56
  successfully,
• 5:57
  they
• 5:57
  don't
• 5:57
  really
• 5:57
  need
• 5:58
  to
• 5:58
  see
• 5:58
  you.
• 5:58
  I've
• 5:59
  only
• 5:59
  seen
• 5:59
  specific
• 6:00
  phobia
• 6:00
  several
• 6:01
  times
• 6:01
  in
• 6:01
  my
• 6:01
  career,
• 6:02
  and
• 6:02
  it's
• 6:02
  because
• 6:03
  that
• 6:03
  person
• 6:04
  has
• 6:04
  not
• 6:05
  been
• 6:05
  able
• 6:05
  to
• 6:05
  escape
• 6:06
  the
• 6:06
  obligations
• 6:07
  of
• 6:08
  that
• 6:08
  are
• 6:08
  involved
• 6:09
  in
• 6:09
  their
• 6:09
  phobia.
• 6:10
  Like,
• 6:10
  flyers
• 6:11
  are
• 6:11
  a
• 6:11
  good
• 6:11
  example.
• 6:12
  Right.
• 6:12
  Commercial
• 6:13
  flying
• 6:14
  is
• 6:15
  how
• 6:15
  we
• 6:15
  get
• 6:15
  around
• 6:16
  the
• 6:16
  world
• 6:16
  nowadays,
• 6:17
  more
• 6:17
  and
• 6:17
  more
• 6:17
  than.
• 6:18
  More
• 6:18
  so
• 6:18
  than
• 6:19
  ever,
• 6:19
  Right?
• 6:19
  Just
• 6:20
  that
• 6:20
  we're.
• 6:20
  The
• 6:20
  world's
• 6:21
  becoming
• 6:21
  smaller.
• 6:21
  That's
• 6:22
  how
• 6:22
  we're
• 6:22
  navigating
• 6:23
  the
• 6:23
  world.
• 6:23
  But
• 6:24
  my
• 6:24
  point
• 6:24
  is,
• 6:25
  this
• 6:25
  is
• 6:25
  global
• 6:25
  now,
• 6:26
  right?
• 6:26
  The
• 6:26
  economy's
• 6:27
  global.
• 6:27
  People
• 6:27
  are
• 6:28
  just
• 6:28
  traveling
• 6:28
  everywhere.
• 6:29
  There's
• 6:30
  Instagram
• 6:30
  influencers
• 6:31
  that
• 6:31
  are
• 6:31
  like,
• 6:32
  begging
• 6:32
  you
• 6:33
  to
• 6:33
  go
• 6:33
  to
• 6:33
  the
• 6:33
  Maldives
• 6:34
  and
• 6:35
  in
• 6:35
  every,
• 6:35
  in
• 6:36
  every
• 6:36
  doom
• 6:36
  scroll,
• 6:37
  and
• 6:37
  everything's
• 6:38
  like,
• 6:38
  totally
• 6:39
  global
• 6:39
  now.
• 6:39
  It's
• 6:40
  very
• 6:40
  rare
• 6:40
  that
• 6:41
  you
• 6:41
  see,
• 6:41
  like,
• 6:41
  an
• 6:42
  influencer
• 6:43
  trying
• 6:43
  to
• 6:43
  get
• 6:43
  you
• 6:43
  to
• 6:44
  spend
• 6:44
  your
• 6:45
  family
• 6:45
  vacation
• 6:45
  in
• 6:45
  Cleveland
• 6:46
  or
• 6:46
  New
• 6:46
  Jersey,
• 6:47
  right?
• 6:47
  It's
• 6:47
  like,
• 6:47
  hey,
• 6:48
  let's
• 6:48
  fly
• 6:48
  to
• 6:49
  Bermuda.
• 6:49
  Let's
• 6:49
  fly
• 6:49
  to
• 6:50
  Ecuador,
• 6:51
  okay?
• 6:51
  So
• 6:52
  it's
• 6:52
  harder
• 6:52
  and
• 6:52
  harder.
• 6:53
  And
• 6:53
  so
• 6:53
  you
• 6:53
  will
• 6:54
  see
• 6:55
  some
• 6:55
  people
• 6:55
  who
• 6:56
  have
• 6:56
  to
• 6:56
  go,
• 6:56
  whether
• 6:57
  their
• 6:57
  families
• 6:57
  compelling
• 6:58
  them
• 6:58
  to
• 6:58
  go
• 6:58
  on
• 6:58
  vacation
• 6:59
  abroad
• 7:00
  or
• 7:00
  they're.
• 7:00
  They
• 7:00
  do
• 7:01
  like,
• 7:01
  pharmaceutical
• 7:01
  sales
• 7:02
  and
• 7:02
  they
• 7:02
  have
• 7:02
  to
• 7:02
  give
• 7:03
  presentations
• 7:04
  across
• 7:04
  the
• 7:04
  country.
• 7:05
  But
• 7:05
  by
• 7:05
  and
• 7:06
  large,
• 7:06
  these
• 7:06
  folks
• 7:06
  are
• 7:06
  in
• 7:07
  the
• 7:07
  shadows.
• 7:07
  They're
• 7:07
  successfully
• 7:08
  avoiding
• 7:08
  their
• 7:08
  phobia,
• 7:09
  whether
• 7:09
  it's
• 7:10
  heights
• 7:10
  or
• 7:10
  flying
• 7:11
  or
• 7:11
  blood
• 7:11
  or
• 7:11
  spiders
• 7:12
  or
• 7:12
  snakes.
• 7:13
  If
• 7:13
  you
• 7:14
  don't
• 7:14
  like
• 7:14
  snakes,
• 7:14
  you
• 7:15
  know,
• 7:15
  don't.
• 7:15
  Don't
• 7:15
  live
• 7:15
  in
• 7:15
  the
• 7:16
  Southwest,
• 7:16
  right?
• 7:18
  Don't
• 7:18
  move
• 7:18
  to
• 7:18
  Australia.
• 7:19
  You
• 7:20
  might
• 7:20
  want
• 7:20
  to
• 7:20
  get
• 7:20
  like
• 7:21
  a,
• 7:21
  an
• 7:22
  apartment
• 7:22
  in
• 7:22
  Brooklyn.
• 7:23
  And
• 7:23
  those
• 7:23
  people
• 7:24
  are
• 7:26
  successfully
• 7:26
  evading
• 7:27
  your
• 7:28
  practice.
• 7:28
  And
• 7:29
  therefore,
• 7:30
  that's
• 7:30
  kind
• 7:30
  of
• 7:30
  their
• 7:30
  form
• 7:31
  of
• 7:31
  treatment.
• 7:31
  Although
• 7:31
  it's
• 7:32
  not
• 7:32
  treatment,
• 7:32
  of
• 7:32
  course,
• 7:33
  because
• 7:33
  you're
• 7:33
  reinforcing
• 7:34
  the
• 7:34
  phobia,
• 7:35
  because
• 7:35
  your
• 7:36
  brain
• 7:36
  kind
• 7:36
  of
• 7:36
  registers
• 7:37
  the
• 7:37
  fact
• 7:37
  that
• 7:38
  mistakenly,
• 7:39
  so
• 7:39
  that
• 7:39
  you're
• 7:39
  safe
• 7:40
  because
• 7:41
  of
• 7:41
  the
• 7:41
  fact
• 7:41
  that
• 7:42
  you
• 7:42
  avoided
• 7:42
  the
• 7:42
  spider,
• 7:43
  which
• 7:43
  of
• 7:43
  course
• 7:43
  is
• 7:44
  partially
• 7:44
  true.
• 7:45
  It
• 7:45
  is
• 7:46
  also
• 7:46
  very
• 7:46
  damaging
• 7:47
  because
• 7:47
  every
• 7:47
  time
• 7:47
  you
• 7:48
  avoid
• 7:48
  that
• 7:48
  thing,
• 7:49
  it
• 7:49
  reinforces
• 7:50
  the
• 7:50
  fact
• 7:51
  that
• 7:51
  the
• 7:51
  only
• 7:51
  reason
• 7:51
  you're
• 7:52
  safe
• 7:52
  is
• 7:52
  because
• 7:52
  you
• 7:52
  avoided
• 7:53
  it.
• 7:53
  Well,
• 7:53
  that's
• 7:53
  not
• 7:53
  true
• 7:54
  with
• 7:54
  flying.
• 7:54
  Right,
• 7:55
  because
• 7:56
  you
• 7:56
  could
• 7:56
  have
• 7:56
  flown
• 7:57
  that
• 7:57
  plane
• 7:57
  and
• 7:57
  you
• 7:57
  would
• 7:58
  have
• 7:58
  been
• 7:58
  safe
• 7:58
  and
• 7:58
  you
• 7:58
  could
• 7:59
  have
• 7:59
  gotten
• 7:59
  to
• 7:59
  your
• 7:59
  destination
• 8:00
  and
• 8:00
  had
• 8:00
  a
• 8:00
  great
• 8:00
  vacation
• 8:01
  with
• 8:01
  your
• 8:01
  family.
• 8:02
  The
• 8:02
  reason
• 8:02
  you're
• 8:02
  safe
• 8:03
  from
• 8:03
  flying
• 8:04
  isn't
• 8:04
  necessarily
• 8:05
  because
• 8:05
  you
• 8:06
  stayed
• 8:06
  at
• 8:06
  home.
• 8:07
  Sure,
• 8:07
  in
• 8:07
  a,
• 8:07
  in
• 8:07
  a
• 8:08
  sense,
• 8:08
  in
• 8:08
  a
• 8:08
  literal
• 8:08
  sense,
• 8:09
  that
• 8:09
  might
• 8:09
  be
• 8:09
  true.
• 8:10
  But
• 8:10
  you're
• 8:10
  also
• 8:10
  safe
• 8:11
  from
• 8:11
  flying
• 8:11
  because
• 8:12
  flying
• 8:12
  is
• 8:12
  one
• 8:12
  of
• 8:12
  the
• 8:12
  most
• 8:13
  safest
• 8:14
  forms
• 8:14
  of
• 8:14
  travel
• 8:15
  imaginable.
• 8:15
  It
• 8:15
  has
• 8:16
  FAA
• 8:16
  regulations
• 8:17
  built
• 8:17
  in
• 8:18
  safety
• 8:18
  measures.
• 8:19
  It's.
• 8:20
  So
• 8:20
  exposure
• 8:21
  therapy
• 8:21
  is
• 8:22
  really
• 8:22
  the
• 8:22
  gold
• 8:22
  standard
• 8:23
  here.
• 8:23
  And
• 8:23
  so
• 8:23
  the
• 8:24
  treatment
• 8:24
  for
• 8:24
  these
• 8:24
  specific
• 8:25
  phobias,
• 8:25
  my
• 8:25
  friends,
• 8:26
  is
• 8:26
  not
• 8:27
  SSRIs.
• 8:27
  There
• 8:27
  is
• 8:28
  no
• 8:28
  FDA
• 8:28
  approved
• 8:28
  medication
• 8:30
  for
• 8:30
  specific
• 8:30
  phobias.
• 8:31
  Unlike
• 8:31
  GAD,
• 8:32
  social
• 8:32
  anxiety
• 8:33
  or
• 8:33
  panic,
• 8:34
  where
• 8:34
  SSRIs
• 8:34
  and
• 8:35
  SNRIs
• 8:35
  are
• 8:35
  first
• 8:36
  line
• 8:36
  pharmacotherapy
• 8:37
  is
• 8:37
  not
• 8:38
  a
• 8:38
  standard
• 8:38
  treatment
• 8:38
  for
• 8:39
  these
• 8:39
  isolated
• 8:39
  specific
• 8:40
  phobia.
• 8:41
  Okay,
• 8:42
  so
• 8:42
  giving
• 8:43
  them
• 8:43
  sertraline
• 8:43
  is
• 8:44
  not
• 8:44
  the
• 8:44
  answer
• 8:44
  here.
• 8:45
  Unless
• 8:45
  they
• 8:45
  have
• 8:45
  comorbid
• 8:46
  conditions
• 8:47
  that
• 8:47
  are
• 8:47
  layered
• 8:48
  onto
• 8:48
  this.
• 8:48
  That's
• 8:48
  a
• 8:48
  different
• 8:49
  story.
• 8:50
  The
• 8:50
  deal
• 8:50
  here
• 8:50
  is
• 8:51
  probably
• 8:51
  exposure
• 8:52
  therapy.
• 8:53
  And
• 8:53
  it's
• 8:54
  interesting
• 8:54
  because
• 8:54
  the
• 8:54
  prevalence
• 8:55
  of
• 8:56
  specific
• 8:56
  phobias,
• 8:57
  again,
• 8:57
  approximations
• 8:58
  based
• 8:59
  on
• 8:59
  the
• 8:59
  evidence,
• 8:59
  is
• 8:59
  like
• 9:00
  double
• 9:01
  of
• 9:01
  what
• 9:01
  generalized
• 9:02
  Anxiety
• 9:02
  Disorder
• 9:03
  is.
• 9:03
  I
• 9:03
  mean,
• 9:03
  this
• 9:03
  is
• 9:03
  way
• 9:04
  more
• 9:04
  prevalent
• 9:04
  than
• 9:04
  GAD
• 9:05
  or
• 9:05
  panic
• 9:06
  disorder
• 9:06
  or
• 9:07
  separation
• 9:07
  anxiety
• 9:08
  disorder.
• 9:08
  All
• 9:08
  real
• 9:09
  problems,
• 9:10
  but
• 9:10
  it
• 9:10
  is
• 9:10
  the
• 9:10
  most
• 9:10
  common.
• 9:11
  It
• 9:11
  has
• 9:11
  the
• 9:11
  earliest
• 9:12
  onset
• 9:13
  specific
• 9:13
  phobia,
• 9:14
  and
• 9:14
  it's
• 9:14
  also
• 9:14
  the
• 9:15
  most
• 9:15
  treatable.
• 9:16
  There
• 9:16
  are.
• 9:17
  There's
• 9:18
  very
• 9:18
  good
• 9:18
  evidence
• 9:18
  that
• 9:19
  even
• 9:19
  one
• 9:19
  session
• 9:20
  treatments,
• 9:21
  OSTs,
• 9:22
  can
• 9:23
  virtually
• 9:24
  extinguish
• 9:24
  the
• 9:24
  phobia
• 9:25
  in
• 9:25
  one
• 9:25
  session.
• 9:26
  And
• 9:26
  so
• 9:26
  it's
• 9:27
  one
• 9:27
  of
• 9:27
  the
• 9:27
  most
• 9:27
  effectively
• 9:29
  treated
• 9:32
  disorders
• 9:32
  in
• 9:32
  the
• 9:32
  entire
• 9:33
  DSM
• 9:33
  5.
• 9:34
  Right.
• 9:34
  And
• 9:35
  yet
• 9:35
  it's
• 9:35
  the
• 9:35
  one
• 9:35
  that
• 9:36
  people
• 9:38
  are
• 9:38
  radically
• 9:39
  untreated
• 9:39
  with
• 9:39
  because
• 9:40
  they
• 9:40
  don't
• 9:40
  come
• 9:40
  at
• 9:40
  all
• 9:41
  to
• 9:41
  your
• 9:41
  clinic.
• 9:42
  And
• 9:42
  it's
• 9:42
  one
• 9:43
  of
• 9:43
  the
• 9:43
  only
• 9:43
  anxiety
• 9:44
  disorders
• 9:44
  where
• 9:44
  it
• 9:45
  doesn't
• 9:45
  have
• 9:45
  a
• 9:45
  first
• 9:45
  line
• 9:46
  treatment
• 9:46
  that
• 9:47
  the
• 9:47
  form
• 9:47
  of
• 9:47
  pharmacotherapy.
• 9:48
  So
• 9:48
  it's
• 9:48
  this
• 9:48
  unicorn
• 9:49
  in
• 9:49
  the
• 9:49
  DSM
• 9:50
  5,
• 9:50
  and
• 9:51
  yet
• 9:51
  it's
• 9:52
  really
• 9:52
  problematic
• 9:53
  for
• 9:53
  people
• 9:54
  who
• 9:54
  suffer
• 9:54
  from
• 9:55
  this.
• 9:56
  Especially,
• 9:56
  you
• 9:56
  know,
• 9:56
  again,
• 9:57
  if
• 9:57
  you're
• 9:57
  an
• 9:57
  anxious
• 9:58
  flyer,
• 9:58
  that
• 9:59
  can
• 9:59
  really
• 9:59
  interfere
• 10:00
  with
• 10:00
  your
• 10:00
  quality
• 10:00
  of
• 10:00
  life.
• 10:01
  You
• 10:01
  know,
• 10:01
  if
• 10:01
  you're
• 10:01
  just
• 10:02
  afraid
• 10:02
  of
• 10:03
  spiders
• 10:03
  or
• 10:04
  a
• 10:04
  certain
• 10:04
  breed
• 10:04
  of
• 10:05
  giraffe,
• 10:06
  we
• 10:06
  can
• 10:07
  work
• 10:07
  with
• 10:07
  that.
• 10:07
  Right.
• 10:08
  I
• 10:08
  don't,
• 10:08
  I
• 10:08
  don't
• 10:08
  know
• 10:08
  if
• 10:08
  I
• 10:09
  would
• 10:09
  intentionally
• 10:09
  expose
• 10:10
  somebody
• 10:10
  to
• 10:11
  like
• 10:12
  a
• 10:12
  specific
• 10:12
  breed
• 10:13
  of
• 10:13
  giraffe
• 10:15
  and,
• 10:15
  you
• 10:16
  know,
• 10:16
  have
• 10:16
  the
• 10:16
  therapist
• 10:17
  walk
• 10:17
  the
• 10:17
  patient
• 10:18
  to
• 10:18
  the
• 10:18
  zoo
• 10:19
  and
• 10:19
  go
• 10:19
  into
• 10:19
  the
• 10:20
  giraffe
• 10:20
  enclosure.
• 10:20
  I
• 10:21
  think
• 10:21
  that's
• 10:21
  like
• 10:22
  a
• 10:22
  form
• 10:22
  of
• 10:22
  torture.
• 10:23
  It's
• 10:23
  unnecessary.
• 10:24
  I
• 10:24
  think
• 10:24
  a.
• 10:24
  I
• 10:25
  think
• 10:25
  a
• 10:25
  patient
• 10:25
  can
• 10:25
  build
• 10:26
  a
• 10:26
  perfectly
• 10:26
  happy
• 10:27
  life
• 10:27
  in
• 10:27
  the
• 10:28
  absence
• 10:28
  of
• 10:28
  that
• 10:29
  breed
• 10:29
  of
• 10:29
  giraffe.
• 10:30
  And.
• 10:30
  And
• 10:31
  it's.
• 10:31
  It's
• 10:31
  not
• 10:31
  really
• 10:31
  a
• 10:31
  deal
• 10:32
  breaker.
• 10:32
  It's
• 10:32
  not
• 10:32
  going
• 10:33
  to
• 10:33
  stop
• 10:33
  him
• 10:33
  from
• 10:33
  getting
• 10:34
  married
• 10:34
  or
• 10:34
  having
• 10:35
  kids.
• 10:35
  Maybe
• 10:36
  if
• 10:36
  he
• 10:36
  has
• 10:36
  to
• 10:36
  take
• 10:37
  his
• 10:37
  kids
• 10:37
  to
• 10:37
  the
• 10:37
  zoo,
• 10:38
  he's
• 10:38
  going
• 10:38
  to
• 10:38
  have
• 10:38
  to,
• 10:39
  like,
• 10:39
  visit
• 10:39
  the
• 10:39
  rhinos
• 10:40
  instead,
• 10:40
  or
• 10:40
  the
• 10:40
  monkeys
• 10:41
  or
• 10:41
  the.
• 10:42
  Or
• 10:42
  the
• 10:43
  snakes
• 10:43
  or
• 10:44
  the
• 10:44
  penguins.
• 10:44
  That's.
• 10:45
  I've
• 10:45
  never
• 10:45
  been
• 10:46
  a
• 10:46
  fan.
• 10:46
  They
• 10:46
  usually
• 10:47
  aren't
• 10:47
  out
• 10:48
  and
• 10:48
  about.
• 10:48
  I'm
• 10:49
  actually
• 10:49
  not
• 10:49
  convinced
• 10:50
  that
• 10:50
  penguins
• 10:51
  even
• 10:51
  exist.
• 10:51
  I
• 10:52
  know
• 10:52
  they
• 10:52
  exist.
• 10:53
  That's
• 10:54
  not
• 10:54
  at
• 10:54
  all
• 10:54
  what
• 10:54
  I'm
• 10:54
  trying
• 10:55
  to
• 10:55
  say.
• 10:55
  What
• 10:55
  I
• 10:55
  mean
• 10:56
  is,
• 10:57
  I
• 10:57
  have
• 10:57
  never
• 10:58
  actually
• 10:58
  seen
• 10:58
  a
• 10:58
  penguin
• 10:59
  in
• 10:59
  any
• 10:59
  of
• 10:59
  the
• 10:59
  zoos
• 11:00
  I've
• 11:00
  been
• 11:00
  to
• 11:01
  that
• 11:02
  go
• 11:02
  out
• 11:03
  of
• 11:03
  their
• 11:03
  way
• 11:03
  to
• 11:03
  advertise
• 11:04
  that
• 11:04
  they
• 11:04
  have
• 11:04
  penguins.
• 11:05
  By
• 11:05
  the
• 11:05
  time
• 11:05
  you
• 11:05
  get
• 11:05
  there,
• 11:05
  it's
• 11:06
  like
• 11:06
  a
• 11:06
  sheet
• 11:06
  of
• 11:06
  melting
• 11:07
  ice.
• 11:08
  It
• 11:08
  kind
• 11:08
  of
• 11:08
  smells
• 11:08
  like
• 11:08
  poop.
• 11:09
  And
• 11:09
  there's
• 11:10
  never
• 11:10
  one
• 11:10
  penguin
• 11:11
  anywhere.
• 11:12
  It's
• 11:12
  just
• 11:12
  a
• 11:12
  bunch
• 11:13
  of
• 11:14
  sixth
• 11:14
  graders
• 11:15
  with
• 11:15
  their
• 11:15
  faces
• 11:16
  smushed
• 11:16
  against
• 11:16
  the
• 11:17
  glass,
• 11:18
  yelling,
• 11:19
  and.
• 11:19
  And
• 11:19
  then
• 11:19
  I
• 11:20
  go
• 11:20
  home.
• 11:20
  And
• 11:20
  that's
• 11:21
  really
• 11:21
  it.
• 11:21
  And
• 11:21
  I've
• 11:21
  been
• 11:21
  to
• 11:22
  a
• 11:22
  thousand
• 11:22
  zoos.
• 11:23
  So
• 11:23
  my
• 11:23
  point
• 11:24
  is,
• 11:24
  you
• 11:24
  know,
• 11:25
  this
• 11:25
  is
• 11:25
  not
• 11:25
  something
• 11:25
  you
• 11:26
  need
• 11:26
  to
• 11:26
  treat
• 11:26
  necessarily,
• 11:27
  unless
• 11:27
  it's
• 11:28
  really
• 11:28
  an
• 11:28
  obstacle
• 11:29
  in
• 11:29
  your
• 11:29
  patient's
• 11:29
  life.
• 11:30
  But
• 11:30
  it's
• 11:30
  good
• 11:30
  to
• 11:31
  know
• 11:31
  that
• 11:31
  exposure
• 11:32
  therapy
• 11:32
  is
• 11:32
  probably
• 11:33
  the
• 11:33
  way
• 11:33
  to
• 11:33
  do
• 11:33
  it,
• 11:33
  that
• 11:34
  it
• 11:34
  can
• 11:34
  be
• 11:34
  done
• 11:34
  very
• 11:35
  quickly,
• 11:36
  it
• 11:36
  does
• 11:36
  not
• 11:36
  need
• 11:36
  pharmacotherapy.
• 11:37
  And
• 11:38
  it's
• 11:38
  also
• 11:38
  good
• 11:39
  to
• 11:39
  try
• 11:39
  and
• 11:39
  reduce
• 11:40
  your
• 11:40
  patient's
• 11:40
  shame.
• 11:41
  You
• 11:41
  don't.
• 11:41
  You
• 11:41
  don't
• 11:41
  want
• 11:41
  the
• 11:41
  patient
• 11:42
  to
• 11:42
  just
• 11:42
  automatically
• 11:43
  assume
• 11:43
  they're
• 11:44
  broken
• 11:44
  or
• 11:45
  something's
• 11:45
  wrong
• 11:45
  with
• 11:45
  them
• 11:46
  because
• 11:46
  they're
• 11:46
  afraid
• 11:46
  of
• 11:46
  snakes.
• 11:47
  You
• 11:47
  should
• 11:47
  remind
• 11:48
  them
• 11:48
  that
• 11:48
  there's
• 11:48
  very
• 11:49
  good
• 11:49
  evidence
• 11:50
  that
• 11:50
  has
• 11:50
  been
• 11:50
  discussed
• 11:51
  in
• 11:51
  psychology
• 11:52
  literature
• 11:53
  for
• 11:53
  decades
• 11:54
  that
• 11:54
  we
• 11:54
  actually
• 11:55
  have
• 11:55
  innate
• 11:55
  evolutionary
• 11:56
  wiring
• 11:57
  that
• 11:57
  prepares
• 11:58
  us
• 11:58
  to
• 11:59
  be
• 12:00
  fearful
• 12:00
  of
• 12:00
  very
• 12:00
  specific
• 12:01
  stimuli
• 12:02
  such
• 12:02
  as
• 12:03
  snakes,
• 12:03
  spiders,
• 12:04
  heights,
• 12:05
  and
• 12:05
  enclosed
• 12:05
  spaces.
• 12:06
  And
• 12:06
  it's
• 12:06
  odd
• 12:07
  because
• 12:07
  cars
• 12:07
  and
• 12:08
  electrical
• 12:08
  outlets
• 12:09
  and
• 12:09
  guns
• 12:10
  are
• 12:10
  statistically
• 12:11
  much
• 12:11
  more
• 12:11
  likely
• 12:11
  to
• 12:12
  kill
• 12:12
  us.
• 13:07
  And
• 13:07
  yet
• 13:07
  we
• 13:08
  have
• 13:08
  these
• 13:08
  phobias
• 13:09
  of
• 13:09
  things
• 13:09
  that,
• 13:09
  oddly
• 13:10
  enough,
• 13:11
  are
• 13:11
  from,
• 13:11
  like,
• 13:11
  millions
• 13:12
  of
• 13:12
  years
• 13:12
  ago
• 13:13
  that
• 13:13
  they
• 13:13
  actually
• 13:14
  did
• 13:14
  kill
• 13:14
  us
• 13:14
  and
• 13:14
  the
• 13:15
  things
• 13:15
  that
• 13:15
  are
• 13:15
  actually
• 13:15
  killing
• 13:16
  us
• 13:16
  now.
• 13:16
  It's
• 13:17
  very
• 13:17
  rare
• 13:17
  to
• 13:18
  find
• 13:18
  somebody
• 13:19
  who
• 13:19
  has
• 13:19
  a
• 13:19
  phobia
• 13:19
  to
• 13:20
  cars.
• 13:20
  I
• 13:21
  don't
• 13:21
  even
• 13:21
  know
• 13:21
  what,
• 13:21
  like,
• 13:21
  the
• 13:22
  Latin
• 13:22
  term
• 13:22
  for
• 13:23
  that
• 13:23
  would
• 13:23
  be.
• 13:23
  You
• 13:23
  know,
• 13:23
  with
• 13:23
  spiders,
• 13:24
  it's
• 13:24
  like
• 13:24
  arachnophobia
• 13:26
  I
• 13:26
  don't
• 13:26
  know
• 13:26
  what
• 13:26
  the,
• 13:27
  what
• 13:28
  the
• 13:28
  equivalent
• 13:29
  would
• 13:29
  be
• 13:29
  for
• 13:29
  a
• 13:29
  car.
• 13:29
  I
• 13:29
  don't
• 13:29
  think,
• 13:30
  I
• 13:30
  don't
• 13:30
  even
• 13:30
  think
• 13:30
  there's
• 13:30
  like
• 13:30
  nomenclature
• 13:32
  for
• 13:32
  that.
• 13:33
  To
• 13:33
  me,
• 13:33
  that's
• 13:33
  a
• 13:33
  pretty
• 13:34
  striking
• 13:34
  idea,
• 13:34
  right?
• 13:35
  That
• 13:35
  makes
• 13:35
  a
• 13:35
  lot
• 13:35
  of
• 13:35
  intuitive
• 13:36
  sense.
• 13:36
  And
• 13:36
  you
• 13:36
  can
• 13:36
  just
• 13:36
  say,
• 13:36
  hey,
• 13:37
  look,
• 13:37
  this
• 13:37
  was
• 13:37
  very
• 13:38
  protective
• 13:38
  for
• 13:38
  a
• 13:38
  long
• 13:39
  time,
• 13:39
  2
• 13:39
  million
• 13:39
  years
• 13:40
  ago.
• 13:40
  And
• 13:41
  it
• 13:41
  is
• 13:41
  not
• 13:41
  your
• 13:41
  fault
• 13:42
  that
• 13:42
  you
• 13:43
  are
• 13:43
  still
• 13:43
  reacting
• 13:44
  to
• 13:44
  things
• 13:44
  that
• 13:44
  did
• 13:45
  harm
• 13:45
  the
• 13:46
  human
• 13:46
  race
• 13:47
  2
• 13:47
  million
• 13:47
  years
• 13:47
  ago.
• 13:48
  And
• 13:48
  I'm
• 13:49
  sorry
• 13:50
  that
• 13:50
  we
• 13:50
  are
• 13:50
  speaking
• 13:51
  in
• 13:51
  the
• 13:51
  year
• 13:52
  2026
• 13:52
  together,
• 13:53
  and
• 13:54
  I
• 13:54
  wish
• 13:54
  we
• 13:55
  were
• 13:55
  cavemen
• 13:56
  right
• 13:56
  now
• 13:56
  so
• 13:57
  I
• 13:57
  could
• 13:57
  tell
• 13:57
  you
• 13:57
  that
• 13:58
  you
• 13:58
  have
• 13:58
  a
• 13:58
  superpower
• 13:59
  because
• 13:59
  being
• 14:00
  afraid
• 14:00
  of
• 14:00
  snakes
• 14:00
  is
• 14:01
  a
• 14:01
  virtue,
• 14:02
  but
• 14:02
  now
• 14:02
  it
• 14:02
  is
• 14:03
  a
• 14:03
  burden.
• 14:04
  And,
• 14:04
  and
• 14:04
  so
• 14:05
  that
• 14:05
  kind
• 14:05
  of
• 14:06
  conversation,
• 14:06
  right,
• 14:06
  it's
• 14:07
  just
• 14:07
  like,
• 14:07
  lighten
• 14:08
  it
• 14:08
  up.
• 14:08
  It's
• 14:08
  not
• 14:08
  their
• 14:08
  fault.
• 14:09
  Don't
• 14:09
  let
• 14:09
  them
• 14:09
  get
• 14:09
  guilty
• 14:10
  or
• 14:10
  beat
• 14:11
  themselves
• 14:11
  up.
• 14:11
  Because
• 14:12
  especially
• 14:12
  with
• 14:12
  flying,
• 14:13
  it
• 14:13
  can
• 14:13
  be
• 14:14
  pretty
• 14:14
  crushing,
• 14:14
  right,
• 14:15
  to,
• 14:15
  to
• 14:15
  be
• 14:15
  the
• 14:16
  person
• 14:16
  that,
• 14:17
  you
• 14:17
  know,
• 14:18
  has
• 14:18
  to
• 14:18
  warn
• 14:18
  the
• 14:18
  flight
• 14:19
  attendants
• 14:19
  that
• 14:19
  they're
• 14:19
  anxious
• 14:20
  and
• 14:20
  maybe,
• 14:20
  you
• 14:21
  know,
• 14:21
  have
• 14:21
  to
• 14:21
  have
• 14:21
  the
• 14:21
  agony
• 14:22
  of
• 14:22
  worrying
• 14:22
  whether
• 14:22
  you,
• 14:23
  they
• 14:23
  need
• 14:23
  to
• 14:23
  turn
• 14:23
  the
• 14:24
  plane
• 14:24
  around
• 14:24
  for
• 14:24
  you
• 14:24
  and
• 14:25
  you
• 14:25
  have
• 14:25
  a
• 14:25
  panic
• 14:25
  attack
• 14:25
  in
• 14:26
  front
• 14:26
  of
• 14:26
  200
• 14:27
  passengers.
• 14:27
  I've
• 14:28
  had
• 14:28
  patients
• 14:28
  who
• 14:29
  are
• 14:29
  very
• 14:29
  self
• 14:30
  conscious,
• 14:30
  understandably
• 14:31
  so,
• 14:31
  about
• 14:31
  having
• 14:31
  panic
• 14:32
  attacks
• 14:32
  in
• 14:32
  front
• 14:32
  of
• 14:33
  their,
• 14:34
  their
• 14:34
  kids.
• 14:34
  And,
• 14:35
  you
• 14:35
  know,
• 14:35
  it's
• 14:35
  really
• 14:35
  actually
• 14:36
  very
• 14:36
  harmful
• 14:37
  and
• 14:37
  very
• 14:37
  destructive.
• 14:38
  So
• 14:38
  we
• 14:38
  need
• 14:38
  to
• 14:38
  offer
• 14:39
  the
• 14:39
  first
• 14:39
  line
• 14:39
  treatment,
• 14:40
  which
• 14:40
  again
• 14:40
  is
• 14:40
  exposure
• 14:41
  therapy,
• 14:41
  not
• 14:41
  pharmacotherapy.
• 14:43
  And
• 14:43
  we
• 14:43
  need
• 14:43
  to
• 14:43
  have
• 14:43
  compassion,
• 14:44
  put
• 14:44
  this
• 14:45
  in
• 14:45
  context,
• 14:46
  Let
• 14:46
  them
• 14:46
  know
• 14:46
  that,
• 14:46
  you
• 14:47
  know,
• 14:47
  whether
• 14:47
  it's
• 14:47
  evolution
• 14:48
  or
• 14:49
  you,
• 14:49
  maybe
• 14:49
  you
• 14:49
  were
• 14:49
  conditioned
• 14:50
  to
• 14:50
  be
• 14:50
  afraid
• 14:51
  of
• 14:51
  this
• 14:51
  without
• 14:51
  your
• 14:52
  knowledge
• 14:52
  as
• 14:52
  a
• 14:52
  child.
• 14:53
  Right.
• 14:53
  You
• 14:54
  might
• 14:54
  have
• 14:54
  had
• 14:54
  a
• 14:54
  traumatic
• 14:55
  encounter
• 14:55
  at
• 14:56
  a
• 14:56
  young
• 14:56
  age
• 14:56
  that
• 14:56
  you
• 14:56
  don't
• 14:57
  even
• 14:57
  remember
• 14:57
  when
• 14:58
  you
• 14:58
  were
• 14:58
  bit
• 14:58
  by
• 14:58
  a
• 14:58
  snake
• 14:59
  or
• 14:59
  you
• 15:00
  saw
• 15:00
  your
• 15:00
  brother
• 15:01
  jump.
• 15:01
  That's,
• 15:02
  that
• 15:02
  would
• 15:02
  be
• 15:02
  like
• 15:02
  vicarious
• 15:03
  learning.
• 15:03
  That's
• 15:03
  another
• 15:04
  way
• 15:04
  we
• 15:04
  can,
• 15:04
  we
• 15:05
  can,
• 15:05
  we
• 15:05
  can
• 15:05
  get
• 15:06
  a
• 15:06
  phobia.
• 15:06
  Develop
• 15:07
  a
• 15:07
  phobia
• 15:07
  is
• 15:08
  vicarious
• 15:08
  learning.
• 15:09
  So
• 15:09
  you
• 15:09
  observed
• 15:09
  your
• 15:09
  brother
• 15:10
  or
• 15:10
  neighbor
• 15:10
  jump
• 15:11
  away
• 15:11
  from
• 15:11
  a
• 15:11
  snake
• 15:11
  who
• 15:11
  almost
• 15:12
  got
• 15:12
  bit.
• 15:12
  Or
• 15:12
  maybe
• 15:12
  you
• 15:13
  watched
• 15:13
  your
• 15:13
  neighbor
• 15:14
  get
• 15:14
  bit
• 15:14
  by
• 15:14
  a
• 15:14
  snake
• 15:15
  and
• 15:15
  he
• 15:15
  was
• 15:15
  wheeled
• 15:15
  into
• 15:15
  an
• 15:16
  ambulance.
• 15:16
  Right?
• 15:16
  So
• 15:16
  that's
• 15:16
  a
• 15:16
  vicarious
• 15:17
  learning
• 15:18
  by
• 15:18
  which
• 15:18
  we
• 15:19
  can
• 15:19
  acquire
• 15:19
  trauma.
• 15:20
  And
• 15:20
  then
• 15:20
  there's,
• 15:21
  of
• 15:21
  course,
• 15:21
  like
• 15:22
  having
• 15:22
  a
• 15:22
  panic
• 15:22
  attack
• 15:23
  at
• 15:23
  a
• 15:23
  younger
• 15:23
  age
• 15:23
  or
• 15:24
  surge
• 15:24
  of
• 15:24
  anxiety
• 15:25
  in
• 15:25
  the
• 15:25
  context
• 15:26
  of,
• 15:27
  you
• 15:27
  know,
• 15:27
  being
• 15:27
  on
• 15:27
  the
• 15:28
  subway.
• 15:28
  Let's
• 15:28
  say
• 15:28
  now
• 15:29
  we
• 15:29
  develop
• 15:29
  a
• 15:29
  fear
• 15:29
  of
• 15:29
  the
• 15:30
  subway.
• 15:30
  It's
• 15:30
  not
• 15:30
  really
• 15:30
  the
• 15:30
  subway
• 15:31
  itself.
• 15:31
  It
• 15:31
  wasn't
• 15:31
  a
• 15:32
  subway
• 15:32
  accident,
• 15:33
  but
• 15:33
  a
• 15:33
  physiological
• 15:34
  state
• 15:34
  that
• 15:34
  occurred
• 15:35
  that
• 15:35
  was
• 15:35
  terrifying
• 15:36
  in
• 15:36
  the
• 15:36
  context
• 15:36
  of
• 15:37
  a
• 15:37
  subway
• 15:37
  or
• 15:38
  our
• 15:38
  parents
• 15:38
  just
• 15:38
  told
• 15:39
  us,
• 15:39
  hey,
• 15:40
  don't
• 15:40
  go
• 15:40
  into
• 15:40
  caves.
• 15:41
  There
• 15:42
  are
• 15:42
  elephants
• 15:43
  inside
• 15:43
  of
• 15:44
  caves
• 15:44
  that
• 15:44
  have
• 15:44
  Ebola.
• 15:45
  And
• 15:46
  if
• 15:46
  they
• 15:46
  charge
• 15:47
  you
• 15:47
  and
• 15:47
  bite
• 15:48
  you,
• 15:48
  you
• 15:48
  will
• 15:48
  get
• 15:48
  Ebola.
• 15:49
  And
• 15:49
  so
• 15:49
  somebody's
• 15:50
  afraid
• 15:50
  of
• 15:50
  caves.
• 15:51
  There
• 15:52
  actually
• 15:52
  are,
• 15:52
  I
• 15:53
  think
• 15:53
  elephant
• 15:53
  caves
• 15:54
  in
• 15:54
  West
• 15:54
  Africa
• 15:55
  that
• 15:55
  where
• 15:56
  Ebola
• 15:56
  comes
• 15:57
  from.
• 15:57
  So
• 15:57
  it's
• 15:57
  that.
• 15:57
  I
• 15:57
  didn't
• 15:58
  make
• 15:58
  that
• 15:58
  up.
• 15:59
  But
• 16:00
  if
• 16:00
  your
• 16:00
  parents
• 16:00
  teach
• 16:01
  you
• 16:01
  over
• 16:01
  and
• 16:01
  over
• 16:01
  and
• 16:02
  your
• 16:02
  brain
• 16:02
  is
• 16:02
  super
• 16:02
  impressionable
• 16:03
  and
• 16:03
  your
• 16:03
  parents
• 16:04
  are
• 16:04
  your
• 16:04
  protectors
• 16:05
  that
• 16:05
  something
• 16:05
  is
• 16:06
  dangerous,
• 16:06
  you
• 16:06
  can
• 16:07
  have
• 16:07
  what's
• 16:08
  called
• 16:08
  informational
• 16:09
  transmission
• 16:09
  and
• 16:09
  potentially
• 16:10
  develop
• 16:10
  a
• 16:11
  phobia.
• 16:11
  From
• 16:11
  now,
• 16:11
  if
• 16:11
  your
• 16:12
  patients
• 16:12
  are
• 16:12
  ascribing
• 16:13
  otherwise
• 16:14
  kind
• 16:14
  of
• 16:14
  neutral
• 16:15
  objects
• 16:16
  as
• 16:16
  threatening
• 16:17
  like
• 16:17
  a
• 16:17
  cave
• 16:18
  or
• 16:19
  a
• 16:19
  pencil,
• 16:20
  and
• 16:21
  and
• 16:21
  they
• 16:21
  use
• 16:22
  threat
• 16:23
  frightening
• 16:23
  language
• 16:24
  or
• 16:25
  language
• 16:25
  that
• 16:25
  isn't
• 16:25
  really
• 16:26
  neutral,
• 16:26
  but
• 16:26
  it's
• 16:26
  kind
• 16:27
  of
• 16:27
  tinged
• 16:27
  with
• 16:27
  fear
• 16:28
  or
• 16:28
  catastrophic
• 16:29
  worry,
• 16:29
  then
• 16:29
  that
• 16:29
  can
• 16:30
  be
• 16:30
  imprinted
• 16:30
  in
• 16:30
  you.
• 16:31
  I
• 16:32
  hope
• 16:32
  this,
• 16:32
  I
• 16:32
  hope
• 16:33
  you
• 16:33
  got
• 16:33
  something
• 16:33
  out
• 16:33
  of
• 16:33
  this
• 16:34
  for
• 16:34
  sure.
• 16:35
  And
• 16:36
  I
• 16:36
  thought
• 16:36
  it
• 16:36
  was
• 16:36
  fascinating.
• 16:37
  I
• 16:37
  think
• 16:37
  it's
• 16:37
  pretty
• 16:38
  high
• 16:38
  yield
• 16:38
  as
• 16:38
  well.
• 16:39
  To
• 16:39
  put
• 16:40
  into
• 16:40
  context
• 16:40
  that
• 16:41
  not
• 16:41
  all
• 16:41
  of
• 16:41
  the
• 16:41
  patients
• 16:41
  who
• 16:42
  are
• 16:42
  suffering
• 16:42
  are
• 16:43
  going
• 16:43
  to
• 16:43
  come
• 16:43
  see
• 16:44
  you
• 16:44
  in
• 16:44
  the
• 16:44
  office.
• 16:45
  Special
• 16:45
  shout
• 16:45
  out
• 16:46
  to
• 16:46
  personality
• 16:46
  disorders.
• 16:47
  They
• 16:47
  don't
• 16:47
  show
• 16:47
  up
• 16:48
  in
• 16:48
  your
• 16:48
  office
• 16:48
  as
• 16:48
  often.
• 16:49
  Like
• 16:49
  narcissistic.
• 16:51
  Right.
• 16:51
  Antisocial.
• 16:52
  They
• 16:52
  might
• 16:53
  come
• 16:53
  incidentally
• 16:54
  schizotypal
• 16:55
  for
• 16:56
  other
• 16:56
  reasons.
• 16:57
  But
• 16:57
  a
• 16:57
  lot
• 16:57
  of
• 16:57
  folks
• 16:58
  who
• 16:58
  are
• 16:58
  suffering
• 16:58
  are
• 16:58
  not
• 16:59
  even
• 16:59
  going
• 16:59
  to
• 16:59
  see
• 16:59
  you
• 17:00
  because
• 17:00
  of
• 17:01
  the
• 17:02
  quality
• 17:02
  of
• 17:02
  those
• 17:03
  syndromes
• 17:04
  that's
• 17:04
  kind
• 17:04
  of
• 17:04
  built
• 17:04
  into
• 17:05
  them.
• 17:05
  In
• 17:05
  this
• 17:05
  case,
• 17:05
  it's
• 17:05
  avoidance.
• 17:06
  And
• 17:07
  so
• 17:07
  we
• 17:07
  need
• 17:07
  to
• 17:07
  be
• 17:07
  aware
• 17:07
  of
• 17:08
  that,
• 17:08
  have
• 17:08
  compassion
• 17:08
  for
• 17:09
  that
• 17:09
  and
• 17:09
  screen
• 17:09
  it
• 17:09
  when
• 17:09
  we
• 17:10
  can
• 17:10
  to
• 17:10
  see
• 17:10
  what
• 17:10
  we
• 17:11
  can
• 17:11
  do.
• 17:12
  That
• 17:12
  is
• 17:12
  the
• 17:12
  whole
• 17:13
  difference,
• 17:13
  my
• 17:13
  friends
• 17:13
  in
• 17:13
  patient
• 17:14
  care.
• 17:14
  And
• 17:14
  that's
• 17:14
  why
• 17:15
  we
• 17:15
  built
• 17:15
  Patreon.
• 17:16
  It's
• 17:16
  a
• 17:16
  beautiful
• 17:17
  full
• 17:17
  library,
• 17:17
  full
• 17:17
  of
• 17:18
  resources.
• 17:18
  I
• 17:19
  built
• 17:19
  it
• 17:19
  for
• 17:19
  myself
• 17:20
  actually,
• 17:21
  because
• 17:21
  I
• 17:21
  needed
• 17:21
  a
• 17:22
  resource
• 17:22
  like
• 17:22
  that
• 17:22
  in
• 17:23
  school.
• 17:23
  And
• 17:24
  it's
• 17:24
  something
• 17:24
  I
• 17:25
  continue
• 17:25
  to
• 17:25
  go
• 17:25
  back
• 17:25
  to
• 17:26
  and
• 17:26
  learn
• 17:26
  from.
• 17:26
  And
• 17:27
  I
• 17:27
  love
• 17:27
  it.
• 17:27
  It's
• 17:27
  a
• 17:27
  wonderful
• 17:28
  resource.
• 17:28
  It
• 17:28
  keeps
• 17:29
  you
• 17:29
  at
• 17:29
  the
• 17:29
  top
• 17:29
  of
• 17:29
  your
• 17:29
  game.
• 17:30
  So
• 17:30
  please
• 17:30
  go
• 17:30
  to
• 17:31
  our
• 17:31
  show
• 17:31
  notes,
• 17:31
  click
• 17:32
  it,
• 17:32
  join
• 17:32
  it.
• 17:32
  We'd
• 17:33
  love
• 17:33
  to
• 17:33
  have
• 17:33
  you.
• 17:34
  Until
• 17:34
  next
• 17:35
  time,
• 17:35
  my
• 17:35
  friends.
• 17:36
  You
• 17:36
  have
• 17:36
  a
• 17:36
  great
• 17:37
  weekend.
• 17:37
  Bye
• 17:37
  bye.