Podcast: Become Friends With Your Anxiety

Jenn talks to Dr. Lisa Coyne about anxiety and how we can learn to manage it. Lisa unearths the positives about feeling anxious, shares ways to befriend our fear, and answers audience questions about shifting our attitudes about anxiety toward acceptance.

Lisa W. Coyne, PhD, is an assistant professor of psychology at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCD Jr.) at McLean Hospital. Dr. Coyne has published numerous books, peer-reviewed articles, and chapters on anxiety, OCD, and parenting.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Good morning, good afternoon, good evening, wherever you’re joining us from. Thank you for joining today for our talk that is all about becoming friends with our anxiety. I would like to introduce myself.

I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital. And I have a confession. I am a very anxious person by nature, shocking. I’m anxious enough that when I took a rhetoric class in my undergrad I had the ability for my final to use five note cards for a 15 minute speech.

I wrote out my entire speech on five three by five index cards. It gets worse. When I defended my master’s several years later, I had 30 minutes to defend it. I recorded the 30 minutes, listened to it on my commutes, when I was sleeping, when I was running, for three weeks before I had to present because I convinced myself that I would screw it up.

Lisa: Wow.

Jenn: Lisa is aghast.

Lisa: Well, I just have panic attacks, so.

Jenn: I mean, I’m a little embarrassed to share it.

Lisa: That’s awesome, Jenn, I’m so glad you did, though.

Jenn: I mean, that’s anxiety, but what I didn’t know then that I know now is that it’s ‘cause I cared, and I get this anxious when I talk to people on here because I care, and who doesn’t want to feel like they care, right?

Lisa: Absolutely.

Jenn: So while I hope that all of these anecdotes, oh, God, I’m like blushing. While I hope that these anecdotes make you feel a little more at ease about your anxiety, and put into perspective that sometimes anxiety is just because you care.

I would love to introduce Lisa, so we can talk about all of the other ways and reasons why we should be friendly, or friends with our anxiety, so. Dr. Lisa Coyne is a recurring guest.

She is a delightful person, a psychologist, a senior clinical consultant at the Child and Adolescent OCD Institute at McLean Hospital, a sourdough bread extraordinaire, author several times over, Everest Base Camp summiter. There’s been a lot of things that we’ve talked about, like, you personally.

Lisa: It’s been a really interesting series.

Jenn: In all of these sessions I feel like, I’m like, I could write your biography, so, Lisa, hi.

Lisa: Hi.

Jenn: I’m so glad you’re here today.

Lisa: It’s so nice to see you.

Jenn: You’re one of the best people to talk to about anxiety. So I wanted to start by asking why should I try to be friends with my anxiety? Because a lot of times, to me it feels like you’re being told to play nice with the bully in the sandbox because I’m not the problem.

Lisa: That’s a great metaphor.

Jenn: They’re the problem.

Lisa: Right.

Jenn: So, why bother?

Lisa: Right, so let’s start with the idea, or the fact that all of us have anxiety. And, in fact, we need it, we need anxiety ‘cause it’s what helps keep us alive, right?

So anxiety is something that it’s an experience that we have that lets us know that there’s a threat in the environment, and it has three components. It has physical reactions, right?

When we experience a threat, when we perceive that there’s something dangerous, our body ramps up and gets mobilized into a fight or flight sort of response. And if it’s really, really scary we might freeze. There’s the emotional response of fear or worry.

And then there’s the cognitive response. Oh, my gosh, this is dangerous, right? And so there’s three pieces to anxiety. To back up and think about what that means is that anxiety is information.

It is information just like all of our emotions occur to us to give us information about what we might do in the world to give us choices about what to do. Now, if you have an anxiety disorder, right?

Usually that happens and your anxiety or your... Sorry, I’m looking at a dog that’s trying to break into my office while I’m talking to you. I’m like, what, distraction.

When you have an anxiety disorder what happens is you might have become really, really worried about being anxious, and that anxiety may have spread like wildfire to different areas of your life, different domains of worry, et cetera.

And it’s not necessarily good information. It’s not necessarily helpful information, but we’re so accustomed to doing what anxiety says it’s hard to know when do we need anxiety, and when do we not, right? So, I’ll start with that.

So why would you ever want to be friends with it? Well, because it doesn’t work to not feel it. It’s really counterproductive to try and avoid it.

And most of the anxiety disorders are really what you can think of as see if you can shift your thinking a little bit from thinking about a disorder in terms of anxiety as moving away from the idea of too much anxiety to one of too much avoidance, right? Anxiety disorders are avoidance-based disorders, right?

Where when we have an experience like anxiety, an emotion that we don’t want to have our dominant response is to try and push it away, not feel it, get out of the situation, run out of the room, obsessively worry about it ‘til we figure it out, ruminate about it until we can come to the answer, right?

Avoid situations that cause it, and what happens is we end up in a tiny little cage, right? Where there’s no options except the cage gets smaller and smaller and smaller. And you just keep trying to avoid feeling what you’re feeling.

Meanwhile, the rest of the world goes on out there, okay? So, why would you want to make friends? Because you don’t want to be in a cage that’s why.

Jenn: So I know a lot of times fear and anxiety go hand in hand. And a lot of times fear is a natural response to something that’s in front of you. Whereas, anxiety might not be directly in front of you. Like, I’ve got a fear of spiders, and I’d rather burn my condo down than kill one.

Lisa: Right.

Jenn: But is there a connection between giving into fear? And for me, it’s not, like, I can’t kill a spider, but could giving into fear, and being more avoidant make us more anxious?

Lisa: They’re linked, but sometimes it makes sense to give into fear, right? If there’s a snarling dog running at me and I can avoid it, I’m going to run away, right? Or I’m going to stand still, and make sure it doesn’t bite me.

Anxiety can generalize to many different things. And when we run from that what happens is we deprive ourselves of learning that actually we can handle the situation. We just deprive ourselves of discovering that actually this situation isn’t what I thought it was, right?

Take for example, social anxiety. And this is a really common one. Let’s say that you’re afraid to go out to, let’s pretend it’s post COVID, just for a moment, just let’s enjoy that imaginary exercise for a second, right?

So let’s pretend you’re going to go out, and you’re going to a gathering of people, and maybe you know one or two, but there’s a lot of people you don’t know. And you notice that your mind starts to worry about what if I say the wrong thing?

What if I look awkward? What if I do something embarrassing? What if no one talks to me? What if I’m not good at small talk, and this host of worries starts to come up, right?

So if we give into that we might say, you know what? I’m just going to stay home. I’m going to stay in my comfort zone. I’m going to stay comfortable, forget it.

And you never give yourself a chance to learn. Maybe it was amazing. Maybe you would have met, like, the person of your dreams, right? Maybe you would have met some really interesting person. Maybe you would have helped someone who was really sad that day.

Maybe you would have felt inspired talking to someone. Maybe you met somebody else who was feeling even more anxious than you were. None of those are possible if you avoid, right? And so that’s part of the issue.

Jenn: So, obviously, anxiety is in some ways a natural response. We all experience it on a daily basis, but at what point is the anxiety that we’re experiencing a problem?

Lisa: And I think that that’s something that people should, they will know themselves, right? And there’s three different ways that I would kind of think about this. One is it’s going to cause intense distress. And you’re just feeling anxious all the time.

And that’s preventing you from doing things in areas of your life that are important. So you feel impaired in one or more areas, and/or people around you are really noticing, and it’s impacting your relationships, and they’re giving you feedback that this isn’t working, right?

‘Cause it’s sometimes hard for people to really see the effects of their behavior on others. And we see this a lot with teenagers, right? Who are struggling and they don’t want anybody to know. It’s hard to talk about.

They’re ashamed. They don’t want to deal with it. It feels scarier to deal with it than to just avoid it, right? And that’s sort of one of the myths of that anxiety tells us it’s easier to just kind of avoid everything than to ask for help, right?

So I would say when it causes excessive distress, functional impairment, where you’re starting to hear from people around you that they’re noticing you’re avoiding lots and lots of things, and they’re feeling disconnected from you.

Jenn: Do you have any advice around helping us better see our anxiety as an object? And do you feel that having that personification of anxiety being just a thing helps us prevent us from feeling like it’s not an overwhelming part of our identity, but it’s something we can just control?

Lisa: Well, that’s the thing. I think that trying to control anxiety is where we go wrong, right? Now, anxiety tends to control us, or we let it control us when we do what it says. And, actually, there’s a really great quote I’ll read to you, okay?

This is from our “Stuff That’s Loud” book, but the quote is actually from a really beautiful book by Pema Chodron called “When Things Fall Apart.” And she is a Buddhist, and she wrote this wonderful book after she dealt with a tragedy, or a sadness in her own life, and she was grieving.

It’s a Zen koan, so it’s a little story that she used to illustrate a point. The story goes like this. The young warrior roused herself and went towards fear, prostrated three times, and asked, “May I have permission to go into battle with you?”

Fear said, “Thank you for showing me so much respect that you ask for permission.” Then the young warrior said, “How can I defeat you?” Fear replied, “My weapons are that I talk fast, and I get very close to your face.

Then you get completely unnerved, and do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, you can have respect for me. You can even be convinced by me, but if you don’t do what I say, I have no power.” In that way, the student warrior learned how to defeat fear.

So this is a really nice illustration of the point that Jenn is making that where you can kind of think of anxiety as part of you, and you can embody it as something else. Like, we have our little anxiety monster here, love him, or fear and the warrior, right?

It’s separate, but I think that the point of that is to recognize that it’s a part of you. It’s not all of you. That’s the first thing. And you can choose how to respond to it. So it’s going to get right up in your face. Those of us who are anxious, and I am also anxious, you know.

It’s much less these days. It was much louder when I was probably Jenn’s age, but you learn that if you’re willing to allow the experience of anxiety, then you have the bandwidth, and the flexibility to choose what your next step is.

You can choose to stay. You can choose to let it talk to you, and not do what it says. So to apply that let’s say you’re that person with social anxiety and fear is going, you’re going to look like an idiot at that party. Don’t go, don’t go, don’t go.

So your response might be noticing, allowing those thoughts to remain in your awareness, noticing what your body is doing physically, all the physiological responses, noticing the emotion and going anyway. Choosing to go anyway with the fear, right?

Another myth about anxiety that we tell ourselves is I can’t do X until I get rid of my anxiety. So really notice that story ‘cause that’s not a helpful story to have, right? For most people with that story, how it works for you, right? Has it worked ever? Have you moved forward?

What if a more helpful story is I don’t enjoy doing things when I’m anxious, and I can choose to do it. And then over time what you see is you get more and more flexible, and fear becomes less and less salient that voice, right?

That anxiety voice. And then it gets easier and easier to do the things that you were once frightened of, and your comfort zone expands it doesn’t contract.

Jenn: So I know that there’s some relationship between procrastination and anxiety, especially, when folks say, I’m not going to get started on it until I don’t feel worked up about it, which then becomes a self-fulfilling cycle of you get anxious because you have put it off and now you have less time.

And how do we snap out of that cycle of procrastination, and anxiety?

Lisa: Right, that’s that same story kind of masquerading here, again, like I need to be ready to do something, or I need to be. People who struggle with perfectionism do this.

I’ll procrastinate, it feels so huge. Oh my gosh, I can’t do it. And then you’ll wait until the very last minute when you have to do it. Oh, yeah, I’ve been there, trust me.

Jenn: For folks who didn’t see me I raised my hand. I’m guilty of this, yeah.

Lisa: Yes, you did, right. And I imagine many of us are, and all of us at one point or another. And the thing to notice is that there’s this piece here about I have to feel ready.

I have to feel the right way, and then I can start. It’s that I can’t start until I feel that. And so the practice really, you can think of this as flexibility practice, right? Is practicing doing things regardless of how you’re feeling about them.

And if anxiety feels like too big a place to start, well, start with, like, getting out of bed in the morning when you don’t really feel like you’re kind of tired, right? Start with waiting in a line, allow yourself to be patient.

Even if you’re feeling really impatient, kind of drop the rope on that, but the practice is really noticing those hard moments when you’re feeling negative emotions, especially, anxiety, and not letting the anxiety tell you what to do. Do it anyway, even if it’s a small thing. Now there’s some tricks, too, to that.

And there’s just a couple of thinking traps that you can fall into, one is with tasks. I noticed that my mind, if I have something to write, for example, like I’m working on a book, there’s always books that we’re writing, like, as academics, but if I think, oh, God, I’ve got, like, 400 more pages to write.

I’m like, well, I’m not going to do that. I can’t get that done today that’s too big, but if I shift my thinking just a little bit, and I go you know what? I’m going to make a commitment to write for half an hour everyday just to have 30 minutes. And then I am done and I don’t need to worry about it for the rest of the day.

There’s something incredibly freeing in that. So break it down into smaller steps. Notice that your mind globalizes, right? So see if you can break it down into small steps. So that’s just one little practice that’s really helpful.

Jenn: We had someone write in saying that they struggle with anxiety, and don’t use their phone all day, which I wish I had the ability to do that.

So, first of all, kudos to you. How can they effectively communicate to others that they’re not checking their messages all day long?

Lisa: I don’t know, that’s a good question. I’m thinking, like, who are the tech. I feel like we should ask Scott that, he’s a tech guy. I think you might just send an email.

I would maybe just send an email out to everyone, and say, hey, guys, I’m trying to break up with my cell phone. We’re having limited visits during the day. So if I don’t respond right away it’s because I’m not tethered to it during the day. I’ll get back to you soon.

Jenn: Yeah, that would be the advice I would give. I know when I’m writing, I have an iPhone. When I’m writing for work I put it on do not disturb, and folks who are in my, like, favorites. So, basically, it’s my immediate family…

Lisa: That’s a good idea.

Jenn: Can get ahold of me, but other folks get an auto response that’s like, sorry, I’ll get back to you when I can. It’s the same thing like the auto response when you’re driving and it sends that, like, I’ll get back to you when I’m done driving message.

Lisa: That’s a great idea. I never knew you could that.

Jenn: Yeah, so play around with your...

Lisa: I’m not the right the person to answer that.

Jenn: Play around with your vacation out of offices, play around with those do not disturb messages, or just tell people I’m spending less time on my screens.

I’m dedicating time to myself. And for folks who understand amazing. For folks who don’t suggest that they try it, and see how they feel after.

Lisa: I bet you people’s friends will be like, that’s a great idea, I’m going to try that too, you know?

Jenn: So someone wrote in that they are struggling with severe depression and anxiety, and sometimes they experience physical sensations related to anxiety, which makes their anxiety even higher as a result.

Do you have any suggestions for ways to counter this?

Lisa: Yeah, and I mean, I guess we should talk about evidence-based treatment for anxiety, right? So there’s a piece of anxiety called anxiety sensitivity, which means and which refers to sort of fear of anxiety.

And hypervigilance for physical sensations that go along with anxiety, and it’s something is really, sorry, another dog got let in. It’s something that is associated with anxiety disorders, and things like that.

So the treatment for anxiety, all of the treatments really, that are evidence-based for anxiety are called exposure-based treatments. And what they do is exactly what we’re talking about which is helping you over time, and gradually with the guidance of a clinician, face your fears, right?

And learn and teach your body that those physical sensations that you’re experiencing are simply that. We have noisy bodies. Our bodies make all sorts of sensations, things that we notice, and our mind can get caught up in catastrophizing about them and thinking, oh, gosh, this is a dangerous thing.

Oh, gosh, this means that I’m going to have a panic attack. I used to have panic attacks, so I can vouch for that one, right? And it’s really worth seeing someone if you are really struggling who knows how to treat anxiety disorders.

And I actually have some things to recommend here. If you want to learn, I have a really nice acceptance-based approach to anxiety. I recommend this book. I refer people to it all the time. “The Mindful Way Through Anxiety.”

It has a workbook as well. And it’s an evidence-based way to address GAD, but it’s really lovely for OCD, for other kinds of anxiety. And it really gives you sort of a different way of interacting with your fears. So we could start with that.

So the first thing to notice is just see if, one of the first steps of an acceptance-based approach, which is also an exposure-based approach, by the way, is to simply slow yourself down, and let yourself notice what’s going on in your body, right?

Ground yourself, notice the things around you. Sometimes it’s really scary for folks with anxiety to notice their body and the sensations ‘cause they’re so triggering. So you don’t have to do that.

So what you can do is just kind of ground yourself in the present moment, and see what you notice around you. What you see, what you hear, what are you feeling as you sit or stand? What do you smell, et cetera? And see if you can ground yourself in the present moment.

That’s a useful thing to do. Jenn, you talked about box breathing, too, in one of the last sessions. That’s a really nice grounding technique that’s useful if you’re just feeling stressed, and you’re feeling like you just want to bring it down in a situation in between doing your evidence-based treatment, right?

Just so that you feel like you can. You don’t want to control the anxiety, but certainly breathing is something you can do to kind of just center yourself, and make a space with it to ground yourself while you’re feeling it.

Jenn: Another method that I learned from a yoga instructor that I used to go to a lot before we got into, if anybody took yoga, Savasana is, like, your final resting pose and everything.

And she would have everybody in the class lay on the mat, and just clench every single muscle in your body, grit your teeth, everything, basically, like squeezing yourself into a ball for five seconds and then releasing.

And in order for you to actually relax to recognize the difference between what that constant state of tension feels like and what serenity feels like, and being able to understand the difference of sometimes you just need to clench, and then feel yourself unclench.

Lisa: And when you do that what you’re doing is you’re bringing your awareness, and you’re exploring with curiosity. That’s the opposite of avoiding something, right?

So it’s just this practice of even though your mind says anxiety is dangerous, it’s being curious about it, bringing some compassion, some curiosity to it. And I’m not saying that you should learn to endure it, or learn to love it, or like it. I don’t like anxiety, do you, Jenn?

I mean, I’m delighted when I’m not anxious. And sometimes we get visited by anxiety. The difference is don’t treat it like an enemy. You don’t have to like it or love it, but you also can’t control it that’s counterproductive. And that tends to ramp it up and make it worse.

Jenn: I did want to ask a sort of personal question because I know in previous sessions you have openly acknowledged your own anxiety. You’ve openly acknowledged your panic. How have you been able to sit comfortably alongside these, and do big things?

Like, I don’t know, making it to base camp, and getting your MFA, and being on the board of foundations. You do a lot of really cool things.

Lisa: Thank you.

Jenn: For the average person that would look at you, and look at your list of accomplishments they’d be like, she’s cool as a cucumber. So like, how do you do it?

Lisa: And my mind is, like, oh, that’s so silly. They don’t know you’re secretly a loser, right? So just so you know, like, our minds are active things, and when we’re anxious they are always, always talking to us. How did I get to do some of these things? I love to take it with me.

You learn to take it with you, and you learn to walk with fear instead of fighting it. I can honestly say it’s changing your relationship to anxiety is the thing that I think works the best, and is the most important because it is, and that is hard to do, right? It is exposure.

And so how I did it was I would start instead of avoiding things that made me anxious when it really mattered to me, I would choose to do them. And at first it was terrifying, it really was, and I did have panic attacks during talks, and I would get headaches, and GI stuff, all of it, but the alternative was giving up the things I most cared about in my life, right?

And I think the biggest piece, if I could say one thing that’s really helpful too, is humans don’t like uncertainty, right? We like to know the answers. We like to know that we’re going to for sure be successful, that we’re going to get that raise, win that prize, whatever it is.

And I think making friends with uncertainty is really important. And if I could say one thing that I think is super, super useful it is that. Leaning in and learning to make friends with, and embrace uncertainty because that’s where possibility is, right? And notice that it’s not about controlling it.

It’s not about reducing it. It’s about increasing your willingness to experience that. Sometimes things won’t go your way, right? I’ve given plenty of crappy talks. I’ve failed at many things, right?

But the thing is, if you stay in the game you learn, and you learn how to do things better, and it becomes less and less important whether you’re anxious or not because you’re building yourself a life that you really want, and that you care about.

So I would say those are the key things I would think about. It’s really changing your relationship to fear and anxiety.

Jenn: You will love this question someone wrote in.

Lisa: I’m terrified.

Jenn: Well, someone just started OCD therapy, and they’re skeptical that it will work because they believe that the obsessions are true. They want to know is it possible for their brain to become rewired if it’s been taught to fear these obsessions for so long?

Lisa: The lovely thing about humans is that our brains are plastic, which means, yes, we change them. And it’s so funny, we draw this, like, distinction between thoughts and behavior. That’s a false thought, right? We know that behavior can change your brain.

So here’s the thing. If you keep doing the same thing the same way you won’t learn. And if you wait and try to figure it out, and be certain if it will work, you won’t start. So my advice to whoever that is, and good for you that you signed up for treatment. Good for you.

Be a good scientist, take some risks, and try it. It’s the kind of thing where, and I tell all my clients this, like, I can tell you how to ride a bicycle, but you’re not going to know how it works until you get on it.

So get on the bicycle and see how it works, and be curious, and be open, collect your own data, and be mindful that your OCD is going to fight back for sure. And it’s going to fill your head with lots and lots of reasons about why it’s too hard, too risky, won’t work, not going to happen for you, you’re different.

That’s what OCD does. This is OCD, right? It’s a little jerk, right? It really is. And it’s really, really good at arguing, and persuasive speaking. And if it were a chess player, it would beat you every time. The only thing you have that you can do is don’t play its game.

Abdicate, say you know what? You do you, I’m going to go build my life. And remember that story about it’s going to get right up in your face. Talk to you really, really fast. You don’t need to do what it says. And the moment you start stopping doing what it says it will get louder.

And then it’s going to start to pack up its bags and go home. So you go for it, trust your treatment staff. They know how to do it, and open up and see what happens. You’re going to learn a lot of really cool stuff. It will be hard and you can do it, good luck.

Jenn: And I know that there’s been, I’ve been doing a lot of reading myself on, like, how to better instill habits in myself. I’d love a morning routine, all of that jazz.

And I know that there’s the concept of neural pathways that the more that you do something the smoother the pathway becomes because it becomes more of a natural instinct for you to do it.

But creating new ones, or backtracking and trying to relearn something that, like, even if you’re doing squats wrong, and you’ve been doing them for 15 years, relearning how to do a correct squat is going to be really hard the first 50 times, but once you keep doing it it’s going to become more natural.

Lisa: Much easier.

Jenn: It will eventually become second nature.

Lisa: Exactly, and it becomes very fluid. And the same thing is true, like, I’m learning a new musical instrument. Jenn, I think I told you this morning I play the concertina.

Jenn: No, you didn’t, I don’t even.

Lisa: Oh, it’s so fun, it’s like I play the flute.

Jenn: I’m just, like, what is that?

Lisa: I play the flute, and the concertina is a little easier on my hands because the positioning my fingers are getting stiffer, they’re tiny, but it’s like a Rubik’s cube, right? It’s like I can’t put it down.

It’s like a little typewriter, and it’s a wonderful instrument, but before you can actually make music, you got to learn where to put your fingers. In order to learn where you put your fingers you got to do repetitive, repetitive, repetitive.

So, yeah, so in order to make something routine you have to keep going, and you have to do repetitive motions. So, like, a lot of the treatments for anxiety disorders that are exposure-based, it’s stuff that you do gradually, and you keep doing it over time.

And one thing that’s a misconception, right? Sometimes is that when you do a treatment for an anxiety disorder, you’re done after the treatment, and you don’t ever have to do exposure again, but, really, it’s about changing how you live.

It’s about changing your relationship to your fears, and your anxiety for your life. And for most people when they really go through this I don’t think they want to go back to avoiding, right? If they really, really do it well, if they really, really take it on and make a space.

I’ve learned more from my anxiety, like, it’s a good teacher. It teaches you how strong you are. It teaches you about resilience if you let it, right? Not that we would wish it on anyone, but it can be such a really helpful teacher.

Jenn: So I know because this is like the perfect segue because of your kids being at home. How do we make children more aware of their own anxieties, and help them share how they’re feeling?

Lisa: So this is great ‘cause I have all of my references at the ready today. So this is another really great book. “Helping Your Anxious Child.” And there are many books out there, but this is a great basic book for how you can support your child when they’re feeling anxious.

So how do you get them to tell you more? Well, modeling is really the best way to teach how to do this. And so if you want your child to talk about how they’re feeling, you as a parent should talk about how you’re feeling openly, right?

And it might sound antithetical, sometimes, to say it’s okay to be vulnerable with your kids, but it’s really, really important, okay? They learn how to interact with their own emotions, what their relationship to those emotions might be through watching us as parents.

So that’s the very first step. The second step is it’s okay to feel whatever you’re feeling. That is the message you want to give your kiddo, right? So sometimes where parents go wrong are they’ll try to minimize the anxiety. Uh, that’s nothing to be anxious about.

Well, it is for your child if they’re anxious about it, right? And to tell them how to feel can feel really invalidating, okay? So that’s one thing to watch out for. Another thing is to try and fix it right away, to rescue them from their anxiety. Oh, you poor dear, let me wrap you up, right?

Sometimes that’s a right thing, right? If something is actually dangerous or scary we want to be protective of our kids when there’s a real threat, but sometimes it’s unhelpful because it’s giving the message, oh, you can’t handle your anxiety.

So a better response is to be empathic. Wow, I see how anxious you are, and then express confidence that they can do it. And those are two ingredients in supportive parenting, which is here’s another book. Here, this is another book that just came out.

This is a really nice evidence-based parent only approach for how to support your child with anxiety, or OCD. It just came out this January by Eli Lebowitz from Yale. Excellent book. So, supportive parenting is empathizing, seeing it, recognizing, making a space for it, and also expressing confidence that they can handle it, and do that hard thing anyway, right?

And in doing that, what you’re doing is you’re really playing the long game here, right? The long game being I want to teach my child how to effectively, you know, how be anxious, and behave effectively when they’re anxious when we get visited by fear.

Jenn: We had someone write in that is the parent of adult children who have had treatment for anxiety as kids. And as they’ve grown they’ve witnessed them scaling their lives back not exploring the world, not finding their passions, or doing things outside of their limited routines.

Do you have any tips to help them recognize that the anxiety is likely impacting their lives without being that overbearing parent of an adult child?

Lisa: That’s a really tough one because I think here’s how I would do that. And I think that the question is well-placed, and whoever asked it I think has a really good sense of, like, the balance that needs to be drawn, right?

How do I not be pushy? And how do I express my concern honestly? And I would say, have sort of, we’ve talked about this in the previous sessions, like that values and vulnerabilities conversation, and say it just like that, right?

So the value is what’s most important to you as a parent, and it might be something like, I love you. I am so happy for you and your life, right? And it’s important to me to have an authentic, and genuine relationship with you, and tell you what I’m thinking. While also letting you have your freedom to do your life, you do you, right?

And then the vulnerability part of that conversation might be I’m scared I’m going to say this wrong, or I’m worried about you and I don’t want to be overbearing. And I’m noticing you’re scaling your life back. And I’m wondering if that’s something you really want, or whether it’s more it’s because it’s gotten hard again with the anxiety, right?

So when you want to talk to someone, and just be authentic and genuine, those are two really important ingredients. Like, step back, let go of the outcome, right? ‘Cause what might show up for you is I just want them to go get treatment, or I want them to be more brave, and I want them to be more adventurous, right?

That we’re not in charge of, that let go, but it’s perfectly okay to say, I’m your parent I love you. I get that this is not my job anymore. And, also, I’m worried. And I just wanted to say that, and I know you don’t have to listen to me, but I just wanted to say it.

That will help that message get in, in a way that’s more effective than trying to actually, like, move someone to do something, right? Just let them know authentically, and then offer to talk about, talk with them if they want to.

Jenn: So I know we’ve talked about a few different types of anxiety. Does the source of anxiety matter when we’re considering treatment options, or coping mechanisms?

Lisa: It does, actually. So if you have OCD, it’s really important to go to a practitioner that not only does CBT, be very careful, but also does what we call exposure and response prevention.

It is a specific type of exposure-based treatment that is the gold standard for treatment with OCD it’s really important. Most of the other treatments.

So the other one that I’m thinking of, which is really important is, if you have trauma, if you have PTSD, prolonged exposure, written exposure, cognitive processing therapy, those are really your first sources, I think.

So going to a practitioner who’s skilled in treating PTSD is very, very helpful if you’re struggling with that. Panic disorder, right?

With panic disorder, CBT, exposure-based treatment, exposure to interoceptive cues means doing exposure with the physical sensations of panic is really important ‘cause that’s really a big trigger, but beyond that, really the thing that unites all of these treatments is exposure, right?

It’s learning to increase your willingness to allow sensations so that you can learn that you don’t have to be afraid of them, and that you can be flexible in your life whether or not you’re visited by them. And what happens is we do actually see a symptom reduction over time.

Exposure-based treatments are very, very effective. There’s a huge and robust literature on these. It’s one of our most robust areas of the treatment literature because of the science behind these, right?

I would worry if you were doing kind of just supportive counseling, and you had an anxiety disorder, or OCD, and it’s taking months and months and months that’s not what it’s supposed to look like.

So it’s really, really important to go to practitioners, and really look, and be good consumers is what I’m saying here. Be really good consumers, and look into evidence-based treatments for anxiety, and OCD. All of them will be exposure-based. It’s really important.

Supportive counseling is really wonderful. And I love it personally, too, right? But if you really want to knock out that anxiety you want to get the right treatment for it to do it. SSRIs are also, there’s medication that’s useful.

And you can talk to an MD about that, to a psychiatrist. Not everyone needs them, some people do. I’m not a doctor, I’m not giving you medical advice, but there is a literature on SRIs and SSRIs being useful for anxiety disorders as well.

Jenn: We actually did have a question about SSRIs, and with the understanding that you might not be able to answer it, I’m still going to ask it anyway.

Lisa: Yeah.

Jenn: Someone has had an experience with antidepressants where they’ve reduced the amount of worrying that they do to the point where they’re not as productive as they’d like to be. Do you have any suggestions on how to balance these side effects?

Lisa: And that, you know what? That’s a great question for an MD. And I can’t answer that.

I can give you a behavioral answer for that. And what I would say is, another treatment that has got similar evidence, too, and it’s also an exposure-based treatment is acceptance and commitment therapy, right?

Which is an exposure-based treatment with a ton of data behind it that has been used across anxiety disorders, chronic pain, OCD, et cetera. And that approach is really, really lovely because it’s about helping you build your life.

And so what I’m hearing is I care about these things. I’m not doing these things because I’m not feeling so motivated anymore.

What do I do with that, right? And I think an approach like an acceptance-based approach, right, where you’re learning, how do I do things I care about even when I don’t feel that I care about them in the moment, or I’m unmotivated? That’s the practice, right?

And putting yourself in that situation where you’re working on building that behavioral repertoire, or your skillset that might be really useful for you whether or not you do anything with the meds.

Jenn: Is it common for anxiety to be worse at night? And if so, why?

Lisa: I don’t know if there’s data on this, but I do hear this quite a lot in our practice. It really depends on the person. And I think that if I were to guess that’s the quiet time when you’re more likely to be alone with your mind.

And that’s when your mind is going to talk to you, and start bringing up all of those worries that you might have, because during the day we’re pretty good at engaging in other things, and distracting ourselves, right?

So this is why acceptance-based approaches are useful because there are always going to be those windows where you’re going to be alone with your mind. And then what do you do? How do you run away from something that’s in your head? You can’t, right? The more you try to do that the louder it gets.

And so learning how to allow, notice, and just kind of let it be in your awareness, right? Like it’s just going to hang out. You don’t need to do what it says, but it can just kind of be here with you that would be an approach I would think would be useful.

Jenn: If you have a never-ending to-do list how do you avoid feeling overwhelmed? ‘Cause I know someone wrote in saying, feeling overwhelmed, exacerbated by lack of sleep leads to more anxiety. And I’m sure that you are not the only person out there that feels that, totally guilty.

Lisa: 100%, and I think, I mean, just so step back from the question just for a second, and hear what that person is saying. I have an unworkable to-do list I’m really anxious, what do I do, right?

And I think the answer is right there. Too big a to-do list. What parts of it can you let go? Why beat yourself up and step back, and make it a have to, right? And I think that one of the things that gets us into trouble as a culture, right, is feeling like we have to always be doing.

We always have to be working. We always have to get everything done. And it’s unworkable, right? And so remember what we started with this notion that anxiety is information, so that person’s anxiety is accurate. It’s tracking and it’s saying, hey, I need a break here.

This is a too long list. And it’s unworkable to keep trying to do too much stuff in not enough time. So what I would say is see if you can work on giving yourself permission to make a workable list.

And then let yourself off the hook for the rest, and see what you need to do in your life to kind of create more space where possible to set some things down, right? And see if you can break it up.

Jenn: So I know we’ve talked about a couple of co-occurring conditions with anxiety, namely panic and depression, but folks who are on the autism spectrum also experience anxiety. Do you have any recommendations, or strategies for those folks who are on the autism spectrum, and are reporting physical anxieties?

Lisa: Yeah, I mean, I think I would give the same recommendations as I would to anyone else. And I would just, I think, that one of the things that’s really hard for folks on the spectrum is that it’s tough.

Like they might experience things more intensely. It’s harder to maybe label emotions, and this is not, like, for everyone on the spectrum. This is just something that may happen, right? And I think it’s harder.

So I think really starting to cultivate an awareness of what is it that you need to feel comfortable, and then seeing if you can give yourself what it is that you need. Do you need a break? Are you overwhelmed? Can you break things down, right?

And all the while there needs to be a balance between that and then staying in your life in ways that are important to you, so you don’t just opt out and it’s hard, right? ‘Cause that’s the pull, isn’t it? To just kind of avoid everything. So go slow, go slow.

Really learn and see what’s helpful. And see if you can expand your willingness for what you’re willing to experience. And then just kind of keep in mind, Rome wasn’t built in a day. Give it some time, but keep going. Keep trying to learn how to be more flexible.

Jenn: What can I tell my friends and family to better help them understand my perspective of having an anxiety disorder without creating frustration in our relationships?

Lisa: Hmm, that’s a good one. I mean, I think what I would do is I would get some good information, like let them listen to podcasts like this one, something like that and say, hey, did you hear that cool podcast on blah, blah, blah? And then talk about it, right?

Say I struggle with this too. And keep in mind that not everyone is accepting of this stuff, and it might be sometimes an uphill battle to just give them information, but, I mean, the numbers are really high.

Like, I think it’s something like one in three people over the course of their lifetime are going to struggle with clinically meaningful anxiety. That’s a lot of people, right? And we all feel anxious. And so I think normalizing anxiety is really, really important.

I’m a big advocate for talking about it, right? Because I feel like it’s so stigmatized and it shouldn’t be. It’s not a sign of weakness at all. It’s just an experience. It doesn’t mean anything. And I think the more we sort of are secretive about it, hide it, we contribute to the continued stigmatization of having it.

And so, I, for one, I’m always talking about it. I think it’s really important, right? I want people to feel comfortable talking about it. And then if you let it out of the box it’s one less thing you have to worry about.

So I would suggest kind of being open about it to the degree that you’re willing to do that. And just being matter of fact about it. Lots of times when you disclose feeling anxious sometimes people feel like they have to rescue you, and you can influence that too because if you talk about it in a way where you’re like, yeah, sometimes I’m anxious.

They won’t feel the need to jump in and rescue, and you never know, right? Because it is something that’s so stigmatized the people around you may also be feeling anxious, and you wouldn’t know anything about it either.

And the more I talk about it, like, I didn’t know, Jenn, you were anxious. This is the first time I’m hearing. I’m like Jenn’s anxious. She doesn’t seem anxious not to me.

Jenn: I’m very anxious. It’s why I run so much because it counterbalances all of those feelings, oh, yeah.

Lisa: Right, but you seem so smooth, cool as a cucumber. And like, I used to get that too. People are like, I had no idea you were such a ball of anxiety. I’m like, ha-ha-ha-ha, yeah, so. You never know, don’t make assumptions. Be curious about the other people in your life. They may have some of it too.

Jenn: We had someone write in saying that their in-law causes them a lot of anxiety because they are insensitive and they judge people.

So the in-law tries to reach out so that they can have a better relationship, but they don’t know if it’s actually good for their mental health. So how can they balance the feelings, and concerns that they have while still being a good in-law and aunt or uncle?

Lisa: So I think it’s really important in those kinds of situations to zero in on what is the most important thing. So am I willing to have this person in my life? And if so, what are the healthy boundaries I choose to draw for self-care for myself, right?

People aren’t perfect. People can say insensitive things. Sometimes they mean it, sometimes they don’t. So think about are you willing to have this person in your life, and is it possible for you to draw some really healthy boundaries?

And let them know when they overstep, when they’re cruel, when they say something inappropriate, and also to revisit it if this person is unable to be mindful of your boundaries. Do you want to keep them in your life?

Do you want to have them in your life in a less present way? It is up to you, right? And you get to choose that. I think that that’s something we can often beat ourselves up about, but I really think it’s important to be honest with people, and be authentic.

And I tend to gravitate towards those relationships that, like, allow me to be my authentic self, right? And I, also, even though it makes me anxious, I will speak up to the degree that I can to let someone know if this is not okay with me, this hurt my feelings and it is hard, right?

And that’s one that I frankly am still working on. And I think a lot of us are. So, again, it’s that willingness piece. Like, am I willing to have these hard conversations that might improve this relationship to draw some healthier boundaries?

Jenn: I, also, from personal experience, I’ve dealt with a lot of difficult people over my entire life. And one of the things like the sandbox bully, one of the things that my mom told me when I was younger is that, like, hurt people hurt people.

So a lot of times the folks who are the most openly judgmental and cruel are the ones who are battling some of the biggest things on the inside.

So that’s helped me approach things with a little bit more of an empathetic lens when folks have been kind of like callous, I’m like where is this coming from? And treating them a little bit nicer and knock on wood, it tends to pay off most of the time.

Lisa: Great, I was just listening to a great talk, I think it was a TED Talk by a guy named Pat Ryman, and he talked about having compassion for people, right? And he said, he used this metaphor of like this woman at a green light, and the green light kept going on and she kept not moving.

And she kept, like, looking at the back of her car. And the driver behind her was really mad. Like what the heck’s going on here?

And after two lights, or so, he got out of his car, and he went to see what the heck. He was going to go yell at her, and what he found was her eyes were glued to a baby in the backseat that was turning blue that was choking, and she needed help, right?

And his point about that metaphor was what if we treated everybody, and we wondered when they’re cruel, or when they’re mean, or when they’re not making sense to us, like, what is the baby in the backseat here?

See if you can walk through that in your mind, right? Now, I want to come back, that’s important. And, also, being compassionate, choosing that doesn’t mean you need to keep someone in your life who’s cruel to you continually.

It is, I think, 100% okay to draw and needed, and important, to draw boundaries, so. It’s going to be different for everyone. You have to decide for yourself, but, hopefully, those are some options.

Jenn: One more, I promise.

Lisa: One more, okay.

Jenn: It’s an excellent question.

So someone provided a quote by Winston Churchill that says, when I look back on all these worries, I remember the story of the old man who sat on his death bed, that he had had a lot of trouble in his life, most of which never happened.

How do I stop myself from being anxious about the things that have yet to happen?

Lisa: That is a great question. Minds are great time travelers, and they often go into the future. And here’s the thing. You might not be able to stop your mind from doing that.

And, frankly, it’s just doing its job. It’s trying to keep you safe, but, remember, fear is going to get right up into your face. And if you don’t do what it says it has no power.

So what if it’s possible for you to move forward in your life, and do the things that you care about, and not fix those worries that may, or may not happen, right? So we’ll leave you with that one.

Jenn: It’s like the National Park Service saying don’t run from the bears. Try to make yourself bigger than them.

Lisa: Exactly.

Jenn: So, Lisa, I know you have to jump off. So thank you so much. Feel free to head on out now and to everybody who joined. Thank you so much for all of your questions, and all of your insight and all of your engagement.

This actually concludes this session. So until next time, be nice to yourself, and be nice to one another. Thanks for attending. Have a great day.

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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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