Podcast: Your Questions About Anxiety, Answered
Jenn talks to Dr. Lisa Coyne about the types of anxieties that folks are coping with. Lisa talks about the difference between healthy and unhealthy anxiety and provides insight on keeping stress and fear from having a stronghold on our lives.
Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. Dr. Coyne is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.
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.
Okay, folks we are going to get started. So first and foremost, thank you for joining us today. I’m really excited about today’s session because it’s all about anxiety. And at any given point in your life you’re going to experience it.
Anxiety is really healthy to have in small doses. It’s what keeps us going. It’s our fight or flight response but what do we do when we have too much of it? So that’s what Dr. Coyne and I are going to talk about today.
This session is mostly a highlight reel of some of the frequently asked questions we’ve received from previous sessions about anxiety. And, Oh yeah, I should introduce myself. If you haven’t joined us before, thanks for joining us.
And I’m Jenn Kearney. I’m a digital communications manager for McLean Hospital. And joining me today is Dr. Lisa Coyne, who is a clinical psychologist and senior consultant for the Child and Adolescent OCD Institute at McLean Hospital. Otherwise known as OCDI Jr. And recent co-author of a book called “Stop Avoiding Stuff.” Right? I got that, right?
Lisa: Stop avoiding that.
Jenn: I am—
Lisa: You were so confused.
Jenn: I’m about—
Lisa: It’s a good stocking stuffer.
Jenn: I’m about 15%. I already love it so far.
Lisa: Oh good.
Jenn: I’m giving it five stars.
Lisa: Oh, I’m so glad. Thanks, Jenn.
Jenn: So far so good. So, but yeah, let’s get started. First and foremost, anxiety good to have in small quantities, right?
Jenn: What’s a healthy amount, and how can you tell if you’re just too anxious?
Lisa: Right. And it’s so interesting ‘cause like we have been all of us, right? Have been socialized to think in terms of amount, right? Like, is there too much? Is there too little?
And I want to reframe the question a little bit to how is it working in your life? Right? So let’s back up just a little bit. One in three adults, the lifetime prevalence of anxiety disorders, which means the odds that you’re going to get this where you’re going to have an issue with this that’s meaningful, that gets in the way during the course of your life, one in three, right?
So it’s very common. Most of us have some sort of issues with anxiety, at some point in our lives. The question really is does it cause you significant distress? And more specifically, it’s not so much does the anxiety itself cause you significant distress, it’s does how you are managing it or coping with it, cause you distress? Right?
Does that get in the way of your life? And so as psychologists when we are interviewing folks to see if we are going to be useful to them, right? We’re looking to see, you know, if this is getting in your way of you living the best life. Of you living the life you wanted.
Is it getting in the way of you speaking up? Is it getting in the way of you getting that promotion? Because you’re not, you’re feeling too scared to be assertive. Is it getting in your way of, you know, leaving your house these days, during COVID even?
Because, you know, you’re really, really frightened of getting contaminated, getting infected. Is it getting in your way of, you know. Are you constantly worrying? Are you constantly trying to solve that, what if puzzle in your head about, you know, what horrible future thing could happen? Do you have a phobia, right? Meaning are there things you avoid doing?
Because there’s something that you’re scared of. Dogs or heights or planes flying is a big one. Public speaking is the most common fear that we have. Right? Are you really so concerned with social evaluation that, you know, you actually are having trouble getting along with people, you know.
So thinking about those things, I mean and I think the question is one that you have to answer for yourself. Is this getting in the way of your life? And if it is the good news is there are evidence-based treatments out there for you.
Jenn: So I know that you’ve talked previously in sessions before about public speaking. and that you’ve had your own anxiety over it.
Lisa: Oh yeah.
Jenn: And I mean, I seem every time I get on a webinar, I get a little bit of that good like good anxiety. It’s like being at the top of a roller coaster.
Jenn: You know, can you talk a little bit about how you overcame your anxiety for public speaking? Because I mean, I’m speaking for everybody on here. You’re great at it.
Lisa: Yeah, sure. And I want to like give a hat tip to the idea that there’s actually such a thing as an optimal level of anxiety, Like you mentioned. And you know, there’s different pieces. There’s two things I want to say too.
So anxiety is an experience that you have, that’s comprises three things, right? It’s a physiological response, right? And mobilization of your body, your sympathetic nervous system kicks in, your heart rate goes up, you might feel clammy hands, you might notice, you know, you’re breathing differently, you might tense up, right? That’s a physiological response.
Then you have an emotional response, fear. Then you have a cognitive response. Oh no. You know. And a thought based response for what this means, right? Oh gosh, there’s a threat. I’m in danger. I have to get out of here.
So that being said, we do need it as Jenn pointed out. But you know, if you remember, if you went to school maybe in high school or maybe in college, you might’ve learned about the Yerkes-Dodson curve. Which was, you know, a little graph with an upside down horse shoe, right?
And low anxiety or super high anxiety are not especially helpful with performance but at the top of that curve right in the middle that’s pretty optimal level of anxiety. So sometimes we actually perform better if we’re feeling a little bit nervous.
And one way to think about that is, anxiety like most, like all emotions really, is information for you. And it might be telling you there’s something that you really care about here. There’s nothing that’s important to you.
So like Jenn, these talks are important to her, right? And you probably feel a little anxious ‘cause it matters to you, right? We don’t get anxious about stuff that we don’t really care about. And so that’s something to just file away.
So for me, yeah, I absolutely had many, many, you know, social anxiety fears. Runs in my family. Long line of anxious women. And anxiety does tend to run in families. It’s not, which doesn’t mean that if someone in your family has it, you will get it. It just means that you have a higher likelihood.
So for me, that was the case. And I still get anxious sometimes, when I give talks in new settings. Or give talks that are vastly different from stuff I feel comfortable about. I’m already anxious about giving, I have to give a plenary this summer.
I’m the President of the Association of Contextual Behavioral Science. Go figure. Why did they elect me? No idea. But I’m already terrified about this plenary that I have to give this summer. And I’m just like running through in my head like, “Oh God. I could go all sorts of wrong.”
But really the way I got over it, is to say yes to it. When avoiding it got in the way of me being of service. Right? And so for me, I think a lot about acting with intention because I’m a teacher of and, you know, clinician who uses and a researcher in an approach called acceptance and commitment therapy. Right?
And that’s all about how, you know, helping people, you know, choose to take action in the directions that they care most about. So for me, I used to avoid talking in public at all, even though I was doing lots and lots of research that I thought was hopefully useful to the field.
And I would have my students do it. And students if you’re listening, I’m sorry, but ... Thanks for giving those talks. And eventually I started to notice that I was getting sadder and sadder, because I didn’t feel like I was actually making the difference that I wanted to.
And I realized that avoiding the situation was simply constraining. And so one day I was asked to do a like pretty big two day workshop which is a really big ask if you have social anxiety, right?
Two days just you teaching. And I said, yes,. And immediately felt utterly terrified. And that went away for a while. And I planned the talk and as it got closer and closer to the talk I got more and more anxious, and I decided to give in. And I kept saying to myself, well, you know, do you want to make this about managing your anxiety or do you want to make this about teaching well?
And I would choose. And I would choose, I want to make this about teaching well. And what that meant was I needed to think about what do good teachers do, right? They plan, they prepare, they try to connect with their students.
They, you know, do their best and whether or not, they are anxious, they choose. And so that was a really tough, tough weekend workshop to give. And it changed everything. Because that I had learned the move. The move isn’t how do I manage my anxiety so that I can go ahead and do this?
It was, how do I make a space to feel anxious and also take steps in the direction of the stuff that I really care about? And that really describes the evidence-based treatment for anxiety disorders and OCD which is called exposure based therapy, right?
If you’re doing work with OCD, it’s exposure and response prevention. Which means deliberately leaning into the things that are scary and not taking action to make yourself feel better. Right?
And we think the anxiety disorders it’s pretty much the same thing. It’s choosing to say yes to feeling anxious. And I think that as a culture we tend to have these unhelpful stories around anxiety.
Like I can’t have a life that I love unless I manage my anxiety. Unless it’s at the right level. Or I can’t do exposure based treatment until I’m ready to do it. And let me tell you, you’re never going to feel ready. Just doesn’t show up.
But you can always choose. And we’re not in control of our feelings, right? And our thoughts. They are going to pop up as a function of our past history, of our past experiences, of all the things we’ve already gone through in our life. But what you’re always in control of is your choice. And you can always choose to act with intention.
And it’s a really simple little thing, right? Little simple thing to say to yourself. Is what I’m doing right now about me trying to avoid something, right? Or avoid this anxious feeling or is this something that is consistent with the person that I most want to be in this moment? Right?
And that’s really learning to be the person you want to be even in moments of anxiety, is what the name of the game is I think. In my opinion.
Jenn: I can’t help but think about when you mentioned that you’re doing the plenary next summer and—
Lisa: Terrifying. Are you trying to do exposure with me? Go on.
Jenn: Oh, come on. Not intentionally. So. I mean, you’ve said, you’re really nervous about it. And you also said you don’t know why you’re in such a high position?
That you’re like, “What, why would they pick me for that?” Can you talk about and I’m not trying to call you out on imposter syndrome.
Lisa: But there it is.
Jenn: But I guess I am at the same time. Can you talk a little bit about how anxiety and imposter syndrome kind of rub off with one another?
Lisa: Absolutely. And it’s funny, cause I want to, again I’m going to plug this great book by my friend Jill Stoddard called “Be Mighty.” And it’s for women. And it’s all about how you can sort of make choices, to do the things you care about. Make really big, bold moves in your life. Even if you’re feeling like an imposter.
So most humans have this, right? And except for, well, we won’t go there. But most people have this idea, right? Like that we’re not all that were cracked up to be, and that somehow we’re going to be found out.
Somehow, you know, we fooled them all, and we are doing well. And I am no stranger to that feeling. And I just don’t get this whole thing and that’s on purpose, right? So it’s a protective thing that our minds do to us. To think about it. Right?
If you think that you’re not good enough to do something you’re less likely to try it. And if you’re less likely to try it, you’re less likely to put yourself at risk, right? And you’re less likely to feel anxious about taking that risk. And that’s how imposter syndrome and anxiety go hand in hand.
Now here’s the thing. Our minds are wonderful, wonderful tools for us, but they tend to be over-inclusive in the types of things that they view as threatening. And so your mind’s job right, is really to keep you safe. It’s a threat detector.
And so if you have generalized anxiety disorder you know what I’m talking about. But what if this terrible thing happens? So what if that terrible thing happens? But what if I did this? You know, and it’s constantly casting into the future to run interference for you to make sure you can solve all those things so that you’re safe, right?
Doesn’t work that way, of course. But the mind, God love it, really tries. And imposter syndrome is a version of that. Don’t try that, you’ll get hurt. And I remember, you know, even as a grad student, I really wanted to go to Brown for my internship. And it was really like, “I’m not going to get into Brown. That’s ridiculous.”
And I remember my mentor looking at me and he’s like, “Do not, do not let yourself talk yourself out of this. Just put in an application and see what happens.” And it was really, it felt so terrifying to take that risk and do it.
Cause I really was certain that like, “This is the dumbest thing ever. I will never, this is just not going to happen.” And I was absolutely flabbergasted to have been accepted. And I’m so incredibly grateful for that training, you know? And also I’m really glad I took that risk. Right?
So when imposter syndrome shows up, it is something and there’s some really lovely podcasts out there. There’s one, Debbie Sorensen, who’s another colleague of mine and Jill and a couple of others run a podcast called Psychologists Off the Clock. And it’s really lovely. And I know that they did an episode on imposter syndrome.
So you can check it out there. But just the thing to do, that’s sometimes helpful, is to notice that just recognize your mind doing its job, and also notice that it’s not always accurate. Right?
And sometimes you have to kind of hold what it tells you about you, lightly. And get your data from the world, and take a few steps in the direction of the stuff that you really want, anyway and try it out.
Jenn: So if you have kids, how do you help them? If they’re experiencing social anxiety, in particular.
Lisa: Yeah. This is hard. Cause like as a mom who actually, you know, I think like many of us, my kids have had some anxiety as well. And it’s really hard because I think our instincts as parents are to keep our kids safe, you know, pack them in bubble wrap, make sure that we can kind of clear the way for them so that we can protect him them from feeling anxious.
Especially if you know, we as parents feel anxious ourselves. And you know, when you have kids who have anxiety there’s a one in two chance that one of the parents also struggles with anxiety issues.
So to think about that for just a little bit what if we did that? Like what if we actually followed that impulse and like really made sure our kids never ever felt anxious. Never, ever took any risks. We would also be depriving them of the opportunity to learn, right? How to do that.
And that’s really, really important learning experience. And so what you see sometimes in families raising kids with anxiety is parents are doing what we call accommodating. They’re making things easier so that anxiety doesn’t show up so much.
They might also resist what we call autonomy granting which means giving your kids the courage, giving your kids the opportunities to take risks, and learn and master situations that are hard.
o the thing to do is to kind of step back and notice whether how you’re handling the anxiety is working, in the way you think it is. Right? Is it helping your child learn their own latent skills and strengths? Or is it feeding the anxiety? And is it, you know, is it making it bigger?
And so when you work with parents there’s some really important approaches that are out there, our clinic does. And there are few many clinics that do these but helping parents learn how to encourage their kids to take risks is where it’s at.
Mindful risks, you know. So that when they’re older, they’re flexible, they can handle the things that life throws at them. And you know, kids are different. Some kids are gregarious, and you know, love experience and extroverted. And some kids are inhibited and shy. I’m not talking about changing that, right?
Kids are kids, they’re all different. I mean, anybody who has more than one kid knows that they come in different flavors, right? But it is about meeting your kids where they are and supporting them and helping them develop their own self-efficacy in handling these things.
Jenn: So how can we help students, kids who are anxious about being on camera, while they’re remote learning?
Lisa: Yeah, that’s a tough one. And it’s probably going to be a work in progress. And there are different ways to teach. The first and best way is modeling. It depends on the age of the kid out too. Right?
So with younger kids you can model. By being on camera yourself. You can see if you can figure out a way to play around with being on the camera. When it doesn’t matter, as a fun game, like you can be in your room, kid can be in their room, and we’re going to play telephone on Zoom. You know or something like that.
We’re going to play with all the fun things that we can do on Zoom. You know about the filters, have you seen those? Those are really fun. Where you kind of give yourself glasses or funny eyebrows or a beard. I mean, there’s lots of things you can do.
So what I would say is spend a little time just acclimating and getting used to it, when it doesn’t matter. So that the kids are more comfortable when it does matter. You know, flexibility’s important, sometimes starting slow like with older kids, it might be that they’re just not comfortable turning the camera on.
When I’m working with my clients, right? Who are kids, I try to meet them where they are and then gently shape it. So if they can, if they want to leave the camera off and just text me, that’s where we start. And then we encourage, maybe we turn the camera on a text and then maybe we turn the sound on and we talk. Or maybe we leave the camera off and we talk, and then we turn the camera.
So, you know, thinking about successive approximations it’s a procedure called shaping, that can really help. And then always, you know, if you’re working with younger kids or school aged kids, giving some rewards for engaging in the behaviors that you want to see, right? What can they earn? Right?
If you ask them to do this hard thing is there something that they can earn? Can they earn a little free time? Right? Can you give them like, If you do this for two minutes, I’ll give you, you know, another two minutes where you can be off screen or something like that.
And it’s different for each family but I would say modeling, shaping and doing this in a hierarchy, easy to hard, and then giving some rewards you know, that are sustainable. Right? And feasible. Not big things but little things that matter. And those are three things that can help.
Jenn: Is there any way to address anxiety that might be felt by teens in particular when being on camera? I know that we’re in a day and age where I watched the social dilemma a few weeks ago, and I know that there’s so much self-distortion when it comes to all of these filters and use of like the funny faces and everything.
Is there any way to address that when teens in particular can be so uncomfortable with how they look and feel already?
Lisa: I think it’s really hard to and I think schools are really struggling with that. I think again, it’s really important to meet kids where they are, because these are potentially things that will take a little time to fix.
And I also recognize that in the current context of the pandemic, there are things that people feel a lot of urgency to fix right now and quickly. And so the first thing is give yourself some space as a parent and recognize that this is not going to be solved overnight. This is not going to be something that you can direct or tell, make your child do won’t work, right?
But reinforcing tiny steps towards being brave about it are things that you can do that over time can matter a lot, you know. And again, I would use that same shaping approach and then just make a space for your teenager to talk to you about it.
Cause I think the most important thing when you’re parenting teenagers is to keep that communication going, ‘cause this is a time when it can really lapse when kids start to get more private. They don’t want to share their fears.
And sometimes the more parents direct and push, the more kids push back, and the less willing they are to actually engage. So what I would say is ease off a little bit. And instead of being directive, comment on the things that you’re seeing that are good.
Like, “Great that you’re in class. And I can see it’s hard for you to be on the screen. Great that you’re there anyway, you know. And not playing video games.” Which we have observed sometimes in our house some way. But anyway, all joking aside.
You know, it’s better to catch your kids being good. That’s the principle behind most evidence-based positive behavior support strategies. And it’s a workable thing, right?
We often think, you know, being punitive, taking something away is where to start. When in fact that’s actually not something you should use unless other things fail. And the very first step is reinforce stuff you want to see more of, catch kids being good and shape, you know.
Jenn: So how can parents start the conversation about anxiety with their teen or kid especially if they feel like they might be experiencing it?
But a lot of times we just don’t know how to describe it. And sometimes as adults, you don’t even know how to describe the anxiety that you’re feeling.
Lisa: Yeah. It’s really true. And I think it’s really tough to talk to teenagers. One way that I have found useful is to comment them in a very collaborative way. Right? That’s the first thing. And just be genuine.
I think that they really appreciate being treated like little adults, you know. As you know, in a respectful kind of way. But they also appreciate parents authenticity, you know.
And what that means is, you could start by disclosing, you know, “Sometimes I feel anxious, and I’m noticing…” You know, it’s good to observe behavior to them.
“I’m noticing that you seem really quiet lately and I’m wondering what’s up with that. You know, sometimes when I find myself being quiet it’s because I’m anxious. Is that true for you? Do you know what I mean by that? And anxious just means feeling stressed and tense, you know, do you ever feel that? Is there something you’re worrying about?”
Like and kind of just be gentle. But start with you can disclose a little bit, you can, if you are in fact experiencing that stuff, if you’re not that’s okay.
But you can express your concern and say, “I’m wondering how you’re doing? What’s going on?” You know.
And just kind of remember that conversations like these, are not once off conversations. They are sometimes multiple bids for just checking in with you. And don’t kind of be put off if your teenager doesn’t right away disclose their, you know, all of their best kept secrets. In fact expect that they won’t.
Jenn: You mean your life isn’t like “Gilmore Girls?” How weird.
Lisa: I know. And just notice that. And just sometimes it’s more important to just ask the question, and let them know you’re here, you know.
And you know, just giving them the sense that you’re here in the wings and should they need you if they choose to talk to you, you’ll listen, right. And I think that that’s really the best approach to kind of find your way in.
Jenn: So how do you stay calm if you’re surrounded by people with anxiety? Whether it’s coworkers, family members, people sitting in traffic, how do you keep it from fueling your own anxiety about it?
Lisa: Oh my goodness. I don’t know that you can. It’s really tough. I think that one thing to do is to really notice like saying yes to yes. People around me are anxious. This is a really anxious time. And just kind of, rather than trying to again manage it, just allow it.
Acknowledge. Yep. Here it is. This is anxiety. And just remember that you can’t control what you’re feeling, but you can always control your intention. What do you want to do about that? You know. Yeah. Are you thinking of a specific situation, Jenn? I can say more, but I think—
Jenn: No, nothing. Nothing specific.
Lisa: It’s really hard, you know like—
Jenn: We’re living in an anxious world and it’s—
Lisa: We do. Especially these days.
Jenn: It’s really easy for people to just say, “Oh, just relax. Take a deep breath. It’s going to be okay.” And your like, “You don’t understand everybody around me is losing it. How can I keep it together?”
Lisa: We know, one little thing that I do that I think is really useful and this is again sort of a mindfulness thing. Is I’m very like, I don’t always notice that I’m anxious but I’ll get a headache, or I’ll feel tense physically and things like that.
And a lot of people actually are like that. Where they experience their anxiety in terms of physical tension symptoms. So I’ve learned over the years, you know, when you start being mindful of your anxiety and allowing it, you start to learn a lot about it.
And what I learned was that’s a trigger for me to slow down and go, “What were you just thinking about? Are you worried about something?” And then I’ll be like, “Ah right. Yep. That was that.” And it just gives me that little bit of distance and awareness of it.
And then if there’s something that I actually can do like something I forgot to do or something I meant to, you know, do or have to do whatever, I can do that thing that’s within my control. Right?
And I can also check in with myself and say, “What is it that you need? Do you need to take a break? Do you want to go get a cup of tea? Should you go stretch your legs?” You know. And if you spend a lot of time trying not to feel anxious you can’t do any of those things. Right?
So one of the benefits of acceptance and awareness of anxiety is you get to know it. And if it’s information, you start to listen, see, what is it that I need? You know. Am I willing to do this thing that I think will make me feel anxious? Is it important?
Well, if the answer is yes, then go do it. Am I not willing to do this thing? And if it’s not that important, who cares avoid it. Avoidance is a perfectly good strategy. If it doesn’t matter to you, that you’re avoiding the thing, right?
Like I’m not going to go out and hunt down spiders just because they make me anxious. Why? But you know, if I want to go camping, that’s saying yes to spiders. If camping’s important, I’m going to go camping. Hopefully they won’t come in the tent, if they do they do we’ll cross that bridge. Right?
Jenn: So I did want to ask about, is there a link between anxiety and burnout? And one of the things that a lot of people are worried about these days, is very anxious about getting burnt out.
Is that something that’s going to accelerate them getting burnt out? Or is there any relationship between the two of them?
Lisa: Getting anxious about whether they’ll get burned out? Yeah. Well, triggers of burnout are feeling like you have to do things perfectly. Working very, very hard, and probably beyond your capacity, when you’re dealing with a chronic and uncontrolled stressor.
So I think anxiety is there to give you some information, once again. And what I would do if I felt anxious about getting burned out, would be checking in with myself. Or I, you know and ask a couple of questions.
What can I put down? Do I need a break? Can I make a space to do something imperfectly? Can I lower my expectations for now? Can I give myself permission to relax? Right?
And I think, “I can engage in some self-care? Can I engage in some self-kindness?” I think that’s a really important like anxiety is giving you some messages. I think you’re worried about getting burned out. Sounds like you should listen. And check it out and see what can I do. Right?
And if the next thing that happens is your mind saying, “Oh, but you can’t put any of those things down. You have to do it perfectly.” That’s another chance to step back from your mind and go, “Okay, is that helpful right now? Do I feel like I need to listen to that? Is that going to serve me to continue working at this pace? Is it possible?” Right?
And so learning to step back, and that again that’s another ACT skill, we call that defusion. Like just noticing the stuff that your mind gives you and going “Is this useful?” Not as a right or wrong, cause who knows but is it useful? Does it serve you?
And if not, seeing if you can give yourself what you need in that moment. So treat anxiety like information. I think if you’re worried about getting burned out.
Jenn: So I did want to ask you about going out now, especially if you’re joining us present day, COVID is really stressful.
Lisa: Right now, yeah.
Jenn: It can be really taxing and people can feel totally drained when they get home. Any tips for lowering your anxiety while being in public so that you’re not emotionally zapping yourself.
Lisa: This is going to be a mix of the practical and the, you know, other things. And then just logical, and right now, I think we are going to see an enormous spike in COVID cases. Yesterday the New York times recorded 199,000 cases. And it’s just going to go up because of the Thanksgiving travel.
So I think actually this is again a situation where anxiety is information. And I think we do need to be careful. So if I were, you know, going to be logical about this, I would say, really consider going, like you can certainly go out of your house.
If you stay six feet distance, and you wear your mask, you should go out of your house, and go exercise and things like that. And you also want to minimize chances for exposure to COVID, by being in restaurants, you know, being an enclosed spaces, not wearing masks.
These are all things that are really bad ideas right now. Especially right now, as we get through this burst. So I would say, listen to your anxiety, to the degree that it is useful to you and helpful to you.
Now of course we’re going to have to go out to do things like get groceries, and go to the doctor and get our flu shots, and all of those things. So take precautions. Think about what’s in your control and what’s not. And what is in your control are the choices you make about your own health, right?
Your own personal space, wearing a mask, like limiting trips out, and trying to kind of lump them all into one. So you’re not out like hundreds of times during the week, and taking care of your body, right? Like getting your exercise, you can do your socially distant visiting with friends, as long as you’re following the guidelines.
And the things that are out of your control unfortunately are the anxiety beyond that. Right? So anxiety is a little bit like trying to manage anxiety is a little bit like trying to squeeze a water balloon, right? And the harder you squeeze a water balloon the more likely it is to burst. But I’m sorry one of the family just let into two dogs.
So we might have dog noise. But how to carry a water balloon is to expand around it. Give it space. Okay. And one way to say this, right, is to be just increase your willingness to feel anxiety.
Acknowledge that what you’re doing is going to provoke anxiety. We all feel it. And that’s okay. Right? So focus on the things you can control and let go of trying to squeeze the things that you can’t.
Jenn: So how do we manage health anxiety? And I know that you’ve alluded to this before that you’ve actually had personal experience with this in your family.
So like for example, a person would catastrophize things that might feel physically wrong. So my elbow hurts, so I have bone cancer. Or I have a tickle in my throat, it’s COVID.
Lisa: Exactly. And I think that we’re all probably walking around going, “Oh my God. I have a tickle in my throat. Is that COVID?” Just for the record. But yeah, so it helps anxiety occurs when folks get preoccupied that things perceived, things going wrong in their body are catastrophically bad. And it involves a couple of different things, right?
A hyper-focus on that thing. And also checking like, is this that. And maybe seeking reassurance about it. All geared towards managing the anxiety. Right? And so there’s this other piece about like, “Am I, you know, is this a physical thing or am I making this up?”
So there’s that piece as well. So the treatment for genuine health anxiety is exposure, of course. Which means making a space for having the worries. Right? And having the anxiety about the physical stuff and resisting engaging in behaviors to avoid it or fix it or make it better.
So resisting checking, resisting, you know, or stopping avoiding things. Like say for example, somebody who might have health anxiety about heart attack might not engage in physical activity, right?
Somebody who has contamination fears, like I might get sick, might avoid, you know, situations where they might become contaminated excessively. Or they might engage in multiple visits to doctors, to check and make sure they’re safe and they’re okay. They might ask for reassurance. There’s a whole host of things that people do.
And so again, I think the rule of thumb is, is what you’re doing about these fears excessive. Is it getting in your way of your life, and is it causing functional impairment in your family, with your friends, with your work, with your school? Okay?
Is it causing you significant distress that doesn’t seem to be getting better? And have you had doctors tell you this is not something you should be concerned about, right? All of those situations suggest that that might be a good time to get some help and support around this.
And I think I want to emphasize that like, a lot of us walk around thinking like, “Oh, I can just fix this myself.” And really it is important to know that you can actually get help for this.
And there are evidence-based treatments for this. And certainly if you’re experiencing functional impairment or excessive distress, looking for help is a good thing to do.
Jenn: Do you have any advice on whether or not you should disclose to future employers that you struggle with anxiety? And if yes are there accommodations that would be available?
Lisa: That’s a tricky one. And I think it, you know, obviously there are laws in place that people cannot be discriminated against by you know, for anything like that. That being said, I think that there is a lot of stigma around anxiety.
So I think that that’s a personal choice. You know, I personally think that, you know, and again this is my personal choice. Like I of course talk about anxiety because I want to break down stigma. And I want people to understand that this is a really normal thing, you know.
And if you’re struggling with it that doesn’t mean you’re weak or broken or unfixable nothing like that at all. You know, and I think that, you know, as someone who is a mental health provider and someone who’s...
It’s really important to me to make a space for people to disclose to their employers. So I think that in terms of accommodations and things like that, I think it’s important to notice that too, you know, we talked about accommodations in families with kids, as something that actually makes it easier for the anxiety to get bigger and take hold.
So I think it’s different to meet your employees where they are. Right? And I think it’s also important too for you as a person who’s an employee consider do I need to get a little help about this? So that I can actually not let it get in the way of my work.
If my work is important to me, right? If you have a good employer that should be a great conversation to have, right? For how that person can help you make a space for that, and also help you get through it, right?
Or may help you find what you need to move through it. But I think it’s going to have to be a personal choice. My preference is always to be open about these things. That may not be a useful thing depending on individuals and their situation.
Jenn: So what can we do if you try to talk to your teen about anxiety and their response is, “I don’t want to talk about it.” Like, what do you recommend?
And is there an approach that actually works better with breaking the ice and is a little bit more effective than backing down or pushing forward? Any suggestions?
Lisa: Well. You remember the “Shawshank Redemption,” where was it Tim Robbins had that little rock hammer and like for years was chipping away at that wall. And what was the quote pressure and time? Pressure and time.
Jenn: And eventually, so what you’re saying is if we keep approaching this conversation and getting pushback eventually we’ll all make it to Mexico.
Lisa: Basically, yeah. Yeah, we could have fun with this metaphor but yes. So what I’m going to suggest is that’s pretty typical response that a teenager would have. And so first of all, don’t give up. Second of all, remember this is not going to be a once off conversation. And third of all, be flexible. Right?
If you are trying something and that’s not working, try something different, right? You can leave resources around. You can again, talk a little bit about... You can make a space for talking about anxiety. Like since anxiety is something we all experience at some level, you know, should be able to say, “Wow! It made me really anxious about that, you know. Here’s how I handled it.”
You know, and the other thing that I do is I’ll just kind of kids are not... None of us are really great observers of our own behavior, right? We all have blind spots. And so, you know, one of the things you could also try is kind of say, “You know, I’m noticing you seem really isolated these days. You know, you seem really like on your own, is that how you want things?”
You know, and just be very, very gentle, observe their own behavior to them. And again, come at it in a collaborative way. And the other thing is sometimes parents are not the right people to talk to kids about their anxiety, right?
So sometimes the best thing you can do is just offer. “You know, if you feel like you want to talk to someone I might not be that person and I get that. But I’m happy to help you find someone if you want.” Or ask, “Do you talk to your friends about what’s going on?”
You know. Sometimes we, as the parents are not the right people to solve it. And so making a space for that as much as you might want to, and we all want to certainly, right? We’re not always the right people to start that.
But I would say that’s an array of options. And just keep trying sometimes just asking the questions and letting the kids know you’re there in their corner is more important than helping them solve anxiety, you know. Sometimes just if you create that space they’ll come to you and ask for help. So.
Jenn: There’s so much valuable information in that answer, that doesn’t even have to relate to a teenager. That’s a conversation that if you think that as an adult if you think that your parent is struggling and you don’t know how to break the ice with them or a partner that you think is having a hard time who also has a hard time expressing emotion.
I know that there’s still unfortunately when it comes to men’s mental health there’s still so much stigma there.
Lisa: So much.
Jenn: And it’s that, I’m the breadwinner, I’m the sole provider, I’m the resilient one in the family. I’m fine. So I think that there’s just so much valuable information in that response.
That is something that, you know, even if you’re not a teenager, you’re not speaking to a teenager, to make sure I got information.
Lisa: Yeah. And you know what I was just thinking, Jenn, there’s a resource I should tell our listeners the International OCD Foundation has been working on this website, it’s really wonderful called anxiety in the schools. And there are sections for providers for parents and for kids.
And I will send you the link after this but it’s such a great resource. And it has information about just that. Actually in we’re actually in the middle of writing the parenting part. And that’s one of the questions that I’m supposed to be writing about at the moment for it.
And it’s about, you know, how do you talk to kids about these difficult things these avoidance behaviors, right? And so check that out. It’s chock-full good stuff. Oh, also another resource. And this is one of my faves for younger kids.
There is a really wonderful psychologist named Natasha Daniels, who you can find her on YouTube. And she does free videos for kids or for parents about different aspects of anxiety and OCD. And I’m a massive fan of hers. And she is just out of the kindness of her heart, she does all these really wonderful videos that are really short.
They’re really useful for teaching cognitive behavioral evidence-based skills for how to handle anxiety. So I would say, check those out too. And she’s a mom herself. So you get that nice flavor of like, you know, she’s a professional, but she also has lived experience in this as well. So highly recommend her stuff.
Jenn: Wanted to talk a little bit, you’ve touched upon OCD, but having anxiety or OCD can make mindfulness really challenging. And I like to allude to it as being like super ball syndrome, where you go to quiet your mind and it’s like tipping over a jar of super balls all your thoughts, just go bouncing all over the place.
How can you not get discouraged about mindfulness and keep trying to build that habit especially if you’re grappling with anxiety or OCD?
Lisa: Yeah. That’s such a good question. And there’s different traditions about mindfulness, right? And so when we use mindfulness in the context of anxiety and OCD, we’re not necessarily at all as a matter of fact, trying to quiet our mind but rather sort of to be more aware, right?
And slow down and just notice what is going on in our mind. And I think one of the things people do sometimes is they have an idea about what mindfulness should be like, how they should be doing it, what it’s supposed to do. I would encourage folks to let go of those. Right?
And just pull down mindfulness to this one small thing, right? To paying attention on purpose. And you cannot choose the thoughts you have. You can’t choose whether you’re anxious or not. But you can choose what to pay attention to. And so for some folks it’s easier to start learning how to practice mindfulness by choosing to attend to things outside of your body and outside of your head.
Like things that you see, things that you surprise, hear those surprise you by your environment, things that you hear, right? What are the sounds around you right now? How things feel, right? How does it feel to sit in your chair? Where are your feet? You know. How do your feet feel right now in your shoes, right?
And so strengthening that skill of simply paying attention on purpose and directing your attention where you want and then expanding that awareness. So it’s bigger and bigger and bigger, and it’s inclusive of all of those things I just mentioned and also how you’re feeling and also the thoughts that are swirling around in your head and also noticing them without necessarily judging them or responding to them.
But simply just noticing them the way you would notice clouds passing in the sky, right? Or a sunset. That’s what to work on. The other thing that I find super useful in learning the practice of mindfulness is to remember that it’s a practice, right? It’s not a right or wrong.
It’s a simple practice and you can practice it. It’s helpful to practice it during stuff you do every day, right? So are you washing the dishes? Are you having a cup of tea? Are you walking? Are you petting your dog or your cat? Are you looking at the sky outside to check the weather?
Those are all opportunities where you can just slow down and check in with yourself, right? And the benefit of learning it with anxiety and OCD is you get to build it to that little trick that I was talking about at the beginning of this.
How am I doing right now? What was I just thinking? What do I need? Right? So the idea is not to quiet your mind, is to make your mind a cathedral, for all those thoughts to run around as they go. So that you can choose the next things that you want to do.
Jenn: Now that there’s a lot of times folks address anxiety around, you know, I want to be able to better take care of myself. I want to have a routine.
They get up early in the morning they get their workout and they get their quiet time in. And it’s a great reset for the day. We are as everyone has said, “We’re living in unprecedented times.”
Lisa: Oh my God. We are.
Jenn: So what happens when we have to break these routines? How do we address the anxiety that comes up over not having that time for ourselves or being worried about falling even out of a habit?
Lisa: Yeah, I think that’s a hard one. And I think what you’re describing is a very natural response to breaking a routine that kind of you structured to hold you. And so that’s a very natural reaction and I’d give yourself permission to notice that. And have that.
That being said, I would see if you can be flexible about your routine and not all or none, like not it’s this routine or nothing. But, well I needed a new routine that works in this situation. How can I build a simple routine now?
In this context. Dealing with what I’m dealing with. And so, you know, being flexible and practicing that flexibility and approaching things is utterly essential right now during COVID, right? And have that clinging to rigidly. Like it has to be like this. Is not going to be workable in this situation. Right?
And I think we all know that. And it is hard. So like anxiety would be a really natural response to that. You know. So I would just encourage being flexible and seeing where can you build back little routines that feel helpful, right? Little things, little practices. And they can be small micro routines. See if that happens.
Jenn: Alright. Two more questions for ya. First and Foremost, any other books that you would recommend clinicians read in order to better help their patients?
Lisa: Oh my gosh. I was like looking at all of the... Like, I’m surrounded... You should see my office. Literally, I’m surrounded by books.
Jenn: Every time I book recommendation I’m like, “Oh God, we’re starting a McLean book club soon.”
Lisa: Alright. So I know. I’m seriously. So there are for therapists. Let me show you a new one. Hold on, I’m just going to grab a couple. Don’t go away. I think I need to do like a book club for me. Okay. I’m going to show you a bunch. There’s of course, this is actually really fun book. So I’ll just show you this one again.
Jenn: That is “Stop Avoiding Stuff” by Lisa Coyne.
Lisa: Stick in your bathroom. Yeah, there you go. This is a classic, right? And this is a book that’s been around for a lot of years by Ron Rapee. And it’s a really nice evidence-based approach for helping your kids with anxiety. How to help your anxious child. And the principles in it are great. It is written for parents.
So this is one and these are just written, there’s many more but I’m just picking what’s like I can grab off my shelf. If you are worried about burnout and you’re feeling hard on yourself, this is another fave that just came out. It’s a book on self-compassion and how to be kind to yourself. If you’re feeling really anxious.
Cause this is something when we’re anxious and tough on ourself, we’re really crappy at. So this is another one by Laura Silberstein-Tirch. If you have kiddos and you want to talk to them about anxiety this is a book that was recommended to me by Natasha Daniels, who I mentioned, and it’s charming. And it’s about OCD.
It’s a graphic novel about OCD. It’s really cute with great illustrations. About anxiety. And it’s by Jason Adam Katzenstein. Oh, there’s another great book on anxiety for kids. I don’t have it in front of me, but it’s called “Guts.”
And that was something that the New York Time mentioned. And that’s another graphic story about anxiety for younger kids. So that’s a great one. And then finally, this one just came out for therapists.
Two of my most revered and esteemed colleagues, Sue Orsillo and Liz Roemer are both here in Boston, one at Suffolk University, the other one at UMass Boston. The foremost authorities on acceptance-based behavior therapy for GAD.
And this is based on their clinical trials. It’s wonderful. And it just came out. I also like and I’ve recommended before their mindful way through anxiety workbook and handbook for clinicians. And it’s one that I tend to give out like candy to my clients. Especially if when I’m working with parents. So just a little plug for them.
Jenn: Our last—Amazing. Our last question is, I find physical exercise very helpful for dealing with anxiety, but I’m injured. What’s the next substitute for not being able to exercise?
Lisa: Oh my gosh, I totally feel you. And exercise is so good. If you have a physical therapist or if there’s someone that you can work with to figure out some sort of modified exercise or you might try yoga. I don’t know what the injury is.
It’s so hard. So couple of things that might be useful, just if there’s not a way to really move your body in a way that you find helpful having a project that you can look forward to, right?
Thinking about is there something that you can be doing that is an activity that feeds you, that feels good to you, right? If not physically necessarily but that just feeds you spiritually, mentally giving you a sense of purpose. I would try that. And then just see if there’s something you can do with that.
Jenn: Amazing. Lisa, Thank you so much.
Lisa: Much pleasure.
Jenn: This has been like the abridged, everything you need to know about anxiety, truncated into an hour. As usual, you are amazing. So Thank you so much.
Lisa: Thanks so much.
Jenn: And thanks, everybody—
Lisa: Nice to spend time with you all.
Jenn: Oh my God. It’s always great to spend time with you. And to those who are joining us, this is the end of the session. So, thank you so much for joining us.
And until next time, be nice to yourself. Be nice to each other and wash your hands. Have a great day. Thank you.
Lisa: Bye, Jenn. Take care, everybody.
Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.
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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