Anxiety about Anxiety

Good afternoon everyone. It is Dr. Nigro again with our next episode of Psychology Unplugged. This week has been really cool. I've really had a good time facetiming with a lot of people. Phone calls. A lot of you guys are flying in from different parts of the country for me to do Neuralsekivel on you or family members. So this is a very humbling experience and I'm again grateful for this opportunity to impart whatever knowledge I can from the perspective of my educational background and training and just professional clinical experience. So the borderline personality has been an incredibly popular topic and we will revisit it. But today we're going to talk about anxiety. It comes to us all. No one is immune to the consequences, the ideations, the physical sensations of something that is very nebulous. And I've repeatedly said that mental health really doesn't have a face. Sometimes anxiety does. Because people can look terrified. Now from a diagnostic perspective we have generalizing anxiety disorder. We have obsessive-compulsive disorder which is different than obsessive-compulsive personality disorder and that'll be for a different topic, a different session. We have panic disorder. We have agoraphobia. But the key in understanding anxiety and treating anxiety is being able from a treatment perspective. Now again, doing diagnostics, I could come up with whether somebody has an anxiety disorder or whether they don't. And you'll see it with, as I said before, depression, anxiety or call the common colds of mental health, mental illness. And they generally go hand in hand. The important part in treating any type of anxiety disorder is to break the anxiety down into a more specific component. Someone will say, "Oh, I'm anxious. Okay, I get that." But anxious about what? Some people are anxious about being anxious. That's called anticipatory anxiety. And then you can even get into things such as the phobias. And you know, we have the most common phobia. As a matter of fact, is fear of snakes, just as an aside. But a lot of people, I know Julie deals with this and a lot of my colleagues who prescribe medications is there's an overreliance on benzodiazepines and medication. Even, you know, the people are looking for the magic pill. But just like with, you get into like ADHD, et cetera, all the concern is going to help anybody concentrate. But it doesn't teach you the skills. So, adivants, Xanax, clonopin, clonodine, butusbari, they'll help take away the anxiety or the panic of the moment. But it does it in from a therapeutic perspective, get to the root of the anxiety. And is anxiety treatable? Absolutely. And part of this different, again, I come from a very cognitive behavior perspective. And the technique is, is really kind of started with it's called vertical descent. He's being able to take this generalized category of am anxious and breaking it down layer by layer almost as if you're peeling an onion. So then you can kind of get to the core component part. Now, people are anxious about a variety of things. You can think of how confident a narcissist is. They're prone to anxiety because they're so afraid of total pulling the curtain and realizing that there's nothing there and they're completely vapid from a personality perspective. Borderline personality is a high level of anxiety. Bipolar disorder has a high level of anxiety. But important part I'm trying to get across is this none of us are immune to this. And it could ebb and flow and it can even get to a point where you can have something called a gorgophobia, which is a crippling form of anxiety where you may not, it personally, not even leave the house for years because of some perceived fear. Now, is the complete absence of anxiety good? No. If you go back to the episode on stress and anxiety, one of the first ones I did, anxiety is part of our survival mechanism linked to the sympathetic nervous system. That's the nervous system that sympathizes with the body when it perceives us in a state of terror or fear or perceived harm. So the complete absence of anxiety is not ideal because then we could find ourselves putting us in situations that we could potentially for negative consequences. So in managing anxiety, one, it's important for everyone to understand that it is treatable. And as I said before, the work in therapy does not take place in the office. It takes place in between sessions. And often with anxiety, a technique that I like using is something called in vivo exposure therapy. So what that is essentially, it kind of sounds paradoxical. Your anxious about this situation is putting the person in the situation. That's the ultimate goal and being able to develop distress tolerance and challenge the irrational beliefs because you'll, you and I hear this term all the time, I have intrusive thoughts and it's this negative recording. And it becomes some a little bit more complicated, still treatable when somebody has actually had an event that they've either experienced themselves or vicariously experienced. So you know, back to the work of Albrevender and social learning theory that I don't necessarily have to have the experience happen to me. I could watch it happen to somebody else and still develop a similar reaction. So example like treating like a social anxiety. I my office is above a classic bakery in duck spree. So, fortunately, I don't have a sweet tooth. But I've done this with adolescents who will say I can't go out in public. I can't even order coffee and McDonald's. I can't it again. Can't people can't fly? Well, Kabbalah is a huge part of therapy. And it's restructuring that you're choosing not to. It's not that you can't go in the situation. You're choosing not to go in the situation. And that's an important part of therapeutically that you're one empowering an individual, but at the same time, placing a level of responsibility that if you want to overcome this, you can't always regress back to I can't it's too hard. Well, then again, the precursor for change, only one reason, none uncomfortable enough. So I've done this with adolescents where who have a high degree of social anxiety. I'm with them. I'll take them downstairs, have them stand in line and order a nice tea. And I'm with them the entire time. And it's very transformative because we'll go back up to the office. And all of a sudden, it's like, if you look at what are called outliers, a great book by Malcolm Gladwell. Outliers are like, you got this whole constellation of all people all do the same thing, but you have this one person doesn't fit in. Those are the people that I'm fascinated with. But outliers will talk about it at a different time. So then I'll bring the adolescent back upstairs. And we're able to have a dialogue of look, you know, what were you thinking? What were the sensations? But the whole point is you were able to do something that in your terminology and vernacular said that you were unable to do. So you have to, from a therapeutic perspective, the goal is to find the flaw in the logic. It's to find the flaw in the thought process. So the person can say, well, I can't really say that because I actually did stand in line and buy an iced tea. So now I got to look at why am I not able to do it in other situations. So I'm just Just using one example, but I think exposure therapy. is a great way of treating anxiety, but prior to what I said before, is being able to break that anxiety down because with anxiety, the, as we look at it as a, and a continuum, the end result of the anxiety is the perceived fear. Okay? Public speaking, that's one of the most common fears people have. Obviously, it's not something I struggle with, but it's a very common fear because anxiety has a lot to do with our sense of self. It has a lot to do with our sense of self worth, and there's a lot of anxiety, especially in a Western society, where we're constantly comparing people, and I can't tell you how many people, one of the questions I asked during my structured diagnostic clinical interview, any problems related to the internet, social media, how many people, children and adolescents, adults, have a tremendous amount of anxiety because they're doing a lot of social comparison, and you know, there's the assumption, well, it's not on the internet, it must be true, and I tell people, people only post what you want them to see, the idyllic picture of what their life is, and then people internalize it, and they look like, oh my God, I'm not going to this college, I'm not going to be as good, or look, you know, this family, but they bought so and so a car for the graduation. My best friend or somebody I knew I went to college with is getting married. A lot of environmental things contribute to the manifestation of anxiety. Now, can it get to the point where it's crippling? Yes, absolutely. And you know, you get into something, you know, obsessive-compulsive disorder, I'll give you a quick explanation of OCD. Obsessions are ruminative ideations. So think of being stuck in an elevator with the music going, and it's like the needle is stuck, and you're just going over and over and over and over. Compulsions are the compensatory behaviors, an individual engagement to alleviate the anxiety associated with the obsession. So let's take the classic example of the hand washer. My hands are dirty, my hands are dirty, my hands are dirty, my hands are dirty, my hands are dirty. The only way to alleviate that anxiety is the compulsive behavior of washing the hands. Now, it's going to get to the point where it, you know, when you get into the diagnosive piece, you're seeing skin that is chafed, you're seeing, you know, it's pretty serious. There's physical manifestations of it, but with every psychiatric disorder, there's a qualifier that the symptoms have to cause social, emotional, occupational, and/or academic impairment. So if you have quirks and you do things, it doesn't mean you have OCD, but if you're late for work or you're failing to keep up with obligations or things that you need to do and those behaviors are impacting life, I would definitely encourage you to get into cognitive behavioral therapy because OCD is very treatable, but it can result in a lot of negative consequences. So this whole spectrum of anxiety is, again, trying to normalize it in the sense that it comes to us all, and if you haven't listened to the stress and anxiety episode, that's the one where I'm talking about, this is what's going on inside your body and how the different neurotransmitters are connecting with each other and what's being released and what's being inhibited. So yes, is there a physical component for some of the things I had to yes? Heart palpitations, sweating, rapid breathing, sleep, dysregulation. So, you know, a lot of people will say, I have intrusive thoughts at night, but again, it's always be able to break it down into the more specific you can make it, vague goals lead to vague results. And even those called generalizing anxiety disorder, if you are able to work with your individual clinician on breaking it down, it wanna becomes a little bit more manageable. It's like, okay, I realize, okay, I'm anxious about this because nothing can change without awareness. And as I've said, I've just because my wonderful colleagues are just completely full of mental health, at least in the United States is, you can't get an appointment anywhere. I'm, you know, trying my best to give as many people and I've taken out a therapy case load. And one of the things I always will say to people is the first become aware. So, we sit with anxiety, become aware of what you're anxious about. Again, there is no such thing as the unconscious. Just completely, Freud was wrong. There's no such thing as the unconscious. Some things are more automatic and we operate with schemas and automatic thoughts. This is, this is working with anxiety. It's slowing the thought process down to become more mindful and if you want to learn more about mindfulness, and be able to do an episode on that, the work of John Kabat-Zinn. The definition of mindfulness is awareness without judgment. It's simply starting to just notice when I'm becoming more, when I'm entering into an anxious state. Don't, and I tell patients, don't worry about implementing any kind of coping mechanism, any kind of intervention. Don't worry about overcoming it because it, and I think that, from a cognitive perspective, that's very helpful because you're not holding a patient accountable to do all these things at once. It's systematic. So, the first part is the awareness. Become aware when you're anxious and then draw your cognitions into what is going on in the environment. What has just happened? Or what do you think is going to happen? So, that's a very important therapy to technique is, okay, X always causes Y. So, we know what the Y is, that's the anxiety. And, you know, the testing is able to delineate, what are those, how the anxiety manifests, idiosyncratic to a specific person. But I think we all kind of, you know, can generalize what our own individual type of anxiety are, whether it's more psychological, whether it's physiological, or a combination of the two. So, helping a patient become more aware, when I start to feel anxious, what was happening right before then? And what you typically find is you're going to start to find patterns, certain situations, certain people, certain types of people, certain tones of voice. Again, this is, again, it might work with patients with anxiety. I found that it really helps when you're able to break it down and helping people to really kind of grasp the understanding is that you can control the anxiety and not allow the anxiety to control you. Because most people who are very anxious are completely don't espouse that or even aware of that. And, you know, it's not expected to, I mean, but if you're in treatment, anxiety one is treatable from a therapeutic perspective, is it manageable? Absolutely, is it curable? Absolutely. It does it take work? Yes. Is it going to be scary? Yes. Is your anxiety going to increase? But probably. But if you do it in a systematic way, and the first thing again, is the awareness. Become aware of what you were anxious about. That's the first part. And then you work therapeutically in stepping in with other interventions. Because most of us are anxious about certain things and we're skilled deficient. And that's just a matter of working with somebody. And I'll do a lot of role play. You know, in a therapy, you know, a therapeutic environment, I try to create the most safe, laid-back environment that I can. And so you can do invivel role play where someone's like, I'm really anxious about asking a girl out. Or you can role play that. And or, you know, a variety of things. And that's a great therapeutic technique in, you know, how do I have this conversation with my father? Or how do I have this conversation with my husband? Or how do you know what, again, this is such a broad topic. I mean, again, it's idiosyncratic to each of us, what makes us anxious. But the therapeutic environment, I think, is a great place. One, two, again, deconstruct the anxiety to make it more specific. And two, practicing with your individual clinician on developing the skill set and being aware of the bodily sensations and not, and again, back to the irrational beliefs of, you know, catastrophizing, dichotomous thinking, generalization. A lot of this stuff happens within the anxiety disorders. are very rational. But again, like I said, it gets a little trickier if somebody is anxious about something and they've had that experience happen to them or they've vicariously experienced it because then there's a basis of reality. So somebody says, "I did a speech in class and everybody laughs." I felt so embarrassed and now I have to take next semester I have to take, they're like majoring in communications but they have this experience and now the next class they have to give a presentation. So you can't argue that they have a modicum of anxiety because they've actually experienced something negative in terms of performing that sort of skill or requirement or ability. So that's a little trickier to work with because the belief is necessarily irrational but you can kind of challenge on them on how do you know it's going to happen again? Then you're talking about thought forecasting, another rational belief. Again, treatable, workable, manageable, do medications help? Yeah, they do. Low doses of antidepressants treat anxiety, pyrodosis treat depression but they do not take away the individual, individualized experiences, the people, I hate this word, I absolutely hate this word but the triggers, the people who use this all the time, this triggers me. Okay, that's good because that's a useful technique in terms of that's the X. The trigger is what leads to the Y which is the individualized manifestation of anxiety in a specific person. You know, the research is consistently shown, cognitive therapy, psychotropic medications are the most effective in the treatment of the vast majority of psychiatric conditions, very effective in treating the anxiety and depressive disorders. But again, you can overcome your anxiety and take away the power. You have the control and that's the beauty of the human experiences. How much power we actually have? I think when we're mired down by certain situations, negative things have happened to us, negative things have come to us or we're anxious about things happening to us. The human condition and the human spirit is amazingly resilient, turn to spirituality, turn to music, turn to the arts. I mean, we have so much at our disposal and access to things that guide in meditation, the work of Deepak Chopra. Research shows 20 minutes a day, incredibly effective, just YouTube it. I've done it with Julie and I remember one of the few times in my mind, she said, "I think your mind actually was quiet from once." But music is great, therapy, massage is exercise, there's a lot of things you can do because distraction is not an ineffective tool. Avoidance is more problematic because you're just avoiding the inevitable of not wanting to deal with it. But distraction is a great technique. Sometimes, the class example put a rubber band on your wrist and every time an intrusive thought or anxious thought comes to mind, snap the rubber band, works for some people, doesn't work for everybody. A lot of different techniques, a lot of holistic interventions. Julie's mentioned several of those on different episodes. So it's really a treating anxiety. There's so many different component parts and different options. You have it in the therapeutic process. Again, I'm coming from a cognitive behavior perspective, but I certainly incorporate a lot of other things. The mind is a fascinating thing, but the human condition is powerful. I just want to instill a sense of hope that you can overcome this. You guys can overcome anything, but it's working collaboratively with your clinician and something that I want to bring up and talk to your clinicians. If you feel that you're, you know, there's things you want to talk about that you're not talking about, you have every right to bring those things up. It's a mutual relationship. The metaphor I use, when I see somebody for therapy is, I'm like a GPS. You give me the end destination. What does S-Post look like? Like a GPS, it will recalculate. So, this technique is working or this intervention is working. We will recalculate, but I will help you get to your destination every step of the way, but I cannot and I will not drive the car, but I will always be in the car with you. That's the metaphor I use in publishing how I do psychotherapy. So, a very broad topic, but a universal experience. And, you know, for me, when I'm anxious, I listen to Bruce Springsteen or I play the guitar. Again, I mean, it comes to all of us, but distraction is a great technique and intervention, but awareness. I just encourage you to become more aware before you become anxious. Look for the X's. Those are the things, those are the things that are going to lead to the patterns and the foundation and the groundwork. Because you already know what the end result is. You know what the Y is. That's the anxiety. But it's treatable, it's manageable, it's curable. Does it take work? Yes. Will it cause some anxiety and distress as you go along? That's what's called distress tolerance? Yes. But the resolve of the human condition is amazing. And I have seen it in the patients I've worked with over the years, I've had the privilege to work with the amount of effort that they have put in leads to those results. And I'm talking across a wide spectrum of disorders. And I said this before and I've talked to several people this week. Yes, is borderline personality curable? Yes, it is treatable. It is curable. Is schizophrenia curable? No. Is it treatable? Yes. These nebulous conditions and a huge reason doing the podcast is to provide as much education as one professional and again love doing this every week. Glaver region is big minorities as we have. But again, it's very humbling and experience and very privileged to do this and hope you guys are benefiting from it. And next time, take care of yourselves, take care of each other, be well, and I will talk to you then. Bye guys.