How to Overcome Anxiety, Solved

Welcome to Solved Everybody. I'm your host Mark Manson, and today we are ranking anti-anxiety interventions from the worst to the best, according to the current science. Have you ever tried to put out a kitchen fire with a glass of water and then stood there wondering why the kitchen is somehow more on fire than before? No, this has never happened, but apparently this has happened to drew Bernie, so what we're running with it. Because that's kind of what most people are doing with their anxiety, reaching for something that feels like relief, watching it work just well enough to keep reaching for it and then ending up worse than where they started. Most of the interventions that people swear by, the supplements, the apps, the techniques, all the stuff that we're going to get into in this episode, they are not chosen because they're the most effective, they're chosen because they feel easy and they feel quick. We're going to talk quite a bit about that, about the relationship between the quick fix and the actual long-term solution. We've picked 17 of the most common practices, supplements and interventions that people use to combat their anxiety. Here they are in alphabetical order. Adaptogens, alcohol, benzodiazepines, breathwork, CBD, digital detoxes, journaling, physical exercise, magnesium, meditation, probiotics, psychedelics, therapy, sleep, socializing, SSRIs, and your favorite, yoga. We're going to break down each of these 17 interventions into how well they work, how efficient they work, how long lasting the benefits are, whether there are any benefits or not, and how strong the actual research behind them is. As always with these ranking episodes, there are surprises and there are interesting patterns that emerge. And as always, here it's all, we categorize everything into four categories. Things that legitimately work, actually good things to do, the sorted depends category, the stuff that maybe works for some people, not for others, maybe works in some situations, but not every situation. There's the not helping, but not hurting category either. This is where you get a lot of your placebo effects or just things that are, the effect is so minuscule that like, you're not really doing anything, but you're not hurting anything either. And then finally, there's the bullshit category, which is the pseudoscience, the stuff that is potentially harming you, and the stuff that is counterproductive. We will start with the bullshit category, work our way up to the legitimate fixes and end at the number one intervention for anxiety in the world based on the current science. You might be surprised, you might not. There's definitely some interesting caveats either way. Anxiety seems ever present these days true. It seems like everyone in their dog has anxiety. I use that saying a lot, everyone in their dog, but like in the case of anxiety, literally, I can't tell you how many friends I have, they're like, "Oh, my dog has anxiety. I have to go home." I'm like, when did this become a thing? They're maybe even on meds, too. They're dogs. Yep. This is how far we've done. This is where we're at. All right. Everyone in their dog has anxiety. So we will inevitably get into many of the mechanisms and processes behind anxiety. We'll get into a lot of the cultural stigma and labeling around anxiety. We will get into how anxiety is perceived and treated today versus say, generations past. And basically by the end of the episode listeners, you should have a deeper, more comprehensive and more nuanced understanding of anxiety, how it works, and how to actually resolve it than you ever had before. For those of you who are new here, I am the three-time number one New York Times best-selling author, Mark Manson. And this is my co-host, lead researcher, producer, and all around sick man. I'm more or less the one. Yes. Yes. And this is the solve podcast where we are the most over researched and comprehensive personal growth and life advice podcast in the world. If you love the show, please like and subscribe, leave a comment, share with some friends, follow us at solvepodcast.com. You ready? I'm ready. Let's do it. Before we dive into the rankings, Drew, I think we should lay a little bit of groundwork and talk about what is anxiety, what makes it unique. I do think it is a unique emotion in some ways. It is a little bit different than most other emotions that we experience. The American Psychological Association defines anxiety as, quote, "an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune." What's interesting about anxiety, I think, is that it's a, it's future-based, and because it's future-based, there's a certain amount of cognitive load. It's almost like an out shoot of our natural tendency to just want to predict what's going to happen. And so I think what makes it a little bit different than most other emotions is that it is very much influenced by our thoughts. A lot of emotions are almost more primary. It's like we have the emotion and then our thoughts kind of justify that emotion after the fact. I think to a certain extent, anxiety, because it is an outcrop of us trying to predict the future, it is somewhat cognitively induced. I think we'll see this show up in the rankings when we go through them, that a lot of the stuff that doesn't really work is just trying to apply to the emotion, whereas the things that tend to work a little bit better are a little bit more cognitively. Dress was underlying thoughts. It's our ability to predict, or our penchant for prediction where you're saying, marrying that with our negativity bias almost too, right? Yes. You could define an anxiety almost like that. It's our, we have this like strong, just like desire to predict the future and try to figure out what's going to happen, but we're also very negatively biased towards bad things happening as well, which is an anxiety. Which is, if you think about it, evolutionarily adaptive. It's like let's say you and I are hunter-gatherers and we're out on a hunt. This is how anxiety differs from fear. Fear is present-based and it's very specific. Let's say we're on the savannah and all of a sudden a lion jumps out and is ready to attack us. You and I would both experience fear, because there is a present danger. It's immediately in front of us and is very specific. It's like there's a lion and he's about to attack me. I'm afraid. Anxiety would be if you and I are on the savannah and we are thinking about what if there's a lion around here? Where should I look to try to spot the lion? That's anxiety. It's kind of this low level discomfort at potential futures that might happen. And obviously it's important to think about those potential futures. In many ways, the more you worry about something, the less likely it is to happen because the more you're going to prepare for it and prevent it from happening, it is adaptive to a certain extent. It's unrewarding in that when anxiety is actually useful, you don't get to experience that usefulness. Because all you know is that the bad thing didn't happen. So let's talk about causes. Why do people struggle so much with anxiety? I think this is also going to be very useful for once we get into the rankings. Researchers estimate that roughly 30 to 40% of anxiety is largely genetic. Some people just have far more sensitive sympathetic nervous systems than other people. They're more easily triggered. They're more sensitive to their surroundings. They're more predisposed to experiencing fear, anxious thoughts. I think in personality research that you would just call this a highly neurotic person, women are consistently more anxious than men across the board. All ages, all cultures, regardless of how much equality, gender equality, socioeconomic equality, there is. Women are just always more anxious. Second thing that's really interesting is that young people are more anxious than old people. And that I find really interesting, especially given the future-based foundation of what anxiety is. In many ways, young people have a lot more to be anxious about than old people. And also, old people have lived through so many more failures, setbacks, challenges, struggles, etc., etc. That they've probably developed scar tissue where they're like, "I'm going to be fine. I don't need to worry about this." So when it comes to environmental factors, obviously, trauma gets talked about a lot. Trauma or other early childhood adverse experiences. They sensitize to amygdala, and they often disrupt or prefrontal cortex from helping us emotionally regulate. I think this is maybe an important distinction. It's not that trauma causes anxiety. It makes us less equipped to inhibit anxiety. People who experience a lot of trauma, they struggle to regulate their emotions in general. They struggle to think clearly, they get triggered more easily. And so, again, kind of that cognitive intervention of actually thinking to yourself, "Is this threat reasonable? Is there really a line that's going to come eat me?" It prevents you from being able to do that in the moment. The other cause that I've added here, that I have not really seen talked about much in the psychological literature is what I would call more of an existential anxiety. And I've written at this point pretty extensively about how I personally believe that much of the mental health crisis is kind of an offshoot of this existential crisis that people are having. This dates back to Kierkegaard in the 19th century. So Kierkegaard noticed that there was something about modern life that seemed to amplify people's anxieties, that they seem to consistently be anxious about nothing, and that that seemed to be kind of a new thing. And throughout his life, it appeared to be getting worse. Kierkegaard attributed it to this to the "dissiness of freedom." What he argued is that as modern life gives people more freedom, more optionality, more opportunity. in their lives, they become paralyzed and afraid to make decisions. Each individual decision suddenly becomes much more difficult because it has far more long-term implications on their lives. And so paradoxically, that increase in freedom and optionality makes them feel more anxious for the future, even though objectively their lives are better than, say, previous generations. In my opinion, today we're just living through that on steroids. In many ways, I think what people experience as anxiety is kind of just this crippling fear of commitment, of making a decision, of owning a decision, of being accountable to their own decisions. Because you might make the wrong one. Because you might make the wrong one and it'll fuck up your future forever. And so it's better to just be really scared and stay at home and do them scroll for another six hours. Anything you want to add, Drew, before we get into it? Um, I have full anxiety. What's been your history, I guess? I have panic attacks when I was younger, I'm going to do my mid-20s, I would say. Okay. So it's definitely, this is hits close to home, it runs my family, too. Okay. Yeah. Well, I know you have a lot of sleep problems, too. Sleep problems, too. I imagine that. Sleep problems, too. Sleep problems, too. That doesn't help. Yeah. That's attached to it. Yes. Yeah. A lot of rumination at night. There's definitely a lot of that. Yeah. My anxiety is pretty limited to social anxiety. I had a lot of social anxiety when I was young. And interestingly, like, outside of social anxiety, I experienced very little. And I think the social anxiety was just fucking trauma. Oh, yeah. Yeah. I think a lot of people can relate to that, though, too. Yeah. It's probably the most common source of anxiety, society, for sure. Yeah. Absolutely. Yeah. I guess that's the other interesting thing about a lot of this, too, is that, like, some of these interventions, I think, are a little bit more targeted for certain types of anxiety than others. Like, there is, it might be worth defining that there's kind of a, there's a thing called a GAD, which is generalized anxiety disorder. So like, if you go to a psychiatrist and you're just kind of anxious all the time in every context, every situation, like, you can be diagnosed with, with GAD, that's a relatively small percentage of the population. Most people just suffer with either an acute anxiety in one area of their life, whether it's social anxiety or performance anxiety or perfectionism or insomnia or whatever. Some people are just very anxious, neurotic people in general, but it's not like a debilitating disorder or whatnot. I don't know. Sometimes I think anxiety helps me. That's something that never gets talked about. Sure. Yeah. There's a certain level of, like, high-functioning anxiety. Like, if you think of some of the most successful and productive people in the world, they're extremely anxious. You know, there's like, the anxiety is kind of a fuel that runs inside of them. So on the one hand, yes, like, it's not great mental health. You're not feeling good when you're super anxious and that drives you to perform really well or work really hard. But on the other hand, it does potentially produce better outcomes. I don't know where I completely land on this. I think as somebody who personally feels, often feels anxious if I'm not doing something productive or useful, I kind of like having that anxiety there. I think this is a common fear a lot of people have is if I don't have my anxiety, then how am I going to get anything done? How am I going to pressure myself into doing the things that need to be done? And hanging onto that anxiety, I think, is a very common thing that people do. I definitely do it. I think it honestly got me through a lot of university for one, you know, it's just anxious about it. You talk about, yes, social anxiety is a problem for you, but you don't have a lot of anxiety and a lot of areas. Would you tend to hire people who, like, have that anxiety for you, you're kind of outsourced and outsourced to people? So I mean, I get it. It's a tricky one. And I think people are like, no, my anxiety actually helps me in some ways. And there's some truth to that, too. This is a common fallacy, I think, in mental health and personal growth, which is that, like, the optimal amount of a negative emotion is never zero. You should always have some anxiety. Like anxiety exists for a reason. It's adaptive. Like, we evolved it because it actually helps us do things that are important for our survival for our community and our relationships. The problem is when it's chronic and it's occurring in places that it's not healthy. Right. Is the fact that I'm constantly anxious at work? Is that misapplied? Or is it actually like helping me crush all my goals and be super successful? You know? The thing I always come up against, though, too, is there's people who are like, oh, man, just don't worry about that. You know, like, things take care of themselves. No, it's us anxious people who take care of things sometimes, you know what I mean? So, like, I get it when people are kind of like, no, actually, you do need to worry about it. Now, but 100% on board with you there where it's when it's misapplied or just generalized to everything. Yeah, the optimal amount you're right is not zero, but it's also not, you know, 100%. The goal is not to get rid of all anxiety. It's to, I guess, manage or have anxiety in the areas of your life that it's advantageous. I think the other factor here is something I've written about in my books. I have a bit of a spicy take about this, which is that people are not more anxious because the world is scarier today. They're actually more anxious because it's much safer. And it's when your life doesn't actually have real problems to worry about. You start inventing problems to worry about. And the fact that we have access on our phones and the internet and everything to like everything going on in the world, people are convincing themselves that there are very real threats and real problems all the time where it's like if you actually objectively look at the average person's life in the developed world, like you are sitting in an air condition room on a comfortable couch watching screens that are broadcasting information that was created thousands of miles away and you're doing all of this insanely low cost. You're all of your food is provided for, you're warmth is provided for, all of your basic needs are provided for, you're safe, you're secure, you live in a functional society. There's actually not a whole lot to be anxious about. I'm on an evolutionary historic scale, but because there's nothing to be anxious about, we invent things to be anxious about because it feels meaningful, like we need something to worry about, otherwise we wouldn't know what to do with ourselves. Okay, so like an anxious system is so fundamental to like the human species you're saying that it just goes, it's online at all times. So there's a great quote in subtle art that I love, which is, it comes from Jose Marti where he said, if the mind does not have a problem to work on, it will quickly invent some. And I think by and large, that's like the issue of our age, right? You have a lot of people that life is comfortable but meaningless. And so instead of like admitting how meaningless things are, we invent meaning by imagining threats and problems where there aren't any, it comes back to that misapplied anxiety, right? Like it's like anxiety is useful when it's applied in a realistic way that's actually helping you or it's producing some better outcome. If you don't have a place to apply it, if you don't have a direction to point your anxiety, then your mind will just start inventing places to point it. And it will start finding reasons to worry. And because those reasons are not real and they don't exist or you have absolutely no control over them, you can't do anything about them. So they persist. Anyway, let's get into the ranking. Okay. All right, so number 17 are our list. There's only one item in our bullshit category for this episode. There's only one thing that if you actively do it, it will make your anxiety worse, at least that we looked into. And this one will probably not surprise many people, which is alcohol. It's the anxiety cure that two billion people actively use around the world that is making their anxiety worse. The data on the amount of people that self-medicate with alcohol is like absolutely staggering. It is funny that it is conventional wisdom that alcohol helps take the edge off. I used to be one of these people that after a really hard week, I couldn't wait to go out and get a drink because it was just going to help me relax and chill and forget about my problems, but not, and what's interesting is that, yes, alcohol solves anxiety in the short term, but it actually creates more in the long run. Yeah, I mean, about one in four people who have a, as some sort of anxiety disorder, they confess at least to self-medicating with alcohol, right? And it's honestly probably much higher than that, just because it's so accessible. And you're right, there's such a quick fix or it is a quick fix. It works in the short run. The problem is, is the bounce back, there's an over correction towards the other way. If you're paying attention and you've done this before, you know, this is what happens, right? I was talking about, you know, I've had panic attacks before I had some anxiety around things. I noticed too that after like a heavy night of drinking the next two or three days, my anxiety was just off the wall, right? Just it was terrible. Yeah. It gets a little bit more complicated than that though, as well, because your motivation for drinking actually does matter here, to some extent. If you are drinking because of your anxiety, that's usually, there's usually a hard bounce back from that. If it's social drinking, light drinking here and there, those effects that bounce back seems to be attenuated at least to some degree, can't completely eliminate it, I don't think. But alcohol does, again, it does work in the short run. Yeah. Okay. And it has like it's probably the same mechanism as a lot of drugs that will eventually get to here. This bounce back effect is actually strongest in the people who are most likely to engage in alcohol for anxiety, right? Use alcohol for their anxiety. So shy, anxious people who are like socially anxious, who use it tend to have the bigger. bounce back here. There's some evidence that has for a long time pointed out, you know, you probably heard this for a long time, you know, having a glass of wine with dinner is good for you or one drink a day is good for you, whatever, honestly, probably not the case. We're finding out more and more. What happens is a lot of times what they'll do in these studies is they'll compare those people who just have one drink here or there or only drink socially compared to people who don't drink. Usually what happens is these people who don't drink have already quit drinking because of their health issues. Yeah. And so they're, they're just naturally less healthy. Right. In the United States anyway, Arizona has like the highest respiratory illness rate, which is weird because everybody moves to Arizona because they have the clear area, the clear area. But it's because a lot of people with those diseases will move to Arizona, right? Yeah. Same thing with alcohol. People who quit alcohol usually it's because of health issues or problems around their alcohol use. Yeah. But the thing is is that bounce back. I know I would just have terrible anxiety, you know, the next day, just feel awful. I started noticing this probably in my early 30s that I would often feel like an intense sense of like embarrassment or shame the next day, which was like completely irrational. Like it's like I didn't do anything right embarrassing or shameful. I just feel like I had an awkward conversation. Like I just, I would start ruminating about all these things that had happened the night before. And eventually I just realized I'm like, oh, that's part of the alcohol, it's like fucking with my emotions. The interesting thing for me around this, I noticed this back when I was a dating coach. And it was interesting. One of the fascinating things was to see this confirmed in the research when prepping for this episode back early in my career. One of the first businesses I ever started was as a local men's dating coach. And so what I would do is I would actually go with guys to parties and bars or whatever and I would help them talk to girls, probably the most common issue that guys had was anxiety. And it was interesting because obviously most men when they're anxious or nervous and they want to talk to an attractive woman and they don't have the nerve to do it. What do they do? They have a drink and that drink like loosens them up, relaxes them, gives them a little bit of courage. I mean, we even call it liquid courage, right? In the business we used to call this approach anxiety. And it was super common among men. But what I noticed after I had been coaching for like a year or two, what I started to notice was that the men who drank to get over their approach anxiety never actually got over it. Like they would they would have a bunch of drinks and then they go meet a bunch of women at the bar. And then three weeks later, they would hire me again and they'd have the exact same problem. They had they hadn't progressed at all. They hadn't learned how to talk to anybody. They hadn't overcome any of their insecurities or fears, whereas the men who didn't drink and just pushed through it, those guys would get over it. And a month or two later, they're like, they're able to go chat with anybody they wanted. There's an idea of fear extinction, which is like this, it's kind of the the active component of exposure therapy of like actually confronting a fear, realizing that it's not going to kill you. And then like teaching your brain like, hey, don't be afraid of this next time. We're okay. We've got this. Interestingly, some substances interfere with that feedback loop. And they like prevent the ability for the exposure effect to actually take place. I 100% believe that alcohol is one of these because I just I noticed it myself like I didn't get over a lot of my social anxiety until I stopped drinking around other people. And similarly, a lot of my old clients, they wouldn't get over their social anxiety. And so eventually I would start when I worked with guys, I would, if they had a lot of anxiety, I would make them not drink that night. And that in and of itself would freak them out. But it's easy to see how this just becomes a crutch, right? You're socially anxious, you have this negative stimulus going on, you reach for a drink, you drink, you're not as socially anxious, so you're good to go, that cycle just repeats itself. But then you're leaning on that all the time rather than like you're saying, developing these coping skills like actual mature coping skills for this. So yeah, yeah, this is definitely the only one though that gets negative negative ranking in our our book here. Yeah. So I was actually curious and I ran the numbers on what would stopping drinking? Where would that land on this list? Like as an intervention you're saying. Yeah, exactly. So if you took like heavy drinkers with anxiety and you got them to stop drinking, what would the effect size be for those people on their anxiety and then where would that land on our list? Do you want to guess where that would land? Oh, middle of the pack somewhere probably. Number four. Really? Number four. Which again, as like somebody who stopped drinking three years ago, one of the biggest and first benefits I noticed is just like a steady emotional state. Like true. Yeah. Super steady. Nothing like very few things phase me. And your ability to regulate emotions too. Yes, in general. Yeah, just like not getting upset over stupid stuff, not worrying about dumb stuff. Like I, I, I definitely feel that. Yeah. All right, number 16, magnesium. Ah. I'm a boomer. Yeah. I don't, I don't really get, I don't really get on TikTok, but apparently this is a huge thing on TikTok. All the rage. Yeah. There's all of these videos promoting magnesium for anxiety and magnesium supplements and the different types of magnesium and all the different like biocanical mechanisms and all this shit. It's not a thing. Apparently, it's just not a thing. It's like very, very, very modest effect for most people. Yeah. Now, here's the thing though, if you're deficient in magnesium, that might actually be an issue. But I mean, it's kind of hard to tell whether you're deficient in or not, I mean, there are a lot of people who are deficient in magnesium, okay? And so if that's why you're, you're anxious than taking some magnesium, we'll get you back to the baseline. I don't think it's going to fix your anxiety. But there's a lot of other reasons you might be anxious as well. The problem with the magnesium story really though, it's a plausible mechanism. Don't get me wrong. Like if, again, if you're deficient in it or there's also two just neural mechanisms that use magnesium that where if, if there's not enough magnesium there, it could, in theory, produce more anxious states. Sure. But the problem is, is that the evidence that we have for it is just all over the map. In terms of like study quality, they're using different forms of magnesium, it really depends on the type of magnesium you're taking, whether it can actually cross the blood brain barrier or not. The evidence out there is very scant for this because of these methodological issues. Okay. And so supplement companies have come out and they've said, oh yeah, that magnesium works because they point to one small poorly done study. We're going to see this happen quite a bit, but that's definitely happening with magnesium here. Let's do it. So the Israeli government, I think, I'm just joking. There's this new thing that's happening in social media marketing. Most people are probably not aware of this, but if anybody works in online marketing, you probably are. So there's this new thing called UGC marketing, which is, it stands for user generated content. And basically the idea is there are now platforms and mechanisms where you can go, let's say, like let's say I'm a magnesium supplement brand. I can go to one of these platforms and I can, what you do is you pay social media creators on a per view basis. So basically what you do is you go and you like set a bounty, you're like, I'm willing to spend $100,000 to get 10 million views on social media promoting my magnesium brand. But to qualify for the money, you have to post a video that gets at least, I don't know, 50,000 views or something. You post it on the platform and then there's like thousands of like TikTokers and people who post on Instagram and stuff like that. And then they just make content about it. And then if they get one that blows up and goes viral, they get paid. I see. So they're incentivizing trends basically. Exactly. And so in the reason it works really well for brands and products is that you can kind of get this like fake feeling of grassroots, right? So it's like people are, people are suddenly seeing magnesium pop up in like 20 different spots and like 20 different people. There's like that stay at home mom that they follow and TikTok is talking about it. Big study that just came out and the fitness influencer, they follow an Instagram is talking about it and it's like, and so you synthetically generate a social trend just by paying dozens and dozens and dozens of small creators. And I say this is someone who fucking has like three giant bottles of magnesium in this cupboard and takes them every night. Yeah. Yes. I was told years ago that I should be taking magnesium. I'm probably deficient. It's going to help me sleep. It's going to calm me down. Well, again, if you are deficient, obviously magnesium is very, very important. It's very essential. Okay. And get it. For example, there's one study that a lot of people point to is back in 2021, where they found like a magnesium plus B6 or a magnesium intervention that had these two groups like one had magnesium plus B6, one had magnesium found that it calmed anxiety. The problem with that, though, was it was this post-hoc study or this post, I was a different data set that they weren't even using for to test whether magnesium helped with things that either you're not. They just looked at it after the fact they didn't have a control group. So we don't know if it's just a placebo effect or not, but a lot of people point to it. Yeah. And so if it coupled that with your conspiracy theory, you know, where it's like there's kind of like, oh, this one study, which even the authors were like, be cautious about this because we don't have a control group. This was just a post-hoc analysis, but this happens all the time. It defines that. They run with it. Couple that with the UGC campaigns you're talking about. What looks like a science-backed finding, which is actually just a marketing thing, all behind it. I would say this is actually the rule, not the exception in the supplement industry. Shout out to Saul Orwell, so that I'm old friends with the founder of examine.com and they analyze all the research on supplements and basically like really break down like, this is to actually work or does it not and surprise, surprise. Most of it does not. But I remember I was hanging out with Saul like maybe five years ago and he had literally spent his entire career investigating supplements, looking at the research, studying all the research and I remember asking him, I was like, so in 10 seconds tell me what is actually worth taking every day? And he was like, dude, it's super simple. Just take fish oil. Oh, really? That was it. This is pre like creatine boom. Okay. But yeah, I think he was just like, yeah, just take fish oil. Don't worry about anything else. And he was like, Oh, and protein, if you like, you know, if you want to get your other. Yeah. Okay. Number 15, I think this is the first surprise for people. This is the first one that people are going to be like, huh? Really? Journaling. Why, why is journaling this low? Well, okay. There's, it's a little bit of a nuanced story here. Yes. What do you mean by journaling? I guess first. That's the first question you have to ask yourself. Pulling out a piece of paper, writing out your thoughts. You know, I mean, there's a lot, there's a number of different methods of journaling. So there's like gratitude journaling and there's like goal setting and there's a, you know, kind of more of a therapeutic journaling like there's brain dumping. And I think it's worth remembering that this is not an indictment on journaling's usefulness in general. In fact, on our episode last month, on the most effective self-improvement techniques, journal, journaling scored pretty high. Yeah. This is specifically for anxiety, right? As an intervention for anxiety, journaling is not super effective. And I guess to me, it intuitively makes sense, right? Because like, what do people with anxiety do? They think way too much. And what is journaling? It's thinking about your problem a lot. So I could see how it could like not necessarily make things better. But I'm curious what you found like digging deep into the research. I think you're absolutely right. It's the thinking about it too much, the way you're thinking about it too much actually to, I think matters quite a bit. So like for instance, gratitude journaling, which recovered in the self-help techniques thing too, it can make you more grateful. Sure, especially if you're not a grateful person, probably not going to do a whole lot for your anxiety. Freeform expression journaling, where it's just just right about whatever. Again, not very directed. Probably you just get to ruminating more is what happens if you're with anxiety, venting like more catharsis. We talked about that too. That doesn't really work either. Again, just kind of highlights whatever you're anxious about. That said, okay, there is a type of journaling that actually can work. The problem with it is usually that it's the least likely for anxious people to use and/or stick with, which is a form of kind of an exposure therapy. So if you're writing about your anxious thoughts, you're writing about what you're worried about, you're writing about. It's the negative visualization exercise that we talked about on the stoicism episode because I believe a Seneca actually used to recommend this, is that imagine the worst-case scenario, map it all out in your head, and then imagine how you would handle it and deal with it. Basically, mentally rehearse all the things that could go wrong that you're worried about because the process of mentally rehearsing it will give you the confidence to actually confront it. There's truth to that. There's some evidence to suggest that this will work. If you do this for 30 minutes a day for three days in a row, there's some evidence that this actually helps with your anxiety. You have to be consistent with it beyond that, though, probably. Most people with anxiety give up after the first one. That's another problem that they have with it, like even in a very simple online study that they did where it was internet-based, over half the people just gave up on it, which didn't even want to do it for more than a day, which 30 minutes a day for three days shouldn't be that bad. It's not that much. It's bad enough where people with anxiety don't like to do it. I don't have the study in front of me. I do remember early on in the research process coming across a study that one of the things they said is that there is an effect size here, like this method of journaling does help, but you have to do it so consistently for such an extended period of time for so many hours over so many weeks that it's just not super practical. Right. For most people with anxiety again, they're reticent to even go around that or to do that. In the emotions episode, we talked about affective labeling. That can help with emotional regulation, for sure. It's usually a short-term fix, though. It has a short-term effect. Any anxious feelings that you have around it where you label them, yes, that can help you in the moment, but long-term again, you have to have that structured kind of exposure to it. All the things you said, it's like that combination of everything where it's not just the exposure to it, not just thinking about it, but also like how am I going to deal with it? What that does is it creates this narrative for you that can help you address the anxiety. That's more of a long-term thing and it's not a quick fix, which is what most people are looking for when they go to sit down and journal as a quick fix. They want to feel better within five minutes, yeah. That's not going to happen. Yeah, you have to really put a lot of time and thought for sure. I also could see a way that journaling could potentially backfire a little bit. This is not coming from the research. This is just coming. This is a Mark Manson hair brain theory. I do think there's something about labeling yourself as a certain way. If I'm always telling myself I have anxiety at a certain point, that is going to get embedded as an identity as something, as a way that I see myself in the way human psychology works is that as soon as you see yourself a certain way, you will start looking for things that confirm it. I could see how if you were constantly writing down or journaling or talking to friends and telling everybody how anxious you are all the time, you were suddenly reinforcing that anxiety. You will prime your brain to secretly look for reasons to confirm that anxiety. The act of being vulnerable of sharing your truth could be undermining the actual process of getting rid of the anxiety. I think at a certain point, this is going to sound really obvious when you say it out loud, but it's quite profound that part of the way of getting over anxiety is deciding you're not anxious anymore. It's incredibly difficult and complicated to do it. That is part of the end state. I do think there is a certain threshold where the impulse to heal yourself is creating the damage. Again, coming back to the point that the optimal amount of anxiety is not zero. If you don't have anything legitimate to be anxious about, your mind will start creating things to be anxious about. There's that saying, don't believe everything you think. This is a classic, I think anxiety is a great situation to be aware of that. I think you're right. You can write about it. You can write around it without confronting it. That's where you can stay in that hell for a long time. If you're not careful, you're not aware of it. What's worse is that you get the sense that you're doing something. We talked about this in the self-help techniques. In many ways, the worst self-help techniques are the things that give you the sense that you're doing something without actually doing anything. In this context, the context of anxiety journaling can do the same thing. You're constantly writing out all the things you're worried about. All you're really doing is just reaffirming that worry without necessarily solving it. Because I do think there are other things in life that are journaling can be very beneficial for. All right. Moving on. Number 14, CBD. Sorry, California bros. Let me go outside and apologize to all the California dispensaries for this one. CBD oils, CBD products, CBD edibles. Not a whole lot there. Tell us about this one, Drew. CBD. So, cannabis dial. It's a product of the marijuana plant, right? It's a, but it's THG's what's get you high. CBD apparently is what just makes you calm and doesn't get you high. That's kind of the story we've been told, right? It's a $5 billion market. The CBD supplements market is $5 billion. Okay. There was a meta-analysis in 2024. So a very recent meta-analysis. They looked at 1,550 studies of CBD, okay? Okay. And so they're like, okay, we're going to, the meta-analysis, again, you find all the studies about the studies, right? It's a study about the studies. Of those 1,550 research papers that they found, they could only include eight of them in their analysis because they said all the other ones just are so poor quality. They suck. They suck. We can't like, some proper controls to small bad methodologies. There was eight studies that were like these, these fit the bill for, for our criteria, which is stringent criteria, which by the way listeners ate studies is nothing. It's nothing. It's nothing. It's told 316 participants out of those. It's very, very small sample size we were going on here. Okay. Again, all the others were so poorly done there, just like we're not even going to include them in this. Okay. They did find, now in this study, they found a big positive effect. Okay. Okay. But the thing was, is that they're like what they call the confidence interval, right? It was so wide that they're like, it's either amazing or it barely does anything. We're confident of that. Like that's the best we can do. That's what we can tell you. It's either awesome or or nothing. Nothing. Like that's that's that's the best they can do. It's kind of useless. Right. And so useless information. Yeah. With magnesium too. There it makes sense. Like the CB one receptor, which is what the the receptor in your neurons that CBD rate attached to. It probably is a good target for anxiety. It just looks like the supplements like taking oral supplements for it doesn't really work. At least the evidence we have for it is is just really not there, okay? And there's just come some weird findings I found too, like a couple of stars. studies found that exactly 300 milligrams is what you need. Anything more, anything less, doesn't do anything or makes you more anxious. - That doesn't make sense. - Doesn't make a whole lot of sense to me either. And not only that, but most of the commercially available CBD supplements out there are between like 10 and 50 milligrams anyway. So even if it was 300 milligrams, you'd have to take a whole bunch of them. - So you'd have to take six doses. - Well, maybe, maybe, maybe, because then the other problem is quality of these supplements. They've, a 2022 study took 80 different CBD products that were commonly found on the market today and tested them and only just over half of them have what they actually, the amount of CBD said they had. So you don't even know how much you're getting, even if it does work as an overall supplement. - I'm surprised this is higher than magnesium. - Yeah, honestly, this one we probably could have switched with magnesium. - I mean, I think it got skewed by that one study that found strong results. - Huge effect size, yeah. But again, the certainty on it wasn't super high. So in some form, it could work if they come out with some method of delivery that actually, like we can point to it and say, yeah, that's what's going on. - Yeah. - It might work, but what we have so far is, it's kind of garbage, just not a whole lot going on. I don't know how common this is anymore. I remember there's been way more common, say, six to eight years ago, maybe a little more. - Yeah. - I mean, I know there's still some. - Yeah, you know, it's like CBD in your coffee or CBD in butter. - I feel like it blew up kind of late 2010s. I remember taking it, I remember I went to some event and one of the sponsors was a CBD product and they gave me a bunch of supplements. And I remember taking it, it was supposed to help with like injuries and pain management. It's one of those supplements, supposedly it does everything. - When it came out, yeah. - But I remember taking it for like a week or two and I'm like, I don't think this does a fucking thing. I think I'm just pissing this out every day. - Not surprised by this one. - Like, given everything I know and understand about the supplement industry and I took one look at the research summary for this and I just kind of chuckled on like eight good studies out of 1600, okay. So yeah, I guess I don't think we need to dwell on this too much. This is probably nothing, it's probably a placebo. But number 13, I think is going to shock a lot of people. The digital detox, the getting out in nature, getting rid of your phone, getting out in nature, going for a walk, going outside. - I want this one to work. - Yeah, I'm not gonna kind of does. Well, look at that. - Yeah, I'm not gonna lie, I was a little disappointed too. This is definitely one of those things where it's, we're probably getting out of probably nothing and we're getting into sort of maybe depends category. I think the surprising thing here is that if you spend time on YouTube or listening to the other podcasts, like this is the biggest and most important in life changing thing. I mean, just among my friends and family members, the amount of people I know who are like going on retreats and going to the forest and like getting rid of their phones and turning their phones off for multiple days and like all this stuff and then swearing that it's like such a detox and a relief and they clear their mind and everything. It's a very common meme at the moment. I think one of the issues might be those that replacing like your digital habits with going outside, it does actually make you less anxious in the moment. It's just not a long-term fix. But they found like you can decrease anxiety like in the short term by just going outside and not looking at your phone or not looking at screens or not looking at the news I think is a big one too. The thing is is that the bounce back is usually really, really hard. Is that people go back, like as soon as you're out, then you just go right back into it. And then you go right back into this like digital morass or like you're, especially if you're into news media and stuff like that. That's I think more of what's going on here than necessarily. I would be very surprised if you had two people, one who just didn't use their phone at all and was always in nature versus I would be a little bit surprised that those people weren't, didn't have different anxiety profiles for sure. The problem is is that bouncing back and forth between the two, that's gonna be a issue at some point. - Don't necessarily switch your lifestyle around this but like, hey, if you're having a really rough Monday morning, like go for a walk in a park, that'll probably help a little bit. - I mean, I think that's great, yeah, sure. - Yeah. (laughing) - Do that, I mean, it will help your anxiety in the very short term. It's not gonna like sure, if you're having a panic attack, I'm not saying, oh, we just go for a walk. That's what that happened, right? It's not like a long-term fix is probably like added in as part of your routine sure. I go outside and touch grass absolutely, but it's like it's not a fix for exactly. - Yeah. - Maybe this is kind of what this is actually doing, what people think alcohol is doing, right? Take the edge off a little, help you unwind after a busy day, help you decompress after like, maybe a stressful day. - I can get on board with that, yeah. - Yeah. - But it's not really, like you said, as soon as you go back to your life and the screens and everything, everything comes back pretty much immediately. So it's not, there's no sustainability here. (upbeat music) I just finished apologizing to all the weed dispensaries here in West LA, telling them that the CBD, there's no evidence showing that it works. I'm gonna have to go back out and apologize to a lot of people 'cause number 12 on our list is breath work. - Okay. - This one has a lot of caveats. - Yeah. - The important caveat here is that breath work is definitely one of those things that it works for some people in some context, and also works depending on the particular technique you're doing. It does not work for everyone in all context and not all breath work techniques work equally. That's the headline that people should take away from this section. There's a lot of nuance going on here. And as somebody who, by the way, has had friends and loved ones go to breath work classes where the administrator clearly had no fucking clue that they were doing, you can have very adverse effects. Breath work when done incorrectly or when done with the wrong person with the wrong technique, it can induce panic attacks. So it is actually counterproductive when done poorly. So that's all just a PSA for people listening to this that, yes, breath work can be super helpful and there are people, I know people who swear by it, it's been life changing for them. I also know people that fucking hate it. It was one of the worst experiences they ever had. So be aware. - Yes, it can induce some panic attacks. It's also, it can help a panic attack. - Yes. - It's done correctly. - Depending on how it's done. - Yeah, very much depends. This was definitely, well, when I would have panic attacks, for whatever reason, I would get panic attacks when I was driving a lot, which was just, that's not good. - That's not good. - Awful. So I just had to, I pull over and I would do some cyclic breathing, which is actually what, it kind of does help. Usually about a one to two ratio of into out breath, right? So you inhale for a one count, exhale for a two count, or a three count, a six count, whatever it is. It's a one to two ratio though. - Yeah. - And that seems to help. Just as like a kind of general maintenance thing, for anxiety, it doesn't, like small effect. It's not necessarily to, that longer exhale is like the key ingredient here. You're bringing attention to your internal states a little bit more and again, you're confronting them and not trying to avoid them or paper over them. And I think some types of breath work can help with that. - From what I've seen, the most effective technique is what you just described. Sometimes it's called box breathing. There's different second configurations, right? So the one that I learned was 478, right? So you breathe in for four seconds, you hold for seven, you breathe out for eight. - Right. - So one to two ratio again, 488. - Yep, and then you just repeat that. I've seen 488, I've seen 448. The exact numbers don't really matter, but it's mostly the ratio. And what it is, so I learned this, my wife, Fernanda, she has a lot of, she has panic attacks. And so what I learned actually, like one of them was so bad that we had to call the paramedics and the EMT actually explained this to me. He said it's actually very counterintuitive, but like when you have a panic attack, you're breathing so heavily and so quickly that you're actually, you're not allowing your body to like oxygenate sufficiently, which then creates a negative feedback loop because then you feel even more out of breath and that you need to breathe even quicker and sooner. And so you get into this like bad cycle and that you keep breathing harder and harder, but you feel like you're more and more out of breath. In that moment, the last thing you wanna do is breathe slower 'cause you literally feel like you're gonna die if you breathe slower. By breathing slower, you allow your body to actually properly oxygenate, which then like calms your nervous system, which then like kind of reverses that feedback loop. The thing that I wanna call out here is that there's a lot of different breathwork classes, breathwork techniques. There's a very prominent person in our industry that does breathwork interventions that is seminars. I've started seeing all sorts of like very big promises attached that simply by doing breathwork for 20 minutes, you can unearth childhood wounds and heal trauma and like you know, like go of all of your bottled up emotions and all this stuff. What is interesting about these techniques is that by breathing intensely, you can activate yourself into a higher rousal state. And when you are in that higher rousal state, like it can be a conduit for a lot of emotions that come up. And so you do, if you go to these breathwork classes, you will see people who start crying. You will see people who are screaming or like having very intense emotional experiences. And I think if you are the type of person who tends to repress. emotion and has trouble experiencing it. I'm sure this can be useful. The problem is that if you are somebody like my wife or like you who is already prone to panic attacks, already has a nervous system that is like constantly in a higher rousal state, putting yourself in an environment where you are for a very prolonged period of time, pushing yourself into a higher rousal state can have very bad consequences and can actually trigger and induce panic attacks. So I think the clarification that I'd like to make here is that so the box breathing for somebody who is in a highly anxious state, whether you're having a panic attack or you're just in a very, very high-pressure situation, slowing the breath, counting the breath, four seconds, eight seconds in out. This pretty much 10 times out of 10, this will calm you down. It is super effective, but it is like you said, it's a short-term solution. These longer session, 45 minute, 50 minute, 60 minute breath work sessions where you're hyperventilating yourself on the floor for minutes and minutes and minutes at a time. I'm not convinced it does anything really at any sort of deep level. To me, this feels kind of like it's like a new version of catharsis just because you're indulging in an emotion, like it doesn't mean you're relieving it, like this hydraulic theory of emotion of like, oh, I have all this anger bottle up, so I need to be really angry to get it out of my system. That's not how emotions work. Emotions are feedback loops. And so if you are indulging anger, you are actually training your body to become more angry. If you are indulging sadness, you are just training your body to feel more sad. I personally think these sorts of techniques are probably nothing at best, placebo at best, counterproductive at worst, and then if you do happen to be somebody predisposed to panic attacks, it's a fucking terrible idea. If you are experiencing a panic attack and you're doing the breathing, like you said though, and it is calming, it does calm you down. I think what's going on actually is it's not so much the breath itself, it's more, you're becoming more aware of your internal bodily states. I think it's a redirection from external, oh my god, everything's on fire too. Hey, what's actually going on in here? Oh, I can handle this. Then move on. Right. Because if you sit and you dwell too long on it, that is an anxious frame of mind that you're just putting yourself into. It's a tool for the moment. Check in, you're good, put it down and walk away. Because as soon as you start ruminating, that becomes the counterproductive part. All right. Moving on down the list, we get to number 11. This might actually be the first kind of sensitive one that we talk about. As we said, we're in the maybe depends sometimes category at the moment. And this one, when it goes well, it goes really well when it goes poorly. It goes very, very poorly. And that is benzodiazepines. I should say for the record that you and I are not psychiatrists. We're not doctors. We're just reporting what the research says. We're reporting, you know, at this point, binzos, xanax, adivan, valium, clonopens. They've been around for decades, many, many decades. They've been studied back and forth. We have tons and tons of research and data on them. It's a complicated picture. It's a very complicated picture. On the one hand, they can be extremely effective and what's better is that they're extremely effective very, very quickly. On the other hand, there are very intense drawbacks. People can become dependent on them, withdrawals from benzodiazepines can actually kill people. Right. Yeah. You can't just stop taking that. Yeah. It's a very tricky place to be in terms of like a long term solution. There's a lot of potential for abuse. And interestingly, the combination of benzodiazepines with other interventions we talked earlier about how alcohol interferes with the fear extinction required for exposure therapy to work. Benzos have the same sort of thing going on. And so what therapists have known for a long time is that when somebody goes on a benzodiazepine, it can actually reduce the effectiveness of therapy. That feedback loop inside your brain is not forming the same way it would if you were sober. Yeah, it makes sense. I mean, the benzodiazepines operate on the same system that alcohol those to the GABA system, which is an inhibitory system for the most part. So it makes sense that that, yeah, it extinguishes that fear response when you're doing therapy and you're addressing uncertainties and fears and all of that. Extinguishing that probably has something to do with the way you learn about those things. So yeah. It's interesting because this fell down to number 11, almost purely due to the complications and the downsides that potential for harm, which is part of our measurement or ranking on this. If you remove the potential for harm, this would actually be top three. Big effect size. Huge effect size is very well replicated data going back for, like I said, 20, 30, 40 years. It is very complicated. There is a lot of potential for abuse. It's almost like they work too fast. So like I wasn't aware of this, but there's another drug on the market called abuse prone. It's, and it is equally as effective, does not have the downsides, but the catch is it takes two to four weeks to start working. And so patients over and over again tend to go for the, the benzos because they, they kick in basically immediately. And I understand, like if you are an extreme case, like if you have severe panic disorder or severe generalize anxiety disorder and you are literally just crippled by anxiety every day, you probably want something that's going to hit in remedy to situation immediately. Even then though that the recommendation is not to use them for more than two to four weeks. Yeah. So yeah. But that said, I know, I know, I personally know people who have been on like a low dose of benzos for a long time. Years. Yeah. And so years. Doctors don't pay attention to that, apparently. Yeah. I don't know. I've known multiple people who have abused abuse over a long period. It's a high, high chance of abuse. Yes. Strikes. Yeah. For sure. The next one, number 10, probiotics. This gets into the, the gut health, fat phenomenon. I'm curious what the, what the research turned up on this room. Again, this is one of those where like the mechanism, proposed mechanism, it makes sense. Yeah. The vagus nerve, it connects your stomach to your, your brain. There's a literal connection between your gut and your brain, right? Yeah. And that's the vagus nerve that's one of the connections anyway. They've done several experiments where they give a probiotic, different strains of probiotics. And they've measured brain activity. It alters GABA function in your brain, which is again, typically inhibitories. So theoretically, it should work or it could work. This could be a possible pathway by which, you know, your, your gut and your brain talk to each other can calm down or get more excited, you know, based on whatever's going on in your gut. Sure. The interesting thing, though, that I found is just kind of a split in this one. So people who have been diagnosed with an anxiety disorder like GAD or even OCD or anything like that, they, they find that probiotics actually help them more than just if you just kind of have like some mild anxiety that you're worried about, you know, it's not necessarily clinical level of anxiety, but some anxiety that just bothers you. Yeah. Probably not going to get a whole lot from that using any sort of probiotic. Several studies have found like there's a fairly big effect size like anywhere from 0.5 to 0.7 for people with psychiatric anxiety disorders. So yeah. So there, so this is one of those definitely depends situations for sure. It is kind of mind blowing that for some people, depending on their situation, might get better results from a probiotic you buy over the counter than, yeah, say a prescription done. The science is still kind of out on like which strains of probiotics actually help because, so when they try to do these meta analyses, it's really hard because there's always different strains. There's always different methods to go into these different samples that they're different, like the participant pool they're pulling from is very different. So it's really hard to make generalizations from a lot of these studies. We don't have like big pool data that we can pull from. There's definitely some evidence that a few different strains in a few different populations do respond pretty well to them. There was a term in one of the meta analyses for this that I absolutely love. I've never come across it before. It was quote catastrophic heterogeneity, which is like, basically it's like such a large variance in results for people that the methods that they use to that researchers called it catastrophic. That gives you an idea of how all over the map this is. It is interesting though. This is one that I would not have guessed. I would have, I would have guessed that this was kind of more on the CBD side. I know gut health is like a real thing as it relates to mental health, but my understanding was that, or my assumption, I should say, is that it would not be as simple as just taking certain probiotics. It would be something more drastic potentially. Yeah, it does make a lot of sense. 90% of the serotonin neurons and 90% of the serotonin in general is producing. We all know serotonin is probably pretty important. Some way from mental health, we'll get to this a little bit later though, to know exactly how, but there's got to be something there probably. So this is, would you say this is just too soon to say, or is it promising too soon? I think as medicine gets more and more individualized, this is going to be more and more important. And prove to be, for certain people that we can pinpoint, be like, you would be a very good candidate for this. I think this is one of those treatment. Number nine, yoga, I'm a big fan of yoga. - I know you're a huge yoga head. - Well, it's interesting. I've been thinking about this more, especially putting this together. I'm not like into yoga, okay? I go to yoga, I do yoga, I do it pretty regularly about twice a week usually. I do hot yoga for one, so I get the exposure to it too. But I don't think I would say that I am like, I'm not into the whole yoga culture necessarily. I do it as more like a fitness thing, right? Let's talk a little bit about what they found with yoga though. Okay, so there is an effect. - Yes. - Okay, it does help with anxiety, small effect, most likely. There was a clinical trial where they had people perform some yoga versus therapy. Yoga, about 50% of the people responded to it, but with therapy about 70% did. So it's not as good as therapy, but it would be a good compliment, I would say. And I don't think it's for the reasons that a lot of yogis will tell you, the whole maybe centering or whatever it is, the kind of supernatural on the side of things, obviously I'm not gonna probably argue for that. But for me anyway, one of the things I think that it does is it gives you a real awareness of the internal states of your body. Brought this up a couple of times already, but I think yoga is actually a really good vehicle to experience that kind of interoception so that your internal states, your internal bodily states. And not only that, but when I first started doing yoga, you know, the instructors would usually cue you up, like, you know, if this is uncomfortable, try this or, or sit with a discomfort a lot. And I didn't, I was always kind of like, I don't want this to be uncomfortable. I'm here to be comfortable. But the more I got into it, the more I'm like, oh, they're telling you, okay, this is, you're gonna push your limit, get to a comfortable position of whatever pose you're doing, and then push that and get a little bit uncomfortable. That I found was a big like, oh, this helps you sit with a little bit of discomfort for a little bit longer. - Mm-hmm, interesting. - So it's like practicing that kind of muscle, that discomfort muscle a little bit. That's where I think the actual value of yoga is I don't think it's anything beyond that. It doesn't address maybe the underlying rooming thoughts you have. That is why I think like the therapy in that study I mentioned the therapy actually did a little bit better is because it's actually addressing the underlying. - Yeah, so it's funny I was actually just about to ask. Like, I generally associate yoga with meditation. Those two, those two often go side-by-side. They happen together. People do them at the same time, at the same retreat. But it's interesting because I always kind of saw yoga as like the physical form of meditation, right? It's like that the same way meditation like has you focus in on like a cognitive experience. Yoga has you focus in on a physical experience in your physical body. Like I'm not gonna give it, give it away, but like, meditation's on this list. It's higher than yoga. Exercise is on this list. It's also higher than yoga. And so I was curious to ask like, why do you think yoga placed lower? I think in the case of meditation, I think what you said about the cognitive, right? Anxiety is very cognitively driven. So that makes sense that meditation is more targeted towards managing your thoughts and coming the terms with your emotions and all that. My guess on the exercise front is just the dosage level. Like yoga's pretty, I mean compared to like say, doing a cross-fit workout. Like yoga's pretty relaxed. It's like not super strenuous, low intensity. It's relatively easy. A hot yoga can be, it's pretty intense. You know one thing, one thing I'll say is that you get into a room with a whole bunch of other people. And in the case of hot yoga too, like everybody's half naked in there basically, you know? And so there's a lot of like self-conscious feelings I think that come up. The thing is is that with a lot of these poses that you're doing, if you're super worried about what everybody else is thinking, you're gonna fall over on your mat in front of everybody and make a huge ass out of yourself. And so it almost like forces you to be like, no, no, no, come back and be present with you. - That's interesting. - And so you're right, the physical side it is, very much a physical like awareness, right? That you're practicing. But I think that's still a good enough practice for that situation to kind of like tamp down a lot of those self-conscious thoughts that we have. Did you find it helped you feel more confident or? - No, no. - I think it just, why do you like it so much? - I do cross-fit, which is a very high intensity. Short, heavy weights. I like this whole kind of barbell strategy. You go and do something low intensity that's longer. There's a meditative side to it for sure. But I just find it's a really good balance between like that high intensity. Usually I'm a little bit sore from a workout maybe or something like that. And then I can get in, get a good deep stress. It's really low. There's also just no pressure too. Like I'll stop in the middle of some yoga and just lay down for a while and while everybody else is going. I think it's just a good kind of, it balances you out between those two. - Sure, in any way. - So it sounds like a nice supplement to-- - I would not use this as like, this is my go-to anxiety remedy for sure. But it would be a great supplement for a long time. - Right, it's definitely gonna, it's good, but it's not gonna fix anything on this front. - The other thing too, I mean, it takes a lot of time too. Our long class is generally speaking. That's a pretty standard yoga class. Usually they're expensive, you know? So yeah, I wouldn't, I just wouldn't use it as like a first-line defense, yeah. - Moving along, we're about halfway through, we're now on the top half. - Okay. - This one surprised me. - Yeah, I'm not so sure about this one. - Yeah, adaptogens. This is another one. I mean, if this came low, I'd have to leave the studio again and go apologize to a bunch of people around West LA because everything out here has a fucking adaptogen in it these days. There's actually this like bougie fruity drink that I get at the grocery store here that has Ashwaganda in it. Actually, the energy drink I drank this morning had Rodeol in it. So this stuff is showing up everywhere. Ashwaganda, Rodeola, Holy Basil. Early numbers were shockingly good. Some incredible effect sizes, but it seems like we're still early days on this. - Yeah, I think we have a similar problem with CBD though too, is that quality varies a lot. It's kind of hard to pin down which ones are the better ones. The study designs are very variable. So you just get a huge, a lot of heterogeneity there. - What do you mean by study design? Like explain for the audience, people who haven't read a lot of research or done research. What's the difference between say a good study design and a bad, if we're testing Ashwaganda for anxiety? Like what's an example of a good study design and a bad study design? Some of the basics are just like having an actual random sample of people who show up to this. - Not just college students. - Not just college students or even like for some reason your experimental group and your control group are completely different types of people. You don't want that. You want a good mix of people between them. You want a control group too. This is the other thing, we talked about with magnesium earlier where they just had two different kinds of magnesium and they didn't compare it to a placebo. We don't know if that's a placebo or not at that point. There's that size of the study matters too, so how many people are in it? The more the better, obviously, because you can make more generalized inferences from those populations. And then, I mean, just all sorts of methodological stuff too, is that a blinded study as well? You know, like a lot of these, especially with supplements are going to be funded by the supplement company. And even if it's a blind study, that can still. That can still influence a lot of things one way or the other. Those are some of the big ones for sure. But even if you do have smaller studies though, but they're well done, over time, that can help, right? Because you can do a meta-analysis, include those studies that they're well done. They have proper controls. They have proper blinding where the researchers don't know which condition the participants are in. Those sorts of things help a lot. - It's probably worth noting too, that one of the biggest barriers to really good research is just funding. Like, to get a good sample size, to get a nice variability of people in that sample, it costs money. You need to go find that thousands of people, tens of thousands of people that come from all different walks of life that takes a long time. There's lots of recruiting. You've got to put out ads. You've got to like on-board people, interview people. It requires just a lot of administration and a lot of researchers and a lot of help. And it's costly. It takes a long time. - So sometimes the incentive is to take shortcuts. Which is why like you said, with adaptogens, those early studies, they look really promising. Well, that's because they were like, well, we can't do the perfect study. So we're going to do a good enough study. And then those headlines get picked up and you don't have a proportion. - And then you also get this situation where there is a Ashwaganda drink company, like a health drink company that has Ashwagandas, their primary ingredient, and they really want to market that. And so they come to researchers and they're like, and I think maybe this is a misconception 'cause sometimes people think that this is way more diabolical than it actually is. I mean, maybe it is sometimes, but my sense is that it's not like the drink companies come and say, like we need these numbers to line up this way. I think it's more just like-- - That was the tobacco company. - Yeah, yeah, yeah, yeah, yeah. I think it's more just like, hey, we'll fund a study, but this is kind of what we think it should look like. Or this is how much we're willing to give. There's a muddying of incentives, I think, yeah. - There's like a few like pretty good quality studies. They're just small. - Yeah. - Like they do find a good effect size on anxiety and even some other mental health conditions, but they're small and so it's just cautious, I would say. - Yeah. - I've been drinking this Ashwagandas drink quite a bit lately, especially at social events. Now that I don't drink alcohol, it's actually, in fact, a lot of mocktails now have Ashwagandas because supposedly it's supposed to give you a little bit of a buzz and help you relax. - Right. - I don't really notice anything. at this point, I feel like it's probably just placebo. Like I just, I'll have one sometimes at night. before bed because it's like, I've been marketed to that it helps me on wine, so it probably just helps me on wine a little bit, but yeah, I'm not convinced that there's anything going on here. All right. Next one, this one might get us canceled. Okay. SSRI's. All right. So these are your classic antidepressants, pro-Zaxx, o-lof, lexpro. I guess in the pharmaceutical world, these are kind of like your first-line defense for depression and anxiety. Maybe the first thing we should do is just dispel the myth that antidepressants don't work. I don't know how that became a meme at some point. Well, for some people, they don't. Right. Of course. Right. I actually am. But there's nothing there. That's not true. Correct. There's absolutely nothing there. No, they work for some people for sure. Correct. So the Cochrane review, they're a review of SSRI's. Cochrane is, for people who don't know, Cochrane is like the gold standard of like reviewing research coming down saying, does this thing actually work or not? Or these results actually legitimate. Cochrane review said, it's legit, there's an effect size here. They do something. On the one side, it's like they absolutely do help people and I think certain people in certain situations, it can be absolutely life-changing. That said, they are also probably over-prescribed. Like I think both of those things can be true simultaneously. I think it's like they are very useful and in some cases, lifesaving for people and they're probably given out way too much. Cochrane is my non-medical opinion. Don't come at me. And by the way, I've had doctors prescribe antidepressants for me for basically no reason. My wife said antidepressants prescribed her for like fucking headaches. Doctors in the U.S. definitely do give them out like candy at times and there are some documentaries around the incentive structure around that. And not only that, I mean, they've been detected in river water and wastewater before. So I guess it could be, that could be true. I mean, it's useful to start like, how do they work, you know, what's the mechanism going on here? What are the discussion items around like, you know, why they're good, why they're bad? Yeah, it's SSR. I selective serotonin reuptake inhibitors, right? Technically what they do is they increase the amount of serotonin that's in the synapse between neurons, okay, the space between neurons. And serotonin has been implicated in all sorts of different mental health conditions and just in general, right? Like I said, a lot of it is a pretty senior gut though. Really going back, I don't know, 60, 70s, 80s probably, there's this chemical imbalance theory of mental health disorders, right? We're really going away from that. There's been several kind of high profile meta-analyses that have looked at decades and decades worth of data. They really can't establish a link between serotonin specifically and say depression or anxiety, okay? And it was supposed to be the one that was like, yeah, definitely, definitely for depression, there's something going on, maybe for anxiety. But really recent studies have found that, no, they're actually, we can't really find any association between the level of serotonin in somebody's system and their mental health outcomes. That said, SSRIs do work. We know they work for some people at least. We don't know why they don't work for others, okay? We don't really know why they work for these people though, either now. For the longest time we thought it just was, we need to just increase serotonin. That's not the case. Yeah. There's probably some downstream effect. Serotonin can be kind of like a signaling molecule, too, for downstream, further downstream chemicals that might be influencing neural processes. We don't know. There is some sort of functional difference between like people who have mental health disorders and people who don't, okay? And we don't know exactly how serotonin affects that or not, but it does for some people, it does help. We don't know. The more we uncover, the more we realize we don't know about these, for sure. And so SSRIs were very, very promising when they first came out, especially as the newer ones in the '80s, very, very promising early studies had big effect sizes. We've maybe talked about this a little bit before, but a lot of times when something, a new intervention comes out, they use it on kind of the worst cases, and usually there's kind of a floor effect going on there, right? The only direction they can go is up, or if you're using it for people who are the illest, you're going to see a bigger jump. Yeah. It's you always start with the hardest cases, and so you get the biggest effect sizes early, not the spoil, anything. We're going to talk about psychedelic soon, but there's a little bit of a similar thing going on. As it spreads out to the general population, you start to see a moderation in those effect sizes. The effect sizes have actually, they've shrunk over the years because of that, using on educationism, maybe people who don't need them as much or don't respond to them as well, and so the effect size decreases just based on that. If we could identify like who would respond better to SSRIs versus not, that would be great, and they're working on that. It's not a one size fits all. The effect sizes, yes, they've gotten a little bit smaller, and they've kind of topped out. We can't seem to get them to go up or down from there, so you know, there has to be done on this. Yeah, they're not without their risks, right? For instance, sexual dysfunction is a problem. It's fairly common in the short term, sometimes, and kind of rare in the longer term, but it is still a thing, and it's something that worries people, and is one of the leading causes for people to just stop using them as well. It would just make you depressed all over again. Exactly. Right? Right? And then you have emotional blunting too, that's pretty common as well. Yeah, so the people in my life who have taken in-I depressants like that's been very different. You get kind of like, it's almost like they become kind of zombie-like. Everything's great. That's what people tell me. Everything's just kind of great. Everything's just blah. The people I know that take them and use them successfully say it's more like just a window opening for me. It's like, you know, I was just so despondent or so anxious or whatever, that anything to kind of just open me up or lift my mood a little bit for a little while for something else to get in. That's where SSRI is trying, if they can work for them. I think this is probably an opportune point to take a little bit of a sidebar and just talk about like, where does anxiety come from for different people? For the laymen, like, you probably just lump it all together. Like some people are really anxious and some people are moderately anxious and some people are very little, have very little anxiety. Anxiety is one of these areas of mental health, personal growth. There's kind of like a serious version and then there's kind of a mild version. There's like a high quality problem version and then there's like an actual serious kind of psychiatric version. It's similar with depression as well, right? There are people who kind of chronically struggle with depression and it's probably biologically bay. Like, there's some genetic predisposition. It's something they're going to struggle with for their entire lives. And I think for those people, the conversation around something like SSRI is probably a little bit different. Whereas like, just mild depression, like you just went through a divorce or a parent died or you lost your job and you're feeling lost, like everybody feels depression at some point. But it's generally transitory and it's generally for a good reason. And I think it's similar for anxiety that like there's, there are people who experience a lot of anxiety throughout their lives. But that anxiety is always contextual. It is based on kind of what they're going through at the moment. Maybe they're predisposed to a little bit more anxiety in certain situations than other people. But it is something that overall they're managing. It comes and goes in waves. Whereas there are other people that are just kind of like predisposed to lots of anxiety all the time. And I kind of mentally just put these people in two different categories, especially like, you know, as somebody who's been writing to a large audience in the space for a long time now, anybody who seems to be in the latter category of like, Oh, this is probably a diagnosable clinical thing. I'm always very clear of like, you should probably go talk to a doctor like this is not, you're not going to solve this, listening to podcasts and doing yoga on weekends, right? Whereas like, if you're just a little bit of an anxious person who's going through a lot in life right now under a lot of pressure, got a lot of stress going on, and you're a little bit more prone to anxiety than other people like, there are plenty of practices that you can implement to manage that anxiety in your life. I'll come back to the framework that I often come back to, which is the bad, okay, people and the okay to great people, right? There's like a, there's some people who are just like trapped by their anxiety and it is seems to be baked into their neurological wiring to a certain extent and they just like, they really need a long term solution, just to feel normal. Whereas there are other people who like, their lives are by and large normal, but they experience a lot of anxiety and they just want to be able to excel and they feel like their anxiety is like one of the things that's kind of holding them back. The other factor here is that like generally the severe cases of anxiety, you're probably looking at more of some sort of genetic predisposition, it's more of a permanent thing. Whereas the milder forms of anxiety, those waves of anxiety that come and go throughout life, you know, that's when you get into, you know, environment, social experiences where you grew up, you know, maybe some trauma you had when you were young, and those are generally things that you can work through, that you can like process and use some of these techniques and practices to like help you get through the tough periods. Thanks for coming to my TED talk on anxiety. It's important to distinguish between like the clinical and subclinical for sure and then the lines I've gotten so blurred. Yes. So too. Yes. And this comes back to the labeling thing, right, because it's like, I think what happens these days. you have a lot of people who are, let's say they're probably highly neurotic, right, which is a personality trait, but in their prone to anxiety, maybe they're prone to panic attacks. So they experience anxiety above average rate, but then what happens is, is because like we're therapy culture is just fucking labeled everything. They label themselves as an anxious person, somebody who struggles with anxiety, somebody who is doomed to struggle with anxiety, and so that identification with the issue, then calcifies it, it like hardens it into who they are, they start bringing anxiety to their experiences rather than waiting for anxiety to happen to them. I think SSRIs are a perfect example of like, if you are in kind of the clinical territory, they can be life changing. If you're in the subclinical territory, it's probably overkill, and I think one of the issues is that it's largely being over prescribed to people in the subclinical territory. Like there are downsides and side effects, and I've known a lot of people who have gone on them and felt relief for a month or two, and then a year later they're like, "I fucking hate this," and they want to get off them, and I think most people, at least most people I've known, that's kind of the cycle they've gone through. Number six, Mr. Bernie. I believe this is the last of our, some depends maybe category, and it is a big one. Psychedelics. Psychedelic assisted therapy. This had the single biggest effect size of everything we researched, but the research is still scant, and there's not enough trials that have been done yet, but it is very promising, and this is very trendy, very exciting in our space. A lot of people are doing it, talking about it. It is slowly becoming mainstream accepted, and I do think there's a lot of potential here. It is very exciting and interesting, but we have to put that caveat of like it's still early days. Generally these earlier studies are done on the hardest cases, so you get the biggest effect sizes, as it spreads out to the general population, that effect size moderates, and you start to see a lot more complications. You start to run into a lot of people it doesn't work for. You start to run into negative side effects, and of course you start running into practitioners who have no fucking clue what they're doing, like my guru Steve out in Malibu. You have a guru Steve in Malibu, is he your guy? Well, he was last week shaman, this week I'm switching to business coach, yeah, that was last week. This week I have a new shaman, her name is Zoe of Infinity, and she's gonna help me trip on a $10 million estate to find myself. Okay, this is the world I live in, this is Ellen's, okay, yeah, this is Ellen West, they'll leave to me, I've been somewhat of a proponent, a cautious proponent of psychedelics for a while, it is still pretty high on analysts, so we're giving it some cred here, very similar to the early days of the antidepressants, like SSRIs, we see these big effect sizes, but we don't know how that's gonna play out in like a larger population. There's been some very interesting studies early on, one in particular from Johns Hopkins, okay. This was done by Roland Griffiths, who was a serious neuroscientist, okay, and working at Johns Hopkins University, did this study on people with late-stage terminal cancer, they didn't have much time left, and as you can imagine around a situation like that, you're gonna have a lot of anxiety around your own mortality, okay, and so they tried some psychedelic assisted therapy with them with psilocybin, active ingredient, magic mushrooms, okay, and they did find that actually like they had this huge effect size, it was a small sample, but again, it was very, very consistent, almost everyone in the study said it was one of the most significant experiences of their lives. They helped them with their depression and helped them with their anxiety. This was awesome, right? Sadly, and a bit ironically too, Roland Griffiths actually passed away in 2023 of cancer, which was kind of one of those cool jokes that the universe played on us, but as long as he lives on, people are still, you know, they're hopeful, and I think to have a reason to be hopeful, that said, one of the problems with psychedelics is that it's really hard to do a blind control study, right, because if you take a tab of acid or a big ole handful of mushrooms, I can guarantee you one thing, something is going to happen, right, yes, you're going to know whether or not you're in the external control group or not, yeah, yeah, that's been the biggest hurdle to actually figuring out what's going on here, because now there's going to be some people say, well, who cares, it works, well, yes, but why does it work, we need to know that because we like, you can't just start handing it out like you can't be handing out incredibly powerful psychotropic drugs and not know what's going on, right, there's a safety issue, especially if we're going to be regulating this with a regulatory framework and everything like that, right, in 2024, the FDA actually pulled MDMA, they were doing trial studies on MDMA for PTSD and a few other disorders as well, they ended up not approving it in 2024, there was a lot of excitement, a lot of people thought, no, this is a shoe and it's going to happen, the FDA said no, and it was because of this, there was just, we can't induce proper controls and figure out what's going on. The small number of studies that they have done look very promising, they're very consistent, they're very big effect sizes, low variation in their results too, which suggests that it's a real effect, we just don't know what we're comparing at this point. What's interesting about this, I think, is the mechanism, right, like it's everything else on this list is either some sort of lifestyle intervention or it's some sort of substance, some sort of chemical that you're introducing into your biology that's supposed to have a domino effect across things. What's interesting about psychedelics is that it actually somehow triggers neuroplasticity. For people who aren't familiar, neuroplasticity is when you're young, your brain is more easily able to rewire itself and develop new patterns of thought and identity and understanding. As you grow older, neuroplasticity never ends, but it becomes harder the older you get. A lot of your beliefs and feelings and habits and behaviors just become more entrenched in your mind. It's almost like psychedelics just come along and kind of kick all that up and reset your ability to lay new patchwork in terms of who you are, what you believe, what you find important. That's super interesting and exciting. I'm going to go anecdotal here for a second because I did a lot of psychedelics when I was younger and I have spent a lot of time around people who've done a lot of psychedelics. I would actually say that I probably know two or three people, I would call it like a low level addiction. They're people who take psychoactive, like these psychedelics substances is like really regularly, like on a weekly basis, I would say. This some extent, whether it's microdosing, macrodosing. But I notice about these people and when I think back to my early 20s and early 20s when I took a bunch of psychedelics, I think one of the things that psychedelics does is that it really activates salience. It helps you imbue things with meaning. It helps you see kind of the cosmic significance of stuff like this pen mark. So I was just going to say sometimes that is incredibly profound because if you are kind of meditating on your family or your place in the universe or like some talent or gift that you have that you're able to contribute to the world, like it can be incredibly profound and it can have a lasting impact in terms of how you see yourself and how you see your place in the world and all that. It also can cause you to find a lot of meaning and salience in stupid shit like a ballpoint pen. If you've ever spent time around people who've taken a lot of psychedelics or been on a lot of trips or journeys as they call them these days, they will come out saying some kooky things with like some strange ideas around like what's very powerful and important and you're like mmm I'm not sure that passes the reality test. You know psychedelics have been around for millennia and in many cases they've I think for most of the human history they were they were used as like kind of religious ceremonies and rituals which makes a lot of sense to me given what they do. Then going back to like the 60s and 70s they were seeing it's interesting because back then they were seeing more as a mind expander and I do believe I don't have this research in front of me but I do believe that one of the things that they they have noticed on it is that people who take a bunch of psychedelics like their openness to new experiences increases afterwards. Yeah. So it's interesting that in the in the 1960s and 70s it was kind of all about like opening yourself up to possibilities and opening yourself up to the world. So I find it fascinating that today it's much more about like therapy and calming people and bringing them out of depression and bringing them out of PTSD and healing their trauma and everything. There's almost like a cultural reading into what's going on and especially given the fact that I think there is we are living quietly in a little bit of an epidemic of nihilism at the moment. It makes sense to me that our particular brand and flavor of anxiety and depression that most of us struggle with in the 21st century is perfectly suited to be solved by psychedelics. If your anxiety is actually rooted in a deep existential dread of like a pervading sense that your life is meaningless and nothing you do is meaningful and that that is actually actually what is undergirding your sense of anxiety and stress about life, then it makes sense that a substance that comes in and like imbues a ballpoint pen with cosmic significance can be incredibly therapeutic. - Yeah, what psychedelics will do, you're right, is it kicks whatever kind of rut you're in or kind of mind space that you're in, it kind of kicks that open. The studies where they have kind of tried to look at this more carefully, it's usually the post processing. It's not during the trip necessarily. Like that's the experience that again opens you up. - Right. - I think so, you know, anxiety a lot of times we talk about it as it's like it's a, you're ruminating about the future, depression, you're kind of worried about the past, right? - Yeah. - You're processing the past. I think psychedelics, what they can do is kind of kick you out of that. Whenever spiral you're in depression, spiral or an anxiety spiral of some kind, it opens you up at that point like you're talking about. But the processing afterwards is actually what's the most important part. So when you are open up, 'cause I've seen this too, seeing people who are very much stuck in their ways and they go and do this. And for a short period of time afterwards, they're like, yeah, it's got a weird, right? - Yeah. - And I think what where people mess up is they don't take advantage of that time period. The one to two months following this experience where they're just like, I don't know what's real anymore almost, you know, like I don't know. The way I've been seeing things obviously isn't right. And now I'm open to thinking about things differently. - Yeah, the post processing makes a lot of sense to me because it's like you get that window, right? After the trip of actually like change is gonna stick or it's far more likely to stick during that period. You know, when I think about the people I know or have known who like kind of chronically do psychedelics, they're just always living in that window, right? And what I've noticed about those people is that they have a tendency to just kind of believe whatever the last person, the last thing they heard from somebody is probably what they believe. And that's probably like their new philosophy on life. And it reminds me of the Carl Sagan quote of like, I have an open mind but don't have a mind that's so open your brain falls out. And I think you and I are in the same boat and that like I'm very excited about the possibilities. I do think it under the right circumstances for the right person, this can be utterly life changing. Maybe I'm biased by living in California around all these fucking hippies, but it's one of those things that is, I think is both underrated and overrated simultaneously. - Yeah, and I mean just a word of caution too, if you're gonna do this, especially if you're an anxious person, I would do it in a structured way. - It was somebody trying to do a professional, but love of God, find a professional who knows what they're doing. The nice thing is there are a lot of doctors and psychiatrists that are like, they're on board with it now. - Yeah, and they're getting trained in it and they're like, there's processes being developed and standards and all sorts of stuff. - Still pretty illegal at most places though, so. - Yeah, we just won't mention that. (upbeat music) - Moving into the top five, this is where we get into legitimate territory. This is everything from here on out, is going to help with your anxiety. Probably, if not 10 times out of 10, very close, it's probably gonna help everybody. It's probably always gonna work to some extent, whether a little bit or a lot. It's really just a question of your particular issues, how much you need, how much you do it, and what you prefer. What we're also gonna notice in this top five is that these things are gonna get incredibly boring, very quickly, which is another interesting thing I think we should talk about it. But number five, social connection, socializing in general, I think we talked about in our emotions episode last year, two or three ideas that we have uncovered on Solve that I think about on a weekly basis, is how socializing is our human's ability to regulate each other's nervous systems. And when I saw things in that way, it just unlocked so many connections and realizations and understandings, what's ironic about social connection and socializing is that often people who have anxiety, especially people who have social anxiety, it's you get in this doom loop of like, you're anxious, so you're afraid to be around other people, you're afraid to be vulnerable around other people, you carry a lot of shame, so you disconnect from others, you isolate, you numb, you avoid contact and intimacy, which then causes you to feel even more anxious, feel more shame to disconnect the isolate even further and so on and so forth. So there's like, there's a little bit of a upward spiral, downward spiral that comes with social connection and intimacy, knowing everything I know about how good socializing, I mean, you and I have done so many episodes on loneliness and social isolation and the importance of socializing and we did a whole five hour episode on friendships. It doesn't surprise me to see this this high. It makes sense to me that this is kind of bottom of the top five, just given that the problem of anxiety itself is likely to make this a little bit more difficult for people to pursue. - I think one of the more interesting findings I found about this anyway was that loneliness is really a predictor of anxiety, how anxious someone is, but having social support isn't necessarily a predictor of not having anxiety. So it's like, it's a protective layer. - Yes, yeah, right, right. - More than it is a healer. - Right, yeah, exactly, which I found kind of interesting to do. Makes a whole lot of sense though too, just as social animals, obviously the quality of your social network matters a lot, but the baseline is just don't be alone. Don't be by yourself all the time at least. - Yeah, one of the other interesting things that came up in the research that I saw, is that often for people just the belief that they have that support is actually more important than having the support itself, right? So it's just like trusting that there are people around you who have your back, who are gonna take care of you if something goes wrong, moderates the anxiety far more than actually having people who are showing up and taking care of things and doing things for you. - That seems to just check out on a personal level for me. I have a good strong friend network. I feel like a good social network, but I don't feel like I lean on them why. - But just having them there for me, that I think that does go a long way. - I hate asking for help. - That's all the same. - Yes, I'm terrible. - I hate him terrible about that. - I do, I'm not yet, I'm very bad about it, but they're still just like, okay, I know it's there. - Yeah. - If I needed it, it would be there. - Alright, so number four, we're gonna call you out here. We're gonna shame you. - Yeah. - Sleep the optimization. Do know, sleep makes you less anxious. - I see. - Right? I can already see all the people like reaching the turn the podcast off because they're like, oh, we're gonna get sleep, nutrition, exercise again. No, there's a couple of surprises people. There's sleep, but yeah, sleep is huge. Socializing is huge and exercise is huge, but the top two are probably not what you would expect. - Yeah, sleep is bidirectional. If you lack sleep, then you're gonna be more anxious. If you get more sleep, you're gonna be less anxious. And there's pretty robust effects around this. They've shown this over and over again. This is for any mental health disorder, just about. - Yes, I mean, depression, anxiety, like pick your poison. Again, there's another doom loop here, which is that the more anxious you are, the harder time you are to fall asleep 'cause you're gonna be laying in bed, staring at the ceiling, worrying about the awkward thing you said six years ago. And then the fact that you're not sleeping is gonna make you more anxious, which is gonna make you more likely to sit in bed and ruminate and stare at the ceiling and worry about the awkward thing you said four years ago, and on and on and on it goes. The other interesting thing that we found with the research is that your brain is basically doing therapy on itself every night while you sleep. And if you're not sleeping, then you're not letting it. You're actively worsening your mental health. So it's interesting, during an REM sleep, the brain replays emotional memories with the migdala turned down. That's your fear processing center. Like if you ever noticed that a lot of your dreams are kind of like residual of some of the things you've been thinking about or experiencing lately, it's almost like there's a certain emotional processing that your brain is going through while you're asleep. And if you're not getting that deep sleep, that deep restful sleep, then you're robbing yourself of that emotional processing that happens when you're unconscious. Part of me wonders too, 'cause there's a lot of studies and data showing that we're more under slept than we've ever been for, that just the average person's sleep is very bad. It makes me wonder how much of the mental health crisis has been contributed by just people not sleeping enough. - I mean, I would say with the teen mental health crisis, especially I would say this is a huge contributing factor. - Yeah, they're just like kids laying awake, scrolling their phones all night. - Yeah, that's gotta be contributing a huge proportion. - And it creates a doom loop, right? Because it's like if you're laying in bed awake, doom scrolling, freaking out, you're not getting that sleep, so you're not getting that processing happening while you're unconscious. So then you wake up with all of this residual anxiety and unprocessed emotional baggage that you carry into the next day, which then makes you even more miserable and more freaked out and more stressed. And so then you lay in bed even longer doom scrolling and you get into this ugly cycle that is really only broken if you can confront the anxiety itself. I mean, would you say this is probably like socializing in that it's not necessarily an intervention, It's more like a protective layer, right? Like it's like the same way having friends doesn't necessarily remove anxiety. It like protects you in the first place. It sounds like sleep is kind of the same thing. - I think it's a protective effect where it gets you to a baseline. I don't know, is it going to improve your anxiety? If you're sleep deprived, yes. Beyond that, I'm not so sure, but yeah. - Yeah, well, what's interesting is that some of the research has shown that the emotional reset that comes with sleep is lessened at higher anxiety level. So people who experience extreme anxiety level sleep is less of a factor for them. But it's coming back to those kind of mild, subclinical anxiety issues. Like if you're just, if you're in a really anxious and stressed period of your life and you're not sleeping well, like that's probably one of the simplest levers you can pull. Again, what's mind blowing is like this is free. You're already doing it every fucking day. It doesn't cost any money yet. Like how many things on this list have people spent hundreds, thousands of dollars like putting chemicals into their bodies, supplements, like it just go to bed earlier. - Yeah. - Yeah. (laughing) Try that for a week. - Yeah, consistent bed times, yeah, consistent beds. Oh, that's what I've realized lately anyways. Consistent bed times help a lot. Consistent wake times. Listening to your chronotype too, we talked about this a little bit before too. If you're a morning person versus a night owl, if you're a night owl, don't try to be a morning person necessarily. It's okay, you have to be, I get it. The other thing that I think makes this more foundational than it is maybe additive is just that like, if you're not sleeping, nothing else on this list is gonna work a matter. - Yeah, okay, yeah, that I think is a big one, yeah. Right, yeah. Yeah, you can optimize whatever. - You can have all the supplements. You can meditate till you're fucking blue in the face. But if you're not sleeping at night, it doesn't matter. - Right, yeah. - It does not matter. - You can drop a bunch of acid. It doesn't matter, yeah. - I mean, good psychedelics do interfere with sleep. I can tell you from experience, moving on to everybody's favorite. Everybody's favorite. Number three, exercise. Hit, go to the gym, bro. - Yeah, you do. - Hit the gym. Do you even lift? - You know, I've heard it in several different forms and places and whatever, but tame the body, tame the mind. We talked about this in the resilience episode as well, though too, right, like developing the discipline to work out or at least be active in some way, that has this almost calming effect on your nervous system because it shows you have some control, right? And what is anxiety if it's not a lack of control or a sense of a lack of control? And so I think more than anything, yes, there is the physical benefit of it. Like you're getting indoor from release and like all of that kind of stuff. But what I think the actual benefit of exercise comes in is that you are exercising that kind of control over your mind. - Yes. You're showing yourself that, oh, I have some agency here. When I, even when I don't want to do things or even when things are uncomfortable, especially when things are uncomfortable, like I am exercising some form of agency here. And so tame the body, tame the mind. That's how I see it. - I think that's a beautiful explanation of like the cognitive side of this. I, in the process of doing research, I came across a paper that described exercise in a way that I'd never heard before, which blows my mind 'cause I feel like exercise as people have talked about it brought words and backwards. But it basically was like every hard workout is practice for being afraid. Like if you think about it, it's like what happens when you're afraid, right? Elevated heart rate, shallow breathing, you start getting sweaty, adrenaline, courses through your body. Like exercise, lifting really heavy weights is training your body and your nervous system to be afraid and be okay being afraid. Like you are physiologically putting your body in the same state that it is when you're experiencing fear. Exercise is a controlled environment where you are training yourself to be okay, to act despite it. And then the cognitive piece comes in of like I'm choosing to do this. I'm feeling the strain, I'm feeling the adrenaline. I'm like my heart rate is through the roof, but I'm not gonna stop. I'm gonna get that lash wrap. And it's every time you're pushing through that difficulty and that strain, every time you are feeling kind of that panic, that fast heartbeat and the fast breathing and your fingers are tingling and you're like one more rep, one more rep. Like you're kind of training your mind to act despite the physiological signals. And so I just thought that was so fucking cool. - Yeah, yeah. - I never thought of it that way. You're using the agency that you have to purposefully induce an ancient state in yourself and realizing that it's okay. - Yeah. As you would expect, there is just like an absolute dump truck worth of research on this. The largest meta-analysis we found had over 1,000 high quality randomized control trials, over 128,000 participants and just consistent moderate effect sizes across the board, across diverse populations, any country, backgrounds, age, gender, whatever. What's interesting is that exercise affects anxiety on a number of neurobiological pathways, right? So it increases BDNF, which I don't know what the fuck that is. You wrote here, fertilizer for neurons, so I'm gonna believe you. But it spikes serotonin, nor epinephrine, dopamine, decreases neuroinflammation. If I was to put on my Andrew Huberman glasses here and tell you the most effective exercise protocol, for anxiety, you can literally do anything. It's aerobic resistance intervals, like, basically anything that is moderate to high intensity, like anything other than low intensity exercise, 20 to 45 minutes per session, three to four sessions per week, basically what they find is that the consistency is what matters more than what you actually do. So as long as you are showing up exercising on a consistent basis, doesn't even have to be like 20 minutes is not that much. - Yeah, and that's what I think. That's why I think it's more of a, like it's a practice. It's more of a tame, the body tame the mind type of practice is because the consistency is what matters, not necessarily what you do. - Yes. - So to me that's, oh, okay, I'm going in and I have, again, I have some agency, and I'm able to create some sort of discipline around this, and that gives me a little bit of calm and peace of mind at least. - Yeah, I had this social media post a couple of years ago that went super viral and it was basically like, imagine if there was a pill that improved your mood, helps you regulate your emotions, improves your sleep, helps you lose weight, helps you have better sex, decreases anxiety and depression, and improves your longevity. Oh, and it's free and it's available 24/7. - Yeah, that pill's called fucking exercise. It is like when you think of it in those terms, it is just kind of absurd and it's also even more absurd that so many of us don't do it regularly. Like I injured my foot a few months ago and so I'm like, I lost a lot of my exercise, like I didn't exercise much over two or three months and like now I'm trying, the foot's healed, so I'm trying to get back into the gym. - That's just, that's just log, isn't it? - It sucks, man. - It sucks. - If I take a week or two off, I start feeling it. - Yeah, I'm like, that's the other side of this though too, is like once you start doing it, if you stop, it's like taking a benzo man, you gotta keep going, you know? Yeah, I mean, there's inertia in both directions, right? So it's the longer you haven't done it, the harder it is to start, but the more you've done it, you know, the easier it is to keep going. - All right, number two, I'm not gonna lie, this showed up higher than I expected. - Okay. - Meditation, a little surprised. I mean, I expected that it would've worked. I would not have expected that it would've been this high on them. - Okay, why is that? - Maybe it's just 'cause I'm not somebody who struggles a ton with anxiety, but like, I don't know, it just, I've never found it from like a purely kind of mental health, you know, mental stability point of view. I have not found meditation to be the most useful intervention. It's useful, and I did it for a long time, and I definitely recommend it, but it's like, I would've put exercise above it. Like, I definitely feel like my mental health, my mood, my anxiety, my happiness, like everything is my relationships, like, are noticeably better when I'm exercising consistently. I mean, meditation too, but like, it's not as like, clear as that. Like, if I don't work out for a week, like, I feel it. - Yeah. - Whereas like, meditation, you know, if I didn't meditate for a day, like, I never really noticed. - Well, okay, I think that might be the difference, though, is that meditation is a little bit of a slower burn. Specifically, too, is that like, stress and doust anxiety. - Yes. - I think it's pretty well taken care of with meditation. You know, we had an episode on meditation. - Right. - When we talked about some of the common pitfalls and some of the hype around meditation that it wasn't correct, you know, that it was overhyped essentially. - Yes. - But one thing we did say was that stress and doust anxiety responded pretty well to meditation. Specifically, like, mindfulness-based stress reduction. - Yes. - Which is like, an eight-week program. I believe John Cabazim was very instrumental in developing it. - Found it, yeah. - There's a whole, it's very structured, like I said, eight-week program. There's physical aspects to it, too, so there's some exercise involved with it. So, I think you're right. I think in the moment, maybe like, I would go for a workout or even just a walk. That's gonna help your anxiety more short-term and long-term, of course, too. longer term, though, I think the cognitive benefits of meditation are going to come into play in a way that exercise might not. Yeah. That said, I think you're right. I mean, number two and number three, they're like a lot of this research was done on the full MBSR protocol, right, which is like eight weeks long, multiple hours a week, in some cases, full day meditation retreats. So the research, a lot of this research seems to be coming from pretty intense meditation practices. Like, it's not like people pulling out the waking up app for 10 minutes and like once a week. When they measure that, they don't see a whole lot. It's more from serious meditation over an extended period of time. That's my understanding of it at least, whereas I think exercise is more of the thing where it's like, you can start working out and like, probably within a week, you're going to feel better. Yeah. Yeah. Okay. Yes. I would agree with that too. So it's like, it's more of a dosage thing, I think. Okay. Right. Where it's like, it seems like meditation is super effective, but also the dosage is pretty high. Like, you can't just sit for five minutes. Yeah. Do you agree with that? I don't know. Yeah. Oh, yes. Yeah. Like a five or ten minute meditation even once a day. Yeah. That's probably not going to do a whole lot for your anxiety, specifically. Yes. That said, I'll go back to it. Again. Yes. Again, we're talking about anxiety, but yeah. Yeah. Like I said in the meditation episode, I don't think that's why you should necessarily meditate either. I think it will help you with your anxiety. It changes your relationship to your thoughts, whether those thoughts are anxious or whatever they are. And so you can see them more clearly in theirs. I think it gives you a sense of what you can do with those feelings and those thoughts. Yes. Yeah. Meditation does not reduce anxious thoughts. It doesn't actually, meditation doesn't change any of your thoughts. It changes your relationship to your thoughts. And so people will often come to meditation, expecting meditation to kind of turn the volume knob down on their life and on their anxieties. When really what it does is it just, it helps you better sit with the noise and understand the noise. I agree with you. There is like a lot of misconceptions around what meditation does. I'm sure there is a certain call mean effect, you know, of just sitting quietly for a certain period of time. But I do think the long term benefit of meditation really is in that like cognitive re-appraisal of like, what does this mean? Why do these thoughts keep coming up? Why do I resist them? Why do I fight them? What am I so afraid of? Like all of these kind of deep questions that you have to sit with for a certain period of time to like resolve them. Yeah. Of course, through the trees a little bit better with meditation. And yes, all the ancillary benefits you get with it, decreased anxiety or better stress coping, whatever it is. Again, I think it's just, that's all secondary to just knowing your mind better. And yeah, that takes some of the edge off right there, just knowing your patterns and knowing why you do what you do. I wonder how much of it, too, is actually kind of a bleedover of that digital detox, you know, going for a walk and getting rid of a screen, like definitely makes you feel better in that moment. And then as soon as you come back, everything kind of comes back, because I know a lot of people who do meditate for like five minutes every two or three days. And they like it. So it makes me wonder if that's actually what they're experiencing, right? It's just like sitting in a quiet room without their phone, it allows them to like get away from all of the noise in chaos that's going on around them. Yeah. That's, I get, that's one of the benefits I get out of it for you. That said, if you do meditate, definitely recommend the waking up app, because it's more serious courses, longer in depth, more philosophical. I think that's where you get more benefit, you know, rather than the quick hits that you get from a lot of other apps. So the introductory course on waking up to is, it's fantastic, like just going through that alone well is worth it. And then we've got to deal with waking up right now where you can get 30 minutes for free. So you can take the whole introductory course for free. There you go. No risk whatsoever. What I love about that course too is that it is exactly what you talked about is like it's all about your relationship with your own thoughts, because other apps, it's like they, they, they try to just get you to, they're like, yeah, they're, yeah, they're like, oh, relax, breathe. You know, it's like waking up is like, let's talk about your mind, who, who's observing the thoughts right now? Right. Who are you? Who are you? Yeah. And then you sit with that for 10 minutes. And it's like, it's pretty cool. I love it. It's last, but not least drum roll, please. This is not going to, this is, this is not going to surprise anybody. Therapy comes out on top. Sorry. What, what is interesting about this though is different modalities of therapy, all perform well, but in slightly different context, right? So like the, the heavy weight, especially around anxiety is CBT, cognitive behavioral therapy. And I, I do think it is pretty well established at this point that like CBT is probably the best intervention for anxiety issues, but I did find it interesting that that ACT is also effective for certain individuals and certain flavors of anxiety. I love ACT. Yeah, ACT is pretty cool. Yeah. I like ACT a lot. And then, and then of course exposure therapy, which is taking bite-sized chunks of, of your fear and yeah, exposing yourself to them. We've had a lot of kind of side bars on therapy over the years on this show. You know, it's, it's another one of those things that I think is both overrated and underrated, depending on the context and depending on the person. It definitely seems that for anxiety, it is not overrated. It is very legit, very consistent, helps a lot of people, very replicable findings across the board. And yet, I found this pretty surprising too, fewer than 20% of people with an anxiety disorder get therapy for it, which I thought was pretty crazy. It's so interesting. That's pretty wild. Yeah, why? Well, I don't know. Yeah, and I don't know how accurate that number is necessarily either, but yeah, there's, there's some numbers out there to suggest that it's very much under-treated. One of the things that I found, you know, when we were doing market research for purpose, you know, I did a lot of research into kind of the therapy market, the mental health market, counselors, coaches, life coaches, all that stuff. It is shocking how undersupplied the market is. I didn't realize that is that like for every therapist or coach, there's like eight to ten people who want access to a therapist or coach. And I think the biggest hurdles for a lot of people is financial, or they just live in a remote area. They don't have access to anybody, right? CBT therapy in general too is, there's kind of what they call a durability. The advantage, okay? Which is, especially for CBT though, the skills you learn during your CBT sessions, during your training, I guess, or your therapy, the whole point of it is to teach you how to manage your anxiety or any other uncomfortable emotions that you might have out in real life. And so the advantage of that is you get better at it over time, even after you stop therapy, because it gives you these tools and you go out and you practice them in the real world and you get better at it if you have a good therapist anyway. So all these randomized control trials that they did a meta-analysis on found that 12 months post-treatment with GAD, with generalizing anxiety disorder, a huge percentage of people like we're still at like near post-treatment levels anyway of anxiety. So they basically had fixed it a year later still. So pretty durable advantage, which in the mental health world, anything that lasts over a year, that's pretty good. It's very, yeah. Other studies have found very similar results as well. So like older adults, even too, you can find kind of full diagnostic remission even over even more so than with medication. So if you start taking medication and stop it, there's a good chance later on you're going to have to restart taking those medications with CBT and ACT and some other modalities as well. They find that's not the failure rates aren't nearly as high as them too. So it's much more durable advantage to you. Interesting. I think the thing that most people miss about therapy is that the point is to eventually stop. Therapy is one of those weird industries where you can judge the usefulness by how many people quit, right? I always get very wary when I meet people who are like, oh, I love my therapist, I've been going to them for 12 years, I'm like, wow, probably not a good therapist. But what's interesting is that you see this in the research as well as that like when people enter therapy, they get a boost to their outcomes. But what's more surprising is that leaving therapy, many people often get another boost to their outcomes as well. And I think this is one of those things. I've written about this long time ago, I wrote about this in some articles that you start in this place where something's wrong in your life, you don't really know what it is. And so the first big improvement comes from just getting an understanding of what the problem is and how to approach it. But then the fixing of the problem becomes a bigger problem than the problem, right? And so the next big level up comes from stopping fixing the problem. And I think that second lever is where a lot of people get lost. They start to feel I think maybe dependent or addicted to whatever therapy or intervention that they're doing. You see this in the self-help world a lot. People just keep going to seminars forever and it's like, well, actually, the fact that [BLANK_AUDIO] keep going the seminars to fix yourself is the bigger problem than the things you're trying to fix. If you just stopped going the seminars, like you probably be pretty happy, it's a very common problem and not just the self-help industry, but just the mental health space in general. And I think the best therapists and coaches are the ones that recognize it and they understand when to cut a patient off and when to say, you know what, you're doing pretty well. I don't think you should be worrying about this so much. Why don't you just go live your life and see. I used to run into this all the time where I get emails from people and they're like, I've read all the books, I'm like taking all the courses and it's just making me more anxious and I'm more worried and I'm like judging myself 'cause there's all these things I know I should do and I'm not doing them and on and on and on. And I would just, I'd just reply to them. I'm like, so stop reading the books. The problem is that more and more. I'm like, nobody's putting a gun to your head and making you read more books. Like, just fucking stop reading the books. Go live your life. I think a lot of people assume that you have to have some sort of like action plan to like implement all this stuff that you're not gonna actually change unless you, you know, you have like a spreadsheet mapped out and it's like no, like a lot of this stuff just kind of seeps into the background of your decision making and, you know, if you don't have like consistent opportunities to make different decisions, then you're never gonna be able to implement those different decisions. So ultimately, self improvement requires you to go back and live in the world. - A couple of caveats we should mention here as well too. You've already mentioned a few things like, you know, it's expensive, it's hard to access sometimes. Very true. Dropout rates are actually very high too, right? - Yep. - People, a lot of people start therapy and then they have the opposite problem where you were just describing instead of saying too long they don't stay long enough. - Yes. - So I think you do, I don't think there's a set number or a set time that you need to be in therapy necessarily. But, you know, I would say give it six months minimum and try to stick with it 'cause they really don't. It's hard to fix somebody's life in just a few sessions. That's just, that's not gonna happen. - The other issue is some therapist suck. - Yeah, yeah. - Quality varies a lot by any profession like this. - Yes. - Quality's gonna vary a lot. - And you've got a shopper. - And there is some evidence that the best therapist actually drive most of the results. This is one reason why I'm bullish on AI in this area and I don't think AI can completely replace therapists and coaches permanently. But like, I've been around long enough. I know how many mediocre therapists and mental health professionals that are out there. I've heard from so many fucking people of like, I was in therapy for years, like my therapist was awful. I had no idea and then I switched and oh my God, my new therapist is so much better. And now I'm having all sorts of breakthroughs and stuff. There's also like chemistry issues. So I just think it's such a hard thing to scale and it's such a hard thing to like quality control that I'm convinced that at some point in AI it's just gonna take over most of it and go download purpose.app. - Yeah. (laughing) I mean, we definitely have had a ceiling. And that's another, you said, spending your wheels. I think we, it affects us to have not improved for therapy in 30 or 40 years. It's about somewhere in the 30 to 40% of people just don't respond very well to therapy. Again, that could be 'cause they're dropping out too early or just not, you know, they're not putting in whatever. But we need to figure that out and we haven't figured that out in 30 or 40 years. - Yeah, yeah. It is the fact that there have been no improvements on this front since you and I were born. - Right. - Is a loyalty in the '80s, yeah. - A little bit of a red flag. The other thing that doesn't get broadcast a whole lot is that actually a small percentage of people actually respond negatively to therapy, right? So it's like some people, you can go to therapy and be worse. And it is, that's not broadcast a whole lot. I think it's not broadcast because overall not enough people are going, I also think you can overdo therapy. Like I think it's especially in some of the wealthier parts of like say the US. I think people are over-therapized, you know, especially young people, especially kids. You know, it's like a lot of kids, by the time they graduate from high school, like they've already been through 10 years of therapy and like three different therapists. And it's like, you know, like maybe you should just let a kid be upset. (laughing) - Yeah, it gets hard. - It's fucking hard. - It's fucking hard, but that's another podcast. (upbeat music) Any final thoughts you want to wrap up with? Any observations in general? - Well, we've been hinting at this the whole time, but I think if you are going to address your anxiety, the quick fix is not the one you should reach to first, for sure. Panic attacks and stuff like that aside, obviously, you want to get through those. But, you know, reaching for a drink is obviously, it makes it worse. That's the one we started with. It's the absolute worst one for a reason. And there's varying degrees when we go through this, you know, if just going for a walk or some exercise, yeah, it kind of helps with this, but maybe not that. The quick fix is not where it's at, though. - It's a long term, probably lifelong thing for most people. I still struggle with things I do, I do. And it depends on my sleep, but it depends on my exercise and all of these things that we've talked about today, sure. But I will say, if you want like a durable lasting change to it, reaching for those quick fixes, it can't be the answer. - It is interesting in this episode, you know, the list is really clear. Everything in the top, everything that is in the legitimate category is a lifestyle change. Everything outside of the legitimate category is a quick fix. - Right, yeah, a supplement or a, yeah. - Yeah, or like that's one thing one time. - Yes, not going to work, yeah. - I think my take away is that everything that actually works for anxiety is just uncomfortable. And that's the thing nobody wants to hear or accept that there's not a comfortable way out of this. And I think in a way you could say that chronic anxiety is kind of an unwillingness to tolerate discomfort or a certain threshold of discomfort. And I think ultimately that's what exposure therapy is. I think that's, you know, you talked about it with yoga, we talked about it with the exercise. Like everything that works to some extent is an exposure to discomfort and an acclamation to a certain amount of discomfort. Like raising your threshold of the amount of discomfort that you're willing to sit with. People don't like to hear that. People don't want to accept that. They don't want to deal with the consequences of that. - That's why they leave therapy a lot of times too. - Yeah, it's too uncomfortable. I also think part of it is probably why some of the pharmaceuticals are overprescribed. I imagine that a lot of people had just asked for it. Just give me the pill doc. Yeah, I don't want to talk about my problems. Like I'm stressed, like, you know, give me some lexapro or whatever. And the doctors are like, sure, here you go. - Yeah. And, you know, doctors' caseloads are high too. You don't want them to be too much. - Yeah, yeah. We're not sharing the doctors. - Yeah. - What's your biggest surprise and what's your biggest takeaway? My biggest surprise, I mean, yeah, therapy. (laughing) It was one of those things, I guess, though. I was surprised at ACT and CBT, like what you mentioned, that they were, they're basically opposite approaches. It gets you to the same place, which is pretty wild. - It is interesting. - The lesson from that is old school that kind of like exposure to whatever you're anxious about. And just seeing, again, it goes back, like, with the exercise, you have some agency over it, exercise that agency. No, you can't control all of it. That's also part of it too. It's just accepting that you can't control part of it, which is where ACT really shines, I think. But, like, the more you can build evidence, right, that you have some sort of agency around whatever you're worried about. It might not be ideal. It might not be a perfect solution. But I think it's not so much that we're always worried about what's going to happen. It's that we're worried that we don't know what's going to happen over there. We don't have any control over it. And while that's true, you don't have a lot of control over what happens to you. I think you just do have a lot of agency around how you approach it and how you see it. - It's funny. I feel like we're just kind of landing back on stoicism. - Yeah, I think stoicism is a good philosophy. - A little bit of existentialism. I mean, we've noted before how much CBT seems to flow directly downstream from the stoics. And CBT is the most effective anxiety intervention. The biggest surprise for me, I guess it would be meditation. And maybe I've been discounting it too much lately, and maybe also I discount it just because it's for me, I never meditated for anxiety. That was never my issue. For me, it was always more focused problems. And also like self-exploration, self-awareness. I was very interested in a lot of philosophical questions around consciousness and identity. I guess that was a little bit surprising for me or just the size, the significance of the effect size. And therapy, a little surprise, not surprised. One of the things I do tell friends is I say, the one thing that therapy really punches its weight is for anxiety. Like that, I've seen over the years that consistently CBT especially, like just for anxiety, it's kind of the best thing you can go to. All right, everybody, that was another episode of the Solve Podcast. We have solved anxiety forever. Thank you everybody for listening. This was the Solve Podcast. I'm Mark Manson. This is Drew Bernie. We will be back in a couple of weeks. Go to solvepodcast.com/anxiety to download some free, cool materials. And if you haven't checked out purpose, check out purpose.app is my AI coach that I co-founded. And we have a free seven day trial. So you can talk to the AI about all of your anxiety problems. it will. It will definitely let you know what it thinks. Like and subscribe, review, follow us, be your friends, we love you. See you next time. (upbeat music)