002: Please, Just Get Rid Of My Anxiety (NOT!) with Host Karen Conlon, LCSW

Transcript

Hello, hello, hello, and welcome to the, So How’s Therapy Podcast. I’m your host Karen Conlon and my goal for this podcast is that we push beyond the traditional therapy format to demystify, debunk and de-stigmatize what therapy is and what happens in a therapy space.

I’m super excited to be here today, this is our second episode ever, last week’s episode I talked about perfection paralysis, and in today’s episode, we’re going to be talking about a topic that’s actually very much connected to that, which is anxiety.

Anxiety is something that we’re often told we need to get over, or just relax. Sometimes we have that being told to us by other people, sometimes we tell it to ourselves.

So I’m here today to talk to you about anxiety, and not just the bad parts but I’m also going to talk to you a little bit about when it is actually helpful, and then towards the end, I’m going tell you how you can manage, or give you some tips rather on some things that you can do right away to start helping yourself with some of those anxiety reactions that you have that are getting in the way of having your most desired life.

Please, Just Get Rid Of My Anxiety!

The first thing that I want to talk to you about is that common sentiment, a lot of times people come into our therapy space or contact our practice and they say, “I want to get rid of my anxiety. I need to get rid of it, it’s causing me all kinds of problems at work…” if you’re a graduate or college, “… at school, with my family. And I really want to get rid of my anxiety.”

And so the first thing that I want to tell you is, we are not going to help you get rid of your anxiety because we would be incredibly irresponsible first of all, to tell you that we can help you get rid of your anxiety, that’s not true, but the second thing is that anxiety has its place. There is a reason why we have anxiety, just the same reason that we have emotions, they all tell us something about what’s going on in our environment.

The problem is that sometimes our brain’s alarm system, which we’re going to talk about in a couple of minutes, forgets how to decipher the difference between actual danger and perceived danger. That part of the brain, those little guys each called the amygdala, those little guys are tiny but incredibly powerful, and as the brain’s alarm systems, when they go off, they send all kinds of signals to our bodies.

And sometimes when we don’t learn how to manage the different types of anxiety that we might be feeling, we use the wrong coping strategies, we use the wrong tools and as a result, after a while, that part of the brain forgets how to tell the difference between getting chased by a tiger or, oh my gosh, I’m really nervous about this test that I’m taking, or I’m going to be late for work. It responds in the same high-alert ways and when it does respond that way, it sends all kinds of signals to different parts of our bodies.

So why does it exist in the first place, and when is it helpful? What is anxiety and why does it exist?

Why Do We Have Anxiety? Why Does It Exist?

Well, anxiety has been protecting us from danger for millions and trillions of years. It is the thing that when we are walking down the street… I’m in New York City, so if you don’t have this scenario at home, you can apply it to your own scenario at home but it is the thing that comes up when you’re walking down the street, and you say to yourself, “Huh, if I go down this dark alley, it’ll cut my commute by 10 minutes but something’s telling me that maybe I should just take the long road.”

If you’re a parent and you see your little toddler just starting to walk, and they’re bumbling around and you’re just watching them and you see them very quickly going towards a corner of some table, whoa you jump, right? You jump and you go to save them or to help them.

So anxiety is built to help us when we have situations where we have actual danger, however, sometimes as I was explaining before, when we have unmanaged or ill-managed anxiety, that part of the brain that is our alarm system cannot tell the difference between, oh my gosh my baby’s in danger and, oh my gosh, if I have to wait for another train, again New York City reference, I’m going to be late for that job interview and I may not get it for that reason, right? Or I may cause a bad first impression.

So it’s a really difficult thing to deal with, when on the one hand you say okay, well the anxiety is what’s helping me to get me to a deadline or to submit a paper on time or to get to work or school on time but at the same time it’s also causing me all kinds of emotional, psychological and physical issues.

Now there are different types of anxieties that people experience and different types of diagnoses and I’m not going to explain each and every one of them but I will mention some of the more commonly known types of anxieties.

Anxiety Disorders

We have General Anxiety Disorder, we have Panic Disorder, we have specific phobias such as Agoraphobia, and Social Anxiety Disorder. And the ones that we see the most are General Anxiety Disorder, Panic Disorders, and Social Anxiety Disorders, at least in our practice that is what we see the most of.

They all manifest in different ways however, there are some things that all of these types of anxieties do have in common.

So the first thing that they all have in common is that these anxieties, as I was saying before, cause our body’s alarm systems to send signals down to the heart, the lungs. And so when we are in fight, flight, or freeze, which is what happens when our alarm goes off, a bunch of physiological changes take place in your body.

Your blood pressure goes up, your adrenaline pumping goes up, your pupils dilate, your heart races, glucose, which is supposed to be going through the GI tract in order to help with your digestion, actually goes to your extremities to get you ready to run. Right?

Your cortisol levels, cortisol is a stress hormone and ideally cortisol is at its highest in the morning, so when you wake up in the morning, within a half-hour your cortisol level up at about 50% higher. It is the reason why we get up in the morning and we can stretch, and get ourselves going, and then as the day goes, your cortisol levels should be going down. So sometimes I’ll have people say, “I went to a doctor and I got a blood test and my cortisol levels were really high.” And I’ll say, “Well I’m not a physician, right, however it’s important to ask for you to ask about the other things that you were testing for because if you took cortisol level blood work at eight in the morning, it’s going to be pretty high as it should be, right? But when you’re experiencing or consistently exposed to anxiety, those cortisol levels are chronically high and when cortisol levels are chronically high it impacts your body’s immune system and the body’s ability to fight the way it should.”

And I’m not going to get into that part of it too much but I wanted to just give you a little bit of an idea of the types of things that happen in your body that you are not aware of when anxiety is at its highest. Okay?

Top-Down vs. Bottom-Up Anxiety

Now, that being said, I think it’s important for me to explain to you the difference between these two types of anxieties that we experience. There’s one that we refer to as top-down, and then the other one is bottom-up. And to give an explanation or a reason as to why sometimes let’s say you’re experiencing some physical sensations and you say to yourself, “I’m going to be okay, I’m going to be okay. Everything’s fine.” And you’re feeling like, well that’s not working.

Well there’s a reason for that and it’s because the part of your brain that is engaged in that moment is a part of the brain that does not understand language, it only understands body signals, okay?

So with that let’s start with bottom-up anxiety. Bottom-up anxiety is the type of anxiety that you feel literally in your body. It is when your brain and body are in flight, fight, or freeze mode and all these signals are going through your body and your body’s in super high alert and you’re feeling the physical sensations.

You might feel your palms get sweaty, you might feel, oh my gosh, your heart just feels like it’s coming out of your chest. You might feel the blood rushing to your face and you feel yourself get all flushed, right?

This is the type of anxiety, bottom-up, that you feel when your body’s response to anxiety… The stress, I should say the stress that your body’s responding with to anxiety, you feel it from the bottom up, which is your body, and you get all those physical sensations that feel uncontrollable sometimes.

Top-down anxiety is the type of anxiety that gives you a lot of thought, a lot of ruminations, a lot of what-ifs, right. Top-down will give you a lot of those unanswerable questions that just, man they’re sticklers, they don’t want to go away. But what if… What if I had done this? What if I had done that? What if that happens? What identity this doesn’t happen? I always… I should… Oh no. Right?

And you may or may not have physical sensations that go along with top down anxieties which are more cognitive in nature but those types of anxieties require a different strategy than bottom up types of anxieties do.

So we will talk a little bit more about some of those self-interventions that you can apply later on, towards the end of this podcast but I wanted to just touch a little bit first on, how these types of anxieties as they’re manifesting themselves, interfere with daily activities.

When Can Anxiety Be Helpful?

Anxiety is helpful when your body and your brain’s alarm system is responding appropriately to danger, actual danger however, when your brain and body are having an overresponse to situations that really, yeah they’re uncomfortable, I don’t like this, I’m worried but there’s no actual danger, that’s when anxiety starts to interfere with your daily activities. It becomes difficult to control and your reactions are out of proportion to the situation.

And the further that this goes on untreated or not treated in the appropriate manners, the more difficult it becomes to understand what’s happening and how to manage it.

That being said, the good news here, I want you to listen to this very, very clearly because there is a silver lining here. The good news is that at the end of the day we are dealing with the brain. This is what it comes down to. And our beautiful brains are incredibly flexible, there’s a term that I’m going to have you write down, whether you type it in your phone or write it down or just put it in your head and try to remember it.

Neuroplasticity, okay? Neuroplasticity provides us with the opportunity and the ability to retrain our brains so that the triggers that we are disproportionately responding to can be reframed in our minds, and with the right strategies and tools, you can actually create new, what we call neural pathways, okay?

With every new experience that you have and every new application and implementation of an appropriate strategy and tool, I wish I could show it to you in vivo, you are quite literally creating new neural pathways in your brain, which means that the more that you practice these strategies, the more your brain starts to learn that, oh wait so I don’t have to react like that, I can react like this.

Your Brain Is A GPS

One of my favorite authors, Dr. Catherine Pittman, talks about the brain, as the brain is like a GPS and I’ve often used this with clients who I’m working with. Your brain is like a GPS, okay, and when there is a situation, aka maybe a trigger and it’s accustomed to going right, well every time that there’s that situation that comes up or something similar, it doesn’t have to be the same thing, your brain just automatically is programmed like a GPS to go right. However, every time that you implement a new tool or a new strategy what you are in essence doing, and you guys just bear with me because I’m also super visual and I’m always giving all kinds of crazy analogies and cross my fingers that my clients understand me, I do ask them though, “Are you getting this?”

But anyway, so every time that you implement a new strategy or tool, you are in essence, if you could just imagine this, taking control of that wheel in your brain and saying, “No, no, no, no. We’re actually going to turn left now, we’re doing this now. When this happens, when this situation comes us I know that you want to turn right, but we’re actually doing left. Okay? We’re going left now.”

Now, if you can imagine that building new habits, learning to react differently to situations, and retraining your brain is like, I don’t know, like building a new roadway. Imagine, right, now if you’re building a new roadway, it’s not going to happen overnight, you’ve got to break some ground there. You’ve got to break some ground and you’ve got to smooth it over, you’ve got to keep using it, smoothing it over, using it over and over until it becomes usable and it becomes your favorite road. Right.

So in terms of the brain and it reacting to a trigger or something that triggers anxiety, right, every time that you take control of that wheel, whether it is because you’re using a cognitive technique which is going to help you with top-down anxiety, or if it is a breathing technique which is going to help you with bottom-up, every time that you do something different you are breaking ground and making a new pathway to a new way of reacting. You are quite literally retraining your brain.

That is why I love working with anxiety because I know that we all have the power. You have the power to create the change that you want, you just need the right tools.

And just a quick reminder, this podcast is solely informational, it’s not intended to be a substitute for healthcare or medical treatment by a healthcare professional. Do not rely on any of this information in this podcast for diagnosis or treatment, and lastly my team and my practice and I are located in New York City, and I also practice in New Jersey. And we cannot provide information on any other practice but our own.

Avoidance

Let’s talk a little bit about avoidance because avoidance is one of those things that anxiety really loves. I mean it is numero uno and what it likes to make you do. And sometimes, or oftentimes, more often than not actually we avoid things because well obviously we don’t have to look at the person we’re avoiding or the situation, et cetera, et cetera.

But if we dig a little bit deeper, avoidance of places, situations, or things are really about trying to prevent uncomfortable feelings. Feelings, emotions are at the core of all of this. Just think about that for a moment, right.

I’m going to avoid a specific situation, right, and maybe yeah maybe the situation is not comfortable and maybe it’s not anything that anybody would enjoy but if you had to, could you get through it? Probably, you could probably get through it but if your brain’s alarm system is giving you enough signals to say, “Oh no, no, no, no, no, no, no, no do not go there. Do not go there because ha-ha remember last time?” Well, guess what, you’re going to avoid it but what you’re really avoiding is a feeling.

Avoidance, once again, is about avoiding uncomfortable or even feelings that might feel intolerable. The way that you get through that is by training yourself, retraining the brain, and allowing yourself to experience these things so that you can really understand and prove to yourself and prove to the old noggin that you can get through it and that there’s no actual danger.

We Get Through Things, Not Over Things

I want you to take notice that I said get through it. We do not get over things and I know that you all experiencing anxiety have heard it at least once, “Oh you’re fine, get over it. You should relax. It’s not such a big deal… Oh, you’re so sensitive, so dramatic.” I mean I could just go on and on, right?

And that’s incredibly invalidating, not to mention hurtful, right? And it can make us question ourselves and doubt our instincts after a while. So we don’t get over things, we get through things because when we get through things, we see ourselves victorious on the other side, still whole and in one piece. Do you hear me on that? I want that to be very clear. We don’t get over things, we get through things.

Now, earlier on in the podcast, I touched on how and when anxiety might be helpful, right? We talked about meeting a deadline or needing to perform, sometimes actually it gets your creative juices flowing and also obviously when you are in actual danger.

So there’re different ways in which anxiety is very helpful and that’s why we don’t want to get rid of anxiety but when is it not helpful? And I want to review this again because this is the difference, right?

When Anxiety Is Not Helpful

Anxiety is not helpful when your symptoms are getting in the way of your everyday life. When anxiety is not allowing you to socialize or keeps you from doing some of the things that you want to do or achieving some of the goals that you want, no matter how big or small. When it is not allowing you to live your life, and I’m not going to even say to the fullest because that sounds a little cheeky to me, to be quite honest with you.

I’m talking about when anxiety’s not letting you be the best parent that you could be because you are so overly worried that your kid is going to turn out like you or that if you don’t over-help or are not there that they’re not going to know what to do. Not realizing, that the unspoken message might be to those kids or to that child, “I don’t trust that you know what you’re doing, I need to do everything for you.”

And you’re the best-meaning parent, you are quite literally the best-meaning parent, you want to protect that kid because of your own experiences but what you may not be realizing is that the message that child is getting is, “I can’t do anything myself,” or, “I need mom or dad to do this for me,” and you might be creating some insecurities or anxieties in your child, and again, you’re well-meaning. This is not because you want to do that.

But these are some of the consequences that people are not aware of that end up happening. Super incredibly well-meaning with not so great outcomes. Unexpected outcomes.

Also, anxiety is not helpful when your emotions or physical reactions are out of proportion to the situation, I have said that probably three times during this podcast and there’s a reason for that.

It is because it’s important for you to start thinking about, wait, does my reaction make sense? Am I ruminating about it at night and I keep thinking about it, I can’t stop. I don’t know how to stop. Am I getting physically sick? Am I getting stomach aches every time I think about this?

So when things like that start to happen, it’s time to start thinking about whether you might need some help in managing your anxiety.

And the last part to mention about when anxiety is not helpful, is just really, gosh is your overall quality of life lower now than it was at some point when your anxiety was not driving your mental health bus?

Were these times in the past where you were doing much better, and yeah you had some anxiety or some issues that brought you anxiety but it was fine. And now, it’s not fine, now it’s not something that you feel you can manage. And because of so much anxiety your quality of life is just really much lower or deteriorated significantly.

Interventions To Manage Your Anxiety

I want to now spend a couple of minutes to give you some interventions that you can apply yourself and see what works.

What we’re really trying to do here folks, is number one, we are going for progress, not perfection, and I said that in my last podcast which actually was my first, and I’m going to say it again because this is really important. For all my perfectionists out there, you know who you are, all those high achievers, type As, woo, woo.

Yeah, that’s where your anxiety really builds from oftentimes, and so we’re going for progress, not perfection, I know that’s making some of you tweak, literally. I get it, you’re tweaking out, that’s okay. Hey, I’m going to say it again, progress not perfection.

So let’s talk about when worry is helpful versus not helpful. Okay, helpful worries. A helpful worry is… And by the way, I want to give props to my former mentor Dr. Laurie Keefer, she’s with wonderful GI, health psychologist and I was incredibly lucky to have her mentor me during my time at Mount Sinai and she was the one that introduced me to this concept of helpful worries versus unhelpful worries and let’s talk about helpful worries first.

Okay, so how do I decide that the thing that is literally taking over my life right now, the thoughts right, if it’s helpful?

Is There An Actual Problem?

Okay, well the first thing that you ask yourself is, is there an actual problem? Is there an actual problem? And how do I know if there’s an actual problem? I’m not sure. Well, whatever it is that you’re worried about, is there something that you can actually do to impact the outcome? Okay?

Because if you are worried about something and you say okay, I can identify a problem here, yep there’s a problem. And how do I know? Because these are one or two or three of the things that I can do then that is a helpful worry. And you go into problem-solving mode, right?. What are things I could do, is there somebody that I need to talk to? Is there a phone call that I need to make? Is there a conversation that I need to have? Okay. That’s a helpful worry because you have things that you can do to impact the outcome.

An unhelpful worry, is a worry where there is nothing, there’s no actual problem to solve or you have actually done everything possible that you could’ve done and there’s nothing else to do.

If you’re worried about something, and you ask yourself, wait a minute, is there an actual problem here? Have I done everything possible? And the answer is yeah, there’s nothing else here, or there’s nothing here. Then this is really important, okay people? This is when you shift your thinking to distress tolerance because there is no problem to solve, you cannot stay in problem-solving mode and expect to feel better.

Now you have to shift to distress tolerance mode. And the reason for that is that there is nothing that you can do, or you’ve done everything else. So now what you’re really dealing with is the emotions. Maybe the feeling out of control, maybe what you’re really dealing with is questions about uncertainty like what’s going to happen to me, or what are people going to think of me? Or how did I do this or why did I do this? Or what could I have done to prevent this? Okay?

If you’re focusing on a lot of unanswerables then what you need to do is shift your mindset to distress tolerance so that you can get the support that you need.

Support Systems

And this is where having a good support system is really helpful, friends, family, if you’re seeing a therapist, you talk to your therapist about it. If anybody ever tells you that you can control your thoughts, I want you to turn around real slow and you just walk away, you say, “Okay, I gotcha,” and then you never come back. All right? I’m not even kidding about that. I am not kidding.

No, you can’t control your thoughts however, what you can do, is once you are aware of your thoughts you can learn techniques and ways and strategies to redefine, reframe, rephrase, challenge… You can learn how to poke holes in your own story, okay? But you do that by acknowledging the thought, not pretending it’s not there, not telling yourself, it’s okay, it’ll be fine. Okay, we get through things, not over things.

Those things I was just talking about are referring to those top-down types of anxieties and actually, before I move on to bottom-up, let me just give you a couple of other things that you can say to yourself with those worries.

Am I overestimating what’s happening here? What is the worst-case scenario and can I get through it? I’m not saying you’re going to like it, I’m not saying that it’s going to be uncomfortable, that it’s not going to be uncomfortable, I’m just saying, can you get through it? Okay. Am I minimizing my ability to cope? Have I been through worse before, but in this moment I can’t remember that because this moment just feels so freaking big.

So have I been able to get through things like this in the past? If this was my best friend or a loved one, what would I say to them if they were going through this? What would I say to them? Okay.

So those are some things that you can implement right away, to deal with those worries, those thought-based worries, and anxieties, top-down anxieties.

Bottom-up stuff, okay. Here’s the deal. When that alarm system is going off… Here, this is the way I’ve explained it sometimes, okay?

If you are walking down the street, I don’t know let’s picture the suburbs somewhere, right? And you’re walking down the street and behind yard fence number one, there is Fido and Fido is this little dog just there and you’re like, “Oh hey Fido,” tails wagging and then you keep going and two doors down there is Brutus, and Brutus is just barking away, snarling, oh my God, the saliva is coming down. I think I’m getting some visceral anxiety just thinking about that.

Anyway, so if you think about that, right, which one of those two dogs, Fido or Brutus, do you think that you have a better chance of talking to and then following commands? Okay. When you are in fight, flight, or freeze mode, or specifically fight or flight I should say, your brain is like Brutus. And if you go try to talk to Brutus and say, “Good dog,” and put your hand out… Okay, you know the rest.

So body signals, when your body is responding to the brain’s alarm system, you want to talk to your body. You want to talk body, which means not speaking English or Italian or Mandarin or whatever it is that you speak, no, no, no. We want to talk body signals, okay? And the way to do that is to calm the body down, let it know that it’s okay, that there is no actual danger happening here.

Diaphragmatic Breathing

One way that you can do this is by implementing something called diaphragmatic breathing, I welcome you to do some research on it and we’re going to have a link in the show notes with YouTube that gives you an explanation about how to do it. But basically, you breathe in through your nose, and the idea here is you want to pretend like you have a balloon in your belly and you want to inhale through your nose and try to bypass your chest and fill that balloon with air, hold it, hold it, hold it, and then exhale with controlled breaths through your mouth. Controlled breaths, okay?

If you can get to that type of breathing before your body goes into overload, you will be able to get your body to calm down. Once you get your body calmed down, then you can implement some of these more cognitive exercises or questions or strategies. Okay. But if your anxiety manifests itself through that bodily or physical reaction then it’s really important that you talk body, okay.

If however, as I said before, you are having cognitive types of anxieties, in other words, top-down, lot of thoughts, then you want to implement some of those worry control questions, okay?

There are a number of other exercises that you can do that are helpful, there’s something called progressive muscle relaxation, there is meditation. There are mindfulness exercises that you can implement. So there are a number of other things that you can do to help lower your anxiety levels. Those are some that you can pretty much implement immediately.

Closing

So in closing, in today’s episode, we talked a lot about anxiety. We talked about that common sentiment that we oftentimes express of wanting to get rid of my anxiety because it’s getting in the way of my life and why that is not a thing.

We talked about how anxiety is helpful and also when it’s not helpful, and we did some talking about the brain and the brain’s alarm system and its role in the manifestation of anxiety.

Also, we talked about top-down versus bottom-up anxiety, and last but not least, I provided you with some easy-to-implement interventions that you can try right away.

And again, if you want to know more about me or our group practice or this podcast, be sure to head over to cohesivetherapynyc.com/podcast to check out the show notes, and there you’ll be able to find resources, links, and how to get in touch.

As always, it’s my pleasure, and I’ll see you next week.