WEBVTT - Ep153 Can You Unlearn Anxiety? with Judson Brewer 0:00:00.120 --> 0:00:02.960 Today, for Mental Health Awareness Month, we're going to talk 0:00:03.000 --> 0:00:07.880 about anxiety. This is something close to everybody's experience, either 0:00:07.920 --> 0:00:11.400 because they've had it themselves or someone close to them 0:00:11.480 --> 0:00:14.400 has had it. So today we're going to ask several questions. 0:00:14.920 --> 0:00:19.880 Does your brain accidentally teach itself to stay anxious by 0:00:20.280 --> 0:00:24.639 looping on the same fears? Is anxiety helping you perform 0:00:24.720 --> 0:00:29.440 better or making everything harder? What happens when you stop 0:00:29.560 --> 0:00:32.960 running from anxiety and look straight at it. Is it 0:00:33.040 --> 0:00:37.400 possible to unlearn worry the same way that you learned it? 0:00:38.120 --> 0:00:42.440 What if curiosity is stronger than fear? Today we're going 0:00:42.479 --> 0:00:46.080 to talk with doctor Judd Brewer, who suffered with anxiety 0:00:46.080 --> 0:00:48.879 as a young man and then became a psychiatrist and 0:00:48.960 --> 0:00:53.080 a neuroscientist, and he's studied anxiety his whole career and 0:00:53.159 --> 0:00:56.280 he has a very different take on what can be 0:00:56.360 --> 0:01:02.760 done about it. Welcome to Inner Cosmos with me David Eagleman. 0:01:02.920 --> 0:01:06.039 I'm a neuroscientist and an author at Stanford and in 0:01:06.080 --> 0:01:09.640 these episodes, we sail deeply into our three pound universe 0:01:09.920 --> 0:01:13.080 to understand why and how our lives look the way 0:01:13.120 --> 0:01:36.759 they do. What does it mean to feel anxious. This 0:01:36.800 --> 0:01:39.800 is one of those experiences that most people know somehow, 0:01:40.200 --> 0:01:42.520 but if you're asked to define it, it kind of 0:01:42.520 --> 0:01:46.040 slips through your fingers. So most people will grab for 0:01:46.080 --> 0:01:49.560 words like fear and worry. But it actually has to 0:01:49.600 --> 0:01:52.800 do with something very fundamental in the brain, which is 0:01:53.160 --> 0:01:58.160 your brain's projections into the future. Your brain is fundamentally 0:01:58.280 --> 0:02:03.280 a simulation engine that's always running itself ahead of reality. Now, 0:02:03.280 --> 0:02:06.280 this is one of the brain's greatest powers. So although 0:02:06.320 --> 0:02:09.000 you might read a textbook on the brain and think, oh, 0:02:09.040 --> 0:02:13.519 it's just passively recording the present moment, that's not really 0:02:13.520 --> 0:02:18.480 what it's about at all. Instead, it's constantly constructing models 0:02:18.480 --> 0:02:23.880 of what might happen next. It's running simulations and imagining 0:02:23.919 --> 0:02:29.239 outcomes and hopefully preparing you. This capacity to unhook from 0:02:29.240 --> 0:02:33.400 the here and now, to imagine yourself in the there 0:02:33.520 --> 0:02:36.760 and then. This is what allows you to plan a 0:02:36.760 --> 0:02:41.480 trip to Hawaii, or to anticipate a tough conversation, or 0:02:41.560 --> 0:02:46.240 to avoid a situation that would otherwise be dangerous. But 0:02:47.280 --> 0:02:51.000 what happens when this system for simulating into the future 0:02:51.639 --> 0:02:56.040 runs unchecked. Instead of preparing you and guiding your actions, 0:02:56.320 --> 0:03:01.519 it starts to loop endlessly, and this looping, this repeated 0:03:01.600 --> 0:03:06.520 simulation of possible futures, often negative ones, This is what 0:03:06.560 --> 0:03:10.120 we call anxiety. Now. Anxiety shows up in a lot 0:03:10.160 --> 0:03:14.160 of different ways. Sometimes it's obvious, with a racing heart 0:03:14.160 --> 0:03:17.200 and a tight chest in a sense that something is wrong. 0:03:17.440 --> 0:03:21.480 Sometimes it's more of a background hum of worry. And 0:03:21.520 --> 0:03:25.120 sometimes it disguises itself totally. You might think you have 0:03:25.160 --> 0:03:29.760 a stomach problem or trouble sleeping or difficulty concentrating. But 0:03:30.000 --> 0:03:33.040 underneath it all, the brain is doing what it does best. 0:03:33.120 --> 0:03:38.600 It's generating possibilities. It's scanning for threats, trying to keep 0:03:38.600 --> 0:03:43.280 you safe. So the system designed to protect you can 0:03:43.360 --> 0:03:49.000 become self reinforcing. It begins to feed on itself. You worry, 0:03:49.080 --> 0:03:52.240 which makes you feel anxious, which makes you do something 0:03:52.280 --> 0:03:56.440 as a temporary relief. But that thing makes you worry more. 0:03:56.960 --> 0:03:59.840 And this is a loop, and once a loop for 0:04:00.400 --> 0:04:02.920 the brain. That's what we call a habit. 0:04:03.320 --> 0:04:03.480 Now. 0:04:03.520 --> 0:04:06.560 When we think about habits, we usually think about physical 0:04:06.600 --> 0:04:11.600 behaviors like smoking or eating or doom scrolling. These are 0:04:11.960 --> 0:04:14.480 habits that you can see and point to. But what 0:04:14.720 --> 0:04:18.880 if some of our most powerful habits are invisible? What 0:04:18.920 --> 0:04:23.320 if anxiety itself is a habit. What if it's something 0:04:23.520 --> 0:04:28.159 that your brain learns to do. That today's conversation, and 0:04:28.279 --> 0:04:32.160 it matters because instead of treating anxiety purely as a 0:04:32.600 --> 0:04:37.560 chemical imbalance or purely as a cognitive distortion, the question 0:04:37.760 --> 0:04:41.880 is whether there's another lens we can apply, in this case, 0:04:41.960 --> 0:04:46.320 a lens from neuroscience and behavioral science, a lens that 0:04:46.480 --> 0:04:51.040 raises the possibility that anxiety runs on the same machinery 0:04:51.120 --> 0:04:54.080 as every other habit that your brain learns. You have 0:04:54.160 --> 0:04:57.599 a trigger, you do a behavior, you get a result, 0:04:58.240 --> 0:05:02.760 and that lends adjusting that anxiety is at least in part, 0:05:02.800 --> 0:05:06.760 a learned loop that implies you might be able to 0:05:06.839 --> 0:05:10.400 unlearn that. The first step will be to ask, what 0:05:10.560 --> 0:05:13.800 is my brain getting out of this loop? Because, as 0:05:13.800 --> 0:05:17.000 we're going to see today, even the most frustrating patterns 0:05:17.240 --> 0:05:20.560 have some kind of payoff, and if we can understand 0:05:20.600 --> 0:05:24.680 that payoff, we can begin to loosen the loop. So 0:05:24.680 --> 0:05:27.560 today we're going to explore this idea with Judson Brewer, 0:05:28.000 --> 0:05:32.160 an MDPHD, known sometimes as doctor Judd. He grew up 0:05:32.160 --> 0:05:35.520 with anxiety and now he has a psychiatry practice where 0:05:35.520 --> 0:05:39.479 he deals with anxiety and he runs a neuroscience lab 0:05:39.520 --> 0:05:44.200 where he studies strategies in different approaches. He has spent 0:05:44.279 --> 0:05:49.280 decades studying the mechanisms of anxiety and habits formation. So 0:05:49.520 --> 0:05:53.080 we're going to talk about how anxiety can masquerade as 0:05:53.120 --> 0:05:56.839 a lot of different conditions, how it often operates below awareness, 0:05:56.880 --> 0:06:00.520 and how the act of worrying can create feeling of 0:06:00.520 --> 0:06:03.960 control even when it solves nothing. And we'll dig into 0:06:04.000 --> 0:06:09.680 something that can change things, curiosity. What happens when instead 0:06:09.720 --> 0:06:14.320 of running from anxiety, you examine it closely, the sensations 0:06:14.320 --> 0:06:16.840 and the patterns. So today we're going to explore a 0:06:16.920 --> 0:06:20.440 new way of understanding anxiety as something learned and possibly 0:06:20.560 --> 0:06:30.240 something that can be unwound. Here's my conversation with jud Brewer. Okay, Judge, 0:06:30.279 --> 0:06:32.640 So when somebody walks into your office and says I 0:06:32.760 --> 0:06:34.760 have anxiety, what does that mean? 0:06:35.200 --> 0:06:36.720 That could mean a lot of things to a lot 0:06:36.720 --> 0:06:38.600 of different people. You know, a lot of people don't 0:06:38.600 --> 0:06:41.520 even know what anxiety is. So let's start with a 0:06:41.640 --> 0:06:44.920 standard like dictionary definition, which is, you know, feeling of 0:06:44.960 --> 0:06:48.640 nervousness or unease about something with an uncertain future. Basically, 0:06:48.640 --> 0:06:50.920 I think of it as fear of the future. That's 0:06:50.960 --> 0:06:53.320 probably the simplest way that I explain it to my patients. 0:06:53.640 --> 0:06:56.760 And what are the symptoms of that, for example, worry. 0:06:57.760 --> 0:07:01.280 So there can be a physical symptoms and that's typically 0:07:01.640 --> 0:07:05.320 how people experience anxiety, and then there, as you're highlighting, 0:07:05.320 --> 0:07:07.479 there can be some mental elements that come along with that. 0:07:08.040 --> 0:07:10.560 The biggest mental one is worrying, for sure. 0:07:11.200 --> 0:07:15.520 The feeling tends to be a feeling of restlessness, of nervousness, 0:07:15.560 --> 0:07:17.960 and people describe it as like a tightness or contraction. 0:07:18.040 --> 0:07:20.600 They often feel it and their their stomach, their chest, 0:07:20.680 --> 0:07:23.720 their throat, even their head. And for some people they 0:07:23.760 --> 0:07:27.160 don't even know that they have anxiety. I know a guy, 0:07:28.000 --> 0:07:32.520 this guy who had irritable ball syndrome at the end 0:07:32.560 --> 0:07:35.600 of college, and I didn't know what it was. I 0:07:35.640 --> 0:07:37.840 did a lot of backpacking in college, so I chalked 0:07:37.840 --> 0:07:40.800 it up to getting Jardia for not filtering my water properly. 0:07:41.240 --> 0:07:43.600 Was not jardia. I went to student health. The doc 0:07:43.680 --> 0:07:45.080 was like, could you be anxious? I was like, no, 0:07:45.280 --> 0:07:46.360 I run I played the violin. 0:07:46.400 --> 0:07:50.120 I'm a vegetarian. He's like, okay, you know. 0:07:50.520 --> 0:07:53.040 So he gives me the Zipro, the antibiotic of course 0:07:53.120 --> 0:07:56.040 doesn't work. And then I realized that summer before I 0:07:56.080 --> 0:07:59.440 started medical school that this was actually a manifestation of anxiety. 0:07:59.440 --> 0:08:01.880 My body was trying to tell me, Hey, you know 0:08:02.320 --> 0:08:04.640 this is anxious. Wake up to this, so you know, 0:08:04.640 --> 0:08:06.280 it really can be a shape shifter for a lot 0:08:06.320 --> 0:08:06.679 of people. 0:08:06.840 --> 0:08:07.960 What were you anxious about? 0:08:08.640 --> 0:08:09.120 I don't know. 0:08:09.320 --> 0:08:12.720 Well, I was going to medical school and life, I'd 0:08:12.760 --> 0:08:14.080 just broken up with my girlfriend. 0:08:14.160 --> 0:08:15.920 You know, a lot of things to be anxious about. 0:08:16.280 --> 0:08:18.760 Got it? So are there different flavors of anxiety? Does 0:08:18.800 --> 0:08:19.600 everyone have the same thing? 0:08:19.920 --> 0:08:21.760 There are a lot of different flavors. 0:08:21.760 --> 0:08:24.880 So people can have panic disorder where it's related to 0:08:24.960 --> 0:08:27.880 panic attacks. They can have social anxiety where they have 0:08:28.800 --> 0:08:31.200 they're afraid of going out in public. They you know, 0:08:31.320 --> 0:08:34.360 far into the spectrum like obsessive compulsive disorder, where people 0:08:34.360 --> 0:08:37.160 have these obsessive thoughts and these compulsive behaviors. And then 0:08:37.240 --> 0:08:41.040 the most common category, if you think of this diagnostically, 0:08:41.280 --> 0:08:46.000 is the generalized anxiety disorder category where people basically wake up, 0:08:46.040 --> 0:08:47.920 they feel anxious all day, they worry all day, they 0:08:48.000 --> 0:08:49.679 go to speed, go to sleep at night, and they 0:08:49.679 --> 0:08:50.600 repeat the process. 0:08:50.840 --> 0:08:53.120 And is that just a big bucket that we throw 0:08:53.160 --> 0:08:57.040 the rest in, or what is generalized mean in this case. 0:08:56.840 --> 0:08:58.280 I think that's a good way of putting it. 0:08:58.280 --> 0:09:00.120 It's a big bucket that we throw a lot in 0:09:00.120 --> 0:09:04.319 to the Diagnostic and Statistics Manual, the DSM, this kind 0:09:04.320 --> 0:09:07.960 of the psychiatric bible for a long time has had 0:09:08.040 --> 0:09:11.120 these categories, but I'm not sure that it has caught 0:09:11.200 --> 0:09:14.280 up to where the science is showing us that there's 0:09:14.640 --> 0:09:19.160 probably a lot of more individualization and it's hard to 0:09:19.240 --> 0:09:22.560 categories people into you know, like here you all have 0:09:22.679 --> 0:09:26.720 generalized anxiety disorder, for example, although I will say, you know, 0:09:26.800 --> 0:09:29.960 one of the very common things is the behavior of worrying, 0:09:30.000 --> 0:09:31.559 this internal behavior of worrying. 0:09:32.200 --> 0:09:35.800 So when we think about all these different panic disorders, 0:09:36.160 --> 0:09:36.960 how common is this? 0:09:37.800 --> 0:09:38.440 Very common? 0:09:38.800 --> 0:09:41.720 I think the anxiety disorders are the most common of 0:09:41.840 --> 0:09:43.800 the mental health categories. 0:09:44.120 --> 0:09:46.240 So what are we talking like twelve percent of the population. 0:09:46.720 --> 0:09:50.800 It's pretty high. Yeah, And so I can't name them 0:09:50.800 --> 0:09:53.720 off the top of my head. But generalized anxiety disorder, 0:09:53.760 --> 0:09:56.760 for example, tends to peak in mid adulthood, which is 0:09:56.840 --> 0:10:00.280 kind of interesting, but it seems to be on the 0:10:00.360 --> 0:10:01.839 rise in general. 0:10:01.880 --> 0:10:06.440 And mid adulthood is what, oh, forties. Okay, so people 0:10:06.920 --> 0:10:09.040 have been living a life without it and then they 0:10:09.080 --> 0:10:12.320 start feeling really anxious about something. Give us an example 0:10:12.360 --> 0:10:16.360 of a patient walks into your psychiatry practice and starts 0:10:16.400 --> 0:10:19.360 talking to you, and you figure out this person has 0:10:19.440 --> 0:10:20.720 generalized anxiety disorder. 0:10:21.200 --> 0:10:25.040 I'm thinking of a particular patient, we'll call him Dave, 0:10:25.520 --> 0:10:27.640 who walked into my office at the age of forty. 0:10:27.880 --> 0:10:29.680 He walks in the door, he looks pretty anxious. Right, 0:10:29.760 --> 0:10:31.840 Sometimes you can just tell that somebody is anxious, like, 0:10:31.880 --> 0:10:34.880 what do you pick up? Oh, there's this vibe to it. 0:10:35.480 --> 0:10:37.559 You know, I don't want to make this sound gloo woo. 0:10:37.679 --> 0:10:41.080 But there's a lot of work actually on emotional contagion 0:10:41.120 --> 0:10:44.079 and social contagion. You know, somebody walks into the room 0:10:44.080 --> 0:10:46.480 and they're really angry, and everybody can feel that anger 0:10:46.559 --> 0:10:48.160 kind of radiating off of them. 0:10:48.720 --> 0:10:50.040 The same is true with anxiety. 0:10:50.160 --> 0:10:51.520 So you can probably see it in their eyes, you 0:10:51.520 --> 0:10:52.880 can see it in their face, you can see how 0:10:52.880 --> 0:10:56.000 they carried themselves. But then give them a second they'll 0:10:56.000 --> 0:10:59.679 tell you exactly what it's like. So this guy in particular, 0:11:00.200 --> 0:11:03.720 had he started getting panic attacks probably in fifth grade, 0:11:03.760 --> 0:11:06.800 I think, so about three decades before he started seeing 0:11:06.800 --> 0:11:11.120 me and had general and he was just worrying all 0:11:11.160 --> 0:11:14.120 the time, and so he met the criteria both for 0:11:14.320 --> 0:11:17.840 panic disorder, where you know, the key to panic disorder 0:11:17.880 --> 0:11:19.040 is not just the panic. 0:11:18.760 --> 0:11:21.800 Attacks, but it's it's being worried about. 0:11:21.600 --> 0:11:24.040 Having a future panic attack and kind of organizing your 0:11:24.080 --> 0:11:27.360 life around avoiding those things. So this gentleman in particular 0:11:27.920 --> 0:11:30.200 had gotten panic attacks driving on the highway, and so 0:11:30.240 --> 0:11:33.440 he was very afraid to drive even on local roads 0:11:33.480 --> 0:11:36.920 like Providence, Rhode Islands, pretty small roads anyway, I think 0:11:36.960 --> 0:11:39.040 anybody gets a little nervous driving on those roads, but 0:11:39.160 --> 0:11:42.000 he in particular was really struggling even driving a couple 0:11:42.000 --> 0:11:43.440 of miles to my office. 0:11:43.120 --> 0:11:44.920 Because he was worried about getting an accent or about 0:11:44.960 --> 0:11:45.760 hitting somebody else. 0:11:46.120 --> 0:11:48.680 Well, he was in particular worried about having a panic attack. 0:11:49.040 --> 0:11:53.160 Oh I see, yeah, so there's the panic piece. He 0:11:53.200 --> 0:11:56.400 also he got a twofer in life, unfortunately, where he 0:11:56.480 --> 0:11:58.920 was so worried all the time and feeling so anxious 0:11:58.920 --> 0:12:01.200 all the time that he met the criteria for generalized 0:12:01.200 --> 0:12:02.280 anxiety as disorder. 0:12:02.400 --> 0:12:06.199 So he was he was just NonStop anxiety and worry. 0:12:06.000 --> 0:12:07.839 And generally when a patient walks into your office. Do 0:12:07.880 --> 0:12:10.520 they have a particular target of their anxiety? I mean, 0:12:10.720 --> 0:12:12.520 in this guy Dave's case, it sounds like he was 0:12:12.520 --> 0:12:15.680 worried about having another panic attack. But do other people 0:12:15.679 --> 0:12:17.280 worry about very specific things? 0:12:17.640 --> 0:12:20.240 There can be Phobia's a lot of you know, spider 0:12:20.280 --> 0:12:23.120 with phobia is a common one. So people can certainly 0:12:23.160 --> 0:12:26.600 have fears of particular things. And I you know, I 0:12:26.600 --> 0:12:30.320 would say, for example, people that generalize anxiety disorder, they 0:12:30.360 --> 0:12:32.360 just look around and they find something to worry about. 0:12:32.400 --> 0:12:35.800 Got it? As in, am I gonna say the right 0:12:35.800 --> 0:12:37.360 thing at this party? Am I going to get this 0:12:37.440 --> 0:12:38.160 work deadline? 0:12:38.200 --> 0:12:38.400 Met? 0:12:38.520 --> 0:12:41.000 Stuff like that. There's always something to worry about. 0:12:41.400 --> 0:12:43.720 Yes, And if you think about this as fear of 0:12:43.720 --> 0:12:46.800 the future, you know, whatever is up ahead of them, 0:12:46.960 --> 0:12:48.880 they're going to turn that into a worry fest. 0:12:49.160 --> 0:12:52.880 And is it because they are simulating possible futures? As 0:12:52.920 --> 0:12:55.040 we know this is the major job of the brain 0:12:55.120 --> 0:12:58.000 is to simulate possible futures and evaluate them. Is it 0:12:58.040 --> 0:13:00.880 that they're simulating bleak futures or future that are embarrassing 0:13:00.880 --> 0:13:03.640 to them or averse of in some way, and then 0:13:03.840 --> 0:13:06.559 evaluating those and feeling those feelings. 0:13:06.400 --> 0:13:08.760 That's my sense, and I don't think you know, these 0:13:08.800 --> 0:13:10.800 generative models. I think that's a good way to look 0:13:10.800 --> 0:13:13.240 at it. What I mean by that is, you know, 0:13:13.280 --> 0:13:16.280 we have this this world view, and then we're going 0:13:16.360 --> 0:13:19.960 to bias what we see now to meet that worldview. 0:13:20.040 --> 0:13:23.720 And so you know, this is where a confirmation bias 0:13:23.720 --> 0:13:27.880 comes in. So somebody, somebody with general as anxiety disorder, 0:13:27.920 --> 0:13:32.240 for example, might see an upcuping trip that they're planning 0:13:32.360 --> 0:13:35.640 very differently than somebody that doesn't have a lot of worries. So, 0:13:36.120 --> 0:13:38.040 you know, they all they have to book their tickets, 0:13:38.040 --> 0:13:41.000 they've got a book, hotels, whatever the trip is. And 0:13:41.120 --> 0:13:44.960 somebody without the generalised anxiety disorder might say, okay, we're 0:13:44.960 --> 0:13:46.120 going to do this. We're going to do this. They 0:13:46.200 --> 0:13:48.800 might check their you know, their itinerary a couple of times, 0:13:48.880 --> 0:13:51.959 make sure they haven't missed anything. Somebody with worry will 0:13:52.040 --> 0:13:54.200 do that planning, but they'll add on top of it like, 0:13:54.280 --> 0:13:55.520 oh maybe this could go wrong? 0:13:55.559 --> 0:13:56.680 What about this? What about this? 0:13:57.040 --> 0:14:00.840 So they start catastrophizing. One way to kind of get 0:14:01.120 --> 0:14:04.880 a sense for whether this is happening is asking somebody like, 0:14:05.000 --> 0:14:07.480 how many times have you gone over this trip in 0:14:07.520 --> 0:14:10.440 your head. So planning a couple of times to make 0:14:10.440 --> 0:14:12.840 sure you haven't missed anything makes sense. But when it 0:14:12.840 --> 0:14:15.320 goes to four and then fourteen and then forty four, 0:14:16.120 --> 0:14:21.040 that's debt generally tripping into the area of worrying and catastrophizing. 0:14:21.360 --> 0:14:25.000 Do you make a distinction between let's call it adaptive 0:14:25.000 --> 0:14:27.160 anxiety and maladaptive No. 0:14:27.360 --> 0:14:29.440 The nice thing here is there's a lot of stuff 0:14:29.480 --> 0:14:32.120 that's not clear in the science and the clinical realm. 0:14:32.240 --> 0:14:36.040 This one's pretty clear. Okay, there's no adaptive anxiety, got it, 0:14:36.080 --> 0:14:38.960 full stop. So there's good research and actually this is 0:14:39.000 --> 0:14:41.080 worth unpacking a little bit because there's a lot of 0:14:41.200 --> 0:14:46.160 mythology on the internet about this. There's good data showing 0:14:46.200 --> 0:14:50.600 that there's an inverse relationship between anxiety and performance, for example, 0:14:50.640 --> 0:14:53.320 at work performance. So the more anxious somebody is, the 0:14:53.360 --> 0:14:56.160 worse they do. And they say that because there's a 0:14:57.000 --> 0:15:01.280 curious if you've heard this the yerk's Dodson law, no good, 0:15:01.400 --> 0:15:04.640 don't go look it up. Okay on the internet the 0:15:04.800 --> 0:15:07.880 yer Dodson Law talks about this inverted you shaped curve 0:15:08.000 --> 0:15:10.960 around performance anxiety, and the idea is, if you have 0:15:11.120 --> 0:15:13.400 very you know very little anxiety, you're not going to 0:15:13.440 --> 0:15:15.280 perform well. And you if you have too much, you're 0:15:15.320 --> 0:15:18.040 going to be deer in the headlights and not perform well. 0:15:18.080 --> 0:15:18.280 Righty. 0:15:18.320 --> 0:15:20.640 For this, this was based on a nineteen o eight 0:15:20.680 --> 0:15:24.200 study of Japanese dancing mice, for which they didn't even 0:15:24.240 --> 0:15:28.200 report their statistics. Oh so, first off, Japanese dancing mice, 0:15:28.320 --> 0:15:31.160 you can't exactly ask them how anxious they are. Right, 0:15:31.520 --> 0:15:35.040 They did find that there was even though their statistics 0:15:35.080 --> 0:15:37.160 weren't really reported. These were like groups of like two 0:15:37.320 --> 0:15:38.239 or three mice. 0:15:38.200 --> 0:15:39.800 So take that all that with a grain of salt. 0:15:40.000 --> 0:15:42.920 But they were finding that there's a level of arousal 0:15:43.280 --> 0:15:46.160 that correlates with performance, which makes sense, like if you're asleep, 0:15:46.160 --> 0:15:47.920 you're not going to perform well. If you're freaked out, 0:15:47.920 --> 0:15:50.680 you're not going to perform well, whether you're a mouse 0:15:50.760 --> 0:15:54.880 or a person. Right, right, So this has been mythologized 0:15:54.920 --> 0:15:58.000 on the internet to this inverted you shaped Yerks Dodson 0:15:58.080 --> 0:16:00.400 law that you need a certain amount of anxiety form Well, 0:16:00.800 --> 0:16:05.240 this is total correlation at best in humans where people 0:16:05.720 --> 0:16:08.680 my sense is that they're holding onto this story that oh, 0:16:08.880 --> 0:16:10.760 my anxiety is good for me. I get to keep 0:16:10.800 --> 0:16:13.880 it as compared to actually, if you look at the data, 0:16:14.040 --> 0:16:16.800 your anxiety is not helping you, and holding onto that 0:16:16.920 --> 0:16:18.280 story is making it even worse. 0:16:18.920 --> 0:16:20.680 But just to push it on this for one second, 0:16:20.960 --> 0:16:23.240 is it useful to say, Okay, I'm going on this 0:16:23.280 --> 0:16:26.480 big trip to the Antarctic, and I really do want 0:16:26.520 --> 0:16:28.480 to make certain that I've packed this and I'm ready 0:16:28.520 --> 0:16:33.760 for this eventuality and this possibility over here and so on. 0:16:34.320 --> 0:16:37.160 Let me ask you, this is the your Dodson law. 0:16:38.320 --> 0:16:40.360 Do you think there's something about it that caught on 0:16:40.480 --> 0:16:44.640 because it points towards something directionally or it's totally wrong. 0:16:45.040 --> 0:16:47.080 I would say there are a couple of things that 0:16:47.440 --> 0:16:50.280 give it this govitas that people have given it. One 0:16:50.520 --> 0:16:54.680 is that it fits with people's experience. And so this 0:16:54.760 --> 0:16:58.880 is where the more mythology right. Correlation does not equal causation. 0:16:59.360 --> 0:17:04.440 So somebody's anxious, true, and they perform well. True, They 0:17:04.480 --> 0:17:07.800 can start to correlate being anxious with performing well. Another 0:17:08.440 --> 0:17:11.920 good research line has shown that people correlate, or they 0:17:12.040 --> 0:17:16.200 basically correlate problem solving with anxiety. Well, somebody has generalized 0:17:16.200 --> 0:17:19.320 anxiety disorder and they're anxious all day, and they solve 0:17:19.359 --> 0:17:24.159 a problem guess what correlation, right, So the likelihood that 0:17:24.200 --> 0:17:26.280 you're going to associate the two is pretty high if 0:17:26.320 --> 0:17:30.800 you're worrying all day. So I think those pieces play 0:17:30.800 --> 0:17:33.920 a huge role here. And the other is that it's 0:17:34.040 --> 0:17:37.440 hard for people to let go of really being identified 0:17:37.480 --> 0:17:38.200 with anxiety. 0:17:38.240 --> 0:17:39.120 I see this a lot. 0:17:39.400 --> 0:17:42.720 A pilot tester for one of our early anxiety programs 0:17:43.080 --> 0:17:45.639 who wrote me an email is so stunning. 0:17:45.800 --> 0:17:46.600 The way she wrote this. 0:17:46.680 --> 0:17:48.840 She said, you know, I feel like I have this 0:17:49.040 --> 0:17:52.560 deep edged in my bones anxiety. This is how identified 0:17:52.640 --> 0:17:56.720 she was with her anxiety. So here, I think the 0:17:56.840 --> 0:17:59.520 identification piece and anxiety is not unique. 0:17:59.520 --> 0:17:59.680 Here. 0:18:00.000 --> 0:18:02.800 We get identified with anything from you know, I like 0:18:02.840 --> 0:18:05.600 this type of coffee or chocolate, to I like surfing 0:18:05.640 --> 0:18:08.840 to whatever, you know, like we see ourselves a certain way. Well, 0:18:08.840 --> 0:18:12.480 this is also true with the psychiatric conditions, where somebody 0:18:12.560 --> 0:18:16.199 is like, oh, you know, I have ADHD, I have anxiety, 0:18:16.320 --> 0:18:19.880 you know, like I'm an anxious person. That's actually limiting 0:18:19.920 --> 0:18:23.720 for people because they kind of box themselves in, but 0:18:23.800 --> 0:18:27.000 the identification gives them this comfort zone where they feel 0:18:27.000 --> 0:18:30.080 comfortable because they've lived there so long. For example, my 0:18:30.160 --> 0:18:33.680 patient that I described earlier when we were working together 0:18:33.720 --> 0:18:36.280 and he was starting to have periods where he. 0:18:36.240 --> 0:18:39.000 Wasn't having anxiety and he comes in one day. 0:18:39.000 --> 0:18:41.720 I still remember this because he's like, you know, I 0:18:42.080 --> 0:18:44.919 have these periods where I'm just not worrying anymore, and 0:18:44.920 --> 0:18:47.840 he goes, Then I start to worry that I'm not worrying, oh, 0:18:47.960 --> 0:18:51.080 because it was such a habit and it was The 0:18:51.080 --> 0:18:52.879 way I think of this is we move out of 0:18:52.920 --> 0:18:55.719 our comfort zone, even if our comfort zone is discomfort, 0:18:56.480 --> 0:18:59.320 but our brain is saying, hey, this is different, is 0:18:59.359 --> 0:19:01.240 a dangerous and the first thing our brain's going to 0:19:01.320 --> 0:19:04.040 check for is danger. Well, if we can train people no, 0:19:04.119 --> 0:19:06.560 you're moving to your growth zone, You're moving somewhere else 0:19:06.640 --> 0:19:09.960 that's better, then they can learn that that new space 0:19:10.440 --> 0:19:12.879 is the new normal, which is a wonderful sign, but 0:19:12.960 --> 0:19:15.080 it can be scary for people. 0:19:16.280 --> 0:19:18.320 Was he worrying about not worrying because he thought I 0:19:18.320 --> 0:19:20.880 won't be prepared for work tomorrow or for the. 0:19:21.320 --> 0:19:23.240 It was just that it was so different for him. 0:19:23.359 --> 0:19:28.960 Yeah, okay, okay. So a lot of people have anxiety 0:19:29.000 --> 0:19:32.680 of some sort and the question is what are the 0:19:32.720 --> 0:19:34.840 things that they can do about it? So there are 0:19:34.920 --> 0:19:39.159 pharmaceutical interventions, there are cognitive interventions, and we're also going 0:19:39.200 --> 0:19:41.120 to spend a lot of time talking about what you've done. 0:19:41.240 --> 0:19:45.040 Incredible work. So let's start with the pharmaceutical medications. 0:19:45.160 --> 0:19:48.399 Sure, so, as a psychiatrist, the best medications that we 0:19:48.480 --> 0:19:52.920 have out there the selective serotonin reuptake and have SSRIs. 0:19:53.640 --> 0:19:55.919 That number needed to treat, which is just a fancy 0:19:56.000 --> 0:19:58.120 term for like how many people you need to give 0:19:58.160 --> 0:20:01.399 a treatment to before one person shows a significant reduction 0:20:01.480 --> 0:20:04.600 in symptoms. That number needed to treat as five point two. 0:20:04.920 --> 0:20:08.800 So basically, for every five patients that walk in my door, 0:20:09.280 --> 0:20:12.439 one of them is going to show significant reduction in 0:20:12.440 --> 0:20:16.600 symptoms with the medication. The my psychiatric crystal ball is 0:20:16.640 --> 0:20:18.520 kind of broken, so I don't know which one of 0:20:18.520 --> 0:20:19.960 those five is going to benefit. 0:20:20.640 --> 0:20:22.200 And on top of that, you know. 0:20:22.160 --> 0:20:24.280 I can joke that I get anxious as a psychiatrist 0:20:24.359 --> 0:20:25.960 because I don't know what to do with the other 0:20:26.080 --> 0:20:29.720 four who haven't you know, won the genetic lottery or 0:20:29.760 --> 0:20:32.960 whatever and are benefiting. So for me, it's like I 0:20:33.040 --> 0:20:36.320 can get anxious because I'm not sure if I'm limited 0:20:36.560 --> 0:20:39.119 to only prescribing medications. 0:20:38.680 --> 0:20:41.520 And are there many different SSRIs and you try people 0:20:41.520 --> 0:20:42.400 on different ones. 0:20:42.880 --> 0:20:46.480 Yes, yes, and unfortunately it becomes more of a placebo 0:20:46.560 --> 0:20:51.520 game than actual benefit game with anxiety. You know, because 0:20:51.560 --> 0:20:54.199 they with they're all within the same class. They have 0:20:54.400 --> 0:20:57.679 largely the same mechanism of action. They might have slightly 0:20:57.680 --> 0:21:00.480 different side effect profiles and half lives things like you know, 0:21:00.480 --> 0:21:02.800 how long they stand in the body and whatnot, but 0:21:02.920 --> 0:21:05.399 in terms of what they're actually doing in the brain, 0:21:06.520 --> 0:21:09.480 you know, there might be slight variations, but it's really 0:21:09.800 --> 0:21:12.760 you know, once you get past one or two, it's 0:21:12.840 --> 0:21:15.000 it's largely a losing game unfortunately. 0:21:15.280 --> 0:21:19.600 Okay, So besides the pharmaceutical interventions, people have also thought about, 0:21:19.600 --> 0:21:22.280 hey can we do cognitive interventions, the most famous probably 0:21:22.359 --> 0:21:23.960 being cognitive behavioral therapy. 0:21:24.000 --> 0:21:25.840 So explain to us what that is, how that works. 0:21:26.000 --> 0:21:28.480