Podcast: Managing Anxiety and Stress in the Workplace and at Home
Jenn talks to Dr. Lisa Coyne about dealing with stress and anxiety at work, home, and everywhere in between. Lisa shares tips on how to lower anxiety and stress and provides guidance to empower us to feel in charge of our own lives and destinies.
Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. Dr. Coyne is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.
Jenn: Welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Hi there and thanks so much for joining the session today. I’m Jenn Kearney and I’m a digital communications manager at McLean Hospital and this session is all about anxiety. Chances are you either know someone who’s experiencing it, or if you’ve experienced it yourself.
Anxiety affects about 275 million people worldwide and about 40 million people in the US, but only 36% of Americans that experience symptoms of anxiety or an anxiety disorder, are receiving treatment for it and that’s a lot of people. So there’s a good chance that you’re either part of that population or you know someone who is, but thankfully with gratitude to people like Lisa, we don’t have to suffer through anxiety silently.
Dr. Lisa Coyne is a psychologist and senior clinical consultant at the Child and Adolescent OCD Institute, otherwise known as OCDI Junior at McLean Hospital. Lisa, thank you so much for joining us. And I just want to kick it off first and foremost by asking, how do I know if I have anxiety and whether or not it’s chronic or situational and how easy is it to tell the difference?
Lisa: Right, so I think a couple of points, and as you mentioned already, you know, we need to have anxiety. Everyone experiences the emotion of anxiety at one point or another, because it is as all emotions are, really it’s information, it gives our bodies information about what to do next, right?
So when we feel anxious, it makes our sympathetic nervous system engaged, such that we can freeze, flee or fight, depending on what is needed in the situation to get us away from the threat. Now it becomes an issue because we have these wonderful minds, right?
Our cerebral cortex, that’s developed over the course, it’s the oldest sort of part of the brain or the most sorry, the most recent part of the brain that has developed in higher mammals. And it’s the seat of our cognition and language and future planning and abstract thinking and all those things that we use every day, right?
And because we have this ability to speak and understand things in terms of our language, we can also have ideas, abstract ideas of threats and stressors and our anxiety can get aroused by those things whether or not they are real, okay?
So for example, I might think, oh my goodness, what if I get COVID tomorrow, you know? And that’s a scary thought and my body is going to physiologically respond to it by increasing my heart rate, increasing my muscle tension and stress, et cetera, my tummy might be upset and there are a lot of physical signs of anxiety that you might experience.
And here’s the thing, we may or may not have that ever happen to us, but our body’s going to respond the same way, we’re all the same. Now, when you feel anxious or when your response to anxiety is I’ve got to avoid that thing, or I’ve got to fix it or I’ve got to make it go away.
And if that avoidance becomes ubiquitous and gets in the way of your functioning across domains, or it causes you significant distress, such that you’re not able to kind of really be with the people that you care about and, you know, really be present with them, then you want to think about maybe getting some support around it and learning what to do, okay?
So just to recap this very long answer to a short question, sorry, Jenn, so we all have anxiety and it’s okay. The vast majority are like a huge number of us, one in two people, some estimates are going to over the course of their lifetime experience, clinically meaningful anxiety.
Anxiety helps us, right, we evolved to be anxious so that we could keep ourselves safe, but it can be a problem if anxiety is either incredibly distressing to you or it causes lots and lots of functional impairment, or more specifically, whether your attempts to avoid the anxiety cause a lot of functional impairment.
Jenn: So I know that you talked about patterns of avoidance. How do we know if we’re falling into a pattern of avoidance because it’s attributed to anxiety versus a pattern of avoidance just because we’re overwhelmed with things on our to-do list? Or is there really a difference between the two of them, ‘cause I know like…
Lisa: That’s a good question.
Jenn: I tend to avoid doing laundry because I have so many other things going on, but is it avoidance because I’m anxious about the rest of my to-do list?
Lisa: So it’s really interesting that you should ask that because it almost doesn’t matter what you’re avoiding. The key issue really is, is your avoidance getting in the way of you living the life that you really want to live, right?
So whenever I teach about this I’m always using examples and one would be you really like, it’s important to you to teach, it’s important to you to give talks, but you have a panic attack every time you give talks, so you stop giving talks.
And while you might be safe in the short term, maybe, right? At least you’re not talking in the long-term, the anxiety is going to stick around, right? Because that’s the only coping strategy you’ve developed. And on top of that, you don’t get to be doing the things that you really care about doing, right?
So a lot of people, when they think about, well, how do you treat anxiety, they think, well, how can I make anxiety go away? And that’s not necessarily the most helpful way to think about it, a better way to think about it is how can I learn that anxiety is an emotion that won’t hurt me, it’s unpleasant, darn unpleasant sometimes, but it’s not toxic.
It won’t hurt me, it’s information and how do I learn when to listen to it and when to not, and then how do I learn to approach things, and especially when doing so helps me build a life that I really love rather than just avoiding it all the time, right? And so same example, you like to give talks.
So maybe start saying yes to doing that and you choose to do it even though you’re anxious, right? So the thing you’re looking for here in addition to stopping avoiding things, right, is not necessarily making your anxiety go away ‘cause we’re not really in charge of our thoughts and our feelings, right?
They come to us honestly through our learning histories and our biology, but what you’re interested in doing is increasing your willingness to experience whatever it is that’s going on with you in the present moment.
Jenn: So are there any telltale signs of somebody who’s going through chronic anxiety or stress? Is there any, I know obviously it depends on the person and how they actually exhibit emotions and behaviors, but is there anything that would manifest physically or emotionally that you might be able to either identify in yourself or someone you care about?
Lisa: Sure, if you’re feeling anxious and on edge all the time and you feel like you’re not really sure what’s going on but it’s not going away, that’s a situation. And then again, if you’re finding that you’re focusing on avoiding things that make you anxious all the time, right?
Whether it’s a specific phobia like spiders, whether it’s OCD, like I’m having intrusive recurrent images and thoughts that are so unpleasant and I’ve got to engage in rituals to make them stop briefly, right? Social anxiety, avoiding social situations, ‘cause you’re really concerned about the negative evaluation of others.
Generalized anxiety, which is sort of, you know, generalized anxiety, it’s worry about lots and lots of things that could possibly happen, what could possibly go wrong, lots of what if worries, and the compensatory behavior for that, the avoidance behavior is actually worry, right?
It’s actually engaging in worry as a means to problem solve and avoid that possible feared thing happening. And there are many other kinds of anxiety, but those are some of the top ones, panic is another one. So people sometimes when they experience panic, start to develop a fear of fear.
So fear of having another panic attack ‘cause the first one was so awful and they will avoid situations where panic might occur or might, possibly they can escape from, right? So the long and short of it is, you know, it’s function is more important than form here.
And it’s if you start to interact or treat your anxiety, like it’s something that’s dangerous and hard, and of course we do, right? ‘Cause that’s how we roll as humans. And there’s sort of a culture around anxiety words.
It’s supposed to be a sign that something dangerous is afoot, so it would make sense if it feels pretty invasive and like, you should do something about it, right? But the problem is our brains, our minds, right?
Our thinking minds are over-inclusive of considering what’s a threat. And so sometimes we can get stuck avoiding lots and lots and lots of things so that we can make this feeling go away. And that’s really when it gets in the way.
Jenn: I know that you’ve talked about, you touched upon attacks a little bit. Can you talk a little bit more about panic and anxiety attacks if we’re experiencing one or if we know someone who’s experiencing one, any ways that we’d be able to assist them?
Lisa: Sure, so interestingly a small proportion of the population about 10% will experience panic attacks once or a few times even in their lifetime. And that’s pretty normal, right?
So for some people it become a persistent problem, right? And so what a panic attack is, is it’s an experience that happens out of the blue, so when you least expect it, you could be on a sunny day sitting on a beach, having a margarita or whatever it is that you’re doing.
And all of a sudden you notice your heart starts to beat a little faster and then all of a sudden, you’re in the middle of a panic attack. Now the hallmarks of panic attack are, they have three parts, right? There are physiological, emotional and cognitive.
So the physiological things you’re going to be experiencing, include, you know, faster heart rate, you might feel a little dizzy, shortness of breath. You might feel like your arms are tingling or clammy. You might have a hot flash, you might have stomach upset. You might feel just jittery, right.
Then there’s the emotional piece that happens, right? Like, oh gosh, I’m scared, right? And then there’s the cognitive piece. Oh God, this will be awful. Oh my God, what if I have a heart attack and die? Oh my God, what if I lose my mind? What if I have a psychotic break? What if I can’t handle this? What if I’m overwhelmed by it? What if it never ends, right?
And so those three things are sort of a self-like repeating cycle, which can really amp up a panic attack. And one of the things that we know about individuals who suffer from panic are they have higher, what we call anxiety sensitivity, so higher hypervigilance or watchfulness for these physiological cues that are associated with panic.
And so what happens when you have, if you have general panic disorder, right? Is that you are going to be watching your body all the time, for am I going to panic, am I going to panic, am I going to panic? ‘Cause you want to avoid, you never want to have that experience again and as someone who has had these, it’s no fun, right?
They are no fun if you’ve had them you know. The other thing is people avoid going anywhere where they might have had a panic attack in the past. And that can result in what we call agoraphobia, which means, you know, being stuck in your home, unwilling to leave, because if you leave, you might have a panic attack.
Now that is to panic disorder in a nutshell, and then there is treatment for all of these anxiety disorders that we’re talking about today and it is evidence-based treatment.
Jenn: So what would be a good way to initiate a conversation with a provider if you feel like you are going through a lot of anxiety or panic?
Lisa: That is true, so a lot of times people with panic, if they don’t know what it is, we’ll end up in the ER, which you probably want to avoid. You know, given that, it’s really stressful to go to the ER. But a lot of times when people don’t know what it is, they think it’s a heart attack.
And so that’s why they present to a doctor typically the first time it happens. So what I would do is if you think you’re having panic attacks, I’d give your GP a call and see if they’ll do a Zoom session with you. And of course, as a good clinician, whenever I hear people are experiencing these things, the first thing I want to do is rule out that there is any sort of physical thing going on.
And once that’s ruled out, then we know, is it a panic attack, right. So I think I would just start by saying, you know, I’m not sure what’s going on, but here are the physical things I’m experiencing and just describe the symptoms and let them know.
The other thing you should know too, is that most families have some sort of anxiety running through them, right? So most things like this are heritable, which means that if you have someone in your family, who’s experiencing anxiety or OCD or something similar, you have a slightly higher risk of having it yourself.
And so do a little sleuthing and see, is there anybody in your family who’s ever been anxious, right? So like for example, in my family, I always say this, we come from a long line of anxious women, we really do very strong and also we tend towards the anxious side, right?
All the way from my grandmother, to my mom, to me, to my daughter, just is what it is. And so knowing that is a clue and so that will help your provider also diagnose, ‘cause it’s just one more bit of information.
So I would start with that and just describe the symptoms. So I know that people sometimes feel so stigmatized about talking about these issues and I know that sometimes this, especially like, you know, in men, people feel like experiencing these things as a weakness, it is 100% not, absolutely not.
It’s really tough and the reason that, you know, we myself and Jenn are so open about these things and that we like doing these webinars is that it’s important to us to break down the stigma, that number that she mentioned to you at the beginning, like of that small, was it 36% Jenn of people who have anxiety or panic actually get care?
Jenn: Yep, just about 36%, I know.
Lisa: That’s stunning and that’s not okay with me. And it shouldn’t be okay with you either and treatment for this just because there is an evidence-based treatment for these things. And I think more people should be able to access it and it is scary and hard, so I just want to acknowledge that too.
But the other thing too, to kind of know, is that if you are experiencing anxiety and panic you are not alone, right? If it’s so that one in two people during some point of their life will have it look at every two people on the street and go one, two, one, two, and just notice that like half of us, right?
And that’s an upper end I mean the lower end is one in three, right? One, two, three, like a vast majority of us are going to have some sort of struggle with this. And the American Psychological Association every year does a report in America on stress and what they found, not surprisingly is that American stress overall is much higher.
So if you’ve never experienced anxiety, now’s the time. And if you already are experiencing anxiety, very likely, you’re experiencing a symptom burst in that too. And that’s all of us that’s not like literally I think it was 82 or something percent of Americans are concerned about the history of our nation. Like about the future like what’s going to happen. We don’t know, it’s like a horse in a hospital, but we’ll figure it out.
Jenn: It’s so comforting to hear that you’re a John Mulaney fan.
Lisa: One of my clients told me about him and then I forgot the name and then I randomly saw that show and I was like, oh yeah, that’s what I heard about and he was hilarious.
Jenn: If anybody, is looking for a stand up comedian, John Mulaney is on Netflix, several of his specials are there.
Jenn: He’s very smart, he’s very funny so I highly, highly recommend.
Lisa: Laughter is sometimes really the best medicine so.
Jenn: So if a person is having an attack or you feel like you’re going through an attack, is there any way that you can help extricate yourself or the person you care about out of it, and if so, how?
Lisa: Okay, so the first thing to remember is if you have one of these happen to you, it’s darn unpleasant, it’s not going to hurt you. Second of all, they will pass, most of them don’t last beyond a few minutes. The best thing to do is to simply so there’s...
I’ll give you a couple of techniques. One is slow your breathing down and breathe in through your nose and out through your mouth, gives your body a signal to sort of enlist your parasympathetic nervous system to calm you down. It will take time, so give it time mostly these just pass with time, but it can, these can help your experience of it, okay?
The second thing to do is one of the scariest things about these. It’s not the actual physiological sensations themselves, which if you kind of break down and notice them, you can notice each in turn, just kind of observe it as something your body is doing physically.
It’s the cognitive piece, it’s the story your mind is spinning about what this means, what’s going to happen, how long is it going to last? Are you going to go crazy? You’re going to have a heart attack, right?
And having had these, like my fear was, oh my God, I’m going to have a psychotic break. This is terrifying, it was really awful really hard, right? And so noticing that your mind is telling you a story and bringing your awareness, you cannot stop your mind talking to you during these you are just not in charge of that, right?
And to do, to try to do that as counterproductive, it’s trying to control and using your energy to control something that is not under your control, unpleasant as it may be. A better strategy is, And you could practice this right this minute when I say it just for fun is to simply bring your awareness to your five senses experience.
And you might start with noticing all the things that you see around you in the room, slow yourself down and attend and look for things that you haven’t noticed before label them in your mind, right? Notice what you hear around you, and so what this does is it grounds you in the present moment it’s a mindfulness technique and it doesn’t make the panic stuff that’s not the goal.
But remember you can’t control your thinking and feeling. You can always choose where to put your attention, even if it’s hard and it will be hard promise will, but you can use that purposeful awareness to ground you in the present moment. The other thing I’ll say is very often what makes panic worse is avoiding the situation or trying to escape the situation.
And this one’s a tough to ask and I know because I had to do this too, guys, stay. Learn to stay, okay, stay where you are, don’t run, don’t try and escape, don’t try and go home, just stay until it passes, because if you avoid it, you’re going to feed it, you’re going to teach it that it can come back whenever.
And yes, it’s definitely hard and this is why, as Jenn points it out, you should definitely talk to a provider who can teach you these things, right? How do you handle panic? You don’t want to do this on your own. So try the things I’m mentioning, but get yourself some help.
If you’re having panic attacks and they’re persisting, or if you’re stuck at home, you can do it, you really can. And the one thing I can tell you too, about like long line of anxious women, but also working, I mean, that’s my specialty in treatment, right, in practice is that we are far stronger than we ever realize. We really are, we are far more resilient and we evolved to be this way, right?
So you may not feel that and you may not believe it and that is okay, just know it’s there. And a good provider will help you see that and help you find your strengths.
Jenn: So we had someone write in asking if the anxiety is different for neuro-typical people versus those of IDDs or are high functioning ASD, or is it the same for everybody?
Lisa: So it’s a great question and I think that one way to answer it is to observe that people experience anxiety differently, right? And if you are a neuro-diverse individual, it may feel different, it feel more overwhelming. It may feel like you’re not really sure you have the words for it, it may be hard to predict.
For some people, like I’m a huge psychosomatic person. So like I’m not anxious, I just have a headache. I just have muscle tension, what are you talking about? I’m fine, right, so like some people and culturally, this is true too, right, across different cultures.
People interpret anxiety as like physically and that’s their experience of it, right? So I think that the take home message for this piece is, whether you’re a neuro-typical or neuro-diverse individual or from a different culture, or what have you, your experience of it is your truth, right?
And you’ve got to meet it where you are. And so there’s no need to keep up with the Joneses and kind of compare and contrast. It’s more about what’s your experience like, that’s the most important thing and how are you going to handle it and how best to handle it, right?
And so working with a good provider, right? And when I say a good provider, the evidence-based treatment for anxiety and panic and OCD all has the same sort of core and that is exposure, right? Facing your fear, willingly facing your fear, not being made to and not making yourself do it, but willingly leaning into it, right?
You can right-size, you know, if you are able to notice and pay attention to and just be curious about your anxiety, you can definitely right-size your treatment and write size the steps that you take to fix it, how fast and when and where and how sustained.
One thing I will say that is something I observed is that, you know, any organism learns much more quickly how to avoid threats than how to face them, right? Just because, you know, it’s safer to not need a lot of tries to learn how to avoid something dangerous.
Jenn: Yeah, you’re not going to try to tackle a lion, you’re just going to book it.
Lisa: Bingo, right, so it takes more practice to unlearn, right? Not that we unlearn, we don’t, but it takes more practice to develop competing learning in, hey, I can handle this. Hey, I don’t like this experience of anxiety, but it doesn’t have to dominate me. It doesn’t have to have power over me when I have it.
You know, and, honestly, like that’s my experience of it. Like, so when I give talks, now, sometimes I’m anxious. Sometimes I’m not, but the interesting thing is, it doesn’t really matter whether I am or I’m not. To me, like I noticed it as an unpleasant experience, but then I choose, like, I want to focus on speaking clearly.
I want to focus on teaching well and connecting with people, right? And that’s flexibility, so the definition of that would be psychological flexibility. And that is willingness to do hard things in the presence of anxiety when they most matter to you when you care about them.
And sometimes the anxiety is there, sometimes it’s not, mostly it’s not, which is really lovely, ‘cause that’s a side effect is you actually learn or your body learns and your brain learns that I don’t need to be anxious about that, it’ll probably be okay, even if I don’t like it in the moment too much, so.
Jenn: And also remembering that, you know, some of the anxiety that you have is healthy. It’s like being at the top of a roller coaster, right, yup.
Lisa: That’s exactly right, that Yerkes-Dodson curve, if anybody remembers their college, if you went to college or if you went to high school and you did the psychology class, the Yerkes-Dodson curve is a U-shaped curve, like a horseshoe, right, facing down.
And there’s an optimal level of anxiety for learning and performance, right? ‘Cause if you’re like not anxious at all, maybe you dial it in, if you’re super anxious, you’re going to be maybe too focused on your anxiety to be functional.
But there’s this just right zone where just a little bit of anxiety is helpful and in fact, another way to think about anxiety is sometimes it points you towards the things that you really care about, because we don’t get anxious about stuff we don’t really care about, right?
So if I, you know, matter about my friends, maybe I get super socially anxious about them and I worry about what they think and that can be debilitating, right? But it’s also a flashlight kind of a high beam into, hey, friends matter to you, relationships matter to you, okay? So that’s another way to think about it.
Jenn: We did have a couple of folks ask for clarification on some of the language like neuro-typical and ASD and IDD, so if you don’t mind there’s just that sidebar, if we could explain those, that would be really awesome. And thank you for everybody who asked.
Lisa: So there are different ways to describe the diversity of our cognitive functioning in the human species.
And so in the past, and you know now we still have individuals who might be classed on the autism spectrum, which means they learn differently than us or, you know, I am a neuro-typical person, so they learn differently from people who are not on the spectrum, is it always a deficit?
No, it’s a difference and so a newer and more accepting way to talk about it is neuro-diverse, right? And to acknowledge that like and I am a neuro-diverse individual in the sense that I got ADHD. (Lisa laughs)
And it’s fun because you get interested in lots of things all the time, it’s hard, because being bored is very aversive and you need lots of stimulation and stuff, but lo and behold, you know, that can be helpful in learning ‘cause you love learning all the time.
So that’s a good thing. But anyway, it’s just a term that helps us sort of, you know, more inclusively in an accepting way, describe these things, does that make sense?
Jenn: I think so that was a good explanation. We had a couple of folks write in about health anxiety and previously experiencing it and now because of COVID, it seems like even if you didn’t have health anxiety before you’ve got it now, so how can you tell what is real perceived threats and what is something that’s a little bit as a result of your health anxiety, especially during COVID times?
Lisa: So I would tweak that question a little bit and I would say it’s probably more helpful to think about how does this, oh Dougal says hello.
Jenn: Is that your therapy dog?
Lisa: No, this one’s the anti-therapy dog. This was the one that makes me need therapy.
Jenn: Oh, okay, I didn’t know if that was you’re talking about your anxious hereditary.
Lisa: This is the one that has anxiety. This is the one we’re actively working on, his anxiety disorder, but back to health anxiety. So think about does what you’re doing about your worries, about your health serve you?
Now, if your anxiety helps you follow the CDC guidelines and attend to guidelines at say, the supermarket, like, are you following? Are you going up and down the aisles the correct way? Which I always forget that to do. And are you maintaining six feet distance, right?
That’s helpful, right, did you remember to bring your hand sanitizer in the car, that’s helpful, right? Or did you have your mask? Are you spending hours and hours and hours and hours disinfecting your Amazon packages, unhelpful, right?
‘Cause it’s taking you away from your family. It’s modeling for your kids that this is a behavior that’s sort of normal and it’s not. It’s going to get in your way, right? So we all have concerns and actually health anxiety is one of the things that runs in my family too.
So that is for people who are not aware of it is concern, over-concern, right? When it gets to be clinically meaningful that you might have an undetected illness and this hypervigilance towards parts of your body to be like, oh my gosh, what is that, is that a lump? Is that a spot, am I going to die? Is it cancer, is it necrotizing fasciitis? Right, so et cetera and you know, it’s something that can be consuming.
It can lead to multiple doctor’s visits, unhelpful, costly and also putting you at greater risk of sitting in waiting rooms with people with COVID, right? It can amp up your anxiety, also unhelpful. Will tire you out, will you know, disrupt your sleep and all of those things and so again, noticing like it’s a good rule of thumb where check on it once and then if it’s nothing, don’t repeatedly check on it.
And you know, there’s a new paper that just came out by Dean McKay and his colleagues, he’s a wonderful anxiety researcher from Fordham University on over and under response to COVID and stress and anxiety is one of those predictors, right?
And having those concerns about like, who’s over responding and who’s under responding. So yeah, so just ask that question, like, does this serve me or am I just stuck on this? You know and in our house, one of the things that we did when my daughter struggled with this, this popped up for her and I knew ‘cause I could see it coming ‘cause I saw my mom have the same thing and she’d go, mom, what does this look like on my arm?
And we would do little exposures. We’d be like, necrotizing fasciitis, which is the flesh-eating bacteria, my favorite. And she’d go, mom, you know, she’d get really mad at me. And now she’s like, whatever, and you know, she’s over it.
So, which is really good and is it hard to do, yes. But anyway, that’s another reason why you want to talk to a provider that knows their way around how to do that. Otherwise if you try and take it on yourself or if you’re a parent you’re trying to take in on for your kiddos, you don’t want to cause more harm than good, okay?
So get some guidance on it and if you are a parent just FYI, two great resources for anxiety are, the Anxiety and Depression Association of America III, I lied, can’t count either, sorry, I’m ADHD.
There’s the APA, the American Psychological Association has a wonderful website on evidence-based treatments for all of these conditions and a description for these conditions for kids and it’s called, effectivechildtherapy.O-R-G, it’s really great, a really nice set of resources for families. And the third one, especially if you are a sufferer of OCD or an OC spectrum disorder, the International OCD Foundation.
Jenn: Lisa, I did want to ask, what advice do you have for individuals who have anxiety that manifests as chronic pain?
Lisa: Oh, that’s a good one. So there’s actually a very strong literature on acceptance and commitment therapy for chronic pain. It’s actually one of the strongest evidence-based pieces of that treatment approach and so the idea here, is again at the heart of treatment for anxiety is exposure.
And by that we mean willingness, increasing one’s willingness to experience, right? Anxiety and its related symptoms like chronic pain and things like that, willingness and acceptance, right? This is something that’s going to happen.
We can either be trapped by our focus on trying to avoid it, or we can let it be and go about trying to build our lives in ways that really matter to us.
And the more people are willing to engage in those steps and stay engaged in their lives and do the things that they care about whether or not the anxiety or the chronic pain is present, the more flexible they become, the more resilient they begin to feel, the greater self-efficacy they tend to have at their ability to handle these situations.
So it’s a really challenging situation and again it’s one where there’s an evidence-based for treatment, so yeah.
Jenn: How can you tell if your gut is telling you to do the right thing or, you know, the instinct of going with your gut? How do you know if it’s actually reacting to fear or anxiety or whether or not you’re actually like instinctually doing the right thing?
So somebody wrote in that they highly value their intuition, which I deeply appreciate, but they also know sometimes it’s responding to things that are unhelpful.
Lisa: You know, I feel like if I could answer that for everyone, that would be amazing, right? That’s such a deep philosophical question, how do you know? And the truth is sometimes we don’t know. And so one thing that I do and this is also a tenet of acceptance and commitment therapy is to pause, right?
Notice what you’re up to and what I mean by that is notice is your intention to stop or avoid feeling something negative, right? Is it to avoid some feared outcome? Is it to avoid physical sensation, a scary thought?
Sense of dread, sense of wrongness, sense of uncertainty and completeness and how’s that working? Have you found yourself in that place before, doing that same thing, has it worked out for you in the way you thought? And if it hasn’t you may choose a different intention right?
So deliberately choosing, like I choose to move towards this thing that I really care about, right? So it might be it’s a little shift on the question really. And the answer to your question is, I don’t know, I don’t know, right, there’s so much uncertainty in life.
We never really know if we’re doing the right thing or the wrong thing but we can always choose our intention. And we can always act on that intention if we choose and to do that with integrity sometimes feels more meaningful and useful than trying to figure out whether this is the right answer or wrong answer, right?
Sometimes doing the right thing feels terrible, right? Like giving talks when you know, you’re going to have a panic attack, holy moly, right? But maybe that’s the right thing.
Maybe you know, that conversation you’ve been avoiding with the person you love, who you think is avoiding everything, it feels bad and it’s going to bring them sadness and guilt or shame and maybe if done in a loving way, it’s still the right thing to do because it’s in the service of helping this person move forward, helping this person access care.
So who knows, I am a huge fan of intuition, I really am. And also I try to stay connected to those things that matter the most to me and in situations that are super confusing, that’s the thing that’s really helped me the most, is really paying attention to that.
Like my value is X, right, and for me it’s being of service. That means I’m willing to do lots and lots of things in the service of that, not all of them feel good.
Jenn: Can we talk a little bit about anxiety in the workplace? Let’s say, situationally, you get an email from your boss. It says, hey, we need to talk. How’s the next Thursday at one o’clock and that’s, I don’t know, nine days from now.
Your heart rate goes up, you get clammy hands, all of that stuff, how do we tamper our anxiety or temper anxiety in the workplace, especially when we’re having moments and you know, we might be around people, we might be by ourselves, but how do we pull ourselves out of that and bring us back to being like high-functioning, more positive people in the workplace?
Lisa: Right and what I would suggest again, is that you may not be able to temper your anxiety, but what you can do is make a space for it and acknowledge it and notice it and notice, so what I do or what I would encourage people to do is slow yourself down once again, kind of ground yourself in the way we’ve talked about with panic and then, to just notice, what is your mind saying about this?
And it’s probably something like, oh my God, what did they want, why are they emailing me now? Did I do something wrong, what error did I make, oh gosh. And then it would immediately begin rehearsing all the things I did that day or that week to figure out what was the thing I did wrong, right?
And just notice that, that’s what minds do. Your mind is your threat detector, it’s trying to keep you safe, okay? That’s the good news, the bad news is it’s not always right and it’s almost always over-inclusive of all the many things that could be potential threats, right?
So just reminding yourself that you’re noticing your mind talking to you and these things may or may not be helpful or real and remember to ground yourself in the present moment, because you can, again, pause and notice, am I trying to stop feeling anxious? Or if work is important to you, right?
‘Cause if you’re anxious about that email, it would suggest that your work matters, right? You can choose what is the next right thing for me in this moment, is it to try and spin about this and figure it out, or is it to finish this task, right?
And finishing that task in front of you might feel uncomfortable, so the next question is, if doing that is a step towards what you care about the most are you willing to feel anxious and do it anyway?
That’s what I would suggest doing when you’re anxious in the workplace and then that’s probably a more effective, helpful thing to do than trying to breathe and trying to calm down, you know, see what happens.
The other thing I would suggest, last thing I’ll say is, get curious about what that is like, if you try it, do it a few times and then just see, how did it work for me? What did I notice and what is important, right?
Jenn: Do breathing exercises actually work for anxiety?
Lisa: Not a lot, I mean, there’s mixed data on this. I’m glad you said that, ‘cause like, even with some of the panic treatment, like some of those breathing tools are called into question, but one of the things that we can do when we’re panicking is sometimes people hyperventilate.
So it’s not a terrible idea to just slow yourself down and just kind of long, slow breaths. You know, and just, it’s a good way to actually give your attention something to focus on as well. So in that sense, it may be useful, but yeah, there’s mixed data about them.
Jenn: So if we’re having a hard time in the workplace, when it comes to having constant, overwhelming stress and anxiety, do you have any advice for bringing it up with either colleagues, a boss, human resources? How do you get those conversations started? Or do you even start these conversations at all?
Lisa: Well, I think it depends cause there’s so many contextual factors that are there. There are laws to prevent discrimination against anyone who is experiencing a mental health issue at work. So that’s important to know, many companies also have employee assistance programs, which are terrific resources and they’re under-utilized, probably across the board.
But basically they have trained clinicians who are generalists, most of the time who are skilled in at least, helping you figure out what’s going on, giving you some short-term strategies and then, helping you find your way to, you know, someone of who can see you perhaps outside of work.
The other good thing about EAPs is they tend to be free, right? So it’s free resource for you. For me personally, I am a fan of openness. I mean, as a mental health provider, right?
And as someone who cares about people getting the services they need I’m always vocal about whether I’m experiencing any sort of anxiety in the workplace or stress, because I understand that if I am, you know, our mental health is important to us, right, as providers, because you want to be your best for your clients.
And if you are struggling yourself, that is something that should let you know, maybe you need to get some help. Maybe you have some limit that you need to assess and being a competent person, right? Like it’s part of the ethical code, right, of psychologists to work within your area of competence.
And to always be clear about when you are on the edge of that or when you’re learning and doing something that’s beyond it and getting the support that you need to make sure that you are doing that with help and with guidance, right?
So if you’re struggling, you know, and you’re kind of bottling it and you’re trying to ignore it, you cannot be at your best, you just can’t, right? And so making a space for those things and going, you know what, this is hard, I’m struggling.
And guess what, the APA in that stress report, the vast majority of us are struggling right now. You know, and maybe it’s not tons, maybe it is tons. Everyone has battles and we may have no idea what they are.
So I am a fan of being open about it and thinking through how can I better take care of myself so I can manage this right, am I getting enough sleep? Am I eating well, am I avoiding using substances? Which is a high risk during COVID and there are plenty of data suggesting that substance use is on the rise in many people, many age groups, especially actually women, aged 39 to 50, which was really interesting.
So really noticing like, am I doing the things I could do to take care of myself, right. And one of those things is being clear about, I might need a little extra support or asking for help, you know, at the workplace you need it.
Jenn: So what happens if you’re in a toxic environment where you’re consistently experiencing that you’ve been put in a place where either like it’s your fault or you’re being frustrated by the outcome, how do you manage that anxiety, if there’s limited positive action, outcome, minimal support or you just don’t have the ability to like get up and go home from your desk?
Lisa: And I would say most of us who if you’ve worked, right, you know, you’ve probably experienced at least once that situation at work, right? So that’s not something that’s a unique situation. It’s hard, really hard. So one piece of advice I think would be, think about what is in your control and what is outside of your control.
So if you are in a hostile or toxic workplace, talk to your boss, if that doesn’t work, go to HR, if that doesn’t work, there are other organizations that you can reach out to, sometimes they’re anonymous.
Sometimes there’s not, there are there’s guidelines. Your workplace should have a policy for all sorts of harassment and what does it mean to have a hostile workplace? Get to know that policy, there’s numbers you can call in your state where you are, to talk about that and get guidance about that.
So there’s a lot of ways to do that. There’s a lot of things within your control. Now that being said, if all of those things are things that you have done and you are still seeing limited positive action, get some support and have someone help you think through, is this the right place?
Do you want to stay, you know, like, is it something that you are willing to tolerate? Is it really a situation of unfairness that’s unjust? You know, but what should you do? Should you stay or should you leave? And that is something that’s important to think about. You know, we can’t fix everything and not everything’s in our control. So I think consider what that’s like.
Jenn: I know one thing that has changed over the last, like five or six years, but even more so during the pandemic, we’re all using screens so much more. And we’re all going to our phones for that little quick hit of dopamine every time an app light flashes, where we feel kind of okay and then we just feel just as crappy as we may have felt before that.
How exactly is social media worsening, exacerbating our anxiety and stress. Like I know there’s more research coming out about it? You’ve talked about it in previous sessions, but like, how does that actually affect people and how can we start pulling ourselves away from that? Especially when we’re looking for a quick reprieve, it’s like the new smoke break, right, checking social media.
Lisa: It’s the new smoke break and you’re exactly right. And so one way to find out more about how social media works and AI works ‘cause cause like it’s changing so quickly. It’s really hard to stay on top of it, but there’s a great documentary out on Netflix, called the Social Dilemma, which I found actually quite frightening and it’s about the use of AI or artificial intelligence in marketing, right?
The idea behind this and behind a lot of different social media platforms is to learn your behavior, how long are you looking at something, on what page are you looking? What do you click on, what do you not click on? How long do you look at the thing on the page?
So that they have really nuanced individualized data on what sorts of advertising to send you. So this documentary makes a posits, right? It makes the hypothesis that our attention, we are the product, our attention is the product.
And because that’s the case, right, it’s meant to be addictive. The scrolling down, it’s kind of like a slot machine, scroll, scroll, scroll and there might be something in there for me, there might be something in there for me.
And so what you’re going to start to hear if you’re paying attention is a lot of the execs and a lot of folks in Silicon Valley who are parents are prohibiting the use of this in their homes, okay? And the other point raised by the film is that, and it was put out by the Center for Humane Technology, which is a California-based nonprofit.
But their point is, well, if tech has created this situation, shouldn’t it then be their responsibility to consider the ethics of it and how it’s working, right? And so as someone who is a behavioral scientist, and also, you know, someone who’s a child developmental researcher, right? I’m concerned about things like shaping your ability to pay attention and remember.
Think about how many phone numbers you actually remember now as opposed to your phone remembers them for you. Think about how tolerant you are of reading novels as opposed to 144 character tweets, right?
Think about how many times do you pick up your phone during the day and in what context, is it getting in the way of your interactions, or being with your family, is it at the dinner table? Is it in the bathroom with you, right?
Don’t say that loud, sorry, but you know what’s happening? Are your kids super cranky unless they have a screen in front of them, right? And I think it’s important to think again, functionally, how does this work, right?
Like I’m on Facebook, I’m thinking I might get off it after seeing that documentary, but I mean, I have friends around the world ‘cause I’m the president of my scientific organization, so I’m keeping in touch with people in, you know, Hong Kong, in Australia, in Spain, you know, in Italy because of this, right?
At the same time, it’s a cost, are you using it late at night? It’s going to disrupt your sleep, right? I think, think about and be mindful of how frequently are we using it. And is it getting in the way of other things?
Is it preventing my kids maybe from learning to entertain themselves? Is it something that I feel unsettled unless I do, right? How many hours are we on the phone? Can we tear our attention away or are we sitting next to each other on phones, right?
So I keep thinking like every time I think about this, I think about that scene in Wall-E, remember the cartoon, the movie Wall-E where everybody’s floating around next to each other on those chairs, yeah.
Jenn: Yeah, I do think of that a lot. Everybody’s drinking like a Slurpee.
Lisa: What was it like, the Slurpee of the day or something?
Jenn: Something like that, but that’s not to say that Slurpees are bad, I drink the beverage so often. But yeah, it becomes a very convenient world to live in.
Lisa: Yeah, so I would say watch that and see what you think. And online there are, and I can’t remember the name of this website, but thinking about a healthy family, social media plan, that’s less about how many hours are you on it and more about during what, like important points of the day do we all agree, there will be no screens.
Like dinner together, like the hour after dinner where we’re hanging out at the table, like before homework, right? Homework first, then gaming or whatever. So thinking about teaching if this is going to be part of our life, right?
How do I teach my children and how do I model? Like how do I practice myself being willing to be uncomfortable with not having a screen by me? If that’s in the service of having richer, deeper relationships with the people who I love most and my family.
Jenn: I know what you have touched lightly upon kids and anxiety but I did want to talk a little bit more about that, especially since, you know, little kids have a really hard time even conveying the emotion that’s being tired or hungry or just sad.
So how do we talk about anxiety and stress with kids, especially if they mimic adult behaviors and how do we convey it in a way that makes it less scary from the get-go and something that they can control and manage over time.
Lisa: And I think the answer was in the question, ‘cause you just pointed out that they mimic adult behavior and that is actually true and one of the best ways with younger children to teach them what is anxiety? How do you label it is to model that for them yourself, right?
So when you get that work email at home, ‘cause we’re all home now you can model by going, mommy just got a really stressful email and I can feel my chest is tight and I have butterflies in my tummy. And that is anxiety, have you ever felt that? Yeah, I noticed my mind says a lot of scary things too, when I’m anxious, it’s telling me I should be worried about stuff, does your mind do that, right?
And so showing them through what you do, how to label the pieces of anxiety, which if you remember just as like with panic, it’s emotion, physical response, cognitive response, all those three different pieces, letting them know it’s okay, we can make a space for it.
And like, it’s not going to hurt us. It’s not so pleasant, it’ll pass, right? I like to use the metaphor of mental weather, right? Like storms come, we have them and they come and they go, so notice that.
With very young kids, so very young being two, three, four, right, helping them reengage in another activity, giving them comfort, first of all, and empathizing, oh, you seem so scared, I noticed that, yeah. What can mommy do to help, right? And like helping them re-engage in another activity.
So empathy is always like at the heart of any approach to anxiety and then the other thing to say again, is that it’s not about controlling anxiety. It’s about teaching kids how to experience it, right? It’s about helping them be willing to have it ‘cause it’s part of life and you know, it’s useful and actually I’ll give you a little more resource actually and this is one of my favorites that I’m always assigning to parents.
I’m looking to see, I don’t have it on my shelf at the moment, I’ve must’ve given my last copy away, again. But it’s a great book by Susan Orsillo and Elizabeth Roemer and it’s called The Mindful Way Through Anxiety. It’s a self-help book, it’s not very expensive.
They are excellent exceptional clinical scientists that do treatment development research. And they developed acceptance-based behavior therapy, which is a mindfulness-based therapy for generalized anxiety disorder.
And the reason I give it to people, especially parents, is that if I’m teaching their children about anxiety and I want them to have consistent language to what I’m doing, I assign that book to them. And that is something that they find super helpful.
Jenn: I think that’s such a great idea and something that can be so often overlooked too, because it seems like to somebody who’s that young and unaware, if all the adults in their life that are positive influences are using the same language, it makes it almost seem like common knowledge.
Like every adult should be talking like this. So that’s something that’s also going to increase like, oh, when I’m older, that’s what I’m going to do. And that’s how I’m going to understand things. And so I think that’s super helpful.
I know you had mentioned that resource, but do you have any curriculum or activity suggestions for elementary grade level students that are experiencing stress and anxiety?
Lisa: Curriculum things, you know what?
Jenn: Or activities, so either one.
Lisa: I think the same thing is true, so first of all, making a space in a classroom that it’s okay to talk about this, just be open yourself as a teacher. That’s going to go so far, really, it really is, because kids will look to you as the expert.
And if you’re going whoa, really you too, you know, and to help kids label, right, the pieces of anxiety and sometimes a fun activity is, drawing your worry monster, right?
And this is something that we have a wonderful advocate at McLean, Sean Shinnock who has the Monster Initiative, which is basically helping kids use or draw, right, or make with clay or do whatever to kind of define what’s their worry monster.
And the minute that you start separating out you from the worries you’re experiencing, you’re not your worries. You’re not the sum total of your worries, but in fact, there’s a little bit of space between you where you can start to choose more helpful responses to them, right?
So what we do with kids is we help them, name their worry monsters like Mr. Stinky or Mr. Scary or whatever it is and they can draw them and then they can learn, how do I speak to my worry monster?
So that it doesn’t control me. It might be with me and I don’t like it and I know it’s unwilling to let it be there, so I can go do these fun things in my day. And so you can do an activity like that.
Like, you know, talk to McLean actually and they’d be happy to connect you with Sean, who does these kinds of workshops all the time, but just drawing your worry monster and helping, you know, kids talk about it, giving those language around it.
So one of the problems with anxiety, is not the anxiety itself, but it’s our attitude about it, right? So making it acceptable to say things, like I am anxious, I am struggling, I am worried, right? That alleviates so much and that’s within our control as a culture which to do.
Whether or not you feel it, we don’t have tons of control over that, but we do have control over how we handle it when it shows up and in teaching more adaptive ways to be flexible, whether it’s there or not, it stops to have its control and it stops showing up, which is really nice.
Jenn: Do you have anything that would be helpful for parents who are homeschooling kids and also juggling that type of like I’m working from home, but I’m also teaching your kid at the same time, as I pull my headphone plug out, sorry, everyone.
Lisa: It’s okay, what I would say to those parents and there are a lot of us, my son is older now he’s 15. So I’m a little bit on the back half of that I guess, you don’t have to do everything, it is impossible. It is an impossible task that we’re all being asked to do, to be able to manage homeschooling, working from home, all of these things, it’s really hard.
So the very first thing I want to say to those parents is let yourself off the hook, your best is perfect. Do just what you can and there’s no more that anyone can ask of you of that, so that’s one thing, because I think that one of the things that happens is we tend to beat ourselves up if we can’t fix everything and we can’t fix this, we can’t fix everything.
So the second thing is put on your own mask first, not COVID mask, but like on an airplane, right? When you’re flying, they always tell you first your mask, then you put the mask on your child.
So take care of yourself, give yourself breaks, give yourself when you feel stressed and overwhelmed, take a moment, if you can, even if you’re in the bathroom for 30 seconds and you just kind of breathe and have some peace.
That’s important and that’s going to go a long way. And then finally model just like we’ve been talking about, you know, and get some help. There are plenty of us out there that are anxiety providers. See if there are classes in your area, see if there’s any sort of workshops and things like that.
There’s lots of free resources that are put out by Division 53 webinars, Praxis, which is an online, you know, they teach clinicians how to do things and a number of us have done these free talks and they’re full of these little nuggets that you can use to support yourself and to support your child.
Jenn: I am going to end this, the last question is, do you have any other resources that you would say are like, number one in your book, must haves, ‘cause you’ve given us a great laundry list of them, but I don’t know if there’s anything that you would 100% be like if you’re starting here with your anxiety, do this now.
Lisa: For anybody, for parents, for families?
Jenn: For anybody.
Lisa: You know, honestly, I think I would start with that Mindful Way Through Anxiety book. I think it’s a great start and I think I would, if you’re really struggling yourself, I would start with talking to your GP about, you know, I think I have anxiety, I’m interested in finding evidence-based treatment for it.
And here’s something that’s really important. You know, there are lots of people who provide services, you want to make sure you are looking for cognitive behavioral treatment or exposure-based treatment for anxiety, okay?
Acceptance and commitment therapy is an exposure-based technique as well, we’ve mentioned that several times, it is a cognitive behavioral therapy. The unified protocols, something probably clinicians would know, but like that’s another approach that’s really incredibly helpful for helping folks to cope with worry and things like that.
So, you know, I would start there with those things.
Jenn: Lisa, thank you so much for joining me today and thanks to everybody who tuned in. This actually concludes our session. Until next time, be nice to one another, but most importantly, be nice to yourself.
Thanks so much and take care.
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