S1E12 Anxiety

Anxiety is a natural emotion that all humans and most, if not all, living beings experience. In this episode, Dr. Rubin leads the conversation on evolution and how anxiety is adaptive for the 40,000 year old part of our brains. Dr. Rubin and Dr. Pete talk about building a more effective relationship with anxiety when it inevitably shows up.




Nikki: Anxiety is a pretty popular topic these days, I would say, that we're living at the time of recording this episode, we're in the midst of the COVID pandemic. And I would say, Pete, would you agree with this? Even before, I would say, if there's so much more awareness of anxiety now, that I feel like I'm reading all the time news articles about increasing anxiety with adolescence anxiety with social media. So we’re going to talk about this.

Pete: If you’re alive you got anxiety.

Nikki: Yeah, if you're alive, you got anxiety. So, we really thought it'd be important to talk a little bit about anxiety today, provide some necessary and helpful psychoeducation about why we even have, it since a lot of people come see us and say, “Hey…”

Pete: “Get rid of it!”

Nikki: Yeah, “Hey Doc., I really want to get rid of this”. And I'm like, “okay, I totally get that, unfortunately, I can't help you with that part. But we can help regulate it”. And just speak a little bit about how we might want to interact with our anxiety in different ways.

Pete: Yeah, a lot of us want to get rid of it. I don't like to feel it.

Nikki: Yeah, Me either, who does?
Pete: Straight up, put it out there. Well, I wonder about astronauts, or some of these really thrill seeking behaviour people? I don't know I've always been curious about that.

Nikki: This is very anecdotal, I think I should think of a friend who, a very good surfer who, I don't know surfing.

Pete: Follows those big waves.

Nikki: Yeah, like surfs [inaudible-1:42], who actually describes having low levels of anxiety. It's more like adrenaline in those situations, more like a high. So I think that's important.

Pete: I would imagine that they have a better relationship with their anxiety, my senses, that's what I was going to say.

Nikki: Well, I know there's some research on, I'm going blank on his name, but that rock climber that, there's this famous documentary about him. He went up Half Dome, I think it was, at Yosemite, ‘Free Solo’ is the name of the documentary. And they looked at his brain, an FMRI scan. And it was like his amygdala, which is the fear centre of the brain was actually smaller or not as activated. So I want

Pete: I want a smaller amygdala.

Nikki: Don’t we all.

Pete: Because I always said, and know this, I'm going to go into tangent a little bit, but when I watch, I guess Elon Musk had his people went to space. Seeing now, it's so real now in 21st century where you can like, “see”, you watch the whole take off,

Nikki: The whole thing, yeah.

Pete: And inside this capsule, and I'm all like, “Oh, hell no”.

Nikki: Well, I think when you're like, “I wish I had a smaller amygdala”, so obviously with this, I'm so sorry; I'm blanking this guy's name. But this climber in Free Solo, yeah, that's amazing what he did, and it actually contributes to significantly more risky behaviours. So, I think that's actually maybe an important meeting about why did evolution select for fear?

Pete: Why do we need a bigger boy? Alex Honnold.

Nikki: You know what; I don't even think I knew his name.

Pete: There it is though.

Nikki: I didn’t know it at all, but I knew the documentary. So Pete, will you tell our listeners a little bit about the next time you take a 40,000 year time travel expedition right now, and about what was going on when we were out looking for berries one day, and their saber toothed Tigers roaming around.

Pete: You want to be nervous of the saber toothed tigers, so that’s an evolutionary piece, what we do in the third wave. CBTs say that anxieties is adaptive, it's adaptable. You want to have it and so one of the things I find myself often saying is that you need to just build a relationship with it. And so to understand that, if you're going out hunting for food, you need to have your eyes in the back of your head to understand when to be on alert that fight flight or deer in headlights, sympathetic nervous system activating to protect ourselves.

Nikki: Yeah, and these movements keep a little bit more information about what you just said because those are all some really important pieces. Because again, people are like, ‘yeah, yeah, but I don't want to have it’. And I’m like, “Okay, but let's remember that evolution didn't pick these things for no reason. So, what Pete’s really talking about is that, ‘yeah, if you're out looking for berries one day, and we know there's saber toothed Tigers roaming around the forest, it was really helpful to be afraid if we thought that there might be a saber toothed Tiger nearby, we actually see one or we hear rustling in the bushes’. Because our 40,000 year old ancestors, they didn't have language like we had. So, what gave us information? Emotion, so fear shows up it tells you to get the hell out of there that kept our species alive.

Pete: It’s like a text message from 40, yeah.

Nikki: It is. Totally, it’s the original text message.

Pete: It’s the original text message.

Nikki: Because, I love this, in evolutionary psychology, there's a lot of dorky sayings. And one of my favourite ones is that, there were probably prehistoric humans that, that didn't feel afraid and didn't run when they thought there, might be danger. They're not our ancestors, because they got eaten sometimes, those genes did not get passed down to us. So, we want to start by honestly respecting that this is something that does serve a function. Even today, if you are, I don't know, walking alone down a dark street, and you hear somebody begin to walk up on you very fast, I don't know.

Pete: You want to feel, yes.

Nikki: You want to feel afraid, that serves a protective function. So I really like to start there. Because otherwise, people are already in the mind-set of like, “I have to fix this”,

Pete: And what I say is that the brain doesn't talk to the heart, so the mind doesn't talk to the emotions, so I can know all of that and then I still feel anxious. And I think that's part of what you and I work on. Because it's like treating a pilot who's afraid of heights or has anxiety about heights. Most the time, would you say, 100% of time that anxiety is irrational, or that there is an irrational component?

Nikki: 100? No, because think actually, even the heights one, this is important to say, a lot of phobias, also have evolutionary components. Well, 40, 000 years ago, was not a good idea to climb up to the tallest tree, you could fall. Problem, how are you going to pass your genes on?

Pete:  That’s right. And if you're on an elevator that's super protected, or there's certain aspects of that type of stuff where you're probably in a mechanism in the 21st century.

Nikki: Right, you're not accessing other pieces of information. I always say, obviously, you guys can't see me, but I sort of always mime to people, I'll touch the back of my skull, and I'll say, it's like this back part of the brain. It's like the old stuff. It's not the front, the frontal lobe, it's not the front part where we're more conscious about things, because people get very hard on themselves, I would say about that, ‘I should know it's not dangerous’.

Pete: Oh, totally. I've been hard on myself the last couple of months when I've had a night where I've been a little restless or unsure. And I'm like, “wait, really? You do this.” But it's really validating. I think for me, it’s humbling to have those moments that come in and say, ‘Oh, yeah, that's right. This is why we're still doing what we're doing. Because no matter how evolved, and educated our brain is,

Nikki: It’s still 40,000 years old, I mean, there's still parts that just like, evolution works really slowly.

Pete: It is so slow.

Nikki: So anyway, maybe you just go back to, as you mentioned, the fight flight or freeze. And I think that's also important for people understand, because that's also something that's not within voluntary control. So maybe, can you explain a little bit about that?

Pete: Sympathetic nervous system, so this fight, flight or freeze. And so one of the things, it's not in control, because it's part of our central nervous system, and so it's something that just activates by itself. For me, it's like that enteric nervous system that I also teach about where you have that gut feeling. And sometimes your gut can pick up on danger, which is probably communicating with the sympathetic. But I think is key to also identify, it's an automatic response. And the parasympathetic is the other alternative side, and they both can't be up at the same time. So one of the things I work on with people is that they can work on training their parasympathetic to try and at least create a little stabilization to at least manage the anxiety more effectively.

Nikki: Yes, some people aren't so activated all the time. Absolutely, but I was going to say that the part about, because I'm going to guess some people probably don't even know what fight flight or freeze means. And I'll talk about in a moment about I've seen a lot of people that have gone through trauma that judged their responses. So, do a talk a little bit about like, what each of those are?

Pete: Yeah, so yeah, so sympathetic, when it activates fight, flight, or freeze, this is where you're either going to activate and there's other neuro transmitters that are involved, where there could be some adrenaline cortisol. So the fight is when you get up, some people with trauma, for example, they might just punch their manager in the face without any kind of knowing, because they've just gotten to this fight thing. Other people, like myself tend to run away.

Nikki: That's the flight.

Pete: Escape out of a situation, when, and freeze is just like you're stuck. So sometimes we also say like deer in headlights, where you feel like you just can’t move, and you don't know what to do. And anyone who's ever lived in an area where there's deer, you could be driving, and all of a sudden, when they just get stuck in your lights and you're like, ‘who's going to move first?’

Nikki: Well, and so thank you for clarifying those. And what I want to be really clear about is all three of those are adaptive for survival. So I would say, again, and especially in American culture, we'd talk a lot about context on this podcast, it's important to understand contextual lenses. I would say that the fight response is viewed most positively, that if you're in danger that you're supposed to fight back, and the thing is sometimes fight, again, 40,000 years ago, maybe a saber toothed Tigers attacking you, you're scared, but you're going to fight back. Sometimes it's more adaptive to run away. Sometimes it's adaptive to freeze. That's why deer in the headlights so that the predators can see you basically.

Pete: Well, they say that with bears, aren't you supposed to just lay there and play dead?

Nikki: Oh, I don't know, I'm not recommending that to anyone. I have no idea. But yes, sometimes that is in nature, and obviously, humans are part of nature too, that's important. And the reason I say that, I really want to be really clear about that is, in trauma, a lot of times the freeze response is activated.

Pete: That's right.

Nikki: And I've had so many patients say judges themselves, ‘why didn't I fight back?’ And it's because it's not voluntary. We don't know which of those three responses to anxiety and fear might show up. So again, really important to understand that these are parts of our brain that nobody chose.

Pete: Nobody chose, we don't have a choice. 40,000 years ago, it's been made up for us. And the thing I differentiate in class a lot is that anxiety is really a symptom and not a diagnosis, which is getting into the crux of things. But I think that's key, because treatment will vary depending on the actual diagnosis within that anxiety spectrum. Are you with me on that?

Nikki: Yeah, I mean, yes. And so, of course, dialectic here of both ‘and’, is that, yes, anxiety is a symptom, and everybody feels anxiety at some points. We're saying they're adopted times, there are times when it's not adopted, when we feel anxious anyway, like we're going to tell somebody how we feel, or we're giving a big presentation or something like that. Though, diagnostically under the umbrella of anxiety disorders, there are things that aren't just symptoms like obsessive compulsive disorder, OCD is an example. That's a very specific type of anxiety disorder. But the diagnosis, I think is very important because it's going to inform.

Pete: Oh, that's what we're saying. Because the treatment for OCD is going to be very different from a generalized anxiety, which is probably the most misdiagnosed thing out there.

Nikki: Oh, yeah. We're going to have to do a podcast on that sometimes.

Pete: Yeah. Well because, and just really quick, like GAD, general anxiety disorder, it's a thing that is all encompassing. And those people that really have it aren't leaving the house. And so I think, generally speaking, the way I differentiate, because I think if the person is able to come to your office, and they're going out, and they're kind of living their life, GAD is, it can be really debilitating. The actual diagnosis prevents them from getting to work, getting to family occasions, socializing, things of that nature. Whereas OCD, like you said, this is becoming one of your expertise areas, this could just be this obsessional thinking as part of anxiety or just worry about getting infections, things like that.

Nikki: Yeah, absolutely, GAD can be extremely debilitating. Though, I would say, like everything, there's a spectrum, you could also have the diagnosis and not be as severe. Though, I think actually, it's important to talk about this too, because with those diagnoses, the types of thoughts and the behaviours might be a little bit different, like in generalized anxiety disorder, there's a lot of worry, anxieties and emotion. So I think that's another thing we want to clarify, because a lot of times people, and in cognitive behavioural therapies, were really mindful to identify and distinguish between thoughts, emotions, sensations, urges and behaviours. And a lot of times people will say, “I'm worried”, as if it's an emotion. It's like, “well, worrying is actually behaviour”.

Pete: That's right.

Nikki: Anxiety is the emotion that it elicits. So we can change the worry behaviour, we can reduce that in the service of regulating anxiety. But back to this central theme Pete and I are discussing today, we're not going to get rid of your anxiety.

Pete: Ever.

Nikki: So, kind of weaving in some of the eastern practices here. What are some of the interventions that you use to help people regulate their anxiety? Or how to change the relationship as you said.

Pete: Sure. Yeah, it's building the relationship. In the eastern practices, the anxiety would just be general suffering, or it would be a moment of suffering. And so, working on acceptance-based techniques, we do see that a lot of treatment of anxiety disorders, some of the most promising literature, from random controlled trials really focuses on acceptance based strategies, building a different relationship with the thoughts, trying to identify the cognitive distortions, self-care, exercise. One of the things that I try and help people conceptualize is that we are energy. I was writing about this recently, in the Chinese medicine, they talk about it as chi. And so, ci, is this like life force,

Nikki: Yeah, it is.

Pete: And so the chi is a good way for me at least to imagine what anxiety can look like because the energy’s there. And so you could think about just this like fluid that flows through us. And sometimes the chi gets depleted.

Nikki: Or stuck, right? Or get stuck or blocked, right?  

Pete: Blocked, because then it could be the different channels. But in traditional Chinese medicine, they actually look at the level of chi, and I think some teachings feel that you can't restore it. And that's why they are so focused on herbs, acupuncture, massage, because it's really about maintaining chi. And I do think that that's a good image that I use a lot about what anxiety is, it's just this liquid in us that some,

Nikki: We got to move it around a little bit.

Pete: We got to move it around, yeah. And that’s why exercise helps with that too, is just you got to move that around. Sleep is really important. I'll probably keep saying it over and over again. Because sleep I feel like,

Nikki: Oh yeah, it’s huge.

Pete: Do you see that? Do you see a lot of people struggling with sleep, like sleep hygiene?

Nikki: Yeah, I do. And sleep hygiene, by the way, for listeners who aren't familiar with that term. I love it; it's such a dorky term. It basically means good sleep habits, is another way of saying that. But yeah, absolutely. When we're really tired, aren't sleeping well, we're more susceptible to being dysregulated emotionally in any way. Certainly with anxiety as well.

Pete: What else do you use or do you practice for that?

Nikki: Well honestly, I would say the main thing is like mindfulness interventions, so it's number one, meditation, I'll get people going on beginning cultivating formal practice, though, a lot of informal practices of allowing and connecting with what it is that they're experiencing, which mindfulness is an acceptance.

Pete: It's scary, right?

Nikki: It’s scary, yeah. So there's this letting go, I'll share, because we're wrapping up here in a few moments. I'll share the quicksand metaphor, which I love, which is famous metaphor, in Acceptance and Commitment Therapy that sort of illustrates how to come into contact with fear. And so, this is what I always tell people, I’m like, “this is true, look it up. It's a real survival strategy”. So imagine you're walking in the Amazon forest and you trip and fall into quicksand. And you've never been in quicksand before, based on it, and Pete’s a form of competitive source in this particularly development, based on your learning history behaviourally, what are you going to do when you fall into that quicksand?

Pete: Get out!

Nikki: How are you going to do it? What behaviour you can use based on everything you've done before?

Pete: I'm just going to get, just whatever it takes to swim and get out.

Nikki: You're going to swim. Because swimming would work in any other liquid situation. If you fell into a pool of water, or a pool of orange juice or a pool of Coca Cola.

Pete: I wouldn’t want to be in a pool of orange juice.

Nikki: Yeah, so pretty sticky. But swimming would work. Here's the thing, if you try to swim in quicksand, what happens?

Pete: This is a real thing, look it up.

Nikki: You get sucked down, so the way out of quicksand isn't logical, it’s to stops swimming, and it's to increase your surface area. So lay out like a starfish, so you're literally contacting as much as possible, and you'll float to the top and you know you can gently grab a branch. So with anxiety, we actually want to be a starfish in quickset. You actually want to connect with experience and contact the discomfort in the service of regulating it. And I always tell people, that's terrifying; you're going to want to swim.

Pete: It’s kind of like a rip current too, it’s another metaphor.

Nikki: Oh, exactly. Well, I love that one. I always tell people, we learned that in elementary school, we learned like,

Pete: Right away.

Nikki: One parallel, one short, you don't find it. So it's the same thing, it's the opposite of what your brain is telling you. So, I think we can leave people with this notion that when you're experiencing anxiety, you're experiencing discomfort instead of swimming right, try being a starfish.

Nikki: This has been When East Meets West. I'm Dr. Nikki Rubin,

Pete: and I'm Dr. Pete Economou. Be present, Be brave.

Pete: This has been When East Meets West all material is based on opinion and educational training of doctors Pete Economou and Nikki Rubin.

Nikki: Content is for informational and educational purposes only.