The Truth About Anxiety & ADHD: Life-Changing Tools From Renowned Psychiatrist Dr. Tracey Marks

Dr. Tracey Marks 0:00 There's been a, a huge uptick in anxiety. It all started with the pandemic. (instrumental music plays) The World Health Organization reported a 25% increase in an- anxiety globally, and sadly, it's still continuing to rise. It's not like it got better after things settled down. We're still having increases in incidents of anxiety. Probably the most common ones are social anxiety and generalized anxiety disorder.

Mel Robbins 0:32 There are also factors that you're gonna teach us today that can help you get your anxiety under control.

Dr. Tracey Marks 0:37 That's absolutely right. Your brain is changeable, and regardless of what condition you may have, you can improve the quality of your life with simple behaviors and habits. You have control over this, and you have agency over your mental health. (clock ticking)

Mel Robbins 0:58 Hey, it's your friend Mel, and welcome to The Mel Robbins Podcast. I am so excited to be here with you. It is always such an honor to spend time together, to be together, but today in particular, I am fired up for this conversation because it has deeply personal meaning for me, and so I'm glad to be learning together with you. And if you're a new listener, I just wanna take a moment and personally welcome you to The Mel Robbins Podcast family. Thrilled that you're here. And because you hit play and found the time to listen to this particular episode, here's what I know about you. You love to learn, you love feeling inspired, and you also want to understand yourself better, and that's exactly what this amazing conversation is gonna help you do today. And if somebody sent this to you, let me just point out that that's really cool because it means you have people in your life that deeply care about you, and they wanted you to hear something that could potentially make your life better, and that's awesome. And today, the conversation, it's not gonna just blow your mind, it's gonna change your mind because we're gonna dig into the surprising connection between anxiety, ADHD, and symptoms that people with these two conditions experience that you may not be aware of. I certainly wasn't. And more importantly, you're gonna get a lot of tools on exactly what to do if this is how you feel or if it's impacting somebody that you care about. So let me introduce you to the amazing Dr. Tracey Marks who is an absolute powerhouse. Dr. Marks graduated from Duke and then got her medical degree from the University of Florida College of Medicine. She did a residency in psychiatry at NewYork-Presbyterian Hospital. She has been a practicing clinical psychiatrist for over 25 years, specializing in anxiety, ADHD, and mood disorders. She's also the author of three best-selling books on mental health, including the one I'm holding right now, Why Am I So Anxious? She also has two million subscribers on YouTube, making her channel one of the biggest mental health and wellness channels online today. Her YouTube videos break down complicated topics like ADHD and anxiety into simple, relatable strategies that help people like you and me who are struggling with ADHD and anxiety learn how to thrive. So without further ado, please help me welcome Dr. Tracey Marks to The Mel Robbins Podcast. Dr. Tracey Marks, welcome to The Mel Robbins Podcast.

Dr. Tracey Marks 3:24 Thanks for having me here. I am so excited.

Mel Robbins 3:27 I am so excited to sit down and talk with you. And by the way, Why Am I So Anxious?, this is a fantastic book. But more importantly, you know what it is? It is a resource. When I was flipping through this, I cannot believe how many tools, how much research, how many different just strategies that you put together for people. So thank you, thank you, thank you for writing such a fantastic book that I'm sure is helping millions of people.

Dr. Tracey Marks 3:56 Wonderful. That was the intent is to give people a resource. I mean, it kinda reads like an encyclopedia a little bit, but- (laughs)

Mel Robbins 4:04 Well, you're very smart, so yes, it does, but it made me smarter about anxiety for sure.

Dr. Tracey Marks 4:08 Excellent. Goal achieved.

Mel Robbins 4:10 So I would love to start by having you speak directly to the person that is listening, that's spending time together with us right now, and just explain what might be different about their life or the life of somebody that they care about if they take everything that you're about to share with us today to heart and they apply it to their life.

Dr. Tracey Marks 4:32 Sure. I think the biggest thing that someone can take away if they really listen and understand what we're talking about today is the fact that your brain is changeable, and regardless of what condition you may have, you can improve the quality of your life with simple behaviors and habits. You have control over this, and you have agency over your mental health.

Mel Robbins 4:57 Now, you have been a psychiatrist for 25 years, and there are a number of topics that I cannot wait to jump in and just really unpack with you. And in particular, what I'm excited to talk about is anxiety and then to get into its connection with ADHD and other symptoms that people may be feeling that they don't realize are related. What are you seeing in your practice, and with the millions of people that follow you online, what are you seeing in terms of the type of anxiety that people are struggling with? And what do you think we, we should know?

Dr. Tracey Marks 5:34 Sure. So anxiety, there's been a, a huge uptick in anxiety. I mean, anxiety, first of all, it's a very big topic because there's lots of different types of anxiety. Probably the most common ones are social anxiety and generalized anxiety disorder. But, that said, um, it all started with the pandemic. So the World Health Organization reported a 25% increase in... and anxiety globally, starting with the pandemic. And sadly, it's still continuing to rise. It's not like it got better after things settled down. We're still having increases in incidents of anxiety.

Mel Robbins 6:17 Now, why do you think that is?

Dr. Tracey Marks 6:19 I think it has to do with, um, our digital world this day, where we're always on, 24-hour news cycles-

Mel Robbins 6:29 Hmm.

Dr. Tracey Marks 6:29 ... um, social media with constant comparisons, and, um, access to bad news at any time of day. And also, our-our brains can be, um, overloaded with information-

Mel Robbins 6:44 Hmm.

Dr. Tracey Marks 6:44 ... that then can create anxiety. So, we have information overload, lots of hard working. I mean, there's just lots of societal factors.

Mel Robbins 6:52 Well, it's interesting, 'cause at the very beginning you said that one of the things that could change about your life is your brain. Because your brain is malleable. You are able to reprogram it, and if I think about what you just shared with us, which is anxiety's on the uptick, which I just want to say to you as you're listening, if you're experiencing an uptick in anxiety or if people that you care about are experiencing anxiety for the first time, then I think it's important to hear that this is actually kinda normal right now, that Dr. Marks is seeing it. What's also interesting to me about the list that you just gave us, in terms of social media, constant comparison, things constantly changing, the headlines-

Dr. Tracey Marks 7:33 Yes.

Mel Robbins 7:33 ... the news cycle that's so negative, like all of it, is that those factors have changed your brain in terms of you feeling anxious, which means if there are outside factors that can change your brain and make you anxious, I would imagine, Dr. Marks, there are also factors that you're gonna teach us today that can help you get your anxiety under control.

Dr. Tracey Marks 7:54 That's absolutely right. So just as our brains can change in a negative way-

Mel Robbins 7:58 Yeah.

Dr. Tracey Marks 7:58 ... our brains can change in a positive way, and we have the ability to make those changes ourselves.

Mel Robbins 8:05 So if you're like super anxious, 'cause I struggled with anxiety for decades, and one of my biggest fears, Dr. Marks, is I'd never actually get rid of it, that I would always feel like that. And so for somebody that's listening right now or they have a-a loved one, uh, a child or a family member or a friend who's just like in the grip of it, what is possible?

Dr. Tracey Marks 8:29 Sure. So I always, uh, kind of give, when I'm talking to people or talking to patients, the caveat that anxiety is one of those things that waxes and wanes over time. It's like a wave. So you can have periods of your life where it's more manageable-

Mel Robbins 8:43 Mm-hmm.

Dr. Tracey Marks 8:43 ... and then periods of your life where it's-becomes unmanageable because of stressors. And so it is important to realize that this isn't something that, where the end point should be, "I wanna be cured and be anxiety-free," because that's not-

Mel Robbins 8:57 I don't want to hear that. (laughs)

Dr. Tracey Marks 8:58 (laughs)

Mel Robbins 8:58 I don't wanna hear that, Dr. Marks. Get rid of it.

Dr. Tracey Marks 9:02 It's just not realistic, number one, and some amount of anxiety is advantageous. You know? If you get anxious about some kind of upcoming presentation that you me-need to make, it may make you plan more.

Mel Robbins 9:15 'Kay.

Dr. Tracey Marks 9:15 So, some amount of anxiety drives us to be better. But nonetheless, when it gets overwhelming for you, that's when problems set in and it can impair your functioning, and that's the level at which we wanna look at making changes.

Mel Robbins 9:31 Okay. So before we jump into specifics, what actually is anxiety?

Dr. Tracey Marks 9:38 Hold on. I'm taking off my shoes.

Mel Robbins 9:39 Take it off, woman.

Dr. Tracey Marks 9:40 (laughs) Because I keep moving my feet and it's, um, and making noise.

Mel Robbins 9:46 You're doing great, by the way.

Dr. Tracey Marks 9:48 Thank you. (clears throat) Whew. All right.

Mel Robbins 9:52 (laughs)

Dr. Tracey Marks 9:52 (laughs)

Mel Robbins 9:52 Are you feeling anxious right now?

Dr. Tracey Marks 9:53 I am feeling anxious.

Mel Robbins 9:54 Why are you... What-what-how-what does that mean?

Dr. Tracey Marks 9:57 For me, it, because it's-it's probably a performance anxiety, and I have to check myself because my natural tendency-

Mel Robbins 10:05 Yeah.

Dr. Tracey Marks 10:05 ... is to just kind of wanna unload all this information and not keep it, um, I have to work to make information accessible to people and not go down rabbit holes and things like that, or I get, um, I overthink making sure I don't say the wrong thing and all of that. So that's where I am right now.

Mel Robbins 10:25 That is so relatable, Dr. Marks. So to have you be a world-renowned expert with millions of followers and in real time tell me and the person that is making time to learn from you that you're actually experiencing a little bit of performance anxiety, which is just wanting to do well, wanting to meet the moment, and I-I think that that

Mel Robbins 10:51 is so helpful. What do you experience in your body when you are in a moment where you feel anxious about wanting to do well? And I, you know, I-we've all been there, whether it's on a date or an interview. This is a very normal thing and it's a sign that you're actually functioning the way that you should 'cause you care about how you're gonna do, right?

Dr. Tracey Marks 11:12 That's right. So it kind of, this ties into your question about what really is anxiety, and it's a full body experience.

Mel Robbins 11:20 Hmm.

Dr. Tracey Marks 11:20 It's not just in your head and it's not just in your body. It's both. So for me, going back to your question, um, my mouth gets dry, which then, um, you know, my lips could stick if I'm, like, trying to smile and I'm like, "Am I looking ridiculous?" Um, so and then I get in my head about how do I look, how do I sound, and all of that. So that's kind of how I experience anxiety. Um, worrying about what the other person's thinking.

Mel Robbins 11:47 Hmm.

Dr. Tracey Marks 11:47 But, um, so going back to the usual experience of anxiety, which I shouldn't even say usual. It's an individual experience. So you can have, the head symptoms would be like worrying in your head, fear, um, over concern about what people are thinking, like I was just talking about.

Mel Robbins 12:07 Yeah.

Dr. Tracey Marks 12:08 ... in your body, um, you know, we get, um, a sympathetic response, which, um, historically or biologically was designed to give us the ability to fight or flee some perceived threats. But that response turns on even for threats that are real or imagined.

Mel Robbins 12:29 Mm-hmm.

Dr. Tracey Marks 12:30 So, if I'm imagining that I'm gonna look ridiculous because of something I say-

Mel Robbins 12:35 (laughs)

Dr. Tracey Marks 12:35 ... then I can start having my heart racing, I can start feeling, um, gastro- other gastrointestinal things. Some people can feel like they're gonna have the runs and, "Uh-oh, what's that gonna mean?" Um, you can have this sense of just tension in your, in your body and not even realize that you're tensing your shoulders and things.

Mel Robbins 12:55 Ah.

Dr. Tracey Marks 12:55 And then get to the end of the day and you're exhausted and you're like, "All I did was sit all day. Why am I tired?" Because you can get a lot of muscle tension. Um, so those are some of the physical signs.

Mel Robbins 13:06 You know, Dr. Marks, it's so interesting that you bring that up because I just have these days where at the end of the day, I feel exactly that, like completely exhausted and tense. And then I reflect, I'm like, "Mel, you basically just sat all day at your desk." Wh- why is that a symptom of, of anxiety?

Dr. Tracey Marks 13:25 So if you're anxious, you... One sign of that, or one symptom of that is tensing muscles. And a lot of times, we can tense our muscles without even being aware.

Mel Robbins 13:35 Mm-hmm.

Dr. Tracey Marks 13:35 So you sit at a desk, your m- your neck muscles are tight, your shoulder muscles are tight. (laughs)

Mel Robbins 13:40 Yeah. I literally just sat up. I'm like, "Oh my God," I'm slouched over like the Hobbit right now.

Dr. Tracey Marks 13:46 (laughs)

Mel Robbins 13:46 Is, and like that's probably like the, the not bad posture, but anxiety?

Dr. Tracey Marks 13:52 Y- yes, because if you're stressed out, then your muscles tense, okay? And then you can carry that posture for hours. And your muscles are working. When they tense, they're working. So, at the end of the day, your muscles have been working harder than you're aware that they're working 'cause you were just sitting all day.

Mel Robbins 14:10 Wow. Plus, if you're at work and you're kind of bracing, like if you're having a stressful day, that's also another form of you tensing up your muscles.

Dr. Tracey Marks 14:19 Correct. And so, uh, the beauty of this is that if you are aware and understand that this is one of your responses, then you can offset it with things. So for example-

Mel Robbins 14:31 What do I do (laughs) ?

Dr. Tracey Marks 14:32 (laughs)

Mel Robbins 14:32 What do I do, Dr. Marks?

Dr. Tracey Marks 14:34 So, I had a morning where I woke up and I could barely lift my head off the bed. And I thought, "Oh my goodness, am I paralyzed?" The, the downside of being a doctor is thinking about all kinds of things. But anyway, and all it was was that I had kind of a stressful week and I had been sitting at my computer, hunched over, using my mouse and the shoulder up, and I didn't realize that that was what I was doing, that I use my mouse with my shoulder up like this. And so my neck was almost, like I could just, again, barely lift my head off the bed. So, what do I do to offset that now? I do what's called progressive muscle relaxation. Well, first of all, I try not, I try to be aware of how I'm sitting in my chair.

Mel Robbins 15:16 Mm-hmm.

Dr. Tracey Marks 15:16 But even, I can't, that's not perfect. So, progressive muscle relaxation is one of those body tools where you, you know, you start from either the head or the, or the foot and you take muscle groups and you contract them and then relax them. And what that does is it makes you aware of what muscles were actually tense. So, you could be, you know, you could contract your shoulders and then relax them and realize-

Mel Robbins 15:44 Ah.

Dr. Tracey Marks 15:44 ... "Wow, okay, I didn't realize I was kind of sitting like this all day long."

Mel Robbins 15:48 Yeah.

Dr. Tracey Marks 15:49 But that helps, uh, create a relaxation state in your body. It helps, um, kind of release that muscle tension. And I would suggest, you know, trying that during lunch, a lunch break. It could just take five minutes to kind of, from head to toe, contract, relax, and then that will kind of, that will help reset your muscles so that at the end of the day, you didn't spend eight hours all contracted.

Mel Robbins 16:17 I think the majority of us spend eight hours tense at work and we don't even realize it.

Dr. Tracey Marks 16:23 Don't even realize it.

Mel Robbins 16:24 That is unbelievable. I'm gonna try it.

Dr. Tracey Marks 16:27 Try it.

Mel Robbins 16:28 And it's helpful to hear the physical symptoms because when you watch somebody that you care about who's struggling with it, it's very hard to understand because it doesn't seem to make sense.

Dr. Tracey Marks 16:39 Mm-hmm.

Mel Robbins 16:40 And I would love to play a video for you.

Dr. Tracey Marks 16:43 Okay.

Mel Robbins 16:43 Because I was so excited when you were coming on, and, uh, you have a son who's around the same age as our son, so my son's n- uh, name is Oakley, and this morning, when I knew you were coming in, I'm like, "You know, he has struggled with anxiety his whole life, and so I am gonna ask him because I don't know what to do." I know a lot about anxiety, but the way that his manifests is very challenging, and I figured why not wake him up in his college dorm room and tell him that you're gonna be here and ask him, uh, if he would like to ask you a question about the issue that he's struggling with? And so we made a video, and I would love to play it for you.

Dr. Tracey Marks 17:29 Okay.

Mel Robbins 17:30 Okay. Here's Oakley.

Guest caller 17:31 Uh, I don't know if it's morning for you, but it's sure morning for me, nine o'clock for a college student. I just got out of bed, like literally 30 seconds ago. Um, I hope you're well. My name's Oakley, by the way. I shouldn't forget saying that. I'm my mom's son, Mel Robin's son. I'm not just like some random kid that they're getting a video from. Um, I am gonna... I have two questions for you and I'm gonna keep them super s- short because you're busy and I don't wanna waste your time, uh, but we're already at 30 seconds, so let me, let me get this going. Um, and they're both anxiety. Okay. Um, my first question basically what happens normally when I get anxious is before I'm even anxious in the first place-... in my head, I'll start to get this, like, spinning sensation where it's basically a feeling of nausea. Like, I start to get a feeling of nausea. And then, from the nausea, I become anxious. And then I'm just, like, in this state of anxiety and it doesn't go away until I'm not nauseous anymore. But the anxiety, I feel like makes it worse because I'm like, "Oh, I'm anxious, I'm anxious because I'm nauseous," and then it like, gets worse. Um, and so I was curious what you might think about that. Um, thank you.

Dr. Tracey Marks 18:49 That is a- that's perfect example, which is pretty typical that people with anxiety can be very sensitive to body sensations.

Mel Robbins 19:00 Hmm.

Dr. Tracey Marks 19:01 And those body sensations then trip off anxiety in their head. So, um, sometimes, especially if they don't associate it with anxiety, so for example, someone who, let's say, has panic attacks and they know that their panic attacks are classically their heart beating and- or heart racing and trouble breathing maybe.

Mel Robbins 19:21 Mm-hmm.

Dr. Tracey Marks 19:21 And then they- maybe they can then do things to slow their breaths. But sometimes it's not always obvious what the anxiety or the physical sign is, so he's describing this sensation in his head that he's calling nausea and maybe it feels like maybe it's some kind of nausea thing, but it could just be this kind of dissociative experience of just kind of losing track with his environment and things that can happen with people and freak them out.

Mel Robbins 19:49 Really? Okay, so explain that, because he's actually had things like that happen and so have I, and as- and as you see in the video, he kind of loses his train of thought and looks off to the left and then re-centers himself, and so what he's calling nausea or just this sort of lapse in feeling present spirals into something bigger. And so that's kind of common?

Dr. Tracey Marks 20:12 That's pretty common. Yes.

Mel Robbins 20:13 Really?

Dr. Tracey Marks 20:14 Yes. So, dissociative experiences, you can, um, kind of lose touch with your environment or lose touch with even- or an alteration in your experience even with yourself. So someone can say, "Look in the mirror," and just be like, "I don't look like myself." And it- and then they can just think, "What is wrong with me?" And not recognize that as, say, a symptom of anxiety, just let- let's say. So, yeah, he's calling it nausea, and- and maybe he might feel some nausea, but it's probably more of a, you know, a- a depersonalization or derealization experience that he's having which can accompany anxiety or be an anxiety symptom.

Mel Robbins 20:59 Wow. So the

Mel Robbins 21:01 thing that- the reason why I wanted him to ask that is because I've been trying to help him as his mother. I'm clearly not a psychiatrist, but I've been trying to help him as his mother to untangle the physical sensation from what then happens where he then is like, "Oh, I'm anxious," and then he gets caught in telling him he's anxious and I know for me, when I used to experience a lot of anxiety, I was so scared of the feeling of being, like, anxious or being lost in my head or feeling like I was about to get in trouble or that something bad was gonna happen or could have been being afraid of, uh, getting on a plane or afraid that something would happen to my parents. Like, I could so easily get lost in my thoughts, and then once I felt anxious, I got then worse because I was afraid of the anxiety. I'll give you a situational one. So yesterday, I got an email from a business partner of mine, and it was one of those emails that just makes you go (grunts) . You know, you just clench 'cause you know that they're pissed at you. And even though I don't feel like I did anything wrong, they're really mad at me. And so there's that bracing sensation and bracing, when you get a na- a- a- an email where somebody's mad at you, is a mentally healthy response. But the challenge for me is, I have a hard time letting go of the worst case scenario in my head. What if this happens? What if they think that? What if I did something really wrong? What if I did do blah-ba-dee-blah-ba-dee-blah even though I don't think I did do that? And the getting caught in my head thinking about it then becomes the torture and is probably 100 times worse than what they're actually miffed about. Do you- do you know what I mean?

Dr. Tracey Marks 22:50 I know exactly what you mean. Yeah.

Mel Robbins 22:52 So can you help us understand, however you'd like to use those two examples, what anxiety actually is? And what you can do to release yourself from the grip it has on you, because I think the response happens and that's okay, but it's the grip that it holds on you that becomes problematic. Is that a good way to think about it?

Dr. Tracey Marks 23:14 Yeah, that- that is a great way to think about it.

Mel Robbins 23:16 Okay.

Dr. Tracey Marks 23:16 Because you cannot stop the initial response. What you can stop is the propagation of the response that then turns into, um, freezing or- or lots of rumination in your head-

Mel Robbins 23:31 Mm-hmm.

Dr. Tracey Marks 23:31 ... and- and- and worst case scenarios and all of that. That's where it just continues from the original thing that started it.

Mel Robbins 23:38 Yep.

Dr. Tracey Marks 23:38 So there's this- there's this, um, intervention called interoceptive exposure. I talk about it in my book.

Mel Robbins 23:47 Actually, I'm turning right to the page right now.

Dr. Tracey Marks 23:50 (laughs)

Mel Robbins 23:50 You're the one that- this is the first time I've ever heard of this in my entire life. It is genius. It's on page 248 of your book Why Am I So Anxious? So why don't you walk us through that?

Dr. Tracey Marks 24:00 Right. So interoceptive exposure really is, what it is at a high level, is trying to get you to disconnect the physical sensations from it being anxiety provoking.

Mel Robbins 24:15 Okay.

Dr. Tracey Marks 24:15 Because people can get to just where you are of...... fearing the anxiety because, let's say, they feel a little churn in their stomach and, "Uh-oh, I'm going to like... This is gonna turn into a mess for the, for the next hour or so."

Mel Robbins 24:31 Yes.

Dr. Tracey Marks 24:31 Or, "I might have a panic attack or something." So you fear the reaction to the physical sensation. So with interoceptive exposure, you wanna identify what are some of those, um, sensations that trigger this, these responses. And then you want to purp- intentionally in a calm situation, expose yourself to those situations. So let's just say, um, you... if you notice that your heart... when your heart races, or if you feel your heart beat, that that's gonna make you worry that, "Uh-oh, you're getting ready to have a panic attack."

Mel Robbins 25:05 Mm-hmm.

Dr. Tracey Marks 25:06 You could do something to intentionally increase your heart rate.

Mel Robbins 25:09 Oh my God. But wouldn't that make you have a panic attack?

Dr. Tracey Marks 25:12 Y- you'll be surprised. When you don't have a panic attack, because you probably won't because of the situation, so do a couple of jumping jacks. Your heart's beating faster now-

Mel Robbins 25:23 Yeah.

Dr. Tracey Marks 25:23 ... but you're in a safe situation and you can get the reinforcement that, "Just because my heart races or go- gets faster, doesn't mean I'm gonna have full-blown panic or that it's gonna explode into, um, uncontrollable anxiety." So you're, you're exposing yourself to these physical sensations in a safe environment, and you're intentionally doing it, and then you're getting the reinforcement that, "Okay, I can handle this."

Mel Robbins 25:50 So in the case that Oakley just talked about where he gets this sensation in his head, what I read in your book when you talk about this, um... Again, I wanna just give everybody the page number 'cause this is so cool. There's actually a chart for this. I'd never seen this before, it's on page 250, where you say, "Nausea, spin in a swivel chair for a minute." What does that do?

Dr. Tracey Marks 26:12 So th- spinning in the, in the chair-

Mel Robbins 26:14 Yeah.

Dr. Tracey Marks 26:14 ... um, activates your vestibular system or, you know, your, your balance and your ears, and it can trigger that same sensation of feeling, you know, the, the weirdness in your head or like you're dizzy, um, because dizziness, sometimes people if they feel lightheaded will be, you know, like, "What's wrong with me?" And that, they become fearful of being lightheaded because... and then that makes them anxious.

Mel Robbins 26:41 Yes.

Dr. Tracey Marks 26:41 So intentionally make yourself lightheaded or, or have a spinning sensation to, again, reinforce the idea that it's not dangerous. You can, you can handle this, you can manage it.

Mel Robbins 26:55 What about anxiety that feels like a pit in your stomach? 'Cause I think that's sort of the classic thing that people feel. And I love that we're talking about physical sensations because for most of my anxiety and most of the anxiety that I've experienced with all three of our children, it always does seem to start with something physical in their body, this sense. So let's talk about the pit in the stomach. What can you do if you have a pit in the stomach every time you walk into work in the morning? A lot of people have that.

Dr. Tracey Marks 27:29 That's right. So when you get anxious, you get slowed digestion, so you get less movement of your gut and so, yeah, that's how you can get a stomach ache from eating when you're anxious, or even completely lose your appetite to eat when you're anxious. But anyway, the pit in the stomach, yeah, is related to gastrointestinal slowing and changes because of the increased cortisol and stress hormones. So what can you do about that? Well, the first step is, what you've already said, is recognizing that that's part of how you are manifesting anxiety and then address the anxiety with the tools that work for you. Not everything works for everyone. An example of something could be breath work, changing your breathing pattern just to do a reset-

Mel Robbins 28:17 Mm-hmm.

Dr. Tracey Marks 28:17 ... to then relieve some of the anxieties 'cause that's what we're trying to do here. You're, we're saying, "I got this pit in my stomach. I'm probably anxious or tense about walking in." Because you might not always be conscious that, or consciously aware that, "I'm anxious walking into work." It's more like, you know, "I'm doing this thing. Oh, th- here's the pit. Okay. I, you know, hate my life, da-da-da," and you just kinda keep, keep working. (laughs)

Mel Robbins 28:43 (laughs) Yes.

Dr. Tracey Marks 28:43 But if you can, you can separate out, "Okay, I've got this pit in my stomach. It's anxiety. I am going to do something to calm myself."

Mel Robbins 28:51 Like, if you... If we talk about... 'Cause I think it would be super helpful for the person listening to have you describe anxiety in terms of when you're in a calm, resting, you're okay space. You're not in the what if loop going, "What if this happens? What if that?" And then the pit in the stomach and then all of a sudden you think you're gonna throw up, and then you can't sleep, and then you're staring at the ceiling. Yes, I've experienced all this.

Dr. Tracey Marks 29:17 (laughs)

Mel Robbins 29:17 Something just happened in your body when that switch flipped.

Mel Robbins 29:21 So could you just describe for us what's happening either in your nervous system or digestive tract, and why that's happening?

Dr. Tracey Marks 29:28 So we have two competing systems.

Mel Robbins 29:30 Mm-hmm.

Dr. Tracey Marks 29:30 You have the amygdala, which is a, a, a structure in your brain that is responsible for threat detection. It detects threats and it prepares your body to be able to either fight or flee, so by increasing the sympathetic response in your body, um, so that you get increases in epinephrine and things to stimulate you to be able to defend yourself. Once that threat is passed-

Mel Robbins 30:00 Yeah.

Dr. Tracey Marks 30:00 ... then the parasympathetic system kicks in to calm things down. So it's like putting, pressing on the brakes. So the sympathetic system turns up the gas and the parasympathetic turns on the brakes to slow things back down to just kind of a normal resting state.

Mel Robbins 30:18 Got it. So that makes perfect sense and I think we can all imagine you're in a scenario and whether it's just your mother-in-law who you can't stand and they walk in the room and you're like... (gasps) That's what you're talking about, that your body and nervous system and senses sense a threat. All of a sudden, your body steps on the gas. You just mentioned a bunch of chemicals that flood your body. Your n- heart starts racing. Why? Because you know that this person that you're now related to is about to say something nasty to you about your parenting style, so you're like on edge, you hit the gas, you're ready to go, you're bracing. That is the alarm system designed to protect you. But you also then said you have the ability to tap the brakes because when she leaves and you turn to your husband and say, "Why didn't you defend me?" Like, okay, it's a, like... Well, I'm making a joke about it. But you can take a deep breath because it's over and you go back into the present. And so, it's helpful for me to understand that you have the ability to do these two things. And you, you said earlier that anxiety can be a really good thing because if the alarm goes on and you step on the gas because you wanna do well in an interview or you need to protect yourself, then it's working. But the problem becomes, at least this is kinda what I'm hearing, that in the situation that Oakley described, that the second that his brain feels slightly dizzy, he mistakenly steps on the gas and turns the alarm system on. Is that a fair kind of way to describe it?

Dr. Tracey Marks 31:56 That's very fair.

Mel Robbins 31:57 Okay.

Dr. Tracey Marks 31:57 Yes. And you can't always... The person can't always control the stepping on the gas.

Mel Robbins 32:03 Okay.

Dr. Tracey Marks 32:03 So you can step on the gas and accelerate, but then you can come back once you recognize that that's what's happening. So the key here is understanding how your brain works.

Mel Robbins 32:15 Yep.

Dr. Tracey Marks 32:16 So that then you can make your own interventions on that.

Mel Robbins 32:19 I just had a huge, like, breakthrough in listening to you.

Dr. Tracey Marks 32:24 Oh, love that.

Mel Robbins 32:25 Yeah. So let me just unpack this because I think that this is really important because I have always hated it when psychiatrists have... or psychologists or medical experts have said, "Well, you know, you're never gonna make your anxiety go away," because I'm like, "I want it to go away, Dr. Marks. Like, I don't want to live like this. I don't wanna feel like this." But in what you just said, you just said that you can't actually change the things that are gonna be happening around you, whether it's your mother-in-law walking in or your boss's bad mood, and you can't necessarily change the fact that your body is wired to go from that thing to suddenly stepping on the gas. That anxiety response is potentially always gonna turn on. But what you can control is you can catch it when you feel your body go like that and you step on the gas. You can take your foot off and not accelerate it.

Dr. Tracey Marks 33:33 That's exactly right.

Mel Robbins 33:34 And the reason why that's actually important to me is because I've always focused on never stepping on the gas. And so allowing yourself to think about it like, okay, I'm just the kind of person that when I sense a threat or I gotta do something, boom, my body steps right on the gas, but I don't have to accelerate this. In fact, I can use the tools that Dr. Marks is gonna teach us today to decelerate and then tap the brake. Is that... I mean, that's ex- that's exciting.

Dr. Tracey Marks 34:08 Yes.

Mel Robbins 34:09 I've been looking at the wrong thing, Dr. Marks, for 56 years.

Dr. Tracey Marks 34:12 Been f-

Mel Robbins 34:12 For... Where the heck have you been, for crying out loud?

Dr. Tracey Marks 34:14 (laughs) And, you know, and that's transformative. You gotta change the focus from trying to prevent the reaction to controlling the reaction and modifying the reaction so that it's not as damaging or it, you know, doesn't cause problems for you. That's what we're focusing on.

Mel Robbins 34:33 I love that because I think the fear of being anxious and the frustration with it makes you just want it to disappear. What you're basically saying is, "Forget about that. Let's just learn how to decelerate."

Dr. Tracey Marks 34:45 Absolutely. And that takes the pressure off you to feel like your, your, you've gotta do the right thing to get yourself not to be anxious.

Mel Robbins 34:54 Okay, great. So for somebody listening who has somebody in their life who is struggling with anxiety, even just the reframe of thinking about this like, you don't have to get rid of their anxiety. You're gonna be a support system for helping them decelerate their response

Mel Robbins 35:09 to it.

Dr. Tracey Marks 35:09 Absolutely.

Mel Robbins 35:10 That's so cool. I have another video for you. You, you were very popular when everybody, uh, heard you were coming in. Okay. So here's another video for you. All right.

Alyssa (production assistant) 35:19 Hi Mel. Hi Dr. Marks. My name is Alyssa, and I am a production assistant here on the Mel Robbins podcast, and I would love for Dr. Marks to touch on emetophobia, which is the fear of vomit. Um, I've been struggling with this pretty much my entire life. I'm 23 now and I can't really remember a time where I wasn't afraid of vomit. Um, it has definitely impacted a lot of my life. Um, when I was younger, I struggled to go to school because I was so afraid of vomiting in public. Um, there was a time where I was doing virtual school because I just was so afraid of kids vomiting around me, of me vomiting in the classroom, um, and as I got older, it's still kind of prevalent in my life where I really don't like air travel, I still don't really drink alcohol that much because I just don't wanna throw up, um, and I definitely feel like it's... this fear has been holding me back in a lot of avenues of life. So Dr. Marks, if you have any advice to ease these symptoms, I would love to hear it, and I know that our listeners who might struggle with emetophobia, the fear of vomit, might as well. Thank you.

Dr. Tracey Marks 36:34 Thank you, Alyssa, for that question. Actually, emetophobia is not that uncommon....whether it be emetophobia, a fear of vomiting, um, a fear of, um, (laughs) you know, a fear of embarrassing yourself in public.

Mel Robbins 36:49 Hmm.

Dr. Tracey Marks 36:50 Any kind of phobia i- is typically made worse by avoidance. So, the avoidance behaviors become the bigger problem-

Mel Robbins 37:02 Hmm.

Dr. Tracey Marks 37:02 ...than the thing that you fear. So for me, I hate roaches. And so, I could get to the point where if I try and do everything, I lived in New York during my, um, residency, and I considered staying up there because it was five years of very few roaches. (laughs) So, you know, I'm gonna, you know, craft my whole life around trying to avoid roaches. I can't do that. And now I live in the South and I definitely have to deal with them. But the point is, is that, um, you can start with something that you either fear. Phobias can also be generated from disgust, so just not always fearing.

Mel Robbins 37:42 Hmm.

Dr. Tracey Marks 37:42 It can be just, "It's so gross," (laughs) you know, that it's, it's an unpleasant sensation to even face it.

Mel Robbins 37:49 Mm-hmm.

Dr. Tracey Marks 37:51 The ... But if you let yourself move the, the world, um, to keep from having to deal and face that-

Mel Robbins 38:00 Mm-hmm.

Dr. Tracey Marks 38:01 ...it's gonna make the fear even worse, and then the avoidance behavior becomes the bigger problem than the original thing.

Mel Robbins 38:07 I think that's a super important thing to highlight because when you say that the avoidance of it becomes a way bigger problem than the thing that you're actually afraid of, that's when it seems like anxiety spirals into something that makes your life debilitating. And one thing that I worry about, you mentioned that there's been a big rise in social anxiety. I worry when you look at hybrid work and how people don't see their friends and the rise of loneliness, that if you're also somebody that feels a little discomfort around putting yourself out there, that then when you start to avoid it, and you start to stay in, and then you're not reaching out, and then you're not going to the things you are invited to, that the avoiding of putting yourself out there becomes actually the bigger problem than being worried about what it's gonna feel like when you put yourself out there.

Dr. Tracey Marks 39:01 Absolutely. The pandemic reinforced a lot of social anxiety for people. You know, people were like, "Oh, cool, I didn't wanna go anywhere anyway." Well, then now, they have a reason not to. And then now trying to, like, move past that once the pandemic was over, it was even harder for many people like that. And as we know, um, social isolation also makes anxiety worse.

Mel Robbins 39:27 Mm-hmm.

Dr. Tracey Marks 39:28 So it's just, it, it's a problem that just can compound on itself.

Mel Robbins 39:32 What's the difference between being shy and introverted and having social anxiety, Dr. Marks?

Dr. Tracey Marks 39:38 Great question. So introversion, um, is often misunderstood. It's not as though you don't wanna be around people. Um, I'm introverted, and I get my energy from having some downtime, quiet time, time to myself in my head. That's where I gain my energy. So I can get depleted if I'm out all day long and talking to people. Versus the extrovert gains their energy from the interaction with people, and they can get depleted if they have too much alone time.

Mel Robbins 40:16 Hmm.

Dr. Tracey Marks 40:17 So knowing that, um, being introverted doesn't mean that you've got a problem or that being around people makes you anxious. You just have to balance some time to have to yourself to be able to just think in quiet, in peace. Social anxiety is an anxiety disorder where you become preoccupied with, um, being judged and what other people think to the extent that it changes your own behavior and makes you avoid situations where you fear you're gonna be judged.

Mel Robbins 40:54 Oh, really? It's, uh, it's, uh ... They're, like, kind of mixed together?

Dr. Tracey Marks 40:57 They're mixed together. So it's not just that you fear or become anxious being around people. You can become anxious on the performance aspect, with performance being speaking.

Mel Robbins 41:09 Hmm.

Dr. Tracey Marks 41:10 Doesn't have to be, you know, playing a piano on stage. So if I've got, say ... And I, you know, I have patients who have trouble with these, like, meetings.

Mel Robbins 41:20 Yeah.

Dr. Tracey Marks 41:20 And so they'll get really anxious about just having to even, like, deliver or, or talk to a team about what they were doing. That would be an example of performance anxiety. Um, so with that, there's a lot of fear and thoughts in your head about what people are thinking. You're, um, appraising your own be- um, your own performance and, and just assuming that, that you're gonna mess up and have all this criticism. So that's a lot of the genesis or the, the thoughts behind what drives social anxiety, is what other people are thinking.

Mel Robbins 41:58 So can you put us at the scene of what it feels like when you are struggling with social anxiety and, again, where you're putting yourself in a situation. Let's just say that your, y- a bunch of friends are, are meeting out at a bar. And they're like, "Come on out. You know, meet us after work." And the thought of that moment where you walk through the door, and the music is loud, and it's kind of a crowded place, and you're looking around, and you see the group over there, and then you immediately are like, "Ah, you know, I shouldn't have come," or, "My, my friend isn't here yet, I shouldn't go." Wh- what is happening for somebody that feels social anxiety in that kind of situation, or when they walk into a networking meeting and you immediately just feel like the spotlight is on you?

Dr. Tracey Marks 42:52 So there's an overemphasis on-... other people's appraisal of you or other people's judgment of you.

Mel Robbins 43:00 Mm-hmm.

Dr. Tracey Marks 43:00 You assume that, um, you're gonna be, you're the focus of attention, which you're not. Everyone's not directing their attention to the door, but that's what it feels like.

Mel Robbins 43:08 But you know that moment, though, when you do walk in and everyone turns and they're like... (laughs)

Dr. Tracey Marks 43:14 (laughs)

Mel Robbins 43:14 And then they look back, you know? And for, if you're listening, I literally just turned around and then turned and gave Dr. Marks that kind of like blank look that's not very warm, and then you feel like they look you up and down and then they turn back and you go (gasps) . Like, so how... Like, that's a very real experience that we've all had.

Dr. Tracey Marks 43:34 It is, and it's based on your assumptions. So the non-socially anxious person could have that happen and just think, "Oh, they looked and they saw that it, I wasn't the person they were looking for and they turned back around."

Mel Robbins 43:46 Hmm.

Dr. Tracey Marks 43:47 The socially anxious person could say, "They don't like what I'm wearing," or, "They hate that I'm here."

Mel Robbins 43:54 Hmm.

Dr. Tracey Marks 43:54 Or they're like, "Why was she invited?" Like, that's the assumption that the socially anxious person makes.

Mel Robbins 44:01 Got it.

Mel Robbins 44:02 So in that scenario, how do you use the tools to stop yourself from accelerating the situation and separating yourself from the sensation you feel versus running yourself over with an anxiety response?

Dr. Tracey Marks 44:15 (laughs) Right. So there's kind of two branches to this.

Mel Robbins 44:19 Okay.

Dr. Tracey Marks 44:20 One takes a lot of self-discipline and some work behind the scenes before you get to that situation.

Mel Robbins 44:27 Okay.

Dr. Tracey Marks 44:27 Of changing your, your mindset about what other people are thinking, um, recognizing that you're making assumptions, you, you've got a lot of negative self-talk, working on your negative self-talk to be able to accept that... Like for example, accept that people, it's not about you, things like that. Um, and then the second part is addressing the physical sensations that you have in that scenario. So again, this is all, like, homework to do to be able to build these tools for yourself for what works for you, because what works for one person may not work for the other. So it could be... I love the vagal maneuvers.

Mel Robbins 45:12 Okay, what's that? That sounds complicated.

Dr. Tracey Marks 45:14 It does. (laughs)

Mel Robbins 45:14 A bagel maneuver. Okay.

Dr. Tracey Marks 45:15 Vagal maneuver.

Mel Robbins 45:16 Is that when you raise your hand and go, "Bartender, right over here"? (laughs)

Dr. Tracey Marks 45:20 (laughs) So your vagus nerve, it's what's responsible for the step-on-the-brakes response of calming you down.

Mel Robbins 45:29 Mm-hmm.

Dr. Tracey Marks 45:29 The parasympathetic nervous system. And there's things that you can do to trigger it, to trigger a calming response. So things like, um, cold exposure, splashing cold water on your face or chest. Now, you may not be able to do that after walking into a networking meeting.

Mel Robbins 45:45 Right.

Dr. Tracey Marks 45:46 Um, humming. You still may not be able to do that-

Mel Robbins 45:48 Hmm.

Dr. Tracey Marks 45:48 ... when walking into a networking meeting. (laughs) But that activation of your vocal cords is something that then, because of the proximity or the closeness of your, your vocal cords to your vagus nerve-

Mel Robbins 46:00 Uh-huh.

Dr. Tracey Marks 46:00 ... stimulates it and that could... And that's why you see people, um, meditating and making that humming, that oom sound.

Mel Robbins 46:09 Yeah.

Dr. Tracey Marks 46:09 It's to stimulate their vocal cords. Breathing is something you can do if you're wor- walking into a networking meeting, because it's something you can do privately. And so it's not just, "Oh, just breathe." There's certain types of breathing patterns-

Mel Robbins 46:23 Yep.

Dr. Tracey Marks 46:24 ... that you can employ that are calming. Two classic ones are the box breathing, where you inhale for four seconds or a count of four, you hold it for four, then you exhale for four, and then you hold that for four. Now, some people don't like that, aren't able to do it as well. I know sometimes it could trigger hyperventilation for me, 'cause I can feel like, "I'm not breathing." So there's other types of breathing. I'll, I'll give you two more. One is a four, seven, eight breathing pattern. So you inhale for four, hold for seven seconds, and then exhale for eight, and that longer exhale really is stimulating for the, your vagus nerve.

Mel Robbins 47:10 Well, what I love about this is, is you're starting to really cement this theme that there are always gonna be things in your life that trigger the pit in the stomach or make your heart race or that make you jump up into your head and start going, "What if this, what if that, what if they're saying that?" That is something that is just what we all need to learn to live with, but whether or not you hit the accelerator and you run yourself over and allow anxiety to just flood you is within your control.

Dr. Tracey Marks 47:44 Yeah. And, and if you're not into the counting, just breathing in deeply, slowly, and exhaling slowly, even that is helpful. Because again, when you're tense, you're breathing fast and shallow.

Mel Robbins 47:59 You know, Dr. Marks, um, Alyssa's question about the, the fear of throwing up and just the idea of it making somebody anxious, we get flooded in the inbox with questions about this. Based on your 25 years of clinical experience as a psychiatrist, what are mind tools, body tools, and behavior tools that you can use to help yourself manage anxiety?

Dr. Tracey Marks 48:30 Okay. So I'm gonna talk about, um, the tools and then there's lifestyle stuff.

Mel Robbins 48:37 Oh, okay.

Dr. Tracey Marks 48:38 Okay? So the tools are things that are kind of like based on cognitive behavior therapy that could help you, um, manage your anxiety. Mind tools, that's just kind of how I broke these things up, but the mind tools are things like, um, grounding exercises. A simple one is, you know, counting or looking in a room and picking out a color and naming all of the things in the room with that color. What does that do? That takes you out of the moment of, "What about this and what about that?" And brings you into the present moment-

Mel Robbins 49:15 Hmm.

Dr. Tracey Marks 49:15 ... of experiencing the colors in the room.

Mel Robbins 49:18 Excellent. What's a behavioral tool that you could use?

Dr. Tracey Marks 49:22 A behavioral tool would be something like coloring. Now, that's not something that you would do at the networking meeting.

Mel Robbins 49:28 Yeah. (laughs)

Dr. Tracey Marks 49:29 (laughs)

Mel Robbins 49:29 (laughs) Depends how boring it is.

Dr. Tracey Marks 49:31 Yeah, (laughs) exactly. But that would be something that you would do on your own to help bring down the level of tension and anxiety in general.

Mel Robbins 49:41 Got it.

Dr. Tracey Marks 49:42 So, um, an- another behavioral tool would be like the interoceptive exposure that I talked about, or any kind of exposure. So, let's say that, um, if you know that you have got to attend networking meetings-

Mel Robbins 49:54 Mm.

Dr. Tracey Marks 49:55 ... but they make you want to throw up every time-

Mel Robbins 49:57 Uh-huh.

Dr. Tracey Marks 49:57 ... you get ready to walk in the door, you can kind of create a list of little steps that can get you to, um, being able to go into a networking meeting and feel comfortable. So, it starts with showing up at the place.

Mel Robbins 50:12 Hm.

Dr. Tracey Marks 50:13 Then it could be, um, being able to walk into a room, and you don't have to say anything, just be able to walk into the room and manage that level of anxiety. Then the next step could be actually being able to walk into the room and go talk to one person. Then, you know, and so on and so forth.

Mel Robbins 50:30 Yeah.

Dr. Tracey Marks 50:30 You kind of build out this gradual exposure, um, to the thing that makes you anxious, which ultimately would be walking around from person to person and- and talking about stuff spontaneously. So, get good at the first steps of just being able to walk into the room, and you just gradually build your confidence and you desensitize yourself, uh, to these threatening things that then they become less threatening for you.

Mel Robbins 51:00 So, you're basically saying if you're somebody that has a fear of throwing up, you can have that fear and still get on the plane. You can have that fear and learn how to go to the networking meeting. You can have that fear and do a sleepover or go to work, or... Because the fear may never go away, but you can learn how not to accelerate in those situations where you notice you're a little worried about it. Is that a fair way to say it?

Dr. Tracey Marks 51:33 That's a fair way to say it.

Mel Robbins 51:34 You know, I- I- I recently started thinking about anxiety as a moment where there's something that you fear or you're uncertain, and then you doubt your capacity to handle it. And I'd love to hear you reflect on that.

Dr. Tracey Marks 51:52 So, this is where the exposure really reinforces that you do have the capacity-

Mel Robbins 51:58 Hm.

Dr. Tracey Marks 51:59 ... to handle it, and when you take that away, that reinforcement away by avoiding it, then you can't remember that you can actually do this. And so, again, going back to exposing yourself, you're not just trying to jump right in and say, "Okay, I'm gonna go to this, you know, place," and e- let's say you fear throwing up in a public place, "I'm just gonna just jump in and hope for the best."

Mel Robbins 52:27 (laughs) Yeah.

Dr. Tracey Marks 52:29 Instead, you take little steps toward getting to that ultimate place.

Dr. Tracey Marks 52:36 I mentioned the lifestyle stuff-

Mel Robbins 52:37 Oh, please. Yes.

Dr. Tracey Marks 52:40 ... as well. Because one of the biggest ways we can change how we manage anxiety or how it manages us is our lifestyle choices. Those things really do matter.

Mel Robbins 52:51 Mm-hmm.

Dr. Tracey Marks 52:51 And probably the biggest ones: sleep, diet, and exercise. And every time I talk about these things, I always kind of feel like I have to brace myself for the person saying, "Yeah, yeah, yeah, I know that." But really, it really does matter.

Mel Robbins 53:07 Why?

Dr. Tracey Marks 53:07 Because ev- all these little habits rewire our brain-

Mel Robbins 53:13 Hm.

Dr. Tracey Marks 53:14 ... in either a negative way or a positive way. So, just taking diet, um, diet with high sugar content, which I'm guilty of, um, heavily processed foods creates inflammation in your body. It changes the constitution of your- your gut bacteria, and inflammation and things send negative signals to the brain that then make it harder to manage anxiety.

Mel Robbins 53:41 So, eating too much sugar and ultra-processed foods actually increases your anxiety?

Dr. Tracey Marks 53:46 Yes.

Mel Robbins 53:47 Wow.

Dr. Tracey Marks 53:47 And you know how?

Mel Robbins 53:49 No.

Dr. Tracey Marks 53:50 It increases anxiety because those behaviors send signals to the brain, they actually change your- the way your genes express themselves. It's called epigenetics.

Mel Robbins 54:03 Mm-hmm.

Dr. Tracey Marks 54:04 It's kind of a new topic. And so it can make anxiety worse if it affects like the genes that express cortisol production by making it overactive or underactive. So, I think that, you know, for years we've known that these things are helpful but didn't really understand how they're helpful, and these behaviors really do make a difference. Sleep. If you go without sleep, sleep deprivation makes anxiety worse at baseline. So, it's more than just-

Mel Robbins 54:34 Why does it make it worse if you don't get enough sleep?

Dr. Tracey Marks 54:38 There's a lot that goes on during sleep.

Mel Robbins 54:40 Mm-hmm.

Dr. Tracey Marks 54:40 And so just like we have to plug in our phones in order for it to work, our- our b- brains and body need a rest, because when we're sleeping there's lots of, um, regenerative functions and things that happen, and when the- when we don't have enough time for our body to kind of take what we learned during the day, file it away, then you end up with just too much... You end up with the information overload and having trouble processing it.

Mel Robbins 55:07 Got it. It's almost like, as I'm listening to you, I'm thinking about how much sense that makes, because if you don't get the rest you need and you wake up weary, everything around you is gonna feel like a threat.

Dr. Tracey Marks 55:20 That's right.

Mel Robbins 55:21 And what was the third one?

Dr. Tracey Marks 55:23 ... exercise.

Mel Robbins 55:24 Exercise?

Dr. Tracey Marks 55:24 Mm-hmm.

Mel Robbins 55:24 Okay. So how does-- how does not exercising make you more anxious?

Dr. Tracey Marks 55:29 Exercise, it's probably better to think of it as how exercise reduces anxiety.

Mel Robbins 55:34 Okay.

Dr. Tracey Marks 55:34 So, exercise increases brain-derived neurotrophic factor, BDNF, which is a protein that is responsible for regenerating nerves, repairing bad nerve connections. It's the very thing we want to be thriving and it's like fertilizer for the brain. Okay. So exercise increases the amount of BDNF we have to then be able to rewire, um, to allow the- the good habits that we develop to make a difference in our brains. If you don't have that, then you're k- just kind of left with your baseline of what you're- what you're stuck with. So, it's more about enhancement-

Mel Robbins 56:22 Hmm.

Dr. Tracey Marks 56:22 ... than it is about fixing.

Mel Robbins 56:24 Got it. This makes so much sense.

Dr. Tracey Marks 56:27 It all makes sense. If you just understand, if you just understand how your brain works, then you can build a system around yourself to overcome these challenges and turn them into strengths.

Mel Robbins 56:40 You know, one thing that I'd love to talk to you about is the connection between ADHD and anxiety seem to be this thing that goes hand in hand. And I remember when our son, Oakley, was in the fourth grade, he came home from school and he had these, like, bruises on his hands, and I was so upset because I thought he had gotten into a fight at school. And I asked him, "Oak," like, "What- what happened? What happened?" And he- he- he couldn't remember. Well, long story short, it turns out that he had undiagnosed dyslexia, dysgraphia, and ADHD, and it was now the fourth grade, and so everything was crashing around him, and he was apparently sitting in class wringing his hands to the point where he had bruised his own hands. And when we took him in to see a, you know, a- a doctor, they were saying, "Oh, it's anxiety." And it wasn't until... And that's what got diagnosed first, and then when we went and got all kinds of evaluations done, it turned out there were lots of other things going on. And if I look at my own history, I was diagnosed with anxiety in my high school years, and the underlying issue, I believe, was undiagnosed ADHD. I was treated for anxiety for decades, and it wasn't until I was diagnosed with ADHD at the age of 47, like the majority of women are when their kids are going through the diagnosis, and you start to go, "Well that seems a l- very familiar."

Dr. Tracey Marks 58:21 Mm-hmm.

Mel Robbins 58:22 That seeing the issue of ADHD for the first time was absolutely life-changing and helped me- helped me personally separate those two things. But when I think about anybody that I know that has ADHD, they always talk about anxiety and vice versa. And so, what is the connection between these two things?

Dr. Tracey Marks 58:43 Sure. So yeah, they're very interconnected, kind of a bidirectional relationship, meaning one can affect the other. So, absolutely, ADHD can cause what we would consider like a secondary anxiety. So, it kind of derives from ADHD. And if you think about it, um, just the sheer disorganization of thought can make you feel out of control and therefore then create anxiety about your ability to just even, like, hold it together, to be able to perform, be productive, all of these things.

Mel Robbins 59:19 It's sort of like its own type of performance anxiety.

Dr. Tracey Marks 59:22 It is, like it's own-

Mel Robbins 59:23 You know what I... I- I used to beat th- myself up chronically because I constantly forgot people's birthdays. But I resonate with that, because when you have trouble directing your attention and staying on top of details, you do feel like you're not on top of things. You do feel like you're screwing up. And it does create this sense that there's something wrong with you.

Dr. Tracey Marks 59:49 Mm-hmm. Yeah. The- really the lack of control over your own thoughts and behaviors.

Mel Robbins 59:54 Mm-hmm.

Dr. Tracey Marks 59:56 Um, so another thing that's kind of key with ADHD though is... So you've got the standard, um, inattention, hyperactivity, and impulsivity-

Mel Robbins 1:00:08 Okay.

Dr. Tracey Marks 1:00:08 ... that's kind of classically defines ADHD. But then you've got the executive dysfunction. Executive functions are things like, um, time management, organization, working memory, the ability to keep things top of mind for easy retrieval later.

Mel Robbins 1:00:28 Did my husband call you before this-

Dr. Tracey Marks 1:00:29 (laughs)

Mel Robbins 1:00:30 ... and ask you to have an intervention with me, Dr. Marks?

Dr. Tracey Marks 1:00:34 I'm not telling. (laughs)

Mel Robbins 1:00:36 (laughs)

Dr. Tracey Marks 1:00:37 So, those activities or those- those abilities are controlled by the prefrontal cortex-

Mel Robbins 1:00:44 Mm-hmm.

Dr. Tracey Marks 1:00:44 ... front part of the brain. With people with ADHD who have, um, low levels of dopamine in that area, they have less ability to control those functions. So, e- emotion regulation is an executive function.

Mel Robbins 1:01:01 It is?

Dr. Tracey Marks 1:01:02 It is.

Mel Robbins 1:01:03 Well, that explains a lot.

Dr. Tracey Marks 1:01:05 It explains a lot.

Mel Robbins 1:01:06 So, are people that have ADHD tend to be more emotional?

Dr. Tracey Marks 1:01:11 Emotional. Yeah. So if you've got something that would ordinarily cause some level of anxiety, it can just... It can escalate in the person with ADHD because they have less ability to rein it in.

Mel Robbins 1:01:26 That makes so much sense. So what are the key differences between ADHD versus anxiety? Because I've, you know, I've heard ADHD described as, you mentioned the prefrontal cortex and executive functioning. It's like the conductor in the brain that is basically going, "Tap, tap, tap. Uh, string session. Like you guys, sh, sh, sh, sh, sh." And then lifting up this group over here, the percussion. "You can come on now." The ability to kind of direct your attention. That switching feature doesn't really work that well.

Dr. Tracey Marks 1:02:02 Yeah, so one more thing about the relationship. With, um, ADHD, because it ... The prefrontal cortex, yes, being the brain's CEO and the conductor. It will manage the amygdala, which is our fear center.

Mel Robbins 1:02:18 Mm.

Dr. Tracey Marks 1:02:18 If it is compromised, like with ADHD, it won't be able to manage the amygdala as well, so the amygdala can hijack its control and then turn everything into something to be afraid of and, and convince you that you have got to worry about the worst case scenario.

Mel Robbins 1:02:41 We, I, yeah, I, I can't believe we're talking about this because I l- learned for the first time last week, talking to my therapist, who's changed my life, Anne, shout-out Anne Davin, where she was basically saying there's a huge connection between ADHD and actual rumination and spiraling thoughts because you can't pull your attention off of the worst case scenario. You know, I mentioned earlier getting this email from somebody who's miffed at me about something, and I bet I probably wasted three hours because I could not direct my attention to something else. I would try to and I'd be like, "Nope, let's think about that over here." And so that makes so much sense why these are so related to one another. Dr. Marks, do you have any, uh, thoughts on what seems like a huge surge of people getting diagnosed later in life with ADHD, which was the case for me and a lot of my female friends?

Dr. Tracey Marks 1:03:37 Um, I just wanna say, I do think that there's a misconception though that people, more people have ADHD this day and time and that everybody's got it, uh, or that it's overdiagnosed.

Mel Robbins 1:03:52 Mm.

Dr. Tracey Marks 1:03:52 I think what's happening is that there's more education about it and a more appreciation for it, and therefore, a greater detection of it. Even when I was in residency 25 years ago, adult ADHD was just kind of quasi appreciated. In fact, it was kinda seen as something that's not real.

Mel Robbins 1:04:13 Right.

Dr. Tracey Marks 1:04:13 It's, it's a, it's a disorder in children. So over time, we've come to recognize adult ADHD as its own entity that is real. It's not just adults seeking performance enhancement.

Mel Robbins 1:04:27 Mm-hmm.

Dr. Tracey Marks 1:04:28 That said, um, I think there are societal factors that affect people being diagnosed with it. You know, it's just, uh, hyperactivity could be bad behavior. Um, uh, resistance to even seeing something mental as something that needs attention. But I'm just saying all that to say, I think we've evolved-

Mel Robbins 1:04:49 Yeah.

Dr. Tracey Marks 1:04:49 ... when it comes to seeing mental health as a real thing to pay attention to and prioritize, but it's been a long haul that way and there's still a lot of remnant, um, n- uh, bias against it. It's easy to just kind of write it off as, "Well, you know, these are just quirks or something about you."

Mel Robbins 1:05:08 Right, right. Or, "Everybody's distracted. You don't have ADHD."

Dr. Tracey Marks 1:05:11 Yeah.

Mel Robbins 1:05:11 That's what I hear a lot. Like, can you explain, and I think it would be helpful, to really just put the nail in the coffin on this one, because there is sort of that eye roll. "Oh, you have ADHD too? Everybody's distracted." There's a big difference between just being distracted because of the world that we live in versus what it actually feels like day to day to be somebody that does have ADHD as a diagnosed condition that you're dealing with, or an undiagnosed condition that you don't know that you're dealing with. So can you walk us through what a day might look like for somebody who is going through their day and they may not realize they have ADHD?

Dr. Tracey Marks 1:05:57 Sure. So,

Dr. Tracey Marks 1:05:59 I will say, it really is on a spectrum.

Mel Robbins 1:06:01 Mm-hmm.

Dr. Tracey Marks 1:06:02 Because, again, I'll use myself as an example.

Mel Robbins 1:06:05 Have you been diagnosed with it?

Dr. Tracey Marks 1:06:06 I was treated as a child, more for hyperactivity though, but yeah, I was treated as a child for ADHD, and as an adult, I still have trouble owning it because I feel like, of all the people I've treated, and I look at my son and my husband, I'm like, "I'm not like them, so I can't really have this."

Mel Robbins 1:06:25 (laughs) What?

Dr. Tracey Marks 1:06:26 (laughs)

Mel Robbins 1:06:26 You're sitting here as a psychiatrist-

Dr. Tracey Marks 1:06:29 (laughs)

Mel Robbins 1:06:29 ... telling me that you don't like the diagnosis that you have been given-

Dr. Tracey Marks 1:06:34 (laughs)

Mel Robbins 1:06:34 ... because you look at your husband and your son and are like, "I'm not like those losers."

Dr. Tracey Marks 1:06:39 (laughs)

Mel Robbins 1:06:39 I knew I loved you. Oh my God, Dr. Marks. Even though you've been diagnosed with it, you're like, "I can't possibly have that."

Dr. Tracey Marks 1:06:45 I still have trouble accepting that. Well, I don't, I just think I'm one of those adults who's grown out of it, but I know that I haven't and the reason is because- (laughs)

Mel Robbins 1:06:55 I love you.

Dr. Tracey Marks 1:06:55 I still, I recog- What it is is I recognize what my weaknesses are.

Mel Robbins 1:06:59 Okay.

Dr. Tracey Marks 1:06:59 So I'm a slow reader, so I could not have a job where I had to, like, put down a book every week. That, I just wouldn't work in that kinda situation. So, um, and I have trouble s- s- what we call sh- set shifting.

Mel Robbins 1:07:14 What's that?

Dr. Tracey Marks 1:07:14 So it's going from one task where you're into it, and then you gotta stop and go do something else.

Mel Robbins 1:07:20 Oh my God, I say this to my team all the time. I'm like, "If we are gonna do a production day, I will tape for nine hours straight, but the second you put me in a meeting-"... and I have to look at copy, or if I have to change something on my phone, you call this set switching?

Dr. Tracey Marks 1:07:35 Yes.

Mel Robbins 1:07:35 And I go into a different mode, I can't go back to taping.

Dr. Tracey Marks 1:07:40 That's right. That's right. So someone who doesn't have trouble with that can, like, work and then, "Ooh, there's a meeting. Okay, I'll stop, pick up, go to this meeting. Okay, that meeting's over. Okay, go back and jump right back in." No. So I will have, like, I don't see patients on Fridays, and that's days that I kind of do business-related things.

Mel Robbins 1:07:59 Do you actually get anything done? Like, I get something done for, like, the first hour, and then I'm realizing I have a Zoom call and I get nothing else done.

Dr. Tracey Marks 1:08:05 That's what ha- exactly what happens. So if I've got to take my mom to a doctor's appointment-

Mel Robbins 1:08:09 Uh-huh.

Dr. Tracey Marks 1:08:10 ... in the middle of the day, I know that that day is gonna be completely wasted for me. And other people will say, "Well, you had two hours before the appointment and two hours aft- so what's the problem?" That interruption will just ruin my whole day.

Mel Robbins 1:08:23 And is that have to do with the dopamine and the prefrontal cortex being able to direct different parts of your... Is that what that is?

Dr. Tracey Marks 1:08:30 That's what that is. So-

Mel Robbins 1:08:31 No way.

Dr. Tracey Marks 1:08:32 And, and so someone with ADHD, um, one misconception is you can't focus at all, and it's not only about focusing, because people with ADHD can hyperfocus on things that they're interested in.

Mel Robbins 1:08:44 Mm-hmm.

Dr. Tracey Marks 1:08:45 It's a stimulation issue.

Mel Robbins 1:08:47 What does that mean?

Dr. Tracey Marks 1:08:48 That means that the ADHD brain, um, needs stimulation to stay engaged in something.

Mel Robbins 1:08:56 Okay.

Dr. Tracey Marks 1:08:56 So it has to be something that can- that commands your attention and keeps your attention, and as soon as there's boredom involved, then you're gone. You know?

Mel Robbins 1:09:06 Okay, so I wanna see if I can unpack this. So your brain needs stimulation to pay attention if you're somebody that truly struggles with this issue of ADHD. And so I'm thinking about the example that absolutely all of us can relate to, where you have somebody in your life who is, can literally rot away in front of a video game for two days, and n- and you walk into the room and they don't even break their stare, they're so hyperfocused. But then getting them to put their dirty clothes in the laundry basket, or remember to do the homework, or shut the refrigerator door, or put their shoes somewhere other than the middle of the hallway, it, it's, it's just you don't even understand why they're like this, because you've seen them focus on something, so that must mean they're just a world-class jerk in every other area of their life because you're not seeing that level of attention to detail in other areas. And so we presume that the person doesn't care, or that they're rude, or that they're aloof, and what you're saying is, "No, no, no, no, no, the ADHD brain really requires some form of stimulation." Is that where the dopamine comes in?

Dr. Tracey Marks 1:10:29 That's where the dopamine comes in, and the, the whole reward circuit.

Mel Robbins 1:10:32 Okay.

Dr. Tracey Marks 1:10:32 So because of the lower levels of dopamine, then you can struggle-

Mel Robbins 1:10:36 Okay.

Dr. Tracey Marks 1:10:37 ... on staying engaged and paying attention to things that don't interest you.

Mel Robbins 1:10:41 Well, you know, what's interesting is that this makes sense because, you know, if I think about what I've heard a lot of people say and what I've struggled with, is like, if you literally wake up in the morning if you have ADHD, and you grab your phone, and then you look at social media, you've just flushed your dopamine that you needed for the attention during the day right down the toilet, and now you're gonna struggle to gain it back because you wasted it on something really stupid. And understanding that you need that dopamine to focus, that's a really important thing to understand.

Dr. Tracey Marks 1:11:17 Absolutely. And, you know, the thing you were talking about with the leaving stuff in the middle of the floor and making it look like they're just a jerk, they don't care, is why people with ADHD can have relationship problems, a lot of relationship problems, because the, the non-ADHD person can feel like the person doesn't care. It's like, "You don't see this tennis shoe in the middle of the floor? You just stepped over it. How did you miss, how were you missing that? Do you not care about our house looking good?" But it's not that they don't care, it's just not on their radar.

Mel Robbins 1:11:48 And also, because if they've also blasted through their dopamine by being on social media first thing, or playing video games, or whatever, they don't have the stimulation that they need in order to focus on these things that are not that interesting. It's so, that- that- that is so helpful to understand this. I mean, when I think about some of the just nutso things that I do because of my ADHD, I have lists everywhere, I leave cabinet doors and faucets running all the time, cabinet doors open. I also do this thing on social media where I have extensive folders of things that I've saved, thinking that at some point in the future, I will go back and organize them all. I haven't looked at 'em once. I mean, and I just obsessively do this. I'm constantly running late because I have this weird time expansion thing that happens to me, where I feel like I can get 25 things done in exactly three minutes. It, it just makes me crazy because I know that I can focus on other areas, so it seems so weird that I can't just fricking make myself do it.

Dr. Tracey Marks 1:12:56 And-

Mel Robbins 1:12:56 Talk to me, Dr. Marks.

Dr. Tracey Marks 1:12:57 (laughs) Well, the thing is, it would be great if you could control what gets your attention enough to be able to stay engaged, but you can't always do that. Now, you could exploit that if you knew, if you're self-aware enough to know that these are the things that I know I can lock into and these are the things that are not, so I'm gonna try and minimize how much of those things that I have to do, or get help with those, or whatever.

Mel Robbins 1:13:20 Mm-hmm, got it. It's so fascinating. You know, you have unbelievable content on your YouTube channel that...... are all about the overlooked signs and symptoms that people don't realize are symptoms of

Mel Robbins 1:13:37 ADHD and anxiety, and I would love to have you talk about body picking. What is body picking and why do people do it?

Dr. Tracey Marks 1:13:46 Yes. So, um, body picking, the technical term is body focused repetitive behaviors, and it really is its own disorder that mainly is, um, skin picking and, um, hair pulling, and those things can become really problematic for people.

Mel Robbins 1:14:06 So, is hair pulling like when you see somebody constantly, like, twirling their hair and splitting the ends and doing stuff like this? Is that what you mean?

Dr. Tracey Marks 1:14:13 Yeah. Well, so for the compulsive disorder of the body focused repetitive disorders, people can actually, like, pull it out from-

Mel Robbins 1:14:22 Ouch.

Dr. Tracey Marks 1:14:22 ... their, the root, and part of the, like, pleasure of it is actually that pulling it out from the root.

Mel Robbins 1:14:29 Oh my gosh.

Dr. Tracey Marks 1:14:29 So, it's not really splitting.

Mel Robbins 1:14:30 Okay.

Dr. Tracey Marks 1:14:30 But for people... So, there's, there's that.

Mel Robbins 1:14:33 Right.

Dr. Tracey Marks 1:14:33 That's compulsive disorder. But a, kind of a lower level of that-

Mel Robbins 1:14:36 Yes.

Dr. Tracey Marks 1:14:37 ... is general, um, body behaviors that can also include nail biting and, uh, cuticle biting, biting the inside of your cheek.

Mel Robbins 1:14:47 Wait, so nail biting and biting or picking at your cuticles or around your fingers is, is a form of anxiety? Is like a symptom of anxiety?

Dr. Tracey Marks 1:14:57 It can be.

Mel Robbins 1:14:58 Really?

Dr. Tracey Marks 1:14:58 So, people with anxiety can do it to relieve tension and be self-soothing. People with ADHD can do it for stimulation.

Mel Robbins 1:15:10 Why is nail biting and skin picking something that people with ADHD do?

Dr. Tracey Marks 1:15:16 Because the ADHD brain needs stimulation, and this provides sensory input for the brain. So, you could have someone who's, say, studying or watching television-

Mel Robbins 1:15:29 Uh-huh.

Dr. Tracey Marks 1:15:29 ... and they may kind of enjoy what they're watching, maybe, maybe not, but they can kind of get into this trance state of just kind of pulling, picking, or whatever that's stimulating their brain and keeping it active.

Mel Robbins 1:15:42 So, if you're somebody that struggles with nail biting, Dr. Marks, what, what do you recommend somebody do?

Dr. Tracey Marks 1:15:49 So, first of all, there's just even recognizing the habit, because some people can do it and not even really being aware that they're doing it.

Mel Robbins 1:15:57 Okay.

Dr. Tracey Marks 1:15:57 And then when you add on the, the time blindness or time expansion that you mentioned-

Mel Robbins 1:16:02 Oh, with ADHD?

Dr. Tracey Marks 1:16:03 ... with ADHD, you can think you're just doing it for a minute, and it was really 45 minutes that you were doing that thing, and now you've got sores or you've got bald spots. So, what... So, first, there's just the awareness of it, of what it is you're doing, and then being aware of any triggers that make you do it or that make it worse. It can be anxiety can make it worse, boredom can make it worse.

Mel Robbins 1:16:28 Mm-hmm.

Dr. Tracey Marks 1:16:29 Then, putting other things in place, we call it habit reversal. Um, putting other habits in place to replace these more destructive habits. Um, someone who, um, you know, picks their nails or bites their cuticles could either put on gloves. Like s- let's say you notice that you do this while you're watching television a lot.

Mel Robbins 1:16:51 Mm-hmm.

Dr. Tracey Marks 1:16:52 You could put on gloves while you're watching television. You don't need to walk around for your whole life with gloves, but just during these times.

Mel Robbins 1:16:58 And, and if you were to wear the gloves for a couple months, does that train you to stop doing it? Is that what's happening?

Dr. Tracey Marks 1:17:06 It trains you to stop. It, it breaks the cycle, because if you, if you go back to the idea of this being like a, a semi-automatic thing that-

Mel Robbins 1:17:16 Mm-hmm.

Dr. Tracey Marks 1:17:16 ... you engage in-

Mel Robbins 1:17:17 Mm-hmm.

Dr. Tracey Marks 1:17:17 ... it helps break that semi-automatic thing so that you have more intentional behaviors. So, while I'm watching television, instead of me biting my cuticle- cuticles or picking my nails, I am, I'm doing this other thing.

Mel Robbins 1:17:31 That makes sense because-

Dr. Tracey Marks 1:17:33 Mm-hmm.

Mel Robbins 1:17:33 ... I would imagine people do it almost as like a soothing technique. You know, I have another question from my son.

Dr. Tracey Marks 1:17:39 Okay.

Mel Robbins 1:17:39 That I would love to play for you.

Guest caller 1:17:42 Um, and then I have one more question for you, and then this one, this one's a good one. Um, whenever I get anxious, I like, I normally, like, uncontrollably shake my hand like this, or, like, I go like this, like I do a little snap. Uh, isn't that cool? Um, but it's a lot of like shaking, and it's something that I do completely unconsciously at this point, and I was curious what you might think about that too. Um, let me know. Thank you so much. Um, you're amazing. The work you do is incredible. You help so many people, and we are so lucky to have you. Thank you.

Dr. Tracey Marks 1:18:18 All right. So, um, so yes, he spoke to exactly what we were just talking about, the unconscious nature, and not unconscious in the sense that you're not a- awake, you're not aware.

Mel Robbins 1:18:28 Mm-hmm.

Dr. Tracey Marks 1:18:28 So, it's beyond your awareness that you're doing this soothing thing. So, there's nothing inherently wrong with doing things that are self-soothing. It becomes an issue when it either causes problems for you for some reason, like you're pulling out your hair, or, you know, um, destroying your upper lip or bottom lip because you're biting, or it's socially unacceptable. So, yeah, he can't go places doing this when he starts to get anxious. So, it's about finding other self-soothing things. Either... So, twofold.

Mel Robbins 1:19:00 Okay.

Dr. Tracey Marks 1:19:00 One is reducing the... finding things that reduce his anxiety, and that could be, you know, the breathing or something, uh, vagal.

Mel Robbins 1:19:12 Oh, so for example, if he catches himself shaking and he gets to a point where he's like, "This is something that I'd like to stop doing, like, that I'm not aware that I'm doing."

Dr. Tracey Marks 1:19:26 Mm-hmm.

Mel Robbins 1:19:27 Then in moments where he catches himself doing it, so going back to this kind of metaphor of the response happens.That's not what we're focused on, we're focused on not stepping on the accelerator. He might then go, "Okay, I'm, clearly something's making me feel a little unsettled. Let me, let me do a breath." And so he's now catching that he's shaking and he's teaching himself to take his foot off the gas and to step on the brake.

Dr. Tracey Marks 1:19:53 That's right.

Mel Robbins 1:19:54 Oh, wow! And then just like some of the other examples of you're putting gloves on while you watch TV so you don't destroy your finger beds, um, or bite your nails down until they're bleeding, that you are now teaching yourself to stop doing that thing subconsciously in situations where you might feel bored or lonely or nervous about something.

Dr. Tracey Marks 1:20:19 Absolutely. 'Cause a, the biggest step here is the awareness part.

Mel Robbins 1:20:23 Yes.

Dr. Tracey Marks 1:20:24 Because, yeah, a lot of times these things just happen automatically, you're not even aware that you're doing it or you're not aware that you're doing it for as long as you're doing it.

Mel Robbins 1:20:32 Dr. Marks, what would you, uh, say to somebody who is struggling with body picking and it's really challenging and impacting their life?

Dr. Tracey Marks 1:20:43 Yes. So if it's really severe, I think they should seek professional help from, like, a therapist to help them develop some kind of s- uh, like habit reversal therapy to get them to be able to not be able to do this. Sometimes medication is what someone needs to reduce their anxiety, s- especially if they're engaging in a way that's really destructive.

Mel Robbins 1:21:07 Since we're on the topic of repetitive behavior, what is the relationship between ADHD and tics? And what is a tic?

Dr. Tracey Marks 1:21:15 Yeah, so a tic is, um, an involuntary, usually sudden, rapid, uh, behavior that can either be motor or vocal.

Mel Robbins 1:21:28 Okay.

Dr. Tracey Marks 1:21:29 It can be its own thing, so something like Tourette's syndrome involves tics, but not all tics are Tourette's syndrome. Motor tics would be things like, um, grimacing or blinking your eyes or, uh, my son used to do this thing where he'd open up his mouth real wide when (laughs) he'd get, uh, really anxious. Um, vocal tics would be things like sniffing, um, or coughing, clearing your throat a lot, um, or even saying things, that's kind of the television version of it is people yelling out obscenities. Um, so as I mentioned, tics, anyone can have tics and they can come and go.

Mel Robbins 1:22:16 Are they self-soothing? Is it another form of what we've been talking about or is it a different thing?

Dr. Tracey Marks 1:22:21 It's a different thing. It's not self-soothing, it's usually just, um, a response to anxiety. They're usually made worse by anxiety.

Mel Robbins 1:22:30 Mm.

Dr. Tracey Marks 1:22:31 So you get anxious and then you start doing this thing.

Mel Robbins 1:22:34 Mm.

Dr. Tracey Marks 1:22:34 Um, for the Tourette syndrome on the other hand, that's a whole different entity and that's, it can be made worse by anxiety, but it is, it's kind of its own thing self-generated from that neurological disorder. But in the example of someone with anxiety having tics or even there's just a greater, um, prevalence of people with ADHD also having tics.

Mel Robbins 1:22:57 How come?

Dr. Tracey Marks 1:22:59 I think it's related to just the biological mechanisms in the brain-

Mel Robbins 1:23:04 Yeah.

Dr. Tracey Marks 1:23:04 ... kind of sharing real estate in areas of the brain that affect both ADHD. Tics are also dopamine, um, sensitive, if you will, uh, behaviors or, or, uh, the condition is, um, related to dopamine as well.

Mel Robbins 1:23:20 So meaning when you don't have a lot of dopamine, the tic can be worse?

Dr. Tracey Marks 1:23:26 It can s- just, I guess the best way to say it without getting too complicated is it is a setup, like low dopamine levels are also associated with tics as well.

Mel Robbins 1:23:36 Gotcha. So how do you know the difference between kind of a self-soothing behavior like what Oakley was talking about with the hand shaking and the nail biting that we've discussed and what you would classify as an act, as a tic?

Dr. Tracey Marks 1:23:53 So with tics, they, they aren't self-soothing. In fact, people can have a build-up of-

Mel Robbins 1:23:59 Mm.

Dr. Tracey Marks 1:23:59 ... tension that they feel if they try and suppress it.

Mel Robbins 1:24:02 Mm.

Dr. Tracey Marks 1:24:03 So it's, it's usually involuntary, they can't help it, and if they recognize that they're doing it, like heavy blinking, say, they can try and not do it because people are around, but at some point they're just gonna have to let it rip.

Mel Robbins 1:24:17 And so what do you do if you are, s- or somebody that you love is struggling with a tic?

Dr. Tracey Marks 1:24:22 So one other thing I wanna mention about tics and ADHD is unfortunately medication, stimulant medications can also make it worse.

Mel Robbins 1:24:31 Oh.

Dr. Tracey Marks 1:24:31 So if you notice that, that would be something to address with your doctor to see if changing the medication regimen could help, because that's not something you just kind of make go away li- if it's being driven by the medication.

Mel Robbins 1:24:45 Mm-hmm.

Dr. Tracey Marks 1:24:45 Um, tics tend to also wax and wane. They can, they can go away, um, or they can come back if say you get really anxious.

Mel Robbins 1:24:57 So do the factors that you've written about in your book and that we've talked about, diet, sleep, and exercise, also have an impact on tics and also, like, in a positive and negative way?

Dr. Tracey Marks 1:25:10 So they can have... Yes, in a positive and negative way in the sense of you could think of these lifestyle factors as things to kind of, um, reduce the downstream problem.

Mel Robbins 1:25:25 Okay.

Dr. Tracey Marks 1:25:26 So these are things that you wanna do that work in the background to reduce these issues, and then the other tools we were talking about is what do you do when the issue is, arises right now?... but the lifestyle things are to get the issues from happening.

Mel Robbins 1:25:43 Why do people

Mel Robbins 1:25:44 who have ADHD and anxiety struggle with procrastination and perfectionism?

Dr. Tracey Marks 1:25:49 So, with procrastination, um, motivation is one of those executive functions that's part of the prefrontal cortex functions. And so, you have lower motivation, um, that then makes it harder for you to get started.

Mel Robbins 1:26:07 Mm.

Dr. Tracey Marks 1:26:07 But also, um, another thing that can make people, either with anxiety or ADHD, procrastinate, is having kind of a, a huge accumulation of failures, (laughs) criticisms, and, and the- therefore creating performance anxiety of, like, "Well, I don't know if I can do this, 'cause I always screw this up. So, I'm just not even gonna get started." Or it's just, "The problem's just too big. I just can't do it."

Mel Robbins 1:26:38 That makes so much sense. I mean, it ex- basically explains my college and law school careers, and leaving everything to the last night, because I would also add onto that is I'm feeling very validated by what you just said, being so disorganized, and this kind of overwhelming feeling that there's so much to do that you don't even know where to start, and then you just kinda collapse until everything's on fire and you have no choice, and then it becomes the emergency all-nighter because you have put yourself in this corner, and then you want, "I'm never doing that again," and then, of course, you do it again. So I could see how it would become a chronic problem, as it was for me. Dr. Marks, what do you recommend for somebody who is really struggling with procrastination and wants to change their behavior?

Dr. Tracey Marks 1:27:30 So one thing someone could do, um, is what I call the five-minute rule, where you give yourself five minutes to do this thing, and you give yourself permission to stop if you don't like it or stop if it's not clicking, and it's okay. But just that inaction of making yourse- or forcing yourself to get started, you may find that then you're starting to roll with it. "And this isn't that bad. Okay, I'll do a little bit more."

Mel Robbins 1:28:01 Yep.

Dr. Tracey Marks 1:28:01 If not, it's okay. You still achieved something because you got started and you broke past the procrastination. So even that's still reinforcing.

Mel Robbins 1:28:12 Terrific. Dr. Marks, if the person listening today does just one thing based on the unbelievable amount of stuff that you've taught us today, what would be the most important thing for that person to do after this conversation?

Dr. Tracey Marks 1:28:30 Only one. (laughs)

Mel Robbins 1:28:32 You can pick two or three. I'll give you that, okay?

Dr. Tracey Marks 1:28:34 (laughs)

Mel Robbins 1:28:34 (laughs)

Dr. Tracey Marks 1:28:36 So, I think number one would be shifting your mindset from looking at a condition that you have as needing to be fixed, and instead understanding it, understanding how it affects you, and putting things in place to help you manage it to improve the quality of your life. That would be the first thing. Then, I would say I think kind of the number one, um, lifestyle choice would be sleep. I think that is the most important, with diet being a close second, because again, we can talk about, you know, what do you do if... Um, in this situation, what's the tool that you can use? And there's bunches of tools. I have over, uh, 20 of them in my book. It's about finding what works for you when it comes to the tools, 'cause not everything works for everyone, but then really addressing the things like, um, sleep and diet and exercise, and coming up with an inventory of, how well are you sleeping? What's your diet like? How often are you exercising? What's missing from this? 'Cause you can go online, you can go anywhere and find out what, what's the ideal, seven to nine hours of sleep, all of that stuff. Come up with a list of the things that you need to change to improve the quality of your life, and then just, just chunk 'em out little bit by little bit. "Maybe this month I'm gonna work on setting a bedtime. Um, maybe next month I'm gonna work on reducing the number of potato chips that I eat. Um, the next month I'm gonna go on a walk in my neighborhood once a week." You know, so make it bite-sized things so that you can have small wins, and those small wins will keep... will pull you through to ultimately getting to a point where you've made big changes in your life that then ultimately, uh, affect your brain and change the way that these conditions affect you.

Mel Robbins 1:30:46 Amazing. Dr. Marks, what are your parting words?

Dr. Tracey Marks 1:30:49 (laughs) My parting words are, be patient with yourself and your own personal operating system. All of our brains are unique, and if you have struggles, you're not defective, you're just different, and that's okay. And y- if you can understand your differences, you can take control over how these differences manifest for you.

Mel Robbins 1:31:20 Dr. Marks, thank you for getting on a plane. Thank you for everything that you do to help all of