EVERY SPOKEN WORD
160 min read · 31,691 words- 0:00 – 0:25
Intro
- TCTim Clare
... but when you are on the floor having shoved a towel in your mouth to try and cover the sound of you screaming so your baby daughter doesn't hear because you don't want her to be afraid in sort of two rooms away while your wife looks after her, I think it's impossible for anyone, no matter what their relationship to masculinity, to feel diminished by that.
- CWChris Williamson
(wind blowing) What is your expertise? What gives you
- 0:25 – 7:19
Tim’s Anxiety Journey
- CWChris Williamson
license to write a book about anxiety?
- TCTim Clare
So, the awful truth is, (laughs) is, is that I was sitting down having written sort of a couple of novels and thinking, "What can I write about?" And I'd written non-fiction before, and I was like, "What am I an expert?" Well, because like you say, like when you're pitching something, whether it's like an article or a book, one of, one of the four pitch lines, you know, it's like, "This is a story about this," or, "I wanted to look into this. The reason why I'm the person to do this, and you shouldn't get a better known celebrity to do it instead, is 'cause this is my area of expertise." And I was like, "What am I an expert on?" And it was like, "Well, I'm mentally ill, like, (laughs) I guess. Like, I'm really anxious." Like, I was like, at the time, like I had a two-year-old daughter. Um, she's still, she's just older now. I still have a daughter, she's just older. But, um, and I, I was really struggling with, like, severe anxiety and panicked that was like, I was having panic attacks every week. S- sometimes I was having multiple ones a day that would, like, put me on the floor, and I'd have several a day over like a three-day period. And I was like, "This is taking... This is just like, this is unlivable." And also, you know, in my work I do doing like a creative writing podcast, I'd started to have like neuroscientists on. I'd started having psychologists on. I studied like four years of psychology back in school, but I'm not like qualified. My background is in, in writing. But I, I, I'd spoken to these guys and had some really interesting beginning talks about the brain and, you know, the differences when they put like writers in an MRI scan- fMRI scanner and stuff like that. And so I was like think... And then we signed my daughter up to a developmental s- study where they started studying her brain and the development of kids at different ages. And I got to take her in and see, they put this thing called an fNIRS on her, which is, it's like a portable scanner in a kind of skull cap. It looks like a Medusa fright wig. They stick it on her head. She looked like, uh, like, uh, well, she looked like a cross between Medusa, and this is like a very deep cut nerd reference, but like, uh, when Patrick Stewart plays like Locutus out of the Borg, she looked like one of the Borg. She had like one eye, red eye piece on that, um, tracks her vision. And I was seeing on a computer different parts of her brain lighting up, uh, because of something called the BOLD response, the blood-oxygen-level-dependent response showing different parts of her brain, uh, as different levels of demand wanted more or less oxygen. And I was like, "I'm watching my daughter think." We are at a level now where psychology and neuroscience, we can like look inside people's heads. And I'm like, "There's got to..." Like, I only get access to this because we signed up to this study, but I'm like, "There's got..." I now know I, there's researchers out there who are willing to speak to me, uh, for some reason. And I guess the reason, the thing was I just wanted to get well. And I was like, "Well, if I say I'm writing a book, these people are gonna open their doors to me."
- CWChris Williamson
They have to talk to you, mate.
- TCTim Clare
And I'm gonna be... Exactly. I'm gonna be able to grandfather myself in to speak to all these people, and then I'm gonna go like... And at the same time I'd like... Or, you know, like if you've got hay fever, everyone in your family will, like, send you emails going, "Hey, I just read this article with this..." Like, their homespun reme- remedy on how to beat hay fever, and, and, and you, you get it from people-
- CWChris Williamson
Manuka honey, yeah, you need to spread the Manuka honey over your nasals, nasal cavity or something. Yeah.
- TCTim Clare
E- e- exactly. And you'll, you'll never be short of suggestions. Well, obviously people knowing that I was really scared, I, I was never short of people making suggestions, sending me articles, and you see all these articles saying, "We... There, there's new treatment that's been found." So I was like, "I keep reading that we're like five years away from this treatment that's gonna blow it open, whether it's a new drug, uh, a new, uh, sort of, a, a, a new strategy that people are doing, you know, like, uh, I think it's social prescribing, people going for walks, forest bathing, ice baths, things like that." And I was like, "What if I just go and speak to the people? There are people who are spending their lives studying this in all different disciplines. What if I go and speak to them and then I try and do everything?" Because the other thing was I'd also read all the studies on the effect of mental illness, a parent's mental illness, on children, and how that stuff starts early and it gets passed down, and how, across a whole range of profiles, it makes kids' outcomes worse. And like stuff you'd expect, like their chance of mental illness being worse, but also crazy stuff like their chance of having asthma. And I was like, "It... This... I want my daughter to have the best chance in life she can." And like some of us can be like really down on ourselves and go like, "I can't do this. I'm not worth it." But like, the, the, the bottom line was do I think it's worth having a go at this for my daughter's sake? You know, if I don't care about myself, do I care about her? And the answer was like, "Yeah." So I was like, "I'm going to!"
- CWChris Williamson
That's one hell of a motivator, yeah.
- TCTim Clare
I know, yeah. And so that's, that's how I... So, you, you know, the short answer to your question was when I started out doing this, in terms of my qualification, I was quite smug. I was like, "I've been, I've been, I- I've been really anxious for ages. I have the worst panic attacks out of anyone I've ever encountered. I've read a lot of articles. My nan has sent me a lot of clippings." (laughs) I was like, "I'll go and speak to a couple of...... I'll speak to a couple of scientists, right? And they'll kind of sprinkle a l- like a little bit of legitimacy pixie dust on the top of it. They'll just quote stuff that I kind of already know. I'll go, "Yeah, yeah." I, I thought I'd sit in there, I'd get into their labs, I'd chat with them, and they'd tell me stuff and I'd go, 'cause of course it's this, isn't it? I'd go, "It's the m- amygdala, right?" And they'd go, "Oh, you know about that. Oh, you're a colleague." And we'd kind of, like, nod and they'd see that I was an expert. And then, and then I, and then I'd go and write my book. And it is only when I went out and started speaking to people and they're going, "No, Tim, it doesn't work like that at all." And I was like, "Oh, I'm in deep trouble. I'm in really deep trouble." And then I just went down this rabbit hole, read over a thousand peer-reviewed studies end to end, um, spoke to dozens of people, including, like, every expert that I could find in all sorts of disciplines. A- a- and by the end of it, like, w- at least what I can say is I know how little I know, if that makes sense. Like, I know how dumb I am. Like, I know what the edges of my, um, knowledge in any given discipline are.
- 7:19 – 12:23
What Does a Panic Attack Feel Like?
- TCTim Clare
- CWChris Williamson
Well, the difference is that you've got that in-the-trenches experience, you know? Like, even if it, even if it wasn't, uh, medical understanding originally, you were able to appreciate it from an ex- from an experiential standpoint, right? So what... For the people that haven't had one, how would you describe what a panic attack feels like?
- TCTim Clare
So I went to the... You c- I mean, you can get a technical answer, right? Which is you go to the DSM-5 and there's a list of symptoms, right? And you have to have, like, X number from a list of symptoms and, uh, then, then it's officially diagnosed. A psychiatrist could say, "Yeah, you've had a panic attack." Right? And I think it's, uh, just, just like a hair under 8,000 possible, like, l- acceptable combinations of symptoms you can have for a panic attack. So they're incredibly diverse. But reading the explanation of what a panic attack is, it's kind of like licking a photograph of an ice cream, right? Like describing a panic attack. I could t- I can tell you that it, it, it, it's, it feels like, it can feel like you're going mad, like you... A lot of people, especially men, don't know they've got panic disorder until they present at A&E saying they're having a heart attack. They think that they're having a heart attack, that they're having cardiac arrest. They go to A&E and the doctor's like, "No, you're ha- you're having a panic attack," because so many of the symptoms are the same. Breathlessness, what they call, like, air hunger, um, but also a feeling of, like, derealization, which is really difficult to describe until you've been through it. But you can feel like nothing's quite real, l- this sudden feeling that you're in a dream, which is also why a lot of people who are having a panic attack think they're going mad or insane. Um, your, your airways closing up. Um, dizziness, uh, h- racing heart, sweating, uh, y- trembling. Um, you might start getting pins and needles in your extremities. Your extremities might start. Um, they call that pins and needles. And your, the, your extremities might, your fingers might start going into claws, which they call tetany, um, uh, which is to do with, like, calcium deficiency, uh, as you breathe so hard. Um, you might, obviously, like, feelings of dread and fear, often terror. I mean, my panic attacks... But all of this is like, if I described, like (laughs) , you know, they call it, they, you know, they'll call it in the literature, they'll say a panic attack is like this feeling of sudden dread and fear accompanied by extreme physiological symptoms, which is a bit like calling, like, being kicked in the balls, like, a, a sudden extreme pressure to the testicles, right? Like, it's a very, very different thing to go through it.
- CWChris Williamson
Mm-hmm.
- TCTim Clare
Um, and you're like, "Hey, hang on." And, and even after I've had one, I'd look back and go, "Yeah, but that's not so bad." And then you're going through it and you, you, you feel like you're dying. And it's ridic-... In a sense it is ridiculous because you're not, but there's various ways and, and various elements that I would later learn speaking to, like, pulmonary biologists and, uh, psychiatrists, uh, about the physiology that makes it actually very difficult to think straight while you're having one. It's not just a failure of character. Um, so that's what it is. But I would say, like, they can present very differently. Some people have talked to me having... We talk about the fight, flight, or freeze response, right? Those kind of three things. And, and, and panic attacks, I would say, you can kind of split them into those three categories. Some people you wouldn't necessarily know that they're having a panic attack. They just go completely frozen up. I've had a friend I talked to who said he had a panic attack on stage while doing a standup gig, right? And he's at the mic, and he starts having a panic attack. Now, people... All that people saw was him going completely silent, completely still, and staring out, like, war-like over this. It looked like stage fright, right? From his perspective, he's having a panic attack, he can't breathe. There are other people like me that, like, honestly, it looks like a toddler having a tantrum. Like, I l- I'm, like, on the floor. I might be screaming, I might be saying, "I can't breathe." I'm, like, sweating. I might be, like, convulsing. You might think I'm having a heart attack. Um, it was, like, it was super embarrassing. It was, it was, like, the most... It was like the least dignified thing you could... The only way (laughs) like-
- CWChris Williamson
(laughs) .
- TCTim Clare
... it could have been worse if I was, like, doing kind of like honking farts while I was doing it, like any-
- CWChris Williamson
No, I was literally about to say, the only thing you could have done was shit yourself at the same time-
- TCTim Clare
Exactly.
- CWChris Williamson
... and that would've somehow made it worse.
- TCTim Clare
Yeah, it feels like you're emotionally shitting yourself. Yeah, that's how-
- CWChris Williamson
(laughs)
- TCTim Clare
It, it, it, it, it's that, like, complete, like, incontinence of, like, emotion and terror. Which would, you know, i- when you, when we see them in kind of... The panic attack is preserved.... amazingly well over, like, millions of years of e- evolution. You can get very similar reactions from, you know, like, voles and stoats-
- 12:23 – 23:30
Why Panic Attacks Exist
- TCTim Clare
- CWChris Williamson
Why is it a-
- TCTim Clare
... and have-
- CWChris Williamson
Why does it exist? How is it adaptive to have a panic attack?
- TCTim Clare
Okay, so that's a great ... that's a fantastic question, and there, and there's loads of the- like, people have jumped on this, like, going, "Why?" And th- uh, a- there was a psychiatrist called Donald Klein who, in 2003, wrote a paper where his theory was he sees it as a kind of, um, uh, he called it, like, a suffocation false alarm. So he's t- going back to, like, we know that panic attacks can be reliably triggered by something called the CO2 challenge, right? Where you give someone a mask and they breathe in a mix of air that's got 25% CO2 in it, carbon dioxide, right? That reliably gives people, like, smashes of a panic attack. Like, it's the grimmest thing. It's quite ... And I've spoken to a psychiatrist who, you know, did it himself before he used it in his experiments. But we know that people who are vulnerable to panic attacks are much more likely to have bigger and worse panic attacks when they do that challenge, and it's one breath, by the way. Like, you put this mask on, you take one deep breath.
- CWChris Williamson
No way.
- TCTim Clare
It's ... I, I, I ... People who've done it have, like, said you can't ... I, I, I should say, like, there's a w- there's a famous patient called Patient SM who had her, her amygdala, both her amygdalas removed, the amygdalae. They're, they're these parts of the brain that have, have often been thought by kind of like ... When they talk about them in magazine articles, they call it the brain's fear center. Now, it's not, but it is definitely implicated in our threat circuit. She'd had this rare genetic condition that meant she lost both of her amygdalae, were, um, eaten away by calcium deposits. She couldn't feel fear. If she had, like, a gun held to her head and someone threatened to kill her, she didn't even realize that they were threatening her. They've done all these tests on her. They have her held s- they've had her hold snakes. They took her to, like, a fun house and there was a guy dressed up as, like, Pinhead out of the Hellraiser movies, and apparently, she made him jump because she went up and grabbed one of the nails coming out of his mask to, just to find out what was going on. She's been beaten up. She's been assaulted. At no point has she felt fear. She was, like, capable of-
- CWChris Williamson
Not all of these were in a f- ... Not all of these were in an experiment, I'm going to guess?
- TCTim Clare
No, no, no. No, no.
- CWChris Williamson
Right.
- TCTim Clare
They're, they're super ... They're actually ... The experimenters, all of them that talked about her, were really sort of protective and tender about her. She wasn't like some weird, like-
- CWChris Williamson
Yeah.
- TCTim Clare
... caged, um, oddity.
- CWChris Williamson
Well, the problem that you have with, with someone that doesn't have any fear is that they're pretty bad at looking after themselves.
- TCTim Clare
Yeah, she's d-
- CWChris Williamson
And if you're not able to do threat response or threat detection very well, you're unbelievably vulnerable.
- TCTim Clare
Yeah. She's ... I mean, and that's been a ... There's case studies from her life where, you know, a stra- a really sket- sketchy guy just, like, rolled up in his car and said, "Do you wanna get in and come with me?" And she was like, "Oh, yeah. Hi." Yeah, and he took her to a, uh, abandoned barn and assaulted her. Like, the- she's had that throughout her life, trusting people, um, who-
- CWChris Williamson
But then she does the, she does the mask thing.
- TCTim Clare
Y- yeah. Yeah, and then, but th-this is the thing, is like she's just not able to ... She'd, so she does this, um, she did this, uh, CO2 challenge, this 25%, and she had the worst panic attack they'd ever seen, um, with that. So even somebody who cannot feel fear in their life had a panic attack, a terrifying one, when she had it. Now, the difference with her is afterwards they said, "Do you wanna do it again?" She was like, "Yeah, all right." She, she wasn't able to learn from the experience, but during it, she was screaming, "I can't breathe." She was grabbing for the ... So, so the theory is, um, that these chemoreceptors in the brain, um, are there, developed from when we were kind of like burrowing animals. You, you, you go to sleep in a burrow. It collapses. CO2 levels will start going up because you're gonna suffocate. You want something that will just flood the body during sleep with adrenaline, cortisol, get the heart hammering, and go just move, scrabble, thrash around trying to get out. That's the, that's Donald Klein's theory, that it's preserved because there was a time when it was adapted to wake up suddenly, because you ... And it kind of still is, right? Like, um, y- we know that children who, um, have seizures during the night, um, can ... If, if, if the seizure reaches the amygdala, they are capable of, um, of just stopping breathing. In fact, they've had problem ... You know, this has been one of the problems with, uh, COVID. Um, there have been COVID patients who stop breathing, have incredibly low oxygen levels, and just aren't aware. They call them happy hypoxics, right? Like, the infection, this kind of neuro in- it might reach the amygdala, and, and these chemoreceptors are somehow affected in the same way that people report sort of problems with taste and smell, and they don't know that they're not breathing. And that little alarm that says, (laughs) "Shit." Like, "You're suffocating. You've got to breathe now," and, um, sort of jolts you awake, doesn't go off. And people can just sit there and pass out. Um, so that's the, that's one of the theories. Another theory is that, like, a panic attack is like the last resort of the fight, flight, or freeze, the, like, most primal response to being, like, attacked by a predator. Like, if everything else f- has failed, if you've frozen and they still find you, if you try to run away and you still get caught, if you try to fight, the last thing is just to flood the body with adrenaline. And so you thrash, you scream, you fight, in the hope that like, basically, it drops you. That, you know, or it, like y- it ............................ So it's like this last ditch effort, um, which is why, which is, you know, one guy I spoke to, John Wemmie, who's like a psychiatrist and he does, like, pulmonary biology and things like that, and he performs this, um, CO2 test. His position was like-... he said w- when the a- amygdala is removed, what the amygdala might do is help us decide which of the fight, flight, or freeze options- you've got to choose, right, when you get this flood of adrenaline? It might help us decide it. And when that's removed, we might just always default to the, to the worst thing, which is like panic attacks, right? So, uh, yeah, the amygdala is almost like a kind of spigot that chooses how much water you want. And if you hack the spigot off, it's just going to jet water. So, that's one theory of panic attacks, um, why, why some of the elements of them might be adaptive. That w- that it's, it's a chemo receptor in the brain. There's very- well, actually, there's various areas that might have chemo receptors. The amygdala might have them, but also periaqueductal gray, kind of like around the back, um, that the- you might have these oversensitive chemo receptors. And actually, when they've done ambulatory monitoring of people who have panic attacks, where they monitor their breathing as they walk around throughout their daily life, they find that a lot of people who have panic attacks have a tendency to over-breathe, right? So, they're breathing a lot. They're washing out carbon dioxide. They're taking in a lot of oxygen. And so as they do that, right, they're, they're slowly training this kind of like- th- this canary in the mine shaft, right, this, the, these chemo receptors to be more and more acutely aware of the tiniest bit of CO₂. And so all you need then is a period where, you know, people w- frequently with panic disorder will wake up in the night having a panic attack. So, there's been no trigger. It's not like they're, they're in a shopping center and they feel claustrophobic. They're in bed and they wake up thinking they're having a h- a heart attack, right? And, and so there may be some dys- there- it's- it happens- panic disorder correlates with like sleep apnea and like, uh, r- respiratory problems, people who ha- have them. So, there may be some dysregulation of breathing and then, of course, what happens if you're having a panic attack, which we often think is part of it but it's al- almost a second stage, is then you over-breathe, you hyperventilate, which, I mean, it- I don't know, like, if you hyperventilate, it has all these crazy effects on... I mean, and this is what I didn't realize, I didn't get, was like... A- and, and it also explains the very traditional method of stopping someone having a panic attack, right, where you see them on the old movies where they breathe into a paper bag, right?
- CWChris Williamson
Into a paper bag, yeah.
- TCTim Clare
And that's not really dealing with panic attacks so much as the effects of hyperventilation, which are like an overcorrection afterwards, right? Someone breathes and breathes and breathes. It washes out all the CO₂ and then with all that, uh, lack of CO₂ in the bloodstream, you get something called, uh, cerebral hypoxia, where the, um, brain is flooded, uh, with, uh, with oxygen and as a response, it, uh, that you get vasoconstriction in the brain. So, the capillaries, after about a minute of hyperventilating, the capillaries are about 50% of their previous capacity, right? And then, and this is all really complicated, took me ages to get my head around this, because you're like, "Well, the, the- your bloodstream is full of more oxygen. Surely your- more is going to your brain." Well, the body is a homeostatic system, and it's constantly trying to make sure different areas are getting what's needed. And if your body thinks it's in fight, flight, or freeze and there's- your brain thinks it's getting too much oxygen, it'll go, "Right, we don't need this, right? We're going to restrict the blood vessels so the rest of the body presumably would have been chased or in a fight, right? So, I'm going to save the rest of that oxygen to- for the mitochondria in the cells, in sort of my legs so you can run away, right? So, we're, we're all right here." And, and, and that's a mistake that the brain makes. At the same time, you get this thing called a leftward shift on the hemoglobin disassociate- dissociation curve, which basically means that hemoglobin, the trans- the protein transports of oxygen round the bloodstream cling on to that oxygen more tightly when you get a carbon dioxide washout. So, it doesn't- they don't deliver those oxygen molecules as readily. So, not only does your brain get 50% of the blood flow, but all of the oxygen that's flowing through, the bloodstream is not letting go of. So, your brain, like within a minute, your brain has been massively starved of oxygen. So, you start feeling dizzy. You can't think straight. You start getting that derealization. You start thinking you're going mad. You can't take logical steps, um, because your brain is shutting down. And this is why people will regularly, you know, like I say, they will present thinking they're having a heart attack. They'll present thinking that they've gone in s- that they've lost their mind, um, and it's all to do with respiratory function, which is like cra- (laughs) which is mad to me, right? That it's something so simple as, like, that dysregulation and then over-breathing can lead to people g- thinking, "I'm going insane and I'm dying," and it's just a breathing rhythm thing.
- 23:30 – 32:13
How Exercise Soothes Panic
- TCTim Clare
- CWChris Williamson
Looking at the techniques that you went through in an effort to try and discover what can help anxiety disorders, what did you find out about exercise?
- TCTim Clare
So, exercise is a really interesting one. I thought exercise was the first thing I tried, right? Because I was like, "Well, this is a slam dunk." I mean, I was really, really unfit. Like, incredibly unfit. My job is three meters from my bed. My favorite activities are like video games and sleeping. Like, I was not- it's no exaggeration to say I was- I, I know like I was a dad with a two-year-old, right? So, like, my sleep patterns were all out of whack. I was comfort eating because of the anxiety and because of- you know, I'd often get my daughter to bed at a crazy time and then I'd just, like, get a takeaway because the idea of then cooking for myself was- seemed like the least appealing thing and I thought, "I fancy, you know, I deserved a treat."So, but I thought exercise... I was like, "Everyone's always telling me to do exercise. It'll be a shoe-in." And I went and started looking at the literature. I went to see a trainer called Dave Thomas, who owns a gym in London, and he's got like 20,000 hours of like one-to-one sessions under his belt, to talk to him about like sports science and stuff like that. And I started digging into the literature. And what I was surprised to find is the relationship between exercise and reducing anxiety is by no means clear. There's a really interesting paper by a psychologist from Liverpool University called Peter Salmon, who looked at a load of studies on anxiety and exercise. And what he found is that most of the studies that you will read, like in the paper, in magazines, that say, you know, "15 minutes of HIIT a day will reduce exercise, will reduce anxiety," and, uh, whatever. The, the people they get to do th- the, the sample that they use for those, uh, generally, and l- they should be obvious for us, but like, people who sign up to those studies are not generally people who hate exercise. Th- they need volunteers, right? And the people who tend to sign up to exercise studies tend to be people who quite like exercise. So for a start, there's a skewed sample, in that the people who are doing them are people who generally don't hate exercise. Secondly, the samples that are used, and this is another weird one that surprised me, are often not people who are clinically anxious. They will get people who are just, you know, everyday people, and they will study them, and then they'll give them a survey at the beginning and a survey at the end and they'll go, "Do you feel less anxious now than you did before?" And often people do, but they weren't clinically anxious to begin with. They just feel more relaxed. Does that mean it works with someone with PTSD or panic disorder? Th- that study doesn't have anything to say on that necessarily. Secondly, a lot of studies don't... Thirdly, I should say, a, a lot of studies don't really distinguish between what type of exercise. Like, e- th- th- there were a lot, you know, exercises of big... That's like just saying, you know, books. Is a, reading a book good for you? Well, what kind of book? What kind of exercise? Is walking the same as d- you know, sprints or, um, uh, you know, Fartlek or HIIT? Is, are we talking like marathon running? Are we talking about like swimming? Um, what, what duration? Is it, are we talking relative intensity to someone's fitness level or absolute intensity? Uh, what, how many days a week for over what period? So, all of these questions are ones that, um, are not often well addressed in the current literature. And, and of course, one of the things that I got from talking to Dave is like, you know, if you start an exercise regime, the first thing it's gonna start doing is at least transiently raise your cortisol levels, your adrenaline levels, you know, your, your testosterone levels as well, which is like more ambiguous when it comes to how that affects anxiety. But y- your stress hormones are gonna go up initially, right? So, the, the... And it's gonna be unpleasant, ri- When I started running d- doing this book, I fucking hated it. It was grim. I did not like start running down the street whistling to myself going, "Oh, I feel so alive." I... Oh my God, I hated life so much. I could taste blood in my mouth. I was limping. I would like... I was aching. The next day I couldn't get up and down the stairs. I was so angry and I was like, "Why am I doing this? I hate doing this." But, and there is, there is a but coming here, right? Like, despite all that. So those are all the caveats, right? Despite all that, if you then look at the body of literature, there are some great results. Like one thing I'd say, like, let's imagine that e- you did a bunch of exercise, right? And it did nothing for your anxiety, but you started a exercise regime. Well, like w- we already know you're gonna live longer. You're gonna have... Y- y- you're gonna, um, you're gonna w- have more energy during the day. You're gonna be... Your profile, risk profile, across a range of diseases is gonna drop dramatically. Um, so, so, so, so the worst case scenario is that you live longer-
- CWChris Williamson
You're a healthier, better, leaner, sexier version of the person you were yesterday, you just still have anxiety.
- TCTim Clare
Yeah. I- it ma- yeah, exac- exactly. So like, it's not like, w- you know, we're asking someone to put their hand in like a, a meat grinder. Like it's, it's something that's already good for you, I think is, is sort of unambiguous across the range of literature. But can it help, um, uh, a- a- anxiety? Well, there are some suggestions that there are ways it can do... Like w- when we look at, um, athletes and some studies of people who exercise regularly and do intense exercise, and they've done some of this with bodybuilders as well, actually in response to a, a threat, and in the l- you know, there's, in the lab this tends to be something like a, uh, they call it like a shock protocol. So they literally wire someone up and give them unpredictable electric shocks. Um, that's how they find out someone's stress levels and they'll check their cortisol with a swab. When you look at these people, actually their fight flight or freeze response, their, um, hormone cascade is, is, is generally more pronounced than people who don't exercise. However, it tends to normalize more quickly as well. So they have almost like more of an adrenaline boost in response to a stimulus, but then they return to baseline faster. A- and this is something actually we see a lot, across a lot of anxiety that it's not so much someone has a bigger... It's not like someone has a bigger startle reflex, although that can be part of it, but that they're worse at responding to safety cues and returning to baseline. Like, like these-
- CWChris Williamson
You've got less equanimity on the other side of it. Yeah.
- TCTim Clare
E- exactly. Yeah. Like, like there, uh, um, uh, you know, uh, and it was true of me that like a, a can of beans could fall out the cupboard and that would, that would be me gone for the rest... That'd be my nerves shattered for the morning.
- CWChris Williamson
(laughs)
- TCTim Clare
I'm just like, "I've gotta take to my bed now with a case of the vapors and fan myself, saying, 'What shall become of us?'" Because like that was it. Like my... I was just jittery.
- CWChris Williamson
Yeah.
- TCTim Clare
Um, so it's gonna normalize that. Uh, uh, the other thing is, uh, and I'm, I'm sure, you know, you would have, th- been thinking about this as well, but like your blood sugar levels, like when... In response to a shock, you know, your body is gonna release, uh-... glucose. There's various hormones that, um, release, you know, glucose into the bloodstream, anticipating a threat, so it's going to be available to the muscles so you can start running and whatever. So, uh, i- it releases these sugar stores. If you don't immediately use that up, then, um, your body is, i- is gonna release insulin to reabsorb it, so you get these big crashes. So that's why, often, people w- with anxiety have this horrible up and down thing where you get the shock and then you drop into, like, the equivalent of a sugar crash afterwards, where you feel sluggish, you can't think. And then, of course, you, it's tempting to, like, have a sugary sports drink or something which will sort of briefly bring you back up and normalize, but then, you know, you start this kind of, like, your day is this series of peaks and troughs. Um, exercise can help downregulate some of the kind of corticoid, uh, like some of your, um, receptors that, that deal with things like cortisol to make them sort of slightly less responsive, and they can put you in a situation where those kind of, like, sugar spikes, uh, are less pronounced. Um, they, they help with things like i- insulin resistance as well. And that's, of course, you were shading into diet now, but exercise is part of that as well. So-
- CWChris Williamson
But yeah,
- 32:13 – 43:18
Diet’s Impact on Anxiety
- CWChris Williamson
what, what about that? 'Cause I've always heard that there's more serotonin released in your gut than there is in your brain, and that there's a gut-brain connection when it comes to anxiety, and that inflammation is something that you need to watch out for because you can eat some gluten and you'll have an anxiety attack. What did you, uh, what's the lessons to be learned there?
- TCTim Clare
Yeah. So like, that's really important and it's w- that serotonin receptors in that you've got, you, the, that idea of like having loads of serotonin receptors in your gut. Yeah, like serotonin 5-hydroxytryptamine, um, most of it is, you know, is doing stuff around in different things all across your body. Um, and it's also the reason why you can't just take a serotonin pill, right? 'Cause it doesn't cross the, um, blood-brain barrier to get into your brain. It's not, won't be available in your brain. You've got a blood-brain barrier that stops, like, nasties getting into your brain. Obviously, your brain's sort of like very, very ... That's one of the reasons why you get kind of like cerebral vasoconstriction so quickly, why it has these crazy responses is because it, it's really, really conservative on how-
- CWChris Williamson
Finely tuned.
- TCTim Clare
Yeah, yeah, yeah. Because it w- it, it doesn't, you know, because getting a virus into your brain is, is much, much worse than getting one into your stomach. Like, if it's in your stomach, you can just diarrhea it out, which is one of the functions of serotonin, um, in the gut, is, is what they call pe- it, it contributes to gut motility or peristalsis, which is why if someone takes like an SSRI, a, a selective serotonin reuptake inhibitor, to increase the, um, availability of serotonin, one of the side effects is diarrhea. Um, it's, it's, it's also one of the reasons why, like, taking, like, a real strong serotonin agonist like psychos- uh, psilocybin, um, can give someone gut cramps and extreme cases like diarrhea, because it is that you've got all these serotonin receptors in the gut. Yeah. There are ... But, but they do something different, crucially, to what, what they might do in the brain. Um, uh, mostly they're, you know, they're flushing out nasties. Uh, yeah, peristalsis is like the motion a worm makes, and they make your gut do that to kind of p- force stuff through quicker. Um, so what you eat, I'd, I'd say like, like one of the key areas for me, I spoke to a couple of people. I spoke to a, um, microbiologist called Simon Carding at the, uh, uh, in, uh, in Norwich. Um, and he deals with, well, what he deals with, like, the, I'll tell you, I'll be honest, the real reason I spoke to him, like, a little bit, is because they do these fecal microbiota transplants, right? These FMTs, where, and they've been using it to deal with people who've got C. difficile infections, right? Really serious, life-threatening infections in their microbiome. And what they do is they take a cocktail. They take, basically, they take s- they get a fecal tr- transplant from someone else. They, someone donates their poo that, um, w- who's got a healthy microbiome, they kind of whisk it up and then they, and then they sort of syringe it into the patient's ... Either up their rear end or that you can swallow it in something that they call a crapsule and it will like-
- CWChris Williamson
(laughs)
- TCTim Clare
... restore your microbiome. Yeah, I know, right? And there's all these beautiful stories that are like, "My dad's poo saved my life."
- CWChris Williamson
(laughs)
- TCTim Clare
And stuff that you see in the papers. So that's like, well, evidenced for C. difficile, but they started to find these other things where, um, there were sort of like brave mice where they took the microbiome from the quote unquote "brave mice." These, uh, these, um, this one strain are known to be more likely to explore a maze and they'll jump down from a raised platform qui- quicker, and they injected the microbiome from their, uh, from their gut into ... Well, well, uh, from a little pouch in s- that m- mice have called the cecum, and they took that and they injected it into the timid mice. These ones that are c- a strain called BALB/c that come from like a, uh, uh, they're traced all the way back to like a 1913 pet shop dealer in, like, Ohio. And they've been br- and they've just been bred and bred and bred, and they're known to be very sort of n-
- CWChris Williamson
Wimpy mice.
- TCTim Clare
... mouse equivalent of nervous, right? Uh, and so they'll inject that microbiome into those mice, and those mice become braver. They become quicker to jump down from a raised platform. So people are like, "What the hell's going on here?" If you can give one microbiome to another type of mouse that is like genetically, that is like known to be hered- have a hereditary cowardice, and it changes, they don't become as brave as the other mice, but they become more brave, right? What's going on here? So they've been looking at it in humans. Can we give people, can we change people's gut microbiomes and make them braver? (laughs) And so, so the, the, the d- the sort of disappointing answer is like, at the moment, probably not. Like, we've, we've looked at it for ages and it seems to work with mice, but mice have got like three inches of gut. We've got like three meters. Like the, there's a reason, like we are, the, uh, it was funny speaking to Simon Carding 'cause he was like almost like pinching his nose like the number of times he'd had to tell journalists, "Mice and humans are different." And it's like almost surreal to like have that conversation over and over and go, "A mouse is not a per- is not a little person." Like they- l- like they've, they've got all sorts of differences in their guts. They, they can't, like mice, mice, and rats can't be sick. Uh, they, they don't have a gag reflex so they've got massive differences in what they can and can't do. But in terms of like your diet, um, th- w- uh, there's plenty of w- like epidemiological studies, so big, big, big studies where they take huge numbers of people, that suggest like there's a mild association with like th- a, a med- a Mediterranean diet and lowered risk of anxiety and, uh, depression. Uh, it's, it's not like a huge, uh, one, it's like a, uh, a, like for, uh, one in every 45 people who switch to a Mediterranean diet will avoid depression or anxiety that would've otherwise got. But there's like a small s- but o- you, you do that over a population, right, and suddenly, you are reducing, you're getting hundreds of thousands of fewer people hitting the mental health system with anxiety and depression. And hundreds of thousand, and that's only clinical level as well, but hundreds of thousands of people potentially who aren't having their life like ruined by this. So, so, uh, y- you know, it gets to big numbers if you look across a population. Um, but I did speak to, you d- uh, you asked about inflammation. I spoke to a, uh, uh, an immu- uh, she called herself an immunopsychiatrist. I say she called herself. That was her job title. She do, she's, she's at, um, the University of Southampton, Dr. Ruihua Hu, and she told me she looks exclusively at, um, at the links between inflammation and depression and also anxiety. And she said that there are, you know, what the, what we're look, we're, we're finding a bidirectional link between anxiety and chronic inflammation in the body. N- now it just so happens that, um, being sort of like chronically overweight increases inflammation in the body. It just so happens that doing lots of exercise, uh, reduces inflammation in the body. So if there is a bidirectional link between those two things, we can kind of put the pieces together, and I'm kind of like speculating slightly, although she felt that this was reasonable, um, the, the, the eating, uh, you know, a good diet, uh, and th- wha- that'd be one, r- you know, a Mediterranean-style diet r- you know, full of like, um, plant-based like polysaccharides, lots of fiber, things that are gonna like increase that gut motility and stuff, is gonna reduce inflammation and, um, reduce your risk pro- I think it's, I think it's fair to say reduce your risk profile of anxiety rather than immediately cure your anxiety. Uh, and she, she also mentioned things that w- I, I hon- I, I thought she was taking the Mickey, to be honest, when she told me them, 'cause she said, "Oh, there, so what's some other things you can do?" She said, "Oh, well, like be religious." And I was like, "That can't be right." And she was like, "Being religious is reduced with lowered inflammation, lowered mo- this CRT, this marker of inflammation. People who are religious and part of religious communities have l- have lower levels of that." I was like cu- so I ended up looking into the research of that and it, and it is true. Doesn't specify what religion. So, um, you know, if you want to kind of, (laughs) you wanna start your own cult, apparently that will reduce your chances (laughs) of anxiety as well. But I suppose, w- you know, the takeaway from all of this is, id- n- anxiety is not just one thing. It's not, it's a bit more like a headache, right? It's a symptom that could have many causes and it may be that there is a subgroup for whom their chronic anxiety is arising from chronic inflammation, from a kind of feedback loop from poor diet, uh, lack of moving around, and, uh, sort of lowered hormone profiles across a range of things. E- there's other things that, uh, exercise boosts like this, uh, neuropeptide. Why is this one particular peptide that's associated with lower anxiety in people who have it, l- lower rates of PTSD in people who have like high levels of neuropeptide, why? But that is produced by doing lots of exercise. So there is a good chance that there is a, a subgroup of anxiety sufferers who may be, y- you know, they, when, when we've looked at the depression profiles of, with, uh, with inflammation, we can see that there are some people who respond really well to just taking, uh, anti-inflammatories for their, for their depression. There was, uh, like a subgroup who seem, that seems to, like r- they seem to-
- CWChris Williamson
So that's the crux of their depression. That's one of the reasons that their depression manifests.
- TCTim Clare
Yeah, but I would never want to get into this... Y- you can get sucked into these sort of arguments where people are going, "So are you saying that like anxiety exists in the brain or are you saying it's just about inflammation? Or are you, you know, surely if someone's like having a stressful life, that's gonna contribute." And, uh, oh, and then there'll be other people who say, "It's only their environment and you can't ever say anything about neuroscience." Uh, even though like clearly all the thoughts we're having, all the experiences we're having are, you know, in some way instantiated in the brain. Like, there is a, brain is one of the pieces in this puzzle, right? And, and sometimes when I get sucked into those, I feel a bit like I'm watching two people have a brutal fistfight over whether Kermit is a Muppet or a frog. You know, like I, it's, it's just like these things can all, um-... be contributors. And for me, like, inflammation is definitely sort of a reasonable culprit, but it may not be everybody's sort o- primary bogeyman kind of behind what, w- what, the, what's giving them anxiety.
- 43:18 – 57:08
Long-Term Effects of Child Adversity
- TCTim Clare
- CWChris Williamson
What about childhood trauma and bullying and stuff like that? How does that contribute?
- TCTim Clare
Well, I spoke to th- yeah, so I spoke to a, ah, I spoke to a brilliant neuroscientist called, um, Nim, Nim Tottenham, who has done lots of studying of, like, childhood adversity, and particularly how it affects brain development, and how, um, when people have had very traumatic childhoods, uh, either because of, like, a single traumatic incident or because of, like, lots of different things that have happened, um, it affects, uh, there's suggestions that it, it, it affects brain development in a way that's not always immediately apparent at the age of the trauma, but happens later, abnormal development of, I've mentioned the amygdala before, but also the hippocampus, which is associated and implicated in parts of memory. Um, we're trying to get away from this idea that one part of the brain is kind of like one department for doing one thing, but certainly, the hippocampus is important in forming memories. And in, specifically for anxiety, it seems to be, to do with, um, associating certain environments with safety or threat, which is why there seems to be a lot of dysregulation in the hippocampus in, um, soldiers with PTSD, people coming home who can't-
- CWChris Williamson
People who are hypersensitive to it somehow.
- TCTim Clare
Yeah. You know that kind of like, the kind of classic thing is like, a car backfiring, and they think they're kind of under gunfire. But like that un- that, that, the brain's inability to, to differentiate between a theater of war and a, as, a safe zone, um, you know, the hippocampus is almost certainly implicated in some level, in that. Um, but Nim Tottenham, Tottenham looked at how the brain often those, she did this great paper that showed that, like, often, uh, the, our study suggests that the brain starts to change in adolescence, but as the result of things that happen much, much, much younger, and we might get w- a sort of upregulation of when we, if you're looking at, I guess, what they call, like, neuroanatomy, you might get much bigger or much smaller. Er, it's like the one thing I'd say at the moment is the literature is really ambiguous over whether an area like the amygdala, whether, um, having a big amygdala is, uh, worse because you're going to be more anxious or whether having a smaller one is worse because you have less regulation over anxiety. It's not encli- entirely clear what the relationship is between sort of size and, um, function.
- CWChris Williamson
Did they say what sort of age this could begin from? Are we talking about before stuff that we could potentially even remember, sort of toddler age, that there could have been things that have impacted on our brains from then?
- TCTim Clare
Absolutely. I mean, some of, some of the st- I was looking at one study that was suggesting that we can't start forming coherent autobiographical memories that we're able to retell to people until about two and a half. So, uh, you know, they could be things that you don't remember, but certainly, like, from the moment you're born, you, you're, you are learning, your threat circuit's active, right? But babies are not great at, um, certain types of threat perception. But you, you, you, you come out the womb with sort of, like, flinch responses to, say, like being dropped or pain or things like that. Um, babies for a while, they've done these great studies where they get babies to crawl out over a Perspex floor, that suddenly underneath deep, like goes, is a cliff, like drops away and, you know, uh, cr- at a crawling age, they will just crawl happily out over the edge, um, on this Perspex thing. They don't know that they're on a see-through kind of like ledge. Um, and then there'll be a certain developmental point where they'll go, "I'm not... I'm afraid of heights now." Um, so we know that some, uh, fears are, uh, uh, uh, are acquired. Some are developmental steps. Like it's good when a child starts to get a little bit of stranger fear. There'll be a moment where a child gets a bit more clingy. Well, they're starting to differentiate between faces. That's quite good. You know, obviously, like it can be pathological, but it's part, it's a, it's a n- neuro, uh, anatomical and neuro, um, developmental, uh, milestone that's actually pretty great, right? Like they're, they're, they're, they're learning to go, "This space is safe. This is a stranger." But yeah, from really early on. They, she, Nim Tottenham did a great study in mice, um, where they played them music when they were born, like they play a particular song, and then they found m- mice don't normally like to nest around any noise at all, like they're naturally timid. Um, but then, uh, if this song was played when they were adult mice, um, they would want to go, they'd prefer to go and make their nest when this music was playing. So they tried it with, um, adults. They, they got people in and they played them songs. They did this very stressful test, um, where it's, it's this, like, notorious test called the Trias, where basically you're made to do a, a maths test that is rigged, that you're always gonna fail. It's gonna be too hard. And the answers come too quickly. There's like a loud horn sounds every time you get one wrong. Um, you, you can see a bar that supposedly how other people who've done the test before did and you're always doing much worse than that bar, right? People report doing this Trias as like the most stressful thing, more stressful than like noxious thermal stimuli where their hand is burnt, more stressful than seeing like graphic photos of like corpses. The Trias is what people find the most stressful and don't want to go back and do again.
- CWChris Williamson
Yeah.
- TCTim Clare
... and, and she did this test where they, they would be made stressed by that, and then they'd either be played some random music or one group were played music from this, what should they call, the critical period, which is, like, around five and six. And if you're played... m- if... She found that when people were played the music from five and six, I mean, it reliably reduced their stress levels more than the control music. So there's-
- CWChris Williamson
You mean that they went back to the time when these people would have been five and six, looked at the typical songs that were playing on the radio-
- TCTim Clare
Yeah. So it was, like, child music. Exactly.
- CWChris Williamson
... Phil Collins or whatever the fuck.
- TCTim Clare
Yeah.
- CWChris Williamson
Yeah.
- TCTim Clare
So everyone will have, like, a critical period. So she'd think... And so she... her theory is this is a critical deve- developmental period when we are learning safety, because people who had had a trauma around that age, um, their critical developmental period was shifted earlier to about three or four. So, as if the brain just goes, "Shit, we n- we, like, we're not gonna have time to fully develop, we need to, like, get things going, right?" So, they tended to respond better to music that was-
- CWChris Williamson
What was the response? They've, they...
- TCTim Clare
... a couple of years further.
- CWChris Williamson
Their threat response was downregulated? What happened?
- TCTim Clare
Yeah. So, it'll be, it's the, it's lowering of cortisol levels. So they'll do, like, cortisol swabs. It's also things like they'll do galvanic skin resistance, so they'll check the sweatiness of skin, and things like heart rate as well. They'll also just get people to... 'Cause we can... I, I, I got quite, like, obsessed with all these kind of, like, objective measures of, like, anxiety, but they'll also just ask people, "What is y- your subjective expe- how stressed are you feeling right now?" Which is always, like, a useful thing to do because sometimes you can get... A lot of studies they've done on neuroscience and stuff, they'll get parts of the brain that are supposedly associated with s- threat, um, flashing up and they'll go, "Oh, this person must be scared." But then when you ask someone in the scanner, "Are you feeling scared?" They'll go, "No." And actually some of those studies... I spoke to one neuroscientist, Al- A- Aleksander Schackman who was like, "No, actually one of the problems we have is the tests are kind of boring and people fall asleep in the scanner." So clearly we can't be studying anxiety if, like, someone's, like, falling asleep because they're so bored and th- you're g- you're going, "These people are scared of these things." So yeah, like, the res- the response was people were having... They were, like, moving into that kind of parasympathetic rest-and-digest state of kind of going... It's, like, almost like those songs are safety cues for them. And they're like-
- CWChris Williamson
Okay. So is, is, is, is the lesson to... What's the lesson to take from that when it comes to childhood trauma and adult anxiety?
- TCTim Clare
Well, like, there, there, there, there's, there's two. And, like, one of them is, like, the obvious ones that, like, we've got to, like, really protect children and make sure they grow up in the best environments possible because these things can have disproportionate effects on how they grow up. But I would also say, you know, as an adult you can... if you've been through difficult things in your childhood, it can be the most des- most depressing thing in the world for someone to go, "Oh, yeah, I'm afraid you're screwed, and here's, like, 50 studies proving it." The... It... It... By all it... Like, n- we're seeing more and more, like, neuroplasticity is still a thing. So, what I would say is, there is clearly an effect from that critical period of music, and you might find that listening to songs from that period help you, but I'm not convinced that that... having, like, looked across the literature, that effect is necessarily bigger than just listening to music that you love, right? I'm not sure. It might be an effect, but whenever we find an effect in, uh, research, we've got to ask, "Compared to what?" And there... And, and I'd say probably those songs do work better than random songs. Do they work better than, like, your favorite songs? I don't know. But in terms of, like, what we can do about it, the take-, the takeaway is that, yeah, you may have had experiences early on that have predisposed your brain to go... not in a nasty way, it's not even pathological. It's gone, "Okay, the world is a dangerous place. I'm gonna... We are going to be on the lookout for stuff, and we're gonna look around and make sure that we spot this early." So, so, I... You know, I'm... You know, someone might have social anxiety, right? They might, like, constantly think, "Does this person hate me?" They... You know, you might be on a train and there's s- a couple of people are drinking and you start getting anxious in your wo- and, and part of your brain is thinking, "Is it gonna kick off? Are these people gonna be a couple of drinks down the line and gonna start, like, getting lairy, and am I gonna be... gonna get in a fight?" Well, all of that is actually com- quite compassionate and rational of your brain if you grew up in an environment where... like, "Don't piss off Dad. If Dad comes home and he's had a few, like, just get out of the way." Like, spot the early warning signs that someone might be not safe to be around, like, and try and spot the moments where their... You know, the shift in the tone of voice. If you've grown up around that, there's some-... There's, like, a little note of warning in someone's voice, and that is the time you're gonna get, you're gonna get a hiding if you don't get out the way. Your brain's going to go, "Cool." Like, "Well, that's cool. We're gonna apply that, right?" And...
- CWChris Williamson
That's an adaptive lesson, yeah. That's a useful thing.
- TCTim Clare
It is, isn't it? Yeah. Like, if you have a soldier, like, in a theater of war who's just prepared to, like, walk down... sort of walk through an urban environment where there are, like, installed snipers sort of whistling and, like, twiddling an umbrella around their finger, you wouldn't go, "Oh, that's great. That's, like, a healthy human being who has no anxiety disorder." These things are contextual. They're deeply contextual, right?that, that you would think w- you would think that person is... Rightly, I think you would think that person has lost their mind. Their behavior would be maladaptive. To be non-anxious and to not have any threat perception in a dangerous environment is, is, is, is, is in some cases fatal, as we've sort of said before when people, you know, are unable to tell if someone's trustworthy or not. The question is, and I think the question that anyone's got to ask is, like, is this...... how's that working out for you, basically? (laughs) Is this still serving me? If it's not, there is no indication that the brain is not plastic, that... The brain is changing all the time, which is why I got a lot of neuroscientists laughing at me when I was going, "I read a study that said eight weeks of, of, of, of meditation can change the shape of the brain!" And they're like, "Yeah, like taking a shit, take, changes the shape of the brain, like, if you do that in the same loo every day." Like, an, like, y- y- every action we do changes the brain. Every action we do is making new connections, strengthening connections, wrapping these myelin sheaths round neurons. What... This is, you know, what they call Hebb's postulate: what fires together, wires together. You cannot do a thing in your life that isn't changing your brain. So, I, you, I, I would... You know, I think it's a really important takeaway, is to say, like, you, n- n- y- you know... Of c- of course there are neurological conditions. You can get, you can take a brain injury that affects your brain. But, i- in terms of a childhood experience, um, meaning that you were destined for all your life to, to... you can't get better, you can't improve, um, I'd say there is, um... The, the, the, the, the research simply doesn't support that at all, is the good, is the good news. Like, i- i- is the research doesn't support the idea that you can't change the brain. I'd say it's almost impossible not to be changing the brain with almost every action and decision you make, which is its own kind of existential crisis. You're like, "What habits am I laying down? What kind of, like, superhuman..."
- CWChris Williamson
You don't get to not make a habit, man. You only get to choose which type of habit you want to make.
- TCTim Clare
Absou- abso-
- CWChris Williamson
That's what people need to remember. Like, every action that you take moves you towards a tomorrow that is more likely for you to do that thing again. You know, you want to eat the cookie or not eat the cookie. It's not just a case of eating the cookie is not not eating the cookie, it's also ingraining the eat the cookie, uh, module.
- 57:08 – 1:02:40
Being Defined by Panic Disorder
- CWChris Williamson
So, one of the things... Talking about, um, identity, our sense of self, growing up and being an adult and stuff like that, something that I'm really, really interested in, given the fact that you're a man, you're a professional, you have an identity, you have people that follow you online, you've got this big course that lots of people have done about coaching them to write and stuff, father, husband, masculine purpose in the modern world, all this sort of thing. Something that I'm really interested in is, um, how you have dealt with the, uh, sense of self-referential, um, feelings around being someone that has panic attacks. You know, did you struggle with masculinity, with your identity, with what you feel your place in the world is, given the fact that you're doing something that traditionally is not seen as that protector-provider stereotype?
- TCTim Clare
I mean, so, yeah. It, yeah, absolutely. And I think that, of course, like, you wanna... part of you's like, imagines that you're above all that, and you kind of go, "Well, I don't really, you know, I don't... I, I'm confident enough in my own masculinity to, to not feel threatened by that." But when you are on the floor, like, having shoved, like, a towel in your mouth to try and cover the sound of you screaming so your baby daughter doesn't hear because you don't want her to be afraid in, sort of, two rooms away, and your, while your wife looks after her, and you're s-...' Cause you're scared of nothing. Also c- also, you're just in your house, right? There's no threat. Um, it's im- I think it's impossible for anyone, no matter what their relationship to masculinity, um, to feel diminished by that. We know, actually, from a really, some really interesting studies I read, that people who have more of a sense of, sort of what, what we might think of as sort of traditional masculine values. And I wanna be careful how I say that, because that, it's, that's a bit loaded, um, but the idea that men shouldn't get anxious, that men should be s- sort of self-sufficient, um, consistently have worse and more likely to get PTSD and have worse symptoms when, when they do. And so it is-
- CWChris Williamson
Why do you think that is?
- TCTim Clare
I think if you can't... Well, we know that the ability to... This is gonna sound so, like, o- abso- seemly simple, but the ability to talk to someone about what you're feeling, and have it validated, and be heard, is, like, I think, fundamental to getting over anything. To be able to go, like... Partly because it means you've got to be able to articulate it yourself, so it requires some self, uh, level of self-insight. And if you can't, if you can't... If, if, if it shatters your identity to go, "At the moment, I'm really anxious, I'm not coping," so you can't let that in, you're gonna constantly have an incongruence between your daily experience and the person you want to be. And you'll know that you're not living up to what you want to be, right? Like, you can say it all the time, but you know. And so you, you constantly feel like a failure, right? You, you continually do. Also, if you can't go to a doctor or, you know, a f- or just a friend, right, and say, "I'm h- having the shittiest time. I'm, I'm getting, like, stressed. I like getting keyed up. I, like, I can't sleep at the moment. I'm like, keep thinking there's someone in the back gun gonna break in. I was up at two o'clock, like, with a flashlight." Like, all of these things, if you can't speak to someone and they go, "Yeah..." Th- what I was talking about earlier that sounded like a throwaway line about religiosity re- reducing inflammation, well, one of the reasons that might be is just people having supportive communities who they can go to where it's normalized to go, "I'm having a shit time. I've just been bereaved." You know, like, in a religious community, if you loo- if you lose someone in your life, they die, it's expected that you'll be able to talk to them about it. And that is, in itself, like, has such...... a pa- it, it may even account for many of the instances of the placebo effect that sort of so bedevil psychological research, in that just going to someone... In fact, when we look across all types of evidence-based therapy, it doesn't matter what the modality is, right? It doesn't matter, (laughs) it doesn't matter what type of therapy it is, they all perform about the same. And, uh, uh, and, and a lot of that, I think, is just being in a room with someone who listens. We're a social, gregarious species. We are ma- uh, which is why I think, like, so many people found, like, lockdown, and y- I don't think you coulda done anything worse for people's mental health than stop people being able to meet up with each other. It's, it's l- such a terrifying thi- especially, and then people dying (laughs) out- outside, right? Those two things in combination, terrible for people's mental health. And I, and I, I think that, I think there's loads of great a- aspects to masculine values. You know, it's one of the things I talked about with Dave Thomas about exercise and stuff. Um, setting and meeting challenges is, is, is one of the things that m- you know, helps my anxiety the most, like, pushing myself, not going, "I, oh, I need to sort of back away from this." The more you back away from challenges, I think it's understandable that we wanna, people and everyone around you will say, "We shou- you should rest. You should, you know, c- give yourself a break." But actually, the stuff that's always helped me has been like, "I'm gonna train to run a marathon." You know? Like, I-
- CWChris Williamson
Yeah, part of that, lean into it, man. That's,
- 1:02:40 – 1:17:04
Importance of Leaning into Discomfort
- CWChris Williamson
uh, this is one of the things, the kind of recursive self-loop that I see, and I've seen it myself. So throughout my 20s, I was struggling with low mood, depression. Uh, I dunno whether it would have been clinical. I, I went to a GP when I was 21, uh, and this, they gave me a single printout, uh, and sort of ushered me on my way. So I'm hoping that it's, that the NHS has improved a little bit since then. But, um, throughout all of that time when I was suffering with low mood and stuff like that, so much of what happens is you become increasingly less able to lean into discomfort. A difficult thing happens or there's a challenge that's placed in front of you, and you get to the stage where getting out of bed seems like an insurmountable task. You think, like, "I, I, I simply can't go and have a shower. I simply can't go and make myself some food, or even be bothered to go and get myself a glass of water." And then you do it, and you come back and you go, "Oh my God," like, "that was, that's me for today. That's me done for the day." And then what you see when you're in a good place is that that reverses. You see that you're more able, you're more anti-fragile. You go into the gym and you're putting more weight on. And there's this sort of, it is, it is a masculine value, right? You sort of grit your teeth and get through this very, very difficult thing that you're doing. And it's not out of some sense of fear, it's out of a sense that you know that you can and that you're going to do more and you're motivated. But both of these spiral either down or up the same way, you know?
- TCTim Clare
W- uh, w- uh, what's, what's so fascinating about that is that I actually ended up having that confirmed. The, the, the bit where that part clicked for me was when I was speaking to AI scientists, right? they had this whole field of psychology now called computational psychology, where we started making, like, self-piloting drones that would become neurotic, that would stop leaving the, that would stop leaving the factory, right? And we started having AIs that were acting a bit like people with anxiety disorders, right? They, the self-driving cars. Really interesting speaking to a friend who, like, works, you know, as a researcher for self-driving cars, and they had all these problems with the self-driving cars in, um, Milton Keynes, where they were so, (laughs) they were r- they were, th- the, you know, th- these cars are, are m- made to not crash into people, right? And the public realized that the cars were really conservative in how they drive, so they'd just start walking out in front of them. And it got so s- self-driving cars couldn't, would, like, be stopping and starting and just creeping along, because they get m- because people l- adapt their behavior around them. Well, what we see with AIs is we started to n- notice that some AIs would sort of st- would, would, would, would travel less and less far in, like, route finding, and then eventually just wouldn't go anywhere. And what it was is they were learning about r- threats, taking evasive action, and then maybe that threat was only temporary. Maybe a seagull was flying through that area that one time. But because they never try that route again, they stop updating their data on that. Because when we do anything, and this comes from, like, computer, uh, from computational psychology and this kind of AI science, we're actually surreptitiously doing two things, right? We're doing the action, we're doing the behavior. We're also collecting data on the results of that behavior. Well, when you're depressed, if you stop leaving the house, you stop receiving data on what it's like to leave the house, (laughs) right? And it, and, and, and, and, um, and your whole schematic of what is, what wor- what threats are in the world and what the world is even like is, gets more and more skewed. It gets more, you, you get, your data becomes more outdated, and you get a data set from a tinier and tinier cluster of behaviors. Well, as soon as you start doing the opposite, I, I wouldn't even say to people, "You have to get to the stage where you believe, 'I can smash this, I can, I can get fit, I can go down the gym and I can bench my, my per- past my personal best.'" All you have to do is be a good scientist and go, "Should we test this? Like should we ju- should we do a test?" 'Cause like, you know, th- you know, depression's sitting on your shoulder. It's like, or anxiety or whatever, it's going like, "Okay, that is a good hypothesis. "I can't do this." Let's try it out. Let's see what happens, right? "We, we can do this. Le- le- let's do four trials. Let's m- let's do this properly," right? "'Cause if you're con- so convinced, you're not gonna be scared for me trying this, right? Because we, you, you're gonna be proven rapturously right. So let's, let's try it out." And then, of course, what happens is you go, "Shit." (laughs) "Oh, I did that. What the, what's ge- ... So if I was wrong about that, that one localized misbelief, what other things..."... could I be wrong about, and then the whole kind of house of cards.
- CWChris Williamson
Well, that's the spiral again. That's that recursive spiral that I'm talking about. The problem and the point at which I've been at, staring at the ceiling of a bedroom for, uh, more days than I care to remember, trying to break the inertia between those two worlds, trying to break the inertia of "I can't do this" to "let's try and do this." And that, that is the point at which I got stuck an awful lot, and I think a lot of other people do. And now, you know, many years hence and a lot of self-work and stuff like that, it's increasingly difficult for me to think about that. And it's increasingly easy for me to find equanimity when something bad happens, and increasingly easy for me to lean into discomfort when I need to as well. I know, you know, I might relapse at some point in the future or whatever, but every single time that even anything difficult does happen, it seems to happen less. And that spiral makes me feel empathetic for the previous version of me that I used to be, because I know how far that person was from having that positive reinforcement from overcoming something and knowing that we'll be okay and getting out the other side. And it's fine. It's just for now, it's not forever. And all of that stuff. That learning process is, is very meaningful.
- TCTim Clare
Yeah. And it's also, I mean, that feedback as well, they, they, it, it, it's, it goes back to kind of like the old kind of like classical conditioning that Pavlov was doing, um, with, with, with the dogs where, um, his, his, um, his lab where he was testing these dogs, you know, where he was ringing, he was sounding a buzzer or having the ticking of a metronome and showing them like a bowl of meat powder, and they would salivate and he would measure that, that they would cert- learn to associate the buzzer or the ticking of the metronome, um, with food and they'd salivate just at the noise, right? Well, he had a flood in his lab, um, one, one night, and, um, all the dogs had to be rescued. And it was very traumatic for them, like, the water was coming up to the, because it was in a basement area, right? And the dogs had like a pretty shit life under Pavlov anyway, but like, this was particularly bad. But afterwards, um, they found that all the dogs they had in the lab were no longer... They couldn't do that classical conditioning after that. They, they, something had frozen in them and they couldn't learn new associations. And, and this has been like in the work of, um, in, in, in the work on learned helplessness, where a dog gets sort of like one area of the floor will be electrocuted and another won't, and it will be sh- it will be shown a light and it has to move from one to the other. And eventually they make the task impossible for the dog. Eventually it will just lie down and let itself be electrocuted. And the only way that you can retrain a dog that has been through that is the, the, the experimenter has to like literally go in and drag the dog onto the safe area of floor to show that its assumptions about what is and isn't safe, once that, because they'll, they'll, once they make the test possible to win again, the dog won't bother to learn that it, that it can win it because it's just learned that life is impossible.
- CWChris Williamson
But the dog's inertia around its own worldview is so high that it on its own can't overcome it.
- TCTim Clare
And, and so an experimenter has to like come in and literally dr- I mean, it's hard, don't do that to dogs. Like, I could have told you that a dog would be depressed if you electrocute it repeatedly. But nonetheless, the lesson from this is they, you know, that you drag the dog onto the safe area and you do that repeatedly. And eventually it's like, "Okay, my assumptions about the world are wrong." But it, it is not going to do that itself. And, and that's what we can end up like basically in this kind of metaphor is, is like a, we just stay on that electrocuted part of the floor. And I saw this in other experiments, this guy Peter Lovibond did one where people would be, get an electric shock just before a sort of blue square would be flashed up on the screen. And they'd be told there's a button, right? And you can press it. And if you press it like within a second of the blue square coming up, the electric shock won't happen. And what they found is that they could, the button could be wired to nothing, right? And they just tell people that's what's going on. And they learn to press the button and they think they're stopping an electric shock, but there was actually never going to be one. And then when they're shown a blue square, people who have that button to press will get a jolt of anxiety, you know, all those kind of like physiological signs of it, even though they've never been electrocuted by that blue square. Um, and people who weren't given a button to press, who didn't think that there was any sort of a safety behavior, who actually then had the moment of going, "I'm going to be electrocuted." Oh. Oh. No, there was no electric shock. Unlearn that association and don't find it scary anymore. And this is something they call safety behaviors, like our ability to, people thinking, I can't, I'll have a panic attack on the bus unless I sit, I have to sit like one of two seats by the driver. And this is the second bit I wanted to get on really quick based on what you were saying about like facing up to stuff. As I spoke to this amazing researcher from Oxford University called Dr. Andrea Reinecker, who I heard about, someone told me about her and I thought, "That can't be true." Where she was solving, uh, curing people of their phobias and anxieties, like claustrophobics, by locking them in a cupboard, in a dark cupboard while giving them this thing called D-cycserine, which is like increases neuroplasticity and saying, "You won't be let out. Like, I'm going to put you in there and I'm not telling you when I come back. Can't call for me. Don't scream. Don't do anything." And these are people with like chronic, like really bad, um, phobia, claustrophobia. Um, and you just have to trust they'll come back. And you also, you can't do any safe behaviors. No taking, you know, a rescue remedy or a propranolol. You can't like do rosary beads. You can't pray. You can't tell yourself the nice lady will be back soon. You just got to sit there and just like bathe in it.
- CWChris Williamson
How the fuck is this ethical?
- TCTim Clare
... well, it had people's, um, they had their, well had their informed consent. There was a pretty reasonable dropout rate. A lot of people don't want to go through it, right? It's rough. Um, the trick, one of the tricks was actually she came back in 15 minutes. People were, had like cleared the whole day. They thought they might be shut in there all day. She came back in 15 minutes. Her like cure rate is one of the highest I've seen out of any treatment. Um, we, we know that like phobias are probably one of the be- most amenable to treatment out of anything we can do, but these people would like have their amygdala response and their phobic response like normalized. I think it was something like at least two-thirds. That was it. Like 15 minutes and their phobia (laughs) was cured, their claustrophobia was cured, which is nuts, right?
- CWChris Williamson
Why, what's happening there? Is it the drug?
- TCTim Clare
So D-Cycloserine is, um, a controversial drug to use in this situation (laughs) . Um, I read one paper that was called D... Right, so you will have already guessed what the problem with giving something that, um, increases neuroplasticity is if you put them in a very traumatic situation, and the paper was called D-Cycloserine in Making, um, Good Exposures Better and Better Exposures Worse, right? If the person panics in there and starts doing safety behaviors, um, the, the neuroplasticity, um, bakes that trauma in harder. Which is why, um, they're, you know, they're, they're looking at some other (laughs) possibilities because it's a risky thing to use. Um, it's no good sitting down to someone and saying, "A spider isn't gonna bite you." Like, it's n- you... Have you, how many times have you been bitten by a spider? None. How, how many people do you know who've been killed by spiders in, in your friendship circle in the UK? None. Right? Um, d- it's no good telling someone that. It's not getting to the parts of the brain that are making them feel like they're gonna die and they gotta get out of there. Your brain does not believe in hearsay. I- it doesn't care about that. It's got to experience it. And what, what going in that cupboard gives is like a cast iron experience. You have just gone up against everything you feared, and it had jack shit. Like, you turned round to the ax murderer who's chasing you in the dream, and you stood, and it turned out they were just a phantom, right? And there is something... I mean, of course, like, on a, like, conscious level, the idea of, like, facing your fear, we can all kind of like understand how invigorating that must feel. But just on a, on the kind of, uh, neurological level, and again, I'm talking about... I spoke to several neuroscientists who are like, their names are in... I'd got a copy of the manual Neuroscience out of the library (laughs) , and I looked up like the last, the last living name in the history section, um, on anxiety, and then I phoned him, I, I emailed him and he was like, "Yeah, I'll speak to you." And I, I, I got to speak to this guy, Joe Le, Ledou, who's like the amazing, uh, neuroscientist who deals with anxiety and, like, undoubtedly the most famous in the world. And he said that, "What you've got to do is let these parts of the brain..." He talked about the amygdala and the hippocampus, just like, learn that the threat is th- is not a threat. But you can't do that consciously. It's gotta happen non-consciously. It, it's got to go through it and go, "Yeah. Oh, okay, stand down everyone. (laughs) Like, turns out we were worrying about nothing." You can't talk to that part of the brain,
- 1:17:04 – 1:24:02
Lessons from Tim’s Research Experiences
- TCTim Clare
theoretically.
- CWChris Williamson
So having gone through all of these different strategies, tons of different techniques for trying to reduce anxiety, what is it that you've come to believe on the other side of it as someone who had a lot of firsthand experience, but also has now done a good bit of research with a thousand papers that you've read? What have you come to believe about what does and doesn't help anxiety? How has this changed the way that you deal with it in your daily life?
- TCTim Clare
Well, anxiety makes us crave certainty, right? I think w- anyone who's dealing with anxiety wants... Like w- I, I, I don't mind saying I wanted easy answers, right? I just wanted someone to say, "This is what you need to do." Anxiety craves certainty. It, it, it submits to authority. We want people just to tell us what to do. And the way out, and it sucks, is uncertainty. It's exactly what you were talking about when you were saying that moment of doubt where you go, "What if my beliefs about the world are wrong?" There is something much more terrifying behind anxiety, and I think the key to it is in people who have been through childhood traumas and yet blame themselves somehow. And I spoke to one guy who did like psychothera- psychedelic therapies and worked with people who've been through really, really grim shit, um, w- g- doing psychedelics and, um, and doing therapy while they were under the influence. And, um, I said, "Why do people... Why would someone think that was their fault?" And the key thing is if it's not your fault, then it wasn't under your control. If it wasn't under your control, there actually is no sequence of things you can totally do to stop bad things happening again. That is the ho- horrible truth about being a human alive in the world that we are asking anxious people to embrace when we ask them to come out of the woods, right? And I think that's where we've got to start, right? That it's... There's a reason to hold on to the destructive beliefs of anxiety and panic, and it is that if I can just hate myself enough, I can, I can like, uh, set the algorithm up, the fear algorithm. I can actually pr- predict any threat, and I can actually make my life safe. You can't. You, you just can't. We can do sensible things. I'm not saying you should, like, drink, uh, a quart of whiskey and go dance on the motorway, but, um, you cannot...... structure your life to avoid pain ... threat, like it's just not possible. And that is a bitter pill to swallow in the midst of anxiety. But, it's also where liberation lies. And it- that is the, I mean, if you'd told me that at the beginning, I would've been so angry. I'd have been like, "You don't understand." And I'd say, "No, I don't understand. So let's talk about it." 'Cause the other thing is all this stuff about, "Oh, this is how, you know, the cardiopulmonary system works. This is the hormone cascade," is all for naught unless someone feels understood. This is what a, uh, anxiety therapist of 25 years, this guy, he's also an author, Mike Shell, told me. He said he used to go in, he said, like, talking to people about the fight-flight response and telling them all the literature and just dumping it on them. And he said he realized that, that you can't get anywhere until you feel like you've been understood. Until someone has h- heard you and you go... 'Cause that was the breakthrough moment for me, and, and you go, "That's right. Oh, you get it. That's exactly how it is." And then the other... And it's almost like when you accept that, um, when you've been heard, all this other (laughs) other stuff is like, actually, all this other shit is ve- relatively easy. 'Cause we know, like, oh people are going, "Oh, I know I should do exercise. I know I should eat better. I know I should challenge myself, but I can't." And that thing about the impossible task you were talking about, you can't, like put your... People are going, "We, actually, we need to like, the, the world is very stressful and we need to campaign for sort of a, a, um, a, a more just world." Well, I agree with that. But, at the moment, I can't, like, bring myself to like have a wash. So can you understand why I'm not in a state to like upend the current system? (laughs) Like that's not helpful to me. Well, like one of the things that unlocks that ability to start doing things that are in your best interest is in the moment where the message of anxiety feels like it's delivered, like the little carrier pigeon of your anxiety has like delivered that message to someone, and they've heard you, and they've gone, "That is shit." And you've explained it to them, and you hear yourself say it as well, and you hear them say it back to you, and you go, "Fuck, that's actually... Now I say all that out loud, that's pretty bad, isn't it? I've been through a lot. I'm quite courageous." Then like a whole bunch of stuff melts, and then a whole bunch of energy that you've been using to be anxious, you can start like redirecting that. That like adrenaline's fucking great. You (laughs) can use that to like... I started doing like boxing one-to-one lessons and it like beat the shit out of me. I went to the guy, I was like, "Can you, j- I just wanna learn how to get punched in the face." And he was like, "Yeah, let's do this." (laughs) And it was great. And I'm like, it's, it is scary. It's not gr- I don't enjoy particularly having like someone swing at me and punch me in the head, right? But it's, it also is funny. (laughs) It is, it is funny in a boxing contest t- context to do all that stuff. And I'm like, "Oh, I've got all this adrenaline and energy. I can use this to like just rant it on, like, a, a step machine or a, or a, or a bike, or s- doing sprints, or like getting the kind of like battle ropes." And you're, and it's knackering you, and you're like, "This... Oh, like adrenaline feels good." So ultimately, I think like none of it, none of it, I think, can start until you have felt understood. And if you can't find someone else to do that, then being able to write it down and at least for you to come to terms with it, you know? I think, I think, I think everything else comes out, out, out of that. And, and that's why some of this stuff about all the other stuff that we know we should do but we can't bring ourselves to do, that falls into place when that kind of like core part of you inside, which is just like this kid that is freaking out, feels like someone's ha- got the message. And then they're like, "Okay, stand down. Alarms off. Now what were you saying about like eating some vegetables or... I can do that now because I've like delivered my message."
- 1:24:02 – 1:24:02
Where to Find Tim
- TCTim Clare
Episode duration: 1:24:39
Install uListen for AI-powered chat & search across the full episode — Get Full Transcript
Transcript of episode rb8jQnAPXcM
Get more out of YouTube videos.
High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.
Add to Chrome