The Truth About How Anxiety Works - Dr Tracy Dennis-Tiwary

1. 0:00 – 0:18

   Intro

   1. TDDr Tracy Dennis-Tiwary0:00

      Anxiety is not a light switch on and off, it's a dimmer switch. And on that spectrum, yes, there's panic. (laughs)

   2. CWChris Williamson0:06

      Mm-hmm.

   3. TDDr Tracy Dennis-Tiwary0:06

      Yes, there's overwhelming anxiety, but on the other end of the spectrum, there's this traison of this kind of excitement. This, "Wait, I'm kinda in it to win it. I care about this thing."

   4. CWChris Williamson0:17

      Why does anxiety exist?

2. 0:18 – 5:04

   Why Does Anxiety Exist?

   1. CWChris Williamson0:18

      It's the new sort of hot topic concern for pretty much everybody to deal with on a daily basis. Why is it even a human emotion?

   2. TDDr Tracy Dennis-Tiwary0:28

      So, anxiety is sort of the word we use to describe everything going on for us today. We, we e- we feel that we're in a new age of anxiety. You know, I actually think, and the whole premise of my book, is that we actually really have the wrong story of anxiety. That anxiety isn't this malfunction or a disease. That actually, anxiety is a triumph of human evolution. And that takes a little unpacking because anxiety is not necessarily an anxiety disorder, and we've, we've come to equate the two. So, anxiety is an emotion. It's evolved, like many other things, to be useful to us. And, and actually the, you know, when Darwin wrote his Theory of Evolution, it was a, it was, there were, it was a trilogy. There were three parts to it and the third part was called The Expression of Emotion in Man and Animals. And it was all about emotion and its adaptive value. And so, when you think of it from that perspective, well, why would we have evolved to have anxiety? It seems like this destructive, terrible thing. Anxiety is apprehension, this nervous feeling, our, our, you know, the physical thing, feeling, the bi- uh, the, the thoughts. All of those responses. It's, but it's apprehension about the uncertain future, which means that there's something coming around the bend. It could be bad, but it could also be good because it's uncertain. And anxiety actually prepares us to avert disaster and make good outcomes into reality. And so, anxiety evolved to help us actually manage this, perhaps the most critical challenge of humanity over our evolution, which is uncertainty. Things that we can't predict. Things we can't, uh, protect ourselves immediately from. And it prepares us to imagine the future. That's why I called the book Future Tense. You can't be anxious without thinking into the future, being a mental time traveler. You imagine the future, you plan, and in resu- and, and in response to those plans, you're more persistent, creative, innovative, and you prioritize social connections. And so anxiety is really, it has this aspect of being a real asset to us.

   3. CWChris Williamson2:27

      So, anxiety's fundamentally future-focused. You can't be anxious, but we can be anxious about something that happened in the pa... Oh, no.

   4. TDDr Tracy Dennis-Tiwary2:34

      No.

   5. CWChris Williamson2:34

      What we would be anxious about would be, I went and had a conversation with my coworker. It went really, really badly. I feel like a fool. I am anxious about how they are going to treat me the next time that they see me.

   6. TDDr Tracy Dennis-Tiwary2:46

      Yep.

   7. CWChris Williamson2:46

      So, even stuff that we reflect on, we're still going future-focused with it.

   8. TDDr Tracy Dennis-Tiwary2:49

      100%. That's right. And so, and we think about anxiety because it's so amorphous. I mean, language is so crucial. Our mindset, what we believe and filter in about our world. So, we've all come to assume that anxiety... And, and honestly, the reason I wrote this book... I mean, I've been a scientist for 20 years. I'm a researcher, I'm a neuroscientist, and I thought, "Oh, all right. We're gonna, we're gonna take great science. We're gonna beat back this mental health crisis we're facing." I actually became a psychologist officially on September 11th, 2001. That's 9/11. I was defending as the towers... My defense of dissertation as the towers were falling. I didn't know that. I'm a New Yorker. And so, here I am, this newly-minted psychologist, and I'm like, "Okay, we have a crisis here. I'm just gonna put my head down, and do the science, and create the interventions, and do the work." And then 20 years goes by and I look up, and mental health, if anything, is worse than it was before. It's been steadily... Mental illness has been on the rise. Um, we have great treatments. We have anti-anxiety meds if you need them. We have, uh, science-based wellness practices. We have self-help. We have a complete ecosystem that is there to help us prevent and eradicate anxiety, but it's only been getting stronger over the years. And so, I've realized that we've been doing something fundamentally wrong. As psychologists, we've been telling ourselves and others that anxiety is a malfunction, that it's probably a disease. That it, the discomfort of anxiety should be alarming to you, and so suppress it right away, prevent it, eradicate it. But, that is literally a recipe for making anxiety worse when we avoid it, when we suppress it. We know it always comes bouncing back stronger. And you don't develop ways of coping, and you forget that we can actually leverage anxiety to be this incredibly useful source of activation and energy, even though it does feel bad. It sucks. Energy, I mean, the energy of anxiety does not feel good, but it evolved to feel bad so that it grabs us, makes us pay attention. It's that, you know, it's like a smoke alarm going off telling us, "Okay. There's something to care about in the world. Now you better do your job and make it happen."

   9. CWChris Williamson5:00

      It's interesting when you look at emotions or traits that we have

3. 5:04 – 11:37

   How Anxiety can be Productive

   1. CWChris Williamson5:04

      that are adaptive and fitness-enhancing, but also uncomfortable. And, uh, the bottom line is humans are built to be effective, not happy, right?

   2. TDDr Tracy Dennis-Tiwary5:14

      Mm-hmm.

   3. CWChris Williamson5:14

      We're built to be effective. Survive and reproduce. Survive and reproduce. What are the traits that helped us to survive and reproduce? Now, we do have a mismatch, right? Between our current environment that we're in now and the one that every single trait that we now deal with developed in, and in a world which would have been significantly more dangerous, that would have had far more threats, where you could have been killed by a cut on your knee, or there was constant predators around and you didn't have shelter and you were cold in the winter and hot in the summer. As opposed to the other way around, which we now have with heating and air conditioning. Um, all of those traits were adaptive, right? They helped us to survive. And anxiety being... E- everyone understands, you walk toward... I, I do a little morning walk in Austin where I am at the moment, and, um, there's a lot of squirrels here. You guys (both laugh)

   4. TDDr Tracy Dennis-Tiwary6:02

      I'm in New York, we know squirrel-

   5. CWChris Williamson6:03

      Squir-

   6. TDDr Tracy Dennis-Tiwary6:03

      We know from squirrels. (laughs)

   7. CWChris Williamson6:04

      Squirrels intimately, yes. Uh, and...... there, I was looking this morning, I was thinking about the factory, we were gonna have this conversation and it was, I was so far away from this squirrel and it can move so much quicker than I can move. And yet, it was moving away from me, scurrying away from me, uh, because it's got a presumably some form of anxiety or concern or threat response where it thinks, "That big thing in the hoodie over there is walking towards me. I need to make sure that I keep my distance."

   8. TDDr Tracy Dennis-Tiwary6:33

      Right.

   9. CWChris Williamson6:33

      Even though we're, we're 10 yards apart.

   10. TDDr Tracy Dennis-Tiwary6:35

       Right.

   11. CWChris Williamson6:35

       So there is always an advantage, the negativity bias, right, to err on the side of increased danger. And I suppose that, yeah, seeing anxiety as something which is malignant or a, like an aberration of the way that we're put together is probably not fully embracing what it can do. And also, maybe even more importantly than that, as soon as you start to make anxiety a problem in itself, you get anxious, guilty and resentful about feeling anxious, which creates this second order effect that can often-

   12. TDDr Tracy Dennis-Tiwary7:07

       Which is, yes.

   13. CWChris Williamson7:08

       ... be even bigger.

   14. TDDr Tracy Dennis-Tiwary7:09

       It's a recipe for that. And something very interesting about what you said and which I spent a lot of time exploring in the book, what you described about that squirrel, I believe that was probably closer to fear than anxiety. And we tend to equate the two. So fear is, is present, you're in the present tense and you're certain there's danger right there facing you. And you don't have to have simulations of the future. You don't have to be a mental time traveler. Here's this big hoodie guy and he's coming towards me and I'm this little squirrel, hey, cutie, and I need to do something about that. I've learned, right, that's adaptive. But anxiety is about something you haven't seen yet. It's about being able to simulate in your mind and hold it at once, both the positive and the negative possibility. S-

   15. CWChris Williamson7:51

       What if the hoodie guy comes by tomorrow or next week?

   16. TDDr Tracy Dennis-Tiwary7:54

       Yeah. And I think, I mean, you'd have to be the, like the René Descartes of, you know, you'd have to be, you know, you'd have to be this existentialist squirrel to be able to really think that deeply, you know, about, about, um, about that because that's not, you know, animals I think do have some anxiety. I mean, of course, because I wrote a whole book about anxiety, I have a very anxious dog. (laughs) It's, and I can't-

   17. CWChris Williamson8:18

       (laughs) Is that, is that as a byproduct of you writing the book?

   18. TDDr Tracy Dennis-Tiwary8:21

       I have no idea, I can't figure it out. He's a rescue. But, but suffice it to say, when I think about his experiences, it's really about this certain present danger. And anxiety, again, you're thinking to the future, so it's not just protective. And that's something we can wrap our mind around, right? Like, fear can be protective too. It's actually productive. And this is where we've been asking the wrong questions, having the wrong conversations about anxiety because, well, here's something that, um, that's, that's scientifically established, but we don't talk about it. So we know that, uh, that dopamine is sort of the feel good hormone, right? It's that, it's that neurotransmitter in our brain. We think about it as having to do addic- with addiction on the bad side, but also any sort of pleasure, you get a spike of dopamine, right? Um, it's dr- sex, drugs and rock and roll. That's dopamine. And we think about this rewards system, which also is helpful to you because dopamine also spikes when you're anticipating pursuing something that's important to you, trying to work towards a goal. So dopamine's there as this little messenger among, you know, between your brain areas trying to, uh, get your brain to work effectively to meet your goals. But guess what also causes dopamine to strike, uh, to spike rather, is anxiety. So when we're anxious, dopamine has a huge increase in our brain. Now, why? Because when we're anxious, we still are hoping, we still, we're in it to win it. We're caring about the future. And so anxiety, by leveraging the rewards system is actually allowing us to say, "Okay, there's this bad thing that could be happening, but there's also this really good thing in my body, which feels a lot like fear," right? There's the fight-flight, there's all these other things, but those are the, fight-flight and fear are the three Fs. Anxiety on top of that recruits re- your reward system. It recruits your social bonding system. It recruits all this other biology that allows us to be positively focused, not just defensive.

   19. CWChris Williamson10:12

       Does that mean that people can get addicted to anxiety or they can become dependent or increasingly sensitive to it?

   20. TDDr Tracy Dennis-Tiwary10:18

       Well, we a- we actually have not asked a lot about that. It's a great question. What we think probably happens is that, you know, when you're tracking your emotional state, uh, you know, anxiety, you know, it's uncomfortable, it spikes, but so does dopamine. But then when you meet your goal, when you either do the thing you need to, you know, you're worrying about that thing in the future, you're like, "Oh, I better just take care of business?" Then when you've done that, dopamine will start to go down, your anxiety will go down. And that's negative reinforcement, right? So it can keep you doing that same thing and maybe that's a good thing, like persisting, um, because the absence of that, that, that feeling of anxiety ke- is, is rewarding to you. So in that sense what, what you're suggesting is really interesting because you're saying, well, but if we get hooked on that cycle of feeling good (laughs) right after we've done that thing, anxiety... I mean, that's one way that we know anxiety disorders operate. Like take, um, uh, what we now don't term an anxiety disorder, but an obsessive compulsive related disorder, OCD. The trick with OCD is that the obsessions, which are these disturbing thoughts, um, and ideas, we try to control them with the compulsions, the rituals. And so the rituals, we get stuck on these rituals because at least for a brief moment, they reduce our anxiety just in the short term. Of course, it comes screaming back later even stronger than ever. But it's that negative reinforcement cycle that keeps us hooked into obsessions

4. 11:37 – 19:17

   The Biology of Anxiety

   1. TDDr Tracy Dennis-Tiwary11:37

      and compulsions.

   2. CWChris Williamson11:39

      What, what is, apart from the dopamine, what is anxiety at a biological level? What's going on? I feel anxiety. What is being deployed within my body? What's happening?

   3. TDDr Tracy Dennis-Tiwary11:48

      So you have, you do have the, uh, autonomic nervous system, particularly, you know, the fight-flight system that's activated. So on the kind of peripheral biology, that's what you're having, uh, y- what you see happening. You also though, you have your central nervous system, you have your brain activating. And a lot of people, um, you know, because s- mostly because we scientists have talked about it this way, we think, oh, you're anxious or fearful and your amygdala starts firing, this fear center of your brain. But the amygdala, uh, which is the sort of part of this limbic emotional area of our brain, it's much more than just a fear detector. It, um, detects uncertainty.It also detects reward. And a- when you receive treatment for anxiety disorders, it's, it's as if the a- amygdala is representing all these important things in the world to us, neg- negative, positive, uncertain. And when you're treated for an anxiety disorder, that proportion shifts. So you start to maybe were over-emphasizing uncertainty and negativity and then when you get your anxiety a little more roped in, you actually start focusing more on the reward aspects of wh- why anxiety is driving you. So you have the amygdala, you have the limbic system, but you also have these corticolimbic circuits in the brain which connect the emotional brain with the prefrontal cortex. And so that circuitry is crucial because it's the prefrontal cortex and other areas and the temporal, you know, and temporal lobe that allows you to regulate your emotional experiences. It allows you to bring in memories. Um, the prefrontal cortex also allows you to be guided by your... And there's Mnoche in the background. Um, guided abou- (laughs) guided by your dr- your values, your goals, these higher order things that can drive us and give us a sense of purpose. So anxiety doesn't just make the amygdala fire, it recruits this whole brain circuitry, this beautiful, elaborate, uh, multi-layered aspect of who we are as human. And, and we've just sort of put it in this kind of we shuttle, we shuttled it aside and sort of said, "Oh, no, it's just fear and all the negative stuff." But it's all this other stuff too.

   4. CWChris Williamson13:44

      Is there some adrenaline dump in there too? Is there anything else going on?

   5. TDDr Tracy Dennis-Tiwary13:49

      W- when you have a sort of fight/flight response, definitely there is this... I mean, and if you think about how anxiety feels, I mean, everyone knows how it feels, right? It's, it's the heart racing. It's the butterflies in the stomach. And, you know, the word anxiety came from, um, much older words like, uh, angere, which is Latin for choking. And so you also have that sort of, you know, when you're, when all of a sudden you like kick in your, um, your sympathetic nervous system, that branch, that fight/flight system of the autonomic nervous system, you know, you can sometimes cho- you know, feel that like (inhales sharply) tension. Um, so it definitely activates that as well. But really what anxiety is helping us do is navigate uncertainty. So if you think about that, we think, "Oh, in this stressful, terrible world, you know, anxiety, of course it's spiking because there's so much uncertainty." There's so much, it's a poor match with how we evolved to be in reality. But really, in that sense, because we have so much uncertainty now on so many different kinds of levels, anxiety is still this incredible ally because it's an uncertainty detector. The minute we face something, and, you know, a second from now is the future. So it doesn't have to be a year in the future or a month. The minute we detect something that's uncertain, anxiety is there to focus us in on the posi- possibilities, both positive and negative, energize us, activate us, and, and it's there to help us navigate e- this ever-changing world.

   6. CWChris Williamson15:07

      I'm not sure if I would say that there is more uncertainty in modernity than there would've been ancestrally, but there's definitely more complexity.

   7. TDDr Tracy Dennis-Tiwary15:16

      Mm-hmm.

   8. CWChris Williamson15:16

      And complexity I think can maybe display as uncertainty that I, I know unless all hell breaks loose that I should be okay waking up tomorrow morning-

   9. TDDr Tracy Dennis-Tiwary15:27

      Mm-hmm.

   10. CWChris Williamson15:28

       ... the predator's at the door. Um, one of the things that I wonder is l- let's say that I go to sleep tonight, but I'm not going to sleep with a, a dog snoring near me and a fire crackling, both of which have been shown to improve the depth of people's sleep. And presumably that's because ancestrally if you had a fire and you had a dog, that would mean that you could afford to go into deeper sleep, fewer micro awakenings, you're going to be able to be more responsive. Um, the problem is maybe the real increase in actual safety and certainty that we have, I'm more certain... I would f- much sooner be in this locked bedroom than have a fire and a dog, but out in wilderness, right?

   11. TDDr Tracy Dennis-Tiwary16:12

       Mm-hmm.

   12. CWChris Williamson16:12

       Um, but I just don't know if the s- if our systems are, are accepting that. So even though certainty, uh, from a sort of rational perspective has perhaps gone up, first off, it's maybe mismatched with what our body detects as certainty and safety. Uh, and then on top of that, there is absolutely more complexity, right?

   13. TDDr Tracy Dennis-Tiwary16:30

       Mm-hmm.

   14. CWChris Williamson16:30

       There is way, way, way more noise and far less signal, what we consume on a daily basis. Um, as well, what you said about how the amygdala and the front brain are connecting makes a lot of sense because what you're doing usually when you're getting anxious is creating these elaborate dream/nightmare scenarios in which everything goes wrong, but you need to recruit a, a big chunk of brain power, right? To be able to d- it's this super colorful, and you can almost feel it, you can hear what it would be like walking across the floor-

   15. TDDr Tracy Dennis-Tiwary17:00

       Yeah.

   16. CWChris Williamson17:00

       ... to speak to your boss, to have the conversation and what the door looks like and the handle looks like and you're opening and that's his face in front, or whatever it is, right, that you're doing. Or the awkward conversation with your partner. Um, that takes a lot of imagination, right?

   17. TDDr Tracy Dennis-Tiwary17:12

       Yeah.

   18. CWChris Williamson17:12

       So it's, I suppose in one way anxiety is a, a, a pretty, uh, complex and sort of high, um, processing recruitment, uh, thing for our brains to do.

   19. TDDr Tracy Dennis-Tiwary17:25

       Yeah. That's, I mean, that's why I think of it as a triumph of human evolution because that, being a simulate- be- being able to do mental simulations in exquisite detail like you described, that is a very human evolutionary ach- achievement that I believe is probably unique to humans among other, among other animals. You know, the thing is, it's a really great point about certainty and the nature of certainty and uncertainty. And we think of... And of course we had much, a much longer time to evolve being concerned about certainty with basic safety threats, you know, and all of this. But we also have evolved to be highly adaptive to what a, uh, different, you know, a different context or a new context throws our way. And, and that's why, you know, there's a whole chapter in the book that I just call Uncertainty. I don't actually use the word anxiety until the very end of the chapter, because really what anxiety is s- it's solving the problem of uncertainty for us, because that un- you know, we may have our physical wellbeing taken care of, but when we're in this complex world as you, as you note, all of a sudden there are all these other concerns that we consider to be life and death.Will we have status? Will we have relationships? We've been taught to believe that there are, you know, there are these standards of, um, what it means to be well. You know, these sort of toxic standards of positivity, right? That if you fall short, um, of some perfection of being happy or content all the time, then it's just a failure. And so these are sort of, they are not survival needs, but the human brain perceives these kinds of goals that we've, we have decided are central to what it means to live a happy life as being almost like survival. So I agree with you, there's so much that's more certain, but the level of complexity, information flow, and uncertainty, and other higher order domains, I just wonder if it sort of, uh, evens it out in a way.

5. 19:17 – 28:09

   Anxiety’s Relationship with Stress

   1. TDDr Tracy Dennis-Tiwary19:17

   2. CWChris Williamson19:17

      How do you see anxiety relating to stress?

   3. TDDr Tracy Dennis-Tiwary19:21

      So anxiety is an emotion, stress is not. Stress is about this combination of, uh, it's a, it's the, it's our belief, um, that we can handle and cope with certain events in the world combined with the actual demands of, uh, the world as put upon us. So stress is never just, um, you know, I- I went downstairs, um, and there's Union Square Park in Manhattan right below me. And, um, I walked out there and someone, you know, pushed me. Um, and, um, that's very stressful and it's also aggressive. And, you know, so stress is that burden or that experience that requires you to respond, right? But it's also your belief that you can handle it. So me, all 5 foot, almost 5'4" of me, you know, I tend to, I tend to believe, uh, that I- I have a lot of, uh, power in this world. I believe that if someone really came at me, I'd get that adrenaline rush and be able to take them on. And I would probably unwisely, (laughs) you know, I'd feel like I could defend myself. And so when that person pushes me and runs away, I might feel a little less stressed than a person who doesn't believe that they have what it takes to handle a- a confrontation. So it's always this, your- your personal perception of what you can, uh, how much control you have, how much ability, and the experience itself. That's just not anxiety. Anxiety is this picturing the future, there's threats and there's rewards.

   4. CWChris Williamson20:47

      It's interesting that you talk about stress through the same, um, lens that one of my friends, uh, James Smith, he's got a book, How to Be Confident, coming out soon. And I think one of his, uh, fundamental assertions is that confidence is your ability to know that you can deal with any challenges that come up and- and face you. So there is some sort of cashflow system that you have in your mind around-

   5. TDDr Tracy Dennis-Tiwary21:13

      Mm-hmm.

   6. CWChris Williamson21:13

      ... what is, what is the challenge, what is my capacity to meet the challenge. Uh, and I do think that, I do think that you're right. Anxiety just seems to be less rational. I mean, e- even less rational than stress is kind of impressive, but it- it- it does manage to remove... You're, you're not thinking about... Unless you get very conscious about it, unless you're breathing deep and you're trying to formally move through a process, you don't really think like, "Oh, but think about all of the previous times that I've got through this. I know this one's going to be different. This time is going to be the catastrophe that means whatever." Uh, and it's also hilarious to think about how, uh, acute the anxiety response is to something which totally has absolutely nothing to do with anything that we really genuinely care about long term, right? So it's a lot of stuff to do with, uh, social comparison, let's say. You post a stupid, uh, comment on your friend's Instagram page and you think, "Oh, everyone's gonna see that and it's gonna make me look dumb." Or you find out that one of your friends has unfollowed you.

   7. TDDr Tracy Dennis-Tiwary22:13

      Mm-hmm. Yeah.

   8. CWChris Williamson22:14

      But yet you have this- this sort of anxiety dump the same way as if you needed to have a fight tomorrow. Um, it's-

   9. TDDr Tracy Dennis-Tiwary22:19

      Well, you know, that's interesting. I would take issue with that a little if I heard you correctly, that you think that anxiety is less rational than stress?

   10. CWChris Williamson22:28

       I don't know. I- I would say that our ability to- to interject into anxiety... Anxiety to me seems to be more acute.

   11. TDDr Tracy Dennis-Tiwary22:36

       Mm-hmm.

   12. CWChris Williamson22:36

       It seems to be more difficult to pattern interrupt when it's occurring. And perhaps that's simply because it is more acute and stress tends to be a little bit more ch- chronic and long term.

   13. TDDr Tracy Dennis-Tiwary22:47

       Mm-hmm.

   14. CWChris Williamson22:47

       Um, I... Maybe they're both-

   15. TDDr Tracy Dennis-Tiwary22:51

       Let me give you, let me give you an example, if I may, that I, and I'm wondering what you're gonna think of this. So, you know, anxiety, any... So evolutionary theories about emotion and actually the kind of emotion scientist I was trained to be, uh, are, it's called a functional emotion theorist. So the whole idea of functional emotion theory is that emotions are profoundly rational. That they've, and this is really drawing on Darwin, that they evolved to give us information, which we call, which is called appraisal in the theory, and action readiness tendencies. And they're so automatic that they save energy, so they're efficient. So for example, anger is the appraisal, the information that you have a desired goal that's blocked and it's the action... So once you- you've said, "Okay, I'm angry because this thing I want, there's an obstacle to it. It's blocked for me." And that appraisal, that information creates the action readiness tendency to overcome the obstacle. So it prepares you to fight, to do what you need to do, to persist. And so that's fundamentally rational, right? Now... And it's also automatic and efficient. And so the way I think about anxiety is that it's this automatic appraisal that this future is uncertain and it's, but it's something I care about. So your example about posting something stupid on Instagram, and I don't even do social media really that much anymore 'cause I just can't get past the, like, how do I do this? And it's really, you know, and I- I don't know what to say and I feel like I'm a brand and that's... I'm a Gen Xer, so that's fundamentally aversive to me. Anyway, um, but you know, you, that... If you had that feeling, if you posted something and you thought it was stupid, anxiety is the information that you care about that. You care about looking stupid on Instagram. I personally, like, may not... Or let's not talk about me anyway. Someone who can post something and just blithely post anything they wanna and they just don't care. They won't get anxious about it because anxiety...... points you, you can only be anxious when you care about something. So it's that information. Uh, and imagine, uh, y- I don't know if you've ever had this happen, but, um, you know, you wake up at 5:00 AM and you have those worries. It's like free-floating anxiety going through your head, right? So you sit there and y- you can do one of two things. You can say, "Oh my god. I have to surp- I have to get rid of this 'cause it's, it's painful, it's unpleasant." Or you can say, "There's some information for me in here. Let me, let me ... What, what's going through my mind here?" So you might sit there and say, "Oh, wait a second. Is it that fight I had with my partner last night?" And you're like, "Uh, no, we resolved that." And you're like, "Okay, what is ... Is it something at that work thing that I have to do?" Then, "No, that's, that's okay too." And then, you, you're, and then you're feeling it and you feel, "Oh, wait a second. I've been waking up every morning with searing pain in my stomach for two weeks. Oh, maybe I should be caring about that and maybe I should go to the doctor. Hmm. Yep, that's it. Bingo." So, so anxiety is giving us this information about what we care about and when we listen to it and interpret it as useful, it can be an incredible helpmate to us. So there, there was this beautiful study that was done by Jamison and colleagues in 2013 there, um, out of Harvard, also Matt Nock and other colleagues, and they brought in socially anxious patients, so people diagnosed with social anxiety disorder. And when you have social anxiety disorder, the key concern is that you fear social rejection and judgment. And so they brought in this group, uh, of people and then they prepared them to do what is literally a torture session for a socially anxious person, um, which is to, in three minutes, prepare a speech about something very contentious, probably like the death penalty or something like that, um, and present it after this brief preparation in front of a panel of judges who will be evaluating you on your performance and they're, and all the judges are sitting there like, like that. So this is a torture session for someone who's socially anxious. And th- so, and they have this, and they're, and they're getting ready to do this and their hearts are racing, and then they take half of them aside, just half, and the other half are, are left. They take half of them aside and say, "Okay, listen. You're going to feel your racing heart and your, your butterfly, all those feelings. You're sweating. That's not s- about, you know, that's not the feeling that you're about to fail. That's not a malfunction. That's actually your body performing what it needs to do. It's preparing to be at peak performance. It's actually your blood pumping through your veins so that your brain can be sharper. It's actually ..." You know, it's this, you know, and so there's this mindset re- resetting that was happening. They were also given some scientific articles just in case they didn't believe it, and they were like, "See these five scientific articles that show this and Darwin's evolutionary theory and et cetera." So they get 10 or 15 minutes of this and then they do this, this, um, uh, folks who didn't get this information about the adaptive value of anxiety, they do it too, and they were monitoring heart rate and blood pressure and performance during the speech. And what do you find? The half of these socially anxious people who are forced to do what is this torture session for them, their heart rates are slower than the other half of the group. Their blood pressure is lower. They perform better. They stutter less. They- they're more confident. Essentially, they look more like people who are kind of brave and preparing to act and doing their best and at peak performance than, than people who are overwhelmed by anxiety biologically and in terms of performance. And so this was, all this was was helping these folks take in anxiety as information and reframing what that information meant to them, and it, they were actually then able to leverage it.

6. 28:09 – 32:36

   Power of Reframing Situations

   1. CWChris Williamson28:09

      What's the lesson that you take away from that, uh, from a, uh, applied sense?

   2. TDDr Tracy Dennis-Tiwary28:14

      Well, interestingly, Jamison and colleagues are developing a whole intervention for social anxiety based on this concept. It's sort of the, the sole purpose of my book, which is, it's not really a self-help book in the traditional sense. There aren't tons of tips or ... It's really a mindset shift. It's really the idea that right now, our view of anxiety, our language about anxiety, our assumptions and, um, what we believe anxiety to be, uh, the role it plays in our life, these beliefs are setting us up for failure. They're making us do things that make anxiety worse, like avoid anxiety, have meta-fear and meta-worry, you know, all, you know. And, um, and so if we can reconsider our, what anxiety is, what, that there are advantages as well as really just being terrible too 'cause it feel, no one wants to be anxious, so that's not the argument. I ... But by making this mindset shift, you can actually learn better to cope with anxiety. You can benefit more from treatments if you do have clinical anxiety and need that extra support. And you can actually start using anxiety in your life almost like this sort of alchemical process where you can take that energy, take that, that emotion, understand what you care about, leverage it to hope and to work hard and to persist and to be more creative, that you have that opportunity that you didn't have when you thought about anxiety differently. So this can be directly embedded in a treatment approach, a existing treatment approach, and Jamison and colleagues are developing whole new treatment approaches just formalizing that kind of an instruction to people, mindset shift.

   3. CWChris Williamson29:47

      It's interesting talking about how the framing that you place around the emotions that you're feeling or the state that you're in kind of fundamentally changes what it is, right? I have a friend, Bridget Phetasy, who's a comedian and she started doing comedy relatively late and she gets super, super nervous before she goes up on stage and she has a little mantra that she says to herself before she goes up on stage and she's saying inside of her own head, "I'm not nervous, I'm excited. I'm not nervous, I'm excited."

   4. TDDr Tracy Dennis-Tiwary30:14

      That ... Precisely, that's precisely it and it's a small nudge, but those kinds of nudges many, many times over, repeated over time, they're incredibly powerful.

   5. CWChris Williamson30:24

      "I'm not nervous, I'm excited" is such a good reframing before you've got to go and give something.

   6. TDDr Tracy Dennis-Tiwary30:29

      Yeah. Yeah, and that's the spectrum of anxiety. Anxiety is not a light switch on and off. It's a, it's a dimmer. It's a dimmer switch. And on that spectrum, yes, there's panic. (laughs)

   7. CWChris Williamson30:38

      Yeah.

   8. TDDr Tracy Dennis-Tiwary30:38

      Yes, there's overwhelming anxiety, but on the other end of the spectrum, there's this frisson of this kind of excitement, this, "Oh wait, I'm kinda in it to win it. I care about this thing."I mean, talk to any performance artist, like your frie- you know, like your friend, any comedian, any dancer, any performer, and many of them will tell you, "If I'm not throwing up in the bathroom before I go out on stage, something's wrong. It means I don't care about it. And what I've learned," the performer might say, "is that that signal is, is getting me ready and it doesn't mean that I'm about to fail or there's a malfunction."

   9. CWChris Williamson31:10

      I had another friend who is supporting Eric Prydz on a world tour and has been for years and years and years. He used to play for us in Newcastle. And before he goes on stage, he's always very, very close to a toilet. And this is a guy that's played Madison Square Garden on New Year's Eve.

   10. TDDr Tracy Dennis-Tiwary31:23

       Yeah. Yeah.

   11. CWChris Williamson31:23

       Right? He's played the biggest gigs ever and he's been doing this for 15 years and he's one of the most competent, hardworking people that I know. And yet, every single time before he's about to go on stage, he still has that. And it, it almost gets ... But this is where you can see how superstitions and rituals of football players-

   12. TDDr Tracy Dennis-Tiwary31:40

       Mm.

   13. CWChris Williamson31:40

       ... start to form, right? "Well, I put the left sock on, then the right sock on, then I did a double bow on the, the left foot, but not on the right foot 'cause we don't do that. And then I touch the top of the tunnel as I go out." All of these sort of bizarre rituals and superstitions are part of that, uh, frame setting, that pre-game routine that gets them from perhaps nervous to excited to performing, to flow.

   14. TDDr Tracy Dennis-Tiwary32:06

       Exactly. And, you know, I wi- I wish now in retrospect that I'd had a whole chapter on, on sports in this book because it's so clear that this mastery e- of anxiety, having it, owning it, and using it, that th- that this kind of mastery is central to, I think, sport greats and elite athletes. And, you know, and they have those rituals. All those rituals are, are tools to channel, you know, and sort of transform that, that anxiety into something, uh, that they can work with.

7. 32:36 – 36:59

   Errors in Diagnosing Anxiety

   1. TDDr Tracy Dennis-Tiwary32:36

   2. CWChris Williamson32:36

      What mistakes did medicine make when it comes to identifying anxiety, facilitating it, explaining it to the public?

   3. TDDr Tracy Dennis-Tiwary32:44

      I think the biggest thing is, you know, the prime fallacy that we mental health professionals really for the better part of 100 years, really since Freud and even before that, uh, the prime fallacy is that any experience of anxiety is a malfunction or disease, right? And so we don't know anymore how to distinguish between anxiety and an anxiety disorder. And the key distinction is not the level of anxiety. So y- y- you don't get diagnosed with an anxiety disorder if you have ex- you know, high levels of anxiety, you know, even on a frequent basis. The only time you'll be diagnosed with an anxiety disorder is if the way you cope with your experiences of anxiety start to get in your way. So that if you, um, are socially anxious and you cope with that anxiety by not going outside anymore, not going to any parties, not being able to go to work, it's that, it's, it's those ways of coping that actually, that functional impairment, which is what you call it when you're diagnosing someone, it's that that is a sine qu non of an anxiety disorder. Um, there's a beautiful, um ... You know, I'm also, um, a child psychologist by training and so I think a lot about kids and families and, um, and there's this great treatment that takes this as a starting premise coming out of the Yale Child Study Center, Ely Lebowitz and his colleagues. It's called SPACE. Um, it's, uh, it's about helping parents help their kids just experience and tolerate anxiety. So he, he'll, you know, so this treatment, what it involves is, um, you'll bring clinically anxious kids, so kids with anxiety diagnoses, into the clinic, and, you know, h- in some of these controlled trials, half of the kids will get gold standard cognitive behavioral therapy, which is some of the best therapy out there. The other half won't. Instead, their parents will be taught to stop over-accommodating anxiety in their kids. What does that mean? Uh, the kid who's afraid to fly, parents who, out of the best of intentions, want to comfort the child, will stop all family vacations that require taking a flight somewhere. Um, the kid who's, you know, who doesn't wanna be separated from the parent, they'll say, "Well, okay, you don't have to go to school today and you don't have to go tomorrow and you don't have to go the next day." That's accommodation of anxiety in a way that's actually not helping and we know makes anxiety worse. So the parents are simply taught to stop that and instead support the kids in actively coping with all the discomfort of anxiety and all the distress. And what you find is after the parents get that six weeks of treatment and you compare them, the kids of those parents, to kids who got treatment themselves, 80 pers- 80 ... I think that one of the first studies they did, 87% of those kids whose only their parents received therapy showed significant reduction in, reductions in clinical anxiety. They did as well as the kids who got therapy themselves.

   4. CWChris Williamson35:27

      So if you did, if you were able to combine the CBT with the parents' therapy?

   5. TDDr Tracy Dennis-Tiwary35:31

      No, there's no CBT for the kids.

   6. CWChris Williamson35:33

      No, but is there not CBT on the control group?

   7. TDDr Tracy Dennis-Tiwary35:36

      No. It's only the ... Oh, I'm sorry, so in the comparison? Well-

   8. CWChris Williamson35:40

      Yes.

   9. TDDr Tracy Dennis-Tiwary35:40

      Yeah, so the, there w- so the kids, half of them just got CBT.

   10. CWChris Williamson35:43

       Yes.

   11. TDDr Tracy Dennis-Tiwary35:44

       And then the other half just got the parent. Right, so what, the magic, uh, co- combination should be both (laughs) .

   12. CWChris Williamson35:48

       Yes. That's what I was, that's what I was thinking.

   13. TDDr Tracy Dennis-Tiwary35:50

       Yeah.

   14. CWChris Williamson35:52

       Um, what is, what's a, what's ... How heritable is anxiety? That, why, why do you have a, an anxious child and not an anxious other child? Have you got any idea about heritability?

   15. TDDr Tracy Dennis-Tiwary36:05

       There's, there's good evidence that anxiety disorders, again, this is the extreme of the spectrum, are only moderately and probably mildly heritable, which suggests that there's probably a genetic and temperament component, but it's so much more sort of how, you know, what you bring to the world matches with the demands that are thrown at you, the stressors that are thrown at you, combined with how you learn to cope with that. So, you know, for example, I have two kids, a 13-year-old son and a 10-year-old daughter. And my, boy, my son's gonna kill me one day, but he's a little more on the anxious side and there are several stories about sort of that anxious experience, um, that he's always brought to the table. There's stories about how much, how terribly I have failed in helping him with that. But I know that, you know, part of that ...... is him. Part of that is the fit with my parenting style and part of that's the, what we help him, uh, how we help him cope.

8. 36:59 – 44:44

   Anti-Anxiety Medication

   1. TDDr Tracy Dennis-Tiwary36:59

   2. CWChris Williamson36:59

      How effective is anti-anxiety medication?

   3. TDDr Tracy Dennis-Tiwary37:03

      I think that for many people, anti-anxiety meds are a really important temporary step. And, you know, benzodiazepines are ... They were really a revolution when they were created about, uh, 70, 80 years ago now. Of course, they were stumbled upon. It was by mistake, um, (laughs) but, yeah, but-

   4. CWChris Williamson37:20

      What's the story there? Do you know the story?

   5. TDDr Tracy Dennis-Tiwary37:22

      Yeah. So, um, so, um, prior to benzodiazepines, um, um, you know, the treatments for anxiety were, were very, uh, very dangerous, you know. So there are these tra... Essentially, these, these tranquilizers, minor tranquilizers (laughs) that were given to people, um, barbiturates, um, to treat anxiety. So Judy Garland and Marilyn Monroe died of barbiturate overdoses, which were anti-anxiety meds because they suppress the central nervous system. So if you take too much or combine with alcohol, you stop breathing. Your heart stops beating. So this was sort of the go-to treatment. Um, and doctors having medicalized, you know, anxiety to be, to be, "Oh, it's a disease, we better treat it," you know, really wanted some way to relieve people's pain. They didn't think about, "Well, how do we help them through it?" So luckily, um, there was the, uh, discovery of, uh, benzodiazepines, and essentially what happened is, you know, they're, uh, uh, th- these researchers, um, uh, and pharmacists, they were trying to create a better ch- uh, drug and they finally gave up. They were working, working, and one of the, uh, scientists literally just left his mess, uh, on a bench, like on a, on a scientific bench and went away for three months. And finally, someone was sent in (laughs) to clean it up and they found... I'm not a s- a chemist, uh, but they found these beautiful, like, well-crystallized (laughs) I guess, little compounds. And they started looking at them and it turned out these were benzodiazepines. And so now what you have is you have, um, what they believed at the time to be less addictive, um, to be, um, to be more tolerated, well-tolerated, and very effective in reducing anxiety. So the first, uh, anti-anxiety med was Valium, and, you know, it became so popular in the '50... This was in the '50s that they had discovered it. In the '50s and '60s and '70s, you know, they, the doctors would just prescribe it and call it V. (laughs) It was Valium. Um, you know, the Rolling Stones song, um, Mother's Little Helper, that was Valium. Um, it used to be called, uh, Executive Excedrin, you know, the, the painkiller Excedrin because all the executives and business, uh, people would be popping it as they went cross, you know, cross, uh, cross the world in their business trips. And everyone was very optimistic and hopeful, but then what started to happen is we realized that benzodiazepines were very dangerous as well. And they are addictive and they are also nervous system depressors. So that means, again, if you combine them with, say, opioids or you combine them with alcohol, they can s- they can cause coma and death. Um, what we see ... And there's, there was a really interesting, uh ... A lot of, uh, awareness in general, but there was an interesting piece that came out in Complex Magazine a, a little while back, a few years back. I was actually interviewed for it. And it was, it was about the crisis of, um, of anti-anxiety meds in the hip-hop community. And so what you see is a lot of these hip-hop stars were starting to take anti-anxiety meds, um, all the time. And-

   6. CWChris Williamson40:17

      But they were all on Percocet, Xanax.

   7. TDDr Tracy Dennis-Tiwary40:20

      Yeah. And there was that guy, Lil Xan. Do you remember Lil Xan? I think he renamed himself.

   8. CWChris Williamson40:23

      S- SoundCloud rapper. Yeah, he's recently-

   9. TDDr Tracy Dennis-Tiwary40:25

      Yeah.

   10. CWChris Williamson40:25

       He-

   11. TDDr Tracy Dennis-Tiwary40:25

       He was a SoundCloud rapper. All the SoundCloud rappers in history.

   12. CWChris Williamson40:27

       He's recently just called out his manager. A guy with the name Lil Xan called out his manager for providing him with drugs. I'm like, "Bruh, (laughs) bruh, it's in your name."

   13. TDDr Tracy Dennis-Tiwary40:38

       I know.

   14. CWChris Williamson40:38

       But one of my favorite rappers, Juice WRLD-

   15. TDDr Tracy Dennis-Tiwary40:40

       Oh, God. I was gonna talk about Juicy. I have a whole section on him in, him in my book because that is a tragedy. And he died, yeah.

   16. CWChris Williamson40:46

       And he was s- so talented. Like, I adore ... It satisfies two, two very big parts of me. The one part which is to be cool and to listen to rap, and the other part of me which is still an emo from when I'm 15-

   17. TDDr Tracy Dennis-Tiwary40:59

       It's a, it's a perfect mix for you.

   18. CWChris Williamson40:59

       (laughs) It's, it's exactly-

   19. TDDr Tracy Dennis-Tiwary41:01

       It's a perfect mix.

   20. CWChris Williamson41:01

       ... what I've always wanted.

   21. TDDr Tracy Dennis-Tiwary41:02

       And, I mean, and I love it. You know-

   22. CWChris Williamson41:03

       And I discovered him post-

   23. TDDr Tracy Dennis-Tiwary41:04

       ... and my 13-year-old son, so.

   24. CWChris Williamson41:04

       Like, posthumously. I'm like, "No, hang on."

   25. TDDr Tracy Dennis-Tiwary41:06

       Yeah.

   26. CWChris Williamson41:06

       "Hang on a second." Like, I, th- what, there's no more? There's no-

   27. TDDr Tracy Dennis-Tiwary41:10

       I know.

   28. CWChris Williamson41:10

       There's gonna be no more of this? Yeah, it's so sad.

   29. TDDr Tracy Dennis-Tiwary41:12

       Well, when, when he-

   30. CWChris Williamson41:12

       And he was, Percocet coming off his private jet.
9. 44:44 – 55:57

   Technology’s Contribution to Anxiety

   1. TDDr Tracy Dennis-Tiwary44:44

      out.

   2. CWChris Williamson44:45

      In what ways do you think technology has contributed to the modern anxiety epidemic?

   3. TDDr Tracy Dennis-Tiwary44:52

      I, I think that anxiety and digital technology, there is a relationship there. As a scientist, I know and, uh, that we have overstated that relationship and oversimplified it. So if you read the headlines, it's, you know, uh, you know, social media destroyed a generation or, um, you know, TikTok is cause, Instagram is causing, uh, mental illness in people. And it's really never that quite simple. Um, one is that there's no, there are actually no data to, to actually show that if you go in, out, with everything else being equal, you use social media and you become more anxious and more depressed. It's much more of a linchpin in those problems, our digital technology, and you're struggling and you're anxious and you're depressed. We can use things, uh, these social media in, in ways that actually make it worse. So, uh, for example, there, where we do have some good research, um, it shows that it's the way you use social media, not so much how much you use that makes a difference. And people have divided the ways into two, the kind of the active/passive distinction. So when you're using social media in active ways, you're actually creating something. You're seeking out information. You're, you're doing something that's much more goal-directed and, uh, usually something that's also actually leveraging your creative powers. Passive use is when we're tuning out. We're using technology like a big, uh, you know, avoidance machine, right? Just this giant way of just, it's like e- just eating a bag of chips, right? We're just, we're doomscrolling. We're, like, reposting, you know, other people's stuff. We're social com- We're, like, counting how many likes we have and we're doing social comparisons. When we use social media in passive ways like that, that tends to accelerate and exacerbate things like anxiety. So what I see the problem of being is that we have to shift away from black and white ways of thinking about technology and just, you know, we have to become good digital citizens. We have to say, listen, I, well, I personally believe that, that tech companies need to change their algorithms. I mean, they're not for human good, they're just for their bottom line profit. So I think those algorithms and all the toxicity of these, uh, of these platforms is a problem. But until we can figure that out, we need to be empowered to make choices and to know, hey, just like I know I need to eat fruits and vegetables and once in a while salt and vinegar chips, which is my favorite, um, you know, we have to make the same choices about social media. We have to know that if we're doomscrolling all day, it's gonna make us feel bad. It's gonna make us feel crappy. Whereas if we create some really exciting content or a podcast or we're doing something really interesting, that's going to elevate us and elevate others around us.

   4. CWChris Williamson47:23

      What are your thoughts about the insights Jonathan Haidt got when he managed to align, I think it was about 2012, 2013, the introduction of Instagram with this huge spike in terms of young female anxiety and that wasn't mirrored across into men? Have you thought about this?

   5. TDDr Tracy Dennis-Tiwary47:40

      A lot. And I've critiqued those data heavily. And this is really ... (laughs)

   6. CWChris Williamson47:44

      Bring it on. Send it. Come on.

   7. TDDr Tracy Dennis-Tiwary47:45

      And I think Jon Haidt is a great, I think Jon Haidt is a great scientist. I mean, he came out of a, a different field of study. You know, he's, he's, uh, his, you know, he really studies moral reasoning and, um, and has done amazing work. I think his work on, you know, I think his book, The Coddling of the American Mind is a very important and interesting one. Um, I think his work in political, uh, you know, political psychology is very important. But here's where I think he's getting it wrong. Now he's actually citing a lot of Jean Twenge's work, that he and Jean Twenge have joined forces. And she's a social psychologist who has conducted, um, kind of taken large epidemiological data sets. You know, tens and thousands-

   8. CWChris Williamson48:22

      What do you mean when you say large epidemiological data sets?

   9. TDDr Tracy Dennis-Tiwary48:25

      Survey data that it, that she didn't, in most cases, actually gather. And, and, and you have tens and tens and tens of thousands of people, and then you start to look for correlations among things. And so, and she tracks, and she tracks these sort of generational shifts, and that's part of the work that she's contributed to psychology. But where I feel she's gone a step too far, and where I think Jon Haidt is, is also looking, um, at some of those data is to say, "Okay, well, we do see that there's a correlation between the introduction of the mo- of mobile phones, um, and this sort of spike in..."... anxiety and depression that teen- see- seems to be carried by, by girls. Um, and you can also look at, you see correlations between amount of technology use and these kinds of symptom profiles. Number one, um, these were not data that were about clinical anxiety or depression in most cases. So these are, again, these are existing data sets. So, these are not clinical studies of actual clinical anxiety and depression. Number two, a great group out of Oxford actually had access to those same data sets because they're publicly available and they did a reanalysis. And they found that the effect size of the link between technology and say anxiety or depression was quite small, and they could also find a similarly powerful effect size, a link between eating potatoes and mental health. So, the more you ate potatoes, the more anxious and depressed you were. And it was literally at the same level of correlation as the link between technology and anxiety and depression. Now, all that to say, I don't think that rules out the fact or the possibility that there could be a strong link. I think that digital technology and social media, I see lots of negative, potential negative impacts. But to say that there's a simple causal, all screens are bad link between mental health and digital technologies, th- we just don't have the data. I think it's more useful to get nuanced and to say, well what kinds of use are problematic and for whom and why? So these large data sets are ƒthat's actionable and there's also a lot of ways to reinterpret the data.

   10. CWChris Williamson50:31

       I remember seeing a bunch of very strange correlations online that's to do with a graph, and I swear that one of them was the number of movies that Nicholas Cage starred in in a year-

   11. TDDr Tracy Dennis-Tiwary50:41

       (laughs)

   12. CWChris Williamson50:41

       ... and the number of people that died by overdosing on cheese.

   13. TDDr Tracy Dennis-Tiwary50:46

       (laughs)

   14. CWChris Williamson50:46

       Uh, so given (laughs) , given the right data sets, pretty much-

   15. TDDr Tracy Dennis-Tiwary50:50

       Those are two such beautiful things, but together (laughs) -

   16. CWChris Williamson50:52

       Th- there was another one of like, um, the number of songs released by The Rolling Stones and the number of people who suffocated tangled up in their own bedsheets. So-

   17. TDDr Tracy Dennis-Tiwary51:01

       I, I am, I mean, I just think, ho- honestly, I think when we draw such strong conclusions from correlational data, we should be laughed at because it should be just hypothesis generating. It should be-

   18. CWChris Williamson51:13

       Okay, now we know, we need to test this.

   19. TDDr Tracy Dennis-Tiwary51:14

       ... okay, we have to pay attention. Yeah.

   20. CWChris Williamson51:15

       Yeah, we should go test this.

   21. TDDr Tracy Dennis-Tiwary51:15

       And, and it's hard to test some of these things, but it's hard work and we have to do that hard work-

   22. CWChris Williamson51:19

       We need to get Nicholas, Nicholas Cage.

   23. TDDr Tracy Dennis-Tiwary51:20

       ... which means prospective prospective studies and we have to get Nicholas Cage to g- get in a new movie so that we can experimentally control what happens after.

   24. CWChris Williamson51:27

       Precisely correct.

   25. TDDr Tracy Dennis-Tiwary51:28

       (laughs)

   26. CWChris Williamson51:29

       There was, um, one of the things I th- uh, I think is interesting around how that link between technology and the way that we feel after we use technology, um, is The Expectation Effect, which is a new book by David Robson, came out a couple of months ago. He was on the show. He's a fantastic science communicator. The placebo effect, which everyone is familiar with, this is basically that, but scaled across everything and anything that you care to care about. And the best example-

   27. TDDr Tracy Dennis-Tiwary51:55

       Mm.

   28. CWChris Williamson51:55

       ... that he gave was, um, gluten intolerances have gone up by, uh, 10 times from 3% to 30% over the last 15 years. And they brought people into a study. They sat them down. Some people did and did not have biological gluten intolerances. Some people did and did not have self-reported gluten intolerances. They gave everybody the same meal, and they told everybody that had gluten in it, but it had no gluten in it. And you ended up with people in a study who didn't have a biological gluten intolerance, who hadn't eaten gluten coming out with hives, having inflammation, having diarrhea, having to go to the bathroom. And that basically scales across everything. And I think the, the episode's so powerful. Tons and tons of people really, really loved it. And the reason being, I think that it reminds us that we have way, way, way more control through framing, right? How are you framing the experience that you go through? And I'm pretty adamant that part of the discussion that we're having around social media is that we've been told that these tech companies are malign and they're stealing our attention and it's bad for our memory and it's bad for our long-term health and it's bad for our dopamine levels and stuff like that. But the problem is that that creates an expectation effect for everybody.

   29. TDDr Tracy Dennis-Tiwary53:10

       Mm-hmm. Mm-hmm.

   30. CWChris Williamson53:11

       So you start to use your phone and you finish up and you feel guilty about your phone use and you expect to feel bad. "Oh, well, here comes the dopamine crash off the back end of being on Instagram-"
10. 55:57 – 1:04:17

    Common Mistakes in Dealing with Anxiety

    1. TDDr Tracy Dennis-Tiwary55:57

    2. CWChris Williamson55:57

       What do most people get wrong when it comes to trying to deal with anxiety?

    3. TDDr Tracy Dennis-Tiwary56:02

       They presume that as soon as they feel it, they should manage it and suppress it. So really if we think about anxiety as, as information, the very first step needs to be that if it's information, listen to it. So whether that means, like in the, that experiment I mentioned with socially anxious people when, "Okay, I'm gonna listen to my heart racing and rather than assume I'm about to fail at this public speech, I know it's preparing me or that I care about this." You know, listen to that information. Uh, when you're having free-floating anxiety, something's gonna t- something's gonna come to your mind that tells you what you care about and what you need to work towards, so listen to it. It's not always helpful information. So sometimes after we listen, we realize, "Okay, I just have to let this go. It's too much. It's," you know, uh, "it's, uh, it's, it's just me spiraling out." And that's when we do things that we know support our wellness. And for a lot of people, that's exercise. Alan Kazdin, who's a ver- who's one of the founders of cognitive behavioral therapy research in, in the US, he once, uh, at this, um, 50th anniversary, you know, uh, kind of, um, meeting, said, "If we psychologists really cared about people and helping them, the first thing we'd do is get them all to exercise. And then we'd see what problems were left over and we'd create boutique, targeted treatments for those problems." So for a lot of pe- and why does that work? Why does exercise work? Well, there's biological reasons, but I believe when it comes to anxiety, it's also that we remove ourself from this future tense that can grab us when we're in the future and worrying and we immerse ourself in the present. We find flow. We find relief. Maybe we like to, um, take walks. Maybe we do mindfulness meditation. Maybe we ... You know, there are so many things that we can do and we know it helps us. I write very bad poetry. I love to write poetry. It gets me out of whatever mindset I'm in and helps me immerse myself in my own personal sense of flow. And so these are things we can all do. And then, okay, so then you're in the present, and then you can turn back to anxiety and say, "Okay, if there's something to do here, how can I hitch it to a sense of purpose? How can I use it to pursue what I care about, my goals?" Purpose doesn't have to be some grand vision. It can just be what makes your life meaningful. And I think wh- back to the social media question, I think we do expect it to be bad in many ways. I think that's a good correction because before we thought that all those, you know, black turtlenecked, uh, you know, saviors were there to help us. And clearly they were not there to help us. They were there to line their pockets. I mean, that's just very clear or social media wouldn't look like it looks. But, you know, we can, um, you know, sort of have this view, um, with technology that, you know, we're going to put it in its place, uh, we're going to, um, you know, understand where it's helpful for us and where it's not. Um, we're going to stop treating ourselves like a brand, like a, something to be consumed. I think that's where some of the concern is. Because when all we can do, especially kids, they're forming their identities, they're figuring it out, when they have to sell themselves like a brand, when they have to think, "How am I going to be consumed and approved of in this world?" it just distorts their ability to find a purpose that's about what gives their personal life meaning beyond the likes and the, and the, and the shares. What gives their life meaning in terms of what's greater than themselves? What is something that makes them feel alive, that helps them find flow? I think the actual problem with a lot of social media is that we lose, we have so many lost opportunities to tune into those other things in our life. And so those opportunity costs can start to get in the way. So I think we need to question many aspects of social media and we also need to reignite our ability to find purpose in life and pursue it and help our kids do the same.

    4. CWChris Williamson59:45

       So if somebody-

    5. TDDr Tracy Dennis-Tiwary59:46

       And anxiety, and anxiety can help you in that because it helps you hope.

    6. CWChris Williamson59:48

       Yeah.

    7. TDDr Tracy Dennis-Tiwary59:48

       It helps you work hard.

    8. CWChris Williamson59:49

       Points you in the right direction.

    9. TDDr Tracy Dennis-Tiwary59:51

       Points-

    10. CWChris Williamson59:51

        So if somebody, if somebody does begin to feel anxious, if it was me, if some, one of my friends were saying, "Hey man, I, I, I just, I've got this sort of anxious thought process," my prescription would be, uh, "Here's a breath work practice that's gonna take five minutes and you're gonna do box breathing." Uh, then it would be, "Go for a walk," then it would be, "Go to the gym," then it would be, "Have a cold shower."

    11. TDDr Tracy Dennis-Tiwary1:00:13

        Yeah.

    12. CWChris Williamson1:00:13

        That would be my prescription, right?

    13. TDDr Tracy Dennis-Tiwary1:00:15

        Yeah. Yeah.

    14. CWChris Williamson1:00:15

        I'm aware that you're not trying to go super applied with this, but you've already mentioned training ...

    15. TDDr Tracy Dennis-Tiwary1:00:19

        Yeah.

    16. CWChris Williamson1:00:19

        ... as one of the things.

    17. TDDr Tracy Dennis-Tiwary1:00:20

        Yeah.

    18. CWChris Williamson1:00:20

        Are there any other practices that you think people could do with educating themselves around if they want to mitigate their, uh, anxiety response?

    19. TDDr Tracy Dennis-Tiwary1:00:29

        So I love all of those practices you mentioned. I would just put something on the beginning and end of it. So what I didn't hear you say was, well, what is your, you know, why are you anxious? You know, what is going on in your life? Can you ... Is it telling you something? Is that anxiety actually pointing you to something? Because instead w- we all habitually, including we psychologists, we go to, "Okay, we better handle it. We better ..." You know, and that's completely skipping over the part about finding out if there's information to be learned. So I would say one really great practice is how do you sit with an anxiety even when it really feels terrible? And it does. Anxiety always feels terrible. That's its nature, to make us pay attention.How do you find a way to sit with it, to tolerate the distress, and to know you're still okay, and to find out what you can? So for some people, that's journaling. For some people, that's talking to a therapist or a good friend. Um, for some people, um, that might be, um, just meditating and letting, and letting those thoughts arise instead of keeping them down and taking all that energy and all that, the stress of suppressing. It just takes a toll over time. So those are, you know, when we think about those three parts, listening, you know, being in the present and, and kind of managing when we need to. And then the third part is really, again, since anxiety wants to take me into a future where there's my, where actually my dreams are coming true, (laughs) when all these good things are happening, how do I leverage anxiety in this way? You know, my husband about ... He's in the entertainment industry. He's a producer on Broadway and TV, et cetera. And he had a very big work stress, uh, about, uh, eight months ago. And I have anxiety around my own life, but I saw him and I was helpless to do anything to help him. And it was really bad. It was some bad stuff he had to work through. And I was so overwhelmed with an- ... It was so toxic. It was so over- ... I just didn't even know what to do with it. And I tend to be more of a depressed person than an anxious person. So even though I've written this book about anxiety, my real bugaboo is a little different, but they go hand in hand, which is a wholely, th- different conversation. But I realized that the only way I could work through this anxiety, which was feeling very extreme to me, um, in addition to talking to people was, uh, and doing all those self-care, was to actually hitch it to a sense of purpose, which for me was to try to be a support to my husband and to try to use whatever skills I could to, to make sense of it. So I just, I, I decided because the anxiety was, was so present, I'm gonna spend some extra time and just, I'm just gonna listen to him. I'm not gonna try and fix it. I'm not go- you know, maybe I will if he wants me to, but just be there for him in ways that made me ful- feel fulfilled because for me, being a good partner at that moment was really a se- gave me a sense of purpose. And so I felt a little bit more in control, a little bit more, um, well, a little bit less uncertain maybe 'cause I knew that, okay, we can do this together. We can handle this together. And then I also started writing about this and I actually wrote an essay and I, and I wrote ... You know, I just got it all out and I started formulating thoughts and ideas and we started discussing them. And so I found ways to sort of take what was overwhelming to me, and I felt completely helpless to do anything about it, and to find some outlet for that, some sense of purpose, maybe a little control, but, and really just kind of, um, projecting myself into a future where we would be able to be past this. So those are the kinds of things that, you know, therapy is great. I think everyone should be in therapy whether or not you think you have a clinical anxiety disorder or not. Um, I think with, you know, with medication, sometimes we need it to help bring us back down to baseline so we can benefit from other treatments, but that's like giving someone a fish instead of teaching them to fish. Uh, medications like benzodiazepines, which we talked about before can kill people if not used properly and can be addictive, um, they should be used temporarily and they should be used in combination optimally with, with therapy. And that's when they're most powerful.

11. 1:04:17 – 1:13:00

    Are Anxiety & Depression Linked?

    1. TDDr Tracy Dennis-Tiwary1:04:17

    2. CWChris Williamson1:04:17

       I really want to know about the relationship between anxiety and repression now. I, I d-

    3. TDDr Tracy Dennis-Tiwary1:04:22

       Oh.

    4. CWChris Williamson1:04:22

       I, I need to learn it.

    5. TDDr Tracy Dennis-Tiwary1:04:24

       Yeah. (laughs) Which part of it? The way that, that when we suppress anxiety, it only grows stronger?

    6. CWChris Williamson1:04:28

       No, just what you've said, that there is a relationship between anxiety and depression. Uh-

    7. TDDr Tracy Dennis-Tiwary1:04:32

       Oh, and depression. I heard repression.

    8. CWChris Williamson1:04:34

       Depression, sorry.

    9. TDDr Tracy Dennis-Tiwary1:04:35

       So it's really interesting because I was a person who when I was a teenager suffered from clinical anxiety, and, um, the thing about anx- uh, about d- uh, sorry. When I w- I suffered from clinical depression as a kid. The thing about depression, and again, it's sort of this almost functional emotion analysis, right? When you're depressed, you actually really ... You, you've gone through a stage of really caring about things you want in the world. You have dreams, you have hopes, but what depression is is this feel- feeling of real, um, of loss. You've lost that ability to get what you need and want in life. Um, you have despair. You don't believe that those things are possible anymore. Um, and, and so this positive, optimistic focus you might have had has just been dashed again and again and again, and you can't find the hope anymore. Um, and so what you of- and, and so that's quite different from anxiety where you're still sort of in it to win it, right? Because you're still working to make that positive thing come true. So what psychology has documented for a number of decades is that there's a high rate of comorbidity between anxiety and depression. About 50% of people who are anxious also end up being depressed at some time if they're clinically anxious. And what we think might be going on in that in a way is when you're anxious and you're like, okay, I, I want these things. I'm gonna worry about them, I'm gonna make them happen, I'm gonna do everything I need to. I'm gonna avoid threats. Uh, you know, I'm just so anxious about succeeding in life, for example. And it's a positive goal. It's a, it's a, it's a, it's a, it's a really a productive goal, but life throws you curveballs. You, you fail. You, uh, try to pick yourself back up. You work towards it. You just can't quite manage it. You have some bad luck. S- so there's a series of things that happen externally and then internally in terms of your ability to find ways to cope. And, you know, it's really arrogant to say, "Oh, just shift your mindset about anxiety and everything will be okay." And that's really not what I'm saying because sometimes life is just overwhelming, you suffer, and you can't always ... It's messy. You're not always gonna do well, and that's not a failure. That's, that's a process. So sometimes when you're anxious and you just can't keep working towards what you dream of, you become hopeless. You start to despair, and that's when it can flip into the depression, um, end of the spectrum. So the two, it's this sort of what are you working towards in life? What are your goals? What are your dreams? And how you achieve them, whether you achieve them, how you perceive the obstacles, your mindset about that, those are the kinds of things, um, that can lead us towards problematic anxiety and depression, and also be the ways in to help fix them as well.

    10. CWChris Williamson1:07:07

        You mentioned that 50% of people-ish that have anxiety are going to become depressed. Do you know if the reverse is true? Do you know if the relationship between depression being the first mover is the same for anxiety?

    11. TDDr Tracy Dennis-Tiwary1:07:17

        Uh, it tends to be a, developmentally, it tends to be anxiety first, followed by depression. But it does go the other way too. And then, of course, you have co- you have multiple comorbidities. So with depression, there's also, um, you know, high rates of eating disorders, especially in, in females. Um, there's high rates of addiction in depression and anxiety as well. So it's all these, you know, we, it's, it's always a double-edged sword with mental illness. It's always us humans, us messy humans trying to adapt to what can be a terrible world sometimes and a wonderful world. And so every symptom is just an attempt to adapt. So you know, when we, when we're anxious and we become, or when we have OCD and we start developing all these compulsions that start to get in our way, it's just our human nature to try to adapt to overwhelming feelings and thoughts. And it's really effective for a short term. It's kind of miraculous if you think about it. But over time, it just, the costs outweigh the benefits. So every, you know, I started my career, uh, studying child maltreatment, abused kids. My very first job was to go into the basement of Child Protective Services and actually read the detailed reports of how kids were abused and what they suffered, and it was ter- I mean, literally to this day, I get the sick feeling in my stomach. But this was a center at the University of Rochester in, in the United States that was starting to develop the science of maltreatment to understand how maltreatment happens, how it affects kids, and how kids can be resilient, and how people can be resilient in the face of it. And so here I was reading about this terrible maltreatment, I mean, real sufferings, physical abuse, sexual abuse, um, you know, neglect. And then I would go and I'd be working with these kids in this sort of day therapy program. And I would see them and they're beautiful and they're creative, and yes, they were troubled, they, but they were re- they were still remarkable. How did that happen? How in the world did they have that resilience? I mean, and, and so what happens as they adjust to what should not be happening to them, they form weaknesses, but they also form strengths. And so every way of adapting, some kids become hyper vigilant for negativity in the world around them, right? And that's an adaptation. It's helpful if you wanna prevent getting hit by your caregiver, right? To know when they're about to get angry. But if it starts to generalize to school and you start getting in fights with everyone 'cause you're looking for someone being hostile towards you, that gets in the way. But you also, uh, a lot of these kids, there's great research to show they also notice positivity more too, so they're ready to receive that positive feedback as well. So all of these are double-edged swords, and the more that we think about our own struggles as opportunities, it's a mindset shift, the better we'll be able to work with them and own them instead of being owned by them.

    12. CWChris Williamson1:09:51

        You just mentioned creativity there. What's the relationship between anxiety and creativity?

    13. TDDr Tracy Dennis-Tiwary1:09:56

        Oh, it's so interesting. So, um, so there's, uh, I'll just start with one study that sort of illustrates, um, this. So there's this great study that came out around 2008 by Dedreau and colleagues, and they were interested in this idea that anxiety, um, and, and other emotions that they consider activating, activating meaning they, they get you revved up rather than slow you down. So that includes anger, anxiety, happiness, not just, the positive-negative distinction is much less important than how they activate you to do things in the world. And then deactivating emotions are more like sadness or boredom, right? And so what they did is they induced these feelings in people. So they actually had them do a writing exercise where they thought about the most anxiety-provoking thing or the happiest thing and they, and so they really induced that feeling in people. And then they had them do a problem-solving task, a brainstorming task where they had to come up with a new solution, think outside of the box, come up with as many ideas as they could to a problem. Um, I think it was, uh, they had s- said, "Oh, these teachers are trying to teach students this new thing. How would you do it to be innovative?" And then they measured, they had induced people to have each of these emotions separately and then they measured how many, how much fluency there was, meaning how many ideas people came up with and then how innovative and creative they were. And they had a coding scheme to determine that. And they found that anxiety, when you induced anxiety, it made people not only more fluent, there were more ideas, but they were more out of the box in their thinking and they persisted more. They cared about what they were doing, and even when they hit some roadblocks, they just kept going and so they come up, came up with more ideas. There's also a great, um, uh, a concept that Patrick, uh, Gaudreault, who's a Canadian psychologist, came up with that I think is also about the creativity behind anxiety and it's a concept called excellencism. So we know that perfectionism is toxic. It's punishing. It's like this, this, you know, this pursuit of flawlessness that always fails and it le- you know, and we know that perfectionism, real punishing perfectionism is associated with more anxiety, clinical anxiety, more depression, suicidality, and actually, worse performance. People who are perfectionists tend to perform less well because they just don't know when to stop trying to get it right. They just don't know how to use their time wisely in a lot of cases. So that's perfectionism. Excellencism is sort of the light side of that darkness. So excellencism is knowing that, you know, I can never be perfect, but I can be really good. I can be excellent, and I believe I can be excellent, and I'm okay with failing in order to get there. And sometimes on my way to getting to excellent, I can just be good enough and I'll get there. And so excellencists, people who think about achievement that way, they tend to be more anxious. Not clinically anxious, but just have a heightened level of anxiety, but they also have more curiosity, they're more open to experience, and they tend to be more creative and more productive. So here we have this anxiety fueling this pursuit of excellence, not perfectionism, but excellence actually leading to more productivity and creativity when you measure it in these sort of, you know, divergent thinking tasks and all sorts of other ways that Gaudreault and his colleagues

12. 1:13:00 – 1:14:56

    How to Think Straight when Nervous

    1. TDDr Tracy Dennis-Tiwary1:13:00

       have done.

    2. CWChris Williamson1:13:01

       What about when you feel nerves or you have that sort of anxious quasi-nervous response and your ability to think laterally just feels like it's been completely shut down and like I, I, my, my entire mind has gone blank here.

    3. TDDr Tracy Dennis-Tiwary1:13:16

       Yeah.

    4. CWChris Williamson1:13:16

       Is that something different? Is that not anxiety?

    5. TDDr Tracy Dennis-Tiwary1:13:19

       That's totally anxiety. So your body, you know, as we talked about with that, that study with socially anxious people and the, and this giving a public speech, you know, so say you're about to come on a podcast with someone you've never met before and you have to go on this old school, like, video conferencing thing called Skype. And you're feeling a little nervous and you can't quite get it and the butterflies in your stomach start, right? So what do you do? You say, "Okay. First of all, that's information that I care about this interview, you know, I'm not just falling asleep and like, eh, who cares. Um, this conversation is gonna be interesting and actually, it really is my body preparing to overcome whatever obstacles I need to face and to persist even when I can't get that damn video on and it's, like, all talking." Um, and, and so you interpret it that way and there might be a few times as you're, as you're listening to what's being said or you have ideas going through your head, you might draw a couple blanks, but you know, especially if you're an excellencist, you know that, well, I can stumble a little, but I have other ideas that are great and I'll be able to, because I've mastered this topic, I'll be able to come up with something else interesting to say. Or I could ask, uh, the, the person I'm talking to a couple questions and that will... So you just have this curiosity and attitude of, it's okay. Failure is not, failure is not failure. Failure is not a malfunction, you know, being anxious is not dangerous. It's part of being human, it's part of the messy act of being human and it just changes everything as soon as you accept that and really internalize that.

Episode duration: 1:15:44