Category: International

10 signs of Sjogren’s Syndrome Sjogren’s Syndrome is one of the most common  diseases in my practice, Rheumatologist Oncall.   So, today I decided to give you  all the information you need   to understand this disease better. In this video, we will discuss the most common 10   manifestations of Sjogren’s Syndrome. Let’s begin! Hi, I’m Dr. Diana Girnita, a board-certified  rheumatologist and the Founder of Rheumatologist   OnCall. If you are new here, welcome to  my Youtube channel, where I educate people   about rheumatoid arthritis, and autoimmune  diseases, like Sjogren’s Syndrome. So,   don’t forget to subscribe and never miss  one of my videos. If you’ve been following   this channel for a while, I am excited to have  you back and share more information with you! Sjogren syndrome is a rare disorder affecting  about 1.0% of the population. Between   400,000 and 3.1 million adults have Sjögren’s  Syndrome. Females are more affected than males,   and many patients with rheumatoid arthritis  can also have symptoms of Sjogren.   Dryness. The most common   symptom of patients suffering from SS is  dryness of the eyes and mouth. Patients   mostly describe dryness of the eyes as itching,  irritation, grittiness, a foreign body sensation,   and blurry/change in vision. The lacrimal  glands’ secretion from your eyes will decrease   over the years, and you will start feeling  these changes that can become very upsetting.  Suppose you go to see an eye doctor. In  that case, they can quantify your lacrimal   gland secretion using a test called Schiermer  test, where they put a special type of paper   in your eyes that will tell your doctor  how much lacrimal secretion you have.
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Dryness of the mouth is also common in patients  with Sjogren. Your saliva keeps your mouth healthy   and prevents the onset of cavities.  When your saliva secretion decreases,   you may experience frequent tooth  decay, and multiple cavities.  You may also experience difficulty  eating and swallowing dry food,   such as crackers, without drinking liquids. You may need to drink frequent sips of water   to be able to talk. You may have changes  in your taste due to a lack of saliva.  Some patients can have frequent  episodes of parotiditis.  Dryness can affect your skin  and can cause itchiness. Rarely,   the skin can develop a more complicated  disease called small vessel vasculitis. Some females will describe  vaginal dryness, irritations,   pain with sexual intercourse, and itchiness,  which can dramatically affect their sex life.   Joint and muscle pain.  Patients with Sjogren frequently complain of joint  and muscle pain. The joints can hurt without being   swollen. Usually, the pain is symmetric, and it  may come and go. Unlike Rheumatoid arthritis,   Sjogren’s arthritis is not deforming the joints. The hands, wrists, and knees are usually affected.  About 40% of patients can have a  rheumatoid factor test positive,   especially in patients with joint pain. More rarely, patients could have positive anti-CCP   antibodies, these are antibodies frequently  seen in patients with Rheumatoid arthritis,   and these patients could have more aggressive  disease and even develop erosions in their joints.
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As I mentioned, muscle pain is also frequently  seen and could cause weakness in the arms or legs.   It is essential to fully evaluate the weakness as  this could also indicate inflammatory myositis, an   autoimmune disease of the muscles. Lung Disease  About 20% of patients with Sjogren disease can  have their lungs affected. Patients can develop   upper respiratory infections, like sinusitis  or present with a dry, irritating cough.   The cough could be due to severe dryness of the  airways, mucus plugs or reflux from the stomach.   Sometimes, the patients can see  changes in their voices and hoarseness.  In some cases, along with dry cough,  patients will present to the doctor   due to severe shortness of breath that we call  dyspnea. The shortness of breath can initially   affect you after walking a short distance,  going up a flair of stairs, or even resting.  Pulmonary function tests and a high-resolution  CT scan are indicated in these cases.  The CT can identify if you have lung fibrosis  or interstitial lung disease. Some patients   will present with shortness of breath and cough,  before developing dryness of the eyes and mouth.  In these cases, the pulmonologist that  found the lung fibrosis might decide to   test you for autoimmune diseases like Sjogren or  Rheumatoid arthritis, to name a few possibilities. Neurologic manifestations Many neurologic manifestations may   occur in Sjogren patients, including peripheral  and central nervous system abnormalities.  From frequent headaches, paresthesias or tingling  in the hands and feet, even tingling in the   face or other parts of the body, to complicated  neurological diseases like transverse myelitis   and optic neuritis, or  inflammation of the optic nerve.  Some patients can even present with  symptoms that look like multiple sclerosis.  Rarely patients with Sjogren can present with  brain inflammation that we call encephalitis. Heart disease Yes, Sjogren can affect your heart.   Chronic ongoing inflammation can  increase your cardiovascular risk.   What does it mean? Heart attacks, fluid around  your heart, arrhythmias like heart blocks,   strokes, hypertension, and thrombosis  can be seen in patients with Sjogren. Gastrointestinal tract Patients with Sjogren can   have difficulties swallowing due to  decreased saliva and develop nausea,   abdominal pain, and gastritis. Liver  function changes, and sometimes PBC   or autoimmune hepatitis can sometimes happen. Celiac disease is seen in patients with Sjogren.  KIDNEY Bladder dysfunction,   interstitial nephritis and kidney dysfunction,  leading to acidosis, are seen in patients   suffering from Sjogren. Patients develop  an increased frequency of urinating, or   they will have to urinate at  night, affecting their sleep.  These symptoms can be confusing as patients  often think they have a urinary infection.   Still, their urinary tests do not show that. I had a patient that initially developed   kidney problems about five years before  developing dryness of the eyes and mouth. Depression, fatigue and Fibromyalgia  Fatigue is a debilitating symptom and  can lead to depression as patients can’t   understand why they can’t complete their daily  activities and can’t participate in the normal   activities of their families. Depression is most  likely a response to the stress of the disease,   and some researchers believe this is a consequence  of the inflammation affecting the brain.  Hematologic manifestations Patients with Sjogren can develop anemia,   low white blood cells, elevated Gammaglobulins,  cryoglobulinemia, and increased lymphoma risk. Anemia is most likely induced by chronic  inflammation. Still, it may have other causes,   so it is crucial to have a complete  evaluation done by your rheumatologist.  The white blood cell counts can be low,   but most times does not increase  your risk of developing infections.  Elevated levels of IGG immunoglobulins are seen  in up to 60% of patients. In these patients, we   also see positive rheumatoid factors and positive  SSA and SSB antibodies. We will talk in another   lecture about the lab test we follow in Sjogren  patients. In patients with monoclonal gammopathy,   meaning that certain abnormal proteins are in the  blood, we need to carefully evaluate them as they   can be at increased risk of multiple myeloma and  lymphoma. These are two types of blood cancers.
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Lymphoma -Patients with Sjogren Syndrome have an  increased risk of non-Hodgkin lymphoma compared   with the general population; the prevalence  of lymphoma increases with time: For example,   following diagnosis was 4 percent during the  first five years, 10 percent at 15 years,   and 18 percent at 20 years. So, if you notice changes   in your skin, enlarged lymph nodes, or salivary  gland enlargement, call your doctor immediately.  As a rheumatologist, I educate  my patients extensively about   these changes and follow their labs regularly. If you want to learn more about Sjogren and other   autoimmune diseases, please watch my channel, as  I will continue to share my knowledge with you.  Remember, these videos are just for educational  purposes and are not supposed to offer you a   diagnosis or medical evaluation. If you like  the educational content of these videos,   don’t forget to like, share, subscribe  and press the notification button.  Please leave your comments and questions  below, as I would be happy to help you!  Thank you and I will see you soon with  another educational lecture!

Terminal insomnia, also known as sleep  maintenance insomnia, aka early morning waking,   aka “I wake up at 3 a.m and I can’t get back to  sleep and it’s driving me crazy!” This is a pretty   common experience for many people. Now, first  off, it is called terminal insomnia not because   it causes you to die but because it happens at the  end of your night. So many people experience this.   Maybe your mind starts racing; maybe you worry  about everything you need to do, or not; or maybe   you just can’t fall back to sleep – at least not  until it’s almost time to get up, and then you’re   tired and cranky and you don’t function as well  as you’d like. But then the real problem with   this terminal insomnia is that the next night when  it starts happening over and over and over again,   and then you’re just so tired, and then you start  to get stressed out and angry about your inability   to sleep, and that makes things worse because  when you wake up and you see that it’s 3am,   you get mad, and that makes it even harder to  sleep. As the researchers say, this is common but   aggravating. Dude, it is the worst. So if you’re  here, you’re probably desperate for sleep,   you haven’t slept well for a long time,  you’re cranky, irritable, depressed.   I feel you. I have struggled with insomnia off  and on. And I come by it honestly: my dad is   almost always up from 2-4 am, and so is one of  my babies. There is a genetic aspect to this.   And this early morning waking is also closely  linked to depression, both as a cause of   depression and as a symptom of depression.  But don’t worry your little head; there’s   also a lot you can do about it. In this video I’m  going to share with you my bag of tricks – six   non-medication strategies you can use to get  better at sleeping through the night. And at   the end of the video I’ll tell you about a great  YouTube video that helps me fall back asleep.
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Hey everyone, don’t forget, we’re doing a  giveaway of three therapy lamps from Carex. Now,   each of these is worth about $150. And research  shows that light therapy is very effective   at treating seasonal affective disorder and  regular non-seasonal depression. So check out   my Instagram page to learn more. Oh, by the way, I  do have an Instagram page. Right. I put up quotes,   polls, video summaries, and the occasional dancing  baby. So go follow me there too. Okay. Back to   the video. Okay. Let’s talk about six causes of  maintenance insomnia and what you can do about   it. But first, let’s do a quick overview of the  sleep cycle. The average adult needs between seven   and nine hours of sleep, and your sleep rotates  through a couple of different cycles: light sleep,   deep sleep, and REM sleep (when you dream).  Now, most of your deep sleep happens early in   the night, and your lighter sleep and REM sleep  happens closer to morning. So this means that   little things will be more likely to wake you up  and keep you up. So the first thing that can cause   early morning insomnia is biological factors. So  these include genes, gender, aging, and hormones.   So genetically some people are lighter sleepers,  and genetically some people are more likely to   wake up early. I got both of these genes. I  already knew this about myself, but my 23andme   report verified it. Some people are night owls  and sleep much better towards the morning. This   is called your chronotype. And while you can’t  change your genes, learning about your chronotype   can help you accept it. I think it’s helpful to  imagine our ancestors living in a small village,   and let’s imagine the village needed some people  to be on watch all night. So some people would be   on watch at 9 pm, some at midnight, and I’d be the  4am crew, bright-eyed and bushy-tailed – but no   way would I fall asleep on watch. I am literally  no fun after 9pm, and I can do just about anything   at 5am. It’s a blessing and a curse. So I go  to bed early, and that’s just how I work. Now,   the second factor of biology is age. As you  age, it’s more difficult to sleep as well.   You get tired earlier in the evening, and you  sleep more lightly than when you were young.   Some things that help are staying active during  the day, getting exercise, and delaying going to   bed can all help with terminal insomnia. Now,  sleep maintenance insomnia is much more common   for women than for men, especially women nearing  midlife. Hormones impact your ability to sleep   as you age. Even when you’re pre-menopausal, you  have a slow decline in estrogen and progesterone   as you age. Hot flashes, periods, night sweats,  peeing a lot – yeah, it’s fun. You can work with   your doctor if you want to try and manage that.  Also, your body doesn’t use melatonin as well   as you age. You can use a prolonged-release  melatonin supplement to help with that. And   melatonin really is more of a time regulator than  a sleep regulator. It helps to reset your body   clock to know when you should be asleep. Now, when  I was writing the How to Process Emotions course,   I was really struggling with stress and sleep,  so I worked on both. But I did start to use   some slow-release melatonin, and it worked for  me. I used it about seven times over two weeks,   and I was doing a lot better. But there’s a lot  of factors, right? So this improvement in my   insomnia could also have been in part because of  a decrease in stress, but this all could have been   in part because of the change in seasons too. But  more on that later. Okay. The second big factor   with insomnia is conditioning. So conditioning  means that because sleep is something that your   brain associates with a routine or an environment,  we can accidentally train our brain to sleep   poorly by having bad habits. The antidote to this  is sleep hygiene. I made a full video about this,   but basically you go to sleep at the same  time each night, you don’t use your bed for   anything other than sleep and sex, don’t watch  screens in bed, you know, read a book instead.   Basically, your goal is to associate sleepy time  with your bed and not wakey time with your bed.   Now, when it’s hard to stay asleep, it’s important  that you do not associate early morning time with   wakey time. So if you’re awake too early, don’t do  anything too exciting or stressful or stimulating   because that’s going to send the message to your  brain that it’s supposed to be awake at that time   of night. Now, I’ve set some rules for myself on  this. If I’m up before five, I can read a book,   I can write on paper, I can do scripture study,  but I can’t work on anything too stimulating   before 5 am because that basically just trains  my brain to be more awake the next night at that   time. So basically you want to train your brain  that the bed is for sleeping and early mornings   are for sleeping too. Make your bedroom a calming  place. Don’t work in your bed or your bedroom. And   all of these things can help condition your brain  to sleep better. Okay. Number three. Let’s talk   about behaviors that mess up your sleep. So as you  age, you get less active during the day, and that   includes social and physical activity. But a lot  of us young folks are lazy Netflix watchers too,   so it’s important to try to get in more  physical activity, especially in the morning,   and then to do other active things throughout  the day. And CBTI is a treatment for insomnia   that research shows to be as effective or more  effective than medications, but it takes some   work. The basic idea is to use good sleep  hygiene and don’t go to bed quite as early,   but then here’s the important part: you don’t stay  in bed awake for more than 10 minutes. So if you   can’t fall asleep, get out of bed and do something  boring like reading a book for 10 minutes,   and then try 10 minutes back in bed. And you  just kind of repeat that cycle until you’re able   to fall asleep. Don’t try too hard to go to sleep,  but in the long run, you can retrain your brain to   know when sleepy time is. And this also prevents  you from accidentally training your brain to think   that the bed is the place where you lay there and  get angry about not being able to go to sleep.   Also, some medications like antidepressants,  beta blockers, corticosteroids, and allergy   medicines like pseudofendrine, and also drugs  like caffeine, alcohol, and nicotine, these all   interfere with the ability to sleep. Also,  eating late at night can interfere with sleep.   Okay, number four: stress. Now, I’m not going  to spend too much time on this one, but you’ll   improve your sleep when you decrease your overall  stress. Exercise helps with this, as does writing   down all your worries at bedtime. You can check  out my video about anxiety and insomnia. Exercise   and gratitude are helpful too. And it can be  really helpful to set better work boundaries. When   I first started working from home, my sleep got  all messed up. But I’ve learned to better separate   work and home life. So take your work email off  your phone, turn on the “do not disturb” mode,   don’t read the comments on your YouTube channel  before you go to bed unless you want to debate an   obscure concept of therapy with a random stranger  in your head all night. Now, I work from home,   so I set the rule for myself that I can’t work  after 7pm or before 5am. Okay, number five:   your environment can impact your sleep. Your brain  is queued to sleep when it’s dark outside, when it   cools off, and when your core temperature drops.  So let’s start with temperature. Set your room to   68 degrees Fahrenheit or lower. You can also use a  cooling pillow or a cooling mat to help cool off.   But also, taking a warm bath opens your  capillaries, and then it triggers your   core temperature to drop when you get out, so that  can also help you get sleepy. Okay. Now let’s talk   about light. The light that enters your eyes tells  your brains whether to be sleepy or energetic.   Daylight freaking savings and working in  artificially lit environments can really mess with   that. So start by making your room a dim or a dark  environment. Limit how much light you are exposed   to in the evening. When I’m trying to get my kids  to bed, I always start turning off the lights in   my house, and that can help kind of remind  them that it’s getting close to sleepy time.   It’s also helpful to get a lot of early morning  light exposure, so try to get outside in the   morning and see the sun. Another thing you can  try is doing light therapy 12 hours opposite to   when you can’t sleep. So if you can’t sleep at 3  am, try light therapy at 3 pm. Okay. And lastly,   sleep oxygen can be an issue, so try not  to sleep on your back. And if you’re really   worried about it, you could get, you know, a sleep  evaluation at a sleep clinic. Okay. Number six:   if your brain is running wild, you can try all  types of sleep meditations. There’s a good one   out there called A Robot Shutting Down. And  when all else fails, my go-to is to listen to an   archaeology lecture. It’s barely interesting, but  still quite boring. Or Baumgartner Restoration. So   I’ll link those below. These are some channels  I watch when I’m really just trying to get   myself bored enough to sleep. If you’re  still having trouble sleeping, check with   your doctor. There are other health conditions  that can cause sleep problems, like sleep apnea,   hypothyroid, enlarged prostate, gastric reflux,  arthritis, restless leg syndrome, neuropathy,   and depression. So as you work to treat those,  you might be able to help improve your sleep.   Okay. I hope this bag of tricks is helpful. And if  not, if you’re up in the middle of the night and   you’re angry about it, know that at least you’re  not alone – I’m probably right there with you.

Let me tell you a story about the invisible thing  that fuels anxiety and depression, and then I’m   going to teach you some skills to stop letting  it control you and how you feel. So one day when   I was super pregnant, super tired, exhausted,  overwhelmed with parenting three little kids and  
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growing a human inside of me, I had to go to Home  Depot to fix something in the house. And I pulled   into the closest parking spot I could find, but  then I realized that the truck in front of me in   the stall in front of me was sticking out into my  stall a little bit so I couldn’t pull all the way  
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in. And twisting around to like back out find a  new spot just sounded like painful and exhausting   with my huge stomach. So I just checked to make  sure that my van was in the lines, and then I went   into the store. I got what I needed, came back  out, and when I got to my van I found that someone  
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had left a business card on my window. But it  wasn’t a regular business card. It said, “You suck   at parking.” It said, “F you. Learn to drive, you  idiot.” And he gave me the finger. Now, normally   I would have laughed this off, but not today. Not  at 8 months pregnant. “Why are people so cruel?” I  
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thought. “Poor me. I’m having a bad day, and this  mean person needed to come make it worse.” Right?   “What’s their stupid problem?” I thought. “They  took the time to print out you-suck-at-parking   business cards.” Okay. I definitely cried a little  bit on the way home, and I’m going to blame that  
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on the pregnancy hormones. So why was I so upset?  It would be easy to say that I was upset because   someone put a mean card on my window, but that  is not true. Our emotions do not come from the   situation; they come from how we think about the  situation. I wasn’t upset because of the piece  
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of paper; I was upset because I interpreted that  card to mean that people were attacking me, that   I was surrounded by a mean and dangerous world,  that they were out to get me. And this triggered   the stress response, the fear response. Without  even realizing it, I interpreted that situation  
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as threatening. And this was thanks to automatic  negative thoughts. We are all deluded when we   think that the situation, the trigger is what  makes us feel a certain way. You see, there are   hundreds of possible ways I could have interpreted  that situation. If I had just thought, “Meh,  
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they’re probably just an unhappy human being with  nothing better to do. Meh. Whatever,” I probably   wouldn’t have cared much. Maybe I would have  felt a little calloused. If I had thought “Hm,   maybe they’re working on their anger management.  They put a card on my window instead of slashing  
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my tires,” then I would have felt relieved. And  if I’d thought, “Maybe they’re actually a chronic   people pleaser who is doing therapy homework to  be more assertive and this is the way they’re   learning and practicing,” I would have left  feeling like really happy for them, proud of their  
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accomplishments. How we think about a situation  directly impacts how we feel. Automatic negative   thoughts are involuntary, habitual thoughts. They  focus on the negative. They exaggerate problems,   or they predict disaster. the impact of automatic  negative thoughts is profound. they can distort  
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your perspective, trigger strong emotions, and  influence your behavior in harmful ways. So for   example, you might not go to a social activity  because your automatic negative thought says   you’ll have a terrible time, and that can lead  to missed opportunities, which leads to isolation  
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and a cycle of feeling worse and worse. in this  video you’ll learn about the automatic negative   thoughts that fuel the anxiety cycle and lead  to feeling overwhelmed or hopeless. you probably   aren’t even aware of the types of thoughts  that take you there, so we’ll explore them,  
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and then we’ll talk about both a CBT and  ACT approach to dealing with them. [Music] Most people don’t know that when you have  depression, some physical structures in   your brain actually shrink. But most people also  don’t know that when you change the way you think,  
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you can actually change the physical structure of  your brain. Modern imaging has given us a window   into the brain to show us that the brain has  plasticity, meaning it changes depending on how   you think and how you act. Now, most people have  never been taught these simple ways to improve  
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mental health, so that’s why I made the course  Change Your Brain: 10 Essential Skills to Combat   Anxiety and Depression. In this course you’ll  learn a bunch of ways that your mind and body are   connected. You’ll learn what to eat to combat  depression and anxiety and how light therapy  
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actually changes the serotonin levels in your  brain and research shows that it’s more effective   than anti-depressants for mild to moderate  depression. You’ll learn that when you improve   your sleep, 87% of people see their depression  symptoms decrease. These skills are all all backed  
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by research, and many of them only take a few  minutes each day. So if you’d like to learn more,   check out the link below. The course is backed  by a 30-day satisfaction guarantee, so if you’re   just curious about what the research says about  how to change your brain or if you’re ready to  
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improve your depression or anxiety, check it out.  Your life can get so much better. I saw this meme   the other day. My top three assumptions when the  doorbell rings: number one, murderer. Number two,   police telling me that everyone is dead. Number  three, that book I ordered on positive thinking.  
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Isn’t this how anxiety works? But usually it’s  on a much quieter, like chronic scale. We are   swimming in automatic thoughts that we don’t even  know are there. People have between 6 and 60,000   thoughts a day. I don’t know many people who only  have six. We are constantly making assumptions  
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about what others think about us, about some  imagined future that we’re worrying about,   about the catastrophic outcomes that are sure to  occur. Now, you’re most likely not anxious simply   because of your genes; you’re anxious because  you perceive the world to be a dangerous place.  
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And you perceive the world as a dangerous place  because you’re buying into automatic negative   thoughts. When we look at the anxiety cycle,  there’s some kind of stimulus that we interpret   as being dangerous, and that’s what triggers the  fight/flight/freeze response – the interpretation.  
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So the vast majority of the time it’s the  interpretation that makes us believe we’re   in danger. But most of the time we don’t realize  that. We think that it’s the stimulus that made us   feel a certain way. Victor Frankl said, “Between  the stimulus and response there is a space, and  
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in that space lies our freedom and power to choose  our responses. In our response lies our growth and   our freedom.” And he would know – he survived  the Nazi concentration camps when his family   didn’t. He survived the horrors of World War  II as a Jew, and he managed to find purpose and  
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meaning and goodness in life. When we feel fear  and anxiety, we usually don’t realize that we are   looking through the lens of our automatic negative  thoughts. And these thoughts are often fearful.   These thoughts are like we’re walking down the  street in Las Vegas, and there’s people selling  
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stuff. Right? “Hey, you need a new phone.” “You  probably need an all-you-can-eat steak dinner.”   “You definitely need to see this show.” “Hey,  buy a hot dog.” “Hey, want some porn?” Right?   It’s a normal experience to run across people  selling stuff, and it’s a normal experience to  
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have random thoughts pop into your head. But most  of us don’t realize that we’re buying into these   thoughts. It’s like we don’t have any skills to  brush them off, and instead we feel the need to   talk with each salesperson, listen to what they  say, and buy what they’re selling. This is what’s  
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called buying your thoughts. It’s when you believe  them and invest in them without even questioning   if you want what they’re selling. And you don’t  even realize it. We don’t even realize that the   reason we’re feeling the way we are is because of  how we’re thinking thinking because the thoughts  
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are just like the air we breathe. Let me share  some examples with you. I asked my audience what   their automatic negative thoughts are, and here’s  some of their responses: “It’s my fault for 100%   of everything going wrong, and then I shame  myself.” “I’m such a failure.” “I’m all alone.  
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I’m not lovable. I’m broken.” “I won’t be able to  sleep again at night, and I won’t be able to sleep   at all in my life.” “It’s too much. I can’t handle  it, and it will break me down.” “This depressive   episode is never going to go away.” “Something  good has just happened, so something devastating  
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is about to happen next.” “Why am I like this? Why  am I like a terrified Chihuahua when other people   around me are relaxed and don’t seem to anticipate  doom at any moment?” “They’re just saying that to   sound nice” (about any praise or compliments).  “I always mess things up.” “No one really cares  
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about me.” “I’m never going to be good enough.”  “Everyone is judging me right now.” Notice how you   feel in your body after hearing those. Honestly,  when I read through the comments I felt a little   heavy, a little discouraged, a little anxious.  So what do we do about your automatic negative  
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thoughts? Step one is getting super clear on  what these thoughts are. In the next segments   in this um section of the course, we’re going to  talk about some Kung Fu with your thoughts. But   for now we just have to take these thoughts from  being invisible little whispers to being concrete  
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thingies. Right? You’ve got to catch yourself  thinking your worst thoughts. So go back to the   section in your workbook where you wrote down  the situations where you tend to feel anxiety.   Now we’ve got to explore the thoughts that are in  between the situation and the anxiety. I’m going  
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to give you some examples. Okay. So my sister once  told me this um awesome story about this time she   was hanging out with a brand-new friend. And they  went to the beach and they hung out together with   all their kids. And then she gets home. And this  friend was kind of a like very clean and tidy,  
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afraid-of-germs type person. They get home, and  my daughter finds a nit, like one baby lice in   her daughter’s hair after playing with the clean  family. So she started having these thoughts,   “Oh my gosh, she’s going to hate me. She’s going  to tell others how gross I am. She’s never going  
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to hang out with me again. No one will.” And then,  you know, that creates the anxiety response. Why   would our body have an anxiety response around  rejection? Well we used to as, you know,   a species completely depend on our community for  our survival. So our brain is like, “Oh my gosh,  
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if I get rejected I’ll die of starvation.  I’ll be kicked out of my village, and I’ll,   and I’ll die.” So when we notice these thought, we  can challenge them, or we can separate ourselves   from them and realize, you know what, we’re  probably not going to die. She might not even  
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reject me. She might not even be mad. She might  not hate me.” You know, things like that. We can   challenge those thoughts. We separate ourselves  from them, defuse them. Okay, let’s take another   one. You’re laying in bed, got a big day ahead  of you, and you can’t fall asleep. You might  
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start having thoughts like, “I’m never going to  get enough rest. I’m going to be tired all day   tomorrow. I’m going to snap at my kids all day or  I won’t be able to work very well. it’s going to   be awful to get back to sleep.” Um and that leads  to really big fears, catastrophizing, right? “Oh,  
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I’ll ruin my relationship with my kids, and  they’ll cut me off when I’m older.” And again,   that’s that rejection fear, like now I’ll die  starvation or I’ll be alone forever. I’ll feel   pain. I’m afraid of pain.” These are the core  fears, right? Um rejection, um humiliation, pain,  
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death, failure, loss of identity. These are the  four fears we worry about. Okay. Here’s another   one: your boss gives you some negative feedback  at work. Your thoughts around this: “I’m such a   failure. I never do anything right. He’s such a  jerk. I’m never good enough.” Um that could lead  
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to “I’m going to get fired.” Yeah. That’s that’s  a survival threat to your brain, so it’s going   to kick off the anxiety response. “My husband is  going to be disappointed in me.” Rejection. “We’re   going to run out of money and die of starvation”  Right? Again, there’s that survival response. Now,  
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what would happen if instead of those thoughts we  could challenge those thoughts and be like “Well,   this is an opportunity to learn. I can learn  new things.” Or “Oh, my boss must care about my   development if he’s willing to give me feedback.”  I mean, there’s different ways to think about this  
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situation, right? Or you could just say, “Oh, I’m  going to notice those thoughts. Hello, failure   story. Man, you sure come up a lot. I don’t really  have to believe you.” Okay, we’ll get back to that   later though. Okay. Uh here’s another example:  I feel anxious or depressed. You might think,  
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“This anxiety is never going to go away.” “This  depression is never going to go away.” And then   that thought leads to the belief, “I will feel  miserable forever, and my life is ruined.” Okay.   So how are these automatic negative thoughts  impacting your life? How do they impact how you  
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feel? Okay. Step two: thoughts aren’t facts. Your  brain makes stuff up all the time. Okay. So you   spend your day with these thoughts swirling around  your head, and they trigger the anxiety cycle. And   the crazy thing is, you don’t even realize it.  So how are we going to take another step toward  
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stopping the anxiety cycle? The second step is  realizing that your brain is a word machine. It   literally just makes a ton of thoughts all the  time. Its job is to crank out random thoughts.   So your job is to create a little space between  you and the thoughts. There are two approaches to  
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managing automatic negative thoughts: CBT and ACT.  Now, I think they both have merit, so let me teach   them to you. The classic approach to negative  thoughts is from CBT, cognitive behavioral   therapy. With CBT it’s like mental Judo. You learn  to spot these thoughts, challenge them, and swap  
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them out with thoughts that are more balanced and  realistic. You’re basically engage, engaging with   the thought in order to choose something more  helpful. So if we take the thought, “My boss   gave me negative feedback at work,” the classic  CBT approach is to say, “Are these thoughts  
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accurate?” and then replace them with thoughts  like, “Sometimes I succeed. I often do things   right. Last week I did a great job with that  problem we had with widgets,” and then you bring   to mind these alternate facts. Right? Say like,  “Oh, I messed up, but mistakes happen.” Or “I’m  
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going to learn new skills to solve this. I can get  through this. I always do.” Right? It, this can be   a really simple but a powerful way to stop buying  these negative thoughts and then replace them with   something more accurate and helpful. And there’s  a worksheet in the workbook to help you go through  
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this process. And just as a reminder, during this  course I’m going to teach you a ton of skills. And   it’s not like you can just do them one time and  then it’s all better. Like these are exercises   that you’re going to want to practice over and  over for a while until they become easier and  
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easier for you to do throughout your day. Okay.  So let’s talk about the second approach, what   ACT calls cognitive defusion. With acceptance and  commitment therapy you don’t fight the automatic   negative thoughts. Instead, you learn to sit  with them, notice them, but not let them boss you  
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around. Um you’re also encouraged to take actions  that line up with your personal values. This can   give your life a sense of meaning and purpose,  which makes the ants less powerful. So if anxiety   is believing the salesman, you know, um believing  those negative thoughts that say everything is  
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awful, freedom isn’t arguing with the salesman;  it’s not debating with them. Sometimes when we   argue with our thoughts or we spend a lot of  time ruminating on them or analyzing them,   we just end up overthinking and feeling more  confused and miserable than ever. This is called  
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cognitive fusion, right, where we might buy the  thoughts or we’re so engaged with our thoughts,   arguing with them and debating them, that we don’t  really have space to be present, to live our life.   We just keep going in circles. Like, it’s like  you’re in a debate with the salesperson. So even  
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if we aren’t buying what they’re selling, if we’re  arguing with the salesperson or debating facts   with them we aren’t going where we were going. We  aren’t walking down the sidewalk in the direction   we’re going. We’re just stuck there arguing with  our thoughts. And this is a typical overthinking  
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pattern with anxiety and depression. Freedom  is knowing where we’re going when we’re walking   down the street, knowing what we do and we don’t  want, and it also means choosing to engage with a   salesman only if it helps us. Right? So to do this  we need a little bit of space from the salesman,  
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and this is called cognitive defusion. So instead  of debating our thoughts, we need to learn to   notice these thoughts, separate ourselves from the  thoughts, and then choose what thoughts are going   to be helpful for us to live the life we dream of.  Maybe I want to buy that churro, but I definitely  
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don’t want to see that show in Las Vegas. Right?  We need to get better at distancing ourselves   from the salesman so that we can evaluate what’s  going to be helpful for us. This is a skill you   can learn and you can practice a lot, but you  can also just simply switch from saying like,  
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“I’m such a loser” to saying “I’m having the  thought that I’m a loser.” Instead of saying,   “I hate feeling anxious” you could say “I’m having  the thought that I hate feeling anxious.” All   you’re doing is creating a degree of separation  from your true self and your word machine. So  
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there are some really practical ways to learn to  do this. So this this video is already getting   too long, so we’re we’re going to practice more  cognitive defusion skills in the next segment.   I just wanted to give you an overview. So from  my perspective both CBT and ACT approaches can  
00:17:38
be quite helpful. I’ll often try the CBT first,  so like to a salesman, “No thanks, I don’t need a   vacuum cleaner.” Um or to your negative thoughts,  “No thanks, I’m I’m not a complete loser.” And   then if that thought is super persistent I’ll just  let it be there and I’ll redirect my attention,  
00:17:55
essentially ignoring the salesman and walking  on. “Dear mind, thank you for that thought,   but it’s not super helpful. Okay. Now, back to  what I was doing.” Just allowing that thought   to be there and redirecting your attention back  to your value, direction, or the present moment.  
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So just to summarize: automatic negative thoughts  are the habitual, involuntary thoughts that our   word machine of a brain pops out all the time.  They’re often false, unhelpful, and they directly   contribute to anxiety because that perception  of danger, that interpretation that a situation  
00:18:28
is dangerous or threatening triggers the fear  response. You can learn to notice these thoughts   for what they are – just thoughts – challenge  them, and replace them with something more   helpful to you, whether that’s a more realistic  thought or a shift in attention to what really  
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matters to you. Automatic negative thoughts don’t  have to control your life. Okay. Your challenge   for the next week: sit down with your workbook  and explore what kind of interpretations lead   you to feeling anxious. See if you can explore  the automatic negative thoughts that make you  
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feel feel like you’re in danger. Do this at least  once per day for one week. And it’s probably best   to just schedule in a time to do this instead  of waiting until you’re anxious to do it. Um   and you can print extra copies of the worksheet  from the paid course. Okay. Thank you for being  

I don’t know about you but for me 2020  has been a bit of a stressful year   so i thought i’d share with you some of the things  that i do every day to manage stress and anxiety   but in this video i’m also going to explain a way  of thinking about stress that can transform stress  
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from something that is you know just something bad  that happens to you into something that you can   channel to be more productive and also help you  feel calmer so in this video you’re going to learn   10 daily habits to reduce stress and anxiety and  don’t worry i’m not going to tell you to meditate  
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this video is sponsored by better help where  you can get a professional licensed counselor   who can personally coach you through anxiety and  stress for around 65 dollars a week so check out   the link in the description for 10 off your  first month so i’ve been reading the little  
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house on the prairie books to my daughter and in  book three we’re reading a story about almanzo   and his farming family in the 1800s  and they survived off of what they grew   and in one of the stories right before the fourth  of july they’ve got their corn starting to sprout  
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in this in the fields and the weather starts  to get weird so it seems like it’s going to   freeze so before they go to bed the parents  start to worry a little bit about the crops   and they they don’t go to sleep they stay up and  they watch the temperature and sure enough it does  
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start to freeze so they get all the kids out of  bed in the middle of the night and the only way to   save the corn is to pour water on each of these  tiny little stocks before the sun comes up and   if they don’t their corn is going to freeze and  they’ll have no harvest that year so every member  
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of the family anxiously runs through the night  hand watering each little corn sprout in their   acres and acres of fields and by the time the sun  rose they’d managed to save most of their crop   they were exhausted but they were also content  and after they did the rest of their morning  
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chores they were able to sit back and relax  and appreciate the hard work that they’ve done   so the stress response is your body’s activating  response when you sense a threat in almanzo’s case   this was their livelihood about to be destroyed  your body turns on this sympathetic response it  
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sends out some adrenaline to spur you into action  it heightens your breathing and your heart rate   to prep you for performance and almanzo and his  family they use their stress response to spur   them on the worry helps them to be vigilant to not  sleep to take this you know impressive physical  
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action and this stress response potentially saved  them from complete crop failure so anxiety isn’t   just something bad that happens to you it serves a  function but our modern language confuses anxiety   with anxiety disorder and it’s given this  negative connotation to the word anxiety  
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but anxiety isn’t out to get you it’s your body  and mind’s performance mode so the stress or   the anxiety response can help you have more energy  and get more done and then it’ll naturally resolve   if you know how to channel it so i’m going  to teach you some daily habits you can use to  
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naturally resolve your anxiety when you think of  anxiety as a motivating energy to resolve problems   anxiety can become a powerful tool instead of just  something bad that happens to you that you want to   avoid and even if you do have an anxiety disorder  these tools will help you reduce your stress  
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levels and get healthier so let’s talk about a  modern problem that we all have one of the reasons   that so many people struggle with stress and  anxiety is that we face a few modern problems that   make it a lot harder for us to deal with stress  than almanzo and his family back in the 1800s  
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because our anciently evolved brain isn’t so good  at dealing with modern stressors we all need to   take an intentional approach to managing anxiety  so the first problem that many of us face is that   so many of our modern stressors are connected  to problems that we can’t solve physically  
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so in almanzo’s case when they were worried  they got that jolt of adrenaline and cortisol   and they were able to use that physical energy to  solve a physical problem they didn’t feel stressed   afterwards because they burned off the adrenaline  and cortisol when they were running around solving  
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the problem so for many of us our modern stressors  are things like deadlines and assignments   traffic noise and our crops are sitting  at a computer instead of planning corn   so if i’m stressed about a problem at work i may  not sleep and i might even solve that problem  
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but the adrenaline and the cortisol stay in my  system until i physically burn them off so this   is where exercise becomes clutch daily exercise  is an essential part of reducing pent-up anxiety   five minutes of exercise has been shown  to reduce cortisol and adrenaline levels  
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exercise can decrease overall levels of  tension it can elevate your mood it can   improve your sleep and it can improve your  self-esteem so aerobic exercise you know where   you’re breathing really hard that tends to be  the most effective type of exercise at reducing  
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stress but really any kind of movement is helpful  so going for a walk or a bike ride or even just   doing like wall sits or stretching for a minute  in your office those can all be helpful so the   first thing i’m going to encourage you to do is  just find a way to add some movement to your day  
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now let’s talk about your morning routine how  you start your day is going to set the tone for   your entire day so if you’re like many people the  first thing you do makes your anxiety worse so um   this is what it looks like for a lot of  people you’re tired because you went to  
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bed a little bit late and the first thing you do  is start scrolling through your phone you look   at social media or the news and then you drink  some caffeine now caffeine is the most widely   used psychoactive drug in the world it crosses  the blood-brain barrier in seconds and it makes  
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you feel more alert by reducing adenosine but  adenosine is a relaxation chemical in your brain   caffeine can also increase adrenaline and it can  make you feel more irritable more anxious and   more agitated now you can develop a tolerance  to the alerting effects of caffeine meaning  
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you’re going to need more coffee the next time to  feel alert but you don’t develop a tolerance to   the anxiety effects of caffeine so caffeine  use can impact your sleep and your anxiety   for up to 48 hours and caffeine has been shown  to contribute to anxiety and depressive disorders  
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so if you’re serious about decreasing your anxiety  try getting caffeine out of your system for at   least three days and see how how that impacts  you i personally don’t use caffeine because   of the impact it has on on my anxiety levels  if you feel tired one thing you could try is  
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getting more sleep sleep helps your brain  function better which makes it so you can   better solve problems and resolve situations  that bring you anxiety so if the idea of   making these changes seems overwhelming um i’m  just going to encourage you to start slowly just  
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make one little change every month there there is  no quick and easy fix for anxiety like if you’re   looking for some magical cure you’ll have to  check some other channel because that’s not what   i’m selling but you can drastically reduce your  anxiety by making small and sustainable changes  
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okay so now let’s talk about your  media consumption so our ancient   evolved brain is much better adapted to the world  of little house on the prairie than it is to our   modern media almanzo and lara may have gotten a  newspaper once a week or heard the news from town  
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occasionally but that news was often about  local events the news was brief and infrequent   and actionable so stress about the news could  be resolved by taking action so for example   if a couple in town got married they could make  them a present or if a barn burned down in town  
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they could go help their neighbors build a new  one this is the opposite of what we have today   so these 24 7 streams of disaster around the  world these trigger our stress response as if   as if we’re in physical danger but they they  don’t give us any place to act to create safety  
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so if you wake up in the morning and you just  start scrolling through your feeds or you start   watching the news you’re basically giving other  people the power over your adrenaline glands   i do not recommend starting the day off with the  news instead sit back for a second and think what  
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do you want the tone of your day to be for me i  want it to be upbeat calm self-assured peaceful   and powerful now what kind of media does that for  you for me it’s prayer and scripture study first   thing in the morning for you it may be meditation  journaling uplifting music but the important thing  
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is that the first thing you do is something you  choose so i don’t i don’t just bury my head in   the sand when it comes to the news i choose to to  check a couple of of straightforward news stations   um once or twice a day but i don’t do it first  thing in the morning i also i also choose to focus  
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more of my time on areas that i can take action  on instead of on areas that are out of my control   the stress response is supposed to help you  it’s about performance and taking action but   it’s also supposed to be the short-term reaction  so it’s healthy for bursts of speed but it becomes  
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unhealthy when it’s chronic and when that stress  remains unresolved so if you take the little house   of the prairie story they worried they didn’t  sleep they took action they did what they could   to save the corn and some plants lived and some  plants died but then they relaxed our body has a  
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natural balancing reaction to the stress response  this is called the parasympathetic response but   most of us don’t know how to turn it on so you can  choose to turn on this parasympathetic response   through grounding exercises or breathing exercises  which i’m going to talk about later but the most  
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natural way to resolve the stress response is  to simply complete a task so if you feel worried   about an assignment and then you turn it in ah you  feel that stress go away and this is one of the   reasons why coping skills can only go so far in  helping anxiety because anxiety is best resolved  
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by doing one of two things either taking  action to resolve the problem or threat or   whatever it is or practicing active acceptance  so letting go of things that you can’t change   but in our virtual world even when we do complete  a task or we resolve a problem it can be hard to  
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see the results so my next tip is that you find  a way to acknowledge when you can set down a task   you you make it concrete so for me i really like  checklists um i’ll even like if i complete a task   and it wasn’t on my checklist i’ll write it on  my checklist and then i’ll check it off so that  
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i can um feel that sense of completion now there  are lots of ways to do this but find some way to   mark off or to acknowledge when you’ve completed  a task mike boyd just made a really interesting   machine that does this or simone yertz gertz i  wish i know how to say her name right um they also  
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have some interesting ways to kind of mark off  when they’ve completed something so i encourage   you to find some way to give yourself some  physical tangible way to celebrate your success   now this can be really hard to do with  long-running stress or long-term projects  
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but you can learn skills and practice them to  turn off the stress one skill that i learned from   michael barrett who was the director of the center  for change this is an eating disorder treatment   program is to every day when i leave work to make  a conscious practice of setting that work aside  
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so for me i just say a little prayer about my  clients i say lord i’ve done the best i can   i’m leaving them in your hands now there is a  lot of different ways to do this but the basic   idea is choosing when to carry something mentally  heavy and when to set it down so this could be as  
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simple as turning off notifications on your phone  or setting boundaries at work about when they can   and when they can’t contact you when your job  is mostly mental or mostly emotional or virtual   i also really find it helpful to choose something  manual to complete it can be really nice and  
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relieving to see physical progress on a task so  this could look like cleaning something mowing   the lawn fixing something physical there’s just  something about physical tasks and completion   that seem to click that like ah switch in the  brain it triggers that parasympathetic response in  
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our brain that says okay you’re all right you’re  safe now and it turns off that stress response   now managing anxiety is about being intentional  and in control instead of reactionary so i have   this picture in my head of me as a little kid  coming home from playing at a friend’s house um  
00:12:57
you know it’s evening it’s starting to get dark  and i i grew up in a super safe town but when it   started to get dark and i was walking home um you  know how it feels like there’s like that tingle   in the back of your neck and maybe you wonder  if there’s something behind you in the dark  
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um now of course in every single situation there  was nothing back there but if you start running   then you get more scared and you get you  get more and more scared the faster you run   and then you get through the door and you slam the  door whatever you look out the window and there  
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was nothing behind you now that is how i visualize  daily low level stress and anxiety it’s like you   start to feel that tingle in the back of your neck  and your impulse is to run so if you’re at work   and you start to feel a little bit stressed you  try to work harder you try to work faster and you  
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try to get more things done but that doesn’t  make you more effective i have the tendency   to try to fill every waking moment with busyness  you know checking your email or just keeping busy   all the time by always staring at your phone so  just like me as a little kid we perpetuate anxiety  
00:14:00
when we run from it when we run from ghosts  so instead of running like stop slow down   turn around and look around you and  you’ll see that there’s nothing there   so what does this look like in my day-to-day  routine this looks like taking the time to breathe  
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taking the time to slow down to do something  calming or to do something grounding   this is this is how you regulate your nervous  system throughout the day you may feel like you’re   getting more done by just going faster but you’ll  be a lot more effective and less stressed out  
00:14:36
if you take a minute every hour or so to  just clarify and to breathe and to slow down   our brain is not very good at multitasking that  can trigger that sympathetic that fight flight   freeze response so another way to help strengthen  your parasympathetic response is to monetise so  
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our brain gets super overwhelmed by multitasking  basically interprets too much stimulation as   being unresolved threats so close those tabs do  one thing at a time and then just you know one   of the things that i do throughout the day that  helps me calm down is to just notice where you are  
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so just notice right now that you are watching  this video now i promised that i wouldn’t tell   you to meditate but mindfulness is different it’s  just slowing down and noticing the present moment   noticing that you are doing what you are doing and  then you can move on and get back to you know your  
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work or whatever so another essential skill to  manage anxiety for your daily routine is to do   what i call big picture small picture so stress  is not the problem chronic unresolved stress is   the problem this is the problem of the brain not  knowing how to sort and manage all the stimulation  
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and all the triggers and all the threats that come  at it and when we feel too many things coming at   us our brain interprets that as if we’re being  attacked as if we’re in danger if if you’ve got   so many things that feel urgent but you can’t  do them all your brain can go into shutdown mode  
00:16:06
so what do we do with this right no one no one has  the time to do everything they want or need to do   so so how do i manage this i personally take  the time to intentionally sort out and choose   what i’m going to work on what are my priorities  and and what i can let go of and this i really  
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believe can help clear up that chronic unresolved  stress so for me i don’t know whether it’s anxiety   or whether it’s add but i am i constantly  feel like my brain is overflowing with ideas   and tasks and to-do lists and then on top of  that there’s the screaming children so the way  
00:16:38
that i i manage this is i’m constantly throughout  the day writing down my to-do lists so i’ll write   down a list of everything on my mind and then  i’ll just choose one or two things clarify   what is most important what are my priorities  and then i just get to work on a couple of them  
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and that helps me manage my stress and anxiety so  for some people clarifying looks like journaling   and this can really help with anxiety because it  helps your brain sort through the confusing mess   and and to get clarity and then to get going  again um another thing you can do like i do is  
00:17:11
these priority or to-do lists but then just make  sure to highlight only the few that you’re going   to work on or journal the journaling skill of  a brain dump or journaling about your locus of   control each of these things can help you you know  clarify and manage your stress throughout the day  
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now i’m going to jump ahead here to sleep you  know you think going to sleep would be my last   daily routine but sleep is really  important so to be able to sort through   all these tasks you really need the executive  functioning part of your brain to be working  
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and for that part of your brain to  work well you need to get enough sleep   so when your mind is rested it can  better manage all that excess stimulation   and it can resolve anxiety when it comes up but i  know it can be hard to sleep when you’re anxious  
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i have a hard time sleeping sometimes so if  you’re not getting enough sleep or you’re having   a hard time sleeping i would say just choose  one small step you can take to sleep better   now in order to manage anxiety another skill  that i’ve had to learn was to get a little bit  
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better at saying no so resolving anxiety is about  regaining self-control so if you want to resolve   anxiety you may have to say no to the occasional  party so that you get enough sleep so that you   don’t need coffee in the morning so that you’re  not stressed out and anxious throughout the day  
00:18:28
choosing a sustainable path instead of a frantic  one requires like a careful sorting of priorities   in your life so when we consciously choose  to not overload our brain it can handle these   tasks with more composure so this is something  i have to work on all the time is just saying  
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no to a lot of things that i want to do but  i know are not going to be helpful for me   now next one i want to talk about is getting time  in nature i’m not going to spend a lot of time on   this but there is a bunch of research that nature  is really good for anxiety and i personally love  
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it so i’m going to encourage you to try to get  some nature into your day-to-day life i am blessed   to live in an area where i can get out in nature  every day but you can get a dose of nature even if   you’re trapped in the city so go for a walk look  at the sky water a plant keep a fish visit a park  
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or even just watching a documentary or looking  at pictures of nature can be really soothing   for your brain so i’m gonna encourage you to make  nature a part of your daily routine the last part   of my daily habits that i use to reduce stress and  anxiety is i make sure that my day is not too full  
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i make sure that i turn off at some point during  the day so take time to wind down in the evening   so that you have time to get ready to go  to sleep and and get a good night’s rest   and and wake up ready to take care of yourself so  for me my wind down routine looks like turning off  
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my phone taking a hot bath reading some random  book and even though i’m super busy with three   little kids and a job and a business i make it a  priority to get a few minutes of peace most nights   so comment below what are you going to do for  your wind down routine what helps you manage your  
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day-to-day stress levels when you take the time to  resolve problems and to work with your brilliant   ancient brain you really can learn to reduce  anxiety and to get a lot of things done okay   that’s it i hope you find this helpful  thank you for watching and take care