7 Types of Anxiety Disorders

 Do you find yourself feeling stressed out when you’re studying for an important exam Or when you’re practicing repeatedly in front of a mirror before a presentation? It’s perfectly normal to feel stressed out or anxious now and then Unfortunately for some of us our anxiety can get so out of hand that we feel this way constantly That chronic feeling of anxiousness and fear is the marking of an anxiety disorder Before we begin we’d like to make a short disclaimer Please don’t use this video to self-diagnose! If you can relate to most of the signs, we do advise you to go to a qualified medical health professional for proper diagnosis With that being said, Psych2Go presents to you the Seven Types of Anxiety Disorders One) Generalized anxiety disorder also known as GAD It’s the most common among anxiety disorders to be diagnosed People with GAD suffer from intense and persistent worry a GAD sufferer can worry or feel anxious about a number of events ranging from school or work to their family life at home This anxiety is associated with at least three of these symptoms: Restlessness, Fatigue, Difficulty Concentrating, Irritability, Muscle Tension, Insomnia, or Difficulty Falling Asleep People with GAD, often can’t explain their anxiety using specific fears like those with more specific anxiety disorders can And this is because their anxiety stems from various stimuli Those who suffer from GAD can find relief in a number of treatment options ranging from mindfulness meditation and brisk exercise to cognitive-behavioural therapies and medications. Two) Separation Anxiety Disorder This type of anxiety is more common in children than adults. For many, the mere thought of separation causes a high amount of stress People with separation anxiety worry that something unexpected could separate them from their attachment figure Or that their attachment figure will abandon them This anxiety presents as nightmares of being alone and a persistent refusal to leave their attachment figure Kids with separation anxiety may be clingy and insist on sleeping with their parents at night Children often grow out of separation anxiety disorder, but if it persists for six months or longer, they should be provided help Adult sufferers may also find benefit from the available therapies Three) Social Anxiety Disorder, Social Phobia, and Selective mutism Social anxiety disorder also known as “S.A.D.” refer to the fear of public situations and exposure to unfamiliar people S.A.D. sufferers tend to avoid situations in which they’re in the spotlight because they’re worried that they’ll be embarrassed or judged by others The thought or the anticipation alone of an upcoming social situation can cause major anxiety-related symptoms like panic attacks or severe stomach pain People with S.A.D. May show signs of stress in these forms: Little to no eye contact, Freezing in place, Running off, or Avoiding tasks like eating in public Children and adults alike can suffer from S.A.D. But some children with social anxiety may also have a more intense ability to function in social situations Selective mutism is a type of social anxiety in which a child is unable to speak in social situations Despite being able to speak normally otherwise Often, this problem arises at school or in the presence of strangers If a child with selective mutism can communicate at all.  They might only be able to nod or whisper Four) Panic disorder It becomes a disorder when an individual experiences panic attacks multiple times in their lifetime Panic attacks are intense bursts of fear followed by a range of physical symptoms, these include at least four of the following: Cold sweats, Muscle stiffness or Trembling, Hyperventilation, which is fast, shallow breathing Lightheadedness, Numbness or the Fear of death and/or Insanity The fear afterward of another panic attack. Sometimes actually provokes more panic attacks More often than not, panic attacks are had in combination with other anxiety disorders Therapy along with medications can help in handling panic disorder Five) Agoraphobia Does your local train station seem intimidating? Do you feel faint in a crowded place? Agoraphobia is the fear of public places Anxiety arises because they deem them as too open or dangerous It’s triggered by fears like becoming a victim of crime or of contracting a disease or illness Its sufferers coop themselves up in their homes where they’re comfortable and familiar with their environment Agoraphobe often become over-dependent on other people to compensate for their inability to cope in public Agoraphobia can develop at any age and can be extremely debilitating Exposure therapy works effectively against Agoraphobia in conjunction with medication Six) Specific Phobia These are persistent and extreme fears about a specific object or situation and cause a ton of stress to the sufferer Phobias can be environmental like Acrophobia, the fear of heights and they can be animal-based Or even situational like Taphophobia, the fear of being buried alive Such phobias often arise due to traumatic experiences that cause people to make negative associations with these objects or situations Someone who was clawed in the face by a cat in their childhood might have an avid fear of cats in their adulthood In cases where exposure therapy may not be safe or applicable Cognitive behavioural therapy can be effective in changing a person’s negative association to their feared object or situation Seven) Obsessive-Compulsive Disorder OCD and Post-Traumatic StressDisorder PTSD Yes, OCD and PTSD were categorized by many psychiatrists as disorders to be grouped with the aforementioned anxiety disorders Recently there have been new findings about these disorders that team them both unique enough to be in categories of their own, However, this is not to suggest that OCD and PTSD are any less important to deal with The common thread that group disorders like GAD, S.A.D., panic disorder, and phobias together Is that sufferers of these anxiety disorders experience future-oriented fear? OCD differs, and though there is anxiety felt in the sufferer’s obsession They can find temporary relief in their ritualistic compulsions Unfortunately for OCD sufferers, this means a life of cyclical ritualism that can affect daily living Those suffering from PTSD May suffer anxiety-like symptoms similar to GAD or even panic disorder But PTSD is unique and that its past oriented The sufferer suffers flashbacks that bring them back to the event of their traumatization If you’re diagnosed with anxiety disorder, it’s okay Millions of people around the world understand what it’s like to suffer from an anxiety disorder, so you’re not alone Understand that every single one of these anxiety types is often treatable and manageable Also, if you know someone who may benefit from online counseling we’ve partnered up with Better Help, an affordable online counseling platform that you can utilize They’re constantly striving to improve their services and terms and conditions. The link will be in the description box Did you find this video helpful? If so, remember to share this video with those you think might benefit from it As always, Thanks for watching!As found on YouTubeFUNNELIFY is a new, first-of-its-kind, groundbreaking app ➯➱ ➫ ➪➬ which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets ➯➱ ➫ ➪➬ After using the Funnelify product, you will recognize a great increase in your leads and sales. This product shows methods to boost your traffic without using any shortcuts. The best thing is that you can build unlimited …

Bipolar disorder (depression & mania) – causes, symptoms, treatment & pathology

 Maybe you’ve heard the term “bipolar” used to describe someone who’s moody, or who has mood swings, but this colloquial use of the term is different from bipolar disorder. Bipolar disorder, which used to be called manic depression, is a serious mental illness that causes a person to have dramatic shifts in emotions, mood, and energy levels: moving from extreme lows to extreme highs. But these shifts don’t happen moment to moment, they usually happen over several days or weeks. There are a few different types of bipolar disorders, but there are some common features. First, the low moods are identical to those in a related disorder – major depressive disorder, also known as unipolar depression. Individuals with this can feel hopeless and discouraged, lack energy and mental focus, and can have physical symptoms like eating and sleeping too much or too little. But along with these lows, the thing that sets bipolar disorders apart from unipolar depression is that individuals can have periods of high moods, which are called manic episodes or hypomanic episodes, depending on their level of severity. In a manic state, people can feel energetic, overly happy or optimistic, or even euphoric with really high self-esteem. And on the surface, these might seem like very positive characteristics, but when an individual is in a full manic episode, these symptoms can reach a dangerous extreme. A person experiencing mania might invest all of their money in a risky business venture or behave recklessly. Individuals might talk pressured speech, where they talk constantly at a rapid-fire pace, or they might have racing thoughts and might feel ‘wired,’ as if they don’t need sleep. Manic episodes can also include delusions of grandeur, for example,, they might believe that they are on a personal mission from god, or that they have supernatural power. And they might make poor decisions without any regard for later consequences. One way to understand these swings is by charting them on a graph. So let’s say the y-axis is mood, with mania and depression being on the far ends of the axis, and the x-axis is time. The average healthy individual might have normal ups and downs throughout their life, and they might even have some pretty serious lows once-in-awhile, maybe after losing a job or moving to a new place and feeling lonely. An individual with unipolar depression though might have the normal highs, but they might have some crushing lows that last for a long period and may not have an obvious trigger. Now, for the bipolar disorders, the first one is called Bipolar 1, and these are people that have some major lows that last at least 2 weeks, and some major highs that last at least a week or require hospitalization. That said, untreated manic episodes can last as long as 3-6 months. Depression is seen in most cases but is not required for a diagnosis. The second one is called Bipolar-2, and this is when a person experiences similar lows and has additional highs called “hypomania”, which are less severe manic episodes than we see in Bipolar 1. To qualify for a diagnosis, these hypomanic states need to last at least four days. Once again though, these symptoms generally last a few weeks to a few months. Alright the third one is called cyclothymia, or sometimes cyclothymic disorder, and these individuals have milder lows as well as the milder highs or “hypomania” like you see in Bipolar-2, and they cycle back and forth between these two over a period lasting at least 2 years. Sometimes, people with Bipolar disorder can show other, less common symptoms as well, for example having what is referred to as mixed episodes—experiencing symptoms of both depression and mania at the same time. Another symptom they might have is rapid cycling, which describes a situation where a person has 4 or more episodes of depression or mania within a given year. Like most mental health conditions, the exact the underlying cause of the bipolar disorder isn’t known, and there is no single “bipolar gene” identified, but it’s thought that there are genetic and environmental factors that play a part. For example, one interesting clue is that people with family members who have bipolar disorder are 10 times more likely to have it themselves. Another clue is that some drugs and medications can trigger manic episodes, like selective serotonin reuptake inhibitors (or SSRIs). It’s also worth mentioning that people with bipolar disorder often have other disorders like anxiety disorders, substance use disorders, ADHD, and personality disorders as well, making diagnosis and treatment a real challenge. Even though there’s no cure for bipolar disorder, identifying and treating individuals is important, since there’s a real danger that the person could harm themselves or commit suicide. One of the oldest treatments is also one of the most effective treatments, and that’s lithium salts. Lithium acts as a mood stabilizer—smoothing out the highs and lows they experience. That said, it is much better at treating manic rather than depressive episodes, and so individuals who take it often have to take other medications as well, which can be problematic since some antidepressants (like the SSRIs) can trigger manic episodes in individuals who are predisposed to them. Other treatment options include antipsychotics, anticonvulsants, and benzodiazepines, but many of these—including lithium—have side effects that can be severe and lead to non-adherence which can be dangerous for an individual. Now, unlike certain disorders like unipolar depression, psychological interventions, like talk therapy, or cognitive-behavioral therapy are not particularly effective in treating the manic episodes of bipolar disorder. Having said that, they can still be very helpful tools to help individuals with bipolar disorder in general—especially after a manic episode has ended. They can also help an individual handle stressful situations that might otherwise lead to a manic episode, thereby helping to prevent a potential manic episode in the first place. Alright, so super fast recap: bipolar disorder is a mental disorder characterized by depression, periods of lowered mood, as well as mania, and periods of heightened mood. Thanks for watching, you can help support us by donating on Patreon, subscribing to our channel, or telling your friends about us on social media.As found on YouTubeFUNNELIFY is a new, first-of-its-kind, groundbreaking app ➯➱ ➫ ➪➬ which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets ➯➱ ➫ ➪➬ After using the Funnelify product, you will recognize a great increase in your leads and sales. 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12 signs you might be suffering from PTSD


PTSD stands for post-traumatic stress disorder a condition officially recognized in 1980 to describe exposure to a relatively brief but devastating event typically a war a rape an accident or a terrorist incident complex PTSD recognized in 1994 describes exposure to something equally devastating but over a very long time normally the first 15 years of life emotional neglect humiliation bullying disrupted attachment violence and anger a lot of us as many as 20 percent are wandering the world as undiagnosed sufferers of complex PTSD we know that all isn't well but we don't have a term to capture the problem we don't connect up our ailments and we have no clue who to seek out or what sort of treatment might help so here are 12 leading symptoms of complex PTSD we might think about which ones if any apply to us and more than seven might be a warning sign worth listening to firstly a feeling that nothing is safe wherever we are we have an apprehension that something awful is about to happen we are in a state of hyper vigilance the catastrophe we expect often involves a sudden fall from grace we will behold away from current circumstances and humiliated perhaps put in prison and denied all access to anything kind or positive we won't necessarily be killed but to all intents our life will be over people may try to reassure us through logic that reality won't ever be that bad but logic doesn't help we're in the grip of an illness we aren't just a bit confused secondly we can never relax this shows up in our body we're permanently tense or rigid we have trouble with being touched perhaps in particular areas of the body the idea of doing yoga or meditation or breathing exercises these things aren't just not appealing they may be positively revolting we may call them hippie with a snare and deeper down they are of course terrifying probably our bowels are troubled too our anxiety has a direct link to our digestive system thirdly we can't ever really sleep and we wake up very early generally in a state of high alarm as though during rest we've let down our guard and are now in even greater danger than usual fourthly we have deepened ourselves an appalling self-image we hate who we are we think we're ugly monstrous repulsive we think we're awful possibly the most awful person in the world our sexuality is especially perturbed we feel predatory sickening shameful fifthly we're often drawn to highly unavailable people we tell ourselves we hate needy people but what we really hate are people who might be too available for us we make a beeline for people who are disengaged won't want warmth from us and who might be struggling with their own undiagnosed issues around avoidance sixthly we are sickened by people who want to be cozy with us we call these people puppy revolting or desperate seventh we are prone to losing our temper very badly sometimes with other people more often just with ourselves we aren't so much angry as very very worried worried that everything is about to become very awful again we are shouting because we're terrified we look mean we are in fact defenseless eighth we are highly paranoid it's not that we expect other people will poison us or follow us down the street we just suspect that other people will be hostile to us and will be looking out for opportunities to crush and humiliate us we can be mesmerically drawn to examples of this happening on social media the unkindest and most arbitrary environment which anyone with complex PTSD easily confuses with the whole world chiefly because it operates like their world randomly and very meanly ninth we find other people so dangerous and worrying that being alone has huge attractions we might like to go and live under a rock forever in some moods we associate Bliss with not having to see anyone again how a tenth we don't register to ourselves as suicidal but the truth is that we find living so exhausting and often so unpleasant we do sometimes long not to have to exist anymore 11.


We can't afford to show much spontaneity we're rigid about our routines everything may need to be exactly so as an attempt to ward off looming chaos we may clean a lot sudden changes of plan can feel indistinguishable from the ultimate downfall we dread 12. in a bid to try to find safety we may throw ourselves into work amassing money Fame honor Prestige but of course this never works the sense of danger and self-disgust is coming from so deep within we can never reach a sense of safety externally a million people can be cheering but one jeer will be enough once again to evoke the self-disgust we have left unaddressed inside breaks from work can feel especially worrying retirement and holidays create unique difficulties those are the symptoms so what is the cure for all these arduous symptoms of complex PTSD partly we need to courageously realize that we have come through something terrible that we haven't until now properly digested because we haven't had a kind stable environment in which to do so we are a little wonky because long ago the situation was genuinely awful when we were small someone made us feel extremely unsafe even though they might have been our parent we were made to think that nothing about who we were was acceptable in the name of being brave we had to endure some very difficult separations perhaps repeated over years no one reassured us of our worth we were judged with intolerable harshness the damage may have been very obvious but more typically it might have unfolded in objectively innocent circumstances a casual visitor might never have noticed there might have been a narrative which lingers still that we were part of a happy family one of the great discoveries of researchers in complex PTSD is that emotional neglect with an outwardly High achieving families can be as damaging as active violence in obviously deprived ones if any of this Rings Bells we should stop being brave we should allow ourselves to feel compassion for who we were that might not be easy given how hard we tend to be with ourselves the next step is to try to identify a therapist or counselor trained in how to handle complex PTSD that may well be someone trained specifically in dealing with trauma which involves directing enormous amounts of compassion towards one's younger self in order to have the courage to face the trauma and recognize its impact on one's life rather touchingly and simply the root cause of complex PTSD is an absence of love and the cure for it follows the same path we need to relearn to love someone we very unfairly hate beyond measure ourselves the School of Life offers online Psychotherapy to people all around the world our therapists are highly trained and accredited and are a vital source of kindness Solace and wisdom for life's most difficult moments click the link to find out more



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Anti-anxiety medications

 Check out the pharmacology section of thedrnurse.com for a helpful reference guide! Benzodiazepenes This class is exclusively for anxiety and sometimes insomnia The ‘pams Clonazepam, Lorazepam Enhance effects of GABA Side effects include sedation, drowsiness, lethargy RESPIRATORY DEPRESSION Dependence and tolerance is also a concern Benzos treat acute, SEVERE anxiety Atypical anxiolotyics= BuSpar BuSpar increases free levels of serotonin and dopamine BuSpar treats depression also BuSpar will NOT work for an acute anxiety attack or severe anxiety BuSpar treats generalized anxiety disorder Inform your patient of GI side effects Such as nausea, constipation, diarrhea Tell your patient to take BuSpar with food to minimize these effects Antihistamines Hydroxyzine Brand name is vistaril Can also treat insomnia due to sedating effects They directly block histamine receptors NOT to be given for an acute attack OR severe anxiety Antihistamines are used for mild anxiety or performance anxiety Inform of GI side effects such as nausea Anti-histamines dry secretions so inform patient they may experience dry mouth, constipation, dry eyes Abdominal cramps is another possible side effect Headache is also frequently experienced by patients taking antihistamines SNRIs and SSRIs Serotonin norepinephrine reuptake inihibitors Selective serotonin reuptake inihibitors SNRIs increase free levels of norepinephrine and serotonin SSRIs increase the levels of serotonin SNRI prototype is duloxetine Also called Cymbalta; can treat neuropathic pain SSRI used most frequently for anxiety is escitalopram (Lexapro) Both SNRIs and SSRIs are also prescribed for depression These classes are NOT for acute or severe anxiety! Teach about how to cope with GI side effects Take with food Non-selective beta blockers These decrease stimulation from epinephrine and norepinephrine Slow heart rate, and relax blood vessels Non-selective BB do not differentiate between beta receptors in the heart and beta receptors in the lungs MAY INDUCE BRONCHOCONSTRICTION Non-selective BBs are contraindicated in patients with respiratory conditions, ESPECIALLY ASTHMA! This class is great for social and performance anxiety They calm the symptoms of social and performance anxiety Prototype is propranolol Head over to thedrnurse.com! SUBSCRIBE! THANKS FOR WATCHING! As found on YouTubeFUNNELIFY is a new, first-of-its-kind, groundbreaking app ➯➱ ➫ ➪➬ which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets ➯➱ ➫ ➪➬ After using the Funnelify product, you will recognize a great increase in your leads and sales. This product shows methods to boost your traffic without using any shortcuts. The best thing is that you can build unlimited …

Part 1: Anxiety & School – Identifying Anxiety and What To Do About It

 Kelcey Schmitz: We want to welcome you to our presentation today which is part of a series on anxiety and the return to school. My name is Kelcey Schmitz and I work for the University of Washington at the School Mental Health Assessment, Research and Training Center or SMART Center, as the School Mental Health, leads to the Northwest Mental Health Technology Transfer Center, our the center is located in Seattle. So, whether you are returning 100%, virtually, hybrid, or all in person, we do think you’ll find this session relevant to your situation. Our funder SAMHSA has asked that we provide this disclaimer that the views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies at the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the US Department of Health and Human Services. The University of Washington SMART Center The Northwest MHTTC acknowledges that we learn, live and work on the ancestral lands of the Coast Salish people who walked here before us, and those who still walk here, we’re grateful to respectfully live and work as guests on these lands with the Coast Salish and Native people who call this home. We encourage you to learn about the ancestral lands you’re joining us from. On the next slide, I want to spend just a moment to tell you about the Mental Health Technology Transfer Center Network. It was funded by SAMHSA in late 2018. The MHTTC network includes 10 Regional Centers, a National American Indian and Alaska Native Center, and National Hispanic and Latino Center and a Network Coordinating Office. We know that many of you may be joining us from outside of our region, and we want to make sure that you know about the MHTTC where you are located. You can visit the MHTTC Network to find a center near you or to check in with other centers across the nation. So just briefly, I want to introduce those of you who are new to our center. The Northwest MHTTC supports the School Mental Health workforce in Alaska, Oregon, Washington, and Idaho, and on this slide, you can see a variety of ways that you can get in touch with us. You can see our website and email on how to reach us, a link to sign up for our newsletters, and social media accounts for a variety of ways that you can connect with us. We do send out monthly newsletters, as well as training and resource blasts. So, please sign up and be in the know about what we’re offering. So, at this point, I want to invite our guests to come on video. Dr. Kendra Read and Dr. Jennifer Blossom will be spending the rest of our time with us today. They’re going to present some amazing content and then have generously offered to answer any questions that you might have during our Q&A session. So again, at this point, I am going to turn it over and want to give a warm welcome to our guest presenters today. Thank you. Kendra Read: Thank you so much Kelcey for that warm introduction. So, appreciated. So as Kelcey mentioned, my name is Kendra Reed. I am a clinical psychologist and the director of anxiety programs at Seattle Children’s Hospital and Jennifer blossom is also a clinical the psychologist was recent with us at Seattle Children’s as a postdoctoral fellow and is embarking on her new academic career as a professor at the University of Maine. Alright, here we go. Here’s more about our introductions here. Both of we hold expertise in the assessment and treatment of anxiety and mood disorders, including OCD in youth. So that is what we are here to talk about with you all today. As our disclosure, we don’t have any conflicts of interest. We won’t be discussing any off-label product use, and we have no commercial support or sponsorship. This is not a co-sponsored talk, so nothing to disclose here. Our objectives during our presentation, today are to review how anxiety presents in educational settings, to discuss and learn more about the empirically supported strategies to address problematic anxiety in educational settings and to describe school-based approaches for anxiety that encourage and reinforce those empirically supported strategies of approach versus avoidance. We’ll get more into that shortly. Okay, so I like to start here with everybody. I am sure all of you have experienced anxiety and some form or another in your lives, because anxiety is a human emotion, we all have it. So, I’m going to describe anxiety to you all like I would to a family coming in to seek services with us because I think it’s really helpful to hear how we would describe it so that you can implement this in your work with families but what I want everybody to know, kids, adolescence, parents, and you all as educational providers is that anxiety is a normal, adaptive, and protective feeling. This is our body’s natural alarm system. It’s the system that says “Hey, watch out for danger, danger, danger, get out of here”, when something is a threat to our safety. So, it’s an important feeling that we have, it is a good thing and then often, in many cases, it can be kind of a performance boost for us. If I didn’t feel anxious at all about an upcoming test, I might not even crack the book for it. So, anxiety isn’t all bad and I like to start there with everyone because anxiety gets a really bad rap. We hear the word anxiety, we’re like, oh, no, must not feel that but in reality, anxiety, as I said, is a human emotion. We all have it, and it is often a really important one. Though anxiety can become problematic when it causes significant distress or interferes with the functioning of youth or their families. So when it grows, when that natural alarm system grows to be too big for the situation, and I use this example a lot with the families that I’ve worked with, but if we go back to that natural alarm system, I use this analogy of a smoke alarm or a fire alarm in somebody’s house. That is a useful tool. We want them installed in fact that it helps our homes be up to code and we need fire alarms and sometimes those fire alarms go off when there’s no fire, right? So, I tell this story of how in my old house, the smoke alarm would go off every time someone took a shower, which is true and was very problematic because we also have a husky. So it was very loud all of a sudden, and during the shower, the last thing you want to do is get out to like deal with the loud things that are happening but that’s kind of like what happens in the bodies of people who have problematic anxiety. Their body and their mind is going “fire, fire, fire! Oh, no!” but there’s no fire. There’s no smoke, right? There’s, no, there’s no true threat to their well-being. There is a perceived threat that is inaccurate, right? but we don’t want to, quote-unquote gets rid of anxiety, I’m not in the business of curing anxiety, because that would be problematic. That’d be like uninstalling all of the fire alarms in folks’ homes that would, houses would start to burn down. Those alarms are there for a reason. So, we don’t want to uninstall those alarms. We don’t want to take the batteries out but instead we want to recalibrate that alarm to take a second to say, wait for a minute, is there smoke? we need to stay in the situation to see if is it as bad or as problematic, as I am assuming in this moment. So, I’ve, we’ve also included here a table of some common fears and worries that crop up at several different developmental stages and these I think are important to note just to point out how anxiety is super common and pops up all the time and in fact, we see themes for, for youth throughout their developmental stages for when we typically see anxiety about this or that. All of that to say pre-school on, you can still meet the criteria for quote-unquote, anxiety disorder, or have problematic anxiety in the specific topics if kids are starting to pull away from their peers, in terms of the amount of distress and interference they are experiencing about these topics. So, the main takeaway point from this is anxiety is normal. We don’t want to get rid of it altogether. I always tell kids; that you’d end up at the hospital for a different reason. That would be bad, but our job is to help them stay in this situation to recalibrate that false alarm that’s going off. Say, wait a minute, is this as bad, is this, is there smoke? We’ll hand it off to you Jen. Jennifer Blossom: Great, thank you. So at this point, we’d like to welcome everybody to use the chat function and let us know from your perspective what you’ve seen in your students and kiddos, what anxiety looks like. So, if you wouldn’t mind taking a moment to enter the chat, different behaviors or different things that you’ve heard from your students, school avoidance, it looks like is the first thing off the bat that is something that Kendra and I see often stomach aches, I’m seeing a lot of withdrawal and isolation. Some tears, shutting down, sometimes aggression. We see anger, outbursts, and aggression that can come up as a way to avoid it. Covering face, crying, this is great. Thanks so much for jumping right in here and keeping them coming. So a lot of fear. Some I’m seeing sometimes that people are seeing self-harm or suicide ideation, suicidal ideation, the withdrawal that there’s a lot of reaching out to parents that kids are afraid to participate or they’re not answering questions, difficulty regulating. Something that we often see particularly in a school setting is kids going to the nurse excessively, and having difficulty paying attention. That’s a very common one. Sometimes looking for substance use or using substances as a way of avoiding anxious feelings, and sleep disruption. Somebody mentioned, seeing that kids are on their phones a lot and that’s particularly common, right? because if we’re focused on our phones and looking down at the screen in front of us, then that doesn’t mean we do not have to interact with those around us or face things that might be anxiety-provoking in our immediate environment. Great. Excellent. Thank you so much for sharing. So, you’re mentioning a lot of the things that you’ll see on the slide here are things that you’ve just mentioned. So in particular, one of the things as we were preparing for this talk to think about how is anxiety manifesting. How is avoidance manifesting now that a lot of schools or a lot of classes are remote, so kids are meeting via, zoom or some other video conferencing platforms and one of the things that we’re thinking of is that there are in some capacity, it’s maybe easier to fully avoid participation in school. So, school avoidance is definitely a common problem. The hallmark of anxiety, just as Kendra was describing, initially, the hallmark of anxiety is that our bodies react when there’s a the situation in which we were worried about an immediate threat or danger and the automatic response to that is avoidance. Right? If there is a fire in my house, I want to get out of the house. That’s how I stay safe. The problem is that when that the alarm system is going off for things like talking in class or asking teacher for help, then avoidance becomes really problematic because you’re avoiding situations that allow you to participate in the classroom or learn what you need to do or get the help that you need and so oftentimes, what we see is avoidance when kids are physically in school, it might include going to the nurse’s office frequently, a lot of, you were mentioning stomach aches, others might have complaints like headaches. Avoidance might be asking to leave the classroom for a short period of time, excessive bathroom use, either due to semantic distress or because that’s an opportunity to leave classroom. When thinking about the class meetings via zoom, this avoidance can be not joining the zoom session or joining, but not responding verbally to questions, not participating verbally, using the chat function instead, or using the chat function and only responding to the teacher, so not responding so that all students can see. This might also be, you know, avoiding using (and we’ll talk about this on the next slide) but avoiding using the zoom camera function, there might be a lot of missed class or participation due to aches and pains or complaints about illnesses and oftentimes when we think about this from an anxiety perspective, is that when there’s additional medical workup, there’s additional testing that there’s not an underlying organic or medical cause for these semantic complaints. So, frequent stomach aches without an underlying medical etiology are commonly associated with anxiety and in some ways, this is because of cultural differences and emotional expression. So, just describing anxiety as more of a somatic experience is more common, particularly in Latinx cultures and so this is something that we might see more commonly there’s a there can be a lot of distress related to sleep, or eating difficulties. So, students may be less likely to eat while at school. This might not be something we’re seeing when we’re all on zoom based, but definitely something that’s pretty common when we’re in the brick-and-mortar schools. Additionally, excessive reassurance seeking is something that’s pretty common and this is something that we see with students in the classroom happens very frequently with parents but certainly with teachers and other school personnel as well and this is you know, the kind of thinking about your typical student that is on top of classwork but still asking very frequently about due dates are making sure they’re getting the rules just right are they fully understand the expectations for a specific test or project, and that they’re asking excessively and possibly even repeatedly asking the same question. As Kendra was just describing, when there’s an alarm going off when there’s an alarm system going off in your head or your body, it can be really hard to focus, right? If I was standing here trying to talk to you all and there was a smoke alarm going on, behind me, trying to keep track of what I’m supposed to be saying and which side we’re on would be really hard. So oftentimes, anxiety can look like in-attention and this can impact school performance and in some ways appear more commonly like symptoms of ADHD, but it’s actually, anxiety that’s getting in the way because it’s really hard to focus when you’re feeling anxious. So school avoidance, this is something that I saw very commonly in the chat. So, this can include excessive tardiness up to an including chronic absenteeism, particularly when thinking about Zoom meetings. I started to talk about this on the last slide, but showing up late to Zoom meetings are not showing up at all showing up and not turning the camera on and I do want to pause here for a moment and just make note of that they’re very valid reasons which some students are not comfortable turning a camera on, it might be unsafe for them to share information about their school environment, or their housing environment, or where they’re living and that might drive, drive them to keep the camera turned off and in som cases, it might be because o anxiety and worry around ho they look or where even though you know, they’ll see, they’ll say something about that they’ll say something silly or wrong o people will laugh at them. think you know, there’s on the thing that I’ve thought pull up here is when if you all were on camera right now there would be little panels of ove 300 people showing up on the screen and when students are joining as part of a classroom there might be 20 or so 30 or s students showing up on the screen but in, in somebody’s somebody’s mind who has anxiety they’re thinking about it. Like what’s happening right now, I’m the only camera on screens that means everyone’s looking at m and that can really drive a lo of avoidance. I also saw a lot in the chat, that there’ angry outbursts, or there’ difficulty regulating emotions Sometimes, what can happen I somebody feels really anxious about completing a specific task, and they refuse t complete the task, or if they get upset or dysregulated, cr or yell, they’re sent, they’re sent out of the room or they’re asked to leave the area so that doesn’t disrupt other students and what happens over time is that kids learn. If get really upset or I yell and say that I’m not going to do it then I don’t have to do that thing that feels really hard an it makes me scared and anxious So over time, those angry outbursts can actually be driven by anxiety even though the might on the face look more oppositional or quiet Sure and I just wanted to note, there was one question in the Q&A that I felt was really relevant to this moment of noting that some school districts are only having students use their names in the the video function of zoom and not have their video on and there’s concern that students might be zoning out or not connecting, if that’s happening all the time and from my perspective, I think that’s certainly possible. I think it’s hard for us to really know there’s a lot of uncertainty for us and I also want to reflect on how you, we have, you know, roughly 315 participants joining right now and so much engagement, even though I can’t see any of you, so hard to know, for sure. I think there’s a lot of uncertainty and there might be, as Jen pointed out, there might be some good reasons for students to have their videos off. In terms of an equity perspective, both in terms of like Internet bandwidth and the home environment and safety concerns around that and it does certainly allow youth who are anxious about being seen on zoom to avoid the situation. So, I have sort of mixed feelings about it from that perspective. Thanks for jumping in there. So, what we know about the causes and factors that maintain anxiety, it’s complex, there’s not one cause or likely one general issue that goes on when a child experiences problematic anxiety. Did you know that kids can be genetically predisposed to anxiety? So oftentimes, anxiety runs in families, so there might be an anxious parent or an anxious grandparent, and then we’re more likely to see anxiety in kids and the ways that that’s expressed come up and up in a couple of different ways. So, there are temperamental factors, kids who experience behavioral inhibition, they are less likely to engage with novel situations, they’re more cautious and careful in novel situations and this is, these are temperamental factors that we can actually observe as young as children as young as a few months old, that you can start to see these characteristics. They tend to just be more careful and cautious. This is not the kid who’s running out at recess on the first day of school, the new school just checking out all the gym equipment. This is maybe the the kid who’s kind of carefully following their other classmates and looking around to kind of get a lay of the land before jumping into anything and we also know that anxiety can be learned through observing others in the child’s environment. So, we think a lot about social learning about anxiety and in particular thinking about the ways that adults and other kids might model anxious behaviors for kids. So, watching as somebody appears overly cautious or if their – kids might be – observing their parent’s avoidance in certain situations, and that they learn that over time. There’s also a big factor of kids might be getting reinforced for avoiding. So, there might be inadvertent situations where well-meaning adults, teachers, parents, and other adults are trying to help a child feel better and be able to manage a situation and they’re actually reinforcing the anxiety. So, one of the ways that we think about this calmly coming up is that is excessive reassurance provision. So, “You’ll be okay. You’ll be okay. There’s nothing to worry about.”. Oftentimes, that’s really communicating the feeling of anxiety that kids are learning that they can’t handle it and that they really need that help from other others in their environment. We also know that for kids with anxious brains, that alarm system again, as Kendra was saying, it’s really sensitive. So, that means that it’s really picking up on potentially nuanced or minute indicators in the environment that suggest that there might be something threatening. So, I’m walking into a room of 50 people and I hear one person laugh, and I, I’m automatically thinking, “They must be laughing at me. My shirt is so stupid. I can’t believe that, that I decided to wear this today.”. You know, they’re walking, they’re walking through on the bus to go home from school and somebody starts whispering to a neighbor. They must be whispering about me, anxious brains are really detail-oriented. It’s a strength and it can mean that if they’re really detail oriented, they’re picking up on things that could possibly be threatening, especially at school that comes up frequently walking in, you’re often in large groups of people. Sometimes you’re meeting new people you’re changing classrooms. Each class may have a different group of students. At the start of school, you’re thinking about where we all are right now, students are just trying to get up to speed on what different teachers expect. In particular now, in the a learning environment that we’re all managing, figuring out how to manage expectations and what is needed. There’s a lot of information to process and anxious, anxious feelings to really pick up on the things that suggest that there might be something dangerous or threatening. We also know so in addition to attending to those things, we also know that there’s a higher likelihood of misinterpreting things as threatening. So, you know, walking, walking past someone in the hallway or if you’re in a zoom meeting, and look at perceiving that maybe the teacher frowned for a moment and kind of a subtle shift in facial expression, that somebody with anxiety is more likely to interpret that negatively and personalize it. So that you know, the teachers disappointed in something that I did, or oh, they thought what I said, was silly or wrong. So, there are a number of things that come up in terms of processing information in the environment that can cause anxiety and then, in addition, thinking about environmental and life stressors, and that’s certainly something that is relevant for all of us in the current situation and when we think about this as a causal factor for anxiety, we distinguish it from traumatic experiences. So, experience of a specific trauma is considered something separate from anxiety and the treatment looks a little bit different from anxiety and what we know about most anxiety disorders and kids who experience some kind of problematic anxiety are many of them do not actually have a specific traumatic event related to that, their experience of anxiety. Oftentimes, what happens is that there’s a constellation of factors right, they might be predisposed to this experiencing anxiety because of genetics that they got from their parents and then if they exhibit some behavioral inhibition, they’re more cautious in new situations and then they’re reinforced for that the cautious approach in those situations but over time, this becomes problematic, and can lead to problematic anxiety. Great. So when we think about how this plays out, and how over time, these factors can contribute to the cycle of avoidance, so that it continues and becomes truly impairing. So looking at the picture on the the left hand of the screen, the cycle of avoidance, what we think about using that information to figure out how we can intervene and help move the child to the cycle of approach which is the right-hand, right-hand side of the screen. So the goal is to use this information about how we understand that anxiety is learned and maintained over time to figure out what can we do and what can well-meaning adults in the child’s life do to help them address problematic anxiety. So, if we start with the example of the cycle of avoidance, what oftentimes happens is that child the child may encounter a situation and they notice, anxious feeling. So, they start to notice that their heart rates increasing, they might notice a kind of tightness, they notice that their shortening of breath, and they, they have this naturally occurring experience of anxiety and what the body and the brain is telling you to do at that moment is avoid, is to leave the situation. So, the child experiences that anxiety, anxious emotions and physical experience, and then they avoid and what happens after they avoid is that somebody, some well-meaning adults again notice what’s happening, noticing a child having a hard time and jumps in and says “Oh, are you okay? Hey, what’s going on come here” what you know, comfort to them, you’re not feeling well. I want to make you feel better, completely understandable he jumps into say, Oh, you know “what’s going on? tell me what’s going on?” and the child then experiences anxiety reduction, right anxiety goes away. And what they’ve learned because of that is that if I feel anxious, I can’t handle it, what I need to do is a void and when I void, then I get comforted for that I get reinforced for avoiding and when this pattern plays out over time, and what happens that anxiety symptoms start to creep in earlier and earlier, the avoidance becomes more and more problematic. If this is something that the child was experiencing, walking into a specific class, this can begin to escalate to the point of you know, it’s the fifth period and The fifth period really hard for me, and then avoiding fifth period and then more and more relief that they experienced by avoiding the fifth period might try out to help I don’t even go to the school then I never have the risk of attending the fifth period. This is how anxiety and avoidance can play out over time and become really impairing. So with that in mind, we take that information and we figure out okay, so what do we need to do to help the child, approach the situation and learn the goal? As Kendra said we don’t want to get rid of anxiety, anxiety is really helpful. What we want them to do is learn that they can handle and they can tolerate anxiety. Over time in some of these situations are not objectively life-threatening or risk of injury, that they are better able to handle it and over time, their anxiety in those situations might decrease but we really want to focus on tolerating that initial fear and being able to function even when feeling those anxious feelings. So, when we work to help kids overcome anxiety, overcome problematic anxiety. We want them to actually practice doing the thing that makes them anxious and oftentimes, this can seem surprising or counterintuitive, when we’re talking with people about how we think about anxiety but if you think about it, this is, you know, this is a common, a common colloquialism that we hear, right? Face your fear. The idea is, that we want you to practice experiencing this so that you can learn you’ve got this, you can do it and that means we typically take gradual steps. So, we want to think about what’s the thing that makes the child really anxious and then we want them to bring on that anxiety. So, take a step toward that situation. So, can you think about a child who’s really scared about getting shots. It might be that first, we’re going to ask you to look at pictures of a needle and then you’re going to work, work towards watching a video of somebody getting a shot up to an including getting a practice shot and until you notice you know what, oh, I noticed I feel a little anxious, but I can do it. I can do what I need to do. So that I can go to the doctor when I need to so that I can get the vaccines when I need to. When we work on the cycle approach, we bring on that anxiety. We encourage the child we validate this is hard, but we know you can do it, we ask them to face that fear, and then instead of providing comfort, instead of providing comfort after the child has left a situation or has avoided the situation, we jump in and provide lots of reinforcement, and praise about brave behavior. Right. So, “this was so hard for you, and you still walked into that classroom, I’m so proud” and what, what the child learns in that situation, is that they’re actually able to handle more than they thought they could, or if the worst possible situation that they thought was going to happen happened that they were still able to handle it and do it and over time by reinforcing that bravery, we see less and less impairment, related to anxiety and potentially over time, reduced anxiety in those situations. So, from here I really wanted to go over what we know are the evidence-based interventions for anxiety, problematic anxiety, or anxiety disorders. So, because I think what we want to do is take the components that we know work from evidence-based therapy and talk about how we can apply those to educational settings. So, we know that the evidence based intervention for anxiety the most helpful thing is cognitive behavioral therapy and cognitive behavioral therapy has, it looks at the common connection between thoughts, feelings and behaviors. So for example, if you hear you’re going to an amusement park and you think I love roller coasters, you’re going to feel really excited, and you’re going to ride them, and then all that’s gonna feed back to next a time where you’re like, loved it. It was so much fun. Can’t wait to do it again but if you hear you’re going to an amusement park and you think I’m going to die on a roller coaster, you’re probably going to feel anxious, probably try to avoid it, sit on the fence, and not go at all. I’m sick, I can’t go, right and all that’s going to feed back to the next time you hear you have to go to an amusement park, you’re like, the the only reason I lived is that I never stepped foot on those grounds, even though everybody else probably lived or you probably wouldn’t be revisiting that amusement park, right? So, we really want to help people tackle changing the cycle in that thoughts, feelings behavior cycle in two places. That and that is thoughts and behaviors. A lot of times, people come into our offices because they have problematic feelings. They feel really anxious and that’s the problem but we actually don’t target that directly because our whole point is that I actually that’s a really normal feeling, right? but so we want to change how we think about situations that are kind of bringing about that feeling of anxiety, and we want to change our behavioral spots what we do in those situations in order to reduce problematic anxiety over the long run, and that changing the behavior part is exactly what Jen was talking about that facing your fear part and that in CBT is called exposure or facing your fears and exposures that we know are the most a critical piece of treating anxiety disorders, it’s the most the important thing you can do. It’s helped kids of kids approach anxiety-provoking situations, rather than avoid them so that they can have new learning experiences and realize this isn’t as bad as I thought it was going to be and or I am much more capable of handling this than I’ve ever given myself credit for or the anxiety has given me credit for. So that’s, that is the most evidence-based treatment and the most important a component within that treatment. So, as we move on, we’ll be talking about how you do exposures in a school setting. I do want to take a very quick note to say, a lot of times, historically, treatments for anxiety have focused a lot on relaxation strategies and more recently, our field has moved away from focusing on using relaxation strategies for several reasons. One, and kind of, you know, really importantly to me is that it’s really a contradictory message to send kids, you know, we’re starting off by saying anxiety is totally normal but calm your body down, you’re starting to feel anxious, take those deep breaths, right? So, that’s a really confusing message and it starts to build and reinforce this fear of this, those somatic symptoms that start to build when kids feel anxious. So, we want to avoid that contradictory message and instead, help them build mindfulness of the situation. You know, mindfulness not being synonymous directly with relaxation, but just building awareness without judgment of like, oh, there’s my stomach again. Oh, I’m doing that thing where my hands are shaking because I’m feeling nervous. So, awareness without judgment of those feelings of anxiety without feeling like they have a responsibility to tamp it down to bring it down. Kendra Read: The other really the important thing to note is that relaxation strategies have been shown to not contribute to two outcomes for problematic anxiety. So, these strategies are not helping kids in the long run, so we no longer focus on them and I think that’s really important to note because I hear from a lot of schools, where that is the primary focus of their anxiety intervention in the school setting and I would rather than move more toward focusing on how we do exposure in this situation. Jennifer Blossom: So, the other a piece about empirically supported treatments for anxiety in school settings are around or I mean, not necessarily schools, but empirically supported interventions for anxiety are the medication side. So, there are medications that we know are helpful to youth experiencing problematic anxiety, primarily SSRIs, or Selective Serotonin Reuptake Inhibitors. It’s not recommended that anxiety or that medication is the primary or the only line of treatment for anxiety and we do know that youth with CBT and medic who’ve received both CBT and medication together, respond to the best intervention. So, oftentimes families will start with CBT and then consider medications if they’re not responding as we’d like because anxiety is just too high for them to benefit from treatment and then when we bring meds on board, they seem to get a boost so they’re able to engage more in the treatment and benefits. So, that’s just something to note is that kids the research show that kids who get that combined treatment does the best and kids who get just medications or just therapy, do about even not statistically different. All that’s better than a placebo pill and all that’s way better than nothing. Kendra Read: So, how do we support students with anxiety? and at the risk of sounding like a broken record here, I just want to emphasize that the best practices to consider in a school setting are those that encourage approach instead of avoidance. So, I think what becomes really, really hard about this is that it means that you will experience anxiety. As we do exposures. We help families bring on the anxiety. If we are not experiencing anxiety, anxiety during an exposure. We’ve picked the wrong exposure. We need to have that alarm kind of going off. So it can have a moment to say, wait a minute, so my alarm is going off. Is there smoke, right? Is there something bad that’s happening? What is the other evidence in the situation? Rather than just evacuating, right? So, it’s hard to watch kids experience anxiety, it feels like we’re doing something wrong. It goes against our instincts as parents, as educators, as compassionate people. It’s hard for Jen and I still, even though we do this as a job. So, I think it’s just really important to note that, this can feel uncomfortable for everybody. If I go back to the cycle that Jen was talking about, you’ll notice that as adults come in, or peers come into rescue youth who are experiencing anxiety, everybody’s anxiety goes down. So, we are also reinforced for kids avoiding and we want to watch out for that trap because we really need for them to have those new learning opportunities in situations where they experiencing anxiety. Jennifer Blossom: Kendra, I want to just jump in here because I noticed a question that popped up in the question and answer I think, is particularly relevant when we think about encouraging approach and encouraging exposure and facing your fears. There was a question that came in asked about how anxiety intersects with racial microaggressions or experiences racism and thinking about how In those situations the alarm is picking up on a real threat to somebody’s well-being or invalidating them and how oftentimes when people are experiencing that they’re faced with invalidation. They’re told that it’s not a real threat. So I’m curious how you see that intersecting with the decisions to pursue exposure, what other options there might be? Absolutely. So, I think as I read that question, I think one thing that I want to think about there is that we are not telling kids whether or not the threat is real and I think that’s where people tend to fall into that the trap of gaslighting, right? because in for gaslighting somebody is like, oh, this is a threat, this is a problem and other people are dismissive of it and say, “No, it’s not what are you talking about.” right? and when it comes to anxiety for you, we are not weighing in on whether something is threatening or not. Our job is to better help them be able to examine the evidence themselves. and sometimes we do come to the conclusion jointly that actually, this is a dangerous situation. There is a real threat here, in which case, there’s a different intervention that needs to happen in order to, to ensure one’s safety, right, but I think that is really key. We do not want to fall into the trap of weighing in and saying, This is no big deal. Just get over it. That is problematic if there is a true threat and it is very problematic, even if there is not a true threat, right, because it’s also super invalidating for people who are like, actually, this is really hard for me, right? So either way, that’s problematic for us to say, this is no big deal. This isn’t a problem. We want to – our goal is to help them evaluate the situation and really pull in more evidence. Kendra Read: One of the things that Jen noted earlier is that youth and actually people with problematic anxiety tends to interpret the information around them in ways that are either extra picking up on threatening situations or misinterpreting things, so we just want to be careful and for into – for when we think about racial microaggressions, this may not be misinterpretations and often are not misinterpretations. So, we want to be really fair and saying, in laying out the evidence for what’s, what’s happening. So, we can be really clear and not be having conversations where we’ve already arrived at a decision and we’re just teaching you, that’s where, or dismissive in some way. Anything you would add to that, Jen? Jennifer Blossom: I think, to the point that you’re making one of the things that we think about when approaching a situation that kiddo or family is describing as anxiety provoking, just kind of a decision tree that we work through and initially you ask is the fear realistic? So when I think about the question that was asked, and the consequences of racism? The answer to that would be yes. Right? The fear is realistic in that situation and when that situation arises, then we work on figuring out if is this something that the kiddo should know how to manage. If there are specific things that we want them to know how to manage, then we want to give them the skills to do that. So, that’s kind of our initial decision point there and I think that that’s where we want to be thoughtful of experience of racism, there’s the very real reason why that would be immediately threatening to somebody. So that’s, that’s the lens through which we would approach it. Yeah, totally agree. Totally agree. All right. So, in terms of what teachers can do, truthfully, we want teachers to work with students and families as issues come up to encourage this idea of the approach instead of avoidance. I think Jen and I have both read a lot of different, you know, IEP or 504 plans that have clauses in it that end up accidentally reinforcing avoidance and then our feedback is, is around how to turn this piece around so that we’re actually moving toward the feared situation and learning more adaptive responses, rather than encouraging avoidance, just in order to reduce that experience of anxiety and in many ways, we use a school-to-home note, which I’ll show you in a second. I’m sure many of you have used variations of these notes for different behavioral concerns that have come up in classrooms and the application of this to anxiety is not really so different but as you work with youth with anxiety, I really think about how to be supportive and what it actually means to be supportive to somebody with anxiety and that means approaching situations with this an important combination of both validation and confidence. It’s the “I know it’s hard and I know you can do it.” combination. Oftentimes, we see people fall into traps where they’re just, you know, holding on to one of those two pieces of that equation. So either just validating like this is so hard and kind of getting stuck in the admiration of the difficulty, or holding on to the confidence piece of like, buck up, kid, come on, you can do it, this is no big deal, and both of those alone are problematic and in terms of moving anxiety intervention forward, so we really need the combination of both of those to build a supportive environment. Kendra Read: So just, you know, as I mentioned, this is an example of a school to home note, as we apply it to anxiety and I would imagine, you know, I kind of took the framework from this directly from our ADHD disruptive behaviors clinic, which shows you just how similar the behavioral approaches can be. So essentially, we just want to set a behavioral goal with a family around anxiety, obviously this example is for a younger child. If you look at the smiley faces and all of that, we want to set like a really specific, observable, time-limited, you know, smart goal around an anxious anxiety or brave behavior. So for this child, this example child, their goals are around, walking into class independently, whispering to the teacher three times throughout the day, and raising their hands during specials and then we want to make sure that we’re giving them opportunities to reach these goals, tracking their progress and then finding having some way of coordinating that information back to parents so that they can or other caregivers, so they can really reward and reinforce their youth progress toward more brave versus avoidant behaviors in the school setting. Jennifer Blossom: Kenda, if you could just go back to the last slide there is relevant to one of the questions that came in asking about what age you can use these principles with kids and, as noted, Kendra noted here with the smiley faces, this is a school-to-home note that’s really designed for, you know, kiddo as young as in kindergarten, what we know is that you can employ these strategies, you can use these approaches with kids as young as three, you know, oftentimes, we’re then talking more to the adults in the kid’s life. So, talking to the teachers, talking to the parents or other caregivers, that these skills and these strategies still work well, even with really young kids and that oftentimes, if we can catch them that early, we’re just setting them up for better success so that we can really leverage the strengths of that of those brains that are wired more towards anxiety and help them meet their goals. Absolutely, thanks, Jen and I would say that actually our anxiety programs go down to age two at Seattle Children’s, and all the way up through age 18 and beyond. I mean, not at Children’s but these principles are universal, regardless of age and there are just some adaptations in terms of exactly how you would apply this for different age groups. So as Jen mentioned, for kids, I would say roughly seven and younger, I’d be working much more with parents than with kids directly. That’s really different than those than you know, it’s a different kind of story or opportunity for those of you in school settings. So we can talk more about that in the question and answer period if you would like. Kendra Read: Okay, as I mentioned, in terms of supporting youth with anxiety in school settings, we tend to see some common pitfalls, of tending more toward accommodation versus approach in anxiety-provoking situations in formalized 504/IEP plans and I -accommodation is this good word, bad word. In a school setting, it tends to have a really positive connotation. In the anxiety world, it has a really negative connotation. So, accommodation means essentially, you know, being complicit with a child’s anxiety and helping them avoid anxiety-provoking situations. So when Jen and I talk about accommodating anxiety, we’re thinking of, you know, parents who will never ever go out on a date night because their child doesn’t want to be alone or will never eat at the same table as their kid because their child can’t handle it, different things like that. So just want to note that we use that word really differently across our different settings but in general, it has it all goes back to that approach versus avoidance difference. So, a lot of problematic pitfalls that we run into are things like these contra-indicated accommodations, like extra time, not calling on a student or allowing, directly allowing avoidance of certain specific activities. Extra time is a really tricky one and I know, we have a lot of conversations about this all the time, it comes from a good place of wanting youth who may be distracted by their anxiety to have more time to, you know, manage that, when in reality, what tends to happen when we give you extra time, when we give youth with anxiety extra time is that they tend to spend that time worrying or engaging in more anxious behaviors more avoidance, so it ends up not being a helpful intervention in the end. My internet connection is a little unstable. So, apologies if I’m breaking up. As I mentioned, things like relaxation strategies, strategies, and journaling are not bad things to do, but they’re also not helpful. So we would not want those to be considered the primary interventions for anxiety in any setting and really, it also comes down to really requiring this partnership from all parties, from teachers, specialists, and caregivers, so that there is a clear plan for what we’re working on and how we’re going to be approaching this in a situation that is supportive to the child, so involving that combination of confidence and validation. The “I know it’s hard, and I know you can do it, and here’s what we’re going to work on” and I think sometimes we’ve, you know, heard from school-based personnel who feel kind of reticent to approach exposures in their setting thing like, “Well, I’m not a therapist, maybe I shouldn’t be doing this.” but in reality, we all have ownership and agency in this in this behavior change and this change in problem problematic anxiety, even if you’re not a quote-unquote therapist or psychologist, we need youth to practice exposures in all settings in order for this to generalize to all settings. So, it’s really important that these things are practiced in the school setting as well. Okay, Jen, come back on for our Q&A. Jennifer Blossom: So, we have been working with a lot of people internally at Seattle Children’s, as Kendra mentioned, I was there. The working remotely, as I’m sure many of you are just over a month ago, as well as many, many people throughout the greater WWAMI region and there’s been a few common questions that have come up that we opted to highlight here and I’m also aware that there have been a number of questions that may have been coming in over the Q&A section. So, thank you so much for sending those in, please feel free to continue sending those. So, my thought is that we’ll just jump right into the question and answer questions that are coming in. So I think one, one question in which I’m seeing kind of a few iterations are going back to this idea of the 504 plan and how we develop a 504 plan that acknowledges and integrates the evidence-based recommendations for anxiety and one of the ways that I think about that is really getting concrete on some of the goals in the school setting and instead of providing, providing kind of a blanket statement, like more time to finish something is figuring out where the child currently, what are they currently able to do, and where do we want them to be? and then how do we find those steps to get them towards that ultimate goal? So, how can we phrase something that allows them to take steps towards participating in the class? You know, being able to complete that assignment when they’re asked to, in particular, think about a a child who might have difficulty speaking in the classroom, one of the questions that came in was relevant to whether we can apply these principles to selective mutism and the answer is certainly yes, Kendra and I do this a lot. Kendra has a specialty clinic that specifically works with families and helping kids learn how to speak in settings that they feel uncomfortable doing so. So, thinking about a 504 plan in particular with a selective mutism kind of focus, if you have a child who is completely nonverbal, who is not able to speak out in the classroom, oftentimes what happens is we find that teachers are jumping in or providing answers for them. Other students might recognize again, well-meaning compassionate people jumping in providing answers for them, what we want to do is help, help encourage the child to start to be able to answer the question themselves. So, a 504 plan might say something like – initially might say something like respond to nonverbal. So, being able to shake your head yes or no, that’s still providing some kind of information in engaging in some kind of communication. If there’s the complete absence of communication, then it might be being able to whisper an answer to the teacher. So we can think about what is the steps and how can we integrate them into the 504 plan? So that we’re getting the student and supporting them to be able to answer a question in the middle class when, when other students’ peers are there. I would just add that, you know, I know that 504 plans often we can’t change them as quickly as we would like to change behavioral goals. So, sometimes I encourage schools to phrase a 504 accommodation or an IEP the goal, you know, honestly, IEP s with their, like the goal framework kind of lends themselves a little bit more to this idea but the idea that we’re going to gradually be approaching and, you know, moving from totally not speaking to respond, you know, 80% of the time to the teacher in at least a voiced response. So, you know, if you put your hand on your throat, you feel your hand vibrating, right, and we just state in the plan that we’ll be identifying weekly goals. The teacher will be providing, enough opportunities for the child to reach their goal, and we’ll be providing support for the child to try again and just kind of discuss what the communication plan from school to home looks like because that can – that looks different for every school that I’ve worked with, depending on what’s feasible. There’s no one exact the right way to do it and that gives us a little bit more flexibility to work on those successive shaping steps of moving from, you know, just, you know, shaking our head, no, to mouthing no, to then whispering, to then talking. So, the exposures in school said that’s one example. Kendra Read: There are exposures in school settings that can look so many different ways. It just really depends on the different situation. So sometimes we are, you know, as the adults in the situation, setting up some social opportunities, for one child to talk to another, sometimes it’s like, okay, just so you know, I’m going to call on you during this part of the day or sometimes I – a lot of kids have, are so anxious about making any mistake or they redo and redo and redo their work or they, you know that, or there work has to be perfectly neat. So, then we have them turn in work that they finished with their non-dominant hand or they definitely made a mistake in there on purpose and they’re going to turn it in and see what is so bad about this, what is the worst thing that happens when I turn in a mistake? So there are all sorts of different exposures that you do in a school setting and it just so depends on the specific fears that the child is endorsing. Okay, so let’s, there was a the question at the top about PTSD and anxiety, and whether or not they can co-occur or would not be concurrently diagnosed, and absolutely PTSD and anxiety disorders can co-occur 100% they can be diagnosed at the same time, we just want to be careful that we’re not to double counting the same symptoms and we want to be clear that not every anxiety disorder, you know, anxiety disorders don’t come about because someone definitely experienced a traumatic event. Right. You know, fear of spiders doesn’t mean they’ve definitely experienced a horrible situation with spiders, for example, or for selective mutism. This is one of the big ones, where there’s this myth that they’ve experienced a traumatic event and that’s why they’re not speaking. Not true, but for PTSD, you know, that is like one of the only DSM diagnoses where we know exactly that there was an event that precipitated the onset of this disorder. So, it is common for youth who have are just get like anxious. Pre-traumatic events say they have social anxiety. A traumatic event happens they get in a really bad car accident and they can’t get back in the car anymore. They have true PTSD related to the car accident, and they have social anxiety. So these two things were not double counting, but they are happening at the same time. Okay, Jen, I’ll let you pick one. Jennifer Blossom: So, I’m seeing a lot of questions and just getting some clarification around skill building and why we are recommending against using strategies like relaxation or journaling and so in particular, just thinking about why and Kendra talks about relaxation in terms of the message that sends or the threat of the physical experience of anxiety and the general idea is that we want kids to have that physical experience of anxiety and know that does not automatically mean that the worst is going to happen or that they’re not able to handle those feelings. There are many situations we’re experiencing that physical anxieties, really helpful. In the beginning, Kendra was talking about, you know, if you’re preparing, if you have a test on Friday, and I have no anxiety about that, then I’m probably outside playing with my dogs not sitting – in front of a book trying to understand the material, right? In some ways, anxiety is really helpful and adaptive. What can become problematic is when anxiety is so high about the test that I can’t even think about opening the book, because I’m so worried that I’m not going to be able, to learn what I need to learn. So, we really want to help, help kids and help students figure out that I can notice that I’m experiencing some of that anxiety but I can still do the things I need to do. I feel anxious about the test but I’m still able to sit down and focus on the material and study the way that I need to. When we tell them, “Oh you notice that your heart is racing or you notice that your muscles feel tense. Let’s take a moment and sit back and spend some time breathing.”. What we’re doing is we’re sending the the message that bad anxiety is really something to be worried about or scary that they aren’t able to handle those feelings and then what happens is when they walk into class to take that test and they’re feeling those same feelings, they think they can’t handle it. So, we want them to do is practice handling and practice tolerating. When I think about a strategy, like journaling, one of the things that I think about is that, you know, anxious brains again, they do a really good job of thinking. They’re constantly thinking, they’re constantly coming up with the what ifs, what if, what if, that’s what gets in the way of sleep, that’s what gets in the way of paying attention in class. So, if we ask somebody to write down all of those thoughts, and those what-ifs, we’re not necessarily giving them the skills or the strategies to still be able to do what they need to do and in In some cases, we may be letting those what-ifs allow for avoidance because now they’re writing about those what ifs instead of doing that thing, that’s hard and this is something Kendra and I have just recently started talking about kind of how can we rephrase and reframe thinking about exposure and practice based on your fear as a coping skill. I think that’s one of the things that can get lost or is confusing is that when we think about facing your fears that we’re ignoring that, that is still is learning a coping skill because what I’m learning is that when I feel anxious, I can still do what I need to do. When I feel anxious, I can still pick up that book and sit down and read the first paragraph when I feel anxious, I can still open my computer to start writing that essay. That’s coping skill and the way that you build that coping skills by taking those smaller steps until you’re able to do that thing that’s really hard. What would you add to that? Kendra Read: I would just want to add about there’s this piece that we call expectancy violations. We also want kids to have those learning experiences, to see that the thing that I expect to happen, really doesn’t always happen or even if it does, it’s not as bad as my the brain is assuming it is. This is the coping skill and I think a lot of people get wrapped up in the toolbox, and I need to give kids all these other things to do when they feel anxious but the thing we need them to do is to practice staying in the situation, and quote-unquote, riding the wave. So, I’m seeing some other questions about like, what do we do in situations? Like when a kid is anxious, what do I do? and really, when that happens for me, like all day long, I just want to – I sit with them and I say, okay, so you’re experiencing anxiety, what’s happening in your body right now? How are you feeling it? What’s your number? and so I want them to practice rating on a scale from say, zero to 10, how anxious they feel. So, that’s one way that they can build some mindfulness of saying like, okay, I’m at like a seven right now and I’m noticing that my stomach really hurts and that’s like, okay, so what are you thinking at this moment? I’m thinking, I’m totally going to fail this presentation, I’m going to bomb it, everybody’s gonna laugh, etc, etc. And say like, okay, well what is happening in this situation is anybody laughing? Like, well, I can’t hear that anybody’s laughing. So maybe they’re not. Maybe they are in their own homes, but nobody’s mics are on everybody’s automatically muted. So, if I don’t know, if they’re laughing, how will it ever change my life? So, just some thinking through some different situations like that to think through that expectancy violation, violating what we expect – the anxious anticipation of what’s going to happen. Okay. Jennifer Blossom: I see, I think we, I hope we answered some of the questions about the Final Four Planner IEP is about how we can approach it. I see some questions about like homeschooling and one on one the school supports, and how do we help families understand this and man, is it hard, you know, I just want to validate that like, as much as we do this for a job, we don’t convince every family that this is the important way to go and we really try to, to bring them in and discuss how, you know, you know, one of the other programs run at Children’s as a school avoidance program, which is not running this fall because most schools are remote. So, there’s no brick-and-mortar school to avoid for most of our students, but what I tend to see is that the families that pull out into homeschooling because of anxiety, those kids tend to have really escalating very problematic anxiety, very interfering anxiety that continues for years. So it does become a really big problem and so I just want to describe that the trajectory that I see for them before they make that decision and be very clear that homeschooling online homeschool, That like we’re all pigeonholed into that right now because of COVID or most of us are, so we’re not making that decision because of anxiety but when we do make that decision because anxiety is contraindicated. It is problematic in terms of changing this cycle. So it’s very, very much not recommended. ] Kendra Read: Jen, do you have a the question you wanna? Jennifer Blossom: Yeah, I was just searching through the Q&A and I see a lot of questions and thinking about how we can adapt some of these recommendations and approaches, particularly for older students. So, thinking about high school students, and thinking about it, there were some comments about the student kind of report card can be more challenging with a high school student and I think, you know, in some ways, really just kind of working, working with the student and figuring out kind of what’s going on for them at school and at home. I think one of the things that we know that comes up commonly when working with families is that oftentimes parents are not necessarily as attuned to some of the things that may be coming up at school for their kiddos, Kendra and I have worked with families where, you know, after kind of years of school difficulty and some anxious avoidance in high school, that’s when the parent found out about kind of what was going on. So I think, really making sure to work as a team. In some capacity, I think something that can happen developmentally when working with younger kids that there’s a tendency to exclude them completely as if they can’t understand these principles. When, as Kendra says two and three-year-olds, even if they’re not coming in for the treatment the session, they get the idea that was brave, awesome job, right? So we can still be working with them directly and integrating these strategies with really young kids and in the same way when you’re working with high school students, just as you would reach out to parents for, other types of concerns, if you were seeing chronic absenteeism or if there was a lot of missed work but bringing parents in to support high school students are a really helpful and a great opportunity too as much alignment as we can get with practicing some of these strategies both in and outside of school, I think can be really helpful and effective and when we think about some of the types of anxiety that we see, more commonly, social anxiety is much more common in adolescence. By very definition, adolescence is a time period where we are more prone to peer evaluation and judgments and that’s an opportunity that’s ripe for the onset of social anxiety and fears, and really coming up with creative ways to practice bringing on that anxiety, like answering a question, just wrong, purposefully making a mistake or having a long pause in the middle of a presentation. Wearing a t-shirt to a zoom meeting with a huge stain across the front, you know, thinking about ways that you can help bring that on because one of the things I know from working with lots and lots of teams with social anxiety is that it’s really hard for them to be in these situations and they really want those peer relationships and connections. So, figuring out how we can work with their own goals and use their own motivation to help them take those steps, towards doing the things that they want to do. What would you add to that Kendra? Kendra Read: You know, I’m not sure that there’s a whole lot more I would add to that, Jen. You know, one of the things that I’m noticing a lot of the questions are just like, yes, but how do we do exposures? Yeah, how does what does it look like? and so I just wanted to give a couple of more examples for different kinds of areas that kids are anxious, about and how we can do that in a school setting. So, we’ve talked a little bit about how to set up, you know, brave talking exposures for selective mutism. So, really, it’s setting a goal for Okay, so today we’re going to whisper three times and so I’m going to give three opportunities for you to whisper with me one on one, or I’m going to get five opportunities and your goal is to do three out of five. So, I’m going to come by your desk and say, what was the answer to number four? and you’re going to tell me to practice whispering to me the answer to number four. A lot of times as Jen was noting, we need some kid involvement in some youth involvement in setting this goal. We need them to know what the goal is, so that they can practice reaching it and they can, we can give them some forced choice of like, okay, so it sounds like from your parents that, you know, we’re going to work on, you know, saying hi to a peer. So do you want to practice that? This time of day or this time of day? Do you want to do that with you know, you sit next to Johnny and Susie, do you want to practice with Johnny or Susie first and I’ll be listening. So just some, some different examples like that. Practicing making mistakes, practicing, turning in imperfect work. I think I’ve said those already. Jen, do you have any other specific exposure examples? I don’t want to overcomplicate really what exposure is it really is simple. So like I’m telling a kid, okay, let’s go do some trivia with some people down the hall. Here’s a list of trivia questions I’m going to give them I want you to get two of those wrong and then we just go do it. It’s really as simple as that. Jennifer Blossom: Yeah, I think one of the things that come to mind, particularly when we think about the context of COVID-19, is that everyone is managing a lot of uncertainty right now and not being able to tolerate uncertainty is a hallmark of anxiety, right? Anxious brains want to plan they want to know they want to be able to anticipate what’s going to come up, that’s where worry comes from. Worry is a maladaptive coping strategy that if I think about something enough, or if I think about all the possible outcomes, then I’ll be prepared to handle them. So, when we think about the current situation, in particular for kids, maybe who didn’t have, didn’t have much anxiety before wasn’t really getting in the way but right now with COVID and everything and that there’s been a lot of back and forth, of not knowing what to expect for school and as they get used to the startup school still having, you know, trying to navigate what’s going to be expected in terms of grades or things like that is really opening up opportunities to practice tolerating uncertainty. So in going with the example that Kendra had just had, of asking them to go answer questions that they’re not going to know what the questions are in advance and being prepared to answer questions that they’re unexpected for, or having, you know, coming up with a plan that’s not shared and advanced so that they can they can tolerate being in a situation where they weren’t able to think about and plan for really thinking about what are ways that we can think about some of the uncertainty that is typical of everyday life, COVID-19 is causing a lot of stress and a a lot of realistic anxiety for people, particularly when we think about the disproportionality of COVID risk and consequences of COVID we know that there are going to be significant mental health concerns for particularly communities of color. So we want to think about, what are the things happening right now? How can we, again, assess, understand the full context for this kiddo? What are things that are coming up? What are the objective risks that they might be facing? and then what are ways that this anxiety might be creeping in that it’s getting in the way of them being able to do the things that they are able to do right now that they are able to participate in staples that are going to keep them connected to some of those, those social supports? and how can we leverage some of the strengths that they might have currently, certainly, Zoom meetings, Zoom parties, and Zoom classrooms are not the ideal setting for many people, but there are ways that we can still encourage that participation and get creative with getting kids involved. So I think, you know, the uncertainty piece is one that I think comes up a lot. In particular, I think again, we think of that as the – perhaps more commonly with older kids, but certainly right now with COVID, because it’s just a prime situation for us all to be thinking about it. So, think of just different creative ways that you can help kids experience situations that they’re not able to prepare for. I’m curious Kendra, have some other ideas that you might have about thinking in a new school context or particularly in the online school context? What are ways to introduce uncertainty that would allow students to be able to better tolerate that? Well, I think there are just a lot of natural opportunities that come up that we can capitalize on. Sometimes I set up like more contrived situations of like, okay, we’re going to do exposure and you’re not going to know what it is or sometime this weekend, your parents are going to change their plans. You don’t know when you don’t know how you don’t know what it is. So different things like that and their job is to tolerate that meaning to keep their behavior within you know, appropriately behavioral bounds, they can still experience anxiety and frustration and so I would just note like, there are so many natural opportunities coming up for us to tolerate uncertainty every day with COVID and remote learning, and will we have Internet connection? and will this work and, and all the other things happening around us like, the wildfires, like there’s so much uncertainty, and so much we don’t know and, and just sitting in that place of like, what if we don’t know? What if there’s no answer? and that feels really anxiety-provoking, but we just need to sit in that place. So I see a lot of questions like, but what do I do during the exposure? What do I say to them? and I really, especially when they’re starting to get really anxious, and I really just say I want them to check in with them just repeatedly to say like, hey, what number you at, what do you – what are you doing? I know this is hard, but I know you can do this. So just keep going back to that supportive statement of I know this is how I think you can do it. I know you can stick with this situation, and then point out all the little ways that they are already doing it. Like, life is uncertain, and you survived every moment of uncertainty up until today. So, is there any evidence that you’re not going to survive the uncertainty hereafter? No, we have no evidence that that’s true. Might we have evidence that the opposite is true? So the truth is, we all survive uncertainty every minute of the day. I don’t know what, I don’t know actually what’s going to happen in the next hour of my life. I have some things that might, you know, help me predict that but I don’t actually know. So I think just pointing out all these little successes that they may not be giving themselves credit for during the exposure of like, you’re still here, you’re doing it like we’re just going to ride this wave. You don’t have to do anything to make this feeling come down. You are not responsible for that. It just will. It is what it is. So we just need to stay in this situation. So I really want everybody to release themselves and have the responsibility to make themselves calm down, but it’s nobody’s responsibility. It’s just what goes up will come down and we’re just going to ride that wave. If you think about it like you’re in the ocean and like the waves are coming and you’re trying to push them back, like calm down waves, like they’re just gonna knock you over, right? So instead if we ride that wave, and we accepted remindful of it, and we’re like, okay, like, how hard is this? What number is this? Okay, this is a really big wave, oh, I’m going up really high. Wow I’m going really fast into the shore, right? We just want to observe what’s happening. We’re more likely to experience improvement and greater success in the situation than if we’re like, must calm down, got to force this down. So, I really want to let go of that sentence. Kendra Read: I’m jumping around a lot, but I’m feeling the Jen, what did you want to add? pressure of time. So, I just want to note that there are some Jennifer Blossom: Yeah, so I think just to kind of end and questions in there around partnering with PCPs and other medical professionals. I want to say that Jen, and I do have an ongoing connection with PAL or the Physician Access Line here in the Northwest and we are creating and together  we call laboratory Nat Young Bluth in into connection for primary care for anxiety and OCD. So that is forthcoming for those of you who are school nurses, I just want your job to be is to help to connect some of the somatic feelings that address some of the questions that come up with how to help how we’re experiencing anxiety and being a part of the goal setting with others around like may- be their goal is to not check in at the nurse so much, which me annoys that they’re avoiding the classroom, potentially avoiding the thing that’s anxiety-provoking, and potentially trying to just exit altogether. That’s less so happens in the times of COVID but just in terms of like what we typically see. support when kids are in the thick of the anxiety, while anxious brains do a really good the job of being detail-oriented, those details tend towards the threat. So, sitting with them and commenting on what they are doing while they’re feeling anxious is really a way an effective way to be supportive of students and help get them engaged in exposure situations. So, if you notice that they are feeling anxious, or they share with you that they’re feeling anxious, commenting on what they’re able to do in that moment, finding what it, finding, even if it’s a small step, something that they are doing at that moment that is helping them be effective in whatever the strategy is. So, thinking back about participating in a zoom class, if a student went from not participating at all to using the chat, jump on that, that’s the first step towards talking in class and joining via video and joining the class. So, an an effective strategy is really focused on what they’re doing well because at that moment, it’s hard for them to see it and that’s going to be a really rewarding opportunity for you and for them to be able to continue taking these steps towards facing their fears. This has been really great. I’ve so appreciated all the questions that you’ve raised. Kendra, and I love doing these types of presentations and as she’s noted multiple times, it’s a bit of a different situation not seeing any faces, but we’ve really appreciated the engagement and so looking forward to working with you and meeting with you again, in just a few weeks, and with that, I’ll turn it, Kelcey. Kelcey Schmitz: All right, thank you. A huge thanks to Kendra and to Jen for their presentation today. I know for me, personally and professionally, I couldn’t take notes fast enough and for those of you who have participated today, just a reminder that we will have the recording up for you who like me will probably be watching this and sharing it with other people who need to see this. On the next slide, it’s just a a reminder of how you can get in touch with us. We have many opportunities for you to participate in live webinars, we have many recorded School Mental Health webinars that you can check out. We have a newsletter, that we send out monthly newsletters and event blast to you. So, we just highly encourage you to connect with us, especially if you’re in our Northwest region but you’re also welcome outside of our region, as well as reaching out to your local regional center to get more support and then our last slide is to thank you and a a reminder that part two, managing anxiety during COVID-19 will happen on October 20. So we hope that you will register for that. I will say this, this session sold out so if you haven’t registered already for session two, it might be a good opportunity for you to take care of that now. We know we still have lots of questions in the Q&A and we will carry those forward to future events that we have with Kendra and Jen. So, huge thanks to Kendra and Jen. Huge thanks to our Northwest School Mental Health team that is been working behind the scenes to help with the chat and the Q&A and just keep this webinar running smoothly with that, we will officially end the webinar but keep the room open for just a few moments. So, you can take down those links and complete the evaluation but at this time, I want to thank everyone and we will end the webinar.As found on YouTubeFUNNELIFY is a new, first-of-its-kind, groundbreaking app ➯➱ ➫ ➪➬ which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets ➯➱ ➫ ➪➬ After using the Funnelify product, you will recognize a great increase in your leads and sales. This product shows methods to boost your traffic without using any shortcuts. The best thing is that you can build unlimited …

Brain Basics: Anxiety (for kids) Part 1 – All about emotions

 Did you know that your emotions come from your brain? There’s no such thing as a bad emotion – every emotion like happiness, sad, angry, or anxious has an important role to play. Everyone has emotions – kids, teenagers, and adults. Emotions can help us work out how to respond or behave in different environments and situations. Sometimes our emotions can get big they can start to bubble up and up until they come out quickly in ways that are not very kind or helpful to ourselves and others. We might feel so frustrated or angry that we react by screaming at someone even though it could get us into trouble or hurt their feelings. We may feel so overwhelmed with how hard our homework is that we might throw it away or run into our room crying.   By understanding how our brains work we can begin to understand our emotions. Then we can learn ways to help calm down big emotions and express them in more helpful and positive ways. As found on YouTubeFUNNELIFY is a new, first-of-its-kind, groundbreaking app ➯➱ ➫ ➪➬ which finally allows you to deliver separately auto-generated mobile pages with unheard before lighting speed. Plus it skyrockets ➯➱ ➫ ➪➬ After using the Funnelify product, you will recognize a great increase in your leads and sales. This product shows methods to boost your traffic without using any shortcuts. The best thing is that you can build unlimited …

Generalized anxiety disorder and coping strategies

So you know this video is about anxiety but what exactly are anxiety disorders? These are disorders that share features of excessive fear and anxiety and related behavioral disturbances. Although both fear and anxiety are close, related fear elicits an immediate fight-or-flight response to a real threat that has already presented itself. For instance an encounter with a wild animal. In comparison, anxiety is more of a hyper-vigilant state where an individual is extremely sensitive to detect potential threats that may never occur. For instance, an individual may be anxious about public speaking because they anticipate that they will embarrass themselves. Like most mental health problems, anxiety disorders appear to be caused by a combination of biological, factors, psychological factors, and challenging life experiences. all anxiety disorders have irrational and excessive fears apprehensive intense feelings and difficulty managing daily tasks. Other symptoms include anxious thoughts, predictions, and beliefs, avoidance of feared situations, subtle avoidances such as talking more when anxious to describe oneself, safety behaviors like having a cellphone on hand for help, and physiological responses such as increased heart rate. There are many types of anxiety disorders including generalized anxiety disorder which is one of the most common types of anxiety disorders in older adults. It affects 2-5% of the population with more women affected than men. Over an individual’s lifetime chances of developing generalized anxiety disorder are as high as 9%. With respect to ethnicity, people of European descent are more likely to be affected than people of non-European descent and anxiety disorders occur more frequently in developed countries than non-developed countries. Generalized anxiety disorder is characterized by excessive uncontrollable worry about everyday things including social situations. This excessive worry occurs for at least six months and often interferes with one’s daily life. This worrying can be manifested in physical symptoms including restlessness, fatigue, irritability, muscle tension, and difficulty concentrating and sleeping. The severity of the generalized anxiety disorder can vary with those having the mild to the moderate form being able to function socially with treatment and those who have severe generalized anxiety disorder finding it difficult to perform simple daily tasks. Although anxiety can be daunting, there are many ways to cope with it. First and foremost, it is important to realize that you can’t control everything. You must avoid placing pressure on yourself to be perfect in everything you do. Additionally, try replacing negative thoughts with positive ones most importantly identify what triggers your anxiety and focus on tackling this issue. A helpful tip you can do is by writing in a journal when feeling anxious and then look back on your journal entries to identify a pattern. There are some small lifestyle changes you can enforce to help cope with anxiety these include: exercising daily, getting at least eight hours of sleep per night, eating a well-balanced meal three times a day, and limiting alcohol and caffeine. To cope with an immediate panic attack it can be helpful to relax your muscles and focus on slowing your breathing by taking deep and slow breaths. Take control of your thoughts and remind yourself of the times you had overcome your anxiety. Although they’re helpful, these tips are often not enough. Do not be afraid to seek professional help via psychiatrist, therapist, counselor, and other mental health professionals. Here are links to some resources that can connect you with professionals…

The Symptoms of General Anxiety and Panic Disorder

This is Joseph. His mind is constantly racing and it’s racing with negative thoughts. He worries about everything – from saying the wrong thing to a friend, to wondering if he will lose his cellphone, to questioning if he is eating healthy enough. He also thinks about the bigger problems, like if his daughter is safe at school, or how to make sure she has a good future. These may seem like typical worries that everyone has, but for Joseph, they consume his life and he is living in constant anxiety and fear. Caroline also worries quite frequently. She is in a high-stress job that demands a lot of her time. She is also a parent. The worry and stress are natural, but sometimes she becomes overwhelmed and breaks down, becoming ill for a short period of time. Joseph and Caroline both decide it is high time to go and see a doctor. They want to better understand and help to put an end to these unwanted feelings. The doctor tells Joseph he has been diagnosed with General Anxiety Disorder, also known as G.A.D. While Caroline was diagnosed with Panic Disorder. Before the diagnosis, they never knew the difference between the two. G.A.D and Panic Disorder are both Anxiety Disorders with unique differences. G.A.D is a mental condition that is characterized by excessive and uncontrollable worry about everyday life events and the future. Panic Disorder is characterized by panic attacks that can occur for seemingly no reason at all. They both can also happen during or directly after a traumatic event. There is not one single cause for GAD. It is believed to be caused by a complex interaction of genetics, brain chemistry, personality factors, and the environment in which the afflicted were raised. Traumatic experiences and stressful life events can also trigger a person to develop GAD. The symptoms for G.A.D are as follows: Constant high levels of worry about everyday things or things that do not normally warrant anxiety. Inability to let go of your worries even if you know they are irrational or unrealistic. Feeling restless, irritable, or on edge. Problems concentrating. Problems with sleep – either difficulty getting enough sleep or sleeping too much. Being easily frightened or startled. People with GAD may also experience the following physical symptoms: High levels of tension in your muscles. Regular headaches and nausea. Low levels of energy or constant fatigue. Increased sweating, trembling, or heart rate. Panic Disorder is defined as having recurring and regular panic attacks, often without any apparent cause. Panic attacks bring about a sudden rush of intense fear and panic, whereas General Anxiety Disorder is a slowly increasing and constant feeling of apprehension and unease about both the present and the future. Signs of a panic attack are Intense feelings of panic and stress. Trembling and shaking. Sweating. Increased heart rate. Difficulty breathing. Numbness or tingling in hands and feet. Feeling dizzy or light-headed. Chest pain. Feeling unreal or detached from yourself. Due to the terrifying nature of a panic attack and the feelings of pain in the chest area, many people experiencing them for the first time think that they are having a heart attack, or that their life is in danger. An attack can last from a few minutes to an hour, and after it’s over, some people recover quickly and never experience another. Others may start to have them more regularly and the experience can be so frightening that they constantly worry about when the next one will occur. The symptoms of General Anxiety Disorder and Panic Disorder can successfully be reduced or controlled using medication. For GAD, therapy and counseling can be helpful in becoming aware when your worries are unrealistic or exaggerated, along with instilling positive thoughts instead of negative ones. For Panic Disorder, medication and therapy can help manage symptoms so that you can calm yourself down when you feel an attack is coming on. Anxiety disorders can affect anyone, no matter how strong or successful. Getting treatment for anxiety does not mean admitting weakness but means choosing to live life on your own terms, without letting those worries hold you back. If you know someone who struggles with anxiety, telling them to “stop worrying” or to “get over it” will not help. Oftentimes, they know that they are overreacting and behaving irrationally. However, the fear, panic, and feelings of anxiety are still very real. Don’t judge, and let them know you are there to support them without adding any additional pressure. Simply spending time with them and showing that you value them despite their anxiety will have a bigger effect than you can imagine. This video is supported by BetterHelp which is a website where you can talk to one of over 2000 licensed therapists right away. If you use the link in the description you will get a 7-day free trial and you will really help us make more videos for people who are facing difficult life challenges. Thank you for watching…

Depression, Anxiety, and Parkinson’s: Season 2, Episode 1

– Hi, and welcome to ParkinsonTV. An educational series that brings you diverse perspectives of Parkinson’s, and its many possible symptoms. Season one focused on the basics of living with Parkinson’s. In season two, we’re exploring an important topic that’s not discussed often enough: mental health. In this, our first episode of season two, we’ll discuss two frequent companions to Parkinson’s: depression and anxiety. (violin music) Joining us is the series creator and neurologist Dr. Bas Bloem, from the Netherlands. Bas and his team started ParkinsonTV in Dutch, and they’ve now released close to 40 episodes that have reached hundreds of thousands of viewers. Bas, it is so nice to have you today. – And it’s a pleasure to be here, Patrice. – Thank you. We are also delighted to introduce our guests, Dr. Roseanne Dobkin, and Bob Pearson. Roseanne is a clinical psychologist and associate professor of psychiatry at the Robert Wood Johnson Medical School at Rutger’s University in New Jersey. Welcome. – Thank you, Patrice. I am honored to be part of this important work. – Thank you so much. And we’re also joined by Bob Pearson. Bob has Parkinson’s, and he’s experienced anxiety and participated in several research studies investigating new treatments. Thank you all for joining us today. It’s such a pleasure to see you, and to learn from you, and to share this with our viewers. And I guess, to you, Bas, first of all, tell us a little bit about your research, and just these very important first symptoms that we’re discussing, depression and anxiety. – Yeah, I think this is a critical season, for ParkinsonTV. We long thought that Parkinson’s was just a motor disease. It’s maybe good for the viewers to know that James Parkinson described the disease based on people he literally saw walking on the street. And if you start to speak to people like Bob, you will hear that there are lots of non-motor symptoms, including depression and anxiety, which are actually very common in patients with Parkinson’s. And I know that you have experienced this firsthand. – Yes I have, Patrice. I think I’ve had Parkinson’s for maybe 20, 25 years, but my first clinical treatment was for general anxiety, not for Parkinson’s. That was about eight years ago. I was misdiagnosed, I think. And the anxiety was pretty severe, I was put on medication for it, and now I’m getting the proper treatment, and it’s made a world of difference to me. – And I know, Roseanne, you treat patients, you see how these symptoms manifest themselves. And it’s not always the same. – Everybody is different. And just like Bob said, oftentimes we will see depression or anxiety present, 5 years, 10 years, 20 years before the onset of the physical symptoms of Parkinson’s disease. This means that people with Parkinson’s have been living with these very distressing non-motor symptoms for quite some time, and they can be very impairing. You know, there isn’t that much of a difference in the specific mood or anxiety symptoms per se, that people with Parkinson’s present with compared to the general population, but the way in which The present fluctuates, it varies. Sometimes the presentation is chronic, sometimes it’s intermittent, sometimes it’s both, so it looks very different person to person. And oftentimes, these mood symptoms get missed because they overlap with some of the physical symptoms of the disease process, and doctors, the healthcare team, people living with Parkinson’s, and their family members, might not recognize, you know, there are two separate phenomena at play that really require attention and treatment. – And I know that just in talking to people, the first thing they usually say is, oh, I remember, like you said, 30 years ago I had this depression, this anxiety. Never, in their mind, realizing that it could be Parkinson’s. Because maybe they didn’t have any of the motor symptoms. And that’s exactly what happened to you. – Sure was, yeah. It’s kind of a baffling disease. And that’s why I’m so glad we have these experts with us today to help explain this to everybody. Because it is treatable. That’s the important message, it’s treatable. – It is. And people need to know, Bas, that these are normal symptoms. I think sometimes people think that it’s just them, but, quite common. – It’s quite common. And, so, two things. One is, many patients who have the disease today can become depressed, or have anxiety. Bob’s example is one where patients have the non-motor symptom, in his case, anxiety, but also frequently depression, as the very first symptom of what later becomes full-blown Parkinson’s. You can’t turn things around; not everybody with depression will later get Parkinson’s. But in hindsight, we now know that depression can be the very first manifestation of what later becomes Parkinson’s. – And it’s so important for people to ask questions, isn’t it? – You have to ask questions. And as Roseanne was already alerting, in order to identify depression and anxiety, you have to speak to people. So that’s why James Parkinson missed the boat when he was just observing people walking on the street. You have to speak to people. And what I always say is, you have to look behind the mask. Patients with Parkinson’s have the mask face, or the poker face, as it’s sometimes called. This is a core motor symptom of the disease. And it complicates matters in two ways. One is, sometimes the mask face is mistaken for depression. So people feel cheerful, but people think they are depressed because they have this lack of facial expression. But in other cases, the depression is missed because you literally have to dig behind the mask and listen to patients and find their depression. – And I know people will learn so much from these episodes. What do you hope comes out of this one, the depression, and anxiety? Because I know you’ve explored so many topics, and you were just telling me that there are so many more. It’s such a complex disease. – Yeah, as we were saying when we were preparing the episodes, the fact that we’ve done 40 episodes in Dutch says everything about Parkinson’s, and what a complex disease it is. And we still keep finding new topics. What I hope that today will achieve is, first and foremost, recognition. Recognition that Parkinson’s is not just a motor disease. It’s a disease with lots of mental health issues, including depression and anxiety. And the second thing is, the moment people, listeners, viewers, see and hear this, don’t just sit it out. But it’s a treatable condition. I’m sure Roseanne will say a lot more about that. It’s a treatable condition. – I was just gonna ask you, I know that you specialize in this, in recognizing this. What are the treatment options? – So, there are several treatment options. And I always like to share that there’s no cookie-cutter approach, there’s no one-size-fits-all, everybody with Parkinson’s is a unique individual. In general, as first-line therapies for depression and anxiety, we may look to anti-depressant medications or anti-anxiety medications. I do a type of psychotherapy called cognitive-behavioral therapy, which really focuses on coping skills, what people are doing or not doing in response to the symptoms and life stressors they’re experiencing, how they’re thinking about themselves, their life, their future, their ability to handle the challenges in front of them, and this type of therapy, cognitive behavioral therapy has a growing evidence base suggesting that it can be very helpful for people with Parkinson’s, with depression and anxiety, not just in terms of alleviating some of those non-motor symptoms, but enhancing their the overall quality of life, and in some cases, enhancing their physical functioning. – And I know, 50% of Do people with Parkinson’s have some form of depression? – That’s a rough estimate, but it’s probably close to the target. And I think one of the interesting issues with both depression and anxiety is that, in Parkinson’s especially, it doesn’t always look like the type of mood disorder or anxiety disorder that’s portrayed on a TV commercial. So there are a lot of people out there that have very distressing symptoms, but maybe they don’t say anything about it, or those symptoms don’t get detected, because they’re not on the super-severe end of the spectrum, but they’re still very impactful. So I think we always have to be on the lookout, not only for severe symptoms, but even symptoms that come and go, but are very distressing, bother us and really change the landscape of the day. – So, one thing, if I may, just to add to the treatment. One thing that I always find very effective is simple dopaminergic therapy. So, the depression in Parkinson’s is sometimes a reaction to just having an illness. You could lose a leg and become depressed. In Parkinson’s, it’s more complex, because the lack of dopamine in the brain can also be, itself, responsible for both depression and anxiety. And treating Parkinson’s symptoms with dopaminergic treatment, levodopa or a dopamine agonist, works in both ways. It corrects the dopamine deficiency and thereby treats the depression and anxiety directly, and people feel better, they can move, they can achieve things again, and thereby feel more cheerful. – And I’m really glad that you brought this up. We want to make sure that the Parkinson’s treatment regimen is optimized. That there aren’t any big misses in that area. Get that under control first, and then layer on additional interventions as needed. And for some people, just getting the Parkinson’s medication right can make a big difference. Other times, more is needed, and it’s not so straightforward. – And we’re going to be talking a lot more about this as we continue, but so insightful, thank you all. We had a chance to speak with Rocco Romano, who also has Parkinson’s. We talked to him about his experience and strategies for coping with depression. Let’s take a look at that now. (violin music) – [Patrice, voiceover] Rocco Romano lost his sense of smell when he was in his 30s. And he also suffered deep depression. But he was shocked to learn, a decade later, he had Parkinson’s disease. – When I heard it from the first doctor, I just, I felt like … I felt like my heart just dropped to the floor. It was awful. It’s like a sudden loss. You’re like, “oh my God, what’s gonna happen to my life?” Well, I found out when I was 43 years old, so that was five years ago. And I had these symptoms, probably, as I said, 15 years beforehand. – [Patrice, voiceover] He also had trouble turning his phone in his hand. – For me, my symptoms are extreme fatigue at times, stiffness of joints and muscles, and slow movement. – [Patrice, voiceover] He says depression is the worst symptom. – Depression is such a shaming symptom or condition. And of recent, I’ve been going through quite a bit of depression. You just kind of withdraw into yourself, and, you know, the worst thing I can do is start to withdraw. – [Patrice, voiceover] Rocco was afraid of his diagnosis at first but now has no fear. He focuses on slowing the progression of the disease. Medication helps. So does mountain biking. Rocco has always been active; he loves getting on his bike and hitting the trails near his house. He believes the high-intensity workout helps relieve symptoms of Parkinson’s and restores the chemical dopamine, which diminishes in Parkinson’s. That’s a chemical that gives us a sense of well-being and a good feeling. – I mean, it’s almost like medicine itself. It really is. And it just helps out so much. I would say, the biggest effect, right after I’m done with exercising, is the depression is almost immediately gone. And it doesn’t resurface until three or four days later. It’s the exercise. Really, that blood flow to the brain is so crucial. – [Patrice, voiceover] But sometimes he’s so drained, he can’t ride. And the cold weather makes his muscles stiffen up. But he got back on that bike recently, and he realizes it’s something he has to do to feel better. – Yeah. Sometimes I don’t wanna do it. – [Patrice, voiceover] Doctors have also changed medicines to help lessen the symptoms of depression, and improve his sleep at night. Rocco says the toughest part was explaining the diagnosis to his three young children. But he laughs when recalling their reaction. – Once I was diagnosed, we pretty much immediately told them. Their reaction was, “Are you going to die?” I said, no, I’m not going to die. And then they said, okay, and then they just went about what they were doing. – [Patrice, voiceover] Rocco says one of the hardest parts about this disease is having to retire early from his job as a technology teacher, a job he loves. – It takes a lot of energy out of you, and at the end of the day, I am completely exhausted. I’ll have to come home and sleep for two to three hours. – [Patrice, voiceover] After he retires in June, he’ll still teach, but in a more personal way. – I wanna be there to help people, and show them a path of being positive, or maybe even exercise, or whatever it might be, that it isn’t the end. – So let’s talk about Rocco’s experience, in what ways his symptoms are typical of someone with Parkinson’s and depression, as well as anxiety. I know, Bob, you have experienced more anxiety, but also bouts of depression. Tell us what you went through and still are going through. – Well, before I was diagnosed, I mentioned that I was already in treatment for anxiety. That time, I thought I was worried about stuff. You know, my family, my situation. I had no idea I had Parkinson’s. So, when I got Parkinson’s, the good news for me was, well, now I know what it is, but then I started learning a little bit, and that it could be bad. Like Rocco, I identified with that feeling of, wow, now what have I got? And that’s where you have to get the intervention of treatment. – And I know we heard Rocco say how down he gets, and that sometimes he feels alone even surrounded by people. It’s not uncommon, is it? – It’s not uncommon at all. And a complicating factor is, for me, sleep problems. I was having fragmented sleep, waking up every 90 minutes, having trouble getting back to sleep. When you don’t have sleep, you can rapidly feel bad. And sleeping pills were not the answer, alcohol is not the answer. But there are good treatments available for this, that we can get into, but you have to realize that it’s the disease. It’s not caused by external factors, like your environment. – Right. And I know that Rocco had expressed, too, his sleeping is horrible, which makes him more depressed, more fatigued. And I know, Roseanne, this is not uncommon. – No, it’s not uncommon at all. And like we were saying earlier on in the episode, we always try to optimize the Parkinson’s medication as a starting point to treating depression and anxiety. Sleep is another area where we really want to optimize when we’re embarking on other treatment approaches. If somebody isn’t getting a good night’s sleep, it’s going to make effective daytime coping that much harder. And we don’t want this to be any harder than it needs to be. – Bas, what about you? What did you learn from Rocco? – A lot of things. First of all, I have seen thousands and thousands of patients, and when I see Rocco, it touches me. The impact on his life, a young man, a young family, beautiful children, devastated by Parkinson’s. The same thing, and it always gives me goosebumps when I see the film, is, he doesn’t sit down, he’s proactive, he starts to exercise. And you beautifully see how it’s not just drugs, but how exercise is a treatment, helps him to regain confidence and to treat his symptoms. I think it’s a very compelling movie. – And I know, sometimes, the medications can cause other symptoms, correct? And I know that happened in Rocco’s case. They were adjusting medications because they were causing worse things for him. – Right. In some of the other episodes of ParkinsonTV, we’ll talk about side effects, like impulse control disorders. Most patients tolerate Parkinson’s pills relatively well, because it corrects something that is missing from their brain. But obviously, there can be side effects, which you have to be aware of. – Roseanne, any advice to people who are, maybe, seeing the symptoms, such as Bob and Rocco, and just the general need for awareness, correct? – Absolutely. And one of the things that I take away from hearing Rocco, and learning about his story, is that one of the very powerful tools that he used to cope with was taking on this proactive approach in his own self-care, and I want everyone who’s listening and watching right now to recognize that we have power. We have control. There are skills, there are techniques, there are tools that you can start using today to manage depression and anxiety, and to live a better life with Parkinson’s. And for Rocco, some of those tools were exercises, really trying to prioritize his social connections with his family. And the other thing that I heard him allude to, which is so important, there were times when he just didn’t feel like exercising. He didn’t have the motivation, he didn’t have the get-up and go, but he did it anyway because he set a goal. And he knew why it would be important to actually get on that mountain bike and go. – Bob, what do you do? What kind of physical exercise? – Well, I used to be a runner. And I felt really good, at that time when I was running. I have problems, now, with my feet, so I get on my spin cycle at home, and I go to the gym. But I love being outside, so walking is very important for me. Set goals and don’t listen to your feelings. That’s a good part of therapy. Cognitive-behavioral therapy. I also have joined support groups. And that’s the socialization, my care partner. We talk about everything. You need that social capital, that safety net. Also, meditation is very important for me. One of my worst symptoms of all is fear. There’s a way out of that. Because fear is a thought. And the average thought lasts for maybe 20 seconds. So if I can identify what’s bothering me, a fearful thought, for example, I can accept that, that I’m having a thought, and I can put it in perspective. – Thank you. Thank you all. We’re looking at hope for the future, Bas. What do you see out there for folks, in terms of treatments and hope and new things coming along? – Well, as we said earlier, recognition is key. So everybody who senses depression, or feelings of anxiety, should go see their physician and be treated. We talked about some of the treatments that are out there today, optimizing dopaminergic treatment, antidepressants, talking to a psychologist, cognitive behavioral therapy, there are new treatments on the horizon, there’s very fascinating work on light therapy for treatment-resistant depression, there’s electroconvulsive therapy. Viewers may remember One Flew Over the Cuckoo’s Nest film, those treatments have now been made much, much more friendly for us. So, for severe depression, there are treatments. I think, overall, the prognosis, if you have depression and anxiety, and you don’t treat it, you make your prognosis, unnecessarily, much, much worse. And conversely, if you treat it, it’s a treatable condition. You improve your future, not just for yourself, but for your whole environment. Your spouse, your family, for everyone. – Roseanne, how about you? There’s so much out there, and so much hope for people. – Absolutely. And I echo everything that Bas just said. Nobody watching had any control over the diagnosis. Everybody has every ounce of control over the coping response. And I just wanna encourage people, it’s a call to action. Go out there, learn new skills, mobilize your support, talk to your friends, talk to your family members, talk to your healthcare team. Figure out how you can think outside the box a little bit, in terms of what new strategies, new approaches you can try, in terms of how you’re structuring your day, how much you’re exercising, how much you’re exposed to the people, places, and things that enable you to feel good about yourself. And let’s get really creative about how we engage with our day, how we engage with our support system, so we can really feel that tremendous sense of satisfaction that’s so healthy for us. And everybody can do this. Everybody can make really targeted changes to optimize their mood. – And I know, Bob, you’ve already done a lot of these things. And you’re a hopeful person. What is your hope for the future? – My hope for the future, number one, is that there’s gonna be a cure for Parkinson’s. It’s out there, as Dr. Bloem has said. We just have to find it. By getting engaged in all these different treatments, and advocacy, looking out for yourself, being your own advocate, but helping others in the Parkinson’s community, and your care partners. It’s a very strong message. And you’ll get a dopamine release out of it, I guarantee you. – And you know, you brought that up, and it is important to be involved, and I know some of our other panelists in our episodes to come have said the exact same thing. I could sit home and wallow, but I would rather be out meeting people, sharing a message of hope, finding support, giving support. Correct? – That’s 100% true, because the more we give, the more we get. And you have to take care of yourself. Get your priorities in order. You’ve got a condition. You have to take care of yourself. Once you start doing that, you can give back to others, and lead a very satisfying and worthwhile life. – And so much of a good message, for so many people to learn from. And, you know, for each of our episodes, we ask our viewers beforehand what questions they have about a topic. And we also pick a selection of questions that are the most often asked. And we wanna share some of those with you right now. Again, these are questions about depression and anxiety from our viewers. “Do the majority of people with Parkinson’s “suffer from depression, anxiety, or both?” and I know, Roseanne, we talked a little bit about this. The percentage could be as high as 50%. Do most people have some form of depression and anxiety? – At some point, you know, the answer is most likely yes. And, again, the type of symptoms they have, how long they last, the way in which they impact them, are going to vary greatly from person to person. But I think it’s so important for everybody to know that if you’re feeling any symptom that you don’t like, that makes you uncomfortable, you know, maybe you’re worried well, maybe you’re what-if-ing every decision that you’re considering, you’re finding yourself avoiding activities in your life rather than embracing them, you’re becoming more isolated, you’re always predicting worst-case scenarios, those are really good red flags that suggest maybe I should talk to somebody about this. – Okay. And our next question, “How do you know if “your partner suffers from depression and anxiety, “or one or the other?” Bas? – It can be difficult, even for a spouse, because it kicks on very gradually. But some of the symptoms that Roseanne was referring to, always seeing the dark scenario, loss of appetite, problems sleeping, always being worrisome, and not being the same person you were once married to, which can signal that something’s going on. And I would always recommend a low threshold, a low bar, to immediately seek advice and expert opinion. – And that support from the spouse is so important. “Can Parkinson’s medications cause depression and anxiety?” – No. If anything, as we talked about earlier, the lack of dopamine in the brain can cause depression, and it can cause anxiety. In fact, we know from people who are treated with dopaminergic medication, and where they experience fluctuations in response to the treatment, not only is, in an off phase, when the medication isn’t working well, are the motor symptoms worse, slower walking, more tremor, but they can coincide with more depression and more anxiety, which then immediately improves after intake of medication. So, medication doesn’t cause the problems, it’s a treatment. (soft violin music) – And that wraps up this episode of Parkinson’s TV, on depression and anxiety. We wanna thank our panelists, Bas, Roseanne, and Bob, for joining us, and sharing their knowledge, experience, and their stories about what is important, and why it is so necessary, to get the support you need. A big thank you to all of you. We also wanna thank Rocco for sharing his perspective and his advice. Any last thoughts, to wrap this up? Bob? – My advice to anybody that’s got a Parkinson’s diagnosis is, get going. Get up. If you have felt like you’ve taken a fall, get up quickly, and get control of your future. – Roseanne? – If you feel something, say something. There’s no need to suffer in silence. There are effective treatments out there. Share with your loved ones, with your healthcare team, what you’re noticing, what you’re experiencing, and let’s talk about it. Let’s get the conversation started. Because only good things will follow. – Bas? – Depression is a part of Parkinson’s. Anxiety is a part of Parkinson’s. You’re not to blame. It’s not your fault. But if you sense the symptoms, seek help and get treated, so you can lead a better life. – Thank you, Bas. We hope these episodes are both engaging and informative for you and your loved ones. And if you have questions or comments, we’d love to hear your feedback in the public comment section, or by private message. Our goal is to bring outstanding care and education to anyone, anywhere, with Parkinson’s disease. And ParkinsonTV is a very important way to do that. To close, let’s hear an overview of the whole episode in 60 seconds, from Bas, in our very first Parkinson’s Minute. (music concludes) – I believe this has been a particularly important episode of Parkinson’s TV. I was personally impressed by Bob’s story, Rocco’s story, and I think we all now realize, depression and anxiety are a real, core part of Parkinson’s disease. They’re often hidden, hidden behind a masked face, hidden behind simple symptoms such as seeing things always on the negative side, or worrying all the time. We’ve heard today that those symptoms can be signs of depression or anxiety. And they are treatable by optimizing the Parkinson’s medication, by speaking to a psychologist, by other types of treatment. I think, for me, this has been an episode of hope, and I hope that the viewers will share that view, that depression, and anxiety, cumbersome as they may be, are treatable symptoms, and when you do it, you will lead a happier and a more meaningful life. ♪ Take a moment, feel the rhythm of life ♪ ♪ It keeps beating, it keeps keeping time ♪ ♪ Every minute, it’s yours and mine, mine, mine ♪ ♪ Be the reason, I’ll be the rhyme ♪ ♪ Listen to the sound and hear the laughter in the air ♪ ♪ Open up your heart, feel the love, love, love, love, love ♪ ♪ ‘Cause the world is beautiful ♪ ♪ The world is beautiful ♪.

How Your Brain Can Turn Anxiety into Calmness

(whooshing) – [Narrator] This program is a presentation of UCTV for educational and non-commercial use only. (upbeat music) – Marty is a delight to have here and a delight to introduce, especially to a room full of people who are interested in learning about mind-body medicine. Marty Rossman has probably done more to bring integrative medicine to where it’s at, especially regarding mind-body medicine than any other person I will ever get to introduce or perhaps even get to shake hands with. Marty was very early on was one of the proponents of medical acupuncture. He was a founding board member of the American something or other. American Board of, American Academy of Medical Acupuncture, he tells me. He has been instrumental in developing guided imagery to the robust field that it is today. He works as well a great deal with hypnosis, with many different techniques to help calm us down to help us get to a point of relaxation. Using hypnosis, health hypnosis, biofeedback, bodywork, but especially guided imagery. He is a member of the advisory board for the Osher Center for Integrative Medicine, and I was interested to discover he’s also a member of the advisory board for the Rosenthal Center for Complementary Medicine at Colombia University in New york. I’ve known Marty for a number of years now. I’ve been privileged to attend several talks that he’s given. I know that he’s a great speaker. – Well, thank you very much. That was very kind of you to say. Good evening, everybody. So how many of you have ever worried about anything? (audience laughing) Has anybody here ever worried about anything? Okay, good, that’s our topic tonight. And of course, everybody worries sometimes, and some people worry all the time. And if you’re one of those people who finds themselves worried all the time, I think that you might get something very useful. I hope that you get something very useful out of tonight’s talk. If you just worry intermittently, I hope you get something useful anyhow, but you don’t probably don’t need it quite as much. So I’m calling my topic tonight Worrying Well, and I’m still looking for a subtitle, but tonight we’ll call it how to use your brain to relieve anxiety and stress and turn it into more desirable things like calmness and confidence. Worry, I think, gets a lot of bad press because we don’t use it very well, and so when I call it Worrying Well, it’s really about what is worry? How do we do it? What’s the purpose of it? Is it possible that worrying has a positive function, which it does? Worry basically is an adaptive function. It’s something that allows us to go over and over something in our minds in an attempt to solve a problem or resolve a situation, so I think that that’s adaptive. We humans have been born with faculties in our brain that as far as we know don’t belong to any other creature on Earth, and it has allowed us to come from being a pretty vulnerable prey animal on the African savanna to becoming the dominant the creature on Earth. We don’t have many tools for survival if you look at a human as an animal. We’re pretty vulnerable. We don’t run very fast. We don’t have big teeth. We don’t have big claws. We can swim a little bit but not very well. We can’t fly very well. So out there, without a lot of technology and on the African savanna, we are meat basically. And we’ve got systems built into our system that we inherited from the development of other prey animals that lead to things like fight and flight response, which are adaptive in some situations and maladaptive in others. But one of the things that are, that one of the qualities that we’ve developed is, or one of the mental abilities and functions is imagination. I could really make a strong case that imagination is one of the key things, and maybe the key mental faculty that separates the human from all other forms of life. Imagination lets us remember things from the past. It lets us project things into the future and think about how things would be in the future if we did something this way or that way. And everything that exists on Earth that wasn’t made by God or nature, take your pick, or some combination of the two. Everything else that exists, everything that humankind has created started in somebody’s imagination. That’s where it made its first appearance on Earth, as somebody’s imagination. “Ooh, we could do that. “Could make it round, it’ll roll. “We could chip these.” They noticed that two rocks chipping together make fire and they figured out a way to do that. So imagination, you could make a case that outside of God or nature, the human imagination is the most powerful force on Earth. And the thing is, very few of us have ever really been taught how to use it. Most of our education, especially all the way through to higher education, is on using other mental faculties, which also have made us very powerful. The ability to analyze. The ability to calculate. Linear, logical, rational, scientific ways of thinking have also contributed to us being very powerful because they allow us to take the things that we imagine and make them real in a certain way, but a lot starts in the imagination. Worry is a function of imagination. If you didn’t have an imagination, you wouldn’t be worried. That’s what lobotomies are about. (audience laughing) And that’s what a lot of certain medications are about. So we used to joke at our academy for guided imagery that if we could find a simple, non-toxic way to do a vaginectomy, we could resolve everybody’s worry and stress problems. You just wouldn’t be very worried. You wouldn’t do much, either. You wouldn’t be creative, but you wouldn’t be worried if we could do that. So I think rather than taking the imagination out, what we wanna do is learn how to use it better, and so a lot of what I’m gonna share with you about Worrying Well or worrying more effectively has to do with how you use your imagination. So worry and stress have a lot of overlap, right? And we often use them interchangeably. I’m gonna spend a little time to differentiate these things a little bit, but they do overlap quite a bit. And then anxiety also overlaps with worry and stress. They’re all a little bit different, and they’re very interrelated. They share in a lot of different kinds of ways. The reason this is important is that our consciousness and our ability to become self-conscious is potentially the greatest tool that we have for improving our lives. And it also, if we don’t know how to use it, can be something that can make our life miserable. So I like this Ashleigh Brilliant quote. “Due to circumstances beyond my control, “I am master of my fate and captain of my soul.” So you’re it. If you wanna do something about your anxiety, your stress, the way that you think, the way that you create your life. You are the captain whether you like it or not. So we might as well learn how to use these capacities ’cause there’s really no going back. I think sometimes unconsciously we try to go back with other ways of managing anxiety and stress like drinking too much or taking drugs, medications, or eating too much. All the millions of ways we have of going unconscious and kind of trying to just put our head in the sand and maybe it’ll go away, which it frequently does. So it’s not that it’s not a good strategy in the short run, but as a total life plan, it’s kind of lacking, okay? It won’t take you where you want to go. So how are worry, stress, and anxiety different? So worry is a type of, this is how I think about it, and I can be argued with. I’m not sure that any of this is actually true. I’m kind of throwing it out there. I’m writing a book on it. So if I’m wrong, please tell me before the book is written. But it seems to me that worry is a type of thinking, okay? And our friend here Ziggy says, “The figments of my imagination are out to get me.” That’s kind of the most common use of the imagination is just letting your imagination kind of go to the worst scene scenarios, getting kind of entranced or hypnotized by your worries and letting your imagination scare you. ‘Cause I think in a sense, the most common unconscious use of the imagination is to drive ourselves crazy or worry ourselves sick. So the bar is set pretty low. That’s the good news. We can learn to use it more on purpose and do better than that. So worry is a type of thinking. It’s a repetitive kind of thinking. Sometimes a rumination, it’s generally troubled. It often has to do with things that are either in the past or in the future, okay? It’s the opposite of being here now. It’s the opposite of the present center. That doesn’t mean it’s bad, and that doesn’t mean that it doesn’t have a function. But we’re in our brain, we’re thinking about something. We’re going over and over it. And again, I think that’s because of the adaptive function of worry, I always assume that something is there is an attempt by nature or by life to solve a problem or to give us an advantage. So if you think about what could the advantage be of being able to go over a problem over and over in my mind? Well, I think it’s kind of like if you have a big, tangled ball of yarn or thread. And you’re trying to untangle it and you find a place that’s loose and you pull it for a while and you get some looseness, and then it gets stuck again so you turn the ball over and you find another loose place and you free up some more stuff, and you turn it over again and you free up some more stuff. And if you keep doing that, turning it over and over, looking at it from different angles, finding the loose places, finding where things are knotted together. Excuse me, if you persevere with it, more often than not, you’re gonna get that whole thing untangled and then go on to the next tangled mess that you find, okay? But you are likely to get that one untangled, and I think that’s the function of worry. It lets us, it makes our concerns transportable so you can think about it at any time, and that can be an advantage or a disadvantage. And I think that that depends on whether you’re using your brain or you’re being run by it. That your brain is an incredible organ. Your mind has something to do with it. And at least in certain circumstances, your mind can learn to use your brain in better ways. That’s what this is about. So it’s very easy though for this adaptive function of problem-solving and turning things over and over to become a habit or to become repetitive and to become ruminative and just kind of become its own thing. And I think there are a couple of reasons for that. One is that worry can serve kind of a magical function. There’s a magical, unconscious function of worry. A couple of ’em actually. So one is that most things that you worry about never happen. Most things that you worry about never happen, and if you, that’s an old rubric that we’ve all heard and I found myself wondering, “Well, is that really true?” So I’ve been teaching this as a six-week class, this Worrying Well class. I’ve taught it a few times now, and I’ve asked people at the beginning of the class to list all the things that they find themselves repetitively worrying about. And then sometime later on, we’ve just checked in with the first class, which was about nine months ago, to see how many of those things have happened, and not very many of them have happened. So I don’t know if anybody’s ever studied that really before, but you could do it yourself by writing them down and then checking it in about six months or a year. Now the interesting thing about that, the way that the brain works is, at some unconscious level of the brain, the brain could conclude that the thing didn’t happen because you worried about it, right? (audience laughing) That’s the function, and there’s an old story about a woman who walks around her house. She’s an old woman. She’s walking around her house every day. Mumbling, walking around her house. She walks around her house all day long until she’s curved a rut around her house, and that goes up to about the middle of her thighs. And finally, one of their neighbors can’t take it anymore. He goes over and he says, “I hope you don’t mind if I ask you “why you walk around your house all the day, every day.” And she says, “Well, I’m keeping it safe from tigers.” And he says, “Well, we’re in Indiana. “There aren’t any tigers here.” And she says, “See?” (audience laughing) (laughs) So it’s possible that we get rewarded for worrying because so many of those things don’t happen, and at some magical, unconscious primitive level of thought those two things could possibly be connected. The other thing that has been researched is that sometimes, worrying about things distracts us from things that are actually bothering us. So that worrying about little things and do-lists and so on and so forth, always fussing and always worrying and always having something to fuss up about and to worry about actually distracts us from something that might be deeper and more emotional and actually be harder for us to take. So, and we know that that’s a function. That’s actually been studied. So that worry prevents deeper, richer, more emotional-laden thinking, which typically comes in images and comes in the quiet times. So if there’s a lot of feeling there that’s hard to process or hard to feel or that’s unprocessed and that we’ve never dealt with, it’s in a sense useful to keep the mind very busy. Because if you get quiet, your emotions will come up. And ultimately, we think that that’s a good thing. Emotions are natural, they’re healthy. They have a wisdom to them that most of us have not also been educated in. But they can be hard to feel. Nobody, very few people have very much trouble feeling joy. Although a lot of times we’re blocked from feeling joy because we are unable or unwilling to feel other emotions. When you start feeling one emotion, the others go, “Hey, the door’s open.” And they might wanna come up and be felt. So there are functions of worry, and again, some of them unconscious, magical, maybe not in our best interest over time. Others adaptive, problem-solving, go over the problem. So it behooves us to kind of learn what we’re doing with the worry, and that gives us choices in terms of what we’re doing with the rest, okay? So worry’s a thinking function, whereas anxiety, anxiety is an uncomfortable feeling. It’s usually in the chest or the upper abdomen. Not always, but it’s most often up in this area or this area. It’s an uncomfortable feeling of fear or apprehension or dread. Dread is, it’s that feeling, “Oh my God, something bad is going to happen, I know it. “Something bad is going to happen.” You don’t know. It may be attached to something or it may be free-floating and not attached to anything. And anxiety often comes with physical symptoms like rapid heartbeat, pain in the chest, sweating, shortness of breath. There’s often a feeling of anxiety if anxiety is very strong, like panic attacks. There’s often a very characteristic feeling that comes with panic attacks and the feeling is of impending doom. People with panic attacks feel they’re about to die. And it’s often, again, since the symptoms are often in the chest or in the abdomen, we see these things in medicine all the time. And you could really make a case for one of the maybe the primary functions of a primary care doctor is seeing if there’s anything else but anxiety going on because anxiety can cause so many symptoms in so many systems of the body and make us afraid. A sense that something bad is gonna happen. Anxiety is a function of a part of the brain that is the emotional part of the brain. It’s called a limbic system or the emotional brain, so worry belongs to the thinking part of the brain. And there’s a lot of interaction, but worry belongs in the thinking part of the brain, the cortex. Anxiety typically comes from the limbic or emotional part of the brain, and I’ll show you what that looks like. And stress, which is the third leg of our uncomfortable stool here, is actually a physical response to a threat, real or imagined. And in modern life, most of the threats are either perceived or imagined, but they’re not. So somebody’s probably told you the story of the saber-toothed tiger and the fight-or-flight response and so on. That this was a response we think was designed by nature. So when you walked out of the cave and you ran into a big predator like a saber-toothed tiger, part of your nervous system fires off and you get a big shot of adrenaline and your heart beats faster and your blood clots faster and your blood pressure goes up and your muscles get super charged and you’re ready to run, or run the fastest two miles you’ve ever run in your life or fight the tiger to death. And then it super charges you. It’s that kind of thing we hear about when a mother moves a car to save the baby. The thing is that this response can go off in response to threats that are not predators. That are not, it can go off in response to stock market movements, economic changes, thinking about aging, thinking about whether you can meet your responsibilities. All kinds of stuff, and all kinds of stuff that is, that unless you know where the off button is on your television or your radio or your computer, that you can just literally pump into your brain 24/7 if you stay up. All the bad news of every bad thing that has happened around the world to anybody, or if it’s a slow news day, what could happen, okay? Like the H1N1 flu, ’cause it’s not a terribly, doesn’t look like a terribly dangerous flu right now, but it could become really dangerous. And that’s what’s got everybody scared and everybody freaked out and standing line. What could happen, so. And yes, there’s a balance between, again, being able to predict the future and take measures to prevent things happening that don’t need to happen, and freaking out for months about something that probably will never happen. It’s a yin-yang kind of relationship. So stress is, the important thing here is that stress is a physical response. It’s not stuff that happens to you. It’s a physical response that your body has to survive a short-term stress. And if you survive that short-term stress like fight like the saber-toothed tiger, you’ve either killed it or you’ve run away from it. And run as fast as you can, climb the highest tree that you can. You’ve burned up all these stress chemicals, and when the tiger goes away, you kind of limp back to the cave and breathe a big sigh of relief and tell everybody about how you killed the tiger or ran away from the tiger. And your body rested and compensated and recharged itself and replaced all the chemicals that it used during that intense 20 to 30 minute fight. Or else the tiger has eaten you and you don’t have anymore stress. (audience laughing) But one way or another, it’s all over in about 20 or 30 minutes. (audience laughing) Okay? So there’s none of this years of stress that go on if you’re a good worrier, where you wake up in the morning and the first thing on your mind is, “Oh my God, what’s gonna happen with this? “Am I gonna be able to do this? “Am I gonna be able to beat that?” And so on and so forth. And of course, the really good worriers are not only doing it during the daytime. You’re up at night, too, because you can’t sleep, right? And so it’s taking your, and that takes your resilience away, and it becomes a real negative, vicious cycle. So, to review. Worry is a type of repetitive, circular thinking. Anxiety is an uncomfortable feeling of fear or dread. Stress is a physical response that prepares you to meet challenges and so it’s interesting to look at. This is sort of a somewhat dated model of the brain. It’s called the Triune Brain, but it’s good enough for government work. We can work with this model, okay? This is that, there is what’s called the cortical brain or the neo-cortex. The big, gray matter, wrinkled, big brain that we’re so proud of that allows us to speak and add and calculate and reason and so on and so forth. And imagine, and do all these things that again, as far as we know, no other creature on Earth does, and that is really the most adaptive thing that’s helped us survive and dominate. Lower down, limbic system, mid-brain, okay. The basic brain, we call it the reptilian brain. That’s the brain we share with lizards and reptiles and amphibians. That’s the oldest part of the brain. That part of the brain basically concerned with survival. It basically sorts things into two or three categories. “Can I eat this? “Can it eat me? “Can I mate with it?” That’s basically what it’s concerned with, okay? (audience laughing) It sorts down all the information that you receive into those three things, okay? And it acts like that. It acts reflexively and instantaneously. Just like if you come across a lizard on the path and you make a move towards it, it’s gone like that. It doesn’t go inside. It doesn’t do a Woody Allen thing. “Should I move? “Should I not move? “Would it be better for me? “Is this dangerous? “Is it not dangerous? “How dangerous is it?” It doesn’t do any of it, it’s just gone, okay? If there’s any indication that there’s a threat, it sets off the stress response and it’s gone. The thing is, this developed evolutionarily from the bottom up, okay? This was, this part of the brain developed first. And then as animals developed, the limbic system pretty much developed in mammals, and other, in warm, furry creatures, who characteristically have social relationships. And for mammals, for most mammals, not all mammals, social relationships like prides of lions and packs of wolves and families of people and things like that have adaptive value. We do better when we’re connected to groups. We have more strength. We have more problem-solving ability. We have emotional support. We are social creatures, and our social positions mean a lot to us. And all that emotional processing happens mostly in this limbic system, and then on top of it, the big, smart, intellectual brain. Every layer added new possibilities and new complexity to our ability to understand our world and to navigate our world. And part of the problem when we look at this whole issue is that the new guy is very entranced with himself, okay? The thinking brain thinks that nothing was important before he came along. And I saw he kind of deliberately. It could be she too, but it’s a kind of, it’s not that there aren’t tremendously bright and intellectual women, but it’s kind of thinking analysis, logic, that kind of thinking on a yin-yang scale we typically characterize as a kind of a masculine thinking. Not that it doesn’t belong to women too. Whereas the feeling, the intuitive, tends to be a more kind of receptive, softer. It has its own logic, but it’s not the same as the logic of mathematics and science, okay? So this brain is very good at, especially part of the brain, the part that’s suited for verbal and mathematical skills, which typically is in the left hemisphere of the brain. And there’s some variation, but that typically is in the left brain, which is called the dominant hemisphere. Speech capability, mathematical capability and so on. Whereas in the right side of the brain in the same area, lie areas of the brain that have to do with the body image, with emotional recognition and facial expressions, and tone of voice, and those kinds of skills. So they each have their place. I mean, logical skills have to do with building buildings like this and building MRIs and doing the kind of incredible science that goes on in a university setting like UCSF and looking through electron microscopes and doing chemical analysis. And these are tremendous feats, don’t misunderstand me. They’re completely useless in a relationship, okay? It doesn’t matter how many Nobel prizes you have. You may not be able to maintain a marriage. Would be if that’s the only kind of intelligence you have, right? And you may not be able to maintain good relationships with people. Whereas somebody who emotionally, and in terms of social networking and understanding and compassion and empathy, may have a different kind of intelligence, as well as an intellectual kind of intelligence. So my point is that these are different kinds of intelligences that are useful in different situations. What has happened since the advent of the age of reason and which is, and the advent of discovering the immense power of our intellectual capabilities, I think has been a devaluing and ignoring of the earlier kind of intelligence that has to do with our relations with each other and with other living things and with our environment. And I think that a lot of the crisis we’re seeing is we’re trying to come back to that and own those relationships while still maintaining our ability to be technically creative and help solve those problems that way. I think that these have been around a lot longer. This guy’s really fascinated with himself and sometimes thinks he’s the only game in town. So the reason we used to say, when we’re talking about left and right hemisphere, and I don’t wanna go into it too deeply tonight, but the reason that the left hemisphere is called the dominant hemisphere … Can anybody guess? It does dominate, but the main reason that it’s called the dominant hemisphere is that it’s the one that names things. It’s the verbal hemisphere. It’s the one that gives people, thinks, “I’m the dominant hemisphere, “and you’re the subdominant hemisphere. “I’m the major hemisphere, you’re the minor hemisphere.” And it’s kind of a joke, but I think it’s also true, and we have valued that. Think about your education. How many hours of emotional education did you get? How many hours of education in using your imagination did you get? Or your intuition? So your education, and I’m not saying that it was, hopefully, at least when I went to school, it was reading, writing, arithmetic. It was those left brain, analytic, logical skills. Tremendously useful, but not all of us. And this other kind of intelligence, I think we need a lot more education experience with it. Learn how to communicate with it, and that’s why in a little while I’m gonna talk about imagery, which is its coding language in a sense of this more emotional and intuitive brain. So here’s a kind of a picture of a real brain cut in half this way. And I don’t know how well you can see this, but there’s the wrinkled cortex, neo-cortex. It goes all the way around. And then in the center, this area here more or less is the limbic or emotional brain. And you can see that there’s an, and then this would be the reptilian, reflexive, survival brain. And you can see there’s lots of connections between the two, so that this brain could send messages into this brain and create an emotional reaction, which would send messages down to this part of the brain and sent it out to the body and vice versa. Like for this guy. So this guy’s having a, he’s not having a good day. He’s having a rage reaction, and without going through all of these things, just if you want to study this, you can, but something didn’t match up with his expectations, okay? That’s where most anger comes from. He had an expectation. Something didn’t come up to it. It sent some kind of a message of danger or threat to this emotional brain. It’s signaled his lower brain that to get ready for a fight, and this thing sends out, through all the cranial nerves and spinal cord and so on, messages to every organ in his body and your physiology changes very dramatically. When you’re angry, when you’re frightened, when you’re sad, when you’re happy, when you’re calm, you are physiologically different than, okay. So there’s plenty of connections and this is basically just to show yes, there’s a real wiring diagram and a real chemical messaging system. So anxiety, stress, and worry are interactive, they’re bidirectional. If you have a tendency to be anxious, that emotional brain is gonna be pumping out more messages of, “Look out.” It may not know what it’s looking out for, but it’s gonna be more vigilant. It’s going to raise the, it’s gonna send more messages to the cortex to be on guard for problems. And then the cortex is gonna be able to imagine all the problems that there could be out there, and it’s gonna send messages back and they can get into a real, kind of a reverberating circuit. All these parts of the brain are chemically sensitive, and of course in medicine, typically we try to chemically manipulate these things if somebody’s got a real anxiety disorder. We’re not talking about anxiety disorders which where the anxiety level is just cranked up high in spite of the thinking here. But we try to manipulate that with medications. Those of us who have studied nutritional medicine know that there are naturally occurring molecules. That there are molecules in our foods that can be used as nutraceuticals to modify how active or upregulated the nervous system is or downregulated, so we try to do it through more natural molecules, but the other thing to know about this is that they’re also thought-sensitive. That thoughts that become chemicals at a certain level and those chemicals stimulate the physical mechanisms that underlie our reactions, so. And that’s gonna be our focus tonight, is about thinking. For any of you who have any doubts that the mind and body are really connected and create physiology, just a real quick, this is biofeedback data. And to make it simple, this is muscle tension. This is electrical response in the skin. This is fingertip temperature, which is a sign of either stress or relaxation. This nice, even white line here is respiration. So this guy is sitting in a biofeedback therapist’s office with a bunch of sensors hooked up to his muscles and his fingertips to measure the way that his circulation responds to stress. And he’s got a belt around his chest, and he’s just breathing nice and around his abdomen, this is actually his abdomen. And he’s breathing nice and normally, even. He’s just sitting there relaxing. There’s not much going on, so. You won’t be able to read all this stuff. Just watch what happens here. So he’s a guy. This is an actual patient who has a phobia about driving over bridges and he lives here. (audience laughing) Okay. Bad combination, right? So he’s sitting, so he goes to the biofeedback therapist. Here he’s just sitting there relaxing. Then the biofeedback therapist asks him just to think about, just imagine approaching the Golden Gate Bridge. And all of this goes in the same direction. There’s an immediate fight-or-flight response. Just goes off from imagining driving across the bridge. You can see it best here, what happens to his breathing. It just goes to pod. It’s just very shallow, very irregular. Stops breathing into his abdomen. His skin temperature, actually this reversed. It should go decrease. His muscle tension goes up. He’s physiologically ready to defend his life by imagining going to the bridge. Now, if he can learn to get his breathing under control again and his therapist can guide him to think about some other things that are more relaxing. They typically break it down. “Just think about coming down the stairs “and seeing your car keys.” In a person who’s developed a phobia, that would be enough to stimulate a huge reaction. Now, if the person then can learn to breathe more deeply and to induce a relaxation response, which most people can, while he’s imagining that, go back to the calm physiology. By the time he gets to the place where he can actually imagine driving across the bridge and staying calm, he’ll be able to go across that bridge. That could take months to get to. There’s a lot of practice in here, but it’s a good example of a mind-body connection and how much we respond to just thinking about things. So there’s a lot, how many have heard the term neuroplasticity? Has that been talked about here? So it doesn’t mean your brain is made of plastic. It means that your brain is changeable, and there’s been a lot of literature lately about how changeable the adult human brain is. Up until very recently, the dictum was we have an adult brain, that’s it. Your cells die off, but that’s about it. And you can’t teach an old dog new tricks, and all that kind of stuff. And we know now, how many of you have read this book by Norman Doidge, “The Brain That Changes Itself?” It’s an astounding book on brain science. A couple of, an example, there are researchers now that have developed techniques, sending, taking people who have been blind since birth. Hooking up a little video camera to an electric device that kind of draws a picture on their back by poking ’em. Kind of a thing that puts multiple little pokes and gives them a picture on their back, and they start to see. Okay, they can see so that they can walk around. Now they have it where a little video camera and a glass goes to a little wafer on the tongue that sends out little electrical signals. And they start, and they are able to see. Probably not like most of us who are able to see naturally and normally, but they are able to see. They can walk around the room and not bump into objects and so on and so forth, okay? And what happens over time, what they found was, in these people, that watching a device called a functional MRI, which can show us what parts of the brain are active while people are thinking, that it was the part of the brain in the occipital cortex that processes visual information, that took all of this data from their back or their tongue and started putting pictures together. So the brain’s taking this data and putting pictures together ’cause that’s what it does. Normally it gets the input from your eye, but if we can get it the information some other way, it can create new pathways that create these abilities. Isn’t that astounding? So part of Jeffrey Schwartz at UCLA, his research has been with people with Obsessive-Compulsive Disorder, which has been traditionally a very difficult condition to treat, and finding very structured, repetitive exercises, which fortunately, obsessive-compulsive people are very good at. (laughs) (audience laughing) By focusing their mind in a certain way, that they literally can change, not only their behavioral patterns, but that their brains change after a decent period. We’re talking about months of practice so that you can actually lay new hard wiring down, as well as changing your mind. You can change your mind in a nanosecond, but it seems to take weeks to months to change your brain. But when you change your brain, now you’ve got a new default position installed, and you don’t have to be the same way that you were before. Louann Brizendine, who’s a professor of psychiatry here at UCSF, wrote this, how many have read this book, “The Female Brain?” If you never read another book in your life, and if you’re either male or female, (audience laughing) you should read this book. This is an astounding book. A really astounding book about the brain and how it’s organized and what different capabilities there are. Both genders have similar capabilities, but it’s a bit of a digression, but it was tremendously useful to me to learn from this book that all fetuses as they’re growing in the womb are female, are male at the beginning. And at eight weeks, yeah, they’re all female. They’re all female. At eight weeks, the fetus with the Y chromosome gets a wash of testosterone, and do you know what that testosterone does to the brain? You’re gonna love this. (audience laughing) It explains so much. (audience laughing) It kills 80% of the neurons in the male brain that process emotional communication. (audience laughing) This is apparently brain science. And when they get it again when they’re 14 or 15, I don’t know how many of you remember being 14 or 15, or if you have a 14 or 15-year-old son who sits at the table like this and looks like a cretin and spends all of his time in his room and is barely human, and he was a brilliant, loving little kid. He’s got testosterone poisoning, which is again, seriously, (audience laughing) is again, killing neurons in his brain that have to do with emotional communication. And increasing the parts of his brain that have to do with sexuality and aggressiveness, okay? While the female’s brain is still maintaining this big part about four to five times as much brain area devoted to emotional communication. To talking about sensing emotional nuances. Which is why in general you ladies are so much better at it than we are and you like to talk to each other about all that stuff. You like to talk to us about it. You don’t understand why we don’t understand. Okay, this would be like, and this is no offense. I need a better archetype, but this would be like my dog who has 20,000 times the smell neurons in his nose than I do. This would be like my dog asking me, “Why don’t you smell that Jake was here earlier? “I’m sniffing his book. “Why don’t you, I’m living in a world of smell. “Smell is all around us.” It’s a world of smell to the dog, right? I don’t smell any of it. I don’t hear the high-pitched sounds ’cause his brain is tuned differently, so. This is has saved my marriage. (audience laughing) This discover. And when you wonder, and when the guys, these are all overgeneralizations and I’m playing it up a little bit, but your guy may not be able to tell what you’re feeling as easily as you can tell what he’s feeling. It’s a different world. He just may not, he’s just like, and this is what guys always say to each other. “Why is she mad? (audience laughing) “I don’t get it. “Why is she mad? “I asked her out to lunch on Tuesday. “She got mad at me. “I don’t know why.” So one mystery not exactly solved, but the brains are organized differently. It’s really fascinating. That is a great read. All right, I’m gonna go ahead and go on before I get stoned here. The brain changes throughout life and here’s the basis of my interest in thinking about how we think. Thinking about how we worry. That if the blind can learn to see, then the anxious should be able to learn to relax. I would think it’s much easier to learn to relax than it is to see when you’ve never seen before. I may be wrong, but this is kind of at the center of it. If our brain is capable of that kind of learning, then what do we need to do in order to teach it? And this is a great term that comes from Jeffrey Schwartz self-directed neuroplasticity, which is fascinating because you’re using your own mind to change your own brain. Really an interesting concept. As one of my favorite Gary Larson cartoons that has to do with this, this is the ultimate self-help technique. And the guys here are reading these books, like “Do It By Instinct” and “Dare To Be Nocturnal.” (audience laughing) “Predator-Prey Relationships.” And the best one of course is “How to Avoid Natural Selection,” which is (mumbles). (audience laughing) So this is ultimately, I mean, our greatest self-care tool. So let’s talk about how we can think about this, and this is how I’m thinking about it now. I’m thinking that there’s good worry and bad worry. And by that, I mean good worry is functional worry. It’s worry that’s trying to solve a problem and that has some potential to solve a problem. And that, and if we separate our worries into good worries and bad or futile worries, okay, we can treat each one of them in a different manner. We can use our brain in a different way. So good worry is, “I’m worried about this project. “I’m worried about where to go to school. “I’m worried about whether I’m gonna be able “to pay for my kid’s education.” Real stuff to worry about. It’s not that there’s any lack of real stuff to worry about, but stuff that, if you asked yourself, “Is it likely “that I could actually do something about this?” That you would say either yes or maybe? As opposed to, when you actually write out the stuff you’re worrying about, a lot of times you find out, you look at stuff and you say, “Well, “I can’t do much about that, ‘2012.’ “Gee, I’m worried that the world’s gonna end in 2012.” What are you gonna do about that? Okay, are you likely to be able to do anything about that? You might wanna put that on your bad worry list, okay? And just enjoy the movie as a great roller coaster ride. So good worry anticipates and solves problems. Bad worry, circular, habitual, magical. Doesn’t go anywhere. Doesn’t lead to solutions, scares you. In a sense, it starts to become a type of auto-suggestion, right? ‘Cause you’re thinking about this thing all the time, you’re scaring yourself. You’re sending out those fear pathway and that makes it harder to use your brain when you’re feeling that way. And so, how many of you are familiar with the Serenity Prayer? How many of you have heard of it before? Okay, now I wanna ask how many of you are in 12-step programs? (audience laughing) The 12-step programs adopted the Serenity Prayer. The Serenity Prayer goes back probably as far as Roman times, and then in modern times was attributed to a theologian in WWII, but the 12-step programs have adopted it. It’s a brilliant prayer thought. If you don’t like prayer, just take off the God word, okay? But the Serenity Prayer goes, “God,” or whatever, “grant me the serenity “to accept the things I cannot change, “the courage to change the things I can change, “and the wisdom to know the difference.” Okay, so if we use the Serenity Prayer as kind of the skeleton of our Worrying Well practice, we wanna think about separating things we’re worrying about into things you can change, things you probably can’t change. And then if there are some that are left over that you’re not sure of, where you need the wisdom to know the difference, I’m gonna talk to you at least about ways that you can use imagery to help with all three of those things. So the first question is if you’re not sure about something and you need more wisdom, how do get more wisdom? Besides living another 30 or 40 years, okay? By which, I mean that’s not all that useful when you’ve got an immediate problem. So there’s ways, ordinary ways to access more wisdom. Talk to people that you think are wise. If you have wise friends, if you have wise teachers, see if they’ll talk to you and you can share your problem, listen to ’em, consider what they say. That’s one good source of wisdom. This stands for what would Jesus, Buddha, Dalai Lama, or Yoda do? (audience laughing) So if you don’t have access to a wise friend or teacher, this is a type of imagery technique. Think about what would somebody that you imagine is genuinely wise, what would they say in that situation? Remember Hillary Clinton got all kinds of flack from people when she was the First Lady ’cause she said she was in a circumstance where she wasn’t sure what to do and she thought a lot about Eleanor Roosevelt and what Eleanor Roosevelt would have done in that situation, and of course, all the kooks got up on her. “She’s into spiritualism,” and so on and so forth. She was conjuring the ghost of Eleanor Roosevelt. She was imagining what a wise, ethical, role-model would do in that situation. It’s a perfectly natural and very intelligent thing to do. What would somebody with class and wisdom and caring and morals do in this situation? And if you took it another step and you do it a guided imagery where you actually relax, you go into a meditative or relax, just a relaxed state, and you kind of daydream that you were walking in the garden with Eleanor Roosevelt, and you told her what was going on and you imagined that she spoke back to you. That’s not spooky. As long as you know that it’s not really Eleanor Roosevelt, or if it is, that she’s, that you’re not identifying with her. You’re not the person in the crazy house who thinks that they’re Jesus, but you could imagine what Jesus would say. What Jesus would do, if Jesus is important and meaningful to you. Or if what the Dalai Lama would do or what your wise grandmother would do, or what your wise grandmother would do if you had a wise grandmother, right? So you start accessing, what would it be like if I were to approach this from a wise place and you take the time to quiet down and take the time to get deeper inside. And that’s what we do with an imagery we sometimes call inner wisdom imagery or inner advisor, inner guide, inner ally, inner whatever. You can have your higher power, guardian angel. People have called this by different names throughout history, and some people feel like, “Well, you are calling on on a spirit.” And other people feel like, “It’s just a way to get to the part of my brain “that has this wisdom.” Because there is a part of all of us that has a lot of wisdom. You know when it comes out? It comes out when your friend’s in trouble. When your friend comes to you for advice ’cause they can’t figure it out, right? And have you ever noticed how easy it is to give advice to your friends? Good advice, usually. And if it’s a serious thing, you take time to think about it. You don’t just give them a glib answer. You take some time and you think about it. You go down as deep as you can inside yourself and you give them that wise advice. The thing is, it’s probably easier for you to get to your wisdom than your friend if your friend is really frightened. Because when we are frightened, when we’re anxious, when we’re worried, there’s a psychological phenomenon called regression. We tend to regress. We tend to feel like we’re too little, we’re too weak, we don’t have the resources, we don’t know what to do. We’re wishing that somebody bigger, wiser, stronger were there to tell us what to do. And we feel more childlike and that blocks our access to our own wisdom. And that’s why taking the time to go to actually do a relaxation practice, relax your body, shift your mind, imagine that you go to a place that’s beautiful and peaceful and safe, so that you get out of that fearful loop. You imagine, or you invite an image, of someone or something that’s wise and loving, and that cares about you, whether it’s someone or something you’ve ever met or something you just make up. You just imagine, you imagine what it would tell you or show you or do with you, and it’s quite remarkable what can come from a meditation like this. Does that make sense to people? And so it’s easier to do that for your friend because as much as you love your friend, you’re probably not gonna be as freaked out as they are if it’s a serious situation. We see this all the time. The most common place that I see this in my practice is with people who’ve just been newly diagnosed with cancer, and they’re just shocked and freaked out as most people are. And in the meantime, they’re visiting all these different doctors and oncologists, and trying to become an oncologist in two weeks and learn the whole field of oncology and figure out their best option. While emotionally, they’re feeling like a three-year-old. So, and it’s very difficult for them to make the decisions that way. These kinds of techniques, if you start early and help them connect to a deeper level enough that scared child can really make a difference in terms of wise decision-making. So sometimes they give, your inner advisor will say something like this. “The secret of living without frustration and worry “is to avoid becoming personally involved in your own life.” This is definitely a good treatment for worry, okay? But usually, and that’s not bad advice. Here’s how I think this thing kind of works. So if we go through this process of thinking about the worries, I actually have people in class write them down and then go through and separate them. I mean, it sounds mechanical. It’s just using our ordinary intelligence. Separate them into three columns. Things you think you could change if you wanted to, things you think you couldn’t change if you wanted to, and things that you’re not sure about. And people rarely do this, so we carry it around in our head. Just writing it down is often very helpful for people in sorting it out. And then where we want to get to is down here, either if it’s something you can’t change, basically what you wanna do is get to a place where you either get to a place of some kind of acceptance. Some kind of coming to terms. Or you turn it around into an intention or a prayer. So in other words, you’re worrying about something. That something’s gonna happen, but it’s not something that you can physically do something about. It’s interesting to see what happens if you take it and you turn it around and you put it into a positive visualization of what you would rather have happen, okay? So, and I’m gonna skip the whole argument here about whether or not that has a physical effect and the secret. Whether we just make something happen by changing our intention, and sometimes it seems that we do and sometimes we don’t. But what does happen when people, in other words, some friend gets diagnosed with cancer and you are overcome with worry because you are just worried that she’s gonna die, okay. Or be sick or go through some horrendous thing ’cause you care for your friend. That’s a typically normal reaction. But you find yourself losing sleep and you’re thinking about and you’re just getting obsessed with it and so on and so forth. Well, and there’s nothing more that you can do. You’re bringing her food and you’re a source of support and so on and so forth, but you aren’t personally going to be able to cure that cancer, okay? But now you start to say, “Okay, instead of constantly imagining “what I don’t wanna have happen, “I’m gonna think about what I would rather have happen, “so I’m gonna start to imagine that she gets great treatment “and that her cancer responds “and that she comes through that treatment “and she survives it and she comes out being “an even stronger and healthier person. “That if it’s up to, if it was up to me, “if I was God, that’s what would happen.” And I don’t know if that’ll make any difference, but that’s where I’m gonna put my energy, instead of putting my energy over here. And whether it changes the outcome or not, way beyond me, but what it does do is that when people start focusing on that image, they become less anxious. You become less anxious because you feel like, “I’m doing what I can be doing “and I’m putting my energy into what I wanna see happen.” Does that make sense? And there’s a lot of principles of suggestion that are at work there. There’s a couple analogies I use for people. One is, I’m not a skier myself. A mountain biker and I skied. I don’t know how many of you are, but you can imagine being a skier. So imagine that you’re up on the top of a very steep, very challenging ski run. What you wanna do when you’re up there at the top before you start, before you push off, you wanna check it all out. You wanna see, “Hey, there’s a big rock over here. “I don’t wanna bump, hit that. “There’s big trees over here. “I don’t wanna hit those.” Then what you wanna do, and any skier will tell you, that you wanna see what the line is that takes you through safely through those things. And once you start skiing and you’re going fast or riding your bike downhill or any other thing that’s like that, what you wanna focus on is you wanna focus on where you wanna go, not on where you don’t wanna go because if you fixate on that rock, you will crash into it. Because that is how your body-mind is put together. It tends to go where you look. The other example I use for people is if you wanna hit a bullseye in a dartboard, it helps if you look at it, okay? If you look at it, you’re not guaranteed to hit it but you’re much more likely to hit it than if you close your eyes or your attention is just all over the place. And if you keep looking at it, even if you keep missing, your whole nervous system is wired to recruit resources and to control your body so that you get closer and closer to it and that you hit it more and more often. So it’s goal-setting, it’s focusing your intention on what you wanna have happen. Does that make sense? Without doing that, I was talking to a psychiatrist friend of mine the other day about this and he says, “I think you’re talking about intention deficit disorder.” (audience laughing) ‘Cause a lot of this comes down to whether how much control we can have about where we put our attention. So we put our attention in this case on a, if you’re a prayer, if you’re a religious person and you have a way of praying, then you pray for the outcome that you desire. If you’re not a religious person, if you don’t pray, you visualize or you intend it. You say, “If it’s up to me, “I’m worried that my friend will succumb. “I don’t want that to happen.” “But the way that I’m gonna put my energy “into her getting better, “into imagining that she gets better.” And if nothing else, it’ll help you. It’ll help reduce your anxiety level. Sometimes a little, sometimes a lot. So the other thing is, is that on the other side, is if something that you can change, there’s a couple of processes for doing this. One of the questions is sometimes people don’t act on things that they can change because they feel like they don’t have enough creativity. They haven’t been able to solve a problem. They don’t have the guts, the courage to act on it. They don’t have the assertiveness. They don’t have the confidence. So imagery, and I’m gonna hopefully share with you an imagery that you can experiment with yourself is a fantastic way of both accessing and building these kinds of personal qualities in yourself so that you can be more effective in making changes that you want to, okay. And leading to an action that can actually resolve these problems. So imagery is a type of thinking, people often say that it involves your senses. Thoughts that you can see, hear, smell, feel, daydreams. It’s a language, it’s an emotional language. It’s a synthetic, just thought language. It’s a language of the arts. It’s all the visual arts, drama, poetry, painting. Even music, dance, images that bring, convey a lot of information, but not in the same way that an equation conveys information. That it makes sense. It’s the difference between listening. I think Einstein once said, “You could break a Beethoven sonata down “into wavelengths and frequencies, “but you’d be missing the point.” So there’s that linear, scientific part. There’s that experiential part. We’re after that. So imagery, it’s a natural way that we think. It’s very closely linked to the emotions. It’s a natural, if you think about it as a coding language, it’s a coding language of the emotional, intuitive gray. And it’s just that we haven’t had much education in using it, and runaway imagination is probably the primary source of modern stress. It’s not just what’s happening, it’s what you think will happen to you, and how it will affect you that sends the signals down into your body. On the other hand, developing a skillful imagination, one that you can use to send messages of calmness, of confidence, creativity, of there’s a lot of different ways to use it. Your most potent tool for stress relief, but you need to learn some skills in order to use it on purpose. So the imagery, what the imagery does is if we’re having a problem that we can’t solve in that cortex, the imagery brings the limbic brain into it. It brings the emotional, intuitive intelligence to that issue or problem, so it just brings a whole other big area of the brain to bear on whatever the problem is. So it doesn’t take anything away. It adds intelligence to your problem-solving. So you can calm your brain with imagery, just like you can make it anxious. I could take you through a little imagery, just ask you to imagine the scariest thing you’ve ever been through. Don’t do that right now. If we went through it and had you really, “What do you see? “What do you hear? “What do you smell? “Imagine you’re there again.” You could work up pretty good anxiety. If I asked you instead to imagine that you go to a place that’s peaceful and beautiful to you and that you just loved to be in, we have nothing to do and it’s safe and it’s the right temperature and notice what you see and hear and smell and immerse yourself in that daydream. Your brain will send messages down through the limbic system, down into the lizard brain. It’ll say, “It looks beautiful, peaceful, and safe. “It sounds beautiful, peaceful, and safe. “It smells nice. “It’s peaceful here, it’s safe. “Hit the All Clear button.” And your body will shift into that. So there’s that place is, “Where right now do I wanna focus my attention? “What train of thought do I wanna put my attention on?” And again, few people have ever really been taught this, so we have got … I’ll get to the commercial aspect later, but it’s one reason that I’ve devoted as much time as I have to writing books and doing audio CDs and downloads for to teach people these skills. They’re very, they’re simple skills. Your imagination is your birthright. It’s built into you. Nobody ever really just taught you how to do some fairly simple, but potentially profound moves with them that can literally change your life depending on what you’re doing. It can certainly improve your life. So rather than talk with you more, I wanna offer you a chance. Let’s do, would you like to do some imagery? Some guided imagery instead. We’ll rest your left brain. We’ll fan it off, cool it off. So I wanna share with you a fairly simple imagery that we call evocative imagery. How many of you have used guided imagery on purpose before? So a fair number. Maybe half or a little more than half. So this is a way to use imagery to help you access particular quality that you might wanna have more of. Okay, and that could be, it could be courage, it could be confidence, it could be creativity, it could be patience, it could be humor, it could be assertiveness. Any quality that you wanna think about. And the way that we usually use this, and you could do this is to think about the situation that you’ve got going on, that you have had difficulty solving or resolving. And you just feel like you just haven’t been able to resolve it and it seems like something that you could potentially solve or resolve. Well, you just don’t feel you have enough fill in the blank to do this. You need a little more, again, courage, assertiveness, patience, humor, whatever it is, okay? If you can’t think of one right off the bat, just think about a quality that you would like to experience more of in yourself. Joy, calmness, again, confidence, self-love. Whatever floats your boat. Just some quality you’d like to experience more of. And give it a name. Think about what the name of it, and you could do a couple of qualities. I wouldn’t do more than, sometimes it’s unclear what you need more of. I feel like I need more, I don’t know if it’s courage or I need more strength, so you could do them both kind of together. Kinda know what you’re after. But think about a specific quality or a couple qualities that you would just like to feel more of in yourself, okay? And then let yourself be as comfortable as you can be in your seats. You can close your eyes. You don’t have to. But it’s usually easier to pay attention to your imagination and your inner world if you do. And then just let yourself take a couple of deeper breaths in your breathing. Let your breathing get a little deeper into your abdomen, and- (exhaling) let your out breath be kind of a letting go kind of breath. Without forcing anything or straining anything, just, again, drawing a deeper breath into your abdomen and to your belly, letting the out breath be a letting kind of a breath. Just inviting your body to begin to soften or relax. And just another time or two as you welcome the breath into your body. Just notice that you’re literally bringing fresh energy and oxygen into your body. You can invite it to circulate and flow around your body in the bloodstream to every cell of your body. Brings fresh energy. And as you let the breath out, if you like, just let it be an invitation to your body, your mind, even your spirit, to just let go of any tension or discomfort you don’t have to hold right now. And you don’t even have to worry about whether you need to hold or what you can let go of. Just invite the body to soften. The mind to begin to quiet. And invite your body to continue to soften and relax. Perhaps to become a little more spacious without worrying about how it does that. Feel free to shift or move to be even more comfortable. And if you haven’t already let yourself go inside to a place that’s very beautiful to you, let yourself daydream yourself to a place that’s very beautiful, peaceful, safe. And that might be a place that you’ve actually been in your life. Either in your outer life or even in your inner life. Or it might be a place that just comes to mind right now, an imaginary place or some combination. It doesn’t really matter, as long as it’s a place that’s beautiful to you and peaceful and safe. And if more than one place comes to mind, just pick whichever one attracts you the most right now. And imagine in your own way that you’re actually there. And take a few moments to just look around and notice what you imagine seeing in this beautiful, peaceful place. Notice the colors and the shapes and the things that are there, and don’t worry about whether it’s very vivid and clear like your usual eyesight or whether it’s kind of vague or it comes and goes, but just notice what you imagine is there in this peaceful, beautiful place, safe place. And notice what you imagine hearing in that place, or if it’s just very quiet. Notice any sounds you imagine hearing. Notice if there’s an aroma or a fragrance or a quality of the air. And notice what time of day or night it seems to be. And I wonder if you can tell what season of the year it is. Just notice, find the spot in that place where you feel most comfortable and at ease. And just trusting your instincts just like a dog or a cat will circle around and find the most comfortable place to be and let yourself get comfortable there. And then think about a quality that you think you’d like to feel more of. The name of a quality, a particular quality or feeling state that you’d like to feel more of. And then let yourself go back in your memory to some time when you experienced yourself having that quality in yourself. Just let your memory go back to some time when you felt that quality in yourself. And some of you may not have a memory of having that quality, so let yourself go to some time when you witnessed somebody else expressing that quality or embodying that quality. that could be a real person or a fictional person or a historical person. And if you found a time when you yourself had this quality, imagine that you’re there again now. And notice what you see, what you hear, what you feel as you’re feeling that particular quality within you. And if you’re imagining somebody else embodying that quality, imagine that you bring them inside you so that you can feel what it feels like to have that quality inside you. And then notice where you feel that quality most strongly in your body. You might want to just gently scan through your body with your attention from head to toe and back up, as if your attention were a sonar beam or a radar beam, and just see if you, where do you feel that particular quality most strongly in your body? Strongest in your feet or your legs? Your pelvis? Abdomen? Chest? Your neck and shoulders? Arms and hands? In your face? Just notice wherever it seems to be strongest. And let it grow a little bit larger. Imagine that you can just allow it to grow a little bit larger and stronger, just a little bit. And notice how it feels to feel that quality in yourself. And notice what your posture wants to be like as you feel that quality more strongly in yourself. And if you’re comfortable with it, imagine that you turn up the volume on that quality like you had a control, like a volume control on a radio or television, and you turn it up so that it radiates out from wherever it’s centered in all directions. Radiates out and fills your body with that particular quality. And as you feel that in your face, notice how your face feels. And as you feel that quality, notice what you imagine your voice would be like if you were in touch with that quality when you spoke. And if you like the feeling of this quality, go ahead and turn it up even more so that it overflows the space of your body and fills the space around your body for a foot in every direction. And imagine that it radiates inside your body and touches every cell in your body with that quality. From the deepest part of your bone marrow to your bones. To your connective tissues, your muscles. The organs and your pelvis. In your abdomen. In your chest. Especially in your brain. Your spinal cord and your nervous system. As if every cell of your body were touched by a ray of this quality. As if you were a sponge and you were bathing in this quality and could soak up as much as you’d like. And if you like, you can turn it up even stronger and bigger, fill the space around your body for several feet in every direction. You can experiment with that. Never turn it up so strongly that you’re uncomfortable, but if you like the way it feels, imagine you can turn it up. That there’s an abundant source of this quality, and you can turn it up so that you fill the space around your body for 12, 15, 20 feet around. Fill the room with it. Fill the bay area with it. Fill the world with it. Just experimenting, and then let yourself turn the volume into whatever’s most comfortable for you right now. No matter how strong or weak, how big or small that is, just give yourself permission to let it be like listening to music when you’re all by yourself. Whatever volume is most comfortable for you right now is exactly the right volume. And just let yourself rest in that for a few more minutes. And just take a moment before you bring your awareness back into the room. Just take a moment to review what’s happened in this brief imagery experience. What quality you were looking to experience more of. Whether you have or not. What it was like. And if there’s anything in particular that you want to bring back form this experience and remember when you come back to the outer world. And before you come back to the outer world, take a moment. If there’s a particular situation that you wanted more of this quality in order to address, imagine addressing that situation while being in touch with this quality. And just notice whatever you notice. Notice whether it seems the same or different in any way. Whether bringing more of this quality into the situation seems to change anything about it or your relationship to it. And before you come back to the outer world, just remember that you can recall this quality, access it, feel it, built it more strongly in yourself anytime you like just by going through this process again. And so when you’re ready, just let the images go back to wherever they came from and become aware of the room that we’re in together. And just gently start to bring your awareness from your inner world back out to the outer world. Us in this room here together. And if you like, just very gently stretch your body and feel your fingers and toes and everything in between. I wanna give you just a few minutes to write or draw anything that you wanna remember about this experience. This is just for you. I’m gonna give you about three or four minutes just to write or draw anything, and I would recommend that you do it, whatever happened. Even if nothing happened. Let’s take three or four minutes and write about the experience, especially about anything that you want to remember that you thought was important or that you thought was interesting about this experience. Let’s just have some discussion. Comments, questions? Did everybody hear that? It sometimes you get into such a stressful state and an anxious state, it’s just. She’s had experiences where relaxation, guided imagery have been very useful. And other times when she’s been so stressed and so anxious and upset that she couldn’t even get into it, or if she did, it just didn’t even touch it. And yes, that can happen. This is not a magic panacea. So sometimes that’s a place where you can use somebody else to help you or to take enough time, or to do some things that are, get a massage, take a hot tub. Talk to a friend. This is a place where medications may come in. I find a double shot of Jack Daniels works really well. I wouldn’t recommend it as a daily diet, but it certainly helps really get your anxiety level down, and you may be able then to relieve enough of the anxiety that you can pay attention to these things. So there are many other things we can do, from medications to nutrients to other relaxants to doing whatever you need to get to that place, where you can focus. One of the qualities of imagery thinking is that it can help you connect with the bigger picture and how things are connected in kind of a bigger picture, so that can include your faith. Or you may find, “Well, if that happens, “I don’t want that to happen. “But maybe there’s a good part of it, “or maybe I’ll just deal with it the best that I can.” So that’s just to expand the picture and let yourself kind of go out to what the consequences might be. Because that’s part of really sorting it into things that you might be able to do, something about things you can’t do something about, is to let yourself run it out. Does that make sense to you? Yeah? So sometimes when people are making treatment choices that are very difficult, I’ll invite them to imagine that they’re at a crossroads. Again, this happens when, and if they go down this road, they choose this kind of treatment, and just imagine walking down that road and just imagine it going as far as you can and see what you imagine go down this road or go down as far as you can see what you imagine. Along the way, you’re just gonna flesh out the picture, and part of that’s gonna be able to see, “Is there something I can do about that? “Is there not something I can do about that? “Which one do I imagine “is gonna ultimately be better for me?” And kind of make that choice. What’s the difference between imagining going to the beach and being at the beach? So imagining being in a quiet, peaceful, safe place is the next best thing to actually being there. And it has certain advantages in that you can go anytime you want. And it’s, you can be there very quickly, and it’s very inexpensive. So you can go, so I’d like to go to the beach in Hawaii a lot. But I can’t go every day ’cause I work and I have responsibilities and so on, and I’m lucky if I can go every couple of years. But, I can, when I decide, “I’ve had enough, I need a break.” I can take a few deep breaths and I can close my eyes and I can be back in a particular, floating in the water just off of a beach. And I can immerse, when I do immerse myself and take the time to notice the different sensory qualities. What we know now from looking at brains on the functional MRI, is that if I make an effort to notice what I imagine seeing and hearing and feeling in the weightlessness of my body as I’m floating and the lapping of the waves on the surf and the smell of the plumerias and the humidity in the air, and I go through all that sensory stuff, that when I’m noticing what I’m seeing, the part of my brain that processes vision is active. When I’m noticing the sounds I’m hearing, the parts of my brain that process sound is active. When I’m noticing the sensory details, that part of my brain’s sensory cortex is active. So what you have is you have more and more parts of your cortex sending messages down to those lower, more reflexive parts of your brain, and they’re saying, “It looks like I’m in Hawaii, sounds like I’m Hawaii. “It feels like I’m in Hawaii. “It smells like I’m in Hawaii.” And that part of your brain just goes, “Okay, all clear.” Sends out the All Clear signal, and a lot of things in your body start to go to work in a more effective manner that haven’t been able to work as well when you’re constantly reacting to messages of, “Look out. “What’s next? “How am I gonna get that done? “Danger, threat, problem.” So on and so forth. Which is where we spend so much of our time, and that, so this little lizard brain is sitting there, “Look out.” Right? And it’s constantly getting the body prepared for that and that’s exhausting. So if we’re spending 98% of our waking time and half our sleeping time dealing with those kinds of things, we see why we get exhausted. We get wired and tired. We have trouble sleeping. The body starts to signal that it needs something. So finding a way to get to those deeper levels and plug in a couple of those relaxation places as just a basic tool is I think one of the real fundamental benefits of guided imagery, which is a type of meditation at that level. And I really appreciate your attention. Thank you very much. I hope it was useful. (audience clapping) (upbeat music).