How stress affects your body – Sharon Horesh Bergquist

 Cramming for a test? Trying to get more done than you have time to do? Stress is a feeling we all experience when we are challenged or overwhelmed. But more than just an emotion, stress is a hardwired physical response that travels throughout your entire body. In the short term, stress can be advantageous, but when activated too often or too long, your primitive fight or flight stress response not only changes your brain but also damages many of the other organs and cells throughout your body. Your adrenal gland releases the stress hormones cortisol, epinephrine, also known as adrenaline, and norepinephrine. As these hormones travel through your bloodstream, they easily reach your blood vessels and heart. Adrenaline causes your heart to beat faster and raises your blood pressure, over time causing hypertension. Cortisol can also cause the endothelium, or inner lining of blood vessels, to not function normally. Scientists now know that this is an early step in triggering the process of atherosclerosis or cholesterol plaque build-up in your arteries. Together, these changes increase your chances of a heart attack or stroke. When your brain senses stress, it activates your autonomic nervous system. Through this network of nerve connections, your big brain communicates stress to your enteric, or intestinal nervous system. Besides causing butterflies in your stomach, this brain-gut connection can disturb the natural rhythmic contractions that move food through your gut, leading to irritable bowel syndrome, and can increase your gut sensitivity to acid, making you more likely to feel heartburn. Via the gut’s nervous system, stress can also change the composition and function of your gut bacteria, which may affect your digestive and overall health. Speaking of digestion, does chronic stress affect your waistline? Well, yes. Cortisol can increase your appetite. It tells your body to replenish your energy stores with energy-dense foods and carbs, causing you to crave comfort foods. High levels of cortisol can also cause you to put on those extra calories as visceral or deep belly fat. This type of fat doesn’t just make it harder to button your pants.  It is an organ that actively releases hormones and immune system chemicals called cytokines that can increase your risk of developing chronic diseases, such as heart disease and insulin resistance. Meanwhile, stress hormones affect immune cells in a variety of ways. Initially, they help prepare to fight invaders and heal after injury, but chronic stress can dampen function of some immune cells, make you more susceptible to infections, and slow the rate you heal. Want to live a long life? You may have to curb your chronic stress. That’s because it has even been associated with shortened telomeres, the shoelace tip ends of chromosomes that measure a cell’s age. Telomeres cap chromosomes to allow DNA to get copied every time a cell divides without damaging the cell’s genetic code, and they shorten with each cell division. When telomeres become too short, a cell can no longer divide and it dies. As if all that weren’t enough, chronic stress has even more ways it can sabotage your health, including acne, hair loss, sexual dysfunction, headaches, muscle tension, difficulty concentrating, fatigue, and irritability. So, what does all this mean for you? Your life will always be filled with stressful situations. But what matters to your brain and entire body is how you respond to that stress. If you can view those situations as challenges you can control and master, rather than as insurmountable threats, you will perform better in the short run and stay healthy in the long run.As found on YouTubeAnimationStudio ꆛ☣ꐕ Be The “Middle Man” And Profit With AnimationStudio Agency License. Here’s How You Can Earn $100, $200, or even $300 For Every Video You Create With AnimationStudio… Activate Your Profit Machine With The Agency License … $197/month For Just $67 One Time Payment

The psychology of post-traumatic stress disorder – Joelle Rabow Maletis

 Many of us will experience some kind of trauma during our lifetime. Sometimes, we escape with no long-term effects. But for millions of us, those experiences linger, causing symptoms like flashbacks, nightmares, and negative thoughts that interfere with everyday life. This phenomenon, called post-traumatic stress disorder, or PTSD, isn’t a personal failing; rather, it’s a treatable malfunction of certain biological mechanisms that allow us to cope with dangerous experiences. To understand PTSD, we first need to understand how the brain processes a wide range of ordeals, including the death of a loved one, domestic violence, injury or illness, abuse, rape, war, car accidents, and natural disasters. These events can bring on feelings of anger and helplessness, which activate the brain’s alarm system, known as the “fight-flight-freeze” response. When this alarm sounds, the hypothalamic, pituitary, and adrenal systems, known as the HPA axis, work together to send signals to the autonomic nervous system. That’s the network that communicates with adrenal glands and internal organs to help regulate functions like heart rate, digestion, and respiration. These signals start a chemical cascade that floods the body with several different stress hormones, causing physiological changes that prepare the body to defend itself. Our heart rate speeds up, breathing quickens, and muscles tense. Even after a crisis is over, escalated levels of stress hormones may last for days, contributing to jittery feelings, nightmares, and other symptoms. For most people, these experiences disappear within a few days to two weeks as their hormone levels stabilize. But a small percentage of those who experience trauma have persistent problems —sometimes vanishing temporarily only to resurface months later. We don’t completely understand what’s happening in the brain, but one theory is that the stress hormone cortisol may be continuously activating the “fight-flight-freeze” response while reducing overall brain functioning, leading to several negative symptoms. These symptoms often fall into four categories: intrusive thoughts, like dreams and flashbacks, avoiding reminders of the trauma, negative thoughts and feelings, like fear, anger, and guilt, and “reactive” symptoms like irritability and difficulty sleeping. Not everyone has all these symptoms or experiences them to the same extent and intensity. When problems last more than a month, PTSD is often diagnosed. Genetics, ongoing overwhelming stress, and many risk factors like preexisting mental illnesses or lack of emotional support, likely play a role in determining who will experience PTSD. But the underlying cause is still a medical mystery. A major challenge of coping with PTSD is sensitivity to triggers and physical and emotional stimuli that the brain associates with the original trauma. These can be everyday sensations that aren’t inherently dangerous but prompt powerful physical and emotional reactions.  For example, the smell of a campfire could evoke the memory of being trapped in a burning house. For someone with PTSD, that memory activates the same neurochemical cascade as the original event. That then stirs up the same feelings of panic and helplessness as if they’re experiencing the trauma all over again. Trying to avoid these triggers, which are sometimes unpredictable, can lead to isolation. That can leave people feeling invalidated, ignored, or misunderstood like a pause button has been pushed on their lives while the rest of the world continues around them. But, there are options. If you think you might be suffering from PTSD, the first step is an evaluation with a mental health professional who can direct you toward the many resources available. Psychotherapy can be very effective for PTSD, helping patients better understand their triggers. And certain medications can make symptoms more manageable, as can self-care practices, like mindfulness and regular exercise. What if you notice signs of PTSD in a friend or family member? Social support, acceptance, and empathy are key to helping and recovery. Let them know you believe their account of what they’re experiencing, and that you don’t blame them for their reactions. If they’re open to it, encourage them to seek evaluation and treatment. PTSD has been called “the hidden wound” because it comes without outward physical signs. But even if it’s an invisible disorder, it doesn’t have to be a silent one.As found on YouTubeAnimationStudio ꆛ☣ꐕ Be The “Middle Man” And Profit With AnimationStudio Agency License. Here’s How You Can Earn $100, $200, or even $300 For Every Video You Create With AnimationStudio… Activate Your Profit Machine With The Agency License … $197/month For Just $67 One Time Payment

Managing Stress and Anxiety during the Covid-19 Pandemic – Part 2: Feelings

 [Music] and now we’re going to talk about feelings physical feelings and emotional feelings that we may experience when we’re feeling stressed so the physical feelings can vary from anything to having headaches or tension in her head even dizziness we can have a drying month anything that you are having tension and tightness in any of our muscles even sometimes pain but even or a jaw our shoulders are still like any any part of our body can experience physical tension we can feel that our heart is racing more we can fit in our breath is shallower or faster you can feel that we’re sweating more you can also have problems with indigestion possibly even going to toilet more often these are all really normal physical symptoms of when we’re feeling stressed the difficulties that may be there happening more often or maybe when you don’t feel that there is an actual stress at the moment the other thing with feelings is emotional feelings so some of the symptoms of emotional feeling that we have when we’re feeling stressed would be feeling apprehensive or feeling of dread even the feeling of fear we might be looking and watching for signs of danger like looking to see what what do we see may be more vigilant in what we’re looking for in a supermarket when right in the street who’s touched water who’s close to me things that we hear people talking and on the news and you know even if there’s lots of noise going on maybe were more sensitive to noise and what we’re hearing we could be anticipating the worst we could be having difficulty with feeling temps and feeling we’re jumpy maybe feeling more irritable this can impact on our emotions hugely we can also have difficulty concentrating and also feeling like our mind has gone blank it’s just really hard to think about things there’s just some examples of how we might feel physically and emotionally so try to keep track of those and write them in your diary as we talked about before and it might be difficult to have a pinpoint what exactly I’m feeling right now or emotionally or physically but just you will get used to that maybe over time with practice so try to keep it up and the more you are where you are how you’re physically and emotionally and morally be able to address them later so coping with some of the physical and emotional symptoms one of the first things we can do is exercise you know that exercise is really good for us and it’s really important for our mental health and if you’re walking the Lots people are walking now which is fantastic if you can walk if you have an exercise routine that you’ve been doing and you can keep up that’s brilliant or if you’ve been looking to start a new one online or calling some of the programs have been on TV that’s fantastic other ways that we can get exercise or even just around the house so things like doing hoovering are if you have two twenties in your house maybe instead of go to do quick under stairs toilet to go up and down the stairs more disability tips like that can help you to do more exercise around the house if it’s difficult to get out it’s also important to not feel like you have you know under stress that because you’re not exercising it’s a lot of surfing like oh I’m just motivated I’m just not feeling like doing it today nothing like doing I would normally do so it’s really important there to just think like where are you at today how are you feeling today and what would be helpful today so even if you have a routine where you’re doing a little bit of exercise every day and then you wake up this morning from what I just don’t feel like doing any of that figure out where what would be best for you so even if you don’t feel like doing your whole routine doesn’t necessarily mean you don’t have to any exercise today you can even just like I was saying like do a bit of coopering or do a little bit extra rent a house or you can just walk a little bit more around the house even just to sit out so I can get the fresh air that you would have got when you’re going on a walk that will all still be really beneficial rather than doing that doing nothing and then feeling bad that you haven’t so diet at the moment it can be difficult to keep with our normal diet what we were doing before and how we were eating regular meals and at the moment we’re spending more time at home and we’re more likely to snack to comfort each to have some more chocolate than we normally do to have more alcohol than we normally do to have more indulgent in our food or the opposite you could be feeling anxious and not want to eat or eating less and you we do so our diocese is a bit off and you know what if we’re all waiting or having those extra bits of chocolate that’s fine comfort eating is okay we have to just see where we’re at a way of what’s gonna help us and what’s not as things come back to normal we’re gonna be able to collect our diet and things will naturally come back and our routines will naturally come back and it’ll be easier than to say no to those different things you have to remember I suppose as well that there’s a fine line between what’s helping us if we’re going to have that extra snack or those extra bits of food or those extra drinks that is how far is that going to be good and help us and then where’s the line that oh it’s actually not great because it’s it’s too much it’s making us feel bad or feeling more sluggish or more tired or worse for it the next day so it’s really good to just figure out you know what where is my limit at and how can I be at my best one my diet the other thing is that there is research to say that food definitely can have a calming effect on us so for example and complex carbs can be really good and have a calming effect so I think we know that brown breads and brown passes are much better for us to eat and they actually have that a calming effect compared to deploy pasta and bread obviously avoiding things like caffeine is really important because I can lead to more anxiety and it can also affect your sleep and keeping hydrated is really really important and being dehydrated can actually affect your mood and how you’re feeling so if you can change any of your diet it to help with your anxiety that would be really great sleep it’s really important for us all to get good sleep sleep is a time where our brains ever take process all the information that we get during the day and help us to get through that and understand it and be ready and prepared for the following day sometimes and with everything that’s going on there the minute your head hits the pillow is the time that all the thoughts come on the worries calm your thinking about what happened today what will happen tomorrow what could happen in the future and that’s normal at the moment we’ve given what’s going on but it can be really hard and then it can affect your sleep and have them knock-on effects so one thing that can be helpful for that is to use a worry period or a worry journal so what that can be and it can be different for everybody but even that’s before bed or if there’s another time during the day where you find it useful to sit down and write down every worry every thought that you have in this diary just get it all out get it onto some paper and write everything down every worry every thought everything that’s really getting to you and then once you’ve even at that time so people do it as a 3-minute thing whether it’s like to spend a little bit more time but see what works for you but just getting it down to paper and getting it out of your head is such a go-to process and at that point then you close your book you say that is my time for doing that worry and period and now that I would do that again tomorrow at that same time and I will not think about it after – and even if does go all water it’s know I’ve talked about that already and I can think about it again tomorrow but for now I’m gonna just relax so that can be really really helpful there are things in terms of sleeping what can be really helpful is just having good habits and trying to keep a good awake and sleep pattern well I know we can all be go to bed a bit later or getting up later at the moment sleeping err stainer pajamas for longer different things but it’s really good to try and just keep a good routine try and get up in the morning at a certain time make your bed then get your clothes on have your shower do all those rituals and habits that you already have because that will help you feel better so relaxation meditation mindfulness these are all really really good practices to help us manage our stress and anxiety so relaxation can be anything you find to be relaxing to help you calm down and chill out I mean for some people it can be reading it could be playing some music it could be drawing what is it that you feel that you do and before you know it the time has passed and you just feel so much more relaxed and better off or it can be just very very simple things that you can do around your heads but just to be mindful of what are those things that you enjoy is it that showering first thing in the morning that just wakes you open it’s really relaxing and helps you sets you up for the day so there are other and in terms of relaxation there’s letter a very purposeful relaxation techniques such as deep breathing the body scan progressive muscular relaxation and visualizations in terms of meditation this is something where you’re not trying to think about things but you’re trying to transcend your thinking and there’s lots of really great meditation techniques out there and relaxation techniques so even though Beaumont Hospital have a really great resource on their website if you want to check that out or anywhere else you feel has a good and something that works for you might wellness then it’s mindfulness we can do in our everyday life so even if you you can do mindful walking mindful eating I’m mindful drawing anything that you’re doing can be mindful so if you are making a cup of tea for example you can display I’m okay so I thought into getting a cup where the teabags where it’s my kettle love to wait for the caffeine okay then we pour a tea to stirring it around and how it’s the house feeling and just being aware of the different sensations like what am I seeing what am i hearing what sounds even if you’re walking in on your daily walk to kilometres or even if you’re sitting in your garden or sitting on a balcony what can you see what can you hear what can you smell can you taste anything what can you feed on your skin there’s even taking those senses and being aware of what they are it can be really really helpful just to be present in the moment and not to worry about all of the different things so it can be really helpful for managing stress so managing your emotional symptoms around stress so everything before it’s really good to identify what emotions you’re feeling if are you feeling stressed sad worried fearful dread anticipating what is it that you’re feeling and then once you can identify them it’s really good to try and figure out a way to just let the mountain some emotional outlet so so for example if you’re feeling worried about something or worried about any of the things that are happening it’s really good to talk to somebody to share your worries as they say problem sharing is upon so some somebody that you can talk to and get those worries off your chest can be really helpful if your feelings that maybe is something like washing a really sad movie or listen to some math sad music and just letting out those emotions letting them be it’s okay to be sad it’s okay to be worries you know these things are normal in this situation just to be able to let them out if you’re angry how about flipping some pillows are making a bed something that lets you be quite physical and get that anger out or if you’re feeling just anxious or jittery and in your body maybe just dance and come on shake your hands and shake your hips and just have fun and just let that anxiety out it’s really good to have an emotional outlet and to be able to address those feelings to help you cope with anxiety and stress [Music] you As found on YouTubeAnimationStudio ꆛ☣ꐕ Be The “Middle Man” And Profit With AnimationStudio Agency License. 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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).

Anxiety Disorder Test

> And you speak a little bit about the importance of that continuity. > Yes. What we try to do is we try to be very consistent with the patient’s calling them every two weeks once they… especially if they started a new medication we want to know like how they’re doing if they’re having any reported side effects, that we can communicate with the primary care doctor. The other thing that we do is call them on a monthly basis and we asked the same questions on the ph-9 questionnaire to see if there’s been any progress made. This helps us monitor you know their feelings and also you know we are there to link them to providers psychiatry, psychology. We stress the importance… –To close that gap — that’s that gap in care like we say right. Let’s talk dr. Frankel a little bit about gg7. > So that GED seven are our anxiety screening questionnaire depression and anxiety oftentimes go hand-in-hand and patients may come in seeing that they’re having anxiety or panic attacks and this is another screening tool we do to basically quantify the symptoms patients are expressing with their words and kind of give us an idea of how much anxiety they’re having many times we will then give them a ph-9 and kind of put the depression anxiety together if they have both of those overlying diagnoses is the treatment is also very similar the support of the supportive network with the empowerment program you know getting patients linked into mental health or some sort of behavioral therapy and the medications we use to treat depression are also used to treat anxiety it oftentimes coexists.

What is an Anxiety Disorder?

(electronic chimes) I can’t believe what my boss just said to me. She must think I’m doing a terrible job. I have to quit. All my friends are so happy when they go out. I don’t get it. I can’t even imagine what they’re thinking of me. If I don’t get this internship I’ll never get a job. I don’t know what else I can do. I’m stuck. I hate airports. Driving there, construction, traffic, parking, and then security. Everything about it just overwhelms me. (electronic chimes) Anxiety disorders are the most common mental health problems. While everyone experiences stress and anxiety at some point in life, some people become so overwhelmed they can’t manage their day-to-day or minute-to-minute lives. I know. One of these voices is mine. There are several types of anxiety that can affect people in different ways. You might have heard of specific phobia, social phobia, panic disorder, generalized anxiety disorder, or others. Some of these seem like they might be manageable, like a fear of heights. It’s not always convenient to avoid tall buildings, but you could do it. Others, like panic disorder or social phobia, might be harder to manage, because they cause problems in unpredictable times, like when you’re in public. Each anxiety disorder is different, but basically, they all have one thing in common. They cause excessive worry that affects thoughts, feelings, and physical symptoms. And that causes problems in a person’s life for at least six months. For me, I struggled with generalized anxiety disorder. I was worried about everything. Things I couldn’t control, like getting stuck in traffic and being late for an appointment, made me really angry. I worried about what other people thought of me. Looking at my schedule each morning was the worst part of my day. It felt impossible to do everything I put on my list. This really caused problems in my relationships. I yelled at people. I know I seemed demanding and rigid. At night I was exhausted and sad, and I’d cry because I was so upset. Most people with anxiety disorders also experience physical symptoms like shortness of breath, racing heart, sweating. Some people even get headaches or high blood pressure. Stress and anxiety are very real physical problems, and eventually, people avoid doing anything stressful so they don’t have these symptoms. The good news is that anxiety disorders are treatable. Cognitive-behavioral therapy, or CBT, exposure therapy, and acceptance and commitment therapy, or ACT, are evidence-based treatments that can treat any type of anxiety disorder. Relaxation techniques, controlled breathing, and meditation have also been shown to be effective in reducing the physical symptoms of anxiety. There are lots of medications that are also helpful, including medications for depression and anxiety known as SSRIs and SNRIs. Social support, stress management, and self-care techniques are also common parts of any treatment plan for an anxiety disorder. I was worried about so many things for so long. But I got help. I worked with a great counselor and took an SSRI. I even started yoga. Now, when I begin to feel stressed, I can look at the situation more carefully, slow down my breathing, and take care of any tasks that are reasonable. Treatment can really help people overcome their symptoms of anxiety. I know. I did. (electronic chimes).

What is Anxiety?

[Music] there is no way I’m going to pass this exam I don’t even want to show up I was so uncomfortable at that party it was hard for me to breathe and I got all sweaty I had to leave I won’t go to sleep or leave the house unless I’ve made sure the stove is off and the doors are locked sometimes I do this three or four times I have to get to the airport five hours early you just never know what might happen [Music] these are the voices of people who have experienced anxiety anxiety is a common reaction to life events like taking a final exam we’re speaking in front of a crowd but when it becomes really uncomfortable and makes day-to-day life hard to live then it’s a problem or even what we call a disorder I know I’ve lived with anxiety for a long time my own anxiety feels like it’s about everything I worry about so many things in so many ways and it impacts my life big-time I stress about things that are about to happen or might happen and it means I can’t really focus on where I am or who I’m with sometimes my heart pounds I speak really fast and I kind of snap at people my family gets really frustrated when it’s really bad I have a knot in my stomach all the time I can even feel depressed and then I just want to be alone I feel like if I do something I’ll screw it up or something will go wrong so a lot of times I just rather avoid it all I feel so much better staying home and maybe having a drink turns out anxiety is a very common mental health symptoms it can be the main sign of generalized anxiety disorder which I have or social anxiety disorder which is when people have a fear of being in public or meeting new people for those of us with social or generalized anxiety disorders it’s really difficult to live the way we want to live some people have anxiety about really specific things they are afraid of heights snakes spiders or something else these are called phobias and when people avoid these things anxiety mostly stays away but when people can’t avoid their phobias it is a real problem some people experience anxiety and post-traumatic stress disorder or obsessive-compulsive disorder which can make people really overcome with anxiety in these conditions anxiety can be so intense that people are at risk for suicide and they use alcohol or drugs to cope and sometimes their lives feel like they come to a halt I’m one of the lucky ones my doctor told me how to get the treatment that would help me and it did I understand now what my anxiety feels like when it happens and what I can do about it I learned some great coping skills and even just naming it keeps it in perspective sometimes my anxiety can still get pretty big but it doesn’t seem to last quite as long as it used to my anxiety was treatable for most people this is true you can get your life back to where you want it to be I know I’ve got mine back [Music]