Welcome to Sheeper Assisted. I'm your host Sadie Sutton, a 19
year old from the Bay Area studying psychology at the
University of Pennsylvania. Sheeper Assisted is the teen
mental health podcast made for teenagers by a teen.
In each episode I'll bring you authentic, accessible and
relatable conversations about every aspect of mental Wellness
you can expect. Evidence based teen approved
resources, coping skills including lots of DBT insights
and education, and each piece of content you consume.
She Persisted offers you a safe space to feel validated and
understood in your struggle while encouraging you to take
ownership of your journey and build your life worth living.
So let's dive in this week on She Persisted.
Life is impermanent and that impermanence will be on your
side. And I think for a lot of us,
when we feel anxious, it feels like it's not going to end.
It feels like it's all enduring, really intense, overwhelming
experience. Also, when you're experience
anxiety that feels like it will be a permanent fixture of your
life. You're like, I'll always have
this level of uncertainty and discomfort and distress, But I
promise the things that are making you anxious now won't be
the same things that make you anxious in 10 years.
And arguably, you won't be as anxious or as distressed on a
large scale. Hello, hello, and welcome back
to She Persisted. I'm so excited you guys are here
today. It is really been a hot minute
since I've done a solo episode. We've been a bit sporadic with
our episodes this semester because I'm applying to clinical
psychology PhD programs for Graduate School, which has taken
so much of my time. I was also at a psychology
conference this past week, which luckily was in Philadelphia, so
I only had to Uber like 10 minutes away.
But that was ABCT, or the Association of Cognitive and
Behavioral Therapies. I learned a lot of things this
weekend, some of which informed this week's episode, so I'm
excited to dive into it. As you probably know from the
title, we are talking about things I wish I knew about
anxiety. I have learned a lot from my
lived experiences with anxiety since the first time I
experienced being anxious or having a panic attack.
So a lot of coping skills and insights and things that worked
along the way, but also a lot of psychological insights from
taking classes at Penn, being involved in research, going to
conferences. And so I wanted to do an episode
about how my views on anxiety have changed, Things I wish I
would have known when I was really in the thick of it and
struggling skills and habits that I implement today to
maintain a healthy baseline. Or when I feel anxious, the
things I do because these things weren't intuitive or things that
I just was equipped with when I started to feel anxious.
So I hope this is helpful for you guys.
If you are actively struggling with anxiety or you have someone
in your life that's anxious or maybe at some point in the
future you get anxious, you are not worse for the wear and
instead have all these insights and things to implement.
So the first thing that I want to start with is something you
guys hear me say all the time. If you've listened to every
episode, you're like, we know this, but this is a quote that I
heard in episode 28 of the podcast with Doctor Blaze
Aguirre. He was one of the clinicians I
worked with at 3 E McLean Hospital when I was in intensive
treatment. And that period of time was
really, really formative with how I understood my anxiety, how
I cope with it, how I asked for help.
And I went from being like, this is this thing that really
controls a lot of my life and caused me a lot of distress to
like, okay, I get this. I know how to have an effective
relationship with my anxiety, what skills to use when.
And it's not this thing that is controlling me.
And we can't control anxiety. We can't will it to go away, but
we can work with it and we can set ourselves up for success.
So the quote is life is impermanent and that
impermanence will be on your side.
And I think for a lot of us, when we feel anxious, first of
all, in the moment, it feels like it's not going to end.
It feels like it's all enduring, really intense, overwhelming
experience. Also, when you're experiencing
anxiety at like a medium to low level on a daily basis about
lots of things that feels like it will be a permanent fixture
of your life. You're like, I'll always have
this level of uncertainty and discomfort and distress.
I'll always view things from this lens of anxiety.
Or will this cause rejection? Is this a safe situation to be
in, whatever that fear is for you?
And so speaking from my experience, and maybe you guys
can really, anxiety felt like a really permanent fixture.
And I also remember when I was in my early stages of treatment
that I identified a lot with my diagnosis.
It wasn't like I have depression, I have anxiety.
It was like I'm depressed and anxious.
That was very much a prominent fixture of my identity and my
life. And part of that was because it
was controlling so much my functioning, whether it was, was
I able to be at school, what my relationship looked like with
family, was I showing up in friendships, Literally just how
I felt on a day-to-day basis. A lot of that was influenced and
dictated by depression, anxiety because I didn't know how to
effectively cope with those things or I didn't have the
right resources and support set up.
And so my identity and turn, I really latched on to that
because it was like an explanation for why I felt this
way. It was a shortcoming on me.
It wasn't like this is just how I respond to life.
It was like, it's the anxiety, it's the depression, if that's
what's happening here. And I remember very vividly
being in a partial hospitalization program, which
is basically when you spend a few hours of your day in a
hospital setting and you do group therapy, individual
therapy, family therapy. Sometimes you do medication
management, both throw in like occupational therapy activities
that you do and you you stay at home, maybe you go to school,
but you also are in this intense setting to learn skills, do the
work, do therapy and have that structure applied to your day.
We were doing art therapy or occupational therapy.
One of the two I can't totally remember.
And we were doing colleges of our identities and ourselves.
And I remember that a lot of people in this group, when they
were creating this picture of themselves and who they were,
depression and anxiety was a really prominent fixture of
their identity and who they were and myself included.
It was like, I'm Sadie, I have this many siblings, I live in
this area, I have a dog, I'm depressed, I'm anxious.
Like it was just, it was part of me, it was part of my identity.
And so I think that can be a really common experience,
especially if you are in intensive treatment.
You're kind of in an echo chamber, like you're only
surrounded by other people that are struggling.
But if you're doing well with your mental health, at least as
a young adult, you're probably not like, oh, these are the
things I'm doing. This is what works here.
So I speak to myself. Here's how I go about creating
my daily schedule so I don't feel overwhelmed and burnt out.
I think that's one of the biggest challenges with the teen
mental health space that I have come across.
And I'd love to know your guys's thoughts if you're like, that's
accurate or you're like, there's no way.
But I think that echo chamber really exists.
And I really do think it reinforces that identity piece
of anxiety because you're engaging in relationships,
you're building relationships with your therapist, with your
peers based on the fact that you're anxious or depressed.
And a lot of your vulnerability comes from that side of you.
When we're vulnerable, that's a really formative piece of
identity development. And so that can be something to
struggle with. And I think it just adds this
layer like this is a permanent fixture.
This is part of me. And I think it can be really,
really, really helpful to embrace the impermanence of
anxiety. And this is pulling in some
positive psychology here. But the most effective way to
think about life is that when you have losses, you attribute
them to external factors that don't have to do with you.
And when you experience wins, you assign them to yourself and
your personality traits and things that you could control.
So if you do badly on a test, you don't say I'm dumb, I'm
stupid, I'm not good enough. You say that test was hard, I
could have studied harder. I didn't understand the material
that was going to be on the test, but if you do well on the
test, you're like, I'm smart, I'm organized, I'm well
prepared. I am a great student.
And this pulls from a lot of research and positive
psychology. And I don't want to like throw
all of that at you right now because we're at number one of
like 8 bullet points I'm trying to get through.
But if you can internalize that and remember your losses, your
shortcomings, the quote UN quote negatives, attribute that to
external things and the wins, the positive, the good things in
your life, attribute them to yourself.
And anxiety is one of those things.
It's external. We're feeling anxiety, we're
experiencing anxiety. We're not anxious as a baseline.
And I know maybe it's objectively feels different.
It feels like a permanent fixture.
And you've been struggling with this for so long.
And we know that our personality traits change a lot, not only in
adolescents, but through adulthood.
And especially as a teen, the way that you interact with your
emotions and experience them subjectively is so, so, so
different from how you'll feel them in 10 years.
And the way that you cope with things, the way that you set up
your life, I promise the things that are making you anxious now
won't be the same things that make you anxious in 10 years.
And arguably you won't be as anxious or as distressed on a
larger scale. So that's my first thing.
And a skill that you can use for this is the ride the Wave skill.
And this is from DBT. We're going to talk lots about
DBT in today's episode, but the skills in the distress tolerance
module. And so we have this big picture
anxiety is impermanent. We're not attaching it to our
identity. It will change.
The research supports that. But in the moment when you're
having a panic attack, when you're having those thoughts
spirals, when it's all you can think about, I want you to
imagine and visualize each anxiety symptom and each thought
as a wave. These things aren't constant,
consistent levels of experience. The thought will be more
intense, and then you'll get sidetracked and then you'll come
back. Your heart rate is going to be
increased and then it'll go down, and then it'll go up
again. Same thing.
Your breathing will go up and then it'll go down.
Your muscles will be clenched, but then you release them for a
SEC. All of these things happened in
waves. And so if you can bring your
attention, do whichever 1 is the most front of mind.
Is it your breath? Is it your heart rate?
Is it your muscles being clenched?
Is it the thought? Pay attention to the wave like
nature. You can picture the wave going
up on the shore and then going back and retreating and really
lean into that idea of this isn't permanent, it's lessening
right now. It's not staying consistent.
And this too shall pass. So you can use that long term
and short term. And I find that to be really
effective and one of my favorite skills here.
The next thing I wanted to touch on was the evolutionary purpose
of anxiety. This is one of my favorite
things that I've learned in college, which is that the way
we experience anxiety serves a purpose.
There's not no reason for it. And when we understand why we're
feeling the way we do and the reactions we have, I think it
reduces a lot of the shame, a lot of the blame.
And then you can get into, OK, how can I work with this
biological part of me and cope with it more effectively?
So a lot of the ways that we experience emotions go back to
Cavemen days and how we evolved because humans evolved very,
very, very slowly. And so our brains and our bodies
have not evolved past what we were doing when we were living
in the wild with no shelter and we were hunting and gathering
and all these things. Like our bodies and brains are
not evolved to be living in cities and towns and our biggest
stressors being like school and the SA TS and a conflict in our
social group. Like our bodies are still
functioning as if we were living in the middle of nowhere in a
cave. And so one of the really
prominent ways that shows up is anxiety.
And I'm sure most of you guys have heard of fight or flight.
Like when we experience a threat where they respond by trying to
fight it or we flee and we get away and out of that situation
and sometimes people freeze. It's another response to
distress and a threat in a situation.
And so I'm not going to touch on that as much because I feel like
you've probably heard of the fight or flight response.
But I want to talk about the specific purposes that each of
them have because I think it's really interesting.
Maybe this is the nerd in me. But also, again, takes away some
of that shame. And you can interface with these
feelings in a different way. Like, that's funny.
That's such an ineffective way for my body to respond.
I know I can't control it, but I don't need this evolutionary
response because I actually live in a house and not in a cave
with a lion outside. So the first one is social
anxiety. At our core, our number one
wiring is relationships. If we don't find partners and
reproduce, our species goes extinct.
If we don't stay in a group of other individuals, we would be
killed off instantly. Like we're not very physically
strong. We're not a shark, we're not a
killer whale, we're not a lion. Like we don't have the physical
strength or capabilities to fight a predator.
So the ways that humans survived were by staying in groups and
some of US would be hunting, some of them would be protecting
The Cave, all of us together would fight off a larger animal,
but we were not surviving if we were alone.
And that survival, the fittest, the fittest were in a group
together. And so that's what prevailed.
And so these instincts, we have to be in a group and stay in a
group and form relationships are really, really, really strong.
And social anxiety is a way that that shows up.
Will I be rejected? Will I be accepted?
It's the most innate human need to be accepted because your
survival depended on it. And so when you have these
moments of like, Oh my gosh, I'm so worried people are going to
laugh at me or reject me, or I'm not going to be accepted into
this friend group or whatever it is.
Remember, that's not a reflection of you not being
confident enough or you not being brave enough.
Like that's just your body doing what it's supposed to do to
survive. Your body thinks, Oh my gosh,
there's so much riding on this. If I don't have this
conversation or it be accepted into this group, I'll be
attacked by the lion. And that's not the case.
But your body doesn't know that. So social anxiety has this
really, really strong, arguably the most intense wiring from an
evolutionary perspective. And so your body's doing its
job, it's serving its purpose. Similarly related to social
anxiety, when you have those anxiety urges to stay home and
withdraw and stay with family and friends and like not do
things that put our resources at risk, that's also our anxiety
from an evolutionary perspective.
We want to protect what we have and not lose these important
resources, whether it's family or friends or now in modern day,
maybe it's something related to a grade, which then would in
turn potentially impact our success and acceptance or doing
well in a sport or an activity. And again, acceptance and
cohesion, like all of these things are driven by these very
internal biological systems. Now, in a panic attack, like in
fight or flight mode, there's some really interesting ways
that your body responds. So I'm going to quickly go over
what those are because it can hang the funny end.
Interesting to understand and unpack.
So the first one is you sweat. The reason that you sweat is
that if you were in theory running away from a predator,
your sweat makes you more slippery, so you're more likely
to escape from them if they grab onto you.
Like it's literally why you sweat when you're anxious
because you are in fight or flight mode.
And if you're in flight and this predator tries to grab you but
you're slippery, you're more likely to get away.
Same thing. You probably get stomach aches
when you're anxious. This is because your body's
like, we're not digesting things right now.
Your digestive system is put on pause and your blood flow and
other systems like your increased oxygen to your
extremities and being able to see better and hear better,
those are prioritized. So your digestive systems put on
pause and then you get a stomach ache because nothing's being
digested again. It serves a purpose.
Same thing. Also your heart rate increases,
your breathing rate increases. That's because your body is
preparing you to run and get away from the threat.
So there's more oxygen being pumped to your limbs so that
you're ready to engage those muscles.
Your might have that experience when you're having a panic
attack, like everything is so loud and everything so bright
around me. Your eyesight and your hearing
literally gets better and more attuned when you're in fight or
flight mode because you have to be aware of the threats and the
predator that might be coming at you.
So we have really interesting ways that we respond from an
evolutionary perspective. I think it takes a lot of power
away from these symptoms because that can be the most distressing
part of an anxiety attack or a panic attack cause being like, I
can't breathe, I can't control my body.
I feel like I'm dying. And when you break that down,
you're like my body's reacting exactly how it's supposed to and
you can take some of that power away.
I'm sweating because I'm trying to be slippery and get away from
a predator. My heart rate and breathing rate
are not increasing because I'm having a heart attack.
My body is just trying to get more oxygen to my muscles so
that I can maybe run faster and more efficiently.
My stomach's hurting not because I have this illness or that I
need to go to a doctor, but my body has decided to stop
digesting my food so that I can run away.
And so engaging with these symptoms less, like I don't know
what's happening, I can't control this, but my body's
doing exactly what it's supposed to do.
And the response it's having is kind of funny and kind of dumb
that we haven't evolved past that point.
So that's something I wanted to share and point out because I
know those physical symptoms can be so overwhelming and
distressing. And so I hope those non
alternative explanations because they are the explanations, but I
hope that information can be helpful because it's
interesting, but also I think holds a lot of utility and
taking that power away from it. The next thing that I wanted to
touch on is the fact that everyone can empathize with what
you're experiencing and you might be like.
My friends and family have never had panic attacks before.
Why isn't anyone else's anxious about taking the SAT or this
test coming up? Everyone else seems to be making
friends. I can't talk to a single like
what are you talking about that everyone can relate?
We all experience emotions. Again for evolutionary purposes.
Shame keeps us embedded in a group so that we don't end up
alone and not able to fight off threats.
Sadness prevents us from losing resources that are important to
us. Guilt forces us to repair our
relationships so again, we don't get rejected and exiled from
these really important groups. Anger helps us fight off threats
and keep things that are important to us.
Happiness motivates us to go out and get more of these resources
and things that boost our well-being.
Keep these things that keep us thriving and reinforce these
behaviors that allow us to thrive and succeed.
Like having resources, having relationships, and then fear and
anxiety keeps us alive. It keeps us from these threats
that at one point literally were life or death.
So if you are a human, you experience fear.
And the things that we experience fear too today, like
a test or a new conversation with someone or asking for help,
maybe it's not justified in the larger scale of things.
Maybe it's a disproportionate reaction, but it's still a valid
reaction. And we all have those emotions.
Everyone can relate to fear on some level because those
evolutionary processes still take place and fear gets evoked
in everyone at some point in their life.
And so even though you might be thinking no one gets how it's
just I am. No one gets how much this
determines my life. We can all empathize with the
experience of being scared or ashamed or uncertain or
distressed and asking for help about those things.
Talking to others about their experiences there and what
worked, and just connecting and taking the power away from those
anxious experiences by labeling them and unpacking them is
extremely powerful. So I want you to know that
everyone has experienced anxiety to some degrees.
You can talk about it even if it seems like you're coping with it
differently or you're experiencing it to a higher
level. And the other thing to mention
here is anxiety is complicated because we all get anxious, but
we might not all have generalized anxiety disorder.
And we've done episodes on this before where it's like, why do
we have these mental illness diagnosis?
And they serve different purposes like getting insurance
coverage for treatment and being able to do specific research on
these specific things. But when we have these
colloquial discussions about like, I have anxiety, I'm
anxious versus I have generalized anxiety disorder or
I have social anxiety disorder, The key thing there and how to
evaluate that for yourself, which of course you need to get
a diagnosis from a doctor if you're going to bill your
insurance for that kind of treatment.
But if you're kind of like, do I need help?
Do I want to ask for help? Like, do I just feel anxious
sometimes? Or is this something I need
support with? What we look at with abnormal
psychology or psychopathology is, is it causing you distress?
Does the way that you're experiencing anxiety not just
like, Oh my gosh, that thing made me anxious.
I coped with it, it went away. I moved on with my life.
Is it causing you significant distress to where it's
interfering with your quality of life and your well-being?
And the second question there is, is it interfering with your
functioning? Are you able to go to school to
work? Complete your assignments?
Show up in your relationships? And if the answer is yes, it's
causing distress and yes, it's interfering with my ability to
function, that's when it's time to ask for help and get support.
And not to say that you can't get help or support before that
point, absolutely do. And I would recommend that.
But that's kind of what we look at when it's psychopathology
versus like typical human experiences that we all have and
struggle with. So basically just to add that
nuance and layer to this episode because it's complex in that we
all have anxiety, we all get anxious, and we might not all
have anxiety disorders and we might not all need intensive
treatment. But again, we can all empathize
because we all get anxious and experience anxiety.
And not to take away from these really intense experiences that
for some people cause a lot of distress and absolutely
interfere with life as a whole. The next thing we're going to
touch on is CBT or cognitive behavioral therapy.
And I went to ABCT this weekend, which was so fun.
And I've listened to a lot of panels about CBT and ways that
that is used for depression and anxiety and exposure therapy.
And we're going to get into all of it.
But one of the basic parts of CBT is the CBT cycle, which is
that we have the cycle of thoughts, behaviors, and
feelings. And it's like a continuous loop.
When we feel something, we then think something and then we have
a behavior and response. And then the behavior and
response then causes feelings, which cause thoughts, which
cause behaviors, and it just goes on and on and on.
And so why people get CBT treatment or pursue support in
this area is the idea that some way that we're thinking and
behaving with our emotions is ineffective.
Maybe it's how we're coping with them.
Maybe it's how we're thinking about situations.
Like when you're in a new social environment and no one
immediately comes up to talk to you.
If you think I and not good enough, no one wants to be
friends with me versus OK, no one knows me.
They're also probably nervous. And it's not really like a thing
where everyone just approaches everyone in every situation to
introduce themselves. Someone has to like make that
brave leap and maybe you have to be the one to initiate it.
So CBD kind of has this idea behind it that something about
the way we're behaving and thinking is ineffective and is
there for a lot of times causing us to stress and interfering
with our quality of life. Like I mentioned earlier in this
episode, we can't wheel away our anxiety.
We can't wake up. I'm not going to be anxious, I'm
not going to have anxiety. It's just, it's not me.
It's not happening, not part of my life.
It just doesn't work that way. But we do have a lot of agency
over our thoughts and our behaviors.
And I'm sure you're like, what are you talking?
I, I've tried to think differently.
I try and behave differently. It's really hard and it's really
impossible, and I totally get that.
And one of the reasons for that is you've been thinking in the
same way for so long and behaving in the same way for so
long that it's almost like a habit.
You've reinforced that way of thinking and acting that it
takes so much power to then overcome that way of thinking
and behaving. And so this can be really hard
and really challenging. And this is the way to interrupt
these ineffective patterns. And so to shift our feelings and
to shift that anxiety, we adjust the way that we think about
situations or appraise them, if you want to use the psychology
term, and how we behave in those situations.
So how we cope with anxiety? Do we avoid?
Do we run away? Do we think this is never going
to get better? I'm just not even going to try.
Or do we say, OK, I'm feeling anxious right now, That's OK.
What are the coping skills that I know work for when I'm feeling
this way? All right, my behavior, I'm
going to do some deep breathing. I'm going to give myself a
minute. I'm going to give myself a
mental pep talk, and then I'm going to move forward into the
situation. So that's the kind of CBT cycle
framework I think that's really important to mention here.
And we're going to talk about some DBT skills, but we're like
rather far into this episode and we can do a whole other episode
just about CBT if you guys wanted to.
But I think it's a helpful thing to remember in the context of
anxiety that we can't necessarily control the feelings
themselves. Remember, they have really
prominent evolutionary purposes. Those aren't going to go away,
but we can change how we think about them and we can change how
we behave in response to them. And if you've been feeling this
way for a really long time and maybe not coping as effectively
as you could, it's going to be hard.
And also it's very possible. The next thing I want to mention
is that the biggest thing with anxiety, if you take nothing
away from this episode except for this, is that the TLDR
avoidance amplifies your anxiety.
Every time you avoid something that you're anxious of, you
become more anxious the next time you encounter it.
So if you're scared of flying and you never get on a plane,
you never go near an airport, you don't watch any videos or
read any books that have anything to do with flying.
If it has to do with a plane or flight, you ignore it.
You run away, you go the opposite direction.
Every time you've avoided that thing that might cause you to
stress, the level of anxiety you experience the next time gets
even bigger because you've reinforced that idea that this
thing is scary and dangerous and I shouldn't go towards it and
it's just going to make me anxious and give me bad
feelings, so I absolutely should not put myself in that
situation. So every time you avoid that
thing, you're reinforcing the idea that it's dangerous and bad
and it'll cause you to stress since the next time you approach
it, you're even more anxious. And yes, the urge to avoid is
even stronger. It's the best thing that you can
do if anything brings you to stress or makes you anxious is
exposure therapy. This is CBT principle and it's
really, really, really effective.
We use it at anxiety. We use it in OCD and the idea is
that you expose yourself to things that make you anxious in
a way that is manageable to cope with, and you build mastery over
that anxiety and over that thing.
So say you are scared by social interactions, you're scared to
make friends, you're scared to approach people in new places.
You would start out small. Maybe you reply anonymously,
like on a Reddit thread or a pen.
We have side chat. So you start anonymously and
then you're like, Oh my God, anxious.
Like what if someone figures out, even if it's a nice comic,
you're like, someone figures out it's me and then they respond to
me and it becomes a whole thing. And then you do your deep
breathing, you cope with that anxiety.
It's OK, you are still alive. The next day you're like, OK, I
handled that anxiety. I worked through it.
I was OK, I'm going to leave a comment on someone's Instagram,
maybe start with like the New York Times or like a big page
that isn't going to see your comment.
And you are like, love this. So interesting.
Whatever it is, you're probably a little anxious.
I'm going to be, your heart is beating, maybe you're breathing
faster, maybe your thoughts are spiraling a bit.
You breathe through it. You're like, I'm feeling
anxious, that's OK, that makes sense.
I've avoided this in the past. I'm worried about being rejected
or judged. That's a completely normal thing
to feel and I'm going to be OK. You work through the anxiety,
you cope with that. Then maybe you leave a comment
on an Instagram of someone that you know and you work through
that anxiety and you keep moving your way up the cycle.
So then maybe you go and order a coffee and you ask the barista
how their day is going. Maybe you ask for help in the
library to find a book or at a store.
Be like, do you have this size and something?
You get practice and then you go somewhere like a conference or a
class where you never have to see that person again.
It's like a one time thing. You talk to someone, you leave,
you're never going to cross paths again.
Then maybe you do it in a class where you'll see them every
week. So you introduce yourself, you
say hi, and there's that increased amount of like you'll
continue to see them if this goes badly.
And then you work your way up to introducing yourself to someone.
Maybe you ask if they want to study together or if they want
to go and like do an activity or like go get coffee or something
like that. So you work your way up to this
really big scary thing, which is approaching a stranger, making
small talk, and then trying to have a next step that would then
continue into a friendship. And some people call this
rejection therapy. Some people call it exposure
therapy. It's big on TikTok right now.
Like people will stand up on airplanes and be like, I hope
everyone has a great flight. And I still have a new segment
on it. But this works.
There's a lot of research and literature showing its
effectiveness. And I think this is one of the
best skills you can have in your pocket.
And for anyone, whether you have an anxiety disorder or we all
feel fear at some point, anytime something brings you to stress,
you should absolutely do a little bit of exposure therapy.
So maybe that anxiety is about raising your hand in class,
Practice with staying after class to ask a question,
practice going to office hours, work up to asking that question
in class in front of everyone. Maybe you're really nervous
about your final exam. You're going to start by doing a
smaller quiz somewhere early on the semester.
Maybe you go to the room where your exam is and practice
mentally. OK, I'm sitting down to put in
the timer on the board, I'm taking the test, that type of
thing. So anytime anything brings you
to stress, know if you avoid it, it will amplify that anxiety.
So do that small step to expose yourself to that anxiety in a
healthy and Safeway. And then if you have a really
big fear or a really big phobia, typically you'll work with a
therapist or clinician. You'll do an exposure hierarchy.
So you make that list that we talked about like this is the
scariest, worst thing possible that I could imagine, like
approaching a stranger and trying to make friends with
them. This first thing I want to start
with is leaving an anonymous comment.
So that's the exposure hierarchy.
And then you make all the list in between and you check your
way up and you go through the list and you get therapeutic
support. We had Doctor Han Schroeder on
the podcast from the University of Michigan.
We talked about depression and I'll leave that link in the show
notes, but I am a member in his lab now and I hope he's OK with
me sharing this. He emailed US one week and was
like I'm so sorry I'm super sick.
We're going to have to reschedule for the following
week. And he comes on zoo and he's
like, guys, I was doing exposure therapy with the patient as I do
every week, and I ate a cookie off a toilet seat as I do every
week. And I got violently I'll and we
were like, what? But it just was like a funny
story. If you go to therapy for the
first time, they're not going to like throw you into eating food
off of toilet seats. It's going to be OK, I promise.
But this is something that is used all the time in therapy.
There's like really cool and fun creative ways that they
implement it. Again, lots of research showing
its effectiveness. It really works.
I'm trying to think if there was any funny exposures that I did
in treatment. We had vulnerability groups
every week. We just practice sharing
something vulnerable and we did karaoke group, which honestly
was my biggest exposure. And I do think that fear serves
a purpose because if I sing, then I'm being a little
hyperbolic here, but like I should be rejected by everyone
that knows me because I'm so bad at singing like that.
Fear is serving a purpose because this is not a skill.
It does repulse people. So yeah, we did karaoke, which
brought me a lot of anxiety. I think I, I'm pretty sure I lip
synched. I like had another friend do it
with me and I was lip syncing Happy birthday because I'm so
bad at singing guys. I really wish I was good and
completely, completely tone deaf and I wish I was better.
I'm just not. We did a more rejection therapy
type thing. So we'd pull different tasks
from a hat and one of them would be like go up to someone in the
cafeteria and bargain with them to trade lunch or go up to
someone asked for their phone number.
These tasks that people will likely say no to, but you
practice getting rejected. So they're really fun ways that
exploded therapy is implemented. It's great.
Not a downside to doing. It's a great skill to build to
kind of be able to tolerate that distress and practice coping
with it and then overcome these things that you might be
avoiding. And that's a really another big
kind of philosophy. And part of DBT is that you're
avoiding things in life and there's that that level of not
wanting to engage with your emotions because of the level of
distress they're causing. So now we're going to talk about
skills. We're going to talk about long
term skills and short term skills that you guys can use
with anxiety. And I wish I knew these going
into it. And then what last, I'm going to
talk about why anxiety is good, which also is something we don't
talk about a lot. So long term skills, we're going
to talk about 3 DBT scales. So just coping ahead, building
mastery and the please scale. So coping ahead is one of the
best skills if you have a situation that you're really
anxious about. So not just day-to-day, like,
Oh, I always feel like I'm kind of anxious.
My thoughts are always kind of going like I'm never just calm
and at peace. But if you're like, I have a
public speaking thing coming up or I'm starting a new job or the
first day of school or a final exam, like these big things
where you're like, I think this situation is going to cause me
anxiety. This is when we do a cope ahead.
And so basically what you do is you write out The Who, what,
when, where, and then you talk about how you're going to cope
with it. So like I have a final exam On
this date in this classroom, I am going to feel anxious because
I'm really worried about my grade in this class and how I'm
going to do on this test. And whenever I take test, I just
get really anxious. Like my mind goes blank, like my
heart goes really quickly. I can't catch my breath
somewhere. They feel nauseous, my stomach
is hurting. Like what are you expecting to
feel in this situation? Who's going to be around you?
You're like, there's so many people in this class.
Everyone else is writing and seems like there's someone on
top of it. And my mind is just link and I'm
distressed and the teachers in the front staring at everyone
and the timers going off like get really detailed about what's
happening. And then a really key part of
the cope ahead and you can do this for a realistic situation.
And then a non realistic situation is like, what is the
worst thing that is going to happen?
And this is really great, especially for social anxieties.
Say you're like, I'm walking into the first day of class next
semester with new people I've never met before, and I fell on
the floor and get a giant black eye.
Like maybe that's the worst thing.
That or you just faint and then you wake up and everyone's
staring at you. How would you cope with that?
Would you do some deep breathing?
Would you be like, I'm sorry, I'm going to the nurse now.
Would you pay attention to your heartbeat, take a try and ground
yourself? Would you look around the room
and five things you can see, 4 things you can hear, three
things you can touch, two things you can smell, one thing you can
taste, like grounding your senses.
How would you cope with that situation?
Because you would cope with it and you can cope with it.
And then once you've done that, cope ahead for the worst
possible situation, you then can go bad for like, OK,
realistically checking the facts, what is likely to happen.
And so you want to be really specific with what skills you're
going to use. Imagine yourself going through
the situation and coping with it.
Like I'm sitting down. I'm going to get out my water,
I'm going to get out my pencil and I'm going to start doing
deep breathing as soon as I get there.
And I'm going to get there 10 minutes early so I can feel
really grounded and ready before this test.
And I'm going to go to my teacher's office hours before
and say, hey, I get a lot of test anxiety.
I know that maybe you might not be able to offer accommodations,
but I'm going to get there early.
I'm going to sit in the front row.
I just want you to be aware that like if it's OK with your
testing policy, like I might need to go to the bathroom or
get some water. This is just something that I
expect to bring a lot of anxiety and I want to keep you in the
loop as much as possible. So what is everything you're
going to do to navigate the situation and cope with it and
mentally go through that process?
And then if it's helpful for you day of, maybe like write down,
OK, if I feel anxious, I'm going to do my deep breathing, I'm
going to do the five things around me and I'm going to count
backwards from 100. Like what are those skills that
you're absolutely going to use? If I'm having a panic attack,
I'm going to ask Ralph and go to the teacher and say I need to
step out and use the restroom for a minute.
So that's Copahead. We love copahead and I do think
an important part of copahead is checking the facts, like is this
realistically going to happen? Are you going to pass out?
Probably not. Is it possible?
Yeah. Why not do the cope ahead for
that? But like, realistically, not
super likely. Even in Princess Tyree, she
doesn't pass out. She just runs out of the room.
She doesn't actually throw up, presumably, and she copes with
it. She survives it, and then she
becomes Princess of Genovia. Building mastery.
This is another DBT skill that kind of has some crossover with
CBT. We talked about exposure
therapy, building mastery over your coping skills and getting
really good at like, I feel anxious.
I'm going to do deep breathing. That is going to help you a lot.
And so anytime you view a little bit of anxiety, use those coping
skills. Practice those coping skills.
And with time, you will get better at building mastery, not
only with your ability to implement those skills and know
when you need them and how to execute them, but also building
mastery over the feeling itself and becoming less anxious and
less responsive to these things that in the past brought you a
lot of distress. And then the play skill.
This is arguably the most important thing for anxiety.
There's a lot of things that can make your anxiety worse, and I
know you probably hear this all the time, but it's really
important. So we're going to talk about it.
The police scale in DBT is kind of talking about our emotional
vulnerabilities. So it stands for a physical
illness, eating balanced, avoiding mood altering
substances, sleeping enough, and exercising balanced.
And so it's taking care of our physical health so that we can
reduce our emotional vulnerability for our mental
health. So emotional vulnerabilities
basically, like at your baseline, how reactive are you
to various stimuli? You get enough sleep if you have
eaten well, if you haven't had caffeine, if you were able to
get out on a walk and get some movement in, if you're not sick,
how susceptible are you to feeling anxious versus you slept
for two hours last night, you had three celsiuses.
Don't do that. That's really bad.
I've never done that. But don't, don't drink 3
celsiuses. I think that's against the FDA
guidelines You have any in yet today you have not done any
exercise whatsoever and you're like heart rates going crazy.
If you have 3 Celsiuses, maybe see a doctor.
You can't catch your breath, your thoughts are spiraling,
you're exhausted, so you're sleep drive.
Like all these things make us a lot more reactive and a lot more
anxious and our baseline is just so out of whack.
And so taking care of these things is really, really
important. Sleep especially, there's so
many like I want to do an episode for you guys about sleep
and how it impacts all these different things.
But one of the purposes of sleep is just like an inside out.
We process through each emotion. We process them through our
dreams. That's one of the reasons
psychologists think that we dream is like process through
these unresolved emotions. We catalogue them.
They go back in the memory ball chamber, whatever the heck it's
called. An inside out sleep plays a very
important role there and but we feel more anxious when we don't
get REM sleep for that reason. There's also the physical aspect
or heart rate variability and how much our heart rate is
increasing and decreasing in response to things connected to
how much sleep we get. And so it's absolutely pivotal,
especially if you do have those intense physical anxiety
symptoms that can be really debilitating, avoiding mood
altering substances. We have to touch on this from
the caffeine lens. I know you guys probably hear
it, but it really does have such a difference.
When I was in middle school, I went through this phase of
drinking a lot of coffee. Like I'd wake up and make a hot
coffee and drink a large amount of caffeine because I was not
sleeping at all. It was really ineffective.
It made my mental health exponentially worse.
And that was one of the reasons I saw such a shift in my first
couple weeks in McLean because I started getting actual sleep and
it was like, wow, I am no longer astronomically depressed and
anxious the moment I open my eyes.
And then even when I was getting sleep, whenever I would drink
coffee, my heart rate, my breathing rate, just the way
that I was thinking and interacting with the world was
overwhelming. I didn't have caffeine for years
after that initial experience, like having too much caffeine
and being so anxious after I was aware, like KK, what I'm
experiencing is anxiety. And this is a really tough thing
to navigate. I did not have coffee or
caffeine for years. And so if you are someone who
has a really anxious baseline, being aware of how caffeine
interacts with your body is really, really important and
really, really helpful. O being really aware of
substances, how they impact your mood, especially if you have
anxiety. Because across the board, these
changes that we make with our physical health have a really,
really big impact on our mental health as well.
The last part of the please scale that we're going to talk
about is movement. And this varies from person to
person. I think also if you're
navigating depression or depressive symptoms and anxiety,
it can be a whole complex relationship, but movement is
really, really effective for moving anxiety through the body,
having that physical release because we hold a lot of tension
and energy. I know everyone in their mother
has been like, have you tried exercising?
Have you tried moving? It'll help your mental health.
But this semester, especially dealing with the stress of grad
apps and all these things, I have never walked more in my
life. Like I'm not running, I'm not
lifting. I'm just walking myself around,
put on my headphones. I blast my Taylor Swift and
Gracie Abrams and Sabrina Carpenter because that's all I
listen to. And I walk myself in laps around
campus like I am a suburban dog. And it works great.
It helps me sleep better. It helps me feel like I've
worked through some of that anxiety.
After it, my heart rate's lower. I'm feeling calmer.
Like there were certain days of semester where I was like, I
need my walk or I'd go in the morning.
I'd beg this has to be an afternoon activity so I can
work, work through some of the anxiety I've built up figuring
out what kind of movement works for you and for me.
I want to enjoy it. If I'm jogging, even though it's
probably at a similar speed to what I'm walking, I don't enjoy
it. I'm not happy if I'm walking and
I'm outdoors and I'm listening to music.
Like that's a positive experience for me.
So I'm getting that benefit of like physically moving through
the anxiety, which there's so much research on it being
effective. And I'm also getting the
positive benefits of just, I saw the pretty views, I listen to my
music, I walked around, I feel productive.
So figure out what kind of movement.
You like, maybe it's cycling, maybe it's walking, maybe you
like running, maybe it's weights, maybe it's Pilates
chance, I don't know. Whatever it is that you enjoy,
adding movement to your routine can really help to work through
anxiety, but also from a preventative perspective of
keeping that baseline low and effective.
Those are long term skills I like to pull from and I use on a
daily, weekly, monthly basis. And then the short term skills.
So these are things you use when you're feeling really anxious,
when you're having a panic attack.
And the key short term skills or distress tolerance if you want
to go from the DBT perspective, is that we use them to tolerate
distress. We can't use them to cope with
things long term because they lose their effectiveness.
So we use these when we're feeling really, really anxious.
And then we lean on those longer term skills of like lifestyle
changes, asking for help, doing exposure therapy, coping ahead,
building mastery over that anxiety.
So if you're having a panic attack, these are the skills
that I would recommend. The first one is STOP.
It's an acronym from DBT that stands for STOP.
Take a step back, Observe, and proceed mindfully.
This seems so intuitive, but when you're having a panic
attack and you can't breathe, it's not so stop physically,
mentally, just freeze. Take a step back if you can,
take yourself out of the situation.
Walk outside, leave the conversation, get out of the
room that you're in. Observe mentally and physically.
OK, what happened? Symptom check.
Is my heart rate going really fast?
Is my breathing rate really intense?
Are my thoughts spiraling? Where am I?
What caused this? Observe kind of how we got in
this position. And then you make your plan to
proceed mindfully. And the proceeding mindfully a
lot of the time is using coping skills, which we'll talk about
here in a second. But we often skip that step.
Like we just run into deep breathing or like, Oh my God, I
need to drink water. Oh my God, I'm anxious.
I better walk around taking that step to be like, OK, what is
truly happening physically and mentally?
What am I anxious about and how did I get to this point of
feeling so distressed and overwhelmed?
The TIP skills, the next one you guys know I love the TIP skill.
This should be common knowledge. It's just it's such a game
changer and it works 100% of the time, which is hard to say for
mental health things. So TIP is an acronym in DBT and
it stands for Temperature, Intense exercise, pace,
Breathing, and paired Muscle relaxation.
So temperature, this pulls from a biological phenomenon called
the mammalian diving reflex, which is stimulated by your
vagus nerve. I might get this wrong because I
am not a biologist, but your vagus nerve runs underneath your
eyes. I believe it goes down your
neck, your chest, and then it like ends kind of in your
stomach near your kidneys, liver area.
And your body has this thing called your mammalian diving
reflex. And so when you come into
contact with cold butter, your body's like OK, I'm going to go
swimming now. I'm going to need to be
underwater, and so if I keep my heart rate at a high level, I'm
going to produce a lot of carbon dioxide really quickly.
And I'm going to have to get up to the surface really quickly to
release that carbon dioxide and get more oxygen so that I can
survive. And that's not efficient or
effective. So your body has a system in
place where when cold water comes into contact with your
vagus nerve, your body immediately lowers your heart
rate and lowers your breathing rate so that you're not
producing carbon dioxide as quickly and you don't need more
oxygen while you're quote UN quote underwater.
And so we can hack this, we can use it to our advantage.
And so when we're having a panic attack, you're going to get a
bowl of ice water, or you can use an ice pack, or you can just
use cool water if you're in a situation where you can't access
a bowl of ice water, but a bowl of ice water will be most
effective. This is what we used in
residential. They have like so many ice cubes
and so many bowls of water and towels because they use them
almost on a daily basis to help people get through anxiety.
You fill up your bowl of water, you've put your ice in it, you
take a deep breath and you submerge your face.
You count for maybe like 10 seconds, however long you need
before you take another breath, and then you submerge your face
again. You'll probably repeat that four
or five times until you're no longer breathing really quickly
with a really fast heart rate, and that physiological distress
will go away 100% of the time. You might have to repeat it a
few times. You might have to do a few
cycles, but it will work. That physiological distress will
lessen because we're using this biological mechanism that is
foolproof. You might have seen this on
TikTok. People will be like lowering my
cortisol after my hangover and then they'll do an ice dive.
But it works for mental health, for anxiety.
I wish everyone knew this. And if you're ever around
someone having a panic attack, this is a skill you can offer
them that will work 100% of the time.
The rest of the tip skill is intense exercise, pace,
breathing, impaired muscle relaxation.
So intense exercise is a similar idea that when we are
exercising, our body can only maintain a certain level of
outputs for so long. So if we're sprinting and we
stop sprinting, our bodies like I'm no longer moving, I'm
lowering my heart rate and my breathing rate to conserve
energy. Basically all our bodies ever
want to do is conserve energy. They don't want to be having a
lot of output or moving. So anytime in any place we can
conserve energy, we will. And one of the ways is by
exercising and then stopping exercising.
So when your heart rates going really fast, when you can't
catch your breath because you're having a panic attack, do
sprints, do a bunch of squats, do burpees, do something really
high intensity, run in place, do jumping jacks.
Your heart rate will get raised past the level that it was at
from that anxiety and then your body will lower it below that
threshold and again alleviate that physiological distress.
It also again, helps move that anxiety through the body, which
is also very helpful. And you release endorphins
because you're doing some exercise.
So added benefit. And then paired muscle
relaxation and pace, breathing. Pretty intuitive, but basically
we carry a lot of stress in our body.
Our muscles get really tense and tight when we're anxious.
And so this works really well in tandem, but you're going to
breathe in. As you breathe in, you clench
your muscles, pause with your muscles clenched.
And then as you breathe out, you release the clenched muscles.
You could do this one muscle at a time.
So like starting with your fist, then your whole arm move around
your body more of like a flashlight meditation situation.
Or you can just like your whole body, breathe in, tense your
muscles release them, and again you're tensing them past the
threshold that they were tensed from the anxiety and releasing
it again below that threshold. So you let go of that tension
and then the key with pace breathing, you could do whatever
count works for you. For me, normally I do 2 slower
counts in pause and then three outs and people like to do 3
counts in, four out. The key is that your exhale
needs to be longer than your inhale and that will also lower
your heart rate, lower your breathing rate, and doing that
for a few minutes is really helpful.
And then the last thing that I'll mention, and this is the
last one because again, it loses its effectiveness, but distract.
If you're having a panic attack, if you're really anxious, have
your list of distraction skills that works really well.
Is it watching your favorite TV show?
Is it blasting music? Is it doing a workout?
Is it coloring, drawing? Like what is it that distracts
you from your emotional experiences that you can lean on
in the short term to survive through that crisis?
Again, these are crisis survival skills.
We don't use these on a daily basis because they lose their
effective activeness and it's a crutch.
But in those moments where you are really, really anxious, it's
really helpful to have a list on your phone or a photo or no.
Like if I feel anxious, I listen to music.
If I feel anxious, I bake, I pet my dog, I go on a walk.
What is that answer for you? And lean on distraction in the
short term. So those are our distress
tolerant skills. The last thing we're going to
talk about in this episode of Things I Wish I Knew about
anxiety is that anxiety can be good.
It serves a purpose and actually benefits us in some situation.
Again, this is the difference between we get anxious, we feel
anxiety and like generalized anxiety disorder, social anxiety
disorder, where it's causing us to stress and interfering with
our quality of life. But anxiety is a feeling can be
good and it can serve a purpose. We talked about how anxiety is
sending us messages about potential threats.
And a lot of the times it's like we don't want to be rejected.
We care about these people. We care about love and
acceptance and feeling supported.
We're worried we're going to lose something that matters to
us, that person, that thing, that acceptance, that matters to
us. We care about that, that is of
value. So it's good and sending us
those messages. There's also this really
interesting thing in psychology called the Yorks Dodson Law.
If you've taken intra psych, you've probably realized that.
But if you're completely calm, like you're a Buddha, you're
meditating, there is no anxiety in any bone of your body.
People don't perform very well. Similarly, on the other side of
the spectrum, if you're having a full blown panic attack, you
don't perform very well and performance, I mean like mental
activity. So taking a test.
So if you take a test completely calm, you don't do great.
If you take a test having a full blown anxiety attack, you don't
do great, but somewhere in that middle range, it's like a bell
curve. When you have a medium amount of
anxiety, you are using those physical symptoms that we talked
about, increased attention, increased awareness, better
eyesight, better hearing, more awareness.
There's something riding on that you care about.
And so we actually perform better mentally when we're a
little bit anxious. Anxiety helps us perform at our
best. And so it can be good and small
doses. And then we talked about this in
another episode, in this episode.
So he talked about how procrastination is like natural
Adderall. That's a really clickbaity over
generalization. But when we procrastinate
things, we have this boost of anxiety before the deadline.
And then we work faster, we work more efficiently because now
it's like, OK, adrenaline, I need to get this done.
There's this deadline. This is a threat.
Like I got to work through this. And so this is another way that
anxiety shows up. It gets us motivated, it gets us
to act, it gets us to behave. It causes that adrenaline to be
able to get us to get things done.
So anxiety can be good. It just serve a purpose, but
when it's causing us to stress and it's causing us to avoid and
it's interfering with our quality of life, we got to work
through that. We got to be more effective and
hopefully everything I talked about today will help you do
that. So those are some things I wish
I knew about anxiety. If you have something you wish
you knew about anxiety, let me know.
Send me an e-mail or an Instagram DM or tag me on
Instagram stories, any of the things I'm always here and make
sure to share this episode if it was helpful.
I really hope it was and I'm glad we're back to the solos.
I love these and it's just been so busy, but I miss talking to
you guys. So we're going to do more of
these. I'm also going to do a things I
wish I knew about depression, so get excited for that episode.
Really happy topic. No, it'll be good.
But yeah, I hope you guys are having a good semester.
This is going to come out before Thanksgiving, so happy
Thanksgiving. I'm thankful for all of you.
You guys are the best. I love you loads and leave a
review, share all the things. I hope you're not experiencing
too much anxiety and if you are experiencing anxiety, hopefully
now you know how to cope with it.
So have a great rest of your week.
I loved and missed you guys, so with that, I'll see you next
week.