AnxCalm - New Solutions to the Anxiety Epidemic

Om AnxCalm - New Solutions to the Anxiety Epidemic

In weekly episodes, Dr. John Dacey will explain the causes of the eight types of anxiety, why they do what they do to us, and how we can learn new ways to control them.

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Bob05.08.2020 (00:10:10)
Today, I am very happy to have with me a former client of mine and he’s very brave to be willing to talk about fear of flying in a straightforward manner! John: Hi. This is Doctor John Dacey with my weekly podcast, New Solutions to the Anxiety Epidemic. Today, I am very happy to have with me a former client of mine and he’s very brave to be willing to talk about everything straightforward. His name is Bob and I’m really happy to have him in the studio today. Hey Bob, how are you? Bob: Good, John. Glad to be here. John: Now the major thing when I typically deal with former clients, is I ask them the 8 kinds of anxiety and have them talk about what it felt like and what they did to be successful, but in your particular case, it was very clear what you needed to deal with was fear of flying. Could you talk a little bit, Bob, about how you came to be a fearful flyer? You were flying to France and a whole lot of places and then all of a sudden something happened, isn’t that right? Bob: Yeah, I never had trouble flying before. I few all over to Europe and had no trouble in planes whatsoever, but I got married, and this was quite a long time ago. John: Where did you get married then? Bob: I got married in Finland. John: Oh Finland. Ok. Bob: Finland. My wife was Finnish, we met in Paris, and then she went back to Finland and I went back to join her and we got married after knowing each other for about 2 months or so. We had a honeymoon, by cruise, in the Mediterranean, and then we flew back to the United States from Milan. It was on the flight back that I had a totally unexpected panic attack. I can explain what it was like but looking back I realize, I was very ambivalent about the marriage. I was really of the feeling that maybe it was a mistake, that we knew each other for too short a time. John: Now let me just ask you a question there, Bob. So, you’re married, you had your honeymoon, etcetera, etcetera, and everything seems to be okay and then all of the sudden, something happened on this trip on the way back. Is that right? Bob: Right. I mean I did have my doubts, even going into the flight back. It wasn’t as if everything was totally hunky-dory and then completely out of the blue this happened, but I certainly didn’t expect—I had never had anything like this before. John: On the other hand, this is the first time she’s going to be meeting your parents, your relatives, your friends, is this correct? Bob: Well actually my parents had flown over for the wedding. John: Oh I see. Ok. Bob: But you know, this is the first time that she’s coming to the states. She was a very successful journalist and artist in Finland and she gave all that up to come over here with me. John: Can I interrupt you once again? I’m sorry to do that. You’re rather accomplished yourself. Would you tell us a little bit about your own educational background? Bob: Yeah. Well, I’m a biochemist. I have a Ph.D. in chemistry from Yale. I graduated Columbia Undergraduate and I had post oped in a couple of places, one of them which was Paris. We were coming back here where I was going to take up a position at Boston University in the Chemistry department. John: So you have pretty high standards I can imagine. Bob: Well you might say. You know, I was very excited about everything and looking forward to an academic career and my wife had, again, given up everything to come here with me so I felt quite a sense of responsibility for her. I had to really introduce her to the United States, how to go shopping in markets, and just ordinary everyday things. And also, to help her get a job over here. But on the plane, suddenly I felt very strong claustrophobia. I felt trapped in the plane, that I couldn’t get out. These were feelings that I had never really had before. John: Why would you want to get out, Bob? Bob: Yeah, I mean I wouldn’t want to get out. There’s absolutely no reason. In that sense, it made no sense, but looking back on it, I was also feeling trapped in this marriage even right at the beginning and that maybe played into this feeling of being trapped in the airplane. And it was pretty awful. It was a kind of panic attack. My breathing got sort of short and I didn’t feel I was going to die. I just felt I was in an impossible situation where I was trapped and couldn’t get out. John: So, naturally, you assumed that being on the airplane was part of this whole thing. Bob: Yeah, right. John: And that’s why after being a fearless flyer for a long time—this is what amazes people—in one experience, it went from being perfectly comfortable to perfectly terrifying. Bob: Exactly right. Exactly right. That was part of the problem because it was so unexpected and I had never had anything like this before. I was not an anxious person, I didn’t have these kinds of anxieties before. I had the normal anxieties, you know, like before a final exam or something like that, that everybody has, but I never had these kinds of feelings before. So, we got back to the states and I had a number of phobias I guess you’d call them, that were connected, I suppose, to this that I had never had before: a phobia of heights, a fear of elevators, being trapped in a subway if it’s stopped between stations. A whole bunch of phobias that were kind of connected to being trapped in some way. John: So I can understand this. You sort of transferred being psychologically trapped in the marriage to being physically trapped in these various situations, which in fact you were. If you go up in an elevator, for a short time you are trapped. Bob: Right. That’s what they all had in common. John: And for a long time on an airplane, especially in an intercontinental flight like that, you’re trapped for quite a while. Bob: That’s right. The next summer, we went back to Finland, to visit her family, and it was pretty awful for me because I knew how awful the flight would be and it was. And it’s a long flight. The flight there and back was pretty bad. That was the beginning of all of these. As I mentioned, I never had these anxieties before and it all sort of came crashing down. Meanwhile, I had to continue my work which I wanted to do as a biochemist and had students working with me and was teaching classes and meanwhile dealing with all this so it was quite difficult. John: Now as I said to you, we have a limited amount of time and I wonder if we can jump right into what you and I did. You came to see me about this, which was a brilliant plan on your part. I’m just kidding. However, what we did—tell us a little about what we did to deal with the flying. Bob: Well, we sort of worked in stages. We first spoke about what brought all this on, which I kind of summarized, in the first place. Then, we tried to imagine what it would be like in the plane, and then I worked with John on a simulator, a flight simulator that tried to give me an even stronger feeling than just talking about it, an actual visual feeling for being in the plane. Going up then landing, flying and then landing. Then we went out to the small private plane field and we looked around and gradually worked up where we first went on an airplane and it was a small Cessna and sat in the plane for a while to give my self a feeling for sitting in the plane. The next step we were in the plane and we just taxied around the field, we didn’t take off. John: By the way, we have a pilot with us, I remember, because even though I was with you, I’m also a student pilot so I couldn’t really take you up if I wanted to, but we did have an instructor and the company that did this with us was very understanding and really wanted to see you be able to fly again so they were perfectly willing to do these things like traveling around the airport. They got permission and they traveled around the airport on the ground at first to get you back to being used to it. Bob: Yeah, they were very supportive. John: And by the way, I think it’s important to add that the big difference in being on a super liner and this little pane is that you get 270 degrees of view from where you’re sitting up in the front, I was sitting in the back. Also, we had a pilot who if you say to him, “I have to go down right now,” he will do it. If you say that to a 747 pilot, they probably won’t do it. Bob: You’re in big trouble right. John: That’s right. Bob: The next time we actually took off and we circled around the airport and came down, and each time it git a little hard, but a little easier in a way. John: By the way, I want to add that I think we went out and did a little celebrating afterward, and it’s very important that you do celebrate, that you do have some really nice reward for doing this because that’s what cements the success feeling. Bob: Yes. Absolutely. Then we moved up to taking shorter flights on a regular commercial plane. We took Cape Air once to Hyannis and once I think it was to Provincetown. That worked out quite well. They’re small planes, but they’re commercial flights. John: Well you did a great job. You were very nervous and I believe that if you don’t mind me saying this, that you took one small tranquilizer just to help a little bit and we didn’t do that every time, but we did it in the beginning. Bob: Yes, and it really did help. I took some Ativan and that did help. John: Ativan is a great drug for that. Bob: Yes. And then after those, we really graduated, I did to commercial jets, we took a flight to New York. I think we took two flights to New York and then I did one with my girlfriend without John and then I went to visit a friend in Washington, DC, which was for me a real triumph. John: By yourself. Bob: That was the longest one. Yeah, it was by myself. John: I was so proud of you because that was a really big jump and you did wonderfully well. Bob: I was a little trepidatious but it worked out fine and that was the last flight and you know it’s been a few years, but I wouldn’t have any trouble taking those flights again and I’m still hoping to reach for the stars in a way, and get back to my beloved Paris. John: We’re going to get you back to Paris, Bob. That’s the plan. Well, I want to thank you so much for giving your testimony here today. I’m sure there’s a lot of listeners, we have over 6 thousand listeners now, I don’t know if I told you. It’s just wonderful and of course, we’re talking about the Corona Virus sometimes, but mostly it’s about stories like yours. You’re proud of yourself and I have to say, I’m very proud of you also. Bob: And I’ve enjoyed working with you so much, John. You’ve made all the difference to me. All the difference. John: Well thank you so much. Thanks a million. And I’ll talk to you folks next week.
Mark14.07.2020 (00:11:20)
John: This is Doctor John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Today, I have an old friend of mine, by the name of Mark. He’s going o talk to us about his own experiences with Anxiety. Good morning, Mark. How are you? Mark: Good, John. How are you? John: Fine. First of all, I’d like you to tell us a little about yourself. What work have you done and where are you at today? Mark: I was born and brought up in Massachusetts. I was in the family business, I became a truck driver for 35 years and most recently my company filed for bankruptcy. A note to my listeners: When I interviewed Mark, I had no idea which of the 8 types of anxiety he would say he had a problem with. He alleged that he had no problems with the first 7, only a serious problem with the last one. So I’m going to skip that part of our interview and go right to the last type of anxiety: Post-traumatic stress disorder. John: Having been through an extremely stressful situation and sometimes getting flashbacks from it. Mark: Maybe. John: Can you tell us a little more about that? Mark: The death of a parent. John: Oh, of course. And which parent was that? Mark: Mother. 1973. John: Ok. You say this was ] traumatic for you. Why was this such a hard thing for you to deal with, if you’d be willing to share with us? Mark: Growing up without a mother I was just a young boy. John: How old were you? Mark: I was 13 years old. John: Oh that’s really terrible. Can you tell us how she died? Mark: She died in bed. She was a sick woman, but she died at the age of 49. John: Oh, that’s really sad. It was more than just very sad for you. You think it might have been traumatic. Mark: Yeah I think it was traumatic for me. John: Is it still traumatic? Like, do you miss her terribly every day? Or have you gotten more used to it? Mark: I’ve gotten used to it. John: How do you think you got to the place where you felt pretty used to it? Mark: Can I give you credit. John: Sure. Mark: When I met you, you were just a man at an AA meeting, and then when I was 10 years sober, then we talked. John: You don’t mind saying that you were my client for a while. Mark: Not if you don’t mind. John: No I don’t. I’d love to take the credit. So we talked about your mother, didn’t we? Mark: We did. John: Can you tell us a little bit about — was that successful? Do you feel like you were able to do better after that? Mark: I dealt with my pain with alcohol and booze and I was at a crossroads in my sobriety and you helped me through that without drinking. John: That’s terrific. I’m really proud of you and I think 34 years is an incredible achievement. Do you have any children? Mark: None. John: Ok. Who is the person you are the closest to, would you say? Mark: My oldest brother. John: So he went through the same trauma. How old was he when your mother died? Mark: He was probably 15. John: Do you think he had a really hard time with it also? Mark: No- Yes. I think he had a hard time but he picked a different avenue to deal with his pain. John: Okay. I’m not going to pry into that. What about your father? Was your father around at this time? Mark: My father passed away 3 years ago at the age of 97. John: Oh my God. 97 that’s . . . So how old was he roughly when your mother died? Mark: He was a few years older I believe. John: So around 50 years old. Mark: Yes. John: Was he helpful to you in dealing with such a young kid to lose his mother? Was he helpful to you? Mark: He would’ve been, but I didn’t know how to express myself. John: So he would’ve been there for you but you just weren’t able to tell him about it? Mark: Correct. John: This was pretty much something you kept to yourself. Mark: Correct. John: Did the therapy help the most because you were able to talk about her? Mark: Among other things, yes. I can handle death better. I don’t need to drink or drug. I can walk through the pain. John: And you give a lot of credit to Alcoholics Anonymous for that? Mark: Among other things. John: It’s often occurred to me that I feel sort of sorry for people that aren’t alcoholics because it’s such a wonderful club. It’s such a great deal of help. The 12 steps says that if somebody is hurting and they’re a fellow alcoholic, you have to help them. All over the world, I’ve traveled quite a lot and if I ever got into any trouble, I call up AA and they got an English-speaking person on the phone for me. Several times I’ve met with them, several times I just talk to them on the phone but it’s a wonderful club to be a member of. Don’t you agree? Mark: I agree. John: Well, Mark, thank you so much for talking with me today. I appreciate it and I wish you the very best. From my own life, briefly, about post-traumatic stress disorder. Not my own. If you listen to podcast 3 you know the story of the fire that happened to my family that killed my mother and two brothers and two sisters. The next day, the local newspaper, The Binghampton Press, had published on the front page on the center at the top of the paper a photograph that was the most poignant I think I’ve ever seen. It is a picture of our driveway next to our burned down house with five body bags lined up on it and a very good friend of our family’s father, the Rev. Leo Crawley, standing with his hat in his hand. Next to him, kneeling on the ground, is my uncle, who is also a Catholic priest. He was delivering the last rights to the bodies and in the picture, one of the body bags has been opened somewhat and he’s reaching in, as all priests giving the last rights have to do, and he put a blessing on the chard bodies of one of my family. I don’t know of course which one. This is with his right hand and with his left hand, he’s got his hand up to his mouth, and he just looks the epitome of the grieving person. Six months later he was dead, and I would hear stories about him going into the hospital and coming back out again. I asked one of the nuns who took care of him at the local Catholic hospital. I asjed a nurse what was the matter with him and she said, “Oh he has some kind of stomach disorder.” I have never heard anybody say exactly what his problem was but I can only assume that it was alcoholism and that he had to go in the hospital from time to time to get straightened out. The nuns of course were very good to him. He was the head of Catholic Charities for upstate New York. It was a huge job. I remember that when I went into the seminary to become a priest myself after high school, I had to go and visit the bishop in Syracuse upstate New York. He never asked me any questions about myself, but only about my uncle and how he was doing. The bishop said, “He’s a wonderful director of Catholic Charities. He does a great job, but I’m very worried about him because he’s sick so much.” This is only by way of saying that not only is PTSD, post-traumatic stress disorder, the most serious of all the types of anxiety, but it actually can be a killer. It can be as much of a killer as the Corona Virus. And it got my poor uncle. I remember when I was going into the seminary, I went to see him and he said to me, “John, don’t do it. It’s a very hard life. Don’t do it.” I was amazed. I thought he was a very happy priest, but it was very clear to me that he was not. I think that this having to give Extreme Unction as it’s called, the final rights to my family, just pushed him over the edge. I’m sorry to tell you such a sad story but often times anxiety can be a very serious problem. I’ll talk to you next week.
James12.07.2020 (00:15:13)
John: Hi, this is Doctor John Dacey with my weekly podcast, New Solutions to the Anxiety Epidemic. Today, I have a friend of mine, James, who’s going to be talking to us about his own situation and his own familiarity with anxiety. James, how are you? James: I’m doing alright, how are you? John: Good, thank you. I wonder if you could tell us a little something about yourself before we get started. James: Well, I am currently a junior in high school. I’m 17. John: How are you finding taking courses online? James: Online? It’s presented its own set of challenges. I wouldn’t say it’s better or worse than regular school but, I think there’s less work but it’s a different kind of material. It feels a little bit less meaningful. John: Yeah, I can understand that. People say that there’s such a thing as Zoom exhaustion. After you’ve spent a certain amount of time on Zoom that it’s much more tiring than sitting there and talking to somebody. James: Yeah, I don’t do too many Zoom calls because of the way the school has set it up for us but I get that. John: Today, what I would like to do is go over 7 of the 8 types of anxiety that there are and have you tell me, do you think that you have a condition in that area, the anxiety syndrome, and we’ll talk a little bit about if you’ve discovered anything that’s helped with you. Is that ok? James: Sounds good. John: I’m going to skip the first one which is called simple phobias because everybody has them, agoraphobia, afraid of falling from heights, things like that. We’ll start with probably the most common one which is social anxiety. Social anxiety is things like fear of speaking in public, feeling of not wanting to go to parties, that sort of thing. Do you think you’re bothered by any of that? James: Not generally. Sometimes I’ll have a little bit in large groups but generally speaking, that’s not something that I tend to experience. John: I remember some years ago watching you sing by yourself in front of probably 300 people in the audience and you seemed to be very calm about the whole thing and very confident. Is that typically the case? James: Yeah that tends to be the case. John: And you’ve been in some theater things where if you were going to have social anxiety, that’s where you’d have it. James: Yeah, I’ve been doing theater from a very young age so it’s something that I’ve got pretty used to. John: That’s great. Separation anxiety usually bothers younger people but sometimes older people. Separation anxiety is when you feel like if you’re not around a person who is very powerful, that knows how to take care of you, that you’re in trouble. Did you have any trouble starting school, for example leaving your mother? James: No, I don’t think I did. John: I don’t think you did either. The next one is called generalized anxiety. Just a general nervous feeling at least half of the time. James: Yeah, that’s the one that I definitely have. John: That usually comes about from a bunch of experiences that didn’t go so well for you, or that you feel like they didn’t go so well for you, and you become sort of nervous, on the lookout and what we call “hypervigilant.” Do you know what I mean when I say hypervigilant? James: Yeah, exactly. John: What about that does that seem like something that you’ve been dealing with? James: Yeah I think it’s something that I definitely have. It’s something I was diagnosed with and it’s something I’m on medication for. John: Oh ok. When you talk to your therapist who’s the one who did the diagnosis I suppose, what suggestions do they make about why you have this? Do you have any guess as to why you’re generally anxious? James: There’s a history of anxiety in my family. John: So, you think it might be genetic? James: I think genetics certainly has a large role in it. John: We say that everything is biopsychosocial in my field so the biological part would be genetics. Can you think of anything that psychologically might have oriented you toward that? From your experiences, for example. James: Yeah, I think some of it’s genetic and some of it’s from my experiences. Some of it from when I was younger, but it’s a combination of things that have added up to this. John: What is your position in the family? James: I’m the youngest. John: Do you think that might have anything to do with it? James: Being the youngest? I think there’s a certain level of insecurity about being young and having to prove yourself so I’m sure that played a role. John: Yeah, that’s absolutely true. Your siblings are pretty smart if I remember. They are smart people. James: They are. They’re quite intelligent. John: But as I think you know, I think you’re very smart and I’m inviting you to be in a group of mine called “Spirituality and Science.” It’s almost all adults, older adults for that matter but you’re probably the youngest person in the group but you seem to do very well supporting yourself. James: Well thank you. John: Do you feel nervous when you’re in that group? James: No, it’s a very relaxed environment. John. Oh, that’s great. Now that’s the first four and they tend to be less serious so let’s look at the next ones. Agoraphobia is fear of being away from home because of lack of control. Are you bothered by that at all? Do you feel nervous when you’re about to go on a trip or something like that? James: No. John: Ok so being out of the house or being away from the home is not a problem. James: No. John: The next one is called panic attacks. Those are feelings of fearfulness that seem to come from nowhere. They don’t seem to be related to anything. All of a sudden you start to feel really nervous. How about that one? James: Yeah that’s one that I experience. John: I’m going to guess that you probably think that’s genetic also. James: I don’t know if it’s genetic. It’s not something that I experienced when I was younger. It really didn’t come up until fairly recently, actually. John: How recently, James? James: About a year or two ago is when it first started and then it’s ramped up in the past year or so. John: When you say started, what was the first one like? James: The first one I think was actually in my chemistry class and it was just like I was doing my work. The whole room was silent and I was just doing my work and then all of a sudden, something changed and I’m not 100% sure what it was but something shifted and it was like I couldn’t breathe, my chest was compressing, shaking. It was a terrifying experience. John: That’s exactly how everybody describes it. We can be very sure you had a panic attack because that’s exactly what it sounds like. And it seems to come out of nowhere am I right? James: Yeah. John: Has anybody ever told you that it seems to be, but it actually isn’t? When I talked to my clients about panic attacks, I make an analogy to a bunch of cowboys out with a heard of cattle and if the heard of cattle starts to get nervous and one or two of them start to stand up, the cowboys have to start whistling and singing to calm them back down. Because if they all get up and going, then the next thing you know, you got a stampede on your hands and there’s nothing you can do except follow along. That’s sort of an analogy to what a panic attack is described as. I’ve had a couple myself, only about two, and it’s the weirdest thing, it seems to come out of nowhere but it really doesn’t. And what we tell people is, “you’ve got to try and be aware of your subconscious.” And that’s a really hard thing to do especially when the subconscious is saying, “something scary is about to happen” because you try to deny it. Nobody wants to be scared out of their minds. It’s a very unpleasant feeling and that’s what a panic attack is like. Instead of saying, “I think I’m beginning to feel the beginnings of a panic attack” you try and avoid it and it makes it worse. Does that sound right? James: Yeah. John: have you had any success with stopping them? James: Yeah I think I have. John: As I might say, “cutting them off at the pass.” Do you know what I mean? James: Yeah. It’s something that’s really hard to do. John: It is really hard to do. The biggest thing that’s hard about it is that you don’t want to be thinking about this. Am I right? James: Exactly. It’s something that I’ve had a lot of, so I’ve had to get pretty good at preventing them, cutting them off before they get to that point and recovering after them which is also something that’s I’ve struggled with because they’re pretty debilitating. They’re hard to come back from. John: One of the things that I’ve heard is that they’re especially hard for males because males are supposed to be strong and not give in to something like this. Am I right? James: Yeah, I think there’s some pressure. John: When you’re having a panic attack, do you tell all your friends around you that you’re having one? James: Generally, no. John: Do you feel a little bit ashamed of it? James: Yeah, I mean, it’s not something that I want to be experiencing. John: Yeah of course not. Of course, you don’t. And of course, with the stereotype that we have that men are so brave and tough, it’s not the image that we want to give to ourselves. “I can’t talk to you right now because I’m having a panic attack.” But, you know, that’s how it is. Okay, there’s only two more. OCD, which is obsessive-compulsive disorder. James: I think I have a little bit of that. John: What’s your evidence? James: I find myself having to do things a certain number of times. It’s pretty manageable and it’s not super severe, but there are certain things where like, I have to flip a coin in my hand a certain number of times or whatever so it’s even on both sides. John: James, my understanding of OCD, or obsessive-compulsive disorder, is that it is not necessarily coming from a learned experience but from another part of your brain called the amygdala and that’s it’s definitely genetic. Do you have anybody else in your family, you don’t have to say who, but do you have anybody else in your family that has trouble with this? James: Yeah, definitely. John: Would that be your father or your mother? James: I believe it’s my mother’s side. John: And anybody else in your family? James: Yeah, some siblings. John: Ok, well dealing with that is a tough one and what you have to do is basically reprogram your amygdala, is what we say about it and it means when you got to go back in the house or you got to do somethings repeatedly because they make you feel safe, you know that old phrase, “don’t step on a crack, you’ll break your mother’s back,” do you remember that? James: Yeah John: That sort of OCD-ish because it means that if you don’t step on a crack, then your mother’s back won’t be broken. But if you do step on a crack, your mother’s back will probably not be broken. It just makes you feel a little bit better that you can do something about which you almost really have no control. Am I right? James: Right. John: Okay, James, one more. Post-traumatic stress disorder. You’re pretty young for this. It’s usually soldiers and people who have been in battle or firemen who have seen burnt up bodies. Do you think you have anything in PTSD? James: I don’t think so. John: Well, James, I appreciate very much you talking to me about this. You’re very brave and I think also one of the things it does is it shows other males that it’s OK to talk about some of this stuff and in fact, it’s really necessary to talk about it, even if you don’t feel like it. Would you agree with that? James: Yeah, 100%. John: Okay, James. Thanks a million for participating today, I appreciate it.
Adols07.07.2020 (00:00:00)
I this is Dr. John Dacey coming to you with my weekly podcast dissolution study anxiety epidemic today Today I’ll be speaking to you about how to deal with the problems teenagers are facing with the coronavirus. Many of my listeners, I know, are the parents of teenagers, but even if you aren’t, you probably know a few. It’s quite possible that you could be as helpful, or even more so, to them than their parents. For example, “Jill Emanuele, senior director of the Mood Disorders Center at the Child Mind Institute in New York City, says ‘[COVID 19] is having an impact — particularly on kids who are perhaps more vulnerable and already have existing mental health issues.” Because they are teenagers, they typically lack the coping skills of adults. They may really need your help! For one thing, they probably lack the capacity necessary to accurately and openly express their emotions. Nevertheless, their psychological health depends on their ability to discern and state those feelings. So step one is to ask questions, such as: “Objectively, what is the level of your ability to handle this pandemic on a scale from 1 to 10?” “Do you find yourself staying up late at night and sleeping all morning?” Such behavior runs contrary to healthy practices for most teens’, whose circadian rhythms will be disrupted by this new drill. Remind them of how different their schedule is from when they were attending school. Then try to work out some compromise on when they go to bed and when they get up. “Generally speaking, would you say that this is a happy or unhappy time for you?” Remember, for some teens, reduced chances for social relations, pressure to get good grades, and the impossibility of competing at sports, negative occurrences for most kids, actually may be seen as positives. Even this outcome may ultimately be negative, howeve]\r, because they might feel ashamed of the relief they are experiencing from reduction of these pressures. And always remember, most teenagers are not known for their openness with adults, and especially not their parents! This is particularly true if they are tormented by such demons as suicidal thoughts. “If you or another family member are essential workers, are you concerned about what that means for your health and/or theirs?” “If your family’s financial situation has just deteriorated, are you more frightened by that than your family realizes?” “Even if you are only dealing with having school canceled and sheltering in place, changes like those have a big impact on your social life, right? In what ways do these changes interfere with your psychological balance?” “Do you sometimes worry that you are too dependent on your family?” After all, this is the time of life when most teenagers start to become more reliant on themselves and less so on their parents. Again, really huge events in teens’ lives are slipping away from them in real time: canceled sports seasons, plays, dances, school concerts, clubs, tests they’ve prepped for for months, graduations, internships, jobs — the list goes on. The thrust of these questions is not necessarily to get correct answers. For one thing, they show that you are genuinely interested in your teens’ attitudes and worries. The main goal is simply to get them to talk about their thoughts and feelings. In of itself, this exercise will reduce some of the pressure they feel. Also by listening reflectively (see podcast #30), you can show that you care without overwhelming your teen with unsolicited advice. As Dr. Emmanuelle stated recently, “Of course, your teen will have bad days (and nights) as the pandemic wears on. Note how long these problems are lasting, and maybe write them down so you can clearly remember. If it’s been a few weeks, or the behavior seems like it’s getting more intense, that’s a potential red flag. If you are concerned, reach out to your child’s pediatrician or to a mental health professional. Now that so many clinicians are offering their services online, in some ways they’re more accessible than before. If you notice that your own teen is struggling a bit, experts say it’s OK to be honest with them about your own fears and frustrations. Tell them when you’re feeling anxious, and reassure them that it’s probably an appropriate reaction to a really stressful situation. If you’re having a bad day (or a bad string of days), talk about it. Just remember: Don’t fully unload all of your concerns on your teen. You will need to make a judgment about how much they can successfully take. “The way you’re handling it communicates to them the way they should handle it,” Emanuele says. “Get hold of your own feelings on it, your own anxiety, so you can help your kids.” The World Health Organization has announced that it is developing guidelines on mental well-being, which they label “burnout.” Burnout is a syndrome resulting from “chronic stress that has not been successfully managed, characterized by feelings of exhaustion, reduced effectiveness, and negative or disconnected feelings toward one’s life.” In my experience, this pretty well describes the feelings that many adolescents have when they experience burnout. For example, when it comes to socially distancing, as required by the coronavirus, teenagers often believe they “can’t stand it anymore!” It has now been about two months since our country has been requiring this behavior, and most of us are getting very tired of it. Unfortunately, such behaviors are going to be required of us some time to come (none of us knows how long that will be). Just discussing the specific reaction, called burnout, can help to dispense the inevitable anxiety that goes with it. Teens, it seems, are particularly vulnerable to emotional overload. When I was that age, we never had to socially isolate, but there were plenty of events that could lead to emotional burnout, such as the polio epidemic. When that happened to me it probably set me up for later PTSD. I’ll tell you that story now, which I call: Drunken Auntie I believe I was 14 when I first saw my mother naked. It was night, around 8:30, I was watching TV, cuddled up in the blanket because I had the flu, and she was taking a bath. My father and my other siblings had gone to watch the circus set up. Dad could not afford to take us all to the show itself, so this is what our family did instead. Suddenly someone began pounding on our back door and growling, “Let me come in! You better open this door. Let me in!” Terrified, I raced upstairs and banged on the bathroom door. Now my mother could hear the gravelly voice, too, and ran nude from the tub past me to her bedroom. When she had thrown on some clothes, she barked, “Call the police and call Mr. Seppa!” Letter was our next-door neighbor, and he came running, soon pointing his hunting rifle at the interloper! Guess who -- my mother’s sister, my 24-year-old aunt Ann. No surprise – she was very drunk! After we invited her and Mr. Seppa in, we tried to explain to her that her foolish action had almost gotten her shot, but Ann couldn't get it. She just thought the whole thing was hysterically funny. Soon things began to calm down and my mother started making coffee, when another dilemma arose. We could hear the wail of a police siren coming toward our house. Who would be the one to open the door for the hyped-up police officer, his gun drawn? What can you do that might help your child to deal better with the anxiety-causing incidents of life? Here are some questions you might ask when your teen and you have reflected on this vignette: What do you think should be a checklist of reactions that anxious persons need, in order to manage crises like this? Can you imagine an app that would tell you exactly what to do if you found yourself in a situation like this one? How could adjusted reality techniques be useful in dealing with the repercussions of this terrifying experience? In summary, let me just say that questions, almost any questions, are likely to help your teen-age child resolve some of these quandaries. Why not give it a try? See you next week.
Biological Formative Evaluation, Part 330.06.2020 (00:18:30)
This week, I continue with my instruction in how to evaluate your anti-anxiety plan as you carry it out. As I said in an earlier podcast, such evaluation not only offers you an objective view of how well you’re doing, but also helps you to do better. What’s the best type of stress-reliever for you? Here's another way to discover what are the best type of strategies for you to use: Read the statements below, and circle those that make the most sense to you. In total, it would be best if you could choose FIVE of the 21. To start, simply circle the numbers of the FIVE strategies you like the best. If you can’t decide between six, or even seven, that’s fine. Write those five numbers down on a piece of paper. For now, pay no attention to the letter that appears at the end of each sentence. This leaves 15 unchosen options, and for now, you may disregard them. Finally, the best strategy may be to listen to this podcast once, then actually do it by reading it in transcript form, which I also provide. The benefits of yoga are readily apparent. P I am more likely to get help with my anxiety from psychology than from religion. M I would love going on a vision quest, during which people isolate themselves to meditate for several days at a time, with only water to drink. N I think a lot of my anxiety probably comes from unconscious guilt feelings. A If you want to be happy and serene, you have to believe in the idea that “Wherever you are, there you are!” M I believe in the motto, “Want what you have.” Most of us want too much, and it makes us unhappy. "Desire is the direct cause of most unhappiness." B The best tranquillizer is listening to monks chanting. R Stretching ligaments, as well as muscles, truly calms a person down when she gets agitated. P Life is an illusion. It is a mistake to take it too seriously! B Some people say that repeated motions such as bowing you head can relax you. R I find that saying the rosary beads (or worry beads}, with a set prayer for each bead, works best for me. R It makes sense to me to replace the term "God" with the “Great Spirit.” N When you have wronged another person sometime in the past, the best policy is, “admit it honestly and ask for forgiveness.” A One of my strengths is my awareness of who I really am. A An excellent way to avoid becoming anxious is to be “mindful of my mental landscape.” M I can easily imagine why staring at a candle might do you some good. R Most of us are tense and nervous because we are trying too hard to keep up with the Joneses. B The best way for me to relax is through is tensing and untensing my muscles. P I try to avoid perseverating on fear about the future or some regret about the past. M I agree that passing the smoke from a burning bundle of dried sage around your body (called smudging) is a spiritual way to calm your nerves. N Oxygen, when breathed the right way, is a terrific tranquillizer. P You should have a list of FIVE numbers of statements that you like best. One final step is called for: to see which type of strategy you like best. This is where the letters that you see at the end of each statement come in. These letters represent six methodologies that are quite different from each other. Your choice of the FIVE statements above should indicate which of these systems appeals most to you. They are: A= Alcoholics Anonymous (even if you’re not an alcoholic); B = Buddhism; M = mindfulness, N = Native American; P = physiological exercises; and R = repeated rituals. Perhaps you picked only two types of strategies because you especially like the methods they are grouped under: e.g. Buddhism and repeated rituals. If so, you will probably want to learn more about those sources of counsel. Easy to do online. On the other hand, perhaps your choices included most of the methods. That would be a statement about your openness to many different ideas. At any rate, it will prove useful to you to have some idea about what works best for you. I will have more to say about this later Self-egulation And now, consider: Most artists are slovenly, and most scientists look like they have springs coming out of their heads. Both are wildly eccentric, and neither can focus on anything but themselves. They are so intent on their big ideas, the rest of their lives are a mess! Are these three statements true? As with all stereotypes, some exemplary people are like this. Not many, though. My research and that of others have found that most highly talented people are, in their personal habits, pretty much like the rest of us. This is because gifted individuals tend to have a higher than usual ability to control their emotions and behavior. And that is because, no matter how innovative their creations, people won’t want to hear from the innovator if she is socially inappropriate. In fact, a symbiotic relationship exists between creativity and self-regulation. To be creative, you must be able to visualize a desired outcome and also to conceive of a plan to achieve it. Both these elements are also essential to self-control. One needs self-control in order to use time wisely, to work diligently, and to have the perseverance to fully develop their wishes and goals. And all of this needs to be evaluated! People who are good at self-regulation learn better than their peers. For example, they: Seek out advice and information. Commonly seat themselves toward the front of a conference. Seek out additional resources. Voluntarily offer answers to questions. Manipulate their learning environments to meet their needs. Last but not least, perform better on tests of performance and achievement. That’s quite a list of advantages. Together, they make self-regulation one of the highest priorities of in our battle against anxiety. Now, suppose you are walking along a road on a warm summer day and your stomach is growling. You are SO HUNGRY! However, you realize that the nearest place you can get food is almost a mile in either direction. Even if you run, you know that it’s going to be some time before you can satisfy your hunger. You can be miserable until you get to the food, or you can use self-control. How can you manage your feelings so that they don’t drive you crazy? What are some techniques you might use to distract yourself from your hunger? Write down some of the methods that have worked for you in the past. You might also want to ask some of your friends, your work associates, your neighbors, or others what they do in these circumstances. When you get through this activity, perhaps you should make a list of the techniques you find useful, and memorize it. . Lest you think that self-control is only about social goals, listen to Steven Sosny: “Research also shows that self-regulation skill is necessary for emotional wellbeing. Behaviorally, self-regulation is the ability to act in your long-term best interest, consistent with your deepest values. Violation of one's deepest values causes guilt, shame, and anxiety, each of which undermines wellbeing. Emotionally, self-regulation is the ability to calm yourself down when you're upset and cheer yourself up when you're down. Whether subtle or intense, conscious or unconscious, overt or covert, all emotions have one of three motivations: approach; avoidance; and attack.” Let’s explore this idea through a couple of activities. Imagine that your boss has just yelled at you because she thought you upset one of your workmates, but it wasn’t you. When you told her you didn’t do it, she wouldn’t believe you. How would you feel? What emotions would you have? Write down as many as you can: ________________________________________________________ ________________________________________________________ ________________________________________________________ Please add some more. Now let’s look at these feelings. Which ones seem the socially appropriate ones to you? Which emotions do you wish you didn’t have? What can you do about each one? Finally, here is the last of my three types of anxiety self-analysis questionnaires: The Dacey Questionnaire - Social Think about how much each statement is true of you. Then mark the statement on the right with an X after the phrase that indicates how much you think that statement is true about you. Be as objective and forthcoming as you can. Symptom Scoring 1.Most of my friends would say that I am not a person with a confidant personality. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 2. I think the people who trust others are being very foolish. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 3. I would judge myself to be a fearful person. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 4. I am often worried about what trouble people can get into if they are not careful. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 5. Most of my friends would say I am not easily frightened. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 6. I believe I am seen as a person who is truly in charge of herself. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 7. I am usually very relaxed; that is, I seldom have a trouble in the world. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 8. I am unhappiest when I am at a dance or party. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 9. I enjoy myself more when I am home than when I am travelling. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 10. I am the kind of person who trusts everyone. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 12. I like to give everybody a couple of chances, before I am ready to reject them. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 13. I often worry that people are feeling critical of me. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 14. When I find myself with people I don’t know well, I try to get away from them as soon as possible. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 15. I really enjoy going to places that others think of a somewhat dangerous. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 16. At a party, I am definitely likely to be one of the “wallflowers.” Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 17. Although I am a good pianist, I usually refuse to perform in front of other people. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 18. In crowded places, I almost always start sweating, even though the air is cool. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 19. I enjoy strolling around big cities, even if I sometimes get lost. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 20. I’m pretty flexible; for example, I don’t think I have any obsessions or compulsions. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ This survey measures a broad spectrum of feelings you may have about yourself. The best way to use it is to fill it out before you design your anxiety plan, and then when you have finished it. You can also use it when you are carrying out your plan, to see how you are progressing. See whether the posttest yields a significantly lower score on anxiety than the pretest. If so, your plan is successful. Scoring: For items 5, 6, 7, 12, 15, 19, and 24, the scoring is as follows: Strongly agree = 4, Agree = 3, Disagree = 2, Strongly disagree = 1. For the rest of the items, this scoring is reversed, that is; Strongly agree =1, etc. Add up the scores for each item to get one overall measurement of your social anxiety level. Soon I will help you look at summative evaluation, the measure for measuring the success of your entire plan. Until next week …
Dr. Elizabeth Bracher, Part 323.06.2020 (00:15:28)
John: Hi this is Doctor John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Last time, we were talking with Doctor Biz Bracher about college students and social anxieties. Today I’d like to ask her to continue this, and talk about the difference between seniors and freshmen. She teaches both groups and I think it’s going to be interesting to hear what she has to say about that. Good morning Biz. Biz: Hi. So the first-year students seemed to settle into distance learning and their new home situation over time. It certainly hasn’t been ideal. Any of us who have spent hours on Zoom and trying to teach a seminar on Zoom and have the same sort of energy and rapport in the classroom will know that this distance learning isn’t as easy as it might appear. But the first-year students have settled into it. John: By the way, how about for the teacher? Is there anxiety for the teacher also? Biz: Most absolutely. I think that for teaching a seminar course of 20 students when you’re looking at sort of what I call “the Brady Bunch” of squares across. I pride myself on my ability to draw students into the conversation. I notice their physical response to conversations and I can draw them in saying, “Suzzie, you look like you have something to say on this topic” or “John, what do you want to add to this conversation?” and it draws them in in a very comfortable way. It’s really hard to monitor that online. John: But you don’t do that at random? You’re saying you pick students on the basis of what they’re presenting as to whether or not they want to say something, right? Biz: Yeah absolutely. John: And that’s harder to do with the Zoom? Biz: It’s so much harder because first of all, my 50-year-old eyes can’t also see the detail on someone’s face but how do I know that their facial expressions are reacting to what I’m saying or are they watching something else online? Are they doing email? Are they really checked in or checked out of the conversation? There certainly have been many students who I don’t think were really giving me their full attention. And who can blame them? There are so many things happening around us that you don’t have them in a classroom so their attention is pulled away. Ultimately, I think the first-year students transitioned and the light at the end of the tunnel for this semester and going through exams and such, they still have three years of college left. While they’re sad about this semester ending, they’re hopeful that this is not the college of the future. Our seniors, they’re still not settled with it because — and this is my hypothesis of it — I often refer to our students or, as a parent, our children as the baby on board generation. They’re the playdate generation. College students these days and millennials, they were raised to have their days scheduled first by their parents. They came home from the hospital in cars that had a placard that said “baby on board” as if everyone else was going to drive around that car differently because there was a new life in that car, as if the other people driving around them didn’t matter. Why isn’t there a “70-year-old on board”? John: I never thought about that before but that’s a terrific insight. I like it very much. Biz: But why is there any more value? So there’s this idea of protecting them, right? And then push that out as they get older, having playdates. There’s lots of research and conversation about “free-range kids” and kids that are let out to go play and maneuver the streets of the suburbs by themselves. More than not, parents mitigate those situations so rather than just telling your kids to go outside and play and come back when the streetlights turn on, as you and I were told to do as kids, our kids are being scheduled. I was caught off guard when my oldest child turned to me once, he was three or four years old and he said, “Do you think Ben is available today?” as if Ben had a schedule and somebody organizing his time. John: Which was true, right? Biz: Absolutely. Which was true was that I had to call his mother and find some time and we arranged for a drop-off and then we played games with the kids. We didn’t just send them out into the yard, that was scary. Then they got into school age and in schools, everything is organized for them and they’re being taught to the test, very few schools allow for an open curriculum of bringing in new ideas and such. John: Excuse me for one second but what does “taught to the test” mean? Biz: To teach to the test meaning whether it’s the state regulations of exams to benchmark our students or if it’s in the high school AP exams or final exams, what students are going to be tested on in the end to show proficiency. Teachers are spending their time teaching to the test as opposed to just general learning and curiosity. Naturally, college graduates get out, and then, I’ve always noticed that while commencement day can be as much of a celebration, it’s sad for the student. My students start anticipating it months before saying, “don’t talk about commencement day. That’s going to be so sad.” I pushed them on that to think about the fact that by the time they graduate from college, sometime in May, they’ll be ready to leave. In most cases, they will feel like they did all they needed, all they wanted, and granted they will miss the proximity of their friends, but they don’t feel unprepared to go out into the world. They don’t need to take one more semester of classes or sit through one more set of exams they’re ready to move on. It’s not until September the next fall that their sadness really sets it because it will be the first time in their memory that they won’t be going back to school. For most people, some of them will be going to grad school but the vast majority of college students are going into jobs or volunteering situations and also in that, this will be the first time not all of their peers will be doing the same thing. Some will be going to grad school, but some will be in the world of work and some will be volunteering and some will be taking a year before they start grad school, and so there is no grand normal anymore. Everybody in their grade isn’t doing the same thing. And that to them is anxiety-provoking. There’s no clear road map. But what I noticed this year is that that process of not having a road map and not being together as a class happened, not only earlier but not on their own schedule, not in a predictable manner so this transition that was going to happen anyway in May has happened much earlier, almost like pulling the rug out from them. John: It was so abrupt, is that what you’re saying? Biz: It was so abrupt, unexpected, and uncontrolled. We were at a school where we just had spring break and so students left campus with all of their stuff. Many universities and colleges across the country told their students, go on spring break, take an extra week, and then come back and this will all be resolved. We know that that didn’t happen. Those students went on spring break, they then went home, their stuff was on campus. I know students who had to fly across the country to go get their stuff and come home or had to pay services to pack their dorm rooms up and send their stuff home. There was just this crazy amount of detail and orchestration and not knowing what it all meant. And then in the midst of it, the economy is bottoming out. Many students who have been promised jobs were told in the worst-case scenario the job no longer exists or in the best-case scenario we were gonna have you start in June but now you’re not gonna start until July or October which put a little more anxiety on students. And on top of it, many of them were going to urban or metropolitan areas they aren’t necessarily from so they’re supposed to be starting a job in July in New York City but they don’t have anywhere to live because they didn’t have time to get roommates and go to see apartments and find someplace to live so there’s still a lot hanging out there in the balance for the seniors. Whereas the freshmen, god willing and knock on wood, are going to be back on a campus next fall. And if they’re not on a campus, at least they’ll know that they’re going to be in online classes. Now I’m not saying there’s still not a lot of anxiety because parents have lost jobs and financial packages have changed and they need to decide whether or not they want to be in distance learning. Is that the kind of educational experience they want - no one wants it but are they willing to endure it and pay for it. So I’m not saying the freshmen are totally out of the woods but the stakes are a lot less extreme because seniors are now moving into the world of work and into the world of grad school. We have students who are applying to medical school who haven’t even sat for the MCAT yet, they have no idea what their scores are for their standardized testing. That’s provoking a lot of anxiety among premed students. There’s just a lot of unknown and this is a generation that has never had to deal with an incredible amount of unknown. Even within their unknowns, they had a cadence and a road map of sorts. John: By the way, it occurs to me that a lot of people who are premed students are beginning to think, “Boy if I become a doctor then I’m going to be really risking my life.” Do you find decrease in the number of people who want to be premed students? Biz: Well I don’t know nationally those numbers and I am a premed advisor at our university and in these last 8 weeks I’ve been meeting regularly online with seven med school candidates and actually I have found every single one of them have been more committed to their vocation of medicine and that has been really inspiring. Some of them were working in labs, they were already out of their undergrad studies and taking a year to work in labs and gain some experience and I have a couple students who have been redeployed to the front lines, two students who are working nights with COVID patients as nurses, aids and watching people die and they’re in the worst situation because there’s not much that medical doctors can do, it appears that there would be even less for a nurse’s assistant, someone who has no formal medical training yet and is just waiting to get into medical school but quite honestly in the midst of COVID and people dying without their families, they found that they have been incredibly important to their patients and their patients’ families as they assure and comfort families that they’re carrying for their loved ones as they’re dying. It’s been an incredible amount of anxiety on those students but I would say that every single last one of them whether they’ve been redeployed and working with COVID patients or they’re in labs or they’re still in undergrad waiting to finish undergraduate studies in order to apply to med school, every single one of them has been more committed than ever to be a part of the medical community. John: Biz, unfortunately, our time has run out again and I have to say I really would love to have you come back. I think a lot of my listeners, even if they don’t have college students right now, they can understand a lot more about anxiety by listening to what you have said so thank you very much and I will be inviting you back if you’re willing to do it. Biz: It’s always my pleasure to talk to you and your listeners. John: Thank you so much.
Dr. Elizabeth Bracher, Part 216.06.2020 (00:12:23)
John: Hi this is Doctor John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Today, I am being revisited be one of my best colleagues and also respondents to this podcast. Her name is Doctor Elizabeth Bracher and she and I teach a course together. We’re hoping to teach it this fall. The last time we met, she talked about separation anxiety among college students. Today, she’s going to talk about some of the other anxieties that college students experience. I just want to say, “good morning to you.” Biz: Good morning, John. Thanks for having me. John: I was very very happy you were willing to come back again. What do you have to say about social anxiety among students? By that, I mean nervousness about going to parties, nervousness about speaking in public, raising your hand in class, that sort of thing. Especially under the circumstances that we have now. I presume you’ve been teaching by zoom, is that correct? Biz: Yes, I’ve been teaching two classes of freshmen and one class of seniors, so I have students at both ends of the spectrum. John: What’s the difference between them? That would be quite interesting. Biz: Yeah, it is interesting. Well, no one is going to parties these days unless they’re virtual zoom parties, right? I think that there was a lot of anxiety that I didn’t quite anticipate in the first weeks of social distancing and when we were sending students back to campus. It was interesting that our university made the announcement on Wednesday after classes finished that day, so about 5 o’clock, they made the announcement that students had 4 days to get themselves home. Unlike many schools, we were already through spring break so students were asked to pack up their stuff and go home for the remainder of the semester. My immediate concern was for the freshmen, my first-year students because what I was starting to see in them was a trust in the process where things start to come together in the last few weeks of their first year. At this point, they were back from spring break, they were about to start the housing selection for their sophomore year, they were committing themselves to majors - either recommitting after taking some classes and feeling confident in their first decision of major, or they were confident in having some experience in the labs saying, “I thought this was going to work and I’m not so interested in this major as I thought“ and their willingness to explore a little and try some other things out. They’ve also been through a semester so they’ve received grades and learned how to study for exams so the exam period that was approaching wasn’t as concerning or anxiety-provoking as the first semester, and friendships were starting to solidify. Clubs and organizations were starting to plan for next year, they were applying for executive board positions in organizations and clubs, they are committing their time. Everything was starting to come together. It’s coincidentally that here in the northeast, the weather was also getting nicer and the days are getting longer and winter was subsiding. For a whole lot of reasons, the spring semester is very important to the transition to college. So many people think that it’s the fall semester, but really everything starts to even out and fall into place by spring semester to the point where the majority of first-year students go home after their first year and start to feel like their university is a home. I’m not trying to submit that they’re trying to trade one home for another but it’s a place where they finally feel confident and secure. John: Let me interrupt you there for a second. Can you make a distinction between reasonable fears that they have and anxieties which are unreasonable concerns about the future? Biz: Right, well some students certainly have some reasonable concern about how this is all going to play out because they’re not in their same orbits. They might be on the other end of the country or the other end of the world in different communities. Unless you’re going to a particularly small focused conservatory or such, most of the students in this country will go to a university or college that’s bigger than any place they’ve ever taken classes before. Whether it’s a big state university of 50,000 kids or a smaller liberal arts private school that’s 2,000-3,000 kids. In most cases, it’s still the biggest school they’ve ever gone to. Some of that concern is reasonable. It’s anxiety only in that it’s new. But then there’s the anxiety that comes with worrying and the true sense of anxiety is worrying about what might happen even though it’s not likely. For example, “I’m worried I might never make friends.” You and I know that’s an extreme anxiety about belonging, but over the course of their time, they will all develop a sense of friendship with some core people in their lives, so there absolutely is a distinction. What I noticed in the first weeks of the pandemic was that the real anxieties started to come out and they showed themselves very quickly. That Thursday that I went back to my office to start to wrap things up, I had a line of students outside of my office wanting to discuss - they didn’t even know what they wanted to discuss but they needed my attention and they needed to voice their worries and concerns. So much so that some were wringing their hands and were physically agitated and others, you couldn’t even tell what their response was. They were almost paralyzed with not knowing how to put one foot in front of the other because this was so unexpected and so out of the ordinary and there was no road map for it. What people all over the country were telling them was, “Yeah, it’s bad but oh you poor seniors and oh you poor freshmen. You never had to be pulled away from your university like this.” That provoked a lot of anxiety. The students that I saw that were the most immediately troubled were students that were struggling with eating disorders, both male and female, and students that I had no idea of their eating disorder or their eating struggle. And many of them also admitted to me struggles with OCD. John: OCD being obsessive-compulsive disorder. Biz: Exactly. What I surmised by that was this lack of control. That suddenly this structure that they have always known was being pulled out from under them and they didn’t have time to think about it, many of them needed plane tickets they couldn’t organize and put their stuff away and move out. I have a son who’s in college and we ended up taking most of his roommates, he had seven roommates, we took most of their bedding home, we cleaned their kitchen out and everything because they weren’t planning on leaving. There was no order or system to it. They were just being told you need to leave in a couple of days and get home and then we’ll start online in a week and we don’t know what that will look like but just hold on. First-year students were concerned about that because they were being pulled from their university and they were just starting to get a groove and seniors were equally distraught because they didn’t see anything tethering them to the future. They were leaving campus for good. John: Can you say anything about males and females being different? Who had the most trouble? Biz: I would have thought that there was going to be a difference between the sexes and I saw equally troubling in male and female. The only difference was that I had a few females come to me because their roommates or friends brought them to me and said, “You need to talk to her. You need to process this.” And the males suffered quietly because they don’t want to admit their weakness, whereas women will talk about their emotions a little more easily. If men were brought to me it was by a female student, a female friend, but the numbers were about equal. That was at first surprising to me but then I thought to my self, “Of course. Eating disorders and OCD are about trying to have control of your life in hopes of limiting the possibility of catastrophe of some sort. John: Exactly. Biz: When I look back on it, it seemed a lot more obvious than I had expected. The other interesting thing to me was comparing the first-year students to the seniors. Over time my first-year students transitioned back home easier and into distance learning easier than the seniors did. John: I have to stop you there because time has run out but I’m hoping you can come back next week and talk some more about this fascinating view that you have of college students.
Biological Formative Evaluation, Part 209.06.2020 (00:00:00)
This week, I continue with my instruction in how to evaluate your anti-anxiety plan. As I said in my last podcast, such evaluation not only offers you an objective view of how well you’re doing, but also helps you to do better. Bio-Counting One of the best things you can do is to design charts to track more objective data. Measurements such as pulse rate, blood pressure, oxygen-in-the-blood calculations, and galvanic skin response are also relevant, although the last three require equipment. For charting your relative pulse rate, press the largest two fingers of your left hand on your carotid artery at the side of your neck, and as the second hand hits 12, begin counting beats. As the second hand passes 4, stop counting and record the total number of beats you counted in 20 second, times 3. This will give you a good approximation of your actual heart rate. You can make these entries at various times of the day and/or before, during and after an anti-anxiety activity. One word of caution: as with anything else in life, it is possible to overdo chart making: The Obsessive Pulse-Taker I have advocated a number of evaluation methods that involve self-evaluation. I should warn you about a possible backlash, however. I once was asked to counsel a 21-year-old woman, Cassie, who was diligent in her efforts to monitor her anti-anxiety plan. She unfailingly took her carotid pulse before, during, and after each effort to confront her panic. She meticulously entered these readings on a chart that she had carefully designed. Unfortunately, instead of getting lower and lower readings, her rates gradually ascended. She was very frustrated by this, finally to the point of tears. When her parents called me, she had been experiencing the problem for about three weeks. When she and I discussed the situation, her plan made sense to me, and even more important, Cassie really liked it. Further discussion uncovered the core of her difficulty. She wanted too desperately to succeed. Many anxious folks are perfectionistic. Whether that causes the anxiety, or the anxiety causes striving to be perfect, we do not know. At any rate, in Cassie’s case, she was so worried that her pulse readings would not drop, of course they rose. When anxiety is mixed with perfectionist leanings, it is probably best to de-emphasize evaluation and concentrate on keeping your nerves calm. Now for a quick look at the other three techniques. Blood pressure, which is associated with anxiety in both its upper number (systolic) and lower number (diastolic), can be checked by a blood pressure meter available at your local drugstore for around $30. As with heart rate, you must be careful that your drive to reduce your anxiety doesn’t drive your blood pressure up. Two other bio-indicators of anxiety levels are blood oxygenation, measured by an oximeter and galvanic skin response, measured by a GSR meter. These can be obtained from any number of medical supply sources such as Amazon. It probably won’t be necessary for you to use either of these, but if you think you’d like to come read more about them online. The next item on the agenda is a questionnaire about biological factors that affect your level of anxiety. When you have scored the test, I will give you data as to how you compare to the hundreds of others who have taken this test. The Dacey Biological Factors Questionnaire Think about how much each statement is true of you. Then choose the statement after the phrase that indicates how much you think that statement is true or untrue of you. Be as objective and forthcoming as you can. Symptom Scoring 1. I am worried at least a quarter of every day. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 2. I wake up soaked in sweat at least once a month. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 3.I would say I am almost never fearful of catching other people's diseases. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 4.A number of things scare me, even though they are not really dangerous. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 5. I sometimes find myself sweating with panic, and yet I don’t know why. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 6. I expect that even friendly dogs are likely to bite me, although I must admit that none ever has. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 7. Nothing awful has ever happened to me. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 8. I almost never worry about whether dirt and germs will make me sick. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 9. I have never gone anywhere on a weekend. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 10. Most nights, I am awakened by a scary dream. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 11. I enjoy myself more when I am home than when I am away. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 12. When I leave home, I usually feel like going back to make sure things are okay. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 13. Few things give me a bigger kick than riding a roller coaster. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 14. It doesn’t bother me when my heart beats faster than usual. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 15. I must admit I am usually on the lookout for danger more than is necessary. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 16. I hate speeding of any kind, no matter what the vehicle. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 17. I really enjoy trying out new places, even if they are somewhat dangerous. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 18. I love to walk in the woods, because I feel that fresh air is good for my lungs. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 19. I am not aware of obsessing over my health, airborne sicknesses or disease. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ 20. I worry a lot that if my anxiety makes me so scared, I might have a heart attack. Strongly agree ___ Agree ___ Disagree ___ Strongly disagree___ This survey measures a broad spectrum of feelings you may have about yourself. The best way to use it is to fill it out before you design your anxiety plan, and then when you have finished it. You can also use it when you are carrying out your plan, to see how you are progressing. See whether the posttest yields a significantly lower score on anxiety than the pretest. If so, your plan is successful. Scoring: For items 1, 2, 4, 5, 6, 10, 11, 15, 16, and 20, the scoring is as follows: Strongly agree = 4; Agree = 3; Disagree = 2; Strongly disagree = 1. For the rest of the items (numbers 3, 8, 13, 14, 17, 18, and 19), this scoring is reversed, that is; Strongly agree =1; etc. Numbers 7 and 9 is not scored lying. as they measure, . Add up all scores to measure your biological anxiety. Save your data – later you will combine it with other results to get one overall level. This self-report measure is used to analyze the biological part of your anxiety. In accordance with the biopsychosocial model, the next two tests will involve psychological and social areas of your life. Remember, these tests are designed for formative evaluation (measuring progress as you plan is carried out). The final questionnaire I will ask you to take, one with 60 questions on it, will be for summative purposes. See you next week!
Patrick02.06.2020 (00:00:00)
John: Hi this is Doctor John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Today, I have a friend of mine, Patrick, who is going to talk about his own anxiety and what he’s done about them. How are you doing, Patrick? Patrick: Very good, John. Great to be here. John: Well thank you for coming. I’m just going to name the 8 kinds of anxiety and let’s start off with you saying which one has affected you the most. Is that ok? Patrick: Absolutely. John: Thank you. Those are simple phobias, which we won’t talk about those since everyone has them, separation anxiety, social anxiety, generalized anxiety, those are the 4 sort of lower ones, more common. A little less common are the 4 more difficult ones: agoraphobia, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Do any of these ring a bell with you, Patrick? Patrick: For me, it’d be a panic disorder. Yes sir. John: So tell me, what does it feel like when you get a panic attack? Patrick: Sure. I think to get a better sense of how it happened to me, what it’s been like, I’ll talk a bit about my experiences in recent years and where it lead me and where I’ve come since then. John: That would be great Patrick. That’s just what we’re looking for. Patrick: A little bit about me: I’m a senior neuroscience major at Boston College, almost graduated now, from Massachusetts. I love playing golf, love my friends, love my family, especially my pug, Charlie. For me, I had a very happy upbringing, very happy childhood. John: Where did you grow up? Patrick: Attleborough, Massachusetts. So not too far from Boston. My brothers, best two friends. Very loving and supporting parents. Middle school, high school, college, it was all very good. I loved it. Things for me came to a standstill in the middle of my junior year. So this is end of 2018 to 2019. This is when I started my experience with panic. So I never experienced anything like that before. At the time, when it first started, I really had no idea what to do. Everything was so unfamiliar and so unexpected. I didn’t think that there was any way that whatever was happening could possibly happen to me. John: Can you describe it? What did it feel like? Patrick: So I’ve thought a lot about it and what it’s like when it happens. As much as I describe it in hindsight, it’s always very different when it’s happening in the moment. It’s a lot of confusion. I can really never quite understand what’s going on when it happens. It’s a lot of overwhelming sensations. I really just lose any sense of control over what’s going on at the current moment. John: Does it come on you all of a sudden? Patrick: Yep and a lot of times for me it happened in recurring places so if I had a tendency to have a panic attack in one certain type of location, then anything that was similar or the same type of location, then I would feel that sense of panic again when I would return. So for me, my solution, early, was avoidance. I went on a pretty crazy string of avoiding things that did or may cause panic. I mentioned this to some people where I had times where I couldn’t go to certain classrooms. I felt like I had a few panic attacks in those classes and I would do anything to get avoid those classes and those places and I hated that feeling. John: Who wouldn’t? It’s an awful thing. Patrick: Another one was cars. Here I am, I’m 21 at the time, I’m a college kid, I’ve been happy my entire life, I’ve got tons of great friends, I’m handsome, modest -that’s a joke, but things are getting out of control. I feel like I can’t even get into a car. That’s when I started to think, “that’s really no way for me to be living.” Mentally, emotionally, academically, it’s affecting all parts of my life and in the back of my mind, I knew that but still, I didn’t quite know what to do about it. It basically took me hitting rock bottom, for lack of a better term, to finally make a change. I mentioned this to you, I have this friend who has this quote that he always says to me: “You know what they say about rock bottom?” I know how it goes but I’ll tell him, “What do they say?” and he says, “It makes a great foundation.” So he’s always telling me that after his favorite sports team loses or he loses a bet or something. I never really took this quote seriously, but rock bottom for me was about February 2019 so close to a year ago or so. Again, junior in college, I’m 21, supposedly the best years of my life right now but I walk out to the reservoir at Boston College. It’s February but it’s beautiful. It was one of those very lucky February days. It’s sunny, not a cloud in the sky. I sit on the bench and there’s kids laughing, there’s dogs going by, all these people. You really can’t picture a better day but I vividly remember myself sitting on a bench thinking, “I’m probably the only one thinking about God right now.” I’m sitting there, I’m born and raised Catholic - Catholic in elementary and high school, Jesuit college, mass on Sundays and that beautiful February day, I’ll never forget asking if anyone was listening up there. For me really, that was the first time I had had doubt about faith in my life, about spirituality. I learned much later that doubt is the very thing that makes faith just so beautiful. Eventually, I realized my friend was right, and rock bottom can make a great foundation, so right there, that was the perfect place to do something and make a change. That’s how basically anxiety lead me to rock bottom. Obviously now, I’m in one of the happiest places I’ve ever been. John: When you say “make a change,” what kind of change did you make? Patrick: It was a process of building a few habits, I think. After consulting with people, after telling other people about what was going on, and seeking help for myself, I had to build a few habits to get me back to where I am now. One of the first ones was I had to know that I was very far from alone in this process. Early, hearing other people’s stories, seeing other people who have gone on to live happy and successful lives, was such a great source of comfort and peace. I hope mine will maybe be one for someone too. The second was I really had to tell myself that there’s not a damn thing wrong with me. There’s really nothing more than that. One of the big faults, especially during times of panic, is thinking something’s wrong with you and thinking that you’re different or thinking that “I can’t do anything about this.” I keep telling myself that nothing’s wrong. The third habit was patience. I really wanted to rush things back to a normal version of life, if there ever was such a thing, but I had to be patient with myself. I had to let myself take little steps, whatever I could do each day, just get a little better. Things aren’t gonna go away immediately, but just be patient. It all came down to building a habit of learning. Learning to be grateful for every experience in the past and know that whatever happened in the past, I can use that for today, right now, for tomorrow, and for the future. John: Patrick, can you say a few words more about why you think this worked? First of all, do you have a theory about why you got this in the first place? Secondly, have you got a theory about why this solution worked for you? Patrick: I’ve thought about it quite a bit. I’ve mentioned this, I really thought this was something that would never happen to me. Basically, I’m stubborn as hell so, at the early on, I very much bought into the stigma of being a man in the sense of if you have a problem, I have to figure it out myself. I didn’t see other people around me who had this similar type of problem. I didn’t know that this was going on to other people. I thought if this is going on, I’ll just figure it out by myself. John: You must have felt kind of weird about the whole thing too, right? Patrick: Absolutely. That’s another big fault that I had was thinking that it was only me. I really don’t know where it came from. I never would’ve imagined it really. So it’s interesting. It’s interesting how things happen. That’s life, I guess. You never know where life is gonna take you. John: That’s for sure. I can tell you almost with complete certainty that it’s coming from a part of your brain called the amygdala. The amygdala sets off a lot of alarms for reasons we can’t really understand because the amygdala has no contact with logic or reason. When it gets fired off, we’re never really sure exactly what the cause of that is, but you can be somewhat aware that it’s coming if you’re on the lookout for it. It sounds to me like you began to realize when one was coming on sooner. Is that correct? Patrick: Oh absolutely. Over time, I’d realize that panic is really such an interesting experience. There’s a really unique paradox in the way that I’m understood to how to deal with it I believe that for me, panic, its biggest weakness is entirely disguised in what makes it seems so bad. It seems so bad because it makes you feel like you’re losing control. It’s completely taking over. In the way I feel has worked best for me to sort of deal with it is sort of let it run its course. I develop a mantra of not caring whether or not I have panic and whether or not I have anxiety in these certain situations. I say, “so what? I’ll be ok. I’ve been fine every single other time.” So I say, “who cares?” John: There’s an expert on this whole thing by the name of Claire Weekes and she calls this experience “floating.” You imagine yourself floating above yourself watching yourself and saying, “what a shame that that poor person is having this tough time.” But its not exactly you. You float above the whole thing. It sounds like that’s part of this also. Patrick: I absolutely get at the Dacey motto of not caring what other people think because they aren’t. I know nobody’s thinking about me if I’m sitting in a class and maybe I’m having a panic attack. I say, “who cares what they think of me anyway. See me in 20 minutes and I’ll be perfectly fine.” It’s worked. It really has. I give that anxiety no more power over me than it deserves and it’s worked really well. John: That’s wonderful, Pat. There are some other questions that I’d love to ask you but our time has run out on us here. Would you be willing to come back sometime and let me ask you some more questions? Patrick: I’d love to. Absolutely. John: That’s wonderful. Thank you so very much. Patrick: Thank you, John. I appreciate it.
How to Evaluate Your Progress with Your Plan26.05.2020 (00:00:00)
Hi. This is Dr. John Dacey, with my weekly podcast, New Solutions to the Anxiety Epidemic. If you have started carrying out a plan to reduce your anxiety levels, and I hope you have, it’s time to lay the groundwork for evaluating your progrgess. I’m going to introduce you to the concept of formative evaluation. The good news about formative evaluation, that is, checking while your plan is in effect, is that once we learn to do it, this process alone can help to reduce anxiety. Evaluating progress in your plan as you are carrying it out offers several advantages: It helps you gain perspective on the problem. It takes you away from your worries about future dangers back to a concern with the present (called “centering,” as you may remember). Concentration on checking progress often also disrupts anxious thoughts. Being self-aware tends to breed a sense of self-control. Evaluation causes you to think of yourself as a person who "has anxiety," rather than a person who "is anxious." This allows anxiety to be seen as a part of you rather than the whole, and thus it becomes more manageable. Formative evaluation encourages “how” questions (“How are you feeling right now?”) and “what” questions ("What is the most troubling aspect of your situation?"). These promote the sense of being a "self-observer." "Why" questions, on the other hand, only produce more worrying. At its best, formative evaluation amounts to what has been called "watching myself watch myself." When you master this skill, your anxiety levels are always reduced. In this section, I present activities that illustrate effective strategies: charting; using drawings; getting help from buddies or from a therapist; check listing; journaling; and photographing. I hope that as you learn the techniques I recommend, the beneficial outcomes of evaluation will become obvious to you. I feel certain that you will experience these benefits. Checklists and Charting A major problem with most anxieties is that they tend to build up to a high level of stress without your being aware of it. Checklists and charts can help you keep track of the symptoms of your anxiety while you carry your out his current plan. They also inform you of the frequency of certain symptoms that may be reoccurring. There are many ways to use charts to keep track of the effectiveness of your plan. For example: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Breakfast Lunch Dinner Design a chart like this, done by José X. He drew one of three faces on the chart three times a day; one at breakfast, one at lunch and one at dinner. If Jose’s anxiety level was low, he drew a happy face, if moderate, a neutral face, and if his anxiety was high, he drew a frowning face. He couldn’t help noticing the differences in the pattern in his chart. When you fill out the chart three times a day, you may be surprised at the results. For example, most mornings, your anxiety level may be high. You might think you would realize this without the chart, but anxious people are often unaware of their emotional patterns. We tend to repress most information about our problem because we find it too painful to think about. Variation: Some people do not like to use happy faces for this exercise – they consider this image to be too childish or out-of-date. Any other image will do. Thinking up a good one can be an important part of this activity, one that calls for using some of the creative thinking techniques I discussed earlier in these podcasts. Draw four or five icons that could be used as markers for your chart, and then you can choose the one you like best. If you are a baseball fan, for example, you might use a baseball diamond as your icon. If you rate your anxiety level to be high, you could draw a diamond with no bases crossed out. If you find your anxiety level to be moderate, you could draw a diamond with second base blacked out. If you feel you did a really good job, the diamond you draw would have home plate blacked out. If you favor some other sport, an icon might be shorter or longer passes on a football or soccer field or number of pins knocked down on a bowling alley. A non-sports image might be partially closed doors to wide open doors. As a result of using the charting activity above, José found that his anxious feelings usually dissipated by noon, and by dinnertime he generally felt much better. This pattern is quite common. I think it results from the production of adrenaline that occurs as we sleep, making the morning time seem more fraught with frightening circumstances. As the day goes on, we burn up some of our supply of adrenaline just by living, so that when we reach the dinner hour, we tend to feel calmer. Using Drawings Psychologists have long understood that a person’s drawings can reveal her feelings in ways that words or symbols like numbers cannot. Instruments like the “Draw-A-Person Test” allow a person to express attitudes and evaluations that she might not even be aware of consciously. This technique may be adapted for evaluating anti-anxiety plans by drawing pictures, of two kinds: Realistic pictures that portray what happened while you attempted to carry out your plan. Abstract pictures that portray your feelings about yourself before you started the plan, your feelings during the plan’s operation, and even how you feel about the plan itself. You will have to exercise good judgment in interpreting these drawings. It is easy to over-analyze them. For example, one parent I know was worried because his child would come out from his room having produced drawings that were always colored in black. This father was concerned because he assumed the color indicated a seriously depressed child. When the child was asked why he only drew in black, he replied, “Because that was the only crayon I could find.” Nevertheless, you don’t normally need a Ph. D. in psychology to get a great deal of relevant and valid data from these drawings. They can provide a most useful evaluative tool. Working with a Buddy Anxious people often don't want their circle to know about their problems. Often, though, you can make a lot more progress with your plan if you have the help of one or several of your buddies. When you have come to accept your anxiety problem without a sense of blame and shame, then you will be able to talk to friends about it in a matter-of-fact way. Remember, it’s not your fault! This allows you to explain your performance to your friends effectively, and also show them that you expect to be treated like a sane person who has a problem rather than someone who is not acceptable. Also, your friends are often in a better position to make judgments about your behavior than you are. Explain what has been happening with you to a friend whom you see as being completely trustworthy. The buddy need not be the same age as you. The buddy might be another family member or even one of your not-so-close friends. If you make a daily report, you may become aware of many details that have escaped you in the heat of the day's activities. Your report can be made in person or over the phone. If the buddy is farther away, messaging or e-mail may be a quick and easy way to communicate. Your report should be made in terms of actions taken and how they worked out, of course, but also should include your feelings about those strategies. Your description of feelings should involve one or both of two dimensions: Qualitative -- a subjective evaluation of your feelings ("I felt scared before I started my plan, and a little sad that I'm the type of person who has to do this sort of thing, but I felt great when things went okay!"). Quantitative -- how many times or how well you have performed ("I would rate my anxiety level before beginning the plan at about 8. It dropped to around 6 while I was doing it, and was down to 3 by the time everything was over.") As you speak to your buddy, you are also hearing yourself review how well you have been Working with a Therapist to Become More Objective about Your Progress You may decide that your symptoms are not so severe that you must have professional help, and that you can probably handle the problem effectively with the help of my podcasts. Nevertheless, you may want to engage a psychologist to advise you on the plan you have formulated, to provide encouragement when the going gets rough, and, especially, to offer expert evaluation of your progress. Creating an imaginative plan is one step, but there are numerous plans and revisions that could help you succeed in reducing your anxiety. No one is as well trained to gauge various aspects of your progress in reducing anxiety as a licensed psychologist or social worker. Psychologists have learned that once a habit has become embedded in the mind, elements of it will pop up unexpectedly, even after the habit has been broken. This they call “spontaneous recovery.” For example, even when you have overcome acrophobia (fear of heights), later a picture of a view from a high place might set your heart racing. Don’t worry; this too shall pass. Another good idea is to compile a list of reminders of things you need to do to make your plan work well, such as giving yourself a pep talk before an oral report. These items should be written on cards, one item per card. Then tape up the notes in conspicuous places around your personal space – on the door, above the light switch, and in the closet, for example. As you work on your plan, you can't help being reminded to make spot checks on your progress regularly. Journaling There are many ways that you can keep a journal. you needn't be restricted only to making notes in a notebook. For example, go to your "grokking rock,” the peaceful place somewhere in your house or neighborhood where you can get good ideas for reducing your anxiety level. This is also a good place for doing formative evaluation of your plan. Once you have established a routine of going to your grokking rock (perhaps on a daily basis), you might bring a journal to write about how well your plan has been working. You should be able to write more freely because you are in a place where you have already been conditioned to be calm. Leaning against the rock should encourage you to be reflective, and to write more objectively about how you have been doing. A related strategy is to write yourself a letter describing in detail how well your anti-anxiety plan has been working. You should then mail it to yourself. When you open it a few days later, you may discover that your evaluations were colored by your emotions at the moment. With the passage of time, you may view the situation with a less jaundiced eye. If you get tired of writing letters to yourself, you can always write a poem about your experiences, or draw a picture or cartoon, and mail that. Candid Camera Cameras can be useful adjuncts to any formative evaluation approach. There are many uses for snapshots. You can use photography as an especially productive tool when dealing with social phobias. You may tailor the photography to your interests and aspirations. Let's suppose that you have performance anxiety -- for example, you find it difficult to speak in public. As surreptitiously as you can, ask a friend to take pictures of you while you are in the midst of combating this phobia. Ask her if she possibly can to do it so that you are unaware of it. View the snapshots your friend has taken and ask her to analyze the expressions she has seen and heard, and your body language as well. These judgments should help you get a more objective conception of your performance. I’ll have more on this topic, next week!
Dr. Dotty Vacca19.05.2020 (00:00:00)
John: Hi, this is John Dacey with my weekly podcast New Solutions to the Anxiety Epidemic. Today I have a good friend of mine, Doctor Dotty Vacca. Dr. Vacca has had a wide variety of experiences. Dotty, will you tell us something about your training and your background. Dotty: I started my career as an elementary school teacher and most of my career has been in the public school system so I bring that as a backdrop to a number of the experiences I have had and the way I have looking at different disorders. I went from being a classroom teacher of 15 years to a school counselor to a school psychologist then I went on to become a licensed psychologist and a certified school psychologist. Recently I have been working at Northeastern University and at William James College and I am supervising psychology interns. John: That is a wide variety of experiences and certainly qualifies you to talk about anxiety disorders. Let me start off with my general first question: I see there being 8 kinds of anxiety, 4 of them have to do with the cerebral cortex, and those are separation anxiety, social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder. Those are all experiences that we can be aware of and they do respond to cognitive behavioral therapy (CBT), typically. The other 4 are much more likely to originate in the amygdala and although the cortex is involved, the amygdala pretty much controls them so they have really little response to discussions. Those are simple phobias, agoraphobia, panic disorders, and post-traumatic stress disorder (PTSD). How does that fit with what you understand? Dotty: I like the 8 categorizations because I think its a very useful way of looking at the many different kinds of anxiety. In addition to those areas of the brain that you mentioned, there are also other areas of the brain that are also affected with anxiety. For example, not too many people pay attention to the cerebellum, but at the brainstem for many of the anxiety disorders, if the brainstem happens to be overly sensitive, then there’s an abnormal brainstem regulation of things like the reduction of oxygen and it causes people to have quick panic responses so anxiety is a very complicated disorder. You use the biopsychosocial model which I think is a very important way of understanding how anxiety comes about because as a neuropsychologist and as a psychologist dealing with children and adults dealing with anxiety, almost every condition that I’ve worked with has an anxiety component to it. For example, with anxiety, usually in comorbid with depressive disorders, there is a belief that in conditions like bipolar disorder the anxiety of the manic phase of the disorder is a way to offset the depression that’s about to come so anxiety can be helpful in that way. But also some people have a genetic predisposition to anxiety and children can be born with the predisposition. John: You use the word “sensitive” before. I kind of think what you’re talking about right now is sensitivity, which is good because it makes one very responsive to the needs and feelings of others but it’s also bad because it makes us super, what we call, catastrophizing: ready to see catastrophe in everything. Dotty: Yes that isn’t quite what I was getting at in terms of the way the brain is organized when you have an abnormality in the brain stem in terms of regulation but there is the other component of anxiety where people are hypersensitive and are looking out to the environment for clues for what to do and so there’s a hyper-vigilance there and that can - as a result of that, they can misinterpret signals from the outside world. John: There’s no question about that. You’re absolutely right. Can you say anything more - do you think there’s some case where the biopsychosocial - those three factors, are pretty much equal or is there some, where one predominates over the other two. Dotty: Well for years we’ve talked about nurture versus nature and I think that’s an artificial way of looking at that. It helps with research and other things like that but I think over and over again the research has shown that the biological and the environmental are inextricably interwoven with each other. For example, if you have a seed, and that seed has the genetic composition to be a beautiful flower, but in order for that seed to flourish and become its full potential, it has to be planted in the right kind of soil, with the right kind of water and sunshine. If you don’t have those three components, then the seed won’t flourish. I feel the same way about a human being. A human being comes into the world with a certain genetic predisposition and that predisposition won’t flourish unless the environment supports it. John: There’s no question about it. In fact, I was reading recently about the fact that trees are not only psychological in the sense that they’re very sensitive to the environment, of course, they’re very biological, but they’re even social. They communicate through their roots about what’s going on in the area. Isn’t that amazing? Dotty: That is amazing. That’s absolutely amazing. If you have a child who has certain predispositions- let’s say you have a child who has a predisposition to anxiety, and that child is born into a family that’s very anxious, where the mother and father are very anxious, then the chances are very good that that child will develop some kind of an anxiety disorder. John: Yeah, you’re absolutely right about that. I’m reminded of a study that was done on how children develop at toilet training depending on how the mother fed the baby when it was just a baby. They found no difference whether the mother breastfed or bottle-fed and they found very little difference between whether the mother wanted the child or did not want the child, which is kind of amazing. But when they studied them together, they found out that breastfeeding mothers who wanted the child had the best results and breastfeeding mothers who did not want the child had the worst results. The other two - both bottle feeding - we’re kind of in the middle, which makes some sense when you think about it because breastfeeding seems to be much more emotionally close and the child can somehow tell how the mother feels towards it. Dotty: Right so the bonding is taking place and the child is picking up the feelings of the mother in a much more intimate way while being breastfed. Then the other thing, the child doesn’t know what’s happening to the mother’s milk if the mother is having hostile feelings towards the child. John: Oh that’s absolutely right. You’re referring here, it seems to me, to some extent, to bidirectionality, which is the concept we always talk about is it a good baby or a not good baby. And without thinking about what the baby is like, without thinking about what the mother is like, but of course, the mother reacts to the child just as well as the child reacting to the mother. So we have bidirectionality. Dotty: Absolutely. The child cannot grow and develop unless there’s an environment that’s inviting back to the child so there’s an interaction right from the get-go. Usually, there’s a mutual satisfaction that goes on between the two of them, so the child smiles the parent smiles back, the father smiles back, the grandparents smile back, and the child learns to have a social interaction with these people who care about the child and to feel good about him/herself and to grow and develop into a happy infant. John: You’re absolutely right. Dotty, I have only about 4 hours of questions but of course, I can’t ask them. I’m going to have to shut this off now because we try to keep them around 10 minutes. Would you come back and talk to us again sometime because you’re obviously very knowledgeable about this whole field. Dotty: I would be very happy to. John: Well thank you so much.
Social Isolation12.05.2020 (00:00:00)
Hi. This is Dr. John Dacey, with my weekly podcast, New Solutions to the Anxiety Epidemic. Although feeling fearful during the coronavirus pandemic is entirely normal, seriously disruptive anxious reactions are fast becoming common. Soon, if not already, the number one anxiety category will be separation anxiety. This is because the “social isolation” we have been experiencing due to the coronavirus is, at least in my opinion, ultimately the result of separation anxiety. A major dictionary defines: isolation as “the complete separation from others of a person suffering from contagious or infectious disease; quarantine.” Let’s look at this term a little more closely. First of all, are you isolated if it is your choice to be in isolation? The answer is yes – that is, the act of being isolated does not depend on choice for its definition. However, the impact of isolation must depend on whether it is voluntary or not. How you feel about being separated from others, whether you believe you had a choice about it or not, will influence how you react to it. As I talk to people about their responses to social isolation, I find that some people living alone like it, and some do not. The same is true for those living with others. I think that how people react depends a lot on whether or not they feel deprived of the security they get when in contact with powerful others. For example, I feel singularly blessed to be living with my wife because she takes such good care of me. Nevertheless, there are others, such as doctors and nurse practitioners I know, whose counsel and nurture are denied to me unless I got really sick. In truth, that stirs up feelings of separation anxiety which I thought were long past. Does this make sense to you? Do you feel the same way? There is also the specialized definition of Sigmund Freud: Social isolation in psychoanalytic theory is a defense mechanism that relies on keeping unwelcome thoughts and feelings from forming associative links with other thoughts and feelings.” That’s the other side: the inability to keep scary thoughts from becoming conscious. Many of us anxious folks find this to be a problem. Especially among the elderly, for whom COVID19 may be deadly, quelling such ideas can be quite difficult. As an elderly person myself, I know how that feels! For one thing, to be unable to have face-to-face contact with significant others can lead to “catastrophizing“: Imagining that something might go wrong, which then becomes something that will probably go wrong, which often becomes a serious incident that will definitely go wrong— you might as well give up! Of course, we anxious folks often fall victim to this kind of thinking, and wind up avoiding the situation, which makes us even more vulnerable the next time. So what can you do? Let me explain your best option to the use of a metaphor: sailing a small boat. “You can’t change the direction of the wind, but you can change set of your sails.” Anonymous As any good sailor knows, you can sail in any direction except directly into the wind. There is a space from 15 degrees to the left of the wind to 15 degrees to the right where, if you point your boat into it, you will actually move backwards. That’s called “in irons.” The solution is to haul your sail in close to the center of your boat and turn it slightly more than 15 degrees off the direction of the wind. When you want to go in the same direction as the wind, you need to go back and forth, the same way skiers traverse a steep slope. You keep repeating these turns, called “jibing,” until you ultimately sail to your goal. What has this got to do with anxiety? It’s a good analogy for what you need to do when fear blocks you from your desired goal. As a good friend of mine said recently, “I enjoy sailing and I own a boat, but I don’t go out much. I can never get back to the dock where I started.” He needs to “change the set of his sails.” And you cannot help being afraid of an object or situation that almost nobody else finds dangerous. However, you can: Change the way you feel about that object or situation. Change the way you react to your anxious state itself. As it is often hard to use the first option, here‘s what you can do, using the second. Distracting yourself from frightening thoughts can often be achieved by taking action. As I suggested in a previous podcasts, you need to distract yourself from frightening thoughts by occupying yourself with more pleasant activities. These days, the Internet is full of suggestions to this end, watching great movies and TV series, playing cards (with someone with whom you‘re living, just or online), planting a garden, doing a task you‘ve been putting off forever, getting outside for a walk, etc., etc. Possibly the best option, however, is to help someone you know who is isolated. Contact them by phone, Internet, or over the backyard fence. Below are a few suggestions for how you can help them Ask them to have a conversation with you. Even inviting them to something as simple as doing a favor for you is meaningful. And listen reflectively. It is important to remember that every person experiences anxiety reactions in her own individual way. Most people find it calming to be able to describe exactly how their anxiety feels to them, and to explain what they think is causing those feelings. You should listen with respect, accepting what is said as being a true representation of what the person thinks is true, and should avoid making premature judgments. This does not mean that you should be mute. You need to “listen reflectively.” Sometimes the most important aspect of listening is validating the child's emotions and experiences. People are more likely to talk -- about sex, alcohol, and other important issues -- to other adults who know how to listen. But certain kinds of responses, such as giving too much advice or pretending to have all the answers, have been shown to block the lines of communication. Effective listening is more than just “not talking.” It takes concentration and practice. Remember, if you are judgmental or critical, your person may decide that you just don’t understand. You cannot be a good influence on someone who won’t talk to you. Below are several communication skills that are useful to anyone who wants to enhance communication with others. Rephrase the person’s comments to show that you understand. For example, "When you say that you feel sick when you think about playing the piano at your school recital, do you mean that your stomach hurts or you might throw up?" Watch the person’s face and body language. Often that person will assure you that she does not feel sad, but a quivering chin or tearing eyes will tell you otherwise. Your correspondent may deny feeling frightened, but if you put your fingers on her wrist, as a caring gesture, you may find that she has a racing pulse. When words and body language say two different things, always believe the body language. Give nonverbal support. This may include a smile, a hug, a wink, a pat on the shoulder, nodding your head, making eye contact, or holding your friend’s hand (or wrist). Use the appropriate tone of voice for what you are saying. Remember that your voice tone communicates as clearly as your words. Make sure your tone does not come across as sarcastic or all-knowing. Use encouraging phrases to show your interest and to keep the conversation going. Helpful little phrases, spoken appropriately during pauses in the conversation, can communicate how much you care: “Oh, really?” “Tell me more about that.” “Then what happened?” “That must have made you feel bad.” Other ideas are to invite the person to join you in visiting a virtual zoo or museum tour. There are many ideas like this online. Two of the best sources are to be found at: .thereadystore.com/diy/1608/9-essentials-sheltering-place/ AND stonegroupinc.com/100-things-to-do-while-sheltering-in-place/ Email them to read an e-book or audiobook, Help them find a COVID mentor. Help them to plan a garden. Ask them to join you in a socially distant exercise program. Suggest you go on a hike, take a walk/jog, or any other kind of workout. Suggest they find a “grokking rock.” Originally a concept in a novel about science fiction, this idea has gained in popularity because it works so well. A grokking rock is simply a boulder or other relatively permanent marker such as a park bench, which can be found in a quiet place such as by the side of a lake in your neighborhood. The rule is you cannot go there or stay there if you become upset. You can only be at your grokking rock when you’re relatively calm. Ask for advice. When someone is in trouble, the temptation is to try to give them good advice so they can get out of it. Sometimes, though, it is more helpful to seek their suggestions for how you might deal with a similar problem. Their answer will be good advice for them, too.And remember: when you help someone else, you help yourself. Until next week, then…
A Case of OCD05.05.2020 (00:00:00)
J: I have a friend of mine, whose name is Ben, and he's going to talk about some of the anxiety situations he's gotten himself into, and what he did to get himself out of them. Hi Ben. B: How are you doing, John? J: Just fine, thanks. What I'd like to do, if you don't mind, is to go through seven of the eight kinds of anxiety and just ask you if you've experienced them, and maybe a little bit about what you've done about them. I'm going to skip the first one, which is simple anxieties, such as claustrophobia or agoraphobia, because they are very common. The first one I want to talk about is social phobia. That includes things like giving speeches or going to parties. Things like that. Do you think you have any social phobias? B: I wouldn't say I have a social phobia. I'm a bit of a performer, and kind of an extrovert, but I also really don't like being around people all the time. I kind of describe myself as an extroverted introvert. J; That's fine, Ben. But that's pretty clearly not anxiety. Let's move on to the third one, which is separation anxiety. Do you experience any separation from anybody as being particularly frightening. B: Not particularly, no. J: Ok fine. The fourth one is generalized anxiety. What about that? B: Yeah. I'm pretty much always anxious about something, or just have a sense of anxiety, whether its towards any specific thing or not. J: When you feel kind of anxious about something, What do you do about it? What helps you? B: It's always something different. Thats something I’ve learned, that you can't always use one coping strategy for every situation, you have to try different things for different situations and figure it out, and even if its a similar situation to one you've had before, sometimes the same solution won't work. J: Boy, are you absolutely right about that. You've got to have a number of arrows in your quiver in order to hit the target, that's for sure. Now I do want to mention this: some research that my colleagues and I did with large numbers of young adults, the results were that males, about seventy-five percent of males do much better with physical techniques of relaxing such as tightening all your muscles and letting them go, or deep breathing, and the women, about seventy-five percent of them, worked much better with mental things. That includes imagining yourself by a nice, quiet lake, or that you're listening to a chorus of monks singing. So are you more like the males here or the twenty five percent category? B: I think I'm more towards the twenty five percent. Of course there's deep breathing that works occasionally, but mental stimulation tends to help me more, so I think more the twenty five percent. J: Can you tell us what kind of imagery that you tend to seek when you're feeling anxious? B; Yeah, I think of people who I love, or good times I've had. Sometimes I'll sing a little song in my head that I enjoy, or just try to make up a story to distract myself. J: I seem to remember that one of your favorite songs is “oh la de da” is that correct? B: (laughing) Absolutely! J: That's an inside joke. Ok. Number five on our list: agoraphobia. Kind of not liking to be away from home very much. B: Yeah, kind of. Not super, but a little bit yeah. J: What typifies the situation where you don't like being away from home. Is it a long trip to a strange place? Or what would categorize this? B: Something I can't get out of. So if I can't escape to calm down, or if I'm kind of stuck in a place that causes me some anxiety, if I'm not in a place I feel safe. J: That brings up an interesting point, Ben. I have the same thing. Especially if I go to somebody's house for dinner and I find myself to be surprised to find myself quite bored by the conversation, I don't experience it as boring and that I've just got to get through it. I experience it as being trapped, being claustrophobic, and of course that makes it a lot worse for me. So very often you get to a place where you just as soon would not go out with friends or whatever. I remember back in 1984 I almost got housebound. Just didn't want to go any place. Have you had anything like that? B: Yes, I think when I was younger, like middle school age, I was going through a lot and just couldn't make it outside or go anywhere J: Ok. Have you ever experienced a panic attack. One of those very sharp and very strong anxieties, even to the point where you feel like maybe you are going to die or something terrible is going to happen to you. B: Absolutely. Unfortunately I've experienced that many, many times. J: I'm sorry to hear that. Can you tell me the circumstances that typically brings it out? B: Usually it's a result of many things piling up over time and then I just can't handle it anymore and I snap. J: Yeah somebody I was talking to, a woman recently who had been through a very long, difficult period of time, and she said when she thought it was going to be over, all of a sudden she experienced a panic attack. She said to me “ I always thought that people who said they were having a panic attack were just trying to get out of something, they were malingering or whatever” she said “ but I've had two of them now and they're just awful. They seem to come on you all of a sudden” and Ben you've probably heard me talk about the analogy to a stampede. If you don't pay attention to the early warning signs of a panic attack, and we do get them, we just don't pay attention to them. Sometimes we just don't want to think about it. Then the next thing you know the cows are up and they are running and it's too late, you've got a stampede on your hands, so you need to try to be more responsive and ore aware of the fact that you're on the verge of a panic attack and cut it off at the pass. Does that make sense to you? B: Yeah absolutely, that’s something that's allowed me to have far fewer panic attacks. J: That's terrific. I'm so glad to hear that. Number seven is Obsessive Compulsive Disorder. I happen to have known you for a long time, and I know that at least at one time, when you were only four years old, you were collecting rocks on the beach, and your mother said “that's enough rocks” and you said “ no I have to collect them all'' and she said you just can't, we don't have any room for all the rocks on the beach, and you started to cry and I remember I thought “wow it looks like he's got OCD.” At such an early age I'd never seen it before. Did that turn out to be true? B: Absolutely. And my OCD has kind of evolved over the ages from needing to collect things to search for symmetry, and a need for tradition and keeping certain activities, and doing them the same way whenever I do them. J: Well those are some excellent examples of what happens when somebody has OCD. As you know, it's obsessions which are thoughts, and compulsions which are behaviors, but they are both pretty much the same thing. I make the analogy to superstitions. Superstitions tend to come about because somebody says, you know the old story “Don't step on a crack, you'll break your mother's back” and so you avoid stepping on a crack and when you get home you find out that indeed, your mother's back is not broken, and we laugh about that but that's kind of the syndrome to the extreme of OCD, is that you learn that if you double check the oven to make sure you turned it off, or that the iron is turned off, or that the water is not running, then you feel better; relieved because of this. And it may be that you are trying to punish yourself for these thoughts. I don't know. But at any rate you feel a lot better when you go and check so what you learn from that is id better always go back and check. Does that sound right? B: Yeah that's a description of OCD I hear often. But sometimes it's like that for me, but it's also less superstition in other cases, many other cases. It's just I feel a kind of existential dread or extreme discomfort until I perform an action or do a certain thing a certain way. J: So it sounds to me like theres the threat of a panic attack, and it is relieved by doing something obsessive or compulsive. Does that make sense to you? B: Yes it could be described that way. But there's always a wide variety of things that could determine whether or not I feel a certain way about something. J: there's one more, which I presume you do not have, because you haven't been in the military, at least not yet. And that's Post Traumatic Stress Disorder. Do you think you have any signs of that? B: No, I don't think so J: Well Ben, this has been very helpful. This was exactly what I was looking for when I invited you to be on the podcast. And I think you've given us some really good examples of what these various kinds mean. I hope we'll get a chance to talk again sometime. B: Hopefully so! I'd be happy to come back.
An Original Plan to Defeat Anxiety, Part 228.04.2020 (00:00:00)
Hello. I am Dr. John Dacey, coming to you with my weekly podcast, “New Solutions to the Anxiety Epidemic. This time, I’m going to be talking again about the second step of my COPE strategy, originality. I remind you that this step of the model calls for you to be as creative as you can in organizing a series of tactics, designed just for your own personality. I promised that I would help you to become more original, and this is the second time I have tried to keep that word. To begin with, it is wise to assess your own creative abilities. Regardless of whether you are one of the most original people you know, or are not very high at all in that trait, everyone can move up. Everyone can get better at being creative. It will be very much to your benefit if you design your own imaginative plan for becoming less anxious. You will need to get some benchmark of your overall ability. This is hard to do, not only because creativity is somewhat ephemeral, but also because it is difficult for us to be objective about how gifted we are. Nevertheless, we have make a try. To begin this venture, fill out what I call a “personal shield.” This is like a family crest, or coat of arms, except it doesn’t exist. You wil have to design it yourself. Imagine, if you will, a shield that has been divided into five sections. The crest has a line down the middle, and two horizontal lines dividing the shield into thirds. Furthermore, you need to know that the vertical line is not extended into the bottom section. Therefore, there are five sections. You can see a picture of the shield in the transcript (blog) that accompanies this podcast. Or you can just make a list of the five traits I am asking you to put in each box. The five traits are: What you consider your greatest strength. Your worst weakness. Your greatest personal achievement. Your worst screw-up. Your most hoped-for lifetime achievement. The most imaginative thing to do would be to draw symbols of your answers, as you would see on such an escutcheon. However, if you like, you could just answer the questions. Your Personal Crest -- Creativity 1 Best Strength 2 Worst Weakness 3 Greatest Personal 4 Worst Screw-up Achievement 5 Hoped for Lifetime Achievement Personal Shield: _____________________________________________ Give careful thought to filling in your shield, as it will be the foundation for step 2 of your COPE strategy. Okay, it’s time to move on in your quest for original thinking, by writing a haiku. And what is the definition of a haiku? It is a very short form of Japanese poetry typically characterized by these qualities: The essence of haiku is "cutting" (kiru). This is often represented by the juxtaposition of two images or ideas and a kireji ("cutting word") between them, a kind of verbal punctuation mark which signals the moment of separation, and colors the manner in which the juxtaposed elements are related. Traditional haikus consist of 17 on , in three phrases of 5, 7 and 5 on, respectively. Although haiku are often stated to have 17 syllables, this is incorrect, as syllables and on are not quite the same. Fortunately, however, it is not necessary for you to understand the difference. Here is a haiku poem I composed some years ago: Hidden deep inside, My soul, gleaming like diamonds. My whole truth lies there. Do you like it? Oh, well, you can’t please everyone. And now, to further your understanding of original thinking, I offer you the “two-string test.” Your goal is to find a way to solve this unusual problem. Imagine a large room at least 30 feet square and 10 feet high. Attached to the ceiling are 2 strings, each of them 9 feet long. The strings are 14 feet apart, each of them 7 feet from the center of the ceiling. Your job is to discover how to tie the two strings together. As you would easily recognize if you were to look at the drawing of the problem in today’s transcript of this podcast (p. 5), the two strings are too far apart for you to reach them both at the same time. Somehow, you need to get hold of one of the strings while holding the other, so you can tie them together. That’s it! There is one item available for your use in finding the solution—a wooden mousetrap. Mouse traps are only about four inches long so they are not long enough so that you could use one to reach the second string, no matter how tall you are. When you think of how you can tie the strings together, please tell your solution to a friend before you look at the answer [or write it in the space below]. Were you able to figure out the answer? The mousetrap may be used to solve the problem: it can easily be attached to one of the strings as a weight, then swung away from the problem solver. The other string is grasped, and then the first string caught as it swings back. Now they may be tied together readily. Many people are unable to reach this solution because they cannot imagine mousetraps being used for something other than their usual purpose. That’s called “functional fixity”: the function of each entity in the person’s world is fixed in their minds, so that they cannot think of any other use for that object. Here's an example of what we mean: a graduate student in my psychology class studied the problem and said, “I’ve got it! The answer is with the mousetrap. You catch a bunch of mice until you get one that isn’t seriously hurt. You make a pet of it, then train it to be a ‘trapeze’ mouse. It will then jump up on one of the strings and swing back and forth until it is able to swing over to you while you are holding the other string!” This is a good example of what we mean by functional fixity: this student believed that a mousetrap could only be used to capture mice. His solution could conceivably work, but it is much more complicated than simply using the trap as a weight. Is this another example? One young nun in my class attempted to solve the problem. She decided that the mousetrap was really not necessary. Lifting the apron of her religious habit (the long formal dress nuns used to wear), she seized the over-sized rosary beads hanging from her belt. She swung them over her head while holding one of the strings. The beads caught onto the other string and, beaming with self-satisfaction, the sister pulled the string caught by the rosary beads, and tied the strings together while those watching applauded! Although this is an imaginative method for solving the problem if you happen to be a nun, it wouldn’t work for most of us. It is not, however, an example of functional fixity. She used her rosary beads for a purpose quite different from what they had originally been attended. In that sense, she was probably more creative than the young man in the previous example. Let me wind up this episode with an example of original thinking provided to us by astronaut Chris Cassidy. With the coronavirus in mind, a reporter asked him how he dealt with the extreme isolation of being encapsulated on the International Space Station. His response: “If everybody just kind of lounges around and doesn't get up until 11:00, and nobody's brushing their hair or their teeth, not only do you look crappy and you feel crappy, but you just get in that funk. So sticking to a Monday-through-Friday routine is probably the most basic thing . . .” Pretty good idea, right? You will need more than a couple of very good ideas like this one to settle your anxious mind, and it will be best if they all come from you. Talk to you next week.
Nancy21.04.2020 (00:00:00)
John: A good friend of mine, Nancy Alloway, has been a teacher for all her career, and she’s going to be talking about her own and her fellow teachers’ anxieties. Let me start off by asking Nancy to give you just a thumbnail sketch of her career. Where did you teach? Nancy: So I taught for 35 years in public and private schools in the United States and I taught 1st through 5th grade. I enjoyed my teaching very much. John: Thank you. I wonder if you could tell me about the kinds of things teachers typically are concerned about these days. Make a distinction between reasonable worries like the school not having enough money to do what it wants to do and anxieties which are fears that are probably exaggerated or not entirely true. When you think about your fellow teachers, what are some of the major things that they’re concerned about that would probably count as anxieties? Nancy: I think most of the teachers that I have worked with would say that the emphasis on testing creates a lot of anxiety among the teachers, the students, and the administrators. I think that testing is one of the things that bring out maybe the worst in people because we’re all trying to do the best for our students but when that means testing, prep, and examining past years test scores and looking at improvements and so much emphasis on the data, I think that that’s a very big anxiety producer, especially among young teachers. John: I’m not surprised to hear that. I was reading in a report the other day that something like 150 teachers in a southern major city were fired because they were caught changing the responses on the test and the superintendent, as I was reading the article at least, had been the supervisor of the year nationally the year before and this year she’s going to jail because she helped the teachers change the results. What occurred to me is that if I were a 45-year-old teacher with a master’s degree and I’ve got one of those classes that just aren’t working very well and my students do very poorly on the state exams, I could be fired for that. I suddenly realized that if I were fired at 45 with a master’s degree in education, I not only probably wouldn’t get a white-collar job, but I couldn’t get a blue-collar job either. I probably would be unhirable. That’s a very scary kind of thing because suppose I have the standard two kids and a family. What do I do about it? So I could see why teachers would be worried about that. One of the things I want to talk to you about is that I volunteered at Nancy’s class for some lengthy time because I wanted to learn about 4th graders and what kinds of things made them nervous and what made them edgy. One of the first things I noticed in Nancy’s classroom is that the teacher’s chair was piled high with books and teaching materials and Nancy never sat down the whole time. Why is that Nancy? Nancy: Well I didn’t sit down because I was always interacting with students. I think any good teacher does that. In 4th grade, kids are moving around and I was moving around with them and I wasn’t the kind of teacher who ever sat at my desk. During independent reading, for example, I would go conference with individual kids and any other time that they were working independently I was interacting with a small group or someone so I sat at a table with students but I never sat at my desk when students were in a classroom. John: I want to go back to the new teachers’ anxiety for a moment. Can you think of other things that they were nervous about besides the testing? What other concerns would new teachers have? Nancy: I think in any high-pressure school system the concern with the way parents interact with the teachers and the pressure that parents put on teachers is pretty immense and until you learn how to listen and understand and take time to not be defensive and learn how to control that until you learn to get some of those skills under your belt, it’s very very intimidating for young teachers. John: You just said one of the words that certainly occurs to me and that’s defensiveness. When I was a kid if you came home and said, “the teacher hit me,” you’d probably get hit again because the teacher was God in the classroom and whatever the teacher said was the case, they believed. That’s not true anymore, is it? Nancy: No, I don’t think so. I think that parents have anxieties and that build up on wanting their kid to be the best and to do the right thing and to be the best student and that sometimes comes across as really pushing teachers to do things with the kids that they either aren’t ready for or is just not something that is done in the school. For example, in the high power system that I taught in, there were students who were really doing all kinds of math outside the school so when they came into 4th grade, they weren’t in a position to understand the way we were teaching math. Parents didn’t believe in it so there was a lot of pressure on teachers to instead of extend what they were learning but to add more to onto the students’ plate and I think i learned to handle that by talking and listening and trying to explain the philosophy and what we were doing and how I was extending creative ways of doing math with kids. But a new teacher has a lot of trouble making that statement because they don’t have a lot of experience working with that kind of parents that really are pushy. They always want the best for their kid and I can really understand that but as a teacher, you often sometimes see the child in a different light and sometimes that light is that there’s a lot of anxiety on some kids that are really pushed in any area. John: I know that the two major areas that students get tested in and therefore you get tested in, in a way, is language arts skills and what is now called STEM. One thing that I’ve heard about from a number of sources is the time you and your class started a pretzel manufacturing unit You researched how to make the pretzels, and you made the dough, you shaped them, you put salt on them, you baked them, you packaged them, and then you had them figure out who you were going to sell them to and how you were going to sell them. Then you had to give a report to the superintendent of schools. They don’t let you do that anymore, do they? Nancy: Well, I haven’t been teaching lately and I think the last 10 years - even 15 years ago they started the board of health idea that kids would make something in school, even though we were really really careful about cleanliness, I think there were probably reasons that’s true, but it was a fantastic learning experience and kids loved it. We sold stock in the company and I had kids come back and tell me 10 years later that they went into business because they really liked making money in the pretzel company. What we did was we earned the money but I said as the CEO that you had to figure out a way to give some of this money back. So we would come to the consensus where we would put this money for a good social action cause. And it was really kind of fun and kids learned a lot and they loved it and they loved school. We did a lot of it before school but some of it happened in school hours too. John: This sort of brings us over to the anxiety that the administrators feel because I couldn’t agree with you more, that sounds like such a wonderful idea but because they’re only testing in what we used to call English and Mathematics, those are the two big subjects for teaching - and science too, I suppose. Then the superintendents and principals are not going to want you to do such a broad-brushed activity because it’s not clear how that’s going to show up on the test and I think that’s too bad. Nancy: Yeah, I agree with you. John: Can you think of anything that you yourself had to deal with in terms of anxiety. Was there anything special that made you nervous in your years of teaching? Nancy: Well, I know that there are some teachers who can go home and stop thinking about students, and I really had a hard time doing that. If I had a child who had special needs or was really bright but wasn’t performing or I didn’t quite understand what was going on with them, sometimes those kids would really make me lose sleep because I would wake up thinking about them and then I couldn’t go back to sleep so I think that was an anxiety that was probably stronger when I was younger but definitely became something I would think about. And of course, if you had parents with situations that were difficult I think that sometimes caused anxiety just thinking about “what do I do?” and “how do I handle this situation?” I really do think I got better at that as I had more experience. John: Okay. Well, as I told you before we’re trying to keep these interviews between 10 and 15 minutes and we’re about at that point right now so I’m going to release you. So thank you so much for participating in this and I hope you come back and talk to us again sometime. Nancy: Of course, John. My pleasure.
Petrified Altar Boy14.04.2020 (00:00:00)
I believe that most people who are afflicted by an anxiety disorder have at least one situation that they dread. Constant concern about the situation can lead to generalized anxiety. For me it was fainting. Several times prior to when this incident actually happened, I felt like I was going to faint. When it actually did happen, it was, no doubt, as a result of dehydration. And, it was in an environment was about as awful as I could imagine. I call the story, Petrified Altar Boy. When I was 12, another incident occurred that deepened voidance fear of social situations. It happened in church. As have I said, I was unusually religious, perhaps because religion seemed to offer some protection from all the things of which I was afraid. I was an altar boy and I loved it -- getting up at 5:30 in the morning, quietly slipping on some clothes, and running to get to St. Thomas Aquinas church by six it was all so secretly exciting. I liked it even better if I was the only altar boy to show up. There were so many interesting things to do. I loved lighting the candles that towered over the altar, and, even better, the achievement of blowing them out after Mass with a single puff from the mechanical candle snuffer (this took practice, and was much admired among us altar boys, even though we pretended that it was "no big deal"). I loved pouring the wine into the richly carved glass cruets before Mass, and during Mass, pouring it from the cruets into the priest's gleaming golden chalice. I loved giving the correct Latin responses to the priest's prayers. I loved ringing the bells three times to announce the consecration of the host. Most of all, I loved the feeling of spirituality it gave me. I genuinely felt close to Jesus when I was kneeling in front of the altar in my cassock and surplice. Therefore, you can imagine how excited I was when I was picked to serve the eleven o'clock Mass on Easter Sunday morning. It was pretty unusual for the head altar boy to choose one of the younger boys for this honor. I thought about it for weeks in advance, and when I woke up that special morning, the first thing I did was vomit. Despite my mother's cajoling, I couldn't eat a thing. I was so excited, I ran all the way to the church, getting there at nine so I would be sure to be ready. I looked out through the secret "peep hole" just before the Easter high Mass was to start and saw that the church was jammed. People were standing in the aisles, among them two of my best friends from the sixth grade. At a special Mass like that, there are many additions to the usual ceremony. There was more than one priest involved in the celebration, each with a unique role to play, there was an incense boat to prepare and light at the right time, there were a lot of extra choir parts and prayers to be performed. I was scared silly that I would make a mistake. Though I was very nervous, I managed to do my small part correctly, until just after the reading of the Gospel. I began to feel light-headed, and sweat started rivuleting down my back. My hands got clammy and a powerful nausea swept over me. I remember only one feeling: irritation. I should have been in my glory, and this was a hell of a time to be coming down with some disease. Then the world began to go in and out of focus. It was obvious that this was something more than a bout with the flu. I had never fainted before, but at that moment, the image that came to my mind was of my mother fainting in church. Finally, as if I were dreaming it, my body gradually folded itself down onto the altar steps and the bright lights faded away. When I regained consciousness, I was back in the sacristy lying on one of the benches. At first, I couldn't imagine what had happened, and then I realized I'd fainted. One of the younger priests was sitting beside me, and asked if I were all right. In a weak voice that didn't sound like mine, I assured him I was just fine. A friend walked me home, and the priest called my mother to explain what had happened. When I got home, the family doctor was waiting for me (this was in "the gold old days" when doctors made house calls). He examined me and said there was nothing wrong. It was just that it was a hot day and I had become overly excited -- nothing to get upset about. I was upset, though. I felt that I had made a fool of myself while practically everyone in our neighborhood had watched. When I went to school Monday morning, I expected to be chided for my embarrassing collapse, but aside from a couple of friends asking if I were okay, nothing much was said. For a while, I thought people were looking at me strangely, but by the end of the week, things were back to normal. They were normal, that is, until the next Sunday morning when, as I was serving Mass, I began to feel like it was going to happen again. I started to feel the same symptoms, and left the altar during the middle of the Mass, before I could disgrace myself again. I went straight home, so I saw none of my friends until school the next day. This time, my schoolmates weren't so respectful of my feelings. "Hey, Dacey," one of them chided, "How come you took off during Mass yesterday? Whatsa matter, were you afraid you were gonna take another nosedive?" Another rested his cheek in his hand, rolled his eyes skyward, and immitated me crumpling to the ground. Needless to say, these antics got quite a laugh. I was mortified, and reacted in the typical adolescent way: I quit being an altar boy. I told myself that I really no longer wanted to serve at Mass, anyway, and hoped that that would put an end to this distressing period of my life. Of course it didn't. Increasingly, my fear of fainting in church began to spread to other situations. When I was called upon in seventh grade English class to stand up and tell an anecdote, I became extremely agitated. In our Health class, our incompetent teacher spent most of the period having the students take turns reading a paragraph from the book. Each day, he would start with the first person in the first row, and go right around the class. As I waited for my turn to read, I could not help imagining myself fainting. As I sat in the middle of the fourth row, I had plenty of time to work up an exceedingly clear image. Often I felt had to leave the room. Soon it became the case that whenever I expected I would have to speak in class, I would fake an illness and stay home. I became quite adept at massaging a thermometer with my tongue, producing enough of an elevation to alarm my mother and persuade her that I needed to remain in bed for the day. The most disturbing of these phobic situations to me was school assemblies -- that is, watching older students acting as master of ceremonies for the assembly program. I'm certain that I was much more frightened than they were. I couldn't imagine how they could do it, and I was absolutely certain that if ever I had to do it myself, I would die. Altar 2 Loss of control over body functions when we become fearful is an experience that most of us have had. The cotton-candy-mouth, the quavering voice, the quivering hands and shaking knees that may accompany a stint of public speaking are common. Fainting under these circumstances is rarer, but it is an even clearer example of loss of control. Fainting usually happens just when we are trying our best to stay in control, such as when we are very frightened. It first happened to me when I was 12. Unlike most of my male friends, I was an unusually religious kid, perhaps because religion seemed to offer some protection from all the things I was afraid of. At any rate, I was an altar boy and I loved it -- getting up at five in the morning, quietly slipping on some clothes, and running to get to St. Thomas Aquinas church by 5:30 to prepare for the six o’clock mass -- it was all so secretly exciting. I liked it even better if I was the only altar boy to show up, because then I could savor the magic without having to talk to anyone else. There were so many special things to do: lighting the candles that towered over the altar, and, even better, blowing them out after Mass with a single puff from the mechanical candle snuffer; pouring the wine into the brilliantly carved glass cruets, and during Mass, pouring it into the priest's gleaming golden chalice; giving correct Latin responses (mostly) to the priest's prayers; ringing the bells three times to announce the consecration of the host. Most of all, I loved the feeling of spirituality it gave me. I genuinely felt close to God when I was kneeling in front of the altar in my cassock and surplice. You can imagine how thrilled I was when I was picked to serve the eleven o'clock Mass on Easter Sunday morning. It was pretty unusual for the head altar boy to choose a 12-year-old for this honor. After he told me, I thought about it every day, and when I woke up that special morning, despite my mother's cajoling, I couldn't eat a thing. I was so eager, I ran all the way to the church, getting there at nine so I would be ready. I looked out at the congregation through the secret peep hole just before the 11 o’clock Mass was to start and saw that the church was jammed. People were standing in the aisles, among them two of my best friends from the sixth grade. At a special high Mass like that, there are many additions to the usual ceremony. There were several priests involved in the celebration, each with a unique role to play. There was an incense boat (a metal bowl that held the smoking incense) to prepare and light at the right time. There were a lot of special prayers to be recited. I was scared silly that I would make a mistake. Though I was very nervous, I managed to do my part correctly, until just after the reading of the Gospel. I began to feel light-headed, and sweat started winding its way down my back. My hands got clammy and a powerful nausea swept over me. I remember only one feeling: irritation. I should have been in my glory, and this was a hell of a time to be coming down with some disease. Then the world began to go in and out of focus. It was obvious that this was something more than a bout with the flu. I had never fainted before, but at that moment, the image that came to my mind was of my mother fainting in church. I had seen this happen on at least six occasions, and had wondered if I might have inherited this weakness from her. I heard a voice -- mine, but it didn’t sound like it -- say, “No, I don’t want to!” Finally, as if I were dreaming it, my body gradually folded itself down onto the altar steps and the bright lights faded away. When I regained consciousness, I was back in the sacristy lying on one of the benches. At first, I couldn't imagine what had happened, and then I realized I'd fainted. One of the younger priests was sitting beside me, and asked if I were all right. Weakly, I assured him I was fine. A friend walked me home, and the priest called my mother to explain what had happened. When I got home, the family doctor was waiting for me. He examined me and said there was nothing wrong. It was just that it was a hot day and I had become overly excited -- nothing to get upset about. I was upset, though. I felt that I had made a fool of myself while practically everyone in our neighborhood had watched. I had completely lost control of myself in a way that I identified with my mother, and saw as a female weakness. When I went to school Monday morning, I expected to be chided for my embarrassing collapse, but aside from a couple of friends asking if I were okay, nothing much was said. For a while, I thought people were looking at me strangely, but by the end of the week, things were back to normal. They were normal, that is, until the next Sunday morning when, as I was serving Mass, I began to feel like it was going to happen again. I started to feel the same symptoms, and left the altar during the middle of the Mass, before I could disgrace myself again. I went straight home, so I saw none of my friends until school the next day. This time, my schoolmates weren't so respectful of my feelings. "Hey, Dacey," one of them chided, "How come you took off during Mass yesterday? Whatsa matter, were you afraid you were gonna take another nosedive?" Another put his hand on his head, rolled his eyes skyward, and imitated me crumpling to the ground. Needless to say, these antics got quite a laugh. I was mortified, and reacted in the typical adolescent way: I quit being an altar boy. I told myself that I really no longer wanted to serve at Mass, anyway, and hoped that that would put an end to this distressing period of my life. Of course it didn't. Increasingly, my fear of fainting in church began to spread to other situations. Soon it became the case that whenever I knew I would have to speak in class, I would fake an illness and stay home. I became quite adept at massaging a thermometer with my tongue, producing enough of an elevation in my temperature to alarm my mother and persuade her that I needed to remain in bed for the day. I had developed a serious social phobia. The most disturbing of these phobic situations to me was school assemblies. It terrified me even to watch an older student acting as master of ceremonies for the assembly program, standing there all alone, being judged by 1,400 other kids. No doubt I was more frightened than they were. I couldn't imagine how they could do it, and I was absolutely certain that if ever I had to do it myself, I would die. One of the curious things about most phobics is our popularity with other people. As Claire Weeks, author of several widely-read texts on phobia, puts it, "Most of the phobics I have met are unusually nice people!" Whether we are nice or not, it is clearly true that most of us badly want to be liked. Perhaps it is a result of our sense of vulnerability. Our fearfulness tends to spread from one type of situation (public speaking) to others (parties, interviews), and soon we feel we'd better be especially nice to other people, since we never know when we may need them to help us if we begin to lose control. At any rate, throughout my junior high school years, I found myself being elected to several class offices, and in my final year, was nominated for graduating class president. I was horrified. The president also served as assembly MC. As I walked home from school that day, I remember banging a stick against the side of a fence I was passing. I found myself cursing the Lord for making me the kind of person who had to suffer this terror. I thought about the first assembly for which the president-elect for the spring term would be the MC. It was the worst one, the one when the Christmas season was celebrated. The first thing the MC had to do was read the Christmas story from the Bible. The reading took about five minutes. For five minutes, I would be all alone on that huge stage, with 1,400 pairs of eyes watching me, 1,400 pairs of ears listening to me describe the birth of Jesus. Thinking about Him, I found myself picturing Him at His "sermon on the mount." Thousands of people hanging on His every word. He must have been mighty scared as He started that speech. I know it sounds egotistical, but suddenly I felt inspired. Maybe I was meant to do this thing. Instead of copping out, I should run for the presidency, and if elected to it, maybe I would be able to be the MC. I was elected and one day in the middle of December, found myself sitting in the large chair on the stage of West Junior High. I waited there with the Bible under my arm, the words of the Christmas story printed in large type on sheets of oak tag paper inside. The students began to fill the auditorium, both the main floor and the balcony. Soon they got settled, and I rose and walked slowly to the center of the stage, hoping to make it through. That's all I remember. They tell me that I read the story well enough and that the assembly went well, but I have no recollection of it at all. For a long time, I had a suspicion that maybe I had fainted again, and no one was willing to tell me, but I think someone would have told me by now, so no doubt that didn't happen. One of the curious things about most phobics is our popularity with other people. As Claire Weeks, author of several widely read texts on phobia, puts it, "Most of the phobics I have met are unusually nice people!" Whether we are nice or not, it is clearly true that most of us badly want to be liked. Perhaps it is a result of our sense of vulnerability: we feel we'd better be pleasant to other people, since we never know when we may need them to help us if we panic. Another common trait is a highly developed sense of humor. No doubt we like to laugh, and to make others laugh, because it helps to dispel fearful thoughts.
Dr. Jack Lloyd07.04.2020 (00:00:00)
Transcript of Dr. John Dacey’ podcast Dr. John Dacey: Today I have a guest who is my first psychiatrist that I’m going to be eagerly listening to a lot of the things he has to say about anxiety disorders. His name is Jack Lloyd, Dr. Jack Lloyd and I’m going to welcome him to the studio today. Hi Jack. Dr. Jack Lloyd: Hi John. So nice to be here. Dr. John Dacey: Thank you. Jack, I want start off by asking you to describe your clientele to me as much as , in as much detail as you can. What kinds of people do you typically see? Dr. Jack Lloyd: well John, I work by in large with the college undergraduate and graduate student population. I’d say 80% of the clients I see are in that category. Dr. John Dacey: Ok Dr. Jack Lloyd: I also work with some... Dr. John Dacey: Are they at a college some place? Dr. Jack Lloyd: Yeah, primarily at a university. Dr. John Dacey: You’re at MIT if I remember correctly. Dr. Jack Lloyd: Right. Dr. John Dacey: No shortage of anxiety problems. Dr. Jack Lloyd: Yeah, it’s a good anxiety generator. I think that for all, it’s that age is rife with reasons to be anxious. And I also work in my private practice with some older adults middle age and even older adults so I really run the gamut but I don’t work with children. Dr. John Dacey: OK. All right. fine. That’s good because that’s not what we’re talking about too much here anyway. I have another colleague who does work almost entirely with college students. Her name is Dr. Elizabeth Brocker. And, I, So I’m glad to be talking to you. I want to talk to you of course about the psychological side of things but you’re also able to speak about the physical side of things. Maybe we should start right off with that. I know that I have a very good friend who is a psychiatrist. And when I see, quite a few clients I’ve seen over the years have needed some mild tranquilizer situation, some kind of medication, because they found it very hard to pay attention when they’re in the middle of an episode. And they find it very hard to remember what I told them to do. And if they can remember what to do, they’re fine. They can work things out pretty well. But it’s very hard to remember when you’re really having, when you’re really having a bad case of the jitters. So, what percentage would you say of the clients that come to you as opposed to a psychotherapist, I imagine A fairer number, you get more serious cases. Am I right? Dr. Jack Lloyd: Well, yes, I suppose I probably do. And I may, I may, some of my clients may be individuals who have been working in therapy for a while and making the best use they can, as you say, of cognitive behavioral therapy, and of exposure and response prevention; Different techniques, mindfulness meditation, Behavioral techniques, exercise. And I think When those techniques haven’t quite gotten as far as the therapist and the client would like, they will often refer them to me, and I, I actually think that for everybody those therapy and behavioral techniques ought to be the real cornerstone of treatment. But as an adjunctive, as an adjunctive measure and treatment, I certainly prescribe medications. And in my, I also do therapy, And so I sometimes in a sense would refer to myself in an analogous way, and there are a number of medicines that can be helpful. Would you like me to talk about some? Dr. John Dacey: Yeah I really would like you to talk about them. I would like to About the various categories and I think it would be wonderful chance to to to go to the horses mouth here so to speak. What kind of categories are there? And why do we prescribe them? Dr. Jack Lloyd: Well, there are a number of different varieties of anxiety, of categories. Some, one clear obvious one is simple phobias; for instance if someone is frightened of flying or frightened of escalators. They can benefit. Fear of flying is a good example. Someone Who flies a couple times a year could benefit from taking a benzodiazepine type of medication. As you say, kind of like a tranquilizer, which can really do well to calm their anxiety, help them to be able to get on the plane, Get out to visit their families during the holidays. Dr. John Dacey: What are some exact examples of, you don’t mind if I call you Jack? Dr. Jack Lloyd: No, please do. Dr. John Dacey: What are some examples of benzodiazepines, Jack? Dr. Jack Lloyd: Commonly known ones are Xanax or lorazepam. Any that the... Dr. John Dacey: Clonopin? Dr. Jack Lloyd: Clonopin. Another word for that is clonazepam. Dr. John Dacey: Yeah that’s right. Dr. Jack Lloyd: Diazepam which is Valium. Alprazolam which is Xanax. Those are all, all those “-asolams” are all benzodiazepines. Dr. John Dacey: They are. Dr. Jack Lloyd: And they work very quickly. After taking it, they will take sometimes as short as 20 to 30 minutes to work and they last for a while. Dr. John Dacey: Xanax Will work faster even than that. Dr. Jack Lloyd: Xanax might even work faster than that. And sometimes just the act of taking it will help anxiety. Or the active having it in your cupboard or in your purse may make it so that you don’t even need it after a while, but, ... Dr. John Dacey: One of the most fascinating medical discoveries that I found, read about recently Is that for a lot of people even if they know that it’s a Dr. Jack Lloyd: Placebo? Dr. John Dacey: A placebo. Even if they know it, It still helps. Dr. Jack Lloyd: Yeah, it’s awesome that way. Dr. John Dacey: That’s incredible! Dr. Jack Lloyd: iI’s a wonderful tool to use that. Dr. John Dacey: What do you think is going on there? Is it that…? Dr. Jack Lloyd: Belief that it will work. It’s that power. Is the belief that... Dr. John Dacey: Oh, of course. Unintelligible Dr. Jack Lloyd: ... Thinking ...If someone is taking a sugar pill and the real pill and the individual who’s taking it doesn’t know... Dr. John Dacey: Well if that’s the case…then... Dr. Jack Lloyd: Then the placebo effect might be even stronger. Dr. John Dacey: That’s right. We could, but we’re not surprised about that because they think it may well be the kind of thing, they are looking for the response and they get it, and of course that’s really terrific. I wonder if there are some doctors Who say, “I’m going to give you a tranquilizer.” And it’s really a sugar pill. But it works fine and ... Dr. Jack Lloyd: (laughs) Dr. John Dacey: and I don’t know. Have you ever…? Dr. Jack Lloyd: No, I’ve never done that, but I have given, I often load up the medicine that I’m prescribing with hope. Dr. John Dacey: Yes. Yes Dr. Jack Lloyd: And so, one might consider that placebo. But I will often say this is a this is a powerful medicine. This is likely to help you. And I think you’re going to find that after such and such minutes you’re going to feel a little bit like a little bit more relaxed. And I will try to point people in the direction of what I think that they’re expected to feel. And I think that helps the medicine along... Dr. John Dacey: I have to ask this question before we get back to the other types of medications that there are. I went to a doctor once with a very sore back, a lot of back pain. And he said “you know what I would like to tell you is...” And I think he was talking about more about depression. That he thought had something to do with what was going on.And he said “you know, I would like to have a bowl of 50 pills and I’d just say ‘take one, anyone whatever,’ and if it gives you a really bad side effects that you can’t tolerate Or it doesn’t seem to do anything for you, I would say ‘OK, now I can remove that pill plus four others that are just like it in some other ways’. Now I’m down to 45 pills, And take another one…” Dr. Jack Lloyd: Right. (Laughing)Try this one. Dr. John Dacey: Is it like that way with anxiety? Or can you pretty well tell in advance what’s going to ... what effect it’s going to... because I’ve heard that from a lot of people, about either the side effects are unbearable or there wasn’t much effect from the pill, at least in terms of depression. Dr. Jack Lloyd: Yeah… Dr. John Dacey: Is it the same kind of thing with anxiety or not? Dr. Jack Lloyd: Well depression and anxiety really are siblings. Dr. John Dacey: They really are. 50% of people who have one, have the other. Because anxiety is scary and it’s depressing, and depression is scary, so... Dr. Jack Lloyd: Well we talked about one of the types of medicines used to treat anxiety which are the benzodiazepines. Dr. John Dacey: Yeah that’s right. Dr. Jack Lloyd: The other most common type of medication used to treat anxiety are the anti- depressant class of medicines, the selective serotonin reuptake inhibitors. Dr. John Dacey: The SSRIs Dr. Jack Lloyd: SSRIs; Zoloft, Prozac, Paxil, a host of them.And they, they act differently than the benzodiazepines. They’re more of a in a sense a preventive type of medicine that you need to take daily and for a period of time before they begin to lower the anxiety levels Dr. John Dacey: so, you don’t take them PRN as they say. You don’t take them… You take them on a more orderly or regular basis. Dr. Jack Lloyd: Right, exactly. Dr. John Dacey: And why do they work better if they’re taken on a more regular basis? Dr. Jack Lloyd: Well, really because they don’t work at all if they’re not taking regularly. Dr. John Dacey: Oh , I see. Dr. Jack Lloyd: If you just take it like a benzodiazepine, just once, then you’re really only exposing yourself to the side effects and the risks of the medication. It’s not having, the medicine will not have benefit of just once unless there’s a placebo effect as we talked about earlier. Dr. John Dacey: So someone who carries one around in his wallet for the rare, for the rare opportunity, rare problem that he has with anxiety, is making a mistake? Dr. Jack Lloyd: Well, it ought to be a benzodiazepine as opposed to an SSRI. Dr. John Dacey: It should be. OK. Now I see what you’re saying. That makes good sense to me. And I’ve also heard that Valium and Librium both through the liver. Dr. Jack Lloyd: Diazepam and Ativan which is lorazepam will go, will pass... Dr. John Dacey: ...and Klonopin. Dr. Jack Lloyd: ….will pass through the liver. Dr. John Dacey: They do pass through of the liver. Dr. Jack Lloyd: I think Librium does not. Dr. John Dacey: Oh, then perhaps I’m confused about that. Because I always heard that Valium and Librium do go through the liver, and you could become addicted to them.But a psychiatrist friend of mine once said if you take that whole bottle of Libri...Ativan you’ll just go to sleep. Dr. Jack Lloyd: Well, this is the, this is the problem with benzodiazepine use is that they are; the benzodiazepines are really quite effective at decreasing anxiety, and people feel it right away. The problem, and the downside and the reason why there’s the need for another medicine like the SSRis which are actually less effective in the moment.The problem with the benzodiazepines is that those are all potentially habit-forming. Dr. John Dacey: They are because they’re so quick. And that’s what I heard about the really fast one there the Dr. Jack Lloyd: Xanax? Dr. John Dacey: Xanax. Yes. That Xanax is problematic because it’s so fast acting.That it can easily become addictive. Not necessarily physically addictive, is that correct, but psychologically,? Dr. Jack Lloyd: Well if you take any of the benzodiazepines regularly, not on an as needed basis, you can get tolerant to them. And they begin to work less well and you need to take more. And they really end up going down in a bad direction.. I think. I don’t like prescribing those medicines on a routine basis.Although in some cases it’s all that works and so that’s what we end up doing. But i think it’s much better to take them on an as needed basis. Dr. John Dacey: So it’s a little bit of an exploration. You really have to try some things out to see what going to happen. And I’ve often heard psychiatrist talk about “well I tried this.That didn’t have any…” And I thought, “ that’s really interesting“ It’s sort of like almost impossible to predict which of the… SSRIs… are you going to have exactly, Are going to really work the way that you want them to. Dr. Jack Lloyd: John, I think maybe I should mention a third type of medication which is sometimes very helpful particularly for individuals wiith performance anxiety of any almost any sort. Dr. John Dacey: There is a third category, yes. Dr. Jack Lloyd: And this is a medicine that’s a long-standing medicine used for blood pressure control, propranolol. It’s very interesting. Dr. John Dacey: Really. I have not heard of that. Dr. Jack Lloyd: Yes It’s really interesting. This is a medication that will control physical effects of anxiety. For instance, what it does is that he keeps the heart; this is how it controls blood pressure, it keeps the heart from squeezing very hard and very quickly. It kind of governs the heart from going very hard. Dr. John Dacey: So it keeps your blood… Your heart rate is a little slower. Dr. Jack Lloyd: It helps keeps your heart rate and also the intensity of the squeeze less. It also decreases tremulousness. So people don’t get a shaky. And so it does all these things to the body, peripherally. It doesn’t have much direct affect on the mind. But the mind seems to take a cue from the body. Dr. John Dacey: It certainly does. Dr. Jack Lloyd: Since the body is not shaking and the hearts not pounding the mind thinks “oh, this is usually a situation in which I’d be anxious, but somehow today I’m not.“And if the body is relaxed the mind will follow. So, sometimes professors who have difficulty with tremulousness as they’re holding their pointer and don’t want to shake, or musicians who are giving a performance. Dr. John Dacey: Could be a violinist. Dr. Jack Lloyd: The violinist doesn’t want to shake. Dr. John Dacey: (Laughing) arpeggios. Dr. Jack Lloyd: They can use this kind of medication, propranolol. Dr. John Dacey: Propranolol Dr. Jack Lloyd: Propranolol, it’s a beta blocker. Dr. John Dacey: It is a beta blocker. OK and what do you feel about beta blockers in general? Dr. Jack Lloyd: Well, I think they can be very useful for this type of anxiety. As opposed to the benzodiazepines they are not addictive or habit-forming and and they can be very effective. And they don’t have that risk. That’s the real problem with the benzodiazepines; That’s they’re so useful that someone might just want to take them routinely and all the time and then they end up being less effective over the long run. Dr. John Dacey: I was told by a friend of mine, who is a psychiatrist, that I should probably… I was taking one, the smallest dose of lorazepam in the middle of the night. It helped me to go right back to sleep. And otherwise I would lay awake thinking about what I’m writing or whatever. And he said to me “now that you’re as old as you are, you should think about getting off it because it could make you fall. “ Dr. Jack Lloyd: Right. Dr. John Dacey: So, it makes you a little less steady on your feet. What category is that the result of? Is that the whole category or is it just lorazepam? Dr. Jack Lloyd: That’s the benzodiazepines. The whole category. Dr. John Dacey: The whole category, they’re all that way they can make you a little less stable. Dr. Jack Lloyd: Yeah, they also, can, if you take them kind of during the day for instance before a performance or before a lecture, they can decrease your anxiety, but they are also a little bit sedating. So, they may not keep you quite as cognitively sharp as you might want to be as opposed to the beta blockers which don’t affect your cognition really at all. Dr. John Dacey: That is really very interesting. You know our time is just about up here and I try to keep these at the longest to 15 minutes. This has been extremely helpful, and I wonder if maybe sometime I can come back to you again and have you talk some more about this. Dr. Jack Lloyd: Oh, absolutely, John. It’s a pleasure. I’m happy to talk to you whenever you like. Dr. John Dacey: Well thank you so much I certainly appreciate it. Dr. Jack Lloyd: Thank you, John.
Yogic Sponge31.03.2020 (00:00:00)
As I have said, the essence of dealing with anxiety is the ability to relax. One of the best ways I know of to calm your nerves is called the “yogic sponge.” In this podcast, I am going to read the text that is very good at inducing relaxation. If you prefer your own voice, or that of a relative or friend, have them read it into the recording device such as the one on your phone. Play it at least once a day, or as often as you feel the need. After a number of repetitions, you won’t even need the recording anymore, as you will hear this script in your head. The Yogic Sponge Begin by lying down on a firm but cushioned surface, such as a rug or towel. Read this script in a soft, soothing voice. You may want to record your reading, or have it taped by a friend with a great voice, so that you can play it whenever you wish. It's best to lie down on a soft place. Put your hands beside you with your palms down, then let them turn up by themselves naturally. Let your feet spread apart a little bit. Get stretched out and try to get yourself in a nice relaxed position. The idea is to go on a mental trip. Instead of going on a trip away from home, you’re going into the deepest part of yourself, your own personal home. This is a time specifically just for you, nobody else. You’re going to be thinking only about getting yourself into position, so that you can do some really good relaxing. [Begin taping.] Concentrate on your feet, especially your toes. Wiggle them around a little bit. Tense your feet up if you want to, pull them toward you and then just let them go. Let them just relax completely. That’s really good. [Pause.] Now let this feeling of relaxation spread up into your ankles, shinbones, up to your knees. You may want to straighten your legs out and bend them just a little. Make sure the tightness is out of your knees, then let this mellow feeling move up your thighs. Your muscles are letting go and now your legs are starting to become very, very heavy. They are pressing down against the rug and maybe almost through the rug. It feels wonderful to just lie there and sink deeper into this state of serenity. [Pause.] This feeling now is beginning to spread up into your hips and your lower abdomen, up into your stomach. It is beginning now to infiltrate into your chest. Notice that as you start to relax, breathing now becomes slower. In fact, you can take a deep breath, hold it for a while let it go, then hold it. First let all your breath out—all your breath. Now you’re going to inhale. Try it now—I’ll count so that you can tell how long to do each of these three tasks. Breathe in: 2, 3, 4, 5, 6; breathe out: 2, 3, 4, 5, 6; and hold it: 2, 3, 4, 5, 6. Notice that you did not after breathing in. The way you are instructed here is better. As you practice this, you’re going to become just like a sponge, just lying there soaking things up. You want to get your breathing to become slower and slower and deeper and deeper.Not just in your chest, but down in your belly, too. [Pause.] Now let the feeling spread into your shoulders. Scrunch your shoulders up, wiggle them around, and make sure that they really let go. Let them “fall” into the floor, so that your entire body now feels very, very heavy. [Pause] This feeling of heaviness is starting to move through your shoulders into your upper arms, down through your elbows and now it’s flowing down into your forearms. Your arms are becoming very heavy. [Pause.] This feeling is now going into your palms, the backs of your hands, slowly going out through your fingers and your thumbs, a feeling of heaviness and deep relaxation. Now return back up through your shoulders and into your neck. [Pause.] Let this feeling come up through your chin, up through the back of your head and into your face. Your mouth is probably a little open, because you’re doing nice deep breathing in through your nose and out through your mouth, feeling the oxygen go up through your nose and cheekbones, even your ears. Concentrate on total, total relaxation. [Pause] Next check your eyes and make sure that they’re just barely closed. Let this feeling of relaxation go up now through your forehead. It’s a very lovely, heavy feeling. The serenity is moving up through your scalp and you’re extremely relaxed. [Pause.] Now I would like you to concentrate on that part of your face that is directly between your eyes and the top of your nose. Imagine that a magical golden fluid is starting to pour into your head through this special opening in the center of your forehead, down right between your eyes. You feel a golden yellow liquid, like honey, a warm relaxing fluid, just tremendously soothing as it moves into your head now, and fills your head and down through your neck. [Pause.] You feel it flowing down inside, down through your shoulders and your arms, through your hands. It gives you total peace. Now it’s starting to flow to fill your entire upper body, starting to flow into your legs. Slowly but surely you feel this warm, relaxing sensation surge down through you, down through your knees, down through your shins and your calves, total relaxation and a sense of safety and peace. Total serenity floods through you and now down through your ankles into your feet, all the way through your feet down to your toes. And now your entire body is filled with this serene, warm, golden fluid. [Pause, then speak in a slightly softer voice.] Instead of feeling heavy, now, you notice that you’ve developed a lightness, as though you’re floating. You’re completely relaxed. You’re thinking of nothing but the warm, very comfortable feeling that you’re getting from this. And you’re sinking down into it. You’re letting yourself just be filled with this. You hear my voice very well, but it seems like it’s from far away. And you find yourself drifting farther and farther away. You’re thinking of nothing, nothing at all, but the peace that’s there. You may want to picture a scene, like looking at the ocean or some other beautiful place. You do not feel sleepy, you do not feel tired at all, you feel just very, very relaxed, quite safe, at peace. [Pause.] You’re filled with peacefulness, you’re filled with the wonderful sense of freedom. Nothing’s bothering you at all. You’re at peace. You are now down in a very special, safe place, deep inside yourself, completely relaxed and completely safe. [Pause.] All right, now start to think about coming back up to the surface again. You feel yourself sort of floating back up. You have become so light and free that you’re actually floating. As you start to re‐enter the “outside world,” you may want to just wiggle a finger. Do it slowly, at your own pace. Slowly come back. Move your feet around a little bit if you want to. As you feel ready to do it, open your eyes. Eventually you may want to get up on one elbow. [Pause.] Gradually get yourself up to a sitting position. Now think back. Do you feel calmer? Happier? More mentally alert? Would you like to do this again sometime? I hope this exercise proves useful to you in your struggle against the pernicious pandemic we are all dealing with. For now, I wish you the very best in your struggle to remain calm. See you next week!
Help with Anxiety about the Pandemic, Part 224.03.2020 (00:00:00)
As you probably already know, the most common mental illness in the world today is anxiety. Although feeling fearful during the coronavirus pandemic is entirely normal, seriously disruptive anxious reactions are fast becoming common. Although reading articles and listening to podcasts about this cataclysm is not recommended for those suffering from any of the eight varieties of anxiety syndromes, because the sources might serve to exacerbate your fearfulness, my brief summary of the best new ideas should prove helpful to you. I also want you to know that my new book, Why Don’t You Just Relax? is available at amazon.com, as an electronic book for Kindle, and also as a paperback book. There is some overlap between my podcasts and this new book, but the latter is designed much more as a self-help instrument. I hope you will give it a look! Hi. This is Dr. John Dacey, with my weekly podcast, New Solutions to the Anxiety Epidemic. As you probably already know, the most common mental disorder in the world today is anxiety. Although feeling fearful during the coronavirus pandemic is entirely normal, seriously disruptive anxious reactions are fast becoming common. Reading articles and listening to podcasts about this cataclysm is not recommended for those suffering from any of the eight varieties of anxiety syndromes. These sources might serve to exacerbate your fearfulness. However, this very brief summary of the best new ideas that I offer you today should prove helpful to you. First, let me remind you, my theory about the anxiety syndrome in general is that it is based on childhood claustrophobia. For example, there is the time when I crawled under a pillow in my baby carriage, and was blue-faced by the time my mother discovered me. That laid the basis for associating fear with being trapped, later in my life. Seems to have happened often, and generalized to many other circumstances. Does this ring any bells with you? So what can we do if we feel trapped now? Trapped in our houses, without our normal social stimuli. Trapped in our bodies, with constant concerns that we are experiencing some coronavirus symptoms. Trapped in our minds, with constant fears that this is never going to end, or that it will end badly for us. What can we do? Well, we need to prove to ourselves that we are NOT trapped! We can go for a walk or a drive by ourselves. A good friend of mine and I met yesterday on a park bench, and, sitting on either end of the bench, we had a stimulating conversation. At one point a lady walking by chided us, saying, “You two are only 5 feet apart!” I think she was kidding. We can take advantage of our restrictions by completing jobs we’ve been promising ourselves we would do for ages. My favorite writing team, Douglas Preston and Lincoln Child, demonstrate the ultimate example of freedom. Their major character, FBI agent-at-large Aloysius Pendergast, has been chained to a table in a wicked man’s cellar. He was promised that when the man comes back in three hours, Pendergast will die. Our hero decides not to waste the time, so he goes on a delightful trip through a gorgeous garden, in his mind. At the end of 3 hours, Pendergast is well rested, and of course is able to overcome his opponent. The point is, if you don’t like where you are, you can go someplace else, mentally. Sure, it takes some practice, but you can do it. And if you do it, you will no longer feel constrained, that “wrapped-in--rug” horror show so many of us have known, if only in our nightmares. Remember, in the final analysis, YOU ARE THE BOSS OF YOU! Don’t forget your mental executive function that I spoke of in my last podcast on the subject, #22. By the way, even better even than a walk, if you are able, go for a run. One man combats his anxiety by starting each day with a 30-minute run, a perk of not having a two-hour train commute anymore. He says, “The morning workouts aren’t about how many calories I burn. It’s really about getting that chemical structure and endorphins for the day.” And he tries to notice the little things, like the leaves starting to bud. Also, “Having the news on every second of every day just feeds into the mania,” Christine Magill adds. “If we can put things in chunks, they’re manageable for us, usually,” Larry Berkowitz says. He also suggests that people working from home try to create daily or weekly schedules with their families, and negotiate any expectations or challenges, like needing space away from each other, before tensions flare up. And, of course, humor is essential. I asked a friend how she was doing the other day, and she replied that everything with her was just great. “Of course,” she said, “that’s probably because I’m a germophile! I love germs, so this pandemic suits me just fine!” Search for and emphasize good news. For example, a new study has found that “often-milder cases, while prolific, are about half as infectious as confirmed ones. And a team of researchers from McMaster University and the University of Toronto have isolated the agent within the novel coronavirus that will help the world develop better diagnostic tools and, eventually, a vaccine.” We are hard-wired for a fight-flight-or-freeze response. “The greater the simmering anxiety,” Dr. Harriet Lerner explains, “the more you will see individuals stuck, in fighting and blaming on the one hand, or distancing and cutting off on the other.” This is normal, she says, but if we can identify our anxiety-driven reactivity, “we can get some distance from it, rather than being propelled into action before we have calmed down enough to do our best thinking.” Social distancing and sheltering in place require us to stay in our homes, but that doesn’t mean we have to isolate. “It’s essential to stay in communication with family, friends, neighbors and other resources,” Dr. Lerner says, “and find ways to keep calm.” Don’t let fear and anxiety become pandemics, too. Read or listen to up-to-date info on reducing anxiety level (including mine) for no more than half an hour a day. Pick out the ideas that make the most sense to you, and make sure that you practice them assiduously. I wish you the best. Talk to you next week.
Is Coronavirus Making You Anxious?17.03.2020 (00:00:00)
How to Deal with Coronavirus as an Independent Thinker I think it is high time that I offer you the best solutions for anxiety about the coronavirus. I have spent the last two weeks searching sources for advice on this universal problem. Here is the most useful advice I was able to find.
A Young Woman's Point of View10.03.2020 (00:00:00)
Today I have a junior in college, friend of mine, Madeline. We call her Maddie and, I'm going to ask her to talk about her own experience, but also what she sees in college students her age these days.
Does Separation Anxiety Lead to Agoraphobia?03.03.2020 (00:00:00)
My first solo vacation was a two-week trip to Aunt Anna’s dairy farm, 29 miles to the south of home. I was 10, and the trip lasted for five miserable days. It was also the beginning of serious separation anxiety, and perhaps of even more serious agoraphobia, I call this story “Farm Boy.” PS: My new book, “Why Don’t You Just Relax?” is now available on Amazon Kindle, and will be available as a soft cover book there in a couple of days.
Dr. Combs25.02.2020 (00:00:00)
Dr. Sheila Combs is a well-established counselor to young- and middle-aged adults, Many of her clients suffer from anxiety syndromes, and she has a plethora of good strategies to offer.-
Stuck at Home18.02.2020 (00:00:00)
When I was five, we lived on the Delaware River. Several incidents in those days led to my having at Homen agoraphobic disorder. Here's how it transpired.
The Anesthesiologists11.02.2020 (00:00:00)
A married couple of retired anesthesiologists explain how they deal with anxiety, their patients' and their own!

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