Almost Anxious

actually it's kind of a clinical term. The medical literature, as she says in her book, currently recognized as many problems or syndromes that don't quite meet the standard definition of a medical condition. They're what medical professionals often referred to as subclinical, and it's what they call the almost effect. So in this episode, we'll talk about how anxiety is a spectrum. It's not a dichotomy normal and then full blown pathology. You have an anxiety disorder. There are things

in the middle. There are a lot of us who are in the almost effect of anxiety. We sort of use bad tools for lack of a better term, and can move over into the full blown anxiety disorder category. But I loved talking with Dr Marquez because we talked about some things that hasn't come up on this show yet, specifically avoidance, which is you know, it's come up here and there, but it's it's really it's the go to tool of the anxious person or the person who has

panic disorder. It's the go to tool before you get help with learning how to cope in the situation. And honestly, it's it's a lifelong go to tool, and it's not. It's a broken tool, but I still find myself using it in certain situations. And we talk about um ways that we are in avoidance that aren't even obvious. One obvious way of being in avoidance is don't go into a building that scares you. But another non obvious way

of being in avoidance is seeking reassurance. So I'll get into all of that, but it was interesting while I was, you know, reading her book and getting to know the doctor. As I was researching, I happened to be away. I my parents, who live on the East Coast, had to come out to Palm Springs for something, and so we drove down together. I drove now that is a huge feat for me. In the past, I used to have a fear of driving on freeways. And it wasn't about

driving alone. I just didn't want to drive on them at all, and even if people were with me, UM just wasn't a thing, And mainly because I would have panic attacks, and I don't want to have a panic attack while I'm driving, because it feels like you're dying. Sometimes I would physically start shaking so badly. I mean it would look like, you know, my knees are bouncing up and down under the steering wheel, and and you feel like you're going to lose control and or pass

out and die. And it's it's really tough to drive a machine while you're panicking. So it's a sensation that I didn't want to experience UM ever, and had experienced a few times. And so I spent most of my life in avoidance of driving on freeways. And now I do it freely. But I do remember one of my first um, you know, day jobs, just to pay the bills. When I first moved to Los Angeles, I was twenty eight. It was two thousand two, and I worked for a guy who worked out of his home and he was

in I don't know, just some low level production. So in other words, he had some audio equipment and you know, a studio might call him and say, hey, you know, one of our speakers blew out. Can you get a speaker to us, you know, sometime today. And so it was of the utmost importance that if my boss Jim had a speaker, you know, a huge industrial size speaker

to deliver to the studio that would need it. That part of him having his own little warehouse was that he could get it to you, you know, within the hour. It's like nowadays, it reminds me of like a Postmates, you know, rush order or something. But I was the person that had to deliver it. And if you know anything about Los Angeles, you know there's traffic, but it's

not always what you think. During the day, there are certain freeways that it's not bumper or bumper, it's you know, you're driving along the freeway at a normal pace, and it's much faster than taking what we call surface streets or the back roads. I mean, if you need to get somewhere, you jump on that freeway in the middle of the day when it's not rush hour, traffic, you will get to where you need to go ten minutes,

as opposed if you took the back roads forty five minutes. Well, I didn't know that was going to be part of my job. I was mainly just a bookkeeper. And then suddenly this delivery aspect gets introduced and I can hear him on the phone saying, yep, Jen will be there

in oh, I don't know, uh, thirty minutes. And then I would hear this is way before you know Google Maps and all that thing, and he would say, yeah, okay, so you take the one thirty four to the two and the five and the six, and my head would already start spinning, sitting at the desk, just thinking I can't, I can't, I can't, I can't. I can't get on

the freeways. And so so many times I just took those surface streets and the order was late, and I would say, oh, there was crazy traffic, and thank god, there was no way to tell back then you couldn't get on some kind of online mapping thing and say no, there isn't. But um, eventually, at one point a job was important enough that I had to do it. And I remember, I mean, I'm not kidding. I'm acting it out physically. Understand that this is a podcast, but I

don't have the words for it. I was going the whole time. My entire body was shaking up and down in such an intense panic attack. And I know that. On last week's episode, UM, we talked to Dr Angela and she said a lot of people don't ever let their panic hit its highest point and just sort of burnout on its own. Well, I had no choice, and the panic was so overtaking me. It did hit its highest point, but I swear it felt like the panic attacks were lasting five or ten minutes, which is a

long time when you are driving on the freeway. And so now I really don't have that. I've spent a lot of my life as a comedian on the road. I do a lot of my own driving between cities and just living in Los Angeles. Jump on the freeway, jump off. It's not always my favorite thing, but it's not from an anxiety standpoint. It's more I don't feel like sitting in traffic, or everyone's driving crazy today, they're in a mood, or it's raining whatever. However, going back

to my original point, I was in Palm Springs. When I was interviewing Dr lauana Um, I was there half on a little thing with my parents, and then at the end of the week I had a wedding to go to, So there was a few days where I was just there hanging out and doing my research for this week's episode and conducting the interview. And during those days I kept picturing the drive home and how i'd be driving home by myself from Palm Springs. Now, again, I don't really know why I was worried that I

would panic. I've driven by myself to and from San Diego from Los Angeles, which is a longer distance, so it's about the same. But I don't know why. Uh. And I kept thinking, well, okay, Jen, if you have a panic attack, you'll have a panic attack. What is the problem? And I kept just thinking, I wish I didn't have to and I hope I don't panic, and

it's going to be miserable. And I think it's my theory is um, the more I have going on in life that's a little stressful, a little unknown, I will tend to panic in certain situations that can cause a panic attack, And for me, that is again it's more now not driving on the freeway, but getting stuck in traffic. That that is something that I find I will have

anything from uncomfortable sensations to full blown panic attack. And you know, I'm sort of in the middle of a move, just a lot of new things happening, and I felt a little pressed for time. I felt like I didn't really even have time to be in Palm Springs that long. Wasn't quite a vacation for me. So I just feeling stressed. And when I have a lot of other things going on, um situations that can cause me to panic most likely will. So. Dr Marquez talks a lot about exposure therapy in her book.

She's worked with patients that, you know, have a fear of getting in an elevator, of fear of heights. And I never did exposure therapy about driving on the freeway. I just sort of did it and applied all of

my panic disorder and generalized anxiety tools to it. But I thought to ask her a question about, you know, what what do I do in this case where it's three days from the drive and I'm still I'm kind of dreading it, and it's almost making me think I'm not even gonna enjoy this wedding I'm going to the night before because I'm just thinking about this drive and it was starting to pick up steam in my brain, and I wanted to ask her, should I think of it more as something that you know, Do I get

in the car and start assuming there will be panic and doing a breathing tape or whatever a tape? I have a car with an eight track tape player, you know, doing a breathing app or what? I don't know? Or do I just kind of ignore it because I have conquered this. I have more examples than not of driving on the freeway alone in traffic without panicking. Do I just live my life and if it happens, I do

have tools, but I don't have to anticipate it. And she did answer, and I will have an answer for you on the flip side of this episode about what ended up happening. But it was interesting in that more meant to, you know, I don't know, get a little free advice from a therapist, but but I figured I would take you all into that situation so that you could see in real time what talking to someone looks like. If you've never been to therapy, does that make sense.

And something else she mentioned that I that I wanted to talk about is, you know, a lot of times we do avoid situations that scare us, you know, airplanes, tall buildings, the mall. I don't know anything. A lot of times we do avoid things because these are places we have panicked before, and we associate that place with the panic attack. And for me, I avoid you know,

tall buildings. Now, there are few cases where I do have to go up to the forty floor of certain buildings, and there's just there's just no option that I'm not going to. There are certain radio stations. If I have to go do press for something, you've got to get on the floor, and I have my coping skills and I make it work. But in general, UM, if you tell me that you just bought a penthouse and you live on the fifte floor, I'm probably not going to

your Christmas party. I just the discomfort would be too much. I don't like roller coasters. I don't see that happening, but unlike the Christmas party that I bet would be great. And thank you for inviting me in your new penthouse. Uh No, regrets not going back on a roller coaster. Ben once I get it, but I probably would do some exposure therapy around trying to get to that Christmas

party because that's something I really want to do. And so that was something that Dr Marcus and I talked about, and she uses this with her patients, which is, you know, it's fine to avoid certain things if you if it's just not even worth it, But what's your quality of life like with your anxiety in the sense that we can avoid certain things. You don't need to go on a roller coaster, right, you don't need to go on a zip line down a mountain. You don't need to

bungee jump, you don't need to sky I have. All of those things could cause anyone to have a panic attack. But when we look at everyday things like getting on an airplane to go, you know, across the country, or driving on a freeway, when we look at those things as inherently as dangerous, as taking some big risk, that's when we start to convince ourselves that that we're right,

you know, and then our life gets really small. And so what I loved about talking to Dr Marquez was she reminded me that one of the emotionally very sad things about panic and anxiety is that my life was kept small in a lot of areas. And she posed a question to me during another part of the interviewer I retroactively got some therapy. She reminded me by by saying to me what she would say to her patients about what kind of life do you want to live? And working from there and so I'll tell you we

mentioned UH nine eleven in this episode. And the reason I brought it up to her was because when I was living in New York and that was, you know, working my temp jobs and wanted to be a comedian at night and was doing comedy at night, but unpaid, and you know, just a few years into comedy and just doing when everybody else did, working out your material, doing your day job, whatever it may be. And I

was hooked up with a temp agency. And you get a job anywhere from a day last it could last a day, it could last a week, a could last months. And I would get these calls, well, you have a job at this building and it's uh. When you get there, check into the thirty six floor, and that's always where I'd say, Nope, can't take that job. The building is I can't, I can't I can't with the elevator, I

can't be up that high. And I was offered a job in the World Trade Center, I don't know, answering the phones at some such company, and I said no because I've always had a fear of the World Trade Center and I was just thought, nah, I don't want to go in that building. It. I don't know what if something happens, what was something. I always thought that even just like a helicopter could fly into it. I just better for me to avoid that building. And so

I didn't take the job. Now. Of course, as I said in the interview, I don't know if I would have been working that temp job a year later, probably not. But as someone who at the time I was living in New York City and wasn't in therapy, I had a really bizarre reaction Among many reactions to nine eleven, but one of the most bizarre ones was thinking I was right. I knew it. See, I'm I'm keeping myself safe by not going to places like this, and I

don't care what these therapists say, you know. No, So I'd had a really great therapist, which I've i think mentioned in previous episodes, the woman who taught me about mindfulness, and she was my therapist when I first first went in the mid nineties when I was living in Boston. But when I went to New York, I didn't get

a new therapist right away. And I had this one woman and she fell asleep during my sessions and I don't think I'm that boring, and uh, she said something once, well, if you want to be a comedian, be a comedian, why do you why do you answer phones at this tech company? And I went, well, you can't just be a comedian. Goes up, there's that can't and I said, no, no, no, like literally, that's not how it works, Like I'm still

at the open mic level. You literally just it's not you can't like And I couldn't explain to her because she kept insisting I was being negative, and I was like, well, you had to go to school for this, you didn't just get to say you were a therapist. Um, and then she kind of looked at me and she's like, you seem like you're being very stubborn, and then she

fell asleep. So you know, I was a little down on therapist at that point, so I I asked Dr Marquez what she would have said to me back then if I came into her and said, well, I told you, you know, planes hit buildings, they fall. Uh, I don't really need any of this therapy where you're telling me that I need to, you know, get out there and live, because look what happens when you do. You know, she gave me a great answer that just stopped me short.

Even even here twenty years later, it's like, right, it's not about looking at it in terms of what we need to avoid. It's about what kind of life do we want to build? And you'll hear more about it if I ever stopped talking. Okay, let's get into it. Dr Luanna Marquez is an Associate professor of psychiatry at Harvard Medical School. Have it. I'm from Boston. I was talking to her. She was in Boston. It was exciting a lot of wicked, smot people there. And she's the

director of Community Psychiatry at mass General Hospital. She is a national and international expert in cognitive behavioral therapies. Oh, you can tell to when you hear this episode, You'll be like, she's good anyway. She's the president of the Anxiety and Depression Association of America and Also, as I mentioned the author of Almost Anxious, is my or my loved ones wary or distress a problem? Now there is a longer biography and I will put the link in

the show notes. You can see it wherever whatever app you're listening to this on. You can click to buy her book. You can click to read her longer bio. But as for anap enjoy my chat with Dr Lawana Marquez. Thank you Dr Lawana Marquez for joining me on Anxiety Bites. So let's just jump into it now your book, Almost Anxious. What I loved about the title, um is that I'm always learning something new about anxiety. And honestly, sometimes I think I know everything there is to know and I'm

obviously wrong. And something I didn't know about was this, you know, very real medical situation of as you put it, a bunch of things can be classified as the almost effect. So one of the things that you said and here is you know, a sunburn, right, it's not skin cancer, but it could lead to skin cancer. A glucose intolerance may not always lead to diabetes, but but it could.

So in other words, diseases they developed slowly and after an amount of years they could become full blown and so can you talk to us about the almost effect of anxiety? Sure? And so I think about anxiety is a spectrum. We are all anxious, right, that's their reality. Everybody has anxiety, and the question really is what is the anxiety doing to you in your life and you

loved ones? And the idea behind that almost the fact is that there's plenty of research suggesting that subclinical anxiety, so not at the level diagnosing um generalizing side of disorder panic for example, but enough symptoms that start to

interfere with people's lives. And so that's really why I wrote Almost Things, just to bring awad to this idea that you may be in the path to develop a full blown anxiety disorder, but the skills that we used to treat full blown anxiety disorder the same that can help you prevent getting there. And so to really get people to think about where they are in that spectrum, how is interfere in their life and and then what

can you do about it? How does someone know if they're in the almost or if they're in the normal amount of anxiety that we humans get. So, you know, when you think about anxiety, the first thing you want to think about is what's it doing to you and what's the impact? Right, Um, A little bit of anxiety actually propels us and in the normal quote unquote normal

um helps you actually do things right. For me, when I feel anxious, it motivates me, It signals something important, and it gets me to think about where am I in that spectamen, and what I need to do. When we get to sort of almost you start to have things like your brain is just not on. You start to have a little trouble focusing, or you might have a little trouble with sleeping. You might notice that starts to change your fear in different domains of your life.

It doesn't feel debilitating the sense that you were having a full blown panic attack and you feel like really exhausted and paralyzed, but it certainly feels um troublesome. Starts to interfere with your life. So in other words, someone could have a night or two of sleepless nights. I don't know, you know, for normal I keep saying normal, but I'm saying it sarcastically. For normal reasons, they just had a kid, or their jet lagged or something. That's

not what you're talking about. You're talking about out of the blue, someone who doesn't normally have insomnia. I'm just using that as an example, starts to have it, I don't know, every night, once a week, And how long does it have to go on before they've kicked over into maybe a full blown anxiety disorder? And when do they have to start, for lack of a better word, I'll say, for lack of a better word, worrying about it but addressing it. So let's say, out of the

blue tonight, I have insomnia. Now, am I gonna go rushing to you know, my you know, rushing to a psychiatrist? I'm in the almost anxiety part, you know. How do we know when it's going? How do we know when we're going from almost to own? There might be something there. It is a really interesting question, especially um during a pandemic where we've seen increased in levels of clinical levels of anxiety. And I don't know anyone in the last eighteen months and didn't have almost anxiety, So how how

do you define it? It's really individual to you, and I wouldn't InCor on one symptome like sliplessness. I anchor on how is it impacting my life? Is it getting in the way of me producing functioning, Is it getting in the way of my relationships? And so when starts interfere across the means and the symptoms are going to be different. For some people. Is difficult sleeping, Some people are are having a trouble because they feel like their

hearts bounding too much. But I want to encourage our listeners here to really think about is it starting to get in the way of my life? Right? And most people that I've talked to you for the last twenty years as a clinician, the sort of know, they have a sense of like, you know, this is just not me. And when you start to say that to yourself, that's what you need to say, Okay, what about this is not me? And and what can I do to get

back to the you that you're used to. So they start to notice that this is impacting their life, whether it's sleeplessness or whatever. Now they're not necessarily going, ah, I'm I'm in the almost anxious category. You know, they're going to call it insomnia, they're going to call it stress, they're going to call it loss of appetite or too much appetite. And then they're gonna say, oh, well it was a pandemic. Oh well, my husband's bothering me lately

because he's out of work. I mean, it's I don't see people running to admit that something has crossed over into the territory where they need to be careful and watch it because it could develop into full blown pathology of anxiety, or that it does. I feel like it's like, no, no, no, I don't have anxiety. That's for crazy people. I've got I've got stressed. You know, it's all these other words.

And do you find that you have to break it to people like this is anxiety and do they tend to I mean, do people kind of go, You're you don't know what you're talking about it? Or am I being Am I making that up? I feel like if it's hard to get people to accept that it's anxiety, because then they think, oh, I'm screwed. The rest of my life is going to look a certain way. I can't have anxiety. I have a job, you know it. Do you find that or am I making that up?

I don't think you're making it up. I think they're behind the where you're saying is there's still a huge stigma on mental illness, right, and whenever you call something a mental illness like full blown anxiety disorder, then um, there's a perception that people are going crazy or there something is really wrong with you. Just talk about my

rest of my life is going to be this way. Um. It's it's hard to say clinically though, because by the time somebody comes to me for treatment, they've identified something is not going well. And so usually my patients really want to get rid of their anxiety. They come in and they're like, Okay, I have this anxiety, just get

rid of it, which I can't really write. Knowing anxiety is actually not helpful either, and so I have less trouble with identifying a more trouble convincing somebody that, listen, the enemy may not be the ansiety completely. What you do with it attends to get you into trouble. Well, that's what I've heard you say in in other interviews, that it's your relationship to your anxiety that tannon should be fixed. Who knows if anxiety itself will ever go away.

Like you said, we do need a healthy amount so that we don't just like walk out into the street and let of cars. But you know, um, what does that mean exactly? Then? So what what what is the responsibility of the patient from there in terms of how they see it? The way I think about this, and it's we hate this comfort as human beings. Right for some people, it's really exciting some people with sadness. But whenever we experience this comfort, we tend to run away

from it. Right. It's what psychologists called avoidance, And avoidance helps because you feel a little better. You know, I was afraid of heights, and so not going to roller coaster was great. I didn't have to deal with it, right, But that avoidance teaches you that it's really dangerous to do something when the reality is most of the time it's a false alarm. It's like a brain fart, your brain saying you know, there's align in front of you winning, for there isn't. And so the real enemy is that

avoidance is sort of continually to avoid anything. I have an example often with patients that you know, sometimes before before interviews like this, I get a little excited and my heart pounds a little fast, and it's to me, what it means is, I'm excited to talk to Jed. But if I had a full blown anxiety disorder. My patient would be like, what's going on? Wise? My heart pound? Like,

oh my god, am I having a heart attack? And that becomes your relationship with anxiety becomes this fear relationship instead of curiosity. Given a little excitement while my heart's bounding supposed to be faster. If I'm excited, I'm excited. So it's almost like, you know, the the usual that that that's been brought up a lot on this podcast is being the observer, being mindful, saying okay, that's that sensation.

It's it's excitement, but it could turn to anxiety if I start believing the stories my brain is telling me. Not having a heart attack, I'm just talking to a new person. It's exciting a little anxiety producing what will happen? And so that's your relationship, right to or not you. But the universal your relationship to anxiety in that moment is sort of how you're observing it is that in the ballpark. It's definitely the ballpark. And you know, mindful

is just one way to observative. You're talking about another one, which is the narrative in your brain, the stories that we to ourselves and our brain is programmed to jump to conclusions pretty fast, right, That's how we process information fast. And so if our interpretation is always that hard pounds equals anxiety, then the brain is not gonna pause and

say what a second? Is it right? And and in the domain of cognitive therapy, they is becoming a detective looking at your thinking going wait a minute, does this actually that makes sense? Is this really true? Or is this my interpretation of it? Because that narrative in your brain certainly can lead to more anxiety. Will be right back. The avoidance thing is interesting because that was my only coping mechanism before I found therapy, and it does work

until it doesn't, you know. Um, My first experience was having panic attacks on airplanes. As a kid. My parents used to take me to Disney World once a year, and then at a certain ange said I can't do it anymore. So okay, now we don't go to Disney World. Sad but worth it for me because I never had fun anymore. I was panicking about the flight even on the way there, and at Disney the whole time. Okay, great, but now I'm getting in my twenties and now I'm

missing opportunities. I'm not going on free trips to go to someone's wedding or study somewhere or whatever. Um, so that doesn't work anymore, you know. Um avoiding driving. I used to have a fear of driving on the freeway. That worked until it didn't. There were just times when I needed to get somewhere fast and you have to take the freeway. And to be honest, I love driving, but I didn't love having a panic attack while driving. And there was no way I couldn't have a panic

attack while driving. So it's a it's it gets very sad, you know. You go, I actually like this thing. I don't want to avoid it, but I have to to stay safe, quote unquote. So I've worked on those things. I now fly all the time. I love it. Um. I'm in Palm Springs as I'm interviewing you, which is not where I live, and I have to drive back to Los Angeles in a few days by myself, about a hundred mile trip. I'm not loving the idea of it.

I'm already sitting here getting anxious thinking about it. I will not avoid it, but there's part of me that doesn't want to work on it too too much and think about it too too much while I'm driving. There's a world where I may not panic, but there's a world where I might, you know, but I don't want to think about it too much when I'm driving. So is there a way? You know, I know that there's like exposure therapy and all that, but if someone has cry us over into okay, I don't avoid anymore, but

I might still panicle. I'm doing this thing. Is it best to not think about it when you're doing it? Or is it best to just try to think about it and prepare just in case? M what are you preparing for it? Though? Preparing for the possibility of a panic attack? So so, in other words, I might instead of listening to music, I might put on a podcast about breathing and anxiety, which I'm wondering that might trigger it, as opposed to just having some fun listening to some music.

You know, it's like, can can you get into over correcting in a way where it's like you're aggravating it? You're you know, you're fine, you can drive, You don't have to keep thinking about I might panic? What can I do about it? Does that make sense? Absolutely? So? Two things. The first one is it's so important for you to share you know how avoidance really robbed you

from trips and important things. And it is said, right, and I think it works, but us make life smaller and smaller, right, And so that's why I still think it's it's the enemy, because although it brings the fever down, it doesn't cure the infection that that panic continues to live there. The second thing you're talking about is this idea of like do you overcorrect it? And so it's it's tricky because if you're doing exposure therapy right with the idea of facing your fears, then you don't want

to be listening to the music. You don't want to be distracting. However, if you were really in the possession that you haven't had many panic attacks when you're driving and you like driving, then drive because preparing for it makes it bad? Right? What is preparing? And I'll start of joking to him because when you prepare, what you're doing is you're trying to tell your brain, Okay, if it's happening, what am I gonna do? Am I gonna be? Okay?

And it's actually have a narrative, right, your brain, your limbic system, your old brain, here's dangered dangered danger. It's stupid, it doesn't actually under and there's an a line. So it's increasing your fear response. And now you are actually priming yourself for a panic attack because you get to the car and you're like skinning to be sure it's gonna be okay, scanning that's right. Yeah, I do all

the yeah. And you know it's funny. I already know what will happen if I have a panic attack, which is it's going to suck for a minute. Um. I may not get into full blown panic attack. I may just get into feelings of discomfort. And there's something I tell myself, which is, I'm not alone on the road. There's a million other cars with friendly people, and they

all care about me. And if I have to, I will pull over and I will wave and maybe someone will stop and I'll just say I'm having a bank attack. Or maybe I'll get off at a rest stop and I'll just calm down. You know, there's a million options, and that usually helps for me in a panic attack. The deep breathing doesn't always help, but but something like that where I just make up stories. As long as making up stories, I make up nice stories now instead

of you're gonna die, the car is gonna crash. Now, I say, oh, look at these friendly drivers. They're here to help if I need it. I don't need it just yet, and I kind of keep putting it off so that that's like my little gen thing that I made up that I do. Now it's a great job. I mean, you're sort of becoming your own Cogni therapist,

which is incredible. You're refraining from focusing on the worst case and error, which, by the way, it has happened to you and you survived, so you sort of know what's going to happen, and you're saying to yourself things like, you know what, I can handle even if it happens, I can handle it. That's sort of the summary and and that's really helpful. It helps your brain to hear

it's okay, I can handle this. Yeah, and you know, and this kind of it is the point of my podcast is that like we can still talk to ourselves in silly ways and have fun with it, and we don't have to bring like, you know, this encyclopedia of psychiatric terms with us every time we think we might pack you know, no, absolutely not. And I want to actually reaffirm something you said. It's really important deep breathing thing, and panic attack will make the panic attack worse, not better,

because what happens is you're ready doing it. You're trying to force your breathing. Your body can't just shut down for an a panic attack. That's not It's gonna peak and it's gonna come down, right, So trying to get ahead of it by changing your thinking, now, that works that that seems to work for me. So it's good to hear that that's actually because it's it's true. Now I will throw a wrench in this. I know you'll have an answer to it. But I used to live

in New York City. Again, I don't like heights, don't like elevators and tall buildings. And I was a you know, performer at night and had temp jobs as an assistant by day. My temp agency called and said, we've got you a job in the World Train Center and it's on the floor and I said, I do not go near that building. It is too tall. Something's gonna happen some day to that building. And this was one year

before eleven, and I didn't take the job. Now again, I don't know if I would have been in the building on nine Ole, it was a temp job, it probably would have lasted a few months, you know. But in my mind when it happened, I said to myself, I'm right. You know, that's the anxiety is an anxious person who still wasn't driving on freeways and still wasn't flying on vacation. That was my thrill was to say I'm right, everybody. I told you something would happen in

that building, and thank god I wasn't in it. And so if you had been my doctor when I came to you the next year, I would have just said, why are you taking all of my safety precautions away from me? Why are you telling me lies? Yes, buildings fall, planes hit them. We saw it happened, now what you know. I would have been that defiant, And so I know there's an answer in there that you will have about Okay, you were right that time sort of, but dot dot dot,

why does it not matter? Like? Why is that not helpful at all in my recovery? So I wouldn't actually have told you that bad things don't happen, because bad things happen, and we would love for bad things not to happen. But the realities, bad things happen, and so the question is what do we do when they happen? And most of the time it is not like But that being said, I work with a lot of trauma survivors and really bad things have happened to them. So

the question then is um for you? At that point, I'd have said to you, J you know what, let's talk all the life you want to live and and and what matters to you. Right A tip job may not have mattered tremendously, and so maybe that's the right decision. I'm not sure i'd have agreed with your conclusion because

there's a couple of steps removed. But I go back to like Disney World, you sort of talked about it like you wanted to go all right, I talk about the life you want to live, and then what are the things they can tolerate to live that life or not? Some people say to me, know what, I'm fine. I never have to go in a place that's tall, and it's fine, and they're right, Then it's the life they when I live. Right, for you, you'd have to make the decision before we could figure about what kind of

treatment we need. Because without annoying and I can't help you. It's so true because let's say, um, at the time I was I am now a professional comedian. At the time, that's what I wanted to be, and I wasn't. So if someone said to me, well, you can only be a professional comedian. Your dreams can only come true in this building, the World Trade Center, I would have had to take that job because I'm not saying it like

it's worth dying for, but it's worth living for. And when we live, right we don't know what's going to happen. Um as I'm talking to you right now, the roof could follow in my head, you know. But but U So it's sort of like that's a great way of putting it, which is like, yeah, working at a temp job, I don't want to put up with any more discomfort, like a tall building an elevator, So I'm not gonna

if I don't have to there the buildings. And I love that you're putting it in terms of what's important to you in your life, and I think what can be so sad. It just makes me so sad to think about other people still struggling with anxiety. Is like you said, it makes your life small. And then some people they don't really mean it, but they go, no,

I'm gonna get by with just this, you know. And I'm sure you can tell though as as a as a doctor, when someone comes into you and they really mean it, no, no, I truly don't need to go into tall buildings. I'm good. And when someone is saying to you, no, no, I don't need anything else, and can you see it in their in their behavior and psyche that that they aren't living the life they want but they're just they don't even know anymore because they're

so used to keeping it so small. You know, usually can tell. But the way I negotiate with my patients, like we do a little bit of what a cloud behavior experiment. You know, there was part of your brain to say you don't need it, but then you're sitting here with me sort of saying your life doesn't really feel great, and so let's experiment and do some of the things. Let's drive in the highway and see what happens and and how does that change your life? Does

it change your life? And if people can't explore sometimes I thought having to be like I have to do it right I don't like people telling you what to do, and so as a therapist, I'm not gonna tell you what to do. I'm gonna say, can we experiment And sometimes we find out that the patient really was leaving a small life and they wanted something different. Sometimes they want to be in their conference zone, and I would never judge, you know, comfort zones feels good for most people.

It just limits our ability to push ourselves. It's like me with the roller coaster. I hate roller coasters, terrifying, I'm missing nothing. I don't like it, so never going on one. But yeah, there was a time when I convinced myself, no, no, no, I just I'll never go anywhere and I'll just stay. You know. Imagine it was going to get to where I'm just standing in a corner going this is great, this is great, you know, but you you're a book blew my mind when I

read this thing that I had never thought of. And I've done it, and I've had people do it to me. Reassurance seeking as a form of avoidance. And you say it can function as a form of avoidance since it immediately reduces your anxiety level, but it can keep you stuck on their hamster wheel by keeping you from facing your fear. So can you tell our audience and I'm sure they might hear themselves in this description. What is

a reassurance seeker doing? For insurance seeking is this, you're so uncomfortable you have to have somebody else make you feel comfortable, so you seek reassurance. It's sort of like you're saying to me, you know what, am I gonna be okay? If I drive home today? And I said, oh, absolutely, you can hand away. You know you've had panic attacks before where you can handle it. And by giving you that reassurance immediately most people start to feel better. Right,

it's it's gonna be okay. But the reality is number one, I don't know if it's gonna be okay. Number two, you need to learn to tolerate this comfort to overcoming and you, I mean any of us. And so reassurance is a quick being d and we all do it and always say to our loved ones, he do you

love me? Or And so it's not it's bad necessarily, it's just that if it is the only way you manage your anxiety is by seeking reassurance, then you were preventing yourself for an opportunity to overcome anxiety that's stabilitating. And then you were saying in this little blurb in the book too, that someone can seek reassurance. Am I going to be okay when I go to the mall? Oh? Absolutely? And then well that wears off after a few minutes for them, and then they have to ask it a

different way. Well what if I went to them all that, you know, like they keep asking in a different way, right, it just gets almost like more addicting. It definitely does, because your brace clever. Right. In fact, when I start with patient, say to them, I will always answer your question once. But if you ask the same question five

different ways, you're seeking resurance, And so I can't. And my patients start getting in the in the random and they go, oh, that's resurance, right, I'm like, that's resurance And I can't tell like to me and you're making you sick or if I keep giving you reassurance, anxiety bites will continue on the flips out of this message from our sponsors. So I wanted to before I let

you go here. Uh, there was a case study in your book about this man named Ricardo, and he's like, you know, I'm a fiery Latin man and I just I'm passionate, and but eventually his irritability would cause him to blow up at people. And you're saying, you know, he'd get in a relationship about three months go by now that irritability comes out and he was exhausted by

the end of the day from muscle tension. And you were talking about how irritability is a sign of anxiety, and I know for me that was definitely one of mine. And again, I think this is something that might be new to a lot of people that they think anxiety is I'm nervous and I'm biting my nails and I'm shaken. But irritability, really, um can be anxiety. And can you explain to us how you know it is and how you know it's not like an anger management problem or

is it all the same? Mm hmm. Yeah. I mean, so that's the thing. You're You're hitting something important that people have a idea within anxieties in their brain and and you know it's the panic attack, is the worry. But for different people is different things, and for something it's really real ability. They just feel edgy. And the way you describe to me is like if you poke them,

it's like a balloon that's just about to explode. And so the whole time they're trying to keep that inside because they don't want to explode, but eventually they do, right, And so it's really what is the function? What's happening there for them? You know in this case, somebody this patients like spinning all the time, You get little edgy and then they try to dismiss it, but then it blows up, right, And so how do we defer for an anger management? Anger management tend to go around different

domains in your life. And you notice that's a lot more anger than irritability. Right, I'll first benger versus like just feeling edgy, feeling edgy, feeling edgy, and then you might have an anger outwurst. But what I'm really talking about the aridability of like edgeinists feeling on a lot. And then eventually, of course you're gonna have muscle tension because you are right, you're tighten up. As I talk about this, I like compress the immediately because I can

see my patients doing it. So it's sort of like an irritability example would be I'm running errands and every single thing annoys me. Why is a person in front of me using pennies? Oh? Why didn't the cashier know that that was on sale? Oh my god, look at how that person parked. It's just like every single thing is like a mild irritation. But it's like not funny, you know, it's not You're not saying it in a funny way. It's like you just can only laser focus

on things that are irritating. That's a great example, and and in that way you can see how it gets exhausting, right, because your brains on all the time. We'll go back to that skinning, and it's hyper focused on things that sort of few really annoying. Is there any reward in that? Like our people in any way at all, it's soothing their anxiety, but in a bad way by being that irritable or like what is happening there that that wouldn't it be better to just be anxious? For some of us?

Maybe the brain is always filter information, right, and it's based on our belief systems. The way we see the world our lens is how I think about it. And for some people, you know, they say the world that way that things are annoying to them. And that's just and so when the brain is scanning its skins for that, and it does because of a concept called cognitive dissonance, which just means your brain does not like when things

don't fit. Right. If you walk in the middle of the woods and you see a cow and that called meows, you're gonna go, wait a minute, what happened? Right? It just doesn't make sense. And so this is sort of the idea. If your brain skins for irritability, that's what it does. It is not rewarding, but certainly it's consistent. It's it's less energy than not. Okay, that makes sense, and so you know he's going to bed stiff muscles

and all that. And and I found in my work, like with recovering from anxiety, that progressive muscle relaxation one of my favorite things to do. And I feel like people talk so much about meditation, and meditation is great, but the real thing for me where you actually do feel because anyone who's an experienced meditator knows you don't necessarily feel relaxed after it's challenging, you know, thing to

sit with your thoughts. But I love progressive muscle relaxation, just the simple tightening of muscles and then relaxing, going from head to toe. That is my favorite thing to do. And I feel like nobody talks about that. We've all jumped to mindfulness meditation, and I feel like people need Don't you think if people focused on their bodies a little more it could maybe help? Because I heard somewhere that if your body has relaxed, your mind can really

be anxious. I don't know if that's sort of a myth, but so it's interesting. What's so powerful about progressing must realization And for those that don't understand, it's really the idea of like Titan muscles and and releasing them. And what he does is by contracting the muscles immediately they released. And you know there are seven and it's sixteen progress progressive muscle relaxation. It was in every treatment protocol when I was in graduate school twenty years ago. Every protocol

for everything had progressed a must realization. Then the third wave of con to behavior therapy came in and mindfulness became the thing progressing smust realization that is super powerful. By you just mentioned it, chin, my shoulders relaxed because I've done. It was so many patients just the term of it. My body went, oh right, And so what I think It's important to find the recipe that works for you. That's what I suggest is like for some people,

meditation works for some people. Per works for some people. Is you know, going for a yoga class regardless whatever brains your temperature though, that's the thing you gotta do. Yeah, I'm a big fan of progressive muscle relaxation. It just I can. I like to think you know, it's a result you can feel right away. That's always nice. Um. So lastly, I'll just ask you about this very subtle part of your book, almost Anxious. Is my parentheses or

my loved ones worry or distress a problem? Now? I have so many people saying, will you talk on the podcast about you know, what do I do? My husband's anxious? My wife is anxious? And it's like, listen, I think we're getting into a whole other area. We could veer off into code dependency. Who knows, But what do you do if someone close to you is anxious and they don't know, but you can kind of how they are.

Is there any way to approach that person and suggest I mean to me, it seems like g walking into a bear trap. But what what what do you tell people who ask you? Or do you tell them no, you're gonna mind your own business, you can't do anything. It really depends on the relationship, right. But um, if you've seen somebody around you that they are suffering and you seem to think what it is, I think it's appropriate to sort of say, hey, John, I've noticed that

you're really tense lately. I want if you want to talk about it, or hey, every time I asked you should do something, you sort of jump at me. That doesn't feel so good? Right, You can talk about what they're in desiety does to you because you can own your own emotions, your own behaviors, and it's one way that you can say not that you're bad, but like, listen, you yelling at me doesn't feel so good, or um, slamming doors doesn't feel so good, or the fact that

you're in your head thinking all the time. Um. I I also like the idea of talking to somebody about you know, I've noticed the intense and how is that getting the way of your life? Right? So, going back to this, like do they want a different life? So how does impact you? Do they want a different life?

The last thing I think you can say to somebody as well, it's it's sort of um, understanding that concept of your sturtans seeking that we talked about and agree that you know what, maybe you don't want to seek treatment, but I can't give you reassurance because I learned that that actually makes you much more anxious. So whenever you seek reassurance, I'm gonna stop doing this. And I've had

lots of success treating couples that way. When you know they maybe the husband is really anxious and the wife comes in and we agreed the assurance is off the table. It makes the person usually a little more uncomfortable, right because now they don't have their fix or reassurance. But being a little uncomfortable sometimes is what propels people to seek treatment and try to get better. Yeah, it's like a little mini intervention in a way, right, Like I

cannot be a part of this anymore. If you're going to be anxious, you know, these are the ways I cannot support you and it or enable you, I guess is kind of what people are doing. Um, okay, that's great advice. And then lastly, I know that you are the president of the UM, the Anxiety and Depression Association of America. Do you find that there is a connection

between anxiety and depression? UM? Do do most anxious people who are pathologically diagnosed with generalized anxiety disorder or phobia or whatnot, do they have a tendency for depression or is it really two separate things? It can beat your separate things, but they tend to come together. Not always though, but you know, again we're talking about the almost effect here. Sometimes somebody is anxious in a little set. They're not

depressed clinically, but they do tend to come together. A lot of patients that I've treat have some anxiety and some depression, but for most people there's one that is worse than the other. And and that's really UM how I think about it. But they do tend to correlate. I know, for me, I had anxiety first and then

the depression showed up years later. And for me it would be when the depression days would come, What a relief because I'm less turned on and heightened and anxious, and with depression it was never as bad as suicidal or anything. But with depression there's a sort of I don't care, and that felt so good as opposed to the anxiety, and so I kind of learned to love my depression days, and on those days I was a little more fearless, if that made sense, because I just

then the energy didn't care. And so eventually I learned to in a healthy way, you know, not be heightened and not care, not of anxiety. But for me it was almost like, oh good, it's like a rain storm after a drought. Like I kind of was like, oh

thank god, the depressions coming into soothe me. You know, I've heard that from many patients actually who really hate their anxiety, and when they feel depressed, it does have that sense of I don't care of help, listening, hopelessness, and just like and so it really is about your relationship again to your anxiety. And for some people, so rid I hit a patient as we say, I just feel like I'm gonna explode, and Nephelie is uncomfortable for sure. Well,

thank you so much for talking with me. I mean I couldn't go on and on for a million years and and ask you things. But I definitely think this episode is so unique to all the other ones because we've we've talked about things that I just have not heard people really articulate. And uh, I'm so grateful to you for taking the time. Thank you. No, no, I'm delayous to be here and I'm glad that you're talking about it because I used to open so many people

that need it. It's really just a flash which you get to know even be here. And that was my chat with Dr Lawana Marcusin. So coming up are the takeaways from this episode. But if you are curious, I will let you in on the flip side of my driving home from Palm spring So even though her advice was fantastic, it's just sometimes anxiety doesn't quite give up its fight. And I felt like I was in an arm wrestling match with anxiety and we were just, you know,

maybe it was a tie. So basically the bottom line is I just overthought the whole thing, and then also circumstances beyond my control happened. So my plan was to get up at six thlirt in the morning, get on the road by seven. There is zero traffic from Palm Springs towards l A at that time of day. You can get home in an hour and fifty minutes, which is about normal for a hundred mile drives. So I thought,

that's great, I'll do that. And you know what, if I'm freaking out, I can get off at any exit and just calm myself. There is really the worst case scenario, Jen Moore's case. You just pull over for a while and I don't know, I don't know, or drive home on a side road, which isn't a thing really. And for some reason, when I woke up that morning, I was so tired that I convinced myself that driving while you know, tired after only getting six hours of sleep

as opposed to eight, would induce panic. Now, sometimes that's true, but other times, being sleepy kind of works for me because I, you know, it feels relaxing. I wasn't worried about, you know, anything physical like motor skills being affected, even though I have read Sure Sure Sure that driving well

tired is is almost akin to driving well buzzed. But besides all that, for a second and I decided, no, I'm gonna look at my um app, the ways app, and it's predicting that traffic will be this clear until about noon. You know, around noon, it starts to get a litle heavier. I said, well, let's split the difference. I'll leave around nine, and so I let myself sleep another hour. I got some yogurt, I was had some food, and I got on the road and there was a

sign that said, you know, accident up ahead. It's all good, but there will be traffic, and I saw it. It was bumper to bumper traffic like a parking lot, not moving for miles, tens and tens of miles, and my app said it would take four hours to get like most of those hours would be the first two hours of the trip, which just sitting. And I went, uh no, I mean, who could do that, even in the sense of like what if you have to pee or something.

And I just said, that's not gonna happen. And luckily I was at a point in the road where I could do a U turn it wasn't quite the freeway yet and go back, and so I went back, and there there actually was a post wedding day brunch that afternoon, and I went, I'll go to the brunch, and I went and I just watched the traffic on my app, and it was just getting worse by the second because

of all these weird minor fender vendors. But I had some friends who were leaving and getting on the road at the same time as me, and so we both drove. For some reason, I'm stopping. My neurosis is saying, people are going, why didn't you drive with other people? Because I had come up a week earlier with my parents, these people were in a car with their kids and this whole thing, that's just how it happened to be.

So we were driving sort of near each other. I could see my friends on the road as we sat in this parking lot of a freeway, and it felt good. I could old, there's my friend, I can see them, and it moved a lot quicker. I got home in two and a half hours rather than four. It ended up fine, but yeah, I did have some moments of feeling like I was having a panic attack. It didn't go full blown, but it wasn't very comfortable either. And

then ultimately it just got more boring than anything. And as I got closer and closer to Los Angeles, it just got like not it was nothing. It was fine, and I realized I've spent more time worrying about it then was necessary. Zero seconds worrying about it is unnecessary. But I thought about it too much. But that's what ended up happening is I had just I had already done it for so long. I really just my tools were just I don't know, just wasn't working day. But

you know, I made it through. It was fine. The biggest thing that I know how to do now is sit with my discomfort and not add on crazy stories to what I'm thinking. I just sometimes have to have some anxiety, Like sometimes you're just going to have some anxiety. Sometimes you're just going to be on the verge of a panic attack. But the one thing I know I can do now is not add crazy stories like oh my god, you're stuck here and you're all alone. And I didn't do any of that, And I guess that

is a win. I know that's a win. As I would tell someone else, that's a win. I believe it is hard for me to acknowledge that for myself, if that makes sense, But I'm going to acknowledge that's a huge win, even if I want to shout from the roofs I'm normally not anxious like that. All right, Well, on the days you are, you did great, Jen so some of the takeaways from Dr. Lauana Marquez is that anxiety is a spectrum. We are all anxious at times. A little bit of anxiety is normal and can propel us.

If anxiety is interfering in your life, but it's not going into full blown panic attacks, you are in the almost If you aren't sure if you need help with anxiety, don't just base the decision on maybe a symptom you're having, but asked yourself, how is this symptom impacting my life? Is it getting in the way of me producing or functioning? Is it getting in the way of my relationships? A therapist can't get rid of your anxiety, but the enemy

may not completely be anxiety. It's what you do with the anxiety and how you handle it that can get you into trouble. People tend to run away from discomfort, which psychologists call avoidance. When you give into avoidance, you're falsely teaching yourself that something is dangerous that isn't. Avoidance can bring down the fever, but it doesn't cure the infection. Again, it's not really possible to overall, for the rest of your life get rid of anxiety, but instead it is

possible to see what our relationship to anxiety is. When trying to over hum using avoidance, we have to ask ourselves, what's the life you want to live, what matters most to you? What are the things that you can tolerate to live that life. Another way that we avoid is by asking people to reassure us. And it gives us what we want in the moment, but it doesn't last very long. And if we are giving in and reassuring our loved ones who are anxious, we're actually helping them

stay sick. Progressive muscle relaxation is a great way to get rid of anxiety in our body. That's it. I hope you enjoyed this week's episode. Of course, come back next week for more, and just remember anxiety bites, but You're in control. For more podcasts for my Heart Radio, visit the I Heart Radio app, Apple podcast, or wherever you listen to your favorite shows.