Hey, and welcome back to Resilience, Unravelled. And today we're going to talk about a subject which affects so many people, probably the vast majority of the people in the world. And the vast majority of people who think about resilience at some stage want to talk about anxiety. The vast majority of people who confuse emotional conditions don't realise that the roots are anxiety. A lot of people who describe things like cascading thoughts or ruminations or not being able to sleep, often experiencing the symptoms of anxiety. And anxiety is one of the modern forms of health issues, mental health issues, which I think are spreading like wildfire, partly because, of course, we know more about it. And the key, of course, is to have some understanding of what it is, how it works, and, crucially, what you can do about it, and maybe some resources to help.
Russell:And so today I'm delighted to be joined by Dr. David H. Rosmarin, who I'm very reliably informed is Canadian. So, we're all going to stand up now and salute at the site of the Maple Leaf and the Moose fan. And good afternoon, David. How are you?
David:I'm great. Thank you very much for having me on your show.
Russell:That's good. It's a delight to meet you. But you're not in Canada today. You've sort of slid southwards somewhat over the border.
David:Yes, I now live in the United States, but Boston is the most European city in the country and very happy to call it home.
Russell:It is beautiful, isn't it? It's one of those places. Yeah. And it's sort of a peculiar blend of British or European, as you would say, and the fewest excesses of American culture. So actually, there's a beautiful sort of unique feel to the place, I always think.
David:Fully agree, very happy.
Russell:I'm not going to talk about the food, so that's good. Well, look, tell us a little bit about you and what it is that you do.
David:Sure. I wear a couple of hats. So, as an academician, I work at the Harvard Medical School, and I've done research here in clinical psychology for about a decade, a little longer than that, actually. And I also run a private practice, a large private practice called Centre for Anxiety, which has offices both here in Boston, Cambridge, as well as in the New York area, and now in Princeton, New Jersey, as well. Seven offices and see about a thousand patients at every given time, presenting with anxiety and all sorts of other concerns as well.
Russell:So we're going to talk about anxiety. So, shall we start it off by just hearing your definition of what anxiety is? Because I think a lot of people confuse what it is.
David:Yes, anxiety is certainly on a lot of people's minds today, and it does require some precision in defining it. We all know what a fear response is. Fear is when you have an actual threat comes at you could be where you're on the Tube in London and doors are closing and what do I how do I handle that? Or a ubiquitous bus. Your American tourist steps off and looks the wrong way on the street and a bus is careening towards them. That's a present fear. That's a fear that we have. And we have all these physiological responses which are helpful to get us out. It's a fight or flight response with adrenaline pumps into your system and helps mobilize us. Now, anxiety is the same exact circuit, it's the same symptoms, but it occurs when it's out of the blue. You don't really need to have that response.
Russell:So that's interesting because I've often heard anxiety described as fear of the unknown or fear of the future. So, it's almost like a priming sort of response. So, it's exactly the same response, as you'd say, with fear, but it's sort of more linked to that. Fear is a sort of visceral response to what you can see in front of you. And anxiety more a sort of primed response of what the hell might happen.
David:Correct. If the danger is right in front of you, that would be fear. If the danger is not there, it's something in your mind and it might over. That's true. But it's in the future, as you put it. That would definitely be anxiety.
Russell:And it's a primal response. It's really handy because if you think about the neurochemistry of this, if you were walking through the savannahs 200,000, 100,000 years ago as a hominid and you met the proverbial saber-toothed tiger, which didn't really exist in those times, I'm certainly not in that place. But if you're walking through a savannah and you hear a crack or a noise, it's that primary mechanism where the body's systems begin to run but not fully formed. So, you are ready to actually begin to really activate the fear responses. And people don't seem to understand this. It's completely natural response. It's actually very useful for you. But the extent to which we generate it is out of kilter to the need these days. Is that fair?
David:Very fair. I would actually go a step further though, which is that even to say that the anxiety response, which is not warranted or always needed, that's also an adaptive, healthy, potentially healthy thing. And if we learn how to harness it the correct way, that can actually propel us towards thriving in our lives. Often people think of anxiety as negative and fear as positive. But to me, I think anxiety is a bad rap today. And people are often very afraid when they get anxious thinking that something's definitely wrong, when in fact even anxiety, which is not fully warranted and it is in the future, can be very much a positive thing if we have the right tools and skills.
Russell:It's interesting because one of the sort of narratives around anxiety is that actually you should deal with it. So, it's really useful. That's very handy because actually it's the same physiological response as anticipation or pleasurable anticipation because actually the body is performing exactly the same way. What changes the perspective of it is the sort of prevailing thought method. Is that something you see as being a useful thought?
David:It's an interesting perspective on it. I'd have to think more about that. To me, anxiety has a number of positive characteristics. I was thinking about this recently. If you're in the gym and you're working out and you're lifting weights and it's not painful, it's not uncomfortable, it's probably not a sign that you're pushing yourself to the point that you're going to end up with bigger muscles, with getting strength. I'm a distance runner and I know that at a certain point in a long distance run it's going to be very uncomfortable. And if it's not, that means I'm not pardon the double negative, I'm not really pushing my cardiovascular system to the next level that it needs to be at. Anxiety is a similar thing when we're overwhelmed by stress, when we are feeling uncomfortable, that in some ways, if we understand it this way and deal with it this way, can be a strengthening of our emotional system as opposed to a sign of weakness.
Russell:And that's interesting, isn't it? Because I think cognitively, again, there's a move to this idea of defining ourselves as being anxious rather than saying that we're experiencing the effects of anxiety. It's a bit like the obesity argument. And I think that's quite interesting because that plays to what you were saying, which is, given the right circumstances, it's a useful physiological reaction to things. Because actually, that anxiety to do it during a run can stimulate adrenaline, stimulate a performance curve, by saying to yourself, oh, my God, what happens if I don't? So that will stimulate another response once it so you can use the narrative to actually drive a physiological response. But I like what you're saying about anxiety which is that people have given it a bad rap and like stress, it's the same argument, isn't it? It's become victim of semantic degradation and actually it's a word that means nothing these days, isn't it?
David:I love that semantic degradation. I would even go further and say it's pathologising. We have pathologised anxiety and turned it into a disease, as opposed to recognising that in many cases, it is a normal, healthy human emotion, which is a sign that we are pushing beyond our limits in a positive way. And in a manner that our bodies can and will adapt to if we stay the course and if we use the right skills and tools to be able to manage it.
Russell:So are you suggesting there that there's a toolkit that runs alongside the response which actually, if you flex that muscle, use that toolkit enough, you can get a bigger return from anxiety or you're more able to deal with the negative effects of it, or both, I suppose it really both.
Russell:And certainly if a person does need those skills and tools, though, if we simply have the anxiety all the time and we're always white knuckling it constantly uncomfortable, we don't know how to convert it into something positive in our lives. It might not lead to thriving. We do need to have certain guidelines.
Russell:So let's unpack a couple of tools if we would. What would be a useful place to start in terms of that place?
David:Yeah, I'll give you a couple of them. One of them is well, the root of anxiety is an intolerance of uncertainty. If I can't tolerate not knowing what's going to happen next, the future is unknown, and I'm going to feel anxious, as you put it before it's about that apprehension about the future. However, if I can increase my tolerance of uncertainty and actually say, hey, I don't know what's going to happen next, and that's okay, I'm just a human being. I don't need to know. My ancestors never knew next generation, they're not going to fully know what's going to happen next. Part of my humanity is that I am not always in the know, not always in control. Then anxiety actually can become this tool is using anxiety as a way of actually increasing our tolerance of uncertainty and our tolerance of being out of control that can breed resilience in tremendous ways.
Russell:So you're almost advocating like a fate-based approach. Fate, not faith. Well, I don't know about being able to accept the fact that being able to accept the fact that things happen correct is a fate-based approach, isn't it? Because actually stuff happens because its stuff happens, and it doesn't have to happen because I've been bad or I've done something wrong or I'm trying to control those things. I can't actually physically control ever. That's part of it, isn't it?
David:Well, fate is a very theological word, and I don't know if I'm quite there, but what I would say is that human beings are a lot more limited in our knowledge and our control than we acknowledge day to day. But when we do acknowledge and go there, allow ourselves to accept the limits of our humanity, there's a strength that happens. An inner strength can come out of that, and anxiety can be a catalyst for that.
Russell:Yeah. Okay, so we've got increasing our tolerance, and you've sort of given us a bit of a script to actually help us deal with that. So, I like that. Makes a lot of sense. What else might be a useful thing to pack into our toolboxes?
David:Another one is this. The first tendency when people feel anxious or stressed is to try to reduce their feelings of apprehension. We run out of the situation. We cool ourselves down with a cold drink. We run into the air conditioning we deep breathe in order to try to cool ourselves down and reduce the flow of adrenaline. All of those typically make things worse because what we're really doing is teaching our bodies, you can't handle the stress, you can't handle the anxiety. This is bad for you. So, an opposite tool is actually to run towards anxiety, to do one thing every day that makes you feel uncomfortably anxious.
Russell:Right. Interesting. Can you give me some examples?
David:Sure. What makes you anxious? Well, whatever that is, don't take it up to a ten out of ten, but maybe a seven out of ten. Six out of ten. If you're afraid of whether it's spiders or heights or flying or swimming or maybe you're worried about the future, go there in your mind, what are you really worried about? As opposed to keeping with shallow thoughts and sort of gradually increase the amount of anxiety that you allow yourself to experience on a day-to-day basis.
Russell:It's like a flooding technique.
David:Well, flooding would get to ten out of ten on the first okay. Right away. So, want to gradually build up to it something. But we would call it exposure therapy, which is, I think, what you're trying to reference.
Russell:Yeah, that makes a lot of sense. I'm just thinking about what if I fancy exposing myself tomorrow, but maybe I should rephrase that sentence, because that's not the best way of expressing it. But I think that's quite an interesting technique. So basically, what you're saying is let's lean into the anxiety. It's interesting, isn't it? Because we have a world where we are afraid of fear itself, haven't we? And so we're anxious about anxiety. So that's quite a liberating way of thinking about that.
David:I agree. Thank you.
Russell:Yeah. Okay. Love it, love it, love it. And so, I know you've written a book about anxiety, and like you said earlier, it's about thriving with anxiety. Who's the book written for would you say?
David:That's a good question. Whenever I tell people that I specialise in anxiety, they immediately have lots of questions. So, it's for all of those people. It's for really not only individuals who are struggling with anxiety, but also people who have loved ones who are struggling with anxiety, people who have ever had anxiety in the past, people who are in employment and want to understand how to help their anxious employees thrive more. This could be a resource to them with some practical skills and tools to be able to talk with employees about it and maybe even help organisations to move things forward. Mental health awareness and such. So, I think it's a pretty broad audience.
Russell:Interesting. And when's it going to be launched?
David:Yes. Title is Thriving with Anxiety. Nine tools to make your anxiety work for you. And launch date is October 17, 2023. Coming up, making me anxious thinking about it.
Russell:Hey, well, lean into that anxiety, and on the next one. Now, it's interesting looking at your profile, because one of the things that caught my eye is this phrase, he is an international expert on spirituality and mental health. So I wonder if you could unpack that a little bit for us.
David:Sure. So, I mentioned my research here at the Harvard Medical School the last ten years, the focus of that has been spirituality and mental health. And it's a topic that in psychiatry, people don't usually talk about very much at all. And there's a disparity between how researchers and clinicians approach the subject, which is by avoiding it and patients, the statistical majority of patients, even here in Eastern Massachusetts, which is one of the least religious enclaves of the entire country, and internationally, this is the case as well. More than 50% of our patients have spiritual beliefs that are relevant to their treatment, and they want to discuss this. So, this is often a theme that is important for mental health but gets ignored.
Russell:Just to jump in for 1 second, just to clarify this. So, by spirituality, are you talking about organised religion or are you talking about a wider thing than that?
David:Yeah, spirituality is a broader term than just religion. I think it's a way of relating to anything which we perceive to be greater than ourselves. And for many people, that's religion in the United States, it's the majority of people. In Europe, it's not the majority of people, it's the statistical minority. But nevertheless, this idea of relating to something which is greater, whether it's values what we are really aiming for in life, having meaning, greater meaning, greater purpose. I've been studying that for a little while.
Russell:And what are your conclusions?
David:Well, that spirituality is a powerful force in shaping people's mental health, both in positive and in negative ways. And people have struggles in this area. It can be relevant to their depression or anxiety or even more severe disorders. And it can also be a very important resource that is often untapped in the process of psychiatric treatment.
Russell:There is something about the choice to believe which is part of the process of teaching people or helping people understand cognitive choices, isn't there?
David:I would certainly agree with that.
Russell:Yeah. I mean, I work a lot in Africa where the religious, specifically religious thing, is broader than one religion. But there are many religions that have a wider focus on spirituality as well, even through to the idea of the social good being spiritual as well as actual non corporal things. And this idea, as you say, of being doing something that's wider than ourselves, is that sense of meaning, which I think a lot of us have lost in a world where we're focused on material things or this idea of complete individualism. I wonder to what effect the fact that we've gone to this idea of individualism so quickly has actually been part of building anxiety, because we've almost not figured out how to replace what we've lost with a new thing to find.
David:I 100% agree with you. I would even go one step further. When a person is on a mission or has a certain value that they're pursuing, they have a vision for themselves and it has some sort of greater meaning if they feel anxious and uncomfortable along the way, it's actually not that bad. This is sort of what I signed up for. I signed up for a challenge. It has cosmic meaning or whatever language for some people, they would say religious meaning or divine meaning or whatever language sort of meaning, important meaning. It's important to me. I know that this is going to be hard along the way, and if I'm feeling panicky or uncomfortable or my vasovagal system is kicking into gear, then that's probably a sign I'm on the right path, not a sign that something's off. And I agree with you. I think our tendency to not pursue higher order values and purpose in our lives and simply to be more material individualistic, as you put it, has actually made us more susceptible to anxiety. Because at the end of the day, if it's all about me and how I feel, then if I don't feel good, something's wrong.
Russell:Yeah. There's something about brain health, which is about the innate human need to cluster together, gang together, work together, collaborate, build tools. There's something there, isn't there? This sense of community. And one of the best things for brain health are actually to communicate with other people. And it's actually a major form of dropping anxiety, isn't it, is to socialize and actualize and discuss and verbalize your interferes. I mean, it's the basis of counselling, I suppose.
David:Very much so. And often people sort of have a sense in the feeling that they have to show that they're not anxious and show that they're not uncomfortable, which is not adaptive and healthy for building close relationships.
Russell:Brilliant. Okay. Who I have in my life, I've told them exactly how I feel and been extremely vulnerable with them and experienced that anxiety. It's been very good for Bridging connection.
Russell:Yeah. There was something actually quite exciting about feeling the body stressing itself coursing through you heating up. You can feel the pressure and the tension building up on you and you're aware. I mean, it's a visceral thing, showing you're alive at one level. And then, of course, the cognitive process is about, well, actually, how do I use all this power, all this energy inside of me? And I think people don't understand there is a way to take that visceral reaction and turn it into action, because that's the point of it in the first place, isn't it? Emotion means emotion, and people seem to forget that bit.
David:That's great. Well, it sounds like you're thriving with anxiety quite a bit.
Russell:Well, we're both in that world, so it'll be scary if weren't. I suppose so, yeah. Okay, then. Right then. So basically, where can people find out more about your work? Where can they find the book? How can they touch base with you?
David:Yeah, people can definitely get in touch through my website, which is Dhrossmarinmylastname.com, and there's a book page on the website. The book is available for pre-order now anywhere that books are sold, and very happy to connect with people about this on LinkedIn as well.
Russell:Are you on all the socials?
David:Oh, yeah. That's been an adjustment and actually quite anxiety provoking for me personally, let me tell you, because when this book doing a trade, nonfiction was not something I was ever trained for. And when I started talking to publishers like, well, you're going to have to do this, and, okay, we're going to sit with our anxiety and get out there. So, yes, you can find me on all the platforms, somewhat to my sugar.
Russell:I'm looking forward to seeing you dancing on TikTok. That's all I'm saying. That's a new anxiety for you to face tomorrow. You and I can do it together. How about that?
David:You're making me viscerally uncomfortable.
Russell:Maybe that's my anxiety, not yours. Let's do TikTok. Okay, well, look, it's been an absolute joy to talk to you today. And the book is Thriving with Anxiety and will be all over the Internet in weeks and months to come. So, brilliant. Well, thanks for spending time with us today, David. I really appreciate it.
David:Thanks for having me. It’s been a joy.
Russell:You take care.