good evening and welcome to doctors on call I'm Mary morouse psychotherapist at Insight Counseling duth where I specialize in working with children teens young adults and parents I am your host for our program tonight on anxiety and mental health our panelists this evening include Sydney Shay psychotherapist Insight Counseling duth Mike psychotherapist inight counseling duth and Thomas modal associate professor Department of psychology and sociology at the College of St Scholastica and now on to tonight's program anxiety and mental health thank you all for coming tonight I appreciate you guys uh joining me and talking about this very um important uh uh timely topic of anxiety and and mental health we hear so much about it I'm very intentionally wearing my red white and blue tonight um because I think this election that's coming up and so there's a lot of in in the media and um on social media there's a lot of talk about this particular election and stress and anxiety and so if we could just uh kind of talk a little bit about you know what you're seeing either in your clinical practice what you're seeing at the University level um about again specifically this election well I'm just seeing a lot of my clients just lately I mean the elections were two or three not not too far no which is weird October is almost over but um I'm just seeing a lot of clients talking about it and having open conversations and just um wanting to be able to share how they're feeling about all of the election stuff and some family Dynamic stuff I know for sure you know having disagreements between family members and I think that's just what I'm seeing for me okay Mike yes I'll Echo that and I see that as well and um I can also attest to that I I'm experiencing it as well um I just find myself always looking at the recent polls and then uh when I find a positive one it calms me a little bit but then when I find that next negative one then it just sends me back into uh a high anxious mode there here so I've really had to kind of intentionally withdraw from some of the some of that flash media around the election yeah AB absolutely and I think that that's a really um a really good point in that we get these you know the news is made to to be to be seen and that's where that's where they get the numbers which is which is fine and and well and good and all and to know that we need to balance that know when to step away and I think no matter who you are and what age you are really knowing when this is starting to negatively affect you know e sleep exercise or some of those more biological based um things is to really know when to step away and then to kind of how to fill up your cup or feed your soul for those things that to balance that um with some you know cat videos or whatever is you know happy you know kind of some of that so if you could speak to to the election stress and what you're seeing in um at at the University level yeah I mean I see a lot of the same stuff and I think there's this real push or pull with with things like the news uh in that uh what creates anxiety is the sense of unpredictability or uncontrollability about the future and there's a sense of if I find the right if I find the right information it'll it'll make me feel like I have more control or more predictability about that unfortunately with the way the the politics are there isn't going to be any real predictability and certainly not a lot as much as much control as we probably would want over the election and so we're we're seeking that actively as a way to try to amarate our anxiety and yet it produces more of the exact same thing as we see close polls and we recognize there's not a whole lot I can do to suddenly magic our client or our candidate into winning and things like that I I saw a graphic the other day that was um of all the different scenarios that each candidate would have to do to to win each state and what that looks like and I started going down and there were just there the combinations were just almost you know too many to count and so after it it about 30 seconds of that it did not take me long I'm pretty well I was pretty well in tune with uh this isn't working move on to something else so so yeah okay thank you very much yes um so let's talk about Mike let's start with you and talk about kind of some of the physical manifestations of anxiety and so to kind of understand the biology if you will of that sure yeah so stress is universal for all living organisms um anxiety tends to be more for us as humans because we can we can create our own stresses in our minds um and so if you're if you're a wild animal you're definitely stressed when you're being pursued by ion for example um but when that's over um it doesn't take long for the body to reset and just go back to grazing um but for us as humans we can be in that state and we can um put oursel in that state just by our thoughts and just by our worries about the future um and so it's really uh you know it's really unique to us in in its most extreme forms uh the anxiety there okay yeah okay um um Thomas if you could talk a little bit about um some of like the uh uh anxiety disorders that you know we kind of have and their our DSM our our our personal psychology Bible but can you talk about like some of the disorders that happen under the anxiety like social anxiety and some some of that if you could speak to some of that please sure the uh anxiety disorders as a as a general family of disorders are the most common set of disorders out there about one in three Americans are going to uh meet the criteria at some point in their life for an anxiety disorder so these are the most common set that we have have uh the the most common one within that is what we call specific phobia it's the fear of a very specific object or situation you may have somebody afraid of snakes or or spiders or something like that and that's the most common one and there's also more pervasive versions of of anxiety disorders uh for instance generalized anxiety disorder this is a an anxiety around a number of life situations where it feels like anxiety is a constant presence in one's life and it uh usually manifests to such a degree that people have some sort of physical uh manif festations of the anxiety as well it's a inability to sleep or really feel like you can't stop yourself from being keyed up or you have a lot of tension or pain that you carry with you from being stressed out and tight all the time and so it becomes really a a part of somebody's overall life and there's a few different anxiety wordss within that category uh within the family U but those are two of the most uh common ones or at least some on that really affect people okay so one in uh one in uh three people gets diagnosed sometime in your life so I think kind of going along with that so if people are diagnosed can these kind of come and go can we can someone get diagnosed with like a general orop phobia and can these kind of I guess at at some point you have all the um all the symptoms to to be to have that disorder and then can they kind of go away yes uh treatment rates for these things are are usually the prognosis is very good okay with treatment uh some people seek treatment more often for some disorders versus others uh but for across the anxiety disorders the success rates for treatment are very good especially when you start to combine things like pharmacological treatments and psychotherapies um there's a lot of things that are very effective in conjunction with each other uh to help work on these things yeah so kind of the gold standard but like some for for some like that that Psychotherapy and and some some sort of some sort of treatment okay and and so good results because I think a lot of people if they um uh I don't want to say get labeled but if they have this diagnosis there's a certain amount of fear that this is never going to go away and I'm I I am this instead of you know this is a temporary thing and in many ways that's the way anxiety works too it promises that it's going to stay there and it's never going to go away it's the way it works in our head it feels like it's forever yes uh and and there is a lot of Hope out there for folks who do seek treatment around the anxiety disorders uh and a lot of people everybody pretty much experiences some amount of anxiety in their life it's only whenever it becomes impairing and and becomes a part uh it prevents somebody from living the full life a meaningful life that they want we to really call it a disorder so although people may or may not meet criteria for a particular disorder get diagnosed uh a lot of people may deal with anxiety and may seek to have some sort of treatment around that even if they're not have a diagnosable condition something like that okay great thank you and Sydney if you can kind of follow up with that we were talking earlier about normative and non-normative anxiety can so can you speak to that a little bit and then maybe what you see in um some of the school AG children that you work with yeah totally so I was I with a lot of um people that come in I feel like they kind of expect us to just talk about in their anxiety to be gone CU having any anxiety seems like it's a bad thing or we're not supposed to so I think something that I work with with teens with all my clients is just kind of trying to differentiate maybe between when I'm assessing kind of in the beginning of seeing them or just down the line when they're talking about their anxiety is kind of like you know what is normal like for example let's give an example here a a client is having a test or something so they're going to feel really you know nervous about the test which is totally normal um but I think where it might step on to the disorder or something where they might need a little bit more help is um when they're continuing to think about the test or they're not being able to sleep at night because of the test or every test that they have that's how they're feeling so I kind of try to help them differentiate between those two things so that's kind of the main I I think the difference between helping clients understand normative and non-normative is that impaired versus you know normal life stressor that's happening yeah and we were talking um uh before about um social anxiety and so can you speak on that a little bit and then a little bit around the co covid because we're still feeling the effects of what Co the um you know um what happened with school and children and young adults with with um the social anxiety piece of the of the shutdowns so what are you seeing with social anxiety and then we can wrap that into um we'll head to to Mike for Co okay yeah I mean I definitely think a lot of kids I mean I try to do the math a little bit when I'm in session with them it's like you know what what time period were they were they in when Co happened what grade were they and and I definitely try to have those intentional conversations with clients because sometimes it's in those developmental ages of like adolescence or like Middle School especially when you're learning to make friends and create relationships with other peers so I'm seeing a lot of that than translating I mean some high schoolers I would say today with not I think around Co was around their middle school time so like not having that um time to develop that in their brains and experience that so I think just being able to normalize that and talk about it and what's going on and also I'd say with social media too a lot of kids were on social media a lot during Co and I would definitely say that has an influence on social anxiety and what we're supposed to be doing and kind of trying to challenge and talk through those things with my kid clients of where's that coming from where are you finding that and challenging that then bringing it into their life and being like you know when you're experiencing the world world and you're seeing other peers are those things that you're thinking with your peers and kind of challenging that social anxiety too and what's really the you know where's that coming from where's that coming from absolutely and I think during the lockdown and during covid the only way to connect was virtually and was on the phone and was through their computer so that was a good thing and now that we're back to and has been a few years now kind of coming back and you know depending on the the the person and the personality um and the tendency to kind of become I'll say it's kind of addicted to that type of type of of connection it's hard to pull it apart so Mike what have you been seeing from kind of under this covid um umbrella as far as like kind of the kind of the the anxiety and and kind of the postco anxiety if you will sure I I see a lot of I see a lot of young men in their early 20s to mid 20s and I I think the covid combined with technology and computers um that they're spending a lot of time on their computer and they might be engaged with others in that virtual world um but in the three-dimensional world uh they have very little contact and and then by the time they are becoming adults in their early 20s they really have a difficult time engaging with the world in the way that you know we expect or we think that that that would be happening and so it can be really high anxiety really difficult times uh leaving the house um just and again continued computer use um yeah yeah and it's becomes part of it Thomas can you tell speak to that a little bit about the covid and the trends also that you um um like this postco world that we live in yeah I mean certainly in college at manifests uh for a lot of students coming right out of uh of Co they hadn't really taken in-person test in a long time an exam and so sitting for a big minterm uh in a college setting felt very anxiety-provoking for them or things like a presentations uh standing physically in front of a set of people um you know to present these presentation skills were something that were maybe not as as refined and that manifested in in more anxiety and this isn't a new thing though uh when we look at like overall uh data about what uh makes people anxious in the United States uh the number one thing that comes up is public speaking that's the first thing number two on the list is death so literally you have people that will say like this is worse than than than my fear of dying is is public speaking and so the anxiety around performing and potentially being judged negatively by others is it's a big uh anxiety and worry uh amongst these folks and especially if you haven't had the skills or the exposure to being able to do that a lot and have successes and failures along the way it can feel really overwhelming yeah so you didn't have those little um ra your hand in class or the Teacher Calls on you in class which is a very you know small way of public speaking right you're still having to answer to plus two is four and you're in first grade or whatever that is and so taking away during those certain developmental years those little you know and that's H how do we learn well by by doing I there's no shortcut to that um and so you know taking away those those years and so what do you feel like um what are the best coping skills or kind of ways to kind of to to think about it to kind of re to kind of look at at the okay so public speaking is hard social anxiety is is hard I don't have those skills now what so what what sorts of skills do you like teaching your clients about either anxi you know about anxi about coping with it well I think the first thing is really just being in touch with what's going on in your body too so a lot of kids I feel like and a lot of people in general live in their heads so being able to be mindful and focus what's going on around you focus what's going on in your body when you're feeling anxious um even just like breathing like deep breathing like uh triangle breathing for example that's where you'll breathe in for tell us tell us about your try and I think everyone has their favorite favorite uh uh breathing technique so tell us about triangle so triangle breathing you'll breathe in for breathe in hold and then breathe out for the C for the same amount of second so I like four I mean different people you can kind of customize it however um that feels good for you but you'll breathe in for 4 seconds I Mayan we could all kind of like do it together a little bit so breathe in for four hold for four and then breathe out for four and then doing that as many times as you know you can feel more regulated or feel less activated is a skill that I really like to teach my clients yeah that's great feel calmer already thank you Mike um so I would say that when I work and it depends on the presenting concerns of the of the person so I will do sometimes do some cognitive behavioral therapy like uh exposure response prevention so you okay you know if you have a phobia of something that you try to work your way towards that uh and then not have the response that you would have had when you're anxious so that you can then slowly come to acclimate to that that phobia or that piece there um I also do a lot of internal family systems work where we explore this anxiety and we we always try to say it's a part of you that you're feeling anxious right now and we try to create a relationship with that part uh and then we also really are curious about how that anxiety is trying to help you because um you know people tend to really hate their anxiety often times but really your anxiety is there for a reason um and it's trying to trying to keep you safe in some way and usually what I find is behind all of this then there's some core negative beliefs or some childhood experiences or there's something else in there that's at play that's helping to manifest those anxious symptoms um there that so the anxiety is there to help them to not have to experience something that they have to go through at an earlier point in their life okay so that part that anxious part as a child helped them and now it's a little bit to it's no longer helping or it's no longer serving them as well is that sure or it still is or it's stuck in where it was it's still stuck where it was serving them initially um there but but in the end it's always at least your anxiety thinks it's helping you out U and trying to trying to talk it away or trying to ignore it um and just doesn't work so it's really an experiential relationship to your anxiety I find can be very helpful um rather than trying to avoid it or um feel shame about it okay great what are some of your go-to coping um mechanisms coping skills that you that you um teach or you know provide for for students or well I really like that idea of of thinking about anxiety as as data right this is information about your world about about your experiences this can allow you to to to use it well like use your anxiety well it can be motivating because you don't want the anxiety uh there anymore that means make a good plan that you believe in to go and uh and then attack the source of this anxiety not yourself or something else or procrastinate but go and try to examine what is actually going on that may be causing this do I need to study more for my exams or how can how can I use this data in an actionable way to get my feet moving and more in the life that I want because it's telling me right now that there's something not going right there's something not going well in my life and and that can be uh really important pieces of information so can the person maybe in the moment slow down take some breaths uh look at their anxiety not uh not as something that's an enemy uh but how it can be a useful point of data and then develop a good plan to move move next and that that's really hard in the moment and so helping clients stop for a second pull back and kind of see uh what what's going on with them and how it could possibly be useful Orient themselves in that way to their anxiety feels pretty yeah yeah and so um kind of U talking about minim not elimination minimization not elimination you know is something that we that talk about and so sometimes again like what you spoke to earlier is I want to just eliminate just want to get rid of it and so that is sometimes that just in and of itself is a hard space for people to get to because it's so big and it's so scary that it's they just want to want to be rid of it and I think that there's um also a space of being um becoming comfortable with being uncomfortable yeah which kind of goes um makes me think again kind of this kind of I guess we're kind of talking more about kind of a younger population but some of this well-intentioned helicopter parenting um snowplow parenting um that um and half of us our parents here um that it's our best intentions and we want those things because we want um our children to be safe and healthy and sometimes kind of that overstepping not allowing that space of uncomfortableness for our children and our loved ones um and that can go to enabling behaviors too right um so can speak about you know we'll start with you Sydney just talk a little bit about what you see for that again and I think that kind of goes to that that that some of that uh that helic type parenting is is that um not wanting our children to be uncomfortable yeah I think I my work with clients a lot is trying to be able to sit with that discomfort and what are like a lot of it is not invalidating that they feel that way so really validating like yes this test for example I'm going to use test again this test is really nerve-wracking and you studied for this long and you got this you and giving them some evidence too of you you aced the last test and you killed the last test so you're going to do this you're going to do it the next time so it's like yes these things are uncomfortable or they're anxiety-provoking and you got it so two competing feelings maybe can be true at the same time absolutely I was going to say I think oftentimes you know we have these cognitive distortions of all and nothing thinking too so we think that either I'm anxious or I'm not and it's just it's like a light switch rather and I always work with clients so we look at it as like a dimmer or like let's just try to see if we can turn down the volume by maybe a couple Deb here and if we can do that then we have some successes here but a lot of us you know have the sense of when we go in that we want it to be gone um we want we don't want to feel anxious ever again because it it can be debilitating yeah and which makes me think of black and white versus gray so that some of that black and white thinking can you speak to some of that kind of like that all or nothing that black and white thinking that anxiety just loves oh sure yeah yeah especially whenever people get in mindsets like well since when I feel anxious when I get really anxious I can't do certain things I can't I can't function this way or I can't live the life that I want and when that kind of thinking kicks in you'll have people kind of be beholding to that that anxiety and the ultimate goal that I have for my clients is is i' sure I'd love them to live less anxious or anything like that but they're going to have days with high anxiety no matter what they just like all of us will and I hope that in those moments they're able to move with that anxiety and still live the life that they want even carrying that anxiety with them and so to know that even if something feels big or it feels unmanageable we can still move in directions that are meaningful to us and and that's ultimately what I love I'd love for them to have the anxiety turned down a little bit but also when it's ramped up what can you do that's important to you in those moments even whenever you're in a highly anxious State can you still do something that's meaningful and important valuable yeah that's and I think that's a good a good example um is is that you know things you're going to have these really down days with depression which we're not talking about but it it goes hand in hand with anxiety a lot um and so whether these down days or these really anxious days and yep going with it and I I use kind of a metaphor of like holding it out like if I held this out for this whole I my arms would be pretty tired if I put it in a backpack or if I carried my water in my backpack I can carry a 20 ounces of water in my back pack all day and so it's still with you it's just not in front of you so you don't have you don't have to stare at it the time you can but so it can still it's still going to be there but maybe just get it to a space where it's not as heavy I really like that yeah like it's carrying you're still carrying with you but it's not you're not all about that you can focus outside of that have a bigger perspective on your life I think you alluded to M yeahh yeah so those um anything else with like a real real quick like with with depression do you see anxiety and depression kind of coming along with each other very much so yeah they are uh closely closely related yeah which we often don't think they are yeah we often think depression and anxiety are are Polar Opposites but they really are strange bed fellows yeah they are very strange very strange bed fellows y that brings us to the end of tonight's show I want to thank our panelists Sydney Shay Mike clayball and Thomas modal next week join Dr Peter nen as he leads the discussion on arthritis rheumatoid tendinitis and btis thank you for watching good night w [Music] [Music]