How to pronounce "deepen"

So the most important thing to know about anxiety straight out of the gate,

is that it has gotten an unnecessarily bad rap,

as has happened for a lot of negative emotions.

But you should know that psychologists have long understood

that anxiety has both healthy forms and unhealthy forms.

And a lot of the anxiety we experience in the day-to-day is healthy.

OK, so what makes anxiety healthy?

Anxiety is healthy when it is serving as an alarm system

that lets us know that something's not right,

that it gets our attention and helps us to keep ourselves safe.

So if you're driving and somebody swerves and cuts you off

and you have a surge of anxiety, that's a good thing.

It will focus your attention,

it will help you be safe around that driver,

maybe take evasive maneuvers.

But it's good for you to respond.

If you're entirely indifferent or relaxed in that setting,

it's not as safe.

So we look for anxiety to be of help to us, to guide us

and to let us know what we're supposed to be doing and not doing.

I care for a lot of teenagers clinically, and, you know, I will say to them,

if you walk into a party that you thought was going to be a little get-together,

and it turns out it's kind of, you know, wild and you feel anxious,

pay attention to that reaction.

Like, that's telling you something,

that's indicating that you may not be as safe

as you thought you were going to be.

So that's healthy anxiety.

The only time we consider anxiety to cross the line

from healthy to unhealthy

is under two conditions, actually.

One is when we have anxiety, but there’s no threat,

that there's nothing wrong.

So if it's, you know, a lovely Sunday morning and you're taking a drive

and there's no traffic nearby,

you shouldn't be having an anxiety response in that moment.

And if you do, we would consider that grounds for concern.

The other time we pay attention to anxiety

and consider it to be unhealthy

is if the anxiety response is way too big for what's happened,

out of proportion to events.

So if somebody swerves and cut you off

and you have a panic attack in that moment,

that is not healthy anxiety, it is not helping you.

And we would address that clinically.

Other than that, we really see anxiety as largely normal, protective,

healthy and useful in our lives.

OK, all the same, it feels terrible, right?

I mean, I think one of the things that's so true about anxiety

is it doesn't feel good

even if it's actually serving a useful purpose.

And so whether the anxiety is healthy or unhealthy,

it's really great to know how to get it in check if you want to.

And that's what I'm going to teach you now.

And you may be surprised to hear me say,

"Oh, let me just teach you how to do this,"

because our experience of anxiety is that it's kind of out of control,

that it sort of takes over.

But despite that,

the reality is that anxiety is probably the most systematic human emotion.

It unfolds in a very stepwise fashion,

it's actually a one-two-three process when it really goes off the rails.

And so I'm going to walk you through the one-two-three

of how anxiety unfolds for all of us.

And then we're going to come back

and I'm going to show you how at every step of the way

there are things you can do to bring that anxiety back under control.

OK, so the first thing that happens when we have an anxiety response

is our bodies react.

There's actually just a physical reaction that we have,

and it's pretty universal and it's very familiar to all of us.

Your heart rate accelerates,

your breathing gets really quick and shallow.

It feels uncomfortable,

there's other stuff happening in our bodies, too, at the same time.

But that activated heart,

that kind of hyperventilating sense of breathing,

everybody knows that feeling.

OK, what's happening here?

The sympathetic nervous system,

which is the part of our nervous system

that is paying attention to the environment,

is sympathetic to what's around us,

is kicking off some degree of the fight or flight response, right?

That ancient response that we all know about.

And in the fight or flight response,

what we want to do is get ready to run or attack.

And so our sympathetic nervous system is taking measures

to send a whole lot of heavily oxygenated blood

out to our large muscle groups for that purpose.

That's why the heart accelerates, that's why breathing changes.

And I, you know, especially in caring for people

who have not ever heard any of this before,

it can be really helpful to understand that as strange as this reaction is,

it has a sort of ancient logic to it, may not fit the moment,

but it definitely makes sense.

And it's not something going, you know,

kind of, out of whack when our heart and our lungs accelerate.

So that's the first thing that happens.

The second thing that happens is we notice that change in our body

and we come to the conclusion that we're going to call it anxiety.

We decide to use that label.

This is often an arbitrary decision.

We can call it something else,

but we can sometimes default, unhelpfully, to calling it anxiety.

And then the third thing that happens,

and this is where things really do go off the rails,

is we engage in catastrophic thinking.

And the definition of catastrophic thinking is actually very straightforward.

It's when we overestimate the risks

and we underestimate our ability to manage the risks.

That's it.

So if your body reacts, you're like, "I must be anxious,

oh, my gosh, this situation is completely out of control

and there's nothing I can do to stop it."

That's when anxiety really becomes miserable.

And that's the one-two-three.

Alright, so knowing that,

let's go back and hit every one of these in terms of how we can work against them.

So the first one, the body reacting.

OK, so one of the most powerful ways to get the body to calm down,

is through controlled breathing.

And I will tell you,

if you're having like, this, "Uh, really, breathing?

Like, you're going to go to breathing?"

I totally get it.

For years, I was like, "Oh, that's so woo woo.

That's not that technical. It's not that scientific."

Ok, I was wrong.

I learned I was wrong.

And in fact, breathing is this really biological intervention.

And what it does is it kickstarts

the parasympathetic part of our nervous system.

And the parasympathetic nervous system,

its job is to reset the body to its resting state.

OK, here's how this works, it's kind of amazing.

So just as the brain can signal to the heart and lungs

like, "go into overdrive,"

you know, "we might have to do something here,"

we're also of a mind that the lungs can communicate back to the brain.

So when we’re anxious, we’re breathing quickly and ... shallowly.

And if we override that,

if we deliberately deepen and slow our breathing,

what we think we're doing,

this is sort of the understood science,

is that we are hacking into a set of nerves

on the surface of our lungs

that are stretch receptors.

And all day, every day,

those nerves are paying attention to our breathing

to keep us safe.

And they notice that we have slowed our breathing

and things have gotten calmer

and they read that as evidence of safety

because we only breathe deeply and slowly when we're safe.

And they send that message up to the brain saying,

"you're kind of having a reaction that doesn't make sense

because the nerves on the lungs are telling us that we must be safe."

And that's how anxiety comes under control.

That's step one.

Step two, if we want to, need to,

is to consider whether anxiety is the right name for what's happening.

That we have a kind of activated response all the time.

So it might be like, I was excited for this presentation.

And before this presentation, I kind of felt a little bit of a rev.

I could have said, "I must be anxious."

But instead I said, "No, I think I'm really excited."

And that shift in thinking actually makes a huge difference

in terms of how we feel about what we're engaging.

The third thing we want to watch out for

is anxiety going off the rails with catastrophic thinking.

And again, that's overestimating risk,

underestimating our ability to handle it.

So if something is feeling really, really scary to you,

really, really anxiety-provoking,

key questions to ask yourself are,

"Am I imagining this to be worse than it might really be?"

So you're going to try to bring that estimation of risk down.

And also, "Do I have more say in how this is going to go

than I'm giving myself credit for?"

"Are there things I can do to actually increase my sense of control,

not feel as helpless as I do right now?"

So you're not trying to get rid of the anxiety entirely,

but you're trying to sort of get it in the narrower band

of not overestimating risk

and not underestimating your own powers.

So I'm going to start to wrap up, but here is the bottom line.

Most of the time,

we don't need to feel anxious about feeling anxious.

It really is there to help us out.

And whether we want it there or not, or whether it's helping us or not,

if we want to get it under control,

knowing the basics of how it unfolds

really does put you in the driver's seat

of knowing how to calm yourself when you feel anxious.

And so you don't have to feel

like it's something that you are at the mercy of.

David Biello: You spoke about breathing

and how you were skeptical in the early days.

Do you have the particular breathing practice you like?

Lisa Damour: I do.

Once I got over my snobbery about breathing,

I use something called square breathing or box breathing.

And, you know, people have often heard of this.

And it's really simple.

It’s where you breathe in on a count of three,

so one, two, three, in --

and I'm actually going to walk us through it as a group.

Then you hold it for a count of three: one, two, three.

Then you exhale slowly on a count of three: one, two, three.

And then you wait, one, two, three.

So, one, two, three, in.

One, two, three, hold.

One, two, three, exhale.

One, two, three, wait.

OK, so let's all do it together.

But here is my instruction to you.

If you really want this to work,

picture the nerves on the surface of your lungs getting the message.

You're not just breathing to breathe, right?

You're breathing because you are hacking into this system

and using those nerves to communicate to your brain that everything's OK, right?

So everybody, like, (Exhales) blow out breath a little bit, ready?

Breathe in slowly.

One, two, three.

Hold it.

One, two, three.

Exhale slowly, one, two, three.

Now, pause.

One, two, three.

That’s it. (Laughs)

And you can do it a few times.

If you get really anxious a lot,

you should be practicing this when you're not anxious

so that you can slip right into that groove.

But it is powerful.

It is really powerful.

And I am a little embarrassed

about how long it took me to get on the breathing train.

DB: I mean, it's actually incredible because just doing that with you,

you know, the little ball of whatever, excitement in my stomach

just sort of dissipates.

So breathing, people, it's real.

It's important.

So we already have some questions flooding in.

And I want to make this useful for the members.

Let's get right to them.

First up, Gordon wants to know about helping other people.

How can we help if we notice

that a friend or a family member is experiencing excessive anxiety?

LD: OK, I love this question.

So the first thing I would say just by being generally useful,

is, we'll get to the excessive piece,

but just, people need validation that anxiety makes sense

most of the time.

And one of the real hazards

of anxiety being talked about as though it's everywhere

and always pathological

is that people experience normal anxiety

and then they think, "Oh, I'm having anxiety.

Oh, no, there's something really wrong."

And so one quick thing you can do to say [to] somebody who’s anxious

if they’re like, “Oh my gosh, I have a big talk tomorrow and I’m anxious,”

you can say, “You’re having the right reaction ...

That's going to give you energy and juice.

There's nothing wrong with being anxious about a talk"

or "there's nothing wrong with having to go tell your boss

something they don't want to hear.

And that making you anxious,

that's evidence that you work perfectly."

So that alone reassures people a lot.

And then I think the next step you can do is to say,

"If it gets uneasy,

if it gets to be too much more anxiety than is helpful to you, right?” --

Even framing it is like, “This should help you out until it doesn’t.” --

“You can actually dial it back.”

So walk them through why breathing works.

Everybody knows they're supposed to breathe.

Very few people know why.

And so that's why people won't do it.

And so when I'm caring for people, I will say,

think about your anxiety being on a dial, right?

And if it's a zero to 10 dial,

two to three, you actually tend to do a better job

with whatever you're needing to do

if you have a little energy, a little rev.

Once it gets into four, five, six, seven, you start to be in trouble.

And so I teach people to use the breathing to actually turn down the dial.

But that idea of like, you're not at the mercy of this.

You can be in the driver's seat on this

and you can use breathing or reframing

or questioning your own thinking,

is really helpful because there is a general sense of like,

we're helpless in the face of anxiety, and we're really not.

DB: So Catarina describes an anxiety that leads them to avoid things.

So meeting new people because it’s scary.

Do you --

What do you recommend for that kind of avoidance tactic around anxiety?

LD: Oh, Catarina, I'm so glad you brought up avoidance.

This is actually the most important thing we need to say

when it gets to talking about anxiety.

So, when we're frightened of something,

our instincts are like,

"Get away."

And if that is a tiger or a bad driver,

those are really good instincts.

And so when we remain frightened of something that's in our everyday lives,

we can actually feel very compelled to avoid it.

Here is, if you remember anything from what we talk about today,

these are the three words I want you to remember most.

Avoidance feeds anxiety.

So here's the process.

It's actually a wonderfully -- I think it's fascinating science on this.

So say, Catarina, you're thinking about going to a party.

You've been invited to a party and you're like, OK,

"I'm going to try to go to this party."

And then it's time to go to the party

and you feel your anxiety starting to bubble up

and you're like, "Forget it. I'm going to cancel."

OK, here's what's going to happen.

You'll go from feeling very, very anxious

to suddenly feeling much, much better.

So this is the first helping of how avoidance feeds anxiety,

which is that it feels good.

That, we call it a reinforcing experience.

You felt bad, you avoided, you feel better.

So you're like, avoidance is kind of fun.

Or not fun, but it solves the problem.

Here comes the second helping.

Because you haven't gone to the party,

nothing challenges your beliefs about how frightening that party is.

The party remains whatever you have pictured in your mind --

people not talking to you, you know, people, you know, whatever.

Like whatever you have imagined about what makes that party scary

goes unchallenged.

If you actually go to the party,

you often find it's a little bit, if not a lot, better than you expected.

But if you don't go, it remains very frightening.

So that is how avoidance actually entrenches anxiety over time.

It feels good to do it and it actually doesn't give us any competing data.

So when you go see a clinician for treatment of anxiety,

often we will start by asking about what are you avoiding

as a result of your anxiety?

And we will work with you

on -- we call it graduated exposure, which is like basically baby steps --

getting you in there, right?

So we'll say, OK,

could you go to a small thing with a couple people?

Could you use your breathing to make that bearable?

And it would just sort of work you into it very, very slowly,

because the solution to anxiety is often what we call exposure,

making yourself do it.

But you are not alone in this sense of like, you know,

why not just not go?

It feels better to not go.

And that's something that we, as clinicians, work really hard on.

And I will tell you, you know, the pandemic and kids and school,

you know that, and, you know,

we've always known if this child is frightened of school,

the solution is get them to school.

Even if they sit in the teacher’s ... back office for the day.

Physically being at school is better than being home

if it's otherwise safe for them to be there.

DB: So another ...

Area of anxiety that's popping up in the chat

is dealing with it in our sort of, children.

Robert wants to know what,

or are there any differences between words like

anxiety and worry or fear

as it might pertain to how a teenager is describing

or trying to put a name to what they're feeling?

LD: I think it means for the kid whatever it means.

But I will say teenagers use the term anxiety a lot,

and they use it very broadly.

And I've been practicing for a very long time.

And then in the last I'd say 10 years, I started to notice,

like, kids use this term a lot

and I wasn't quite sure what to make of it.

And then I was actually rereading "Jane Eyre" --

no, it was "Pride and Prejudice."

And Mrs. Bennet, I don't know if you remember her,

she's like, the kind of piece of work mom in that book.

There is a line in the book that was,

"Whenever Mrs. Bennet was discontented, she fancied herself to be nervous."

And I thought, Oh, I think that's often what I'm seeing with teenagers,

is they'll say, "I feel anxious" when they usually mean not calm.

"I don't feel calm."

And so the first thing I would do if a teenager says

"I feel anxious" is to say, "Tell me what's going on."

And they might say, you know, “I’ve got a big try out tomorrow”

or, you know, “This concert is happening

that I’m going to with my friends.”

And listen for the possibility that it’s something besides anxiety.

It could be they're excited, they're amped, they're apprehensive.

So try to make more granular

their description of what is causing the stirred-up feeling.

And sometimes they are anxious.

And that's when there's a threat, right?

Like, "I'm feeling anxious because I have my driver's test tomorrow

and I am not ready."

That is anxiety.

There is a threat, they could fail that driver's test, right?

So listen for a threat and then ...

if they’re anxious about something, be like, “Yeah, of course you’re anxious.

That's kind of scary.

Let's see what we can do to reduce your sense of risk,

increase your sense of control."

But often it's very important that we help them

bring more nuance to the language they use

around a sort of sense of being stirred up.

And what's so nice is that act of a teenager saying or a kid saying,

“I feel really anxious about school tomorrow.” --

“What’s making you anxious?” --

"New classroom, new kids, don't know where things are going to be."

You say, "Yeah, you should feel apprehensive,

there's a lot there,

and also maybe a little excited."

If you can get in there with words that are more accurate

than the big generic of anxiety,

that act is in and of itself therapeutic.

Kids are like, "Yes, I am apprehensive and also excited."

That they feel heard, they feel better,

and they have a better language.

So what I watch for especially,

is kids saying, "I have anxiety."

I like to say, “You’re feeling anxious.”

Because I think, there is this sense of, “I have anxiety,”

I think there's very much among adolescents a sense of like,

"I have anxiety,"

but I try not to say, well, everybody has anxiety at some level

because I don't want to be dismissive,

but to really help them make that distinction

between a feeling that comes and goes,

and a diagnosis they would need to be concerned about.

DB: Several folks want to know how can they tell when to seek help,

when anxiety has become too crippling?

LD: This is a great place to wrap up. This is a perfect place to wrap up.

So mostly this has been an ad for anxiety.

Like, don't be frightened of it.

Be curious about it.

Trust that it’s trying to tell you something.

If it feels too uncomfortable,

try these strategies to get it under control.

But two conditions.

Let's go back to them.

If you feel like your anxiety is showing up

and there's no reason, like, there's no threat,

there's nothing to be worried about,

that would be a great time to seek out support.

The other is if your anxiety like, well, there's a threat,

but like my anxiety is off the charts and making me miserable

or getting in the way of my life,

that's a good time to seek support.

So, you know,

pretty straightforward in terms of how we define

what we consider concerning.

But I really want you to know,

most anxiety does not need to make you feel anxious about its own presence.

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