The Many Facets Of Anxiety

In this episode, Dr. Gina discusses various aspects of anxiety and if we can ever be “cured” from anxiety. She differentiates anxiety stemming from simple phobias to trauma to childhood attachment. She discusses how anxiety manifests and how it can be addressed in treatment.

Transcript

Welcome to Living Simply,

A guide to mindful living and mindful parenting with your host,

Dr.

Gina.

Hey,

Everybody.

Welcome to Living Simply with Dr.

Gina Maggiograno.

My name is Ben Barber.

That's Dr.

Gina,

And this is Crystal Tubbs.

Hello.

Hey,

Everybody.

Hi,

Dr.

Gina.

How are you doing today?

I was good.

You caught me.

You caught me.

I was messaging a friend,

So you caught me off guard.

You were messaging a friend.

We're live.

I know.

I didn't know.

I thought we were cut off.

You were live and you were messaging a friend.

That gives me anxiety.

Speaking of,

Today we are talking about anxiety,

And that is sort of a big thing right now.

It was a big thing in this day and age anyway.

I forgot to silence my phone.

It was sort of a big thing happening right now in the world that we live in,

But it's also been worse since the pandemic started.

Last week,

I just threw up on Facebook and Instagram a question that was anxiety,

Better or worse?

I got a ton of responses on both Facebook and Instagram.

The majority of people said that their anxiety has gotten worse since March,

Since the beginning of the pandemic in North America.

Some people said that actually it's gotten better in some aspects because their jobs,

Their worries were taken away in some aspects.

They're day-to-day worries.

So some people had perspective shifts because it put things into perspective of what's really important,

Which was really cool.

It was just a fascinating topic and we had a lot of really great answers,

Most of them personal.

By the way,

If you're watching this right now,

And I know that we have dozens of people watching at the moment live,

Which is awesome.

So,

How is your anxiety doing if you have anxiety,

If you deal with anxiety,

If you have any questions about it?

Dr.

Gina is a wonderful expert to talk to about that.

So if you have any questions,

Please ask them in the comments below.

Tell us,

Has your anxiety gotten better or worse since the beginning of this pandemic?

Yeah,

So that's sort of the basis for this episode of the show.

Thoughts,

Dr.

Gina?

Yeah,

I noticed the same thing in my practice.

Some people,

It actually got better because they've had to work from home,

Their kids are home,

So their workload has been reduced by their employers.

So they're spending more time with their kids.

Others aren't enjoying it because they have less stress from the work environment itself.

So some have colleagues that are difficult or bosses.

And on the other end,

Some people,

Same thing,

It just got worse.

So if they have already some fears about getting ill or their parents getting ill.

So I find it's pretty divided both ways,

But I suspect there's going to be an increase in anxiety,

More like a trauma from this and all the changes because a lot of people have,

Many have lost their jobs and income.

And some people,

As we all know,

Who are already in abusive relationships being locked up with someone who's abusive,

We've seen an increase in child abuse and spousal abuse.

So I think in the long run,

There might be an increase in new anxiety.

That's a good point.

I'll get to that in a second.

Crystal,

What are your thoughts on yours?

You know,

I deal with anxiety in my day-to-day life.

And I kind of wonder for myself if it,

I don't necessarily think it got worse,

But I think it shifted.

It shifted to a different viewpoint and what I needed to be anxious over.

And it's been kind of interesting just personally dealing with that because it's like what,

You know,

I can't control other people.

I can't control their actions.

I can only control myself and my environment.

So what can I do,

You know,

To help but not,

You know,

I can't argue with people about wearing masks.

I can't be afraid to go to the store.

Like I still have to get groceries and eat dinner.

So it's been kind of interesting dealing with that.

We're supposed to still be buying groceries and eating dinner?

Yep.

I've been doing the pandemic wrong.

Darn it.

Yeah.

Oops.

I didn't realize.

You must be hungry.

Yeah,

For sure.

Definitely am.

So what's something that's really interesting for me is that my anxiety,

I've always been an anxious person.

I've had anxiety since I was a kid for sure.

But my own personal anxiety,

My really bad anxiety,

Stems from the last pandemic that we had,

Which was not as,

You know,

When you say that people think 1918.

The SARS one?

No,

That was an epidemic.

But the H1N1 was,

I believe,

Was considered an actual pandemic in 2009.

And H1N1 swine flu.

And I got that.

Oh,

Yes.

Yeah,

I got that fairly badly.

Some kids,

I was directing a show for high school,

And some kids were going to miss the weekend of the show because they were sick.

And,

You know,

They fought through it,

Which is great.

In theater and sports,

You know,

You try to go anyway.

And not that we didn't ask them to,

But they wanted to come and they wanted to make the show because they put in,

You know,

Three months worth of work for it.

And it was great.

And they both came up and gave me hugs after the show.

And then a week later,

I felt terrible.

But I didn't think about it.

I wasn't,

You know,

It was a big deal on the news,

But it wasn't like this.

There was no shutdown.

Kids were still going to school.

Everything was still OK.

And I thought it was a cold and it was OK.

And then on Halloween,

The day before Halloween,

I went into the hospital and I thought that it was just a bronchitis or something.

And they were like,

No,

You have H1N1.

So they did the thing.

They put me into the quarantine room and I still thought that I was OK.

I felt bad,

But not terrible.

And then Halloween night,

I crashed and I woke up because they let me.

I woke up two weeks later on the 15th of November.

Yeah,

So I had the whole thing.

I was intubated.

I have.

And then they they didn't even take me off normally.

They gave me the tracheostomy so that I could breathe through through a trach.

And they didn't think that I was going to make it.

They sent me to New Haven,

To Yale Medical Center,

Which is about an hour and a half away from where I live.

And they were that,

You know,

When I woke up,

They were like,

You're not you're still not going to do well.

You're probably going to be in the hospital for another year.

Thankfully,

Like I defied all of their expectations and I was home in a month after that.

And all of the functions and stuff came back and everything was good.

And there was the moment of time where there was relief afterwards,

Where you're grateful and you're happy and like all of that stuff happens.

And then just life sinks in.

And you start getting scared of every little thing because of what you just went through.

And that formed a really bad PTSD within about nine months to the point where anytime I lost control of anything,

I had panic attacks.

And like I developed a tick where I couldn't stop blinking a lot,

Like anywhere where I was in public.

And that lasted in different forms for the last 10 years.

And ironically,

This pandemic that's happening right now,

I've had less anxiety than I've had in the last 10 years,

In the last three months.

And I don't know why.

But that's it's just I normally I wouldn't want to share like a five minute story like that.

But it's really interesting to me that I got the worst anxiety of my entire life from almost losing my life in a pandemic.

And while I'm super scared of this thing that's happening right now and have barely left my house in four months and are taking as much precaution as I possibly can.

My anxiety has pretty much gone away for the most part,

Which is insane.

And I don't know why that is.

So,

Dr.

Gina,

Could you be my therapist for a minute and tell me why that is?

Listen,

This is what I think is happening.

I could be wrong,

But here's what I think.

One of what maintains anxiety is avoidance.

So we have a fear and we avoid what scares us and the fear subsides and it reinforces anxiety.

You're plunged into the exact same situation.

You still have fear.

You're controlling what you can control.

So you're literally facing your fear and instead of avoiding,

You're facing it and you're going into action.

And that's what we need to do when we work with anxieties,

Exposure and response prevention,

Meaning we teach people to stop avoiding.

So your brain's experiencing it.

Nothing super bad is happening.

And so your nervous system is calming down and learning,

I do have some control and it's not as bad as I imagine.

And to me,

That's that's what I think is possibly happening.

And you had a practice run,

You know,

Where the first time you had no control,

Like it took you by surprise,

Right?

Yeah,

That's enough practice.

Nobody ever needs to practice this.

And so why?

Let's talk about the responsibilities,

Right?

So the day to day responsibility is shifting the way that they did.

So for some people,

The having more time,

Having more free time,

Having more downtime was better for them.

And for some people,

It made them feel like they were losing their mind.

Can you talk a little bit to both scenarios?

Yeah,

I think let's talk about those who are losing their mind.

It's a bit why some people can't do meditation because they have to sit still and be with themselves and no more distractions.

So the busy,

Busy ones are so distracted with life.

They don't need to necessarily see their problems.

They can put it in the back burner,

You know,

Let's say an unhappy marriage.

Well,

You're so busy with the day to day going to work,

Putting the kids through sports that you don't have time to realize how unhappy you are.

You're not happy,

But you go with with emotions,

Right?

So I think when you're forced to idle a little bit,

Reality hits harder because now it's in your face.

So I think part of it is that.

And so if you're addicted to being busy,

Busy,

Busy and distracted all the time,

It would be unnerving to suddenly slow down.

As for the other ones,

I think could be the opposite is they've been so miserable or unhappy and couldn't take a break or were too scared to leave a job or whatever it is they didn't like.

And suddenly someone forced them to slow down,

Even if they knew they should slow down.

So now nature has forced them on a holiday,

Has forced them to be with their kids.

And they've always wanted to be with their kids,

But their kids are so busy and they're scared their kids will miss out.

And now it's like,

Oh,

Kids,

Well,

We can't do hockey or baseball.

We're together.

But deep down,

Parents are like,

It's so nice not to have to drive around every day and they don't need to feel guilty.

So they're kind of happy.

So in both cases,

I think people are just avoiding and not facing reality because they're they're scared and making the hard decisions is scary.

So people,

You know,

Let's do what everyone else is doing.

Kids are in sports five days a week or 20 million activities.

And deep down,

They don't want to do it,

But they're scared their kids will miss out.

And that's what you should do.

Yes.

So I think it's forcing people to go within and look at what matters most and their values.

And there's no escape.

What do you think as far as like parents or parenting goes during this time?

Like,

You know,

Kids tend to maybe be more I know like my niece can be more anxious than,

Say,

Some of the adults in the room.

Like,

How do you think that anxiety is affecting kids during this time and how can we help them?

I think the kids I've seen are actually doing better because they don't have the anxiety of going to school.

The,

You know,

School,

The social aspect can be difficult.

Kids can be mean.

If there's kids who are scared of getting sick,

You know,

Like kids who are scared to catch the virus,

Then it's about educating them and supporting them.

And I would treat it no differently that I would treat a kid with anxiety when there's no pandemic,

Which is not reassuring them because reassuring them makes the anxiety worse.

It's teaching them the skills to face their anxiety,

Give them confidence.

You know,

A lot of kids anxiety is maintained by their parents and their parenting.

So I work a lot with the parents and I think it would depend what the anxiety is specifically.

Makes sense.

I was just asking generally.

So what's the,

What's the end game for anxiety?

Like,

Is it something that you just have to live with?

Is it something that you can manage and that's the best you can hope for is to manage it?

Is it something that you can sort of rid yourself of?

Like,

What is the end game when you have an anxiety issue?

So I think,

I think part of it is in our nature.

If we're anxious or not,

It comes from our upbringing or our history or a trauma.

So,

You know,

If someone's a veteran,

PTSD is an anxiety disorder.

So I think the end game is basically to learn how to cope with the anxiety,

Find the skills.

I don't think,

Not all anxieties are created equal,

Right?

There's phobia.

So fear of dogs.

You can get rid of that.

Fear of spiders.

So there's specific phobias.

That's an anxiety disorder.

Then there's complex PTSD,

Which is where there's anxiety,

But it comes from childhood trauma or experiencing adverse childhood events.

So that would require more therapy.

There's anxiety caused by attachment and anxiety and anxious attachment.

So if it's more complex,

I think it's you learn to live with it,

But it's less acute and chronic and intense versus a phobia,

Which is pretty easy to treat.

There's a beginning and an end.

So I think it depends on the anxiety disorder,

But I think the reason I love treating it is because of the outcomes are so good.

You don't have,

Like I have anxiety,

So I get triggered by certain things.

So it's not that I never have anxiety.

First,

There's a level of anxiety that's normal.

If you're about to get hit by a truck,

You avoid it,

You're going to have an anxious or fearful response.

That's not pathology.

So it's when it becomes chronic and you avoid and you become agoraphobic is another form of anxiety where you never leave the house.

So you can easily treat someone where they've never left their house in 20 years and get them out of the house.

So when the feelings pop up instead of dwelling in the anxious feeling is OK,

When it shows up,

Give them the skills to let it pass and then move on with their lives.

I think it's learning to manage it and in some cases can actually go away.

Yeah.

Let's talk about anxiety and relationships for a minute.

Sort of two different angles on this.

Number one,

Managing the anxiety,

Like not managing the anxiety of a partner,

But dealing with the anxiety issues of a partner.

And so that would be my first part.

And then my second part is anxieties around the relationship in and of itself.

So,

Yeah,

Two very different.

So,

Yeah,

I work with quite a few couples where one partner has anxiety.

So just pure anxiety,

Not necessarily related to the relationship,

And it literally hijacks the whole family.

So not just not just the couple,

Like everything revolves around the anxious person.

And the only way around that is the person with anxiety needs to get treated because it literally destroys marriages.

Because at some point,

The people I've seen,

They come see me,

It's been 20 years of this and they've had enough.

They don't know what to do anymore because they're constantly accommodating the anxiety,

Which reinforces it and it never goes away.

So it's very important for the anxious person to get help.

And at the same time,

Couples therapy so that the anxious person doesn't blame or make the other one responsible.

Couples dynamic that ends up happening.

So there's the couple and the individual.

Then there's the anxiety from the relationship.

So if one person has an anxious attachment,

So from their childhood where the parent was not consistent in responding to their needs.

Well,

This perpetuates in their relationships where they fear abandonment and fear they're not good enough.

If I don't behave a certain way,

The other one's going to leave me.

So it's always battling that fear of rejection and abandonment and misinterpreting.

I work with a couple where one partner has a secure attachment and he likes to have his Friday night with the guys.

And he has a job that requires 24 hour shifts.

So he can't spend as much time as the partner would like to see him.

So she gets very anxious that it's going to impact the relationship when it has nothing to do with the relationship.

It's just her anxiety that it'll end the relationship if they're not together all the time.

So when it's that kind of case,

You need to work on the anxious attachment and the other partner who's secure.

How to love their partner to reassure them and interact in a way so that the anxiously attached person becomes securely attached with their partners.

So that's a different dynamic.

Right.

How do you work on that?

Oh my.

Communication?

Well,

Let's assume both partners are not anxiously attached.

So the securely attached partner usually is a good model of healthy relationships.

So they would teach communication skills,

Empathy and a whole bunch of skills on how they interact with each other,

Have open discussions,

How they want their lives to be,

Their values.

How do we show up for each other?

So the couple to work together at defining their values,

How they want the couple to,

How they want it to look like.

And the anxious person,

Again,

Should get help for themselves to build more secure bond with their partner.

And that's work the partner cannot do for them.

They need to get help for themselves and work on themselves and start working on the childhood wounds that created that insecure attachment.

Can we talk a little like maybe just for a second?

I took a class many years ago,

It's like mindfully managing anxiety or something.

It just kind of piqued my interest and they gave us a list and I just thought of it and I don't have it handy,

But it was just the different ways that anxiety can manifest.

And I remember reading over the list and I realized at that moment that my entire life was being controlled by my anxiety because I didn't realize the ways that it can manifest are sometimes what we consider normal.

Just in society today.

Can we,

I don't know if you have a few handy that people may not think of as being signs of anxiety,

But.

.

.

Yeah,

Traits you often find,

You know,

If I see someone who,

They come and see me for something,

Not anxiety,

But they're talking to me about their child or their partner and I,

To kind of detect if they have anxiety,

Are they perfectionists?

Are they control freaks?

Do they not like when things change,

Plans change at the last minute?

Do they need to have things always planned out ahead of time?

These are a bit of signs that separately are not anxiety,

But when you put them all together are kind of traits we often see with people who have anxiety.

Does it make sense?

Oh,

Yeah,

No,

Absolutely.

I'm just like,

How much have I let go of these things in the recent past?

Just going through that in my mind.

I don't know if Ben is hiding.

I left for a minute.

Okay.

Didn't like how much I resembled those things.

Yeah,

So,

And I guess the,

When the relationship isn't a romantic relationship,

Right,

So it's your family member,

Your child,

You know,

You have an anxious child or you are the anxious child,

Or you're,

Actually that's not what we're talking about dealing with other people's anxieties right now.

You have anxious parents,

Your child,

You have anxious parents,

Your brother,

You know,

Something like that.

So when it's not a romantic relationship,

When it's not your partner,

So like,

Eventually you could get out of there.

How do you deal with that when it's a family member or like a close friend in the sort of relationship?

Is it the same thing?

Or is there some nuances?

Well,

It's partly the same.

Let's assume a parent first.

Assume away.

We're not responsible for our parents' emotional states.

So we don't need to poke at them and make them anxious,

You know,

Like to test them.

But it's important that we set boundaries because they'll suck you into their anxiety and try to make you walk on eggshells to accommodate them.

So if there's a degree of accommodation you're comfortable doing,

You do it.

But if there's a level where you're not comfortable,

It's important that you set boundaries.

So let's invent an example.

Let's say you have an anxious parent who's,

And you're an adult and you're in your 30s and they expect you to call them every single day to,

So call me,

I want to make sure you're okay and nothing happened to you and if you don't call me,

They call you three,

Four times a day.

That's excessive and you need to set boundaries and go,

Listen,

I promise you if something does happen to me,

I will call you.

So assume if I'm not calling you that nothing's wrong.

I cannot call you every day or three times a day.

So you validate,

I understand you're worried about me and you're scared.

I get it.

But I still can't,

You can't call me ten times a day.

I'm working,

Let's say.

I can't answer my texts.

I'm in the middle of a meeting.

So boundaries are very,

Very important when you have a family member or anyone,

A friend who's anxious.

We're not responsible for other people's feelings or disorders.

Yeah,

Absolutely.

I know it sounds cold,

But it's true.

People need to take responsibilities for their own issues.

And we can have empathy for them,

Be there for them,

Offer support,

But if we fall into the patterns that maintain the behavior,

Then we're enabling it.

It's no different than addictions.

We're not helping them.

We're just perpetuating the problem.

Right.

And it's the same with friends or people we interact with.

So our question for the day was,

Has your anxiety gotten better or worse since the start of the pandemic?

We want to hear from you.

So if you're watching this video later or listening to this on the podcast or on Insight Timer,

Check that out.

Answer the question because we want to know.

And if you need help with that,

Dr.

Gina would be much,

Much,

Much happy to help you.

I started a sentence.

Reviews

Very interesting! Thank you!