182. Anxiety 101: What We Do Wrong, How to Cope, and Facing Our Fears feat. Dr. David Rosmarin

Mar 8

listen to this episode:

Today's guest is Dr. David Rosmarin— an associate professor at Harvard Medical School, a program director at McLean Hospital, and founder of Center for Anxiety—a practice that services over 1,000 patients per year in multiple states. Dr. Rosmarin studies the relevance of spirituality to mental health and his work has been featured in CNN, NPR, Scientific American, the Boston Globe, the Wall Street Journal, and the New York Times.

Dr. Rosmarin's Instagram: https://www.instagram.com/dhrosmarin/

In this episode, we discuss:

+ A clinical definition of anxiety

+ Differences between fear, anxiety, & worry

+ The relationship between rumination & social anxiety

+ Ineffective (and sometimes unconscious!) ways we deal with anxiety

+ Ways to navigate anxiety that have helped thousands of people at his anxiety program

+ How to stop avoiding what’s making you anxious

+ Personality traits that anxious people tend to have

+ The relationship between anxiety & resilience

+ Supporting someone with anxiety without invalidating or enabling them

+ Finding professional help for your anxiety

+ Resources for learning about anxiety

+ so much more!

Mentioned In The Episode…

+ ADAA

+ Center for Anxiety

+ Contact Dr. Rosmarin

+ Dr. Rosmarin's Website

+ Thriving with Anxiety

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

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About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Dr. Rosmarin: I think people just need to get it in their gut that running away from anxiety, trying to put it away. , trying to run away from it, you know, people have different ways of avoiding anxiety.

We're very creative in avoiding this emotion. But at the end of the day, all of these approaches are aimed at essentially one thing, which is I don't want to feel bad. Conversely, though, when we learn to embrace our anxiety, I think it is a key. To unlocking human potential, almost like no other

181 FRONT: Hello, hello and welcome back to She Persisted. I am so, so excited to be here today because we have one of my favorite interviews for the podcast this week. Today, we have Dr. Rosmarin on the podcast. He is a Harvard Medical School professor. He is also a program director at McLean Hospital, which you guys know we love McLean.

I went to a McLean program when I was 14, 15 years old, I think I went there when I was 14 and then I turned 15 while I was there. My freshman year of high school changed my life, saved my life. It was such a game changer and I was just so incredibly excited to do this interview and have Dr. Rosmarin on the podcast to talk about anxiety. This is one of the most frequently asked questions, one of our most downloaded episodes ever is a therapist's advice and insight on anxiety And so I'm so happy to bring you this episode, which is really just a masterclass on what is anxiety?

Why does it happen? How can we overcome it? What does treatment look like? And everything that you need to know when it comes to anxiety and navigating it. Dr. Rusmarin is a clinical psychologist, scientist, educator, author, all the things. You can find his book in the show notes.

It is called Thriving with Anxiety. nine tools to make your anxiety work for you. Tons of other resources and his website will be in the show notes. He again is at McLean, so tons of treatment options there, as well as podcasts you can listen to, articles you can read, all the things.

And so, just so excited for this episode. let's dive in.

Sadie: Well, thank you so much for joining me today on She Persisted.

I am so excited to have you on the show and talk all things anxiety.

Dr. Rosmarin: Thanks, excited to be here.

Sadie: I would love to start with how you define anxiety because I think understanding how it relates to fear and the fact that fear serves a purpose and anxiety isn't just this thing that we have for no reason can be helpful for people that have anxiety to understand.

I think if you can understand what it's trying to do and why it's ineffective, I think that can be really helpful in overcoming some of those thoughts. So how do you explain anxiety and fear and how that comes into the equation?

Dr. Rosmarin: Sure thing. Yeah, let's start at the very beginning, like right when a person's born and there's a test which physicians do and nurses do literally like minutes after delivery for something called the Moro reflex.

And the Moro reflex is a startle that hopefully healthy babies have, which if a child is born with an intact neural system with, , emotions that are functioning well , then they will startle when they hear a loud noise or when they see, like, a, a change in, , in their depth that they're all of a sudden, you know, lifted up two inches off the table and then drop back, they'll, they'll sort of jerk out and they'll, , extend their fingers.

And , if an infant does not have that startle reflex, if we don't have a fight or flight response A neurologist is called in and typically those babies do not survive. And, you know, we live in a society, typically in the West, where we don't need a fear response too many times. But if you think about, like, a modern example would be walking off a curb, holding your phone, right?

All of a sudden, oh no, what's that? Or, you know, obviously there are other situations as well that are bona fide, genuinely dangerous. people need that. But you need a fear response to fight. flee or freeze, and that'll keep you potentially alive, , at least a couple points during your life.

Sadie: Yeah, and then I think differentiating fear and anxiety can be really helpful, because I think if you're not familiar with mental health, they're almost interchangeable.

You're like, well, I feel scared when I have anxiety. How are they similar and different, especially in a clinical setting?

Dr. Rosmarin: Perfect. Okay, so fear and anxiety are actually the exact same physiologically from a neural standpoint. The symptoms are the same. , and like, let's talk about the symptoms of anxiety, right?

So you got a pounding heart, right? Start to race. You have labored breathing, your muscles start to tense and all of that happens because adrenaline is going through your blood. Epinephrine is being released a neurotransmitter in order to start this. process to get you mobilized to act. So the symptoms of fear, if you've ever had a fear response and your stomach is in knots, well that's because physiologically your body is shutting down your stomach.

You don't need to digest when you're running away from, right? You just got to make sure you get the heck out of the way or you're able to fight it. Like it doesn't matter what you had for breakfast. You have to survive the moment. And anxiety is the exact same, but there's one tiny difference. You know what that is?

Sadie: I do because I edited the clip and we said exactly this. , it's that anxiety, the threat is not justified. It's not an actual threat to your life. And so that fear response isn't necessary to get you through the situation.

Dr. Rosmarin: Okay, so I love the fact that you used justified. I'm going to pick at that. Yes.

I don't want to come back to it, but for starters, I will say you're right. It's not necessary because there's no actual threat in front of you. The threat is in the mind's eye. But that doesn't mean that anxiety is bad. This is where, , I think people get it, , I would say wrong, to be really bold. And if you have a misfire of your fear system, which is essentially what anxiety is.

It's a misfire of the fear system. It doesn't mean that something is broken. It doesn't mean that, you know, , something's pathological. It doesn't mean that there's a disease that is present. What it means is that your body is priming itself. If you need that fear response, it's going to be available to you.

Sadie: Yeah.

Dr. Rosmarin: I don't know about you, I would prefer to have my fear response intact and accidentally go off every once in a while than not to have it at all, and then you can get into serious trouble if you don't have a fear response.

Sadie: Mm. Yeah. A hundred percent. Are there different Thought patterns and mechanisms that take place with fear versus anxiety, I would imagine because fear is so closely tied to that fight flight freeze response.

It's so physical. It's hard to even think about what to do next, whereas anxiety can be so mental. Are there Differences, , in mentally what takes place in anxiety versus fear?

Dr. Rosmarin: Fundamentally, no. I mean, you're right. Fear is usually a more immediate process and there are aspects of anxiety that are a little bit slower acting.

, what I think you're describing there is worry when people worry a lot. Yeah. So worry, interestingly, is actually a way of wording off anxiety. It's a way of stopping yourself from feeling a full, intense experience of panic. If somebody is really going to Face the uncertainty inherent in a situation you think like proverbially of a mother or a parent.

I should say worried about their kid, right? Where's my kid right now? I don't know. It's after dark. There's bad weather. They were with this friend. You know, they haven't called me. I don't see them on the GPS. You know, all that sort of what they're really doing is warding off actually thinking about catastrophically what could be going on in the moment.

It's a way of maintaining your anxiety at a lower level. So I wouldn't say fundamentally anxiety is any different than fear, but some of our coping mechanisms are actually quite creative. And those can look like anxiety, but they're actually, they're actually ways of dealing with the fundamental emotion of anxiety, which is the same exact as fear, with the one exception that there's no real.

Tangible threat in front of us at the time that warrants a full fight or flight or freeze response.

Sadie: Does rumination serve a purpose when it comes to like coping with the anxiety like worry does or is that?

Dr. Rosmarin: Okay, great. So rumination is thinking about the past and worry is thinking about the future, right?

So rumination is more associated with depression usually, interestingly, , somewhat with , social anxiety, right? We have the post mortem, like after you have that conversation with someone and you're like, Yeah. , again, this is a more of a coping mechanism that people use to deal with their anxiety. At the core of anxiety is, Oh my God, what if that person rejects me?

Right? The social anxiety. What if? Yeah. What if I can't? What if I feel alone? What if I don't have that connection ever again? And , that's really, you can see how that relates to fear, although it's not presently in front of us, being social creatures. The rumination or worry are sort of ways of, of dealing with that.

, so it does serve a purpose. I wouldn't say an adaptive one, but it does serve a function.

Sadie: And then what are some of these other? coping skills, maybe effective, maybe not, that we do to try and almost like quell that anxiety that we experience. , I feel like worry and rumination, these are these inherent things.

We don't even realize that we're doing them. But are there other ways that anxiety shows up and that we try and navigate that even if it's not intentional?

Dr. Rosmarin: Okay, so I love that you said we don't even realize that we're doing it. Yeah, I think it's, I think it's spot on. A lot of people, when we feel anxious, it's uncomfortable.

Sadie: Yeah. Okay.

Dr. Rosmarin: And since it's an uncomfortable emotion, we tend to lean away from it. We tend to not allow ourselves to experience it fully. We tend to be more, , avoidant of it and because of that, lot of the processes that we use, They're really aimed at getting rid of anxiety or pushing it away, and that's usually where the anxiety gets magnified.

In reality, anxiety is not dangerous. It is not a pathology. I don't think it's a disease. I think it can get disordered when we become super sensitive to it, and then we are afraid of it, and we run away from it through all these different Coping mechanisms that you were mentioning beforehand and others as well.

Avoidance, behavioral avoidance, not going in situations that make you feel anxious. But if we lean into those feelings and actually allow ourselves to experience that dread, it's not fun, but it's kind of like it builds our emotional capacity. I believe it can build our emotional capacity and our resilience.

Yes. And potentially our connection with others and to be able to grow in, in ways that are very healthy for humans.

Sadie: Yeah. So before we get into all the ways that we can see anxiety as a strength, and especially the experience of overcoming anxiety as That's a huge character strength and something that is really challenging to navigate but can have benefits.

I'd love to talk about this actual experience of overcoming. We talked at the, before we started the recording about exposure therapy, which is one way that we can overcome anxiety and work to not avoid or not run away, like you mentioned. What is the process of? Overcoming anxiety and treating anxiety, especially in a clinical setting.

Because I think a lot of people that listen either go to therapy or plan to go to therapy, maybe they've been to treatment, might go to treatment. And I think when you're like, I want to work on my anxiety, I want to try and become more effective because it's interfering with my life, I feel like that approach and the information you're looking for is a bit different than like, okay, I have anxiety.

I deal with it and I live with it and move on. So from a treatment perspective, how does one navigate and overcome anxiety?

Dr. Rosmarin: Okay. Here you really, I got it. I got the question. So, , , you mentioned before in my intro that I'm the founder of Center for Anxiety, which has offices in New York and in Boston, , and in Princeton, New Jersey, okay?

We have over a thousand patients who come to our offices a year. These are clinical cases, okay? A lot of them have pretty severe symptoms that they're coming in and pretty intense levels of anxiety. And I called the program Center for Anxiety for exactly this reason.

Part of the, in fact, the mainstay of what we do is help people to actually live with their anxiety, to face it head on, to experience it fully and to integrate it into their lives as opposed to trying to get rid of it. My colleagues sort of chided me, they're like, why didn't you call it Center for Anxiety Relief?

Center

for Calm.

Dr. Rosmarin: Center

for Calm,

Dr. Rosmarin: Center for Tranquility and Peace on Earth and Happiness and Solace and all sorts of, you know. That kind of stuff and the answer is no like I'm I'm done with trying to get rid of our anxiety I think we need to change our relationship with this emotion and The first step even for clinical cases what you would call And even in severe cases, you know, sometimes it's even more so it's even more important for people with severe levels of anxiety To stop fighting it Yeah, and some of the best strategies you mentioned exposure therapy and happy to talk about that When it's used in order to get rid of anxiety, it often can make things worse.

Sadie: Really?

Dr. Rosmarin: Yes, because if you're chasing getting rid of your anxiety, what you're essentially going to do is dump more adrenaline into your system in order to push it away.

Sadie: Mm hmm.

Dr. Rosmarin: The first thing to know about anxiety is that you're, just like fear, will come down. Nobody can afraid forever. You cannot remain anxious forever.

Your sympathetic nervous system is what kicks your anxiety into gear. As soon as that starts, there's something called the parasympathetic nervous system, which is a calming effect. It's like coolant in your car. Now, you can push off the parasympathetic nervous system from, from working if you're trying to get rid of your anxiety and then you're just throwing more kerosene and gasoline onto the fire by inflaming it.

But if you actually say like, okay, you got me, I'm going to feel anxious. And in fact, I'm even going to approach that which makes me upset and makes me uncomfortable. It's not easy. It's not. It's very hard. My patients. Oh my God. They are so brave and so incredible. , , but that's the best path, that I've seen in the literature bears this out and certainly from clinical experience.

Sadie: How do you balance the mental and the physical of like Going through the anxiety. You mentioned the mental reframe of like this is hard and this is uncomfortable and I'm going to get through this. It won't last forever and not the like, okay, I'm overcoming this. I'm treating this. It will then go away, but still, , kind of reframing how you're approaching the anxiety rather than avoiding.

And then we talked about all the physical symptoms and that can also be a barrier when navigating things that make you anxious. Is there like a split or order of operations when dealing with something that makes you really anxious of like, do I deal with the physical and then the mental? Or do I like give myself the pep talk and then do deep breathing?

Like, how do you advise patients navigate that?

Dr. Rosmarin: It's a great question. , you know, I think people just need to get it in their gut that running away from anxiety, trying to smother it, trying to squelch it, trying to put it away. , trying to run away from it, all of these approaches, whether they're cognitive, whether they're behavioral, whether they're emotional, you know, people have different ways of avoiding anxiety.

We're very creative in avoiding this emotion. Some like they call it liquor, like liquor courage before a party, right? Like you down a beer or two and like all of a sudden I'm not socially anxious anymore. So that's called avoidance and that's why social anxiety is a very high risk factor, especially among college students.

for alcohol and other drug use, , disorders, interestingly. , some people just go into their own mind's eye, they'll become shy, they'll walk away, they won't go into the situations, they'll, we talked about worry and rumination, which are even more complex cognitive strategies of being able to avoid these symptoms, but at the end of the day, all of these approaches are aimed at essentially one thing, which is I don't want to feel bad.

Sadie: Yeah. And

Dr. Rosmarin: let me, like, let me ask you a question. Do you work out?

Sadie: , again, we don't like to feel bad. And when I mentally think about doing something physically uncomfortable, I'm like, I'd rather not. But mentally, I try to do it. Got it.

Dr. Rosmarin: Okay, I got it. So once

Sadie: a week, I cannot avoid it. Maybe twice a week. I like walking because I'm less physically uncomfortable, but yes, I do try to.

Dr. Rosmarin: Got it. Okay. So when, how do you know when you've had a great workout?

Sadie: I would say it is the physical discomfort. It's like yesterday I went and worked out with my mom and every single set I was like, Oh, I can barely make it through the set. I was like, how much is left? And then at the end I could like barely breathe.

And then today I'm totally sore. And you're like, okay, this discomfort means that I was pushing myself past my physical limit.

Dr. Rosmarin: A hundred percent. That is an awesome workout. That's an awesome workout. It was horrible. It was awful. It's terrible. If it feels terrible, you are in the right place.

Sadie: Yeah.

Yeah. Isn't that

Dr. Rosmarin: crazy? Like what, what's with that? And the answer is because you're building strength. You're literally, you're, you're getting your capillaries to like dig further into whatever muscle you're trying to push. You're, you're breaking down muscle fibers in order that they become built back better.

You're increasing your lactate threshold in order to, you know, increase your aerobic capacity. You're, , increasing your efficiency of being able to metabolize either fat or glycogen or oxygen into energy in order to be able to expend that in whatever activity you're engaging in, whether it's anaerobic or aerobic, none of that is comfortable.

Every single, all of those physiological processes that I just spoke about, there's going to be a degree of discomfort, pain, unpleasantness. You know, sweating, and actually it even, it even mimics the symptoms of anxiety, right? You got sweating, your heart's beating, your breathing's increasing, your muscles are tense, you know, there's all the same physical symptoms and it's all like perfect.

Yeah.

Sadie: Yeah. What do they call it in exposure therapy when you're literally doing that, where you're like breathing through a straw so that you're short of breath and you're like, I

Dr. Rosmarin: have straws in my bag.

Sadie: I love it. I love it. It's perfect. And they're not, they're not

Dr. Rosmarin: like, we're not talking about, , you know, definitely not quarter inch, , what do you call it?

Smoothie? Smoothie. It's like the Delta teeny tiny. You can

Sadie: barely drink your beverage.

Dr. Rosmarin: Okay. So when I was starting to do exposure therapy with patients and stuff like that, I'm like, you know, I have to be able to do this myself. It's not fair. I'm going to ask them to do all sorts of stuff. I'm like, and I have a rule in my clinic, a clinician may not ask a patient to do anything that they're not willing to do themselves.

Sadie: Oh, my gosh, I love that so much. That's incredible. Yeah, it's fair. If an

Dr. Rosmarin: OC, if I'm going to ask an OC to be patient to get like down and dirty with a toilet, like I'm going to be on the ground with them with my hands. Like, I'm not even gonna describe it. But we're we're gonna we're gonna do this together.

Okay, this is gonna gross me out. It's gonna gross you out. We're gonna ick it. Like that's just the way it is. And , same thing, heights, you name it, animals. Okay, so the stroll. Karaoke,

Sadie: all the things.

Dr. Rosmarin: , karaoke's where I draw the line. No, meet us through karaoke

Sadie: every single week, and to this day I'm like, Ugh, worst, so bad,

Dr. Rosmarin: Yeah, it's terrible.

Sadie: at the DBT program singing, I would lip sync happy birthday. It was a low point in treatment that I was like, I can't do this. It's too much.

Dr. Rosmarin: Craziness. And yeah, so I started doing this thing with a straw and I'm like, you know what? I'm going to do this and, and I'm going to, I can do this while I'm driving.

This should be fine. Yeah. Three minutes later, I'm like,

Sadie: Yes, can barely breathe.

Dr. Rosmarin: I did pull it off. , I did pull it off for three minutes while driving, but oh my God, was that horrific. It was so bad. But constricted breathing doesn't, it doesn't, unless you have COPD, , it's not deadly. And I learned that, , which is important to know.

Sadie: Yeah. Yeah. , if we internalize the idea that avoidance amplifies anxiety and that we're running away from things, it's. It's going to be more intense to face it in the future. How do you go about combating that avoidance? I feel like this is the self help question. There's like the five second rule.

There's like just mind over matter for patients that are really struggling to go up against that avoidance. There's maybe a lot of willfulness. It's maybe I don't have the skills. I just don't know how. What are the first steps that people can take to begin to building that almost like willpower muscle?

Dr. Rosmarin: Okay. Great. , firstly, I think there's a, a cognitive shift that we have to have, you know, in our culture, if you have anxiety and you go to a physician's office, they will say you have a disease. There's something wrong with you and we need to take care of this. And even any anxiety, any level of anxiety, any level of worry, and you go to a physician's office, you will come out with a prescription for a benzodiazepine.

Try it. Yeah. It will happen. And I think we need to set the first step before trying any skills again, is just resetting Our perspective that all human beings have anxiety. This is the same as a fear response, which is actually healthy and adaptive. It's simply a misfire of it. There's nothing wrong with you if you experience anxiety, and it doesn't mean that you can't handle the symptoms, and that something is dangerous, that this shouldn't be happening.

No. It's like working out at a gym. It's like breaking a sweat. And now once we have that perspective, I think Taking a gradual approach, doing one thing that you fear every single week.

Sadie: Yeah.

Dr. Rosmarin: You know, I wish that was taught in grade school, in high school. You know, I wish that teachers and educators would say, Hey, you're feeling uncomfortable?

Fantastic. That's your gym. That's your emotional gym. That's your opportunity to build emotional resilience, to build strength of character. But by the way, just as you can put too much weight on your , you know, dumbbells at the gym and strain yourself. You can also do the same thing emotionally. So it can't be too much just because you can't see it doesn't mean it's not real or tangible.

So it has to be titrated to your, where you're at next. It should be moderately uncomfortable, but not super uncomfortable because you could cause, I don't know, I want to say cause damage, but we want to avoid those situations where you're stretching too far.

181 FRONT: Just popping in to remind you guys that you can win a 15 Starbucks gift card When you leave a review on Apple Podcasts for She Persisted.

All you have to do is write a review, send a screenshot to me on Instagram or email, and every month I am choosing a winner to get coffee on She Persisted. So, write your review, send me a screenshot, information is in the show notes for bonus entries, and I can't wait to treat one of you to a fun little accumulating positives coffee moment.

Let's get back into the episode.

Sadie: I would love to talk about the, I don't know if like, character strengths is the right word, but the traits that correlate with anxious people.

I think people commonly associate maybe like perfectionism with people that are anxious, , being really conscientious, but there are these aspects that are strengths and that do have benefits and that serve real purposes and I think that can be One thing that's really helpful to be aware of and understand as we start to embrace anxiety as part of our life and be like, this is just part of me.

And yes, it's a misfiring of my fear response. And it also allows me to do all these great things or have these traits that help me in these other areas. So what are these different traits that anxious people tend to have or different personality, , I guess traits again would be the word there.

Dr. Rosmarin: Yeah.

Great question. So it depends on how we respond to our anxiety or better put, I would say what our relationship is with our anxiety. If we spend our lives trying to get rid of this emotion, I have seen patients become very inward focused, very self centered. I can see people becoming, , more angry.

Because when other people make them feel uncomfortable, they don't want to show any vulnerability. So better to just blame the person or say, you know, you're a jerk than to say, Hey, like that really makes me feel uncomfortable and I kind of need your help. , so I think if we respond to anxiety in, in the way that, that many people do, which is by becoming more insular, try to avoid it, trying to judge ourselves, catastrophizing.

You know, I think we end up spinning our wheels, becoming more disconnected, and we're seeing that happen more and more. We're seeing violence increase in our society. When other people disagree, it's, there's no civil disagreement anymore.

Sadie: Yeah.

Dr. Rosmarin: Right? Yeah. You made me feel uncomfortable, and therefore we don't have any relationship at all, like the cancel culture piece.

Conversely, though, when we learn to embrace our anxiety, I think it is a key. To unlocking human potential, almost like no other. I think it can make us more empathic and more aware of other people's emotions. Because if I'm feeling uncomfortable and I let myself feel that, I can see, oh wow, that person's feeling uncomfortable too.

And like, you know, this is like the therapist anxiety, which, we don't really talk about, but a lot of clinicians, myself included, have, you know, reasonable amounts of anxiety. And that can help us to understand like, well, I know what it's like to struggle, so, you know, I, I can be there for my patients, for my colleagues in, in ways because I understand them.

, I understand those emotions. I also think it can keep us humble because we can actually accept the uncertainty of life.

Sadie: Yeah.

Dr. Rosmarin: Like, Sadie, let's, let's talk, you know, let's talk turkey here. Do you really know what's going to happen later on today or tomorrow? Or next week.

Sadie: Definitely not. I have a long paper due, so I'm hoping that that gets turned to end, but we don't know.

Dr. Rosmarin: Who knows? Like, who knows? And, and there's so much, like, uncertainty just seems to be getting more magnified by current events. You know, we saw with the coronavirus, like, there's, there's just. It, the world is becoming almost chaotic. Look at the weather. I mean, you literally can't predict anything. And I think all of that, when we settle into anxiety, we can actually have much more equanimity if we take the cue to embrace that uncertainty and to take a more humble approach to our lives.

So to answer your question. I think the personality traits that are associated with anxiety really depend on what's our relationship with those emotion. Is it something we can allow ourselves to feel, and to process, and to use to connect, and to use to see the world through a more accepting lens? Or is it the kind of thing where like, I can't feel this, I don't want to deal with this, I hate everybody else, and I just cannot tolerate not knowing and not being in control.

And I, I think that's the, those are the two paths in many ways that we all are on, , to varying degrees, , throughout each day.

Sadie: Yeah. Another aspect that comes to mind of, This process of overcoming anxiety is the resilience that's required to continue to go up against these things that you want to avoid and sitting with the uncomfortable and changing your relationship with how you interface with anxiety like you just mentioned.

Are there other psychological benefits, maybe the relationship benefits? To overcoming anxiety and putting in that work, and I guess overcoming is not the right word, but , shifting your relationship with it and doing that work so that you are able to live with it in a healthy and effective way, , I think that can also be helpful because obviously you have this like quote unquote end goal, but also understanding that the journey has all these benefits as well and you're picking up these skills that can be really beneficial.

So what are some of those, , Resilience correlates, I guess you would describe it as.

Dr. Rosmarin: Yeah, you know, what's, what's coming to mind, , I mean, resilience, I think, let's, you know, let's talk about resilience a little bit. , often when people are overcoming, haha, now I'm using the word. When people are

Sadie: I know, I'm like, we're not overcoming, we're just, we're getting to a better spot.

Dr. Rosmarin: When people are working on developing their inner strength in the context of anxiety, which is really what it is. , and by the way, ironically, you are right. Like people do end up with less anxiety as a result, so you're, you're not factually incorrect.

But again, the goal of those exposures, the goal of, , , facing one's fears really needs to be to become more, able to experience it as opposed to overcoming it. But in any event, one of the things that happens is. , emotional resilience really across the board. I've seen individuals who, , face their fears in one specific area.

For example, , I had a patient who had a fear of spiders. And, uh, , aside from that, really very high functioning, you know, no issues, but they lived in an area of the world where there were spiders, even large ones, and even tarantulas occasionally. Oh no. Huh. And they came to my office for a single day exposure therapy treatment.

One

Sadie: day.

Dr. Rosmarin: And it was rough. It was Rob. We called in John the Spider Wrangler, who came in with his case of tarantulas. John is

Sadie: on staff. He's on staff, but he's on my speed dial.

Dr. Rosmarin: He's on my speed dial. Good guy. He also has snakes,

Sadie: lovely,

Dr. Rosmarin: of course, but that's for the other patients who have snake phobias. And he's brought in, he's brought in a corn snake more than once to my office.

And, , yeah, so we learned about tarantulas up close and personal patient freaked out. I freaked out. Yes. What a mess. Did you

Sadie: see that, clip where she's filming the movie and they tell her it's a trained spider and she actually gets bitten and then no one realizes she got bitten because they're like, oh, she's acting because she was supposed to pretend she'd gotten bitten.

And I was like, this is my worst nightmare. Not that I'd ever be acting in a movie where they would put a spider on me, but I was like, oh my God.

Dr. Rosmarin: Okay, next time in New York, we're doing exposure therapy for the spiders.

Sadie: I'm like good at killing them. there's like ever like a bug or anything, I can again not avoid, but it's not fun.

Dr. Rosmarin: No, it's not fun. I get it. I was just kidding before. , but at any event, so this young, , woman at the time, , came in and it was, she was retching. She literally was retching. I, I, like the spider went flying at one point. It was, it was a complete, the spider was scared. Yeah, the spider was scared. Like it was, it was palpable fear in the room.

It was not a pretty scene. , by the end of the day, she's got spiders on her hands, multiple spiders, you know, on her pictures, you know, the works, she's not comfortable, but she's like, wow, I actually accomplished so much in just a couple of hours, she went on to face other fears. That had nothing to do with the spiders.

I was speaking to her years later and she's like, Yeah, I went scuba diving. She ended up doing, like, all sorts of stuff. And I'm like, hello, Miss Adventure. Like, where did this come from? And she's like, my fear was holding me back, not only here, but actually across the board. And once I got the bug, Bad pun.

Once, once I got the bug of you know, I'm gonna do this. , I'm gonna work out in the gym. I'm gonna build my emotional resilience. Emotions are not gonna kill me. Anxiety is not a disease. I can really overcome this. I can naturally experience it and use it to help to grow.

She, she just, she started to fly. It's amazing.

Sadie: Incredible. That's awesome. That's really amazing. It happens a lot. A lot of my exposure

Dr. Rosmarin: therapy patients, years later, they're like, I can't believe I did that. And it was one of the best things I ever did across the board. It just, you know. I mean, if you can sit with

Sadie: spiders on you, you can do anything, so I'm not surprised.

I would love to talk about supporting someone with anxiety, especially for parents that have teens where they're like, maybe social anxiety is getting in the way, or maybe it's like a lot of anxiety about academics. I think those are very common things that parents are concerned about, they notice in teens.

How can you support someone with anxiety without? Enabling it, but also not invalidating the experience. How do you counsel parents or friends or family members, , who are in that person's community?

Dr. Rosmarin: I love the question. , a lot of the times this is what magnifies anxiety big time. I'll tell you what not to do.

You know, you already mentioned invalidation and also enabling and, , I'm not sure how familiar your audience is with. Those two specific things, but to go into a little bit more detail, you know, I think probably the one of the worst things parents can do when their kids are feeling anxious, kids of any age, , even adult children, is to get anxious about the fact that your child is feeling anxious.

Because that anxiety is like, Oh, no, what's wrong with, you know, little Jenny or little Johnny or whatever's going on? Like, I don't know. How's this? How's this going to be? You know, that sends the message that anxiety is something dangerous. And it's not it is typically not it is a normal human emotion that people experience when they are facing adversity when their , fight or flight system is triggered through whatever you're for whatever reasons are going off in their life.

And the conversation needs to be like, Oh, it makes sense that you feel anxious. That's the validation, right? Your feelings are valid. And it's going to be hard. That makes sense too. , And I'm here to support you in overcoming, there's the word again, in facing this fear and moving forward in your life while you have the anxiety.

, enabling, which is basically taking away the external circumstances that are triggering the anxiety. Right? Like if someone has OCD, a child opening the car door for them if they want to open the car door. Right? Because they fear, afraid of contamination. , if someone's, like you mentioned, social anxiety, not, you don't have to go to the party or whatever it is, you know, there is a fine line between forcing someone, I wouldn't want to do that.

But at the same time, not, , , enabling and making it easy for them to get out of situations. But the main thing, I think, for parents is not to get freaked out. If your kids feel anxious, they're human. Like, that's part and parcel of the landscape of human emotion, and they are going to feel that way. So, I think it usually comes from anxiety on the parents part, , about their kids anxiety.

And that's, that's really the root of most of the problematic stuff that parents do.

Sadie: Yeah. I would love to get your perspective on treatment and finding a therapist. Obviously, if people are near, , locations for the Center for Anxiety, that will be number one recommendation. But if your primary concern or thing that's interfering with your life is anxiety, what do you recommend when looking for a therapist, , or someone to work with?

Are you looking for a CBT therapist? Are you looking for someone who specializes in anxiety? Is it exposure therapy? Like, how would you approach that process?

Dr. Rosmarin: Great question. So my first trick, so to speak, first line treatment is definitely going to be exposure therapy and it is under the category of cognitive behavior therapy, otherwise known as CBT, but it's more specifically a variant of BT or behavior therapy.

And I would specifically ask a clinician if you're interviewing one, , is, , you Is, , behavior therapy something you do? Is exposure therapy something you do? How many patients have you treated with exposure therapy? You know, let's say, you have concerns with social anxiety. How many patients with social anxiety have you treated with exposure therapy?

, but, but there's a caveat. , I don't think there's one size fits all when it comes to therapy. I used to. I used to think it was like behavior therapy or busting exposure therapy for everyone is just the way and like, and I love it. And I practiced, you know, I've been 20 years. I mean, it's still the mainstay and my number one tool that I'm going to use.

But there are people for whom the interpersonal aspects, their connection with other people is in some ways more of a priority and also a better tool to use in order to deal with their anxiety and a better tool tool that they can use their anxiety to connect with. So, there are a lot of interpersonal aspects treatment that I think are important to potentially address.

I guess a third piece also is spirituality A lot of patients, you know, when we sampled our patients in, , Eastern Massachusetts at McLean Hospital, nearly 60 percent of them wanted spirituality to be spoken about in therapy. And there's often a huge disparity between that and what's being offered by clinicians.

So if that's an aspect of your life, , or your family's life, I wouldn't shy away from having conversation or frank conversation with a clinician, whether that's an aspect that they're comfortable addressing or even speaking about, , and raising the subject, , as well. So I guess these three things are our relationship with ourselves and building resilience through exposure, our relationship with others and then spiritual relationships as well.

I think that's sort of the way I would go about, , finding a clinician.

Sadie: Incredible. And then if people want to continue to learn about anxiety, especially like these different cognitive mechanisms we talked about, , even like just behavior change, understanding that in the of anxiety can be super helpful.

, we talked about like coping skills and evolution and all those kinds of things. Do you have certain books or podcasts or even Obviously you're at Harvard and McLean and they have incredible lecture series and webinars But do you have any of those types of resources if people want to continue to learn about the psychology of anxiety after listening to this?

Dr. Rosmarin: Sure. Well as a member of the Public Education Committee of the and Depression Association of America, I would definitely recommend ADAA It's a fantastic resource and there's lots of different Nooks and crannies to the website for professionals, for patients, for, , the general public, for everybody, and, , informed consumers, less informed consumers.

So you name it. , and as well as a lot of, , webinars and, , , some of them I've done myself and, , other materials. So ADAA, , I believe it's ADAA. org. , I have to check that, but we can put it in the show notes, whatever it

Sadie: is. Amazing. And then to wrap things up, you have a book, you have an incredible social media page.

Where can people continue to learn from you, consume your content? , and then if they are near either the Boston area, New York area, and I forget the other area you mentioned. Princeton, New Jersey, yeah. Amazing. Learn about the Center for Anxiety.

Dr. Rosmarin: Sure. So, , I also, in fact, I actually have a free giveaway for people listening, , on my author's website.

Sure. My pleasure. D H R O S M A R I N dot com, D H R O S M A R I N dot com, , there is. , a free 12 page guide, which is based on the new book, Thriving with Anxiety, Nine Tools to Make Your Anxiety Work for You. , there's a book page, and you can go and download it for free, check it out. , so that is, , a fun resource that's been, I think we've had about, , 8, 000 downloads in the last month or so.

So, it's getting, some traction, and, and people are getting, excited about it, have some nice responses. , in terms of Center for Anxiety, I mean, yeah, we'd love to hear from you. And center for anxiety dot org is the URL. , and we do provide some telehealth to patients outside of our cashman areas as well, depending on a variety of different factors.

There's 60 different clinicians and a thousand patients. So you know, it depends on the situation, but there are some telehealth options and we also have a referral lists in multiple states. So people can definitely call the office, , for more information.

Sadie: Amazing. Well, thank you so much. This was amazing.

Dr. Rosmarin: Thanks. Great to chat with you about all matters of anxiety.

Sadie: Thank you so much for listening to this week's episode of she persisted. If you enjoyed, make sure to share with a friend or family member, it really helps out the podcast. And if you haven't already leave a review on apple podcasts or Spotify, you can also make sure to follow along at actually persisted podcast on both Instagram and Tik TOK, and check out all the bonus resources, content and information on my website.

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