House Calls Podcast

Can Anxiety Be Good For Us?

With guest Dr. Tracy Dennis-Tiwary,

Professor and Founder and CSO of Wise Therapeutics

Hello and welcome to House Calls. I'm Vivek Murthy, and I have the honor of serving as U.S. Surgeon General. I'd like to introduce you to Dr. Tracy Dennis-Tiwary, a psychologist and expert on anxiety. We believe conversations can be healing. And today we'll be talking about how we can flip anxiety from a stressor to a superpower.

We all get anxious. It's part of being human. Maybe you have a deadline at work. A test at school. A stressful family situation. And I don't think anyone escaped anxiety during the last few years of the pandemic. In fact, anxiety disorders are the most common mental health challenge in the United States, affecting 30% of adults. The question I've been thinking about is what's behind that uncomfortable feeling? How should we understand our anxiety and how should we respond to it so it doesn't debilitate us? My guest today is Dr. Tracy Dennis-Tiwary. She believes that the emotion of anxiety can be our friend, not our foe, if we can figure out how to harness it and use it as a strength. In her book Future Tense: Why Anxiety is Good for You (Even Though It Feels Bad), Dr. Dennis-Tiwary, a professor of psychology and neuroscience at Hunter College, makes the case that anxiety is a normal feature of being human. Anxiety is not something that's always bad, that we should always fight like an illness. Instead, our anxiety can be a guide and can in fact make us more persistent, clear and creative. Anxiety, when approached in the right way, can actually help us achieve our goals. I'm excited to share this conversation with Dr. Dennis-Tiwary because it will give us a better sense of how to be curious about our anxiety. We also talk about concrete ways to channel the anxiety we feel, what she calls the three L's: Listening, Leveraging, and knowing when to Let Go. We also talk about how this can help us parent better and navigate social media. I don't think anyone enjoys feeling anxious, but from what I've learned in this conversation, I do believe anxiety can be an ally. Also, a request from the House Calls team. We'd love to hear from you about feedback and ideas for future episodes. Write us at: HouseCalls@HHS.gov Or reach us through social media. We'd also appreciate if you take a moment to rate and review the podcast.

Hi Tracy. Thank you so much for joining me on House Calls.

Hi Vivek. I'm so glad to be with you.

Well, I'm especially glad that we're talking because the subject of anxiety is so top of mind for people across our country right now. And I know that especially during the pandemic, that people have been experiencing anxiety to varying degrees. And I'm hoping that in our conversation we can help people understand more about what anxiety is and what it's not, as well as how to deal with it in a healthy way. And I also want to get to talk about the term itself, anxiety, because I do think that sometimes it gets conflated with all kinds of other feelings that people are experiencing, including stress. So I'd love to start with with that basic question, like, what is anxiety and why does it exist?

So the first thing I think that's important to say about anxiety is that it's an emotion. And I think in the way we use, you know, the language of anxiety and the way we talk about it every day is that as soon as we say the word anxiety or anxious, I’m anxious, we think that it's a danger. You know, it's dangerous. And so we sort of, I think, have come to almost automatically conflate anxiety with an anxiety disorder. But anxiety as an emotion is really a fascinating one. I was educated as a as an emotion scientist, as well as a clinical psychologist. And one thing we learned very early on about emotion and this and it started with Darwin. A third of his evolutionary theory is about emotion. Not not everyone realizes that the adaptive value of emotion. But the first thing you learn is that anxiety, and every other kind of emotion, has two parts: information and preparation. And so when we can analyze each emotion in that context. So anxiety is the information that we are facing an uncertain future, and we're apprehensive about that. Something bad could happen, but something good is also still possible when we're anxious. That is the information that anxiety is giving us. It's really about this anticipation of the uncertain future, and it evolved to help us navigate that uncertainty. Whereas fear, even though it feels like anxiety, fear is all about the present moment. It's not about the future at all. It's about present threats. You know, a snake is about to bite you. You're getting that information. There's no uncertainty in it. And and you're prepared to fight, take flight or to freeze. And so if you analyze those two emotions in that way, you see that they're quite distinct.

So that's really helpful to think about anxiety is about the future and fear as being about the present. Talk to me a little bit about where stress fits in. Many people when asked to describe how they're feeling, will say, I feel really stressed right now. So how does that fit with anxiety versus fear?

Stress is not an emotion. It's a dynamic biological state that really is a result of the balance between the demands of what is the world throwing at us, what are the demands put on us, what are the, you know, the challenges we're facing? It's the balance between that and the resources that we have and believe we have to bear on those challenges, so that so that we can be experience stress about positive things just as much as about negative things. So I'm stressed that I'm planning my wedding. And of course, there's so much joy in that and a mix of emotions versus I'm stressed about that, you know, a job interview or that I have to face this unpleasant thing tomorrow. So stress can contain all the emotions. And it's really about that balance and our belief in the balance of do I have what it takes to cope with the world and to and to do what I need to do and want to do and dream to do?

So that's helpful. And when we think about the term anxiety, as it's often used in colloquial conversation, help us understand what the difference is between anxiety and a diagnosis of anxiety disorder, which many of us as clinicians may may deal with.

So you could experience pretty frequent and even intense anxiety on a daily or weekly basis, and you might not be diagnosed with an anxiety disorder, unless you have this really essential part of the diagnosis, which is functional impairment. So it's not so much that you're diagnosed because you have anxiety. I mean, all of us are born anxious. We all have that emotion, but we're diagnosed with an anxiety disorder when the ways that we're coping with that anxiety are getting in the way. That's the functional impairment. Where say, we have social anxieties like we're frightened of, you know, just the judgment of others or maybe giving public speeches, which is very common. I might experience that anxiety, but, you know, find ways around it or to cope with it or to deal with it. But if I'm not going to work anymore or school, or if I stop agreeing to speaking engagements or I don't see my friends anymore because I just think everything I say, everything that comes out of my mouth might humiliate me, and you're cutting off from your life, that is the functional impairment.

That that's helpful. That piece about functional impairment. And and my sense is that this can exist likely on a spectrum. There may be some people who whose lives are you know, mildly impacted in terms of their basic function by anxiety. And others for whom it's severely impactful may prohibit them from getting up in the morning and going to work or socializing with others. So like many other conditions that we may think about, like depression, these exist on a spectrum in terms of functional impairment. And, you know, one thing I'm curious about to get your take on is, is what anxiety actually looks like when people experience it. So like, how does it actually manifest in people?

You know, we've long known, you know, from, you know, neuroscience research as well as from psychological and clinical research, that when you're anxious, you know, there are certain areas of the brain that tend to be activated. That's, you know, the threat detection and response system. We often love to talk about the amygdala, like everything's the you know, it's the fear brain. It's you know, it's about it's an emergency. The amygdala, so much more than that. That's kind of another conversation. But we do know that when we're anxious, we are more vigilant because, again, we're in this future tense. We're thinking about the future and we're ready to perceive and cope with some negative thing that might be coming around the bend. But because anxiety also contains hope, we still have this positive outcome we're striving for. We have also more recently discovered as scientists that when we're anxious, dopamine increases in the brain and dopamine, of course, is a neurotransmitter. It's you know, we think of it as sex, drugs and rock and roll, the feel good hormone. But it's actually as a neurotransmitter, it's a little shuttlecock, right? It's helping areas of the brain communicate with each other more effectively and efficiently. And so when dopamine is increased, when we're feeling, you know, as anxiety starts to rise, our, you know, our sort of, you know, the limbic brain, the emotional brain starts to be able to communicate with that prefrontal cortex a little more effectively. We're holding in mind what are our goals? How can we get there? Dopamine helps us do that. So in many ways, anxiety prompts our ability to pursue our dreams more effectively. It also, there's some there's some evidence that anxiety, especially in more moderate and mild levels, activates oxytocin. So it increases the production of oxytocin, which is a social bonding hormone, a hormone that not just increases when we're bonding, like between a mother and child or a loved one, but actually primes us to seek social connection and, you know, as you know, Vivek, you know, having done such incredible work on loneliness and the importance of social connection, it's this it's this priming of seeking those connections that is really one of the best ways to manage and to cope with all of our emotional challenges, our life challenge,. like when we can plug into that network of support of others, we we are optimized. We are better that, you know, we we are going to do better. And and so anxiety is our helpmate.

So I think that's a really interesting perspective shift. And it was one of the things that really struck me when I first heard about your book some time ago, that sort of shift to look at anxiety, not necessarily something that's universally and unequivocally bad, but as something that may be a signal that our body is sending us that we could use in ways that may actually help us down the line. And in this respect, I actually find that there's some interesting parallels here with loneliness as well, which is a signal our body sends us when we are lacking in something we need for survival, which is human connection. And if we respond to that in a positive way by actually seeking out connection, spending time with family or friends, and that feeling may elevate. But it's when it persists, when it exists at a profound, you know, a deep level, that's when it can start to cause harm. And so I appreciate how you're helping us navigate and think about this perspective shift when it comes to anxiety. I was curious if you could tell me a little bit about how you personally became interested in this work around anxiety?

Well, you know, I it's been a it's been a path. And I and I actually started life as a classical musician. I was an oboist, of all things. And then I, I sort of fell in love with psychology because I've been doing work with kids and with maltreated children in particular. And I saw this incredible resilience. So if they were being abused by a caregiver, they developed a vigilance for, you know, threat around them and that could protect them. At the same time, the double edged sword of that is that it could really get in the way and they'd see a threat where it didn't exist. And it and this you know, and that kind of adversity would build over time. But but I learned early to say, well, even in the midst of this adversity, these kids I was working with, they were still kids. They were incredible. They were resilient. They were creative. They had that sparkle that we want to see in kids. And I just I needed to know how is that possible and what can we do to promote that? And so that was sort of the beginning. And then I defended my dissertation on September 11th, 2001. I literally was walking into my dissertation defense at 9:30, 9:00 a.m. in the morning. Oh, my. It was in Pennsylvania. I was living in New York with my I, you know, my then boyfriend, Vivek, the other Vivek in my life. My now husband. He was in the city. So but we decided, you know, we went and I defended my dissertation and but then I entered this new world afterwards and it was very clear to me that mental health was going to be the health crisis of our time and being a New Yorker, living in New York at the time, I saw the suffering, but I also saw the resilience and what anxiety bought us because it made us fierce, you know, it made us determined. I mean, New York at that time, I mean, I'm just thinking about what it felt like to live in New York right after 9/11. It was an incredible time and we didn't want to be anywhere else. We believed that there was a future worth fighting for.

Well, I'm so glad you you made that pivot, because, you know, I so also clearly remember that day, 9/11, 2001, and just how profound the sense of fear was, how deeply we were all shaken. I can only imagine what it was like to be living in New York City at the time. But I think if we look now, more than 20 years later, we find a profound amount of anxiety. You know, in our communities and our population, not just in the United States, but in other countries as well. So I do think that your focus on anxiety has been is very timely. And one of the things that I would love to to dig into is as we think about this new approach of how to look at anxiety in a more productive way, are there any key principles that you think people can keep in mind to help them make that shift, to use anxiety in ways that can strengthen them and improve their lives?

There are three things, what I call The Three Ls of how to in each moment kind of engage with our anxiety. And The Three L's are: Listen, Leverage and Let go. We often skip to the let go. We just want it to go away. But, but with the three L's, it's, it's actually saying, well, because anxiety is an emotion that's information and preparation to actually get the benefit to negotiate with this ally, instead of treating it like an automatic enemy, we need to understand what that information is. And so we need to build skills and emotional agility in giving anxiety, as you mentioned in the beginning, you know, it's often we were not sure what to call that yucky feeling inside. So we need to, you know, start to to give emotions, those specific words, that emotional granularity that automatically helps us manage them better, to feel less overwhelmed. We need to you know, I know I don't know if this ever happens to you, but I sometimes wake up at three or four in the morning and there worries going through my mind and it just feels like a muddle of yuck. It just is this fog of free-floating anxiety sometimes. When we decide that anxiety is worth listening to and that we need to be sort of lending anxiety an ear like a friend, like it happened this morning. I was had this muddle. I was like, Oh, I'm going to be talking with Vivek later. And there's that my dog might bark. And I was I was thinking about that and what to do. And then something else came to my mind and it sort of slowly rose to the surface, a ball I had dropped at work and I realized, Oh, wait a second, I'd been ignoring this, but my, but my anxiety didn't let me ignore it because it's something I really cared about. And we're only anxious when we care about that future, about our hopes and our dreams. So when I left that, when I gave space to that yucky feeling and allowed that thought to rise, then you get to the second L, which is that you can actually leverage that information. Oh, I dropped that ball at work. Now, I have an opportunity to make some plans. I can take some steps, I can figure out what can I control and what can't I control. And so then we start to actually feel that anxiety isn't just this burden or a sign that we're broken, but it's like this wave that we can ride. It gives us this energy. It doesn't feel good. It has to make us sit up and pay attention so it doesn't feel good. But then as we ride that wave, we can decide, Oh well, I can learn to swim, I can build skills, I can make plans and I can take action. And so it's that opportunity to actually hone us towards purpose and things that matter to us in life, that's that, that we can practice and get better at day by day every time we try.

Well, I really love that. I mean, what a constructive way to think about anxiety. And, you know, you mentioned your own experience about getting up in the night and feeling anxious. You know, I've been experiencing that a lot myself. And it started, I think, at some point early in the pandemic. But I found myself getting up at like one in the morning and just lying there and thinking and having a lot of thoughts going through my head. And it took me a while to realize that that was related to everything that was happening during the pandemic, the uncertainty about the future, and wondering about everything from what was going to happen to my family to what my role should be in all this, and was I being helpful or not? And all of these things around the world, but also internal questions, you know, around identity, I think often surfaced in the form of of anxiety. And so I really appreciate what you're saying because I it took me a while to really listen to that and to think recognize that maybe that was some anxiety that was surfacing and that to figure out what it was actually coming from. But I do think you're right, that anxiety can be a powerful teacher if we're willing to listen to it and sit with it, which can be uncomfortable at times. But But from what you're saying and it sounds like it's an incredibly important step to take.

Absolutely, and thank you for sharing that. Just as you say, it's it's it's giving us this, when we think of emotions as a form of wisdom that can be transformed, now, that doesn't mean that the the suffering that people with anxiety disorders experience is any less real. It doesn't mean that it's, it's not you know, it doesn't negate the fact that this is at this stage debilitating anxiety and that someone has been diagnosed with anxiety disorder. But the fascinating thing is that the solutions remain the same. We're never going to get rid of anxiety. It is a feature of being human. And and it's it's messy, but it's beautiful and it's funny and it's like it's all those things that make us most human. And so even when we struggle with debilitating anxiety, we still need to befriend it, even if we hate it, even if it's really getting in the way. But again, the only way out is through. There's this great research coming out of Yale Child Study Center, and this is really about how parents can support their anxious children. And Eli Lebowitz and colleagues and you might have heard of this this work in this intervention, have developed an intervention called SPACE, which is Supportive Parenting for Anxious Childhood Emotions. I might have missed a word in there somewhere, but it's but it's essentially a training for parents that can either complement or even take the place of direct therapy for children who suffer from anxiety disorders. And the whole, the core of the concept is that we are we are anxious about our children's anxiety. Of course, we want to protect them. But what we actually have to do is prepare them and know that they're not fragile. They're not teacups that will shatter in a million pieces. They're antifragile, that they're more like, that emotions are more like the immune system where you have to challenge them and throw some germs and bacteria at them to actually optimize the functioning of our immune system. Like muscles, you have to strain them sometimes to build strength and emotions are the same way. So what SPACE teaches parents to do when they when their anxious children are refusing to go to school or won't sleep in their own bed or are really struggling is to not allow kids to go around the anxiety, but to slowly and steadily help kids go through the anxiety by scaffolding them to get back to school. And maybe at first you just go to the bus stop and then you come back home and then maybe the next day you go to school for half a day and you but you slowly support your children in making those steps and learning those coping skills instead of accommodating, over accommodating, the anxieties and thus really not allowing them to build those skills.

So I'm glad you raised this and in part for selfish reasons, because as a parent myself of a four and six year old, I'm thinking about this a lot. And, you know, my kids have these moments where they are anxious sometimes about social interaction, sometimes about going to school. And it's always a tussle, like in our house to figure out when is the right, how much is the right amount to push them. Do you have any advice as you know, to parents out there like me who are trying to figure out how much to push their child in those moments where they don't feel comfortable with something versus when to know, you know, when the right time is to pull back.

One thing we can do to start is to trust our parenting instincts again. I think these days there's this sort of parenting advice culture that that's wonderful and there's great advice and experts out there, but it's also a very high bar. Sometimes it feels like there's this perfect parenting checklist with 100 items on it. And if you don't get a 99 out of 100, you know, it's it's a fail. So I think we can start knowing that there is such a thing called good enough parenting that you can you can get it a little wrong and you can repair it. And and I think we can trust our instincts about, you know, a balance in knowing that we want to help our kids through, but also know that we can do that gradually. But beyond that, you know, there's a culture of an emotional culture we can each create in our homes that I think can really take root if we have patience to do it. So, you know, I also have two kids that are a little bit older. They're 14 and 11, just turned 14 and 11. I remember you said four and six, right? That's right. I remember those ages very well. And, you know, and I write about this in the book a bit, too. You know, my my older child, my son, Kavi, has always been a little bit more on that on that anxious spectrum. So he's always you know, he's felt those feelings a little more strongly. And so, you know, we've practiced over time is what is the right amount to expose. And and the first thing that I found with him and with, you know, with any kid and with my daughter as well, is is that we need to create space for those emotions and not try to fix them immediately so that if your child is coming to you with a struggle and maybe they're having you know, I'm trying to think that I have all these 14 year old and 11 year old examples. But if you have, you know, a four and six year old example, but, you know, my son or daughter might come with a test anxiety or they're like, you know, I prepared for this test, but I'm still really worried about it. My son said this to me a few months ago. It's like you're the anxiety expert. What should I do about this? And okay, fair enough. That's a lot of pressure. Touche. And I said, Well, the first thing is that it sounds like you really care about this test because we're anxious when, you know, we're worried when we care. And he said, yeah, you know, so so the first step was to allow that emotion to be there, not try to make it go away, but to kind of lean in on it. And I and then we explored it a little bit more, Well, what is it that you care about? He's like, Well, you know, I really like this subject and I've been studying really hard. I want to do well. But, you know, I just feel like I just don't feel quite right. I just feel like, do I need to keep studying? I'm just not sure. I feel unsure. And so we dug a bit deeper in and he and I said, Well, do you feel like a little bit of studying more would help? And and he gave it some thought. And when he started putting it into words, he realized, Oh, wait, there was this, there's this thing, one of these math problems I actually didn't totally understand. I'm like 90% there, but not 100%. And this is what my worry was. I just didn't put it to words. It just felt yucky. But once I had lean in, I realize that. And so, you know, long story short, he put in a little bit more studying time. He took that action, he leveraged it that would be listened. And then he leveraged and then the anxiety kind of went down. So now we're listening to the fact that anxiety went down and oh, I guess you're on the right track. Does it feel better? He's like, Yeah, you know, I think I think I got this now. It's not always that straightforward. We can have much more intense anxiety than that, but but it sort of gives a framework for giving the emotion space, not just immediately trying to get rid of it, trying not to put words to what's now when you have younger kids, you want to help them a little. But instead of saying, Oh, you feel really bad or you feel worried or you feel let them tell you. Give them a little bit of space to let you know what what are those feelings? Does it feel like a storm or does it feel like a sunny day? Does it feel like, you know, we can give them that space because often where we want to fix it, because we feel anxious about what they're going through. And so we just want to like, you know, they have this term “curling parents,” you know, the sport of curling. Yeah. You know, there's snow plowing and there's curling especially I guess if you're if one is Canadian or, you know, or Scandinavian and it's that sport where you have the sweepers who are clearing the and you and you and they're clearing the path. And there and then there's the person who's pushing them. I don't really understand curling completely. I need to get more expertize before I use this metaphor. But but essentially, you know, we're like curlers. We're we're telling our children, okay, this is the way you need to go and I'm going to smooth every hard surface for you. And so I think, you know, so that's one part of it. And then knowing what's enough, don't be afraid to take little steps. Don't be afraid to check in. Don't be afraid to let them take the lead and let them have, you know, have some of the choice and you have some of the choice. And, you know, so I think I think that each situation is different. But as soon as we collaborate with our kids about these emotions and we don't fear them and we have a culture in our family of saying “yes and,” kind of like the improv technique, yes, this is what's happening. And now what do we do with it? I think that can slowly and very steadily and powerfully create this sort of more more helpful, maybe emotional stance in all of our families.

Oh, I love that. You know, what a great example, also that you shared with Kavi. You know, you're making me think also, you know, these tools you’re mentioning of approaching at first by listening to anxiety and trying to understand what it's telling you about your life that makes so much sense. I also know that there are moments where sometimes the anxiety be can be so overwhelming that it's hard to listen, it's hard to sit with it. So do you have any advice for what people can do in those moments where it does feel like it's overwhelming and, you know, but you still need to find some relief? Are there actions that people can take or approaches that might be useful.

When when I think of overwhelming anxiety, I often think about how we often equate mental health with the absence of emotional discomfort. So we feel like, Oh, I have this overwhelming anxiety. Of course, you know, it feels terrible. It must mean there's something wrong with me. There's something wrong with the world. And we we don't often have this stance of alright life is messy. I'm doing the messy work of being human. And, you know, anxiety got me this time. I don't I, there's nothing really useful right now. And so I think the first step is, is acceptance and curiosity about that. And and just to say too, sometimes it's okay to go to bed early and start the next day fresh and press the re-set button. So I think that stance is helpful because then we're kinder to ourselves. We judge ourselves so harshly when we feel overwhelmed. And I think especially when we're parents because we have to hold it all together for for ourselves, for our kids, for our families. But then the second thing, and it's my third L, which I ignored. I told you this big mnemonic three L-hint I never got to the third L because we sort of always do this, but it's the way I think about the third L, which is letting go is that because anxiety sends us into this future tense, that can be helpful. We can't live there. I mean, it's this triumph of human evolution that we can imagine and plan for the future with exquisite detail. We can persist and be motivated. This is beautiful, but we can't live there. We have to come back to the present and immerse ourselves in that nourishment and that healing and that, you know, we know that this power of being present in the moment is very real. And so when we think about the third step of letting go is not being suppressing or avoiding, but rather coming back to the present. I think then we have wonderful tools in our toolkit and all of us have them. It's not just mindfulness, it's not just, you know, we think, oh, we have to do meditation or mindfulness, or if that's something you've learned about and there are huge benefits, but that's hard and some people don't like it. There are other options. Some people love to exercise. Exercise is something that brings us back to our bodies, to the moment, to a flow, to a sense of flow where we have this beautiful balance between the challenge we're facing and our ability to do it. And so exercise is great. I love, because I do so much scientific writing, I love to write poetry. Bad poetry, you know, super like sweet, you know, kind of sickly sweet poetry sometimes. But it brings me to this different way of thinking that immerses me in the present. My mind just going and associating. We might want to reach out to a therapist, a spiritual counselor, a best friend who just knows who we are, every part of us. So. So once, you know, I think that when we think about overwhelm as being, okay, I'm too much in this future tense, let me come back to the present. We will feel empowered to use those tools that are part of our toolkit already to do that, I think. And so that's one thing I, I think a lot about when I think about overwhelm.

I like this idea of having a toolkit, like you mentioned, an exercise I can attest for my own experience is so powerful and helpful in just getting your mind off of what might be bothering you and getting you into your body. And I feel like we spend so much time in our heads because of our work and the way we live our lives, what we consume in terms of information. But being in our body can be incredibly powerful. And I also think that, you know, spending time doing things that bring us joy, whether it's listening to music, whether it's connecting with people we love, whether it's watching, as I often do, inspiring movie clips or speeches or whatever it is that gives you a sense of relief and joy, I think, is important that I don't think that's avoidance. I don't think it's escapism. I think it's a useful strategy to not allow things like anxiety to consume you and then to come back to it at a time where you're better able to take the steps you mentioned, like listening, for example, and leveraging that anxiety.

I love that because all and purpose and all of that and inspiration, you know, these are because we've put anxiety and a lot of our difficult emotions into this box over on this other side, we don't think of it as a full spectrum of of our humanity. And I think, you know, as you were saying that, I was thinking, you know, I think we feel so shut down and choked when we're anxious, which is natural, and yet we can use it to accelerate our desire to seek out those beautiful moments, that inspiration, awe connection. And so, again, when we think of it that way, we become sort of an emotional ninja. We know that it's not going to always be great, but that it's it's not black and white. It's not yo’re you’re emotionally healthy or not. It's that how can I infuse more flexibility into my emotional life? How can I know that there are ups and downs and ride those waves and and be and be kind to myself about it and know that that is the work that there's you know, I hate to quote Keirkegaard a little because it's a little bit out of the out of the blue, but but he wrote a 180 years ago, the philosopher Kierkegaard wrote a whole book about anxiety. And he said whosoever learns to be anxious in the right way has learned the ultimate. So kind of putting stake in the ground that there is a right way. It is part of our journey and I love that.

I want to get to some of the drivers here, of anxiety, and obviously there are many. But when you look at the rise of anxiety, is there a particular force that you think seems to be driving anxiety in most people?

You know, in many ways, our lives today are a perfect storm for anxiety because recall anxiety is all about uncertainty. So and it's also about being in this sort of spiral of future thinking and not being able to flexibly pull back as easily, like losing some of that agility. So, you know, whether it's health and economic disparities, which can, you know, which cause this sort of uncertainty, you know, I'm not one to blame social media for our ills, but it's an amplifier in many ways because of, you know, the way that it distorts and amplifies our social lives, negative emotions, the way we escape from emotional discomfort into these devices and some of their, you know, the way that they've been designed to to foster compulsive use. So, you know, the speed of life, the the speed of information, you know, all of these things do conspire against us. At the same time, we have often had periods in history that have been characterized by these sorts rapid changes and dis-settling changes and uncertainty. And so as a as a species, as you know, as humans, we can point those out and try to change the circumstances. But we're still left with what do we do now to work within this reality. And so after we've considered those and also increased access to mental health care, which is so crucial and and as you've drawn so much critical attention to youth mental health, like all of those things, if we're doing those things, then I think the biggest thing we can do is to change our personal relationship with anxiety and these difficult emotions, as I’ve been, I feel sometimes, blathering on about because because what these mindsets do and there's this incredible research that shows that even in a 15 to 30 minute moment, you know, taking a brief moment of time to reconsider our beliefs about about ourselves and about anxiety and stress, we can transform how we handle stressors. So great work that's by Jamieson and colleagues that’s since been replicated by Dave Yeager and his colleagues, recently published in Nature, a wonderful set of studies that that essentially demonstrated that these brief mindset interventions that take 15 to 30 minutes focused on reimagining our our experience of stress and anxiety as well as growth mindset interventions that help us rethink learning and failure. That when we say there's a great one of the studies that demonstrated this is socially anxious people, people diagnosed with social anxiety disorder come into the lab. A core symptom of social anxiety disorders is fear of public humiliation. And then, of course, the experimenters ask them to do something that's kryptonite for for them and for many of us, which is to give a public speech with almost no preparation time in front of a panel of judges who are trained to be pretty negative and kind of scary and for half of this group. And these were clinically anxious people, debilitated by social anxiety. Half of them, though, were taught to rethink what they were about to experience. And they were told, okay, you're going to feel your heart racing. You might feel that you're about to panic and you might feel that everything's about to fall apart. But actually, that's not you getting ready to fall apart. That's your body and mind preparing to perform. So your heart's racing to send oxygen to your brain so you can think more clearly. Here's some science behind that. Here's evolutionary theory. Here's why. Actually, this response, this anxiety, this stress is actually your friend in this situation and some things you can do about it. And so half of the people are taught that just for 15 or 20 minutes and the other half of the folks were not. And what do you know when they were actually giving that speech, their heart rate was measured, their blood pressure was measured, and their performance was was scored, how well how well they gave the speech, and the people who had this very brief reset of their view towards this challenge they were about to face, they performed better, their heart rates were lower and their blood pressure was lower so that their biological profile was of facing a challenge, not falling apart. And so I think that the future of where we need to go and how we scale this this re-conceptualization of anxiety and many other difficult emotions is to really know that these mindset interventions that are clinically validated and that we don't even have to do in a therapist's office that we can in our family culture, in our day to day lives with ourselves, we can make these shifts in our expectations about what we're going to experience and how we’ll react. And it can have a powerful impact that will grow over time. And so I think that, you know, it seems simple. It's hard to do in that it takes persistence and it's a new habit to create, but we are capable of that. And it can help all of us, whether it's day to day anxieties or even debilitating anxiety, it can really benefit all of us, and we can start to own our anxiety more instead of feeling so owned and overwhelmed by it.

Well, that's incredibly empowering that these mindset interventions can be used. They don't take very much time. But what an empowering thing to know that that those are available and those, give us something we can do on our own to manage anxiety during these difficult moments. I do want to to also acknowledge what you mentioned earlier about social media and about its potential role at times in, you know, increasing social comparison or creating social anxiety. And for other people who may use social media also as their news source, the negative tilt, you know, of a lot of information that tends to be shared can also sometimes create more anxiety in our minds about the future as well. I've certainly felt that, you know, in my own life, when I've consumed social media. At times, it has left me feeling more anxious, you know, about myself in the world. But do you have any advice for how people should think about using social media in ways to limit the anxiety they may provoke in their lives?

What you're saying is is is so right on, because you're you're talking about sort of becoming a mindful digital citizen in that we we can tune in and evaluate and be little to be a little scientist in a sense of ourselves and for our children, too, as we know, that's I mean, that's also something we're very challenged, feel challenged to navigate sometimes. How do we become thoughtful, wise digital citizens and how do we help our kids do that? So that's how I'd like to frame that question, because I think all-or-none thinking about social media and digital, it's not going anywhere. We can we can advocate to make things better, and we can, but now it's down to what do we do in our own lives? And so I think about these sort of four pillars of how social media can get in our way and one, you know, and we can evaluate where we fall on each of these, you know. So how are we making choices in each of these domains? And how can it so and really briefly, it's one of them is that, you know, we often use these devices not just for information or fun, but just to escape and to numb ourselves. And so if we are finding that we're compulsively escaping into these devices and then we find ourselves doomscrolling or we or we do, we see, oh, my gosh, I feel so much worse after being on X, Y, Z, you know, digital platform, social media platform, we can start to see where we might actually be using social media in an unhelpful way, just like we might use other things in an unhelpful way if, say, we're using too many substances or you know, we're using substances in our life in a way that's not healthy at all, the occasional drink is okay, but if we're drinking every day to numb ourselves and escape, that's a problem. So we can start to we think of technology as so special, but we can actually apply common sense judgment to social media and digital tech as well. A second thing is that, as you say, when you mentioned social comparisons, these are social distortion machines on many levels. So if we if a parent makes a choice to allow their kids on social media, we need to be very aware of their of what the experience of our our own but our kids experience of self and others, what that experience is like. So is there this constant social comparison? Is it much more passive than active? So researchers, you know, when we do research on social media costs and benefits, we're often looking at are we using social media as sort of an active tool for self-expression, or are we just passively scrolling through our feeds and seeing how much better everyone's lives are? So so we can look at that balance. I think a big problem that we don't talk about enough is that we create that when we use social media. Now, the way that we have been incentivized as social media users by these tech companies is to become a brand. Kids are growing up treating themselves like a as a product to be consumed and that their self-worth and judgment and sense of self is very closely tied to metrics that have nothing to do with ourselves, things like likes followers. And so if that when that distortion starts to happen, both in terms of how we relate to others and how we relate to ourselves, that is a red flag. That's when we need to really become mindful about what we're doing and how. You know, as you said, it's a negative emotion amplifier, too, that says sometimes we go on, we're doomscrolling, we're seeing all the negative stuff and we go further and further down that rabbit hole. We have the, even if it's hard to stop ourselves, we can build the skills to say that enough is enough. You know this I'm feeling worse after. You know, maybe I need to make some different choices and I can figure out how to do that in a balanced way, especially if there's, and this is kind of the fourth thing, if there are opportunity costs in terms of what we're doing in the real world. If we're spending so much time on screens, if our kids are on screens more than they're learning to play the piano, having face to face time with friends, exploring the woods, whatever it is, if that balance is off, we might need to recalibrate. So again, it's that opportunity cost that. And so, you know, that's how I think about it. If I let my kids play games sometimes or get on the screen, which I do, I make sure that it's not stopping them from doing these other things. We really value IRL.

Yeah, that's, I think, a really thoughtful, balanced way to think about social media, to look at what it may be costing us in terms of crowding out other meaningful experiences in our lives, but also to be mindful of how it's making us feel in the moment. And I think this gets to your broader point of listening to how we feel and recognizing the impacts of the activities we do on creating the feelings we may be experiencing. I do want to acknowledge that one of the, I think, challenges for people moderating their use of social media is that these platforms are often developed by some of the best product engineers in the world to hook us in, you know, and to make it hard to put the device down or to stop scrolling. And I do think that that's a challenge. But I think of it as really a public health challenge, given the some of the consequences that we've seen of social media use negative consequences for some people. So I do think that a society that's something that we have to contend with, that these platforms are designed to make it harder to moderate use, which makes it harder to ensure that our use is healthy and that it serves as well. You know, this has been such an optimistic conversation in so many ways, and you've helped us do, Tracy, is really think about anxiety in a different way, one that we can we can actually use it as a tool to make our lives better, as a tool to actually teach us more about ourselves and what we need and what we respond negatively to. But ultimately, as an approach, the approach you're talking about is one that I think can help amplify and enhance our resilience in the face of any number of factors that may continue to contribute to our anxiety, given that we can't control all the factors around us, especially the things that are happening in the world? I'd love to end just by asking you this final question. If we do know what you are urging us to do, and in a very compelling way, I may add, If we do know what you are urging us to do, if we manage our anxiety in productive ways, if we listen, if we recognize that our experience of anxiety does not mean that we're fundamentally broken, if we do that, not just as individuals, but at scale, what does society look like? What is a world look like? If we do this well.

I love that question. Thank you for that. I think that we will start to think of mental health as just health. I think that a challenge that we have, not just in mental health but in health care in general, is that we don't think of health as a the presence and active the active presence of states of health. We don't even have really good language for that. Instead, we take a disease model which has been powerful in the, you know, in the past 100 years, especially with all these incredible advances. But when we take this disease approach to all types of health, we just focus on eradicating what's broken and fixing it instead of building a positive state. So what I hope will come from some of these conversations is a reprioritization of articulate, first articulating what it even means to have the presence of mental health And that and that when we do that and we realize that, you know, mental health is actually the process of experiencing these difficult things, I think that, you know, and and sometimes falling down and then picking ourselves back up and that and and building and building little by little, I think that we will think of health like fitness, mental health, like a fitness state that we can all support each other in pursuing. I think I think there's so many opportunities to change where we put our resources as well and that we should start early in schools but also in our families, so that we feel empowered to to have these kinds of conversations and to not just worry about, oh, gosh, is my kids going to become anxious or are they going to, you know, is that and instead of saying, I'm going to build I'm going to help and scaffold my child in building these skills that will prepare them for a lifetime and sometimes that will involve messy, messy work. And that's okay because that is actually part and parcel of it.

Well, Tracy, thank you so much for that hopeful note and for just all the incredible you've done to help us to think about anxiety in a different way and I think a very helpful way. So I appreciate everything you share today. Thank you so much for joining House Calls, Tracy. And it just I can't wait till our next conversation about this. So I appreciate you. Thank you so much.

And I just want to give you my really heartfelt thanks for putting I'm getting a little verklempt thinking about it, really putting youth mental health at the center of public health conversations.

Thank you. Now, I know this is personal for a lot of us, including for me, and my hope is similar to yours, that one day we can be a society that sees mental health as health, that sees mental health as a source of strength, where kids who are struggle don't have to feel ashamed and where help is available to them. And so I think we can get there. I think we know how to get there. And I am encouraged that all around our country there are more and more young people who are stepping up and speaking out with courage about what they're going through, but who are also becoming advocates, who are helping fashion the solutions that we need in in our community. So we've got to have their backs. So I couldn't agree with you more. This is a time to make youth mental health a priority. Thanks for all you're doing, Tracy, and thank you so much for this conversation. I'm leaving feeling more inspired and hopeful about the world.

That concludes this conversation with Dr. Tracy Dennis-Tiwary Join me for the next episode of House Calls with Dr. Vivek Murthy. Wishing you all health and happiness.