Search for tag: "anxiety"

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Mitch: Anxiety. What is it? Why do we have it? And how do we kind of cope with it? This is "Who Cares About Men's Health," where we try to give you some information, inspiration, and a different interpretation of your health.

I'm Producer Mitch, and today I'm joined with Scot. He brings the BS to our show.

Scot: Glad to be here. Can't wait to talk about anxiety.

Mitch: Right? How exciting.

Scot: Can I sing it every time I say it? I'd love to.

Mitch: Anxiety? Okay, yeah. We'll see if you commit. And to bring a bit of the MD to the rest of our BS is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Good to be here.

Mitch: And joining us today to talk, he's back, it is Dr. Scott Langenecker. Hey, Dr. Scott.

Dr. Langenecker: Howdy.

Mitch: So before we dive too far into what anxiety is, how we deal with it, etc., I wanted to ask the rest of the team here. Scot, when was the last time you felt anxious?

Scot: Not that long ago.

Mitch: Oh, really?

Scot: Yeah. The last time I felt anxious was during my graduate studies. Working on my final project, I had to make a couple of presentations for that. I get a little anxious. I find myself getting anxious as I approach deadlines.

Mitch: Sure.

Scot: I am curious to find out . . . I've heard there's a difference between just normal . . . I just labeled it, right? And I shouldn't have done that. Just kind of anxiety out of events like that versus maybe more severe anxiety. There'd be times where I would notice I was getting a little short of breath and I just have to go, "All right. Calm down. Take a couple of deep breaths and you'd be good." I had never really experienced that level of anxiety before. Otherwise, it was just kind of butterflies in the stomach.

Mitch: Like having to talk your body down?

Scot: Yeah. A little bit.

Mitch: Okay. Interesting.

Scot: And to a past episode, that I remembered box breathing, right? That our brain and body are so tied together. Calm one down, it'll help the other. So yeah, that's my story with anxiety.

Mitch: Oh, cool. Okay. And what about you, Troy? I mean, you're in a really intense job. It's a little bit more than a podcaster. Do you get anxiety a lot?

Troy: I try not to. And it's one of those things you have to check yourself sometimes because if you are feeling anxious at work, it can be very distracting and detrimental.

But I will tell you the shift I worked just a couple of days ago, there was a point I had several patients I was trying to see, and then they just kept bringing more patients back. And it was kind of a moment where I just had to catch myself like, "Okay. Take a few deep breaths. Just go one at a time. See the patients. No rush."

It was kind of that feeling of being anxious and also feeling a little bit overwhelmed, which is funny to say after doing this job for however many years I've done it. So yeah, I definitely felt a bit of anxiety at that moment, for sure.

Mitch: That's interesting because those are both situations where it kind of makes sense, right? There's a threat, there's a stressor, there's something.

One of the things that I've been dealing with for the last year working with mental health, and one of the reasons I really wanted to do an episode and bring Scott back on to talk through this with us, is I apparently have some generalized anxiety where it's just like I'm always just a little anxious. And it has been a long journey to be able to just quiet those feelings down a little bit.

And so just to give us a little bit more perspective about what is anxiety and how do we work with it, etc., Scott, why don't we start there? What is it? What is anxiety? Because you hear people say, "Oh, I'm feeling anxious today." Is that really anxiety, or is that just a catchall term for "I'm a little nervous about something"?

Dr. Langenecker: Yeah, it's a great question. I think I'd like to start out with this concept of pain. So why do we tell kids when they're young not to put their hand on the stove? Why do we have pain receptors in our hands? It actually keeps us from harming ourselves.

And so anxiety at its core is a danger warning system in your brain. And it turns out it's a pretty old system. It developed a long time ago. Many animals have anxiety. We humans have anxiety. It's not really a fine-tuned system, and so it's pretty easy for it to go a little bit awry.

Mitch: Okay. And when you say old, it's pre-caveman? We're talking way down the line in the evolutionary line, or what?

Dr. Langenecker: It depends who you ask. But if you ask somebody who likes to be contrary, they will say an amoeba can have anxiety because it can move toward or away something based upon the danger of that object to the amoeba.

Mitch: Wow.

Dr. Langenecker: Now, obviously, that's a bit of hyperbole. We like to think of anxiety as having a little bit more sophistication than that. But that's sort of at the far end of the spectrum on what we think of anxiety, is moving toward or away things that may be dangerous to us.

Troy: That's what we need, Scott. The next book is going to be "The Emotional Life of the Amoeba: Dissecting Their Emotions and Treating Them."

Mitch: Is anxiety an emotion, or is it a biological response?

Dr. Langenecker: I would opt for a biological system or a biological response that can lead to a host of emotions.

Mitch: It's not an emotion. Your body is actually afraid or telling you, "Hey, there's danger here"?

Dr. Langenecker: Yeah. Most often, when we think of anxiety, we think of it going along with the emotion of fear, but there are other emotions that can come with it, like excitement, or anger, or disappointment, disgust. It doesn't have to be that specific.

Mitch: Before we started the interview, you mentioned that you like to think about anxiety as the tiger of the mind. Do you want to explain that a little bit to me? That sounds very exciting and interesting.

Dr. Langenecker: Sure. This is the way that I make anxiety real for patients of all ages. But it's really helpful for talking with kids too, because kids have lots of fears. Some of them are useful, some of them not so useful. As we move into adulthood, we get better at managing them, by and large. Not always.

So when I think of tigers of the mind, I think of "What is the evolutionary purpose of anxiety?" And the evolutionary purpose of anxiety was literally to keep us from eating that poison mushroom, from going out in the dark and being eaten by tigers. And so, anxiety was a good thing, right? It made us cautious. It made us think rather than feel.

And those people who were more cautious and did the thinking rather than the acting impulsively are the ones who passed their genes onto their kids. So anxiety has been preserved, and I would say even strengthened as we've evolved.

Mitch: If it is this kind of evolutionary thing, almost everyone has a little bit of anxiety, it's a biological system that allows us to respond to dangers, at what point does that become, say, an anxiety disorder? And what kinds of anxiety disorders are out there?

Dr. Langenecker: So that's a whole thick book, but the basic idea is we have anxiety. The best way I've heard it described is anxiety is about a loss of control. So control about safety, control about your social status, it could be control over a number of things.

So social anxiety is one, right? That's potentially a loss of status. That goes back to Scot's anxiety around his performance in exams and projects and so on. "If I don't do well, I may not gain the social status that I'd like, or I might lose some social status."

When Troy was talking about it, it might actually be related to danger. "If I don't find a way to manage the anxiety there, there might be some danger to me."

And then we have fears, phobias of various things.

The generalized anxiety that you referred to before, Mitch, is kind of . . . I'm going to use the word unsettled.

Mitch: Sure.

Dr. Langenecker: Things don't seem to be settled often and your brain is constantly looking for why. Why are things not feeling settled? And so it becomes generalized and you're just looking. You're looking for the monster under the bed, even when the bed is not there. That's what your brain is doing to you when you have more of a generalized anxiety.

That's just a couple. There are more complicated ones around trauma and obsessions. And I think just in the interest of time, let's get past those for now.

Mitch: For sure. It's interesting to hear that because one of the things that I've been working on with my therapist was the idea that my generalized anxiety may be connected to some childhood trauma. It might be connected to some instability in my life for a long period of time when I was jumping from job to job doing freelance stuff, etc., whatever.

But he explained it to me and generalized it, my particular case, that just I'm super-duper sensitive, right? My whole system is constantly searching for "What is danger?" And it is starting to create danger where there is none. And it would be everything from like Scot would end an email with a period rather than a smiley face. And I would just be like, "Oh, Scot hates me. He's going to fire me. What am I going to do?"

Scot: Wow.

Mitch: No, it's real.

Dr. Langenecker: Periods should be banned from sentences.

Mitch: And so it was that kind of stuff. And it's been really interesting viewing it from that side. It's not, "Hey, you're not crazy. You're just . . . Because of one reason or another, your system is hyper-wired and very responsive to these things." It's trying to protect yourself. And that gave me kind of a different, I guess, appreciation for what I was experiencing.

Dr. Langenecker: One way to think about it is our DNA is super complex and it's designed to create variability. And so if you think of trying to find the sweet spot for anxiety, our DNA is actually going a little bit high sometimes and a little bit low sometimes. And unfortunately, you and I actually end up a little bit high on that scale. And the non-therapist therapist advice here is the biggest part of managing it is actually just calling it what it is, like, "I'm high on the scale."

Mitch: And that has been, for me at least, one of the biggest changes because I'm finally able to be like, "No, you're not scared. Your body is over overcompensating. This is where you're at. Calm down." The higher brain can talk me down a little bit, which I appreciate.

Dr. Langenecker: And the trick then is if your system is super sensitive . . . If we just think about tests, there are false positives, false negatives, true positives, and true negatives. If your system is super sensitive, you're going to end up with a lot more false positives, which means you're going to feel anxious when there actually is absolutely no reason why you should feel anxious.

Mitch: Yeah. There was a day or two in therapy where I just was like, "I feel really anxious." And he's like, "You just spent the last 15, 20 minutes telling me how good your life is going. What are you anxious about?" And I'm like, "I don't know. Something is going to happen." There's a rubber band theory out there where it stretches and stretches and stretches and things are going good, things are going good, just snap it back.

So yeah, it's interesting to hear that.

Dr. Langenecker: And these are the parts of the brain that we understand the least well. There's the very simplistic way of thinking about the amygdala is looking out for threats in the environment, and it triggers a fear response. But there's a whole bunch of cortex that's actually linked in with the amygdala that's making all sorts of complex calculations about, "What's the likelihood of this event being truly dangerous? And how often has this happened before? Am I in the same environment that this happened before?"

And when we think about anxiety for humans, we have the capability of adding all of these layers to it. And that's where I think we end up with things like generalized anxiety. There's a cerebral element to it as well.

Scot: Can I try my hand at an analogy? It sounds like if somebody has generalized anxiety, their threshold for setting off the alarm system that would normally help keep somebody safe is really low, which is what you've said. And then it also seems like that then when the alarm is going off, your body is almost going, "But there's an alarm going off. There must be a problem." It's this loop almost.

Dr. Langenecker: Yes.

Scot: Would that be accurate at all?

Dr. Langenecker: Yeah. I think you're spot on the money. And then there's another element to it as well, which is sometimes you as the person are like, "Hey, the alarm hasn't gone off in a while. Is it working? Maybe I should set it off to see if it works."

Mitch: Oh, man. And it would cause me to be suspicious of people sometimes, kind of like, "Hmm, there should be a danger here. Maybe this person is my danger." Yeah, it's fascinating.

Troy: This reminds me of the smoke detector in our bedroom. I looked up at it the other day and the smoke detector is there, but it's pulled out so the batteries are pulled out. So it doesn't work. And I said, "Well, why are we doing this? The smoke detector needs to have the batteries in." So I put the batteries in.

I shower the next morning and the smoke detector goes off. I'm like, "Oh, that's right. That's why I pull the batteries out. Every time we shower, the steam comes out of the bathroom next to the bedroom and lets off the smoke detector."

So it sounds like you're saying anxiety disorder is a little bit like that, where its threshold is just too low and it senses danger from things that don't present danger.

Dr. Langenecker: Yeah. That's absolutely right. Now, I'm making light of it because we're on a podcast and we're trying to make light of it. But there's a darker side to it as well, which is people who have experienced adversity and trauma. Their brain is actually changing and adapting to that. And it's not that clever, funny analogy anymore.

That's why I use the analogy of tigers of the mind, because tigers are sneaky and tigers are dangerous. And there's a bit of mindfulness we can do with anxiety, but there's also a bit of, "Hey, this is a real thing. You went through some real trauma and your brain has changed because of it. And so then what are we going to do next?"

Mitch: So I guess going down that line, what are some of the signs that someone might notice in themselves that they might have not just the run-of-the-mill responsive anxiety, but maybe something that could use some professional help?

Dr. Langenecker: The big grab bag category we use is "Does it affect your functioning in your life?"

So, for example, if I have social anxiety and, therefore, I can no longer go on a podcast because I'm afraid people are going to send me hate mail, that's where it moves into, "Oh, boy, that's leading to some dysfunction."

If it makes me uncomfortable and I do it anyway, that's sort of in a gray category.

If I have a fear of fire in my house since I'm constantly checking the smoke alarms and making sure that the oven is off and it takes me an hour or two a day to go through those loops 17 times in the morning, 5 times at lunch, and 5 times before I go to bed, that's moving into a dysfunctional area.

So when we talk about anxiety and dysfunction, we say, "Well, does it change the way you pursue your goals? Does it prevent you from pursuing your goals?" And when it does, then it's time to get some help.

Scot: Somebody who's more sensitive or who has had trauma that's experiencing this type of anxiety, that sounds exhausting. So beyond just it impacting the goals that you're trying to achieve, does it just mentally wear you out, tire you down to a bad place?

Dr. Langenecker: Yeah, it can. So one of the things that I focus on a lot in my therapy with patients is, "Is it affecting your sleep? Is it affecting your energy level? And is it affecting your mental focus?"

So you can run into this situation where people are sleeping, but they're not sleeping well and they feel like . . . They go through an entire day, every day thinking, "I just need to take a nap." And there are actually some biological reasons for this. If we trigger the stress response over and over and over again, that stress response actually loses some of its elasticity. It loses some of its ability to recover over time.

So let me give you an example. We're going back to tigers again. I find myself, unfortunately, in a jungle and there's a tiger there, and there's a huge surge of cortisol that comes through my system to help me, probably unsuccessfully, fight against this tiger.

That cortisol surge is to actually assist me in getting more strength, more agility, to heal faster, but it's supposed to last maybe 20, 30 minutes. But what happens if that gets triggered with the tigers in your mind 50, 100, 150 times a day? That response after a while is going to get a little bit worn out.

And I know that's not a technical description, but yeah, you can end up being pretty worn out from that constant stress.

Mitch: I was. I was getting really tired, really fast and it was leading to inability to sleep, inability to work out. I just was exhausted all the time.

Dr. Langenecker: Yeah. And it ends up being a bit of a trigger for depression, actually.

Mitch: Yep.

Dr. Langenecker: Folks with anxiety are at twice the risk for depression, probably because of that very mechanism of getting hyped up so often and then getting worn out.

Troy: Certainly there the underlying issues, but how much of this, though, is situational where you do face those threats, and legitimate threats? And obviously, the easy analogy for me is just a point to my work. It is a high-stress job with high levels of anxiety just with dealing with unpredictability, both in terms of the kind of things you take care of and just the number of issues you have to deal with.

How much of that becomes a trigger for people? Or would you say that anyone, regardless of their job situation, if they're getting to that point where they're just feeling overwhelmed and exhausted by anxiety, that it truly is a sign of an underlying anxiety disorder?

Dr. Langenecker: Yeah, you've moved into an uncomfortable area here, Troy, which is I honestly don't know how you do it. I honestly don't know how ER docs and first responders and military personnel do it, and yet many do and do for a long period of time and do so successfully.

There are many people where that's just not something that they should be doing. Their body isn't designed to handle stress in that way. But I don't have an answer for why some people seem to be able to manage high levels of anxiety reasonably well.

Troy: When you talk to people in those situations, in high-stress jobs or environments, do you ever simply counsel them to say, "Hey, maybe this is more of a response to what you're facing. Maybe try something different before we recommend medication"? Is that an approach or do you usually say, "Well, clearly, this is disabling. Let's try medication and see if this helps you to work reasonably well in that high-stress environment"?

Dr. Langenecker: I think most people weed themselves out in the process of pursuing these types of careers, but there are times where that's my actual counsel to folks.

So let me give you a couple of examples. We've run a couple of projects with firefighters, and what they'll say to me is, "It's a young man's job, or a young woman's job," which is your ability to physically and mentally be agile in responding to stress just changes over time, and they find themselves less able to do that with as much plasticity as they move into middle age.

And the counsel is often exactly that. "You've had a good run of it, you've done amazing work for your community, and your body is just not able to do that work anymore, and your brain is not able to do that work anymore, so maybe let's find something else for you." And sometimes that's enough.

Mitch: For people that maybe their lives are being impacted by the level of anxiety, maybe not even to a full disorder, but if it's impacting their life at all, how do we cope with it? Is it medication? Is it talk therapy? How do we help people that are experiencing those types of things?

Dr. Langenecker: So this is the really uncomfortable part of this discussion for me, in that for most people, anxiety is not something . . . It's not like an infection, right? You don't treat it and then it goes away. It's more kind of along the lines of diabetes, which is once you have it, you probably have it for life. And then the question is how do you manage it?

And by manage it, there are things that you can do in your life: exercise, mindfulness, sleep hygiene, diet even, things that can help. But for many or for some, we have to go one step further and pursue medication. And that makes, I think, everybody including myself uncomfortable, which is, "Do I have to take these medications for the rest of my life?"

It's an uncomfortable conversation, and so that's why I like to use the analogy of diabetes, which is the medications are there to help balance out your system. You would never say to a diabetic, "Hey, let's try not using the insulin this week. Let's see what happens." We wouldn't do that. That would be a bad idea. And so, for some folks, their anxiety is just at a level right now where medication is a good idea.

Mitch: So I actually started taking some anti-anxiety meds last year, and it took a little bit to get used to them, but it is night and day for me. It feels like the system has calmed down. It feels like I can actually do some of the mindfulness kind of activities and cognitive behavioral, self-talk type stuff. And it's gotten significantly better, but it did take me a while to find a guy, a mental health person. And then on top of that, to just straight up say, "Hey, I think I have anxiety, and I think this is impacting my life."

So I think just to wrap things up a little bit, is there anything that you would want to tell maybe a guy out there who's like, "Maybe I have anxiety. I don't know"?

For me, sometimes it feels like, especially with my upbringing and everything, mental health is a mystery and a foreign language, and the people in it are not me. That's the ideology that comes behind it. What would you tell the someone out there that maybe would be curious and what they should do to address the issues?

Dr. Langenecker: So let's start with the myths right up front. These medications with titration, with maybe some switching and augmentation, they'll help about 60% of folks who have anxiety live better, more fulfilling lives. Will they make anxiety go away? No. But maybe it takes the edge off a bit. So that's the first thing.

The second thing is it does take a bit of time to figure out the best mix for you. Sometimes that's months. Hopefully not years.

The third thing I would point out is that people . . . there's a bit of machismo here, which is, "I can do it on my own. I don't need medications." And I get that. I hear people when they say that and I just ask myself a simple question, which is, "Does it need to be that hard?" And the answer is no. It doesn't need to be that hard. You can take a shortcut.

And the shortcut here is actually helping your brain to do what it wants to do anyway, which is to give you the goods, which is to make your life fulfilling and meaningful and allow you to connect to other people. And if anxiety is getting in the way, medications are worth a shot. They're worth a shot to try out.

Troy: I know a lot of people are hesitant to take medications just because of potential side effects and issues. Do you find that that's a big issue when you're talking to people about these things? And how do you work through that?

Dr. Langenecker: Oh, yeah. We forgot about that one. So the word on the street is that some of these medications might lead to sexual impotence. And yes, that can happen for a small subset of people. If that happens to you and it's cutting into your enjoyment of your life, you can cross that bridge when you get there. You can try different medications. You can stop taking medications.

Again, it doesn't have to be that hard. Try it out and see if it actually can work for you. And for many, many people, their quality of life will improve not just a little bit, but substantially.

Mitch: So if someone is, say, struggling with anxiety at any level, where do they go first if they are looking for help? Is it your PCP? Is it a mental health specialist?

Dr. Langenecker: This is where I'm going to get into a little bit of trouble, but I'm going to the data. So the data suggest that if you go to your PCP, most of the time, a PCP is going to be helpful. They're going to try and prescribe a med for you. But they're more risk-averse in that they might under-dose in an attempt to avoid some side effects, which basically means that you're trying something, but not really trying something. And so the data just show that that's the most common thing that happens if you go to your PCP.

Fortunately, there are lots of online resources to sort of verify whether or not you might be under-dosed. I know Troy is probably going to slap my wrist and say, "You shouldn't go to Google MD. You should use it as a resource to augment what you know. You should not use it as the sole source."

Troy: Yeah, Google MD kills me. Please. The number of times I hear about things people read on Google that brought them to the ER, it's just . . .

Mitch: "I've done my research."

Troy: "I've done my research. This is what Google said." Okay. Here we go.

Dr. Langenecker: But the basic idea is going to see a psychiatrist even for something we might consider minor like anxiety is fine. If you're wanting to try it, it's okay to try it in a context where you're going to get an expert to help you.

Mitch: Scott, thank you so much for answering all of the questions that we had about anxiety. Hopefully, for someone out there, that'll help them. It doesn't have to be that hard. And myself, I cannot tell you how much better I feel after getting some treatment. So thank you so much for talking to us, and thanks for caring about your health.

Dr. Langenecker: You bet.

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Dr. Jones: We are all anxious from time to time and that's normal, but what if it seems to be all the time? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health and this is anxiety on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on, The Scope.

Dr. Jones: Anxiety is a normal response to stress, and stress is hard to define but you know when you feel it. Biologically, we define stress as that which activates the stress cascade of hormones. The brain feels stress, sends messages to our pituitary to send messages to the adrenal gland, to send out more cortisol and norepinephrine. Now, those two hormones makes us a little shaky, our tummies uneasy, and our hearts beat faster. Then when the stressful thing is over, we calm down.

The exam is over, the wedding is over, we hear the front door close at midnight, we know that our teenager is home, but what happens if we don't calm down? What happens if we're anxious all the time? And what if we're anxious about things we shouldn't really be anxious about? Washing our hands, going out in public, checking to see if the door is locked over and over, that kind of anxiety makes you sick.

So anxiety disorder is when the anxiety response to stress becomes hard to control and is out of proportion to the stress and affects your daily day-to-day life. Anxiety disorders are diagnosed twice as frequently in women as in men. Now, there are a couple reasons this may be so. One is that women are more likely to admit anxiety and seek help than men. Another is that women are wired differently to respond to stress. The fight or flight mechanism, "protect your babies, mama bear," is activated more readily in women than men.

Some scientists think that estrogen and progesterone, made in the normal menstrual cycle and in high amounts during pregnancy, may contribute to this difference between men and women. And women tend to react to stressors in their life differently. Men may respond to stress in a more active way, to punch the guy out or yell about it, and then get over it. Women tend to ruminate, think about it over and over, and that leads to chronically elevated levels of stress and stress hormones that makes it harder to calm down. And the brain becomes wired to overreact to stress.

Women and men who've been physically or psychologically stressed as children rewire their brains to overreact to stress. Women who've been sexually abused may have had the same response. Cultures and environments are different as to what may be perceived as stressful. Asian cultures put a bigger emphasis on shame as a result of causing embarrassment to family and not meeting family expectations. This can be a cause of chronic anxiety. Women and men in the West, not so much. Women with General Anxiety Disorder worry excessively about day-to-day things like health or money, and work, and family. This gets in the way of normal coping mechanisms. This can also increase the risk of panic attacks, episodes of acute terror when there's no actual danger.

The physical symptoms of panic attack can include chest pain, difficulty breathing, and a sense of impending doom or death. And some women have specific phobias or irrational fears, such as fear in social situation or of germs or heights. We all can be overwhelmed in crowds or worried about germs, but for some women, these fears rule their life.

So what to do? Let's play the RULER game again. R is for recognize. U is for understand. L is for label. E is for explain. And R is for regulate. When you are feeling something overwhelming, is it that you have felt this before in this situation? Can you label it now as anxiety? Can you help others to understand how you feel? And can you regulate it? For many, the first step maybe cognitive behavioral therapy, CBT. This takes time and practice. But when you recognize, understand, and label your symptoms, you can change your thinking patterns, change the channel and try to come down physiologically.

Some women have found that daily exercise, yoga, and meditation practice help them deal with anxiety. There are a number of medications that have been successfully used to treat anxiety disorder. The most common and successful for many people includes a group of drugs called SSRIs that can change brain chemistry a little to help your brain not overreact with stress hormones. Now, there's some trial and error in that no one therapy works exactly the same for everyone, and some people need more than one drug. Working with your mental health professional will help you with the menu of options, which can include CBT and medications. And of course, you can change some of your own responses.

Of course, great concern to parents, family, health and law enforcement professionals, and society is the trend for many women and men to self-medicate with alcohol, marijuana, opioids, and other people's drugs, including valium-like drugs. Self-medicating anxiety has helped lead to addiction, overdose, and suicide. So if you're struggling, don't struggle on your own. There's a lot that can be done, and you can learn to control your anxiety and use prescribed medications correctly. Feeling anxious all the time is awful and it's isolating, and you don't have to do this alone. Check out womenshealth.gov for more information on anxiety in women, and thanks for joining us on The Scope.

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Dr. Jones: Anxiety in young women is on the rise and is there any wonder why is this happening and what can we do? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health Care and I'm anxious about anxiety and this is The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Anxiety is a very common and perhaps the most common mental health concern in the United States. About 40 million Americans have anxiety disorders and women are twice as likely to be diagnosed with anxiety than men. College health centers are seeing a dramatic increase in anxiety in their students. One recent study of 63,000 college students found that there were five times as many young adults with high levels of anxiety compared to college students in the 1930s. So are we just more aware of mental health issues? Are young women more willing to seek help and, therefore, get counted?

As the pace of life and social media increased anxiety in young women, the truth is probably all of the above, but let's drill down on some of the causes, the consequences, and what to do. Firstly, there is evidence that the way a child responds to stressors may be both genetic and epigenetic. That means there are inherited genes that can contribute to overreacting the stimulus. But these genes have been around for a long time. So why is there more anxiety now?

The epigenetic story is that genes are modified by early stressors in early fetal development and early childhood development. Moms who are exposed to high levels of stress give birth to babies that are more likely to overreact to stressors. Children who have high levels of stress in their lives, poverty, homelessness, instability in their home life, have an increased chance of having anxiety and attention problems as adolescents.

Secondly, the environment of children and young adolescents is increasingly stimulating social media which may not be very supportive, bullying in schools, TV, increasingly dramatic news coverage, and video games that are violent and stimulating can contribute to high levels of stress hormones. Kids are getting less sleep and consuming more caffeine than ever before. Increasing use of some stimulants for attention disorder may also increase anxiety in kids who may not be taking it appropriately.

Thirdly, there is clearly an awareness in the schools and colleges that more kids have anxiety. Giving it a name lets us count it in adolescents. An increasing availability of medications to treat anxiety allows adolescents to state care. What is the bad part of anxiety for young women? Firstly, it feels awful and limits a young woman's ability to focus on the task at hand: school or work or healthy relationships.

Secondly, young women may self-medicate with alcohol or sedating drugs like opiates or Valium-like drugs that they obtain from friends or a family medicine cabinet. Young women who self-sedate in social settings are more likely to be sexually abused or overdosed.

So what should we do? The first thing is recognition of the problem. This goes back to the RULER project for emotional intelligence. "R" is for recognize. When you feel it, understand that you've felt this way before and you've survived it before. "U" is for understand what the triggers are and if the anxiety is about something that's really dangerous or not really dangerous. Label it. When you give that feeling the correct name, you can learn about it.

Express it. "E" is for express it. Let others know how you're feeling so they can learn more and help you. And "R" is for regulate it. Okay. How do you regulate anxiety? A healthy diet with less bad fats and high-sugar carbs and less caffeine can be helpful, actually, for everything. Eat regularly in small meals. Exercise vigorously four times a week with healthy friends, if possible. Get your sleep. Yes, if you're anxious, you can't sleep. But when you're not so anxious, make sure you get the sleep your brain needs.

Get more phone-free time. Are you addicted? It's time to withdraw from the stimulus of your social media and get some exercise. Every time that little beep goes off or the little buzz in your pocket, it makes your stress hormones go up. Practice mindfulness and deep breathing. Many studies have found that these practices can be helpful for anxiety. The old saying, "just take a deep breath," comes from some basic neurobiology of stress hormones. Take that deep breath and keep doing it for several minutes.

There are many websites to help with mindfulness training and breathing techniques. There are several good websites for young women, girlshealth.gov is one here in the US. One I really like comes from Australia. jeanhailes.org.au is a website for women's health issues. The AU is the Australia part. If you Google "anxiety young women Jean Hailes," you'll get to a terrific website on symptoms and healthy self-treatments for anxiety. anxiety.jeanhailes.org.au, and click on "Young Women."

Get help. Talk therapy can give you skills to break your anxiety. You will probably always have some level of anxiety, but the goal is to give you the toolbox to tune down a level of anxiety hormones so you can live a less stressed life. If your therapist isn't able to help you get control, medication taken daily that isn't addictive can help and it's approved for adolescents. You have the power to feel better and if that isn't working, we can help.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

Interviewer: Coping with anxiety, we'll talk about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: You know there are a lot of things that can happen in this world that can cause fear and anxiety and most of the time they're not really under our control but what do you do about them? How do you cope with them? Maria Reyes is a psychiatrist with University of Utah Health Care and she's going to give us some tips right now on how to deal with anxiety-causing events in your life that you don't have control over.

Maria: To your point about anxiety, as a psychiatrist, and I think this about it, every emotion in general I think the first step in being an emotionally healthy person is acknowledging your feelings and not judging them. So feelings and thoughts are just those - feelings and thoughts - but the first thing you need to do is acknowledge those and put a name on them. Don't ignore them is the bottom line because they will ultimately come to fruition in ways that may not be so pleasant sooner or later.

Interviewer: So it's better to just face up with it and just go, "I'm feeling a little stressed or sad or whatever about this situation."

Maria: Absolutely.

Interviewer: And go, "Okay. I'm feeling it."

Maria: Right. That means you're alive, that means you're a human being.

Interviewer: That's a good thing.

Maria: Yeah. And join the club.

Interviewer: So acknowledging is kind of the first step. Within that what else would you want to do as part of acknowledging it?

Maria: I think what distinguishes humans from primates is the ability in general to articulate our thoughts and feelings and I feel that people that tend to talk about their feelings tend to be more emotionally healthy and so I would encourage people when they do experience anxiety to talk to someone you know and trust. It doesn't have to be myself or a health care professional necessarily, but just being with friends, family and just using them as a sounding board for kind of what you're thinking and feeling.

Interviewer: Find that person that listens to you or that you have a good rapport, some trust with I'd imagine.

Maria: Absolutely.

Interviewer: Would be a big part of that. So acknowledge it, experience that emotion, talk about it. That's kind of the big first step when you're faced with some source of anxiety. What would you do after that?

Maria: After that, I encourage people to step back from their problems. Now I want to make the distinction between stepping back and avoidance. I'm not encouraging avoidance. That actually makes anxiety worse in the long run. However, creating some healthy distance when you feel overwhelmed emotionally is a good thing and it can be helpful in the long run. By that I mean things like engaging in hobbies, exercise, sometimes disengaging from social media if that's something that is anxiety provoking.

Interviewer: Especially if it's a world event.

Maria: Exactly.

Interviewer: You keep diving into more news stories about it or go to social media or go to the comments section.

Maria: Exactly.

Interviewer: So it's healthy to get away from that.

Maria: Right, or going on a news social media cleanse of sorts or just kind of being cognizant of the time you spend in those realms. So part of stepping back, the outcome of that is hopefully just a reframing of the situation. So stepping back could kind of give you the emotional distance to kind of look at a problem from a different perspective, seeing that silver lining around the cloud.

Interviewer: That's a good thing to look for?

Maria: Yes.

Interviewer: It's a healthy thing to do.

Maria: Yes. Our ancestors had it right when they came up with that adage.

Interviewer: So try to find something in the situation that maybe makes it not seem quite so bad or what good could come out of this or . . .

Maria: Absolutely. So just finding what lessons are there to be learned or how could I have done things differently are good ways to think about problems.

Interviewer: So step back and then is there something else you could do to help maybe make it not seem so big and scary?

Maria: Absolutely. Again, I don't want us to get the message that I'm advocating for burying your head in the stand or avoiding your problems. Of course, the step after stepping back would be to re-approach the problem or the precipitator of that anxiety but hopefully now it would be with a clear head. Then the outcome of that, I would hope, is some sort of sense of control over a situation that you may have limited control in. However I think there's always some part of that problem that seems beyond your control that you have a little bit of control over and I encourage people to know the difference between what you can control and what you can't.

Interviewer: And try to find that little piece maybe that you can do to make yourself feel better about it all.

Maria: Exactly.

Interviewer: So how do you know when it's time for an in-person session with a professional?

Maria: I think anytime you have feelings and emotions that interfere with your ability to fulfill your role as a mother, a spouse, a friend or if it's interfering with your ability to work or go to school or function in general. Also I have to throw in there any time you feel that life is not worth living anymore, these should certainly prompt your attention to seeking immediate help.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 31, 2019
originally published: November 10, 2016

Dr. Gellner: Every year, it seems more and more children are coming in to see me and other pediatricians because of anxiety issues. And the kids are getting younger and younger. So what do you do if you have an anxious child? I'll give you some tips on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kid Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: A lot of parents have concerns that their child is developing anxiety. Their child will stress over everything and no matter what they say, nothing seems to be able to calm their child down. Some anxiety is okay. We all have fears. But when this anxiety starts causing a lot of problems, that's when they should come to us.

Some parents want anxiety medications for their children. Others do not. Medications really should be a last resort, as many are not really safe in young children, often not approved use until age 12. And like any medications, they come with their own set of side effects.

So how can you help your anxious child before things get out of hand? There are some things you can try before resorting to medication. I'm going to give you some suggestions that could help change your child's fear-based thinking on both the conscious and subconscious level.

First, let your child know it's okay to feel afraid at times. But don't act too worried. Anxiety gets worse if your child feels anxious about being anxious. Remind your child how strong they are. This will help them believe in themselves. Explain that their anxiety is their body's automatic response to fear because their body thinks they're in danger. Sometimes the body gets tricked and it thinks it's in danger when it really isn't in danger. And that's just the brain's way of trying to protect them.

Have your child close their eyes, focus in the moment. Have them tell you what they're hearing or smelling and pay attention to their breathing. Tell them slow, deep breaths remind the brain that they are safe.

Give them a pillow or stuffed animal or even a box of tissues and tell them to grab it and throw it as far as they can. This can help release the high energy they have. Teach your child that panic attacks are temporary and they have the skills to make it through them.

Remember, if you make a big deal about it, this will make it bigger for them and it only serves to increase the anxiety. Figure out what your child is really afraid or anxious about. Once you understand this, you will understand what they need to help feel better. You will be able to better explain the difference between fears that help and keep us safe and fears that hurt and only cause more anxiety.

Teach your child to ask, "Will worrying about this do any good?" If the answer is no, then it's a fear that hurts. Finally, teach your child relaxation and self-calming skills. I call this their toolbox for when they get anxious. Once they learn how to calm down their fears, remind them that they can do anything.

If your child's anxiety is still keeping them from enjoying the things that children should enjoy, talk to your pediatrician about helping to find a good therapist. By coming to a pediatrician, we can help with figuring out some things to help your child initially. But if things are too complicated, we can find exactly who you need to see and get you a referral to a mental health specialist that will work with your child and do exactly what your child needs.

Tell your child that this is someone that they can talk to that will help with their feelings. And remind your child every day, "You can do this." Empowering them to be in charge of their feelings will give them the courage they need to face their fears.

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Interviewer: How to help your young child after a traumatic event. We'll talk about what you can do next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life from University of Utah Health Sciences. This is the Scope.

Interviewer: Dr. Katherine Rosenblum is the director of the infant and early childhood clinic at the University of Michigan. When scary things happen to young children, we're talking about infants, toddlers preschoolers, what can you do to help them through that? Is this something that a lot of parents don't recognize first of all?

Dr. Rosenblum: I think it's something that people often overlook because we think young kids are really little, maybe it won't affect them so much, maybe they won't remember things that happened, and also because it's hard for them to tell us what they're thinking and feeling if they don't have the words for it yet. But in fact little kids are affected by scary things that happen in the environment or that happen to them. So we often think about how young kids actually do experience trauma or stress and what we want people to be thinking about is how we can help them to manage those feelings. I think how we can help them cope.

Interviewer: How do you define trauma or stress to that age group?

Dr. Rosenblum: Little kids deal with little stresses all the time. For example, starting at a new school, Mom or Dad is going to work and we have to adapt to separations. It's hard but kids can learn to manage that. It's a stress and it helps them learn I can manage little stresses.

Trauma, in contrast, is something that's so big that actually it overwhelms the individual's ability to cope effectively, and especially for little kids. When they're faced with something that is traumatic or really, really distressing, then what they need is a lot of help to be able to figure out how to recover from that and to be able to recover from that. It really requires additional support from outside.

Interviewer: So are we talking about emotional trauma exclusively or physical trauma as well?

Dr. Rosenblum: Actually, it can be a whole range of things. One of the most common traumatic experiences for young kids is accidents. They get injured or hurt. And that can be really scary and overwhelming and parents might see that after an accident they're afraid, they're more fearful, they're more clingy, that sort of thing, dog bites, things that can happen in the environment.

Interviewer: Falling off of a play set maybe even.

Dr. Rosenblum: Absolutely right. If it was really a scary experience, maybe they had a broken arm, or they had to have some sort of a medical procedure, those things can be really distressing. But with support they can really recover from that.

Big traumas are things that are just told really overwhelming to to the child. It might be witnessing someone being seriously hurt or injured, or really scary events that happen in the community. Those are things that we really think of as true traumas. They overwhelm that young child's sense of, "I can I can cope." It really creates a sense of intense fear or threat, danger.

Interviewer: Seems like we're talking about a wide range of things like from separation anxiety because a parent is going to work versus a traumatic accident. Are they all kind of dealt with the same way or do they require different strategies?

Dr. Rosenblum: The one thing that's sort of common across all of those things for young kids and the number one thing that young kids need when they're managing things that are challenging is the support and help of their primary caregivers, what we think of as their attachment figures, their parents. Young kids are totally dependent on their caregivers to help them navigate life's challenges, and whether those challenges are small or big they're turning to their primary caregivers for help with coping.

Interviewer: I'm sensing here as a parent a little bit of a struggle because on one hand, I don't want to over . . . because a little bit of stress and that sort of thing's good so I don't want to maybe overprotect or over . . . I mean how do you decide how much?

Dr. Rosenblum: It's really important to on one level follow your child's cues. So your child is going to be showing you, :I need you in some way," and parents have an intuitive sort of sense often of, "When my child needs me, I'm going to go to them and help them." Doesn't mean that you're going to prevent them from having to face challenges. Normative things like going to school, that's really important and you're helping them learn how to balance. But when young kids are experiencing something that a parent knows is really really stressful, then I think it's actually really important for the parents to sort of say, "Hey I'm here. I'm here with you. You're safe right now. I'm going to take care of you. I'm going to protect you"

Interviewer: And what does that interaction look like? Say a child falls off of a play set. You can tell the over the next couple of days there is a big fear there. My dad was a rancher. He'd say, "You get bucked off the horse you get back on". Is that the approach you take or is there a better approach?

Dr. Rosenblum: Let me sort of step back and share something with you that's sort of interesting. We often have people who sort of say, "Hey, I'm worried about spoiling my child. If my child is crying and I pick them up, is that going to spoil them?" What we actually know from the research is that when kids express feelings like being afraid or sad and they have parents who pretty consistently and reliably go to them and help them with those experiences, they actually end up as they get older being more able to cope with life's punches if you will, the hard things that come in life. They can sort of bounce back get up and do things better on their own as well.

So I think two things. One, we want kids to be able to try to sort of manage small things on their own. If your dad saw you sort of fall down and bump your knee, it might be totally appropriate to take a moment, sort of look and say, "Hey, wait a second, is he really hurt? Is he really distressed or is he going to be able to sort of bounce back from this on his own?" That's totally appropriate. But if he sees that you're really crying, that you're really hurt, and you're looking up, that's a time where we really hope a parent is going to say, "Hey buddy. You know I'm here for you. I've got your back. Come here and let me help you."

Interviewer: With an adult I might validate somebody's feelings a bit. "I totally understand why that was a scary experience." Do you do the same thing with kids?

Dr. Rosenblum: Absolutely. "That was really scary. But you know what? I'm here. I'm going to help you and you're going to be okay." Little kids really like to know that someone's there, someone's got their back, someone's going to scoop them up, give them a hug and then help them be able to sort of do that bounce, get back into normal daily routines and experiences. That's another piece that's really important here. I think the other part of your question was, "I don't want to over react." I don't think it's overreacting to really be asking how is my child managing, am I seeing . . . If something scary, something really big happens, use your child as your guide. Look at your child's behavior. Is your child looking more fearful, having trouble sleeping, a little bit more clingy? If all of those things are true then that's a time to give a little bit more. But if your child seems to be doing okay, all right, be a watchful observer. Use your child to help you determine what your child needs.

Interviewer: Would there be a point where you'd visit a counselor?

Dr. Rosenblum: Absolutely. So if your child is continuing to persist in showing more clinginess, looks very fearful, can't sort of do the normal routines, seems really distressed or you're just really concerned about them, trust your gut, talk to the primary and pediatricians are a great resource. They can help you sort out is this something that we can sort of wait and see and sort of watch and wonder? Or is this something where it might actually be helpful to get some extra help?

Interviewer: Do you have a resource if a parent's listening right now on their like, "This is great. I'd like to learn more"?

Dr. Rosenblum: There's a really wonderful website called the National Child Traumatic Stress Network and they have a website, NCTSN.org, and that provides wonderful resources for parents, for teachers of young kids about how to help kids manage really scary or big things. For smaller sort of things, the more every day sorts of occurrences, there are a number of resources that are available as well. The American Academy of Pediatrics has a website dedicated for parents and there's also a wonderful resource called Zerotothree.org. Again, lots of resources to help parents navigate life's challenges with young kids.

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Dr. Jones: About 10% of US adults experience mental illness such as depression or anxiety every year. How to overcome that stigma? This is Kyle Bradford Jones, family physician at University of Utah, coming up next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Dr. Jones: So lots of people, particularly adults in the US, suffer from depression or anxiety but have difficulty overcoming the stigma of having that. A lot of people think, "Hey, am I crazy if I'm depressed? I can buck up. I can do this on my own." The culture in the United States tends to revolve around being the cowboy, "I am independent. I can do this on my own. I do not need your help," but depression and anxiety is more than that. This is something that is a real illness that you cannot simply overcome on your own.

There are a couple of things to keep in mind. This is more than just being sad. That's kind of the first thought that most people have. Depression can be an emotion, it can be a symptom of something else, or it can be a diagnosis. The emotion is feeling sad. It is having a bad hair day. It's going through something tough. That's completely normal. It can also be a symptom of something else, such as thyroid disease or something like that.

But the diagnosis of depression, you feel a little bit more sad, you feel guilt, you have trouble concentrating, you have less energy. You no longer take pleasure in things that are normally fun and entertaining for you, and it leads to decreased function. And so having that thought of, "Hey, I can overcome this on my own," is actually going to be detrimental if you have the diagnosis of clinical depression.

So what things can you do? First of all, go see your physician. This is something I can start with your primary care physician. Talk to them about what you are experiencing. They can give you some guidance on how severe it is, if it is the diagnosis versus if it's an emotion, a symptom, they can offer some different things for you.

A lot of people think that therapy is just talking to someone and that's it. But that's not the purpose of it. So certainly that helps a little bit, but there are therapeutic methods that have been proven to give you better coping skills, to help you better deal with the things that you're experiencing.

Now, the best way to deal with depression is a combination of therapy and medication. A lot of people are worried, "Hey, if I go on medication, I'm going to be on this for the rest of my life. It shows that I am crazy and I'm going to feel like a zombie. It's going to completely take away my ability to feel." It's actually the opposite on all those accounts.

The vast majority of people who are on medication for depression or anxiety take it for about 6 to 12 months, and then they're okay without it after that. It's actually not something that's going to make you feel like a zombie and keep you from feeling. It actually quiets the depression and anxiety so that you can get back to your normal self, to your normal feelings, your normal activities. Less than 50% of adult men get treatment for their depression or anxiety. Obviously, that's a big deal.

Now, how do we get rid of this stigma? The first step is understanding it, understanding that this is a medical condition. It's caused by a decrease of chemicals in your brain. This is not a moral weakness. Oftentimes this can be brought on by a stressful life event and it can just be a short-term thing. Like we said, you don't need to have treatment long-term for most people. Also, understanding that as a society we just need to talk about it more. It's okay.

There are actually a significant amount of people that struggle with this from time to time and that's okay. Treatment helps because if you don't get it treated, it actually worsens your relationships, it worsens other health problems that you have and overall can simply make things worse. So seeking treatment and seeking the appropriate diagnosis can really make a big difference.

In summary, if you feel like you may be suffering from depression or anxiety, you are not crazy. Seek therapy. Go see your physician. Don't be afraid of it, because denying it only further ruins everything else going on in your life.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.