Afford Anything - The Roots of Procrastination, Inattention and Anxiety, with Dr. Ellen Vora, M.D.

Episode Date: March 2, 2022

#367: Since the start of the Covid-19 pandemic, many commentators have remarked that we’re living in an “epidemic of anxiety.” More than 40 million Americans suffer from anxiety, and countless millions more notice themselves “acting out” against their responsibilities in smaller, self-sabotaging ways: procrastinating, lacking motivation, grappling with an inability to concentrate. In today’s episode, Dr. Ellen Vora, M.D., discusses both the internal and environmental factors that can exacerbate anxiety. She talks about nutrition and sleep, as well as the fact that, frankly, your job just might suck. She applies these ideas to tactics that allow us to better handle our finances, investments, careers and lives. Dr. Ellen Vora holds a B.A. from Yale University and a medical degree from Columbia University. She’s a board-certified psychiatrist. Enjoy this conversation, and share your comments and feedback with members of our community at affordanything.com/community For more information, visit the show notes at https://affordanything.com/episode367 Learn more about your ad choices. Visit podcastchoices.com/adchoices

You can afford anything but not everything. Every choice that you make is a trade-off against something else, and that doesn't just apply to your money. That applies to any limited resource that you need to manage, like your time, your focus, your energy, your attention, saying yes to something implicitly means, turning away all other opportunities. And that opens up two questions. First, what do you really want?

What matters most? What are your priorities, your values? Second, how do you align your decision-making to reflect? that, since often there can be a behavior gap between what we think we want and how we behave. Answering these two questions and living the answers to these two questions is a lifetime practice, and that's what this podcast is here to explore and facilitate. My name is Paula Pant.

I am the host of the Afford Anything podcast, and today, Dr. Ellen Vora joins us to talk about procrastination, motivation, and anxiety. since these are the elements of psychological and emotional resistance and resilience that we need to grapple with if we want to be better at managing our money, our careers, our businesses, our investments, and our lives. Dr. Vora completed her undergrad at Yale and her medical degree at Columbia. She is board certified in psychiatry, and she joins us in today's episode to talk about how the symptoms of anxiety are the result of various physiologic inputs, meaning it's a whole body condition, not simply a brain condition. In this upcoming interview, she talks about the difference

between what she refers to as false anxiety versus true anxiety, and how each can alert us to something being out of balance, whether it's some aspect of how we're taking care of ourselves, our nutrition, in our sleep or some element of our external lives, like maybe we're in the wrong job. Maybe we need to make a career change. Maybe we need an early retirement. For that discussion, here she is, Dr. Ellen Vora. Hi, Dr. Vora. Hi, Paula. How are you? I'm doing well today. How are you doing? I'm excellent. Dr. Vora, can you tell us, at the risk of asking an overly broad question, what is anxiety and how does it differ from closely related concepts like worry or stress? Yeah.

I refuse to have a satisfactory answer to that question. Basically, what I've been taught, the way to think about anxiety through the DSM, the sort of Bible in mental health of how we structure diagnoses, it's really intended to gatekeep and to draw the distinction between someone who might meet a criteria for a clinical diagnosis versus. as someone who's quote unquote just struggling with stress or overwhelm or feeling worried. To me, that distinction is not all that useful because in my book, it's all suffering. It's all valid.

Anybody there deserves to feel better. I think the only thing worth gatekeeping are interventions that can have risks like medication. But my approach is not something that needs gatekeeping. It's really safe. It's accessible. It's affordable. It's non-invasive. and so there's nothing there to gatekeep.

And I'm much more interested in thinking about anxiety, worry, stress. All comers are really welcome to experiment with these strategies. And to me, the distinction that's much more useful in guiding management is to think about false anxiety versus true anxiety, which we can talk about and define. But to me, that's the more meaningful distinction. And if somebody is fully lifelong meeting criteria for generalized anxiety disorder, Let's talk about it. Let's work with it.

If somebody has a subjective identification with the term anxiety, even though a psychiatrist might not diagnose them with anxiety, I say let's help that person as well. And so what is false anxiety versus true anxiety? The way I think about it, false anxiety is avoidable anxiety. And I know that that term feels so invalidating to a lot of people. You know, certainly in the meetings as I was writing this book, you know, people like my editor, my agent, they were like, is this maybe I'm triggering. If you could not use this term, I was like, it's going to be fine. But, you know, people have brought forth that feedback. And I totally acknowledge it's fair. It's not intended to invalidate the very real suffering of all anxiety. I myself lived for over a decade with what I would call false depression. And, you know, that suffering is all. too real, the false is intended to connote that it has a physical basis and there's a straightforward

path out of it. So the suffering is very real, but it speaks to the fact that what we need to start to appreciate is that mental health is often physical health. And when our body is in a physical body is in a state of imbalance and it gets tripped into a stress response, that can show up as what we're calling mental health issues. A lot of times it's these very seemingly benign, common mundane aspects of modern life that trip our body into a stress response and show up as anxiety. And the solution is not seven years of psychotherapy. It's maybe drinking a little bit less caffeine, maybe doing a little gut healing, going to bed a little earlier, maybe not bringing the phone into the bedroom, keeping blood sugar stable. It's a really straightforward remedy. And then the anxiety is something

we can just walk away from. We don't need to carry that diagnosis and that identity any longer. So that's false anxiety. True anxiety, on the other hand, is not something that we would want to medicate away. It's not something that we can gluten-free or decap our way out of. It's not something I think we should pathologize either. I think that it's really our inner compass trying to communicate to us. Something's not okay. In some corner of our life might be an our personal life, in our community, in our family, in the world at large. But it's tapping on our shoulder and asking us to slow down and pay attention and take steps to write the situation, to course correct. Can a person feel both simultaneously? Absolutely. I think the way to navigate

that best is to start out by, it's really like an inventory. You go through all the potential causes, common culprits that can cause false anxiety. You identify which ones might be at play in your life, take care of them, you're suddenly not really feeling all this false anxiety. And what remains is often our true anxiety. And then our responsibility is to slow down and have some practice for tuning in so that we can hear that whisper of our true anxiety. We've talked about anxiety as something that is closely connected to the concepts of worry or stress. But you mentioned depression. How common is it for mild anxiety and mild depression to go together? And what trends have you seen even anecdotally in the past year as we've all collectively gone through a pandemic and a

reshifting of everything we've previously understood about life? Yeah, well said. Yeah. I mean, they travel together so often and the best description I've heard was Johann Hari, the author of the book, I think it's called Lost Connections, and he describes it as depression and anxiety are like covers of the same song. And so there's a lot of commonalities in terms of our brain chemistry, in terms of how it's a, it's a brain manifesting some state of unmet needs or imbalance. And for some of us, it shows up more along the anxiety spectrum. For some people, it looks more like depression.

and some people really toggle between the two. A pattern I see frequently in my practice is that somebody is in a state of high anxiety. It's almost like they kind of burn through their reserves and then find themselves bottomed out and depleted, and that can look more like depression. Do levels change throughout the day? I mean, isn't it that cortisol spikes in the morning? Oftentimes people report having, I know myself personally I have high anxiety when I wake up, and I'm completely laid back in the early.

evenings. Is this, even in the best of cases, is this something that we can modulate or is this just how life is? Yeah, I think it's such a great insight. Anxiety can track with things like cortisol levels, which are higher in the morning and lower in the evening when they're functioning properly. For some people, we have sort of paradoxical, different kinds of spikes in our cortisol levels, which causes this own whole host of problems. And also, many of us have a habit of consuming caffeine in the morning, which can be anxiogenic for some people, creating a state of anxiety. Some of us are in a pharmacologic matter, first thing in the morning. So we sort of have gotten to that point where we've metabolized most of a medication that we take daily. And your body wakes up kind of yearning for

its next dose of something. And that's another thing I see commonly is that that creates another false anxiety is when your body's like, I'm waiting for my lexapro. And if we leave it a little too late. Sometimes that can create a stress response in the body. And so all of that mellows out as the day goes on. And for some people, that can just feel like a state of being more relaxed in the evening. But for others, they might have been kind of running on fumes and the cortisol, which was giving them energy during the day. And so then in the evening, there's almost this sundowning effect where people can have more of a darker mood, more of a feeling of despair or low energy or less of a drive. And so, you know, it can feel positive or it can feel somewhat heavy as well.

How do all of these relate to distraction, procrastination, inattention? Yeah. So what a knot that we're all living in without that. It's a different book, but I think that our relationship to motivation and attention is its own false and true split. And sometimes, we're struggling with attention because we are in a state of chronic sleep deprivation, which can be because of our habits and our lifestyle, maybe we're doom scrolling or on TikTok until 1 a.m. Or maybe we have a kind of subclinical sleep apnea or for some reason, you know, maybe we're mouth breathers and we're just not properly oxygenating our brains overnight. And then it's very hard to be fully rested and rejuvenated the next day. A lot of inattention and hyperactivity I see

relates to the quality of sleep. And a lot of times low quality. sleep has to do with low quality breathing. And so then that hyperactivity the next day is really just a tired brain attempting to keep itself awake. And it's really hard to have good attention when we're sleep deprived because that is like the highest level order human capacity. It's this part of our brain that's so ornery and fragile. And when it doesn't have everything going right, good sleep, good nutrition, steady supply of blood sugar, it kind of goes on strike. And so these are some of the false ADHDs and things like that that I see. But I think that there's this other very true inattention that's occurring where sometimes we are living in a mismatch with our work,

whether we're out of alignment with the values of the work that we're doing, or we might be perfectly aligned with the values, but it's inhumane working conditions in some way, in the ways that our time is valued or in the autonomy that we're given or all the ways that sort of corporate America is not necessarily conducive to human beings. getting their needs fully met. And so I think sometimes procrastination and inattention is the way I call it. Here's my most clinical definition is like the soul rebelling against inhumane working conditions or feeling out of alignment with our work.

And so I see a lot of my patients that that's how it's showing up, is that they're like, I wish I was more motivated. I wish I could focus. Why am I always procrastinating? But if we really look underneath the hood, they hate their job. Wow. What's uplifting about hearing you say that is that so often those behaviors, procrastination, distraction, not giving your all at what you're doing, can be sources of shame because you might think to yourself, why am I self-sabotaging my career, my work, my finances, why am I self-sabotaging all of these opportunities that have been given to me? And what I'm hearing you say is that it's the soul rebelling.

I'm so glad you brought up shame because I think there is also something in how we're raised where some of us struggle with trusting in our inherent self-worth. And so that gets really wrapped up in our perfectionism, which itself ends up being a cause of a lot of procrastination. I often have my patients say, like, I can't get started on something. And if we look really deeply into that, it's usually that they feel this overwhelming burden of its high stakes. It has to be really good. It has to be perfect. Everything's riding on this. And so, of course, who would want to get started? That's too much pressure. And so a lot of times it's kind of about the, you know, to avoid cursing about it, like a lousy first draft, getting something down on the paper so that it's not so intimidating. But I think that when we are operating from a place of feeling fundamentally unworthy or unlovable, We really struggle to step into, this sounds so woo-woo, but to step into our power, to receive

recognition for being good at our job, for creating a good piece of work or making a contribution that's meaningful to other people. I think sometimes that feels like it feels vulnerable to even try at that. And so that can unconsciously feed into our procrastination as well. a big part of how I work through this with patients is to talk a lot about there's this ancient Hindu philosophy called karma yoga where the idea here is you show up and do the right thing for the sake of doing the right thing and you remain unattached from the outcome and I think this is so healing for modern life because we are in an outcome focused society it's how much money did something make are the board members happy how many likes did something get on social media it's all focused on outcome. And outcome is actually the part we don't control. We try to white knuckle it. We drive ourselves crazy in an attempt to micromanage how we're perceived, how the outcome goes. But it's actually out of our control and not even our responsibility. And the part we do control and the part

we are responsible for is to show up and do our best. And if we do that, we can actually feel satisfied, even if something goes badly. And we can still then, rather than have it be an opportunity to give ourselves negative self-talk, we can instead say, shrug, you know what, I did my best, it's all I can do, and it doesn't shut us off from feedback. We can still hear the feedback and learn from it and grow, and next time our best is slightly better. But it completely changes how it feels when we might have ordinarily called ourselves a failure. when something doesn't go well. We instead talk to ourselves much more gently and compassionately

and say, you know what, I did my best. It's all I can do. I'll add one asterisk to that, which is that doing our best to a perfectionist, they might hear that as my best. Oh, I know what that is. Okay. I'm going to give it my 150,000 percent effort.

It's going to be airtight. I'm going to remove any possibility of failure. That's my best. And that's, of course, not what I mean by do your best. It's do your reasonable best. It's show up and do your 85% effort, something you can feel proud of, but also that you can do sustainably without getting bent out of shape. So that's the idea here. So what I'm hearing you say is focus on process, not result, and stay inside of your internal locus of control.

Beautifully summarized, yeah. You mentioned in your description of false anxiety that there are environmental factors ranging from caffeine, to smartphones that trigger the sense of false anxiety. Can you talk about various environmental triggers that the average person who's listening to this might encounter during a day and what they can do about it? Yeah. So I don't make any friends with the conversation about caffeine, but I feel a responsibility to at least open up the conversation about it. We're all really different with caffeine. Our bodies have about an average half-life of five to seven hours for metabolizing caffeine. What that means is some of us are rapid metabolizers. We can have an espresso

after dinner, no problem. And some of us are slow metabolizers, which means we can have a coffee yesterday and we're still not going to sleep like tomorrow night. It's just important to know for ourselves if we're sensitive to it. And if we, you know, we've normalized caffeine. We've romanticized it. At this point, it's our one true friend in the world and we post pictures of our lattes on Instagram. I think that part of the reason we love it so much, is that it is the antidote to its own withdrawal. So we have to recognize the reason it feels good is because it's solving a problem that it created.

And if you are someone prone to anxiety and you're drinking strong coffee and then you feel sort of shaky and tremulous, it's probably not doing you any favors. And that doesn't mean you go cold turkey tomorrow. That would be a terrible idea because there's a very real withdrawal. You get headachey and tired and irritable,

but you might want to gradually make adjustments. drink a little bit less, switch to half-calf, push it a little earlier in the day so it's not impacting your sleep. Caffeine is one. Blood sugar is a really impactful one where I find that a lot of my patients, many of us, are on a blood sugar roller coaster because the modern American diet is refined carbohydrates and coffee drinks that are actually milkshakes and rosé all day. And so where blood sugar spikes, the insulin chases it, and then our blood sugar crashes.

And the design of the body is to respond to that bloodshakes. blood sugar crash with a stress response. And that's just how it works in our body, but that stress response can feel exactly synonymous with anxiety or panic or feeling easily overwhelmed. And so you want to avoid that unnecessary anxiety by avoiding the blood sugar crash. And that can be achieved through a definitive solution of eating a much more blood sugar stabilizing diet, real food, more healthy fats, better protein, starch utubers rather than sugar, refined carbs. But there is a hack that a lot of my patients feel drawn to because they feel overwhelmed

by the idea of a total diet overhaul. And so something like a spoonful of almond butter, you know, in the morning, early afternoon, before you brush your teeth at night, can create a safety net of stable blood sugar that'll blunt any superimposed blood sugar crash. And technology, there's a lot that can be said about that. You know, everything from compare and despair and the opportunity cost of not spending that time connecting with people in real life. But one of the aspects of our phones that I'm most focused on is the impact on our sleep, which in turn directly impacts our mood and our anxiety levels. The solution there, I believe, is just to make sure that we don't bring our phone into

the bedroom, that it doesn't live on our bedside table at night while we sleep. That can feel like an intimidating change to make, but you can pilot it. You can set up your charger somewhere else in your home, kiss your phone good night, and then try going into your bedroom at night and reading a paper book or doing a little journaling before bed. And what happens is that then we're not scrolling with that, you know, the way it has no stopping point. So nothing ever cues us to say, oh, you know what, look, I got to the end of TikTok. So it's a good time to go to bed. And then the blue light that's emitted from our phone screens disrupts our circadian rhythms,

suppresses our melatonin release. There's so much about the phone that is disruptive to our sleep, and having it outside of the bedroom is really protective to good sleep and good mental health. So what strikes me, as I hear you talk about screen time and sleep and nutrition and caffeine, these are changes that are, I don't want to say easy to make, but they are within our autonomy to make. Whereas, as you mentioned earlier, if a source of your anxiety is that you're in the wrong job, or you have a toxic work environment, you have a boss who yells at you publicly, for example, or you're working for a company that has a mission that you don't believe in, technically, sure, that's within your autonomy to change it, but it's higher hanging fruit. What can a person do if they feel that those harder to change factors are the source of their anxiety?

Yeah, and I'm not sure I have the answer. I think that it helps to start by eliminating the avoidable anxieties because everything is harder if we're running around in a physiologic pinball machine and we're constantly in and out of stress responses. So once we really ground our body physically and we're no longer in unnecessary, stress response and stress response-induced anxiety, we get more clarity, we feel a little bit stronger on our two feet, and then we take a survey of our life. We say, okay, here's what's working, here's what doesn't feel right. And I think at that moment, it's deep breath. It's big step is just to be honest with ourselves about the inconvenient truths. And then we do the next right thing. We just take the first step. We don't boil the whole ocean at once. We don't try to solve everything

overnight. But we also don't want to despair and feel completely victimized or stuck. We want to think about it as what's one change I can make. With my patience, I might secretly harbor a feeling that they're in the wrong job and ultimately they might need to get out of that job. But it never hurts to advocate for our needs, especially if we think where this might be heading is leaving a job, then what have you got to lose by going in and saying, hey, manager, here's what's not working for me and it's making this untenable? And I think that when you start to speak up and advocate and say, here's how you can help make this a win-win, you never know. But sometimes people really work with that. And sometimes they don't. And there's your clear.

It just makes it that much more clear that you have to take steps and make a change when it's possible. But I have a lot of patients who operate from a place of our conditioning to be people pleasers, to assume that we don't have any leverage, that we feel a little disenfranchised and asking to have our needs met. So we just assume that this job is bad and it's going to be bad and I either have to leave or stay and be miserable. And I think there's usually more middle ground. there's perfectionism that comes into play here where people feel like, well, I can't do that because my boss will be disappointed in me. And again, these are all things along the path towards leaving is the ultimate disappointment, right? So if you're trying to make something work, being in that gray area and trying out different intermediate solutions, it's a great, it's a great skill to practice. And I have a lot of patients who need encouragement to start exercising boundaries with work.

and they fear like not being seen as committed or as motivated or they fear being seen as lazy. And it's somewhat surprising. But what you see so much more often is that when they stop answering an email at 11 p.m. Or they stop getting the project done on Saturday night, rather than getting fired or having somebody be mad at them, it's almost like they start to be viewed as having kind of, mature boundaries. There's almost like an admiration that develops. And we train our coworkers to treat us really the way we respect our own boundaries. And so it usually goes better than people expect. We'll come back to this episode in just a minute. But first, Fifth Third Bank's commercial payments are fast and efficient, but they're not just fast and efficient. They're also

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Wayfair's Black Friday deals for up to 70% off. That's W. W. W. W. F-A-I-R-com. Sale ends December 7th. On the topic of lack of work-life boundaries, one point that you make in your book is that the fact that we are accessible 24-7 creates a lack of boundaries. In our leisure time, we can still be contacted. But vice versa, when we are at work, oftentimes we slack off because the boundaries between when we're working and when we're not are just so fuzzy.

Yeah. Particularly with so many of us working from home now. With regard to the behavior gap, I mean, sure, there are the obvious tactics of choose a start point, choose an endpoint, put on work clothes, have a tradition that you do at the end of the day that signals that you're finished with work for the day. I think we've all heard these tactics, but that self-enforcement of those tactics. That can be incredibly hard to execute. Do you have any tips for that? When we think about like, why am I not focused? Why am I procrastinating or distracted during the workday? We focus on that and we think, let me use my mind vice to solve this problem. And I think we actually should be putting our focus on our leisure time and completely reframing it and starting to value our leisure time and to fiercely and unapologetically protect our leisure time.

And so it's by protecting our leisure time and saying, this is the time of day I'm done with work. And this is the weekend. And it's sacred. And I don't actually check my work email. Because even if just glancing at that email, even if I wasn't going to do anything about it, that glance is not free. It gets into our mind. It steals the leisure from that moment. And when we don't protect our off time, it's really hard to be completely on.

And that's why we find ourselves so distracted. because we're depleted by the time we show up at our desks Monday morning. And it's by protecting the time and letting ourselves be truly off that we're actually restored. So we can show up fresh, creative, motivated, and engaged. What should a person do if the source of their anxiety is something that is entirely out of their locus of control? So, for example, the stock market. I think stepping back and, contemplating the illusion of this reality.

I don't know. I understand that we live in a world where we need money for survival, but I think that we have to be so proactive and cognizant of our own priorities and values. And I think this world really seduces us into all kinds of junky values. And a lot of times earning more money, kind of wanting the big wins, all of that is wrapped up in junkie values. So therefore what? So therefore you can sort of get nicer things or dazzling objects or impress your neighbors,

all these different things. And none of them create happiness or enduring calm. And it's really in getting our fundamental human needs met that we create happiness and calm. And they have very little relationship to the stock market. It's community. It's love and feeling heard and seen and understood. It's time in nature.

It's rest, it's play, it's laughter, it's pleasure, and, you know, a little bit of nourishing food and sunshine. Sometimes, I think, wrapping up our anxiety and things that have very little to do with our fundamental human needs, we've really lost the plot of how to live a fulfilling life. That, frankly, that makes sense to me when the conversation pertains to people who have enough and are trying to go from enough to more. Yeah. But certainly there are many people whose anxiety is that they're buried in student loan debt, they've got credit card debt, they're worried about their parents' retirement or their grandparents' retirement because they see that the elder generations in their family are insufficiently funded. They're worried about how they're going to pay for their child's daycare because the cost of daycare is so high that it's questionably may or may not be worth. the cost of them even going to work. When a person is facing that many financial stressors,

these concerns create real anxiety, and yet there's also this pervasive sense of helplessness. Yeah, so this is very, very true and important. I'm so glad you brought it up. The whole everything I'm saying about the stock market, which in some sense, when I hear that term, I think about going from a have enough to wanting more. And there's, There's this other enormous segment of the population, which is from not enough to having enough. This is a source of very true anxiety. That's not something solved by going gluten-free. That is not something solved by just saying, hey, I'm a fulfilling life, is sunshine a community.

What can a person do if that's the situation that they're dealing with? And of course, this is a finance podcast. So a lot of people come to this podcast initially, because, there's some financial issue that they're trying to solve, whether it's, sometimes it's relatively common or benign, like I've got student loan debt, I'm trying to figure out how to pay it off. Sometimes it's more complex than that. Sometimes it's aspirational, whereas other times it's reparative. But everyone listening has some type of financial goal. How can a person take the concepts that they've just learned from the discussion that we've had, concepts around

the relationship between anxiety, depression, procrastination, motivation. How can a person take this basket of ideas and apply it to solving this problem in their life, given that major parts of that problem, are outside of their locus of control? I'm not sure I have the answer, I think that in a sense, working through all of the avoidable anxieties doesn't hurt. It helps, but it also, I make no, I have no delusions that it solves the very fundamental true anxieties. So I think that if you are grappling with financial insecurity, food insecurity, housing insecurity, all of this, solving your avoidable anxiety, it doesn't actually solve any of that.

But I think it does help us meet those challenges with more resilience. And that at least allows us to kind of roll up our sleeves and say, let's tackle this challenge. Many people who are listening to this experience anxiety or the Sunday scleries because of that disconnect that they have with their work. They don't believe in what they're doing. They're burned out. Their boss is a jerk. For people who are listening who are fortunate enough to not be in that position, how do we prevent getting into that situation in the first place? Yeah, let me take a couple different layers to respond to this question.

Okay. I first want to attack the idea of Sunday Scaries. Not attack the idea of it. Let's attack the problem about it. I think of the Sunday Scaries as having a false anxiety and a true anxiety component to it. There is something unique about Sunday night where there's a confluence of, different false anxieties coming together. Many of us exist with a kind of social jet lag over the weekend.

Maybe we're going to sleep at 10.30 or 11 on weeknights, and maybe it's more like midnight 1 or 2 a.m. on weekends. So Sunday night, we're trying to almost like change time zones back to get enough sleep before the alarm goes off Monday morning. And then we have different habits on the weekends. Maybe we ate at a restaurant or ordered takeout. Maybe we ate foods that we might not ordinarily indulge in and the more routine ways that we eat during the weekdays.

And then there's sometimes more alcohol. There's sometimes free refills of coffee at brunch. There's sometimes all these different things that are going to contribute to a physiologic state of imbalance on Sunday night. And that's not helping us. But then I think there is also a true anxiety component to Sunday Scaries where it dawns on us that we are heading into a week of work. And if we are out of alignment with our work, if there are inhumane,

working conditions. If anything's not quite right there, if we're not sufficiently rested, then our soul rebels once again. And it says like, hey, we're heading into something that does not feel good. And I think anybody who, like, take for me, for example, I've been in jobs where my soul really rebelled against it, where I didn't feel treated well or I didn't feel valued, and I was having some serious Sunday scaries. I'm at a phase in my career now where I love what I do. And I'm passionate about it. I have some autonomy and locus of control. So there's a lot about it that's not, my soul doesn't rebel against my job at all. But Sunday night, there's still that feeling, of course, of like, oh boy, here we go. And I think in many ways it's a habit at this point that I have to retalk,

I have to talk to and reframe Sunday night and be like, no, I'm just going to get into the rhythm. It's going to feel good this week. It's going to be engaging and I'm going to make a meaningful impact. and I have to remind myself that here's what I love about what I do. Something I see a lot in my patients. There are so many different ways that we rebel against our jobs. And I have a lot of patients where it's almost like they're living for somebody else's goals. I have a couple examples right now in my practice where my patients are children of immigrants. And there's this really interesting evolution of what goes on there, where their parents immigrated to the United States, often with nothing.

and worked tirelessly to go from a place of scarcity where it felt like survival was at stake to some semblance of having just enough and creating the conditions where their kid can have a good education and opportunities and access to good employment. And so those are my patience. And it's a lot of pressure. It's a lot of pressure. And a lot of them are in jobs that pay the bills and satisfy the parent-prudely. pressure, but don't address their passions, what they want to be doing, the contributions

they want to be making. Part of that is there's like fear or shame around disrespecting parents if they decided to leave this career path and do something different. They fear the retribution and the anger. But there is also something around the fact that they have inherited a scarcity mindset. It's really strong. It's why wouldn't you do anything but work as hard as you can. maximize on making as much money as you can, that that is the sole priority.

The interesting thing that can evolve sometimes, if we're lucky, is that parents lived by that scarcity mindset and then created the conditions for the kids to have a different set of circumstances, a state of relative abundance. And then the priorities can and I think should reassemble a little bit. And at that point, it's no longer the right strategy. to just prioritize making as much money as possible. At this point, in a way, what did the parents fight for? It's to create a different life, a better life in many ways. And now these kids have the ability to say, well, I want to balance my priorities.

On the one hand, I want to make enough money so I have enough so I don't have to be stressed about it. But on the other hand, I want to help people. Or I want to do this thing that I'm passionate about. Or I just want to feel fulfilled in a slightly different way. or maybe I want to rest because I'm burned out. And I think that it's a more complex balancing of priorities. That's sometimes what's being asked of us if our parents created a state of relative abundance for us.

Right. Well, what's interesting about this is that within this discussion is the unstated premise that career selection is based not just on monetary gain, but also on prestige and identity. And so realizing that you are in a career because your family or your society wants you to be in that field, not because it's what's right for you. The questions that come up around that are not just financial. They're also tied to a grappling with the concepts of reputation, prestige, identity, and overall worthiness. it's one thing if you're, and I say this as, I'm technically a first generation immigrant, but I came here as a baby. So I say this as an immigrant and child of immigrants.

There is sort of this notion that it's one thing if your parents sacrificed so that you could become a doctor, but it's another thing if they sacrifice so that you could be a podcaster, right? Let's talk about that. I love this. It's interesting to think about how societies have their ways in a very pro-social way of trying to positively reinforce good pro-social behaviors, right? We put valences of prestige on careers that require hard work, that require helping people. You know, it's not just about making money. You're absolutely right.

Prestige sort of follows a lot of different things that we're trying to say as a society, strive toward this. and that's why we attach that prestige to it. Part of what the struggle here is that we live in a really different moment right now where a doctor, that one's easy, right? We're like, oh, you're a good person, you're a doctor. A podcaster is more complicated. Well, okay, what does that mean? What does that look like?

In many instances, it's actually a massive contribution and it's absolutely prestigious. But the term we haven't necessarily arrived there yet. And I think that there's this other thing, which is that we so want our parents' approval and our feeling of self-worth is wrapped up in it. Of course, because it feels like these are the people who biologically are forced to love me on some level and know me and see me particularly deeply. So if they are giving me the thumbs up, that feels really validating, really grounding.

I am okay and worthy as a human if my parents approve of what I'm doing. And if they don't, it's a devastating feeling. And I think sometimes what we have to do in adulthood is see our parents for the complex products of their own conditioning that they are. And sometimes they can't help, but what they really mean when they say, like, I want you to be a doctor is I want you to be okay. I want you to be happy in your life and have enough. And I wish this for you because I love you. And I don't know another way to communicate that other than have a good career like this. But if we can demonstrate like, but I am okay and satisfied in my work and I have enough and I'm making a contribution and I'm fulfilled in another way, they might not know how to recognize that.

And so they can sometimes withdraw their approval inappropriately. and I think that we as adults do have, let's call it a responsibility and opportunity to remind ourselves of our own inherent self-worth, whether or not our parents are able to reflect that. Sometimes we can read between the lines of their approval or their disapproval and see that it all comes from love. Sometimes it doesn't. They're absolutely imperfect dynamics here, but parents are products of their own conditioning, and they sometimes do. don't know another way of communicating love, communicating caring. It's what they learned. And so sometimes we really have to do it for ourselves to remind ourselves, even though they don't get it, I am worthy of love, and I know that I'm on the right path.

And to expand this out so that it doesn't just apply to children of immigrants, but to everyone listening, there are, I imagine, a multitude of reasons why people will go into a career or will buy a house or will buy a car or will make or will marry the wrong person or will make some type of life altering decision because it's what society expects of them not because it's what they want and in addition to that sometimes they then rationalize that decision to such a point that they internalize that rationalization and convince themselves that this is what they want even though deep down there is a quiet voice that knows otherwise. So to everyone who's listening to this, who can relate to that description, what next?

What do you do? Yeah. Oh, take us there. So here's the thing. Wouldn't it be interesting if in like third grade we shaved off one or two days of learning about fractions and instead learned about knowing ourselves and being okay with who we uniquely are. And I think one problem is that we do have cultural conditioning that tells us we should all strive for similar best case scenario, careers or love matches, that here's what it

looks like on paper. Those careers or those partners might be right for some people. They're going to be wrong for so many people. And the fact that we're all trying to strive for that same goal gets a lot of us off course. And what we really need to practice is not recognizing on paper or on some absolute scale, this is what is a good job. But really, here's uniquely who I am, what I'm about, that's valid. And I need to figure out what's the lock and key, hand and glove fit out there. And not saying it's an easy journey to identify that in our career, in our partner. But I think at the very least,

societally. We can be giving each other permission to seek something that doesn't necessarily look like what everyone should be striving for. It's what feels absolutely right to us as individuals. And I think that the movie Enkanto is actually doing a really nice job. I've never seen it. It's a new Pixar movie. It might be Disney. I'm not sure which. And it is really great. And look, it takes characters. There's a character, Isabella, who through conditioning and really like family expectation thinks that she should be with a particular kind of partner. And it required her to wake up to her own interest

to realize like, nope, I was doing that for somebody else. And there's another character, Louisa, who exists to serve and take care of everybody else. And she was barreling towards burnout. And she needed to recognize in herself, here are my needs. And it is okay for me to accept rest. And I think that it's a really nice moment that we're in a kids movie showing people you're going to be subject to certain amounts of cultural conditioning telling you here's what's expected of you. And you also need to listen to yourself and to your own needs and your own desires.

And they also matter. We'll come back to this episode after this word from our sponsors. There's a lot of popular press right now that states that we are going through an epidemic of anxiety. and that this has been amplified and exacerbated by the isolation and stresses of the pandemic. Can you talk about this epidemic of anxiety and what we can do to address it? I think that one consideration when it comes to structuring our financial lives, our careers, the balance of priorities in our lives, is that we have a culture right now, which I think has become, it's been exacerbated by the pandemic,

and working from home and social distancing, and all of those blurred boundaries between work and life, we are even less oriented around community than we were before. This is playing in on a really fundamental level to our epidemic of anxiety. And this is just part of our hardwiring on the proverbial savannah of evolution. We were not the species that was the fastest. We were not the strongest. We were just the ones who figured out how to cooperate.

And because of that, it's inbuilt for us that we feel safe and protected when we have a sense of belonging, when we are part of a community that's cooperating with each other. You know, not to mention the fact that we're so hyper polarized, there have been so many rifts among families and friends as we all feel so strongly, politically, and feel like we've diverged from other people that we know. I think that we just need to get back to a place where we prioritize community above other aspects of our lives, that we really think of that is kind of one of the most important things for our well-being. And when we talked about the sort of unsolvable true anxiety around financial insecurity, I actually do believe that community plays a really important role there. So when we get back to a deeply interconnected sense of belonging, what we do is we cooperate and our survival hinges on it.

And I think when we're really connected to community, we step up, we help each other. We don't feel so alone. It doesn't feel so much like we are dangling over a pot of boiling water at all times. We have a little bit of that communal safety net. And I think that that's something really essential right now. And it pertains directly to why so many of us feel so anxious because we're so disconnected from each other. And how does a person form community in a world in which all your friends are busy? Yeah, it's so hard.

Everything else in my book, it's like, you know, here's your three steps. It's an actionable strategy. Community, the most true thing I can say is prioritize it. How we actually go about having it and achieving it, it's harder. One thing I can say at least is that in my own life where everyone's busy and, you know, I'm at the point where a lot of us have kids, and it's so easy for that to become the thing that gets cut from our lives. I think a lot of us actually just have to lower our standards for how we commune. And what I personally do a lot of the time is I think I want to spend time with the people that I love.

So I know I'm going to have people over. And rather than thinking of this as, oh, man, I better clean up the house. better cook a meal. I better look like I didn't just get hit by a truck. As you can see, right? I better break out the fine china. Like I put no barriers to hanging out with people. And at this point, I don't even have to warn people. They just know the expectation is you come over. I'm going to be an athleisure. There are going to be Legos everywhere, try not to step on them. And we are going to eat takeout. There's really no activation energy. And it's not about those trappings and those are beautiful things like if that's your love language to make somebody a meal

that's a wonderful thing but if the effort and time involved and planning stands in the way of social connection scrap it save that for a different phase of life and order take out and have people come together because the real main event the main course of that is just being around the people that we love sharing in an experience processing what we're going through feeling connected. And so I think there are ways to lower our standards, remove the barriers, and just kind of build it and they will come. Make it as low friction as possible. Yeah. Thank you for spending this time with us, Dr. Vora. Where can people find you if they would like to know more about you and your work? I'm pretty active on Instagram. I'm at Ellenvora MD, and my website is ellenvora.com,

and then they can take a look at my book, which is called The Anatomy of Anxiety. Thank you, Dr. Vora. What are some key takeaways that we got from this conversation? Here are three. Number one, there are multiple reasons why you may lack motivation, lack attention, lack energy, find yourself procrastinating, why you may struggle to concentrate. One potential reason or set of reasons could be internal. It could be that your body needs better nutrition and better sleep.

Our relationship to motivation and attention is its own false and true split. And sometimes we're struggling with attention because we are in a state of chronic sleep deprivation, which can be because of our habits and our lifestyle. Maybe we're doom scrolling or on TikTok until 1 a.m. Or maybe we have a kind of subclinical sleep apnea or for some reason, you know, maybe we're mouth breathers and we're just not properly oxygenating our brains overnight. And then it's very hard to be fully rested and rejuvenated the next day. There's a second set of reasons why you may lack motivation or why you may be procrastinating. And that set of reasons are external. It may be that you're

not in alignment with the type of work that you're doing. Either you're in the wrong career or you're in the right career but the wrong company or organization or working with the wrong set of colleagues or the wrong managers. And so it may be that your work environment is not conducive to you making full use of your skills and talents. But I think that there's this other very true inattention that's occurring where sometimes we are living in a mismatch with our work, whether we're out of alignment with the values of the work that we're doing, or we might be perfectly aligned with the values, but it's inhumane working conditions in some way, in the ways that our time is valued, or in the autonomy that we're given

or all the ways that sort of corporate America is not necessarily conducive to human beings getting their needs fully met. And so I think sometimes procrastination and inattention is the way I call it, like here's my most clinical definition is like the soul rebelling against inhumane working conditions or feeling out of alignment with our work.

And so if you find that you lack motivation that you're procrastinating, that you aren't showing up to your work as your best self. Look at both factors, internal and external, your inner health and your environment, to try to figure out what your procrastination is telling you, which is the culprit, is it one or the other, or both. So that is key takeaway number one. Key takeaway number two, if and when you do decide to make some type of change,

whether you're switching jobs, making a midlife career change, retiring, moving to a different city, or in a less traumatic fashion, changing up your day-to-day lifestyle, the rhythms of how you spend your days and weeks, whatever change you make, don't overwhelm yourself by trying to do everything all at once. Go one step at a time. And then we do the next right thing. We just take the first step. We don't boil the whole ocean at once. We don't try to solve everything overnight, but we also don't want to despair and feel completely victimized or stuck. We want to think about it as what's one change I can make. With my patience, I might secretly harbor a feeling that they're in the wrong job and ultimately they might need to get out of that

job. But it never hurts to advocate for our needs, especially if we think where this might be heading is leaving a job, then what have you got to lose by going in and saying, hey, manager, here's what's not working for me and it's making this untenable. And I think that when you start to speak up and advocate and say, here's how you can help make this a win-win, you never know. But sometimes people really work with that. And sometimes they don't. And there's your clarity. Like it just makes it that much more clear that you have to take steps and make a change. As Dr. Vora says, don't boil the whole ocean at once. Make small changes go one day at a time, one step at a time, and over time those small changes will compound.

On this podcast in previous episodes, we've talked about the notion of being 1% better. And if you are constantly making 1% improvements, and you're doing so in the most critical areas, in the areas that serve as lead dominoes, then those small, improvements in the arenas that matter most have an outsized effect. And so that is key takeaway number two. Finally, key takeaway number three, don't live someone else's life. One problem is that we do have cultural conditioning that tells us we should all strive for similar best case scenario, careers or love matches, that here's what it looks like on paper. Those careers or those partners might be right for some people. They're going to be wrong for so many people. And the fact that we're all trying to strive for that same goal gets a lot of us off course. It is tempting,

whether consciously or unconsciously, to make decisions based on what society wants us to do. But when we make those choices, we are living a script that someone else wrote, not the one that's our own. And the consequence of that is that we will never bring our own talents, skills, unique gifts, we will never be able to share those fully with the world if we are living under someone else's script. So living a life, a career, a set of choices that is true to us, that's not only good for us, it's also best for facilitating our ability to make amazing contributions to society. And so that's key takeaway number three. Don't live someone else's life. Those are three Takeaways from this conversation with Dr. Ellen Vora. You can learn more about her work in her new book,

The Anatomy of Anxiety. Thank you so much for tuning in. If you enjoyed today's episode, please do three things. Number one, most importantly, share it with a friend or a family member. That's a single most important thing that you can do to spread the message of great financial health and making smarter decisions about your life. Number two, open up whatever app you're using to listen to this podcast and hit the follow button so that you don't miss any of our awesome upcoming shows. And number three, while you're there, please leave us a review. I want to give a shout out to some of our recent reviews on Apple Podcasts. Yamaman wrote, quote, the thoughtful thought process in everything is great.

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