HealthyGamerGG - How to Succeed with Anxiety w/ @LaurDIY

Episode Date: July 12, 2025

In this episode, Dr. K sits down with YouTube creator LaurDIY to talk about managing anxiety while chasing big goals. They get into how anxiety shows up, the fears that hold you back, and real ways to push through. You’ll hear: LaurDIY’s personal experience juggling creativity and mental health What anxiety really feels like and why it stalls progress Dr. K’s suggestions for calming your inner critic Practical tools you can start using today, like shifting your focus, structuring your routine, and practicing kindness toward yourself If anxiety has ever slowed you down even when youre being really productive. This chat offers honest stories and useful advice to help you keep moving forward. Learn more about your ad choices. Visit megaphone.fm/adchoices

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I'm Dr. Alokanojo, but you can call me Dr. K. I'm a psychiatrist gamer and co-founder of Healthy Gamer. On this podcast, we explore mental health and life in the digital age, breaking down big ideas to help you better understand yourself and the world around you. So let's dive right in. Okay. Chat. Let's get started.

Welcome to another Healthy Gamer Gigi stream. My name is Dr. Alok Kanoja. Just a reminder that although I am a medical professional, a psychiatrist, nothing we discussed on stream today is intended to be taken as medical advice. everything is for educational or entertainment purposes only. So today we have an awesome interview with Laura D.I. We're going to be talking a little bit about her journey as a creator, her mental health challenges and triumphs. So really looking forward to that interview. So without further ado, let's hop in. Give me a second. Okay. So welcome. Hi. So what do you?

go by? Lauren or Lord DIY. Okay. So is it okay if I call you Lauren? Yeah, yeah, of course. Okay. So can you start by telling us a little bit about what you do on the internet and where we can find you? Yeah, absolutely.

I've been on YouTube for 13 years. I'm essentially like an internet fossil, I feel like. So I started with DIY projects of like little do-it-yourself crafts and like how-to tutorials. and eventually transitioned into vlogging and kind of like a lifestyle creator across all the platforms. But yeah, it's been 13 years and I'm still tracking away. That's awesome. So when you say lifestyle and vlogging, can you explain to me what that is? Yeah.

It's essentially like documenting parts of your life to share with your audience. I would say is like the best way to encapsulate it. So, for example, I just went on a wild bachelorette in Las Vegas this past weekend for a girlfriend. And so it's like, you know, vlogging the things that you're wearing, the things that you're doing, you know, like unboxing different parts of like the goodie bags, et cetera. So it's just like, you know, choosing to share different parts of your life with your audience. And can you tell me about The Bachelorette? What was that like? Oh, my God.

Honestly, I'm someone who I would feel like I think identifies as like an ambivert, so I'm not necessarily an actual. extrovert or an introvert, but like I definitely need time to recharge the social battery. There were 16 of us, girls and gays in Las Vegas over about three and a half days. And it was, it was a lot. It was a lot. It was so much fun. But I'm 31 now. And I, my social battery is not what it was when I was in university in terms of partying and going out and drinking. I kind of like one of those people that can, I can, I can really rally for a nighttime event or a daytime event, but you don't get me for both. Okay, gotcha. I like the word rally there. It's like, you know, you have to like marshal your resources and sally forth into socializing. I can sally forth into

socialization at 100% enthusiasm for a nighttime event or a daytime event, but you might get 50-50 for both. Yeah, that's cool. And so it sounds like there were 16 people there. And what is that? I've never been to a Bachelorette party in Vegas. Can you tell us a little bit? And I understand. And we can just check out your vlog. But what was it like? Yeah, yeah. I mean, it was so much fun. It was a great, I would say like the bride is such a wonderfully wholesome individual that she's

really attracted equally great people in her life. So shockingly, not a drip of drama. I feel like when people hear like 16 people in Las Vegas with mixed with alcohol, you're like, oh, that sounds like an absolute nightmare. But it honestly was so wholesome and wonderful. And I feel like when you get married is one of the times in your life when everyone clears their calendar to make time and prioritize attending that event. So it was really, it was honestly, it was so nice. That's great. It sounds like it was a lot of fun. What kind of stuff did y'all do?

We, um, I'm not sure if you're familiar with Magic Mike. Yeah, it's a, it's a stripper show. A stripper show, yeah. So we did the Magic Mike show, which honestly, like, was such an incredibly, uh, impressive show. Like, I thought it was going to be just like, you know, this. standard like stripper hot guys abs the the whole you know what you would expect but it was it was amazing so we did that we did a day club we did a um a nightclub a few dinners a PJs and persico her roommate of honor did a great job of like planning all the themes et cetera so it was like mermaids and matrimony so i i know that that's not you might not find yourself at a mermaids and matrimony day club in Vegas but that was the gist of it yeah so what is the day club

A day club is essentially I would like a nightclub, but it's light and you're at a pool with a DJ. Okay. That sounds so much better than a nightclub. Honestly, it's my personal preference over a nightclub for sure. Why is that? What do you like more about the day club? I like being in bed by 10.30 p.m. It is essentially, if I say, well, how that rounds out.

That sounds great. I too like being in bed by 10.30 p.m. Unless I'm gaming, in which cases, you know, sometimes we have late nights. But that's so interesting. So, you know, just hearing about this, Lauren, it seems like my first reaction, like, not in a bad way, is that I'm part of a different world than you are. Like, my life is just very different. And, like, not in a bad way at all. So it's, I'm really looking forward to understanding what, what your, like, people, like your side, how you all, it's like, it's interacting with a foreign culture for the first time.

Yeah, an alien, an alien species. Yeah, it's great. So I'm really looking forward to this. So can you tell us a little bit about just how you got to where you are? So you've been doing YouTube content. You said you're 31. So you started when you were 18 and you started in 2012. So that was like before it was cool. Yes. Oh yeah. Before it was cool. Before it was like, yeah, way before it was cool. It was when people were doing it for a hobby. Like I feel like, you know, the positioning of social media has shifted so much now where a lot of people go into it being like, oh, I want this to be potentially my career. Yeah. But back then, 13 years ago, I was in my first year of university. The program that I entered into wasn't quite as creative as I had anticipated. And so I was really just looking for a creative outlet. So I started a blog first back when blogs were still a thing. And it eventually transitioned to a YouTube channel. And I kept it up until I graduated. And by time I graduated, I was making enough revenue for it to be my full-time career. Wow. That was in Toronto, so I'm Canadian. So I graduated from Ryerson, which is actually, it got renamed. So it's called TMU now. But graduated, got my immigration sorted, and then moved to L.A.

about six months after I graduated. Okay. And have been here ever since. And what was growing up like for you? Honestly, my husband roast me for this all the time because I had such a wonderfully sheltered childhood. My parents are still together. They love each other. They just got back from a beautiful trip in Hawaii.

I'm an only child. And we have, I'm so lucky. I just have such an incredible relationship with my family. And I grew up in like a very communicative household. What does that mean? Although like I feel like I as I grew up, I realized that there were so many of my peers who never learned how to, like their parents wouldn't apologize to them.

or they felt like they were to blame for things that went wrong in their parents' lives. I just feel like I was so lucky to have such, my parents just had such, I guess, my mom worked in not only healthcare, but also in like management. So I feel like she was so great at dealing with people and building and flexing that muscle of people's skills. So I feel like she was such a great pillar of building that communication tool within our own household. as well. So when there were issues, it was never, like, there was never like a, am I just going to, you know, just get over this and not address it? And so I feel like that's been such a great pattern throughout my entire life from such a young age. But yeah, I was, I was incredibly

sheltered and my parents were wonderful and I am so, so lucky because I know not everyone has that privilege. What do you mean by sheltered? Like, I think I never had, and again, this is also too, I feel a, just like is up to timing as well. But like I never had to process any kind of really intense trauma or when things did go wrong. I feel like my parents did a, and whether this set me up for success later on in life, but I feel like they did, they put in a lot of effort towards sheltering me from understanding how severe something was.

So my mom was hospitalized when I was in maybe grade six or so, grade five maybe, with what I later found out was like a much more serious kidney disease. And they, I feel like, withheld the truth to spare my worry and anxiety at that young of an age, maybe thinking that I wouldn't be able to understand it or process it and they didn't want to scare me. And so I think later on, maybe it backfired a little bit because when I encountered like my very first traumas, I was like, oh my God, I don't have any tools on my tool belt to like process these things.

but I think that they did a really good job of feeling like everything was always okay for the most part. Oh, interesting. Okay. And so it sounds like they were very protective of you. Oh, for sure. Yeah. Yeah.

Okay. And so and then going off to college, you mentioned that you mentioned something like when things got hard for you, you felt like you may not have had. the skills to handle it. Can you tell us a little bit about that? Yeah, yeah. So I had, um, um, I had a one of my first like serious relationships, well, you know, what feels like you're serious when you're 17 or 18. Um, we had been dating for maybe five, six months and he had like this big medical emergency where he had a seizure. He went into a coma for three, four days. And it was like the very first time that I feel like my body really like went into shock of being like,

my God, things are not okay after having had such what felt like a stable life beforehand of everything is okay. And so, you know, like looking back when my mom had been sick, I think about like maybe if that had been, you know, processed differently, I would have had, you know, some more tools to be like, oh, this is a familiar setting. I've been in a hospital before. I know what this feels like. Medical professionals, we trust them. They're very, very smart and educated. But I think that that was like the very first big thing that happened to me where I was like, oh, my body doesn't know what to do with this information and how to process this. That's such an interesting way to describe it. You said, my body doesn't know what to do with this information and how to process that.

That is almost something that I never hear people say. I don't know how else to put it. Like, because most people, they'll be like, oh, yeah, this happened. It sucked. Like, you know, I, you know what I mean? Like they don't, it was hard. They don't, they don't use such specific language. So that implies to me that you, you've learned a lot about this. Oh yeah, years of therapy. Yeah. So, or do you feel comfortable talking about that?

Oh, yeah, yeah. I'm a totally open book and I've always been online about, um, my own mental health. And I think also, too, a big part of vlogging because I'm quite transparent about, you know, what is happening in my life sometimes includes, um, a recap of a panic attack that I had on an airplane or when things are good and when things are bad. So how did you start that journey? Can you specify which part of the journey? So you say you're open to talking about your mental health.

So here I'm envisioning Lauren is a 15-year-old girl who's in high school, has a sheltered existence. Mom and dad are super nice, super supportive. They communicate when they make mistakes. They don't blame you for things that are going wrong in their life. right so everything is good you have this like experience with this boyfriend where he has a seizure he's in a coma for like four days you're kind of spiraling maybe or something i'm not quite sure and and so um and so even at that point do you remember what it like felt like like what were you experiencing sure your body didn't know how to handle it or process it but what was your

experience of it i mean i think that the best way to describe it was like loss of control right I think being like a very like type A individual too. Like there's so many things that I do in my daily routine to like mitigate risk and feel in control of certain elements of my life. And so I think like that was the very first time where I was like, oh, there is absolutely nothing that I can do in this moment to mitigate any risks to change the outcome. And I am full hands off in this situation, full loss of control. And that sounds terrifying. Right, exactly. And so also like at that age too, when it's like you feel like you're in love for the very first time, like it was just such an overwhelming emotion. Again, my body just didn't know how to process. Oh my God. So you're in love for the first time. You're in love. This is the one. And then suddenly this person has seizures in his coma. This sounds like the makings of a terrible romantic tragedy. Right. Exactly. Right. Could have been a movie. Yeah. Absolutely. It's never too late. So. So. So. So. Yeah, so and how did you handle that at the time?

I think leaning into my support system was, I think, the main pillar of being able to process a lot of that. My parents were wonderful, dropped everything, came to the hospital with me, and we also, like, essentially he got transferred to, so I lived in a city called St. Catharines. It's just outside of Niagara Falls. It's about an hour, hour, half from Toronto. So he got transferred to, like, a more serious hospital. hospital in Toronto. So my parents like dropped everything. We drove to Toronto, um, stayed overnight, et cetera. Like they were just so supportive of being like, oh, this is serious and we're treating it as so. Um, but yeah, it was really, it was really the support system of like friends and family.

I think that was, I think the, the first time that I'd really had to like lead into that in like a bigger way. Wow. Okay. And so what, what, when did you start to think that you maybe needed to engage in mental health support more formally like therapy or something like that? My mom encouraged me in high school. I would say in grade 11 or 12 maybe to give therapy a try. It was also covered because she again works like in health care. So like that was great. And so it felt like I had a lot of resources kind of at my disposal, which was so nice.

And again, I know not everyone has the privilege of it. But I was in therapy. I think it was maybe grade 11 or 12 to not only process a little bit of like what had happened with that boyfriend, but also to talk about like via metaphobia that I had also been, I think, starting to identify exactly what it was. And I think I'm not sure how how. Yeah, can you tell us about that? Yeah, with metaphobia. Sure. So essentially it's like an irrational fear at its core of, um,

of being sick, so throwing up and vomit. And so for me personally, it is more of like the anticipatory anxiety of feeling sick. And again, like a familiar theme that I feel like you'll start to see in me is like the loss of control. So feeling like it's a bodily function that if it's going to happen, it's going to happen and you don't have control over it. So it's very much the anticipatory anxiety behind getting sick that kind of drives my metaphobia. And social media has been so interesting to see how many people, I think, struggle with this and I in grade 11 and 12 was kind of feeling very alone in this and it felt again so irrational and so it's like it's it's it's one of those things where it's like why am I so

focused and hyper focused on this that I feel like it drives so much of my day and takes up so much of my mind but like it's not actually a life threatening like I'm not going to die you don't mean so it's like you go in and out of feeling clear about what it is Okay. Let me a second. So can you tell us like what, so when you were like, let's say in high school, what would you experience? I would say it was, I would say I was probably like looking back at myself in high school and elementary. I definitely was like an anxious kid. But I don't think it was until I had that like hospital, coma, C.S. situation that I experienced my first like panic attacks later on when I then moved to Toronto almost like just like a couple months after that situation happened with the coma and the hospital. I had my first panic attack in my first year of university. And I think that was

kind of what changed the trajectory of my mental health. So let's can we this is great. Thank you so much for sharing this. I want to, so you said that you were an anxious kid. What does that mean? Um, I think about the time, like, I think about when I would go to, I was like a summer camp kid, right, with like two working parents. And I would think about what I needed to pack to like have a safe day so that things don't go wrong or like being anxious about the social situation of like, and this is, you know, on the more normal side, I would say of like, who am I going to to be friends with for the week. I feel like that's like a very normal kid, especially like as an only child. I'm like, okay, going into this, I'm riding so low and I'm going to have to go find a

buddy. But I think about all of like the mitigation techniques that I was kind of doing unknowingly as a kid to again have like a day where things didn't go wrong, whatever that meant at the time, whether that be like, so that I'm not hungry or so I don't have to go to the bathroom or so that if I fall in scrape my knee, I have a bandaid type of situation. Okay, so it sounds like you would anticipate all kinds of things going wrong and you would start planning for them. Yes, for sure. And what kinds of things would you do to plan for them? Like, how would you protect against that loss of control?

How would you maintain control? I think everything was just like a little more simple then. So if it was like having a water bottle so that I don't feel thirsty, you know what I mean? Feels like the grade four version of like the mitigation things that I do now as an adult. Okay. And so you'd carry around water bottle, carry around a Band-Aid, and then it started to, so what was high school like in your head? Deals actually quite stable, I would say. Can I just jump in for a second?

So sometimes your voice gets kind of tinny. I'm wondering if we can try switching your mic input. Chat, I'm going to ask you all to just jack the volume a little bit because we're going to have to try to balance that. Okay. So let's keep going. So thank you so much for sharing this. So what was high school was like similar in terms of when you were a kid or did things start to change? High school feels like in my memories it feels more stable, I guess. Like there weren't any standout moments. I feel like for me in high school it was fine. You know what I mean? Like that's kind of how I summarized it. I was fine. Okay. And so when did a metaphobia start to, what did you first start to notice there? It was, I think the very first signs of it were along the lines of like, I hope I don't get sick on this day. That would really be inconvenient to be sick on.

So like, for example, we had something called ski club and it was where once a week for 10 weeks in the winter, Canadian high school, we would get bused over. to like a ski hill to go snowboard and ski one day of the week and love those days. They were like one of my favorites. And so like it was the extra worry of like, oh, I hope I don't get sick on this day because I don't want to miss this. But there would be no reason why I would get sick. Right. So it was like that irrational worry if there's nothing. There were there were no indications that I would get sick, but I still had the existing worry of well, what if I do get sick? And what's your understanding of where those irrational worries come from? I think it was, there was a, what felt, again, in grade five, like the most high pressure day of my little 10-year-old life at a cross-country meet where I woke up that morning throwing up because I was so nervous for it.

And I don't know if I had the flu, but I would, I would hazard to guess. that it was anxiety provoked because I was so nervous about this finals for this cross-country meet. And so I think from that day moving forward, and it's so interesting because with a metaphobia, people with a metaphobia tend to throw up so much less than the average person. So like I can count on one hand how many times I've actually been sick, which is so ironic thinking about how like how intense the control of a metaphobia can be over someone's life even when like if you were taking step back and rationally be like okay but i've only been sick six times my entire life and i'm 31 like that's a pretty good ratio yeah so how do you understand that

how does it why does it work like that right so funny my husband my husband asked that question all the time how do you understand that um how do you understand that how do you understand why your husband asks you how do you understand that all the time? I understand that because he went into therapy and his therapist asked that and he absorbed that for being to do his own lingo. Okay. But how I understand that I think is just that like, I think it again just like highlights how irrational it essentially feels because like again, if you take a step back and look at like the actual facts,

it's like one throwing up 99.99% of the time is not going to kill you. So it's like you're looking at that. You're looking at, okay, well, if I've only thrown up five or six times in my entire life and I'm not someone who is prone to it. Like, you know how some people, if they just like don't feel well, they can just go and make themselves be sick and they're like, oh, I feel so much better and they continue to rally throughout their day. Like, I'm just not one of those individuals.

Okay. So it's like, it's like you have all of these facts that at the end of the day would lead you to believe that I don't have anything to worry about. But then the reality of like a metaphobia is that you've created this pathway

in your brain of having this constant worry of what if I get sick? How will this inconvenience my day? Is this going to embarrass me? Is this going to make a mess in public? And worrying about all those other elements

that I think can be tied to it. And for some people, it's so severe to the point where they can't even leave their house. Okay. So, um, sorry, no, I just saw a lot. No, no, no, this is fantastic. So, so when you have these kinds of thoughts, what do you do? I work with an amazing therapist. So I've worked with, I would say probably like five, six, seven different therapists, you know, at different points in my life. Okay. But I worked with a cognitive behavioral therapist, like a CBT specific therapist who was so incredible in helping me walk back a scenario. So he kind of taught me this notion of like,

what if, then what? So it's like if you, okay, so let's walk something back to like the worst case scenario of, again, like you're this ski trip that I so badly wanted to be on. Okay, what if I do wake up and I am sick? Okay, worst case scenario, what if that does happen? And then what are you going to do? And so being able to walk all of these, like, like worst case scenarios back in my mind, step by step, you'll realize that the outcome is

never catastrophic. There's always options and there are always different paths that you have to choose from. And I think that helped mitigate the anxiety for me every time I do start to feel that anxiety about, okay, well, what's the worst case scenario? And let's walk that back to what if, okay, then what? Okay, what if that happens? Okay, then what? What if that happens? Okay, then what? that happens. Okay, then what? And I think it just helped. Oh, sorry. I'm a bit confused about the walk back. So what, the worst case scenario is where you start or where you end? So what do you start? Sorry, I guess you're walking forward. You're right. Okay. No, I mean, so I know it's weird. Sometimes we say things that click in our brain. Like, right? So walking back. So I, I sort of get a sense of take a step back.

That's interesting because what I do is, I mean, I call it playing the tape through to the end. Oh, okay. Yeah, yeah. That feels. So. So. But it's interesting because I think what you said feels like it makes sense to me, but I'm like intellectually confused. Like walk it back. Like take a step back, like move back and then let's run through the scenario. Right. Right.

I guess you're, I guess it's like I would walk all the way back and then continue to step forward. Like if we were putting it into like a visual, it would be like a let's walk forward and figure out. So what I'm kind of getting is that there's catastrophe in your mind. Let's walk back to the start of. that catastrophe. Correct.

And then move forward through the what ifs. So here's the catastrophe. Where did this catastrophe start? Okay, what would you do? If this thing happened, what would you actually do? And then if that thing happened, what would you actually do? And then it sounds like you end up in a place that is not catastrophic. Correct.

Even if you assume the worst at every step, you still don't end up where your mind thinks you end up. Correct. every single one of those next what if then what what if then what i'm like oh that's not that bad this also isn't that bad this also isn't that bad okay that's very helpful so so how much has that helped you changed everything like i love the idea of neuroplasticity in the way that we can change you know the pathways that our anxious mind might go down um i think that's so comforting for me and I loved learning about that. And so I think that I know that things weren't actually

moving, but it felt like when I was able to put that into practice, things literally shifted in my brain of the way that I was able to process an anxious scenario in my mind. Okay. And what would that do for you? I think it calms. I think again in the pattern of me wanting to mitigate overall risk. It would help calm all of those nerves, all of those anxious feelings of being able to have a rational perspective of what the situation is. Can I think for a second? Yeah, absolutely. I've got a hard question for you, but you seem really knowledgeable.

Okay. Okay. Hit me with it. Hit me with it. What is the relationship between rational thinking and a calm mind? I want to preface this with saying that I don't think this works for everyone. But I think it, I think that it helps me. Like, I think that when I learn the science behind something, even if it's literally the highest level, simple, top line of, like, why this happens,

I think not only does it normalize, once like my dog is desperate to be lifted out of his chair. How does your dog need help getting lifted? out of his chair. How does that work? Because he's just a giant baby and he can jump down but doesn't want to jump down. Okay. Remember how he mentioned the protective, the protective parents? Yeah. This is me continuing the pattern.

Okay. Um, the hard question. Yeah. So what's the relationship between rational and a common mind? Oh, yeah. Okay. So I think that, I think that one, the first thing is that it makes me feel not crazy. It makes me feel like... To learn about what's going on in you. To learn about what's happening. Yeah, exactly. To like, again, even the highest level, again, I didn't go to school for any kind of

psychology or whatever. But like learning to be like, oh, that actually does make sense why I feel like that when that happens. I think that first connection is nice to hear and makes it feel normal. Because I think so much of anxiety feels. irrational and not normal, that having that little highlight of normalcy feels comforting. That's interesting. So what I'm noticing is that there's a direct effect of, so when you are irrational, when you are anxious, you don't feel normal. And if, oh my God. Yeah, when you feel anxious, you feel crazy. What does that mean? I mean, it just feels like it feels like, I think anyone who's experienced. Okay, here's a great example. I had a panic attack once where I somehow, the brain is just so

strong, right? Like, it's just, it's incredible. I had a panic attack that ended up being, that felt so severe that my spine felt numb. And so I took myself to the ER because I was like, oh, obviously, I'm about to die. And obviously I go to the ER, get, you know, my levels and stuff checking it. They're like, no, no, you're fine. You had a panic attack. But I think that like when you're experiencing anxiety and obviously experiencing anxiety and having a panic attack, like that's obviously on a spectrum of the different sensations you can feel throughout your body. But like when I'm having a panic attack and my teeth are chattering or I'm feeling wobbly and like loss of balance, you get tunnel vision and you have changes in how you're seeing the world. Like it just you feel so disconnected from reality when you're feeling anxious that I think that's impossible to say that like you could feel more. in those moments.

So here's what confuses me. That's so helpful, thank you. Okay. But that's not what confused. What confuses me is, so when you're feeling so crazy, how on earth can you possibly feel normal? How do you get from teeth chattering spinal numbness to like, I read something about neuroplasticity, therefore I feel normal?

This feels like trying to boil the ocean with a match. Um, well, I think like in, have you, have you had a panic attack before? No. I love that for you so much. Oh my God. What an incredible journey for you. I love that. Um, I think when you're having a panic attack, the only thing that gets you through is knowing that, obviously, you've got grounding techniques and different tools in your tool belt, etc. But like, a panic attack is going to end eventually. And like, I'm, like, I'm. when I'm mid panic attack, I'm not thinking about

neuroplasticity. I'm thinking about, okay, let's ride this out and it will end. I know it's going to end. I would say that's kind of like the main rational anchor that I'm thinking about when I'm at level 100 of anxiety. So like, totally get what you're saying. I'm not thinking about neuroplasticity. I'm not thinking

about, you know, like any of the testing I've done. Like, I'm not thinking rational thoughts. It's, I think simplifies down to like, this will end. I'm going to just process. for a second. So, so this is, this is incredibly helpful. So, so then what impact does reading about neuroplasticists?

So, so if it doesn't help you when things are abnormal, when does it help you? I think when, so let's say, let's say panic attack level 100 is teeth chattering, feeling nauseous, tunnel vision, spine numb, like all the things. And, uh, maybe every day, daily maintenance anxiety level. are at 20 to 30%. I would say when I'm in that 20 to 30%, and I'm maybe approaching a scenario where I know that my anxiety levels are going to be a little bit higher.

Like, for example, going on this Bachelorette trip to Las Vegas, like there's drunk people everywhere, people throwing up at any point in time because everyone's too drunk. You know what I mean? It's like, I know that I'm going into higher anxiety territory for the weekend. So I think in preparation for that, thinking about the rational things like neuroplasticity or anything that I've learned, I think helps prime me for a successful or a hopefully more successful weekend. That's so fascinating. So what I'm kind of hearing is like, do you play video games? I had an Animal Crossing stint, but that's about it.

Okay. So one of the things that is that I like about video games, usually have a lot of tools in your tool belt and you bust out some of the tools depending on what you're up against. So if you're fighting like- I feel like that also applies for like mental health. Yeah. Absolutely.

So I've never heard it illustrated in such a clear way where it's like, okay, if I'm dealing with like there's the baseline level of enemies that I fight and then there's like a moderate enemy and then there's like the final boss. Final boss. That's panic attack level. Yeah. Yeah. Right.

And at that point, the only thing you can do is just. take it and tolerate it and and understand that it'll end, but that you've sort of developed a different set of like options for different levels. And then the two things that I would kind of think about there are, I imagine that the lower levels of anxiety are more common. And also that things have a way of progressing upward if you don't mitigate them properly. Correct. Okay. So that's so interesting. So it's because I, I've never conceptualized. So usually like even in medicine, you know, like 80 to 90 cents on the dollar that we spend on someone's health care is in like the last six months or year of their life. So we're really, really good at very, very severe things. But the really interesting thing and there's plenty of data that that shows this is that spending all that money on the most severe things is not really an efficient way to, allocate our resources because less severe things are far more common and actually impact people's

lives way more than like you know someone's high blood pressure impacts someone's life way more than a heart attack does I know it sounds kind of weird but because a high blood pressure leads to heart attacks but so so that's so interesting to hear how it seems like you've learned different methodologies for the severity of what you're dealing with and I think it's a great way to summarize it I think it's also interesting because when I hear people, when things don't work for them, I think this is a missing piece of the puzzle because people will say like, okay, you're saying learn about neuroplasticity, fair enough. But neuroplasticity doesn't help when I'm having a panic attack. So they're looking for one solution that will deal with the most severe thing.

Or what will happen is as someone says, okay, if you're dealing with a panic attack, the thing that helps me the most, is this will end, which is totally fair, but then that doesn't help them for the 80% of the time when they're going to Bachelorette parties, when they're putting themselves in high-risk situations. So it's so interesting because I hear that, like, you know, therapy doesn't work for me or this solution doesn't work very often. And I wonder if the missing piece is that this solution does not work for this problem. There's not a thing for panic attacks. it's like there's a there's a great like a gradient of different things and you have to figure out things at each level 100% agree yeah it's so interesting it's wonderful talking to you and kind of hearing about this these revelations yeah i mean i love talking about a metaphobia because it's just so interesting to see how many people

it affects and again it's such like a different scale of severity and i also have been on you know both ends of the spectrum of like how much it can impact my life based on like how I'm doing in therapy and if my medication is at like the right fit for you know the the the what I'm going through in life at the time can you tell us a little bit you feel comfortable talking about medication yeah yeah absolutely yeah yeah I was on um I started an SSRI when I was in my first year of university um after I had that very first panic attack and so I kind of was doing I was doing therapy and that was the first time that I ever tried medication. And for me personally, it was the combination of the two that were so incredibly effective.

I think how I always describe it to friends who have asked me my experience. And again, I know it doesn't work for everyone. And side effects are different for everyone. But for me personally, when I started the anti-anxiety medication, it like parted the clouds and allowed the techniques that I was learning in therapy to actually be effective and to be absorbed into my life and be able to actually apply those techniques that I was learning. I think without being able to dial back what was like my resting state of anxiety until I was medicated, I wasn't able to properly apply what I was learning in therapy.

That's so interesting. So, you know, my, as a psychiatrist, I think sometimes the way that I sort of think about it is like, you know, aquaerobics is, so sometimes people are in a sense. situation where let's say they have an injury or something like that and exercising in a regular way is very difficult for them and so what you need is something special to get you started right so if you start with like aqua aerobics and you're supporting some of your body weight there's less of a load on your joints it allows you to strengthen and then you know kind of like what you're saying it allows you to actually like build up the skills and then you're you're actually strengthening

but the load against strengthening is so high that sometimes you need something to, as you put it, park the clouds. What do you mean by that, by the way? It's a really interesting phrase. Like, I feel like when you have that, that like if the resting state of everyday anxiety is very, very high, I feel like the way that I'm seeing the world

is very different than how someone who is not experiencing, experiencing anxiety is seeing the world. And so it feels like it's just putting you back on the regular playing field of life. And how does seeing the world is so anxious? What makes that, how does that make it hard to apply what you're learning in therapy? I mean, I think it's like if your heart is racing and you're not breathing normally, just say you're at the grocery store, right? It's like, and so for some reason, the grocery store used to be like kind of an anxious place for me for some reason. And so if I'm, it feels like you're playing on hard mode to make the most simple decisions when your heart rate is elevated, when I feel like I'm short

of breath, when I feel like I've got tunnel vision. You know what I mean? It feels like everything just becomes a little bit harder. And I think I've heard that echoed throughout, you know, so many different mental health disorders. People have ADHD. It feels like you're playing life on hard mode because you're having to sort through the priorities. So I think when I'm speaking to like party in the clouds, it's like it puts your heart right back at regular levels. It makes your breathing normal. You know what I mean?

It's like now you're just experiencing it as the human body should without that, that higher level of everything. Yeah. So it's interesting because you talk about neuroplasticity. I think we have good evidence that SSRIs increase BDNF. I'm not sure how much you've read about. this stuff, but BDNF is brain-derived neurotrophic factor, which encourages neuroplasticity. So one of the mechanisms that SSRIs probably work, we really don't know.

I mean, everyone thinks about serotonin, but I think if you look at, there's absolutely an effect on BDNF, which is very well studied. So it's interesting to think about your emphasis on neuroplasticity and how it allows you to maybe use some of these CBT techniques and they like sync in more. is sort of what I'm hearing. Okay, that's so fascinating. And so do you feel, so sometimes people are concerned about becoming dependent on medication. Have you ever been concerned about that? Oh, I'm someone who I am, I really enjoy being able to experience life in what feels like, you know, just like an enjoyable. I think when I didn't have my medication, um, right.

because I eventually did come off the SSRI. I actually love to get your thoughts on these, but the tests that kind of test your genetic disposition to chemicals like serotonin, I felt like my medication after nine years wasn't really doing, it wasn't making me feel like how I used to feel. And so my psychiatrist at the time encouraged me to take this test.

We realized that genetically I was predispositioned to metabolizing serotonin faster than the average person. So eventually I'm now, on an SNRI, which genuinely gave me my life back. So there was about a nine-month period between the SSRI and the SNRI, where I was, I would say functioning at like 15% capacity. I would have never been able to go on a weekend trip. I could barely leave the house to go see friends that were like totally familiar, not

new people whatsoever. So when my medication wasn't right, I was genuinely, functioning at such a low level of being able to experience literally anything. Yeah, can you say more about that? So when you say you couldn't leave the house to see friends, what was getting in the way? Literally, just sheer immediate panic attack. I remember my husband drove us to a friend's house, and I could not get out of the car. I was hyperventilating.

I couldn't see straight. Like, again, like the tunnel vision, like you, like, it feels like you lose your peripherals. I felt like I was going to be sick. I was like, I'm obviously in no state to go be social. But it just felt, again, like the total loss of control of how my body was reacting to what is a totally, what seems like a totally normal situation. I mean, what sounds really scary to me about that is like the, I don't know if I, I've ever thought about it this way, but what you've lost control of is yourself. 100%. And it was like, it's like, I had control, right, for all of those years.

Oh my God. That's so scary. Right. And so it's coming back. And it's harder. And it's worse. It's harder. It's worse.

It's like the worst it's ever been. And so seeing a glimpse of that in that nine month period between having the medication be right was terrifying. And so I think to go back to your question about like being scared about being dependent on medication is that I'm totally at peace with knowing. that there is some kind of chemical imbalance that is not quite right. And if it, likely, and I'm sure at some other point in my life, it might have to change. But I'm totally at peace with the fact that to be able to function at a regular, what feels like, you know, a regular person's life, I likely will have to supplement something chemically. Yeah. So it sounds like you've done a lot of work in. therapy and you've done, you've just recognized that medication helps you just live the life that

you want. And I'm not hearing so much concern about dependence. I think the way that you're thinking about it is, is interesting. And that's the way that I tend to think about it and the patients that I work with. You know, when we reach our sort of healthy equilibrium, that's kind of what we're thinking about is, it's just what kind of life do you want to live? And is this in service to that, which I think is the same for diet or any other thing. It's just a tool in the tool belt. And so you had some, you had some questions. You said you mentioned something about questions for me about genetic testing. What do you mean? Yeah, yeah. I mean, I'd love to get your, just like your thoughts on them, because I know that they're still a little bit new. And it's always, it's not the first thing that

people jump to. Obviously, I know that it's typically something that gets, you know, reached for a little later on in the medication journey if things aren't working to make adjustments. But we just love to get your thoughts on it. So do you mind if I ask you a couple of specific questions about your treatment history. So were you on one SSRI for nine years? I tried two different SSRIs for nine years. And how long were you on each one? Eight years for the first one. And then about one year for the second one. Okay. So, and then you got genetic testing. Do you remember what it showed? Essentially just that the serotonin, The way that it was explained to me is that essentially like the pathway that the serotonin is being absorbed or, you know, accepted into my brain is normally this wide, but mine is this wide.

And so it's just absolutely just barreling down that pathway. And so I'm just absorbing it faster, hence why it's maybe not as effective as it used to be. I see. So you're absorbing serotonin faster. I have to just think about what that means. And was there something in the test that led them to an SNRI? I actually was the one based on my own research that suggested an SNRI because the So essentially for that nine months period, they tried me on a combination of propranol, which helps to mitigate.

Like essentially it makes my heart rate a little bit lower. I'm sure you have a more scientific explanation. And then also gabapentin, which typically I feel like people associate being used with pain. But I think that they were thinking their thought process was this helps reduce the overall overactivity that's happening in your brain. Okay. And that combination did not work. That was the nine months of me not functioning at all in life. Okay.

And so then, yeah, keep going. And so eventually, I think the noroprenephrin element of the SNRI, I was interested in trying that. I was like, okay, well, whatever, like this test says that I may be metabolized serotonin a little too fast. But the norapherin, I think element of an SNRI was interesting to me. And it ended up being great. Okay. Thank you for sharing that. So now I think I can try to answer your question.

So you suggested the SNRI. Yeah. So essentially my psychiatrist gave me a list of things of being like, I think that these could all be good next steps. I think eventually after the nine months, I was like, hey, this is absolutely not working. My quality of life is so low right now. We have to like make a big change.

and so they gave me a few different, I'm trying to think of the other one, there was another medication that sometimes used for ADHD as well too. I can't remember the name of it, but there were a few different new approaches that they were like, here's what my next round of suggestions might be. Okay. Take a little bit of time to think about it and do some research and come back to me and we can discuss. Okay, perfect. So let's talk about genetic testing for a second.

So we have, there are now tests that you can run that will evaluate the metabolism and function of various like enzymes and transporters, I think, in your, in your brain. So as an example, so let's like, let's do, I'm wondering if I can, we're going to teach. Okay. So let's talk about genetic testing. So your story is you're on an SSRI plus therapy for eight years. CBT, we can talk about the other kinds of therapy that you were doing later because I understand you were, you tried a couple of other things. Then you had a period of what sounds like worsening symptoms. So what I'm going to do, Lauren, is we're going to, we're going to, we're going to,

teach your case like we would in med school. Right? So like if I was teaching like psychiatry residents, I would present a case. This is a 31 year old woman with a history of anxiety that probably started in childhood. I had their first panic attack in the setting of, and for those of all medical students listening at home,

if you're trying to figure out how to present a good presentation, like how to present a patient, this is what I would do. I'm not saying that it's right or whatever, but hey, arguably I'm pretty good at this. And I did get honors in my rotations and stuff. So this is a history of a 31-year-old woman with a history of probably anxiety symptoms starting in childhood with their first panic attack around the age of 18 in the setting of a major life first major life stressor who then continued to have panic attacks that are characterized or also with comorbid ametophobia, has had started with an SSRI that was pretty helpful, also did cognitive behavioral therapy and other. forms of therapy, that after eight years of being relatively stable, has worsening symptoms,

characterized by panic attacks, agoraphobia. So it sounds like it's hard for you to leave the house at times? Totally. Okay. So characterized by panic attack, worsening panic attacks and agoraphobia, kind of severe debilitation, who then is switched to propranolol. and gabapentin doesn't work. And then chief complaint comes in for genetic testing and asks, hey, what's the deal with this genetic testing?

Is it going to help me? And I know that maybe you didn't come in with genetic testing, but I'm kind of making that part up. Does this fit your scenario? Like pretty well? Genetic testing, genetic testing was in between the SSRI to the gabapentin propranilal. Okay. So we're going to move that over here. Okay, so switched, okay, switch to, comes in with, gets genetic testing based on genetic testing,

then gets switched to gabapentin and propranolol, because there are a couple of genes that show altered serotonin reuptake is my guess. when you say your brain absorbs it. I think we're talking at the level of the neuron. Okay. And so based on that is switched to a non-serotonergic medication. And then this leads to even worsening symptoms? Correct. Okay.

All right. So now let's like teach this. So I'm not going to make recommendations to use a medical doctor. But I'm like, let's understand how a doctor thinks about this, how genetic testing works, how we think about medications. Is that fair enough? Yeah. Okay. So, first thing is that they're, when we look at genetic testing, there are all kinds of enzymes

and transporters. So what are these two things? An enzyme is something that takes compound A and turns it into compound B. A transporter is we have a cell that has little gates. And then things like serotonin, oh, sorry. So here's serotonin. And normally what happens is serotonin gets released over here and then gets reabsorbed into the cell over here. So we can kind of think about serotonin as a boomerang.

So I'm going to like send out a signal. And then I need to get my ammo back so that I can send out another signal. So I'm going to go collect my ammo. It's going to come back. I'm going to reabsorb it so that I can send it again. Okay. So there are different. And if we look at like our genes,

our genes will determine the level of serotonin that gets dumped out, the rate at which it gets reabsorbed. So if I have like a very strong reabsorber that like takes serotonin in very quickly, the amount that will be outside to communicate with my nearby neurons goes down. Does that make sense? Right?

So like I dump out 100 units of serotonin and within a second, 60 of those units are gone, whereas in someone else, maybe only 20 of those units are gone. So 80 are still floating around. So what we're interested in is the serotonin between our neurons. That's what really causes stuff to happen. So if you look at the American Psychiatric Association, they have a guideline that I think they released in 2024 that basically did not recommend. the standard usage of genetic testing for psychopharm. And the reason for that is very simple.

If we take 100 patients and we give them, if we take, let's say we take 200 patients, and for 100 patients we do genetic testing, and for 100 patients we don't do genetic testing, their outcomes are roughly the same. Okay, so this is where like propranolol and gas, Gabapentin is a really weird medication combo for panic attacks. So like generally speaking, the algorithm for panic attacks is going to be try SSRI number one, try SSRI number two.

Step three is try an SNRI. Or even step two is try an SNRI. So if you look at like the algorithm for even without genetic testing what would have happened, I would say that a significant number of psychiatrists would have just tried you on an SSNRI as a third option. I wish I had skipped that nine months of get a pentapropanilal. And so I think your case is a really good example of why just because something is new and hot gives us information doesn't mean that it actually helps us. So I'm not saying that your psychiatrist did a bad job or anything like that. We can't use a sample size of one and say this is good or this is bad.

But I think this is basically what the APA did. They looked at lots of cases like yours. They looked at all the people. And what they noticed is that when you get genetic testing, people get to weird, like, second, third, fourth line treatments maybe earlier than they normally should. So, you know, propranol and gabapentin. So gabapentin is like a mood stabilizer. It's like an anti-seizure medication, has an anti-anxiety, like off-label, I think,

technically kind of thing. It's also used in things like chronic pain and stuff like that. So gabapentin absolutely is like a medication that works on the jitteriness of your neurons. And propranololol is something that works on your, if I remember correctly, it's alpha blockade, beta blockade. I don't remember exactly. But propranolol basically works at the adrenaline receptors or things like adrenaline receptors on your heart, on your peripheral tissue. So it's not necessarily like a solely neurologically active medication. So it works like on your heart. And the reason that we do that is because we know that panic attacks are not just in your head. They're also in your body. So we have adrenaline. We have noradrenaline, nor epinephrine.

These are all hormones that are flooding through our body and they will trigger increases in heart rate, increases in respiratory rate. You're hyperventilating. Your heart is pounding. You have tunnel vision. these are all due to like these cardiac, not cardiac effects, but epinephrine and norephenephrine. And then if we stop the physiology of it, and what happens in a panic attack is there is a cycle. So I have a thought, and then thought activates my physiology. And then when I have a physiological activation, that then increases the thought. And so then this creates a vicious cycle where we're doubling and doubling and doubling and doubling until eventually, like, you just kind of shy. down, sometimes people will trigger like these weird dissociative reactions. You become hypersensitive.

So all these things like spinal numbness, which like normally we don't even feel our spine. Like we don't usually feel our spine, right? So like spinal numbness is actually like normal. So there's even things like something called visceral hypersensitivity, which I'd wonder about for you where in your emetophobia, I would guess that when it's active, there are normal sensations in your stomach, which start to feel very dangerous. But we don't know. Right. Right.

So maybe. So does that happen? Yeah, I would say. And like, I think that I'm very in tune with it where I'm like, okay, do I feel like it's in my stomach or is it in my throat or does it feel like it's in my chest cavity? And so I've been able to, I think, do work there in terms of like being more in tuned with my body. So if we kind of go back to this like idea of genetic testing, is it helpful? Like on balance, the answer appears to be not yet. Now, the key thing to remember about some of this genetic testing is just because on balance, it isn't, it doesn't appear to be helpful yet.

That doesn't mean that it isn't helpful for some people. So for example, like, you know, you can make a good argument that, you know, if you got this genetic testing and the key thing is let's move away from serotonin, that makes like a lot of sense to me, right? So it's just the way that they chose to move away from serotonin seem to be like not the best first step. And this is also where like the other thing that we have to consider in your case, right, is if I had a patient who came in who is stable on a serotonergic medication for eight years and then became unstable, I think an SNRI makes perfect sense because we want to keep that serotonin

on board. and we maybe want to add a neurotransmitter, let's start working on norepinephrine, and van lafaxine and duloxatine, which are like the SNRIs that we tend to reach for, tend to work. They're very effective at anxiety and panic disorders and things like that. So, you know, the other problem with the genetic testing

is that we don't really know, I don't know if this makes sense, we don't know what the connection between a serotonin and transporter and something like depression really is. So there are some studies that show, for example, there's like a short chain serotonin transporter that is associated with depression. So of the serotonin transporters, one of them is shaped like this and one of them is shaped like this. If you get the shorty, then you have an increased risk of depression. So we absolutely know that there are correlations between some genetic versions of transporters.

and certain mental illnesses. But then this still begs the question, does an SSRI work more for this or work more for this? We don't know. So there's a lot that's basically missing where people will run these tests. We know how to determine which kind of transporter you have. We know how to determine which kind of enzyme you have,

and this is where things get technical. And we know that this transporter is associated. So transporter 1, transportor 2. This is, sorry, this is low risk. This is high risk. But then if we look at like SSRIs, SSRIs may be equally effective for both of these conditions. So then if we do genetic testing, it's not clear,

Like, because SSRIs can work for both, even depending on what your genes are. You know, that's not always clear. There are some studies that do show that maybe some medications are less responsive if you have a particular genotype. But like, basically, there's still like a missing piece between here are your genes, here's the medication. And, and I don't know, I feel like I'm not, actually, I'm not doing a good job explaining this. There's a gap between the clinical significance of your genetic makeup and what treatment. we use. So we can determine whether you're high risk, you're low risk. We can determine, okay, you're a fast metabolizer of this serotonin or your enzyme that produces serotonin is like a slow rate.

We can determine all that stuff. But to bridge this basic science stuff of what is going on in your brain to this medication will work for you, there's a huge gap there. And the reason, one of the reasons there's a gap is like, how does CBT work? What is the role of BDNF? What is the role of mindfulness? What is the traumatic significance if we do something like EMDR or something like that? Like there's a lot that goes into panic attacks that is not determined by neurotransmitter transmission. But like there's just so much more to it. The way that you think, the way that the mental coping mechanisms you use, how does all of that intersect with us? We don't know. at what effect does an SSRI really have?

What is the mechanism of action through which an SSRI reduces panic attacks? We don't know. So that's why there's a lot of like good information and then we have all these medications, but there's like a huge like missing piece, which depending on who you are, depending on like who your clinician is, they can be useful. I've used them for some of my patients. I've not found that it's been like very helpful personally. but like it's like it's kind of like a piece of technology that's in the early stages

which has not reached like general clinical use because there is not a clear benefit and I think your example is I think your case is a really good example of kind of why that could be where sometimes it maybe even I've never heard of your situation actually before where it almost seems like it kind of moves you in the wrong direction but then that also gets to this like really simple thing, just really simple idea in psychiatry, which is we don't know, like, every case is one of individual experimentation, where we just like, we just, we don't know until we try. And unfortunately, in psychiatry, when it comes to pharmacologic, like, recommendations, it's

kind of like you just try stuff out until you find something that works. And the good news is that we do have a lot of data that should. shows basically what sequence of things you should try. Does that answer your question? Yeah. Yeah, that was super insightful. And I think that's how I feel. Because I think I go, I think there's a part of me that is grateful that although that nine

months sucked so much ass and it was awful and it was literally rock bottom, I think having that perspective of understanding what my spectrum of like, you know, the gradient of how I can feel with this anxiety disorder. I do think that there were valuable things that I learned. But yeah, I do, I am like, based on the little bit of research I did, it felt like SNRI was the way to go and that ended up being right. And so I'm like, damn, that nine months was rough. Yeah.

So I think, you know, your story is like one that I think is really does a good job of highlighting just how much trial and error we have in cycle form. And like frankly, it kind of sucks, but it's like the best we've got. Like we just don't know. Like what your individual chemistry is going to be like. Like, you know, maybe it picked up some genetic things, but we just don't know. And then there's all kinds of weird things that happen with medication where once you start taking a medication, your body adapts to it. So what are those adaptations, you know, like, and that gets really, I mean, there's all kinds of weird steps in between.

like just because you have a particular gene does not mean that that gene is being used. So like genes are dormant all the time. So you have these two transporters, but what is the, like, what is the ratio of those transporters on your actual neurons? We have no idea. So there's like all kinds of gaps. But I think it's a promising direction. I'm glad we're moving in in it.

I'm sure there are clinicians and psychiatrists who are more adept at using genetic tests. testing than I am. And so maybe like they have better outcomes. But generally speaking, you know, as of about a year ago, we don't see a consistent benefit for genetic testing for clinical purposes. Yeah, makes sense. I was just trying to think about where we were. I think also too, like the process of coming off of an SSRI for that nine months was was also tough. Like brain zaps are a crazy. experience to go through.

And my psychiatrist was great in terms of like giving me like the proper like, you know, off-boarding schedule of reducing the dosage at such a slow, slow, slow rate. Out of curiosity, do you remember what the off-loading schedule was? Let's see. I probably have it saved. Because I think this is another really interesting thing where I think we probably taper SSRIs. We had a guy named Mark Horowitz on a like a, like maybe. two years ago and he had some really interesting ideas about SSRI tapering and I've since come to

really think he's onto something but generally speaking we'll like cut things in half for a while but he has some ideas that we need to do something called hyperbolic tapering but that's a different story we don't have to get into it it's okay good I mean like I'm such a hypochondriac that I was like let me even slow this down even further yeah that's so that that may have been good I mean I think we need to maybe taper because because there are a lot of reports about harmful effects of SSRIs, SSRI withdrawal, SSRI dependence. So I think that there's, and it's like not clear how bad those really are. Like there are a lot of like since since there are reports, it's not like people are,

when we do more robust studies, it seems like the effect is not as bad as what people are reporting. So, and it's not that that isn't happening to those people. the big difference is is the SSRI withdrawal, what is causing that kind of stuff? And that's what's kind of like we're not sure about. Yeah. Because it's a class of medications when we do post-market meta-analys on medications like SSRIs, they seem to be quite safe and quite effective.

But there absolutely appears to be a subset of people who really has problems coming off of it. We just don't know how big those people are. And also what else is going on because they have other kinds of risk factors and other kinds of comorbidities and things like that. Makes sense. So, yeah, can we talk a little bit? Do you want to mention anything else about medication or your journey there? I think that pretty much covers my story because, like, I'm, SNRI is smooth sailing right now.

And so that's kind of like, that's kind of the, yeah, the end of the medication chapter, I think. And so what, so you said you, I know you mentioned this kind of in our prep, but like it sounds like you did CBT, but you've, tried other things too? Yeah, I did a little bit of EMDR. And then what does that stand for again, Dr. Kay? Um, I movement desensitization, retraining or reprocessing. I always forget which of it. Oh, reprocessing. I think it's reprocessing. Yeah. Um, did EMDR for a little bit, um, which was okay, but I think CBT was, it was the most effective for me personally. Um, and then I also did a little bit of, uh, hypnotherapy, which was not for me. How so?

I think again in the same vein of feeling like I wasn't in control. I think as soon as I felt like I was starting to like drift into like the state where like it's supposed to start being, you know, therapeutic. I started freaking out. And so I think that, you know, I probably could have learned to push past that and eventually, you know, navigate that feeling maybe more familiar. but I think I wasn't ready and it wasn't the right fit for the right time. Okay. And when you say you tried to EMDR for a little bit, what was, what were you EMDRing? So you usually, yeah, go ahead.

It kind of just felt like a little bit of everything. And so maybe if you want to speak to more of like the process of like the movement, I can give you my experience with it. So when I think about EMDR. So here's how I understand the MDR. So we have certain memories, experiences that when our mind goes there, trigger a profound physiologic response. So we'll have a trigger that then cascades into all kinds of things. So if I, like, see something, my eyes see something,

and then that triggers activity in my memory circuits of the brain. So if I see, like, you know, if I've been bitten by a dog, and then I see a dog. Now I see the dog. My thalamus, my occipital cortex activates. My thalamus activates. Thalamus goes to the hippocampus, triggers a memory. That memory then triggers my amygdala. Now I feel anxious. Now I feel scared. That then triggers a physiological cascade. Adrenaline is pumping through my system. Noradrenaline is pumping through my system. So there's a whole cascade of things that get triggered by something. So if I recall a traumatic memory, the same thing will happen again. I'll feel like I'm there again. So what EMDR does is we're moving our eyes back and forth. And since our attention is on moving the eyes back and forth, that cascade doesn't trigger in the same way. So if any, if any all have had a, you know, trigger into a traumatic memory, you notice what happens is your attention gets absorbed in it. So when you start to have panic attack, your attention, you can't distract yourself. Your attention goes to whatever you're

focusing on, or not focusing on, whatever you have to focus on. So you get forced into focusing on something. And as you focus on the source of the panic, that intensifies. Like now the memory start coming back. Now the amygdala hyperactivates more. Now the adrenaline is pumping. So what EMDR, the way I understand it, is that basically what it does is by shifting our attention, and still activating a trigger, it stops the cascade. But, and so as it stops the cascade, our brain learns. And then we can get exposed to the trigger over and over and over again. And then it no longer triggers the cascade, which is when EMDR works.

Because now I can go outside. I can see dogs. And like this whole like neuronal wiring, this physiologic wiring has basically been rewired by accessing the memory. while maintaining my attention over there. So it's kind of like, you know, like if I have a, you know, a dog that's scared of humans, like what I have to do is I have to like be very careful, let it come to me, maybe pet it very gently. And so we can sort of do this like physiologic retraining. So the thing that I was kind of confused about is like usually I think about EMDR being

focused on a particular traumatic event that we're then trying to reprocess. So I think for me, and I think this is what's great about therapy is that I feel like, you know, for different parts of your life, there are different therapies that I think make the most sense. And so for me, I think EMDR was, I think, mildly effective to help reprocess them of like the seizure-related trauma that I had experienced. So that boyfriend from high school, we then dated for another four years after that and he had severe epilepsy. So I've probably seen a hundred hundreds seizures in my life. So I think later on, years later, I was like, you know what, there's obviously a lot of trauma that I hold here and a seizure is a trigger. So seeing it at like a music festival or on TV and a movie or whatever was reprocessing or trying to reprocess some of those memories that were connected to seizures. Okay. That makes that, I think that makes a lot more sense because I don't, I mean, I don't usually think about EMDR for panic attacks. I think there's something similar. but it's kind of like not quite apples and oranges,

maybe like apples and pears where I think there's a lot of like physiologic rewiring that can absolutely be very helpful in panic attacks. So how are things for you now? I would say the best. And again, I think that like because I have done so much work in the realm of like my medication is right, I've done so many different. forms of therapy. I have the most tools in my tool belt that I've ever had. And my daily life is like my resting level of anxiety is quite stable. I know my patterns of,

you know, higher, anxious moments and my triggers. I know myself better than I ever have now at this point. So things are, things are really, really good. I would say the best they have been. I think, again, coming from that incredibly low point of that nine months, which would have been about four years ago. I think like the juxtaposition of that really not being that long ago in the span of like my entire period of life being, you know, medicated or feeling more in tune to my anxiety. That feeling like knowing that that was my reality four years ago versus where I am now are just absolutely worlds apart. And so what is a metaphobia like for you now? I think the main thing is like the mitigation efforts like the same way that someone who is

maybe like I have a good friend who has migraines frequently. And when they travel, they sometimes feel a little anxious about getting a migraine because again, they don't want to like miss an event. I feel like the migraine portion of it is a little maybe more rational. And so it may be easier for people to understand. But it's like knowing that, okay, when I travel, do I have my 911 medication? Do I have my plan in place for if this does happen? Because I don't want it to happen.

And it would be a higher level of inconvenience if it were to happen at that. this specific time. So it sounds like you basically plan for it, but it doesn't affect you too much? I think that in high stress situations, my pattern is that I typically almost always get through it. And then when I get home or I make it through whatever anxiety is, I kind of crash afterwards. And so I typically, can try to mitigate for that routine and that pattern afterwards. Just by, you know, being more mindful and checking in with myself across whatever, like, the higher period of anxiety is. How do you get through it?

Like, you know, you just said checking in with yourself. But what does that look like? And what does the crash look like? The crash is what it feels like when you, like, finally exhale a giant big breath after or something really stressful. Like, just say you do like an interview and you're like really, really tense, really, really tense and like everything, your shoulders are up at your ears and like, you know, your heart rate is probably elevated.

And then as soon as you're done, you're like, ah, and you finally like let out that giant exhale. The crash kind of feels like that. And I feel like I've gotten better at, I feel like actually, the more that I expect the crash, the less often it actually happens afterwards. So, for example, I shot a show for two and a half weeks. and we were doing like 16 hour days and I was the host and I'm like, okay, this is like a really high pressure situation where like I am very necessary on all of these days. Like there, there is no room. And obviously, again, like if I were to do the what if, then what application of, you know, walking through the

scenario, if there were to be a day where I was actually ill, like, would we be fine? Yes, totally. But like getting through that two and a half weeks, again, was super, super tense. And I'm like, okay, nice. I made it another day of feeling okay. I made it another, like, okay, one more day down, one more day down. And then as soon as we wrap and we're done, I crashed hard. Yeah, that doesn't seem to me to be related to metaphobia. That just seems like, but I'm guessing that you're keeping the emetophobia at bay. And then that is very draining.

and so when you don't have to keep it at bay anymore, the exhaustion kind of comes in. Correct, correct. Okay, that's really interesting. So, by the way, you're very good at attending to like what I'm saying, what's happening on my face. Like, you change your words very quickly. Like, not in a bad way, but like it's interesting

because earlier I said, like, you know, I forget, I said there was something that was confusing to me about the exercise that the CBT person taught you, and you stopped using that phrase, even though that's what you called it. So like... But I think that this will probably change the way that I visualize it. Like I think I had it in my mind mapped out,

but like when I actually think about it, visualized after we've talked about it now, I think it'll probably change the way that I, like if I were to draw it, like I think that our conversation has changed the way that I would draw it. Do you find yourself being very, very capable of noticing what other people are thinking, feeling, seeing. Like, do you feel like super tuned in to other people?

It's exhausting, yeah. Yeah, it seems like it's cognitively very intense. Yeah, yeah, yeah, no, it's exhausting. I think I understand why you're an ambivort. Exactly, exactly. It's like, I need time to be away from people. Yeah, yeah. So, I mean, because I think you lift a lot when you're with people.

Like, it's not, you're not just chilling right now. Like, I know you're like, have, like, it seems like you're having a good time. and stuff, but I can also, I can feel the cognitive intensity. Like, even the way that your posture is like, you're like dialed in. Like you're like, you're like leading forward. I'm just like a cool, a great conversation. Yeah, I'm not saying it's bad, but I'm just, I'm just noticing how cognitively like it. I mean, this is one of the cases where I really feel like I'm looking in a mirror because I'm super dialed into conversations. And, and so I'm, I'm noticing how incredibly responsive you are to if I open my mouth to say something, you'll stop talking, like

right away. Like you'll, you'll notice when I have questions, you'll notice my facial expression. So it seems like you're super like tuned in. I mean, happy to be here. Yeah. No, it's fun. And it's exhausting. And I'm going to, I'm going to hibernate after. I usually hibernate after I have conversations like this for like a few hours. I mean, I'm sure you just taught a whole, a whole doctor lesson on the medication. So that makes sense. Yeah. How very considerate of you and empathic. to support my hibernation. Hey, y'all, just a reminder that in addition to these awesome videos,

we have a ton of tools and resources to help you grow and overcome the challenges that you face. We've got things like Dr. Kay's Guide to Mental Health, personalized coaching programs, and things like free community events and other sorts of tools to help you no matter where you are on your mental health journey. So check out the link in the description below and back to the video. Yeah, so I'm kind of curious, what do you think, anything, anything, else come up for like anything that we've talked about that you want to talk more about or um anything that you want to share that we haven't covered I mean nothing specific comes to mind um I mean I like overall I love just being an open book about um my experience because I just feel like nothing bad has ever come from me sharing more details about my mental health journey um so like I just try to be so transparent about it like my husband I just went on an incredible and obviously the photos from it look amazing and it was so great but like the travel day on the way home after socializing for five days and like being super highly active was like a 17 hour day with a boat and three planes and like I had an awful panic attack on the way home and so like I just love being able to share that part of the journey as well versus people just seeing the tropical vacation photos because that's just not the reality that I live in and I don't want ever to give that idea to the people.

who, you know, follow me. Yeah. So, I mean, how, so this sounds like stuff that you, do you ever get a break from this? What's this? The panic, emetophobia, anxiety. Like, is this like every day is like, I mean, you're marshalling your resources. Like, do you get, are there times where you're just like straight chilling and you don't have to manage this? Or do you like manage this like every single day?

I would say, um. Ametophobia is something that is managed every day. I think that, yeah, it's not really, I think a great way to kind of summarize it is that it's one of the first things I think of when I wake up and one of the last things I think about at night. And based on the distractions of the day, it's a periodic check-in with the ametophobia throughout the day as well to, like, how am I feeling?

Where do I feel that? What else is happening in my day? That will change how I might be. be exhausting. It sounds exhausting. It really, it really is. Yeah. I mean, so do you, is this just something you're going to live with for the rest of your life? I think it's, I guess, I guess the honest answer is I'm not entirely sure. I think one conversation that comes up a lot with, like, within like the ametophobia community is motherhood and being pregnant because a lot of people in their first trimester, you know, have a really hard time with morning sickness and being sick. And so it's

one of those things where eventually maybe through, you know, forced exposure therapy, maybe it will be something that changes when I encounter that chapter of my life in later years. So I don't know. I think at this point right now, it feels like manageable. And obviously I think when we're talking about it, of course, it can feel mentally exhausting, but I think compared it's to where it has been, it feels manageable and my tools feel within reach at almost all times. And I've got a great support system. I feel stable on my medication. I have the resources, you know, in my life to make it feel manageable. But yeah, the honest answer is I'm not entirely sure. And it's kind of one of those things that you just kind of take in strides as it comes.

So this is going to sound like kind of a weird question. And I want you to be careful about your content creator reaction. Okay. So like how are you not like completely destroyed? Right. So like it's a genuine question. And please don't give us. I'm privileged and I have a great support system unless that's really what it is.

But like what I'm hearing is that for, you know, a large portion of your life ever since you were a kid, you've been dealing with this crap. There are periods of time where it's been really hard. You've managed to build a life. But it honestly sounds like such an uphill climb every step of the way. And as I'm listening to you, I'm just trying to think to myself like, okay, is this a situation where life being this hard is so normalized for you that this is just all you know. And so every day is a struggle?

Or is there like, because like, like, I mean, it's. sounds it sounds so challenging like it sounds like there are so many ways that this has and could take things away from you right and yet somehow you're going on trips it sounds like you're genuinely having a good time it sounds like you're happily married like you know like but there are so many people for whom this stuff is like absolutely crippling like how did that happen with you? Like, how did you not get completely, like, how is not, like, how do you not just get exhausted and worn down day after day after day? And even when things are going so well, it still sounds like it's really hard. It's not easy. I think that's like the reality of it. And I think

you summarized it really well is that it's kind of all I know. And I think it just does feel like my normal. I think also, um, my heart is, um, my heart is that. And I think also, um, my, husband has really severe ADHD and I just feel like I see the things that he struggles with and you know I know my own struggles and his set of struggles are just so different in the way that he has to navigate and use his tools to um have the best quality of life too with ADHD and so it kind of I think his ADHD has put my anxiety into perspective of just like everyone has their own shit essentially and this feels like just I guess my normal um and I think also too I've made a valiant effort in protecting my own peace so like blah blah blah support system yeah yeah all the stuff

but I also am really good at putting boundaries in my personal life and how I spend my time because I do think that it is incredibly easy to burn out and I have burned out so many times and I think it's probably just a combination of like feeling like I'm on this hamster wheel forever with this emetophobia portion, but also, you know, the career and the industry that I'm in and being chronically online as well too,

you know, those paired together, I think, can be a brutal wheel that is literally never ending on both sides. So it's like, then you put those together and you're like, oh my God, I'm exhausted forever. But yeah, I think it's just, I think it's, Sorry, go ahead. No, go for it. I think it's my normal,

and I think that, like, the social boundaries of things have made a big difference in terms of how I spend my time. What does that mean practically? Like, what does that mean, social boundaries? Like, I know that if I go out five nights a week,

whether it just be to the movies, for dinner, et cetera, like, not, like, go out and, like, go rage at, like, a club or something. But even just, like, socially, Like I know that my rate of burnout will happen faster because I'm also thinking about what if I get food poisoning and get sick from the dinner that I go out to. You know what I mean? So like eating dinner at home versus eating dinner at a restaurant has an elevated level of a metapobia anxiety as well.

So it's like balancing, feeling fulfilled socially and making time with people that are important in my life, but also knowing that it. comes with the cost of that burnout happening faster. So here's what kind of exhausts me hearing you is like the, it's not so much what you do. It's just that you, it sounds like you're always balancing. Always. Yeah. And so that just is normal for you? Yeah.

But I also think that like, like, I think drinking is a great example because like if you drink too much, you throw up and a metapobia, that is bad. Right. It's like, so I think about that. And it's like, okay, well, even with drinking. it's a balance of like I enjoy having a glass of wine with dinner, but I also know the balance of like drinking too much equals be sick. And so it's like, I just feel like I apply that logic to a lot of different elements in my life.

Got it. Okay. So that makes a lot of sense. So you treat many things in your life kind of like drinking where it's just a constant state of balancing. I would say so, yeah. Yeah. And it sounds like you've used that muscle a lot so it's pretty swall because you do it. all the time. It's so full.

It's so soul. Okay. So one or two kind of last questions for you. One is, why do you think you're so concerned about control? God, if that ain't, if that ain't the overarching question of my whole life, I think control, for me, like control in like the most simple form equals something good, right? So it's like control over if I study for a test, I will achieve good grades. If I put the effort into editing this video to the best of my ability, it will perform better than if I hadn't put the effort into this video.

If I am in control of my diet, I will feel better because I applied the control to make the decisions that I know that I want to make. So I think it's the alignment of how it makes me feel in terms of like, I think holistically, but also from a validation sense as well, too, like it's associated with all things in my head good. And so when I feel out of control, that feels more negative. And so I think in the most simplest form, it's swaying to want to be in from the more positive perspective. Okay. So when you're in control, things are better for you. I think that's what I've trained my brain to convince myself because I don't necessarily think that's always true. Because I think that like some of the most unexpected things that have happened in my life

have been incredibly positive. So, but I think that that's what I have taught myself mentally. Do you, did you have a, is there, is there a time in your life where you started fearing a lack of control? Do you remember? I would say it was probably the, the, the, the, coma situation where I was like, oh, this is, this is what it feels like to be totally not in control. And I guess that makes sense, right? Because that was your first panic attack or it was around that time. Yeah.

I'm just thinking. Do you have any questions for me? I asked this question and no one ever does or almost never because people usually are spent at this point and or their mind is like, but. I mean, have you ever, have you ever worked with other patients who have a metapobia? Like, it's always, like, I'm from someone who has it, it's always so interesting to hear other people's experience with it. Yeah. So I have never worked with a patient with a metaphobia.

Mm-hmm. However, I've worked with many, many patients who sound a lot like you. So I think it's just like in a different clothing. But when you describe your physiology, when you describe your thought process, when you describe your experiences, when you describe the karma of your life, it like tracks, like very, very closely. And there are a lot of things that it's so interesting to hear your journey because I think you've done a couple of things.

I mean, you've done a lot of things amazingly well. You seem to be an incredibly resilient person. And also there's a lot that I think is still like missing when I hear your story. I don't know if that's actually the case. I'm not your doctor. you know, I don't know. And that's why I'm kind of curious because you've done so well and yet it seems so exhausting. Like it seems like it's like constant. And there have absolutely been cases. And the reason I kind of ask that is because I think my experience as a clinician has been that there's sort of the management and mitigation, which allows you to live a functional life. But then there's almost like, I would say on the psychotherapy side, it's like a little bit more psychodynamic where it's like, like, like deeper like what is your deal with control and and even beyond the psycho the deeper psychodynamic side i would even call it spiritual where it's like like what is your like this is a this is like

your life like it's not just your psychology this is like the struggle of your life is this balance of control how do you make sense of that you know how do you deal with that how do you in in this world do we have control do we not have control how do we grapple with the kinds of things. The other thing is that when I sit and I listen to you, I understand that a metaphobia has a name, but this, I've seen people who are in your situation where this smells and feels like OCD. Yeah, that's come up for sure in other conversations. So, and the really interesting thing is that like OCD treatment is highly effective is very commonly missed by professionals. I think the mean, the average amount of time it takes for someone to have symptoms

of OCD and get treated for OCD is 16 years. I'm right on track. Okay. Yeah. And sometimes it's even two plus years of clinical treatment before people realize this is not anxiety, this is maybe not pain, that there's OCD underlying. So the things that I think about are there is an intrusiveness a permanence, you are constantly, it's the first thing I think about when, so OCD is about obsessions, which are intrusive thoughts that are recognized as irrational. So you recognize the irrationality of it. So, so it's really interesting because I'm not saying you have OCD, but like, you know, it's clear that you've had very thoughtful clinicians and I'm sure they know what they're doing

and it's come up, which makes a lot of sense to me. I think this is more for people at home where, like, the tricky thing about OCD is that, see, when we use the words anxiety or depression, and we talk about them as illnesses, there's a link between the subjective experience and what we call it. So if we have major depressive disorder, it feels like depression. It feels like a lot of depression. The problem with OCD is the words that we use to describe it clinically are not what it feels like. What OCD feels like is terrible anxiety and panic attacks. Right. But that's not, it's, you know, when I'm anxious about something, my thoughts are a little bit like intrusive.

Like I get worried about things. I can't control them. I have thought loops. I have spirals, whatever. But OCD feels the same way, which is why I think it's missed so much. right right i think also to your point too like i think there's a large part of me that believes that i just latched on to this one specific obsession which is the metapobia piece like the getting sick piece but like had something else happened in my life at some point it could have been anything

like i don't think it's specifically like so centered around like the getting sick portion i think it's the control and i think it's like the obsession um to your point and i think it could have been anything like could have been spiders you know what i mean like it just ended up being this one like pill. Yeah, and it doesn't sound like there was any vomiting involved. Yeah, mine is that like one high, you know, again, like high pressure finals meet for cross country when I was like a kid outside of that. Yeah. Yeah. So that that's also somewhat common with OCD like where the nature of OCD that makes it so weird is that it's kind of like the opposite of trauma in the sense that if we look at like things that you're afraid of,

if you've been traumatized by something and you're afraid by it, then that makes sense. But what happens in OCD is that we'll have these intrusive thoughts that are not our experience. So it comes and it's not actually tightly tied to our experience. So sometimes people will even get like intrusive violent thoughts about like their loved ones. They'll just have images in their head of themselves hurting people or things like that. And it's not like you've actually had that experience. It's just some part of your brain is just producing these thoughts. Right.

You know, the two things that I, you know, I get super curious about. out. One is I think you're onto something or maybe the forms that you frequent are where, you know, one of the ways to deal with something like a metaphobia is exposure therapy essentially. So we call it exposure therapy. There's another way to that I sort of think about it, which is see, the mind fears that which it does not know. So fear usually, unless we're talking about trauma. So there's like two kinds of fear. There's one fear which is like we've experienced this so we've learned that this is dangerous. But if you look at the majority of anxiety and fear, it's hypothetical in nature.

Right. So I fear that which is, like, by definition, I fear like that which has not happened. Like fear is about a future projection, therefore it has not happened. So what we find with things like anxiety, panic attacks, and even OCD, is exposure therapy is very helpful. And the reason that we do that, and I think this is not just for people who have like, diagnoses, but there are so many people that are in our community that are afraid of things. And the ultimate antidote for a lot of those fears is experience. So when we experience something, you can combat the fears in your head as much as you want.

You can mitigate things as much as you want. You can try to plan for things as much as you want. But if you really think about it, the more you mitigate and the more that you plan, the less experience with the fear that you have. So one of the things that I found, is so strange as a psychiatrist is that people, you know, we'll help people protect themselves from their fears. That's part of our job. And at the same time, I think one of the healthiest things that you can ever do in some cases is to really, like, face your fears kind of head on.

And that activates a completely different circuit. So like when I'm anxious in my head, you know, I play all these mental games and I fight with it up here, but I fundamentally don't have experience. The moment that I have experience, the way it changes my hippocampus, which is my learning and memory center, the way it changes my amygdala, it is profound. So the moment that I live through something, it activates different parts of my brain and can really cause things to, like, calm down, which is what we know from ERP exposure and response prevention, which is sort of a good treatment for OCD. And then the second thing is this loss of control thing, like, you know, that's also something where I've worked with people who, you know,

will kind of do some of the stuff that you're talking about. I'm not a great CBT therapist, but I do psychopharm and I do some CBT. Sometimes I'll refer people out for CBT. And then I sort of notice that there's like managing, but with some people that I work with, like managing is not satisfying to me, especially, which is probably what's driving it,

but also not satisfying to them. Like I'll have patients who, you know, I had a patient once come into my office and I was like, look, man, like, I can patch you up and send you back into battle. It's so interesting that used the word rally, right? So it's like they'd have this, like, negative experience over and over and over again. And each time we, like, fix it for them. And then they're back, you know, they kind of like go back into the world.

But there's a difference between that and, like, being able to, like, just relax completely. Like, being able to have this problem gone, which I think is a dangerous territory to enter because it's not clear to me that that's even possible for everyone. And then if it doesn't work for you, does that mean that you're failing? Does that mean your psychiatrist is failing? Or is it just not a possibility? And at the same time, there's a part of me that sort of says that if you're like yourself,

you know, if there are people out there who are struggling with this idea of like loss of control, and this is where I think we really get more into the spiritual realm of like, there are people like the Buddha who sort of like discovered that there is a way to gain sustainable, lasting, and effortless piece. That's the key thing. It becomes your default state. It becomes normalized for you. And really grappling with some of these concepts of like surrender and stuff like that. I found it incredibly helpful in my life. I found it incredibly helpful for other people. And, you know, maybe at some point walking down that path will be right for you,

will be appropriate for you. I get a lot of like positive energy about like this is a journey for you and you're moving in the right direction and things are like pretty good. I also love this idea of like getting pregnant and nauseous because I really wonder, like I'm so curious, does that really fix things for a lot of people? Do you know or make things worse? Yeah. I don't know.

Like I think honestly too, like even it feels like like pregnancy, not pregnancy, light, but like exposure therapy light, I have two dogs. And I think that they have taught me so much about not having control and also exposure therapy to getting sick and experiencing again like going having that like actual fundamental experience of experiencing it so many times now that like when my dog used to he's like the the one that I've had since a puppy he is eight now and so when he used to get sick when he was a puppy like heart rate is a heart is racing and I'm going through all of like the physiological symptoms of you know panic and anxiety but now it feels so much.

different because I have that that actual hands-on experience of what that is to love something that is getting sick and not being you know not having that adverse reaction to it. Yeah, I mean, that's going to get way. I mean, it's going to be wonderful, but also super scary if you do decide to have kids one day because that just gets amplified. Right, exactly. So that's what I'm saying. It's like having dogs feel like, feels like exposure therapy light to this because we have

a dog who has a really sensitive stomach and he's throwing up all the time. And so that's been, I think, a great exposure for me that has kind of, you know, been forced upon me to be like, here you go. That's cool. I mean, so it sounds like you're, yeah, you're on your journey. You've got an exposure therapy light. It sounds like you're thinking about the consequences of pregnancy and stuff like that. But it's awesome. Like, I really, it's been a pleasure talking to you.

Like I'm sort of, I don't have anything else to say. So if you've got other questions or things like that, we can absolutely go there. But like I'm just sort of noticing, you know, because now I'm even noticing like, now we're like looking forward and like kind of what's next for you. Do you have any like last thoughts or questions before we wrap up for the day? I think, I think that's, hello? What? Oh, my husband has a question. I have a question.

Yeah. Do you want to come and screen? Yeah. No, I'm just going to scream from the side. That's fine. Screen from the side. How does the support of the partner help to notice and encourage with what we talked about today? It's so interesting.

I don't know how to like be a better observer. How to be a better observer. Are you not, are you a good observer already? Yes. Yeah. Why do you want to be better? I can be better. Why?

He wants me to keep making dinner every night. What does that mean? No. you pointed out some really important things that I think are great to like notice but not like I don't know so that's that's I think that might be the thing that Dr. Kay was talking about and like I want to be able to like when I see things in real time talk about them bring them up be supportive okay I understand what you want and this is this is strange um can I ask for do you want to sit if you want to be off camera that's fine

But I have an answer for you, but I don't. It's going to. Oh, Oprah. I forgot that he can't hear you. No, I can hear him. I can hear him. No, no, he can't hear you in my output. Oh.

Okay, can you hear me? Okay, I hear myself echoing. Gigi. Oh, no, no, it's fine. It's fine. No, you know, it's the, it is. Yeah. Okay.

So, so you want to be better, right? Why? I can't imagine hearing what I just listened to and not going, there's no part I play in that. I can do nothing better. I should change nothing. No notes. It's such an interesting, just slightly different degree perspective of something that I feel

like I'm aware of today, but like, hmm, maybe there is more there. Maybe there is a reason to encourage how we not run away from people. things that are so difficult on a daily basis for her. And there's no one closer and with her in those opportunities and times behind scenes to be like, hey, I feel like that was really difficult for you today. What was going on? Okay. So I think a couple of things. First is, I don't know your name. I just met you, but it's very clear to me that you love this woman very much, which is like awesome to see. So when we love someone, We feel protective.

We feel responsive. We want to support them, right? So if my wife were going through something, I would want to support her too when our kids are going through things. And I know it sounds weird, but like my instinctive reaction to you was like, take a step back and breathe. So this is not your responsibility.

Like your job as her husband is to be her husband. And so I don't actually, I know it's going to sound crazy. Like I know on paper, we could be doing better. Like, I know theoretically that's possible. I don't know if practically that's true. So I don't know if there's really anything that you can...

I mean, theoretically are the things that you can do, but practically, I don't know if that's actually the case. That being said, I think that if I had to give you one thing, so there's like two or three different dimensions that she hasn't sound like she hasn't worked on yet. So one, for example, is rewiring visceral hypersensitivity. So we know that when people have...

have, and this is where you asked if I've worked with people with a, emotaphobia, the answer is no. But one of the things I've worked with plenty of people who have some combination of fear of a physical thing, a physical thing, a fear of a physical thing and a physical thing. So, IBS, agoraphobia related to IBS, panic and anxiety related to IBS. So I don't know if this makes sense, but we use these terms. but the underlying mechanisms are shared, right? So SSRIs and serotonin is involved in depression. It's involved in IBS.

It's involved, especially SNRI. So SNRIs are, so SNRIs are FDA approved treatment for chronic pain for fibromyalgia. So for this weird mind-body crap, the SNRI works incredibly well. And so the fact that you are responding incredibly. well to an SNRI and you have a metaphor in metaphobia. It's in the realm of this body mind stuff. So there's a physical component, which it sounds like you've done CBT and stuff like that. Sounds like you've done therapy.

But what I found is that 50% of mental illness is in the body. So there's an area of visceral hypersensitivity, which is kind of the root thing that I would call, which is like the way that your body interprets physical signals. This is something that your lovely husband cannot do anything about. This is something that you've got to figure out if you want to do this physiologic rewiring. You talk about neuroplasticity, physioplasticity. So this is usually the biggest thing that we miss in panic disorders,

anxiety disorders, emetophobia, OCD, IBS, all of these conditions that involve the body involve a physiologic rewiring. This is also why most... Mind body practices like yoga and Tai Chi are superior to things like physical exercise, maybe even superior to meditation. I believe they are when it comes to this kind of stuff. So there's a physiological wiring. You can't do anything with that.

The one thing, if you need something. So question number one is why do you feel like you need to do better? Right. So you love her or whatever. Like that's great. But like I would take a step back. She said you have severe ADHD. So kids with severe ADHD grow up believing they're inadequate.

Grow up, they think they could be doing better. So what I'm like sniffing is like... See you didn't know me. You know everything about it. I know a lot. You'd be surprised. Maybe not. So I think that that question, the reason I resist your question is because I think there's

genuine love there, but it's also coming. It's masquerading. It's genuine love. No, sorry. It is inadequacy masquerading is love. that all that crap is like tangled together. So don't reflexively give into it. Just because she's having a bad day

doesn't mean that you're doing anything wrong. Okay? Number one, that's my reflexive pushing back. Number two is if you want to help her with something, help her with the loss of control, right? Help recognize that for the next phase of y'all's life. And she's good, man. she says his loss of control is not to be feared it is what my mind has been taught there's so much

separation between Lauren and her mind there's so much separation between Lauren and her body poor Lauren is inhabiting this body in this mind it's not who she is she just lives there and it's like it's like fuck I woke up this morning and it's the first thing I think think about. And it's the last thing I think about. And it's like all the shit is actually okay. The SNRI is working. I'm happily married. My husband loves me. I've got two dogs. One of them is puking everywhere. Everything. All of this stuff should be gone, but it's not. She's just inhabiting this space. I don't know how you're going to help her with this. I have no idea. But I suspect that the deeper we go, it's not your job to help her with the mental stuff. That's for her psychiatrist. That's for her therapist. She can go

to yoga class. If you want to encourage her to do that, go for it. You should go to, by the way. The thing, though, that you can help her with is something about her life and how she tries to control her life. And what does surrendering control in her life look like? If you all decide to have kids, if you guys, you know, when you all have kids, like, there's going to be a lot of times where her tendency to control is going to be, like,

front and set her. Because I know you know this. So when she gets activated, she goes crazy. Right? And you're trying to tell her like, hey, like, I know that we're getting a well-formed version of her right now. And she uses all of her coping skills and shit like that. But that's like when she's at the 30 to 50 percent and the clouds are parted. You've seen what it's like when it's a cloudy day.

There are thunderstorms. All that shit goes out the window. In those moments, I don't know exactly how, but I think there's something with the loss of control that you can really help her with. You know, that all of these things, all of your worst, she's got the foundation. All of your worst fears are coming true and it's okay. Like, we'll get through this, right? So everything can fall apart and we will get through this. This will end.

This challenge will end. I have a feeling that you can be a rock for her, not for her or a metaphobia. That's not your job. But for control, a loss of control, things, the shit hitting the fan. And that's also what brings out the best part. of you. So you have severe ADHD, except when she's having a problem. Then you're focused in. Your ADHD disappears. Y'all aren't a match made in hell. Y'all are a match made in heaven. Right? So like the two of you bring something together and like so you're doing it already. You don't

need to be doing more. You're doing plenty. And that's the direction maybe you can help her in. But that's not. Favorite assignment ever. No notes. No notes. Keep going. Yeah. Absolutely. Right. And like look at like I know you try hard and you take. lots of notes, but like even with no notes and keep going, I mean, that's been the number one thing that has allowed you, I mean, I know ADHD is hard, but I suspect that no notes and keep going is when you become the best version of yourself. True. Couldn't read my handwriting if I tried. Great. Thanks, Dr. Jay. Yeah. Appreciate you guys. All right. Impromptu couples therapy. No, not couples therapy. That's not, there's no conflict there.

Yeah. I mean, it's more about him, I think, than it is about y'all. But, Okay. Yeah, I accept what you said. Sorry. Okay. So any other thoughts or questions before we wrap up for the day? I mean, that was, that was great. I feel like we can't end better than that. Well, so I love your husband. He's great. Yeah. I mean, he's, I just got such a profound, positive energy from him, like just in the brief interaction. He's really, it sounds like a remarkable individual. So good luck with everything. before we wrap up, do you want to tell us where we can find you?

So like what channels do you use and, you know, it seems like you're super open about this stuff. You share a lot of this stuff. So where can we hear more and learn more about what you do? I'm primarily on YouTube, Lord DIY and Lord DIY vlogs. And then across all the other social platforms, TikTok, Instagram as well. Okay. Thank you so much for coming today, Lauren. Thank you so much for sharing your story.

I'm sure it helps to like a ton of people. So good luck with everything. And, you know, keep us posted on the whole if you guys decide to have kids and how that goes for you. Because I'm, you know, I'm curious about it. Absolutely. All right. It was so great to meet you, Dr. Kay. Take care.

You too. I'm going to do this. Okay, take care. Bye. Okay. How was that, chat? Did we enjoy? Yeah, that was great.

Okay. Yeah. like something was missing until he showed up. There's a cool question about, yeah, she's, she's awesome, dude. Like, it's so, it's so interesting.

I'm still processing, like, how, so it's clear she understands the stuff really well, right? So she's like, lived through it and learned the things that she's supposed to learn.

And she's just so dialed in. Like, I'm sure that, like, she's got to be exhausted. I mean, she's just so, sensitive. I don't mean that in a bad way. I mean, like, in a very practical, like, her ability to detect using her senses is very high. And, you know, someone's asking about physiologic rewiring. So let's talk for a second. Someone asked a question, how do we physiologically rewire?

So if you have a panic attack, or if you have a panic disorder, or if you have a panic disorder, or you have generalized anxiety disorder or if you have OCD or if you have something like IBS or a physical condition like fibromyalgia, if you've got some kind of condition where there is a body component and a mind component, how do we approach that? Okay. So let's understand. So the first thing that we have to understand is that if you've got pain, let's just take the the case of panic disorder. Okay. So in panic disorder, in generalized anxiety disorder, in something like IBS, which is characterized

by diarrhea, sometimes vomiting, sometimes constipation, if you've got chronic pain, these are all conditions where there is a terrible cycle between your body and your mind. and this feeds both ways. So, for example, let's take the case of someone with IBS plus agoraphobia. So in IBS, irritable bowel syndrome, sometimes you'll have periods of like just random diarrhea. And like, it's not tied to a particular food. We don't really know what causes it, but you can't really control it. So what happens in IBS is, you know, there's some kind of bodily sensation.

which then triggers the mind and then creates anxiety. Now, the problem with anxiety is that it actually triggers the body, right? So if you're like going on a first date with this person that you've been madly in love with for six years and you're finally going on a date, that is going to create nausea. Right? So when we have anxiety, this creates a physiological. response. And that physiologic response is mediated by things like adrenaline, mediated by noradrenaline, is also mediated by things like your sympathetic nervous system activation of which

adrenaline and noradrenaline are pieces. But then we also see things like inhibition of the vagus nerve. So the vagus nerve is what calms you down. Slows down your heart rate, slows down your respiratory rate. So there's a whole physiologic cascade. Okay. Now the problem is that once we have nausea, once we have this anxiety in our mind and then we feel anxious, so we have nausea that leads to anxiety. And then the problem is that the anxiety gets worse, right? So the anxiety propagates within the mind. So then there's another loop like this. There's like a second loop that is getting worse. So then I start to thought loop. I start to get into a thought spiral. So then the anxiety amplifies. amplifies, amplifies, and each time it amplifies, it is going to make my nausea worse.

It's going to make my heart rate worse. It's going to make my respiratory rate worse. I'm going to become tachypnic. I'm going to become tachycardic. So this cycle is going to feed on itself. Okay? So highest concentration of serotonin in the body, number one and number two are the brain and the gut. Most common side effect of SSRIs is GI upset.

Not necessarily nausea, not necessarily vomiting, just some weird stuff going on in your stomach. Serotonin is very important for your gastrointestinal system, peristolsus, things like that. Parastalysis is the movement of food through your intestinal system, okay? So when we're treating this stuff, and you'll notice that what's shared between, all of these things.

These are all conditions that have a body-mind component. So when I work with patients who have fibromyalgia and chronic pain, it's not just the pain that's the problem. It's that if you have fibromyalgia and someone is like, hey, let's go on a bachelorette party, you start thinking about all of the things, all of the struggles that you will have to deal with when you go on this bachelor party or this bachelorette party. Everyone's going to be going to the beach. What if your pain is bad that day?

Everyone's going to go jet skiing. You're not sure if you can do that. So all of these conditions are very mind, very body. And as when you have chronic pain, as you start to anticipate all of the problems, right? So now we're going to draw this in another way. So mind is over here. We're going to anticipate.

problems. Okay? When we anticipate problems, we are going to release cortisol. Cortisol is going to go to the body and increase inflammation. It's going to cause demarginalization of white blood cells. What does this mean? So at any given time, about 50% of our white blood cells, which are the cells that fight infection or on standby. You can kind of think about them as reservists in a military. We've got active duty personnel that are patrolling, and then we've got all of our reservists that are hanging out in the barracks. When we release cortisol, all of the reservists basically come out.

So our body is like, hey, it's time to get everyone. Now a bunch of white blood cells that we're chilling become active, and they induce inflammation. So when we have this kind of condition and we increase inflammation, we have a problem, which is that we have this mechanism called, oh, sorry, visceral hypersensitivity. This episode is brought to you by CarMax. Want to buy a car the easy way? Start at CarMax.

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Want to drive? CarMax. So what does this mean? So we always have signals. If you close your eyes for a moment right now, you'll see that there's stuff going on in your stomach. You'll notice things going on in your back, maybe some tension in the neck, maybe you have an itch somewhere, my toes are a little bit cold, there's all kinds of signals that my body is sending me all the time.

But we have this part of our brain called the thalamus, which blocks these signals all the time. Okay? So I don't know if this makes sense, but if y'all have ever had food poisoning, you know, you started to feel uncomfortable before you noticed you started feeling uncomfortable. right? So you start to feel a little bit uncomfortable, but you're like, ah, it's nothing. And then, like, as the discomfort increases, then your awareness of it increases. In visceral hypersensitivity, the thalamus doesn't work as well. So we amplify all of the signals. There's no gatekeeping for signals from the inside of our body. So now everything gets amplified.

Every little, you've got a little bit of gas. Maybe you need to burp. But now this is a sign of, oh, my God, this is nausea. So visceral hypersensitivity is going to increase the anxiety in our mind. Because now we're becoming aware of all of these signals. As we become aware of these signals, we start to anticipate problems. Oh, no, it's happening again. Oh, crap, it's happening again. Cortisol increases.

Inflammation increases. Visceral hypersensitivity. Well, if it's a visceral hypersit sensitivity doesn't increase, it's a state. But visceral signals increase. And then you see the loop? So for all of these conditions, there's a loop between mind and body. That's the TLDR. Now the question becomes, how do we treat this?

Right? How do you fix this problem? And this is why I think that our outcomes for these disorders are really bad. because we don't understand, we don't intervene on this connection. So if you have generalized anxiety disorder or you have panic disorder, people will say go see a therapist.

How much training does the average therapist have about the GI system? Very little. Now, the cool thing that I've seen is a lot of therapists are learning this stuff because they've discovered that in order to effectively treat their patients, they need to move one step closer to medical doctors.

Okay? So now let's talk about how to treat this. So first thing, we're going to have psychotherapy and pharmacology. These are our bedrocks. Doesn't mean that they're the best, but this is what we start with. So let's start with pharmacology. We have SSRIs, SNRIs, are like number one and number two. Okay. Why is this? So we know that serotonin transmission causes... Okay.

So serotonin, 5HT, is associated with peace. Okay? Serotonin is associated with elevated mood. Okay? So when our serotonin, we don't really know this because we don't really measure spinal tap serotonin concentrations. But generally speaking, when our serotonin levels are low, our mood is worse and our anxiety is worse. So what we know about SSRIs is they slow down, probably slow down the transmission of things like anxiety. So one of the side effects of SSRIs is to feel numb. And the reason that we feel numb is because if we boost our serotonin transition, it kind of levels us out. If we have side effects from it, it even levels out our highs so we don't feel happy.

Some people are unlucky and experience that. But basically we can think about artificially boosting serotonin transmission will lead to a reduction in anxiety, will kind of numb you out. And when serotonin is produced endogenously leads to a feeling of like peace and satisfaction. not pleasure. Now let's talk about SNRIs. So SNRIs are 5HT plus norapinephrine. Okay?

And norapinephrine is involved in things like alertness. So we're not quite sure. I mean, these neurotransmitters are like letters of the alphabet, depending on what word they're in, they serve a different function. So dopamine is a good example of this where like, oh, no, let's just use serotonin. So serotonin is also in the gut, right? So serotonin leads to, like, helps us with peristolsus. So it's not like serotonin is exclusively about peace and mood.

It does all kinds of different things. Okay. My favorite of which is serotonin is also a precursor, is the building block of DMT, which is endogenously produced by the human brain. Okay? So serotonin is even implicated in psychedelic experiences. So S&RI.

have something to do with our alertness stuff. This kind of like numbs us out. SNRIs have some action on our nerves. Something about the way that these work make these first-line treatments for things like fibromyalgia and basically some of these like psychosomatic illnesses. We use SNRIs. So if you're someone who's struggling with any of these things, SNRIs are also useful.

Now there's one other thing about SSRIs. They are also first-line treatment for OCD. So if we look at OCD, OCD is characterized by intrusive thoughts. Now, this is important to understand. This is a separate mechanism from this mind-body mechanism. Right? So we said that there's mind, goes to body, goes to body, goes to mind.

The thing about OCD is OCD takes intrusive thought. I'm just going about my business. There's no trigger. There's nothing wrong. There's no visceral sensation. And it just lumps, just tosses things into my mind,

just randomly. So what OCD does is it starts triggering the cycle, just randomly on its own. We also know that SSRIZRISR first line treatment for OCD, right? So this slows down the mind. slows down the intrusive thoughts.

And if we look at these conditions, they will oftentimes develop an intrusive, obsessional kind of quality. Where now I can't stop thinking. So when we look at panic disorder with agoraphobia, so agoraphobia means like fear, fear of leaving the home. So you're afraid of leaving the house.

So if we kind of think about it, this becomes quite obsessional, right? So I'm constantly thinking about what's going to go wrong. What's going to go wrong if I leave the house? I can't afford to leave the house with IBS. I've had patients who won't fly because they're like, if I start having diarrhea on a flight, like there's like two lavatories. Sometimes when I have diarrhea, I have to sit on the toilet for two and a half hours. Like I can't do that on a flight.

So this over time can develop an obsessional quality. So I think all this stuff is like kind of tied together, is my point. OCD is a little bit different. Key thing here, though, is that we have some medications that work for this crap. Okay? Here are some of the mechanisms. Now, second bedrock of treatment is psychotherapy. There are different kinds of psychotherapy.

So let's start with CBT. Cognitive behavioral therapy. We have thoughts. We have emotions. And we have actions. And if we look at this mind-body connection, I don't know if this makes sense, but these three things are what happen here and here. This part of the loop is these three things. Now, that may sound confusing, so I'll explain.

So literally, when I sense something, I have a thought about it, right? I have an emotion related to it. My stomach feels a little bit queasy. my mind interprets. It draws an automatic connection between a visceral signal and a conclusion. Oh, no, it's happening again. Suddenly, that's an emotion. Suddenly, I can't leave the house.

That's an action. Right? So the bodily signals have thoughts associated with them, trigger certain emotions. Emotions trigger actions. So if we listen to Lauren, what does she kind of say? She says that when I have these thoughts and I have these emotions, I stop and I do this practice of like playing the tape through. I think, okay, if this is the worst case scenario, then what's going to happen?

How am I going to deal with that? You can literally, instead of this process being, I don't know if you all have had a panic attack, but what you notice about your thinking is that it runs away from you. You don't control your thoughts. You can't argue with yourself. It just runs away. So CBT is the way in which we put the leash on our mind and we yank it back. And we say, hold on a second.

What does this really mean? Do I really have to act in that way? What is, I'm noticing this emotion just because I'm feeling panic doesn't mean that I have to run away. So basically what happens in CBT is we have thought, emotion, and action. And these three things will loop. Right? Sometimes they loop like this. So this is how it works. So we stop this looping. We can interject. So just because I'm having this thought doesn't mean that I have to, just because I'm feeling depressed doesn't mean that I have to drink. I can meditate instead. When I'm feeling depressed, doesn't mean I have to drink. I can meditate instead. Right? So this is how CBT works.

bedrock of psychological rewiring is CBT. Now, then we have a couple of other kinds of treatment. We have EMDR. Okay, so how does EMDR work? So we have this mind body. I'm going to use red here. We have this mind body like cycle that gets triggered and then goes to shit. So what happens is in EMDR, we have a trauma.

And when we have a trauma, our sensory system becomes hypervigilant. We are looking for signals of danger. And when we see signals of danger, we are going to activate, let's call it, we're going to activate survival dot EXE which is our trauma response now

sometimes the sensory system this can be a sensory trick actually hold on so our sensory system we can have like you know a trigger like a door slamming or something like that or I see a dog which will trigger survival dexc the other really interesting thing is that trauma

also works on our hippocampus This is our memories. And our memories become so overwhelming that they trigger a dissociative response. And when we trigger a dissociative response, this becomes a dormant memory. It becomes buried. And a dormant memory can become active

and trigger survival. Right? So I can trigger my trauma response through a sensory input or an internal input. The trauma response can be triggered from the outside or the inside. Okay? So what we do in EMDR is we purposely activate this memory. But when we activate this memory, our attention is on moving our eyes.

We literally are just, I'm recalling the memory and I'm just moving my eyes back and forth. I'm just moving my eyes back and forth. And I want you all to do this for a second. So listen to the sound of my voice and move your eyes back and forth. And what do you notice? When you move your eyes, maybe I'm moving a bit too fast. When you move your eyes back and forth, what do you notice about your mind? Like what happens to you if you just go like this?

And I'm talking to you, oh yeah, like I started playing Expedition 33. It's great. I have some hot takes on gaming. I think that FF7 is the start of the decline of the Final Fantasy series. And there are going to be two people who are listening to this. One person is not going to be doing what I'm asking to do, and they're not going to understand what I'm talking about. The other group is going to do what I am actually asking y'all to do. Y'all are going to participate, and you're going to immediately notice that it's like your mind has like a line down the middle.

Your mind becomes fractured. It's not focusing on one thing. And when our mind becomes fractured in that way, this stops survival. dot EXE. Okay? So as we do EMDR over and over and over again, once we shut off

survival. EXE, then something really cool happens. Because if we look at our sensory system, the reason that our sensory system activates survival.

exe is through our hippocampus. Right? So when I see a dog, my mind automatically thinks about the dogs that I've worked with. So this is truly the mechanism. And so when we do EMDR,

are, we're working over here. And then the trauma response shuts off. Now, in a similar way, we have ERP, which is exposure and response prevention. Okay. So we have a cycle. We have a sensory input, right, or a mental input, which trigger OCD.exe. And an exposure and response prevention, what we'll do is we'll expose someone to the thing that triggers their OCD. So someone is a germaphobe, we will expose them to some germs, but just tiny amount of germs. And then someone feels like washing their hands

and we're going to stop that behavior from happening. So normally what happens in OCD is we've got thought, emotion, action, and these two are going to be

distress, and then relief. So what happens, So what happens is every time I feel distressed, I'm going to act in a certain way and then I'm going to feel better. And then this pipeline gets reinforced. Because my brain is like, oh, when I'm hungry, eating food makes the bad thing go away. Therefore, when I feel hungry, I will eat, right?

Makes sense. The brain works by if something, take something bad in your life. If you have something bad in your life and you do something and it feels better, you're going to do it again. That's why we get addicted to video games and pornography and alcohol. I feel depressed. I'm going to drink and now I feel better. Therefore, when depressed, drink. It becomes like we're programming.

Okay? So what exposure and response prevention does is really interesting. Distress happens, but then we do not act. And then what ends up happening? The distress gets better on its own. Right? So if you're a germophobe and you expose yourself to some germs, you're not going to be stressed for the rest of your life. Eventually, the mind will come to homeostasis. And when it comes to

homeostasis, then you'll feel better. And so what happens with exposure and response prevention is we cut out the action. Now the compulsion is gone. Now the hand washing to the point where my hands are raw and my chances of infection increase is gone. So the compulsions are oftentimes the biggest damaging part of OCD. So that's how ERP works. So we can also use ERP, EMDR. Some of these techniques can be useful for things like panic disorders, generalized anxiety disorder. But then there are, so this is what we do normally.

Then there are a couple of things which are going out of vogue. So let's start with psychodynamic. As we notice from our conversation today, oftentimes all of these conditions have some kind of root. So really common is loss of control. I can't afford to be out of control. So I don't know if this makes sense. So all this physiology stuff is there,

but there's some deep association in your subconscious mind of like paranoia about loss of control and you need to be in control in your life. So getting into that deep unconscious, where did this loss of control come from? What is your relationship with loss of control? Why do you have to be in control? the time. If you guys watch this last bit that I did with Lauren's husband, you guys saw a little

bit of the psychodynamic sniffing is what I would call it. I'm sure psychodynamic therapists will say that I'm way off, which is fair enough. I do my own version of psychodynamic psychotherapy, which sure I've learned, but then I inject a certain dose of spirituality into it. Okay. So this is like this is like this deep stuff. It's not about the pattern or functional of your mind. This is not about the technicality of what happens in your mind. This is about the why. This is about the what do you want? Like what's going on within you? What's this deep-seated, adipal, complex, Jungian archetypal kind of stuff? Like, that's where that stuff is. So it's like this deep work where you make some breakthrough discovery. And the cool thing about this

kind of therapy is that when you make the breakthrough, it like sticks. The reason I love this stuff is because what I've noticed with both of these things is the likelihood of being like fixed goes down. Absolutely possible with some degree of CBT. But we're talking about like fixing, not managing, not mitigating. This is where this stuff really starts to come in in, in my clinical experience. Okay. I've absolutely seen CBT therapists basically fix anxiety disorders. Panic disorders, you can use EMDR to basically fix a certain part of trauma. So like that, that works too.

But what I see more often is exactly what we saw today, which is that we're functional. That's the goal of these therapies, by the way. It's not to fix you to make you functional, to remove the impairment in function. That's the purpose of psychiatric treatment. not to make you happy to keep the sadness from crippling you. That's what we shoot for. Okay? So this kind of stuff is great. I love it.

Problem with the psychodynamic therapy is that it's not clear how long it takes to work. It's not clear if it'll ever work. And it's not clear if you're doing it right or you're doing it wrong. So your mileage may vary when it comes to psychodynamic. therapy has been my experience. I think that, you know, it's effective. And good therapists know when you're in the right direction, when you're not in the right direction, you're chasing affect and all this kind of stuff. But like, there's a reason why CBT is like dominating because it's a lot more reliable. It's a lot more time limited. So in 12 to 16 weeks of CBT, you can get some solid

stuff done. It's not clear how long psychodynamic therapy really takes. Okay. Now, there are two other dimensions. One is I'm going to say spirituality. And so this is like my angle at dealing with this loss of control. Why do you need to be in control anyway? Right? What do you truly control in life? This is almost a little bit philosophical. So there's a philosophical angle to it. But when I talk about spirituality, what I usually mean is some degree of philosophy plus some degree of practice. So if you look at the big difference between like stoicism and yoga, what's the big difference? Well, I would say that yoga is a combination of stoicism and Epicureanism. It's about tranquility and also finding the most joy in life.

But the big difference between philosophy is philosophy doesn't come with a skill workbook. The concepts are there. But the big difference about spiritual practice is it comes with particular practices. Breathe in this way. Do put your body in certain postures. Chant these mantras. And so it's kind of like you could say that, what's the difference between kinesiology and going to the gym or being a personal trainer? So you can study kinesiology on a theoretical level and never go to the gym.

And you can get a lot. You can understand how your body works is very helpful. But if we look at philosophy, and I'm not trying to like dogg on philosophy, so philosophy is way more than that. It's a system of critical thinking and things like that. But when we're talking about helping an individual,

applying stoicism to your life, what is the daily practice? So maybe it's journaling, maybe it's contemplation. There's some of that, but that's not a big part of the formal system, at least that I'm aware of. I'm sure that people who love stoicism and philosophy will say that I'm mischaracterizing it,

which is probably true because I'm not an expert in that stuff. This is what I've observed. On the flip side, if we look at some spiritual practice, there's no philosophy. So some people are like, all you need to do is meditate. You don't need to worry about the philosophy. You don't need to do niani yoga. If you just meditate enough, you'll figure everything out. So they'll even say that.

Okay? But this is where when I work with my patients, I tend to take, like, this spiritual sort of approach, which is like, let's like understand what's going on. Let's understand why this is happening. Let's develop a philosophy for understanding it. Let's develop a practice to, how do we practice surrender? And I think this stuff is invading psychotherapy, right? That's why we have dialectical behavioral therapy.

We have acceptance and commitment therapy. We have all these third wave psychotherapies that involve some degree of spirituality. It's the, and their formulas the same. someone who is a therapist goes and studies spirituality and then they make something that is a combination of the two. Literally what happens in every case that I'm aware of. I have not seen a third way therapy that is not developed by a psychologist who went and studied some combination of Buddhism, Hinduism,

whatever, Eastern spirituality. Maybe there's some Western spirituality in there like Abrahamic religions. I just haven't seen it. Maybe it's there. I don't know. Okay. So this is the next thing. You have to understand why is control so important to you? Can you learn to surrender? And what I tend to find is that people who can learn to surrender, they basically knock this out. And if they knock this out, some of these mental patterns will still remain.

Some of these neuronal habits will still remain. But the juice is gone. Now all we need to do is let it wither. So this loss of control, this obsession around control, is like the water, the soil, and the fertilizer for the plant. And when we remove these three things, the plant will stay alive for a while. And if you choose to sustain it, it'll stay alive. But on its own, it melts away. You've taken out the root of it. Okay?

So I think it's very effective for a long-term sustained thing. sorry, long-term sustained improvement. Last thing we're going to talk about, which people asked about, is physiologic rewiring. This is the part that I think is missed the most. So when we look at cognitive behavioral therapy, there are thoughts,

their emotions, and their actions, and they relate to each other in a particular way. And we are basically rewiring the emotions that are associated with our thoughts, the actions that we take when we, feel a certain way we're rewiring that. We can rewire at the level of physiology too.

So that visceral hypersensitivity, how do we rewire chronic pain? I'll show you all. This is so cool. Okay. So in chronic pain, hold on. Let me show you all something. I show.

I show something. Okay. So tactile acuity, in experienced, Tai Chi practitioners. Evidence for the use of dependent plasticity is an effect of sensory attentional training. Okay.

Does anyone notice anything special about this paper? So this is a paper that is looking at how the somatosensory cortex gets rewired through... Okay, I'm not going to tell y'all. You guys can take a look at this paper and see if you notice anything interesting about it. Okay, you all found it, right? Woo-hoo.

Look at that. Look at that. Okay. So when I was, this is one of the like two publications that I've ever had. So this is what our somatosensory cortex looks like. So our, I know it's kind of weird,

but our brain, this is the percentage of tissue in our brain that is associated with a certain part of our body. So like a third of our, the brain that involves touch is devoted to the hands. Okay, so this is this homunculus, this is a good example. So this is what percentage of the tissue in our brain is associated with which portion of our body? So there is a huge chunk of brain that is the face.

There's a huge chunk of brain that is the hand. There's a very small chunk of brain that is the foot. A tiny chunk of the brain is the knee. So like literally like 80% of our somatosensory cortex, which is the part of our brain that has to do with touch, is devoted to our face and our hands. Okay? So that's why like you can't feel a whole lot on your back.

There's a really cool exercise that y'all can do called two point discrimination, which is you have to do this with someone else. But you take two fingers. you take two fingers and you see the distance that people can detect that they're being touched

with two fingers. So if you close your eyes, you put your fingers like this, you close your eyes and you touch your arm, does it feel like one finger or two fingers? Then you spread it out, does it feel like one finger or two fingers?

And what you'll find is that the two point discrimination on your face is very sensitive. You can even have two fingers very close together and you can tell it's two fingers. This definitely feels like two fingers. But if you put two fingers,

here, you can't really feel that it's two fingers. It just feels like one finger. That's called two-point discrimination. That's how you know which parts of the somatosensory cortex work and don't work. Okay? So now let's talk about physiologic rewiring. So in chronic pain, we have this homunculus. And basically what happens is some part of our attention gets locked in to some part of our body. So if I have chronic pain in my back, this part of my somatosensory cortex is always focused on my back. I can't stop thinking about my back. I feel my back all the time. There's no relief.

Okay. Now, if we do a practice like yoga, what yoga does is when I adopt a yogic posture, my attention becomes focused. Let's say I do a posture where I have one leg this way. got my second leg like this, and I have my two arms like this, right? So I'm standing on one leg and I have my arms above me like this. When I adopt this posture, my somatosensory cortex feels this, it feels this, and it feels this. It feels my arms feel really tired. So I don't pay attention to my hands. I don't feel pay attention to my lower back. I don't pay attention to my face. So chronic pain is when the part of our brain that experience,

our body gets locked into a particular configuration and it cannot leave. It gets stuck focusing on the back. So when I do yoga and Tai Chi, it unstucks me. Now my attention can move to other parts of my body. Now here's the really cool thing. Attention and pain are also a vicious cycle. When something hurts, I pay attention to it. If I start paying attention to something, it hurts more. When I focus on the pain, when I start to pay attention to it, if I can distract a child who fell down, they'll stop crying. So there's a cycle here as well. So one way that we can physiologically rewire with chronic pain

is through shifting our attention to different parts of our body. So non-sleep, deep rest, or yoga nidra, post-cultural, appropriation by medical science is another technique that does this really well. Body scans or another technique that does this really well. Okay. But it's not just this part. It's also when we do, so if we look at anxiety and panic, this gets complicated, okay? So this is going to get a bit technical.

So in a healthy person, this is my heart rate. And in periods of stress, my heart rate goes really high. Let's say my heart rate is up here. And when I'm relaxing, my heart rate goes really low. So in a healthy person, the range of their heart rate is large. So my heart rate can go up to 130. my heart rate can go down to, let's say, 60. Or heart rate can go to, let's say, 150.

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See website for details. Now, I'm going to actually change this a little bit. I've got to fix this up. Say this is 60. Say this is 150. Okay, so this is 150. This is 60. Now, if I'm an Olympic athlete,

my heart rate goes like this. Okay, so the peak heart rate of an Olympic athlete may be 180, and their resting heart rate can drop even lower, down to 40. They can be bradycardic. So do you all understand that an Olympic athlete, their heart rate variability, the range between the top and the bottom actually increases. Heart rate variability, the change in heart rate goes up.

Now, let's take someone with anxiety. So someone with anxiety has a heart rate like this. So they can still go to 160. The lowest they can go is 80, and they sit at 95. So their heart rate variability goes down. So what does this mean practically? This means that their nervous system is in a... It's wired at a higher set point.

Normal for them is higher than normal. That becomes a new normal. Their sympathetic nervous system tone, the baseline level of sympathetic nervous system activity that they've got. When they're walking around down the street, their sympathetic tone is higher than someone without anxiety. Their HRV goes down. The capability of their heart to respond to stress goes down.

The capability of an Olympic athlete's heart to respond to stress is way higher. Do you all understand that? So lower heart rate variability is bad for health. Higher heart rate variability is good for health. And this is not just health. Let's think about this. So if I have a bank account of a million dollars, the capability of me to respond to a financial stressor is greater. This is a good thing. If my bank account has $100, the capability of me to respond to stress is way lower. I cannot handle losing my job. I cannot handle a medical bill.

I cannot handle a hole in my roof. So when we have anxiety, our HRV is low. So it turns out that if you rewire your physiology, you can increase HRV. Right? So I don't know if this kind of makes sense, but the same heart that is responding to your anxiety and is triggering your anxiety can be modified by exercise, can be modified by meditation, can be modified by yoga. There are all these fancy devices that try to measure the electrical activity in your brain when you meditate.

The best parameter, which is measurable by a device, which determines whether you are meditating correctly or poorly is not anything relating to your brain, it is relating to your heart. The difference between if two people are closing their eyes and both of them are trying to meditate, the way that you can tell which one is succeeding on the inside and which one is not succeeding on the inside,

is their HRV. Good meditators have increased HRV. If you do yoga, you will have increased HRV. If you exercise, you will have increased HRV. And there are more detailed versions of being able to do this. These are just the general things. But when we're talking about the somatosensory cortex and chronic pain, there are certain things you can do to physiologically rewire.

When we're talking about pot syndrome, postural, orthostatic, tachycardic syndrome, we're talking about a different set of exercises. So with pots especially, the asanas that we use are going to be different. They're going to be very careful, but eventually what we want to do is increase the blood flow in position of our head in relation to our heart. So we want people to lay flat. We want to do upside down asanas, eventually. We want to do things like downward facing dog, Barvatasana, Bhujangasana, cobra pose. We want to do these kinds of things.

But carefully, because people will not be. they'll pass out if you do it right away. So you got to be careful. If you have something like IBS, a different kind of physiologic rewiring needs to be done. A rewiring of your gut. Certain asanas for that. Right. Certain meditation practices for that. Certain even regular practices for IBS too. You want to alter your diet, alter your gut microbiome. So there's a physiologic change that can happen. Gut microbiome is another good example of this. Right. Arguably, that's not physiology. That's gut health. But so there are all these dimensions. And what I've found as a psychiatrist is when you do all of this, these conditions,

sorry, these four conditions get profoundly better. Right. So I see, like the Lauren's story is like super classic. Like she's doing way better. She's living her life. She's functional. But like, that's good. It's really good. And it's enough. And I think there's a lot more we still have to learn. I think there's a lot further you can go. And when you employ all of these mechanisms, what happens to your panic disorder, what happens to your GAD, what happens to your IBS,

what happens to your chronic pain, can change immensely. So I think out of these, I think chronic pain is the toughest. So I think chronic pain is like, the clinical outcomes I've seen from these three or consistently excellent. This one is, for some reason, is tough.

I don't know why. But definitely Tai Chi and stuff helps a lot, as do things like duoxetine. So it's like, your mileage may vary. But if y'all are struggling with this, hopefully this helps. And like when we say, go see a therapist, go get treatment,

this is not a substitute for treatment. I hope you all understand. I am not doing this with y'all on the internet. I'm just talking about how this stuff works. And if you all have a condition that feels intractable, that feels untreatable, it feels like I've tried everything and nothing works, there's a lot that you can do. And some people respond way better to some of this stuff than other people do. I've had plenty of people who have a history of trauma and they've tried like seeing a therapist, but that therapist is not trained in ERP or EMDR. And it like, it doesn't work.

and then there are people like Lauren who's like, yeah, the SNRI like saved my life. So it's about finding the right treatment. And unfortunately, that involves like a lot of trial and error. But anyway, I hope today was helpful for y'all. We've been running an hour over, which is totally fine. And yeah, good luck. So thank you all very much for coming today. Huge shout out to Lord DIY.

why and hopefully I'll learn something and hopefully we were able to help we will see y'all tomorrow for the world is on fire stream thanks for joining us today we're here to help you understand your mind and live a better life if you enjoy the conversation be sure to subscribe until next time take care of yourselves and each other