Ten Percent Happier with Dan Harris - 356: Anxiety, Explained | Luana Marques

Episode Date: June 16, 2021

Taming Anxiety Series - Episode 2: Anxiety is very common -- but also commonly misunderstood. So today we’re doing a show that you might think of as: Everything You Wanted to Know About Anxiety (But Were Afraid to Ask). This is the second episode in a four-part series we’re calling “Taming Anxiety.” (By the way, if you missed the first episode, with pop-star/Broadway star/sitcom-star Sara Bareilles, I strongly recommend checking that out.)  Today, though, we are diving into the science of anxiety with Dr. Luana Marques. Luana is an Associate Professor of Psychiatry at Harvard Medical School, President of the Anxiety and Depression Association of America, and the author of Almost Anxious: Is My (or My Loved One’s) Worry or Distress a Problem? You might also recognize her from this show, because she was also our very first guest on the topic of Covid, way back in March of 2020, in an episode titled “How to Handle Coronavirus Anxiety.” In this episode, Luana will explain, from a scientific perspective, what anxiety actually is; why it isn’t actually a problem in and of itself – instead, it’s our relationship to it that’s (often) a problem; what the "TEB Cycle" is, and how to work with it; the short-term benefits of avoiding things that cause us anxiety – and the long-term consequences of that avoidance; and how to handle anxiety-induced phobias, including, in my case, a pronounced fear of elevators. Plus, we’ll take some voicemails that you, our listeners, have submitted. You can also learn how to actually practice everything we'll talk about in today’s episode by participating in our free Taming Anxiety Challenge over in the Ten Percent Happier app, which kicks off next Monday, June 21. Join the Taming Anxiety Challenge by downloading the Ten Percent Happier app: https://10percenthappier.app.link/install. You will be prompted to join the Challenge after registering your account. If you've already downloaded the app, just open it up or visit this link to join: https://10percenthappier.app.link/TamingAnxietyChallenge. Full Shownotes: https://www.tenpercent.com/podcast-episode/luana-marques-356 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelly McGonical and the Great Meditation Teacher Alexis

Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay on with the show. to Baby, this is Kiki Palmer on Amazon Music or wherever you get your podcast. From ABC, this is the 10% happier podcast. I'm Dan Harris. Hey guys, anxiety is of course very common, but it's also very commonly misunderstood. So today, we're going to do a show that you might think of as everything you wanted to know about anxiety, but we're afraid to ask. We've got an expert from Harvard who is gonna answer your questions

about all sorts of flavors of anxiety, which isn't especially relevant topic during this time of pandemic and political upheaval. This, by the way, is the second episode in a four-part series we're doing called Taming Anxiety. By the way, if you missed the first episode with pop star, Broadway star, sitcom star, Sarah Bareilles, I strongly recommend you go check that out. And the third part, by the way, and this is important to know, the third part's gonna be posted on Friday. Friday, we normally post bonuses, but we're gonna do a

full, proper episode on social anxiety, specifically coming up on Friday. So, stay tuned for that. Today, though, we are diving into the science of anxiety with Dr. Luana Marquez. Luana is an associate professor of psychiatry at Harvard Medical School. She's the president of the anxiety and depression association of America, which sounds like a really fun group. And she's the author of a book called Almost Anxious,

Is My or My Loved One's Worried or Distress a Problem. You might recognize Luana actually from this show because she was our very first guest on the subject of COVID way back in March of 2020, in an entirely different lifetime. In an episode we entitled, How to Handle Coronavirus Anxiety. So today she's back because let's face it,

anxiety sucks. In fact, I actually wanted to call this whole series, anxiety sucks, but taming anxiety felt a little bit more mature. And perhaps more on point because anxiety can in fact be tamed. And in this series, we're gonna to teach you how to do that. To that end, in this episode, Luana is going to explain

from a scientific perspective what anxiety actually is, why it actually isn't a problem in and of itself, instead it's our relationship to it that is often a problem. She's going to talk about what the tab cycle is and how to work with it. That's going to talk about what the tab cycle is and how to work with it. That's a term of art, the tab cycle. She'll talk about the short term benefits of avoiding things that cause us anxiety

and the long term consequences of that avoidance, which are quite pernicious. She'll talk about how to handle anxiety-induced phobias, including in my case, a pronounced fear of elevators. Plus, we're going to take a bunch of voicemails that you are listeners have submitted. Okay, I also want to add this because you can also learn how to actually practice everything we're talking about in this special series. You can learn how to kind of integrate it into your neurons by participating in our free

taming anxiety challenge, which will take place over in the 10% happier app. And that challenge kicks off next Monday, June 21st. So you can listen to the podcasts and then do the challenge. As many of you know, I think we have an entire app, the 10% happier app that is dedicated to helping you practice all the ideas we talk about on this show. I think it's a great resource and it's free to try. And this challenge is a great opportunity to go check out what we do in the app

because you can get a real feel for how we do, what we do. It's a 10 day challenge. It will combine the clinical chops of our guests today, Dr. Luana Marquez, with the meditation expertise of a great teacher named Leslie Booker who's actually gonna be on the show this coming Monday. Every day you get a little video featuring yours truly, and one of the aforementioned experts,

some of the videos actually feature both of them, and then that video rolls directly into a short guided audio meditation from Leslie Booker, who likes to go by the name just simply Booker, and you'll receive daily reminders to help you keep on track, and you can invite your friends to participate with you and you can see how they're doing and gloat if you're doing better than them.

To join the challenge, just download the 10% happier app wherever you get your apps or by visiting 10%.com, all one word spelled out. If you already have the app, just open it up and follow the instructions. Join. Okay, here we go now with episode two in our anxiety, Paloza, with Dr. Luana Marquez. Dr. Luana Marquez, welcome back to the show.

Nice to be here, Dan. Thanks for having me. It's a pleasure, although as we will reveal to listeners, it's not always fun hanging out with you when you're in your tougher mode, but I'll explain that coming up. So let's start just so we can kind of level set here. How do you define anxiety? So I think there are lots of definitions, but let's think about it and overestimation

of threat in an underestimation of your ability to actually handle that threat. It's really related to what your saints yourself, right? Because I had to affect our thoughts, our emotions, our behaviors, but really is our prediction that we can't handle what's going to be thrown at us. This is navigating the world fretfully, both in terms of the challenges we face and our resources. That's absolutely right. Now we imagine that our resources are not going to be enough to handle whatever it is we're predicting

is about to happen that we'll have a negative impact. What do we know about what anxiety does to the brain? Well, anxiety really often turns on our amygdala, the old lizard brain, and allows us to sort of start preparing for fight, flight, or freeze in extreme signs of anxiety. It also does something unique about our ability to think. It turns off our prefrontal cortex, so I should say it dims it. It's just not as much activity.

So that's why often when somebody comes to me and says, hey, I'm anxious and I can't think straight. And that's absolutely right. Your brain is just not working. It's vast when anxiety becomes too much. It's so interesting because, I mean, this is sometimes referred to as the amygdala hijack that you get activated.

The lizard brain gets going. The reptilian folds of the brain are activated. And the newer parts of the brain, the prefrontal cortex, which does our planning and rational thinking, the ability to use that goes close to zero sometimes. It really does, because we don't have to think to run from a lion.

In fact, the body shuts down a lot of the organs. So if you are really in a threat situation, often people are gonna say, I have stomach ache or I have, and I'm sweating. That's your body just preparing you for dealing with what needs to be dealt with. It was just keeping you safe. And you don't really need to think. In fact, you don't.

Anxiety is almost never thrown around as a positive thing. That word is never thrown around in a positive sense. But it is trying to serve us, right? It is trying to protect the organism. Absolutely. I actually think of anxiety as a positive thing. Maybe why I do what I do for a living is that for me, it signals that something internally is not going well.

And for me, it's an ability to then pause and ask myself, what's going on here? How I'm feeling. And so I find it to be positive, personally. What is negative about it, if I'm feeling. And so I find it to be positive personally. What is negative about it, if I'm understanding you correctly, is that we relate to it unwisely. Instead of seeing it as a signal that, oh, we should wake up

and deal with something, we get carried away. That's right. We often get carried away. We add our own narrative. We protect the worse. And in that scenario, then anxiety starts to paralyze people. It makes you feel like you really can't handle it. So let's dive into now to some of the paralytic aspects of anxiety. You and I conducted an interview for the anxiety challenge. And you talked about something called cognitive distortions, which were as soon as you described them,

just sounded like something that occupies a huge chunk of my waking hours. And I just want to play a little clip of you describing cognitive distortions and then we'll dive more deeply into it on the other side. So here it is. So often when we anxious, we believe that thoughts are facts. But the reality is our thoughts at that point are really being filtered through the lens of anxiety. So this is a concept of cognitive distortions when our brain missing trippered information and jumped to conclusions or imagined that the worst case scenario is going to happen. I think most people will hear that and think it sounds very familiar.

So what can be done in the face of cognitive distortion? How do we even know we're doing it? Because often we just believe it. We often believe it. In fact, most of us believe that thoughts are facts. So I think a couple of things we should think about. First is everybody has it. So if you're listening to us and you're thinking, well, yeah, yeah, I think that way. Absolutely. So the first piece is everybody has cognitive distortions. The question

is, are you taking them as facts? And so how do you know you're having them? Often people start to feel bad. You're telling a narrative to yourself, I can't do this. This is never going to be over. Life is too challenging. And then you start to feel pretty bad. You get more anxiety, heart, my pound. You may want to avoid things. And so the emotional, either physical or in your heart kind of parts of your bodies when you sort of go, what's going on here? And often I say to my patients, just ask yourself, what am I saying to myself right now? And do I have data here? Can we question? Can we become detectives?

And that's how we do it. Right, we don't take thoughts as facts, especially thoughts that are driven through emotion. There's something we talk about on the challenges, kind of entering the cognitive distortion courtroom where you're cross-examining some of these thoughts as they're happening. Exactly. You're asking yourself,

no, what data do I have here? What a judge and a court of law actually believed us. And sometimes though, the distortions are true. In fact, may not even be distortions, right? They may be things that have happened that are upsetting. And in that case, not only asking about, do I have data about this, but also asking, is it helpful? If you say to yourself something that's pretty negative all the time, how is it impacting

you? And so sometimes we really need to get to more balanced ways of seeing the world so that we don't get stuck on that black and white or nothing kind of view of the world. And think about this, if we need our thinking brain to get out of situations that are stressful, then stressing about them is certainly way to just turn off your brain. So if it's not helpful, then we need to sort of reexamine, find them more balanced views so that we can actually use the thinking brain for something that can help us.

But how to actually do this? I mean, this is two-part question. How to actually, I often don't wake up to my cognitive distortions until years later. So how do we wake up to my cognitive distortions until years later. So how do we wake up to these cognitive distortions? And then once we have woken up, I mean, beyond the cross-examining which you've talked about, how can we bring the prefrontal cortex,

the newer, more rational part of the brain back online? So the first part to wake up is to really have a curiosity of what's going on in your life in your brain To pause for a second to literally go, wait a minute What am I saying to myself? Not to judge not to correct, but the first step is to even understand that you have a pause button And I think most of us just go on automatic pilot and we don't pause to ask ourselves Wait a minute. What's going on here? And we thought that pause, we can't ever wonder about cognitive distortions, right?

So you create that pause, and I usually tell my patients to link to something, even if it's like one time a day, your phone goes off, and you go, what was I thinking about right now? I started to just create moments of curiosity into your brain, creating that pause button. Then once you create that pause button, by just asking the question, what am I thinking?

What is going on in my brain? You are actually activating your pre-formed cortex. If you don't do even better, write down your thoughts. When we start to write down, especially in a pen and paper kind of idea, you start to slow down. That's why people talk about diarying sometimes, journaling, being being helpful because it's slowing down the brain. You can't actually write as fast as you can have cognitive distortions in your brain. It's just not possible. So the cross-examination, the

asking yourself, what am I thinking right now? The journaling, all of these moves inherently engaged at prefrontal cortex. So you are by doing them, bringing it back online. That's exactly right. You're really just getting your brain to work for you by turning it on. And the trick thing here, and we haven't talked about this, but I think it's important is the relationship at the true parts of the brain. By forcing yourself to activate your prefrontal cortex,

you are, by definition, forcing your amygdala and your limbic hijacks to start to go down a little bit. And so you're sort of, you know, they compete for energy in your brain. That's how I think about it. And so for you to get out of that amygdala hijack, you wanna turn on your prefrontal cortex. I would imagine, and I'm biased here, that meditation is extremely helpful in this whole system,

because meditation is systematically engineering a collision between you and the voice in your head. So you're creating the habit and boosting the skill of self-awareness, which would allow you to catch yourself in these cognitive distortions. That's absolutely right. Science teaches us that meditations extremely help, especially for anxiety. Research suggesting that meditation can certainly help people decrease their anxiety. When I tell my patients in terms of the anxiety and mindfulness and meditation here, is that if you're meditating often, you are allowing your brain to have a slower speed.

You're observing, you're creating that self-awareness, as you said, and that is a much more fertile ground for you to then challenge your brain, right? You're building the muscle that allows you to slow down a little bit. Okay, so that's interesting. I would have thought the mechanism by which meditation has a positive or mitigating influence on anxiety would be the self-awareness that you are sitting, trying to focus on your breath and then every time you get distracted, you start again and again and again. And it's in those moments of waking up from distraction you see what your life is all

about, you see what your mind is doing. And you can then take, even if it's just a minute daily-ish, you can then take that skill out into the world. You have a leg up when the cognitive distortion monster is at work. I think we're saying something pretty similar. I think for me at least, that self-awareness allows for a slower engagement in the world in general that slows down my own engagement in the world. Right? So the viability of that self-awareness and the meditation that you're not as frantic if you engage in the world. And that's what I mean by it serves the ability not only as self-awareness, but your own experience of the world, I think, can be calmer one, as a side effect, not as the thing

they're striving for. It's interesting to say this, because I often, when people ask me what are the benefits of meditation, I usually list three things. And this isn't necessarily always in the context of talking about anxiety, it's just talking about why would I sit there with my eyes closed. The first thing I talk about is calm, And a calm can be a little misleading as a when you talk about it as a benefit of meditation because people sometimes go into meditation sessions, an individual session, expecting to become, which expectation is the most obnoxious party guest in the meditation party. And so it's this weird thing where if you

expect something in meditation, it's almost guaranteed not to happen. So you're going into meditation not to feel anyway, you're going into meditation, not to feel anyway, you're going into meditation to feel whatever you're feeling, clearly, so that your feelings no longer own you as much. And the net effect of that over time is what you just described. This overall increase in common in terms of how you engage with the world.

The second benefit I have to talk about, I don't think is relevant in this context, but it is the ability to focus, and we see this on the brain scans of people who meditate, the part of the brain associated with attention regulation changes. And then the third is mindfulness or self-awareness, which again, we've been discussing, it seems like another way in which meditation can help in the face of anxiety, which is that you see it more quickly. Exactly. And you know, I think the first time I heard about a meditation, I was in graduate school

and was John Cabinzen, and I read books and I started thinking about it. And it was very clear to me that sitting didn't make me calm immediately, right? In fact, it's a hell of a ride in the beginning, but I do think it's low down my engagement in the world that I'll allow that commoners over time. I do think that the self-focused though helps here because the ability to focus your brain better, the more your focus, especially if you can do one thing at a time, research shows us the creases and anxiety. Right? When I called you, they were told to multitask all the time, but we know that doing one thing at a time actually decreases and anxiety. So I do think in many ways, that's why I call the deferred around because it gives you

the things that your brain needs when anxiety comes up to then relate to it differently. That's such a great point. So I had said that maybe the second benefit I listed focus might not be an anti-exity lever, but I take your point because so many of us are in multitasking mode which makes us frenzied because our brains are not equipped to do many things at the same time, learning how to unit task, to pay attention to one thing at a time,

just couldn't have that net effect of cooling down your engagement with the world. We collected a lot of voicemails for you, people calling in with questions, and I want to play one of them, and it actually kind of just tees off of your notion that anxiety isn't the problem per se. It's how we're relating to the anxiety. So let's take a listen and then we'll chat about it on the other side. Hi Dan. This is Laura. I love your podcast, and thank you so much for this special on anxiety.

My question has to do with stories we tell ourselves about anxiety. I struggle with general anxiety, but sometimes I wonder if I'm really anxious or just think, well, I should be anxious because I'm an anxious person. So I guess I'm anxious in this situation. So I'm wondering if you or your experts have any advice for kind of distinguishing between when anxiety's really happening, or we just think, you know, we're experiencing it. Is it dropping into the body, or is it something else?

Thank you for everything you do. Bye-bye. That's a very interesting question because maybe there could be sort of pernicious impacts of giving somebody an anxiety diagnosis because then they're walking around with the story of, oh yeah, I'm an anxious person.

So of course, whatever's happening right now, I'm meeting it with anxiety. Does that seem like a danger to you? Well, it depends how you give that diagnosis. Certainly, the way you just described it is a huge danger. And Laura is talking about generalizing anxiety, which is worrying about worrying. That's the definition of generalizing anxiety. So I think it's really about, I think Laura's right, the stories with ourselves.

And in that, we really talked about our thoughts. We started by cognitive distortion, but understanding that once you feel something in your body and you're calling that anxiety If you then go to feed that anxiety monster, well, you're certainly gonna get more anxious So if you start to feel and you go, oh, that's anxiety. I should be few anxious Just that pot alone turns on that mig lane goes with a minute is something bad happening and then the minute you think Well, maybe it is happening. And then now you're off the runs and your body saying something bad's happening. I had this experience this morning, right about to work with a patient and had this very chaotic moment in the morning. A bunch of things

happening and I was walking into my office and my heart started to pound. And it happened that the patient was going to work with. He's having a lot of heart pounding. But when she has heart pounding, she goes, oh my God, something is bad, I'm anxious, something's wrong. I was walking in and go, oh, this is super exciting. My heart is beating fast because I'm really excited about the opportunities I have today. And just that thought changed my relationship immediately.

And when I shared with her, she went, oh, I can see. So the heartbeat does not mean I'm having a heart attack. And I think that's what Laura is talking about here. A lot of my patients talk about the same thing. I can you have a different relationship with that Incaside, making it something that can tell you what's going on instead of predicting something different. That's bad necessarily. Right. So it's reporting, not prognosticating. It's telling you the body is preparing for something. It's not necessarily saying the world isgnosticating. It's telling you the body is preparing for something. It's not necessarily saying the world is about to end. That's a great way to put it then. And, you know, the same heartbeat fast happens when we age, but happens when we're exercise. It happens

when we're happy. And so it's really that story that changes what happened in our brain. Laura also mentioned this notion of dropping into the body. I think it's worth talking about that for a second, because this is a big part of the anxiety challenge that we're running on the app. We really stress this in many of the meditations we do of dropping out of the swirling stories in the head and into your body.

Again, this could get into a triterritorial, listen to the body, et cetera, et cetera. And yet, there's a reason why clichés become clichés because they're true. So, what are your thoughts on this kind of listen to your body notion? I think it's extremely important to listen, observe, but not judge. Pay attention, bring curiosity. In fact, for the patient I just mentioned, what I encourage her to do is when her heart starts to beat instead of adding the narrative, she just say, oh, my heart is beating.

And name it and pay attention and ride that wave without making it worse. And so that connection between what you're feeling and what you're saying and really noticing is extremely important and acquiring cognitive behavior therapy. One of the center pieces, if not the centerpiece of your approach to treating anxiety and your patients, is the tab cycle.

You talk about it in the anxiety challenge. I just want to play a little bit of that and then we'll go into more depth on the other side. Tab stands for thoughts, emotions, and behavior. It's a way for us to really understand what we are saying to ourselves, our thoughts, our emotions, what we are feeling, our bodies, and our hearts, and our behavior, what we do. It's really a way for us to sort of pause a little bit and understand what's happened in our brain before we had skills to be able to really break spinning cycles.

So one thing that we do by exploring the tab cycle is we're pressing a pause button. And that pause button activates our prefrontal cortex our thinking brain. And by that, we're actually slowing down that limbic hijack. And now we can say, okay, what am I saying to myself? How does that make me feel?

What does it make me do? And in just observing that, you're actually slowing down your brain, and then you're more equipped to add skills that will break that spinning cycle. Okay, so let's talk about how the tep cycle would help us in a moment of anxiety. So I'm, I don't know,

it's not hard to make me that anxious, but I get a elliptical text from my boss that says, call me. And then I start to spin. How would I use the tips like on a moment like that? So the minute you get that text, what happens in terms of your body, your physiology, your emotions, what happens there? What do you feel? Chest Titans, for me, that's the big place where I experience anxiety. I imagine she's going to fire me. I call probably too fast before I take a breath. I just like, I leap into action. Call right away and I'm tight going into the conversation. And why do you call right away, Dan? Because I can't stand the uncertainty.

That's it. So situation, right? You get the stacks from your boss and that's call me. Everybody listen, if you put yourself in that position, you can see immediately that you're going to get something. For me, I got my heart just to tighten a little bit. You got chest thing. And then immediately goes from that feeling to a specific thought she's going to fire me and Now you're feeling pretty uncomfortable and what do you avoid and it will void your discomfort by calling right away You can't stand this right because you feel so unbearable and so the tab cycle really allows us and it draws from cognitive behavior therapy Right the basis of it, but it's thinking about skills, not therapy. In such a way that in that moment,

you're positive your brain going with a minute. What's going on here? And just by even looking at that thought, she's going to fire me. If you were to use the technique that we talked about earlier, instead of being coming in detective, what data do you have, then, that she's going to fire? The data of what a terrible job I do. For sure. And you've done a terrible job I do. For sure.

And you've done that terrible job how many times? 21 years at ABC News. And you got fired how many times again? It could always happen tomorrow. For sure. The worry brain will do that. And that's why thoughts are not facts, right? That's why it could happen tomorrow.

Right. The emotions are valid, but they're not reliable here. Because what you're telling me is you're getting anxious about what could happen in the future instead of in the moment. If you looked at the probability of getting fired tomorrow, based on the past 21 years, what's the probability? Low. You see that?

It's hard to even say close to zero because it brings like, well, but I could hear you, Bray. I could see what your brain is doing. So embarrassing. Well, it happened to all of us. And I love that you're sharing them because it happened to all of us. You know, I got an email yesterday at work and it was sort of similar thing. And it was 11 o'clock a night and with my husband going, okay, what do I do?

Do I respond? It's 11 and one. But really? And so we all do it, right? The question is, what is the utility of the tab cycle? I love me to pause last night, the same way we would you with a text and go, do I have to call right away?

And if you really do, you do, but it gives you that moment to then engage perhaps, not so pressed, engage perhaps not through the lenses of emotions, but through your thinking brain. And that's pretty powerful. We are using this moment of getting an email in your case or a text in my imaginary case. And we're talking about the T in the 10 cycle thoughts, emotion, behavior, how can we employ the E in the B in a moment like that?

I'm going to slow it down and back up. I'm talking about taking a picture of your brain. That's how I see it. I'm very visual, right? And in the picture of one of cases, I'm blame and bad. I see this. That's how I see it. I'm very visual, right? And in the picture of one of cases, I'm laying bad, I see this. That's the situation. Laning band versus this. The thought he's mad at me, emotion, anxious behavior, I have to respond. Right? That picture is the tab cycle. Is the linking between thoughts, emotions, and behaviors? And that's what we usually don't do. We don't link them. We just, once

you sped it, you don't even know if it's the feed that's making you spin, if it's the e or if it's the behavior. Right? Just pausing on that picture before you engage is actually quite advantageous before we get to any of the parts. I'm no mental health professional, but Dr. Marquez, as I gently wag my finger at you, you probably shouldn't be checking your email at 11 o'clock at night. That's exactly right. I promised myself not to do it, but it's really hard. Like everybody else, when something happens, and yes, there's one of those days that things happen at work during the day, how is pretty anxious?

I checked it to calm myself down, and like I tell my patients, they had the opposite effect and made me more anxious. I think it's incredibly liberating to hear you say that you are not perfect. I am not perfect at all and I'm far from it. I get anxious, I spin, I avoid. I just tend to catch you a little earlier because I like it. Okay, so you just brought up a word avoid. We've been kind of talking about doing the opposite

of leaning in, spinning, reacting too fast, but another classic behavior, which would be the B part of the tab cycle, is to avoid a chai have some familiarity with, but let me play a clip from the anxiety challenge where we talk about avoidance and then we'll dive into avoidance and actually why it's not a great strategy on the other side Avoiding has a short-term benefit. The problem is, is teaching you a brain that opposite how we want to teach is teaching it the only way you can tolerate anxiety is by avoiding.

And so long term it gets more and more difficult to get on the elevator and you in desire to start to come before you even get there, which becomes nearly impossible then to approach. All right, you're talking about elevators there because I came to you with a big fear of mine, which is claustrophobia and that came show up in an elevator that's that my brain doesn't like. And I will avoid to the point of back when I lived in New York City and now I live in the suburbs, but I would go see friends in New York City and I would walk 20 flights stairs if I didn't like the elevator. That is a voidance, but it felt better to me than you know risking meltdown. Why was I wrong? Every time you did that, you walked up 21 flights stairs. It felt better momentarily, but it doesn't solve the problem. The problem is your interpretation that you're going to get in that elevator. You're going to have meltdown

to use your words and then something bad is going to happen. And you never get to test the hypothesis by avoiding. You just get to basically learn that avoiding makes you feel better, but the only way to feel better is to continue avoiding, which is not what we want to teach our brain. We want to teach our brain to approach, not avoid, and really in particular, that approaching and staying with that, that you can't stay anxious forever. Now, often patients say to me, but I'm going to explode. Luckily, none of my patients have ever exploded by just staying with the situation. Right? It just hasn't happened. And so it really is teaching your brain that you can tolerate that amygdala hijack that you can stay with it. And then what happens is the brain goes, okay, nothing bad is going to happen. And so I say this to everybody,

this is the skill that I use the most. It's approach and avoid. If you anxious, figure out what you're avoiding and go for it, just slowly and steady. But people say they tell you that I'm worried I'm gonna explode, but for me, there's a line, and I don't know if I, I mean, again, I am really not a mental health professional, but I don't know where the line between anxiety and panic is, and so I worry that I'm gonna

cross the line in an elevator over to panic where I start like trying to rip the doors open or like what, I don't know, really just, I can't sit there and tolerate it anymore I'm acting out in ways that are I'm not really in control of is that make any sense? It does and I've heard that for many patients that has calisophobia or panic disorder for that matter that their fear is that they're going to lose control and everybody's going to be there and they really can't handle it. Similar patients that are afraid of having a panic attack by driving, they're going to have this horrible car accident.

And so that's something I hear often. The reality is the likelihood of that is small, but because people have an experience of having in the past, the brain pressure is the probability much higher. So you make an overestimation, that probably probably probably by having a panic attack in the past. And now thinking like, well, if that happens, I'm going to get to panic. Takes a lot to get to panic. And so it really is that idea of allowing yourself to get in a situation that doesn't lead to panic immediate because you don't want to learn that that's where

you bring goals so that the brain comes down enough to then get to more challenges situations. to then get to more challenges situations. Okay, so this is key. What you're talking about is, while you do not recommend avoidance, you also don't recommend willing, nearly running towards your fears because that's likely to have some catastrophic outcomes. You talk about comfortably uncomfortable,

ratcheting up the level of discomfort slowly over time in the face of things you're scared of, which brings me to what I said at the beginning about how sometimes, most of the time I've spent with you in person or virtually has been incredibly pleasant and fascinating, but sometimes you're very tough to be with because you will push people, because that's part of your job to be uncomfortable in a regulated way and that's what you did with me while we were shooting the anxiety challenge. You had me get in an elevator which we made increasingly uncomfortable in a variety of ways and it was genuinely uncomfortable. So talk about why this idea of being comfortably uncomfortable is so important in your approach.

So comfortably uncomfortable really is based on the principles of what co-exposure therapy, which is very different of being exposed to something. In your case, then you've been exposed to elevators most of your life and still every time you got to an elevator that felt uncomfortable, then you had this sort of panic sensation leading even to a panic attack, right? So if you're completely uncomfortable, then you had this sort of panic sensation leading even to a panic attack.

So if you're completely uncomfortable, the brain's on fight-of-flight and it's like you're going to the emergency room because you think you're having a heart attack. You're learning not at that point, right? You're completely a mid-law hijack and you're survival moment. If you're completely comfortable, you're home playing with your kid and join yourself or in your case going up 21 flights of stairs saying, you know, I'm at least I'm getting exercise. It's good, right? That's a comfortable place, but we're not learning. Comfortable and comfortable is really allowing yourself to find the sweet spot that you can approach the thing you're afraid of in your case, the elevator. In such a way that you

can stay with it long enough that your amigur learns that nothing bad is really going to happen. And even if it does, imagine the worst case scenario, you do have a panic attack, you can actually handle it. And if you do this in a way that's regulated enough, then what happens is your brain pretty quickly, habitually gets used to it and says, you know what, this is okay. And you're described beautifully. We just kept making the situation in the elevator a little more uncomfortable. But at no point in time, we just went from one to the other. We looped again and again.

We went up to third floor and down again to help you brain to learn, hmm, I can handle this. And you know, over time, if you practice this well, patients really get better. We all get better. I did it with my hyphobia. It works. Yeah, it was interesting. We had a couple days and I felt like I made real progress, but sometimes with some patients,

I've heard you describe that it actually requires, you know, maybe three, four, five days or a repeated engagement over a longer period of time. But I, what I found in writing the elevator with you over and over and over again. And again, if anybody wants to see this, just take the challenge, you'll see some funny footage of this. I found that there were two things were really helpful. Maybe three. One was just a habituation over time was useful. The other was your injunctions to me where I remember two of them. One was drop out of your head into your body and just notice what's happening.

Test is getting tight. I got dizzy at a few points when it got particularly dizzy. You're like, the elevator stopped and I had no idea why I was stopping. So the one thing you told me to do was kind of just pay attention what's happening in the body. And the second was to cross examine my thoughts. How many times have you been stuck in an elevator and how many times have you died?

So what's gonna happen if you get stuck right now? What's the worst thing that's gonna happen? And it was very useful to do these two things over and over again. And you do need both, right? Because it's not just heavy trading is also being able to think differently so that the next time you walk towards an elevator, you can actually have that more balance feel the world.

That you're not feeding that monster of anxiety and say, I can tolerate this, but you know, it could be bad. Sort of like what you braided earlier. Well, I could get fired tomorrow. We want to get the brain to really have a more balanced viewing real time so that he can tolerate that discomfort and overcome it. You told me when we were shooting this in Boston that you've taken people with severe claustrophobia all the way to being able to handle getting locked in the trunk of a car. I have. As you said, and I think appropriately so, I tend to be a little direct as a therapist.

I want my patients to get better and we're gonna do what it takes And so this particular patient we did a lot and eventually She was able to be locked in the trunk of the car. It really is about what is the worst case for me being locked The trunk of the car means nothing but for her, I felt the worst case I think for you, we need to get you to an MRI machine or something like that Yes being locked in the trunk of a car would be a bad case the worst case. I think for you, we need to get you to an MRI machine or something like that. Yes, being locked into a trunk of a car would be a bad case, but I'm going to take that off the table because I'm hoping that's never even something that comes up. But an MRI, I will need to do at some point, despite my plans never to get sick. So I would like to be able to have that capacity.

What about people listening to this who don't have a Luana Marquez in their lives or, you know, like, can we freelance on exposure therapy? Can we cure our own claustrophobia, or public speaking, or whatever phobia we have? Before I jump there, I want to circumcise for a second, and because I think this is important for people to understand. When I talk about finding somebody in the trunk of the car, right, I think what people need to understand is to overcome your fear completely. You sometimes have to get to the trunk of the car, right? I think what people need to understand is you're overcoming a fear completely. You sometimes have to get to the top of the thing that make you the most afraid.

So I'm gonna use my case here. Skydiving was the worst thing when I considered a fear of heights. That being said, no one is gonna go skydiving every day in their life. And so it's really about getting to the top so that you brain can stop questioning it. But we certainly don't want people to have this idea that you have to get to that extreme

to be able to overcome it. So then to answer your question about can we sort of freelance some of this, it depends where you are in terms of your relationship with anxiety, how long you've had it and how much is impairing your life. I really believe that this skill, especially approach, not avoid, so comfortably and comfortably, and really looking at thoughts as not facts, and being able to understand that emotions are valid,

but not reliable. If you practice that early and often your life, and you have enough flexibility, you certainly can do it by yourself. But if it's starting to fear a lot, then I think that's the time to sort of think about, I need to seek a professional here. Got it. I've said this a lot on the show, but I really do think we're in this, and we've been here for a while, at least in the United States, we're in this strange

in-between with the pandemic was horrible, but it's not over, but things seem to be getting better, that this is, if you're in other parts of the world, you're still in the full on horrible stage, so I wanna recognize that, but I'm just curious, what are your thoughts about anxiety at this stage in the pandemic? What are you hearing? What are you seeing?

What are you feeling? It's sort of getting better, but it's not fully better. So we still have a lot of uncertainty. And when you put in the global context, then with variance and off that, then we have even more uncertainty. So I'm hearing a lot of anticipatory anxiety from patients, colleagues, friends, sort of what, when is it going to end and when it does, what does it look like? So trying to get certainty for that uncertain range. So there's a lot of that going on. And I think there's also a lot of fear of what this life

look like after this. And we don't know because we're still in the middle of it. And that's something that I think is important for us to remind ourselves, any data that we have predicting emotional long-term impacts of this are data after a major disaster. So if you look at September 11, we can anchor after September 11. So we still in the middle of the pandemic.

So some level of anxiety is normal, some anticipation is normal. And I think it's really about allowing yourself to practice resilience, building skills to help yourself, whether what could be a tsunami of emotional challenges. We're going to do a whole episode on social anxiety, which I think is, you know, not uncommon right now, is in some parts of the world we're starting to reengage socially. So we don't need to do too much on it right now because we, again, we're going to dedicate a whole episode to it.

But what are you telling folks who are coming to you about, you know, here we are emerging from our involuntary cocoon and I'm worried about talking to other human beings. What are you saying to folks in this situation? So if you had social phobia before, social anxiety, then actually some of the isolation is a good form of avoidance. The problem is it made it worse, right? Because now you have to face people.

So what I'm saying is, listen, having some level of anxiety socially and redirecting makes sense. But if you had this before, this is the time to release extreme. Because you've been for 14 months or so and other avoidance. And I hear this from patients all the time that they shut off a zoom and they can, you know, not shop for a meeting. They don't have an a camera when there's breakout rooms they are turning off. And so if he really has been there for that long, this is the time to seek some treatment.

The good news is the treatment is quite effective and people can get much better. Much more of my conversation with Lwana Marquez right after this will be answering a lot of your voice mail. Hey, I'm Eresha, and I'm Brooke. And we're the hosts of Wundery's podcast, Even the Rich, where we bring you absolutely true and absolutely shocking stories about the most famous families and biggest celebrities

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You can listen ad-free on Amazon Music or the Wondery app. Okay, we're back with Dr. Luana Marquez. We're going to dive into some of your voicemails. As I said, we got a bunch of voicemail questions. I want to tee up one that has to do with anxiety contagion. Here we go with that. Hi, this is Mary. And I think that I am on the average scale for anxiety. Now I'm pretty calm in those situations, but definitely getting anxious in others. But I can deal with that pretty healthfully.

But unfortunately, my husband, who I've been married to for 27 years, gets very anxious during travel situations. And it's the type of anxiety where I think he gets threatened when he doesn't feel in control in like, you know, fairly minor situations where like we're checking in luggage or, you know, I think that is, you know, we need to rebook. Situation is that definitely provoked anxiety in many people, but he gets very anxious. And and unfortunately I just then get anxious myself because I observe him getting anxious and then I will get into it whatever he's doing with the ticket

agent. And I definitely fuel this anxiety spiral. And I think that I'm learning how to step out of it. Of course, I haven't had much practice given travel restrictions, but now that I'm aware of it, I am a little better able to step out of it. But I would really love to learn how to do it more quickly. And also, what can I do that would actually help the fuses situation as opposed to adding fuel to the fire.

Thank you. Bye bye. What say you? This is something that happens in every relationship, romantic or not, and in any situation when somebody's spinning. Whenever somebody starts to spin around us, it really means that their emotional brain is kidnapping their whole brain. And then what happens is we forget to regulate ourselves. And so we start to sort of think about what can I do? And how do I, and she said it beautiful. Like she starts to feed it by starting to spin herself.

And so the first trick is this. We can't help somebody to manage any of their anxiety, if our anxiety is not in check. And it's as simple as that. If you don't have enough of your brain available for you, you're just going to feed other persons. And so really observing the tab site was slowing down, understanding. Two, in the case of this, if you can't have a conversation with that person, it would be

the idea of an error. Her and her husband before any trip, sort of have an negotiation about, listen, this is what happens, I observe it. This is what I can't do it that way. So let's negotiate. So do it beforehand. And then the other question is like, so how do I help?

I think helping in terms of anxiety is minimizing avoidance. So when I mentioned this was my husband, he was spending for luggage and stuff, get out of the way. Let them do with it. If you don't feed their cycle, then they tend to come down or they escalate. But as long as you don't feed it, it goes down. I have a three-year-old at home. The tempered tender doesn't less forever, thankfully. Now if you and your fear were with it, you can get pretty loud. And so, you know, I think about this when I think about

kids, the louder they get, the cooler you want to get. And you want to slow it down and you want to bring your rational brain. And I teach this to youth workers on the street they're working with kids, how this regulated regulate yourself first to then regulate the other.

I don't know if this is relevant, but something that I've noticed that was pointed out to me that I have a tendency to do, which is that somebody will come to me anxious and I will rush to fix it or put us into solution land. Instead of just signaling that I've heard them, validating what's going on for them, reflecting back to them that I'm listening Which in and of itself can have a cooling effect on the other person What you're doing and correct me from wrongton, but what I hear you doing is what I call set of avoidance

Somebody comes to you. They anxious and to not feel their anxiety You want to solve it and so you jump in and you try to solve it Which is avoiding you on this comfort most of the time for people because they're anxiety, you want to solve it. And so you jump in and you try to solve it, which is avoiding you on this comfort most of the time for people because they're anxious. You're like, well, I don't want my wife or somebody I love to be anxious. So you step in to really avoid you on this comfort and all the time to the person is make them more anxious because the reality is most of us need to be heard first before we get to solution. And often we are sharing so that we can think through it or be able to just have somebody say, listen, yeah, dust sock, it feels awful.

And so you're absolutely right that most of us get into fixing mold when we should listen first. And then I think in families, it's really important. What would be helpful right now? What are you actually asking me to do here? Because sometimes we just don't even pay attention to what the person actually needs. I keep learning that lesson over and over.

Let's do another voicemail. There's a caller who was curious about the link. I'm curious about this too. The link between anxiety and depression. Let's listen. Hi there, my name is Julie. I'm calling from Charleston, South Carolina. I often wonder with anxiety, with the relationship between anxiety and depression is, and that's

something I've explored throughout my lifetime and constantly. And a little bit conflicted, does anxiety cause depression? Can an episode of anxiety cause lifelong depression or vice versa? Would love to hear you guys touch on that in some way during your experience. Thanks so much. Bye bye. These two conditions seem to be quite commonly co-morbid, but I've never quite understood what, if any, causal link there might be. What's your understanding? So they're very comorbid. They happen together very often, in fact, the majority of patients that are treat for anxiety have some depression,

and vice versa. Very seldom we can talk about cause here. For example, I'm treating somebody currently that has a social fears. And what first happened really is people are going to judge them negatively. And then she started to avoid situations that had social fears. And then she started to feel helpless and hopeless, and sad, and then the depression kicked in. And so in that, it seems like a depression

is a consequence of the social fears. But the majority of the time, you can't actually tell because the more anxious you feel, the worse are your thoughts, the more negative your thoughts get, the more the pressure people get in terms of feeling helpless and hopeless. And so it really is about which one is interfering more, but the question is a chicken and egg.

It's hard to answer. So we don't really know why so many people who have one condition also have the other. But what we know is that the symptoms share variance, meaning that, for example, when you have an excited disorder, you may have a sleep disturbance, and if you're depression, you may have a sleep disturbance. So some of it is just the common denominator of how we diagnose and how faulty are the agnosticism of this. Unless one clearly happens before the other, we can't really say if it's this or that. Usually we treat both, and the good news is, the tab skills that we've been talking about in this course are the skills that treat depression and anxiety.

So if you're learning, listen to this course, they're thinking about your thoughts, right? And being the detective, the core of that is cognitive therapy, which is designed for depression and then adapted for inc So to me feels like, is the question as relevant if this feels the same, I'm not sure.

I've often thought about it as sensitivity, you know, that if you're a sensitive person, you're, which, you know, is raised in our culture as a red-blooded male, is not something I relish saying about myself, but as a sensitive person, you are more prone to getting sad by what's happening in the world or getting scared. Does that land? A little bit.

The research here gets a little challenging because you're using sensitive and I think in two ways. One is just emotionally sensitive, right? The other one is being told that you're sensitive and then learning that you're sensitive and then using as a filter, the things come in and you're more sensitive, which is more likely to get you spinning. And so I do think there's a vulnerability, we talk about anxiety sensitivity,

that some people just more vulnerable if the anxiety hits to hit them in a different way. If I breathe out of a straw, and that's called in a receptive exposure with a patient that has panic. For me, there's nothing. If I spin in a chair. For somebody that has panic, their anxiety sensitivity is different than mine.

So there's such a research that tells that we have different levels of anxiety sensitivity, but being sensitive to me feels like you're saying something to yourself that then filters your own view of the world. It's a story you're telling yourself which can become a sort of a self-reinforcing prediction. Like because you're telling yourself the story, you then become more sensitive.

Our brain filters information to minimize energy spent in the bright. So information comes in, and if you believe this guy's blue, you look at it, it's blue, Jack. If you looked in the sky, looked black, your brain goes, wait a minute, what's going on? And that takes energy, right?

This is the principle of cognitive resonance. And so if your filter says, I'm sensitive, anytime somebody says something, that makes you feel a certain way, you check sensitive. You never ask yourself, wait a minute. Am I really feeling sensitive here? It goes back to our first color,

and the idea of, am I really anxious or am I telling myself I'm anxious? And so it's really important to think about clearing our filters and thinking about our current life and not the history and the stories that we tell ourselves because that's to be distorted. Living with anxiety for a long time can have health impacts. And we've got a couple calls about that.

Let's play the first one. Hey Dan, so my question or my comment is, I feel like I was born with anxiety. I kind of feel like my entire life. I've been a warrior. I've had that clenching feeling in my stomach or my head or my chest when I was confronted with difficult situations or people. And, you know, fast forward to today. I'm 60 and I've developed some digestive and G.R.I. conditions, which I totally believe are part we do to the lifetime of a family anxious. And while the meditation helps, and I just have physical conditions that know amount of common practices will reverse. So I just would like to hear from

some of your expert guests, the relationship between anxiety and real physical illness. As I said, I felt physical symptoms during periods of anxiety, but now they've manifested into actual medical conditions. So I just wanted to hear more about that. What do we know about that? Research, I think they need back 2005, shows an association between the vages. There are diagnosed with an anxiety disorder and physical illness. So GI trouble, respiratory bone problems, even controlling for other mental health conditions. In fact, I lucked this up and you know between 50 to 90 percent

of individuals who come for treatment for IBS, a rateable bowel syndrome, all sort of diagnosis and anxiety disorder or depression. And we're seeing new data pointing to a longitudinal effect that haven't an anxiety disorder that can lead to GI trouble. And so what we are getting is a sense that long-standing anxiety certainly can affect our physical body and it makes sense, right? You're in the heightened state and that has some impact on your body. What causes what? We don't have clear data here. This gut brain connection is interesting to me. I recently moved houses, which is extremely stressful. I mean, everybody knows that.

And so it happens that I had to get an endoscopy where they sent a little camera down at your belly in the middle of this move. And they were like, yeah, your stomach is a mess. And I was experiencing it as we were moving. My stomach was really upset. They were like, you are a pre-alcerned level here. And it went away when the move subsided.

But that was just really telling for me. It really is. And I hear this from patients and in fact, different cultures, you know, in the Latino culture, which I'm part of, I grew up in Brazil. We know that people come in and say, I have stomach pain. They don't come in, say, I'm anxious. Oh, I have a headache.

Right? Many of my patients who are, let's say, listen, my stomach aches a lot. The doctor tells me there's nothing wrong, so it must be anxiety, but I don't really think it is. And so we have data really suggesting that. And you're right, the body tells you, right? And so it's an interesting idea of starting to think about, wait a minute, if my stomach is that hurting

because I'm feeling anxious about the transition, what can I do? And I think about brain health. Then what can I do to come down my brain? So my stomach comes down a little bit? And we're talking about skills here that are designed to help your brain. So I think we're right on target. One last voicemail here also about the question of what anxiety does to our health.

Let's listen to this one. Hello Dan. I'm a regular listener to your podcast and also as subscriber to your app. And I definitely do have an interest in the topic of anxiety. Having a lot of experience in a negative way with anxiety associated with medical procedures and medical treatments. So many people sit in wait for results of tests like mammograms and colonoscopies and such as well as sit in wait for surgical procedures. All of these are anxiety invoking and I would welcome a program or part of a program

devoted to this topic as to how to deal with or possibly successfully relieve the anxiety that comes with medical matters. I thank you so much for listening, and I do hope that you're able to address this topic. I think it's quite widespread. Thank you. Bye-bye. I agree it's widespread. I remember my wife had breast cancer a few years ago just waiting for test results or

just pacing around the waiting room while she was having surgery. And it was hard for me. It was way harder, harder of course for her. What do you say to people who are waiting for test results for themselves or somebody they love? The first thing is that anxiety is normal, right? Well, those researches actually compare people. They're sitting there waiting for a test result versus people that know I'm gonna get a month for now. When you are in that anticipatory anxiety, people have more difficulty, their

brain more distracted, and they have more trouble recalling information. So it's telling me that the brain is not taking information for short term to long term, which makes a lot of sense based on the conversation we have. Is that a middle high jack? So the first thing is you're going to have some anxiety. So expecting not to is certainly not going to help. Two is what to do in real time. And I think even the practice of meditation here can be helpful then. Really sort of, you know, queuing in,

being able to be mindful, being attentive. Our using of this goes that we talked about, but I don't want people to expect the things I don't be there. It's nerve wrecking when you loved one's hurting. And I think you need to sort of cool off your brain to be able to be there for them. In a moment like that, the cross-examining of the fears is tricky. They just did a biopsy in my wife, and I'm worried that she's going to die.

So if I ask myself, what's the worst thing that's going to happen? The answer is pretty legitimately, she's going, die. So if I ask myself, what's the worst thing that's going to happen? The answer is pretty legitimately she's going to die. And so I worry that wouldn't help me with the anxiety to do the cross-examining that we talked about before in this context. You would not. In fact, it's more likely to make you even more anxious because what you're talking about is uncertainty. So there's a different of thoughts there linked to clear facts with uncertainty. We're talking about a medical diagnosis that's banding, and then the worst case scenario based on data now,

not just in your brain, it could lead to death. And so in that moment, what I teach people and I do is first is face reality. And facing reality does not mean you like reality. It's being able to sort of look at the data and sit with it for a little bit. It's not going to make you feel momentarily better, but you can say things like, my wife is getting the best care she possibly can. We're in the best hospital.

In this case, we're doing everything we can. And so really talking to yourself in a way that minimizes that catastrophe that's the worst was case scenario, which in this case could happen. And so that's one piece. The other one is really to try to not feed the bright. So in that case, our brain tends to want some certainty. And when you can't find it, start to see pictures of that worst case scenario. So even just dropping back, and when I've been in situations like this in my own life, I remember sitting in doctor's office waiting for test results and going,

worst case, worst case, wait a minute. Let me just describe the room. And I literally started to describe the room to myself to activate my thinking brain, to be present there so that I wouldn't be feeding that worst case in there, which in that case could have happened. That's why we have so many different skills though Dan. I think that's the thing we're saying here, you know, being a detective may not work, but experiencing emotions and writing the wave of

emotions in that case will help. One last thing before we go here, you've written a book which I mentioned at the top of the show but I think you should mention it again. So let us know about your book and also what else you've got going on, where else we can learn more about you, aside, of course, from the anxiety challenge and subsequent course you're doing with 10% app here. We can find out a lot about what I'm doing in my website, drluana.com. We have a great course called Mental Health for All, which is free for everybody. It's available in English, Spanish, and Portuguese subtitle.

So if you're interested in learning more about the skills that we talked about is there, and stay tuned for my next book that I'm currently writing. The book that's already out there is called Almost Anxious. Almost Anxious. And it's based on the skills that we talked about on cognitive behavior therapy, helping you really build resilience. Lohana, it's counterintuitively given the nature of the subject. It's really a very fun to do anxiety-pollosa with you. So thanks for coming on. Really appreciate it. Great job.

It was fantastic, Dan. Thanks for having me. Big thanks again to Lohana, really appreciate her coming on and participating in the challenge. And a reminder, if you want to put everything we just talked about in this episode, into practice, in your daily life, in your mind, join us in the Taming Anxiety Challenge over in the 10% happier app. The challenge starts Monday, June 21st, download the app wherever you get your apps to join the challenge. This show, which is a massive undertaking, is made by some incredible people,

including Samuel Johns, DJ Cashmere, Kim Baikama, Maria Wartell, and Jen Plant with Audio Engineering by Ultraviolet Audio, as always a huge shout out to my ABC News comrades, Ryan Kessler and Josh Cohan. We'll see you all on Friday for the special episode. I mentioned earlier, we're not doing a bonus to this Friday. We're actually dropping a full-length interview. It's the third in our Kaming Anxiety series. We're gonna bring on a fantastic expert

in social anxiety named Dr. Ellen Hendrickson. We'll see you then. Hey, hey, prime members. You can listen to 10% happier early and ad-free on Amazon Music. Download the Amazon Music app today, or you can listen early and ad-free with Wondery Plus in Apple Podcasts. Before you go, do us a solid and tell us all about yourself by completing a short survey at Wondery.com slash survey.

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