Ten Percent Happier with Dan Harris - 604: A Three Part Plan for Anxiety | Dr. Luana Marques

Episode Date: May 31, 2023

The notion of “being your authentic self” might sound like too much of a tired trope, but getting real and stripping away your fears and hang-ups can help you live a more meaningful life. In her new book, “Bold Move: A 3-Step Plan to Transform Anxiety into Power”, Dr. Luana Marques shares her story about growing up in chaos and learning early skills of cognitive behavioral therapy that helped her cope with anxiety and live boldly. Dr. Luana Marques is an Associate Professor of Psychology at Harvard Medical School, a former president of the Anxiety and Depression Association of America (ADAA), and a renowned mental health expert, educator, and author.In this episode we talk about:Luana’s personal story growing up in Brazil and struggling with anxiety as a childWhat it means to live boldlyWhat is psychological avoidance and the 3 R’s of AvoidanceLuana’s three step plan to transform anxiety into powerHow to be comfortably uncomfortableWhy the brain is a faulty predictorWhy being bold is not the same as being fearlessWhy social support is the number one buffer across any mental health issueHow aligning your daily actions with your values can help you deal with anxiety How to identify your values by looking at painAnd what Luana means by “being the water not the rock”  Full Shownotes: https://www.tenpercent.com/podcast-episode/dr-luana-marques-604 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This is the 10% Happier Podcast. I'm Dan Harris. Hello, everybody. Becoming your authentic self, finding your true voice. These are such clichés. I mean, we've seen these ideas play central roles and countless movies and TV shows where the characters learn to just be themselves. Random side note here, I was just on a cross-country flight the other day and I binged season two of the HBO show Hacks, which is all about finding your voice.

And they, I should say, managed to do it in a non-hack need and hilarious way, which gets me back to my point, which is this. It's hard to talk about authenticity without lapsing into tired tropes, but there is a reason why it's such an important issue. It is only when you strip away your fears, your defenses, your habits, your ancient storylines that you can be real and spontaneous. And that is the key to having good relationships with other people, which of course is the key to being healthy and happy. In spiritual circles, they refer to this as opening your heart.

I call it pulling your head out of your ass. I say all of this because it very much relates to my guests today. I have known the anxiety expert, Dr. Luana Marquez, for a few years now. She's been on this show a couple of times. Actually, you should go back and listen to those episodes. We'll put links in the show notes, not only because those episodes are super helpful,

but also because you will hear a real transformation in Luana herself. When I first met her three years ago, she came off as extremely competent and massively helpful, a real transformation in Luana herself. When I first met her three years ago, she came off as extremely competent and massively helpful, especially for somebody like me who really struggles with anxiety. The difference now is she still has the competency

and the helpfulness in spades, but something has changed in a good way. She seems real or more relaxed, more herself. A little bit more about Dr. Luana Marquez before we dive in. You can hear this for yourself. She's an associate professor of psychiatry at Harvard Medical School, founder and director of community psychiatry, pride at Massachusetts General Hospital, and former president of the anxiety and depression association of America, which, as I often joke, sounds like a very fun group. She has a new book called Bold Move, a three-step plan to transform anxiety in it.

She gets very personal in ways that she's never really attempted before. And in this conversation, we talk about Luana's personal story growing up in Brazil and struggling with anxiety and poverty, what it means to live boldly, what psychological avoidance is, and the three R's of avoidance, Luana's three-step plan to transform anxiety. Those three steps are shift approach and align, I'll let her unpack those. How to be comfortably uncomfortable, why the brain is a terrible predictor, why being bold is not the same as being fearless, why social support is the number one buffer across any mental health issue. How aligning your daily actions with

your values can help you with anxiety. How to identify your values by looking at your pain and what Luana means by being the water, not the rock. 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. Hey y'all, it's your girl, Kiki Palmer. I'm an actress, singer, and entrepreneur. I'm a new podcast, Baby This is Kiki Palmer.

I'm asking friends, family, and experts, the questions that are in my head. Like, it's only fans only bad. Where did memes come from? And where's Tom from, MySpace? Listen to Baby, this is Kiki Palmer on Amazon music or wherever you get your podcast. Dr. Luana Marquez, welcome to the show. Thank you,

Dan. Excited to be here. I should have said welcome back your frequent flyer. I'm proud of that. It is the third time isn't it, Kiva? Yes, yes. I was saying to you before we began recording that I think I probably get more out of these conversations than you do given my history of anxiety. So thanks for putting up with me. It is a pleasure to be here. It is totally mutual. So it would be fun. So you've got to do a book.

Congratulations. It's called Bold Move, a three-step plan to transform anxiety into power, filled with all these science-based skills. I want to dive very deeply into the book. But let me ask you, and this is in the book, but let me just ask you about your personal background here because you don't come from the United States. You know, you're associated with Harvard these days, but your your background wasn't super cushy. And so I'd love to hear a little bit about your background and how that led you to get interested in anxiety in the first place.

So I grew up in Brazil in a family that Kiosk is the only thing that we knew. This is the first time I actually talk publicly about this. The book is sort of my coming out of the closet with myself, you know, as my mom, my sister and I, after my father left, and it was pretty tough. Like growing up was not easy. I've been out of the closet with myself, you know, as my mom, my sister and I, after my father left, and it was pretty tough. Like growing up was not easy. There are times that food was scarce, not often,

but there were moments that I just thought life was going to be too much. And as I wrote the book, I realized then, it's funny, I've been a therapist here at Harvard for almost 20 years, and my patients have asked me, have you ever had a panic attack? And I'd say no, I've not had a panic attack. But I realized that as a kid, I got rushed to the hospital all the

time with this asthma attacks. And as I was writing the book, I was like, oh my god, I was having panic attacks. They were not asthma attacks. They were always after a fight between my parents where there was a lot of domestic violence. And so it was a long journey. I had the privilege of a grandmother that taught me a lot of the skills during the book. I had the privilege of a grandmother that taught me a lot of the skills during the book. I eventually got out of Brazil, got here, and continued to fight, sort of, to pursue whatever I thought was the American dream for me, which landed me Harvard.

And for the past 10 years, I've been working in inner city, taking the skills during the book and working with organizations that serve primarily diverse youth. And about a year and a half ago, I was talking to you. And we were talking about this book that I had in my brain and you said, you have to write this book. And I was so scared and I was like, do I really got this? But here we are, the book is gonna come out

and it's 100% me in the book because I've never I think talked about before. I love that. I love that. Let me just stay in Brazil and your childhood for a second here. So you described what at the time you thought were asthma attacks, which you now in hindsight with your expertise believe were panic attacks. So there's as as I understand it, and as I've experienced it personally, there's panic, which you might call sort of high anxiety or anxiety on steroids. And then there's more garden variety anxiety, which I also live with, a kind of background static of fear and worry. Is that an experience that you share?

Is that an experience that you share? So I was an anxious child. I remember vividly having thoughts and having conversations about 12 with my mom of like, I can't go to school. If I go to school, I'm going to come back and you're not going to be here. I remember vividly whenever things were tough, I would eat my anxiety. I just like, there's this cookies in Brazil that I love. And I just, certainly with that. And so I was like, I think I had a heightened baseline of anxiety and I think I managed it by like going to school and trying really hard and all those things.

And then there were moments like you're describing that I think, and it's so common, actually, there's research on this, which is so crazy that I've done the research on this and never associated with myself. There was research that in the Latino community, we're more likely to talk about physical symptoms of anxiety. So you would describe stomachache, headaches, asthma versus actually calling it a panic attack.

And I had published on this but never applied to myself and it wasn't as good as the book that I was like, but then my father left and I had no asthma. It disappeared. Like, how is that possible? I said, it doesn't disappear that way. So I have both. So that's your question along the winded way. I still leave with a great of anxiety every day.

I just found the way to make it work for me most of the time, not all the time. There's nothing like, I mean, I hate writing books. I do it anyway, but there's nothing like writing a book to figure shit out. I know it anyway, but there's nothing like writing a book to figure shit out. I know it's painful to write a book, but it was the best therapy I had in my life. I have to tell you, like I wrote this book

between like four and seven in the morning, and I just got to like, sit with myself, naked, and go, what's behind the curtain? And it's fascinating to just look and allow yourself to see what's there. Fascinating therapy for you and also just all adds up to useful information and coping skills for the rest of us. So it's kind of useful on many levels. You mentioned your, specifically you mentioned your grandmother, but in some of the supporting materials for the book,

you talk about how some of the skills you teach today were picked up from both your grandmother and your mother and some of these skills turned out to be validated by science. Can you just put a little meat on the bone there and describe that? Yeah. So one of the things that my mom taught me is this idea of what we know today to be, you know, an emotion regulation skill, which is this idea that what we know today to be, you know, an emotion regulation a skill, which is this idea that when you're few anxious and distressed instead of walking away and avoiding emotions, you need to go towards them. And that the picture in my mind is, you know, my mom is trying to, my father leaves and

it's really challenging. And now she has to like figure out how to feed us. And I remember moments that she would come home and you could see on her face, that she just wanted to crumble. But she would just look at us, she'd cook something, and then she would do whatever was the next thing that was going to the next day, get us a little better.

She created this sewing company, and then she sold hangers, and then she sold brooms, and then she worked in a butcher. But all of it was like not without pain. Like it being a kid and being the oldest, I remember seeing the pain there and going how does she keep doing this. And so there was a first experience of this like strong, worth ethic that's aligned with values towards something that's really important, but painful.

I guess that that's what I learned from her. And I think that's the work ethic that got me here, actually. If I really have to sit with it, I never quit. Like my mom never quit. And then my grandmother is just this like, you know, she came to my life when I was about 14, 15. She is not my official grandmother. My mom dated my stepdad, so she called my grandmother. And I lived with her for about two years.

At first, I moved from a little town in Brazil, gov. Adelaide Aris de Belorizonchi, and I went from life, it's okay, we're safe, now we had a safe nato with my stepdad, to this big city, and being terrified and afraid of strangers. And to nobody believes when I say this is an adult because I'm super outgoing, but like, I did not want to talk to people. Like, they were scary to me. And my grandmother just said, you know what? We're just gonna go to the mall.

And then she forced me to talk to people. The same way I sort of forced you to be an elevator. Kind of sort of the same idea. Now that I think about it, you might reflect about it, because she didn't give me much of an option. It was like, you know what, you're doing this. And she would just help me do two things.

She taught me how to approach instead of avoid and to go towards that incisiting. The second thing was cognitive flexibility, right? Science talks a ton about the power, cognitive flexibility. But all she did is I'd be crying on upset and she says, is there a different way to think about this? Can you see this in a different angle? And it would force me to see different scenarios in the world, which is all there is, it's cognitive therapy.

So she was doing cognitive behavioral therapy with you before that was even a thing? Before that was even a thing with no college education, just being yourself. And that's what I love about this. It's like, they're skills. You know, we make therapy such a big thing, but like they're skills that we can learn. And that's why I teach them in inner city, because we can teach paraprofessions to do this. Like my grandma had taught me how to do it. Just around out your biography here, your work hard in college, you end up in the States. How did you decide to dedicate your life to studying

and treating anxiety and panic? So I don't know if the anxiety and panic was actually very thoughtful. So I chose psychology, so I came, I actually did the college and the rest. I came as an exchange student, went back to Brazil and then came back and I was pre-med and also taking psychology classes.

And I jokingly nod, I went to Brazil to talk to my grandmother over my holiday. And we were talking about this idea that, you know, why did I really want to be a physician of this and she looks at me and says it's simple. You think psychology class is him and you take my knowledge classes. Whatever is easier in your brain and you're happier, that's what you do. Like you don't have to struggle with this.

And so I looked there and I said, well, I get deasing biochemistry. I get A's without studying psychology. She's like, then become a psychologist. There is no struggle. And I was like, I needed her permission. To be honest, as an adult, I needed her permission to be honest as an adult, I needed her permission. And so then I went forward and I started to do research and early on worked on OCD, then I worked on PTSD, then social phobia, then I pretty much studied and working all across

the anxiety disorders. And I landed probably in anxiety and panic as an anxious person. And I like seeing people get better and exposure works Exposure works Well, that leads me to this next question. I think I think exposure works will probably be part of the answer to this question But the title of the book is bold move. So what do you mean by that? What does it mean to live boldly? To me, it means you show up fully as you. You are clear on what you want out of life and you every day take a step towards those things,

going towards discomfort. Like you sort of bringing anxiety along and you approach instead of avoid, but it's your recipe. Like it's one of the things that I want people to understand when I'm talking about bold move is not like just doing grand things out of your, you know, comfort zone all the time. It can be small. I think for some people being able to go on a date feels like a bold move. For some people being able to ask for a raise or just even telling their partner, I'm upset with

you, right? But it is going towards this comfort instead of just running away from it. Because you and I know really well, like running away from anxiety. It doesn't work. It just comes along and runs faster. Well, as you've explained to me before, when you avoid what you're anxious about, it makes the source of your anxiety worse. It makes it all scarier. You're teaching the brain that you have to avoid this.

It's so scary. Yeah, I mean, the brain then starts to anticipate anything related to it. Creates a narrative that's going to be worse. And next thing you know, you're not even close to that thing, that was scary because you think you're going to be eaten by a lion when it's perceived threat, not a real lion.

So what we're talking about here, there's a term you use. I think it applies to what we're discussing here, but you'll correct me. Psychological avoidance. That's exactly what we're talking about. So I define psychological avoidance as anything that we do that has a function of bringing our emotional temperature down fast,

the long term gets a stuck, right? If we we apply this to when I was 15 with my grandmother, had my grandmother not forced me to talk to strangers and had I been allowed, just stay at home and not make friends, I very likely would have developed social phobia and very likely would not be sitting here with you. Because I would have felt better, right? I sitting at home felt much more comfortable than going to the mall and talking to strangers, but the entire trajectory of my life would have changed. And I not only believe this personally

done, but if you look at the data on social phobia around that time, 15 to 18 is when people that avoid make less money overall in their life, they choose the locations there are more avoidance related, like quality of life gets worse if you avoid. You say there are three hours of avoidance, what are those? The reason I coined the three hours before I even share what they are is important, which is whenever we feel this comfort, anyone is going to have some symptoms of fight flight or freeze, right?

And most of us have heard of fight flight or freeze, it's sort of your biological response to threat. Now, in modern life, we are having the same response to perceived threat, so a presentation going on a date. And the three ways we avoid is to react, the first r. This is what I do, by the way. So reacting is going towards the threat to eliminate that threat. You want to basically bring you anxiety down no matter what by going towards that. So for me, this just happened a week ago, I was going to a conference. And I got this email that has such politics behind them

that this person would be upset and this person would be upset. And so I get the email, my heart starts to bother and I'm playing. I take a screenshot of this. I send to my husband. And David goes, do not respond. It's reacting and that's avoidance. I was typing the response by the way.

Right? I didn't want to feel that this conference will have in to wait to figure out what I was going to do about the same now. Let me jump in for a second, because I think some people might hear and I hate interrupting people, but you're on something interesting.

A lot of people might hear react and say, well, how is that avoidance? You're reacting to the thing, you're running right toward it. Because the only function of what I was doing was actually to bring down my anxiety. I was not being thoughtful. I was not composing an email that actually would give me

that outcome I want. And I was not gonna deal with the conflict. I was basically pushing away conflict by just literally reacting, right? And we do this after I was just talking today with a reporter for the Wall Street Journal, who I really loved. This woman was amazing. And she says, to know what I do, talking today with a reporter for the All Street Journal who I really loved. This woman was amazing.

And she says, do you know what I do? I just do a lot of my work when I'm anxious. I do more and I do more. I do more. And she's like, I just react so I feel better. And I said, how do you feel? She's like, it is rostered and tired. And I said, that's it.

Like, sometimes we're doing good things, but the function of those things to eliminate this comfort. But they only lead to this comfort. So let me clarify because I love the rest of the questions. There's two pieces on the psychological avoidance. One is, what is the function of my behavior? Why am I doing this? Does this feel better fast?

The second one is, is this a price tag with this? Right? I've got myself in a lot of trouble writing emails fast. A lot of trouble. I've got called in by some superiors at Massage, I'm going, you know what, you're a little impulsive, like we can't have that. And that's why that makes it psychological avoidance. Does that help a little bit? Yes, it's like the psychological equivalent of a comb over. It's like you're hiding the, you're hiding the problem with a lot of,

you know, fancy moves. Oh my God, I love that. That's exactly right. And it looks so good for society. And you just keep doing it. And here you're like, rundown and not the way to wow. All right, so react. That's the first r of avoidance. The second r is retreat.

Retreat. So retreat is moving away from this comfort. So you feel anxious, you feel the stress. This is my husband's favorite. It is, you get that email that sets you. I would just email back fast. David will open the email, and that's what he told me. He'll put in a second screen, and he just leaves it there.

And then he starts to think about it. He starts to nominate, what if I do this, and what if I do that? And all of those thoughts help him sort of avoid the fact that the email itself made him anxious. So like, retreating really is instead of going on a day to stay home because he's just not feeling well, right? It tends to be more on the thinking than the action. React tends to be like going towards it.

Retreating tends to be more in the thinking, and just to make yourself do better. And then finally remaining. Remaining? The best thing to think about is the deer on the headlight. Something happens, you make some anxious, and you just don't know what to do, you freeze. People remain in jobs, they don't like.

People remain in relationships, they don't like. They know. And the interesting thing about remaining is I never met somebody that is stuck on remaining, that they're just avoiding and stay put that didn't know how bad it felt. Like people that do this in jobs for years, they're going to their job, they're going to their job,

and they're like, no, it's not the best job, but just the idea of something else, they're like, no, just they put. Okay, so I think we've defined the problem reasonably well. I'm tempted to move into the promised three step plan. Is there more to say about the problem writ large before we moved into the three aspects of your plan, which include shift approach and align?

And now I just, I was wondering what you're thinking about. You just had this pause on avoidance, and I was like, what is it then thinking about? It was just a good pause there. I am really good at all those forms of avoidance. That's what I was thinking. So yeah, I can do the react, which anger is a good one for me. It's been explained to me that anger is a secondary emotion.

It's often motivated by fear. And so I get scared or threatened by something and I go right to anger and it never makes anything better. Retreating where I'm just, you know, putting my head in the sand and thinking about it endlessly but not doing anything about it and then remaining where I've just completely paralyzed. I had an experience I remember a long time ago, I should have wrote about this in my first book,

where I got a very charismatic new boss at ABC News, a guy named Ben Sherwood, who's no longer at ABC News, but we're still in touch, he's still a friend. But when he came on the scene, I was just so terrified by his presence that I just kinda went limp and did nothing, and it actually hurt my relationship with him and hurt my career.

And so there are many ways to avoid anxiety and I feel like I might have a PhD and all three of them. Thanks for sharing. I love that you shared all three though because we all tend to have a flavor, but we do all of them. And the examples you just gave are great because they all have a cost, right? And they tend to repeat, right?

And I don't know about your life. But for me, like, I tend to avoid the same way and tell them like, don't with it. Like, gotta break this. And so that's why we have the three skills. Are you still getting pulled into the office at Mass General where you work and told that you're too impulsive or have you figured out a way, another way?

You know, I figured out a different way. A lot of things have changed in Mass General and one of them is the primary person leading the department has changed. I think that has helped. But I also found my voice. I think the some of the experiences I've had on that, I've been really saddened. And I talk about them in the book. And so now I just don't accept them. I just don't react as much. And so when I'm threatened, the same way, you go twinger, I go to reacting this way, but now I go, this really hurt me.

And I'm not ready to talk about it, but I will still respond sometimes, but I'll just respond with, you're hurting me and that doesn't feel okay. You know, my mother was a pioneering physician at Mass General for several decades. She was in the pathology department. She's also an editor at the New England Journal of Medicine. And she was pretty, when I say pioneering, I mean, there were not a lot of women who were

full professors at Harvard in that time. I think she started working in the 70s at Mass General. And, you know, I've heard her talk many times about how hard it is to be a woman in that environment. It really is. It probably got a little better since your mom started but it's still tough. I mean I had one point you shouldn't say to me at one point like you know somebody had complained about something that I had done. I basically gave feedback and this person felt like the feedback was too rough and a senior male says you know you're only being reprimanded because you're a woman. I mean, if you're a man, nobody would care, but you need to act more like, you know, a girl, less like a boy.

And I was like, what? What? What? What makes you think it's a location and say that, right? And at that point, I just quit that job. I was like, no, I'm not working for you anymore. That's for sure. But it's a tough environment still.

I can't say it's getting better. Our new chief is incredible. And so it is getting better, at least in our department. But it's a tough system. It's crazy that that person said the quiet part out loud. I mean, we know that there's a double standard and that women who, you know, if it gets a double standard and that women who are, you know,

if I guess on this show, who've talked about, you know, that if you're a woman and you display anger, it's viewed as shrill and unacceptable. And if you're a man who displays anger, it's viewed as decisive and strong. Coming up, Dr. Luana Marquez talks about her three-part plan to transform anxiety, understanding why it's nearly impossible to shift, which is the first step when you're in a state of panic and what to do about that, and why the brain is such a terrible predictor.

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All right, well, let's talk about what we can do about anxiety because as I've said, you really do have this three-part plan and there's so much in here and I want to carve out enough time to really live in each of these aspects of the plan. And the first is shift. So what do you mean when you say shift is the first step? So for a lot of us, including myself, when anxiety knocks on the door, our brain gets black and white. We predict the worst case scenario, we predict that we can't handle it,

we get in the what if I can't do it with us, what if I'm not good enough, what if I'm never going to be successful. And all of that happens because the way our brain functions, right? There's discomfort in our brain sort of like locks out and uses our belief systems to sometimes predict the worst. Shift is the idea of looking at what you're saying to yourself, really pausing for a second and examining your thoughts. It's sort of like what my grandmother did with me, right? What she basically said was, is there another way to see the situation? Right? And I really encourage people to like be able to understand that thoughts are not facts.

In fact, we would never say to our friends what we say to ourselves. In fact, we would have no friends. If we went to a friend and said, Oh, no, you're horrible. You can't do this. You're not good enough. You're never going to get a good job. You're not successful. And so shift this shift to perspective, talk into ourselves as if we're talking to our best friends. So it's a reframing of your current thought patterns. It's an interrogation of your thoughts with this element of friendliness. You're channeling this mentor ability that's easy for us to summon when we're talking to a friend, but rarely do we apply it to ourselves. Am I repeating that with some degree of accuracy? A hundred percent. So first you pause and you look what you're saying

to yourself, then you interrogate that thought, right? You ask, is there another way to see this? Is there data to support this? And most of the time, we arrive at conclusions that what we're saying to ourselves is pretty distorted. And then what do you do? You arrive at an alternative, more balanced world, and that's where the friendless comes in. Can you talk to yourself with more kindness,

with more compassion, with more authenticity, in a way that is not so black and white. And ideally, a little more data-driven. So there's a lot of data around the power of talking to yourself in a different way, reprogramming your inner dialogue. And we've had guests on the show who've talked about that from Ethan Cross to Chris Teneff. And we'll post some links to those shows in the show notes just so people can hear more about this. Specifically, I personally am very intrigued by this notion that you can sort of counter-program

against your inner fear monger, your inner critic, your inner drill sergeant. It's been very powerful as a technique for me in my own life. Now, I'm going to ask a question after I've specified there for a second. The question is, I find that when I'm in garden variety, anxiety, putting my hand on my chest and being like, dude, you're good. Just speaking to myself the way I would talk to my son or a friend, that really works. But if I'm in panic or peri-panic, close to panic, it's much harder. It's actually nearly impossible,

because when we're in panic, we're basically saying biologically, right? That if you think about the two parts of your brain that's competing for attention, you're thinking of prefrontal cortex, you're thinking brain, and you're lizard brain, or amygdala, when one is on fully, it's almost like the other one is out for lunch,

especially when the fear brings on. If you're really, really on fear, your brain has only one function to protect you. And there is no way to think yourself out of a panic. It's impossible. It's one of the things that whenever we're more concerned about it and this is, well, but when I'm panic, what do I say to myself? I said, no, at that point, we need to experience the panic. We need to approach the sensations. We need to not avoid the panic sensations because we want to train your brain that you're really not in danger. And the only way to go in there is through the amygdala.

You cannot think you're way out of a panic attack. I'm sure you've tried before. It's not possible. Okay. So let me just give you an example. You know because I reached out to you personally when the started happening, I developed a pretty gnarly case late last year of of claustrophobia or resurgence of a lifelong condition of claustrophobia and I was having trouble getting on planes and elevators. It's gotten a lot better through exposure therapy. I mean, a lot better. This this shit really works.

And there are still challenges still edges for me. So I had to get on a very small plane the other day after having been on a series of like regular planes and being fine. And I couldn't do it or told myself I couldn't do it. And I tried. I got on the plane. And then I got off and booked a later flight. So what would have been the move there? Because I tried to muscle through with the amygdala and talking to myself, but it but I was at the edge. Yeah, it's too high on your fear up there, Dan. Like for you, like from what I know

and we've talked about this, this is just too high. The experience that we've describing is equivalent for me to say to you right now, let's stop this podcast and let me put you in the MRI machine. And you'll be like, yeah, I'm never talking to you again. Hard, like, yeah, hard fast. Like there's no way. And so the brain, the way I think about it,

it has a limit on what we can muscle through. Right? And that's the beauty of exposure therapy. You muscle through slowly. You don't go straight to the MRI machine because nobody gets better that way. That's just white knuckling. It's not actually exposing yourself. And so you found an edge.

And so the only way as to go towards that edge is, you know, can you take smaller flights often? Can you simulate smaller places? But you'd have to do that enough before you got on that plane. Because with your history of anxiety and what you're sure, like, that's just too much. You can't do it.

And I want to people to hear this because often when that happens, we feel like a failure or feel like, oh my God, I was doing so well and I regressed. It's not a regression, it's just that you're hitting a limit against how much of the exposure has worked. It's like when I had to go skydiving, I had a fear of heights and I learned this at your seminar show park and the end on the cables,

oh my God, I came down to cry, it was awful. I don't wanna think about that. I never went back to your seminar park in the end on the cables. Oh my God, I came down to the crowd. It was awful. I don't wanna think about that. I never wanted to actually just not be able to do the cables. That's how I learned I had a fear of heights. And I did really well on the roller coasters and this. And then when he got just kaydiving, he took a friend of mine, who was a damn good-site college

to get me on that plane the first time. And I thought I was gonna die. Like I thought I was going to die, but I went skydiving three times in a row that day. There was no way because if I didn't do three times, I know what was going to happen. The next time the opportunity came, I just wouldn't do it. All right, and it doesn't mean I want to go skydiving all the time, but like once you find the edge, you have to stay with the edge. And I can see how much you like in my suggestions here. I can see how much you like my suggestions here. I can. No, no, I do like your suggestions just because I have so much confidence now because with you, you know, we, you and I rode elevators together for the anxiety course that we

produced jointly for the 10% happier app. And that was before the big resurgence of claustrophobia that I had last fall. And then I worked with somebody local here as a psychologist who rides elevators with me at the Westchester Mall once in a while. And you know, he talks to me before I get on planes. I don't really need any of that anymore, but I developed so much confidence through going from sheer brain blanked out terror to slowly, gently exposing myself over and over and seeing, yeah, I got comfortable. I mean, so I not only have confidence

that I can work my edges, I have confidence that in the future, when or if I have another research of this, I can deal with it. Yeah, 100%. I mean, it really is comfortably uncomfortable, right? It doesn't go away completely. I think that's the thing that people want me to be able to take their anxiety and discomfort completely away.

It's impossible. Biologically, we can't. So that's why I wrote a book about avoidance. What we can take away is avoidance. And you might be always a little uncomfortable for you in a plane, but as long as you can get in and stay comfortably uncomfortable, you have a more meaningful life. Yes, because life can get really small

if you're just avoiding all the time. Ooh, yeah, that's for sure. Under the rubric of shift, and you touched on this earlier, but I think it's worth flushing it out a little bit more. In the part of the book where you're talking about shifting, you mentioned that the brain is a faulty predictive machine. Can you say a little bit more about that?

It really is. Our brain is so powerful, but it only predicts to minimize this comfort in many ways. So, the way we predict information is based on our history and what we know. So, given the example to illustrate this, Growing up, the way I talked about, and with my parents eventually spilling up and feeling like I couldn't really save my mom from the domestic violence, I have this filter that basically says to me,

I'm not enough. No matter what I do, I'm never gonna be enough. And so, that is the way my brain wants to predict information. And it does something so, so annoying. That's what everybody I've ever worked with. So one day, I got this paper accepted to a really prestigious psychology journal. And I was first author, you know, for those of you that are not academic,

it's a big deal. It takes a lot of time to do this stuff. My first thought is, all this paper only got accepted because other smart people are callatrous. I'm definitely not good enough. First thought, like the brain just like farted it. Like I hadn't even caught it. So what is this? Right. And so my brain is predicting that I'm not good enough based on something that anybody in the world say it's amazing. And it's doing because of my history. And that's what I mean. The brain is a faulty predictive machine. It's predicting based on history to minimize this comfort, right? Which psychology is

called the sonance. The brain doesn't like the sonance. When two things don't match. In this case, you know, I can't be good enough and have a paper. And I can't be not good enough. I have a paper accepted so I just jumbled that information. Does that answer, does that make sense? Yeah, it does. It does. I mean, we have this negativity bias, which makes sense. You know, we should be scanning for threats because especially when we evolved, there were a lot of threats in the environment. And yet it can give us a distorted view of reality.

100% because what we are scanning for perhaps at one point, of threats in the environment. And yet, it can give us a distorted view of reality. 100% because what we are scanning for, perhaps at one point was a threat, but right now in that moment, it's far from a threat. I mean, my example getting a paper accepted, how is that threat? But my brain thought it was. Yeah, well, we can turn anything in,

you know, we can wear garbage colored glasses and turn anything into something nasty. It's a real special skill that our species has. I do want to say just speaking of bold, I've interviewed you three times on the show and then we will produce this course together. I wouldn't say I know you super well or that we know each other super well, but I've been able to observe you longitudinally over several years. I'm struck by the boldness. You seem to have crossed some sort of threshold in terms of talking about your own life

and your own mind with a degree of candor that seems new to me. So I just wanna remark upon that and celebrate it. Oh, thank you. It is very new. It's very new. I had an experience right before, and during when we were creating the anxiety

course that we produced together, they really shook me to the core and made all the skills that we're talking about really come to a halt. And I had to sort of like set and think about, who am I really in the world and what do I want to do next and how do I show up like me. For so long, I think I tried really hard to fit into this Harvard academic professional person that does this and this and this. And the softest parts of me, I think the people that knew me well, and were there, but they were girded. And it just felt so, what is the word, separate.

I think I just needed to integrate me. The me that you saw in the elevator is me. I show up fully of both parts, but it was missing the me that you're seeing today, which just feels good. I have to say, meeting you was so helpful because it allowed me to really set, I think, was things I had a course, actually. I was hating things at Harvard, I mentioned, but continue to do it. I was just going to do it because that's what you do, good academic. And then meeting you, and you're such an incredible interviewer and a kind human being,

and like gave me time to talk, that was a moment that I was like, oh my god, that's what it feels like to flow and be you. Because I didn't have to think about being me when I was working with you. I just was me. And that was the beginning of this transformation. And I think that's where I landed.

And so thank you, Dan. Honestly, generally, you open the door that allowed me to integrate, which is not easy to do, but it feels good. Well, I appreciate that. I think you're probably giving me too much credit. But let me say that there is real, I think a lot of people struggle with this. You know, there's all kinds of anxiety

and we've covered many of the flavors, but there is a lot of fear about being real, especially in an era where we're in this panoptocha on social media and people are curating their lives. And so this persona, this false front, we're encouraged to have it, we're encouraged to build a brand. Everybody's got to have their own brand.

You know, it's not just today, you know, if you read the first couple of pages of Ketcher and the Rye, you know, he's holding call fields complaining about all the phonies around him and that was way before the internet. And this is just part of the human condition and it takes a lot to actually, I don't love words like authenticity

and vulnerability at first sort of like realness or not bullshitting. But there's a lot of anxiety around that justifiably so because you were that if you're rejected when you're being real, then that's a real rejection. So I think you're modeling a kind of approach state by doing what you're doing. Thank you. And you know, I keep saying this to myself and my friends, like, being bold is not being fearless. I'm scared every day. And I'm embarking on this whole new phase of my career that is public facing and writing this book and talking about my stuff. And every day I wake up and there's part of my body is like, oh my god, if people don't like this. And what is this? And I just, you know, I shift, I approach, I show up

and I try to shock fully, but I can't say I'm not anxious. It's really there. Yes, that's really important. I've heard my meditation teacher Joseph Goldstein quote some poet, and maybe Emily Dickinson, I don't know who, and I'm not a huge poetry fan, as you can probably tell, but the poet said something to the effect of or the novelist, the writer,

said something to the effect of that she'd been terrified every day of her life and never stopped her from doing anything. That's it. I think if we can teach people that in general culture, because I think we're taught the opposite, that if you're scared, run away, if you're scared, stop doing it.

If you're scared, it's too much. What taught the opposite. If you're scared, run away. If you're scared, stop doing it. If you're scared too much, what if the opposite? What if it's like you're scared and there is a way to go towards that life that you want? That to me, I don't know. I think that's why I'm sitting here with you today and not back in Brazil, an mediocre job, not happy. Yeah, I mean, wonder if we can turn anxiety into a signal for curiosity and perhaps an opportunity.

Like, oh, this is the body getting nervous about something that maybe I should pay attention to, and maybe there's something worthy of exploration here. Yeah. I mean, I think that's where I love when you talk about meditation and and using meditation in that way, right? Instead of running for it, meditation allows you to set and see what's happening without running. Which I think is so powerful. Yes, I mean, it sucks, but it's better than the alternative. It's like,

I mean, if you've got a few issues, Andy, how might as well do something productive with it? Like it's just, you know? Yes. So we've been talking about shift, which is the first step in this three step plan to work with anxiety. But before I move on to the next step, I believe the book says something about why shifting can fail in cases of discrimination.

What do you mean by that? So the example I gave about my boss is commented about, I need to be softer, like a girl and less like a man, right? There's no way to call this anything but sexism at a minimum, right? There's no way I could shift my perspective that day. Or when I walked in the office one day in the first week of Mass General, oh my god, this is so embarrassing to say I love it, but it's in the book. Somebody's gonna say, I locked in. I was like very excited. I had just started there, you know, very feeling scared being a mess general, I'm resilient.

And then somebody looks at me and says, oh my God, you look so Latina today. What the hell does that mean? What I heard is you don't fit in. You're not good enough. I actually ran home, changed my clothes, believe it or not, because I was so scared that I couldn't fit in.

But in that moment, it's a microaggression. And as an adult now, not a beginning psychologist anymore, I have to have states, somebody, wait a minute, that's not okay. And there isn't a shift in there that you can just tell another story for yourself. I think what it's dangerous, and I've worked a lot of clients this way that you have moments like this, but then you use them against yourself. And you actually make it much more challenging. Something is bad with me. And then there, I think we can shift, right, ending the interpretation of the event. But we need to face reality, sexism, discrimination, microaggression.

Those things we shouldn't be making lemonade out of them. We should be talking about them. Right, so don't self-gas light in the face of totally inappropriate and unfair behavior. You're the best at summarizing things appropriately. Yes, that's exactly right. I just love that power they have. I have no original ideas, but I can't repeat them back.

Coming up, Luana talks about the second and third steps of her three-step plan. The second and third steps are approach and align. The role of social support in working with your anxiety and how to identify your values by looking at your pain. All right. So we've talked about shift. That was a very key point. And I'm glad you made a shout out to my producer, Justin, who pointed that out to me. And so I'm glad I asked you about it. So let's move to the second step of the plan here. So the first again, just to recapitulate, was shifting, not believing your thoughts, necessarily talking yourself, channeling the sameness part of your inner repertoire to talk to yourself,

the way you would talk to a friend or somebody that you really care about in your family. The second step is called approach. I think it's probably somewhat obvious, but I'm gonna give you the floor and describe what you mean by approach. So you and I have been talking about approach a lot. And usually I talk about approach as we've been talking about approach a lot, and usually I talk about approach as

we've been talking about, which is exposure therapy. So, the basic idea is when you're feeling uncomfortable, what you want to do is walk away from this comfort instead of avoiding you to approach. In exposure therapy, we talk about the specific steps of approaching how to approach. But for most of us, we don't really need exposure therapy. We need to figure out how to go towards that discomfort. So in the book I talk about a skill called opposite action. So anxiety has a mandate. That's always the case. An anxiety mandate to do something. Immendated you to get off of that plane. In your case, which already discusses too high on your fear, but for most people, what is one thing I can do that is opposite to what the anxiety is telling me to do.

And the trick here is you don't want to go or nothing. So if you're terrified of going on a date, okay, and you have a date schedule and the anxiety mandates you cancel, and it's the third date you're going to cancel, what is opposite to completely canceling? Could you have a call with that person? Could you have a bunch of text messages? Could you try to say to that person, I would meet you for a coffee for 20 minutes, but I have to leave. Is there a way to go towards anxiety instead of again? So, and the reason I was saying, the reason I like the idea of opposite action is because it makes it simpler. I don't want you to develop a whole hierarchy on the idea.

It's just two-zone thing that goes against what the anxiety is telling you to do because what is anxiety telling you to do? Let's just be real. Avoid. It's telling you to avoid. So go against it. But it doesn't mean you need to go against it, and I'm just accentuating something you've already said.

It doesn't mean you need to go against it in a way that just accentuating something you've already said, doesn't mean you need to go against it in a way that's gonna completely short circuit your brain. It means wisely, carefully, cleverly, titrating your response. So yeah, if you're freaking out about going on the date, you don't have to actually go on the date, but you might call the person and take the risk of being honest and real and say,

hey, I'm having some anxiety. Can we start on the phone and then go to a walk and then work our way up to dinner? Absolutely. In fact, you do not want the same way we can't climb Everest overnight. Just wake up and say, I'm going to climb Everest. We can't do all we're not. When it comes to things, they're fear-based and training-based. And in here, we're a trainer and brain not when it comes to things they're fear based and training based. And in here, we're a trainer or brain that our perception of fear is just a perception that there is no lion. And so you have to exercise your brain. And the only way to do is is baby steps.

If you take too big of a step, you crumble. And that's where I see a lot of people fail. It's like if I chose to go skydiving the first day that I chose to fight my fear heights, I would not have gotten on that play. Right? I started with letters and other things and the example is just to illustrate baby steps. Just what can you actually handle? And there's a trick here. I didn't put this in the book but I think it's really important. What can I handle it? Can I do it now? Because often we start to ruminate about anxiety and then the anxiety just gets bigger and

bigger and bigger. So if you're going to just to approach, is there one little thing that you could do now? I'm going to send a text right now to that person just at least rescheduling that they it's instead of just canceling. Because if you don't act now, it's kind of a form of avoidance because you'll just sit on it and it's almost a retreat. It's almost a retreat and what it does is feel the incisive, just make the incisive worse. Right? Because what we battle most of us, we think is what we call anticipatory incisive. It's like you're anxious before you even get on that plane. The minute you heard that the plane was a small plane, I'm sure you're brain went, this is not okay. Right? And so like for the regular person, whenever you notice that you want to avoid, choose one little step, maybe step.

But I would do it as soon as you can so that you're not feeding the monster so to speak. What is the role of social support or other people in approaching? I can tell you that if I fly with my wife or my son, it is way easier for me to regulate than when I'm flying alone. Am I alone in that? No, social support is the number one buffer against any kind of mental health problems.

I across every research study that you look you do all sorts of meta-analysis. So social support is super important, right? And it can be helpful. The question is when is somebody being supportive and therefore you and propelling you towards your ultimate goals versus when are they enabling you to avoid?

There's a scenario here that you can never fly again with your wife and your son. Well, that might be problematic. And so like, maybe they can do it. In my family, we couldn't do it. And so I think there is a fine line between supporting and enabling. And as long as there was a conversation about the ultimate goal and there was still taking baby steps, I mean, that's, in many ways, the job of a therapist, right?

It's to sort of support until you can do it by yourself. Yes. So it's helpful as training wheels, but you should not turn it into another form of avoidance, which can quickly develop. Yes. Yeah. My son has started referring to himself as daddy's emotional support animal. I was just going to say that there's been something powerful for me about being open with my son about this panic because he's got his own anxieties and like, you know, having him watch me consistently forthrightly deal with it. Like we'll go to the mall sometimes because that's where Shake Shack is

and he likes to have his burgers there. And he'll say, we can take the stairs if you want. I'll be like, no, we're gonna take the elevator. I've been taking the elevator in a couple of days. I gotta do this. And, you know, we don't talk much about it, but he's just seeing me consistently take this on. And maybe this is wishful thinking,

but I kind of hope that this is a good model for him in terms of the stuff that he's worried about because he certainly has his anxieties. I think it's incredible. I think parents need to model that anxiety exists and there was a way out. So every time you take the elevator with him, you're basically saying yes, I'm having anxiety,

but guess what, I can approach. The reason I left so hard, it wasn't that, my son is younger than yours. I have a five year old and we just set up this recording studio in my house and he decided he's going to record a podcast on Sunday night when I was getting ready. And so he sits here and he's speaking Portuguese, otherwise I would send it to you, but he basically creates this podcast that he's singing the song of, how are you feeling?

And he goes, how are you feeling? How are you feeling? If you can't tell how you feel, nobody can help you. So you need to tell me how you're feeling. So I can be helpful to you. And I was like, clearly, I've been talking about feelings a lot. So that's why I left. All right. I saw Diego just doing this song and my family thought was the funnest thing. They're like, he's a psychologist. I was like, wow, we talk about feelings a lot. So. I mean, he's definitely, he may be a psychologist,

but he's what all kids are, or mimics of their parents. And so he's like, he's hearing you, he may be playing with his stickers, or his blocks, or his action figures, but he's hearing you. Oh, yeah. My son turned to me the other day. I was trying to help him drill on layups and basketball. And I was talking about, I was like, this, you got to do this, you got to learn how to approach because

you're too tentative on the court. And he was like, daddy, don't give me a boring inspirational speech. They are amazing. They keep us sharp. That's for sure. It's a sharper humble. I don't know which both. All right. We've done shift. We've done approach. Is there more to say about approach before we move to the third step? No, I think we covered it. I think we're good on both. Okay, so the third step is maybe not going to be as obvious for people, but it is a line. What do you mean by a line?

So a line draws from what's known as acceptance and commitment therapy. And, basically, is the idea that all of us have values. The things are important to us. Family, health, wisdom, etc. And that what we know is that actually aligning your actions, your daily actions, with your values tend to decrease anxiety, stress, and lead to a more meaningful life. This is a skill that's interesting because I've talked about approach a lot

and I've talked about shift a lot in my career. You and I have talked about it many times. I had talked about a line a lot and I used with my patients but I had never really thought about my values as much as I did when I hit the wall with Mass General. And I share this because values, it's so popular right now. We talk about values living in this and that, but like, what does it actually look like? And usually what it

looks like is when you are having a really hard time. So for me, when I had this experience at Mass General, I remember just waking up in the morning and crying and somebody violated my trust. And I was so crushed. Then like this piece of me is like, why is this person doing this to me? I've dedicated my entire career to working for this person. Why is he saying that, you know, I did something wrong? I knew I had a nonsense even though I was on the right, I was really hurting. And in the book, I talk about this, how do we identify our values and our line? And one way to do it is really look at pain. And the same way we want to run for an anxiety, we want to run for pain, but pain is only there because something that matters to us is getting hurt. Let me

say this in a different way. This guy who did something really mean to me violated my trust. If I didn't care about him, I'd say, hey, listen, I don't care about you, dude. But because I cared about the relationship and he violated a core trust, a core value trust, he crushed me. Right? And so that's a misaligned life. I was in the job working for somebody who violated my trust and it was making it about me instead of looking at the values and like found a way to realign. So long answer to basically say a line just means, look at your values, identify them, paint is one place you can identify them and then change your life, like do things

they're more aligned. Like I loved working with you then because that was a moment I talked about flow earlier place you can identify them and then change your life. Like do things they're more aligned. Like I loved working with you then because that was a moment. I talked about flow earlier. That was a moment in alignment for me. I got to like show up fully as me. So if you're living a false life where some part of your life just feels wrong. It's not what you want to be doing professionally.

Personally, you're in the wrong marriage, you're in the wrong relationship, you're in the wrong job, that can feed your anxiety. That magnifies your anxiety. Magnifies. I'd say I've always been mildly anxious in that moment. He wasn't just anxiety, like everything starts to feel wrong and then we avoid more. I mean, I put on 40 pounds after that thing, 40 pounds. And, you know, it's funny because the other day somebody says,

well, do binge eating. Do I exercise six days a week? I actually eat significantly healthy, but I can tell you this. When I get stressed, I can go on a diet and put on weights. The strangest thing. And to me, it was just stress. The stress was eating me alive because I was misaligned. Well, so you talked about changing your life. You didn't always

occupy this sort of social strata, but you know, you and I have pretty, yeah, lucky lives. We have a lot of advantages. And so I've been able to make a lot of radical changes to my life, but not everybody has that option. So what do we say to folks who may feel, you know, legitimately trapped? You know, I think about that often because there are moments that you trapped, but I don't believe anybody strapped for a lifetime until let me answer this differently. In the beginning, my mom was trapped and had to do whatever it took to just put food on the table. Eventually, he moved towards things that she actually enjoyed doing more.

So like she never enjoyed selling brooms or hangars, but she always loved sewing and she found a way to slowly move from the things she had to do towards the things that she had to do, but we're more aligned with her. And so you'd see a little more happiness, right? She was working late still, but I remember, there's this, I don't know the word in English, in Portuguese, it's a small, basically the things that you used to cut the clothes. And I remember her like creating those things and cutting, but like now with a lot more happiness to them. And so, you know what, in the inner city work that I work, I've seen janitors show up so happy because it was meaningful to them to have a place

that was good for the kids they were there. And so I wonder if there is within a place that we are trapped, if there was way to find meaningful values in that, with the understanding and the reality that sometimes it's impossible, sometimes life is shit. And you have to sort of do the best you can in those moments. But I don't know. I've seen people find meaning in things that are very little that can really carry them forward.

And I have to believe that there is a way out sometimes, not always though. I work in inner city, I've seen the worst. I work with young men coming out of prison. Sometimes there was no out, but I've seen some of them come out of it. So I think there's both sides of the coin there. That's what I'd say to them.

I'm hearing some similarity between how we have to be careful and calibrated in our approach to things that scare us and how we have to be given our life circumstances, strategic and step wise in our approach toward building a life that aligns with our values. That's exactly right. That's exactly what I'm saying. There's this parallel. It's like, can we strategize our life? And in this case, the strategist, can I think about how to do it in a value-driven way,

the same way that if you're approaching, you have to be in a careful way? You ask a really compelling provocative question, which is, what would your life look like if you did what mattered most to you? And if you asked me that question two years ago, I would have sort of create all sorts of answers, but not answered. Like that's what I'd had done. Today, I am absolutely living a life that matters most to me. Every moment of it, and I don't know what's going to end up. I have dreams about what is going to end up. But it was sitting in pain that allowed me to dream of it. It's a provocative question, as I said, and it's likely to make some people uncomfortable. But I think it's a very healthy thought experiment.

I think it's a trick of this book because, know the book by definition if I've done it a while should make people uncomfortable and whether people want to do when they're uncomfortable we want to void so my fear is that people are just gonna stop reading because they start reading about a void is they're like oh no no no I don't want to see my one avoidance and so my hope is that people can after Covid in particular tolerate more the comfort enough that they at least get through the first two chapters. And I'd be happy people can even understand that they avoid. That would make me so happy. Well, it's about understanding like what kind of suffering do you want? Because the suffering of having a small life, the suffering of avoidance is, if you're looking at it correctly

in my opinion, worse than the suffering of approaching what scares you. Because approaching what scares you, yeah, it's scary by definition, but it's also, in my experience, like really thrilling to see that you can start to get over this stuff. It's empowering, isn't it? Like, you know, it's, you know,

the parallel for the fear that you're talking about for you, but like for me, like just join up as me, like it took a little bit to find my voice, but now it's like, I don't have to like be hiding anymore and I can approach and it's going to be scary, but like, it feels so good. Well, I think you're going to find that in the response to your book and the response of this interview and all of the other press that you'll do that, that you're going to get a positive reaction from people. And I mean, I have some experience here because you know, when I, you know,

I was a very kind of generic cookie cutter anchor man for most of my adult life and then wrote this book of, you know, that featured cocaine and panic attacks and lots of other embarrassing shit in it. And I was really worried as was, and my mom who begged me not to publish it, that it would ruin my career, but that risk completely paid off and every way. And so I really have seen in my own experience, in my own life, and then watching it for other people that if you're real, and people can animalistically sniff out phonies.

But if you're real, you know, it's likely to work to your advantage. Thank you. It's interesting because this piece of me, because now I'm leaving the life that I really want to leave and I'm doing the things I really want to do, I really hope that that's the case. But like, there's this part of me that just feels so proud that the little girl in Brazil got to harbor and got a voice and perhaps can help people that like, I just, I feel good about her. No matter what. No matter what. No matter what. Right. Well, that's the right attitude.

And I think that pride is absolutely justified for whatever it's worth. Thank you. On this issue of alignment, you use a couple of terms that I just want to get you to talk about a little bit. One is golden circle. What is that?

Simon Sinek talks about the golden circle. And if you really want to know a lot about the golden circle and if you really want to know about the golden circle, you can of course read his books, which are amazing. I love his books, but it's the idea of really starting with why going to how and what and the way I use this in the book is really understanding your values before you do anything in your life. So often people are so focused on what they do, what they do, what they do. But why are you doing what you do? And then if you know that why,

then you can come up with a clear how and what. So for me, my value is ambition, ambition, ambition. When I hit the wall, I was like, what do I care about? I was like, impact, okay. What do I mean by impact? The world is hurting right now in terms of mental health. I want to find a way to bring that temperature down.

Okay. And what do I do? Well, what I do is what I do at my psychology, I do science. How do I create that impact? That's when I got to you and you said, you should write this book. Right, so that is alignment.

I had a clear why, a clear how and a clear what. And in the book, I talk So that is alignment. I had a clear why a clear how and a clear what. And in the book, I talk about in the alignment that you should then do the when you need to schedule your alignment. It doesn't show up in your life. By the way, the gym does a knock and the things that matter don't appear in my grandmother's to say this, you want to date, you get to get out in the world and it has to be planned because people just don't knock in your door. Like you have to just schedule things the world and you have to be planned because people just don't knock in your door. You have to schedule things. And so that's an aligned life for me using the Golden Circle to really create a plan

for your life. Let me ask you a question that I've wrestled with a lot. I think I've kind of come to an answer on this, but motivation is tricky. So you said you found your why and it's impact, but you know, I could say the same thing for myself, but if I'm really honest, you know, I also like getting paid and I like getting attention. So I have some why's that are, you know, more embarrassing to talk about, but are there. It doesn't mean I don't care about impact. I care about it deeply. So how do you balance all of that without feeling like the things polluted?

I've wrestled the same thing many times. You know, there's one thing that I tell, I've said this to my colleagues a bunch of times, I don't know why wealth or getting paid or having a meaningful salary is such a bad thing. Just to start with, like just love the playing field. And I'm not saying that you have to become a billionaire, but like, I didn't have food before. I know what that feels like. I'm never saying that you have to become a billionaire, but like, I didn't have food before.

I know what that feels like. I'm never going back there. And so if I told you that having a very good paycheck that supports me and my family is not important, I'd be lying, right? So like, it's not that that value doesn't matter. It's just not the value driving me most of the time. Now, if you ask me, you know,

I have two speaking opportunities and one of them is going to pay this much, hundred, the other one is going to pay ten. The pens, if I take the ten, based on impact. Sometimes I will choose to take the ten. If I get invited to speak to a nonprofit in inner city that pays nothing right now, but gets my buck into kids, that's impact, and that's not wealth. And as long as it's balancing it out, I feel okay. Like, it doesn't have to be one of the other in my brain. That's where I think flexibility helps. I don't know if I'm answering. That's how I wrestle with that. Flexibility makes a lot of sense. I made a ghost effect that this is a bit of a messy process, you know. We can tell ourselves

that our lives are about these big ideals and they are. But they're also about like, you know, I want a nice vacation and I want to be respected by my peers and I don't think it's helpful to deny that those motivations are there. And so that's why flexibility, balance, honesty with yourself and others, all of that seems important. Yeah, I mean, you have to choose the value that you're after today, this week, and the

season of your life, but they have to have a collection of them, right? You can't just be one thing running your life all the time because I think you'd be boring and scary, right, honestly. To me, doesn't feel like a aligned, meaningful life. By the way, impact doesn't mean you're wearing a hair shirt and living in poverty. You can have impact on yourself. I mean, you're included in the goal. And so you are helping a lot of people, just literally right now. And it also helps you. Well, that's fine. The expression I sometimes use is it can be a beneficial

double helix, you know, mutually reinforcing. I don't think you can live your values just for others. I think the first way should apply to yourself. I mean, since I had the while, I've been going to gym. I lost 50 pounds. I'm the healthiest I've ever been in my life. And that was the first impact I needed to be out in the world and be able to talk about impact for others. Let me close by asking you about something that you close your book on, which is this notion of becoming bold by being the water, not the rock. What's that all about? You know, this interview feels a lot like my grandmother, but that's where it started. So I have to go there. Actually, I was start with where I see my patients and where I've been before. Whenever

there was obstacles, whenever there's change, whenever we're in transition, and the world is in a big transition, still in my mind, often I feel like we're doing two things. We're like trying to hold on to the old and grabbing for the new and basically being stuck in place. We're not living, we're sort of on a fate of doing either. And my grandmother called that being the rock,

that when adversity challenge transitions, you just, they put and you're like, hold on to your views of the world. You don't actually want to listen to anything else. What you know to be truth is the only truth and there's nothing else. The opposite of that in her mind was a life where you are the water, right? The water is not a solid and can go around underneath. They can go beneath. They can shape that rock so to speak. That has been how I lived my life. In fact, I think that's why I survived so long in academia. The first day I got to mention, or I asked the chief, I said, you know, how do you get your own research lab here? And he laughed at me. He's like, you just got in.

That takes years. But I did it in six or seven. I just went around, then went around, then I ran around, then people would say, you can't do it. And I was like, well, how do I do that? And so behind that is flexibility, it's cognitive flexibility. If you know your values, and you can think about

how to align with them, It's not a straight path. I guess that's really the best thing to say this. There is no straight training life that goes from A to B and you arrive at check a box and it's done. Like it's gonna be a winding kind of road, but if you flow with it, this for me, it feels so much better. Agreed.

Is there something I should have asked but failed to ask? I don't think that's possible. They're like the wizard of asking questions so now. Before I let you go, can you please just remind everybody of the name of your book and any other work you've created that you want people to know about? So the book is called Bold Move, a three step plan to transform anxiety into power. You can find out more about it at www.lwana.com. Backslashbook of the speaking engagements will be there as well. And I have a course on resilience coming out in June with Harvard at X. So I'm super excited about that.

And I'm very proud of the course on anxiety that we created. So if somebody hasn't done it yet, you should definitely check it out. It's on your app. And just to point out to people, there's a previous book called Almost Anxious. There's a previous book, Almost Anxious. And it's the parallel of Dan Sandin of Vanilla and Kermann is every said. That was the Vanilla Luluana.

So. Okay. Okay. So go with bold move instead. I think it's a much better book. Okay. Luana, congratulations again on this book. And thanks for coming on. Great job.

Thank you, Dan. Delighted to be here. Thanks again to Dr. Luana Marquez. Thank you to you for listening. And thanks to everybody who worked so hard to make this show a reality. 10% happier is produced by Justin Davie, Gabrielle Zuckerman, Lauren Smith, and Tara Anderson.

DJ Cashmere is our senior producer, Marissa Schneiderman is our senior editor and Kimi Regler is our executive producer. We get our scoring and mixing from Peter Bonaventure over at Ultraviolet Audio and Nick Thorburn of one of my favorite bands, Islands, delivered our theme. We'll see you all on Friday for a bonus.

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