Anxiety: Stop Negative Thoughts

welcome to Washington Hospital today dedicated to informing residents about healthcare topics and issues through programs featuring community forums and free health and wellness classes our goal is to empower community members with the information needed to make informed health decisions Washington Hospital has been providing health care to the residents of the Washington Township healthcare district for the past 60 years [Music] today's presenter is dr. Seema sagal dr. sagal is a board-certified psychiatrist and practices medicine with the Washington Township Medical Foundation it's always great to be here and to do these talks and I love it when we have a packed house like this because I feel that the more people I can empower the more people I can help learn strategies to manage that anxiety out of my office I'm doing myself a favor so this is a gift that keeps on giving me so thank you so much for your support and for coming out here today to help support the series and also just to show your support for you know what we do here for the community so without further ado let me get started today's topic as by the turnout here is evident it's something that a lot of people struggle with and you know anxiety or repetitive thoughts are something that yes we hear other people suffer from people who have defined mental illness but all of us here present whether we have a defined diagnosis or not at certain points in our life do suffer from repetitive thoughts sort of the recurrent ruminative thinking which if left unchecked can progress on to anxiety which left unchecked can progress on to depression so this is really an important topic and you know since I had given a previous talk on anxiety I thought I would pick this particular aspect of anxiety this repetitive our automatic thinking which is at the core in terms of symptoms of both depression and anxiety and together we are going to try and learn how to increase our awareness of their existence their impact on our mental health and to find tools and strategies of dealing with them because thoughts I feel are really one of the most you know important generators of our wellness because it is our thoughts that really determine our perception and it is a perception that influences our reality so if we can understand our thoughts and we can change our thinking and our thoughts we can in effect change our reality and change our connection to it so let's get started if I know how to let's see if this works perfect so a couple of wonderful thoughts to get us started all you are is what you think about a man's life is what his thoughts make of it a man is what he thinks about all day long human beings can alter their lives by altering their attitudes of mind and like we you know had just started talking that thoughts really are I think sort of the you know the juggernaut it's what keeps our wellness it can take us to Heights of wellness and it can sink us to depths of depression and anxiety so they're very very powerful and I think no amount of time spent on them is wasted or too much in fact people say that one lifetime is not enough to really understand the power of our own thoughts and to begin to have a relationship with ourselves which in turn determines the relationship with everybody else that we have and our relationship to everything that we do in our world Deepak Chopra lots of you might have heard about him says that the best use of imagination is our creativity and the worst use of our imagination is anxiety we are the only animals in the kingdom in the animal kingdom that can actually imagine an event and mount a stress response to it I have a little pet I have a little Boston Terrier and I learned so much from his behavior there is no way that I can make him sit have an imagine a scenario of a bigger dog chasing him and hasn't become anxious about it he just doesn't get it so when the dogs there his survival instinct kicks in and he's runs but the moment the threat is gone and I show him a ball he's ready to play fetch so he's absolutely in the moment because he doesn't have the capacity to imagine a threat something that I think inflicts all of us so we have to be careful about how we use that gift the average brain does a lot of thinking and I purposely left that blank to see if anybody here in the audience I recognize a couple of you in the audience so can anybody shout out approximately how many thoughts our brain thinks in a 24-hour period it's a lot and yes men do think less than women but it's still substantial on an average it's about 60,000 thoughts 6-0 yeah 60,000 again to give you an idea about how powerful and how active this is it is continually thinking it's thinking when you wake up it's thinking through your day it's even thinking when you're asleep and it thinks not just in words it thinks in visual imagery we can sometimes close our eyes and think about a beautiful moment we spent with a loved one with our child at a wedding and we can recreate the emotion we felt weeks months and years later similarly we can think back on a terrible event and we can visualize how we felt in that moment the emotional coloration of it and we can mount a sad emotional response to it years later so it's powerful and the beauty about these 60,000 thoughts is a lot of them the majority in fact are repetitive we aren't Einsteins we do not think sixteen novel thoughts every day we recycle them we think the same thought over and over and over again and we do it repetitively we do it unconsciously and we do it with such conviction that even we believe that what we think is true there was a study done there was a Swedish monk who decided that he was going to dedicate his life and do penance and understanding the meaning of life and after 18 years when he reemerged somebody asked him what did you learn after 18 years of introspection and his response was I no longer believe what I think and that's powerful right so again the point being do not take at face value what you think it's not often true in fact 80 to 90 percent of the time it's downright false so can test what you think bring the evidence tell your mind show me the evidence is what I'm thinking true and if not feel free to reject it the big trash container press that down it goes all right so why are we talking about it so much negative thoughts what they do and we learn about that they actually have a direct impact on our brain on the neurotransmitters in the brain it actually depletes our beneficial neurotransmitters things like dopamine and serotonin it can have and you know MRI and functional imaging testing now proves beyond a reasonable doubt that our thinking and our method and our modality and a patterns of thought really impact the way our brain things the way it's wired the way we program our brain by our own thoughts there is this BDNF brain-derived neurotropic factor which is an essential protein for new brain cell development the more we worry and the more we are anxious in the more we have these thoughts the less amount of this is secreted and less amount of new brain cells are stimulated to grow and this chronic worry shrinks the size of your brain and ongoing with the impact it increases the size of your fear center now this is an interesting concept when we are born you know again we are the only mammal in the kingdom that requires us to be looked after for such a long time after our birth if you think of any other mammalian creature no mother follows its offspring for weeks and months and years trying to protect it and help it you know completely grow and mature except us and when we are born the only part of a brain which is fully functional is a fear center it's a survival instinct tool Center because it is essential for survival so the your I guess a cosmos thought if this job this girl has any chance of survival she better have that fully functional the rest can follow so my frontal lobes the ones that are responsible for reasoning my rational actions future thinking planning executive functioning it's not yet fully formed in fact barely at all it's completely formed after about 22 to 26 years so why are teenagers so impulsive because the only part of the brain that's fully functional where they think from is the immediate impulsive immediate rewarding part of the brain and so when you know I see young parents I tell them that help help the child develop conceptual thinking in sort of planning help them build that freeway which is sort of incomplete between the back of your brain which is ready and developed but very impulsive and instinctual to the front of the brain so again how we talk to our children how we model behavior how we model taking care of ourselves are all important things of course it increases the risk of psychiatry illness and it changes the brain down to very very molecular levels now this way of thinking becomes destructive and we've seen why and the impact on the brain and yes both depressed and anxious people tend to have more than their fair share of repetitive repetitive negative thinking all day long however the nature of that thought process is different people who are depressed tend to have a very pessimistic a very gray outlook on life death hearts will go something like there's no point in life I'm worthless I'd be better off dead the world would be better off dead right and so on and so forth so there's guilt there's pessimism anxious people I'm gonna die life is too dangerous something Bad's gonna happen I can't cope I can't manage you see the level of anxiety you see the level of engagement with that quality of thought so even though the thinking you know the engine is churning but what it's spitting out is completely different in the to depression and anxiety now our anxiety like I mentioned is actually meant to be protective and it was the and it is still the only survival tool we have the differences seventy thousand years in our hunting-gathering forefathers years it was an essential tool that got triggered with real stress with real threat in our environment there's a line in the bush I have to outrun that lion and so does the survival or the the Instituto the instinct would trigger this reaction the stress response in my body all my blood would drain to my limbs the only thing I needed to work really well were my limbs because I had to outrun that lion and so everything would drain to my limbs I would start feeling light-headed because there's not enough brain in that time not enough blood in my brain at the time all my non-essential functions slow down digestion slows down I don't really go to the bathroom I'm just run hyper-charged sort of a state my skin is tingling I can feel the hair rise at the back of my neck because I'm ready I'm spoiling for a fight or a good run except that today there is no lion in the bush the lion is in our phone the line is in our computer the lion is in our own thought so we have the ability of triggering our own anxiety merely by how we think about a situation about an event past or present or future so we are very powerful feature creatures the anxiety itself can take several different forms you know and I've just labeled a few of them up here the generalized anxiety the panic attacks that people often have which is basically you know a fancy name for a full-on stress response where people experience all that I had just mentioned you know the tingling the dizziness the the frequent you know somatic complaints having the sweating the raised heartrate so all of it basically a physiological response to a perceived or real threat so remember it doesn't have to be real it can be perceived but that's the response that they mount which is extremely discomforting and often will land these people in the emergency room because they really do feel they're having a heart attack and they're not but by the time they come to me they've had exhausted workups they've had you know thousands of dollars wasted in terms of trying to rule out a medical cause which has its value but I'm hoping that after you know being educated about it here today that you can further educate other people that you might know who suffer from anxiety or you've seen experienced these and sort of give them you know some words of advice now between the depressed people and the people suffering from anxiety the common thread again as we spoke are these automatic negative thoughts and they are called ants a and TS automatic negative thoughts and the reason they were you know named this by a couple of very famous cognitive behaviors it's because they likened them to actual ants that can invade a picnic a few you can stomp out but if there's a swarm of them it kind of ruins your picnic and so these thoughts if you sort of you know visualize them in the same way when you're under stress you sort of worry and that normal worry it's a few ants that you know they you sort of take care of them you figure it out and the moment passes but there are moments where try as you may you cannot rid yourself of this ongoing thought process that just doesn't shut off and so they're called ants now why again you know this is important we had touched on this briefly that our brain the deep limbic system which is our emotional part of the brain really gets impacted in that the filter through which you start looking at life starts to also become gray and dulled and pessimistic and remember that we do not respond emotionally to what is happening in our environment we respond emotionally to what we perceive is happening in our environment and that's a very important distinction to make because if I was to you know show a really stressful video to three people not all three would respond in exactly the same way because each of them view it the the event happens in real time in the world we perceive it in our mind we put it through a filter a filter of our own experience our own coping our own background our own trends our own learning and then we mount a response to that and that's why it's really clear it's very important to have a clean filter you know even if you had a HEPA filter at home to clear the air in your house you would clean that filter on a regular basis but somehow we never take the time to look at the filter through which we view the world and every now and then do a good deep clean and since this really working for me and it's a really important piece because you get to control how you view things and you get to decide and choose how much and what kind of response you want to mount so the treatment as you can see already begins to take shape as you begin to understand the process that our mind puts all of this through now again we've sort of I think belaboring the same point and here is just you know the only thing the slide really shows is that our thoughts you know as we are living now in a world of artificial intelligence we all feel threatened that we are going to become obsolete and you know robots are going to take all our jobs and they are beginning to actually teach robots consciousness the one thing that we felt separated us from machines that you know all else fails the robots can never take our place because they can't think like a human but what they're finding is that thoughts are nothing but electrical impulses I experienced something that experience translates into an electrical impulse in my brain if it's something frightening my pupils dilate my skin becomes a little warm my hair stands on end my blood pressure variation is just so and all of this can now be recorded so a robot by analyzing this data now begins to understand what fear is when I'm joyful the opposite happens and so enough data can be fed into robots to understand what joy is and so they say that you know you can actually teach consciousness now to robots I hope it's not true but that's what they're working on now here's a face that makes you feel fearful right away so just looking at an angry face having a sad thought having a cranky thought having a mad thought releases certain chemicals in the brain that impact our brain directly so our thoughts are not as simple and innocent as we may think them to be they're very powerful with direct impact on our brain and a body does react to every negative thought we have on the other hand it does react to every positive happy thought that it has as well even just looking at that little baby you know it makes you sort of feel happy it makes you want to smile it just gives you an warm gooey feeling and that's the body just responding by a visual this is not even the baby talking or you're not even touching the baby just a mere look makes you feel happy so again just to feel how reactive we are and how all our senses are interconnected positive thoughts definitely help you be more productive more effective at work and so the most important thing today is to understand learn and educate ourselves about the different types of destructive thoughts that sort of flit through our mind so I've got a list of I think about nine or ten of the commonest automatic thoughts and I'm sure all of you will be able to identify with at least one maybe more of these thoughts so let's start with the first one all or none thinking right examples would be he never listens to me he's always putting me down he'll never understand what I really want right no one cares about me no one will call me so very specific and very dramatic but very wrong thoughts and again we have the thoughts we don't challenge them and we don't say you know that's actually not true it's not always it's just today when I need to talk to someone I miss the fact that I'm unable to talk to someone or maybe the person was busy if you're expecting a call and they haven't called that it maybe has nothing to do with you or your situation but something to do with the other person situation so again the perspective the filter through which you view what is happening to you it's the same and so you have to widen that and you have to entertain other possibilities and sometimes it's not easy because your brain the neural pathways are so strong because you have thought this way for 20 30 40 60 80 years so it's not just overnight going to have this new way of thinking so you have to first contest it and say let me pull back what are the other possibilities so just to invite that what you're thinking is not true it's a good start this is a red ant particularly poisonous focusing on the negative or mental filtering this is something we all do we've all you know we are all probably complicit in doing these at some points in our life and then we all have our favorites that we do over and over again so what is this focusing on the negative if you do badly and worthless I never do anything right and if I do something really well it was just fluke it was just chance you know my maybe the teacher was in a good mood and gave me an e so we don't pat ourselves on the back we don't give ourselves credit where credit is due but we are good very quick to be punitive and harsh on what we struggle with and so pay attention to your own inner self talk it really determines your state of well-being you are what you think so in this case you know I don't know how many of you know the Pollyanna story but it's not a small snippet from it goes something like this Pollyanna you know she loses both her parents and is being raised by her aunt in the small village and her father before you know he had passed they they were very poor growing up so they didn't have much to go by and not too many presents and things that she could wish for she got but the father taught her that in anything that happens to you always look for something positive something to be happy about something to be glad about and they would call it the glad game and so when pollyannas living with her and she really really really wants a doll and she's never been able to afford one doesn't have one so some missionaries who are working in the area say you know when we go back we're going to send you a doll so they go her gift arrives in a big box when she opens it she finds a pair of crutches and she's really disappointed and she says oh no this is not the doll I wanted and as she's feeling sad she thinks of her father's words and she looks and she says how can I be glad about this and then she says oh I know I'm so glad I don't need to use them so again you know the point here being in whatever happens try to find the something something in it that's good and I had that experience actually today in the morning when I was seeing my patients or a patient who you know was talking about a couple of bad things that had happened in her life and you know how her mother had almost died in an incident and then had another very scary sort of you know mishap but she was okay and so this patient was extremely anxious and so much so that she had a tracking device on her mother's phone so that she could keep track at all times of where the mother was because she's so afraid of her safety and so I sort of explained this concept to her and I said you know another way to look at it is your mother is still isn't that wonderful and it's almost like she had never thought of it through that perspective or lens she was so focused on the fear of something bad happening that she just sort of missed the point that the mother was still alive despite those close misses so again play the glad game fortune-telling I just know it's going to be horrible I just know it's not going to work out and I often say so where's the crystal ball how are you making all these prophecies and and why do you think they're going to come true again we don't think we just proclaim and we proclaim with such certainty that we actually fool ourselves into believing it may be true so fortune-telling is again very very common and these are hard to pick up because they are so natural to who we are we have lived in this body for so long and done the same thing over and over again for so long that we are not able to see how wrong it is and how really unproductive and downright harmful they can be so the example hi I have here is you have a bad day at work you're in this sort of you know not very optimistic mood and you already thinking I'm going to go home my house is going to be a mess and it's going to be a terrible day nobody's gonna greet me you walk in home there's no one there to greet you and right away you're in a bad mood now who did anything to put you in a bad mood nobody except you again you imagine the scenario you mounted a response to this imagined scenario you waited for it to come true it does and you said there I knew it nobody loves me nobody cares about me so again paying attention to our own engagement with our own thoughts is important mind reading I know what they're thinking they think I don't amount to anything I think that just they don't like me that's why they've sort of you know they're avoiding me at a party I did get an invite to something they know you know they've seen through my facade and so on and so forth you're in the office your boss doesn't say hello to you she's mad at me what did I do again the only filter through which you look and through which you connect to what is happening is negative you don't challenge it you take it as gospel you react to it ruin your day and then you blame the other person for doing it so I say to most of my patients you're more most precious commodity is your mental health why would you farm it out to other people why would you outsource it to other people if she talks nicely to me I feel great if she treats me well I feel good if he does this for me I feel this she he redid them I say it's nobody's responsibility to take care of you but you and the good news is who knows better what you need to take care of you than you and then you can stop being mad at other people for not doing a good job of what is not their job in the first place right so the world may treat you shabby why must you so when you actually turn down the blinds close these doors and windows to the outside world become introspective and say what is my role in creating my own happy or sad the answers are right there thinking with your feelings you come home your partner is busy you're talking about your day and there grunting mmm you're like I don't think he's paying attention to me I don't feel loved I feel he doesn't care you're thinking with your feelings you're not thinking with your logical mind and that's why they say the longest distance in the world is the 13 inches between here and here and it takes several lifetimes to actually walk that distance a lot of us we just operate from here we are operating from an emotional place and again like we have you know sort of talked about the emotional place is a result of our thinking so if you really change your thinking you become really a sort of a detective and I say you have to be a witness to your own thoughts and behavior you know sit here like a commentator like a referee like someone who's just plain telling you what the game is all about without playing it so if you and a way to do that is imagine a little you sitting here and commenting on what you're thinking and what you're feeling in the moment so let's take an example I come home my husband is busy and I start talking about my day and he is not paying attention to me so I begin to feel hmm not good so this little me says I don't feel good right now maybe because I'm not getting the attention I need okay not getting the attention because he's busy does it have anything to do with me probably not maybe I should check maybe I can ask honey can you pay attention to me for five minutes this is really important sure I've got his attention I can check I feel that you didn't I you didn't care of course I do what you want listening when I was talking I'm sorry down there i you have my attention so if I actually check it out and I tell him what I need what I want rather than mounting a response on feeling belittled or ignored it doesn't go anywhere so when I train myself to actually understand pick the feeling out in the moment I can do something about it I can do it even later if I think about it and I come back I can go back and say you know that thing there I just wanted to say whatever I have to say so again it's important to nothing just with your feelings if you do connect the dots go to why it made you feel the way you did guilt beatings we've all been there I'm not a good enough mother I'm not a good enough doctor I'm not good enough wife I'm not a good enough sister I'm not a good enough employee on and on and on something happens to us in our lives which we feel is really difficult to surmount we can take 30 years of being say a good parent and in that moment we are reduced to being terrible parents because of the one thing that may have happened to us and this is you know particularly a difficult one and the trigger words here to sort of to let you know that that's where you're at our I must I should I ought right these are very strong words and the moment you it becomes like a test and the moment you think you should have must have done it there's a good chance you're actually not going to do it right so to again reframe and to treat ourselves with the compassion with the love with the kindness with the forgiveness when things happen to us that were out of our control or even a realization that we may have contributed in some small part to what happened is I think really really very powerful and you know we are better friends to our friends than we are to ourselves and really if we all think back we can all come up with instances where we've beaten ourselves up over something really small and you have to again look at why would my relationship with the most important person in my life which is me be so bad and it's something I almost have to have my patience say out loud when I see them in my practice that can you say that I'm the most important person in my life and they look sort of a gas and they say that feels sort of strange I'm like yeah because you've never said it you've never felt it and so when you go with that I think that you are kinder to yourself and things are a little bit easier to handle labeling we have all done this right what a jerk what a cold arrogant guy right so what do we do when we label people with these sort of reductionistic labels we take away it's sort of you know and this is something we were taught in training a lot which is if you see a patient with a particular illness you never say look at that autistic child right you would always say look at their child with autism so in that it's a distinction between the human being the person and what they suffer from if I label them autistic I'm reducing that person to just that little label and that's it so again it's the awareness that has to increase about how we relate to people in our world because that's how we are going to relate to ourself so if I mess up on something I'm not going to say oh I was so stupid I hate myself well we all do it no I don't I struggled today it was tough I did my best I did what I could it'll be better right so the tenor the coloration the words I use for myself really will impact ultimately how I feel about myself whether I feel anxious whether I feel depressed whether I feel that you know what it's okay today was a bad day I'm just going to rest I'm going to take extra special care of me today because I'm really feeling down it's what I should do not I'm already feeling down and I'm going to beat up on myself on top of that and we do that unconsciously so again to make the unconscious conscious is the goal of all these exercises personalization everything that happens in my life I am responsible for right my boss didn't talk to me this morning she must be mad at me it has nothing to do with the boss the boss's life does not exist everything that happens I am responsible so again look at the other side what are the other options and the mantra I give you know my patients who are anxious and reactive and responsive I tell them that learn to unreactive learn to just just be don't react something happens you just observe it you sit with it and that's it you do not have to bring the full-on response to everything that happens around you because it's impossible to do and it's frustrating and takes up too much energy so learn to and react blame if you hadn't spoken with me like that I wouldn't be mad if you had done the laundry and the dishes I would be happy again back to the outsourcing we outsource our happiness to other people and when they let us down we feel justified in our being mad at them so take the responsibility take the responsibility for your own emotions for your own reactions and then for your own wellness so blame is again doesn't do anything it just makes you feel worse releasing different neurotransmitters you don't want more off so again and react and say oh well he didn't do it it wasn't his job to do it it's my job to make sure I feel good most negative thinking is automatic goes unnoticed and again there they just form bad brain habits so people will you know at this point if I'm having a discussion along these lines in my practice people will say what do I do about it what do I do and I tell them all you know you don't have to do anything most of life is about tolerating negative emotions if you just learn to sit with the emotion it usually passes it goes away and very little really needs to be done and it's a question that comes up often if I you know talk on depression or schizophrenia people will say we don't know what to do when somebody says they're depressed I have a friend who said she was feeling suicidal what do I do and I tell them you don't have to do anything you just have to be present you have to sit with them you have to allow them to be able to be themselves with you I see so many patients in grief I see so many patients you know who have lost loved ones who've had terrible losses in their life and you know one patient comes to mind who's now past I saw him for a total of three months from the day he got a diagnosis of a terminal cancer and was sent to see me - the day he died three months later and when he first came to see me I had this sort of same reaction you know what am I going to do for a minute and then I said you know the greatest gift I can give him is probably partner him on this journey not be freaked out not be scared not be afraid and just be present for him and it was probably in so many ways such a wonderful three months that taught me so much in a way that I would never have had that experience and he was the one who actually told me he says he was a Catholic of Catholic faith and he said you know I don't know about what happens after death whether there's hell or there's heaven but one thing I can tell you and that is that heaven is here and hell is here and I thought that was profound and absolutely point on and so in the wisdom I guess that comes with knowing that you have very little time left the focus really sharpens and so if you know all of us can harness that energy in our day to day I think it would enrich it in so many ways treatment what can I do about all of this and I think we've sort of alluded to you know a lot of the strategies but we'll go into the specifics now the treatment you know essentially consists of this there's always medications I feel that that's sort of again you know my whole sort of idea about medications is the medications make you feel good enough to allow you to do the work of healing yourself so if you're not sleeping well you're not eating well you're so anxious all the time your focus is so bad you're so distracted you can't really focus on the work of healing yourself so medications certainly have a role I don't think that's the only answer but an important component and among you know the medications the Communists ones that we use are some of the serotonin agents and you might have heard names of you know prozac Zoloft paxil so the some of these antidepressants have wonderful effects on anxiety as well and they're commonly and widely used fairly well tolerated and there you have it and benzodiazepine valium clonazepam lorazepam xanax again they have you know their own pitfalls they can be habituating so they are usually use them for a short amount of time till the other medications I might have started kick in for a longer term treatment of anxiety so for the short time for a short timeframe they're very effective and they have a almost immediate effect on the physical symptoms of anxiety you know people who have a lot of the the stress response symptoms the racing heartbeat the pulse the sweating the passing out the dizziness so these are tend to act almost immediately within about 15 minutes the other serotonin agents the Prozac and the light take about you know three to four weeks to really build up in your system and sometimes when a patient is really in acute distress you don't want them waiting that length of time so we will give them a benzodiazepine to sort of cover that that period buspar or do spiral is another medication which is sort of in between the two it takes about maybe two weeks to kick in not at all habit forming you know doesn't act as quickly as the benzodiazepines but not as long as the serotonin agents it's very well tolerated and again popular to be you know used for anxiety beta blockers this is a medication that cardiologists use a lot the inderal or propranolol again it works on really dampening that stress response sin or the heart beating fast increase pulse rate it's sort of just dampens all of that so these are the four big categories of drugs that are very useful in anxiety again the like you know we we've touched on their the treatment is not straightforward it's not as prescriptive you know I can't just write a prescription and say change your thinking that'd be so easy right I do say that over and over and over again till it happens but again the the treatment has to be you know really I think individualized to the patient's because again like we we spoke that our thinking is the manifestation of our relationship with ourselves which is a product of our own or bringing our traditional cultural belief system our experiences all the things we have been through a coping mechanism our family histories so we are complex beings who you know it takes a while to sort of and people say one lifetime is not enough to get to know you and I feel really at the end of the day that is the true meaning of purpose of our lives to get to know who you are in business with who is this person that you're living with for the entirety of your time on this planet so we are more externalized in our interest to get you know we are more interested in what's happening around us to people around us than to us and within us so again a bit of introspection I think really helps our attitude is huge what is my attitude towards my own anxiety my own depression because my relationship to my panic or anxiety my judgement of my panic or anxiety will determine how quickly I seek help for it how seriously I take it what value I place on getting better from it so all of that sort of you know does weigh in and the attitudes can be one if you can yes bigger there than it is for me good so the attitude could be I can't let anybody know where does that come from I think it comes from a stigma that we all have about not talking about anything related to a mental wellness and like I said it is one of our most precious commodities we should make it a point to talk about it and to say I am not ashamed this is this is sort of you know a stress test when people come to me they're usually anxious in the context of a life event a stressor a loss something that has showcased the fact that what I'm going through and how I'm equipped to deal with it there is a mismatch so my stressors are overwhelming my coping mechanism and I need ways to buff up my coping mechanism I may not be able to control what is happening in my world but I am able to control how I relate to it connect to it and deal with it so our attitude is everything another attitude which is really destructive is panic is bad it's the enemy I must never be anxious I must keep myself from ever showing that I'm anxious again our anxiety teaches us about us so to use it as a teacher and and here you know I love to sort of use the fact that it goes from being an automatic thought process I go from going panic is bad to what can I learn from this I have a choice panic is a natural inborn instinctual response yes it's been triggered in ways and in places that are inconvenient but by itself panic is not bad I want to avoid the symptoms you cannot avoid the symptoms right they come at the most inopportune times and you have to get used to it and learn from it and I love to use the example of you know martial arts and people who are training in martial arts have a saying that says love the mat the mat on which they practice because they spend so much of that time face down on the mat they're not down over and over again so I say love the mat that's where you learn that's how you teach yourself how to do it different what to do different what worked and what didn't so be a student and let it teach you I must relax right now people who are anxious in certain situations you know they'll clench their hands and say ok I'm going to really not I'm not going to allow myself to be anxious it's ok if you're anxious how does it matter I have a patient who had really bad panic attacks so much so she couldn't leave her home to drop her children across the street so she wouldn't go to stores or Target and so we worked together for a while and she sort of you know got this piece that it's ok to be anxious so she was in target one day and she had a full-on panic attack so she says you know she came back to relate this to me subsequently and she said I had a panic attack I just lay down on the floor put my legs on my cart and just lay there and people came and said are you ok and she said he are just having a panic attack it'll pass and they said ok and she's like it was the most empowering thing I did because now I don't fear it what's the worst thing it'll come at an inopportune time I'll wait for it to pass and it does pass I must stay on God again you cannot predict you cannot predict life by Death life is unpredictable but what you do control is your reaction and response to it so work on that tease rather than saying I'm not going to allow myself to be in a situation that can make me anxious you're going to fail this is a test I have to you know people who are in any kind of treatment or any kind of sort of cognitive behavioral structured therapy will go out you know they've been given all the tools and they say now you have to go out and do things that did make you anxious and see if you still get anxious so they'll take it upon themselves that it's a test I cannot allow myself to be anxious no this is practice I'm going to put in play all the things I've learned and see how much more I still have to learn so you see the difference in your self-talk it's kinder it's gentler it's more compassionate you don't have to be a drill sergeant all the time you can retire that little width that you carry in the back the one with the spikes on it that comes out every few minutes and gives you a few quick lashes and disappears and then we feel you know and we wonder why we feel so rotten and who's making us feel that way so pay attention to that the certainty what do I anxious people hate more than anything unpredictability uncertainty if only I knew if only I can control the outcome if only my plan is exactly so and again can't do that so to tell yourself uncertainty isn't my friend but I can tolerate it it's okay it's okay to not know so you know people who have specific sort of phobias or flying for example you know patients who will just refuse flat-out refuse to climb a plane it's too dangerous and to them I say total number of deaths really related to airplane you know of flying in a year is hundred motor vehicle accidents is 47,000 pedestrians 8,000 in a year accidents that kill you without leaving your home 22,000 you think you're safe at home you're safer in the air so again you have to bring evidence to your thought you can't just hold on to it that I know no you don't you're not a fortune-teller remember you don't and so I and this is probably part of you know what helps and which is part of the treatment I keep correcting patients as they are talking and I'll say stop did I just hear that so why do you say that are you really who where where's the evidence and they will stop and they'll say oh you're right we're just automatically assuming thinking unchanging so another great way to manage your anxiety is to postpone your worries this is a natural you know proven method which is in the course of the day well there are people who are just inundated with worry and they're worrying all day long they can't focus on their work they can't focus on you know anything else so we tell them pick two times in the day which are your worry times and say for 10 minutes twice a day you sit on a chair which is designated your worry chair and you sit and you worry and you don't allow yourself to think of anything good no happy thought no real for nothing only worry if you're and if your mind begins to stray you say oops cannot do that have to worry come up with more things to worry it's amazing how it's hard to fill 10 minutes of constantly worrying so when people say I worry all day it's actually not true we worry in sports all day long and we just ruminate on the single thought all day long so when you actually pull out of that and you say let me see how much can I worry how much time can I worry for so when the worry the you know the advantage of this is when you start to worry at a time that is inconvenient you can just say not now I'll worry in my worry time and you can actually push it aside you can postpone that worry and this is the two times that you set aside for worrying important thing being even if you run out of ideas and have to repeat the same worries you just keep on worrying till your worried out and then you're like okay I'm done it's very powerful writing down our worries sounds so simple but so powerful if you have to you know there are people who just worry that I think something terrible is going to happen today just a general worry something is going to be terrible today and they can unconsciously think that 400 times but if I tell them write it down 400 times for me just now I'll give them a pen and a paper to write it down after about the 10th maybe 15th time they put the pen down this is crazy this is to watch I'm like well when you actually concretize you give deeds to those worries you begin to see how ridiculous it is and how powerful and what a psychological sucker they are because we all ultimately have a finite amount of psychological energy right so if you're going to have a major leak from there which is what these worries do you have very little energy left over for things that you really want to do so you have to sort of you know seal those those points and say nope got to keep the secure I have to dip into it all day so not doing it shifting our emotions when you actually write down your worries or when you put aside this worry time you are going from this passive action which is whirring whirring whirring with no active control or in changement into it becoming a very active engagement if I have to write my worries I have to get my paper I have to organize myself get my pen dedicate time push all my other essential work aside to put it down on paper so it becomes an actual goal-directed event and it gives me control it gives me choice how much do I want to do this maybe I want to move on and do something else so it becomes from a passive sort of you know motion to an actual active engagement and that can help going on to sort of other mechanisms which I think are very very powerful and you know among them we are going to talk about meditation we are going to talk about the breathing and they say that your breath is really the one connector between your mind and your body it's really powerful and sometimes when we are anxious just focusing on your breath is enormous ly calming and you don't have to do any fancy breathing you just have to breathe normally but you just have to focus on the fact that you're breathing in and you're breathing out and you just count to about ten times of your breath going in and your breath going out it's very very calming and very very helpful and I actually recommend that you do this about two or three times in the course of your day take you know counting ten breaths doesn't take more than ten seconds maybe fifteen you're just breathing in you're breathing out and you're just counting the fact and you're following your breath as you're breathing in and breathing out it's it really does help and more and more studies show that meditative activities breathing activities do help in really restructuring and rewiring our brain it's powerful another way to breathe is now to take a long breath a deep breath and the way we you know do this particular type of breathing we call it diaphragmatic breathing or abdominal breathing so a simple way to know that you're doing it correct is to keep your hand over your umbilicus and you can do it with me let's do one of them so just take your right hand put it over your umbrella cos when you take a deep breath your stomach should go out which means that your lungs are completely expanding in your chest cavity so take a deep breath and you're again your hands should move out as you breathe in and it will go in as you breathe out so breathing in I'll stand on the side so that you can see maybe you know so if you keep it here and you breathe in out in out in again and out so this is sort of the diaphragmatic or the abdominal breathing and you know a lot of the Eastern cultures the Indian culture calls it so that the the prana or the life force the Chinese culture calls it Chi and the Europeans you know just call it life force and Americans don't call it anything so they say that it's concentrated behind your umbrella cos and so if you you know if you just sort of think pregnant women often will talk we walk like this they sort of walk with their hands on their you know belly like this if you if you're fearful or you're protecting yourself from someone you do this right so it's like all your energy is sort of concentrated here so some people say when you breathe with your hand over that particular part of your body you're sort of tapping into that energy source another way to breathe is to do calming counts which is you again you take your breath and here before you let the breath out you count till ten then you let your breath out so your take it takes a little bit longer probably a minute and a half or so to do this exercise and how it helps is that when you're really anxious it gives you that minute and to sort of reset to sort of press that reset button it calms you down and you're back into the fray or the fight or you know whatever made you anxious so it's a nice period of just calming yourself let's do this one together as well it doesn't take us long so I'm going to take a deep breath in we're going to count till ten and we're going to let it out we'll do five such breaths okay let's do it so hand over your belly sitting comfortably you can have your eyes open have your eyes closed so we'll take a deep breath I'll count to ten one two three four five six seven eight nine ten and out deep breath in hold one two three four five six seven eight nine ten and out and last one deep breath in hold one two three four five six seven eight nine ten and out you see just how when we focus on this activity it helps just release all the worries from your mind because for that particular time you're not thinking about them you're focusing on your breathing you're thinking about your breathing you're connected to your body so they are they're powerful in that way now guided imagery for relaxation this is another method that you know a lot of the therapists use and which i think is really easy to learn and very easy to implement on your own essentially what it means is you think of some happy calming place from your life it could be imagined it could be real you could think of you know a wonderful picnic you had someplace a beach sort of a scene you could think about the forest the waterfalls you just being at your parents anniversary party or your kid's birthday party doesn't matter so you just close your eyes and you bring up as vividly as possible all the aspects of that scene the sounds the feel the taste the smells the people everything that you can recreate about that that scene and you let yourself be immersed in it close your eyes and just be in that moment for few minutes and you let yourself experience the calm the safety and the protective sort of feeling you had being there the happiness you felt and this really helps again reset our anxious button it's sort of dial it down a bit and so the important thing being that you have to do these even when you're not anxious you know you cannot learn how to fight in the middle of a battle if you're having a full-on panic attack that's the wrong time to start learning how to do these things so you have to arm yourself in advance you have to prepare yourself and do these meditative breathing exercises on a regular basis so that your mind also begins to understand oh when I feel panicked and she starts doing that the brain gets the idea I feel calm I feel less stressed and anxious and on edge I feel better so you're sort of barring that I'm in charge and and you know a question I have my patients say ask is who is the boss of your anxiety I use the boss of your anxiety or is your anxiety your boss and so you have to reframe and say you know I'm in charge I decide sometimes I succeed and sometimes I fail but I'm in charge so when you persist in your consistent you do start to find results now meditation we all know we all have heard about it we all want to do it none of us really a lot of us don't find the time to do it and I'm here to tell you that again all we do with meditation is putting aside a dedicated amount of time to be with our thoughts we spend a lifetime running from them distracting ourself from them and you know in this world that we live in we are so concerned about our physical health our physical well-being you know the foods we eat and the stuff we put in our body unfortunately not half that attention goes to what we feed our mind you know we are surrounded by so much sort of addictive activities you know whether it is watching movies or sports or TV or social media it's basically feeding our mind junk so we are inundating our mind with junk input and it just keeps collecting we don't monitor it we don't take your responsibility for how much input I allow my brain to have when I go home after a long day's work yeah I have a long a time sort of psychologically exhausting day if I don't take the best care only I know how of me to ready myself for the next day what good am i to the people who come to me so there's no blame there's no guilt there's no shame in taking care of me because that's my job and I take it seriously and part of it is not going home and turning on news and hearing about death and war and terrorism and this and that it does nothing for me and there's nothing I can do about it but I can do a lot about taking care of myself by turning it down and turning on a maybe more happy Channel so paying attention to our psychological diet is really important and how meditation sort of helps it helps quiet our mind it helps slow down these racing thoughts and tuning in to our own internal self like I said you are the most important person in your life wouldn't you like to know if about you mean what could be more interesting you know we are like a puzzle and every event every person and every activity that we are in contact with reveals a little bit about us so I cannot grow or mature or learn in isolation I need people to come and sort of turn over to unmask those little pieces that teach me about me and so be out there don't be afraid learn from your experiences come back and sort of look at them embrace them change them grow from them so again in in meditation what I recommend you know the pure diehards will say you should meditate at least fifteen minutes four days a week they're sort of a prescription for it what I say is meditate for a minute if that's all you can do but do it consistently and that meditation can be just a breathing we did it can be just focusing on a non stimulating object and usually it can be your breathing it can be an actual physical object where you just calm yourself you focus on that eyes open eyes closed you can focus on a mantra if you have one or a single word that you want to pick and all you do is allow yourself to have your thoughts float by think of them as clouds you can't hook a cloud it just has to go by so when you again become the observer of your own behavior your own action and you learn to unreacted us be with the emotion that's the greatest gift you can actually give yourself that I can tolerate my own negative emotions I don't have to act on them I don't have to medicate them with alcohol or drugs I don't have to act out on them by yelling or screaming at someone it's my motion my mind generated it I take responsibility for it I can sit with it and so the fear that we have of our own mind our own thoughts slowly starts to diminish and the focus that we had on them the fear that it has the power to generate in us starts to diminish and again done regularly you know before sleep maybe because a lot of people who have anxiety are unable to sleep well so again you have a very active role in calming yourself and you can say some sort of self-talk that says I had a terrible day today today was trying in so many ways but I made it through I somehow made it through and I'm proud of how there were moments in the day that I really thought I was going to unravel but somehow I pulled it through now it's my time to put that to rest and allow myself a night of restful sleep when you talk it's very much more powerful than thinking you know the thinking is as passive noise in the background but when you talk you actually dumb down your thoughts and you focus on your words and that itself can be meditative but itself can be calming and it teaches you the self-talk that can then go on in the day when you're out and about and doing your work I recommend you know my patients three times in your work day put everything that you're doing down just close your eyes and say what am I feeling what am I thinking and what am i doing if those three things are completely off there's no overlap that's the space in which anxiety and restlessness live so if what you're thinking you know right now I'm giving this talk that's all I'm thinking about that's all I'm doing my mind is not on a million other things I'm completely focused and present here so there's calm and it's a great way to recenter to sort of hit that quick reset in the day and you get going for the next bell so try doing that in your day another grounding technique I did this today with a patient who you know had recently had surgery an older woman in her mid to late 80s very anxious and she had had a prolapse and she had had some surgery and she had this sort of feeling that she had to go to the bathroom every few minutes even though it was a sensation but not release her needing to go so to distract her I did try this I told her to count three things or five things that you see again you're engaging all your senses and this is easily doable when people are getting very anxious just look around you to again center yourself count five things you see four things you hear three things you can touch two things you can smell and one thing that you can taste so again what it does is instead of just being swept away in your thoughts which is easy it brings you to the here and now again grounds you in your reality another exercise that they actually recommend is if you're really anxious do any mathematical skill it doesn't have to be this you can start counting backwards from 100 taking away 7 and go back as far as you can it's pretty tough actually 193 and 86 79 so the part of your brain that has to be engaged in this activity cannot be anxious at the same time I don't know who does his research but it's great so so do some sort of a mathematical trick like this again it sort of instantly calms a healthy lifestyle keeping active eating well nature that's why in hospitals you know if you walk around you see big pictures of beautiful trees and the beach and a sunset somehow a brain loves all things nature whether it's pictorial whether it's out in nature itself just walking out among the trees very calming so in your break if you give to being very anxious in your work there take little 10 minute breaks 5 minute breaks and even if you can't actually go out of your office have a screensaver that is a beautiful nature scene kick off your shoes and just look at that and immerse yourself in the beauty of that scene it's very calming challenging yourself talk often anxiety is so powerful because it has gone unchecked for so many years in our minds it's caught off it's perfected that art of freaking us out and sort of you know making us think the worst drumming things up to be more than what they really are so challenge yourself talk and say is this really true where is the evidence show me that show me the evidence I say that all the time you know to patients that stop when you find yourself getting sort of worked up on react show me the evidence play the glad game something to be glad about okay I'm practicing I'm learning about my anxiety when you're anxious right if you're having a full-on panic attack remind yourself it's not going to last more than 30 minutes physiologically it's not possible to sustain a panic attack more than 30 minutes so the worst thing that will happen is okay 30 minutes gone I've got to sit this one out okay I can do it that I can do so focusing on your strengths and really giving yourself a good pat on the back when you do do something different that empowers you it's important so be your own best cheerleader it's nobody else's job to do it take it seriously it's yours guided meditation video for people who really want to learn more there's now I think there's a couple of great apps out there there's one called calm CLM there's one I think called headspace which people use a lot and so some sort of guided you know app that walks you through the other advantage of doing this is if you do this on a regular basis the way our habits are formed in our brain when we do something in repeated fashion we actually begin to associate and link and connect feelings to it for example I have my little Google home on my bedside so at night before I sleep I have two instructions for my Google home hey Google set alarm for 6:30 a.m. I wish it could be 8:30 but it's been 6:30 for the last 10 years and second hey Google Play ocean sounds it's beautiful and I could you know I can be feeling any which way the moment I start to hear those ocean sounds I am Ruby my lids are getting heavy and I am ready for sleep so it's actually the Google is sending my brain a message that when this place it's time for bed so link something and that's why I keep harping on consistency it's really the only way to retrain our brain is to do it doesn't matter you don't have to do 15 things perfectly you have to do only one thing consistently so pick a simple thing something that's really easy but stick with it painting by numbers knitting anything that's repetitive it's calming you know think about a mother who has a newborn when the baby is crying what does the mother do [Music] right the rocking repetitive motion is coming for the baby it puts the baby to sleep calms down the crying so anything that's repetitive is very calming so it could be something very you know demanding a lot of attention like painting by numbers or knitting just a part of your brain that is not really engaged but engaged at the same time I do my best thinking on the treadmill it's when my body is working its distracted and there's a clarity and I can think better than I can anywhere else so I know that about me and I do use that listening to a podcast there are some fabulous podcasts out there even if you listen to a TED talk you know you're feeling panicked you have these anxiety thoughts let me put on a TED talk on anxiety so all you need to do is go to youtube and say TED talk on anxiety you'll get about 500 hits pick your best you know listen to something it's powerful because you're not alone it's the Communist mental health illness out there it's the most treatable 1 in 5 American has it so you know just sitting looking around in the room if there's maybe 40 50 people here instead of us who have diagnosable anxiety we are talking now really severe anxiety and it's a spectrum so all of us have anxiety because we are born with it it's our friend so think about it as a dragon if you're trying to train a dragon you're not going to be able to train it if you put it in a dungeon and don't give it food and you whip it regularly it's going to become more ferocious in order to befriend it you have to go and get to know it you have to let it get to know you you have to get to know how to work with it so your anxiety in a lot of ways is like this ferocious pet that's out of control and rather than fear it and run from it get to know it because it will be your protector that's what it's meant for so do not be afraid watch an episode of your favorite TV comfort show - the office you just put it on and it's just funny the people who just don't find it funny and I find that strange but I find this funny so again you know this is just a list of things that that are here a lot of resources here and some of them are actually really good some that I found while I was preparing you know the talk itself there's a panic attack helper calm again a lot of tips on other activities other things that one can do in the moment in the immediate in the long-term so you know look at a couple of them mindfulness recovery so lot of tips and finally that's it that's the end of my talk and I'm thank you for your attention thank you [Music] you

Channel: InHealth: A Washington Hospital Channel

Views: 577,476

Rating: 4.8376975 out of 5

Keywords: WHHS, Washington Hospital, Healthcare, Health, Care, Mental Health, Mental Health Education Series, Seema Sehgal, Psychiatrist, Anxiety, anxiety disorders, panic, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, phobias, medications, Fremont, Newark, Union City, California

Id: fSwmbEjX4NA

Length: 83min 12sec (4992 seconds)

Published: Mon Jan 27 2020