The Art of Flourishing: A Mental Health + Trauma Recovery Podcast

S1:E2 Do I have Anxiety?

• Flourish Counseling Co. | Cristina Ally • Season 1 • Episode 2

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  Welcome to the Art of Flourishing, a mental health and trauma recovery podcast. I'm your host, Christina Ali, a licensed mental health counselor and owner of Flourish Counseling Co. We're so glad you decided to tune in today, so let's get started. 

Well, thank you so much for joining us on our second episode of The Art of Flourishing. We had an amazing launch of episode one, which was about the definition of trauma. And in today's episode of Do I Have Anxiety, number one. We will cover what is the function of healthy anxiety, what it is, how to identify it, and what are normal, healthy levels of anxiety. 

Number two, we're going to discuss the signs of what I would call clinical anxiety, which means it's diagnosable or it's clinical. Clinically significant in some way. Uh, we'll talk about a little bit of what that looks like from a diagnostic perspective, and we will talk about some of the risk factors.

What puts us at risk for having anxiety, those clinical levels of anxiety. And then we'll talk about some of those common solutions. We all want to know what to do if we indeed meet the criteria for clinically significant anxiety. So. If you're ready to hop in, so am I. I'm so excited. Let's get started. 

Today's episode might be a little bit longer, so I am excited to walk you through all of this amazing content. But of course, if you're either short on time or interested in a particular Tickler part of this episode, please feel free to skip ahead. We're going to have those chapter markers that I talked about earlier.

Those, the, the outline I gave, I will have chapter markers in the show notes or the description box if you're on our YouTube channel. So just make sure you check those out if you want to skip ahead or kind of pick through some of the content. Specifically. Also, please remember that this podcast is intended just for educational purposes.

It is not intended to be a substitute for seeking help from a mental health professional. If some of this material resonates with you, maybe it's something that's great. You can bring to your mental health professional. So just. Make sure that you note that and yes, that's always an important thing. This is not a substitute for your therapy.

Go get some professional help if you need to.  Okay, well let's talk about the healthy function of anxiety. You know, I think a lot of times people don't want to think that anxiety is normal or they think if they have anxiety that there's something wrong with them. But first things first. I am here to tell you that everybody has anxiety, just like everyone is going to have some level of depression or sadness.

Anxiety is just part of everyday life. Really, when we look at anxiety, it is a worry for the future. Just like trauma might be a rumination about the past, anxiety might be a rumination of the future, but just like.  We have a recall of our history that doesn't necessarily have to be traumatic. Anxiety, even though we're thinking about the future, it doesn't have to be clinically diagnosable levels of anxiety.

It can just be helpful anxiety. And when we are looking at the function of healthy anxiety, we want to call this Adaptive anxiety. I've done a couple different shorts on YouTube and some of our social media platforms like TikTok, but adaptive anxiety is our ability to adapt and move forward. Therefore, it is adaptive for us to solve problems, to live a good life and to survive in the present.

In the future. So there is a spiritual proverb that says a wise man foresees danger and takes precautions. A fool goes on blindly and suffers the consequence. I love that this is a spiritual aspect. Of  looking at anxiety, because honestly, this is, this is allowing us to have anxiety and that actually be based in wisdom at a healthy level, rather than just saying, Oh, if we try to look ahead and, and there was a problem in the future, Oh my goodness, there's something wrong with my brain.

No, if you have anxiety, that is you just trying to problem solve for the future. We all have it. So more than anything, I just want to really, really emphasize in this first section that it is normal. And might I even dare say it is healthy to have some version of anxiety, just a little bit, which is problem solving for the future.

It would be inappropriate if you did not have that warning system. I would actually worry a little more about you. If you didn't have this warning system. So with normal anxiety, what does that kind of look like? Well, number one, our brain can shift from one gear to another. When we start to worry about something, we can kind of note it and we can move on to more pressing matters.

So that's kind of the first sign of healthy anxiety. Oh, there's a problem I need to solve. Let me note that and I can move on. The second thing that I would say is also a part of adaptive or healthy anxiety is that there are shorter periods of worry. So there's not necessarily this need for a ton of imagination around it.

We don't start to kind of zoom in and play the, the what if game. People that have normal healthy levels of anxiety, they have shorter times of worry. They can move on and they don't play that what if game, they're really able to separate reality versus fear. So this is just an example of healthy anxiety.

I want you to imagine a college student who is about to run out of money, but it creates some version of anxiety, that problem solving for the future. Okay. Well, somebody with healthy levels of anxiety would say, you know what, Let's create a budget. I'm not going to create a budget this moment, but I note in the back of my head, I need a budget.

It's a foreseeable problem. And I'll meet that with a practical plan or solution to avoid the danger of running out of money. It's a practical problem. And eventually we look at a practical solution. So that's just an example of a healthy function, adaptive anxiety, and that is. Uncommon for those who actually have clinical levels of anxiety, and we'll get into that because their brain sort of gets stuck at various levels of solving problems.

So, yeah, anxiety can definitely go sideways. So this is kind of the first introduction into healthy. 

It's shorter periods, it's healthy, we can shift gears, we solve problems, we don't play the what if game. It feels very good. So hopefully that kind of summarizes what healthy anxiety is. But I want to hop into some of the signs of that clinical levels of anxiety, especially in generalized anxiety disorder, also known as GAD, G A D.

So let's hop in. To some of that clinically significant maladaptive anxiety. 

Okay, so we call this maladaptive anxiety. The reason we call it maladaptive is because it doesn't help us to adapt or survive. It actually robs us of confidence. It robs us of that joy, that freedom that we feel in life. It's sort of this. Really hard game in our brain that we're just creating anxiety with things that may or may not happen, may or may not have happened.

It really makes us start to feel out of control. So the best way that we can. Really start to outline this. I figured we'd go through that generalized anxiety disorder criterion. And what that means is when I look at the diagnosis of generalized anxiety disorder, which is that overarching general branch of anxiety, we're going to look at what exactly does the  DSM five, the diagnostic and statistical manual of mental disorders, which is what.

I would use for diagnosing generalized anxiety. And we are going to look at exactly what does that say in order for me to diagnose it. Number one, you're going to have excessive worry or apprehensive expectation more days than not for at least six months about a number of events. or activities. In other words, it's not just on one topic.

You are worrying about your kid's health, your home, your business, your friends, your everything. All of this is kind of bouncing around more than one topic. Number two, we're looking at the individual finding it hard to control the worry. So the individual might not like worrying, but it almost feels somewhat intrusive or hard to control.

Number three, We're looking for, from this list, at least three items. The list we're about to go through must be present for more days than not in the last six months. So you don't have to have all of these and what I'm about to list, but you have to have at least three in the six months. So you're going to feel restless or keyed up or on edge.

So that's one, one line  being easily fatigued,  difficulty concentrating. Or feeling like your mind is going blank,  feeling increased irritability,  feeling muscle tension,  and having sleep disturbances, meaning you either find it difficult to fall asleep or stay asleep, or maybe you have issues with either restless or unsatisfying sleep.

As we move forward, the anxiety or worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of function. So you might find it really difficult to go hang out with your friends or show up for work in a way that feels personal. Like you're 100 percent there, or maybe it's impacting your romantic relationship, your marriage, your partnership, whatever that is, it is impacting in some way, shape or form.

It's impacting your life negatively. And this is where we really have to. Use your lens of, of experience because not everybody's going to understand that this feels extremely limiting to you in all areas of your life, because what I have found is that sometimes people who are very anxious tend to internalize it because they may.

Get a little overwhelmed by the fact that other people may notice or feel overwhelmed by the fact that some people may actually judge them for it. The next criteria is you cannot be diagnosed with generalized anxiety if your anxiety is being caused by either another medical condition like hyperthyroidism.

Or maybe it's from a different drug or like it's a side effect of a drug that you just started taking or medication you just started taking. So just kind of being aware of that, if your generalized anxiety starts to kind of creep up in response to medication, you do not meet the criteria for generalized anxiety disorder.

You would actually look at that being a side effect of your, of course, medication. And the last one is that your. Generalized anxiety disorder, your GAD, is not better explained by something like obsessive compulsive disorder, OCD, social anxiety, panic disorder, separation anxiety, body dysmorphia, or delusional disorder.

These are all different disorders that include high levels of anxiety. So for OCD, We're going to find those obsessions paired with compulsions, those behaviors that are trying to take care of the obsessions, social anxiety, we are going to see a lot of fear around, of course, social interaction. Panic disorder would be intense somatic symptoms or symptoms in your body.

Separation anxiety. You can even have separation anxiety as an adult. Actually, a lot of people don't know that. We always chalk it up to. It being something for kiddos, but separation anxiety is when you experience that intense anxiety in response to the absence of a loved one or a caregiver. And you kind of fear something bad is going to happen in the absence of that person.

And then of course, body dysmorphia is when we hyper fixate or we ruminate with anxiety That our bodies in some way, shape, or form are unacceptable. And of course, delusional disorder, there was a bunch of different types of delusions within delusional disorder. Like we have erotomania where you believe that somebody's obsessed or in love with you.

We have jealous type delusions. We have all sorts of different types of delusions, but the generalized anxiety is not better explained by one of those other disorders.  So in order to recap this, I want you to notice the difference between adaptive anxiety  and maladaptive anxiety. Maladaptive anxiety or clinically significant anxiety, you're going to have periods of anxiety that definitely last longer.

You're going to feel more fixated on these problems. There's going to be a greater intensity, or distress when you're feeling this anxiety and the common things that might happen in your body when we're starting to see generalized anxiety showing up, your legs might feel a little shaky, you might feel a bit wobbly, you might feel fatigued, sleep issues accompany anxiety, your mind might go blank like we said.

This is a common one, IBS, so digestive issues or maybe even diarrhea sometimes accompany those who are feeling clinically significant distress and also will see headaches. So that's definitely something that's notable. I will put in the show notes or the description box a GAD screener, Generalized Anxiety Disorder Screener from the DSM 5 so that you can check out.

If you have generalized anxiety or if you're thinking you might check out the website, the art of flourishing. co and that again will be in the show notes. The other resource that I'll be sharing with you guys to kind of help you sort out, is this generalized anxiety or is this just normal healthy anxiety?

Is the Beck's anxiety? Inventory. It's called the BAI and that is a standard anxiety inventory that we will take during session. Sometimes it's a 21 symptom screener to see how you're feeling in terms of the body presentation of anxieties. And I'll share a little bit more about these assessments when we go through our resource section.

But I just wanted to introduce these resources to you as we have that conversation about maladaptive anxiety. Okay, so I gave you an example of healthy anxiety and how somebody that's healthy as they look at anxiety would bounce through a budgeting issue if they were in college. So let's take that same college student issue.

And look at how would somebody that has maladaptive anxiety handle that same problem. So we said there's a college student that's about to run out of money. Of course, that creates some anxiety, worry about the future, and then they try to budget. And when they're trying to budget or solve this problem, just like anybody else would, their brain starts to go into what we call catastrophizing.

And catastrophizing is where you take something little and you make it into a catastrophe. Just like it sounds. So we play what I call the what if game. What if I got into a car accident? If this college student is receiving support from their parents, what if something happens to my parent, then how am I going to plan for that?

And so we talked about with maladaptive or not helpful anxiety that starts to play with us. And so that's an example of a college student who's just trying to simply create a budget. But when they go to create that budget, they start playing that game of what if and catastrophizing. So. It, it just gets really overwhelming really, really quickly for somebody who has generalized anxiety because it just starts to consume us.

And so I want to definitely take a look at some of these risk factors, what puts us at risk for that clinically significant diagnosable anxiety. But this wouldn't be a podcast unless we had a sponsor. And we do! Can you believe it? Second episode. We have a sponsor. So let's take a little break for our mid roll sponsorship. 

Today's show is brought to you by Audible. Audible has an incredible content library, including some amazing content on the topic of anxiety. Two titles we suggest you check out on the topic is number one, Retrain Your Brain, A Cognitive Behavioral Therapy Approach in Seven Weeks, A Workbook for Managing Depression and Anxiety by Seth Gillihan,  and number two, The 10 Best Ever Anxiety Management Techniques, Understanding How Your Brain Makes You Anxious and What You Can Do to Change It by Margaret Werenberg. 

Audible is offering our listeners a free audio book with a 30 day trial membership. Just go to  audibletrial. com forward slash the art of flourishing. Download a title free and start listening. It's that easy. Go to audibletrial. com forward slash the art of flourishing. 

Alright, well let's hop into those risk factors like we said we would. These statistics that we're about to talk about and some of the risk factors are actually taken from the DSM 5 TR. I will give you a link to actually purchase this book. It's available through Amazon. Of course that link is going to be listed again in the show notes.

Please be sure to take a Note of that, if you'd like to check out this book. So a lot of these statistics, of course, are going to be U. S. based populations because the DSM 5 is, of course, a U. S. based book. But these are some of the things that the DSM 5 actually lists under the generalized anxiety diagnosis as some of the risk factors.

Women are actually two times more likely than men. To have generalized anxiety disorders. So if you're a woman, listen, ladies, the worry is real.  Statistically, it is real. So the average age in North America is 35. So that's the average age of the onset of generalized anxiety disorders. Can you believe that?

It's a bit later than some of the other anxiety disorders, but it's notable because if we live so much of our life without generalized anxiety, it's hard to believe that in our thirties or around that time that we could actually develop generalized anxiety. Yeah, the average age in North America is 35 years old.

I can't believe it kind of interesting rates of full remission are actually low. And what this means is that throughout your life, if you are diagnosed with generalized anxiety disorder, it's more likely to wax and wane throughout the lifespan. This was interesting. There are lower income countries that are actually more likely to have persistent rates of anxiety, which makes sense, of course, because the lower income would create.

More persistent worry about the future which may or may not be adaptive, but according to the diagnosis here Lower income countries are more likely to have persistent rates of anxiety.  Higher income Countries will tend to have impairment that tends to be seen at a higher rate  So even though it might not be as persistent, we see a higher level of impairment so that occupational, relational, social, or other areas of function.

Remember, we talked about that being part of the criteria. Well, actually, in higher, higher levels of affluence, we might have higher rates of, uh,  Impairment. I thought that was interesting.  As we look at genetics, a third of the risk is chalked up to genetics. So about 30 percent of that, 33. 333 percent if you want to be  a little bit more accurate, um, but about 30 percent more or less is heritable.

So I think this is the perfect time to mention something called epigenetics.  So epigenetics means it is a genetic Expression based on environmental factors. And when we look at epigenetics, it's not nature or nurture. It's nature and nurture. So this is both internal factors and external factors. So I thought that was very notable.

Another thing that the DSM  five covers is commonly co occurring or happening at the same time diagnoses.  So. Um, oftentimes those who have depression,  have insomnia, have ADHD or phobias can commonly co occur and one that's a little bit tricky that you can have at the same time as generalized anxiety. is OCD.

So generalized anxiety can be separate than OCD, but you have to be able to meet the criteria for both. And again, that's when a clinician  will be able to walk you through that. Because remember part of the criteria to be diagnosed with generalized anxiety disorder would be that you're not The generalized anxiety is not better explained by OCD, but you can have both at the same time. 

Okay. So I think that takes care of our risk factors, which means guys, we are onto some of the solutions. Yay.  Let's talk about what we can do to help your brain get better. After that. We'll go to resources. And again, remember you can always hop in and out of certain sections through the show notes, through that description box, let's hop in to solutions. 

Okay. So some of the solutions that we're going to talk about would include medications. And that's the first thing that we're going to go through. I am not a prescribing psychiatrist,  you and your medical provider need to go through a tailored treatment plan for you. But here are some common things that I would hear in sessions and or things that you could talk about with your providers.

The first thing that I want to mention is a class of drugs called SSRIs, which stands for a Selective Serotonin Reuptake Inhibitor. This is a class of drugs called SSRIs, which stands for a Selective Serotonin Reuptake Inhibitor. SSRIs actually work by stopping nerve cells in the brain from reabsorbing serotonin, which is a chemical that plays a vital role in both mood regulation and giving us that mood stability.

So serotonin is both actually a neurotransmitter, meaning it's a connector in the brain, but it also acts as a hormone. So in some of the literature you might hear serotonin is a hormone and some of the literature you might hear that. Serotonin is a neurotransmitter. I'm here to confirm it is both. And these medications, you typically will start to see some progress within two to six weeks, they may or may not work for everybody, but normally you have to take some time trying this out.

Um, people usually take SSRIs for around six to 12 months to treat anxiety and then gradually reduce the dosage. But of course, because you may have those. GAD issues that are waxing and waning throughout your lifespan, you may or may not need this medication throughout your life. So something that's important to note is that these drugs are actually not habit forming.

You can't get addicted to SSRIs, but we do normally need to kind of wean you off because of course it is affecting the reabsorption of serotonin. We want to wean you on, we want to wean you off. So don't just. Drop off or immediately increase your SSRI dosage. Some common names for this medication  is escitalopram,  which is also called Lexapro.

Citalopram, which is also called Celexa. Prozac, which is also known generic as fluoxetine, and Sertraline, which is also known as Zoloft. There are more SSRIs, but those are some of the more common ones. The other class of drugs I do want to tell you about that are commonly prescribed are benzodiazepines.

Now these actually are highly Addictive, and how they work is by calming our central nervous system, and it's considered as a depressant to calm our nervous system, so a lot of times people will take Xanax, that is a benzodiazepine, Klonopin, or Valium, those are all forms of benzodiazepines, they are highly addictive, but at the same time, They are effective in calming that panic for short periods of time.

They're less than ideal, but they are common. So just know that benzodiazepines are definitely an option, but just use those with some wisdom and of course not mixing that with alcohol. That's another important thing, but benzodiazepines, that is a whole class of drugs that are helpful because they actually slow down the nervous system and SSRIs actually help us to feel more stable.

At a lower level, but over a longer period of time, benzodiazepines kind of go in there and put the brakes on everything, so they really do each have their function.  Other forms of drugs that you can take would be serotonin norepinephrine reuptake inhibitors, SNRIs. The other class would be tricyclic antidepressants, TCAs. 

Another class would be norepinephrine and dopamine reuptake inhibitors, also known as  NDRIs. And the last one is beta blockers. So today we went through two classes of drugs that are actually helpful, that I see commonly coming through my door. But just remember, there are a number of other types of medications that are extremely helpful.

And there are a lot of other types of drugs that are off label usage for anxiety. But again, I just went through SSRIs and benzodiazepines for our purposes. The next thing we're going through is Cognitive Behavioral Therapy. It's a very logical approach, it is a way that we look at both the cognition, which is the thoughts, and we look at the behaviors.

And with CBT, the thing is that we look at how thoughts influence feelings and feelings influence behaviors. So a CBT therapist, Cognitive Behavioral Therapy therapist, CBT therapist, would be so helpful in helping you identify those behaviors. The connection between all of those, and there is a whole system with CBT that you can take.

Remember, we mentioned through the Audible partnership that there is an Audible book that offers a seven week at home program. Through that book, retrain your brain cognitive behavioral therapy in seven weeks, a workbook for managing depression and anxiety by Seth Gillihan. So if you are interested in that, remember audibletrial.

com forward slash the art of flourishing to check out that book, which is extremely and supremely helpful for you to do some CBT. Techniques at home. So the second form of therapy that can be supremely helpful is trauma resolution. What we see is that trauma inherently impacts the nervous system. How it can help you is that it can help your mind release what is keying up your nervous system.

So trauma resolution can actually help down regulate that nervous system that is actually, uh, Really triggering, remember epigenetics, it's triggering that predisposition for you to experience anxiety and meditation. You know, this sounds like a woo woo conversation, but meditation is so helpful. The reason is because it calms your mind.

It actually helps retrain your neurons to fire correctly. We are all about bringing you back to a nervous system that can regulate and can feel. Calm, because what happens is our brain starts to kind of panic or catastrophize. Remember, we talked about that word earlier. So we are teaching your brain to actually calm down.

A lot of times within the category of meditation, guided imagery, which is A script where somebody walks you through images to induce feelings of calm in a way that helps you focus on calm, kind of like relaxing pictures, like being on the beach and things that would be like a guided imagery. And then the second thing is affirmations.

So affirmations are statements that are designed to counter that negative thinking, somewhat similar to CBT in a way, because we're trying to retrain the thought, to retrain the feeling and the behavior, but it is definitely different than CBT. So affirmations are just a way that you kind of feed your brain something else to chew on, to again, to, Change feeling and then eventually change behavior, but that's affirmations.

I will put a link to one of the companies I like. I think it recently just changed owners, but it's called health journeys. And I will put a link in the show notes to my favorite guided imagery and affirmation programs and, uh, bell, Ruth knapper stack. She is a boss babe with guided imagery and affirmations.

I love her. I love her so much. So I wanted also to remind you, anxiety is meditation gone wrong. You are literally spending a good amount of time focusing on what is going wrong or what could go wrong. That's a form of meditation, bibs. That's meditation. So, anxiety actually is a form of meditation. With meditations to heal anxiety, we're actually just trying to induce feelings of calm on purpose.

So, that is where meditation fits in, into the solution category. The last thing that we will talk about in terms of solutions for anxiety is actually exercise. Of course, speak with your medical provider, but exercise may improve our brain's ability to cope better with stress. And it also releases endorphins that help our brain just generally feel more positive.

And that will take our brain's ability to focus on things that are going right. And it will kind of boost that ability. So endorphins are awesome. We have some really great blood flow in the brain. Sometimes when we feel keyed up about something, we have that fight or flight response. And exercising can help release that from our body and can help our brain and body to feel more calm in the face of stressors.

So that is the list of solutions. There are a number of different things that you can do, both medication and non non medication solutions. But I definitely want to empower you to take your healing into your hands.  And really start to sort through how can you heal from some of your anxiety. Some of our favorite resources for anxiety would include the GAD 7, which is the Generalized Anxiety  Disorder Screener that has seven questions from the DSM 5 that is in the show notes.

The Beck's Anxiety Inventory, which is the 21 question survey that you will answer and it will give you a score of, um, just normal or minimal anxiety all the way to severe anxiety. So that is again, 21 questions, Beck's Anxiety Inventory, a huge industry standard. I will share with you Health Journeys, which is a website. 

That has a number of my favorite resources for guided imagery and affirmations to kind of help with that Relaxation  and I will also put a link into the Beck Institutes website. So Aaron Beck was basically the guy who created CBT he is credited for that and so the Beck's anxiety inventory comes from Erin, Beck, and I will put the Beck Institute's website on there.

So the Beck Institute will give not only professionals resources and training for CBT, but it will also give individuals who are struggling with anxiety. information on the clinical services and information about CBT. And I think that'll be supremely helpful. I will put a number of different book suggestions in our show notes, including the book by any books by Margaret Werenberg, which I've mentioned one of them through our audible and a couple other ones by Margaret Werenberg will be in the show notes, a website called the.

A D a a. org. It stands for the Anxiety and Depression Association of America. Again, you'll find helpful articles and different resources for anxiety and depression on there, and I will put in our Audible. Links and Amazon affiliate links for all of the resources for the books that we mentioned today. 

Well, I'm so grateful for the opportunity to walk you through answering some of your questions that you might've had about anxiety today. We really did talk through what is the normal healthy function of anxiety and what is that clinical or diagnosable anxiety. And honestly, it is my hope that today you feel both empowered and encouraged and identifying and targeting.

Some of your anxiety and you have the ability to take your mental and emotional health into your control. Hopefully today you feel more equipped and empowered to do just that.  Just remember if you found this information helpful today, I encourage you to share it with someone who you genuinely think could benefit.

If you haven't already subscribed to our podcast, we invite you to subscribe now and to join us on your favorite podcasting platform every two weeks. Also, if you have not yet given us a review, please give us a review. That definitely helps us. And makes this content more credible because we have listeners that are vouching for it.

So if you have found this content helpful, be sure to give us a review because this information can help other people work towards healing. Well, thanks for listening. And as always, happy healing. 

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