S1E8: Anxiety Breakdown 1: Friend or Foe?

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Transcript S1E8

This is It’s like this podcast with your host Dr. Uejin Kim. They dual board-certified child, adolescent and adult psychiatrists. If you want more understanding and control over mental decisions and options in your life, this podcast might be for you. By providing fun analogies, real stories, and empowering messages, I want you to have the tools to live your best life and thrive.

In this episode, we're going to be talking about anxiety. This is something that I personally struggle with all the freakin time. One time, I tried to bring my family on a camping trip. It was my husband's first camping trip ever. So we got there a little bit later than I expected. And I was frantically trying to start the campfire and get this campsite set up before the sundown. And I know that I had two young kids and I knew that it was gonna be a nightmare. My husband, seeing me struggle with so much anxiety in my freak-out mode, he stopped me to remind me that this is our first camping trip as a family and to try to just enjoy each moment. And that's what anxiety does. It always leaves us living in the future and prevents us from being present with our loved ones. And I know that process of anxiety is draining not only for the person affected but for everybody around you. So I'm here sharing this mental health burden and conviction with you. You know, whenever the pastor says at a church that this particular sermon was, you know, especially very close to his or her heart. This topic of anxiety is very close to my heart. I struggle with perfectionism and what-ifs and preparing for the worst-case scenario. You know, in one aspect, this kind of mindset got me far in life. But very quickly, it got control of me and I lost control over my life until I started my own mental health journey. And I just want this podcast to make you understand that you're not alone. You and I are doing this together. And the whole point, you know, going back to previous episodes, is the control. So that you can use aspects of anxiety that are healthy and helpful. And you can lose the aspect of anxiety that's crippling and draining. So we're going to be looking at anxiety as a process like a four-step process and how it starts to grow. And I'm going to be using some analogies throughout the episode. My purpose for this episode is so that we don't think of anxiety as dislike untouchable problem, but to understand it and to actually know that there is some good you know, beneficial aspects of anxiety and what is not so beneficial. 

Anxiety is not a new modern or millennial concept. It actually dates back to even 460 BCE, in a collection of green metal Greek medical texts called Hippocratic corpus. And in this text, they were talking about making Icanor's phobia. He had a phobia of a flute girl at a drinking party. And there was a pattern that he would freak out, and he would have a sense of terror whenever he heard the flute. And it only happened at night and not during the daytime and the symptoms persist over a very long period of time. So this is a historical text saying that anxiety and phobia were a medical disorders. You know, nowadays I hear anxiety be used in an accurate way or sometimes in an inaccurate way to describe how they're feeling. So my hope is that we can kind of clarify our understanding of anxiety and how it progresses in our life. 

I like to kind of break down the steps of how anxiety manifests into four steps. Number one is a trigger. Number two is the threshold number three is the response. And then before is compensatory behavior. So number one, the first element of anxiety is the trigger. And most of the time, these are sensual triggers as having five senses, you know, seeing smells, hearing, and touch and taste. Or sometimes it could be your memories that could be functioning as a trigger. And the part of the brain that collects all the senses is called the thalamus, and Thalamus collects central evidence of a threat and starts to process it and understand what this new evidence means for us. So for example, let's say that you're walking into the woods, and you hear the rustling of the leaves. And you see the two ears poking out of the bushes. And you also see that they're hairy, and they're brown, you start to smell an animal nearby, and you wait and see, and you see that it is a brown bear in the forest. Now, the thalamus is going to collect, you know, what you saw what you smelled, and what you heard, into a complete assessment of a threat. Now, the second element of anxiety is the threshold. Now the threshold is different for everyone. And also threshold can change over time for individuals. Now, what do we mean by threshold? So imagine if you're driving for the first time, right, and you never held a wheel before, when you get into that car and you start the engine, your threshold, for any sense of threat is so low, as of any car on the street, any car, even if it's two miles away, sets off that anxiety, because your threshold for a sense of threat is very low, right, and you get anxious easily, you get nervous easily, you're spastic, you, you know, stop and go stop and go. So your threshold of anxiety or sense of threat is very low, when you first start stress, start driving. Now, as you get experienced, you know, you could be very close to the next car, but it doesn't set off, you know, the anxiety response. So at this point would experience or threshold for a sense of threat is very high. So I want you to kind of take-home, that threshold is different for everyone. And that threshold can change over time, especially by experience or exposure. So now we're walking in the woods, we see and heard and smelled the bear. And if you're a zoologist and you know how to handle bears in their natural habitat, you might not feel as threatened as a person who has never seen a live animal that's bigger than a puppy. So depending on the threshold, let's say that at this point, if I was walking in the woods, and I saw a brown bear, I'll be pretty freaked out right? And assess the third element of anxiety, which is called response. Now, when I say response, I'm talking about a natural response called fight or flight response. Now, remember, the thalamus collected all the senses to have a complete assessment of the sense of threat, and it passed the threshold. And now you're going to respond. The thalamus is sending off signals to the hypothalamus and eventually adrenal glands to make your body respond to the threat. Now, some other ways that this change is, is your heart starts to pump faster, your lung starts to expand, your muscles are gearing up and the blood supply, which is a source of resource for different organs start to rearrange itself. So that the blood is going towards essential organs to survive like the heart, and lungs; blood supply is going to draw the resource away from nonessential organs such as like stomach, you know, liver, and your intestines. This is also true for people who got in a car accident or very traumatic event, your fight or flight response is going to be able to help you have that adrenaline running so that you can get out of the burning car or burning house. Now it leads to the fourth element of anxiety and I labeled this compensatory behavior. So if you can imagine running away from a bear is not a walk in the park. It's not a picnic. And if you can imagine, you know traumatic events like car accidents or house fire, or even social traumatic events like getting bullied or getting yelled at by your boss is never fun. So because it wasn't fun, and it was actually pretty dangerous, our minds and body tried to preserve our life and prevent unnecessary chaos. So the first example is hypervigilance. Let's say that you got yelled at by your boss because you didn't do the Excel sheet for this year's finances just right, you're going to be always looking out for possible reasons why your boss will yell at you again, then you start to think you know, is you are your co-workers, you know, talking about you, are they reporting to your boss, you're always going to be on the lookout for possible, another episode of your boss yelling at you. The second example could be avoidance, you're avoiding anything that will resemble a trigger or situation like the past. So you might quit your job, you might stop showing up for work, and you might start to actually get sick. Or you might avoid dating a person who resembles your boss who yelled at you. The third example is mind racing, you could be thinking about all these reasons why your boss could be yelling at you in the future. Or you could be thinking about who's closest to the boss? And who do I need to avoid? What are the worst-case scenarios? You know, can I get fired? Or can I get put on leave, you know, this example of mind racing. And the fourth example is hyper arousal, we're always on edge to be prepared for any future traumatic episode. So for example, if somebody is saying hi to you at work, you might be very irritable. And you might be really grouchy because you don't know who to trust. And you might see every colleague as your enemy because they might be on the boss's side and not your side. So you're always on edge and ready to attack or defend yourself. So these are compensatory behavior, dad gives us a sense of control by trying to mitigate or minimize the risk of running into another traumatic event. So I like to kind of just stop and remind you that these are the four elements, four steps, and anxiety and how it manifests in our lives. But I also just wanted to bring back the point that the point of anxiety and an even in this process of compensatory behaviors, is natural, and needed for us to survive. It is not bad in itself. And we need to appreciate the intended function of anxiety and fear in our lives. I think one of my friends said that picky eaters have an evolutionary benefit because they don't eat anything, you know, that was given. And this is kind of true here, people with anxiety have this mechanism built-in, in that helps them survive. And so there is an evolutionary benefit to anxiety. And also because we are relational people, sometimes the anxiety, you know, a mechanism that we have not only helps us to survive but people around us. So for example, people with anxiety, you know, like to have very secure retirement funds, and who benefits from the retirement funds, probably their spouse and their kids and next generations to come. So sometimes anxiety is very beneficial to people who have anxiety and the people around them. But there's a difference between anxiety and anxiety disorder. And here, we have to kind of step back and look at the pattern of how anxiety is taking over someone's life and their family's life. And how it is affecting their level of function in different areas of life. So we have to look at the pattern and the severity of anxieties present in somebody's life. And there is a criterion for anxiety disorder. So for example, that person with a good retirement fund, if they’re obsessed about, you know, having more and more money in their retirement fund, as a security blanket and as taking over, you know, their mind space all they talk about is affecting their marriage, their role as a parent, their job that is kind of catering towards meeting the criteria for anxiety disorder. So it's not the fact that anxiety itself is bad, but how much anxiety is controlling your life. Now, I just like to pause here. Now if you're a person with anxiety like me, you might have a sense of feeling hopeless or maybe feeling alone. Maybe I'm a freak, you know, like, oh, how, how can I let myself let this problem go? And I want to kind of describe the patients with anxiety issues, just to let you know that you're definitely not alone. Okay? So patients that I see, including myself with anxiety problems often feel alone in their endeavor to be prepared or to protect themselves and their loved ones from future inconveniences and pain. They feel very tired and drained from what their mind and body tells them to do. day to day, you know, to-do list to be prepared list never ends, anxiety often steals their moments of peace and joy and mindfulness, not only from themselves but others. And patients with anxiety problems often feel tricked, or surprised by new threats and new pain, and new inconveniences. You know, they spend so much time thinking of all the possibilities, what-ifs, and all the worst-case scenarios. And when life just happens again and throws another lemon, they feel so surprised, and it spirals down to another anxiety attack. And patients with anxiety problems often feel hopeless, because they can't do everything, or be everything for themselves and others. And patients with anxiety problems often live in the future, not in the present. So I just want you to know that I'm able to see these patterns and how anxiety affects people, not only because I have issues with it, too, but I've seen plenty of people who share that they don't want to be this way. And I know you don't. And I know that this is why you're listening to this podcast, I just want to make you aware, that if there's any hesitancy in getting help, anxiety not only affects you but those around you. So in summary is like this. Anxiety is not a millennial or modern concept that just, you know exploded in the name of the pandemic. It's been here for ages 1000s of years, and it has a beneficial component to it. anxiety and fear help us survive. And I explain that there are four steps or four components of anxiety and how it grows. And first was the trigger.  The second was the threshold. The third was the response, the fight or flight response. And the fourth was compensatory behavior. And there are ways to differentiate when anxiety and fear become an anxiety disorder, a clinical diagnosis. In the next episode, I'm going to be breaking this apart, and further, explore how anxiety becomes an anxiety disorder. So there are two components out of the four that are most problematic and most dynamic ones. And then we're going to be asking you some good questions to start your journey, gaining control over your anxiety. So I hope you join us for the next episode. And thank you so much for being here. Thank you for allowing me to share my mental health journey and struggling with anxiety and I'll see you again next time.