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Taming Anxiety
Episode 1416th May 2022 • Stress-Less Physician • Sara Dill
00:00:00 00:26:50

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Occasional anxiety (not clinical anxiety) is a normal part of life. All those “What ifs?” creep into our brains and send us into a place of worry, fear and uncertainty. But what if anxiety didn’t have to result in feeling out of control of your life? What if it no longer caused you to miss out on things in the present? What if you could actually learn to tame anxiety and reduce it?

I know it may be hard to believe but taming anxiety is possible. I won’t say easy, but possible. In this episode, I offer some ideas for how to hold out anxiety and observe it for what it is, and then reframe it. As you listen, I especially want to emphasize this: anxiety is often problem solving, just without the actual solving part. The good news is, you can do something about it.

“As soon as you recognize you’re feeling anxious, that’s really the first step... It sounds simple but yet it’s really incredibly powerful when you can recognize it and name it… As soon as you start to be the observer of what you’re feeling, you step out of the feeling a little.... You detach a little bit from it… It actually almost immediately makes me feel better.”  – Dr. Sara Dill

What You’ll Learn

  • Anxiety is inevitable but not an identity
  • Emotions technically can’t hurt us
  • 4 ways we deal with feelings
  • 5 ways to actively accept anxiety
  • Thought starters for taming anxiety

Contact Info and Recommended Resources

Connect with Sara Dill, MD, The Doctor’s Coach

Is there a topic you’d like me to talk about on a future podcast? Email me or reach out on social media. All my contact details are below. I’d love to hear from you!

Transcripts

I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, episode number 14. Welcome to the Stress-Less Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feel good to you, you are in the right place.

Hey, everyone, welcome back to the podcast. I am happy to be here. Today, I really wanted to talk about anxiety, and how to tame anxiety, how to deal with anxiety, how to really sort of hopefully reduce anxiety. And so this is something that’s interesting. If you had asked me maybe 10 or 15 years ago whether I was someone who was sort of considered an anxious person, I don’t think I would have said I was. And I think what was really happening is that I wasn’t even aware of how pervasive my feeling of anxiety and my tendency to worry, or I just sort of thought that was the normal situation, the normal, sort of like the water that you swim in, right? You didn’t even notice it.

And so as I got into self-development, and coaching, mindfulness, meditation, all of this that really builds awareness, I became aware of how anxious I was, and how much I worried. So initially, I almost felt worse before I felt better, which is not uncommon, sort of like we become aware of how terrible we’re feeling all the time. And from there, we can actually start to work on it. So I also just want to say that I wouldn’t now call myself an anxious person, or a worrier. And if I had a coaching client, who called themselves that, I would probably gently suggest that that’s a terrible way to label ourselves. It suggests that it’s an identity or a part of identity that is sort of fixed.

So instead, I like to maybe point out that I’m someone who is a human being. And as a human being, I feel anxious sometimes. I have feelings and sensations coming from my thoughts that generate some anxiety. I have thoughts that produce worries. Not that I am a warrior, right? I’m someone who sometimes worries, just like everyone else. So just notice if you sort of label yourself as someone who is anxious, someone who is a worrier, and whether you want to loosen a little bit of that identification with having anxiety and maybe worrying at times. Can you not make it part of who you are? That’s a lot of the goals of what we do is to notice how a lot of our personality, I think, is a little more fluid, especially when we don’t hang on to those aspects of our habitual ways of thinking and feeling. But maybe we are open to not clinging to those parts of ourselves. It doesn’t mean that they’re wrong, but maybe just don’t cling quite so much.

So today, I want to talk about how to tame anxiety, how to deal with it. But when I say tame it, I don’t want you to misunderstand that, you just deal with it one time, or maybe two times, and then you never have to deal with anxiety again. If that happens, please let me know, but it has not been the case for me. So, what taming anxiety to me means is that we sort of redefine our relationship with it and make it so that it actually doesn’t feel so terrible. And from that standpoint, we often can start to experience it a little bit less frequently. And that’s really my goal, is to sort of dampen the tenor of it, make it not so intense, and then really sort of extinguish it over time. So that it maybe becomes less common, less pervasive, less intense, and we have a little bit more sense of control over it, and around it.

So, anxiety is often the resulting in anticipation of an event or possible event. If you think about it, our brain often keeps asking “what if” questions too many times, and then it keeps coming up with a lot of answers that you and your brain don’t really like. And since we don’t know the future, we can’t really problem solve efficiently. And a lot of the times, these aren’t even really problems; they’re just hypotheticals, it’s like catastrophizing over and over again. So, anxiety is often the result of sort of trying to problem solve, but without really the solving part. Sometimes I like to notice that.

And then you can notice when you’re feeling anxious and worried that you’re typically sort of lost in your thoughts, mostly negative ones, and then missing out on your life right now. You’re missing out on the present moment, you’re missing out on what is actually happening, or not happening right now. And that’s why feeling anxious can be such a problem. Not only does it feel terrible, but it also creates this sort of fake reality in which we’re stuck in our minds, right, we’re often spinning, and then we’re missing out on our real life, which is happening right now.

So, I just want to start by saying, I think anxiety is a normal part of being alive, it’s a normal part of the human brain. The way I like to think about it, is that it makes sense from an evolutionary standpoint that we evolved to have some anxiety, that we think about problems, or we’re looking for problems. I’ve already talked about the negativity bias of our brain. But I also like to think about the fact that most likely, one of the reasons that I’m here alive today is that my ancestors were probably anxious and hyper vigilant, and looking for danger. And that makes sense in a world in which there is a lot more danger, or a world in which there was a lot more danger. For most of us, though, the amount of anxiety and what we’re anxious about doesn’t necessarily contribute either to our survival, and certainly doesn’t contribute to feeling happy, feeling content, enjoying our day, and actually enjoying our life as it is unfolding now.

So, I always like to start with what is anxiety. And so, anxiety is a feeling or an emotion. And the way I would describe it is sort of a feeling of generalized worry, maybe a little fear, or nervousness, sort of like nervous apprehension. And I also have heard it described as a cover emotion, because it’s often very vague, and so sometimes it’s just on the surface. And then underneath might be other emotions like fear, dread, etc. And so, again, it’s often sort of vague and unspecific. And I think sometimes anxiety thrives on that, right? It’s sort of like under the radar. We just sort of feel this nervous, worry, fear, apprehension, whole conglomeration, and we label it anxiety.

The first thing I like to remind myself when I’m feeling anxious, is that emotions can’t hurt us. They just feel uncomfortable. They might feel terrible. Some emotions feel terrible, but they are harmless in the end, like literally harmless. There are sensations in my body, caused by what I’m thinking. Emotions are just indicators that something is going on in our brain. Sometimes I like to think about it as like the check engine light. It’s just a signal to check in with what’s going on, what’s happening.

And I’d just like to suggest, like, what if anxiety is really not the problem? What if it’s really our reaction to it? Either our resistance to it or dislike of it, our trying to escape it, making ourselves wrong for feeling it? What if it’s all of that, that really causes most of our suffering around it? So as soon as you recognize you’re feeling anxious, that’s really the first step, recognizing it and naming it, and that gives you so much power. It sounds simple, but yet it’s really incredibly powerful when you can recognize it and name it. And so there are four ways we can deal with the feeling. I talked about this earlier in the podcast. The ways we tend to deal with feelings are either resisting, reacting or avoiding. And then there’s a fourth way that we tend not to do, where you can accept and allow a feeling.

So, let’s talk about resisting it. So that tends to be where I would go to with anxiety. So, I wake up, maybe feel anxious, and I start to not want to feel anxious. I, like, “Why am I feeling anxious? This is so silly. I don’t want to feel anxious. I want to fall back asleep.” Whatever it is, we don’t like it, we tend to give it more power. It’s like trying to sort of push it away, make it disappear, make it go away. And what that does is it sort of just bounces back, it’s like a boomerang. The more you try to resist it, the stronger it’s going to come back again. It also makes it seem bigger, often. It’s like we’re giving all of those anxious thoughts more power, we’re giving the fact that we’re feeling anxious, or making it mean something even more. So, resisting it tends to be a very common way to respond to anxiety. And I would just notice, if that is how you tend to respond to it. And just get curious, just notice, oh, I’m resisting it. I’m wanting it to go away. I’m arguing with it, trying to push it away and making it a problem.

The second way we can deal with feeling anxious is to react to it. It’s sort of to buy into the thoughts creating our anxiety. It’s to start to make lists, maybe we stay up late, maybe we try to problem solve, maybe we run through all the different scenarios. We definitely sort of step into the fight, flight, freeze response, and we’re sort of acting it out. Maybe we are trying to get other people involved too. Maybe we’re like arguing with other people, whatever we’re doing, we’re reacting to it, we’re in it. You’re sort of in the anxiety storm, and taking it all seriously.

The third way we can deal with feeling anxious is to try to avoid it. Again, this is sort of like resisting it. But this is a little bit more of distracting ourselves. It’s like looking away from it. It’s like pretending it’s not there, trying not to think about it. Maybe you over eat or get a glass of wine or a drink. Maybe you try to read a book or get on Netflix or Facebook or something like that. All of those, right? There’s nothing wrong with any of those things. But you can notice, are you doing it in an effort to avoid looking or feeling anxious, to avoid looking at your anxiety, or feeling it? And is it helpful, because often, when we do that, it’s not really like it goes away, it just sort of hangs out and waits for us to be done with those things, and then it comes back again. So what I find is, it’s just not very effective.

Certainly, if you’re feeling very anxious, it can be very kind to yourself to do something that helps you feel less anxious. I’m going to talk about that a little bit later in the podcast. But you can just notice, when I go eat something when I’m feeling anxious, what is the result? Is it a result I like or not? Does it actually solve for the anxiety? Typically, the answer is no.

So, the fourth way we can respond to feeling anxious, is to actively accept it. And this sounds like a big ask. But I would really like to encourage you to practice this. And it is a very active thing. It’s not just accepting it, and surrendering, and throwing up your hands and saying, “Fine, you win, Anxiety.” It’s a very different kind of accepting it. And it’s really what I consider sort of a ninja move, in that, it actually almost immediately makes me feel better. So the way I would encourage you to sort of think about accepting it is to be like, “Oh, hey, I’m really anxious. This is what’s happening right now” It’s at least allowing for the fact that right now, this is what is happening; you’re having some anxiety, you’re having some thoughts that are creating anxious sensations in your body. So I practice opening to the anxiety, trying to relax into it, I think about leaning into it, getting curious about the flavor of the anxiety. Sometimes I have what I would describe as more free-floating anxiety, where I’m not even sure what’s causing it. Or maybe it’s just sort of a general sense of worry about the day or worry about the future, or just thinking about my to-do list, whatever it is, I just sort of notice, what kind of anxiety is this? What’s the flavor? Is it just sort of low-level buzzing anxiety? Or is it really sort of intense? Does it feel a lot more intense, bigger, sort of closer to me? Just start noticing my thoughts. I’m not trying to change my thinking right now. I’m not trying to judge my thoughts, or solve them or anything. I’m just noticing and allowing.

So, these are sort of the steps I go through with the accepting and allowing, and then working with my anxiety. So again, the first step I mentioned earlier is to recognize it, to become aware of what I’m feeling, “Oh, I’m feeling anxious.” You want to name it. As soon as you start to be the observer of what you’re feeling. You step out of the feeling a little right, you get some space, you sort of de-identify you detach a little bit from it. That’s why this act of acceptance is sort of like this ninja move, in that, it seems like by accepting it, I wouldn’t feel better, right? And the whole point is to not need to feel better, but it actually almost immediately makes me feel better.

Step two, after recognizing and naming it, is to just allow it to be there, allow it and accept it. Don’t try to resist it. Don’t act it out. Don’t push it away. Don’t distract. Sometimes I like to try welcoming it. I like to listen to this meditation on 10% Happier called Welcome to the Party. And the whole mantra is whatever you’re feeling, whatever you’re thinking, you just say welcome to the party. Welcome to the party, Anxiety. Sometimes I like it. Sometimes I don’t. So, you could try that on: welcome to the party. Everyone’s welcome. Everyone might leave eventually. It’s not a forever party.

Step three is, check in with your body. How do you know it’s anxiety? Where do you feel it? How would you describe it? Does it always feel the same? Does it feel the same today, right now, as it did earlier, or another time? Is it changing? How is it different? Are you starting to get to notice it how it typically shows up for you? Again, maybe the intensity of it? All of that, again, gets you into this observer mode, this watcher mode that gets you sort of out of it so that you’re not so attached to it.

Step four - I like to remind myself, it’s not a problem. It’s a feeling. I’m feeling anxious. Not that I am anxious. Just having some feelings and sensations in my body that I would call anxiety. It’s coming from my thoughts. This is very helpful for me to remind myself of. It’s not a problem. Remember, you are not your thoughts. Thinking is happening, feeling is happening. Just because you think something doesn’t make it true. Just because you think something doesn’t make it useful. You can just notice, oh, when I think these things, especially when I’m not even aware that I’m thinking them, it tends to make me feel anxious. Of course, it’s pretty normal.

And then the fifth step, and this is really useful, is to intentionally try to breathe into it. Breathe in your body. Notice how your breath is when you’re feeling anxious. A lot of us sort of forget to breathe, that we breathe very shallowly, maybe a little bit more rapidly. You think about it, we’re in sympathetic fight, flight, freeze. Some of us freeze, some of us fight, some of us want to flee. So intentionally, breathing in and out slowly, making your exhalation longer. Some people like to breathe in for a count of two or three and then pause for a count of one or two. And then exhale for a count of four, or five. So again, exhaling a little bit longer.

I like to relax my shoulders, physically relaxed them. Mostly I noticed, oh, I’m not breathing and my shoulders are up by my ears. Can I take a couple of deep breaths? Can I slowly exhale? Can I relax my head, my neck, my body? Relaxing and deep breathing will actually get us back into a parasympathetic tone. So you can just notice if it’s possible. If you’re really in the middle of an anxiety attack, it can be difficult, so you can just try. If not, just keep breathing, just keep noticing your breathing. But again, three long, slow breaths can reset you into parasympathetic. And you might notice that you immediately start feeling a little bit better. Often you want to get into your body. Your body is in the present moment, it’s not in the future in your head, right? It’s not in that sort of thought storm you’re having. So, I find checking in with your breathing, checking in with your shoulders, maybe looking around the room, noticing what’s actually happening, those can all be effective tools for when you are in the middle of feeling anxious.

And then often, what we want to do is solve for the anxiety-producing thoughts. We’re like, “Well, if I can just write down all my thoughts, and then problem solve, then I won’t feel anxious.” But that’s like buying into the narrative. It’s buying into the whole story that your brain is creating. The problem is really that our brain is just over producing somewhat crazy-making thoughts, right? It’s what-iffing and catastrophizing, it’s asking questions that we probably can’t find any good answers to. It’s just pretending to be useful.

So, the solution can be to write down all of your thoughts when you feel anxious. I would actually encourage you to do that. But then just notice them. So, when I’m really anxious, and I’m sort of feeling myself tempted to freak out, or try to distract, I do often like to sit down and write all my thoughts down—It’s what I call a thought download—and just get them out onto paper, see what’s going on in there. And so many times, what’s going on in my head isn’t logical or useful, or realistic. It can be sort of crazy and dramatic in there. It’s normal. That’s what our brains do. And then it becomes very clear why I’m feeling anxious. Then I can just tell myself, of course, I’m feeling anxious, look at what I’m thinking, it makes total sense.

And so sometimes I don’t even have to then work with those thoughts. Sometimes that’s all you need to do; you can see that you can drop the whole thing. Sometimes, though, it does help to work on the repetitive thoughts that create anxiety for you specifically. What are your top 10 anxiety-producing worries? Can you start to recognize them more quickly? Can you label them? Maybe it’s like work worries or worries about your children and their future? Can you start to practice disbelieving some of those repetitive thoughts? Just noticing that they’re thoughts, noticing that they’re optional, noticing that they might not be true or useful. The time to do thought work is not in the middle of an anxiety attack. You have to prep for it. You need to do work for it. When you aren’t feeling anxious, that’s the time to find some of the thoughts that you can grab on to that can help you to allow and accept and then switch out of fight, flight, freeze into a more chill state to feel more intentionally relaxed, more open.

So, some thoughts I like that I can turn to when I’m feeling anxious that start to sort of get me out of the sort of anxiety state are thoughts like this: I’m just feeling some anxiety. This is just an emotion. This is totally normal. This is uncomfortable, but it can’t hurt me. This is just an emotion that’s caused by my thinking right now. What if nothing has gone wrong? Aside from what I’m thinking and believing, am I okay right now? Worry just pretends to be useful. Worry is just a misuse of my imagination. Just think about all the things I’ve worried about that have never happened. What if everything is happening just as it should? Just because I think something doesn’t make a true. Welcome to the party. Emotions just come and go. Not a problem. I’m just experiencing a little stormy weather here. It’s all my anxiety, it’s not a problem. Those are some of the thoughts that helped me. You could find some of your own thoughts. I would encourage you to do so. But I just again want to reiterate, what if feeling anxious is normal? What if it had an evolutionary benefit? And what if we can just practice allowing and accepting?

And experiment with the breathing. The breathing is a game changer for me. It just helps me actually get out of the anxiety a little bit faster and gives me authority over it. It doesn’t mean I always love feeling anxious. But it doesn’t really scare me. It doesn’t really bother me. It doesn’t seem like it’s a big deal. It’s just an emotion that I feel sometimes coming from my thinking, and I know how to work on my thoughts. I’d love to help you work on yours. Love to help you if anxiety is something that you struggle with, so feel free to send me an email. I read all of my emails personally, www.saradill.com. Hope you have a wonderful week, and I will talk to you soon.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.

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