| April 12, 2018

Last updated: October 24, 2018

Podcast

Podcast #396: How to Deal With Anxiety

Recent surveys have shown that rates of anxiety are up, especially among young people. What’s going on? And if you’re someone of any age who struggles with anxiety, what can you do about it? Those are just a few of the questions I ask my guest today. His name is Kevin Ashworth and he’s the clinical director at the NW Anxiety Institute. Today on the show Kevin and I discuss the difference between regular worrying and anxiety disorders, the ill effects of anxiety, and its causes. Kevin then explains some of the different ways anxiety manifests itself in men and women and some of the theories out there as to why it’s has been on the uptick. We end our conversation with research-backed ways to get handle on your anxious feelings.

Show Highlights

  • What started Kevin’s interest in the area of anxiety?
  • How can anxiety be debilitating? 
  • What’s the first sign of anxiety?
  • The relationship between anxiety and self-medication
  • Are some people more prone to anxiety disorders?
  • Environmental components of anxiety 
  • Why anxiety disorders are on the rise among young people 
  • How are anxiety and depression related?
  • How anxiety manifests itself in men
  • The irrational fears that drive anxiety 
  • Coping with anxiety 
  • What is exposure therapy?
  • Focusing on what you can control
  • How to handle anxiety in your kids 

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Recorded with ClearCast.io.

Read the Transcript

Brett McKay: Welcome to another edition of the Art of Manliness Podcast. Recent surveys have shown that rates of anxiety are up, especially among young people. What’s going on, and if you’re someone of any age who struggles with anxiety, what can you do about it? Those are just a few of the questions I ask my guest today. His name is Kevin Ashworth, and he’s the clinical director at the Northwest Anxiety Institute.

Today on the show, Kevin and I discuss the difference between regular old worrying and anxiety disorders, the ill effect of anxiety, and its causes.  Kevin then explains some of the different ways anxiety manifests itself in men and women and some of the theories out there as to why it’s been on the uptake in recent years. We end our conversation with some research-backed ways to get a handle on your anxious feelings. After the show’s over, check out the show notes at AOM.is/anxiety.

And Kevin joins me now via Clearcast.io.

All right, Kevin Ashworth, welcome to the show.

Kevin Ashworth: Thank you very much. Happy to be here.

Brett McKay: So, you’re a psychologist. I read about you in the New York Times because you also are the director of the Northwest Anxiety Institute, and that’s based in Oregon, correct?

Kevin Ashworth: That’s right. We’re in Portland, Oregon. I’m actually a licensed professional counselor and the clinical director of Northwest Anxiety Institute.

Brett McKay: What got you into focusing on clients or patients or people, individuals, who have anxiety problems?

Kevin Ashworth: You know what? My interest in psychologist, I kind of got there by, I don’t want to say by mistake, but I initially started working with adjudicated youths, realizing I need graduate training.

Once I got into grad school, I met a professor that he really was an anxiety guru. He had published on anxiety and really taught me how to do exposure therapy which is the kind of work that I do. It’s a type of cognitive behavioral therapy, and since meeting him and reflecting on my own life, I realize that I was a much more anxious kid than I thought I was, and I really saw this passion of working with people that, one, you could actually help get better. Anxiety is very, very treatable, and do it with a type of therapy that is very hands on, very matter of fact, and I love the idea of helping people build tolerance to distress versus helping them just layer their life with extra coping skills which we already know how to do.

Brett McKay: So let’s talk about what is an anxiety disorder because I think all of us have experienced worry about some point.

Kevin Ashworth: Absolutely.

Brett McKay: When does worry transition to like, okay, this is actually an anxiety disorder?

Kevin Ashworth: Good question. We look at two things. We look at impairment and distress. You’re right. We all worry, and we should. If there’s anything that’s important in our lives, we have some interest or some investment in anything, whether that’s going on a date or having a job interview or passing a class or whatever it is, we should have some anticipatory concern that we’re going to do well, and that’s pretty standard.

It becomes problematic when that level of worry or that level of anxiety stops you from functioning, and that doesn’t mean complete functioning like you’re not going to work or anything like that, but you’re not enjoying work because you can’t focus on your daily tasks because you’re constantly living in the future. You’re anticipating every worse case scenario, or you’re having panic attacks where you start really questioning whether you should leave your house when, especially in this day and age, when you can order everything to your home, it becomes really easy to avoid.

The difference between angst and general concern and worry versus anxiety disorder is we’re looking at like pathological levels of distress and impairment.

Brett McKay: And can individuals be anxious about certain types of things but not others?

Kevin Ashworth: Oh absolutely. Yeah, I mean, one of the reasons I love doing this work is I work with really, really, intelligent, logical, high-functioning individuals that are anxious about the strangest things, and that’s partly why they’re so anxious is ’cause they’ve got such an awesome brain that allows them to think about stuff too much, and so I can be obsessed with this irrational fear of contracting AIDs, let’s say from walking down the street, or that I’m going to be judged at an interview for a podcast, and then have absolutely no concern about public speaking, or no concern about skydiving or any other kind of normal or abnormal or extreme life events or behavior, so anxious individual or a worrier do not necessarily worry about everything.

Brett McKay: Gotcha. And besides … Maybe you’ve talked about what constitutes anxiety disorder. Like, you worry to the point where it impairs you in some way. Besides the impairment where your work isn’t going great or whatever, how else can anxiety debilitate people?

Kevin Ashworth: The number one way that most people try and cope with their anxiety is through avoidance, and so this is probably the most clear sign that individuals are starting to suffer from anxiety. Ultimately, I ask people, “Are you making decisions throughout your day based on preference or fear?” And avoidance doesn’t have to be extreme avoidance. It’s really insidious. It could be the difference between sitting at a coffee shop facing the wall or not, and if you do that based on, “I don’t want people to notice me ’cause I’m sitting alone, and that makes me worried.” Now, you’re making a decision based on fear.

Or it could be the student that’s not going to school because they’re …. And avoidance shows us that they’re anxious, but we don’t know yet why. That could be because of the school, the grades, the academics. That could be because of the public speaking component. That could be ’cause of the social component, but avoidance is for sure the best way to identify anxiety in individuals.

Brett McKay: And do people with anxiety disorders also try to self medicate in detrimental ways?

Kevin Ashworth: Yeah, anxiety is a lot about just not wanting to feel bad, and so this comes back to that question about how do you make your decisions. I enjoy whiskey. I enjoy bourbon a lot, and there’s a big difference if I get off work and have a bourbon versus if I feel bad, I have a bourbon. Now, the difference is one’s developing a functional relationship, and so every time I have a drink, I feel less anxious. Now my brain is learning pretty quickly that that’s really helpful. And so whether it’s that or I smoke a joint, or I do any other kind of substance, my brain quickly learns that I actually feel less bad, and I don’t have to tolerate these worrisome thoughts or these awful physical symptoms, and so my goal is helping people enjoy whatever recreational substance you may enjoy. Of course, that’s not my role is to judge people on how they make decisions, but it’s more of what’s the relationship you have with that.

But we know pretty quickly that alcohol’s a depressant, so anxiety is about being too activated, so it helps. Marijuana, on the other hand, can make people actually more anxious ’cause you’re messing with your physiology in ways that you’re not quite sure how. Alcohol’s pretty consistent in how it does that.

Brett McKay: I’m curious … You mentioned depression. Research has shown there’s a genetic component to it. It’s something that’s inheritable, and you might a tendency or a temperament towards depression. Is it the same thing with anxiety? Are some people more prone to having anxiety disorders?

Kevin Ashworth: Yes. Absolutely, and again, it’s similar to depression in that we don’t exactly know why or how much, but we know there’s genetic loading. We know that anxious parents typically have some anxious children, and again, it’s hard to [inaudible 00:08:05] because they’ve kind of modeling anxious behaviors, but there is definitely more of a vulnerability to the reactivity of thinking too much and worrying too much and also being just sensitive to your physiological reactivity.

I’m pretty sensitive to my body. If my stomach hurts or my heart skips a beat, I’m aware of it, where my wife, for example, I think she just thinks less or cares less about those things because she’s just not wired that way, and so if I start behaving very differently because of my changes in my body or anxious thoughts, then I can quite quickly develop an anxiety issue.

Brett McKay: And besides that, you just mentioned that there could be an environmental component. So maybe you grew up around anxious parents, and you caught that vibe from them, and you learned how … That’s how you cope with life is just by worrying about it excessively.

Kevin Ashworth: Yeah, so the story I tell people is when I was in graduate school, I had never had a panic attack before, but I got stuck in an elevator, and I never thought I was claustrophobic or particularly an anxious individual, so this is an environmental stimulus. I got stuck in an elevator, and my body just said, “No way dude. Get me out of here.”

I felt extremely anxious. Felt like I was panicking. Got out of the elevator, of course. That’s the process of classical conditioning. My brain pairs this neutral stimulus of the elevator with the feared stimulus, and they become whetted.

When I left class that day, I walked up to the elevator, and my brain triggered that same response without me even getting on, so I took the stairs, which is avoidance. That’s how an anxiety disorder is born. I start making decisions based on feeling, and there may or may not have been a genetic loading there or not for any individual, but if you make those decisions based on feeling that, you can quickly get in that loop.

Brett McKay: So there’s been recent research, and I’ve been reading articles about this this past few years is that anxiety disorders are on the rise, particularly amongst young people, like teenagers and young 20-somethings. Have you noticed that in your own practice, and what do you think is going on there?

Kevin Ashworth: Yeah, there’s a few things I think to account for that. One is we are just getting better at having conversations about what anxiety is. 40 years ago, 50 years ago, we called it things like nervous breakdowns, and we had different names for it, and our diagnostic criteria has gotten better for understanding it, so that definitely has a component, I would say, but we are also … Parenting shifted in the 70s and 80s, and with the baby boomers having children, they started parenting quite differently, and I think a big component is we went away from helping teach children how to tolerate distress, and we started helping them really to soothe, and I think the job of parents went from child raising to basically how successful my kiddo is, is a reflection of how I am as a parent, so parents started doing everything for our kids.

So now we’ve got kids in our 20s who parents have been the ones that registered them for college, and they’re the ones that probably still do their laundry, and they’re the ones that when they feel distressed, bail them out, and so over time, you really reduce your tolerance for feeling bad, and I think that has a huge component.

Brett McKay: So yeah, the kids today haven’t exercised that muscle of tolerance.

Kevin Ashworth: Correct. Yeah, exactly.

Brett McKay: I’m curious, you mentioned depression … Is anxiety often linked with depression, or can you be anxious and not depressed, or do you often see the two come together?

Kevin Ashworth: We do see them together a lot. There’s a high, what we call comorbidity rate between anxiety and depression, but there’s plenty of individuals that suffer from anxiety disorder and are not depressed. They age-old chicken or egg question becomes with this, but anxiety is very, very prevalent, and we’re talking 25 plus in childhood percentage, that’s a lot of people, and if you’ve ever experienced distress or intense anxiety, you feel pretty hopeless, and that often turns into a feeling of demoralization which looks just like depression, and the litmus test that I ask my clients is, if your anxiety disappeared tonight, no more worry, no more panic attacks, no more obsessive thoughts, would you still feel depressed?

And they often say, no. They don’t think so. But the truth is, if their depression went away, would you still be anxious and have obsessive thoughts, and panic attacks, and the answer is yes.

So we know there’s plenty of people that suffer from depression that don’t have an anxiety disorder, and there’s plenty of people that are anxious that aren’t depressed, but I think, often, depression is misdiagnosed when anxiety is the cause.

Brett McKay: Since this is the Art of Manliness Podcast, most of our audience are men, and I know we’ve had guests on the podcast talking about depression, how depression often manifests itself differently in men than in women. That’s why it’s often hard to find. So I guess men, when they’re depressed, they’ll often get angry. They don’t look sad. They act angry.

Kevin Ashworth: Right.

Brett McKay: I’m curious, is there something similar with anxiety? Do men express anxiety differently than women?

Kevin Ashworth: Yeah, men are very good at avoiding, and emotionally that looks like just shutting down, and so if I distract, phones, video games, magazines, bars, alcohol, whatever it is, the gym … If I pour my attention into something else, I’m trying to relieve any kind of distress that I have related to anxiety, so the difference is we know the rates of anxiety are higher in women, but that’s most likely because women are reporting it more. It’s just … Culturally, it’s safer for women to say, “Hey, I’m suffering from anxiety.”

It’s really hard for guys to admit that because it is really owned as sense of weakness or vulnerability’s not good, or not to talk about it, and I see a lot of men in my practice that it’s taken them some serious work and time just to even call and make the initial intake appointment, but you’re right. Things like agitation … When I see angry or agitated men, usually there’s an anxiety beneath there that they haven’t ever processed or haven’t really ever been able to even identify it, and if I can say a little bit more, I think many times, what I tell people is, most of us remember the first time we ever saw our dads cry, if ever. And the fact that that’s like a pivotal event that you can remember speaks to how poorly our culture allows men to express emotion. That’s not the first time your dad was sad. I can promise you that. But usually that’s either done behind closed doors, or they have learned, very quickly, don’t express sadness.

So as we grow up as men, we have never really been modeled how to manage negative emotion. We know how to behave when we’re happy or surprised or excited, but now we have no practice or modeling on what to do with these really hard feelings, and I think that’s a big component of why guys then express that in other ways.

Brett McKay: So let’s get into sort of the specifics of the faulty thinking that goes on with anxiety problems.

So you mentioned when you have an anxiety problem, you’re making decisions based on fear. That fear must be irrational, so what happens in our brain to kickstart that irrational thinking where … You mentioned the elevator thing. You got stuck in an elevator, then you started avoiding elevators ’cause you thought, “Next time I get in an elevator, I’m going to get stuck again.” Well, that’s irrational.

So what goes on that sort of perpetuates that faulty thinking?

Kevin Ashworth: Our brain has developed, and it’s evolved over time to make sure that we’re alive, to make sure that we’re safe, and when there’s anything that is potentially even dangerous, our brain wants us to protect ourselves, so to give a non-anxiety example, most of us have experienced food poisoning, and what happens after we’ve had food poisoning is most of us stop eating that thing that got us sick, right? Despite logic and knowledge knowing that, “Hey, I’ve had an egg salad sandwich 600 times in my life, the chances of me getting sick from another one is pretty minimal.” But your grain prevents you from having anymore whether that’s with a disgust factor or whether that’s irrational if you logic.

Anxiety works the same way. So when we experience distress, one thing that we do is look for meaning, and sometimes it’s not there, but we start making association connections with things that are scary.

So, our brain then, through this process of classical conditioning and negative reinforcement works really hard to make us feel better, and then we associate whatever we’ve done in that time with feeling better, and we avoid everything else. It’s this fight or flight response. Anxiety is the anticipation of something bad happening, but it’s not actually dangerous. We don’t use vocabulary related to anxiety for actually dangerous events. People don’t get t-boned in a cross-walk and say, “I was hit by a card, and I went into a panic attack.” Or, “I was really scared with the explosion that occurred, and I had all these intrusive thoughts.” These are actually dangerous events that people don’t even use words to describe anxiety, but if you anticipate driving, and that you may get in an accident at some point, the feelings associated with that, the brain says, “Hey, you’re feeling bad about that? You probably shouldn’t do it.”

And so they are irrational. They don’t make logical sense, but we make a lot of emotional-based decisions like if I feel bad, then it must be true. Does that make sense?

Brett McKay: Yeah, that makes sense, and another thing I’ve seen in my own life when comes to sort of like … At least with worrying, you make these conclusions that are illogical, but the way you get there, and the way it makes sense is you make small steps.

I remember when I was in law school, every time I took an exam, it was, “I failed … Oh my gosh, I failed that exam. Since I failed that exam, I’m not going to get on law review, and if I’m not going to get on law review, it means I’m not going to get an internship, and if I don’t get an internship, I’m not going to have a job, and then I’m going to be unemployed and have all this law school debt.” Which that conclusion is illogical, but it made sense ’cause I made these small, little incremental steps there.

Kevin Ashworth: Yeah, and we call that catastrophic thinking. You’re worried about one exam that may or may not impact your future, and your brain is helping you get there, and for some times, that’s really rewarding, so if that makes you then study harder for your next exam, there’s many processes that are going to reinforce that behavior. Like, “Look, I actually don’t feel distressed after I studied really, really hard, so that’s good for me.” The problem is, is people that worry like that, often they worry like that over everything. They worry like that over their exams. They worry like that over their friends.

Johnny hasn’t called me back. What’s up with Johnny? Why hasn’t he called me back? That’s weird. I wonder if … I guess I didn’t respond to his message last time. I wonder if he’s not talking to me.

And we can go all the way down that catastrophic … Until we bump into Johnny, and he’s like, “Hey, what’s up man? I haven’t heard from you.” Oh, yeah. Right. You haven’t thought twice about this.

And so, we can do that with finances. We can do that with romantic relationships, and that follows a pattern of what we would call generalized anxiety disorder which is excessive worry about things that you actually don’t have any control over in the moment.

Brett McKay: And what can you do if you … First you have to recognize that you’re experiencing this faulty thinking, but what do you do once you recognize? Are there actions you take to stop it in its tracks?

Kevin Ashworth: Helping people change the way that they … Helping people get better from anxiety is analogous of managing ones health. It is not a coping skill that I can say if you do x, y, z, you’re going to feel better. That would be like saying every time you feel fat, do a push up. You might help right there, and you’ll probably distract yourself from your thought of being overweight, but being healthy physically is a hundred decisions a day from fries to a salad to walking down the stairs versus taking the elevator, and that’s the same with anxiety.

So, we have to help people change their relationship with their thoughts. It’s not about trying to push their thoughts away. It’s not about trying to disagree with their thoughts. In fact, if you’ve ever had an anxious thought, and you try and push it away, you know that thing just gets bigger and bigger and bigger, and that’s why lots of people struggle to fall asleep of night with their worry is they’ve just distracted themselves all day, and then once they lay down, they’re hit with all these thoughts that they just don’t have the cognitive resources to keep away anymore, so a strategy that takes time is, I think, having this dance with your anxious thoughts and actually agreeing with them.

So when my brain tells me something that’s scary like, “Hey Kevin, something might happen to your daughter today.” I don’t know that that’s true or not. It’s a very irrational thought, but if I tell myself, ” No. She’s safe. She’s home. She’s probably with my wife. They’re probably driving safely.” That actually reinforces that I should be concerned.

If I’m a little bit more provocative with those thoughts, and I say things like, “Yep. Yep. Something might happen to her today.” I’m really just kind of saying, “This thought carries no weight.” It’s like how you teach kids to manage someone that’s teasing you or bullying you.

Brett McKay: So there’s some cognitive behavioral therapy things you can like that, but you mentioned at the beginning that your approach, and maybe the research says this is the best way, is exposure therapy.

Kevin Ashworth: Correct.

Brett McKay: Tell us what exposure therapy is exactly, and what does the research say about that when it comes to anxiety?

Kevin Ashworth: Yeah, so exposure is known to be the gold standard treatment, and that’s both looking at the National Institute of Mental Health, and exposure is a type of cognitive behavioral therapy, and essentially what it is, it’s helping people move towards the things that are scary to demonstrate in real time that the worries, that the potential threat, doesn’t actually exist.

So how do we know there’s actually no danger? If I have a thought right now that in your studio there’s 10 people behind you listening to me, mocking me right now, if I think that, that’s going to make me pretty anxious, although I don’t know that to be true.

So the best way to manage that would be to change the way that I’m speaking, be very careful about what I say, or in fact, just hang up would be the best way to protect myself.

But to manage that thought, an exposure thought, would be to say, “Yeah, well I hope that they are. I hope that they are, and I’m just going to be myself.” Because what happens is the anxiety kind of builds, and once there’s no actual danger, it resolves itself.

So to give a very concrete example, if someone is scared of dogs, which is a very basic example, you can’t be better … You can’t be more comfortable about being around dogs or know that you’re not going to be bit every time you’re around a dog by avoiding dogs, turning off commercials with dogs, not watching movies with dogs, and you can’t buy a coping skill with a long stick that you can pet a dog from afar.

What we would do with that individual is depending on their level of fear is, we would help them be around dogs until their body relaxes. So, that fight or flight system, that brain system that we talked about before, we active it on purpose. So we say, “Let’s get a dog. Let’s activate that, and then let’s just sit here.” And what happens is your brain goes fight or flight, fight or flight, danger, danger. Oh, nothing’s happening. Let’s turn off this system which turns on this parasympathetic nervous system and relaxes an individual or calms them from their distressed state, and then the brain learns very quickly that I don’t have to respond with anxiety when I’m around this stimuli, and it doesn’t matter if it’s a dog or anything else because I’m not actually in danger.

Now, if the dog walks in, and I leave every single time, I’m actually proving to my brain that is potentially dangerous. I haven’t been bitten because I haven’t been around a dog. Well, that’s true, and so that becomes … That’s why avoidance works so well for people because even though they’re enduring the distress, nothing bad is happening, but they have no tolerance now for managing it.

Brett McKay: And how long does exposure therapy take? Does it just depend on the person, is it different?

Kevin Ashworth: Yeah, it really depends on the person. Some things, though, like phobias … Phobias, we actually have a lot of success in treating in one day, and so I’ve treated individuals with fear of heights, fear of needles … What are some of the other fears? There’s a protocol that is a six-hour prolonged exposure protocol that has been proven to be very effective, and so you’re essentially just recreating the feared stimulus over and over and over until the brain says, “Oh yeah. That’s true. I got this.”

But for most people, they’re in therapy about … It depends. They have about 16 to 20 weeks. We have, at Northwest Anxiety, we have an intensive outpatient program, and so we have a three-week program where people come three hours a day every day for three weeks, well, five days a week. And that’s very effective because it’s not … Therapy is not set … The way that we do therapy is I don’t need you to go home and just experience life to come back and have a chat about it. If you’re here for a specific anxiety issue, whether I see you every day in a row or not, we need to work on that issue. So the frequency is really, really important.

Brett McKay: What about more, not a phobia, but say you’re a college student, and you’re just anxious about failing out of college. Or you’re out in the job market, and you’re anxious about not being able to find a job, and it’s just causing you a lot of anxiety because you’re not able to pay the bills. How does exposure therapy work for things like that?

Kevin Ashworth: Typically exposure then becomes a conversation about what you can control. So those kind of anxieties usually come with uncertainty. Most people would be actually okay if they had the certainty … Even if they had the certainty you’re not going to get a job with the degree that you got, and you know that now 100%. Then they can shift their focus. Or you may … But that, “I don’t know if I’m going to. I’m don’t know if I’m going to be successful.” Is a normal anxiety response.

But exposure then, is about helping people learn to tolerate that feeling of uncertainty, and some sometimes we’re just looking at what’s realistic. How much of you graduating college and looking for a job can you actually control? There’s only so much of looking for a job you can control. You can prepare your resume, print it out, and apply for jobs. Other than that, there’s very little. You can network. You can do lots of things.

But anxious individuals worry far past that, and part of the issue is, anxiety is a very future-oriented problem, so even when people that are anxious are in the middle of a job interview, their focus is on failing it, or they’re focused on the next interview, or what if I don’t make it to the second round of interviews which just allows them to be present and actually successful at doing well in that interview, and so the goal is helping them be present at the same time, and sometimes we can do exposures around just things that are uncertain. Things like, we ask people to do things like see a movie that you’ve never seen a preview for, or eat at a restaurant that you haven’t read the Yelp review. People require certainty so much that are anxious, that they won’t eat anywhere unless they’ve asked 10 people or read 10 things about something, or they know exactly what the food is, and they don’t do spontaneous things. So for those kind of things, developing exposures around being spontaneous, managing uncertainty can be really helpful.

Brett McKay: That reminds me. I heard about this guy. He did a TED talk about … He called the rejection therapy where he just went and asked people just ludicrous things because he was super high strung. So he’d ask people like … He forced himself to ask … He went to a burger restaurant and asked for a burger refill. Like you would a soda refill, and he got rejected most of the time, but he learned that, “Oh, nothing really bad happened.”

Kevin Ashworth: Right. And that’s exactly what I do with our clients that have social anxiety. I’m going to do something that’s going to make me look so foolish. So, if I walk around, and I have people ask questions like that, or ask them … There’s a big stadium here where the Portland Timbers play, and we’ll walk around out front there, and I’ll have people ask strangers, “Excuse me. Where do the Timbers play?” And people will go, “Right there.”

After about five or six times of doing that, they don’t care anymore, and if you can tolerate that, then you can have small talk with the person on the train in the morning. If you can ask the person on the train 20 questions in the morning, now when you sit in your first freshman class in college, it’s pretty easy to lean over say, “What’s up?”

Brett McKay: Yeah, yeah. So is this exposure therapy more towards generalized anxiety? Does it transfer over? So say like you get a handle on uncertainty in social situations, does that transfer over in to being able to handle uncertainty in say the job market, or do you have to like actually be specific about handling . . .

Kevin Ashworth: No, it really does translate over because actually the content, so whether it’s social situations or job market or whatever it is, or a dog, the content is different, but the process is the same, so we care less about the content. People that come to therapy care a lot about the content of course, but the process is helping you feel bad and tolerate it anyway.

So if I know that I can manage this awful feeling of distress, and it actually goes away, and I get some mastery with that, a lot of confidence comes from that, and so now, if I go and apply to a job, and I get the job, and now of course, there’s lots of things that are anxiety provoking, deadlines and things like that, I now trust that I can tolerate my own distress, and so it really does translate well into other areas.

Brett McKay: All right, so it’s all about, again, exposing yourself, letting that, I guess what would we call it? Resilience muscle to grow-

Kevin Ashworth: Yeah, yeah.

Brett McKay: I know we have a lot of parents who listen to this show. What if you’re a parent, and you notice your kid has a tendency to be anxious? What can parents do to help their kids manage that or confront that and reduce that anxiety?

Kevin Ashworth: Yeah, I would say one of the things that parents do the most with great intention, but becomes really problematic is that they feel bad that their kids are struggling. They feel bad that their kids are anxious, and when they feel bad, now they’re working on managing their own stuff by helping their kids. It becomes less about the kids, and so some of the earliest signs that we know kids are anxious is there’s often a lot of reassurance seeking, and that looks like things like asking the same question over and over because they’re looking for that certainty even though it doesn’t exist. And so helping parents learn not answering those reassurance questions are not accommodating the anxiety, and so what’s really helpful is helping parents identify what decisions are my kids making based on anxiety, and then how am I accommodating those anxieties?

So, obviously a big issue for anxious kids is not going to school, and parents work really, really hard to make sure their kids are comfortable, and so when kids don’t have to go to school, and they get work brought home or they’re online, or they’re doing different things, they may feel better in the moment, but they’re not building that resilience muscle. They’re not building that tolerance over time, and then parents realize that they’re doing everything to manage their kids anxiety. They’re checking in with their kids, “Have you eaten?” “Are you up on time?” “Are you okay?” “Do you need anything?” And they’re really working hard to make sure that kids never feel distressed, and they have to feel distressed, and so some of the most helpful things parents can do is actually dial back a lot of the accommodations that they’re making for their kid’s anxiety, not for their kids. We want parents to make every accomodation they can for their kids. They’re lovely, I’m sure, but not for their kid’s anxiety. And so, that just maintains the anxiety over time.

Brett McKay: So that looks like … So if your kid’s asking you for reassurance, you just … What do you do? Do you say, “I’m not going there.” What does that look like?

Kevin Ashworth: Yeah, I would say, “That sounds like something your anxiety wants me to say. I’ve already answered that. It’s not that you’re not giving the information, and so if a kid says, “I got invited over to Sarah’s house tonight, do you know who’s going to be there?” “No honey. I don’t know who’s going to be there.” “Mom, do you know who’s going to be there?” “I’ve already answered that. I feel like that’s an anxiety thought that wants to answer that.”

Because now what you’re saying is, “I hear you, and I validate that you have a concern, but I am just going to let you sit there and tolerate that.” But what many parents will do, is they’ll say, “I don’t know. Let’s find out.” And they’ll call, and they’ll call Sarah’s mom, and they’ll figure out who’s there, and now this kid is not learning how to develop any of those skills of tolerating, I guess I’ll just have to figure out who’s there when I show up.

Because the truth is, finding out who’s there or not actually doesn’t change whether the person’s going to go or not, it just changes their level of distress walking into the situation, and we want them to be confident walking in not knowing.

Brett McKay: Right, yeah. Sounds like the internet can just exacerbate because if your kid has a worry, you can answer it-

Kevin Ashworth: Oh my goodness.

Brett McKay: Let me check Google on my phone here really quick, and here’s an answer for you.

Kevin Ashworth: All day long. Google is very, very challenging for anxious individuals because now can look up everything from a physical ailment to a question of infidelity to any kind of worry, we ask Google.

Brett McKay: And it just … Everyone’s been down that route of checking WebMD, and I have pain in my arm, and now I have cancer.

Kevin Ashworth: Yep. Exactly.

Brett McKay: Don’t go down that path. Well Kevin, this has been a great conversation. Where can people go to learn more about your work?

Kevin Ashworth: Yeah, so I have a YouTube channel, and it’s under Fighting Fear with Kevin Ashworth. We have a website. It’s NWAnxiety.com, and people are actually welcome to send me an email at [email protected], so [email protected], and our website … We’re in the process of getting our new website redesigned. It should be launched here by the end of the month, and then check out the YouTube channel, and I have some blogs on the website.

Brett McKay: Fantastic. Well Kevin Ashworth, thank you so much for your time. It’s been a pleasure.

Kevin Ashworth: My pleasure. Thanks so much.

Brett McKay: My guest today was Kevin Ashworth. He’s the clinical director of the North West Anxiety Institute. You can find more information about his work at NWAnxiety.com. Also, check out his YouTube channel, Fighting Fear with Kevin Ashworth where he’s got lots of videos on some of the things we’ve talked about and goes more in depth. Again, Fighting Fear with Kevin Ashworth. Also, check out our show notes at AOM.is/anxiety where you can find links to resources, where you can delve deeper into this topic.

Well that wraps up another edition of the Art of Manliness Podcast. For more manly tips and advice, make sure to check out the Art of Manliness website at ArtOfManliness.com, and if you enjoy the show, I’d appreciate it if you’d give us a review on Itunes or Stitcher. It helps out a lot, and if you’ve done that already, thank you. Please consider sharing the show with a friend or family member.

As always, thank you for your continued support. Until next time, this is Brett McKay telling you to stay manly.