Anxiety is typically thought of as a disease or a disorder. My guest has a very different way of looking at it, and says that rather than being a burden, anxiety can actually become a benefit, and even a strength.
Dr. David Rosmarin is an associate professor at Harvard Medical School, the founder of the Center for Anxiety, and the author of Thriving with Anxiety: 9 Tools to Make Your Anxiety Work for You. Today on the show, David explains why the prevalence of anxiety has risen while the reasons to feel anxious have fallen, and what the increase in anxiety has to do with our growing intolerance for uncertainty and uncontrollability. We discuss how the perception of anxiety is a big part of the problem that has made anxiety a problem, and how you can change your relationship with anxiety, transforming it from something that hinders your life, to something that helps you develop greater self-awareness, reach your goals, make needed changes, connect better with others, and build your overall resilience.
Resources Related to the Episode
- AoM Podcast #497: The Meaning, Manifestations, and Treatments for Anxiety
- AoM Podcast #614: Get Out of Your Mind and Into Your Life (With Steven Hayes)
- AoM Podcast #782: Anxiety Is a Habit — Here’s How to Break It
- AoM Podcast #868: Escape the Happiness Trap
- AoM series on developing resilience
- AoM Article: Just Go to Sleep
- AoM Article: 5 Tools for Thriving in Uncertainty
- AoM Article: The Best Books to Read in Uncertain Times
Connect With David Rosmarin
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Read the Transcript
Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness Podcast. Anxiety is typically thought of as a disease or a disorder. My guest has a very different way of looking at it, says that rather than being a burden, anxiety can actually become a benefit and even a strength. Dr. David Rosmarin is an associate professor at Harvard Medical School, the founder of the Center for Anxiety and the author of “Thriving with Anxiety: 9 Tools to Make Your Anxiety Work for You”. Today on the show, David explains why the prevalence of anxiety has risen while the reasons to feel anxious have fallen and what the increase in anxiety has to do with our growing intolerance for uncertainty and uncontrollability. We discuss how the perception of anxiety is a big part of the problem that has made anxiety a problem. Now you can change your relationship with anxiety transformative from something that hinders your life to something that helps you develop greater self-awareness, reach your goals, make needed changes, connect better with others, and build your overall resilience. After the show’s over, check out our show notes at aom.is/thrivingwithanxiety.
All right. David Rosmarin, welcome to the show.
Dr. David Rosmarin: Thanks for having me.
Brett McKay: So you are a clinical psychologist and you founded the Center for Anxiety to help people who are struggling with anxiety problems. I know a lot of people have that issue. You also got a new book out called “Thriving with Anxiety: 9 Tools to Make your Anxiety Work for You”, where you walk readers through the tools you give your clients or patients on how to manage their anxiety, not only manage but thrive with it. That’s the whole point of this. I’m curious, what led you to specialize in anxiety?
Dr. David Rosmarin: Yeah, when I was getting into clinical psychology, I really wanted to do something that was evidence-based, and there are lots of different areas to focus in. Anxiety was definitely the most well-researched, well-understood in terms of how to do it. And that appealed to me, the scientific approach, and that’s the first part about it. Little did I know that getting into this field, I would learn a lot about myself, a lot about the world, a lot about my patients, and it’s been quite the journey.
Brett McKay: So let’s talk about definitions first. How do you define anxiety? ‘Cause I think it’s a word now that’s become part of the popular culture. Everyone’s talking about it. There are songs about anxiety.
Dr. David Rosmarin: Sure.
Brett McKay: So how do you define it?
Dr. David Rosmarin: So anxiety is the same as fear. It shares the same brain circuitry, shares the same physiology, and it’s the fight or flight system, which we all know, where your heart starts beating and your breathing gets constricted and your muscles get tense and your stomach might get upset and you might feel even a little dizzy ’cause your pupils are dilating. And fear, you have to start with understanding fear before you define anxiety. Fear is an adaptive healthy thing. All right. It keeps you safe. It’s the fight or flight system that if you need it, that’s gonna come into play and you’ll either fight or flee from some threat. Now anxiety is the same exact thing, but there’s one small difference. It’s actually a large difference, which is that there’s no actual threat present. You’re having all the feelings of the fight or flight system, but you’re not actually experiencing a real threat in front of you at the time.
Brett McKay: Okay. So fear would be you see a bear on the trail in front of you when you’re out backpacking, then you’re experiencing that fight or flight response, and in that situation, that would be inappropriate fear response. Anxiety would be experiencing that same sort of physiological reaction to thinking about going to a party and socializing. In that situation, the worst thing that could happen to you is you feel awkward or uncomfortable, but you’re not under actual threat in that situation. So what’s interesting then is that despite us living in the safest, most prosperous time in human history where there’s not a lot of threats out there, anxiety keeps increasing. More and more people have or report having anxiety than ever before. So what’s going on there? Why are we more anxious despite not having any real threats to be afraid of?
Dr. David Rosmarin: Yeah, it’s a great question, and it’s at the core of my new book. I actually think it’s because we are in one of the most safe and prosperous times in human history that we have the highest levels of anxiety, and I’ll explain that one. If you look at high-income countries, they have twice as much anxiety as middle-income countries, and middle-income countries have twice as much anxiety as low-income countries. And as things have become more prosperous and more safe in our society with more safeguards and more information, which we’re presented with, our anxiety is actually increasing substantially, and this is objective. Look at the suicide rate, if you look at the levels of disability, it’s not just people reporting it. So we have a big problem. The question is why I think and we expect to be in control all the time, we expect that things are gonna go well, we expect that if we start a business right away, things are gonna be hopping, we expect that we can get the medical care that we need, that our technology is not gonna fail us. And because of that, we are not resilient. We’re actually very un-resilient to anxiety and when we experience it, even low levels, all of a sudden, boom, that cascades into a massive amount of anxiety, and I think that’s what we’re seeing on mass. Our expectations are just unrealistic.
Brett McKay: Well, here’s a perfect example of that I’ve seen in my own life. The expectation that you should be able to be in touch with your loved ones and know where they are at all times, thanks to cell phones, I think has made a lot of people anxious ’cause now, whenever you call your spouse or you text your kid, and they don’t respond, you’re like, “h my gosh, something terrible happened. They’re in a car wreck.” But I grew up before cell phones and I would leave at 7 o’clock in the evening and go out and hang out with my friends and not come home until midnight, and I don’t think my mom ever freaked out about it.
Dr. David Rosmarin: Yeah, I think it’s a perfect example. You see, hey, they read it, or like, hey, they’re around the corner. I can see on the GPS, but why aren’t they calling? Why aren’t they doing this? Where are they? It’s almost like the more information we have and the better things are going day-to-day, the less, like I said, resilient we are, and it’s a big problem.
Brett McKay: Okay. So the more in control we feel with our life, thanks to technology and all the things we have in our life, the more anxious that we can potentially feel.
Dr. David Rosmarin: Yeah, and you mentioned the word control, and that’s exactly what it’s about. In reality, we’re not in control. Let’s acknowledge it. There’s so much less that we can control than we really think day-to-day, even with the information, even with the technology, even with the medical systems and financial systems we have in place, but we don’t like to live on the edge. We don’t take risks. We don’t like to feel uncomfortable. We assume that even feeling uncomfortable is a disease. It’s not. It’s called being human and I think we’ve really forgotten how to be emotionally resilient and to learn how to thrive with difficult emotions, which are part of life.
Brett McKay: Well, that’s another point in the book that stood out to me was this idea that even feeling anxiety, people can feel anxious about that they feel bad, that they feel bad, which just causes even more anxiety.
Dr. David Rosmarin: Yeah, the minute you feel anxious today, you don’t say, oh yeah, of course, I’m working really hard, or, oh yeah, that’s because there’s this news, which is really, really tough for me to stomach, or it’s because I didn’t know that something was happening. Instead we say, oh my God, I have a disease. Something’s wrong with me. Now if you perceive your anxiety as a disease, you’re gonna trigger your fight or flight system more. You’re literally gonna dump adrenaline more into your system and create a cascade of anxiety. So we’ve created this monster and the effects are really quite problematic.
Brett McKay: Yeah, I think it’s one of the big problems with the popularization of psychology of people reading psychological books or consuming psychological content like lay people and then diagnosing themselves, well, I have anxiety. And as soon as they make that self-diagnosis, they’ve made this normal feeling of feeling nervous because of uncertainty into a bigger problem than it needs to be and then it can become debilitating.
Dr. David Rosmarin: I would agree. But unfortunately, I think the medical field has played into this as well. This last summer, there was a panel of federally-funded in fact physicians across the United States who made a recommendation to use a very brief measure at all PCPs visits, any primary care visit. And the net result of that was that if you report any level of worry or any level of anxiety at a visit, it flags you for diagnosis and potential treatment of an anxiety disorder. Now, let me ask you, how many people have you seen this week who had no anxiety and no worry at all in the last two weeks?
Brett McKay: We had no one. Everyone’s had some sort of…
Dr. David Rosmarin: None, zero. There’s nobody ’cause it’s a normal human emotion. So I think that it’s not only the… Yes, popularization of psychology, 100%. No question, but the medical field, I would even see the pharmaceutical industry has played into this myth of having perfect emotions all the time, and in doing so has greatly disrupted our capacity for well-being and for flourishing.
Brett McKay: And something you do with your work, you’re working with people who have varying levels of anxiety. You have people who they’re mostly well-functioning, but they might experience just like how I feel nervous all the time, and I like to get a handle on that. But then there’s also to the point where the anxiety becomes a problem and it’s something you… Actually there’s a clinical diagnosis. At what level, at what point do you as a clinician diagnose someone with anxiety disorder?
Dr. David Rosmarin: Yeah, I mean, the simple answer to that question is when it causes significant distress or impairment, and that’s a very subjective call, to be perfectly honest. There’s no lab test to say you have anxiety or an anxiety disorder or you do not. There’s no clear physiological, neurobiological markers of these. There are some indications of pathology, what we call it, but not really. It’s not… You can’t use those as diagnostic for each person. So to me, it’s less about whether a person has a clinical level or a subclinical level, and more about what do we do when we feel anxious, how do we change our relationship with anxiety that it’s not an indication that something’s wrong with us, it’s not the end of our happiness and well-being. It’s just considered to be part of life and something that actually can make us stronger and even thrive better.
Brett McKay: Well, that’s a big argument in your book. This book’s called “Thriving with Anxiety. You make the case that anxiety can be used as a strength in our lives. How can this thing that we see as a disorder and everyone’s trying to get rid of actually be a blessing?
Dr. David Rosmarin: Yeah, it’s really simple. A really solid workout in the gym, you don’t feel good at the moment, right? You’re sweating, you’re uncomfortable, you’re feeling a burn in your muscles. If you’re increasing your lifting, you’re lifting heavy stones or whatever it is that you got going and it’s uncomfortable, it burns, it feels like death at one point. If you have a trainer or someone standing over you, they’re like, “keep going, keep going”, it looks like torture. If you’re filming it from the outside, it would be you didn’t know what was going on. You’d be like, why is that person torturing them, but they’re not.
And the person who’s doing it is actually voluntarily going through that pain in order to develop their muscle tone, to develop their reaction time, to develop their cardiovascular health. And an emotional health is no different, it’s no different. Going through anxiety can enhance our emotional and neural strength, and make us more resilient and more capable of handling difficult situations, which by the way, are gonna come up, especially if you’re pursuing your dreams and your goals in life. If you’re taking the easy road, maybe not, but if you’re doing something that’s out there and you’re being a man, so to speak, and really out there on a limb and pushing yourself to the max, you’re gonna feel stressed, you’re gonna feel anxious. That’s the way it’s gonna be and can we use anxiety to build that resilience in order to propel us forward in our goals and dreams? I think the answer is yes.
Brett McKay: Okay. And I hope throughout this conversation, we can discuss some of the tools you’ve come up with and use with your clients and patients on how to use their… Turn their anxiety into something that can be used as a strength instead of a liability. But one of the first things you do when you have someone that comes in to see you saying, “I’ve got so much anxiety”, is you talk to ’em and say like, “Well, do you really have anxiety?” ‘Cause you’ve heard the fact that a lot of times people confuse being stressed out with being anxious. So what’s the difference between stress and anxiety and why is that difference important?
Dr. David Rosmarin: Yeah, great question. First, I’ll just mention that people only ask this question if they’re feeling anxious, if they’re feeling uncomfortable. So here we already see how anxiety can help you to thrive because it helps you become more self-aware and you’re gonna hopefully start to ask yourself questions, am I just stressed out by situations in my life, or is there an imbalance between my demands and my resources between the number of things I have to do and the amount of time, money, whatever it is that I have to accomplish all that stuff? That would be called stress. Or is my anxiety really a misfire, if you will, of my fear system, in which case I need to take a different approach? That would be the difference between stress and anxiety. Stress is the imbalance between demands and resources and anxiety is again, that fear response, which is not in response to natural threat. It’s in response to something which is really in your mind.
Brett McKay: Okay. So you can just be stressed when there’s an imbalance in your life between your demands and your resources, but then you can also feel anxiety about that stress ’cause you’re like, “Oh my gosh, this is gonna crush me. My life’s gonna fall apart.” But then the anxiety you’re feeling about your stress, it could be helpful sometimes, ’cause it can help you recognize, okay, I’ve got a problem here that I need to do something about.
Dr. David Rosmarin: Yeah. Anxiety helps you unpack all of this. If you’re stressed out, look super stressed and chronically stressed, because there’s just way too much to do in your life, the structure is such that you never have enough time, never have enough money, never have enough capacity to handle whatever is coming your way, then your body is gonna get anxious and feel uncomfortable as a sign to tell you, hey, let’s check, let’s recalibrate, let’s rebalance, let’s maybe do something and make some different choices here. And that’s actually a healthy thing. So leaning into the anxiety, letting you experience it can help you to be more self-aware.
Brett McKay: And so when you have a patient that comes to you like, “Okay, I’m anxious.” You’re like, “Well, let’s take a lot of your life. It looks like you have a lot of stress in your life.” What do you tell people to do to help manage their stress?
Dr. David Rosmarin: My go-to is when someone’s stressed out, number one is gonna be sleep, and I kid you not, I have had many patients come to me. I have them go through an exercise of sleeping for eight hours a night for two weeks, and two weeks later, they have no symptoms of anxiety. They are really restored, they’re rejuvenated, and basically their body was telling them, please, please put me to bed. And finally when they listened, then the symptoms went away. Now it doesn’t happen all the time, but that is gonna be my go-to for dealing with stress.
Brett McKay: Gotcha. And then you also talk about exercise is an important one.
Dr. David Rosmarin:: Yeah, that’s my second one.
Brett McKay: Getting out in nature ideally can help out a lot, and then doing things. I think a lot of people these days, they feel overwhelmed with the amount of news and social media they’re consuming. That can just add stress that you don’t need.
Dr. David Rosmarin: Yeah, I like to think about social media, and even the news that we have as the great social psychology experiment of all the time, and it does not seem to be going well. Never before in history have you had a generation with unfettered access to international news at this order of magnitude. It’s incredible what we can look up in 10 seconds on our phones, and we have to be mindful of the effects of that. That can be intense.
Brett McKay: Yeah. Okay. So if you’re feeling anxious, first question to ask, well, maybe I’m stressed out. Look at that and do an inventory. Then if you are, get some extra sleep. I know I’ve noticed in my own life with sleep, I’m sure everyone else has experienced this as well is at nighttime, that’s when you start ruminating and you start going down this dark place like, oh my gosh, my life’s terrible. I’ve got all this stuff going on and now this problem. There’s just something about being tired and it’s dark outside, and then it’s usually at that point, it’s like, I gotta go to bed. If I just go to bed, all the problems go away for at least eight hours, and then I wake up and then I see those things I thought were problems are not actually problems. I feel I can take them on.
Dr. David Rosmarin: Sounds like you’re also not your best self when you’re super tired late at night. Hey, we got that in common. Imagine that.
Brett McKay: Right. Yeah, it’s like sometimes we’re… Grownups are just big babies, like, okay.
Dr. David Rosmarin: It’s funny.
Brett McKay: Is the baby crying because it needs sleep and it’s hungry, et cetera? And usually the same thing is going to apply to grown humans as well.
Dr. David Rosmarin: I think that’s really well put. I like that.
Brett McKay: So one of the things you talk about is let’s say someone gets triggered by anxiety and they start feeling that anxiousness starting to percolate in their body, that feeling can be okay. It can be a signal that something’s off and then you explore something. But you talk about how people can get on this anxiety spiral that takes them to a not so great place. So what’s the anxiety spiral?
Dr. David Rosmarin: Yep, that’s definitely the key here and I think this relates to what we were saying before. To me, the anxiety spiral is the reason why we have an anxiety epidemic today. The minute we start to feel a little uncomfortable, our first perception is what’s wrong with me? Something’s not right here, and we start to judge ourselves and say, “Oh, I’m diseased. Everyone else feels fine. Why do I feel this way?” And we start to get upset about the fact that we’re anxious, okay? The second thing we do is we catastrophize. I can’t handle this anxiety. This will kill me, this will make me a weak person, this will make it impossible for me to function. And by the way, none of that is true. People actually function better when they’re anxious surprisingly. Often people function better when they’re anxious. But those two horsemen, if you will, horsemen of the apocalypse, the first one, the judgment of oneself, and the second one is the catastrophizing, they actually physiologically increase the intensity of your anxiety symptoms ’cause you’re gonna have a dump of adrenaline into your system, and around and round we go. That creates the anxiety spiral or the cascade, as I like to call it, ’cause the initial experience of anxiety met with judgment, met with catastrophizing leads to greater levels of anxiety and that’s what’s happening in our society on mass.
Brett McKay: What’s an example of the anxiety spiral, like a very concrete example you might see in your practice? Let’s say I’ve got an anxiety problem around let’s say socialize. I have a social anxiety. What would that anxiety spiral look like in that situation?
Dr. David Rosmarin: Great. Okay. So you’re in a social situation, you’re walking into a party, you don’t know too many people, and you’re worried about making small talk so you start to feel a little bit panicky, a little bit of a flutter in your heart, start to feel a little bit of pit in your stomach, you feel the cotton mouth coming on, and then immediately start to think, “Oh no, other people are gonna see I’m anxious. Oh no, why do I feel this way? I’m weak. I can’t really handle this.” So at that point, there are a couple of things that happen. People either leave the party or they start drinking or they can take a bold, bold move, which is what I’m recommending, which is to weather the storm, and to say, “No, I’m not feeling uncomfortable because something’s wrong with me. This is just part of a new territory for me. I’m not the most social guy, I’m not the most… I’m a little too shy. Okay, fine. So I’m gonna learn how to do this. I’m gonna build the resilience, I’m gonna build that capacity, and then I’m gonna move through.” And that choice of going into the anxiety re-spiral, or what I call the positive spiral makes all the difference in the world when we’re dealing with anxiety in the moment.
Brett McKay: Well, yeah, let’s talk about that positive spiral. That’s the antidote to the anxiety spiral. What does the positive spiral look like?
Dr. David Rosmarin: Yeah, a positive spiral is when we accept I’m gonna feel anxious sometimes, okay? Some people just aren’t that social. In social situations when they’re meeting new people, or when they’re having conversations with… I don’t know, superiors at work or whatever it is, they’re gonna feel awkward, they’re gonna feel uncomfortable and that’s okay. There’s no judgment. There’s actually self-compassion, there’s an understanding, okay, this is just my makeup, and I have to build my resilience and build my connection and these opportunities, you know what, I’m gonna do it once a week. I’m gonna go into an uncomfortable situation and I’m gonna build that, that muscle just like I would in the gym once a week, a couple of times a week in order to make the anxiety catalyst towards thriving and growth as opposed to something that gets me down and then I get upset about.
Brett McKay: Okay. So for someone who has maybe social anxiety, you’re in that social situation, you have to make small talk at a party, you’re feeling that at the moment you’re like, “Oh my gosh, I’m starting to feel a little anxious, feeling tight in the chest,” the positive spiral will be like just, okay, I’m just gonna experience this. I’m not gonna try to fight it. You’re not gonna try to convince yourself there’s nothing to be afraid of. You’re just gonna allow yourself to feel that tightness, and usually what ends up happening by just allowing it, it usually just washes over you pretty fast, and oftentimes the anxiety just stops after a few minutes.
Dr. David Rosmarin: It does. A couple of years ago, this happened to me. I was giving a talk for an audience and I was not expecting to feeling anxious at all. I don’t usually get anxious giving public lectures as a public speaker. It happens all the time that I’d probably give 30, 40 lectures a year at this point, but I was in this situation, and all of a sudden, I started to feel anxious and I’m like, okay, great, we’re gonna build our resilience. I looked at my watch and 120 seconds later, the anxiety symptoms were gone.
Brett McKay: Yeah. Well, and this reminds me a lot of “Acceptance and Commitment Therapy” from Steven Hayes. We had Steven Hayes on the podcast before. His whole thing is instead of fighting these negative emotions, just sit with them for a bit and maybe even explore them, like what’s going on there? Why am I feeling that tightness in my chest and counter-intuitively by really leaning into those negative feelings or emotions to go away.
Dr. David Rosmarin: Yeah, Steve he’s a bit of a mentor of mine back and he actually wrote a probation of a previous book that I wrote. So he definitely has had a huge influence on my work. I think acceptance is the starting point. The question is, can you actually use anxiety in a positive way in your life to increase your relationships with others, your connection with yourself to start to really parlay that into pursuing higher goals and dreams? That’s really where act is the foundation point for my approach.
Brett McKay: Well, something I’ve done as I’ve coached flag football for my son and his friends for the past couple of years, and there’s a few boys who get really anxious before a game and they’ll be like, “Oh my gosh, I just have a lot of anxiety.” And you can see them starting to go down that anxiety spiral where they’re going through this catastrophizing like, “What if I do this during the game?” And then they start beating themselves up like, “Oh, why do I feel like this? I’m just… ”
Dr. David Rosmarin: “Why do I feel this way?”
Brett McKay: “What is going on?” And I have to stop them and be like, “Hey, look, it’s perfectly normal to feel nervous or anxious before a big game, ’cause it means it’s important to you. You wanna do well. That’s great. It’s okay to just feel it. It’s gonna go away.” And then I also try to reframe it and say, “Hey, you know that feeling of anxiety, that’s just your body’s way of getting ready to take on this challenge.” And it seems to help reframing and it’s like, “Hey, you can use that energy to do well on the football field.”
Dr. David Rosmarin: Yeah, it’s exactly what teachers and mentors need to be doing these days, and unfortunately it doesn’t happen nearly enough. Usually it’s like, “Oh, you feel anxious? Something’s really wrong. That’s a problem. You should really speak to someone about that.” And we sort of… It just reinforces the sense that we can’t function in the anxious way. Sometimes people play their best game when they’re anxious. Comedians, I can’t tell you how many comedians have had who’ve come into the Center for Anxiety offices often plagued with anxiety, hilariously funny, and played with anxiety because you gotta be on. You’re doing improv. You have to be on in order to do comedy in front of hundreds of people, and if a joke fails, you gotta be able to recover quickly. It’s really anxiety broken. That’s good. That actually is part of the strength of comedy is that it’s predicated on being on your game.
Brett McKay: Right. You could fall flat on your face. That’s what makes it exciting.
Dr. David Rosmarin: Yeah, exactly.
Brett McKay: And also you highlight there’s a lot of athletes who have a ritual. Some of them just throw up before a game, and that’s what they do. That’s how they get ready for… ‘Cause it means that the game is important to them. If they don’t do that and they don’t have that, “I’m feeling nervous, I’m throwing up”, they often play worse because they don’t have that edge that they need.
Dr. David Rosmarin: Yeah. We often misinterpret today, unfortunately, our anxiety that something’s wrong as opposed to recognizing that, hey, this is actually my adrenaline is starting to flow through my body here, and that’s preparing me for actually a higher level of performance. Often it open you up and keeping you on your game.
Brett McKay: We’re gonna take a quick break for a word from our sponsors. And now back to the show. Okay. So if you feel those feelings of anxiety, don’t go down the anxiety spiral, don’t catastrophize, don’t beat yourself up, don’t say this is a big problem, ’cause that’ll just make things worse. Antidote is the positivity spiral, the positive spiral, and you can do that by if do you feel those negative anxious feelings, just sit with them. And then also maybe you do some reframing like, well, how can I use this to allow me to excel in whatever task I’m about to do or in my relationships? We’ll talk more about the relationship aspect of anxiety ’cause I thought that was really interesting. So you mentioned that most people don’t respond with the positivity spiral. So what are the counter-productive ways in which we try to manage our anxiety?
Dr. David Rosmarin: Yeah, your number one counter-productive way is by avoiding it and by shutting it off, by squelching it, by trying to reduce the amount of distress. That’s kind of the equivalent of going to the gym, starting to do your workout and being like, “Oh, you know what, this is uncomfortable. I’m not gonna do this.” You’re not gonna build your muscles. It’s just the way it is. If you avoid it, if you avoid all the distress. Now I’m not saying we need to be facing a nine out of 10 on the anxiety scale on a daily basis. Obviously, that’s too much. That’s gonna lead to… The equivalent in the gym would be whatever, however many hundreds of pounds of the barbells you’re lifting or just beyond whatever your current capacity is. But I definitely think we should be moving into the area of a four or five even on a daily basis. When I’m pursuing a big dream and a big goal, I’m feeling uncomfortable. My stress level is high, I’m facing it, I get it in my chest this like it’s an uncomfortable thing and that’s good. That’s like an indication that I’m on the right track. So I think we need to flip into a completely different relationship with our anxiety compared to the way we currently see it, which is as a disorder and a disease and something’s wrong.
Brett McKay: Okay. So the person with social anxiety, the way they might manage the anxieties, they just avoid social situations completely, ’cause they don’t wanna feel that.
Dr. David Rosmarin: Yeah. And people who are afraid of heights won’t go in elevators or they won’t go up in a plane, and people who have panic attacks are gonna avoid any situation that might lead them to panic. I’ve had patients who stopped riding the subway because they didn’t wanna panic when they were underground. I’ve had patients who stopped going over bridges, stopped going through tunnels, stopped traveling completely. I had a patient who stopped going to the supermarket. She would not leave her house because she was so terrified that she might have a panic attack and die. And these are real life situations that the anxiety if it leads into avoidance, it can just take over your life as opposed to being like, whoa, hold on. I gotta actually face this and get that opportunity to build that inner strength. And once they do that by facing it through what we call exposure therapy, that can be a huge catalyst for bravery for really moving one self forward towards flourishing.
Brett McKay: Well, you always talk about exposure therapy. How does that look in a clinical setting and then can people do this? Let’s say someone has mild anxiety with social situations, could they do this exposure therapy on their own?
Dr. David Rosmarin: Okay. Two great questions. I’ll tell you what it looks like first. It looks a little bit like death, and what I mean by that is people face their specific anxiety head-on in a structured way. So if you’re afraid of spiders, then, yes, I do have the name of a spider wrangler that I can call and he will bring over tarantulas to my office. Now of course, we don’t start off with live tarantulas. It’s usually videos, it’s pictures, it’s maybe going to a zoo or some sort of a museum, a national history kind of deal, but eventually, yeah, you’re playing with spiders in the office and it’s very uncomfortable and the persons has super high levels of anxiety. And I kid you not, two to three hours later, two to three hours later is often all it takes. They are able to actually tolerate the anxiety that they have been avoiding sometimes for years. In terms of doing it at home, we like to say, don’t try this at home, kids, but in all seriousness, you can try a little bit. I might just to approach some of these things. Like if something makes you uncomfortable to watch on the screen, I would stay in that a little bit longer than pulling away from it, but it’s not a bad idea to have a coach when you’re training for something big and it’s not a bad idea to have a therapist when you’re trying to train for the anxiety to build your resilience in anxiety.
Brett McKay: Okay. So if you’ve got some serious anxiety, a coach therapist would be really helpful to guide you through this exposure therapy. Another way people often avoid anxiety or it allows them to do the thing that makes them anxious, but not be there mentally or checked out is substances. How have you seen your patients use different substance?
Dr. David Rosmarin: Yeah. So we were speaking a lot about social anxiety beforehand. Social anxiety and alcohol abuse are like brother and sister, very common, especially among college students, especially among males, I’ll add, that… Although females as well, where people feel socially anxious and they gotta get their liquor courage as they say. That’s really kind of dangerous territory. Firstly, it can clearly lead to substance abuse and alcohol abuse and alcohol dependence and all sorts of other issues there, but the other thing is that if you need a drink in order to be in a social situation, you’re never gonna learn how to feel truly comfortable and how to develop closer relationships with people. And that’s a skill that can leave… I should say, without that skill, you can feel pretty lonely and pretty disconnected. And I think ultimately, we all want that level of you wanna call it emotional intimacy or connection or whatever language you wanna use, and being able to lean into the anxiety actually can help us to get there. So that’s one way that they’re related.
Brett McKay: You talk about another response people have whenever they go down that anxiety spiral, start going down it, is worrying. How is worrying different from anxiety?
Dr. David Rosmarin: Yeah, it’s a great question. So the clinical signs on worry is really interesting. People who worry a lot tend to have low levels of anxiety almost forever, and the reason why is ’cause the worry, believe it or not, it’s a behavior that people engage in in order to keep their anxiety at a low level without actually facing the truth that there’s so much that we can’t control in life and there’s so much that we can’t know. When we worry, we’re like, what if I got sick? What if I lost money? But it’s not like really what if that were to happen. People don’t actually face the real possibility of those terrible situations, which is genuinely terrifying, it is genuinely terrifying and perilous, but that leaning into the real anxiety beneath the worry is where the opportunity for resilience lies.
Brett McKay: Okay. So worrying is kind of a superficial anxiety.
Dr. David Rosmarin: You got it.
Brett McKay: Okay. So if you’re a worrier and you find yourself on that worrying cycle, anything, any advice on getting out of it?
Dr. David Rosmarin: Yeah, this is a tough one, and this is one where a therapist intervention is probably gonna be even harder because it’s a little bit amorphous, it’s a little bit harder to actually do. If you’re afraid in exposure therapy, if you’re afraid of, like I said, spiders before, you’re afraid of heights, so okay, you can physically get into an elevator and look out the window. It’s hard, but you know what you gotta do. With worry, you gotta actually sit and imagine the worst case scenario, and to do it for five minutes a day at a specific period of time and to really delve into the depths of your worry. That can be harder to do. People can do it on their own, I’ve seen it, but that’s the kind of thing where it’s usually you need a little more guidance and someone to give you a little bit more of a push from the outside ’cause it’s so mental. It’s really in your head.
Brett McKay: So just to clarify, what’s the positive version of worrying? So worrying is kind of productive ’cause it’s not actually causing you to confront the thing that’s actually making you anxious.
Dr. David Rosmarin: It’s true.
Brett McKay: What would the flip side of that look like?
Dr. David Rosmarin: The flip side of that is actually becoming brave and learning to accept and to tolerate how little is within the scope of our knowledge and control ’cause we’re human beings. We can only know so much, we can only control so much and actually coming to peace, coming to terms. The analogy I’ll give you is like this, I have this exercise, I do wanna get on a plane where I look at this aluminum box that I’m about enter and I touch the outside of the plane and I walk in over the threshold, and I sit down and I buckle my seat belt and I say to myself, “David, you are not in charge for the next however long.” I’d say it’s a two-hour flight. “You are not in charge for the next to hours. You’re not gonna fly the plane, you’re not gonna know where it’s going. You can look on the screen, but like at the end of the day, you don’t know.” And we have to learn to be okay with that and to embrace the unknown, to embrace the lack of control, and to sort of man up along those lines.
Brett McKay: My experience with worrying, going on the lines that it’s a superficial anxiety, I think one of the problems with worry that I’ve seen is that it makes you feel like you’re doing something but you’re not really doing anything.
Dr. David Rosmarin: That’s well put.
Brett McKay: Yeah.
Dr. David Rosmarin: It’s an attempt to convince yourself that you have control that you really don’t have.
Brett McKay: Right. So that you’re just constantly thinking and going through all these different situations, I could do this, I could do that. And you find yourself eventually just going through the same two or three things over and over again, and you realize, okay, this is actually not doing anything. I just accept that I don’t know what’s gonna happen. There are certain actions I could take, but I don’t have control over the outcomes of those actions.
Dr. David Rosmarin: You’re just gonna do the best you can and the rest you just gotta give it up. In my work, it might not work, and there in lies the challenge, but there in lies the opportunity to be more emotionally resilient and to accept the limits of our control. That’s part of being human.
Brett McKay: Okay. So anxiety in relation to ourselves, our anxiety can… I like the idea that the anxiety can be a signal to what’s important to us in life, or signal to how we can excel or where our strengths might lie, but we might be afraid to embrace that. And we talked about some tools you can do, avoiding the anxiety spiral, embrace the positive spiral. I like this idea in the book you had about how anxiety can either disconnect us or connect us to others. So how can anxiety lead us to be disconnected from others?
Dr. David Rosmarin: Yeah. I think some men in particular, I think are pretty bad at this in our culture, and the reason why is because when we feel anxious and we’re humans or we’re gonna feel anxious sometimes, let’s acknowledge that. Your fight or flight system is gonna get triggered every once in a while erroneously with the anxiety spike. What do you do? Do we actually acknowledge that and say, hey, I’m feeling kinda uncomfortable right now? No, it seems like not like the most guy thing to do, but if you wanna develop emotional connection, I would say generally speaking, especially with females, it’s gold, it’s just gold. It’s the best way to open up and to show that feeling. There’s a vulnerability that comes with it, and I think it can really, truly enhance our connection with others, and it allows people to drop their guard around us and to actually be with us and connect with us on a different plane, but it’s gutsy. It’s a gutsy move to put it out there and to say, hey, I’m feeling anxious. I’m having a hard time.
Brett McKay: Something you talk about in the book is that some people who are really anxious about relationships, they might see that as a weakness, but actually this idea that the anxiety can be a strength. Those people who are really anxious about relationships where they’re like, “Okay, how’s my marriage? Does this guy who’s my boss think I’m a loser or not?” They’re constantly thinking about that. These individuals, they can read people better because they’re more tuned to what people are thinking, feeling, doing, etcetera.
Dr. David Rosmarin: That’s definitely the case. There are these categories of people and people who are flourishing, everything’s going well for them, they got a great business, they got a really nice car, they’ve got a great house, they’ve got everything flying for them often are misreading the emotions of others around them. Typically that’s the most hated boss ’cause he doesn’t pick up on how other people are really feeling and people don’t like them and kids usually hate him. [laughter] I’ve seen this a lot in the clinical setting. But if you look at the anxious guys, people who are a little more likely to feel uncomfortable in certain situations and they actually care about what other people think, they’re more in tune with other people’s emotions, their relationships are often closer and better, and that can predict people’s happiness as we age to a much greater extent than our level of success.
Brett McKay: But just as there’s like an anxiety spiral with ourselves, right? We experience those feelings of anxiety and then we can go down that, okay, catastrophize and then self-judgment. This can happen in a relationship. So someone might be in a relationship with… Let’s say, some guy is dating a woman, but he’s anxious about the state of the relationship, and he starts going down this spiral of like checking in and kind of becoming needy and like, “Oh, are you okay? What do you think about our relationship? I’m really sorry.” And then it becomes… It’s coming from a good place ’cause the guy really wants to make the thing work, but he becomes so obsessed with it that it becomes off putting.
Dr. David Rosmarin: Yeah. And sometimes it destroys the relationship.
Brett McKay:: It destroys the relationship, right? They become overly needy and attached.
Dr. David Rosmarin: Yeah. Or angry by the way. People sometimes say, “Oh, what do you mean? Why’d you say that?” And ’cause they’re taking it personally when she didn’t mean it personally. She was just saying what she said, but he’s emotionally reactive because he’s not aware of his feelings. It’s sort of the fight response or the flight response. The clingingness is one side of it and the other side is getting angry. And yeah, both of those responses are maladaptive and not going to build your connection. And if you care about her, then well, that’s… I think be honest and be open instead and embrace the anxiety and say, “Hey, I’ve been thinking about our relationship. I really like this and I like where it’s going. I’m wondering where you stand.” And it’s hard to put yourself out there and to sort of… And if she’s like, “No, I’m not so sure.” That’s too bad. “I really kind of like this thing and I hope that changes in the meantime”, whatever your plan is. But it’s hard to embrace your anxiety and actually put it out there, but it really builds connection.
Brett McKay: Right. You have to put it out there and then again accept that you have no control of the outcome.
Dr. David Rosmarin: No, she might say no. She might say yes. Who knows? It’s not up to you.
Brett McKay: And I think this is why one of the factors that might be contributing to… You read a lot about young people having a hard time with relationships these days and I think it goes back to this idea of a sense of control. We feel like we can control every aspect of our lives, including our relationships so we want our dating life to be perfect, our marriage life to be perfect. And so we try to do all these little tactics to control everything, but that just makes us more anxious about those relationships, which just makes it harder to have those positive relationships.
Dr. David Rosmarin: Yeah, definitely. All relationships are real relationships and great relationships are messy. They’re just messy. People have miscommunications and misunderstandings, they rub each other the wrong way, they have these interactions which are problematic and these patterns that often stem from childhood and butt up against each other. And therein lies the opportunity to actually create real connection. I think it’s a lost art in our society, the art of love, if you will. I think it’s a lost art and not in our favor.
Brett McKay: So you mentioned anger.
Dr. David Rosmarin: Oh, yeah.
Brett McKay: How can anxiety be a source of our anger?
Dr. David Rosmarin: Now, when I see angry people, almost always, almost always, the root of it is anxiety, but they’re not expressing it, and sometimes they’re not even aware of it. And it’s amazing. We talked about this at the beginning that the anxiety response is based on fear, which is called the fight or flight response. Remember fight? So fight is anger and that’s often what happens. When somebody does something that makes you anxious, you have a choice. You can say to them, “Hey, what you’re doing is making me uncomfortable.” Or some sort of language around that. Or you can just say like, “You jerk, stop doing that. What’s wrong with you?” And blaming them as opposed to sharing how you feel. And that blame, that anger is the exact opposite. That’s leaning away from your anxiety, that’s covering it up making it harder to connect with others, and usually it pushes people away.
Brett McKay: Okay. So if you have an anger problem, maybe look at, okay, what am I potentially anxious about in life and then work on that.
Dr. David Rosmarin: Yeah, definitely. It’s hard to get there because anger is usually a way of avoiding the feelings of anxiety. So you might need a therapist to actually probe the depths of that. We call it a secondary emotion anger because it’s a response to the primary emotion of anxiety. Sometimes sadness, but often it’s anxiety, most often.
Brett McKay: Gotcha. So with anxiety, there’s either the flight, fight response, right? Fight or flight. So anger is the fight response. Like I’m going to get really angry about this, I’m going to do something about it. The flight response would be, I’m going to avoid the situation completely. You’re arguing that if you really want to thrive with anxiety, that’s like the third way. You just kind of have to sit with it and be okay with it.
Dr. David Rosmarin: Sit with it, tolerate it, and then find a positive way to do it which might mean expressing it and saying, “Hey, I’m really having a hard time right now. I’m having an anxious moment.” And if you can’t do that in a romantic relationship, then at least doing that with a friend or with a therapist for that matter. Just being able to get it off your chest is really, really critical and something that we have to learn how to do as humans.
Brett McKay: Something you do with your practice is you bring in spiritual traditions from around the world to help people with their anxiety. How have you done that with your work?
Dr. David Rosmarin: Yeah. Well, first of all, I want to say it’s dependent on the patient and this is only for people who want it. When I was writing this book, the publisher, HarperCollins, they said, “Well, we want a third of the book to be devoted to this subject ’cause we think that people in general are going to want spiritual approaches.” And I said, “Sure, I’m very happy to do it.” And I try to use really accessible language, which comes across different religious traditions. I say it’s for people with any faith or none at all and I stand by that. And I think the spiritual concepts in the book are very broadly applicable. So just that sort of preamble. From a faith perspective or from a spiritual perspective, I should say, what’s wrong with anxiety? It’s a very biomedical, materialistic, reductionistic approach to say that human being should never feel anxious, should never feel uncomfortable, should never have any pain. And I just think when we take that approach and we apply it to our emotions, the spiritual lens is that, well, maybe there’s a higher purpose, maybe there’s something greater in our lives. Maybe we’re here to self-actualize and to bring out our potential in this world, maybe we’re here to build connection with each other. And emotional distress can enhance every single one of those processes, every one of those processes. So here’s a place where I think the spiritual traditions approach anxiety so much better than the current biomedical model.
Brett McKay: So what are some practices that you’ve done with your patients to incorporate the spiritual aspect?
Dr. David Rosmarin: One of them is understanding that and I talk about this in the book, what are your biggest goals? What are your biggest dreams? What do you really want to be doing? Is your current job… Is your current day-to-day life reflective of your core values of what you really, truly want to do? And if the answer is no, usually anxiety is involved because it’s scary to pursue your deepest dreams and to try to bring out your latent potential in the world. Even to think about it can be really terrifying ’cause what if I fail? What if I fail? What if I can’t quantify my results? What if it has to be some sort of qualitative complicated way of evaluating whether I really achieved and I won’t even know? Nobody will know. So it gets anxiety provoking but I think from a spiritual perspective that that’s the case. Anxiety can actually enhance our spiritual growth and our self-actualization ’cause it’s part and parcel of self-expression.
Brett McKay: Right. And also you talk about just looking at spiritual traditions from history and around the world, all of them usually have a tenant about human beings they don’t control the world. You are not the center of the universe and your goal in life is just to figure out how to navigate the world in which you have no control.
Dr. David Rosmarin: At the center… And clinical science has borne this out. At the center, at the core of anxiety is an intolerance of uncertainty and an intolerance of uncontrollability. If you need to know and you need to be in control, you will feel anxious, I promise. You are going to feel anxious. And I think spiritual traditions teach us that there are human limits, there just are human limits and whether you believe in something greater or even if you don’t, I think all of us can understand that we didn’t choose whether to be born, when to be born, where to be born, and a zillion other factors that have a colossal impact on our day-to-day. There’s so much that we don’t know, so much that we can’t control and can we come to a place of acceptance of those terms? I think spirituality can enhance our acceptance and our awareness of our human limits.
Brett McKay: So there’s a few books that I’ve read during my lifetime that have hit on this idea that humans, the limitations of humans and your inability to control everything. “Bhagavad Gita”.
Dr. David Rosmarin: Sure.
Brett McKay: A really big one. Like at the opening scene, you have Arjuna basically having anxiety attack, right? He sees this great war unfolding before him and he says, “My limbs sink, my mouth is parched, my body trembles, the hair bristles on my flesh. The magic bow slips from my hand. My skin burns. I cannot stand still. My mind reels.” And then he gets a lesson from Krishna saying, “Yeah, you don’t have control of everything. You can’t control the outcomes.” Book of Job, another good one that I like to read. I know Abraham Lincoln loved to read the Book of Job, particularly during the Civil War. “The Odyssey of Homer” another one where character doesn’t have any control over the outcomes and then another one that I really like is “Lonesome Dove”. People who’ve listened to this podcast a lot know I’m a big fan of “Lonesome Dove”, but I think that novel, one of the themes is just how life is constantly changing and you don’t know what the outcomes are going to be, but you just have to deal with it. You just kind of have to live with it and accept whatever outcomes come your way. So there’s some, I guess we can call them, spiritual books that have helped me out.
Dr. David Rosmarin: I love that. Sounds like a great collection and it sounds like something that’s also missing from the education of many young people today to our detriment. We live in a society that prizes itself on predictability, on controllability, on quantitative measures as opposed to really embracing the limits of our humanity.
Brett McKay: And another one, you talk about this one in the book, one of my other favorite books, “Man’s Search for Meaning” by Viktor Frankl.
Dr. David Rosmarin: Sure, Viktor Frankl. Yeah, Viktor Frankl, his whole story was incredible and really having to accept really incredibly trying horrific circumstances and finding meaning despite that, or maybe even because of it, I’ll say.
Brett McKay: So we’ve talked about a lot in this conversation. Is there… Let’s say someone’s listening to this podcast and they’ve got an issue with anxiety, right? It’s a problem in their lives. What’s like one thing that someone could start doing today to start turning their anxiety into a strength?
Dr. David Rosmarin: The one thing that I would say is do something that makes you anxious once a week. It doesn’t have to be a huge thing, it doesn’t have to get you to an eight or a nine on a scale of zero to 10 of anxiety, but try to do something that’s going to get you to a four or a five and when you feel anxious, when you feel anxious. In response to that, instead of squelching it, allow yourself to experience it. Take a look at your watch, see how long it’s going to last. And if you don’t fight it, I’d be shocked if it lasts more than five minutes.
Brett McKay: I love that. And I think that that goes back… What you just said goes back to the beginning of our conversation, right? Like each time you do that, it’s like you’re going to the gym and doing a workout. You’re building your bravery and your resilience muscle. Well, David, where can people go to learn more about the book and your work?
Dr. David Rosmarin: Sure. So my author’s website, which actually is a free giveaway of a 12-page guide that people can use whether or not they buy the book, which is based on the nine tools. So people are welcome to check me out at dhrosmarin.com. The book’s available wherever books are sold, including our audible, and even on Spotify, I actually saw it. So the audio book is available. And I love to hear from people about the topic of anxiety and about the book and I can be contacted through the website.
Brett McKay: Fantastic. Well, David Rosmarin, thanks for your time. It’s been a pleasure.
Dr. David Rosmarin: Hey, thanks for the great chat. Really appreciate you having me on your show.
Brett McKay: My guest today is Dr. David Rosmarin. He’s the author of the book, “Thriving with Anxiety”. It’s available on amazon.com and bookstores everywhere. You can find more information about his work at his website, dhrosmarin.com. Also check out our show notes at aom.is/thrivingwithanxiety where you find links to our resources we delve deeper into this topic.
Well, that wraps up another edition of the AOM Podcast. Make sure to check out our website at artofmanliness.com where you can find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you haven’t done so already, I’d appreciate it if you take one minute to give us a review on Apple Podcast or Spotify. 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 who you think will get something out of it. As always, thank you for the continued support. Until next time, this is Brett McKay, reminding you not only to listen to the AOM Podcast, but put what you’ve heard into action.