Hope Starts With Us: Stress, Anxiety & Coping

In this episode of NAMI’s podcast, NAMI CEO Daniel H. Gillison Jr. speaks with author, clinical psychologist and leading anxiety researcher Dr. Tracy Dennis-Tiwary about how we can cope with stress and anxiety during Stress Awareness Month and beyond. Tune in to hear about the role technology can play with stress and anxiety, how we can harness difficult emotions for good, and how we can cope through healthy practices like mindfulness and meditation.
 

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Featured Guest:

Dr. Tracy A. Dennis-Tiwary, Ph.D.

Follow on Twitter: @tracyadennis

Dr. Tracy A. Dennis-Tiwary, Ph.D., is a professor of psychology and neuroscience, Director of the Emotion Regulation Lab, and Co-Executive Director of the Center for Health Technology at Hunter College, where the mission is to connect researchers, community stakeholders, and technology innovators to bridge the healthcare gap. As Founder and CSO of Arcade Therapeutics, she translates neuroscience and cognitive therapy techniques into gamified, clinically validated digital therapeutics for mental health. She has published over 100 scientific articles and delivered over 400 presentations at academic conferences and for corporate clients. She has been featured throughout the media, including the New York Times, Wall Street Journal, ABC, CBS, CNN, NPR, The Today Show, and Bloomberg Television.  

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Episode Transcript:

DR. TRACY DENNIS-TIWARY (00:01): I really believe that the flip side of anxiety is hope. It’s not despair because when we’re despairing, we’ve given up. But when we’re anxious we’re still in it to win it. When we learn to work with it, when we learn to channel it, when our interpretation of it allows us to feel like it’s actually a normal part of being human. It’s the messy work of being human. We can learn skills to be anxious and to cope in the right way.

DAN GILLISON (00:26): Welcome to “Hope Starts With Us,” a podcast by NAMI, the National Alliance on Mental Illness. My name is Daniel H. Gillison Jr. I’m the CEO of NAMI, and I’m your host for this podcast. We started this podcast because we believe that hope starts with us, and there’s five reasons.

Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice. Hope starts with us sharing our stories. And last, hope starts with us breaking the stigma.

If you or a loved one is struggling with a mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode with each conversation brings you into that collective to know you are not alone.

Today, I’m joined by clinical psychologist Dr. Tracy Dennis-Tiwary, who wrote the book “Future Tense: Why Anxiety is Good for You, Even Though It Feels Bad.” She is also the founder and CSO of Arcade Therapeutics, as well as a professor of psychology and neuroscience, director of the Emotion Regulation Lab and co-executive director of the Center for Health Technology at Hunter College.

As April is National Stress Awareness Month, we’ll be talking today about stress and anxiety and even reframe our thinking about it to minimize negative impacts. So, let’s talk for a second about good versus bad stress. What many people don’t realize is that there is both good and bad stress. Good stress — what psychologists call “eustress” — can actually help motivate us to overcome challenges.

For example, have you ever felt nervous before giving a big test or competing in a race or something similar, and not only before giving a big test, but before taking a big test? The stress and anxiety you feel beforehand can actually help motivate you to study and train more. The increased blood pressure and adrenaline, your body produces can actually help you focus more clearly and perform better.

But when stress is chronic and unmanageable, stress can have negative impacts on our bodies and minds over time. For example, being in an environment where you are constantly put down or told your work is never good enough or in situations of abuse, or experiencing what many researchers have deemed adverse childhood experiences, can lead to toxic stress that can have long-term damaging effects on learning, behavior and health over time.

When your body is constantly on high alert, but there is no way to overcome the obstacle, you can begin struggling with your sleep, experiencing depression and burnout, gaining weight and dealing with a great deal of health issues. Stress can also be cumulative. The small stressors we encounter throughout the day, like being stuck in traffic, can actually add up over time and begin to take a toll on us if we are not careful to continually manage those small stressors.

Stress can also turn into good or bad stress, depending on how we actively choose to interpret it. I’ll repeat that line. Stress can also turn into good or bad stress depending on how we actively choose to interpret it.

Tracy, you’ve done a lot of research and speaking about this topic in particular relation to anxiety. In fact, you even have a book about it as well. Can you talk to us more about how we can use anxiety and stress for our good? Is there a difference between the two?

DR. TRACY DENNIS-TIWARY (04:16): Thanks so much, Dan and I love that introduction because so much of what you said about stress really helps us think about anxiety. And I think that that phrase you were emphasizing at the end there about interpretation is really important to part of what I think we need to talk about when we talk about anxiety. So, like good and bad stress, there’s good and bad anxiety in the sense that the emotion of anxiety is good.

It’s an anxiety disorder when we’re really struggling with coping with those feelings of anxiety that become bad. And that’s even the distinction that we make as clinical psychologists when we diagnose anxiety disorders. You can have frequent and kind of intense anxiety almost every day. But it’s only when the way that we cope with those feelings cause what we call functional impairment — that is this, this way that we’re coping is getting in the way of living and loving and being productive and having joy — that’s when a diagnosis is given.

And so really, one of the biggest things I’d love people to consider when it comes to the emotion of anxiety is that we evolved to have it. It’s an emotion that none of us will ever escape. It’s the inevitable, right? And here’s where defining anxiety might be helpful here — because anxiety is not the same as fear, and it’s not the same as stress. And we often sort of conflate all three of those words because they feel similar. But anxiety is the emotion that we evolved to have when we’re facing the uncertain future.

So that means that when we’re anxious, we can all attest to this feeling like, you know, you talk about test anxiety and test stress. When we’re anxious, we’re looking into this uncertain future, and we know that something bad could happen. We could fail that test. But anxiety is also telling us that there’s still hope that we can work hard and make the positive outcome into reality. So anxiety inhabits that space between where we are now and where we want to be. And it evolved to show up to give us that information and didn’t prepare us to take productive action to avert disaster and make our dreams come true.

So, I say this sometimes, and it’s sort of makes people do a double take, but I really believe that the flip side of anxiety is hope. It’s not despair because when we’re despairing, we’ve given up, but when we’re anxious, we’re still in it to win it. When we learn to work with it, when we learn to channel it, when our interpretation of it allows us to feel like it’s actually a normal part of being human. It’s the messy work of being human, and we can build skills to learn to be anxious and cope in the right way.

DAN (07:02): Wow, that is so powerful, and thank you. This is just building on a wonderful conversation we’re going to have. Our world continues to become increasingly complex, and the last few years have been especially stressful for many. Something that has become more incredibly helpful, but also somewhat harmful for people in our modern world, is technology. In one sense, because we had this 24 seven access to email work, social media, news, communications, there is a sense of constant pressure, endless comparisons and competition and frequent notifications that can cause stress and anxiety in ways that we really did not have to worry about before.

In another sense, we’ve been able to harness technology to actually make advancements for how we can access tools and resources to cope with stress and anxiety. Tracy, you’ve done this with your work through Arcade Therapeutics that actually create games people can play on their phones that can help them manage anxiety. Can you speak more about how technology can and has brought both challenges and advancements for people in dealing with stress and anxiety?

TRACY (08:14): This is a question we’re all wrestling with because digital technology is the infrastructure of our lives today, and as a parent, I know a lot of us parents are very worried. My view is very you know, it’s very much what you were alluding to when you talked about digital citizenship. This idea that whether it’s our digital lives or helping our kids navigate theirs, we can we can blame technology for things — and I think there are some things we can blame technology for — but one of the key things is that things are that technology is an amplifier of whatever we bring to the table.

And it’s not so much how much screen time we’re spending — although clearly that’s an opportunity cost if we’re too much on screens, and we’re not doing other healthy things — but it’s not just how much more on but what we’re doing when we’re on screens.

And so when we think about making wise choices around technology use, we can do a sort of mental checklist, you know, how is my time on screens? Is it taking away from things I want to do in the real world or health choices that I want to be making? What needs am I getting through technology? Am I going there because I’m lonely?

Well, often when we use social media, we feel a lot worse after we’ve gotten off. I don’t know about you, but I know kids today too, they feel very drawn to using it. It’s how they grew up. But often when they come off of it, they’re not feeling better or more inspired or more hopeful.

So we can teach our kids, and ourselves really, to ask the question, what are we getting from technology and what is it taking from us? And if we’re seeking out connection, if we’re seeking out not feeling so lonely or learning or whatever it is? How do we divide our time in meeting those goals between screens and the real world?

Because the fact is that there’s only some kinds of social connection that are really good on screens. It’s, you know, it’s great ways to get more information, learn something new, bridge our contacts. But that’s not where we go for really deep connection. It’s just not going to happen. That’s not what it’s good for.

In my work with Arcade Therapeutics, we develop clinically validated games for mental health. So we actually embed clinical treatments for things like anxiety disorders, depression and substance use disorders in a game. Now, we’re really committed, though, to not causing more screen time. You know, we don’t want to add to the screen burden, but we also want to optimize digital for what it’s good for, which is to lower barriers to access, to engage people, to give them hope — because sometimes, you know, especially when we play games, if it’s on the screen, if it’s in a game, all of a sudden stigma has been reduced, and we start to think about these tools as things that, you know, it’s not that we’re broken, it’s that we’re building new skills. So at Arcade, we’re really excited about using this great science on techniques like cognitive bias modification, which is sort of in this cognitive behavioral therapy umbrella, but really retrain our brain to gain more flexibility in our habits of thinking habits… like when we’re anxious, and we pay too much attention to threat.

So if I’m giving a speech and I’m a socially anxious person, you know that when I look out into that audience, I’m going to see 100 people in front of me. But I will have a spotlight on that one guy in the back falling asleep or frowning. And these are habits that drive the vicious cycle of anxiety. It’s called the threat bias. What we do in our therapeutics is we create these techniques, embed them in games that help us rewire that habit, gain more flexibility. And all of a sudden we’re able to notice more flexibly, oh, are 99 people smiling at me and really excited about the speech I’m giving in front of this audience today.

So these are the kinds of nudge interventions that actually show clinical evidence of reducing anxiety severity alone and also boosting the effectiveness of other kinds of techniques. So I think when we think about screens, we have to think, what are they good for? Are they good for deep social connection or for bridging social connection? Are they good for hours and hours of therapy? Sometimes they are. But maybe they’re also good for these brief interventions that can help them heal.

DAN (12:31): You know, Doc, what you what you’re sharing is so incredible. And we’re not going to go backwards from the standpoint of stepping away from technology — our lives are digital. And you mentioned using technology as an amplifier. We see a lot of young people now that there’s another word I want to use called trust. They trust technology before they trust humans from the standpoint of they will trust something they will get from their device before they will trust that same information from a person.

It’s almost like because many of them have grown up with technology. Recently at a grocery store, I was at a grocery store, and I saw two examples of this. I saw a father whose youngster was really distressed because he was using his phone, and she wanted his phone. And this was a little toddler, no more than maybe three or four, as soon as he finished with whatever his text was, he handed the phone to her and she started playing again. And he could then go into the grocery store and do his shopping.

So another example of a parent that had almost like, I don’t know, a large type of a device that had a screen. And as they put the child in the shopping cart, she hands her this device and she’s totally focused. The little one is totally focused on her game that she’s playing. And you can see that both of these parents, two different parents, two different situations, were using the tools for other reasons. But we know technology is the amplifier. And if we do want to work on helping people to understand how to use it, how do we help as adults, parents navigate what is and what isn’t, what needs to be and what can be from the standpoint of embracing technology?

TRACY (14:36): I mean, it’s really about these choices we make every day, and it’s about the family cultures that we create. So those two examples are such interesting examples because we see them all the time. The fact you even notice them is incredible, right? Because you’re paying attention. And you know, my kids are 14 and 11. And I was sort of at this cusp where this technology emerged just before I kind of had my kids, I, so I sort of had time to figure out what I wanted to do about it.

And we made a decision really early on that, you know, we’re not going be screen-free. We’re going to allow some screens, but we’re going to be very aware of what we’re using the screens for. If we’re handing our kids screens all the time… Now, listen, I’ve had handed my get a screen before. God knows, you know, how during a long plane flight or whatever, you know, sometimes you do it.

But if every single time a kid is uncomfortable, is bored, makes noise, if what we do is give them the screen, we’re teaching a very specific habit that will take hold that when that young person becomes a middle schooler and a high schooler and an adult, any time they feel discomfort or boredom, they’re going to reach for that screen.

And these screens are giant escape machines. We can escape whatever’s going on in the moment, we can escape our feelings. And so if we’re amplifying as a way to cope this one solution at the expense of others, I think that’s where the problem comes in. So we have to think, where is our balance?

You know, again, I don’t want to parent shame. I don’t want to be all or none. So it’s really about, okay, this one grocery store visit, I’m going to give my kid that screen. But then you say, you know what? Next time, I’m going to hand them a more creative toy to play with so that they’re not being just passive, They can be active.

And that’s the other thing we look for on screens. Are we being active creators or passive consumers? And one thing that I get very concerned about that we don’t talk enough about with screens and social media is we are training our children to be massive consumers. We are training them. And that’s what these tech companies want, I have to say.

And they’re not well-intentioned about it. They’re not out there for our well-being. They’re businesses. So we have to have our eyes completely open and know that our kids are being trained to consume and to click and to buy and to be on hours and hours, because that’s their business model. So we can disrupt that and give our kids knowledge to make more choices about how they’re using screens and when they’re on and off it. I think that’s a really important first step.

DAN (17:12): You know, this is wonderful. And then I’m not into the parent shaming as well. I brought up those two examples because we have what we call a “Next Gen” group — these are young adults that are working with us — and I got a chance to meet with them not too long ago. And what was interesting is they were very nervous to meet with the CEO. But as soon as I showed them something that we had with technology, they embraced it, and they were on the edge of their seat, and they loosened up.

I want to come back to something you said that helps all of us, which is cognitive behavioral therapy and our habits of thinking. And you talked about threat bias, and you use the example of someone who gets anxious in doing public speaking. That was such a wonderful example. And if you have some other thoughts on that, as we as we as we talk, please share because the other thing is how do we get the message out to more people about how technology can help them with their habits of thinking?

That is something that we need more people to know: the upside, the positive, the engagement of how it can help them improve their level of comfort in those anxious moments. So, I’m really excited.

So, for me, for someone who is listening, it might be feeling particularly stressed out or anxious. Today, my first day back after some significant travel. Do you have any practical insight or words of wisdom for what I or anyone else that does quite a bit of traveling can do to help cope with those with those feelings in a healthy way?

TRACY (18:52): That’s such a great question. So, the thing about anxiety and stress, as you were talking about in the very beginning, is, you know, our perspective on it shapes how we respond because our mindset is what we perceive and believe about this experience. Right? And the direct result is what we do. So our mindset, the dominant mindset about the emotions that feel uncomfortable, like anxiety, is that — well there are sort of two mindsets really.

One is that there’s a disease mindset, and there’s a character flaw mindset. And the disease mindset, real briefly, is just this idea that if we feel anxious, we’re broken; if we feel anxious, it’s a failure of mental health. And so what we do when we feel that way is we start to lose confidence in hope, in our ability to cope.

So I think this disease mindset, even though there really are anxiety disorders that need help and treatment, is actually setting us up to do a very destructive thing when it comes to anxiety and coping, which is to engage. That is when we fear anxiety, we start to avoid it, and we do the same thing with the character flaw mindset when we feel it’s a weakness, that it’s a failure of our strength of character, we should just pull ourselves up by our own bootstraps.

We start to avoid all experiences of anxiety. And what does that do? First of all, anything we suppress makes it stronger, and it’s an opportunity cost. You can’t learn to cope with something you never allow yourself to experience. And so for me, as I think about tips for whether it’s travel anxiety or whatever kind of anxiety, we start with the idea that anxiety is a normal struggle and a normal emotion.

Then we have three L’s that we need to go through. These are my little my little mnemonic tips the three L’s stand for, listen, leverage and let go. Now, the listen part is important because when we’re anxious, say it’s about traveling or something else coming up in our life. Yes. Sometimes it can be, quote unquote, irrational or maybe it’s not helpful.

But often when we listen to anxiety, we find out there’s something it’s telling us. So for me, I wake up a lot and there’s a lot on my head or there’s stresses at work. I wake up at 4 a.m. in the morning, I’m in bed. Right? I think it’s not an uncommon experience, and it happens like clockwork for me when there’s just too much going on.

And at those moments I could sweep those feelings under the rug. But when I choose to listen to anxiety, what I do is I calm down, maybe I breathe, maybe I, you know, some people meditate. You take a moment, you take a breath and allow that space. And pretty soon, 95% of the time, I discover that there’s something really important that I dropped the ball on.

So, for example, the other week I had a lot of work stress going on, and I just paused and listened. At 4 a.m. in bed, I realized, oh gosh, there was something I left undone at work that’s really negatively affecting everything else right now. I thought I could just forget about it. I thought I could get past it.

I need to take responsibility and deal with this. And the minute I listened to that knowledge, that that wisdom really that was coming from that uncomfortable feeling, my anxiety started going down. And then I realized, Oh, I need to actually make a plan. I need to do something. And that’s where leveraging comes in. So I said, I’m not going to do it now, I need a little more sleep, but I’m going to when I get up — I’m going to send this email, I’m going to have this conversation.

I just made this like rough plan about what I would do when I woke up. And then when I made that plan, my anxiety went down even further because that told me I was on the right track because now I’m not treating anxiety as a destructive danger, but as actually information because that’s what emotions are. And then and only then, after I tried to listen, I leveraged it a bit.

I used it for purpose, for action, for planning. Then I let go and then I said, okay, I need a couple more hours of sleep. So I did my breathing techniques. I love the four, seven, eight technique where you breathe in for four, hold for seven, exhale for eight. It’s a great biological calmer and I was able to get back to sleep.

And so that’s just a small little example of how when we when we experience anxiety, it’s coming on deck for us, if we can create a little space between having the emotion and reacting to it, we can start to actually build these coping skills. Listen, leverage, and then let go. And with practice, it’s not going to work great the first time maybe, but we will get better with practice because the anxiety, like all emotions, with these emotion regulation skills, we can build them. Even when we take steps back, we can keep building these skills and get better and better every single time.

DAN (22:29): Doc, this is this is incredible. And I have another I have so many questions I want to ask you because, you know, and then in in my role in this, as well as my colleagues and peers, there’s always something to be anxious about. And it’s how we manage it. But we need tools as well.

So I want to ask you, because you are just incredible in terms of all the roles that you have. And I want to know what do you do personally to manage your anxiety and stress levels as someone who has clearly has a tremendous amount to balance and you do it quite well. But between your role at Arcade Therapeutics, as an author, as a researcher, as a professor, as a public speaker, oh, and as a mom and a wife, how do you manage anxiety and stress?

TRACY (24:22): Well, Dan, I don’t always manage it every day. So that’s one thing. I do want to say that mental health is not some destination where it’s like everything’s perfect. It is messy, right? It’s not the absence of struggle, it is the struggle. So I want to start by saying that, you know, that’s one thing. And even telling myself that helps me in coping because I forgive myself, I’m less hard on myself, and all of the horizons, the possibilities that are there for me, I think they open up more when I don’t shut myself down. So that’s number one.

Number two is, you know, I think all of us, we can think back to the height of the pandemic when we were in lockdown and there were really bad things that were happening to people.

I do want to say that as we talk about, you know, mindset or interpretations, you know, I really want to pay respect and heed to the fact that that life is really hard for many people a lot of the time. And there are things out of our control. And at the same time there are things we can do.

And a big part of that — keeping that hope that you started this whole conversation with, which I was so grateful that you started that way — is to know that when we tune in to our difficult feelings and our emotions, we listen, leverage and let go (because that is the first thing I do every single time), is we realize that we can gain wisdom about what we can’t control.

Like in the pandemic, we couldn’t control that there was a global pandemic. It was happening. Many of us had terrible loss, terrible challenges. But when we actually listen to anxiety, which is sending us into the future, where there’s still possibility of hope, we can often find something that we can do. Many of us connected more with family and loved ones in whatever ways we were able to.

Many of us made changes in our life that were overdue because we realized that our joy to crap ratio — forgive me for using that word — but that ratio was out of balance, and we needed to make some new choices. So that’s really important. And then I think and then I think having daily routines that don’t take a lot of time, but that set you off on your day.

Like I start every day, even days I don’t have time, even with a 30-second intention or a 30-second wellness practice. That for me just reminds me to keep oriented to making good choices for myself. That’s something I start each day with. And then one last thing, there are literally two acronyms that helps me remember. I start each…