Debt Doesn't Cause Anxiety: This Does

Debt doesn’t cause anxiety.
The fear of not being able to repay it does.

In this episode, Dr. Vicki Rackner unpacks the real reason debt triggers so much stress for physicians — and why unmanaged debt anxiety can quietly sabotage your wealth-building.

Medical school loans. Practice buy-ins. Mortgages. Investment leverage.

These aren’t character flaws. They’re financial tools.

But when your safety brain takes over, even smart, math-backed decisions can feel like drowning.

In this conversation, you’ll learn:

• Why debt is a neutral number — and why context changes everything
• The difference between good debt, bad debt, safer debt, and concentrated risk
• Why your safety brain activates around leverage
• How trauma and past financial experiences shape your reactions
• The 2×2 Debt Matrix framework
• 10 practical tools to regulate anxiety so your planning brain can lead
• The difference between anxiety and intuition

If you’ve ever woken up at 2 a.m. worrying about debt — even when the numbers work — this episode is for you.

Financial leadership is nervous-system leadership.

Anxiety belongs in the room — but not in the driver’s seat.

📥 Download the companion report in the show notes to reinforce the ideas and apply them to your own financial decisions.

—

Dr. Vicki Rackner is a retired surgeon and founder of The TrueWealth Way — a framework that helps physicians build wealth without burning out by aligning money decisions with nervous-system regulation and long-term vision.

Subscribe for more conversations about:

• The Three-Brain Model
• Building net worth with intention
• Moving from burnout to TrueWealth
• Emotional tolerance in investing
• Financial adolescence → financial leadership

You don’t need to eliminate fear to build wealth.
You need to learn how to lead yourself through it.

For more tips and strategies about how to get more of what you want--and less of what you don't.

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Transcript

0:10

Debt Doesn’t Cause Anxiety. This Does. Have you ever experienced anxiety about debt you carry? Here’s what you need to know. Debt doesn’t cause anxiety. The fear of not being able to repay it does.

And if you don’t learn how to manage that fear, you’ll do exactly what many well-intentioned do: 0:13

you’ll avoid leverage, delay investing, and slow the rate at which you build wealth—even when the math is on your side. I was speaking with a physician who had taken on a significant debt to scale a profitable entrepreneurial venture. She ran the numbers with her trusted advisors. They all concluded this was a safe investment. Still, she said that she got up in the middle of the night with debilitating anxiety about her debt. What if she was wrong about the future of her business? What if she lost her money—and more troubling—her investors’ money? Anxiety around money—especially debt—is incredibly common for physicians. Medical school loans. Mortgages. Investment leverage. This isn’t a character flaw. It’s a predictable human response to perceived threat. Today let’s have an honest conversation around debt. We’ll explore what debt is—and what is is not. We’ll deconstruct debt-related anxiety. And, last, you’ll take away some specific ideas about how to manage that anxiety so you can make the reasoned investment decisions that will help you accelerate the rate at which you build your net worth. In the show notes below, please download a special report to reinforce the ideas, If we haven’t met, I’m Dr. Vicki Rackner. I’m a retired surgeon ho helps doctors get more of what they an and less of what they don’t want through the process of The TrueWealth Way. Let’s kick this conversation up with another story. After I delivered a talk, a physician finishing his fellowship training approached me. He said, “Each year in college and medical school, I took out loans. For eight years I felt like I was wading into a sea of debt. Each year the debt came higher. To my knees, to my thighs and to my waste. Today as I think about my career launch, the buy-in to the practice I want to join and my mortgage, it feels like the debt is up to my chin. I fear drowning in debt. Here are some ground rules to guide our conversation. Ground Rule #1 Debt is just a number; it’s a neutral condition that had no inherent meaning. When you look at license plate numbers, you rarely tell a story about them. Numbers are just numbers. However, the numbers you use to measure your finances don’t feel neutral. You might tell a story about what it means to carry debt. However, your debt does not not define the nature of your character, your self-worth or your moral compass. Debt-related anxiety is caused not by the debt but by the story you tell about what it means to carry debt and your ability to pay it back. The way you manage your debt says something about you. You credit score is a number that describes how responsibly you manage debt.

Ground Rule #2: 0:27

Debt Feels Different at Different Income Levels Borrowing $100 as a teenager can feel overwhelming. Borrowing $100 as a practicing physician barely registers. The number didn’t change. Context did. That alone tells us anxiety isn’t about the number itself. Ground Rule #3. Debt offers leverage. Leverage is your ability to do more with less. Think of an Allen wrench. When you use the short end in the screw, the long arm gives you more force. That’s leverage. Debt allows you to grow your net worth more quickly. It’s why many high–net-worth individuals use debt strategically—especially in real estate. Micro-loans to women in third world countries can transform their lives. Debt offer the power t transform, or grow more quickly.

Ground Rule #4: 0:37

Interest Is the Cost of Leverage Interest isn’t a punishment. It’s the cost of using money. Like paying for cleaning your house or traveling—you’re paying for access. Interest rates can be negotiated. They’re part of the structure of a deal—not a moral judgment.

Ground Rule #5: 0:42

Not All Debt Is Equal Using debt to fund lifestyle consumption is generally considered bad debt. Using debt to acquire or grow assets is often considered good debt. Even then, the numbers have to work. Good intentions don’t override math.

Ground Rule #6: 0:46

The Planning Brain Must Be Online We’ve talked about the architecture of your nervous system. Think of your brain as three brains in one. Your best financial decisions that serve you the best are made in your planning brain. In your pre-frontal cortex. But debt conversations often activate the safety brain. This is the part of your brain that perceives a threat to you life. After all, money is our ultimate survival resources. Debt-related anxiety is initiated in your safety brain. Then there are only three things you can do—fight, flee or freeze. And none of these will allow you to harness the wealth-building power of debt.

Ground Rule #7: 0:49

Risk Is Always Part of the Conversation Let’s get real. All investing involves risk. You can lose money. Courage and fear can coexist. I’m about to invest in multifamily real estate—and yes, it’s scary.

I recently attended a meeting of physician real estate investors. One physician at that meeting said something unforgettable: 0:53

“I’m millions of dollars in debt—and my goal is to be tens of millions in debt.”

What he meant was this: 0:54

asset-backed, intentional leverage. Not bravado. Math—paired with emotional tolerance. Debt doesn’t eliminate risk—it concentrates it. Ignoring risk creates anxiety. Naming and planning for risk creates leadership.

The 2×2 Matrix: 0:59

How to Think About Debt

I find it helpful to think about debt on two dimensions: 1:01

* What it’s used for* How much risk it carries That gives us four quadrants.**Good + Safer Debt** Medical school debt. Education or coaching that increases earning power.**Good + Riskier Debt** Startups for accredited investors. Highly leveraged real estate.**Bad + Safer Debt** Low-interest car loans. Zero-interest promotional financing. Affordable lifestyle upgrades.**Bad + Riskier Debt** What I sometimes call the *“Dumb Doctor Deal.”* This isn’t about intelligence. It’s about concentration and lack of diversification. One deal. One partner. One income stream. Significant leverage. When everything has to go right, your nervous system knows it. Your The Three Brains and Debt Here’s where anxiety enters.

The Planning Brain says: 1:14

“I’ll run the numbers and decide whether this is the right time for debt.”

The Here-and-Now Brain says: 1:16

“Go ahead—put that vacation on your credit card. You can easily afford the minimum payments.”

The Safety Brain says: 1:18

“You could lose everything. That would ruin your life—and maybe the lives of others.” None of these brains are wrong. Problems arise when one brain runs the show alone. A Critical Rule About the Safety Brain You must verify messages from the safety brain. Its job is not accuracy. Its job is survival. Sometimes the safety brain is right— just like a broken clock is right twice a day. The problem isn’t that it’s wrong. It’s that it doesn’t know *when* it’s right. The safety brain is a smoke detector—not a fire marshal. It alerts you to danger. It cannot tell you whether there’s actual fire. Fear deserves attention—but not authority. When Debt Meets Financial Trauma Many people who lived through the Great Depression avoided debt for the rest of their lives. Not because they misunderstood leverage— but because borrowing hurt them. The bank called in loans and families lost their asset. Some people who lived through the great depression had their relationship with money forever changed. They never felt financially safe. They experienced financial PTSD. Trauma is a primary condition of nervous system dysregulation. The body is responding to an immediate threat. You cannot think your way out of trauma; trauma doesn’t respond to spreadsheets. However, effective treatment I avaiable. Practical Tools for Managing Debt-Related Anxiety Here are some tools for moving forward in the face of debt-related anxiety--- 1. Notice the Anxiety in Your Body We are designed to survive. This is thee nervous system’s highest priority. When your brain detects a threat, your autonomic nervous system prepares your body to get back to safety by fighting, fleeing or freezing. You can feel the physiologic changes. Your heart beats faster, your respiratory rate quickens. Your senses are heightened. All of this can happen before you have conscious awareness of the presence of a threat. Then you can observe the changes in your body and conclude, “I’m in danger.” When your autonomic nervous system prepares you to respond to a threat , where do you feel it? Chest? Stomach? Breath? The goal is to say, “I’m noticing changes in my body created because a part of me feels unsafe.” Anxiety is physiological before it’s cognitive. This does not mean that you face danger. 2. Treat the anxious part of yourself as a frightened child What did you do when your kids were frightened of the dark? You would go to them calmly and say, “I see you’re frightened.” You might ask, “What’s wrong?” If they are worried about monsters under the bed, you would get out a flashlight and say, “Let’s look under the bed and see.” After you do this enough night in a row, you might get annoyed when your child expresses their fear. You might be tempted to say, “There’s nothing too be scared of . Go back to bed.” Does the help your child? No. Now they just feel alone in their fear. You don’t say, “What’s wrong with you? Why are you always scared?” You don’t punish your child for being scared. You say to your child that you see that they’re scared. In the morning you might brainstorm with your child about what might help them feel safer. A night light. Having the dog sleep in the child’s bedroom. Treat the part of yourself that’s anxious about debt with the same compassion. 3. Run the Numbers—With the Planning Brain If a warning light on your car goes on, you know it’s time to go into the mechanic because there could be a problem. Debt-related anxiety is a warning light telling you that debt could be placing you at financial danger. Are you? When you first experience anxiety, run the numbers with your prefrontal cortex. Assure yourself that you’re making smart choices. Someone with a propensity to experience anxiety has a brain that sets off false alarms. But as they say, a broken clock is right twice a day. Reassure yourself with your planning brain*, not panic. This is like responding a child’s fears about monsters under the bed by taking out a flashlight and looking. The challenge is that you mist get back to calm for your prefrontal cortex to come back online. 4. Be Willing to Feel Anxiety Anxiety rises, peaks, and falls—*if you allow it.* Resisting it is like holding a beach ball under water. Eventually, it pops up with more force. I often use the snake-bite metaphor. The bite is frightening. But it’s the struggle—the panic—that spreads the poison. Feeling anxiety isn’t dangerous. Fighting it is exhausting. If the numbers work, manage the anxious part of you with the same compassion you would use with a frightened child.

Instead of fighting with your anxiety, say: 2:11

“Thank you for working so hard to keep me safe. We’ve got this. Its okay”“Oh—how human of me. Money is the ultimate survival resource. Of course I’m anxious.” If you are immobilized by anxiety, try not to worry alone. Find an accountability buddy. 5. Explore the Worst Case What if the worst happened? What would you do? Who would you call? What options would still exist? Often, it’s painful—but not catastrophic. 6. Change Your Physiology—Especially at Night If you’re worrying at 2 a.m., don’t lie there thinking harder. Get up. Move. Breathe. Lengthen the exhale. Signal safety to your nervous system.--- 7. Don’t Beat Yourself Up Anxiety is a human response to uncertainty. Shame amplifies fear. Compassion reduces it. 8. Seek Treatment if Trauma Is Driving the Fear If anxiety is persistent or overwhelming, support matters. Therapy, coaching, or trauma-informed care can help your nervous system update old patterns.--- 9. Forgive Past Losses Losses are part of wealth-building. The goal isn’t to avoid all losses. It’s to stay in the game. 10. Distinguish between Anxiety and Intuition You build a life of TrueWealth by listening to your intuition. Anxiety is different than intuition. Anxiety is loud. Urgent. Repetitive. Catastrophic. Intuition is calm. Grounded. Spacious. Distinguish between the two

Closing: 2:39

Financial Leadership Is Nervous-System Leadership Debt-related anxiety doesn’t mean something is wrong with you. It means your nervous system is trying to protect you. Financial leadership isn’t the absence of fear. It’s the ability to stay grounded, engaged, and intentional—even when fear shows up. It’s learning how lead yourself through uncertainty with clarity and compassion. The bottom line is this. Failure to manage your debt-related anxiety can sabotage wealth-building. Anxiety belongs in the room—but not in the driver’s seat You don’t need to eliminate anxiety to build wealth. You learn how to lead yourself through it.