Insights from the Couch - Mental Health at Midlife

Ep.34: Understanding and Coping With Anxiety

• Colette Fehr, Laura Bowman • Season 3 • Episode 34

Share episode

In this week’s episode, we take a deep dive into anxiety—something that affects nearly 20% of the population and twice as many women as men. We chat about the different ways anxiety can show up in your life, the underlying causes, and the tools you can use to cope. Whether it’s hormonal fluctuations, past trauma, or just the demands of our fast-paced culture, anxiety can hit us all, but there’s hope for healing and thriving.

We also share our own experiences with anxiety (yep, even therapists feel it!) and discuss effective approaches like EMDR, exposure response prevention, and mindfulness. You’ll walk away with a better understanding of anxiety and practical tips to help you or someone you care about take control. 

Episode Highlights:
[00:00] - Reflecting on our personal experiences with anxiety.
[02:56] - How anxiety manifests differently in women, from Type A tendencies to the effects of hormonal shifts.
[07:18] - Exploring the “volcano metaphor” for anxiety and the hidden cultural, genetic, and environmental layers that contribute.
[14:05] - Common triggers for anxiety, from childhood experiences to significant life events, and their impact on mental health.
[21:27] - The role of fear and how it connects to anxiety, plus how to push through when it matters most.
[28:49] - Simple yet powerful coping strategies like exercise, mindfulness, and being in nature.
[39:36] - The importance of exposure therapy and facing fears gradually to build resilience.
[45:20] - Why medication is a valuable option for managing clinical anxiety and overcoming stigma around it.
[53:16] - Lifestyle strategies like diet, sleep, and relaxation techniques to ease everyday anxiety.
[1:01:56] - Recommended books and resources for learning more about anxiety and effective treatments.

Resources:

Recommended reading:

  • The Anatomy of Anxiety by Dr. Ellen Vora
  • Feel the Fear and Do It Anyway by Susan Jeffers
  • More book recommendations are listed on our website!

For more on this topic visit our website insightsfromthecouch.org If you have questions please email us at info@insightsfromthecouch.org we would love to hear from you!

If today's discussion resonated with you or sparked curiosity, please rate, follow, and share "Insights from the Couch" with others. Your support helps us reach more people and continue providing valuable insights. Here’s to finding our purposes and living a life full of meaning and joy. Stay tuned for more!

Colette Fehr:

Laura, welcome back to insights from the couch. We've got a great episode for you today where Laura and I are going to dive deep into anxiety, how women experience anxiety, the different types of anxiety, what causes it, and how to best cope with it. So this is one you won't want to miss, because anxiety affects as much as 20% of the population. So Laura, I'm excited to talk about this today, because you specialize in treating anxiety, and I kind of specialize in having it, even though, obviously I have some experience treating it as well, especially in the past when I did EMDR, but I think this is a great topic to dive into. You

Laura Bowman:

know, it's so interesting. You say that because, like, I am an anxious person also, but I have, like, I don't think it's as noticeable, because I think my tendency when I'm anxious is avoidance. Do you know what I mean

Colette Fehr:

I do, but is this You telling me my anxiety is noticeable?

Laura Bowman:

I mean, you are like, you're out front about it, right? Like, if you're worried about something, but the thing about you is your your anxiety really works for you, yeah, because it propels you to act. It propels you to problem solve. It's the right kind of anxiety. I'm actually a little jealous of your brand of anxiety. Thank you. I sometimes want to do like, a whole blog about wanting to like the want to be type A, because I am such a. Want to be type A. I'm not type A, but I like, kind of aspire to be, how

Colette Fehr:

do you define type A? Because I think we want to today talk a little bit too about the different variants of anxiety in women, and let me just set the stage before we answer this question, that anxiety is the most common health disorder. It's estimated that as much as nearly 20% of the population struggles with anxiety. It's twice as common in women as in men, and and that may be for a variety of reasons, some of it may be misdiagnosing based on gender norms, but regardless, those are the current numbers. And there is a difference between anxiety, which is a natural emotion and can be extremely useful, right? Situationally, anxiety is letting you know that something is dangerous and you need to act, but that it really becomes problematic for people when it's pervasive, it interferes with functioning, right? And it really can derail people. So that's the stage to set, but we're going to talk a little bit about like the type a sort of high functioning, anxious Woman versus the crippling, debilitating body is in a state of alarm, regardless of situational variables. So with that said, I want to hear your definition of type A. I'm so curious, not clinical, just like how you think of it,

Laura Bowman:

I see type A people as being driven and uncomfortable with leaving things undone and and having to act whereas and they're compelled. So I know it's uncomfortable. It can be really uncomfortable for people. This is me. I'm kind of more of a beta person to begin with, so I look at it enviously, because I have a tendency to take something and be like, Oh, I I'm great at compartmentalizing. Like, this is a little special skill I have, and I think some people might be jealous of that ability, but I can be like, Oh, I'll deal with that one later. And then I will get into like, a moment where every like, the anxiety is too heavy and I have to act all at once. So when I see people who are always got that drive to act like, I'm going to work out, I'm going to send the email, I'm going to do the project, I'm going to start early, I'm going to get it done early. I'm like, oh, what would it be like to just have the ability to act all the time? Okay,

Colette Fehr:

okay, so you're talking about it as a driver rather than an avoidance. And it's interesting, because I think anxiety can lead to both manifestations, and I can actually do both. I can get very procrastinatory and very quickly narrate reasons why something that feels too overwhelming, or I feel it feels too overwhelming because I feel like I don't know how to do it right, I don't know how to get it done. Then sometimes I just want to stick my head in the sand and just say, like, Fuck it, la, la, la, la, la. And then I'll be like, Oh, well, I deserve a day off. And, you know? And of course, I deserve a day off, but that's procrastination, yeah. But

Laura Bowman:

how do you deal with fear, like when you're really afraid? Well, it depends what to act. Does it most often lead you to act?

Colette Fehr:

Not necessarily. It depends the way, yeah, the way I think of it is so my personal brand of anxiety and and truly, even as. A clinician, and before I started only working with couples, I did work with a lot of people with anxiety, and I predominantly treated it with EMDR, which is Eye Movement Desensitization and Reprocessing, and had some good results with that. But I saw many different flavors and manifestations of anxiety, including a lot of I had many male clients with anxiety that they mostly tried to suppress, mask and bury and like, alcohol consumption, yeah, you know, yes. So, and they have these high achieving careers, and they're not standing there going like this, like I'm so worried on the street corner, like I am, right? So, right. So it's not as noticeable. I the way I approach, the way I experience anxiety, is that I don't live in a state of body alarm. I don't live in a state of activation. My anxiety does tend to be precipitated by something that's happening. I'm afraid of that said, I'm afraid of a lot, like a lot, I'm extremely claustrophobic. I'm afraid of heights. I'm afraid of being murdered to like, a quasi irrational degree. I walk around with a lot going on up here now. Am I anxious, or am I just neurotic? Or am I just a very

Laura Bowman:

what does it feel like to you?

Colette Fehr:

What it feels like to me is that I'm just a warrior. I think my self assessment, after 51 years of exploring this and trying to work on it, is that I have a very sensitive limbic system, a very hypersensitive amygdala, which is the fear center, and the limbic system is your emotional brain, so it's part of what makes me creative, and it helps me attune to people, and helps me Intuit what's going on. But as a result, if I'm walking down a road and somebody feels shady to me. I've already, in 10 seconds, narrated my murder, where I'm going to be buried. Will it be solved? How can I leave evidence? What will I do to fight back like that? Cause, my god, yeah, I mean, I'm exaggerating, but only a little, a little so,

Unknown:

yeah. So like, let's talk. Because I think that most people I always see, like, anxiety is like the dormant volcano, and that by the time you're really getting symptoms, it's erupting, right? But like, people are always like, Why do I have anxiety? And it to me, it's like, it's all these like things underneath the volcano that you don't see. So, like, it starts with our culture. I think we have a very anxiety producing culture. It's capitalistic, it's competitive, it's fast paced. It's not designed to make you feel great about yourself. So I think that it just grinds on the human system. And then on top of that is like, what you're talking about is like your temperament that you're born with, yeah, you know the shy child, the sensitive child? I mean, I'll never forget your little shoe story at the circus and how worried you were your mom would not get her shoe back, like those kinds of like I thought somebody was gonna climb in my window and kill me as a kid. Like I was sensitive fearful.

Colette Fehr:

So I was sensitive and fearful, but not shy. Yes, yes, yes. And very sensitive and very always going into my parents room and being like, like, if we saw a movie, the movie would be in my head for like, three years, same so I really have gotten better at protecting my brain from certain things, but not enough. Because, like, I know what I should keep out of my helmet, but, like, I'm still completely

Unknown:

go for it. Now all your like, murder stories, you totally I'm still

Colette Fehr:

compulsively watching Dateline because I'm, like, drawn to the dark. But what I wanted to say to you about fear that I think is so important, the way I see fear, regardless of anxiety, is that if I want what's on the other side of the fear, then I'm going to push through the anxiety and take action. That's interesting, yeah, so, like, I'll give you an example. I'm afraid of heights. Okay? I don't care that I'm afraid of heights. I have no desire to go up high. I don't want to ski. I did it once. I was like, never again. I'll go for the appreci ski. But like, No, I'm not doing it. I'm not getting on a chair. Let's value it. No, I don't value it, but I'm scared of getting up in front of an audience. But I also love public speaking, and want to do it and enjoy it and think I'm good at it so that fear is actually extremely potent and activated, and not unlike getting on a chair lift, but I'm willing to get up and do it because I want what's on the other side.

Laura Bowman:

I love that you said that and like, let's put a pin in that, because I think that's one of the ways. Ways that we treat anxiety, because there is stuff that isn't worth tackling, and then there is stuff that you really do value, and you want to get to the other side of fear, and that's where exactly really begin to think about treatment.

Colette Fehr:

So let's come to that when we talk about treating it. Yeah, okay, but

Laura Bowman:

like in my little dormant volcano, we have culture, we have temperament, and then you go a rung above that, and it's like, what? How is your caregiver with your temperament? Did they exacerbate that? Did your environment exacerbate your temperament? Or was it, you know, great with your temperament and you had great experiences. What are your aces? You know, adverse childhood experiences. How much trauma lives in your body?

Colette Fehr:

Yes, you know? Yeah, I know. And for some people, it really is more, I think it's always, for everyone, a combination of what's happened to you and your inborn genetic nervous system. And then I see even differently from that is your personality and your disposition, right? There's how your nervous system runs, right?

Unknown:

Yeah. Like, place it even thinner, right? Like, if

Colette Fehr:

we look at disposition and personality, which are also slightly, slightly different, but let's lump that together for a second, it's almost like, if you look at two different cars, right? Like, like, a Ford, I don't know this where I'm gonna, like, lose my metaphor, and f1 50, okay, I don't even know if that drives fast, but that's that big truck with, like, the open back, right? And then I know, I don't know my trucks. And then you look at like a Ferrari, right? I mean, a Ferraris engine is not going to do the same thing as an f1 50, even if they're both on the highway being chased

Unknown:

exactly right? But then you like your metaphor. Thank

Colette Fehr:

you. Thank you. I just wish I knew, I don't know why I picked a truck when, like, I don't even know anything about trucks, but you get it, but then you have what happens to you. And I do think there are many people, and I know this as like someone who used to work very deep into the ocean with trauma. Some people, regardless of nervous system, what they have experienced is so intense that that is still living in their body, and they're living in a permanent state of alarm. And anyone who's even been through something shaky, where you sort of face death, or a brush with death, or something really scary happens. You know? You know how you sometimes your body just can't work through it right away,

Laura Bowman:

right? And then you get somebody who is like a fragile temperament, and then you put them in a highly traumatic situation that's a mess. We also see people who live through awful things and have very like, resilient, hearty temperaments that are able to kind of get through it. One of the things I see all the time in women with anxiety is that they've had to be like premature caregivers to parents. That is, like, a trend, Oh, you think, or like, or like a chronically ill parent, yeah, or a psychic, you know, psychiatric issue with a parent that will cue and wire in that anxiety into the system pretty

Colette Fehr:

quick, right? And also can often produce, I think, one of the one of the common presentations of anxiety and women, is women with a narcissistic mother, who have who are intelligent and sensitive, and they because their mother has emotionally mature deficits and mental health struggles, they are the one who calibrates to that mother. They are on the receiving end of a lot of criticism withholding performance based love. And so they learn to really perform, to achieve love and validation. And that can turn into its own variant of type A where the driver is really if I'm not doing and I'm not achieving, then I'm going to feel worthless, yes, or empty or unloved,

Laura Bowman:

yes. So there's, like, all kinds of things, and we didn't even talk about, like, the presence of epigenetics and like the intergenerational transmission that exists in all families where you have, like, maybe alcoholic fathers for four generations, or, you know, like Holocaust survivors, and what gets passed through the DNA, just in the fiber of the being, yeah, but Okay, so you're picturing my dormant volcano, right? Like people are like, I'm fine, you know, I'm fine, but like, you've got all these things that are putting down pressure on you. And then what I see is that some precipitating event occurs. Usually it's like a betrayal, a loss of a relationship, a humiliation, something that causes deep shame. It's like something just or deep, deep fear. Somebody gets sick, something happens, and. Then you're symptomatic. Your volcano is erupting. You're coming in and you're saying, like, I just don't know what's wrong. I'm I'm having panic attacks. I'm flooded by anxiety. I've never had that before, but you have all these, you know, risk factors that have preceded it.

Colette Fehr:

Yeah, the volcano is a good metaphor. You know what I've seen? First of all, I see a lot at how anxiety and anxious partner, or two anxious partners, can really affect one another, you know? And of course, there's relational anxiety, but I'm thinking back to when I was working with individuals more and how there were just some people that there, they were just sort of constantly elevated heart rate, jumpy, jittery, like whether things were happening or not. You know, their legs bouncing and they're tapping and they're worrying, and they can't sleep because there's thoughts and then, ironically, coincidentally, whatever the accurate word would be, they're in these high stress jobs, like they're attorneys with these, like, insanely high pressure cases, and they're like, an absolute train wreck internally, but it's not visible on the outside, and again, often medicated with alcohol. And then I'd see a lot of people more like you, where, you know, maybe there's some kind of low level anxiety that exists, and it's kind of manageable, and then something happens that hits a tipping point, and all of a sudden, the symptoms are really taking over, and the functioning goes down. And that would be true for what happened with me, I think, where I never thought of myself as anxious, as a young person, but I think I kind of pushed aside and stayed away from the things that pushed my buttons and let other parts take over. And I really first experienced symptomatic anxiety after I had my first daughter, Charlotte, and I probably had postpartum anxiety. It was not like anything I'd ever experienced before. I was so worried about everything that would happen to her, I could not relax. You know? I was like, I remember breastfeeding her, and you know, anything you read about that could go wrong. I was like, this could go wrong. This could go wrong. This could go wrong. And I had a very traumatic birth, so that may have played a role in it, but your hormones go haywire and you don't know what they're going to do. And postpartum anxiety is more common in women that already have an anxious proclivity, yeah, and I remember taking her to like the the Advent health had the booby buffet. It wasn't even Advent health, it was Florida Hospital 2024,

Laura Bowman:

years, like a lac tation consultant. So

Colette Fehr:

you'd go with your newborn, and because you never knew how much breast milk they were getting, and I had all this anxiety that she wasn't getting enough food, and that she was like under fed, and what if I wasn't making enough milk? And it was triggered by the fact that she would own, you know, they'd say 20 minutes on each boob, and Charlotte would only eat for like, three to five minutes on each boob, and I'd be, like, shoving my boob and her face, like, eat for 20 minutes. Okay, and so I go to this booby buffet, and I'm and basically everyone came who had a baby at Florida Hospital. Maybe you didn't even have to do it there, and you sat around and talked about it, and you had support, and then you breastfed, and you you weighed your baby before you breastfed, and then you weighed your baby after you breastfed, and then you could see how many ounces

Unknown:

they got. Oh, my god, yeah, but it, it

Colette Fehr:

told you if your kid was getting enough food. So this is where anxiety, though, this is how it shows you how much it can distort your mindset. Charlotte was born six pounds. She literally, like, like, porked up, like a balloon overnight. She was just a rapid, efficient eater, and I had a ton of milk, so she was getting, like, the maximum quantity, ounces, just in like, five minutes. But I didn't know that. Meanwhile, if you looked at her, it was very obvious that the child was being fed. And I remember sitting there sobbing while I was breastfeeding her, going, like, I can only get my baby to eat for five months. Like, I don't know what's wrong. I've tried everything and, like, just sobbing, yeah. And then I put her on the scale, and I don't remember if it was like three ounces or five ounces. She was really little, but everyone was like, holy shit. Your

Unknown:

kids, like, like, Fine, having like, a 711 like, Big Gulp, but

Laura Bowman:

you're. Perception was that it wasn't working. You weren't doing it right. Things weren't going well. Yeah,

Colette Fehr:

am I starving? Was gonna die,

Laura Bowman:

yeah? But, I mean, we're all like, so like, that's the other thing about why women are diagnosed with anxiety. So much more is these we've talked about in other episodes, these, like, ledges of hormones, you know, like after I had Anna, and I, like, nearly died in my delivery, I went through like a, like a postpartum anxiety where I would, like, fly out of bed in the morning, like with just like driving anxiety, like fear, and I'd have to walk, like, around, like a three mile loop just to sort of discharge the stress I felt in my body. And I got, like, obsessive about cleaning, in a way where I was like, obsessed with, like, the smell of Clorox. Like, don't even ask me what that was about. But it was so weird, and it was definitely what it what it shows you is that hormones drive anxiety, and this, you know, this biological and mental piece is so, so tightly wound, and anybody can find themselves there

Colette Fehr:

absolutely so let me ask you this before we talk into how you cope with it and how you can make anxiety work for you. What do you how do you experience anxiety to the degree that you do today. Because first of all, everyone gets anxious at certain moments. Like nobody's anxiety free. I

Laura Bowman:

think that everybody has specific pain points, and they always say that anxiety will tackle the things that you value the most, or places where you've had, like, previous experiences with fear. I bar none, can get like, I can be okay with almost anything, like I have space to cope with almost anything other than health. And there I have health, no margin, no margin. Like, I can get wound around the axle so quickly with fear. And I think that's understandable. Like, I mean, I know I went to the hospital when I was like three, and nobody went with me. I have no idea that live that probably like lives in my body. Why? Why did that happen? What happened? I had a PD of my my pediatrician, I was really sick, said to my mom, she needs to go in, into the hospital. You need a break, go home. I was sent by myself. I have no idea what that how that lives in my body, but I have a feeling it was abject fear. I was a very clingy baby, very fearful baby. So I just, I don't know what three year old me experienced, but I have a feeling my body says, hell no, yeah, around that my my grandfather got sick with lymphoma in 1987 I was nine. I thought the worst thing that could happen was cancer in a hospital. I had an ectopic pregnancy where they like, you know, you get the sonogram and they say you're going to surgery right now, like that feeling where the floor drops out and your safety is real, so nothing gets me, like, help, okay, and to me to watch people who are like, Yeah, I'm getting tests run. I'm like, aren't you like, a master? Like, yeah, well, I'm just, you know, gonna wait and see what, what's what? I'm like, I would be hard to talk to if I you know when I'm in those situations? Yeah,

Colette Fehr:

no, I think health anxiety is powerful, and definitely I see and hear about that from a lot of clients, and I can relate to that. I think it's scary, but my variety is a little more the like the painful, shocking, violent death more than the getting sick, believe me, I'm terrified of getting sick and dying, but I don't get as activated by those stories. But if I hear a story of someone who died in a horrific, unusual way, it will really permeate my consciousness, and it will keep coming up. And then anytime something is remotely like that, I'll think of it. Now, it may not necessarily activate my body, but I think of it. I mean, to the degree I walk around the lake here in Baldwin, and I do not ever go around the lake without thinking about an alligator coming out. I

Unknown:

need me. I've seen videos like that, yeah.

Colette Fehr:

And because I've seen videos like that, it's not like the whole time I'm walking around like this and I'm in fear, but the thought is there, or the places in the lake where the shoreline is sort of lapping up, I'm like, wow, I could just see, like, what would I do? Like, fuck, I don't want to be one of those videos where, like,

Unknown:

I know my she's like, her leg is sticking out of the water

Colette Fehr:

and, oh, my god, yeah. So that's more my, my variant that really like creeps in. I

Laura Bowman:

think that we all have. This, right? Like, and this is the difference between a highly anxious brain and a we all have thoughts that roll through like tumbleweeds, right? Like our kids are on the highway and we're like, oh my god, what if they get in a car accident die, or a fam loved ones on a plane? And you're like, what if this is the time a plane crashes? But the thought rolls in the head, you know, through the brain, and it we talk to it pretty quickly, yes, like, okay, look, you know, it's fine, it's fine, and that is

Colette Fehr:

what I do, yeah,

Laura Bowman:

but that's because you're like, normal functioning, but when you are in a corner with anxiety, you cannot put those feelings down. You cannot put those thoughts down, yeah, and they get bigger and they ruminate and they spin, not

Colette Fehr:

to mention OCD, where there's really anomalies that per in the brain that prevent you from being able to discharge the thought, yeah, but I also think that when, okay, so let's say, you know, I don't think, and I've looked at this many times, I don't think I meet the criteria for generalized anxiety disorder, but I have had situational bouts of anxiety where I have the same symptomology as generalized anxiety disorder, and where part of it is the thing that I'm feeling fearful and activated about is so Big that I can't discharge it, the thoughts become ruminatory. I'm cycling through the same thing I may, rationally know fully well that the thing I fear most is not likely to happen, and I still can't get out of it, and my body is activated by it, like when people say, Oh, don't worry about what you can't control. Like, fuck off. Okay, yeah, I mean, sure that'd be great. And then there would be no therapist, and everybody would be out living their best life.

Laura Bowman:

What helps you when you're in that space, getting

Colette Fehr:

a lot of exercise, getting my heart rate up so I can balance with endorphins, being outside in nature, being able to talk to people. For me, it's helpful to externalize and talk about my fears, and it's almost like pulling out weeds from the garden of my mind when I can just say like I'm scared and validating that I feel the way I feel, and also shifting into a little bit of inner part dialog where, you know, what's helped me is befriending anxiety and seeing it as mostly a positive, whatever you want to call it. You know, I do jump out of bed and like, tackle the day and some of it's motivation and excitement, and some of it's like, oh my god, I gotta get this done, and I want it to be good. You know, you don't really want somebody to go do a performance and not feel any nervousness, because then you're too like you're supposed to care. So I think accepting that I feel the way I feel, but then doing the things that help those feelings to stay manageable and keep me in my window of tolerance. Yeah.

Laura Bowman:

I mean, I think everything you just said is exactly how you do cope. I mean, one of the things that I think is so an underutilized strategy is like completing that stress cycle, like you have to move that nervous energy through your body, yep. So, I mean, I have a guy that has is high, high anxiety, and he, I mean, he's almost disabled by his his level of anxiety. Rides his bike for hours a day. That's how he manages, because there's so much tension in his system, yeah. But a run, a walk, anything out in nature is even better, right? It's like you get just the that sensation of, I don't know, nature is so healing,

Colette Fehr:

yeah, and that, they have done studies around people walking and seeing water, and some studies have shown that it's more powerful, that seeing water for 10 minutes is more powerful than medication. Now, I may not be quoting the research exactly right, but it is something very close to those lines. So we know that there is we're designed for that to be a healing bomb. And you're right. You gotta get that the activation. Move the activation through. And some people need more than others. Where I see clients go wrong, people go wrong for themselves is trying to fight it, trying to talk themselves out of it, fine, right? Or like, I'll just suppress this, compartmentalize it, mask it with marijuana, alcohol, workaholism, pornography, television, Doom, scrolling and eventually it'll go away. I mean, we know definitively that those things do not help your nervous system. No,

Laura Bowman:

it just makes it worse. And I mean, I think all anxiety is sending the signal of that you're not okay, because it's such a body sensation, like especially clinical levels of anxiety, so in the body and that you cannot handle it. So that's the that's the signal it's sending. You're not okay and you can't handle it. So if you give into the urge of masking all of that and numbing that and trying to, you know, distract from that, you are making that, that feeling stronger. So we know that, like, the way to handle anxiety is to confront it and to learn that it is okay and I can handle it. Yep, that's all anxiety treatment. That's a huge piece of anxiety treatment,

Colette Fehr:

yes, and this is why, back to fear. And you know, talking segue into talking about coping with anxiety. This is why. And I know you do this work, exposure Response Prevention is the gold standard for anxiety, because there really is no other way to let let's say there's something you're fearful of that you have to do or want to do, right then there's no other way to lower the anxiety around that activity than to do it and to teach your body Not by trying to convince yourself intellectually, but by experientially showing your body I can do this, and I'm okay, I can do this, and I survived, right? You know, yeah, I have to go for my mammogram tomorrow. And does it give you anxiety? Oh, hell

Laura Bowman:

yes, really, oh yes. I have a feeling in there that I want to run out into the parking lot and drive away, like I just always feel that way. I mean, I'm telling you, I have a feeling of, like, Do not tell me that I'm dying, right? Like it's just like, it's just terrifying. But I I go, and this is where it's like, you know, you talk to your part, right? I have like myself energy that's going to hold that little girl's hand and be like you can do this. This is you. You value back to your values. I value taking care of myself, right? Value being alive for my kids and myself. You know? I value being proactive about my health, so all of that you know, my wise adult is gonna, like, drag me in there and, like, talk me through it, and say, like, you can handle whatever happens, and

Colette Fehr:

it's okay to feel how you feel. And I do find this to be the most effective way be taking the action anyway, and the inner talk between parts of self to cope with, at least, you know, normal bouts of anxiety, right? That I do the same thing. I'm very validating. I'm not like, what's wrong with you? This is no big deal. Get your shit together ever I'll do this every day. Yeah, yeah. Who cares? I now know I'm a very quirky, fearful little bird, and I'm also a super strong, powerful, very bold women. And there's stuff I'm not scared of, that everybody else is terrified of, that I do on a regular basis, and nobody else feels as like confident in those areas as I do. And then there's things that other people do every day that I'm absolutely terrified, and it's okay, I'm me, so I talk to the little girl too, and say, You know what? It's okay that you're terrified. I know you're scared. I'm here with you, meaning me, adult Colette, and we're gonna do this because this is, like, good for you, and

Laura Bowman:

you care about this. And you know, this is where people, like, begin to lose their power. Is like, if I were to let that little girl part win and be like, I can't handle this today. I can't do it. I'm gonna call. I'm going to reschedule. We'll do it later, right? And then the next time I go back to do that mammogram, again, my level of anxiety is now up above the old level of anxiety, exactly. And then the likelihood I give into that part again and say, I just can't handle this right now, exactly. And you see this, people do this all the time, and they are their anxiety about, you know how scary things are, intensifies,

Colette Fehr:

right? And it becomes crippling. And this is how people end up, where the the phobia, if you will, takes over, and they can no longer do it at all. And in fact, I learned this the hard way before I was a therapist, really with flying, because after, I had a really, really terrifying two bad flights in a row, one of them being on 911 and being up in the air while the thing was happening at New York airport. And it was just do it right, yeah. It was very powerful. Very scary. And I had had a bad flight before that. And really, until that point, I had never had a bad flight experience. My dad used to fly little planes. I'd go up with him and like a two seater little thing. And I mean, I had no fear of flying at all. This also was during what I now look back was still the postpartum period. Charlotte was five months old when 911 happened, and I got off that plane, and I was like, I am never, you know, I mean, I saw it happen out the plane window. So after that, and then we flew around for almost an hour with no information on what was happening, if our plane was okay, where we were going to land. So when I got off the plane, I had not smoked cigarettes in seven years. I went and bought a pack of cigarettes, sat down on the curb and smoked like, 10 of them in a row. And I was like, I'm never getting on a plane again. And thus began a period of time of like, if I went to New York, I mean, one time I took the Amtrak for Yeah, it got really bad, because as I it was too much. It did not feel like I could handle it. There was too much fear in my body, spending all that time in the air, not knowing if I was going to die or not, overwhelmed my resources, and for years after, when I did get on a plane, because I did it so infrequently, like I only did it when I absolutely had to, I would start shaking on the plane like this. I'd start crying before we took off on takeoff. I would hold my, then husband's hand, and, like, sob. And people were like, well, I mean, it was like, hardcore, yeah,

Laura Bowman:

but I did, what that example shows is, like, how quickly something benign, right, can be become so, like, hardwired as intolerable, like, you know, you can drive for 30 years, get in a car accident, and then never be able to drive again. Or you are a driver, you know, been driving forever, but you have a panic attack over a bridge, and then you can't ever drive over a bridge again. So these things get wired up in one second. Yes,

Colette Fehr:

exactly. And it doesn't even have to be such an extreme thing. It can be, you know, someone swerves and almost hit you, and your body goes into like just an instantaneous experience of what it might be like to die, and your body's like, No Never again, never again. That's dangerous, but my point, too with the flying is that I did the exact wrong thing, and I see why, because I was so overwhelmed, but by reducing the amount of flying I did and getting on the plane only when I absolutely had to, I actually, really ensured that the fear intensified and lasted for longer, and I'm much better now. The minute there's turbulence, I turn into like, Yeah, I kind of decompensate, but I'm no longer sobbing on takeoff. I used to be if I knew I had a flight for five days before I Was A Rat a mask, and now I can actually fly without Xanax, without alcohol, sometimes massive exposure, massive exposure. And also the luck of massive exposure with uneventful flights, like non turbulent flights, you know, it taught my body like, okay, yeah, it could happen, but most of the time it's gonna be okay. And it's one of the reasons now that I'm so claustrophobic, I still force myself to get on elevators occasionally because I have too many friends and family. And like, New York City, like, I can't never get on an elevator, right? And if I avoid, if I start, I already avoid it a little, but like, if I start avoiding it completely, I'll never get on an elevator again, exactly.

Laura Bowman:

And that's a like a message is that if you have something that you avoid because you're fearful the how, how quickly can you begin to approach that and expose yourself to that and slice

Colette Fehr:

it really thin? Yeah, so if it's an elevator, don't go to the top of the Empire State Building, because then your body is going to go, Fuck no go one floor on an elevator every day for a couple months, and then go two floors, right? If it's public speaking, get up and talk in front of a group of 10 people for two minutes, right? You've got to build a window of tolerance, yeah, right, right, and then keep the frequency

Unknown:

up. Like, I know people who are afraid of escalators, like, you know, then you know. See, can you daily hit an escalator somewhere, or can you, like, ride the escalators at the mall, you know, right, just to expose yourself and to to, like, send the signal like, I can handle this. You have time. You want to avoid. I want to shout out to people who are listening to this, who've had really crippling you. Levels of diagnostic anxiety, yeah, and if you have been, if you've ever been caught in that where you're having panic attacks everywhere you go, or you're just like, you can't do anything, you know, medication is really kind of the thing that we need to, like, give you to dampen that level of anxiety just to begin to be able to work on it. There is a there is anxiety that's too high to work with. I mean, that's my feeling. Maybe, maybe somebody else would say, No, well, I'm

Colette Fehr:

sure there are people. But I one of the saddest things that I think you and I both sometimes see and have to work with people through a lot in therapy is there still, even though mental health has gotten destigmatized, there's still so many people who believe that somehow medication is bad. It's a weakness, it's bad for you. And there are a lot of medications that really they're not addictive. Doesn't say anything about you. It's just turning down the volume on where your system set, and you'll still have to it's not a panacea. You still have to learn those other coping skills. But it is so hard as a therapist when you see someone struggling so hard with something that they can't will themselves out of and I've seen so many people shift when they finally do try medication and go like, Oh my God, right. Just doesn't have to be so hard, right,

Laura Bowman:

right? And that's like, a part of it, you know, that's like one piece. It's maybe not where you stop, because then you get the other experienced clients is like, this is all a biological process, and, like, I just need a pill, and as long as I have my medication, and then it's like, no, you know, the the dormant volcano, or the volcano has all these layers you really have, if you were somebody who has clinical anxiety or deals with OCD, I mean, there's all different types of anxiety disorders, Right? It's a signal you have to take great care of yourself. You have to take better care of yourself than the average person.

Colette Fehr:

Yeah, yeah. And I think to use the volcano metaphor again, you know the activation the sim, the signal in the body that you're in danger, that you need to be on high alert, that something's going to happen. Some systems, whether it's from past, trauma, genetics, a combination thereof, are set where the volcano is active and there's lava right to some degree, regardless of what's happening, yes, and then there's other people that all of that's in there. And if there's a fault line that cracks, then it may start to activate, right, right? So you've got to really figure out which is for you. But I think we're both saying that, you know, if you feel in an anxious, activated state a good portion of the time, which, let's face it, people really medicate most in society through alcohol, yeah, yeah. And marijuana these days, right? And marijuana, which is raising the floor of anxiety, if nobody knows that, like you know, it may suppress anxiety, but you come back above baseline, exactly, making yourself more net, exactly over time. And just the cultural, stigmatized part of this. I was just thinking about this. I remember in the worst phase of my divorce 20 years ago, when I just felt in a constant state of anxiety, like, how was I going to make money, a job, manage the kids? I had a very adversarial situation with my ex husband. At the time, it just felt like Whack a Mole all day, every day, with like stress. And I always thought of myself as so capable and together that the therapist I was seeing at the time I had not become a therapist yet, was like, you know, maybe this would be a good time to just take a little medication. Help yourself calm down a little for now. And I was like, I don't need medication. Like, I'm not a person who takes medication. I'm a very healthy, strong, capable person who does not take medication, who could use the medication, right? And then she was like, well, you are telling me how, like, every night after the kids go to bed, you sit outside and smoke cigarettes and drink two or three glasses of wine. I was like, Yeah, I told you, I'm fine. That's how I cut, motherfucker. So the reality is, you know, those to me at the time were, I didn't see that as meanwhile, that's so unhealthy. But like, those were the coping mechanisms I thought were normal 20 years ago, and I had this idea about medication. I did end up realizing that I wasn't doing myself any favors, and seeing that I had an idea that really wasn't serving me and wasn't true, and I ended up taking. Medicine for six months, it helped tremendously. I was able to go off it after a little while. It really helped me to get through a crisis. Rather than chain smoking and, you know, drinking every night by myself and just I'd be out there ruminating like, what do I need to do? What do I need to do? What do I need to do? You know, and I was the best thing.

Laura Bowman:

Yeah, I'm glad you said that, because I think that we are all there. It's probably inevitable that most of us will be at an inflection point where we will be that ruminatory, that fearful, that kind of out of our skin with anxiety, that we may have to consider that right? And it's, oh, that's life, guys, yeah, yeah. I'd also be remiss if we didn't talk about the rate at which women somaticize anxiety. This is just such a huge thing that I see is that women pull anxiety and stress into their body and they become it becomes physical symptoms, then do this too. Yeah, women, I mean the fibromyalgia, you know, all of the like, sort of nebulous pain disorders that we see and sensations in the body. I mean, women pull stress into their body in a way, and this is, this speaks to why it's so important to learn to be assertive in your communication and stand up for yourself, and is that your body will speak if you can't speak for you, your body will speak for you, because

Colette Fehr:

this is energy. This is energy imagine to personify anxiety that there is a crisis happening outside of your house and you're asleep, anxiety is coming to the door, banging on your door, saying, there's danger, there's danger. Wake up. Wake up, wake up. So if you keep going, it's going to bang louder and it's going to bang louder, and if it can't get you to pay attention at the front door. Then it's going to go to your window and it's going to try to open. So it's it's going to that energy and that alarm that's saying pay attention you're in danger. You need to act, whether it's true or not, that there is an active danger outside your door. It's going to present somatically, if that anxiety can't get your attention emotionally, 100%

Laura Bowman:

and we know women, that's another piece too, is that women have these vulnerabilities in hormone health, thyroid health, there are all these things that makes women's bodies prone to anxiety, depression, like, you know, you I have people clients come in, and I have one woman that always says, I'm in a deep luteal which means, like, her luteal phase is like popping off, and she's, you know, miserable, because, you know, the, you know, because a progesterone and estrogen And the whole thing, and we are always dealing with that stuff as women, so it makes us more more vulnerable to, like, all kinds of sensations in the body, headache, you know, all, all sorts of things,

Colette Fehr:

yeah, and not to mention, you touched on this at the beginning. But as women, something men don't understand. And it's not just me and my little Dateline, fear based stuff. Women are constantly targeted, sexually assaulted, yeah, murdered. I mean, it's a real thing. You know, I've seen those, those memes, or where that whatever, where they say, like every single woman has at some point felt unsafe walking by herself. Now I feel unsafe every time I walk by myself, but like we are so much violence and perpetration is done to women, and then at midlife, we've got hormonal factors. So I think what we're saying is that, first of all, anxiety is so common to varying degrees, and the disorder, I hate that word, but Right, like the clinical anxiety affects as much as 20% of the population. So you're not alone. Explore if medication could be an alternative for you. And if you have ideas about medication, we're urging you to challenge those because there's nothing wrong with it. The right medication for the right person is helpful and additive and a positive and it doesn't say anything about a person or who they are, and also that there are some very regular things for general, normal daily anxiety or anxious periods that really help talk through that

Laura Bowman:

let's go through like, the things that are just universally helpful, like helpful for healing, for anxiety and and coping and coping, and then people like, talk. Out, there's a difference between managing anxiety and healing anxiety. Like, I know Russell Kennedy is, like, very big and, you know, he has his, he has anxiety. Yeah, he has terrible anxiety. But it's he believes that his comes from, like, a complex PTSD. He had a wet like, a skit schizophrenic father

Colette Fehr:

or bipolar father, but, yeah, I can't remember, yeah, yeah, yeah. So he

Laura Bowman:

has, like, the gut love, like the body level, sense of not being safe. And he, he has great healing kind of mechanisms, if you're interested in that kind of trauma based anxiety, and it's all, it's all about bypassing the mental story and going to the body. Yeah, it's all about the body, and that's where a lot of the healing is. These days, I agree. In the body we go, we try to argue too much in the mind with anxiety, why am I feeling this way? I've got to understand why I'm feeling this way. It's like bypass that that will get you nowhere.

Colette Fehr:

It's true. Yeah, regardless of what is really causing your anxiety, your head is not going to help you resolve your anxiety, your way out of anxiety, right? But I, what I don't like is when people, and I hope is coming through in this because there are different versions of anxiety and different causes. And for some people, what I would see on EMDR, if there were variables even Complex PTSD, right? Like, if you had a very traumatic childhood, pervasively abusive parents and activated home, you know that can be stored in the body in a way that you can really work through by bringing your body and your brain into processing. That was then and it's over, this is now, and I'm safe, and if you can get your system to recognize that, there's a lot of relief. But not everyone's anxiety is that variety. And you know, I think EMDR worked really well for which is trauma therapy, for some of that kind of stuff. But some people's systems are set at a higher level, and they're not going to be able to just work through what happened in the same way. So you got to really figure out what that is. And I think these coping mechanisms that we're about to talk to are helpful for everyone, but some may need more than just this, right? Exercise is one of the best things you can do for anxiety,

Laura Bowman:

feeding that stress cycle, like, whether it's like shaking or, you know, discharge, discharge the stress, yeah, uh, weight lifting. I mean, this is people don't realize this, but like, contracting the muscles and release, that's what progressive relaxation is, yep, and you get the same discharge from like, lifting heavy weights. I mean, you get even a better discharge of stress through that. So that's another thing. And none of these things are like silver bullets, but this is a holistic way of addressing anxiety. I think diets another one that's underutilized. Yeah, we do know that gut microbiome and the brain are, you know, on the same access. Don't connect it, right? So if you're like, you know, medicating with alcohol and sugar and, like, simple carbs, you are not going to feel good and your anxiety is going to get worse,

Colette Fehr:

right? So that's so many people go that route. Yeah, sleep is another thing. Sleep should be a religion.

Laura Bowman:

Thank you. Yes, and, and, really, like, if people get proper sleep, anxiety gets can get cut in half

Colette Fehr:

if people get sleep and I believe even a burst. I mean, I love what you're saying about muscles, and I can't wait till I start my weight training that was supposed to happen in October, because I'm going to be so relaxed. But getting whenever I get my heart rate up, even for a short period of time, there's a really long effect of a mood boost that's been that's been researched and proven to be true, and that can really just counter a lot of the ruminatory thoughts and the tension.

Laura Bowman:

Yep, yoga, like anything that, like is increasing breathing and presence that can be great. You know, it's like, the thing that I always hear is get out of your head and into your body, yeah? So whether that's walking or or yoga or massage or anything that's like helping you just stay present in your body and getting out of your head.

Colette Fehr:

Walking outdoors, I think, is huge. And I even think going for walks where you don't have music, not talking, just walking and being still and experiencing nature and mindfulness meditation. You know, I mean, every it's become such a cliche, almost in a way, but it really helps a lot if you're willing to develop a practice what I personally. Will never be. And I've been through the Mindfulness Based Stress Reduction training twice in a pretty intense way, and I fought it, fought it, fought it. I was like this. I hate this shit at first in grad school when I took it, and then eventually I came to see the benefit. But I'm not someone who wants to spend 40 minutes of my day meditating, even though I think that would be wonderful, but I make sure I do at least five minutes. It's very short. Sometimes I do 10 minutes where I'm just still and I'm noticing whatever's there, accepting it with non judgmental awareness, right? And letting it go like I visualize my thoughts like lotus flowers, and I'm placing them on a river and letting them flow. I love that. I love that imagery. I've had that vision for almost 20 years. Yeah, it's it's so calming to me, and it just keeps my brain in a little kind of baseline of fitness to to ruminate less, or to notice when I'm getting pulled into thoughts that don't serve me. And to be able to say, oh, there's that thought again, it's okay. And now I'm going to just, I love, let it, let it go. And

Laura Bowman:

then another one is anything that increases presence. So like they say, playing with animals, playing with children, doing anything creative, you know, like arts and crafts, literally, this is why there's adult coloring books, you know, anything that can, just like, let your brain kind of slip into flow. Or

Colette Fehr:

if you're Laura, doing a puzzle. Did

Laura Bowman:

you see that there is now puzzle Olympics, where everybody gets a puzzle, the same puzzle, and then they set a timer, and then it's like a race to see who can build it first. Is this gonna be like, ruin it for me, honestly. But I was like, oh my god, I have a sport.

Colette Fehr:

Oh my god, that is hysterical. I know I'm

Unknown:

gonna send you the video. Oh

Colette Fehr:

my god, so maybe you'll be in the puzzle of books. Okay, I hate puzzles. I try. I

Laura Bowman:

make some people anxious. They

Colette Fehr:

just make me annoyed. I have a low tolerance for boredom. It's too many pieces that like look the same. I like my word puzzles as

Laura Bowman:

you know. I know, I know. I like word puzzles too, but there's something about puzzles for me, is about the sorting, like the quick sorting. That's why I like to clean, too. It's like, okay, I love to

Colette Fehr:

clean. I love to organize. I love to throw things out. Oh, I get high of throwing things out. So go for a run and then throw out everything in your house except, you know, like Marie Kondo says, Whatever sparks joy. So, okay, so in wrapping up, you know, we're saying everyone has anxiety. There's some things that can help. And some people have anxiety to a different degree. It can be biologically wired. It can be trauma based. It can be both. Don't judge yourself, you know, figure out what's good for you. And if you think you're someone who has anxiety, you're not sure, and maybe you've never talked to a therapist at all like it's really worth it to to consider doing that, because there's so it can be so much better than it is. Yeah, and I don't want

Laura Bowman:

to sound like proprietary over anxiety information, because No, certainly a lot of therapists are well trained, but anxiety is one of these things that you have to do, or really throw intake of people's lives, you have to understand how behavior is functioning for people, how people are doing safety behaviors to keep themselves safe in situations and like stopping themselves from getting well. There are, like, a ton of anxiety disorders. There's specific phobia and OCD, which is its own social anxiety, right? Social Anxiety these things, they require somebody to do a really thorough intake and then design really, really targeted approaches for you get better. So don't go to somebody who doesn't know what they're doing with anxiety, because a well intentioned person can, like, make it worse, because there's an urge, you know, there's this, like, tendency to want to reassure, like, Absolutely, it's going to be fine. You don't know if it's going to be fine, right? You don't know. So it's like that the way some people want to intuitively deal with anxiety is not always what's helpful,

Colette Fehr:

yeah, and for people who are listening in different parts of the country and the world. You know, it's what you're saying is very similar to the way I feel about couples therapy and really anything that you're treated, not that there aren't great generalists, but find somebody who really knows about anxiety. There's so much in mental health, and you. Go to somebody that this is something they're treating often. You know, they are using evidence based modalities like ERP right, cognitive behavioral therapy is also validated for anxiety. It doesn't really work for me, but it works for many, many people. Yeah, you know, EMDR, eye movement desensitization, reprocessing is very helpful for many people, but not for everyone. Same thing with medication, you've got to find the right thing for you. But if you are going to get professional help, find somebody who's experienced an anxiety, ask them, how much of your population do you treat with anxiety? What approaches and even if you don't know what these approaches are, ask them and look them up, because you know you don't want someone hate yourself. Yes, yes, yes. And, and you know, if you're in a different place you don't know how to find a therapist, you can always start by looking at Psychology today.com. You can enter your zip code, and you can search for therapists who treat anxiety, but do your homework beyond that, because some people put they treat everything under the sun,

Laura Bowman:

yeah, that's a sign, guys, if they treat everything under the sun, they treat nothing, yeah, you know. And and also educate yourself like nobody is going to direct your healing, like you are going to direct your healing. So we will. I will list my favorite anxiety books, one of that and so that you can begin to look and see what's what's good out there. One of the newer ones that I like is the anatomy of anxiety by Elder, she's a holistic psychiatrist, so she really breaks down anxiety into all of the bins and like shows how all the physical stuff can lead to anxiety. So there's so many

Colette Fehr:

components. Say it again. Say it again, the knee

Laura Bowman:

of anxiety. Okay, I haven't read it. I'm gonna read it for I'll list all this stuff. I'll list my favorites in our on our website and put

Colette Fehr:

in there too, even though it's not specifically on anxiety, feel the fear and do it anyway. By Susan Jeffrey, yeah, that's my favorite book, and it's really about those things in life you want that you are going to have a lot of anxiety around because it's scary and how to cope with it. It's amazing. She's now deceased. I've read it like five times, and I never reread books. It's so good.

Laura Bowman:

Love it. Love it,

Colette Fehr:

all right. So thanks everyone for listening.

Laura Bowman:

Like, 10 more episodes on this, maybe we will, but

Colette Fehr:

yeah, and I want to do, like, let's do one soon, where we talk about OCD. Yes,

Unknown:

that it's its own huge topic, because

Colette Fehr:

I'm like, almost OCD, but I'm not. I see

Laura Bowman:

a lot of OCD, actually one of my favorite things to work with. Yeah, it's

Colette Fehr:

definitely not mine. But I keep feeling like I have OCD, and then I keep looking at it, I'm like, Ah, I just don't think I do. But like, I'm so close on the

Unknown:

edge I'm not hearing

Colette Fehr:

All right. Thanks everyone for listening. Check out our website, insights from the couch.org. For a list of great books to read. And also, we'll list Psychology Today there too. Can we do that so that people can find a

Laura Bowman:

therapist the things that you want to look for when you're looking for anxiety care? Beautiful. We

Colette Fehr:

appreciate you all so much, and if you're enjoying our show, please leave us a five star review to help us spread the word and share this episode with any friends you have. You think this might help as well. We will see you all next time on insights from the couch.

Unknown:

Bye, guys. You