TOTAL BRAIN

REFRAMING ANXIETY - Dr David Whitehouse MD. MBA

April 06, 2020 Dr Evian Gordon PhD. MD. Season 1 Episode 10
TOTAL BRAIN
REFRAMING ANXIETY - Dr David Whitehouse MD. MBA
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TOTAL BRAIN
REFRAMING ANXIETY - Dr David Whitehouse MD. MBA
Apr 06, 2020 Season 1 Episode 10
Dr Evian Gordon PhD. MD.

Dr David Whitehouse. MD,PhD is a Cambridge University undergraduate, a Harvard trained psychiatrist with over 20 years experience, with leading managed behavior change companies in the US. He also has an MBA from the University of Connecticut and a doctorate in Theology from Harvard.  He is now the psychiatric medical director for AbleTo the leading evidence guided, outcomes defined, virtual and digital cognitive therapy focused behavioral solution company. 

Show Notes Transcript

Dr David Whitehouse. MD,PhD is a Cambridge University undergraduate, a Harvard trained psychiatrist with over 20 years experience, with leading managed behavior change companies in the US. He also has an MBA from the University of Connecticut and a doctorate in Theology from Harvard.  He is now the psychiatric medical director for AbleTo the leading evidence guided, outcomes defined, virtual and digital cognitive therapy focused behavioral solution company. 

spk_0:   0:08


spk_0:   0:08
Welcome to the Total Brain Podcast series hosted by Dr Vivian Gordon, founder and chief medical officer of Total Brain. Today's podcast is on reframing anxiety, and I'm particularly delighted to have as a key opinion leader, presenter Dr David Whitehouse. Dr. Whitehouse is a Cambridge University graduate,  a Harvard trained psychiatrist with greater than 20 years experience leading managed behavioral companies in the United States, he has an MBA from the University of Connecticut and a doctorate in theology from Harvard. He's now the psychiatric medical director for Ableto, the leading evidence Guarded outcomes defined virtual and digital cognitive therapy focused behavioral solution company.  Welcome, David. It is extraordinary that we've known each other since 2006 where David and I were two of the five presenters at M. I. T in Kendall Hall at the first personalized medicine conference on the brain in the United States, and we had coffee after that and, um, collaborated and have never stopped, and ah, David embedded  us into united and Optum on a large scale and has been just a phenomenal shaper of many of the deepest ideas, are integrative applied ideas in Total Brain, so  just hugely grateful David for our collaborations and our friendship over the many years and all the challenging reframing anxiety issues we've had to go through but, it's wonderful. David look, we do start off as you know with these podcasts starting with the key takeaways and ending with the key take away. So I wonder if you wouldn't mind, please, just starting with the key takeaways. And then let's get into our conversation.

spk_0:   2:05
Welcome to the Total Brain Podcast series hosted by Dr Evian Gordon, founder and chief medical officer of Total Brain. Today's podcast is on reframing anxiety, and I'm particularly delighted to have as a key opinion leader, presenter Dr David Whitehouse. Dr Whitehouse is a Cambridge University undergraduate,  a Harvard trained psychiatrist with greater than 20 years experience leading managed behavioral companies in the United States, he has an MBA from the University of Connecticut and a doctorate in theology from Harvard. He's now the psychiatric medical director for Ableto, the leading evidence guided, outcomes defined, virtual and digital cognitive therapy focused,  behavioral solution company. Welcome, David. It is extraordinary that we've known each other since 2006 where David and I were two of the five presenters at M. I. T in Kendall Hall at the first personalized medicine conference on the brain in the United States, and we had coffee after that and, um, collaborated and have never stopped, and ah, David embedded us into United and Optum on a large scale and has been just a phenomenal shaper of many of the deepest ideas, our integrative applied ideas in Total Brain and am just hugely grateful, David, for our collaborations and our friendship over the many years and all the challenging reframing anxiety issues we've had  to go through but that's wonderful. And David look, we do start off as you know these podcasts, starting with the key takeaways and ending with the key take aways. So I wonder if you wouldn't mind, please, just starting with the key takeaways and then let's get into our conversation.

spk_1:   2:07
So here are the four key takeaways for tonight. One is the first with your emotions. You have to name it to tame it. The second is you have to break the cycle of catastrophizing. The third is you need to spend your time focusing on the positive, much more than the easier to focus on negative. And the last is focus on something else, especially something that might be in your right brain to do with the arts, music, literature, drama, painting in order to take the mind off the left brain analytics. Those are the four takeaways

spk_0:   2:58
Whoa,  wonderful. Look in this time, David, as we know of this extraordinary hijack , nonconscious brain hijack at a time when we know that our brain is driven by our nonconscious biases, stress and fear being the most obvious and prevalent at this time. And we've seen the challenges now are about how to switch into a more calm, flexible, so called Vegas state that's going to give us a more solution focused, positive, realistic optimism. How do you go about helping people to find that pivot?

spk_1:   3:43
So the first, under the name it to tame it is to try and help them actually identify and speak about the emotions that are going on. Most of us don't even remember how it was we first began to put words to various feeling states, whether it was a parent who, when we were autonomically, aroused and shouting said, Stop being angry. So we said, Oh, well, whatever that is that must be anger. But one of the hardest things to do, too, in terms of getting control of your emotions, is to actually be ableto label them. In the midst of this Corona virus, there are so many mixed emotions. Is what you're feeling depression? There was a wonderful article this week by Scott Berinato in the Harvard Business Review. It was called "That discomfort Your feeling is grief". It really was, Ah, signal to me to again go back and think about the many and confused feelings once had and kind of say, Well, uh, things that you would expect from grateful there the initial feeling of denial. Oh, it's never going to really be a cz bad as they say it is, then, anger. You really mean that they're actually going to contain us and keep us look up for this long, then bargaining. Well, of course I can go to the store because I am gonna wash everything off when I come back then. The last two stages agree for depression and acceptance and to which Baron Otto had added the last, which I think is wonderfully positive for us at this time is will we come all out of this with a renewed sense of meaning of real value about will we check in once more? What really matters in this life is what your feeling anxiety is it fear? The first thing you have to do is stop and take stock, understand what you're feeling. Only then when you can express it and share that with others, will you find that you have power over the feelings rather than the feelings having power over you, because they're just a kind of a MME office confused black cloud. The clearer you get, the more power you will have. That's number one. The second thing is stop catastrophe izing, and this gets back to the good and the bad of the brain. We would never have survived as long as we have as a species. If the brain was not first and foremost a threat detection system, it from the moment it comes awake is looking out for danger around us. And the good thing is that those dangers and normally fairly circumscribed, minimal and we know them. So the brain also looks for patterns, and it will then appraise the threats in our life and say, OK, this is one that we expected. This really isn't very harmful. We can give it a minimal response, weaken downgrade, the way your body's reacting and if it's something that is new, uncertain, confusing, our system is more alarmed by that and so we have a tendency to catastrophe eyes, especially when things are uncertain well off all situations. The present situation is the most likely to catastrophe ises. We have unconscious operating rules in the brain that without realizing it, we wake up to, For instance, you might have an operating rule in your brain that says people in positions of authority or positions of respect can normally be trusted and expected to tell the truth. Well, in the current environment in which we're living, this one has been sorely tested between interparty bickering between statements which frequently conflicting That statement that we had put in our brains that experts are experts and can be trusted has been broken when trust is broken. Ah, lot of the cognitive operating rules are then broken along with it. Oh, viruses occur like the flu, but they never really are that harmful. We've had epidemics H one n one, the bird flu, the swine flu. But they're pretty harmless, and they certainly won't harm me. Now we're told there's a virus and it could be harming you. And unwittingly you could I to be transmitting it will be the victim of it. That was not an operating rule that was in there. And so we catastrophe eyes. Oh, my word, my medical knowledge. They can't even tell me what I should do. They just say, wash your hands. That's the best they could tell me. And so from that everything trust belief in experts. Who can we rely on? A ll gets threatened and we then get into this terrible cycle in which we become frightened of the news. And then we become frightened of what it's doing to us. We become angry, we become upset, we become anxious. The third rule is focus on the positive over the negative, our brains, because their threat detection mechanisms find it much easier to remember. At the end of the day all the things that have gone wrong. And I'm always fascinated sitting with patients when you say to them, Can you tell me the worst thing that happened to you yesterday? There is barely a pause. That list of the bad things that happen to you yesterday is so high and so long you can float into that in a second. If you say to somebody, tell me the three best things that happened to you yesterday. They sit in front of you and they go absolutely mute. They have the hardest time recollecting and putting a frame on something that it was a good thing. If you imagine that it takes three times the amount of energy or time spent on positive things, toe wipe out the power of that one negative thing you could imagine what a day sitting in front of CNN does. So, as you've seen for many of the resource is around, you do lim focus on the negative limit the amount of time you spend sitting in front of the White House update the New York State Update. You could spend hours per day listeningto all the negative news, reminding yourself of every single thing that is gone wrong. And yet, in that same day, there may be stories of heroism of positivity it may have even had. The sun shining in the midst of this spring is trying to emerge, and none of that gets noticed as we focus on the negative, especially last thing. At night you go to sleep, but your brain doesn't go to sleep. Why does anxiety disturb? Mostly falling asleep because we lie in bed and we ruminate and what comes up are the negatives. In preparation for tomorrow, we try and examine all the disasters that ham that we would hope to avoid the following day. You fall asleep eventually, but your brain does. If there is one time, you should try to recollect those three positive things. It is as you're falling asleep because maybe, just maybe, the brain will attend toe one of those during all the time you're sleeping

spk_0:   13:18
just wonderful. It's such a great summary, David, Thank you. And you know, having a framework is so critical. And that is as good a frame workers I've ever heard for dealing with making explicit how to deal with the negative and nudging towards the positive. One of the things David did is that I ask myself that the end of every day we have about 50,000 thought today, and I ask myself, How many of those thoughts did I switch from negative to positive? Whether it was through naming, stopping, focusing on the positive and basically focusing on something else. It's a fascinating answer, sometimes to see how neurons that fire together wire together. So we have a default mode, and if it's negative, we can be Perceval a tive and overwhelmed by the sheer volume of negative thoughts. And so this strategy. This conscious, deliberate practice way off switching is phenomenally important. What are the other strategies David that you find have have been most helpful to people to switch out of that negative state and become more realistically positive?

spk_1:   14:35
So So an interesting one is that after we hear presented with a threat, there are these thes two responses. There is the threat response, which has bean ingrained in his deep into the brain, which will go down into the auto gnomic systems faster than we can name it. It has flown and taming the threat response itself through things like breathing focus on heart rate variability can be crucial in terms of training. That rapid automatic response long before you can go thinking but at the same time is that threat hits and goes down with that autonomic response. It goes up into the brain from the same center, but up into the brain where it's going to be appraised. And all the things we've been talking about thinking have a role. The interesting thing is, as I said, when it's appraising that this wonderful area of the brain of the mome alien brain, the working memory, which is like in my imagination is like a giant table, and it takes from it all the books of your past experiences. So here we are viruses. It's taking out everything that ever saw on television show everything it ever read or heard on a TV station, everything you were exposed to as a child when they brought Children over to catch the chicken pox or the German measles because of concerns about if the Children got it when they were going through puberty or whatever. You remember all these things, and all these books come out and get laid on the table of the working memory with all their negative associations. And that's what we talked about catastrophe izing and everything else. While the interesting thing is, it seems that if you can actually fill that table up with something else, then the brain doesn't have a chance to bring out all these books on terrible things about the current situation. So if you find something that you can use to completely distract and most amazingly, if you could take something on the right side of your brain, so instead of appealing to your analytic brain, which will goto a ll The analytic resource is in the library. You, in fact, put onto that working table music, Uh, creative things, Like writing. You can in fact, dr that negative analytic off the table And for that limited time that you are focusing on the other, you are so absorbing, the resource is of the break that it hasn't got the energy to carry out and give energy to the other. Resource is with all that catastrophe izing negativity.

spk_0:   17:57
Yeah, that's such a great point about the brain. Strategically, if you have a strategic approach to switching off your left analytical brain and and and and accessing and allowing your right and your non conscious versus conscious whichever way you want to look at that dynamic so critical that we all know that the biggest gap is between knowing and doing what is shocking to me, David, at the time of fear and threat how hard it is for many people for the brain to reorganize the strategic input to being more positive and not getting into that cycle of decline on the negative. So that's a great way of just some simply keeping the focus on how this balance between magnifying positive and diminishing negative lift drop brain, whichever where you want to really think about it from a brain point of view. But there's also that connection between the brain and the body, and you mentioned heart rate variability. And it's just fascinating to me that there is such an incredibly simple way to switch off your brain and bodies, fight flight system, put a brake on it and activate the conflict herbal system that the Vega system. And that's simply by breathing at six breaths per minute. That sounds kind of little arbitrary, but it's not. It's that is being discovered by people like Dick converts from Ali and University and others. Whole network of people over 20,000 publications and I actually have demonstrated the benefit off. Boosting heart rate variability. The B two B two variability in your heartbeat. The into the interval between your beat is variable that's more flexible. That's what allows us to be flexible versus the fight flight. Shut down consistent physiology. And so that's one of the reasons that total brain put that simple breathing tool front and center of the anxiety journey because it's such a simple way off switching the brain and body into that flexible, calm state. What do you see as the primary kind of impediments that off, going from the knowing to doing, crossing that bridge with these kind of simple concrete strategies and tools.

spk_1:   20:19
So one of them, I think, is just the belief. So when you and I first met, I think one of the things that that you said which I carry with me, always is You said I wish that I could teach people to befriend their brain and in that library that we have in our brain that will the brain more readily access to put on the table of working memory. In many cases, there are people who have dark volumes of traumatic and bad incidents in the past who have lost hope and everything else. And when we're growing up, we frequently feel powerless over these emotions. We see emotions and others. They seem to hijack people on hijacked the way they behaved. And we don't feel comfortable that that we are going to be ableto own. That what you've talked about in terms of being ableto own the physiological response and then what I've talked about is to say that. Actually, we can own the cognitive response as well. We can actually own and direct what we're thinking about, and it is something that is unusual. Tow us. We're not just a reflex. We're not just threat in a response automatically out. The great opportunity we have is an opportunity to befriend our brain, strengthen, operate, learn more about it. And I think you you so beautifully said It takes repetition. It takes work and it's a struggle. So if you hear something and you try it and you say, Well, that didn't work for me there, So it can't possibly be true. I would just encourage you to try a little longer. And that's one of the other you unique things because, interestingly enough, another way too toe hijack the brain is Besides, using the right creative brain is in the very act of compassion when you empathize, and what you put on that table is your awareness of the feelings of others and that that is the work that you are doing on the table to cure, to hell, to support, to soften, to cherish, to create, to give hope. Then your brain will leave you feeling so much more positive. And those will be the books. At the end of the day, you are replacing in the stock of your library and you will feel them and touch them. And that power will be effective.

spk_0:   23:32
Yeah. Here, David. We're almost coming to an end. I do want to know the have Ah, last few minutes too discussed with you. You know, you are so uniquely placed in your in your context of what's going on across the country because of the exposure you had not just from your medical background, but from your position at the largest player in the country as the head of innovation, the continuum off anxiety, stress and depression. And obviously, with depression, particularly negativity buyers, I wonder if we could end off before we end up on the takeaways again. Off just discussing a little bit about that whole continuum and and how you would point people to baste, deal with that whole dynamic and doing what we can to avoid going into the circle of the clan of depression.

spk_1:   24:24
So yes. Oh, thank you. So I think one of the things I would say is I really wish that people understood that doing nothing is not neutral. So if you you may not realize it but like it'll like it not, you will have information coming into you and you will have tapes and emotions that are processed through your day and you are filling that library up and what we know because of this'll potential for bias for negativity. There are people who are more vulnerable than others, who frequently see threat everywhere. And when we say negativity, biases so easy. People mistake that for the word pessimism. And I think that one of the analogies that made it easy for me to kind of see the difference is if you think about what it's like when you're sitting in a class in school and the teachers doing something on the board and you really don't get it, and you'd like to put your hand up and say, I really didn't understand what you just did But you don't because you're worried that the other kids would tease you or you're the only kid in the cost who doesn't get it, and then some kid, two rows in front, says, Excuse me, I haven't got a clue what you're talking about and you think, Oh my God, I'm so embarrassed for that kid. Have that kid must feel terrible. That's negativity buys. It's your perception that the world in which you operate is a much more threatening place, and we all have that in variation and with what's going on. There are people whose brains when they get stress, when the negativity and threat that surrounds us in something like a national crisis like this is there day in, day out, their brain breaks in a way that it will not automatically pop back popping bag. Maybe that's resilience. We talk about grit and that if we know howto take it to its limit and let it pop back, that would be good. It would be like exercising a muscle that's a talk for another time, resilient. But for some people under this that stress that anxiety will cause it to pop out and it won't pop. And that is depression. And the sad thing about depression is we become less aware of our emotions. We do not speak to others. We don't want to name it because it's too frightening and we can't summon up the energy to find the positive. And when that happens, that's when you need to reach out for help. So along that continue, you can strengthen the brain, maximize your resource is and be as healthy in mind as you can bay. But if things tip over, that's when it's time to reach you.

spk_0:   28:00
Wonderful. Thank you so, so much, David. I'm never gonna be doing a number of these together on DDE. They're just being such a wonderful journey of collaboration since 2006. I would love you to please just end off on your takeaways again. Please

spk_1:   28:19
said of four takeaways. Please, Dr. Name it to tame it, focus on the emotions and try to be very particular about what am I really feeling? Take away too. Don't catastrophe Eyes don't let one negative slip into the next. And so you generalize toe everything. The whole world is falling apart. The virus is going to kill everybody. Everybody's lying to me. That's catastrophe writing. Stop! Catastrophe waiting Number three Focus on the positive over the negative. There are good things happening around you. We will get through this We will learn and be better prepared And everywhere around you there acts of kindness. Four. Focus on something else. Switch to the right brain, right? Listen to music. Use your right brain to fill your brain to drive out the worry with something creative, active, soothing and helpful. And that's my advice.

spk_0:   29:28
Thank you so much, David. You have provided the ultimate context for people to befriend their brain and bridge the gap between knowing and doing. And let's say goodbye until until next time till next time. Thank you again.