What the F*ck is Anxiety? - Dr. Nicole Cain

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At the beginning of every episode, there will always be time for an acknowledgement. You know, the more we do this, people ask, why do you have to do the acknowledgment? And every episode, I gotta tell you, I've never been more grateful for being able to raise my babies on a land where so much sacrifice was made. And I think what's really critical in this process is that the ask is just that we don't forget. So the importance of saying these words at the beginning of every episode will always be of utmost importance to me and this team. So everything that we created here today for you happened on Treaty 7 land, which is now known as the center part of the province of Alberta. It is home of the Blackfoot confederacy, which is made up of the Siksika, the Kainai, the Pikani, the Tatina First Nation, the Stoney Nakota First Nation, and the Metis Nation. Region 3. Our job, our job as humans is to simply acknowledge each other. That's how we do better, be better, and stay connected to the good. Okay, Dr. Nicole Caine, I have been waiting for this conversation for some time, and it's interesting. We were just talking about this fact that when you get two people in the same field together, there's lots of sort of jousting that happens off the scene. Like, if I'm gonna be honest about this, I'm like, okay, what can she really know? And I'm like, yeah, I'm sure she knows about anxiety and trauma. I know about anxiety and trauma. And then I read your book, which is not released yet. So we got the early copy of this book printed off the print. And listen, there has never been a more important time to talk about anxiety. And I. I want to tell you about all the things that I think are so critical in this space. And if you know somebody who struggles with anxiety, if you struggle with anxiety. And let me just preface this by saying I don't know a single human on this planet that has not experienced anxiety A, because it's normal, and B, we've never had so much noise. And anxiety loves the fucking noise. It loves it when the land is not clear, right? Uncertainty, fear, no end in sight. That's what we really love, to feel anxiety. And all those things seem to be very present in our worlds today. So I listen. My biggest question is this. Dr. Nicole Kane, you tell me what is going on with anxiety? Where do we start? You tell me why you wrote this book and how I think it's going to change the world, but I want to hear it from you.

I wrote this book because I wanted to prove to myself that despite what I had been told my entire life growing up, that I could actually heal from anxiety.

So this is in your body and in the patients you treat, which is. P.S. so true for all of us, right? Tell me, so did we accomplish this? Do you feel how? Like, what is the thing that really came to fruition in this book for you?

This book is the book that I needed decades ago, growing up in a culture where, number one, anxiety isn't a real thing, and number two, if you are feeling yucky, then you go to your doctor, they give you a pill, or you just suppress it and do something else. I'm from the Midwest. I have a. A father who's a Marine and a lot of Dutch relatives. And so this creates this recipe for suppression and avoidance. But we know from clinical research that what we resist will persist. And what we deny will amplify.

Okay. Whoa. And what we resist will persist. Look at her just truth bombing us here. What we resist will persist. What we deny will amplify.

Yes.

Tell me more.

Yes. And so when people avoid their symptoms, if they're not addressing the why of their symptoms, oftentimes the symptoms will get louder. And so they start as a whisper, and if we don't listen, they'll turn into shouts.

Oh, I love that. And so why do you think we're seeing a significant increase in anxiety among our population, like, particularly our adolescents? You know, as a psychologist, and I know you, you know this to be true. You know, so many people these days in my clinical practice are like, this kid is anxious. This. You know, I've never seen this level of anxiety. My husband's anxious. I don't know what to do about this. Do you see this, too, in your work?

Yeah. The prevalence is skyrocketing. In fact, during the COVID pandemic, so many people were so anxious and receiving so many benzodiazepine prescriptions like Xanax or ativan or Klonopin that there was a New York Times article that came out and they were like, we're worried about a medication shortage here.

Really?

So numbers are high. Numbers are at record highs of anxiety. And part of that could be because the actual incidence is higher. It could be that because of people like you and other thought leaders are actually giving us permission to have conversations about it. And so then when we have that conversation about, okay, we're noticing, we're acknowledging this pattern, this trend, and that's despite incredible medical advancements in diagnosis and surgeries and treatments, and yet the numbers are getting higher and higher and higher. Yeah. And so we're doing something wrong. We're missing something.

Yeah. And can we just start at the beginning? Give me your take on what is anxiety? Because so many people use this word so colloquially. Right. I'm too anxious. This is anxiety. Strive. I'm, I'm, you know, this is. Lou, I'm. Clinically, there's a big difference. Right. Between the natural response to a situation where we don't have a script for our bodies are to prep us for that to then when it becomes sort of disruptive in your life. But what, how would we describe anxiety from, you know, your expertise in this, years of putting this work together.

Yeah, it's. It's context of what's happening in the body, in the mind, in your soul, in your spirit. As we think about all of these changes that happen, that's a part of natural arousal and then it's the context that we give it. And so if we think about Susie gathering berries in the fields back in the day, you know, our ancestors, Susie from the stone Age, if you will, she's gathering berries, she hears the roar of a tiger in the bushes and her body will produce adrenaline and cortisol, her heart rate will speed up her default mode network and her brain will kick in so that she autopilots it out of there to safety. So those physiological cues and then her behavioral and emotional responses in the context of danger are life saving for her.

But it's intended to keep us safe. Right. When anxiety works well, it's the best thing ever. And we do this automatically. Right. Like, yes. Susie doesn't have to be like, oh shit, I'm going to die. She is almost. Anxiety works ahead of your thought process, typically. Is that right?

It does. It's faster than you're thinking it is. Yes. In fact, the signal travels from the salience network, the filtration part of the brain, to the emotional responsive part of the brain, the amygdala. And then that can send a signal to create that whole axis throughout the body to get activated into fight, flight, freeze long before, moments before that signal even gets to the logical part of the brain, the prefrontal and frontal cortex. That takes more time.

So then Susie puts those two things together and she's like, ah, my body is doing this to keep me safe because holy smokes, there's a tiger.

Yes, okay, yes.

So then when does it start to not be effective? Right, so, like, most of the time, yes, got it. Like, particularly, it's supposed to protect us. It works well. Well, thank goodness we have those systems. Does anybody not have that system? Like, are we all born with that? Does that come inherent in all of us?

It's been so important for survival that the ancestors that we have that were able to identify danger and run from danger quickly and effectively were the ones who were able to reproduce. And so everybody listening to this conversation, you have this built into your physiologically. This is in your DNA.

Got it, Got it. Okay. So that's not the thing we have to develop. Where and when does it get messed up? How does that. How does then it, you know, start. Does we. Do we start to misinterpret the signals? Does our body get overwhelmed and we start. Like, how does that process then get. I was going to say get fucked up, but get messed up.

Let's talk about winter coats. It's a really great metaphor. Okay. And so half of the year, I live up here in Michigan, and it's really cold here. Eight months of the year, I need some sort of a jacket or a sweater or a coat on. And that is an adaptation that I have been able to utilize to protect me from getting cold, getting frostbite. We need that. And so that adaptation, that metaphor of putting on the coat, your body, your mind, your nervous system, have been adapting in lots of ways. And since even before you were born, based on the environment, when you were a fetus in the womb, based on the nutrition you received, based on the environment that you grew up in, your body, your mind, your nervous system, and all the other systems in your body, like your gut and your hormones and your neurotransmitters and your immune system cells, they have all been adapting to what did happen to you or what didn't happen to you with respect to what you've inherited from your ancestors, like Susie. And it's like putting on a coat. But here's where it can go wrong. I'm from Arizona. I became an adult in Arizona. And so if I keep that Michigan coat on that has been protecting me from the cold, I keep that adaptation with me. And then I go back to Arizona, where it's been 100 degrees, 100 degrees plus for record days, and I retain those adaptations. Now I overheat. Now it's causing problems. And so what we want to see for healthy autonomic arousal is a nervous system and other systems that are able to continue adapting to what continues to happen to us. And when that adaptation doesn't occur appropriately and it gets stuck, then we get symptoms that we can then attribute with anxiety from head to toe, the different types of anxiety and how they manifest differently for everyone.

Yeah. So your body then is not like. It's like, oh, my God, I'm overheating. Something is happening here, and it's the story in our bones. I mean, you also use this beautiful analogy in the book that I love about a house that we've come from multiple generations before us.

Right.

That in our walls, in our bones, there is a sen. Sort of have. Has been sort of into us. And so if you, for example, have come from multiple generations of abuse, neglect, and trauma, you've survived an attempt at a cultural genocide.

This.

This. This complexity of trauma and anxiety. I know that is your sweet spot. So tell me how, then, anxiety is so closely related to trauma?

Trauma. I describe this. I kind of parse this out as the ninth type of anxiety. But really, arguably, trauma is anything that overwhelms your ability to manage or cope with it. And we could also think of trauma across the spectrum. So a lot of the original research into trauma was done in combat trauma. Really severe. We call those. Those big t events, like a big car accident or war or national disaster or something like that. But then we can look across the spectrum and see that it could be severe. But then we have what we describe as little t traumas. And those could be everyday experiences that overwhelm or undermine or perhaps even the opposite, where there's an unmet need or neglect. And so I use the word in the book. I use adaptive opportunities. I use incidents. And I think that that's really important because a lot of people listening may be like, well, I haven't been to combat. I don't have trauma. But anything that you have to adapt to as easy as putting on a light jacket, that is an adversity. And if those adversities get stuck and we don't continue to adapt to them, if they overwhelm your system and then encodes that, and then you somatically reenact it. You keep playing as though you're still in Michigan, even though you're in Arizona. Then you get symptoms. And so trauma is really at the forefront of what our research is talking about, needs to be addressed and needs to be healed. And that's the why of anxiety. That's the what happened or what didn't happen that's resulting in the production of these symptoms that we associate with powerlessness and a lack of control, overwhelm and fear causing anxiety. So that's the why. That's the root.

Oh, I love that. And what I'm thinking about is if I take us back to Susie, for example, okay, so she's in there. She then gets anxious, her heart starts to pound. She's running. She knows she's sort of like, oh, my gosh, yes, it's because the bear was there. So she can sort of attribute this. Got it. Okay. That's why my body lost its mind there. Right. If she has nowhere to put that, if she doesn't process it, as you sort of suggested in the beginning. Right. Then oftentimes when those symptoms come back.

Right.

Well, can she develop a fear of bears or, I mean, of tigers? Can she then, you know, I wonder every time the heart beats again, does she start to think like, holy shit, there's. There must be a tiger here. Like, is that sort of how trauma starts to. People get stuck in this space where they start to sort of stay in those places and then, you know, a picture of a bear or. Why do I think it's a bear anyways? She's with the fucking tiger. I got it. You know, sometimes, like, this is what I just love about anxiety, is that we get stuck in those places and we're just like. We don't even know why is our body overreacting? There's no bears here. You are fucking tigers. So it's a.

It's a horde of animals, tigers.

Anytime she's. She cannot go to a zoo is really what we've established here, because she is now, which is so true about anxiety, because then it starts to go from not just the tigers, but the bears and then any animal that has four legs. And then can you, like, is. Am I getting that process right? Like, did those things. Is that how we sort of expand and then we just stay home and become agoraphobic because we want to avoid anything that looks like anything? Is that how anxiety manifests down the line?

Totally, yeah. You're bringing to mind, because you're such a genius psychologist, Here you're bringing to mind the little Albert study with a little rabbit. Do you remember that? That poor child.

Yes. Psychology 101. Can you get, like, tell us this story, because this is the most unethical work that's ever been done in the history of psychology. But it provided such, like, undeniable impact. So tell us about poor Albert.

Yeah, they had this cute little, little baby, and they sat him down and put the cutest fluffy little white rabbit. And so he originally didn't. He's like a little reticent, but then he realized it was cute and fluffy and harmless. And so he's kind of interacting with the bunny and everything is wonderful. And so that's kind of our baseline. And so then they put him in front of the rabbit, and then they would startle him with a loud horn or a bell or a noise, and he would be fearful and jump. And then what the brain does and what they observed in this study and what it helped us to realize is that the brain is very associative. And so he started to make a connection between startling sound, fear response, fluffy bunny is evil and scary and dangerous. And so now he becomes phobic of rabbits. But what is interesting about this, which is what you were touching on, is that Zen that will start to generalize, is that Little Albert then became afraid of other fuzzy animals that had four legs. It wasn't just rabbits. And so we see this in anxiety. We see how smells can activate people. They may be driving down the highway, minding their own business. A red truck passes them. Forty years ago, a red truck maybe T boned them in the car when they were a kid and they got hit. They don't even remember it. But the brain is so associative. And the brain will log away all of these experiences, like in the hippocampus. Its job is to give context to our environment, whether it's smell or sight or sound or rabbits or tigers or bears. And then we can have these responses and we're like, what the heck was that? Yeah, my body is. It's going rogue. There's.

I must be going crazy. Am I having a heart attack? What is that? Like, we are just. We just drove past a red truck. Sometimes you're not even cognizant that the red truck went past. Your body keeps the score. Vessels were.

Yes.

And so it's. That's so fast. So when you were saying that too, I was thinking about all the police officers. So I do a lot of work with first responders because you can Imagine that for people who do work where their job is to step into terror, their job is to step into anxiety provoking situations because they're there to walk people through it. And there is very little historically, opportunities built in to regulate the system. Post a shift on any of our, for any of our emergency responders, right? We're just like, you got it, you got it, you got it. And what I see in my practice often is like three things. And I often talk about this, right? The things that kind of mess police officers up the most is the smell of gasoline, ladybugs and Christmas lights. And so in and of themselves, right? Christmas lights can't hurt you. A ladybug can't hurt you. But I have seen a ladybug and a Christmas light send a grown human the size of John Cena into a absolute puddle. And you see, when we take the Christmas light in and of itself, it, I mean, you know, it can't kill you, huh? It's like it's a Christmas light, but the context in which it occurred. And people say, well, why gasoline? Okay, so you think about lots of MBAs, you're at the scene, cleaning up, you're with dismembered bodies, whatever the deal is, and you're just smelling the things that you're not putting two and two together. Christmas lights, domestic abuse, and any death that happens at Christmas seems to be much more overwhelming and integrated. So if you have to do an N. Okay. On Christmas Eve, you will remember that one as a first responder. And bugs, bugs and ditches. And so being able to navigate people through those things, right, Is like it's oftentimes we're working through, huh? What does that mean? Where did that come from? So that we can put those pieces in the brain back together and it can live in your body as a memory, not as an experience. Is that. Would you agree with that?

So brilliant. So brilliant. I feel like that's a really concrete, so substantiated by research. Perfect example of how these associative networks can occur. Something that is totally benign, like a ladybug or a Christmas light, can then become associated with something that's really dangerous. And then you described the way that the nervous system then programs that. And we have the opportunity, we have the research showing us that we can reprogram that. I want to take it a step further though, is that a lot of times I've seen we have these brilliant specialists and they're like, okay, I'm going to work from the shoulders up and we're going to do the talk therapy. We're going to talk about logic. We're going to analyze it. And then you have people who are like, okay, I got you with the nervous system. We're going to do polyvagal. We're going to reprogram the nervous system. We're going to do tapping emdr. We're going to get. Yeah, emdr. I love that. Hearts work, all of that, right? So then we're in the nervous system and then we start to forget the other adaptive mechanisms that are taking place. And so when something happens to you, it doesn't just happen from the shoulders up. It also happens in the gut microbiome. We see that there's an abundance of incredible literature showing that our experiences will create changes in the gut microbiome. We know that there's a bidirectional highway via the vagus nerve, that gut brain axis that connects the gut and the brain. And it turns out the gut is doing most of the talking. So when we think of those adaptations, seeing that ladybug or driving past that truck, or being chased by a tiger, bear and a lion or a rabbit, that we see changes that can occur in the gut microbiome that better protect us. They're part of putting on the coat to exist and survive in that stress state. And then we see also changes in the immune system and we see changes in the hormones. We see changes in peripheral metabolism and processing of hormones. And so now we have all of these feedback loops that are stuck. And this is such an opportunity for really powerful research and development into how as a whole person, we can actually heal from anxiety.

Well, and you can imagine, you know, as you sort of lay out so beautifully, I mean, like, let's talk about symptoms. Because if you are in those scenes still in your mind five minutes later, five months later, five years later, 25 years later, racing, pounding or skipping of the heart, chest pain. I mean, this is in your section where you're talking about commonly reported symptom symptoms. Chest tightness or difficulty with breathing. That should happen if you're about to do a death notification or you're in a ditch getting chased by a tiger. Flushes, heats or chills, dizziness, feeling disconnected, numbness or pins and needles, a need to pee, a need to poop churning or tightness, fluttering, sickness, racing, intrusive, disturbing, anxious thoughts, a terror illibi like hopelessness, despair, criticism, flash nightmares. That, that when you are at the scene is helpful. That thank you body, thank you body for doing this. The issue becomes, in this place of anxiety, Is that when we don't understand why that's happening and the context doesn't make sense, we panic. We start to lose our mind. Which, again, this is the title of your book is Panic Proof. And I think it is so interesting. Probably the most important part, I think, for me, of this is the nine types of anxiety. Clinically trained, you and I, you have much more of a naturopathic background than me, and I love how you've really filtered this through. Most of us would speak about anxiety very clinically, right? Like, do you have separation anxiety? Do you have generalized anxiety? Are we looking at a panic disorder? What I love so much about your book is that you are considering the diagnostic categories that all of us are familiar with, and then you've really broken them down into nine types of anxiety, including things like gut anxiety. Can you help me understand? Because I think that really will provide people this sense of like, acknowledgement, of, like, oh, that's where it's living in my body. So talk to. Talk to me how you came to this, you know, in your practice. I know, but, like, the nine types, what are they? And tell me a little bit about them if you can.

Yes. So the nine types of anxiety. What I love, love, love about this is that it is looking at our symptoms as particular data points. And we do this in medicine, right? So if somebody comes into my office, and so in Arizona, I'm a primary care, so somebody comes into my office and they have constipation, dry skin, fatigue, and weight gain. I am able to say, based on these compositive symptoms, one of my working hypotheses is hypothyroidism. So I'm able to run a very specific blood test and confirm that. And with anxiety, we don't have a diagnostic blood test yet. We can't just be like, oh, you have autonomic arousal. It's showing up in these ways. Here's the blood test, but we still have data from symptoms. And the data from your unique compositive symptoms will give us information about those feedback loops that are stuck so that we can go in and correct those stuck feedback loops. And so the unique presentation of your anxiety will give you data about what unique treatments will work for you. And this is so cool in that instead of going to a doctor and them saying, okay, you're anxious, do you need an SSRI like Zoloft? Or maybe you would be better with Wellbutrin that attenuates and affects dopamine, or maybe you need a benzo, or maybe A benzo.

So we can just move on. Yeah, yeah.

But then. Then let's say that that person who's going in, and these are their general options. But the anxiety is due to an imbalance in estrogen and progesterone. Because they're perimenopausal. They're gonna have to then go to another doctor to then deal with their perimenopause while they're now taking this treatment that doesn't deal with the root cause of the anxiety. Imbalance in hormones.

Amen. And here's the interesting thing, right? Because anxiety can show up for so many different reasons. And part of, I think, our most important ethical work is to figure out not what's wrong with you, but what happened to you. And this is. I mean. I mean, Bruce Perry wrote a book about it. But I also really love your line. That is what's wrong with me is the question we ask ourselves. Our physicians ask us often, our psychologists ask us often. We don't ask, what's my body telling me? And I think that question is so healing in and of itself. What's my body telling me? That every time in June, I start to. I can't sleep, I start to get pukey. Like I'm noticing this pattern or like every time I go to my dad's house, every time I go back to the farm, or every time I'm with a ladybug or a Christmas, you know, what's my body telling me? Becomes the question. And so you've really broken it down then into those nine sort of areas of anxiety that we're looking at. Can you run me through those?

Yes, those nine types. So number one is endocrine anxiety. And so that's imbalances in your hormones, whether it's progesterone, estrogen, thyroid, cortisol, those hormone passageways. And so those can cause anxiety. Or they could be the adaptive mechanisms that are maintaining autonomic arousal to protect you, but then, of course, make you feel anxious. Okay. And then we have immune system anxiety. And it is inarguable that there is so much literature talking about the relationship between your brain, your immune system, and your emotions. And so one particular example of immune system anxiety is histamine, that chemical that we know as our friend that causes runny nose and sneezing and itchy watery eyes and a skin rash, histamine. What we often don't know about that when I talk to people, is that it is as stimulating as adrenaline, which is mind blowing. I've been chasing adrenaline, but it's my histamine. We're treating the wrong thing. Right. So immune system anxiety is another one. And then we have chest anxiety, which you talked about. That heart, the pounding in the heart. Air hunger, like I can't get enough oxygen.

Air hunger. So common. Hey. So many of. I find particularly severely, you know, people with severe trauma histories. It lands in your chest and it, it makes a lot of sense to me. Right. And, and I'd love your take on this because it's really like that sense of like my body shuts down, it's putting me in fight or flight, I have to run because I'm not safe. And so that's such a common sort of initial response, is that, right, that chest anxiety?

Absolutely.

Okay, so chest, what's number four?

Gut anxiety. So you touch gas, bloating, reflux, belching, diarrhea, constipation, it shows up in the gut. And so then if we have somebody who's anxious and it's really presenting in the gut, then we have the opportunity to get curious about what the heck is going on in the gut.

Instead of just like ram, Pepto Bismol.

Yeah.

Like how many people are on anti, on antacids that just like sort of assume that, you know, they're just like getting heartburn because they're getting older. Right. Which, which may be true. I think your, your sort of point here is like, let's get curious. What else could these symptoms mean? And when we, particularly with men, I would argue there's not a lot of place to put emotions. And so but the holder of emotions tend to be women. So when we look at autoimmune disorders, women tend to show up far our practices with autoimmune issues because they've held those emotions, everybody's emotions. I got you, I got you, I got you. Right. It's really so far on these four, it's the lack of processing of feelings that get stuck in our body. So okay, so gut, my favorite five.

Yep. And then we have depressive anxiety, which is anxiety that can show up mixed with hopelessness, despair, feelings of worthlessness. And so that's important because that gives us data about what remedies solutions are going to work better. Because if someone is mixed depression and anxiety, then we can look at okay, what neurochemically might be going on with that. So maybe we support dopamine, or maybe we support the gut with specific psychobiotics that can increase serotonin, or maybe we decrease inflammation. So it gives us data about treatment. And then we have anger, anxiety Which I see commonly in men, especially, because at least growing up in my culture with a vet father, and we don't experience express anything. Anger's okay. And so this is that fight part of Fight Flight, Freeze, where we can have that frustration and anger. And the strategies that can calm anger are going to be different than those that are going to lift depression. And so the next type of anxiety is nervous system anxiety. And so this is when, as you were talking about earlier, I feel numb and tingly. Am I having a stroke? My side of my face is numb? Or I've kids all the time. They come in with terrible headaches. They've been bullied, they're stressed, they're overwhelmed with academics. Is there going to be a school shooter? I don't know. And they're getting all of these somatic symptoms. They're getting headaches, muscle aches, backaches, and we get numbness and tingling for sure.

And then we go down the big neurological pathway. We're like, okay, is something wrong with them? We look for cancer. We look for all of these physical problems, and we really just. Anxiety becomes the thing that is sort of secondary. Right. And I think connected to this idea of mental health is still so stigmatized. We'd much rather many of us have a physical illness than something going on in sort of like the emotional part of our bodies. Right. Because that still is considered such a weakness piece. Can you have one or more of those at the same time? Can you have all nine anxieties?

Okay, yeah. The value in this, a lot of people will write and they'll be like, well, what good was that quiz if I have all of them? And we want to think of the spectrum of autonomic arousal. And so when you start becoming aroused, as you and I talked about earlier, is your symptoms will oftentimes start as a whisper, and then they will amplify into a shout. And I think about this like a stoplight. So green light is when you're feeling really good, really calm, really chill, really relaxed. Think about what you feel like in your body and your nervous system, in your mind and your thoughts, your behaviors. And then we start going up the stoplight. We get into the yellow zone, where things start getting a little bit more agitated, a little bit more overwhelmed, a little bit more intense. And so start thinking about, okay, what is it like for me when I'm starting to notice I'm getting more aroused? Because if you can identify those I call canaries, those little whispers, those indicators, ooh, I'm feeling like a little Bit of pressure in my chest or, ooh, I'm getting a little bit of a tension headache here. Those little initial symptoms, if you can figure out what that is and then employ the appropriate treatments for yourself, then you don't have to get into the red light zone, which is the crisis zone, where your whole body is like. Like, it's like when your house is on fire and every alarm is screaming. So there's a lot of value in that. And then the gift of being able to identify the sequence at which it occurs. What is your clinical history? What was your very first symptom? When I was a kid, maybe I had stomach aches. And now as an adult, I have horrible everything. Right. So give us information about healing is often like an onion, where, okay, I used to have chest pains and now those are back. But last week, hear that? Oh, now I have gut anxiety. I used to have gut anxiety when I was a kid, and now we address that and that goes away. And my very first symptom may have been eczema, and I was reacting to whatever I was eating as a little one. And that comes back. We treat it and it goes away. And then oftentimes they're done, they're better.

Wow. And so it's like really unpacking that. And I think, like, this is the issue oftentimes when people come to you or me, when we start to really notice it is that we are screaming and there's so many things, and so, so many times we panic and are like, okay, let's just quiet everything. Which I got to tell you, is sometimes necessary because in order to unpack it, if you're in a state of hyper arousal, it's very difficult to sort of unpack that and figure out where in your body you're feeling it.

Right?

Like, so if I'm not sleeping, I'm not eating, I'm in this state of panic, then that's the time that we need things like benzos or things that like, okay, let's just regulate you a little bit. Because our body is incapable of doing that on its own right now. So the introduction of medication in some of those times is like, okay, we need a help. And then the problem is we often stop there, that we're just like, okay, we've. We have just serendipitously closed the prefrontal cortex. We've got every. We're calm, but we have not figured out why. So then people get confused. They're like, oh, God, the medication is no longer working. Or I still feel like A piece of or Christmas Eve is still really difficult for me. Okay, cool. So we need to know why. Right? It's. It's. It's like putting a band aid on a festering wound in the beginning. Sure. We can like just sort of put it over there, but it just keeps coming back and we're like, what the hell? Yeah, yeah. And so it's like that question of. Oftentimes in my practice, my favorite question is not, you know, what's wrong? It's like, where do you feel it? And first responders hate this question, right? Where do you feel it? What the do you mean, where do I feel it? I'll tell you what happened to me is like, I been serving in this country for 50 years and nobody cared. Okay, where do you feel it? What do you mean? And then it's like in my neck, in my chest, in my jaw, in my head. And then we can get started. That for me, I mean, I get. I love this. So when I can get you into your body, then that's where we're at, huh? And I love. So what. I'd love to know. So I thank you for, you know, explaining all those things. You then also do this beautiful job of some strategies. So the strategies that you talk about are so usable and specific. And I think, you know, again, to your point, it's like medication is sometimes so important because when the body gets so into a screaming phase, what we need is sort of that extra help. And we live in a time where we have so much access to this beautiful combination of things. You are like, just a second though, right? Why? And some of your specific strategies really speak to those nine kinds. So tell me how these work in the body. You know, like the panic pack.

Yes. I love that the panic pack is so important in getting us back in our logical brain because as you said, when we're in that red light zone, when we're in fight flight. Freeze. The neuroscience shows us that the logical brain is offline. It's like, Susie. She's not Susie.

Her lid is flipped.

Yeah, her lid is flipped. She's not like, analyzing. Like, I wonder if this tiger is a male or a female. Look at those.

Just beautiful.

That animal, it's so darling. No, she's like, tiger. Oh, my God. Run away. Yeah. And so your emotional brain is turned way up. Your. Your limbic system, your more automatic, reptilian, ancient brain is running on all cylinders and logic isn't going to work. And so that's why people get really frustrated when someone's having an anxiety moment or a rage moment, whatever it is. And we're like, just. Just calm down. Yes, that. That doesn't work. That's a very unhelpful thing to say.

They don't want to be there either.

Yes, they don't. Maybe they're just gonna totally just dissociate and they won't pay any attention to that, which is a nervous system anxiety. And so the panic pack is a specific solution. So I've kind of broken this down into like four sequence of events. And I was smiling so big as you were saying, like, we always abandon it once we calm ourselves down. And then we wonder why it comes back. I love your brain. Oh, my gosh, this is so exciting. So the first step of the four steps is to online your logical brain. And we can't do that without targeting the body. And so this is the panic pack. And you can make your panic pack go inside of a backpack. You can put it in your desk. I like to wear a sequin fanny pack that's, like, sparkly that I can bring with me. And my hands are free.

Yes, girl.

Yeah. And what you're gonna put inside of it are things that are going to stimulate the body and that are gonna bring you back into your logical brain by calming the nervous system. And so this is gonna stimulate touch and smell and temperature and sight. It's gonna ground you back in your body.

Okay.

My favorite one in that, though, is the cold pack. And so this comes from dialectical behavioral therapy. Marsha Linehan's like, oh, stick your face in an ice bu water. Which isn't practical. Like, I don't carry around a bucket of ice water, but I do have a hack for you. And if you go online and you can get these little first aid kits and there'll be a chemical freezer pack. So it's like the size of a deck of cards. It can fit in your back pocket. And then when you shake it up, it gets really cold. And then you can apply that to your face, to your chest, to the back of your neck. That can activate vagus nerve to very quickly, within seconds, calm the body. So that's the first step. Calm the body. Love it.

Super. And so good for kids. You know, I. I think just really like giving them some autonomy in this space of being. Like, let's just put your cold pack in your backpack. And when you need it, nobody even needs to see it. You can have that. And as an adult, I mean, when you're on scene, when you're any, you know, it's just such an easy, easy fix. And that vasovagal research is so interesting. Right. We just know in the body, like, let's forget about what happened to you. I'm most interested in what's happening inside of you. And so I just need to get you back online. And I love that sense of like, the back of the neck is where it is or on your face. Right. So let's just cool that right down and it automatically brings you back home.

It's so effective. Yeah. So fast. It's so effective.

Disposable cold packs. Got it.

Next. So we've now brought your brain back online. And so now we want to start to utilize those top down skills. And this is where psychology, this is psychology's zone of genius. You go to any talk therapist, any cognitive behavioral therapist, they got you. So top down is where you use your logical brain now that it's back online to rationalize through what happened. What were the triggers? Why did you respond the way that you respond? This is doing your case history. And we want to use this acknowledgment because it gives us power over our environment in the sequence of events. Okay, that was a red light moment. What the heck was that? And what can I change in? You know, earlier, you and I were talking about stimulation stimuli. What is what's going on in my environment? And then we also want to really start to strengthen those connections so you have better access to it, because the way you wire it, it is the way you're going to fire it. And so if you live your life kind of on autopilot and then being afraid that anxiety is going to come and get you again, but you're not activating those logical analytical networks in the brain and using those talk therapy skills, they're not going to be available for you when you need them most. And so step two is all about enhancing that prefrontal cortex and those logical parts. Okay. Okay.

Love it.

So then step three is bridging the gap. So this is. Okay, logically, I get it. I know how to calm myself down. But I really hate it that before I go into work in the morning that I have diarrhea, my body is betraying me, my body is going rogue, or my doctor gave me a beta blocker because I literally feel like I'm gonna have a heart attack every time I have to get on the interstate. Like, can't my body just calm down? And. And so feeling. When you're at war with your body, there's a disconnect there's a divide between like, yeah, I've done all the CBT work. Well, now we want to start doing the bottom up. We want to start to integrate or bridge that gap. And we can use that with strategies like interoception, somatic practices, mind body practices, yoga practices. And so what you're doing what the foundation, the unifying factors in these practices is that you stay mindfully aware of whatever is happening in the body and start practicing like you were talking about with those individuals. And you're like, well, where do you feel it? Where do you feel it? These people, they haven't been practicing that third step. They have no idea what's happening. And you've been helping them make that connection.

I love that. And what I often say, even a little bit deeper in that place, is that just notice it, but also invite it in. Give it permission to be there right when it's like, okay, it's an angry. I don't want to look at it. It's like a big red ball, and I just fucking want it out of there. And I'll be like, okay, in this moment, I just want you to give it permission to stay. Thank you for being here. And what is amazing to me every single time is it shrinks. And oftentimes people will be in my chair going, like, I can approach it or it seems it likes that. Huh? Because it's not our enemy. It's trying to tell us that something is wrong, in danger. You're at the scene. This is really going to hurt you. And we just need to remind it that now we're not at the scene anymore. And when we notice it and acknowledge it and bring it in.

Right.

That's the time that we start to heal it and integrate it. Is this true?

Absolutely. And adversity and trauma doesn't often only occur in logical parts of the brain that have a sense of time.

So true. So true. Yeah.

That's why it could feel like it's happening again. And so you're emphasizing the importance of, I'm not back there. I feel the feelings I felt when I was back there. But it is 20, 23, 24, 25, 26. It is right now. And I can notice and feel that while being in my present body, inviting that, giving it compassion and empathy so that it can then release. It can then realize that we're safe now, we're not there.

So brilliant. So brilliant. And four. Did you say there's four?

The last one is then intentionally putting yourself into situations to create autonomic arousal and Then practicing pulling yourself out of it. So it's kind of like training for a marathon, because you will encounter situations that provide arousal. And so then the step four is to then practice mastering that from a place of power and control so that you aren't afraid of anxiety, that you're no longer anxious. You're panic proof because you've practiced this. You got it.

I love that. And so I'll just tell you, early in our career, when they taught us such bullshit that we would just. They called it flooding. So they wouldn't prep. Prep our patients, or we weren't taught to prep patients. We'd be like, just throw them in and prove to the body that we've got it right. Which has induced all kinds of, as you can imagine, but that this idea of exposure matters. But the first three steps have to be in place first. Right. And so I really love that. Oh, my gosh. Okay. And I have one more thing that I just wanted to pick your brain about before I let you go. I. I want to know, you know, given the sense that we are having maybe less and less place to make sense of things, how do you think that anxiety and loneliness intersect? You know, we talk a lot about, you know, what it takes to become unlonely around here. What's your sense about that? You know, when you see in your patients this loneliness epidemic, how does anxiety and loneliness interact?

I have two thoughts that are coming to mind about that. And the first is just. Just practically speaking, is anxiety can be a really lonely place. If somebody has a broken foot, no one's gonna be like, ah, just walk it off. We're like, ooh, we get that you can't walk. That makes sense. But when we're having a panic attack at a restaurant with our friends, people are like, what's going on with you? Or when we decline an invitation to your best friend's baby shower because you have agoraphobia, she's hurt by that. And so it can be very lonely. And oftentimes people feel they're not understood. They feel isolated. They feel like they have to hide it. Their world gets smaller and smaller. And up until fairly recently, we weren't talking about anxiety. And so it's even more lonely because there aren't conversations happening about it. But that's getting better and better thanks to people like you, who are like, less like, talk about this. Why is everyone's experiencing it? Why aren't we talking about it? So that's the first thing. And then the second thing is that anxiety is inherently Disintegrative. And what I mean by that is that you have parts of you that are holding on to winter coats that aren't stored in time, and that those parts of you can get activated, and then that part will run the show. So it's like Susie, she hears the roaring in the woods, and then part of hers that's familiar with that sound, that's learned that sound takes over. And so we've studied this in ego state, emdr, internal family systems, where we have these parts of ourselves, and when we haven't yet done the work, they're fairly disintegrated. So we're not even aware of, like, why do I do this? Why do I feel that way? We're not even connected to the totality of the self. And so through the process of healing our anxiety, we start to integrate. So instead of us being separate roots to a tree, we realize that we're the trunk and the leaves and the roots. And so then we start to become more integrated with the sense of self and the sense of I, which is then a foundation for creating more fulfilling relationships.

It's all about the integration, isn't it? And a place to have somebody assist you in that process. Because we often live so compartmentalized. So system theory is really around. You know, none of us occur in isolation. And even in our own bodies, we break into parts. And when we can have that sense. What I love about the family systems work is that I never considered, you know, Schwartz's work around the internal part stuff, where we bring the things we can have, a shitty, angry mom and a young baby and the fat kid, all inside our body, and we react in those specific places, given our experiences and how it's sort of busted us apart. And it's the integration of those things, the why, that surrounds the context of what has happened to us that really allows us to sort of move on to the next step. And this can take minutes, this can take hours, this can take years. But it's. But it's really the curiosity that allows us to be. Back to your original question, right? Like, the idea of, what's my body telling me? All right, listen. Dr. Nicole Cain, ladies and gentlemen, my fellow humans, this book, Panic proof, comes out October 8th. I've read it. You need to read it. I just feel like this is such a timely work in a very overwhelmed world where we need to understand why not just treat the symptoms? And so, thank you for this work. I'm going to put everything in the show. Notes about where you can find it where you can find you anything we need to leave with this beautiful community who I now hope become a part of yours.

Oh, it's such an honor to be here. And your anxiety is here to tell you what needs healing and how and through the process of changing your relationship with it, it doesn't become anxiety anymore. It's. It's a friend, it's a partner. It's collaborative to not just help you feel like. Okay, I'm not anxious now, but one of my old books that I love to read, one of my favorite excerpts says is that the job of the doctor, the job of the healer, is to help people to heal in such a way that it obliges wonderment. And what that means is that you don't just survive, but you thrive. And that's what your symptoms are trying to help you do. And so keep it up, my friends. You've got this.

Oh, I love it. I love you. I cannot wait to hang out in Michigan. This is. We're now new best friends. Listen, thank you for joining us again today. This on lonely journey for me has been just, just so lovely so far. And I hope that these humans that you meet here can only make help you make sense of the journey that you're on. So in the meantime, stay connected to each other. Take care of yourself, and I'll meet you right back again here next week. The Unlonely podcast is Produced produced by three incredible humans, Brian Seaver, Taylor McGilvery and Jeremy Saunders, all of Snacklab Productions. Our executive producer, My favorite human on this planet is Marty Hiller. Soundtracks were created by Donovan Morgan. Unlonely branded artwork created by Elliot Kuss. Our big PR shooters are Desbonneau and and Barry Cohen. Our digital marketing manager is the amazing Shayna Hadden. Our 007 secret agent from the talent bureau is Jeff Lonis. And emotional support is provided by Asher Grant, Evan Grant and Olivia Grant.

Go live.

I am a registered clinical psychologist in Alberta, Canada. The content created and produced in this show is not not intended as specific therapeutic advice. The intention of this pro podcast is to provide information, resources, education, and the one thing I think we all need the most. A safe place to land in this lonely world. We're all so glad you're here.

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