The Elements of Anxiety

“Anxiety is the combination of uncertainty plus our lack of trust in our ability to handle it” 

                  Becky Kennedy, PhD Clinical Psychologist aka “Dr Becky”

Ah COVID, here we are again. Welcome to a very special, (mild) COVID edition of Ending Physician Overwhelm. 

But really it’s a perfect background to explore this framework of anxiety, and talk about how instead of trying to reduce uncertainty, often with rigidity and controlling, grasping energy, we can work on leaning into self-trust instead.

When we learn to trust that we can handle difficult circumstances, simply by focusing on the next best step, we mitigate uncontrolled anxiety. Eliminate it? Probably not. Dial it down? Yes. Stop getting stuck in it? Yes. Believe that we aren’t doomed to live trapped in a bundle of anxious nerves? Yes.

Let’s stop trying to control the uncontrollable; Instead, believe in your own capability. Believe in your ability to handle other people being upset/worried/frustrated about their health, and to try to help them navigate the medical concerns. 

My friends, trust in yourself. Trust in your goodness. Trust in your desire to help. Trust that you will use your knowledge and skills and do the best you can in any situation with what you have.

Want to hear more? Listen to Dr Becky on The Daily Stoic podcast, episode from December 15, 2023, link here. Or catch the YouTube version here. 

Transcript

00:01
Well, hello, hello and welcome to the show this week. My friends, COVID really is going around. Ironically, I had two friends cancel plans on me in the last 24 hours. I was supposed to go to dinner with someone last night and go for a walk with someone this morning, and both of them canceled because of COVID. And of course, as luck would have it, I developed a very slight sore throat last night.

00:31
I was like, okay, and tested this morning and I am so incredibly faintly positive. It's almost laughable, but I was just like, okay, well, it's my turn to have COVID again. Thank you, universe. Thankfully, super mild. I might cough very slightly, but I think that's really just because I had a big breakfast with lots of berries this morning and so it's probably more of a reflux thing.

00:59
grateful to be only very mildly ill, grateful to work in a job where I can, you know, I can pretty easily reschedule people to be quite honest and I can do some telehealth because I'm not feeling that sick. So a little annoyed, but ultimately doing just fine. And I really was reflecting on what I wanted to talk about today.

01:29
And I'm going to talk about anxiety, and I'm going to kind of pull in these COVID experiences that I have experienced as part of the lens through which we talk about anxiety and the different elements of it, and what we usually are trying to do to help our anxiety that ultimately isn't working very well. So please do tune in for this.

01:58
I have talked about Dr. Becky Kennedy before, Dr. Becky as she's known. She is a psychologist. She's got a wonderful podcast, a wonderful book called Good Inside, and really focuses on pretty much millennial parents, right? The challenges that millennial parents are currently facing, you know, sort of being in the sandwich generation. And I am the oldest type of millennial. I was born in 1981.

02:28
and that usually falls into the sort of oldest cutoffs for millennials. So it was kind of right up my alley, but I have read her book before, and I recently tuned into her talking on a podcast. And I heard new things in the discussion that I had probably frankly read in the book, but sometimes we need to hear it out loud or we need to hear it when we're ready to hear it.

02:57
And I'm not sure which one is true here in this circumstance, but I really wanted to talk about it because I think it's such an important framework for thinking about our anxiety and knowing my audience, knowing the people who reach out to me, I know that anxiety is a resonating theme. We are generally anxious folks. And so I know that there's something in here for you as well. But

03:24
What Dr. Becky shared on that podcast is this framework or equation where anxiety is uncertainty coupled with our lack of trust in our ability to cope with whatever might happen. And she went on to talk about how often when we are experiencing anxiety, we will try and focus on reducing uncertainty.

03:53
And I want you to think about that for just a minute. How often when you're feeling anxious, are you really trying to wrestle and grip into control? Do you find yourself being more sort of snippy and persnickety and really sort of hyper-focused on controlling situations? And that might be controlling things in your work setting. It might be being very controlling of your kids.

04:23
or partners or friends, really sort of diving into those, I don't know, sometimes they're even sort of OCD traits, where we're trying to like really tidy, make this to-do list, stick with it, and we're all trying to reduce our anxiety. That, my friends, doesn't work. We are not really truly able most of the time.

04:52
to reduce uncertainty or to really relieve our anxiety by gaining control over something. And I want you to just reflect on any recent experience where you have noticed yourself feeling anxious and how that's gone when you've tried to tighten your grip and control something. Even if you are able to gain control of

05:18
some element of whatever situation you're thinking about, that doesn't really generally lessen our anxiety, and it also doesn't help us feel good, right? We don't feel calm and centered when we are tightly trying to control. And if we think about the circumstance we see this in, you know, thinking about maybe our clinic day, right? Knowing we have a really busy schedule, feeling really anxious, and then

05:48
deciding that, I don't know, everybody has to show up on time or else it's gonna be a bad day, right? You know, telling your medical assistant, if you have one, you have to really like get in and get out because we just have to keep moving, right? This gripping sensation, this tightness, we are trying to relieve our anxiety there.

06:18
and it does not work.

06:22
So what Dr. Becky suggested in her conversation is that instead of trying to tighten up and control and work on that uncertainty side, which we really don't have control over, what we should be doing, should, I shouldn't use the word should, should I? What works better for us to try doing?

06:53
is to lean into our self-trust, that whatever the circumstances are, we're going to be able to manage it. We're going to be able to cope. And let's talk a little bit about the anxiety centered around COVID. I'll share my experience, which is that

07:20
when COVID started right in February and March of 2020, living in Seattle, married to another physician, working in a big HMO setting with two children who were, let's see, turning five and eight shortly. So they turned five and eight a few months after the pandemic started. So relatively young, my youngest was still in pre-K.

07:49
My oldest was in second grade. And not only were we wrestling with the uncertainty of the health crisis, right? Were we going to be safe? My organization didn't have N95s. Most of us were not respiratory fit. You know, we had very little systemic preparation going on. And as we started to learn more about this virus and learn more about the spread,

08:19
we were getting very conflicting messages about should we mask, should we not mask, what kind of mask? I remember throughout 2020, we would be asked to definitely wear a mask and then it was a certain type of mask and then it was to save your mask and wear it all week and then it was to change it every half day of clinic care. Like it was just wildly all over the place because there was so.

08:47
much uncertainty about how we dealt with the virus, right? Certainly other people had very significantly different experiences, right? If you were working in the hospital, if you were working in the emergency setting, I was still delivering babies at that time. And so we had this very weird rotating 24-hour call thing that we'd never done before. And, you know, we're trying to do

09:13
limited in-person visits for prenatal care. It was just such a time of crazy uncertainty at work coupled with our own human fears of what happens if I get sick. And of course, in those early days, we could see how sometimes young healthy people were getting sick. Sometimes it was

09:39
It was more older people and people with comorbidities, right? And there was very mixed messaging, right? It was a time of a lot of chaos. I don't mean to incite, you know, significant sort of traumatic emotions here in you. So obviously if you need to pause, go ahead and pause. But if you think to your experience of that time and how much anxiety was going on in you,

10:09
what were you doing in those moments? I remember trying to read, trying to find out information. There was very little sort of written information that was new and up to date. It was just kind of day by day, right? And the usual ways of trying to reduce uncertainty weren't really working because this was a novel experience. None of us had ever.

10:37
lived through a pandemic, let alone been healthcare professionals through a pandemic. I know that certainly there have been serious viral other things going on in other parts of the world, but most of us here in the United States really had not lived through this type of experience and definitely not as healthcare professionals, right? So we were experiencing a tremendous

11:07
and we didn't have the experience of knowing that we could cope with that circumstance, even though I would argue that many of us have coped with significantly difficult circumstances before. And all of us who are here today and standing and breathing and alive today, right, have lived through.

11:35
the experiences that we've had. Now that's not to say that we have always had perfect experiences, that we don't have scars, that we haven't experienced tremendous stress and trauma. I'm not belittling that, but I am saying that we have had the experience of coping with difficult circumstances. And if you can imagine yourself back to that time where we were all experiencing tremendous anxiety.

12:04
Instead of wrestling with the uncertainty, what if we had leaned into that self-trust of, I'm going to do the best that I can today. I'm going to do what makes sense to help protect my body. I'm going to do what makes sense to help protect the other people's bodies. I'll pivot a little bit out of that sort of collective anxiety at the forefront, but share my experience as well of

12:34
what happened in my home, which is that, fast forward to December of 2020, and I was going to be the first in the household to have access to COVID vaccine, right? Because I was doing some hospital care, delivering babies, and so I was kind of first on the list in terms of between myself and my husband. My husband does lab medicine and doesn't have any direct patient contact, so he was going to be able to get his vaccine.

13:02
A few weeks after me, I think he was he was scheduled. But I kid you not, two days before my vaccine appointment was on the books, he got COVID. So my husband got COVID. It was at the time, right, where there was a full 14 day isolation. And we had the rest of myself and my two kids, you know, who were quite young. So they would have been five and eight at that time. You know, had to go into a two week quarantine.

13:30
a tremendous uncertainty and me not knowing or not trusting really that I could handle the experience of being quarantined with these two kids, taking care of my husband who was in isolation in our bedroom, you know, trying to manage how do I entertain them? How do I, you know, cope with some feelings of not being able to go to work?

13:59
um you know was having to rely on my family to you know bring us some food and supplies and things like that you know thankfully again tremendously privileged in having family and resources and all the things that we needed. My husband was not severely ill but just a tremendous time of intense uncertainty and me not really knowing whether i could handle it. Now

14:25
I can't think of a similar time when I've had that experience, right? But if I had reflected, if I had understood this equation, I could have said, you know, I have been through very significantly challenging experiences before. I've have parented these two children in difficult circumstances. I have been sometimes alone in doing that. I know that this will be a difficult time, but I know that I can handle it.

14:56
I could have tapped into that line of thinking. Again, I was not familiar with this concept. So instead, I did my default and just kind of spun in uncertainty. And I share that not to imply that I blame myself, but just to look back on a circumstance and to appreciate that if I had understood

15:23
this equation the way that I do now, I probably could have gotten through that time experiencing less anxiety. And again, it's not about blaming or belittling myself for having experienced that, it's simply to recognize that what I know now can help me not only have a different experience, in future circumstances where I can really

15:53
lean into this self-trust of, I know that I will be here for my children, I know that I will be here for my husband, I trust that I will take care of myself and I will take care of them to the absolute best of my ability with the circumstances, resources, whatever I have available. I trust myself and so even when I don't know an outcome I will no longer sort of

16:22
over dwell in anxiety, instead I will remind myself. And I can look back on that version of me that existed in December, 2020 with so much self-compassion and kindness. She didn't know how to help herself with her anxiety. Oh my gosh, I'm just thinking back as well how I was getting phone calls from employee health telling me good news, we've changed.

16:52
You know, we've changed the rules and you can come back to work anytime. Uh, you know, after five to seven days or something like that, it was literally on the phone with this poor, uh, you know, employee health nurse saying, oh yeah, well, who's going to take care of my kids. Can't come back to work because I can't leave my five and my eight year old, uh, alone in the house with my husband, who's in isolation and can't be near them because again, it was that very,

17:20
separated, you know, true isolation at that time, because we were not vaccinated. We didn't know, you know, the virus was different at that time. It's just like, are you sending a babysitter into the house where someone is isolating with COVID? Because that's what it's going to take to get with them to work. Oh, Lord.

17:46
Let's fast forward to future experiences with COVID in our house. Oddly, it has been the circumstance where either three of us have been positive and one of us has been negative, or one of us has been positive and three of us have been negative. That has been our experience four times now with COVID. I'm trying to think, let's see, it's two this year.

18:15
one in 2022 and one in 2020. And there is some experience here, right, that helps to lessen anxiety. There is some of that. We are all vaccinated. We have all seen the changes in the virus and how it manifests in, you know, people who are vaccinated right now and people who have had previous illness for the most part, having much less severe.

18:45
disease and much lower risk, right, for severe illness. So there is, generally speaking, less anxiety overall, but also there is a shift in my self-trust, some of which is connected again to those past experiences, some of which is connected to some different knowledge, but I also know now my own capacity.

19:14
I know and really trust and really reflect on my ability to cope with difficult circumstances. Not, you know, not thinking that I'm superhuman, right, because I don't think that any of us are. Not thinking that I need to overextend or overbend myself. I happen to be very mild right now, so I'm choosing to go ahead and continue to work.

19:43
Because I can and I don't feel pressured. I just feel like yeah, no, I feel okay. I don't need to lay in bed I don't need to You know spin out and worry and I know what to do if I'm more severely ill right? There are more resources available to me so there is absolutely elements of this but there are absolutely also a different ability to reflect on

20:11
this equation right of anxiety equaling uncertainty and the lack of trust in our ability to cope.

20:20
So think about some experiences that you have where you feel anxious. Again, that might be a very busy clinic day, or perhaps you're a hospitalist or a surgeon, right? You've got a lot on your schedule.

20:41
you don't know how the day is gonna go. You don't know exactly what's coming in to see you, right? Like if you're in the emergency room, you really, really don't know, right? If you are someone who works in clinic and has a schedule or you know what surgeries you're planning to do because they are pre-scheduled surgeries, right? You have some general sense of what you're expecting for the day. You don't know of course exactly what's going to happen, right? Maybe everybody doesn't show up.

21:09
Maybe everyone shows up, maybe you have a patient with really weird complex anatomy that you did not know before you started your operation. There are lots of very real instances of uncertainty that happen just regardless. And again, are you frequently relying on trying to over control, trying to reduce uncertainty?

21:38
And is that creating hardness, tightness, a sense of rigidity that there is no flexibility? If that is your experience, you are so normal because that uncertainty is real. And many of us in medicine have experienced times where we've had very real uncertainty, right? Again, pandemic or...

22:06
I don't know, say some big catastrophic event has happened in your city, right? And things are flooding into your hospital. I remember again, during the beginning of the pandemic, we were sort of preparing our stadiums to be sort of giant field hospital settings and that never ultimately materialized. But I remember really scratching my head and thinking, gosh, could I really do inpatient, hospitalist type medicine again?

22:35
if I needed to and I was like, well, I guess I could, but man, it's been a long time. So much uncertainty.

22:45
And because of the nature of our work, that uncertainty we know has very real consequences, right? If you are completely uncertain about things and you have no resources and no help and no support, and you have no idea what is going on with the person in front of you, that is truly terrifying because there have been instances where very real consequences have happened. Death has happened. Complications have happened, right?

23:14
we know the severity and intensity of that. But that has changed, that has absolutely influenced our experience of uncertainty to make it even more, I don't know, even more negative, scary, hard to cope with, right? Which increases our anxiety, right? It creates anxiety in circumstances that really

23:44
This is a non-judgmental statement, but really don't warrant it. And what I mean is that it, this, this experience of uncertainty and searing seen dire circumstances happen, right. Has like up ratcheted our anxiety so much. And we have this such a strong desire to over control things that just creates this intense, sympathetic, traumatic response in many of us.

24:16
and we are forgetting the part of the equation and most of us were never taught the part of the equation where we trust that we have enough skills, enough knowledge, enough compassion to make a next step if those things happen. Will we always have the right answer or the right next step? Probably not, probably not.

24:44
that's not always going to be through a fault of our own that is because we deal with an incredible amount of uncertainty and

24:54
people come in in all different kinds of states and in all different kinds of stages right of their illnesses injuries things like that we only have so much ability none of us knows every thing none of us knows every variation every disease every anatomic variant

25:16
studying more, you know, feeling like I can't close my note because I don't have a, you know, the answer. You know, feeling anxious if I am not making everybody happy. You know, when I'm feeling very uncertain about what's going on with them, and why are they pissy today and all of these things. Can I start to really focus on my ability to trust?

25:45
I trust myself that I can handle another human being who is having difficult emotions. Now, sometimes that means that I'm going to need to get some help, right? If they are acting in a way that seems dangerous or altered. But do I trust myself to handle somebody who's having a bad day? Yeah, do I trust myself to set some boundaries there if I need to? Yeah, I do. Do I trust myself to be with my kids when they're having a giant tantrum? Yes, I do. Do I trust myself now to...

26:15
Yeah, parent during a global pandemic and, you know, figure it out the best I can. Yeah, I do. Right. I have cultivated a lot of self-trust and I think that we all need to lean into that more. That's something that I continue to work on. Can I trust myself to come up with a good enough next step? Can I remind myself to?

26:41
pause and breathe in that self-trust, right? To really acknowledge to myself, yes, I can, because now I have this framework and now I'm sharing it with you so that you will have it as well.

26:54
The next time that you are finding yourself really steeped in anxiety, I want you to think about this. Okay, what is the uncertainty? And can I choose to trust myself to be able to come up with the next thing? Perfect plan, probably not. Give a lecture about the thing that I'm uncertain about.

27:22
Probably not, and that's probably not what it's called for. But can I trust myself that I can manage my feelings, that I can acknowledge my feelings, that I can do what's necessary, right? I might have to put my feelings aside and run a code, right? I might have to choose to stay calm as my child is having a tantrum somewhere, right? There are things that I may need to do that will come before.

27:52
acknowledging and accepting my own feelings, but can I trust myself to take care of myself? Yes, I can now.

28:01
Let's all do this work together. When you find yourself trying to over control, when you find yourself trying to reduce uncertainty, I want you to pause and I want you to reflect on if there's a similar circumstance or just a similarly difficult experience of some kind, even if it doesn't really mirror what's going on, can I trust myself to handle this? This will help us

28:31
to experience less anxiety overall? Is it gonna take away the anxiety? No, no. Is it gonna lessen it? Yeah. Is it gonna mean that I don't spend hours and hours and days and days steeped in super high levels of anxiety? Probably most of the time, to be quite honest. Right, if I pause and acknowledge that there is uncertainty here, and that I have handled similar difficult experiences before.

29:02
then I can take a breath, right? And then I can calmly decide what is my next step.

29:12
If you think about all of the instances where this has turned up, this is why we practice running codes, right? This is why we have algorithms, especially in the emergency room setting, right? So that we can just lean into that trust, that confidence that this is the next right step when someone is not breathing or when they have lost their heart rate, right? We don't have to...

29:39
immediately know the answer, we just need to be able to proceed along that algorithm.

29:46
But where else does this come up for you?

29:51
I think this is such an important topic and if you want a slightly different take on it, I encourage you to check out my blog which is on my website at www. And if you're not on my email list, get on my email list which you can also find at my website. I share this kind of content weekly with people and

30:18
share thoughts and insights. I, if you have listened to the show, you know that I read a lot and I listen to a lot of podcasts and that helps in addition to my own experiences in addition to the experiences of my clients to really help us cultivate really robust conversations about the many, many challenges that we face. And when we come together and we share and we open and we acknowledge these shared experiences.

30:47
we get to feel more connected. We get to feel like we are not alone in our struggles. We get to feel like, oh, I'm not the only one and maybe, just maybe I'm not broken, right? If I find myself frequently anxious, overwhelmed, you know, feeling like, gosh, someone's gonna find me out and they're not gonna let me be a doctor anymore and maybe that's a good thing because I don't know, I feel like I don't know what I'm doing.

31:14
Right, when we can look at frameworks like this and see, oh, okay, all right, what's going on? Right, there's so much uncertainty here and I'm not reminding myself that I can trust myself to handle difficult experiences. Ah, there's that deep breath again, right?

31:37
It's so tremendously healing for each of us to know that we are not alone, that I think all of us who are here listening experience a lot of anxiety. And isn't it nice to be able to come together to reflect on it, to think about it, and to find ways to work through it. My friends, I'm going to stop chattering at you. Thank you so much.

32:05
By the time this episode comes out, I am very confident that I'm gonna be COVID negative and back to normal. I'm not feeling anxious at all. I'm just, I'm a little annoyed of like, okay, well, there's some mild inconvenience here. And really, I'm okay. And I'm grateful, like I said at the beginning. Thank you as always for listening. Please get on my email list. It's where I share additional content. Please continue listening. And...

32:34
You know, share this episode with a friend if it has resonated with you. I promise you, you are not alone in feeling anxiety and in working together and building community. That's how we fix it. All right. Until next time, take care.