Follow along with the transcript below for episode: Managing Holiday Anxiety With Dr. David Rosmarin
[INTRODUCTION]
[0:00:02] PF: Thank you for joining us for episode 444 of Live Happy Now. It’s beginning to look a lot like the holiday season, and for many people, that means a whole lot of anxiety. This week, we’re going to tell you why that might not be such a bad thing.
I’m your host, Paula Felps, and today I’m sitting down with Dr. David Rosmarin, an associate professor at Harvard Medical School, Program Director at McLean Hospital, and Founder of the Center for Anxiety. He’s also author of the new book, Thriving with Anxiety: 9 Tools to Make Your Anxiety Work for You. David is here to talk about why the holidays cause so much stress and anxiety, how we can use that to our advantage, and give us tips on getting through the season with our physical and mental well-being intact. Let’s have a listen.
[INTERVIEW]
[0:00:52] PF: David, thank you for joining me today.
[0:00:54] DR: My great pleasure. Thanks for having me on your show.
[0:00:56] PF: Well, we are kicking off our holiday season coverage, and we’re going to really be diving into some mental health struggles and some of the challenges that we face during this time. You are a great way to kick it off, because your message is about anxiety. Before we talk about what the holidays do to us, I want to talk, you have a new book out and it’s called Thriving with Anxiety. For a lot of people, that’s a title that just sounds impossible. Can you tell us what you’ve found about how we can actually thrive with anxiety?
[0:01:27] DR: Yeah, absolutely. The holidays are definitely a time for high anxiety and also, a time that many people do not thrive. I can understand the question, why is this book called Thriving with Anxiety? The truth is that anxiety, the more you fight it, the more you try not to feel anxious, the more anxious you’re going to feel, because you’re just feeding it. You’re actually feeding adrenaline into your system, the more you fight against it.
The reality is we are going to feel anxious this holiday season. When we’re dealing with those family members we don’t want to deal with, when we’re dealing with those situations and running up a credit card bill when it comes to the presents and all the familiar stuff and eating too much of the holiday meals and feeling overweight and trying to compensate and all sorts of other standard stuff at the end of the year as the weather changes also. There are so many ways that that normal human experience can keep us humble, can keep us connected to others and help us to reach out to friends who we really want to connect with and that we can become more emotionally resilient through facing these difficult feelings, as opposed to trying to, I would say, snuff them out and get rid of them.
[0:02:39] PF: What’s really natural for us too, as soon as we feel anxiety creeping up, we do try to stop it. Because we don’t want to go there, so how do you embrace that? Or is that the right thing to do?
[0:02:50] DR: Yeah. Well, I just want to clarify, we do that in our culture. In many other cultures, that’s not true. That’s actually not true, that anxiety is simply part and parcel of the human experience and understood to be, “Okay, I’m having a bad day.” In the United States, in my income Western countries, we have adopted this culture of, “I can never feel bad. If I do, something’s wrong with me. It’s a medical diagnosis. I shouldn’t be feeling this way. I shouldn’t have to feel panicky, or uncomfortable.” I think it’s that attitude towards anxiety that has actually created the anxiety epidemic in these countries right here, right here at home.
[0:03:29] PF: That’s so interesting, because I had never thought of it in that way. Now you founded the Center for Anxiety, and I was curious to know what made anxiety your choice of practice? What made you decide to really look at anxiety?
[0:03:45] DR: Personally? Oh, well, that’s a personal question. I’m happy to go there, because definitely, I have a good deal of anxiety myself, and there’s been a life journey that I’ve gone through to try to figure out the best ways to accept it and to understand it and to actually use it as a strength, which is something that I’m very proud to be able to do today. I still get anxious from time to time, but I think when that happens, I speak about it with people I trust, with people I love, and it creates more connection. I think it humbles me on a good day, and I accept that there’s only so much that I can understand, and only so much I can control, which is hard to do, but it’s an important aspect of being human.
I think it also helps me relate to others to understand that emotional pain and emotional difficulties are part of life, and certainly part of my patient’s lives. I think speaking about it, as one of my patients actually wrote me an email saying, “It makes me more human.” I’ll take that compliment .There’s not much more I can ask for.
[0:04:44] PF: I like that. As the holidays start approaching and are already talking about this, so we know that anxiety comes with the holidays. Is that making it worse, or people do have that anticipatory, “Oh, here it comes”?
[0:04:59] DR: Actually, I think it makes it better, which is why I wanted to speak about it at the beginning, and make it clear. What happens with the holiday anxiety, and one of the reasons I think we have so much holiday anxiety, is because a lot of people go in, even though we know we’re going to feel anxious. At the end of the day, we know what’s coming, right? There’s this faint hope that this holiday season, it’s going to be different, right? That the conversations with family are going to be great, and I’m not going to overdo it on the Thanksgiving turkey, and I’m not going to – that expectation – we also have this expectation of ourselves, like it should be a joyous season, we should be happy all the time. There becomes a chasm between our expectation for this season, and what actually happens. It’s that chasm which actually sets us into anxiety, I believe.
[0:05:50] PF: How so? How does that trigger us?
[0:05:52] DR: Well, when you expect to feel happy and content, and you don’t expect to feel anxious, and then all of a sudden, you’re anxious, well, now you’re going to be pissed off about the fact that you’re anxious, right? You feel this way. That will physiologically trigger more adrenaline into your system, and actually make you more upset and more anxious.
[0:06:11] PF: Oh, man. Yeah, so I do want to get here in a couple minutes, talk about how we deal with those feelings and that adrenaline, but we have more stress during the holidays, and that leads to anxiety. Can you talk about the difference between stress and anxiety? Because sometimes I hear it used interchangeably, and they really are two different things.
[0:06:32] DR: They are two different things, but they feel the same. The reason is because the physiological processes that are involved are similar. They have the same symptoms, if you will, like having a bit of a racing heart, muscle tension, increased breathing, stomach upset and distress. Some people feel a little bit dizzy and off-kilter, having a little bit less energy. These are common to both stress and anxiety, but there is a difference. Stress is very simple to define. Stress is when you have too much to do and not enough resources to be able to do it.
If you’re 10 minutes away from an appointment, and you have to be there in four minutes, or two minutes, you’re going to be stressed for the residual. In six minutes, or eight minutes, or whatever it is, because you’re not there. You have to do something and you only have so much time. The same is true for money. The same is true for emotional resources, and other resources that we might have. Whenever there’s this shortfall, or this gap between our demands and our resources, you are going to feel stressed.
The way to handle it is by rebalancing and recalibrating. I have to increase my resources and I have to decrease my demands. That’s really the only way to manage it. Anxiety is a bit of a different animal. If you understand anxiety, you have to understand fear. I’m going to throw a third juggling ball into the mix. We have stress, then we have fear, and then we have anxiety.
What’s fear? Fear is a healthy response. It is a healthy thing that your body is programmed to do when there’s a real threat which comes upon. If that threat occurs, if somebody’s being chased, if someone’s being, is a car coming towards you, if there’s some a situation where you have to respond immediately in order to protect yourself, you have this built-in mechanism called the fight or flight system and it’s triggered by adrenaline. Adrenaline goes instantly into your bloodstream and increases your heart rate, the rate of oxygenated blood flowing through your veins, increases your muscle tone, increases the field of vision, so you’re able to see better across the board, and all sorts of amazing physiological changes to keep you safe and healthy.
Now, anxiety is the same thing, but there’s one small difference. The only difference is that anxiety is a fear response without a real threat. If there’s no real threat, if it’s in your mind, that would be anxiety. If it’s a potential threat. Not something that’s clear, present danger in front of you. That would be fear. Without the clear and present danger, that would be anxiety.
[0:09:04] PF: Oftentimes though, we feel that it is a real threat.
[0:09:08] DR: Yeah.
[0:09:09] PF: It seems very, very real when that’s happening.
[0:09:13] DR: There’s nothing wrong with that. Sort of like, your system is just priming itself to be able to react if it needed to.
[0:09:19] PF: When it becomes overwhelming, what about when it’s so much that it’s like, “Okay, I can’t breathe, or I can’t – There’s so much adrenaline, I need to sit down.” Different people can just feel completely overwhelmed by it. How do you regulate that to keep it from hitting that point?
[0:09:35] DR: Well, I think, first, we have to reframe it and understand that that means that your neural system is actually intact and your emotional system works. If there were some sort of a threat, your body actually would respond very well to that. Anxiety is an overactive fear response, but fear is a good thing. The first thing we need to do is reframe and understand, if you have an anxiety response, that means that your body is actually working well. Your fear response is intact, which is actually a very healthy thing. It’s like testing your smoke alarms and knowing that it works.
[0:10:10] PF: I love that analogy. That’s really good.
[0:10:13] DR: It’s a true thing. The other day, it happened to me. I was in a doctor’s office and they were doing this procedure. I hadn’t eaten much that day and I just – it was an international trip that I was on, so my sleep was off-kilter. They were doing this procedure, which I was not expecting to have. It really, all of a sudden, clammy hands, cotton mouth, feeling a little bit woozy and a little dizzy, which sometimes happens when people have that anxiety response.
I said to myself, “Oh, wow. Your fear response works. Here you are.” Under the stress. It was not comfortable, but I just leaned into it. I didn’t judge it. I didn’t get upset about it. It was over within two minutes.
[0:10:54] PF: How do you learn, or did you learn to lean into it like that? Because many of us, anyone who’s dealt with anxiety for a long time, we have a pretty well-conditioned response to that. It’s going to take a minute to change that thinking. Were there any practices that you did, maybe even when you weren’t anxious, to start reframing it in your mind?
[0:11:17] DR: There definitely are practices, but the first and foremost step was to get this very clearly into my mind that when I feel anxious, nothing is wrong with me. This isn’t something that’s going to kill me. Anxiety doesn’t kill people. It’s just not the way it is to really, truly come to that belief very clearly. Are there practices? There definitely are practices that you can use. One of them is to stop avoiding things that make you anxious.
[0:11:50] PF: If a crowd makes you anxious, you need to go shopping in a crowd, not sit at home and [inaudible 0:11:54].
[0:11:56] DR: A 100%. You got to go during the rush. Now, if you want to avoid situations when your anxiety is going to be, I don’t know, on a scale of zero to 10, like an eight, or a nine, okay, I get that. You want to work your way up to it? Fine. But definitely go when it’s going to be a four or five. Push yourself and experience the anxiety and let it wash over you.
[0:12:21] PF: Can we talk about some of the things that might be exclusive to the holiday season? One of those being office gatherings. We have our office party. Some people really cannot stand going to those. It’s a very nerve-wracking thing for them on many different levels. Say, you’ve got to go. You know you need to do this. What are some of the ways that you can prepare yourself going into that?
[0:12:44] DR: That’s a great question. For some people, this might be an eight, or a nine out of 10. I want to be clear. If that’s the case, then you probably do need some professional support and help around this and to strategize. To give some general strategies, I’ll tell you what not to do. Don’t drink away your anxiety at the holiday party.
[0:13:04] PF: No one’s ever done that. Come on.
[0:13:06] DR: Yeah, never. You’d be surprised in college, how many people – that’s not the holiday party, but in college, how many students, how many college students develop alcohol use disorders because of anxiety, because of social anxiety.
[0:13:20] PF: Oh, interesting.
[0:13:21] DR: In the weeks leading up, getting back to the holiday party analogy, in the weeks leading up to it, think about it. What are you anxious to do? Are you anxious to make small talk? Are you anxious to speak to certain specific people on the team? Are you anxious with people of the same gender, opposite gender? What exactly is it? You’re nervous about what to wear? Often, when we feel anxious about these things, we don’t think about it. We put it out of our mind. “Oh, I’ll deal with it later.” It’ll be fine, but you know it’s not going to be fine, right?
Come up with a plan for whatever it is making you anxious. Think it through and start in advance. If you’re nervous about speaking to whoever it is on the team, well, you have a little bit of time now before your holiday parties. Have a conversation with them in advance. Try to strike up a convo and lean into that anxiety in advance. Maybe hard at the holiday party. Might be too late. But while there’s time, take it.
[0:14:21] PF: Is it possible to use self-talk in the time leading up to that, to flip your thinking on it? I’ll try to cheerlead myself into when I have something coming up that I don’t want to do, I will start weeks sometimes in advance telling myself how excited I am about this, how great it’s going to go. It’s going to be fantastic. Even thinking about some of the conversations I’m going to have to really get myself jazzed for it.
[0:14:46] DR: I like the idea of psyching yourself up. I think it’s a good idea. I think it’s also important to have the self-talk, to say, your job is not to have a good time at the holiday party. Your job is to show up, to be nice, that other people will like you, and that you’ll be – and to leave at an appropriate time. Does not have to be a fun, fantastic, awesome experience, so people just don’t like it and that’s okay. The goal is to face the fear, be socially appropriate, and leave. I think that’s a much lower bar. If we psyche ourself up to facing the challenge and moving on, I’m totally fine with that one.
[0:15:27] PF: Absolutely. Then another biggie is those family gatherings. It’s not just the gathering itself. It’s all the planning, the demands around it, especially when you’re married and there’s grandchildren and different people want to pull at it. What’s your survival guide for people this holiday season when it comes to dealing with family?
[0:15:49] DR: Yeah. I like how you said survival guide, because you do need to, personally to survive. Secondly, is you need a comprehensive guide. I’ll give you a couple of ideas. Firstly, it is important again to lean into the uncomfortable feelings and to think about it in advance. What is going, probably going to happen at the party? Which cousin, uncle, family, sibling, whatever is going to make that off-color, uncomfortable, remark at the wrong time? How is that going to go down? How can you prepare for this in advance?
Sometimes it doesn’t mean saying something in advance like, “Hey, we’re really looking forward to seeing you. Could we please avoid the topic of whatever it is.” Dejure. There’s plenty that can really upset just other people and say, “Okay, we want to get together and have fun. If you want to have a conversation about that, let’s get together another time to talk about that issue, but not – please, if we could avoid it.” You can be a little assertive about those things.
I’m a big fan for automating what you got to do. If there’s any ways to decrease the stress of preparing. You mentioned preparing meals, or having people over, by ordering in advance, by catering, by doing potluck, by doing these sorts of things, take it. You don’t have to do everything yourself. If you’re the host, or the hostess, that can really ruin the holidays. There’s no reason why it needs to be that way. It might mean having conversations with people around. We’d love to get together, but this is too much for me and this is what I need. This is what we’re going to do.
[0:17:26] PF: I love that approach, because we’re often afraid to say that. Or especially say a woman who’s always hosted Christmas, or Thanksgiving at their house and is saying like, maybe she feels overwhelmed, but she doesn’t feel right saying, “I can’t do it this year.”
[0:17:40] DR: Yeah. It could be that it just, you can’t do it this year, or you don’t want to do it this year. That’s a conversation to have with the people around you and to see how they can pitch in and make it a little easier for you. Maybe a little more inconvenient for them. But well, that’s part of the conversation.
[0:17:58] PF: Yeah. Yeah. Because I know I have a friend who they had a blow-up last holiday season. He’s already, I mean, back in September, he was already dreading like, “How are we going to get through this with her family?” It is very important to have that conversation ahead of time, but I think people are also concerned to do that. They’re a little wary of bring – they don’t want to be the one who brings it up.
[0:18:22] DR: Yeah. Yeah, I got that. Part of it is that we live in a society that really values being on your game, being in control, being able to do everything you possibly can, working two jobs and also making Thanksgiving dinner for 50 people, or whatever it is, the proverbial host or hostess is with the most this. I think that there are limits. We’re human. People go through periods of higher stress and lower stress. If you’re already running ragged going into the holiday season, well, it might be time to accept and to embrace those limits.
Actually, that might be the reason to, I shouldn’t say the reason. That might be the catalyst for enhancing relationships with family. Often, when people don’t say, “Hey, I need help. I can’t do this. These are my limits.” That’s when the blowups happen, because the stress is so high before you even go in. “I’ve done so much for this. How could they possibly say that? Don’t they understand?” The answer is they don’t understand, because you never said anything.
[0:19:28] PF: Right.
[0:19:29] DR: There’s that dynamic.
[0:19:31] PF: How important is it to be able to let your family know? I’m not saying your extended family, but just immediately, if you are anxious, if you’re anxious about getting together with your spouse’s parents and family, or if there’s a lot of anxiety for you, how important is it that you can share that with your partner, or with somebody that you’re close to in the family?
[0:19:50] DR: I like how you said someone that you’re close to, because it doesn’t have to be your partner. Ideally, it would be your partner. Sometimes it’s hard for you. I can imagine one partner saying to the other, “I really have his trouble dealing with your family.” That’s a hard –
[0:20:05] PF: What could go wrong there, David?
[0:20:07] DR: Right. Those conversations don’t always go well. Let’s just put it that way. It can go sideways pretty quickly. However, having someone to speak to, even if it’s a therapist, or another family member, or a sibling, or someone to strategize about it, to speak to, to bond with over it. I think also, there are certain ways that you can say certain things. It could be that, “I’m really looking forward to having your family over this year. I’m also thinking about last year and these three things happened. I’m wondering how you can help me navigate it, because that was really hard on me when that happened.” Starting with the positive, really focused, being prepared for that conversation.
Unfortunately, some spouses can’t even have those conversations. That’s not all marriages, or partnerships are going to be that close. That’s just the way it is, but it’s important to speak to somebody about it. Don’t weather it alone.
[0:21:01] PF: That’s important. Yeah, that could be the sound bite of the whole thing. Just don’t weather it alone. The holiday season, a specific event, you really do need someone to have your back and to know that you can bounce things off of them.
[0:21:14] DR: For sure. I definitely do.
[0:21:16] PF: What kind of self-care practices can people do on a daily basis?
[0:21:20] DR: Yes, I’m so glad you mentioned self-care. Now, this is one of the ways that anxiety can help you to thrive. Because if you know that you are feeling anxious, you’re feeling ramped up, you’re feeling stressed, you’re having a hard time already, and it’s just getting into holiday season, we’re only getting started. That’s your body signaling to you. You need to increase your sleep. You need to start having breakfast before not eating throughout the day and then gouging at nighttime and feeling terrible about it. You start shutting off your phone half hour before bedtime and also, having a bedtime, starting an exercise routine now, not waiting until January. All of these kinds of things.
Even if you just take the sleep. I can’t tell you how many patients I’ve seen, where they were super stressed out and I simply said to them, “I don’t want to see you on a regular basis. I just want you to work on your sleep. Get seven to eight hours of sleep for two weeks and then you can call me back.” They called me back and did not need any therapy.
[0:22:20] PF: That’s amazing.
[0:22:21] DR: It’s happened multiple times.
[0:22:23] PF: Yeah. That TV in the bedroom is a bad, bad thing.
[0:22:26] DR: Oh, my God. TV and devices. Do not keep your device next to your bed. Get a regular dumb alarm clock, if you need it.
[0:22:35] PF: Yup. If something happens, people will find you. If you need to be contacted –
[0:22:38] DR: Yeah. So, yeah.
[0:22:41] PF: Yeah, that’s really important. That sleep. Then also, this is – we had already alluded to it. We don’t eat properly. This isn’t about overeating. This is about being sure that your body is getting the nutrients and getting the nutrition that it needs, because when we’re stressed out and when we’re anxious, we are burning through our calories. How important is it that we start really looking at, making sure we’re getting some good nutritional food in us, too?
[0:23:08] DR: It is important. Sleep, I would say, is more of a card to play. Exercise, I would also say is another more important card. Nutrition certainly is up there. One of them also is caffeine and alcohol. Those come up a lot during the holidays in both amounts. When you have caffeine, even one cup of Coke, or Dr. Pepper, these are highly caffeinated beverages, or coffee. If you’re having it in the evening, or even after 3, 4 pm, 150, 200 milligrams of caffeine, you’re probably going to have trouble sleeping at night time.
I think it’s time probably to kick the afternoon Coke habit if you’re going to go into the holiday season and be prepared. Have those good night’s sleep at a regular time. Wake up and do your thing. Then the other one is alcohol, which we mentioned, which can – just to be mindful of how you’re drinking, when you’re drinking, who you’re drinking with, why you’re drinking. All of these are important to keep in mind.
[0:24:03] PF: That’s a really tough one during the holiday season. I know we have two events this week, during the week. I wouldn’t normally go out and have a cocktail, but that’s going to be probably the reality of it. As you said, we are just getting started.
[0:24:19] DR: Yeah. I don’t have a problem with drinking, or social drinking. Where people get into trouble is, if you are drinking when you feel anxious, especially if you are drinking, because you feel anxious, that’s where people can get into trouble. They end up overdoing it. They end up having to recover from it the next day.
[0:24:39] PF: If someone’s feeling anxious and it’s like, “I’m just going to have this glass of wine and that’s going to solve it.” What should they do instead?
[0:24:47] DR: It’s hard to say, but try to lean into the anxiety more and embrace it. Understand that it’s the holiday party might not be festive or fun and that’s okay. Can you weather that storm? What I would prefer to see is somebody makes it through the party, they make it through dinner, they’re not drinking, they’re dealing with their anxiety, they leave early, but a socially appropriate time to leave. They go home and then they have a glass of wine. That would be okay with.
[0:25:16] PF: That’s great. Yeah, that makes a little bit more sense.
[0:25:18] DR: Drinking in response to your anxiety, you’re really rewarding yourself at the end of the day. I worked hard and here’s what I’m going to do. I’m going to enjoy it now. Then you’ll actually enjoy the drink, as opposed to –
[0:25:28] PF: That’s what I was going to say. It’s probably a lot more enjoyable, because you don’t have this – you’re just trying to get this medicine in you.
[0:25:34] DR: It is self-medication. It’s exactly what it is. People, aside from the alcohol abuse, the propensity of the risk for abuse and independence, even for anxiety, it’s not a great idea.
[0:25:47] PF: Yeah. Yeah. As we enter this holiday season, what is the one thing that you would like everybody to keep in mind? We are going to tell them about your book and how they can find it. If you had, if this was a masterclass and this is the one thing they’re going to take away, what do you hope they will keep in mind this holiday season?
[0:26:05] DR: Yeah. I’ll tell you right now. Don’t fight your anxiety. The more you fight the anxiety, the worse it gets. Instead, understand that your anxiety is there to strengthen you, to increase your emotional resilience, to help you bond with other people when you speak to those one or two other people about it. And to help you to recalibrate and rebalance and understand that there’s only so much we can do. There are human limits. If you’re feeling really jazzed up and anxious, well, or stressed out, I should say, it’s time to rebalance. One thing I have to say is don’t fight it. Do not fight your anxiety. Let it be there and let it teach you what it means to teach you.
[0:26:42] PF: Very well said. David, thank you so much for joining me today. This is very insightful. I know our listeners are going to get a ton out of it as we move into the holiday season.
[0:26:51] DR: I hope so. Thanks so much for having me on your show.
[END OF INTERVIEW]
[0:26:58] PF: That was Dr. David Rosmarin, talking about anxiety. If you’d like to learn more about David, check out his new book, Thriving with Anxiety: 9 Tools to Make Your Anxiety Work for You. Follow him on social media, or download a free guide on anxiety. Just visit us at livehappy.com and click on the podcast tab.
That is all we have time for today. We’ll meet you back here again next week for an all-new episode. Until then, this is Paula Felps, reminding you to make every day a happy one.
