Train Your Brain to Cope With Anxiety with Dr. Scott Bea

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host, Nada Youssef, and you're listening to Health Essentials Podcast by Cleveland Clinic. Today, we're broadcasting from Cleveland Clinic main campus here in Cleveland, Ohio, and we're here with Dr. Scott Bea. Dr. Bea's a psychologist at the Center for Behavioral Health and will be talking about anxiety. And please remember, this is for informational purposes only and it's not intended to replace your own physician's advice. Thank you so much for being here today.

Dr. Scott Bea:    Thanks for having me, Nada.

Nada Youssef:   Let's go ahead and start talking about anxiety.

Dr. Scott Bea:    Sure.

Nada Youssef:   First of all, I want to just ask what is anxiety? Just the definition.

Dr. Scott Bea:    You know, anxiety is really a reaction in our body and brain that can be a feeling of worry, apprehension, sometimes excitement in anticipation of an event or in the face of uncertainties.

Nada Youssef:   Okay, great. So it's not uncommon for us to feel anxious once in a while, but can you explain when it's perfectly reasonable and when it's not?

Dr. Scott Bea:    I think it's perfectly reasonable when you're about to do a podcast to be a little bit anxious. Or you know, perhaps in advance of a job interview, taking an exam. When there's a performance component or evaluation of ourselves, sometimes it's appropriate to feel anxious. In other instances, it's a reaction that's too strong to the condition. Our brain is very sensitive to perceptions of threat, and when anxiety gets in our way, starts to interfere with our lives, jobs, obligations or social relationships, then that becomes a problem.

Nada Youssef:   Sure. And what are the symptoms of anxiety disorders?

Dr. Scott Bea:    See what's going on with me right now ... racing heart, sweaty palms, sweat gland activity just in general can be kind of upsetting our digestive system, sometimes racing thoughts, lots of thoughts about potential future dangers. And like I say, it's happening both physiologically in our brains but also in our bodies. There's sensations and also worrisome thoughts that seem to be correlated with anxiety.

Nada Youssef:   Okay. Do emotions play into that at all?

Dr. Scott Bea:    Anxiety is an emotion, I think, that people will label. It has to do with our fear center and spot in our brain called the amygdala that gets activated. We can feel all the sensations of anxiety. Stress hormones get dumped into our body, and we feel all those things that we call fight or flight.

Nada Youssef:   Yes.

Dr. Scott Bea:    The racing heart, muscles tensing. We breathe a little faster, getting more oxygen into our body to fuel those large muscles, and generally either our gastrointestinal system shuts down or it lets go.

Nada Youssef:   Yeah. What about when our body normally reacts differently depending on the intensity of anxiety, what is the difference between acute anxiety versus chronic anxiety?

Dr. Scott Bea:    Acute anxiety might be something simple like having a car cut you off when you're driving, and you have to turn the wheel to avoid the collision. And then, perhaps you'll right yourself, and you'll feel that quick innervation in your body. Your heart's racing a little bit. Your arms are kind of rubbery or tingling, and that would be an acute anxiety reaction. It's very appropriate in that circumstance because you need to act very quickly. That dissipates very quickly because we don't try to do anything about it.

More chronic anxiety is that reaction going on in a much more sustained way or being activated periodically throughout the day. Certain people have brains that are predisposed to have that reaction much more commonly, and they can actually train themselves to be chronically anxious.

Nada Youssef:   So you'd say that chronic would be more long term versus acute would be short term?

Dr. Scott Bea:    Short term, yes. Acute is short term. Happening in this moment, very quickly, dissipating quickly. Chronic, stimulating much more commonly, many times maybe throughout the day, day after day after day.

Nada Youssef:   And it kind of sounds like almost like an adrenal rush ... Like if you almost get into a car accident or even you see a car accident, you're feeling anxious, right?

Dr. Scott Bea:    An adrenal rush is part of anxiety.

Nada Youssef:   A response to anxiety.

Dr. Scott Bea:    Right, absolutely.

Nada Youssef:   Okay. And what are the different types of anxiety disorder?

Dr. Scott Bea:    We really have all sorts of them. Their labels are things like generalized anxiety, social phobia. Obsessive-compulsive disorder is something that people hear a lot about.

Nada Youssef:   Yes.

Dr. Scott Bea:    Panic attacks or panic disorder. Agoraphobia which is an avoidance of lots of things. Other specific phobias are considered anxiety disorders as well. There are some traumatic experiences that can produce anxiety such as post-traumatic stress disorder. That's in the range of anxiety disorders, although slightly distinct because it's trauma based.

Nada Youssef:   Sure. And what causes the disorder?

Dr. Scott Bea:    We think there is a dysfunction in brain circuits that regulate our emotional response to threat.

Nada Youssef:   Okay.

Dr. Scott Bea:    So it's an over activation in our brain of a response to threat.

Nada Youssef:   Right.

Dr. Scott Bea:    It's important that our bodies respond to threat, but certain brains and bodies, they over-respond and then consistently respond to a sense of threat.

Nada Youssef:   Okay. But are there like biological predispositions to anxiety?

Dr. Scott Bea:    That definitely happens. We see this trait transmitted amongst family members. It can also be modeled to you in families. If you have a worrisome parent who's always voicing concerns about threats in the world to their children, they can be kind of trained or conditioned to be hypersensitive to threats as well.

Nada Youssef:   Okay. How to cope? And let's talk about it without medications. How can we help ourselves and how to train our own brain and our kids' brains not to be anxious about situations?

Dr. Scott Bea:    It's going to take practice.

Nada Youssef:   Yeah. What do we do?

Dr. Scott Bea:    And it's going to require that you allow yourself some discomfort. You know, what people really want to do is stop discomfort. And so, when a person is anxious, their knee-jerk reflex is to try to do something to stop the anxiety. That doesn't work so well. Managing anxiety's kind of like managing quicksand. If you find yourself standing on quicksand, it's a good idea not to do anything about it, right? That keeps you real safe. The same is true with anxiety. Anxiety's really harmless, and if you take steps to fix it, it generally gets worse because you're sending a signal to your brain that you're in a bad spot and your brain's going to keep responding by dumping more of those chemicals into your system associated with threat responses.

Nada Youssef:   Sure.

Dr. Scott Bea:    So learning how to do nothing. How to not avoid. How to be here now, to put our attention into the present moment, to get away from our thoughts a little bit. That's kind of a general conception of what we can do. Now, the absolute practice of that, there's some steps that we can go through to kind of produce these placid responses in the face of anxiety. But anxiety's harmless. It feels bad, but it's an illusion. It's completely harmless.

Nada Youssef:   It's all in our brain.

Dr. Scott Bea:    Yeah, it's happening in our brains. I mean, that's real. The chemistry in our body and brain, it's all real, but there's no threat to that.

Nada Youssef:   Right.

Dr. Scott Bea:    But people are paying attention ... I would say it this way, if you were trying to, let's say, run from the police. You'd be having an anxiety reaction and a panic attack, but you wouldn't be aware of it because you're attention would be on the people pursuing you.

Nada Youssef:   Yes.

Dr. Scott Bea:    When nobody's pursuing you, then the object becomes all the sensations in your body, and that becomes a threat ... the sensation that I'm having. They get catastrophized. People want to avoid that, and it actually stimulates more of a chemistry in our brains and bodies ... exactly what we don't want.

Nada Youssef:   Right. And when you're anxious, you're almost thinking about the worst thing that can happen and you're worrying about that, right?

Dr. Scott Bea:    Right. And so, anxiety is often just a response to thinking experience, not real experience. So often, human beings are disturbed by their relationship with their thoughts. Not by the thing they're thinking about, but by-

Nada Youssef:   Right.

Dr. Scott Bea:    ... the thoughts about the thing.

Nada Youssef:   Okay, well, it sounds like meditation would be a good thing for that, right?

Dr. Scott Bea:    Yeah, I actually would term it mindfulness.

Nada Youssef:   Mindfulness.

Dr. Scott Bea:    That's kind of the modern take on meditation these days. Mindfulness is easily defined as paying attention to the present moment on purpose with attention without judging. So just noticing, being here now, noticing. Now there's a practice of that, and the practice is sit comfortably, don't have to sit in any particular way, notice your breath. You don't have to breathe in any particular way. Now just notice what sorts of things start to take you away from your breath. It could be a thought, a sound, and a sensation. If you notice that you've gotten away from your breath, try to let that experience pass from your awareness, ease yourself back onto your breath. That's the practice of mindfulness. But in a real way, we're mindful anytime we're engaged outside of self-awareness without judging. Now if you and I are engaged right now, we're being mindful. We don't even know that we're working or on a podcast.

Nada Youssef:   Right.

Dr. Scott Bea:    And so, it's a simple thing we're doing all the time, but it takes practice in order to utilize it as one way of coping with the world and anxiety.

Nada Youssef:   Now, I have a question for you. Now I've practiced meditation. I think it works very, very well.

Dr. Scott Bea:    Sure.

Nada Youssef:   But when I tell someone about it and I try to explain it, I can never explain it the way you do.

Dr. Scott Bea:    Sure.

Nada Youssef:   But the first thing's always like, "Well there's so much going on in my head. There's so many thoughts. I don't know how to stop." Well your brain is made to think. What would you tell our listeners? What should they do? You said, kind of listen to your body, to your breathing, anything else?

Dr. Scott Bea:    Yeah, I'd like to ask people, are your thoughts important? And people will reflexively say, "Yes, my thoughts of course are important." I'd say, "But you have 50,000 thoughts, ideas, and images every day. Are they all important?" And then, people start to think about that.

Nada Youssef:   Sure.

Dr. Scott Bea:    And when they estimate how many of their thoughts are important, they overestimate it.

Nada Youssef:   Right.

Dr. Scott Bea:    We know half of our thoughts are spontaneous. They have nothing to do with what's really going on. But if one of those thoughts, creates this emotion, all of a sudden we've created a thought that we tell ourselves is important and the sentiment that we want to try to fix, even though that thought may be completely unimportant and the sentiment needs no fix at all. It will go away as soon as we step away from the thought.

So learning to regard our thoughts as kind of unimportant is a really great skill. And so, even if my brain is active with lots of thoughts, they're not particularly important.

Nada Youssef:   Sure.

Dr. Scott Bea:    I think we're kind of dreaming with our eyes wide open. We have lots of mental activity when we sleep and it produces lots of emotion. That's dreaming. I think smart people when they wake up from a dream say, "Uh, oh, that was unimportant. That was just a dream." That's why nobody really cares about our dreams.

Nada Youssef:   Yes.

Dr. Scott Bea:    Even if we're trying to tell them, they don't show a lot of interest because they know it's unimportant.

Nada Youssef:   Sure.

Dr. Scott Bea:    Now with our eyes wide open, somehow all these spontaneous thoughts, this mental activity and emotion, becomes really important when perhaps it's not important at all.

Nada Youssef:   Right.

Dr. Scott Bea:    And the way I know that is nobody ever asks me what I'm thinking. Makes me believe that my thoughts are particularly unimportant.

Nada Youssef:   And for the tech savvy people out there, there are mobile apps that-

Dr. Scott Bea:    Oh, yeah.

Nada Youssef:   ... help with calming down your brain, correct?

Dr. Scott Bea:    One of the national news services last night was talking about one of these apps, Headspace, which a lot of folks-

Nada Youssef:   Headspace.

Dr. Scott Bea:    ... that I have worked with utilize. I think there are many of them, but Headspace has a little bit of notoriety now for teaching mindfulness skills and practical applications of mindfulness skills. So if somebody wants to be guided along that path, something like Headspace is really good. There are lots of great workbooks-

Nada Youssef:   Sure.

Dr. Scott Bea:    ... that teach a lot of these skills, too ... this mindfulness skill ... the acceptance thing. Allowing things to be exactly as they are is kind of one of the attitudes of mindfulness. I don't have to be a fixer.

Nada Youssef:   Right.

Dr. Scott Bea:    Just a noticer.

Nada Youssef:   Right. Just be aware.

Dr. Scott Bea:    Mm-hmm (affirmative).

Nada Youssef:   Excellent. Well what you're saying makes so much sense to me. Now I have two little kids, okay?

Dr. Scott Bea:    Sure.

Nada Youssef:   Four and seven.

Dr. Scott Bea:    Okay. My heart goes out to you, Nada.

Nada Youssef:   So I want to ... I've always looked into like books or something that I can teach them-

Dr. Scott Bea:    Sure.

Nada Youssef:   ... what I'm learning, but I can't tell if they would understand in my level of understanding of awareness and being in the now. How to tell, first of all, if a kid has an anxiety problem versus being a kid? And what am I to do?

Dr. Scott Bea:    Sure. Kids will naturally have some moments where they're anxious. They go through the phase of separation anxiety where they'll cry if you're not around. Most kids will go through a phase of anxiety of what's underneath my bed-

Nada Youssef:   Yeah, right.

Dr. Scott Bea:    ... okay, as their imaginations start to kick off a little bit. Really we only get concern where it's starting to produce interference for kids. If they're avoiding circumstances strongly ... something we might call school refusal ... if they refuse to go to school. If they are afraid of the dark so much that they can't go to bed and be alone by themselves. Instances like that might be instances where we really want to intervene with kids. If they become too worrisome and they're voicing worries all the time, once again, we might want to start to intervene with those children.

Nada Youssef:   Sure. Would you say something like yoga, is it ... Are kids too young for yoga? Or is that ...

Dr. Scott Bea:    I don't think kids are too young for yoga. I think they might not always know what is the value of this.

Nada Youssef:   Purpose, yeah.

Dr. Scott Bea:    How do I make this come alive in my life? But I'll tell you, you can teach kids mindfulness skills very early on in life. Goldie Hawn wrote a book called Ten Mindful Minutes, in which she helps parents teach mindfulness skills to their children so they grow up with a set of skills that argues against being anxious and helps them regulate their emotions.

Nada Youssef:   Sure.

Dr. Scott Bea:    And so, it could be something like mindful eating. You know, the old mindfulness experiment is to hand somebody a raisin, and actually, you know, put it in your mouth and actually before you bite into it to feel the texture and just begin to notice the flavor and then bite into it. So we're really studying it. If I'm mindfully picking up my cup of water, I can mindfully feel the texture of the Styrofoam, feel the coolness, and actually feel the water going down my throat. Usually, we're doing this mindlessly.

Nada Youssef:   Yes.

Dr. Scott Bea:    And so, it's just about tuning in to what's going on here. I would say, my thoughts are unimportant. What's going on here?

Nada Youssef:   Sure.

Dr. Scott Bea:    And with children, you can say, "What sorts of thoughts are you having? What is going on in your body?" Well those two things might be connected a little bit. And you can start to help them form relationships between thoughts and feeling states and also help them understand that some thoughts are just thoughts and have nothing to do with what's really going on so that they're kind of harmless and we can become more playful with thoughts and feelings.

Nada Youssef:   Sure, sure. Just like dreams, right?

Dr. Scott Bea:    Just like dreams.

Nada Youssef:   And actually, last summer I started taking them hiking because I started realizing that they were very present when we were hiking because they were looking at each step versus thinking about anything else in the world.

Dr. Scott Bea:    That's right.

Nada Youssef:   So that was-

Dr. Scott Bea:    Those things that pull us outside of-

Nada Youssef:   Yes.

Dr. Scott Bea:    ... self-awareness like hiking, that's it. I mean, that's what ... When we're engaged, that's when tension goes down.

Nada Youssef:   Sure.

Dr. Scott Bea:    And we don't do enough of that.

Nada Youssef:   I agree.

Dr. Scott Bea:    We fall back into self-awareness. I do a talk called, When I'm in My Head, I'm in a Bad Neighborhood. And it's, I think, legit. There's a bunch of circuits in our brain we call the default mode network. It's where our thoughts go when nothing else is going on or pulling our attention outside. It's not a particularly happy place. It's often where we're going to upset ourselves.

Nada Youssef:   Right.

Dr. Scott Bea:    Dredge up past experiences that were unpleasant, anticipate future events, or generally upset ourselves.

Nada Youssef:   Sure, sure. So it's not just about not thinking about ... Actually choosing the thoughts that come to your brain and sticking with the positive ones to keep them kind of-

Dr. Scott Bea:    Actually, we can't control thoughts.

Nada Youssef:   Yeah.

Dr. Scott Bea:    It's about relating to thoughts differently. I could say, "Nada, don't think about a blue baseball for the next sixty seconds-"

Nada Youssef:   Just thought about it.

Dr. Scott Bea:    ... And yeah, it's going to be a pretty tough task.

Nada Youssef:   Yeah.

Dr. Scott Bea:    But if we say, "Hey, you know, why don't we just notice that I had a thought about blue baseballs, and that it comes and goes in and out of my awareness like all external experiences. It comes and goes in and out of our awareness. Nothing to be done about it. So we can relate to thoughts just by noticing, rather than by having to fix, and that to me is the secret for managing anxiety. To be one that notices, doesn't fix, that allows discomfort rather than tries to avoid it-

Nada Youssef:   Sure.

Dr. Scott Bea:    ... and that we're going to move towards things, even things that are slightly uncomfortable based on our values and our commitments. And we do know this, by the way, if you're moving towards something that makes you anxious, your anxiety will actually go down and your confidence will go up with practice. If you avoid, it's just the opposite. Anxiety goes up and confidence goes down.

You can imagine a dentist. If you haven't gone for six months, you might be a little anxious. It might be a little hard to go. If it's been six years, it's going to be really, really hard-

Nada Youssef:   Sure.

Dr. Scott Bea:    ... to go into that circumstance. So we try and get rid of avoidance behaviors also.

Nada Youssef:   Great. This is excellent. Now, with tragic events happening as often as they do or, you know, in the media as much as they are. Is there any way to talk to kids about tragic events but at the same time eliminating or lowering their anxiety levels?

Dr. Scott Bea:    It's hard. We know that the young generations are a particularly anxious generation. The generation they call Generation Z experiences much more anxiety than preceding generations.

It depends on the age of the child, Nada. If a child's really young, I think you really want to offer them assurances of safety. They'll believe that, and they'll appreciate that you, as a parent, are protecting them. With older kids that can appreciate some abstractions or abstract thinking, you want to be honest with them. You say, "Hey, you know that does happen in the world." But you also want to talk about statistical models that say, in general, the world is pretty safe. There are things that might be challenging, but here are steps that adults take to protect you. Here's what we're doing to protect you. What can you do to protect yourself? So that they get a more realistic but balanced view.

I think the way our media is these days, we hear about all these events and so we overestimate their prevalence and so we walk around feeling really, really threatened. And this generation grew up ... They were six years old or younger when 9/11 happened, and our world really changed with respect to anxiety. We experienced threat at a different level these days.

Nada Youssef:   Right. And then, let's talk about treatments.

Dr. Scott Bea:    Sure.

Nada Youssef:   If mindfulness doesn't work, going into treatments ... What kinds of medications? What kind of different things that we can do?

Dr. Scott Bea:    You know, if you're really struggling, that is you're having really a lot of trouble functioning in the face of anxiety, some really useful medicines are anti-depressant medicines, something called SSRIs, selective serotonin reuptake inhibitors. That's a fancy name for an anti-depressant.

Nada Youssef:   Okay.

Dr. Scott Bea:    But it has really nice, protective, anti-anxiety effects. It really limits the emotional response of the brain-

Nada Youssef:   Right.

Dr. Scott Bea:    ... to common provocations or thoughts that might produce anxiety, so it produces nice protection. In some rare cases, you might need something that's a little more quick acting, doesn't stay in your system as long. Benzodiazepines are that class of drug. They're a little bit habit forming, so we don't like to keep people on those medications too very long ... generally not more than four months. It can provide some quick relief.

But you want to teach people coping skills, and if a medicine is coping for you, then you're not really going to learn the skill. It can also happen with drugs and alcohol. People might try to self medicate. Something like social anxiety. I think taverns and pubs and bars are designed for those who are socially anxious. We give you alcohol. We turn the lights down so you feel more anonymous. The alcohol's just inhibiting, but you're not really learning anything. You're allowing some chemical agent to do the work, so you're not learning. So even if you are using medications for anxiety, it's a real great idea to be actively learning coping skills like mindfulness, acceptance-based sorts of skills, along the way so you're really changing your brain along with the medicines.

And sometimes, the anxiety can be overwhelming. And so, I say you can learn calculus in a room that's 120 degrees, but it gets easier if you turn it down to 70 degrees. So the medications turn the heat down for us so that we can learn some new skills.

Nada Youssef:   Okay. Would you say therapists would work first ... Or to try a therapist first for coping mechanisms versus going straight to medication?

Dr. Scott Bea:    It kind of depends-

Nada Youssef:   Or alcohol-

Dr. Scott Bea:    ... how you're built. There are many paths up the mountain. Some people will try different things. Some people have a bias. Some people say I'm absolutely not taking medicine. Some people say I'm absolutely not talking to a therapist.

Nada Youssef:   Right.

Dr. Scott Bea:    And the best treatments tend to be combined treatments, particularly if it's really interfering. If it's getting diagnosed as an anxiety disorder, combinations of medicines like anti-depressants and cognitive behavioral therapies or an offshoot of cognitive behavioral therapy called acceptance and commitment therapy ... Those are shown to work awfully nicely, often in concert. And if you get really good at the coping skills, then oftentimes you can fade the medicine.

Nada Youssef:   Okay, great. And then, with the coping skills and medication, is this also appropriate for kids?

Dr. Scott Bea:    You know, that's an area that's not quite in my expertise. I think with kids you really want to try to teach a coping skill first.

Nada Youssef:   Yes.

Dr. Scott Bea:    Unless there is just tremendous impairment and interference from anxiety, you'd want to help a kid train their brain to respond differently to what it's doing. Look, if we're going to learn a musical instrument, it's great to learn it when you're really young.

Nada Youssef:   Right.

Dr. Scott Bea:    If we try to do it at my age, I won't be so good at it or I'll only go so far.

Nada Youssef:   Sure.

Dr. Scott Bea:    So when we're dealing with young brains, they're much more able to grasp these ideas-

Nada Youssef:   Sponges, yeah.

Dr. Scott Bea:    ... and make them useful and practice them across their lifetime.

Nada Youssef:   Right. Okay. And what do you say to people who are scared to ask for help?

Dr. Scott Bea:    Stomp through the fear. You know? You have to do it anyway. I'd say feel the discomfort, but do it anyway.

Nada Youssef:   Sure.

Dr. Scott Bea:    And that's actually one of the tools for managing anxiety. Go ahead and feel uncomfortable, but do it anyway.

Nada Youssef:   Yeah.

Dr. Scott Bea:    I think one nice little analogy is like skydiving. Skydiving's like a great idea two weeks before you do it. You sign up with all your friends, and you decide you're going to jump out of a plane. And this is what happens with human beings. We call this an approach avoidance conflict. We want to approach this because it sounds like it's going to be a lot of fun. Over the next couple of weeks, we start to have more thoughts about skydiving, and it starts to produce these little anxiety reactions. Well on the day of the event, they take you out to the skydiving school, and they keep you really engaged outside awareness-

Nada Youssef:   Yes.

Dr. Scott Bea:    ... like a hike with your kids. You're packing up your shoot, and you're learning how to jump off picnic tables to simulate landing. I understand it gets real quiet as the plane takes off, and everybody's thinking-

Nada Youssef:   Yes.

Dr. Scott Bea:    ... about am I really going to do this? Well when do people have better ideas than jumping out of a plane, as soon as the door opens.

Nada Youssef:   Wow.

Dr. Scott Bea:    And then, they're faced with what they said they wanted to do and they freeze.

Nada Youssef:   Yeah.

Dr. Scott Bea:    Okay. Anxiety, right? So the pilot tells you something cockamamie like you have to jump out of the plane. We can't land with your weight in the plane. It forces people to stomp through that discomfort, and as soon as you're out the door, your anxiety starts to plummet ... along with you.

Nada Youssef:   Yes.

Dr. Scott Bea:    But it's taking that step, you know? It's that moment where we feel that terror that we don't want to move forward. Move forward anyway. Ask for help. As soon as people make that step, some of the tension goes down. And it's funny, when you're hanging out with a psychologist, I'll sometimes ask people, "Are you feeling anxious right now?" Well of course not. I say, "Does it feel like you're hanging out with a psychologist?" It doesn't. We're just engaged in a conversation like you and I are. So it's a little bit less painful than it appears outside.

Nada Youssef:   How do neurotransmitters in our brain really ensue anxiety?

Dr. Scott Bea:    Well neurotransmitters, a pretty fancy name for little chemicals in our brain that are messengers that get transmitted through the circuits in our brain, and some of those are related to anxiety. So neurotransmitters that people might have heard of ... serotonin, dopamine, norepinephrine, something called GABA ... are all little messengers in our brain that can be associated with anxiety and the circuit of anxiety, some of which is coming from this fear center in our brain, the amygdala. But when we're using medicines or we're trying to train our brain differently to respond differently to anxiety, those are the chemicals that we're trying to influence.

Medicines kind of work from the bottom up. They're trying to change those little chemical events in order to change our experience of anxiety. When we're teaching mindfulness, acceptance-based skills, allowing things to be the way they are, my thoughts are unimportant, then we're trying to change something more generally about the circuit in our brain to influence those little chemicals.

Nada Youssef:   So we can change our own neurotransmitters by coping skills and mindfulness?

Dr. Scott Bea:    Like any learning, yes. It changes our brain and we can learn and change our brain. It takes practice, and it takes dedication and commitment across time. But absolutely, we think we can be brain engineers and help ourselves.

Nada Youssef:   Sometimes I feel like my stress response ... because I can be impatient ... That teaches my kids to react to my reaction to stress.

Dr. Scott Bea:    Sure.

Nada Youssef:   What can I do?

Dr. Scott Bea:    It's really important to take some steps to manage our own expressions of tension and anxiety. This is not easy because sometimes it comes out of us reflexively. But rather than voicing the stress ourselves, we might notice something like, "Oh, we're running late. I guess we'll get there when we do." To normalize it and normalize that the consequence for such things, while not ideal, is not particularly hazardous either.

I can remember walking home, carrying my four-year-old daughter home in an electrical storm under tall forestation huddled under a lightning rod that I was holding in my hand, and telling her, "Hey, you know, everything is all right." Now, I didn't quite believe that, but I didn't want to convey that sense of threat to her. And so, it takes practice in our role as parents to kind of stifle the verbalization and try to normalize how we get through all things in life.

Nada Youssef:   Sure.

Dr. Scott Bea:    Sometimes, training ourselves out of a reflex takes practice. Sometimes you can run a little four-step thing where maybe I image a provoking scenario. "Oh my gosh. We're running late to an important thing." We can imagine that haywire reaction. The second step, imagine ourselves going haywire and verbalizing all our fears. We could then stop that, replace it with an image of how we'd like to see ourselves responding ... with calmer body, calmer brain, calmer words, normalizing what's going on. And then, the last step, spend a moment talking to yourself about how you'd come up with that kind of rational response in an upsetting circumstance. Being late is not great. It happens all the time. We get through it in every instance. Everything's going to be okay.

Those little steps can help us. If we rehearse that for 60 seconds once a day, next time we're in that spot, you might be able to reach for that new response rather than getting into the reflex. Without the practice, the reflex is probably going to be dominant.

Nada Youssef:   So practicing and training will get us there?

Dr. Scott Bea:    That's it.

Nada Youssef:   It'll be our-

Dr. Scott Bea:    You have rehearsals.

Nada Youssef:   ... reaction.

Dr. Scott Bea:    Yeah, we can actually rehearse new emotional reactions in that way. We don't talk about that very much. And if you ask people, do you have perfect emotional responses so that in any provoking scenario you just respond with wonderful dignity. Nobody will agree to that, so-

Nada Youssef:   Right.

Dr. Scott Bea:    We all can stand to practice.

Nada Youssef:   Now I actually watched something ... Tell me if that's true, but I just watched something talking about if you imagine that you are, let's say, riding a roller coaster, that your brain neurons would go off the same way that it would if you were actually riding a roller coaster. So you can think your thoughts into almost neurons moving.

Dr. Scott Bea:    Well people can frighten themselves about riding roller coasters before they ever get on one. That's for sure. Indeed, we can have anxiety responses to mental representations. That's really what anxiety is about. I mean, as I say, if I'm really faced with a snake, I might feel an anxiety reaction. If somebody says, "Hey, do you want to go spend time with snakes?" I might immediately feel that response in reaction to my imagery about snakes. So yes, it can happen that way.

And of course, they're developing all these new technologies like virtual reality technologies. If you're a fearful flyer, you can put on a virtual reality headset and have the image of actually being on a plane or riding a roller coaster or any circumstance that you can imagine that people might respond with anxiety in order to expose them. Because exposure actually is one of the things that really works.

Nada Youssef:   Yes.

Dr. Scott Bea:    I'll say this. Like with obsessive-compulsive disorder, if you really don't like contamination, and we want to help you over that a little bit, we might say ... Let's say you hand wash or you wash your hands too many times a day, way too long. We might say, "Here's a concoction of dirt and hair of unknown origin. We're going to put that on your lap for the next hour, and then we're going to prevent you from touching water for the next 24 hours." That produces a real dilemma for that person. Their brain will go crazy for a little while, but eventually, if they stay in that condition, the brain will correct itself, and when it does, it learns an emotional lesson that you can't learn any other way. This is not dangerous to me.

Nada Youssef:   And learn to cope.

Dr. Scott Bea:    That's it.

Nada Youssef:   And that-

Dr. Scott Bea:    Exposure, by the way, is a very common treatment for anxiety. So if we're phobic, we expose. If you're avoidant because of OCD, we expose. If you're socially avoidant with social phobia, we use exposure to social conditions. So exposure's often a very key component to the treatment of anxiety.

Again, shaking up the brain, making it uncomfortable, preventing escape so that the brain corrects itself, and no other intervention. And then, you figure out the puzzle. I never had to avoid this.

Nada Youssef:   And speaking of that, I've heard that they now use virtual reality for PTSD patients to go through the same traumatic experiences so they can kind of cope with.

Dr. Scott Bea:    It sounds pretty hazardous, right? But if you think about it, marine boot camp ... Marines are exposed to unrelenting discomforts for 13 solid weeks. They say they tear you down to build you up. They actually never build you up. They just keep tearing at you so that the thing that really shook you up on the first day doesn't move your brain at all. So that's the training that we're trying to do with some difficult anxiety conditions. And it does work, but you do have to have a willingness to be uncomfortable.

Nada Youssef:   So for kids, how much exposure is too much exposure when it comes to stress?

Dr. Scott Bea:    You know, I think we do want to expose our kids to situations that occur in real life, see if they can develop some problem solving. The older they get, the more we should allow them to figure out a circumstance. If it's with a teacher, if it's with a fellow student. I think too often we jump in and intervene on behalf of our kids and see exposure builds immunity, right? Just like with germs. If you protect your kid from germs, then the first day they go to school they're bound to get sick because they've built no immunity. Likewise, we need to let kids kind of figure out some of life's dilemmas. We can talk about those dilemmas. We can say, what do you think you might do about that? Rather than, let me go fix that for you. If we always are fixing, the kid never develops coping skills and it's actually one of the challenges that parents are facing ... Walking that tightrope. Do I fix it for them because it makes me uncomfortable to see my child uncomfortable. Or do I allow them to develop some immunity for-

Nada Youssef:   Resilience.

Dr. Scott Bea:    ... what ... yeah, and resilience, exactly ... for what life is really like. No one can make those judgments for you, but we do think that we're handicapping our children by not allowing enough exposure to what's real about life. And again, you can develop a dialogue. "What's going on in your thoughts? What sorts of sentiments or sensations are you having? That might be kind of safe. What sorts of thoughts do you have about how you might solve that? What steps could you take on your own behalf?" Those would be important conversations to have.

The reactions in our body are harmless. Okay? Having a child do uncomfortable things and not sparing. If they didn't do their homework, maybe they have to go face the teacher with that reality rather than us calling the teacher and trying to run interference and asking for forgiveness. So those would be little examples of how we might allow exposure.

Nada Youssef:   Well, you know we are actually out of time. This is all we have for today. But is there anything else that you wanted to add on for our audience?

Dr. Scott Bea:    No, I said, truly one of the keys to managing anxiety is you have to have a willingness to be uncomfortable. We're in a comfort-ridden culture where we sell comfort and we think this is the way to live. You know, the most important moments in our lives and our biggest accomplishments come when we accept discomfort and do it anyway. And that's how we overcome anxiety.

Nada Youssef:   Yes, well, thank you so much, Dr. Bea, for joining us.

Dr. Scott Bea:    Super, really.

Nada Youssef:   It's been an absolute pleasure.

Dr. Scott Bea:    Fun for me.

Nada Youssef:   It's a great, great talk.

Dr. Scott Bea:    Thank you, Nada.

Nada Youssef:   Thank you. And for more information or to make an appointment with a behavioral health specialist, call 216-636-5860, or visit ClevelandClinic.org/behavioralhealth. And thanks, again, to our listeners and viewers for joining us today. We hope you enjoyed this podcast. And to listen to more of our Health Essentials Podcasts from our Cleveland Clinic experts, make sure you go to ClevelandClinic.org/HEpodcast or you can subscribe on iTunes. Thank you so much for listening. We'll see you next time.