Podcast #497: The Meaning, Manifestations, and Treatments for Anxiety

Show Highlights

• Scott’s lifelong experience with anxiety   
• The benefits and usefulness of anxiety 
• Society’s general increase of anxiousness, and why this is happening
• How did anxiety used to be diagnosed and treated?
• The arbitrary diagnosing of anxiety disorders
• Genetics vs. environment vs. culture in causing anxiousness 
• What can we do to boost our resilience and resistance to anxiety?
• The pros and cons of therapy, drugs, and other treatments
• The power of regular exercise
• Can anxiety really ever be cured?

Resources/People/Articles Mentioned in Podcast

• AoM series on Male Depression
• How to Deal With Anxiety
• Agoraphobia
• Our podcast with Lenore Skenazy about free-range parenting
• AoM series on Overprotective Parenting
• Modern “Neurasthenia”: Curing Your Restlessness
• Are Modern People the Most Exhausted in History?
• A Simple Cure for Restlessness
• Mastering Mindset to Improve Happiness, Health, and Longevity
• Action Over Feelings
• Neuropeptide Y
• Meditation for Fidgety Skeptics
• National Alliance on Mental Illness
• Anxiety and Depression Association of America

Connect With Scott

Scott’s website

Scott on Twitter

Listen to the Podcast! (And don’t forget to leave us a review!)

Listen to the episode on a separate page.

Download this episode.

Subscribe to the podcast in the media player of your choice.

Recorded on ClearCast.io

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Read the Transcript

Brett McKay: Brett McKay here and welcome to another edition of The Art of Manliness Podcast. According to recent statistics, the number of Americans dealing with anxiety disorders is over 40 million, and that number is increasing. My guest today is one of those Americans who suffered from bouts of anxiety all of his life. He is also a successful journalists. So, we decided to use his journalistic chops to explore the history of anxiety and how we treat it in the hoax he could gain more insight and about the mental disorder that has plagued him since his youth.

His name is Scott Stossel. He’s an editor at the Atlantic and the author of My Age Of Anxiety: Fear, Hope, Dread And The Search For Peace Of Mind. We begin our conversation discussing Scott’s experience with anxiety that began as a child. What anxiety feels like and how he’s treated it throughout his life. We then dig into the history of anxiety looking at how its been viewed differently through time and at what point psychologists classified it as a mental disorder. Scott then walks us through the different theories about what causes anxiety and what the research says about the best ways to treat it.

We end our conversation discussing the state of Scott’s anxiety today. Whether he thinks he will ever be cured. After the show’s over, check out our show notes at aom.is/ageofanxiety. Scott joins me now via clearcast.io.

Right, Scott Stossel, welcome to the show.

Scott Stossel: Thanks so much for having me.

Brett McKay: You wrote a book, My Age Of Anxiety, which is a cultural history, scientific history of anxiety. Which is something a lot more Americans are struggling with, they’re reporting struggling with. But not only is this a history, it’s a narrative of your own struggle with anxiety throughout your life. Let’s start there. How long have you been struggling and dealing with anxiety?

Scott Stossel: Its honestly been pretty much a lifelong struggle from a very young age. The earliest I can remember, I had terrible acute separation anxiety when I was a little kid. Any time I was away from my parents, I was convinced that they were dead or died in a car crash or that they were actually robots and I was part of some experiment. By the time I got to school, I would have anxious stomach aches and anxious headaches and I would always end up in the nurse’s office. I would worry incessantly about all kinds of things.

So, really from the time I was … My earliest memories, I remember being worried about things. I have, I think a temperamental tendency towards anxiety and worry that manifested itself at a very, very young age.

Brett McKay: Did it manifest itself differently over the years as you got older.

Scott Stossel: Yeah, the separation anxiety and that’s a classic early manifestation of people who grew up to develop what you clinically called anxiety disorders. But over time, I developed specific phobias; fear of heights, fear of enclosed spaces, fear of cheese and fear of vomiting, fear of flying, which was a pretty acute one that still plagues me today.

I also, as I got older, started having panic attacks, which anyone who’s experienced them knows are often when they recur with any frequency over a period of time, that becomes clinically known as panic disorder. I had that. When I got to middle school and high school, I had all kinds of social anxiety where I worry about interacting with other people, particularly performing in public. I was in the school play in sixth grade, it was humiliating, I had to walk off stage because I lost the ability to speak.

And then I carried all that with me into adulthood, basically these anxieties were unfortunately added if not substituting. I wasn’t switching one for the other. Just every time I got a new anxiety, I would just add that to the ones I already had. By the time I got to high school and then young adulthood, I was not all the time but pretty constantly struggling with some collection of fears about going to school, traveling, getting sick, dealing with other people.

The strain of dealing with that would lead to depression. It was a pretty toxic stew of negative emotions I was dealing with by the time I was a young adult.

Brett McKay: Right, one two punch. I imagine, we’ll talk about you’re still working with this stuff today. But you’re a writer for The Atlantic. You’re a public figure. Is it still something you struggle with? The fact that you have to do speaking engagements or things like that, is that something you have to manage as well?

Scott Stossel: It is. I’m what they call … I’m a high functioning person with anxiety disorder. There’s some people who get so anxious that they’re what’s called agoraphobia, where their panic disorder gets so bad that the range of things they can do gets smaller and smaller. Eventually, they are people who are confined to their houses or even confined to one room in their house and can’t do anything for years at a time.

I’ve had periods like that, fortunately, short periods where I could feel the world closing in on me. But for the most part, with a combination of medication, other kinds of therapy, and just force of will sometimes, mostly managed to live a normal life and have a career.

There are ways in which, and I talk about this in the book in which anxiety has its benefits or at least it’s connected to temperamental traits that are good. If you’re super anxious about things, you’re kind of hyper vigilant, which makes you good at scanning the environment and being aware of your social situations or being able to read social cues. People with social anxiety probably over read them, but it can be a useful skill. Your worrying a lot can be debilitating if it’s excessive, but it also helps you to plan for different eventualities. You can look ahead.

I think that just the struggles I’ve had with my mental health have made me more empathetic towards other people have those struggles and even to people who don’t have those struggles. I think it helps with communication. There are a lot of ways in which even though I hate my anxiety when it’s flaring up, it’s probably propelled me along, its made me conscientious because I’m afraid of screwing up, I’m afraid of looking bad. That becomes a motivator.

A lot of times I feel like I’m patched together or barely holding it together because my anxiety is so bad or, I’m pharmaceutically armored against my anxiety. That’s how I’ve struggled through, and I still struggle with it today a lot. We can talk about that more later if you want. But I’ve been fortunate enough to manage to, mostly be a productive member of society.

Brett McKay: Well, this book came out 2014. It’s been five years. You’re seeing all these reports come out week after week about how Americans, particularly young Americans and young Westerners in general, are increasingly feeling like they’re anxious or they’re suffering from anxiety. What are the numbers? How many Americans do we know are reporting being anxious?

Scott Stossel: They’re really high. There was a study a couple, before my book came out, some years ago that talked about how the average level of anxiety for a typical high school student now self-rated report on anxiety is the same as it was for inpatient psychiatric patients in the 1950s. Basically, the average kid today is as anxious and neurotic and miserable as people who are in psychiatric hospitals a couple of generations ago. Then there’s all kinds of other statistics that just show levels of stress, worry, anxiety, anxiety disorder diagnoses, are much, much higher in young people pretty much across all Western countries. Particularly, there’s a lot of data about Europe and the United States.

In the US, I think, there’s so much data that this is something real. I think part of it is our definitions of what constitutes a clinical anxiety disorder have expanded and become a little bit more elastic. Probably can be know more about these disorders so people now can identify them partly because you’ve got now drugs that have been approved to treat them. You’ve got the marketing imperatives of the drug companies. The more broadly you can define an anxiety disorder, the more people you have that you’re able to prescribe it to.

Partly, this is inflation of a diagnostic category. I think in any society, there’s some complement of people who will be anxious under many circumstances. But I also think that there are a lot of factors about the culture in the society right now that are driving people, and particularly young people to be more anxious. At the largest societal level, we’re in a long period really going all the way back to the dawn of the industrial revolution, but accelerating now in the internet age, of just rapid change, economic dislocation, all kinds of transitions. There’s just a pace of life because of the internet. The way people select themselves into tribes, put the pressure to create your own personal brand on the internet. There’s just so many countervailing pressures that confuse young people about what their identity is.

In centuries past, you were born into your role. Your family had a status in the tribe or in the medieval village you lived in or even in your farm village in the 19th century America. Now, who are you? You can choose your gender, you can choose your sexual preference, you can choose the groups you affiliate with socially. All this creates a lot of stress. And then the last factor I would say, is just there’s been a lot written about this, particular people in the millennial generation and younger, there’s so much helicopter parenting. Your parents are super involved and driven and trying to make their kids succeed.

But the combination of overprotectiveness and pressure to achieve is really toxic, because on the one hand, these kids feel all this pressure to succeed and do better than their parents and get into good colleges or do whatever. At the same time, the parents are doing things for them that parents of previous generations wouldn’t. It robs them of their feeling of autonomy and resilience. It’s really an epidemic thing. I’ve talked to a lot of psychiatrists both for the book but then also people I’ve come to know who are now friends who are psychiatrists, who are therapists and they see this as just an epidemic phenomenon. All those factors combined to create soaring levels of anxiety.

Brett McKay: Let’s talk, you mentioned there’s a cultural component to anxiety. It’s not that anxiety is a cultural construct. That it exists, it rooted in biology, but the culture has an influence. For example, the diagnostic of anxiety disorder didn’t exist 35 years ago. I’m older than that, I’m 37. How old am I? 36. I forget how old … At some point you stop counting how old you are.

Scott Stossel: That’s right, because of a defense mechanism.

Brett McKay: Right? But that doesn’t mean that people weren’t anxious. What did we call anxiety say like 2,000 years ago, or 100 years ago or even 50 years ago?

Scott Stossel: Good question. Its been called all different things. Obviously, the emotion that we feel, or the set of emotional and physical experiences you have in your body when you are feeling what we now call anxiety, humans have experienced since they were humans. What did they call it in [inaudible] times when they were cavemen? They didn’t have a concept of anxiety, but when they went out of the cave and they were worried about getting eaten by a saber tooth tiger, their problems would sweat, their hair would stand on end, their stomachs would hurt. That is anxiety.

Even in animals, the fight or flight response is a sort of evolutionary program instinct to help keep species alive. What we call anxiety today emanates from that deeply rooted evolutionary, biological reality. But over the years different cultures have and science has called it all kinds of different things. For many years, the Renaissance, they would group what we now call anxiety and depression together under melancholy. If you suffer from what, you’re worried about things, or you were depressed, your were called melancholy.

Once you get into the 19th century, in Europe and America, they would call it asthenia. It was meant to just a set of traits that was a combination of physical things. It could be like dizziness, sweats, gastrointestinal problems and emotional things; phobias, worry, basically could encompass anything because your anxieties, you experience it in your brain, but it has effect throughout your body.

Getting into the Freudian age, Freud became very influential through the 20th century, particularly into the mid-20th century. He talked about what we today call anxiety as neurosis. He had a different theory of what caused it; childhood sexual, repressed sexual desire, conflicts with your parents, the edible complex, which a lot of which has been debunked now. But as a cultural idiom, the idea of neuroses became very prominent in the culture. That was through World War II, up until 1980 when the Diagnostic and Statistical Manual, which is the Bible of the psychiatric profession, they redefined the neurosis as anxiety.

Technically, anxiety disorders didn’t exist when you were born and they didn’t exist when I was a little kid. I’m 49 now. For the first 10 years of my life when I was starting to get taken to psychiatrists, they would say I have childhood neurosis or something like that. It’s now been redefined as anxiety. The labels we put on this do inflect how we think about them and how we treat them. But it is the same underlying set of you and I or if I think of myself, I would be feeling the same set of unpleasant thoughts, emotions, and physical sensations, whatever age I was in, and whatever we choose to call it. Just now we classify them as anxiety disorders.

Brett McKay: Right? The way we describe and the way we talk about it has changed. For example, within the Renaissance, melancholia, yeah, you were considered depressed and anxious. But it was romantic too. It was like, well, you’re just ponderous, romantic person who’s thinking about big thoughts. It was a positive spin on it. But then Freud saying, “No, neurosis is bad. We got to solve your neurosis by sitting on a couch and talking to a therapist over and over again until you solve it.”

There’s that swinging back and forth. Yeah, there’s some good and bad, but then it’s all bad.

Scott Stossel: Yeah. There’s often been, you referenced the Renaissance era, this sense that having melancholy is attached to having an artistic or refined or sophisticated sensibility. It was actually seemed to be a desirable trait. If you were melancholic, it meant you were creative and artistic and must be very smart. Sometimes, there are, and this is contested among actual experts about whether is there a link between mental illness of various kinds, including anxiety and depression and creativity. So many famous writers, for instance, and artists have had very prominent psychiatric disorders or alcoholism or things like that. Is there an alliance between the things that make you anxious and depressed and the things that give you an artistic sensibility?

Maybe there’s, like I say, different people dispute that. You’re right, that the cultural interpretation we put on anxiety changes. One thing in particular, as a man, that this has been changed recently, but there’s a lot of shame associated with is anxiety cowardice? And cowardice is shameful. There’s almost no worse epithet you can swing at a man than being a coward or whatever.

But suppressing this stuff or not treating it can be very dangerous. Instead of going to a therapist, a lot of people turn to alcohol or drugs and basically try to manage their anxiety in very unhealthy ways, that can be quite dangerous.

Brett McKay: We’ll get into that a little bit more because I’d like to talk about stuff like Navy SEALS and neuro peptide wide and whatever. But talking about the current diagnosis of anxiety, I thought it was interesting, you explore the DSM and how they came up with it. We talked about some other people and we talked about depression. How a lot of this stuff, it’s ad hoc. There was just threw spaghetti at the wall, or sometimes there’s dinners, and they’re like, “Well, here’s the five things that we think that you can use to diagnose anxiety.” It often seems very arbitrary sometimes.

Scott Stossel: It’s often completely arbitrary. I was fascinated when doing research for this book and hearing some of these people talk. The people who did a previous edition of the DSM, every 10 or 20, 30 years, they reissue a new one. When they introduced all the anxiety disorders for the first time, that was in 1980, with the DSM three, the third edition. Yeah, I would hear from people who are part of the committee that came up with the categories. They’d be sitting around and they would have come up with a definition for panic disorder. But even that was arbitrary. They’d say, “Well, it’s if you have six …” I’m trying to remember. If you have X number of panic attacks over a period of six months, well, then you have panic disorder. Well, why did they choose six months instead of a year or two months? And why X number of panic attacks instead of why?

The more interesting one was then they were talking about, well, we’ve got all these different kinds of anxieties categorized into discrete disorders. You’ve got phobias, which is fear of specific things, you’ve got social anxiety, which is fear of social situations. We’ve got panic disorder, which is panic attacks. We’ve got OCD, which is obsessive compulsive disorder. They’re at this dinner, they’re like, well, what about our colleague Joe? He’s just generally anxious. They’re like, oh, well, let’s come up with something called generalized anxiety disorder.

They wrote that into the third edition of the DSM. Then once it exists as a real category, then researchers and drug companies start to treat it as a real thing. And they do studies based on the sets of symptoms that you’re supposed to have, to be characterized with that disease. It starts to become certified into you’re testing for a thing that you made up in the first place.

Again, not that the underlying suffering is not real and not there, but is generalized anxiety disorder really its own separate disorder, or is it, as some people now think, just a subset of depression, or depression with anxiety, or people who are depressed often worry a lot and get sucked up into their head? Well, that’s what people with generalized anxiety disorder do. They just worry incessantly and spin in circles in their head.

Being very anxious can be depressing. No wonder that anxiety and depression are so often co-occur in people. And then many people with depression experience anxiety. It’s unclear how these things really … In the DSM, they’re very neatly cleaved from one another. This disorder is distinct from that disorder. A lot of people are now starting to think maybe, especially as they start to look at the neuroscience of this, which is still in early stages, but maybe this is all variants of the same thing. I imagine, 100 years from now, when scientists look back, they may think that our categorizations of these things are pretty crude, but they’re the best we have right now.

Brett McKay: It’s like when we think about how people talk about [inaudible] that was kind of silly.

Scott Stossel: Or hysteria. Hysteria was particularly for women. But there was some … What was that? Was that a cultural phenomenon? Was it a medical phenomenon? It was both, and these things always intersect. That’s always interesting to me, when you have a real biological thing that gets interpreted culturally, that’s fascinating and really does change how we treat and think about people who have these disorders.

Brett McKay: I imagine that it can cause a lot of confusion and frustration for people struggling with it. They’re going to help and they’re getting inconsistent diagnosis from different … One therapist is like, well, you have this, but not this to this. It’s like, well, what am I? What am I supposed to be doing with what I … How much to go after what I have?

Scott Stossel: Yeah, when my book came out, I had a lot of people say that or versions of that, that they struggled a lot. But in general, I would say, most therapists, there’s a lot of agreement, and it may change, but there are certain things that there’s emerging data about what works for all these things, or many of these things. For instance, there’s a form of therapy called cognitive behavioral therapy, which is basically a combination of helping people to change their thoughts to make them less maladaptive. Break the cycle of negative thinking and reality test a better way. People are worried about things who have generalized anxiety disorder, they always see the worst case scenario. Cognitive behavioral therapy helps you restructure your way of thinking so you can see things in a more realistic way. And then help you change your behavior and exposing yourself to the things, if you have anxiety, exposing yourself to the things you’re afraid to decondition you from the fear.

There’s a lot of evidence over now, more than a decade, that that kind of therapy can work for all kinds of anxiety disorder, from obsessive compulsive disorder, for depression. There are things that work. There are certain medications. Medication, when we talk about that, that’s all complex to where my sense is, your medications can work, but there is a great mystery about how they work, when they work, who they work for, what the downsides are. But there are some studies and a lot of evidence to suggest that for some people, certain medications can help them with their anxiety and depression.

Even though we’re still groping around for proper definitions and everything is categories and are messy. There are things that are generally believed to work.

Brett McKay: We’ll talk about medications, that’s interesting as well. Again, it’s like how we define and diagnose anxiety. A lot of the medication developed were very ad hoc, and we’ll talk about it, because it’s really interesting as well. But let’s talk about, what causes anxiety? Because some people will look at it, “Well, it’s like a choice. You can just snap out of it. Get yourself together.” But there’s also evidence that says no, there’s a genetic component to it.” What’s going on? What causes anxiety?

Scott Stossel: There are multiple causes. But there’s tons of evidence, there’s a strong genetic component. Just about everybody has some adaptive predisposition to experience, have a fight or flight response to have a fear response. But there are some people, who because of their genes, are born with what psychologists call it, temperament that is more highly reactive.

It’s literally, that their DNA and codes for a physiology that is more high reactive. Those people … You can detect it in babies. You can often tell the ones that are going to grow up to have anxiety disorders because they have more exaggerated, what’s called startle responses. If you make a loud noise or flash a light at them, you can see their heart rate increases more, or they sweat more, they have electric conductance in their skin is greater. It literally is, it’s something that you can’t control it, it’s deeply, deeply wired in and scientists are starting to look at the various clusters of genes that lead to that.

Some people are just born with a ready predisposition to be anxious. But then on top of that, there’s the environmental factor. There’s also tons of evidence that, and this is where Freud was wrong, early childhood experiences have a profound impact on your psychology and your mental resilience, psychological resilience for the rest of your life.

So, people, kids, and adults who are exposed to trauma, it changes your brain chemistry and even your brain structure in such a way that this is what PTSD is. You’re now much more prone to anxiety and depression, panic attacks. It’s a gene environment interaction. There are some people who are born with such an anxious predisposition that even small stressors are going to send them into spiraling anxiety or depression and make them develop a disorder. There are other people who are going to be much more resistant to it, but even those people, most of them, or many of them anyway, if exposed to enough trauma; war or something horrific in childhood will develop the elements of an anxiety disorder.

Then overlaid on top of that, as we were talking about earlier, there are the cultural and social level stuff, are there certain cultures or periods of history that are more anxiety causing than others? I think the evidence suggests that there are. But I think the strongest contributor by far is your jeans. Some people just have the misfortune to be born highly anxious, and some people who are born more serene. But as with all human traits, then environment plays a role too.

Brett McKay: Yeah, well, you talked about even your own family anxiety seems to run in your family.

Scott Stossel: Yeah. When I was both in my therapy, but as I was researching the book, I was trying to figure out, well, what is the source of my own anxiety? My mom, super high warrior, had a lot of phobias, which I got from her, that I get them from her by watching her because I learned them from her from environmental or is it genetically encoded. Then her parents both had worrying personality traits. Her grandfather, my great grandfather, had struggled terribly with what they then called anxiety neurosis. Was institutionalized in psychiatric hospitals many times.

Again, he had a very successful career. Was a smart, accomplished guy, but that would just get completely incapacitated by his anxiety, would have to go to the mental hospital and get electroshock therapy to get his brain reset. I’ve got other relatives who struggle with this. Studies show that once you have some number of anxious people in a family, you’ll find many many more. Is that transmitted by environment? Did I learn it from my mom, from watching my mom, from watching my grandparents? Maybe, or was it transmitted through my genes? Well, probably that too and you can never completely disentangle them.

Brett McKay: Well, you’re going back to that idea that you brought up that for men anxiety can be like a slap in the face because if you have it, you’re a coward. But we were talking about Navy SEALs. Some people are born with a predisposition to be very anxious, but some are born like they’re just water off a duck’s back. Navy SEALS, they’ve done research on them where they found they actually have a genetic predisposition to be hyper resilient, even in super stressful situations.

Scott Stossel: Exactly. I was fascinated by that study. Navy SEALs are a really interesting study because they’re such extreme human specimens. To get to the point where you get through Navy SEAL training, it’s like you must be incredibly physically fit. Then they put you through these physical hardships, like sleep deprivation and incredible hardship.

The physical part is hard enough, but these guys, they’re able to withstand almost a form of torture, that would cause me or many other people to just break down. There’s a guy at Yale who was studying, what is it that makes these guys so resilient. He would take, I think it was from their blood samples, measuring different neurotransmitters in their brain. He found that the Navy SEALs who succeeded in doing the Navy SEAL training, had unusually high levels of something called neuro peptide Y. Basically, if you have a high level of … They could actually predict in advance to try to determine cause and effect. Finishing the course gives you a boost of confidence or something that causes your neuro peptide Y to rise or do you have a natural baseline level of it?

When they looked at these people in advance, they could almost predict how they would do on the test by their levels of neuro peptide Y in advance. And there are other studies that show that neuro peptide Y, your levels of that are genetically determined, or at least partly genetically determined. Which to me is powerful evidence that your level of psychological resilience is conferred by your genes, which allows you to produce this neurotransmitter that makes you unusually psychologically resilient. But what psychologists are now really interested in studying and in the military too is, how can you cultivate this in non-genetic ways? Many of us would benefit from being more resilient?

There things that we can do through therapy or through life experiences that boost our levels of neuro peptide Y, or that create the psychological structures in our head that are associated with neuro peptide Y and that make us resilient and resistant to anxiety, traumatic stress, that kind of thing. It’s really promising area of research. It’s basically focusing on the people who are the least anxious and figure out, how can we use what they have going for them both in terms of how they think and what’s in their brain to treat people who are particularly non-resilient or highly anxious?

Brett McKay: Well, let’s talk about the history of treating anxiety. You mentioned earlier, right now, there’s a lot of promising research, and studies have shown that cognitive behavior therapy can help mitigate or help people manage their anxiety. But besides that, what are some of the other ways as far as therapy goes, and we’ve used to try to treat anxiety disorders?

Scott Stossel: Well, so these days, there’s cognitive behavioral therapy. There’s more traditional talk therapy. CBT is a form of talk therapy. Bu [inaudible] when you think of from the movies, which is just talking to a psychiatrist, or psychologist or a social worker, or a therapist or some other kind of psychodynamic therapy that’s called. There’s a lot of evidence that just, talking to someone who listens sympathetically to your problems, has some training, both helping you solve basic life challenges, but also helping you resolve childhood issues. There’s some evidence that that works.

Then there’s medication. Going back, really millennia, if you read the ancient Greeks or even Hippocrates, the most original, most famous doctor in history, talks about how wine can treat anxiety. For years people have been using alcohol and opium and things like that to medicate anxiety.

Just going back 100 and some years, there have been waves of different things that have been used to treat particular anxiety and then anxiety and depression. Way back at the turn of the 20th century, you had barbiturates and other sedatives that were used to treat anxiety. Then around mid-century, you had the dawn of what are called the benzodiazepines. That’s valium and librium and these days you have Klonopin, Xanax, [inaudible] even Ambien that work on your set of neuro transmitters in your brain called GABA that basically calms your brain down. That can be very effective in treating anxiety, but very dangerous too in terms of it’s addictive potential and the tendency to form habit and dependency.

For depression, there have been different waves of drugs. There was the wave of what they called the tricyclic antidepressants. Tricyclic describes the structure of the molecule. These were things like [inaudible 00:30:18]. Then in the ’80s, you had the first, what’s called the SSRI, Selective Serotonin Re-uptake Inhibitors. The first one and most famous one is Prozac. But these days you got Prozac and Paxil, and Zoloft and [inaudible] and Lexapro and a whole bunch of others in that category, and related ones too that affect, serotonin and norepinephrine.

Basically, all these drugs work on different sets of neuro transmitters to augment their levels in the brain in ways that we still don’t fully understand how they work, but seemed to have some efficacy in reducing anxiety and reducing depression. I’ve taken a lot of these drugs myself, and some of them seem to work and some of them don’t. Some of them have terrible side effects.

The depressing thing about a lot of this is that, a lot of these doesn’t work. It takes a lot of trial and error. Therapy can be effective, and I would encourage anyone who’s suffering with these things to seek out treatment, because it can be a lifesaver. But it can sometimes takes a few tries to find a therapist that you like, or medication that works. If you look at the long term evidence, really, it’s like a third to a half or something of any treatment works. It’s not always clear why the thing that’s working is working.

That’s why CBT has the best evidence in its favor, and it also has in its favor, since it’s not a drug, it’s not addictive, it’s not dependency forming, and ideally, you can learn the skills from CBT and take them with you through your life, keep practicing them unlike if you’re on a drug and it works, what happens if you go off the drug? Sometimes you can have withdrawal issues.

Brett McKay: I think you brought up an interesting point that anxiety sounds like it’s something that you’re never going to be cured of it. You’re always going to have to just manage it for most of your life.

Scott Stossel: I would love to be able to be cured of it. Some of the time with 10% of my brain hope to achieve like complete serenity. Not that there won’t be things that scare me or that I worry about legitimately, but it’s not something that plagues me. I think, some people they get really … The one thing I didn’t mention is mindfulness practice. These days, there’s tons of evidence that various meditation skills and practices and other forms of mindfulness really can help confer the kind of resiliency and calm that say neuro peptide Y does in these Navy SEALs.

In my therapy, I’ve tried a combination of CBT with trying to do meditation stuff. I think it is, and you’re not cured, you’re always going to have your underlying genetics. If you’re a high reactive person, someone who’s prone to be nervous about things, that’s probably always going to be the case. But you can reduce the amount of it, and as you say, you can learn to manage it with different sets of skills for whatever kind of therapy you’re using, or to manage it with medication or to adjust your lifestyle.

Sometimes, if you’re anxious or depressed, that’s your body and your brain telling you something’s not right in your life and you need to make some changes, and sometimes having a better lifestyle. All this obvious clichéd stuff that people tell you is true. It’s really important to get sleep. For me, if I’m under slept, my anxiety goes through the roof. It’s for me also, and tons of studies support this, regular exercise. These are basic things that don’t cost anything, you don’t need insurance for. But in modern life, it’s sometimes hard to work out regularly, it’s hard to get a good night’s sleep when you’ve got deadlines.

All these things, if you do them all, you can actually minimize the effect that anxiety has on your life. There’s always going to be, for me, there’s things that erupt that cause my anxiety to spike. But when I’m doing well, I can both have those spikes be fewer and farther between and also when they happen, manage them better and not have them suddenly spiraling off the rails or over medicating myself. It’s a long winded way of saying yes. If one can learn to manage them and if you could do that, then you can live a pretty fulfilling and rewarding life that’s not the constant misery that anxiety can sometimes be.

Brett McKay: Right. I think that’s hopeful. Because there’s a strong genetic component to anxiety. People who have that problem and they’re listening is like well, crap, I’m hosed. That could be the approach or it could be like well, okay this is the thing, I got to work with it. It’s not great, but I can manage. There’s things I can do.

Scott Stossel: Yeah. I’ve ever talked to my therapist when I was learning about my great grandfather and all the terrible troubles that he had had, and then multiple hospitalizations. I was thinking, God, he reminds me so much of myself, and I have his genes, and I’m doomed to this. My therapist was like, “First of all, he’s your great grandfather. You have a tiny fraction of his genes. And second of all, there’s medications that we have now that he didn’t have access to that can help you. There’s just lots of stuff that you can do. Yes, genetics is powerful, but you’re not doomed to your genetic fate. We can learn to cultivate resilience.”

A lot of the therapies that are effective, like I say, behavioral therapy just in general, facing your fears. It’s easy for me to say this, and sometimes hard for me to do. But if you have specific phobias, like fear of flying or fear of public speaking, the more you do it, the easier it gets. That’s a simple lesson, but it’s true. For me, sometimes those things can be so anxiety producing that I can’t do them, and then I feel like it’s a setback and my anxiety gets worse. But what my therapist is always telling me, is get up, persist, do it again, and you will get better.

Brett McKay: Right, exposure therapy, I think that-

Scott Stossel: Exposure therapy, exactly. If you have a fear of heights, they’ll take you up on higher and higher buildings. Sometimes these treatments sound kind of extreme. If you have severe claustrophobia, there’s actually therapists who will put you in a coffin. You have horrible anxiety but then you just wait it out and you realize I didn’t die. I’m okay, I can manage it. It was just a really unpleasant emotion.

For people with flying phobia, there are pilots who will take you up. A lot of airports have programs where you can go and get walked around the plane by a pilot, explains how the whole thing works, and basically little by little, expose yourself, sit in the plane and then go on a short plane ride. Eventually, hopefully you can be flying to Europe without being completely miserable, as I’ve sometimes been on international flights.

Brett McKay: I think that’s an important point for parents who might have children who are hyper sensitive or super anxious. Oftentimes, when you’re a parent, you’re like, “Well, I just don’t want my kid to freak out. So, I’ll just avoid the thing that causes them lots of anxiety gets them worked up. Rather, the better approach might be well, just slowly introduce that thing over and over again so they don’t get scared and they’re not scared or it doesn’t worry them anymore.

Scott Stossel: That’s absolutely right. I think that’s really important. What I’m about to say may sound paradoxical, but it’s not. If you think that there’s all kinds of evidence that suggest that if you think your kid might be developing unusual level of anxiety, it could be a clinical level of anxiety. The evidence says, the earlier you can get help and get them therapy, the better outcome they’ll have, the less likely they’ll be to suffer anxiety disorders as an adult.

Early interventions to keep, but early intervention doesn’t mean sparing them from anxiety. What almost any therapist today would tell you is actually, and this is the antidote to helicopter parenting, don’t try to do everything for your kids. Don’t try to spare them the unpleasant experience or the thing that’s making them nervous in particular, if it’s being anxious about going to school. I know how hard that is, both having been a very anxious kid and now being a parent who has anxious kids, it’s incredibly painful and hard to watch your child suffering and feeling nervous. Everything in my body wants to be, I just want to take him out of that situation so he’s not nervous.

But every therapist I’ve ever seen says, “No, no, you have to let them, within reason, experience the anxiety and learn that they can overcome it and that’s how they develop resilience. Don’t do it for them. That’s how you’ll helicopter your parent, your kid into being a helpless, neurotic 22 year old who can’t make his own dinner.

Brett McKay: Right. What’s the state of your anxiety today? You’ve said you’re doing cognitive behavioral therapy, some mindfulness meditation. Are you taking medication?

Scott Stossel: I am. I’m still really bad at the mindfulness. I think it’s one of these catch 22s that the people who benefit from mindfulness and yoga and that kind of thing, meditation the most are the ones who are worst at it, because my thoughts are always racing, I have a hard time sitting still. But I’m trying that, doing CBT with a really good therapist, and that’s helped doing exposure therapy, which is really unpleasant. But I think does help, and then yeah, I am currently on Lexapro, which is one of these SSRI medications.

Then I take a medication called gabapentin, which was originally an anti-seizure medication, and a medication for pain, but has shown some effectiveness in treating anxiety. And then, I used to take a lot of benzodiazepines. I’ve now tried not to. They work incredibly well for me. For me, that was always my magic bullet. I knew I could always survive if could have access to enough Xanax.

The problem is it worked a little too well. The danger is, I started to become too dependent on it. The more of it you take, the more you need to take in order to get the same effect, and it can be very dangerous. People become dependent on it. I’m trying not to use that now. It was pretty widely prescribed by both psychiatrists and just-

Brett McKay: Just family doctors.

Scott Stossel: Just family doctors because it is so effective. But there’s also a pretty big school of thought out there that’s like, they really shouldn’t be prescribing it so widely because it can be, in certain people, very addictive and dependency forming.

Brett McKay: I imagine, in all you’re doing things like getting enough sleep, exercising, managing stress, reducing that when you can, et cetera.

Scott Stossel: Yeah. I don’t know why, but for me, getting regular exercise it’s like night and day. My wife can even tell if at the end of the day I’m on the phone, she’ll be like, “Why don’t you go work out.” I’m like, “Why?” She’s like, “I can just tell in your voice that you haven’t.” It’s like my personality changes somehow. You don’t always feel like working out, there are some people who just don’t exercise at all. But for me, forcing myself to work out even when I don’t feel like it, is just so good for my state of mind and good for my physical health as well. That’s true for just about everyone.

Brett McKay: Right. I imagine, that there’s someone’s listening to this podcast, they’re struggling with anxiety, best advice, go get help, go talk to somebody. There’s things you can do to help manage it. You have a flourishing productive life. Like yourself, like you said, you’ve struggled with this your entire life, but you have a good career, and you’re doing a lot of great things.

Scott Stossel: Yeah. There are a lot of ways you can get help. I’m forgetting what it stands for. But NAMI, is like the National Alliance of Mental Health Initiative, or something like that, can help you find even if you don’t have insurance, can help you find access to individual therapy or group therapy or just resources in your area. If you have anxiety in particular, there’s an organization, nonprofit organization called the Anxiety and Depression Association of American, the ADAA. If you go on their website, they have a list of therapists in your area.

You can always just go to your primary care physician and they can help refer you. Any city that has a university will often have an anxiety disorder clinic. There’s lots of help available out there.

Brett McKay: Scott, is there some place people go to learn more about your work?

Scott Stossel: You can go to my website. I’m embarrassed, I’m blanking on now with-

Brett McKay: Is it scottstossel.com?

Scott Stossel: It’s scottstossel.com. Yes, thank you. I never go to it.

Brett McKay: Right. Well, hey, Scott, this has been a great conversation. Thanks so much for your time.

Scott Stossel: Thanks, man. I really appreciate it.

Brett McKay: My guess today was Scott Stossel. He’s the author of the book, My Age of Anxiety. It’s available on amazon.com and bookstores everywhere. You can also check at our show notes at aom.is/ageofanxiety. Where you can find links to resources, where you can delve deeper into this topic.

Well, that wraps up another edition of the AOM Podcast. Check out our website at artofmanliness.com, where you can see our podcast archives. We’re coming up on 500 episodes here pretty soon. You should see them all there. While you’re there, check at our articles we’ve written, got a couple of thousand there just about anything; depression, how to manage that. Personal finances, how to be a better husband, better father. Check it out, and if you haven’t done so already, please give us a review on iTunes or Stitcher. Just takes one minute, it helps us out a lot. If you’ve done that already, please consider sharing this show with a friend or family member you think would get something out of it.

As always thank you for the continued support. Until next time, this is Brett McKay reminding you not only to listen to the AOM Podcast, but put what you’ve heard into action.

Nate Wengert

Submitted by: Nate Wengert in St. Johns, Arizona, USA