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What You Should Know About Anxiety

Dr. Libby Brown discusses symptoms of anxiety, the different types of anxiety disorders, and treatment options available.
What You Should Know About Anxiety
Libby Brown, PhD, PsyD
Libby Brown, PsyD is a Licensed Clinical Psychologist who earned her bachelor’s degree in Occupational Therapy from the University of Texas in 1975. She graduated from the University of Evansville in 1984 with her master’s degree in Counseling. Libby earned her PhD in Clinical Psychology from Spalding University in 1994.

Learn more about Libby Brown, PhD, PsyD

Melanie Cole (Host): If you’re like me and you experience stress; you don’t always know the best ways to help yourself and to get rid of some of that anxiety and stress the you feel; but there are ways and my guest today is Dr. Libby Brown. She’s a clinical psychologist at Deaconess, The Women’s Hospital. Dr. Brown let’s start by talking about some of the negative physical consequences of stress, particularly on our hearts and what can it do to us, really?

Libby Brown, PhD, PsyD (Guest): Well, you’re jumping right into the area of fear that a lot of people have when they are anxious and that is what is in their body. So, when you have the – you have symptoms of dizziness or you have heart palpitations or you feel your muscles are pinched, you’re nauseous, you have a dry mouth; a lot of that kind of numbness, those things are your body’s reaction to what it is considering to be a fearful situation.

As you tune into your body and you are aware of those symptoms; you really do begin to feel like there’s not a mind body association; it’s just body. And if it continues long enough, you can be convinced you are having a heart attack. So, there’s kind of the acute stages of it and many people go to the ER and discover that they really weren’t having a heart attack, that they were just having a panic attack.

When you have those symptoms on a chronic basis; then they really can begin to set you up for chronic migraines or maybe irritable bowel. You sometimes end up with – you will have kind of a heart flutter. So yeah, if they are chronic, they can affect you in a way that it sets you up for more chronic types of disorders. But most people are having acute situations that feel chronic.

Host: So, are there different classifications then? Because you said if it starts to be chronic or you have these panic attacks; do you classify anxiety and stress in different ways based on how severe they are?

Dr. Brown: Well I think we have different categories of anxiety. And one of them, more chronic is one that you hear is generalized anxiety disorder. And that’s something that’s just been with you for most of your kind of thinking life where you just felt like that you always were excessively worrying about something, that you seem to have a tendency toward unrealistic fears and people keep trying to talk you out of them. But it’s just a pervasive sense that things are uncomfortable to you.

Some people will have a social anxiety. They really like to stay home more because in social settings, including schools and work, you can feel overwhelmed and have kind of an excessive worry. A worry that people are going to ridicule you, so you are seeing yourself in a negative way. When you have phobias, that’s another area that people talk about anxiety and although it seems like we use them almost in fun when we talk about a fear of spiders or a fear of being closed in places like elevators or people tend to almost make light of, or a fear going across a bridge, to the person that’s experiencing them. This is very intense and so they seem to be quick to react to even the thought or the idea or a trigger of some of their phobias.

Then you have what we also talk about and I just made reference to which is the panic attacks. And that really is when your body, your whole body goes into what it thinks is a heart attack. So, those are kind of the overall categories that someone looks at. And then we just talk about anxiety. People just talk about anxiety, they are anxious about this, or anxious about that and what I like to help differentiate at that point is, is there enough anxiety there that it may fit some of those categories to help me understand the person or are they kind of using the word anxiety instead of the word worry. And I feel like a lot of times we kind of use the bigger word for something that everyone does every day. We worry about things a lot. But our society tends to say they are depressed or anxious in a very comfortable way when they are actually big diagnoses if they are with you all the time.

Host: Are there some other causes like menopause? Can those kinds of things cause anxiety? And in which case, because I’d like you to really speak about treatments, because I think that that’s what listeners want to hear is what can I do if I’m somebody who worries all the time or who is anxious all the time. But are there certain environmental or hormonal factors that can play a role in anxiety?

Dr. Brown: Well, yeah you are kind of going in two different directions there. And one is, how much of what we are reacting to are environmental factors. If you had stress upon stress upon stress especially greater than six months where it just seems like things just keep coming and the old adage things come in threes, well suddenly you feel like they are in multiples of threes and you’ve got all these months of you had something at work happen, you got into a financial situation, you had a wreck. You can go on and on and those are situational, and they feel environmental.

And then you do have bodily time periods. I mean hormones are big. They really do end up with the whole endocrine system can in response to your question, yes hormonal things can make you feel a lot of anxiety. But where it really comes down to in going to your question of treatment; we can spend a lot of time on the why is something happening but talking about what to do about it rather than focusing on the why and that’s where you realize that you can override some of your triggers that make you feel so anxious. And in trying to override the sympathetic nervous system; where you think your body thinks that there is something that is making you want to run away, flee or turn around and fight. And if those two things don’t work, we tend to freeze. And when we’re frozen, that also is where we are just almost paralyzed in a fear where you can’t think, you can’t hardly move. You are just kind of stuck.

And in being aware of the thoughts that you are then having, that tend to perpetuate the way that you’re feeling. A lot of people don’t make the connection of what their thoughts are in terms of is this a catastrophe or is this an inconvenience. Am I truly being watched and judged by everyone in the room or is that kind of my nervousness and need for acceptance. Am I comparing myself to everyone and if so, why am I comparing myself in a negative way.

So, assumptions and thought patterns often help trigger or at least maintain the anxiety once it is triggered.

Host: So, then how can we deal with it, talk ourselves out of it, get help for it? What should we be doing when we feel those bouts of anxiety?

Dr. Brown: Well it depends on what part of the circle that you kind of step into. Sometimes, we’re stepping into just being aware of the body side of things and sometimes we step into it in the mind side of things. And so you have kind of different – you have a lot of different things you can do. Some people if you listen to them; they are telling you what they’ve always done that’s made them feel better and so if you are just listening to general conversations; you may hear that someone has always loved movement. They like to dance, or they liked running or they played sports, or they tend to, if they get restless, or somewhat anxious, they move. Sometimes we forget that because we are over here in our head thinking about anxiety and we are not paying attention to what we’ve always done when we weren’t feeling well.

So, sometimes connecting you back to where your source is that you naturally went to. Children are really good to watch because you kind of see some will go towards art, they just want to draw something or make something, and some kids are moving. And so even before they know what they are doing; they are naturally doing what works for them. And as adults, we need to tap back into that a little bit.

If you are someone that kind of tends to go toward thoughts and you do words, you like to read, you like to talk, when you are upset, you get on the phone with someone. You distract yourself with a movie. Those are things that if you do those anyway and then in a state of anxiety you can tap back into those things but with purposeful intent.

So, there’s a whole group of – well there’s research around cognitive behavioral therapy and that term is used quite a bit and it’s really – it’s basically saying pay attention to your words. Look at categories and then see if you can purposely choose something else besides the thought that you have. So, you begin to make an association between when I feel this way or when I’m this upset; these tend to be the ways that I’m thinking. And to slow down and to do that.

Sometimes people will do it naturally with friends or they’ll read books, or they’ll go to a therapist. The other part of that is if you really are uncomfortable with sharing a lot of words then I really will ask people to purposely try to work on breath work, anything that makes you take deep breaths, anything that you kind of get your mind distracted and your breathing under control will turn off the switch that flipped on the sympathetic nervous system which is telling you to fight or flight. So, getting you back into a body and mind connection that you are actually in a safe environment and you are actually in control of it.

And those things take practice. And we are very impatient. We don’t want to really have to practice. We want someone to tell us well just change your thoughts or change your movement and I’m going to feel immediately better. And if it was as easy as one time learning, then I would be a concert pianist or a great tennis player. We’re very intolerant of having to work on something that we want to go away so fast. So, it helps to kind of have a teammate to encourage you yes, we are going to walk every morning, or we are going to start playing tennis or we are going to workout together or to talk with someone that really can interrupt you when you go off on a tangent. Because the more you let your mind go toward things it’s worrying about; you’re actually reinforcing it and so stopping it, interrupting it and categorizing it is one way to keep it from escalating and to quit accidentally reinforcing the very things that you’re anxious about.

Host: Wow. What a great description and I was writing stuff down. That was so important what you were just saying about how we can turn it around, look to something else and the things that we can do and the buddy system. Now before we finish, when does medication come into the picture? Whether it’s Prozac or Xanax and what about herbal remedies? Do you like any of those to help with our anxiety?

Dr. Brown: I really believe that we are very fortunate at this time in history that we have discovered the benefits not just the disadvantages of at times in life, using medications. They usually – depending on the person, they could have a stigma, or the person feels like they’re failing if they have to use medicine, like it’s a self-worth thing. Like I should have been able to pull myself through this. What is wrong with me? I’ve been taught to pull myself up by my bootstraps and just go through it.

So, medications, if the person is willing to try them, they also have to change the perception or the stigma that this is a bad thing and I have just failed and so I’m giving in to medicine. Because for some people, if you’ve had a lot of things happen, or you find the quality of your life is being affected on a daily basis and you’ve done what you think is everything right; I’ve started working out, I have a personal trainer, I’m aware, I’m reading all the inspirational books, I’ve gone to the bookstore and I have everything on meditation and I’ve worked on all of these things and yet I’m still overwhelmed by this; well then why not add an attempt to use medication and see if that is another component.

You always have to stay connected to the mind and the body and how they work together. And then there are times in people’s lives where the medication can assist with you being able to slow down enough to actually apply all the things that you’ve been trying so that you can be successful. So, if you can change your biology the way your head is thinking and your situational factors; you change all three of those things at one time, you will feel better, faster. But you have to go at the rhythm of the person, and you have to go with when they are ready.

I don’t start out talking to people medicine, because I don’t want it to look like oh well, just take this, you’ll be great. Because you can override any medications that you are taking for anxiety or depression if you don’t change how you are thinking and what’s going on in your environment. So, I do believe that we’re fortunate enough that nowadays you can choose different medications to help with different symptoms and that’s where some of your longer acting medications such as what you were just mentioning like a Lexapro or Celexa or Prozac. All of those are helping you 24/7 and it’s kind of helping you get back into a sense of balance and taking kind of an edge off of something.

If you are in a situation where you really are so overwhelmed and you’re breathing fast and you’re having like you really feel like you are short of breath and you can’t think very well; in a grief situation sometimes or a funeral or traumatic event or something that’s just overwhelmingly shutting you down; then that’s when we can use some anxiety specific medications that work for a very short time. So, you would take them, and they are going to kick in in about 20 to 30 minutes and they are going to work for about three and a half to four hours and then they leave. So, we do have specific medicines for specific situations and then we also want to look at the big picture, the day to day picture.

Host: Oh, those sound like they’d be good for people who are afraid to fly, like that would be something that would calm you down when you have to take a flight. Do you have any final thoughts for us on anxiety and ways that we can help prevent it or what we can do in our daily lives to help ourselves really deal with it?

Dr. Brown: I do believe that as we get older, you know children, they don’t have the ability to think about thinking. So, sometimes we need to kind of be their external brain and say the things to them to kind of begin the template so that they can learn the phrases that as they become adolescents and can begin to think about thinking; they can begin to use the self-talk messages they’ve been hearing. And then if we practice those things and we become thinking adults; the power of how you think, the power of being able to have a plan and distract yourself; those things are tools that we can really good at using.

And that’s what I would ask people to strengthen. Practice it on days when you’re not feeling so anxious. Just be aware of your thoughts. Be aware of your breathing. Not what is working for you instead of waiting to note what is not working for you. And if we begin to practice the skills of saying okay, this is not that big of a deal, everyone in the room is not staring at me, they cannot mind read. I mean I kind of use a little bit of humor sometimes myself just to practice on okay really, I’ve become that important that everyone is comparing me. You know.

The most common things we do, everyone else is doing but we think it’s just us. And so I – talking to people about how they deal with anxiety and admitting it, but also peeling back that anxiety is supposed to be a strong survival skill. It’s not supposed to punish us. I think it’s got a bad reputation. I think everyone uses the word anxiety like we want to get rid of it. And I love anxiety because it makes me get up in the morning and show up at work on time, because I’m a little worried. I like that I get my bills paid because I’m a little anxious. I like that it’s made me study for that test or prepare for that presentation.

So, we are supposed to have anxiety. That’s how we survived as a species. The hair on the back of the neck warns you of things. The concern that I need to do something makes me go out. It’s when we allow it to overwhelm us and control us that it becomes a problem. So, I don’t tell people let’s get rid of your anxiety. It’s like embracing anxiety it makes us functional. It makes us motivated but then learn how to control it. It’s like you have a racing wild stallion and at that point, it’s out of control. It’s beautiful to watch sometimes, but it’s out of control. But put a bridle and a saddle on it, train it and let it work with you and it takes you some wonderful places.

Host: Thank you so much Dr. Brown. Great information as always. What a great guest you are. Thank you for joining us.

That wraps up this episode of The Women’s Hospital – A Place For All Your Life. To schedule an appointment with Dr. Libby Brown, please call 812-842-4020 to learn more or head on over to our website at to get connected with one of our providers. If you found this podcast as informative as I did, and I was hanging on her every word, please share with other friends and family members, share on your social media because anxiety is really something that you can learn to work with as she said. So, really share with your friends and family. I feel that’s very important. Especially in these days and be sure to check out all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.