good evening and welcome to doctors on call I'm Mary morouse psychotherapist at Insight Counseling duth and I'm your host for our program tonight on Stress and Anxiety our panelists this evening include Dr Steve southernland psychiatrist from asentia and amberwing dandy Allard psychologist from the duth Psychological Clinic and Northwoods Children's Services and Josephine eids psychotherapist here in duth and now on to tonight's program on Stress and Anxiety thank you all for coming here this is one of my favorite topics something I uh I uh specialize in and um I just think it's so prevalent in this world right now it's such a topic of conversation and so I'm we got a lot of questions so I'm really excited about um uh really diving into those so I'm going to start with you Dr Sutherland um kind of a medic a medication question so how do I know when I need medication so what are kind of that Psychotherapy versus medication and and together so if you could speak on that sure when it comes to anxiety the gold standard the only thing that's Curative in an approach to anxiety is um doesn't have to come in the form of psychotherapy but anytime we um are taught or teach ourselves to face fears and learn to or teach our how to calm our bodies down often times that process happens in Psychotherapy that has a potential Curative effect we actually lay down new neurons and kind of help uh create detours and healthy Pathways and that's so medication has a different role in that um the way I would put it best I think is to say that when um the process of a of living with anxiety both the um the sense of adrenaline and tight muscles and racing thoughts and um other physical manifestations of anxiety when that crosses over with loops of thinking that distract a person from other things that they'd rather be doing or need to be doing and when those are present on let's say more days than not for a two we or longer period um and it's not responding really well to the intervention the person is trying to do oftentimes that's a time to consider medication approaches and with the medication role is a bit is different than that approach to the therapy uh which is uh the the goal with medication is to help the body regain its uh maybe re reboot or reset process so that those those circuits get a little bit of a boost if the medication's working the body gets a little bit easier time getting back rebooting resetting back to equilibrium okay and with medication is this um I'm sure there are all sorts of timelines that you can be on medications I think sometimes there's a hesitancy to go on medication because I don't want to be on this for the rest of my life so what are your thoughts on that obviously it it varies it varies yeah I mean the the main medication treatments that are effective for treating anxiety disorders are those that are daily medications the same medicines usually that treat depression for that matter um and once a person goes on those if they're helpful usually it takes somewhere between two and six weeks to know the medication being helpful once they're on that then oftentimes you look at the first 9 to 12 months of a helpful medication before you consider tapering off and that's the kind of time period we look at uh there are also such things as as needed medications for anxiety but those really play a supporting role in um let's say a person with generally stable anxiety who panics when they go on an airplane and want a dose of a an as needed medicine or something on that order okay okay great thank you so much um Dan um is sleep good cure for anxiety sleep is wonderful for lots of reasons I'm not sure it's Curative for anxiety but it might be necessary good sleep might be necessary but not sufficient to help with anxiety um anxiety requires more of our resources to cope with than a than a baseline relatively anxiety free state sleep rejuvenates our resources so to sleep well will almost always help with coping with anxiety not Curative anxiety of course can interfere with sleep and that's another matter um but yeah if you're struggling with anxiety prioritizing good sleep makes a lot of sense yeah and so for falling asleep staying asleep or waking up too early so those are kind of some of the questions I always ask so do you have any you know tips for falling asleep staying asleep or waking up to work uh certainly for falling asleep you know good good sleep hygiene makes a lot of sense you know not a lot of screen time or bright lights before you go to sleep not a lot of um food or other intake certainly no caffeine intake I think six to nine uh hours is roughly Steve the recommendation um so good sleep hygiene and try not to be thinking about stressful things while you're going to sleep easier said than done but sometimes journaling beforehand or you know having a conversation around dinner time about stressful topics but not later can help um staying asleep sleep um uh I don't know I I I think um maybe some of the same things that would work for falling asleep would help also not um staying in bed if you're having a hard time staying asleep so get out of bed do a reset come back to sleep if you're waking up a lot before you want to in the morning that could be a sign of depression sometimes that early morning Awakening could not be about anxiety so make sure you got accurate assessment there okay okay great um Josephine so um a question about uh toxic work environment and no jobs prospects so kind of being stuck in a in a not great work environment and the Stress and Anxiety with really nothing lined up if you could speak to that Josephine sure that's a really good question I think there's a lot of people who are probably feeling stuck in a position where they're at whether that's because they don't have the education that they need or whatever reason that they're feeling stuck um one of the things that I would recommend if you're feeling stuck in the toxic work environment is to at least consider you know spending some time thinking about your exit strategy doesn't necessarily mean that you're going to do it right away but sometimes we can kind of trick or coax our body into being you know what is the right word that for what I'm trying to say um you I think therefore I am right like if you're thinking about it your body's going to respond as if it's doing it so so to sit down and to create a strategy think what is my next step dream like doing all the things that we tend to forget about doing when we are under anxiety we pull in we think I can't do this it becomes a a no- win situation in our brains so to just kind of set aside all of those you know negative things that that tend to take away our reserves and make us feel even more stuck but just stop and say okay I'm going to do a reset I'm going to think to myself what is one thing I can do today to make a change in my life and it might not even be about your job situation it might not even be about work it might be about something else that's G to fill your cup it might be doing some yoga you know going getting back to tap dancing whatever it was that you used to love and enjoy and then the more you feel that the more you're going to feel like you have some um energy and uh you know some of your old self back to start looking for something else when's the last time you felt like yourself you know kind of go back to some of those things that it may have been in high school but what were those elements of making you feel like yourself can kind of sometimes be a little bit of a clue to how we can kind of improve from from moving forward exactly okay great thank you um another question so and this is kind of a a a question we see a lot or kind of this a a bigger discussion THC gummies and um uh cannabis use because it's legal now um I feel like we we have to think about it differently we have to talk about it differently than I was trained so um our THC um gummies um and uh cannabis use I hear from my clients that they use it a lot to help them fall asleep and and with anxiety we talk about that um but what are your thoughts on that Dr southernland yeah interestingly first off the the scientific dialogue hasn't really changed since legalization okay um the the scientific dialogue is the same um and almost universally people who use cannabis on a regular basis describe it as having a calming or mellowing or however the terms might be effect on their demeanor at the time um and notably when it's been studied um in good scientific methods um when they've tried to for instance say take people with panic disorder or people with post-traumatic stress disorder um real life anxiety disorders and compare um what are the treatment results when somebody tries a certain medication or Psychotherapy or or cannabis or some blend of different things there's there's zero scientific evidence that cannabis treats anxiety disorders it was a really interesting decision of the State Medical uh cannabis committee to add post-traumatic stress to the list because there's almost no scientific evidence that it helps so what we're left with is like a lot of things where science doesn't provide the answers is people's individual reports they'll just say I feel this way when I take this thing and and that's where we're at but we don't there's no there's no real scientific evidence to support that that there's a there's a Rec there's a role for us to say recommend um that the cannaboids as a treatment for anxiety related conditions and can it increase anxiety yeah it certainly can uh it there's all kinds of ways in which um cannabis when the metabolites build up in the body can interfere with things range from our digestive systems to the way our stress hormones respond to stress um and so yeah then we can sometimes see that compounding effect of increasing anxiety okay okay um so um Dan how long should a person struggle with anxiety before seeking help and I think that that's kind of a good kind of overall question of when um you know when is anxiety uh how to distinguish between protective anxiety and problematic anxiety yeah so anxiety is part of living so we're always is going to have some form of anxiety or stress when to seek help it sort of depends on what how you define help um sometimes Psychotherapy is the help sometimes medicines to help but sometimes your own decision about who to talk to when or how to structure your day or what new challenges to take on so I think you want to try to do a pretty thorough job of exhausting your own resources to figure out what's stressing me out what's causing anxiety what can I do about it who can I talk to about it in my own life if those um efforts aren't successful and if you find that your Stress and Anxiety is impairing the sort of life you want to have it's your sleep your relationships your work your academics that's probably a good signal I've tried what I can do and it's still impairing I think those are good markers okay great great um and is there any difference you know between um like the age like eight from Little Children um knowing when to seek help from a parent perspective when do I seek help for my for my child big question versus kind of this young adult adult and then also kind of this elderly population do you see any any differences or any way you would kind of tweak some of those that's an excellent question as with most parenting matters parents sometimes have to be the Judgment for kids and that's true about anxiety so again if you you know you've helped your child try some usual things that might help if this person bothers you see if you can get your seat moved in the classroom that sport is stressing you out maybe we can can switch Sports you try to do those things but again if they don't work and they're impairing then maybe it's time to seek help you know for older folks of course they have their own independent judgment about it but again is it impairing is it getting in the way of the sort of life you want to live and you've tried things and of course what they can try is different than what uh real young people can try so I think the principles are the same but how you apply them across the lifespan obviously differs okay if I could add in to that too um we've seen an increase in this since Co hit um three and a half years ago or is it almost four years ago now yeah uh um in that school avoidance yes is uh more prevalent now than ever and you know anxiety and avoidance have always been in The Human Condition a natural pairing right the the what's famous is that anxiety or fear causes a fight fight fight versus flight response but there's also avoidance is like is a natural human instinct in response to anxiety and so there's a lot of there's more and more kids that than ever that are saying I can't go to school I'm too anxious the place makes me anxious Etc and that's one of the ones where as Dan was saying the parent Direction about saying listen I believe you you're anxious and there's no way that anxiety gets the final vote about whether you go to school or not yeah you know we're there for you 100% we're going to try to help you with that anxiety but it does not get to tell you where you attend or where you don't attend and what you get to do and oftentimes parents struggle to get into that um role because they uh they feel like they're there to support their kid and it feels sometimes almost punitive parents describe uh trying to get a kid who doesn't want to go to school to school for instance so that's just another angle on that question to a parents needing to be directive yeah absolutely and that you know kind of goes to that whole um you know with Co with all the kids that there was no uncomfortableness for the kids they could watch online school with the screens off laying in their bed taking a nap you and so all of a sudden going back to school became very uncomfortable for a certain set you know I my my as a like a overall general rule my introverts loved um uh online school and my extroverts were the ones in my office and then when they went back to school it flipped uh more or less that's obviously very you know very very general but you but that kind of that dealing with this uncomfortableness and things I there wasn't anything we could do so there weren't a lot of things that people had to do and so I think that that has kind of gotten into um especially with school age kids it's tough before I move on last piece absolutely just because I you know I am a a mom of a new baby and I think sometimes a a segment that gets missed is that postpartum depression is something that people are talking about a lot more but a lot of women don't realize that postpartum anxiety is also a thing and um you know when you have a young baby right you have a lot going on and so it's normal to have a certain amount of anxiety it's normal to have a certain amount of feeling of overwhelm and like oh my gosh I'm drowning I can't do this and you know I think a lot of times people will will miss the fact that oh this might actually be a clinical like I I might be more anxious than I need to be um and so just to kind of put that into people's minds too of like if you're feeling really where it just feels like it's too much you know talking to your doctor about potentially getting a referral or um you know reaching out to your friends psychotherapist somebody just don't you don't have to struggle alone with that and it is a thing M absolutely you're right I think the postpartum depression and anxiety is is not talked of about enough so thank you for that yeah um so uh Josephine um continuing with you some good coping mechanisms for dealing with stress obviously it kind of depends but just kind of overall what are your um I know I'm asked this a lot a lot right it's one of the big questions we get is how do I deal with it yeah yeah yeah I know I have it now what yeah like how do I how do I cope with this what do I do um and and you're right there it is it is is dependent on what's happening in your world it's dependent on if it's um you know just a normal level of Stress and Anxiety if we're talking you know we're we're at a panic level what you're going to use is going to be different you're going to have a whole set of tools and some of my favorites are um I like to talk to my clients about um we're going to we're going to hit anxiety um from a two-pronged approach you know we're going to look at reducing your Baseline anxiety because that's going to help your overall ability to be resilient and and to cope with it so we're going to do things like looking at daily routines how can we change your daily routines um yoga is a huge favorite of mine I'm a daily practitioner well I used to be before I had the baby I gotta get I gotta get back to that you'll get you'll get there you'll get there and that's I think also something to you know to if you're if you're beating yourself up about not doing the thing that well I used to be doing well you know what you can always get back on the horse because even even therapists take breaks from being really good about their mental health but um so doing things like your Your Daily Yoga routine mindfulness running like whatever it is that is you know your um you know whatever is your your your flavor um you know and find that that daily thing that you can do um even three minutes of mindfulness like a lot of people will say I I don't have time I can't do it um it's too hard to carve out that time I know I have two young children so I don't I don't know I don't have a time like where am I supposed to find that okay so I have 30 seconds I'm waiting at a stoplight instead of like running through my mental list of everything that I have to do when I get home I can take those 30 seconds and just be present I can breathe I can I can use my five senses I can you know listen to my daughter as she's talking to me and telling me about her day instead of kind of tuning out or saying uhuh like I can be in the moment and that is I think really good so all of those things are sort of like that General um you know reducing your Baseline and then there are things that you need like in the moment right I'm having a panic attack I'm I'm experiencing an intense level of fight or flight my body is you know and then what do I do right because you got people around you that are telling you just calm down it's okay you're fine that never helps by the way don't do that don't never say calm down never say calm down to a person who's who's who's having a panic attack it's not GNA work um but what you can do is just in that moment like feel your feet on the ground again like that is a favorite of mine in a panic attack like if you're you know if you don't have medication that's helping you if you're just experiencing this for the first time you know take a minute to just like use your vision just zero in on something just describe to yourself what am I seeing right now um you know what am I smelling what am you know what what what what can I feel what can I hear and just you know again ground yourself in the present moment and that can help kind of take down that that level of panic also Four Square breathing is a favorite of mine taking a deep breath in and Counting as you breathe in to four holding it for four breathing out for the count of four and then holding out for the count of four and all those things are just going to help you to reset your nervous system and then of course there are other things that you can do like when things are more chronic like if you have like more stress in your life than you're able to handle um that's a time where you know you might want to partner with a therapist and do some things like um the safe and sound protocol which um kind of works to use music to help your system sort of reset and feel safe um you know brain spotting like any of these other things that therapists can be trained to do to sort of help you get in a place where you can attack it with all these other coping skills and use them better more effectively and and thank you and and the the goal is not elimination it's it's it's management it's get it back to the level where it's working for you not against you and I think I people come in say I want to get rid of my anxiety it's like let's talk about that're exactly you wouldn't be here yeah you don't want to you do not want to get rid of your littleit because you'd be dead we want you to have you know a little bit of I always say you know like I I'm glad you're you had just the right amount of anxiety because you showed up here you know three minutes before the session perfect nailed it that's the kind of anxiety we want I have to get there on time so I'm not late but I'm not you know yeah but not I'm showing up a half hour early to we might be need yeah I'm G to tweak that a little bit um so um risks and benefits for taking ssris for for Stress and Anxiety yeah the same rules risk and benefits the same rules apply to depression and anxiety which is convenient the the the risks um have to do with the common nuisance uh side effects of at least temporary stomach upset uh sometimes there are people eight out of 10 people can just basically choose what time of day is easiest for them to remember but one out of 10 might get a cup of coffee effect that means they they'll have to be a morning person one out of 10 will get the opposite effect and be sleepy and have to take it at night um and then there's the scary looking side effect of suicide warning which fortunately there's uh evidence shows that only 2% chance so two of 100 chance that a medicine would cause an increase in suicide thoughts but it's on the label as clearly the scariest thing so those are some of the U there's other quirky side effects like increase in yawning or a change in sweating habits and some things like that that can happen some people that they would consider a nuisance but not a reason to not take the med the pros uh get back to what I was saying earlier about um your body's capacity to um return to equilibrium to reset or reboot um once stuck in a state of sadness and the thoughts that go with it anxiety and the loops that go with it irritation and the frustration that goes with it your body's ability to exit those Loops um can improve as that's the perhaps the biggest noticed benefit from taking a medication when it works and you mentioned earlier a lot of these medication anxiety and depression and there's a lot of times anxiety and depression co-occurring so do you see that sometimes these medications and and also that's just kind of a bigger question of you know of of anxiety and depression co-occurring and how to kind of parse that out and treat that and deal with that yeah I there are some studies for instance that show that 80% of the time it's impossible to tease apart which part of their stress that day that person stress is from anxiety versus wi is from depression it just it is it's integrated 20% of the time can be distinct egg yeah yeah right yeah um just about a minute left here but um Dan what are the long-term risks or harms of of stress over a long period of time so um our bodies are designed to um sort of have a burst of stress that we're effectively problem solved for and then recover from chronic stress just overtaxes our body in so many ways and it affects our sleep and our mood and our appetite and our ability to think clearly so um there's systemic effects from chronic anxiety and so what we've been talking about here are ways to interrupt that so that you have episodic controllable stress addess that you problem solve effectively for it remains a signal that you respond to effectively rather than something that's a signal that's always on and just um keeps your body too aroused it's it's it's too elevated hence the um you know the the you know this the social media or being kind of having all this information coming at us it's more than our bodies were really designed to from a stress perspective social media is diabolical it really activates us far too much yeah and so that's one of the things I say do more of what works and less of what doesn't if if if the if the social media is stressing you out or the media is stressing you out do less of it you got it I want to thank our panelist Dr Steve southernland Dandy Allard and Josephine eids please join Dr Ray Christensen next week for program on eye problems cataracts glaucoma and macular degeneration thank you for watching good night