Disability and Progress-May 29,2025-Anxiety!

[00:00:00] Speaker A: KPI.org SAM. [00:01:00] Speaker B: This is KFAI 90.3 FM, Minneapolis, and kfai.org this is disability in Progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the host of this show. Thanks so much for tuning in. Charlene Dahl is my research person. Hello, Charlene. [00:01:18] Speaker A: Hello, everybody. [00:01:20] Speaker B: Erin is my podcaster. Thank you. As always. Erin, we want to remind you that if you want to be a part of the show, give some ideas of concepts or topics we feel you, we, you feel we should cover, you can email [email protected] that's disabilityandprogressamjasmin.com as always, we thank you for listening and welcome you to be on our email list. You can also email at the above email disabilityinprogressamjasmin.com this week, something that we all seem to experience time and again, sometimes more than others, anxiety. Dr. Barnes is with us to talk about that anxiety. What is it? And doesn't everyone have it? Thanks so much for being with us. Dr. Barnes. [00:02:14] Speaker A: Hi. Thank you for inviting me. It's great to be here. [00:02:17] Speaker B: Can you give us a little, a brief history about you and how you got to where you are? [00:02:25] Speaker A: Yeah, absolutely. I grew up in North Dakota, Jamestown, North Dakota. [00:02:30] Speaker B: Oh, my gosh, I know that place. [00:02:35] Speaker A: There's the Ann Carlson School up there. That really influenced my career choice going into pediatrics. So I came to Minnesota for medical school and for residency in pediatrics. And then I did an additional three years of training after that in developmental behavioral pediatrics, which is part of what I do now is see kids with autism spectrum disorders, attention deficit hyperactivity disorder, mental health, and behavioral health conditions, and the overlap of all those things. [00:03:09] Speaker B: Great. Well, thank you for that. And let's start out just by talking about what anxiety is. [00:03:18] Speaker A: Well, it's a good question because it. [00:03:21] Speaker B: Feels so broad, doesn't it, territory, you. [00:03:24] Speaker A: Know, because we think about words like fear, worry, anxiety, and we kind of lump them together, but they probably mean a little bit different of things like worry. We think of as like the thought process of thinking about things over and over or thinking ahead into the future. And a fear is kind of like that phobia or something where we have a response in our body that makes us, you know, like fight or flight, run away or try to, try to, like, get away from the problem or, you know, fix it. And that's, that's like a fear reaction. And anxiety is like the bigger, probably bigger picture of Kind of feeling not, not at ease, feeling uncomfortable because we're uncertain about what's going to happen. [00:04:12] Speaker B: Ah. So I still feel like there's such a crossover with fear and anxiety. You know, it's. I feel like for me, sometimes I wonder if it's hard to separate which is which. What is like the mechanism that causes anxiety. [00:04:35] Speaker A: It's probably that we think something bad is going to happen, some kind of threat, something that we think will occur in the future. It could be a few seconds from now, or it could be days or weeks or just anticipating something can be kind of like a nervous feeling. So sometimes, you know, like a common thing in the clinic for the kids I see, for example, might be that they're starting middle school in the fall. And so I usually say, well, how are you feeling about that? And they'll say, well, I'm. I'm nervous. And I'll say, what else are you feeling? They'll say, I'm feeling excited. And I'll say, well, that's, that's because they kind of live next to each other in the body. Excited and excited and nervous together do kind of feel like anxiety. We're expecting something to happen, we're kind of prepared for it and we don't really know how it's going to turn out. And so it's not always fear doesn't always go along with that. It's just sometimes a feeling of like, I don't know, I'm just not quite sure about this. Like, I'm looking forward to it, but I also kind of am not. That's kind of anxiety in a nutshell. Ah. [00:05:48] Speaker B: And, you know, surely, you know, I think about this and I feel like, I hate to sound like one of these people that when I was young, but when I was younger, I don't remember the such so much attention being brought to anxiety. Like we all felt it. Right. You. There are various situations that you feel anxiety, but I just don't remember having so much attention brought to it. And surely all of us experience anxiety. So when does it become a problem? [00:06:27] Speaker A: Yeah, I mean, for. It is. It is pretty common. I think we just didn't talk about it as much back in the day. Old days. I remember that too. It just wasn't. Wasn't a word we threw around as much right there. [00:06:41] Speaker B: Right. [00:06:41] Speaker A: So for about one in five people, it eventually becomes. The anxiety becomes something that they just can't handle very well anymore. And so what an anxiety disorder is, is when we're completely avoiding the anxiety by trying to tamp it down by like not participating in certain things or avoiding certain situations. Like dogs. Maybe we have a phobia of dogs, so we avoid going to the park. If there's going to be a dog at the park. We might feel like general kind of that general anxiety where we're just feeling not at ease about many, many things. There's a lot on our mind, and it's starting to play into not concentrating well or not sleeping well or not eating well. And if once anxiety starts to kind of creep into our life in such a way that it's. That it's so persistent and it's so just always kind of causing us to change our behavior in a way that's not adaptive anymore. That's. That's the. That's an anxiety disorder. [00:07:49] Speaker B: Yeah. Do you feel like. I mean, sometimes I think what is the. I'm. I'm trying to formulate this. Like, like sometimes if you bring more attention to something, it makes it more of a. A problem. Like sometimes I feel like people concentrate more on it if you're. If you're concentrating on it, you know. So, like, if you're like, you know, it's anxiety, you dress it, obviously, and you say, everyone has some. And, and to me, I feel like it's a matter of you learn how to control it, how to deal with it. Is there such a thing as bringing too much attention to it, or am I just being one of those tough love people? [00:08:39] Speaker A: I think there's the right kind of attention to pay to anxiety and the wrong kind of attention to pay to anxiety. The wrong kind is listening to it and doing its bidding. So if anxiety is something that we're feeling and we're talking about it to everybody, you know, I'm scared of dogs. I can't go to the park. [00:09:01] Speaker B: Right. [00:09:02] Speaker A: And we, and we start to reinforce the behavior by talking ourselves into the anxious behavior or the anxious thought, we start to justify it or rationalize. We might. We might know it's anxiety, but still we think we are somehow talking it into submission or something. But that's not how it works. Talking about it can be another way of avoiding it. The most important thing is to notice that it's there and then, like you said, manage it or to talk back to it or to say, well, I'm feeling anxious about the dogs and I can go to the park anyway. I can handle it. I can do whatever I got to do. You know, I can always leave if I have to. Or, you know, we talk ourselves into it, or we just do A behavioral experiment. [00:09:48] Speaker B: Have a plan B. [00:09:49] Speaker A: Have a plan B. But maybe we pulled. Maybe we told somebody about our anxiety so they could support us. You know, I think that's adaptive, too. That can be helpful if. If they know how to support us, but if they're going to just also fall prey to the anxiety and say, oh, honey, are you okay? Do you need to leave now? You know, that's not helpful either. So, yeah, I think we can talk. We can talk ourselves right into having more anxiety by. By looking at it so much and kind of like admiring the problem instead of moving up to a solution. [00:10:20] Speaker B: So obviously there's a spectrum. Right. A lot of things seem to fall on the spectrum. So there's what I would call a, quote, normal type of anxiety. Is that. I mean, is there a normal. But, you know, like just the basic anxiety that you can feel sometimes of preparing for a test or whatever, and then there must be a severe. So are there names for the spectrum of anxiety things or is it just. Just it lives on the spectrum and there's a level. And there's a level that's not healthy anymore and that you need to be. There needs to be some kind of treatment or counseling for. [00:11:03] Speaker A: Yeah, I think that. I think you're right. Like, there is a spectrum of anxiety. There's. That. There's the kind of, on the one hand, having absolutely no anxiety and being completely calm and at ease with everything does not actually help people do well. There's a certain amount of anxiety that's. That's a good amount right in the middle kind of. And the. Too low isn't healthy. Once we get it to higher levels of anxiety, people can have those different types of anxiety disorders that. And often people have more than one. So there's like, there's some. Some kinds of anxiety you really only have when you're a child, like separation anxiety disorder. So that's apart from my caregiver and feeling like you can't handle that. I had some. Some episodes of that as a child. My parents would get a babysitter, and I just couldn't handle that. Right. Yeah. And another kind of anxiety that kids get sometimes is called selective mutism, where they'll only speak in front of people they're already very comfortable speaking in front of. So they may never speak at school, but they'll speak to their parents, for example. But adults don't seem to get those kinds of anxiety disorders and that probably Starting around age 3 or 4, kids can start to get these phobia disorders like fear of Dogs or fear of needles. And then they start to avoid situations. And of course, adults can have those too. Fear of heights or fear of, you name it, weather or certain situations like going over bridges or something. And then there's this. The spectrum can include things like social anxiety disorder, not know, not wanting to speak in front of people or go out in public. Agoraphobia is kind of related where it's like being out in a big open place or in a crowded place can feel really uncomfortable. That can go along with panic disorder sometimes where people have those episodes of just outright panic or feeling like they're, they're going to die. It's kind of flooded with these epinephrine and adrenaline. And then things like the more generalized anxiety disorder, where it's worrying about so many things all the time, hard to get things off your mind. Those are kind of the big spectrum. Some people might put obsessive compulsive disorder in there, but it's probably a little bit different, but has some similarities or some people have that along with an anxiety disorder. That spectrum, even among all those different disorders, can range from mild to moderate to severe. And mild is usually like it's causing some problems but not, not, not limiting somebody's life too much. But severe is, is the type of anxiety where you might not leave the house or you might not eat or, you know, where it's really, really getting in the way of living a life, having friends or having, just having physical health even. So that that spectrum can sometimes end up in hospitalization for that reason. Or people might feel like suicidal because their anxiety is so bad. Those are the most severe ends of the spectrum. [00:14:16] Speaker B: Is, and can anxiety be genetic? And if so, is there like an anxiety gene? [00:14:25] Speaker A: There's not a gene. There's not one gene, but it is. There are genetic predispositions to anxiety, but the genes that have to do with anxiety probably have to do more with sensitivity to the environment, with just picking up on lots of things at once. So there are good things about having those genes too. In the supportive environment, those genes can lead to being quite successful in life. [00:14:51] Speaker B: So I'm just thinking about this, and I've heard sometimes that people will say, oh, I must have eaten whatever I feel anxiety. Can foods cause anxiety? [00:15:07] Speaker A: You know, I hear people say that too, and I think it's more indirect. Maybe like sometimes when we have an uncomfortable physical sensation like bloating or sweating, because those are sometimes very much the same sensations we have when we're anxious or nervous, we can feel those things Together or pain can cause anxiety even, you know. So I think some foods that maybe people are sensitive to can make them kind of feel uncomfortable and that can feel. That can feel like anxiety. But then there are of course, some substances that really would make anxiety much more likely or harder to deal with. But those are mostly like alcohol, you know, or. Yeah. Or if you're eating an edible with cannabis or THC or something, maybe those will make you nervous, you know, but anxious. [00:15:57] Speaker B: But now there's that. That's right. [00:15:59] Speaker A: But other than that, there aren't really like toxins and foods that make somebody. Anx. Anxious. I will say that actually it's true that food dyes can make. Some people are sensitive to those artificial dyes, like the ones that come with a number like red dye number three or whatever. Some people feel jittery or kind of hyperactive or nervous when they eat or drink those food dyes. So it might feel like anxiety for some people. [00:16:25] Speaker B: I think too, what I've heard kind of attached is like, I've known people who have celiacs and they'll say if they get a reaction to having eaten something, they, they can feel anxiety and that's the start of them having. They know they're going to have a celiacs attack. Have you heard that? [00:16:45] Speaker A: Yeah, that's true. Some people who have food, like. [00:16:48] Speaker B: And what is that? That does that. Do you know? [00:16:52] Speaker A: I don't know exactly how that. How the anxiety part of that is. Is coming. If it's maybe just an anticipated patient because they've had discomfort before when they've eaten those foods, or if it's a direct effect of the, of the, like, the immune system response. The immune system is tied very closely to the, like the sympathetic nervous system that has adrenaline. And so there's, there's a link there between the immune system and how we're feeling and what we're thinking. But I don't, I don't understand it that well. [00:17:26] Speaker B: So one of the things you touched on and I wanted to visit, revisit is the, the idea that there are some people who have like, I don't know if you call it. No anxiety. And surely anxiety is there for a lot of good reasons. Like. Right, it can protect us. If you, if you think maybe you shouldn't be doing something, you're thinking of making a decision, you just, just something's nagging at you and feeling wrong. Maybe you shouldn't do what you think you're going to do. There's that protect. I call it protective anxiety. I'm not sure what the real term is, but what happens when somebody can people have no anxiety and then talk a little bit about some of the downfalls of that. [00:18:18] Speaker A: Yeah, I think that everybody's capable of having anxiety, but some people are in situations that lead to very low levels of challenge or stress, and that can lead to, like, very rarely feeling anxiety because they don't have anything to prepare for or to challenge them. So if you think about the most boring day of your life, there probably wasn't much anxiety either, you know, unless you get bored, anxious when you're bored like some of us do. I do. But you know that if. If somebody is constantly under challenged, they may have no anxiety, but they're also maybe not accomplishing much. They might not be learning much. So anxiety and learning are actually really tightly tied together. We tend to our brains remember things better when we're a little bit anxious. Our bodies perform better when we're a little bit anxious. [00:19:11] Speaker B: Right. [00:19:12] Speaker A: So all of the things that prepare us to do well and to retain information for the future are also the same things that make us feel anxious. So I would say somebody who doesn't have that happening might not be forming important memories and learning important things that they would need to do to prepare for their future in a good way. Whereas somebody who has some challenge and maybe shows some caution or is showing some, you know, normal amounts of preparation is taking that anxiety and kind of using it as fuel. [00:19:46] Speaker B: You know, I do notice that for me at least, people who know me will say I'm quite a competitive person. And I do notice that if I'm doing some kind of competition with, you know, like a sport or something, a recreational activity, and if I'm like, feeling like, you know, I know that that person I'm going against is competitive, I want to win. And I get this little bit of anxiousness if I feel like I'm falling behind. But when it's somebody that I feel like it's no big deal or whatever, you do get that kind of bored sensation. That's probably not the right term, but it's kind of like the, oh, lackadaisical thing, and you just don't try as much and you don't do as well often. But so that is interesting. I feel that. I see what you're saying on that. [00:20:42] Speaker A: Like the tortoise and the hare. That hare got way ahead. It just kicked back. Lost race, took a little nap. [00:20:49] Speaker B: That's right. Ah, it's okay. Take a little nap. Is there testing you do for anxiety to decide if the level is not, you know, where it should be or too high. [00:21:04] Speaker A: We, we don't have very sophisticated tests, but we, we do have like paper and pencil, you know, surveys and quizzes, basically, you know, and that's about as good as it gets. Like good interview, good, you know, kind of some survey items, questionnaires that we can score and compare it up to like national or age based norms. That's about as good as it gets. It's certainly not perfect. I mean, people read those questions differently. We use a form in our clinic with children, for example, really commonly that uses a lot of big words and sometimes it uses the word worried and sometimes it uses the word frightened, and sometimes it uses the word scared. And you know, those words have slightly different meanings to different people, like you were saying earlier. And it's not, it's not clear how perfect they are. They're far from perfect. You know, some, sometimes we just do the best we can to understand what's happening, but we don't have really all that great of tests. Certainly there's no blood test or brain scan for any certain person that could tell us anything. Sometimes we might look at what other medical conditions might be going on and check labs like you said. If it's something like celiac disease or diabetes, maybe there's part of the disease process that's leading to more anxiety, but that's about as good as it gets for us. [00:22:25] Speaker B: Yeah, let's talk about anxiety drugs. Are there a lot of different kinds of anxiety drugs? First of all, there seems to be like short term and long term. Can you talk a little bit about the difference and what that means? [00:22:45] Speaker A: Oh, I think we could have a whole hour just talking about those, unfortunately. But yeah, there are a lot of drugs. I say unfortunately because I think it's confusing. It's confusing how much they can help. And it's, it's unclear sometimes what the downsides are. But you're right, there's a kind of these short term ones and longer term ones, and the short term ones tend to be more habit forming, but in two ways. So they can be habit forming because we learn that that's how we get through anxiety kind of psychologically. And then they can also have a physical dependence that requires a higher dose if you use them for too long. So those are like the benzodiazepines they're called. That's the big family. But that's like Valium, Xanax, Ativan, you know, those Klonopin are some of the brand names for Those, over the years. So those have been around for, boy, you know, way over 50 years now. Yeah, for a long time. And you know, they're, they're not the safest either because they can make people breathe more slowly. If too much is taken, they can cause an overdose. They can be, if they're combined with alcohol or other drugs that, that effect can be much bigger. [00:23:58] Speaker B: Yeah. [00:23:59] Speaker A: And so the other problem is they interfere with forming new memories. So that can, that can interfere with the process of learning to manage anxiety. Because let's say you're afraid of the dentist. You take a little dose of one of those, like an Ativan before you go to the dentist. You get through the dental visit, but you won't remember much about it. And therefore your brain doesn't really learn how to deal with being at the dentist. It just learns that it used Ativan to do that, you know, but the memories themselves are kind of hazy. So that can be, that can be an inhibitor and sometimes they make things a little too relaxed, you know, so that you're not even really with it and somebody's got to like pull you along. Come on. You know you can't drive, right. So they're a little too relaxing. There's some other short acting medications that might be less likely to cause that. They might not work quite as well, so to speak, but they do work pretty well. So there's like an anti histamine called hydroxyzine that is helpful and it doesn't cause all those other problems so that, that one can be used sometimes. And then there are the, the longer acting ones that people take sometimes for months or years or even their whole lives, which are mostly the selective serotonin reuptake inhibitors like Prozac or Sertraline or Celexa Alexa Pro. Those, those, those class, that class of medications that usually take a few weeks to start working and, and they can be a little bit harder to stop if people have been taking them for a long time. [00:25:38] Speaker B: Right. [00:25:38] Speaker A: Often be, you know, very slowly weaned off because people's brains kind of adjust to having them and if you stop them too quickly, the anxiety can be almost overwhelming or people can feel depressed just because the medication was taken away too quickly. But, but it is possible to get off of them. And I think when they're combined with therapy, they actually can lead to more rapid learning of new ways of doing things and managing anxiety. So for people with more moderate to severe anxiety, it's interfering with their life. Those, those are the medications that are most, most Frequently used. There's other medications that are used situationally, sometimes short term, like propranolol for like the side, like this jitteriness or of performance anxiety, like for somebody who might be doing a piano performance or something. Those kinds of things can be helpful short term, but generally we would recommend not using medications as the first thing. For most people with anxiety disorders, we would usually recommend therapy first. [00:26:43] Speaker B: And so what are the short term medications working with? Like what, what are they doing with your brain as opposed to what the long term medications are doing? [00:26:54] Speaker A: Yeah, the, the benzodiazepines anyway are, are doing something with this chemical called GABA in the brain. That's a, it's really a big time relaxant, kind of relaxes the whole body. And so it has a muscle relaxing effect, but it also has a brain relaxing effect. And it just kind of makes everything a little quieter in the brain. So which is part of why it can make people sleepy. And that can be helpful for lots of other things too. But for example, people use these medications and some forms of epilepsy to help reduce the odds of having a seizure. So they just kind of reduce brain activity overall versus the long acting medications that have to do with serotonin. We actually don't understand quite as much how those help with anxiety, but seems that somehow helping with the transmission of serotonin does some beneficial stuff for anxiety that we don't completely understand. Whereas the other ones, like the short acting like propranolol, that's not habit forming, that just blocks adrenaline, so you don't get as much of a rapid heartbeat or that kind of jittery, sweaty response. [00:28:06] Speaker B: Right, right. So how common is it for kids to be on an anxiety drug, do you feel? And has that changed in the last 10, 15 years? [00:28:24] Speaker A: Well, it's changing a lot. The rate of anxiety disorders in kids is skyrocketing right now for reasons we don't completely understand. And so it's, it, it. The overall like rate of treatment for anxiety is still pretty low actually. So a lot of people have anxiety disorders, but they're not getting any treatment at all. They're not getting therapy, they're not getting medications. And there are disparities in that. So for example, people with neurodevelopmental disabilities and anxiety or other disabilities and anxiety are much less likely to get treated actually for anxiety. [00:29:04] Speaker B: And why is that? [00:29:07] Speaker A: Well, I think it's discrimination and bias, quite frankly against people with disabilities that doesn't see anxiety maybe, or just attributes anxiety to, well, they're disabled. What are you going to do about it? You know, I don't know. There's a lot of. A lot of bias in my field. Right. There's a lot of doctors and. [00:29:24] Speaker B: Yeah. [00:29:25] Speaker A: And who just kind of overlooked the health conditions that are present for people with disabilities because of the way we just don't really see people with disabilities as fully human. Sometimes, you know, I think it's just pure discrimination. [00:29:42] Speaker B: That's amazing, isn't it? So do you feel that anxiety is often accompanied by another disability or. I mean, is it. How often is that the case that you've seen? [00:30:02] Speaker A: It's very common. And so anxiety often comes along with other disabilities, such like neurodevelopmental or intellectual disabilities, such as autism spectrum or adhd. Really common. So probably around half of people with autism or ADHD also have an anxiety disorder. And for other disabilities, like intellectual disabilities, it varies. The estimates are less probably well established because sometimes people with intellectual disabilities don't have quite as good of studies across populations. They might be studying like only people with down syndrome or whatever, some special population. So we don't know for sure. But we do think that in people with intellectual disabilities, depression and anxiety are much more common, like maybe twice as common as people without those disabilities. So there, there are other disorders like Tourette syndrome, where there's almost always some anxiety present. So. Yeah. And then, you know, for other disabilities, like motor disabilities or sensory disabilities, it varies, but it's probably a little bit closer to a population without those disabilities, that portion of people's anxiety. [00:31:19] Speaker B: Right. [00:31:20] Speaker A: But we do know that for some, some kinds of sensory impairments are. Anxiety is a little. Can also just look different. And I think that's another reason it gets missed by. By doctors or even people with disabilities themselves. So, for example, hearing people with hearing impairment or complete deafness might have some anxiety around some sensory sense, basically sensitivities that have to do with visual sense. Sometimes people who have blindness might have anxiety about noise. So it can. [00:31:49] Speaker B: Right. [00:31:50] Speaker A: And that can look different. [00:31:51] Speaker B: Yeah, yeah. You talked a little bit about treating anxiety without drugs, with counseling. How visit that a little bit. How does that work? [00:32:09] Speaker A: Yeah, there's lots of Right ways to. To do counseling and help anxiety that way. You know, we think about some of the names of those therapies, like cognitive behavioral therapy, and that just, it was like, what does that even mean? The cognitive part means the thing, the thinking part of anxiety, and the behavioral part means the part where we change what we're doing. You know, so the actions we take and the ways that we talk about our anxiety, for example, can be shifted. So, like, one example might be if I'm worried about many things at once. I have a test coming up, and my person I have a crush on hasn't talked to me in two days. And, you know, my mom is telling me I have 800 chores to do, and my dog is getting old, and I. And I think I might vomit. And it's all happening at once. You know, it's almost like, where do I even start here, right? You know, so the starting place for therapy is often just saying, well, all of those things are anxiety. It almost wouldn't matter if one of them went away, another one would come up because it's like a kind of like a forest fire in your brain. And, you know, you can't just put one out. It's going to pop up somewhere else. So it's the first part of. Of counseling for anxiety, just learning about it. Just learning that all those uncomfortable feelings, nervousness, fear, worry, those are all part of anxiety and learning that the. What anxiety wants to do is like, hold us back. You know, it wants us to get. It wants us to get rid of anger. It wants us to feel so comfortable. It's. It's the illusion that we could just. If only we could just solve these problems, everything would be fine. So let's just avoid the problems, you know, and it's just. First part of therapy is just learning that. Just learning that we can't avoid that stuff because our world will get smaller and smaller if we do. And it's learning to talk about it in a way that calls it what it is, and finding the words that are best for a certain person. Like, you know, if it's nervous or fear or worry or whatever, those words are just to give voice to it because it's so. It's. Anxiety thrives in silence and pretending it's not there and pretending we have to be comfortable. So the second part of therapy is usually learning to be uncomfortable. Right? [00:34:43] Speaker B: Right. [00:34:44] Speaker A: So it's learning, like, I can feel like I have to vomit, and I can be really worried that I'm going to vomit and I can still go to school. [00:34:52] Speaker B: Right. [00:34:52] Speaker A: You know, I could go to school anyway. Like, they know how to help me. If I vomit, I might feel embarrassed. The other kids will. What if every. What if everybody laughs at me because I vomit? Well, how would you handle it? You know, and so that's kind of the thinking part of treatment is like, well, what if. What if it did happen? What if it did happen? And Going all the way to the end of that story in our mind, like, well, then nobody will ever talk to me again. And it's kind of going, oh, wait a minute. That probably isn't what would happen. You know, it's starting to question the story in our mind a little bit so that we can do more of the uncomfortable experiment of just doing it anyway. So the key ingredient in almost every kind of counseling for anxiety is it's called exposure, you know. [00:35:36] Speaker B: Right. [00:35:39] Speaker A: It's mastering that reaction we have that says, get comfortable. Get comfortable. And it's saying, it's okay, I can be uncomfortable. [00:35:47] Speaker B: And so there's clearly a, quote, healthy level of anxiety. How do you determine what that is? [00:35:56] Speaker A: That's. So. That's such a good question. I think on. At any given moment or day, you know, probably most of us give in to anxiety once or twice. You know, we don't call the person that we're afraid of talking to. You know, we. We probably do something that gives into the. You know, we don't eat that thing that looks a little disgusting or, you know, those little things that come up in the day, and that's okay. You know, that's normal. It gets to. I think that over the course of a few weeks, we might notice it's getting to be a problem, you know, oh, I. I've been avoiding calling this person for two weeks. That's a. That's an anxiety problem. Right. If it becomes I'm avoiding calling everybody for two weeks or, you know, a month, I think it's that length of time and how deep it goes that makes it a disorder. [00:36:48] Speaker B: I want to visit the concept that you said that you feel like more kids are developing anxiety than or have been diagnosed with an unhealthy balance of anxiety. More than what was typical that you remember. And my first thought was, well, of course they are. Look at the climate that's going on. [00:37:14] Speaker A: But. [00:37:14] Speaker B: And I'm sure the people that are extra sensitive are like, especially if you're in the treatment field of children are, like, watching their parents and watching their teachers and watching the media and watching. There's so much things pulling on them. So how. And I feel like there's a lot more drug prescribing going on rather than counseling. Am I seeing that correctly? And if so, why is that? Because are we avoiding the short term or the long term? Let's get this actually managed rather than, let's just throw a pill at you, boy. [00:37:56] Speaker A: Yeah, I don't know. I don't. I don't know. I mean, I think you're, you're right, Sam. I mean that the kids are right to be anxious. First of all, I want to say, like, I think there's something about what you said that's really poignant and important. Kids see things that are right in front of them that, that are, they're right to be worried about like climate change and inequality or, you know, there's, there's things happening that kids feel completely powerless about. They don't get to vote, they don't get to take action, and they're getting handed a world that is, you know, broken from a lot of perspectives that, you know and. Well, I don't know that we're equipping them to deal with it particularly well sometimes. And are. And how do we. So how do we equip them to deal with the anxiety that comes with all that uncertainty and uncontrollability? Schools are making pretty good inroads. You know, they're trying to have more, you know, basically school based mental health. In Minnesota, we do a good job federally. It's, it's. Those funds are starting to be questioned or cut also. But, you know, it's state by state. There are some examples of states like Minnesota that do try to reach kids who are having anxiety problems and keep them in school and keep them functioning by doing the kinds of counseling we're talking about. But when we're talking about, you know, a third of kids or something, you know, the rates have like doubled over the past, you know, four or five years. It's really hard to keep up with that. We can't make a workforce fast enough. So there are some really promising things like teaching kids to help each other, you know, and to empower like youth leaders for mental health in schools and in communities. I think that is really promising. I think just helping adults know how to deal with anxiety better. Because our tendency as adults when we see an anxious kid is to kind of like bail them out, you know, like fix the problem for them. Like, oh, you're worried about your test? I'll call your teacher and tell them you need a mess. Mental health day. [00:40:05] Speaker B: Well, you know, maybe not the best. [00:40:06] Speaker A: Thing, that maybe once, once in 10 years might be okay. Right. But if that's happened a lot. So I think there's part of it is helping adults understand how to really support kids. You know, kind of getting, getting into the feeling of discomfort from anxiety and getting through it successfully. [00:40:26] Speaker B: What age is anxiety usually noticed in kids? I mean, besides the, you know, you see then maybe 9 or 10 month old infant, anxious separation. I don't really, they call that separation. I don't really count that because that's something that most babies go through. [00:40:46] Speaker A: Yeah, right, yeah, it's a developmental milestone, you know, and, and separation anxiety, having a little bit of it when you're four, five or six is, is normal. Right. So yeah, but those are, but when kids start to have those tendencies, we do notice it, you know, pretty early in maybe like 10% of kids. And they'll go, we know that they'll go on to have like a childhood anxiety disorder. For the most part though, most adults who have anxiety started to develop it around the time of puberty to the point where it became a problem. So, you know, there's that kind of 13 to 18 year old age group that starts to have anxiety disorders, but the roots of those are often in childhood. So kind of having a more inhibited temperament where you're kind of more cautious or slow to kind of warm up or explore, that's not the same as having an anxiety disorder. But it kind of predisposes people to that because it sort of, it brings out that in the adults around the child who often might have anxiety themselves for the genetic reasons. You said those adults are often going to try to make things so comfortable for the kid or push the kid too hard that it can make anxiety calm. So a child who's a little bit shy and inhibited, that's not an anxiety disorder. But. And if you let them just warm up on their own pace, they'll be happy as a clam. But if somebody's pushing them and say, smile, go talk to that person, you know, go talk to that stranger. Or on the other hand, oh, oh, honey, don't worry, we'll never go out and see anybody. You know, those leads to an anxiety disorder. Right. [00:42:20] Speaker B: Do adults have different anxiety conditions than kids or does it start when you're a kid and just kind of roll on into adulthood? [00:42:31] Speaker A: Yeah, it just kind of morphs into its, the shape changes, you know, because you might be anxious about tests when you're 15, but as an adult you might be anxious about people, you know, thinking that you're making mistakes all the time at the, on the job or something. [00:42:48] Speaker B: You made an interesting thing about. Talk about. If parents make it too easy, it can be a problem. If they're making it too tough, it can be a problem. What happens when a parent ignores it? Like, I feel like mine was ignored and I learned to suck it up is probably the right concept. You know what I Mean, it's like you. Obviously there's some things that I avoided or some things that I just didn't do, but in general, I got along and I got through. So what happens with that? [00:43:27] Speaker A: Yeah, I think it's ignoring combined with warmth and caring and celebrating the wins of getting through something that's hard, that work, you know, so it's, it's ignoring the big anxious, avoidant or outburst thing that the kid's having, but it's also coming back with like, okay, you can do this, let's go, you know, or oh, wow, what, look what just happened. Or, you know, celebrating the fact that you got through that hard thing. So it's like the warmth and the limit setting. I think of the ignoring more like I'm setting a limit, you know, like you've asked me a hundred times if there's going to be a dog at this party, you know, I answered it once and that was enough. So now we're just going to go to the party, you know. [00:44:12] Speaker B: Right. [00:44:13] Speaker A: So having a limit on that is really important, you know, So I think for parents to be able to find that middle ground between, you know, helping a child feel some reassurance and support, but not solving the problem for them or not trying to give them the answer, you know, telling a child, like, just relax, you know, take a deep breath, that doesn't help so much. Right? Like, it helps, it helps the first time. You've taught them that. But then they know how to do it. So then it's up to them. It's giving them the space to do it. It's giving them. And that means sometimes it's not going to work and they'll have a, they'll feel terrible. And it's hard to watch that. But after they're done feeling terrible, you come with the hug and you go, hey, it's all right, we'll try it again tomorrow. Right. So it's, it's coming back with warmth and support and letting kids know that they, they can, they can do hard stuff. [00:45:06] Speaker B: You bring the dog issue up a lot, and I'm guessing that's a top anxiety. Are there things that are like the three most top anxiety things that cause kids? What would they be? [00:45:24] Speaker A: Yeah, I mean, I think they probably are a little bit different for kids and adults, but you know, for kids it's definitely separating from a caregiver. You know, there's no doubt about it. For kids and adults, though, number one is public speaking. Almost everybody is anxious about public speaking. In fact now, by the way, three Four or five year olds? Not really. Actually. They're like, look at me. Yeah, it's hard to stress them out, but, but starting at about, you know, kindergarten, first grade age and right on up till we're elderly, you know, public speaking will reliably stress you out. Like you can measure like the stress hormones in somebody very reliably when they have to do that. [00:46:11] Speaker B: Ah, excellent. But dogs must rank right up there. [00:46:16] Speaker A: Dogs and, you know, phobias of dogs. Well, probably one of the biggest phobias is needles. [00:46:21] Speaker B: Oh yes, yes, that's right. What do you see in the future for treatments or ways to handle anxiety? Is there anything new coming? [00:46:37] Speaker A: It's a great question. A lot of. One kind of therapy that's gained a lot of popularity for many kinds of things is dialectical behavioral therapy. Dbt. [00:46:47] Speaker B: What is that? [00:46:48] Speaker A: It's a kind of therapy that is really aimed at understanding that negative feelings don't have to be dealt with in a negative way. Like we can measure how we're responding to something and make it appropriate to the problem and not, and not even see anxiety or other unpleasant emotions as a problem. Just see them for what they are and accept what's in front of us. So it's more of a middle ground approach where, you know, people use like grounding techniques, different ways of breathing, or different kinds of ways of calling problems by different names. And it can just be really helpful in the moment to notice how we're feeling. But it wasn't really developed for anxiety. So I see that kind of as a frontier because people are adapting it that way. But I do think there are things that are really promising, like biofeedback, where you're looking at a computer screen of your own body's reaction and kind of retraining the body's response system. That can be really helpful. And biofeedback systems are getting really sophisticated so they can look at muscle tone, brain waves, heart rate, and integrate those into a picture of a different kind of response to something that was stressful. I think there are probably some other technologies like that on the horizon, like ways of stimulating the brain with current, you know, small currents through a cap for people with severe anxiety. And there are probably other treatments like psychedelic drugs that are, that aren't, aren't approved yet. [00:48:31] Speaker B: I'm not sure how I feel about that one. [00:48:33] Speaker A: I'm not sure either. I don't know enough about it to really have an opinion. But I mean, you know, these things could be promising for some people who had really severe anxiety without, you know, People who couldn't eat or something could have breakthroughs with some of these newer treatments, I think. [00:48:47] Speaker B: So the biofeedback seems interesting. So can you just enlighten me a little bit quickly about that? Is that just an idea that it's sensing the chemical or reactions of what your body's doing and telling you you're getting anxious, or how is that working? Because you probably already know you're getting anxious, right? [00:49:08] Speaker A: Yeah, exactly. Well, definitely. Like, the first time I did it was with one of my clinical mentors who I really admired, and I got performance anxiety. And I. You. The little thing on the screen getting worse, it was a. It was measuring my temperature in my finger, actually. So when we're. Our fingers can get a little cold or our toes can get a little cold. That's why there's that phrase, I got cold feet. Right. [00:49:30] Speaker B: Okay. [00:49:32] Speaker A: So when we're relaxed, it's warmer. Like a mood ring changes because of this, but the computerized one changes really fast. And my temperature was going, like the wrong direction was getting colder. And the more I saw it getting colder, the more nervous I got. He's like, my mentor said, just stop looking at the screen and just think of something pleasant and relaxing. So, you know, I just went in my imagination to someplace more relaxing, like a beach. And next thing you know, my temperature was back, getting into the warm territory. And. And he showed it to me and I was like, wow, that's amazing. You know, I can change it with just my mind. And then the more you practice that, the more you kind of memorize how that feels and you can tap into it when you need it. [00:50:13] Speaker B: So maybe there is something to that, that idea that we used to learn. Okay. If you're feeling anxious, you need to slow down, relax, think, you know, calm. Try to be calm or as calm as you can, because obviously you can't just be calm. Do some breathing or use some techniques that work for you. There's something to that. Right. And it worked before. It should be able to work again. [00:50:39] Speaker A: Yeah. [00:50:40] Speaker B: So can you give some advice to adults who. Because I see this as not just a kid thing, but adults that have never addressed their anxiety and should. And start dealing with things. What are some advice that you can give? They also may be parents and they may be doing the same thing with their kids or like you said, over. Overdoing it with them. [00:51:07] Speaker A: Yeah, Yeah. I mean, I'm. That's a great question. I. I think one of the best things that, that we can do for our kids for really just our Partners, our friends, is address the anxiety now. It's never too late. It's. People can work with this for the first time when they're 80 and get amazing results, you know, so it can. It can feel intimidating or daunting or like, I've been living this way my whole life. I can't change. You can. You can. And, you know, there. There might be some parts of it that are harder than others to face. And you don't have to. You don't have to completely solve your anxiety to feel a lot better. You can make really good progress and live a full life again. And so I would say, like, don't hesitate to reach out. And some things, I think sometimes as we get older, we start to think, well, that's just how I do things. Or that's the. I prefer it. I prefer it this way, you know, And I like. I prefer never to be around dogs. I just don't like dogs. You know, it's like, no, you know, you're avoiding dogs because you're worried about dogs. You know, like, you're worried about how they're. What they're going to do and how unpredictable. So don't. I know I do use dogs a lot because they're kind of easy to pick on, but they're also, like, people don't understand it, right? They're like, well, I love dogs. How could you be afraid of them? So, you know, we feel. I think it's a stigma about anxiety. Like, nobody understands this. And you're. But the truth is you're not alone. You know, whatever you're worried about, like, other people have been there, and it can get better. [00:52:44] Speaker B: Charlene, I was wondering if you had any thoughts or any questions you'd like to ask Dr. Barnes since he's here. Maybe not. Okay, well, Dr. Burns, thank you so much for coming on. This has been a great conversation and this will be interesting to watch because I feel like there's so much back and forth going on in, you know, in the environment, the political environment, and just how people are to each other. And I see things declining, but I hope that is that I'm just more on the gloom and doom spectrum. I think that's partly it, but I hope that's not the case. So thank you so much. I really appreciate you coming on and the time you spend with us. [00:53:48] Speaker A: I think your show makes it makes the world a better place. So I have optimism about it, you know. Thank you for having me. It's a real honor to be able to talk with your audience. [00:54:00] Speaker B: Thank you, Dr. Barnes. I appreciate that. All right. Good luck with all the treatments. [00:54:06] Speaker A: Thanks. [00:54:07] Speaker B: You're tuned to KFAI 90.3 FM, Minneapolis, and KFAI.org you've been listening to Disability in Progress. The views expressed on the show are not necessarily those of KFAI or its board of directors. My name is Sam. I'm the host of this show. Charlene Dahl is my research PR person. We've been speaking with Dr. Andrew Barnes, who is talking about anxiety. Everyone has it. It's what you do with it. Thank you so much for joining me, and I hope you'll decide to be on the email list. You can email me at disabilityandprogressamjasmid.com if you have a question, comment, or just want to chat, Please reach out disabilityandprogressemjasmin.com and remember that we exist because of you. So your feedback, your monetary support, and everything counts. Thanks so much for listening.