The Secret to Stopping Anxiety & Fear (That Actually Works)

David Rosmarin (00:00:19):

You've been taught since birth that something's wrong with you if you're anxious. You've been taught by your parents, you've been taught that by your teachers. You've been taught that by society. We are getting it wrong.

 

Mel Robbins (00:00:27):

Dr. David Rosmarin is about to flip everything that you and I know on its head about anxiety.

David Rosmarin (00:00:40):

I am even more excited.

 

Mel Robbins (00:00:42):

I would love for you to tell the person listening who has made the time to learn from you today, what could change about their life or the person's life that they're going to share this with. If they take everything to heart that you're about to share with us based on all of your experience, and they use it in their life,

 

David Rosmarin (00:01:05):

There are two things.

 

Mel Robbins (00:01:06):

Okay?

 

David Rosmarin (00:01:07):

The most fundamental is to stop judging yourself for feeling anxious, to stop feeling anxious about the fact that you have anxiety in your life because everyone does. It's a normal human emotion. In fact, if you don't have anxiety, something's probably wrong. That's number one. And number two, once you accept that it's part of your life, you can use it as an ally instead of an enemy.

 

Mel Robbins (00:01:31):

That's a pretty tall promise, the ally versus an enemy, because I think anybody who is struggling with anxiety or watching somebody struggle with it, it does seem like an enemy.

 

David Rosmarin (00:01:43):

It sure does.

 

Mel Robbins (00:01:44):

And that's why I was really curious because the title of your bestselling book is Thriving with Anxiety, because when I hear thriving with anxiety, it almost presumes that I got to keep it. And I'm like, but Doc, I want to thrive without this stuff. Of course. So what is possible when you say you can make it an ally or you can thrive?

 

David Rosmarin (00:02:04):

I would say it's almost as counterintuitive as let them.

 

Mel Robbins (00:02:08):

What do you mean?

 

David Rosmarin (00:02:08):

Well, I don't want to let them. I want to control them. I want to stop them. These annoying, irritating situations in my life, once you accept that you can't, that actually becomes a resource for you to become more resilient, more connected to people who are worth connecting to, worth focusing more on things in your life that you can control. And anxiety is the same way. It's kind of like let them for your internal world.

 

Mel Robbins (00:02:35):

So meaning that because we don't understand what anxiety actually is and because we're afraid of it. Actually, it reminds me of a passage in your book that I want to read to you that I found so interesting. Okay. Anxiety is nothing to fear in and of itself. This is page 35, I'm reading from my office, has serviced over 10,000 patients.

 

David Rosmarin (00:02:57):

Correct.

 

Mel Robbins (00:02:58):

And we have never had a patient die from anxiety. No one has ever been hurt from their anxiety symptoms or gone crazy from the acute experience of anxiety. Even though I'll add that you often feel like you're going crazy and you write, yes, people can develop behavioral problems in the context of anxiety, including alcohol or substance misuse, self-injury and suicidality. The last thing you want is to flood your system with more adrenaline. So reacting with catastrophic or self judgmental thoughts to the fear response only makes it worse. And so what I take from just that passage is that we kind of have anxiety all wrong, and because we do, we're making it worse.

 

David Rosmarin (00:03:47):

A hundred percent. That's exactly what's happening. Our society is over medicalizing, over pathologizing a normal human emotion. Now, don't get me wrong, at a certain point, it does become pathological, but we are conflating clinical pathological anxiety with normal anxiety that all healthy human beings experience. And in making all of that one big lump of craziness, we have become allergic to the normal side of anxiety, and that's creating the anxiety epidemic today.

 

Mel Robbins (00:04:19):

Wow. So will you unpack that allergic part because you also write about that in your book that anxiety is almost like an allergy. So you just said something that I think needs to be said even louder, which is there's a massive difference between the kind of chronic crushing anxiety that becomes a massive debilitating problem in somebody's life and the very normal anxiety that absolutely every human being is going to feel. And if you understand it, it doesn't have to get worse. It can be something that can actually be an ally that you're not afraid of. What do you mean when you said allergy, though?

 

David Rosmarin (00:05:01):

I did this for years myself. I would show up to work, have clammy hands, have a little bit of an upset stomach. My breathing would be a little bit labored. It's a stressful day. And I would say, David, what's wrong with you? Until it was really during the COVID pandemic that it hit me. I'm like, that's not true. We're going through a hard time. We're going to feel somewhat anxious. In fact, if I didn't feel anxious, then something would be wrong. And then I realized we need to bifurcate between normal anxiety, which is actually potentially a very great resource to thrive in your life. And then clinical anxiety, which does need professional treatment, whether it's medication or psychotherapy or something more sophisticated and targeted, but we are getting it wrong and it's having disastrous consequences, especially for kids.

 

Mel Robbins (00:05:46):

How does being nervous or feeling on edge, how is that an example of thriving when you're facing something challenging?

 

David Rosmarin (00:05:56):

Well, it does depend what you do with it. If we take those nerves, those regular healthy anxiety, feelings, sensations, thoughts that are going through, and we actually get to the bottom of it, we probe, we think about what's making us anxious, we can become more self-aware, right?

 

Mel Robbins (00:06:16):

Yeah.

 

David Rosmarin (00:06:16):

If we share it with someone else, we can broaden and deepen our connections with other people and become more intimately related to them. And if we embrace it well, we can actually build our emotional fortitude to be able to face adversity. And we can also even use it to let go. And I think that's the process that we have to start using with normal healthy aspects of anxiety as opposed to get rid of it. And our immediate knee jerk reaction is get rid of these feelings. Something is wrong with me. I shouldn't be feeling this way. And immediately your adrenaline is going to spike because you're interpreting the lower levels of anxiety as a problem. So that's literally going to create a physiological cascade and it dumps more adrenaline into your system.

 

Mel Robbins (00:07:03):

It makes so much sense. And yet when you're in that spiral or that panic about your job or the interview or whether or not you're going to meet quota, or if the person that you're seeing is falling out of love with you, you don't have access to that ability, or at least not now, that's what you're going to teach us how to do to catch is this sadness or depression, and I guess I would put in the, is this normal nerves or is this actually something to be worried about as a state?

 

David Rosmarin (00:07:33):

It's exactly the first question to ask,

 

Mel Robbins (00:07:35):

And it's something I've never done is stop myself in those moments where I'm starting to go up in my head and ruminate and panic and think about all the worst things that could happen, which only freaks me out more. And I've seen my kids do the same thing, and then I avoid the thing that I need to do, which only makes me feel more doubtful and affirm that I can't handle it. And so I could see how the first thing would be, whoa, whoa, whoa, whoa.

David Rosmarin (00:08:08):

Correct.

 

Mel Robbins (00:08:09):

Could you just explain to the person listening how exactly you found yourself in this work and starting the Centers for Anxiety? What led you here?

 

David Rosmarin (00:08:21):

Sure. Looking back in the last 20 years, I would probably, if I had to be honest, it's going to be my own anxiety. And this has very much been a personal journey for me. I was taught in graduate school, I was taught in my training to diagnose, treat, help people to get rid of their clinical anxiety. And those tools are still something that I use on a daily basis in a variety of different contexts in my work. But it took going through the pandemic to actually click into this concept that not all forms of anxiety are problematic and bad. And we could potentially even use those lower levels of anxiety in a constructive, positive, healthy way to help us to thrive and to grow in our lives.

 

Mel Robbins (00:09:10):

Well, I mean, I'll just admit right away, having struggled with anxiety for almost 30 years, I'll take full responsibility for the fact that I was afraid of anxiety. I hated it. I ran from it. I tried to drink it away. I tried to outwork it and none of it worked. And some of the medications worked to mute it, and there were lifesaving ladders to help me climb out of a hole, but not understanding what you're talking about already. And so I want to take a giant highlighter and say there's a huge difference between low level anxiety that is normal and the higher level debilitating anxiety. That is the focus of your clinical practice.

 

David Rosmarin (00:09:51):

Correct.

 

Mel Robbins (00:09:52):

We're going to get into the tools that you can use for yourself and you can also use with people in your life that are feeling anxious. But I should probably just back up and start with some of the basics.

 

David Rosmarin (00:10:01):

Sure.

 

Mel Robbins (00:10:02):

What is your definition of anxiety, Dr. Rosmarin?

 

David Rosmarin (00:10:05):

Okay. There are cognitive aspects, things that are going on in your mind. There are physiological or emotional aspects, and then there are behavioral aspects, usually avoidance, but maybe some checking. So let's go through them. The cognitive aspects, worry, apprehension, you're nervous, something's going to happen, focusing on the negative thoughts spinning in your head. If I go to this event, somebody will judge me. People won't. I will have a panic attack. I'm not going to feel good. I'm not going to be able to manage it.

 

Mel Robbins (00:10:33):

If I don't do well in this sales meeting, I'm going to get fired.

 

David Rosmarin (00:10:36):

Sure.

 

Mel Robbins (00:10:37):

Yeah.

 

David Rosmarin (00:10:38):

I'll be gone.

 

Mel Robbins (00:10:38):

If I don't wear the right thing on this date, they're not going to like me.

 

David Rosmarin (00:10:41):

At best. Maybe even worse, never have another date again. Right. This is my only opportunity. I'll

 

Mel Robbins (00:10:48):

Be along. I'll be forever. I mean by best, the thoughts are way worse. I'm never going to find anyone. I'm going to always be the single for blah, blah, blah, blah, blah, blah, blah. Okay, gotcha.

 

David Rosmarin (00:10:56):

And then there's the physiological. So that's something, the sweaty palms, the upset stomach, the labored breathing, and that's really adrenaline, which is going through one system and it creates those cotton mouth. It creates these symptoms that people have and the feeling associated with that foreboding, those kinds of emotions that go along with it. That's the constellation.

 

Mel Robbins (00:11:19):

That's the constellation. Why does this happen? So why does this happen before a test? Why does this happen before a date? Why does this happen if you have a stressful day at work? Why does this happen if you have to see your in-laws and you don't particularly enjoy them?

 

David Rosmarin (00:11:31):

Sure. I'll ask you, why do babies right when they're born let out this massive scream?

 

Mel Robbins (00:11:39):

Is it because they're getting air in their lungs for the first time?

 

David Rosmarin (00:11:42):

And it's kind of new and scary and they've been in this comfortable little bubble for however many months and they're in this all of a sudden, this different environment and there's lights and there's people and there's like you mentioned, and there's a digestion change and heart changes and all sorts of stuff all at once. And a healthy child will go and freak out. And if they don't freak out, what do we say? Oh, exactly. You call in a neurologist, those kids usually don't survive.

 

Mel Robbins (00:12:09):

So what's happening in my body if I am going into work on a stressful day and I feel anxious, how is that the same as a baby crying?

 

David Rosmarin (00:12:18):

You're a healthy person on a stressful day at work. If you're not having a little bit of your hands aren't a little bit clammy and you're not feeling a little bit jazzed up, you don't recognize that there's a task for you to do. There's something important. You may be disconnected from the meaning of your work. You might be disconnected from the relationship you have with your peers. That doesn't sound like a good work colleague. Having a little bit of apprehension and anxiety and nervousness walking into those situations shows that you care.

 

Mel Robbins (00:12:48):

That's a beautiful reframe.

 

David Rosmarin (00:12:50):

It's true.

 

Mel Robbins (00:12:50):

And I think for those of us that are feeling it or we see this present in our children or our partner or a colleague, what is the thing you could say in that moment? Because I think it's those micro moments that we really screw up.

 

David Rosmarin (00:13:06):

Totally.

 

Mel Robbins (00:13:08):

And so what do you do in that moment?

 

David Rosmarin (00:13:10):

I love your specific example of parents and children. Little Jimmy or Jenny comes home, they feel a little bit anxious, and the parent themselves is a little anxious themselves and they're freaked out about the fact that their kid is feeling anxious. So what do they do? Try to put out the fire. They try to calm them down. They try to say everything's going to be okay. They give them reassurance. Say, you don't have to go to school. Don't worry. You don't have to go to that event. We accommodate them as opposed to, oh, you're feeling anxious. That sounds interesting. Tell me more. With no judgment, just to explore it and actually create a more deep connection between parent and child. Ask questions. What is little Jimmy or Jenny afraid of? And why? Is it embarrassment? Are they afraid of messing up and being overly responsible?

 

(00:13:57):

Are they afraid of the physical sensations? Do they feel like a failure? Are they afraid of losing friends? Ask them lots of questions and without trying to change it, don't try to change how they're thinking, how they're feeling, their behavior in any way. Just be there with them while they feel anxious. They just want you to connect with them, turn into a point of connection as opposed to a moment of education. We are missing this fundamental perspective on anxiety, and it's having disastrous consequences for those micro moments. We judge others, we judge ourselves for feeling anxious, and we go down the tubes in a hot second because of it.

 

Mel Robbins (00:14:34):

So even just stopping yourself from joining in and that's terrible and you got to calm down and I'm going to call the school and you don't need to do this.

 

David Rosmarin (00:14:43):

Definitely don't do that.

 

Mel Robbins (00:14:44):

You're just actually making it worse because why?

 

David Rosmarin (00:14:47):

Because you're conveying a message. I wouldn't even say subliminal or subconscious. It's direct. You are directly showing your child something is wrong here and they become afraid of their anxiety as a result.

 

Mel Robbins (00:15:02):

And then when you become afraid of your anxiety, what happens?

 

David Rosmarin (00:15:04):

Then you're done.

 

Mel Robbins (00:15:05):

What do you mean then you're done. Now, you just described 30 years of my life because I lived for 30 years of my life, that being afraid of my anxiety, I started to fear that I would be anxious. So I was anxious all the time.

 

(00:15:19):

So what's the mistake that the person who is listening right now might be making when they're dealing with their own anxiety in life?

 

David Rosmarin (00:15:31):

Misinterpreting it as a problem or a weakness or a disease, or that something is wrong with you as opposed to this is a normal human emotion. And then once we accept that, what do I do with it?

David Rosmarin (00:15:51):

The four steps are as follows, identify, share, embrace, and let go. And I'll explain each one, identify means getting to the root. What are you truly afraid of? Instead of putting it out of your mind, instead of squelching the symptoms, go there, think about it, get to what's actually bothering you. Two. Share. Talk about it with someone else. Open up about it. Make it a point of connection as opposed to sitting in a state of loneliness. Three, embrace your favorite. Do that which makes you feel anxious when you're ready and at a rate that you're comfortable with. But that is the path for emotional resilience. And finally, let go. There are certain things we can't control. Anxiety is always surrounded around control and at a certain point we need to let go. To the extent that you can do that, you've completed the four steps.

 

Mel Robbins (00:16:42):

It seems so simple, which is probably why it works so well. Let's take a kid who has trouble doing a sleepover, which is a very normal thing or even bigger one, a kid who is anxious about throwing up.

 

David Rosmarin (00:16:56):

Happens every day.

 

Mel Robbins (00:16:57):

Well, and my son, even to this day, at the age of 19, Oakley will allow me to share this is afraid of throwing up. Even though he has thrown up and knows that he can throw up, he still will get anxious about throwing up. And it was a huge thing when he was a kid.

 

David Rosmarin (00:17:14):

So if you were here, I would want to know what's the focus of his apprehension? That's a very fancy way of saying what's at the root of his anxiety? Can we identify what is he really afraid of? When you vomit, it's unpleasant. Is it a taste? Is it embarrassing yourself? Is it some sort of just the gag reflex and you just don't like how it feels? But if so, I'd want to know what about it? Did he watch a video once? And there's an association with that video. I would have a whole bunch of questions here to ask with no judgment simply to explore what that situation is so upsetting for him.

 

Mel Robbins (00:17:54):

You know what I love about this is that I so screwed this up. I'd be like, you're not going to get sick. You're going to be fine. It'll happen. There's a nurse at school. Get on the bus. And what you are doing is you're actually slowing down that micro moment and you're going deeper and saying, well, what would happen And what is it really? And when you get to that answer, let's just say it's that I just hate the taste and I hate the pressure on my face and I hate it that it's going to happen and you're not there or that somebody's is going to see it.

 

David Rosmarin (00:18:26):

Hold on. If it's going to happen and you're not there is important. What about vomiting without mom is upsetting? I'd want to know that if that's, I would probe based on what they say. I'm going to probe a little bit further and get like, what about that specifically is going to be upsetting to you?

 

Mel Robbins (00:18:43):

You know I heard our pediatrician share with me that the fear of throwing up is one of the biggest fears that kids have behind their parents dying. And when you hear kids talk about this in your practice, what typically is underneath some of these very common things that cause kids anxiety, whether it's sleepovers or it's separation anxiety or it's throwing up.

 

David Rosmarin (00:19:08):

Yeah. I'll tell you what I often think it is about throwing up. There's an association because the kid threw up at some point and one of the parents cleaned it up and it was not pleasant.

 

Mel Robbins (00:19:19):

So we shamed them.

 

David Rosmarin (00:19:20):

Well, there is a fit of a fear of that. I'm not saying that you did, by the way, the therapist in me really wants to probe for your over-responsibility, kid's anxiety. I'm dying to do that, but I don't want to turn this into a therapy session. So we'll stay on topic with regards to whatever it is though, you want to probe and really get down to the root of it. And I think this is something we can do ourselves.

 

Mel Robbins (00:19:42):

Yes.

 

David Rosmarin (00:19:43):

Right?

 

Mel Robbins (00:19:43):

Yes.

 

David Rosmarin (00:19:44):

I'm going to feel ashamed if I throw up. It's embarrassing. Someone else is going to have to clean it up. And if it's someone else's house and I'm doing a sleepover, it's like someone else's mom and dad, like, ugh. That's a valid fear.

 

Mel Robbins (00:19:57):

Yeah and I also feel like I've heard this definition recently around anxiety that made so much sense to me, and I'd love to hear your reaction. And then I want to get into more examples about the things that you're seeing in your practice with your patients to just normalize the types of not only fears and anxious feelings that people have, but the way they rationalize this stuff in their head and then hold themselves back because of it. And it's this, that anxiety is really a moment of uncertainty in life.

 

David Rosmarin (00:20:32):

Yes.

 

Mel Robbins (00:20:33):

And you doubt your capacity to handle it.

 

David Rosmarin (00:20:35):

That's exactly correct.

 

Mel Robbins (00:20:37):

And because we then start worrying about how things are going to be I'm going to throw up, or the work's going to be terrible, or I'm going to get fired, or this person's never going to love me or I'm never going to meet anybody again. Or if I park in a parking garage on the top floor, then the car is going to roll off and fall to its face and I'm going to,

 

David Rosmarin (00:20:52):

Could happen.

 

Mel Robbins (00:20:53):

It could happen. Probably not. But it could happen that yeah, those things could happen. It's the fact that you doubt your ability to handle it. That gets you trapped in your mind going over all of the what ifs.

 

David Rosmarin (00:21:11):

Well, that's where the next two steps are, the embracing.

 

Mel Robbins (00:21:14):

So let's go to the second

 

David Rosmarin (00:21:14):

Step. Well, the second step is sharing. Okay, sharing your emotions. The core of it with someone else can create connection with someone. Now you have to share with purpose, and there's not everyone in all circumstances, can you share with them If you're sharing with a stressed out loved one who's coming back after a really nasty business trip, or really they're going through a hard time themselves. They might not be able to hear it right now, but sharing it in a certain context and being clear, I need you to validate me. I just need you to hear me out. I'm feeling anxious. I want you to be here and present with me. And then sharing, it can create more intimacy and connection between parents and children, certainly between loved ones, between friends. I've even seen it happen with strangers where people open up to each other like, Hey, I feel that way too. Like instant connection

 

Mel Robbins (00:22:02):

Or on a plane, a friend of ours flew in here, a colleague and had horrendous turbulence, which by the way, if I'm taking what you're teaching us, Dr. Rosmarin, if you're anxious on a plane, that is like riding a bucking bronco. It's a sign that you're mentally well and that your body's working as it should.

 

David Rosmarin (00:22:23):

Yeah. What's wrong with you if you're not feeling anxious?

 

Mel Robbins (00:22:25):

Correct. And he said the woman next to him started hyperventilating. So he held her hand and told her, I'm nervous too, but we're going to be okay and look at the attendance. They're chatting away. We're going to be okay. And so her sharing with him that she felt that way created a complete connection with a stranger,

 

David Rosmarin (00:22:44):

She will never forget him.

 

Mel Robbins (00:22:46):

That's true.

 

David Rosmarin (00:22:47):

Ever.

 

Mel Robbins (00:22:48):

That's true. What's the third step after you tell somebody?

 

David Rosmarin (00:22:50):

Once we share and we're connected to people, embrace the anxiety. This is where

 

Mel Robbins (00:22:56):

Now how the hell do I do that?

 

David Rosmarin (00:22:57):

Face it. Do something that makes you anxious.

 

Mel Robbins (00:23:00):

I don't want to.

 

David Rosmarin (00:23:00):

I know, but you also don't want to go to the gym to build your physical muscles, but you do that.

 

Mel Robbins (00:23:04):

That's true.

 

David Rosmarin (00:23:06):

Why doesn't every school in the United States of America have a mental, emotional agility, resilience building by doing something that makes you feel a little bit uncomfortable? As long as it's safe and it's something that you want to do, do it.

 

Mel Robbins (00:23:21):

Well. So if you're going to embrace your anxiety, and that's the answer which I don't like to hear, I'm just going to say right out. Because if I am a person, we all have this person in our life whose identity has become anxiety, and it is also the thing that they say to opt out. And I have been that person.

David Rosmarin (00:23:59):

Sure. There's this brilliant approach called the five second rule.

 

Mel Robbins (00:24:02):

Oh no, do not turn my work back on me.

 

David Rosmarin (00:24:05):

Am I wrong? No, that's what it is. I'm getting out of bed even though I feel like hell right now. I'm going to do this. I don't want to. I've had people with a fear of snakes. Okay.

 

Mel Robbins (00:24:15):

Okay.

 

David Rosmarin (00:24:15):

I literally have a guy on speed dial who I can. Should I bring 'em in?

 

Mel Robbins (00:24:20):

No, not right now.

 

David Rosmarin (00:24:23):

That's fine. You're not

 

Mel Robbins (00:24:23):

Ready for it. So how do you coach somebody through this? Because you do have a section in your book where you on, let's see here, I marked it actually. It's page 96, facing up to anxiety.

 

David Rosmarin (00:24:36):

Exposure therapy. Yeah. Chapter three

 

Mel Robbins (00:24:38):

Is exposure share therapy the only answer?

 

David Rosmarin (00:24:41):

It's not the only answer. It's a very, very good tool. And when you have clinical anxiety, it has to be part of the picture. If you're not going to face your anxiety eventually it's going to be hard to get over it. But I think it's one step. I think we do have to identify it. We do have to share it. We do have to embrace it. And I think there's something beyond it, but let's focus on exposure therapy for now.

 

Mel Robbins (00:25:02):

Okay, so you're afraid of flying?

 

David Rosmarin (00:25:04):

You're going to fly at some point. When you're ready. We're going to take, by the way, are you more nervous about short hauls or long hauls?

 

Mel Robbins (00:25:11):

Me?

 

David Rosmarin (00:25:12):

No, just let's make it up.

 

Mel Robbins (00:25:13):

Oh, got it. Probably smaller planes.

 

David Rosmarin (00:25:15):

Smaller planes. Great. Perfect. So there's an airline that goes out of Boston, Logan called Cape Air. It's got like seven seats, I think it's eight, and one of them is actually in the cockpit, and I've been in it. It's a Cessna plane. It's basically a minivan with wings.

 

Mel Robbins (00:25:34):

Dr. Rosmarin, I would quit as your patient. Do you actually get people to do this?

 

David Rosmarin (00:25:41):

Sure. I should say I was going to say it's a lot of fun, but not only is it fun for me, it's fun for them. At a certain point, they are embracing their anxiety and saying, I can do this. I'm not going to let it get in my way.

 

Mel Robbins (00:25:55):

What about shyness?

 

David Rosmarin (00:25:57):

Great. Harder to target, tends to be longer term tends to be focused. Also comorbid with depression. People get a lot more depressed. If you're shy, you're more disconnect from others, more isolated, more alone, more sad. So often building that person up first is important. Clinically through more identification and a lot more sharing, not just with the therapist, but also with other people in their world. Sometimes posting on social media, whatever it is, but at a certain point they're going to have to go to the party and not have a martini.

 

Mel Robbins (00:26:31):

Why no martini?

 

David Rosmarin (00:26:32):

Because the martini is an anxiolytic.

 

Mel Robbins (00:26:34):

That's a big word. What does that mean?

 

David Rosmarin (00:26:36):

It's a big word for saying it reduces your anxiety.

 

Mel Robbins (00:26:39):

Temporarily.

 

David Rosmarin (00:26:40):

Temporarily.

 

Mel Robbins (00:26:41):

But then you wake up in the morning with a massive hangover and is the big symptom that you feel.

 

David Rosmarin (00:26:45):

And then you're ruminating about all the stuff that you said that you shouldn't have said because you were a little bit tipsy.

 

Mel Robbins (00:26:49):

What about for OCD? Somebody who's worried about germs, cleanliness, and germs.

 

David Rosmarin (00:26:54):

Great. So let's just say these hands have been in many places that I will not tell you about.

 

Mel Robbins (00:27:01):

Today?

 

David Rosmarin (00:27:02):

Not today.

 

Mel Robbins (00:27:02):

Just kidding.

 

David Rosmarin (00:27:03):

Not today. Don't worry. And I do wash my hands before I eat, but before washing my hands and before eating, you'd be surprised to where these go. Part of being an anxiety therapist means you have to do everything that your patients do also.

 

Mel Robbins (00:27:17):

So what do you do with those really dirty, grimy hands?

 

David Rosmarin (00:27:20):

Okay, so I'm thinking of a specific patient who came in who was terrified of germs and for many years had been avoiding all sorts of situations, really wouldn't open car doors, certainly wouldn't ride the subway, and was at one point putting gloves on their hands. Lots of Purell, lots of excessive washing. Had actually had very significant chafing, even needed some medical treatments in order to be able to deal with abrasions on their hands from all the washing. And really, we started with touching things that would make them feel uncomfortable. Started with things in the office. It could have been as simple as this desk surface. It could have been things that in the bathroom would be next and eventually moving towards the inside of a toilet wall or things that are way over the top that you wouldn't normally do in order for them to develop the resilience to stand up to their anxiety head on.

 

Mel Robbins (00:28:17):

The toilet. So how does somebody get through the uncomfortable feelings that they have while they're doing this exposure therapy with you?

 

David Rosmarin (00:28:27):

The first step is always the same, which is, do you want to do this? Once somebody wants to face their anxiety and build their resilience by deliberately putting themselves in an anxiety provoking situation, once you catch the bug once you want to do it, there's nothing that'll stop you.

 

Mel Robbins (00:28:45):

What if when they first start doing it, they feel so uncomfortable or the anxiety just spikes and they're like, I can't do this. I can't do this. I can't get on that plane. I can't put my hands on the toilet. I can't put my hands on the table. What do you do?

 

David Rosmarin (00:28:59):

So we prep people beforehand. They will think, you will think I can't do this. I'm not going to be able to handle this. My anxiety is going to spike, I'm going to get sick. All of those thoughts are going to be rocketing through your head because that's what facing anxiety entails. That's part of the process, and that is exactly why it's an opportunity to build emotional resilience.

 

Mel Robbins (00:29:19):

How many times Dr. Rosmarin does it take for somebody to start feeling less anxious when they start forcing themselves to do this thing, expose themselves to the thing that they're terrified to do?

 

David Rosmarin (00:29:35):

Often we see a significant drop in anxiety even after once or twice from doing it, but sometimes it does require many, many more repetitions in some ways it depends on how long they've been avoiding situations. If people have been avoiding germs and microbes and all sorts of things for decades, it might take a while for them to get through it, but it's kind of like a mortgage. Eventually you pay it off.

 

Mel Robbins (00:30:02):

What about a parent who has a child who is starting to develop a pattern of not wanting to either go to school or participate in sports or who won't do sleepovers and it's with a family that's safe, it's not some creepy family you don't know and they don't want to do it because they don't want to be there.

 

David Rosmarin (00:30:20):

Fair enough.

 

Mel Robbins (00:30:21):

What about then?

 

David Rosmarin (00:30:23):

When we push kids to do things that they don't want to do? There's a balance and helping scaffold kids that they want to do it, selling them on it, so to speak. Onboarding, we talk about onboarding kids, onboarding teens. Once somebody recognizes this will help build my resilience, this will help make me a stronger emotional person, then they're like, okay, I'm in. And at a certain point with planes, you might be there too. You know what? I want to do this. I don't want this to get in my way in any way. I want to be more fearless in my life. Just like you want to learn how to pump iron or be able to run a marathon or run at a certain time period or time pace or whatever it is. We all have our fitness goals and I think we should also have our emotional goals, but we don't have that.

 

Mel Robbins (00:31:10):

Well, one of the things that I love that you said at the very beginning of our conversation when you made this life altering distinction.

 

David Rosmarin (00:31:17):

Thank you.

 

Mel Robbins (00:31:18):

Now for real sadness is a normal emotion that you're going to feel, and it comes and it goes. Depression is a clinical condition that interferes with your life, that demands and deserves treatment.

 

David Rosmarin (00:31:31):

Correct.

 

Mel Robbins (00:31:32):

Anxiety in terms of kind of chronic anxiety or this fear that you have of things that keeps you from living your full life is very different than being nervous or on edge because the stakes are high or something's uncertain or you really care about doing well. I would imagine there's a tremendous amount of anxiety that you would feel before you take the LSAT or before you are turning in a college application or

 

David Rosmarin (00:32:01):

Going on a first date.

 

Mel Robbins (00:32:02):

Going on a first date. And that's again, in this range of nervousness and just uncertainty, which is a part of life. And what you taught us is in those moments, we literally do the wrong thing.

 

David Rosmarin (00:32:16):

Correct.

 

Mel Robbins (00:32:16):

We either go, uhoh, this is a sign, something's about to go wrong, and it's not. It's just a sign that you're about to do something where you doubt your ability for a bit. And then as the bystander, the friend, the boyfriend, the girlfriend, the husband, the wife, the parent, the grandparent, we literally are either like, oh, you're going to do fine. So we don't acknowledge it or we join in with the anxiety,

 

David Rosmarin (00:32:42):

Oh my God, something's wrong.

 

Mel Robbins (00:32:43):

Yes. Oh, you don't have to go to sleepover. Oh, you don't have to try out for that team,

 

David Rosmarin (00:32:46):

Right.

 

Mel Robbins (00:32:47):

Oh, you can take the test again if you screw it up, and I can see how powerful it is to catch these moments and reaffirm, oh, really? That makes sense that you'd be nervous. Tell me why exactly. Are you nervous about this test that's coming up or I can see why you'd be nervous. Tell me more about the state you're going on. What does that do for a person in the moment?

 

David Rosmarin (00:33:10):

It takes so much of the edge off as opposed to giving me more of a reason to be anxious about my anxiety. It normalizes and makes it so much more manageable. It's just that different framework. It's kind of like having glasses that are different color. It just changes the whole view of everything around you. And by the way, it's not just the parents and the teachers. It actually comes from the medical profession. Something crazy happened last summer, something very unfortunate.

 

Mel Robbins (00:33:42):

What happened?

 

David Rosmarin (00:33:43):

Well, there was a federally funded panel of physicians in the United States who came up with, I think it was in some ways I think was well intended, and I think it was a good idea to screen all patients at their annual PCP visits, primary care physician visits for anxiety. Now, I have no problems with screening people for anxiety, but the way it's done well, the recommendation was to use the GAD two, which is a two item measure. It asks, how much anxiety have you had in the last two weeks, and how much worry have you had in the last two weeks?

 

Mel Robbins (00:34:17):

Well, who isn't going to answer a lot?

 

David Rosmarin (00:34:18):

Well, the cutoff, who's going to say zero to any of those questions?

 

Mel Robbins (00:34:24):

Right.

 

David Rosmarin (00:34:25):

The cutoff was set at a zero, which means any modicum of anxiety or stress over the last two weeks is actually enough to flag a person today in their PCP office for clinical anxiety and treatment.

 

Mel Robbins (00:34:39):

What? Well, I mean, and is that why we've seen all these reports that anxiety from a clinical standpoint is on the rise? Or are you saying that this is more that doctors are now overindexing normal, healthy human emotion into a clinical anxiety setting?

 

David Rosmarin (00:34:58):

It's the latter, but it's actually both. We are definitely over diagnosing lower levels of human stress and anxiety as a pathology as opposed to something normal.

 

Mel Robbins (00:35:09):

I agree with you.

 

David Rosmarin (00:35:10):

Who have you met in the last two weeks who have had no anxiety and no worry?

 

Mel Robbins (00:35:15):

Honestly, no one. And I think it's written about so much, and that's not to downplay the very real rise in, of course, sadness and worry and stress that kids feel and teenagers feel and people in their twenties feel. But I do think we don't have the language, which was why I was so excited about your work because for somebody who had anxiety that did not get addressed this way, I was afraid of it. So I drank myself into the ground. I tried to work myself through it. The second I got chronic anxiety where I would wake up panicking, I then get medicated and I never address the underlying issues and the medication was lifesaving, but it also I think kept me trapped in this place where I was afraid to go off it.

 

David Rosmarin (00:36:13):

Yeah and it could have been at a certain point, you shouldn't have gone off of it. You should have stayed on it and you needed it in order to function.

David Rosmarin (00:36:22):

No. I'll tell you the way I think about it, anxiety occurs on a scale of zero to 10, but really there's no zeros because no one has zero anxiety and there's no 10 because that would be literally catastrophic. So we're left with one to 9, 1, 2, 3 is low, 4, 5, 6 is medium, 7, 8, 9 is high. If you're into seven or eight and a nine, you probably need something professional to take it down to a mid range.

 

Mel Robbins (00:36:46):

And how would you, as a doctor and an anxiety physician therapist, how would you actually categorize a seven, eight, or a nine?

 

David Rosmarin (00:36:55):

If it's getting in the way of your at that level, it's going to be getting in the way of your life. If you're feeling

 

Mel Robbins (00:37:00):

Meaning it's disrupting your sleep, you're avoiding doing what you need to do.

 

David Rosmarin (00:37:03):

Yeah. If you can't sleep because of your anxiety, that's a dysfunctional issue. That's something that has to be addressed.

 

Mel Robbins (00:37:07):

And now let's go with the kind of four or 5, 6, 4

 

David Rosmarin (00:37:10):

Four five six. So that now depends. Some people can function actually reasonably well at a four or five and a six. Six may be less likely, but a four and a five for sure.

 

Mel Robbins (00:37:18):

What would you be hearing typically from someone in your practice if they were saying, I'd say my worry and anxiety is about a four or five or a six.

 

David Rosmarin (00:37:25):

It depends on what's going on. Are an emergency room doctor, are they going through med school? Are they going through a breakup? Are they starting, they have a new baby, then? Okay, people have periods of time where they might ramp up and that actually might enhance their performance. It might enhance their connection. You can use it.

 

Mel Robbins (00:37:42):

The important thing there that I want to make sure that the person listening understands is that what you just identified? First of all, it's the step one that you taught us of identify what's the root cause. And there's a huge difference in those moments in your life where something is causing you to be on edge and you to be nervous and you to be worried and doubting yourself or scared about what's going to happen. Because that to me sounds like there's a situation I mentioned at the beginning of this episode that literally two hours before you walked in the studio, I got a text from a very close friend of mine who said, my daughter is unable to sleep, has crushing anxiety, and then added that there is this massive medical test that she needs to take for med school, which to me said, oh, well, there's thing happening that is high stakes, that explains it. But because my friend has never dealt with this with any of her kids, and because it's really scary when you see somebody who's normally seems like they have it pulled together, truly start to spiral, you don't know what to do.

 

(00:38:56):

And what I said to her is, well, I'm going to tell you something. First of all, it seems appropriate that she's nervous because she has high stakes, but I've got the world's leading expert walking in here and this is the name of his book and you should go buy it right now because I know I screw it up every time I see somebody, even when I know it's situational, I get anxious for them. And so I think it's important to understand that even in your practice, and this is something you can do for yourself and you can do for somebody you care about, you identified, okay, one to nine, how much is this interfering? And no matter what they say in terms of the ranking, you can also say what's going on in your life

 

David Rosmarin (00:39:40):

A hundred percent.

 

Mel Robbins (00:39:41):

And what's the difference between something that is situational versus something that becomes way more chronic?

 

David Rosmarin (00:39:50):

Well, you know that is important. The situational aspect is very important, but how you are sort of engaging in your anxiety, like I said, the four, five and six, are you able to use that level of anxiety in a constructive positive way? Is it?

 

Mel Robbins (00:40:05):

Well, if I'm sitting there with you, probably not. You know what I mean? If I'm going a doctor and I'm like, doc, I am feeling very anxious, 4, 5, 6, I'm not sleeping very well. I don't feel like anybody that even would say a four or five or six feels like they're thriving or able to kind of use it.

 

David Rosmarin (00:40:27):

I don't know. I think a lot of people might be like, Hey, I'm building. I'm an entrepreneur. They're starting a new business. They're having a battle of a time. They're feeling stressed out, might've gained a couple pounds, and they know that they're at a four or five and a six, but they're like, but I'm going to get through this.

 

Mel Robbins (00:40:42):

I can think of periods in my life like that. So what is a one, two or a three when somebody that you're treating says that?

 

David Rosmarin (00:40:49):

So that often we see that as the goal? I'm not sure I do. I think that if firstly with medication, clinicians often over promise and they say, I'm going to get your anxiety down to a one and it's going to stay there. I'm not sure that's even helpful.

 

Mel Robbins (00:41:05):

I love what you just said. What you just said is the goal is not to get to zero.

 

David Rosmarin (00:41:09):

Correct.

 

Mel Robbins (00:41:10):

That if we take as truth, which it is, that feeling on edge and nervous and doubting yourself, normal human emotions, the anxiety becomes a real problem from a clinical standpoint when it's interfering with your life and it is robbing you of the possibilities and the full potential that you have because you're now held hostage by the anxiety and you're scared of it. Well put, if the goal is that we can do simple things to identify what's making you anxious to remind you that you have the capacity to face this, to have you share and connect with other people and to take small steps and go, the goal isn't to go to zero. The goal is just let's just get this to a three and there's some simple things I can do before we go into how do you actually go from the higher end down to the one to threes here?