Paul Winkler: Welcome to “The Investor Coaching Show.” I am Paul Winkler, talking about the world of money and investing. And sometimes we get off the beaten path — as you know, I like to do that.
That’s kind of my thing: To get off the beaten path because there’s a lot more to finances than just investing in the right place.
The Prevalence of Anxiety
Sometimes you have to get your mind right because if you look at the research on people and how they do with their finances, they underperform the market in a big way historically, and a lot of it has to do with the psychology.
And I’m going to tell you, a lot of it has to do with how our anxiety can kick in at the wrong times. We get all euphoric and excited when the market goes up, and then when the market goes down we go, “Oh man, it is going to fall, I’m going to lose everything,” and then we tend to make really bad decisions.
And then, we also have anxieties about how we earn a living. Matter of fact, one of the biggest things that we have anxiety about happens to do with money and our finances.
So actually, I have the pleasure of this hour talking to a couple of friends of mine, Lindsey Casabella and Lauren Combs, and there they are right there. Okay, so ladies, we are going to talk about anxiety. And you both work as counselors over at the Babb Center in Hendersonville.
Lauren Combs: Yes.
PW: Lauren, go ahead, why don’t you give your background? And you have a couple of designations behind your name — I’m big on designations — but what do they stand for?
Lauren Combs: LPC MHSP, so licensed professional counselor, mental health service provider.
PW: Okay. And Lindsey?
Lindsey Casabella: Yes, so I’m an LCSW, a licensed clinical social worker.
PW: Okay. So, let’s talk about, shall we, anxiety.
I was just thinking that there are so many things to be anxious about right now.
People are worried about melting ice caps and they’re worried about politics, going into an election year. They’re worried about whether football is actually rigged or not.
Lindsey Casabella: Right.
Lauren Combs: Yes.
PW: Okay. So either one of you that wants to take this: Define for me what anxiety is and what it leads to. How prevalent is it something that you see? Do you think it’s the number one thing that you see in your practice that people come in with?
Lauren Combs: Yes.
Lindsey Casabella: Definitely, definitely. And actually, I was looking earlier and statistically, it is the number one mental health diagnosis.
PW: Yeah, I think you’re right because with the little part-time stuff I do over there, I think that’s what I see the most.
Lindsey Casabella: Right.
PW: Lauren, how about you?
Lauren Combs: Yes, absolutely. And I think a lot of that too is awareness because of how anxiety shows itself, and I think more people are aware of just the symptoms of anxiety now and they can know that’s what that is. Does that makes sense?
Lindsey Casabella: Right.
PW: And so, from that perspective, a lot of people are starting to self-diagnose. They’re getting out on social media and they’re self-diagnosing and saying, “That’s what’s I’ve got.”
Lauren Combs: That’s another one we’ll have to do next year.
PW: So yeah, let’s spend some time on that. I definitely want to spend a little bit of time on that as well.
What is Anxiety?
PW: Okay, so define it for me, kind of give me an idea of what anxiety is. I have my definition, but I want to see what yours is. My definition, just to throw it out there, is, “I have a fear of the future; I have a fear of what’s coming.” What else would you have to say about that?
Lindsey Casabella: It’s definitely that.
But I would say there’s a difference between fear and anxiety.
I describe it this way a lot. I use this example where I walk into my office. I have an overwhelming fear of snakes, okay? We’ll just use this example.
Lauren Combs: I didn’t know that.
Lindsey Casabella: So if I were to walk into my office and I open up the door and there’s a snake, immediately I’m going to be overtaken by fear, okay? I really don’t know how I would react to that because that has not happened, but I would probably have a couple of different responses. I might either slam my door, run and scream or ask for help. I might freeze.
PW: Fight, flight, freeze?
Lindsey Casabella: Right, yeah. I might slowly close the door.
But let’s say you’re there, Paul, at work, and you’re not really afraid of it, so you come and you get the snake, you remove that perceived threat and the threat is gone. What I might do is go back to work, calm down and just kind of come back to a level place.
PW: So anxiety can be right in the present, not necessarily what’s going to happen in the future, but in a way, I’m afraid of what that snake might do and then how it might affect me in the future, I suppose. But there’s a little bit of both? Okay.
Lindsey Casabella: That’s kind of fear. I come back to that level place and the anxiety kind of decreases — it doesn’t really become anxiety.
But let’s say that I’m so shook up that I have to leave for the day, and I go home and then I begin to think on it and think on it and worry. Then I began to just think, “What if there’s more? What if that snake had baby snakes?”
PW: Yeah, I love what you’re saying there, Lindsey, because I think it’s not only fearing what might happen in a way — and you’re saying that I just might be a little bit freaked out about it or whatever term you want to use — but it’s that I can’t handle what is coming down the road.
Lindsey Casabella: That’s right. So then I begin to think on it and it grows and it grows, and then the next day I might call in because I’m so afraid.
Lauren Combs: Can’t go to work.
Lindsey Casabella: Right, because of that perceived threat. Even though I know that maybe it was removed, the fear has overtaken, and I began to just think and think on it and then follow that with my behaviors or my actions of avoiding it.
PW: Oh, I like that. It’s kind of like the rumination thing.
Lindsey Casabella: Right.
PW: I remember somebody I was talking with about anxiety and depression was saying that 100% — the numbers I mean we can argue about — of depression and anxiety is due to our self-talk and the fact that we keep replaying these risks over and over and saying to ourselves, “I can’t handle it; I’m not going to be able to deal with this.” That’s the rumination part. So that’s really interesting.
How to Deal With Anxiety
PW: So when we’re dealing with these things, okay, what do you do? What are some of the things that you think about in terms of helping people with this? Lauren, what do you want to say?
Lauren Combs: It depends on the age group because I work with much younger kids than she does. I work with six years old and up. So if I’m seeing a kid versus a teenager versus a young woman — that’s my general population that I work with, not couples or anything like that — it really just depends.
It’s a lot of learning about mindfulness and relaxation techniques.
For little kids, I always want to let them know that the more education you have of what’s going on in your body and what’s going on in your mind, in your brain right now when this is happening, it helps you separate from that big scary monster that it feels like.
PW: So a lot of the stuff we talk about, what is mindfulness? I mean, that’s a term that maybe is lost on people. What is it?
Lauren Combs: I think it can be different techniques that are used for a lot of people. It’s grounding, a lot of grounding, a lot of finding a safe place.
PW: Now safe place for some people is like, “What on earth is that?” The attachment idea.
I think Lindsey, you actually referred to that just a second ago in a different way. Do I have somebody that’s going to come in there and come to the rescue, and do I know that somebody has my back and can help me take care of things? A lot of people don’t have that.
But it’s having somebody there with you. I know there was a study I remember where you had two people, and they didn’t know each other, and the one was there by the person’s side and they responded to the threat completely differently than if the person had somebody that was there very familiar to them right by their side.
Lindsey Casabella: Yeah, comfort.
PW: Yeah, yeah, if you have somebody that you know. And they actually measured bodily how your responses were to threats. So I think it’s really important. I think that leads to thinking about how much we have people around us and making sure that we are surrounded with people and that we have a support network.
Lauren Combs: Yes.
Lindsey Casabella: Oh, definitely.
PW: Because people are isolating nowadays more and more. You want to talk a little bit about that? How we just don’t have that? Have you found that it’s as people get older or is it in general that people are isolating more?
Lauren Combs: I think COVID too really did a number on it. Not only kids were worrying about that. They already have those pressures of friends and everything, but that doesn’t go away when we grow up; we still can struggle with needing community, obviously.
But I think COVID really did a big number on a lot of anxiety and also people feeling like they’re connected to others. And then we have social media too — that’s a whole other way people feel connected within.
PW: Yeah, but very disconnected at the same time because it’s fake connection in so many different ways.
Lauren Combs: Yes, yes.
Feeling Anxiety and Stress in Your Body
PW: Now you mentioned Lauren, you were talking about feeling it in your body. Some people have stress and they don’t recognize that it impacts a lot of the diseases that we have. I was blown away by ACEs — adverse childhood experiences.
Lauren Combs: Yes, yes, the higher your score.
Lindsey Casabella: Yes.
PW: And diabetes, heart disease, cancer tumors and those types of things. But talk about a little bit more what you’re talking about when you say that.
Where do you express it and why does that matter if you recognize that? Why does it matter for you to actually identify, “Where am I kind of feeling this stress?”
Lauren Combs: Yeah, we were actually talking about this the other day, how we see so much, I don’t know if you want to say it at the same time too, but so much fear surrounded by the bodily — whether that’s they get nauseous, they’re hyperventilating, they’re shaking, crying, just the different symptoms that you can have. But we were talking about how common it’s been, that we’ve been seeing a lot of the fear of throwing up or people who struggle with anxiety, just having that fear.
Lindsey Casabella: Right, the fear.
Lauren Combs: That’s the body.
Paul Winkler: The mind-gut connection?
Lauren Combs: Mind and gut, yes, exactly.
Lindsey Casabella: And the fear of the actual body sensations of anxiety, which no one wants, right?
PW: So they fear it. And then it’s kind of like what I heard somebody talking about regarding anxiety the other day, and I thought this sounds like maybe what you’re saying. Sometimes what we do is think, Don’t think about it, don’t think about it, don’t think about it.
And what happens when you say don’t think about the thing that you’re fearing, is your brain says, “Ooh, this must be really bad. My host, the person, is telling me not to think about this.”
So in essence, one of the things that you guys do when people come and talk about these types of things, is you give voice to the things that I’m worried about and that helps people overcome some of those fears and anxious types of things that they’re going through.
Lauren Combs: As well as give education. So if you have someone who knows what’s going on in their body, they can go, “Oh, I can separate my brain and anxiety brain, so to speak, of what’s running the show at the moment.” Because then it doesn’t feel like, “Oh, it’s just me, and I’m crazy.” That’s what people say.
Lindsey Casabella: Right. And then we help them to learn that you actually can do something about the body and to realize what is happening from the anxiety.
Because anxiety is a disorder where you feel completely out of control sometimes.
So we’re just helping someone to understand and take back some of that control, that there is a very neurological piece to anxiety, but there are parts that we can control and work on through.
Mindfulness and Learning How to Breathe
PW: How? I got to know how.
Lindsey Casabella: Through learning how to breathe. And that seems so simple. Sometimes I feel like a lot of people just kind of roll their eyes at that like, “Oh yes, the whole mindfulness, the whole breathing thing, right?”
PW: Right. Yeah, I get it, yeah, I get it.
Lindsey Casabella: Right, right, but there is so much science; it’s so much deeper than that. So learning how to just properly breathe and learning how to recognize the things that often trigger anxiety, and then learning how to recognize the first kind of symptoms, what’s happening in your body, and learning then how to cope with that, and put in tools that we often teach, that helps someone to get a sense of control back.
PW: Okay, so when we talk about how to breathe, people say, “Well, why is breathing a big deal?” Just if you think about it, you don’t think about it.
In other words, when it comes to breathing, you don’t think about it, and when you bring it to the conscious thought, it actually has an effect on overall anxiety because you’re taking something that is typically not something you’re ever thinking about and making it conscious. But when you talk about breathing, what kind of things would you be telling somebody to do that help with anxiety in general?
Lindsey Casabella: Well, the first thing is, I hear this a lot, “When I’m in the middle of panicking or anxiety, breathing doesn’t work for me.”
PW: Yes, yes, address that, really seriously go.
Lindsey Casabella: So one thing that’s important is learning how to practice these things when you’re calm, learning to implement them not in the moment, but when you’re actually in a state of feeling calm.
Because if you practice them in that calm state, you’re much more likely to naturally implement them when you’re feeling heightened.
PW: And be less likely to get to that heightened state, is that what you’re saying?
Lindsey Casabella: Right, right, exactly.
PW: Go ahead.
Lauren Combs: Because it feels more natural; it feels more comfortable. Of course, if you’re in the middle of a huge panic attack and you’re at a 10, so to speak, you’re not going to feel comfortable trying to focus on your breathing in that moment. If you haven’t practiced it, it’s going to feel weird, it’s going to feel odd, versus something you’ve practiced.
PW: Right, that makes a lot of sense. So let’s say that you’ve done that, you understand a little bit about breathing.
PW: I guess you probably should give some tips that you typically give people on breathing.
What would those be? What would some of the tips that you would give people who say, “I know how to breathe, come on. What are you talking about? I’ve been doing it my whole life.”
Lindsey Casabella: Well, I think for me, one of the most important things that I like to teach is that you always want — when you exhale, when you’re breathing — to get a deep breath that’s not shallow, but all the way down deep in your diaphragm.
PW: So make your belly go out?
Lindsey Casabella: That’s right, that’s right.
PW: Ladies, you’re not going to have that little tiny stomach that you want when you’re doing that, but breathe out from there, sure.
Lindsey Casabella: But one of the important things is the exhale needs to be longer. You want that to be slow and much longer.
Challenging Anxious Thoughts
PW: Yeah, and I think about that as you say that one of the things that I’ve had people do is challenge the things that they are anxious about, the things that they’re thinking about, the negative thoughts, start to challenge that. I’m sure you guys do that.
What does that look like? Just give me an example of how you might have somebody challenge something.
Lauren Combs: Coming from a therapy perspective, like using CBT, or do you want me to break that down?
PW: Yeah, let’s use CBT. Yeah, cognitive behavioral therapy. How do you challenge them? Yeah, for sure, yeah, let’s use that as an example.
Lauren Combs: Again, it depends on the age that I’m working with. Okay, let’s say it’s a teenager or a young kid, I like to go through and go, “Okay, let’s get a list of the things that really trigger your anxiety. What is a five?”
PW: Have them write it down, number one. And then have them do a ranking of it from on a scale of one to 10.
Lauren Combs: One to 10.
So then I know, “Hey, when you were talking about this one situation, is that a five? Is that a seven? 10? Where are you at with that?”
That helps me to know — no one else is in their shoes but them — what is their ranking of that? How much fear is coming up for them, anxiety and panic?
PW: So come up with a thing that you’re worried about and start there. Say it’s a listener and they’re thinking, “I’m worried that the stock market is going to crash and I’m going to lose all my money and I’m going to be living under a bridge someplace.” Let’s use that as an example because people do generally worry that everything is going to fall apart, and they’re going to lose all their money.
Lauren Combs: Fortune telling error, right?
Lindsey Casabella: Yes, that thing, yes.
PW: Yeah, go. So you would walk them through it how?
Lauren Combs: Do you want to go with this one?
PW: Or do you want me to go with it? Well let me just start you off because I don’t want you to walk into how the market works.
But number one I would think of is this:
What are the odds of this thing that I’m worried about happening? What would it take for that to happen?
And I’ll give a practical example. I don’t know if you guys come up with anything else, but when people worry about the stock market crashing, I go, “Okay, so you own 30,000 stocks in your investment portfolio and you’re worried about 30,000 companies all around the world in every country around the world simultaneously going bankrupt.”
And if they do, that means earnings have gone away. If earnings go away, then taxes go away. If taxes go away, then the government goes away. And if the government goes away, then the FDIC goes away and your CDs are worth nothing.
Lauren Combs: It’s connected.
PW: But you see where I’m coming from?
Desensitizing and Exposure
PW: So yeah, give an example from your world of what you would do with somebody that is maybe worried about something else, maybe a teenager that’s worried about failing a test or something like that. How would you walk them through that fear and that anxiety about their possible failing out, and then what happens next? Go through that.
Lauren Combs: Right. No, I love that point you made.
I like to go through and, if it’s a teenager struggling with that, to almost desensitize by going, “What’s the worst that could happen?”
And I know that sounds really simple, but you need to be also walking through a professional who knows what they’re doing with that to help you with relaxation coping skills and helping you calm at that moment to learn to do that to use at home.
Because if not, then your anxiety starts thinking, Oh, the stock market’s going to crash. It starts getting really high.
PW: I really like the word you just used, desensitize, I think it’s absolutely major.
Lindsey Casabella: I agree.
PW: Go ahead, Lindsey.
Lindsey Casabella: I agree. Because one thing I love CBT, one of the parts that I love about it, is somewhat the exposure part.
Lauren Combs: Yes.
PW: Yes, yeah, it’s exposure. And just to give you an example, folks, of what she’s talking about there, I’m afraid of spiders so you go little by little. Go ahead.
Lindsey Casabella: That’s right. So I go back to my beginning example of my snake. If I go home and I continue to just let that build and build and build, and I don’t come to work the next day, and the thoughts continue to just build in my mind, then I end up just saying, “I can’t do this. I quit my job.”
Lauren Combs: Yeah. “I can’t go to work.”
Lindsey Casabella: “I can’t go to work.” Then I am just reinforcing that anxiety over and over and over.
PW: “I knew I should have been scared of that.”
Lindsey Casabella: That’s right. Let’s say I do it afraid. The next day I get up, I may be very worried about opening that door.
But I go in, I sit down. I may be very hypervigilant the rest of the day, on edge, but I make it through that day. I’ve done it afraid.
PW: I just thought it’d be kind of fun to talk a little bit about anxiety because we’re going into a year where there’s a huge amount of anxiety, with so many things to worry about — what’s going to happen, who’s going to be president, who’s going to be vice president? Oh my goodness, who’s whatever, there’s so much stuff. And then what’s going to happen to the stock market? And people worry about all of these things, and I thought it’d be nice to have some tools.
So we talked about cognitive behavioral therapy for dealing with anxiety and the idea that so often our anxiety comes from the middle part of our brain, which is the emotional part of our brain, and we’re trying to engage the front part, which is the thinking part of the brain in what we do.
Feel the Fear and Do It Anyway
PW: We were talking a little bit about how with exposure, what you’re doing is running the person through — for lack of a better word — I’m going to call it a “what if” scenario. So talk a little bit about that.
Lindsey Casabella: Yeah. Going back to kind of what I was saying, if I am afraid and I begin to avoid something, I’m reinforcing the anxiety.
PW: “It must be really, really dangerous because I’m avoiding it.” Yes.
Lindsey Casabella: That’s right.
So I tell clients this all the time: Sometimes we just have to do it afraid.
Lauren Combs: Yes. I love that.
Lindsey Casabella: They’ll look at me and say, “That simple? Do it afraid?” And I’m like, “Yes, sometimes we just have to do it.”
PW: Feel the fear.
Lindsey Casabella: Feel the fear.
PW: And do it anyway.
Lindsey Casabella: And do it anyways, because you begin to desensitize yourself. The more that you do that — going back to my example that I was continuing to talk about with the snake, if I show up the next day to work, and I might be really afraid, but I make it through that day, and I come back, I do it the next day, I do it the next day, a month down the road — that fear is probably going to be gone.
PW: It is extinguished.
Lindsey Casabella: That’s right.
PW: So real life example, ready for this?
Lindsey Casabella: Yes.
PW: I was worried about a leak under the house. I don’t know if you’ve ever gone in the crawl space under a house.
Lindsey Casabella: No.
PW: You got spiders, you got snakes, you got rodents. Lord only knows what’s under that thing.
And true story, about a week ago I did this and I went in, I was about 20 feet in, and I was looking and going, “Oh man, that’s a long ways.” I had to go 30 yards, no exaggeration, to get to where I had to go to.
I’m seeing ductwork, I’m going, “That ductwork is really low, Paul, just keep going, keep going.” And you’re right, that’s exactly what happened. I kept telling myself, “Feel the fear and do it anyway.”
By the time I was done, I wanted to go under there again. I was like, “Wow, this isn’t nearly as bad.” But it’s funny, we don’t think about that. If we face the fear, the fear dies.
Lindsey Casabella: Right, that’s right.
PW: So, so true. So that’s a good one. Now, on to the “what if” kind of thinking.
Who is coming up with this “what if” scenario? Who’s coming up with these things? Are you telling the person what they’re afraid of? Walk through that.
Lauren Combs: No, no.
Lindsey Casabella: Right, no.
PW: What’s going on there?
Lindsey Casabella: Definitely the client.
Lauren Combs: Yes. Everyone’s different; everyone’s fear is different. But I also want to echo that with a lot of anxiety, there are certain things that are big fears for a lot of people; they’re not alone in that. For example, again, I had mentioned earlier a fear of maybe embarrassing themselves by getting sick in public.
PW: I think that I looked up the top 10 things that people are afraid of, you ready for this?
Lauren Combs: Please tell us, yes.
PW: Yeah. You got money and finance as the number one.
Lauren Combs: Is it?
PW: Yep, money and finance. Health and safety of loved ones was number two. Job and career worries was number three. Relationship problems.
Anxiety and Depression
PW: People fear fear, they fear anxiety and depression.
Lindsey Casabella: Definitely, definitely.
PW: And so what’s the relationship between anxiety and depression? Because we see a lot of depression right now. What is it and what are you doing to deal with that?
Lauren Combs: Yeah, I was going to say, they have what’s called a high comorbidity. So if you have anxiety, you’re much more likely to have some depression in there and vice versa.
But you have to think if you’re at a 10 — like I was referring to that thermometer, kind of where we’re at — if you’re at a 10 all the time and you’re so anxious, you’re not able to be very present and living your life.
Your body’s in overdrive, your mind’s in overdrive, and that in turn starts to affect you both in your physical self and in your mental self.
PW: And it affects relationships too.
Lauren Combs: Absolutely, yeah.
PW: It’s thinking about your own anxiety when it becomes hopeless, becomes depression.
Lauren Combs: Yes, and then it just goes from there.
PW: And from depression, it can become apathy. Look at how much apathy we’re seeing right now. “I don’t care anymore, I don’t care about anything.”
Lindsey Casabella: “I’m a burden.”
Lauren Combs: Yeah, I hear that one all the time.
PW: Do you really?
Lauren Combs: Yeah, yeah, really sad, yeah.
PW: Oh, if you’re a parent, you’re dealing with that. Okay, you just hit something right here.
What are you saying to your kids when you hear that kind of thing? Because kids feel that way. And what kind of a message would you want to tell a parent who might be dealing with that, where their kid’s dealing with anxiety, depression concerns?
What types of things are you talking about how to deal with this? What would you do?
Lauren Combs: Yeah, if we get to that point and they’re saying those kinds of things, that’s when I definitely say, “Hey, it’s time to get a counselor, someone who knows what they’re doing, how to treat this, and to walk alongside this person.”
Especially if let’s say it’s a teenager. If they’re every day affected so deeply by this and you’re noticing personality changes, maybe their sleeping is off, their eating is not how it was, that’s definitely a time to go, “Hey, we need some professional help.”
PW: So a couple things, I’m going to take a break and I want to come back, and then one thing I want to have you guys talk about is when you go to meds, number one. Number two, because a lot of people have never done counseling, another never have gone through the process — what is the process like? I think that would be really helpful because we fear that which we don’t understand, right?
Lindsey Casabella: Yes.
Lauren Combs: Yes, yes, stigma.
PW: And a lot of people even fear talking to anybody because they think it’s something different than what it really is.
Those of you that know me know that I decided to go get a Master’s in Psychology and Marriage and Family Therapy because I just think it’s cool stuff, and I think it’s really, really helpful. Matter of fact, for the Certified Financial Planner designation, they require psychology now because one of your biggest issues with money happens to be psychological in nature. So that’s why we’re talking about this.
PART 2
Paul Winkler: All right, we’re back here on “The Investor Coaching Show.” I’m Paul Winkler, here along with Lauren Combs and Lindsey Casabella from the Babb Center in Hendersonville, Tennessee, talking about anxiety and the things that we are anxious about, leading to depression for some people and leading to apathy and just leading to all kinds of bad things.
But it’s probably the number one thing that we see today. Lots of things to be worried about.
When Medicine is Prescribed
PW: So talk about when you go to medications. Because a lot of people say, would you just take anxiety medications to deal with it or what?
Lauren Combs: Yeah. And I’m really glad you asked that. Every provider’s different — obviously we specifically cannot prescribe medication, but we can say, “Hey, here’s our observation, as professionals, of what we see.”
The age, too, makes a big factor for me. Working with young kids all the way up to teenagers, because I understand. And I think coping skills, let’s try all that out.
I also want to say, “Hey, when’s the last time you’ve been to your doctor? Let’s check out everything medical, right? Let’s rule that out.”
Lindsey Casabella: Yes.
Lauren Combs: And then, we work on coping skills. If we get to a place where maybe we’ve improved some, but then some really big event comes up, and we are triggered by it really bad, and we start taking maybe a few steps back, in the sense of our anxiety increases and increases and increases, that is when I would say, “Okay, it’s interfering with our day-to-day life.”
Let’s go back to your example with the snakes. You’re going to lose your job, but you’re not able to go work.
PW: So you can’t function.
Lauren Combs: You can’t function.
PW:
Literally, you can’t function, and you’ve got to do something to jumpstart you out of that, just so that the therapy will work.
Lindsey Casabella: Right.
Lauren Combs: Right.
PW: Right. Because therapy doesn’t even work if you’re so far gone.
Lindsey Casabella: That’s right.
PW: It’s kind of what you’re saying it sounds like.
Lindsey Casabella: Yes.
Lauren Combs: I always say it’s like, and obviously I’m speaking, not showing, but I always say, “You are in the center, right, and everything else is a ripple effect that is going to be impacted if your anxiety’s at a 10 at all times.”
PW: So you may just wait and have somebody talk to somebody about medications when they’re just not functioning. They’ve got to get to a place where some of the previous things that you talked about, the CBT and those different types of therapy models, actually will start to get them out of it. So that’s one thing.
Fears About Medications
PW: Then when we’re looking at the medications, you’re not going to be prescribing; somebody else is going to be prescribing. There are probably fears that people have that they’re going to get hooked on it.
Lauren Combs: Sure. Sure.
Lindsey Casabella: Right.
PW: What are the fears that people have when putting their kids on medications, and typically how do you deal with that?
Lauren Combs: Yeah. A lot of teenagers obviously have them. It’s an age where your moods are kind of all over the place.
PW: Yeah, for sure.
Lauren Combs: And I know a lot of parents voice, “Well, I’m afraid this is going to make them worse.” And I understand that.
I tell every parent, I say, “Go to their doctor. If we’ve ruled out medical, if we’ve done coping skills, we’ve tried what we can do, go to your doctor and just ask them questions, specifically about medication and your fears. Sit down with them because you have the right as their parent to make sure that they’re safe.”
We have seen — obviously research shows, especially for anxiety — therapy along with medication together can be so, so life changing.
PW: So maybe it’s just a short term thing.
Lauren Combs: Sure.
PW: And that’s why you actually do it, is because it’s very short term. It’s just to jumpstart them, is the word I’d like to use. Just to get it going.
Lauren Combs: To get us back to your office. That’s right.
PW: You don’t leave the cables. You don’t leave the jumper cables on the car forever. You just put it on there for a short period of time.
You take them off when the car starts, and you’re good. You don’t have to leave them. Yeah, so that makes a lot of sense.
Meditating and Practicing Gratitude
PW: You’re talking about anxiety. We’re talking about how do you deal with that, what it is. We talked a little bit about things that people are anxious about and then talked a little bit about exposure and all of that good stuff.
So what are some other tips that you guys want to talk about for things that you tell people to do when they’re dealing with anxiety? What are some of those things?
Lindsey Casabella: Well, one thing, we’ve talked about is the breathing and then mindfulness, and a little bit of meditation. We have not talked about that piece.
PW: Yeah. People think in meditation, you’re sitting in cross leg position.
Lindsey Casabella: Right.
PW: And you’re going, “Hmm.”
Lindsey Casabella: Right.
PW: Yeah. So what is it in your world?
Lindsey Casabella:
Really, it’s just anything that you can do — and I kind of tie it in with mindfulness — to practice being present in the moment.
So that may be as simple as, when you get in your car, you pay attention to putting your seatbelt on.
Notice the click of the seatbelt. Just feel what the steering wheel feels like. Turn the air on, feel the air.
Just simple things. When you’re eating, slow down.
PW: Five things you see.
Lindsey Casabella: Right.
PW: Four things you hear.
Lindsey Casabella: Five things you see, hear, smell, those things. And there again, implementing those, just throughout your day over time really changes your brain. It changes so much.
PW: I really like the way you put that. It’s noticing when you’re doing that.
Lindsey Casabella: Right.
PW: And then when some thought comes into your brain, you notice it. It’s like, “Oh yeah, I’m thinking that again.” Talk about that a little.
Lindsey Casabella: Well, one thing that I was going to say that I also do, because we’re a Christian-based counseling center, I also go to scripture a lot and talk about meditating on scripture. There’s so many scriptures that reference anxiety. And so, one that I often go to is, “Be anxious for nothing, but by everything through prayer and petition…”
PW: Yes. Yes. Yes.
Lindsey Casabella: Right. “…with thanksgiving, make your requests known unto God.” And I think that the important piece there is with thanksgiving.
PW: Oh yeah, yeah, yeah. Yes, yes, yes.
Lindsey Casabella: Right.
PW: That’s really good.
Lauren Combs: And gratitude.
Lindsey Casabella: Right. And so begin to journal, just daily things that we’re grateful for and really practice gratitude because it really begins to decrease anxiety when you are beginning to daily look at the things that you’re grateful for. So gratitude is a great thing to really implement and begin to work on.
PW: And again you mentioned that. I’m thinking about Viktor Frankl, “Man’s Search for Meaning.”
Lindsey Casabella: Yes.
PW: Think about questions like, what am I here for? What can I do for somebody else?
Lindsey Casabella: Right.
PW: Because so often what we do is we get so involved in ourselves.
Lindsey Casabella: Self, right.
PW: And thinking about what’s going on with me.
Lindsey Casabella: That’s very important, beginning to get out of ourselves. It is really helpful. You’re right. You’re right.
The Impact of Exercising
Lauren Combs: Yes. Going to get in a hobby, exercising.
Lindsey Casabella: Yes.
PW: Yeah. Talk about that. Talk about that.
You said exercising. Why is exercising such a big deal? I’m all into exercising.
Lindsey Casabella: Yes.
Lauren Combs: Yes.
PW: But why is it such a big deal?
Lauren Combs: Yeah.
It’s that increase in your dopamine in your brain. It’s reducing cortisol, which is a stress hormone.
You’re usually outside or around other people.
PW: Cortisol is one of those things that can have such a terrible impact. We were talking about the health issues with anxiety, and when you have a lot of cortisol streaming through your bloodstream, which is where you get anxiety, and then you end up with a lot of that, it can have such a horrible impact on so many of your different organs and vital functions and things like that. Yeah, that’s a big deal.
Lindsey Casabella: Right.
PW: So exercise, weightlifting is great. Anything weightlifting because you can really just get aggression out. But running or whatever, anything, aerobic exercise, anything like that is great.
Lauren Combs: I say find your thing.
PW: Yeah, find your thing.
Lindsey Casabella: Right.
Lauren Combs: Cycling, if that’s it. Rock climbing, whatever it is.
Lindsey Casabella: And when you engage in regular exercise, it actually increases the heart rate and gives you a lot of the same feelings and symptoms that anxiety does. And so at that point, we’re beginning to learn how to tolerate anxiety even better.
PW: Oh, Lindsey. You’re killing it. Because the thing I was just thinking about as you were saying that is that anxiety and excitement are two sides of the same coin.
Lauren Combs: Right. They’re the same thing. That’s right.
It’s just, how are we labeling it? You’re right. You’re right.
PW: Yeah. I can say I’m excited, actually. And then it has a whole different feel to it, doesn’t it?
Lauren Combs: Yes.
PW: Yeah. That’s super good.
Hobbies Save Lives
PW: And then you talked about, Lauren, you said hobbies. Go. What about hobbies? Why is that such a big deal?
Lauren Combs: Oh, it gets you involved. A lot of people have really high anxiety — and understand that social anxiety is huge right now. Again, we could go in the whole other topic with that.
But it gets you out. It gets you around other people. You meet friends at a gym.
PW: That’s a big thing. Social anxiety right now. The online thing, we haven’t even really talked about the online thing.
Lindsey Casabella: That’s a whole other topic.
PW: It’s going to be a whole other show that we’re going to have to talk about that. How do you get kids away from social media? How do we get ourselves away from social media?
Lauren Combs: Right.
Lindsey Casabella: Oh, right.
PW:That’s going to be a whole other deal. We’ll talk about that.
But yeah, hobbies being a big thing. I love the phrase, “Hobbies save lives.”
Lindsey Casabella: Yes.
PW: Just because we can get in and we can lose ourselves in it, and then we can stop thinking about the things that we’re worried about.
Lindsey Casabella: Right.
PW: I think that’s a really big deal.
Lindsey Casabella: Well, I think for hobbies, it goes back to the whole mindfulness piece.
Lauren Combs: It does.
Lindsey Casabella:
Because when you’re engaging in a hobby, you’re fully focused, your attention is on that and it has that calming effect.
PW: All right. Wow. Yeah. So I’ll tell you what, we could have gone for another hour.
Lauren Combs: Yes.
Lindsey Casabella: Yes.
PW: Easily for two hours, three hours, four hours.
Lindsey Casabella: Easily.
Lauren Combs: Easily.
PW: Oh, man. So Lindsey Casabella and Lauren Combs from the Babb Center in Hendersonville, Tennessee. They are two phenomenal therapists.
And we didn’t even get into some of the stuff that you guys do, which you guys do some really specialized work that makes me just go, “Whoa, what is that you’re doing?” It’s really, really good.
So if you want to look these ladies up, you can go to babbcenter.org, and you’ll see their pictures there. As I said, it’s Lindsey and Lauren.
And the thing that you could do is just call up there and you see if they have availability on the schedule. We talked a little bit about therapy. What is it? It’s not that scary.
Lauren Combs: Right?
PW: You walk in. You’re hanging out with somebody. They’re just finding out who you are, your backgrounds, because history doesn’t repeat, but it rhymes. You look at your family history,.and then you get to talking about things and you can share stuff that you don’t get to share anywhere else, and it really super helps people get through these things.
So I just wanted to introduce my audience to them. Lovely having you here. We’ll do this again.
Lindsey Casabella: Thank you, Paul.
Lauren Combs: Thank you so much for having us.
Lindsey Casabella: Thank you.
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