 Okay, here we are, once again, switching sides this time. Yep, just trying to keep it fresh. On my left now. But we're correct now, we're fire and ice. Oh, no, we're not fire and ice. The people gonna, you'll see, that's gonna catch on, people are gonna start to know us that way. The fire and ice of anxiety. Yes, I know them. I got a fire and ice tickets for Friday night. Anyway, I feel like with a name like that, we're gonna disappoint people, but that's fine. We'll disappoint everybody. There's no doubt about that. I think, anyway, welcome back guys to my left or whoever. It's Lauren Rosen at the Obsessive Mind on Instagram, my friend and now frequent collaborator, which is freaking awesome. Just so fun, I love it. Yes, actual best working therapist in LA. That's right, yeah, just south. And this to my right is Drew Linsolata, The Anxious Truth, the.anxious.truth on Instagram. And he's amazing, if you're coming from my page, go follow him. He's got a podcast, he's, you know, great books. He's very, very prolific in his offerings. First official day of grad school too. It was? Initial first day, yes. How was it? I do not want to cite any more papers that talk about nature versus nurture and anxiety and depression. I'm done. I'm done for today, that's it. Okay, for today, I was like, I've got bad news. Yeah, you're doing this for the next two years. Yeah, there's a lot of citation in grad school. Yeah, it's true. Yeah. Anyway, today we're going to talk about health anxiety because people have asked us to talk about it. Here is what I'm going to throw this at you right away. We have not pre-discussed this. We have no idea we're going to talk about. So I'm going to put Lauren on the spot immediately. Health anxiety in the DSM is not OCD. I know. I don't like the DSM. Can I be honest? I just was. I'm okay. You can stay with me. You just were, exactly. So yeah, it's not even an anxiety disorder in the DSM. In the DSM 5, I think it's in with the somatiform disorders. I think that's the broader category. I'm not positive on that because it's not typically something that I look into. I don't see a lot of other disorders in that realm, but of course I see a fair amount of health anxiety. But this is the problem with trying to categorize things is that we end up putting things into boxes that in many respects probably do make sense. And I'm sure that based on the research and the people who create the DSM, it does make sense. From a clinical vantage point, the idea that health anxiety and OCD are not part of the anxiety disorders is beyond me. That makes no sense to me at all. Mm-mm. No. I don't claim qualifications yet in this, but it doesn't look much different to me. The person who has health anxiety seems to exhibit all of the same issues. There's an obsession and there is just a slew of compulsions that feed that obsession. Right? But I guess my question to you is, I have some pretty strong feelings about this, but do you see a big difference between people with panic disorder and agoraphobia and OCD? Do you see a big difference with people with generalized anxiety disorder and OCD? No, I mean, I think in the end, it all is the themes are always the same. There's tension and release, tension and release, tension and release. That's really in the end, but I mean, you could probably argue that all of life is that. But yeah, I think no, I don't see a lot of difference. The specific fixations and the specific fears, that's the difference. Totally. It's like they're all particular phobias, basically. Yeah, I would agree with that. I would agree with that. And I guess maybe health anxiety would be a little more specific than panic disorder or agoraphobia, like non-specific phobia, but nonetheless, this is just splitting hairs. Yeah. And maybe health anxiety is a little less specific than something like arachnophobia, which is very narrowly focused or any of the like a metaphobia, which is very all about fear of throwing up, right? Like that's super narrow. And then to your point, like we get broader with things like panic disorder and agoraphobia and OCD, it's just, you know, again, it's often very specific things. So generalized anxiety, it'll pick on, but it's the same cycle. And I think maybe talking about that would be helpful for people who are listening to better appreciate how this relates to OCD, because of course there are so many videos about OCD out there, probably a lot more than health anxiety. And seeing the relationship between all of these things helps you to listen and pick out things that resonate for you. Yeah, that's a great conversation. The thing that I get all the time, since I'm generally the panic disorder and agoraphobia has been my wheelhouse and the health anxiety folks and the OCD folks and the GAD folks will say, yeah, but what's my recovery plan? What's my plan for health anxiety? I don't have to worry about driving on the block, I can do that. So they miss the principle that says, yeah, but your discomfort comes from not doing things as opposed to doing things. So you have to start not doing things. So if I walk in the door and present with health anxiety for you, what is my plan? Let's answer that question because people ask me all the time. They're probably tired of hearing me answer it. Well, no, I love that. That's such a great question. So somebody comes in and they have, let's say, anxiety about whether or not they might have cancer. And they've been to any number of doctors who have all said definitively, no, you don't currently have cancer. And yet there is this huge fear that keeps coming up for the person. The way that I'm gonna conceptualize that with them and I'm essentially in the first session, I'm gonna lay this all out for them because I think it's important that they understand this is that the whole process starts with a trigger. So, and that can be an internal trigger or an external trigger. You're walking along, minding your business when all of a sudden an image pops into your head of you laying in a hospital bed and then all of a sudden you think, oh my gosh, but I forgot, what if I have cancer? You might also have a physical sensation which is where this starts to appear a lot like panic disorder, agoraphobia. You might feel, I don't know, like a pinching in the area of your lungs and think, oh my gosh, what if that's lung cancer? And, or you might be walking along and see a sign for cancer treatment and all of a sudden, again, that thought pops in, oh my gosh, what if I have cancer and I don't know it? And this, of course, elicits a great deal of anxiety for somebody with this particular condition, the uncertainty and the doubt that are generated by this unknown make people feel very uncomfortable and so they do compulsions and compulsions are also known as safety behaviors and those things in my estimation are almost identical. The idea is that, okay, if I think about this, if I ruminate about this, if I try to feel and check my physical feelings and make sure that they're normal, if I call the doctor or if I avoid the doctor, if I call a friend or a family member who was with me at the last doctor's appointment who can reassure me, if I, let's see, I'm trying to think of anything else. If I take this supplement or this pill, this will prevent me from having cancer develop or whatnot, which it gets messy because of course, people do take supplements and do things to prevent, but it's when it becomes excessive. And there's the pervasive, if I Google this and I research enough about it, I can be sure that I don't have it. Yes, yep, that's a good one. Dr. Google to the not rescue, actually, as the case might be. Anti-rescue, yeah. Yeah, so yeah, so there are all of these things, these behaviors that people do, this is by no means exhaustive and people get very creative and this all results sometimes in temporary relief, which means that the next time that you're walking and you see a sign for cancer and you have that thought, you know exactly what to do with that anxiety. You know that you're gonna do this behavior and over time, the behaviors start to impede upon your ability to live and pairing your life. And so to round this out though, because I feel like I've been talking, I wanna hear from you. Oh, that's a very good stuff. Well, thanks. But I think if we're looking at this process of trigger leads to thought, leads to feeling, leads to behavior, that's the same across the board and that negative reinforcement, that temporary relief that you, again, you don't always get it, but you get it enough that it reinforces that whole cycle that happens in panic disorder, it happens in agoraphobia, it happens in health anxiety, it happens in OCD, it happens in phobias, it happens in generalized anxiety disorder, it happens across the board. And so people learn that these behaviors are the answer and they are until they become the problem. Yeah, or they become part of the problem, they make things worse. So the plan, you know, how can I have a plan for my health anxiety while identifying what those compulsions, those safety behaviors, those rituals are, and then phasing them out. You're gonna have to work on not doing those. So when you are convinced that you must call the doctor again for the fourth time in three weeks, you have to not. And it might be, I was trying to tell people like, okay, look, it's not like you can never call the doctor ever again for the rest of your life, instantly like call Turkey, but don't call for two hours. You're gonna have to surf through two hours of discomfort. Then if you think you gotta make that call, go ahead. But the next time it better be three hours and the next time it's gonna be four hours. So that seems to work for people in a lot of instances. Yeah, delaying the behavior I think is huge and it helps people to understand that they have the capacity to tolerate that discomfort for sure. Yeah, a little space between the thought and the action so that, you know, okay, can think about this a little more. One thing that I find particularly insidious and health things are too hard to me, the two hardest groups of people to deal with are the people with health anxiety and the metaphobes because oath will tell you that they, no, no, no, it's entirely justified. Yeah. It's entirely justified. So I like to look at health anxiety sometimes as like an uncertainty intolerance disorder really because in the end, unless you can get anything less than 100% certainty or 0% chance of cancer is unacceptable. Right, which is totally unreasonable. If it isn't zero, it's not acceptable because I'm gonna say, well, the doctor could have, the 10th doctor could have missed it. That's true. But the odds are so against that, but it doesn't matter. The odds are not zero. So I must act to get them to zero. And it can't, you can never get to zero ever with anything ever in life. No, and that's actually, I think of OCD as an intolerance, yeah, of uncertainty. Intolerance disorder, they almost all are. They all are, yeah. Like I could have a panic attack when I leave the house. So I'm not gonna leave the house. It's like, yeah, you could have a panic attack. That's a possibility. And so learning how to make space for the fact. And I think with health anxiety, because we are, we're all going to die if, you know. Just so you know. No, good for you. That's great. I mean, we could do an episode on that. I'm interested. Next month? Yeah. That's true. Me and my flows and have like Walt Disney. It's gonna be great. Good for you. So yeah, I think that because of that and recognizing that we have to make space for the fact that we are going to have illnesses, that has to be an acceptable element of our lives or it's going to take over our lives. It's either or. It's not like you either allow for uncertainty or you are consumed with trying to defeat uncertainty, which spoiler alert is not an actual, you can't do it. It's not possible. Right, it's not possible. I always find one thing that's fascinating too. And again, it's health anxiety, but yes, it spills over into all of these things. We swim in uncertainty every day, all day long. Like life arose on the planet 3.5 billion years ago and it's been uncertain every day since. So you're uncertain when you get in your car. You're uncertain when you eat an apple. I could choke on that apple. It's certainly possible. There's uncertainty everywhere, but for some reason when it comes to this, my health, oh, I can't tolerate, but not that uncertainty. Everything else I can tolerate, not that. Right, and not specific. It's important. Yeah, I can't take a chance. Right, but what's interesting is that in the same breath you just said, if you get in your car, you're accepting uncertainty, that you might get into a car accident. That's your health. I know, but it's so interesting how that connection is often not made. Well, and I think part of it is the perceived control and the responsibility that we take, right? That there's, and some people are afraid of driving and afraid of getting into car accidents and that for them, that's the one that they're not willing to accept. But I think whenever somebody zeroes in on where they have the ability to prevent something catastrophic from happening, that's where it's like, well, but I could do this. I could do this thing to prevent this. And that's where, again, of course we do things to prevent bad things from happening. I take supplements, right? Because there's supposed to be, some of them are supposed to be good for my health, right? Like, okay, and that's not a problem. It doesn't deter from my life. It's not like I'm constantly looking up new supplements and I'm making sure that I'm on the right ones or something to that effect. Right. The action is not life impacting, it doesn't. Right, because it's, yeah. Well, this is where I like to go into the realm of economics. I bet you didn't expect to get that today, but. My bearings, all right, let's do it. Well, I think it's all down to opportunity cost and the law of diminishing returns. Oh boy. Yeah. I use the term life math. I'd like to think I invented that. Life math? Life math. All day long, we all do life math. There's risk reward in everything. We're calculating all day long in our heads. The variables that get plugged into life math for health anxiety are completely twisted. So you put in variables, and where I think that variable is worth 0.6, you think that variable is worth 6 million. And so it completely changes the outcome of the equation. So I like the opportunity cost, though. It's similar, very similar. I love the life math. That's excellent. Yeah. Yeah, maybe I got to say that, I don't know. I like that a lot. No, and I think, yes, the opportunity cost piece, you're looking at, okay, at a certain point. Well, and I think what's more relevant here is the element of the law of diminishing returns, because at a certain point, you're investing resources into something, but you're getting increasingly less on your return over time. So for anyone who's listening, like I'm a geek and I love economics, but the idea, and I'm somewhat limited, is that at first there's a direct correlation. This is a graph, by the way, it's a line on a graph, just so you know. So there's a direct correlation, right? Between input and output. So if I invest, let's look at like money, if I invest, I don't know, $100 into my home to get something fixed, that that's going to have a direct result in how much I could, I don't know, rent my home for, for example. So at first it's a direct input, and then you get a nice output, right? And the same thing goes for health anxiety. If I input, you know, 30 minutes a day to go for a jog or a walk, like that's going to positively impact my health. If I am so consumed with trying to make sure that I don't get cancer, that I'm incapable of spending time, like meaningful time with my friends and family without asking for constant reassurance or spending all of my time in my head trying to figure it out or on my phone with Google, we've gotten to a point where the return on investment is starting to level off and eventually go down. It ultimately becomes negative. That's right, that's right. It's the point of diminishing returns and then there's the point, oh, I can't remember what it is, but there is a second point where you start to level off. Yeah, you start to level off. I would imagine, yeah, certainly less than, like it's, you start, it starts to be an added cost. So. The person who is crippled by that and is just continually involved in those compulsions and safety behaviors would probably describe a negative net effect. Yes. I have no life anymore because I'm just consuming all the time and I hear that heartbreakingly every day. Totally, me too. And so, you know, if you're watching, I would encourage you to go look at a graph because that's gonna give you a better sense than my little hand puppet show over here. But like, yeah. And out the car window. But I think recognizing we're, okay, we're trying to land right around the point of diminishing returns, which means sometimes you're gonna go a little bit further than what is going to best serve you. And sometimes you're gonna go a little less far than what's gonna serve you. And that's the point that people with health anxiety are afraid of. I'm going to miss something. I'm not gonna, I'm gonna go a little under too far or a little under far enough rather. And then I'm gonna miss the thing. I'm gonna miss the disease. But I think that's the part that makes health anxiety into certain, one day we'll do in a Metaphobia episode because that's another topic. But I think that's the part where health anxiety becomes almost unique in the resistance that it presents, at least in my community. Somebody with addict disorder or agoraphobia understands, these are irrational fears. I don't want to be like this anymore. There's no good reason for me to run back home every time I think I'm gonna have a heart attack. They recognize that and they recognize the negative impact. The person with health anxiety knows there's a negative impact but will still assert, but it's rational. There's a reason for it though. That I might miss something if I don't do this. Whereas the person with panic disorder or agoraphobia never says, but I might miss something. It's very rare. Instance by instance maybe, but what if this time it's really a heart attack? But I feel like the person with health anxiety and one of the things I hear all the time is, I have a family, I can't take that kind of chance. I have kids, I can't take that kind of chance. The disorder will rationalize why it has to continue to exist. And at some point it becomes, I can't argue, I can't try to reason with your health anxiety. I can only show you what it is. After that you're gonna have to accept or not accept that. Right, yes, absolutely. And you're right. People with OCD do this all the time too. I can't take the risk that I might murder my family. What are you talking about? Sure. And the reality is that if we want to live our lives at a certain point you, that's the choice to be made. And then I would suggest that the best choice is to accept that possibility so that you can move on with your life and live what life you have. It's ultimately, it's rearranging deck chairs on the Titanic. That's what that is, right? Is I'm gonna make sure that I don't have cancer right now but the reality is it's coming. Like you can check all the time and trying to make sure that your time on the Titanic, like everything looks just so but the ship is sinking. It doesn't matter in the end. No, so do you wanna like spend the last two hours of your life doing purposeful, meaningful things? And I'm not saying like in the metaphor two hours of your life. Or do you wanna rearrange the deck chairs which seems to me to be a huge waste of your energy and your time. One of the things I also find interesting where I think it helps, how things already starts to look a lot like OCD is, I guess you wouldn't officially call it a backdoor spike because it's officially not OCD but the person who does start to get over those compulsions who suddenly discovers I'm freaking out because I'm not scanning for cancer or I haven't checked my blood pressure in three weeks and that's what if that means I want to have a heart attack or what if so. Or what if it means that I missed the thing. You missed it, right? I missed it. I'm anxious because I'm not vigilant anymore. So it's again, it's tough. I'm not like I'm angry at the people. It's heartbreaking to see that because they break through it and then it wants to drag them back in by telling them, no, it's wrong to not do that. Yeah. Yeah. One of the things that I will say though, for like the plus column of having a disorder that you can make a reasonable argument for spending time churning or doing whatever behaviors is that in recovery it generalizes to a much broader spectrum of things in life which accepting uncertainty across the board is probably the best thing that I've learned how to do as a human, right? Like it's served me so well. And I think when you recognize, oh, it's with everything. It's with everything's uncertain that whereas if you're saying, oh, well but this thing doesn't matter. So of course I can accept uncertainty here. When you learn to accept uncertainty about the things that matter that's where real freedom is, right? It's a big deal. For me, I always say one of the lessons I learned, that's true and people will say to me now, I've always been kind of a cooler cucumber but now especially in there like the building is on fire and you're just like, I'm like, I got in my car every freaking morning resigned to die on the Long Island Expressway with a horrible heart attack where I would take out 16 families with me. This is nothing. The fact that I'm not so sure about what my tax bill is gonna be is literally nothing now. So it does, it does generalize. It puts life into perspective and it makes you so much more psychologically resilient and flexible, I think. Totally, no, that's absolutely yes. Because once you face the big thing, yeah. Yes, if you get through this, your threat I call it threat assessment. Like what most people see as a threat these days, there are no threats. I see almost no threats in the world anymore. There are, don't get me wrong, there are but they are very small list now because. And when they come up, I don't know because I certainly have, there are threats. There are threats in the world. I'm not trying to dismiss the world, they're all. Totally, and even things that make me anxious, right? But when they come up, it's sort of like, all right, well, here it is. I'm not gonna, I don't have any control over it. So I guess we'll see, that there's either do something about this and if I can't, oh well. I guess I'll have to wait to see tomorrow and see what happens. Yeah, so if you can get past the health anxiety thing as difficult as we both know that that is, the rewards are really something. Yeah, yeah, for sure. So I think it's all down to limiting behavior to what's reasonable in terms of practical application of this is saying, okay, well, it's reasonable to get a second opinion on something, probably not to get a 15th, you know? Yeah, that's true. And I think in the end it becomes, and it's hard to find that point. I always try and say, look, if you feel like the thing that you're going to do, or you feel compelled to do to stay safe, is a thing you would have to explain to me why you have to do that? You probably don't have to do that. That's such a good, yeah. Well, whether it explain to me, Lauren, a friend, your mother, who doesn't matter, the guy at the grocery store, if somebody would look at you sideways and say, why are you doing that? There's a really good chance that you probably don't have to do that. Yeah, and ultimately you have to accept uncertainty in order to move on. You have to accept that maybe that is the right choice because that's where people want to find that point. It's the same thing with the law of diminishing returns. They want to find the exact point when they're maximizing the results of what they're putting in and they're not willing to go below that. And the reality is you have to be willing to not get there, to not get to that exact point. You might fall shy of it a couple of points and that's the price of freedom. Yeah, sometimes you'll miss the mark. But I think sometimes, if the mark is here, sometimes like you said, you're above it, you're below it, there's no way you can lock it in. It's not a groove, it's a target and it floats. And sometimes you miss it and sometimes you get it. Right, and that's where you have to be willing to sometimes make the mistake of doing compulsions or safety behaviors too. And it's not, the aim isn't to be absolutely free, right? Of doing all behaviors. But maybe sometimes you make the extra call to your doctor and in retrospect you go, oh, I didn't. I didn't have to do that. Yeah, but you don't need to now beat yourself up over it or try to get recovery so perfect and not make, make sure that you only make the right amount of calls because then you've turned recovery into just another way to do it right and to fix it and it's compulsive. That was worth the price of admission right there, folks. Those last two minutes, yeah. Yeah, well, you too. Sometimes you get it wrong and it doesn't mean you failed and you're crashing and burning. It just means, well, what can I learn from that? Exactly, exactly. So good. I love our conversations. I know, it's so fun. Like, we could do these every day. So we'll do it again next week for sure. Anyway, we'll wrap it up. That's health anxiety. We could talk about this. People with health anxiety would listen to us talk about this for a day, like a marathon. Totally, oh my gosh. You would have hate us after. Yeah. You'd have to be like, okay, I'm out. I can add it. Yeah, really? Is this still happening? Well, I'm sure if you guys have questions or comments, by all means, throw them in the comment section wherever you happen to be watching this, which really is either my YouTube or maybe, I don't know if you post these on Instagram. I don't post them on Instagram. I haven't posted them on Instagram. They're just on YouTube, I think. But although I can, because they're great. Like, you know, I think. Yeah, by all means, I've had it. But anyway, if you want to ask questions, ask them in the comment section and we'll be happy to answer them of course. And I'll put it up on the screen if you're coming from my side of the fence and you do not follow Lauren, here she is at the obsessive line on Instagram. So go get that because it's all good stuff. And this is Drew. Don't forget the dot anxious dot truth. Go follow that guy. He's awesome. He's got lots of good stuff to say. Oh, thank you very much. All right guys, I guess we do this every month. I don't know we're gonna talk about next month, but we'll do it again. So. This is a surprise. You have a topic that you want to suggest, throw that in the comments also and we'll throw it in the hopper. All right, sounds good. See you next time. Bye. Awkward end the record.