 Well hello everyone and welcome to another episode of Resiliency Radio with Dr. Jill. I'm so glad you're joining us again and if you enjoyed other episodes or enjoy this episode please stop by and leave us a review, share with friends or family that might benefit from this information. Today I have a special guest and a new friend and I'm so excited to introduce her. We are just talking right before we get on here of how needed the information today is going to be for our society, for our teens, for our adults, for really everyone. Today we're talking about the anatomy of anxiety and we're going to do a deep dive with Dr. Ellen Vora. So let me introduce our guest and then we'll jump right in. So Dr. Ellen Vora is a board certified psychiatrist, acupuncturist and yoga teacher and I want to mention you're an MD because there's a lot of people out there calling themselves doctors that aren't a medical doctor so I love that you're coming to this with you know the medical degree and she's an author of the best-selling book, The Anatomy of Anxiety. She takes a functional medicine approach to mental health considering the whole person and addressing imbalances at the root. She received her bachelor's from Yale University and MD from Columbia. Welcome. I'm so delighted to have you here today. Thank you Dr. Jill. I'm so glad to be here today. So as I always start with guest and mention to you I always love the story of how we get into healing professions and I'd love to hear a little bit about your journey into medicine. Was it something you always wanted to do? How did you get into medicine and then how did you kind of get into a functional and holistic medicine? Yeah so I got into medicine a little bit. I'm sure it was an early connection to intuition but I was not yet aware of how my intuition was operating. I was obsessed with the brain but I'd also been an English major as an undergraduate and really I was passionate about hip hop dancing but that did not materialize into a career so I ended up in med school and by the time I was in my psychiatry training I already felt deeply out of alignment with allopathic medicine with what I was being trained to do and I was in these two parallel crises. One was feeling like I wasn't convinced that I was doing no harm. It wasn't convinced that I was actually helping my patients thrive and that's a bad feeling 10 years into training and it's an expensive education. It's your blood sweat and tears and to feel like maybe this has all been for naught and are these tools not as helpful as we are taught to believe that they are but the parallel crisis with that was that I was really unwell and I had autoimmune markers in my blood work. I had a malar rash on my face. I was bloated. I couldn't poop to save my life. Wasn't getting a period. Had polycystic ovary syndrome, ocular migraines, joint pain. There was so much that wasn't working in my body and I thought here I am a med student. I should know how to keep myself well. I thought I was doing everything right and it really took a very, you know, we at the time used the word alternative. Now I just think it's the oldest fashion most basic way to support human health but it took a lot of alternative strategies to get myself well and then I started applying that in my practice and I felt more hopeful that I had tools for supporting my patients and that has all worked together to lead me to be this radical weird psychiatrist that I am. I love it. What if we are actually more the norm? I know you and I believe this but I still understand every bit of your story. Like we didn't know it sounds like both of us the intuition and that deep like inside and right brain and you were English so you had all this creative pieces. I really think that not only women in medicine but the more intuitive healers bringing that to conventional medicine. I could just cry because it's so, so critical to the crisis we're having right now in our medical system and especially in mental health. Like the fact that you are able to sit with a patient. I can't wait to dive into more but I so resonate with your story because I almost didn't go into medicine because it was so like didn't feel aligned but then I realized wow we can actually change it and you're doing that and hopefully I'm doing that a little bit too. So I already love you and love the energy that you bring and I also love those of us who are truly healers and maybe didn't know it in the beginning. We often have that journey right that it's our own illness and when we find I find this with colleagues and with myself when we found those pieces where Western medicine didn't have an answer it's wonderful if you have a heart attack or stroke but if you have depression or you have obesity or you have diabetes or you have autoimmune lupus any of these things we don't have the best answers because drugs are not the cure right. This is right and I mean it's just I share that that appreciation of the heroics of Western medicine can really rescue you out of a bad situation and so much gratitude to that but we just keep misapplying it to situations where it's not only inappropriate and doesn't help someone get well but it often leaves them worse off and so it's really nice to expand our toolbox and have other ways to support patients to gently rebalance rather than react and throw someone into a new state of imbalance. So I love that and today we're talking about anxiety now just before we went on I mentioned I was talking to a very high-level community leader who was talking about the crisis in mental health especially among teens like literally every week there was another child being admitted for suicide and you and I both see this but let's talk first about the state of things because I think there's like the pandemic and the isolation and the social media and then our talks again I could name a hundred things that are contributing but I'd love to hear from you as the expert what is the state of anxiety and mental health especially in the younger generations what are we dealing with what are you seeing. Yeah so I mean we were already in an epidemic and then of course things got precipitously worse through the course of the pandemic for a variety of reasons and we've seen skyrocketing rates of prescriptions for psychiatric medications and some 30 million Americans have anxiety in every given any given year but I think that statistics are so intangible and really if you look around we all know someone who struggles with anxiety we ourselves struggle we see the rates in kids we see how kids are struggling and so it's I think of it as the pH of our age that if you drop a litmus strip into this stew that we're all in the quality of the way we experience imbalance right now and how we experience unease is something we subjectively call anxiety. Yeah so let's go into what is anxiety because I think a lot of times you have this movie at least I even as a medical professional I have a stereotype of what anxiety looks like right and your book titled Anatomy of Anxiety what a great name what is the anatomy what does it look like and how can it be actually anxiety but be masquerading at maybe something as maybe like even an OCD type of presentation. Tell us the many faces what does this look like in our friends and family and our patients. I think it can really present so with such a diversity of symptoms and one person has what we would call generalized anxiety disorder they're chronically worrying and tense and have difficulty relaxing and letting go whereas somebody else might have social anxiety or someone might have obsessive compulsive disorder there's so many different manifestations panic disorder is very common you can have agoraphobic traits to that but I've really moved away from my training or as a psychiatrist we're taught to use the DSM the diagnostic statistical manual and it's our Bible but I've come to observe that that doesn't steer management in a meaningful way for me and that's really the central thesis of my book is that what did feel like a meaningful classification system was to divide anxiety into two types and they're what I call true anxiety and false anxiety and I want to be really clear false anxiety doesn't mean that the suffering is any less real it speaks to the underlying root cause and with false anxiety which you can also think of as avoidable anxiety this is physical anxiety it's based in the physical body and it's related to something tipping our body into a stress response and it's usually something pretty innocuous some aspect of modern life like maybe we're tripped into a blood sugar crash or we're sleep deprived or we had an extra cold brew coffee that day or we're hung over or we just came out of a going down a rabbit hole on the internet and all of these can leave our body in a stress response which we then subjectively experience as anxiety but we would do well to identify that root cause eliminate it and we can move away from this it's unnecessary suffering we can eliminate the avoidable anxiety but on the other hand we also have true anxiety which is we can also think of it as purposeful anxiety this is not something to pathologize it's not something to suppress or try to make it go away this is actually something to honor and true anxiety is not what's wrong with us it's what's right with us when we are able to viscerally connect to what's wrong in the world around us and that can pertain to our personal lives our immediate surroundings our communities the world at large we're in a moment right now where people are having immense amounts of true anxiety where you are aware that there's something out of alignment and you feel that you have a role in the ecosystem in addressing that however large however small you know that you have to course correct or show up in some way to get things back into alignment and so true anxiety it's not something to pathologize or suppress it's really something to learn how to listen to and honor wow i'm just one of those times where i'm literally like so there's such an ha with what you said because several things just click number one when we really experience our somatic body and system anxiety is a very normal part of being it's just literally a signal you're saying that something is out of alignment whether it's in our personal relationships or the world at large or suffering that we've experienced right so i love this because i'm always helping patients to go back to their body and actually feel because when we can connect we actually intuitively often know what to do next right so i love what you're saying there and then my other thought is i remember years ago treating a patient with atrial fibrillation and i remember understanding that all of a sudden i had this aha years ago their heart was beating abnormally it was an irregular rhythm for those who don't know what atrial fibrillation is but what that did was create an anxiety but it wasn't anxiety like i'm worried it was the heart was beating abnormal and that gave a signal to the brain that something's not right and i realized all of a sudden oh this is not classic anxiety this is literally from a physiological dysfunction right so that's the other part of what you're saying is like what if it's actually a signal that something is and again i've understood that but you just made it so clear and how you spoke it um you know so eloquently i should say and it makes sense and i think those listening will understand that too let's dive deeper into what are the things physiologically can that that false anxiety you called it right i love that idea tell us more about that i mean the one you bring up with afib that's such a perfect example because our mind is the consummate meaning maker and so if you give our body a stress response that tracks up to the brain and it says okay we're in a stress response and our brain its role is always to attempt to make sense of stimuli of inputs and so it sees this stress response and it thinks okay i'm anxious right now i must be anxious because this thing happening at work or this interpersonal dynamic that feels uneasy and we'll tell a story and we'll have a narrative to make sense of that physical sensation and there's always validity to the story we tell ourselves because we do always have stressors but it's in many ways unhelpful because what caused what generated that feeling of anxiety was not these stories we tell ourselves not the circumstances it's the afib it's the heart literally you know generating a stress response or it's the hangover or the sleep deprivation or the blood sugar crash and so once we know that it can be so powerful and grounding to just be able to reflect in a moment of peak anxiety i usually instruct my patients to to say it this way which is i give myself permission to be anxious right now i'm feeling anxious and it makes sense that i'm anxious right now and maybe i need a snack or and i'm aware that i had a lousy night of sleep or and i know i'm getting my period tomorrow and to just have an awareness of the physiologic underpinnings that might be generating a stress response it can be really helpful sometimes it's actionable like you're having a blood sugar crash have a snack sometimes it's really just there's not necessarily a to-do it might help you make different choices in the future but sometimes it's just to take the power out of the anxious feeling in that moment a lot of my patients have what's called interdose withdrawal so if someone's taking psychiatric medication and if they're you know we all are slightly different with our pharmacokinetics and our unique biology and somebody might metabolize their medication a little bit more rapidly than average and maybe they're at a pharmacologic nadir or low point when they wake up in the morning and their bodies do for the next dose of medication that can certainly trip somebody into panic anxiety feeling overwhelmed feeling kind of a dark doom and gloom feeling and we run with that and we think okay everything is terrible but if you can just remind yourself in that moment maybe this is interdose withdrawal then you can just know things might not be as terrible as they feel right now this might just be my body due for its next dose hey everybody i just stopped by to let you know that my new book unexpected finding resilience through functional medicine science and faith is now available for order wherever you purchase books in this book i share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience i found along the way this book includes practical advice for things like cancer and crone's disease and other autoimmune conditions infections like lime or epstein bar and mold and biotoxin related illness what i really hope is that as you read this book you find transformational wisdom for health and healing if you want to get your own copy stop by readunexpected.com there you can also collect your free bonuses so grab your copy today and begin your own transformational journey through functional medicine in finding resilience next dose this is so helpful and it sounds like what you're saying is be kind to yourself and actually instead of going to that place i could just hear myself or anyone else saying oh my gosh what's wrong why am i feeling this way like going to that kind of like which accelerates the anxiety right and pathologizing it making it like this is a bad thing what the world's going on or and i've heard patients say that too they tell the story of that um and instead of doing that you're actually having this kind compassion like maybe this means i need something like a glass of water or i had this joke with good friends and boyfriend um that if i ever get cranky i'm like a two-year-old i'd eat either a nap or a snack so i totally get that yeah if i'm we are just oversized toddlers in so many ways when i had my daughter i had to keep a list on the refrigerator like is she hungry does she have a wet diaper does she need to be burped maybe she's teething she's tired overtired and i needed to cue myself and remind myself it was just a little too many things to keep track of without a list and that's why in my book i have this avoidable anxiety inventory because we just need a list that list right and to remind ourselves like maybe this is going on right now and to just give ourselves grace and compassion in that moment and maybe it helps us form a plan that can prevent future unnecessary suffering oh this is such a beautiful way to look at it i love love love what you're saying um what about panic attacks those to me obviously are accelerated and they're definitely driven by neurotransmitters and adrenal and all those things give us a little bit of anatomy of a panic attack and i feel like that's another level for people experiencing that where they might not be able to as easily talk themselves through it what would you do or tell a patient with chronic you know maybe severe panic attacks yeah so whenever i'm working with someone who experiences panic they always want to know what do i do once i'm panicking and i like to say i'm below average at supporting someone once they're past the point of no return like there isn't a whole lot we can do at that point some people splash cold water on their face or go outside and move in the fresh air some of my patients will do a sensory practice that really grounds you in the present moment like you name five things you can see then you do a four seven eight breath then you name four things that you can feel and then you do a four seven eight breath and then you name things that you can smell or taste or touch and all of this and it's helpful but i'm so much more interested in preventing a panic attack from happening in the first place i'm like a little bit uninterested what do you do once it's happened because it's kind of like it goes up and it resolves and it's it's kind of one of these it's that's how it's going to behave almost no matter what you do and that can be helpful to know if you experience panic you're not trapped you're not stuck you're not going crazy this is going to crest and then it's going to resolve on its own pretty much no matter what you do so the more you can actually not be in resistance to it and you can kind of allow it that's really helpful because resistance does tend to pour oil on the flames of panic whereas allowing and softening in the face of it does tend to change our suffering around it but i'm always interested in preventing panic and i think it's actually quite physiologic there's of course always psychospiritual and emotional mental underpinnings but the physical stuff is where i think we can move the needle the most and it's preventing big peak stress responses i recently was talking with someone who was getting into a panic disorder when they were using cocaine and they didn't connect those dots until a physician was like do you use drugs and the person was like actually yes and it's like bingo yeah and so sometimes we forget that things that put our body into a very pronounced stress response can be contributing and the fact is you know we here in the united states it's it's common it's cool and trendy to drink really significant amounts of caffeine and i have nothing against caffeine but sometimes you just want to be conscious of how much and i have a lot of patients where they just assumed anxiety was part of their identity that's who they are it's how their life would always feel until they dramatically decreased their caffeine consumption and then it was like actually i don't have to be anxious all the time wow these are some great pearls and actually love that you said maybe you just leave it alone and let it crust i found when i really started to do somatic work and started to re-experience emotions i had allowed myself like sadness and anger the very first time like the sadness it was like a wave and by that time i had started understanding i can let this go and ride the wave like a surfer just like you're describing and it's going to come and go and once i learned that it was so much easier to deal with difficult emotions because my first 40 years i just like suppressed it and resisted and did not do any good things for my health so i really like that you're saying that that maybe it's actually a part of the allowing and knowing uh it's hard but you will get through it because once we do that whatever emotion it is and especially panic it really is just like riding a wave it's not fun but in many ways that's you know everyone writes a book and then it takes a long time for the book to come out and then by the time it's out in the world you're like well i would write it a little differently now if i could rewrite it and one thing that i've really shifted with over time is that i have a very mister fix it approach to mental health and i still stand by that i don't want unnecessary suffering happening for my patients for my readers but i also think that there's just a lot of wisdom to allowing and i think a roomies poem i think it's called the guest house and sadness comes you invite it in and the other day i was walking down the street right now we're recording this it's october i live in new york city it's that time of year for me where i start to get a little bit seasonal effective and i was noticing the early sunset and it was cold and it was dark and i felt these old feelings of sadness creeping and i knew to identify this as related to the seasons and in the past i've always had taken such a mister fix it approach to that i've thought well what's the right vitamin d amount and fish oil and bright light therapy and let me get some sunshine and i was like maybe we actually need an opportunity to be sad it's the yin to our yang it's the purge of pent up grief unmetabolized feelings so it's like actually i'm just going to really allow myself to be in some seasonal effective disorder it's almost like not a problem to solve it's actually a wave to ride that serves me on some level thank you for sharing that i think that is so so helpful to me and to everyone listening because the truth is this is part of why western medicine didn't quite align with both you and i we tend to pathologize everything right and i i'm the guiltiest of all of you listening in my not i am the queen of pathologizing and saying oh what's wrong what do i do just like you said i go to my cabinet i figure out a supplement i figure out a biohack i'm all about that however i've just recently learned what if this is actually not pathology what if there's this kindness to yourself that you can feel it's okay to be sad it's okay to be grieving it's okay to have anxiety and and it's almost like you take that little girl and say sweetheart it's okay you're beautiful and you can have full range of emotions and at least for me i grew up in a kind of a very stoic kind of farm family where some of these emotions weren't really allowed or they weren't really encouraged so i thought okay you know you put on this face and this happy so it really reinforced that and as i've grown and learned that allowing that kindness to ourself with all of its faces is so powerful and the healing isn't it and like honor to earlier times and previous generations where there was a different set of you know what what we needed to get by and it's a privilege really to be in a position where you can invite in sadness where it's not just a matter of survival and i think that um yeah i'm in a similar position of really learning to embrace the full range of emotion i'm grieving right now and and i and i just really grieve and to me there's nothing wrong with it i don't apologize for it i don't even feel like this is a burden or a nuisance if i start crying in a conversation with someone i actually think that crying in someone else's presence is a little bit of a gift to them because we use our mirror neurons and we all get a little dose of oxytocin it bonds us and crying in the presence of others we always are so embarrassed we think oh i'm sorry i'm sorry and we try to suck it back in and make it small and i'm really done with that i think that i just try to cry as big and fully now as as my body wants you know what kind of cry it wants to have in that moment that all this is so good so you wrote anatomy of anxiety and what when was that published i know we'll talk about March 2022 okay so just a year ago and again such a needed resource i want to be sure if you're listening here you go out and get that book right away we'll link up wherever you're listening to the websites and resources of dr warra but i want to talk about like writing that book i find because i just wrote my own book and that is such a process of really understanding ourselves and our patients and therapeutic what was the biggest lesson or takeaway or thing that you maybe didn't think you were expecting when you wrote the book that came out of the writing of the book any piece or it has so many parallels to pregnancy and childbirth you know you're gestating something for a while and there's aches and pains and discomfort that comes with that and identity crises you know you come up against all your all your stuff all your imposter syndrome and your perfectionism and feeling of not good enough and then you birth it into the world and it it just lives on its own and it's it's like your heart traveling outside your body it's very vulnerable and you just hope that people are kind to it and that it carries out its mission in the world you know and has a fulfilling experience and i think that i'm starting my second book now which similarly with childbirth you have your write your first book and you're like oh god i'm never going to do it again and then you get the inspiration biology trumps it all and you find yourself wanting to do the process again but what i'm really trying to do this time around more more richly than the first time is is really channel and to to pray before i start writing and so that's my process now it's very meditative i burn a candle i sit in meditation and then i basically ask for source to use me and to use my unique perspective or strengths or insights and then to birth something into the world that will benefit the world through me and so that's the process now and it's simultaneously harder and easier easier because it flows and harder because i'm tackling much bigger harder questions wow uh you are like my long lost soul sister i love i love every bit of what you're saying and i really love that piece because i learned in my first book and for sure if i ever write another book i'm still in the post delivery stage where i'm like oh not yet but all that to say like i really realize the best pieces came out of that really letting go surrounding to the divine and allowing that to flow through me and like stuff that i didn't even know was in me came out that was profound for myself and for the reader so i really really appreciate that because i feel like the most vulnerable best most powerful content is in that space of complete surrender and and realizing that with humility how limited we are but also how vast we are with the power of the divine flowing through so i really really appreciate you saying that and it's encouragement for me for the next book someday yes i'm so excited for your book to be birthed into the world thank you um so let's talk a little bit about because this morning i had this conversation with the leader about teens and about and what do you see around do you see many uh you know do you see young adults and teens are you just adults or what kind of population and then what are you seeing because i feel like they are in maybe a bigger crisis than any generation before yeah i mean so i am an adult psychiatrist so technically not trained in 18 and younger although many of my patients are parents and so kids are a central topic to my practice and what i'm seeing is that so we've had this framework of true anxiety false anxiety and i think that the young people right now uniquely have a whopping dose of both and i do find that the younger you are the more you're able to viscerally connect to what's wrong in the world you're less hardened and less concretized and rigid and so you can really feel injustice you can feel it on a visceral level so they're carrying that and they were born into this world with 9 11 with climate change with the pandemic they you know with social media which is an enormous one and so they're aware of what's wrong i think that the underappreciated aspect of what it means to be young right now and the part that i feel like is more actionable and we can do something about is the whopping dose of false anxiety that they carry i think that they gestated in an inflammatory environment even just you know i was born in 1980 so i gestated just at the end of a world that wasn't yet using high fortress corn syrup in everything wasn't yet spraying ground up on everything we just weren't yet making engineering foods to be hyper palatable i think things have gotten really deranged in the last 40 some years and so these kids gestated in a womb that is endocrine disruptive and inflammatory and lacking in microbial diversity and so all of this i think impacts their physical health and then foods are engineered to be hyper palatable which messes with your brain chemistry but also messes with how your body is depositing fat and that then is triggering especially for young females i think that they're drinking coffee in a way that kids didn't used to drink coffee but the big big big factor that trumps everything else is screens and social media and it's just so it's such a problem because it's so addictive and so necessary and so poisonous to the young brain on a lot number of different levels and if we just looked at a very biologic aspect of this the blue light in the evening suppresses melatonin and disrupts circadian rhythm and so that itself disrupts hormone production and so even it's altering puberty it's altering brain development and compromising sleep quality which itself compromises brain development and the ability to have a good stable mood the next day to have good clear attention and cognitive function the next day so all of this is big and then there's all the compare and despair and relational aggression and FOMO that happens with social media there's one other factor and this one is the most controversial and the most sensitive to talk about but i say this because this will pertain to this this will be a truth for some people and i think they deserve to know this which is that i'm a psychiatrist i prescribe psychiatric medication i know it can be helpful i know it can be lifesaving so i say this with nuance and with balance i also know that people experience adverse effects side effects they experience withdrawal when they miss a dose when they go off of it when they change medications or change doses and all of this is a silent epidemic and it impacts young people so starkly and so i think that we have made people more mentally fragile with all of the psychiatric medication prescribing and that's also a really big problem and there's no easy path out once again you have said that so eloquently i just want to pause and like take it in because what a beautiful way to say that just use i mean there's we need to use caution and you and i as a medical doctors should be the leaders in talking clearly about not only the benefits but the risk which is what we're talking about now i think that's very very valid i see the same thing and i see the withdrawal symptoms of between doses and all of that that you're discussing and it's very real what's really sad is i think whether it's a pharmaceutical or even not all doctors but some doctors maybe not giving full disclosure what ends up as a patient themselves was like there's something wrong with them that they're not responding or that they're having these ebbs and flows and i want to take that off of the patient and say you know we need to have discussions about this with your doctor and you and i hear just bringing to life that there could be a piece of the puzzle that involves your actual medications right exactly and i think that that stands repeating that people do attribute all these things to themselves they'll call something relapse when in fact it's withdrawal they'll just say you know if this is just hard when in fact that's introduced withdrawal or that's a side effect and and you know i think people just don't know to attribute things to effects of medication like a child who's on stimulants and has a come down at the end of the day and is irritable and a family might come to me and say like you know this is a problem and why are they have such bad behavior and they're a problem and what's the right medicine to treat that and we fail to look at the root cause that this is actually a really obvious effect of a medication they're taking during the day and there are things we can do to mitigate it but we need to start with a recognition of what's happening here yeah and on this note i'm going to bring up something may or not may not be controversial but benzodiazepines obviously one of the common ones that as physicians were taught to use to treat anxiety but as you and i know there's definitely withdrawal issues and there's definitely addictive issues tell us a little about your stance and again we both know there's appropriate uses for these things i'm not demonizing them but i would love to hear what you think about benzodiazepines the good and the bad and the cautions oh my god the bad and the bad i think that i have a less nuanced view on benzos i agree i mean i think that you can convince me they're helpful in seizures and you can convince me that as an absolute one-off rescue from a panic attack there's a role but the tricky thing about benzos is that they are habit forming not for everyone it's a little bit unpredictable but i've over the years had so many patients wash up to shore in my practice and say i went to see my primary care doctor i was put on an ssri i was still anxious i was having panic attacks so they gave me xanax or they gave me clonopin and just doing what i was told to do by my doctor being a good law abiding citizen i started taking this when i was anxious and now they are addicted and to me the harrowing process of getting off of a benzodiazepine is so brutal for some people it's so damning that i don't actually ever think that it's doing no harm to start someone down that path and so i have not started someone on a benzo in so many years and even just the one time i did i felt a little bit like bullied into it it's not it's not my truth and i don't and i think that also i have so much sympathy for primary care doctors who hand these out sometimes like candy but they have what eight minutes maybe 15 minutes with a patient someone's crying someone's not well in their life and you need to be able to solve the problem and send someone off feeling like a happy camper and no time and that person needs to be heard and witnessed and their false anxiety needs to be adjudicated and there's just so much that we need to do to actually support healing in that moment and it can't be done without time and training and space holding and so they end up on xanax and i really think that for the people that are listening that are okay in their relationship to benzos consider yourselves the lucky ones and no need for my words i don't want you to i don't want this to be a hex and to make you think that it's worse than it is but i just want to send so much sympathy to anyone who feels stuck on it who's struggling with the withdrawal process who feels a little bit um a little really let down by the health care system that they trusted and then they they found themselves on a on a situation that's making things worse and that's the last thing on benzos i'll add is that it exacerbates the exact problem we use to treat it for us so if we're using it to treat anxiety rushing the brain with the neurotransmitter gab the brain in an attempt to restore homeostasis pulls the GABA receptors and this is part of why we develop tolerance and dependence is that then when we're not on the benzo anymore you can't feel calm at a regular level of GABA in the brain because you it's almost as though your brain can't hear the GABA because you don't have the receptors anymore so we've then exacerbated the anxiety and the panic by attempting to treat it wow i once again so eloquent and i couldn't agree more i'm really glad you are very honest about it because i i think it's a really really big issue and patients very much are unaware of the severity of what could happen uh because like you said they go and like you said compassion to the primary doctor who's doing this because they're trying to do the best they can but even as physicians you and i both know we are not trained on the severity of the side effects in the withdrawal are we right no it's it's i mean benzos are the one exception we're at least i mean partly because maybe it's off-label and they're cheap and generic but we're at least told these are not safe for long-term use but we're not really properly told therefore you kind of can't really ever start someone on it because they create the need for themselves and it's really hard to get off once you're hooked thank you for that and again i know our listeners are appreciating every bit of wisdom you're sharing i want to end with a question that you may have already said something that fits this so you feel free to repeat but what is the one thing that you wish everyone knew about anxiety i think it really does come back to that central thesis of false and true anxiety i want someone to basically do an algorithm with themselves where at first you start with the false anxiety it's the low hanging fruit and it muddies the waters you can't really know what your true anxiety is while your physiology is pinballing between a blood sugar crash and sleep deprivation and hangovers and overcaffeinated hormone imbalance you you kind of need to get some of that resolved you need your physiology stable so that you can feel clear and then the job really becomes welcoming in your anxiety and listening to it and it's very natural for humans not to want to be still and not to want to feel our feelings and we come by it honestly it's hard but we have a feeling when we head towards anxiety of oh no oh no oh no i won't be able to handle this and if we actually soften into it and allow it it's not there to hurt us it's actually there with a loving message to help us get back into alignment once again beautifully said i have a sign in my living room it says be still it's just that reminder because i'm someone who moves a lot and does not like to be still and when after 40 when i started somatically experiencing my emotions i realized oh the reason for that was because i didn't want to feel so i think this like kindness to ourselves because when you first if you're out there listening you're a type A and you're driven and you're busy all the time there's probably a piece of you that doesn't like to be still because of what we're talking about because some of the stuff percolates up and i just like use that i want to echo Dr. Ellen and be kind to yourself and take that time in the quiet and let yourself fill the wave and the tsunami of these emotions Dr. Ellen this was so full of wisdom and pearls i'm super excited to get a copy of your book myself but where can everybody else find your book and in your website yeah so my book is wherever books are sold and it's called the anatomy of anxiety and my website's ellenvorah.com and i'm also very active on instagram i'm at ellenvorahmd fantastic thank you again for your time today thank you dr gel i've loved this conversation