How to Face and Manage Your Anxieties, Fears, and Phobias

Welcome everybody why don't we go ah and get started feel free to keep using that chat I'll just acknowledge that I won't be seeing that in real time but I will check it intermittently at different points and my colleague from the support team will also be sort of communicating to you all in there as well so my name is Amin I use He Him pronouns I am coming to you from Land of the Olone Muk WMA and Confederate Villages of Lis John here in Oakland California I love this map if any of you are curious this native-land.ca allows you to Overlay Google map with the sort of historical and sort of territories of peoples that were there before you so it's good opportunity to learn about different communities I also want to do an another acknowledgement some of you have heard the expression of pictures worth a thousand words and when I don't know where it comes from I go to Wikipedia a favorite resource in mine from Wikipedia you learn that Arthur Brisbane is the sort of man who's quoted as having sort of invented that expression and I like to actually paraphrase him and say that an osmosis picture is worth 10,000 words so I want to acknowledge The Talented medical illustrator team here at osmosis from Elsevier just because they do amazing work I just want to acknowledge their images which I use throughout the talk I unfortunately need to do a war acknowledgement as well so it's sort of a year ago and a week and some change ago Antonio Gutierrez the Secretary General of the UN had what I think was an important quote around releasing hostages and creating unimpeded access for humanitarian aid for the civilian population in Gaza when H Wars come up I look for sort of like guidance from history there's a quote here from an American president giving a talk to the UN General Assembly sort of almost 50 years late earlier around how chronic disputes really are help no one and then even more recently the US president about to leave office in his final quote sort of speech to the United Nations General Assembly also sort of talked about how full scare Wars in no one's interest and I think is even as we see what's happening today here now in the West Bank and Israel in Palestine in Lebanon I just really appreciate these Statesmen sort of thinking about how war is really not an answer or a solution I also want to share with you this is kind of personal for me my father is Palestinian American that's my dad in the 1960s he came to the US to do his PhD in anatomy and here he is sort of class president in the 60s learning alongside other people from other parts of the world I'm privileged that he's still alive so there's a recent photo and here's a photo from his 1960s yearbook where he's boring his students as he lectures about Anatomy joking aside my father and I both agree that the only solution is a two-state solution so I'm just sending care and love for all the peoples who are in Gaza Palestine Israel we really do need to find a way where people can peacefully coexist and also to the people in in Lebanon Ukraine other parts of the world that are suffering okay with that let me tell you a little bit more about me so this is my family I'm half Palestinian half Armenian I'm privileged to be in a multicultural family and have two healthy children that's my family and here's my academic identity so I am an academic psychiatrist through and through I'm at three San Francisco Bay or health science universities where I have the privilege of teaching students and working alongside patients and I also work with two different health education companies and so those are my disclosures of conflicts of interest I do believe that we bring academic rigor to the work of industry and Industry brings us speed of innovation and technology that we can't necessarily invent in the University together we form healthier societies all right so here's what I want to cover with you today now that you know who I am and my disclosures so we've kind of done the disclosures here check on the right side you'll see the sort of learning objectives any good Educators should think about learning objectives as we designed presentations and so that's what I'm hoping we will cover together and that you might learn some about today and then on the left side you'll see kind of the structure we're going to talk through fear versus anxiety and The evolutionary roles of those two sort of feeling States we'll talk about the range of normal versus clinical something being abnormal and then I'll off you some key tips and then lots of practical resources Galore my goal here is to help you feel empowered with a lot of resources you can take long after today's session okay so let's dive into fear versus anxiety so it turns out that there is an evolutionary role for fear I think we all kind of know fear when we see it but I'll just describe if you happen to be walking along where wherever you are and this tiger jumps out you're going to express and feel fear so the thing is that sort of fear is a useful evolutionary role because it helps us do the right thing which is not get eaten by this tiger right and so on the one hand if we don't have enough fear we get eaten right and we don't procreate and perpetuate the species on the other hand if we have too much fear and we're paralyzed we're sort of in that Frozen moment we might also get eaten and not procreate and perpetuate the species and so it turns out that the our bodies are physiologically designed ideally to have the right amount of fear which gives us that flight instinct to run away from this tiger not get eaten survive calm down and continue in in life so I want us to acknowledge that fear does have an evolutionary role within our range of emotions okay the problem I think is that that tiger doesn't jump out at most of you most of the places you live and so in the sort of expression of fear in in in other life stuff we can ask ourselves you know like how do I have the right amount of fear that's not too low not too high when I'm not facing a tiger and so I want to just acknowledge that this this same fear response may not May apply when you're studying for a test let's say or you're sitting for a test in school in health professional School and we just have to have that right amount of not too laidback that you don't study and you don't pass exam but not so paralyzed with anxiety and fear and overwhelm that you don't pass the exam because you don't let the knowledge you have acquired come out in the way it should okay so with that I want to differentiate fear from the emotion of what we all tend to additionally call anxiety okay so fear if I've done my job right enough here is when that tiger is jumping out at you so fear we want to Define as something that is happening so one way to differentiate these two is you know you are afraid of the tiger because the tiger is real is in front of you you're afraid of the test because the test is real in front of you right now when you're sitting for it okay and that triggers a lots of physiologic responses heart rate sweating all of those things you'll learn about in health professional school or that you know from your experiences being afraid in contrast I want you to think about anxiety or one definition is worrying about something that could happen so in that test taking example the anxiety is your fear that or your anxiety is your worry I shouldn't use the word fear it's your worry that you might fail or get too low a grade on that test or not be able to pass nursing school med school the course you're in whatever it may be so that anxiety is worrying about something that isn't actually currently happening it's about something that could happen and so if you if you accept this sort of differentiation between fear and anxiety then then I hope we would all agree that fear is biologically important to survive in situations that are happening a car accident a plane crash a sort of a sort of a risk like if somebody jumps out in front of you in the street or if you're walking home and there is somebody that you are worried might attack you anxiety here worry about something that could happen may not have the same physiologic importance or benefit in society or benefit in your life that fear does okay so I just offer that as one framework to think about differentiating between fear and anxiety and The evolutionary role for those two types of worry all right so check on that for now for at least a superficial sort of for today definition of the difference between fear and anxiety and the role all right now let's talk a little bit about clinical versus range of normal stuff okay so in all things in society that are sort of continuous variables we could think about things like height here if we were to measure all the height of all the people in the world and at the far right of the people who are seven foot or taller and at the low end are people who are three foot or shorter and if we were to measure everybody in society we would have this nice what we call it bell-shaped distribution a normal distribution normal curve here we could do that for something like anxiety too right so let's just make up a means anxiety scale and we're going to say that's a scale from zero the people who are not anxious at all to 100 the people who are sort of sort of paralyzed in in sort of in place with the anxiety and if we could measure every human in the world we would end up with some sort of distribution that would look something like this a normal distribution of on that am means anxiety scale now somewhere we're going to have to draw a cut off and decide that anything to the left of this we're going to call oops anything to the left of this we're going to call range of normal and anything to the right of this we're going to call abnormal in Psychiatry or in mental health professionals we think about sort of that cut off score as health professionals assessing humans but in this example I've drawn that cutoff score here I could just as easily have drawn that line that cut off R to the left and in that case everybody to the right of this sort of purple bar are now in the abnormal scale so that's what of those six seven 8 nine people N 10ish More people that are now being labeled abnormal anxiety okay so how do we decide where we draw this cutoff score as mental health professionals so for here I will turn to the diagnostic and statistical manual or dsm5 text revision the current version of the holy book for mental health disease diagnosing and when we look at that any and all of the anxiety disorders U will say there must be fun impairment so what do we mean by functional impairment so in the sort of in the DSM we think about like how does it affect your life so there has to be some decrease in the quality or the quality of life of the human that we're trying to diagnose and so when I'm talking with my patients and I'm trying to figure out sort of whether they're to the left or the right of this cut off line and we're going to call it a disorder or a disease I'm going to ask them questions about how it affects their life and so I think about this in the context of their social functioning in their social lives occupational functioning in their work lives or School lives in your cases for many of you in their family life etc. so all of those domains are legitimate domains to assess whether somebody has a anxiety disorder that we're going to call right of this cutoff score and therefore abnormal okay and so this is true across all of the anxiety sort of diseases or disorders and so for example if we were to just look at this one human let's just say this one human is afraid of snakes so I'm trying to figure out what them whether that makes a difference in their life and affects their social occupational family functioning their functional impairment so if that human is a herpetologist h then it really is affecting their occupational capacity they can't work or if they work in a zoo and they can't go to the snake sort of exhibit and they're supposed to go there because they're maybe say on the janitorial staff and they're cleaning and it and it causes tension and it can't it's impacting their work life then we're going to consider calling them having a phobia of snakes right but if that human Works in an office building and there's no snakes in the office building and they're never going to see snakes and it doesn't impact their family life or their home life or their work life then maybe we don't need to label them with a diagnostic disease of fear of snakes or phobia of snakes right okay so that concept the functional impairment that's true across all the anxiety disorders and so it's not just fear of snakes it could be any other phobia fear of flying fear of public speaking etc. etc. this is also true let's say for when we use things like generalize anxiety disorder or social phobia or any of the anxiety disorders where we're assessing does it impact their life enough functional impairment that we're going to call it a disease or disorder okay so today we're not going to be diagnosing anybody so I want to acknowledge you know I'm wearing my educator hat today teaching you with my psychiatrist hat but I want you just to remember this framework for caring for your patients and when you seek care of yourselves and so the goal here is just to remember that functional impairment thing and to assess the whole human you're assessing when you're talking to patients loved ones family members to kind of get a sense for is this affecting the quality of your life and if it is then there is value in seeking treatment from mental health professionals or other ways of treatment like the resource I'm going to share with you later so they can live a healthier life more emotionally healthy and stable life all right that's everything I want to say on defining clinical versus range of normal let's move on to some key tips I want to make this very practical all right so I was talking about planes earlier if any of you have had the privilege of flying the sort of flight attendance will tell you before they take off if there is a drop in oxygen presser and the oxygen masks fall down and you're traveling with someone who needs assistance please be sure to put your mask on first before putting the mask on that person and the basic line here is that we have to take care of ourselves first so we can take care of others okay so my key tip to all of you as health professional students or if you have anxiety disorders or you are thinking about whether you do or don't I need you to take care of yourself first so you can take care of others for years to come right there is no point in putting that mask on others first and burning out and then losing oxygen and passing out because you can't help anymore so this is just a fundamental thing that I want you to sort of like burn into your brains I remember hearing this piece of advice when I was a Psychiatry intern from one of the attendings and she was teaching our shared patients about it and I was just like that is such a good practical tool and I'm going to carry that forward with me here now 20 years later still sort of sharing this so that's my key tip number one for all of you take care of yourselves all right now I want to talk about some other sort of practical key tips or tools or resources that are useful in thinking about how you take care of yourself so one is that I want to just spend a little more time on is cognitive behavioral therapy or CBT if basically it's this notion that our thoughts affect our feelings and vice versa hence these two arrows that our feelings affects our behavior and vice versa and then lastly to complete the triangle that our Behavior affect our thoughts and vice versa so we've got these two-headed or double arrows in all of these pieces of the triangle here and the basic premise of CBT is that if we understand how these arrows affect how thoughts affect feelings and behavior all those arrows if we understand those arrows better you can lead healthier and happier lives okay if you look up CBT on the internet and you look at CBT images you'll see that it's all over the internet right and so I'm saying a little playfully to you that must be true right because if it's in the internet is true well of course not true not everything you read on the internet is true but the prevalence of CBT and this this triangle everywhere the different ways that they're drawing it is because there is a lot of scientific evidence to prove CBT and that has been done to prove that CBT is a legit sort of framework for improving quality of life all right and so CBT has been studied for years and been shown to be effective in a variety of settings so you can do CBT individually you can do it with couples or families and you can do CBT in groups you can also use CBT for a v variety of conditions so you know a number of anxiety disorders a number of depressive disorders and it's been shown to be effective for all of these different things as well and that's all nice with in theory but how do you apply it so let me just show you how this gets applied on a practical level if somebody were engaged in CBT okay so basically with CBT you take one of these well sorry first let me say this could be done with a therapist or coach or a guide or it could be done on your own so both of them are legit forms of engaging in CBT work and I'm going to show you both okay so let's just think about the framework so let's start with the thoughts piece so if you're doing this doing CBT you will learn about that domain of thoughts and I like to think about it as having there are Health demoing thoughts oh my God I'm a failure I'm going to fail this test I'm never going to pass a nursing school and I will have to drop out and then there are Health promoting thoughts I've actually done a lot of studying for this exam I should feel confident that I put all that I'm putting my best into this performing at this test and I am worthy of being in nursing school I'm worthy of being in this school and I know that I going to be a good nurse in the future so those are Health promoting thoughts as opposed to health demoting thoughts and basically when you do CBT you keep a log or a diary about all of these thoughts so you can do that on paper you can do that digitally it doesn't matter how you do it the key is to keep a log or diary about them that you can then look at and notice when you are notice when you can do more of Leaning into the green in this picture the health promoting thought okay and so and then you just what I like to say you rinse and repeat so now we talk about your feelings what are Health demoing feelings what are Health promoting feelings we're going to keep a symptom Dog Log or diary about that and we're going to lean into the health promoting feelings and then we're going to repeat that same cycle for the behavior what are Health demoting behaviors what are Health promoting behaviors let's lean into the green keep a log and repeat so you rinse and repeat and you go down you go around this triangle over and over again sort of understanding how thoughts feelings and behaviors are affecting your well-being all right so I told you can do this with a prom with a therapist guide or coach and so when you do that with a therapist guide or coach you have these recurring meetings where you can check in on how you did and so that person can give you some of their mental health expertise on how to lean into the green better or what you're doing that may not be as effective for you so that way you can maximize the efficacy of CBT in partnership with that mental health professional but you don't need a therapist coach or a guide to do it you can absolutely do this on your own or at least asynchronously without another human and so same concept here you're asking yourself how am I doing with this thoughts feelings Behavior rinse and repeat lean into the green so you absolutely don't need to seek treatment for this in order to use and leverage the tools of CBT for your emotional well-being okay so key tip number three of three I want you to loud and clear self-care is not selfish I like to say self-care is selfless and if you look at the definition of selfless I won't Define it for you here I just invite you all to look it up you're going to see that that is super powerful self-care is selfless you are taking care of others by taking care of yourself so here's a nurse that's doing a or let's just make this a physician I don't want to assume nurse so this physician is taking deep breaths perhaps before going in to see a patient perhaps going before going into an operating room perhaps going before going into a teaching session where they're teaching health professional students it is a selfless act to take care of yourself and I'll tell you at one of my universities we actually do a centering moment before every simulation for all students at all times Takes a Minute and it just preps them for going into that sort of learning educational experience and I love that we have a centering moment before every encounter because oops I went backwards selfcare is selfless again if you remember nothing else get your oxygen mask and self-care is selfless is not is selfless that's right okay it's not selfish all right so here comes now let's that's everything I want to say on to the key tips all right so what I'd like to do next we're doing great on time here is we're going to go through a long list of practical resources I'm going to start with CBT so these are four books that our department our Psychiatry department has sort of gotten a grant to sort of give to patients as a way for them to engage in sort of what we call bibliotherapy so if you don't have if we don't have enough clinics to sort of engage in CBT with patients or they're on a waiting list or if we don't have the particular expertise for that particular need these are four books that that we recommend to our patients that have been published by psychologist have been or psychiatrist from the far right have been shown to be effective they are they are the compilation of years of research and sort of a best practice in doing CBT on your own and Stephanie I believe is already posting in the chat links to these books they happen to be on Amazon you can buy them anywhere you don't have to subscribe to you don't have to get them off Amazon if you don't like that but these are some books that we use with our patient population that I find amazing and they go over some of the same strategy and techniques that of CBT or on the left one it uses a different type of therapy called acceptance commitment therapy but they are the practical tools and tips within the books that you can use to improve the quality of your life both for depression and for anxiety okay and other of those spectrum of emotions so hopefully Stephanie's posted all four in the chat I just peek and see if they're there or El set thanks Stephanie all right so all right so those are four wonderful resources I recommend okay secondly again from our department and Stephanie will post in the chat here we have a library of emotional well-being videos we had a webinar series during the worst of the pandemic we were presenting these sort of remotely and we recorded them and kept them available on our public facing website and so these are hour long webinar series produced by clinicians in our department and that can help you how to reduce personal stress again this was during the worst of the pandemic but still relevant today we're talking I was talking about those Wars and so there is a lot of distress in the world and U this can be extremely useful to you to watch some of those videos at your own pace your own time there's also the second one is the resilience and emotional well-being sort of just some more stuff that may not be as focused on the pandemic and the bottom pictures just to share with you that those are some of those were recorded and available in Spanish for the Spanish speaking and listening community so that's one resource in our department and the other one I want to show you is what I like to call a list of lists thank you Stephanie for posting this as well so the emotional well-being videos are the top list on this list on the bottom on everything on the right here are some other tools and resources that can be useful so you can see the third link down is a useful wellness and mental health app fourth one is seeking help for anxiety mental health issues and addiction dealing with fatigue and burnout trauma moral injury grief great stuff and these are a list of lists because basically these are all things that people in our department have vetted and believe to be scientifically accurate as we know it so you don't have to worry about it being internet trash okay so another resource available to all of you on public facing side of our department's website okay another one I want to show you is something that I've only recently learned about and so I don't know much about it yet but there is a Dr Ed list serve is a global subscription list serve for educators of health professional students worldwide and many of us post on that different things that are resources to share around not just within our University or school so Michael FY is a clinical assistant professor of internal medicine at Turo University and he has started this Focus Wellness Minds split Cafe med school edition sort of U sort of resource and you can see on the left there focus is to provide practical tools tips and resources for Med students but I would broaden this to any health professional student to manage stress prioritize self-care and cultivate mindfulness they offer as you see techniques for improving Focus reducing anxiety and improving overall well-being and well-being is a great thing we don't have to be overwhelmed in in health professional school I want you to be well while you are on your journey towards becoming health professionals so relatively new resource and I know that that he I think it's a he he's posted in the do list Ser some links that Stephanie's posting here to read the wellness first edition and if it looks like it's something you'd like to do you can subscribe to it and so hopefully that's an additional resource that will be available over time I imagine each of your health professional schools may also have some resources from local providers and so I just want you to remember that too all right from here I'm going to share a whole bunch of stuff again in partnership with Stephanie about some resources from osmosis so all of these are written by either osmosis Affiliated sort of Staff or faculty or sort of health professionals Andor osmosis sort of Affiliated students and so first one at least humor a mature defense mechanism sort of an unqualified guide for studying for the US medical licensing exam step one around anxiety so I really love this acknowledgement of humor I know my patients appreciate when we use humor appropriately to sort of decrease stress and so and worry and so I really think that'd be a good read and so Link in the chat second one from James Jang how to manage excessive exam anxiety like I hinted at the beginning when you are overwhelmed at the exam such that the knowledge that you have in your brain isn't pouring out that's an excessive exam anxiety or if you're if the anxiety is preventing you from studying a effectively then that Jane's going to have some tips there on how to manage that so that way we titrate that anxiety to the right level not too much not too little but just right okay next up the mindful health professional techniques for effectively communicating with patients so I really like this one because these are practical tools beyond the classroom setting right and this is of course these techniques are effective with any communication be that patients or classmates or professors but just appreciate the sort of the techniques the Practical techniques there and then as we drill a little B more deeply into the formal like meeting the diagnostic criteria of functional impairment to the right of that cutoff score you want to help helpfully understand sort of what the diagnostic criteria are this is a good tool here understanding sort of the anxiety disorders for us as health professionals as well all right next up on the blog sort of a lists that Stephanie's posting here how to discuss sensitive topics with your patients so here we're not thinking just anxiety for them but also us like because talking about these sensitive topics unless we're we've had a lot of practice at it can be very anxiety-provoking for us and we want to make sure that we don't that our anxiety doesn't interfere with our goal of being the most effective clinicians we can be for our patients so here's some good advice and tips here from that on how to get more comfy with these sensitive topics and the truth is the more you practice this the more you will become comfortable and then it becomes super second nature for you and I just the that just reduces the tension in the room and it's super helpful for our patients so really good tips in there and then for those of you that are earlier in your training and may be learning more about the foundational science elements of how our bodies work as a quick reference guide here for conditions related to cortisol so C certainly our cortisol goes up when we're experiencing a panic attack for example and then sort of chronic stress and how that impacts your body physiologically as well so that's useful too one last one U and this is again for those of you that are nearing some of those National licensing exams this example is step one for the US medical licensing exam but I know that many of you are in other countries you'll have other National licensing exams so they're going to cover comparable content even if it's not the same exam so here's a just a very specific practical tip on sort of differentiating several different anxiety disorders and in a clinical example there so just to sort of offer and acknowledge the Practical reality of your test taking as part of your professional development all right so lastly I would be remiss if I didn't talk about apps so there has been an explosion of mental health apps in the last five years really remarkable they just I hear about them every day on the radio and in sort of podcasts and sort of and the apps developers and there is this is phenomenal on the one hand phenomenal right because there is this resources at your fingertips at all times but I do want to just acknowledge that the research on these apps is sorry yeah I'll put them both up here the research on these apps is still in its early phases right so research can take a long time to do well and we want to do good high quality research to prove that what we think we're doing is really doing what we say it is and so the emerging literature on these apps is still quite new still quite emerging still quite limited and so I just want to acknowledge with that U because I'm a mental health professional that that I want you to just be aware like I tell my patients if you're investing a lot of money on something and you don't know the evidence that it works just be cautious I don't want you to spend a lot of money and then be not sure that it's helping on the other hand if it's not a lot of money and you think it's helping you there and it's not taking up a lot of your time you can be one of these early adopters of these the mental health app world and ideally it's helping you right in addition to those apps I just need to be explicitly clear with you as students you should have student health services available at your universities there should be well-being resources that are provided by your programs in the United States at least there's this relatively new National 988 line which is like if you're emotionally distressed and unlike a 911 where you're going for physical stuff the warm line 988 line is a fabulous resource to get you connected with some Mental Health Services locally close to you and then of course there's always Emergency Services the reason we have 911 in the US and any other emergency services in any other country is they're there for emergency so if you are experiencing a mental health crisis that that does feel like an emergency you're worried about your life and safety please go ahead and use those resources to seek emergent help and there are available mental health professionals on call available on site to address your emotional emergency okay so check on the Practical resources so I think what I'm supposed to do now is go to the Q?A so and so please feel put those Q?A in there and then I'll look at the chat as well to see if I can address any of those concerns in the chat or comments in the chat could 1 a help when a person is experimenting anxiety could one a I don't know what one a or I a is so maybe the person that asked that question can clarify what acronym you're using by what you mean by that I'm not sure I know all right and there's a bunch of questions that I think that my colleague Stephanie has already answered but I'm just going to review them as well sort of a looking for sort of participation in an event good that Osmos team help that how can mindfulness and meditation help alleviate anxiety symptoms right great question happy to answer that so I'll use the Practical example from my sort of Simulation Center so we do this mindfulness moment every time before students go into a simulation scenario and let's say we're simulating a code scenario where a patient is acutely at risk of dying and we need to call in the code team the crash card bring it in simulate sort of a chest compressions using the mannequin that's a high stress a high fidelity learning situation right so the students know in advance going in that this is what we're simulating so they're going to be stressed walking in just worried about that they're going to do it right so when we take that mindfulness moment to sort of decompress and prepare sort of physiologically and emotionally for going into that learning environment that's going to reduce the anxiety symptoms so that way they are optimally prepared to go in and do that so mindfulness meditation lots of literature that proves that this reduces the up stress of the worrying about something that could happen so basically physiologically is reducing your heart rate it's reducing some of the other sort of U symptoms of anxiety so the sweating the stuttering the cold clammy sort of feelings in your hands so mindful meditation are working on a on a biologic level but on an emotional level as well from what I shared at the beginning hope that answers that question recording will of course be available difference between anxiety and nervousness okay so we're going to Define those as overlapping constructs I think that in the DSM we're going to we do a big deal of saying anxiety crosses that threshold so we're call it a disorder but I think you can think about it anxiety and nervousness as being very similar things some people would Define nervousness as sort of anticipation for going into a specific thing so I'm nervous on a date because I don't know if this person likes me I'm nervous before I go on an interview because I'm not sure how it's going to go so we might call that nervousness in anticipation of a specific event whereas anxiety may be more broad sort of a and not specifically associated with one specific imminent event again they are overlapping constructs so I think there's a lot of similarity between the ways those two words are used okay slide deck not shared but the sort of recording is I will answer a question about subscription coming up list link for the link of lists Stephanie's already posted that list of videos Stephanie's already posted that yay Stephanie thanks for your partnership how to differentiate anxiety from undiagnosed obsessions yeah so this is one of those things where think a clinician a mental health professional would be able to work through that fine line between are you on the range of normal of anxiety or obsessing and within what we'd consider normal range or have we crossed that threshold where we're going to call it an obsessive compulsive disorder and meets diagnostic criteria there's other criteria in addition to the functional impairment that would need to be met in order to meet the diagnosis the disease of OCD so again that would be a mental health professional could assist you with that so AI oh did IIA mean AI is a good question can I AI help when a personal experience anxiety okay so if you did mean AI then I'm going to say it is remarkable how much AI has penetrated all of society including the ways in which people are using AI to address emotional distress so I think we're going to find that AI will have a role in being able to do that and what I said earlier about the apps being next or the proof of that the apps are working not yet fully developed that same thing is true about AI so if you are somebody who's trying to use AI as a tool for addressing your emotional distress you may find that it's helping but we don't yet know that we haven't yet proved that too so I think that we're in this great sort of land of experimentation with AI across all domains of our lives and so it doesn't surprise me that people are considering using that and I'm sure some the app developers are using generative AI as a tool and resource for addressing the emotional needs of their subscribers and then sort of osmosis Prime doesn't have U psychiatric help online we are not a mental health provider we are a health education resource for supplementing your local resources in your context so I just happen to be a mental health professional who's a passionate educator who's sharing this for all of you as well okay another question about experience with group CBT for social anxiety disorder yeah so I think that's great and you know there's the irony of going to a group when you are experiencing social anxiety on the other hand the mental health professional present in the room is was trained on how to maximize the efficacy of that space how to create a psychological safe space so that way the amount of distress in the group is not so high that you're flooding the patients or so low that they're not actually growing and learning so absolutely group CBT your social anxiety very appropriate in fact I would argue that that it's actually more effective to use groups than it is to do individual treatment because part of the social anxiety is being around other the humans so one can do those in tandem or sequentially you can do individual treatment and then go on to group treatment I've also sort of similarly since we mentioned some of the Technologies there are headsets Oculus headsets and other sort of manufacturer headsets and I'm hearing of emerging treatments for different types of phobias for that too so you can imagine a fear of flying you can use the headset to create an environment that's High Fidelity but that if you're starting to feel flooded you can pull off the headset so you're not overwhelming the patient so you can systematically work your way up treating that without having to pull them off a plane or something like that right so very emerging cool technology I there too relationship between anxiety and panic attacks so panic attacks are a specific type of severe anxiety is the umbrella term there's a number of anxiety disorders panic attacks are a specific anxiety disorder and panic attacks occur for a variety of reasons they can occur for physiologic I mean for sort of physical health reasons in addition to emotional health so we want to try to figure out what the underlying cause of a panic attack is so if there's a hyperthyroidism for example that can cause panic attacks sort of other physiologic abnormalities so we wouldn't call that a panic disorder we would say that it was a panic attack caused by that physical disorder next question someone asks about a problem in school where they can't when studying you can't sort of the sort of can't effectively study because of what might be perceived anxiety yeah there's a div diversity of reasons why people can't effectively study certainly if you're not getting enough sleep if you're not getting enough nutrition those are sort of physiologic sort of core sort of body needs that can affect your ability to study and take in information anxiety is another reason why you may not be effectively studying and so again I would advise you to talk to your health professional School local resources around effective study techniques there should have some resources for you I hope because they want you to succeed and so help them think you can think through with them if this if there are tools or resources they would advise you to help study more effectively and some of that may be addressing some of what you might perceive as anxiety as well how do you desensitize yourself to constant triggers of anxiety those books that I res reference are examples where CBT can help desensitize the apps will also have some of that mindfulness will help with that as well what's my opinion on process based therapy compared to Classic CBT so I'm not sure that I would I'm using the word process based therapy in the same way you I think I would have to understand I'm guessing that sort of the process-based therapy is actually quite overlapping with CBT as well but process based therapy means you're thinking about you're processing what happened in the past and thinking about strategies that you can use in the future to when those situations come up again to have a healthier reaction or response to those future situation so I think that there's a lot of overlap between that so I imagine that they've been that that they are very similar and many of these therapies do overlap they take from each other because they've been shown to be effective and so there is some U some less precise terminology in the words CBT act C IP etc. etc. so parental stress think coping mechanism a good choice to help them deal with everything that is happening in their life yeah I if I understand this question about the thesis on Parental stress coping mechanisms are going to be an effective strategy to help parents experiencing parental stress and sort of the tricky part for your thesis is going to be figuring out how you assess their stress and how you assess their utilization of this sort of coping mechanisms so you just like if you're going to assess whether medication Works you're going to have to make sure the patient's taking the medicine or the study subjects taking the medicine you're going to have to assess adherence to the treatment option and so there's some complexity in answering that question but I think it's a good idea to think about teaching coping mechanisms to help address parental stress is there a crossover between Psychiatry and Immunology going forward absolutely yes psychoneuroimmunology is the sort of field as I've heard it described now where we're thinking about the overlap between the immune system and mental health and those the brain gut sort of axis is another thing I've heard there understanding sort of how our gut affects our emotions remember the vagus nerve goes from the brain all the way down to lots of organs in the body and the sort of the location of the receptors for neurotransmitters the gut is the other part of the body that has a lot of neurotransmitter receptors so absolutely we're going to be learning a lot more about the overlap between the immune system and the Brain ahead how do we approach Breaking Bad Habits which were formed over many years so that is where I would encourage you if you have diagnosed di if you have diagnostic threshold you've crossed the abnormal thing someone has mental health professional has diagnosed you this is where I'm going to encourage you to strongly seek active local treatment in your with your local mental health professionals because that's how they're going to that's their job they're mental health professionals to help with those who have mental health diseases or conditions to address these PTSD is a type of anxiety it's a specific anxiety disorder and I don't know about Hoffman's process therapy so that's new to me I'm sorry Daniela that I don't know and I can't answer that question how does anxiety manifest differently in children versus adults so in children we see o overall there's a lot of overlap between these in children you will see some perhaps more somatic sort of presentation of anxiety so belly aches sort of diarrhea headaches sort of the physiologic the ways in which anxiety is expressed is not I'm worried but rather my body is expressing symptoms that we can think of as either physical or emotional but really it's both and children you're going to see a lot more of that okay for public speaking anxiety sort of a there are a fabulous manualized treatments for that and again I would strongly encourage you to be able to do that with a mental health professional or with a guide book because basically you start at the lowest end you work your way up the fear of sort of like practicing speaking in front of a mirror in front of an audience in one that you know then you work your way up totally treatable and addressable cannabis for anxiety long question long answer emerging literature on this one lots of research being done I think we're going to learn a lot more about it I know for my own patient population some of my patients are using sort of sort of medical marijuana and different sort of configurations to treat symptoms and many of them anecdotally speak about how much it's helping them so I will acknowledge that I think we're getting close to the end here let's see if I can answer a few more questions cultural connection so cultural cross-cultural Psychiatry is a whole field and cross-cultural care as a whole field broadly across all of care so I think I would just acknowledge that there's a lot to learn there across cultures and that allows you to be what we call cultural humility so you can learn about your patients cultural expression of disease and then still offer effective support okay there's a somebody who's in the someone in the more temporally challenging years of training where you're on call in the hospital lots of years lots of time and I apologize that sort of that you are in some of those extremely challenging years here for those kinds of individuals I'm going to encourage you to look at the apps because the apps are with you all at all times and even mindfulness takes 30 seconds and you can build 30 seconds into your in your mindfulness routine throughout the days even when you're working 12 hours a day so that that would be my time sort of sensitive advice on that and then when you have more time you can address these more thoroughly with the books passion and hard work for International Medical graduate fear I would so this is a question about sort of International Medical graduates thinking about sort of a addressing sort of the relative lack of emotional Wellness perhaps in your training am I hope that with a global audience here you all would agree that emotional well-being is should be a right and what we can all do together is try to raise the raise the quality bar globally and expectations that sort of that mental health is physical health that it's an artificial separation and that we should work towards the emotional well-being of our patients and us while we're in training at the same time I think that's probably as good a place for me to stop as I want to apologize for the posting to the questions I didn't get to that one thing I like to do with all of my teaching that I we can't really do with all of you today but you can put your answers in the chat I want to invite you to think about one thing you learned today or one thing you're going to carry forward into your practice or one thing you remain curious about it can be small and it can be the same thing other people said if you put it in the chat then we're maximizing the educational value here of our time spent together your time invested in being here present with others today and so we're I'd love you to share one thing you learned one thing you remain curious about one thing you'll carry forward into your practice and everybody please read those I can see some coming in right here already so I appreciate that a few more things I just to say as we begin to wrap up let's see so you have all those links so please click on those before we wrap up the session live thank you to my colleague Stephanie for posting all those in the chat for us I want to thank you for joining the webinar and for your insightful questions I really enjoyed talking with you all about it to access the recording of the webinar to register for future webinars there's a link in the chat and this recording you know you got to give Stephanie a little time to sort of clean it up and do all of the sort of post- production stuff so it'll be early next week that we'll have this available for those of you that want to watch it or share it with others and before we leave I think it's important to acknowledge because osmosis is a wonderful company doing wonderful stuff with help RS education resources we're going to offer you for participating in today's webinar a free two-e trial of Osmosis and you can see if you like that or not and so the link for that's in the chat as well okay there's a list of webinar events in addition to other webinars that we've given and then there's two more coming up this year the first one on November 14th what it takes to become a nurse practitioner and the second one on December 5th skills that set you apart becoming a remarkable clinician so those are more osmosis webinars ahead and if you'd like to discover more great content watch a recorded webinar or register for a future event check out the osmosis blog we posted seven links about the blog from those ones I mentioned in today's webinar and then there's Osmos events page for future Osos sponsored events so with that just remember taking care of yourself is not selfish it's selfless and when those oxygen masks come down you got to put your mask on first so you can take care of other thank you all for being here I appreciate you stay well be well helping current and future clinicians Focus learn retain and Thrive learn more ?Music?