Your Anxiety – with expert Diana Garcia (LMHC)
Hi, everyone. This is your host, Michelle, and you’re listening to The Mindful Podcast, the show that aims to break the stigma associated with mental health. Today we have Diana Garcia, a licensed mental health therapist in South Florida. Today we will discuss all about anxiety, including symptoms, treatments, and when to actually seek help. Stay tuned. Hi, everyone. Welcome back to the Mindful Podcast. Today we have Diana Garcia. How are you today? I’m good. Glad to be here, Michelle. Thank you for coming. So today we’re going to be talking about anxiety, but before we start this amazing subject, can you please tell our audience a little bit about yourself? Yeah, absolutely. So I’m a licensed mental health counselor in Florida. I have a private practice down here called Nurturing minds counseling. I’m a first gen. I provide therapy in Spanish or Spanglish, like I like to say. My parents are in well, born in New York, relocated here really young. Really? Yeah, I was born in Jersey. Oh, that’s funny. My fiancee is from Jersey. Oh, wow. Fun fact. Yeah, small world. But yeah, I moved here really young and yeah, living first gen life. Nice. Oh, my God. Well, thank you. Again. I want to talk a little bit about everything, but let’s start with the basics right from the beginning. For those who don’t know, what is anxiety? Because I feel like that word has been lightly used here and there. If you’re a little nervous anxiety, I’m anxious. But what is really anxiety as a diagnosis? Yeah, and so great point, I think distinguishing, like, anxiety situational anxiety, or even sometimes stress versus an anxiety disorder. Right. So when we’re thinking of anxiety disorder and just anxiety in general, it’s really when we start to get afraid or concerned or worried about something, like I might have dread about something happening. And that fear or worry tends to really dominate my life. Depending on the type of worry that you have, it can be a little distinct, but that kind of worry that you have will kind of show up in you feeling overwhelmed, not being able to get the things you need to get done, maybe overthinking over planning, worst case scenario. Right. So I always give the perspective of we all will have, let’s say if I know I had stress coming into this, right? Like, I have a situation and I have normal stress, even a little bit of anxiety. When I think of anxiety disorder, it’s not that it’s even situated based. It’s more that it’s consistent and persistent and it’s causing an impairment in my ability to function. Okay, that makes completely sense. Wait, so you were nervous today? Yeah, absolutely. I mean, what they say, right? You work with the people that you can really relate to. So I work with a lot of people who struggle with anxiety, which means that self disclosure. I also have moments of anxiety. I also get all stirred up and putting myself out there because I’m social anxiety. But this is what we’ll talk about that the one way to really deal with the anxiety, is to be able to move through it. It’s okay for me to have this and still show up in my life the way that I want to. You’re doing a great job, by the way. Oh, thank you. Thank you for that. Reassure curtains. That’s what we do here. Cliche okay. What may cause this anxiety? You mentioned a few light examples of natural ways or normal ways to feel anxiety, but what could cause such anxiety that makes you distraught? Yeah, so a couple of different things. It’s really the way you react to your anxiety. Right. So in terms of we think of risk factors and are you more likely to have an anxious or anxiety disorder? For sure. There is some studies that say genetics could play a role. So if a first relative does have anxiety, you might be more likely to have anxiety. But there’s also that kind of nature nurture, because then that same maybe anxious individual is also raising you. Right. So it’s also like the modeling and what you learn growing up, right. So how you’re anxious, like, what you see the people around you, how they handle anxiety. And just in general, when you have an anxious response, how you handle that in the moment. And so I think in general, regardless, even if you don’t have any of those risk factors, also, if you’ve had maybe some history of trauma or, like, early childhood stressors or something along those lines, you might be more likely to develop anxiety. But really, at the core, what maintains and really develops into an anxiety disorder is when you start to have anxious response. It’s how you react to it. So, again, I’ll go to my example of me having even some social anxiety about coming here today, if that caused me such distress. And I decided, like, no, I’m going to avoid this opportunity and any other opportunity where I might have to put myself out there at that point. That reaction, that avoidance response, is what’s maintaining my anxiety. Got it. So it completely stops you from going to that activity that’s making you nervous. Right. And so then it’s like this kind of weird thing that happens that in the moment. So if you were to reach out to me and give me this opportunity, and I say, you know what, Michelle? I can’t do it, maybe I’ll come up with an excuse, and I say, no. In the moment, I’ll feel like a sense of such relief, because it’s like, oh, I don’t have to deal with it. I don’t have to kind of go through the scary activity. But in the long run, next time someone asks me to do a public speaking event or another situation that might trigger my anxiety, that means that my tolerance for handling it is a lot lower got it. Because you’re avoiding it. Correct. Right. Avoiding it. Yeah. And so a lot of times when I’m working with my clients, it’s really like helping them understand that avoidance makes sense. Right. Because it makes sense that you want to avoid something that feels scary, but in the long run it’s really not helping you. Yeah. It’s a temporary relief, basically. Absolutely. Okay. What are some of the most common symptoms for anxiety? Yeah, so really it’s this kind of the cognitive part. So like our thinking so really having some type of worry about something happening and then being afraid of that and going back to depending on what type of worry you have. Maybe you’re more afraid of a dog, maybe because you got bit at some point in your life from a dog. Maybe you’re more afraid of public speaking. Right. Maybe you’re more afraid when we think of more of a generalized anxiety, it’s more like you tend to just worry about anything and everything. All these things tend to really feel like a sense of dread. And then there’s all the behaviors you do. So if you have all these worrying thoughts, then again the avoidance. So do you avoid the situations that bring that on? And also, though, like, physically, so anxiety can manifest really physically and you can have more irritability sleep issues, stomach issues, and that’s not even when I’m thinking of like a panic attack. Just in the everyday, you can start to notice that anxiety will show up physically and in your body as well. Yeah, just sweating of the palms. I get that one sometimes. Oh, yeah. I’m like, okay, this is not normal. Yeah, I got this. Or restlessness. Right. So I think that’s a really common one. Or like just sweating in general, I swear. Why, you ask? Is it hitting home? Michelle, throw it all graspy like, I’m fine, I can do this. Okay. What about risk factors? What are some of the risk factors for anxiety? Yeah, so kind of going back, some of those kind of risk factors would be like if you had any childhood exposure to trauma or early kind of really stressful experiences, any biological factors, like I said, but the big one being your response to it. Right. So if you already have, maybe you are someone that tends to be a little bit more kind of careful. Right. And so just knowing that okay, if that’s a little bit your personality style doesn’t mean that you’re more likely to get anxiety, but know that maybe if something stressful does happen, how that being careful can really kind of shift into a little bit more of avoidance. That makes complete sense. What are some of the most common anxiety disorders that you see in your practice? Yeah, so I would say kind of the top ones that really show up for me and like clients that show up would be generalized anxiety disorder, social anxiety disorder. And then someone who’s having panic attacks, like panic disorder. So those are, I would say the top three that people really I see in my practice show like, hey, there’s some type of struggle in those realms and out of those do you have one that is most common than others or at the same rate? I would probably see generalized is a little bit more common. I don’t even know though, if someone would endorse that. Right. Typically someone wouldn’t come to my office. Sometimes they would say, like, I’m really stressed out, I can’t stop letting go of worry. They might be coming in. Because it’s like, yeah, I just noticed I can’t go to sleep no matter what I do, my sleep is getting in the way. So they might not endorse that, but that when we sit down and look at like, oh, yeah, you are having more of like some general yeah. Your diagnosis looks like you might check off some of these boxes. Yes. And I know you mentioned a lot anxiety attacks and panic attacks and a lot of people don’t know the difference. Yeah. Do you mind explaining? Sure, absolutely. So when we’re thinking of a panic attack, that’s typically when within a couple of minutes it can be triggered or untriggered. Meaning like it could be because something specific happened. Again, I’ll use my example of coming on this podcast if that would have brought on this intense kind of surge of uncomfortable physical symptoms. And that could look like, again, sweating, heart beating, nausea, tingling, numbness, and that happens for about two to ten minutes. That’s really high level of anxiety. And typically someone would say, like, I think I’m dying, or I think I’m going crazy. Breathe. Right, you can’t breathe. Had some clients that thought they were going to die because they couldn’t breathe right. They’re hyperventilating real for them. And actually you’ll see a lot of people who go through who struggle with panic attacks and not necessarily knowing what’s happening will check themselves into the Er because they think, maybe I’m having a heart attack. So typically, kind of when we’re thinking of that response, it’s really when your fight or flight response has kicked in, something has triggered it. And so your body is thinking that you’re under attack and is getting you prepared, but in most instances there’s no threatening situation, but your body doesn’t know that. Your mind doesn’t know that. But in the moment it feels like that’s the case. So that’s when we’re thinking of a panic attack, an anxiety attack, again, it’s more so when you’re having an anxious response to something, it would be more, let’s say, situational, or maybe you’re stressed and you might be having some physical symptoms, but it’s not that intense surge that tends to peak within a couple of minutes. You don’t think that you’re dying or you’re going crazy or you can’t breathe. It’s a little bit extra fidgety. Yeah. You just might feel uncomfortable. You still might have some physical symptoms, but it’s not that burst that comes when we’re thinking of a panic attack. Got it. And I had a client with a lot of panic attacks and it could be scary if you see it, if you’re not trained and you just see that it does look like they’re going to stop breathing. Yeah, absolutely. Especially if you’re not aware that someone is struggling with the panic attack. Maybe they don’t know what’s going on. Right. Especially if you’re not even yourself. Maybe it’s your first panic attack. Be very scary. Yeah, absolutely. I mean, I’ve worked with therapists and even them knowing, like, I think this is a panic attack, you can know it, and it still feels really uncomfortable. And I think that’s the one thing with anxiety disorders is that they feel really uncomfortable. And that’s why it’s really hard sometimes because I know sometimes saying like, well, just do the scary thing. Well, if it were that easy right. It does take some work to get you into that place and some skills to help you because it does feel physically uncomfortable. Whether you’re struggling with a panic attack or just some kind of general symptoms of anxiety, the fear is real in that moment. Right. Like what has gotten activated is uncomfortable. Yeah, I think it’s so hard because like I mentioned before, everybody’s using the term lightly and at least with my students, they’re actually having anxiety or panic attacks and the parents won’t believe them or they’re just trying to cause attention, or everybody has anxiety. Now. It’s like ADHD, right? Oh, yeah, now everybody has ADHD. Well, maybe it is being overly used, but it doesn’t take away from the fact that some of them do have a disorder and needs to be treated. Yeah, absolutely. So it’s like kind of a two edged sword, right. On one end, it’s like it’s great that more people have knowledge and education and even clients will come into my office and say, I saw a TikTok, I think I’m dissociating, or like, I think my partner is narcissistic. And I always think that’s great that consumers are getting more information about mental health through all these mediums. And sometimes it’s like, okay, well, let’s really look at that because again, self diagnosed. Exactly. Please. Yeah, absolutely. And listen, I think we’re all guilty of it at times to do the self diagnosis, but I think now it’s way more prevalent. But it’s really then kind of airing in like if one of your students or anyone is having that concern, it’s okay, what’s the harm in really looking at it? Right? Let’s explore it. If as a child or adolescent, they’re saying they are struggling with anxiety, even if they’re not, let’s say, meeting criteria for anxiety disorder, it’s like, okay, are you kind of signaling that you would like some help or something’s going on? Regulate yourself? Yeah, absolutely. Are you trying to get out of your presentation. Tell me the truth. I’m about to call your parent. What are some ways that we can treat the anxiety? Sure. So typically when we think of evidence based methods for anxiety, it’s really under the cognitive behavioral therapy umbrella, which looks like classic cognitive behavioral therapy. And then there’s kind of some third wave, which is acceptance and commitment, dialectical behavioral therapy, which really not to get too technical, it’s just really looking at kind of the role that your thoughts are having on your behaviors and really engaging in behaviors that are helpful. So in most of these types of therapies, it’s a big component of anxiety is what we call exposure work. So again, like having to really kind of confront the behavior, the fears that are getting in the way, so that you can start to teach your body and your brain that you do have the resiliency you can handle. You can tolerate it, because that’s the thing. Even with panic attacks or any type of panic disorder, that anxiety will peak for so long, but eventually it will go down. The problem is that if we avoid in that intense moment of when it’s really high, we’d never teach ourselves or our body that we can handle it and that it’ll go down. And so really, any type of therapy that’s going to be doing exposure and getting really clear on what are the fears that are showing up. So having a real clear sense of are you afraid of embarrassment or are you afraid of someone dying? Are you afraid again, of getting contaminated? Fear. Right. Whatever that fear is, the therapy should be targeting that, getting clear on that, and then doing any type of behaviors, exposure, so that you’re putting yourself in situations where that’s going to be activated. I tend to do a little bit more of acceptance and commitment therapy. And a huge part of that is also looking at values work. So getting really clear when we do an exposure, I’m not going to have you do an exposure just for the hell of it. I don’t know if we can say that, but more so, like, when it matters to you. Right. So getting really clear on like, okay, again, using my example, why would I put myself out there? Okay, well, because I’m sharing knowledge about anxiety that could help someone. Okay. Is that in line with my values? Yeah. Okay, so then it would be worth it for me. So again, going back to any of these third waves, also a lot of the newer research saying, like, mindfulness. So I feel like mindfulness is a buzword. Yeah. But again, any type of present moment activities, exercises that’s going to help you, again, help your body regulate. I come from the perspective of when we do mindfulness activities, the goal isn’t to calm down or get rid of your anxiety. The goal is to just be a little bit more comfortable and open with the experience that’s showing up. Funny thing, you mentioned that. Can you give us some self coping techniques to manage our own anxiety at home, maybe? Yeah, absolutely. So I think on one hand is getting really clear. A lot of times I’ll ask my clients to scale their anxiety, especially when we’re thinking of a panic attack. So, like, zero to 1010 being like, you’re in that peak where you think you’re going to die something’s horrible. You’re about to I feel like if I ask that, they’re all be like, ten, maybe, because you work with students. And most of my clients will be like, well, I’m at a six, or I’m at a four. And they can like, okay, right. If someone says they’re at a less dramatic, they’re a little bit slightly I did work with adolescents for a while, so I get it. But yeah, helping yourself kind of scale in and check in with yourself of like, okay, where is my anxiety now? And intervening at a place like you really want to notice when you’re maybe at a three or four or five where it’s still manageable for you to do some tools versus when you’re at a ten. Because now we’re looking at a little bit something different and really any tool that’s going to help you use your senses, right? So the most common one is some breathing activities. So taking a moment, stopping and taking some deep breathing and really tuning into that. For some clients, especially with anxiety, breathing is counterintuitive because it tends to trigger their anxiety. That’s fine. So I always talk about, okay, you have use your other senses. Right? So a really common one, it’s like, okay, stop and look around your environment. What are like, five things that you’ve never noticed in your environment? Right? Can you really focus on that? What are four things that you can feel right? Touching? Right? So using your senses in the moment, like, what are the squeezing your exactly. And so any kind of physical and then you kind of go down. Like, what are three things you can hear? What are two things you can smell? What’s like the taste you have in your mouth again. And it could just even be just picking one of those and honing in on something to help ground you, because that’s what it is. When we start feeling really overwhelmed, it’s like our internal experience has gotten away from us, and we feel like we’re scared that we can’t handle it. Right. So kind of helping yourself. A common one I also do with clients is like grounding, like literally ground your feet on the floor, kind of put your two foot, feel your feet there and really take some time to come back to this moment. And so, again, anything that will help you in the moment kind of just regulate your nervous system that you’re okay, so think of your happy place exactly while you touch your thighs and put your feet on the floor. Absolutely. It sounds so tacky, but it does work. It does. And I think that sometimes and again, going back to the propensity for social media now and all these tools and tips, and sometimes, again, one tip might not work. So finding what’s really going to work for you, but I think it’s really sometimes going back to the basics right. And figuring out what’s going to work to help you kind of really manage the uncomfortable feelings, not get rid of them. Because I always say this, it’s not like we can just turn off a light switch and you’re no longer going to have these feelings, but that you can be in a stance where you can be more open to them and again, do the things that are important to you in your life. Yes. So anxiety is treatable. Anxiety is so treatable, which I think that’s the thing where I wish more people could know that and be aware of that, especially this is the other thing, because if you had an experience with therapist and it wasn’t so helpful, it’s kind of the analogy. Like if you went on one bad date, you wouldn’t just stop dating and rule out worry. Yeah, just keep trying. Because anxiety and evidence based treatments do really work to really help you kind of gain control back of your life versus when your anxiety takes over, it becomes a full time job. Yeah. At what point for someone that might be listening and they’re like, well, I kind of have these symptoms, at what point should someone seek help? Yeah, for sure. Going back to this impairment. So if you’re noticing that it’s interfering with your day to day, even weekly, whether that’s work, school, your relationships, are you so nervous that your partner is going to leave you? So you need reassurance whatever area in your life? It’s like when you start noticing that it’s like interfering and that you can’t cope with it, then I would definitely recommend someone seek counseling. But again, I think this other piece, there’s this term called high functioning anxiety, which I think is also a thing now, which really just means you’re having symptoms of anxiety, but it’s not impacting your functioning. And so a lot of times maybe someone won’t seek counseling because it’s okay. Well, my functioning, I’m still hitting all my goals. I’m still doing everything. But internally, I’m so overwhelmed. I’m struggling with these symptoms of anxiety, but on the outside, everything’s okay. So honestly, I know I tend to be biased, but I feel like if you feel like you’re having some symptoms and that you could benefit from more skills or tools or learning a little bit more about your anxiety, don’t wait. You don’t have to wait till it gets to the point where you are having some type of impairment. I always tell people the minute you start questioning if you need therapy, you might as well go, see, that’s a good sign. It’s the thought it’s there. How can we help a loved one, a family member, a partner that might be suffering from anxiety? Yeah. So I think the best way to help someone who’s struggling with the anxiety is really asking your loved one. And I know that might seem really cliche, but really? Because again, everyone’s anxiety looks a little bit different, what the theme? Is it’s getting clarity on learning what does show up for you? Right. So having an open mind of like, I really want to understand what your anxiety is. Right. So being open to like, hey, let me sit down and figure out what are the things that really come up for you? Being really caring and listening and understanding. Because I think that’s another fear. It’s like people aren’t going to get it, they’re going to invalidate my experience. So if you’re coming from, as a loved one, trying to be supportive, that means being able to really hear and understand. That doesn’t mean you agree with everything that someone’s saying. But asking them what support looks like one thing I will say, it’s being clear to maybe not get in the role of enabling or reassuring, because that can be sometimes, especially with children. It could be easy as a parent, especially if you’re a parent who has anxiety as well, to get in the role of helping your child. Not helping, but facilitating their avoidance. Right. So if they’re struggling and they want to avoid and then you also want to help them avoid, again, that kind of catch 22 that then it’s going to be a little bit harder. But I also don’t want to say you have to be someone that’s, like, do every single situation and kind of really be that bully, because that wouldn’t be productive either. So figuring out, again, talking to this person what they need, what type of support as well, versus just assuming what’s best. Yes. And again, if you’re a parent who suffers from anxiety yourself, don’t feel bad for getting help for your son or daughter. Yeah, absolutely. Professional help. If you can’t help them, let somebody else help them, but get them the help. Yeah, right. It’s like as a parent, you would definitely hire a tutor, right. If you don’t know how to help them prepare for the SATS, there’s usually no stigma around that. And so same perspective of like, hey, why don’t you hire someone to help you? Especially, again, if you are a parent who struggles with anxiety and then it triggers on your own anxiety and you struggle to really follow through. Right. Because again, then it’s like, now we’re dealing with two things, right? Your child’s anxiety and then your anxiety that shows up. Exactly. Now, for those who are listening, are there any resources you can recommend where they can get more information? Yeah, so my kind of top recommendations, the association for Anxiety and Depression or Anxiety and Depression Association. I’m sure the Notes will be in the links will be in the Notes. So that has a ton of resources, stats where you can actually find therapists, the National Institute of Mental Health as well, and Mental Health America. All those websites again, have even tools that you can do questionnaires to kind of see for you to start to look at your own anxiety and then depending on, okay, going back to like, well, what if, that would be a great way to explore that and see like, hey, maybe treatment is something to consider. So, for example, during the pandemic, I worked with a client who of course was having some health anxiety, which was very common through the pandemic because talk about what would be a trigger, right? If someone struggles with contamination fear, then this individual was struggling with that. And really, they had really limited their life in response to the health anxiety, which I saw this again with COVID it was hard to determine. Okay, following proper guidelines again, because we want to endorse that. Do what the CDC is saying. At the same time, though, when is it causing such an impact that it’s more like the fear taking over and you’ve gone above and beyond. So really working with this client to help this individual understand that and help them understand how much their life had kind of become really narrow in response to this fear. So they had made their partner kind of shift their career in response to it. They had really made sure that they weren’t going out as lot. So even the people in their lives were impacted, not just them, because of their desire to control their bubble. It meant not only like, I have to restrict my behaviors, I have to restrict the behaviors of my loved one. And so really helping this person, ironically, even getting the vaccine right? And that was in line with their values. It wasn’t like they had any beliefs about not getting it, but it was the fear. Like, okay, well, what if that goes wrong and then I get sick and then die, right? So helping them do that to help them slowly get to the point where then they can start to expand their life, where they could go to the grocery store, they could take their kid to the park. I mean, they just recently, like, I took my kid to the library where it was really dirty and I did it and I stayed. And so again, really helping someone kind of move through that, going back so that they can start living their life, that’s really important to them. And what diagnosis did that person have in particular? So it would be more of like the health anxiety kind of hypochondriac. Okay, I can’t imagine just being stuck in the house. Well, and again, I think even if we look at through the pandemic. I saw that a lot. Even someone that doesn’t even necessarily have a propensity for it, right? Maybe they’re more of, like, have anxiety in general, but because of what we were all going through on a global scale, this was a theme that was really getting triggered and was showing up. And even if it was, I had another client who wasn’t even so much about getting sick. Thankfully, they were healthy, and they weren’t concerned as much about that. They were concerned about doing something wrong. So they were concerned more about like, what if I do something and then expose someone else? And then that and what does that look like? Right? So again, there’s all these little nuances that show up and like, with the pandemic, a lot of that was getting triggered for people who kind of already had some anxiety in place. Yeah, even myself, I’m not a big anxiety person or clean freak, if I must say. But during that pandemic, you just become more aware of how many seconds you wash your hands. Do you wash your hands every time? And then you’re seeing all this proper ways to clean your hands. You’re like, I’ve never cleaned my hands this much this many times. It’s almost like now I do it all the time. Yeah, and that’s like a habit now. You’re like, if you don’t do that right, the 20 seconds on your watch, you’re like, okay, watch. I feel bad. I was like, oh my God, I have five more seconds. I’m sorry. I’ll be washing dishes, be like, Ha, I’m not washing my hands. Oh, my God. But, yeah, no, definitely changed everybody, and I’m glad that you were able to help them. Yeah. As I’m sure a lot of also therapists. So, again, going back to it’s really important if you’re noticing you’re struggling with that, you can really learn how to move through with that. Thank you so much for coming. It’s been a lovely conversation about anxiety. How are you feeling at the end of this interview? Less anxious. Less anxious. My anxiety is like, at a two. Right? I think we started it was on a six or seven and absolutely. It was such a pleasure to talk about this. I love talking about anxiety, as counterintuitive as that sounds, because again, I want to be really clear. Anxiety is treatable. Don’t wait to get help. This is a disorder that is really treatable, and it’s actually one of the most common disorders. So really, if you are someone that falls in that bracket, go get help. And I think the one thing I’d also say let go of the avoidance. Let go of the avoidance. You can do it. Let go of the avoidance. It’s really, really hard. But you can figure out how to do that. Yes, I agree completely. You also have a book coming up? I do. So next year I will have a book. It’s called negative self talk. So it will also kind of COVID some kind of topics related to anxiety, but mostly how to kind of tap into your inner ally when you’re dealing with the inner critic. So a lot of kind of when you get really self critical, which, again, some of my clients that struggle with the anxiety also struggle with the inner critic being really hard on themselves. And so my book will be all about that and really coming from an acceptance and commitment therapy perspective. Nice. Yay. All right. Thank you for coming. Again, thank you guys for listening. Don’t forget to, like, comment and subscribe to our channel, I hope. Do you enjoy this interview. I’ll see you next week. Bye, Ram.