Approach Rather Than Avoid

Oct 10

Dr. Kerry Kinney, a psychologist at Vanderbilt University, joined co-hosts Meagen Rosenthal, Ph.D, and Alexis Lee for The Mayo Lab’s seventh episode of Season 2. Dr. Kinney shared about anxiety, emotional regulation, and the challenges of addressing mental health with its increased social media context.

According to Dr. Kinney, anxiety, as opposed to fear, is “more future-focused [and] tends to be a little bit more cognitive as well, so it involves a lot of worry and a lot more of that kind of thing where it’s just more thought-focused rather than that fear.”

Because anxiety is so common, Dr. Kinney shared the markers one should look out for to inform whether someone should search for treatment, such as if anxiety is getting in the way of important parts of life. Getting treatment, she said, is usually the hardest part. Symptoms often get better when people receive the help they need.

“It’s treatable, it’s changeable, it doesn’t have to be a forever kind of thing,” she said.

Dr. Kinney explained how one gold-standard treatment for anxieties, exposure therapy, can help by getting closer to what a patient is fearful of.

“When we want to avoid getting wet, we use an umbrella. So it makes sense, and it's intuitive, that you would want to avoid something that causes anxiety. But, that said, that sort of reinforces these thoughts that the situation is dangerous or that you can't cope with it, and then we see that over time, anxiety gets worse and worse.”

“If you’re feeling avoidant of something that is important to you, and if avoiding it is getting in the way of you reaching your goals or living a fulfilling life, try approaching instead of avoiding … I would say approach instead of avoid, and really be mindful of how we talk about these things and how that might affect other people as well and how they feel too.”

— Dr. Kerry Kinney

In a conversation around stigma, Dr. Rosenthal asked Dr. Kinney whether there has been a downside from the normalization we see around mental health and anxiety in the media today. Has it added to misinformation? Dr. Kinney thinks it can.

One issue she’s seen has been an increased sense of identifying with mental health diagnoses in a way that can be harmful. “It kind of reinforces this idea that this can't be changed,” she said, “and that is something that I feel really strongly about, because we know that it can. We know that people can get better, and it's important to me that people know that.”

To hear more from Episode 7 of Season 2, scroll down to listen to the episode or read the transcript.

Watch the podcast on YouTube:

Meagen Rosenthal:
I'm Meagen Rosenthal.
Alexis Lee:
And I'm Alexis Lee, and this is the Mayo Lab Podcast.
Hello everyone, and welcome back to the Mayo Lab Podcast. This season we are talking about stigma and we're excited to have Dr. Kerry Kinney with us to talk about anxiety. But first of all, welcome to the podcast.
Dr. Kerry Kinney:
Thank you.
Alexis Lee:
And will you give us a little background on your history, your education, experience, and how you got to where you are right now?
Dr. Kerry Kinney:
Sure. Yeah. So I started researching anxiety disorders actually back when I was in undergrad at Northwestern, kind of by chance. And I just really liked it and was really fascinated, particularly by generalized anxiety disorder and decided to keep pursuing it. Got my PhD at University of Illinois at Chicago, and then I did some training actually in Mississippi at University of Mississippi Medical Center for my residency in a couple of years of postdoc. And then I moved to another postdoc position at Vanderbilt, which is where I am currently.
And I'm currently on a training grant focused on the development of psychopathology, but all throughout that time I've been researching the development and treatment of anxiety and related disorders, and more recently I've shifted a little bit to include some research on disparities as well in anxiety disorders.
Alexis Lee:
That is awesome. And I'm excited to dig in because I think anxiety is such a hot topic right now and a word that people use maybe interchangeably in ways that they don't mean to or that's not necessarily appropriate. So before we dig in, can you explain to us what anxiety is in the technical sense?
Dr. Kerry Kinney:
Sure. So anxiety is basically an anticipation of any future threat. So it's similar to fear, but it's a little bit different. We would define fear as more of an emotional response to a real or perceived imminent or immediate threat. So anxiety is more future-focused, tends to be a little bit more cognitive as well so it involves a lot of worry and a lot more of that kind of thing where it's just more thought-focused rather than that fear, which can be a little bit more visceral, I think.
But when it comes to anxiety disorders, so everybody has anxiety of course, and in many ways it's adaptive. Some level of anxiety can actually improve performance. So I was a little bit nervous for today, for example, and so I spent some time preparing some answers to questions and practicing saying a few things. So hopefully my performance will be better than if I had no anxiety, for example. But then of course, anxiety can become really elevated to the point where it can interfere with performance or lead to what we would call clinically significant distress. So those really, really high levels of distress or impairment, and that just means it can interfere with functioning in different aspects of life, whether that's social interactions or it interferes with our work, something like that. So that's when it would become that disorder level of anxiety where we would really recommend treatment for that.
Alexis Lee:
So as you progress from that anxiety that everyone just has to, it's actually good for you to, okay, maybe we should address this, is there a progression or things that you would say to our listeners of things to watch for in that progression so maybe you can identify it before it is interfering with work, school, family, friends, et cetera?
Dr. Kerry Kinney:
Yeah, I would say of course everything exists on a continuum, so there's going to be varying levels of it. And when it comes to treatment, we have to divide it into disorders and not, and a lot of that has to do with insurance, reimbursement, and things like that. But any time where anxiety is getting in the way of things that are important to you, I think that's something to look out for. And as that happens more and more, that is headed more in the direction of a disorder where we would recommend treatment.
And one thing I think that's important to keep in mind is just because you have anxiety doesn't mean you will always have anxiety. Just because some situation causes you anxiety right now doesn't mean it always will. We're actually fairly good at treating anxiety when we're actually able to get people the treatment that they need, it's just that seems to be the hard part of it. So anxiety disorders are one of the most... Actually, they're the most common form of mental illness. So they affect almost 20% of the US adult population. They affect over 30% of adolescents aged 13 to 18. So we're talking about tens of millions of people in the US that suffer from an anxiety disorder, and only less than a third actually receive the treatment that they would need. Or actually I think receive any kind of treatment. And the ones who receive good quality treatments even lower.
I just think it's important to keep in mind that this is treatable, it's changeable, it doesn't have to be a forever kind of thing. And a lot of people with anxiety disorders suffer for a really long time before they actually seek out treatment, and we need to do a better job of getting the treatment that people need to them when they need it. But at the same time, I think it's important that the public knows that there are options out there basically.
Meagen Rosenthal:
That is fascinating. Could you walk us through some of the... I have so many questions, but to start off, some of the gold-standard treatments or the things that we know work right now, where we have data and evidence to support?
Dr. Kerry Kinney:
Yeah, so there's two primary treatments for anxiety disorders. So there's one medication treatment, which is usually SSRIs or selective serotonin reuptake inhibitors. Those are also used to treat depression. As a clinical psychologist, I can't really speak too much to the treatment of it except to say it's one of the two gold standard treatments for anxiety disorders. The other one would be cognitive behavioral therapy. In particular, exposures tend to work really well for anxiety disorders, and that's because what we tend to see in anxiety is anxiety makes us want to avoid a situation.
Like I said, anxiety is anticipation of a future threat. So if we're anticipating some kind of future threat or some kind of negative interaction or whatever it might be, we tend to want to avoid it because that's what we do in all other aspects of life. So when we want to avoid getting wet, we use an umbrella. So it makes sense and it's intuitive that you would want to avoid something that causes anxiety, but that said, that sort of reinforces these thoughts that the situation is dangerous or that you can't cope with it, and then we see that over time, anxiety gets worse and worse. So the antidote to avoidance would be to approach and what we would call that in therapy is exposure.
So I think that the most common example that people would probably think of is with specific phobias. So if you're afraid of spiders or something, for example, we would have some kind of hierarchy of situations that cause anxiety and fear related to spiders. So it might be looking at a picture of a spider, looking at a real spider in a glass box across the room, and then getting closer to it. So we would do that over time, sort of like a graduated exposure, and that works really well for treating anxiety disorders.
Meagen Rosenthal:
That is so interesting, and I think the term exposure therapy has kind of been in the ether for a while now, but I appreciate how you just walked through that this is a stepwise process. And if you recognized you had an anxiety, is this something that you should do without or can do without somebody's supervision in that process? Or does this really need to be put into a clinical care-esque type of situation?
Dr. Kerry Kinney:
That's a great question. I think it really depends on the situation and the level of fear. Generally speaking, I encourage people to, when there's a situation that causes you some level of anxiety, to approach instead of avoid because we know that that's going to help over time. If it's something that is going to cause so much distress that you almost feel flooded and then it's going to get in the way of doing similar things in the future, then I would say you probably want some treatment to go with it.
The other thing is that the cognitive piece of cognitive behavioral therapy is we focus on the cognitions or the thoughts related to these situations. So there's different schools of thought about how to approach therapy. Some people really think that it's important to get as high of anxious arousal and fear in an exposure to see improvement over time. There's some more recent research that calls that maybe into question, but in any case, some people would argue that doing some cognitive therapy first can actually help you when you're in that situation so that your distress isn't as high as it would be otherwise. So all is to say, if you're in doubt, maybe just seek out therapy and then a clinician can work with you on all of these approaches and doing it in a way that's going to be helpful.
The other thing is when you're doing exposures, like a true exposure exercise, there's certain things you want to make sure that you're doing that a clinician would be able to catch. So for example, safety behaviors can sometimes interfere with the effectiveness of an exposure. And what I mean by a safety behavior is anything that is going to decrease your anxiety in that situation. So again, this is coming from the school of thought of you want high anxiety and distress and exposures, which again, there's different schools of thought, but if you want anxiety and distress to be really, really high in that exposure, anything that you're doing to decrease it in that situation can actually interfere with long-term improvement. So that can be a lot of different things. It might mean if you're afraid of flying for example, it might mean keeping a Xanax in your pocket when you fly, even if you don't take it. That's one example of a safety behavior because you know that it's there.
Meagen Rosenthal:
Interesting.
Dr. Kerry Kinney:
And one reason that that can interfere with long-term improvement is because you might think, "Oh, I can do this thing, but only if I have this backup in my pocket." And really, that has nothing to do with it. You can still do it without that. So to really see that what we would call extinction or to see that long-term improvement and see that anxiety or fear really go away, you would want to eliminate safety behavior. So that's just one example of how having a clinician there can be really helpful.
Alexis Lee:
Interesting. It also reminds me or makes me think about, at least, for folks who are looking to go into therapy, it seems to me like these are important questions to maybe ask your therapist or the clinician that you're working with. And this feels a little heavy and kind of fancy, but what is their approach? How are they thinking about this? What is their philosophical view on the outcomes of these things? Because lots of things will work for different people in different kinds of ways, and that might not be a good fit for you if that's not how you think it's going to work for you. So it's interesting, and especially because there isn't a lot of clarity, I think I heard you say, not a lot of clarity on which approach might be better long-term, right?
Dr. Kerry Kinney:
Yeah. Well, I mean, we know that exposures work, and this is really getting in the weeds of the theory behind exposure therapies. There's some more recent research showing that, it's called inhibitory learning, that seems to be what's really important in exposures. But either way, we know that exposures work. It's just different schools of thought about how to approach those exposures, and it seems like both work and there's just some debate over which is the best way to approach it, if that makes sense. We know that exposures work, we know that restructuring works as well, but when it comes to anxiety disorders, like I said, because of that avoidance, exposures tend to be kind of the best way to treat anxiety disorders.
Meagen Rosenthal:
That is so fascinating. That is so fascinating. And I want to circle back. Alexis, did you have other questions on that piece of it?
Alexis Lee:
No.
Meagen Rosenthal:
I wanted to circle back to a comment you made about the statistics and number of people who are currently in the midst of anxiety disorders, and if anybody has been paying any amount of attention to the news lately, we have heard about the explosion of anxiety and depression and explosion of this in lots of different populations of people.
And so as someone who is steeped in and has been researching this space for the time that you've been doing it, what do you think when you hear those kinds of things on the news? And are we talking about a true explosion in numbers or are we talking about being able to identify it better? Or is it some combination of the two, from your perspective as an expert in this space?
Dr. Kerry Kinney:
To be honest, I think we don't really know at this point. The research that has been done on whether the pandemic really increased the prevalence of anxiety disorders seems to be pretty mixed, and it depends on how you look at it. So I guess my unhelpful response is that we don't really know, I don't think.
Meagen Rosenthal:
That's okay.
Dr. Kerry Kinney:
But yeah, I do think that there's definitely increased awareness of mental health issues and anxiety and depression in particular, and so that could be contributing to this. I think that even on social media, there's a lot more references to things like anxiety disorders that has definitely brought it into the consciousness a lot more in some helpful ways and some not so helpful ways, in my opinion. But I do think that you're right that there is definitely an increased focus on it now.
Meagen Rosenthal:
And let's dive into that a little bit, because one of the things that I started thinking about as you were talking too about this just now and end earlier is that proliferation of the conversation on social media and it being both a blessing and a curse, right? Great, we're talking about this. We had some of our early episodes we're talking about this idea that now people are more comfortable having these conversations, and that's a good thing, right? We're reducing the stigma, especially for our younger people nowadays, but then there's the flip side of it of maybe it's not as helpful as we think and we're seeing more potentially inappropriate self diagnoses or things of that nature. And so I'd be curious, what is your perspective on that piece of this as we unpack anxiety in our world right now?
Dr. Kerry Kinney:
I think you really hit the nail on the head, to be honest. I do think that talking about it more is really helpful, and I think that de-stigmatizing mental illness is important, and I think that TikTok, and especially TikTok, there seems to be a lot of discussion of mental health issues on TikTok. I think that that increased focus on mental illness and mental health in general is really helpful in terms of de-stigmatizing.
I do think that there's a lot of misinformation out there about mental health though, that I think can be just really unhelpful in some ways. So for example, if somebody is diagnosing themselves with an anxiety disorder and saying this thing that would cause anybody a very normal amount of anxiety or a typical level of anxiety, if they're saying that that is disordered and then somebody with more severe anxiety that's more impairing sees that, they might think, "Well, what's wrong with me? Why can't I handle this? They have anxiety and they're able to do this, but I can't. What does that mean? Am I hopeless then?" So I think that's one downside.
I don't know that there's been any research on this in particular, but with all the self-diagnosis, there seems to be this increased sense of really identifying with these diagnoses, viewing it almost as a part of someone's identity. And again, I don't think that there's been any research on it yet. Not to my knowledge. There has been a lot of research or some research showing that there's a lot of misinformation and that most of the information about mental health on social media apps is inaccurate, and it's not coming from experts.
But in terms of this increased focus on these diagnoses as part of your identity, I don't think that there's any research on that. But I think that that is also really harmful because again, it kind of reinforces this idea that this can't be changed. And that is something that I feel really strongly about because we know that it can. We know that people can get better, and it's important to me that people know that. And so I find that really discouraging when I see that on social media apps. But like I said, there's pros and cons.
Meagen Rosenthal:
Well, and I think both of your observations about the kind of over-identification, I want to dive into that, but then you said something a second ago too about the impact that this self-diagnosis or identification with these disorders as being part of who we are and the impact that it has on other folks who have the true diagnoses and are going through that. I think that really relates a lot to this idea of stigma that we're dealing with in this season in a different kind of way than we've actually covered so far.
Alexis, I'm thinking about this as we assume and we work from the assumption like, "Oh, we're talking about it. It's good. The more we talk about it, the more we de-stigmatize it." But we've actually seen the pendulum maybe go a little bit too far and that this talking about it is actually harmful to the people who are in the midst of dealing with what that condition is for them and how they come out of it on the other side or seek recovery, seek treatment.
So I'd be curious, could you talk a little bit more about that as it relates to the individual and out to our families and out to our communities? I think that's a slightly different way of, like I said, how we've been thinking about it so far this season.
Dr. Kerry Kinney:
Yeah, sure. I think that you're right, that talking about it is great, but I think that the way that we talk about it is really important. So if we're talking about parents modeling for their children, for example, you can talk about your feelings and talk about anxiety in a way that's useful to your child and in a way that's not so useful. You can talk about and acknowledge the anxiety you might be feeling about a given situation, and then model how to regulate those emotions or approach a situation anyway and show your child, I can do this even though it's hard for me and here's how I do it.
That's very different than I have anxiety, so I'm going to avoid the situation because I just feel anxious and it's just never going to change. So I think that that is one big way that we can change the conversation a little bit to be a little bit more helpful while still keeping that conversation going and hopefully de-stigmatizing as well. Yeah, I think that's the primary way. Does that answer your question though?
Meagen Rosenthal:
It does, it does. And I think I'd be curious to know, because you spend time working with lots of different people, you're not just working with folks who have anxiety. And so how would we do that on a larger level? You just gave a really great example of me modeling good behavior for my children or people around me, doing hard things despite them being hard. How do we level that up to our community and talk about this in a different kind of way or start sprinkling that thought process on a larger scale?
Dr. Kerry Kinney:
That's a great question, and I don't know if there's a good answer to it. I think that a lot of these conversations happen at more of a personal level if they're going to be helpful, because every situation is going to be different for each person. Anxiety affects people in different ways. Talking on a podcast makes me a little bit anxious, but for somebody else it might not, and I don't get that nervous for tests, but somebody else might. And not only that, but even if someone else gets nervous in the same situations that I do, that might affect them differently or they might handle it differently than I do.
So I think a lot of it is just on this individual level. I think that things like this, like this podcast, are really important though too, because you're getting accurate information out there and I think that's huge. And I don't know, it's actually something I've spent a lot of time thinking about and how to make a difference, and I have not come up with a good answer here.
Voiceover:
You're listening to the Mayo Lab Podcast. For more information and resources, visit themayolab.com. Now back to the episode.
Dr. Kerry Kinney:
So I focus mainly on adults, but I do think that it's important that social and emotional learning and learning how to regulate our emotions and behave appropriately is important in school as well. I know that there is research out there showing that. I can't say much more on it in terms of how that happens, but I think that schools can play a really big role in that too.
Meagen Rosenthal:
Yes, absolutely. And I'd be curious to know if you could point us to resources that we can direct parents to of young littles on how to do that. Because I hear things like emotional regulation and I'm like, sounds cool theoretically, but how do you do that in real life? I think that that's the kicker for so much of this, and I appreciate you also so far just getting into the weeds on all of these conversations with us because that's what we've been doing. We're digging in deep, we're talking about complicated stuff that most of the time our listeners don't get to have access to. So this is really, really helpful.
The other thing I wanted to come back to you is the observation you made about people internalizing identities or co-opting self-diagnoses as part of their identity. I think that's a really interesting observation, and to the best of my knowledge, such that it is in that space, there's not been a lot of work done in that space. But I'd be curious to know what, in your experience, has led you to that observation of being like, "Hmm, there's something else going on here." Because you think about it from a clinical perspective and the primary care doctors, pharmacists, nurses, all the folks that people engage with on a regular basis, we're actually taught not to do that.
Specifically, we were talking about person-first language. You are not a diabetic, you are a person who has diabetes. And that has spilled out into all different kinds of conversations that we have and around a lot of different topics. So this is actually the reverse of that. And like I said, what has your observation been that has been leading you to think about that in a different kind of way than you may have in the past?
Dr. Kerry Kinney:
Yeah. So I know anecdotal evidence is not the best kind of evidence, but unfortunately that's what I have at this point. So I would say it's been partly just what I've seen on social media, but then also what I've seen in the clinic. What I've seen is that particularly younger folks that I've seen in the clinic have been a little bit more prone to really almost wanting a diagnosis, which I can understand if you're feeling distressed, really wanting a reason for it. Well, I think that that has maybe always been there, but I think the difference now is that they're using this language that they're picking up on social media, but attaching these inaccurate facts or this misinformation to it and just really identifying with that.
And I've been doing clinical work at some level, starting as doing intake interviews and all of that all the way up to, at this point I'm licensed, in Mississippi at least. So I've been doing that at some level for 13 years now, and it does seem that there has been a shift over time to just more talk about this. Patients seem to be coming in with more seemingly... They seem to think that they have a clear idea of what their diagnosis is because they've read about it or their friend has it or whatever. And I really think that it's coming from a place of just feeling really distressed and wanting a label for it, but there's just this misinformation out there now.
Meagen Rosenthal:
Right. And you talked a little bit about that already and mentioned this idea that anxiety is something that can't change and that you'll always have it, and that leads us to this idea that it will be part of who you are, personality, what have you, forever. What are some of the other key pieces of misinformation that you've observed on social media that we can share with our audience to make sure that they are getting attuned to these either within their own consumption with social media or in engaging with friends, family, et cetera?
Dr. Kerry Kinney:
I would say another big one is that people seem to think that... Well not everybody, but there seems to be a subset of people who seem to think that therapy should be forever, and that's not their fault. There's a lot of for-profit therapy options now that want your money for a very long time, which I would argue is unethical. So I think that that's a piece of it.
The general consensus is that therapy should be time-limited and goal-oriented because if you're coming to me for therapy forever, that's not teaching you to be independent and have your own sense of agency. It's sort of almost like what I was saying with safety behaviors. If you think you can only deal with this because you come to see me once a week or something, that's not really helpful in the long-term, in my opinion. I think that therapy should be really goal-directed and time-limited in most cases. Of course, there needs to be decisions that happen with the patient and the provider on a case by case basis, but in general, I think that that's a big one. Those are the main ones that come to mind for me.
Meagen Rosenthal:
Well, and I think that's a really great observation too, because as we've kind of talked about already, this idea that everyone is talking about therapy and mental health issues and all of these kinds of things, that the underlying assumption has been you're just in therapy forever versus it being, like you said, time-limited and goal-oriented. Alexis, you look like you had a question that you were going to jump in there with.
Alexis Lee:
And I kind of lost part of it, and so I'm trying to reel it back in. And I get the fortune to talk to a lot of students, and a lot of them are female college students just being in the space, working in college, and then at the church I go to and just all that. And so whenever they bring up anxiety or there's certain words they say, and that's one of the things I'm really trying to be better about, is talking to people about the words they use in the verbiage they use.
So one of the things I've noticed on my anecdotal evidence, and I was curious if you had any comments or thoughts, is when they say they're anxious and I say, "Why?" And what it is, sometimes it almost boils down to just time blocking better or managing their schedule, or maybe they need to exercise. They're maybe more in their head and they just can't think clearly enough to make that next step about the future. They're just anxious because they can't see clear on what's next because they feel so bogged down, like you were saying.
Dr. Kerry Kinney:
Yeah. So I think that that is something that we see a lot with anxiety, actually. When we are really stressed and overwhelmed, it's really hard to know where to start. And I think that it sounds like you're giving them good advice in terms of really blocking off their time and managing their time effectively and setting those goals, and that's what I would do with patients as well. That would be part of what I do with patients if they came to see me too. So yeah, I think especially with generalized anxiety disorder, which is my area of most interest, that tends to be something that we see a lot. There's this anticipation of this uncertain threat that feels kind of nebulous because they're worried about a lot of things, and that's very typical. So I think that anxiety or worry would be the right word to use in that situation, and it does sound like just being able to really think about it concretely.
And that's another thing that comes up a lot in therapy is just once you put something that you're worried about or anxious about or scared of into words, then you can actually think about it more critically. So that's, again, that cognitive piece when that comes in. So we would call that cognitive restructuring or reappraisal, which just means thinking about something in a different way, basically. So with anxiety, that might look like, what's the worst thing that can happen in this situation? How likely is that to happen? If that were to happen, how would you cope? What might be other outcomes? And so when you're able to look at the full picture, our anxiety tends to come down.
What we tend to see a lot of times though, is with anxiety, people get really fixated on one thing or they're so overwhelmed that they can't even think about anything. So when you're able to really look at the full picture, that tends to be really helpful. And that's also an example of an emotion regulation strategy as we were talking about before, [inaudible 00:31:55] what does that really mean? And I can point you to resources too, but that's one option for how to regulate emotions is to think about things differently.
Alexis Lee:
And what other types of anxiety disorders are there other than the generalized anxiety? Could you just briefly explain what each were high level for our listeners?
Dr. Kerry Kinney:
Sure. So generalized anxiety disorder is kind of this uncontrollable worry about multiple aspects of life. There are other aspects that go into it, like it has to be six months or longer, things like that. But generally, it's worry about lots of situations that's uncontrollable. There's social anxiety disorder, so sort of self-explanatory, but anxious in social situations. There's a subtype that is specific to performance anxiety, so that might be stage fright or anxiety about speeches, things like that. Or there's the generalized type, which can include a lot of different things for social anxiety. And then, let's see, we've got specific phobias as well. So that's that fear of spiders like I was talking about. It might be flying. It could be a lot of things, but it's specific to that situation.
There are some child anxiety disorders as well, like separation anxiety, that I know a lot less about just because I am focused on adults. And then there are a lot of other disorders that are characterized by anxiety, but don't fall under the category of anxiety disorders. So for example, obsessive compulsive disorder is not classified as an anxiety disorder anymore, but a lot of anxiety goes along with it. So that's one, or post-traumatic stress disorder, PTSD. That is classified as a trauma or stressor-related disorder. But obviously anxiety and fear play a really big role in PTSD as well. There's also depression with anxious distress, which just means depression and anxiety, basically.
So there are the anxiety disorders, but then there are a lot of other disorders that anxiety plays a role in. Even eating disorders as well, that's another common one. And then you talked to Dr. Woodruff [inaudible 00:34:22] as well. So anxiety is one of those things that can play a role in a lot of different things and just in our everyday life, kind separate from any mental health diagnosis as well.
Meagen Rosenthal:
I had some sense of how far-reaching it was, but not quite as big as it seems to be. Thank you for that. It also made me think about too, what are we doing as a community amongst ourselves and our family and people around us to make the identification and treatment and recovery from anxiety worse or harder than it needs to be? Are we engaging in behaviors or thought processes that are just making it tougher on folks to find that recovery piece, as you've been talking about?
Dr. Kerry Kinney:
I think we've touched on it a little bit already, just in terms of those unhelpful things going around social media and things like that. I think another piece is just we should try to be really open-minded and hear someone else's experiences and not dismiss or invalidate their feelings. So if someone is feeling anxious about something, just telling them not to be anxious isn't going to be helpful probably, and it's probably just going to make them feel like they're not understood by you or feel less close to you. So I think that that is one thing that we could do better oftentimes. And then I think that we as a field have kind of failed in terms of getting treatment to the people who need it. And again, I don't really know what the solution is to that. I've thought about it a lot and I'm doing research on it, but I don't have answers for you yet.
Another thing is that people with anxiety disorders often present to their medical providers first rather than mental health providers, and so their medical provider is really important in terms of connecting them with the treatment that they need. And so knowing what to ask for can be really helpful, because some providers might not screen for anxiety disorders or ask about it unless you bring it up, which can be hard because, again, anxiety goes along with avoidance, so it can become this perpetuating cycle. But yeah, I think educating ourselves and really knowing what to ask for is the option that's available right now because unfortunately, we're just not very good at getting the treatment to the people that needed it.
And I also forgot to mention one other anxiety disorder before, which is panic disorder. So that is characterized by panic attacks. Panic attacks can occur in a number of disorders, but panic disorder specifically is fear of having another panic attack and then avoidance, likely significant distress and avoidance and impairment that goes along with it. So that's the other one.
Meagen Rosenthal:
No, you're fine. You're fine. No, that's great. Alexis, did you have any other questions that you wanted to ask?
Alexis Lee:
Uh-uh.
Meagen Rosenthal:
Well, because it's my favorite question to ask when I have conversation with the folks, do interviews, et cetera, what is the thing you thought we would talk about today that we haven't covered yet? I know there's something in your preparation for our podcast today that you're like, "Oh, I'm going to answer this question," and then of course we didn't ask it. So what is your one thing that we haven't talked about today that everybody needs to know?
Dr. Kerry Kinney:
Yeah, I don't think it's that you haven't asked the question, I think it's that I've been a little bit scattered in my responses. But one other thing that I wanted to make sure I touch on is just that the stigma related to anxiety disorders I think can affect different people and different ways in different communities in different ways. There is research showing that people from minoritized backgrounds, for example, are more likely to worry or to endorse some anxiety about the stigma of anxiety. And honestly, a lot of that is warranted because providers are more likely to use stigmatizing language with patients from minoritized backgrounds as well. And so that's another thing to keep in mind.
So there's some research showing that prevalence rates of anxiety disorders might differ by race, for example, with it being more common in white individuals, but that actually is unlikely to be the case. There's other research showing it's probably more likely that we're just not screening for it as well and identifying it in patients from other backgrounds. So it's important to just not make assumptions like that, like, "Oh, this person, let's not be worried about this thing," or whatever it might be. And also, anxiety disorders are twice as common in women compared to men, but that doesn't mean that men can't have anxiety disorders. So just important to keep those things in mind as well.
Meagen Rosenthal:
And I think that that is a really amazing observation, and thank you for bringing that up too, because I think it has implications for how we engage with each other in the world. If we're assuming that men can't have this, that prevents them from having feelings that they're probably already having, have been having for a really long time, and makes it less likely for them to seek out treatment and care. And same thing if you're looking at differences between people who are white and people who are Black or what have you, that prevents them from seeking out those treatments and those care opportunities that might be available to them otherwise, and so I thank you for making that observation and sharing that background literature with our listeners.
One of the things that we've been trying to do this season is really leaving our listeners with a few things they can do right away, so things they can do as individuals, things they can do for their families, and things we can start to do for our communities. And you've touched on a little bit on all of those so far today, but I wanted to give you an opportunity to just take a minute, reflect for a second. What are the three take homes that you would like to leave for our listeners for this episode?
Dr. Kerry Kinney:
Yeah, I would say first of all, make sure that you're getting your information from reputable sources. I think that another thing that's important is just in general, if you're feeling avoidant of something that is important to you, and if avoiding it is getting in the way of you reaching your goals or living a fulfilling life, try approaching instead of avoiding. Even if you're not sure if you'll succeed, try talking to that person even if you're not sure if they'll reject you or not. Try applying for that job, even if you're not sure how it'll work out or whatever it might be. So I would say approach instead of avoid, and really be mindful of how we talk about these things and how that might affect other people as well and how they feel too.
Meagen Rosenthal:
Those are great take home messages. Thank you so much for being here with us today and sharing a little bit about your experience and your expertise in this space. And because you said this way back at the beginning, two postdocs is kind of like the norm now, so you're doing fine. This is awesome. And you're going from good institution to good institution, so you're on a good trajectory.
Thank you again so much, and we'll be sure to share all of the resources that you provided in the show notes for today so folks can make sure that they save those links to the places where the good information exists instead of getting back on social media somewhere and maybe not getting the best information. But thank you so much again for your time, and we appreciate it very much.
Dr. Kerry Kinney:
Thank you. I really appreciate it.
Voiceover:
Thank you for joining us on this episode of the Mayo Lab Podcast. The Mayo Lab Podcast is produced by Dr. Natasha Jeter, Dr. Meagen Rosenthal, Alexis Lee, Slade Lewis and Hannah Finch. This podcast was recorded at Broadcast Studio in Oxford, Mississippi. The show was mixed and mastered by Clay Jones, and our original music was composed by Slade Lewis. The Mayo Lab podcast is brought to you by the William Magee Institute for Student Wellbeing.
For more information on the Mayo Lab Podcast, head over to themayolab.com and follow us on social media @TheMayoLab. If you enjoyed listening to the Mayo Lab Podcast, we'd love for you to subscribe, rate, and give a review on iTunes, Spotify, or wherever you're listening to this podcast.
This podcast represents the opinions of Dr. Meagen Rosenthal, Alexis Lee, and their guests on the show. This podcast is not intended to be a substitute for the medical advice of a licensed counselor or a physician. The listener should consult with their mental health professional in any matters relating to his or her health or the health of a child.