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Welcome to Solved, everybody.

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I'm your host, Mark Manson, and today we are ranking anti-anxiety interventions from the worst to the best, according to the current science.

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Have you ever tried to put out a kitchen fire with a glass of water and then stood there wondering why the kitchen is somehow more on fire than before?

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No, this has never happened.

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But apparently this has happened to Drew Bernie.

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So we're running with it.

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Because that's kind of what most people are doing with their anxiety.

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Reaching for something that feels like relief, watching it work just well enough to keep reaching for it, and then ending up worse than where they started.

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Now, most of the interventions that people swear by, the supplements, the apps, the techniques, all the stuff that we're going to get into in this episode, they are not chosen because they're the most effective.

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They're chosen because they feel easy and they feel quick.

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And we're going to talk quite a bit about that.

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about the relationship between the quick fix and the actual long-term solution.

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We've picked 17 of the most common practices, supplements, and interventions that people use to combat their anxiety.

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Here they are in alphabetical order.

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Adaptogens, alcohol, benzodiazepines, breath work, CBD, digital detoxes, journaling, physical exercise, magnesium, meditation, probiotics, psychedelics, therapy, sleep, socializing, SSRIs.

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And your favorite, yoga.

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We're going to break down each of these 17 interventions into how well they work, how efficient they work, how long-lasting the benefits are, whether there are any benefits or not, and how strong the actual research behind them is.

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As always with these ranking episodes, there are surprises and there are interesting patterns that emerge.

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And as always here at Solved, we categorize everything into four categories.

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Things that legitimately work, actually good things to do.

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The sort of depends category, the stuff that maybe works for some people, not for others, maybe works in some situations, but not every situation.

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There's the not helping but not hurting category either.

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This is where you get a lot of your placebo effects or just things that are – the effect is so minuscule that like you're not really doing anything but you're not hurting anything either.

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And then finally, there's the bullshit category, which is the pseudoscience, the stuff that is potentially harming you and the stuff that is counterproductive.

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We will start with the bullshit category, work our way up to the legitimate fixes, and end at the number one intervention for anxiety in the world based on the current science.

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You might be surprised.

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You might not.

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There's definitely some interesting caveats either way.

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Anxiety seems ever present these days, Drew.

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It seems like everyone and their dog has anxiety.

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I use that saying a lot, everyone and their dog.

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But like in the case of anxiety, literally, I can't tell you how many friends I have.

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They're like, oh, my dog has anxiety.

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I have to go home.

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I'm like, when did this become a thing?

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And they're maybe even on meds to their dogs.

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Yeah.

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Yep.

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Is this how far we've come?

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This is where we're at.

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This is where we're at.

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All right.

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Everyone and their dog has anxiety.

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So we will inevitably get into many of the mechanisms and processes behind anxiety.

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We'll get into a lot of the cultural stigma and labeling around anxiety.

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We will get into how anxiety is perceived and treated today versus, say, generations past.

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And basically, by the end of the episode, listeners, you should have a deeper, more comprehensive, and more nuanced understanding of anxiety, how it works, and how to actually resolve it.

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Thank you.

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If you love the show, please like and subscribe, leave a comment, share with some friends.

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Follow us at SolvePodcast.com.

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You ready?

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I'm ready.

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Let's do it.

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Before we dive into the rankings, Drew, I think we should lay a little bit of groundwork and talk about what is anxiety, what makes it unique.

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I do think it is a unique emotion in some ways.

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It is a little bit different than most other emotions that we experience.

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The American Psychological Association defines anxiety as, quote, an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune.

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What's interesting –

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about anxiety, I think, is that it's, A, it's future-based.

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And because it's future-based, there's a certain amount of cognitive load.

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It's almost like an outshoot of our natural tendency to, like, just want to predict what's going to happen.

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And so I think what makes it a little bit different than most other emotions is that it is –

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very much influenced by our thoughts.

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A lot of emotions are almost more primary.

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You know, it's like we have the emotion and then our thoughts kind of

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justify that emotion after the fact.

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I think in a lot, to a certain extent, anxiety, because it is an outcrop of us trying to predict the future, it is somewhat cognitively induced.

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And I think we'll see this kind of show up in the rankings when we go through them, that a lot of the stuff that doesn't really work is just trying to apply to the emotion.

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Whereas the things that tend to work a little bit better are...

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Or a little bit more cognitively.

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Address those underlying thoughts.

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Yeah, exactly.

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So it's kind of like it's our ability to predict or our penchant for prediction.

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Yes.

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That's what you're saying.

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Marrying that with our negativity bias almost too, right?

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Yes.

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You could define an anxiety almost like that.

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We have this like strong just like desire to predict the future and try to figure out what's going to happen.

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But we're also very negatively biased towards bad things happening as well.

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And that's an anxiety.

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Yeah.

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Which is, if you think about it, evolutionarily adaptive, right?

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So it's like, let's say you and I are hunter-gatherers and we're out on a hunt.

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This is how anxiety differs from fear.

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Fear is present-based and it's very specific.

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Let's say we're on the savanna and all of a sudden a lion jumps out and is ready to attack us.

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You and I would both experience fear because it is – there is a present danger.

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It's immediately in front of us and is very specific.

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It's like there's a lion and he's about to attack me.

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I'm afraid.

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Anxiety would be if you and I are on the savanna and we are thinking about what if there's a lion around here.

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Where should I look to try to spot the line?

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That's anxiety.

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It's kind of this low-level discomfort at potential futures that might happen.

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And obviously, it's important to think about those potential futures because in many ways, like the more you worry about something, the less likely it is to happen because the more you're going to prepare for it and prevent it from happening.

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It is adaptive to a certain extent.

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It's unrewarding in that like when anxiety is actually useful, you don't get to experience that usefulness.

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Yeah.

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right right yeah because because all you know is that like the bad thing didn't happen so let's talk about causes like why why do people struggle so much with anxiety and i think this is also going to be very useful for once we get into the rankings researchers estimate that roughly 30 to 40 percent of anxiety is is largely genetic some people just have far more sensitive sympathetic nervous systems than other people they're

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more easily triggered, they're more sensitive to their surroundings, they're more predisposed to experiencing fear, anxious thoughts.

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I think in personality research that you would just call this a highly neurotic person.

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Women are consistently more anxious than men across the board, all ages, all cultures, regardless of how much equality, gender equality, socioeconomic equality there is.

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Women are just always more anxious.

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Second thing that's really interesting is that young people are more anxious than old people.

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And that I find really interesting, especially given the future-based foundation of what anxiety is.

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In many ways, young people have a lot more to be anxious about than old people.

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And also, old people have lived through so many more failures, setbacks, challenges, struggles, challenges.

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et cetera, et cetera, that they've probably developed scar tissue where they're like, I'm going to be fine.

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I don't need to worry about this.

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So when it comes to environmental factors, obviously trauma gets talked about a lot.

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Trauma or other early childhood adverse experiences, they sensitize the amygdala and they often disrupt our prefrontal cortex from helping us emotionally regulate.

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I think this is maybe an important distinction.

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It's not that trauma causes...

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causes anxiety, it makes us less equipped to inhibit anxiety.

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Right, yeah.

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Attunes you to it, yeah.

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People who experience a lot of trauma, they struggle to regulate their emotions in general.

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They struggle to think clearly.

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They get triggered more easily.

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And so, again, kind of that cognitive intervention of actually thinking to yourself, is this threat reasonable?

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Is there really a line that's going to come eat me?

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It prevents you from being able to do that in the moment.

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The other cause that I've added here that I have not really seen talked about much in the psychological literature is what I would call more of an existential anxiety.

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And I've written at this point pretty extensively about how I personally believe that much of the mental health crisis is kind of an offshoot of this existential crisis that people are having.

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This dates back to Kierkegaard in the 19th century.

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So Kierkegaard noticed that there was something about modern life that seemed to like

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amplify people's anxieties, that they seem to consistently be anxious about nothing, and that that seemed to be kind of a new thing.

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And throughout his life, it appeared to be getting worse.

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Kierkegaard attributed this to the, quote, dizziness of freedom.

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What he argued is that as modern life gives people more freedom, more optionality, more opportunities in their lives...

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they become paralyzed and afraid to make decisions.

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Each individual decision suddenly becomes much more difficult because it has far more long-term implications on their lives.

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And so paradoxically, that increase in freedom and optionality makes them feel more anxious for the future, even though...

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objectively their lives are better than say previous generations in my opinion today we're just living through that on steroids in many ways i think what people experience as anxiety is kind of just this crippling fear of commitment of making a decision of owning a decision of being accountable to their own decisions because you might make the wrong one because you might make the wrong one and it'll fuck up your future forever and so it's better to just like be really scared and stay at home and doom scroll for another six hours and

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Anything you want to add, Drew, before we get into it?

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Um, I have anxiety.

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What's been your history, I guess?

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I had panic attacks when I was younger.

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I'm into my mid twenties, I would say.

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Okay.

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So it's definitely, this is hits close to home.

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It runs my family too.

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Okay.

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Yeah.

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Well, I know you have a lot of sleep problems too.

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Sleep problems as well.

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That doesn't help.

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Yeah.

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That's attached to it.

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Yes.

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Yeah.

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Yeah.

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A lot of rumination at night.

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There's definitely a lot of that.

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Yeah.

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Yeah.

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My anxiety is pretty limited to social anxiety.

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I had a lot of social anxiety when I was young.

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But interestingly, like outside of social anxiety, I experienced very little.

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And I think the social anxiety was just fucking trauma.

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I think a lot of people can relate to that though too.

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It's probably the most common source of anxiety is anxiety for sure.

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Absolutely.

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I guess that's the other interesting thing about a lot of this too is that like some of these interventions I think are a little bit more targeted for certain types of anxiety than others.

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Like there is, it might be worth defining that there's kind of a, there's a thing called GAD which is generalized anxiety disorder.

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So like if you go to a psychiatrist and you're just kind of anxious all the time in every context, every situation, like.

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can be diagnosed with GAD.

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That's a relatively small percentage of the population.

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Most people just suffer with either an acute anxiety in one area of their life, whether it's social anxiety or performance anxiety or perfectionism or insomnia or whatever.

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Some people are just very anxious neurotic people in general, but it's not like a debilitating disorder or whatnot.

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For sure.

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I don't know.

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Sometimes I think anxiety helps me.

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That's something that never gets talked about.

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Sure.

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Yeah.

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There's a certain level of like high functioning anxiety.

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Like if you think of some of the most successful and productive people in the world, they're extremely anxious.

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You know, there's like the anxiety is kind of a fuel that runs inside of them.

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So on the one hand, yes, like it's not great mental health.

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You're not feeling good when you're super anxious and that drives you to perform really well or work really hard.

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But on the other hand, it does potentially produce better outcomes.

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I don't know where I completely land on this.

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I think as somebody who personally feels, often feels anxious if I'm not doing something productive or useful, I kind of like having that anxiety there.

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I think this is a common fear a lot of people have is if I don't have my anxiety, then how how am I going to get anything done?

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Right.

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How am I going to pressure myself into doing the things that need to be done?

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And hanging on to that anxiety, I think, is a very common thing that people do.

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I definitely do.

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I think it honestly got me through a lot of university.

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Yeah.

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For one, you know, I was just anxious about it.

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You know, you talk about, yes, social anxiety is a problem for you, but you don't have a lot of anxiety in a lot of areas.

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But you tend to hire people who like have that anxiety for you, kind of outsource some anxiety to people.

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So, I mean, I get it.

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It's a tricky one.

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And I think people are like, no, my anxiety actually helps me in some ways.

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And there's some truth to that too.

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This is a common fallacy I think in mental health and personal growth which is that like the optimal amount of a negative emotion is never zero.

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You should always have some anxiety.

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Like anxiety exists for a reason.

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It's adaptive.

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Like we evolved it because it actually helps us – it helps us do things that are important for our survival.

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Right.

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for our community and our relationships.

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The problem is when it's chronic and it's occurring in places that it's not helping.

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Misapplied, yeah.

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Right.

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Is the fact that I'm constantly anxious at work, is that misapplied?

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Or is it actually like helping me like crush all my goals and be super successful?

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You know, it's- The thing I always come up against though too is there's people who are like, oh man, just don't worry about that.

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You know, like things take care of themselves.

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No, it's us anxious people who take care of things sometimes.

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You know what I mean?

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So like I get it when people are kind of like, no, actually you do need to worry about it.

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But 100% I'm on board with you there when it's misapplied or just generalized to everything.

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Yeah.

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Yeah.

220
00:14:49.291 --> 00:14:52.474
The optimal amount, you're right, is not zero, but it's also not, you know.

221
00:14:53.629 --> 00:14:53.890
100%.

222
00:14:54.110 --> 00:14:55.852
The goal is not to get rid of all anxiety.

223
00:14:55.892 --> 00:15:01.098
It's to, I guess, manage or have anxiety in the areas of your life that it's advantageous.

224
00:15:01.538 --> 00:15:04.842
I think the other factor here is something I've written about in my books.

225
00:15:05.142 --> 00:15:10.528
I have a bit of a spicy take about this, which is that people are not more anxious because the world is scarier today.

226
00:15:10.848 --> 00:15:12.891
They're actually more anxious because it's much safer.

227
00:15:14.240 --> 00:15:19.948
And it's when your life doesn't actually have real problems to worry about, you start inventing problems to worry about.

228
00:15:20.368 --> 00:15:30.903
And the fact that we have access on our phones and the internet and everything to like everything going on in the world, people are convincing themselves that there are very real threats and real problems all the time.

229
00:15:31.403 --> 00:15:47.944
Where it's like if you actually objectively look at the average person's life in the developed world, like you are sitting in an air-conditioned room on a comfortable couch watching screens that are broadcasting information that was created thousands of miles away and you're doing all of this for like –

230
00:15:48.985 --> 00:15:50.425
Insanely low cost.

231
00:15:50.485 --> 00:15:53.366
Like all of your food is provided for.

232
00:15:53.426 --> 00:15:54.867
Your warmth is provided for.

233
00:15:54.987 --> 00:15:57.007
Like all of your basic needs are provided for.

234
00:15:57.367 --> 00:15:57.987
You're safe.

235
00:15:58.028 --> 00:15:58.788
You're secure.

236
00:15:58.888 --> 00:16:00.268
You live in a functional society.

237
00:16:00.288 --> 00:16:07.110
Like there's actually not a whole lot to be anxious about from like on an evolutionary historic scale.

238
00:16:07.730 --> 00:16:14.478
But because there's nothing to be anxious about, we invent things to be anxious about because it feels meaningful.

239
00:16:14.658 --> 00:16:16.921
Like we need something to worry about.

240
00:16:17.722 --> 00:16:19.744
Otherwise, we wouldn't know what to do with ourselves.

241
00:16:20.084 --> 00:16:20.305
OK.

242
00:16:20.325 --> 00:16:24.990
So like an anxious system is so fundamental to like the human species.

243
00:16:25.010 --> 00:16:28.454
You're saying that it just goes – it's online at all times.

244
00:16:28.895 --> 00:16:38.640
So there's a great quote in Subtle Art that I love, which is it comes from Jose Marti where he said, if the mind does not have a problem to work on, it will quickly invent some.

245
00:16:39.100 --> 00:16:42.983
And I think by and large, that's like the issue of our age.

246
00:16:43.283 --> 00:16:43.443
Right.

247
00:16:43.463 --> 00:16:47.545
You have a lot of people that life is comfortable but meaningless.

248
00:16:48.065 --> 00:16:56.890
And so instead of like admitting how meaningless things are, we invent meaning by imagining threats and problems where there aren't any.

249
00:16:57.170 --> 00:17:00.072
It comes back to that misapplied anxiety, right?

250
00:17:00.092 --> 00:17:06.798
Like it's like anxiety is useful when it's applied in a realistic way that's actually helping you or it's producing some better outcome.

251
00:17:07.118 --> 00:17:12.522
If you don't have a place to apply it, if you don't have a direction to point your anxiety –

252
00:17:13.363 --> 00:17:17.244
then your mind will just start inventing places to point it.

253
00:17:17.924 --> 00:17:21.885
And it will start finding reasons to worry.

254
00:17:22.185 --> 00:17:28.647
And because those reasons are not real and they don't exist or you have absolutely no control over them, you can't do anything about them.

255
00:17:28.727 --> 00:17:29.447
So they persist.

256
00:17:29.667 --> 00:17:29.987
Okay.

257
00:17:30.447 --> 00:17:33.328
Anyway, let's get into the ranking.

258
00:17:33.448 --> 00:17:33.748
Okay.

259
00:17:39.140 --> 00:17:39.460
All right.

260
00:17:39.580 --> 00:17:41.381
So number 17 on our list.

261
00:17:41.641 --> 00:17:45.022
There's only one item in our bullshit category for this episode.

262
00:17:45.962 --> 00:17:51.224
There's only one thing that if you actively do it, it will make your anxiety worse, at least that we looked into.

263
00:17:52.124 --> 00:17:55.385
And this one will probably not surprise many people, which is alcohol.

264
00:17:55.825 --> 00:18:01.947
It's the anxiety cure that 2 billion people actively use around the world that is making their anxiety worse.

265
00:18:02.567 --> 00:18:06.551
The data on the amount of people that self-medicate with alcohol is like absolutely staggering.

266
00:18:06.871 --> 00:18:11.075
It is funny that it is conventional wisdom that alcohol helps take the edge off.

267
00:18:11.156 --> 00:18:21.005
I used to be one of these people that after a really hard week, I couldn't wait to go out and get a drink because it was just going to help me relax and chill and forget about my problems and whatnot.

268
00:18:21.025 --> 00:18:21.766
Yeah.

269
00:18:21.986 --> 00:18:29.689
And what's interesting is that, yes, alcohol solves anxiety in the short term, but it actually creates more in the long run.

270
00:18:30.110 --> 00:18:30.390
Yeah.

271
00:18:30.470 --> 00:18:35.052
I mean, about one in four people who have some sort of anxiety disorder.

272
00:18:35.838 --> 00:18:38.440
they confess at least to self-medicating with alcohol.

273
00:18:38.560 --> 00:18:38.740
Right.

274
00:18:38.780 --> 00:18:42.842
And it's honestly probably much higher than that just because it's so accessible.

275
00:18:43.082 --> 00:18:44.083
And you're right.

276
00:18:44.363 --> 00:18:45.283
There's such a quick fix.

277
00:18:46.084 --> 00:18:46.824
It is a quick fix.

278
00:18:47.125 --> 00:18:48.005
It works in the short run.

279
00:18:48.325 --> 00:18:49.706
The problem is, is the bounce back.

280
00:18:49.726 --> 00:18:51.627
There's an overcorrection towards the other way.

281
00:18:52.047 --> 00:18:55.369
If you're paying attention and you've done this before, you know, this is what happens.

282
00:18:55.409 --> 00:18:55.709
Right.

283
00:18:55.870 --> 00:18:58.111
I was talking about, you know, I've had panic attacks before.

284
00:18:58.151 --> 00:18:59.712
I had some anxiety around things.

285
00:19:00.550 --> 00:19:06.618
I noticed too that after like a heavy night of drinking, the next two or three days, my anxiety was just off the wall.

286
00:19:06.858 --> 00:19:07.039
Wow.

287
00:19:07.079 --> 00:19:07.279
Right.

288
00:19:07.339 --> 00:19:08.200
Just, it was terrible.

289
00:19:08.280 --> 00:19:08.480
Yeah.

290
00:19:08.841 --> 00:19:13.847
It gets a little bit more complicated than that though as well because your motivation for drinking actually does matter here.

291
00:19:14.743 --> 00:19:21.350
To some extent, if you're if you are drinking because of your anxiety, that's usually there's usually a hard bounce back from that.

292
00:19:21.390 --> 00:19:29.539
If it's social drinking, light drinking here and there, those those effects, that bounce back seems to be attenuated, at least to some degree.

293
00:19:30.460 --> 00:19:31.981
Can't completely eliminate it, I don't think.

294
00:19:32.121 --> 00:19:34.424
But alcohol does it again.

295
00:19:34.444 --> 00:19:35.084
It does work.

296
00:19:35.785 --> 00:19:36.486
In the short run.

297
00:19:36.626 --> 00:19:36.846
Yeah.

298
00:19:37.026 --> 00:19:37.326
Okay.

299
00:19:37.646 --> 00:19:43.030
And it has like, it's probably the same mechanism as a lot of drugs that we'll eventually get to here.

300
00:19:43.710 --> 00:19:52.616
This, this bounce back effect is actually strongest in the people who are most likely to engage in alcohol for anxiety, right?

301
00:19:52.636 --> 00:19:53.997
Or use alcohol for their anxiety.

302
00:19:54.037 --> 00:20:00.781
So shy, anxious people who are like socially anxious, who use it tend to have the biggest bounce back here.

303
00:20:00.801 --> 00:20:00.961
Okay.

304
00:20:01.162 --> 00:20:01.442
Okay.

305
00:20:02.022 --> 00:20:10.232
There's some evidence that has for a long time pointed out, you know, you probably heard this for a long time, you know, having a glass of wine with dinner is good for you or one drink a day is good for you, whatever.

306
00:20:11.507 --> 00:20:13.147
Honestly, probably not the case.

307
00:20:13.287 --> 00:20:14.308
We're finding out more and more.

308
00:20:14.688 --> 00:20:22.929
What happens is a lot of times what they'll do in these studies is they'll compare those people who just have one drink here or there or only drink socially compared to people who don't drink.

309
00:20:23.369 --> 00:20:29.011
Usually what happens is these people who don't drink have already quit drinking because of their health issues.

310
00:20:29.471 --> 00:20:32.091
And so they're just naturally less healthy.

311
00:20:32.291 --> 00:20:32.471
Right.

312
00:20:32.871 --> 00:20:35.132
In the United States anyway, Arizona has like the highest –

313
00:20:35.772 --> 00:20:37.373
respiratory illness rate.

314
00:20:37.673 --> 00:20:37.913
Okay.

315
00:20:38.253 --> 00:20:41.995
Which is weird because everybody moves to Arizona because they have- The clear air.

316
00:20:42.355 --> 00:20:43.216
Yeah, the desert air.

317
00:20:43.276 --> 00:20:43.756
All that, right?

318
00:20:43.816 --> 00:20:46.698
But it's because a lot of people with those diseases will move to Arizona, right?

319
00:20:46.778 --> 00:20:47.018
Yeah.

320
00:20:47.038 --> 00:20:47.918
Same thing with like alcohol.

321
00:20:47.958 --> 00:20:51.360
People who quit alcohol usually it's because of health issues or problems around their health.

322
00:20:51.500 --> 00:21:15.147
call you yeah but the thing is is that bounce back i know i would just have terrible anxiety you know i call it the next day just feel awful i started noticing this probably in my early 30s that i would often feel like a like an intense sense of like embarrassment or shame the next day which was like completely irrational like it's like i didn't do anything right embarrassing or shameful i just feel mm-hmm

323
00:21:15.767 --> 00:21:16.908
Like I had an awkward conversation.

324
00:21:16.928 --> 00:21:23.794
Like I just – I would start ruminating about all these like things that had happened the night before and eventually I just realized I'm like, oh, that's part of the alcohol.

325
00:21:23.854 --> 00:21:25.436
It's like fucking with my emotions.

326
00:21:25.710 --> 00:21:30.172
The interesting thing for me around this, I noticed this back when I was a dating coach.

327
00:21:30.692 --> 00:21:31.832
And it was interesting.

328
00:21:31.892 --> 00:21:36.654
One of the fascinating things was to see this confirmed in the research when prepping for this episode.

329
00:21:37.114 --> 00:21:42.996
Back early in my career, one of the first businesses I ever started was as a local men's dating coach.

330
00:21:43.556 --> 00:21:45.397
And so what I would do is I would actually –

331
00:21:46.415 --> 00:21:51.061
go with guys to parties and bars or whatever, and I would help them talk to girls.

332
00:21:51.282 --> 00:21:55.007
Probably the most common issue that guys had was anxiety.

333
00:21:55.167 --> 00:22:01.936
And it was interesting because, obviously, most men, when they're anxious or nervous and they want to talk to a...

334
00:22:02.797 --> 00:22:06.258
an attractive woman and they don't have the nerve to do it, what do they do?

335
00:22:06.358 --> 00:22:06.998
They have a drink.

336
00:22:07.198 --> 00:22:11.859
And that drink like loosens them up, relaxes them, gives them a little bit of courage.

337
00:22:11.879 --> 00:22:13.739
I mean, we even call it liquid courage, right?

338
00:22:13.979 --> 00:22:15.839
In the business, we used to call this approach anxiety.

339
00:22:16.519 --> 00:22:19.380
And it was super common among men.

340
00:22:19.920 --> 00:22:29.842
But what I noticed after I had been coaching for like a year or two, what I started to notice was that the men who drank to get over their approach anxiety never actually got over it.

341
00:22:30.482 --> 00:22:39.771
Like they would have a bunch of drinks and then they'd go meet a bunch of women at the bar and then three weeks later they would hire me again and they'd have the exact same problem.

342
00:22:39.831 --> 00:22:41.713
They hadn't progressed at all.

343
00:22:41.753 --> 00:22:43.294
They hadn't learned how to talk to anybody.

344
00:22:43.354 --> 00:22:49.079
They hadn't overcome any of their insecurities or fears whereas the men who didn't drink and just pushed through it.

345
00:22:49.872 --> 00:22:52.035
Those guys would get over it.

346
00:22:52.395 --> 00:22:56.440
And a month or two later, they're like – they're able to go chat with anybody they wanted.

347
00:22:56.580 --> 00:23:06.932
There's an idea of fear extinction, which is like this – it's kind of the active component of exposure therapy of like actually confronting a fear, realizing that it's not going to kill you and then like –

348
00:23:07.352 --> 00:23:10.894
teaching your brain like, hey, don't be afraid of this next time.

349
00:23:11.294 --> 00:23:11.855
We're okay.

350
00:23:11.875 --> 00:23:12.515
We've got this.

351
00:23:12.955 --> 00:23:20.240
Interestingly, some substances interfere with that feedback loop and they like prevent the ability for the exposure effect to actually take place.

352
00:23:20.660 --> 00:23:24.762
I 100% believe that alcohol is one of these because I just, I noticed it myself.

353
00:23:24.982 --> 00:23:28.785
Like I didn't get over a lot of my social anxiety until I stopped drinking around other people.

354
00:23:29.505 --> 00:23:33.047
And similarly, a lot of my old clients, they wouldn't get over their

355
00:23:34.748 --> 00:23:41.332
Eventually, I would start when I worked with guys, if they had a lot of anxiety, I would make them not drink that night.

356
00:23:41.972 --> 00:23:44.414
And that in and of itself would freak them out.

357
00:23:44.674 --> 00:23:48.596
It's easy to see how this just becomes a crutch, right?

358
00:23:48.656 --> 00:23:49.516
You're socially anxious.

359
00:23:49.536 --> 00:23:51.077
You have this negative stimulus going on.

360
00:23:51.117 --> 00:23:51.918
You reach for a drink.

361
00:23:52.258 --> 00:23:52.659
You drink.

362
00:23:52.779 --> 00:23:54.501
You're not as socially anxious.

363
00:23:55.081 --> 00:23:55.642
So you're good to go.

364
00:23:55.662 --> 00:23:57.043
That cycle just repeats itself.

365
00:23:57.344 --> 00:24:04.271
But then you're leaning on that all the time rather than, like you're saying, developing these coping skills, like actual mature coping skills for this.

366
00:24:04.291 --> 00:24:04.532
So, yeah.

367
00:24:04.552 --> 00:24:04.652
Yeah.

368
00:24:05.047 --> 00:24:09.388
Yeah, this is definitely the only one, though, that gets negative ranking in our book here.

369
00:24:09.528 --> 00:24:09.728
Yeah.

370
00:24:10.208 --> 00:24:17.010
So I was actually curious and I ran the numbers on what would stopping drinking, where would that land on this list?

371
00:24:17.190 --> 00:24:18.730
Oh, like as an intervention, you're saying?

372
00:24:18.750 --> 00:24:18.970
Right.

373
00:24:18.990 --> 00:24:19.570
Yeah, exactly.

374
00:24:19.610 --> 00:24:27.732
So if you took like heavy drinkers with anxiety and you got them to stop drinking, what would the effect size be for those people on their anxiety?

375
00:24:27.832 --> 00:24:29.433
And then where would that land on our list?

376
00:24:29.453 --> 00:24:30.653
Do you want to guess where that would land?

377
00:24:30.953 --> 00:24:32.333
I don't know, middle of the pack somewhere, probably.

378
00:24:33.134 --> 00:24:33.754
Number four.

379
00:24:33.914 --> 00:24:34.294
Really?

380
00:24:34.314 --> 00:24:35.154
Number four.

381
00:24:35.834 --> 00:24:46.718
Which, again, as like somebody who stopped drinking three years ago, one of the biggest and first benefits I noticed is just like a steady emotional state.

382
00:24:46.738 --> 00:24:47.278
That's true.

383
00:24:47.558 --> 00:24:48.378
Super steady.

384
00:24:49.158 --> 00:24:51.079
Nothing like very few things faze me.

385
00:24:51.519 --> 00:24:53.262
And your ability to regulate emotions too.

386
00:24:53.342 --> 00:24:53.682
Yes.

387
00:24:53.702 --> 00:24:54.223
Just in general.

388
00:24:54.263 --> 00:24:54.524
Yeah.

389
00:24:54.604 --> 00:24:57.989
Just like not getting upset over stupid stuff, not worrying about dumb stuff.

390
00:24:58.029 --> 00:25:00.452
Like I definitely feel that.

391
00:25:00.653 --> 00:25:00.893
Yeah.

392
00:25:01.454 --> 00:25:01.834
All right.

393
00:25:01.914 --> 00:25:02.475
Number 16.

394
00:25:08.780 --> 00:25:09.540
magnesium.

395
00:25:10.241 --> 00:25:11.561
Ah, I'm a boomer.

396
00:25:11.581 --> 00:25:12.102
Yeah.

397
00:25:12.242 --> 00:25:16.784
I don't, I don't really get, I don't really get on Tik TOK, but apparently this is a huge thing on Tik TOK.

398
00:25:16.844 --> 00:25:17.404
All the rage.

399
00:25:17.424 --> 00:25:17.764
Yeah.

400
00:25:17.884 --> 00:25:27.369
There's all of these videos promoting magnesium for anxiety and magnesium supplements and the different types of magnesium and all the different like biochemical mechanisms and all this shit.

401
00:25:27.709 --> 00:25:28.289
It's not a thing.

402
00:25:29.090 --> 00:25:30.350
Apparently it's just not a thing.

403
00:25:30.671 --> 00:25:33.752
It's like very, very, very modest effect.

404
00:25:34.612 --> 00:25:35.293
Um, for most people.

405
00:25:35.313 --> 00:25:35.453
Yeah.

406
00:25:35.473 --> 00:25:35.613
Yeah.

407
00:25:35.891 --> 00:25:36.692
Now, here's the thing, though.

408
00:25:36.712 --> 00:25:40.635
If you're deficient in magnesium, that might actually be an issue.

409
00:25:40.675 --> 00:25:44.558
But, I mean, it's kind of hard to tell whether you're deficient in it or not necessarily.

410
00:25:44.578 --> 00:25:47.920
I mean, there are a lot of people who are deficient in magnesium.

411
00:25:48.100 --> 00:25:48.341
Yeah.

412
00:25:48.401 --> 00:25:52.584
And so if that's why you're anxious and taking some magnesium, it will get you back to the baseline.

413
00:25:52.604 --> 00:25:53.965
I don't think it's going to fix your anxiety.

414
00:25:54.085 --> 00:25:54.265
Yeah.

415
00:25:54.365 --> 00:25:56.567
But there's a lot of other reasons you might be anxious as well.

416
00:25:56.887 --> 00:26:00.471
The problem with the magnesium story really though – it's a plausible mechanism.

417
00:26:00.511 --> 00:26:01.112
Don't get me wrong.

418
00:26:01.172 --> 00:26:14.047
Like again, if you're deficient in it or – there's also two just neural mechanisms that use magnesium that where if there's not enough magnesium there, it could in theory produce more anxious states.

419
00:26:14.327 --> 00:26:14.507
Sure.

420
00:26:15.208 --> 00:26:21.671
But the problem is, is that the evidence that we have for it is just all over the map in terms of like study quality.

421
00:26:21.992 --> 00:26:23.652
They're using different forms of magnesium.

422
00:26:23.692 --> 00:26:28.055
It really depends on the type of magnesium you're taking, whether it can actually cross the blood brain barrier or not.

423
00:26:28.335 --> 00:26:31.957
The evidence out there is very scant for this because of these methodological issues.

424
00:26:32.377 --> 00:26:37.860
And so supplement companies have come out and they've said, oh, yeah, that magnesium works because they point to one small poorly done study.

425
00:26:38.540 --> 00:26:42.202
We're going to see this happen quite a bit, but that's definitely happening with magnesium here.

426
00:26:42.322 --> 00:26:44.265
You want to hear my conspiracy theory about magnesium?

427
00:26:44.285 --> 00:26:46.247
Yes, let's do it.

428
00:26:47.789 --> 00:26:48.930
So the Israeli government.

429
00:26:50.452 --> 00:26:51.133
No, I'm just joking.

430
00:26:51.494 --> 00:26:55.218
There's this new thing that's happening in social media marketing.

431
00:26:55.999 --> 00:27:00.986
Most people are probably not aware of this, but if anybody works in online marketing, you probably are.

432
00:27:01.639 --> 00:27:06.420
So there's this new thing called UGC marketing, which stands for user-generated content.

433
00:27:06.580 --> 00:27:11.481
And basically the idea is there are now platforms and mechanisms where you can go.

434
00:27:11.561 --> 00:27:14.602
Let's say I'm a magnesium supplement brand.

435
00:27:15.282 --> 00:27:23.283
I can go to one of these platforms and I can – what you do is you pay social media creators on a per view basis.

436
00:27:23.463 --> 00:27:26.984
So basically what you do is you go and you like set a bounty.

437
00:27:31.925 --> 00:27:36.307
10 million views on social media promoting my magnesium brand.

438
00:27:36.527 --> 00:27:42.669
But to qualify for the money, you have to post a video that gets at least, I don't know, 50,000 views or something.

439
00:27:42.969 --> 00:27:49.072
You post it on the platform and then there's like thousands of like TikTokers and people who post on Instagram and stuff like that.

440
00:27:49.632 --> 00:27:51.313
And then they just make content about it.

441
00:27:51.833 --> 00:27:55.054
And then if they get one that blows up and goes viral, they get paid.

442
00:27:55.254 --> 00:27:55.574
I see.

443
00:27:55.834 --> 00:27:57.715
So they're incentivizing trends basically.

444
00:27:58.055 --> 00:27:58.516
Exactly.

445
00:27:58.656 --> 00:28:06.863
And so, and the reason it works really well for brands and products is that you can kind of get this like fake feeling of grassroots.

446
00:28:07.523 --> 00:28:07.783
Right.

447
00:28:07.823 --> 00:28:14.769
So it's like people are, people are suddenly seeing magnesium pop up in like 20 different spots and like 20 different people.

448
00:28:14.869 --> 00:28:17.452
There's like that stay at home mom that they follow on TikTok is talking about it.

449
00:28:17.472 --> 00:28:19.073
There must have been some big study that just came out.

450
00:28:19.493 --> 00:28:22.635
The fitness influencer they follow on Instagram is talking about it.

451
00:28:22.855 --> 00:28:30.981
And it's like – and so you synthetically generate a social trend just by paying dozens and dozens and dozens of small creators.

452
00:28:31.341 --> 00:28:39.286
And I say this as someone who fucking has like three giant bottles of magnesium in his cupboard and takes them every night.

453
00:28:39.446 --> 00:28:39.666
Yeah.

454
00:28:39.806 --> 00:28:44.009
Because I was told years ago that I should be taking magnesium.

455
00:28:44.049 --> 00:28:45.050
I'm probably deficient.

456
00:28:45.110 --> 00:28:46.010
It's going to help me sleep.

457
00:28:46.050 --> 00:28:46.871
It's going to calm me down.

458
00:28:47.055 --> 00:28:50.078
Well, again, if you are deficient, obviously magnesium is very, very important.

459
00:28:50.398 --> 00:28:51.339
It's very essential.

460
00:28:51.419 --> 00:28:52.020
Okay, I get it.

461
00:28:52.120 --> 00:28:54.182
For example, there's one study that a lot of people point to.

462
00:28:54.202 --> 00:29:00.848
This was back in 2021 where they found like a magnesium plus B6 or a magnesium intervention.

463
00:29:00.868 --> 00:29:01.649
They had these two groups.

464
00:29:01.689 --> 00:29:05.693
Like one had magnesium plus B6, one had magnesium, found that it calmed anxiety.

465
00:29:05.793 --> 00:29:09.418
The problem with that, though, was it was this post hoc study.

466
00:29:09.578 --> 00:29:14.646
It was a different data set that they weren't even using to test whether magnesium helped with anxiety or not.

467
00:29:14.666 --> 00:29:16.108
They just looked at it after the fact.

468
00:29:16.428 --> 00:29:17.450
They didn't have a control group.

469
00:29:17.810 --> 00:29:21.415
So we don't know if it's just a placebo effect or not, but a lot of people point to it.

470
00:29:21.996 --> 00:29:30.326
And so if it coupled that with your conspiracy theory, you know, where it's like there's kind of like, oh, this one study, which even the authors were like, be cautious about this because we don't have a control group.

471
00:29:30.346 --> 00:29:31.748
This was just a post hoc analysis.

472
00:29:31.808 --> 00:29:33.249
But this happens all the time.

473
00:29:33.269 --> 00:29:34.050
Media finds that.

474
00:29:34.291 --> 00:29:34.931
They run with it.

475
00:29:35.232 --> 00:29:37.975
Couple that with the UGC campaigns you're talking about.

476
00:29:38.115 --> 00:29:42.117
What looks like a science-backed finding, which is actually just a marketing thing.

477
00:29:42.397 --> 00:29:42.738
Yes.

478
00:29:42.958 --> 00:29:43.358
All behind it.

479
00:29:43.738 --> 00:29:48.721
I would say this is actually the rule, not the exception in the supplement industry.

480
00:29:48.981 --> 00:29:50.462
Shout out to Saul Orwell.

481
00:29:50.562 --> 00:29:53.924
So I'm old friends with the founder of examine.com.

482
00:29:53.944 --> 00:30:01.588
And they analyze all the research on supplements and basically like really break down like does this actually work or does it not?

483
00:30:01.768 --> 00:30:04.309
And surprise, surprise, most of it does not.

484
00:30:04.389 --> 00:30:07.071
But I remember I was hanging out with Saul like maybe five years ago.

485
00:30:07.531 --> 00:30:13.318
And he had literally spent his entire career investigating supplements, looking at the research, studying all the research.

486
00:30:13.498 --> 00:30:20.026
And I remember asking him, I was like, so in 10 seconds, tell me what is actually worth taking every day?

487
00:30:20.206 --> 00:30:22.148
And he was like, dude, it's super simple.

488
00:30:22.509 --> 00:30:23.170
Just take fish oil.

489
00:30:23.790 --> 00:30:24.210
Oh, really?

490
00:30:24.450 --> 00:30:24.810
That was it.

491
00:30:25.451 --> 00:30:27.991
This was pre-creatine boom.

492
00:30:28.091 --> 00:30:28.432
Okay.

493
00:30:28.652 --> 00:30:32.313
But yeah, I think he was just like, yeah, just take fish oil.

494
00:30:33.153 --> 00:30:34.033
Don't worry about anything else.

495
00:30:34.353 --> 00:30:37.554
And he was like, oh, and protein if you want to get stronger.

496
00:30:37.694 --> 00:30:37.915
Yeah.

497
00:30:37.975 --> 00:30:38.335
That was it.

498
00:30:38.595 --> 00:30:38.935
Okay.

499
00:30:39.435 --> 00:30:40.395
Number 15.

500
00:30:40.495 --> 00:30:42.456
I think this is the first surprise for people.

501
00:30:43.376 --> 00:30:45.797
This is the first one that people are going to be like, huh?

502
00:30:46.137 --> 00:30:46.577
Really?

503
00:30:47.818 --> 00:30:48.338
Journaling.

504
00:30:48.458 --> 00:30:48.598
Mm-hmm.

505
00:30:49.790 --> 00:30:51.712
Why is journaling this low?

506
00:30:52.132 --> 00:30:53.113
Well, okay.

507
00:30:53.133 --> 00:30:55.515
There's, it's a little bit of a nuanced story here, right?

508
00:30:55.535 --> 00:30:55.635
Yes.

509
00:30:56.215 --> 00:30:57.156
What do you mean by journaling?

510
00:30:57.276 --> 00:30:57.837
I guess first.

511
00:30:58.477 --> 00:31:00.079
That's the first question you have to ask yourself.

512
00:31:00.259 --> 00:31:02.341
Pulling out a piece of paper, writing out your thoughts.

513
00:31:02.361 --> 00:31:02.761
Okay.

514
00:31:03.001 --> 00:31:06.985
You know, I mean, there's a lot, there's a number of different methods of journaling, right?

515
00:31:07.005 --> 00:31:07.385
So there's like,

516
00:31:07.445 --> 00:31:12.666
gratitude journaling and there's like goal setting and there's kind of more of a therapeutic journaling.

517
00:31:12.686 --> 00:31:14.307
Like there's just brain dumping.

518
00:31:14.587 --> 00:31:20.088
And I think it's worth remembering that this is not an indictment on journaling's usefulness in general.

519
00:31:20.128 --> 00:31:25.690
In fact, on our episode last month on the most effective self-improvement techniques, journaling scored –

520
00:31:26.590 --> 00:31:27.091
pretty high.

521
00:31:27.551 --> 00:31:29.793
This is specifically for anxiety.

522
00:31:30.173 --> 00:31:34.497
As an intervention for anxiety, journaling is not super effective.

523
00:31:35.077 --> 00:31:38.820
And I guess to me, it intuitively makes sense, right?

524
00:31:38.840 --> 00:31:40.581
Because like, what do people with anxiety do?

525
00:31:40.982 --> 00:31:42.003
They think way too much.

526
00:31:42.323 --> 00:31:43.124
And what is journaling?

527
00:31:43.584 --> 00:31:45.325
It's thinking about your problem a lot.

528
00:31:46.186 --> 00:31:50.229
So I could see how it could like not necessarily make things better.

529
00:31:50.510 --> 00:31:54.633
But I'm curious what you found like digging deep into the research.

530
00:31:54.653 --> 00:31:54.753
Yeah.

531
00:31:54.853 --> 00:31:55.794
I think you're absolutely right.

532
00:31:55.854 --> 00:32:01.479
It's the thinking about it too much, the way you're thinking about it too much, actually, too, I think matters quite a bit.

533
00:32:01.919 --> 00:32:05.863
So, like, for instance, gratitude journaling, which we covered in the self-help techniques thing, too.

534
00:32:06.844 --> 00:32:09.566
It can make you more grateful, sure, especially if you're not a grateful person.

535
00:32:09.726 --> 00:32:11.768
Probably not going to do a whole lot for your anxiety, though.

536
00:32:11.788 --> 00:32:11.948
Yeah.

537
00:32:12.128 --> 00:32:15.451
Free form expression journaling, where it's just right about whatever.

538
00:32:15.892 --> 00:32:17.313
Again, not very directed.

539
00:32:17.793 --> 00:32:20.656
Probably you just get to ruminating more is what happens with anxiety.

540
00:32:20.756 --> 00:32:21.016
Yeah.

541
00:32:22.855 --> 00:32:49.482
venting like more catharsis we talked about that too that doesn't really work either again just kind of highlights whatever you're anxious about that said okay there is a type of journaling that actually can work the problem with it is usually that is the least likely for anxious people to use okay and or stick with yep okay which is a form of kind of exposure therapy basically so if you're writing about your anxious thoughts you're writing about what you're worried about you're

542
00:32:51.683 --> 00:33:00.207
It's the negative visualization exercise that's – we talked about it on the Stoicism episode because it's – I believe Seneca actually used to recommend this.

543
00:33:00.267 --> 00:33:07.670
Is that imagine the worst case scenario, map it all out in your head and then imagine how you would handle it and deal with it.

544
00:33:07.770 --> 00:33:07.970
Right.

545
00:33:08.550 --> 00:33:19.135
Like basically mentally rehearse all the things that could go wrong that you're worried about because the process of mentally rehearsing it will like give you the confidence to actually confront it.

546
00:33:19.435 --> 00:33:20.195
There's truth to that.

547
00:33:21.190 --> 00:33:23.071
There's some evidence to suggest that this will work.

548
00:33:23.131 --> 00:33:28.752
If you do this for 30 minutes a day for three days in a row, there's some evidence that, like, hey, this actually helps with your anxiety.

549
00:33:28.853 --> 00:33:31.833
You have to be consistent with it beyond that, though, probably.

550
00:33:32.314 --> 00:33:34.494
Most people with anxiety give up after the first one.

551
00:33:34.914 --> 00:33:36.435
That's another problem that they have with it.

552
00:33:36.815 --> 00:33:42.577
Like even in a very simple online study that they did where it was Internet-based, over half the people just gave up on it.

553
00:33:42.617 --> 00:33:46.658
They just didn't even want to do it for more than a day, which 30 minutes a day for three days –

554
00:33:47.418 --> 00:33:48.099
Shouldn't be that bad.

555
00:33:48.119 --> 00:33:48.900
It's not that much.

556
00:33:48.960 --> 00:33:51.764
It's bad enough where people with anxiety don't like to do it.

557
00:33:51.904 --> 00:33:53.126
I don't have the study in front of me.

558
00:33:53.266 --> 00:33:58.413
I do remember early on in the research process coming across a study that one of the things they said is that

559
00:33:59.425 --> 00:34:00.986
Like there is an effect size here.

560
00:34:01.046 --> 00:34:14.112
Like journaling does, this method of journaling does help, but it's, you have to do it so consistently for such an extended period of time for so many hours over so many weeks that it's just not super practical.

561
00:34:14.152 --> 00:34:14.372
Right.

562
00:34:14.732 --> 00:34:14.873
Yeah.

563
00:34:14.913 --> 00:34:20.755
And for most people with, with anxiety, again, they're just, they're, they're reticent to even go around that or to do that.

564
00:34:20.815 --> 00:34:23.857
So in the emotions episode, we talked about affective labeling.

565
00:34:24.568 --> 00:34:26.690
That can help with emotional regulation for sure.

566
00:34:27.070 --> 00:34:30.313
It's usually a short-term fix though.

567
00:34:30.353 --> 00:34:32.495
It's usually, it has a short-term effect.

568
00:34:32.935 --> 00:34:36.778
And so any anxious feelings that you have around it where you label them, yes, that can help you in the moment.

569
00:34:36.798 --> 00:34:41.122
But like long-term, again, you have to have that structured kind of exposure to it.

570
00:34:41.202 --> 00:34:42.403
It's all the things you said.

571
00:34:42.443 --> 00:34:48.588
It's like that combination of everything where it's not just the exposure to it, not just thinking about it, but also like, how am I gonna deal with it?

572
00:34:49.048 --> 00:34:53.392
So what that does is it kind of creates this narrative for you that can help you address the anxiety.

573
00:34:53.938 --> 00:35:01.021
That's more of a long-term thing and it's not a quick fix, which is what most people are looking for when they go to sit down and journal is a quick fix.

574
00:35:01.262 --> 00:35:01.462
Right.

575
00:35:01.502 --> 00:35:04.083
They want to feel better within five minutes.

576
00:35:04.123 --> 00:35:05.244
And that's not going to happen.

577
00:35:05.424 --> 00:35:05.844
Yeah.

578
00:35:05.864 --> 00:35:09.426
You have to really put a lot of time and thought into it.

579
00:35:09.886 --> 00:35:13.928
I also could see a way that journaling could potentially backfire a little bit.

580
00:35:14.008 --> 00:35:15.388
This is not coming from the research.

581
00:35:15.448 --> 00:35:18.150
This is just coming – this is a Mark Manson harebrained theory.

582
00:35:18.610 --> 00:35:19.911
I do think there's something about –

583
00:35:20.932 --> 00:35:23.574
labeling yourself as a certain way.

584
00:35:23.914 --> 00:35:39.646
If I'm always telling myself I have anxiety, at a certain point that is going to get embedded as an identity, as something – as a way that I see myself and the way human psychology works is that as soon as you see yourself a certain way, you will start looking for things that confirm it.

585
00:35:40.306 --> 00:35:51.110
And so I could see how like if you're constantly writing down or journaling or talking to friends and telling – like just telling everybody how anxious you are all the time, you are subtly reinforcing that anxiety.

586
00:35:51.270 --> 00:35:58.013
You are – will kind of prime your brain to secretly look for reasons to confirm that anxiety.

587
00:35:58.253 --> 00:36:04.976
The act of being vulnerable, of like sharing your truth could be undermining the actual process of getting rid of the anxiety.

588
00:36:05.016 --> 00:36:07.677
I think at a certain point you have to like –

589
00:36:08.377 --> 00:36:16.423
This is going to sound really obvious when you say it out loud, but it's quite profound that like part of the way of getting over anxiety is deciding you're not anxious anymore.

590
00:36:18.585 --> 00:36:20.506
Oh, that's it?

591
00:36:20.546 --> 00:36:20.866
Yeah, no.

592
00:36:20.906 --> 00:36:21.327
All right.

593
00:36:21.407 --> 00:36:22.227
Episode over.

594
00:36:22.287 --> 00:36:23.388
Yeah, right, right.

595
00:36:23.428 --> 00:36:24.129
No.

596
00:36:24.309 --> 00:36:30.133
It's incredibly difficult and complicated to do it, but like that is part of the end state.

597
00:36:30.253 --> 00:36:35.497
Like I do think there is a certain threshold where the impulse to heal yourself is.

598
00:36:37.012 --> 00:36:38.233
is creating the damage.

599
00:36:38.953 --> 00:36:43.176
And again, coming back to the point that the optimal amount of anxiety is not zero.

600
00:36:43.376 --> 00:36:48.540
If you don't have anything legitimate to be anxious about, your mind will start creating things to be anxious about.

601
00:36:48.900 --> 00:36:50.921
There's that saying, like, don't believe everything you think.

602
00:36:51.141 --> 00:36:52.082
Like, this is a classic...

603
00:36:54.103 --> 00:36:58.147
I think anxiety is a great situation to be aware of that.

604
00:36:58.227 --> 00:36:59.087
Yeah, I think you're right.

605
00:36:59.107 --> 00:37:00.068
You can write about it.

606
00:37:00.088 --> 00:37:01.910
You can write around it without confronting it.

607
00:37:02.110 --> 00:37:06.914
And that's where you can stay in that kind of hell for a long time.

608
00:37:06.934 --> 00:37:07.394
Yeah, right.

609
00:37:07.414 --> 00:37:08.715
If you're not careful and you're not aware of it.

610
00:37:08.996 --> 00:37:11.558
And what's worse is that you get the sense that you're doing something.

611
00:37:11.578 --> 00:37:12.799
Right, yeah.

612
00:37:13.019 --> 00:37:14.761
And we talked about this in the self-help techniques.

613
00:37:14.841 --> 00:37:21.306
In many ways, the worst self-help techniques are the things that give you the sense that you're doing something without actually doing anything.

614
00:37:21.486 --> 00:37:21.907
And I think...

615
00:37:22.447 --> 00:37:26.748
In this context, the context of anxiety, journaling can do the same thing.

616
00:37:27.088 --> 00:37:29.628
You're constantly writing out all the things you're worried about.

617
00:37:30.569 --> 00:37:35.650
All you're really doing is just reaffirming that worry without necessarily solving it.

618
00:37:35.970 --> 00:37:40.591
Whereas I do think there are other things in life that our journaling can be very beneficial for.

619
00:37:40.611 --> 00:37:41.351
All right.

620
00:37:41.451 --> 00:37:42.251
Moving on.

621
00:37:43.031 --> 00:37:43.431
Number 14, CBD.

622
00:37:43.451 --> 00:37:43.651
CBD.

623
00:37:47.608 --> 00:37:53.353
Sorry, California bros. Let me go outside and apologize to all the California dispensaries for this one.

624
00:37:53.894 --> 00:37:56.896
CBD oils, CBD products, CBD edibles.

625
00:37:58.398 --> 00:38:00.379
Not a whole lot there.

626
00:38:00.419 --> 00:38:01.260
Tell us about this one, Drew.

627
00:38:01.961 --> 00:38:02.341
CBD.

628
00:38:02.361 --> 00:38:03.863
So cannabidiol, okay?

629
00:38:03.883 --> 00:38:04.283
Yes.

630
00:38:04.363 --> 00:38:07.085
It's a product of the marijuana plant, right?

631
00:38:07.366 --> 00:38:09.908
But it's THC is what gets you high, CBD.

632
00:38:10.318 --> 00:38:12.620
apparently is what just makes you calm and doesn't get you high.

633
00:38:12.640 --> 00:38:14.261
That's kind of the story we've been told, right?

634
00:38:14.361 --> 00:38:14.521
Yeah.

635
00:38:14.721 --> 00:38:18.524
It's a $5 billion market, the CBD supplements market is.

636
00:38:18.745 --> 00:38:19.225
$5 billion.

637
00:38:19.305 --> 00:38:19.545
Okay.

638
00:38:20.106 --> 00:38:23.768
There was a meta-analysis in 2024, so a very recent meta-analysis.

639
00:38:24.269 --> 00:38:27.271
They looked at 1,550 studies of CBD, okay?

640
00:38:27.291 --> 00:38:27.491
Okay.

641
00:38:27.511 --> 00:38:27.712
Okay.

642
00:38:28.472 --> 00:38:33.057
And so they're like, okay, we're going to – the meta-analysis, again, you find all the studies about the studies, right?

643
00:38:33.178 --> 00:38:33.338
Yeah.

644
00:38:33.618 --> 00:38:34.759
It's a study about the studies.

645
00:38:35.140 --> 00:38:44.451
Of those 1,550 research papers that they found, they could only include eight of them in their analysis because they said all the other ones just are – they're so poor quality.

646
00:38:44.471 --> 00:38:44.831
They just suck.

647
00:38:44.971 --> 00:38:45.512
They suck.

648
00:38:45.932 --> 00:38:46.753
We can't – like –

649
00:38:47.574 --> 00:38:51.116
Improper controls, too small, bad methodologies.

650
00:38:51.396 --> 00:38:55.517
There was eight studies that were like these fit the bill for our criteria.

651
00:38:55.617 --> 00:38:56.378
Stringent criteria.

652
00:38:56.418 --> 00:38:58.859
Which, by the way, listeners, eight studies is nothing.

653
00:38:58.879 --> 00:38:59.419
Is nothing.

654
00:38:59.439 --> 00:39:00.099
That's nothing.

655
00:39:00.640 --> 00:39:03.501
We're told 316 participants out of those eight studies too.

656
00:39:03.681 --> 00:39:03.981
Nothing.

657
00:39:04.001 --> 00:39:06.142
It's a very, very small sample size where we're going on here.

658
00:39:06.382 --> 00:39:06.622
Okay.

659
00:39:06.802 --> 00:39:08.283
Again, all the others were so poorly done.

660
00:39:08.303 --> 00:39:10.284
They were just like we're not even going to include them in this.

661
00:39:10.304 --> 00:39:10.504
Okay.

662
00:39:10.524 --> 00:39:10.744
Okay.

663
00:39:11.664 --> 00:39:15.049
They did find – now in this study, they found a big positive effect size.

664
00:39:15.069 --> 00:39:15.729
OK. OK.

665
00:39:16.050 --> 00:39:23.740
But the thing was is that they're like what they call the confidence interval, right, was so wide that they're like it's either amazing or it barely does anything.

666
00:39:24.501 --> 00:39:25.442
We're confident of that.

667
00:39:25.642 --> 00:39:26.563
Like that's the best we can do.

668
00:39:26.643 --> 00:39:27.064
Yeah.

669
00:39:27.144 --> 00:39:27.945
That's what we can tell you.

670
00:39:27.965 --> 00:39:30.408
It's either awesome or nothing.

671
00:39:30.868 --> 00:39:33.151
Like that's the best they can do.

672
00:39:33.171 --> 00:39:33.912
It's kind of useless.

673
00:39:34.092 --> 00:39:34.953
Right.

674
00:39:35.273 --> 00:39:36.134
Useless information.

675
00:39:36.414 --> 00:39:36.615
Yeah.

676
00:39:36.915 --> 00:39:38.096
With magnesium too.

677
00:39:38.737 --> 00:39:39.338
It makes sense.

678
00:39:39.398 --> 00:39:43.903
Like the CB1 receptor, which is what the receptor in your neurons that –

679
00:39:44.699 --> 00:39:48.021
CBD would attach to, it probably is a good target for anxiety.

680
00:39:48.362 --> 00:39:52.785
It just looks like the supplements, like taking oral supplements for it, doesn't really work.

681
00:39:53.125 --> 00:39:56.888
At least the evidence we have for it is just really not there, okay?

682
00:39:56.908 --> 00:39:59.349
And there's just kind of some weird findings I found too.

683
00:39:59.389 --> 00:40:04.112
Like a couple of studies found that exactly 300 milligrams is what you need, anything more, anything less.

684
00:40:04.133 --> 00:40:04.853
Yeah.

685
00:40:05.793 --> 00:40:07.174
Doesn't do anything or makes you more anxious.

686
00:40:07.194 --> 00:40:07.834
That doesn't make sense.

687
00:40:08.014 --> 00:40:09.434
Doesn't make a whole lot of sense to me either.

688
00:40:09.454 --> 00:40:17.177
And not only that, but like most of the commercially available CBD supplements out there are between like 10 and 50 milligrams anyway.

689
00:40:17.197 --> 00:40:20.437
So even if it was 300 milligrams, you'd have to take a whole bunch of them.

690
00:40:20.558 --> 00:40:21.958
So you'd have to take six doses.

691
00:40:22.298 --> 00:40:28.601
Well, yeah, maybe, maybe, maybe because then the other problem is quality of these supplements.

692
00:40:29.021 --> 00:40:36.664
They've – a 2022 study took 80 different CBD products that were commonly found on the market today and tested them.

693
00:40:36.724 --> 00:40:41.026
And only just over half of them have what they actually – the amount of CBD they said they had.

694
00:40:41.626 --> 00:40:44.768
So you don't even know how much you're getting even if it does work.

695
00:40:45.578 --> 00:40:46.339
as an oral supplement.

696
00:40:46.439 --> 00:40:48.361
I'm surprised this is higher than magnesium.

697
00:40:48.421 --> 00:40:48.841
Yeah.

698
00:40:49.141 --> 00:40:50.983
Honestly, this one we probably could have switched with magnesium.

699
00:40:51.043 --> 00:40:55.246
I mean, I think it got skewed by that one study that found strong results.

700
00:40:55.447 --> 00:40:56.107
Huge effect size.

701
00:40:56.127 --> 00:40:56.467
Yeah.

702
00:40:56.488 --> 00:40:59.730
But again, that the, the certainty on it wasn't super high.

703
00:40:59.830 --> 00:41:07.837
So in some form it could work if they come out with some method of delivery that actually like we can, we can point to it and say, yeah, that's what's going on.

704
00:41:08.017 --> 00:41:08.218
Yeah.

705
00:41:08.398 --> 00:41:08.938
It might work.

706
00:41:08.998 --> 00:41:10.640
But what we have so far is,

707
00:41:11.579 --> 00:41:12.640
It's kind of garbage.

708
00:41:12.720 --> 00:41:13.100
Okay.

709
00:41:13.120 --> 00:41:13.840
Just not a whole lot going on.

710
00:41:13.860 --> 00:41:14.981
I don't know how common this is anymore.

711
00:41:15.021 --> 00:41:19.204
I remember this being way more common, say, six to eight years ago, maybe a little more.

712
00:41:19.304 --> 00:41:19.484
Yeah.

713
00:41:19.584 --> 00:41:20.905
I mean, I know there's still some people.

714
00:41:20.945 --> 00:41:21.225
Yeah.

715
00:41:21.305 --> 00:41:23.586
You know, it's like CBD in your coffee or CBD in butter.

716
00:41:24.387 --> 00:41:26.448
I feel like it blew up kind of late 2010s.

717
00:41:26.468 --> 00:41:26.889
Yeah.

718
00:41:27.089 --> 00:41:28.149
I remember taking it.

719
00:41:28.229 --> 00:41:33.613
I remember I went to some event and one of the sponsors was a CBD product and they gave me a bunch of...

720
00:41:34.351 --> 00:41:49.883
bunch of supplements and um i remember taking it it was supposed to help with like injuries and pain management like it's one of those supplements supposedly does everything when it came out yeah uh but i remember taking it for like a week or two and i'm like i don't think this does a fucking thing yeah i think i'm just pissing this out every day

721
00:41:50.263 --> 00:41:51.543
Not surprised by this one.

722
00:41:51.923 --> 00:42:06.447
I got to say like given everything I know and understand about the supplement industry and I took one look at the research summary for this and I just kind of chuckled like eight good studies out of 1,600.

723
00:42:06.487 --> 00:42:06.727
OK.

724
00:42:07.427 --> 00:42:10.068
So, yeah, I guess I don't think we need to dwell on this too much.

725
00:42:11.068 --> 00:42:12.829
This is probably nothing.

726
00:42:12.869 --> 00:42:13.849
It's probably a placebo.

727
00:42:14.549 --> 00:42:18.050
But number 13 I think is going to shock a lot of people.

728
00:42:19.350 --> 00:42:20.352
The digital detox.

729
00:42:21.734 --> 00:42:28.404
The getting out in nature, getting rid of your phone, getting out in nature, going for a walk, going outside.

730
00:42:28.424 --> 00:42:31.289
I want this one to work.

731
00:42:31.730 --> 00:42:31.910
Yeah.

732
00:42:33.643 --> 00:42:34.444
And it kind of does.

733
00:42:34.484 --> 00:42:35.164
We'll get to that.

734
00:42:35.224 --> 00:42:36.224
Yeah, I'm not going to lie.

735
00:42:36.244 --> 00:42:37.265
I was a little disappointed too.

736
00:42:37.965 --> 00:42:46.089
This is definitely one of those things where it's – we're probably getting out of probably nothing and we're getting into sort of maybe depends category.

737
00:42:46.330 --> 00:42:55.014
I think the surprising thing here is that if you spend time on YouTube or listening to other podcasts, like this is the biggest and most important and life-changing thing.

738
00:42:55.034 --> 00:43:00.637
I mean just among my friends and family members, the amount of people I know who are like –

739
00:43:00.957 --> 00:43:07.799
Going on retreats and going to the forest and like getting rid of their phones and turning their phones off for multiple days and like all this stuff.

740
00:43:08.220 --> 00:43:15.202
And then swearing that it's like such a detox and a relief and it cleared their mind and everything.

741
00:43:15.222 --> 00:43:17.763
It's a very common meme at the moment.

742
00:43:18.017 --> 00:43:27.803
I think one of the issues might be those that replacing like your digital habits with going outside, it does actually make you less anxious in the moment.

743
00:43:27.823 --> 00:43:29.104
It's just not a long term fix.

744
00:43:29.344 --> 00:43:29.544
Yeah.

745
00:43:29.684 --> 00:43:40.351
What they found, like you can decrease anxiety like in the short term by just going outside and not looking at your phone or not looking at screens or, you know, not looking at the news, I think is a big one, too.

746
00:43:40.571 --> 00:43:43.373
The thing is, is that the bounce back is usually really, really hard.

747
00:43:44.161 --> 00:43:47.443
is that people go back, like, as soon as you're out, then you just go right back into it.

748
00:43:47.483 --> 00:43:47.623
Right.

749
00:43:47.643 --> 00:43:54.466
You go right back into this, like, digital morass or, like, you're, especially if you're into, you know, news media and stuff like that.

750
00:43:55.306 --> 00:43:59.028
That's, I think, more of what's going on here than necessarily.

751
00:43:59.388 --> 00:44:10.373
I would be very surprised if you had two people, one who just didn't use their phone at all and was always in nature versus I would be a little bit surprised if those people weren't, didn't have different anxiety profiles for sure.

752
00:44:10.693 --> 00:44:17.605
The problem is that bouncing back and forth between the two, that's going to be an issue at some point.

753
00:44:17.833 --> 00:44:24.715
Don't necessarily switch your lifestyle around this, but like, hey, if you're having a really rough Monday morning, like go for a walk in a park, that'll probably help a little bit.

754
00:44:24.755 --> 00:44:25.615
I mean, I think that's great.

755
00:44:25.655 --> 00:44:26.116
Yeah, sure.

756
00:44:26.136 --> 00:44:26.876
Yeah.

757
00:44:27.816 --> 00:44:28.116
Do that.

758
00:44:28.156 --> 00:44:32.157
I mean, it will help your anxiety in the very short term.

759
00:44:32.177 --> 00:44:33.378
It's not going to like cure.

760
00:44:33.458 --> 00:44:35.678
If you're having a panic attack, I'm not saying, oh, we just go for a walk.

761
00:44:35.738 --> 00:44:37.139
That's not going to happen, right?

762
00:44:37.399 --> 00:44:41.680
It's not like a long-term fix is probably like added in as part of your routine.

763
00:44:41.720 --> 00:44:42.020
Sure.

764
00:44:42.040 --> 00:44:43.481
I go outside, touch grass.

765
00:44:43.581 --> 00:44:44.221
Absolutely.

766
00:44:44.301 --> 00:44:46.822
But it's like, it's not a fix for anxiety.

767
00:44:47.022 --> 00:44:47.262
Yeah.

768
00:44:47.542 --> 00:44:53.285
Maybe this is kind of what this is actually doing, what people think alcohol is doing, right?

769
00:44:53.325 --> 00:44:54.446
Take the edge off a little.

770
00:44:54.506 --> 00:44:54.846
Right.

771
00:44:54.986 --> 00:44:56.807
Help you unwind after a busy day.

772
00:44:57.308 --> 00:44:59.609
Help you decompress after like maybe a stressful week.

773
00:44:59.629 --> 00:45:00.730
I can get on board with that, yeah.

774
00:45:00.770 --> 00:45:01.330
Yeah.

775
00:45:01.390 --> 00:45:10.155
But it's not really – like you said, as soon as you go back to your life and the screens and everything, it like – everything comes back pretty much immediately.

776
00:45:10.175 --> 00:45:12.897
So it's not – there's no sustainability here.

777
00:45:19.281 --> 00:45:28.443
I just finished apologizing to all the weed dispensaries here in West LA, telling them that the CBD, there's no evidence showing that it works.

778
00:45:29.223 --> 00:45:34.244
I'm going to have to go back out and apologize to a lot of people because number 12 on our list is breathwork.

779
00:45:36.144 --> 00:45:37.304
This one has a lot of caveats.

780
00:45:37.324 --> 00:45:37.744
Yeah, yeah, yeah.

781
00:45:38.045 --> 00:45:46.046
The important caveat here is that breathwork is definitely one of those things that it works for some people in some contexts and also works depending on breathwork.

782
00:45:47.925 --> 00:45:49.626
the particular technique you're doing.

783
00:45:50.187 --> 00:45:54.550
It does not work for everyone in all contexts and not all breathwork techniques work equally.

784
00:45:54.811 --> 00:45:57.273
That's the headline that people should take away from this section.

785
00:45:58.454 --> 00:45:59.755
There's a lot of nuance going on here.

786
00:46:00.075 --> 00:46:09.443
And as somebody who, by the way, has had friends and loved ones go to breathwork classes where the administrator...

787
00:46:09.943 --> 00:46:13.986
clearly had no fucking clue what they were doing, you can have very adverse effects.

788
00:46:14.106 --> 00:46:21.651
Like breath work when done incorrectly or when done with the wrong person, with the wrong technique, it can induce panic attacks.

789
00:46:21.931 --> 00:46:26.934
So it is like actually counterproductive when done poorly.

790
00:46:27.795 --> 00:46:36.000
So that's all just like a PSA for people listening to this, that yes, breath work can be super helpful and there are people, I know people who swear by it.

791
00:46:36.040 --> 00:46:37.121
It's been life-changing for them.

792
00:46:37.541 --> 00:46:38.602
I also know people that like,

793
00:46:38.882 --> 00:47:02.959
fucking hate it it was one of the worst experiences they ever had so be aware yes it can induce some panic attack it's also it can help a panic attack yes it's done correctly depending on how it's done yeah very much depends this was definitely like when i would have panic attacks for whatever reason i would get panic attacks when i was driving a lot which was just that's not good awful yeah so i just had to i pull over and i would do some cyclic breathing which is actually what it kind

794
00:47:05.050 --> 00:47:07.791
a one to two ratio of in to out breath, right?

795
00:47:07.831 --> 00:47:13.392
So you, you inhale for a one count, exhale for a two count or, you know, a three count and a six count, whatever it is.

796
00:47:13.412 --> 00:47:14.532
A one to two ratio though.

797
00:47:14.632 --> 00:47:15.292
Yeah.

798
00:47:15.352 --> 00:47:22.254
And that seems to help just as like a kind of general maintenance thing for anxiety doesn't like small, small effect.

799
00:47:22.494 --> 00:47:27.995
It's not necessarily to that, that longer exhale is like the, the, the key ingredient here.

800
00:47:28.455 --> 00:47:28.675
You're

801
00:47:29.401 --> 00:47:32.582
bringing attention to your internal states a little bit more.

802
00:47:33.522 --> 00:47:39.824
And again, you're confronting them and not trying to avoid them or paper over them.

803
00:47:40.264 --> 00:47:42.645
And I think some types of breath work can help with that.

804
00:47:42.805 --> 00:47:46.146
From what I've seen, the most effective technique is what you just described.

805
00:47:46.186 --> 00:47:47.967
Sometimes it's called box breathing.

806
00:47:48.207 --> 00:47:50.287
There's different second configurations, right?

807
00:47:50.307 --> 00:47:52.668
So the one that I learned was four, seven, eight, right?

808
00:47:52.688 --> 00:47:56.489
So you breathe in for four seconds, you hold for seven, you breathe out for eight.

809
00:47:56.629 --> 00:47:56.809
Right.

810
00:47:57.210 --> 00:47:58.610
There's a one to two ratio again, four to eight.

811
00:47:58.790 --> 00:47:58.990
Yep.

812
00:47:59.150 --> 00:48:00.031
And then you just repeat that.

813
00:48:00.051 --> 00:48:01.051
I've seen 488.

814
00:48:01.191 --> 00:48:02.692
I've seen 448.

815
00:48:02.812 --> 00:48:05.113
The exact numbers don't really matter, but it's mostly the ratio.

816
00:48:05.433 --> 00:48:11.556
And what it is, so I learned this, my wife, Fernanda, she has a lot of, she has panic attacks.

817
00:48:11.856 --> 00:48:15.658
And so what I learned actually, like one of them was so bad that we had to call the paramedics.

818
00:48:15.798 --> 00:48:17.839
And the EMT actually explained this to me.

819
00:48:17.859 --> 00:48:24.742
He said, it's actually very counterintuitive, but like when you have a panic attack, you're, you're, you're, you're, you're, you're, you're, you're, you're, you're, you're,

820
00:48:24.802 --> 00:48:43.002
breathing so heavily and so quickly that you're actually you're not allowing your body to like oxygenate sufficiently which then creates a negative feedback loop because then you feel even more out of breath and that you need to breathe even quicker and sooner and so you get into this like bad cycle and that you you keep breathing harder and harder but you feel like you're more and more out of breath.

821
00:48:43.202 --> 00:48:50.332
In that moment, the last thing you want to do is breathe slower because you literally feel like you're going to die if you breathe slower.

822
00:48:50.652 --> 00:48:58.824
By breathing slower, you allow your body to actually properly oxygenate, which then like calms your nervous system, which then like kind of reverses that.

823
00:48:59.404 --> 00:49:00.025
feedback loop.

824
00:49:00.325 --> 00:49:07.089
The thing that I want to call out here is that there's a lot of different breathwork classes, breathwork techniques.

825
00:49:08.671 --> 00:49:14.895
There's a very prominent person in our industry that does breathwork interventions at his seminars.

826
00:49:15.195 --> 00:49:24.621
I've started seeing all sorts of like very big promises attached that simply by doing breathwork for 20 minutes, you can unearth childhood wounds and heal trauma.

827
00:49:27.363 --> 00:49:29.965
Let go of all of your bottled up emotions and all this stuff.

828
00:49:30.825 --> 00:49:40.011
What is interesting about these techniques is that by breathing intensely, you can activate yourself into a high arousal state.

829
00:49:40.451 --> 00:49:45.855
And when you are in that high arousal state, like it can be a conduit for a lot of emotions to come up.

830
00:49:46.655 --> 00:49:50.817
And so you do, if you go to these breathwork classes, you will see people who start crying.

831
00:49:51.277 --> 00:49:56.699
You will see people who are screaming or having very intense emotional experiences.

832
00:49:56.779 --> 00:50:04.142
And I think if you are the type of person who tends to repress emotion and has trouble experiencing it, I'm sure this can be useful.

833
00:50:04.702 --> 00:50:15.547
The problem is that if you are somebody like my wife or like you who is already prone to panic attacks, already has a nervous system that is constantly in a high arousal state,

834
00:50:16.247 --> 00:50:27.810
putting yourself in an environment where you are for a very prolonged period of time, pushing yourself into a higher arousal state can have very bad consequences and can actually trigger and induce panic attacks.

835
00:50:27.950 --> 00:50:45.514
So I think the clarification that I'd like to make here is that, so the box breathing for somebody who is in a highly anxious state, whether you're having a panic attack or you're just in a very, very high pressure situation, slowing the breath, counting the breath, four seconds, eight seconds, in, out,

836
00:50:46.595 --> 00:50:49.878
This – pretty much 10 times out of 10, this will calm you down.

837
00:50:50.739 --> 00:50:54.384
It is super effective, but it is – like you said, it's a short-term solution.

838
00:50:55.165 --> 00:51:03.014
These longer session, 45-minute, 50-minute, 60-minute breathwork sessions where you're like –

839
00:51:04.195 --> 00:51:13.200
hyperventilating yourself on the floor for like minutes and minutes and minutes at a time, I'm not convinced it does anything really at any sort of deep level.

840
00:51:13.540 --> 00:51:16.442
To me, this feels kind of like it's like a new version of catharsis.

841
00:51:17.122 --> 00:51:20.424
Just because you're indulging an emotion doesn't mean you're relieving it.

842
00:51:20.444 --> 00:51:26.948
Like this hydraulic theory of emotion of like, oh, I have all this anger bottled up, so I need to be really angry to get it out of my system.

843
00:51:26.988 --> 00:51:28.529
That's not how emotions work.

844
00:51:28.649 --> 00:51:29.830
Emotions are feedback loops.

845
00:51:29.950 --> 00:51:33.692
And so if you are indulging anger, you are actually training your body to become

846
00:51:33.892 --> 00:51:57.405
more angry if you were indulging sadness you are just training your body to feel more sad i personally think these these sorts of techniques are are probably nothing at best placebo at best counterproductive at worst and then if you do happen to be somebody predisposed to panic panic attacks um it's a fucking terrible idea right yeah yeah yeah

847
00:51:58.386 --> 00:52:03.753
If you are experiencing a panic attack and you're doing the breathing like you said though and it is calming, it does calm you down.

848
00:52:03.933 --> 00:52:07.377
I think what's going on actually is it's not so much the breath itself.

849
00:52:07.458 --> 00:52:11.863
It's more you're becoming more aware of your internal bodily states.

850
00:52:12.744 --> 00:52:15.167
I think it's just a – it's a redirection from –

851
00:52:16.288 --> 00:52:20.731
external, oh my God, everything's on fire to, hey, what's actually going on in here?

852
00:52:20.911 --> 00:52:21.832
Oh, I can handle this.

853
00:52:22.372 --> 00:52:23.173
Then move on.

854
00:52:23.673 --> 00:52:31.358
Because if you sit and you dwell too long on it, that is an anxious frame of mind that you're just putting yourself into.

855
00:52:31.538 --> 00:52:32.358
It's a tool for the moment.

856
00:52:32.398 --> 00:52:35.500
Check in, you're good, put it down and walk away.

857
00:52:35.520 --> 00:52:39.483
Because as soon as you start ruminating, that becomes the counterproductive.

858
00:52:40.123 --> 00:52:43.344
All right, moving on down the list, we get to number 11.

859
00:52:43.604 --> 00:52:47.006
This might actually be the first kind of sensitive one that we talk about.

860
00:52:47.406 --> 00:52:51.488
As we said, we're in the maybe depends, sometimes category at the moment.

861
00:52:51.728 --> 00:52:52.308
And this one,

862
00:52:54.064 --> 00:52:56.046
It's – when it goes well, it goes really well.

863
00:52:56.066 --> 00:52:58.369
When it goes poorly, it goes very, very poorly.

864
00:52:58.869 --> 00:53:00.311
And that is benzodiazepines.

865
00:53:01.172 --> 00:53:04.496
And I should say for the record that you and I are not psychiatrists.

866
00:53:04.516 --> 00:53:05.277
We're not doctors.

867
00:53:05.537 --> 00:53:07.099
We're just reporting what the research says.

868
00:53:07.579 --> 00:53:14.787
We're reporting – at this point, benzos, Xanax, Ativan, Valium, Clonopens, they've been around for –

869
00:53:15.988 --> 00:53:17.529
decades, many, many decades.

870
00:53:17.549 --> 00:53:19.309
They've been studied back and forth.

871
00:53:19.889 --> 00:53:22.070
We have tons and tons of research and data on them.

872
00:53:22.310 --> 00:53:23.311
It's a complicated picture.

873
00:53:23.671 --> 00:53:24.871
It's a very complicated picture.

874
00:53:24.891 --> 00:53:31.753
On the one hand, they can be extremely effective and what's better is that they're extremely effective very, very quickly.

875
00:53:32.714 --> 00:53:36.355
On the other hand, there are very intense drawbacks.

876
00:53:37.135 --> 00:53:39.676
People can become dependent on them.

877
00:53:40.597 --> 00:53:44.438
Withdrawals from benzodiazepines can actually kill people.

878
00:53:45.130 --> 00:53:46.771
You can't just stop taking that picture.

879
00:53:46.991 --> 00:53:52.752
It's a very tricky place to be in terms of like a long-term solution.

880
00:53:53.453 --> 00:53:55.613
There's a lot of potential for abuse.

881
00:53:56.073 --> 00:54:08.337
And interestingly, the combination of benzodiazepines with other interventions, we talked earlier about how alcohol interferes with the fear extinction required for exposure therapy to work.

882
00:54:08.637 --> 00:54:10.918
Benzos have the same sort of thing going on.

883
00:54:10.978 --> 00:54:13.639
So what therapists have known for a long time

884
00:54:14.199 --> 00:54:21.202
is that when somebody goes on a benzodiazepine, it can actually reduce the effectiveness of therapy.

885
00:54:21.422 --> 00:54:27.085
That feedback loop inside your brain is not forming the same way it would if you were sober.

886
00:54:27.205 --> 00:54:27.685
Yeah, it makes sense.

887
00:54:27.705 --> 00:54:30.346
I mean, benzodiazepines operate on the same system.

888
00:54:30.366 --> 00:54:31.307
The alcohol does too.

889
00:54:31.827 --> 00:54:35.809
The GABA system, which is an inhibitory system for the most part.

890
00:54:36.329 --> 00:54:43.532
So it makes sense that that, yeah, it extinguishes that fear response when you're doing therapy and you're addressing therapy.

891
00:54:43.791 --> 00:54:48.475
uncertainties and fears and all of that, extinguishing that probably has something to do with the way you learn about those things.

892
00:54:48.595 --> 00:54:49.155
So, yeah.

893
00:54:49.475 --> 00:55:00.404
It's interesting because this fell down to number 11 almost purely due to the complications and the downsides, the potential for harm, which is part of our measurement and our ranking on this.

894
00:55:00.744 --> 00:55:03.927
If you remove the potential for harm, this would actually be top three.

895
00:55:03.947 --> 00:55:04.207
Oh, yeah.

896
00:55:04.507 --> 00:55:06.168
Big effect size, pretty big effect size.

897
00:55:06.188 --> 00:55:12.531
Huge effect size is very well replicated data going back for, like I said, 20, 30, 40 years.

898
00:55:12.892 --> 00:55:14.132
It is very complicated.

899
00:55:14.212 --> 00:55:16.233
There is a lot of potential for abuse.

900
00:55:16.513 --> 00:55:18.434
It's almost like they work too fast.

901
00:55:18.635 --> 00:55:24.538
So like I wasn't aware of this, but there's another drug on the market called Buspirone.

902
00:55:25.318 --> 00:55:27.960
It's – and it is equally as effective.

903
00:55:28.520 --> 00:55:29.921
Does not have the downsides.

904
00:55:30.281 --> 00:55:33.342
But the catch is it takes two to four weeks to start working.

905
00:55:33.362 --> 00:55:40.146
And so patients over and over again tend to go for the benzos because they kick in basically immediately.

906
00:55:40.346 --> 00:55:41.447
And I understand.

907
00:55:41.487 --> 00:55:53.774
Like if you are an extreme case, like if you have severe panic disorder or severe generalized anxiety disorder and you are literally just crippled by anxiety every day –

908
00:55:54.614 --> 00:55:58.695
you probably want something that's going to hit and remedy the situation immediately.

909
00:55:59.095 --> 00:56:03.516
Even then, though, the recommendation is not to use them for more than two to four weeks.

910
00:56:03.877 --> 00:56:04.597
Yeah.

911
00:56:04.657 --> 00:56:05.777
So, yeah.

912
00:56:06.537 --> 00:56:10.918
But that said, I know, I know, I personally have people who have been on like a low dose of benzos for a long time.

913
00:56:10.938 --> 00:56:11.259
Years.

914
00:56:11.339 --> 00:56:11.619
Yeah.

915
00:56:11.719 --> 00:56:12.179
And so.

916
00:56:12.279 --> 00:56:12.559
Years.

917
00:56:13.219 --> 00:56:13.499
Yeah.

918
00:56:13.699 --> 00:56:15.020
Doctors don't pay attention to that, apparently.

919
00:56:15.240 --> 00:56:15.460
Yeah.

920
00:56:15.540 --> 00:56:15.960
I don't know.

921
00:56:16.120 --> 00:56:20.021
I've known multiple people who have abused them over long periods of time.

922
00:56:20.081 --> 00:56:20.841
High chance of abuse.

923
00:56:20.861 --> 00:56:21.401
Yes.

924
00:56:21.421 --> 00:56:22.021
Yeah, for sure.

925
00:56:22.462 --> 00:56:23.362
The next one, number 10.

926
00:56:24.470 --> 00:56:25.210
Probiotics.

927
00:56:25.951 --> 00:56:29.693
This gets into the gut health fad phenomenon.

928
00:56:30.233 --> 00:56:32.775
I'm curious what the research turned up on this, Drew.

929
00:56:32.935 --> 00:56:36.837
Again, this is one of those where like the mechanism, proposed mechanism, it makes sense.

930
00:56:37.197 --> 00:56:37.357
Yeah.

931
00:56:37.537 --> 00:56:40.159
The vagus nerve, it connects your stomach to your brain.

932
00:56:40.179 --> 00:56:43.180
There's a literal connection between your gut and your brain, right?

933
00:56:43.261 --> 00:56:43.501
Yeah.

934
00:56:43.541 --> 00:56:44.421
And that's the vagus nerve.

935
00:56:44.441 --> 00:56:45.762
That's one of the connections anyway.

936
00:56:45.962 --> 00:56:52.124
They've done several experiments where they give a probiotic, different strains of probiotics, and they've measured brain activity.

937
00:56:52.344 --> 00:56:56.826
It alters GABA function in your brain, which is, again, typically inhibitory.

938
00:56:57.186 --> 00:57:00.727
So theoretically, it should work or it could work.

939
00:57:00.747 --> 00:57:02.568
This could be a possible pathway by which...

940
00:57:03.168 --> 00:57:09.617
You know, your gut and your brain talk to each other, can calm down or get more excited, you know, based on whatever's going on in your gut.

941
00:57:09.657 --> 00:57:09.857
Sure.

942
00:57:10.598 --> 00:57:14.764
The interesting thing, though, that I found is there's kind of a split in this one.

943
00:57:14.864 --> 00:57:20.952
So people who have been diagnosed with an anxiety disorder, like GAD or even OCD or anything like that.

944
00:57:22.066 --> 00:57:28.171
They find that probiotics actually help them more than just if you just kind of have like some mild anxiety that you're worried about.

945
00:57:28.191 --> 00:57:34.856
You know, it's not necessarily a clinical level of anxiety, but some anxiety that just bothers you.

946
00:57:35.076 --> 00:57:39.279
Probably not gonna get a whole lot from that using any sort of probiotic.

947
00:57:39.359 --> 00:57:49.247
Several studies have found like there's a fairly big effect size, like anywhere from 0.5 to 0.7 for people with psychiatric anxiety disorders.

948
00:57:49.847 --> 00:57:50.508
Yeah.

949
00:57:50.708 --> 00:57:53.351
So this is one of those definitely depends situations for sure.

950
00:57:53.731 --> 00:58:04.824
It is kind of mind-blowing that for some people, depending on their situation, might get better results from a probiotic you buy over the counter than, say, a prescription drug.

951
00:58:05.144 --> 00:58:10.706
The science is still kind of out on like which strains of probiotics actually help.

952
00:58:10.906 --> 00:58:15.128
Because so when they try to do these meta analyses, it's really hard because there's always different strains.

953
00:58:15.148 --> 00:58:18.749
There's always different methods that go into these different samples that they're using or different.

954
00:58:19.229 --> 00:58:21.450
Like the participant pool they're pulling from is very different.

955
00:58:21.670 --> 00:58:23.891
So it's really hard to make generalizations from a lot of these studies.

956
00:58:24.271 --> 00:58:26.252
We don't have like big pool data that we can pull from.

957
00:58:26.572 --> 00:58:32.174
There's definitely some evidence that a few different strains and a few different populations do respond pretty well to them.

958
00:58:32.602 --> 00:58:36.244
There was a term in one of the meta-analyses for this that I absolutely love.

959
00:58:36.264 --> 00:58:37.544
I've never come across it before.

960
00:58:37.945 --> 00:58:49.290
It was, quote, catastrophic heterogeneity, which is like basically it's like such a large variance in results for people that – And methods that they use too.

961
00:58:49.470 --> 00:58:51.371
That researchers called it catastrophic.

962
00:58:51.391 --> 00:58:52.171
Yeah, right.

963
00:58:52.391 --> 00:58:54.712
That gives you an idea of how all over the map this is.

964
00:58:55.413 --> 00:58:56.273
It is interesting though.

965
00:58:56.293 --> 00:58:57.794
This is one that I would not have guessed.

966
00:58:58.454 --> 00:59:01.775
I would have guessed that this was kind of more on the CBD side.

967
00:59:01.976 --> 00:59:05.337
I know gut health is like a real thing as it relates to mental health.

968
00:59:05.357 --> 00:59:13.500
But my understanding was that – or my assumption I should say is that it would not be as simple as just taking certain probiotics.

969
00:59:13.580 --> 00:59:14.481
Yeah, sure.

970
00:59:14.541 --> 00:59:17.882
Like it would be something more drastic potentially.

971
00:59:18.260 --> 00:59:20.081
I mean, yeah, it does make a lot of sense.

972
00:59:20.121 --> 00:59:25.463
90% of the serotonin neurons and 90% of the serotonin in general is produced in your gut.

973
00:59:25.523 --> 00:59:29.125
You know, we all know serotonin is probably pretty important in some way for mental health.

974
00:59:29.145 --> 00:59:30.605
We'll get to this a little bit later, too.

975
00:59:30.625 --> 00:59:34.187
We don't know exactly how, but there's got to be something there probably.

976
00:59:34.347 --> 00:59:34.547
Right.

977
00:59:34.567 --> 00:59:34.787
Yeah.

978
00:59:35.127 --> 00:59:39.189
So this is, would you say this is just too soon to say?

979
00:59:39.989 --> 00:59:42.851
Or is it like promising too soon?

980
00:59:42.871 --> 00:59:45.772
I think as medicine gets more and more individualized, this is going to be more and more

981
00:59:46.052 --> 00:59:53.376
important and prove to be like for certain people that we can pinpoint and be like, you would be a very good candidate for this.

982
00:59:53.416 --> 00:59:54.736
I think this is one of those treatment.

983
00:59:54.877 --> 00:59:55.457
Number nine.

984
00:59:56.775 --> 00:59:57.215
Yoga.

985
00:59:58.936 --> 00:59:59.897
I'm a big fan of yoga.

986
00:59:59.977 --> 01:00:00.257
I know.

987
01:00:00.277 --> 01:00:02.078
You're a huge yoga head.

988
01:00:02.098 --> 01:00:03.838
Yeah, well, it's interesting.

989
01:00:03.858 --> 01:00:06.400
I've been thinking about this more, especially putting this together.

990
01:00:06.420 --> 01:00:08.261
I'm not like into yoga.

991
01:00:08.621 --> 01:00:08.901
Yeah.

992
01:00:09.141 --> 01:00:09.601
I go to yoga.

993
01:00:09.661 --> 01:00:10.282
I do yoga.

994
01:00:10.302 --> 01:00:12.763
I do it pretty regularly, about twice a week usually.

995
01:00:12.783 --> 01:00:14.924
I do hot yoga for once.

996
01:00:14.944 --> 01:00:16.805
So I get the heat exposure to it too.

997
01:00:17.705 --> 01:00:20.867
But I don't think I would say that I am like –

998
01:00:21.647 --> 01:00:24.609
I'm not into the whole like yoga culture necessarily.

999
01:00:24.629 --> 01:00:27.171
I do it more like a fitness thing, right?

1000
01:00:27.191 --> 01:00:27.311
Yeah.

1001
01:00:27.951 --> 01:00:30.653
Let's talk a little bit about what they found with yoga though first.

1002
01:00:30.673 --> 01:00:30.913
Okay.

1003
01:00:30.933 --> 01:00:32.174
So there is an effect.

1004
01:00:32.535 --> 01:00:32.735
Yes.

1005
01:00:32.755 --> 01:00:32.955
Okay.

1006
01:00:33.175 --> 01:00:34.336
It does help with anxiety.

1007
01:00:34.616 --> 01:00:34.796
Yep.

1008
01:00:35.256 --> 01:00:35.817
Small effect.

1009
01:00:36.370 --> 01:00:36.911
Most likely.

1010
01:00:37.211 --> 01:00:42.117
There was a clinical trial where they had people perform some yoga versus therapy.

1011
01:00:42.798 --> 01:00:45.481
Yoga, about 50% of the people responded to it.

1012
01:00:46.182 --> 01:00:47.764
But with therapy, about 70% did.

1013
01:00:47.824 --> 01:00:49.065
So it's not as good as therapy.

1014
01:00:49.085 --> 01:00:50.927
But it would be a good complement, I would say.

1015
01:00:51.248 --> 01:00:54.512
And I don't think it's for the reasons that a lot of yogis will tell you, you know, the whole...

1016
01:00:55.385 --> 01:01:00.328
maybe centering or whatever it is, the kind of supernatural side of things.

1017
01:01:00.428 --> 01:01:03.290
Obviously, I'm not going to probably argue for that.

1018
01:01:03.490 --> 01:01:11.255
But for me anyway, one of the things I think that it does is it gives you a real awareness of the internal states of your body.

1019
01:01:11.275 --> 01:01:19.100
We brought this up a couple of times already, but I think yoga is actually a really good vehicle to experience that kind of interoception.

1020
01:01:19.140 --> 01:01:21.942
So that your internal states, your internal bodily states

1021
01:01:22.182 --> 01:01:31.727
And not only that, but when I first started doing yoga, you know, the instructors would usually cue you up like, you know, if this is uncomfortable, try this or or or sit with the discomfort a lot.

1022
01:01:31.767 --> 01:01:34.309
And I didn't I was always kind of like, I don't want this to be uncomfortable.

1023
01:01:34.329 --> 01:01:35.349
I'm here to be comfortable.

1024
01:01:35.389 --> 01:01:45.515
But the more I got into it, the more I'm like, oh, they're telling you, OK, this is you're going to push your limit, get to a comfortable position or whatever pose you're doing and then push that and get a little bit uncomfortable.

1025
01:01:46.015 --> 01:01:51.540
That I found was a big like, oh, this helps you sit with a little bit of discomfort for a little bit longer.

1026
01:01:51.580 --> 01:01:55.403
So it's like practicing that kind of muscle, that discomfort muscle a little bit.

1027
01:01:55.923 --> 01:01:57.865
That's where I think the actual value of yoga is.

1028
01:01:57.885 --> 01:01:59.606
I don't think it's anything beyond that.

1029
01:02:00.007 --> 01:02:03.149
It doesn't address maybe the underlying ruminating thoughts you have.

1030
01:02:03.249 --> 01:02:03.429
Yeah.

1031
01:02:03.870 --> 01:02:10.115
That is why I think like the therapy in that study I mentioned, the therapy actually did a little bit better is because it's actually addressing the underlying.

1032
01:02:10.296 --> 01:02:11.197
Yeah, so it's funny.

1033
01:02:11.217 --> 01:02:12.539
I was actually just about to ask.

1034
01:02:12.599 --> 01:02:16.624
Like, I generally associate yoga with meditation.

1035
01:02:16.964 --> 01:02:19.107
Those two often go side by side.

1036
01:02:19.127 --> 01:02:19.908
They happen together.

1037
01:02:19.988 --> 01:02:22.591
People do them, like, at the same time, at the same retreat.

1038
01:02:22.871 --> 01:02:27.657
But it's interesting because I always kind of saw yoga as, like, the physical form of meditation, right?

1039
01:02:27.697 --> 01:02:27.997
It's like...

1040
01:02:28.518 --> 01:02:38.242
that the same way meditation like has you focus in on like a cognitive experience, yoga has you focus in on a physical experience in your physical body.

1041
01:02:38.522 --> 01:02:41.983
Like I'm not going to give it away, but like meditation is on this list.

1042
01:02:42.043 --> 01:02:43.004
It's higher than yoga.

1043
01:02:43.424 --> 01:02:45.845
Exercises on this list, it's also higher than yoga.

1044
01:02:46.205 --> 01:02:50.567
And so I was curious to ask like why do you think yoga placed lower?

1045
01:02:50.627 --> 01:02:53.728
I think in the case of meditation, I think what you said about the cognitive –

1046
01:02:54.308 --> 01:02:54.488
Right.

1047
01:02:54.588 --> 01:02:56.990
Anxiety is very cognitively driven.

1048
01:02:57.670 --> 01:03:05.055
So that makes sense that meditation is more targeted towards managing your thoughts and coming to terms with your emotions and all that.

1049
01:03:05.415 --> 01:03:08.678
My guess on the exercise front is just the dosage level.

1050
01:03:08.718 --> 01:03:09.978
Like yoga is pretty.

1051
01:03:09.999 --> 01:03:15.162
I mean, compared to like, say, doing a CrossFit workout, like yoga is pretty relaxed.

1052
01:03:15.302 --> 01:03:18.124
It's like not super strenuous, low intensity.

1053
01:03:18.224 --> 01:03:19.585
It's relatively easy.

1054
01:03:20.025 --> 01:03:21.546
Hot yoga can be.

1055
01:03:21.607 --> 01:03:22.287
It's pretty intense.

1056
01:03:22.607 --> 01:03:27.552
You know, one thing I'll say is that you get into a room with a whole bunch of other people.

1057
01:03:28.132 --> 01:03:32.376
And in the case of hot yoga, too, like everybody's half naked in there, basically, you know.

1058
01:03:32.716 --> 01:03:34.858
And so there's a lot of like self-consciousness.

1059
01:03:34.978 --> 01:03:35.939
Feelings, I think, that come up.

1060
01:03:36.299 --> 01:03:45.167
The thing is, is that with a lot of these poses that you're doing, if you're super worried about what everybody else is thinking, you're going to fall over on your mat in front of everybody and make a huge ass out of yourself.

1061
01:03:45.627 --> 01:03:47.929
And so it almost like forces you to be like, no, no, no.

1062
01:03:48.029 --> 01:03:50.091
Come back and be present with you.

1063
01:03:50.111 --> 01:03:51.131
That's interesting.

1064
01:03:51.232 --> 01:03:52.413
And so you're right.

1065
01:03:52.433 --> 01:03:55.975
The physical side, it is very much a physical like awareness around it, right?

1066
01:03:56.056 --> 01:03:56.296
Right.

1067
01:03:56.856 --> 01:03:58.038
that you're practicing.

1068
01:03:58.418 --> 01:04:04.245
But I think that's still good enough practice for that situation to kind of like tamp down a lot of those self-conscious thoughts that you have.

1069
01:04:04.705 --> 01:04:08.770
Did you find it helped you feel more confident or?

1070
01:04:10.792 --> 01:04:11.653
No.

1071
01:04:11.893 --> 01:04:13.735
I think it just... Why do you like it so much?

1072
01:04:13.915 --> 01:04:14.256
I do...

1073
01:04:15.377 --> 01:04:19.841
CrossFit, which is a very high intensity, short, you know, heavy weights.

1074
01:04:20.422 --> 01:04:22.964
I like this whole kind of barbella strategy.

1075
01:04:23.225 --> 01:04:23.385
Yeah.

1076
01:04:23.405 --> 01:04:26.047
You know, you go and do something low intensity that's longer.

1077
01:04:26.147 --> 01:04:28.309
There's a meditative side to it for sure.

1078
01:04:28.950 --> 01:04:33.514
But I just find it's a really good balance between like that high intensity.

1079
01:04:34.035 --> 01:04:37.779
You know, usually I'm a little bit sore from a workout maybe or something like that.

1080
01:04:37.799 --> 01:04:38.579
And then I can get in.

1081
01:04:39.460 --> 01:04:40.781
get a good deep stress.

1082
01:04:40.801 --> 01:04:42.003
It's really low.

1083
01:04:42.283 --> 01:04:47.988
There's also just no pressure to like, I'll stop in the middle of some yoga and just lay down for a while while everybody else is going.

1084
01:04:48.149 --> 01:04:51.972
I think it's just a good kind of, it balances you out between those two extremes anyway.

1085
01:04:52.172 --> 01:04:52.353
Yeah.

1086
01:04:52.893 --> 01:04:54.455
So it sounds like a nice supplement.

1087
01:04:55.315 --> 01:05:01.899
I would not use this as like a, this is my go-to anxiety remedy for sure, but it would be a great supplement for a lot of people.

1088
01:05:01.919 --> 01:05:06.542
It's definitely going to, it's good, but it's not going to fix anything on this front.

1089
01:05:06.562 --> 01:05:08.523
The other thing too, I mean, it takes a lot of time too.

1090
01:05:08.784 --> 01:05:11.866
Hour-long classes, generally speaking, that's a pretty standard yoga class.

1091
01:05:12.426 --> 01:05:18.750
Usually they're expensive, you know, so yeah, I wouldn't, I just wouldn't use it as like a first line of defense, yeah.

1092
01:05:18.770 --> 01:05:18.930
Yeah.

1093
01:05:19.327 --> 01:05:21.147
Moving along, we're about halfway through.

1094
01:05:21.548 --> 01:05:22.708
We're now in the top half.

1095
01:05:22.808 --> 01:05:23.088
Okay.

1096
01:05:23.808 --> 01:05:24.748
This one surprised me.

1097
01:05:24.888 --> 01:05:25.389
Yeah.

1098
01:05:25.409 --> 01:05:26.769
I'm not so sure about this one.

1099
01:05:26.989 --> 01:05:27.849
Yeah.

1100
01:05:28.349 --> 01:05:29.110
Adaptogens.

1101
01:05:29.610 --> 01:05:30.550
This is another one.

1102
01:05:30.630 --> 01:05:40.332
I mean, if this came low, I'd have to leave the studio again and go apologize to a bunch of people around West LA because everything out here has a fucking adaptogen in it these days.

1103
01:05:40.713 --> 01:05:41.813
There's actually this like –

1104
01:05:42.913 --> 01:05:47.655
bougie, fruity drink that I get at the grocery store here that has ashwagandha in it.

1105
01:05:48.076 --> 01:05:50.637
Actually, the energy drink I drank this morning had rhodiola in it.

1106
01:05:50.917 --> 01:05:52.578
So this stuff is showing up.

1107
01:05:53.360 --> 01:05:53.720
Everywhere.

1108
01:05:54.240 --> 01:05:56.702
Afraganda, rhodiola, holy basil.

1109
01:05:57.162 --> 01:06:01.244
Early numbers were shockingly good.

1110
01:06:01.444 --> 01:06:02.904
Some incredible effect sizes.

1111
01:06:03.365 --> 01:06:05.766
But it seems like we're still early days on this.

1112
01:06:05.986 --> 01:06:10.628
Yeah, I think we have a similar problem with CBD, though, too, is that quality varies a lot.

1113
01:06:10.688 --> 01:06:13.629
It's kind of hard to pin down which ones are the better ones.

1114
01:06:13.870 --> 01:06:17.671
The study designs are very variable, right?

1115
01:06:17.731 --> 01:06:20.853
So you just get a huge, a lot of heterogeneity there.

1116
01:06:21.113 --> 01:06:23.054
Trevor Burrus, Jr.: What do you mean by study design?

1117
01:06:23.074 --> 01:06:30.459
Like explain for the audience, people who haven't read a lot of research or done research, like what's the difference between say a good study design and a bad study?

1118
01:06:30.499 --> 01:06:36.823
If we're like testing ashwagandha for anxiety, like what's an example of a good study design and a bad study design?

1119
01:06:37.343 --> 01:06:43.646
Some of the basics are just like having an actual random sample of people who show up to this.

1120
01:06:43.886 --> 01:06:44.826
Not just college students.

1121
01:06:44.846 --> 01:06:52.209
Not just college students or even like for some reason your experimental group and your control group are completely different types of people.

1122
01:06:52.269 --> 01:06:52.810
You don't want that.

1123
01:06:52.850 --> 01:06:54.530
You want a good mix of people between them.

1124
01:06:55.371 --> 01:06:56.731
You want a control group too.

1125
01:06:56.791 --> 01:07:02.934
This is the other thing we talked about like with magnesium earlier where they just had two different kinds of magnesium and they didn't compare it to a placebo.

1126
01:07:03.134 --> 01:07:03.354
Right.

1127
01:07:03.394 --> 01:07:05.275
We don't know if that's a placebo or not at that point.

1128
01:07:05.856 --> 01:07:06.276
There's that.

1129
01:07:06.436 --> 01:07:07.697
Size of the study matters too.

1130
01:07:07.717 --> 01:07:08.897
So how many people are in it?

1131
01:07:09.378 --> 01:07:14.880
The more, the better, obviously, because you can make more generalized inferences from those populations.

1132
01:07:15.460 --> 01:07:17.801
And then, I mean, just all sorts of methodological stuff too.

1133
01:07:17.901 --> 01:07:19.562
Is that a blinded study as well?

1134
01:07:19.722 --> 01:07:25.104
You know, like a lot of these, especially with supplements are going to be funded by the supplement company.

1135
01:07:25.304 --> 01:07:26.164
Yeah.

1136
01:07:26.184 --> 01:07:32.147
And even if it's a blind study that can still influence the results, tilt things one way or the other.

1137
01:07:32.167 --> 01:07:32.267
Yeah.

1138
01:07:32.807 --> 01:07:34.968
Those are some of the big ones for sure.

1139
01:07:34.988 --> 01:07:40.891
But I mean, even if you do have smaller studies, though, but they're well done over time, that can help.

1140
01:07:41.151 --> 01:07:41.351
Right.

1141
01:07:41.391 --> 01:07:44.173
Because you can do a meta analysis, include those studies that they're well done.

1142
01:07:44.373 --> 01:07:45.474
They have proper controls.

1143
01:07:45.734 --> 01:07:49.816
They have proper blinding where the researchers don't know which condition the participants are in.

1144
01:07:50.876 --> 01:07:52.137
Those those sorts of things help a lot.

1145
01:07:52.467 --> 01:07:59.389
It's probably worth noting too that like one of the biggest barriers to really good research is just funding.

1146
01:07:59.689 --> 01:08:06.950
Like to get a good sample size, to get a nice variability of people in that sample, it costs money.

1147
01:08:07.250 --> 01:08:11.992
You need to go find thousands of people, tens of thousands of people that come from all different walks of life.

1148
01:08:12.072 --> 01:08:13.612
That takes a long time.

1149
01:08:13.652 --> 01:08:15.512
There's lots of recruiting.

1150
01:08:15.572 --> 01:08:16.493
You've got to put out ads.

1151
01:08:16.513 --> 01:08:18.653
You've got to like onboard people, interview people.

1152
01:08:19.013 --> 01:08:19.533
It requires

1153
01:08:22.714 --> 01:08:42.497
researchers and a lot of help and it's costly it takes a long time and so it's so sometimes the incentive is that to take shortcuts which is why like you said with adaptogens those early studies oh they look really promising well it's because they were like well we can't do the perfect study so we're going to do yes a good enough study and then those headlines get picked up and going out of proportion so yeah

1154
01:08:42.657 --> 01:08:52.422
And then you also get this situation where there is, say, a ashwagandha drink company, like a health drink company that has ashwagandha as their primary ingredient and they really want to market that.

1155
01:08:53.163 --> 01:09:01.127
And so they come to researchers and they're like – and I think maybe this is a misconception because sometimes people think that this is way more diabolical than it actually is.

1156
01:09:01.427 --> 01:09:02.448
I mean maybe it is sometimes.

1157
01:09:02.508 --> 01:09:07.931
But my sense is that like it's not like the drink companies come and say like we need these numbers to line up this way.

1158
01:09:08.451 --> 01:09:10.452
I think it's more just like – That was the tobacco company.

1159
01:09:10.532 --> 01:09:11.793
Yeah, yeah, yeah, yeah.

1160
01:09:12.793 --> 01:09:20.037
I think it's more just like, hey, we'll fund a study, but this is kind of what we think it should look like or this is how much we're willing to give.

1161
01:09:20.257 --> 01:09:22.378
There's a muddying of incentives, I think.

1162
01:09:22.699 --> 01:09:22.819
Yeah.

1163
01:09:22.839 --> 01:09:23.059
Yeah.

1164
01:09:23.779 --> 01:09:26.340
There's like a few like pretty good quality studies.

1165
01:09:26.541 --> 01:09:27.381
They're just small.

1166
01:09:27.741 --> 01:09:28.342
Yeah.

1167
01:09:28.502 --> 01:09:34.125
Like they do find a good effect size on anxiety and even some other mental health conditions.

1168
01:09:34.305 --> 01:09:34.565
But –

1169
01:09:35.725 --> 01:09:38.428
They're small and so it's just I'm cautious I would say.

1170
01:09:38.608 --> 01:09:38.869
Yeah.

1171
01:09:39.129 --> 01:09:44.094
I've been drinking this ashwagandha drink quite a bit lately especially at social events now that I don't drink alcohol.

1172
01:09:44.214 --> 01:09:44.394
Yeah.

1173
01:09:44.514 --> 01:09:52.643
It's actually in fact a lot of mocktails now have ashwagandha in it because supposedly it's supposed to give you a little bit of a buzz and help you relax.

1174
01:09:52.703 --> 01:09:52.943
Okay.

1175
01:09:54.339 --> 01:09:55.440
I don't really notice anything.

1176
01:09:55.900 --> 01:09:58.201
At this point, I feel like it's probably just placebo.

1177
01:09:58.301 --> 01:10:04.384
Like I just – I'll have one sometimes at night before bed because it's like I've been marketed to that it helps me unwind.

1178
01:10:04.544 --> 01:10:07.686
So it probably just helps me unwind a little bit.

1179
01:10:08.006 --> 01:10:10.047
But yeah, I'm not convinced that there's anything going on here.

1180
01:10:10.347 --> 01:10:10.668
All right.

1181
01:10:10.768 --> 01:10:11.228
Next one.

1182
01:10:11.568 --> 01:10:12.709
This one might get us canceled.

1183
01:10:12.889 --> 01:10:13.009
OK.

1184
01:10:14.460 --> 01:10:14.720
SSRIs.

1185
01:10:14.760 --> 01:10:15.680
All right.

1186
01:10:15.700 --> 01:10:20.101
So these are your classic antidepressants, Prozac, Zoloft, Lexapro.

1187
01:10:20.481 --> 01:10:25.142
I guess in the pharmaceutical world, these are kind of like your first line defense for depression and anxiety.

1188
01:10:25.482 --> 01:10:29.823
Maybe the first thing we should do is just dispel the myth that antidepressants don't work.

1189
01:10:30.083 --> 01:10:33.104
Like I don't know how that became a meme at some point.

1190
01:10:33.124 --> 01:10:34.745
Well, for some people they don't.

1191
01:10:34.925 --> 01:10:36.025
Well, of course.

1192
01:10:37.730 --> 01:10:39.192
I got you, yeah.

1193
01:10:39.232 --> 01:10:40.313
But there's nothing there.

1194
01:10:40.413 --> 01:10:41.034
That's not true.

1195
01:10:41.054 --> 01:10:41.595
Yes, correct.

1196
01:10:41.615 --> 01:10:42.376
There's absolutely nothing there.

1197
01:10:42.416 --> 01:10:43.597
No, they work for some people for sure.

1198
01:10:43.677 --> 01:10:44.077
Correct.

1199
01:10:44.158 --> 01:10:48.863
So like the Cochrane review did a review of SSRIs.

1200
01:10:48.943 --> 01:10:52.707
Cochrane is, for people who don't know, Cochrane is like the gold standard of like,

1201
01:10:54.318 --> 01:10:58.642
Reviewing research, coming down saying, does this thing actually work or not?

1202
01:10:58.682 --> 01:11:00.043
Are these results actually legitimate?

1203
01:11:00.323 --> 01:11:02.225
Cochrane Review said, it's legit.

1204
01:11:02.925 --> 01:11:03.966
There is an effect size here.

1205
01:11:04.006 --> 01:11:04.787
They do something.

1206
01:11:05.467 --> 01:11:09.111
On the one side, it's like they absolutely do help people.

1207
01:11:09.151 --> 01:11:13.274
And I think certain people in certain situations, it can be absolutely life-changing.

1208
01:11:13.734 --> 01:11:16.437
That said, they are also probably overprescribed.

1209
01:11:16.857 --> 01:11:19.599
Like I think both of those things can be true simultaneously.

1210
01:11:19.839 --> 01:11:25.802
I think it's like they are very useful and in some cases life-saving for people and they're probably giving out way too much.

1211
01:11:25.922 --> 01:11:27.823
That is my non-medical opinion.

1212
01:11:28.884 --> 01:11:29.604
Don't come at me.

1213
01:11:29.764 --> 01:11:35.387
And by the way, like I've had doctors prescribe antidepressants for me for like basically no reason.

1214
01:11:35.427 --> 01:11:39.249
My wife's had antidepressants prescribed to her for like fucking headaches.

1215
01:11:39.289 --> 01:11:40.010
Like it just –

1216
01:11:40.970 --> 01:11:44.551
Doctors in the U.S. definitely do give them out like candy at times.

1217
01:11:44.911 --> 01:11:48.172
And there are some documentaries around the incentive structure around that.

1218
01:11:48.392 --> 01:11:52.873
And not only that, I mean, they've been detected like in river water, you know, and wastewater before.

1219
01:11:52.893 --> 01:11:55.033
So I guess it could be, that could be true.

1220
01:11:55.293 --> 01:11:59.014
Maybe it's useful to start like, how do they work?

1221
01:11:59.755 --> 01:12:01.835
You know, what's the mechanism going on here?

1222
01:12:02.255 --> 01:12:06.636
What are the discussion items around like, you know, why they're good, why they're bad?

1223
01:12:06.756 --> 01:12:09.977
Yeah, so SSRI, selective serotonin reuptake inhibitors, right?

1224
01:12:10.675 --> 01:12:17.218
Technically, what they do is they increase the amount of serotonin that's in the synapse between neurons.

1225
01:12:17.298 --> 01:12:18.839
Okay, the space between neurons.

1226
01:12:19.519 --> 01:12:26.282
And serotonin has been implicated in all sorts of different mental health conditions and just in general, right?

1227
01:12:27.122 --> 01:12:28.843
Like I said, a lot of it is produced in your gut, though.

1228
01:12:29.103 --> 01:12:37.407
Really going back, I don't know, 60s, 70s, 80s probably, there's this chemical imbalance theory of mental health disorders, right?

1229
01:12:38.653 --> 01:12:40.334
We're really going away from that.

1230
01:12:40.474 --> 01:12:46.417
There's been several kind of high profile meta analyses that have looked at decades and decades worth of data.

1231
01:12:46.737 --> 01:12:50.079
They really can't establish a link between serotonin specifically.

1232
01:12:50.790 --> 01:12:52.332
and say depression or anxiety.

1233
01:12:52.792 --> 01:12:53.072
Okay.

1234
01:12:53.373 --> 01:12:57.757
Depression was supposed to be the one that is like, yeah, definitely for depression, there's something going on, maybe for anxiety.

1235
01:12:57.897 --> 01:13:08.508
But really recent studies have found that no, they're actually, we can't really find any association between the level of serotonin in somebody's system and their mental health outcomes.

1236
01:13:08.668 --> 01:13:10.809
That said, SSRIs do work.

1237
01:13:11.170 --> 01:13:11.350
Yeah.

1238
01:13:11.490 --> 01:13:13.251
We know they work for some people at least.

1239
01:13:13.411 --> 01:13:15.432
We don't know why they don't work for others, okay?

1240
01:13:16.113 --> 01:13:18.114
We don't really know why they work for these people though either now.

1241
01:13:18.254 --> 01:13:21.076
For the longest time we thought it just was, we need to just increase serotonin.

1242
01:13:21.356 --> 01:13:22.017
That's not the case.

1243
01:13:22.177 --> 01:13:22.377
Yeah.

1244
01:13:22.577 --> 01:13:23.257
We don't know what it is.

1245
01:13:23.557 --> 01:13:25.098
There's probably some downstream effect.

1246
01:13:25.959 --> 01:13:35.665
Serotonin can be kind of like a signaling molecule too for downstream, further downstream chemicals that might be influencing neural processes.

1247
01:13:35.685 --> 01:13:36.105
We don't know.

1248
01:13:38.747 --> 01:13:43.129
functional difference between people who have mental health disorders and people who don't.

1249
01:13:43.970 --> 01:13:47.712
And we don't know exactly how serotonin affects that or not, but it does for some people.

1250
01:13:47.932 --> 01:13:48.412
It does help.

1251
01:13:48.672 --> 01:13:49.073
We don't know.

1252
01:13:50.773 --> 01:13:51.754
That's what we're saying.

1253
01:13:51.834 --> 01:13:53.735
The more we uncover, the more we realize we don't know about serotonin.

1254
01:13:54.892 --> 01:13:55.212
for sure.

1255
01:13:55.692 --> 01:14:01.076
And so SSRIs were very, very promising when they first came out, especially the newer ones in the 80s.

1256
01:14:01.496 --> 01:14:02.297
Very, very promising.

1257
01:14:02.877 --> 01:14:05.699
Early studies had big effect sizes.

1258
01:14:06.219 --> 01:14:15.665
We've maybe talked about this a little bit before, but a lot of times when a new intervention comes out, they use it on kind of the worst cases, which usually there's kind of a floor effect going on there, right?

1259
01:14:15.685 --> 01:14:18.407
The only direction they can go is up.

1260
01:14:18.547 --> 01:14:20.369
Or if you're using it for people who are

1261
01:14:21.790 --> 01:14:24.654
the illest, you're going to just see a bigger jump.

1262
01:14:24.814 --> 01:14:25.655
Yeah.

1263
01:14:25.675 --> 01:14:27.237
You always start with the hardest cases.

1264
01:14:27.297 --> 01:14:30.962
And so you get the biggest effect sizes early, not to spoil anything.

1265
01:14:30.982 --> 01:14:35.127
We're going to talk about psychedelics soon, but there's a little bit of a similar thing going on.

1266
01:14:35.508 --> 01:14:39.593
As it spreads out to the general population, you start to see a moderation in those cases.

1267
01:14:39.913 --> 01:14:40.714
those effect sizes.

1268
01:14:40.894 --> 01:14:44.617
The effect sizes have actually, they've shrunk over the years because of that.

1269
01:14:44.637 --> 01:14:46.198
You're using it on educationism.

1270
01:14:46.358 --> 01:14:49.721
Maybe people who don't need them as much or don't respond to them as well.

1271
01:14:49.801 --> 01:14:52.103
And so the effect size decreases just based on that.

1272
01:14:52.263 --> 01:14:52.483
Yeah.

1273
01:14:52.663 --> 01:14:56.747
If we could identify like who would respond better to SSRIs versus not, that would be great.

1274
01:14:57.507 --> 01:14:58.248
They're working on that.

1275
01:14:58.308 --> 01:14:58.548
Yeah.

1276
01:14:58.848 --> 01:15:00.429
It's not a one size fits all.

1277
01:15:00.849 --> 01:15:04.131
The effect sizes, yes, they've gotten a little bit smaller, but and they've kind of topped out.

1278
01:15:04.792 --> 01:15:06.873
We can't seem to get them to go up or down from there.

1279
01:15:06.913 --> 01:15:09.834
So, you know, it has to be done on this.

1280
01:15:10.094 --> 01:15:11.495
So, yeah, they're not without their risks.

1281
01:15:11.615 --> 01:15:12.155
Right.

1282
01:15:12.396 --> 01:15:14.897
For instance, sexual dysfunction is a problem.

1283
01:15:15.257 --> 01:15:19.439
It's fairly common in the short term sometimes and kind of rare in the longer term, but it is still a thing.

1284
01:15:19.679 --> 01:15:26.143
And it's it's something that that worries people and is one of the leading causes for people to just stop using them as well.

1285
01:15:26.363 --> 01:15:27.904
It would just make you depressed all over again.

1286
01:15:28.164 --> 01:15:28.685
Exactly.

1287
01:15:28.965 --> 01:15:29.225
Right?

1288
01:15:29.545 --> 01:15:31.226
Right?

1289
01:15:31.406 --> 01:15:33.288
And then you have emotional blunting too.

1290
01:15:34.148 --> 01:15:35.449
That's pretty common as well.

1291
01:15:35.509 --> 01:15:36.190
Yeah.

1292
01:15:36.670 --> 01:15:42.053
So the people in my life who have taken antidepressants, that's been very apparent.

1293
01:15:42.414 --> 01:15:45.856
You get kind of like, it's almost like they become kind of zombie-like.

1294
01:15:45.956 --> 01:15:46.677
Everything's gray.

1295
01:15:46.797 --> 01:15:47.457
That's what people tell me.

1296
01:15:47.497 --> 01:15:48.598
It's like everything's just kind of gray.

1297
01:15:48.758 --> 01:15:49.698
Everything's just blah.

1298
01:15:49.719 --> 01:15:49.899
Yeah.

1299
01:15:50.039 --> 01:15:50.339
Yeah.

1300
01:15:50.519 --> 01:15:55.184
The people I know that take them and use them successfully say it's more like just a window opening for me.

1301
01:15:55.324 --> 01:16:04.753
It's like, you know, I was just so despondent or so anxious or whatever that anything to kind of just open me up or lift my mood a little bit for a little while for something else to get in.

1302
01:16:05.434 --> 01:16:07.636
That's where SSRIs shine if they can work for you.

1303
01:16:08.336 --> 01:16:12.340
I think this is probably an opportune point to take a little bit of a sidebar and just talk about like –

1304
01:16:13.401 --> 01:16:15.463
Where does anxiety come from for different people?

1305
01:16:15.623 --> 01:16:19.446
For the layman, like you probably just lump it all together.

1306
01:16:19.586 --> 01:16:25.851
Like some people are really anxious and some people are moderately anxious and some people are very little – have very little anxiety.

1307
01:16:26.291 --> 01:16:30.094
Anxiety is one of these areas of mental health, personal growth.

1308
01:16:30.114 --> 01:16:30.855
There's kind of like –

1309
01:16:32.073 --> 01:16:34.636
There's like a serious version and then there's kind of a mild version.

1310
01:16:34.656 --> 01:16:41.184
There's like a high-quality problem version and then there's like an actual serious kind of psychiatric version.

1311
01:16:41.444 --> 01:16:43.086
It's similar with depression as well, right?

1312
01:16:43.106 --> 01:16:48.152
Like it's – there are people who kind of chronically struggle with depression and it's probably –

1313
01:16:48.893 --> 01:16:52.597
biologically based, like there's some genetic predisposition.

1314
01:16:52.937 --> 01:16:54.999
It's something they're going to struggle with for their entire lives.

1315
01:16:55.680 --> 01:17:05.650
And I think for those people, the conversation around something like SSRIs is probably a little bit different, whereas like just mild depression, like –

1316
01:17:06.210 --> 01:17:11.555
You just went through a divorce or a parent died or you lost your job and you're feeling lost.

1317
01:17:11.575 --> 01:17:14.818
Like everybody feels depression at some point.

1318
01:17:15.798 --> 01:17:19.061
But it's generally transitory and it's generally for a good reason.

1319
01:17:19.462 --> 01:17:21.183
And I think it's similar for anxiety.

1320
01:17:21.483 --> 01:17:25.027
Like there are people who experience a lot of anxiety throughout their lives.

1321
01:17:25.587 --> 01:17:28.991
But that anxiety is always contextual.

1322
01:17:29.231 --> 01:17:31.293
It is based on kind of what they're going through at the moment.

1323
01:17:31.633 --> 01:17:35.978
Maybe they're predisposed to a little bit more anxiety in certain situations than other people.

1324
01:17:36.819 --> 01:17:39.462
But it is something that overall they're managing.

1325
01:17:39.882 --> 01:17:41.384
It comes and goes in waves.

1326
01:17:41.424 --> 01:17:46.509
Whereas there are other people that are just kind of like predisposed to lots of anxiety all the time.

1327
01:17:48.540 --> 01:18:03.088
And I kind of mentally just put these people in two different categories, especially like, you know, as somebody who's been writing to a large audience in the space for a long time now, anybody who seems to be in the latter category of like, oh, this is probably a diagnosable clinical thing.

1328
01:18:03.668 --> 01:18:06.910
I'm always very clear of like, you should probably go talk to a doctor.

1329
01:18:07.010 --> 01:18:13.774
Like this is not, you're not going to solve this listening to podcasts and doing yoga on weekends.

1330
01:18:13.894 --> 01:18:14.094
Right.

1331
01:18:14.194 --> 01:18:14.695
Whereas like.

1332
01:18:15.555 --> 01:18:31.394
If you're just a little bit of an anxious person who's going through a lot in life right now under a lot of pressure, got a lot of stress going on, and you're a little bit more prone to anxiety than other people, like there are plenty of practices that you can implement to manage that anxiety in your life.

1333
01:18:31.594 --> 01:18:38.379
I'll come back to the framework that I often come back to, which is the bad to okay people and the okay to great people, right?

1334
01:18:38.399 --> 01:18:55.153
There's like a – there's some people who are just like trapped by their anxiety and it is – seems to be baked into their neurological wiring to a certain extent and they just like – they really need a long-term solution just to feel normal.

1335
01:18:55.373 --> 01:18:57.274
Whereas there are other people who like –

1336
01:18:58.195 --> 01:19:03.296
Their lives are by and large normal, but they experience a lot of anxiety and they just want to be able to excel.

1337
01:19:03.616 --> 01:19:07.137
And they feel like their anxiety is like one of the things that's kind of holding them back.

1338
01:19:07.537 --> 01:19:16.299
The other factor here is that like generally the severe cases of anxiety, you're probably looking at more of some sort of genetic predisposition.

1339
01:19:16.359 --> 01:19:17.559
It's more of a permanent thing.

1340
01:19:17.979 --> 01:19:23.720
Whereas the milder forms of anxiety, those waves of anxiety that come and go throughout life,

1341
01:19:24.140 --> 01:19:32.964
You know, that's when you get into, you know, environment, social experiences, where you grew up, you know, maybe some trauma you had when you were young.

1342
01:19:33.605 --> 01:19:43.509
And those are generally things that you can work through, that you can like process and use some of these techniques and practices to like help you get through the tough periods.

1343
01:19:43.970 --> 01:19:46.291
Thanks for coming to my TED Talk on anxiety.

1344
01:19:46.891 --> 01:19:50.454
It's important to distinguish between like the clinical and subclinical for sure.

1345
01:19:51.115 --> 01:19:53.236
And then the lines have gotten so blurred.

1346
01:19:53.376 --> 01:19:53.637
Yes.

1347
01:19:53.677 --> 01:19:54.197
So too.

1348
01:19:54.998 --> 01:19:55.338
Yes.

1349
01:19:55.498 --> 01:19:57.359
And this comes back to the labeling thing, right?

1350
01:19:57.420 --> 01:20:04.065
Because it's like I think what happens these days is you have a lot of people who are, let's say they're probably highly neurotic, right?

1351
01:20:04.165 --> 01:20:05.546
Which is a personality trait.

1352
01:20:06.166 --> 01:20:07.548
And they're prone to anxiety.

1353
01:20:07.588 --> 01:20:09.849
Maybe they're prone to panic attacks.

1354
01:20:09.889 --> 01:20:11.971
So they experience anxiety sometimes.

1355
01:20:12.131 --> 01:20:14.412
At an above average rate.

1356
01:20:14.612 --> 01:20:20.095
But then what happens is because like we're – therapy culture is just fucking labeled everything.

1357
01:20:20.615 --> 01:20:27.318
They label themselves as an anxious person, somebody who struggles with anxiety, somebody who is like doomed to struggle with anxiety.

1358
01:20:28.038 --> 01:20:33.641
And so that identification with the issue then like calcifies it.

1359
01:20:34.061 --> 01:20:35.722
It like hardens it into –

1360
01:20:36.482 --> 01:20:45.891
into who they are, they start bringing anxiety to their experiences rather than, you know, waiting for anxiety to happen to them.

1361
01:20:46.231 --> 01:20:54.799
I think SSRIs are a perfect example of like, if you are in kind of the clinical territory, like they can be life-changing.

1362
01:20:55.619 --> 01:20:59.022
If you're in the subclinical territory, it's probably overkill.

1363
01:20:59.663 --> 01:21:01.044
And I think one of the issues is that it's

1364
01:21:02.165 --> 01:21:04.947
largely being over-prescribed to people in the subclinical territory.

1365
01:21:05.407 --> 01:21:07.989
Like there are downsides and side effects.

1366
01:21:08.049 --> 01:21:13.673
And I've known a lot of people who have gone on them and felt relief for a month or two.

1367
01:21:13.713 --> 01:21:15.894
And then a year later, they're like, I fucking hate this.

1368
01:21:15.914 --> 01:21:17.335
And they want to get off them.

1369
01:21:17.415 --> 01:21:23.479
And it's, I think most people, at least most people I've known, that's kind of the cycle they've gone through.

1370
01:21:23.860 --> 01:21:26.021
Number six, Mr. Bernie.

1371
01:21:26.441 --> 01:21:30.244
I believe this is the last of our some depends maybe category.

1372
01:21:30.264 --> 01:21:31.325
Yeah, I think so.

1373
01:21:31.905 --> 01:21:32.647
And it is a big one.

1374
01:21:33.709 --> 01:21:34.310
Psychedelics.

1375
01:21:34.711 --> 01:21:36.233
Psychedelic assisted therapy.

1376
01:21:36.875 --> 01:21:40.862
This had the single biggest effect size of everything we researched.

1377
01:21:41.083 --> 01:21:41.403
But –

1378
01:21:42.714 --> 01:21:47.739
The research is still scant and there's not enough trials that have been done yet.

1379
01:21:47.779 --> 01:21:52.264
But it is very promising and this is very trendy, very exciting in our space.

1380
01:21:52.484 --> 01:21:55.227
A lot of people are doing it, talking about it.

1381
01:21:55.727 --> 01:22:02.114
It is slowly becoming mainstream accepted and I do think there's a lot of potential here.

1382
01:22:02.154 --> 01:22:04.957
It is very exciting and interesting.

1383
01:22:05.157 --> 01:22:05.437
But –

1384
01:22:06.592 --> 01:22:09.374
We have to put that caveat of like it's still early days.

1385
01:22:10.294 --> 01:22:13.476
Generally, these earliest studies are done on the hardest cases.

1386
01:22:13.496 --> 01:22:17.639
So you get the biggest effect sizes as it spreads out to the general population.

1387
01:22:18.659 --> 01:22:22.101
That effect size moderates and you start to see a lot more complications.

1388
01:22:22.121 --> 01:22:24.343
You start to run into a lot of people it doesn't work for.

1389
01:22:24.423 --> 01:22:26.304
You start to run into negative side effects.

1390
01:22:26.804 --> 01:22:34.149
And, of course, you start running into practitioners who have no fucking clue what they're doing, you know, like my guru Steve out in Malibu.

1391
01:22:34.209 --> 01:22:34.369
Yeah.

1392
01:22:35.277 --> 01:22:36.678
You have a guru, Stephen Malibu?

1393
01:22:36.939 --> 01:22:37.759
Is he your guy?

1394
01:22:38.620 --> 01:22:40.382
Well, he was last week shaman.

1395
01:22:40.482 --> 01:22:43.885
This week I'm switching to... Business coach?

1396
01:22:47.733 --> 01:22:48.734
Yeah, that was last week.

1397
01:22:48.754 --> 01:22:51.155
This week I have a new shaman.

1398
01:22:51.416 --> 01:22:54.337
Her name is Zoe of Infinity.

1399
01:22:54.638 --> 01:22:59.841
And she's going to help me trip on a $10 million estate to find myself.

1400
01:23:01.542 --> 01:23:01.823
Okay.

1401
01:23:01.863 --> 01:23:03.404
This is the world I live in, Drew.

1402
01:23:03.444 --> 01:23:04.304
This is LA.

1403
01:23:04.424 --> 01:23:04.724
Okay.

1404
01:23:04.744 --> 01:23:06.346
Yeah, that sounds West LA to me.

1405
01:23:06.586 --> 01:23:10.809
I've been somewhat of a proponent, a cautious proponent of psychedelics for a while.

1406
01:23:11.409 --> 01:23:12.550
It is still pretty high on our list.

1407
01:23:12.690 --> 01:23:14.411
So we're giving it some cred here.

1408
01:23:14.851 --> 01:23:16.853
Very similar to the early days of –

1409
01:23:17.693 --> 01:23:24.215
of the antidepressants like SSRIs, we see these big effect sizes, but we don't know how that's going to play out in like a larger population.

1410
01:23:24.675 --> 01:23:26.456
There's been some very interesting studies early on.

1411
01:23:26.856 --> 01:23:28.316
One in particular from Johns Hopkins.

1412
01:23:28.776 --> 01:23:29.037
Okay.

1413
01:23:29.437 --> 01:23:32.918
This was done by Roland Griffiths, who was a serious neuroscientist.

1414
01:23:33.018 --> 01:23:33.298
Okay.

1415
01:23:33.378 --> 01:23:39.320
And working at Johns Hopkins university did this study on people with late stage terminal cancer.

1416
01:23:39.760 --> 01:23:40.920
They didn't have much time left.

1417
01:23:40.960 --> 01:23:41.180
Right.

1418
01:23:41.540 --> 01:23:43.301
And as you can imagine around, uh,

1419
01:23:44.221 --> 01:23:47.002
situation like that, you're going to have a lot of anxiety around your own mortality.

1420
01:23:47.682 --> 01:23:52.864
And so they tried some psychedelic-assisted therapy with them with psilocybin, active ingredient magic mushrooms.

1421
01:23:53.945 --> 01:23:56.866
And they did find that actually they had this huge effect size.

1422
01:23:56.886 --> 01:23:59.146
It was a small sample, but again, it was very, very consistent.

1423
01:23:59.467 --> 01:24:04.128
Almost everyone in the study said it was one of the most significant experiences of their lives.

1424
01:24:04.809 --> 01:24:06.969
It helped them with their depression.

1425
01:24:07.009 --> 01:24:08.170
It helped them with their anxiety.

1426
01:24:08.190 --> 01:24:08.530
Yeah.

1427
01:24:09.030 --> 01:24:10.011
This was awesome, right?

1428
01:24:10.511 --> 01:24:18.315
Sadly, and a bit ironically too, Roland Griffiths actually passed away in 2023 of cancer, which was kind of one of those cruel jokes that the universe played on us.

1429
01:24:18.415 --> 01:24:21.457
But as legacy lives on, people are still, they're hopeful.

1430
01:24:21.777 --> 01:24:23.578
And I think they have reason to be hopeful.

1431
01:24:24.278 --> 01:24:30.541
That said, one of the problems with psychedelics is that it's really hard to do a blind control study.

1432
01:24:31.222 --> 01:24:31.402
Right?

1433
01:24:31.682 --> 01:24:37.145
Because if you take a tab of acid or a big old handful of mushrooms, I can guarantee you one thing, something is going to happen.

1434
01:24:37.285 --> 01:24:37.505
Yes.

1435
01:24:37.566 --> 01:24:37.806
Right?

1436
01:24:38.026 --> 01:24:38.266
Yes.

1437
01:24:38.447 --> 01:24:40.529
You're going to know whether or not you're in the experimental group.

1438
01:24:40.549 --> 01:24:41.551
In the control group or not.

1439
01:24:41.591 --> 01:24:41.771
Yeah.

1440
01:24:41.811 --> 01:24:42.131
Yeah.

1441
01:24:42.231 --> 01:24:42.452
Yeah.

1442
01:24:43.253 --> 01:24:46.617
That's been the biggest hurdle to actually figuring out what's going on here.

1443
01:24:46.657 --> 01:24:50.322
Because there's going to be some people that say, well, who cares?

1444
01:24:50.362 --> 01:24:50.762
It works.

1445
01:24:50.842 --> 01:24:53.085
Well, yes, but why does it work?

1446
01:24:53.306 --> 01:24:53.466
Right.

1447
01:24:53.486 --> 01:24:54.687
We need to know that because we –

1448
01:24:55.348 --> 01:24:57.708
You can't just start handing it out like Skittles at fucking Halloween.

1449
01:24:57.728 --> 01:25:02.349
You can't be handing out incredibly powerful psychotropic drugs and not know what's going on.

1450
01:25:02.429 --> 01:25:02.629
Yes.

1451
01:25:02.709 --> 01:25:03.510
Right?

1452
01:25:03.650 --> 01:25:09.471
There's a safety issue, especially if we're going to be regulating this with a regulatory framework and everything like that.

1453
01:25:09.531 --> 01:25:11.811
In 2024, the FDA actually pulled MDMA.

1454
01:25:12.111 --> 01:25:19.093
They were doing trial studies on MDMA for PTSD and a few other disorders as well.

1455
01:25:19.433 --> 01:25:20.553
They ended up not approving it.

1456
01:25:21.173 --> 01:25:21.514
in 2024.

1457
01:25:21.554 --> 01:25:22.475
There was a lot of excitement.

1458
01:25:22.495 --> 01:25:24.517
A lot of people thought, no, this is a shoe and it's going to happen.

1459
01:25:24.858 --> 01:25:25.819
The FDA said no.

1460
01:25:26.199 --> 01:25:27.020
And it was because of this.

1461
01:25:27.040 --> 01:25:30.844
There was just, we can't induce proper controls and figure out what's going on.

1462
01:25:30.965 --> 01:25:33.287
The small number of studies that they have done look very promising.

1463
01:25:33.307 --> 01:25:34.168
They're very consistent.

1464
01:25:34.188 --> 01:25:39.454
They're very big effect sizes, low variation in the results too, which suggests that it's a real effect.

1465
01:25:40.195 --> 01:25:41.777
We just don't know what we're comparing to at this point.

1466
01:25:42.017 --> 01:25:45.139
What's interesting about this I think is the mechanism, right?

1467
01:25:45.179 --> 01:26:00.370
Like it's – everything else on this list is either some sort of lifestyle intervention or it's some sort of substance, some sort of chemical that you're introducing into your biology that's supposed to like kind of have a domino effect across things.

1468
01:26:00.890 --> 01:26:04.232
What's interesting about psychedelics is that it actually –

1469
01:26:05.233 --> 01:26:07.695
somehow like triggers neuroplasticity.

1470
01:26:07.775 --> 01:26:08.656
Right, yeah.

1471
01:26:08.676 --> 01:26:19.485
And for people who aren't familiar, neuroplasticity is, you know, when you're young, your brain is more easily able to rewire itself and develop new patterns of thought and identity and understanding.

1472
01:26:19.545 --> 01:26:25.209
And as you grow older, you know, neuroplasticity never ends, but it becomes harder the older you get.

1473
01:26:26.110 --> 01:26:32.893
And a lot of your beliefs and feelings and habits and behaviors just become more entrenched in your mind.

1474
01:26:32.933 --> 01:26:44.918
And so it's almost like psychedelics just come along and kind of kick all that up and like reset your ability to like lay new patchwork in terms of like who you are, what you believe, what you find important.

1475
01:26:45.458 --> 01:26:47.779
And so that's super interesting and exciting.

1476
01:26:48.239 --> 01:26:52.621
I'm going to go anecdotal here for a second because I did a lot of psychedelics when I was younger.

1477
01:26:52.901 --> 01:26:57.063
And I have spent a lot of time around people who have done a lot of psychedelics.

1478
01:26:57.123 --> 01:27:00.625
I would actually say that I probably know two or three people.

1479
01:27:01.065 --> 01:27:03.186
I would call it like a low-level addiction.

1480
01:27:03.786 --> 01:27:07.528
They're people who take these psychedelic substances like –

1481
01:27:08.454 --> 01:27:33.641
pretty regularly like on a weekly basis i would say to some extent whether it's microdosing macrodosing what i notice about these people and i and when i think back to my early 20 my late teens and early 20s when i took a bunch of psychedelics i think one of the things that psychedelics does is that it it really activates salience it like helps you imbue things with meaning it helps you see kind of the cosmic significance of stuff like this pen mark

1482
01:27:34.401 --> 01:27:39.684
So I was just going to say sometimes that is incredibly profound, right?

1483
01:27:39.704 --> 01:27:51.291
Because if you are kind of meditating on your family or your place in the universe or like some talent or gift that you have that you're able to contribute to the world, like it can be incredibly profound.

1484
01:27:51.311 --> 01:27:56.714
And it can have a lasting impact in terms of how you see yourself and how you see your place in the world and all that.

1485
01:27:57.034 --> 01:28:03.478
It also can cause you to find a lot of meaning and salience in stupid shit like a ballpoint pen.

1486
01:28:03.498 --> 01:28:03.678
Right.

1487
01:28:04.019 --> 01:28:17.167
If you've ever spent time around people who have taken a lot of psychedelics or been on a lot of trips or journeys as they call them these days, they will come out saying some kooky things with like some strange ideas around like what's very powerful and important.

1488
01:28:17.207 --> 01:28:20.770
And you're like, I'm not sure that passes the reality test.

1489
01:28:21.190 --> 01:28:35.261
You know, psychedelics have been around for millennia and in many cases they've – I think for most of the human history, they were used as like kind of religious ceremonies and rituals, which makes a lot of sense to me given what they do.

1490
01:28:35.701 --> 01:28:42.906
Even going back to like the 60s and 70s, they were seen – it's interesting because back then they were seen more as a mind expander.

1491
01:28:43.747 --> 01:28:55.709
And I do believe – I don't have this research in front of me, but I do believe that one of the things that they have noticed on it is that people who take a bunch of psychedelics, like their openness to new experiences increases afterwards.

1492
01:28:55.749 --> 01:28:56.289
Yeah, yeah.

1493
01:28:56.649 --> 01:29:05.511
So it's interesting that in the 1960s and 70s, it was kind of all about like opening yourself up to possibilities and opening yourself up to the world.

1494
01:29:06.511 --> 01:29:10.272
So I find it fascinating that today it's much more about like –

1495
01:29:11.606 --> 01:29:19.614
therapy and calming people and bringing them out of depression and bringing them out of PTSD and healing their trauma and everything.

1496
01:29:19.755 --> 01:29:24.419
There's almost like a cultural reading into what's going on.

1497
01:29:25.440 --> 01:29:33.949
And especially given the fact that I think there is – we are living quietly in a little bit of an epidemic of nihilism at the moment.

1498
01:29:33.969 --> 01:29:34.390
Yeah.

1499
01:29:34.670 --> 01:29:47.436
It makes sense to me that our particular brand and flavor of anxiety and depression that most of us struggle with in the 21st century is perfectly suited to be solved by psychedelics.

1500
01:29:47.636 --> 01:30:04.223
If your anxiety is actually rooted in a deep existential dread, like a pervading sense that your life is meaningless and nothing you do is meaningful, and that is actually what is undergirding your sense of anxiety and stress about life.

1501
01:30:05.316 --> 01:30:12.787
then it makes sense that a substance that comes in and like imbues a ballpoint pen with cosmic significance can be incredibly therapeutic.

1502
01:30:12.980 --> 01:30:13.200
Yeah.

1503
01:30:13.480 --> 01:30:21.385
What psychedelics will do, you're right, is it kicks whatever kind of rut you're in or, you know, kind of mind space that you're in.

1504
01:30:21.405 --> 01:30:22.466
It kind of kicks that open.

1505
01:30:22.746 --> 01:30:26.588
The studies where they have kind of tried to look at this more carefully, it's usually the post-processing.

1506
01:30:26.708 --> 01:30:28.690
It's not during the trip necessarily.

1507
01:30:28.930 --> 01:30:31.712
Like that's the experience that, again, opens you up.

1508
01:30:32.072 --> 01:30:32.292
Right.

1509
01:30:32.332 --> 01:30:32.812
I think so.

1510
01:30:33.132 --> 01:30:35.374
You know, anxiety, a lot of times we talk about it as like it's a.

1511
01:30:35.894 --> 01:30:37.875
You're ruminating about the future depression.

1512
01:30:37.915 --> 01:30:39.895
You're kind of like you're worried about the past, right?

1513
01:30:39.915 --> 01:30:40.996
You're processing the past.

1514
01:30:42.236 --> 01:30:48.058
I think psychedelics, what they can do is kind of kick you out of that whatever spiral you're in, right?

1515
01:30:48.518 --> 01:30:50.939
You're in a depression spiral or an anxiety spiral of some kind.

1516
01:30:51.019 --> 01:30:53.440
It opens you up at that point, like you're talking about.

1517
01:30:53.996 --> 01:30:58.440
But the processing afterwards is actually what's the most important part.

1518
01:30:58.460 --> 01:31:05.165
So when you are open up, because I've seen this too, seen people like they've, like people who are very much stuck in their ways and they go and do this.

1519
01:31:05.205 --> 01:31:09.869
And for a short period of time afterwards, they're like, it's kind of weird, right?

1520
01:31:11.150 --> 01:31:16.295
And I think what, where people mess up is they don't take advantage of that time period.

1521
01:31:16.455 --> 01:31:20.879
The one to two months following this experience where they're just like, I don't know what's real anymore.

1522
01:31:20.959 --> 01:31:22.360
Almost, you know, like, I don't know.

1523
01:31:23.406 --> 01:31:25.288
The way I've been seeing things obviously isn't right.

1524
01:31:25.468 --> 01:31:28.150
And now I'm open to thinking about things differently.

1525
01:31:28.630 --> 01:31:29.011
Yeah.

1526
01:31:29.131 --> 01:31:41.901
The post-processing makes a lot of sense to me because it's like you get that window right after the trip of actually like change is going to stick or it's far more likely to stick during that period.

1527
01:31:42.141 --> 01:31:47.066
You know, when I think about the people I know or have known who like kind of chronically do psychedelics.

1528
01:31:47.686 --> 01:31:50.028
they're just always living in that window, right?

1529
01:31:50.128 --> 01:32:01.557
And what I've noticed about those people is that they have a tendency to just kind of believe whatever, like the last, whatever the last person's, the last person they, the last thing they heard from somebody is probably what they believe.

1530
01:32:01.577 --> 01:32:03.818
And that's probably like their new philosophy on life.

1531
01:32:04.039 --> 01:32:11.644
And it's, it's, it reminds me of the Carl Sagan quote of like, have an open mind, but don't have a mind that's so open your brain falls out.

1532
01:32:11.985 --> 01:32:14.407
And I think you and I are in the same boat and that like,

1533
01:32:15.665 --> 01:32:17.867
I'm very excited about the possibilities.

1534
01:32:18.088 --> 01:32:21.311
I do think it under the right circumstances for the right person.

1535
01:32:21.331 --> 01:32:22.873
This can be utterly life changing.

1536
01:32:24.094 --> 01:32:27.458
Maybe I'm biased by living in California around all these fucking hippies.

1537
01:32:27.838 --> 01:32:33.545
But it's one of those things that is I think is both underrated and overrated simultaneously.

1538
01:32:33.565 --> 01:32:33.665
Yeah.

1539
01:32:34.072 --> 01:32:41.155
Yeah, and I mean, just a word of caution too, if you are going to do this, especially if you're an anxious person, I would do it in a structured environment.

1540
01:32:41.215 --> 01:32:45.618
Find a professional, for the love of God, find a professional who knows what they're doing.

1541
01:32:45.798 --> 01:32:49.780
The nice thing is, is there are a lot of doctors and psychiatrists that are like...

1542
01:32:50.220 --> 01:32:51.040
They're on board with it now.

1543
01:32:51.220 --> 01:32:57.163
Yeah, and they're getting trained in it and there's processes being developed and standards and all sorts of stuff.

1544
01:32:57.223 --> 01:33:00.265
It's still pretty illegal in most places though.

1545
01:33:00.305 --> 01:33:02.005
Yeah, we just won't mention that.

1546
01:33:08.740 --> 01:33:13.122
Moving into the top five, this is where we get into legitimate territory.

1547
01:33:13.182 --> 01:33:17.124
This is everything from here on out is going to help with your anxiety.

1548
01:33:17.564 --> 01:33:20.805
Probably, if not 10 times out of 10, very close.

1549
01:33:21.366 --> 01:33:22.786
It's probably going to help everybody.

1550
01:33:23.226 --> 01:33:26.968
It's probably always going to work to some extent, whether a little bit or a lot.

1551
01:33:27.288 --> 01:33:28.949
It's really just a question of.

1552
01:33:30.384 --> 01:33:36.532
Your particular issues, how much you need, how much you do it, and what you prefer.

1553
01:33:36.933 --> 01:33:43.141
What we're also going to notice in this top five is that these things are going to get incredibly boring very quickly.

1554
01:33:43.361 --> 01:33:43.582
Right.

1555
01:33:43.682 --> 01:33:46.085
Which is another interesting thing I think we should talk about.

1556
01:33:46.446 --> 01:33:47.527
But number five.

1557
01:33:48.514 --> 01:33:51.996
Social connection, socializing in general, I think.

1558
01:33:52.596 --> 01:34:07.364
We talked about in our emotions episode last year, two or three ideas that we have uncovered on Solve that I think about on like a weekly basis is how socializing is our like human's ability to regulate each other's nervous systems.

1559
01:34:07.704 --> 01:34:14.848
And when I saw things in that way, it just unlocked like so many connections and realizations and understandings.

1560
01:34:15.868 --> 01:34:29.117
What's ironic about social connection and socializing is that often people who have anxiety, especially people who have social anxiety, it's – you get in this doom loop of like you're anxious.

1561
01:34:29.357 --> 01:34:31.058
So you're afraid to be around other people.

1562
01:34:31.078 --> 01:34:33.360
You're afraid to be vulnerable around other people.

1563
01:34:33.420 --> 01:34:34.861
You carry a lot of shame.

1564
01:34:35.381 --> 01:34:36.742
So you disconnect from others.

1565
01:34:36.762 --> 01:34:37.563
You isolate.

1566
01:34:37.643 --> 01:34:38.263
You numb.

1567
01:34:38.723 --> 01:34:40.505
You avoid contact and intimacy.

1568
01:34:40.525 --> 01:34:40.625
Yeah.

1569
01:34:41.285 --> 01:34:47.667
which then causes you to feel even more anxious, feel more shame, to disconnect, isolate even further, and so on and so forth.

1570
01:34:47.707 --> 01:34:54.488
So there's like, there's a little bit of a upward spiral, downward spiral that comes with social connection and intimacy.

1571
01:34:55.048 --> 01:35:07.932
Knowing everything I know about how good socializing, I mean, you and I have done so many episodes on loneliness and social isolation and the importance of socializing, and we did a whole five-hour episode on friendships.

1572
01:35:08.532 --> 01:35:08.772
It's...

1573
01:35:09.652 --> 01:35:11.713
Doesn't surprise me to see this this high.

1574
01:35:12.413 --> 01:35:24.016
It makes sense to me that this is kind of bottom of the top five, just given that the problem of anxiety itself is likely to make this a little bit more difficult for people to pursue.

1575
01:35:24.376 --> 01:35:32.419
I think one of the more interesting findings I found about this anyway was that loneliness is really a predictor of anxiety.

1576
01:35:33.400 --> 01:35:38.946
how anxious someone is, but having social support isn't necessarily a predictor of not having anxiety.

1577
01:35:38.986 --> 01:35:41.008
So it's like, it's a protective layer.

1578
01:35:41.088 --> 01:35:41.408
Yes.

1579
01:35:41.468 --> 01:35:41.709
Yeah.

1580
01:35:41.849 --> 01:35:42.129
Right.

1581
01:35:42.269 --> 01:35:42.469
Right.

1582
01:35:42.750 --> 01:35:43.871
More than it is a healer.

1583
01:35:44.011 --> 01:35:44.271
Right.

1584
01:35:44.391 --> 01:35:45.212
Yeah, exactly.

1585
01:35:45.352 --> 01:35:45.873
Interesting.

1586
01:35:45.973 --> 01:35:47.234
Which I found kind of interesting too.

1587
01:35:47.454 --> 01:35:50.457
Makes a whole lot of sense though, too, you know, just as social, social animals.

1588
01:35:50.998 --> 01:35:51.178
Yeah.

1589
01:35:51.238 --> 01:35:54.802
You know, obviously the quality of your social network matters a lot, but.

1590
01:35:55.343 --> 01:35:58.565
The baseline is just don't be alone.

1591
01:35:58.925 --> 01:36:00.787
Don't be by yourself all the time at least.

1592
01:36:01.207 --> 01:36:01.767
Yeah.

1593
01:36:02.147 --> 01:36:13.014
One of the other interesting things that came up in the research that I saw is that often for people, just the belief that they have that support is actually more important than having the support itself.

1594
01:36:13.275 --> 01:36:13.435
Right?

1595
01:36:13.455 --> 01:36:19.459
So it's just like trusting that there are people around you who have your back, who are going to take care of you if something goes wrong.

1596
01:36:19.479 --> 01:36:20.039
Yeah.

1597
01:36:20.440 --> 01:36:25.826
moderates the anxiety far more than like actually having people who are showing up and taking care of things and doing things for you.

1598
01:36:25.927 --> 01:36:27.929
That seems to just check out on a personal level for me.

1599
01:36:28.089 --> 01:36:29.551
I have a good strong friend network.

1600
01:36:29.731 --> 01:36:32.615
I feel like a good social network, but I don't feel like I lean on them a lot.

1601
01:36:32.715 --> 01:36:35.579
But just having them there for me, I think that does go a long way.

1602
01:36:35.839 --> 01:36:37.381
I just, I hate asking for help.

1603
01:36:37.601 --> 01:36:38.302
Are you like that?

1604
01:36:38.342 --> 01:36:38.582
Yes.

1605
01:36:38.922 --> 01:36:39.242
Oh yeah.

1606
01:36:39.262 --> 01:36:39.543
I hate it.

1607
01:36:39.563 --> 01:36:39.843
I hate it.

1608
01:36:39.863 --> 01:36:40.684
I'm terrible about that.

1609
01:36:41.044 --> 01:36:41.365
I do.

1610
01:36:41.485 --> 01:36:48.271
I, I, I'm very bad about it, but there's still just like, okay, I know it's there.

1611
01:36:48.391 --> 01:36:48.612
Yeah.

1612
01:36:48.932 --> 01:36:50.133
If I needed it, it would be there.

1613
01:36:50.614 --> 01:36:50.854
All right.

1614
01:36:50.874 --> 01:36:54.017
So number four, we're going to call you out here.

1615
01:36:54.257 --> 01:36:54.457
Yeah.

1616
01:36:54.477 --> 01:36:55.218
We're going to shame you.

1617
01:36:55.318 --> 01:36:55.658
Yeah.

1618
01:36:56.279 --> 01:36:57.440
Sleep optimization.

1619
01:36:59.342 --> 01:36:59.782
Who knew?

1620
01:36:59.903 --> 01:37:00.183
Sleep.

1621
01:37:01.588 --> 01:37:02.890
Makes you less anxious.

1622
01:37:02.910 --> 01:37:03.671
Right, right.

1623
01:37:04.312 --> 01:37:12.824
I can already see all the people like reaching to turn the podcast off because they're like, oh, we're going to get like sleep, nutrition, exercise again.

1624
01:37:13.044 --> 01:37:14.346
Sure, sure.

1625
01:37:14.366 --> 01:37:15.988
No, there's a couple surprises, people.

1626
01:37:16.028 --> 01:37:16.289
There's –

1627
01:37:17.678 --> 01:37:19.739
Sleep, but yeah, sleep is huge.

1628
01:37:20.559 --> 01:37:22.520
Socializing is huge and exercise is huge.

1629
01:37:22.540 --> 01:37:26.422
But the top two are probably not what you would expect.

1630
01:37:26.562 --> 01:37:28.702
Yeah, but I mean sleep is bidirectional.

1631
01:37:29.843 --> 01:37:32.104
If you lack sleep, then you're going to be more anxious.

1632
01:37:32.144 --> 01:37:34.145
If you get more sleep, you're going to be less anxious.

1633
01:37:34.625 --> 01:37:36.085
And there's pretty robust effects around this.

1634
01:37:36.125 --> 01:37:37.246
I've shown this over and over again.

1635
01:37:38.146 --> 01:37:39.988
For any mental health disorder, just about.

1636
01:37:40.128 --> 01:37:40.448
Yes.

1637
01:37:40.649 --> 01:37:44.171
I mean depression, anxiety, like pick your poison.

1638
01:37:44.331 --> 01:37:54.219
Again, there's another doom loop here, which is that the more anxious you are, the harder time you are to fall asleep because you're going to be laying in bed, staring at the ceiling, worrying about the awkward thing you said six years ago.

1639
01:37:54.300 --> 01:37:54.460
Yeah.

1640
01:37:54.960 --> 01:38:05.293
And then the fact that you're not sleeping is going to make you more anxious, which is then going to make you more likely to sit in bed and ruminate and stare at the ceiling and worry about the awkward thing you said four years ago and on and on and on it goes.

1641
01:38:05.653 --> 01:38:11.961
The other interesting thing that we found with the research is that your brain is basically doing therapy on itself every night while you sleep.

1642
01:38:12.341 --> 01:38:15.102
And if you're not sleeping, then you're not letting it.

1643
01:38:15.202 --> 01:38:18.322
You're actively worsening your mental health.

1644
01:38:18.542 --> 01:38:19.203
So it's interesting.

1645
01:38:19.263 --> 01:38:24.024
During REM sleep, the brain replays emotional memories with the amygdala turned down.

1646
01:38:24.324 --> 01:38:25.944
That's your fear processing center.

1647
01:38:25.984 --> 01:38:34.366
Like have you ever noticed that a lot of your dreams are kind of like residual of some of the things you've been thinking about or experiencing lately?

1648
01:38:35.066 --> 01:38:38.067
It's almost like there's a certain emotional processing center.

1649
01:38:38.467 --> 01:38:40.548
that your brain is going through while you're asleep.

1650
01:38:41.189 --> 01:38:50.014
And if you're not getting that deep sleep, that deep restful sleep, then you're robbing yourself of that emotional processing that happens when you're unconscious.

1651
01:38:50.314 --> 01:38:55.637
Part of me wonders too because there's a lot of studies and data showing like that we're more underslept than we've ever been before.

1652
01:38:55.857 --> 01:38:58.198
Like just the average person's sleep is –

1653
01:39:00.139 --> 01:39:00.659
very bad.

1654
01:39:00.999 --> 01:39:06.101
It makes me wonder, like, how much of the mental health crisis has been contributed by just people not sleeping enough?

1655
01:39:06.161 --> 01:39:11.302
I mean, I would say with, like, the teen mental health crisis especially, I would say this is a huge contributing factor.

1656
01:39:11.362 --> 01:39:11.622
Yeah.

1657
01:39:12.063 --> 01:39:12.183
Yeah.

1658
01:39:12.203 --> 01:39:15.504
They're just, like, kids laying awake, scrolling their phones all night.

1659
01:39:15.644 --> 01:39:15.864
Yeah.

1660
01:39:16.004 --> 01:39:16.924
Yeah.

1661
01:39:17.104 --> 01:39:19.465
That's got to be contributing a huge proportion.

1662
01:39:19.485 --> 01:39:19.685
Yeah.

1663
01:39:19.705 --> 01:39:19.925
Yeah.

1664
01:39:20.085 --> 01:39:21.265
And it creates a doom loop, right?

1665
01:39:21.305 --> 01:39:26.987
Because it's like if you're not – if you're laying in bed awake, doom scrolling, freaking out, you're not getting that sleep.

1666
01:39:27.007 --> 01:39:29.828
So you're not getting that processing happening while you're unconscious.

1667
01:39:29.868 --> 01:39:41.132
So then you wake up with all of this residual anxiety and unprocessed emotional baggage that you carry into the next day, which then makes you even more miserable and more freaked out and more stressed.

1668
01:39:41.213 --> 01:39:45.034
And so then you lay in bed even longer doom scrolling and you get into this just –

1669
01:39:45.434 --> 01:39:50.137
this ugly cycle that is really only broken if you can confront the anxiety itself.

1670
01:39:50.537 --> 01:39:57.141
I mean, would you say this is probably like socializing in that it's not necessarily an intervention?

1671
01:39:57.321 --> 01:40:00.042
It's more like a protective layer, right?

1672
01:40:00.062 --> 01:40:05.445
Like it's like the same way having friends doesn't necessarily remove anxiety.

1673
01:40:05.605 --> 01:40:07.387
It like protects you in the first place.

1674
01:40:07.867 --> 01:40:09.948
It sounds like sleep is kind of the same thing.

1675
01:40:10.148 --> 01:40:12.889
I think it's a protective effect where it gets you to a baseline.

1676
01:40:12.929 --> 01:40:13.330
I don't know.

1677
01:40:13.410 --> 01:40:15.731
Is it going to improve your anxiety?

1678
01:40:16.211 --> 01:40:17.311
If you're sleep deprived, yes.

1679
01:40:17.532 --> 01:40:17.712
Yeah.

1680
01:40:18.032 --> 01:40:19.232
Beyond that, I'm not so sure.

1681
01:40:19.552 --> 01:40:19.913
But yeah.

1682
01:40:20.193 --> 01:40:20.413
Yeah.

1683
01:40:20.453 --> 01:40:29.317
Well, what's interesting is that some of the research has shown that the emotional reset that comes with sleep is lessened at higher anxiety levels.

1684
01:40:29.517 --> 01:40:34.343
So people who experience extreme anxiety levels, sleep is less of a factor for them.

1685
01:40:34.423 --> 01:40:40.870
But it's coming back to those kind of mild subclinical anxiety issues.

1686
01:40:40.890 --> 01:40:48.879
Like if you're in a really anxious and stressed period of your life and you're not sleeping well, like that's probably one of the simplest levers you can pull.

1687
01:40:49.159 --> 01:40:52.944
Again, what's mind-blowing is like this is free.

1688
01:40:53.024 --> 01:40:55.306
You're already doing it every fucking day.

1689
01:40:56.007 --> 01:40:57.409
It doesn't cost any money yet.

1690
01:40:57.649 --> 01:41:04.817
Like how many things on this list have people spent hundreds, thousands of dollars like putting chemicals into their bodies, supplements?

1691
01:41:04.937 --> 01:41:06.359
Like, yeah, just go to bed earlier.

1692
01:41:06.539 --> 01:41:06.799
Yeah.

1693
01:41:07.000 --> 01:41:07.280
Yeah.

1694
01:41:09.502 --> 01:41:09.922
Try that.

1695
01:41:10.243 --> 01:41:11.103
Try that for a week.

1696
01:41:11.123 --> 01:41:11.603
Consistent.

1697
01:41:11.643 --> 01:41:13.244
But yeah, consistent times.

1698
01:41:13.304 --> 01:41:13.504
Yeah.

1699
01:41:13.524 --> 01:41:14.045
Consistent.

1700
01:41:14.105 --> 01:41:16.486
Oh, that's what I've realized lately.

1701
01:41:16.506 --> 01:41:18.147
Anyways, consistent bedtimes help a lot.

1702
01:41:18.427 --> 01:41:18.787
Yeah.

1703
01:41:18.847 --> 01:41:19.808
Consistent wake times.

1704
01:41:20.368 --> 01:41:21.669
Listening to your chronotype, too.

1705
01:41:21.949 --> 01:41:23.369
We talked about this a little bit before, too.

1706
01:41:23.390 --> 01:41:26.091
If you're a morning person versus a night owl.

1707
01:41:26.211 --> 01:41:28.152
If you're a night owl, don't try to be a morning person necessarily.

1708
01:41:28.432 --> 01:41:28.872
It's OK.

1709
01:41:28.892 --> 01:41:29.633
Unless you have to be.

1710
01:41:29.653 --> 01:41:29.953
I get it.

1711
01:41:30.613 --> 01:41:40.648
The other thing that I think makes this more foundational than it is maybe additive is just that like if you're not sleeping, nothing else on this list is going to work or matter.

1712
01:41:40.788 --> 01:41:41.028
Okay.

1713
01:41:41.049 --> 01:41:41.309
Yeah.

1714
01:41:41.509 --> 01:41:42.971
That I think is a big one.

1715
01:41:42.991 --> 01:41:43.112
Yeah.

1716
01:41:43.312 --> 01:41:43.532
Right.

1717
01:41:43.552 --> 01:41:43.692
Yeah.

1718
01:41:43.712 --> 01:41:43.813
Yeah.

1719
01:41:44.501 --> 01:41:46.402
Yeah, you can optimize whatever.

1720
01:41:46.422 --> 01:41:47.743
You can have all the supplements.

1721
01:41:47.783 --> 01:41:50.665
You can meditate till you're fucking blue in the face.

1722
01:41:50.705 --> 01:41:53.587
But if you're not sleeping at night, doesn't matter.

1723
01:41:53.647 --> 01:41:53.807
Right.

1724
01:41:53.827 --> 01:41:54.287
Yeah.

1725
01:41:54.567 --> 01:41:55.228
Does not matter.

1726
01:41:55.248 --> 01:41:56.388
You can drop a bunch of acid.

1727
01:41:57.749 --> 01:41:58.950
Doesn't matter.

1728
01:41:58.970 --> 01:42:03.372
I mean, good psychedelics do interfere with sleep quality.

1729
01:42:03.453 --> 01:42:04.713
I can tell you from experience.

1730
01:42:05.254 --> 01:42:06.955
Moving on to everybody's favorite.

1731
01:42:07.868 --> 01:42:08.568
Everybody's favorite.

1732
01:42:08.808 --> 01:42:10.249
Number three, exercise.

1733
01:42:11.229 --> 01:42:13.691
Go to the gym, bro.

1734
01:42:13.751 --> 01:42:14.411
Hit the gym.

1735
01:42:15.071 --> 01:42:16.132
Do you even lift?

1736
01:42:16.152 --> 01:42:20.553
I've heard it in several different forms and places and whatever, but tame the body, tame the mind.

1737
01:42:21.654 --> 01:42:24.395
We talked about this in the resilience episode as well, too, right?

1738
01:42:24.515 --> 01:42:34.399
Developing the discipline to work out or at least be active in some way, that has this almost calming effect on your nervous system because it shows you have some control, right?

1739
01:42:34.479 --> 01:42:36.100
And what is anxiety if it's not...

1740
01:42:36.480 --> 01:42:39.002
a lack of control or a sense of a lack of control.

1741
01:42:39.543 --> 01:42:43.526
And so I think more than anything, yes, there is the physical benefit of it.

1742
01:42:43.586 --> 01:42:45.988
Like you're getting endorphin release and like all of that kind of stuff.

1743
01:42:46.549 --> 01:42:52.574
But where I think the actual benefit of exercise comes in is that you are exercising that kind of control over your mind.

1744
01:42:52.734 --> 01:42:52.934
Yes.

1745
01:42:53.415 --> 01:42:55.737
And you're showing yourself that, Oh, I have some agency here.

1746
01:42:56.803 --> 01:43:00.566
Even when I don't want to do things or even when things are uncomfortable, especially when things are uncomfortable.

1747
01:43:00.786 --> 01:43:00.986
Yeah.

1748
01:43:01.226 --> 01:43:03.768
Like I am exercising some form of agency here.

1749
01:43:04.449 --> 01:43:06.130
And so tame the body, tame the mind.

1750
01:43:06.230 --> 01:43:06.450
Yeah.

1751
01:43:06.670 --> 01:43:07.811
That's how I see it.

1752
01:43:08.066 --> 01:43:12.508
I think that's a beautiful explanation of like the cognitive side of this.

1753
01:43:12.528 --> 01:43:25.435
I – in the process of doing research, I came across a paper that described exercise in a way that I had never heard before, which blows my mind because I feel like exercise is – people have talked about it frontwards and backwards.

1754
01:43:25.475 --> 01:43:29.397
But basically it was like every hard workout is practice for being afraid.

1755
01:43:31.389 --> 01:43:34.551
Like if you think about it, it's like what happens when you're afraid, right?

1756
01:43:34.691 --> 01:43:40.995
Elevated heart rate, shallow breathing, you start getting sweaty, adrenaline courses through your body.

1757
01:43:41.575 --> 01:43:50.521
Like exercise, lifting really heavy weights is training your body and your nervous system to be afraid and be okay being afraid.

1758
01:43:50.581 --> 01:43:54.564
Like you are physiologically putting your body in the same state that it is.

1759
01:43:55.204 --> 01:44:02.487
When you're experiencing fear, exercise is a controlled environment where you are training yourself to be okay, to act despite it.

1760
01:44:03.087 --> 01:44:06.628
And then the cognitive piece comes in of like I'm choosing to do this.

1761
01:44:07.028 --> 01:44:08.869
I'm feeling the strain.

1762
01:44:08.909 --> 01:44:11.310
I'm feeling the adrenaline.

1763
01:44:11.550 --> 01:44:15.171
I'm like my heart rate is through the roof, but I'm not going to stop.

1764
01:44:15.191 --> 01:44:16.592
I'm going to get that last rep.

1765
01:44:17.270 --> 01:44:41.647
And it's every time you're pushing through that difficulty and that strain, every time you are feeling kind of that panic, that like that fast heartbeat and the fast breathing and, you know, your fingers are tingling and you're like one more rep, one more rep. Like you're kind of training your mind to act despite the physiological signals.

1766
01:44:41.767 --> 01:44:42.027
Yeah.

1767
01:44:42.267 --> 01:44:44.109
And so I just thought that was so fucking cool.

1768
01:44:44.169 --> 01:44:44.369
Yeah.

1769
01:44:44.609 --> 01:44:44.889
Yeah.

1770
01:44:44.929 --> 01:44:45.970
I never thought of it that way.

1771
01:44:46.190 --> 01:44:53.496
You're using the agency that you have to like purposefully induce an anxious state in yourself and realizing that it's okay.

1772
01:44:53.756 --> 01:44:54.016
Yeah.

1773
01:44:54.556 --> 01:45:00.681
As you would expect, there is just like an absolute dump truck worth of research on this.

1774
01:45:01.181 --> 01:45:08.447
The largest meta-analysis we found had over 1,000 high-quality randomized control trials, over 128,000 participants, and just consistent –

1775
01:45:11.489 --> 01:45:19.778
moderate effect sizes across the board, across diverse populations, any country, backgrounds, age, gender, whatever.

1776
01:45:20.398 --> 01:45:27.185
What's interesting is that exercise affects anxiety on a number of neurobiological pathways, right?

1777
01:45:27.205 --> 01:45:30.989
So it increases BDNF, which I don't know what the fuck that is.

1778
01:45:31.829 --> 01:45:34.552
You wrote here fertilizer for neurons, so I'm going to believe you.

1779
01:45:34.572 --> 01:45:35.193
Right.

1780
01:45:35.633 --> 01:45:40.695
But it spikes serotonin, norepinephrine, dopamine, decreases neuroinflammation.

1781
01:45:41.095 --> 01:45:49.658
If I was to put on my Andrew Huberman glasses here and tell you the most effective exercise protocol for anxiety, you can literally do anything.

1782
01:45:50.058 --> 01:45:57.221
It's aerobic resistance intervals, like basically anything that is moderate to high intensity.

1783
01:45:57.421 --> 01:45:57.621
Like –

1784
01:45:58.441 --> 01:46:04.687
Anything that anything other than low intensity exercise, 20 to 45 minutes per session, three to four sessions per week.

1785
01:46:04.887 --> 01:46:09.290
Basically, what they find is that the consistency is what matters more than what you actually do.

1786
01:46:09.751 --> 01:46:15.856
So as long as you are showing up exercising on a consistent basis, doesn't even have to be like 20 minutes is not that much.

1787
01:46:15.876 --> 01:46:16.697
Yeah.

1788
01:46:16.717 --> 01:46:17.758
See, and that's what I think.

1789
01:46:17.838 --> 01:46:21.921
That's why I think it's more of a like it's a practice.

1790
01:46:22.242 --> 01:46:22.462
Mm hmm.

1791
01:46:23.323 --> 01:46:28.049
It's more of a tame the body, tame the mind type of practice is because the consistency is what matters, not necessarily what you do.

1792
01:46:28.329 --> 01:46:34.336
So to me, that's, oh, okay, I'm going in and I have, again, I have some agency.

1793
01:46:34.516 --> 01:46:34.737
Yes.

1794
01:46:34.937 --> 01:46:37.500
And I'm able to create some sort of discipline around this.

1795
01:46:37.520 --> 01:46:40.003
And that gives me a little bit of calm and peace of mind at least.

1796
01:46:40.123 --> 01:46:40.303
Yeah.

1797
01:46:40.503 --> 01:46:44.286
I had this social media post a couple of years ago that went super viral.

1798
01:46:45.047 --> 01:46:57.096
And it was basically like, imagine if there was a pill that improved your mood, helps you regulate your emotions, improves your sleep, helps you lose weight, helps you have better sex.

1799
01:46:57.977 --> 01:47:02.040
decreases anxiety and depression and improves your longevity.

1800
01:47:02.540 --> 01:47:04.282
Oh, and it's free and it's available 24-7.

1801
01:47:04.322 --> 01:47:07.664
Yeah, that pill is called fucking exercise.

1802
01:47:07.704 --> 01:47:08.104
Right, yeah.

1803
01:47:08.304 --> 01:47:11.547
It is like when you think of it in those terms, it is just kind of absurd.

1804
01:47:11.567 --> 01:47:14.909
And it's also even more absurd that so many of us don't do it regularly.

1805
01:47:14.969 --> 01:47:20.353
Like I injured my foot a few months ago and so I'm like I lost a lot of my exercise.

1806
01:47:20.373 --> 01:47:26.898
Like I didn't exercise much for two or three months and like now I'm trying – the foot's healed so I'm trying to get back into the gym.

1807
01:47:26.918 --> 01:47:27.018
Yeah.

1808
01:47:27.504 --> 01:47:28.404
It's a slog, isn't it?

1809
01:47:28.505 --> 01:47:29.485
It sucks, man.

1810
01:47:29.905 --> 01:47:31.366
It sucks.

1811
01:47:31.406 --> 01:47:33.087
If I take a week or two off, I start feeling it.

1812
01:47:33.127 --> 01:47:33.767
Yeah.

1813
01:47:33.887 --> 01:47:39.510
I'm like – That's the other side of this though too is like once you start doing it, if you stop, it's like taking a Benzo, man.

1814
01:47:39.710 --> 01:47:41.170
You got to keep going, you know.

1815
01:47:41.791 --> 01:47:42.011
Yeah.

1816
01:47:42.051 --> 01:47:44.752
I mean there's inertia in both directions, right?

1817
01:47:44.872 --> 01:47:48.554
So it's the longer you haven't done it, the harder it is to start.

1818
01:47:48.754 --> 01:47:53.316
But the more you've done it, you know, the easier it is to keep going.

1819
01:47:53.836 --> 01:47:54.316
All right.

1820
01:47:54.636 --> 01:47:55.337
Number two.

1821
01:47:56.780 --> 01:47:57.561
I'm not going to lie.

1822
01:47:57.621 --> 01:47:59.162
This showed up higher than I expected.

1823
01:47:59.282 --> 01:47:59.603
Okay.

1824
01:48:00.103 --> 01:48:02.265
Meditation.

1825
01:48:02.405 --> 01:48:03.146
Little surprised.

1826
01:48:03.326 --> 01:48:07.290
I mean, I expected that it would have worked.

1827
01:48:08.131 --> 01:48:11.494
I would not have expected that it would have been this high on the list.

1828
01:48:11.514 --> 01:48:11.614
Okay.

1829
01:48:11.634 --> 01:48:12.034
Why is that?

1830
01:48:12.555 --> 01:48:15.597
Maybe it's just because I'm not somebody who like struggles a ton with anxiety.

1831
01:48:15.617 --> 01:48:16.478
But like, I don't know.

1832
01:48:16.498 --> 01:48:18.060
It just – I've never found it –

1833
01:48:19.640 --> 01:48:31.402
From like a purely kind of mental health, you know, mental stability point of view, I have not found meditation to be the most useful intervention.

1834
01:48:32.222 --> 01:48:35.943
It's useful and I did it for a long time and I definitely recommend it.

1835
01:48:36.063 --> 01:48:38.323
But it's like I would have put exercise above it.

1836
01:48:38.443 --> 01:48:48.425
Like I definitely feel like my mental health, my mood, my anxiety, my happiness, like everything is my relationships like are noticeably better when I'm exercising consistently.

1837
01:48:49.872 --> 01:48:57.848
I mean meditation too but like it's not as like clear as – like if I don't work out for a week, like I feel it.

1838
01:48:58.128 --> 01:48:58.269
Yeah.

1839
01:48:58.289 --> 01:48:58.389
Yeah.

1840
01:48:58.610 --> 01:49:04.656
Whereas like meditation, you know, if I didn't meditate for a day, like I never really noticed.

1841
01:49:04.716 --> 01:49:05.177
Well, okay.

1842
01:49:05.197 --> 01:49:08.400
I think that might be the difference though is that meditation is a little bit of a slower burn.

1843
01:49:08.720 --> 01:49:16.648
Specifically too is that like stress-induced anxiety I think is pretty well taken care of with meditation.

1844
01:49:16.668 --> 01:49:18.871
You know, we had an episode on meditation.

1845
01:49:18.911 --> 01:49:19.111
Right.

1846
01:49:19.231 --> 01:49:21.133
We talked about some of the common pitfalls and –

1847
01:49:21.433 --> 01:49:41.175
some of the hype around meditation that it wasn't correct uh you know that it was overhyped essentially but one thing we did say was that stress-induced anxiety responded pretty well to um to meditation specifically like mindfulness-based stress reduction yes which is like an eight-week program i believe john kabat zim was very instrumental in in developing it yeah

1848
01:49:41.395 --> 01:49:43.316
There's a whole, it's very structured.

1849
01:49:44.056 --> 01:49:45.376
Like I said, eight week program.

1850
01:49:45.836 --> 01:49:47.677
There's physical aspects to it too.

1851
01:49:47.697 --> 01:49:49.297
So there is some exercise involved with it.

1852
01:49:49.657 --> 01:49:51.118
So I think you're right.

1853
01:49:51.138 --> 01:49:55.299
I think in the moment, maybe like I would go for a workout or even just a walk.

1854
01:49:56.599 --> 01:49:59.640
That's going to help your anxiety more short term and long term, of course, too.

1855
01:50:00.591 --> 01:50:09.813
Longer term, though, I think the cognitive benefits of meditation are going to come into play in a way that exercise might not.

1856
01:50:10.653 --> 01:50:11.734
That said, I think you're right.

1857
01:50:11.754 --> 01:50:13.314
I mean, they're number two and number three.

1858
01:50:13.334 --> 01:50:14.294
They're like – Yeah.

1859
01:50:14.634 --> 01:50:25.457
A lot of this research was done on the full MBSR protocol, right, which is like eight weeks long, multiple hours a week, in some cases full-day meditation retreats.

1860
01:50:31.038 --> 01:50:32.779
pretty intense meditation practices.

1861
01:50:32.799 --> 01:50:38.462
Like it's not like people pulling out the waking up app for 10 minutes and like once a week.

1862
01:50:38.662 --> 01:50:40.743
When they measure that, they don't see a whole lot.

1863
01:50:40.983 --> 01:50:44.605
It's more from serious meditation over an extended period of time.

1864
01:50:45.305 --> 01:50:46.666
That's my understanding of it at least.

1865
01:50:47.066 --> 01:50:54.970
Whereas I think exercise is more of the thing where it's like you can start working out and like probably within a week you're going to feel better.

1866
01:50:55.710 --> 01:50:55.910
Yeah.

1867
01:50:56.215 --> 01:50:56.475
Yeah.

1868
01:50:56.616 --> 01:50:56.796
Okay.

1869
01:50:56.916 --> 01:50:57.196
Yes.

1870
01:50:57.817 --> 01:50:58.658
I would agree with that too.

1871
01:50:58.758 --> 01:51:00.781
So it's like, it's more of a dosage thing, I think.

1872
01:51:00.901 --> 01:51:01.161
Okay.

1873
01:51:01.362 --> 01:51:01.542
Right.

1874
01:51:01.562 --> 01:51:07.469
Where it's like, it seems like meditation is super effective, but also the dosage is pretty high.

1875
01:51:07.569 --> 01:51:10.293
Like you can't just sit for five minutes.

1876
01:51:12.081 --> 01:51:12.361
Yeah.

1877
01:51:12.381 --> 01:51:13.062
Do you agree with that?

1878
01:51:13.202 --> 01:51:13.722
I don't know.

1879
01:51:14.423 --> 01:51:14.783
Oh, yes.

1880
01:51:14.843 --> 01:51:15.464
I agree.

1881
01:51:15.504 --> 01:51:21.488
Like a five or ten minute meditation, even once a day, yeah, that's probably not going to do a whole lot for your anxiety.

1882
01:51:21.508 --> 01:51:21.588
Yes.

1883
01:51:21.628 --> 01:51:23.970
That said, I'll go back to – It doesn't mean you shouldn't do it.

1884
01:51:24.110 --> 01:51:24.671
Again, yes.

1885
01:51:24.951 --> 01:51:26.572
Again, we're talking about anxiety, but yeah.

1886
01:51:26.652 --> 01:51:27.012
Yeah, yeah.

1887
01:51:27.333 --> 01:51:30.815
Like I said in the meditation episode, I don't think that's why you shouldn't necessarily meditate either.

1888
01:51:30.915 --> 01:51:32.757
I think it will help you with your anxiety.

1889
01:51:33.137 --> 01:51:37.821
It changes your relationship to your thoughts, whether those thoughts are anxious or –

1890
01:51:38.561 --> 01:51:38.801
Yes.

1891
01:51:39.221 --> 01:51:39.962
Whatever they are.

1892
01:51:40.722 --> 01:51:42.163
And so you can see them more clearly.

1893
01:51:42.203 --> 01:51:47.925
And I think it gives you a sense of what you can do with those feelings and those thoughts.

1894
01:51:47.985 --> 01:51:48.225
Yes.

1895
01:51:48.805 --> 01:51:48.966
Yeah.

1896
01:51:49.046 --> 01:51:51.387
Meditation does not reduce anxious thoughts.

1897
01:51:51.427 --> 01:51:54.848
It doesn't actually – meditation doesn't change any of your thoughts.

1898
01:51:55.468 --> 01:51:57.249
It changes your relationship to your thoughts.

1899
01:51:57.789 --> 01:52:05.713
And so people will often come to meditation expecting meditation to kind of turn the volume knob down on their life and on their anxieties.

1900
01:52:06.273 --> 01:52:13.876
When really what it does is it just, it helps you better sit with the noise and understand the noise.

1901
01:52:14.436 --> 01:52:15.016
I agree with you.

1902
01:52:15.077 --> 01:52:18.578
There is like a lot of misconceptions around what meditation does.

1903
01:52:19.198 --> 01:52:24.560
And I'm sure there is a certain calming effect, you know, of just sitting quietly for a certain period of time.

1904
01:52:24.600 --> 01:52:31.563
But I do think the long-term benefit of meditation really is in that like cognitive reappraisal of like.

1905
01:52:33.331 --> 01:52:34.112
what does this mean?

1906
01:52:34.272 --> 01:52:36.093
Why do, why do these thoughts keep coming up?

1907
01:52:36.434 --> 01:52:37.395
Why do I resist them?

1908
01:52:37.635 --> 01:52:38.335
Why do I fight them?

1909
01:52:38.355 --> 01:52:39.336
What am I so afraid of?

1910
01:52:39.416 --> 01:52:47.704
Like all of these kind of deep questions that you have to sit with for a certain period of time to like resolve them.

1911
01:52:47.864 --> 01:52:48.084
Yeah.

1912
01:52:48.344 --> 01:52:51.427
You see the forest through the trees a little bit better with meditation.

1913
01:52:51.527 --> 01:52:51.907
And I, I,

1914
01:52:52.988 --> 01:52:59.155
Yes, all the ancillary benefits you get with it, decreased anxiety or better stress coping, whatever it is.

1915
01:52:59.475 --> 01:53:02.999
Again, I think that's all secondary to just knowing your mind better.

1916
01:53:03.459 --> 01:53:05.061
And yet that takes some of the edge off right there.

1917
01:53:05.501 --> 01:53:07.844
Just knowing your patterns and knowing why you do what you do.

1918
01:53:08.144 --> 01:53:13.025
I wonder how much of it too is actually kind of a bleed over of that digital detox.

1919
01:53:13.326 --> 01:53:18.607
You know, going for a walk and getting rid of a screen like definitely makes you feel better in that moment.

1920
01:53:19.427 --> 01:53:21.368
And then as soon as you come back, everything kind of comes back.

1921
01:53:21.548 --> 01:53:27.510
Because I know a lot of people who do meditate for like five minutes every two or three days and they like it.

1922
01:53:27.810 --> 01:53:30.771
So it makes me wonder if like that's actually what they're experiencing, right?

1923
01:53:30.831 --> 01:53:31.291
It's just like –

1924
01:53:32.351 --> 01:53:40.639
Sitting in a quiet room without their phone, it allows them to get away from all of the noise and chaos that's going on around them.

1925
01:53:40.759 --> 01:53:42.061
Yeah.

1926
01:53:42.141 --> 01:53:44.984
That's one of the benefits I get out of it for sure.

1927
01:53:45.204 --> 01:53:49.768
That said, if you do meditate, definitely recommend the Waking Up app.

1928
01:53:50.669 --> 01:53:55.793
Because it's more serious courses, longer, in-depth, more philosophical.

1929
01:53:56.113 --> 01:54:01.097
I think that's where you get more benefit, you know, rather than the quick hits that you get from a lot of other apps.

1930
01:54:01.137 --> 01:54:04.239
The introductory course I'm waking up to is – it's fantastic.

1931
01:54:05.080 --> 01:54:07.922
Like just going through that alone is worth it.

1932
01:54:08.022 --> 01:54:10.824
And then we've got to deal with waking up right now where you can get 30 dates for free.

1933
01:54:10.844 --> 01:54:13.526
So you can take the whole introductory course for free if you want to.

1934
01:54:13.586 --> 01:54:16.028
So it's no risk whatsoever.

1935
01:54:16.308 --> 01:54:19.450
What I love about that course too is that it is exactly what you talked about.

1936
01:54:19.490 --> 01:54:22.572
It's like it's all about your relationship with your own thoughts.

1937
01:54:22.772 --> 01:54:27.454
Because other apps, it's like they try to just get you to – It's for the fitness crowd.

1938
01:54:27.675 --> 01:54:30.296
Yeah, they're like, oh, relax, breathe.

1939
01:54:30.356 --> 01:54:31.817
It's like waking up is like –

1940
01:54:33.087 --> 01:54:33.888
Let's talk about your mind.

1941
01:54:33.928 --> 01:54:35.949
Who, who's observing the thoughts right now?

1942
01:54:36.069 --> 01:54:36.750
Right.

1943
01:54:36.790 --> 01:54:37.330
Who are you?

1944
01:54:37.451 --> 01:54:37.971
Who are you?

1945
01:54:38.091 --> 01:54:41.794
And then you sit with that for, for 10 minutes and it's like, it's pretty cool.

1946
01:54:41.894 --> 01:54:42.234
I love it.

1947
01:54:42.795 --> 01:54:43.235
All right.

1948
01:54:43.636 --> 01:54:46.878
Last but not least drum roll, please.

1949
01:54:47.339 --> 01:54:51.262
This is not going to, this is, this is not going to surprise anybody.

1950
01:54:52.943 --> 01:54:54.224
Therapy comes out on top.

1951
01:54:54.785 --> 01:54:55.485
Sorry.

1952
01:54:58.655 --> 01:55:08.719
What is interesting about this though is different modalities of therapy all perform well but in slightly different contexts.

1953
01:55:08.739 --> 01:55:13.542
So like the heavy weight, especially around anxiety, is CBT, cognitive behavioral therapy.

1954
01:55:13.922 --> 01:55:21.605
And I do think it is pretty well established at this point that like CBT is probably the best intervention for anxiety issues.

1955
01:55:22.065 --> 01:55:28.108
But I did find it interesting that ACT is also effective for certain individuals and certain flavors of anxiety.

1956
01:55:28.348 --> 01:55:28.968
I love ACT.

1957
01:55:28.989 --> 01:55:30.049
Yeah, ACT is pretty cool.

1958
01:55:30.069 --> 01:55:31.951
Yeah, I like ACT a lot.

1959
01:55:32.271 --> 01:55:39.115
And then, of course, exposure therapy, which is taking bite-sized chunks of your fear and exposing yourself to them.

1960
01:55:39.656 --> 01:55:43.098
We've had a lot of kind of sidebars on therapy over the years on this show.

1961
01:55:44.039 --> 01:55:50.263
You know, it's another one of those things that I think is both overrated and underrated depending on the context and depending on the person.

1962
01:55:50.623 --> 01:55:55.246
It definitely seems that for anxiety, it is not overrated.

1963
01:55:55.667 --> 01:55:57.168
It is very legit.

1964
01:55:57.808 --> 01:56:03.790
Very consistent, helps a lot of people, very replicable findings across the board.

1965
01:56:04.750 --> 01:56:13.752
And yet, I found this pretty surprising too, fewer than 20% of people with an anxiety disorder get therapy for it, which I thought was pretty crazy.

1966
01:56:13.772 --> 01:56:14.613
That's so interesting.

1967
01:56:14.653 --> 01:56:15.333
That's pretty wild.

1968
01:56:15.693 --> 01:56:15.933
Why?

1969
01:56:16.413 --> 01:56:17.033
Well, I don't know.

1970
01:56:17.073 --> 01:56:17.253
Yeah.

1971
01:56:17.293 --> 01:56:19.454
And I don't know how accurate that number is necessarily either.

1972
01:56:19.534 --> 01:56:23.775
But yeah, there's some numbers out there to suggest that it's very much undertreated.

1973
01:56:24.187 --> 01:56:35.875
One of the things that I found when we were doing market research for purpose, I did a lot of research into kind of the therapy market, the mental health market, counselors, coaches, life coaches, all that stuff.

1974
01:56:36.135 --> 01:56:40.358
It is shocking how undersupplied the market is.

1975
01:56:41.259 --> 01:56:42.259
I didn't realize that.

1976
01:56:42.500 --> 01:56:44.981
It is that like for every therapist or coach, there's like –

1977
01:56:46.162 --> 01:56:49.103
eight to 10 people who want access to a therapist or coach.

1978
01:56:49.163 --> 01:56:54.744
And I think the biggest hurdles for a lot of people is financial or they just live in a remote area.

1979
01:56:54.764 --> 01:56:56.204
They don't have access to anybody.

1980
01:56:56.844 --> 01:57:02.865
CBT, therapy in general too, there's kind of what they call a durability advantage.

1981
01:57:03.245 --> 01:57:03.626
Okay.

1982
01:57:04.106 --> 01:57:13.988
Which is, especially for CBT though, the skills you learn during your CBT sessions, during your training, I guess, or your therapy,

1983
01:57:16.426 --> 01:57:21.071
how to manage your anxiety or any other uncomfortable emotions that you might have out in real life.

1984
01:57:21.631 --> 01:57:34.003
And so the advantage of that is you get better at it over time, even after you stop therapy, because it gives you these tools and you go out and you practice them in the real world and you get better at it if you have a good therapist anyway.

1985
01:57:34.023 --> 01:57:37.567
So all these randomized control trials that they did a meta-analysis on,

1986
01:57:38.427 --> 01:57:51.313
Found that 12 months post-treatment with GAD, with Generalized Anxiety Disorder, a huge percentage of people were still at near post-treatment levels anyway of anxiety.

1987
01:57:51.333 --> 01:57:53.734
So they basically had fixed it a year later still.

1988
01:57:54.154 --> 01:57:59.697
So pretty durable advantage, which in the mental health world, anything that lasts over a year, that's pretty good.

1989
01:57:59.738 --> 01:58:00.238
It's rare, yeah.

1990
01:58:00.258 --> 01:58:00.518
Yeah.

1991
01:58:00.878 --> 01:58:03.680
Other studies have found very similar results as well.

1992
01:58:03.760 --> 01:58:13.826
So, you know, like older adults even too, you can find kind of full diagnostic remission even over even more so than with medication.

1993
01:58:13.846 --> 01:58:19.490
So if you start taking medication and stop it, there's a good chance later on you're going to have to restart taking those medications.

1994
01:58:19.750 --> 01:58:23.092
With CBT and ACT and some other modalities as well.

1995
01:58:23.492 --> 01:58:27.513
they find that's not – the failure rates aren't nearly as high as that too.

1996
01:58:27.553 --> 01:58:29.953
So it's a much more durable advantage to it.

1997
01:58:29.973 --> 01:58:30.393
Interesting.

1998
01:58:30.413 --> 01:58:30.613
Yeah.

1999
01:58:31.033 --> 01:58:35.374
I think the thing that most people miss about therapy is that the point is to eventually stop.

2000
01:58:36.354 --> 01:58:37.875
Like I – Right?

2001
01:58:39.395 --> 01:58:44.916
Therapy is one of those weird industries where you can judge the usefulness by how many people quit.

2002
01:58:44.936 --> 01:58:45.116
Yeah.

2003
01:58:45.376 --> 01:58:46.956
Right, right.

2004
01:58:46.976 --> 01:58:50.297
I always get very wary when I meet people who are like, oh, I love my therapist.

2005
01:58:50.317 --> 01:58:51.757
I've been going to them for 12 years.

2006
01:58:51.777 --> 01:58:52.117
I'm like –

2007
01:58:52.957 --> 01:58:54.959
wow, probably not a good therapist.

2008
01:58:57.120 --> 01:59:04.104
But what's interesting is that you see this in the research as well, is that like when people enter therapy, they get a boost to their outcomes.

2009
01:59:04.585 --> 01:59:10.668
But what's more surprising is that leaving therapy, many people often get another boost to their outcomes as well.

2010
01:59:10.888 --> 01:59:14.691
And I think this is one of those things I've written about this a long time ago.

2011
01:59:14.711 --> 01:59:19.714
I wrote about this in some articles that you start in this place where something's wrong in your life.

2012
01:59:19.754 --> 01:59:20.995
You don't really know what it is.

2013
01:59:21.715 --> 01:59:29.297
And so the first big improvement comes from just getting an understanding of what the problem is and how to approach it.

2014
01:59:30.477 --> 01:59:34.939
But then the fixing of the problem becomes a bigger problem than the problem, right?

2015
01:59:35.019 --> 01:59:40.060
And so the next big level up comes from stopping fixing the problem.

2016
01:59:40.460 --> 01:59:44.381
And I think that second lever is where a lot of people get lost.

2017
01:59:45.441 --> 01:59:47.382
They start to feel I think maybe –

2018
01:59:48.242 --> 01:59:53.964
dependent or addicted to whatever therapy or intervention that they're doing.

2019
01:59:53.984 --> 01:59:55.505
You see this in the self-help world a lot.

2020
01:59:55.525 --> 01:59:57.145
People just keep going to seminars forever.

2021
01:59:57.205 --> 02:00:04.768
And it's like, well, actually, the fact that you keep going to seminars to fix yourself is the bigger problem than the things you're trying to fix.

2022
02:00:04.968 --> 02:00:08.149
If you just stopped going to seminars, you'd probably be pretty happy.

2023
02:00:08.469 --> 02:00:12.571
It's a very common problem in not just the self-help industry, but just the mental health

2024
02:00:13.371 --> 02:00:21.237
And I think the best therapists and coaches are the ones that recognize it and they understand when to cut a patient off and when to say, you know what?

2025
02:00:21.297 --> 02:00:22.158
You're doing pretty well.

2026
02:00:22.925 --> 02:00:24.645
I don't think you should be worrying about this so much.

2027
02:00:25.185 --> 02:00:27.006
Why don't you just go live your life and see?

2028
02:00:27.026 --> 02:00:32.107
I used to run into this all the time or I get emails from people and they're like, I've read all the books.

2029
02:00:32.147 --> 02:00:36.768
I'm like taking all the courses and it's just making me more anxious and I'm more worried.

2030
02:00:36.808 --> 02:00:41.389
And I'm like judging myself because there's all these things I know I should do and I'm not doing them and on and on and on.

2031
02:00:42.049 --> 02:00:44.429
And I would just, I'd just reply to him.

2032
02:00:44.469 --> 02:00:46.710
I'm like, so stop reading the books.

2033
02:00:47.750 --> 02:00:49.271
The problem is not more information.

2034
02:00:49.572 --> 02:00:52.594
I'm like nobody's putting a gun to your head and making you read more books.

2035
02:00:52.614 --> 02:00:54.216
Like just fucking stop reading the books.

2036
02:00:54.596 --> 02:00:55.277
Go live your life.

2037
02:00:55.797 --> 02:01:07.067
I think a lot of people assume that you have to have some sort of like action plan to like implement all this stuff that you're not going to actually change unless you have like a spreadsheet mapped out.

2038
02:01:07.127 --> 02:01:07.627
And it's like no.

2039
02:01:07.647 --> 02:01:11.131
Like a lot of this stuff just kind of seeps into the background.

2040
02:01:11.771 --> 02:01:12.772
of your decision-making.

2041
02:01:13.292 --> 02:01:22.099
And, you know, if you don't have like consistent opportunities to make different decisions, then you're never going to be able to implement those different decisions.

2042
02:01:22.159 --> 02:01:27.583
So ultimately self-improvement requires you to go back and live in the world.

2043
02:01:27.883 --> 02:01:31.205
A couple of caveats we should mention here as well too.

2044
02:01:31.285 --> 02:01:33.327
You've already mentioned a few things like, you know, it's expensive.

2045
02:01:33.387 --> 02:01:34.548
It's hard to access sometimes.

2046
02:01:34.868 --> 02:01:35.288
Very true.

2047
02:01:35.729 --> 02:01:37.390
Dropout rates are actually very high too.

2048
02:01:38.087 --> 02:01:38.267
Right.

2049
02:01:38.287 --> 02:01:38.948
Yep.

2050
02:01:39.248 --> 02:01:45.714
People, a lot of people start therapy and then they have the opposite problem where you were just describing instead of saying too long, they don't stay long enough.

2051
02:01:46.014 --> 02:01:46.214
Yes.

2052
02:01:46.234 --> 02:01:56.543
So I think you do, I don't think there's a set number or a set time that you need to be in therapy necessarily, but you know, I would say give it six months minimum and try to stick with it.

2053
02:01:56.563 --> 02:02:00.947
Cause they really don't, it's hard to fix somebody's life in just a few sessions.

2054
02:02:01.087 --> 02:02:01.267
Right.

2055
02:02:01.387 --> 02:02:02.649
That's just, that's not going to happen.

2056
02:02:02.869 --> 02:02:03.629
The other issue is,

2057
02:02:04.906 --> 02:02:05.887
Some therapists suck.

2058
02:02:05.927 --> 02:02:07.589
Yeah, yeah.

2059
02:02:07.789 --> 02:02:08.509
Quality varies a lot.

2060
02:02:08.630 --> 02:02:08.910
Yes.

2061
02:02:08.930 --> 02:02:13.995
In any profession like this, yes, quality is going to vary a lot.

2062
02:02:14.015 --> 02:02:14.695
You've got to shop around.

2063
02:02:14.715 --> 02:02:19.580
And there is some evidence that the best therapists actually drive most of the results.

2064
02:02:19.840 --> 02:02:22.683
This is one reason why I'm bullish on AI in this area.

2065
02:02:22.843 --> 02:02:26.806
And I don't think AI can completely replace therapists and coaches permanently, but like

2066
02:02:28.106 --> 02:02:29.247
I've been around long enough.

2067
02:02:29.407 --> 02:02:34.089
I know how many mediocre therapists and mental health professionals there are out there.

2068
02:02:34.810 --> 02:02:39.072
I've heard from so many fucking people of like, I was in therapy for years.

2069
02:02:39.172 --> 02:02:40.432
Like my therapist was awful.

2070
02:02:40.472 --> 02:02:41.213
I had no idea.

2071
02:02:41.253 --> 02:02:43.874
And then I switched and oh my God, my new therapist is so much better.

2072
02:02:43.914 --> 02:02:46.195
And now I'm having like all sorts of breakthroughs and stuff.

2073
02:02:46.616 --> 02:02:48.016
There's also like chemistry issues.

2074
02:02:48.436 --> 02:02:52.018
So I just think it's such a hard thing to scale.

2075
02:02:52.078 --> 02:02:54.900
And it's such a hard thing to like quality control.

2076
02:02:55.540 --> 02:03:01.101
Then I'm convinced that at some point AI is just going to take over most of it and go download purpose.app.

2077
02:03:01.381 --> 02:03:01.641
Yeah.

2078
02:03:04.142 --> 02:03:05.922
I mean, we definitely have hit a ceiling.

2079
02:03:06.202 --> 02:03:06.622
Yeah.

2080
02:03:06.782 --> 02:03:08.642
And that's another, you said spinning your wheels.

2081
02:03:08.662 --> 02:03:13.823
I think we, effect sizes have not improved for therapy in 30 or 40 years.

2082
02:03:13.843 --> 02:03:14.003
Yeah.

2083
02:03:14.043 --> 02:03:18.424
It's about somewhere in the 30 to 40% range of people just don't respond very well to therapy.

2084
02:03:18.504 --> 02:03:21.725
Again, that could be because they're dropping out too early or just not, you know, they're not putting in whatever.

2085
02:03:21.785 --> 02:03:22.765
But we need to figure that out.

2086
02:03:22.825 --> 02:03:23.885
And we haven't figured that out.

2087
02:03:24.728 --> 02:03:25.569
In 30 or 40 years.

2088
02:03:25.789 --> 02:03:26.329
Yeah.

2089
02:03:26.349 --> 02:03:26.930
Yeah.

2090
02:03:27.110 --> 02:03:32.333
It is the fact that there have been no improvements on this front since you and I were born.

2091
02:03:32.393 --> 02:03:32.613
Right.

2092
02:03:32.954 --> 02:03:33.974
CBT in the 80s, yeah.

2093
02:03:33.994 --> 02:03:35.255
A little bit of a red flag.

2094
02:03:35.435 --> 02:03:41.560
The other thing that doesn't get broadcast a whole lot is that actually a small percentage of people actually respond negatively to therapy.

2095
02:03:41.780 --> 02:03:41.940
Right.

2096
02:03:41.960 --> 02:03:44.281
So it's like some people, you can go to therapy and be worse.

2097
02:03:44.542 --> 02:03:44.642
Yeah.

2098
02:03:44.722 --> 02:03:47.423
And it is, that's not broadcast a whole lot.

2099
02:03:47.463 --> 02:03:48.944
I think it's not broadcast because –

2100
02:03:49.905 --> 02:03:51.306
Overall, not enough people are going.

2101
02:03:51.706 --> 02:03:53.508
I also think you can overdo therapy.

2102
02:03:53.528 --> 02:04:00.733
Like I think it's especially in some of the wealthier parts of like say the US.

2103
02:04:01.113 --> 02:04:05.356
I think people are over-therapized, especially young people, especially kids.

2104
02:04:05.436 --> 02:04:12.962
It's like a lot of kids by the time they graduate from high school, like they've already been through 10 years of therapy and like three different therapists.

2105
02:04:12.982 --> 02:04:17.105
And it's like maybe you should just let a kid –

2106
02:04:17.603 --> 02:04:18.163
be upset.

2107
02:04:18.523 --> 02:04:19.264
Yeah.

2108
02:04:19.544 --> 02:04:20.424
Being a kid's hard.

2109
02:04:20.524 --> 02:04:20.684
Yeah.

2110
02:04:20.704 --> 02:04:21.845
It's fucking hard.

2111
02:04:21.985 --> 02:04:22.945
It's fucking hard.

2112
02:04:23.185 --> 02:04:31.749
But that's another podcast.

2113
02:04:31.869 --> 02:04:34.030
Any final thoughts you want to wrap up with?

2114
02:04:34.330 --> 02:04:35.650
Any observations in general?

2115
02:04:36.310 --> 02:04:41.893
Well, we've been hinting at this the whole time, but I think if you are going to address your

2116
02:04:43.427 --> 02:04:48.510
the quick fix is not the one you should reach to first for sure.

2117
02:04:49.151 --> 02:04:56.095
Panic attacks and stuff like that aside, obviously you want to get through those, but you know, reaching for a drink is obviously it makes it worse.

2118
02:04:56.115 --> 02:04:56.996
That's the one we started with.

2119
02:04:57.076 --> 02:04:58.697
It's the absolute worst one for a reason.

2120
02:04:59.097 --> 02:05:01.019
And there's varying degrees we go through this.

2121
02:05:01.039 --> 02:05:06.962
You know, if just going for a walk or some exercise, yeah, it kind of helps with this, but maybe not that the quick fix is not where it's at though.

2122
02:05:07.143 --> 02:05:07.263
It's,

2123
02:05:08.424 --> 02:05:11.047
a long-term, probably lifelong thing for most people.

2124
02:05:11.468 --> 02:05:13.551
I still struggle with anxiety at times.

2125
02:05:13.711 --> 02:05:14.332
I just, I do.

2126
02:05:15.113 --> 02:05:19.819
And it depends on my sleep and it depends on my exercise and all of these things that we've talked about today, sure.

2127
02:05:20.400 --> 02:05:25.827
But I will say, if you want like a durable, lasting change to it, reaching for those quick fixes is,

2128
02:05:26.909 --> 02:05:28.911
It can't be the answer.

2129
02:05:29.131 --> 02:05:30.893
It is interesting in this episode.

2130
02:05:31.313 --> 02:05:33.075
The list is really clear.

2131
02:05:33.475 --> 02:05:38.339
Everything in the top – everything that is in the legitimate category is a lifestyle change.

2132
02:05:38.840 --> 02:05:42.383
Everything outside of the legitimate category is a quick fix.

2133
02:05:42.783 --> 02:05:45.585
Yeah, a supplement or – Yeah, or like – Do this one thing one time.

2134
02:05:45.665 --> 02:05:45.885
Yes.

2135
02:05:45.985 --> 02:05:46.465
Not going to work.

2136
02:05:46.625 --> 02:05:46.785
Yeah.

2137
02:05:47.045 --> 02:05:53.109
I think my takeaway is that everything that actually works for anxiety is just uncomfortable.

2138
02:05:53.249 --> 02:05:55.050
It's anxiety-inducing almost.

2139
02:05:55.170 --> 02:05:55.370
Right.

2140
02:05:55.390 --> 02:05:58.712
Like that's the thing nobody wants to hear or accept, that there's –

2141
02:06:00.293 --> 02:06:02.175
There's not a comfortable way out of this.

2142
02:06:02.716 --> 02:06:11.366
And I think in a way you could say that chronic anxiety is kind of an unwillingness to tolerate discomfort or a certain threshold of discomfort.

2143
02:06:12.227 --> 02:06:15.631
And I think ultimately that's what exposure therapy is.

2144
02:06:15.732 --> 02:06:16.372
I think that's –

2145
02:06:17.273 --> 02:06:18.535
You talked about it with yoga.

2146
02:06:18.615 --> 02:06:19.936
We talked about it with exercise.

2147
02:06:20.256 --> 02:06:31.608
Everything that works to some extent is an exposure to discomfort and an acclimation to a certain amount of discomfort, like raising your threshold of the amount of discomfort that you're willing to sit with.

2148
02:06:31.988 --> 02:06:33.470
People don't like to hear that.

2149
02:06:33.710 --> 02:06:35.332
People don't want to accept that.

2150
02:06:35.472 --> 02:06:38.315
They don't want to deal with the consequences of that.

2151
02:06:38.753 --> 02:06:40.354
It's why they leave therapy a lot of times too.

2152
02:06:40.414 --> 02:06:40.954
Yeah.

2153
02:06:41.154 --> 02:06:42.194
It's too uncomfortable.

2154
02:06:42.394 --> 02:06:48.136
I also think part of it is probably why some of the pharmaceuticals are overprescribed.

2155
02:06:48.316 --> 02:06:50.097
I imagine there are a lot of people that just ask for it.

2156
02:06:50.417 --> 02:06:51.277
Just give me the pill, doc.

2157
02:06:51.477 --> 02:06:51.677
Yeah.

2158
02:06:51.757 --> 02:06:52.917
I don't want to talk about my problems.

2159
02:06:53.598 --> 02:06:54.558
Like I'm stressed.

2160
02:06:54.678 --> 02:06:57.479
Like, you know, give me some Luxapro or like whatever.

2161
02:06:57.639 --> 02:06:59.279
And the doctors are like, sure, here you go.

2162
02:06:59.299 --> 02:06:59.479
Yeah.

2163
02:06:59.760 --> 02:06:59.940
Yeah.

2164
02:07:00.080 --> 02:07:01.980
And, you know, doctor's caseloads are high too.

2165
02:07:02.020 --> 02:07:03.821
You don't want to like pin too much on them or whatever.

2166
02:07:03.841 --> 02:07:04.821
We're not shitting on doctors.

2167
02:07:04.921 --> 02:07:05.321
Yeah.

2168
02:07:05.621 --> 02:07:07.702
What's your biggest surprise and what's your biggest takeaway?

2169
02:07:08.440 --> 02:07:14.443
Um, my biggest surprise, I mean, yeah, therapy.

2170
02:07:16.444 --> 02:07:18.265
It was one of those things, I guess, though.

2171
02:07:18.526 --> 02:07:29.051
Um, I, I was surprised that ACT and CBT, like what you mentioned that they were, they're, they're basically opposite approaches and get you to the same place, which is pretty wild.

2172
02:07:29.091 --> 02:07:29.711
It is interesting.

2173
02:07:29.851 --> 02:07:32.413
The lesson from that is old school, like kind of like exposure.

2174
02:07:32.433 --> 02:07:32.533
Yeah.

2175
02:07:33.133 --> 02:07:39.897
To whatever you're anxious about and just seeing again, it goes back like with the exercise, you have some agency over exercise that agency.

2176
02:07:39.997 --> 02:07:41.098
No, you can't control all of it.

2177
02:07:41.538 --> 02:07:46.901
That's also part of it, too, is just accepting that you can't control part of it, which is where ACT really shines, I think.

2178
02:07:47.021 --> 02:07:54.845
But like the more you can build evidence, right, that you have some sort of agency around whatever you're worried about.

2179
02:07:55.570 --> 02:07:56.410
It might not be ideal.

2180
02:07:56.470 --> 02:07:57.771
It might not be a perfect solution.

2181
02:07:58.671 --> 02:08:02.573
But I think it's not so much that we're always worried about what's going to happen.

2182
02:08:02.613 --> 02:08:06.534
It's that we're worried that we don't know what's going to happen or that we don't have any control over it.

2183
02:08:07.394 --> 02:08:11.536
And while that's true, you don't have a lot of control over what happens to you.

2184
02:08:11.556 --> 02:08:16.237
I think you just do have a lot of agency around how you approach it and how you see it.

2185
02:08:16.958 --> 02:08:17.318
It's funny.

2186
02:08:17.338 --> 02:08:20.579
I feel like we're just kind of landing back on stoicism.

2187
02:08:20.599 --> 02:08:20.699
Yeah.

2188
02:08:20.919 --> 02:08:21.179
Yeah.

2189
02:08:21.460 --> 02:08:21.800
Yeah.

2190
02:08:22.041 --> 02:08:24.264
I think stoicism is a good philosophy.

2191
02:08:24.284 --> 02:08:25.485
A little bit of existentialism.

2192
02:08:25.586 --> 02:08:25.866
I mean –

2193
02:08:27.325 --> 02:08:32.910
We've noted before how much CBT seems to flow directly downstream from the Stoics.

2194
02:08:33.350 --> 02:08:38.294
And CBT is the most effective anxiety intervention.

2195
02:08:38.534 --> 02:08:41.917
The biggest surprise for me, I guess it would be meditation.

2196
02:08:42.177 --> 02:08:44.339
And maybe I've been discounting it too much lately.

2197
02:08:45.019 --> 02:08:49.763
And maybe also I discount it just because it's – for me, I never meditated for anxiety.

2198
02:08:49.943 --> 02:08:51.004
That was never my issue.

2199
02:08:51.665 --> 02:08:53.827
For me, it was always more focus problems.

2200
02:08:54.507 --> 02:08:56.869
And also like self-exploration, self-awareness.

2201
02:08:57.209 --> 02:09:01.432
I was very interested in a lot of philosophical questions around consciousness and identity.

2202
02:09:01.512 --> 02:09:07.977
And I guess that was a little bit surprising for me or just the size, the significance of the effect size.

2203
02:09:08.377 --> 02:09:10.158
And therapy –

2204
02:09:11.760 --> 02:09:13.421
A little surprised, not surprised.

2205
02:09:13.681 --> 02:09:20.426
One of the things I do tell friends is I say like the one thing that therapy really punches its weight is for anxiety.

2206
02:09:20.506 --> 02:09:28.953
Like that I've seen over the years that consistently, CBT especially, like just for anxiety, it's kind of the best thing you can go to.

2207
02:09:29.213 --> 02:09:29.833
All right, everybody.

2208
02:09:29.853 --> 02:09:32.435
That was another episode of The Solve Podcast.

2209
02:09:32.475 --> 02:09:35.238
We have solved anxiety forever.

2210
02:09:36.068 --> 02:09:37.149
Thank you, everybody, for listening.

2211
02:09:37.329 --> 02:09:38.670
This was The Solve Podcast.

2212
02:09:38.950 --> 02:09:39.690
I'm Mark Manson.

2213
02:09:39.710 --> 02:09:40.631
This is Drew Burney.

2214
02:09:41.011 --> 02:09:42.632
We will be back in a couple weeks.

2215
02:09:43.012 --> 02:09:48.316
Go to solvepodcast.com slash anxiety to download some free cool materials.

2216
02:09:48.536 --> 02:09:51.518
If you haven't checked out Purpose, check out purpose.app.

2217
02:09:51.978 --> 02:09:59.443
It is my AI coach that I co-founded, and we have a free seven-day trial, so you can talk to the AI about all of your anxiety problems, and it will –

2218
02:10:00.464 --> 02:10:01.965
It will definitely let you know what it thinks.

2219
02:10:02.305 --> 02:10:03.266
Like and subscribe.

2220
02:10:03.526 --> 02:10:04.006
Review.

2221
02:10:04.207 --> 02:10:04.767
Follow us.

2222
02:10:05.688 --> 02:10:06.368
Be our friends.

2223
02:10:07.469 --> 02:10:07.950
We love you.

2224
02:10:07.970 --> 02:10:10.091
See you next time.