Manson delivers a solid reality check by trading trendy wellness hacks for the uncomfortable, evidence-based discipline of basic lifestyle changes. It’s a pragmatic reminder that the "solution" to anxiety isn't a secret shortcut, but the hard work of building tolerance for discomfort.
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How to Overcome Anxiety, SolvedAdded:
Welcome to Solved everybody. 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. 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? No, this has never happened. But apparently this has happened to Drew Bernie. So we're we're running with it because that's kind of what most people are doing with their anxiety. 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. 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. They're chosen because they feel easy and they feel quick. And we're going to talk quite a bit about that, about the the relationship between the the quick fix and the actual long-term solution. We've picked 17 of the most common practices, supplements, and interventions that people use to combat their anxiety. Here they are in alphabetical order. Adaptogens, alcohol, benzoazipines, breath work, CBD, digital detoxes, journaling, physical exercise, magnesium, meditation, probiotics, psychedelics, therapy, sleep, socializing, SSRIs, and your favorite, >> yoga.
We're going to break down each of these 17 interventions into how well they work, how efficient they they work, how longasting the benefits are, whether there are any benefits or not, and how strong the actual research behind them is. As always with these ranking episodes, there are surprises and there are interesting patterns that emerge.
And as always here at Solved, we categorize everything into four categories. things that legitimately work, actually good things to do. The sorted depends category, the stuff that maybe works for some people, not for others, maybe works in some situations, but not every situation. There's the not helping but not hurting category either.
This is where you get a lot of your placebo effects or just things that are the the effect is so minuscule that like you're not really doing anything, but you're not hurting anything either. And then finally, there's the [ __ ] category, which is the pseudocience, the stuff that is potentially harming you, and the stuff that is counterproductive.
We will start with the [ __ ] 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.
You might be surprised, you might not.
There's definitely some interesting caveats either way. Anxiety seems everpresent these days, Drew. Seems like everyone in their dog has anxiety. I use that saying a lot. Everyone in their dog. But like in the case of anxiety, >> literally.
>> I can't tell you how many friends I have. They're like, "Oh, my dog has anxiety. I have to go home."
>> I'm like, "When did this become a thing?"
>> And they're maybe even on meds, too, their dogs. Yeah. Yep.
>> Is this This is how far we've come.
>> This is This is where we're at.
>> This is where we're at. All right.
Everyone on their dog has anxiety. So, we will inevitably get into many of the mechanisms and processes behind anxiety.
We will get into a lot of the cultural stigma and labeling around anxiety. We will get into how anxiety is perceived and treated today versus say generations past. 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 than you ever had before. For those of you who are new here, I am the three-time number one New York Times bestselling author, Mark Manson, and this is my co-host, lead researcher, producer, and allaround sick man, Drew Birdie.
>> Uh, in more ways than one.
>> Yes. Yes. And this is the Solve Podcast, where we are the most overressearched and comprehensive personal growth and life advice podcast in the world. If you love the show, please like and subscribe. Leave a comment. Share with some friends. Follow us at solpodcast.com.
>> You ready?
>> I'm ready.
>> Let's do it.
>> 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. I do think it is a unique emotion. In some ways, it is a little bit different than most other emotions that we experience.
The American Psychological Association defines anxiety as quote, "An emotion characterized by apprehension and sematic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune." What's interesting about anxiety, I think, is that it's a it's future-based. And because it's future-based, there's a certain amount of cognitive load. It's almost like an outshoot of our our natural tendency to like just want to predict what's going to happen.
>> And so I think what makes it a little bit different than most other emotions is that it is very much influenced by our thoughts. A lot of emotions are almost more primary.
You know, it's like we have the emotion and then our thoughts kind of justify that emotion after the fact. 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. Okay.
>> 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 >> uh apply to the emotion whereas the things that tend to work a little bit better >> are a little bit more cognitively >> address those underlying thoughts. Yeah.
Exactly. So it's kind like it's our ability to predict or or our our penchant for prediction where you're saying marrying that with our our negativity bias almost too, right? Yes.
>> You could define anxiety almost like that. Like it's our we have this like strong just like desire to predict the future and and try to figure out what's going to happen, but we're also very negatively biased towards bad things happening as well. That's an anxiety >> which is if you think about it evolutionarily adaptive, right? So it's like let's say you and I are hunter gatherers and we're out on a hunt.
Right? This is how anxiety differs from fear.
>> Fear is present-based and it's very specific. Let's say we're on the savannah and all of a sudden a lion jumps out and is ready to attack us.
>> You and I would both experience fear because it is there is a present danger.
It's immediately in front of us and is very specific. It's like there's a lion and he's about to attack me. I'm afraid.
Anxiety would be if you and I are on the savannah and we are thinking about what if there's a lion around here. Where should I look to try to spot the line?
That's anxiety. It's kind of this low-level discomfort at potential futures that might happen. 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. It is adaptive to a certain extent. It's unrewarding in that like when anxiety is actually useful, you don't get to experience that usefulness.
right?
>> 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% of anxiety is is largely genetic. Some people just have far more sensitive sympathetic nervous systems than other people. They're more easily triggered. They're more sensitive to to their surroundings. They're more predisposed to experiencing fear, anxious thoughts. I think in personality research that you would just call this a highly neurotic person. 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, women are just always more anxious. The second thing that's really interesting is that young people are more anxious than old people. And that I find really interesting, especially given the future-based foundation of what anxiety is. In many ways, young people have a lot more to be anxious about than old people. And also, old people have lived through so many more failures, setbacks, challenges, struggles, etc., etc., that they've probably developed scar tissue where they're like, I'm going to be fine. I don't need to worry about this. So when it comes to environmental factors, obviously trauma gets talked about a lot. Trauma or other early childhood adverse experiences. Um they sensitize the amydala and they often disrupt our prefrontal cortex from help helping us emotionally regulate. I think this is maybe an important distinction. It's not that trauma causes anxiety. It makes us less equipped to inhibit anxiety.
>> Right. Yeah. Attunes you to it. Yeah.
people who experience a lot of trauma, they they they struggle to regulate their emotions in general. They struggle to think clearly. They get triggered more easily. And so, again, kind of that cognitive intervention of actually thinking to yourself, is this threat reasonable? Is there really a line that's going to come eat me? It prevents you from being able to do that in the moment. The other cause that I've added here that I I have not really seen talked about much in in the psychological literature is what I would call more of an existential anxiety. And I've written at this point pretty extensively about how I I personally believe that much of the mental health crisis is kind of an offshoot of this existential crisis that people are having. This dates back to Kirkagard in the 19th century. So Hagard noticed that there was something about modern life that seemed to like amplify people's anxieties that they seemed to consistently be anxious about nothing and that that seemed to be kind of a new thing and it and throughout his life it appeared to be getting worse. Kirkagard attributed this to the quote dizziness of freedom. What he argued is that as modern life gives people more freedom, more optionality, more opportunities in their lives, they become paralyzed and afraid to make decisions. Each individual decision suddenly becomes much more difficult because it has far more long-term implications uh on their lives. And so paradoxically that increase in freedom and optionality makes them feel more anxious for the future even though 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 [ __ ] 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.
>> Anything you want to add, Drew, before we get into it?
>> Um, I have anxiety.
>> Do what what what's been your history, I guess. Uh, I like I have panic attacks when I was younger for sure. I've been into my mid20s, I would say. Okay. Too.
So, it's definitely This is hits close to home. It runs my family, too. So, Okay.
>> Yeah.
>> Well, and I know you have a lot of sleep problems, too.
I imagine that's doesn't help. Yeah, >> that's attached to it.
>> Yes. Yeah.
>> A lot of rumination at night.
>> There's definitely a lot of that. Yeah.
>> My anxiety is pretty limited to social anxiety. I had a lot I had a lot of social anxiety when I was young. But interestingly, like outside of social anxiety, I I experienced very little. And I I think the social anxiety was just [ __ ] trauma.
>> Oh yeah. Yeah. I think a lot of people can relate to that though, too. Yeah, >> it's probably the most common source of anxiety is social anxiety. For sure.
>> Absolutely. 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. 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.
So like if you go to a psychiatrist and you're just kind of anxious all the time in every context, every situation like you can be diagnosed with with GAD.
That's a relatively small percentage of the population. 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.
Some people are just very anxious neurotic people in general, but it's not like a debilitating disorder or whatnot.
>> For sure.
>> I don't know. Sometimes I think anxiety helps me. That's something that never gets talked about.
>> Sure. Yeah.
>> There's a certain level of like high functioning anxiety. Like if you think of some of the most successful and productive people in the world, they're extremely anxious. You know, there's like the anxiety is kind of a fuel that runs inside of them. So on the one hand, yes, like it's not great mental health.
You're not feeling good when you're super anxious and that drives you to to perform really well or work really hard or but on the other hand, it does potentially produce better outcomes. I I don't know where I completely land on this. 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.
>> 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, right? How how am I going to pressure myself into doing the things that need to be done? And hanging on to that anxiety, I think, is a very common thing that people do. I I definitely do it. I think it honestly got me through >> a lot of university. Yeah. uh for one, you know, I was just anxious about it.
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, but you tend to hire people who like have that anxiety for you, kind of outsource some anxiety to to people. So, I mean, I get it. It's it's a tricky one. And I think people are like, "No, my anxiety actually helps me in some ways." And there's some truth to that, too.
>> This is a common fallacy, I think, in in mental health and personal growth, which is that like the optimal amount of a negative emotion is never zero. You should always have some anxiety. Like anxiety exists for a reason. It's adaptive. Like it we evolved it because it actually helps us. It helps us do things that are important for our survival, >> for for our community and our our relationships. The problem is when it's chronic and it's occurring in places that it's not helping.
>> Misapplied. Yeah.
>> Right. Is the fact that I'm constantly anxious at work, is that misapplied or is it actually like helping me like crush all my goals and be super successful? You know, it's >> I I don't The thing I always come up against though, too, is there's people who are like, "Oh, man. Just don't worry about that." You know, like things take care of themselves. No, it's us anxious people who takes care of things sometimes. You know what I mean?
>> So, so like I get it when people are kind of like, "No, actually you do need to worry about it." Now, but 100% on on board with you there where it's when it's misapplied or just generalized to everything. Yeah. That >> the optimal amount, you're right, is not zero, but it's also not, you know, >> 100%.
>> The goal is not to get rid of all anxiety. it's to I guess manage or have anxiety in the areas of your life that it's advantageous. I think the other factor here is something I've written about in my books. I have a bit of a spicy take about this which is that people are not more anxious because the world is scarier today. They're actually more anxious because it's much safer.
And it's when your life doesn't actually have real problems to worry about. You start inventing problems to worry about.
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 uh there are very real threats and real problems all the time 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 insanely low cost like your all of your food is provided for your warmth is provided for like all of your basic needs are provided for. You're safe.
You're secure. You live in a functional society. Like there's actually not a whole lot to be anxious about from like an like on an evolutionary historic scale. But because there's nothing to be anxious about, we invent things to be anxious about because it feels meaningful like we need something to worry about otherwise we wouldn't know what to do with ourselves.
>> Okay. So like an anxious system is so fundamental to like the human species.
You're saying that it just goes it's it's online at all times.
>> So there's a great quote in in subtle art that I I love which is uh it comes from Jose Marty where he said um if the mind does not have a problem to work on it will quickly invent some. And I think by and large that's like the issue of our age right you have a lot of people that life is comfortable but meaningless. And so instead of like admitting how meaningless things are, we invent meaning by imagining threats and problems where there aren't any. It comes back to that misapplied anxiety, right? Like it's like anxiety is useful when it's applied on in a realistic way that's actually helping you or or it's producing some better outcome. If you don't have a a place to apply it, if you don't have a direction to to point your anxiety, then your mind will just start inventing places to point it and it will start finding reasons to to to worry and 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, so they persist.
>> Okay.
>> Anyway, let's get into the ranking. Okay, >> this episode is brought to you by Wealthfront. You know what's a massive source of anxiety that nobody likes to admit? Money. You know, where you know you should be doing something smarter with all your savings, but you don't have the time or energy to figure it out. So, you leave it in some big bank account earning basically nothing and try not to think about it. That's a trap that I've fallen into in the past, and Drew actually found a way out of it recently, and that is Wealthfront. Their cash account earns 3.3 annual percentage yield or APY on your uninvested cash from program banks. It's got the flexibility of a checking account. So, there's instant no fee withdrawals to eligible accounts, zero monthly fees, and it's FDIC insured up to $8 million through Program Banks. So, when you're ready to invest, you can transfer into Wealthfront's expert-built investing account in minutes. Over 1 million people already trust Wealthfront to save more, earn more, and build long-term wealth with confidence. And honestly, it's one of those things where once you set it up, the money anxiety drops because you know it's actually being handled. So, for a limited time, Wealthfront is offering my listeners an exclusive 75% APY boost over the base rate for 3 months, meaning you can get up to 4.05% variable APY on up to $150,000 in deposits. So, start earning today by heading to wealthfront.com/solved.
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All right, so number 17 on our list, there's only one item in our [ __ ] category for this episode. There's only one thing that if you actively do it, it will make your anxiety worse. at least that we looked into, >> right?
>> And this one will probably not surprise many people, which is alcohol. It's the anxiety cure that two billion people actively use around the world that is making their anxiety worse. The data on the amount of people that self-medicate with alcohol is like absolutely staggering. It is funny that it is conventional wisdom that alcohol helps take the edge off. 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. And what's interesting is that yes, alcohol solves anxiety in the short term, but it actually creates more in the long run.
>> Yeah. I mean, about one in four people uh who have a some sort of anxiety disorder, they confess at least to self-medicating with alcohol, right? And it's honestly probably much higher than that um just because it's such so accessible and it you're right there's such a quick fix for it is a quick fix.
It works in the short run. The problem is is the bounce back. There's an overcorrection towards the other way. I if you're paying attention and you've done this before, you know this is what happens, right? I was talking about, you know, I've had panic attacks before. I had some anxiety around things.
>> I noticed too that after like a heavy night of drinking, the next two or three days my anxiety was just off-the-wall.
Wow. Right. Just it was terrible.
comp.
That's usually there's usually a hard bounce back from that. If it's social drinking, light drinking here and there, they those effects that bounce back seems to be attenuated at least to some degree. Can't completely eliminate it, I don't think. But alcohol does it again, it does work in the short run. Yeah.
>> Okay. And it has like it's probably the same mechanism as a lot of uh drugs that we'll eventually get to here. This this bounceback effect is actually strongest in the people who are most likely to uh engage in alcohol for anxiety, right? Or use alcohol for their anxiety. So shy, anxious people who are like socially anxious who use it tend to have the biggest bounce back here.
>> Okay. 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, you know, one drink a day is good for you, whatever.
>> Honestly, probably not the case. Uh, we're finding out more and more. 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.
Usually what happens is these people who don't drink have already quit drinking because of their health issues their health issues and so they're they're just naturally less healthy, right? In the United States anyway, Arizona has like the highest um respiratory illness rate.
>> Okay, >> which is weird because everybody moves to Arizona because >> they have >> the clear air and all that, right? But it's because a lot of people with those diseases will move to Arizona, right?
Same thing with like alcohol. People who quit alcohol usually it's because of health issues or problems around their alcohol use. But the thing is is that bounce back. I know I would just have terrible anxiety, you know what 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 embarrassing or shameful. I just feel >> Mhm.
>> like I had an awkward convers 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 it's part of the alcohol. It's like [ __ ] with my emotions. The interesting thing for me around this I noticed this back when I was a dating coach and it it was interesting. One of the one of the fascinating things was to see this confirmed in the research when prepping for this episode back early in my career. One of the first businesses I ever started was as as a as a local men's dating coach.
>> And so what I would do is I would actually go with guys to parties and bars or whatever and I would help them talk to girls. Probably the most common issue that guys had was anxiety. And it was interesting because obviously most men when they're anxious or nervous and they want to talk to a an attractive woman and they don't have the nerve to do it, what do they do? They have a drink. And that drink like loosens them up, relaxes them, gives them a little bit of courage. I mean, we even call it liquid courage, right? In the business, we used to call this approach anxiety.
And it was super common among men. And but what I noticed after I had been coaching for like a year or two, what I what I started to notice was that the men who drank to get over their approach anxiety never actually got over it. like they would 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. They had they hadn't progressed at all. They hadn't learned how to talk to anybody. They hadn't overcome any of their insecurities or fears. Whereas the men who didn't drink and just pushed through it, those guys would get over it and a month or two later they're like they're able to go chat with anybody they wanted. There's an idea of fear extinction, which is like this, it's kind of the the active component of exposure therapy of like actually confronting a fear, realizing that it's not going to kill you, and then like teaching your brain like, "Hey, don't be afraid of this next time.
We're okay. We've got this."
Interestingly, some substances interfere with that feedback loop, and they like prevent the ability for the exposure effect to actually take place. I 100% believe that alcohol is one of these because I just I noticed it in myself.
like I didn't get over a lot of my social anxiety until I stopped drinking around other people. And similarly, a lot of my old clients, they wouldn't get over their social anxiety. And so eventually I would start when I worked with guys, I would if they had a lot of anxiety, I would make them not drink that night and that in in and of itself would freak them out. But >> it's easy to see how this just becomes a crutch, right? You you you're socially anxious. You have this negative stimulus going on. You reach for a drink, you drink, you're not as socially anxious, so you're good to go. That cycle just repeats itself. 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. So, yeah. Yeah. This is definitely the only one though that gets uh negative negative ranking in our our book here.
>> Yeah. So, I was actually curious and I ran the numbers on what would stopping drinking, where would that land on this list?
>> Oh, like as an intervention, you're saying, right?
>> Yeah. Exactly. So, if you took like heavy drinkers with anxiety and you got them to stop drinking, what what would the effect size be for those people on their anxiety? And then where would that land on our list? Do you want to guess where that would land?
>> I don't know. Middle of the pack somewhere. Probably >> number four.
>> Really?
>> Number four. 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. Like >> true.
>> Super steady. Nothing like very few things faze me.
>> And your ability to regulate emotions too. Yes. Just in general. Yeah.
>> Yeah. Just like not getting upset over stupid stuff, not worrying about dumb stuff. Like it I >> Okay, >> I definitely feel that.
>> Yeah.
>> All right. Number 16.
Magnesium.
>> Ah, >> I'm a boomer.
>> Yeah.
>> 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.
>> All the rage. Yeah. 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 [ __ ] It's not a thing.
Apparently, it's just not a thing. It's like very very very modest effect um >> for most people. Yeah. Now, here's the thing though. If you're deficient in magnesium, that might actually be an issue. But, I mean, it's kind of hard to tell whether you're deficient in it or not necessarily. I mean there are a lot of people who are magn deficient in magnesium. Okay. And so if that's why you're you're anxious then taking some magnesium will get you back to baseline.
I don't think it's going to fix your anxiety. Yeah. But there's a lot of other reasons you might be anxious as well. The problem with the magnesium story really though it's a plausible mechanism. Don't get me wrong. Like if again if you're deficient in it or uh there's also two just neural mechanisms that use magnesium that where if if there's not enough magnesium there it could in theory produce more anxious states. Sure.
>> But uh the problem is is that the evidence that we have for it is just all over the map in terms of like study quality. They're using different forms of magnesium. It really depends on the type of magnesium you're taking whether it can actually cross the bloodb brain barrier or not. The evidence out there is very scant for this because of these methological issues. Okay. And so supplement companies have come out and they've said, "Oh yeah, that magnesium works." Because they point to one small orally done study.
>> We're going to see this this uh happen quite a bit. But that's definitely happened with magnesium here.
>> You want to hear my conspiracy theory about magnesium?
>> Yes, let's do it.
>> So the Israeli government >> No, I'm just joking. There's this new thing that's happening in social media marketing. Yeah, mo most people are probably not aware of this, but if anybody works in online marketing, you've you probably are. There's this new new thing called UGC marketing, which is stands for user generated content. And basically the idea is there are now platforms and mechanisms where you can go let's say like let's say I'm a magnesium supplement brand.
>> Yeah.
>> I can go to one of these platforms and I can what you do is you pay social media creators on a perview basis. So, basically what what you do is you go and you like set a bounty. You're like, I'm willing to spend $100,000 to get 10 million views on social media uh promoting my magnesium brand. 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. You post it on the platform and then there's like thousands of like Tik Tockers and people who post on Instagram and stuff like that. And then they just make content about it and then if they get one that blows up and goes viral, they get paid.
>> I see. So they're incentivizing trends basically.
>> Exactly. And so and and the reason it works really well for brands and products is that you can kind of get this like >> fake feeling of grassroots. Yeah.
>> Right. So it's like people are people are see suddenly seeing magnesium pop up in like 20 different spots and like 20 different people. there's like that stay-at-home mom that they follow on Tik Tok is talking about >> some big study that just came out >> and then the fitness influencer they follow on Instagram is talking about it and it's like and so you synthetically generate a social trend um just by paying dozens and dozens and dozens of small creators and I say this as someone who [ __ ] has like three giant bottles of magnesium in his in his cupboard and takes them every night >> because I was told years ago that I should be taking magnesium I'm probably deficient. It's going to help me sleep.
It's going to calm me down.
>> Well, again, if you are deficient, obviously magnesium is very, very important. It's a it's very essential.
Okay, I get it. For example, there's one study that a lot of people point to.
This was back in 2021, uh where they found uh like a magnesium plus B6 or a magnesium intervention. They had these two groups like one had magnesium plus B6, one had magnesium found that it calmed anxiety. The problem with that though was it was this post hawk study or this post it was a different data set that they weren't even using for to test whether magnesium helped with anxiety or not. They just looked at it after the fact. They didn't have a control group.
So we don't know if it's just a placebo effect or not but a lot of people point to it. Yeah.
>> And so if coupled that with your conspiracy theory, you know, where it's like there's kind of like oh this one study which even the the authors were like be cautious about this because we don't have a control group. This was just a post hawk analysis. But this happens all the time. Media finds that they run with it. Couple that with the UGC campaigns you're talking about what looks like a sciencebacked uh finding uh which is actually just a marketing thing.
>> Yes.
>> All behind it. Yeah.
>> I would say this is actually the the rule not the exception in the supplement industry. Shout out to Salt Orwell. So the the I'm old friends with the founder of examin.com and they analyze all the research on supplements and and basically like really break down like does this actually work or does it not?
And surprise surprise most of it does not. But I remember I was hanging out with Saul like maybe five years ago and he had literally spent his entire career investigating supplements, looking at the research, studying all the research.
And I remember asking him, I was like, "So in 10 seconds, tell me what is actually worth taking every day?" And he was like, "Dude, it's super simple. Just take fish oil."
>> Oh, really?
>> That was it. This was pre like creatine boom.
>> Okay.
>> Um but yeah, I think he he was just like, "Yeah, just take fish oil."
>> Mhm. don't worry about anything else.
And he was like, "Oh, and protein if you like, you know, if you want to get stronger." Yeah, that was it.
>> Okay, >> number 15. I think this is the first surprise for people. This is the first one that people are going to be like, "Huh? Really?
>> Journaling?
>> Why journ Why is journaling this low?"
>> Well, okay. There's It's a little bit of a nuance story here, right?
>> What do you mean by journaling? I guess first, that's the first question you have to ask yourself. pulling out a piece of paper, writing out your thoughts. Okay?
>> You know, I mean, there's a lot there's a number of different methods of journaling, right? So, there's like gratitude journaling and there's like goal setting and there's uh, you know, kind of more of a therapeutic journaling, like there's just brain dumping. And I think it's worth remembering that this is not an indictment on journaling's usefulness in general. In fact, on our episode last month on the most effective self-improvement techniques, journ journaling scored >> pretty high. This is specifically for anxiety as an intervention for anxiety.
Journaling is not super effective. And I guess to me >> it intuitively makes sense, right?
Because like what do people with anxiety do? They think way too much. And what is journaling? It's thinking about your problem a lot. So I could see how it could like not necessarily make things better. But I'm I'm curious what uh what you found like digging deep into the research.
>> I think you're absolutely right. It's the uh the thinking about it too much.
The way you're thinking about it too much actually too I think matters quite a bit. So like for instance gratitude journaling which we covered in the self-help techniques thing too.
>> It can make you more grateful. Sure.
Especially if you're not a grateful person. Probably not going to do a whole lot for your anxiety though. Yeah. Free form expression journaling where it's just just write about whatever. Again, not very directed. Probably you just get to ruminating more is what happens if you uh with anxiety.
>> 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.
>> Y >> 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 writing about um >> it's it's the negative visualization exercise that that's we talked about it on the stoicism episode because it's um I believe uh Senica actually used to recommend this 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, >> right? and 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. There's truth to that.
>> There there's there's some evidence to suggest that this will work. 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. You have to be consistent with it. Beyond that, though, um probably most people with anxiety give up after the first one. Yeah, that's another problem that they have with it. Like even in a very simple online study that they did where it was uh internet based, it over half the people just gave up on it. They just didn't even want to do it for more than a day, >> which 30 minutes a day for three days shouldn't be that bad, but >> it's not that much.
>> It's bad enough where people with anxiety don't like to do it.
>> I don't have the study in front of me. I do remember early on in the research process coming across a study that uh one of the things they said is that like there is an effect size here 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.
>> Right.
>> Yeah. 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. So, in the emotions episode, we talked about a effect of labeling that can help with emotional regulation for sure. It's usually a short-term fix, though. It's usually has a short-term effect. And so, any anxious feelings that you have around it where you label them, yes, that can help you in the moment, but like long term, again, you have to have that structured kind of exposure to it. It's all the things you said, 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 going to deal with it? So, what that does is it kind of creates this narrative for you that can help you address the anxiety. That's more of a long-term thing. And it's not it's not gonna it's not a quick fix, which is what most people are looking for when they go to sit down to journal is a quick fix, >> right? They want to feel better, >> right, then >> within five minutes.
>> That's not going to happen.
>> Yeah.
>> Yeah. You have to like really put a lot of time and thought for sure >> into it. Yeah.
>> I also could see a way that journaling could potentially backfire a little bit.
And this is this is not coming from the research. This is just coming this this is a Mark Manson hairbrain theory. I do think there's something about labeling yourself as a certain way. 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. 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. You are you are will kind of prime your brain to secretly look for reasons to confirm that anxiety. The act of being vulnerable of like sharing your truth could be undermining the actual process of of getting rid of the anxiety. I think at a certain point you have to like this is going to sound really obvious when you say it out loud, but it it's quite profound that like part of the way of getting over anxiety is deciding you're not anxious anymore.
>> Oh, it episode over.
>> No, >> it's incredibly difficult and complicated to do it, but like that that is part of the end state. Like I do think there is a certain threshold where the impulse to heal yourself >> is creating the damage >> and again coming back to the point that the optimal amount of anxiety is not zero. If you don't have anything legitimate to be anxious about your mind will start creating things to be anxious about. You know there's that saying like don't believe everything you think. Like this is this is a classic I think anxiety is a great situation to to be aware of that.
>> Yeah I think you're right. You can write about it, you can write around it without confronting it. And that's where the you can stay in that >> kind of hell for a long time if you're not careful, you're not aware of it.
>> And and what's worse is that you get the sense that you're doing something, right? And like this is and we talked about this in the self-help techniques like in many ways the worst self-help techniques are are the things that like give you the sense that you're doing something without actually doing anything. And I think in this context, the context of anxiety, journaling can do the same thing. you're constantly writing out all the things you're worried about. All you're really doing is just reaffirming that worry without necessarily solving it. Whereas I I do think there are other things in life that our journaling can be very beneficial for. This episode is brought to you by Shopify.
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All right, moving on. Number 14, CBD.
Sorry, California bros. Let me let me go outside and apologize to all the California dispensaries for this one.
CBD oils, CBD products, CBD edibles.
Not a whole lot there. Tell tell us about this one, Drew.
>> CBD. So, cannabol. Okay. It's a it's a it's a product of the marijuana plant, right? It's a but it's THC is what gets you high. CBD apparently is what just makes you calm and doesn't get you high.
That's kind of the story we've been told, right? Yeah.
>> It's a$5 billion market. The CBD uh supplements market is5 billion dollars.
Okay. There was a a meta analysis in 2024. So a very recent meta analysis.
>> They looked at 1550 studies of CBD.
Okay.
>> And so they're like, "Okay, we're going to the meta analysis. Again, you find all the studies about the studies, right? Or it's a study about the studies. of those 1550 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 suck. They suck.
We can't like >> improper controls, too small, uh bad methodologies. There was eight studies that were like these these fit the bill for for our criteria, stringent criteria, >> which by the way, listeners, eight studies is nothing >> is nothing.
>> That's nothing.
>> Uh it total 316 participants out of those eight studies, too. nothing.
>> It's a very very small sample size what we're going on here.
>> Okay.
>> Again, all the others were so poorly done they were just like we're not even going to include them in this. Okay.
>> They did find now in this study they found a a big positive effect size.
Okay. But the thing was is that there like what they call the confidence interval, right? Was so wide that they're like it's either amazing or it barely does anything. We're we're confident of that. Like that's the best we can do. That's what we can tell you.
It's either awesome or >> or nothing. Like that's that's that's the best they can do.
>> It's kind of useless at that.
>> Right. So useless information. Yeah.
>> With magnesium too. There it makes sense. Like the CB-1 receptor, which is what the the the receptor in your neurons that um CBD would attach to, it probably is a good target for anxiety.
It just looks like the supplements like taking oral supplements for it doesn't really work. At least the the evidence we have for it is just really not there.
Okay. And there's just kind of some weird findings they found, too. Like a couple of studies found that exactly 300 milligrams is what you need. Anything more, anything less doesn't either doesn't do anything or makes you more anxious.
>> That doesn't make sense.
>> Doesn't make a whole lot of sense to me either.
>> And and then not only that, but like most of the commercially available CBD supplements out there are between like 10 and 50 milligrams anyway. So even if it was 300 milligrams, you'd have to take a whole bunch of them.
>> So you'd have to take six doses.
>> Well, yeah. Maybe, maybe, maybe because because then the other problem is quality of these supplements. They've uh a 2022 study took 80 different CBD products that were commonly found on the market today uh and tested them and only just over half of them have what they actually the the amount of CBD they said they had in it. So, you don't even know how much you're getting even if it does work as an oral supplement.
>> I'm surprised this is higher than magnesium.
>> Yeah, this honestly this one we probably could have switched with magnesium. I mean I think it got skewed by that one study that found strong results. Yeah.
>> Huge effect size. Yeah. But the again that the uh the certainty on it wasn't super high. 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. Yeah.
>> It might work. But what we have so far is >> it's kind of garbage.
>> Okay.
>> Just not a whole lot going on. I don't know how common this is anymore. I remember this being way more common say six to eight years ago. Maybe a little more. Yeah, I I mean I know there's still some people, you know, was like CBD in your coffee or CBD and butter.
>> I feel like it blew up kind of late 2010s. I I remember taking it. I remember I went to some event and and one of the sponsors, it was a CBD product and they gave me a bunch of >> a 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 >> and 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 [ __ ] thing. I think I'm just pissing this out every day. Not not surprised by this one. I got to like given everything I know and understand about the supplement industry and I I took I I took one look at the the research summary for this and I just kind of chuck like eight good studies out of 1600. Okay. So, yeah. I guess I I don't think we need to dwell on this too much. Um this this is probably nothing.
It's probably a placebo. But number 13, I think is gonna shock a lot of people.
>> The digital detox, the getting out in nature, getting rid of your phone, getting out in nature, going for a walk, >> going outside.
>> I want this one to work.
>> Yeah, I Yeah, I'm >> It kind of does. Well, we'll get to that. But >> yeah, I'm not going to lie. I was a little disappointed, too. 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. I think that 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. I mean, just among my friends and family members, the amount of people I know who are like 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 and then swearing that it's like such a a detox and a relief and it they it cleared their mind and everything. It's a very common meme at the moment. I think one of the issues might be though is that replacing like a your your digital habits with going outside um it it does actually make you less anxious in the moment. It's just not a long-term fix. Yeah.
>> What they found like you can decrease anxiety like in the short term, right?
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. The thing is is that the bounceback is usually really really hard >> is that people go back like as soon as you're out then you just go right back into it. 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.
>> That's I think more of what's going on here than necessarily. 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 uh different anxiety profiles for sure. The problem is is that bouncing back and forth between the two, that's going to be an issue at some point.
>> 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.
>> I mean, I think that's great. Yeah, sure.
>> Yeah, >> do that. I mean, it's it will it will help your anxiety in the in the very short term. It's not going to like cure if you're having a panic attack. I'm not saying, "Oh, just go for a walk." That's not going to happen, right? It's not like a long-term fix. It's probably like add it in as part of your routine. Sure.
I go outside, touch grass. Absolutely.
But it's like it's not a fix for anxiety.
>> Yeah.
>> Maybe this is kind of what this is actually doing what people think alcohol is doing, right? Take take the edge off a little, right?
>> Help you unwind after a busy day. help you decompress after like maybe a stressful meeting.
>> I could get on board with that. Yeah.
>> Yeah. But 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. So, it's it's not there's no sustainability here.
I just finished apologizing to all the weed dispensaries here in West LA. Uh telling them that the CBD there's no evidence showing that it works. Um I'm going to have to go back out and apologize to a lot of people because uh number 12 on our list is breath work.
>> Okay, >> this one has a lot of caveats though.
Yeah, the important caveat here is that breath work is is definitely one of those things that it works for some people in some contexts and also works depending on the particular technique you're doing.
It does not work for everyone in all contexts and not all breath work techniques work equally. That's the headline that people should take away from this section. Um, there's a lot of nuance going on here. And as somebody who, by the way, uh, has had friends and loved ones, uh, go to breath work classes where the administer clearly had no [ __ ] clue what they were doing.
You can have very adverse effects. Like the breath work when done incorrectly or when done with the wrong person with the wrong technique, it can induce panic attacks. So, it is like actually counterproductive when done poorly. So, that 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 I I know people who swear by it. It's been life-changing for them. I also know people that like [ __ ] hate it. It was one of the worst experiences they ever had. So, be aware.
>> Yes, it can induce a panic attack. It's also it can help a panic attack too when done correctly. So, >> 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 of does help. Usually about a like a a 1:2 ratio of in to out breath, right? So, you you inhale for a one count, exhale for a two count, or you know, a three count, a six count, whatever it is. A one to two ratio, though.
>> Yeah.
>> Uh and that seems to help just as like a kind of general maintenance thing for anxiety. doesn't really like small >> small effect. It's not necessarily to that that longer exhale is like the the the key ingredient here. You're bringing attention to your uh internal states a little bit more. Uh and again you're confronting them uh and not trying to to to avoid them or or paper over them. And I think some types of breath work can help with that.
>> From what I've seen the most effective technique is what you just described.
Sometimes it's called box breathing.
>> Box breathing. Yeah. There's different second configurations, right? So the the one that I learned was 478, right? So you breathe in for 4 seconds, you hold for seven, you breathe out for eight, >> right? There's a 1 to2 ratio again. 48.
>> Yep. And then you just repeat that. I've seen 488. I've seen 448. The exact numbers don't really matter, but it's mostly the ratio and and what it is. So I learned this uh my wife Fernanda, she has a lot of she has panic attacks. And so what I learned actually like one of them was so bad that we had to call the paramedics. And the EMT actually explained this to me. He said it it's actually very counterintuitive, but like when when you have a panic attack, you're you're 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. In that moment, the last thing you want to do is breathe slower because it's you you literally feel like you're going to die if you breathe slower. By breathing slower, you allow your your body to actually properly oxygenate, which then like calms your nervous system, which then like kind of reverses that that feedback loop. The thing that I want to call out here is that there's a lot of different breath work classes, breath work techniques. Um there's a very prominent person in our industry that does breath work interventions at his seminars. I've started seeing all sorts of like very big promises attached that simply by doing breath work for 20 minutes you can unearth childhood wounds and heal trauma and like uh you know like let go of all of your bottled up emotions and all this stuff. What is interesting about these techniques is that by breathing intensely you can activate yourself into a high arousal state and when you are in that high arousal state like it can be a conduit for a lot of emotions to come up >> and so you do if you go to these breath work classes you will see people who start crying you'll you will see people who you know are screaming or like having very intense emotional experiences and I think if you are the type of person who tends to repress emot emotion and has trouble experiencing it, I'm sure this can be useful. The problem is is that if you are somebody like like my wife or like you who is already prone to panic attacks, already has a nervous system that is like constantly in a high arousal state, 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 and can actually trigger and induce panic attacks. 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 4 seconds 8 seconds in out this pretty much 10 times out of 10 this will calm you down. Um it is super effective but it is like you said it's a shortterm solution. these longer session, 45 minute, 50 minute, 60 minute breath work sessions where you're like 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. I to me this feels kind of like it's like a new version of catharsis. M just because you're indulging an emotion like doesn't mean you're relieving 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. That's not how how emotions work. Emotions are feedback loops. And so if you are indulging anger you are actually training your body to become more angry. If you are 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 [ __ ] terrible idea, >> right? Yeah. Yeah. Yeah. If you are experiencing a panic attack and you're doing the breathing like you said though, um and and it and it is calming and it does calm you down there. I think what's going on actually is it's not so much the breath itself. It's more you're you're becoming more aware of your internal bodily states.
>> Mhm.
>> I think it's just a it's a redirection from external, oh my god, everything's on fire to, hey, what's actually going on in here? Oh, I can handle this. Then move on, right?
>> Because if if if you sit and you dwell too long on it, that that is an anxious uh frame of mind that you're just putting yourself into. It's a tool for the moment. Check in. You're good. put it down and and and walk away because as soon as you start ruminating that becomes the counter uh productive part.
>> All right, moving on down the list. We get to number 11. This might actually be the first kind of sensitive one that we talk about. You know, as we said, we're in the maybe depends sometimes category at the moment.
>> And this one, >> it's when it goes well, it goes really well. When it goes poorly, it goes very very poorly. And that is bzzoipines.
And uh I should say for the record that you and I are not psychiatrists. We're not doctors. We're just reporting what the research says. We're reporting, you know, at this point benzo, Xanax, Adavon, Valium, Clonopens. They've been around for decades, many, many decades.
They've been studied back and forth. We have tons and tons of research and data on them. It's a complicated picture.
It's a very complicated picture. On the one hand, they can be extremely effective and what's better is that they're extremely effective very very quickly. On the other hand, there are very intense drawbacks. Um, people can become uh dependent on them. Withdrawals from from benzoazipines can actually kill people, >> right? Yeah. You can't just stop taking them.
>> It's a very tricky place to be um in terms of like a long-term solution. um there's a lot of potential for for abuse and interestingly the combination of ben benzoazipines with other interventions.
We talked earlier about how alcohol interferes with the fear extinction required for exposure therapy to work.
Benzo have the same sort of thing going on. And so what what what therapists have known for a long time is that when somebody goes on a benzoazipene, it can actually reduce the the uh effectiveness of therapy. that feedback loop inside your brain is not forming the same way it would uh if you were sober.
>> Yeah, it makes sense. I mean uh the benzoazipines operate on the same system that alcohol does too. The GABA system which is an inhibitory system for the most part.
>> So it makes sense that that Yeah, it it it extinguishes that fear response when you're doing therapy and you're addressing uncertainties and fears and all of that. Extinguishing that probably has something to do with the way you learn about those things. So yeah, >> 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 our measurement and our ranking on this.
If you remove the potential for harm, this would actually be top three.
>> Oh yeah. Hu big effect sizes, pretty big effects, >> huge effect sizes, very well replicated data going back for like I said 20, 30, 40 years. It is very complicated. There is a lot of potential for abuse. It's almost like they work too fast. So like I I wasn't aware of this, but there's a there's another drug on the market called Bucperone. It's um and it is equally as effective does not have the downsides, but the catch is it takes two to four weeks to start working. And so patients over and over again tend to go for the the benzo because they they kick in basically immediately. And I understand like if you are a 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, you probably want something that's going to hit and remedy the situation immediately.
>> Even then though that that the recommendation is not to use them for more than two to four weeks.
>> Yeah. Uh, so yeah. Uh, but that said, I know I know I personally know people who have been on like a low dose of benzo for a long time. Years. Yeah. And so years.
>> I Yeah. Doctors don't pay attention to that apparently. Yeah. I don't know.
>> I've known multiple people who have abused abuse them over long periods of time.
>> High high chance of abuse drugs. Yeah, for sure.
>> The next one, number 10, probiotics.
This gets into the the gut health fad phenomenon.
>> I'm curious what the what the research turned up on this, Drew. Again, this is one of those where like the mechanism >> proposed mechanism. It makes sense.
>> Yeah, >> the vagus nerve, it connects your stomach to your your brain. There's a literal connection between your gut and your brain, right? And that's the vagus nerve. That's one of the connections.
Anyway, they've done several experiments where they give a probiotic, different strains of probiotics, >> uh, and they've measured brain activity.
It alters GABA uh function in your brain, which is again typically inhibitory. So, >> right, >> theoretically, it should work or it could work. this could be a possible pathway by which you know your 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. Sure.
>> The interesting thing though that I found is there's kind of a split in this one. So people who have been uh diagnosed with an anxiety disorder like GAD or even OCD or anything like that, >> they 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. you know, it's not necessarily a clinical level of anxiety, but some anxiety that's just bothers you. Yeah, >> probably not going to get a whole lot uh from that using any sort of probiotic.
Several studies have found like there's a fairly big effect size like anywhere from 0.5 to 7 for people with psychiatric uh anxiety disorders. So, yeah. So, there so this is one of those definitely depends situations for sure.
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 >> Yeah.
>> say a prescription drug.
>> The science is still kind of out on like which uh strains Yeah.
>> Uh um of probiotics actually help because so when they've tried to do these meta analyses, it's really hard because there's always different strains. There's always different methods that go into these different samples that they're or different uh like the participant pool they're pulling from is very different. So, it's really hard to make generalizations from a lot of these studies. We don't have like big poolled data that we can pull from. There's definitely some evidence that uh a few different strains and a few different uh populations do respond pretty well to them.
>> There was a term in one of the meta analyses for this that I absolutely love. I've never come across it before.
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 >> that researchers called it catastrophic that that that gives you an idea of how all over the map this is. It is interesting though this is one that I would not have guessed. I I would have I would have guessed that this was kind of more on the CBD side. I know gut health is like a real thing as it relates to mental health, but my understanding was that or my assumption I should say is that it would not be as simple as just taking pro certain probiotics.
>> Yeah, sure.
>> You know, like it it would be something more drastic potentially.
>> I mean, yeah, it does make a lot of sense. The 90% of the serotonin neurons and and 90% of the serotonin in general is produced in your gut.
>> You know, we all know serotonin is probably pretty important some way for mental health. We'll get to this a little bit later though, too. I don't know exactly how >> there's something there probably.
>> So this is would you say this is just too soon to say or is it like like promising too soon?
>> I think as medicine gets more and more individualized this is going to be more and more important. Okay. And and and prove to be like for certain people that we can pinpoint be like you would be a very good candidate for this. I think this is one of those treatment.
>> Number nine, yoga.
>> I'm a big fan of yoga. I know you you're you're a huge yoga head.
>> Yeah. Well Well, it's interesting. I've been thinking about this more, especially putting this together. I'm not like into yoga. Okay. I go to I do yoga. I do it pretty regularly about twice a week usually. I do hot yoga.
Okay.
>> Um for one, so I get the heat exposure to it too, >> but I I don't think I would say that I am like I'm not into the whole like yoga culture necessarily.
>> I I do it as more of like a fitness thing, right? Let's talk a little bit about what they found with yoga though first. Okay. So, there is an effect.
Yes.
>> Okay. It does help with anxiety.
>> Yep.
>> Small effect most likely. There was a clinical trial where they they had people perform um some yoga versus uh therapy. Yoga about 50% of the people responded to it. Uh but with therapy about 70% did. So, it's not as good as therapy, but it would be a good compliment I would say. And I don't think it's for the reasons that a lot of yogis will tell you. you know, the whole maybe centering or whatever it is, the kind of supernatural side of things.
Obviously, I'm not going to probably uh argue for that, 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. We've brought this up a couple of times already, but I think yoga is actually a really good uh vehicle to experience that kind of interosception. So, that your internal states, your internal bodily states. 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. And I didn't I was always kind of like, I don't want this to be uncomfortable. I'm here to be comfortable. But the more I got into it, the more I'm like, oh, >> they're telling you, okay, this is you're going to push your limit. Get to a comfort comfortable position, whatever pose you're doing, and then push that and get a little bit uncomfortable. That I found was a big like, oh, this this helps you sit with a little bit of discomfort for a little bit longer. So it's like practicing that kind of muscle, that discomfort muscle a little bit.
>> That's where I think the actual value of yoga is. I don't think it's anything beyond that. It doesn't address maybe the underlying ruminating thoughts you have.
>> Yeah.
>> That is why I think uh like the therapy in in that study I mentioned the therapy actually did a little bit better is because it's actually addressing the underlying thought.
>> Yeah. So it's funny. I was actually just about to ask like >> I I generally associate yoga with meditation. Those two those two often go side by side. They happen together.
people do them at the like at the same time at the same retreat. But it's interesting because I always kind of saw yoga as like the physical form of meditation, right? It's like that the same way meditation like has you focus in um on like a cognitive experience.
Yoga has you focus in on a physical experience in your physical body. Like I'm not going to give it give give it away, but like meditation's on this list. It's higher than yoga. Exercise is on this list. It's also higher than yoga. And so I was I was curious to ask like why do you think yoga placed lower?
I think in the case of meditation I think what you said about the cognitive >> right anxiety is very cognitively driven.
>> So it makes sense that meditation is more targeted towards managing your thoughts and coming to terms with your emotions and all that. My guess on the exercise front is just the dosage level.
Like yoga is pretty I mean compared to like say doing a CrossFit workout like yoga is pretty relaxed. It's like not super strenuous, low intensity. It's relatively easy.
>> A hot yoga can be pretty intense. You know, one thing one thing I'll say um is that you get into a room uh with a whole bunch of other people uh and in the case of hot yoga too, like everybody's half naked in there basically, you know. And so there's a lot of like self-conscious feelings I think that come up. 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 gonna fall over on your mat in front of everybody and make a huge ass out of yourself. And so it almost like forces you to be like, "No, no, no, come back and be present with you."
>> That's interesting. And >> and so the you're right, the physical side, it is very much a physical like awareness around it, right?
>> That that you're practicing, 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. Yeah.
>> Did you find it it helped you feel more confident or >> No, >> I just I think it just >> Why Why do you like it so much?
>> I do CrossFit, which is a very high intensity, short, you know, uh heavy weights. I like this whole kind of barbell strategy. Yeah.
>> You know, you go and do something low intensity that's longer. There's a meditative side to it for sure, >> but um I just find it's a really good balance between like that high intensity You know, usually I'm a little bit sore from a workout maybe or or something like that and then I can get in, get a good deep stress. It's really low.
There's also just no pressure, too. Like I'll stop in the middle of some yoga and just lay down for a while and while everybody else is going. I think it's just a good kind of it it balances you out between those two extremes anyway.
>> Yeah.
>> So, it sounds like a nice supplement to >> I would not use this as like a this is my go-to anxiety Yeah.
>> remedy for sure. But it would be a great supplement for >> it's it's definitely going to it's good but it's not going to fix anything on this front.
>> The other thing too is I mean it takes a lot of time too. The hourlong classes generally speaking that's a pretty standard yoga class. Uh usually >> they're expensive. Yeah. You know so yeah I wouldn't I just wouldn't use it as a like a first line of defense. Yeah.
>> Moving along. We're about halfway through. We're we're now in the top half.
>> Okay.
>> This one surprised me.
>> Yeah. And I think >> I'm not so sure about this one. Yeah, this episode is brought to you by Waking Up. So, here is something that took me a long time to understand about anxiety.
Anxiety isn't really the problem. The problem is that when you're anxious, you're controlled by the anxiety. You can't see it. You are it. The thought is driving and you are just along for the ride, which is actually the thing that got me into waking up and why Drew and I both still use it. It's the only meditation app that I've ever stuck with and I've been meditating for over 20 years now. It doesn't teach you to calm down or think positive. It teaches you to watch your own mind in real time to catch the anxious thought the moment it shows up instead of being 10 minutes deep into a spiral before you realize that you're spiraling. It was created by Sam Harris, the neuroscientist, philosopher, bestselling author, and you can feel that inside the app. They're grounded lessons from worldclass teachers, no religious dogma, and just people who are serious about understanding how their mind actually works. I curated a playlist of my favorite Waking Up content for you to sample, and they're giving Solved listeners a free 30-day trial, so you can try it with no risk. And if you keep it, you'll get $30 off your annual membership, meaning it's only $119 a year, which is a great offer. So, if you want to check it out, go to wakingup.com/solved.
That's wakingup.com/solved.
Adaptogens. This is another one. I mean, if this came low, I' 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 [ __ ] adaptogen in it these days. There's actually this like bougie fruity drink that I I get at the grocery store here that has ashwagandha in it. Actually, the energy drink I drank this morning had rodeiola in it. So, it's this stuff is showing up everywhere. Ashwagandha, rodeiola, holy basil. early numbers were shockingly good, >> right?
>> Some incredible effect sizes, but it seems like we're still early days on this.
>> Yeah, I think we have a it's a similar problem with CBD, though, too, is that quality varies a lot. It's kind of hard to pin down which ones are the better ones. The study designs are very variable, right? So, you just get a huge >> a lot of heterogeneity there.
>> What do you mean by study design? Like explain for the audience people who haven't read a lot of research or done research like what what what's the difference between say a good study design and a bad if we're like testing ashwagandha for anxiety like what's a example of a good study design and a bad study design.
>> Some of the basics are just like having an actual random sample of people who show up to this is not like >> not just college students >> not just college students or even like for some reason you your your your experimental group and your control group are completely different types of people. You don't want that. You want a good mix of people between them.
>> Uh you want a control group, too. This is the other thing, you know, 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, right?
>> We don't know if that's a placebo or not at that point. Yeah, >> there's that size of the study matters too. So, how many people are in it? Um the more the better obviously because you can make more generalized inferences from those those populations.
>> And then I mean just all sorts of methodological stuff too. Is it a blinded study as well? You know, like a lot of these, especially with uh supplements, are going to be funded by the supplement company.
>> Yeah.
>> And even if it's a blind study, that can still >> that can influencers things one way or the other.
>> Those are some of the big ones. Um for sure. But if you I mean, even if you do have smaller studies though, but they're well done over time, that can help, right? because you can do a meta analysis, include those studies if they're well done, they have proper controls, they have proper blinding where the the researchers don't know which condition the participants are in.
>> Those those sorts of things help a lot.
>> It's probably worth noting too that like one of the biggest barriers to really good research >> is just funding. Like to get a good sample size, to get a nice variability of people in that sample, it costs money. you like you need to go find thousands of people, tens of thousands of people that are come from all different walks of life that like that takes a long time. There's, you know, lots of recruiting, you got to put out ads, you got to like onboard people, interview people. It requires just a lot of administration and a lot of 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 to to take shortcuts, which is why, like you said with adaptogens, those early studies, oh, they look really promising.
Well, that's because they were like, well, we can't do the perfect study, so we're going to do a good enough study.
And then those headlines get picked up and >> thrown out of proportion. So, yeah.
>> And then you also get this situation where there is say uh ashwagandha drink company, like a health drink company that has ashwagandha as their primary ingredient and they really want to market that. And so they come to researchers and they're like, and and I think maybe this is a misconception because sometimes people think that this is way more diabolical than it actually is. I mean, maybe it is sometimes, 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."
I think it's more just like >> that was the tobacco companies.
>> Yeah.
>> I 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."
There's a mudding of incentives, I think.
>> Yeah.
>> Yeah. There's like a few like pretty good quality studies. They're just small.
>> Yeah. uh like they do find a good effect size on uh anxiety and even some other mental health conditions, but they're they're small and so it's just I'm cautious I would say. Yeah, >> I've been drinking this ashwagandha drink quite a bit lately, especially at social events now that now that I don't drink alcohol. 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 little bit of a buzz and um help you relax.
>> Okay.
>> I I don't really notice anything at this point. And I feel like it's a probably just placebo. Like I just I'll have one sometimes at night before bed >> cuz it's like I've been marketed to that it helps me unwind. So it probably just helps me unwind a little bit. But yeah, I'm not convinced that there's anything going on here. All right. Next one. This one might get us canceled.
>> Okay.
>> SSRIs.
>> All right.
>> So these are your classic anti-depressants. Prozacs, Olaf, Lexro.
I guess in the pharmaceutical world, these are kind of like your first line defense for depression and anxiety.
Maybe the first thing we should do is just dispel the myth that anti-depressants don't work. Like I don't know I don't know how that became a meme at some point. Uh >> well for some people they don't.
>> Well, of course. Like >> I got you. Yeah. But like there's nothing there. That's not true, right?
There's absolutely nothing there. No, they work for some people for sure.
>> Correct. So like the the Cochran review did a review of of SSRIs and Cochran is for people who don't know Cochran is like the gold standard of like reviewing research coming down saying does this thing actually work or not?
Are these results actually legitimate?
Cochran review said it's legit. There is an effect size here. They do something right >> on the one side. like they absolutely do help people and I think certain people in certain situations it can be absolutely life-changing. That said, they are also probably overprescribed.
Like I think both of those things can be true simultaneously. I think it's it's like they are very useful and in some cases life-saving for people and they're probably given out way too much. That is my non-medical opinion. Don't come at me. And by the way, like I've had doctors prescribe anti-depressants for me for like basically no reason. My wife's had anti-depressants prescribed to her for like [ __ ] headaches. Like it just >> doctors doctors in the US definitely do give them out like candy at times and there are some documentaries around the incentive structure around that.
>> And not only that, I mean they've been detected like in river water, you know, and waste water before. So I guess it could be that could be true.
>> Maybe it's it's useful to start like how do they work?
>> You know, what's the mechanism going on here? what are the discussion items around like you know why why they're good why they're bad >> yes SSRI selective serotonin reuptake inhibi inhibitors right technically what they do is they increase the uh amount of serotonin that's in the syninnapse between neurons okay that the space between neurons and serotonin has been implicated in all sorts of uh different mental health conditions and just in general right uh like I said a lot of it is produced in your gut though really going back I don't know 60s7s 80s probably um there's this chemical imbalance theory of mental health disorders, right?
>> We're really going away from that. Um there's been several kind of high-profile meta analyses that have looked at decades and decades worth of data. They really can't establish a link between serotonin specifically and say depression or anxiety. Okay, depression was supposed to be the one that is like, "Yeah, definitely definitely for depression there's something going on maybe for anxiety." But really recent um 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. That said, SSRIs do work.
>> Yeah, >> we we know they work for some people at least. We don't know why they don't work for others. Okay, >> we don't really know why they work for these people though either. Now, for the longest time, we thought it just was we need to just increase serotonin. That's not the case. Yeah, >> we don't know what it is. There's probably some downstream effect. Um, serotonin can be kind of like a a signaling molecule too for downstream further downstream chemicals that might be uh influencing >> Yeah.
>> uh uh neural processes. We don't know.
There is some sort of functional difference between like people who have mental health disorders and people who don't.
>> Okay. And we don't know exactly how serotonin affects that or not, but it does for some people it does help. We don't know is what we're saying. The more the more we the more we uncover, the more we realize we don't know about these. Yeah, >> for sure. And so that, you know, SSRIs were very, very promising when they first came out, especially as the the newer ones in the 80s. Very very promising. Yeah. Early studies were had big effect sizes. We've maybe talked about this a little bit before, but a lot of times when something a new intervention comes out, they use it on kind of the worst cases and you which usually there's kind of a floor effect going on there, right? The only only direction they can go is up, >> right? or if you're using it for people who are the the the illst, you're gonna just see a a bigger jump. Yeah. With >> it's you always start with the hardest cases and so you get the biggest effect sizes early. Not to spoil anything.
We're going to talk about psychedelics soon, but there's a little bit of similar thing going on. As it spreads out to the general population, you start to see a moderation in those those effect sizes. the effect sizes have actually they've shrunk over the years because of because of that using on educationism maybe people who don't need them as much or don't respond to them as well and so the effect size decreases just based on that.
>> Yeah.
>> If we could identify like who would respond better to SSRIs versus not that would be great and they they're working on that.
>> Yeah, >> it's not a onesizefits-all. Uh the the effect sizes yes they've gotten a little bit smaller but and they've kind of topped out. We can't seem to get them to go up or down from there. So, >> you know, more has to be done on this.
So yeah, they're not without their risks, right? Um for instance, sexual dysfunction is a problem. It's fairly common in the short term sometimes and kind of rare in the longer term, but it is still a thing and it's it's something that um that worries people and is one of the like leading causes for people to just stop using them as well.
>> Yeah. It would just make you depressed all over again.
>> Exactly. Right. Right. Uh and then you you have emotional blunting too. That's um that's pretty common as well.
>> That's Yeah. That's so the people in my life who have taken anti-depressants like that's that's been very apparent that you you get kind of like it's almost like they become kind of zombie- like.
>> Everything's gray. That's what people tell me. It's like everything is just kind of gray.
>> Everything's just blah.
>> Yeah.
>> The people I know that take them and use them successfully say it's more like just a window opening for me. 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 or lift my mood a little bit for a little while for something else to get in. That's where SSRI shine if they can work for it.
>> Yeah. Yeah.
>> I think this is probably an opportune point to take a little bit of a sidebar and just talk about like >> where does anxiety come from for different people. For the layman like you you probably just lump it all together. Like some people are really anxious and some people are moderately anxious and some people are very little anxiety.
Anxiety is one of these areas of mental health, personal growth. There's kind of like a there's like a serious version and then there's kind of a mild version.
there's like a high quality problem version and then there's like a like an actual serious kind of psychiatric version. It's similar with depression as well, right? Like it's there there are people who kind of chronically struggle with depression and it's probably biologically b like there's some genetic predisposition. It's something they're going to struggle with for their entire lives. And I think for those people the conversation around uh something like SSRI is probably a little bit different whereas like just mild depression like uh you just went through a divorce or a parent died or you lost your job and you're feeling lost like everybody feels depression at some point and but it's generally transitory and it's generally for a good reason and I think it's it's similar for anxiety that like there's there are people who experience a lot of anxiety throughout their lives But that anxiety is is always contextual. It is based on kind of what they're going through at the moment.
Maybe they're predisposed to a little bit more anxiety in certain situations than than other people. Um but it is it is something that overall they're managing. It comes and goes in in waves.
Whereas there are other people that are just kind of like predisposed to lots of anxiety all the time. And 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 diagnosible clinical thing, I'm always very clear of like you should probably go talk to a doctor. Like this is not you're not going to solve this listening to podcasts and uh doing yoga on weekends, right? Whereas like 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. 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? There's like a there's some people who are just like trapped by their anxiety and it it is seems to be baked into their their neurological wiring to a certain extent and they just like they really need a long-term solution just to feel normal. Whereas there are other people who like their lives are by and large normal, but they experience a lot of anxiety and they just want to be able to excel and they feel like their anxiety is like one of the things that's kind of holding them back. The other a factor here is that like generally the severe cases of anxiety, you're probably looking at more of some sort of genetic predisposition. It's more of a permanent thing. Whereas the mild milder forms of anxiety, those waves of anxiety that come and go throughout life, you know, that that's when you get into, you know, environment, uh social experiences, where you grew up, you know, maybe some trauma you had when you were young. And those are generally things that you can work through that you can like process and uh use some of these techniques and and practices to like help you get through the tough periods. Thanks for coming to my TED talk on anxiety.
>> It's important to distinguish between like the clinical and subclinical for sure.
>> And then the lines have gotten so blurred. Yes. Though too. Uh >> and this comes back to the labeling thing, right? Because it's like I think what what happens these days is you have a lot of people who are let's say they're probably highly neurotic, right?
Which is a personality trait, but and and they're prone to anxiety. Maybe they're prone to panic attacks. Um so they experience anxiety above a at an above average rate. But then what happens is is because like we're therapy culture is just [ __ ] labeled everything. They label themselves as an anxious person, somebody who struggles with anxiety, somebody who is like doomed to struggle with anxiety. And so that identification with the issue then like calcifies it. It like hardens it into into who they are. They start bringing anxiety to their experiences rather than you know uh waiting for anxiety to happen uh to them. I think SSRIs are a perfect example of like if you are in kind of the the the clinical territory like they can be life-changing. If you're in the subclinical territory, it's probably overkill, >> right?
>> And I think one of the issues is that it's it's largely being overprescribed to people in the subclinical territory.
Like there are downsides and and side effects and and I I've known a lot of people who have who have gone on them and felt relief for a month or two and then a year later they're like I [ __ ] hate this and they they want to get off them and it's it's I think most people at least most people I've known have that's kind of the cycle they've gone through. Number six, Mr. Bernie. I believe this is the last of our some depends maybe category.
>> Yeah, I think so.
>> And it is a big one. Psychedelics.
psychedelic assisted therapy. This had the single biggest effect size of everything we researched, but the research is still scant and there's not enough trials that have been done yet. But it is very promising and this is very trendy, very exciting in our space. A lot of people are doing it, talking about it. It is slowly becoming uh mainstream accepted and I I do think there's a lot of potential here. It is very exciting and interesting, but we have to put that caveat of like it's still early days. Generally, these earliest studies are done on the hardest cases. So, you get the biggest effect sizes. As it spreads out to the general population, that effect size moderates, and you start to see a lot more complications. You start to run into a lot of people it doesn't work for. You start to run into negative side effects.
And of course, you just run you start running into practitioners who have no [ __ ] clue what they're doing, you know, like my guru Steve out in Malibu.
>> Yeah, you have a guru Steve in Malibu.
Is he your guy?
>> Uh, well, he was last week's shaman.
This week I'm uh switching to uh >> business coach. What?
>> Yeah, that was last week. This week I have a new shaman. Uh her name is uh uh Zoe of Infinity and um she's going to uh help me trip on a $10 million estate to find myself.
>> Okay, this this is the world I live in.
Drew, this is LA.
>> Sounds okay. Yeah, sounds West LA to me.
>> I've been somewhat of a proponent, a cautious proponent of psychedelics for a while. Uh it is still pretty high on our list, so we're giving it some cred here.
very similar to the early days of of the antid-depressants 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.
>> There's been some very interesting studies early on. One in particular from John's Hopkins, okay, this was done by Roland Griffiths, who was a serious neuroscientist, okay, and working at Johns Hopkins University did this uh study on people with latestage terminal cancer. They didn't have much time left, right? And as you can imagine around a situation like that, you're gonna have a lot of anxiety around your own mortality. Okay. And so they tried some psychedelic assisted therapy with them with psilocybin, the active ingredient in magic mushrooms. Yeah. Right.
>> And they did find that actually like they had this huge effect size. It was a small sample, but again it was very very consistent. Almost everyone in in the study said it was one of the most significant uh experiences of their lives. Uh they it helped them with their depression. It helped them with their anxiety. This was awesome. Right. Sadly, and I and a bit ironically, too, Roland Griffith actually passed away in 2023 of cancer, which was, you know, kind of one of those cruel jokes that the universe played on us. But his legacy lives on.
People are still, you know, they're they're hopeful, and I think they have reason to be hopeful. That said, one of the problems with uh um psychedelics is that it's really hard to do a a blind control study with this, right? Because there's 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. Yes. Right. you're going to know whether or not you're in the the experiment control group or not.
>> Yeah. Yeah.
>> That's been the biggest hurdle to actually figuring out what's going on here because now there's going to be some people that say, "Well, well, who cares? It works." Well, >> yes, but why does it work? We need to know that because we like >> you can't just start handing it out like >> you can't be handing out incredibly powerful psychotropic drugs and not know what's going on. Yes. Right. like there's there's a safety issue especially if we're going to be you know regulating this with a regulatory framework and everything like that right in 2024 the FDA actually pulled MDMA they were doing trial studies on MDMA for PTSD um and a few other disorders as well they ended up not approving it in 2024 there was a lot of excitement though a lot of people thought no this is a shoe and it's going to happen the FDA said no and it was because of this there was just there we can't induce proper controls and figure out what's going on here the small number of studies that they have done look very promising. They're very consistent.
They're very big effect sizes, low variation in the results, too, which suggests that it's a real effect. We just don't know what we're comparing it to at this point.
>> What's interesting about this, I think, is the mechanism, right? Like, it's every 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 your biology that's supposed to like kind of have a domino effect across things.
What's interesting about psychedelics is that it actually somehow like triggers neuroplasticity, >> right? Yeah.
>> And for people who aren't familiar, neuroplasticity is, you know, when you're young, your your brain is more easily able to rewire itself and uh develop new patterns of thought and identity and understanding. And as as you grow older, you know, neuroplasticity never ends, but it becomes harder the older you get. and your a lot of your beliefs and feelings and habits and behaviors just become more entrenched in in your mind. And so it's 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. And so that that's super interesting and exciting. I'm going to go anecdotal here for a second because uh I I did a lot of psychedelics when I was younger and I have spent a lot of time around people who've done a lot of psychedelics. I would actually say that I I probably know >> two or three people. I would call it like a low-level addiction. There there are people who take psychoact like these psychedelic substances like pretty regularly like on a weekly basis I would say to some extent whether it's micro doing macro doing 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 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.
>> So I was just gonna say sometimes that is incredibly profound, right? 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 and it 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. It also can cause you to find a lot of meaning in salience in stupid [ __ ] like a a ballpoint pen.
>> 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 uh with like some strange ideas around like what's very powerful and important and you're like I'm not sure that passes the reality test. You know, psychedelics have been around for millennia and in many cases they've I think for most of human history they were they were used as like kind of religious uh ceremonies and and rituals which makes a lot of sense to me given what they do. 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. And I I I do believe I don't have this research in front of me, but I do believe that one of the things that they they have noticed on it is that people who take a bunch of psychedelics, like their openness to new experiences increases afterwards.
>> Yeah.
>> So, it's interesting that in the in the 1960s and 70s, it was kind of all about like opening yourself up to possibilities and opening yourself up to the world. So, I find it fascinating that today it's it's much more about like therapy and calming people and bringing them out of depression and bringing them out of PTSD and and healing their trauma and everything. There's almost like a cultural reading into um what's going on and especially given the fact that I think there is we we are living quietly in a little bit of an epidemic of nihilism at the moment. 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.
>> Yeah.
>> If your anxiety is is actually rooted in a deep existential dread, a like a a pervading sense that your life is meaningless and nothing you do is meaningful. uh and that that is actually what is undergirling your sense of anxiety and stress about life, then it makes sense that a substance that comes in and like imbuss a ballpoint pen with cosmic significance can be incredibly therapeutic.
>> Yeah. 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, it kind of kicks that open. The studies where they have kind of tried to look at this more carefully, it's usually the post-processing. It's not during the trip necessarily.
>> Like that's the experience that again opens you up, right?
>> I think so, you know, anxiety a lot of times they talk about it as like it's a you're ruminating about the future, depression, you're kind of you're worried about the past, right? You're you're processing the past.
>> Um I think psychedelics what they can do is kind of kick you out of that whatever spiral you're in, right?
>> If you're in a depression spiral or an anxiety spiral of some kind, it opens you up to that point like you're talking about. But the processing afterwards is actually what's the most important part.
So when you are opened up because I've seen this too seen people like they they like people who are very much stuck in their ways and they go and do this and for a short period of time afterwards >> they're like >> it's kind of weird right >> um >> and I think what where people uh mess up is they don't take advantage of that time period the the one to two months following this experience where they're just like I don't know what's real anymore almost you know like I don't know >> the way I've been seeing things obviously isn't right and now I'm open to thinking about things differently.
Yeah, the the post-processing >> makes a lot of sense to me because it's it's like you you get that window right after the trip.
>> Yeah.
>> Of actually like change is going to stick or it's far more likely to stick during that period. You know, when I think about the people I know or have known who like kind of chronically do psychedelics, they're just always living in that window, right? And what I've noticed about those people is that they have a tendency to just kind of believe whatever >> like the la whatever the last person the last person they the last thing they heard from somebody is probably what they believe and that's probably like their new philosophy on life. And it's it's >> it reminds me of the Carl Sean quote of like >> uh have an open mind but don't have a mind that's so open your brain falls out. And I think you and I are in the same boat and that like >> I'm very excited about the possibilities. I do think it under the right circumstances for the right person, this can be utterly life-changing.
Maybe I'm biased by living in California around all these [ __ ] hippies, but it's one of those things that is I think is both underrated and overrated simultaneously.
>> Yeah. Yeah. And I mean, just a a word of caution, too, if you are if you are going to do this and especially if you're an anxious person, I would do it in a structured environment with somebody for the love of God. Find a professional who knows what they're doing. The nice thing is is there are a lot of doctors and psych psychiatrists that are like >> they're on board with it now.
>> Yeah. And and they're getting trained in it and they're like there's processes being developed and standards and all sorts of stuff. So >> still pretty illegal in most places though. So >> yeah, you know, we just won't we won't mention that.
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Moving into the top five. This is where we get into legitimate territory. This is everything from here on out is going to help with your anxiety. Probably, if not 10 times out of 10, very close. It's probably going to help everybody. It's probably always going to work to some extent, whether a little bit or a lot.
It's really just a question of your particular issues, how much you need, how much you do it, um, and you know, what you prefer. What we're also going to notice in this top five is that these things are going to get incredibly boring very quickly, >> right?
>> Which is another interesting thing I think we should talk about. But number five, social connection, social socializing in general. I think 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 humans ability to regulate each other's nervous systems and when I saw things in that way it just unlocked like so many connections and realizations and understandings.
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 this doom loop of like you're anxious, so you're afraid to be around other people. You're afraid to be vulnerable around other people. You carry a lot of shame, so you disconnect from others.
You isolate. You numb. you avoid contact and intimacy which then causes you to feel even more anxious, feel more shame, to disconnect, isolate even further and so on and so forth. So there's like there's a little bit of a upward spiral downward spiral that comes with social connection and uh and intimacy. Knowing everything I know about how good social 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 5 hour episode on friendships. It's doesn't surprise me to see this this high. 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 um to pursue.
>> I I think one of the more interesting findings I found about this anyway was that loneliness is really a predictor of anxiety, how anxious someone is, but having social support isn't necessarily a predictor of not having anxiety. So, it's like >> it's a protective layer.
>> Yes. Yeah. Right. Right.
>> More than it is a healer.
>> Right. Yeah. Exactly. Exactly. Which I found kind of interesting too. Makes a whole lot of sense though too, you know, just as social social animals.
>> Yeah.
>> You know, obviously the quality of your social network matters a lot. But >> the baseline is just don't be alone, you know, don't be don't be by yourself all the time at least.
>> Yeah.
>> Yeah.
>> Yeah.
>> One of the other interesting things that that came up in the research that I saw is that often for people just the belief that they have that support, >> right? Yeah. is actually more important than having the support itself, right?
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 >> moderates the anxiety far more than like actually having people who are showing up and taking care of things and doing things for you.
>> That seems to just check out on a personal level for me. I have a a good strong friend network. I feel like a good social network, but I don't feel like I lean on them a lot. But just having them there for me, I think that does go a long way.
>> I just I hate asking for help. Are you like that?
>> Same. Yes. Oh, yeah. I hate it. I hate it. I'm terrible about that.
>> I I do. I I Yes. Yes. I'm very bad about it, but there's still just like, okay, I know it's there. Yeah. If I needed it, it would be there.
>> All right. So, number four, we're going to call you out here.
>> Yeah.
>> We're going to shame you.
>> Yeah.
>> Sleep optimization.
>> Who knew? Sleep >> makes you less anxious.
>> Right. Right. I can already see all the people like reaching to turn the podcast off because they're like, "Oh, this we're we're going to get like sleep, nutrition, exercise."
>> No, there's there's a couple surprises, people. There's >> sleep, but yeah, sleep is is huge. Uh socializing is huge and exercise is huge, but there the the one the top the top two are not probably not what you would expect.
>> Yeah, but it's I mean, sleep is it's birectional.
If you lack sleep, then you're going to be more anxious. If you get more sleep, you're going to be less anxious. And there's pretty robust effects around this. They've shown this over and over again.
>> This is for any mental health disorder just about.
>> Yes. I mean, depression, anxiety, like name pick your poison. Again, there's another doom loop here, which is that the more anxious you are, the harder time you are to 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.
>> Yeah. 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. 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. And if you're not sleeping, then you're not letting it.
You're you're actively worsening your mental health. So it's interesting.
During RAM sleep, the brain replays emotional memories with the amygdala turned down. That's your fear processing center. Like, have you ever noticed that, you know, a lot of your dreams are like are kind of like residual of some of the the things you've been thinking about or experiencing lately? It it's almost like there's there's a certain emotional processing that your brain is going through while you're asleep. 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. 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.
That like just the average person's sleep is is very bad. It makes me wonder like how much of the mental health crisis has been contributed by just people not sleeping enough. I mean, I would say with like the teen mental health crisis especially, I would say this is a huge contributing factor.
>> Yeah.
>> Yeah. They're just like kids laying awake scrolling their phones all night.
>> Yeah.
>> Yeah. That's that's got to be contributing a huge proportion of that.
Yeah.
>> And it creates a doom loop, right?
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. So, you're not getting that processing happening while you're unconscious. 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. And so then you lay in bed even longer doom scrolling and you get into this just this ugly cycle that is really only broken if you can confront the anxiety itself. I mean, would you say this is probably like socializing in that it's not it's not necessarily an intervention. It's more of like a protective layer, right? Like it's like the same way having friends doesn't necessarily remove anxiety. It like protects you in the first place. It sounds like sleep is kind of the same thing.
>> I think it's a protective effect where it gets you to a baseline. I don't know.
Is it going to improve your anxiety if you're sleep deprived? Yes. Yeah.
>> Beyond that, I'm not so sure. But yeah.
>> Yeah. Well, what's interesting is that the some some of the research has shown that the emotional reset that comes with sleep is lessened at higher anxiety levels. So people so people who experience extreme anxiety levels, sleep is less of a factor for them. But it's coming back to those, you know, kind of >> uh mild subclinical anxiety issues. Like if you're just 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. Again, what's mind-blowing is >> is like this is free. You're already doing it every [ __ ] day. It doesn't cost any money yet. Like how many things on this list have people spent hundreds, thousands of dollars like putting chemicals into their bodies, supplements, like Yeah. Just go to bed earlier.
>> Yeah. Yeah.
>> Try that. Try that for a week.
>> Consistent. Yeah. Consistent bedtimes.
Yeah. Consistent beds. Oh, that's what I've uh realized lately anyways.
Consistent bedtimes help a lot. Yeah.
>> Uh consistent wake times. Listening to your chronotype, too. You know, we've talked about this a little bit before, too. if you're a morning person >> uh versus a night owl. If you're a night owl, don't try to be a morning person necessarily. It's okay unless you have to be. I get it.
>> Yeah.
>> 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.
>> Okay. Yeah, that I think is a big one.
Yeah.
>> Right.
>> Yeah.
>> Yeah. You can optimize whatever.
>> You can have all the supplements. You can meditate till you're [ __ ] blue in the face, but if you're not sleeping at night, >> doesn't matter, >> right? Yeah.
>> Does not matter.
>> You can drop a bunch of acid doesn't doesn't matter. Yeah.
>> I mean, good psychedelics do interfere with sleep quality. I can I can tell you from experience.
>> Moving on to everybody's favorite.
Everybody's favorite. Number three, exercise.
>> Hit go to the gym, bro.
>> Hit the gym. Do you even lift? You know, I've heard it in several different forms and places and whatever, but tame the body, tame the mind.
>> We talked about this in the resilience episode as well, though, too, right?
Like developing the discipline to work out or at least be active in some way that has like this almost calming effect on your nervous system because it shows you have some control, right? And what is anxiety if it's not a lack of control or a sense of a lack of control? And so I I think more than anything, yes, there is the physical benefit of it. Like you're getting endorphin release and like all of that kind of stuff. But where I think the actual benefit of exercise comes in is that you are exercising that kind of control over your mind.
>> Yes.
>> And you're showing yourself that, oh, I have some agency here. When I even when I don't want to do things or even when things are uncomfortable, especially when things are uncomfortable.
>> Yeah.
>> Like I am exercising some form of agency here. And so tame the body, tame the mind.
>> Yeah.
>> That's that's how I see it. I think that's a beautiful explanation of like the cognitive side of this. 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 it blows my mind because I feel like exercises people have talked about it front words and backwards, but it basically it was like every hard workout is practice for being afraid.
>> Like if you think about it, it's like what happens when you're when you're afraid, right? elevated heart rate, uh, shallow breathing, you start getting sweaty, adrenaline courses through your body, like exercise, lifting really heavy weights is training your body and your nervous system to be afraid and be okay being afraid. Like you are you are physiologically putting your body in the same state that it is when you're experiencing fear. Exercise is a controlled environment where you are training yourself to to be okay, to act despite it. And and then the cognitive piece comes in of like I'm choosing to do this. I'm feeling I'm feeling the strain. I'm feeling uh the adrenaline.
I'm I'm like my heart rate is through the roof, but I'm I'm not going to stop.
I'm going to get that last rep. And it's it's every time you're pushing through that that difficulty and that strain, every time you are feeling kind of that panic, that like that fast heartbeat and and and the fast breathing and and you know your your fingers are tingling and you're like, "One more rep, one more rep." Like you you're kind of training your mind to act despite the the physiological signals.
>> Yeah.
>> And so I just thought that was so [ __ ] cool.
>> Yeah. Yeah.
>> Like I never thought of it that way.
You're using the agency like that you have to like >> purposefully induce an anxious state in yourself and realizing that it's okay.
>> Yeah.
>> Yeah.
>> As you would expect, there is just like an absolute dump truck worth of research on this. The largest meta analysis we found had over a thousand high quality random randomized control trials. Over 128,000 participants and just consistent moderate effect sizes across the board across diverse populations, any country, backgrounds, age, gender, whatever.
What's interesting is that exercise affects anxiety on a on a number of neurobiological pathways, right? So, it increases BDNF, uh, which I don't know what the [ __ ] that is. You wrote here, "Fertilizer for neurons, so I'm going to believe you."
Um, but it spikes serotonin, norepinephrine, dopamine, decreases neuroinflammation. If I was to put on my my Andrew Huberman glasses here and um and and tell you the most effective exercise protocol for anxiety, you can literally do anything. It's aerobic resistance uh intervals like any basically anything that is moderate to high intensity like anything that anything other than low inensity exercise 20 to 45 minutes per session 3 to four sessions per week basically what they find is that the consistency is what matters more than what you actually do. So as long as you are showing up exercising on a consistent basis doesn't even have to be that like 20 minutes is not that much. Yeah.
>> See, and that's what I think that's why I think it's more of a like it's a practice.
>> Mhm.
>> It's 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.
>> Yes.
>> So, to me, that's oh, okay, I'm going I'm going in and I have again I have some agency. Yes.
>> And I'm able to create some sort of discipline around this and that gives me a little bit of calm and peace of mind at least.
>> Yeah. I had this social media post uh a couple years ago that went super viral.
Um and it was basically like imagine if there was a pill that improved your mood, helps you regulate your emotions, improves your sleep, uh helps you lose weight, helps you have better sex, decreases anxiety and depression, and improves your longevity. Oh, and it's free and it's available 24/7. Yeah, that pill's called [ __ ] exercise. Right.
Yeah, >> it is like when you think of it in those terms, it is just kind of absurd. And it's also even more absurd that so many of us don't do it regularly. Like I'm I injured my foot a few months ago and so I'm like I lost a lot of my like I didn't exercise much over the two or three months and like now I'm trying the foot's healed so I'm trying to get back into the gym.
>> It's it's long, isn't it?
>> It sucks, man. It sucks.
>> If I take a week or two off I I start feeling >> Yeah. I'm like >> I 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 you got to keep going you know >> yeah I mean there there's there's inertia in both directions right so it's the the longer you haven't done it the the harder it is to start but the more you've done it >> you know the the easier it is to keep going all right number two I'm not going to lie this showed up higher than I expected okay >> meditation >> little little surprised I I mean, I expected that it would have it would have worked. I I would not have expected that it would have been this high on the >> Okay. Why is that?
>> Maybe it's just cuz I'm not somebody who like struggles a ton with anxiety, but like I don't know. It just I've never found it from like a purely kind of mental health, you know, uh mental stability point of view. I have not found meditation to be the most useful >> intervention.
>> It's useful. and I did it for a long time and it I definitely recommend it, but it's like I would have put exercise above it. Like I 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.
I mean, meditation too, but like it's not as like clear as day. Like if I don't work out for a week, like I feel it.
>> Yeah. Whereas like meditation, you know, if I didn't meditate for a day, like I I never really noticed.
>> Well, okay. I think that might be the difference though is that meditation is a little bit of a slower burn.
Specifically, too, is that like um stress induced anxiety, >> yes, >> I think is pretty well taken care of with with meditation. You know, we we had an episode on meditation, right? We talked about some of the common pitfalls and 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 Kabin was very instrumental in in developing it. Yeah.
>> There's a whole it's very structured. It like I said 8week program. There's physical aspects to it too. So there is some exercise involved with it. So I I think you're right. I think in the moment maybe like I would go for a workout or even just a walk. um that's going to help your anxiety more short term and long term of course too.
>> Longer term though, I think the cognitive benefits of of meditation are going to come into play >> to to in a way that exercise might not.
>> Yeah.
>> That said, I I think you're right. I think I mean they're number two and number three. They're like >> Yeah. A lot of this research was done on the full MBSR protocol, right? which is like 8 weeks long, multiple hours a week, in some cases full day meditation retreats. So the research, a lot of this research seems to be coming from pretty intense meditation practices. Like it's not like it's not like people pulling out the waking up app for 10 minutes and like once a week. When they measure that, they don't see a whole lot. It's more from serious meditation over an extended period of time. That's my understanding of it at least. Whereas whereas it 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.
>> Yeah. Yeah. Okay. Yes. I I I would agree with that too.
>> So it's like it's more of a dosage thing I think.
>> Okay.
>> Right. Where it's like it seems like meditation is super effective but also the dosage is pretty high. Like you can't just >> sit for five minutes.
>> Yeah.
>> Do you agree with that? I don't know.
Like I >> Yeah. Oh yes. No. I agree. like a a five or 10 minute meditation even once a day.
Yeah, that's probably not going to do a whole lot for your anxiety specifically.
>> Yes.
>> That said, >> doesn't mean you shouldn't do it >> again. Yes.
>> Again, we're talking about anxiety, but yeah.
>> Yeah. Yeah. Like I said in the meditation episode, I don't think that's why you should necessarily meditate either. I think it will help you with your anxiety. It changes your relationship to your thoughts, whether those thoughts are anxious or >> yes, whatever they are. Um and so you can see them more clearly and there's I think it gives you a sense of what you can do with those feelings and those thoughts.
>> Yes. Yeah. Meditation does not reduce anxious thoughts. It doesn't actually meditation doesn't change any of your thoughts. It changes your relationship to your thoughts.
>> And so people will often come to meditation expecting meditation to kind of turn the volume down knob down on their life and on their anxieties when really uh what it does is it just it helps you better sit with the noise and and understand the noise. I agree with you.
There there's like a lot of misconceptions around me what meditation does and I I I'm sure there is a certain calming effect, you know, of just sitting quietly for a certain period of time. But I do think the long-term benefit of meditation really is in that like cognitive reappraisal of like what does this mean? Why does why do these thoughts keep coming up? Why do I resist them? Why do I fight them? What am I so afraid of? like all all of these kind of deep questions that you have to sit with for a certain period of time to like resolve them.
>> Yeah. You see the forest through the trees a little bit better I think with meditation. And I >> Yes. All the ancillary benefits you get with it. Decreased uh anxiety or you know better stress coping whatever it is. Again I think it's just that's all secondary to just knowing your mind better. And yet that takes some of the edge off right there. Just just knowing your patterns and knowing why you do what you do. I wonder how much of it too is is actually kind of a bleed over of that digital detox. You know, going for a walk and getting rid of a screen like definitely makes you feel better in that moment and then as soon as you come back everything kind of comes back because I know a lot of people who do meditate for like five minutes every every two or three days >> and they like it. So it makes me wonder if like that's actually what they're experiencing, right? It's just like sitting in in a quiet room without their phone. It allows them from to like get away from all of the noise and chaos that's going on around them.
>> Yeah, that that's I get that's one of the benefits I get out of it for sure.
So, yeah, >> that said, if you do meditate, definitely recommend the Waking Up app because it's more serious courses, longer, in-depth, more philosophical. 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.
So, >> the introductory course on Waking Up 2 is it's fantastic. it like just going through that alone will is is worth it and then we've got a deal with waking up right now where you can get 30 days for free so you can take the whole introductory course for free if you want to. So I mean it's >> no risk whatsoever.
>> What I love about that course too is that it is exactly what you talked about is like it's all about your relationship with your own thoughts because other apps it's like they they they try to just get you to they're like >> benefits. Yeah. It's for crowd.
>> Yeah. They're like, "Ah, relax. Uh, breathe." You know, it's like waking up is like, "Let's talk about your mind.
Who who's observing the thoughts right now?"
>> Right? Who who are you? Yeah.
>> Who are you? And then you sit with that for for 10 minutes. And it's like it's pretty cool.
>> I love it.
>> All right. Last but not least, drum roll, please. This is not gonna >> this is this is not going to surprise anybody.
>> Therapy comes out on top.
>> Sorry.
What what is interesting about this though is different modalities of therapy >> all perform well but in slightly different context. Right. Right. So like the the heavyweight especially around anxiety is CBT, cognitive behavioral therapy. And I I do think it is pretty well established at this point that like CBT is >> probably the best intervention for anxiety issues. But I did find it interesting that that ACT is also effective for certain individuals and certain flavors of anxiety. I love ACT.
>> Yeah, ACT is pretty cool.
>> Yeah, I like ACT a lot. Uh and then and then of course exposure therapy, which is taking bite-sized chunks of of your fear and exposing yourself to them.
>> We've had a lot of kind of sidebars on therapy over the years on this show. Um you know, it's it's another one of those things that I think is both overrated and underrated depending on the context and depending on the person. It definitely seems that for anxiety it is not overrated. It is very legit, very consistent, helps a lot of people, very rep replicable findings uh across the board.
>> And yet, which 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.
>> That's so interesting.
>> That's pretty wild. Yeah.
>> Why?
>> Well, I don't know. Yeah. And I don't know how accurate that number is necessarily either, but yeah, there's there's some numbers out there to suggest that it's very much undertreated.
>> One of the things that I found, you know, when we were doing market research for purpose, you know, I did a lot of research into kind of the therapy market, the mental health market, counselors, coaches, life coaches, all that stuff. It is shocking how under supplied the market is. I I didn't realize that is that like for every therapist or coach, there's like eight to 10 people who want access to a therapist or coach. And I think the biggest hurdles for a lot of people is is financial or they just live in a remote area. They don't have access to anybody, >> right? CBT therapy in general too is they there's kind of what they call a a durability advantage. Okay.
>> Okay. which is especially for CBT though um the skills you learn during your CBT sessions during your training I guess or your your your therapy the whole point of it is to teach you how to manage your anxiety or any other uncomfortable emotions that you might have out in real life. And so the advantage of that is 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, so all these uh randomized control trials that they did a meta analysis on uh found that post uh 12 months post treatment uh with GAD with generalized anxiety disorder, a huge percentage of people like were still uh at like near po post treatment levels anyway of anxiety. So they they basically had fixed it a year later still. So um pretty durable advantage which in the mental health world anything that lasts over a year that's pretty that's pretty good.
>> It's rare. Yeah.
>> Yeah. Other studies have found very similar results as well. So you know like older adults even too you can find kind of full diagnostic remission even um over uh even more more so than with medication. 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. With CBT and ACT and some other modalities as well they find that that's not that the the failure rates aren't nearly as high as that too. So it's much more durable advantage to Interesting.
>> Yeah.
>> I think the thing that most people miss about therapy is that the point is to eventually stop.
>> Like I >> therapy is one of those weird industries where you can judge the the the usefulness by how many people quit.
>> Yeah. Right. Right.
>> I always get very wary when I meet people who are like, "Oh, I I love my therapist. I've been going to them for 12 years." I'm like, "Wow, probably not a good therapist."
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.
>> But what's more surprising is that leaving therapy, many people often get another boost to their outcomes as well.
And I I think this is one of those things I've written about this long time ago. I wrote wrote about this in in some articles that you start in this place where something's wrong in your life.
You don't really know what it is. And so the first big improvement comes from just getting an understanding of what the problem is and how to approach it.
But then the fixing of the problem becomes a bigger problem than the problem. Right. And so the next big ad the next big level up comes from stopping fixing the problem. And I think that second lever is where a lot of people get lost.
>> Yeah. uh they get they they start to feel I think maybe dependent or addicted to to whatever you know therapy or intervention that they're doing. You see this in the self-help world a lot.
People just keep going to seminars forever. And it's like well actually it the fact that you keep going to seminars to fix yourself is the bigger problem than the things you're trying to fix. If you just stopped going to seminars like you'd probably be pretty happy. It's a very common problem in in not just the self-help industry but just the mental health space in general. 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? You're doing pretty well. I don't think you should be worrying about this so much.
>> Why don't you just go live your life and see?"
>> I used to run into this all the time where I I'd get emails from people and they're like, "I've read all the books.
I'm like taking all the courses and it's just making me more anxious and I'm more worried 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." And I would just I just reply to him. I'm like, "So, stop reading the books.
>> The problem is not more more information."
>> I'm like, "Nobody's putting a gun to your head, making you read more books.
Like, just [ __ ] stop reading the books. Go live your life." 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 you're not going to actually change unless you you know, you have like a spreadsheet mapped out. And it's like, no, like a lot of this stuff just kind of seeps into into the background of your decision-m 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. So ultimately, self-improvement requires you to go back and live in the world.
>> A couple of caveats we should mention here, okay, >> as well too, you've already mentioned a few things like, you know, it's expensive, it's hard to access sometimes. Very true. Dropout rates are actually very high too, right? Y uh people a lot of people start therapy and then they have the opposite problem what you were just describing. Instead of staying too long, they don't stay long enough. Yes.
>> So you 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 because they really don't it's hard to fix somebody's life in just a few sessions, right? That's just that's not going to happen. The other issue is some therapists suck.
>> Yeah. Yeah. Quality quality varies a lot. But in any profession like this, yes, quality is going to vary a lot. You got to shop around.
>> And there is some evidence that uh the best therapists actually drive most of the results. This is one reason why I'm bullish on AI in this area. And I don't think AI can completely replace therapists and coaches permanently, but like I've been around long enough. I know how medioc how many mediocre therapists and mental health professionals there are out there. Um I've heard from so many [ __ ] people of like I was in therapy for years like my therapist was awful. I had no idea and then I switched and oh my god my new therapist is so much better and I'm now I'm having like all sorts of breakthroughs and stuff. There's also like chemistry issues. So, I just think it's it's such a hard thing to scale and it's such a hard thing to like quality control that I I'm convinced that at some point AI is just going to take over most of it. And go download purpose.app.
>> Yeah. Well, >> I mean I I we definitely have hit a ceiling. Um and that's another you you said spinning your wheels. I think we um >> effect sizes have not improved for therapy in 30 or 40 years.
about somewhere in the 30 to 40% range of people just don't respond very well to therapy. Again, that could be because they're dropping out too early or just not, you know, they're not putting in whatever. But we need to figure that out and we haven't figured that out >> in 30 or 40 years.
>> Yeah, it is. It is the fact that there have been no improvements on this front >> since you and I were born, right, is a little >> CBT in the ' 80s. Yeah.
>> A little bit of a red flag. The other thing that doesn't get broadcast a whole lot is that that actually a small percentage of people actually respond negatively to therapy, right? So it's like some people you can go to therapy and be worse and it is that's not broadcast a whole lot. I think it's not broadcast because >> overall not enough people are going. I also think you can overdo therapy like I think it's especially in in some of the uh wealthier parts of like say the US. I think people are over therapized, you know, especially young people, especially kids, you know, it's like a lot of kids by the time they're they graduate from high school, like they've already been through 10 years of therapy and like three different therapists. And it's like, you know, like >> maybe you should just let a kid be upset.
>> Yeah.
>> Being a kid's hard.
>> It's [ __ ] hard. But that's that's another podcast.
any any final thoughts you want to wrap up with? Any observations in general?
>> Well, I we've been hinting at this the whole time, but um I think if you are going to address your anxiety, the quick fix is not the >> the one you should reach to first for sure. 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. That's the one we started with. It's the absolute worst one for a reason. And there's varying degrees we go through this. 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. It's a long-term probably lifelong thing for most people. I'm I still struggle with anxiety at times. I just I do.
>> Um, and it depends on my sleep and it depends on my my exercise and all of these things that we've talked about today. Sure.
>> But >> I will say if you want like a durable lasting change to it, reaching for those quick fixes just it can't it can't be the the answer.
>> It is interesting in this episode, you know, the list is really clear.
Everything in the top everything that is in the legitimate category is a lifestyle change. Everything outside of the legitimate category is a quick fix, >> right? Yeah. A supplement or Yeah. Or like >> one thing one time not going to work.
>> Yeah. I think my takeaway is that everything that actually works for anxiety is just uncomfortable and I >> it's anxietyinducing almost, >> right? Like that that's the thing nobody wants to hear or accept that there's there there's there's not a comfortable way out of this. And I 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. And I think ultimately that's what exposure therapy is. I think that's, you know, you talked about it with yoga, we talked about it with exercise, like everything that works to some extent is uh an exposure to discomfort and a and an acclamation to a certain amount of discomfort. Like raising your your threshold of the amount of discomfort that you're willing to sit with. People don't like to hear that. People don't want to accept that.
They don't want they don't want to deal with the consequences of that.
>> It's why they leave therapy a lot of times, too.
>> Yeah.
>> It's it's too uncomfortable. I also think part of it is probably why uh some of the pharmaceuticals are are overprescribed. I imagine there are a lot of people that just ask for it. Just give me the pill, doc. I don't want to talk about my problems. I like I'm stressed. Like, you know, give me some Lexapro or like whatever. And the doctors are like, sure, here you go.
>> Yeah. Yeah. I And you know, doctor's case loads are high, too. You don't want to like pin too much on them.
>> We're not [ __ ] on doctors. Um what's your biggest surprise and what's your biggest takeaway?
>> Um my biggest surprise I mean, yeah, therapy. Uh, it was one of those things, I guess, though. 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.
>> It is interesting.
>> The lesson from that is old school like kind of like exposure to whatever you're anxious about. And just seeing again, it goes back like with the exercise, you have some agency over it. Exercise that agency. No, you can't control all of it.
That's also part of it, too, is just accepting that you can't control part of it.
>> Um, which is where ACT really shines, I think. But like the more you can build evidence, >> right, that you have some sort of agency around whatever you're worried about. It might not be ideal. It might not be a perfect solution, but I think it's not so much that we're always worried about what's going to happen. It's that we're worried that we don't know what's going to happen or we don't have any control over it. And while that's true, you don't have a lot of control over what happens uh to you, I I think you just do have a lot of agency around how you approach it and how you see it.
>> It's funny. I feel like we're we're just kind of landing back on stoicism.
>> Yeah. Yeah. I think stoicism is a good philosophy to >> little little bit of existentialism. I mean, >> we've noted before how much CBT seems to flow directly downstream from the Stoics. Um and CBT is >> the most effective you know, anxiety intervention. The biggest surprise for me I I I guess I guess it would be meditation and and maybe I've been discounting it too much lately, but and maybe also I discount it just because it's it's for me I never meditated for anxiety. That was never my issue. It my for me it was always more focus problems and also like self-exloration, self-awareness. I was very interested in a lot of philosophical questions around consciousness and identity. I guess that was a little bit a little bit surprising for me or just the the the size the significance of the effect size and therapy a little surprised not surprised one of the things I do tell friends is I say like the the one thing that therapy really punches its weight is is for anxiety like that I've seen over the years that consistently CBT especially like just >> for anxiety it's it's kind of the best thing you can go to. All right, everybody. That was another episode of the Solve Podcast. We have solved anxiety forever. Thank you everybody for listening. This was the Solve Podcast.
I'm Mark Manson. This is Drew Bernie. We will be back in a couple weeks. Go to solvepodcast.com/anxiety to download some free cool materials.
And if you haven't checked out Purpose, check out purpose.app. It is my AI coach that I co-founded. And we have a free 7-day trial so you can talk to the AI about all of your anxiety problems. And it will it will definitely let you know what it thinks. Like and subscribe, review, follow us, be be our friends. We love you.
See you next time.
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