Hello, this is Richard Jacobs with the Finding Genius Podcast, now part of a Finding Genius Foundation. I have Dr. Ellen Vora. She’s a holistic psychiatrist and author and she has a book called “The Anatomy of Anxiety”, so we’re going to talk about anxiety. Ellen, thanks for coming.
Ellen Vora: Rich, thanks for having me here.
Richard: Tell me what’s your background? Did you suffer from anxiety yourself, how did you get into this area?
Ellen Vora: I got into this area because I’m a psychiatrist in practice and it felt like nearly every patient I was treating was struggling with anxiety to some extent.
Richard: Right. And what about the past two years? I’m sure it’s ramped up either a little or a tremendous amount; what do you see?
Ellen Vora: A little bit of an uptake in the last two years indeed. Yes, it was really already such a problem and I feel like I could have made claim to an epidemic of anxiety even before the pandemic. But it has just reached fever pitch since then.
Richard: So what are the different types of anxiety that people exhibit?
Ellen Vora: So the way I was trained in psychiatry residency is to break the anxiety down into these different categories like generalized anxiety disorder and panic disorder with or without a agoraphobia, social anxiety, PTSD, OCD and all of this. And that’s not actually what I find to be most useful in my practice. The idea behind these classifications is always the steer management like when is medication indicated, when a different therapies like cognitive behavioral therapy indicated. The way I see it, I break anxiety into two categories: False anxiety and true anxiety. And false anxiety is really what I consider to be avoidable anxiety. It’s unnecessary anxiety, it’s caused by seemingly benign aspects of modern life that tip our physiology a little bit out of balance and create a stress response in the body that then feels exactly like anxiety. And true anxiety is really something that’s not avoidable and not something that we could medicate away if we wanted to. It’s not something that we should pathologize, I think that true anxiety is really something coming from deep within us kind of a call-to-action or a true north that tells us “Hey, slow down, there’s something not right in the world around you. Please pay attention”.
Richard: So I guess everyone probably has like a lifestyle induced anxiety but then for some people, there’s a deeper core anxiety as well, it sounds like?
Ellen Vora: Exactly.
Richard: So when you work with someone, do you first focus on the I don’t want to call self-cause but lifestyle induced anxiety, strip that away first and then see if there’s any core left? What’s your methodology?
Ellen Vora: That’s the strategy. I think of the false anxiety as the low hanging fruit, unlike the way we think about mental health as our thoughts, our behaviors, our genetic chemical imbalance, something that might require medication and 7 years of anxiety. False anxiety is something that we can usually remedy in a matter of weeks or months and just get the physical body into the state of balance and then we see what remains after that. Some people really are no longer identifying as anxious after they’ve gotten the physiology back in the balance.
Richard: What are some of the things people can do to take the edge off their environmental or lifestyle induced anxiety?
Ellen Vora: Yes, there are a lot of different strategies that we can take. For many patients, I start with blood sugar. I think a lot of anxiety is actually just the feeling of the stress response caused by a blood sugar crash and many of us in modern life are swinging wildly up and down with their blood sugar because our modern American diet is so blood sugar destabilizing. For some people, it’s healing the gut or decreasing inflammation throughout their body. Sometimes it’s about depleting missing nutrients. There are sometimes micro-nutrients like B12 that many of us are deficient in, Magnesium is another one and improving sleep quality is one of my favorite things to do to treat anxiety. That can really just be a matter of getting very strategic about light exposure to make sure our circadian rhythm is functioning properly so we get tired at the appropriate time at night and fall asleep and sleep deeply. Exercise breath work, even sometimes some functional manual therapy to make sure that we’re breathing properly through the nose. There are so many different ways to approach the physical body and the ways it gets tripped up into a stress response.
Richard: So when people come to you, what solution do they want? Like what do they tell you is going on with them? Are there certain archetypes or stories you hear over and over and then what do they tell you would they want versus what you suggest them to do?
Ellen Vora: That’s a great question. I think it depends on the phase of my career earlier on when I was working in more of a conventional setting. People sort of wanted the more disease-model understanding of their anxiety like “This is genetic, it runs in my family, it’s something I have no power over and so give me the meds” basically. And there’s sort of a coddling approach that I think we’re culturally conditioned to really want right now, which is to tell people there’s nothing you can do to control this, it’s not your fault and so basically to release any blame and shame that people carry around with mental health, to release any stigma and they want to be told this is a genetic disease. And I have nothing against, like I’m not here to support blame, shame, stigma, like that’s not what I’m here for but I do think in a way that shouldn’t be seen as shaming or overwhelming but instead seen as empowering and hopeful. I want people to realize that they actually do have some ability to influence their mental health, that their aspect of our diet and lifestyle that determine how our mental health manifests. There’s often a genetic pre-disposition but it’s a pre-disposition, it’s not a destiny. And in functional medicine, we say genetics loads the gun, environment pulls the trigger. So I like to teach people about environment.
At this point in my practice, since I’m known as a holistic psychiatrist, no one’s coming in to see me for the conventional approach. They’re jumping through many hoops and waiting for years on a wait list to finally come in and say like “How can I approach my anxiety holistically?”
Richard: Is that what they say is holistically or “How can I get rid of my anxiety” or how do they express it to you?
Ellen Vora: Yes. So I think a lot of people come to see me because they’re actually already on psychiatric medication and they want to get off and they have not found a psychiatrist who was knowledgeable about that or supportive of that process. So sometimes they’re trying to say to me “I don’t think the meds have been the answer, they haven’t been sufficiently helpful but I’m stuck”, that’s when they try to go off, they get very symptomatic. And so that’s a big problem. People are tipped into withdrawal when they try to taper off their psych meds and so a big part of what people are asking from me is to support that process and to do that skillfully and with a lot of different strategies to make sure it goes smoothly and we can sustainably get somebody off of meds. But some people, basically they want to go deeper. They want to know both the false anxiety strategies, especially like very customized to their own physiology and some people want guidance on how to dive into the true anxiety, how to do that more psycho-spiritual inquiry to understand where we’re blocked, where we’re out of alignment, where we have some deeper seeking to do.
Richard: Yes, what does that look like? What’s the protocol you have for people that — how do you figure out what’s going on with them and how to help them? And it sounds like they have to do it themselves for the initial part, so what do you tend to suggest to people?
Ellen Vora: Yes. That is somewhat protocolist. That is a walk through jungle with somebody and I’m trained as a psychiatrist, as a therapist, so I have at this point a lot of practice observing somebody and understanding based on their micro-expressions and where they have resistance, where they’re not comfortable talking about something, usually that helps guide me. And I really think of myself as like I’m just at their side walking through the jungle with them shining the flashlight on the path ahead, so I’m looking for those kinds of signs to know that that’s where we need to be walking. And I have found that when safe and indicated and appropriate psychedelic medicine is sometimes a good support to help people really connect to some kind of deep, sometimes guarded, inner-truth and it also helps people reclaim sort of engagement in their lives and it can make somebody feel a lot more inspired and hopeful.
Richard: This just sounds someone generically. What are some examples, without naming names of issues people have had that you have helped them work through, like what was the linchpin that took away their anxiety or helped them feel better?
Ellen Vora: So I think of one patient that comes to mind. She originally came to see me so many years ago and there were many layers of false anxiety that was the first thing that we needed to address. She was inflamed, her hormones were out of balance, she had acne, she had migraines, she had polycystic ovary syndrome, she was on a number of different medications and anti-depressant and anti-anxiety drug, a benzodiazepine, something for a stimulant for her ADHD, a sleep aid and birth control pill. And so we worked on her getting her body back into balance. It turns out many times she was having a panic attack as a result of a blood sugar crash, so we stabilized her blood sugar by transforming her diet to more of a blood sugar stabilizing diet. And then we also noticed a pattern with her hormones and she would get very depressed with hormonal swings, so in the end, we ended up taking her off birth control and using different kinds of inflammation, so targeting inflammation to take her out of this very symptomatic polycystic ovary syndrome that she was struggling with.
And then in the end, improving her sleep quality and getting her off the sleep aid helped her with her focus so then she no longer needed her stimulant. But her anxiety was sort of still the problem for really long time and she was still taking a Benzodiazepine and I started to realize that she was in something called interdose withdrawal, so basically she would be relying on Klonopin and every time her body sort of would get to the needer or the point where pharmacologically she metabolized most of the Klonopin and she was coming down from it, it would make her feel pretty panicked. And so she kept needing more just to get the same effect and we could have just stayed on that treadmill and just kept increasing her Klonopin for year after year but I didn’t feel good about that. And what we did instead was we very gradually taper her off of the Klonopin and that was a rough process but she did eventually get off of the Klonopin and she is at this point off of all medications, her hormones are working like clockwork, her digestion is working like clockwork, she exercises, she sleeps well, she’s really seen so many leaps and bounds of improvement with her social life and her career and she’s doing well. And there’s been some true anxiety along the way, she really needed to get out of the bad job. She actually needed to change geography and live in a place that was more of the right fit for her and she’s really thriving at this point in her life.
Richard: All right, that’s good. I don’t know, so what about these deep-seated anxieties that really changing environments or habits or diet can’t reach? Is there a lot of it, is there a little bit of it and what’s the cause for those?
Ellen Vora: It depends. We’re all different. I think for some people, there’s like a giant inconvenient truth that they kind of know on a deep, deep-guarded level but they haven’t really admitted to themselves. Maybe that’s we need to change a relationship we’re in or we need to change career path and we know that if we open up to that, it would kind of blow up our lives. So we resist it but I think that creates anxiety to be living in that bit of denial. So once we tip-toe towards it and start to really open up and explore that, that actually is never as scary as it seems in our imagination and then we can take steps accordingly and that really transmutes our anxiety from kind of like dread intention into a feeling of purpose.
And some people, it’s much more global like they might feel in alignment with how they’re living their day-to-day lives but they feel really called to be an activist about something whether it’s climate change or mental health stigma or any number of other causes and so they know that unless they’re taking action to help remedy a situation that they feel is wilfully wrong in the world, there’s attention until they start to take steps to remedy it.
Richard: What do you mean? How are they supposed to change the world? How are they supposed to do that first of all and what do they just have to give in and say “Okay, I can change the world” or “Do what they can” or what do you mean?
Ellen Vora: This is a bigger question but basically what can any of us do is just one foot in front of the other and make whatever impact we are in a position to make. So it doesn’t have to be grand, it doesn’t have to solve the whole problem in one fell swoop, we can’t expect ourselves to boil the whole ocean but we can’t also just ignore the problem and say “Hey, I can’t fix it all myself, there’s no point in doing anything”, we have to take at least some small step.
Richard: Okay. I mean do you have any recommendations for people and how they can work with their anxiety in a better way than they are currently?
Ellen Vora: Yes. I think that you want to first just open your eyes and become aware of all the ways that you might be getting physiologically tipped into a stress response and that this is not your identity, this is not your true anxiety, this is something really unnecessary and avoidable. So keep an eye on your blood sugar, on your sleep quality, on how your digestion is feeling and notice when you’re feeling anxious, does it track with any of these benign aspects of your physiology. And then beneath that, listen for what your true deeper anxiety is telling you. Don’t see the anxiety as a nuisance, see it as a communication and try not to pathologize it, feel no shame about it and basically let it be a cult action that you slow down, you pay attention, you listen to what that little quiet voice from within is trying to whisper.
Richard: Okay. I mean if someone’s anxious, I don’t know how they could listen to anything. They’re anxious, how do they calm down or take the edge off so that they can reflect and what are the levels of anxiety you’ve seen where people just can’t do anything versus they’re able to think and help themselves?
Ellen Vora: Yes. I’m not sure I want to use the word that you used “calm down”, I think I’m telling people to slow down so it’s more like you get still and you sit and you listen. And sometimes that can be very uncomfortable, it doesn’t have to look calm or feel calm, it often doesn’t but it’s kind of honoring ourselves, it’s not just trying to distract or avoid or numb out from our feelings. That’s a very common cultural practice is let’s eat to avoid, let’s get drunk to avoid, have sex to avoid, work to avoid and basically always avoid feeling our feelings and it’s instead permitting to sitting right in the middle of our feelings and actually letting our feelings move through us and to truly metabolize them in that way.
Richard: What are some resources for people that are experiencing anxiety that you think will be helpful to them?
Ellen Vora: There are so many. I mean I think my book helpfully can serve as a resource, The Anatomy of Anxiety, I think that there’s incredible resources online around mindfulness mediations, so many good apps to support that. And I think that really whatever somebody is drawn to, if you know that you want to do dance or movement or journaling or morning pages that there’s so many different resources and practices to make sure that you’re slowing down and tuning into whatever your body is trying to communicate to you.
Richard: Should people see a psychiatrist or psychologist or should they try and help themselves or what would be a set of general possibilities or recommendations for people to try?
Ellen Vora: Yes. So it’s actually I think more of a nuanced issue than most people realize. I think of course there’s an easy thing to say, which is like get treatment, get into care. I wish that there was a perfect system to that but there isn’t. So we have problems of accessibility and affordability when it comes to mental health care. And I harbor a different issue with it, which is that I think even if you’re the lucky one and you make it past the hurdles of affordability and accessibility and you get into see a mental health professional, sometimes that means that you talk for 15 minutes and you walk out with a prescription. And I don’t think that that’s actually really good care. I don’t think it’s understanding the full breadth of your experience and what you’re going through and what would help you and so then you’re just on meds for a long time, sometimes without appropriate follow-up and it’s not a great recipe for ultimately thriving and doing well.
So I think that part of my message is to let people know that when safe and appropriate, you can start on your own at home. There’s a lot that we can do as individuals for ourselves to support our mental health. It doesn’t have to be gate-keep behind the hallowed halls of the mental health profession even just improving the quality of our sleep, prioritizing our sleep, moving our bodies, getting some exercise, nourishing ourselves, feeling our gut a little bit, getting out into nature, getting some sunshine, connecting with our community, these are also determined into environmental health and these are things that we can often do for free for ourselves and we can feel better.
Richard: What types of anxiety you’re seeing increasing now as the face of anxiety changing again especially over the past two years?
Ellen Vora: I’m not sure there’s a changing quality, there’s just a change in how many people are struggling and to what degree. I think that if anything, the one qualitative change I’m seeing is more of a kind of languishing state where people have really just totally exhausted their search capacity, they’re burnt out and now they’re just sort of running on empty at this point. So it’s a very anxious and depleted state sort of simultaneously wired and depleted and I’m seeing a lot of that at this point in a pandemic.
Richard: Okay. So are the recommendations different for people that are damaged by the pandemic or same is just what you said before?
Ellen Vora: I think it’s a tricky situation. When you feel damaged by the pandemic, I mean ideally what we would do is we would start to meet our fundamental human needs that we haven’t been meeting, the need for community to not feel isolated for parents or anybody who just feels like they haven’t had any time to themselves or any space. They need to fill their cup in those ways, they need a little bit of a break and for many us, that is still not easily accessible but I think that people need a release, they need something to support them, they need to be processing what they’re going through, talking out loud whether it’s with a friend or a community or a support group or a therapist and I think that in essence the suggestions in my book are not really — like that’s very appealing to many of us, like if I have this kind of anxiety, I should take this supplement and it’s not so much like a matching puzzle like that, it’s really like all of these things, in a very elegant way, support all of these different states of depletion and anxiety. So improving the sleep quality is going to help all forms of anxiety and all forms of burnout and depletion.
Richard: Well, very good. What’s the best ways for people to find out more about your work and your suggestions, where can they go?
Ellen Vora: So I’m very active on Instagram, I’m @ellenvoramd and I have a website ellenvora.com and then my hope is that my book “The Anatomy of Anxiety” can really be a tool that people can lean on to help support them with their anxiety.
Richard: A quick question about the book. What are some of the highlights of that you want to mention that people would get out of reading the book?
Ellen Vora: So the book is really split into two sections and the first half is very focused on the false anxiety. So it’s very actionable strategies that help you identify where is your body getting out of balance and what can you do about it with a real appreciation for behavioral psychology and the fact that this is hard. So a very gentle, accessible bite size steps that you can take. And then, the second half of the book is really understanding these deeper psycho-spiritual questions at play with anxiety, so there’s a little bit of a metaphysical angle, there’s a bit about connection of spirituality and purpose and there’s a lot about helping us find the way that works for us to connect to that inner whisper. So whether that’s meditation or working the psychedelics or different kinds of movement practices that you figure out what’s right for you in terms of getting still and getting quiet, hearing that true anxiety.
Richard: Very good. Well, Ellen, thanks for coming on the podcast and I appreciate it and I want to check out your book and thanks for your help.
Ellen Vora: Okay. Thanks so much for having me.
