Now that we’re in the middle of a pandemic, more people than ever are experiencing anxiety, especially those who struggled with mental health issues before COVID-19. And to make things even worse, many of our coping mechanisms, like going to the gym or hanging out with friends, have been taken away.
In today’s show, our host, Gabe Howard, talks with Dr. Jasleen Chhatwal, who helps explain why so many people are having anxiety symptoms and what we can do about it.
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Jasleen Chhatwal, MD, is Chief Medical Officer and Director of the Mood Disorders Program at Sierra Tucson, a premier residential behavioral health treatment center. Dr. Chhatwal also serves as Assistant Professor at the University of Arizona College of Medicine. Board certified in Psychiatry and Integrative Medicine, she is well versed in psychodynamic psychotherapy, cognitive behavior therapy, psychopharmacology, neuromodulation including ECT & rTMS, and various emerging modalities.
Dr. Chhatwal is active in the mental health community, advocating for her patients, colleagues, and profession through elected positions with the Arizona Psychiatric Society and American Psychiatric Association.
About The Psych Central Podcast Host
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.
Computer Generated Transcript for ‘Managing Anxiety’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Dr. Jasleen Chhatwal. She is the chief medical officer and director of Mood Disorders Program at Sierra Tucson, a premier residential behavioral health treatment center. Dr. Chhatwal, welcome to the show.
Jasleen Chhatwal, MD: Thanks for having me. I’m delighted to be here.
Gabe Howard: Well, we are super excited to have you here today because you’re also an anxiety expert, and many people who aren’t used to feeling the effects of anxiety are because of COVID. I want to start with, are you seeing people that never had anxiety and stress issues before suddenly developing anxiety disorders because of the global pandemic?
Jasleen Chhatwal, MD: I am noticing that there are a lot of people who notice anxiety type symptoms, and since they’ve never really experienced them before, they’re really taken aback and they don’t really know what’s going on. And so I feel like one of our big duties at this time is to help people become more aware, because I think once you can name the beast, then it’s a lot easier to tame the beast. And I think a lot of individuals will have a hard time if they don’t know what to call it or what to do with it.
Gabe Howard: The Psych Central Podcast has been on the air for almost five years, PsychCentral.com has been around for 25 years. So we are well versed in mental health advocacy. And for the most part, it’s always sort of been in its own little corner. There’s the people that have a mental health issue or a mental illness and they understand it. There’s people who develop one or have a loved one who develops a mental health issue or a mental illness, and they’re searching for information. But by and large, the majority of the population was not discussing this openly. We’ve seen that change dramatically in the last six months where suddenly it’s sort of mainstream news about how adults that never had any mental health issues before are suddenly suffering from the symptoms of depression, anxiety, stress, and on and on and on.
Jasleen Chhatwal, MD: So a lot of people talk about anxiety like it’s a pathological thing. I really try to explain to people how anxiety is normal. You have to have the neurobiological fear response to be safe as a human being. Like you’re going to the Grand Canyon and walking over the skywalk, the fact that we don’t just climb over the rail and try to jump down is because we do have a biological response to anything that’s not within the normal human experience or scope. If you think about having a snake by your chair, you want to have an anxiety response so that you can quickly panic and run. And what will happen if you don’t have that fear response is you will die because the snake will bite you or you’ll have some pretty negative consequences of that. How can you not have anxiety when you’re being told all day on the news that you need to take all these extra precautions to just be safe, to not fall sick, to make sure your loved ones don’t die. That is something that just normally will cause some degree of anxiety. The difference between that type of anxiety and what can be called a DSM anxiety disorder ends up being that it becomes overwhelming to the point that you can’t function. And what we start to see is people who may have had a higher level of anxiety before, but were being able to do things to help themselves, like going to the gym to work out or going for a run outside or spending time with loved ones. All those people, their coping skills have been taken away. And that is where you start seeing that they now fall into more of that clinical anxiety disorder category. If you look at most mental health conditions, they are on a spectrum. And it just really depends on how far along the spectrum you are today. It could be that today it’s a disorder. But, you know, a week ago or two weeks ago, it wasn’t quite meeting the criteria.
Gabe Howard: One of the themes that runs through The Psych Central Podcast is we try to explain that mental health and physical health actually are, they have a lot in common. Meaning most people have good physical health most of the time. But you can still get a cold. You can still get injured. And that’s a very temporary problem. But you can also have, for example, diabetes, which is severe and persistent and lifelong. Mental health is the same way. I think a lot of people think that you either have good mental health or you’re mentally ill and that there’s nothing in between. Do you believe that because of the pandemic, people are starting to realize that everybody has mental health and that you can have the equivalent of a cold, which in this case is stress and anxiety or panic? Do you think this is helping to educate people that we all have mental health and anything can trigger bad mental health?
Jasleen Chhatwal, MD: Yeah, I think reading a lot more content about that in very popular channels. Maybe your podcast or me like this is our world, but other people
Gabe Howard: Sure, yeah.
Jasleen Chhatwal, MD: For whom this is not their world, we are seeing them talk more about mental health. And in my own world, I try not to talk about somebody having just mental illness. I think about mental health on a continuum. You can do things every day to improve your mental health and you can do things every day that may not really be serving it well. The kind of food that you eat, the places that you go to, the people you spend time with, each of those things can help build up that mental health.
Gabe Howard: Dr. Chhatwal, thank you so much for establishing that more people are suffering from anxiety and that it’s a very real thing. We’ve been doing this work for a long time, so we’re not surprised by this. But I think that the general population is and one of the hallmarks of being surprised by something is that you don’t know what to do about it. Do you have advice for listeners who are overwhelmed, anxious and filled with stress due to the COVID-19 pandemic?
Jasleen Chhatwal, MD: The one thing that we can all do and maybe do a little bit better is starting to become more aware. Naming what is going on for you is really important and naming not in the sense of saying, oh, I have so-and-so disorder or diagnoses, but more naming like how does it feel for me? How am I feeling in my body? What are the signs that I’m seeing for myself? What are the changes that I’m seeing in my behavior? So recognizing that you’re not as engaged, you’re not as motivated or fulfilled to saying, OK, well, I don’t really feel like doing my work or when my children ask me a question, I feel exasperated and want to roll my eyes that that can be a step to saying, OK, something is definitely going on. And now let me sit and think how I’m feeling physically. What are the emotions I’m feeling? Some of us have a broader language for emotion and some of us have a narrower language and words for emotion. And that’s OK. Even being able to identify I feel good, I feel bad. That may be a great place to
start. And then starting to look at what are really options for you to start to change things that make you feel bad? Is it something related to your job, like either the hours are now feeling too much or the workload is feeling too much. Talking to your human resources department, or when it comes to your home life maybe getting together with your partner or people who live in the household with you, or if you live alone connecting with friends and starting to really talk through this and asking for the support that you might need. Another strategy can be then to start to follow some degree of a schedule, because we hear a lot about pajama sales are on the rise or that people are doing the zoom uniform with the formal top and shorts at the bottom.
Gabe Howard: I love that.
Jasleen Chhatwal, MD: Yeah, it’s comfortable and it can also give your mind a signal that you’re just supposed to be relaxing. However, what you’re doing is sitting in front of your computer and working. So now your mind is really confused. It’s like, well, I’m supposed to be feeling relaxed, but I’m doing work. So what we’re hearing from people is that they’re working longer hours because now they’re just connected on the computer all the time. They still have to take care of their children and now they have to go pick up their groceries and wipe them all down like everything’s become just a tiny bit or a whole lot more complicated. And so trying to at least get your life into a little bit of a schedule may make you say, OK, I start my workday at eight and then I am going to end it at five, just like I would normally clock out.
Jasleen Chhatwal, MD: And then maybe in that evening time you can start to recognize what are pleasurable activities that you can do in your home environment? I’m hearing from people that they can’t work out, but I can tell you, like doing push ups doesn’t take a lot of equipment. And so it may be deciding here right now I can only do five pushups a day. Within the next two weeks or a month, I’ll get up to ten. So setting realistic goals that make you feel like you’re being able to achieve something and that are in a direction of something. For myself, I think two or three months ago I was feeling like, oh, I’m just at home going to work, coming back. But I got myself an easel and canvas and I picked up something I hadn’t done in about a dozen years. I made a painting. It’s not great. I’m not going to sell it, but I did something that was enjoyable. Finding anything that you can do that serves your soul is really very important at this time.
Gabe Howard: When all of this started, we sort of had this mindset that, OK, we just need to hunker down and get through it, it’s only going to be a couple of weeks or even a couple of months. Now, here we are and we’re starting to learn that we don’t really know when this is going to be over.
Jasleen Chhatwal, MD: Yeah.
Gabe Howard: So now we’re sort of in this kind of like a limbo state where we don’t know if we want to make new habits that we want to last for years or if we should still stay in this, oh, things are going to get back to normal tomorrow. The example that I always use is, look, if I lost my job, I would understand that that job’s not coming back and I would prepare for a new future. But if I was laid off from that job and they told me that as soon as things pick up, we’ll call you back. Well, now what do I do? Do I look for a new job? Do I wait for things to pick up and they call me back and I resume my life? We don’t know when this is going to end. We don’t have that hard stop.
Jasleen Chhatwal, MD: My advice to people and my thought for myself and my loved ones is that this is maybe a time for us to really start reinventing and reconsidering what our new normal is going to be. We know that not only has the pandemic obviously affected our way of life drastically but also that there’s a potential financial crisis that’s brewing. So really looking at restructuring our lives and seeing are we really on the right path? And even as a human species is the direction that we’re going really the direction we need to go? In all the things that we cannot control, the thing we do get to control is how we’re going to react and how we’re going to start to make our own decisions in our lives. Connection is fairly important. Make sure that there is a regular way to connect with other human beings, even if you’re working from home. I’ve heard these amazing stories about families that do Zoom sessions every week or who will play card games on Zoom or might even just turn on something like a video platform and have conversations throughout the day.
Jasleen Chhatwal, MD: We’ve done things like with my in-laws and family where we watch a movie at the same time. Also, I think, starting to look in terms of employment and what are sustainable ways to work, because as a culture, we work a lot. And I think a lot of companies are now realizing that maybe people don’t need to be clocked on or on site as much as we previously thought they needed to be. So starting to really see if that is OK for you, because for some people, like telework does not work, and for others, telework seems like the best thing since sliced bread.
Gabe Howard: You’ve hit on a very interesting point there with your example of telework, some people absolutely love it other people absolutely hate it. We’re seeing this a lot with anxiety. Some people are handling this pandemic no problem. They have literally zero anxiety. Other people are falling apart at the seams. Why is it hitting some people harder than others? And then there’s this tendency, if you’re one of the people who anxiety is hitting you really, really hard to find somebody who’s managing this global pandemic like gangbusters and compare yourselves to them. And I imagine that makes it much more difficult to manage the anxiety and move forward.
Jasleen Chhatwal, MD: Comparison has always been one of those things that kills your drive and really starts to make you feel deflated because we don’t know what that other person’s life looks like. We don’t know what their life experiences have been. In mental health, now, we’ve noticed for a long time that our early lives have a huge impact on how we respond later on. And some people who are more anxious than others either at this point don’t have access to their usual coping strategies or the other thing could be that a person who has more anxiety likely had more adverse childhood experiences or early life trauma. Some of that trauma can get relived when you’re isolated, alone, don’t have support. And then finally, it can also sometimes be that you’ve had a really comfortable and quote unquote, normal life. And when suddenly something comes and upends your way of life, it may be your first time really facing something that feels overwhelming. So you may not have had practice at managing that before. So the more we think that others are doing well, the more likely it is that we’re more focused on them rather than ourselves. Rather than just sitting and saying, well, you know, Tom seems to be doing really well and I see that
Gabe Howard: Right.
Jasleen Chhatwal, MD: Gabe’s kind of killing it, being more connected with yourself is probably your best bet in being able to find that new normal and move forward post pandemic.
Gabe Howard: I really like what you said there about if we’re paying attention to others, were clearly not paying attention to ourselves and anxiety is not going to clear up by convincing it that Bob or Jane is living their best life and therefore I should be living my best life as well. It involves more nuance and work than that. Which leads me straight into my next question of how can I know if I’m being realistic about the risks and dangers and when I’m letting anxiety just simply get the better of me?
Jasleen Chhatwal, MD: Anxiety can get the better of anybody. It is a neurobiological response. We have this tiny area in our brain called the amygdala, whose job it is to give us fear signals. It’s really once you start feeling like you can’t quite function in your life, you’re not really being able to do the things that you typically can get done, or especially if you start having thoughts about suicide or not wanting to live or starting to feel like your life is not worth it. Those are danger signs and those are times I would say don’t even think, go seek help. There’s really no harm in seeking help. And if nothing else, most of our communities have what we call warm lines. And you can call those and speak to somebody and see if that starts to help you, because a lot of us may not be able to clearly think about what’s happening to us till we start speaking about it. I usually say, you know, if you go to a therapist, you can always decide you don’t go for the second visit. It’s not like they’re going to force you to come by. You at least start to tell your story and start to try that out as an option for if that’s going to help you or not.
Gabe Howard: We’ll be right back after these messages.
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Gabe Howard: We’re back discussing COVID-19 anxiety and stress with Dr. Jasleen Chhatwal.
Gabe Howard: Now, Sierra Tucson has started a program called Health Care Heroes, and that’s specifically designed to treat doctors, nurses, and other frontline health care workers coping with the trauma of disease and death from coronavirus. How can you help health care workers heal from this tragic experience? Because up until now, we’ve been talking about just lay people managing the pandemic, but they’re literally on the front lines.
Jasleen Chhatwal, MD: Health care workers are already at a greater risk of fatigue, burnout, suicide, and that was pre-pandemic. Most of us generally go to school and do years of training with the goal of helping other fellow humans. And so now that the pandemic has really challenged our own lives and we’ve also had to go to work with having increased anxieties about being exposed, most of us may also know fellow health care workers who may have contracted coronavirus and may even have lost their lives to coronavirus. From a health care worker perspective, I feel like life is more stressful than it has ever been. You are being called to really show up and help people. However, we also haven’t quite had all the tools that we typically need, for all the shortages of PPE, shortages of ventilators, increased hospital bed capacities. People are working longer hours. There is more expected of them and there’s less reward because we are losing our patients. We are seeing people be sicker. Health care workers themselves are experiencing helplessness. And there has been so much stigma around seeking mental health support for even lay people and then for health care workers, it’s compounded because we then have to start reporting it to our boards or we need to start telling people that we’re getting mental health treatment. A lot of health care workers are used to kind of putting on their armor and saying, I’m OK, I can work long hours, I can do what needs to be done. So, Sierra Tucson as a group, when we started looking through, how could we show up and help our community and help our people, we decided to try to create this program which we want to make it OK for people to say I’m not OK. That’s the message that we’re trying to give. It’s OK to need support. And we’re here for you. We are also health care professionals and we’re experts in trauma healing. And we’re uniquely positioned at this time to support our fellow health care professionals with a nurturing environment, trauma focused therapies, and then also additionally peer support. So finding ways to help them get back on that spectrum of mental health, to move closer towards mental wellness and further away from having a mental health diagnosis or mental illness. There are health care workers who already live with mental health conditions prior to this. So making it OK for them also to know that they can take time off and really care for themselves because they’re the most important person.
Gabe Howard: From my perspective, it doesn’t serve the greater society to have a health care worker who is so stressed out, so overwhelmed or is suffering from a mental illness or a mental health condition, not seek treatment, because how beneficial are they going to be to my care if they themselves are in crisis or potentially in crisis? So, do you want health care workers who know that they’re at risk for a mental health issue, not seek help because they’re afraid of the stigma, the discrimination, the judgment? That doesn’t serve the greater good. Are people starting to realize that? Do you see a shift both in terms of health care workers being willing to seek help and in the general society understanding that, hey, health care workers are people too?
Jasleen Chhatwal, MD: Interestingly, it seemed like maybe the pandemic has helped, that people are more accepting that, oh, this is traumatic and you’re hearing the word trauma a lot more. I would like to say it’s slowly improving. And I think the more the general public accepts mental health conditions, the easier it will be even for health care workers. But it’s still very hard. It’s still not a good place. We’re not doing well by our people. I think the big piece of that is that we’re separating physical and mental health and you just can’t do that. One thing affects the other. Even with something like anxiety, which is what
we’ve been talking about, you have physical symptoms. You feel like your heart is beating. You have chest pain. People show up to the E.R. thinking they’re having a heart attack when they’re having a panic attack. Unless we as a society, the health care system, insurance companies in their own areas start to really marry the two together and say it’s whole health, we really can’t get away from stigma. Like we said right in the beginning, everybody has mental health and everybody has physical health. And like the WHO says, there is no health without mental health. So we’ve got to get them together.
Gabe Howard: I completely agree with your assessment that the pandemic does seem to be helping mental health understanding because so many people are in the exact same boat. They themselves are suffering from anxiety because of COVID. So therefore, they’re less likely to be judgmental against somebody else who’s suffering from anxiety. Also, if a global pandemic doesn’t cause anxiety, I don’t know what will. For some reason when somebody says I’m anxious, our first question is why? And then we decide if that’s a good reason, that’s very unfair. Right? To determine if somebody is allowed to be anxious based on the reason that they give — anxiety doesn’t work that way. Is that correct?
Jasleen Chhatwal, MD: You’re exactly right, Gabe, anxiety can only be assessed by a person’s own barometer. So, myself, I’m not scared of heights. I used to skydive, but I have a friend. We went together to the Grand Canyon and they have a walkway on the Nevada side. And we were walking over it and she was like, nope, not doing it, not doing it. And I was like, oh, come on, we’ll walk and well, I’m trying to hold her hand. And she just couldn’t. So I can’t say she is more anxious than I am because it’s not the same for everything. She may not be anxious in a lot of other situations that I may be anxious in. And so anxiety is per your own context, and it is per the lessons you’ve learned in life for things that are fearful to you, the stories you tell yourself. And it’s usually from early life experience, you’ve either had a negative experience with something, so you’re more fearful of it, or you’ve been told stories about that thing that make you more worried. So there are all those components which fall into the nurture category. And then some people do have just a slightly higher sensitivity.
Jasleen Chhatwal, MD: And that becomes the nature element, which is your genetics, how your amygdala, which is the fear center, like how that’s tuned. And some people just have a more sensitive amygdala. Their fear response is greater. And then we also know that having negative experiences early on in life will make it that your fear center kind of reacts a lot quicker or may start to be easy to get stimulated. So if you’ve had a lot of early life trauma, it’s almost like your fear muscle is stronger so you can react a lot quicker and that is an evolutionary mechanism for human beings to keep themselves safe. So when we were hunter gatherers, if we were roaming around dangerous areas and there were going to be javelinas chasing us, then our fear around javelinas would need to be a lot more to protect ourselves. And for your listeners who don’t know what javelina is, you can Google it. It’s a wild animal. It’s a wild boar that we have here in Arizona. So that’s really my
Gabe Howard: Oh, wow.
Jasleen Chhatwal, MD: Closest context. They’re mean looking creatures.
Gabe Howard: Dr. Chhatwal, I have one more question, which is kind of an ironic question, and that’s why I saved it to the very end. All of the content surrounding COVID-19, it can be overwhelming. It can be disturbing. It can be hard to listen to. How can our listeners balance staying informed with the information that they need to stay safe like this podcast, for example, but also not be overwhelmed by this onslaught of negativity brought on by just constant COVID-19 information? Much of it scary, quite frankly.
Jasleen Chhatwal, MD: It really is. I’ve recommended and I practice this in my own life to take sort of a news break or a news holiday to stop listening to the news. Because when people are sitting at home, they’re just listening to the news channels all day sometimes. So really giving yourself a sliver of time when you look at whatever content that you want to look at and then put it away. Also looking at platforms that maybe present this news in a more palatable format. So maybe like your podcast.
Jasleen Chhatwal, MD: Everybody can tune in to Psych Central. You have a great sense of humor and you try to make it approachable. Some people listen to the late night comedy shows which will give you the information you need, but with a chuckle. You can also subscribe to news outlets now have daily newsletters that they can send you with the headlines. So maybe that you say, I’m not going to read all the news, I’m just going to get a newsletter and look at it once in the day. So that’s one way of reducing your exposure, not only in quantity, but also just in intensity. And then it’s good to balance it out with positive things, things that bring you pleasure, things that make you feel better about your world. I hope your listeners will do something to add value to somebody else’s life. And that may be in the form of helping out their neighbors who are elderly with their grocery shopping and may be checking in with their friends who are also stressed out. Creating some sort of a book club, whatever it is that is part of their own interest, but a way to start feeling better about yourself, because whenever we give value to somebody else, that’s really our best way of getting some positive back to us. That can be a way to move forward at this time with more kindness in our world and really being able to rebuild our communities in a more wholesome way and going in a direction, as a country, as a human species that will take us all in a positive direction with the lessons that we’ve learned from the pandemic. We can’t let these lessons go to waste. That would be a waste of a pretty awful condition. And usually, I think if there’s adversity, you want to try and get something out of that adversity, learn a lesson, build some resilience so that in the future you have more skills to move forward in your life.
Gabe Howard: We want to find the silver lining in the cloud.
Jasleen Chhatwal, MD: Definitely, yeah.
Gabe Howard: Thank you so much for being here. Where can folks find you online?
Jasleen Chhatwal, MD: I’m present on LinkedIn, which is one of the places I’m trying to get better at. I’m also on Twitter. I haven’t quite gotten the hang of Twitter yet, but I just started last week. That’s my goal for the next month. I’m going to try to learn this. And if any of your listeners are excellent at Twitter then I would say, please send me tips and I will help you with mental health education and sending you interesting information about mental health.
Gabe Howard: That sounds like a great deal. Once again, thank you so much for being here. We really, really appreciate it.
Jasleen Chhatwal, MD: Thanks so much, Gabe, it was so wonderful to talk to you.
Gabe Howard: All right, everybody, my name is Gabe Howard and I’m the author of Mental Illness Is an Asshole, which is available on Amazon, or you can get signed copies for less money by going to my website at gabehoward.com. You can also subscribe to the show’s Facebook page just by going to PsychCentral.com/FBShow. Please remember to subscribe to the podcast. Share us on social media. Rate, rank and review. Use your words. Tell people why they should listen and remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere, simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.