Now that we’re in the middle of a pandemic, more beings than ever are experiencing anxiety, especially those who struggled with mental health issues before COVID-1 9. And to shape 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 legion, Gabe Howard, talks with Dr. Jasleen Chhatwal, who helps explain why so many beings are having anxiety symptoms and what we can do about it.

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Guest information for’ Managing Anxiety’ Podcast Episode

Jasleen Chhatwal, MD, is Chief Medical Officer and Director of the Mood Disorders Program at Sierra Tucson, a premier suburban behavioral state care hub. Dr. Chhatwal too suffices as Assistant Professor at the University of Arizona College of Medicine. Board showed in Psychiatry and Integrative Medicine, she is well versed in psychodynamic psychotherapy, cognitive behavior therapy, psychopharmacology, neuromodulation including ECT& rTMS, and many emerging modalities.

Dr. Chhatwal is active in the mental health community, advocating for her patients, peers, and professing through elected orientations with the Arizona Psychiatric Society and American Psychiatric Association.

About The Psych Central Podcast Host

Gabe Howard is an award-winning columnist and orator who lives with bipolar disorder. He is the author of the popular record, Mental Illness is an Asshole and other Findings, available from Amazon; ratified mimics are also available directly from the author . To know 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 engendered and therefore may contain mistakes and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest professionals in the field of psychology and mental health share thought-provoking information using plain, daily word. 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 emcee Gabe Howard and calling into the show today, we have Dr. Jasleen Chhatwal. She is the chief medical officer and head of Mood Disorders Program at Sierra Tucson, a premiere residential behavioral health therapy core. 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 too an distres professional, and countless 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 questions before abruptly developing anxiety ills because of the world-wide pandemic?

Jasleen Chhatwal, MD: I am noticing that there are a lot of people who notice anxiety type evidences, and since they’ve never genuinely suffered them before, they’re certainly taken aback and they don’t genuinely know what’s going on. And so I feel like one of our large-hearted imperatives at this time is to help people become more aware, because I study once you can name the brute, then it’s a lot easier to domesticate the ogre. And I reckon a lot of individuals will have a hard time if they don’t know what to call it or what the hell is do with it.

Gabe Howard: The Psych Central Podcast has been on the breath for almost five years, PsychCentral.com has been available for 25 times. So we are well versed in mental health advocacy. And for the best 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 evidences of depression, tension, stress, and on and on and on.

Jasleen Chhatwal, MD: So a lot of people talk about tension like it’s a pathological thing. I genuinely 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 sauntering over the skywalk, the facts of the case that we don’t time advance over the rail and try to movement down is the fact that 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 lope. And what happens if you don’t have that horror response is you will die because the snake will pierce you or you’ll have some somewhat negative consequences of that. How are you able not have anxiety when you’re being told all day on the report that you need to take all these extra precautions to time be safe, to not precipitate sick, to make sure your loved ones don’t die. That is something that really ordinarily will start some degree of anxiety. The difference between that type of anxiety and what can be called a DSM anxiety disorder aims 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 setting 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 suspicion agitation list. If you look at most mental health conditions, “theyre on” a range. And it just really depends on how far along the range you are today. It could be that today it’s a agitation. But, you know, a week ago or two weeks later, it wasn’t relatively 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 state actually are, they have a lot in common. Meaning most people have good physical health the majority of cases. But you can still get a cold. You can still get injured. And that’s a highly temporary question. But you are eligible to have, for example, diabetes, which is severe and persistent and lifelong. Mental health is the same way. I recall 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, parties are starting to realize that everybody has mental health issues and that you can have the equivalent of a cold, which in such cases is stress and distres or panic? Do you think this is helping to educate people that we all have mental health and anything can trigger bad mental health issues?

Jasleen Chhatwal, MD: Yeah, I foresee reading a lot more content about that in very popular canals. 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 nature, 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 acting it well. The kind of food that you chew, 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 to hear this. But I think that the general population is and one of the specific characteristics 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-1 9 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 calling not in the sense of saying, oh, I have so-and-so disorder or diagnoses, but more appointing like how does it feel for me? How am I feeling in my form? What are the signs that I’m examining for myself? What are the changes that I’m examining in my behavior? So recognizing that you’re not as locked, you’re not as caused 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 irked and want to roll my gazes 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 spirits I’m feeling? Some of us have a broader language for excitement and some of us have a narrower language and oaths for ardour. And that’s OK. Even being able to identify I feel good, I feel bad. That may be a great situate to

start. And then starting to look at what are really options for you to start to change things that determine 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 agency, or when it comes to your residence life perhaps getting together with your spouse 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 help 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 outfit with the formal top and short-changes at the bottom.

Gabe Howard: I adore that.

Jasleen Chhatwal, MD: Yeah, it’s pleasant and it can also give your mind a signal that you’re merely supposed to be relaxing. However, what you’re doing is sitting in front of your computer and acting. So now your memory is really confused. It’s like, well, I’m supposed to be feeling loosened, but I’m doing work. So what we’re hearing from parties is that they’re driving longer hours because now they’re really 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 lick them all down like everything’s become merely 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 prepare you say, OK, I start my workday at eight and then I am going to end it at five, just like I was usually clock out.

Jasleen Chhatwal, MD: And then maybe in that evening time you can start to recognize what are enjoyable undertakings that you can do in your residence environment? I’m hearing from beings that they can’t work out, but I can tell you, like doing push ups doesn’t take a lot of rig. And so it may be deciding here right now I is impossible to do five pushups a epoch. Within the next two weeks or a month, I’ll get up to ten. So mounting realistic goals that procreate you feel like you’re being able to achieve something and that are in a direction of something. For myself, I picture two or three months ago I was feeling like, oh, I’m only at home going to work, coming back here. 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 coating. 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 feeling 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 been 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 genuinely 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 government where we don’t know if we want to do brand-new attires that we are ready to last for years or if we should still stay in this, oh, things are going to get back to ordinary tomorrow. The instance that I ever use is, watch, if I lost my job, I would understand that that job’s not coming back here and I would prepare for a brand-new future. But if I was laid off from the number of jobs 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 “peoples lives”? We don’t know when this is going to end. We don’t have that hard stop.

Jasleen Chhatwal, MD: My advice to parties and my suppose for myself and my loved ones is that this is maybe a time for us to really start reinventing and reconsidering what our brand-new regular is soon to be. We know that not only has the pandemic patently affected our way of life drastically but likewise that there’s a potential financial crisis that’s brewing. So actually looking at restructuring our lives and watch are we really on its path? And even as a human species is the direction that we’re vanishing 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 impel our own decisions in “peoples lives”. Connection is fairly important. Make sure that there is a regular route to connect with other human beings, even if you’re working from residence. I’ve heard these amazing storeys about families that do Zoom times every week or who will play card tournaments on Zoom or might even only turn on something like a video platform and have discourses 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 thoughts, starting to look in terms of employment and what are sustainable ways to work, because as a culture, we work a lot. And I guess a great deal of companionships are now realizing that maybe parties 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 instance of telework, some people perfectly love it other people utterly hate it. We’re seeing this a lot with distres. Some parties are handling this pandemic no problem. They have literally zero nervousnes. 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 administering this world pandemic like gangbusters and compare yourselves to them. And I imagine that performs 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 certainly starts to conclude “youre feeling” collapsed because we don’t know what that other person’s life looks like. We don’t know what their life suffers ought to have. In mental health , now, we’ve noticed for a very long time that our early lives have a huge impact on how we react later on. And some people who are more desirous than others either at this pitch don’t have access to their customary coping policies or the other thing could be that a person who has more anxiety likely had more adverse infancy knowledge or early life trauma. Some of that trauma are able to obtain 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 repeat unquote , normal life. And when abruptly something comes and upends your way of life, it may be your first time certainly facing something that feels overwhelming. So you may not have had practice at finagling 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. Preferably than simply 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 affix pandemic.

Gabe Howard: I really like what you said there about if we’re paying attention to others, has significantly not to listen 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 subtlety and labor than that. Which causes me straight into my next question of how can I know if I’m being reasonable 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 insignificant sphere in our mentality called the amygdala, whose task it is to give us horror signals. It’s certainly formerly you start feeling like you can’t fairly function in your life, you’re not really being able to do the things that you typically can get done, or extremely if you start having envisages 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 periods I would say don’t even anticipate, go seek help. There’s certainly no mischief in striving assistant. And if nothing else, most of our communities have what we call warm orders. And you can call those and speak to somebody and see if that starts to help you, because a great deal of us may not be able to clearly think about what’s happening to us till we start speaks with it. I frequently 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 policy options 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-1 9 nervousnes 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 are you able cure health care workers mend from this tragic experience? Because up until now, we’ve been talking about really lay parties managing the pandemic, but they’re literally on the front lines.

Jasleen Chhatwal, MD: Health care workers are already at a greater risk of tirednes, burnout, suicide, and that was pre-pandemic. Most of us generally attend school and do years of training with the goal of helping other fellow humen. And so now that the pandemic should certainly challenged our own lives and we’ve also had to go to work with having increased suspicions about being disclosed, 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 traumatic than it has now been. You are being called to really show up and help people. However, we also haven’t quite had all the tools that we generally need, for all the shortages of PPE, shortages of ventilators, increased hospital bunked capabilities. People are working longer hours. There is more expected of them and there’s less honor 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 trying 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 timbers or we need to start telling parties that we’re coming mental health treatment. A lot of health care workers are used to kind of lay 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 working group, when we started looking through, how could we is an indication and cure our community and help our people, we decided to try to create this program which we want to make it OK for beings to say I’m not OK. That’s the meaning that we’re trying to give. It’s OK to need support. And we’re here for you. We are likewise health care professionals and we’re experts in pain healing. And we’re uniquely positioned at this time to support our fellow health professional with a nurturing environment, pain focused therapies, and then also additionally peer endorsement. 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 forming it OK for them too to know that they can take time off and genuinely care for themselves because they’re the most important person.

Gabe Howard: From my point of view, it doesn’t provide the greater society to have a health care worker who is so stressed out, so overwhelmed or suffers from a mental illness or a mental health condition , not strive therapy, because how helpful are they going to be to my maintenance 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 judgements? That doesn’t act the greater good. Are people starting to realize that? Do you consider a transformation 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 more?

Jasleen Chhatwal, MD: Interestingly, it seemed like maybe the pandemic has helped, that people are more accepting that, oh, this is harrowing and you’re hearing the word trauma a lot more. I would like to say it’s gradually improving. And I judge the more the public abides mental health conditions, the easier it will be even for health care workers. But it’s still very difficult. It’s still not a good target. We’re not is working well by our people. I reflect the big part of that is that we’re separating physical and mental health and you time can’t do that. One thing feigns 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. fantasizing they’re having a heart attack when they’re having a panic attack. Unless we as a society, the health systems, insurance companies in their own neighbourhoods 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 state. 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 parties are in the exact same boat. They themselves are suffering from anxiety because of COVID. So hence, they’re less likely to be judgmental against somebody else who’s suffering from anxiety. Also, if a global pandemic doesn’t generate feeling, I don’t know what will. For some reason when mortal 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 cause — feeling doesn’t work that road. Is that remedy?

Jasleen Chhatwal, MD: You’re exactly right, Gabe, suspicion 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 pas. And she exactly 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 suspicion is per your own context, and it is per the lessons you’ve learned in life for things that are fearful to you, the fibs you tell yourself. And it’s usually from early life knowledge, you’ve either had a negative experience with something, so you’re more terrible of it, or you’ve been told storeys about that thing that constitute you very worried. So there are all those components which fall into the nurture category. And then some people do has only just been a slightly higher sensitivity.

Jasleen Chhatwal, MD: And that becomes the nature component, which is your genetics, how your amygdala, which is the fear center, like how that’s tuned. And some people merely have a more sensitive amygdala. Their fear response is greater. And then we also know that having negative knowledge early on in life will make it that your horror centre kind of greetings a lot quicker or may start to be easy to get quickened. So if you’ve had a lot of early life damage, it’s almost like your fear muscle is stronger so you can act a lot quicker and that is an evolutionary mechanism for human being to keep themselves safe. So when we were hunter gatherers, if we were roaming around perilous areas and there were going to be javelinas chasing us, then our nervousnes 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 swine. 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 ogling creatures.

Gabe Howard: Dr. Chhatwal, I have one more question, which is kind of an paradoxical question, and that’s why I saved it to the very end. All of the content circumventing COVID-1 9, it can be overwhelming. It can be disturbing. It can be hard to listen to. How can our listeners match 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 brings with it by only constant COVID-1 9 datum? Much of it terrifying, quite frankly.

Jasleen Chhatwal, MD: It really is. I’ve recommended and I rehearse this in my working life to take kind of a story divulge or a report anniversary to stop listening to the news. Because when people are sitting at home, they’re just listening to the news directs all day sometimes. So actually giving yourself a shred of time when you look at whatever content that you want to look at and then put it away. Too looking at programmes 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 congenial. Some beings listen to the late nighttime comedy evidences which will give you the information you need, but with a laughter. You can also subscribe to news channels 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 formerly in the day. So that’s one action of reductions in your show , not only in capacity, but also only in ferocity. And then it’s good to balance it out with positive things, things that bring you pleasure, things that constitute 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 browsing and may be checking in with their friends who are also stressed out. Creating some sort of a record organization, whatever it is that is part of their own interest, but a course to start “re feeling better” about yourself, because when we are utter price to somebody else, that’s actually 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 countries around the world and genuinely being able to rebuild our communities in a more healthful course and going in a direction, as a number of countries, as a human species that will make us all in a positive attitude with the lessons that we’ve learned from the pandemic. We can’t cause these exercises go to waste. That would be a waste of a pretty awful condition. And often, I think if there’s adversity, you want to try and get something out of that catastrophe, to draw lessons, build some resilience so that in the future you have more talents to move 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 better for being now. Where can kinfolks 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 come the hang of Twitter hitherto, but I really 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, satisfy cast 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 very much for being here. We really, truly appreciate it.

Jasleen Chhatwal, MD: Thanks so much, Gabe, it was so wonderful to talk to you.

Gabe Howard: All right, everybody, my reputation is Gabe Howard and I’m the author of Mental Illness Is an Asshole, which is available on Amazon, or you can get signed transcripts for less money by going to my website at gabehoward.com. You can also subscribe to the show’s Facebook page really by going to PsychCentral.com/ FBShow. Please remember to subscribe to the podcast. Share us on social media. Rate, grade and discus. Use your words. Tell people why they should listen and remember, you can get one week of free, opportune, economical, private online advise any time anywhere, simply by visiting BetterHelp.com/ PsychCentral. We’ll ascertain everybody next week.

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