Navigating Anxiety: What’s Normal, What’s Not & What Helps | Dr. Tracey Marks

Summary

Podcast Summary: Good Life Project

Episode: Navigating Anxiety: What’s Normal, What’s Not & What Helps
Host: Jonathan Fields
Guest: Dr. Tracey Marks (Psychiatrist, Author of Why Am I So Powerful?)
Date: February 23, 2026

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Episode Overview

This episode unpacks the complicated landscape of anxiety with Dr. Tracey Marks, who draws from over two decades of psychiatric practice and her work as an educator. The conversation explores the spectrum from everyday anxiety to anxiety disorders, emphasizing a compassionate understanding of normal physiological responses and when anxiety becomes a functional impairment. Dr. Marks offers practical insights on tools, treatments, and the importance of changing one’s relationship with anxiety—moving away from a mindset of elimination toward acceptance and management.

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Key Discussion Points & Insights

What is Anxiety?

[04:15] Dr. Tracey Marks explains:

• Anxiety is an emotional, fear-based response to threat or the need for self-preservation.
• Not all anxiety is pathological:

  “There's just the emotional experience of anxiety that everyone has. That's not a disorder.” [04:15]

• Anxiety disorders occur when the response is persistent, unlinked to real threat, and interferes with life quality.

Fear-based Cognition

• Anxiety largely stems from fear about the future or adverse outcomes—ranging from tangible threats to more abstract worries.
• The amygdala in the brain plays a key role in threat perception.

  “The concern that something bad is going to happen…is really fear.” [05:22]

Normal vs. Disordered Anxiety

• Healthy anxiety motivates protective or productive action (e.g., taking precautions in a dark parking lot, meeting deadlines).

  “Anxiety can motivate us as well to do things that we should be doing.” – Dr. Tracey Marks [09:54]

• Pathological anxiety persists beyond the trigger, catalyzes avoidance, and causes significant distress or impairment (social, occupational, personal).

  “We call it catastrophizing, like thinking of the worst case scenario…always assuming bad things are going to happen.” [11:06]

• Avoidance often reinforces anxiety, and people are usually aware of how anxiety limits their behavior, though not always the extent.

Physical Symptoms and Misattribution

[19:56] Dr. Tracey Marks:

• Anxiety can manifest physically (nausea, vomiting, palpitations) even when no medical cause is found.
• Many seek medical help first, believing the issue is physical, before recognizing it as anxiety.

  “Oftentimes they will think it's something physical and it's not anxiety.” [19:56]

Causes of Anxiety

• Genetic and Environmental:

  “Anxiety disorders run in families.” [21:11]

  • Can be inherited genetically or learned through parental modeling.
• Some people have a lower tolerance for uncertainty—sometimes a genetically influenced temperament.

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Tools, Treatments & Approaches

A Toolkit, Not a Silver Bullet

[23:44] Dr. Tracey Marks:

• No single solution fits everyone; effectiveness depends on individual preferences and resonance.

  “It's not about this one thing will erase all of your anxiety. It's what works for you.” [23:44]

Medication

• Antidepressants (often SSRIs/SNRIs) are first-line for daily anxiety.
• Buspirone (Buspar): Another daily option.
• Benzodiazepines (e.g., Xanax, Klonopin): Fast-acting, “like prescription alcohol,” but risky for daily use due to dependency.

  “Those pills, because of the way that they're structured, can be habit forming and lead to a dependency.” [30:58]

• Medication is not about eradicating all anxiety but making it manageable.

  “The goal is not that you are anxiety free. That's not a reasonable expectation.” [24:04]

• Shame and stigma around medication still persist, but cultural attitudes are improving.
• Most people are not “on for life”; use may be episodic, and interventions depend on life context.

Cognitive and Behavioral Therapies

• Gradual Desensitization/Exposure Therapy: Particularly for phobic avoidance (public speaking, going to social events).

  "Little baby steps that you practice to get yourself to where you can tolerate it...” [42:37]

• Cognitive Behavioral Therapy (CBT): Addresses catastrophic thinking and avoidance.
• Normalize the presence of “tolerable anxiety” as part of growth.

Mindfulness & Meditation

• Mindfulness is about bringing attention back to the present moment, counteracting ruminative or future-focused stress.

  “When one of the things about anxiety…is that your mind is not in the present.” [47:44]

• Simple present-moment exercises can calm the nervous system (e.g., noticing sensory details while washing dishes or waiting in line).
• Practice improves efficacy–it’s normal for these to feel awkward at first.

  “Just can you, how long can you sit at the traffic light and just look at the light and look at...your environment?” [47:44]

Body-Based Tools

• Exercise: Releases endocannabinoids & endorphins, supports neuroplasticity (BDNF), and relieves anxiety.

  “Exercise is one of the things that can trigger or promote neuroplasticity and promote brain health.” [54:42]

• Gut Health: Diet affects mental health via the gut-brain axis. Whole foods, less sugar, and processed food recommended.

  “The gut brain connection is real.” [54:44]

• Weighted Blankets: Deep-touch stimulation is calming and can help sleep.

  “Weighted blankets work through deep touch pressure receptors in our skin to send positive signals back up to the brain.” [56:10]

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Notable Quotes & Memorable Moments

• On anxiety as a signal, not a flaw:

  “Anxiety isn't always a bad thing, it's a signal, and potentially there's a motivational energy which can help us do things we want to do.” – Jonathan Fields [10:26]

• On the myth of elimination:

  “The goal is not that you are anxiety free. That's not a reasonable expectation.” – Dr. Tracey Marks [24:04]

• On avoidance and functional impact:

  “When you avoid things, the fear just grows. It gets bigger and bigger...” – Dr. Tracey Marks [42:37]

• About mindfulness in daily life:

  “Just can you, how long can you sit at the traffic light and just look at the light and look at the…environment?” – Dr. Tracey Marks [47:44]

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Important Timestamps

• What is anxiety? [04:15]
• Difference between normal and disordered anxiety [07:07]
• Physical symptoms & misattribution [19:56]
• Genetic & environmental causes [21:06]
• Therapy and tools overview [23:44]
• Medication use and stigma [29:42]
• CBT and exposure therapy [42:37]
• Mindfulness explained [47:44]
• Exercise, diet, and body tools [53:04, 54:44, 56:10]
• Weighted blankets as anxiety aids [56:10]
• Closing reflection on living a good life [58:12]

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Conclusion: Living a Good Life with Anxiety

The episode ends with Dr. Marks reflecting on what it means to live well—

“Spending time with people who matter and doing something good out there in the world, like leaving something behind that helps people.” [58:12]

The takeaway is hopeful: you are not broken for experiencing anxiety; the path is about finding a personalized set of practices, tools, and mindsets that let you live fully and meaningfully—even (and especially) when things are hard.

Transcript

[Jonathan Fields]

So anxiety shows up for so many

[Interviewer/Co-host]

of us these days.

[Jonathan Fields]

Sometimes it's a loud and obvious thing, sometimes it's just a low level hum

[Interviewer/Co-host]

that never really goes away.

[Jonathan Fields]

And a lot of us quietly assume that feeling anxious means something's wrong, something's wrong with us. But what if that's not true? Or at least not entirely true? In this conversation, I'm joined by Dr.

[Interviewer/Co-host]

Tracy Marks, a psychiatrist and mental health

[Jonathan Fields]

educator who has spent over two decades helping people understand what's really happening in

[Interviewer/Co-host]

their minds and bodies.

[Jonathan Fields]

She's the author of why Am I so Powerful Tools for Recognizing Anxiety and Restoring your Peace. And together we explore what anxiety actually is, why your brain creates it, and how to tell the difference between anxiety that's protecting you and anxiety that's quietly limiting or loudly crushing your life. We talk about why anxiety can feel so physical even when medical tests come back normal, and why counterintuitively. The goal isn't actually to try to eliminate anxiety, which can make it worse,

[Interviewer/Co-host]

but to change your relationship with it.

[Jonathan Fields]

This is one of those conversations that

[Interviewer/Co-host]

helps you feel less broken and more informed. So excited to share this conversation with you.

[Jonathan Fields]

I'm Jonathan Fields and this is Good Life Project.

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[Interviewer/Co-host]

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[Interviewer/Co-host]

this topic of anxiety we are living in a time where I feel like people open their eyes in the morning

[Jonathan Fields]

and without even interacting with anything, any

[Interviewer/Co-host]

news source, any stream, any person, so many people feel that there's a baseline level of ugh. Like they're just there's an angsty kind of thing going on with them. A lot of us talk about anxiety.

[Jonathan Fields]

I am anxious. I feel anxious.

[Interviewer/Co-host]

It's been, I think, an increasing part of the conversation.

[Jonathan Fields]

But what actually is anxiety? When we talk about anxiety, what are

[Interviewer/Co-host]

we actually talking about?

[Dr. Tracy Marks]

That's a great question because we talk about a couple of things. First, there is just the emotional experience of anxiety that everyone has. That's not a disorder. It's a normal reaction to fear, a threat, self preservation, the need for self preservation and then when it go extends beyond the normative reaction and just is present in the absence of any particular threat and persistent and causes and interferes with your life for the quality of your life, then it's more along the disorder range of anxiety. It's usually fear based, but sometimes it is just generalized distress. There doesn't have to be an identifiable stressor that you're afraid of. You can just feel this sense of unease or dis ease chronically.

[Jonathan Fields]

When you say it's usually fear based, take me deeper into that.

[Dr. Tracy Marks]

So what I mean by that is one of the brain structures that detects threats for us is the amygdala. And that's kind of what we typically think of as the main brain structure responsible for generating anxiety and generating the brain responses to a perceived threat. Whether it's a real threat or just a perception that's not really a threat. And so the concern that something bad is going to happen, therefore I need to do something, whether it be worry or take action, really is fear. You're afraid that something is going to happen. You know, I'm trying to think of a scenario where anxiety wouldn't be fear based.

[Interviewer/Co-host]

So then the main thought then just from a cognitive standpoint, like the main

[Jonathan Fields]

thing that's going on in your brain

[Interviewer/Co-host]

is I'm thinking about the future. And maybe that's a second, maybe it's a day, maybe it's a week, maybe it's a year. And then there's something scrolling in my brain that says I fear the possibility of this thing that I don't want to happen, actually happening.

[Dr. Tracy Marks]

Exactly. And so that thing could be someone breaking into your home, someone dying, it could be being insulted, not getting a promotion, not finishing your homework. I mean it could be lots of things.

[Jonathan Fields]

Yeah.

[Interviewer/Co-host]

You also described this notion that we can experience this and you made a distinction between anxiety and anxiety disorder. Take me deeper into that.

[Dr. Tracy Marks]

Sure. So just as we can experience happiness, joy, anger, anxiety is just another, can be just another emotion. So again, if I am driving and a car runs the light and I almost get hit, that reaction of my chest beating, my, you know, hyperventilating, afraid of what could have happened to me, all of that is an anxiety respons. But I would expect in the absence of having a disorder, anxiety disorder or anxiety problem, that as time passes, it'll go away. So I'll recover and get back to my usual routine. I won't be ruminating or thinking a lot about what? About the next intersection. I don't think I can drive now. Like that is more the pathological response. So I guess a different way to think about this is pathological anxiety that causes problems and that is excessive beyond the stimulus or beyond the trigger. And normal anxiety or non pathological anxiety that is part of just an emotional response that we should have. Like I should fear someone breaking into my home or leaving my car unlocked. You know, those are things that I should be afraid of something bad happening and anticipate that these things could happen. So to protect myself.

[Interviewer/Co-host]

So if, for example, I want to make sure I understand this, if for example, you're walking outside, you're at a bar with friends, you're at a restaurant with friends, you've gone on your own and it's 10 o' clock at night, you walk outside and you have to cross a dark parking lot to get to your car. Right. There's Probably a healthy anxiety that says, okay, so I don't know if this is safe or not. So maybe that anxiety, because you're kind of saying like, well, bad things could potentially happen here, I'm alone, it's a dark environment, it's nighttime. But that's the anxiety where it's kind of realistic, it's in the moment.

[Jonathan Fields]

And maybe that leads you to take

[Interviewer/Co-host]

some sort of protective action. Maybe you drop back into the bar and you talk to a friend, say, hey, can you walk me to my car? Or you turn on the light on your phone just so that there's a little more light in. Or you talk to somebody on your phone while you're walking to your car just so, like, you're in contact with somebody while you're doing it.

[Jonathan Fields]

That would be kind of like, okay, I'm anxious.

[Interviewer/Co-host]

But that's not the disordered kind of anxiety. That's an anxiety that's leading you to take intelligent action. Does that land so far?

[Dr. Tracy Marks]

Yes, absolutely. And, you know, another example of how anxiety can be motivating in a good way is if I've got a deadline to meet. I don't want to fail at this task that I'm working on or this project. I might start to feel a little bit or have some ang or anxiety about not finishing this. So I'm going to put my best foot forward and punch it and get this done. So anxiety can motivate us as well to do things that we should be doing.

[Interviewer/Co-host]

Yeah.

[Jonathan Fields]

So anxiety isn't always a bad thing, is what?

[Dr. Tracy Marks]

It's not always bad.

[Interviewer/Co-host]

It's a signal. And potentially there's a motivational energy to it which can help us do things

[Jonathan Fields]

we want to do.

[Dr. Tracy Marks]

Absolutely.

[Interviewer/Co-host]

So then how do we know? Let's take you to one of those scenarios. Right, the work scenario, where there's a deadline, there's a big thing, maybe there's a promotion or a big presentation online, or walking across the parking lot. How would we know when a behavior like that tips from being, okay, I'm anxious, but there's a reason for this and there's a healthy way to deal with it. To this is now disordered anxiety. What would that look like?

[Dr. Tracy Marks]

Sure. So probably the easiest way to conceptualize this is when the behavior is persistent. It's not necessarily linked to a specific stressor that's right there in front of you and. And it causes problems for you. So what does that. What could that look like? If we take the walking to my car scenario, you know? Yes. It's normal to Take precautions and be a little worried or anxious that something could happen to me walking to the car. But say it's 6pm, it's not dark out yet, and I am, you know, trying to find anyone who'll just walk me to my car. And what if this happens? What if that happens? What if that. And I'm driving other people nuts because I'm like laying out all these negative situations. We call it catastrophizing, like thinking of the worst case scenario. And that's kind of always what I talk about. Like I'm always looking at worst case scenarios for things and assuming something, all these bad things are going to happen. That's a different look to this whole issue of walking to my car by myself. You know, sometimes people will wake up in the morning feeling nauseous. I was just talking to a patient recently talking about how their anxiety was kind of ramping up with the new year. And the person was saying, you know, I'm back to throwing up in the mornings. And it's not anything specific, but it's just this free floating, we call it free floating anxiety about nothing that you can really put your layer hat on, but you just don't feel good. You just feel afraid. You know, when we look at our diagnostic manual that like lays out the definition of different disorders, one of the criteria for pretty much all of them is that it causes functional impairment. That's, that's the terminology that it uses. But it's impairment or problems in different areas of your life. So occupational, personal or social. And so, you know, the social aspect could be for say anxiety could be you've become a hermit or let's say going back to the working person. You don't go to required mixers because you're just too anxious about what people are thinking about you. And so you come up with excuses of why you can't go, you got to pick up your kid, blah blah, blah. And it just never works out. You've always got an excuse. But that causes problems. Work wise occupationally, because you're expected to be at these things, these networking events. So you know, the person without a disorder could, may still not like the networking, but they can still stomach it. They find a way to get through it and then once they leave again, they recover and they can go to sleep at night.

[Interviewer/Co-host]

Right?

[Dr. Tracy Marks]

The person with the anxiety disorder may avoid, or if they can't avoid because they don't want to lose their job, they go. But then they can't sleep that night or they wake up and throw up or you know, have headaches and things like that. Like all of these physical manifestations. So that's kind of the difference in how it could look between the person who has an aversion to something that makes them uncomfortable, but they still do it and they get through it, versus the person who has disordered or pathological anxiety about this thing.

[Interviewer/Co-host]

Yeah, I'm actually really curious about what you described as the person who sort of. They actually stop doing all the things, but for each, no, for each time they opt out of it, there's an excuse that they can point to.

[Jonathan Fields]

Do you find at all in clinical

[Interviewer/Co-host]

practice when you're sort of like working with patients that somebody comes in and this is what they're experiencing? They have all these excuses, they're not doing this thing, but they're kind of telling themselves.

[Jonathan Fields]

But these are rational reasons. Like I'm, like they actually can't. They're not identifying that they're anxious underneath it.

[Interviewer/Co-host]

Or the anxiety is a part of this. They think that all these decisions are actually rational. Like these are all rational, good, solid reasons not to do these things. Or are people generally pretty aware of the fact that there's an underlying experience of anxiety?

[Dr. Tracy Marks]

You know, that's a great question because I think that anxiety is probably one of the, I don't know, few, if I'd say few, but like one of the disorders that it's hard to deny. Like people aren't in denial about it. They know that they don't like the way they feel, their heart's racing or whatever the symptoms are that they're having. And so they acknowledge it. They may not acknowledge the extent to which it is. It's keeping them from doing things they may feel like, well, I got this, you know, I just don't like meeting. So I don't, I don't want to go, but I don't know if, if it's my patients and they're, they're just, you know, self actualized people or what. But you know, usually we don't have that problem of saying, I'm not doing X because it makes me too anxious.

[Interviewer/Co-host]

Yeah.

[Jonathan Fields]

And we'll be right back after a

[Interviewer/Co-host]

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[Interviewer/Co-host]

You also brought up this really interesting example of somebody, I think you were referencing a patient of yours who kind of just wakes up with this generalized sense of doom, fear to the extent where it's affecting them physiologically, where they actually throw up. So is there a distinction then where somebody sort of says, I'm anxious because I'm thinking about a very specific thing or something happened to me and I'm worried about having again versus just, just this generalized feeling of I open my eyes in the morning and I'm just,

[Jonathan Fields]

I can't even tell you what I'm

[Interviewer/Co-host]

anxious about, but I am.

[Dr. Tracy Marks]

So that scenario of I can't even tell you what I'm anxious about, I just feel horrible, or I, I'm just very anxious. So getting back to the question of people recognizing that they have anxiety, when people have a predominance of physical symptoms, oftentimes they will think it's something physical and it's not anxiety. So particularly when it has stuff has to do with like heart bracing or palpitations and things like that, they might feel like, you know, having panic attacks. They'll think there's something, there's just something wrong with me. And they may end up in the ER a couple of times until finally someone says, you're all clear. You've had a cardiology workup, you've had all this stuff, it's anxiety. And so I've had people come to me and say, I'm here because the doctor said it must be anxiety. But I know there's still, I just still feel like there's something physically wrong with me. But I get it that, yeah, it does make me anxious.

[Jonathan Fields]

Yeah.

[Interviewer/Co-host]

When we talk about all the different ways that anxiety can show up and the origins and you describe some of the ways that thoughts can lead to these different things, fears can start to become the genesis. These different things, the feelings in our body, in our mind.

[Jonathan Fields]

And that sounds largely the way that

[Interviewer/Co-host]

we relate to our environment. Is there a genetic element to any of this?

[Dr. Tracy Marks]

Oh, absolutely, yeah. Anxiety disorders, pretty much. I think most of the psychiatric disorders, but anxiety disorders run in families. I couldn't give you percentages, you know, as far as, you know, as far as how it's passed down. But yes, you have anxious. So there's a couple of things. You have anxious parents can produce anxious children. But also you can learn to be anxious based on how you're raised. So, you know, sitting around the dinner table hearing parents fret over this and fret over that and whatnot, and we can't. We can't make a decision because we just don't know. You can kind of learn that, learn to adapt that way. Also, another genetic component is some people have less tolerance of uncertainty. That's thought of as a temperament kind of genetic thing or predisposition. There are some people who can just. Just go through each day recognizing that there's this level of uncertainty and hope for a better tomorrow. And then there are people who, going back to sleep, aren't sleeping at night because they're worried about whether or not they're even going to have a job tomorrow. I mean, even if that's that, yeah, for a lot of people, that's a real thing. But even if that's not a real threat, that no one's ever told them that they may lose their job, they just might, just because of how things are kind of thing.

[Interviewer/Co-host]

So we know that anxiety is a feeling that's common across at some point, probably everybody, that it's not always a bad thing, that sometimes it's a completely rational and helpful and constructive reaction, that sometimes it can give us energy and motivation. But then it can also tip into disorder, which stops us from living functionally, living the way that we want to live, that there are multiple contributors to it.

[Jonathan Fields]

It. Let's talk about if we feel like

[Interviewer/Co-host]

it's tipping into this part of our

[Jonathan Fields]

life where it is stopping us from

[Interviewer/Co-host]

showing up the way they want to show up, participating, from doing the things that might open opportunities to us, what we can do about that.

[Jonathan Fields]

You're somebody who lists out a whole

[Interviewer/Co-host]

bunch of different sets of options or tools. And before we even go into some of the individual areas or categories, my understanding is that. But you're not necessarily somebody who says, okay, here's the one thing for you. But oftentimes it's kind of like what is the basket of things that will make most sense for you?

[Jonathan Fields]

Is that right?

[Dr. Tracy Marks]

That's right. I can't tell you how many times I've heard people say, well, I've tried all that stuff. Well, there's so many things you could try, number one. But it really isn't about this one thing will erase all of your anxiety. It's what works for you. So for example, breathing techniques. Some people, I mean it's, we know that it's effective, but still for some people, they just can't implement it in the time at the moment or they just don't feel a lot of it just, it just doesn't resonate enough with them to practice it so that in the moment they, it will be just, just a knee jerk response. So that just might not be a tool for you, you know, versus something like in meditation. I think kind of falls into that category too because it requires a certain amount of discipline to practice it, get good at it so that it becomes knee jerk for you. But for people who, who it does resonate with them, they can tell you, you know, I, I, I'm at so much more peace now that I do this. I, you know, carve out this amount of time every day, 10 minutes, and this is what I do, et cetera. So it really is about trying to find things that work for you and having them at the ready so that you can implement them at the time. I, I do want to add though that I, I tell patients, the ones who are taking medications for anxiety, that like, if I, if I start someone on a new medication, I'll say, okay, so let's just get straight here that the goal is not that you are anxiety free. That's not a reasonable expectation. So whether you're taking medication or whether you're using tools, if you've got an anxiety disorder or you've got a lot of anxiety, we'll just say instead of getting away from this disorder issue, anxiety tends to come and go in waves. So you can have periods of your life where it's manageable. Meaning, let's say, you know, during the day you start to feel the tightness in your chest or muscles tight. But you know, you power through, you get your work done, or you, you go run after work and you kind of relieve some of that tension and now you feel better and that's how you're managing it. And then other times where it just overwhelms you and you can't manage it alone, so maybe then you take medication but even so, with the medication, still, the expectation isn't that if, you know, someone bursts into my house holding a gun, then I'm just gonna be like, hey, hey, thanks for coming. You know, you're still gonna have an anxiety response. So we should never expect to be completely anxiety free.

[Jonathan Fields]

Yeah.

[Interviewer/Co-host]

I mean, that's such a powerful thing, I think, expectation to set.

[Jonathan Fields]

Because I would imagine people do come

[Interviewer/Co-host]

to you often and say, I just want this gone from my life. It's disabling. I can't live and breathe the way that I wanted, and I just need it gone. And as you described earlier in conversation, we actually don't want it entirely gone.

[Jonathan Fields]

It plays a really important role in us being safe and intelligent and inviting

[Interviewer/Co-host]

really good things into our lives. It's when it tips into that area where it's disabling in a lot of ways. But that must be also a bit of a weird conversation to have someone who comes to you trying to convince

[Jonathan Fields]

them you actually don't want it entirely gone.

[Interviewer/Co-host]

Or the expectations shouldn't be to make it go away. Especially if somebody's deep in anxiety or in the throes of repeated panic attacks.

[Jonathan Fields]

I have to imagine that person's like,

[Interviewer/Co-host]

no, this has to go away forever. I don't ever want it. Give me whatever I need to do, whatever level of medication, whatever practices. I just need this entirely annihilated from my life.

[Dr. Tracy Marks]

Yeah. So then we have to have a different kind of conversation about. About having reasonable expectations. Because that mindset of, you know, I don't want to feel anything unpleasant, so give me something so I don't have to feel anything unpleasant is really an addiction mindset. I mean, like, it can lead to addictions because of this idea of I need to. I need. I don't want to have to cope on my own. I want something to just take it away. So I try and help people shift from thinking that way of everything has to just be taken away with a pill of some sort. But what makes that palatable or makes them able to accept that is. Well, let's look at. What do I actually mean by you're still going to have some anxiety? Well, what I do. What's bearable anxiety, you know, maybe feeling a little tense at the thought of doing xyz, but once it's over, okay, I'll be all right. Well, that's normal anxiety. So, okay, you can live with that versus if someone, you know, the plea to take this all away is usually for the more intense, severe manifestation, like the panic attacks. Or, you know, the inability or feeling unable to. To go anywhere or drive your car because of some fear or something like that's the stuff that they want to go away versus any unpleasant feeling.

[Interviewer/Co-host]

Yeah, that makes sense to me. Let's talk about some of these major categories. Why don't we start out with medication? Because we've referenced it a number of times now. And also this is a category where a lot of people. There's a shame associated with it for a lot of people, like, oh, you, quote, shouldn't need that. Or there are all these other things that you can quote, quote, do first. You know, talk to me about anxiety and medication.

[Dr. Tracy Marks]

Yeah, so you made me think about something with. As far as the shame and guilt about. Well, you know, I'm not. I must not be doing enough to need to take medication for this or I'm not crazy. So crazy people take medications like all of that kind of thinking. I think, think we've gotten better with that over the years with more people speaking out about taking medication for something, whether it be depression or anxiety. So I think we're getting better. But there's still in certain communities and certain cultures where if, you know, I'm thinking, I'm a Christian and I think about Christian culture of if you trust God, then why are you anxious versus I'm anxious because this is a physiological reaction. Okay, so I went down a rabbit hole. Sorry about that.

[Jonathan Fields]

So it's good because I think these

[Interviewer/Co-host]

are actually the real things that come up when somebody is dealing with this. And it may be some of the internal and also external pressures that come their way or judgments that come their way that might stop them from considering

[Jonathan Fields]

something that actually might be appropriate for them, at least for a moment in time.

[Dr. Tracy Marks]

Exactly. So, you know, for daily anxiety, the recommended medication are antidepressants. Actually antidepressants we use for both depression and anxiety. There's another one that's a serotonin agent that's not really an antidepressant though, but it's similar, and that's called Buspar or Buspirone. But these medications you take every single day because you have anxiety every single day. Some people would prefer to take sedative type medications like clonazepam. Xanax or Alprazolam is a generic name for those, because those medications kind of work like pain pills where you take it and within 30 minutes, poof, you feel so much better. They're pretty much like prescription alcohol because they work similarly in the brain. And so you get that. That instantaneous or immediate relief. Those pills, because of the way that they're, they're structured, can be habit forming and lead to a dependency on it. So then if you stop taking it, you can get withdrawal and all of this. So those are the kind of medications that are best taken as needed and not every day. So let's say I only get, I had, I get panic when I fly, okay? You get a bottle of, of Klonopin or Xanax that lasts you a year because you fly three or four times a year and that's the only time you take it. Or even a panic attack, you know, every now like maybe once a week or something and you just take it and then it makes it go away and then the rest of the week you're good. But if you have a daily experience, it's best to take the medications that are intended to be taken daily. There's downsides in that, you know, aside from the idea of buying into I'm taking a pill every day. This must be, you know, because another thing about the as needed pill, I think there's the perception for the person that I'm not that bad because I don't need this all the time, so I can just take it every blue moon. Whereas to take something every day means I've got like this chronic illness. I'm taking a pill every day. So at any rate, even once you take something every day or take one of these medications, they do can have a lot of side effects like dulling your emotions or giving you gastrointestinal problems and dry mouth and things like that. And sadly, when those side effects occur, it just can reinforce this idea of why do I have to take medication? How do I have to deal with this every day to deal with my anxiety? So, you know, for people who have, who experience side effects from these medications, they can, they can end up going on and off of them because they just don't like the experience

[Jonathan Fields]

when somebody

[Interviewer/Co-host]

is taking the sort of like the, the daily. Again, I want to make it, I think it's clear to anyone joining us for this conversation, this is not individual medical advice. This is just sort of like a general exploration of what is available in different categories. But one of the things that I've heard from people who resist sort of like starting on something daily is I don't want to be on this for life. Are these sort of a class of medications something that most people are on for life or is it sort of episodic?

[Jonathan Fields]

And, and if it is a long

[Interviewer/Co-host]

term or a lifetime Thing is that.

[Dr. Tracy Marks]

Okay, yeah. So this question, the answer to this question goes back to what I was talking about. Anxiety coming and going in waves. And that wave can be really long. And the interval in between the waves can be long enough such that. So let's say you have to this really stressful period of your life and you have unmanageable anxiety. You get on medication, you're on it for a couple of years and then things kind of settle down, you're in a steady job, the kids are out of the house or something, and just life is more calm for you. I talk with patients about, okay, let's see how you can do without the medication now. And they get off and see if they can kind of wing it on their own. And they may wing it on their own with mild levels of anxiety or anxious moments that they manage with behavioral things like the exercise or the meditation or whatever it is. So lifetime could be in and out of, or chunks of time that you take it and then you get off. Take it and then you get off.

[Jonathan Fields]

Off.

[Dr. Tracy Marks]

For some people though, going back to this isn't medical advice. That doesn't work for everyone. There are some people with debilitating enough anxiety that's daily that it could mean a lifetime of medication. It's hard for me to like sign somebody up for lifetime if they're 38 years old saying, you're going to need this every day for the rest of your life because I don't know what their life is going to look like. Yeah, they could, could again retire and have a chilled life every day. And so they can just deal with the occasional stomach upset that they get when they hear something on the news or occasional bad sleep that they can have because their mind was racing. So. But things like obsessive compulsive disorder, oftentimes those symptoms can be not manageable enough without medication to need medication. I know we're talking about medication, but you know, OCD doesn't always respond well to medication and sometimes people need more behavioral treatment for that. So the long and the short of it is is that it depends on how the anxiety manifests. Like one more thing. So someone with social anxiety, let's say this, with social anxiety, people have this. Are preoccupied with what people think about them and, and people's judgment and things like that. So it's not just social, like I just don't like crowds. It could be worrying about what someone is going to, what someone's going to think when you're talking to them, even one on one. It's called social and performance anxiety. The performance could be speaking up in a group. So I work and we have, you know, a zoom meeting and it's my turn to present. Like I could get choked up and can barely speak. Like that could also be social anxiety. So all that to say is I may go through a period of life where the stressors on me or the things that I do make my social anxiety really get in the way of me functioning. So I get treatment for it, whether that treatment be medication or something behavioral. And then I switch jobs, I'm working at home. There's not a lot of things that trigger me into having panic and things. And so I don't need medication during this period of my life.

[Jonathan Fields]

Yeah.

[Interviewer/Co-host]

So it's really, it's very individualized. And even for an individual, this may shift in really meaningful ways based on the moment or the season of life that they're in. There's really no way to say at the point of intervention or prescribing, like how long or what the dosage is going to be. It's just important to really keep tabs on it, it sounds like. And adjust as needed along the way.

[Dr. Tracy Marks]

Absolutely. Yeah, you said it perfectly.

[Jonathan Fields]

And we'll be right back after a

[Interviewer/Co-host]

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up a number of other tools also to potentially bring into the toolbox here. And I think a lot of people when they think about anxiety, one of the first things they think is well like psychology and oftentimes CBT or that sort of behavioral therapy is something that's been brought up a lot. Mindfulness based cognitive behavioral therapy also is something that I think we've heard a lot more about over the years. What does that look like and how does it actually work? That may be too big a question, but see what we can do with it.

[Dr. Tracy Marks]

Yeah, a little bit, but I'll, I'll narrow it down. So it just depends on what you're trying to address. So for example, someone who's got, who's we call it phobic, who is avoiding things because of their anxiety. So let's go back to the social anxiety is someone who just, just cannot stand the idea or just make themselves go to some event. And it's becoming a problem because, you know, the family wants me to be there for the soccer game, but it just makes me want to throw up before I go. So. But I, I want to see my child at the soccer game. So I got to get past this. A beh. So a behavioral intervention for that could be what's called gradual desensitization or just a desensitization process where you, you like. If my fear, you look at what the ultimate fear is, the fear is being at this place with people talking to me and me having to talk back to them. So if I've already started avoiding going to these things in a way that, that I start feeling anxious, even getting in my car, then that's where I would start. I would start with these exercises of getting in my car, I'm going to drive to the place, or even getting in my car, dealing with the anxiety I feel about that I'm safe, this is okay. And then going back in the house and like doing that until it's. I'm desensitized, it doesn't make me that anxious anymore. Then I go to the next, next step, be driving to the place. The next step beyond that might be going to this event and being so far in the back that I'm not challenged to having to talk to people or, you know, I'm just kind of making this up. But the idea is little baby steps that you practice to get yourself to where it, you can tolerate it without, without all that anxiety and you're no longer avoiding because when you avoid things, the fear just grows. It gets bigger and bigger and the op, it becomes even more of an obstacle to get past. So, you know, desensitization could work with something like that where there's a phobia, the thing that you're avoiding. It can also work with certain types of trauma, although that would still be kind of a phobic avoidance thing. So you get in a car accident and now it's hard for you to get behind the wheel of the car anymore. So you work through different steps to get comfortable going, getting in the car. So, so that's one type I don't do. Even though trauma is no longer like PTSD type stuff isn't really considered an anxiety disorder anymore. It can come with a lot of anxiety. And so I don't do trauma based therapies, but specific trauma based therapies I think are what are needed to address trauma and anxiety related to trauma. And some of those also involve kind of exposure type therapies we call it. So the desensitization exposure, kind of different sides of the same coin of re exposing yourself to these things that cause you a lot of fear and distress because of it causing you trauma in the past and doing it in a way that you eventually overcome that fear of being exposed to it.

[Interviewer/Co-host]

Yeah. So it sounds like a lot of what this is, is about. And tell me if I'm. If this is off or if it's sort of like on. You think about the thing that causes the anxiety. You chunk it down into a series of tiny little steps and then you start with sort of like the, the most accessible, the tiniest little, most accessible step that would start you towards that experience or towards that thing. You do that and kind of see how you feel until you're comfortable with that. And then you add the next tiny step and the next, and each one kind of waiting until you're comfortable before adding the next one. But I'm guessing also part of this is again going back to that thing that you would tell patients up front, which is you're not necessarily looking for zero anxiety right along the way. You're looking for, okay, I'm anxious, but I can handle this.

[Jonathan Fields]

Would that be right?

[Dr. Tracy Marks]

That's right, yeah. It's a tolerable level of anxiety.

[Interviewer/Co-host]

Yeah, that makes sense. Let's talk about some tools here also.

[Jonathan Fields]

And I guess these could kind of fall under CBT because they're often offered in that context.

[Interviewer/Co-host]

But I think a lot of these tools also people explore on their own. You mentioned one of them earlier that a lot of people still roll their eyes at, which is either meditation or mindfulness. Talk to me a little bit about this and its relationship in the context of anxiety.

[Dr. Tracy Marks]

Sure. So with. So mindfulness. Mindfulness is really a big. It's a general category really of essentially your state of mind, but not necessarily a meditation of sorts, but nonetheless, people will say mindfulness meditation and things like that, but when one of the things about anxiety and fretting and worrying and ruminating is that your mind is not in the present. You're either worrying about the future, ruminating about the past, but you're not here. And generally the present, present moment is safe. I mean, if it's not, then, you know, we got bigger problems but generally our minds are somewhere else and the actual moment is safe. So a person who is, let's just say, tightly wound, always feeling anxious or always feeling uptight, they may not see themselves have an anxiety disorder, but they're just kind of generally uptight. One of the things that they can do without realizing it, it is spending too much time, not in the present, but thinking about other stuff. And that's taxing on the brain, you know, that's taxing on our minds and can cause internal distress. So the way to offset that is to intentionally bring yourself into the moment. And there's like different ways to do that, but let's just say I'm washing dishes and, and you know, I'm guilty myself, I'm washing dishes, I can be thinking about, okay, I got this to do, I got that to do that. And so the experience of washing dishes isn't an ex. It isn't a real experience. All it's doing is giving me an opportunity to worry about all the stuff I gotta do and all the stuff on my to do list. Instead, I bring, I get out of my head that way, bring myself back into the moment of using all of my senses to experience the current moment. What's the temperature of the, of the water? How does the plate feel? The, the, you know, how hard is it? The suds. Like all of that takes the burden off of your kind of executive functions of like keeping up with all this stuff and allows it to just focus in on a singular thing of the, of the present. And it's, it's, it's calming in a way of slowing your mind. Not so much calming because I'm not anxious. It's a way to slow your, your thinking and your processing and therefore be a calming experience for your body in general. But that's a very simple thing that anyone can take with them and do at any time. I suggest trying it sitting at the traffic light. I've had to force myself probably like other people of if I'm at the traffic light not to grab for my phone and see if I have any time texts come through, like, stop that. Just can you, how long can you sit at the traffic light and just look at the light and look at the, you know, is it dark outside? Is it. Look at your environment. I, we probably, most people probably don't do that. You know, their, their mind is somewhere else. So being in a perpetual state of your mind is somewhere else is, is mentally draining and it lessens your, or chips away at your mental resources to be able to handle the daily stresses of life.

[Interviewer/Co-host]

Yeah, as you're describing that I often when I'm standing in line waiting for a cup of coffee and if you look at everybody else there, every single head is down in their palm looking at the device and just as a practice I'll be like, okay, so this is probably anywhere from two to five minutes, minutes before I step up and place my order. I'm going to challenge myself just to keep my device in my pocket.

[Jonathan Fields]

It's remarkably how hard that is.

[Interviewer/Co-host]

It is, it's like it's calling to me, it's taunting.

[Jonathan Fields]

Everybody else is doing it.

[Interviewer/Co-host]

So I had permission to do it. But you really do feel.

[Jonathan Fields]

And all of a sudden I'm like, oh wait, I'm looking around, I'm smelling

[Interviewer/Co-host]

the aroma of the beans. Somebody's got a yummy scone that's being warmed up. I'm hearing the cumbersome conversations and the music.

[Jonathan Fields]

Like this moment is actually pretty sweet,

[Interviewer/Co-host]

you know, and, and when you really do that, I agree. I think there it at least for me, it really, it just helps me kind of down regulate a little bit in the moment. And also it just helps me notice some of what's right around me in the moment too. Which is something I think oftentimes we just kind of ignore along the way.

[Dr. Tracy Marks]

We do, we do. And you know, then just life just passes us by because we're not in it, we're just thinking about it either retrospectively or worrying about the future.

[Interviewer/Co-host]

Yeah, I want to talk a little bit. Also you referenced earlier, maybe you go out for a run and that helps you for a moment.

[Jonathan Fields]

There's sort of like a body based

[Interviewer/Co-host]

set of tools here that are available to us too.

[Jonathan Fields]

What is the relationship between our physical

[Interviewer/Co-host]

body and especially ways that we would exert ourselves physically and anxiety?

[Dr. Tracy Marks]

Yeah. So exercise is a good thing. Not only from the perspective of staying in shape and all of that. Exercise actually releases endorphins. It releases endocannabinoids, which is like your body's own cbd, which is actually thought to be more responsible for the relaxing or anxiety reducing effects than endorphins are the whole runner's high. It's actually thought to be more related to endocannabinoids rather than those. But at any rate, and then it also activates bdnf, brain derived neurotropic factor, which then affects, affects your, your brain's wiring. And that's a whole nother big topic, but suffice it to say is the tighter and the more connected our Brain circuits are. The better we think, the better our brain is able to control our mental health and physical health and all of that. So we like the idea of doing things that promote neuroplasticity or promote regeneration of connections in the brain that promote adaptive behavior. That's a mouthful. But so exercise, long story short, exercise is one of the things that can trigger or promote neuroplasticity and promote brain health.

[Jonathan Fields]

Health.

[Dr. Tracy Marks]

Another kind of body focus, which people probably don't always think associate this with mental health is your gut health. So the whole gut brain connection is real. Having paying attention to the constitution of the bacteria that we have in our gut by eating whole foods and less processed foods, less sugar. I'm guilty of eating the sugar, even though I know it's bad for me. Like all of that stuff. If we could, if we have good bacteria in there, that then sends signals, healthier signals, back up to the brain through the vagus nerve. That is also a way to promote good mental health and reduce anxiety, since that's what we started out talking about by adjusting your diet. And kind of the easiest way to do that. There's lots of different diets out there, then this isn't about what diet is better. The moral of this story is the best way to do that is reducing processed foods and eating foods as close to their natural state as possible.

[Interviewer/Co-host]

So it's almost like you can approach this from the brain out or you can approach it from the body in. It's like the body will sort of reverse its way up into effectively helping the body brain rewire to be able to deal with anxiety and feel calm more readily.

[Dr. Tracy Marks]

That's right. One of my favorite, the body tools that I talk about in my anxiety book is weighted blankets. I love my weighted blanket. And weighted blankets work through deep touch pressure receptors in our skin to kind of send positive signals back up to the brain. That's just kind of a generic way of explaining it. But you know, the concept of. I know every time that the fourth of July comes around, I see these, these advertisement for thunder vests for your, your dogs, for the ones where the noises scare them. But the idea is that you have this compression around their body and, and it's the same concept. So with that, that is calming. So, you know, if you have trouble falling asleep at night or just feel, you know, just want even just a better sleep, I would highly recommend or suggest the use of weighted blankets. And the ideal is that it is 10% of your body weight, but the common weights are like 10%, 10 pounds, 15 pounds. And it just, it just kind of wraps around you and has this, like, cuddling effect that's similar to, you know, swaddling.

[Interviewer/Co-host]

That's what I was just thinking. Yeah, it's like, what do you do with an infant especially? And, and as soon as you swaddle an infant, it's like you can just, it's almost like you watch this baby exhale and they just. Yeah, they get really calm and just like, oh, I feel safe.

[Jonathan Fields]

And I guess that instinct is still

[Interviewer/Co-host]

inside of us for it's still there. Yeah, it's wild. Feels like a good place for us to come full circle in our conversation as well. So in this container of Good Life project, if I offer up the phrase to live a good life, what comes up?

[Dr. Tracy Marks]

I think of spending time with people who matter and doing something good out there in the world, like leaving something behind that helps people.

[Jonathan Fields]

Thank you.

[Dr. Tracy Marks]

Thank you.

[Jonathan Fields]

Hey, before you go, be sure to tune in next week for a powerful conversation with Nedra Glover Tawab and Terri Cole about life changing boundaries and how to say no without guilt and how to stop over giving. Make sure you follow Good Life projects project in your favorite listening app so you don't miss this episode.

[Interviewer/Co-host]

This episode of Good Life project was

[Jonathan Fields]

produced by executive producers Lindsay Fox and me, Jonathan Fields editing helped by Alejandro

[Interviewer/Co-host]

Ramirez and Troy Young. Christopher Carter crafted our theme music.

[Jonathan Fields]

And of course, if you haven't already done so please go ahead and follow

[Interviewer/Co-host]

Good Life project in your favorite listening

[Jonathan Fields]

app or on YouTube too. If you found this conversation interesting or

[Interviewer/Co-host]

valuable and inspiring spring chances are you did because you're still listening here. Do me a personal favor. A seven second favor.

[Jonathan Fields]

Share it with just one person. I mean, if you want to share

[Interviewer/Co-host]

it with more, that's awesome too.

[Jonathan Fields]

But just one person Even then, invite

[Interviewer/Co-host]

them to talk with you about what

[Jonathan Fields]

you've both discovered to reconnect and explore

[Interviewer/Co-host]

ideas that really matter. Because that's how we all come alive together. Until next time, I'm Jonathan Fields signing off for good luck Life Project.

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