Dr. Traci Marks (5:28)

Thanks for having me here. I am so excited.

Mel Robbins (5:30)

I am so excited to sit down and talk with you. Why am I so Anxious? This is a fantastic book, but more importantly, you know what it is? It is a resource. When I was flipping through this, I cannot believe how Many tools, how much research, how many different just strategies that you put together for people. So thank you, thank you, thank you for writing such a fantastic book that I'm sure is helping millions of people.

Dr. Traci Marks (5:59)

Wonderful. That was the intent, is to give people a resource. I mean, it kind of reads like an encyclopedia a little bit.

Mel Robbins (6:07)

Well, you're very smart, so yes, it does, but it made me smarter about anxiety for sure.

Dr. Traci Marks (6:12)

Excellent goal achieved.

Mel Robbins (6:14)

So I would love to start by having you speak directly to the person that is listening, that's spending time together with us right now and just explain what might be different about their life or the life of somebody that they care about if they take everything that you're about to share with us today to heart and they apply it to their life.

Dr. Traci Marks (6:35)

Sure. I think the biggest thing that someone can take away if they listen and understand what we're talking about today is the fact that your brain is changeable. And regardless of what condition you may have, you can improve the quality of your life with simple behaviors and habits. You have control over this and you have agency over your mental health.

Mel Robbins (6:59)

Now, you have been a psychiatrist for 25 years and there are a number of topics that I cannot wait to jump in and just really unpack with you. And in particular, what I'm excited to talk about is anxiety and then to get into its connection with ADHD and other symptoms that people may be feeling that they don't realize are related. What are you seeing in your practice and with the millions of people that follow you online, what are you seeing in terms of the type of anxiety that people are struggling with? And what do you think we should know?

Dr. Traci Marks (7:36)

So anxiety, there's been a huge uptick in anxiety. I mean, anxiety, first of all, it's a very big topic because there's lots of different types of anxiety. Probably the most common ones are social anxiety and generalized anxiety disorder. But that said, it all started with a pandemic. So the World Health organization reported a 25% increase in anxiety globally starting with the pandemic. And sadly, it's still continuing to rise. It's not like it got better after things settled down. We're still having increases in incidence of anxiety.

Mel Robbins (8:17)

Now why do you think that is?

Dr. Traci Marks (8:19)

I think it has to do with our digital world this day where we're always on 24 hour news cycles, social media with constant comparisons and access to bad news at any time of day. And also our brains can be overloaded with information that then can create anxiety. So we, we have information overload, lots of hardworking I mean, there's just lots of societal factors.

Mel Robbins (8:50)

Well, it's interesting cause at the very beginning you said that one of the things that could change about your life is your brain. Because your brain is malleable, you are able to reprogram it. And if I think about what you just shared with us, which is anxiety's on the uptick, which I just wanna say to you as you're listening, if you're experiencing an uptick in anxiety or if people that you care about are experiencing anxiety for the first time, that I think it's important to hear that this is actually kind of normal right now that Dr. Marks is seeing it. What's also interesting to me about the list that you just gave us in terms of social media, constant comparison things constantly changing the headlines, the news cycle that's so negative, like all of it, is that those factors have changed your brain in terms of you feeling anxious. Which means if there are outside factors that can change your brain and make you anxious, I would imagine, Dr. Marks, there are also factors that you're gonna teach us today that can help you get your anxiety under control.

Dr. Traci Marks (9:52)

That's absolutely right. So just as our brains can change in a negative way, our brains can change in a positive way and we have the ability to make those changes ourselves.

Mel Robbins (10:03)

So if you're like super anxious. Cause I struggled with anxiety for decades. And one of my biggest fears, Dr. Marks, is I'd never actually get rid of it, that I would always feel like that. And so for somebody that's listening right now or they have a loved one, a child or a family member or a friend who's just like in the grip of it, what is possible.

Dr. Traci Marks (10:26)

Sure. So I always kind of give when I'm talking to people or talking to patients, the caveat that anxiety is one of those things that waxes and wanes over time like a wave. So you can have periods of your life where it's more manageable and then periods of your life where it becomes unmanageable because of stressors. And so it is important to realize that this isn't something that. Where the endpoint should be, I wanna be cured and be anxiety free.

Mel Robbins (10:55)

Because I don't wanna hear that. I don't wanna hear that. Dr. Mark. Get rid of it.

Dr. Traci Marks (10:59)

It's just not realistic, number one. And some amount of anxiety is advantageous. You know, if you get anxious about some kind of upcoming presentation that you need to make, it may make you plan more. So some amount of anxiety drives us to be better. But nonetheless, when it gets overwhelming for you. That's when problems set in and it can impair your functioning and that's the level at which we wanna look at making changes.

Mel Robbins (11:28)

Okay, so before we jump into specifics, what actually is anxiety?

Dr. Traci Marks (11:35)

All right.

Mel Robbins (11:36)

Are you feeling anxious, Katie?

Dr. Traci Marks (11:38)

I am feeling anxious.

Mel Robbins (11:39)

Why are you, what does that mean for me?

Dr. Traci Marks (11:42)

Because it's probably a performance anxiety. And I have to check myself because my natural tendency is to just kind of want to unload all this information and not keep it. I have to work to make information accessible to people and not go down rabbit holes and things like that. Or I get, I overthink, making sure I don't say the wrong thing and all of that. So. So that's where I am.

Mel Robbins (12:10)

That is so relatable, Dr. Marks. So to have you be a world renowned expert with millions of followers and in real time, tell me and the person that is making time to learn from you, that you're actually experiencing a little bit of performance anxiety, which is just wanting to do well, wanting to meet the moment. And I think that that is so helpful. What do you experience in your body when you are in a moment where you feel anxious about wanting to do well? And we've all been there, whether it's on a date or an interview, this is a very normal thing. And it's a sign that you're actually functioning the way that you should because you care about how you're gonna do. Right?

Dr. Traci Marks (12:55)

That's right. So it kind of, this ties into your question about what really is anxiety. And it's a full body experience. It's not just in your head and it's not just in your body, it's both. So for me, going back to your question, my mouth gets dry, which then my lips could stick if I'm like trying to smile and I'm like, am I looking ridiculous? And then I get in my head about how do I look, how do I sound? And all of that. So that's kind of how I experience anxiety. Worrying about what the other person's thinking. But so going back to the usual experience of anxiety, which I shouldn't even say usual, it's an individual experience, so you can have the head symptoms would be like worrying in your head. Fear over concern about what people are thinking. Like I was just talking about in your body, we get a sympathetic response, which historically or biologically was designed to give us the ability to fight or flee some perceived threats. But that response turns on even for threats that are real or imagined. So if I'm imagining That I'm gonna look ridiculous because of something I say. Then I can start having my heart racing. I can start feeling other gastrointestinal things. Some people can feel like they're gonna have the runs and, oh, what's that gonna mean? You can have this sense of just tension in your body and not even realize that you're tensing your shoulders and things. And then get to the end of the day, and you're exhausted, and you're like, all I did was sit all day. Why am I tired? Because you can get a lot of muscle tension. So those are some of the physical signs.

Mel Robbins (14:45)

You know, Dr. Marks, it's so interesting that you bring that up, because I just have these days where at the end of the day, I feel exactly that, like, completely exhausted and tense. And then I reflect. I'm like, well, you basically just sat all day at your desk. Why is that a symptom of anxiety?

Dr. Traci Marks (15:04)

So if you're anxious, one sign of that or one symptom of that is tensing muscles. And a lot of times we can tense our muscles without even being aware. So you sit at a desk. Your neck muscles are tight, Your shoulder muscles are tight. Yes.

Mel Robbins (15:19)

I literally just sat up. I'm like, oh, my God. I'm slouched over. Like, the hobbit right now is like, that's probably, like, not bad posture, but anxiety.

Dr. Traci Marks (15:29)

Yes. Because if you're stressed out, then your muscles tense. Okay. And then you can carry that posture for hours. And your muscles are working. When they tense, they're working. So at the end of the day, your muscles have been working harder than you're aware that they're working. Cause you were just sitting all day.

Mel Robbins (15:47)

Wow. Plus, if you're at work and you're kind of bracing, like, if you're having a stressful day, that's also another form of you tensing up your muscles.

Dr. Traci Marks (15:56)

Correct. The beauty of this is that if you are aware and understand that this is one of your responses, then you can offset it with things. So, for example, what do I do? So I had a morning where I woke up and I could barely lift my head off the bed. And I thought, oh, my goodness, am I paralyzed? The downside of being a doctor, thinking about all kinds of things. But anyway, and all it was was that I had kind of a stressful week. And I had been sitting at my computer, hunched over, using my mouse and the shoulder up. And I didn't realize that that was what I was doing, that I used my mouse with my shoulder up like this. And so my neck was almost like I could just again, barely lift my head off the bed. So what do I do to offset that? Now I do what's called progressive muscle relaxation. Well, first of all, I try not to. I try to be aware of how I'm sitting in my chair, but even I can't. That's not perfect. So progressive muscle relaxation is one of those body tools where you, you know, you start from either the head or the. Or the foot, and you take muscle groups and you contract them and then relax them. And what that does is it makes you aware of what muscles were actually tense. So you could be, you know, you could contract your shoulders and then relax them and realize, wow, okay, I didn't realize I was kind of sitting like this all day long. But that helps create a relaxation state in your body. It helps kind of release that muscle tension. And I would suggest trying that during lunch, a lunch break. It could just take five minutes to kind of, from head to toe contract, relax. And then that will help reset your muscles so that at the end of the day, you didn't spend eight hours all contracted.

Mel Robbins (17:51)

I think the majority of us spend eight hours tense at work, and we don't even realize it.

Dr. Traci Marks (17:57)

Don't even realize it.

Mel Robbins (17:58)

That is unbelievable. I'm gonna try it.

Dr. Traci Marks (18:01)

Try it.

Mel Robbins (18:02)

And it's helpful to hear the physical symptoms, because when you watch somebody that you care about who's struggling with it, it's very hard to understand because it doesn't seem to make sense. And I would love to play a video for you because I was so excited when you were coming on. And you have a son who's around the same age as our son. So my son's name is Oakley. And this morning, when I knew you were coming in, I'm like, you know, he has struggled with anxiety his whole life. And so I am gonna ask him because I don't know what to do. I know a lot about anxiety, but the way that his manifests is very challenging. And I figured, why not wake him up in his college dorm room and tell him that you're gonna be here and ask him if he would like to ask you a question about the issue that he's struggling with. And so he made a video, and I would love to play it for you.

Dr. Traci Marks (19:01)

Okay.

Mel Robbins (19:02)

Okay, here's Oakley.

Oakley (19:05)

I don't know if it's morning for you, but it's sure morning for me. 9:00 for a college student. I just got out of bed, like, literally 30 seconds ago. I hope you're well, my name's Oakley, by the way. I shouldn't forget saying that. I'm my mom's son, Mel Robbins. Son. I'm not just, like, some random kid that they're getting a video from. I am gonna. I have two questions for you, and I'm gonna keep them super short because you're busy and I don't want to waste your time, but we're already at 30 seconds, so let me. Let me get this going. And they're both anxiety. Okay, my first question. Basically, what happens normally when I get anxious is before I'm even anxious in the first place, in my head, I'll start to get this, like, spinning sensation, where it's basically a feeling of nausea. Like, I start to get a feeling of nausea, and then from the nausea, I become anxious. And then I'm just, like, in this state of anxiety. And it doesn't go away until I'm not nauseous anymore. But the anxiety I feel, like, makes it worse because I'm like, oh, I'm anxious. I'm anxious because I'm nauseous. And then it, like, gets worse. And so I was curious what you might think about that. Thank you.

Dr. Traci Marks (20:19)

That is. That's perfect example, which is pretty typical, that people with anxiety can be very sensitive to body sensations. And those body sensations then trip off anxiety in their head. So sometimes, especially if they don't associate it with anxiety. So, for example, someone who, let's say, has panic attacks, and they know that their panic attacks are classically their heart beating or heart racing and. And trouble breathing maybe. And then maybe they can then do things to slow their breaths. But sometimes it's not always obvious what the anxiety or the physical sign is. So he's describing this sensation in his head that he's calling nausea. And maybe it feels like maybe it's some kind of nausea thing, but it could just be this kind of dissociative experience of just kind of losing track with his environment and things that can happen with people and freak them out, really.

Mel Robbins (21:19)

Okay, so explain that, because he's actually had things like that happen, and so have I. And as you see in the video, he kind of loses his train of thought and looks off to the left and then recenters himself. And so what he's calling nausea, or just this sort of lapse in feeling present spirals into something bigger. And so that's kind of common.

Dr. Traci Marks (21:41)

That's pretty common, really. Yes. So dissociative experiences. You can lose touch with your environment or lose touch with even or an Alteration in your experience, even with yourself. So someone can say, look in the mirror and just be like, I don't look like myself. And then they can just think, what is wrong with me? And not recognize that as, say, a symptom of anxiety. Just, let's say. So, yeah, he's calling it nausea, and maybe he might feel some nausea, but it's probably more of a, you know, a depersonalization or derealization experience that he's having, which can accompany anxiety or be an anxiety symptom.

Mel Robbins (22:28)

Wow. So the thing that. The reason why I wanted him to ask that is because I've been trying to help him as his mother. I'm clearly not a psychiatrist, but I've been trying to help him as his mother to untang the physical sensation from what then happens where he then is like, oh, I'm anxious. And then he gets caught in telling him he's anxious. And I know for me, when I used to experience a lot of anxiety, I was so scared of the feeling of being, like, anxious or being lost in my head or feeling like I was about to get in trouble or that something bad was gonna happen, or could have been being afraid of getting on a plane or afraid that something would happen to my parents. Like, I could so easily get lost in my thought. And then once I felt anxious, I got then worse because I was afraid of the anxiety. I'll give you a situational one. So yesterday I got an email from a business partner of mine, and it was one of those emails that just makes you go, you know, you just clench because you know that they're pissed at you. And even though I don't feel like I did anything wrong, they're really mad at me. And so there's that bracing sensation. And bracing when you get an email where somebody's mad at you is a mentally healthy response. But the challenge for me is I have a hard time letting go of the worst case scenario in my head. What if this happens? What if they think that? What if I did something really wrong? What if I did do blahbity blahbity blah, even though I don't think I did do that? And the getting caught in my head thinking about it then becomes the torture and is probably a hundred times worse than what they're actually miffed about. Do you know what I mean?

Dr. Traci Marks (24:17)

I know exactly what you mean. Yeah.

Mel Robbins (24:19)

So can you help us understand, however you'd like to use those two examples, what anxiety actually is and what you can do to release yourself from the grip it has on you? Because I think the response happens and that's okay, but it's the grip that it holds on you that becomes problematic. Is that a good way to think about it?

Dr. Traci Marks (24:40)

Yeah, that is a great way to think about it.

Mel Robbins (24:42)

Okay.

Dr. Traci Marks (24:43)

Because you cannot stop the initial response. What you can stop is the propagation of the response that then turns into freezing or lots of rumination in your head and worst case scenarios and all of that. That's where it just continues from the original thing that started it.

Mel Robbins (25:04)

Yep.

Dr. Traci Marks (25:05)

So there's this intervention called interoceptive exposure. I talk about it in my book.

Mel Robbins (25:14)

Actually, I'm turning right to the page right now. You're the one that. This is the first time I've ever heard of this in my entire life. It is genius. It's on page 248 of your book. Why am I so Anxious? So why don't you walk us through that?

Dr. Traci Marks (25:27)

Right. So interoceptive exposure really is what it is at a high level, is trying to get you to disconnect the physical sensations from it being anxiety provoking.

Mel Robbins (25:41)

Okay.

Dr. Traci Marks (25:42)

Because people can get to just where you are of fearing the anxiety because let's say they feel a little churn in their stomach and oh, I'm going to like, this is going to turn into a mess for the next hour or so or I might have a panic attack or something. So you fear the reaction to the physical sensation. So with interoceptive exposure, you wanna identify what are some of those sensations that trigger these responses. And then you want to intentionally, in a calm situation, expose yourself to those situations. So let's just say if you notice that your heart, when your heart races or if you feel your heart beat, that that's gonna make you worry that, oh, you're getting ready to have a panic attack. You could do something to intentionally increase your heart rate.

Mel Robbins (26:34)

Oh my God. But wouldn't that make you have a panic attack?

Dr. Traci Marks (26:36)

You'll be surprised when you don't have a panic attack because you probably won't because of the situation. So do a couple of jumping jacks. Your heart's beating faster now, but you're in a safe situation and you can get the reinforcement that just because my heart races or gets faster doesn't mean I'm going to have full blown panic or that it's going to explode into uncontrollable anxiety. So you're exposing yourself to these physical sensations in a safe environment and you're intentionally doing it and then you're getting the reinforcement that, okay, I can handle this.

Mel Robbins (27:14)

So in the case that Oakley just talked about where he gets this sensation in his head. What I read in your book. When you talk about this again, I wanna just give everybody the page number. Cause this is so cool. There's actually a chart for this. I'd never seen this before. It's on page 250 where you say, nausea. Spin in a swivel chair for a minute. What does that do?

Dr. Traci Marks (27:35)

So spinning in the chair activates your vestibular system or your balance in your ears. And it can trigger that same sensation of feeling the weirdness in your head or like you're dizzy. Because dizziness. Sometimes people, if they feel lightheaded, will be, you know, like, what's wrong with me? And that they become fearful of being lightheaded because. And then that makes them anxious.

Mel Robbins (28:02)

Yes.

Dr. Traci Marks (28:03)

So intentionally make yourself lightheaded or have a spinning sensation to again, reinforce the idea that it's not dangerous. You can handle this, you can manage it.

Mel Robbins (28:16)

What about anxiety that feels like a pit in your stomach? Cause I think that's sort of the classic thing that people feel. And I love that we're talking about physical sensations. Because for most of my anxiety and most of the anxiety that I've experienced with all three of our children, it always does seem to start with something physical in their body, this sense. So let's talk about the pit in the stomach. What can you do if you have a pit in the stomach every time you walk into work in the morning? A lot of people have that.

Dr. Traci Marks (28:49)

That's right. So when you get anxious, you get slowed digestion, so you get less movement of your gut. And so, yeah, that's how you can get stomachache from eating when you're anxious or even completely lose your appetite to eat when you're anxious. But anyway, the pit in the stomach. Yeah. Is related to gastrointestinal slowing and changes because of the increased cortisol and stress hormones. So what can you do about that? Well, the first step is what you've already said is recognizing that that's part of how you are manifesting anxiety. And then address the anxiety with the tools that work for you. Not everything works for everyone. An example of something could be breath work. Changing your breathing pattern just to do a reset to then relieve some of the anxieties. Cause that's what we're trying to do here. We're saying, I got this pit in my stomach. I'm probably anxious or tense about walking in. Because you might not always be conscious that. Or consciously aware that I'm anxious walking into work. It's more like I'm doing this thing. Oh, here's the pit.

Mel Robbins (29:58)

Okay.

Dr. Traci Marks (29:58)

I, you know, hate my life. Da, da, da. And you just kind of keep working.

Mel Robbins (30:02)

Yes.

Dr. Traci Marks (30:03)

But if you can separate out. Okay, I've got this pit in my stomach. It's anxiety. I am going to do something to calm myself.

Mel Robbins (30:11)

Like if we talk about. Cause I think it would be super helpful for the person listening to have you describe anxiety in terms of when you're in a calm, resting, you're okay space. You're not in the what if loop going, what if this happens? What if that happens? Blah, blah, blah, blah. And then the pit in the stomach. And then all of a sudden you think you're gonna throw up, and then you can't sleep and then you're staring at the ceiling. Yes, I've experienced all of this. Something just happened in your body when that switch flipped. So could you just describe for us what's happening either in your nervous system or digestive tract and why that's happening?

Dr. Traci Marks (30:46)

So we have two competing systems. You have the amygdala, which is a structure in your brain that is responsible for threat detection. So it detects threats and it prepares your body to be able to either fight or flee. So by increasing the sympathetic response in your body so that you get increases in epinephrine and things to stimulate you to be able to defend yourself Once that threat is passed, then the parasympathetic system kicks in to calm things down. So it's like pressing on the brakes. So the sympathetic system turns up the gas and the parasympathetic turns on the brakes to slow things back down to just kind of a normal resting state.

Mel Robbins (31:35)

Got it. So that makes perfect sense. And I think we can all imagine you're in a scenario and whether it's just your mother in law who you can't stand, and they walk in the room and you're like, that's what you're talking about? That your body and nervous system and senses sense a threat. All of a sudden your body steps on the gas. You just mentioned a bunch of chemicals that flood your body. Your heart starts racing. Why? Because you know that this person that you're now related to is about to say something nasty to you about your parenting style. So you're like on edge. You hit the gas, you're ready to go, you're bracing. That is the alarm system designed to protect you. But you also then said you have the ability to tap the brakes. Because when she leaves and you turn to your husband and say, why didn't you defend me? Like, okay, well, I'm making a joke about it, but you can take a deep breath because it's over and you go back into the present. And so it's helpful for me to understand that you have the ability to do these two things. And you said earlier that anxiety can be a really good thing because if the alarm goes on and you step on the gas because you want to do well in an interview or you need to protect yourself, then it's working. But the problem becomes, at least this is kind of what I'm hearing, that in the situation that Oakley described, that the second that his brain feels slightly dizzy, he mistakenly steps on the gas and turns the alarm system on. Is that a fair kind of way to describe it?

Dr. Traci Marks (33:13)

That's very fair.

Mel Robbins (33:14)

Okay.

Dr. Traci Marks (33:15)

And you can always, the person can always control the stepping on the gas.

Mel Robbins (33:20)

Okay.

Dr. Traci Marks (33:20)

So you can step on the gas and accelerate, but then you can come back once you recognize that that's what's happening. So the key here is understanding how your brain works so that then you can make your own interventions on that.

Mel Robbins (33:36)

I just had a huge, like, breakthrough in listening to you.

Dr. Traci Marks (33:40)

Oh, love that.

Mel Robbins (33:41)

Yeah. So let me just unpack this because I think that this is really important because I have always hated it when psychiatrists have, or psychologists or medical experts have said, well, you know, you're never gonna make your anxiety go away. Cause I'm like, I want it to go away, Dr. Marks. Like, I don't want to live like this. I don't wanna feel like this. But in what you just said, you can't actually change the things that are gonna be happening around you, whether it's your mother in law walking in or your boss's bad mood. And you can't necessarily change the fact that your body is wired to go from that thing to suddenly stepping on the gas. That anxiety response is potentially always gonna turn on. But what you can control is you can catch it. When you feel your body go like that and you step on the gas, you can take your foot off and not accelerate it.

Dr. Traci Marks (34:46)

That's exactly right.

Mel Robbins (34:47)

And the reason why that's actually important to me is because I've always focused on never stepping on the gas and so allowing yourself to think about it like, okay, I'm just the kind of person that when I sense a threat or I gotta do something, boom, my body steps right on the gas. But I don't have to accelerate this. In fact, I can use the tools that Dr. Marks is gonna teach us today to Decelerate and then tap the brake. That's exciting.

Dr. Traci Marks (35:20)

Yes.

Mel Robbins (35:20)

I've been looking at the wrong thing, Dr. Marks, for 56 years. Where the heck have you been, for crying out loud?

Dr. Traci Marks (35:27)

And you know, and that's transformative. You gotta change the focus from trying to prevent the reaction to controlling the reaction and modifying the reaction so that it's not as damaging or it, you know, it doesn't cause problems for you. That's what we're focusing on.

Mel Robbins (35:45)

I love that because I think the fear of being anxious and the frustration with it makes you just want it to disappear. What you're basically saying is, forget about that. Let's just learn how to decelerate.

Dr. Traci Marks (35:56)

Absolutely. And that takes the pressure off you to feel like you've got to do the right thing to get yourself not to be anxious.

Mel Robbins (36:04)

Okay, great. So for somebody listening who has somebody in their life who is struggling with anxiety, even just the reframe of thinking about this, like, you don't have to get rid of their anxiety. You're going to be a support system for helping them decelerate their response to it.

Dr. Traci Marks (36:20)

Absolutely.

Mel Robbins (36:20)

That's so cool. Dr. Marks, I am learning so much from you today. I'm so grateful that you're here. I know the person that is listening right now is grateful that you're here. And I wanna take a quick pause so we can hear a word from our sponsors, but also so that I can give you a chance, as you're listening, to share this with people in your life. I'm gonna tell you who I'm sending this to. Sawyer. Kendall Oakley. This incoming immediately. I'm even gonna send this to my husband because this is going to help him understand the four of us even better. But don't go anywhere, because Dr. Marks is just getting started. She has so much more to share with you, to teach you tools to give you and the people that you care about. And we'll be waiting for you after a short break, so stay with us. Welcome back. It's your buddy, Mel Robbins. And today, you and I are learning about the connection between anxiety and ADHD and surprising symptoms from the remarkable Dr. Tracy Marks. She's leveraging 25 years of clinical experience as a psychiatrist. And you know, Dr. Marks, I've been thinking a lot about what you've already shared. And I have another video for you. You were very popular when everybody heard you were coming in, okay? So here's another video for you.

Alyssa (37:39)

Hi, Mel. Hi, Dr. Marks. My name is Alyssa and I am a production assistant here on the Mel Robbins podcast. And I would love for Dr. Marks to touch on emetophobia, which is the fear of vomit. I've been struggling with this pretty much my entire life. I'm 23 now, and I can't really remember a time where I wasn't afraid of vomit. It has definitely impacted a lot of my life. When I was younger, I struggled to go to school because I was so afraid of vomiting in public. There was a time where I was doing virtual school because I just was so afraid of kids vomiting around me, of me vomiting in the classroom. And as I got older, it's still kind of prevalent in my life. Where you really don't like air travel. I still don't really drink alcohol that much because I just don't want to throw up. And I definitely feel like it's. This fear has been holding me back in a lot of avenues of life. So, Dr. Marks, if you have any advice to ease these symptoms, I would love to hear it. And I know that our listeners who might struggle with emetophobia, the fear of vomit, might as well.

Dr. Traci Marks (38:50)

Thank you. Thank you, Alyssa, for that question. Actually, emetophobia is not that uncommon. Whether it be emetophobia, a fear of vomiting, a fear of embarrassing yourself in public, any kind of phobia is typically made worse by avoidance. So the avoidance behaviors become the bigger problem than the thing that you fear. So, for me, I hate roaches. And so I could get to the point where if I try and do everything. I lived in New York during my residency, and I considered staying up there because it was five years of very few roaches. So, you know, I'm going to craft my whole life around trying to avoid roaches. I can't do that. And now I live in the south, and I definitely have to deal with them. But the point is that you can start with something that you either. Fear phobias can also be generated from disgust. So it's not always fearing. It can be just. It's so gross, you know, that it's an unpleasant sensation to even face it. But if you let yourself move the world to keep from having to deal and face that, it's gonna make the fear even worse. And then the avoidance behavior becomes the bigger problem than the original thing.

Mel Robbins (40:16)

I think that's a super. Because when you say that the avoidance of it becomes a way bigger problem than the thing that you're actually afraid of, that's when it seems like anxiety spirals into something that makes your life debilitating. And one thing that I worry about. You mentioned that there's been a big rise in social anxiety. I worry when you look at hybrid work and how people don't see their friends and the rise of loneliness, that if you're also somebody that feels a little discomfort around putting yourself out there, that then when you start to avoid it and you start to stay in and then you're not reaching out and then you're not going to the things you are invited to, that the avoiding of putting yourself out there becomes actually the bigger problem than being worried about what it's gonna feel like when you put yourself out there.

Dr. Traci Marks (41:09)

Absolutely. The pandemic reinforced a lot of social anxiety for people. People were like, oh cool, I didn't wanna go anywhere anyway. Well, then now they have a reason not to. And then now trying to like move past that. Once the pandemic was over, it was even harder for many people like that. And as we know, social isolation also makes anxiety worse. So it's a problem that just can compound on itself.

Mel Robbins (41:38)

What's the difference between being shy and introverted and having social anxiety?

Dr. Traci Marks (41:43)

Dr. Marks, great question. So introversion is often misunderstood. It's not as though you don't want to be around people. I'm introverted and I get my energy from having some downtime, quiet time time to myself in my head. That's where I gain my energy. So I can get depleted if I'm out all day long and talking to people. Versus the extrovert gains their energy from the interaction with people and they can get depleted if they have too much alone time. So knowing that being introverted doesn't mean that you've got a problem or that being around people makes you anxious. You just have to balance some time to have to yourself to be able to just think in quiet and peaceful. Social anxiety is an anxiety disorder where you become preoccupied with being judged and what other people think. To the extent that it changes your own behavior and makes you avoid situations where you fear you're gonna be judged.

Mel Robbins (42:57)

Oh really? They're like kind of mixed together.

Dr. Traci Marks (43:00)

They're mixed together. So it's not just that you fear become anxious being around people. You can become anxious on the performance aspect. With performance being speaking doesn't have to be playing a piano on stage. So if I've got say, you know, I have patients who have trouble with these like meetings. And so they'll get really anxious about just having to even like deliver or talk to a team about what they were doing. That would be an example of performance anxiety. So with that, there's a lot of fear and thoughts in your head about what people are thinking. You're appraising your own performance and just assuming that you're gonna mess up and have all this criticism. So that's a lot of the genesis or the thoughts behind what drives social anxiety is what other people are thinking.

Mel Robbins (43:59)

So can you put us at the scene of what it feels like when you are struggling with social anxiety? And again, where you're putting yourself in a situation, let's just say that you're. A bunch of friends are meeting out at a bar and they're like, come on out, you know, meet us after work. And the thought of that moment where you walk through the door and the music is loud and it's kind of a crowded place, and you're looking around and you see the group over there, and then you immediately are like, ah, you know, I shouldn't have come, or my friend isn't here yet. I shouldn't go. What is happening for somebody that feels social anxiety in that kind of situation or when they walk into a networking meeting and you immediately just feel like the spotlight is on you.

Dr. Traci Marks (44:52)

So there's an overemphasis on other people's appraisal of you or other people's judgment of you. You assume that you're the focus of attention, which you're not. Everyone's not directing their attention to the door, but that's what it feels like.

Mel Robbins (45:07)

But you know that moment, though, when you do walk in and everyone turns and they're like. And then they look back, you know, and for. If you're listening, I literally just turned around and then turned and gave Dr. Marks that kind of, like, blank look that's not very warm. And then you feel like they look you up and down and then they turn back and you go like, so how? Like, that's a very real experience that we've all had.

Dr. Traci Marks (45:32)

It is. And it's based on your assumptions. So the non socially anxious person could have that happen and just think, oh, they looked and they saw that I wasn't the person they were looking for and they turned back around. The socially anxious person could say, they don't like what I'm wearing, or they hate that I'm here, or they're like, why was she invited? Like, that's the assumption that the socially anxious person makes.

Mel Robbins (45:59)

Got it. So in that scenario, how do you use the tools to stop yourself from accelerating the situation and separating yourself from the sensation you feel versus running yourself over with an anxiety response?

Dr. Traci Marks (46:14)

Right. So there's kind of two branches to this.

Mel Robbins (46:17)

Okay.

Dr. Traci Marks (46:17)

One takes a lot of self discipline and some work behind the scenes before you get to that situation of changing your mindset about what other people are thinking, recognizing that you're making assumptions. You've got a lot of negative self talk working on your negative self talk. To be able to accept that, like, for example, accept that people, it's not about you, things like that. And then the second part is addressing the physical sensations that you have in that scenario. So again, this is all like homework to do to be able to build these tools for yourself for what works for you. Because what works for one person may not work for the other. So it could be. I love the vagal maneuvers.

Mel Robbins (47:08)

Okay, what's that? That sounds complicated. A vagal maneuver. Vagal maneuver is that when you raise your hand and go, bartender, right over here.

Dr. Traci Marks (47:17)

So your vagus nerve is what's responsible for the step on the brakes response of calming you down. The parasympathetic nervous system. And there's things that you can do to trigger it, to trigger a calming response. So things like cold exposure, splashing cold water on your face or chest. Now, you may not be able to do that if you're walking into a networking meeting, right. Humming. You still may not be able to do that when walking into a networking meeting. But that activation of your vocal cords is something that then, because of the proximity or the closeness of your vocal cords to your vagus nerve, stimulates it. And that could. And that's why you see people meditating and making that humming, that sound. It's to stimulate their vocal cords. Breathing is something you can do if you're walking into a networking meeting because it's something you can do privately. And so it's not just, oh, just breathe. There's certain types of breathing patterns that you can employ that are calming. Two classic ones are the box breathing, where you inhale for four seconds or a count of four, you hold it for four, then you exhale for four, and then you hold that for four. Now, some people don't like that, aren't able to do it as well. I know sometimes it could trigger hyperventilation for me because I can feel like I'm not breathing. So there's other types of breathing. I'll give you two more. One is a four, seven, eight breathing pattern. So you inhale for four, hold for seven seconds, and then exhale for eight. And that longer exhale really is stimulating for your vagus nerve.

Mel Robbins (49:05)

Well, what I love about this is you're starting to really cement this theme that there are always gonna be things in your life that trigger the pit in the stomach or make your heart race or that make you jump up into your head and start going, what if this? What if that? What if they're saying that that is something that is just what we all need to learn to live with. But whether or not you hit the accelerator and you run yourself over and allow anxiety to just flood you is within your control.

Dr. Traci Marks (49:38)

Yeah. And if you're not into the counting, just breathing in deeply slowly and exhaling slowly, even that is helpful because, again, when you're tense, you're breathing fast and shallow.

Mel Robbins (49:53)

You know, Dr. Marks, Alyssa's question about the fear of throwing up and just the idea of it making somebody anxious, we get flooded in the inbox with questions about this. Based on your 25 years of clinical experience as a psychiatrist, what are mind tools, body tools, and behavior tools that you can use to help yourself manage anxiety?

Dr. Traci Marks (50:24)

Okay, so I'm going to talk about the tools, and then there's lifestyle stuff.

Mel Robbins (50:30)

Oh, okay.

Dr. Traci Marks (50:31)

Okay. So the tools are things that are kind of like, based on cognitive behavior therapy that could help you manage your anxiety. Mind tools. That's just kind of how I broke these things up. But the mind tools are things like grounding exercises. A simple one is, you know, counting or looking in a room and picking out a color and naming all of the things in the room with that color. What does that do? That takes you out of the moment of what about this? And what about that? And brings you into the present moment of experiencing the colors in the room.

Mel Robbins (51:11)

Excellent. What's a behavioral tool that you could use?

Dr. Traci Marks (51:14)

A behavioral tool would be something like coloring. Now, that's not something that you would do at the networking meeting.

Mel Robbins (51:21)

Yeah. Depends how boring it is.

Dr. Traci Marks (51:24)

Yeah, exactly. But that would be something that you would do on your own to help bring down the level of tension and anxiety in general.

Mel Robbins (51:33)

Got it.

Dr. Traci Marks (51:34)

So another behavioral tool would be like, the interoceptive exposure that I talked about, or any kind of exposure. So let's say that if you know that you have got to attend networking meetings, but they make you want to throw up every time you get ready to walk in the door, you can create a list of little steps that can get you to being able to go into a networking meeting and feel comfortable. So it starts with showing. Showing up at the place. Then it could be being able to walk into a room, and you don't have to say anything, just be able to walk into the room and manage that level of anxiety. Then the next Step could be actually being able to walk into the room and go talk to one person, so on and so forth. You kind of build out this gradual exposure to the thing that makes you anxious, which ultimately would be walking around from person to person and talking about stuff spontaneously. So get good at the first steps of just being able to walk into the room, and you just gradually build your confidence, and you desensitize yourself to these threatening things that then they become less threatening for you.

Mel Robbins (52:49)

So you're basically saying, if you're somebody that has a fear of throwing up, you can have that fear and still get on the plane. You can have that fear and learn how to go to the networking meeting. You can have that fear and do a sleepover or go to work, because the fear may never go away. But you can learn how not to accelerate in those situations where you notice you're a little worried about it. Is that a fair way to say it?

Dr. Traci Marks (53:19)

That's a fair way to say it.

Mel Robbins (53:21)

You know, I recently started thinking about anxiety as a moment where there's something that you fear or you're uncertain, and then you doubt your capacity to handle it. And I'd love to hear you reflect on that.

Dr. Traci Marks (53:37)

So this is where the exposure really reinforces that you do have the capacity to handle it. And when you take that away, that reinforcement away by avoiding it, then you can't remember that you can actually do this. And so, again, going back to exposing yourself, you're not just trying to jump right in and say, okay, I'm gonna go to this place, and let's say you fear throwing up in a public place. I'm just gonna just jump in and hope for the best. Instead, you take little steps toward getting to that ultimate place. I mentioned the lifestyle stuff. Oh, please.

Mel Robbins (54:22)

Yes.

Dr. Traci Marks (54:22)

Because one of the biggest ways we can change how we manage anxiety or how it manages us is our lifestyle choices. Those things really do matter. And probably the biggest ones, sleep, diet, and exercise. And every time I talk about these things, I always kind of feel like I have to brace myself for the person saying, yeah, yeah, yeah, I know that. But really, it really does matter.

Mel Robbins (54:49)

Why?

Dr. Traci Marks (54:50)

Because all these little habits rewire our brain in either a negative way or a positive way. So just taking diet, diet with high sugar content, which I'm guilty of. Heavily processed foods creates inflammation in your body. It changes the constitution of your gut. Bacteria and inflammation and things send negative signals to the brain that then make it harder to manage anxiety.

Mel Robbins (55:22)

So eating too much sugar and ultra processed foods actually increases your anxiety?

Dr. Traci Marks (55:26)

Yes.

Mel Robbins (55:27)

Wow.

Dr. Traci Marks (55:28)

And you know how?

Mel Robbins (55:29)

No.

Dr. Traci Marks (55:30)

It increases anxiety because those behaviors send signals to the brain. They actually change your. The way your genes express themselves is called epigenetics. It's kind of a new topic. And so it can make anxiety worse if it affects, like, the genes that express cortisol production by making it overactive or underactive. So I think that, you know, for years we've known that these things are helpful, but didn't really understand how they're helpful. And these behaviors really do make a difference. Sleep. If you go without sleep, sleep deprivation makes anxiety worse at baseline. So it's more than just why does.

Mel Robbins (56:15)

It make it worse if you don't get enough sleep?

Dr. Traci Marks (56:17)

There's a lot that goes on during sleep. And so just like we have to plug in our phones in order for it to work, our brains and body need a rest. Because when we're sleeping, there's lots of generative functions and things that happen. And when we don't have enough time for our body to kind of take what we learn during the day, file it away, then you end up with just too much. You end up with the information overload and having trouble processing it.

Mel Robbins (56:45)

Got it. It's almost like as I'm listening to you, I'm thinking about how much sense that makes, because if you don't get the rest you need and you wake up weary, everything around you is gonna feel like a threat.

Dr. Traci Marks (56:58)

That's right.

Mel Robbins (56:58)

And what was the third one? Exercise. Okay, so how does not exercising make you more anxious?

Dr. Traci Marks (57:05)

Exercise. It's probably better to think of it as how exercise reduces anxiety. Okay, so exercise increases brain derived neurotropic factor bdnf, which is a protein that is responsible for regenerating nerves, repairing bad nerve connections. It's the very thing we want to be thriving, and it's like fertilizer for the brain. So exercise increases the amount of bdnf we have to then be able to rewire to allow the good habits that we develop to make a difference in our brains. If you don't have that, then you're just kind of left with your baseline of what you're stuck with. So it's more about enhancement than it is about fixing.

Mel Robbins (57:58)

Got it. This makes so much sense.

Dr. Traci Marks (58:01)

It all makes sense. If you just understand. If you just understand how your brain works, then you can build a system around yourself to overcome these challenges and turn them into strengths.

Mel Robbins (58:14)

Wow. You know, this feels like a good moment to hit the pause button, because there's someone in my life that I actually want to share what you just said with. And so I want to give you, as you've been listening to Dr. Marks, a chance to share this information and this conversation with people that you care about. I also want to give our sponsors a chance to share a few words. Don't go anywhere. Dr. Marks and I will be waiting for you after a short break. Stay with us. Welcome back and hey, it's your buddy, Mel Robbins. Today you and I are learning from Dr. Tracy Marks. We're learning about the connection between anxiety and adhd. Thank you for being here and listening to this. Thank you for sharing this with people that you care about. Now, Dr. Marks, you know, one thing that I'd love to talk to you about is the connection between ADHD and anxiety seemed to be this thing that goes hand in hand. And I remember when our son Oakley was in the fourth grade, he came home from school and he had these, like, bruises on his hands. And I was so upset because I thought he had gotten into a fight at school. And I asked him oak, like, what happened? What happened? And he couldn't remember. Well, long story short, it turns out that he had undiagnosed dyslexia, dysgraphia, and adhd. And it was now the fourth grade, and so everything was crashing around him and he was apparently so sitting in class, wringing his hands to the point where he had bruised his own hands. And when we took him in to see a doctor, they were saying, oh, it's anxiety. And that's what got diagnosed first. And then when we went and got all kinds of evaluations done, it turned out there were lots of other things going on. And if I look at my own history, I was diagnosed with anxiety in my high school years. And the underlying issue, I believe, was undiagnosed adhd. I was treated for anxiety for decades. And it wasn't until I was diagnosed with ADHD at the age of 47, like the majority of women are when their kids are going through the diagnosis and you start to go, well, that seems very familiar, that seeing the issue of ADHD for the first time was absolutely life changing and help me personally separate those two things. But when I think about anybody that I know that has adhd, they always talk about anxiety and vice versa. And so what is the connection between these two things?

Dr. Traci Marks (61:01)

So, yeah, they're very interconnected, kind of a bidirectional relationship, meaning one can affect the other. So absolutely. ADHD can cause what we would consider like a secondary anxiety. So it kind of derives from ADHD and If you think about it, just the sheer disorganization of thought can make you feel out of control and therefore then create anxiety about your ability to just even, like, hold it together to be able to perform, be productive, all of these things.

Mel Robbins (61:36)

It's sort of like its own type of performance anxiety.

Dr. Traci Marks (61:39)

It is.

Mel Robbins (61:39)

You know what? I used to beat myself up chronically because I constantly forgot people's birthdays. But I resonate with that because when you have trouble directing your attention and staying on top of details, you do feel like you're not on top of things. You do feel like you're screwing up. And it does create this sense that there's something wrong with you.

Dr. Traci Marks (62:05)

Yeah, really? The lack of control over your own thoughts and behaviors. So another thing that's kind of key with adhd, though, is so you've got the standard inattention, hyperactivity, and impulsivity that kind of classically defines adhd. But then you've got the executive dysfunction. Executive functions are things like time management, organization, working memory, the ability to keep things top of mind for easy retrieval later.

Mel Robbins (62:42)

Did my husband call you before this and ask you to have an intervention with me, Dr. Marks?

Dr. Traci Marks (62:48)

I'm not telling. So those activities or those abilities are controlled by the prefrontal cortex, front part of the brain. With people with ADHD who have low levels of dopamine in that area, they have less ability to control those functions. So emotion regulation is an executive function?

Mel Robbins (63:14)

It is.

Dr. Traci Marks (63:15)

It is.

Mel Robbins (63:17)

Well, that explains a lot.

Dr. Traci Marks (63:18)

It explains a lot.

Mel Robbins (63:19)

So are people that have ADHD tend to be more emotional?

Dr. Traci Marks (63:24)

Emotional, yeah. So if you've got something that would ordinarily cause some level of anxiety, it can escalate in the person with ADHD because they have less ability to rein it in.

Mel Robbins (63:38)

That makes so much sense. So what are the key differences between ADHD versus anxiety? Because, you know, I've heard ADHD described, as you mentioned, the prefrontal cortex and executive functioning. It's like the conductor in the brain that is basically going, tap, tap, tap, string session, like, you guys, shh, shh, shh. And then lifting up this group over here, the percussion. You can come on now. The ability to kind of direct your attention. That switching feature doesn't really work that well.

Dr. Traci Marks (64:14)

Yeah. So one more thing about the relationship with adhd, because the prefrontal cortex. Yes. Being the brain CEO and the conductor, it will manage the amygdala, which is our fear center. If it is compromised, like with adhd, it won't be able to manage the amygdala as well. So the amygdala can hijack its control and then turn everything into something to be afraid of and convince you that you have got to worry about the worst case scenario.

Mel Robbins (64:52)

I can't believe we're talking about this because I learned for the first time last week talking to my therapist who's changed my life, Shout out Ann Davin, where she was basically saying there's a huge connection between ADHD and actual rumination and spiraling thoughts because you can't pull your attention off of the worst case scenario. You know, I mentioned earlier getting this email from somebody who's miffed at me about something and I bet I probably wasted three hours because I could not direct my attention to something else. I would try to and I'd be like, nope, let's think about that over here. And so that makes so much sense why these are so related to one another. Dr. Marks, do you have any thoughts on what seems like a huge surge of people getting diagnosed later in life with adhd, which was the case for me and a lot of my female friends?

Dr. Traci Marks (65:47)

I just want to say I do think that there's a misconception though that people, more people have ADHD this day in time and that everybody's got it or that it's over diagnosed. I think what's happening is that there's more education about it and a more appreciation of for it and therefore a greater detection of it. Even when I was in residency 25 years ago, adult ADHD was just kind of quasi appreciated. In fact, it was kind of seen as something that's not real. It's a disorder in children. So over time we've come to recognize adult ADHD as its own entity that is real. It's not just adults seeking performance enhancement. That said, I think there's societal factors that affect people being diagnosed with it. You know, it's just hyperactivity, could be bad behavior, resistance to even seeing something mental as something that needs attention. But I'm just saying all that to say I think we've evolved when it comes to seeing mental health as a real thing to pay attention to and prioritize. But it's been a long haul that way and there's still a lot of remnant bias against it. It's easy to just kind of write it off as well. You know, these are just quirks or something about you, right?

Mel Robbins (67:13)

Or everybody's distracted you don't have adhd. That's what I hear a lot like, can you explain? And I think it would be helpful to really just put the nail in the coffin on this one because there is sort of that eye roll. Oh, you have adhd, too? Everybody's distracted. There's a big difference between just being distracted because of the world that we live in versus what it actually feels like day to day to be somebody that does have ADHD as a diagnosed condition that you're dealing with or an undiagnosed condition that you don't know that you're dealing with. So can you walk us through what a day might look like for somebody who is going through their day and they may not realize they have adhd?

Dr. Traci Marks (68:01)

So I will say it really is on a spectrum because, again, I'll use myself as an example.

Mel Robbins (68:08)

Have you been diagnosed with it?

Dr. Traci Marks (68:09)

I was treated as a child. More for hyperactivity, though. But yeah, I was treated as a child for adhd. And as an adult, I still have trouble owning it because I feel like of all the people I've treated and I look at my son and my husband, I'm like, I'm not like them. So I can't really have this.

Mel Robbins (68:28)

What? You're sitting here as a psychiatrist telling me that you don't like the diagnosis that you have been given because you look at your husband and your son and are like, I'm not like those losers. I knew I loved you. Oh, my God. Dr. Marks. But even though you've been diagnosed with it, you're like, I can't possibly have that.

Dr. Traci Marks (68:47)

I still have trouble accepting that. Well, I don't. I just think I'm one of those adults who's grown out of it, but I know that I haven't. And the reason is I love you. I still. I recogn. What it is, is I recognize what my weaknesses are. So I'm a slow reader. So I could not have a job where I had to, like, put down a book every week, that I just wouldn't work in that kind of situation. So. And I have trouble set shifting.

Mel Robbins (69:15)

What's that?

Dr. Traci Marks (69:15)

So if going from one task where you're into it and then you gotta stop and go do something else.

Mel Robbins (69:21)

Oh, my God. I say this to my team all the time. I'm like, if we are gonna do a production day, I will tape for nine hours straight. But the second you put me in a meeting and I have to look at copy or if I have to change something on my phone, you call this set switching?

Dr. Traci Marks (69:35)

Yes.

Mel Robbins (69:36)

And I go into a different mode. I can't go back to taping.

Dr. Traci Marks (69:40)

That's right. So someone who doesn't have trouble with that. Can like work and then, ooh, there's a meeting. Okay, I'll stop, pick up, go to this meeting. Okay, that meeting's over. Okay, go back and jump right back in. No. So I will have like, I don't see patients on Fridays and that's days that I kind of do business related things.

Mel Robbins (69:58)

Do you actually get anything done? Like I get something done for like the first hour and then I'm realizing I have a zoom call and I get nothing else done.

Dr. Traci Marks (70:05)

That's what exactly what happens. So if I've got to take my mom to a doctor's appointment in the middle of the day, I know that that day is going to be completely wasted for me. And other people will say, well, you had two hours before the appointment and two hours. So what's. That's the problem. That interruption will just ruin my whole day.

Mel Robbins (70:22)

And does that have to do with the dopamine and the prefrontal cortex being able to direct different parts? Is that what that is?

Dr. Traci Marks (70:29)

That's what that is.

Mel Robbins (70:30)

No way.

Dr. Traci Marks (70:32)

And so someone with adhd, one misconception is you can't focus at all. And it's not only about focusing, because people with ADHD can hyper focus on things that they're interested in. It's a stimulation issue.

Mel Robbins (70:46)

What does that mean?

Dr. Traci Marks (70:47)

That means that the ADHD brain needs stimulation to stay engaged in something. So it has to be something that commands your attention and keeps your attention. And as soon as there's boredom involved, then you're gone.

Mel Robbins (71:04)

Okay, so I wanna see if I can unpack this. So your brain needs stimulation to pay attention if you're somebody that truly struggles with this issue of adhd. And so I'm thinking about the example that absolutely all of us can relate to where you have somebody in your life who is, can literally rot away in front of a video game for two days. And you walk into the room and they don't even break their stare, they're so hyper focused. But then getting them to put their dirty clothes in the laundry basket or remember to do the homework or shut the refrigerator door or put their shoes somewhere other than the middle of the hallway. It's just, you don't even understand why they're like this because you've seen them focus on something. So that must mean they're just a world class jerk in every other area of their life because you're not seeing that level of attention to detail in other areas. And so we presume that the person doesn't care or that they're rude or that they're aloof. And what you're saying is. No, no, no, no, no. The ADHD brain really requires some form of stimulation. Is that where the dopamine comes in?

Dr. Traci Marks (72:24)

That's where the dopamine comes in and the whole reward circuit. So because of the lower levels of dopamine, then you can struggle on staying engaged and paying attention to things that don't interest you.

Mel Robbins (72:36)

Well, you know what's interesting is that this makes sense, because if I think about what I've heard a lot of people say and what I've struggled with is like, if you literally wake up in the morning, if you have ADHD and you grab your phone and then you look at social media, you've just flushed your dopamine that you needed for the attention during the day right down the toilet, and now you're gonna struggle to gain it back because you wasted it on something really stupid. And understanding that you need that dopamine to focus, that's a really important thing to understand.

Dr. Traci Marks (73:12)

Absolutely. And you know the thing you were talking about with leaving stuff in the middle of the floor and making it look like they're just a jerk, they don't care. Is why people with ADHD can have relationship problems, a lot of relationship problems. Because the non ADHD person can feel like the person doesn't care. It's like, you don't see this tennis shoe in the middle of the floor. You just stepped over it. How did you miss? How are you missing that? Do you not care about our house? Looking good. But it's not that they don't care. It's just not on their radar.

Mel Robbins (73:43)

And also, because if they've also blasted through their dopamine by being on social media first thing or playing video games or whatever, they don't have the stimulation that they need in order to focus on these things that are not that interesting. That is so helpful to understand this. I mean, when I think about some of the just not so things that I do because of my adhd, I have lists everywhere. I leave cabinet doors and faucets running all the time. Cabinet doors open. I also do this thing on social media where I have extensive folders of things that I've saved, thinking that at some point in the future I will go back and organize them all. I haven't looked at them once, and I just obsessively do this. I'm constantly running late because I have this weird time expansion thing that happens to me where I feel like I can get 25 things done in exactly three minutes. It just makes me crazy because I know that I can focus in other areas. So it's seems so weird that I can't just fricking make myself do it. Talk to me, Dr. Marks.

Dr. Traci Marks (74:53)

Well, the thing is, it would be great if you could control what gets your attention enough to be able to stay engaged, but you can't always do that. Now you could exploit that if you knew, if you're self aware enough to know that these are the things that I know I can lock into and these are the things that are not. So I'm gonna try and minimize how much of those things that I have to do or get help with those or whatever.

Mel Robbins (75:17)

Got it. It's so fascinating. You know, you have unbelievable content on your YouTube channel that are all about the overlooked signs and symptoms that people don't realize are symptoms of ADHD and anxiety. And I would love to have you talk about body picking. What is body picking and why do people do it?

Dr. Traci Marks (75:41)

Yes. So body picking, the technical term is body focused repetitive behaviors. And it really is its own disorder that mainly is skin picking and hair pulling. And those things can become really problematic for people.

Mel Robbins (75:58)

So is hair pulling like when you see somebody constantly like twirling their hair and splitting the ends and doing stuff like this? Is that what you mean?

Dr. Traci Marks (76:06)

Well, so for the compulsive disorder of the body focused repetitive disorders, people can actually like pull it out from the root. And part of the like pleasure of it is actually that pulling it out from the root. Oh my gosh, it's not really splitting.

Mel Robbins (76:22)

Okay, but for people.

Dr. Traci Marks (76:24)

So there's that compulsive disorder, but a kind of a lower level of that is general body behaviors that can also include nail biting and cuticle biting. Biting the inside of your cheek.

Mel Robbins (76:39)

Wait, so nail biting and biting or picking at your cuticles or around your fingers is a form of anxiety, is like a symptom of anxiety?

Dr. Traci Marks (76:48)

It can be really. So people with anxiety can do it to relieve tension and be self soothing. People with ADHD can do it for stimulation.

Mel Robbins (77:01)

Why is nail biting and skin picking something that people with ADHD do?

Dr. Traci Marks (77:07)

Because the ADHD brain needs stimulation and this provides sensory input for the brain. So you could have someone who's say, studying or watching television, and they may kind of enjoy what they're watching, maybe, maybe not. But they can kind of get into this trance state of just kind of pulling, picking or whatever that's stimulating their brain and keeping it active.

Mel Robbins (77:32)

So if you're somebody that struggles with nail biting doctor Marks, what do you recommend somebody do?

Dr. Traci Marks (77:39)

So, first of all, there's just even recognizing the habit because some people can do it and not even really being aware that they're doing it. And then when you add on the time blindness or time expansion that you mentioned.

Mel Robbins (77:52)

Oh, with adhd.

Dr. Traci Marks (77:53)

With adhd, you can think. You're just doing it for a minute. And it was really 45 minutes that you were doing that thing. And now you've got sores or you've got bald spots. So first there's just the awareness of it, of what it is you're doing. Even being aware of any triggers that make you do it or that make it worse. It can be. Anxiety can make it worse. Boredom can make it worse. Then putting other things in place. We call it habit reversal. Putting other habits in place to replace these more destructive habits. Someone who picks their nails or bites their cuticles could either put on gloves. Like, let's say you notice that you do this while you're watching television a lot. You could put on gloves while you're watching television. You don't need to walk around for your whole life with gloves, but just during these times.

Mel Robbins (78:46)

And if you were to wear the gloves for a couple months, does that train you to stop doing it? Is that what's happening?

Dr. Traci Marks (78:54)

It trains you to stop. It breaks the cycle. Because if you go back to the idea of this being like a semiautomatic thing that you engage in, it helps break that semi automatic thing so that you have more intentional behaviors. So while I'm watching television, instead of me biting my cuticles or picking my nails, I'm doing this other thing that.

Mel Robbins (79:18)

Makes sense because I would imagine people do it almost as like a soothing technique, you know? I have another question from my son.

Dr. Traci Marks (79:26)

Okay.

Mel Robbins (79:27)

That I would love to play for you.

Oakley (79:29)

And then I have one more question for you. And then this one. This one's a good one. Whenever I get anxious, I like, I normally, like, uncontrollably shake my hand like this or like, I go like this. Like, I do a little snap is that. But it's a lot of, like, shaking. And it's something that I do completely unconsciously at this point. And I was curious what you might think about that, too. Let me know. Thank you so much. You're amazing. The work you do is incredible. You help so many people, and we are so lucky to have you. Thank you.

Dr. Traci Marks (80:05)

All right, so, yes, he spoke to exactly what we were just talking about. The unconscious nature. Not unconscious in the sense that you're not awake you're not awake, so it's beyond your awareness that you're doing this soothing thing. So there's nothing inherently wrong with doing things that are self soothing. It becomes an issue when it either causes problems for you for some reason, like you're pulling out your hair or, you know, destroying your upper lip or bottom lip because you're biting or it's socially unacceptable. So, yeah, he can't go places doing this when he starts to get anxious. So it's about finding other self soothing things either. So twofold. One is reducing the finding things that reduce his anxiety. And that could be, you know, the breathing or something vagal.

Mel Robbins (80:58)

Oh. So for example, if he catches himself shaking and he gets to a point where he's like, this is something that I'd like to stop doing, that I'm not aware that I'm doing that in moments where he catches himself doing it. So going back to this kind of metaphor of the response happens, that's not what we're focused on. We're focused on not stepping on the accelerator. He might then go, okay, clearly something's making me feel a little unsettled. Let me do a breath. And so he's now catching that he's shaking and he's teaching himself to take his foot off the gas and to step on the brake.

Dr. Traci Marks (81:39)

That's right.

Mel Robbins (81:40)

Oh, wow. And then just like some of the other examples of you're putting gloves on while you watch TV so you don't destroy your finger beds or bite your nails down until they're bleeding, that you are now teaching yourself to stop doing that thing subconsciously in situations where you might feel bored or lonely or nervous about something.

Dr. Traci Marks (82:05)

Absolutely. Because the biggest step here is the awareness part.

Mel Robbins (82:09)

Yes.

Dr. Traci Marks (82:10)

Because, yeah, a lot of times these things just happen automatically. You're not even aware that you're doing it or you're not aware that you're doing it for as long as you're doing it.

Mel Robbins (82:18)

Dr. Marks, what would you say to somebody who is struggling with body picking and it's really challenging and impacting their life?

Dr. Traci Marks (82:29)

Yes. So if it's really severe, I think they should seek professional help from like a therapist to help them develop some kind of like habit reversal therapy to get them to be able to not be able to do this. Sometimes medication is what someone needs to reduce their anxiety, especially if they're engaging in a way that's really destructive.

Mel Robbins (82:52)

Since we're on the topic of repetitive behavior, what is the relationship between ADHD and tics? And what is a tic?

Dr. Traci Marks (83:01)

Yeah. So a tic is an involuntary, usually sudden, rapid behavior that can either be motor or vocal. It can be its own thing. So something like Tourette's syndrome involves tics, but not all tics are Tourette's syndrome. Motor tics would be things like grimacing or blinking your eyes or my son used to do this thing where he'd open up his mouth real wide when he'd get really anxious. Vocal tics would be things like sniffing or coughing, clearing your throat a lot or even saying things. That's kind of the television version of it, is people yelling out obscenities. So as I mentioned, tics, anyone can have tics and they can come and go.

Mel Robbins (83:57)

Are they self soothing? Is it another form of what we've been talking about or is it a different thing?

Dr. Traci Marks (84:03)

It's a different thing. It's not self soothing. It's usually just a response to anxiety. They're usually made worse by anxiety. So you get anxious and then you start doing this thing. For the Tourette syndrome, on the other hand, that's a whole different entity and that's. It can be made worse by anxiety, but it is, it's kind of its own thing, self generated from that neurological disorder. But in the example of someone with anxiety having tics or even there's just a greater prevalence of people with ADHD also having tics.

Mel Robbins (84:37)

How come?

Dr. Traci Marks (84:38)

I think it's related to just the biological mechanisms in the brain of kind of sharing real estate in areas of the brain that affects both. ADHD tics are also dopamine sensitive, if you will, behaviors or the condition is related to dopamine as well.

Mel Robbins (84:59)

So meaning when you don't have a lot of dopamine, the tic can be worse.

Dr. Traci Marks (85:04)

I guess the best way to say it without getting too complicated is it is a setup. Like low dopamine levels are also associated with tickets.

Mel Robbins (85:13)

Gotcha. So how do you know the difference between kind of a self soothing behavior, like what Oakley was talking about with the handshaking and the nail biting that we've discussed, and what you would classify as a tic.

Dr. Traci Marks (85:30)

So with tics, they aren't self soothing. In fact, people can have a buildup of tension that they feel if they try and suppress it. So it's, it's usually involuntary. They can't help it. And if they recognize that they're doing it, like heavy blinking, say they can try and not do it because people are around, but at some point they're just gonna have to let it rip.

Mel Robbins (85:53)

And so what do you do if you are or somebody that you love is struggling with a tic.

Dr. Traci Marks (85:59)

One other thing I wanna mention about tics and ADHD is unfortunately, medication, stimulant medications can also make it worse.

Mel Robbins (86:06)

Oh.

Dr. Traci Marks (86:07)

So if you notice that, that would be something to address with your doctor to see if changing the medication regimen could help. Because that's not something you just kind of make go away if it's being driven by the medication. Tics tend to also wax and wane. They can go away or they can come back if, say, you get really anxious.

Mel Robbins (86:31)

So do the factors that you've written about in your book and that we've talked about, diet, sleep and exercise, also have an impact on tics and also, like in a positive and negative way?

Dr. Traci Marks (86:44)

So they can have. Yes, in a positive and negative way, in the sense of you could think of these lifestyle factors as things to kind of reduce the downstream problem.

Mel Robbins (86:59)

Okay.

Dr. Traci Marks (87:00)

So these are things that you want to do that work in the background to reduce these issues. And then the other tools we were talking about is what do you do when the issue arises right now, but the lifestyle things are to get the issues from happening.

Mel Robbins (87:17)

Why do people who have ADHD and anxiety struggle with procrastination and perfectionism?

Dr. Traci Marks (87:23)

So with procrastination, motivation is one of those executive functions that's part of the prefrontal cortex functions. And so you have lower motivation that then makes it harder for you to get started. But also another thing that can make people, either with anxiety or adhd, procrastinate is having a huge accumulation of failures, criticisms, and. And therefore creating performance anxiety of like, well, I don't know if I can do this. Cause I always screw this up. So I'm just not even gonna get started. Or it's just the problem's just too big. I just can't do it.

Mel Robbins (88:08)

That makes so much sense. I mean, it basically explains my college and law school careers and leaving everything to the last night. Because I would also add on to that as I'm feeling very validated by what you just said, being so disorganized and this kind of overwhelming feeling that there's so much to do that you don't even know where to start. And then you just kind of collapse until everything's on fire and you have no choice. And then it becomes the emergency all nighter because you have put yourself in this corner and then you want, I'm never doing that again. And then of course you do it again. So I could see how it would become a chronic problem as it was for me. Dr. Marks, what do you recommend for somebody who is really struggling with procrastination and wants to change that behavior?

Dr. Traci Marks (88:58)

So one thing someone could do is what I call the five minute rule, where you give yourself five minutes to do this thing and you give yourself permission to stop if you don't like it or stop if it's not clicking and it's okay. But just that inaction of making yourself, forcing yourself to get started, you may find that then you're starting to roll with it and this isn't that bad. Okay, I'll do a little bit more.

Mel Robbins (89:29)

Yep.

Dr. Traci Marks (89:30)

If not, it's okay. You still achieved something because you got started and you broke past the procrastination. So even that's still reinforcing.

Mel Robbins (89:40)

Terrific. Dr. Marks, if the person listening today does just one thing, based on the unbelievable amount of stuff that you've taught us today, what would be the most important thing for that person to do after this conversation?

Dr. Traci Marks (89:58)

Only one.

Mel Robbins (89:59)

You can pick two or three. I'll give you that. Okay.

Dr. Traci Marks (90:04)

So I think number one would be shifting your mindset from looking at a condition that you have as an needing to be fixed and instead understanding it, understanding how it affects you and putting things in place to help you manage it to improve the quality of your life. That would be the first thing. Then I would say, I think kind of the number one lifestyle choice would be sleep. I think that is the most important with diet being a close second, because again, we can talk about, you know, what do you do if in this situation, what's the tool that you can use? And there's bunches of tools. I have over 20 of them in my book. It's about finding what works for you when it comes to the tools, because not everything works for everyone. But then really addressing the things like sleep and diet and exercise and coming up with an inventory of how well are you sleeping, what's your diet like, how often are you exercising, what's missing from this? Because you can go online, you can go anywhere and find out what's the ideal seven to nine hours of sleep, all of that stuff. Come up with a list of the things that you need to change to improve the quality of your life and then just chunk them out little bit by little bit. Maybe this month I'm gonna work on setting a bedtime. Maybe next month I'm gonna work on reducing the number of potato chips that I eat. The next month I'm gonna go on a walk in my neighborhood once a week. You know, so make it bite Sized things so that you can have small wins. And those small wins will keep will pull you through to ultimately getting to a point where you've made big changes in your life that then ultimately affect your brain and change the way that these conditions affect you.

Mel Robbins (92:07)

Amazing. Dr. Marks, what are your parting words?

Dr. Traci Marks (92:12)

My parting words are be patient with yourself and your own personal operating system. All of our brains are unique, and if you have struggles, you're not defective. You're just different. And that's okay. And if you can understand your differences, you can take control over how these differences manifest for you.

Mel Robbins (92:42)

Dr. Marks, thank you for getting on a plane. Thank you for everything that you do to help all of us around the world and the people that we care about. I want you to know from the bottom of my heart that I appreciate you. And you absolutely destroyed this today. And the reason why I wanted to say that to you is because you are living proof that everything that you spoke about today is achievable, because you showed up here worried about how you were going to do, and you didn't accelerate the anxiety. You actually slammed on the brakes and you met this moment. And I know that because there are gonna be millions of people that listen to this who are going to feel better and do better because of the tools that you shared, and then they are going to share that with the people that they care about. And the ripple effect is going to be extraordinary. So thank you.

Dr. Traci Marks (93:38)

Thank you. Thank you for giving me this opportunity.

Mel Robbins (93:41)

You're welcome. Thank you for saying yes. And I also want to thank you for taking the time to listen to something that could truly make your life better. And I also want to thank you for sharing this with everybody that you care about, because the tools that you learned today and the research that she unpacked will absolutely empower you to do that for yourself and for the people that you care about. And in case no one else tells you, I wanted to be sure to tell you today that I love you and I believe in you and I believe in your ability to do what Dr. Marks just taught us to do, which is to be more accepting, to use the tools and to change your brain and your life for the better. Alrighty. I'll see you in a few days. I'll be waiting for you in the very next episode. The moment you hit play, I'll welcome you in. I didn't do. I didn't clean my glasses. These literally look like I licked them.

Dr. Traci Marks (94:32)

Oh.

Mel Robbins (94:33)

When you learn about the connection between anxiety and adhd, it's going to Blow your mind. You want to know what else is going to blow your mind? Hit subscribe. Because you the connection between anxiety and ADHD is just going to blow your mind. Oh, God.

Dr. Traci Marks (94:50)

I want to be cured and be anxiety free because I don't want to hear that.

Mel Robbins (94:54)

I don't want to hear that. Dr. Mark. Get rid of it.

Dr. Traci Marks (94:57)

Hold on. I'm taking off my shoes.

Mel Robbins (94:58)

Take it off, woman. I know that I basically had to change my underwear after being on Oprah Winfrey's podcast because I had such unbelievable performance anxiety. No, you're killing it. Just for you. You're doing dynamite. Seriously.

Dr. Traci Marks (95:12)

Or shallow? Shallow. I can't say it.

Mel Robbins (95:15)

Me either. You're going to have to shallow.

Dr. Traci Marks (95:18)

Lure lit. Anyway, we breathe very shallow.

Mel Robbins (95:21)

Yep. I'm going to do the 4 in the 7. Hold the 8. Long breath out as I walk up to these that didn't want me here. No, I'm just kidding. Dr. Marks, I am learning so much. For you. Oh, my God. From you. For you. What am I doing?

Dr. Traci Marks (95:34)

Boom.

Mel Robbins (95:35)

That's how we do it. It's like you have a YouTube channel or something. I don't know. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist. And this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.

Dr. Traci Marks (96:20)

Stitcher.