Talking To Teens: Expert Tips for Parenting Teenagers

Andy:
The book is called Unwinding Anxiety, and you're not just writing this based on some blog posts you read on the internet or something. You have been studying this topic a little bit. How did you get into this and what has led you to write this book?

Dr. Jud:
Yeah. It's a good question. I was anxious back in college and didn't even know it. And then in my residency training, when I was training to be a psychiatrist, I got full-blown panic attacks. I write a little bit about that in the book as well. And as a practicing psychiatrist, I've struggled with helping my own patients with anxiety. So when I prescribe medications, there's this number needed to treat that gives a sense for how well something works. That number for the best medications out there is 5.2, which means I need to give five patients a medication, and one of them is going to show a significant reduction in symptoms. So I don't know which of the five is going to benefit and what to do with the other 80%, which causes anxiety on my part.

Dr. Jud:
So what led me to write this book was those things in terms of, how am I going to help folks? And also, it came together with some research that my lab was doing, where we were developing these digital therapeutics, which is just a fancy term for an app, but developing these digital therapeutics for habit change. So we had some early research with my lab where we delivered mindfulness training. We got five times the quit rates of gold standard treatments, which was pretty good.

Dr. Jud:
We developed an app called Eat Right Now and have studied it now extensively. One study showed a 40% reduction in craving-related eating. In that program, it was interesting. Somebody said to me, one of the participants said, "Hey, I'm noticing that anxiety is driving me to stress eat. Can you create a program for anxiety?" And I was thinking, well, I prescribe medications for anxiety, but it put a bug in my ear. As a researcher, I went back and looked at the literature, and it turns out there's a nice literature from the 1980s suggesting that anxiety can be driven like any other habit.

Dr. Jud:
My eyes popped out of my head when I read that and I put them back in and I was like, "Wow, I never thought of anxiety as a habit. And, wait a minute, I know how to treat habits. We've been developing programs for that." So we developed this app called Unwinding Anxiety and we started testing it to see how well it works. I won't bore you with all the details, but basically one study with anxious physicians, we got a 57% reduction in anxiety. In a study with people with generalized anxiety disorder, we got a 67% reduction.

Dr. Jud:
There we could calculate the number needed to treat. As I mentioned, medications, 5.2. In this study, ready for it? 1.6.

Andy:
Ooh.

Dr. Jud:
Yeah. So all of that came together with my clinical work, and it just seemed like it was time to write this book to put it out there so people can really understand how anxiety forms and how they can actually work with it.

Andy:
So, okay. Now you mentioned anxiety acting like a habit. Can you explain what that is? You lay out in the book the three steps involved in that. How does anxiety function like a habit?

Dr. Jud:
Yeah. So any habit is formed with three... There are three necessary and sufficient elements. A trigger, a behavior and a result. So just to give you an example, this process is set up to help us survive. So let's say our ancient ancestors are out on the savanna trying to find food. They don't have refrigerators, so they need a mechanism to remember where food is. So they see the food, there's the trigger. That's the first element. They eat the food, there's the behavior, that's the second element. And then their stomach sends this dopamine signal to their brain that says, "Remember what you ate and where you found it." You can summarize that as the reward. So trigger, behavior, reward.

Dr. Jud:
What that does is if a behavior is rewarding, it feeds back, so that the next time it's triggered, our brain says, "Oh, do that again. Go back and get that food." The same is true for avoiding danger. You're out on the savanna, you see the saber-toothed tiger, there's the trigger. You run away, there's the behavior. You don't get eaten, there's the reward. And so you repeat that. You avoid that part of the savanna.

Dr. Jud:
So anxiety is interesting in the sense that anxiety itself, the feeling of anxiety can trigger the mental behavior of worrying, where we start to worry about something, and that mental behavior gives us this feeling of control or at least a feeling of like we're doing something.

Andy:
Totally. Yeah.

Dr. Jud:
Yeah. For example, if somebody has teenage kids and their son or daughter gets a driver's license and they go out driving with their friends for the first time and they say, "Don't worry, mom or dad." What's mom or dad going to do? They're going to worry every minute until the kid gets home. I can promise you that worrying doesn't keep their kids safe. But it gives the brain something to do, and in that sense, it's rewarding.

Andy:
But then I thought it was interesting in your book because you point out there's actually maybe been a change that's occurred where now you can actually track your teenager using an app as they drive your car down to wherever they're going, and every intersection they're stopping. You have so much more access to information now that there's more to worry about.

Dr. Jud:
Yes, there are plenty of things to worry about. So parents can go on and look at their kids' social media feed and start worrying about what their kids are talking about or what they're reposting. They can track their kids and see where they are and start worrying. There are lots of things that we can worry about.

Andy:
And so we have to be better than ever, I guess, at managing anxiety.

Dr. Jud:
Indeed.

Andy:
So how does it help us to know about how anxiety functions like a habit? What can we do with that information?

Dr. Jud:
Well, that information, I think, is critical as a first step for helping anybody work with anxiety. So if we don't know how our mind works, how can we possibly work with it? Just mapping out these habit loops around anxiety can be really helpful. And I give some examples of some of my clinic patients in the book. But just as an example, if somebody comes into my office and they have panic disorder, for example, and they don't know this habit process, trigger, behavior, result or reward, they're not going to be able to work with it.

Dr. Jud:
One of the case studies I write about in my book is somebody with panic disorder who was panicking around driving. And the first thing we did when he came to my office for an intake, I took his history. Then I pulled out a blank piece of paper and I just wrote trigger, behavior, reward on the piece of paper and drew the arrows between the three and completed the circle.

Dr. Jud:
I said, "Okay, let me make sure I'm getting this straight." So for him, he was having these thoughts when he was driving on the highway, that he was in a speeding bullet. That was the trigger. The behavior was that he would start to avoid driving on the highway because it was unpleasant to have those thoughts. So it was this avoidance behavior. Then the reward was that he could avoid having those thoughts.

Andy:
Didn't have to think about the bullet. Yeah.

Dr. Jud:
Yeah, yeah, exactly. So he was basically avoiding driving on the highway altogether. It took us 30 seconds to map that out. He just had this aha moment where he said something like, "I had no idea that's how my brain works. That's how my mind works." I just sent him home and I said, "We'll start mapping out all your habit loops around anxiety."

Andy:
Interesting, yeah.

Dr. Jud:
So that's really the first step for anybody to map out anxiety habit loops, and to be able to start to work with them.

Andy:
That's sounds like fun. You talk in the book about curiosity. I think that's such a cool exercise to get curious about yourself and try to start mapping those things out. I wonder where, or if you have any tips on finding those or where to look for those, or how to think about where you might locate some of your habit loops.

Dr. Jud:
I think that it's helpful to simply go throughout the day and just kind of keep it in the back of one's mind. In fact, we created a free habit mapper. I think the URL is mapmyhabit.com. Anybody can go there and download this free PDF where they can just start mapping out their habit loop.

Dr. Jud:
I tell my patients to print this out and just carry that piece of paper with them. When they notice that they're caught in a habit, or afterwards, they can just take a moment to map out the trigger, the behavior, and the reward. And in that sense, it's a great way because often we're not aware of our habits because they're habits. So it helps bring them to light. I would say it's helpful to just go throughout the day mapping them out.

Andy:
You talk about a phrase that was taught to you by your PhD mentor, and the phrase is true, true, and unrelated. What's so important about those words?

Dr. Jud:
Yeah. I find that helpful, not only in doing research, but in daily life. So our brains love to connect things. They correlate this with that, and then our brains make this attribution of causality. Correlation does not equal causation, is the term, the phrase. I wrote about this in the book because there's a lot of, I would say, misattribution around performance anxiety, that somebody needs to be anxious to perform well.

Dr. Jud:
So the way that that works is, let's say that somebody is about to give a speech or perform a musical instrument or do a sporting event, and they're nervous, they're anxious. So anxiety, true, they're anxious. Then let's say that they give a good speech or they do a good performance in music or sports. True. So anxious, true, good performance, true. It doesn't mean that the anxiety actually caused them to perform well. In fact, people perform at their best when they're relaxed, when they're not anxious.

Dr. Jud:
But our brains love to think, they make that misattribution of causality, and they say, "Oh, well, last time you were anxious. You should be anxious this time." Then people feel like they've got to be anxious to perform well.

Andy:
It worked.

Dr. Jud:
Yeah. The only thing that worked in that case was that the brain was making this correlation into a causation. I wouldn't even say that that worked, but it's an indication of how our brains work, let's put it that way.

Andy:
Okay, but wait a minute, now. You're saying anxiety, isn't a little bit of anxiety helpful? Isn't there this inverted U pattern where at the low, you don't want to have no anxiety at all because then you don't care and you're not motivated or something. And you don't want to have a bunch of anxiety on the high end and be really nervous, but maybe somewhere in the middle is actually where you're going to perform the best.

Dr. Jud:
Yeah. Are you ready for a great story? So I was tracking down this inverted U-shaped curve, which seemed to be perpetuated on the internet. So first red flag there. It was on the internet. It does not mean it's true.

Andy:
What!?

Dr. Jud:
So it turns out that there were a couple of researchers back in 1908 who were studying arousal in Japanese dancing mice. I kid you not. Japanese dancing mice.

Andy:
That makes sense. Yeah.

Dr. Jud:
In the 1950s, what they figured out was that if mice are basically asleep or not aroused, they're not going to perform well in a maze, if they're kind of sleepy, it makes sense. If they're too aroused, then they're not going to perform well in that task. But if somewhere in the middle, this Goldilocks thing, there's a good amount of arousal, whatever that is for a Japanese dancing mouse. I think they shocked them, a little bit of shock, they're like, "Yeah, whatever. That's not going to get me off my butt to go through the maze." And then a lot of shock, they're like, "Ow, what'd you do that for?" They're going to decrease their performance that way because they're like, "Damn, that hurt."

Dr. Jud:
So there was a famous psychologist who, in the 1950s, he was giving a speech at some conference or something like that. In his speech, he loosely brought together even more correlation. Well, not even correlation, but he just talked about arousal and anxiety in the same sentence. Then one of his graduate students or his former graduate students, a couple of years, later published a paper basically saying that anxiety and arousal, they use them synonymously.

Dr. Jud:
From there, nothing really happened for a while, but then the internet came along. For example, this dancing mouse paper, it was only cited. When somebody cites a paper and says, "Oh yeah, I'm referencing this paper," that gives a sense for how much it's being read. Although who knows how much these things are really being read if somebody cites them. But it was only cited maybe 10 times between 1908 and, I think, the year 2000 or something like that. Or 1990, something like that. Then it was cited a hundred times, maybe from the year 2000 to 2010 or something. And then it was cited over a thousand times. So it just started getting cited exponentially as these people were talking about, "Oh, you've got this inverted U-shaped curve and you've got to have some level of anxiety."

Dr. Jud:
This was completely debunked, because it was just this internet meme, wherever everybody was like, "Oh yeah, that makes sense, because when I get anxious-"

Andy:
Totally. It sounds kind of intuitive, like it sort of makes a little bit of logical sense. But it's not borne out by science.

Dr. Jud:
Right. So long story short, when you look at the literature, there's an inverse relationship between increased anxiety and performance. So the more anxious you are, the worse you perform, which when we really look at it, it makes sense. There is no inverted U-shaped curve. That applies to Japanese dancing mice who are being shocked.

Andy:
There's also an interesting thing that you talk about in your book that I guess you uncovered in an ancient 5th-century meditation manual. And it's about breaking people into three categories of fight, flight, or freeze. What's going on with that?

Dr. Jud:
Yeah. So we were looking at this manual of Buddhist psychology and they talk about being able to basically get a personality type or a phenotype of somebody, and they would use that phenotype or that personality type as a way to give people instructions for meditation. So for certain types that would give one instruction and for other types that would give different instructions.

Dr. Jud:
It turns out that these roughly line up with these fight, flight, freeze basic survival mechanisms that we have. The idea is if you're confronted with danger, you'll either fight the danger, you'll run away, or you'll freeze in the hope that it didn't see you, the deer in headlights type of thing. These personality types that they described fall into three categories. One, is where we approach things, where it's like, "Oh, that looks good." Another where we kind of avoid things, and another where we kind of just zone out and we don't approach. It's more along that freeze line.

Andy:
Interesting. Yeah.

Dr. Jud:
So I worked with a Pali scholar, a scholar of the ancient language in which this manual was written. We looked to see if we could develop a modern day equivalent of that, so people could basically do their own personality test. People like to take personality tests.

Andy:
Yeah. There's a whole quiz in here that you can take to score yourself.

Dr. Jud:
Yeah, exactly. It's 13 questions. Somebody can take it and it applies to modern day life, and then they can use that as a way to look to see what their general habitual tendency is when it comes to situations. They can one, learn about what their habits are around that. And then two, they can learn how to work with their own mind, to see where they might be getting caught up in just how they generally approach life habitually, and see where it's helpful, because often it is helpful. And also see where it's not so helpful, so it can help them learn and grow.

Andy:
If you're reading this book as a parent, do you think that you're mapping out your own habit loops and then talking about those with your kids and showing them about what you're doing? Or how you introduce this information to your kids or family members?

Dr. Jud:
I think it's a great idea for parents to take the quiz first themselves and spend a little time exploring that mental territory. So kind of mapping out where they tend to fall into one category. It's often where somebody has a predominance of one and then less of another, and sometimes people have all three equally. So parents can map this out for themselves. They can start exploring it in their own lives. And then if they find it helpful for them, they can introduce the quiz to their kids. It's a pretty short quiz. It's kind of—

Andy:
It's kind of fun. Yeah, you get some insight about yourself and everything. Also, it could help you understand each other, I think, in a cool way.

Dr. Jud:
Absolutely. So the parents can understand their kids more. The kids can understand themselves, as well as their parents who currently say, "Oh, I'm this predominant type." They can relate to each other perhaps a little bit more, understand each other a little bit more, and have fun with it, where they can learn and grow even together.