RHR: The Anatomy of Anxiety, with Dr. Ellen Vora

In this episode, we discuss:

• The epidemic of anxiety in today’s society
• Defining anxiety- What is “true” versus “false”?
• The impact of technology and social media on anxiety
• Psychedelics and their role in addressing anxiety
• Awareness of the larger ecosystem in our anxiety response
• How religion and spirituality relate to anxiety
• Viewing anxiety as a positive opportunity for growth

Show notes:

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Hey, everyone. Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome Dr. Ellen Vora as my guest. She is a holistic psychiatrist, acupuncturist, and yoga teacher and the author of The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response. That’s what we’re going to be talking about today.

Anxiety was already an epidemic prior to the COVID-19 pandemic, and, of course, over the past two years, we’ve seen cases of anxiety in both kids and adults soar. And I’ve always felt like anxiety was very poorly treated in the conventional [medicine] model, and even not often addressed very well in the holistic and Functional Medicine model. Mental and behavioral health disorders are a growing problem in both kids and adults, and I’m really excited to see more attention on these issues. I’ve known Ellen for many years. I think she has an incredibly balanced and root cause-based approach to mental health issues. So I was really excited when I learned she was writing a book on this topic, and I asked her to come on the show to talk about it.

We’re going to begin by talking about what anxiety actually is. It’s a word that we hear a lot, but it’s often poorly defined. And Ellen has an interesting take on this. We’ll talk about some of the causes of the increase in the prevalence of anxiety. We’ll talk about how to approach anxiety and the different types of anxiety that Ellen defines. We’ll talk about the impact of technologies like smartphones and social media on anxiety and what we can do to protect ourselves from those impacts. This was a really fascinating conversation. I enjoyed it a lot, and I think you will, too. So let’s dive in.

Chris Kresser:  Ellen, it’s such a pleasure to have you on the show. Welcome.

Ellen Vora:  Thank you, Chris. It’s really good to be here.

The Epidemic of Anxiety in Today’s Society

Chris Kresser:  I was really excited to learn that you were writing a book when you reached out and let me know that. I’ve had the pleasure of working with you in the past and really respect your approach to mental and behavioral health issues from a functional perspective. And I think this is such an underserved area in medicine, in general, and even in Functional Medicine, specifically. There’s still, I think, a lot of territory to explore in the realm of mental and behavioral health and such a huge need to explore that territory, given that these mental and behavioral health challenges have really become epidemic. And I think it’s safe to say in the last two years that there’s been a pretty dramatic uptick, understandably, in those conditions, as well. So what led you to write a book about anxiety?

Ellen Vora:  Yeah, we were already really having an epidemic of mental health issues, even prior to the COVID-19 pandemic. And here we are with such a precipitous uptick. I knew that I wanted to take my learnings from the work I’ve done with patients and all the different reflecting I’ve done on how to approach mental health with a Functional Medicine and ancestral perspective. I knew I wanted to turn that into a book. I thought about a couple [of] different approaches, but it just kept being so apparent that what people were struggling with was anxiety. So framing it in that way felt important to make sure that people knew that this was applicable to what they’re really struggling with.

Chris Kresser:  I think it’s useful to even talk about the word anxiety, and what we mean when we use that word. Because I’ve found in my work with patients, and I’m sure this is even more true for you since this is your area of specialization, that someone might say, “Well, I’m not anxious; I don’t experience anxiety,” and then they’ll describe all the symptoms of anxiety. And I’m like, wait a second, that’s anxiety. And, for whatever reason, they don’t identify with that word, identify their set of signs and symptoms with that word. So what is anxiety, actually?

Ellen Vora:  Yeah, and I have complicated views on how much I want to take the people who don’t identify with the term anxiety and hand them that diagnosis.

Chris Kresser:  I agree, 100 percent. But I think it’s useful to know, what are we even talking about when we’re talking? What are you talking about when you’re writing a book about anxiety?

Ellen Vora:  What the heck am I talking about?

Chris Kresser:  You’re writing about something, presumably. Those pages are not blank. I’ve seen the book. So what are you talking about?

Ellen Vora:  I’m up against the idea that the term has been diluted at this point and that people are just stressed or just a little overwhelmed, and that they’re calling it anxiety. And you’ll see pushback, people [who] feel like, well, they really do have “clinical anxiety.” And I want people to appreciate the distinction that this is really meaningful anxiety; it’s not just stress. And I fully honor how severe anxiety can be. But I also really feel that I welcome all comers because I don’t think that any of my suggestions need to be gatekeeped. I think that there’s an understanding, I understand why in conventional mental health, we would gatekeep the treatment. We would say, if you meet this number of criteria for a diagnosis, then that’s true-blue clinical anxiety. And then what’s indicated? Maybe it’s cognitive behavioral therapy; maybe it’s medication.

When I’m coming up with Functional Medicine strategies around nutrition and gut health and diet and lifestyle modifications, it’s all safe, it’s affordable, [and] it’s accessible. And so really, anybody who has a subjective experience of anxiety, whether that’s a little bit of social anxiety, whether it’s frequent panic attacks, whether it’s just muscle tension, or worry or racing, ruminative thoughts when they’re falling asleep at night, to me, that’s all appropriate for coming to this approach. And there’s nothing to gatekeep about it. And so it can be really mild, it can be really severe, and the book is hopefully helpful for everybody.

Chris Kresser:  Let’s approach this a little bit differently there. There are some words that have already emerged in this conversation: anxiety, stress, and then another word is fear. So maybe we could talk a little bit about the differences between those terms as a way of contextualizing what anxiety is or how we’re defining anxiety.

Ellen Vora:  Part of what I break down is this idea of true and false anxiety, which we’ll go into in a moment. But what I think is really at the heart of true anxiety is that human beings are hardwired to try to promote survival, and a piece of that is fear. It’s not what’s wrong with us; it’s what’s right with us. And it’s a way of being in a state of anticipating negative potential consequences and staying vigilant and staying aware. And it’s an adaptation.

I think where we are in modern life right now is that there’s a lot of interesting inputs that are driving our fear response. And it can be everything from the fact that we’re not just aware of what’s going on in our immediate village, but we are aware of what’s going on in every village or across the globe. Even the fact that marketing has figured out to prey on our fear response to get us to buy something we don’t necessarily need. So we’re really bathed in things that are telling us there’s a reason to be afraid. I think we’re almost spending too much time in that fear response, and not necessarily for appropriate reasons. In the world we’re living in right now, sometimes it’s absolutely indicated to be in a fear response. So, anxiety is not always pathologic, but we just want to be aware of what inputs we’re getting to that fear response.

Chris Kresser:  Yeah, I’ve talked a lot on the show about the cognitive heuristics that we developed as a species to enable our survival. We couldn’t really live without those because much of how we act throughout a day is based on those heuristics. If we had to mentally process every action that we were going to take, that would be very expensive in terms of the brain energy required to do that, and we couldn’t function. And negativity bias, which you were alluding to there, is definitely something that was adaptive in a natural environment where we’re only thinking about the most immediate threats around us. Are we being stalked by a predator? Is there somebody that we’re competing with for resources? Is there some other natural disaster or threat that’s going to harm us? We’re not thinking about global, geopolitical, macroeconomic factors and protests that are happening in another country, and how those will impact us, and all the various things that we can be tracking now with the internet and social media and [the] 24/7 news cycle, etc.

Defining Anxiety: What Is “True” versus “False”?

Chris Kresser: When I think of anxiety, I’m curious to hear your take on this. There’s a quality of—what’s the best way to put it?—there’s a quality of a threat being not entirely tangible or even clear or identified, that there’s almost like a background. It’s existing as a background layer that’s just ever-present, and it actually makes it harder to deal with because it’s not a clearly defined stressor. Like, “I’m about to lose my job.” Well, yes, that can produce stress, it can produce fear, [and] it can probably produce anxiety. But a lot of people I talk to with anxiety describe a kind of ever-present sense that things are not okay. And I can’t even necessarily tell you why. But I just feel like things are not okay.

Ellen Vora:  Yeah so, I want to take this in a couple [of] directions. One is that we’ll talk about in a moment the true anxiety quality of that. But I think that for the most part, what I’ve witnessed in my practice is that when people have that vague sense of something’s just not okay and they can’t really identify the source, to me, that’s a clue that it may be an instance of what I call false anxiety. And that’s based on the work of Julia Ross who wrote the book, The Mood Cure, and talks a lot about using amino acid therapy. But basically, she first identified we had these true moods where something happened and we’re in a mood as a result, and it makes sense. And then we have those times when we just wake up on the wrong side of the bed, or seemingly out of nowhere, we’re suddenly angry or sad or anxious, and we can’t necessarily point to the source. But if we could omnisciently know what’s often going on under the hood of the body is that we’re in a stress response, and it’s been triggered by some mundane aspect of modern life: strong coffee, some data of dysbiosis, inflammation, sleep deprivation, you name it. And I think that what’s happening in those false anxiety moments is that our brains are all too happy to swoop in with a narrative.

First, there’s that vague sense of stress response, something to be afraid of. [The] amygdala gets activated, [and] we start to scan the environment for a threat. It’s a state of hyperarousal. And then our brain says, “Oh, yeah, okay, I think I know why I’m stressed. It’s that email I got from my boss that’s making me feel like maybe I’m underperforming.” Or, “It’s something going on interpersonally over here.” Our brains are meaning makers. If you give us two dots and a line, we see a face there. And if we give ourselves strong coffee and [skip] breakfast, and [have] sleep deprivation, and [spend] an hour on Instagram, we’re in this ginned up stress response, and our brain is happy to swoop in with an explanation. But it’s actually a retro-justification for what’s actually a physical state.

Chris Kresser:  What’s fascinating to me about that, I mean, a couple [of] things. One is [that] this is something that has been a major theme in many spiritual practices, mystical traditions, and mindfulness and meditation practices, of course, is the practice of just paying attention to sensations and not telling [a] story about what those sensations mean. And that story that comes later, that sits above the layer of sensation, is where we often really get ourselves into trouble. And so, a lot of meditation practice, like in Zen tradition, which I’ve been involved in for many years, is just learning to pay attention and separate those things out so that we can witness the sensation, and not necessarily see it as inexorably connected to the whole cascade of emotion and thought that happens after that. So it’s pretty cool that modern psychology is in alignment with those [kinds] of ancient principles or parts of meditation practice.

And on a personal note, one of my earliest experiences of this was when I was in high school in a debate club. Like most people, before speaking, [I] would experience clammy hands and hot flashes and [gastrointestinal] issues, and all the strong sensations that come with [the] fear of public speaking. And one of my teachers or mentors at that time encouraged me to not label those sensations as fear or anxiety, but just look at them as energy that was helping me prepare for that event. And I remember this quote from Sammy Davis Jr, that I’m going to just paraphrase, which was something along the lines of, “The moment he stops feeling that, those sensations before performing will be the moment that he stops performing.” And that totally helped me reframe those sensations in a different way. So yeah, I think that’s a really interesting distinction between true anxiety and false anxiety and the way that our meaning-making brains contribute to that distinction.

Ellen Vora:  Yes, I feel like I’ve once heard the term “eustress,” like almost beneficial stress. And I think about what’s at the heart of when we feel like I’m stressed before this speaking engagement or before going up on the stage in the debate team. And what really informs that feeling of, “Oh no,” is the idea of not enough. Like, “I’m not enough,” “I’m not good enough,” “It’s not going to be good enough,” “I won’t be okay,” “I’m not prepared enough.” And I think that with my patients, I often want them to try on a slightly different mantra around like, all I can do is do my best, and that is enough. And it might go terribly, but if I showed up and did my reasonable best, it’s not a failure. There’s learning in the ways that didn’t go well. But it’s enough, and to just reframe in that way and to trust that if we show up and do our best, it’s going to be enough, and therefore, that eustress can feel beneficial. To feel like, “Okay, this is how I’m engaged and motivated. But I know that I’m going to be okay.”

Chris Kresser:  Yeah, I think that’s an important distinction. And I’ve found it helpful in my work with patients and even in my own understanding of this term “perceived stress,” which really points [to] the fact that stress is very subjective and depends on all kinds of factors, like our cultural context, our sense of self-worth, our beliefs about ourselves and the world around us. And the acronym that scientists or psychologists have come up with to determine what causes perceived stress is NUTS, which is, I think, great that they worked that one out. N is for novelty, U is for unpredictability, T is for threat to ego or sense of self, which you were just getting at there, and S is loss of a sense of control. And I found that just being aware that those are the things that tend to cause a sense of perceived stress is helpful in and of itself. Because then it’s a little bit easier to track my response and how I’m processing what I’m responding to in a way that makes sense and that sort of depersonalizes it in some fashion.

Ellen Vora:  Yeah. I think that’s so fantastic. And it obviously connects to, especially in the earlier moments of the pandemic, but really throughout, how that was so triggering for so many of us because it really checked a lot of those boxes and really left a lot of us reeling.

The Impact of Technology and Social Media on Anxiety

Chris Kresser:  Yeah. So I imagine, you tell me if this is true, that there is not a fine, hard line between true anxiety and false anxiety, and it really exists more on a spectrum, like most things. And one thing I’m very curious about where you place it on this spectrum is technology and, in particular, smartphones, social media, video games, and some of the technologies that have become so prevalent in our lives. It seems to me that it could easily fall into both categories, just because of what we know about the actual neurological effects that something like scrolling endlessly through a feed has, or checking Instagram incessantly to see if your photo has been liked as many times as you would hope. And these things are, technology is the medium, but they’re plugging into very deep-rooted human needs and fear of being excommunicated from the tribe and really core survival stuff that could trigger what would feel like true anxiety. But on the other hand, a lot of it was just kind of generated by interacting with a technological device in a certain way, and if you hadn’t done that, you wouldn’t have that stress or anxiety. So is it really true? Or is it false? Is it both?

Ellen Vora:  Yeah. Technology is absolutely at the interface of both, and there [are] some pretty clear-cut ways that it generates false anxiety. You think about bringing the phone into the bedroom at night and the exposure to blue spectrum light from the phone screen suppressing melatonin and disrupting circadian rhythm. The fact that many apps don’t have a natural stopping point. So we’ll scroll endlessly and stay up later than we otherwise would. So we’re getting overtired, where it’s contributing to chronic sleep deprivation.

What are some effective strategies for defining and approaching anxiety? Join me on this episode of Revolution Health Radio as I talk with Dr. Ellen Vora, the author of The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response #optimalhealth #wellness #chriskresser

But then there are these ways that it’s definitely contributing to true anxiety. And I think, perhaps most of all, it’s that opportunity cost where we almost feel like we’re scratching the itch of our need for community, and we’re spending our time connecting in this way, and then therefore not feeling driven to connect in real life, as it were. So really, in certain ways, it does meet some needs. I do see the value in the fact that if you have a niche if you have a unique way that you need to match up with other people to really feel like you’re seen and other people understand you, what could be better than being able to connect with the few people that line up with that need across the globe? But then it also is occupying our time and our attention and our eyeballs and standing in the way of us seeking out real physical connection, which I think has all these other benefits, not from a moral perspective, but just in terms of our hardwiring and how we feel truly held and safe in community.

I think two other ways that it contributes to false anxiety is the fact that we live in the attention economy, and very smart companies have figured out how to prey on our fear response and that the algorithm favors controversy. And so there’s so much kind of the banality of fear here, the way that the algorithm just shows us more and more of what will make us feel like our environment is not safe. And then I think that there’s also, there was one other.

Chris Kresser:  Well, while you are thinking about that, I couldn’t agree more. I think, and I’ve, as you probably know, had a lot of people on the show to talk about this. And it’s not a fair fight. I think individual people don’t often realize how deeply influenced the choices they feel like they’re making related to technology are by these enormous multinational corporations that are profiting from maximizing their attention on whatever platform or device it may be. And these corporations, as you know, Ellen, employ neuroscientists, brain hackers, and whole teams of people to figure out how to maximize that attention. And so, yeah, our brains were not set up to defend against that level of exploitation and intrusion, and they really tap into very core survival needs that, again, helped us in our ancestral environment, but have been hijacked for other people’s gain in this modern environment.

I know from my own experience and talking to so many people that going camping for a week and leaving their phone at home, or doing a digital detox—having so many problems that [seemed] intractable and the mental health issues that seemed enormous and insurmountable just melt away. And not to say that all mental health issues are caused by technology. I’m not saying that at all. But it’s remarkable how much and how significantly these technologies have influenced almost all of us to some degree or another.

Ellen Vora:  That’s right. I [will] talk about a particular patient who, for treating his really intractable insomnia, it actually, after we did every sleep hygiene technique under the sun, he even did a course of cognitive behavioral therapy for insomnia, which is a pretty intense treatment using sleep restriction, what did it for him was camping. And I think for him, it was actually light exposure most of all. He really needed true-blue authentic darkness at night and he needed bright daylight during the day. And there was just no way for him to truly achieve that in his high-rise apartment with ambient light pollution in New York City. So he finally achieved that on a weekend camping.

Chris Kresser:  That’s great. I’ve seen studies actually supporting camping, even short weekend trips, for resetting circadian rhythm. And the effects of that can be quite lasting, not just for a few days, but for a while afterward, so I’m a big advocate of that.

Psychedelics and Their Role in Addressing Anxiety

Chris Kresser: So correct me if I’m wrong, [but] it sounds like with false anxiety, there’s a lot of opportunity for lifestyle intervention. Like with technology, for example, restricting your use putting boundaries or limits around how you do that. If you’re dealing with gut–brain axis issues, you can take steps [like] work with a Functional Medicine provider to do a gut healing protocol. If you’ve got digital alarm clocks and bright light in your bedroom, you can get blackout curtains and an analog clock. So [there are] a lot of steps you can take on that level to deal with false anxiety. What about true anxiety? What are the pathways that you suggest in your book for dealing with that?

Ellen Vora:  First, with being able to hear it and I think that, in certain ways, the first step to [hearing it] is actually eliminating the false anxieties, the avoidable anxieties. So addressing all those diet and lifestyle modifications, [which] removes a lot of the noise of all this avoidable anxiety that we’re going through. And then once that’s fallen away, what reveals itself is our true anxiety, which is not avoidable anxiety. It’s not something to pathologize, it’s not something to medicate away, [and] it’s definitely not something that we can gluten-free or decaf our way out of. It’s a true north. It’s an inner compass telling us here’s what’s important; here’s what’s not right in our lives, in our community, in the world at large. And I think for many of us, we need to find ways to slow down and get still so that we can actually hear it. And then once we’ve developed some practice, whether it’s a meditation practice or journaling or just taking an unplugged walk in nature, slowing down and hearing it, and then for many of us, we also have to learn how to trust it. I think a lot of us have been somewhat conditioned out of hearing that inner whisper, trusting it. It has some overlap with intuition, which I think has been branded as somewhat irrational, so a lot of us need to get back to how we can pick up on the difference between intuition and fear, hear the intuition and actually honor it and heed what it has to say.

I talk in the book about psychedelics and the role that they can play. And it’s a whole complicated and huge topic with all the caveats, [because] it’s really not actually safe or indicated for all conditions, all people, and proper set and setting matter. I do find that for some people who are somewhat blocked from hearing their true anxiety, it creates this hotline through that inner knowing, and I found it helps a lot of my patients bring into focus what really matters in their lives and what they might be missing, as we’re just going through our day-to-day lives and steamrolling over our true anxiety.

Chris Kresser:  Yeah, I’m very interested in this continued exploration of psychedelic-assisted psychotherapy. I’ve had several folks on the show to discuss it, and I’ve been an advocate of it myself with the caveats that you mentioned. I think there are people who are in a place where that’s actually not the direction that it makes sense to go and that could be further disintegrating for someone who is in a pretty fragile place and doesn’t have a really solid sense of self. But for the right people, or for the right person in the right situation or the right set of circumstances and who has the right support—which I think is a big piece of it—I’ve seen pretty incredible shifts that are lasting come from that. I’m not saying this to denigrate psychotherapy, because I think psychotherapy can be phenomenally useful, but in some cases, [psychedelics] can be a real shortcut to accessing certain parts of the psyche or consciousness that are very difficult to access otherwise. So I’m curious about how that will continue to unfold as a therapeutic option for people.

Ellen Vora:  Yeah,I think the reasons why and the ways that psychedelics are beneficial are interesting. And they help in some of the standard ways that we’re all familiar with. They’re anti-inflammatory, some of them; they increase brain-derived neurotrophic factor, [and] increase neuroplasticity and neurogenesis. They’re active at the 5HT2A serotonergic receptors. But, I’m most intrigued by the ways they work that [are] different [from] our current standard of care. And in certain ways, it has overlapped with when psychotherapy really does work. The reasons why it works have more to do with our fundamental human needs for connection and feeling heard and seen and witnessed and held than perhaps any particular discipline or technique of psychotherapy. And I think sometimes the reason psychedelics work is that [they create] such a state of awe and gratitude and a feeling of being able to trust or surrender, to feel guided or loved [in] some broader, somewhat intangible way, that is, I think, deeply therapeutic. And it doesn’t come easy in our modern world.

Chris Kresser:  Absolutely.

Ellen Vora:  It’s interesting. And there’s research to back that up, that’s the mystical experience hypothesis that the degree to which you have a peak mystical experience in a psychedelic ceremony, that correlates with the enduring antidepressant benefit.

Chris Kresser:  Absolutely. I think it’s a place where we have a lot more to learn. And I’m glad to see that real research is being done by people like [the Multidisciplinary Association for Psychedelic Studies], and the door is now open for more of that to happen. I think whenever there’s a new therapy like this, you have a risk of, “This is now a panacea; everybody should do it. It will solve all problems.” It was kind of like [when] fecal transplants went through that honeymoon phase, and I think now we’ve reached a more balanced place with when those are appropriate and when they’re not and what the upsides and downsides are. I see probably getting to a similar place with psychedelic-assisted psychotherapy or therapeutic approaches, but [there’s] definitely a lot of potential there.

Ellen Vora:  And even when it does work, 10 percent is the psychedelic ceremony itself. It’s 90 percent the fodder it creates for ongoing integration work.

Chris Kresser:  And that’s, I think, one of the downsides and risks is that—I mean, the way I’ve often described it to people is [that] psychedelics can open a door, but you have to ultimately walk through that door. And what I see sometimes from people is a lot of door opening and not a lot of going through the door, because the door opening is the exciting part and the revelatory part. And it’s a part that is easy to get enamored with and addicted to in some way. Whereas the harder part, but actually the more transformative part, is walking through the door. And that’s just the day-to-day work that is required to do that. It’s not [as] sexy or as fun as the door opening. I think we’re probably on a pretty similar page there as far as how these can be used.

Awareness of the Larger Ecosystem in Our Anxiety Response

Chris Kresser: I want to rewind a little bit to something that you alluded to in terms of the relationship between anxiety and even with true anxiety, how much of that is internally generated versus— that’s not the right way to say it. How much of that is individual versus how much of that is best understood as the individual in an ecosystem? And I think sometimes I have a frustration with some approaches to psychotherapy that don’t pay enough attention to the impact of the ecosystem on the individual. We as individuals are part of this larger, extremely complicated fabric of existence, and I’m not specifically talking here about [things] like environmental toxins and air quality, Functional Medicine sort of stuff. I’m just talking about being human beings in a complex social ecosystem.

There’s the very famous Erich Fromm quote, right? Which is, “To be sane in an insane society is itself a marker of insanity.” And a similar quote that I like is from Abraham Maslow from [his book] Toward a Psychology of Being where he says, “Does sickness mean having symptoms? I maintain now that sickness might consist of not having symptoms when you should. Does health mean being symptom-free? I deny it. Which of the Nazis at Auschwitz or Dachau were healthy?” So the point there is, maybe in some cases, anxiety is actually an appropriate response to a really messed up situation that they were living in. Maybe people who have anxiety are tuning into something that other people are not tuning into. And I’m not, again, saying that to diminish the effects that anxiety can have on one’s life or the real impact of clinical true anxiety. But it is an interesting question for me around how much of anxiety is mine and indicative of a pathology versus how much of it is actually more of a reflection of being aware and awake in a pretty anxiety-producing world?

Ellen Vora:  Yeah. This is why I’m really loath to ever pathologize it. I think that I’m always on the lookout for potential sources of false anxiety, and I see no problem with stripping that away. To me, no one’s getting any benefit from having a ginned up stress response in their body unnecessarily. But that true anxiety is often an appropriate response. And I still believe there’s room to suffer from it less. Part of that is giving ourselves compassion for why we’re feeling that way and part of that is transmuting some of that feeling of, “I’m helplessly sitting here in a swirl of rumination about something that doesn’t feel right in the world,” [to] “I’m taking steps to help on any small scale,” [transmuting] the feeling into one of purpose.

But I think even [in] our sensitivity to our ecosystem, we exist along a spectrum there, and I think for good reason. And I reference the Dian Fossey primate study where she was looking at chimpanzees, and she noticed that some chimpanzees had more of a tendency to anxiety, insomnia; they were more sensitive, and they were the ones that hung out on the periphery of the tribe, in the tops of the trees. They seemed to be the early warning system. They were on the lookout. And when she removed those chimps from the tribe, she actually found that six months later, the whole tribe was dead. So our anxious folks exist to protect the whole community. So just like within ourselves, we have our own spectrum of what brings out our stress response more or less, as a collective. We need our unflappable, even-keeled folks. We need our surgeons and our pilots. We need people on that end of the spectrum. And we equally need people who have a more highly tuned antenna and are picking up on the things that are not right in the ecosystem.

I think about patients of mine in January, February of 2020, and I saw this huge spike in my practice of some of my anxious patients feeling like everything was doomed. And I really think I was less sensitive than many of my patients. I didn’t exactly know what they were tuning into. But I saw the signal; I noticed the pattern. And it almost had me thinking, is something about to happen? And then, sure enough, we entered the pandemic. And it was interesting to see how those [people] really [had] their antennas just dialed more sensitive. They were picking up on something.

Chris Kresser:  Yeah. Well, my dog knows when the UPS driver is coming before he’s even come up to the house.

Ellen Vora:  A prophet.

Chris Kresser:  That’s kind of a tongue-in-cheek example. But absolutely, animals, of course, can tune into those kinds of things in a nonverbal way. And we’re animals, whether we like it or not. So it’s not surprising that we have that capacity, as well, and [that] some people perhaps are more in tune with that capacity than others.

How Religion and Spirituality Relate to Anxiety

Chris Kresser: This gets to another question. Historically, and for many people currently today, religion and spirituality play a big role in how to potentially respond to anxiety and navigate it. Putting your faith in a higher power, whether that’s God, or Jesus, or Muhammad, or any number of other divine figures that you trust in, and there’s this kind of—like in Hinduism, the bhakti path of surrendering to this higher power. And then, a more secular spirituality that we could call a mindfulness-based approach or a Buddhist approach. So, in your practice, in your research, in your experience, what role does spirituality and religion play in helping people work with anxiety?

Ellen Vora:  It’s sensitive territory. But I think just as we’re slowly arriving at an understanding [that] certain substance use issues can sometimes coexist with a lack of a sense of purpose, meaning, [or] higher power, and that sometimes that’s the salve, I’ve noticed that the same thing is true with anxiety. And I think anxiety, if it boils down to certain things, there’s certainly that inbuilt fear response, which is adaptive to a certain extent; it’s just being given pretty out of control inputs at this point. But there [are] also ways that we are just, as you were saying a moment ago, animals whether we like it or not. We also live in an awe-inspiring universe that’s beyond our comprehension, whether we like it or not. And I think sometimes, when we go through our lives and we’re focused on mortgages and stock exchanges and just getting through the day, we lose connection with these very fundamental truths.

I’ve noticed that a lot of anxiety centers around this idea of a worst-case scenario, catastrophizing and a feeling of, “Let me white knuckle and control and anticipate, and if I just get every test and every scan, and make every extra preparation step, then I might prevent the worst-case scenario from happening.” And in so doing, in certain ways, we’ve created this worst-case scenario [of] present moment life, where we’re never really getting to live or enjoy or relax. And in keeping the people we love safe, we’re not even enjoying the people we love. And I think that when someone can connect on any level to a feeling of something that inspires awe, something that inspires trust or the ability to surrender, it eases that source of anxiety, because it doesn’t feel like it’s all up to us. And even the idea of the worst-case scenario doesn’t feel so absolute. So I do encourage my patients with anxiety to at least explore what feels true for them.

It’s not proselytizing. I’m not here to impose any particular belief system on anybody. But I’m here in this secular world [with] many people who were on the rebound from organized religion [or who] rebelled against that, just to give people permission to come back to it in a way that feels true or appropriate and approachable for them. And that can be religion, but it can [also] be nature, it can be astronomy, and it can be singing and music. It really is whatever gives people that feeling of awe. And I think of this quote by a colleague of mine, Will Siu, who talks about the role psychedelics play in this where he says, “Psychedelics are not just tools for healing trauma, but they’re also making spirituality palatable for our starved Western world.”

Chris Kresser:  Right, that’s interesting. And that’s, depending on what sources you look at, the thinking of probably how psilocybin mushrooms—medicinal mushrooms—were initially used in traditional cultures. Certainly, with peyote and many other substances, they were not used recreationally. People weren’t going out and partying, so to speak, and using these substances. They were used for spiritual purposes and, generally, under the guidance of a shaman or some other person who played that role in that culture.

I think it’s interesting and it’s something, as a researcher, and someone who pays a lot of attention to the scientific literature, I’ve always been impressed by. And this is coming from someone who was born and raised Catholic or [a] holiday Catholic, if you will, and I’m not Catholic now. And I don’t really identify with Buddhism as a religion, even though I’ve had a zen practice for many, many, many years. If you look at the scientific literature and you start to read any of the studies about religion, like the impact of religion on health and well-being, you quickly see that people who are religious generally have a longer lifespan, they have a longer health span, they’re happier, they’re better adjusted, and there’s something to that. I don’t think it’s necessary [or that] it’s exclusive to religion alone, as you pointed out. There are other ways you can—I think you can find that same level of meaning and purpose [elsewhere], but it’s not something that we can just brush away, which is what we’ve tried to do, I think, as a society [by] our increasing focus on other things and movement away from those fundamental principles of what it means to be human.

Ellen Vora:  Yeah, and I think there [are] so many reasons that we can explore [about] why having some connection to religion is beneficial to our lifespan, our health span, and mental health. And [religion] can motivate good behaviors, or I think you see things [about how] people with religion are more likely to floss or drink less and things like that. But I think, also, seeking and worship and [asking] those questions and finding meaning in challenge is helpful, but I think a really big factor is community. And I think that religion in many ways originally overlapped with this, [which] is how we come together and navigate the vagaries of human existence together. So I think that’s a major benefit in many ways. What I want my patients to take away is permission to go back to gathering with people in worship, in seeking and asking the bigger questions. And I have none of the answers. Where they arrive is immaterial; it’s really just that we gather and ask.

Chris Kresser:  Ellen, this has been such a fantastic conversation. I always enjoy chatting with you, and I’m really excited about your book, The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response, which will be out by the time this podcast airs, I believe. The release date is March 15. So where can people learn more about the book and about your work?

Ellen Vora:  The best place is probably Instagram. I’m at EllenVoraMD, and my website is EllenVora.com.

Chris Kresser:  Great. Well, good luck with the book. I think it couldn’t be better timing. Like you said, the epidemic of anxiety predates the COVID[-19] pandemic, for sure. But I know from my own world and extended family, friends, but also patients, subscribers, listeners, that so many people are struggling with this right now. And I am really happy to have a phenomenal book that I can recommend to them by somebody that I trust, and who’s on the same page with a lot of these things. So kudos for writing the book. I know, that’s a big undertaking, especially over the past couple of years, I imagine. And I wish you the best of luck with the launch.

Ellen Vora:  Thank you so much, and just an expression of gratitude to you; it really all started with you. You were my original mentor in the Functional Medicine space, and I have so much gratitude and appreciation for the quality of [the] content you put out in the world. Thank you for what you do.

Chris Kresser:  Well, thank you. I’m happy to hear, like I said, that I was helpful for you, and I’m really excited to see where this goes. I think there’s so much—like I said in the beginning of our conversation—there’s so much opportunity for growth here. And that’s something that I think we touched on throughout the show is that [in] anything like anxiety, or fear or any challenging situation that we face, like there’s always a seed of opportunity for growth and evolution there. And that if we’re willing to use it that way, and I think your book is a great entry point for people who are experiencing this, to explore how this can actually be a positive experience. And like you said, not a pathology, not something that’s broken, not something that necessarily needs to be fixed, but a pathway for more self-awareness and understanding and growth and evolution.

Ellen Vora:  Yeah, I think you just summarized resilience in many ways. To not just feel helpless and overwhelmed, but to be able to use our challenges as an opportunity to find meaning [and] grow. And the heart of my message, really, is that people who are struggling, people who feel discouraged or demoralized by their encounters with the mental health field, just [should] not lose hope. That there’s always so much we can do, and there are a lot of different paths up that mountain.

Chris Kresser:  Fantastic. So the book, again, is The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response. I highly recommend it; go check it out. And thanks again for listening, everybody. Keep sending your questions in to ChrisKresser.com/podcastquestion. We’ll see you next time.