Overcoming Anxiety, Solved: We Ranked 17 Fixes. Only 5 Work.

00:00:00Welcome to Solved, everybody. I'm your host, Mark Manson, and today we are ranking anti-anxiety interventions from the worst to the best, according to the current science. Have you ever tried to put out a kitchen fire with a glass of water and then stood there wondering why the kitchen is somehow more on fire than before? Well, No, this has never happened. But apparently this has happened to Drew Bernie. So we're running with it. Because that's kind of what most people are doing with their anxiety. Reaching for something that feels like relief, watching it work just well enough to keep reaching for it, and then ending up worse than where they started. Now, most of the interventions that people swear by, the supplements, the apps, the techniques, all the stuff that we're going to get into in this episode, they are not chosen because they're the most effective. They're chosen because they feel easy and they feel quick. And we're going to talk quite a bit about that.

00:00:47about the relationship between the quick fix and the actual long-term solution. We've picked 17 of the most common practices, supplements, and interventions that people use to combat their anxiety. Here they are in alphabetical order. Adaptogens, alcohol, benzodiazepines, breathwork, CBD, digital detoxes, journaling, physical exercise, magnesium, meditation, probiotics, psychedelics, therapy, sleep, socializing, SSRIs. And your favorite, yoga. We're going to break down each of these 17 interventions into how well they work, how efficient they work, how long-lasting the benefits are, whether there are any benefits or not, and how strong the actual research behind them is. As always with these ranking episodes, there are surprises and there are interesting patterns that emerge. And as always here at Solved, we categorize everything into four categories. Things that legitimately work, actually good things to do. The sort of depends category, the stuff that maybe works for some people, not for others, maybe works in some situations, but not every situation.

00:01:55There's the not helping but not hurting category either. This is where you get a lot of your placebo effects or just things that are – the effect is so minuscule that like you're not really doing anything but you're not hurting anything either. And then finally, there's the bullshit category, which is the pseudoscience, the stuff that is potentially harming you and the stuff that is counterproductive. We will start with the bullshit category, work our way up to the legitimate fixes, and end at the number one intervention for anxiety in the world based on the current science. You might be surprised. You might not. There's definitely some interesting caveats either way. Anxiety seems ever present these days, Drew. It seems like everyone and their dog has anxiety. I use that saying a lot, everyone and their dog. But like in the case of anxiety, literally, I can't tell you how many friends I have. They're like, oh, my dog has anxiety. I have to go home. I'm like, when did this become a thing? And they're maybe even on meds to their dogs. Yeah. Yep.

00:02:52Is this how far we've come? This is where we're at. This is where we're at. All right. Everyone and their dog has anxiety. So we will inevitably get into many of the mechanisms and processes behind anxiety. We'll get into a lot of the cultural stigma and labeling around anxiety. We will get into how anxiety is perceived and treated today versus, say, generations past. And basically, by the end of the episode, listeners, you should have a deeper, more comprehensive, and more nuanced understanding of anxiety, how it works, and how to actually Thank you. If you love the show, please like and subscribe, leave a comment, share with some friends. Follow us at SolvePodcast.com. You ready? I'm ready. Let's do it. Before we dive into the rankings, Drew, I think we should lay a little bit of groundwork and talk about what is anxiety, what makes it unique. I do think it is a unique emotion in some ways. It is a little bit different than most other emotions that we experience. The American Psychological Association defines anxiety as, quote, an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. What's interesting – About anxiety, I think, is that it's a it's future based and because it's future based, there's a certain amount of cognitive load. It's almost like an outshoot of our our natural tendency to like just want to predict what's going to happen. And so I think what makes it a little bit different than most other emotions is that it is. Yeah.

00:04:56very much influenced by our thoughts. A lot of emotions are almost more primary. You know, it's like we have the emotion and then our thoughts kind of justify that emotion after the fact. I think to a certain extent, anxiety, because it is an outcrop of us trying to predict the future, it is somewhat cognitively induced. And I think we'll see this kind of show up in the rankings when we go through them, that a lot of the stuff that doesn't really work is just trying to apply to the emotion, whereas the things that tend to work a little bit better are a little bit more cognitively address those underlying thoughts yeah it's kind of like it's our ability to predict or or our penchant for prediction yes what you're saying marrying that with our our negativity bias almost too right yes you could define an anxiety almost like that like it's our we have this like strong just like desire to predict the future and and try to figure out what's going to happen but we're also very negatively biased towards bad things happening as well which has an anxiety Which is, if you think about it, evolutionarily adaptive, right? So it's like let's say you and I are hunter-gatherers and we're out on a hunt. Right. This is how anxiety differs from fear. Fear is present-based and it's very specific. Let's say we're on the savanna and all of a sudden a lion jumps out and is ready to attack us.

00:06:15You and I would both experience fear because it is – there is a present danger. It's immediately in front of us and is very specific. It's like there's a lion and he's about to attack me. I'm afraid. Anxiety would be if you and I are on the savanna and we are thinking about what if there's a lion around here. Where should I look to try to spot the line? That's anxiety. It's kind of this low-level discomfort at potential futures that might happen. And obviously, it's important to think about those potential futures because in many ways, like the more you worry about something, the less likely it is to happen because the more you're going to prepare for it and prevent it from happening. It is adaptive to a certain extent. It's unrewarding in that like when anxiety is actually useful, you don't get to experience that usefulness.

00:07:04right right yeah because because all you know is that like the bad thing didn't happen so let's talk about causes like why why do people struggle so much with anxiety and i think this is also going to be very useful for once we get into the rankings researchers estimate that roughly 30 to 40 percent of anxiety is is largely genetic some people just have far more sensitive sympathetic nervous systems than other people they're more easily triggered. They're more sensitive to their surroundings. They're more predisposed to experiencing fear, anxious thoughts. I think in personality research that you would just call this a highly neurotic person. Women are consistently more anxious than men across the board, all ages, all cultures, regardless of how much equality, gender equality, socioeconomic equality there is. Women are just always more anxious. Second thing that's really interesting is that young people are more anxious than old people. And that I find really interesting, especially given the future-based foundation of what anxiety is. In many ways, young people have a lot more to be anxious about than old people. And also, old people have lived through so many more failures, setbacks, challenges, struggles, problems.

00:08:15et cetera, et cetera, that they've probably developed scar tissue where they're like, I'm going to be fine. I don't need to worry about this. So when it comes to environmental factors, obviously trauma gets talked about a lot. Trauma or other early childhood adverse experiences, they sensitize the amygdala and they often disrupt our prefrontal cortex from helping us emotionally regulate. I think this is maybe an important distinction. It's not that trauma causes... causes anxiety, it makes us less equipped to inhibit anxiety. Right, yeah. Attunes you to it, yeah. People who experience a lot of trauma, they struggle to regulate their emotions in general. They struggle to think clearly. They get triggered more easily. And so, again, kind of that cognitive intervention of actually thinking to yourself, is this threat reasonable? Is there really a line that's going to come eat me? It prevents you from being able to do that in the moment. Yeah.

00:09:09The other cause that I've added here that I have not really seen talked about much in the psychological literature is what I would call more of an existential anxiety. And I've written at this point pretty extensively about how I personally believe that much of the mental health crisis is kind of an offshoot of this existential crisis that people are having. This dates back to Kierkegaard in the 19th century. So Kierkegaard noticed that there was something about modern life that seemed to like amplify people's anxieties, that they seem to consistently be anxious about nothing and that that seemed to be kind of a new thing. And throughout his life, it appeared to be getting worse. Kierkegaard attributed this to the, quote, dizziness of freedom. What he argued is that as modern life gives people more freedom, more optionality, more opportunities in their lives, they become paralyzed and afraid to make decisions. Each individual decision suddenly becomes much more difficult because it has far more long-term implications on their lives. And so paradoxically, that increase in freedom and optionality makes them feel more anxious for the future, even though...

00:10:20objectively their lives are better than say previous generations in my opinion today we're just living through that on steroids in many ways i think what people experience as anxiety is kind of just this crippling fear of commitment of making a decision of owning a decision of being accountable to their own decisions because you might make the wrong one because you might make the wrong one and it'll fuck up your future forever and so it's better to just like be really scared and stay at home and doom scroll for another six hours and Anything you want to add, Drew, before we get into it? Um, I have anxiety. What's been your history, I guess? I had panic attacks when I was younger. I'm into my mid twenties, I would say. Okay. So it's definitely, this is hits close to home. It runs my family too. Okay. Yeah. Well, I know you have a lot of sleep problems too. Sleep problems as well. That doesn't help. Yeah. That's attached to it. Yes. Yeah. Yeah. A lot of rumination at night. There's definitely a lot of that. Yeah. Yeah.

00:11:20My anxiety is pretty limited to social anxiety. I had a lot of social anxiety when I was young. But interestingly, like outside of social anxiety, I experienced very little. And I think the social anxiety was just fucking trauma. I think a lot of people can relate to that though too. It's probably the most common source of anxiety is social anxiety for sure. Absolutely. I guess that's the other interesting thing about a lot of this too is that like some of these interventions I think are a little bit more targeted for certain types of anxiety than others. Like there is – it might be worth defining that there's kind of a – there's a thing called GAD which is generalized anxiety disorder. So like if you go to a psychiatrist and you're just kind of anxious all the time in every context, every situation, like – can be diagnosed with GAD. That's a relatively small percentage of the population. Most people just suffer with either an acute anxiety in one area of their life, whether it's social anxiety or performance anxiety or perfectionism or insomnia or whatever. Some people are just very anxious neurotic people in general, but it's not like a debilitating disorder or whatnot. For sure.

00:12:27I don't know. Sometimes I think anxiety helps me. That's something that never gets talked about. Yeah. There's a certain level of like high functioning anxiety. Like if you think of some of the most successful and productive people in the world, they're extremely anxious. You know, there's like the anxiety is kind of a fuel that runs inside of them. So on the one hand, yes, like it's not great mental health. You're not feeling good when you're super anxious and that drives you to perform really well or work really hard. But on the other hand, it does potentially produce better outcomes. I don't know where I completely land on this. I think as somebody who personally feels, often feels anxious if I'm not doing something productive or useful, I kind of like having that anxiety there. I think this is a common fear a lot of people have is if I don't have my anxiety, then how how am I going to get anything done? Right. How am I going to pressure myself into doing the things that need to be done?

00:13:22And hanging on to that anxiety, I think, is a very common thing that people do. I definitely do. I think it honestly got me through a lot of university. Yeah. For one, you know, I was just anxious about it. You know, you talk about, yes, social anxiety is a problem for you, but you don't have a lot of anxiety in a lot of areas. But you tend to hire people who like have that anxiety for you, kind of outsource some anxiety to people. So, I mean, I get it. It's a tricky one. And I think people are like, no, my anxiety actually helps me in some ways. And there's some truth to that, too. This is a common fallacy I think in mental health and personal growth which is that like the optimal amount of a negative emotion is never zero. OK. You should always have some anxiety. Like anxiety exists for a reason. It's adaptive. Like we evolved it because it actually helps us – it helps us do things that are important for our survival and for our community and our relationships. The problem is when it's chronic and it's occurring in places that it's not helping. Right. Misapplied. Yeah. Right.

00:14:20Is that misapplied or is it actually like helping me like crush all my goals and be super successful? You know, it's – The thing I always come up against though too is there's people who are like, oh man, just don't worry about that. You know, like things take care of themselves. No, it's us anxious people who take care of things sometimes. You know what I mean? So like I get it when people are kind of like, no, actually you do need to worry about it. But 100% I'm on board with you there when it's misapplied or just generalized to everything. Yeah. The optimal amount, you're right, is not zero, but it's also not – 100%. The goal is not to get rid of all anxiety. It's to, I guess, manage or have anxiety in the areas of your life that it's advantageous. I think the other factor here is something I've written about in my books. I have a bit of a spicy take about this, which is that people are not more anxious because the world is scarier today. They're actually more anxious because it's much safer.

00:15:14And it's – when your life doesn't actually have real problems to worry about, you start inventing problems to worry about. And the fact that we have access on our phones and the internet and everything to like everything going on in the world, people are convincing themselves that there are very real threats and real problems all the time. Where it's like if you actually objectively look at the average person's life in the developed world, like you are sitting in an air-conditioned room on a comfortable couch watching screens that are broadcasting information that was created thousands of miles away and you're doing all of this for like – insanely low cost, like all of your food is provided for, your warmth is provided for, like all of your basic needs are provided for, you're safe, you're secure, you live in a functional society. Like there's actually not a whole lot to be anxious about from like on an evolutionary historic scale. But because there's nothing to be anxious about, we invent things to be anxious about because it feels meaningful. Like we need something to worry about.

00:16:17Otherwise, we wouldn't know what to do with ourselves. Okay. So like an anxious system is so fundamental to like the human species. You're saying that it just goes it's online at all times. So there's a great quote in Subtle Art that I love, which is – it comes from Jose Marti where he said, if the mind does not have a problem to work on, it will quickly invent some. And I think by and large, that's like the issue of our age, right? You have a lot of people that life is comfortable but meaningless. And so instead of like admitting how meaningless things are, we invent meaning by imagining threats and problems where there aren't any. It comes back to that misapplied anxiety, right? Like it's like anxiety is useful when it's applied in a realistic way that's actually helping you or it's producing some better outcome. If you don't have a place to apply it, if you don't have a direction to point your anxiety – then your mind will just start inventing places to point it. And it will start finding reasons to worry. And because those reasons are not real and they don't exist or you have absolutely no control over them, you can't do anything about them. So they persist. Okay. Anyway, let's get into the ranking. Okay. Okay.

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00:19:33The data on the amount of people that self-medicate with alcohol is like absolutely staggering. It is funny that it is conventional wisdom that alcohol helps take the edge off. I used to be one of these people that after a really hard week, I couldn't wait to go out and get a drink because it was just going to help me relax and chill and forget about my problems and whatnot. And what's interesting is that, yes, alcohol solves anxiety in the short term, but it actually creates more anxiety. in the long run yeah i mean about one in four people uh who have a some sort of anxiety disorder they confess at least to self-medicating with alcohol. Right. And it's honestly probably much higher than that just because it's so accessible. And you're right. There's such a quick fix. It is a quick fix. It works in the short run. The problem is, is the bounce back. There's an overcorrection towards the other way. If you're paying attention and you've done this before, you know, this is what happens. Right. I was talking about, you know, I've had panic attacks before. I had some anxiety around things.

00:20:31I noticed too that after like a heavy night of drinking, the next two or three days, my anxiety was just off the wall. Wow. Right. Just it was terrible. Yeah. It gets a little bit more complicated than that, though, as well, because your motivation for drinking actually does matter here to some extent. If you are drinking because of your anxiety, there's usually a hard bounce back from that. If it's social drinking, light drinking here and there, those effects, that bounce back seems to be attenuated at least to some degree. Can't completely eliminate it, I don't think. But alcohol does – again, it does work in the short run. Yeah. Okay. And it has like probably the same mechanism as a lot of drugs that we'll eventually get to here. This bounce back effect is actually strongest in the people who are most likely to engage in alcohol for anxiety, right, or use alcohol for their anxiety. So – So shy, anxious people who are like socially anxious who use it tend to have the biggest bounce back here. OK. There's some evidence that has for a long time pointed out – you know, you probably heard this for a long time. You know, having a glass of wine with dinner is good for you or one drink a day is good for you, whatever.

00:21:42Honestly, probably not the case. We're finding out more and more. What happens is a lot of times what they'll do in these studies is they'll compare those people who just have one drink here or there or only drink socially compared to people who don't drink. Usually what happens is these people who don't drink have already quit drinking because of their health issues. And so they're just naturally less healthy. Right. In the United States anyway, Arizona has like the highest – respiratory illness rate. Okay. Which is weird because everybody moves to Arizona because they have- The clear air. Yeah, the desert air. All that, right? But it's because a lot of people with those diseases will move to Arizona, right? Yeah. Same thing with like alcohol. People who quit alcohol usually is because of health issues or problems around their health. alcohol use. But the thing is, is that bounce back. I know I would just have terrible hang-xiety, you know what I call it, the next day, just feel awful. I started noticing this probably in my early 30s, that I would often feel like an intense sense of embarrassment or shame the next day.

00:22:39Which was like completely irrational. Like it's like I didn't do anything embarrassing or shameful. I just feel like I had an awkward conversation. Like I just I would start ruminating about all these like things that had happened the night before. And eventually I just realized I'm like, oh, that's part of the alcohol. It's like fucking with my emotions. The interesting thing for me around this, I noticed this back when I was a dating coach. And it was interesting. One of the fascinating things was to see this confirmed in the research when prepping for this episode. Back early in my career, one of the first businesses I ever started was as a local men's dating coach. And so what I would do is I would actually – go with guys to parties and bars or whatever, and I would help them talk to girls. Probably the most common issue that guys had was anxiety. And it was interesting because, obviously, most men, when they're anxious or nervous and they want to talk to a...

00:23:34an attractive woman and they don't have the nerve to do it, what do they do? They have a drink. And that drink like loosens them up, relaxes them, gives them a little bit of courage. I mean, we even call it liquid courage, right? In the business, we used to call this approach anxiety. And it was super common among men. But what I noticed after I had been coaching for like a year or two, what I started to notice was that the men who drank to get over their approach anxiety never actually got over it. Like they would have a bunch of drinks and then they'd go meet a bunch of women at the bar and then three weeks later they would hire me again and they'd have the exact same problem. They hadn't progressed at all. They hadn't learned how to talk to anybody. They hadn't overcome any of their insecurities or fears whereas the men who didn't drink and just pushed through it.

00:24:21Those guys would get over it. And a month or two later, they're like – they're able to go chat with anybody they wanted. There's an idea of fear extinction, which is like this – it's kind of the active component of exposure therapy of like actually confronting a fear, realizing that it's not going to kill you and then like – teaching your brain like, hey, don't be afraid of this next time. We're okay. We've got this. Interestingly, some substances interfere with that feedback loop and they like prevent the ability for the exposure effect to actually take place. I 100% believe that alcohol is one of these because I just, I noticed it in myself. Like I didn't get over a lot of my social anxiety until I stopped drinking around other people. And similarly, a lot of my old clients, they wouldn't get over their Eventually, I would start – when I worked with guys, I would – if they had a lot of anxiety, I would make them not drink that night. And that in and of itself would freak them out. It's easy to see how this just becomes a crutch, right? Yes. You're socially anxious. You have this negative stimulus going on. You reach for a drink.

00:25:23You drink, you're not as socially anxious, so you're good to go. That cycle just repeats itself. But then you're leaning on that all the time rather than, like you're saying, developing these coping skills, like actual mature coping skills for this. So, yeah. Yeah, this is definitely the only one though that gets negative ranking in our book here. Yeah. So I was actually curious and I ran the numbers on what would stopping drinking, where would that land on this list? Oh, like as an intervention you're saying? Right. Yeah, exactly. So if you took like heavy drinkers with anxiety and you got them to stop drinking, what would the effect size be for those people on their anxiety? And then where would that land on our list? Do you want to guess where that would land? I don't know. Middle of the pack somewhere probably. Number four. Really? Number four. Which again, as like somebody who stopped drinking three years ago, one of the biggest and first benefits I noticed is just like a steady emotional state. That's true. Super steady. Nothing, like very few things phase me. And your ability to regulate emotions too. Yes. Just in general. Yeah. Just like not getting upset over stupid stuff, not worrying about dumb stuff. Okay. I definitely feel that.

00:26:37All right, number 16, magnesium. I'm a boomer. I don't really get on TikTok, but apparently this is a huge thing on TikTok. All the rage, yeah. There's all of these videos promoting magnesium for anxiety and magnesium supplements and the different types of magnesium and all the different like biochemical mechanisms and all this shit. It's not a thing. Apparently, it's just not a thing. It's like very, very, very modest effect. For most people, yeah. Yeah. Now, here's the thing, though. If you're deficient in magnesium, that might actually be an issue. But, I mean, it's kind of hard to tell whether you're deficient in it or not necessarily. I mean, there are a lot of people who are deficient in magnesium. And so if that's why you're anxious and taking some magnesium, it will get you back to the baseline. I don't think it's going to fix your anxiety. But there's a lot of other reasons you might be anxious as well.

00:27:28The problem with the magnesium story really though – it's a plausible mechanism. Don't get me wrong. Like again, if you're deficient in it or – there's also two just neural mechanisms that use magnesium that where if there's not enough magnesium there, it could in theory produce more anxious states. Sure. But the problem is, is that the evidence that we have for it is just all over the map in terms of like study quality. They're using different forms of magnesium. It really depends on the type of magnesium you're taking, whether it can actually cross the blood brain barrier or not. The evidence out there is very scant for this because of these methodological issues. And so supplement companies have come out and they've said, oh, yeah, that magnesium works because they point to one small poorly done study. We're going to see this happen quite a bit. But that's definitely happening with magnesium here.

00:28:13You want to hear my conspiracy theory about magnesium? Yes, let's do it. So the Israeli government. No, I'm just joking. There's this new thing that's happening in social media marketing. Most people are probably not aware of this, but if anybody works in online marketing, you probably are. Yeah. So there's this new thing called UGC marketing, which stands for user-generated content. And basically the idea is there are now platforms and mechanisms where you can go. Let's say I'm a magnesium supplement brand. I can go to one of these platforms and I can – what you do is you pay social media creators on a per view basis. So basically what you do is you go and you like set a bounty. 10 million views on social media promoting my magnesium brand. But to qualify for the money, you have to post a video that gets at least, I don't know, 50,000 views or something. You post it on the platform and then there's like thousands of like TikTokers and people who post on Instagram and stuff like that. And then they just make content about it. And then if they get one that blows up and goes viral, they get paid.

00:29:26I see. So they're incentivizing trends basically. Exactly. And so, and the reason it works really well for brands and products is that you can kind of get this like fake feeling of grassroots. Yeah. Right. So it's like people are, people are suddenly seeing magnesium pop up in like 20 different spots and like 20 different people. There's like that stay at home mom that they follow on TikTok is talking about it. There must have been some big study that just came out. The fitness influencer they follow on Instagram is talking about it. And it's like – and so you synthetically generate a social trend just by paying dozens and dozens and dozens of small creators. And I say this as someone who fucking has like three giant bottles of magnesium in his cupboard and takes them every night. Yeah. Because I was told years ago that I should be taking magnesium. I'm probably deficient. It's going to help me sleep. It's going to calm me down. Yeah.

00:30:18Well, again, if you are deficient, obviously, magnesium is very, very important. It's very essential. Okay, I get it. For example, there's one study that a lot of people point to. This was back in 2021 where they found like a magnesium plus B6 or a magnesium intervention. They had these two groups. Like one had magnesium plus B6, one had magnesium, found that it calmed anxiety. The problem with that, though, was it was this post hoc study. study or this post it was a different data set that they weren't even using for to test whether magnesium helped with anxiety or not they just looked at it after the fact they didn't have a control group so we don't know if it's just a placebo effect or not but a lot of people point to it yeah and so if it coupled that with your conspiracy theory you know where it's like there's kind of like oh this one study which even the the authors were like be cautious about this because we don't have a control group this was just a post hoc analysis but this happens all the time media finds that they run with it couple that with the ugc campaigns you're talking about What looks like a science-backed finding, which is actually just a marketing thing. Yes. All behind it. I would say this is actually the rule, not the exception in the supplement industry. Shout out to Saul Orwell. So I'm old friends with the founder of examine.com. And they analyze all the research on supplements and basically like really break down like does this actually work or does it not? And surprise, surprise, most of it does not. But I remember I was hanging out with Saul like maybe five years ago.

00:31:38And he had literally spent his entire career investigating supplements, looking at the research, studying all the research. And I remember asking him, I was like, so in 10 seconds, tell me what is actually worth taking every day? And he was like, dude, it's super simple. Just take fish oil. Yeah. Oh, really? That was it. This was pre-creatine boom. Okay. But yeah, I think he was just like, yeah, just take fish oil. Don't worry about anything else. And he was like, oh, and protein if you want to get stronger. Yeah. That was it. Okay. Number 15. I think this is the first surprise for people. This is the first one that people are going to be like, huh? Really? Journaling. Mm-hmm. Why is journaling this low? Well, OK. There's – it's a little bit of a nuanced story here, right? Yes. What do you mean by journaling, I guess, first? That's the first question you have to ask yourself. Pulling out a piece of paper, writing out your thoughts. OK. You know, I mean, there's a lot – there's a number of different methods of journaling.

00:32:38So there's like gratitude journaling and there's like goal setting and there's kind of more of a therapeutic journaling. Like there's just brain dumping. And I think it's worth remembering that this is not an indictment on journaling's usefulness in general. In fact, on our episode last month on the most effective self-improvement techniques, journaling scored – pretty high. This is specifically for anxiety. As an intervention for anxiety, journaling is not super effective. And I guess to me, it intuitively makes sense, right? Because like, what do people with anxiety do? They think way too much. And what is journaling? It's thinking about your problem a lot. So I could see how it could like not necessarily make things better. But I'm curious what you found like digging deep into the research. I think you're absolutely right. It's the thinking about it too much, the way you're thinking about it too much, actually, too, I think matters quite a bit. So, like, for instance, gratitude journaling, which we covered in the self-help techniques thing, too. It can make you more grateful, sure, especially if you're not a grateful person. Probably not going to do a whole lot for your anxiety, though. Yeah. Free form expression journaling, where it's just right about whatever. Again, not very directed. Probably you just get to ruminating more is what happens with anxiety. Yeah.

00:33:54venting like more catharsis we talked about that too that doesn't really work either again just kind of highlights whatever you're anxious about that said okay there is a type of journaling that actually can work the problem with it is usually that is the least likely for anxious people to use okay and or stick with yep okay which is a form of kind of exposure therapy basically so if you're writing about your anxious thoughts you're writing about what you're worried about you're It's the negative visualization exercise that's – we talked about it on the stoicism episode because it's – I believe Seneca actually used to recommend this. It's that imagine the worst case scenario. Map it all out in your head and then imagine how you would handle it and deal with it. Right. Like basically mentally rehearse all the things that could go wrong that you're worried about because the process of mentally rehearsing it will like give you the confidence to actually confront it. There's truth to that.

00:34:51There's some evidence to suggest that this will work. If you do this for 30 minutes a day for three days in a row, there's some evidence that like, hey, this actually helps with your anxiety. You have to be consistent with it beyond that, though, probably. Most people with anxiety give up after the first one. That's another problem that they have with it. Like even in a very simple online study that they did where it was Internet-based, over half the people just gave up on it. They just didn't even want to do it for more than a day, which 30 minutes a day for three days – Shouldn't be that bad. It's not that much. It's bad enough where people with anxiety don't like to do it. I don't have the study in front of me. I do remember early on in the research process coming across a study that one of the things they said is that Like there is an effect size here. Like journaling does – this method of journaling does help. But it's – you have to do it so consistently for such an extended period of time for so many hours over so many weeks that it's just not super practical. Right. Yeah. And for most people with anxiety, again, they're just – they're reticent to even go around that or to do that. So in the emotions episode, we talked about affective labeling.

00:35:55That can help with emotional regulation for sure. It's usually a short-term fix though. It's usually, it has a short-term effect. And so any anxious feelings that you have around it where you label them, yes, that can help you in the moment. But like long-term, again, you have to have that structured kind of exposure to it. It's all the things you said. It's like that combination of everything where it's not just the exposure to it, not just thinking about it, but also like, how am I gonna deal with it? So what that does is it kind of creates this narrative for you that can help you address the anxiety. That's more of a long-term thing and it's not a quick fix, which is what most people are looking for when they go to sit down and journal is a quick fix. Right. They want to feel better within five minutes. And that's not going to happen. Yeah. You have to really put a lot of time and thought into it. I also could see a way that journaling could potentially backfire a little bit. This is not coming from the research. This is just coming – this is a Mark Manson harebrained theory. I do think there's something about – labeling yourself as a certain way. If I'm always telling myself I have anxiety, at a certain point that is going to get embedded as an identity, as something – as a way that I see myself and the way human psychology works is that as soon as you see yourself a certain way, you will start looking for things that confirm it.

00:37:11And so I could see how like if you're constantly writing down or journaling or talking to friends and telling – like just telling everybody how anxious you are all the time, you are subtly reinforcing that anxiety. You are – will kind of prime your brain to secretly look for reasons to confirm that anxiety. The act of being vulnerable, of like sharing your truth could be undermining the actual process of getting rid of the anxiety. I think at a certain point you have to like – This is going to sound really obvious when you say it out loud, but it's quite profound that like part of the way of getting over anxiety is deciding you're not anxious anymore. Oh, that's it? Yeah, no. Episode over. Yeah, right, right. No. It's incredibly difficult and complicated to do it, but like that is part of the end state. Like I do think there is a certain threshold where the impulse to heal yourself – is creating the damage. And again, coming back to the point that the optimal amount of anxiety is not zero. If you don't have anything legitimate to be anxious about, your mind will start creating things to be anxious about. There's that saying, like, don't believe everything you think. Like, this is a classic...

00:38:25I think anxiety is a great situation to be aware of that. Yeah, I think you're right. You can write about it. You can write around it without confronting it. And that's where you can stay in that kind of hell for a long time. Yeah, right. If you're not careful and you're not aware of it. And what's worse is that you get the sense that you're doing something. Right, yeah. And we talked about this in the self-help techniques. In many ways, the worst self-help techniques are the things that give you the sense that you're doing something without actually doing anything. And I think... In this context, the context of anxiety, journaling can do the same thing. You're constantly writing out all the things you're worried about. All you're really doing is just reaffirming that worry without necessarily solving it. Whereas I do think there are other things in life that our journaling can be very beneficial for.

00:39:12This episode is brought to you by Shopify. There's a specific flavor of anxiety that hits when you're trying to actually build something. You have an idea, you believe in it, and then the panic starts. It starts creeping in around all the stuff that has nothing to do with the thing that you're good at. Payment processing, shipping, inventory, taxes, some sketchy checkout page that a guy in Bulgaria made for you. And this is the part that kills most small businesses before they get going. No, not the guy in Bulgaria. All of the anxiety and panic. The friction around the idea. And that's where all the what-ifs and what-should-I-dos start to overwhelm us. What if the site looks amateur? What if their checkout page breaks? What if I spent six months and then I launch and I wake up to crickets? Those questions don't go away because you talked yourself out of them. They go away because you started the right way. And the right way is Shopify. It's the commerce platform behind millions of small businesses around the world and 10% of all e-commerce in the United States. From brands that you've heard of hundreds of times, like Allbirds and Gymshark to someone who just sold their first t-shirt this morning. You get a storefront that looks good right out of the box, a checkout that converts, AI tools that handle the stuff you don't want to, all the back end stuff.

00:40:29payment, shipping, inventory, all in one place instead of scattered across seven different tools, like you're duct taping together a piece of furniture at midnight. And suddenly that gap between what if and what is, is a lot smaller than your anxiety is telling you. So it's time to turn those what ifs into with Shopify today. Sign up for your $1 per month trial today at shopify.com slash solved. That's shopify.com slash solved. All right, moving on. Number 14, CBD. Sorry, California bros. Let me go outside and apologize to all the California dispensaries for this one. CBD oils, CBD products, CBD edibles. Not a whole lot there. Tell us about this one, Drew. CBD. So cannabidiol. Okay. It's a product of the marijuana plant, right? But it's THC is what gets you high. CBD is what gets you high. apparently is what just makes you calm and doesn't get you high. That's kind of the story we've been told, right? Yeah. It's a $5 billion market, the CBD supplements market is. $5 billion. Okay. There was a meta-analysis in 2024, so a very recent meta-analysis. They looked at 1,550 studies of CBD, okay? Okay. Okay.

00:41:43And so they're like, okay, we're going to – the meta-analysis, again, you find all the studies about the studies, right? Yeah. It's a study about the studies. Of those 1,550 research papers that they found, they could only include eight of them in their analysis because they said all the other ones just are so poor quality. They just suck. They suck. We can't – like – Improper controls, too small, bad methodologies. There was eight studies that were like these fit the bill for our criteria. Which is – Stringent criteria. Which by the way, listeners, eight studies is nothing. Is nothing. That's nothing. We're told 316 participants out of those eight studies too. Nothing. Very, very small sample size is what we're going on here. Again, all the others were so poorly done. They were just like we're not even going to include them in this. Okay?

00:42:26They did find – now in this study, they found a big positive effect size. OK. OK. But the thing was is that they're like what they call the confidence interval, right, was so wide that they're like it's either amazing or it barely does anything. We're confident of that. Like that's the best we can do. Yeah. That's what we can tell you. It's either awesome or nothing. Like that's the best they can do. It's kind of useless. Right. Or useless information. Yeah. With magnesium too. It makes sense. Like the CB1 receptor, which is what the receptor in your neurons that – CBD would attach to, it probably is a good target for anxiety. It just looks like the supplements, like taking oral supplements for it, doesn't really work. At least the evidence we have for it is just really not there, okay? And there's just kind of some weird findings I found too. Like a couple of studies found that exactly 300 milligrams is what you need, anything more, anything less. Yeah.

00:43:19Doesn't either doesn't do anything or makes you more anxious. That doesn't make sense. Doesn't make a whole lot of sense to me either. And not only that, but like most of the commercially available CBD supplements out there are between like 10 and 50 milligrams anyway. So even if it was 300 milligrams, you'd have to take a whole bunch of them. So you'd have to take six doses. Well, yeah, maybe, maybe, maybe because then the other problem is quality of these supplements. A 2022 study took 80 different CBD products that were commonly found on the market today and tested them. And only just over half of them have what they actually – the amount of CBD they said they had. So you don't even know how much you're getting even if it does work. as an oral supplement. I'm surprised this is higher than magnesium. Yeah. Honestly, this one we probably could have switched with magnesium. I mean, I think it got skewed by that one study that found strong results. Huge effect size. Yeah. But again, that the, the certainty on it wasn't super high. So in some form it could work if they come out with some method of delivery that actually like we can, we can point to it and say, yeah, that's what's going on. Yeah. It might work. But what we have so far is, uh, It's kind of garbage. Just not a whole lot going on. I don't know how common this is anymore. I remember this being way more common, say, six to eight years ago, maybe a little more. Yeah. I mean, I know there's still some people. Yeah. It was like CBD in your coffee or CBD in butter. I feel like it blew up kind of late 2010s. Yeah. I remember taking it. I remember I went to some event and one of the sponsors was a CBD product and they gave me a bunch of.

00:44:49bunch of supplements and I remember taking it. It was supposed to help with like injuries and pain management. Like it's one of those supplements supposedly does everything. It came out. Yeah. But I remember taking it for like a week or two and I'm like, I don't think this does a fucking thing. Yeah. I think I'm just pissing this out every day. Yeah. Not surprised by this one. I got to say like given everything I know and understand about the supplement industry and I took one look at the research summary for this and I just kind of chuckled like eight good studies out of 1,600. Okay. So yeah, I guess I don't think we need to dwell on this too much. This is probably nothing. It's probably a placebo. But number 13 I think is going to shock a lot of people. The digital detox. The getting out in nature, getting rid of your phone, getting out in nature, going for a walk, going outside. I want this one to work. Yeah.

00:45:48And it kind of does. We'll get to that. Yeah, I'm not going to lie. I was a little disappointed too. This is definitely one of those things where it's – we're probably getting out of probably nothing and we're getting into sort of maybe depends category. I think the surprising thing here is that if you spend time on YouTube or listening to other podcasts, like this is the biggest and most important and life-changing thing. I mean just among my friends and family members, the amount of people I know who are like – Going on retreats and going to the forest and like getting rid of their phones and turning their phones off for multiple days and like all this stuff. And then swearing that it's like such a detox and a relief and it cleared their mind and everything. It's a very common meme at the moment.

00:46:33I think one of the issues might be those that replacing like your digital habits with going outside, it does actually make you less anxious in the moment. It's just not a long term fix. Yeah. But they found like you can decrease anxiety like in the short term by just going outside and not looking at your phone or not looking at screens or, you know, not looking at the news, I think is a big one, too. The thing is, is that the bounce back is usually really, really hard. is that people go back, like, as soon as you're out, then you just go right back into it. Right. You go right back into this, like, digital morass or, like, you're – especially if you're into, you know, news media and stuff like that. That's, I think, more of what's going on here than necessarily. I would be very surprised if you had two people, one who just didn't use their phone at all and was always in nature versus I would be a little bit surprised if those people weren't – didn't have different anxiety profiles for sure.

00:47:25The problem is, is that bouncing back and forth between the two, that's going to be an issue at some point. Don't necessarily switch your lifestyle around this. But like, hey, if you're having a really rough Monday morning, like go for a walk in a park. That will probably help a little bit. I mean, I think that's great. Yeah, sure. Sure. Yeah. Do that. I mean, it will help your anxiety in the very short term. It's not going to like cure. If you're having a panic attack, I'm not saying, oh, we just go for a walk. That's not going to happen. Yeah, yeah, yeah. Right? It's not like a long-term fix. It's probably like added in as part of your routine. Sure. I'd go outside, touch grass. Absolutely. But it's like it's not a fix for anxiety. Yeah. Yeah. Maybe this is kind of what this is actually doing, what people think alcohol is doing, right? Take the edge off a little. Right. Help you unwind after a busy day. Help you decompress after like maybe a stressful week. I can get on board with that. Yeah. Yeah. But it's not really – like you said, as soon as you go back to your life and the screens and everything, it like – everything comes back pretty much immediately. So it's not – there's no sustainability here.

00:48:34I just finished apologizing to all the weed dispensaries here in West LA, telling them that the CBD, there's no evidence showing that it works. I'm going to have to go back out and apologize to a lot of people because number 12 on our list is breathwork. This one has a lot of caveats. The important caveat here is that breathwork is definitely one of those things that it works for some people in some contexts and also works depending on the particular technique you're doing. It does not work for everyone in all contexts and not all breathwork techniques work equally. That's the headline that people should take away from this section. There's a lot of nuance going on here. And as somebody who, by the way, has... had friends and loved ones go to breathwork classes where the administrator clearly had no fucking clue what they were doing, you can have very adverse effects. Like breathwork, when done incorrectly or when done with the wrong person with the wrong technique, it can induce panic attacks. So it is – like actually counterproductive when done poorly. So that's all just like a PSA for people listening to this that, yes, breathwork can be super helpful and there are people – I know people who swear by it. It's been life-changing for them. I also know people that like fucking hate it. It was one of the worst experiences they ever had. So be aware.

00:49:57Yes, it can induce a panic attack. It's also, it can help a panic attack when it's done correctly. Depending on how it's done. Yeah, very much depends. This was definitely like when I would have panic attacks. For whatever reason, I would get panic attacks when I was driving a lot, which was just awful. That's not good. Awful. Yeah. So I just had to, I pull over and I would do some cyclic breathing, which is actually what it kind of does help. Usually about like a, a one to two ratio of in to out breath right so you you inhale for a one count exhale for a two count or you know a three count a six count whatever it is a one to two ratio though yeah and that seems to help just as like a kind of general maintenance thing for anxiety doesn't like small yes small effect it's not necessarily to that that longer exhale is like the the key bringing attention to your internal states a little bit more. And again, you're confronting them and not trying to avoid them or paper over them. And I think some types of breath work can help with that. From what I've seen, the most effective technique is what you just described. Sometimes it's called box breathing. There's different second configurations, right? So the one that I learned was four, seven, eight, right? So you breathe in for four seconds, you hold for seven, you breathe out for eight. Right. One to two ratio again, four to eight.

00:51:13Yep. And then you just repeat that. I've seen 488. I've seen 448. The exact numbers don't really matter, but it's mostly the ratio. And what it is – so I learned this. My wife, Fernanda, she has a lot of – she has panic attacks. And so what I learned actually – like one of them was so bad that we had to call the paramedics. And the EMT actually explained this to me. He said it's actually very counterintuitive, but like – When you have a panic attack, you're breathing so heavily and so quickly that you're not allowing your body to oxygenate sufficiently, which then creates a negative feedback loop because then you feel even more out of breath and that you need to breathe even more. quicker and sooner. And so you get into this like bad cycle and that you keep breathing harder and harder, but you feel like you're more and more out of breath. In that moment, the last thing you wanna do is breathe slower because you literally feel like you're gonna die if you breathe slower. By breathing slower, you allow your body to actually properly oxygenate which then like calms your nervous system, which then like kind of reverses that feedback loop. The thing that I want to call out here is that there's a lot of different breathwork classes, breathwork techniques. There's a very prominent person in our industry that does breathwork interventions at his seminars. I've started seeing all sorts of like behaviors, Very big promises attached that simply by doing breath work for 20 minutes, you can unearth childhood wounds and heal trauma and like, you know, like let go of all of your bottled up emotions and all this stuff. What is interesting about these techniques is that by breathing intensely, you can – activate yourself into a high arousal state. And when you are in that high arousal state, like it can be a conduit for a lot of emotions that come up. And so you do, if you go to these breathwork classes, you will see people who start crying. You'll, you will see people who, you know, are screaming or, you know, Like having very intense emotional experiences. And I think if you are the type of person who tends to repress emotion and has trouble experiencing it, I'm sure this can be useful. The problem is, is that if you are somebody like my wife or like you who is already prone to panic attacks, already has a nervous system that is like constantly in a high arousal state – Putting yourself in an environment where you are for a very prolonged period of time pushing yourself into a higher arousal state can have very bad consequences and can actually trigger and induce panic attacks.

00:54:01This – pretty much 10 times out of 10, this will calm you down. It is super effective, but it is – like you said, it's a short-term solution. These longer session, 45-minute, 50-minute, 60-minute breathwork sessions where you're like – hyperventilating yourself on the floor for like minutes and minutes and minutes at a time. I'm not convinced it does anything really at any sort of deep level. To me, this feels kind of like it's like a new version of catharsis. Just because you're indulging an emotion like doesn't mean you're relieving it. Like this hydraulic theory of emotion of like, oh, I have all this anger bottled up. So I need to be really angry to get it out of my system. That's not how emotions work. Emotions are feedback loops. And so if you are indulging anger, you are actually training your body to become more angry. If you are indulging sadness, you are just training your body to feel more sad. I personally think these sorts of techniques are probably nothing at best, placebo at best, counterproductive at worst. And then if you do happen to be somebody predisposed to panic attacks, it's a fucking terrible idea. Right. Yeah. Yeah. Yeah.

00:55:12If you are experiencing a panic attack and you're doing the breathing like you said though and it is calming, it does calm you down. I think what's going on actually is it's not so much the breath itself. It's more you're becoming more aware of your internal bodily states. I think it's just a – it's a redirection from – external, oh my God, everything's on fire to, hey, what's actually going on in here? Oh, I can handle this. Then move on. Because if you sit and you dwell too long on it, that is an anxious frame of mind that you're just putting yourself into. It's a tool for the moment. Check in, you're good. Put it down and walk away. Because as soon as you start ruminating, that becomes the counterproductive. All right, moving on down the list, we get to number 11. This might actually be the first kind of sensitive one that we talk about. You know, as we said, we're in the maybe depends, sometimes category at the moment. And this one, It's – when it goes well, it goes really well. When it goes poorly, it goes very, very poorly. And that is benzodiazepines. And I should say for the record that you and I are not psychiatrists. We're not doctors. We're just reporting what the research says. We're reporting – at this point, benzos, Xanax, Ativan, Valium, Clonopens, they've been around for – many, many decades. They've been studied back and forth. We have tons and tons of research and data on them. It's a complicated picture. It's a very complicated picture. On the one hand, they can be extremely effective. And what's better is that they're extremely effective very, very quickly. On the other hand, there are very intense drawbacks. People can become dependent on them. Withdrawals from benzodiazepines can actually kill people. Right, yeah.

00:57:00You can't just stop taking that picture. It's a very tricky place to be in terms of like a long-term solution. There's a lot of potential for abuse. And interestingly, the combination of benzodiazepines with other interventions, we talked earlier about how alcohol interferes with the fear extinction required for exposure therapy to work. Benzos have the same sort of thing going on. So what therapists have known for a long time – is that when somebody goes on a benzodiazepine, it can actually reduce the effectiveness of therapy. That feedback loop inside your brain is not forming the same way it would if you were sober. Yeah, it makes sense. I mean, benzodiazepines operate on the same system. The alcohol does too. The GABA system, which is an inhibitory system for the most part. So it makes sense that that, yeah, it extinguishes that fear response when you're doing therapy and you're addressing therapy.

00:57:58uncertainties and fears and all of that. Extinguishing that probably has something to do with the way you learn about those things. So, yeah, it's interesting because this fell down to number 11 almost purely due to the complications and the downsides, the potential for harm, which is part of our measurement and our ranking on this. If you remove the potential for harm, this would actually be top three. Oh, yeah. Big effect size, pretty big effect size. Huge effect size is very well replicated data going back for, like I said, 20, 30, 40 years. It is very complicated. There is a lot of potential for abuse. It's almost like they work too fast. So like I wasn't aware of this, but there's another drug on the market called Buspirone. It's – and it is equally as effective. Does not have the downsides. But the catch is it takes two to four weeks to start working. And so patients over and over again tend to go for the benzos because they kick in basically immediately. And I understand. Like if you are an extreme case, like if you have severe panic disorder or severe generalized anxiety disorder and you are literally just crippled by anxiety every day – you probably want something that's going to hit and remedy the situation immediately. Even then, though, the recommendation is not to use them for more than two to four weeks. Yeah. So, yeah. But that said, I know, I personally know people who have been on like a low dose of benzos for a long time. Oh, for years. Yeah. And so. Years. Yeah. Doctors don't pay attention to that, apparently. Yeah. I don't know. I've known multiple people who have abused them over long periods. High chance of abuse. Yes. Yeah, for sure. The next one, number 10.

00:59:39Probiotics. This gets into the gut health fad phenomenon. I'm curious what the research turned up on this, Drew. Again, this is one of those where like the mechanism, proposed mechanism, it makes sense. The vagus nerve, it connects your stomach to your brain. There's a literal connection between your gut and your brain, right? And that's the vagus nerve. That's one of the connections anyway. They've done several experiments where they give a probiotic, different strains of probiotics, and they've measured brain activity. It alters GABA function in your brain, which is, again, typically inhibitory. So theoretically, it should work or it could work. This could be a possible pathway by which... You know, your gut and your brain talk to each other, can calm down or get more excited, you know, based on whatever's going on in your gut. Sure. The interesting thing, though, that I found is just kind of a split in this one. So people who have been diagnosed with an anxiety disorder, like GAD or even OCD or anything like that, they find that probiotics actually help them more than just if you just kind of have like some mild anxiety that you're worried about. You know, it's not necessarily clinical.

01:00:46level of anxiety, but some anxiety that just bothers you. Yeah. Probably not going to get a whole lot from that using any sort of probiotic. Several studies have found like there's a fairly big effect size, like anywhere from 0.5 to 0.7 for people with psychiatric anxiety disorders. So yeah. So this is one of those definitely depends situations for sure. It is kind of mind-blowing that for some people, depending on their situation, might get better results from a probiotic you buy over the counter than, say, a prescription drug. the science is still kind of out on like which strains of probiotics actually help because, so when they've tried to do these meta-analyses, it's really hard because there's always different strains. There's always different methods that go into these different samples that they're using or different, like the participant pool they're pulling from is very different. So it's really hard to make generalizations from a lot of these studies. We don't have like big pooled data that we can pull from. There's definitely some evidence that a few different strains and a few different populations do respond pretty well to that.

01:01:47There was a term in one of the meta-analyses for this that I absolutely love. I've never come across it before. It was, quote, catastrophic heterogeneity, which is like basically it's like such a large variance in results for people. And methods that they use too. That researchers called it catastrophic. That gives you an idea of how all over the map this is. It is interesting though. This is one that I would not have guessed. I would have guessed that this was kind of more on the CBD side. I know gut health is like a real thing as it relates to mental health. But my understanding was that – or my assumption I should say is that it would not be as simple as just taking certain probiotics. Yeah, sure. Like it would be something more drastic potentially. I mean, yeah, it does make a lot of sense. 90% of the serotonin neurons and 90% of the serotonin in general is produced in your gut. You know, we all know serotonin is probably pretty important in some way for mental health. We'll get to this a little bit later, too. We don't know exactly how, but there's got to be something there probably. Right. Yeah. So this is, would you say this is just too soon to say? Or is it like promising too soon? I think as medicine gets more and more individualized, this is going to be more and more important and prove to be like for certain people that we can pinpoint and be like you would be a very good candidate for this. I think this is one of those treatments. Number nine.

01:03:11Yoga. I'm a big fan of yoga. I know. You're a huge yoga head. Yeah, well, it's interesting. I've been thinking about this more, especially putting this together. I'm not like into yoga. Yeah. Okay. I go to yoga. I do yoga. I do it pretty regularly, about twice a week usually. I do hot yoga for once. I get the heat exposure to it too. But I don't think I would say that I am like – I'm not into the whole like yoga culture necessarily. I do it more like a fitness thing, right? Yeah. Let's talk a little bit about what they found with yoga though first. Okay. So there is an effect. Yes. Okay. It does help with anxiety. Yep. Small effect. Most likely. There was a clinical trial where they had people perform some yoga versus therapy. Yoga, about 50% of the people responded to it. But with therapy, about 70% did. So it's not as good as therapy. But it would be a good complement, I would say. And I don't think it's for the reasons that a lot of yogis will tell you, you know, the whole...

01:04:10maybe centering or whatever it is, the kind of supernatural side of things. Obviously, I'm not going to probably argue for that. But for me anyway, one of the things I think that it does is it gives you a real awareness of the internal states of your body. Brought this up a couple of times already. But I think yoga is actually a really good vehicle to experience that kind of interoception. So that your internal states, your internal bodily states. And not only that, but when I first started doing yoga, the instructors would usually cue you up like, if this is uncomfortable, try this or sit with the discomfort a lot. And I was always kind of like, I don't want this to be uncomfortable. I'm here to be comfortable. But the more I got into it, the more I'm like, oh, yeah. They're telling you, okay, this is – you're going to push your limit. Get to a comfortable position of whatever pose you're doing and then push that and get a little bit uncomfortable. That I found was a big like, oh, this helps you sit with a little bit of discomfort for a little bit longer. So it's like practicing that kind of muscle, that discomfort muscle a little bit. That's where I think the actual value of yoga is. I don't think it's anything beyond that.

01:05:14it doesn't address maybe the underlying ruminating thoughts you have. Yeah. That is why I think like the therapy in that study I mentioned, the therapy actually did a little bit better is because it's actually addressing the underlying thoughts. Yeah. So it's funny. I was actually just about to ask. Like I generally associate yoga with meditation. Those two often go side by side. They happen together. People do them like at the same time, at the same retreat. But it's interesting because I always kind of saw yoga as like the physical form of meditation, right? It's like – that the same way meditation like has you focus in on like a cognitive experience, yoga has you focus in on a physical experience in your physical body. Like I'm not going to give it away, but like meditation is on this list. It's higher than yoga. Exercise is on this list. It's also higher than yoga. And so I was curious to ask like why do you think yoga placed lower? I think in the case of meditation, I think what you said about the cognitive – Right. Anxiety is very cognitively driven. So that makes sense that meditation is more targeted towards managing your thoughts and coming to terms with your emotions and all that. My guess on the exercise front is just the dosage level. Like yoga is pretty, I mean, compared to like, say doing a CrossFit workout, like yoga is pretty relaxed. It's like not super strenuous, low intensity. It's relatively easy. Yeah.

01:06:34Hot yoga can be. It's pretty intense. You know, one thing I'll say is that you get into a room with a whole bunch of other people. And in the case of hot yoga, too, like everybody's half naked in there basically, you know. And so there's a lot of like self-consciousness. feelings I think that come up. The thing is, is that with a lot of these poses that you're doing, if you're super worried about what everybody else is thinking, you're going to fall over on your mat in front of everybody and make a huge ass out of yourself. And so it almost like forces you to be like, no, no, no, come back and be present with you. That's interesting. And so you're right. The physical side, it is very much a physical like awareness around it, right? that you're practicing. But I think that's still good enough practice for that situation to kind of like tamp down a lot of those self-conscious thoughts that you have. Did you find it helped you feel more confident or? No. I think it just... Why do you like it so much? I do...

01:07:30CrossFit, which is a very high intensity, short, you know, heavy weights. I like this whole kind of barbell strategy. Yeah. You know, you go and do something low intensity that's longer. There's a meditative side to it for sure. But I just find it's a really good balance between like that high intensity. You know, usually I'm a little bit sore from a workout maybe or something like that. And then I can get in. get a good deep stress. It's really low. There's also just no pressure to like, I'll stop in the middle of some yoga and just lay down for a while and while everybody else is going. I think it's just a good kind of, it balances you out between those two extremes anyway. Yeah. So it sounds like a nice supplement. I would not use this as like a, this is my go-to anxiety remedy for sure, but it would be a great supplement for a lot of people. It's definitely going to, it's good, but it's not going to fix anything on this front. The other thing too is, I mean, it takes a lot of time too. Hour-long classes, generally speaking, that's a pretty standard yoga class. Usually they're expensive, you know, so yeah, I wouldn't, I just wouldn't use it as like a first line of defense. Yeah. Moving along. We're about halfway through, we're now in the top half. Okay. Okay.

01:08:38This one surprised me. Yeah. And I think I'm not so sure about this one. This episode is brought to you by waking up. So here is something that took me a long time to understand about anxiety. Anxiety isn't really the problem. The problem is that when you're anxious, you're controlled by the anxiety. You can't see it. You are it. The thought is driving and you were just along for the ride, which is actually the thing that got me into waking up. and why Drew and I both still use it. It's the only meditation app that I've ever stuck with, and I've been meditating for over 20 years now. It doesn't teach you to calm down or think positive. It teaches you to watch your own mind in real time, to catch the anxious thought the moment it shows up, instead of being 10 minutes deep into a spiral before you realize that you're spiraling.

01:09:21It was created by Sam Harris, the neuroscientist, philosopher, bestselling author, and you can feel that inside the app. They're grounded lessons from world-class teachers, no religious dogma, and just people who are serious about understanding how their mind actually works. I curated a playlist of my favorite waking up content for you to sample, and they're giving Solved listeners a free 30-day trial so you can try it with no risk. And if you keep it, you'll get $30 off your annual membership, meaning that it's only $119 a year, which is a great offer. So if you want to check it out, go to wakingup.com slash solved. That's wakingup.com slash solved. Adaptogens. This is another one. I mean, if this came low, I'd have to leave the studio again and go apologize to a bunch of people around West LA because everything out here has a fucking adaptogen in it these days. There's actually this like...

01:10:11This bougie, fruity drink that I get at the grocery store here that has ashwagandha in it. Actually, the energy drink I drank this morning had rhodiola in it. So it's – this stuff is showing up – Everywhere. Afraganda, rhodiola, holy basil. Early numbers were shockingly good. Right. Some incredible effect sizes. But it seems like we're still early days on this. Yeah. I think we have a similar problem with CBD, though, too, is that quality varies a lot. It's kind of hard to pin down which ones are the better ones. The study designs are very, very variable. Yeah. So you just get a huge, a lot of heterogeneity there. What do you mean by study design? Like explain for the audience, people who haven't read a lot of research or done research, like what's the difference between say a good study design and a bad – if we're like testing ashwagandha for anxiety, like what's an example of a good study design and a bad study design?

01:11:06Some of the basics are just like having an actual random sample of people who show up to this. Not just college students. Not just college students or even like for some reason your experimental group and your control group are completely different types of people. You don't want that. You want a good mix of people between them. You want a control group too. This is the other thing we talked about like with magnesium earlier where they just had two different kinds of magnesium and they didn't compare it to a placebo. Right. We don't know if that's a placebo or not at that point. There's that. Size of the study matters too. So how many people are in it? The more the better, obviously, because you can make more generalized inferences from those populations. And then, I mean, just all sorts of methodological stuff too. Is that a blinded study as well? You know, like a lot of these, especially with supplements, are going to be funded by the supplement company. Yeah. And even if it's a blind study, that can still influence their results, tilt things one way or the other.

01:12:02Those are some of the big ones for sure. But I mean, even if you do have smaller studies, though, but they're well done, over time that can help, right? Because you can do a meta-analysis, include those studies if they're well done. They have proper controls. They have proper blinding where the researchers don't know which condition the participants are in. Those sorts of things help a lot. It's probably worth noting too that like one of the biggest barriers to really good research is just funding. Like to get a good sample size, to get a nice variability of people in that sample, it costs money. You need to go find thousands of people, tens of thousands of people that come from all different walks of life. That takes a long time. There's lots of recruiting. You've got to put out ads. You've got to like onboard people, interview people.

01:12:51researchers and a lot of help and it's costly it takes a long time and so it's so sometimes the incentive is that to take shortcuts which is why like you said with adaptogens those early studies oh they look really promising well it's because they were like well we can't do the perfect study so we're going to do yes a good enough study and then those headlines get picked up and yeah out of proportion so yeah And then you also get this situation where there is, say, a ashwagandha drink company, like a health drink company that has ashwagandha as their primary ingredient and they really want to market that. And so they come to researchers and they're like – and I think maybe this is a misconception because sometimes people think that this is way more diabolical than it actually is. I mean maybe it is sometimes. But my sense is that like it's not like the drink companies come and say like we need these numbers to line up this way. I think it's more just like – That was the tobacco company. Yeah, yeah, yeah, yeah.

01:13:41I think it's more just like, hey, we'll fund a study, but this is kind of what we think it should look like or this is how much we're willing to give. There's a muddying of incentives, I think. Yeah. Yeah. There's like a few like pretty good quality studies. They're just small. Yeah. Like they do find a good effect size on anxiety and even some other mental health conditions. Yeah. They're small and so it's just I'm cautious I would say. Yeah. I've been drinking this ashwagandha drink quite a bit lately especially at social events now that I don't drink alcohol. Yeah. It's actually in fact a lot of mocktails now have ashwagandha in it because supposedly it's supposed to give you a little bit of a buzz and help you relax. Okay. Yeah. I don't really notice anything. At this point, I feel like it's probably just placebo. Like I just – I'll have one sometimes at night before bed because it's like I've been marketed to that it helps me unwind. So it probably just helps me unwind a little bit. But yeah, I'm not convinced that there's anything going on here. All right. Next one. This one might get us canceled. OK.

01:14:43SSRIs. All right. So these are your classic antidepressants, Prozac, Zoloft, Lexapro. I guess in the pharmaceutical world, these are kind of like your first line defense for depression and anxiety. Maybe the first thing we should do is just dispel the myth that antidepressants don't work. Like I don't know how that became a meme at some point. Well, for some people they don't. Well, of course. Okay. I got you, yeah. But there's nothing there. That's not true. Yes, correct. There's absolutely nothing there. No, they work for some people for sure. Correct. So like the Cochrane review did a review of SSRIs. Cochrane is, for people who don't know, Cochrane is like the gold standard of like Reviewing research, coming down saying, does this thing actually work or not? Are these results actually legitimate? Cochrane Review said, it's legit. There is an effect size here. They do something. On the one side, it's like they absolutely do help people. And I think certain people in certain situations, it can be absolutely life-changing. That said, they are also probably overprescribed.

01:15:46Like I think both of those things can be true simultaneously. I think it's like they are very useful and in some cases life-saving for people and they're probably giving out way too much. That is my non-medical opinion. Don't come at me. And by the way, like I've had doctors prescribe antidepressants for me for like basically no reason. My wife's had antidepressants prescribed to her for like fucking headaches. Like it just – Doctors in the U.S. definitely do give them out like candy at times. And there are some documentaries around the incentive structure around that. And not only that, I mean, they've been detected like in river water and wastewater before. So I guess it could be. That could be true. Maybe it's useful to start like, how do they work? What's the mechanism going on here? What are the discussion items around like, why they're good, why they're bad? Yeah, it's SSRI, selective serotonin reuptake inhibitors, right?

01:16:39Technically, what they do is they increase the amount of serotonin that's in the synapse between neurons, okay, the space between neurons. And serotonin has been implicated in all sorts of different mental health conditions and just in general, right? Like I said, a lot of it is produced in your gut, though. Really going back, I don't know, 60s, 70s, 80s probably, there's this chemical imbalance theory of mental health disorders, right? We're really going away from that. There's been several kind of high profile meta-analyses that have looked at decades and decades worth of data. They really can't establish a link between serotonin specifically. And say depression or anxiety. Okay. Depression was supposed to be the one that is like, yeah, definitely for depression there's something going on, maybe for anxiety. But really recent studies have found that, no, they're actually – we can't really find any association between the level of serotonin in somebody's system and their mental health outcomes.

01:17:37That said, SSRIs do work. Yeah. We know they work for some people at least. We don't know why they don't work for others, okay? We don't really know why they work for these people though either now. For the longest time we thought it just was, we need to just increase serotonin. That's not the case. Yeah. We don't know what it is. There's probably some downstream effect. Serotonin can be kind of like a signaling molecule too for downstream, further downstream chemicals that might be influencing neural processes. We don't know. There is some sort of functional difference between, like, people who have mental health disorders and people who don't. Okay? And we don't know exactly how serotonin affects that or not. But it does for some people. It does help. We don't know. That's what we're saying. The more we uncover, the more we realize we don't know about serotonin.

01:18:23Yeah, for sure. And so, you know, SSRIs were very, very promising when they first came out, especially the newer ones in the 80s. Very, very promising. Early studies had big effect sizes. We've maybe talked about this a little bit before, but a lot of times when a new intervention comes out, they use it on kind of the worst cases, which usually there's kind of a floor effect going on there, right? The only direction they can go is up. Right. Or if you're using it for people who are... the illest, you're going to just see a bigger jump. Yeah. You always start with the hardest cases. And so you get the biggest effect sizes early. Not to spoil anything. We're going to talk about psychedelics soon. But there's a little bit of a similar thing going on. As it spreads out to the general population, you start to see a moderation in those.

01:19:09those effect sizes. The effect sizes have actually, they've shrunk over the years because of that. Using on educationism, maybe people who don't need them as much or don't respond to them as well. And so the effect size decreases just based on that. Yeah. If we could identify like who would respond better to SSRIs versus not, that would be great. They're working on that. Yeah, it's not a one size fits all the effect sizes. Yes, they've got a little bit smaller, but and they've kind of topped out. We can't seem to get them to go up or down from there. So, you know, there has to be done on this. So, yeah, they're not without their risks. Right. For instance, sexual dysfunction is a problem. It's fairly common in the short term sometimes and kind of rare in the longer term, but it is still a thing. And it's it's something that that worries people and is one of the leading causes for people to just stop using them as well.

01:19:55It would just make you depressed all over again. Exactly. Right? Right? And then you have emotional blunting too. Yeah. That's pretty common as well. That's, yeah. That's, so the people in my life who have taken antidepressants, like that's been very apparent. Right, right. That you get kind of like, it's almost like they become kind of zombie-like. Everything's gray. Yeah. That's what people tell me. It's like everything's just kind of gray. Everything's just blah. Yeah. Yeah. Yeah. The people I know that take them and use them successfully say it's more like just a window opening for me. It's like, you know, I was just so despondent or so anxious or whatever that anything to kind of just open me up or lift my mood a little bit for a little while for something else to get in. That's where SSRI is trying if they can work for you. I think this is probably an opportune point to take a little bit of a sidebar and just talk about like – Where does anxiety come from for different people? For the layman, like you probably just lump it all together. Like some people are really anxious and some people are moderately anxious and some people have very little anxiety. Anxiety is one of these areas of mental health, personal growth. There's kind of like a – There's like a serious version and then there's kind of a mild version. There's like a high-quality problem version and then there's like an actual serious kind of psychiatric version. It's similar with depression as well, right? Like it's – there are people who kind of chronically struggle with depression and it's probably – biologically based, like there's some genetic predisposition. It's something they're going to struggle with for their entire lives. And I think for those people, the conversation around something like SSRIs is probably a little bit different. Whereas like just mild depression, like – You just went through a divorce or a parent died or you lost your job and you're feeling lost. Like everybody feels depression at some point. But it's generally transitory and it's generally for a good reason. And I think it's similar for anxiety. Like there are people who experience a lot of anxiety throughout their lives.

01:21:54But that anxiety is always contextual. It is based on kind of what they're going through at the moment. Maybe they're predisposed to a little bit more anxiety in certain situations than other people. But it is something that overall they're managing. It comes and goes in waves. Whereas there are other people that are just kind of like predisposed to lots of anxiety all the time. Yeah. And I kind of mentally just put these people in two different categories, especially like, you know, as somebody who's been writing to a large audience in the space for a long time now, anybody who seems to be in the latter category of like, oh, this is probably a diagnosable clinical thing. I'm always very clear of like, you should probably go talk to a doctor. Like this is not, you're not going to solve this listening to podcasts and doing yoga on weekends. Right. Whereas like.

01:22:44If you're just a little bit of an anxious person who's going through a lot in life right now under a lot of pressure, got a lot of stress going on, and you're a little bit more prone to anxiety than other people, like there are plenty of practices that you can implement to manage that anxiety in your life. I'll come back to the framework that I often come back to, which is the bad to okay people and the okay to great people, right? There's like a – there's some people who are just like trapped by their anxiety and it is – seems to be baked into their neurological wiring to a certain extent and they just like – they really need a long-term solution just to feel normal. Whereas there are other people who like their lives are by and large normal but they experience a lot of anxiety and they just want to be able to excel and they feel like their anxiety is like one of the things that's kind of holding them back.

01:23:36The other factor here is that like generally the severe cases of anxiety, you're probably looking at more of some sort of genetic predisposition. It's more of a permanent thing. Whereas the milder forms of anxiety, those waves of anxiety that come and go throughout life – You know, that's when you get into, you know, environment, social experiences, where you grew up, you know, maybe some trauma you had when you were young. And those are generally things that you can work through, that you can like process and use some of these techniques and practices to like help you get through the tough periods. Thanks for coming to my TED Talk on anxiety. It's important to distinguish between like the clinical and subclinical for sure. And then the lines have gotten so blurred. Yes. So too. Yes. And this comes back to the labeling thing, right? Because it's like I think what happens these days is you have a lot of people who are, let's say they're probably highly neurotic, right? Which is a personality trait. But – and they're prone to anxiety. Maybe they're prone to panic attacks. So they experience anxiety – At an above average rate. But then what happens is because like we're – therapy culture is just fucking labeled everything. They label themselves as an anxious person, somebody who struggles with anxiety, somebody who is like doomed to struggle with anxiety. And so that identification with the issue then like calcifies it. It like hardens it into – into who they are, they start bringing anxiety to their experiences rather than, you know, waiting for anxiety to happen to them. I think SSRIs are a perfect example of like, if you are in kind of the clinical territory, like they can be life-changing. If you're in the subclinical territory, it's probably overkill. And I think one of the issues is that it's Largely being overprescribed to people in the subclinical territory. Like there are downsides and side effects. And I've known a lot of people who have gone on them and felt relief for a month or two. And then a year later, they're like, I fucking hate this. And they want to get off them. And it's, I think most people, at least most people I've known, that's kind of the cycle they've gone through. Number six, Mr. Bernie. I believe this is the last of our some depends maybe category. Yeah, I think so.

01:26:00And it is a big one. Psychedelics. Psychedelic assisted therapy. This had the single biggest effect size of everything we researched. But – The research is still scant and there's not enough trials that have been done yet. But it is very promising and this is very trendy, very exciting in our space. A lot of people are doing it, talking about it. It is slowly becoming mainstream accepted and I do think there's a lot of potential here. It is very exciting and interesting. But… We have to put that caveat of like it's still early days. Generally, these earliest studies are done on the hardest cases. So you get the biggest effect sizes as it spreads out to the general population. That effect size moderates and you start to see a lot more complications. You start to run into a lot of people it doesn't work for. You start to run into negative side effects. And, of course, you start running into practitioners who have no fucking clue what they're doing, you know, like my guru Steve out in Malibu. Yeah.

01:27:04You have a guru, Stephen Malibu? Is he your guy? Well, he was last week shaman. This week I'm switching to... Business coach? Yeah, that was last week. This week I have a new shaman. Her name is Zoe of Infinity. And she's going to help me trip on a $10 million estate to find myself. Okay. This is the world I live in, Drew. This is LA. Okay. Yeah, that sounds West LA to me. I've been somewhat of a proponent, a cautious proponent of psychedelics for a while. It is still pretty high on our list. So we're giving it some cred here. Very similar to the early days of... of the antidepressants like SSRIs, we see these big effect sizes, but we don't know how that's going to play out in like a larger population. There's been some very interesting studies early on. One in particular from Johns Hopkins. Okay. This was done by Roland Griffiths, who was a serious neuroscientist. Okay. And working at Johns Hopkins university did this study on people with late stage terminal cancer. They didn't have much time left. Right. And as you can imagine around, uh, A situation like that, you're going to have a lot of anxiety around your own mortality. Yeah. Okay. And so they tried some psychedelic-assisted therapy with them with psilocybin, active ingredient magic mushrooms. Yeah. Right? And they did find that actually, like, they had this huge effect size. It was a small sample, but again, it was very, very consistent. Almost everyone in the study said it was one of the most significant experiences of their lives. It helped them with their depression. It helped them with their anxiety. Yeah.

01:28:38This was awesome, right? Sadly, and a bit ironically too, Roland Griffiths actually passed away in 2023 of cancer, which was kind of one of those cruel jokes that the universe played on us. But his legacy lives on. People are still, they're hopeful. And I think they have reason to be hopeful. That said, one of the problems with psychedelics is that it's really hard to do a blind control study. That's right. Because if you take a tab of acid or a big old handful of mushrooms, I can guarantee you one thing, something is going to happen. Yes. Right? Yes. You're going to know whether or not you're in the experimental group. In the control group or not. Yeah. Yeah. Yeah. That's been the biggest hurdle to actually figuring out what's going on here. Because there's going to be some people that say, well, who cares? It works. Well, yes, but why does it work? Right. We need to know that because we – You can't just start handing it out like Skittles and fucking Halloween. You can't be handing out incredibly powerful psychotropic drugs and not know what's going on. Yes. Right? Like there's a safety issue, especially if we're going to be, you know, regulating this with a regulatory framework and everything like that. Right? In 2024, the FDA actually pulled MDMA. They were doing trial studies on MDMA for PTSD and a few other disorders as well. They ended up not approving it.

01:29:50Yeah. What's interesting about this I think is the mechanism, right? Like it's – everything else on this list is either some sort of lifestyle intervention or it's some sort of substance, some sort of chemical that you're introducing into your biology that's supposed to like kind of have a domino effect across things. What's interesting about psychedelics is that it actually – somehow like triggers neuroplasticity. Right, yeah. And for people who aren't familiar, neuroplasticity is, you know, when you're young, your brain is more easily able to rewire itself and develop new patterns of thought and identity and understanding. And as you grow older, you know, neuroplasticity never ends, but it becomes harder the older you get. And a lot of your beliefs and feelings and habits and behaviors just become more entrenched in your mind. And so it's almost like psychedelics just come along and kind of kick all that up and like reset your ability to like lay new patchwork in terms of like who you are, what you believe, what you find important.

01:31:14And so that's super interesting and exciting. I'm going to go anecdotal here for a second because I did a lot of psychedelics when I was younger. And I have spent a lot of time around people who have done a lot of psychedelics. I would actually say that I probably know two or three people. I would call it like a low-level addiction. They're people who take these psychedelic substances like drugs. pretty regularly like on a weekly basis i would say to some extent whether it's microdosing macrodosing what i notice about these people and i and when i think back to my early 20 my late teens and early 20s when i took a bunch of psychedelics i think one of the things that psychedelics does is that it it really activates salience it like helps you imbue things with meaning it helps you see kind of the cosmic significance of stuff like this pen mark So I was just going to say sometimes that is incredibly profound, right? Because if you are kind of meditating on your family or your place in the universe or like some talent or gift that you have that you're able to contribute to the world, like it can be incredibly profound. And it can have a lasting impact in terms of how you see yourself and how you see your place in the world and all that.

01:32:26It also can cause you to find a lot of meaning and salience in stupid shit like a ballpoint pen. Right. If you've ever spent time around people who have taken a lot of psychedelics or been on a lot of trips or journeys as they call them these days, they will come out saying some kooky things with like some strange ideas around like what's very powerful and important. And you're like, I'm not sure that passes the reality test. Yeah. You know, psychedelics have been around for millennia and in many cases they've – I think for most of human history, they were used as like kind of religious ceremonies and rituals, which makes a lot of sense to me given what they do. Even going back to like the 60s and 70s, they were seen – it's interesting because back then they were seen more as a mind expander.

01:33:12And I do believe, I don't have this research in front of me, but I do believe that one of the things that they have noticed on it is that people who take a bunch of psychedelics, like their openness to new experiences increases afterwards. Yeah, yeah. So it's interesting that in the 1960s and 70s, it was kind of all about like opening yourself up to possibilities and opening yourself up to the world. So I find it fascinating that today it's much more about like therapy and calming people and bringing them out of depression and bringing them out of PTSD and healing their trauma and everything. There's almost like a cultural reading into what's going on. And especially given the fact that I think there is – we are living quietly in a little bit of an our particular brand and flavor of anxiety and depression that most of us struggle with in the 21st century is perfectly suited to be solved by psychedelics. If your anxiety is actually rooted in a deep existential dread, like a pervading sense that your life is meaningless and nothing you do is meaningful, and that is actually what is undergirding your sense of anxiety and stress about life, then it makes sense that a substance that comes in and like imbues a ballpoint pen with cosmic significance can be incredibly therapeutic.

01:34:42Yeah. What psychedelics will do, you're right, is it kicks whatever kind of rut you're in or, you know, kind of mind space that you're in. It kind of kicks that open. The studies where they have kind of tried to look at this more carefully, it's usually the post-processing. It's not during the trip necessarily. Like that's the experience that, again, opens you up. Right. I think so. You know, anxiety, a lot of times we talk about it as like it's a. You're ruminating about the future depression. You're kind of like you're worried about the past, right? You're processing the past. I think psychedelics, what they can do is kind of kick you out of that whatever spiral you're in, right? You're in a depression spiral or an anxiety spiral of some kind. It opens you up at that point like you're talking about. But the processing afterwards is actually what's the most important part. So when you are open up, cause I've seen this to see people like they, they like people who are very much stuck in their ways and they go and do this. And for a short period of time afterwards, they're like, yeah, it's kind of weird. Right. Um, and I think what, where people, uh, mess up is they don't take advantage of that time period, the one to two months following this experience where they're just like, I don't know what's real anymore. Almost, you know, like, I don't know.

01:35:52The way I've been seeing things obviously isn't right. And now I'm open to thinking about things differently. Yeah. The post-processing makes a lot of sense to me because it's like you get that window right after the trip of actually like change is going to stick or it's far more likely to stick during that period. You know, when I think about the people I know or have known who like kind of chronically do psychedelics. they're just always living in that window, right? And what I've noticed about those people is that they have a tendency to just kind of believe whatever, like the last, whatever the last person's, the last person they, the last thing they heard from somebody is probably what they believe. And that's probably like their new philosophy on life. And it's, it's, it reminds me of the Carl Sagan quote of like, have an open mind, but don't have a mind that's so open, your brain falls out. And I think you and I are in the same boat and that like, I'm very excited about the possibilities. I do think it under the right circumstances for the right person, this can be utterly life changing. Maybe I'm biased by living in California around all these fucking hippies, but it's one of those things that is, I think is both underrated and overrated simultaneously. Yeah.

01:37:03Yeah, and I mean, just a word of caution too, if you are going to do this, especially if you're an anxious person, I would do it in a structured environment with somebody who knows what they're doing. Find a professional, for the love of God, find a professional who knows what they're doing. The nice thing is, is there are a lot of doctors and psychiatrists that are like- They're on board with it now. Yeah, and they're getting trained in it and they're like, there's processes being developed and standards and all sorts of stuff. It's still pretty illegal in most places though, so. Yeah, you know, we just won't mention that. This episode is brought to you by Factor. Look, anxiety is not always the dramatic existential stuff. Most of the time, it's a low-grade hum of 70 small things that you have not decided yet. And one of the loudest that doesn't even sound like anxiety until you clock how often you ask it is, what am I going to eat? How am I going to sustain myself? You have to answer that question three times a day. It is a burden.

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01:39:21Moving into the top five, this is where we get into legitimate territory. This is everything from here on out is going to help with your anxiety. Probably, if not 10 times out of 10, very close. It's probably going to help everybody. It's probably always going to work to some extent, whether a little bit or a lot. It's really just a question of, Your particular issues, how much you need, how much you do it, and what you prefer. What we're also going to notice in this top five is that these things are going to get incredibly boring very quickly. Right. Which is another interesting thing I think we should talk about. But number five. Social connection, socializing in general, I think. We talked about in our emotions episode last year, two or three ideas that we have uncovered on Solve that I think about on like a weekly basis is how socializing is our like human's ability to regulate each other's nervous systems. And when I saw things in that way, it just unlocked like so many connections and realizations and understandings.

01:40:28What's ironic about social connection and socializing is that often people who have anxiety, especially people who have social anxiety, it's – you get in this doom loop of like you're anxious, so you're afraid to be around other people. You're afraid to be vulnerable around other people. You carry a lot of shame, so you disconnect from others. You isolate. You numb. You avoid contact and intimacy. which then causes you to feel even more anxious, feel more shame, to disconnect, isolate even further, and so on and so forth. So there's like, there's a little bit of a upward spiral, downward spiral that comes with social connection and intimacy. Knowing everything I know about how good socializing, I mean, you and I have done so many episodes on loneliness and social isolation and the importance of socializing, and we did a whole five-hour episode on friendships. It's... Doesn't surprise me to see this this high. It makes sense to me that this is kind of bottom of the top five just given that the problem of anxiety itself is likely to make this a little bit more difficult for people to pursue. I think one of the more interesting findings I found about this anyway was that loneliness – is really a predictor of anxiety, how anxious someone is. But having social support isn't necessarily a predictor of not having anxiety. So it's like – It's a protective layer. Yes. Yeah. Right, right. More than it is a healer. Right. Yeah, exactly. Interesting. Which I found kind of interesting too. Makes a whole lot of sense though too, you know, just as social animals. Yeah. You know, obviously the quality of your social network matters a lot.

01:42:08The baseline is just don't be alone. Don't be by yourself all the time at least. Yeah. One of the other interesting things that came up in the research that I saw is that often for people, just the belief that they have that support is actually more important than having the support itself. Right? So it's just like trusting that there are people around you who have your back, who are going to take care of you if something goes wrong. Yeah. moderates the anxiety far more than like actually having people who are showing up and taking care of things and doing things for you. That seems to just check out on a personal level for me. I have a good strong friend network. I feel like a good social network, but I don't feel like I lean on them a lot. But just having them there for me, I think that does go a long way.

01:42:48I just, I hate asking for help. Are you like that? Yes. Oh yeah. I hate it. I hate it. I'm terrible about that. I do. I, I, I'm very bad about it, but there's still just like, okay, I know it's there. Yeah. If I needed it, it would be there. All right. So number four, we're going to call you out here. Yeah. We're going to shame you. Yeah. Sleep optimization. Who knew? Sleep. Makes you less anxious. Right, right. I can already see all the people like reaching to turn the podcast off because they're like, oh, we're going to get like sleep, nutrition, exercise again. Sure, sure. No, there's a couple surprises, people. There's – Sleep, but yeah, sleep is huge. Socializing is huge and exercise is huge. But the top two are probably not what you would expect. Yeah, but I mean sleep is bidirectional. If you lack sleep, then you're going to be more anxious. If you get more sleep, you're going to be less anxious. And there's pretty robust effects around this. I've shown this over and over again.

01:43:50This is for any mental health disorder just about. Yes. I mean depression, anxiety, like pick your poison. Again, there's another doom loop here which is that the more anxious you are, the harder time you are to fall asleep because you're going to be laying in bed, staring at the ceiling, worrying about the awkward thing you said six years ago. Yeah. And then the fact that you're not sleeping is going to make you more anxious, which is then going to make you more likely to sit in bed and ruminate and stare at the ceiling and worry about the awkward thing you said four years ago and on and on and on it goes. The other interesting thing that we found with the research is that your brain is basically doing therapy on itself every night while you sleep. And if you're not sleeping, then you're not letting it. You're actively worsening your mental health. So it's interesting. During REM sleep, the brain replays emotional memories with the amygdala turned down. That's your fear processing center. Have you ever noticed that a lot of your dreams are kind of like residual of some of the things you've been thinking about or experiencing lately? It's almost like there's a certain emotional processing that your brain is going through while you're asleep.

01:44:53And if you're not getting that deep sleep, that deep restful sleep, then you're robbing yourself of that emotional processing that happens when you're unconscious. Part of me wonders too because there's a lot of studies and data showing like that we're more underslept than we've ever been before. Like just the average person's sleep is very bad. It makes me wonder like how much of the mental health crisis has been contributed by just people not sleeping enough. I mean, I would say with like the teen mental health crisis especially, I would say this is a huge contributing factor. Yeah. Yeah. They're just like kids laying awake, scrolling their phones all night. Yeah. Yeah. That's got to be contributing a huge proportion. Yeah. And it creates a doom loop, right? Because it's like if you're not – If you're laying in bed awake, doom scrolling, freaking out, you're not getting that sleep. So you're not getting that processing happening while you're unconscious. So then you wake up with all of this residual anxiety and unprocessed emotional baggage that you carry into the next day, which then makes you even more miserable and more freaked out and more stressed. And so then you lay in bed even longer doom scrolling and you get into this just this ugly cycle that is really only broken if you can confront the anxiety itself.

01:46:03I mean, would you say this is probably like socializing in that it's not necessarily an intervention? It's more like a protective layer, right? Like it's like the same way having friends doesn't necessarily remove anxiety. It like protects you in the first place. It sounds like sleep is kind of the same thing. I think it's a protective effect where it gets you to a baseline. I don't know. Is it going to improve your anxiety? If you're sleep deprived, yes. Yeah. Beyond that, I'm not so sure. But yeah. Yeah. Yeah, well, what's interesting is that some of the research has shown that the emotional reset that comes with sleep is lessened at higher anxiety levels. So people who experience extreme anxiety levels, sleep is less of a factor for them. But it's coming back to those kind of mild subclinical anxiety issues. Like if you're in a really anxious and stressed period of your life and you're not sleeping well, like that's probably one of the simplest levers you can pull.

01:47:01Again, what's mind blowing is, is like, this is free. You're already doing it every fucking day. It doesn't cost any money yet. Like how many things on this list have people spent hundreds, thousands of dollars, like putting chemicals into their bodies, supplements, like, yeah, just go to bed earlier. Yeah. Yeah. Try that. Try that for a week. Consistent. But yeah. Consistent bedtimes. Yeah. Consistent beds. Oh, that's what I've realized lately. Anyways, consistent bedtimes help a lot. Yeah. Consistent wake times. Listening to your chronotype too. You know, we've talked about this a little bit before too. If you're a morning person versus a night owl, if you're a night owl, don't try to be a morning person necessarily. Yeah. It's okay. Unless you have to be, I get it. Yeah. The other thing that I think makes this more foundational than it is maybe additive is just that like if you're not sleeping, nothing else on this list is going to work or better. Okay. Yeah. That I think is a big one. Yeah. Right. Yeah. Yeah.

01:47:57Yeah, you can optimize whatever. You can have all the supplements. Yes. You can meditate till you're fucking blue in the face. But if you're not sleeping at night, doesn't matter. Right. Yeah. Does not matter. You can drop a bunch of acid. Doesn't matter. Yeah. I mean, good psychedelics do interfere with sleep quality. I can tell you from experience. Moving on to everybody's favorite. Everybody's favorite. Number three, exercise. Go to the gym, bro. Hit the gym. Do you even lift? I've heard it in several different forms and places and whatever, but tame the body, tame the mind. We talked about this in the resilience episode as well, too, right? Developing the discipline to work out or at least be active in some way, that has this almost calming effect on your nervous system because it shows you have some control, right? And what is anxiety if it's not...

01:48:49a lack of control or a sense of a lack of control. And so I think more than anything, yes, there is the physical benefit of it. Like you're getting endorphin release and like all of that kind of stuff. But where I think the actual benefit of exercise comes in is that you are exercising that kind of control over your mind. Yes. And you're showing yourself that, Oh, I have some agency here. Even when I don't want to do things or even when things are uncomfortable, especially when things are uncomfortable. Yeah. Like I am exercising some form of agency here. And so tame the body, tame the mind. Yeah. That's how I see it. I think that's a beautiful explanation of like the cognitive side of this. I – in the process of doing research, I came across a paper that described exercise in a way that I had never heard before, which blows my mind because I feel like exercise is – people have talked about it frontwards and backwards. But basically it was like every hard workout is practice for being afraid.

01:49:43Like if you think about it, it's like what happens when you're afraid, right? Elevated heart rate, shallow breathing, you start getting sweaty, adrenaline courses through your body. Like exercise, lifting really heavy weights is training your body and your nervous system to be afraid and be okay being afraid. Like you are physiologically putting your body in the same state that it is. When you're experiencing fear, exercise is a controlled environment where you are training yourself to be okay, to act despite it. And then the cognitive piece comes in of like I'm choosing to do this. I'm feeling the strain. I'm feeling the adrenaline. I'm like my heart rate is through the roof, but I'm not going to stop. I'm going to get that last rep. And it's every time you're pushing through that difficulty and that strain, every time you are feeling kind of that panic, that like that fast heartbeat and the fast breathing and, you know, your fingers are tingling and you're like one more rep, one more rep. Like you're kind of training your mind to act despite the physiological signals. Yeah. And so I just thought that was so fucking cool. Yeah. Yeah. I never thought of it that way.

01:50:59You're using the agency that you have to like purposefully induce an anxious state in yourself and realizing that it's okay. Yeah. As you would expect, there is just like an absolute dump truck worth of research on this. The largest meta-analysis we found had over 1,000 high-quality randomized control trials, over 128,000 participants, and just consistent – moderate effect sizes across the board, across diverse populations, any country, backgrounds, age, gender, whatever. What's interesting is that exercise affects anxiety on a number of neurobiological pathways, right? So it increases BDNF, which I don't know what the fuck that is. You wrote here fertilizer for neurons, so I'm going to believe you. Right. But it spikes serotonin, norepinephrine, dopamine, decreases neuroinflammation. If I was to put on my Andrew Huberman glasses here and tell you the most effective exercise protocol for anxiety, you can literally do anything. It's aerobic resistance intervals, like basically anything that is moderate to high intensity, like – Anything other than low-intensity exercise, 20 to 45 minutes per session, three to four sessions per week. Basically what they find is that the consistency is what matters more than what you actually do. So as long as you are showing up exercising on a consistent basis, it doesn't even have to be like 20 minutes is not that much. Yeah. See, and that's what I think. That's why I think it's more of a – like it's a practice. Mm-hmm.

01:52:35It's more of a tame the body, tame the mind type of practice is because the consistency is what matters, not necessarily what you do. So to me, that's, oh, okay, I'm going in and I have, again, I have some agency. Yes. And I'm able to create some sort of discipline around this. And that gives me a little bit of calm and peace of mind at least. Yeah. I had this social media post a couple of years ago that went super viral. And it was basically like, imagine if there was a pill that improved your mood, helps you regulate your emotions, improves your sleep, helps you lose weight, helps you have better sex, decreases anxiety and depression, and improves your longevity. Oh, and it's free and it's available 24-7. Yeah, that pill is called fucking exercise. Right, yeah. It is like when you think of it in those terms, it is just kind of absurd. And it's also even more absurd that so many of us don't do it regularly. Like I injured my foot a few months ago. And so I'm like I lost a lot of my exercise. Like I didn't exercise much for two or three months. And like now I'm trying – the foot's healed. So I'm trying to get back into the gym. That's crazy.

01:53:40It's just long, isn't it? It sucks, man. It sucks. If I take a week or two off, I start feeling bad. Yeah. I'm like – That's the other side of this, though, too, is like once you start doing it, if you stop, it's like taking a Benzo, man. You got to keep going, you know? Yeah. I mean there's inertia in both directions, right? So the longer you haven't done it, the harder it is to start. But the more you've done it, you know, the easier it is to keep going. All right. Number two. I'm not going to lie. This showed up higher than I expected. Okay. Meditation. Little surprised. I mean, I expected that it would have worked. I would not have expected that it would have been this high on the list. Okay. Why is that? Maybe it's just because I'm not somebody who like struggles a ton with anxiety. But like, I don't know. It just – I've never found it – From like a purely kind of mental health, you know, mental stability point of view, I have not found meditation to be the most useful intervention. It's useful and I did it for a long time and I definitely recommend it. But it's like I would have put exercise above it. Like I definitely feel like my mental health, my mood, my anxiety, my happiness, like everything is – my relationships like are noticeably better when I'm exercising consistently. Yeah.

01:55:02I mean, meditation too, but like it's not as like clear as that. Like if I don't work out for a week, like I feel it. Yeah. Whereas like meditation, you know, if I didn't meditate for a day, like I never really noticed. Well, okay. I think that might be the difference though, is that meditation is a little bit of a slower burn. Specifically too, is that like stress-induced anxiety I think is pretty well taken care of with meditation. You know, we had an episode on meditation. Right. We talked about some of the common pitfalls and- some of the hype around meditation that it wasn't correct, you know, that it was overhyped essentially. But one thing we did say was that stress-induced anxiety responded pretty well to meditation, specifically like mindfulness-based stress reduction. Yes. Which is like an eight-week program. I believe Jon Kabat-Zinn was very instrumental in developing it. Founding it, yeah. Yeah.

01:55:54There's a whole, it's very structured, like I said, eight week program. There's physical aspects to it too. So there is some exercise involved with it. So I think you're right. I think in the moment, maybe like I would go for a workout or even just a walk. That's going to help your anxiety more short term and long term, of course, too. Longer term, though, I think the cognitive benefits of meditation are going to come into play in a way that exercise might not. That said, I think you're right. I mean, they're number two and number three. They're like – Yeah. A lot of this research was done on the full MBSR protocol, right, which is like eight weeks long, multiple hours a week, in some cases full-day meditation retreats. pretty intense meditation practices. Like it's not like people pulling out the waking up app for 10 minutes and like once a week. When they measure that, they don't see a whole lot. It's more from serious meditation over an extended period of time. That's my understanding of it at least. Whereas I think exercise is more of the thing where it's like you can start working out and like probably within a week you're going to feel better. Yeah.

01:57:09Yeah. Okay. Yes. I would agree with that too. So it's like, it's more of a dosage thing, I think. Okay. Right. Where it's like, it seems like meditation is super effective, but also the dosage is pretty high. Like you can't just sit for five minutes. Yeah. Do you agree with that? I don't know. Oh, yes. I agree. Like a five or ten-minute meditation, even once a day, yeah, that's probably not going to do a whole lot for your anxiety. Yes. That said, I'll go back to – It doesn't mean you shouldn't do it. Again, yes. Again, we're talking about anxiety, but yeah. Yeah, yeah. Like I said in the meditation episode, I don't think that's why you shouldn't necessarily meditate either. I think it will help you with your anxiety. It changes your relationship to your thoughts, whether those thoughts are anxious or – Yes. Whatever they are. And so you can see them more clearly. And there's, I think it gives you a sense of what you can do with those feelings and those thoughts. Yes. Yeah. Meditation does not reduce anxious thoughts. It doesn't actually, meditation doesn't change any of your thoughts. It changes your relationship to your thoughts. And so people will often come to meditation expecting meditation to kind of turn the volume knob down on their life and on their anxieties.

01:58:19When really what it does is it just, it helps you better sit with the noise and understand the noise. I agree with you. There is like a lot of misconceptions around what meditation does. And I'm sure there is a certain calming effect, you know, of just sitting quietly for a certain period of time. But I do think the long-term benefit of meditation really is in that like cognitive reappraisal of like. What does this mean? Why do these thoughts keep coming up? Why do I resist them? Why do I fight them? What am I so afraid of? Like all of these kind of deep questions that you have to sit with for a certain period of time to like resolve them. Yeah. You see the forest through the trees a little bit better with meditation. And I – Yes, all the ancillary benefits you get with it, decreased anxiety or better stress coping, whatever it is. Again, I think that's all secondary to just knowing your mind better. And yet that takes some of the edge off right there. Just knowing your patterns and knowing why you do what you do.

01:59:21I wonder how much of it too is actually kind of a bleed over of that digital detox. You know, going for a walk and getting rid of a screen like definitely makes you feel better in that moment. And then as soon as you come back, everything kind of comes back. Because I know a lot of people who do meditate for like five minutes every two or three days and they like it. So it makes me wonder if like that's actually what they're experiencing, right? It's just like – Sitting in a quiet room without their phone, it allows them to get away from all of the noise and chaos that's going on around them. Yeah. That's one of the benefits I get out of it for sure. That said, if you do meditate, definitely recommend the Waking Up app because it's more serious courses, longer, in-depth, more philosophical. I think that's where you get more benefit rather than the quick hits.

02:00:12that you get from a lot of other apps. The introductory course on waking up too, it's fantastic. Like just going through that alone is worth it. And then we've got to deal with waking up right now where you can get 30 dates for free. So you can take the whole introductory course for free. There you go. So I mean, it's no risk whatsoever. What I love about that course too is that it is exactly what you talked about. It's like, it's all about your relationship with your own thoughts. Because other apps, it's like, they try to just get you to, they're like- Oh, the health benefits, yeah. It's for the fitness crowd. Yeah, they're like, oh, relax, breathe. You know, it's like waking up is like- Let's talk about your mind. Who's observing the thoughts right now? Who are you? Who are you? And then you sit with that for 10 minutes and it's like, it's pretty cool. I love it. All right. Last but not least, drum roll, please. This is not going to surprise anybody.

02:01:05Therapy comes out on top. Sorry. What is interesting about this though is different modalities of therapy – All perform well but in slightly different contexts. So like the heavy weight, especially around anxiety, is CBT, cognitive behavioral therapy. And I do think it is pretty well established at this point that like CBT is probably the best intervention for anxiety issues. But I did find it interesting that ACT is also effective for certain individuals and certain flavors of anxiety. I love ACT. Yeah, ACT is pretty cool. Yeah, I like ACT a lot. And then, of course, exposure therapy, which is taking bite-sized chunks of your fear and exposing yourself to them. We've had a lot of kind of sidebars on therapy over the years on this show. You know, it's another one of those things that I think is both overrated and underrated depending on the context and depending on the person. It definitely seems that for anxiety, it is not overrated. It is very legit.

02:02:10Very consistent, helps a lot of people, very replicable findings across the board. And yet, I found this pretty surprising too, fewer than 20% of people with an anxiety disorder get therapy for it, which I thought was pretty crazy. That's so interesting. That's pretty wild. Why? Well, I don't know. Yeah. And I don't know how accurate that number is necessarily either. But yeah, there's some numbers out there to suggest that it's very much undertreated. One of the things that I found when we were doing market research for purpose, I did a lot of research into kind of the therapy market, the mental health market, counselors, coaches, life coaches, all that stuff. It is shocking how undersupplied the market is. I didn't realize that. It is that like for every therapist or coach, there's like – eight to 10 people who want access to a therapist or coach. And I think the biggest hurdles for a lot of people is financial or they just live in a remote area. They don't have access to anybody. CBT, therapy in general too, there's kind of what they call a durability advantage. Okay. Which is, especially for CBT though, the skills you learn during your CBT sessions, during your training, I guess, or your therapy, the whole point of it is to teach you how to manage your anxiety or any other uncomfortable emotions that you might have out in real life. And so the advantage of that is you get better at it over time, even after you stop therapy, because it gives you these tools and you go out and you practice them in the real world and you get better at it if you have a good therapist anyway. So all these randomized control trials that they did a meta-analysis on – Found that 12 months post-treatment with GAD, with Generalized Anxiety Disorder, a huge percentage of people were still at near post-treatment levels anyway of anxiety. So they basically had fixed it a year later still.

02:04:07So pretty durable advantage, which in the mental health world, anything that lasts over a year, that's pretty good. It's rare. Yeah. Other studies have found very similar results as well. So, you know, like older adults, even too, you can find kind of full diagnostic remission even. over even more so than with medication. So if you start taking medication and stop it, there's a good chance later on you're going to have to restart taking those medications. With CBT and ACT and some other modalities as well, they find that the failure rates aren't nearly as high as that too. So it's a much more durable advantage to it. Interesting. Yeah. I think the thing that most people miss about therapy is that the point is to eventually stop. Like I – Right? Therapy is one of those weird industries where you can judge the usefulness by how many people quit. Yeah. Right, right. I always get very wary when I meet people who are like, oh, I love my therapist. I've been going to them for 12 years. I'm like – wow, probably not a good therapist. But what's interesting is that you see this in the research as well, is that like when people enter therapy, they get a boost to their outcomes. But what's more surprising is that leaving therapy, many people often get another boost to their outcomes as well. And I think this is one of those things I've written about this a long time ago. I wrote about this in some articles that you start in this place where something's wrong in your life. You don't really know what it is.

02:05:34And so the first big improvement comes from just getting an understanding of what the problem is and how to approach it. But then the fixing of the problem becomes a bigger problem than the problem, right? And so the next big level up comes from stopping fixing the problem. And I think that second lever is where a lot of people get lost. They start to feel I think maybe – dependent or addicted to whatever therapy or intervention that they're doing. You see this in the self-help world a lot. People just keep going to seminars forever. And it's like, well, actually, the fact that you keep going to seminars to fix yourself is the bigger problem than the things you're trying to fix. If you just stopped going to seminars, you'd probably be pretty happy. It's a very common problem. And not just the self-help industry but just the mental health space in general. And I think the best therapists and coaches are the ones that recognize it and they understand when to cut a patient off and when to say, you know what? You're doing pretty well.

02:06:35I don't think you should be worrying about this so much. Why don't you just go live your life and see? I used to run into this all the time or I'd get emails from people and they're like, I've read all the books. I'm like taking all the courses and it's just making me more anxious and I'm more worried. And I'm like judging myself because there's all these things I know I should do and I'm not doing them and on and on and on. And I would just reply to them. I'm like, so stop reading the books. Yeah. The problem is not more information. I'm like nobody's putting a gun to your head and making you read more books. Like just fucking stop reading the books. Go live your life. I think a lot of people assume that you have to have some sort of like action plan to like implement all this stuff that you're not going to actually change unless you have like a spreadsheet mapped out. And it's like no. Like a lot of this stuff just kind of seeps into the background.

02:07:24of your decision-making. And, you know, if you don't have like consistent opportunities to make different decisions, then you're never going to be able to implement those different decisions. So ultimately self-improvement requires you to go back and live in the world. A couple of caveats we should mention here as well too. You've already mentioned a few things like, you know, it's expensive. It's hard to access sometimes. Very true. Dropout rates are actually very high too. Right. Yep. People, a lot of people start therapy and then they have the opposite problem. What you were just describing instead of saying too long, they don't stay long enough. Yes. So I think you do. I don't think there's a set number or a set time that you need to be in therapy necessarily, but you know, I would say give it six months minimum and try to stick with it. Cause they really don't, it's hard to fix somebody's life in just a few sessions. Right. That's just, that's not going to happen. The other issue is, Some therapists suck. Yeah, yeah. Quality varies a lot. Yes. In any profession like this, yes, quality is going to vary a lot. You've got to shop around. And there is some evidence that the best therapists actually drive most of the results. This is one reason why I'm bullish on AI in this area. And I don't think AI can completely replace therapists and coaches permanently. But like – I've been around long enough. I know how many mediocre therapists and mental health professionals there are out there. I've heard from so many fucking people of like, I was in therapy for years. Like, my therapist was awful. I had no idea. And then I switched. And oh my God, my new therapist is so much better. And now I'm having like all sorts of breakthroughs and stuff. There's also like chemistry issues. So I just think it's such a hard thing to scale. And it's such a hard thing to like quality control. Yeah.

02:09:08Then I'm convinced that at some point AI is just going to take over most of it and go download purpose.app. Yeah. I mean, we definitely have hit a ceiling. And that's another, you said spinning your wheels. I think we, effect sizes have not improved for therapy in 30 or 40 years. It's about somewhere in the 30 to 40% range of people just don't respond very well to therapy. Again, that could be because they're dropping out too early or just not, you know, they're not putting in whatever. But we need to figure that out. And we haven't figured that out. In 30 or 40 years. Yeah. Yeah. It is the fact that there have been no improvements on this front since you and I were born. Right. CBT in the 80s, yeah. A little bit of a red flag. The other thing that doesn't get broadcast a whole lot is that actually a small percentage of people actually respond negatively to therapy. Right. So it's like some people – you can go to therapy and be worse. And it is – that's not broadcast a whole lot. I think it's not broadcast because – Overall, not enough people are going. I also think you can overdo therapy. I think it's especially in some of the wealthier parts of like say the US. I think people are over-therapized, especially young people, especially kids. It's like a lot of kids by the time they graduate from high school, like they've already been through 10 years of therapy and like three different therapists. And it's like maybe you should just let a kid – be upset. Yeah. Being a kid's hard. Yeah. It's fucking hard. It's fucking hard. But that's another podcast. Any final thoughts you want to wrap up with? Any observations in general? Well, we've been hinting at this the whole time, but I think if you are going to address your The quick fix is not the one you should reach to first, for sure. Panic attacks and stuff like that aside, obviously, you want to get through those. But, you know, reaching for a drink is obviously – it makes it worse. That's the one we started with. It's the absolute worst one for a reason. And there's varying degrees we go through this. You know, if just going for a walk or some exercise, yeah, it kind of helps with this, but maybe not that. The quick fix is not where it's at, though. It's – a long-term, probably lifelong thing for most people. I still struggle with anxiety at times. I just, I do. And it depends on my sleep and it depends on my exercise and all of these things that we've talked about today, sure. But I will say, if you want like a durable, lasting change to it, reaching for those quick fixes is, It can't be the answer. It is interesting in this episode. The list is really clear. Everything in the top – everything that is in the legitimate category is a lifestyle change. Everything outside of the legitimate category is a quick fix. Right.

02:11:55Yeah, a supplement or – Yeah, or like – Do this one thing one time. Yes. Not going to work. Yeah. I think my takeaway is that everything that actually works for anxiety is just uncomfortable. Anxiety-inducing almost. Right. Like that's the thing nobody wants to hear or accept, that there's – There's not a comfortable way out of this. And I think in a way you could say that chronic anxiety is kind of an unwillingness to tolerate discomfort or a certain threshold of discomfort. And I think ultimately that's what exposure therapy is. I think that's – You talked about it with yoga. We talked about it with exercise. Like everything that works to some extent is an exposure to discomfort and an acclimation to a certain amount of discomfort. Like raising your threshold of the amount of discomfort that you're willing to sit with. People don't like to hear that. People don't want to accept that. They don't want to deal with the consequences of that.

02:12:51It's why they leave therapy a lot of times too. Yeah. It's too uncomfortable. I also think part of it is probably why some of the pharmaceuticals are overprescribed. I imagine there are a lot of people that just ask for it. Just give me the pill, doc. Yeah. I don't want to talk about my problems. Like I'm stressed. Like, you know, give me some Luxapro or like whatever. And the doctors are like, sure, here you go. Yeah. Yeah. And, you know, doctor's caseloads are high too. You don't want to like pin too much on them or whatever. We're not shitting on doctors. Yeah. What's your biggest surprise and what's your biggest takeaway? Um, my biggest surprise, I mean, yeah, therapy. It was one of those things, I guess, though. Um, I, I was surprised that ACT and CBT, like what you mentioned that they were, they're, they're basically opposite approaches and get you to the same place, which is pretty wild. It is interesting. The lesson from that is old school, like kind of like exposure. Yeah.

02:13:45To whatever you're anxious about and just seeing again it goes back like with the exercise you have some agency over exercise that agency. No, you can't control all of it. Yeah, that's also part of it too is just accepting that you can't control part of it, which is where a CT really shines I think but like the more you can build evidence. Right that you have some sort of agency around whatever you're worried about. It might not be ideal. It might not be a perfect solution. But I think it's not so much that we're always worried about what's going to happen. It's that we're worried that we don't know what's going to happen or that we don't have any control over it. And while that's true, you don't have a lot of control over what happens to you. I think you just do have a lot of agency around how you approach it and how you see it. It's funny. I feel like we're just kind of landing back on stoicism. Yeah.

02:14:34Yeah, I think stoicism is a good philosophy. A little bit of existentialism. I mean – We've noted before how much CBT seems to flow directly downstream from the Stoics. And CBT is the most effective anxiety intervention. The biggest surprise for me, I guess it would be meditation. And maybe I've been discounting it too much lately. And maybe also I discount it just because it's – for me, I never meditated for anxiety. That was never my issue. For me, it was always more focus problems. And also like self-exploration, self-awareness. I was very interested in a lot of philosophical questions around consciousness and identity. And I guess that was a little bit surprising for me or just the size, the significance of the effect size. And therapy – A little surprised, not surprised. One of the things I do tell friends is I say like the one thing that therapy really punches its weight is for anxiety. Like that I've seen over the years that consistently, CBT especially, like just for anxiety, it's kind of the best thing you can go to. All right, everybody. That was another episode of The Solve Podcast. We have solved anxiety forever.

02:15:49Thank you, everybody, for listening. This was The Solve Podcast. I'm Mark Manson. This is Drew Burney. We will be back in a couple weeks. Go to solvepodcast.com slash anxiety to download some free cool materials. If you haven't checked out Purpose, check out purpose.app. It is my AI coach that I co-founded, and we have a free seven-day trial, so you can talk to the AI about all of your anxiety problems, and it will... It will definitely let you know what it thinks. Like and subscribe, review, follow us, be our friends. We love you. See you next time.