- For many of us talking about mental health may be uncomfortable or overwhelming.

And seeking help can be confusing and intimidating, but it doesn't have to be, especially if you know you're not alone and you have options.

This show is not about a pill or a prescription, it's not about finding the solution or pressing an easy button.

It's simply a conversation.

Let's get started.

(slow dramatic music) (slow dramatic music continues) (slow dramatic music continues) Welcome.

I'm so glad you've decided to join us.

Today's topic is dealing with anxiety.

Our guests include Dr. Kyle Boerke, director of Behavioral Health with OSF HealthCare system, Christina Gerlach-Mooney, director of Mental Health, Residential, and Crisis Services with Trillium Place, Tiffany Jordan, clinical and professional counselor with The Antioch Group, and Chad Nightingale, licensed pastor, certified counselor, and church care director with Biblical Counseling Ministries.

Everyone, welcome so much to "Let's Talk Mental Health."

- Thank you.

- Thank you.

- It's an honor to be here.

- Thank you.

- Well, this is just so exciting.

We've been working towards this show for quite some time, noting that now more than ever there's a need in our community, and really worldwide, to have candid conversations about mental health.

Before we dive into the topic on dealing with anxiety, I wanna take a moment for us to get to know each other a little bit more, since the purpose of this show is really to equip the community with resources, and to kind of remove barriers that might prevent people from accessing care.

And the more I was reflecting on this, I was like, "You know, sometimes even just the thought of meeting with a counselor for the first time can be really intimidating."

And, at least for me, the first time that I saw a counselor, it's almost like, "Well, this isn't a real person.

This is someone who has all of the answers.

I clearly have none of the answers.

So how could I possibly put myself in a vulnerable situation and start to have those conversations?"

So just for everyone, you know, you're all real people, yes?

- Yes.

- Absolutely.

- All right, so Dr. Boerke, let's start with you.

Tell us a little bit about your approach to treatment with mental healthcare and wellness.

- Yeah, well first, let me say it's an honor to be on, you know, this group with such remarkable clinicians.

So thank you for having us.

This is an important topic.

So I am by title a licensed clinical child and adolescent behavioral psychologist, which is a really long, fancy title that basically means I work with children, teenagers, and of course, their families, to help improve whatever behavioral health challenges they may be experiencing.

As a doctor, I tend to be a little bit more directive.

I focus a lot on empirical, empirically validated research and protocols.

And so it's maybe a little less of the talk therapy and more of the, "This is what we're seeing from our evaluation and these are the things that will really be beneficial for you."

And of course that's gonna vary from patient to patient with what their presentation is.

- And Dr. Boerke, what are you hoping that audiences will take away from listening into this conversation?

- Yeah, it's such an important time for everybody, for behavioral health specifically, So I really, I want this to be a de-stigmatizing time.

I think mental health can be intimidating, as you mentioned, and I just want people to realize that this is something everybody deals with.

Whether you seek help or you don't seek help, we all have our own individual challenges, and I hope this empowers people to go and seek help if they need that.

- Wonderful.

Christina, over to you.

You've had a lot of experience with crisis intervention.

Tell us a little bit more about yourself and your approachment to treatment.

- So, again, at what Kyle said, thank you very much for having us here.

I really appreciate just the opportunity to normalize this conversation.

By title, I am a licensed clinical social worker, as well as a certified addiction drug counselor.

In the world of crisis, I think the part I like about it the most is you get to really help the person in the moment, and you are that entryway to hopefully ongoing conversations.

And I really work with my teams and in my own practice about we are that window to recovery, whatever that looks like.

And so you meet the client where they are at, and what their struggles are, to start that road to things getting better.

- So you're seeing folks who may not have taken the initiative to seek out help, but they're in a position where help has found them because of- - We definitely see 'em where they, this is their first time where they're, they have other things in place that maybe are not working, and so we really are getting 'em at truly the most vulnerable of time.

And, you know, I try to tell people, "Crisis is in the eye of the beholder."

It's gonna look different to every single person.

And so when they are saying, when they're reaching out, we have to respond.

So we really need to meet them where they're at.

- Chad Nightingale.

- Hi.

- You come from a faith-based approach to treating mental health and wellness.

Tell us a little bit about that.

- Yeah, so my seminary training is in practical theology.

So how does the Bible affect life?

And I have certified counselor in biblical counseling.

We believe that the Bible is a supernatural book that the Lord gave us to direct us in the lives that we live.

And we believe that the church shouldn't be shying away from caring for people when they're going through these difficult times.

So myself, our organization, we train people to engage with biblical counseling.

We teach them how to care for one another, and then we train some of their counselors and help some of their people become certified, and things like that, so that the church is equipped to handle much of the stuff that happens in normal life with their people.

And then we offer the counseling free, 'cause we say the Bible is free, so (chuckles) the counseling should be free.

- Yeah, so you're catching people that might otherwise not be seeking help outside of the church.

- Yeah, and we're hoping to, we're actually hoping that the church is equipped to catch them before they get into a desperate time.

So hopefully their Sunday school teachers and their small group leaders, whatever kind of church you're in, those individuals feel competent to walk alongside the people in their groups and care for them before things get too bad.

- Fantastic.

And Tiffany, one of the things I love about your background is that you worked for years as an educator.

- Yes.

- So tell us a little bit about that and what you're doing now.

- Yeah, so I started my career as a classroom teacher.

I taught 8th grade, 7th and 8th grade for about eight years in District 150.

And then I went into full-time private practice and I've been doing that for about 15 years.

There's some coaching and some other teaching in there.

So I'm a licensed clinical professional counselor and a certified alcohol and drug counselor.

And I say teenagers are my jam and they still are.

So one of the things that I get to do is, well, I think one of the most important things is developing that therapeutic relationship because that's so critical, especially when you're dealing with a teenager.

'Cause a lot of times during that stage they start to pull away from the adults in their life, so one of the things I always tell them is, "I'm not just going to be another adult in your life trying to tell you what to do.

I'm here as part of your support system."

And I give them probably the gift of listening and validating feelings, which oftentimes teenagers don't always get.

And they're dealing with big thoughts, big feelings, and big demands.

And so that's one of the best parts of my job.

I get to work with that population.

- Well, thank you in advance, because my kids are not teenagers yet, but they will be in a couple years, so I appreciate the work that you're doing.

- Well, I got a couch for 'em, if they need it.

(group laughs) - There we go.

There we go.

There we go.

So as we're diving into today's topic on dealing with anxiety, we're really gonna be navigating this conversation in three different sections.

The first is gonna be talking about just understanding what it is.

Next we'll go into causes and triggers.

And then we'll end up with managing anxiety.

And I wanna pause and just underscore, as you all know, the questions that I'm going to be posturing all reflect real questions that you have vetted from clients and from people over the years.

So these are real questions that come from real people, and hoping to provide some real sense of hope for all of our listeners as we go through 'em.

So let's just dive right into this, with the fascinating landscape of anxiety.

Dr. Boerke, can you walk through a little bit, what physically happens inside the body when you start to have that feeling of anxiety?

- Yeah, it's a great question, 'cause some people think anxiety is simply a cognitive component, right?

But the reality is, there's true physiological changes that happen in the body too.

And what we're really talking about is four primary changes.

So if I get nervous about something, right, I.

The first thing that happens is our muscle tone increases.

You're gonna see that tightening of the muscle tone.

You're gonna see an increase in breathing rate or respiration rate.

(pants) And then you're going to see, they will feel, I should say, the increased heart rate.

And then last, but not least, is the increased body temperature, so you actually get hot and sweaty.

So when you are nervous, you have that, you know, sweaty, you know, palm going on.

The great news about this is, if you realize what physiologically happens in the body, and you're more attuned to recognize that, when it starts to happen at lower levels, you can recognize it, and start to do something about it.

As Chad was mentioning, right, early intervention is the key.

Early intervention, what he was mentioning is before there's a crisis, but early intervention, when I first start to notice anxiety rearing its head, if I recognize it, I can do something about it.

- Do you often find that some of us, we aren't recognizing anxiety until we're much further down the road of feeling those physical symptoms?

- Oh, for sure, yeah.

- Yeah, so as we talk a little bit more about that, and this might be a question that we don't even think to bring up, but is anxiety a normal part of the human experience?

Chad, I'm gonna look at you first to dive into this.

- Well, I would say anxiety is a helpful thing when it prevents us from doing something that we shouldn't be doing.

And anxiety then sometimes interferes with life, and there has to be a delineation between the two, because some things we do are dangerous, and there should be some fears or anxieties about that, but some things we know that they're not actually as dangerous as we're making them, and they're stopping, the anxiety is stopping us from doing that thing.

- Yes.

That's fascinating.

I hadn't thought about anxiety as being a friend in some instances, that can pull you back from making a poor decision.

- Well, it also creates a need to prepare.

Like, if you have not prepared yourself for a situation, you're gonna have more anxiety about that.

So you prepare so that you won't have the anxiety.

So it can be a helpful thing.

It just has to be utilized in the right way, and it has to be managed, as Dr. Boerke said.

It's when it's unmanaged, that it becomes a problem.

- Is there a sense, Tiffany, with some of the young people that you see, who feel like the anxiety that they are dealing with is something that they can't talk about with their peers or with their friends?

How do they explain their struggles to people that might be part of their support network?

- Yes, oftentimes when, like, a teenager is talking to their friends, they will talk about being anxious.

I don't know how much detail they actually go into about their anxiety, they probably talk less to us as adults about it, but they'll say, "You know what, I'm feeling anxiety."

And a lot of times when they're describing it, it is pretty intense, overwhelming, and it literally prevents them from doing things that they either would want to do or really need to be able to do.

And it could cause a lot of avoidance, especially with, like social anxiety, I see it a lot with teenagers, and even adults.

And again, it just, it gets in the way.

And so, they'll talk to each other about a lot of things, and sometimes anxiety can even become that thing that gets you into a group; we're all anxious and we're kind of battling this together.

- Okay, is that something that you've seen more of a kind of an increase of in the last several years with social groups centering around anxiety?

- Yes.

(laughs) That, among other issues, yes.

- So if a young person finds themself with a group of peers that are just constantly talking about being anxious, how, you know, I know we're kind of skipping ahead a little bit, but you know, how do you even identify that as a young person and put up some boundaries that could provide some health and wellness for you?

- Well, I think (chuckles) learning how to set boundaries around that, they probably need some help to be able to do that, 'cause most teenagers don't naturally do that on their own.

You know, we live in this world full of a lot of information that moves pretty quickly, and there's a lot of things that are shared that aren't entirely helpful, and I find teenagers don't always know how to filter that out, so they need us to help them learn how to do that.

So yeah, boundaries aren't usually their strong suit, or maybe many people's strong suit, but they're things that can be learned.

- Like most things, if we ignore that anxiety exists altogether, right, it's not helpful.

If all we focus on is the anxiety, it's not helpful.

There is that sweet spot in the middle where I recognize it, identify that this is a thing, this is something that's impacting me, and we talk about it, but without making it the all encompassing piece of that.

And I think that's what she was getting at.

- Like, your life doesn't need to cycle around your anxiety.

So I have to throw this out to everyone, because I thought it was a fascinating movie, but the Pixar movie that came out, "Inside Out 2," where there was actually a character named Anxiety.

I saw that with my 10-year-old daughter, and first of all, I was very concerned about her adolescence coming up, but secondly, I just thought, "Wow, this is fascinating, a whole character about anxiety," and kind of that picture that anxiety is gonna be part of your life, you know, but how to navigate the waters of walking with anxiety.

Christina, anything that you wanna speak into that one?

- A lot of times I refer to anxiety as kind of that yellow light of life.

A lot of times people are really good at the red light and the green light, not so good with the yellow light.

And so really that that anxiety is kind of your body saying, "Stop and think about your next decisions."

- I see.

- And your body, like you were referring to, I mean, I'll give you an example.

When I get anxious, my shoulders get really warm, and I didn't figure that out until I was definitely an adult.

And really now, when I feel that, it's like, "Okay, what are your next steps?

What are you gonna do in this decision?"

And like you had said, sometimes it's like, "I'm feeling this because my body is saying, 'You have no business making that choice that you were going to make.'"

And then other times it's like, "Okay, we're gonna get through this and it's gonna be great on the other end."

And so, but really stopping at, or pausing at the yellow light.

- [Jenn] At the yellow light.

- You know, it's always fun when you ask kids, "What's the yellow light?"

It's, "Oh, I go faster."

"No, no."

(group laughs) - No, no.

- It's a different conversation with Mom and Dad.

But it always comes up.

But really it's that yellow light, it's that pause that you're allowed to give yourself on "What are the next steps I can make?"

- And Dr. Boerke, going back to what's happening inside, you talked about some of the physical manifestations.

Is it a chemical, like, eruption that happens inside that causes those physical manifestations?

How does that all interface?

- So quite honestly, this is still a huge debate.

- Wow.

- And it's a vigorous debate.

So you have a camp of behavioral health that says, "You have these thoughts that are nervous thoughts, and then the body starts to react."

You have a different camp saying, "No, no, no, no, you have a physical reaction, and then your brain picks up on the physical reaction and causes, right, the thoughts."

And they argue, I mean, really, a lot.

And the reality is they're both wrong.

Right?

Because it's not just this one, and it's not just this one.

We've been working with patients for long enough to know that there are times where it is, they are sitting and stewing in thoughts, and that sitting and perseverating on those thoughts leads to the anxiety.

And then there's other individuals that we work with where there is no thought, they just feel anxious.

And so, depending on which way you are bent, if you're more the cognitive piece or more the physiological piece, it's great information for professionals like us to know, because we can then tailor our interventions based upon the way that you are bent.

- I love that you mentioned the thought piece of it, and what that plays into it.

Funny anecdote.

I was talking with my sister about how we were getting ready to film this wonderful show, and she said, "What's the topic?"

And I said, "Well, it's on dealing with anxiety."

And she said, "Are you anxious about the show?"

(group chuckles) And I said, "Well, I wasn't until you said something."

You know, but how that kind of, when a seed gets planted, where otherwise you might not even begun, you know, had started down the road of anxiety, sometimes that thought can (clicks tongue) start to percolate and get in there.

- Absolutely.

- So you talked also about kind of these different levels.

There are some people that are gonna be more struggling with something that just feels physically uncontrollable.

How do you differentiate between like, normal worry that you run into, we all worry, we all have, you know, every day little things, and the level of anxiety that comes into like a disorder realm, or a problematic anxiety, so to say?

- Yeah, so I think the simplistic way to answer that is, if it interferes with the things you wanna do.

If I worry about driving over the bridge, right?

I've had patients that worry about driving over the bridge from, you know, in or out of Peoria.

If I worry about it and I have to prep myself, and I'm like, "Okay, I can do this."

And I go and I do it and it's uncomfortable, but I get through it and I get to the store, or I get to whatever, you know, maybe we wanna talk to somebody.

But if I worry about that and I get in my car and the last exit before the bridge I turn off and I go back home, now we have something that's interfering with my ability to function.

And that's when we really need to seek that professional help.

- Oh, fantastic.

Any other thoughts on that component?

- Sometimes it's because of bad experience, like you got into a car accident and now that becomes, that's always going to be the experience, so they don't wanna get into a car because "Every time I get into a car, it's gonna become an accident."

And so they begin to lie to themselves that now the car's not safe because this thing happened.

Instead of, "No, the car is actually, it's safe.

You drove it a thousand times before you got into an accident.

This only happened once."

But that lie permeates in their mind.

- That's a perfect segue, Chad, to kind of go into the causes and the triggers.

We all know that there are situations where something happens, and it maybe isn't a logical response, but boy, your body has this massive physical response to a trigger.

So I wanna spend a little bit of time talking about that.

Tiffany, how do I figure out what's causing my anxiety, because I often feel anxious for no good reason?

So if you logically can't connect the reason, how do you find those triggers?

- Yeah, I hear that often.

Like, something happens for no good reason, and I strongly encourage my clients to slow down.

Like, a lot of the techniques I like to teach are mindfulness techniques, where we're aware and present in the moment.

And I say, "The past is the past, the future isn't here yet.

Let's spend most of our time right here."

And oftentimes we will say things like that.

"Oh, it just happened," or, "I don't know why I did that."

Or, you know, and then we'll move on to the next thing so quickly without actually stopping.

So I encourage my clients, "Let's slow down, let's reflect, let's do some body scans, take some deep breaths and actually tune into what's happening in our bodies, and how that changes as we deep breathe and relax."

And so as clients are... and even conversations about, "Think about a time when you felt this way.

Where did you feel that feeling in your body?

Okay, so that's what your anxious feelings feel like.

So when that comes on the scene, you know that what you're dealing with is anxiety."

And then we can start to address it, because like it's been said, let's get to it when it's small, because it's a lot easier than when it gets really big.

And so I love how to teach clients like, "Let's slow it down," or a therapist's words, "Let's sit with that."

(chuckles) "Let's sit with that."

So we can get as much information as possible, so when we run into that next anxiety-producing situation, 'cause it's going to come, then we know how to address it better.

- You use the word body scan for that.

Can you unpack that a little bit more?

- Yeah, body scan is just a simple technique where you take some deep breaths and you literally just shift your attention to different parts of your body and any sensation that you feel there.

You don't feel the need to try to change it, or do anything with it, you just notice.

And what you often notice is, "Oh, you know what?

My leg was a little bit achy.

I didn't know that before."

Or, "You know what?

Actually I'm hungry.

I didn't tune into that before."

Or, "I have a slight headache."

Or, "You know what?

My head actually feels light."

Or, "My shoulders were up here and now I've relaxed and they're down here."

We just start to notice those things that we don't always pay attention to.

- So this next question, for anyone, but kind of piggybacking off of this, is it fair to say that people will hold anxiety in different places of their body?

- Oh, absolutely.

Absolutely.

Part of the body scan, the shoulders, anxiety, I think, lives there, you know?

And so when you start teaching people how to recognize that, they'll get the validation of, "Oh yeah."

But part of the process is now how do we treat that?

How do we address that?

And so, as we continually work with people through that therapeutic relationship, "How does that feel today?

Do you remember how it felt the first time we met and talked?"

Because progress is obviously a motivator too, for dealing and coping and coming up with a different game plan.

And so having those, teaching those skills, like body scans, mindfulness, really helps in future situations, versus "Well, what happens if this exact situation happens again?"

I'm a big proponent in, respond to what your body's doing versus a situation.

And that helps too with, if you were anxious in that situation, "Well, what happens if your body feels like that again?

What can you do the next time your shoulders feel tense?

Or your temples," you know, "You can feel your pulse," kind of things.

And really coming up with solutions based on that versus, "Well, the next time I'm grounded, this is what I'm gonna do."

Well, guess what, even as grownups, there's times we feel like we're grounded.

So, you know, it's more about what our body is doing.

- Does that help individuals kind of take it down a level in terms of what you can and can't control?

Noting that so much of anxiety, at least in my life, comes out of a sense of like, "Well, I don't think I can control this situation that's coming up."

- I just think it normalizes it.

- Normalizes it.

- And regardless of what the situation is, you have some control in it.

And a lot of times we hear, or we feel, "I didn't feel like I was in control of the situation."

And so let's unpack that, you know, because we can control our response, we can control whether or not we tap our foot.

We can control whether or not we're doing a body scan.

You know, there are certain things we can still control in that situation.

- Wow.

So some of these triggers can be really intense, can be trauma-related.

And for individuals who are in the middle of navigating anxiety that's caused from a trauma-related trigger, what's the first step that you would say to them, Chad, as you're unpacking that?

- Well, I'd take them to Matthew, where Jesus says, "Come to me, all who are burdened and heavy-laden, and I will give rest to your souls.

Place my yoke upon you and learn from me, for I am gentle in heart, and you will find rest for your souls."

And what I believe he's telling them there is if you'll just slow down, 'cause you think about a yoke, you, there's a... - [Jenn] It will slow you down.

(laughs) - It will slow you down.

(group laughs) Like, you have to walk side-by-side, you can't do it quickly, and so just slow down, and walk with me in the labor of the day, and learn from me.

And a lot of anxiety is because people are trying to do too many things too quickly, and they just need to, they just need to slow down and figure out, "What things do I actually have to be doing right now?"

And begin lightening the load a little bit.

- I wanna add on to that for a second, because there's another a verse in the Book of Lamentations that says, "His mercies are renewed every morning."

And I think, and you can finish the rest of the verse for me if you need to, but I think that's a big component of anxiety is, "I'm not really worried about what I have to do right now.

I'm worried about what happened yesterday, and how that's gonna impact how people look at me today.

Oh, and then later today I have a test, and then tomorrow I have to go to this, and then I have tryouts for that."

And we're not trying to deal with what's right here.

We're trying to deal with yesterday, today, tomorrow, four months from now when I have a trip that I have to go on, that I'm worried about.

And the reality is, we are designed in such a way that we are given the ability to deal with the things that we need to deal with today.

And that's what, you know, professionals can certainly help people tap into that strength.

- When people have experienced physical trauma and there are so many things that you can't control what happens in your life, but that physical trauma that may have come out of a car accident, or something like that.

Is there an extra layer of anxiety mitigation that comes into play, if you're recovering from an injury or a severe illness, or something that's really taken you out of pocket for a while?

- Yeah, I think when it comes down to like trauma in general, yes, there is that anxiety that comes there and it creates like triggers, buttons, things that we're gonna be affected by as we move through, you know, space and life and we can't control those things.

But part of trauma treatment is, it's not just, you know, sitting on someone's couch talking about everything that you went through and replaying that, because that could be traumatizing- - Traumatizing.

- In and of itself.

- Whew!

- It is really learning how to feel safe in your body again.

It's called Resource Installation.

Like, you know, we talked, I mentioned the mindfulness techniques, and there's a lot of other techniques that are used in trauma treatment to learn how to calm the body.

And so that's like a place to start.

And there's some clients I've worked with who, that was what they needed in treatment, they didn't want to go back and relive, and they don't have to.

It was like, "Let me feel safe in my body again now."

- I love that.

- And that was that.

- Yeah, feeling safe in your body, and hopefully that also might dispel some myths, that, again, a barrier for people seeking care, that it's gonna be like, "Well gosh, if I go seek a counselor, I'm gonna have to relive all of the hard things."

So when folks are first approaching you, or when you first have a meeting with them, how are you building confidence that this is not going to be awful?

(group laughs) - I always explain that in treatment we're gonna make progress.

I don't care how fast the progress is.

Progress could be from here to here, but we're gonna make some level progress, so we're gonna follow your lead.

We're not gonna push you beyond a place that you're capable of.

We might push you beyond where you're comfortable of, but we won't go beyond where you're capable of.

- That's beautiful.

I wanna talk through a couple of examples that you've all kind of relayed to me from clients, knowing that this kind of spans a wide range of ages, everyone deals with anxiety and all this.

The first one, teenage girl, anxiety caused through a fear of humiliation.

"I can't go to school because people will make fun of me."

So what would you say, Tiffany, to a young person dealing with that trigger for anxiety?

- Well, I mean, that may be true.

She may go to school and people may make fun of her, so I'm probably not gonna start by saying, "Oh, that's not gonna happen."

Because if it does, then now I've set her up.

And so I'd start by one, exploring kind of one, why she believes that, you know, what's already happened.

And one, I would wonder if she has a support system there?

Do we have friends?

Do we have people that we can lean on as we're, you know, moving through school, which can be a brutal place and an anxiety-producing place at times.

And really get down to those thoughts.

It's like, "Okay, one, how are you seeing yourself?"

Because a lot of teenagers, and not just teenagers, it's adults as well, we care about what other people think of us.

Okay, so one of my favorite things to say, it's like, "Okay, well, can we like narrow that down?

So we're not caring about what everybody thinks, but we limit that to a select few people whose opinions actually matter.

And those folks should be people that know us, that love us and that actually have, you know, our best interests at heart.

And so let's narrow that."

All right, and so usually that helps, you know, temper that fear of going into social situations.

When I bring it back to like, "What do you think?

Where are you?"

And then also exploring what are they feeding themselves with?

We have our eyes and our ears that, you know, are the gates and there are things we take in information-wise that can flood our hearts.

Comparisons play a huge role in that.

And so we have to get down to, you know, ultimately, what's driving that.

A lot of thoughts, you know, that cognitively-driven like anxiety piece, you know, plays a huge role in that too.

- I love that you said it's okay to care a little bit about what a couple people think.

- Sure.

- Like that's appropriate and good, but setting up some structure around, you know, not letting that rule your thoughts, and your mind.

Another scenario from a person.

Academic failure.

So I'm even going back to my college years and thinking about, "Oh, I'm so glad I never have to do finals ever again in my life."

Like, all the anxiety that comes along with that.

You know, "What if I don't do well on this thesis or this project?"

Chad, how would you walk someone through that?

- Well, I would talk to them about where they are, where they've come to, how they're in that program.

"How well have you done in that program?"

If they've done well in the program, you're asking the question, "Why would it be different now?"

right?

You know, "Maybe, maybe these professors have been lying."

Well, "Probably not," right?

(group chuckles) "They probably haven't been just handing out A's," you know.

So I talk about where they've come from, where they've been, the work that they put into it.

"Have you put your best effort into this?"

Or, you know, "Did you wait till the last minute and you're throwing this together?

Like, what reason do you have for the anxiety about the paper?"

- I like to explain that part of, it depends on what we focus on, right?

We live in a society and a culture that is very outcome driven.

I have to get the A. I have to be the valedictorian.

I have to make this team.

I have to get the promotion at the job.

And we're so focused in the outcome that we oftentimes forget about the process to get there.

And so I talk incessantly about, it's process over outcome.

So Chad, as you're having that conversation, is, "Did you go to class?

Let's start there."

"Yes, I went to class."

"Great.

Good starting point.

Did you take some notes?

Have you reviewed the notes?

Did you study?

Did you do the process in such a way to set yourself up for success?"

And if you have done those things, and I get an A great, the process works.

If I did all those things and I worked as hard as I could and I did my best and I get a B, great.

If I get a C, great.

Quick anecdote.

I have had my own kiddos succeed incredibly, 100% on a test, and they come home, they're so excited, and I said, "I'm sorry, what?"

And they said, "Yeah, I got an A."

"I didn't know you had a test."

"Oh, I knew it, I didn't even study for it."

I'm like, "Okay, I'm not proud of you though for not studying and getting an A, I'm sorry."

'Cause it's not about the A, it's about setting up the process the right way in order for the outcome to then follow.

- Oh my goodness, I'm taking notes as a parent, because I think I probably would've been the parent that said, "Awesome job."

(laughs) - So we would say, "Did you do these things to the glory of God?"

Do all things to the glory of God, right?

Whatsoever you do.

So, "Did you do this to the glory of God?

Is this your best effort?

Did you put forth the process?"

- I love that.

When we talk about triggers that involve like really scary things that you've come out of.

So you're a cancer survivor, or maybe you've survived a traumatic relationship, and there's a fear that that might happen again.

How do you walk someone through that?

- I think that's just the real conversation of recognizing those feelings and how to cope with them in real time.

And that's probably one of the biggest things I focus on when I work with people who have been through different traumas, is "I can't fix it so you're never gonna have those feelings again.

But what I can do is prepare you for when you have those feelings, how you get to a place you want to be."

And really, I mean, a lot of it is that trusting relationship where you have a real conversation and they trust you to do the walk with them.

I've been a social worker long enough, I remember when we were told to not share parts of our personal lives with our clients.

And through, and I will be honest, I've been doing this almost 30 years, now I share stuff all the time.

And it's really a balance of what to share, but I do feel like that that helps our clients, our patients, whichever dynamic you wanna give 'em, they've been through some things too, you know, and it gives them hope, you know?

And I really, really, really try to stress with anybody, as long as you have the hope that things are gonna get better, that you're gonna get through the process, that we're gonna get through progress, we can get through anything, you know.

As long as you keep coming back, even if it's to tell me that I was 110% wrong, then guess what?

Now we get to find another solution.

You know, you're still invested as long as you continue to do the walk with me.

- I love that.

I wanna pause too.

You're talking about walking with clients, and there is sometimes when maybe there needs to be a changing of the partner who's walking a client through something, because, you know, for one reason or the other.

Can someone kind of speak to that?

That that's A, permissible.

So if someone's going to see a counselor and they're feeling anxiety going to see the counselor, or maybe it's not working.

Like, they can advocate for a change there as well, yes?

- Absolutely.

I even tell my clients I'm not everybody's flavor and that's okay, so.

(chuckles) - I love that.

- If we're not connecting and they need something different, that's fine.

Sometimes we can even get to a point in treatment where it's time to transition and they need something different than what I can offer.

There's also something to be said for like higher level of care.

So I treat- - Sure.

- Like substance abuse, typically in the adolescent population, and I have to do, I'm constantly assessing, is outpatient appropriate for them?

And if not, then I will refer to someone else.

Or if it's something that I'm simply not truly competent to treat, then- - So is it safe to say that like, if someone needs to break-up with their counselor, the counselor's feelings will not be hurt?

- No.

- Right?

(chuckles) - So long as it's for the right reasons, right?

- Right.

- If it's a fit.

If we're challenging them to do something that we want them to do and we're like, "Okay, we'll pause there," and they just can't recover from that, maybe not the right time to break-up, you know, with your counselor.

But the reality is, yes, we're not all the right fit for everybody.

And I'll take it a step further is, for the most part we're pretty good generalists.

We're good at a lot of different things, but we're specialists in only a finite number of things.

And so if I'm not the expert in, I'm not the expert in substance abuse, I would happily refer over, and then she can see them for a little while and probably come on back to see me again for the next thing, right?

So it's a very collegial group of professionals we have in this area, which is great.

- I love that.

So we're gonna transition into talking a little bit about managing anxiety, which we have kind of throughout the course of this bit, and keeping it in check.

One question, just to get it out there.

Can you ever get rid of anxiety, your symptoms with anxiety, forever?

Is that something that's possible?

- No.

- [Kyle] No.

Easy answer, no.

- No.

- No.

- I mean, we live in a world where you get invitations to be anxious about so many things.

So it's going to be constantly presented.

- Do you find though that sometimes in our human nature that individuals are seeking to find, again, like a easy button to press, to put them in a position where they just don't have to even deal with anxiety at all?

Or to circumvent anxiety?

- Sure, it'd be called weed.

(group laughs) Or alcohol, or another substance.

(Jenn speaks indistinctly) I'll leave them.

- Yes.

- And I would take that a step further, and that's where avoidance comes in.

And the reality is, so talking about management of anxiety, I'm gonna flip it a little bit and say how not to manage anxiety.

Don't try to avoid it.

Right?

- I love that.

- If you're a parent of a kiddo who's struggling with anxiety, or the spouse of somebody with anxiety, don't try to take the anxiety away from them.

Avoiding the situations that cause anxiety will do nothing but increase the anxiety.

The technical term is, it's called the negative reinforcement loop, right?

Negative, I'm taking something away, I'm avoiding the situation.

Reinforcement, more likely for it to happen.

So I have an anxiety-producing stimulus, I have this physiological arousal, we talked about earlier, the muscle tone increases, heart rate increases, respiration increases, and I attribute this uncomfortable feeling to this anxiety stimulus.

- Wow.

- And so I want to avoid it at all cost.

And if I avoid it, guess what?

Naturally anxiety goes away.

It's called the parasympathetic response system.

It will come down.

And now I say, "Well, I felt better because I avoided this."

No, you felt better because your body did its job.

But unfortunately, if I feel better, now the next time that I'm in that situation, I'm gonna feel even worse, and I'm gonna wanna avoid even more, and I'm gonna feel even better.

And it's a very vicious spiral.

So avoidance is a really damaging thing to anxiety.

It can make it, you know, roll outta control very, very quickly.

- So what's the first step at building that relationship with our friend anxiety, where you can start to walk down the path not avoiding them, maybe looking anxiety in the face, and starting to take those baby steps into that direction?

- I just think, I mean, the first step, the biggest step, is that it's normal.

You know, and everybody would say, "Well, what is normal?"

But I like how you referenced "Inside Out," because I mean, that is really a child that has all those emotions.

So if we just start there, that that's the baseline, that it's there for everybody, this is how we deal with it.

And there are, and we can apply that to many things in our life, that everybody has similar struggles with.

It's our role to help you navigate that.

I don't understand math.

I had to get a math tutor.

The math tutor helped me navigate math, because there was no way I was going to avoid it throughout school.

So luckily I found a career where there's not a lot of math.

- Love it.

- You know, but there's still times I have to do it.

And so there are different things, whether it's math, anxiety, school, friendships, moving, where different things are gonna come into our lives that we have to figure out how to navigate them.

- Yeah, there's something called exposure therapy.

You talked about baby steps.

So how we like slowly but surely kind of move up to the main event.

Short scenario.

I have a 6-year-old, she didn't like going through the car wash.

They're with me most of the time.

I go to get my car washed, so I'm not gonna drop them off at the side and not go through it.

It's going to happen.

But it just, it really scared her the first time around.

So I started off by, we washed the car at just a regular bay so she could see how powerful the water was, the soap, how everything worked.

And she helped me do it.

Then I was like, "Okay, we're gonna go through, are you ready?"

Now there were some steps in between, but I said, "I'm gonna narrate this for you.

Okay, that's the soap coming up the side of the car.

There's," you know, "these are the lights.

Okay, these are the," you know, "this is how it's wiping it down and spraying it.

This is the dryer.

Okay."

And then her eyes were big, we got out, kinda came down, was done.

And then it was maybe a little bit after that, she would ask me when we would drive by, "Hey, are we gonna go get a car wash today?"

And that was the first time she'd asked me to do that.

I was like, "Well, sure, let's go."

(group laughs) - Right now.

- We drove through.

- Not due, but let's go.

- And she was ready, and she told me that.

But I wouldn't because I was going to do it anyway, at some point in time.

I took baby steps to get her to the place where she was okay, because there was no real threat.

The car wash wasn't gonna harm her.

We were in the car.

- Yeah, most of us today have talked about, or used the term sit with, right?

And when it comes to anxiety, and it comes to those uncomfortable feelings, instead of avoiding it, right, "I wanna get outta there right now."

Don't do that.

Sit with it, set a goal.

I'm gonna set a timer on my watch and I'm gonna sit in this uncomfortable setting for five minutes maybe, 10 minutes, 20 minutes.

I don't know what it is.

I'm gonna go into this social interaction that I'm nervous about, with my peers at this party, that I'm really worried about, I'm gonna set a timer for half an hour, and after half an hour, now I can leave.

Now I'm not avoiding.

Now I succeeded.

- Wow.

- Now I've met my goal and I can leave, and I have self-confidence and self-assuredness that I can handle that, and maybe next time I go for 40 minutes instead of 30 minutes.

But it's setting little goals and sitting in that discomfort, that's really important.

- And I think we have to talk to them about the lie that they're telling themselves.

We need to understand so that we can help them overcome that lie.

There's a psalm, Psalm 3, short synopsis, but King David's son is taking over Israel, and has decided that's not enough, "I need to kill my dad."

And so he's hiding in a cave, and it says, "Many are rising up against me.

Many are saying of my soul, 'There is no help for you in God.'"

Like, so, like, God's not even gonna help you.

And that's the lie that David has to overcome.

And David overcomes it by saying, "No, no, no.

The truth is the Lord's always been a shield about me.

He's been my comforter and the lifter of my head."

And so he's able to move forward after that, in the psalm.

And so helping them see the lie and go, "Well, let's talk about what's true."

And bringing them back to that truth and giving them a new foundation to live on is so important.

- That's well said.

That's incredible.

So also, does that truth also play out even outside of, like, the biblical practice or approach, where you have to get a negative thought out, but then you have to replace it with something else, yes?

- Oh, absolutely.

And to use Dr. Boerke's example, when you're sitting there for 20 minutes in the party you were too anxious to even walk in the door, you should be doing 20 minutes of self-talk.

(group chuckles) - Okay.

- And pepping yourself up.

I mean, we are our own greatest cheerleader.

- Oh, I love that.

- And we are the only ones that know the words that are gonna matter to us.

And so you should be giving yourself that self-talk while you're there.

Kind of like how he was, you know, "No, that's not the truth.

No."

You know, "No, that person's not staring at you," or, "10 minutes wasn't so bad, I think I can do this."

You know, I mean, that's part of the recovery plan in that is "Okay, instead of being there for 20 minutes and feeling my watch tick with every second, what can I do during that time period?"

And the best answer is positive self-talk, you know, to get you through that.

Because I'm willing to bet if you do that, at 21 minutes, you're gonna be like, "Oh, it's already 21 minutes, time to go," you know, kind of thing, so.

- Yeah, the self-talk, right?

We call that thought-stopping, in a lot of what we do.

So that's, you got the cognitive component, for sure, but remember, right, underlying a lot of this anxiety is also that physiological piece of it.

So there's other skills that we can teach that are gonna help bring down that physiological anxiety that we feel as well.

So there's a great tool that everybody teaches their patients, right?

Which is diaphragmatic breathing.

It is a way of breathing.

The reality is, my body cannot be anxious and relaxed at the same time.

It's an impossibility.

It cannot be in two different states at the same time.

So if I'm nervous and I'm breathing really fast, and my muscles are really tight, if I slow down and I do diaphragmatic breathing, where we're breathing in through our nose- - Okay, oh, can we do it all together?

- Let's do it together.

- [Jenn] All right, let's do it.

Okay.

- We're gonna breathe in through our nose for three seconds.

(group inhaling deeply) We're gonna breathe out through our mouth for six seconds.

(group exhaling deeply) And you repeat that.

And if now, instead of doing a panicked (panting) breathing in and out every, you know, half second, I'm now doing one full cycle in nine seconds, my breathing is slower.

That's going to slow down the heart rate.

I'm gonna get more oxygen into my body, which helps my muscle tone relax.

And because my heart's slower, my body temperature comes back down.

So we can be in that, you know, social setting, doing our self-talk and doing the diaphragmatic breathing, and all of a sudden I'm feeling better, and, physically, and I'm feeling better cognitively and have more confidence.

And it's a win-win situation, yeah.

- And that's something that you can do if you're in the car, or if you're having lunch, or, you know, whenever, just to pause, if you start to recognize those symptoms coming.

- Yeah, we have kiddos do that during tests.

Right, we have test anxiety at school.

- Wonderful.

- Before you start your test, take a moment, do a couple breaths, and then go about the test.

- Well, I have to say, you know, 45 minutes into our conversation, that felt great.

(group laughs) I mean, I feel relaxed.

(chuckles) - [Chad] Somebody should have brought that up 45 minutes ago.

- Right.

- Right?

- Absolutely wonderful.

So I, you know, Tiffany, you had mentioned kind of talking about the parental role, and that there are times when you're not just managing your anxiety, you're recognizing anxiety in someone that you are care-taking, or responsible for, and could it, sometimes, is it more difficult to recognize symptoms of anxiety in other people, even than yourself?

- Yes, I think it always starts with you.

So if you become accustomed to recognizing anxiety, like even within in your own body, like, my anxiety, I feel it most in my stomach and in my shoulders.

Then, as I learn how to tune into that, then I can give that gift to my children and to my clients as well.

You know, I observe my kids, and I have a 4-year-old, and when she goes into a large, she's more of my introverted, you know, loves connection, but will kind of look at you like, "I don't know who you are," so we'll hang on the wings, where my oldest won't do that, she's all in from the beginning.

And so it's been said about her that she acts funny, right, when she, and I looked at that, and I was like, "No, she's anxious, she doesn't know what," you know, "kind of where to go."

She's overwhelmed by a lot of people that she doesn't know.

And so I said, "Hey, you can stay with me," 'cause she'll be pasted to me.

And if I didn't have enough wherewithal, or didn't observe my child, or know what that looked like, then it would be difficult to actually help her address it.

So I think it starts with knowing and understanding what goes on inside of you, and then you can help other folks.

- The similar principle of put on your oxygen mask first, before you go to help someone else with that as well.

- Agreed.

- As we're kind of nearing the end of our time here, let's talk about resources and treatment options that are available in this community.

You all represent a wide variety of different pathways to treatment.

So I'd just kind of would like to go round-robin.

Chad, let's start with you about resources that people can take advantage of.

- Well, there's a website called the ACBC, that's Association of Certified Biblical Counselors that will point you to a biblical counselor in the area.

We work with six churches, one in Lexington and Pontiac, one in Mackinaw, one in Eureka, one in Peoria, one in Pekin.

There's free counseling at all of those churches.

You just have to reach out to them.

So.

- I love that.

And to underscore, that's a free option, so there are opportunities that don't involve any type of cost.

- Yeah.

- Yeah, that's great.

Christina?

- I think the program that I'm most proud of, of my teams, is our Community Crisis Center.

And it is down there, on Richard Pryor.

Phone number is 309-671-8084, I just have to give that- - You're- - Because within that building, it is really, I just, I feel very strongly it is kind of like the mental health superhero of our program set.

And I say that, because within that building we have a medical detox program, a psychiatric crisis stabilization residential program, we have our mobile crisis response team, formerly known as ERS, and then we also have our Living Room program.

And all of those programs are 24/7.

You can walk in the door and just say, "I need to talk to somebody."

Of those programs, I will absolutely tout The Living Room program as the first step for anybody.

That is a program for adults, where everybody there is somebody in recovery, whether it is from mental health, substance abuse, or both.

But they are really there to say, "I have been there, I have done that.

I have been you and I am here to help you."

And so it really does help kind of eliminate the anxiety of, "This person has never been in my shoes."

And they do a really good job of just linking people to the services that they need, whether it's another service within the building or a community, but it really takes away that anxiety of, "I don't know how to ask for help."

You know, "I don't know why I'm here, I just need somebody to talk to."

"All right."

And they go back into our, and it's really set up like a living room.

It's recliners, there's a TV, there's snacks.

It's just very welcoming.

- I love that.

And Dr. Boerke.

- Yeah, so I think within OSF specifically, we have done a really good job at making healthcare accessible, where you get your care.

So we have grown, over the last several years, what is called our Embedded Behavioral Health Program.

So these are behavioral health therapists that are physically located in the Primary Care offices.

So I go to see my physician, while we're having the discussion, I'm expressing that I've been really anxious lately.

There's stuff going on in my, you know, marriage, or at my office or, you know, with my family.

That doctor can leave the room, go grab one of my therapists, and bring them back in and have that warm handoff, and that patient can leave with an appointment for that therapist before they walk out the door.

And when they come for their therapy appointment, they're coming to their doctor's office that they're comfortable in.

They know the front office staff, they know everybody there.

It's a great starting point.

So I would encourage anybody watching, if you are struggling, a great starting point, whether it's OSF or otherwise, is start with your primary care physician.

They're a great opportunity to get information and resources out there.

We also have what's called Behavioral Health Navigation, which is a free service for everybody.

And if you contact the Behavioral Health Navigation team, they will set up you with a clinician, whether that's OSF or you know, elsewhere.

We care about the patients, as everybody, you know, sitting around this room does.

And it doesn't matter to us if you come to us or you go to somebody else, we just truly want what's best for you.

- And Tiffany, you're last.

You only have about 30 seconds, but any other resources?

- So I work at The Antioch Group, so that's a great resource, and I always refer clients to like different podcasts and things like that.

- [Jenn] Excellent.

- [Tiffany] So there's a lot of great resources in the community and we are all of them, like some of them.

- We are very blessed in this area.

- [Jenn] Oh, absolutely.

Chad and Christina, thank you so much for your time today.

- Thank you.

- You're welcome.

- And Dr. Boerke and Tiffany, what a pleasure.

- Thank you.

- And thank you for joining us.

Remember, if you're struggling with anxiety, you're not alone and help is available.

You can find a list of the resources discussed during this episode on our website at wtvp.org/mentalhealth.

If you liked this show, or have ideas for future topics, please contact us on Facebook or Instagram.

I hope you'll join us for the next conversation.

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