If you’ve never had a panic attack, it can be hard to understand. The worry, the anxiety, the physical sensations — What is going on? If you have had a panic attack, you’ve probably gone to great lengths to avoid another… and probably failed.
If you have, or suspect, that you’ve experienced anxiety in any form, or just want hints and tips to better manage anxiety, anxiety attacks, or panic attacks, this is the episode for you.
Join us as the Anxiety Sisters, Abbe and Maggie, explain what anxiety is, give us some tips for combating it at any level, and let you know you’re not alone.
Abbe Greenberg and Maggie Sarachek are trained counselors, mental health advocates, researchers, educators, writers, and long-time anxiety sufferers. In 2017, they launched their online community, which now includes more than 200,000 people in 200+ countries and territories. Together, the Anxiety Sisters write an award-winning blog and host a monthly podcast (The Spin Cycle). Having learned to live happily with anxiety, they spend their time coaching anxiety sufferers and conducting workshops and retreats all over the U.S. Their book, “The Anxiety Sisters’ Survival Guide,” is now available.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast, I’m your host, Gabe Howard, and quickly, I want to thank our sponsor, Better Help. You can grab a week free by visiting BetterHelp.com/PsychCentral. Calling into our show today we have Abbe Greenberg and Maggie Sarachek, who are collectively known as the Anxiety Sisters. They are trained counselors, mental health advocates, researchers, educators, writers and long-time anxiety sufferers. Back in 2017, they launched their online community, which now includes more than 200,000 people. They also write an award winning blog and host a monthly podcast called The Spin Cycle. Abbe and Maggie, welcome to the show!
Abbe Greenberg: Hi, Gabe, thanks so much for having us.
Maggie Sarachek: We are delighted to be here.
Gabe Howard: Can you explain to our audience what anxiety is?
Abbe Greenberg: So here’s the thing about anxiety. If you’re human, you’ve had it. It’s a broad topic because we’ve all experienced it, but by the same token, the type of anxiety that Mags and I like to work with and deal with is the kind when your brain gets a little bit wonky. And the part of your brain that responds to fear is a little trigger happy and therefore creates a situation where a person experiencing anxiety thinks he or she is under a threat that actually is not there, that doesn’t exist. You know, fear is protective. If you see a grizzly bear chasing you, you run because that’s going to save your life. And that is not anxiety. That’s fear. But if you’re standing in the grocery store, minding your own business and suddenly start feeling all those symptoms like you’re being chased by a bear, that’s anxiety. That’s where your brain is perceiving danger, where it doesn’t in fact exist. And there’s a huge continuum of anxiety, right? I mean, it goes from just mild stress over things which we all experience all the way up to folks who can’t even leave their home because they have so much anxiety, they don’t want to leave their house.
Gabe Howard: I’m glad you came in with the continuum, because that’s definitely really important, so many people think that anxiety is just like one size fits all, right? We don’t think physical health is one size fits all. I mean, we don’t think that every broken leg is exactly the same. But many people do believe that anxiety, or any mental health, is just, Oh, well, I have it too. We’re exactly alike.
Maggie Sarachek: Right.
Abbe Greenberg: Yeah, yeah, and another problem, another difficulty that arises because it’s mental health is that it doesn’t get the same, it doesn’t have the same gravitas as physical health. For example, if you break your leg and you’re wearing a cast, no one is going to ask you to climb a flight of stairs. In fact, they’re going to help you to the elevator. They might even bring a casserole to your house for dinner later on. But if you have anxiety, people can’t see it. It’s an invisible disorder, so people are not going to be so inclined to help. As a matter of fact, a lot of us, the help we get is someone saying relax or calm down. And we all know that in the entire history of calming down, no one’s ever calmed down by being told to calm down.
Gabe Howard: Full disclosure, I suffer from panic attacks where I’ll just be standing there, minding my own business and my heart will start to race, I’ll get all sweaty, I become just paralyzed. That’s part of that continuum, right? That would be in the very serious disordered category if I’m stating that correctly. Is that common for people to have when they say I have anxiety? Or is there a more centralized anxiety that people are discussing when they say I have anxiety?
Maggie Sarachek: When they’re saying I have anxiety, I think panic attacks are pretty common. There are many different types of anxiety that people can be talking about. So some people just have worry, they just worry excessively about everything. Some people catastrophize things, which means that they kind of make a mountain out of a molehill about everything. Some people have specific phobias where they’re scared of, I don’t know, driving on the freeway or driving or flying or some other type of situation. But I think panic attacks are a very central part for many people of anxiety.
Abbe Greenberg: And, Gabe, in any given year 284 million people suffer from anxiety disorders in the world, so it is exceptionally common.
Gabe Howard: It’s so surprising to me that you say that it’s exceptionally common because I always felt like I was alone. Whenever I had a panic attack, whenever I had anxiety, I thought that I was the only person in the world who was suffering. Is there a reason that people don’t talk about this so much? Because you would think with 284 million people, nobody with anxiety would ever feel alone?
Abbe Greenberg: You know, the most common thing we hear from people in our anxiety sisterhood, and we should just say that when we say sisterhood, we really mean anyone of any gender. But the truth is the most common thing that we hear from our community, people say to us, I didn’t know anybody else felt this way. People are reluctant to talk about this. There’s been a mental health stigma since way back. In many places it’s still very stigmatized and there’s a lot of shame and blame that goes around with things that are called mental illnesses. So that’s why Mags and I love to call it brain illness, because it really locates it in a place. It’s in your brain. In fact, it’s in a part of your brain called the amygdala.
Abbe Greenberg: You can see this part of your brain on an MRI. It’s not a made up ethereal thing, and it’s not something we should be ashamed of.
Maggie Sarachek: I think also sometimes it’s very hard to understand, like you may hear that your friend has a panic attack, right? But it’s very hard to understand what that actually feels like in reality. So a lot of times what Abs and I do is try to describe some of the things that may happen when someone’s very anxious or when someone’s having a panic attack. More often than not, people tend to say to us, Oh, I didn’t realize other people felt that symptom, too. A good example is we just were talking on our Facebook page about itching, getting very, very itchy when people are very anxious or even when they’re panicked. And so many people said I thought I was the only one that happened to. I never heard about this before. So a lot of times it’s thinking that a symptom or an experience is your unique symptom of it or experience, but it’s really much more universal than you might believe.
Gabe Howard: So just to make sure that we’re all on the same page, how would I know if I was having a panic attack?
Abbe Greenberg: Well, you could have any number of symptoms because each of us is different and we have our own unique presentations, but as Mags pointed out, there are some really common ones that we all share. So I guess the classics would be cardiac symptoms like maybe racing heart or palpitations or even chest pain, shortness of breath or dizziness. Also, stomach upset is very common in a panic attack. Either nausea or excess gas. You can have things like headache. You could have itching, you could get a rash or develop hives. One thing that I always say is that anything the body can do, any sensation it can produce, any sound it can make and any fluid it can produce can happen during a panic attack.
Gabe Howard: And if you find yourself having a panic attack, what should you do?
Maggie Sarachek: Well, the first thing we like to say is the hardest, which is do not fight it. The goal is not to stop your panic attack because the more you fight, the more intense the panic attack can get. So we often use a riptide analogy. You know, if you’re in the ocean and there’s a riptide happening, you can’t swim to shore. If it’s a strong riptide, no matter how good a swimmer you are, you cannot make it to shore. You have to sort of swim parallel or just sort of hang out until the riptide passes. And it always will. Try not to fight it, because the more you fight it, the more you pay attention to it, the more it will grow. So we have a number of strategies that help people not to fight a panic attack. One of them is having with you a spin kit, and that is what we call a kit that has things that will help distract you during the panic attack. Like, for me, that’s always having a crochet needle with me or for some people, it could be having some special music with them or a crossword puzzle, whatever helps distract you, or a picture of your kids. We also like to have a soother with us, and a soother is something that will help ground you. Often when we’re having a panic attack, we feel very discombobulated.
Abbe Greenberg: So something that might help ground you is a strong mint or the smell of lavender, having some lavender essential oil with you, or even one thing that really helps is having a rubber band with you and snapping it on your wrist. And then also in our kit, we have ways to help our symptoms. For me, it’s Gas-X because mine is always stomach symptoms. For someone else, it may be a headache aid. It may be a very cold towel because some people get very overheated. So that helps them. It’s that kind of stuff.
Maggie Sarachek: I just wanted to clarify that a spin kit is really a first aid kit for anxiety. It’s sort of like we believe in planning for panic, right? If you’re an anxiety sister, then you know, chances are I’m going to have anxiety at some point or another. I might as well be ready for it. A spin kit is something you carry with you. It’s portable and you keep any number of things that will help you get through the panic attack that help you ride the wave so that you’re not fighting against it. And we teach people how to make their own spin kits and we call them spin kits because when our brain hears the word panic, we think it’s a command. So we like to rename it to spinning because it’s really a very apt metaphor for many people. It feels like you’re spinning out of control.
Gabe Howard: I love that. Now it sounds like a spin kit is an anxiety management technique, because I imagine that even with anxiety, an ounce of prevention is worth a pound of cure. Aside from the spin kit, are there other anxiety management techniques that you promote?
Abbe Greenberg: Hundreds
Gabe Howard: Hundreds? What’s your favorite?
Abbe Greenberg: Well, it depends on the day. Here’s something that we always tell our community, and that’s this, there is no one size fits all treatment for anxiety. And in fact, there’s not even a one size fits all for the same person two days in a row. In other words, I may do some deep breathing one day to manage a panic attack. The next day I have another panic attack. I try the deep breathing and suddenly that makes me hyperventilate. The key is to have an arsenal of tools. And yes, the spin kit’s one of our favorites because we’ve actually had spin kit parties where we get anxiety sisters together and we all make spin kits together so that people can carry it with them wherever they go. And that’s fun and it’s a great technique. But we have everything from talking to yourself and creating mantras that work, even things like loosening constraints that are on you. Because when we’re in a panic mode, our body tends to get constricted and it’s harder to breathe. So you want to do things like loosen a belt or, you know, if you’re wearing tight pants, unbutton them, or if you’re wearing a hair scrunchie, loosen that. You’d be surprised that the looser that you can feel, the easier it is to get air deeper into your lungs, which helps calm down that fight or flight thing that’s going on when we have anxiety. So if you ask me, my favorite technique, I would say, depends on the day, but Mags and I literally teach workshops.
Abbe Greenberg: We choose a whole handful of techniques and then say to people, but really, you can never have too many techniques because one size does not fit all.
Maggie Sarachek: One thing that usually works for me personally, is to try to cool down. I get very, very hot and overheated, like many people do when they have a panic attack, because it’s like your brain basically thinks it’s running away from danger or fighting danger. So many of us tend to get very overheated, so I know that I need a cool towel or I need to take a walk outside. If it’s cool enough outside or I need to get into a place that’s going to be cold, even take ice and put it on the back of my neck. So cooling down is one of the things that I know will usually work for me.
Abbe Greenberg: And yet there are many anxiety sisters who say what they need most when they’re panicking is to be swaddled tightly or to take a hot shower. You know, that’s where the one size fits all thing doesn’t, you know, it really depends on the person. But I would say the majority of our community finds that talking to yourself, loosening any constraint on you or anything that makes you feel tight and cooling down are three things that are really helpful. We call that TLC. Talk to yourself. Loosen constraints. Cool down.
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Gabe Howard: We’re back discussing anxiety with The Anxiety Sisters, Abbe Greenberg and Maggie Sarachek. I’m really fond of saying that the best treatment for you is the one that works for you, and so many people spend so much time comparing themselves to others. But of course, you’re not promoting comparing yourself to others. You’re promoting getting ideas from others, trying it out and then doing what works for you. Correct?
Maggie Sarachek: Absolutely, there’s no one size fits all approach and one of the reasons we wanted to write a book and one of the reasons that we think it’s so important to have our website and have a community talking to each other is because we know that anxiety is different and panic attacks are different for different people. And so that when we were having so many problems with panic ourselves, we would sort of go into bookstores and find very prescriptive books telling us, you know, take medication or don’t take medication and do cognitive therapy or do mindfulness, or you can breathe this all out or. And there was always like a very specific point of view. And the thing that we realized is that we’re all different and there’s not one size fits all. And one size may fit us on one day and we’re another size the next day. That’s true in anxiety and in life.
Abbe Greenberg: What’s really great about community is that people share their stories. community in and of itself is healing, and that’s why we would say, don’t go it alone, join us. And Mags and I are part of the community ourselves, they help us too. Because even though we’ve largely recovered, we still have our days. I mean, you know, anxiety is definitely a lifetime commitment for most people.
Gabe Howard: Let’s talk about the role of medication in anxiety treatment. How do you feel about that?
Maggie Sarachek: We feel that people should do whatever works for them, and we feel really strongly about that, that there shouldn’t be any shame in taking medication. Some people need medication. Some people need medication for a period of time until they learn some of the skills and techniques. And some people need medication for the long haul. And just like any other kind of medical issue, we feel taking medication is completely appropriate. That being said, we know that there’s a lot of questions you need to ask before you start medication, and we know that there are side effects. You know, we call them front and center effects instead of side effects because some of them are pretty big. But we definitely think medication is extremely helpful. And this is particularly if you’re at the place, which both of us were, where anxiety is making your decisions for you. Anxiety is making your decisions and running your life. You’re starting not to do things or see people or have experiences because of your anxiety.
Abbe Greenberg: And particularly for people with severe anxiety, like if you’re having a panic attack every day, it’s awfully hard to go to work. It’s awfully hard to pick up your kids from baseball practice. It’s hard to do anything as you know, right? It’s debilitating. We say that if you’re suffering from a severe form of anxiety like that or obsessive compulsive disorder where you know you can’t get out of your house because you have all these rituals that you have to perform or a phobia where you are so frightened of, let’s say thunder that if there’s a thunderstorm in the forecast, you can’t leave your home. I mean, these are realities for so many of us, and sometimes for those folks, medication is a lifesaver. Even though there may be side effects, it’s a choice you make. You know, do I want to make the decisions in my own life? Do I want to be in charge? Or do I want to let the anxiety make the decisions for me? So we’re big fans of agency. We always say we’re not pro Big Pharma, we’re anti suffering from anxiety.
Gabe Howard: Let’s segue a little and talk about how you became the Anxiety Sisters. As we mentioned at the top of the show, you’re long-time anxiety sufferers. But that alone doesn’t automatically make you sisters. What’s your back story?
Abbe Greenberg: The truth is, we’ve always been anxiety sisters, I mean, both Mags and I have been suffering from anxiety since we were little kids. We didn’t know that it was anxiety when we were kids, we figured for Mags it was really severe stomach problems. For me, I had all these obsessions and compulsions, and I didn’t know how to articulate that to my parents or what it meant. So, you know, we’ve always been walking the walk. In fact, we hold the patent on anxiety, but our journey together began in college in the 80s. We met at University of Pennsylvania and became fast friends because we both suffered from debilitating anxiety, and that was a real source of comfort to have each other to talk to about it, particularly back then. There was a lot of stigma around mental health issues even more than now. And so it was nice to have a confidante where you could talk to that person and share stories. So that was sort of the origination of the Anxiety Sisters was just the two of us helping each other daily through our anxiety disorders. And then we became formal anxiety sisters in 2010 on a bus from New Jersey to Manhattan. We were just chatting rather loudly, I guess, about the side effects of the medications we were on. And the woman in the seat in front of us turned around and said, I couldn’t help overhearing you, but I’m on that same medication and I have that same side effect. What do you do about it? And honestly, within 15 minutes, the entire bus of strangers was now talking about antidepressants and side effects.
Abbe Greenberg: And when we got off the bus in New York, Mags turned to me and said, Can you believe how willing people were to talk to total strangers about something so personal? And I said, Yes, I can believe it because anxiety is so isolating and so lonely and people don’t want to do it alone. They want to know they’re not alone. And I said, you know, we should make some kind of a community. And she turned around and said, We’re anxiety sisters, and that’s where it started. I was a professor of communication. Mags was a social worker, and so we had had this background of educating and counseling and advocating and research and all that. And so we were able to use those skills to build a community where thousands and now hundreds of thousands of women and men, too. Thirty percent of our anxiety sisterhood are men actually, where people could really share their stories and get together and realize they’re not alone.
Gabe Howard: I think that’s incredible, and your community has grown to over 200,000 people. In that group of 200,000 people, what are the common questions that people are asking you or asking each other?
Maggie Sarachek: I think one of the common questions that people always ask is that can this really be anxiety? Can anxiety really be doing this to me? I have these weird symptoms. Maybe I’ve never told anybody, or maybe I’ve only told my husband or I only told my partner or my wife about this. But you know, can anxiety mean that I can’t swallow my food? Can anxiety mean, you know, whatever the question is, people are very shocked that the symptom they’re having, other people are having. So I think that’s something very, very common in our community. Many people don’t realize that the phobias that they have, very common one as a phobia of driving or driving on freeways, that those phobias are something that a whole lot of other people are dealing with, or they don’t realize that they’re having kinds of thoughts, continual kinds of thoughts and worry that lots of other people have too or they’re having panic attacks and waking up in the middle of the night. So it’s the most common thing is like, is this constant, Oh my God, I could cry because I thought this was me alone. I thought I was going crazy, or this was my problem alone.
Abbe Greenberg: And there’s so many people in our community who write to us and say, I never talked about this with anybody and you guys talk about it like it’s nothing. You make it so comfortable for us. And that’s what we’re trying to do. We want you to feel OK if you have anxiety. Anxious is humans and anxiety is manageable. We can learn to live well, even if you have anxiety. And that’s what our new mission in life has been since we left our full time careers and became full time anxiety sisters. We really want to help everyone all over the world understand that you’re not alone, that your experiences are very common, much more than you’d even think, and that you can learn to be the decision maker in your own life. If you have anxiety when you wake up in the morning, you, I mean, this is what I say to myself every day. If I wake up and anxiety is with me, I say, All right, you’re here, fine, but you’re not driving.
Gabe Howard: If somebody is newly diagnosed with anxiety, I mean, they’ve just found out, we’re talking practically day one. What is one piece of advice that you would want them to have?
Abbe Greenberg: I would give them hope. I would start by saying, I know this feels terrible right now, but you can feel better because where Mags and I started. We both experienced moments or times of agoraphobia where we couldn’t leave our homes because of how debilitated we were by anxiety. And now we’re out and about everywhere, and Mags had a severe phobia of driving. Now she drives for fun. She takes long highway trips just for the heck of it. So what we would say to people is no matter where you are in your anxiety journey, it can get better. That would be the first thing I would say. What about you, Mags? What would you say?
Maggie Sarachek: I think that’s it, I think giving them a sense of hope is the first thing because it can feel very hopeless. I always say that I remember a time in my life where I felt like, I lived in Manhattan in a high rise where you know, you’d often like order in lunch or dinner. And I used to think I probably will never be able to leave my apartment very much. I probably am going to live most of my life in this apartment, having to call in for some of the things that I want or need. That’s where I was with my anxiety. And now it is very rare that I’m in a situation where my anxiety would make a decision for me rather than me making a decision. So it’s a journey, but it is a hopeful journey.
Gabe Howard: Thank you so much for being here, where can folks find you so that they can join your active community? Listen to your podcast? And of course, what is next for the Anxiety Sisters?
Abbe Greenberg: You can find us on our web site at AnxietySisters.com. You can find our podcast, which is called The Spin Cycle with the Anxiety Sisters on Spotify, Amazon, Apple Music, Audible. Anywhere you get your podcast, SoundCloud. You can join our free community on Facebook or on our website. You can subscribe to the community and also you can write to us at firstname.lastname@example.org. Or you can direct message us on Facebook or on Instagram. And I promise you will get an answer. It might take two days, but we will definitely get back to you. We have never not answered anyone, so don’t be afraid to if you have a question, you don’t want to ask anybody, you’re feeling a little shy. That’s totally fine. We would love to help. And our book, “The Anxiety Sisters Survival Guide,” you can find that anywhere you can buy books.
Maggie Sarachek: We’re published by TarcherPerigee. Just go into your bookstore or go on Amazon and you will find us.
Gabe Howard: It’s always on Amazon, every book is on Amazon, what’s your website?
Abbe Greenberg: Www.AnxietySisters.com, and you can order the book directly from the website as well and listen to all the podcasts directly from the website. And one more thing we wanted to share with you about our website is that on the home page, there’s a panic button. It’s a little pink button that says Help! I’m Having A Panic Attack. If you push that button, you will hear a recording of me getting you through the panic attack, helping you ride that wave. It’s free. We’ll never know that you pushed it, but we know that there are about 1,400 people that push it a week, so you would not be alone.
Gabe Howard: Thank you both so much for being here, it’s really appreciated.
Abbe Greenberg: Thank you so much for having us, Gabe.
Maggie Sarachek: Yes, it’s wonderful to talk to you. Thank you.
Gabe Howard: Or you are very, very welcome, it was a pleasure. To all of our listeners, thank you so much for tuning in. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” as well as a nationally recognized public speaker who is available to speak at your next event. You can grab my book, of course, on Amazon, or you can grab a signed copy with free swag and learn more about me just by visiting gabehoward.com. Wherever you downloaded this podcast, please follow or subscribe to the show. It’s absolutely free. Also, take a moment and review the show, use your words and tell other people why they should be tuning in. I will see everybody next Thursday here on Inside Mental Health.
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