did you take your stupid mental health walk for your stupid mental health?

a conversation with dr. ellen vora

One thing you need to know about me is that I have no chill.

Having a buttload of anxiety is something that I’ve been dealing with since I was very small. I was one of those babies that looked liked a miniature adult with extremely adult problems. Even when I would smile in family photos, my eyes would scream “are we sure we’re going to make our mortgage payment?” I’ve read all the books, listened to all the podcasts and watched all the talks about managing anxiety but one has stood out, partly because this is what the book launch looked like:

Dr Ellen Vora is clearly not your grand-mother’s psychiatrist.

Dr. Ellen Vora’s new book The Anatomy of Anxiety Understanding and Overcoming the Body's Fear Response, has a pithy thesis, what if it could be easy? What if managing your anxiety wasn’t about changing the way you think, but rather changing the way you think about anxiety? When I attended her book launch at the Museum of Ice Cream in New York City last week, Vora was in conversation with The New York Times’ Micheal Barbaro in a giant ball pit.

Liz Plank @feministabulous

Gonna tell my kids this is where @mikiebarb recorded every episode of the daily

I noticed that her advice was simple, almost frustratingly so. She gave tips like making sure you’ve eaten enough, sleeping more or being on your phone less. It’s the kind of flippant suggestions that a significant other gives you right after taking a bite of their bagel that makes you want to slap it right out of their hand.

But what if it didn’t have to be this hard?

Her response reminded me of the “taking a stupid mental health walk for my stupid mental health” Tik Tok trend where people take videos of themselves petulantly taking the brisk stroll that helps them manage their dysregulated states.

The hostility we have towards simple tricks that help us tackle complex problems is revealing. While we would happily welcome an easy fix for losing weight, when it comes to our mental health, we resist it. When I asked Vora why we are so frustrated by uncomplicated solutions, she said it could be due to the fact that it reinforces the myth that it’s all in our heads. If something as elementary as drinking water or moving my body relieves anxiety, was my anxiety ever really real to begin with? Vora and I also talked about how the nature of anxiety is to convince us that we are in grave danger, so when a trivial remedy is presented, the panicked brain is reluctant or even untrustworthy of it.

That’s why it’s crucial to craft a list of emotional band-aids when we’re not in a heightened state because the solutions we come up when our bodies are packed with cortisol and norepinephrine will be very different and probably less helpful. Vora was kind enough to answer some of my burning questions for our Airplane Mode community. I highly recommend that you snatch a copy of her book for yourself or a loved one that struggles with mental health, which at this point is most of us.

Liz Plank: Why do we need a paradigm shift about how to view anxiety? 

Dr. Ellen Vora: We’ve been taught to think of mental health from the neck up. But this overlooks the many potential root causes of mental health issues that are based in the physical body (e.g., inflammation, digestive issues, nutrient deficiencies, medication side effects, chronic sleep deprivation). In other words, anxiety is not all in your head--it’s largely based in the body, and it needs to be addressed at that level.

We’ve also over-indexed on the role that genetics play in mental health. When we think of mental illness as a genetically-determined chemical imbalance, this implies that our mental health issues are a genetic destiny. And this doesn’t leave much room for hope. While I don’t deny genetic predispositions for mental health issues, I find that it’s more empowering and hopeful to focus on what we can control. As we say in functional medicine: “genetics loads the gun, and the environment pulls the trigger.” Though there will always be structural factors and aspects of modern life that make it difficult to keep our bodies in balance and get our fundamental needs for community, safety, and purpose met, even slight adjustments to our diet, lifestyle and priorities can help nudge us toward a state of better well being. Anxiety doesn’t have to be our destiny, and there’s always reason for hope.

LP: What is the difference between real and false anxiety?

Dr. Ellen Vora: False* anxiety is avoidable anxiety, based in the physical body. By correcting states of physiologic imbalance, such as inflammation, sleep deprivation, a blood sugar crash, a magnesium or vitamin B12 deficiency, or a caffeine rush, we can head this anxiety off at the pass. 

True anxiety is purposeful anxiety. This is our true north, nudging us to slow down, pay attention, and notice that something's not right in our lives, our communities, or in the world at large.

False anxiety is the low-hanging fruit. Start by identifying the false anxieties at play in your life, address them, and reduce unnecessary suffering. This clears the way for you to hear the sometimes subtle messages of true anxiety.

*Note: the term “false” is not intended to invalidate the very real suffering caused by body-based anxiety. It simply speaks to the physical cause and the straightforward path out.

LP: How can anxiety become a superpower? That sounds stressful!

Dr. Ellen Vora: Just as we need even-keeled people (someone needs to fly the planes), we also need sensitive people who are viscerally connected to the suffering around them and to the ways our society has gotten off track. Rather than pathologizing sensitivity and telling people, “don’t be so sensitive,” we should be listening to what the sensitive folks have to say. Sensitive people are here in a prophetic capacity, and if we heed their warnings, it might just help our society find its way to a much-needed course correction. If you’re one of the sensitive folks, I encourage you to embrace your true anxiety as an inner compass.

It is also essential to let that compass guide you toward action. When we’re mired in anxiety and feeling stuck, this creates suffering. But true anxiety almost always has a call to action baked into it. It shows us where in our lives we can be of service, make a contribution, get back on track, or just show up for someone. If we can translate what our true anxiety is telling us into purposeful action, we no longer feel so anxious--that feeling of helplessness transmutes into a feeling of purpose.

LP: What are natural anxiety cures that ACTUALLY work?

Dr. Ellen Vora:

• Stabilize blood sugar

The modern diet of coffee drinks that are actually milkshakes and rosé-all-day puts us on a blood sugar roller coaster. When blood sugar crashes, it causes a stress response, which can feel identical to panic and anxiety. Keeping blood sugar stable can prevent unnecessary anxiety. The definitive solution is to eat a blood sugar-stabilizing diet (well-sourced protein, healthy fats, and starchy tubers in lieu of refined carbs and added sugar). If that feels like a sharp left turn from your go-to’s of oat milk matcha lattes for breakfast and nachos for dinner, a simple hack is to take a spoonful of almond butter a few times a day to give yourself a safety net of blood sugar to blunt any crash.

• Prioritize Sleep

While anxiety can contribute to insomnia, lack of good sleep also exacerbates anxiety. The most important step to improving sleep is to be strategic about light. Our circadian rhythm is cued by light and, in modern life, our brain gets all the wrong signals. We can approximate evolutionary conditions by seeing bright sunlight in the morning and avoiding artificial light after sunset. Short of homesteading off the grid, a great trick is to wear blue-blocking glasses from sunset ‘til bedtime.

And as a bonus tip, here’s one of the most liberating insights: if you wake up in the middle of the night, it’s probably “middle sleep,” which is a normal, physiologic awakening between two blocks of sleep. Do what you have to do (pee, sip some water), but resist the urge to look at your phone or the clock. It’s the light exposure and our thoughts about being awake in the middle of the night that suppress our melatonin and stir us into a stress response, making it hard to fall back asleep. Instead, lie back down, close your eyes, and trust that you'll fall back asleep in time.

• Reduce Caffeine and Alcohol

I know I don’t make any friends with this one, but we need to understand that, if we’re struggling with anxiety, caffeine and alcohol are probably not doing us any favors. Caffeine can contribute to insomnia and an exaggerated stress response; alcohol, while initially relaxing, causes the conversion of a relaxation neurotransmitters, called GABA, into an excitatory neurotransmitter, called glutamate, which disrupts our sleep architecture and can leave us feeling activated and on edge. Sometimes anxiety is just the after effects of your brain on caffeine and alcohol.

I recommend decreasing your caffeine consumption gradually by a few sips per day to see if lower amounts of caffeine translate to lower anxiety levels; and avoid consuming caffeine after noon to protect your sleep. Meanwhile, start to observe if your anxiety tracks with alcohol use. Make conscious, self-loving choices about when alcohol is truly worthwhile in your life.

• Cry More

We carry around mountains of unmetabolized stress. Our bodies know this, and they attempt to give us a release in the form of crying. And yet, many of us attempt to suppress our tears, apologizing to those around us for being a “burden” and feeling shame for letting ourselves loose control. It’s time to rebrand crying: it is a wise and healthy way to give our bodies a much-needed release from pent up emotions. So here’s the medicine: cry more often and more deeply. Rather than apologize and minimize, normalize and maximize—diving into a good ugly cry and letting it be complete.

• Stop the scroll

We are living in the attention economy. That is, our attention is the commodity that media companies are competing for. They know that if they present us with fear, uncertainty, doubt, or controversy, we’ll stay glued. We give them an increasingly large share of our attention, they get more clicks and ad revenue, but our mental health is the collateral damage.

To take back your peace of mind, make conscious choices as you navigate the information landscape, and try setting up your charger somewhere away from your bed, making your bed a phone-free sanctuary. This alone will prevent late-night doom scrolling and protect our ability to sleep deeply at night.

I hope these reflections on anxiety help you think about mental health a bit differently, and give you hope that you can find a path to feeling better.