How Reframing Anxiety Can Help Calm a Hyper-Reactive Brain

MAPS Webinar Introduction 0:00

So when someone has OCD, they're just doing that at a time they don't need to do it. And so that's the discussion I have with kids, if they are old enough, and it helps them understand and I will tell them, your brain's not broken. The fact that you check things and check and things will benefit you as an adult, it's a superpower. But right now, you're doing it when you don´t have to. So that´s the thing, even people have anxiety or a panic attack, that is a normal stress reaction, just having it, when they do not need it Hi, welcome to the MAPS webinar series, Healing Tomorrow's Future.

We are thrilled to be bringing you this series packed with valuable information and education within our community. My name is Honey Rinusella and I'm the Executive Director of MAPPS, the Medical Academy of Pediatrics and Special Needs. Within these webinars, we're able to empower clinicians on the knowledge and tools to support patients facing a variety of health challenges. For more information on MAPS or to register for a conference, please visit us at www.medmaps.org. Thanks for joining us on this journey towards a brighter, healthier future.

Hi, I'm Dr. Nancy O'Hara, and we are here at the Medical Academy of Pediatrics and Special Needs, Healing Tomorrow's Future.

Anxiety as a Toxicant 1:24

And I am really honored to talk to Dr Scott Antoine. Scott and I always joke we're brother and sister from another mother, because when it comes to PANS, PANDAS, anxiety, OCD, we really see things in much the same way. and Scott just gave an excellent talk on anxiety as a toxicant. And Scott, welcome. Thank you. And tell us a little bit about what that is. So I was originally trained in emergency medicine, did emergency-medicine residency, and did quite a bit of toxicology in that and then my subsequent years in the ER.

I stress the patient population, obviously, that we see. We have a lot of anxiety. As we were preparing for this conference, they said that the topic would be toxicolgy and we've seen so many great lectures on toxicants and toxins. And I thought, you know, stress and anxiety are a little bit like a toxin in a way. Now, interestingly, there's a good element to stress, so things like exercise and things you might do to increase your capabilities, learning a language, things that. Those are good stresses.

Word games, I think, those things are like that, but then, of course, the everyday stressors, both acute stressers and chronic stressor, and they can produce anxiety in people. And so I really started looking at it and thought there are some parallels here. When people have anxiety and have stress, we have to find a way to take it away from them just in the same way we would remove a toxin in their ER. And we look for ways to prevent them from getting exposed again to that stress. Put things in place to help people to deal with it.

So that's kind of where I developed the talk. Yeah, and you really talked a lot about reframing. You're not necessarily trying to get rid of anxiety, but refraining how they feel about it. That's right. I think the way that you describe the world to yourself is the lens with which you see things.

Reframing Stress and Meaning 3:18

People can undergo the same exact event and see things entirely differently. That happens when police officers try and get a report from a crime. People are in the spot looking at the thing and seeing different things. And when things have meaning, you decide and frame for yourself what a particular thing means. In other words, is it a hardship or is that a challenge? I might say to people is you have challenges and so the concept of disability versus challenge. So it's a reframing in the brain.

I think one of the classic examples, I had a patient who had COVID in 2021 and she was a 60 year old woman, had very, very hard time breathing afterward even. And she had to take a flight and back then you were still wearing masks on flights. And so they wouldn't let her on the flight without a mask and she was petrified. So she had taken for like a year driving to California from Indiana and back, which was taking her days. And she came for some help and I sat down with her. What I actually had her do was she has no respiratory issue.

It was just sort of an anxiety she's had. So I had her sit in a chair at home, started in the office, but I let her take the mask she was going to wear on the plane, hold it in her hand, and I have her close her eyes and hold her breath and envision that she is in car that was in water and sinking. And she could not breathe. I held her breathe as long as she can. Then when she just couldn't hold anymore, I open her eye, take her mask up, put it on her mouth and pretend it was a scuba valve, a regulator.

And then she would breathe through that and of course she's a little short of breath and then it gets easier and just envision that. And she did that practice multiple times, ultimately got on the plane, didn't have a problem at all. So it was the same thing that happened. There was no magic to it. It was just reframing that with her and helping her understand and see the mask in a different way rather than a pillow smothering her as a lifesaver. Right. And it's so simple. I mean, we're not giving a medication, an SSRI, antihistamine or an anti-anxiety to make her be able to wear the mask.

We're really helping her to be to do that task that she's afraid of. The other thing that you talked about was, and I thought this was an incredible story, the young woman who, as an eight-year-old, got bullied by her friends. Tell that story a little bit because I think it's so fascinating. Oh, so eighth grade. Yes, eighth-grade. Eighth grade, okay. The beginning was eight years old. It was the story of my wife. Got it. Love her to death. So it was a girl that was in eighth grad, had two good friends and other girls, they stopped talking to her for some reason.

And she Just a disagreement ensued but she ended up being just paralyzed could not have relationships with people didn't trust anyone and it affected her socialization into adulthood so as she was telling me the story I was asking her about all different parts of her life and she told me a story about being

Trauma, OCD, and Pattern Interrupts 5:57

in college well after that had happened and having a boyfriend who stalked her and Then came to her house one night choked her And took a knife and cut her she Ended up with stitches all across the top of our head and just said that matter-of-factly And I thought, oh my gosh, we're sitting here talking about something that happened 20 years ago in eighth grade and you had this big thing. And so my point when I was telling that story was that many times people's brain decides for them what's an important trauma.

Sometimes people will apologize to me. They'll say, Oh, this thing happened in eight grade. I know it's not a big deal and I don't know why I make such a deal about it. It has nothing to do with anything. you don't have to qualify or have some super trauma or assault to qualified for having anxiety about something. And so for her, it was this situation. I said, I'm so glad you processed that later trauma in a way that allowed you not to let it impact your life. Right. It really is, as clinicians about listening to the family, you know, if you go and say, well, that's the big trauma and that is what you have handle.

No, for her, it was the eighth grade girls that still sat with her and caused that internal stress that it's just incredible the way the mind works. And I also have loved the ways you've used neurolinguistic training and reframing things like OCD, you know, your hand washing analogy. Talk about that a little bit. Sure. So children will come to my office and sometimes I haven't met them beforehand. They'll come for to get labs drawn and things and I'll meet them for the first time and say, you know, hey, hi, how are you?

What are here for? And the child will say you want me to stop washing my hands. And I say I don't give up whether you wash your hands or not. It doesn't matter to me. pattern default mode interrupt and so that pattern interrupt just leaves them kind of vulnerable and stunned for a moment and then I can come in and I Can say to them I'm here to show you that washing your hands a thousand times a day or washing Your hands three times. A day is equally safe or equally unsafe but equally And so, once I demonstrate that to you, because you already know that's true, you'll be able to actually choose and decide whether you want to do it a thousand times or three times a day.

Now, neither is right, nor is wrong. You're not a stronger person if you only wash your hands three time. It ends up being, if they're both the same, you actually get to make a choice. So neither is right or wrong. There's no morality to having OCD or doing rituals. It's just demonstrating to people the two things that they thought one of them wasn't safe actually is. And once you do that, they actually got to a make choice, so there's the freedom, enters the conversation. And I think that's so powerful for parents, too, because so much of the time, parents are just trying to change the behavior or get rid of behavior, or punish the behaviour.

And you're reframing it for the child, but the parents right there, and you are also helping them to see, you know, that this is a different way to look at it. I always call it not feeding the beast of a disease, right? But it really helps them see it differently, I had OCD when I was about 16, and what I can tell you is when you have OCT, you know all the things you're doing don't make sense. You know that the thoughts you are having don´t make since. These kids are acutely aware at a very young age that their mind is not thinking correctly about it, but they feel so compelled to do it that they do.

And it's like any other superstition we might have about things. I tell people if you want to understand O.C.D. it´s sort of like if were driving in your car and if your person hopefully who wears their seatbelt all time if you're ever driving and you realize you haven't put your seatbelt on, a little panic ensues and your trying to get it buckled as if your gonna die instantly because the seatbelts not on. That's an all the time feeling for people with OCD. So you can understand, and even if I were sitting in the car with someone and saying, slow down, nothing's gonna happen, just put you seat belt on and it's fine.

People are still gonna be kind of frantically and so that dynamic of OECD, so one of the things I'll tell the kids is, doing things in a ritualized manner is valuable. Pilots do it, they do a checklist before they take off. Doctors do it?

Antidotes for Anxiety and Mindfulness 10:21

Right, we follow, right? We have charts for pediatric resuscitation when children come in, and you would measure them and quickly have doses of medications. We do things because you can't make a mistake. And so that behavior is normal. So when someone has OCD, they're just doing that at a time they don't need to do. and it helps them understand and I will tell them, your brain's not broken. And the fact that you are check things and check and things will benefit you as an adult, it's a superpower.

But right now you're just doing it when you don't have to do it. So that's the thing, even people have anxiety or a panic attack. That's normal stress reaction, you just having it, when don' need to. Right, right. You also talked about antidotes for anxiety. I think you already talking about some of them. Talk about that a little bit more. So in toxicology, when we have someone come in, you know, we want to separate them from the poison. We want give people support and help them out of that. But there's also times where we administrate an antidote, which is to directly counter the effects of a particular poison, and so when think about that with stress or anxiety, talking about fight or flight, things like that, well, We talked about some of those things, reframing.

But I talked about specific things you might think of, like an antidote, something you take, so different supplements. Lemon balm, which I've heard you talk about many times. Valerian root, I heard about you many time. Magnesium, different essential oils can help with anxiety, kind of calm the nervous system down. Of course, we talked reframing, but also hypnosis, neuro-linguistic programming, some of those other things that can really bring that I also talked about mindfulness and so people hear that they kind of think about meditation.

It's different So meditation is I'm gonna empty my mind mindfulness is being present in the current moment So I will talk to people about a great calming exercise with the child might be taking them on a walk and saying okay Let's find three things that are red that you see right now and having them look that being president or picking up a peach and saying to the child, okay, tell me what colors you see. They might describe yellows and reds, and pinks. And then what does it feel like? Well, it's furry.

Is it hot or is it cold? Was it in the fridge? And let's take a knife, if safe to do so, cut it. What do you think it is going to feel to cut through it? Will it be like a lemon? It's kind of bumpy? Or will it feels smooth? Then when you open it up, oh, its a little slippery. But that presence, that mindfulness practice, you can also use prayer and you could use meditation, other things. We also used vagus nerve stimulation in our office, both an external vagust nerve stimulator, and we also us vaguss nerve techniques, things that you think about humming, singing, gargling, cold plunges, breathing.

Breathing exercises. Excellent. Yeah. And it's funny, when I was going through infertility 35 years ago, we were doing that mindfulness with a grape. I will never eat a great the same way, you know, feeling that grape in your mouth, taking that bite, seeing the insides. You know, it's just that sort of being present. And I think it is so important for our patients, but it also is important to us as practitioners. Being present with the person in front of us, that we're not distracted by the noises, by everything else.

That works for parents. Two, being present with where your child is at that moment and those expectations that we may have of our kids, maybe letting that go a little bit too. Oh, absolutely. John Lennon said, life is what happens when you're busy making other plans. And so that concept of expectations, but finding the beauty in today, in this moment right now, and not missing it, thinking about what's next. Another musician, Dave Matthews says, you know, always thinking the best is next to come.

So that Yes, being present in the present. And one of the things that's interesting, you say that about parental expectations, and I will tell parents, is it's so easy when a child has pans or pandas for a parent to project. We did the same thing. You think, boy, I thought my child would do this, this this. Get married, have children, do that. Have this kind of life. Then suddenly the parent will get caught in this so they're going to be homeless or be in prison or something. I'll tell the parents we don't project because there's no reality and that just throws gas on the fire.

Right. I mean, for myself, you know, we had gone through pans and pandas. Everything was better. My son was in college. We were in a hotel room. And he was telling me, Mom, I'm just not right.

Fight-or-Flight and Calming Techniques 14:45

Something's not, right? And I am going straight to that panic mode. OK, is it mold? Is it tick-borne disease? is a strap? Whatever. Four days, sleepless nights, thinking about all the things I may need to do. At the end of it, he says to me. Mom. You know it's about a girl. And that was that moment where I realized my internal stress, whether I call it PTSD or whatever, was still causing that layer of poison to our relationship and to me. And I needed to go back and do work myself because we as parents hold on to that.

We do and I tell parents that is that for sure PTSD is the perfect term because we see that all the time in parents. I mean I know in my own self when it rains I go down to the basement make sure nothing's leaking, make there's no mold when if my daughter happens to say something to me sometimes I wonder if that was OCD but that's my stuff. And I do have to deal with that and I think part of that for parents is what I teach people about anxiety in general, which is the concept of determining you really should only have fight or flight when you're in danger.

And danger as your autonomic nervous system's design is really I'm about to die right now. Like some grizzly bears about the pounce on me or an attackers wielding a knife at me. Anything other than that really shouldn't mount that fight-or-flight. So one of the things I can teach my patients to do and do personally is I will say, as soon as I start having that feeling about anything, I'll say okay, am I in danger? Meaning, Am I going to die right in the spot? If the answer is yes, then have your fight or flight, protect yourself.

But if the answers no, which it will be for the rest of your life, unless grizzly bear gets you, but the answer will no. I say I am safe. Always try and say it out loud, not very loud. But I say it under my breath, I'm safe. Now I've been doing this long enough that when I said that, the sympathetic nervous system will shut down. I'll enter a vagus nerve state and I am home. But when people first start doing it, if you're a trained anxiety athlete like I was, it doesn't happen. You're still having the feeling because your subconscious really quickly gets you into that and starts secreting chemicals.

And so what I'll have people do in the office with me is I will have them sit down, I illicit an anxiety state. I always tell them I'm going to do it ahead of time. But then what i'll do is, okay, describe this feeling. Is it more hot or cold? People usually say hot. What color does it feel like, that feeling that you're having now? And I wait until I get them anxious and you can see people's face change, their posture changes, they get pale. Sometimes they shake a little bit and they'll always say, well, why did that happen to me?

You just made up a story. Why did I get so anxious? Because I'll pick something. I will say to them, what are you really anxious about? And I say okay, imagine this were real. And the reason this happened is because your subconscious is so far in front of your conscious mind. Of course, I made it up. But your sub-conscious mind is continually saying the classic OCD thought, which is but what if. What if that's true? I better react in case that thing is true. And then I'll say to the people, OK, well, if it feels hot to you, we're just going to try some things.

I try not to lead in such a way in saying, you're going do this. That's why when I do hypnosis, I'm typically not saying you will now feel X, Y, and Z. You may notice that your leg feels a little heavy, or you may not that it's feels lighter than normal. And people will then search within themselves rather than saying now you feel sleepy. If they don't, then they think you are full of crap. or they feel that they're not worth it. They're doing it right. Right. I'm not doing right, and so I'll say to them, you may notice a certain sensation and it may be like this or like that.

And it's called a hypnotic double bind and they'll usually pick one. But as we sit there, I say, OK, well, if it is hot, let's imagine you're outside cutting the grass. It's super hot and you are cutting grass, all sweaty. You notice in the yard next to wherever you cut the There is a swimming pool and you walk over, you kick off your grassy shoes and your step in and then you notice the water come up to your ankles. Then you take another step down and set your knees. It's at your hips. And you kind of glide forward like we all do when we're in a pool.

Fill the, water cup around your neck. and Then I'll say, okay, what color is it? They'll usually say red or whatever. And I'll say, okay, let's, instead of it being red, try, just try this with me. Rather than it, being read, Try and make it blue. Think of a blue that you saw, like a summer sky. Maybe it was when you're in 10th grade and you got out of high school and. You saw the way the sky looked as you were walking across the parking lot, knowing that. Had the whole summer ahead of you. Remember that blue sky, not a cloud in the.

Pick that color blue, Just make the feeling that colored blue we're not going to chase the filling away. Cause that fight or flight is protective of us. Good feeling. It's not something to get rid of. And then I'll say, okay, does it move people? Usually with anxiety, we'll see it moves. A lot of times they'll stay it rotates clockwise, counterclockwise. People that get nauseous when they have anxiety will say it does this, flips. And so what I say to them is, OK, well, just go the opposite direction if it rotate some way, or if people say its crushing, I feel like pressure.

I will say, okay, let's imagine that you're laying in a pasture and there's something crushing on you.

Rehearsal, Humor, and Behavioral Practice 19:48

And you look up and it's a basket. Not only is it a basketball, but it is the basket from a hot air balloon. There are people standing in it. It's pushing you into the ground. Imagine reaching up, grabbing a rope, turning the heat on, and having that balloon, imagine what it would feel like to have that lift off of you, then you see that going up into that cloudless sky. As we go through that, I'll usually get to the end and say how does that feel now compared to previous? And they'll usually say that feels better.

I feel calmer. And the first thing I'll say to them is I never let you off the hook. Like I've never told you that anxious situation. When you started getting upset, I didn't say, oh no, no I'm just making it up. Relax, relax. Just let your have your reaction. You did it all yourself. you changed the characteristic. Now I picked blue. Maybe a better color for you would be green. Experiment with it at home. Notice how the feeling feels. Does it feel like sharp rock? Then make it into cotton candy.

It's your thing. So I'll tell people that two-step where they first say, all right, am I in danger? No, I'm safe. Then do a little check-in. Oh, it's still there. then take themself through a process. And a lot of times then after a period of time, weeks to a month, they'll get to point where say I am safe and the feeling shuts off. And that's where you see that the big four people that continually get in that cycle and that was instrumental for me in my own recovery from after our daughter was sick and had a lot of PTSD with her being sick.

And just anytime anything would happen, I would be instantly into that mode. But this is something not only we as adults can do, not just teenagers or tweens, but little kids. Little kids can really do this. And I see it in them, just that relief, that relaxation as they go through this exercise. With kids, I will do a lot of times I'll do rehearsals with children. It's always best if you can get dad involved or mom involved. And I'll tell them, okay, if you have a thing coming up, you know that your child freaks out when you say, it's time to get in the car to go X.

Then what you do is you rehearse and you said, Okay, we're not doing this right now. We're going to pretend we get into a car. And we are going pretend that we don't want to and we really have hard time and freak out about it. say, okay, we have to get in the car. I tell parents, throw yourself on the ground, kick and scream, and say I'm not going to go, I can't stand it, i'm scared,I don't want to. Then say okay iI'm going try something else. Oh,i really don''t want t o go in t he car, but okay I'll give it a try and then sit in th e car very calmly and so i'll tell them that's all say we're just rehearsing that then have dad do it then, have your child do i and take it through it and that sort of teaches the subconscious I have options.

It's not only that I off to freak out. I had this other option and a parent just talked to me when I finished my lecture and she said, this happens with my son and he can't stand to lose when he's in a competition, track competitions or at school or even board games at home. And I'll say, great, then practice. Then I said so he is having trouble at track. If he loses a track meet, he storms off and is by himself. Practice this rehearsal exercise, then tell them to do both. Make it a science experiment and tell him, okay, I want you to storm off and be moody the next time something bad happens in track.

Then the time it happens, try to be calm and say, oh, that's not what I wanted to happen, but you know, it's no danger. And then do that and then compare notes. And a lot of times when you tell people that and you almost give the child permission and say, okay, the next time this happens, do your freak out. Cause you know how to do that really well. And then the time that happens we will do the calm reaction and see which one feels better. Your parents are always a bit afraid and they're like, oh, I'm like no, no.

Trust me. They will pick the calmer one. It always feels. Better. You make it clear, you're not asking them to a happy dance. they still get to say I don't like what happened or I am disappointed. Right. but you're giving them a couple of different ways to respond. A lot of times what I'll do with adults, I do it with parents, with adult patients, even with other people in my life. If you get an unreasonable adult who says things to you, one of the great things you can say back to them is, come on, you are a better guy than that.

So there's a weird thing that that does when you hear someone say to you, you're a better guy than that. When you were acting like a fool, You have two choices. You either have to prove them wrong and say, no, I'm not and continue acting. Like that, but 99 times out of a hundred people say. Well, know I was just so mad. And you go, Oh, well, that was annoying. Oh, so annoying. But you've sort of reframed it for the person in that, you don't have to act this way because I know that you're a different type of person and because of that I'm making you aware of a capability you have of reacting this different way.

Yeah. And so many of the things you talked about are breaking those old patterns. Like, that is one where you are just breaking it in a way that your refraining it again. You broke it when you first started about, you know, saying the swear word, whatever, F this or whatever. That sort of breaks that pattern. And also humor. You talked a lot about using humor, which I think we forget about. We get so mired down in the terror of the OCD or the anxiety. Humor can really break it. When we do rehearsals, I tell people, especially if you have a dad that will lay on the ground and kick and scream when they're doing a rehearsal, kids find that hysterical.

And so I had one girl who was petrified of getting on elevators. In fact, she told her mother, I can't go in a building if there's an elevator in the building, which made it very challenging. They lived in Chicago. And so what I had the mom do was I said, see if you can get her to agree to just step in building and out, and she each time got a little bit closer to the elevator. I made very clear to girl who was in her teens, I don't want you going in an elevator until you ask to go on the elevators.

Nobody's gonna push you on an elevator. And you know what? If you don't ever go on another elevator for the rest of your life, who cares? It doesn't matter. Yeah, doesn' matter There's no right or wrong. It's nearly a morally superior person to go out on elevator Who cares and so what I had her mom do was I at her Mom tell her a story and walk over when

Finding Hope and Resources 25:42

she got close enough to see the elevator I said to her mother. Here's what you're gonna say to you. You're going to say hey if someday you ever want to Go the Elevator with me. Can you imagine if you are on the elevator? And it went down really quickly and I fell right on my bottom. And I told her mother, say it exactly that way. So the mother did this and the girl of course died laughing. Thought that was the funniest thing ever. Then every so often the mom would take her back to the building and she would say, there's the elevator, I feel like I'm going to fall on bottom!

And she kept saying it until it got to the point where the mother would be somewhere else and would just look at her daughter and say, bottom. And her father would start laughing and got her to a point when she got on an elevator and now has no problem at all. So when you are laughing or you're in a good mood or your satisfied or content, it's really hard to have those chemicals in your brain that are making you anxious or angry. And so just by doing that funny thing, it somehow totally separates.

So I'll do that a lot with kids. I mean, if you say fart to a 10 year old boy, the whole room's laughing for half an hour. You can a of times use humor in that way. Absolutely. You know, in addition to all the wonderful things you taught us here at MAPS, the Medical Academy of Pediatrics and Special Needs, you are also one of the leading experts in PANS Pandas. Anxiety, OCD, ticks, all that. You've written an incredible book, A Comprehensive Guide on Pans PandAs. Are there ways that if people want to find you, they can find Certainly, my website, and we have a ton of free information and blogs there for parents and adults even, called The Panda's Docs, ThePanda'sDocs.com.

Also, there's a link there to order my book. It's cheaper than Amazon on there. And I have parent course as well there, for people that, an online course, if they can't come in person to see me, which will help them with their child. You can also find us on both Instagram and Facebook at The Pandas Doc's. Our regular website is FullyFunctional.Com. That's how people can make an appointment to come and see us. Great group of people, not just you and your wife, but a really wonderful clinic and just information.

Get the book, go to the website, and Scott, any last words of wisdom or hope you want to give to your anxious or OCD or ticky kids or anybody? I think the message I kind of leave parents with is sometimes it's tough because online, even some well-meaning support groups will kind-of give parents this information that, well, your child has pandas, they're always having enough pandAs. Anytime they get the sniffles, their going to punch a hole in the drywall. And I tell parents, as I know you do, that's just not our experience, it is not what we see.

And so there's hope for healing for sure. And the other thing that I saw them and kind of the maybe central point of my message today was that when you see someone having the worst panic attack or the worse anxiety attack, or just are totally overwhelmed, that's a completely normal reaction. They're just having it the wrong time. So if a child has a severe, violent, even aggressive attack, I tell parents, that's completely normal if they're walking down the street and a van pulls up to abduct them.

That's what we want them to do. Use every swear word, kick them, bite them do what you can to protect yourself. But we don't want it at the dinner table. So when you see people having anxiety and reacting and having a moment, they're normal. They're just often at wrong time. Right. That reframing and describing to the child when the time is to have that and that it's okay to feel that way. We just want to move it a little bit. Yeah. It's much easier for people to understand. Yeah. Great advice, Scott, and really always enjoy talking to you.

We could talk to for hours more, but thank you for joining us at the Medical Academy of Pediatrics and Special Needs and healing tomorrow's future today. Thank you! Thanks!