112 - Dr. Melanie Badali-Offering Evidence-Based Support for People With Anxiety.mp3 - powered by Happy Scribe

Ruthless Compassion is a podcast about how you can turn your emotional shit into fertilizer for success and see your darkest moments as opportunities to transform into a powerful kindness warrior. If you enjoy this podcast, please leave a review wherever you listen. Welcome Dr. Melanie Badali to the Tuthless Compassion podcast.

Hello, I'm delighted to be here.

I'm very happy to have you on the show because you're talking about one of my favorite topics, which is anxiety. And I think we're going to have a really interesting and fruitful conversation, but always I like to ask my guests before we get started to introduce themselves and kind of give a little thumbnail about how they got to where they are today.

Well, I will make that a short version of the story rather than the long version. And where I am today professionally is I am a clinical psychologist. So psychology is the study of mind and behavior, and clinical psychologists take what we know about psychology and use that to help people in real life clients and patients. And so I have the privilege of doing really meaningful work, which usually entails helping people navigate some very difficult experiences in their lives, and also for people who have built their resilience and they don't have a lot of super stressful things going on their life in the moment. I help those people discover their purpose, figure out what their main strengths are, and use those to develop a more meaningful, rich, joyful life. So I kind of go the spectrum of human behavior and thinking and emotions in my day-to-day work with people.

And how did you choose this field?

I chose the field, and the field chose me. I'll give you a little bit more detail. I started out in university not really knowing what I wanted to be when I grew up, knowing that I loved learning and that I was very curious and always like to go in depth and different whatever area I chose. I really like to learn a lot about it. And psychology was one of the first courses I took, and it really grabbed me. And I had never even heard of psychology before, and if you had talked to me back then, in 1993, I was probably wearing a plaid shirt and whatever fashions were of the era. I don't even think I knew what anxiety was, even though I experienced a fair amount of worry and anxiety myself at the time. So, it was a really great subject for me to be able to learn more about the world around me and the people around me myself. And it grabbed me in a million little ways and some very big, profound ways right from the beginning.

So I guess once it grabbed you that you decided to make it a profession.

No, even then I didn't quite at the end, I was like, okay, well, I'm too sensitive to be a technical psychologist, and that's the type of psychology I would really want to do to a very practical type of person. I knew that I would want to work with people and I'm too sensitive. I'll be crying all the time. And maybe enter in that term compassion, that your podcast is named after, that idea of to suffer together. That's compassion. And then when I learned that, oh, wait, no, there's that second piece of compassion. The first piece is you notice somebody else is suffering, but the second piece is you try to help. Oh, wait, actually, this turns out to be a great job for me, because I get to do that second piece with people, of noticing and sitting with them in those dark times, but also helping them figure out where the cracks are to let the light in and moving towards that. So, yeah, even near the end, I was just like, oh, I'm just really interested in this. I still don't know what I want to do for a job. And then sort of grabbed me and kept me and I'm still here learning and loving it.

Yeah, I guess it's one of those fields that it's endless learning.

Yes.

I know that you do a lot of work with anxiety as well. What are the challenges in working in the field of anxiety?

So I love working in the field of anxiety. I think the biggest challenge I find is that there are not enough resources for people in terms of free, science based, publicly accessible resources. And so that's one of the reasons that I do quite a bit of volunteer work and service work in terms of being able to get, at the very least, the knowledge about anxiety, what it is, what are the best ways to help manage it and overcome it out to the people. And I think one formative experience that I had myself was in my twenties. I was going through a lot of stuff in my personal life and I was in grad school already, so I knew what anxiety was by that point, thankfully. And I had my first panic attack, and I knew it was a panic attack, and thank goodness, because if I hadn't, it would have been an even scarier experience. I might have ended up in the ER, as many people with panic attacks do, because they think they're having a heart attack. They think they're going crazy. They think they're going to lose control. And we know from panic attacks that that's very unlikely.

It's your body's way of setting off your fight, flight or freeze response automatically. It's a very useful response if you need to jump out of the way of a speeding car or fight a bear or something like that. But it's not great when a loved one is in the hospital or something like that. So it was kind of in that moment where I was very grateful for the knowledge I had. Because what could have led from a panic attack to something like panic disorder. Which starts to seep in and make you afraid of going certain places or doing certain things because of the panic. I was able to sort of wrap my head around it in a different way and I thought. I want everybody to be able to do this. And so that's why I'm a volunteer for Anxiety Canada, to help get information out there to people who need it, when they need it. That's my little contribution there in addition to the work I do in my private practice.

I have two questions that came out of that. One is, why do you think there are so few resources for anxiety, given that it's the number one mental health condition that people suffer from? And number two is, I'd love to hear more about Anxiety Canada. So maybe you could start with question number one.

Just a small question. I think it boils down to money. And I think there is always competition for healthcare dollars and mental health is underfunded across the globe. And I think we're starting to see more attention paid because mental health concerns are really getting in the way of people's functioning. And we're starting to see good economic cases being made. For every one dollars you invest in mental health care, you might get one dollars and $0.06 back. Now, it's not like you're going to be making a lot of money, but you could be helping a lot of people without spending a lot of money. Because if you have a course, say, for panic disorder and that costs a certain amount of money, you could save that money in, ER visits, say. And so I think we're going to see, hopefully, this is my hopeful part, more healthcare dollars directed towards mental health care without it dragging the whole system down, because I think it pays off in the end. So I think that's one thing. I think the other thing is for anxiety, because it's such a universal experience and most of us experience anxiety at some point.

It's completely normal and it can even be helpful that it's hard to figure out when it's a problem. And so, for many years, I think we had a lot of people who are sort of suffering in silence and now that there's less stigma, more people are coming forward, but there's just still not the resources available for them. So I think those are the two big driving factors and hopefully we will change that.

Well, I think Covid has really underscored the need for mental health services across the board. So maybe that's the silver lining of the cloud that is Covid.

Let's hope so. And there was a recent World Health Organization press release in March 2022 and the incidence of anxiety and depression increased by 25% worldwide according to their surveys. And other surveys that you look at, you see the levels of anxiety sort of rose and fell to a certain extent, depending on what was going on at that point in the pandemic. So that's just one number. But if there was any cracks in the mental health care system, they have been exposed and they have been blown open. So hopefully we will do a better job of getting services to the people that need them in the future.

And tell me more about Anxiety Canada, this organization. How did it come about and who is volunteering for them?

Well, there's tons of people volunteering for them and some amazing people working for them. Anxiety Canada is a nonprofit organization. It's been around for about 20 years and grew out of two amazing psychologists desires to bring more information and services to more people. So Dr. Maureen Wittle and Dr. Peter McClain were working at UVC Hospital here in Vancouver and in the anxiety disorders unit. And there were always wait lists and they had these treatments that help people. So anxiety disorders are one area where there are set programs that can be delivered in a sort of feasible, cost effective manners that really do make a big difference in terms of overall levels of anxiety and quality of life. And they felt, I think, what I felt and one of the reasons I was drawn to volunteer for this particular organization, that we could do better. And so it really grew off the side of their desks and their volunteer time and more volunteer time. And if you ever had the pleasure of meeting any of them. Unfortunately Peter has passed, but Maureen is still there and she draws people in. And there is a huge team of psychologists and other people who specialize in the study and assessment and treatment of anxiety.

We're on the scientific advisory committee who are contributing lots and lots in terms of volunteer materials and time. And then there's an amazing staff led by the CEO, has enough knowledge at this point to be Doctor Judith Law, who consistently punches above her weight for the organization. And it's www.anxietycanada.com, you can go and there's science based information and programs to help people with anxiety. So lots of resources available that you can go. And if you have an Internet connection, you can go and get for free right now.

Which is so good to know because I certainly speak to a lot of people who are living on the East Coast who have absolutely no access to mental health care. And the waiting list is two years to see a psychiatrist and meanwhile they're just suffering. So if there are resources available that they could access immediately, that would be a great relief for them, I think.

The organization started out as Anxiety BC, Anxiety British Columbia and has since grown to Anxiety Canada. And we recently were able to get funding to translate the website and the app into French to make it more accessible. And yes, as you mentioned, the wait times for public health are very long and realistically an app and a website is not going to make a dent in some people's mental health, but for other people, it absolutely can and will. So it's exciting to be able to get the word out for sure.

So you started out talking about your own experiences with anxiety. And I'm just wondering, here you are, you're both a patient and a practitioner. Do you think there's an advantage to actually having had these experiences personally? Or, like so many people say, well, you don't need to have the disorder in order to treat the disorder? What's your take on it from your own perspective?

Good question. So, one, I don't have the answer to that. I really do value lived experience and the wisdom and knowledge that comes from that. But I don't believe that you need to have every experience to be able to be an effective healthcare provider. I think that the way I treat it in my private practice. I say you're the expert on you, and you know best what your values are, what's important to you, things you've tried that have worked, things you've tried that haven't worked, and you're the expert on you. And I bring to the table a whole toolbox of information that can help with certain types of problems, such as anxiety. And I know how to use the tools and help you learn how to use the tools, and then you can go away with the toolbox and use them on your own. That's kind of the way I balance that. I do think it gives me an added layer of insight in some areas. I think it also gives me an added layer to manage. Right in the beginning of the pandemic when the lines were blurry. I'm trying to figure out what is an overestimation of threat and danger becomes more difficult.

And with anxiety, one of the things you're always trying to figure out is, is this an overestimation of threat and danger, or is there some component of underestimating your ability to cope with that? What is the seriousness of that threat or danger? And you have to kind of play around with those ideas to figure out what is truth and also what is helpful and what is going to allow you to balance risk and good quality of life.

I like that way of conceptualizing it, the overestimation of risk and danger and the underestimating of your own capacity to cope. I think that's a really good way for people to look at anxiety.

Yeah, and I didn't make that up. I think it has its roots in Aaron Beck's work, the originator of Cognitive Behavior Therapy, one of the types of therapy that works really well for anxiety. And this idea of this anxiety equation, for some types of anxiety disorders, it really is so much that overestimation of threat, but then for other ones, it's being able to address that kind of other part of the equation, the underestimation of their ability to cope for the underestimation of the resources is really key. I really like to go in on both levels.

That's a neat way of looking at it. Yeah. I was just thinking as we were talking about my own experience as a therapist for many years, dealing with people who had anxiety. Certainly most of my patients have had anxiety along with many other diagnoses and many other kinds of conditions. And so there have been some associations that I've noticed that I wanted to sort of run by you. One of the things I've noticed is that I've had some patients who had anger issues, unexpressed anger, and they had a lot of anxiety. Do you see any association on your own part between repressed anger and anxiety?

It for sure can walk through the door. One of the things about specializing in anxiety is you also get to learn about everything because all sorts of things walk in with anxiety as their buddy. Again, I mentioned earlier that very kind of primal fight, flight, freeze response. And one way of thinking about it is if we can fight and win, we might do that. If we don't think we have a chance of winning the fight, we might flee, we might run and if we don't think we can get away and we don't think we can win, we might freeze. The anger piece that is not tied to any effective action does pop up a lot because it's quite common for people with anxiety to be really nice, to be super duper nice. And that generally is a wonderful quality and I really have the nicest clients on the planet. But nice isn't always good. And you may have heard the saying clear is kind. You can be kind but also speak your mind. And working on some of those situations to figure out, are you not addressing the issue that's leading to the anger because you're afraid?

And that fear is actually rooted in anxiety. There's an overestimation of threat or underestimation of your capabilities and you actually could take that on or are you afraid because there is real danger there and if you speak up you're going to get hurt, right? And depending on what the context is, it could be either. And this is one of the things I'm sure you encountered in your work, is that there's what's going on for individuals, but there's also the social context and the environment. And these two can lead to all sorts of pearings of emotions such as anxiety and anger and also lead to all sorts of behaviors that make sense and are effective to go along with those emotions and ones that are not so helpful.

For sure. It reminds me of encountering some patients early on in my practice and a couple of women who had a tremendous amount of rage from childhood trauma. And their rage was so overwhelming that they were terrified that they would do something with the rage. They would hurt somebody, they would offend somebody, they would act out in some destructive way. And so they became anxious because of how much rage they were carrying. So the anxiety was actually about the rage as opposed to the anxiety coming out in a different way. You know what I mean? They were anxious about how much rage they had.

The second arrow, that second layer and depending on the person, you might want to start with the anxiety. You might want to start with the anger. The thing that I like about cognitive behavior therapy techniques. And I'm using that in more broader sense to include dialectical behavior therapy and existence and commitment therapy. Some other types of therapy is that you can get kind of a twofer in many cases if you're looking at, okay what are your interpretations of your own feelings? Or how likely is it that you're really going to do the things that you're afraid of doing? And depending on what's going on, it usually is helpful for people to develop kind of a range of tools. So, yes, sometimes we need emotion regulation tools, right? We do have anger and rage, and that's a normal, healthy emotion that comes out in response to when we've had a goal blocked, when we've been disrespected, treated badly. That's the emotion that comes out. And that doesn't necessarily have to be tied to aggressive behavior, right? It can be, but it doesn't have to be. There's usually a moment where you can get in there and create some space and then choose your behavior.

So sometimes it's about, okay, how do you regulate the emotion until you can make the choice? Sometimes somebody won't need to regulate the emotion. They can just segue into effective action that might be using their words instead of their fists and things like that. There are lots of ways that you can get in and work with those things. And, you know, again, I love the title of your podcast, this idea of compassion is really important. Can you direct some compassion towards yourself and say, oh, well, that rage makes sense, that in this moment, necessarily in this moment, maybe it's a little out of proportion to getting cut off in traffic or something like that, but it's not out of proportion given all the years of build up, of being disregarded or being treated badly. And then you can start to, with that compassion as that entry point, understand yourself a little bit better, and give yourself that kindness that you need before then moving on to whatever it is you want to do that's important to you.

So here's another thought I had about anxiety. A lot of my patients who have anxiety also have addictions, and I wanted you to comment on the connection between anxiety and addiction in your own experience and the research that you've looked into.

Yeah, that's a really good question. And it's one of those things that about a million different answers and possibilities. And I tend to view, based on what's going on for the individual in front of me as a clinician, but for untreated anxiety, one of the things that can happen is you're always feeling revved up. You never feel relaxed. And so if you think of your body's nervous system, there are different branches of the nervous system and there's a central nervous system. Many people have heard of that. But when you get down to some of the stuff that gets activated for stress and fear and anxiety, we have the automatic nervous system, which back when I was a student, I used to remember it by auto. Instead of thinking south, I would think of like auto as an automobile, as a car. And then the two branches of that, your sympathetic nervous system and your parasympathetic nervous system as the gas and the brake of the car. And so our sympathetic nervous system is like the gas pedal, right? That's the one that gets activated for fight,flight and freeze. And our parasympathetic nervous system is the one that's for rest and digest and sort of calming us down.

And what can happen if you're living in a very stressful environment or if you have an anxiety disorder that maybe makes you see threat when there isn't even really threat there, or makes you feel like you can't handle anything, then it's like that gas pedal just keeps revving and revving and revving. And if you don't have the skills to kind of put on the brakes once in a while, one of the things that some people can fall into is using substances to change how they feel, right? And so it's one of those things that if you've ever heard this thing, the solution becomes the problem. It starts out as problem solving. Like, oh, I notice I feel better when I drink or eat cookies or whatever. You use a particular type of drugs, this makes me feel better. But those things that make you feel better in the short term, if that strategy is overused and not used in times that it's healthy, unfortunately can become a problem in the long term. So that's one of the things that I see. But I also see people who kind of came fully loaded for it. They have long histories of anxiety disorders and say alcohol use disorders in their family.

And we know that there's these genetic components, there's social environment components there's. What skills are you using? You know, so I think no matter what else is going on with anxiety, there's usually some tools that we can give people to help them manage the anxiety. That will help with some of the other stuff that's going on with them.

As well, for sure. Now, I have noticed over the years that unfortunately, coming back to your comment around lack of resources directed toward mental health, that family doctors get tremendously little training in mental health even though they're supposed to be caring for the general population, and they are the first gatekeepers, they seem to get such minimal training and education. So that here they are seeing somebody with an anxiety disorder, depression, bipolar disorder, all sorts of mental health conditions, and they are overwhelmed. And they tend to give patients a lot of sedatives called benzodiazepines. Examples would be Addovan or other name is Laurasapan or Valium, other name is Diazepam or Clonazepam, other name is Clonapen. So these are benzodiazepines. They're addictive down the road. They cause dementia, they're very relaxing, they're sedating. They make you impaired in terms of your driving and in terms of other functions. But people get put on them and then they stay on them for years because the family doctor doesn't know what else to do about this crippling anxiety. And these people become addicted to their benzodiazepines. Now, back in the good old days of the unhappy housewives were on these things for decades.

It was really horrendous. But even today, with all the education that we have, we still have so many people on these medications. And I've made it kind of a mission on my part to get people off of these once they come in front of me, which it's not the majority of the population, but certainly when I see them, the first thing I do is take them off their benzo if I can. It depends on how long they've been on it. Sometimes they just won't. But have you had that experience as well in your practice?

So I'm a clinical psychologist, not a psychiatrist or a family doctor. So I don't prescribe medications. And so if I had my way for anxiety disorders, we would start with skills before pills, because if you catch them early and you learn the skills, there's a lot of management that can be done at that level. So it's out of my scope of practice to comment on meds. One thing that I can say is that a bunch of folks from Anxiety Canada contributed to the Canadian clinical practice guidelines for the management of anxiety with the intention of helping with the problem that you described, even in terms of the field of medication. And I'm not going outside of my scope of practice to say this is just based on research. Benzodiazepines should not be frontline. They're not gold standard pharmacological treatment for anxiety disorders. And so what you're saying, you're absolutely right, that's not the best choice. Like maybe somewhere down the line that might be if you've tried everything else. And again, out of my scope of practice. But I think if we could get the education to both people and those frontline workers unfortunately, in terms of family doctors, right now in British Columbia, we have a huge shortage of primary care family doctors.

And people can't even get a family doctor, never mind have someone listen to them and be able to do an appropriate assessment, diagnosis and medication treatment plan with them. And I think across Canada it depends on where you are. But there's a huge problem with getting access. And that's really hard because that means that entry level that people used to be able to have with their family doctors isn't even there for a lot of people.

Yes, I do quite a lot of psychiatric assessments for people who are off work due to mental health disability. And I've been having conversations with people in the East Coast and somebody from Nova Scotia told me that there are at least 100,000 people who don't have a family doctor currently, and the same in Newfoundland. And it's just tragic and just feel very, very bad. Especially when I have a patient who I'm just diagnosing with a major mental health condition and their employer saying get back to work, their insurance company is saying get back to work. And this person doesn't even have a family doctor to treat their major mental health condition. What are they supposed to do? The suffering is terrible. It breaks my heart because I can't treat them. I'm just assessing them. So all I can do is send them back to their GP. And if there's no GP, then we're really in trouble.

And then, not that we want to go up on a bunch of huge tangents here, but then that leads to clinician burnout, right? Because it feels horrible. You see this person, you work hard to connect with them and try and come up with a plan to help. And then when you release them into the universe and you know that care is not going to be there for them, it feels terrible.

Doesn't feel good.

Right? Because it's not a good situation. At the same time, we have our role to play. And when we're trying to do our part and do our piece, we need other people and systems in place to be there, help pick up the healthcare pie.

Yeah. I think we need to just keep advocating in every way possible for the listener. Like to lobby your local provincial, federal government to invest more in mental health care. Because nobody doesn't know somebody who isn't suffering from mental health. Right. Like, every single person has probably multiple acquaintances, friends, family members who have some kind of mental health issues. So we need to be more verbal, more vocal about asking the people who are making the decisions about funding to invest more in mental health.

Absolutely. Yeah. And we're seeing the downstream costs of the lack of investment, whether that's in the public health care system or in workplaces where the great attrition or people are leaving the workplaces. And part of that has to do with mental health and psychological safety and workplace conditions and things like that. It's one of those things that we have to keep advocating for and vote for it, lobby for it. I like to maintain hope and not give up. Just keep taking a little piece and say, okay, this is the little part that I'm going to do. And I don't know if you have this experience, but as part of that compassion, when we notice, okay, here's where people are suffering, we want to tie that to the action. Okay, what's something that I can do about it? What's one little piece that I can do today to try and make a difference?

Absolutely. That's one of the reasons I do this podcast. It's like get the word out, right? Let's get people understanding things and talking about things and asking questions about things and lobbying for things so that things change for the better.

Yeah, well, knowledge is power and the topic of mental health comes up and people say, yeah, I see, there's the data and that's a problem, but we don't have the money. And then if you actually also have the data and say no, you don't have the money not to like this actually cost more downstream in terms of whether it's a workplace with talent loss or the health care system. It's not like you're actually escaping these costs. These costs are coming in the ER now instead of primary practice and there's a whole ton of suffering along the way. So if you're not motivated by the suffering, which you and I are highly motivated by the suffering, but let's just say you weren't, caring all you were interested in is money. And bottom line, you still should care about mental health, right?

Because it'll save you money. Oh my goodness. Well, we could keep talking forever, but I think we should start winding it up. If people are looking to find you and the amazing work that you do, where would they go?

The publicly funded resources and Anxiety Canada can be found through the website www.anxietycanada.com. And I also have a private practice at the North Shore Stress and Anxiety Clinic and that's for people in British Columbia who unfortunately have the means to pay privately. So this is the balance that I take in terms of my little piece of the private practice pie, but also balancing that out with the volunteer work I do because we do actually need more psychologists in the public health system for sure.

I agree with that too. And is there any interesting project that you're working on these days to share with the listener?

I usually like to wear lots of hats and have my fingers and lots of pots. Some of the kind of new fun stuff coming out through Anxiety Canada is there's a new video series for YouTube called "Care Tunes" and its goal is to help educate and normalize anxiety. And the little animations are aimed at pre-teens and teens but I really like them as an adult, there's the one about time traveling pizza. His name is Chris Crust and there's this one where he's having some anxiety about going to a barbecue and you see in the animation like the little pizza toppings are changing as though the little pizza is deciding what to wear. And I think it's very charming and it's a good talking point. So if any of your listeners have kids, teens, it's a good starting point. And I really like in the fields of knowledge mobilization, so getting what we know from the scientific studies and from the lab or the bench to the actual people. I love it when people can use creative ways such as cartoons, podcasts, things like this, storytelling, to get that information out there in bite size usable pieces that people can take action based on and also, I think in terms of these little pieces that we can do to try and change the culture, to break up the stigma, to say, hey, this isn't just a you thing.

That sounds really great. And just before we wrap up, do you have a call to action for the listener?

That's a great question. My call to action is move towards the things that are important to you with courage and kindness. And so for people who are suffering with anxiety and anxiety disorders, sometimes we can try and wait around till we feel comfortable or feel less anxious to do something, and we can be waiting a long time sometimes. So that's where the courage comes in, is sometimes we have to act even when every fiber of our being is telling us to run away. And that's where the courage and the bravery comes in. And then with the kindness, peace, kindness, compassion, it's hard to do that, right? It's hard sometimes to be brave. And so being kind to yourself about the struggles that you're experiencing and just keep on moving towards the things that are important to you, let that be the guide. Don't let your feelings be the guide. Sometimes they get really bossy and they're not good bosses all the time.

That's a great note to end on. Dr. Melanie Badali, thank you so much for coming onto the Ruthless Compassion podcast today. It was really a pleasure parsing anxiety with you.

Well, thank you. It's my pleasure.

This is Dr. Marcia, Sirota. Thank you for listening. Please leave a review and your comments wherever you listen to podcasts. And don't forget to sign up for my free newsletter at MarciaSirotamd.com, where you'll learn about upcoming online events as well. Also, we love getting referrals from our listeners about future podcast guests, so please email us at info at marcia Sirota, Md.com.