CBT for Anxiety- Older Adults
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[00:00:00] Dr. Regina Koepp: Our guest today is Dr. Julie Erickson. She's a clinical psychologist in private practice and an adjunct faculty member in the Department of Applied Psychology and Human Development at the University of Toronto in Toronto, Canada. Dr. Erickson is interested in optimizing evidence based psychological treatment for older adults and reducing their barriers to getting treatment.

Dr. Erickson maintains an active clinical practice with adults across the lifespan and provides education to the public and mental health professionals on aging and mental health. Her book, the aging well workbook for anxiety and depression will be released October 1st, 2023.

Let's dive into the interview with Dr. Julie Erickson.

Thanks so much for joining me today on the psychology of aging podcast. I'm delighted you're here. Can you start by telling us a little bit about how you decided to specialize with older adults?

[00:00:55] Dr. Julie Erickson: Yeah. So first off, and thank you so much for having me on here today. Really excited to be chatting with you. And so in terms of my interest in aging believe it or not, one of my first jobs was working in a nursing home when I was in high school. In fact, when I worked in the recreation department of a nursing home.

And so my job was basically to socialize with older people. And at the time I thought, This is the best job ever because I just get paid to have fun, hang out, and do cool things with older adults. But it became more than that, right? I started to really see the challenges that people can experience growing older.

I think a lot of the beauty and the pain that comes with being an older adult and facing things like dementia or other physical health issues, mobility challenges. And I also started to see some discrepancies in how people respond to those challenges. Like I really saw some people who still managed to remain optimistic and engaged with life and engaged with their family.

Fight a lot of different challenges, and then some people who were very much the opposite, who really struggled to adapt and became much more isolated, withdrawn from other people. And ultimately I just became really curious to figure out, you know, what's the difference? What's the discrepancy here? And ultimately, how to help people age better.

And so that's really been at the heart of a lot of my work and what's guided me ultimately to, to being a clinical psychologist and, and working with older adults.

[00:02:32] Dr. Regina Koepp: We're so quick to recognize the pain that comes with aging as a society. What are some of the beautiful parts?

[00:02:40] Dr. Julie Erickson: Yeah. I'm so glad you asked that question.

You know, we don't recognize or put enough weight on things like the wisdom and maturity that comes with late life. I mean, you have a lifetime of experiences that you've banked and basically problems that you face or problems you've probably faced before. And, like, how amazing that is to, to have that experience behind you.

I think there's also, and there's some interesting research around this too, around when there's changes in time perspective in life so as you start to get older and you perceive that time is running out, although to some people that might sound scary, but for a lot of older adults that really helps sharpen goals and priorities to be much more present focused and that tends to make people happier when we're focused on the here and now and the things that are most important in the here and now.

People just Generally tend to be happier, right? And I think that is something about late life that we don't talk about, but is indeed really something to look forward to.

[00:03:46] Dr. Regina Koepp: Yeah. Yeah. Thank you. So you mentioned the discrepancies. So some older adults you witnessed navigating challenges in life, like, like duck's back, and then other older adults may be struggling.

A bit more. So how did you get interested in anxiety disorders and aging?

[00:04:09] Dr. Julie Erickson: You know, I think in my clinical practice, I mean, it ended up seeing a fair amount of these older adults land on my caseload because of, you know, series of challenges they were facing, whether it's a new diagnosis or mobility issues or problems with adult children or losses in their lives.

You know, there's lots of new challenges that come up that I think anxiety is a very normal reaction to those things. And so I sort of landed in it, I don't want to say by accident, but, but just because it is such a common thing that's experienced by older people. Plus combined with my experience with CBT.

Cognitive behavioral therapy being a really effective treatment for these individuals. And of course, it feels great to both see people get better in treatment and really benefit from the work that you do. And I think that just added to my interest and enthusiasm for this type of work.

[00:05:07] Dr. Regina Koepp: Okay. Let's dive deeper.

So what causes anxiety as people get older?

[00:05:15] Dr. Julie Erickson: Well, it's not a simple answer to this question, but I think we can look at causes from a biological perspective, psychological perspective, and social perspective. So biologically, as people start to get older, there are neurobiological changes that tend to impact things like parts of the brain that are like the gas in the brakes of anxiety.

And as people start to get older, the gas and the brakes in the brain for anxiety aren't necessarily communicating as well, and this can make it harder for aging brains to regulate anxiety, right? So, so what that means is from a neurobiological perspective, older adults might be a bit more vulnerable to experiencing and having difficulties regulating anxiety.

Now, on top of that from a psychological and social perspective, when we look at things like experiencing chronic or acute physical health issues, right, can certainly be a trigger to feel anxious. There's a lot of uncertainty, right, in what's to come in your physical health and how to manage the challenges on your plate.

That can be a big trigger. As well as things like relational losses, right? Deaths of spouses or friends things like financial troubles having to relocate, let's say moving into a long term care setting stressors with adult children. cognitive impairment, right? So if we look at all of these things collectively, who wouldn't feel anxious, right?

When you're facing some of these things. So it's certainly a combination of some biological vulnerabilities and psychosocial life stressors that can cause anxiety as people get older.

[00:07:02] Dr. Regina Koepp: Can you just differentiate for us the difference between stress and anxiety or anxiety disorder?

[00:07:10] Dr. Julie Erickson: Yeah, for sure.

It's a really important one. So I think of stress as a temporary, pretty normative reaction to an atypical event in your life. Right? So stress is what might emerge when you've gotten into a car accident. Maybe it's even just a fender bender, right? But the stress that comes. of having to deal with getting your car fixed, contacting your insurance company, getting alternative transportation in the meantime, right?

All of that causes stress and all of that's pretty normal, right? Versus something like an anxiety disorder is characterized by chronic and pervasive worry and worry more so than most people would under those circumstances. So you're feeling really preoccupied with worst case scenarios and experiencing a lot of other physical or behavioral symptoms, things like avoidance of things that might trigger your anxiety or worry or overdoing things like over planning or over preparing or reassurance seeking and physical sensations like feeling wound up or on edge or having difficulty sleeping.

So it's sort of stress, but on overdrive, right? And in a much more generalized way, that ends up being more impairing and, and really coming with a lot of negative consequences for people's quality of life.

[00:08:32] Dr. Regina Koepp: Yeah. So the, the impairment is key when we're talking about

[00:08:36] Dr. Julie Erickson: really key disorder, the scope, the scope of the symptoms and the severity and the impact

on life.

[00:08:44] Dr. Regina Koepp: So now that we know the difference between stress and anxiety, let's, I guess it would help us to understand how does anxiety present differently in older people than younger people.

[00:08:56] Dr. Julie Erickson: I would say by and large, there's more similarities than differences but nonetheless, there is some literature suggesting that older adults are more likely to talk about some of the physical symptoms of anxiety.

So when they show up to, let's say, their general medical practitioner, they might talk about things like upset stomach or not being able to sleep very well. And they're less likely to talk about the sort of cognitive symptoms of worry, they're less likely to say, I've been thinking a lot about you know, what could go wrong with my health, right?

They're less likely to talk about that and more likely to point to some of the somatic symptoms. Now, that might be more a reflection of. lower rates of mental health literacy amongst older adults. So less knowledge of the symptoms of what an anxiety disorder is. So it might be more of a reflection of that as opposed to age related changes.

So, but that's sort of, I guess, generally what, what to, what to look for in terms of some age differences and anxiety disorder presentation.

[00:10:02] Dr. Regina Koepp: And that's also part of what keeps anxiety disorder from going undiagnosed and untreated is that it gets confabulated with real physical health issues.

It's like, is this a physical health issue or is it anxiety or is it both? And how do we tease those apart? Yeah. Time to do that

[00:10:23] Dr. Julie Erickson: takes time, right? And it can be nuanced and complicated, right? To sort of rule out physical explanations for anxiety. But it can also really go undetected, right?

And, and anxiety can get chalked up to, to something else, or just as a quote unquote, normal aspect of aging and anxiety disorders aren't a normal part of aging. And that's important to, to make clear.

[00:10:49] Dr. Regina Koepp: How common are anxiety disorders among older adults?

[00:10:53] Dr. Julie Erickson: You know, the estimates vary really broadly depending on the setting and, and, and what type of anxiety disorder you're looking at.

But really generally, if we're looking in the community, prevalence rates can vary from 1 to 30%, right? Which is a huge range. And in medical settings, it's up to potentially 50% of older adults experiencing some type. Of anxiety, symptomatology or anxiety disorder. So it's really variable. I would say the most common anxiety disorder experienced by older people is generalized anxiety disorder or G and D.

Probably the lesser common of the anxiety disorders are things like panic disorder and social phobia. So those tend to be pretty low prevalence most common being generalized anxiety.

[00:11:44] Dr. Regina Koepp: So are some older adults more vulnerable to developing an anxiety disorder than others? Like what would, what would create some vulnerability in older adults?

[00:11:54] Dr. Julie Erickson: Yeah. Well, the first vulnerability is having a history of anxiety, right? Which kind of seems like a no brainer. If you struggled with it in the past, then odds are, yeah, it's still going to follow you around and maybe kick up again in late life when you face some new challenges. So prior history is one risk factor.

Medical illnesses might also make people more vulnerable to an anxiety disorder onset. I was thinking of a client that I saw who had a diagnosis of tachycardia that made her especially aware of physical sensations in her heart as well as physical sensations of anxiety. So things like that can make people more prone to anxiety disorders.

Stressful life events like some of the ones I pointed to already around. Death of a spouse, relocation, physical health challenges, financial challenges can certainly increase risk. Personality traits so things like neuroticism, which we know are a risk factor for a wide variety of different mental disorders, and that's certainly the case with anxiety disorders.

And finally lack of social support. So our, our social support is really. Really a safety and security net for so many different stressors and buffers us and protects us in life in so many ways. And in the absence of that, older people can really be at high risk for an anxiety disorder amongst many other different mental health conditions in life.

[00:13:21] Dr. Regina Koepp: And you mentioned earlier, anxiety disorders are treatable. And you in particular use the cognitive behavioral therapy to treat. Anxiety disorders among older adults. So how do therapies like CBT or cognitive behavioral therapy help older adults who are struggling with anxiety?

[00:13:41] Dr. Julie Erickson: Yeah, well, you know, CBT and, and should mention too, it's, it's.

Not just an evidence based treatment, but it's considered the gold standard of care for a wide variety of different disorders, including anxiety disorders in late life. And if we look at how CBT operates, we're really focused on the interrelationship between people's thoughts, their emotions, their behaviors, and their physical sensations.

So we're really looking at how each of these things influences one another, and more so than that, we're looking at how to change patterns of thinking, patterns of behaving that really feed into feeling anxious. And I'll give you some examples. Oftentimes in CBT for anxiety, we're looking at people's tendency to catastrophize or jump to worst case scenarios, which is pretty hallmark of anxiety disorders, right?

So we're looking to help people become more flexible in their thinking patterns, learn how to contain the amount of time spent worrying, right? And increase their engagement with things that are important or increase their engagement in problem solving. and reduce really maladaptive types of behaviors that actually just perpetuate anxiety.

So, things like avoidance, really pulling back from things that might activate your anxiety. In CBT, we're trying to help people do the opposite. engage with, face and, and learn how to manage, right? Some of the feelings of anxiety that come up. And so at the end of treatment, you know, clients, it's not like they walk away anxiety free right?

But ultimately at the end of treatment, people are in a better position to be the ones managing their anxiety and not the other way around, right? And not having anxiety manage them. So it's a really Skills based hyper treatment where people are walking away with a toolkit of a variety of different strategies to cope better.

[00:15:40] Dr. Regina Koepp: When you're meeting with a patient for the first time and you recognize, you assess them, you see this person indeed has an anxiety disorder and I'm recommending cognitive behavioral therapy for anxiety. How do you describe it to your patient? Like, what do you say? And I'm thinking about Just caregivers or older adults themselves or other clinicians who are listening, who might need some tools for even just starting this conversation.

So how do you say, you know, I'm observing that you have an anxiety disorder and this is what I recommend this therapy. Can you just like lay out what you say?

[00:16:16] Dr. Julie Erickson: So I usually say CBT is an evidence based treatment, so there's lots of data to suggest and be optimistic that this is going to be helpful to you.

CBT is not a magic bullet, so we're not here to take away an important emotion like anxiety, which exists to actually help keep you safe. But what we're here to do is help you be better at being anxious. Right. And so in order to be better at being anxious, we got to learn how to manage certain thoughts and change how you're thinking when you feel anxious.

We've got to help you learn how to behave differently when you feel anxious so that you're not making it worse by avoiding things or doing things to excess. But we're helping you confront and engage with aspects of your life that matter most to you. So, I mean, that, that, that's, I try to keep it simple in a nutshell, right?

Of that being it and also really highlighting that you're here to learn, right? As much as therapy is about coming and being heard and listened to and validated, it's also about learning a new way of understanding your problems and approaching your problems and learning new skills to help you cope differently.

[00:17:27] Dr. Regina Koepp: Earlier you mentioned lack of access to mental health literacy. And so I think you're describing it really helps improve health literacy and mental health literacy. So thank you. So I'm, I'm going to put you on the spot because we didn't talk about this and you just tell me if this isn't, if you're not up for this, but speaking of mental health literacy, is there like a one simple, small technique you could describe that you use in for anxiety, just to sort of open the curtain and let people peek inside actually looks like yeah for

[00:17:59] Dr. Julie Erickson: sure. I'll highlight one one strategy which usually is Very helpful for people, and that involves distinguishing the difference between productive and unproductive worry. And people sometimes scratch their heads at being like, wait a minute, there's productive worry?

What, what does that even mean or look like? And so productive worries involve things that we're worrying about that are actually happening or will happen soon. Right. I've got a medical appointment next week. How am I going to get there? Right. Productive worries are also about things that we can actually take action on now or sometime soon.

I can call a taxi, make sure I book one for the appointment. Right. And they're also about questions that we can answer. Now, if we look on the flip side, unproductive worries are about hypotheticals. We don't know that they're actually going to happen. So what if I get into a car accident on the way to my doctor's appointment would be an unproductive worry because hypothetical, we don't actually know that that's going to occur.

Unproductive worries are also unactionable. There's not something you can do about it now or sometime soon. There's nothing I can really do to prevent a car accident from happening next week when I go to my appointment. And they're unanswerable questions. Right? So, so by nature unproductive. Now, sometimes just making this distinction, running your worries through this, this list can help you really clarify, is this a worry that's useful for me?

And if so, how do I take action? And if it's unproductive, well, then how can I let this go? Right? Or how can I practice it? Thank you. even tabling that worry and say, well, I'll come back to that later. And sometimes practicing deferring and pushing off worry can help you better focus on the things right now that are more deserving of your attention.

So that's one skill I tend to work on with clients. And even Just looking at your worries differently and learning how to shift the focus of your attention to the worries that are actionable can be really empowering and help save people so much time, right? People spend so much time worrying that detracts from areas of their life that they would rather be focusing on more.

[00:20:17] Dr. Regina Koepp: One worry that I hear, especially with people living with a chronic illness is what if I don't get better? Mm hmm. And on one hand it It, there might be problems within that worry that can be solved and on the other hand, there might not.

[00:20:35] Dr. Julie Erickson: Yeah. Yeah. It becomes really challenging, doesn't it? Right. And, and the hard part of life is living with unanswerable questions, right.

And trying to find maybe a sliver of an answerable question in that, right. Of just like, how can I stay engaged in my dance lessons despite having. mobility issues, right? So, so trying to look for the sliver of productive worry in the unproductive can be a more helpful way to proceed because there's no shortage of unanswerable questions in late life.

Yeah.

[00:21:14] Dr. Regina Koepp: Yes. I was thinking about the The question I just posed, what if I don't get better, which I hear from some of my clients who worry. I was thinking, you know, even I felt when I posed the question a little, where do I go with this? But as we were talking, I was thinking, Oh, right. The sliver in there is, well, then I'm going to do my part and making sure I'm optimizing my health.

And I'll know that I've done my part. whatever the outcome.

[00:21:43] Dr. Julie Erickson: That's it. That's it. And it's perfectly, it's perfectly normal for your brain to go to the unanswerable questions, right? Our brains don't like uncertainty. They're really, they really want to know everything and know everything for sure. But I think part of CBT is realizing that we Can't right and part of part of living life involves living with uncertainty and within that learning how to find aspects of your life that are more known right where you do have some more control and and throwing yourself into those those aspects of your life.

[00:22:18] Dr. Regina Koepp: I think this leads nicely into the next question about what strengths and resiliencies do older adults bring with them to help them cope with anxiety? Like, what do they already have?

[00:22:31] Dr. Julie Erickson: Yeah, well, it was mentioned just the idea of wisdom, right? In a lifetime of accumulated experiences, solving different types of problems.

Right. And so that is no doubt an asset as you, you get to late life and you might be dealing with problems that are maybe in part new, but still might contain something you faced before. So that is no doubt an asset. The second piece is that, that tendency to be present focused, right, which happens as people start to perceive that time is running out.

Anxiety thrives when we're thinking ahead about the future. Anxiety tends to dissipate when we're focused more on the present. You know, and if older adults are generally trending to be more present focused, I think that can really help if you're trying to be less anxious or work on your, your worry.

I think the last piece, or at least one of the strengths I can identify now is just what happens with emotion in late life. So there is some research suggesting that older adults tend to get a bit better at regulating their emotions as they get older. So they're more likely to select situations or environments that help make them feel good.

They're not likely going to go out and try a bunch of ten new hobbies. They're going to stick with the one or two things that they know tends to make them feel good. And there's also some research suggesting that there's a bit of a bias in attention that happens as people grow older. They're more biased towards the positives.

So after a conversation or reading an article, for example, they're going to remember more of the positive information as opposed to the negatives. And I think that can really work to their advantage in regulating their emotions, you know, if, if these tendencies are occurring. So a lot of different things that we don't necessarily, not many people know about or pay enough attention to that might actually be a real asset in managing anxiety in late life.

[00:24:28] Dr. Regina Koepp: I was just taking a plane yesterday from Santa Fe, New Mexico, back to Burlington, Vermont, where I live. And I was sitting next to. An illustrator and he was just drawing the most beautiful, he opened up his little drawing book and he just started drawing cowboys on horses and he, it was, it was incredible.

And as we were departing the plane and I was standing up, I was I was talking to him. I said, Oh, I really like your drawings. And he said, thank you. know, this is, this is. Lewis from Lewis and Clark. And I asked him, Oh, are you a pioneer? And and he said, well, I'm 88 and I was born in South Dakota on a farm.

So I'd say I am quite a pioneer. And I looked at this person up. I was like, is this guy famous? And I heard his name because his partner was on the phone trying to change their flight. Cause our flight was delayed. They're trying to change their connector. And his name was Richard Elmore. He, he's an artist in San Francisco. I was just. So inspired that he had this incredible talent that he cultivated throughout his life and was still working on . We were delayed on the tarmac and he had a couple of advantages. His partner was carrying the stress of their connecting flight, figuring that out and he was just drawing the whole time and he was happy as a clam and yeah, it like, it was just the, the best interaction, but I was thinking there was a episode recently that I had listened to the night before while I was packing on 10% happier.

And it was about neuro aesthetics. It was about art and the brain and how powerful engaging in a daily practice of creativity is for our brains. And and so anyway, I was just putting all of these pieces together as you were talking and yeah. And just what, what Richard Elmore has in his. Tool bank of illustration and art to help regulate his nervous system.

[00:26:41] Dr. Julie Erickson: Well, that's just it. And a lifetime of figuring out this is what I'm into and practicing that and staying engaged with that. Like that's, that's wealth in a completely different way, you know, as you get older to have those things. And yeah. So what a great example.

[00:26:57] Dr. Regina Koepp: Okay. So what can healthcare providers do to better support older adults who are experiencing anxiety?

[00:27:05] Dr. Julie Erickson: Yeah, so I'm thinking of maybe therapists in particular here. If you're a therapist who works with older adults who tend to be anxious you can really set older adults up to benefit a bit more from therapy by spending a bit more time on, called psychoeducation about psychotherapy. therapy. So because of lower rates of mental health literacy, when an older adult is coming to treatment, they may not be as familiar with like, well, what are we doing?

Why are we doing it? What do you expect of me in therapy? And who are you as a therapist? What can I expect of you? Right? So spending more time just talking with the client around what to expect in therapy and what to expect of you as the therapist and their role in treatment, I think is really good. So everybody's on the same page about this.

And I think to spend a bit more time just covering the content of therapy, so move a little bit slower in your work with older adult clients Given the fact that some older adults might experience more cognitive challenges, or just experience normal age related cognitive decline, so things like slower speed of processing or working memory that might just mean taking your time a bit more in session to, to present content.

If you're a therapist who's, let's say, doing CBT and doing exposure based treatments, where you're having older adults confront distress in your anxiety provoking situation, that And think particular about one form of exposure called interoceptive exposure, which is where older adults with panic attacks might be doing things that elicit those panic like sensations, like hyperventilating or running up a flight of stairs or making themselves dizzy.

I'd recommend, because there are some medical contraindications to doing that particular type of exposure therapy, to always consult with a GP, a general medical practitioner prior to doing that with your older adult client, just to get the green light and sign off that they're medically fit to do so.

That's always good just to have that that reassurance. And I'd also recommend for therapists working with older adult clients and especially those who are anxious to enlist the help of significant others in the client's life. I'd say family members are either by preference or necessity just involved a bit more in treatment with older adults.

And I think we can take advantage and, and, and use that to their benefit. And of course, with the, with the client's agreement to this as well. But I'm just thinking of one client in particular who I was seeing who had a phobia of driving and highway driving, and we helped enlist her spouse in some of her initial exposure based homework and CBT, where she was getting out on the highway, you know, for the first time in a while and having her spouse present, at least for some of the initial exposures was really helpful in a good sort of set of training wheels.

So to speak, that helped her face more difficult fears and on her own later on down the road. So seeing where there might be good opportunities to enlist the support of others is a great thing as well.

[00:29:59] Dr. Regina Koepp: And what about family members? So say. You're witnessing your aging parent or your partner who's older and they're anxious and you want to start the conversation.

I'm concerned about you. Help is available and, and can be beneficial. What do you recommend to family members?

[00:30:20] Dr. Julie Erickson: Yeah, well, you know, I think what I've observed and maybe listeners can identify is that when you're around an anxious family member long enough, the tendency is offered to provide reassurance.

Right, it's going to be okay, nothing bad's going to happen, you're going to be alright. And sometimes that's really helpful for a family member to hear, but sometimes it kind of feels like you're just mopping up the ocean, right? It's the reassurance is not actually doing something to help the worry or the anxiety.

So family members might be better suited to consider offering validation instead. So saying things like, I understand why you're worrying about this, and it's okay to feel nervous about your upcoming appointment, right? Starting there can often feel more comforting for clients you know, as, as a good starting point.

Family members might also benefit from just asking their loved one what they're looking for in that moment. Sometimes I have clients who might actually want help solving a problem. If they're worrying about getting to an appointment, then they're expressing the worry because they want someone to help them find a solution.

Versus sometimes when people are anxious and they're worrying out loud, they're just looking for someone to listen to them, right, and to offer the validation. And so asking a family member, what are you looking for from me right now? Is this a problem that I can help you solve, or would you like me to listen?

You know, and starting from there can be a better way to respond to worry than just kind of offering blanket reassurance.

[00:31:53] Dr. Regina Koepp: Do you have a recommendation about how family members can pose the option for mental health care?

[00:32:00] Dr. Julie Erickson: It's tricky. It can be hard to have these conversations because, I mean. Unfortunately, stigma still does exist and people can have a lot of strongly held beliefs about what it means to go see a psychologist or another mental health care provider, and people can get defensive or shut down or, or just be embarrassed to have these conversations.

So I think just kind of asking open ended questions of just like, what do you think about going to see someone? What do you think that would be like? Is there something that scares you about that? Tell me what scares you about that. What are your concerns? And if you knew that this was going to be helpful, would that change anything for you?

Right? So just focus on like understanding what might be getting in the way of treatment can just help open up the conversation. I think if you come in directly with like you need to go talk to somebody, a lot of defenses can kick in and make it easy for someone to push back. But starting first with open ended questions to get the dialogue going.

And then be part of the challenge is that like, there's a lack of evidence based information about older adults and mental health that's out there, right? So, my book that's coming out this fall is intended to be a good self help resource, a good starting point for older adults struggling with anxiety or with depression, to be able to start to wrap their heads around the problem, and to understand some tools to help solve the problem.

And so I think with more things like this, older adults can get some exposure to what therapy looks like in the comfort of their own homes, and then maybe that makes them more willing to then seek out the help of a therapist or other professional once they're more aware of what's involved.

[00:33:50] Dr. Regina Koepp: I often will hear family members and even health providers who are recommending mental health care for treatment of anxiety or depression, describe mental health in a punitive way. Like there's something wrong with you. You need to go see a therapist and you're saying to approach it with warmth and curiosity.

[00:34:11] Dr. Julie Erickson: And I think frame it as. You know, people don't just go see a personal trainer when, you know, they are completely incapable of lifting a weight, although they might, right? But people can also go see a personal trainer just to get a little more fit or a little more healthy, right? And so going to a psychologist or mental health care provider can mean a tune up.

It can mean using your strengths and making things a little better for yourself or at the very least making things a little less bad for yourself, you know, so it doesn't have to mean there's something wrong. It can mean capitalizing and on what's right and, and playing to those strengths.

[00:34:52] Dr. Regina Koepp: That's right.

Yeah. I also find it's helpful when recommending mental health care to sort of start with our own experience if we've engaged in our own mental health care to say, you know, I was really struggling at this stage in my life and I sought out a therapist and it helped me tremendously in these ways and it taking the first step was hard, but it was necessary for me or or whatever your true process was and just sort of relating and de stigmatizing with your own experience, I think can also be very can help to build the bridge

[00:35:30] Dr. Julie Erickson: Yeah, it is so powerful, right? To have someone close to you who can say, this was my experience and it was great. I feel like I got this out of it and I would do it again 10 times over. That is really impactful, right? And, and makes it a bit easier for someone to make that decision for themselves.

[00:35:46] Dr. Regina Koepp: Well, thank you so much for laying down some wisdom on anxiety and aging and what we can do to effectively treat anxiety disorders. You helped us understand the difference between stress and anxiety. Peeled back the curtain about what treatment can look like.

I think gave some really important tips. I think one of the things that I'm taking today is the value of psychoeducation and just spending some time really reviewing expectations so that roles are clarified in the therapeutic relationship. I think we just assume that people have exposure to mental health care and we overlook that part or I do.

I know I do. And and so I think that was such helpful, valuable guidance. Thank you.

[00:36:36] Dr. Julie Erickson: You're so welcome. Yeah, this was so much fun and eager going to talk more with you about this stuff.

[00:36:41] Dr. Regina Koepp: Well, Dr. Erickson, tell us where people can learn more about you and buy your book that's coming out.

[00:36:47] Dr. Julie Erickson: Yeah. So people can take a look at my website.

It's drjulieerickson. com and my book is coming out this fall. So it's called the Aging Well Workbook for Anxiety and Depression. It's published by New Harbinger Publications. Released October 1st.

[00:37:06] Dr. Regina Koepp: Great. Well, we'll link to that in the show notes and wish you all the success in all the lives that I, you'll touch with this book and, and improve.

[00:37:16] Dr. Julie Erickson: Ah, thanks so much. Much appreciated.