Ep 33: How anxiety shapes your behaviour and triggers pain

Michael Dermansky 

Hi everyone and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. My name is Michael Dermansky, I’m a senior physiotherapist here at MD Health and I’ve got a special guest today Valerie Judge. Welcome to the show.

Valerie 

Hi Michael, thanks for having me on today.

Michael Dermansky 

Well, we’ll start a little bit about introducing a bit more about yourself and what you do and what your company, Rose Phoenix Health does as well. And then we’ll talk about what we’re talking about in today’s show.

Valerie 

Yeah, so I’m Valerie Judge. I’m the founder and managing director of Rose Phoenix Health. We’ve been around now for two and a half years. We are a small mental health service. So we provide mental health, psychology services, speech and language assessment to adults, children and families.

And we’re really there as an early intervention service. So we really believe in when there’s a problem that’s arising to get in there and to try and fix it as soon as possible. So yeah, like I mentioned, helping out children, children and families, and also adults with any worries, any problems, any concerns that they have. And then second to that, we also do some psychological testing and speech and language assessment for children and teens.

Michael Dermansky 

Right. Okay. Well, the reason, uh, one of the biggest things I want to talk about today is really about, I guess, fear and anxiety as well and how it affects people’s behaviour.

We see with us, with exercise that, you know, often one of the biggest limiting factors to people is their fear and anxiety. And so in your years of experience, how has in particular anxiety stop you from achieving the desired

Valerie 

Yeah, it’s a really great question and I think in order to answer that first, I think it’s really important to understand anxiety and to know that that’s really a natural response to stress. And anxiety is, it produces a chemical in our body, which I’m sure you’ve all heard of, which is adrenaline. And it’s what we need to help us get up out of bed each morning and to go for a walk. So I want people to think about anxiety, I guess, in stages or as a scale.

So If we think first and foremost of stage one, which I’m gonna call the rest zone, it’s where you’ve got no stress at all really. And so that’s where you’re essentially bored, inactive or sleeping. So hopefully those listening today, no one’s in that zone or that stage at this point in time. But we actually need a certain level of stress or adrenaline or anxiety to get us moving. And that’s what I refer to as the performance stage. So it’s really where you’ve got that right level of adrenaline in order to do the task that you need to do. But what we start to see is that people move from stage two to stage three. So stage three is called the stretch stage.

And that’s where you’ve got that increased level of adrenaline or anxiety. And you’ll know that you’ve got this increased level because perhaps you’re preparing for a presentation, or for some of you it might be just preparing to get to that next physio session. And really it’s okay to have that burst for a short period of time, but you don’t really wanna stay in that stage for a very long time. If you stay in stage three, which is a stretch stage for too long, you actually are moving into what’s known as stage four, the survival stage.

And really what’s happening here is it’s just a constant level of adrenaline and cortisol that’s pumping through your body. And if you’re in this survival stage, you’ll know it. You’ll be feeling exhausted. You’ll be feeling fatigued. The thought of just starting to do something or getting to that physio appointment is just gonna be really, really difficult. So I guess now that I’ve explained those stages of stress and fear and the body’s response. In short, to answer your question, if you’re in that survival stage where your anxiety is really prevalent, you’ll notice it, you’ll feel it, it’s not really helpful anymore and it’s likely to impact on your ability to do things. You’re most likely going to be really unproductive if you’re trying to attempt to do things because there’s just gonna be this constant feeling of overwhelm. 

And really that’s when anxiety is quite debilitating. It’s where it’s no longer supporting you. It’s no longer helping you perform. It’s actually hindering you to do things that you want to do.

Michael Dermansky 

It’s interesting you say that because what we tend to see that where the anxiety or fear of either pain or the inability of doing activity can often be a limiting factor where people even try things out. And, you know, physically, they can often do it, or we can see the potential that can do it as well. But that feeling of overwhelm, whether it be, you know, true or the way they perceive things, stopped them even going to what they could potentially do. And as a practitioner, you see it and thinking, well, how, how do we work with somebody or working with them to help them understand that this is a perception of what they feel, not necessarily reality. They can do more or they can really start and build up to be able to do more, more than their fear is allowing them to do.

Pain is a natural response to a perceived or a real threat of injury as well. So you may have an injury as well, or you may have the perception of an injury, your brain can’t tell the difference. But it still says, I’m in pain, this hurts. And that can often be a real limitation factor as well. We deal with the physical side, but also have to deal with the behavioral and mental side of how much pain affects people’s behaviors as well. What do you see as the relationship between anxiety and pain in your center?

Valerie 

Yeah, look, and as I mentioned, I think it’s really interesting that the two are connected and the pain is very real and the body responds to anticipatory pain and also to actual pain and sometimes the increased pain that we have can increase the anxiety that we have and sometimes increased anxiety can increase our pain. So it’s an interrelated relationship between the mind and the body and so what we would see is that you’d need to work with both the body and the mind. So working with say physio and or a psychologist in order to come up with solutions to help that person better manage what’s happening for them. But I think regardless of where pain starts, it can be through injury or illness. I expect everyone listening here today will have some level of anticipatory anxiety or anticipatory pain.

It’s where we worry about pain being present, where we worry about it either starting or getting worse. And our body begins, as you mentioned, Michael, that fight or flight response, where we start to have adrenaline pumping through us. And that’s what I mentioned earlier about the stretch stage. And when we’ve got that adrenaline and we’ve got cortisol pumping through our body, you get that anxious feeling. And so what happens then is the anxious feeling that you have is just reaffirming to your mind that the worry,or the worry about the pain is real. And so because in the past you have experienced pain, there’s an expectation that you’ve already said that there will be pain and it will exist, even if at that point in time, there isn’t any pain present.

And therefore we anticipate pain returning. And often you’ll see this with your clients, Michael, I’m sure it’s when they start to think about movement and doing exercise and therefore they might start to avoid doing the things that they think might bring on that pain. So again, just that anticipation. I guess the other difficulty with pain and anxiety is that when you’ve got anticipatory pain or you’ve got that actual pain, your body’s actually in that survival stage. So your body’s never really ever getting a chance to relax or repair. And so what happens then is it also stops you having fun and might stop you exercising. It stops you doing the things you want to do. And so what it’s also doing is stopping you getting a dose of feel good chemicals. 

And by dose, I mean your body’s no longer releasing dopamine or oxytocin or esphacerotonin or endorphins. And what we know about endorphins is, there is a level of natural pain relief, which your body does need. And so while the chemicals that make us feel good also have a restorative component to healing our body, if you don’t have those feel good chemicals, then unfortunately what happens is your body starts to move towards some of those more chronic, longer term conditions that eventually just make it a little bit more harder to shift and a little bit harder and longer to get better.

Michael Dermansky 

So it’s very interesting as well because we talked about something similar to this in the previous podcast as well in regards that, the positive effects of exercise on mental health and particularly, I think it was at least about 15, 20 minutes or so of exercise makes a difference in terms of lowering cortisol levels and increasing your positive chemicals like endorphins and so forth. But I mean, we’re bringing it up again today because it is a really big deal, it’s a complicated injury interaction of things that you have anxiety, you fear the movement as well.

The feeling of the pain, whether it be real or a perception of it because it was all amplified, that’s amplifying chemical. You do less of the thing that you like to do, it exacerbates your feelings of anxiety. Positive chemicals go down. Your exacerbation chemicals go up and it has this cycle effect that it’s important to break, but that one perception thing feeds into the other.

And it is a tough thing as well, because you’re in the middle of it and thinking, well, if I do things, it’s going to hurt. If it hurts, I’m doing damage. I’ve got to stop doing it. So I’ll do less of the things I like. So I’ll feel bad more often, although you’re not trying to do that. It becomes more and more, more heightened at the same time.

 It’s a really tough cycle when you’re in it to see that you’re in that cycle. And and it takes a step-by-step approach in order to break that cycle too, which is not a healthy cycle anymore. 

You know, the beginning part, when you first cut yourself or hurt yourself, your body’s going into a healing stage. It needs to do that. It’s to protect your response, but there’s a point where it starts to shift. That healing response has happened. It needs to happen. And now we need to push you a bit more, but the fear of doing so stops you from doing what you need to do, to actually change and improve. And there’s a real tight balancing between the two. And it can be missed, you can miss that point, where you miss the ability to actually make yourself stronger and fitter, because of the fear of anxiety. And there’s a lot of these chemicals going on the background, that’s not helping that process.

Valerie 

And look, sometimes when you do have that pain, it is really tough. And sometimes if you’ve got that level of adrenaline pumping through your body, sometimes a walk is a good thing to try and actually just give your body that balance and your heart will start pumping because you’re exercising and it actually just changes those levels and it goes from cortisol and adrenaline too, to giving you that dopamine and giving you those endorphins. But you’re right, Michael, it’s tough when you know that it’s going to be painful to get moving. And I guess that balance of is that pain okay to keep going or is that an injury pain? And look, I know my brother has hip pain when he runs and he just keeps running and he knows after about the first five or 10 minutes, it sort of sorts itself out. And I know I similarly do something the same as well. There’s a little niggle, I just think, I’ll just keep running, I’ll see if this gets better or worse.If it doesn’t get better, I stop. And if it sort of resolves a little bit and it’s less in pain, then I keep going.

Michael Dermansky 

Yeah, well, let’s go back to some strategies as well. So what are some strategies that you can recommend to people to manage their fear and anxiety, either about everyday things or around injuries as well?

Valerie 

Yeah, so I think first and foremost, it’s really about being aware of what situations cause you anxiety or cause you fear or worry. For some, you might be aware of those, some it might be easy, and it could be what I call situational stress, you know, we have a presentation at work, I think that’s going to give everyone a little bit of anxiety and so long as you’ve prepared for it, you probably get through it. But if there are situations in your life where you’re not quite sure of what those situations are then have a chat to a friend or it might be have a chat to a psychologist, a professional in the area to help you identify them. 

So first and foremost, you need to be aware of what’s causing you that stress or worry. And then I guess, given that we’ve been talking about anxiety and we’ve been talking about fear, there are definitely a range of relaxation techniques available and strategies available to help people manage that anxiety and fear. And there’s also what we call distraction techniques as well. So it’s about finding which strategy or technique works best for you. 

And I’d probably suggest for most people who have a bit of anxiety or worries that talking therapy is probably one of the best things to do. Most often a psychologist will take what’s called a cognitive behavioral therapeutic approach or you might have heard CBT and really what that talks about is it’s looking at well what are your thoughts, what are your emotions and then what can we do in terms of different behaviors to help you feel better about the situation. So giving you some strategies to manage that worry or that fear so that it doesn’t become debilitating for you in your life.

 And then just thinking back to those areas or those stages of stress and anxiety I think for anyone who has identified with what we’ve talked about and hearing themselves and thinking they’re in the survival stage, then I probably think it’s worth having a chat to your GP, having a chat to see if perhaps anti-anxiety meds might be something to support you to help get through and to reduce some of that anxiety, but also to do some talking therapy as well, so that a professional, a psychologist can help you think about how to manage not only your anxiety, but also how to manage some of the pain that you’re also experiencing.

Michael Dermansky 

Right. Okay. I guess you answer my next question is when is it time to see someone about it to identify it as a problem as well. But I guess that’s the biggest thing as well. That when it’s starting to affect your life where you don’t want to do the things that you want to do in your life, that is a really good trigger saying, you know what? This, this shouldn’t be my life. I need to do something about this. It’s worth having a conversation with someone about it.

Valerie 

Yeah, definitely, definitely. If you’re not doing what you want and when you want and you’re not getting enjoyment, or if you find that you’re canceling a physio appointment or canceling a catch-up with friends or family, then yeah, definitely, I think that’s where, even if you’re not really aware of it, if you hear that you’ve been canceling things and not doing the things you enjoy, it might be worth having a chat to someone.

Michael Dermansky 

All right. And I guess, on another note, which is a little bit different as well. So you don’t have a problem with your anxiety. You don’t have any issues at all. Is it normal to talk to a psychologist and what’s the upside?

Valerie 

Yeah. Oh, the upside at Rose Phoenix Health, we do see a range of people who attend psychology sessions on a monthly basis, and I would say they don’t have a specific problem at all. Really, what they’re doing is they’re attending sessions to give themselves some space and time to reflect on what’s happening in their life, to maybe think about what’s if there has been a problem that’s popped up, to have that non-judgmental space, to explore that problem, maybe to just look at how they can better interact with people at work or at home. It’s really about their time and we think that’s really healthy and I wish everyone did that. I wish everyone had a monthly session and put that as part of what I call a well-being plan. So we all do things to stay well and healthy and that sort of, one of those things. So you might exercise regularly, see the physio regularly, go and catch up with friends once a month. All of those things are part of your wellbeing plan and I think also talking to a professional to give you a different perspective to help you through whether it’s a small issue, whether it’s just a check-in and a safe space for yourself, I’d highly recommend it.

Michael Dermansky 

I guess that’s the biggest last lesson you said. A safe space for yourself is a really good reason to have a chat to things and adults will, adults will learn best by reflection. We need to be able to do and feel and then we need to reflect if we’re going to convert into long-term memory. So often that safe space to reflect is a really big part of good mental health with adults.

Valerie 

Absolutely, absolutely. I think that if everyone were doing that, I think we’d see less issues popping up. It’s just a really good safe space to better yourself, further yourself, know more about yourself, learn that relationship that you might have that’s going on with your interactions. Really just to stay healthy in your mind and body.

Michael Dermansky 

Any last thoughts you have available before you finish up today?

Valerie 

I guess one of the things that I was reflecting on and I hear quite often is, you know, should we seek help for this? It’s only a little worry or it’s only a little fear or a little problem. And I guess I started to think about, you know, in our lives, we often seek help for lots of other reasons. So if we put our mind aside and we start to think about our everyday life where we might have a hot water system that breaks down, we would call a plumber to come and fix it or if we had issues with our internet server we would contact the IT company and say hey what’s going on, but when it comes to us as the authors of our life we tend to think oh I’ve got a problem or I’ve got a worry I should be able to fix that or the worst still we think to ourselves, oh, if I just ignore that, it’ll get better. It’ll be fine.

But if we think about it the other way and we think, well, actually, if my hot water system broke down and I’m not a plumber, I wouldn’t think to myself, you know what? I’m sure I’ll be able to fix it. I’ll go out there and tinker with it. Or actually, if I don’t do anything about that, you know what, I’m sure the heating will come back on, I’m sure it’ll be fine. We just wouldn’t do that. We’d get a professional involved and we’d say, hey, look, I need a little bit of help. Can you come and fix my hot water system? So you know, all I can recommend is that if you’ve got a small little niggle or a worry or a fear, it’s best to just ask for help. You know, you can talk to a friend or a family member, but sometimes it’s just best to go straight to the professional and get some strategies and support and, you know, move past whatever was causing you concern and get on and live a, you know, a well and happy.

Michael Dermansky 

Yeah. And I mean, I guess the two big things that stand out to me and about what you said today. Number one, when it’s stopping you from having the life that you want, when a fear, a worry, a niggle are really limiting you from having the life that you want, that’s a good trigger.

The second thing about that too is that it’s a safe space. If you need a safe space to reflect and talk to, seeking professional help is exactly what that is for. A safe space to reflect and look back at things and make decisions a little bit more clearly as well.

Valerie 

Yeah, absolutely. Good summary

Michael Dermansky 

Well, thank you very much for your time, Valerie. It’s some really good information for the listeners as well. And hopefully they can hear a little bit more about where anxiety fits into the picture, what’s normal, when they should seek help as well and where a safe place to seek help is. Thank you very much for your time.

Valerie 

Thanks, Michael.