588: How to Calm Anxiety and Achieve Peak Performance with Dr. Luana Marques

Pete Mockaitis
Luana, thanks so much for joining us here on the How to be Awesome at Your Job podcast.

Luana Marques
Thanks for having me, Pete.

Pete Mockaitis
Well, I’m excited to…is excited the word? I’m highly interested in digging into your expertise when it comes to anxiety, and fear, and coping, and resilience, all that good stuff. But I want to understand, first, I understand that you had a fear of heights at one point. Past tense, I’m using. What’s the story and how did you overcome this?

Luana Marques
You’re absolutely right. I learned it the hard way. I was actually hiking Yosemite National Park, and when I got to the end of Half Dome, I realized that there are cables there and I had the fear that I was going to fall down. My heart was pounding, a classic fight or flight response. I was already in graduate school thankfully and so I took matters in my own hands to make sure I’d overcome that fear, so it is past tense. I go skydiving as often as I can.

Pete Mockaitis
Oh, that’s exciting. I’ve been skydiving once, twice. At least once. And it is a thrill. Well, how did you do it? What were the key steps for you personally?

Luana Marques
So, the key step of anything when it comes to a fight or flight response is, really, approach and not avoid. But it’s not just to approach completely, it’s what I call comfortably uncomfortable. So, the idea is to create your hierarchy, your approach ladder, and to start small. What you’re trying to do is to teach your limbic system, the emotional part of your brain, how to cool off a little bit. And the limbic system is wired really for fight or flight, and so what you want to do here is approach, stay with the fear situation again and again until the anxiety comes down. And so, I started with ladders, then I went up on stairs and roofs, and then I went to Disney, I did 16 rollercoasters in one day. I don’t recommend it. Skydiving is a lot more fun.

Pete Mockaitis
Oh, that is so good. Well, now I’m thinking, I’ve just been playing with my Oculus Quest headset a little bit when I can’t get out in the real world, and they have a plank experience which is just freaky in which it’s like you’re top of a skyscraper walking out on a plank, and it’s not real but it sure makes you feel crazy, like, up there. So, I don’t know where that falls in the ladder, but I guess that’s sort of one other way that you could initiate a type of exercise, experience, encounter, a something, that is not the whole thing but it’s somewhere on the rung there.

Luana Marques
Absolutely. So, the virtual reality world has taken over and, really, today, there’s virtual reality treatments for post-traumatic stress disorder. So, whatever you can do to play with the brain a little bit, and really what we’re trying to teach is it’s a false alarm. And this example of the plank is great because you’re still in your house but I bet you get your heart pounding a little bit.

Pete Mockaitis
Really, you know, the first time I did it, I was actually…my brother came into town and we went. This was maybe a year or two ago, we went to his VR lounge place, and I sort of embarrassed all of us because I was, “Oh,” made quite the scene, and people looking at a dude with a headset on, like, “What’s his problem?”

Luana Marques
Now it makes sense. And I really like that you’re sharing that, Pete, because often we can’t understand when somebody is anxious, what the experience is like, and at the core of it is this fight or flight response.

Pete Mockaitis
Beautiful. Well, I guess we kind of jumped right into it a little bit of the how and some steps. So, maybe let’s back it up a little bit. When we talk about anxiety, could you give us a definition? It doesn’t have to be supremely, precisely, academically perfect, but just so we’re on the same page for what we’re talking about here.

Luana Marques
Absolutely. So, when we’re talking about anxiety, often we’re talking about a couple things. First is the physiology that comes with this fight or flight response. And so, for a mild sort of just heart pounding a little bit to a full-on sweaty palms, tension, feeling ready to run from threat. So, one component of anxiety is really the physical component of anxiety. The other component of anxiety is where it falls more in sort of the anxious thoughts, it becomes worry, “What if this happened? What if that happened?”

And so, I tend to think about anxiety through the Yerkes-Dodson Law, really thinking about how low levels of anxiety results to low levels of performance. At moderate arousal, we have this peak performance. At mid arousal, peak performance. And then when we get to too much arousal, too much anxiety, then our brain shuts down a little bit and becomes really hard to focus.

Pete Mockaitis
I totally buy that in my own experience in terms of…and I’m thinking about…What was the model you mentioned? What was the name?

Luana Marques
So, it’s called the Yerkes-Dodson Law.

Pete Mockaitis
Yerkes-Dodson Law. I guess I’m thinking about Mihaly Csikszentmihalyi and Flow with regard to if it’s too little, it’s we’re bored; too much, we’re freaked out, overwhelmed; and moderate, it’s like, “Ooh, an interesting challenge,” and we’re in the groove and flow. And I experience that as well in terms of just thinking about career moments, like, “Ooh, this is a big opportunity.” I’m a little nervous and excited about it, and then I’m stretched, as opposed to, “This is wildly overwhelming, and I’m freaked out or I’m really bored by what’s going on here.”
So then I would like to hear, in terms of the research and discoveries, what for you has been the most fascinating, surprising, enlightening discovery you’ve made about anxiety and how us humans work during your long career of psychologist and researcher and real-time adventurist?

Luana Marques
So, early on in my career, a lot of the studies I worked on were questions like not, “Does therapy work?” but “Does it work better with medication?” In therapy, the ones I’ve studied really fall on the cognitive behavioral therapy, so what you’re saying to yourself, what’s that making you feel, your emotions, and what is your behavior, the actions you’re taking. And early on, what we knew is that CBT is not only effective but it can help you rewire your brain. Pre-imposed studies, so 12 weeks of therapy. Pre-imposed function MRI, you see a change in the brain domain that you’d want to see, decrease limbic response, increase frontal cortex of thinking brain.

So, early, what was exciting, is to know that, before we even talk about neuroplasticity, that we could actually change our brain with therapy, is really cool to me. And then, now that we know it works, what gets me the most excited these days is, “How do we get out of the ivory tower and into the streets? How do we actually think about this as brain health and so that you need to exercise your brain with those skills? And how can we get it to everyone?” And that’s really what our research lab focuses on mostly these days.

Pete Mockaitis
Well, let us know, what are some best practices if more people want to taste some of those benefits without, to the extent possible, doing a full-blown 12 weeks of therapy? What can we do?

Luana Marques
So, there are a couple of ways you do it. One, on July 12, we’re going to release a course called Mental Health for All, and it is a very simple dosage of the skills I’m talking about. There are four modules, and it’s going to be available for free for anybody in the world. So, if you think about building resilience, you’re going to be able to learn how to slow down your brain, separating thoughts, emotions, and behaviors. You’re going to be able to learn how to charge up. So, the role of eating, sleeping, and exercise for your physical and mental health. We’ll teach people how to approach their fears and to also change some of their thinking.

And you can find more about the course on my website DrLuana.com. You can also practice the skills like mindfulness and meditation. Those are definitely some things that are out there, easily accessible, and shown to rewire your brain.

Pete Mockaitis
Excellent. Well, boy, I’d love to talk about all those things, I’ll just have to take the course. Let’s talk about changing thinking, shall we? We talked a little bit about the going up the steps, and we’ve talked with a few guests about charging up and self-care and energy stuff. So, how do you recommend we go about changing our thinking?

Luana Marques
The first step with changing our thinking is to remind ourselves that thoughts are not facts, and that’s really important. Once we get stuck on patterns of thinking, we forget that those are habits. So, you show up at work and somebody gives you a look, and you might say to yourself, “That person is mad at me.” You jump to a conclusion. And that thought immediately probably makes you a little anxious and you might avoid that person.

So, the first thing is just sort of like listen, “What am I saying to myself? What is exactly that thought?” And then a very simplistic way to change your thought is to say, “Okay, what’s the evidence that I have to support that thought? And what is the evidence I have against that thought?” So, in the example here, you may say, “Okay, maybe that person is mad at me, but I don’t have evidence. Maybe they are preoccupied, maybe they’re tried, maybe they were thinking about something else.” And so, you really want to put the evidence for and against in a balance, like in a scale, and be able to say, “Okay, based on this evidence, do I actually have data that can prove that thought right?”

And if you can’t, then we need to really arrive at a more balanced thought. And the trick here, Pete, is really balanced. Often, when we talk about exploring thoughts, people are like, “Well, is it a happy thought? Is it a sad thought? Is it a good thought?” It really is not. It’s balanced. Sometimes there are thoughts that are realistic. I can’t say to a patient who had an experience of racism that that wasn’t real, right? But if you focus only on that experience, then you’re going to continue to feel upset.

Pete Mockaitis
So, with some fair synonyms for balanced in this context be sort of like accurate, truthful? I get the sense that when you say balanced, you mean that it is reflective of full reality more or less. Is that what you mean by balanced?

Luana Marques
Exactly, Pete. That’s what I mean by balanced. By really looking at the whole picture and understanding sort of all of the facts in front of you, and almost summarizing them in such a way that you can say, “Huh, I’m saying this to myself for a long time. I have a habit of saying this. This may not be an actual fact. It could not be held in a court of law as a fact.”

Pete Mockaitis
Okay. Sure thing. I’d love if you can maybe give an example here, and let’s talk a little bit, shall we, about coronavirus, shall we, a source of much anxiety these days? Let’s say someone has some thought patterns like, “I can’t do this, I can’t do that. I must do this. I must do that. I’m freaked out that I could catch it and have a horrible time, lose my sense of smell or taste forever,” and they’re just all kinds of anxious and freaked out. How would we go about moving to balance?

Luana Marques
So, the first thing I would do is slow down. So, let’s imagine that was you for a second, that you’re the person saying those things to yourself. So, the first thing I’d want to know is, “What is the situation that triggered those thoughts? Where were you? I’d like to see exactly what you’re doing when those thoughts came up.”

Pete Mockaitis
Let’s say, so I’m the person who’s highly anxious. Let’s say my wife suggested she wanted to go get an oil change, and I thought, “Uh-oh, we can’t have that. There’s all sorts of person interaction there.”

Luana Marques
So, your wife suggests, I can see great situation. So, the first step is to actually anchor in the situation, because if we don’t anchor in the situation, we can’t isolate a specific thought that may get you anxious. Now, in that situation, there were a bunch of thoughts that you had, right? So, let’s walk through the thoughts again. What are the first two thoughts that may have jumped in your head?

Pete Mockaitis
Sure. Well, now that we’re anchored in the situation, I’d say, “Uh-oh, she might get it from a mechanic, and then she could be hospitalized, and we’ll be in a world of trouble with taking care of the kids and work and everything.”

Luana Marques
So, I’m going to stay with the person, “She may get it from a mechanic.” Okay. When you say that to yourself, how did you feel? What’s your emotions like?

Pete Mockaitis
I guess I could use the word, I want to say anxious but it almost feel like cheating in this conversation, so we’ll say afraid, concerned, worried.

Luana Marques
So, afraid and concerned, which makes you get worried, right? And what do you want to do? What’s the behavior?

Pete Mockaitis
I’d say, “No, don’t go. Let’s not do that.”

Luana Marques
“Let’s not do that,” right? And your wife then says, “No, I really, really want it.” What does that do to that fear that you’re feeling?

Pete Mockaitis
Well, I guess it makes it more, it’s like I wanted to exert some control over in this hypothetical situation, and now I apparently am failing.

Luana Marques
And so, the first thing I’m illustrating for us, before we even get to this balanced thought, is that before we get there, we need to understand what we call our TEB cycle, T for thoughts, E for emotions, B for behaviors. TEB cycle. That’s really separating thoughts, emotions, and behaviors anchoring in a situation. Once you do that, then you look at that thought, “My wife might get it from a mechanic” Now, let’s ask questions out of that thought. What is the evidence – and evidence, I mean, something that could be held in a court of law, that a judge says true – that your wife might get it?

Pete Mockaitis
I don’t know if it was Dr. Anthony Fauci, or one of these health people, said, like, “Oh, the best course of action is just to assume that everybody has it.”

Luana Marques
So, I agree, that may be the best course of action, but how does that help us prove that your wife will get it?

Pete Mockaitis
Sure. Well, I guess one authority figure said, “Assume everyone has it so you might…” I guess I don’t have the best stats here. I think some health experts estimated perhaps 10% of people in the US have it right now.

Luana Marques
Okay. So, your brain is saying your wife will get it, and the stats are saying 10% of the people are getting it. So, perhaps the probability may be slightly lower than she’ll get it. Is that fair?

Pete Mockaitis
Sure, yeah. It would be 10% or less.

Luana Marques
Or less. What would be the evidence against it, that she might not get it?

Pete Mockaitis
That she might not get it. Well, I guess then the 90% don’t actually get it.

Luana Marques
I know. You see the brain tricks us. The minute you say to yourself, “She’ll get it,” then you’re locked into this worst-case scenario, right? Getting to a balanced thought is really looking at, “Okay, there’s 10% chance, there’s perhaps 90% chance that she won’t, and I bet we could work together through the steps of making her stay so that she could still engage with it in a safe way.”

Pete Mockaitis
Yes.

Luana Marques
Does that make sense?

Pete Mockaitis
I agree.

Luana Marques
So, a balanced thought may look like something like this, “My wife is taking a chance but we really need that oil change to be able to keep doing the things we need to do, so we’ll make sure she’s wearing a mask, that she’s distanced, that we’re going to disinfect the car after, and that would decrease the likelihood that she’ll get it.” That’s more of a balanced thought versus, “She’ll get it.”

Pete Mockaitis
Certainly. Okay. And so then, a balanced thought…well, let’s say it’s as balanced as you can get. Why don’t we say based upon deep research and many epidemiological bottles, we can infer that there’s approximately a 0.34% chance, give or take, that she will contract the coronavirus from an interaction with a mechanic. So, that’s very small. Now, that may be balanced, but it might still have all sorts of anxiety emotion wrapped up in it, like, “Oh, that’s a lot more than zero, and it could be real bad if she gets it.” So, where does that leave us?

Luana Marques
Well, it leaves us to face reality a little bit, and I think this is where it’s hard to fully balance our thoughts when we’re talking about more realistic thoughts. A thought of somebody is mad at me, for example, it’s very distorted and black and white. When we’re talking about a pandemic, there is the reality that some bad things are really happening. And so, there’s this piece of having to tolerate being comfortably uncomfortable, and then I think really trying to right-size your willingness to take some chances, right?

The best chance is to do nothing, to not get the oil change, I agree. But it’s sort of hard to live that way. And so, I think it’s a sense of like, “Can I tolerate some uncertainty?” And if you really can’t, then, in a pandemic, I’d say, “Don’t do it.”

Pete Mockaitis
Right. And then I guess it’s balanced in that we can then really compare, it’s like, “Okay. Well, that is the risk that we would take.” And on the flipside, “What is the consequence of not getting the oil changed? I guess there’s a risk that the car will break if you don’t intend to basic maintenance. You okay with that?”

Luana Marques
Yeah. And it is tough. It is a hypothetical scenario and we’re joking around, but it is a tough time. And the idea of exploring thoughts in a pandemic is to be able to at least making sure that you’re not adding to your anxiety. Anxiety is biologically adaptive up to a point. Up to a point, you get to that zone. What we don’t want to do is be tipping over that zone to a really negative area by having thoughts that distort it. So, that’s really where I think the juice is in exploring thoughts.

Pete Mockaitis
Okay. Well, yeah, let’s talk about that notion of not adding to it. I imagine there’s all sorts of implied do’s and don’ts for us right now or any sort of stressful time of change and difficulty, whether it’s economic or social or health, and we got all three at this moment in the US. So, yeah, I imagine, for example, reading news could make you feel more anxious.

Luana Marques
Definitely do’s and don’ts. So, what we don’t want to do is anything that adds to this fight or flight response. So, anything that activates your emotional brain, we don’t need more of that. We have plenty of it. We have a real threat, coronavirus. On top of it, we have an economic crisis and lots of other difficulties, so we don’t want to do anything that turns it on. So, what do we want to do? The opposite. You want to cool off your brain. How do we do that? By turning on your thinking brain, your prefrontal cortex.

So, the five skills that we often talk about, so the first one is anchor and unplug, and you handed it to me beautifully, which is we know, for example, research shows us that during the marathon bombings here in Boston, that individuals that watched six plus hours of the news related to the bombing at home had a heightened stress response than those that were actually there.

Pete Mockaitis
Wow!

Luana Marques
So, the news can actually induce stress.

Pete Mockaitis
Actually there. Okay.

Luana Marques
Right? And so, think about what that says, that just watching, you’re activating your thinking brain. So, we really need to unplug as much as we can from the news, perhaps watch it twice a day. And then you need to anchor your brain on something that’s good: mindfulness, meditation, talking to your family, doing things to slow down the brain. That’s one of the skills that I often recommend based on science.

Pete Mockaitis
Something good. Well, I think about John Krasinski with his “Some Good News.”

Luana Marques
Exactly.

Pete Mockaitis
So, nice work there, John. I’ve never met him but we’re on first-name basis. So, give us some more examples of maybe even, hey, research-based, sort of a big bang for the buck in terms of good stuff that do good things to us biochemically.

Luana Marques
Well, in many ways, we get actually sort of a second set of skills which you’ve mentioned you’ve talked with several of your guests before, but it’s the idea of charging up. Eating, sleeping, and exercise, our bodies are like the batteries of our heart. We actually have to spend energy to get energy. And the problem is, when we’re feeling really anxious, people get stuck, right? They don’t feel like doing something, so they don’t exercise. They forget to eat or overeat. And we know that those three things not only help your physical body, it actually decreases depression, decrease anxiety, and increase wellbeing. So, charging up is extremely important, and I think not optional during pandemics. It’s one of the few things we actually have some control, for the lucky ones, to be able to do.

Pete Mockaitis
Okay. Well, so then let’s go there for a bit. So, charging up, exercise, good nutrition. Are there any particular high-leverage areas here? Well, there’s sleep. I mean, can you tell us something that we might not know in terms of…?

Luana Marques
About sleep?

Pete Mockaitis
Well, I guess, in some ways, that’s the hard thing with great common-sense wisdom, you know, it’s sort of like, “Oh, yeah, I should eat healthy and I should sleep and I should exercise.” So, I‘d love it if you could put a little oomph to it in terms of, “Ooh, this particular nutrient makes a world of a difference,” or, “Hey, this study showed that, boy, a little bit of sleep deprivation is actually devastatingly harmful.”

Luana Marques
Yeah. Well, sleep deprivation not only decreases your immune system but also create memory deficits, so that, for sure, we know it’s a problem. But when it comes to sleep hygiene, broadly speaking, one of the things that most people completely violate in the sleep hygiene is that their bed should be used for sleep and sex. That’s it. You should never watch TV in your bed. You should really make sure that when you transition to bed, you’re really actually trying to slow down your brain, and that’s what most people don’t do.

Pete Mockaitis
All right. Thank you. Well, tell us, anything else that you recommend we do or not do before we shift gears and hear about some of your favorite things?

Luana Marques
I guess I recommend that we really hyper focus on the value of social support, of staying connected. It’s the only buffer that we really know against mental illness. And so, no matter what it is, even having this conversation, right, staying connected one way or another can really help us decrease the chances of developing emotional difficulties as a consequence of this pandemic.

Pete Mockaitis
All right. Lovely. Well, now, can you share with us a favorite quote, something you find inspiring?

Luana Marques
So, my favorite would be “Whenever you really want something, the whole universe conspires for you to have it,” by Paulo Coelho, The Alchemist.

Pete Mockaitis
Thank you. And how about a favorite study, or experiment, or a piece of research?

Luana Marques
I go back to neuroplasticity. The fact that you can rewire your brain, pre-impose cognitive behavior therapy. It’s incredible.

Pete Mockaitis
And a favorite book?

Luana Marques
I go for The Alchemist. Searching your personal legend, I know it’s a fiction book but it really helped me in my journey here to this country.

Pete Mockaitis
Okay. And a favorite tool, something you use to be awesome at your job?

Luana Marques
Approach, not avoid. So, the most important thing is to be comfortably uncomfortable all the time. I define myself as an over-approach-er, so always ahead of it.

Pete Mockaitis
An over-approach-er. I want to dig into that. So, you’re saying you would approach perhaps even more than…what are we over-approaching?

Luana Marques
So, the thing is anxiety is biologically adaptive up to a point, right? And then when it becomes too much, our brain starts to really stop working, as we talked about. I don’t like the experience of anxiety, like nobody really does. And so, whenever I wake up, if there’s something I really don’t want to do, it’s the first thing I do. I over-approach and I try to get ahead so that I stay as close to the zone as possible. That’s what I mean by over-approaching.

Pete Mockaitis
Thank you. And, well, it seems related, but how about a favorite habit?

Luana Marques
That’s pretty much it.

Pete Mockaitis
Yeah, okay.

Luana Marques
Approach. Approach. Approach. Yeah, that’s pretty much it. Comfortably uncomfortable.

Pete Mockaitis
Okay. And is there a particular nugget you share that you’re known for and people quote back to you frequently?

Luana Marques
Recently it’s really been this idea that it’s okay not to be okay, that we all experience strong emotions in the pandemic but that we can also be able to change what we experience by using science-driven skills like we talked today.

Pete Mockaitis
Okay. And if folks want to learn or get in touch or take that course, where do you point them?

Luana Marques
To my website, DrLuana.com. You can sign up for the newsletter there. And we’ll be releasing the course in mid-July.

Pete Mockaitis
Okay. And that’s D-R-L-U-A-N-A.com?

Luana Marques
Yes, you got it.

Pete Mockaitis
Okay. And do you have a final challenge or call to action for folks looking to be awesome at their jobs?

Luana Marques
Yeah, I would encourage you to really work on approaching areas of discomfort, really this idea of being comfortably uncomfortable, and share with us. I’d love to hear more.

Pete Mockaitis
All right. Well, Luana, it’s been a treat. I wish you all the best in your approaches.

Luana Marques
Thank you. It’s been delightful to be here, Pete. Thank you for having me.