Transcript:

Ben Smith:

Welcome, everybody, to the Retirement Success in Maine Podcast. My name is Ben Smith. Allow me to introduce my co-host, the Mount Desert to my Peaks Island, Curtis Worcester. How are you doing today, Curtis?

Curtis Worcester:

I'm doing well, Ben. Doing well. I like the island theme today. The sun's out. It's getting a little warmer. We may not be at the end of winter, but I think we're getting there.

Ben Smith:

We're closer to spring. You got to think warm thoughts and things.

Curtis Worcester:

Exactly.

Ben Smith:

I know obviously, we've covered a lot of topics lately on our show, and one that I think you and I have seen a little bit more from our population that we service as financial advisors is anxiety and people getting a little bit more wrapped up around or worried about things or nervous about things. It's something that again, we've seen and found more obviously than depression and cognitive disorders sometimes in older adults. I'm going to quote a WebMD article. I know, I know. The resource is we found that 10 to 20% of older adults suffer from anxiety. We all have family members and friends and relatives that we just know anxiety, that constant state of worry is something that's present in our lives.

Curtis Worcester:

Absolutely.

Ben Smith:

So again, in our practice, of course, we see these signs and we see untreated anxiety start to shrink our client's worlds. I think what we want to do in our show in a lot of our practices, well, we have money, we now are retired. What are we trying to do with this money? How do we expand our worlds? How do we experience more of life? When we start getting more anxious about, say, traveling to other parts of the world or social situations or being judged, all of those pressures happen, then I don't go to social situations as much.

Maybe I don't go to the doctor. I don't get checkups because I'm anxious or worried about hearing possible bad news, but it doesn't have to be this way, does it? So there are things that we can all do to address our anxiety and help us manage our fears, whether they're logical or illogical. So, that's what really what we want to talk about today and have a discussion about managing anxiety as we age.

Curtis Worcester:

Absolutely, Ben. As we like to do on our show, we like to bring in experts. You and I are nowhere near experts in this topic.

Ben Smith:

Nope.

Curtis Worcester:

So, our guest joining us today attended Bowdoin College in Brunswick, Maine, where he earned a bachelor's with double major in psychology and music.

Ben Smith:

Nice combo.

Curtis Worcester:

Yeah, exactly. So, after an unsettled year of living for brief periods on Martha's Vineyard and Bristol, England and Raymond, Maine, which I think is just a fascinating trio of places which we might need to explore, he spent the next decade in the great Midwest completing a master's and PhD in psychology at the University of Nebraska and clinical psychology pre-doctoral internship at Indiana University Medical School. So, for more than the past 17 years, he's worked at Northern Light Acadia Hospital as a psychologist, program director, and quality improvement director. He has always found teaching to also be among his greatest interests and passions.

His areas of professional work have included improving the integration of primary care and mental health, improving healthcare quality and organizational performance, and the use of measurement and applied research in healthcare settings. His clinical interests include bariatric surgery, group psychotherapy, and treatment of schizophrenia. So, Hussan University's Health Administration and Public Health major allows him to pull together these many areas of interest to prepare the next generation of healthcare workforce in an industry that provides endless academic impractical challenges.

So, currently living in Hampden, Maine with his wife, Diana, also a psychologist, and their three daughters, he spends a lot of his time working for Hampden Psychological Consultation. He's an avid runner and a not quite so avid hiker. He spends what free time is left, which based off that bio I don't think is much, enjoying the many benefits of living in Maine. So, with that, please join me in welcoming David Prescott to the Retirement Success in Maine Podcast. David, thank you so much for coming on our show today.

David Prescott:

Thanks, Curtis. I appreciate that it almost sounds like you're describing somebody else. Yeah, that's a lot of years there you covered. Thank you.

Ben Smith:

So David, obviously, we read the bio and we're now acquainted with some of your through thread. We always just like to get to know you a little bit and what makes you tick. Love to hear a little bit about maybe the soft part of your background and what drew you to a career in psychology.

David Prescott:

Yeah. I probably started at the point like a lot of folks who end up in psychology, you enjoy helping people and I enjoy listening to people. So, I think that's a big thing that you like to listen and you find the question of what makes people do what they do fascinating. That still does it. I had the really good fortune. I grew up in Lebanon, New Hampshire, which is right next to Dartmouth College and Dartmouth Hitchcock Medical Center. I had the good fortune to work summers when I was in college as a psychiatric technician on their mental health unit up there. I got hooked. I loved the work. I loved helping people, but I'm still just curious.

I never get tired of trying to understand what people are thinking, what makes them tick, how they're put together, and how they handle problems. So, that is probably the biggest thing. The biggest lesson for me as a psychologist is to shut my mouth and listen, because usually, most people, if you can guide them, will come to a solution for their problems by themselves. What you tell them, 90% of it, they hear it at the moment, but it's gone when they walk out the door.

Curtis Worcester:

As I read off there a couple minutes ago, you have experienced many other parts of this country and the world throughout your life. Why have you chosen Maine? What made Maine the place to be?

David Prescott:

Yeah, I think about that year from Martha's Vineyard to England back to Raymond, it was a little random. Like a lot of people, even though New Hampshire's a beautiful state where our family used to come here to vacation over in Western Maine actually, over in the lakes around Bridgton and Freiburg. Then I had the good chance to go to school here. I was really lucky to get a lot of help in both finding Bowdoin College and then being able to frankly afford it, which was beyond my family's reach. They helped out a lot. I often tell people that there was a similarity between Maine and Nebraska.

The pragmatism of the people, the rural nature of the states, and I think the fact that people at the end of the day value helping each other and what's going to work rather than any type of ideology or difference based on anything else just permeates Maine, I think, and certainly did with Nebraska. So, when we got a chance to come back to Maine, they were building Acadia Hospital. We didn't know that. Diana and I were living in Indiana and they were recruiting like mad. So, we thought we'd try it for a year or two. That was in 1994.

Curtis Worcester:

Here you are, stuck.

David Prescott:

Yeah, I love the people here. I really do.

Ben Smith:

Dave, I know that there'll be something we'll talk a little bit more about here over time of obviously, the people here and what makes us tick as a group and some of the things that we find, but let's go back to Northern Light Health Acadia Hospital here a little bit. I know you've had several hats over the years with Acadia. Tell us about your role currently and what impacts you've seen at Northern Light over your career though. What have you seen happen, again, as you're saying, from since inception, almost 1994 through now? What have you seen the difference been made with that organization?

David Prescott:

Yeah, I had the good fortune when I came up, the folks that developed and built Acadia Hospital who were concerned members of our community to talk about their own personal experience either themselves or a close family member of when somebody needed really top-notch psychiatric and mental healthcare, having to go to Boston if they needed to go in the hospital for treatment and how disruptive that felt. Like any of us that have had to travel for a medical condition, it just wears you out. They really took the idea of, "Why can't we build a first-rate world-class psychiatric hospital here in Bangor?"

They knew how to make it happen. I continue through as I've been at the hospital through watching mental health evolve in the opiate epidemic, which has had a huge impact on mental health services and some of the things we now recognize in kids like autism spectrum disorder, which was rare, partly because we missed it, partly because we think it's going up. It's just been a pleasure to be able to tell somebody. If you see them in the emergency room and you've seen them therapy something other than, "Hey look, we're going to have to send you down to Boston. We're going to have to send you to New York, or even just down to Portland." That always feels good. That never gets old.

Curtis Worcester:

Yeah, right. No, that's great. I know the topic we want to really dive into today, talking about managing anxiety as we age. So, as we transition into the beef of the conversation, we think it's best to always just start with some foundational knowledge. So, for our listeners, can you just give us a definition of an anxiety disorder? So what are some of the most common anxiety disorders? What are the symptoms? Tell us how maybe we could talk about anxiety related issues with a doctor.

David Prescott:

Yeah, that's really important and we may return to this, but having anxiety in and of itself is not bad, wrong, or abnormal. It serves a purpose, but the things we look for in mental health are panic disorder, which is repeated panic attacks. Having a panic attack in and of itself is not terribly uncommon, but having repeated ones. So, we have something called generalized anxiety disorder where anxiety instead of focused on one thing has spread to everything in your life. So, everything makes you anxious.

So, panic disorder, generalized anxiety disorder. There's debate in the field about obsessive compulsive disorder, whether or not to count it as an anxiety disorder. So, we have that. The other thing we see a lot are people who have post-traumatic stress disorder, been through some horrible thing, often things that are hard to listen to, abuse, neglect, some very difficult trauma, but they get a lot of anxiety associated with that. So, those generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and maybe for some obsessive compulsive disorder.

Curtis Worcester:

I like that.

Ben Smith:

So David, you mentioned panic disorder. Let's just dig into that one specifically as a common type of anxiety disorders and just seeing my grandparents as they age. You could see that there's things that created this panic attack. So, again, I have several people I obviously know that have had anxiety issues. So, why do panic attacks occur and then what are some triggers of those attacks? Let's get to the core root of why are they happening to us and then what are some triggers that you see over time that you feel like they're more common to be associated with that?

David Prescott:

Yeah, that's a really good question. Interestingly, a lot of people, the first time they have a panic attack show up at the hospital thinking they're having a heart attack. So, it feels a lot the same from what we listen to people. So, the physical symptoms, all of a sudden, your heart is beating really, really fast. You can't catch your breath. Your scope of vision narrows. All you can think about is the anxiety. Often they're shaking, people are sweaty, they feel like they're going to die. They do that. It is intense. One of the things we find for people is that once you've had one, you'll go a long way to avoid having another and turning your life in a pretzel just upside down in and out. So, people get that thing.

The onset is usually a rapid ascent. It's like climbing up one side of a rollercoaster really, really fast. They get there and they feel like they can't get out of it. They feel like they can't breathe, they can't slow themselves down. It's incredibly subjectively unpleasant. I often tell people to think of what happened to your body when you almost got in a car accident or almost fell off a very high place or something where you had one of those experiences. I guess I would ask you guys, do you remember what happened? Maybe if you've ever almost been in a car accident, what the experience was and what happened?

Ben Smith:

Sure, absolutely.

Curtis Worcester:

Absolutely. Yeah.

David Prescott:

I'll put you guys on the spot a little here.

Ben Smith:

Yeah. So, I would just say, so of course, lose control of the car. So, for me, I was in high school driving home, hit black ice, lose control. I'm in the moment and it's like nothing I can do in the moment to control it. The car's just going where it wants to go. I hit a guardrail. In that moment, all of a sudden, I'm just seized up, hit the brakes as much as I can. I don't even comprehend what just happened to me. It took me a second of like, "Well, I'm in high school. Do I tell my parents?" All of a sudden, I get very frightened. I just am in survival mode all of a sudden and I just start then driving back away. I'm like, "Wait, should I even be doing that right now?" I just lost complete control over what I should be doing, what's rational, logical, all that. So, that was my experience.

Curtis Worcester:

Yeah. I guess thankfully mine isn't, I think, as in depth as that one. So, what I'm thinking of, honestly, it happened probably six months ago just driving down Stillwater Avenue here in Bangor. Thankfully, the technology and vehicles now, I think the car stopped before I could have registered and stopped it myself. But someone just pulled out in front of me, I think, coming out of Hanford area, grocery store. It was one of those that I guess the post happening feeling I think is where you're going. I'm sitting in my car, to Ben's point, trying to process what just happened. I'm taking inventory. I'm like, "Did I hit someone? What happened here?"

Everything was fine, but my heart's going crazy. I was headed to Best Buy or something and I just sat there for a minute. Hold on, relax. My Apple Watch is pinging at me. It's like your heart rate's going through the roof. What's going on here? I think where you're trying to go, just all of a sudden, to Ben's point, my body just locked up and I was like, "What happened? What did I miss? Where am I?", that feeling. It is crazy, I guess, is the only way I can interpret what I was feeling.

David Prescott:

Yeah, exactly. You do feel crazy. So, yeah, those are both great examples. So, what happens in those things? You notice one of the things that happens is there's a little bit of a delay between when you see the other car or you realize you're skidding and when your heart starts going and you're breathing and you're sweating and you're breathing really fast. So, as most of us know, that's your fight or flight system getting switched on. It takes a few seconds for it to fully mobilize. So, that's what's happening. Once that flips on, all those physiological responses are just going to run its course. You can slow it down, lessen its impact, but it's going to go. You can't stop that feeling. All right. That's what happens.

So, in a panic attack, what we think happens is that gets flicked on, that system that's hardwired into you, but it's not for a physical danger thing. In your situations, there was a danger at your hands where you were going to get crunched. With the guardrail, you're doing that. But we find for people with panic attack, it's something else. It's a psychological thing that turns that system on and reinforces it. The perceived danger keeps going and going. It's really hard to think, Ben, what you were saying, you start, "Should I be doing this? Should I be doing that?" Your ability to organize and figure out rationally what to do next is just shot all to pieces. So, that's the experience.

Ben Smith:

So David, you made a point about this mental pretzel that people get in. Hey, I went through this fight or flight moment. I elevated myself into this unsettling physical state. So, let's use maybe my example of I'm in my car and I lost control. So, are you saying essentially, maybe that's the thing that led to a panic attack for me so that I would then have anxiety or I would try to avoid maybe getting back in that car because I'm so worried about a repeat event and leading up to a panic attack? So, I just avoid that activity altogether.

David Prescott:

Yes, exactly. That's what happens. The other thing you see sometimes is that people have trouble identifying what it was that triggered the panic attack. Our minds are processing a lot of information. So, you will start to have one. I've worked with people, they cannot at first figure out why. Sometimes it's really obvious. We're talking a little bit about with people as you age and anxiety and stuff like that, but there can be things around your house. It can be sorting through the mail and you see a bill or something that you don't want to think about. You put it aside but your mind grabs onto it.

Then a little while later, all of a sudden, you're having a panic attack and you say, "I can't figure out where this came from." Usually, you can back up and find where the trigger is. Sometimes they're very obvious. You get into something like that. But for some people, the cues, what sets it off is often pretty subtle and you have to get into what their subconscious or barely conscious mind is processing and back it up to that will cause it. In those cases, people are often turning their lives upside down. They don't know what caused it and so they just freeze for a while because they just don't want have another one.

Curtis Worcester:

That's interesting. So, I want to keep going here and talk specifically about older adults. So, as Ben mentioned, I think, in the intro, so as our role as financial planners, we see financial insecurity being an anxiety trigger often for that population that we work with, especially looking back at the year of 2022 when they may see losses in their portfolio and it just starts to become feeling overwhelming for them. I just want to ask, so what are some other topics that you see as common anxiety triggers in this group of people? Then I'll have a couple follow-ups after that, but I'll pause there.

David Prescott:

Okay. The financial insecurity is certainly one. For some people, I see the question of, "What the heck am I supposed to do now with my life?" can cause a lot of anxiety. We spend a lot of time for many people who have families and careers and such that are meaningful, you're just driving through that from your 30s, 40s, 50s, 60s. It really is a shift in, "Okay, what's my purpose? What am I all about?" We call existential anxiety, but I think we're really patient with young people to go through that. There's a whole lot of things about, "Okay, what are you going to do? Try this. It's okay that you haven't figured it out," and all those things.

We don't seem to have that same thing built into our society with older people. We're like, "What do you mean, you've been alive for 65 years? Why can't you figure out what you're supposed to be doing here?" So I think that is a common trigger. The other thing, mild loss of mental functioning or physical functioning is often really anxiety producing for people.

Curtis Worcester:

I can imagine.

David Prescott:

So it's normal to have a little bit of, we've studied this quite a bit, cognitive slowing. For example, for older people, it's normal to take longer to solve a problem or read something or process something. You're just as good as you always were, but you start to think, "Oh, man, I'm losing my edge, I'm losing that." People's anxiety about losing their memory can really take them right up the ramp in a big hurry. So, loss of mental functioning, loss of physical functioning, and that general transition about, "So what am I supposed to do now?"

Curtis Worcester:

Yeah, no, those are all really great points you brought up. As you were explaining the cognitive slowing, I mean I can only imagine what that... I mean I'm sure you would just spiral into, "Am I losing my mind? Do I have dementia?" So I can just only imagine that. I want to ask, so if I'm an older adult, what are some ways that you think I can manage that anxiety better as I age, specifically in this question, say without medication?

David Prescott:

Yeah. Well, psychology, we're not experts in medication. Every physician I've ever talked to says it's usually more tricky in the elderly, the older you get, because you're processing slower and different. So, the thing to avoid, I think, for a lot of people when they're going up an anxiety peak, they get almost to the top of the mountain and then they stop and run away. What you start to learn, this is what we do when we treat clinical anxiety, is that a lot of people have learned that escape and avoidance, either getting out of the situation or just not thinking about it, is how I'm going to manage my anxiety. Like when we were kids, you used to put your hands on your ears.

Curtis Worcester:

Sure.

David Prescott:

That thing. But a lot of people, they deal with their anxiety by avoidance and then it just keeps coming back over and over again. It comes and they have to work harder to shut it off. So, the first thing I say to people is I walk them through that whole anxiety scenario. Okay. So, tell me what happens if your memory isn't really as good, what does that mean? What does that mean? You find a couple things happen. One is it's rarely as scary as you make it out to be. The second thing is you start to figure out what to do about the situation that's causing you anxiety. So, you push a little bit through. Some people are really good at it naturally. You push a little bit through trying to fight that tendency to just not think about it.

Ben Smith:

David, I'll echo that because I know just as we're talking to the population that we support, right now, we're meeting with people and it's like we're reviewing results that are really probably not something that they really want to talk about or see or they know they have losses, but I think they're scared that we're going to come to them and say, "Hey, that lifestyle that you've been living, what that means is that you're not going to be able to enjoy your lifestyle anymore." So they have this avoidance of I don't want to have this conversation because if you tell me that I'm not able to live the life that I'm living now and if I just avoid it, then maybe the results turn around tomorrow and everything's all solved for itself.

Of course, we're trying to do this of let's just talk about where we are. Let's have a productive conversation about, "Hey, what can we do? What behaviors can we adjust to get ourselves back on track to maybe enjoy the lifestyle that you're looking to have long term versus let's ignore?" Then hopefully, it goes away and then maybe it doesn't, right? So I think we have that a lot with that group that we work with and they're paying us to think about their best selves long term. I think that's where we're trying to help them. I want to ask another question here. You gave me a quote. Is it Hans Selye?

David Prescott:

Yes. Yeah.

Ben Smith:

Okay. Hans Selye, a pioneer in stress research, he says, "The absence of stress is death." So, you were saying earlier a little bit of anxiety is actually a good thing. Hey, getting a little bit of anxiety means we care and it can enhance performance and keep us focused. If we didn't have any anxiety at all, we might be a little bit more laissez-faire and just bebopping through life that way. So, my question to you, David, is help us distinguish what is helpful anxiety and what is unhelpful anxiety.

David Prescott:

Yeah, I forgot I'd given you that quote. I love that one. He was an interesting guy, Hans Selye. He did his original stress research. He was a little bit mean really. He would toss a rat or a mouse in a vat of water that had straight steel side so it couldn't climb out and watch it stress itself out. I don't think he killed them, but he would let it get really, really stressed until it was about to drown and then measure like its adrenaline levels and stuff like that.

Ben Smith:

Okay. Wow.

David Prescott:

Yeah, I know you so you just wondered, but still he had some good quotes, right? I think most of us realize this intuitively if we think back to it, but a little bit of anxiety makes you a little better at what you're doing at the moment. So, think of you in school or something like that if you were taking a test or if you were a team sports participant. You wanted to be a little bit on edge when you went into a situation. That helps us in many situations, performers talk about this, but just every day. So, that's not necessarily bad.

The fact that you're a little bit anxious about something, if you can get your mind to think this is telling me something that I need to pay attention to rather than I need to stop now because I don't want to worry about this, but use it as a signal. This is telling me something I need to pay attention to. I wonder what it is. Let's talk about it, think about it. A little bit of anxiety gets us through. It helps us get through all the things we have to do in our day. Or if you're worried about a deadline, you're going to get that form or that paper in or make that phone call or something like that.

So, it's quite helpful. People who take an extreme, people who don't care and have no anxiety or apprehension about anything just don't pay it any attention. So, part of it is just trying to harness and mobilize your own anxiety. It's a little bit energy. Now we've seen for everybody when it gets too much, if you've ever gone over the thing, and again, I use performance or athletics a lot, if you're too keyed up when you go up to bat or swing a golf club or try to recite the poem when you were a kid in front of your class and something like that, then you screw up. You just get disorganized. So, yeah, a lot of it is keeping it in that sweet spot.

Curtis Worcester:

So I want to rotate to the idea of caretakers. So, I'll use myself as an example. Say I'm taking care of my dad or my mom, a family member, neighbor, whoever it may be. What tips or advice would you give to caretakers to help them approach the subject of anxiety and how to best help that person they're caring for?

David Prescott:

This is really hard. Caretaking is just going to happen more and more, but it is a real shift in most people's lives. You're just getting a whole another channel in there. So, one of the things that you have to overcome, as others have talked about, oftentimes your roles are shifting. So, you're like, "Okay, how do I give my loved one, often my mom or my dad or my aunt or my uncle or older brothers or sisters? How do I give them advice because it always went the other way?"

Curtis Worcester:

Sure.

David Prescott:

I mean, this sounds a little lame, but mostly I tell people yes, it just feels weird. So, I think that being direct, getting it out in the open is a big thing. Rarely have I ever talked to somebody who's anxious or wound up that they haven't thought about it or haven't noticed. You're not telling them something they don't know. So, I get it out there. Then I was saying very early on, if I've learned anything or trying to learn, it's to listen more than I talk. When you're going to bring it up, probably the best thing you can say after you bring it up is nothing. I had a friend who said, bite your lower lip.

Just ask them, "Is that true? Tell me a little more about it." Then I usually ask them solutions. I don't say, "What do you think we should do about it?" I say, "What have you thought about doing about it?" Because people have some ideas, because if you say, "What do you think to do about it?", usually they say, "I don't know." But if you say, "What have you thought about doing about it?" So be direct, listen more than you talk, and ask what they've thought about doing about it. Usually people feel better that it's out there.

Ben Smith:

Yeah. So, David, obviously on this podcast, we're trying to give things of advice, of things that people should know about and help them. So, it's one thing to say here's some things to do. There's another way to look at this. What are things that we shouldn't be doing? What are some mistakes that we all make we probably know are wrong or probably not the way to address things or maybe the most productive ways to attack things? Hey, I have anxiety and I'm retired and I could, as you said, just to suppress it, right? Hey, I'm having a panic attacks. If I go near a car, I have a panic attack so I just don't go near cars anymore. That's as simple as that, right? I suppress it. Or when I have maybe a few beers, maybe that helps me.

I have a few beers and I get in that car and I don't have a panic attack. So, if I just continually have a few beers in me all the time, then that's okay, right? Or whatever. Have recreational drugs. You see my point about there's poor outlets maybe for anxiety of if I just maybe self-medicate, if I self-diagnose, and as you said, I think we all can work ourselves into the mental pretzel at times. There's other ramifications of those things which could lead to mistreatment of loved ones. It is all of a sudden someone starts yapping at me that I'm drinking too much or I have other behavioral issues that come out of this core issue. So, my question is, what do you see as common mistakes that us as we age that we're making as we try to self-diagnose and self-medicate our issues?

David Prescott:

Yeah, that's a really good question. Some of them are not unique to aging, although the impact on our body or our bodies can't take as much. So, you mentioned have a few beers or something. Alcohol is one and it's ingrained in our culture, I think, right? We say to somebody, "You seem wound up, you need to go have a good stiff drink." It's just in there. I think it's important to remember with medicine or alcohol or anything as you age, your body's ability to process that quickly is not as good as it once was. So, the same amount will take you longer to process it. You can get an effect that it's more than you think it is. So, that's a good one. Some people, they've struggled either previously in their life or it comes back. You thought you had it licked, but now it's come back.

There are other things we do. People talk about stress eating, right? Sometimes we do, but in any age, a whole bunch of weight gain or not, eating real good foods, I mean it's basic. It's like the advice your mom gave you when you were four, but it really does often not help you. People who are cigarette smokers, oftentimes you see that they will increase that and those just tended to compound the problem. So, you want to watch that. The other thing, Ben, I think you mentioned, but to make the point explicit, a lot of times I see people in counseling settings get referred for anger. Usually, somebody else says, "You're snappy, you're irritable, you're yelling at me." I find that anxiety is underneath that. We've all done it.

Ben Smith:

Sure.

David Prescott:

When you're stressed out and somebody does something that you consider stupid, words come out your mouth or things that you do that you're thinking, "Oh," but some people aren't really aware of it that what's really driving their irritability or their anger is anxiety. If you can get underneath of that, we respond a lot better to somebody saying, "Hey, what's worrying you these days?" than quit being such a jerk.

Ben Smith:

Sure.

Curtis Worcester:

Yeah, no, that's a great point. I want to talk about medication here, and I know that's a continuation there. Maybe not self-medicating anymore, but actual doctor medicating. So, when does a doctor or patient know when it's time to go on medication to assist with managing anxiety? I'll pause there and I have a couple follow-ups.

David Prescott:

Yeah, no, that's really, really good. In the mental health profession, it's a little less clear for guidelines. For depression, we usually say if you're depressed for two straight weeks, you should probably go get treated or consider medication. It's not a bad guideline. If you've been struggling with anxiety or having repeated panic attacks for a couple straight weeks, I think it's a good idea to go talk to somebody. I think having an honest conversation about your preferences with your doctor, your psychologist, or anybody is really good. People are all over the map with their own self-acceptance of anxiety medication. Some people really like that idea. Some people don't.

If you look at the research over time, mostly what happens if you compare medication to counseling, say medication gives you a little bit benefits first, but then after a while, counseling catches up and they stay pretty even over time. There's a little bit of evidence that in the long term, psychotherapy or counseling will hold its progress longer. So, I would say to your question, part of it without being flipped about it is when you think you want to do something, two straight weeks is not a bad idea. Then there's different ways that people who prescribe medication go at anxiety and there's a different types of medication that will do different things for you. So, that's a good conversation to have.

Curtis Worcester:

Yeah. So, I'll just going to keep going on the medication question. So, in this scenario, say now I'm on medication for my anxiety. How do we know when it's time... We may be, how do you all know? ... to up or maintain or lower a dosage for that maintenance of my anxiety?

David Prescott:

Yeah. When I talked to my psychiatrist and primary care friends, we say a couple things. A lot of the medication they're using these days for anxiety were actually originally marketed as antidepressants. So, Prozac, Paxil, Effexor, venlafaxine, Zoloft. The first effect they has is it helps your mood a little bit and then later they help anxiety. Those don't work. It's not like taking a relaxed pill. You don't feel it for quite a while. So, the question of, "When do you know when to up it?", the first thing is often you've got to give it a couple weeks before you get that anxiety effect.

Some of the anxiety meds, we don't use them as much anymore. The old ones we had when I was growing up, my grandma took them, those Valium and stuff. Those you want to be really careful about upping the dose because they're a little bit addictive and what you're doing is you're developing tolerance to them. This is not the most clinical term, they get sloppy. Their speech is a little bit slurred in that. So, those you probably don't want to.

Curtis Worcester:

Yeah, no, that makes sense. So, then just from where you're sitting now and looking backwards over your career, I know you just mentioned Valium is no longer certainly used a lot. What advancements are happening or have happened and are happening right now in the treatment of anxiety?

David Prescott:

Yeah, it's good. Physicians are getting really good. Sometimes they're using what you see them do medications that just target anxiety and certain things. They use things like a medication called propranolol and that, but it just takes away the physical reaction of anxiety and often that can break the cycle. Remember we said that fight or flight cycle?

Curtis Worcester:

Sure.

David Prescott:

I'm going to oversimplify it, but they're just lowering your blood pressure and your breathing rate and everything physiologically, that'll often help. So, we're getting better at that. Actually, the use of those antidepressants for anxiety has been a big shift in the last 10 or 15 years. I would say the other thing I see a lot is the incorporation of nonmedical and non-psychological techniques. People are really getting into, and it's good for anxiety, yoga, mindfulness, meditation, that stuff. It's awesome to me to see these be so available now. I think the pandemic helped us with that one, because you can get these really top-notch classes on Zoom and you don't have to go to a studio, which is great, but our lives are busy. So, I'm pleased to see all those kinds of thoughts. It's good stuff.

Ben Smith:

So, David, I want to ask another question here. So, here I am and I feel like anxiety is just becoming more of a prevalent issue in my life. I'm aging and I'm just sensing it is just something where it's just taking a hold of different parts or I'm avoiding things or I'm doing more of other things. I guess my question is if I want to do something about that, first steps would be go to my primary care physician and have that conversation. If I'm going to look for help, I guess my question is where's the best and first place to go?

David Prescott:

I think you nailed it. As much as I would like somebody to call up a psychologist or a licensed therapist in my profession, unless you know somebody personally, if you use the internet, you do a Google search on psychologists around Bangor or something and all you get are these faces and names and you just don't know anything about it. So, I love going to primary care. Sometimes you will find shifts in your physical health that are causing anxiety or for depression, mood disturbance or stuff like that. So, they can rule that out pretty quickly or at least start to investigate it.

Yeah, I would go to my primary care and they know people. They know who's reliable and they can probably tell you somebody that is maybe not that reliable, but they're going to be your fastest way to get in. We're so stacked up in waitlists and I know primary care is too, but in psychology and psychotherapy, a lot of people I've talked to have called around and they're like five months, seven months. That's too long to wait.

Ben Smith:

Especially as you're saying from, "Hey, I've been dealing with something for two weeks and this is something where I feel like it's getting worse and worse and worse and I need help," I think a great thing about your profession, David, which is similar to us, it's a relationship business. Hey, I want to sit down with somebody that I feel can listen to me, understand what's happening, help me progress and advance through it. So, it's such a big deal. So, I guess that's where I wanted to go versus as you said, hey, I am struggling with this issue, going, I know we don't use the Yellow Pages anymore, but Google or whatever. Yeah, I was about to say that.

We don't use the Yellow Pages. Yeah. So, just to scroll through the Rolodex and say let's just start calling everybody and see who can get in. Because I think from the PCP side, it's like, "Well, hey, at least maybe I already have that relationship and then they know what's happening with me and they can go with, 'Do you think psychotherapy is the best route?'" Then get in versus just self-diagnosed, "I just need counseling and I'm just going to go to that." So it sounds like you're six to one half dozen the other from that side about, "Hey, I had this two-week issue and I might take another month to get to my PCP. Maybe I just go and jump to it." I don't have to get a referral is I guess what I'm hearing.

David Prescott:

Right, exactly. You've helped me think a lot, Ben, about the similarities in our businesses that it is about relationship ultimately. The other thing I tell people when they try it out and I don't know if you all do this in your thing, but I think the people that are best at our professions, they're very genuine. They say, "Let's talk. You figure out what I'm all about. I'll figure out what you're all about. Then for heaven's sake, let's say right away if we don't think we click, let's just say that."

Curtis Worcester:

Yeah.

Ben Smith:

Yes.

Curtis Worcester:

Absolutely.

Ben Smith:

Again, I think it's a two-way street. We both don't want to be unhappy when we're sitting down together. So, I think that's a really big deal. So, I think that's exactly right. David, I want to ask another question, because again, one is to get services, but also from... Hey, I am looking on the web and I know I made the full pod in my intro of looking up WebMD statistics on things, but we all look at WebMD like, "Oh, I have these eight symptoms. Let's Google them all. That's going to tell me that I'm terminal with two weeks left to live here."

So, my question here is, "Hey, listeners out there, I have some anxiety. I have unhelpful anxiety that's happening to me right now. I want to go look at some resources that I think might get me on a path to start..." Again, we examined the PCP and direct to psychotherapy counselor side. What resources would you have them check out to educate themselves about the issues we're discussing today?

David Prescott:

That's a really good question, and I did it yesterday too. I don't know if you can see my left eye is a little bit red. So, the first thing I did was I went to WebMD. I did that and then I called my doctor. Yeah, it's a really good question. Again, I'm sure you're a professional too, you know a Google search will pull up for you, this is a little bit cynical, but whoever has paid Google the most money to rise to the top of the search.

Ben Smith:

That's right.

David Prescott:

So, the ones I like to tell people, the American Psychological Association, it's our professional association. They are really careful about this and they have helped topics. They really broaden them out. So, you don't have to just say anxiety. You can do panic, you can do PTSD, you can do all of that. My profession, I love them to death, but they're meticulous to a fault. So, before they get anything up there, they've had a bunch of people who think they're always right, go over it with a fine tooth comb and come to agreement. So, American Psychological Association is a really good one. The other one that I like to go to the National Institute of Health or the National Institute of Mental Health.

So, these are federally funded research agencies, but where they've shifted their web presence for the general public is on these help topics for that. They've realized that people go to that as an authoritative source. So, they have some really, really nicely worded clear, user-friendly, if you will, thing. So, I tell people that American Psychological Association or the National Institute of Health, and if you do that National Institute of Health Anxiety, you'll get a really nice two or three-page handout on symptoms, differential diagnosis, treatment options. Yeah.

Curtis Worcester:

That's fantastic. Thank you for that. We'll make sure to have those resources available in our show notes too. So, for listeners, don't worry, you don't have to remember that. We'll have the links right there for everyone. So, we have one final question for you, David. So, obviously, our show is all about retirement success. So, we like to ask all of our guests, how are you going to find your personal retirement success when you get there?

David Prescott:

Okay, yeah.

Curtis Worcester:

Threw your curveball, didn't I?

Ben Smith:

Toughest question of all.

David Prescott:

That's a really good question. If I'm honest. I think a little part of me doesn't ever think I'm going to stop working. Even as I say those things out loud and I know that it's not logical, and I had been advised by other people who do what you do that say, they in a nice way say, "Yeah, I hear that a lot." Now let me tell you how it really goes.

Curtis Worcester:

Sure, sure.

David Prescott:

Yeah. What's been helpful for me is even within my profession of psychology is to do some things about trying to get my retirement success has to do with me remembering or reminding myself of there are many things that are important to me, but what things are most important to me. I was doing something recently, it was like a forced choice thing, but it only gave you a couple seconds. You couldn't stew about it. It said, what's more important, this or this? What would you rather, do this or this? And then it calculates a thing to show you and it really rang true. So, I think my idea for retirement success is to remember if I can remember and articulate what my priorities are through the rest of my life, then it all falls into place, including the financial thing.

Because then you were talking about earlier, Ben, if your portfolio or your investment or your income flow is just going not the way you had hoped, I'm sure it's either going up or down, but you start to say, "Oh, well, while it's not that much fun, I know what my priorities are." When you know that, then the rest is just playing it through and it feels okay where psychologically and for myself. What doesn't feel okay is when your retirement, however you do the success, doesn't line up with who you truly feel you are. When that happens, you're just grumpy.

Ben Smith:

Because again, doing more of what makes you who you are versus doing things that are not who you are and then if your money's not tied to it, which I know Curtis and I talk a lot with our clients and our team here. All of a sudden, it's like, "Well, hey, if we're telling people they can't do the thing that gives them the most purpose," which by the way, work is a very valid thing. It's something where maybe to your point about our bodies and our minds having to change as we age, maybe we're not able to do as much, but we're able to do it in different ways. We're able to do it in different capacities. We're able to do it in different quantities, all those things and adapting as we age to do that.

Again, I know I'm giving your answer back to you here a little bit, but it's something where I think when people discover that, they go, "Oh." It's a big exhale because resources that are aligning to that and it's like, "I get it. I understand. I am not changing a binge of vocation for a binge of vacation." It's this purpose thing. So, I think that was a really awesome answer in terms of where we try to help our clients as well. So, David, thank you so much for coming on our show today, sharing with us a lot of your knowledge and expertise. I know it is just, I think, helpful personally, but I know our clients too and our listeners out there that we can go back to this library and it's a really great starting place. So, thank you so much for coming on.

David Prescott:

You're absolutely welcome. I have no idea how much time we spent. I will say it went very fast. Yes. Yeah, that was great for you guys.

Ben Smith:

All right, David. You'd be well, take care.

David Prescott:

Okay, you, too.

Ben Smith:

So, episode 80, managing anxiety as we age, right? We got to 80.

Curtis Worcester:

We've made it.

Ben Smith:

Another decade here. We're getting older too. We're experiencing aging.

Curtis Worcester:

Exactly.

Ben Smith:

So yeah, really good to have David Prescott on obviously, I think as you heard, just has a wealth of information around psychology and especially anxiety. So, this is just something that I know Curtis, you and I and our team, we've talked about a lot is you could just see anxiety and anxiousness around things. So, we always like to highlight things that we took away from today's meeting. Curtis, what was the takeaway that you had about our conversation with David?

David Prescott:

One piece that really stuck out to me, Ben, and it's something I hadn't really thought about with anxiety, you mentioned both of us are both aware and we see anxiety a lot. The point David was making about healthy versus unhealthy anxiety or helpful versus not helpful anxiety, I think was what he said. It was just really interesting to me because the point was being it's normal and it's okay to have a little anxiety about these achievements or goals or whatever it is you're trying to achieve in your day-to-day life. He didn't explicitly say this, but the feeling I got was like, "If you're worried a little bit about how you'll do or how you'll perform, it shows you care. If there's that little bit of anxious, it keeps you on edge, it keeps you focused."

Then obviously, he talked about it building to being not helpful anxiety and unrealistic expectations or wherever you want to go with that that then becomes the spider web of anxiety disorders that we talked about. But for me, just to hear him talking about the helpful anxiety piece, it was something that I think as soon as he said, it made sense to me, but I just hadn't heard it expressed and presented that way. So, I thought that was really helpful to hear.

Ben Smith:

Again, I know the conversation we had with Cliff Singer is what is normal aging and cognitive-

David Prescott:

Exactly, yeah.

Ben Smith:

... health and memory versus what's non-normal cognitive and memory aging there.

Curtis Worcester:

Yeah, exactly.

Ben Smith:

I think those are good lines. Maybe they're not stark lines, but maybe they're gray there. Well, here's where we're blending from my daily life and using normal or "just regular helpful anxiety" versus non-helpful.

Curtis Worcester:

Absolutely.

Ben Smith:

I think that was a key point. I want to add too, again, we've had enough client conversations over the years and talking to people is. Anxiety triggers was something I really thought was interesting and we wanted to ask about. We talked about financial insecurity and something that we're seeing a lot is Maine's a rural state. There's a lot of first generational wealth that's being experienced right now where I've never had this much money in my life and nobody in my family's ever saved this level of wealth.

Curtis Worcester:

That's right.

Ben Smith:

So I have this thought about anytime I start seeing my account balance drop, anytime I start spending from this balance, it's a trigger to me of going back to where maybe I have a memory of, "Hey, we couldn't make that car payment and we got our car repossessed," or "Geez, we were on food stamps. We were on SNAP and we were getting food banks and we were needing to rely on that. I don't want to go back to that place. I worked my whole life to get out of that. I don't want to go back." So, these triggers, the insecurity triggers are really also anxiety triggers here.

Curtis Worcester:

Sure.

Ben Smith:

We start to talk about avoiding that of I don't want to see my account balance drop, so I'm not going to spend anything from it. I'm just going to live on nothing until I see that come back and I avoid that. So, I think those are things in our profession as we're trying to help our clients is something to keep in mind. I think that was a really helpful way to explore that. So, again, those were really our highlights of the day. Obviously, we'll give you some research and links here from, as David said about the American Psychological Association, the National Institute of Mental Health. We'll have links there. In addition, we'll put some Northern Light Health Acadia Hospital links as well.

Curtis Worcester:

Absolutely.

Ben Smith:

Go to our show notes. It's blog.guidancepointllc.com/80 for 80.

Curtis Worcester:

Show 80.

Ben Smith:

Or episode.

Curtis Worcester:

Episode 80.

Ben Smith:

So, you can go check that out there. Just a reminder, my name is Ben, his name is Curtis.

Curtis Worcester:

Exactly.

Ben Smith:

We are the Retirement Success in Maine Podcast. Thank you so much for listening. We really appreciate you tuning in and being on this journey with us. We'll catch you next time.