Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
56 min
2 speakers
8 chapters
transcribed 9 hours ago
Transcript
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What is anxiety and how does it feel in the body?
This episode of the Jerry Paul podcast is CME eligible.
To claim credit, please go to the CME tab on jerrypal.org.
Welcome to the Jerry Paul podcast. This is Eric Guadera. This is Alex Smith. And Alex, today's show is causing a little bit of dread in me, a little bit of anxiety because that's our topic today. Alex, who do we have on with us?
We are delighted to welcome another Alex, Alex Gamble, who's a psychiatrist, internist, and palliative care doc at Stanford. Alex, welcome to the Jerry Pell Podcast. Thank you so much. And we're delighted to welcome Brianna Williamson, who is a psychiatrist and palliative care fellow here at UCSF, and she's in the office with me. Brianna, welcome.
Thanks. Great to be here.
All right. So we got a lot to cover on this topic. I have so many questions, and I promise we're going to get to the management of anxiety and serious illness. But before we do, we always have a song request. Alex Gamble, do you have the song?
Yes. It's Three Little Birds by Bob Marley.
Why did you pick this song?
Well, Bree suggested it under the title, Don't Worry About a Thing. We clarified the name, and hopefully it'll be somewhat self-explanatory, but I think it's a really beautiful jump-off meditation for the topic, both in how we approach it, think about it, and invitations out of our anxiety.
It's great. For the people watching on YouTube, I forgot my guitar, so you're getting me on the keyboard playing an organ version. This is like the super happy version of
Three Little Birds. We like to think about the baseball version.
Don't worry about a thing Cause every little thing gonna be alright Singing don't worry about a thing Cause every little thing gonna be alright Rise up this morning Smile with the rising sun Three little birds Perch on my doorstep Singing sweet songs Of melodies pure and true Singing, this is my message to you
I love that version. I love the organ. We're getting a little seventh inning stretch. We'll play a little
bit more
organ.
Maybe we'll put that version on the live version. I think that one
should go on both, Alex.
It's just too good with the organ.
All right. Well, let's jump into the topic at hand. Let's talk about anxiety. Alex Gamble. What is anxiety? I
call it
the dread. Is that the right word?
Dread is certainly a sense I think a lot of people experience when they're experiencing anxiety. The first thing I think we always have to acknowledge when we're talking about mental states is that we have a lot of different kind of frames and theories, but deeply we don't understand even what consciousness is at a fundamental level. And so I think there's a lot of different ways that we've come to conceptualize and talk about anxiety. There are biological models where we talk about anxiety. different neurotransmitters and pathways that are sort of involved. But often what we're talking about is this experience that we can describe physically inside of our body, the sensation that we're having as we're anticipating that things may go wrong or badly in some kind of way.
So it tends to be future-oriented and tends to show up as a physical sensation in our body. Something I'll often point out to patients is how do you identify your emotions? Because the experience tends to be fairly consistent. It's not that a bright red flashing light goes off in my brain that says anxiety. I'm having a bodily reaction. I'm having a sensation inside of myself. It may be chest tightness. It may be my heart racing. It may be feeling sweaty. But it's this physical sensation that comes along with these ideations, right, often kind of anxious thoughts that tag along, and that this sort of experience in aggregate we call anxiety. But again, there's lots of different ways we can think about it.
I think it just depends on what we're trying to accomplish. But in general, some anticipated bad thing in the future that gives us this sense of anxiety. I'd be interested to hear if Bri has anything to add to that idea or that definition.
Yeah, I think one of the really important points that you mentioned, Alex, is that we're really trusting other folks on their self-report.
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Chapters
8 chapters
1
What is anxiety and how does it feel in the body?
0:00–6:01
2
When does anxiety become maladaptive or pathological?
6:01–13:50
3
How should clinicians screen for anxiety in serious illness?
13:50–20:46
4
What role does the DSM‑5 play in diagnosing anxiety disorders?
20:46–27:43
5
What non‑pharmacologic strategies can break the anxiety loop?
27:43–34:52
6
When are benzodiazepines appropriate for older patients?
34:52–42:50
7
How do SSRIs and SNRIs differ for treating anxiety in late life?
42:50–49:19
8
What communication techniques (like BATHE) help clinicians address anxiety?
49:19–56:17
Speakers
2 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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