Latest / StartUp Health NOW Podcast / Dr. Tracy Dennis-Tiwary of Wise Therapeutics Shares How to Use Your Anxiety to Thrive

Transcript

Dr. Tracy Dennis-Tiwary of Wise Therapeutics Shares How to Use Your Anxiety to Thrive · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] I'd like us to stop thinking about struggle or failure even when we just, we fall down sometimes.
• 0:12
  I'd like us to stop thinking of that as a disease, and take all these tools, digital, social connection, uh, you know, doing great work, having purpose in life.
• 0:22
  Whatever your solution is, to actually know you can make advances. You don't need to... You can aspire to more than comfortably numb.
• 0:36
  [ on-hold music] Welcome to StartUp Health NOW, the podcast where we celebrate the entrepreneurs and innovators reimagining the future of health. I'm your host, Logan Plaster. My guest this week, Dr.
• 0:46
  Tracy Dennis-Tiwary, doesn't pull any punches. She's the co-founder of Wise Therapeutics, which joined StartUp Health last year, and she's the author of the new book, Why Anxiety Is Good For You Even Though It Feels Bad.
• 0:58
  As you'll hear in the interview, Tracy is on a bold mission to change how society thinks about anxiety so that millions of people can thrive in the face of adversity, not settle for being comfortably numb.
• 1:09
  She'll also explain how her work in digital therapeutics uses simple mobile games to help people rewire their brains.
• 1:16
  Her research-backed app, called Personal Zen, trains users to make more positive subconscious choices, one swipe at a time.
• 1:24
  If you wanna hear more inspiring stories about the entrepreneurs building the future of health, check out our back catalog of podcasts or our YouTube channel. You can find all our latest stories at startup.health.
• 1:35
  Now, on to my interview with Dr. Tracy Dennis-Tiwary, co-founder of Wise Therapeutics. [ on-hold music] Tracy, welcome on the show. Thank you so much, Logan. I really appreciate speaking with you.
• 1:49
  So let's just start with the provocative thesis of the book. You say why anxiety is good for you. Let's just start there. Why is anxiety good for you? Right.
• 1:58
  Well, the, the first and most crucial thing to, to highlight is that we have probably mostly over the past fifty years started to conflate and confuse the emotion of anxiety for an anxiety disorder. Mm.
• 2:14
  So that now, as we've gotten to the stage where we have wonderful science about mental health, particularly anxiety disorders, the most common of the mental illnesses, um, we have, uh, wonderful treatments, we have anti-anxiety meds for those who need it.
• 2:29
  We, we have wonderful tools, but we've made a huge mistake. A-and when I say we, I mean we mental health professionals.
• 2:36
  We have taught people not just to treat and get in front of anxiety disorders, but to actually fear and revile and reject all experiences of anxiety. Mm.
• 2:47
  So that means that what is actually a healthy and normal and incredibly advantageous human emotion has been put into this category of disease.
• 2:58
  And as a mental health field, what I think we've done, um, in, in a, in a actually a, to be frank, a, a destructive way, is we've equated mental health with the absence of all emotional discomfort. Mm.
• 3:12
  That to be emotionally healthy, to be psychologically healthy means you have to always be crushing it, be optimized for, for performance, always handle stress, always...
• 3:21
  We always talk about this standard of perfection that actually is unrealistic, and rejects and prevents our ability to actually see the wisdom that exists in our challenging emotions like anxiety, sadness, and fear.
• 3:35
  So the book is really taking on that confusion and that mistake, and talking about how we can recalibrate ourselves to understand what healthy and unhealthy anxiety is, and start to actually, uh, take the best steps and to set ourselves up for, for success rather than failure when it comes to our experiences of anxiety.
• 3:56
  Well, I wanna unpack plenty of that and really get into what those pieces are.
• 3:59
  But you said there's been a fifty-year sort of evolution, a, a process of conflating anxiety disorders with, uh, the important side of anxiety.
• 4:09
  And since we're talking about healthcare today, we're talking about healthcare, um, uh, resources and products, maybe give us a little context as to why you think that that happened.
• 4:21
  Uh, maybe by understanding our past, we can not repeat it in the future. Exactly. I love, I love you putting it that way.
• 4:28
  So we have made, as I mentioned, these incredible advances in psycholog- psychology and psychiatry, and we have really, uh, sort of hitched our wagon to the medical successes, broadly speaking, of the past fifty, sixty, seventy years.
• 4:46
  And what that medical model is, it's scientific, but it's also a disease model.
• 4:52
  It, it's like an infectious disease model, actually, where we have learned so much about to identify a biological dysfunction, a disease state, uh, a virus, uh, you know, something that causes disease and disorder and distress, and the medical model tells us that we have to identify it and eradicate it, and then you heal.
• 5:13
  Mm. And so we psychologists especially, and psychiatrists as well, as we, as we wanted to get...
• 5:21
  You know, psychology was originally in the philosophy department of universities back in the nineteenth and early twentieth century.
• 5:27
  So we wanted to leave philosophy, and we wanted to become medical science, so we decided we needed to adopt this disease model.
• 5:34
  We created the Diagnostic and Statistical Manual, the DSM, to actually start to categorize mental and psychological distress in these discrete categories.
• 5:42
  So, and then we started making some real advances, and we were very, we kind of put our heads down and just did this work. But then, what do you see in the world around us right now?
• 5:52
  Are we mental health professionals, our solutions for mental health problems are not keeping pace with that of medical conditions. Mm.
• 6:00
  The former head of the NIMH, Tom InselWho's left the NIMH for a number of years now and has been working in some tech startups and, and other kinds of contexts.
• 6:10
  He gave a talk at the Aspen Ideas Festival just a few weeks ago.
• 6:13
  He wrote a book recently, too, about this journey, and he said, in no uncertain terms, I'm, I'm literally quoting him, "The disease model of mental illness does not work." Mm.
• 6:25
  This idea that you can identify a dysfunction, eradicate it, solve it, and then there's health, it doesn't... That's not how mental and psychological and emotional health works. Mm.
• 6:35
  So now we have great solutions, and they're not working, and I think it's because of this model. It's holding us back.
• 6:42
  And we need a new model, and we need to rethink what psychological and emotional health actually means. At the same time, acknowledging there are such things as anxiety disorders- Yeah...
• 6:52
  when the ways we cope with anxiety are actually getting in our way. That is... I would never discount the suffering that they cause, but they are distinct from our normal struggles with anxiety.
• 7:02
  I'm curious if this is an understanding that you have, have had for most of your work, working life, or whether there was a eureka moment when you realized that this model really wasn't serving your patients. Yeah.
• 7:14
  You know, I, I didn't have this realization because when I, um, became an official psychologist, it was actually, I defended my dissertation on September 11, 2001. Wow.
• 7:24
  The September 11th, and so becoming a mental health professional in that world, and I still remember it like it was yesterday, I knew that mental health was the crisis of our era.
• 7:35
  And so I really just put my head down, like all of us trying to do good work, develop great interventions.
• 7:40
  You know, that's how I started doing, uh, digital, uh, therapeutics and, you know, which sp- which really the, that foundational research served as the founding of my company, Wise Therapeutics.
• 7:51
  Because I knew that we had some great treatments, but barriers need to be lowered. We needed to rethink how we were delivering mental health.
• 7:58
  You know, all of those things were inspiring me, but I still thought, "Okay, but we've got the tools. We have the science. We have the technology."
• 8:05
  But just about three or four years ago in terms of an aha moment, there was not one moment, but I started writing this book a couple of years before the pandemic, and even then, our mental health as a society was on a downward trajectory- Mm...
• 8:18
  especially among our kids. And I think it's when I saw kids and teens with suicide rates, self-harm rates, anxiety rates, depression rates going up.
• 8:28
  And I don't actually believe the story that, oh, we have to blame it on the onset, you know, kind of the, the, uh, the creation of mobile devices, and then that just destroyed a generation.
• 8:37
  I think there's complex links there, but I don't think we can lay it all at the f- at the feet, so to speak, of these, of, of technology, even though it can be an ex- a, a problem. Um, so I just...
• 8:47
  That's when I had this aha moment, and I wrote the book really as a way to solve this conundrum. Why have we failed so spectacularly as a field, mental health, when we have great science and solutions out?
• 9:00
  Have you made any, uh, enemies or ruffled some feathers by sta- making statements like that within your own field, saying that we have spectacularly failed our patients? Yeah. Yeah.
• 9:10
  You know, I'm, I, I, I think, uh, I get up in the morning and hope that I can be contentious and, and a cause for debate because we have to- Yeah... seriously get more punk rock about mental health- Yeah...
• 9:19
  because we are, we have failed. I love that. Yeah. We have failed, and so we need these discussions. We need to shake up our paradigms because so- I think most mental health professionals are incredibly well-intentioned.
• 9:32
  I count myself among them. But it has become a predatory industry- Mm... because we have convinced people, again, because mental health is somehow equal the absence of human struggle or suffering, right?
• 9:43
  That that's somehow what we aspire to. We have convinced people they're vulnerable, they're fragile. They need constant mental health help, which is great. I think we should...
• 9:53
  I think everyone should see a psychologist to talk through. See a good friend. See a reli- a, a, a spiritual advisor.
• 9:58
  We should talk and connect and seek support, but that doesn't mean we're broken in this diseased sort of way. Mm.
• 10:04
  So I think that this, this metaphor of disease, we have to replace it with more helpful ones, like when it comes to anxiety, like fitness.
• 10:12
  So if we accept that a- anxiety is a healthy human emotion, one, and this is really why I called the book Future Tense, anxiety is not fear, even though it feels like it, right?
• 10:22
  I mean, we feel the butterflies in our stomach, the pounding heart.
• 10:25
  We feel that with fear and anxiety, but anxiety is unique because it makes us into time travelers, into the future, mental time travelers, where we are looking around the bend to the future.
• 10:35
  We have apprehension about the uncertain future. That is the definition of anxiety. But when you're apprehensive, you haven't despaired, not yet. You know that something bad could happen.
• 10:46
  So I have this big job interview tomorrow, for example. Say that's my anxiety. Well, I know I could f- I could totally bomb it. But if I'm anxious, I also know that I could crush it. I could do- Mm... really well.
• 10:57
  And so anxiety is that feeling that prepares you to avert disaster and to work to succeed because you're still in it to win it when you're anxious. Mm. So how can we eradicate this human emotion?
• 11:08
  Instead, we need to learn to ride it like a wave.
• 11:11
  We need to learn to channel it, manage it when it's unmanageable, because it can be, and prevent it from s- kind of veering over on this very broad spectrum from normal anxiety into anxiety disorder territory.
• 11:23
  But we have to engage it. We can't reject it or eradicate it. That's a perfect segue to talk about your work with Wise Therapeutics and Personal Zen, the app.
• 11:33
  Um, you know, you're not someone who's just throwing stones at the establishment. You've created a startup. [laughs] You've co-founded a startup- Yeah... uh, and you're creating a tool.
• 11:42
  So, um, you know, why, why create a tool for combating anxiety and other, uh, mental health challenges, uh, if we've sort of overblown it in the way that, that we have? Sort of break it down for me what you've done.
• 11:54
  So first of all, um, Personal Zen and the products that are actually coming out of that, that was sort of our flagship consumer-facing product. Mm-hmm.
• 12:00
  We're actually developing products and, um, seeking FDA approval for ve- kind of develop, you know, further pipeline products that target specific disease categories like social anxiety disorder, uh, depression, and addiction.
• 12:15
  So Personal Zen as this sort of the first, uh, manifestation of a decade of research in my lab, it really takes as a starting point-You know, there are great mental health tools out there.
• 12:25
  Cognitive behavioral therapies are wonderful. There's great science, but they're not for everyone.
• 12:29
  They're very expensive, they're time-consuming, um, they don't work for everyone, and they also target very conscious, deliberative factors that can make mental health conditions worse.
• 12:41
  So cognitive behavioral therapy, you identify mouth- you know, dysfunctional thoughts, dysfunctional behaviors, and you create new habits. It's a great approach. It's not d- da- uh, native digital, digital, I would...
• 12:53
  Uh, sorry, digital native, I would argue. Because CBT, you, you have to get stuck on a screen for hours and hours to do it well. Mm.
• 13:00
  You have to, you know, yes, you know, teletherapy's great, being able to talk to people online, but there is something with CBT also about the personal human relationship. So we don't want to completely digitize CBT.
• 13:12
  So there are these other, uh, category of, of tools out of this cognitive umbrella of therapy, uh, that are mindset and cognitive bias interventions. Mm.
• 13:22
  And these interventions are actually optimized for digital because they're brief, and this is, these are the foundational tools that we use in Wise Therapeutics as our core kinds of interventions.
• 13:33
  They're brief interventions that change how you process information, what you pay attention to, how you interpret it, and the mindsets that you bring to the world, like the, the expectations, beliefs, and habits that you bring to the world.
• 13:45
  And we know that small, tiny nudge interventions and mindset shi- mindset shifts can have a powerful impact on mental health, and they're ready to be given to people, highly accessible, cheap, and low time, low cost burden.
• 13:59
  So these are the kinds of tools we wanted to really develop for Wise, and it's very much aligned with not a disease model, but a positive skill model of mental health.
• 14:10
  Okay, so break down that process of changing my cognitive bias in sort of short term, uh, sort of quick hit, digital first kind of, kind of way. Right. So some of the...
• 14:21
  So, uh, if you, uh, use tools that come from Wise Therapeutics, like, uh, the consumer facing Personal Zen, um, we, uh, what, what happens when you're... Let's, it's, it targets anxiet- anxiety and stress.
• 14:33
  What happens for anxious and stressed, all of us, whether we have an anxiety disorder or are struggling with anxiety, is we have the opportunity to look at all sorts of information and take in information in the world at any given moment.
• 14:46
  When you're anxious and stressed, you have a systematic bias that's called the threat bias, and this threat bias causes us to overemphasize negative information at, and overvalue it at the expense of the positive. Mm.
• 15:00
  So now you have this distorted filter that you've sort of put on the world, where I could be giving a speech in front of 100 people, and if I have a strong threat bias, I will notice that one single individual who's falling asleep while I'm talking in the front row.
• 15:12
  And I will ignore that 99 people are wrapped in their attention and fascinated by what I'm saying.
• 15:18
  And so you can understand how this distortion over time drives the vicious cycle of stress and anxiety, because you see that and you go, "Oh, I must be failing. I must be a terrible speaker."
• 15:28
  And you're not able to flexibly take into account that a lot of people actually are giving you positive reinforcement, or there's something positive to be gained here.
• 15:36
  And so what we do in our, our gamified mobile apps through, uh, in, uh, that, that Wise Therapeutic creates, is you can, through very simple interfaces and gamified interfaces, um, you can retrain that, that habit of paying attention and to gain more, and to essentially rewire your brain to be more flexible in the types of information you can pay attention to, and
• 15:59
  in the case of the threat bias. It sounds a little bit like you're tricking people into being, or training them into being a bit more optimistic.
• 16:05
  Is that- It is like an optimism bias except unlike op- and, and they're very synergistic, I'd say. Optimism is a much more conscious, deliberative... You kind of know when you're optimistic. Yeah.
• 16:15
  Like I can say I'm like, I'm optimistic almost to a fault, personally. Um, these biases that I'm talking about are subconscious. Mm. They're, they're millisecond fast.
• 16:25
  And so over time, we may not even be aware that this is happening, but they become calcified and rigid and, and become this sort of... And it's the first thing that happens, right? Because it's so...
• 16:35
  The very first thing that in the universe, right, when we're in the universe, what do we even notice? And if that automatic unconscious bias is off kilter, everything downstream will be off kilter to some degree.
• 16:48
  So what we do by targeting this unconscious bias is we loosen up the whole system, so to speak, the whole person, to be able to think more flexibly, unconsciously and consciously.
• 16:59
  And if you need more intensive treatments, like those great cognitive behavioral treatments out there, it synergistically helps those work better because you're ready to receive that information. Got it.
• 17:08
  And just to connect this back to the book, this applies not just to folks who are getting treated for an anxiety disorder, but I'm guessing people who are just on the, the borders of, of sensing that, that they have anxiety in their life, which could be good or bad.
• 17:24
  Is that right? 100 per- 100%. And you know, when I say that anxiety is good for you, it helps us think in the future, it helps us plan and get more innovative and focused, all those things are true.
• 17:35
  But that doesn't mean it, you know, it still sucks. No one likes to feel anxious. It's meant to be unpleasant because we have to... It's like a smoke alarm. We have to sit up and pay attention.
• 17:45
  It orients us what we care about in the world. So it does have to be unpleasant, but that doesn't mean we have to white-knuckle it through. Yeah.
• 17:51
  Because in any given life, we have these ups and downs, and sometimes the world, and th- this world especially, it conspires to throw a lot of curveballs our way. So we need those tools to gain more flexibility.
• 18:05
  But by shifting our f- our mindset about anxiety as a potential help rather than harm, we will find more ways. You know, it's, it's an opportunity cost to just reject it.
• 18:16
  If instead we engage with it, we will find more ways to actually use it, channel it, and manage it when we need to, when it's not useful, when it might be that borderline case that you were talking about.Yeah.
• 18:28
  I-in the one minute we have remaining, uh, I'll ask you sort of a more forward-looking health moonshot question.
• 18:34
  Uh, you know, you are on one hand a, a contrarian, uh, you know, pointing out these broken pieces of the system. On the other hand, you are an entrepreneur. You're trying to create a, a better future.
• 18:44
  And so I wonder, based off of this work you're doing with Wise Therapeutics and developing new digital therapeutics for mental health, you know, how do you hope the world is different five, 10 years from now because tools like yours, uh, have existed?
• 18:58
  I think the world I'd like to see in five or 10 years and sooner, but that's... things happen slow.
• 19:04
  I'd like to see a world in which we've stopped assuming that our psychological and emotional vulner- vulnerabilities make us broken.
• 19:13
  I'd like us to stop thinking about struggle or failure even when we just, we fall down sometimes.
• 19:19
  I'd like us to stop thinking of that as a disease and take all these tools, digital, social connection, uh, you know, doing great work, having purpose in life, whatever your solution is, to actually know you can make advances.
• 19:35
  You don't need to... You can aspire to more than comfortably numb. Mm. You know?
• 19:40
  You can aspire more, and you have the ability to grow and to build strength, not just have this, uh, this feeling that I'm broken and I, someone has to fix me.
• 19:49
  I want that to be the conversation around mental health because we can have lots of conversations about mental health, but unless we're having the right ones, we're gonna dig ourselves deeper into this self-destructive disease model of mental illness.
• 20:02
  I love it. Dr. Dennis-Tiwary, thank you so much for the, taking the time with me today.
• 20:06
  Uh, more importantly, thank you for the, the work you're doing with Wise Therapeutics and really shining a light on this really important area of health. Thank you, Logan.
• 20:14
  I really appreciate the opportunity to speak with you. All right. Take care, and be well. Thanks. You too. [outro music] Thanks for listening to Startup Health NOW.
• 20:24
  Startup Health invest in health transformers around the world who are dedicated to achieving audacious health moonshots.
• 20:31
  If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 400 companies, go to startuphealth.com.
• 20:39
  If you'd like to learn how you can invest in our Health Moonshot Impact Fund, go to healthmoonshots.com. Thanks for listening to Startup Health NOW. We'll be back again with another episode next week. [outro music]