Welcome to the Rose Woman Podcast. Today, we’re exploring how fear can shape the way we see ourselves and how we can begin choosing a different path.
My guest is Dr. Todd Burstain, MD, a physician, researcher, healthcare leader, and author with more than three decades of experience in medicine. He served as Chief Medical Information Officer at UW Medicine and Ochsner Health, where he focused on using technology, data, and science to improve healthcare. He has also led and published large-scale research and held national leadership roles in clinical informatics.
Throughout his career, Dr. Burstain became curious about a deeply personal question: How do the experiences that frighten and hurt us shape the way we understand ourselves? That question inspired his book, Fear Itself: Learning to See Yourself Through New Eyes. Drawing on neuroscience, psychology, and clinical experience, the book explores how the brain’s protective responses can influence our identities, relationships, and behavior long after the original threat has passed. It helps readers recognize fear-driven patterns, question the stories they’ve internalized, and reconnect with a more authentic sense of self. The book introduces eight fear-driven identities and offers a ten-step process for creating new meaning and seeing ourselves differently.
In this episode, we discuss how fear works, how it shows up in everyday life, and practical ways to respond with greater awareness and choice. Fear Itself is available now on Amazon, with the audiobook on Spotify. If the book speaks to you, I invite you to pick up a copy and, after reading it, consider leaving a review to help other readers discover it.
In this episode, we cover:
(00:00:00) - Introduction
(00:04:48) - Why Dr. Burstain wrote about Fear
(00:08:20) - How fear uses past experiences to anticipate danger and shape responses such as anxiety, people-pleasing, withdrawal, and control
(00:13:37) - How neglect can shape coping strategies
(00:17:14) - How fear keeps patterns going
(00:20:17) - How fear can affect brain chemistry and make it harder to think flexibly or see alternatives
(00:22:25) - The 5 steps toward change: Pausing, Comfort, Focus, Observation, and Curiosity as ways to respond differently to fear.
(00:27:26) - The remaining steps: Acceptance, Commitment, Resilience, connecting with others, and connecting with yourself as ways to sustain change.
(00:34:02) - Making room for choice
(00:35:25) - Fear’s effects on the body
(00:41:40) - Imagining safety and finding joy
(00:44:54) - Helping children with big feelings
(00:49:20) - Personal reflections on the process
(00:52:05) - Breathing practices that can help calm the body
(00:53:08) - Retirement and family life
Helpful links:
Dr. Todd Burstain - Author of Fear Itself: Learning to See Yourself Through New Eyes. Available now on Amazon and Spotify
Read the Preview of New Book: Chapter 1: What Is Fear? An excerpt from Fear Itself by Todd Leor Burstain, MD
Facebook @todd.burstain and LinkedIn
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Transcript
Dr. Todd Burstain 0:05
But the goal is not to eliminate fear. But if the authentic voice is speaking in the room at the same time as fear is speaking in the room, you have the option to choose.
Christine Mason 0:18
Hello, everybody. Welcome to the Rose Woman Podcast. I'm Christine Marie Mason, your host. Before we begin with our guest today, I want to offer you a small teaching about fear, because my guest today names something I have seen in myself and in nearly every student I have sat with over the last 20 years. Most of us would not call ourselves foundationally afraid. We might use the words careful, or prepared, or we're simply thinking ahead. But underneath, very often lives a younger part of us that once got hurt and decided it would never let that happen again. That part is loyal to our well-being and means well. It takes the past and holds it up as a lens on the present, and tries to predict the future so that we stay safe. The trouble is that when a protector runs the whole house, the house becomes very small, very constrained. In the language of the traditions I've been studying, they will say things like, "Fear is subtler than we think, and it begins very old. It begins in an original bargain when a child learns that being wrong means love might pull away, and the nervous system ties goodness, good behavior, being right, and belonging to its very survival. So there's a sort of subtle energy of am I doing it right? Am I doing it right? Like always scanning for are you safe, and that is a form of fear. But fear is also a timeline in this tradition. That if it's so embedded in our system, it becomes the sponsoring seed of what we do. So we act from this unconscious fear, and it carries us toward more things to fear, and the ideas that arrive so easily with joy are gated. They might even stop coming altogether. The mind will tell us that the way out is to gather every fact about what could go wrong, or to wait until our circumstances change. But the distance between fear and joy is a frequency gap which we have to cross in the body, and one way to do that is by asking many times a day, "Where is this energy in me right now? Like, is there fear in me right now?" Hmm, a little bit, a little bit anxious about something. What is that? Ooh, the noticing it, feeling it, letting it pass through me. In the yoga tradition, the second sutra of Patanjali reads Yoga Chitavriti Nirodha, which is usually translated as I have told you before. If you were a frequent listener, as yoga calms the fluctuations of the mind. But a truer reading is that yoga is the capacity to direct those fluctuations and to choose where your attention rests. This is dharana, and the skill of it lives in the returning again and again. If your mind wanders to fear, you come back. Each time you come back, your nervous system learns again that you have a choice. So, neuroscience says the same thing in its own language, it says what fires together wires together, but a pause that you practice for a few weeks or a noticing around fear becomes a habit, and then within a few months the habit becomes a belief, and the belief becomes eventually who you are. So my guest today is Dr. Todd L. Burstain, an internist who spent three decades in medicine and the last 10 of them helping doctors and patients through the fear that comes with change, his new book is Fear Itself. He has a gentle, almost tender way of making fear approachable, and he shows how an early wound like neglect becomes a strategy, much like I was talking about earlier, the original bargain that warps into a fixed, firm way of being, and perhaps it's people pleasing or perhaps it's withdrawal. But how that fear keeps that strategy in place with tools like rumination and self criticism, and then he walks us along a path back to the authentic self, which begins with a pause. We get into the chemistry of how a frightened body and chronic fear affects our dopamine and oxytocin levels. Using guided imagery, he helps us see how picturing a place where you feel safe is helpful, and why happiness, picturing a place where you're happy can't hold fear in the same way, and we also talk about raising children who know they are never alone with their big feeling.
Thank you so much for being with me on this big journey into the depths of ourselves and what's possible with a human life. As always, we are here to serve unconditional love and utter liberation. Coherence that invites a better and more beautiful world, and I appreciate you being on the journey. So here we go. Here's Todd. So you spent three decades as a physician, a hospital leader, and a builder of health data systems. So what made a doctor who works in things like databases write a book about fear.
Dr. Todd Burstain 5:24
I think there are three components to my life experience that really brought me to this place. One, as a as an internist taking care of patients, so much of what we ask is why. Why are the symptoms that somebody is having, why are they having them at that time? What disease does it represent? Even why are they responding to treatment or not responding to treatment? And so much of what became apparent in taking care of folks and trying to ask those questions was the role that fear had in making people's symptoms worse, making it more difficult them to respond to treatment, all of those things had a significant impact. For the last 10 years or so, I've been working as a healthcare leader doing informatics, which is the simple way to say that is how can computers and technology help doctors to do a better job at taking care of patients, and if you want to experience or see fear, try and introduce a physician to a new computer system. That is something that I've dealt with repeatedly to the point where I've actually had providers retire out of medicine as opposed to trying to adopt some of the new technology that we're trying to get to, so understanding how to help people understand their fear, cope with change, all of those things became an integral part of my professional work over the last 10 years. And then, just personally, you know, I'm married for 38 years, had four boys, two daughter-in-laws now, and two granddaughters, and so much of those personal interactions, you know, get colored by the dysfunction of fear, and trying to figure out how we can improve some of that dysfunction, how we can live a life that's more focused on what I call our authentic self, or I think you had another term that you were using to it that described it well. But really, the it's the destination that we want to be at. Where who is the person that we want to become? Right. That's the authentic self.
Christine Mason 7:40
I mean, it's such a such a beautiful intersection because, you know, first of all, I've never thought of an internist as sort of a medical detective, like you're saying this why why why thing. That's an interesting thread in and of itself, and the mind body connection being well documented in a lot of other areas. But with this movement toward quantification, it's such an interesting thing to choose because this this emotional undertone of fear seems to be one of the least quantifiable aspects of treating people, right? So so interesting that you're coming out of informatics where you're like measuring everything, galvanic skin response, blah blah blah, but you're dealing with one of the most ephemeral qualities.
Dr. Todd Burstain 8:20
Yeah, it is a very interesting dichotomy, right? About how the the world of medicine is becoming much more technical and and discreet, and yet one of the biggest driving factors behind that, both for patients and for healthcare staff, is this much more nebulous concept of fear. One of the things to to help understand that is to really focus on when we say fear, what it is exactly that we're talking about. I think that that's really useful because it it sets the stage for understanding this whole mind body connection that you're talking about in this regard. People may think of fear as something that I would call more fright, which is somebody runs in front of me as I'm driving my car, or I lose my balance. That's a type of fear, but it's not really the fear that we're talking about. Some people may talk about fear in terms of phobias, like I'm afraid of heights or small spaces or certain situations, and that's a little bit more complicated. But again, it's not really what is driving the vast majority of our types of behaviors. In this context, when we're talking about fear, we're really talking about a threat detection system. It's a way of us understanding and giving meaning to our experiences that is in an attempt to try and keep us safe from danger, you know what is that danger? It comes from so many of the traumas that we have experienced growing up and as young adults, whether that's abandonment or rejection or betrayal or failure. All these different ways that are. Brain has said that's a dangerous situation that we were in abuse, and we need to protect you getting into that dangerous place again. And so, fear becomes that strategy to help try and keep us safe.
Christine Mason 10:16
So it's like an adaptive, an adaptation for pain avoidance.
Dr. Todd Burstain 10:20
It is an adaptation for pain and fear are really tied very much together, but it's not just pain. It's an adaptive mechanism to keep you safe, to prevent you from being hurt.
Christine Mason 10:35
Yeah, I was sort of wondering how you had distilled things like grief and and anger and all of these things down to fear, but now you're getting at it. It's a very wide definition.
Dr. Todd Burstain 10:45
Social safety, mental, emotional, all of it. Yeah, all of it. It's a very wide definition. And and from that, from those traumas, right? What the brain tries to do is it develops strategies to try and help protect us from that danger in the future, right? One of the things I say that fear does is it takes the past and puts it as a lens to looking at the the present to help predict what's going to happen in the future. And in doing so, it it creates these strategies. So, what are some of the strategies? One could be anxiety. I need to worry about things. If I worry about things, I can protect myself from danger. One of the strategies is is depression, right? If I just go back into the past and try and re understand all my mistakes and everything that I did wrong, I won't make those again in the future, and so I will protect myself from danger, right? It could be narcissism, right? Where if I just control everything around me, everybody around me, I can make myself safe. Right? There are all kinds of different strategies, but the end goal is really the same. Of I've been traumatized in the past. I've been triggered in the past by whatever it is, and that was a problem that caused an emotional pain. I have an emotional memory about that. I need to do something to not let that happen again, right? So those are the masks or the the strategies. Because if you ask most people and you say, you know, in general from a day to day basis, are you afraid? You're not going to get many people that are going to say, you know, hey, I'm afraid, right? But it doesn't. Fear doesn't present itself like that. It wears masks, and the the mask may be codependency, which says I don't know if I'm okay or not. But if I make sure that you're okay, then I'm going to be okay. So I'm going to make sure that you're safe, and it's all the same strategies with the same goals. The problem is that that creates a lot of dysfunction, right? If I'm focused on my strategy of of worrying, it prevents me from getting to that point of being my authentic self about what it is I really want to to focus on, right? Who is the person I really want to be? And so fear is in conflict with that, and the way that fear maintains itself is it uses tools to kind of armor up. And so, what are some of those tools? It could be self-criticism, or rumination, or gaslighting, or guilt, or manipulation. There's all kinds of tools that the brain uses to control our feelings, our thoughts, and our behaviors to reinforce this cycle that you're in danger. Trust me, I've got the answer. I'm going to protect you. But what it ends up doing is creating a life of limitation and not a life of growth.
Christine Mason 13:37
Yeah, maybe we can walk through some examples of let's say you you have 10 sort of core traumas, right, or that you articulate in the book, and maybe we could walk through an example of how one of those shows up in early life, how the adaptation happens, and then the fear arises, and then maybe some of these examples on the tools and techniques people use to defend that strategy. Let's just pick
Dr. Todd Burstain 13:59
one. So let's talk about neglect, which is a real interesting one. the The primary fear of neglect is that when I need somebody to protect me or to be there for me, no one will be there. And what does that then do? It makes us believe that we are not important, and that we need to do something different because otherwise we're just not going to be seen, and so we start coping. And with the coping strategies, it's very interesting. With almost all of these coping strategies, there's fall into two camps. One of the camps is an anxious camp, and one of the camps is an avoidance camp. So in the anxious camp, it's the people pleasing. If I'm if I'm just really good at everything, if I'm perfect in every way, I'm going to be so valuable that I won't be able to be ignored. I won't be able to not be seen, right? So I start doing everything I possibly can to be perfect, and then. Some of the other the avoidant category is okay. Nobody's going to see me. I need to protect myself, so I'm going to withdraw and create emotional boundaries so I don't open up myself to being hurt. I'm going to take care of myself, and so we emotionally isolate. Or perhaps the avoidant pathway is I'm going to just dominate everybody else around me, and that way there's no way that I'm I'm going to be in in control, and so I will avoid anybody not seeing me by taking control of that. So different strategies, all at that same goal of trying to protect us from that danger.
Christine Mason 15:38
It seems like the the the one the avoidant one is more like, I I will take care of myself either by being the one in total control or I'll be the one who's you know doesn't need anyone. Is there a predictor of who becomes who adapts an anxious versus avoidant response?
Dr. Todd Burstain 15:55
Yeah, very interesting. I don't think that there necessarily is. I mean, you know maybe there may be some genetic tendencies about you know if if somebody is tends to be more avoidant or they see more avoidance in the family system that they're raised up in, that they may tend to do that. On the other hand, they may choose exactly the opposite, so they may be in an avoidant family system and choose to become more anxious as just a rebellion against that avoidance, right? So I don't think it'd be very hard to necessarily predict, and it's always it's almost always not a one to one. There isn't just one strategy and one tool. There's this cross intermingling, right? People who have anxiety also have depression, and maybe have some perfectionism. And people who use guilt may also have manipulation, and may also be ruminating. And so there's all this mixture of stuff that's going on.
Christine Mason 16:56
So you have the original wound, the neglect, the meaning, the meaning making. No one will be there. The adaptation of either people pleasing or becoming the hero or hiding, and now we're in the world, and we're talking about your response, the tools you use to protect that strategy. Now
Dr. Todd Burstain 17:14
tools that you use, yes, right. So those strategies, we we can recognize this is not a good strategy to be in, right? For me to be anxious all the time, that's not a place that I want to be, right? So how can we stay stuck in this anxiety state, right? And that's because fears are using tools to deceive you, right? It's using tools to try and say there's a benefit here to being anxious, you're not really being anxious. You're just being cautious. You're being rational and just thinking about things that possibly could happen, and that's a good thing. You're being prepared, right? So fear is using these tools to try and convince you that there's a benefit from having that strategy, and some of the tools that may use would be manipulation, right? Or how we control other people, or some of it may be catastrophizing, right? How we control ourselves. So if I'm always thinking about the worst thing that can possibly happen, then you know what? Being prepared makes logical sense. That that's a good thing to do, right? But what it hides is the cost. So it shows you the benefits, but it hides the cost, and the cost is I'm no longer able to do everything that I would like to do. I've limited myself. I've I've made myself smaller than what I could actually be, and so until you start peeling back these layers of the onions by asking why and why and why, you start you don't be able you lose the ability to see that cost.
Christine Mason 18:53
Yeah, that's that's one of the quotes in the book that I liked. You said something. You said fear asks you how do I stay safe, and the authentic self asks you, "How do I become more fully alive?" And that seems to be the heart of what you're saying right now.
Dr. Todd Burstain 19:07
Absolutely, yeah. When you pull all this down, and you can finally say, "Okay, I see this experience. I see the behavior that I'm doing, the tool that I'm using. I understand the strategy that it's trying to do, and I understand finally the trauma of what I was behind all of it. I can then stop and say, "This is fear's voice. This is fear telling me something, and it has all good intentions. It's just trying to keep me safe. It's not some mean monster, but it's not the voice that should be directing my life, and I need to do something different, right? And that's where we start on the authentic self path to really saying, how can I do something besides these cyclical patterns that I've got myself trapped in?
Christine Mason 19:58
I bet there are a lot of people. Who resonate with that? The idea that you're in a cyclical pattern, you're doing the same thing over and over, you're getting the same results. You keep trying to make a change, and it's just not working. It's it's like it's inaccessible. That thing is underneath the visible programming. It's hiding out somewhere in the subconscious mind.
Dr. Todd Burstain 20:17
Yeah, and there's a reason for that, right? So that was what was really fascinating. Is that the reason that fear is the default mode? Is that's because that's how our neurochemistry works. So when we have something that is an experience that our body is saying this is potentially dangerous, right? The the chemical state of what the brain is starts to change. The body releases adrenaline. It releases cortisol. Levels of dopamine start to drop. Levels of oxytocin and serotonin start to drop. Our craving hormone neuropeptide Y goes up. So all these things happen, and it creates an environment that makes it very difficult to break free from fear. So one of the things that happens is our prefrontal cortex, the front part of our brain where our thoughts are, tends to go offline, right? And so our executive function to come up with alternative explanations, it just disappears. Sometimes we call this tunnel vision, where we just see one particular thing, and that's the only thing that we can focus on. And at the same time that our frontal part of our brain goes offline, the deep emotional part of our brain, the amygdala, goes online and into hyperdrive. So the quickest way for me to get out of danger is if I can recognize what it is, and how can I recognize it? Well, if I tie it to a painful emotional memory that I've had in the past, then I can instantly recognize. Oh, I know what this is, right? And whether it's accurate or not, not important. Whether the whether current experience is actually reflective of what was the emotional pain in the past, not important. Fear just needs an answer and needs an answer now. And so this biology of things that kept us really safe when there were snakes and warring tribes and all kinds of other things that were out there doesn't work so well in today's environment.
Christine Mason 22:25
You have some tricks though for people to get around it, like to yeah. You you said like you you give fear its own voice. Like you have little internal family systems with fear taking a seat at the table. Tell us about that.
Dr. Todd Burstain 22:37
So the answer then becomes really what do we do different and and understanding the biology really is the starting point about doing something different. The first step is something I call the pause, and the main purpose of this is to clear out the chemicals that are in the brain that are driving this dysfunction. Right, just getting to a place of silence, and there are all kinds of techniques about doing this. There are breathing techniques. There is tai chi and yoga. All of these things are really designed to get to a place of silence, a place where the sympathetic part of our nervous system, that driving part, is being silenced, and the parasympathetic part of our nervous system is starting to gain strength, reestablishing that balance. Until that happens, you don't have access to that frontal part of the brain that we need for the executive function. All the brain is hearing is danger, danger, danger, and red lights. Right, so we've got to slow it down, press the brakes, get to that place of silence. The next step is comfort, and what this is really saying is, this experience triggered fear because it thought you were in danger. You were not safe. Provide comfort so that your brain now knows that you are safe. It's saying to fear, "I heard you. I heard your alarm bells. I'm going to put you in the parking lot for a little bit here because you know what, we're going to be in a safe space. And so, how do you do that? Whether it's a warm hug or warm blanket or a positive visualization or all these things, that lots of different techniques about providing comfort, tapping, all kinds of different techniques that have been used for this. The next step is focus, and this one was really interesting for me to kind of delve into. For years, my wife would tell me, "You need to meditate," and I'm like, "I don't know how to meditate. I just don't get it." It's because I really didn't understand what it was about. I think when people explain to me about what meditation is and why it works, it was you just need to focus on something, focus on one thing. And what I finally realized is the skill in meditation is not the focusing on one thing; it's when you lose focus to come back. It's the refocusing that's the skill. That we're really trying to get right, and what that really is doing is saying, "Can I take all those distractions that fear is put in my mind right now, and can I put them aside and just focus on what is actually right in front of me right now?"
Christine Mason 25:16
You're totally right on that. In the Yoga Sutras, the verse that they is often quoted, Yoga's Chitavriti Nirodha says that it's translated as Yoga calms the fluctuations of the mind, but that's not the actual direct translations. It's that you can direct the fluctuations of your mind, that you are able to choose where you want to place your attention. So Dharana and all of that, that like the ability to bring your attention onto something and not be at the mercy of your beautiful creative wandering mind.
Dr. Todd Burstain 25:48
Exactly, it's exactly right. the The next step I call observation and understanding, but really this is the whole mindfulness movement. This is being able to say, "What is it that I'm actually observing in this experience? This text message that I got that is making me crazy." Right. Let's actually look at the text message. Let's actually think about what is the setting that this was set in. Who is it coming from? When is it? All the details about being mindful, right, and then from that, trying to just use those details to create a meaning and understanding, not pull from our past emotional memory, but pull from the details, and really, that is exactly what mindfulness
Christine Mason 26:39
is. I can remember being in vipassana meditation, where you're sitting in a room in total silence and nothing is happening, and like kind of losing my mind a little bit, and then all of a sudden it hitting me that I am sitting in a room on a cushion, nothing is happening to me. It's warm. I'm fed. There are no problems at all. Everything is happening inside my head, and then whoosh! From that, then you know, like the lights went on. This moment of understanding that you're not, you're, you know, that that like if I'm observing what's actually here, like you're saying, this lamp, this table, you know, that bird outside the window, you're reminded constantly of the creative power of your thought.
Dr. Todd Burstain 27:22
Yeah.
Christine Mason 27:22
Okay. So we we're on to observing.
Dr. Todd Burstain 27:26
The fifth step is curiosity, and which is saying, now that we've come up with one meaning, what are the other possible meanings that it can have? And what this is acknowledged is our own humility. Right. We we have just perceived what's in front of us, and tried to come up with a meaning from our way of understanding the world. But there are all kinds of other explanations as to why certain things could be the way they are in front of us. Why this experience is happening to us? Being able to question those is a way to really put fear back in the back burner. Fear hates uncertainty; it likes one answer and one answer right now. Curiosity is not compatible with fear, right? But it is totally compatible with our authentic self as we're trying to discover what it is that we really want to be. So those are the first five steps along the authentic self pathway here, and they're really about getting us to that point where we've quieted the brain, we've comforted ourselves, we've focused, we're now establishing some meanings and even challenging some of those meanings. Now we have to get to the point of being able to stick with it, and the next five steps are really how do you stick with this process? The first of those is acceptance. Sometimes we're not going to be able to understand a meaning of what this actually is. This experience is just too confusing. We don't get it. Sometimes the only meaning is a really negative one, and that's okay. It may be a bad experience that happens in front of us, right? That's still okay. There's no guarantees in the world that everything has a positive meaning, right? We have to be able to learn that acceptance of we may not know, we may only see the negative right now, and that's still okay. And maybe the acceptance is this experience is actually dangerous, and that's okay too, right? But it's that acceptance. The step beyond that is commitment. So none of this is easy, as we said before. The biology of the brain drives fear to be the default mode. Everything we're asking you to do here, pausing, comforting, focusing, that's all voluntary activity, and it takes commitment to wake up every morning and do that. Those types of steps. To get to being driven by your authentic self instead of being driven by fear.
Christine Mason 30:05
I mean that acceptance sounds like it has a whole layer of the same humility in the step before
Dr. Todd Burstain 30:11
it. Absolutely. And and for that person who is like needs certainty, being able to just say, "I don't know," that that probably is like a big hurdle in of itself. That's like a capacity to just to be able to say, "I don't know. I'm not sure," and I can breathe into that. Is actually a huge capacity to build. Absolutely, the step after commitment is resilience, and this is that you know every one of us is going to stumble. Every one of us is going to have an experience that really nails on the head that primary trigger of our trauma, and off we go again back into the fear pattern of guilt and self-criticism and all of that stuff, and that's okay. We all stumble. That's life, but we have a path to get back on the track. We start back again with pausing. We start back again with comfort and focusing and understanding and being curious again. And the beauty of resilience is the next time you come to the bump in the road, you know that when you lean left, you're going to fall. So don't lean left there. It teaches you experience about how to face some of these traumas and learn to do them in a way that is not quite as destructive. The step after resilience is super important, and that's connecting to others. We can we're a social animal. We need other people to help comfort us. We need other people's ideas to help provide us with curiosity and meaning. We need other people's vision to help us observe what is actually in front of us. We need other people to help us with acceptance and with commitment. All of those skills benefit from having others in our corner, and so not only do we benefit from having people in our corner, but there's actually a huge amount of literature about the benefit of us being in other people's corner and supporting them, and this virtuous cycle that we get into with that. And then the final step, which I think is probably the most important, is connecting to self, and that is saying, you know, what is the destination that we want to get to? Who is it we really want to become? And even more specific than that, who is it that we want to become right now? And that may change with time. So who we want to become now may not be who we want to be in two years or in five years. This is a constant process of discovery. I think the important thing about understanding who we want to become is that it is a 100% internal decision. This is not something about I'm supposed to be a good person, or I'm supposed to be successful, or whatever it is. Right? It's internally. I choose this as my goal. This is my destination, and whatever that destination is, it's the right destination because you chose it, so being able to connect to that and understand that's the real goal.
Christine Mason 33:27
I mean, I'm I'm feeling into the amount of time you could put around this. Who do I want to become? It could be as short as Who do I want to be in this moment of conflict? Like, I'd actually like to be a loving, respectful person. I'd like to be that right now. Or who would I like to be at my son's playoff game next week? Who would I? You know, you could. Who would I like to be by the time the big holiday year end party at work rolls around? Like it doesn't have to be. I love this idea of thin slicing our becoming.
Dr. Todd Burstain 34:00
Yes. Yes.
Christine Mason 34:00
Yeah. Very. Very cool.
Dr. Todd Burstain 34:02
Yeah. the The authentic self can be big and it can be small, and anywhere in between. Right. About what is that that that picture of that? Right. But the goal, right, is not to eliminate fear, but if the authentic voice is speaking in the room at the same time as fear is speaking in the room, you have the option to choose, right? When fear is the only voice speaking in the room, there is no choice. This is what you get stuck with, and I think that's the the real suffering that so many people have with this is that they get stuck in that default mode and in these cycles, and they they don't see the path of of how to break free from that.
Christine Mason 34:49
This is the the invitation to softening and putting a space. It's very Viktor Frankl esque on the stimulus response space between, you know. But your your invitation feels so soft. Across the board, like hey, fears here. It's a smarty pants. It was wise, but it's also running the show. And if it's running the show, then you don't have access to all these other possibilities, including your most beautiful, authentic expression. So let's just chill out, give it some space, ask it some questions. And I love the the quietude of that. It's it's very it's very mature. It's very it's very sweet.
Dr. Todd Burstain 35:25
I love that. It
Christine Mason 35:26
also leaves space to do the other thing that you were saying in the book, which is that chronic fear blunts dopamine and opioid oxytocin stuff, and that the chemistry of pleasure is unavailable to you when you're living in the fear body, so let's talk a little bit about what it open. It's not just that it opens cognitively; it opens the body too.
Dr. Todd Burstain 35:47
Absolutely, yeah. So there are five neurotransmitters that in the brain that are affected by the fear state. So the the first is dopamine. Dopamine is our motivation hormone. It tells us, you know, what it is we want to focus on, what it is we want to investigate or discover or create, and fear shuts down dopamine. It makes the dopamine production less. It makes the receptors more resistant to dopamine, and so we get stuck in this this rut that you know we're just not motivated. We give up. We become hopeless. You know, one of the other podcasters I did said, "What is the one message you want to give people?" And I said, "Well, it's hope," and and that is really one of the things that fear takes away from us, right? And it does that through these dopamine channels. Fear lowers the levels of endorphins and enkephalins, which are natural hormones that help us with pain and help us with pleasure, so we experience more pain, and the pain is more intense, both physical pain, mental pain, emotional pain. The really interesting part about this is that all of those are processed in the exact same area in the brain, so the same channels that cause physical pain cause emotional pain, cause mental pain, and they're all fear makes all of them worse, right? And you can just think about how catastrophizing is going to make pain worse, right?
Christine Mason 37:16
Any contraction it makes you contract around it, like oof.
Dr. Todd Burstain 37:19
Yes.
Christine Mason 37:19
Yeah.
Dr. Todd Burstain 37:20
Yeah. The third is a very interesting chemical called neuropeptide Y. Neuropeptide Y is our craving hormone. 90% of the cells in the brain have a receptor for neuropeptide Y, and neuropeptide Y is what makes us want to gamble. It makes us want to have a donut. It makes us want to smoke? All of these things are driven by neuropeptide Y, and some really interesting thing coming out now about the GLP one use and how that they are showing very effective in the treatment of things like smoking cessation and alcoholism and things like that, because they're blocking the cravings, and so they're acting through this neuropeptide Y pathway. But that neuropeptide Y pathway is enhanced in the state of fear. So we have more cravings, more compulsions, all those types of things. And when we think about that, that is naturally creating another type of vicious cycle because the more we give in to those cravings and those compulsions, the less we feel we're in control. The less we feel we're in control, the less safe we feel, which creates more fear, which creates more cravings, and so it's this vicious cycle that that just erupts in response to this way that the brain is functioning,
Christine Mason 38:48
and then probably shame fits in there.
Dr. Todd Burstain 38:49
Shame, absolutely. The fourth one is serotonin. Serotonin is our contentment hormone. It's when we achieve something, how do we feel about it? And so serotonin levels drop in states of chronic fear activation. We are less able to appreciate our successes. We tend to diminish them and call them luck. We overexaggerate our failures and and convert a failure into shame. As you were saying, that it's not I had a problem; it's I am the problem, and so all of those things are driven and made worse by serotonin levels dropping. And you know, big component in depression that we've known for many years of the link to serotonin. And then the final hormone is oxytocin. So oxytocin is our bonding hormone. It's the hormone that's released during childbirth and breastfeeding, during sexual activity, all those types of things. Even holding hands or kissing releases oxytocin, and oxytocin levels drop during chronic fear activation. And so, what happens then with that is we decrease our ability to tie into our. Social bond and that ability to connect to others, and that makes us feel more isolated. More isolation leads to more perception of danger, lack of control, and all of that again cycles back in a positive way. So fear is creating this mindset in the brain that is reinforcing its default state, and it's why it's so hard to break free from it. The really good news about all of this, right? So all that may sound very depressing, right? But the really good news about it is that the brain has something called neuroplasticity, and the easiest way to understand that is the more you fire it, the more brain the brain wires it. And so once you start doing the path of breaking through and being kinder to yourself with pausing and comforting and focusing, the brain starts learning those pathways. And it doesn't take long three or four weeks of doing those things, it starts to become a habit. After it becomes a habit for several months, it starts to become a belief, and after it becomes a belief, it then becomes your identity. And so, change is absolutely possible with this. The brain is wired to do that type of change. The flip side is, if you don't do the change, though, you're reinforcing those fear pathways all the time.
Christine Mason 41:25
Yeah, the the oxytocin one, also any oral mucosa stimulation, like putting anything in. So I think a lot of smoking and eating, overeating, is basically trying to get the oxytocin to activate.
Dr. Todd Burstain 41:39
Yes, yeah. You can
Christine Mason 41:40
do that by sucking out a spoon. By the way, you can just put a spoon in your mouth, and it doesn't have any calories, nor does it have lung cancer-causing chemicals. So this is all beautiful. So we're neuroplastic. We can unlearn this. We can find new ways and invite a new future for ourselves. You give them guided imagery suggestions in here, but I found it very interesting that you said to imagine a place where you're safe, not happy. Tell me about that. The
Dr. Todd Burstain 42:06
connotation with it that it may be temporary. First of all, it may be not happy, but not happy enough, or maybe I'm too happy and I'm not being realistic, and it's going to be taken away from me. So happy by nature is unstable, and so happy and danger are not opposites. And so fear can look at happy and go, "Yeah, I can deal with you being happy. I can turn that right around for you." Okay, but the opposite of of fear and of danger is safety, right? So when fear comes across and hits safety, it's like it stops in its path because that said that its core purpose of what it was trying to do was get you safe. And if you already say you're safe, it doesn't know where to turn.
Christine Mason 43:02
That's pretty bold. This is like the Ramana Maharshi quote: "Who is having this thought?" You go look for it, and you can't find who is having this thought. So, if the fear is like, "Wait, wait, I'm already safe. Nothing to be done here." You're muting it. Basically, you're shutting it down.
Dr. Todd Burstain 43:19
You're muting it. You're you're you're you're making it stumble in its in its pathway. All
Christine Mason 43:24
right, great, that's helpful. So we're doing safety, not happiness, because happiness isn't trustworthy.
Dr. Todd Burstain 43:30
Yeah, basically.
Christine Mason 43:32
How does the body move out of safety then into delight, into this positive aspect?
Dr. Todd Burstain 43:38
Ah, that's a great question. How do we get to a place of joy, right?
Christine Mason 43:43
So now we're safe. We're safe. We've done all the things. We're being very good, rewiring, rewiring ourselves aggressively. No, softly. Now what?
Dr. Todd Burstain 43:52
Right. The joy really it's driven a lot by dopamine and by serotonin, and it's being able to create a place where you want to be, getting to that place, and then feeling the contentment of being in that place, and so all of those things center around that definition of your authentic self. To say, okay, these are. are. This is what I am saying is important. Is relevant to me. This is where I want to focus on. This is what I. My goal. And then doing the work to be able to experience life and make it in an alignment with that authentic self, then gets you that fulfillment, and that fulfillment of being able to achieve what it is that you wanted to be, becoming the person you wanted to become, that's the heart of joy.
Christine Mason 44:54
There's a very old text, like 1925, Florence Scoville Shin. And she says, "Your health, your wealth, your love, and your most perfect self-expression are the four indicators of the fulfilled life." Which I think is the whoever says the most perfect self-expression is like, "Yeah, how would you like to?" This is what I want for your granddaughters, that they grow up with the most perfect self-expression. That's actually a question that I have for you. So now that you've developed sort of a way to you know have your radar for fear and to see it in patients and to see it in the community, you probably also see it in your littles, in your grandchildren, and in your family. And what are you what are you doing to like interrupt it, nip it in the bud before it becomes a rigid pattern.
Dr. Todd Burstain 45:45
Yeah, so I think there are lots of different things that can be done. Obviously, trying to minimize our traumas of abandonment or rejection and betrayal and all of those types of things, and creating a comforting, safe environment for kids is super important. You know, tragically, that is a really difficult thing across the world right now, as well as even in the United States. So, but working on that, I think, is really important. The other thing, though, I think that is super important is to be able to provide validation and empathy for folks as they're maturing in their young life. When a small child has an event that happens to them, they have very little cognitive ability to do emotional regulation. Everything becomes a crisis, right? This is the whole basis of the terrible twos. Being able to say to them, "It's okay, you're having a big feeling right now, and that's okay, and we're going to work through that big feeling together," right? To try and, if you will, carry them through the emotional regulation process as they learn how to build that skill in their own brain. I think is really an important thing for parents to work on with their kids. So probably just as much as it is to avoid the traumas, because not all traumas are going to be able to be avoided. Right? You're going to have, you know, one of the traumas is illness and death, and we cannot prevent illness and death, so that may be a factor. You know, kids may get sick, parents may get sick, and all those things provide a source of trauma and of danger and instability, especially for a young child, so we do our best to try and control the traumas. But I think the better the better thing is to be able to provide the tools to let them recover from those traumas, and that is really building their ability to emotionally regulate and and hear that they're not alone, that they're you know in a family, that they are important, that they're loved, all of those things are like super important. I'm reminded of the the movie The Help, where the nanny says to the girl that you are kind and you are important to the little girl, and it's like, yes, that's exactly the right message. Yeah,
Christine Mason 48:20
and and we're and to your point, we're in it together.
Dr. Todd Burstain 48:23
Yes,
Christine Mason 48:24
I think the the expectation that life will always go well is a false promise. You know, there are going to be things all the time. So this this capability building in children to be like, wow, that was really hard. I'm really scared. Wow, what are we gonna do? You know that they can be with it, and that there's someone's eyes that they can meet, and someone to co-regulate with, and then then they can they can feel it and integrate it and pull it through the system, and not have to hold it as an unprocessed thing, and that would be beautiful as a starting point. I want to ask you before we move on to just telling people to go get the book because there's so much in it. What have you found in your own authentic self as you've done this work? What surprised you most about who you were before you identified fear as this mask, and who you've become?
Dr. Todd Burstain 49:20
There's several things. The power of the pause is incredible. The the I think for folks maybe the first or second time that they really are able to successfully pause and stop that storm that's going on in their brain, and it's like a light opens up in the sky. You know how powerful that really is, and and both power in releasing you, but also to recognize how much power there was controlling you and keeping you in that that fearful state. So I think that was a big surprise. The other big surprise for me was the joy of curiosity. Seems so counterintuitive that you know. If you have one answer, why would it be beneficial or joyful to try and question that and and challenge it and come up with 17 other different answers? But that's there's a creativity that exists with that. It almost sometimes makes you chuckle. Oh well, yeah, it could be this, and I never thought about that. And isn't that kind of humorous and just a tremendous release of pressure that happens with that once you have the ability to really start being curious and and asking what else?
Christine Mason 50:32
Even that feels like a muscle that has to be trained. What did you find it difficult in the beginning when you're doing the like the what else or what else could it like? I can't think of another explanation. This is the explanation. It
Dr. Todd Burstain 50:44
is very interesting because fear works on both sides of the equation here. Yeah. Right. Fear can say to you, "You already have an answer. Don't go looking." This is you know what this is. This is people persecuting you. You people criticizing you. You've been through this before. Stop thinking about it. Right, fear can also work the other way, and get you stuck in perpetual questioning. So it gets you stuck in rumination. So every time you think about something, the fear will ask, "Well, what about this? And what about that? And could it be this?" And so you have to figure out that balance with curiosity, where you're curious enough to ask other questions, but the questions that you're asking are coming from what you're observing, not from what you believe or some emotional memory or some catastrophizing or something else like that. Then you start to slip into rumination, and so it is absolutely a skill to be developed.
Christine Mason 51:43
Yeah, listen, I'm going to have fear stand down. I'm going to do a little ritual. Thank you very much. You've been very helpful. Goodbye. Go sit in the corner. I'm going to take a deep breath now. I want to ask you: Have you done? I saw that you had, like, you use the actual yogic names of your practices in the book, or have you been doing that? The
Dr. Todd Burstain 52:05
pranayams? Not. I've been doing some of the the breathing yoga exercises for sure. Yeah, I find them to be very very helpful. You know, it's amazing that autonomic part of the nervous system how well it responds to the breathing exercises. Really, within two or three minutes of doing them, you can measure decreases in pulse, increase in heart rate variability, all those types of things. It's really tremendous.
Christine Mason 52:34
So even just that, people, if you were looking at us right now, you'd see me taking a big breath, exhaling longer than I inhale, wrapping my arms around myself, giving myself a little affirmative squeeze, looking around, noticing what's really here, looking what I'm really I'm doing the whole exercises that Dr. Burstain has spoken of, and I feel like you could really, you could really benefit from this if you're a person who's caught in fear or anxiety or any of its flavors. Are you still doctoring?
Dr. Todd Burstain 53:08
I have just retired as of a few months ago to spend more time with my granddaughters.
Christine Mason 53:12
Okay, okay. You're a full-time author,
Dr. Todd Burstain 53:15
and now I'm an author. Yes, yeah, always filling the void.
Christine Mason 53:19
How's that? How's your? How do you like having your days open and unstructured like that? It
Dr. Todd Burstain 53:24
is fun because I get to number one focus on being outdoors and being in nature a little bit more, which I really love. So doing more hiking, but also you know grandparents' day. We are fortunate enough that two of our granddaughters live here in Seattle with us, and so we have once a week granddaughter grandparents day where we get to take them and do all kinds of fun things from the aquarium to you name it. Yeah, that's the joy. That's that's the authentic self that I want to get to.
Christine Mason 53:55
So you're on the other side of a formal career. You're in the joy of your family life. You're in the joy of nature, and you're actually sharing like a big piece of the integrative path of your last 30 years in in book form, like it's it's such a I feel you and your authentic self. How lovely!
Dr. Todd Burstain 54:15
Well, I appreciate that. That is really the goal. Is to, as within all of medicine, it's to alleviate suffering, and we know how much, especially in today's world, where we're assaulted with social media, breaking news, everybody's problems from all around the world coming to us in an incessant flood. That it's creating a lot of suffering, and people are struggling to try and get out from underneath it. And I hope that this can help.
Christine Mason 54:48
I will put all of the access to your website.
Dr. Todd Burstain 54:51
I have a website, drtodburststain.com. You can read the first chapter, listen to the first chapter there. You also can send me any comments. I'm happy to respond by email to those. The book is going to be released November 10th on Amazon, and the audio book will be on Spotify as well.
Christine Mason 55:15
Congratulations! Thank you so much.
Dr. Todd Burstain 55:17
My pleasure. This was great, Christine. Thank you.
Christine Mason 55:21
That was Dr. Todd Burstain. What stays with me is his image of two voices in the room. You don't silence the fear when your authentic self is also speaking. You get to witness the fear, and you get to choose. So before you go, try this with me. Take a big breath, and let the exhale be longer than the inhale. Wrap your arms around yourself and give a little squeeze, and look around and notice what is actually here in the room. I see perfume bottles. I see a tray. I see a painting of a lotus. I see a chair. I see a rug, and it's got little dusty blue and gold. I see a mirror. The fan is going like I notice physically the space I'm in, and then I notice the sensation and the feeling in my body. Look around and notice what is actually here. You are safe in this moment. You can let your body hear that with actual words, but you become more present to yourself. Todd's book Fear Itself comes out on november 10 on Amazon, and the audio book will be on Spotify. On his website, you can read and listen to the first chapter, and he welcomes your notes by email. You'll find all of that in the show notes. So, Dr. Todd, thank you for bringing 30 years of asking why at the bedside into a book that is full of hope, and thank all of you for listening, for being curious with us, and for letting fear take a seat, so that love might lead. Keep blooming. This has been the Rose Woman podcast. Please support rosewoman.com. It is your go-to for the beautiful products that support your personal and private life, rosewoman.com.
