#1872 Agency and Anxiety Part 1

Therapist Erika Forsyth joins Scott Benner to explore how building agency combats anxiety. Learn how understanding your brain's "flipped lid" can help you regain control during diabetes management challenges.

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Key Takeaways

• Anxiety vs. Agency: Anxiety is the physical and mental experience of feeling out of control or uncertain, while agency is the belief and ability to act, influence, and affect outcomes.
• Agency as a Protector: While agency does not eliminate fear, it plays a protective role by interrupting the nervous system's cycle of helplessness and reducing the escalation of a threat response.
• The "Flipped Lid": Using Dr. Dan Siegel's hand model of the brain, a "flipped lid" occurs when the emotional amygdala overrides the logical prefrontal cortex. Practicing agency helps bring the prefrontal cortex back online.
• Micro-Successes Retrain the Brain: Repeated, small successful actions in managing challenges (like diabetes) build neural pathways that replace learned helplessness with confidence and goal-directed action.
• Nervous System Regulation: Engaging your sense of agency shifts your body from a sympathetic state (fight or flight) to a parasympathetic state (calm, capable of problem-solving), mitigating feelings of panic.

Resources Mentioned

• Contour Next Gen Blood Glucose Meter: contournext.com/juicebox
• Medtronic Diabetes (MiniMed 780G, Instinct Sensor, Simplera Sync): medtronicdiabetes.com/juicebox
• Juicebox Podcast Pro Tip Series & Resources: juiceboxpodcast.com
• Wrong Way Recording: wrongwayrecording.com
• Dr. Dan Siegel: Hand Model of the Brain / The Whole-Brain Child

FULL EPISODE TRANSCRIPT

Introduction & Show Sponsors

Scott Benner (0:00)

Hello, friends, and welcome back to another episode of the Juice Box podcast. Anxiety is your nervous system noticing uncertainty and feeling like it can't do anything about it. Agency is the opposite. The sense that you can act and affect what happens next. This episode is about how that one shift calms the alarm in your brain.

Scott Benner (0:29)

Agency doesn't erase the fear. It gives your nervous system a way through it. My diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple actionable tips.

Scott Benner (1:05)

The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu. Nothing you hear on the juice box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin.

Today's episode of the juice box podcast is sponsored by the Kontoor Next Gen blood glucose meter. This is the meter that my daughter has on her person right now.

Scott Benner (1:39)

It is incredibly accurate and waiting for you at kontoornext.com/juicebox. Today's episode is also sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed seven eighty g system and their new sensor options, which include the Instinct sensor made by Abbott. Would you like to unleash the full potential of the MiniMed seven eighty g system? You can do that at my link, medtronicdiabetes.com/juicebox.

Erica, Erica, Erica, you have returned.

Erika Forsyth (2:14)

Hi. It's been a while.

Scott Benner (2:16)

Yeah. Yeah. We, I don't know what happened. What did happen? Is it scheduling?

Erika Forsyth (2:21)

The busyness of life, scheduling.

Scott Benner (2:23)

Yeah. I did because you looked at me and you said, I haven't seen you in a while. I thought, have not seen her in a in a hot...

Erika Forsyth (2:29)

April was a busy month. I that was part of it. Okay. And on my side, and you were traveling Yeah. A little bit.

Defining Agency and Anxiety

Scott Benner (2:36)

Oh, let's get this in now before I've gotta go do the stuff I'm doing this summer, and I won't be back for a while. So what are we gonna talk about today?

Erika Forsyth (2:45)

So I believe and know that we have talked about anxiety in different ways in how we experience living with diabetes, and I thought we could talk about it in the context of how agency and anxiety work kind of with and against each other. It it all really ages and stages of diagnosis and also from the caregiver's perspective and also the person living with diabetes. So I thought we could just start by defining Yeah. What agency and anxiety are.

Scott Benner (3:19)

Go for it.

Erika Forsyth (3:20)

Okay. So agency but you might be more familiar with the term, you know, self efficacy, but agency is often used in the way that we can have the sense or belief or thought that we can act and influence and affect outcomes. Right? So I it's often learned. That might be a whole other interesting conversation of how does one develop agency, but I think that's what we're gonna talk about throughout our conversation today.

Erika Forsyth (3:49)

So just the, yeah, the belief in oneself that when I do when I do x, I can anticipate that y will happen in simpler terms.

Scott Benner (3:58)

Because I have to admit, I'm a little light on this definition myself. But is it just the idea that, like, I'm in charge and when I do like, I'm in I don't Like, I'm in the driver's seat? Like, I I'm not a passenger in this or, like, what's the what's the, like, real plain definition of agency? Because it's I think it's a word people throw around.

Erika Forsyth (4:15)

Yes. And often in in the kind of the mental health world, therapy world, we use it a lot. Mhmm. So the simplest way is, yes, I can act, influence, and affect outcomes. However, it also is used in a way of, like, I can choose.

Erika Forsyth (4:32)

I have choice. I have independence. I, yeah, I'm kind of in the driver's seat, but it it comes with this, like, overall sense that you kind of have ownership in your life, and maybe not in all areas and aspects of your life. But, for example, people might use agency as, okay. Let there are some things that you are you are wanting your kids to do.

Erika Forsyth (4:59)

Right? You have guidelines. You have expectations, but maybe you want them to experience agency tonight by saying, hey. We're gonna have dinner tonight, but do you wanna have pizza or pasta?

Scott Benner (5:10)

Mhmm.

Erika Forsyth (5:10)

That's letting them experience a little bit of agency where they have choice.

Scott Benner (5:15)

Choice and control to some degree? Yes.

Erika Forsyth (5:17)

Yes. Okay.

Scott Benner (5:18)

Alright. So No. No. I I it really is one of the you know, my son...

Erika Forsyth (5:22)

Mhmm.

Scott Benner (5:23)

Makes fun of me all the time. He's like, you don't know what that word means. And I was like, I do. And I use it in a sentence. I go, that's correct.

Scott Benner (5:27)

And he goes, what's it mean? And sometimes I'm I think it's just the word I say. I think when you say agency, everyone gets a vibe about what that means. And I think you're getting your point across, but digging into it is, like, I I think interesting. So, like, how do you, like how does some people just have it?

Scott Benner (5:46)

How do you give it to somebody? How do you go find it if you don't have it? Right? Like, that's I mean, there's a lot of questions in there, to be perfectly honest.

Erika Forsyth (5:53)

Yes.

Scott Benner (5:54)

Okay. But how does it go go ahead. Say that. I'm sorry.

Erika Forsyth (5:57)

No. I said we're we're gonna get into that. I think is it something that you just have, or is it something that evolves? Is it something and I think it the general sense would be it's something that you kind of learn. Right?

Erika Forsyth (6:10)

And you also can be given if you're the child's agency, but you also can exercise it, right, in your in your own life.

Scott Benner (6:18)

Is it a thing that, like, could be misread? Like, I think people would say that I feel like I'm in control of, like, what I'm doing. I make decisions kind of, like, promptly, boldly. I have confidence in myself. But other people would look at that and and call that a problem.

Scott Benner (6:34)

So, like, you know, like, you know, but he he thinks everything he does is right. He's a narcissist, like, that kind of thing. Like, I feel like I trust myself, but I think I trust myself because I grew up without people helping me with things. And I've made decisions, and I haven't died. So I believe that my decisions are, generally speaking, gonna move me in a good direction.

Scott Benner (6:53)

Like, very simply, like, I think that's how it feels.

Erika Forsyth (6:55)

You have the capacity to make the decision. You have the ability whether it's kind of learned over time. Mhmm. But it's not...

Scott Benner (7:09)

Is the capacity something someone could take?

Erika Forsyth (7:11)

It's capacity, but it's not like I hear you. It's not like like a right. Like, I have a right to to dictate. It's not like a dick...

Scott Benner (7:20)

It just feels like so so somebody could maybe deconstructing it helps. So someone could take the capacity from you. You could have an overbearing parent that doesn't let you make any decisions, and therefore, you don't have agency.

Erika Forsyth (7:31)

Correct.

Scott Benner (7:32)

Okay. And you could also have a parent that's, you know, giving you too much freedom and maybe turning into a a little bastard. And and, like, you know, like, I just like...

Erika Forsyth (7:44)

Or entitled.

Scott Benner (7:45)

Entitled. Right? But you have agency, but it maybe has gone too far. So, like, agency seems to me more like a middle ground of of I feel I feel like it's something I'm allowed to do. I'm comfortable making a decision, and I feel like it's going to go, okay.

Scott Benner (8:01)

I have agency, but I'm not gonna wield it in some crazy way where I'm a terrorist to people, you know, and they're and in the moment, and I don't have my head down and don't feel like I can raise my eyes up and and make a decision for myself. The middle there is agency.

Erika Forsyth (8:16)

Yes.

Scott Benner (8:16)

Am I getting that? Okay.

Erika Forsyth (8:18)

Yes. Having a choice and I just actually I like this definition. It's the ability to act as an effective agent for yourself. I mean, we're using the word in the definition, which is a no no, but I think...

Scott Benner (8:33)

What's blue mean? You know blue.

Erika Forsyth (8:36)

But it's yeah. Actually, it's interesting even as we try and define it. It is one of those words that you can just it like, it's a feeling.

Scott Benner (8:46)

It's a vibe. Yeah. Yeah. It's a than a word. Right.

Scott Benner (8:49)

So okay. And now let's move to anxiety because I'm I'm confused about how they're gonna intersect with each other. So

Erika Forsyth (8:57)

Okay. So, I mean, anxiety also will probably be very it's a feeling. Right? It's it is two different things. Think if we're thinking about worry, which might feel more like the mental, exercise of anxiety, anxiety is usually more defined as the physical and mental experience of feeling uncertain, feeling like you cannot influence outcomes.

Erika Forsyth (9:25)

So almost the opposite...

Scott Benner (9:27)

Mhmm.

Erika Forsyth (9:27)

Of agency, but it's the perception that you do not have the ability to influence outcomes of kind of feeling out of control. And as a result of that feeling of being out of control, you might experience worry. You might experience symptoms of anxiety that feed each other.

Scott Benner (9:45)

Is anxiety the worry about a thing you don't have agency over? Because if you're thinking about something you can control, that's thinking about it. If it right? Because you get nervous when you you know what I mean? Like, if you put me at the end of a rope bridge and it was broken, and I thought I could probably fix this and get across, I'd feel a little anxious, but I wouldn't collapse.

Scott Benner (10:06)

I'd feel like, oh, I can do the thing and get across. But then there are sometimes that people look at something, and I always imagine that what anxiety is is when you're worrying about the unknown. Yes. Because you don't have the rest of the story, so you can't complete the circle and decide if it's a a conquerable thing or not.

Erika Forsyth (10:22)

That's right.

Scott Benner (10:23)

That's how I think about it, but I could be wrong too. Interesting. Okay. Good. Because I have here anxiety is a false alarm in your brain.

Scott Benner (10:30)

A feeling that something bad is going to happen and I'm completely powerless to stop it.

Erika Forsyth (10:34)

Mhmm.

Scott Benner (10:35)

Why do some people feel anxiety more than others? I guess that's a the million dollar question. Right?

Erika Forsyth (10:41)

Yes. I don't I don't think we can answer that.

Scott Benner (10:44)

Yeah. Is this a good place for me to put in my my fishing idea about anxiety, or do want me to wait till later?

Erika Forsyth (10:49)

Yeah. Go ahead. Share share away.

Scott Benner (10:51)

I just I I shared with Erica before we started that I feel like if I had started a podcast on a different topic, I would not have met so many anxious people. And I can't decide if that's because they're anxious because they have diabetes or if because their child does or if anxiety is an inflammation related issue and that autoimmune maybe makes it more common among this this group of people. Or if maybe it's maybe a mixture of it or not one and maybe all the other. I'm not sure, but I I record five days a week. Three people call themselves anxious.

Scott Benner (11:29)

I talked to a woman the other day. She was anxious with a b word. You you know, like, she was really tortured by it. And then I spoke to another woman who felt anxious, but then after I asked her more questions, I realized she was anemic. Like, I think I diagnosed her as being anemic while I was speaking to her.

Scott Benner (11:48)

But she was having, like, this crazy anxiety. Dumb. Yeah. Yeah. Yeah.

Scott Benner (11:51)

And I was like I'm like, were you ang have you always been anxious? She's like, not this much. I think she was blaming the kid's diagnosis, and I started asking a bunch of questions. Then she mentioned she had a hysterectomy, and I was like, hey. Are you anemic?

Scott Benner (12:05)

And she goes, no. Well, they did give me iron after the hysterectomy. And I went, oh, okay. She emailed me after we got done recording. They did give her iron.

Scott Benner (12:15)

She had a ferritin of 14. It only moved it up to 20. She's anemic. And, like, so maybe she's an anxious person to begin with, but anemia actually makes that there's technical reasons why that I can't just pull out of my right now, but I know are there. And and there's reasons why you might seem more anxious with while you're anemic.

Scott Benner (12:34)

And, also, I meet a lot of anemic people, and I think that's also got something to do with the autoimmune autoimmune too. Like, I feel like it's all, like, you know, right church, wrong pew kind of thing. Like, I think it's it's in the building. It's just not always it's not like you have diabetes, so you're anemic. Or you have autoimmune, so you have this.

Scott Benner (12:52)

But, man, I meet a lot of people who are anemic, a lot of people who have anxiety, a lot of like, I've I've mentioned before, I meet a lot of people with a bipolar relative. Just the general population doesn't know that many bipolar people, do they? Mm-mm. You you know? Like right?

Scott Benner (13:06)

But, like, I talk to people with type one, and they all seem to know somebody in with with that situation. So, anyway, I think anxiety is partially I think it's partially, like, inflammation or something that, like, is nebulous to me, but it seems obvious, you know, colloquially. So, nevertheless

Erika Forsyth (13:23)

I mean, yeah, there there could be, and it could be a result of this kind of interplay between living with a chronic illness that can increase anxiety when you don't experience a lot of agency all the time.

Scott Benner (13:35)

Yeah. Oh my god. Well, by definition, if you don't get educated well or didn't understand your education, you have no agency with that type one. And and then on top of that, if you're experiencing, like, physical, like, input implications imagine you're a little anxious and a little anemic and don't understand the tools to take care of your diabetes with, and all the problems you have are just worry because you don't understand how to get to the end of them. I mean, that's a that's a perfect storm.

Sponsorship Break: Medtronic & Contour

Scott Benner (14:02)

Unlike other systems that will wait until your blood sugar is a 180 before delivering corrections, the MiniMed seven eighty g system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. Today's episode of the Juice Box podcast is sponsored by Medtronic Diabetes and their MiniMed seven eighty g system, which gives you real choices because the MiniMed seven eighty g system works with the Instinct sensor made by Avid, as well as the Simplera Sync and Guardian Force sensors, giving you options. The Instinct Sensor is the longest wear sensor yet, lasting fifteen days and designed exclusively for the MiniMed seven eighty g. And don't forget, Medtronic Diabetes makes technology accessible for you with comprehensive insurance support, programs to help you with your out of pocket costs, or switching from other pump and CGM systems. Learn more and get started today with my link, medtronicdiabetes.com/juicebox.

Scott Benner (15:12)

The Kontoor Next Gen blood glucose meter is sponsoring this episode of the juice box podcast, and it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right. If you go to my link, contournext.com/juicebox, you're gonna find links to Walmart, Amazon, Walgreens, CVS, Rite Aid, Kroger, and Meijer. You could be paying more right now through your insurance for your test strips and meter than you would pay through MyLink for the Contour Next Gen and Contour Next test strips in cash. What am I saying?

Scott Benner (15:52)

My link may be cheaper out of your pocket than you're paying right now even with your insurance. And I don't know what meter you have right now. I can't say that. But what I can say for sure is that the Kontoor Next Gen meter is accurate. It is reliable, and it is the meter that we've been using for years.

Scott Benner (16:11)

Kontoornext.com/juicebox. And if you already have a Kontoor meter and you're buying test strips, doing so through the juice box podcast link will help to support the show.

How Agency Protects the Brain

Erika Forsyth (16:22)

That's yeah. It is a yes. It is a perfect storm. So what do we do with this? So what I think is really fascinating is to talk about how agency can play a protective role.

Scott Benner (16:36)

Okay.

Erika Forsyth (16:37)

Agency doesn't eliminate anxiety as you were just sharing with the end of the ropes analogy. It can play a protective role, and it can help shift how you interface and interact with thoughts and feelings of anxiety. So the bullet points here that we're gonna get into is that agency can play a protective role in anxiety because it can increase your perceived control.

Scott Benner (17:01)

Mhmm.

Erika Forsyth (17:02)

It can support active active coping rather than avoidance or shutdown. It can reduce the escalation of your nervous system by interrupting your cycles of helplessness, and it will help shift the nervous system from the reactive threat state to more the regulated, I can make decisions, I can affect change to a more goal directed action.

Scott Benner (17:31)

Okay.

Erika Forsyth (17:32)

So we're gonna get into those things.

Scott Benner (17:33)

Okay. Yeah. So you're gonna step through them?

Erika Forsyth (17:35)

Yes.

Scott Benner (17:35)

Awesome.

The Hand Model of the Brain

Erika Forsyth (17:37)

Before we do that, I thought it would be cool to talk about the brain. And as as I said before, I am not a neuro scientist. I'm not a neuropsychologist.

Scott Benner (17:49)

I am. No.

Erika Forsyth (17:50)

I'm just Okay. Good. Good.

Scott Benner (17:51)

Good. By the way.

Erika Forsyth (17:52)

But yeah.

Scott Benner (17:53)

You are a thing, by the way. You went to you went to college, at least.

Erika Forsyth (17:57)

Okay. So agency, as we were saying, doesn't eliminate it, but it can change the way your nervous system reacts to the feeling of being out of control. Right? It can restore the sense of influence. So if you are familiar with doctor Dan Siegel, who has written a ton of books, he's a very well known psychiatrist and professor.

Erika Forsyth (18:21)

He wrote the whole brain child along with countless other books. He has created the hand model of the brain. So if you once you're done listening and you wanna go look up doctor Dan Siegel's hand model of the brain, you can do that. But quickly, we I thought I could walk you through it. So if you're holding up your hand...

Scott Benner (18:42)

Mhmm.

Erika Forsyth (18:43)

With your palm up...

Scott Benner (18:44)

I'm doing it.

Erika Forsyth (18:45)

Okay. Yes. Okay. So your wrist is the spinal cord

Scott Benner (18:49)

Okay.

Erika Forsyth (18:50)

Which goes up into the middle of your palm, which becomes the brain stem. So then if you fold your thumb over so you're still your your hand is open, but you're folding your thumb over. Yeah. Your thumb represents the limbic system, which houses the hippocampus, the amygdala. That's your fight or flight response.

Erika Forsyth (19:11)

Okay? Oops. Okay. Then if you fold over your hand, that is your cortex. Okay?

Scott Benner (19:22)

Mhmm.

Erika Forsyth (19:23)

And the cortex represents the upstairs brain, and that's responsible for your logical thinking, your empathy, your emotional balance. So when your fingers are down over your thumb, which is the limbic system, he calls that that's your integrated brain. And that's what your cortex is kind of online. Right? And it's managing your limbic system.

Erika Forsyth (19:47)

It's leading to calm, rational behavior. When your amygdala overrides the cortex, which is your fingers, then you he's he kind of defines it as your your lid is flipped. You flipped your lid, and your fingers go up.

Scott Benner (20:04)

Mhmm.

Erika Forsyth (20:04)

Okay? And that basically is the example of, you know, you've your stress system, you've got have gone offline. Right? And to regain control, reactivating the prefrontal cortex, which are the prefrontal cortex are basically in this hand model of the brain, your fingertips, the, like, the first index Okay.

Erika Forsyth (20:30)

Of your fingers. Okay.

Scott Benner (20:30)

Yeah.

Erika Forsyth (20:31)

First knuckle. Thank you. Yep. Through deep breathing, mindfulness, kind of restoring balance back into your brain. Did that that's a very, very simplified way to understand our brain.

Scott Benner (20:45)

I thought you could have just said, if you punch wrong, make your hand like that. That's thumb inside your finger. It's Okay.

Erika Forsyth (20:51)

Yes. Yes. Yeah. Okay. That's right.

Scott Benner (20:55)

Do you ever see a kid go like this? I'm like, oh, you're gonna break your thumb when you hit me.

Erika Forsyth (20:58)

Wait. So how are you supposed to punch?

Scott Benner (20:59)

Your your thumb should be on the outside underneath of your knuckles so that you lead with the tops of the long part of your hand like that.

Erika Forsyth (21:05)

Okay. Yeah. Okay.

Scott Benner (21:06)

So you don't want your thumb inside your hand.

Erika Forsyth (21:08)

Okay. Good to know.

Scott Benner (21:10)

Yeah. Well, now you know. Okay.

Erika Forsyth (21:12)

Okay. So I think and the reason why it I think it's important and why doctor, Roy Deion Siegel has really spent a lot of time trying to educate people on the basic understanding of the brain is because he believes, you know, you you can change both the function and the structure of the brain by knowing about how the brain is structured. Or so I have an understanding, it really helps. And they teach this in schools. I bet if you're listening and you have children, I I wonder if you if they have not been taught already about the hand model of the brain.

Erika Forsyth (21:48)

Okay. So why is that important? So as we talk about agency, as we're referencing parts of the brain, I thought that'd be interesting to know.

Scott Benner (21:59)

It is. Yeah.

Erika Forsyth (22:00)

Okay. Please. So so agency reduces the threat activity, which is the amygdala, right, which is the limbic system represented by your thumb. So when a person when you feel helpless or unsure what to do, the amygdala ramps up and you're feeling threatened, and you might you know, your lid is flipped, so to speak. Mhmm.

Erika Forsyth (22:20)

But when you feel like you can act and you're experiencing and have that sense of agency, the amygdala's alarm response decreases. You don't feel you're not experiencing those threat cues that something bad is about to happen. You're not entering into that fight, flight, or freeze mode, and then your body produces fewer of the stress hormone of cortisol. So why does this happen? Because if you are experiencing that perceived ability to act and influence outcomes, that situation that you're faced with is less is not as it's not threat based.

Erika Forsyth (22:58)

It's it's a challenge. Okay. I can problem solve. I can figure this out because I know I've learned when I do x, y happens. And I know that's very simple.

Erika Forsyth (23:08)

And we're gonna talk about how this works or does not work with diabetes, but we're talking kind of in general.

When Diabetes "Flips Your Lid"

Scott Benner (23:13)

Yeah. Can I tell you something really interesting?

Erika Forsyth (23:16)

Yes.

Scott Benner (23:17)

I do this with a lot of frequency. I'm very transparent with people. Like, you know, Erica tells me what she wants to talk about. Sometimes I tell her. I let her lead the conversation.

Scott Benner (23:27)

She comes with notes and everything. But sometimes just to help myself, I'll I'll open up on a a chatbot somewhere and I'll be like, agency and anxiety, like, just break it down for me. And you end up doing everything and I don't really need help. But when you brought up the hand model, I didn't have context for it at all. So I said to it it I told I told the robot.

Scott Benner (23:48)

I told it I said. And I just typed in the doctor's name and hand brain. So it broke it down for me.

Erika Forsyth (23:54)

Mhmm.

Scott Benner (23:54)

And the question I had leaving that description was, what makes you flip your lid? So I just I swear to you, I just said, what flips the lid? And everything it gave me back, it contextualized around diabetes even though I did not mention diabetes at all in this. This LLM knows the podcast I make.

Erika Forsyth (24:14)

Yes.

Scott Benner (24:15)

And it, so I don't know. Be be be scared or be happy. I'm not sure exactly what, but it it's I it under what flips the lid, it said sudden high stakes uncertainty like a jump scare. What could that look like? A sudden double arrow down on a CGM when you're driving or an unexpected occlusion alarm in the middle of the night.

Scott Benner (24:33)

Number two, cognitive exhaustion, decision fatigue. The lid flips not because a specific number is terrifying, but because the logical brain is just too tired to do the math one more time.

Erika Forsyth (24:44)

Mhmm.

Scott Benner (24:45)

This is when a slightly stubborn blood sugar at APM causes a comp a complete emotional breakdown, whereas the exact same number at 10AM may have been handled with more calm. Number three, the collapse of the action response map, total loss of agency. The brain interrupts this unpredictability not as a math error, but as a total loss of agency and a profound betrayal of the body by the body. The helplessness circuit lights up and logic is abandoned because logic didn't work anyway. And the amygdala takes the wheel in a state of deep frustration or grief, which by the way is fascinating because I always say to people, like, why do you always just say, well, that's just diabetes?

Scott Benner (25:24)

And what they're saying is, I did something logical and it doesn't work. That's how diabetes goes. Like, that's so fascinating to put that together there.

Erika Forsyth (25:31)

Yes. And that's what we're gonna get into.

Scott Benner (25:33)

Oh my god. Am I foreshadowing?

Erika Forsyth (25:35)

You are foreshadowing.

Scott Benner (25:37)

Should I do the fourth one, do you wanna leave leave me alone? She's like, why don't I just go if you're gonna do this? Yeah. Physiologically.

Erika Forsyth (25:45)

I'll see you next week.

Scott Benner (25:46)

Yeah. Bye, everybody. Sleep deprivation illness is this physiological vulnerability, and especially hypoglycemia. When blood sugar drops, the brain is literally starved of glucose and needs the power of their prefrontal cortex. Well, there you go, everybody.

Scott Benner (26:00)

Go down because I'm sorry.

Erika Forsyth (26:01)

Know that when your when your lid is flipped...

Scott Benner (26:04)

Yeah.

Erika Forsyth (26:04)

Your your cortex has gone offline. Right?

Scott Benner (26:08)

Okay.

Erika Forsyth (26:09)

And yes. So what we want we're in kind of going through the steps, and those those are all great illustrations of what makes your lid flip. We are gonna talk through what is it in in more, some more illustrations as well is that that paradox of the agency and the anxiety.

Scott Benner (26:29)

Okay.

Erika Forsyth (26:30)

And so agency increases, and that's what we want, is more of that prefrontal cortex engagement. Right? Because that's again, it's responsible for the planning, the decision making. It can regulate your motion, and you're constantly integrating information Mhmm. Through the prefrontal cortex, which is the part that's right behind your forehead.

Erika Forsyth (26:55)

Yep. Okay. So when agency is present, and this is it you know, the p f the prefrontal cortex comes back online, allowing you to flexible thinking, problem solving, you also are remembering prior successes, which is an important piece. Like, hey. Last time, this I did this, and this worked Mhmm.

Erika Forsyth (27:17)

Which, again, is interesting with diabetes. Right? Because sometimes that works, sometimes it doesn't. So you're you're shifting from reactive to intentional, and you're able to do that because you're engaging in that that prefrontal cortex is engaged.

Scott Benner (27:35)

So you trust that what you know is going to happen is going to happen, and that creates, like, resonance Reinforces. The agency again.

Erika Forsyth (27:43)

Yes.

Scott Benner (27:44)

Yeah.

Erika Forsyth (27:44)

Yes. It's a reinforcement cycle.

Sympathetic vs Parasympathetic Nervous Systems

Scott Benner (27:47)

Okay.

Erika Forsyth (27:48)

So agency shifts. We have we have the autonomic nervous system, which some people say is composed of two branches, some people say three. But the the two kind of main nervous system branches that we think about are the sympathetic and the parasympathetic. So when we have the sympathetic dominance, we might be experiencing low agency, and this is where the physical experience of anxiety lies. Right?

Erika Forsyth (28:17)

We have the shallow breathing. You might be feeling on edge. Your heart is racing. You might have thought racing. You might be on high alert.

Erika Forsyth (28:27)

Right? Like that experience that you would just have the double arrow down. Yeah. That might trigger a a sympathetic response, and or you might already be there. And then you see the double arrow down, and then that reinforces that that fear response.

Erika Forsyth (28:43)

Okay. If you have active agency, you might have more of a parasympathetic dominance, and that is the nervous system that that part of your nervous system slows down your breathing. You're able to ground yourself. You have more capacity to deliberate your decisions and and and consequences, and you have that decreased panic like sensation. So there's a reason why when we say you're experiencing that increased heart rate, the increase, the thought racing, the shakiness of anxiety, the most the most common, you know, first intervention you'll hear is to do your deep breathing

Scott Benner (29:25)

Yeah.

Erika Forsyth (29:25)

And that's to engage the parasympathetic nervous system.

Scott Benner (29:29)

This is fascinating. Thank you for bringing this up. Like Okay. Yeah. Real really.

Scott Benner (29:34)

Then keep going, but thank you.

Erika Forsyth (29:35)

Okay. Okay. Good. Good. Okay.

Erika Forsyth (29:37)

So and that's what I just said. Like, you know, that's why doing something when you but but that's the hard it's hard. Right? When you are in this panic state and maybe even experiencing a panic attack

Scott Benner (29:48)

Mhmm.

Erika Forsyth (29:49)

And people say, well, just, you know, do your deep breathing. Do your grounding exercises. It almost feels impossible to do in in a really heightened state of panic. So as you're anticipating and feeling the symptoms leading up to perhaps even a panic attack, doing something does actually feel calming, whether that's the grounding or the breathing or even making a plan or doing something and engaging with your diabetes does reduce the intensity of the sympathetic nervous system. Okay.

Erika Forsyth (30:25)

Should I keep going?

Scott Benner (30:26)

I think yeah. I'm not gonna stop you. I'm having a good time. Yeah.

Erika Forsyth (30:29)

Okay. So so agency also disrupts and it kind of interrupts this helplessness circuit. So the the formal term is neural neural circuitry. It's hard to to to define. I actually looked it up to see if I could define it well, but, basically, it's the way we learn things.

Erika Forsyth (30:51)

And, you can have learned helplessness comes from that neural circuitry, unless you find no good way to describe it or define it in simple terms with neuron neuron.

Scott Benner (31:05)

Got beyond our, you got beyond our depth there.

Erika Forsyth (31:07)

Yes. Yeah. It did. It did. Beyond our my, pay grade here.

Erika Forsyth (31:12)

So when you have repeated experiences of unpredictability or failure, right, which happens a lot and and, you know, in various life's life experiences

Scott Benner (31:25)

Mhmm.

Erika Forsyth (31:26)

That's how you you develop this learned helplessness. And then it you can often experience that, well, I don't I don't even wanna try. I'm not motivated. You might experience shutdown, overwhelm because of that. What agency does, or again, going back to that belief that I can influence outcomes, I can act, I can make this choice, I can do this, make this decision, it creates those micro successes that then retrain that nervous system, your neural pathways.

Erika Forsyth (31:57)

And you can say, I act, I something changes. When I respond or do this, things improve. When I use my skills or my the things that I've learned, I can influence the outcome. The challenge is we wanna have all of that automatically. Right?

Erika Forsyth (32:13)

Like, we wanna know we wanna have that that faith and trust in ourselves. The challenge is is building patience because that occurs over time. These small corrective experiences accumulate, and then that is what reshapes the the brains the the neural pathways in your brain.

Building Agency Through Micro-Successes

Scott Benner (32:33)

Right. It's that saying, I don't know what I I it's a it's a how do you eat? It's like a big animal. How do you eat Oh, yes. What's what's the saying?

Erika Forsyth (32:44)

How do you eat, like, a buffalo? It's like one bite at a time. Yeah.

Scott Benner (32:47)

Yeah. Like, I I Yeah. That and fake it till you make it jumped into my head. So I figured when, like, when you're really when everything's a real show, just fake it until you make it because you trick yourself into believing you're succeeding. And then that's a little micro win.

Scott Benner (33:02)

Right?

Erika Forsyth (33:02)

Yes.

Scott Benner (33:03)

And then they build up and get bigger and bigger and bigger, and then you just take the problem in chunks that are handleable, and then you move on. And then those grow and grow and grow, and that builds your confidence. Then your confidence gives you agency, and then eventually, that's just what is this all the people mean when they're like, hey. Just do it for a while to get better. Is that really is that it?

Erika Forsyth (33:24)

Yes. But and and that's it. That's very simplified because then what gets in the way that we've talked about, I think, in other episodes or series is the cognitive distortions get in the way. Right. Right?

Erika Forsyth (33:34)

Like, well, if I can't do all or nothing thinking or the catastrophic types of thinking, which leads to, you know, different types and experiences of anxiety Mhmm. Well, if I can't figure this all out, then I'm a failure or whatever it may be. So that's that's what interferes with that mindset.

Scott Benner (33:52)

The fallibility of humans is what gets in the way at some point. Right? Like, it's it's us. At some point, we are the bottleneck for everything. You know, you get into a situation and you're making good progress, but you feel like it's not going quickly enough so you try to take a bigger chunk out.

Scott Benner (34:06)

That bigger chunk makes it overwhelming and you slide back to its chutes and ladders, then you slide back to where you started. And you just have to be able to pace yourself, taking good information, get a little wind, but, you know, I I really don't I'm gonna say something out loud that I'm sure it'll be mocked by most people listening, but I don't wanna make this about me. But when I stop and think about how I've structured the podcast, I'm fascinated by how much of it is coming out of this except I've never heard about this before today when you started telling me about it. Really is like, I'm not giving myself I might be patting myself on the back, but I don't mean to be. I mean to I mean to, like, focus on the idea of, like, like, my dumb like, just took the way I got through life.

Scott Benner (34:48)

Oh, because I grew up in a really bad situation. I've probably done all these things and I didn't realize it. Like, right, segmented myself, did one little thing at a time, didn't get out of over my skis, took my time to get to the thing, made it a little better, reset, did it again. And then I just took the common sense way that I got through that. And then I I just said this to Jenny today when we were recording earlier in the day.

Scott Benner (35:11)

And I said, all I really do, if you really listen to the podcast, I just take common sense life advice and remove a couple of words and jam diabetes words into it. And I'm like, this is a common sense way to take care of this problem. That's all I'm doing. I don't know anything about diabetes. I know about, like, problem solving.

Scott Benner (35:28)

I think that maybe is what I'm good at because my whole life's been a goddamn problem. Oh, yeah. That all makes sense. Okay. I'm not What do not?

Scott Benner (35:37)

Co pay because that would not be illegal. You are not my therapist. Keep moving.

Erika Forsyth (35:42)

My gosh. Okay. So agency, we we kind of have already said this maybe in the beginning, but it it thrives when our brain cannot predict the outcome. Right? And, like, what it cannot predict.

Erika Forsyth (35:57)

There's that sense of unknown. And what when agency thrives is when we have these patterns, these templates, and we have these internal models that we our brain just wants to know. Like, our brain we thrive. Right? We thrive in if I do this, then I know this is gonna happen.

Scott Benner (36:16)

Okay.

Erika Forsyth (36:17)

And that feels very safe and secure. And we are always looking for that type of reliance and security. Mhmm. Okay. So, yes, so the nervous system is looking for that, and then we experience that sense of calm, and it relaxes when we know the map.

Erika Forsyth (36:40)

Right? And even though the map isn't always going to be perfect and a 100% reliable and predictable, and that's the hard part.

Scott Benner (36:49)

Oh, even if the end isn't gonna be great, knowing the path is relaxing. Yes. Oh. Yes. It's interesting.

Erika Forsyth (36:57)

Yes.

Scott Benner (36:58)

Is that why some people are scared by horror movies and some people aren't? Oh. Because, like, if you tell yourself going in, everybody's gonna get axed to death and be dead, then it's not that scary because it's coming. And you know it and you're ready for it, and it's less jarring. A person who's like, I wonder what's gonna happen next is gonna be jump scared by it more.

Scott Benner (37:19)

Maybe. This is a ham ham fisted Yes. Explanation, but, like, let me make it more real world.

Erika Forsyth (37:24)

Okay.

Scott Benner (37:25)

A lot of stuff went wrong in my life. I expect things to go wrong. When they do, I'm like, okay. Well, you know, we'll get the soldiers out and we'll point them in the right direction and we'll overcome this. But I'm not I'm not upset by it going wrong.

Scott Benner (37:40)

I expect it to go wrong. And why am I not upset by it? Because I've gotten through it so many different times that I have a a healthy expectation that I'll get through whatever comes next too. And I don't know. I could take this out farther if you needed to.

Scott Benner (37:52)

I also am not a very religious person. I don't believe in an afterlife. So I just think you're here as long as you can be. And even when death comes, I am very like, okay. Well, this is part of it.

Scott Benner (38:04)

Like, you know, like, we we got as far as we could. We did well and, you know, now mom's going. And this is sad, but, like, I'm not like I I I I really don't I've been saying this out loud. I don't wanna say it the wrong way, but, like, like, my mom's death wasn't devastating to me. Like, it was it was upsetting and it's terrible and I wish she was here right now, but with a little bit of space of time, I'm okay.

Scott Benner (38:28)

Whereas I have friends whose parents have been gone for fifteen years and they are still as shattered as if it happened yesterday. And I and I wonder how much of that, you know, has to do with the maybe a Pollyanna way of thinking about life to some degree. Oh, Pollyanna is the right word. That might be insulting. I don't mean it that way.

Scott Benner (38:46)

But, like, I expect things to go wrong. So I don't know. Maybe just having fought through it a couple of times gives you you know what I mean? Like, when the bullets start flying, why do some people duck and some people run forward? That kind of feeling.

Erika Forsyth (38:59)

Oh my gosh. You're you're asking some sick deep questions. Sorry. When you say you expect things to go wrong, I almost wanna challenge that and say it almost like but you expect you don't expect perfection.

Scott Benner (39:13)

You're I was just gonna you brought that up, and I was gonna correct myself. I just don't expect everything to go perfectly. And so when it doesn't

Erika Forsyth (39:20)

because it feels differently.

Scott Benner (39:21)

Okay. So you use my there. You use your less coarse wording. I don't expect everything to go perfectly. I expect there to be bumps and bruises along the way, and I have a good confidence that I can bring things back into toe and keep going a little bit because I've done it so many times.

Scott Benner (39:35)

And I've had bigger prop I think I've already experienced with the exception of what I would imagine would be my own death, my wife's death, or god god, I hope my children will go before me. That with the exception of those things, the worst stuff that's ever gonna happen to me has probably already happened.

Erika Forsyth (39:52)

Yes. Yes.

Scott Benner (39:53)

Even if life just plays out reasonably well for me, it's a win. It's way better than what I've been through already. And having that experience lets me not feel like, oh, no. What's coming next? I never feel that way.

Scott Benner (40:06)

I just think like, oh, what's like, it's this is only gonna fit for the people who've seen it, but, like, it's in the West Wing way of, like, you know, when, the president would go, what's the

Erika Forsyth (40:15)

I have not I need to I need to watch it.

Scott Benner (40:17)

I don't West Wing? How's wrong with you?

Erika Forsyth (40:19)

Not in its entirety. I know. I know. But all

Scott Benner (40:22)

the times after a crazy day of, like, everything going wrong and the whole world blowing up, they'd get through it and the president would look up and go, what's next? And that's kinda how I feel. Like, alright. We did that. And then maybe tomorrow will be chill.

Scott Benner (40:37)

And I gotta be honest with you, if three or four days go by and just chill, it's kinda boring. I had the night off last night and, like, by 09:00, was like, I guess I should just go to sleep. This sucks.

Erika Forsyth (40:48)

You you have high agency. I mean, that's

Scott Benner (40:51)

You know, where the fuck where does

Erika Forsyth (40:52)

that come

Scott Benner (40:52)

from now?

Erika Forsyth (40:52)

I feel like.

Scott Benner (40:54)

That's ridiculous, though. You know enough about my life. I shouldn't have that.

Erika Forsyth (40:59)

But you do because you have have all of these micro successes, but you also hold the flexibility that it isn't going to go perfectly, but you have enough moments over time that you can affect change.

Scott Benner (41:16)

Luck, isn't it, though? Like, could could a couple I'm

Erika Forsyth (41:19)

trying to think of it

Scott Benner (41:20)

in what context of those things have just gone sideways on me, I wouldn't feel that way. You know what I mean? Like, so if that's if that was a conscious decision I made or someone made for me that moved me in the right direction, like, couldn't somebody have made a decision that put me in a wrong direction and I wouldn't have the confidence that things were gonna work out, and I'd be one of those people running around saying the sky's falling. And then every time something happens, they're like, see? See?

Scott Benner (41:43)

We're all gonna die. Like like that feel instead I'm just like, oh, wow. Another problem. Something fun to fix. I like fixing problems.

Erika Forsyth (41:50)

There's like a balance of optimism and hope.

Wrap Up & Preparing for Part Two

Scott Benner (41:54)

And I never would have used the word agency before today. I would have said confidence that I can get through it. But now as you're talking, I realized an agency. Okay. So how do we give each other are we up to that part yet?

Scott Benner (42:06)

Sorry.

Erika Forsyth (42:08)

So I think we're we're just about there. So, yes, the the nervous system I think we can pause here, like.

Scott Benner (42:14)

Jump back in for our next another part. Where do you think?

Erika Forsyth (42:17)

I think so. Let's we can pause here.

Scott Benner (42:21)

Erica, put a pin in it.

Erika Forsyth (42:24)

Let's oh my gosh. So, yes, in general, when agency is strong, anxiety is less likely to spiral into that feeling of overwhelm. I think what might be interesting for us to talk about in the next episode is, you know, applying this this concept and conversation of agency and anxiety through the lens of of living with diabetes.

Scott Benner (42:46)

That sounds good. Name five things Scott would never say for $500. Put a pin in it. It's definitely one of

Erika Forsyth (42:52)

them. Yes. After after agency.

Scott Benner (42:55)

Yes. I never would have said agency. I would have just said, like, I would have said something stupid like, my life's been forged in fire. Like, you know

Erika Forsyth (43:03)

Or resilience.

Scott Benner (43:04)

Sharpens iron, like, that kind of crap. You know what I mean? Like, something you would've heard on a bro podcast somewhere. You you know, like, who's gonna row the boat, Erica? Who?

Scott Benner (43:14)

I love that one. Who's gonna row the boat? You're nine feet tall. You row it. I can think I'll just ride it.

Scott Benner (43:20)

How's that sound?

Erika Forsyth (43:21)

Oh. Oh my gosh.

Scott Benner (43:24)

But seriously, though, like, this is really this was wonderful. Thank you.

Erika Forsyth (43:28)

Oh, good.

Scott Benner (43:29)

How did we get to this? Was this your idea? This was awesome. I should listen to you more.

Erika Forsyth (43:36)

Thank you.

Scott Benner (43:36)

No. Really great. I'll talk to you soon.

Erika Forsyth (43:38)

Okay. Thanks. Bye.

Closing & Additional Resources

Scott Benner (43:46)

Having an easy to use and accurate blood glucose meter is just one click away. Contournext.com/juicebox. That's right. Today's episode is sponsored by the Contour Next Gen blood glucose meter. I'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which, of course, anticipates, adjusts, and corrects every five minutes twenty four seven.

Scott Benner (44:15)

It works around the clock so you can focus on what matters. The Juice Box community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox. Okay. Well, here we are at the end of the episode.

Scott Benner (44:39)

You're still with me? Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review?

Scott Benner (44:49)

Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me, or Instagram, TikTok. Oh, gosh. Here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't wanna miss please, do you not know about the private group?

Scott Benner (45:09)

You have to join the private group. As of this recording, it has 74,000 members. They're active talking about diabetes. Whatever you need to know, there's a conversation happening in there right now. And I'm there all the time.

Scott Benner (45:21)

Tag me. I'll say hi. My grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan.

Scott Benner (45:48)

What do these three things have in common? They're all available at juiceboxpodcast.com, up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at juiceboxpodcast.com. Have a podcast? Want it to sound fantastic?

Scott Benner (46:04)

Wrong way recording.com.

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