The Truth About Anxiety & ADHD: Life-Changing Tools From Renowned Psychiatrist Dr. Tracey Marks

Here are the top 10 key takeaways from Dr. Tracey Marks' conversation with Mel Robbins about anxiety and ADHD, offering practical insights to help you understand and manage these conditions more effectively.

1. Your brain is changeable

Dr. Marks emphasizes that our brains have neuroplasticity, meaning they can change based on our behaviors and habits. This applies to both negative and positive changes. When we engage in destructive habits, our brains can develop patterns that increase anxiety, but the reverse is also true.

The power of this concept lies in understanding that regardless of what mental health condition you may have, you can improve your quality of life through simple behaviors and habits. This gives people agency over their mental health instead of feeling helpless. Dr. Marks explains that even if you can't eliminate anxiety completely, you can significantly change how it impacts your daily functioning.

2. Anxiety is a full-body experience

Anxiety manifests both physically and mentally, creating a comprehensive bodily response. Mentally, it causes worrying thoughts, fear, and excessive concern about others' perceptions. Physically, it triggers the sympathetic nervous system's "fight or flight" response with symptoms like rapid heartbeat, muscle tension, and digestive issues.

Many people don't realize that their physical symptoms (like muscle tension) are connected to anxiety. Dr. Marks explains that unconsciously tensing muscles throughout the day can lead to feeling exhausted despite minimal physical activity. This connection between mental states and physical sensations is crucial for understanding and addressing anxiety effectively.

3. Focus on deceleration rather than prevention

A transformative insight from Dr. Marks is that we should shift our approach from trying to prevent anxiety to managing our response when it occurs. She explains that anxiety is like stepping on the gas pedal in a car when you sense a threat, and the key is learning how to take your foot off the pedal rather than trying to avoid stepping on it altogether.

This perspective change is liberating because it acknowledges that anxiety responses are often automatic and unavoidable. Instead of feeling frustrated that you can't prevent the initial anxiety response, you can focus on developing tools to decelerate once it begins. This approach removes the pressure of trying to be "anxiety-free" and focuses on practical management techniques.

4. Interoceptive exposure helps disconnect physical sensations from anxiety

Interoceptive exposure is a powerful technique where you intentionally create physical sensations associated with anxiety in a safe environment. For example, if racing heartbeat triggers your anxiety, you might do jumping jacks to increase your heart rate deliberately, helping you learn that the physical sensation itself isn't dangerous.

This practice helps break the connection between bodily sensations and anxiety responses. By exposing yourself to these sensations intentionally, you gain evidence that you can handle them without spiraling into panic. Dr. Marks provides examples like spinning in a chair to recreate dizziness or doing jumping jacks to increase heart rate, allowing you to practice managing these sensations without fear.

5. Vagal maneuvers can activate the calming parasympathetic response

The vagus nerve is responsible for the "braking" response that calms your body's fight-or-flight reaction. Dr. Marks explains that specific vagal maneuvers can stimulate this nerve, triggering a calming response. These include cold exposure (like splashing cold water on your face), humming, and certain breathing patterns.

Breathing techniques are particularly practical because they can be done discreetly in any situation. Examples include box breathing (inhale for 4, hold for 4, exhale for 4, hold for 4) and 4-7-8 breathing (inhale for 4, hold for 7, exhale for 8). The longer exhale is especially effective for vagal stimulation. Even simple deep, slow breathing can be helpful when feeling anxious.

6. Lifestyle choices significantly impact anxiety

Dr. Marks emphasizes that three key lifestyle factors – sleep, diet, and exercise – have a profound impact on anxiety levels. These habits can actually rewire the brain through epigenetic changes, affecting how genes express themselves and influencing anxiety regulation.

Poor sleep makes everything feel more threatening, as sleep deprivation increases baseline anxiety. Diet impacts anxiety through inflammation and gut bacteria changes, with high sugar and processed foods worsening anxiety symptoms. Exercise increases brain-derived neurotrophic factor (BDNF), which helps repair neural connections and allows the brain to adapt positively to new habits.

Making small, gradual changes to these lifestyle factors can create cumulative benefits for anxiety management. Dr. Marks recommends tackling one small change at a time rather than trying to overhaul everything at once.

7. Avoidance behaviors often become bigger problems than the original fear

When people experience anxiety about specific situations, they often develop avoidance behaviors. However, these avoidance strategies typically cause more life limitations than the original fear. For example, someone with social anxiety might avoid gatherings, leading to isolation that worsens their mental health.

Dr. Marks explains that gradual exposure is the antidote to avoidance patterns. This involves creating a step-by-step approach to facing feared situations, starting with manageable challenges and working up to more difficult ones. For instance, someone with social anxiety might first practice just arriving at a social venue, then progress to entering the room, and eventually to initiating conversations.

This gradual approach builds confidence and provides reinforcement that you can handle these situations, breaking the cycle of avoidance that maintains anxiety. The point isn't to eliminate fear but to prove to yourself that you can function despite it.

8. ADHD and anxiety have a bidirectional relationship

Dr. Marks explains that ADHD and anxiety frequently co-occur and can each influence the other. ADHD can cause "secondary anxiety" due to the stress of disorganization and feeling out of control. Meanwhile, anxiety can exacerbate ADHD symptoms by further impairing executive function.

The connection relates to brain functioning, particularly in the prefrontal cortex. This area manages executive functions including emotion regulation, which is why people with ADHD often experience more intense emotional responses. The prefrontal cortex normally helps manage the amygdala (fear center), but when compromised by ADHD, it's less able to prevent emotional hijacking.

This relationship explains why treating underlying ADHD can sometimes help with anxiety symptoms, and vice versa. Understanding this connection helps people recognize that their anxiety might stem from ADHD-related challenges rather than being a separate issue.

9. ADHD is primarily a stimulation issue

A common misconception about ADHD is that it simply means inability to focus. Dr. Marks clarifies that ADHD is actually a stimulation issue – the brain requires stimulation to stay engaged. People with ADHD can hyperfocus on stimulating activities but struggle with tasks that don't provide sufficient dopamine release.

This explains puzzling behaviors like how someone can focus intensely on video games but seem unable to remember simple household tasks. It's not about willpower or caring; it's about neurological differences in dopamine processing. Activities that don't provide enough stimulation simply don't register as important to the ADHD brain.

This insight helps reduce blame and frustration in relationships affected by ADHD. What looks like carelessness to others is actually a brain difference in how attention and stimulation work. Understanding this mechanism allows for better strategies and accommodations.

10. Body-focused repetitive behaviors can relate to anxiety or ADHD

Behaviors like nail biting, skin picking, or hair pulling can serve different functions depending on the underlying condition. For people with anxiety, these behaviors may be self-soothing mechanisms to relieve tension. For those with ADHD, they often provide needed sensory stimulation for an understimulated brain.

Many people engage in these behaviors unconsciously, making awareness the first step in addressing them. Dr. Marks recommends habit reversal therapy, which involves identifying triggers and deliberately replacing problematic behaviors with healthier alternatives. For example, someone who bites nails while watching TV might wear gloves during that activity to break the automatic pattern.

These behaviors exist on a spectrum from mild (occasional nail biting) to severe (compulsive skin picking causing wounds). More severe cases may benefit from professional therapy or medication, especially if they're causing significant distress or physical harm.