Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson

GeriPal - A Geriatrics and Palliative Care Podcast

“Anxiety is a lot like a toddler. It never stops talking, tells you you’re wrong about everything, and wakes you up at 3 a.m.” I’m not sure who wrote this quote, but it feels right to me. We’ve all had anxiety, and probably all recognize that anxiety can be a force of action or growth but can also spiral to quickly take over our lives and our sleep. How, though, do we navigate anxiety and help our patients who may end up in the anxiety spiral that becomes so hard to get out of?

On today’s podcast, we’ve invited Alex Gamble and Brianna Williamson to talk to us about anxiety. Alex is a triple-boarded (palliative care, internal medicine, and psychiatry) assistant professor of medicine at Stanford. Brianna is one of UCSF’s palliative care fellows who just completed her psychiatry residency.

We start by defining anxiety (harder said than done), move on to talking about when it becomes maladaptive or pathologic, and how DSM5 fits into all of this. We then walk through how we should screen for anxiety and how we should think about a differential. Lastly, we talk about both non-pharmacologic and pharmacologic treatments.

It’s a lot to cover in 45 minutes, so for those who like to take a deeper dive, here are some of the references we talked about:

• Alex Sable-Smith’s great BATHE video on YouTube:

• Two books that Alex Gamble often recommends to patients can help build up your capacities to sit with anxiety (per Alex, both are from an Acceptance and Commitment Therapy framework)

• Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety

• The Reality Slap