From the (Uncluttered) Desk of Dr. Robin Zasio

By now, even the new headlines are old hat: There’s a fresh virus variant to mask up against. A new public figure in the throes of cancel culture. Another basic human right that needs an all-out defense. And the cherry on top of that stress sundae we call modern American society? Yet one more holiday season in the swing of the pandemic, now creeping up on two years running. It’s enough to render you sleepless in Sacramento. Based on studies by the CDC, over 40% of adults in America have reported symptoms of anxiety or depression during Covid.

But don’t worry (yeah, right), you’re in good company. According to local psychologist Dr. Robin Zasio, founder and director of The Anxiety Treatment Center of Sacramento, it’s OK to feel untethered in times of uncertainty—in fact, it’s a biological response. “There’s an actual chemical process that happens when somebody gets anxious,” she explains. “Chemicals go to a part of the brain called the amygdala that alerts us to danger, and you go into a fight-or-flight mode—you face it or you avoid it because you’re scared.”

Whether you’re trying to quiet your brain with acts of mindfulness like meditation or you’ve arrived at the realization that no magic number of asanas can possibly take the edge off and you need to seek professional help, Dr. Zasio—who has been on the roster of therapists on A&E’s hit show Hoarders since 2009, including the new season that just began on Oct. 18—provides a glimmer of hope for the fretful and the unglued among us. “Anxiety disorders are very treatable,” she offers. Here, she talks about everything from the Stone Age origins of hoarding behaviors, to what to look for (and watch out for) in a potential therapist, to the dangers of the pursuit of perfection. So if you’re stressed out or checked out, read on because the doctor is most definitely in.

Dr. Robin Zasio smiles at her dog Tessa at The Anxiety Treatment Center of Sacramento near Mather Airport on Sept. 30.

We’ve gotten to know you via your appearances as an anxiety expert on shows like Hoarders and My Extreme Animal Phobia. How did you carve your niche in television?

The thing about anxiety is that even though it’s the human condition, it’s actually extremely specialized. While things like thinking a happy thought, relaxation, yoga, exercise, having a well-balanced and nutritious diet are important, those are not the frontline treatments for anxiety. And that’s a lot of what we’re seeing—people just trying to help people manage anxiety, versus what we do at The Anxiety Treatment Center of Sacramento, which is work to eliminate that anxiety that’s debilitating. There are very, very specific treatment modalities for anxiety, which include cognitive behavioral therapy and exposure and response prevention [confronting triggers through repeated exposure]. I am fully trained and my staff is fully trained in using frontline treatments. That has built our reputation, which then leads to increased exposure in the community.

Hoarders has long imprinted itself onto pop culture. Why has it struck a chord?

There are different reasons, the first being that hoarding behaviors have been in existence since the caveman. They had to go out and hunt and gather before the wintertime and store up because there would be no food available during the cold season. So we can go way back to see that people would stockpile for self-preservation. Would you call it hoarding? Not necessarily. The point is that these behaviors are not new.

There is a population of people who struggle with resisting excessive acquisition to the point where it can clutter their homes and make them, in many cases, unlivable, as we’ve seen on Hoarders. Many people who are struggling with these behaviors usually have some level of awareness that things are getting out of control. But because they have a hard time resisting acquisition and difficulty letting go, they’ll often live in silence. There can be a lot of guilt and shame. So when A&E introduced this idea of producing this show, they began to seek individuals in the community who might be struggling with these behaviors. Sure enough, people started to reach out and say, “Hey, I am struggling.”

The most important thing that I think people should understand is that those struggling with hoarding behaviors are struggling with mental health issues. There are a number of contributors that can lead individuals to hoard. But I think that the show has just raised awareness to the magnitude of how many people are really struggling with this condition. 

What case from the series has had the biggest impact on you?

There was a case in Illinois where a woman was hoarding animals. But not just animals, she was hoarding clothing, food that was 20 some odd years old—she even had difficulty letting go of trash. What made this particular situation so devastating was that animal welfare had been out to this home a number of times and did nothing about it. There was a goat with a broken leg that was just swinging back and forth when it walked because it had no medical attention. There were birds dying because they were in cramped quarters. There were turkeys that were living on wire fencing, which was destroying their feet. I mean, I could go on and on.

So when I got back home, I wrote a letter to the animal welfare service that had gone out there and not taken any action. I basically just let them know that this was going to be aired on TV and that it would be noted that they went out there and failed to take any action. After I wrote that letter advocating for these animals, they did go out and were able to rescue the animals that were still there. They took her to court and she was banned from having any animals. Anybody who knows me knows I’m an animal lover and that it’s extremely painful for me to go out into these situations of overcrowding and lack of care.

Dr. Zasio helps Dale (in cowboy hat) during a 2019 episode of Hoarders. (Photo courtesy of the A&E Network)

So how do you personally sense that you’re feeling stressed or experiencing anxiety?

I would say that I have more difficulty sleeping. I might miss a meal just because I’m caught up in my head. Then I realize after the fact that I didn’t have breakfast. That happened yesterday as I was trying to scramble out of the office [before going out of town], trying to make sure everybody was taken care of, make sure all my animals were taken care of. On my way to the airport, I realized I hadn’t had breakfast, and it never even crossed my mind.

Mindfulness is very popular in our society now. You asked about me personally—my escape is when I get home, I go up to my barn, and I’m with my horses and my donkey. Even if I’m cleaning stalls, which doesn’t sound like a lot of fun for some people—I enjoy those things and that’s how I get out of work [mode]. Right now, as we’re talking, I’m taking my chihuahua Tessa [who also serves as The Anxiety Treatment Center’s therapy dog] for a walk, and she’s in her stroller. She needs to go for walks, she needs to be bathed, she needs to be fed, petted, brushed. Those are really enjoyable things [for me]. But when I find that I’m in my pleasurable activities and thinking about work, that’s another sign that stress or anxiety is starting to creep up on me.

What works for you in terms of stress management?

It would be easy to work 12 hour days, seven days a week. There’s always work to do. But I did realize, I think later than I would have liked, that I was really missing out on life. I was investing so much in work and so much in building my business. I was so caught up in just doing what I was doing, and then I was like, “Wait a minute, I don’t want to live my life working and then die.”

So for me, I recognized the things that were missing in my life. Work is not at home, work is at work. And when I leave work, that’s where it stays. I think that’s another important concept—trying as much as possible to keep your personal life and your work life separate. That drove me and my husband to move from the city of Sacramento to an area [in the region] where we can have land. And I built a barn and I built a riding ring. I took my horse from the stable, flew over another horse from Holland, and got my donkey. I thought, “Oh my gosh, why didn’t I do this sooner?”

There’s an exercise that we do at The Anxiety Treatment Center, which is basically have patients write their eulogy. Which is not easy. If you were at your funeral, what would you want people to say about you? For me, I would want them to say, “She loved animals,” not “She loved animals, but she never had any. She wished she had.” I don’t want people to say that. When you look at your eulogy, then you work your way backward to “This is what I want people to say, and I realize that these are the missing pieces that I need.”

Do you see a therapist?

I do not see a therapist. I did in my early 20s. Even though we all have issues, I’m able to utilize and apply things that I’m encouraging other people to do. If I’m like, “OK, wait a minute, I’m not sleeping well,” I know I need to take a step back and figure out why and then figure out what I need to do to fix that. Because if you don’t recognize there’s a problem, then you can’t apply a solution.

How do you go about finding a therapist that’s right for you?

When you are seeking out a therapist, it’s important that you’re clear on what you’re looking for. And I think it’s very, very important that when you go to somebody’s profile and see that they reportedly can treat an extremely wide range of conditions, I would be cautious, because we can’t be that good at so many different things. We have to remember that mental health conditions are specialized. Bipolar disorder is not going to be the same as an anxiety disorder, and schizophrenia is not going to be the same as depression, even though they all fall under “mental health conditions.”

There is absolutely nothing wrong with asking somebody about their training—where they studied, how long have they been specializing, what are their treatment modalities, what’s their availability, what are their time slots. I think a lot of people don’t even think to ask a new provider, whether it be a doctor or anybody else, “Tell me about your training, tell me about who you are, because I want to make sure that we’re a good fit.” If a therapist feels in any way challenged by that or threatened by that, then that’s a problem.

When do you know you’re a good fit? Do things just click?

I think that you’re really looking for qualities that are important to you. I mean, it’s really no different than a friendship or dating in that we are drawn to people who have like qualities, who have the same interests. In terms of the personality style that you’re looking for, that’s something that’s going to be somewhat automatic. You might have somebody who’s a little too passive for you and who doesn’t hold you to the homework assignments. Likewise, you can have people who are maybe too aggressive and don’t allow you a little bit of latitude in the understanding that, hey, you’re struggling and you’re not going to do this perfectly.

How do you know when it’s time to see a therapist?

When you find that you’re not able to manage demands on the brain like you used to. So you might have trouble sleeping, wakefulness throughout the night, because your brain is just ruminating about whatever happens to be on your mind. Perhaps you might have weight loss because you’re not remembering to eat. Conversely, people might stress-eat, so there could be weight gain. [They could also have] difficulty focusing and concentrating. Perhaps you’re feeling more agitated than you normally do. You might be a little more impatient with people, that sort of thing.

I wonder if it’s possible that some people don’t even realize they’re anxious or stressed?

I think that some people may have been living in a certain way for so long and that’s what they know. That’s just familiar. They’re always wound tight without realizing they don’t need to be wound tight. Oftentimes, people do not treat mental health in the same way that they treat physical health. So you know, let’s say your foot is swollen, and you’re going to take time off work to go to the doctor. Or you know you need to get your teeth cleaned because you don’t want your teeth to rot. So as much as you hate going to the dentist, it’s something that you’re going to do. We see so many people put their mental health aside because they give it less weight. They just think “Oh, this is going to go away.” It’s important for people to put just as much weight on their mental health, and address it as they would their physical health.

Speaking of which, sports stars like tennis player Naomi Osaka and gymnast Simone Biles have been coming forward about their anxiety. Why is this important and remarkable?

I’m on the board of the International Obsessive Compulsive Disorder Foundation. We are talking with individuals who are on national sports teams because anxiety is having a direct impact on their performance. As there is more public awareness of anxiety—that it’s treatable and that it’s not something you need to be embarrassed about—more people are coming forward. The fear with athletes is that they are going to be looked upon negatively, that they’re going to be seen as someone who is less than a player who can perform at their maximum level because they’re struggling with mental health. Having mental health issues does not mean you are any less of a person, any less of someone who can perform.

One of the things that we’re trying to teach people is the difference between excellence and  perfectionism. Perfectionism is a black hole. You can never achieve it because anytime you get close to that experience of perfectionism, the bar gets raised: “Gosh, if I could get to this level, maybe I could get to this next level.” What we’re trying to teach people is how to achieve excellence, which means you can achieve a level and be satisfied and happy and enjoy the process.

“We’re not put on this earth to just go to work, come home, go to sleep, get up, do that the next day, and then just try to recover on the weekends,” says Dr. Zasio on the importance of achieving a work-life balance.

We are going into a second holiday season in a pandemic. What new feelings and behaviors  may arise for people this time around?

People are definitely experiencing more anxiety than they were previously, just with all the uncertainty about where society is headed. With Covid, it’s almost nonstop, especially when you turn on the TV, because you’re always seeing something different with regard to death rate, hospitalizations, variants, that sort of thing.

Everybody’s different. Just like not talking about politics, don’t talk about the pandemic when you are in social situations that should be joyful. People have different ideas about them and those are stressful conversations. It can increase anxiety and stress in situations if there are differing opinions. Talk about the joyful things in your life, rather than the things that are stressful.

There are also a lot of people who are still really scared [of getting Covid], so they’re not going to spend time with their families. Interestingly enough, the holidays are supposed to bring joy, but they can also make people feel isolated and depressed as well. So if you decide that you’re still not feeling safe around others [for extended periods of time], including your family, then try to create an alternate plan to have joy during that holiday season. Maybe it’s staying home and making Ziploc bags that have soap, shampoo, socks and flip-flops, then going out and handing them out to people [in need]. Do something that gives you gratification and joy and makes you feel good.

Do you think service is a useful tool for managing anxiety?

Personally, I believe that it always starts with service to ourselves. That may sound selfish, but this whole conversation is about taking care of our mental health. If you have service to yourself and you identify where you are struggling and where you need help, then you are going to improve your overall mental health and physical functioning as well, because they go hand in hand.

When you take care of yourself, then you can take care of others and you’re able to be mindful in that moment of the joy of giving to others. I think that there is such a sense of gratification that happens when we can bring joy to people who otherwise might not have so much joy in their lives.

’Tis the season not just for giving, but also for gratitude. What role does gratitude play in managing anxiety?

That is a great question because one of the things that we do at our facility every day is when patients come in, we have them focus on the things that they are grateful for. Prior to starting their individual therapy, all of the patients are asked to write down five things that they are grateful for. Feeling sad, lonely or anxious can be super consuming. So this helps people see that when they’re in the midst of having struggles in their life, there are also good things that are happening. Being mindful and appreciative of those things is so important. Many people, once they do this exercise, they really appreciate it because they see that they have had such a focus on the negative that they have failed to consider the positive things in their lives.

What if you’re a natural Grinch?

There are some people who just tend to be more negative. But the way change happens is you have to recognize that there is a problem. If you don’t recognize there’s a problem, then you can’t have a solution. If you’re negative, then it’s helpful to look at how that negativity is impacting your life. One of the things that we really embrace here at The Anxiety Treatment Center is the concept of being able to live your value-driven life. We’re not put on this earth to just go to work, come home, go to sleep, get up, do that the next day, and then just try to recover on the weekends. We really work to help people incorporate balance, whether it be exercising or horseback riding or walking your dog or spending time with your kids. So if someone can see that their negativity is interfering with their ability to embrace a value-driven life, then that can produce change. It can take a while because our personalities are ingrained, so it’s a lot harder to change than something like anxiety, believe it or not, but that doesn’t mean it can’t be changed. I think what’s so important to remember is that humans have the capacity to change.