Beyond Stress

Some people seem to navigate life's challenges effortlessly.
Others become trapped in a cycle of fear and worry known as anxiety.


April 2012

By Lisa James

Nearly everybody is under stress at one time or another; it’s simply a fact of life. But when does stress cross over into anxiety?

The best explanation is to present the cases of Dave and Joe, two employees at the same company. Both are middle aged and married, hold the same job title and have similar educational and employment backgrounds.

Each had heard the layoff rumors but thought his job might be spared. While the pink slips they both received one Friday weren’t totally unexpected, being let go was a shock all the same.

Physiologically, Dave and Joe had very similar reactions. Their bodies churned out cortisol and adrenaline, stress hormones that elevate blood sugar and pressure, increase heart rate and cause other metabolic changes designed to promote quick action (the “flight or fight” response).

Emotionally, they cycled through a number of feelings: shame and fear, anger and sadness.
Dave had always been resilient, recovering quickly from setbacks. After taking some time to adjust to his new circumstances, he revised his résumé and activated his contact network. Several months later, he had interviews scheduled; one seemed especially promising. Dave thought, “Things are looking up.”

Depression: Anxiety’s
Tag-Team Partner

Many patients suffer from anxiety mixed with depression. In fact, “the presence of an anxiety disorder is the single biggest clinical risk for the development of depression,” says Robert Hirschfeld, MD, chair of psychiatry and behavioral sciences at the University of Texas Medical Branch at Galveston. He adds that people who suffer from both disorders not only have more problems in dealing with daily life but are also more prone to suicide.

Depression has been linked to physical ailments, most notably heart disease. One study has even suggested that depression combines with chronic stress to accelerate aging (Biological Psychiatry 2/15/12).

Hormonal disruption tends to drive anxious people towards depression. “You can only maintain high levels of cortisol and adrenaline so long before you crash,” says Rebecca Beaton. “It can go the other way, too. People can become anxious about their depression; they start saying, ‘When am I going to get over this?’”

Hormones help explain why women are more likely to develop depression, although it’s now known that this disorder tends to be under-reported in men. A family history of depression and toxic relationships, such as with a parent or spouse, are other risk factors.

As with anxiety, depression has been linked to the sort of low-level inflammation that research suggests lies at the root of many chronic diseases. “The depressed brain is an inflamed brain,” says Stephen Ilardi, PhD, associate professor of clinical psychology at the University of Kansas and author of The Depression Cure (Da Capo). That makes the same anti-inflammatory diet recommended by Henry Emmons for anxiety a good idea for fighting depression, including the omega-3 fats found in cold-water fish. A report in the Alternative Medicine Review found that an omega-3 source called krill oil was able to help ease depression in women with PMS.

As with anxiety, B vitamins, calcium, magnesium and vitamin D are all recommended for depression. Other helpful nutrients include iodine, which supports the thyroid; an underactive thyroid can lead to depression. SAM-e is a natural substance believed to enhance brain function and St. John’s wort, the best-known mood herb, has helped people with mild to moderate depression (European Neuropsycho­pharmacology 8/12/10.)

It wasn’t going so well for Joe, who had always seen disaster lurking around every corner. Months later he was still waking at 3 a.m., his heart racing. His days were spent turning the events of that Friday over and over in his mind, staring blankly at the TV and arguing with his wife about household finances. Just the idea of looking at his résumé made him nervous. Joe thought, “Why bother? I’m never going to get another job anyway.”

Dave and Joe had both experienced stress, perfectly reasonable given their circumstances. But only Joe went on to develop anxiety.

Anxiety turns challenge into catastrophe—and everyday occurrences into potential catastrophes—by driving people into fearful “what if” thinking. “Stress is to anxiety as sadness is to depression; it becomes a mental disorder when it becomes chronic,” says Rebecca Beaton, PhD, director of the Anxiety & Stress Manage­ment Institute in Atlanta (www.stressmgt.net).

Fear Without End

Anxiety hampers careers and relationships; in one study, anxiety in childhood was associated with lower earnings in adulthood (Journal of Mental Health Policy and Economics 9/11).

“The effects of anxiety go well beyond the brain itself—it affects the whole body. It can affect sleep, the ability to think or concentrate, appetite and diet choices, and energy levels,” says Henry Emmons, MD, consulting psychiatrist at the Penny George Institute for Health and Healing in Minneapolis and author of The Chemistry of Calm (Fireside/Simon & Schuster; www.partnersinresilience.com). Links have been found between anxiety and cardiovascular disease, chronic pain, skin allergies and cognitive decline.

Anxiety is classified by type:

• Generalized anxiety disorder (GAD): Persistent worry and tension, even if there’s no obvious cause. “For those with GAD, a constant feeling of being on edge means there isn’t a moment of the day free from worry,” says Tamar Chansky, PhD, a clinical psychologist in suburban Philadelphia and author of Freeing Yourself from Anxiety (Da Capo/Lifelong).

• Obsessive-compulsive disorder (OCD): Compulsive hand-washing is the best-known sign of OCD, which includes any repetitive thought or fear that compels someone to do something over and over again.

• Panic disorder: Marked by sudden attacks of terror that strike without warning, including symptoms such as sweating and heart palpitations. Patients sometimes fear they are having a heart attack or “going crazy.”

• Post-traumatic stress disorder (PTSD): Most public awareness comes from PTSD in combat veterans. But it can affect anyone who has survived a terrifying event, trapping them in memories they can’t escape.

• Social anxiety disorder: It’s not unusual to feel a little uncomfortable when, say, meeting a large group of strangers. But social anxiety causes overwhelming worry even in everyday social situations. As Chansky puts it, “Every moment is a performance with no backstage breaks.”

While some people are more anxiety-prone than others, there are societal factors that drive anxious behavior. One is the increased isolation and lack of communal support that many people feel. “The paradox is that we’re more connected than ever through things such as Facebook but we struggle to think of someone we could actually call for a ride to the hospital,” Chansky notes. Technological advances have also resulted in people being bombarded with more information than they can process, including what Melissa Tiers, DCH, DAH, founder of the Center for Integrative Hypnosis in New York City (www.melissatiers.com), calls “the fear factor—the constant alert that comes from alarming stories on the news.”

Even those who feel they were born to worry, though, can learn to take setbacks in stride. “I tell clients the only things we have control of in life are our attitudes and our actions. Anxiety is one of the most treatable mental illnesses,” says Beaton.

Stopping the Cycle

The first step in quelling anxious feelings requires breaking those neural pathways in the brain that trigger fear and worry. “Luckily the brain can be rewired more easily than most people imagine,” says Tiers.

In The Anti-Anxiety Toolkit (CreateSpace), Tiers presents fast ways to stop anxious thoughts. One method, called bi-lateral stimulation, calls for spending a minute passing a small object from one hand to the other, crossing the body’s midline “so you are stimulating both hemispheres of the brain. It will have a more rapid effect if you keep one hand in front of you as the other swings out,” says Tiers, who adds that it works by “spreading blood and electrical impulses throughout the brain.”

Another anxiety-stopper is heart coherence: Imagine breathing deeply into your heart, and then feel it radiate energy through your system. “The heart is the strongest emitter of electromagnetic energy in the body. By doing the exercise you are beginning to entrain your brain into a coherent and more relaxed brain-wave state,” Tiers says.

After the fear and panic subside, one has to learn how to avoid future attacks. Beaton says, “The treatment that’s most effective is cognitive behavioral therapy (CBT). It’s teaching people how to think differently, getting them to change their thinking patterns.” Chansky agrees, adding, “The way we narrate our experience very much affects how we feel. We want to see that any situation can have a different explanation.” Studies support CBT’s effectiveness in alleviating anxiety.

Mindfulness meditation, which involves calming the mind by learning to let go of one’s thoughts, “helps people sit with their emotions,” says Beaton. Research suggests this technique can help ease anxiety (Journal of Consulting and Clinical Psychology 4/10).

After treating the immediate symptoms, Emmons looks at other factors that contribute to his patients’ anxiety. “I would have them work with an integrative nutritionist, get them on a sustainable exercise program and work with them on their sleep. And then I would work with them, either individually or in a group, to learn how to approach their life stresses more skillfully,” he says.

Nutritional Relaxation

Proper diet is enormously helpful in controlling anxiety. One reason is “the only way the brain can get its raw ingredients is through the diet,” says Emmons. Another factor is the harmful feedback loop between sugar and cortisol. “One of the jobs of cortisol is to make you hungry for foods that quickly replenish glucose. If people keep eating high-sugar foods that increase their cortisol levels, it becomes a vicious cycle,” Emmons explains.

Poor diet also stirs up unhealthy levels of inflammation. “With anxiety, one of the problems in the brain is that it becomes overactive. Inflammation tends to overactivate the body and that includes the brain,” says Emmons. Chronic inflammation also ties into cravings for sweets. That leads to excess fat accumulation, “usually in the middle of the body. That abdominal fat produces more stress hormones,” Emmons notes.

In addition to reducing or eliminating consumption of sugar, refined carbohydrates and fried foods (along with caffeine and artificial sweeteners), Emmons suggests eating a wide variety of unprocessed, organic foods, particularly complex carbohydrates and colorful fruits and vegetables. (He recommends the crucifers, a vegetable family that includes broccoli and cabbage, for their detoxifying effects.) Your diet should also include cold-water fish for their omega-3 fatty acids, which have been found to reduce both inflammation and anxiety (Brain, Behavior and Immunity 11/11).

Emmons recommends supplements that help build a more resilient brain. They include a high-quality multivitamin or B-complex; vitamin D, low levels of which have been linked to depression; the minerals calcium, magnesium and zinc; and the herb rhodiola, which helps with not only anxiety but also energy levels and mental focus. Other herbs that can take the edge off of nervousness include passionflower, eleuthero, chamo­mile and hops.

Emmons also suggests supplements such as GABA, a calming brain chemical; L-theanine, a green tea compound that promotes both calm and focus; 5-HTP, which helps with both anxiety and depression; and NAC, a potent antioxidant. According to a study in the October 2010 issue of Nutrition Journal, “nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions.” (Speak to your practitioner before starting any supplementation program if you are taking medication for anxiety or depression.)

From Anxious to Awesome

The story told by one of Beaton’s patients proves that anxiety, no matter how ingrained, can be overcome.

Pat, who is in her mid-50s (and declined to give her last name), lives in the Atlanta area. Her childhood was difficult. “My mother had rheumatoid arthritis and she got very, very ill right after I was born. By the time I was seven years old she was already confined to a wheelchair.” That prompted Pat’s emotionally abusive father, whose job required constant travel, to leave the house for good.

“As I got older my father did not see us often. My mother became sicker, and I become her only caretaker. It became like a life-and-death scenario for me. Anything that was an issue with me in terms of a problem or an illness seemed incredibly unimportant compared to her pain. So I grew hyper-vigilant with her.”

Caretaking wasn’t the only source of stress in Pat’s life, who was molested by her grandfather. “That continued until I finally realized that it wasn’t right and told my mom. She said, ‘Don’t be alone with your grandfather.’ That put me in a position at an early age of trying to be a grownup.”

About nine years ago Pat mentioned her problems to her chiropractor, who said, “Oh my gosh, there’s someone here getting a massage you should speak to.” It was Beaton.

Several months after starting treatment, Pat hit a wall. “I just couldn’t get out of bed one day. I told my husband, ‘Call the family, I can’t do this anymore.’” She believes that confronting the dark side of her childhood led to her crisis; “I was coming to terms with how horrible it was.” What’s more, “at that point my husband and I had adopted a child and that put me in the middle. I either had to take care of this child or take care of my mom.” Pat made other arrangements for her mother’s care.

Pat says Beaton reassured her, saying, “Of course you had a breakdown. You couldn’t do that forever.”

Pat’s anxiety problems were compounded by depression. She also showed signs of OCD: “I was terrified that something was going to happen to my daughter or that I was going to do something to her—it’s a bizarre thought that has nothing to do with who you really are as a person.” To help her ride out the worst of her suffering, Pat went on a low dose of antidepressant.

Nowadays, Pat feels “Awesome. My mother and I finally got to the point where she was the mother and I was the daughter. I was able to be with her just before she passed.”

“People do not have to suffer. To be able to push through that fear is like being severely nearsighted and then getting your first pair of glasses—you can finally see.”

 

Tapping Anxiety Away

Melissa Tiers teaches her clients to ratchet down anxiety levels using a number of methods. But she calls Emotional Freedom Technique (EFT) one of her “power tools. If there is one technique that you spend some time really learning, this should be it.”

Eastern healers see the body as a collection of systems through which qi, or essential energy, passes. Qi passes through channels called meridians that guide the placement of acupuncture needles in specific spots—the same spots through which qi can be influenced by finger pressure, a technique called acupressure. Practitioners eventually discovered how to combine self-administered acupressure with the use of positive, self-generated statements called affirmations, a process that led to the formulation of EFT as it exists today.

To use EFT, create a mental picture of a stressful situation—getting on a plane, for instance—and note how stressful that feels on a 1-10 system. Then, using two or three fingertips, you tap a number of points on the head and upper body while saying, “Even though I’m afraid of planes, I totally accept myself and chose to let go of this fear. I’m ready to let it go.” (The exact number of acupoints can vary; one sequence Tiers describes in The Anti-Anxiety Toolkit is the “karate chop” point on the outside of the hand, top of the head, inner corner of the eyebrow, outer corner, under the eye, under the nose, the chin, the collarbone, on the side under the arm, top of the hand between pinky and ring finger, inside of the wrist.) You then do another 1-10 assessment; any remaining anxiety is dealt with through additional rounds of tapping and affirmation.

Practice has turned Tiers from EFT skeptic into EFT believer. “I will tell you that the first time I tried it I let go of a 30-year dental phobia,” she says. “EFT is one of the most thorough ways of getting over fears and anxieties.” (A number of websites deal with EFT; one that Tiers recommends is www.eftuniverse.com).

 

 

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