Preventing and Treating Anxiety

By Mike DuBose with Dr. Surb Guram, MD

 

Some anxiety is natural, and it can even help us make wise decisions. Unchecked worry, however, can take over one’s life! Columbia, SC-based psychiatrist Josh Fowler, MD, explained how anxiety can become a problem: “A good way to think about anxiety disorders as a whole is a feeling of ‘loss of control.’ To combat this, many individuals with anxiety tend to overcompensate by attempting to control all factors of their life. Obviously, this is impossible, so when things do not go as expected, their anxiety may spike.”

If anxious feelings are negatively impacting your life, make an appointment with your primary care physician for a thorough medical examination. Before your appointment, attempt to identify situations that trigger your anxious behavior (for example, when you’re hungry or tired). Use a paper or digital journal to record information about your anxious episodes, then look for patterns.

Several medical illnesses can cause anxiety, and some medications have anxiety as a side effect. Therefore, your physician may order tests to rule out medical issues and will want to know any medications or supplements you are taking. He or she will consider criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine if you should be diagnosed with an anxiety disorder.

Whether or not your anxiety is considered a disorder, if it is impacting your life, you want to reduce your stress and worry. The two most common and effective forms of treatment for anxiety are therapy and medication. Many people find that a combination of both works best, but it may take some trial and error depending on your unique situation, background, and triggers.

Talk Therapy

Common types of talk therapy include:

● Cognitive behavioral therapy (CBT), a long-lasting, effective form of therapy that centers on identifying, understanding, and changing behavior and/or thought patterns. Results are usually seen after 12-16 weeks.
● Exposure therapy, a form of CBT particularly useful for phobias where a patient is repeatedly exposed to an idea, situation, or object that he or she fears, eventually decreasing the anxiety experienced when exposed to the trigger.
● Acceptance and commitment therapy (ACT), which teaches patients to recognize what is happening within their minds and bodies, experience it without judgment, understand how their thoughts and actions may create problems, and make behavior changes in line with their personal values. A recent review found that ACT is comparable to CBT in terms of effectiveness for anxiety disorders.
● Dialectical behavioral therapy (DBT), which uses elements of CBT and mindfulness techniques and incorporates weekly group and individual sessions, usually with homework in between. DBT was developed to treat borderline personality disorder but can help patients with all types of anxiety issues tolerate distress and regulate their emotions.
● Interpersonal therapy (IPT), a short-term, structured type of therapy that emphasizes interpersonal relationships. An IPT therapist identifies relationships in the patient’s life that require improvement and suggests how to fix these relationship problems. IPT has shown promise in treating social anxiety disorder.

To find a good clinician, ask your doctor if he or she has any recommendations; if you are comfortable doing so, you can also ask friends and family. Research local therapists online (there is a good directory at www.psychologytoday.com/us/therapists/) and read other patients’ reviews. Check each potential clinician individually to ensure that your insurance will pay for sessions. If you really want to work with a clinician who is not covered, most insurance policies will partially cover costs for out-of-network providers.

If your desired clinician is not taking new patients, move down your list, but check back over time to see if any appointments have opened up. It’s important that you and your therapist “click,” which means you may have to try several until you find one who works well with you. (In Columbia, SC, we recommend psychiatrist Josh Fowler, MD and Dr. Fredrick Mau.)

Be sure to discuss your expectations and needs with your therapist. As Marissa Miller said in a recent New York Times article, “Your relationship or needs may change over time, or the therapist’s career may go in a different direction.” Periodically assess progress and consider visiting a new therapist if you’re not improving.

Medications

Therapy is an important part of anxiety treatment, but it can’t change biological factors like brain chemistry. Prescription drugs are sometimes needed to help anxiety sufferers regulate their emotions and apply lessons from talk therapy. Four main types of drugs are usually prescribed:

● Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant for anxiety and usually “cause fewer bothersome side effects and are less likely to cause problems at higher therapeutic doses than other types of antidepressants are,” according to the Mayo Clinic. They block the brain from reabsorbing the chemical serotonin.
● Serotonin and norepinephrine reuptake inhibitors (SNRIs) are much like SSRIs, but they also block the reabsorption of norepinephrine.
● Tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors) can also assist in treating anxiety and managing panic attacks, but have a greater potential for side effects and negative interactions than SSRIs and SNRIs.
● Benzodiazepines can also help with anxiety (especially panic attacks) but are more likely to cause side effects like sleepiness, irritability, and lack of concentration. They also carry the risk of addiction, so they are not ideal for long-term use.

Important: All medications can potentially cause side effects. Monitor yourself for any behavioral or physical changes that may occur and report them to your physician. If the side effects are too extreme, another drug may work better for you. Above all, don’t suddenly stop taking antidepressants! You’ll need the help of a trained physician or psychiatrist to wean off of them.

Other Strategies

Although therapy and medication are the most clinically effective ways to treat anxiety disorders, other behavioral and environmental changes can contribute to better mental health. These strategies are particularly useful for those with mild to moderate anxiety, or when performed in conjunction with therapy and medication for those with more serious anxiety. Always consult your doctor before making any lifestyle changes that will impact your physical or mental health!

Meditate. Scientific studies (including one by Stanford University neuroscientists) have proven that meditation—quietly focusing the mind on a particular object or thought—can reduce activity in the amygdala, the part of the brain responsible for fear, thus decreasing anxiety. It can be hard to keep your mind from wandering during meditation, but fortunately, there are great resources available online. The New York Times offers general tips and sample guided meditations of different lengths at www.nytimes.com/guides/well/how-to-meditate, and Dr. Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School, provides free guided meditations at www.mindfulness-solution.com.

Trade catastrophizing for healthy thought patterns. Psychiatrist Josh Fowler describes catastrophizing as “a thought process causing people to assume the worst possible outcomes from an ordinary stressor…for example, ‘I made a B on my last test. I’m so stupid. I’m probably going to fail this class. I’ll never get a job.’” When you recognize that you’re beginning to catastrophize, begin a pattern of calmly bringing your thoughts back under control. Eventually, you will gain the ability to approach situations rationally from the beginning.

Try phototherapy. Light therapy is mostly known for treating seasonal affective disorder (SAD), but some studies have shown that it can also help diminish anxiety by impacting the amygdala, the brain’s “fear center.” Good “light boxes” can be purchased on Amazon.com for less than $100. Look for one that emits 10,000 lux of light with as little UV radiation as possible. When using a light box, don’t look directly at it, but sit with it positioned 16-24 inches from your face while performing other activities.

Visualize a calming mental image. If you realize your anxiety is about to get out of control, focus on a soothing mental picture, gradually calming yourself down.

Relax the body with PMR. Progressive muscle relaxation, or PMR, usually starts with deep breathing exercises (such as inhaling deeply through the nose, then exhaling through the mouth for several rounds) and then moves on to clenching and releasing muscle groups from the toes upward. Practitioners work their way through body and finally up to the face, keeping tabs on where they feel stiff or uncomfortable. PMR has been noted to decrease the body’s “fight-or-flight” response, which can help avoid panic attacks. It also reduces physical tension, which can help release emotional stress.

Exercise. According to the Anxiety and Depression Association of America (ADAA), “Scientists have found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem.” Always consult your doctor before starting an exercise program, especially if you are in poor health, have a specific medical problem, or are a senior.

General guidelines to consider include:

● 5 X 30: perform some type of moderate to vigorous exercise (brisk walking, bicycling, swimming, running, etc.) for at least 30 minutes, five times per week.
● Even if you can only exercise for short bursts, do it! The ADAA says that just “five minutes of aerobic exercise can begin to stimulate anti-anxiety effects.”
● Try different types of exercise until you find one that you can commit to doing regularly.
● Increase accountability by exercising with a friend, family member, or “virtual” fitness buddy found through apps like MyFitnessPal.

Practice yoga. These gentle stretches strengthen the body and help practitioners become aware of their breathing, which can induce a calm state of mind. According to Harvard Mental Health Letter, “Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.”

Eat better. Remove foods that have been linked to anxiety—including alcohol, refined sugars, and processed and/or salt-laden “junk” foods—from your diet. In some people, nightshade plants (tomatoes, eggplants, peppers, and potatoes) can also promote anxiety. Keep a food diary and note what you’ve eaten before anxious episodes, limiting consumption if you see a correlation.

In a Men’s Health magazine article, registered dietician Tanya Zuckerbrot recommended eating avocados to obtain B vitamins, which promote healthy nerve and brain cells. Vitamin C, which reduces cortisol, can be found in foods like citrus fruits and blueberries. Magnesium (plentiful in spinach) and omega-3 vitamins (like those found in salmon, walnuts, and flaxseed) also help regulate cortisol. Zuckerbrot also suggested eating turkey and old-fashioned oatmeal for a serotonin boost and milk for its protein lactium, which can lower blood pressure. Research also suggests that probiotics, the healthy bacteria that naturally occur in our stomachs and intestines, are linked to neurotransmitter production. Consider incorporating a probiotic supplement into your diet, or add healthy gut bacteria food sources, such as pickles or yogurt.

Cut caffeine. One of the biggest anxiety-causers, caffeine, is technically a drug (although widely available in legal substances like coffee and chocolate) because it stimulates the central nervous system, raising heart rate, blood pressure, and body temperature. One Brazilian study found that caffeine could actually induce panic attacks! Gradually decrease the amount of caffeine you consume and consider eliminating it altogether.

Limit social media. If you tend to compare yourself to others, social media can be a big source of anxiety! Try spending the time you would have used on Instagram or Facebook enjoying a fun activity with friends or family. Social interaction supports healthy emotions.

Avoid negative news. Constantly watching negative news can make you more anxious, so turn off that cable TV and take a walk instead.

Reduce smartphone usage. Smartphones can be very helpful, but can also cause stress when people feel pressure to respond immediately to messages all the time. Turn off notifications for work emails during non-work hours and put away your phone during family or social time. Switch alert sounds to “silent” (even vibrations can be distracting) and turn off pop-ups on your laptop or desktop. This will improve focus and allow you to clear your mind!

Get better sleep. Lack of sleep exacerbates stress, and stress can make it difficult to sleep, but the body needs rest to heal itself mentally and physically each night. The amount needed varies by person, but most of us don’t get enough. Here are some tips from articles by Harvard University Medical School, WebMD, and the National Sleep Foundation:

● Go to sleep and get up at roughly the same time each day, even on weekends!
● Minimize light in the bedroom (use curtains and/or a sleeping mask, if necessary).
● Keep the bedroom quiet; consider using earplugs for sounds you can’t control.
● Maintain a comfortable temperature (some experts recommend 60-67 degrees Fahrenheit).
● Avoid caffeine for at least 4 hours before bedtime.
● Don’t eat large meals or foods that will cause heartburn for dinner.
● Keep daytime naps under one hour in length, and don’t nap after 3 PM.
● Exercise regularly, preferably in the morning or afternoon.
● Keep electronic distractions like TVs and computers out of the bedroom. Don’t play or read on your cellphone before bed.
● Don’t use the bed for activities other than sleeping and intimacy, and don’t get in bed unless you are ready to go to sleep.
● Start preparing for bed an hour before you’d like to get to sleep.
● If you can’t fall asleep after 20 minutes in bed, get up for a while and then try again.

If these suggestions do not work, consider undergoing a sleep study under the supervision of a trained sleep physician. We recommend Dr. Joseph Gabriel in Irmo, SC.

Decrease workplace stress. Work is a major stressor for many Americans, according to the American Psychological Association (APA). The organization recommends tracking which situations at work cause the most anxiety, then developing healthy solutions (taking a quick walk, for example) to help diffuse the worry. If interpersonal conflicts are the main source, speak privately to a manager or supervisor at a good time and seek advice on how the issue can be addressed. The APA also recommends utilizing vacation time as a way to recharge: “When possible, take time off to relax and unwind, so you come back to work feeling reinvigorated and ready to perform at your best.”

Pamper yourself. Little things like regular haircuts and the occasional massage can improve your mood and put you in a better mindset. (If money is tight, book an appointment with a training school, where students administer services under the guidance of instructors.) You can even relax at home with a warm bath, some aromatherapy oils, and comfortable, soft clothes of your own!

Restrict worrying to a time slot. Sometimes, you will be faced with situations you can’t help but worry about. Rather than letting anxiety take over your life, set aside 10-15 minutes at a predetermined time each day to go over the issue. You can think about it or even write in a journal, pondering over worst-case scenarios and potential solutions. Once time is up, make yourself put the problem out of your mind until the designated time tomorrow.

Declutter your home and office. If tackling a whole house or room seems daunting, break it down into smaller sections. Set aside items you don’t use or need to donate, sell, or throw away. Losing the clutter can make you feel as if a weight has been lifted from your shoulders!

 

The bottom line: Anxiety is a legitimate illness affecting 18% of the American population, according to the Anxiety and Depression Association of America (ADAA). If you have an anxiety disorder or are generally anxious, you are not alone! There are treatments available to help you enjoy a lower-stress life, including therapy, medication, and lifestyle changes. The first step is often the hardest, but don’t wait. See your doctor and get on the path toward health and happiness!

For an extended version of this article, please visit www.mikedubose.com/anxietytreatments. To learn more about the causes of anxiety, see www.mikedubose.com/anxietycauses.

 

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can email us at [email protected].

Mike DuBose, a former licensed counselor, received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

© Copyright 2018 by Mike DuBose—All Rights Reserved. You have permission and we encourage you to forward the full article to friends or colleagues and/or distribute it as part of personal or professional use, providing that the authors are credited. However, no part of this article may be altered or published in any other manner without the written consent of the authors. If you would like written approval to post this information on an appropriate website or to publish this information, please contact Katie Beck at [email protected] and briefly explain how the article will be used; we will respond promptly. Thank you for honoring our hard work!