Managing Anxiety

Most people feel an increase in anxious feelings before a stressful situation such as an exam or staring a new job, but anxious feelings can occur equally in advance of things we both fear and anticipate. Anxiety can be seen to be a positive as it can provide us with a stimulus that enhances our performance or coping mechanisms in new or testing situations. Worry or anxiety may be the motive for us to take good care of ourselves and make informed and healthy decisions about our lifestyle. Cultivated and managed well, anxiety is a typical response to the joys and stresses of our modern world. However, for almost one in seven people, anxiety can become a debilitating and challenging part of everyday life. Fourteen percent of Australians are affected by anxiety every year, with anxiety disorders being the most common mental health problem in young people, and in the population in general. Anxiety disorders are usually more common in women (approximately 18 percent) compared to men (11 percent). A persistent anxiety disorder is an illness for which appropriate diagnosis and treatment plans by skilled healthcare practitioners can make a significant difference to management and quality of life. Unfortunately many sufferers do not seek medical support – only about one-fifth of sufferers actually present to a GP with anxiety as their complaint – and for this reason incidence rates are most likely significantly higher than the statistics show. Support for anxiety sufferers comes in many forms, particularly when we develop treatment plans from an integrative medicine perspective. The earlier a lifestyle intervention for anxiety can be enacted, the sooner the patient can recover. Anxiety left untreated tends to deepen and only become worse. The American Psychiatric Association defines Generalised Anxiety Disorder (GAD) as excessive worry and anxiety accompanied by more than three somatic symptoms (i.e. restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance) which occurs more days than not for a period of at least six months. (Note: Specific anxiety disorders, as detailed below, may have differing criteria.) The symptoms of an anxiety disorder are often confused with other types of illness and when experienced over a long-term period can become difficult to cope with. Symptoms such as an inability to calm or relax, nervousness, irritability, palpitations/racing heart, difficulty breathing, bouts of crying, trembling, sweating, feelings of anxiety and blushing are common. When anxiety persists depression, insomnia, substance abuse and so on can coalesce with anxiety. Health practitioners may also see people presenting with suicidal tendencies and other illness. What causes anxiety disorders? The causes are still largely unknown and the subject of continuing research worldwide. Like many other illnesses including heart disease and diabetes, anxiety disorders are complex and most likely caused by a combination of genetic, environmental, behavioural, developmental and other factors. Individuals can process fear and other stimuli in different ways, depending on individual brain (amygdala) function. Research is looking at how the brain interprets and manages fear and other stimuli triggers so they can be more consciously controlled, and how the birth of new brain cells can be encouraged. Both genes and experiences interact in how we respond to anxiety-inducing stimuli, highlighting the need for individually based assessment and treatment plans. Lifestyle factors such as chronic stress, poor nutrition, caffeine, smoking, obesity, alcohol and substance abuse may also initiate or perpetuate the symptoms of an anxiety disorder. Stress during infancy and early childhood (and perhaps even in utero, as experienced by the mother) has also been studied and some causal links have been found between these experiences and both mental and physical health in later life. Types of anxiety orders · Generalised Anxiety Disorder (GAD) – A preoccupation with worry (often exaggerated and chronic) about the past, present and future that interferes with day-to-day functioning and occurs without provocation. Characterised by hyper-arousal, physical symptoms such as chest tightness, over-breathing, tension, headaches and diarrhoea. May involve substance abuse (often as a means of managing symptoms). · Panic disorder and agoraphobia – Panic attacks may be spontaneous or in response to a specific stimuli. Agoraphobia is a fear of leaving an environment considered to be safe and familiar. Responses may include bodily (somatic) and thinking (cognitive) features, with a range of symptoms not limited to nausea, chest pain (may mimic a heart attack), choking, fear of dying and fear of going mad. People with a panic disorder may develop intense anxiety between episodes, and phobias. · Obsessive Compulsive Disorder (OCD) – Obsessions can be intrusive thoughts, images or impulses which create anxiety when they are unable to be controlled. OCD develops as an attempt to relieve the anxiety created by the obsession. Often involves highly ritualistic behaviours that interfere with ordinary life. · Post-traumatic Stress Disorder (PTSD) – Can develop months to years after a traumatic event. Often involves re-experiencing the event, avoidance of situations associated with trauma, nightmares and insomnia, with an increased risk of secondary conditions such as depression or alcoholism when used to mask PTSD symptoms. · Social phobia (SAD) and other specific phobias – Anxiety associated with social situations due to a fear of embarrassment, which often has its roots in childhood experiences. May become avoidant of social situations and develop excessive self-consciousness. They can fear being watched, judged or embarrassed and can worry for long periods in advance of situations that are dreaded. May run in families. Fear of the symptoms can create a vicious cycle. Popular culture is talking about a new disorder called ‘social media anxiety’. Although not a diagnosable disorder, social media anxiety – being removed from social media access – is an increasing phenomenon that has been identified by not-for-profit organisation AnxietyUK, as one to watch. Forty-five percent of responders said they felt ‘worried or uncomfortable’ when email and Facebook were inaccessible. The question is yet to be answered as to whether anxious people are more likely to use social media or if it is social media making people anxious. In any case, this points to the very real interaction between modern life, stress and anxiety levels. What can be done? Recent research in the US reported that complementary therapies were used by 57 percent of people reporting anxiety attacks, and 66 percent of patients consulting a physician for treatment of anxiety. Pharmacology provides a range of prescription-based drugs, for example Xanax and Paxil, for the management of anxiety and these can be helpful in gaining traction with behavioural changes. This class of drugs, called benzodiazepine, work on the gamma-aminobutyric acid (GABA) neurotransmitters in the brain to create a calming effect by increasing dopamine levels. Common side effects include, unsteadiness, dizziness, increased risk of accidents (for example, when working with machinery), memory loss and impairment of thinking. Links have been established between these drugs and dementia and older adults may be of particular risk of a serious reaction, as the body tends to become less efficient at eliminating the drugs, which may then accumulate in the system. Concern as to long-term side effects can be addressed with a suitable lifestyle-based program that develops a greater sense of reliance on psychological support, exercise/yoga and dietary management. Other complementary therapies such as herbs and supplements, acupuncture, sleep therapy, music/dance therapy and relaxation/meditation practices are useful adjuvant therapies. The prevention/management prescription A plan unique to the individual and their particular form of anxiety disorder is the key to successful management and amelioration of symptoms. Common front-line lifestyle interventions include: Psychological and Behavioural therapies – Cognitive Behavioural Therapy (CBT) is a series of talking-based therapy sessions that help anxiety sufferers link thoughts, feelings and behaviours. Interventions can include cognitive restructuring, graded exposure to provocations, problem solving, assertiveness training and social skills development. Research proves this to be as highly effective treatment for anxiety, suitable for both groups and individuals. Likewise, counselling can also be beneficial. Diet – Healthy eating is the cornerstone for mental health, as it is for physical health. Fresh fruit and vegetables, quality grains, and good sources of protein are a foundation for optimal health, and support the complex interwoven systems within the human body, including the hormone system, which is understood to influence mood. Maximise nutrition by including foods rich in omega 3 fatty acids, B vitamins and folic acid. Supplementation can be useful with fish oil, selenium, a quality multivitamin, magnesium, melatonin and inositol (a form of glucose involved in serotonin uptake) of proven value. Regular Exercise – Research shows aerobic exercise can be as effective as prescription medications in treating anxiety. Regular walks outdoors will also improve essential vitamin D levels, a known mood vitamin. Low levels of vitamin D are associated with depression, and a connection to anxiety is also apparent. A study found yoga to be superior than a leading form of anxiety medication for generalised anxiety, with breathing awareness and meditation providing effective means of managing anxiety. Breathing Exercises – Anxiety can cause rapid breathing. The Australian Psychological Society advises that learning a breathing technique to slow down breathing can often relieve symptoms and help a person to think more clearly. They advise a simple breathing technique as follows:

· Breathe in through the nose to the count of three (3 seconds) and say: ‘In, two, three’

· Breathe out through the nose, again counting to three, and say: ‘Relax, two, three’

· Keep repeating this for two to three minutes, and then time your breathing

This breathing technique can be used to slow down breathing whenever a person feels anxious and can be done anywhere without anyone else noticing. Herbal remedies – There is a significant research base proving the effectiveness of Kava as an anti-anxiety remedy. Kava works on the same brain receptors as prescription anti-anxiety medications and is widely used in Europe and the US. Indigenous to Pacific Island cultures, it is now a readily available supplement and has few to no side effects. Other herbs that an integrative medical practitioner may prescribe include sage, St John’s Wort, valerian, lemon balm and various forms of ginseng. Avoid or limit known triggers – smoking, alcohol consumption and caffeine are well known triggers for anxiety, especially in the long term. Sleep well – anxiety and insomnia often present together in a vicious cycle that increases stress hormones causing further sleep disruptions. Melatonin can be useful, as is cultivating good sleep habits. Regular rise and retire times, avoidance of technology in the evening and ensuring regular seven to eight hour sleep cycles are key to managing anxiety. Be creative – Whatever provides joy or a sense of calmness in life, be that reading, knitting, painting, playing/listening to music or other activities, can be useful in managing anxiety. A preoccupation with something enjoyable provides not only a diversion from anxiety, but also can soothe and nourish a person and provide a sense of meaning and purpose. Living, working or being with a person with an anxiety disorder, or while they are having a panic attack, calls for compassion and empathy. Trying to relax on command is not easy for anyone, and in the midst of an episode, telling someone to calm down may have the opposite effect. The best support we can give a friend experiencing anxiety or depression is encouragement to seek professional advice from a health practitioner. Integrative medicine provides many pathways toward better management of anxiety and optimal health. Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM). He oversees the facilitation of the practice of Integrative Medicine at the NIIM Clinic in Hawthorn, as well as the promotion of education and research. niim.com.au