Chronic Anxiety and Stress

Plain Talk: What You Need to Know.                By Dan Litov, Ph.D.



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Anxiety – Stress: Everything You Need To Know: The Good, the Bad, and the Ugly Thumbnail example

Chronic anxiety, stress, is one of the most difficult of all human emotions to manage and treat.  Why? Unlike depression, an unusual state of being, fear is a basic human emotion.  Fear is an important survival mechanism, guiding us, helping us make decisions that protect our lives.   It protects us from pain and potential injury or death.  Humans (and animals) are more strongly motivated to avoid pain than to pursue pleasure.  Thus, fear, not surprisingly, has the potential to become overwhelming. 

What About Anti-Anxiety Medications?

Unfortunately, there are no ‘good’ drugs for anxiety. Benzodiazepine drugs like Valium and Xanax are more sedating than calming (and often lead to dependency). The one 'new' drug (introduced over 20 years ago in 1986!) Buspar (Buspirone) takes weeks to work, is not tolerated well by many, and users usually report only a mildly calming effect (for those for whom it works, however, I’m sure even a little is good).  People who suffer panic attacks are often directed to rely on benzodiazepines. Unfortunately, they are often not informed of the well developed Panic Attack prevention protocol, that has been used now for nearly a dozen years by psychologists, and has helped panic attack sufferers get rid of their dependency on these addictive drugs by helping them learn to eliminate or dramatically reduce panic attacks. 

That pretty much sums it up for medications targeted directly at anxiety (there are some antidepressants which sometimes are able to assist with social anxiety, OCD or Panic Disorder).

A Mystery: Depression vs. Anxiety

Psychologists have learned a tremendous amount during the last twenty years about the psychological, physiological and social factors underpinning depression. There are some very clear thoughts and behaviors that need to directly be addressed, and when they are, depression is often dramatically alleviated. In addition, in many cases, after a period of several months, some depressions lift on their own ('time as healer'). Not so clear with Anxiety. While the symptoms of anxiety are well known, there are (apparently) many different underlying causes. And while we know some of the physiological underpinnings, we don’t know how to directly counteract them with medications without resorting to overly strong, often very sedating medications.  In addition, one human being can have many different different sources of stress and anxiety.  Some may be real, some may be imagined!

"I have been through some terrible things in my life, some of which actually happened.” -Mark Twain

The Bad

Psychologically, people with chronic anxiety and stress experience, over time, loss of enjoyment of life (there is always another worry on the horizon), lack of spontaneity, constant wrestling with disorganization, are easily distracted, feel a constant sense of pressure and the need to rush (including fast driving), difficulty concentrating, doing a lot but feeling like one is spinning one’s wheels. Some have difficulty with their sense of time, including a poor sense of how much time it takes to accomplish projects, struggling with procrastination, arriving late (work, appointments etc.).

People who are anxious are often irritable, bothered by things that others appear to tolerate easily (background noises for example). When one constantly worries, one tends to take life seriously, and may find it difficult to simply have fun.

The Ugly

What’s worse is that anxiety/stress wreaks havoc on one’s body and mind. We know that physiologically, there is a chronic secretion of cortisol (a hormone produced by the adrenal glands) associated with chronic anxiety. This in turn appears to have a relationship with weight gain, headaches, blood pressure (hypertension), blood sugar imbalance, thyroid dysfunction, and even decreased bone density. Other physical symptoms include fatigue, lower back pain, gastric distress (both in the stomach and intestinal area). This can cause stomach aches, heartburn, diarrhea, constipation and may be the cause of Irritable Bowel syndrome. Anxiety/stress affects one’s sleeping pattern, making it difficult to fall asleep, difficulty staying asleep, and sometimes causing one to wake early – sometimes with a headache!

Chronic anxiety/stress is also linked to immune system suppression. As a result, people with chronic anxiety/stress may often be fighting colds, flus, infections and other mysterious ailments. Skin disorders are often correlated with anxiety disorders (this is true for many mental health disorders in general).

So, is all lost? No. We have learned a lot in the last three decades of research.  Though, not as much progress as with depression.  Here's some of what we know, in a nutshell.

Anxiety appears, similar to depression, to have three broad underlying factors.

  1. Genetic or physiological predisposition . For example: Researching the startle reflex with 6 week old infants, psychologist were able to predict which children at age 18 months would be more relaxed in a strange environment. Infants with mild to low startle reflexes, later at the age of 18 months were able to leave their caretakers in a strange environment and explore. Those with high startle reflexes clung to their caregivers and were unable to wander more than a few feet away
  2. Family/Social upbringing: No surprise here. Children growing up in unstable environments, suffering abuse, neglect, verbal or emotional abuse, or the offspring of parents with anxiety disorders or other mental health issues are predisposed to having anxiety disorders as well. Here is an interesting study, click here.
  3. Cognitive factors : People who (for whatever reason) hold certain specific negative expectations about the future, negative beliefs about how the world operates, and believe they will not be able to cope in an effective way, are likely to fear the future, and look for signs that ‘disaster’ or a 'catastrophe' is around the corner.

This is called the Bio-psycho-social perspective. It is a (relatively) new way of looking at psychological (and medical) health issues.

Ok. So what do I do ?

Here's the 'Good': There are effective ways to help.  They can dramatically reduce the intensity of anxiety to a much more comfortable and tolerable level, to the point that the feeling of being overwhelmed is rare.

Some general recommendations:

Over many different research studies, a few solutions consistently work:

  1. Practicing some form of progressive muscle relaxation (PMR) on a daily basis
  2. Aerobic exercise for 20-30 minutes daily
  3. Learning how to budget time and plan ahead
  4. Cut down on caffeine intake (preferably altogether)
  5. Talking with someone – anyone- on a regular basis about one’s worries and concerns.
  6. Meditation/Yoga
  7. Listening to calming music
  8. Directly addressing the thoughts ‘cognitions’ that are driving your anxiety engine
  9. Directly confronting the behaviors one wants to avoid
  10. Practicing and mastering how to respond to feared situations

NOTE: One should always obtain a medical check-up, just to eliminate any possible medical disorders that could mimic an anxiety disorder.

Some of the above solutions (1 - 7) can be implemented fairly easily (Progressive Muscle Relaxation CDs abound on the internet, or see a psychologist with anxiety specialization who will create your own custom tape in one session). An aerobic exercise program doesn’t take too much (though if you have difficulty actually doing it, that’s another story). Reducing caffeine (hard, but doable). Talking to someone- that’s up to you, depending on the size of your social network, and your ability to open up.

The rest (8 – 10) can be done with a psychologist trained in anxiety/stress management.

For more information, contact:

Dr. Dan Litov