21st Century Aging

Living longer and better.

Do You Worry Too Much?

Controlling Worry: Advice From Marty Rossman, MD

Everybody worries.  Some of us worry too much. Although there is a lot of advice about how to combat worry, I recently came across a book that presents a novel approach to the management of anxiety. The Worry Solution, by Martin Rossman, MD, caught my attention.

Dr. Rossman is a physician, author, speaker, researcher, and consultant. He founded The Healing Mind in order to raise awareness about the power of high quality Mind/Body self-care tools in self-healing and in the health professions. A graduate of the University of Michigan Medical School in 1969, he has had a long-standing interest in the practical importance of attitudes, beliefs, emotions, and Mind/Body practices in medicine and health. In addition to a busy practice emphasizing non-drug medicine and patient participation, he has taught clinical guided imagery to over 10,000 health professionals since 1982.

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Dr. Rossman is the founder and Director of the Collaborative Medicine Center, located in Greenbrae, California.

I had the chance to interview Dr. Rossman. Here is what he has to say about worry, how we women do it more, and how to control the natural impulse to worry, and a lot more! 

TMG: In all of your books, you describe the human body’s natural ability toward healing. Since we live in a culture dominated by Western Medicine, the focus of healing is often external, not internal. Can you give us a primer on how the body can heal itself?

MR: If the body didn't heal itself none of us would be here, since healing pre-dates medicine of any kind by billions of years. Healing is one of the essential characteristics that define life, along with the ability to reproduce. Most people recover spontaneously from most of the illnesses and injuries they have, and the same energy, principal, or force that organized a handful of biochemicals and water into us in the first place guides that process. A surgeon, no matter how gifted, cannot heal anyone. They can repair wounds and fractures, remove tumors or abscesses, and sew up the wound, but the healing of the wound comes from an innate ability in the patient, or it doesn't happen at all. Antibiotics don't heal – they remove dangerous bacteria, but if the immune response isn't strong enough, no antibiotic in the world can control an infection.

There are things we can do, as doctors or patients, to help or hinder the healing process, and that’s what we try to do by removing proximate causes of illness, encouraging good diet and lifestyle, stress reduction, and resolution of emotional challenges.

TMG: In The Worry Solution, you explain that we are hard wired to worry. Many people come to therapy saying that they just want to “turn the worry off.” Is that a realistic goal?

MR: I don't think so, because I believe that worry, at its core, is a survival skill. It’s a function of imagination, allowing us to turn a problem over and over in our mind until we either find a way to resolve it or find a way to accept it. The problem is that many people become habitual worriers, and let their imaginations run away with them. They spend way too much time mesmerized by all the things they fear, and don't realize that it really is possible to free themselves from the bad habit of worry, not by eliminating worry but by learning to worry better.

What I call “good worry’ solves problems, and may let you avoid unnecessary problems or dangers. When worry becomes a bad habit, it creates problems, and makes us more anxious and stressed. People who work with the processes I teach in The Worry Solution tell me they worry less, but more effectively as they become more skillful with their imagination, which is what it’s ultimately all about.

TMG: You talk a lot about fear and how this impacts our tendency to worry. I was thinking about how Freud started the theory of psychoanalysis with ideas of fear in the context of abusive or neglectful childhoods. He later changed his mind about the salience of fear and started focusing on aggression. Do you have ideas about how fear and aggression are linked?

MR: Brain science shows us that fear and aggression are very closely linked and the neurological underpinning of both share large amounts of space in emotional processing areas of the brain like the amygdala. Fear is a primal survival response to threats, and depending on many things, we learn to respond differently to threats and fear. If you are big enough, strong enough and fierce enough, you might respond to a threat with aggression; if not, you may be better off running or freezing, which is the natural response of the prey animal in us. If you are a child and being threatened or abused by a much bigger, stronger adult, fighting or fleeing may be impossible, and freezing (along with dissociating) may be nature’s way of minimizing the damage to body and psyche. Unfortunately, these responses may generalize and persist later into life creating anxiety, depression, physical illness, addiction and other forms of disability unless the person is lucky enough to access good therapy. I think many of the physiologic responses that create chronic pain and illness in abuse survivors are from both a chronic fear response and attendant inhibition of the ability to express aggression. That chronically aroused stress physiology takes a cumulative toll.

TMG: I thought you made a very important point about how fear is a part of modern life. Fear sells in almost all aspects of media. If we are prone to worry and fear, how can we protect ourselves from external triggers of fear?

MR: The exploitation of fear is a basic principle of the media and scary information can reach you not only by newspaper, radio and TV, but through your computer and phone. People get addicted to this because the brain is wired so as to have to pay attention to threats when they appear. Many of these are pseudo-threats in that the tragic murder of a man in Florida is not much of an immediate threat to a Californian walking on a beach, but it can sadden us and scare us just the same. Fortunately, all of our devices have an “off” button, as does our worrying brain, we just need to use them more frequently.

TMG: Much of your career has focused on the importance of guided imagery. Can you tell us a bit about why you think guided imagery is such a powerful tool?

MR: Imagery is the natural language of our unconscious mind. It is the way we represent the world, inner and outer, to ourselves, and undoubtedly predates written or even verbal thinking by many millions of years. As an older form of thinking, and navigating through the world, it has more experience guiding us through archetypal challenges that life brings. Imagery is also a multidimensional, holistic way of thinking, and is much more closely tied to our emotions than is our rational mind. This is why a poem, a song, a painting or a dance can move us so profoundly. In the day to day practice of primary care medicine, we deal with stress and anxiety every day– from 50%-90% of all visits to primary care doctors are for stress and emotionally related symptoms. Imagery can often help reveal what’s going on underneath the surface and bring to mind the issues that really need addressing rather than suppressing.

TMG: Sometimes when people try to relax or even look inward, they become more anxious. Do you have any tips for helping people who experience “paradoxical anxiety?”

MR: It’s also called “relaxation-induced anxiety” and it happens in maybe 10-15% of people. Many times it can be ameliorated by letting the person know they can begin to relax by breathing more deeply and fully, into their abdomen, and letting the exhalation be a bit longer than the inhalation. I also let people know that if they want to, they can experiment with relaxing just a little bit, using their breathing to control it, so that they “don't relax too deeply” and that they are in control. They can keep their eyes open, or half-open, and they can open their eyes and come fully awake anytime they want. While relaxation can reduce stress, it can also allow strong feelings to come up that the person may be defending against. Going slowly and emphasizing that the person only relaxes because they choose to, and want to, will often, but not always, be helpful.

TMG: I found it humorous and relieving that you noted that women worry more than men! Can you tell us why? Any ideas about how to get men to be more empathic of our worrying potential? 

MR: Women in nature face the same threats as men and in addition must be alert for threats from men, who are in general larger, faster, stronger, and more aggressive than they are. In order to survive and procreate, women needed to be one step ahead of men in their sensitivity to emotional cues or signs of aggression. Apparently, areas of the brain that process fear are significantly larger than they are in men. When a woman has a baby this area grows even larger, and women become even more vigilant for signs of threat. This makes sense in terms of making it more likely that her children survive into adulthood. In terms of empathy, I wonder if we haven’t lost some of that in the movement towards equal rights and opportunities for women. As roles are less clearly defined, it isn't clear for men when to treat a woman with deference to their sensitivity and when to treat them like you'd treat another man. Worry isn't exclusive to women so both genders have the opportunity to be more empathetic for the challenges they each face.

TMG: One thing a lot of people do not realize is that therapy, meditation, and several other mind-body practices can actually alter our brains. Can you tell us a bit about how the brain can change as a result of an improved relationship with one’s own mind and understanding of emotions?

MR: Neuroplasticity, the ability of the brain to change, is the basis of all learning. Until 10-15 years ago we believed that the adult brain didn’t change much, except for degenerative change and the loss of abilities with age. Now we know that old dogs can learn new tricks, and when they learn them they activate new pathways in the brain that can support those new abilities. In Norman Doidge’s remarkable book, The Brain That Changes Itself, he describes research where people born blind can learn to see when they get input from video cameras sending digitized information to an electronic wafer placed on their tongue. Remarkably, the part of the brain that processes visual information takes that information and creates a type of vision so that they can walk in a strange room without bumping into things. Jeffery Schwartz, MD, in Mind and Brain reports his research with OCD patients participating in a ten-week class, where they are taught to respond differently to their obsessive thoughts. Functional MRI studies after the classes show that they actually begin to grow new brain pathways, and that their “worry circuit” pathways from the pre-frontal cortex to the caudate/striate complex (the pathways that the OCD impulses travel) become less active.

TMG: If you had to pick three things that we could all do to improve our emotional and physical health, what would you advise?

MR: 1) Take care of yourself as you would a beloved pet. Feed yourself good quality food in proper amounts, have fresh water always available, take yourself for a walk once or twice a day, let yourself sleep when you are tired, and be kind to yourself. 2) Learn and practice a way to shift into a relaxed and mental state so you can do that if you want to 3) Accept that loss and grief are inherent to life and look for opportunities to appreciate beauty and love.

Thanks so much Dr. Rossman for this thoughtful and provacative interview!  

 

 

Tamara McClintock Greenberg, Psy.D., M.S., is an Associate Clinical Professor of Psychiatry at the University of California, San Francisco.

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