Anxiety

When Anxiety Adds to a Stressful Situation

How to cope with worry and rumination.

Posted Dec 18, 2019

When I called my friend to ask how her mother was doing after being hospitalized with a broken hip, I heard a lot of clanging and water running. “What are you doing?” I asked. “I’m polishing my mother’s silver," she said. "It keeps me from worrying too much."

I understood her behavior completely. My closets and drawers were at their neatest during the week I'd waited to learn the results of medical tests undergone by a close relative. My friend and I were both coping with situations that we could not control by focusing on tasks that did not require much cognitive input. The repetitive tasks we were doing seemed to be calming at a time when we were anything but calm.

Our polishing silver, cleaning closets and drawers are activities known as distraction techniques: activities that move our minds away from being stuck in an emotionally intense mode and into feeling more emotionally neutral. 

The anxiety we were feeling acutely passed once we heard the news we had been waiting on, but some individuals experience this anxiety chronically (along with repetitive panic attacks). The emotional distress also is experienced physically: rapid heart rate, dizziness, stomach discomfort, and sweating are some of the symptoms.  Behavioral techniques and medication have been used to reduce the number and intensity of this so-called generalized anxiety and panic attacks. Anti-anxiety medication, otherwise known as tranquilizers, work quickly and effectively, usually within 30 minutes to an hour, and may be prescribed even for short-lived periods of anxiety. But these drugs, benzodiazepines, have unpleasant side effects such as drowsiness, dizziness, memory problems, confusion, and headaches. They can also be addictive, and not recommended for long term treatment. 

Antidepressants are also used to treat anxiety: the most commonly prescribed are the SSRIs, which include Prozac, Zoloft, Lexapro, and Paxil. The problem with these medications is that it may take as long as four to six weeks for the therapeutic effects to be felt. And for those where anxiety and worry are linked to an immediate cause for concern, waiting that long to feel less anxious is too long.

Sometimes if the stress is short, the wait in the surgical waiting room is shorter than expected for example and the news is good, then the anxiety and worry are simply endured. But when the situation is not readily resoluble and anxiety starts to become a permanent fixture in the emotional cupboard of the brain, strategies have to be tried and adopted to make life emotionally bearable. There is a limit to how much silver can be polished or drawers straightened; other coping mechanisms have to be found.

Distraction techniques have been recommended to help reduce anxiety.  They may not be able to eradicate the anxiety, worry, and helplessness in face of difficult situations, but sometimes can produce a temporary respite. There are a variety of distracting behaviors and they can be tried with the expectation that some may work, and some may simply be ineffective.

Relaxation techniques incorporating deep breathing, systemically relaxing the muscles, meditation, and taped calming sounds may work, but for some, getting to a point of being able to breathe deeply or sit and meditate may require some other calming methods first.  When the mind won’t stop playing the, ‘What if?’ thoughts that are causing the anxiety, it will be hard to turn off that endless loop of worry in order to meditate.

Focusing the mind on something other than the stress itself can help decrease stress. A friend of mine spent several hours in a waiting area for relatives of patients undergoing surgery. She told me she wished she had brought her knitting: “I saw this woman counting stitches, changing yarns, and consulting a pattern and I thought I would be much calmer if I was also doing that. She was totally engaged in getting the stitches right and this must have helped her anxiety while waiting to hear how the operation went."

The importance of focusing on anything but the problem might make exercising in a class more effective than exercising alone because attention has to be directed toward the instructor in order to follow the moves. If one exercises on one’s own, it is often too easy to revert back to compulsively thinking about the stressful situation.

The right friends are also important as a distraction from stress. Keep away from friends like those of the biblical Job, who told him that he must have done something terribly wrong to deserve all the horrible things that befell him. Friends and family members can offer comfort and in the right circumstances, a distraction through laughter and sharing entertainment.

One approach is to take advantage of a natural means of decreasing anxiety: eating (although uncontrolled eating will lead to secondary stress once the scale and eater encounter each other). But self-limited consumption of carbohydrates will increase serotonin, the same neurotransmitter that is made more active by antidepressants. An increase in calmness and decrease in the agitation and anxiety that often accompanies stress can result. When small amounts of carbohydrates are eaten, and as a result serotonin is made, a lessening of the anxiety will be felt.  Unlike antidepressants, the effect will be short, lasting about three hours. And unlike antidepressants, the effect will occur in about thirty minutes, not four to six weeks after the drug is first administered.

Increasing serotonin to produce calming is the first step in easing anxiety. This can be followed by using distraction techniques such as relaxation, exercise, meditation, yoga, cuddling up with your dog, playing with your cat, listening to music, or watching a funny movie.  

Sometimes the situation that generates the anxiety cannot be resolved; it cannot go away. No distraction technique will remove the anguish caused by such a situation. Nonetheless, utilizing methods to decrease the intensity of the emotional burden may make the stress more bearable. 

References

‘Distracting’ patients from anxiety. Rego S, Muller K, Jacobson C.   Current Psychiatry 2005; 4:2-3.