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Stop Being Anxious About Being Anxious

The many approaches to anxiety

Anxiety is fundamentally intrusive, interfering with going to sleep, preoccupying you while driving and preventing you from concentrating on whatever else needs to be done. For many adults and their kids, anxiety is always there, or always on the verge of being there.

It's exhausting, and people want relief.

Medications often work—and have a time and a place, but it's good to know that you have other options as well. Such approaches range the gamut from diet changes to meditation to exercise to talk therapy. And many alternative treatments can be used co-jointly with medication for a more robust treatment. In addition, some treatments are based on better habits of living that will continue to help you years after the anxiety has abated.

It is with pleasure that we note that this article was written with the help of two Vassar College interns who have been working with The Intelligent Divorce Project this semester, Chelsea Anderson and Sarah Spitz. Their contribution is appreciated. Thank you.


Stop Being Anxious About Being Anxious

According to the National Institute of Health, anxiety disorders are the most common mental illness among Americans, with some estimates reaching as high as 40 million people. It's generally accepted that effective treatment for most anxiety combines medication and psychotherapy. These protocols work and I've used them for years. The issue at hand is whether we can do better.

At Issue: So, are drug interventions always needed?

A common trap that people get into with medications in general, and especially psychiatric ones, is thinking that a pill will end their suffering. This may be the case if the ailment has one simple cause; for example, if an improperly treated wound becomes infected by bacteria, an antibiotic can often clear the situation up quickly with minimal side effects. However, anxiety and other psychological issues are more complex, and the effects of medication are less fully understood. And, with all the breakthroughs of modern science, the functioning of the most important organ in our body, the brain, is still oftentimes a mystery.

Example: The placebo effect of psychiatric medications is very high. This means that taking medications does help, but often the effect is less because of the pharmacological action of the agent and more about your believing that the pill will work. The message here is that what makes drugs work may be more complicated than you think. In fact it may be because of the way you think.

Most medications prescribed for anxiety disorders can be characterized as either antidepressants or benzodiazepines. Benzodiazepines can cause a relatively quick calm and are much appreciated by patients who are panicky. The antidepressants work more slowly but maintain a blood level every day so they have the advantage of muting some anxiety throughout the day. Side effects are varied. It is easy to use benzodiazepines too liberally because they work so quickly and are so effective. The antidepressants have a wide range of side effects, from rare cardiac issues to weight gain or loss to night sweats and more. Fortunately, most of the side effects of these meds are relatively benign, but who wants to be on medication if they don't have to?

Good research has shown that medication, especially combined with treatment from a competent therapist, can often give a person what they need to start down the road to recovery. But in the long run, the best way to manage symptoms of anxiety isn't with a drug that might induce dependence or have other side effects.

The best we can offer is to help people learn how to manage anxiety themselves, with medicine being one of many choices. The body is a complex machine, and it has developed a number of ways to keep itself healthy without external aid. Why not tap into the potential for healing that the body already has?

These technologies are both ancient and modern: Many people cringe when they hear about complementary or alternative medicine, imagining that quack on television infomercials peddling expensive "natural" products, or maybe a representative of some counterculture that might be just a little out of touch with the real world. In reality, though, many of these treatments are based on sound scientific principles and encourage people to do the very things that more mainstream doctors are advising (or ought to advise): namely, paying careful attention to lifestyle decisions and recognizing how the body and the emotions can affect one another. To that end, we've compiled a list of simple and proven ways to manage stress and anxiety with less or no medication.

1.) Psychotherapy. Unless you are overwhelmed by your anxiety and need relief immediately, give therapy a chance. There is a technique called CBT, Cognitive Behavioral Therapy, that can be very effective in a few sessions. The purpose of CBT is to teach you to think in a less anxiety-inducing way, and it works! If you have a history of trauma or abuse leading to anxious feelings, you may want to try EMDR or Progressive Exposure Therapy. These two techniques have been shown to relieve intrusive anxiety caused by past or present trauma.

2.) Breathing exercises and meditation. When was the last time you were conscious of your breathing? The proper circulation of oxygen and carbon dioxide is vital to every part of the anatomy's functioning, especially the brain. In times of stress, however, people can unconsciously deny themselves the oxygen they need, either holding their breath or entering a constant, low-level state of hyperventilation without realizing it. Healthy breathing and meditation have been studied extensively and have been systematically introduced to the medical world by John Kabat-Zinn, formerly of the University of Massachusetts Medical Center. See his book, Wherever You Go, There You Are, or listen to his tapes. Daily meditation can make a huge difference in your life, and it costs very little.

3.) Sleep. Another biological imperative that is often overlooked, sleep is the brain's opportunity each day to relax and sort itself out. It's a good idea for adults to get 7 or even 8 hours of sleep per night. If you're like most people, it may seem that there's just not enough time in your schedule to fit in a good night's sleep. Sometimes it's unavoidable, but if you find yourself consistently running on too few hours and suspecting that your mental health may be suffering, it might be time to think about cutting down on your workload, or saying "no" to some non-essential responsibilities. This can be a Catch-22, because fatigue can make you more anxious, which in turn makes it more difficult to settle down at night, leading to tossing and turning, leading to more fatigue and anxiety. Constructive things that you can do is to try melatonin, which is a natural hormone that helps many people settle down. Sometimes, a warm bath before bed can help a lot. Also, it may help to cut down on caffeine after lunch; some people are just too sensitive to the stimulation. And if you're a drinker, note that a drink or two may get you to sleep, but you will may wake up at 3 a.m. and be unable to get back to sleep. This is called REM rebound and it will fatigue you terribly. Just give up the booze at night—you'll sleep better.

4.) Exercise. Everybody knows how important exercise is to physical health, but sometimes people forget that it plays a role in mental health as well. During exercise, you do more than just burn calories and improve muscle tone: you release more feel-good neurotransmitters and endorphins. So, why take drugs when you can make them yourself, safely and naturally? In addition, exercise can also activate the brain in constructive ways, leading to better self-esteem, sharpening your cognition and reduce stressful thinking.

5.) Diet. As far as dealing with anxiety goes, the general advice is obvious: Make healthy choices that supply the nutrients your body needs, without causing dramatic pulses of insulin. Make sure you get your required amount of B vitamins and Omega-3 Fatty Acids. Good hydration is smart for everyone, because it encourages the body to process toxins and can keep you more alert. Many stressed people eat high carbohydrate meals like bagels, bread, pasta, and so on, which make you feel good temporarily, but inevitably trigger an insulin surge only to fatigue you a little while later. Fatigue opens the door to anxiety (and more feel-good carbohydrates), so think healthy—it's good for your head. And, as mentioned before, pay attention to what you drink. For example, caffeinated beverages may make you feel less tired, but they do so by making you more edgy and prone to anxiety. It bears repeating that alcohol can relieve stress in the short term, but can cause mental instability later on as your body processes the toxins. It's true that these habits are difficult to give up, but in the long run it may decrease your anxiety.

6.) Yoga. Yoga is an ancient practice that combines the best of both physical exercise and conscious breathing during a series of poses that range from gentle to strenuous. A small but growing body of evidence indicates that, when practiced regularly, it can help reduce the physical stress response (heart rate, blood pressure) and lessen symptoms of anxiety and depression to a noticeable degree.

7.) Acupuncture. Though less firmly in the "mainstream" than other items on this list, there is a good deal of support for the idea of acupuncture as an effective method of decreasing anxiety. In addition to its value as an integral part of traditional Chinese medicine for 5,000 years, scientific studies have shown that it is helpful in promoting blood flow throughout the body and encouraging relaxation, as well as releasing the same endorphins that cause people to feel good while exercising.

8.) Herbal remedies. It may seem a sleight of hand to include herbs on this list since they can be considered a "drug" in their own right, especially when consumed in a processed and commercialized form, but since they are not a routine part of the drug approach to anxiety relief they may be worth a mention. One plant in particular, kava, has done well in clinical trials and may be proven helpful. Ginko Biloba, which has been used in Chinese medicine for thousands of years, has some promising research behind it as well.

9.) Massage Therapy. Besides feeling great and reducing muscle tension, Swedish Massage Therapy has been shown to reduce cortisol and arginine-vasopressin, both stress hormones. These hormones are supposed to be elevated in response to acute stress, but in those suffering from anxiety they are chronically elevated.

10.) Spirituality and caring people. For many, yoga, meditation, or enjoying a sunset is sufficient spirituality, but for those who are in touch with the Almighty in a religious sense, prayer can be a wonderful tonic. People who pray regularly tend to live longer and have less chemical dependence and chronic disability than those who don't. Also, reconnecting with family and friends or volunteering for a charitable cause means giving back to the world while doing something healing for yourself. Let a friend or family member talk to you or give you a good hug. It helps.


Take-Home Message: While anti-anxiety medications have a legitimate place in psychiatric treatment, it's reasonable to question whether they should be the first (or only) line of defense when a variety of less intrusive non-drug alternatives exist. Pills work (and I support good pharmacological care), but just know that there are other ways to go.

So, if you're struggling with anxiety-related issues, consult with your doctor and get the best care that you can. Even if medication is prescribed, consider some of these suggestions.

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