First Published Tuesday, 14th October, 2008.

Depression and Anxiety Special Report

Managing Anxiety Without Drugs

Do you worry excessively? Johns Hopkins provides nine strategies to help you take control of your anxiety.

We live in anxious times, full of bad news. We worry about our families, our country, our basic health and safety. But while a little bit of worry can be a good thing — it can steer us away from taking unreasonable risks, for instance — free-floating anxiety can be paralyzing, unproductive, and self-defeating. If you think that you, or someone you love, has an anxiety disorder, then therapy or medication may be in order. But even if you’re receiving treatment, or if you’re bedeviled by garden-variety over-worrying that doesn’t warrant treatment, the following tips may help.

• Anxiety tip #1: Notice and name. The first step is to identify your patterns. What specific triggers are linked to your anxiety? Notice what sets your anxiety in motion, and give it a name. Once you bring it into the forefront of your consciousness, you can begin to make sense of it and then to address it.
• Anxiety tip #2: Develop a plan. Many of us run ourselves ragged by not addressing our worries. One classic example: We’re afraid of getting breast cancer, but we don’t schedule the mammogram — instead, we spin our mental wheels. Write your specific worry down, and then develop a plan to address it. Tackle one or two worries at a time. Once you’ve completed those, go on to the next on your mental list. This task-oriented process can give you a feeling of satisfaction; more importantly, it makes you feel less vulnerable, more in control of your life.
• Anxiety tip #3: Move. Exercise is one of the best self-treatments for anxiety available. It doesn’t matter whether you go for a walk, join a water aerobics class, dance, play tennis — what does matter is that you get regular exercise, at least every other day. In the interim, whenever one of those cycles of ruminative worry hits, even simple activity — minor housecleaning, a few minutes of gardening, some simple stretches, even just getting up and walking around for five minutes — can help jog you out of that negative feedback loop.
• Anxiety tip #4: Breathe. A number of breathing techniques can alleviate anxiety. For one thing, many people find that when they’re anxious, they breathe shallowly, from the upper chest — and when breathing is shallow and fast, the body responds with an increase in heart rate, blood pressure and stress hormones. In bad moments, they might even be holding their breath. Instead, take a few moments and simply notice your breathing patterns. After a few breathing cycles, take a deep breath. Let your belly be soft and relaxed, and breathe from your lower abdomen. Repeat — and use this technique any time you notice that you’re tense or worried.
• Anxiety tip #5: Nurture your spirit. Meditation and prayer trigger the relaxation response, helping calm the mind and body. Even the simplest of prayers or affirmations can help you let go of a worry and put everyday problems into perspective.
• Anxiety tip #6: Reframe your thoughts. Free form anxiety often is triggered or accompanied by a litany of negative internal “chatter.” The good news is, the brain is an adaptive organ, and it is possible to break out of the negative mode. However, it takes patience and persistence. The first step is to notice when the negative labels start bouncing around in your mind. Simply notice that your thinking is following a particular track, in a nonjudgmental manner. Next, learn how to talk to yourself in a constructive and rational manner. What would you say to a dear and beloved friend in this instance? Try saying the same thing to yourself. This process is a hallmark of cognitive-behavioral therapy.
• Anxiety tip #7: Watch the toxins. Many people use alcohol, caffeine, or nicotine as short-term solutions for their anxiety. The difficulty is that self-medicating with these substances only creates more problems in the long run. Break the cycle. Similarly, be careful with comfort food—this is one of those times that too much of a good thing can make you miserable.
• Anxiety tip #8: Don’t watch the news. Use discretion with television, newspapers, and other sources of news. Of course, it is important to know what’s going on in the world, but our current culture—“all news, all the time,” highlighting the latest disaster in endless replays—can easily trigger or feed anxiety.
• Anxiety tip #9: Don’t worry alone. In the absence of realistic feedback, we often can spin some fairly creative doomsday scenarios. If something is troubling you, get the reassurance and reality checks you need. Consult someone you trust—a friend, family member, or a religious advisor, for instance. Anxiety often diminishes when we share our worries, and practical solutions to problems may emerge in the course of the conversation.

Coping With Panic Attacks

Johns Hopkins shares four strategies for managing panic attacks so they frighten you less, are less intense, and occur less frequently.

It comes on suddenly, without warning. Your heart races and pounds in your chest, you sweat, you feel short of breath, dizzy, sick to your stomach, faint even. You fear you’re having a heart attack or maybe losing your mind. You have a distinct feeling of unreality and, perhaps, a desire to run away and hide. You fear you may do something crazy or uncontrollable. Being in the throes of these feelings and sensations is terrifying and profoundly uncomfortable. But within minutes, the symptoms are gone (one way to know you’re not having a heart attack).

You’ve just had a panic attack. And now you live with the fear of having another panic attack, the dread of which can be worse than the attack itself. You may also be blaming yourself for allowing your emotions to run away from you. But the truth is that once a panic attack begins, your body is being held hostage by a cascade of physiological events — starting with the release of stress hormones such as cortisol — that are difficult to reign in. This doesn’t mean all hope is lost.

Why do we panic? Ironically, panic attacks most often occur during non-threatening, normal activities. They can hit when you’re walking down the street, sitting at your desk at work, or visiting with friends. The catch is that for some reason the brain misinterprets the situation as threatening.

Although the setting of a panic attack is usually benign, panic attacks commonly occur during stressful periods of life, such as when someone is getting a divorce, grieving a death, or moving to a new town. Stress, it’s believed, may create a physiological imbalance or allow an underlying genetic predisposition to panic attacks to emerge.

Strategies for Coping With Panic Attacks
If you experience a panic attack, keep these facts and tips in mind, courtesy of Edmund J. Bourne, Ph.D., author of The Anxiety & Phobia Workbook, and Denise F. Beckfield, Ph.D., author of Master Your Panic and Take Back Your Life! Twelve Treatment Sessions to Conquer Panic, Anxiety, and Agoraphobia, to help get you through the episode:

• Remember that a panic attack poses no physical danger. You won’t faint, have a heart attack, lose your balance, fall, suffocate, or go crazy. You will not lose control of your body.
• Recognize and accept your symptoms rather than fight them. Intellectualize the situation by telling yourself that you recognize the symptoms and know they are signs of a panic attack. Though disquieting, tell yourself that the attack will run its course and resolve within a few minutes.
• Learn the early signs of a panic attack. Sometimes you can stop a full-blown panic attack from developing by intervening at the first sign of an episode and focusing on something else besides your body and feelings.
• If a panic attack is under way, interrupt the cascade of panicky thoughts by repeating the words “Stop it!” aloud or silently to yourself. Then shift your focus to deep abdominal breathing to slow your respiration rate and relax your muscles so you can “flow through” the attack.

Seeking Professional Help
An occasional panic attack can usually be managed with the strategies discussed above. However, if you have four or more panic attacks in a month and/or your fear of another attack is disrupting your everyday life, it’s time to consult a mental health professional who specializes in panic and anxiety disorders. Both therapy and medication are effective in managing panic disorder and preventing future episodes.

Could It Be a Heart Attack?
The symptoms of a heart attack are quite similar to those of a panic attack. In both cases, the symptoms appear without warning and can include chest discomfort, dizziness or lightheadedness, shortness of breath, stomach upset, and sweating. But there are a few differences. In a heart attack, chest pain often spreads to the arms (particularly the left arm) or to the jaw, and the symptoms continue for longer than 10 minutes. If in doubt whether it’s a heart attack, it’s best to err on the side of caution: Dial 911 immediately for an ambulance.

Anxious Adolescents Respond Differently To Anxiety Triggers

Brain scans show heightened activity among anxious adolescents exposed to an anxiety-provoking situation when compared with normal controls, according to an U.S. National Institute of Mental Health (NIMH) study published in the November 2008 issue of the Archives of General Psychiatry.

In the new study by Amanda Guyer, PhD., of NIMH and colleagues at Georgia State University, Catholic University, NIMH, and the University of Maryland, 14 adolescents with significant anxiety about social situations and 14 healthy adolescents were told that they were going to participate in Internet chat rooms. Each participant would chat with a peer whom the participant wanted to chat with and who wanted to chat with the participant.

To select those they wanted to chat with, participants looked at photographs of peers and sorted them into categories of less desirable or more desirable. Then the participants were photographed. They were told that the peers would receive their photographs and would find out how the participants rated their desirability. The peers would similarly rate how interested they were in chatting with the participants.

Two weeks later, the participants underwent functional magnetic resonance imaging scans of their brain activity while looking at pictures of the peers they had rated. Participants were asked to describe how they thought the peers rated them in return.

When anxious adolescents were anticipating evaluation from peers whom they had rated as less desirable – an anxiety-provoking situation – their scans showed increased activation of the amygdala, a fear processing, almond-shaped hub deep in the brain. This increase was much greater than that noted in the scans of healthy adolescents anticipating evaluation from peers whom they had rated as less desirable.

The scans also revealed a perturbed engagement of the amygdala and ventrolateral prefrontal cortex, a part of the brain thought to regulate emotion, in the anxious adolescents when compared with the healthy participants. Disturbances in the association between the amygdala and the ventrolateral prefrontal cortex, which is located behind the eyes and the forehead, are thought to influence anxiety.

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Guyer AE, Lau JYF, McClure-Tone EB, >et al. Amygdala and Ventrolateral Prefrontal Cortex Function during Anticipated Peer Evaluation in Pediatric Social Anxiety. Arch Gen Psychiatry. 2008; 65(11):1303-1312.   [Abstract]

Anxiety Network Australia
http://www.anxietynetwork.com.au/

Anxiety Disorders Association of America
http://www.adaa.org/

Agoraphobia & Panic Disorder Recovery
http://www.paniccure.com/

The Anxiety Panic Internet Resource
http://www.algy.com/anxiety/index.php

Mayo Clinic: Panic Attacks & Panic Disorder
http://www.mayoclinic.com/health/panic-attacks/DS00338

Mayo Clinic: GAD
http://www.mayoclinic.com/health/generalized-anxiety-disorder/DS00502

“Agoraphobics Building Independent Lives
http://www.mhav.org/programs.html#ABIL

Canadian Network for Mood & Anxiety Treatment
http://www.canmat.org/

Social Phobia/Social Anxiety Association
http://www.socialphobia.org/

Information for People with Anxiety Disorders
http://msmonarchdancer.googlepages.com/

Social Anxiety Support Board
http://www.socialanxietysupport.com/

E-couch: Self Help
e-couch provides evidence-based information about emotional problems (including depression and anxiety disorders) and teaches strategies that may help you to prevent problems and understand yourself better.
http://ecouch.anu.edu.au/welcome

South African Depression & Anxiety Group
http://www.sadag.co.za/

Latest Research/Articles on Anxiety

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http://aspie-editorial.blog-city.com/emotional_memories_study_provides_insights_into_anxiety_diso.htm

“Anxiety Disorders Linked To High Blood Pressure”:
http://aspie-editorial.blog-city.com/anxiety_disorders_linked_to_high_blood_pressure.htm

“Free Publication Provides Fresh Perspectives on Generalized Anxiety Disorder”:
http://aspie-editorial.blog-city.com/free_publication_provides_fresh_perspectives_on_generalized_.htm