Have you ever suffered from butterflies in your stomach? A feeling of dread? Sweaty palms? Feeling that you are struggling to get a breath? Feeling nauseous? Or a general feeling of being on edge, startling easily?
Most of us have experienced this feeling at some point in our life. Usually brought about by being asked to speak publicly, awaiting a job interview or waiting for life changing good or bad news. It's normal, it serves a function and we wouldn't be human without it.
But what do we do when it's seems to stay? When the feeling appears to come on for no reason and then doesn't leave us?
Anxiety is one of the most common problems in the modern world and one that I regularly come across as a nurse and life-coach. It can be one of the most challenging things to overcome.
Anxiety has a wonderful function - anxiety states are produced by hormones as a result of the inbuilt 'flight or fright' mechanism - to prepare us to - well - fight or run the hell away when there is a reason to do so. Saber tooth tiger? Person from another tribe coming to take your food? (unless you want to share!). Needing a quick reaction to defend yourself - the body is all ready to go - it's the promoting of what they term the sympathetic nervous system - the system that operates (unconsciously) for movement, action, excitement. This basically induces a temporary stress response and the body will react and then right itself as necessary. In short term also helps get our immune system in gear for healing if we get wounded. (A wonderful author about stress is Robert Sapolsky who wrote the book "Why Zebra's don't get Ulcers "- see a great three minute video clip by him here.)
However, the modern world on a day to day basis requires little reason for us to fight or abscond, and although we may need to think quickly on our feet from time to time, the ongoing need for our bodies to be in preparation for urgent action is not necessary. Somewhere along the way, our minds have learned to 'over interpret' possible threats which don't require physical exertion (being late for work, getting yelled at by the boss, a negative upsetting memory) but still cause the same chain reaction in our brain / body.
There are several categories of Anxiety disorders as catergorised by the Diagnostic and Statistical Manual of Mental Disorders (DSM), from a generalised anxiety disorder, to more specific disorders such as social anxiety disorder or OCD. And although anxiety is a natural phenomenon - there are signs to suggest that it might be getting out of hand - and when you should seek help. These include: constantly feeling worried, avoiding social or other situations due to feeling anxious, out of the blue panic attacks, unable to do normal or usual activities or repetitively checking locks, washing hands over and above the need to do so for security and safety, feeling depressed with our anxiety or simply feeling that the anxiety is 'out of control'.
CBT (Cognitive Behavioural Therapy) is recommended to help deal with states of chronic anxiety - but there are a few things you can do to help yourself overcome more mild forms of anxiety.
Helping anxiety with the mind
Even though some anxiety may appear to come out of the blue - chances are - there was a trigger. It could be a thought, a memory or an actual minor event which has triggered the anxious state. It can be helpful to identify and get an understanding of the trigger. Unpacking the trigger may help you understand why the anxiety has occurred in the first place - giving rest to the idea that 'it comes out of nowhere'.
For anxiety around specific events - it can help to ask 'what's the worse that can happen?', and 'what is the likelihood of what I am fearing happening?' - in most cases the worst imaginable isn't that bad, and the likelihood of it happening in the first place is often very unlikely.
Meditation and Mindfulness practice have also been shown to be useful in combating anxiety - bringing yourself back to the present moment - can be enough to allay your fears and help you to feel more in control.
Ground yourself using your five senses. Using a different part of the the brain, can help distract and reduce from the anxiety. So, in the moment - look around you, name five things you can see, five things you can hear, five things you can touch. Connect with these five things.
Mild anxiety (for example for a job interview or meeting new people) can sometimes be lessened with asking yourself "what is perfect in this moment right now" and agreeing to enjoy the process rather than being fixated on the outcome - i.e. whether you will get the job or not, whether the people will like you. Focus on the journey, the getting ready, the actual interacting with people as it occurs - let go of future forecasting the outcome (positive or negative).
Accepting that anxiety is present, having an understanding of what it is (it's 'just' anxiety), can sometimes be enough to allay your fears and help you to feel more in control.
Helping anxiety with lifestyle choices
Keeping steady blood sugar levels will help you to feel less anxious. Having regular meals and avoiding simple carbohydrates such (as sugar, processed foods) can be helpful. Whole carbohydrates and a diets which gives complete nutrition is always good advice to follow, to ensure adequate amino acid and vitamin/mineral intake. Along with that, stop drinking coffee (sorry!) - as caffeine is likely to increase you anxiety levels and while we are at it - avoid alcohol (doubly sorry!) Alcohol does work - but it's a short term fix, is likely to promote dependence and it's really just not that good for you. Research is now also indicating that having good 'gut health' may have an influence on mental health - (see my blog on gut health) so feed your body with good pre-biotic and probiotic foods. In fact this study (small as it is) showed how eating yoghurt appeared to have an impact on brain functioning.
Make sure you are getting adequate sleep (eight hours on average is thought to be best), being tired and irritable is likely to lessen your coping techniques.
Helping anxiety with Techniques
Breathe! The best antidote to shallow breathing and feeling anxious is deep breathing... Most useful are deep relaxing belly breaths. Learn a breathing / relaxation technique which you can employ at any time. Practice belly breathing when you are not anxious - this will make it easy to engage in the necessary technique when you start to feel anxious. In short, slow your breathing right down (don't take big deep forced breaths), focus on slowing (the exhalation especially) down. And breathe through your nose. If you need to count the lengths of your inhale and exhale and extend them by a second or so each breath until you can lengthen it to a comfortable slow long breath.
Regular exercise can help rid the body of the build up in adrenaline and other hormones that are released when you are feeling anxious. Activities such as yoga and tai-chi can be very calming and invoke the parasympathetic (calming) nervous system.
The latest craze of adult colouring in is something that people have found very calming - any activity which promotes 'flow', can be helpful in calming our mind, whether it is a favourite hobby, playing an instrument, sport or something else which distracts our mind and causes us to focus on something we find challenging and enjoyable.
Something that can help stressful and tense situations is humour... although not always appropriate - this can and does release many stressful, tense and anxiety producing situations - see if there is room for a bit of black humour in the midst of the angst.
Supplements can be helpful. Please talk to your medical practitioner to ensure medicines are not contraindicted and do not interfere with medications you are currently taking. There is some evidence (and this may be controversial) that the contraceptive pill depletes that body of specific vitamins - mostly of the B variety, but also magnesium, zinc - which can also lead to altered mood states. It's good to ensure that no medicine that you are currently taking is likely to be causing the anxiety in the first place (doxyclycine for example can have an effect on moods.) Vitamin B12 can also be under-absorbed due to anti-biotics, antacids and anti-epilepsy medications and a depletion in vitamin B12 is associated with anxiety. Some supplements that can be useful therefore are:
- Vitamin B12, B6, Folic Acid and Inositol (All part of the vitamin B- complex).
- Kava (can affect the liver - recommended for short term use only)
- 5HTP & L-tryptophan (not to be combined with SSRI's (anti-depressants)
So, first things first. Have a good look at your lifestyle and what might be contributing to the anxiety (food, medications, lack of sleep, too much caffeine, simple carbohydrates etc). Ensure you have 20 mins exercise every day (yoga, Tai Chi are ideal), learn a deep breathing ('belly' breathing technique), introduce a little self talk (it's OK, it's just anxiety, I am safe) and if necessary take a supplement which might help you rid the anxiety.
If none of these things help - do not hesitate to seek help - a short course of CBT will work wonders and it is something that you can use for life.
Mayo Clinic (website)
Web MD (website)
The Users Guide to the Human Mind - Shawn T Smith (Book)
Arizona Center for Integrated Medicine (University of Arizona) - Introduction to Integrative Medicine for Mental Health (course)
Robert Sapolksy - Why Zebra's Don't Get Ulcers (book)