Wednesday, June 1, 2016

All About Anxiety

It's confusing and frustrating, it can really disrupt everyday life, hinder productivity and accountability, and even damage personal relationships. Maybe you've most often encountered it in discussions about medication, specifically medicinal marijuana, or SSRIs like Zoloft, Prozac, or Lexapro (to name just a few of many).

It's more than just stress. It's anxiety.

You know what it is, you've felt it before and maybe you even live with some type of anxiety disorder: general anxiety disorder, social anxiety, panic disorder... Or maybe you don't personally experience anxiety disorder, but you know someone who does.



In today's post, I'm going to write very frankly about anxiety from my own personal perspective and toss in some scientific research about anxiety and medications. I'll also hand out free unsolicited advice about how to deal with anxiety in yourself and in others. I hope some of this is helpful in creating better understanding about anxiety, and I totally absolutely welcome discussion in the comments!

What to know about anxiety disorder

Let's get warmed up with some quick facts and statistics about anxiety disorder...

  • Anxiety disorder is the most common mental health disorder in the US, affecting about 18% of the adult population according to studies in 2005 (Source: NIMH)
  • Generalized Anxiety Disorder affects 3% of the population (Source: ADAA)
  • Panic Disorder affects 2.7% of the population (Source: ADAA)
  • Women are 60% more likely than men to experience anxiety disorder in their lifetime (Source: NIMH)
  • The average age of onset of Anxiety Disorder is 11 (Source: NIMH)
  • Anxiety is highly treatable and people suffering with anxiety disorders can develop skills to maintain their anxiety through the use of medications and/or therapies 
Takeaways? Anxiety disorder is VERY common, especially among women. It also coincides with typical puberty age, which is notable. If you're experiencing anxiety, there are LOTS of ways to get help including medications, therapies, mindfulness training, and developing a set of tools to use when it's getting to be too much.

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Anxiety disorder is different from normal stress

Everyone in the world experiences stress. It's one of the many important experiences on the whole spectrum of human experiences that has helped keep people alive for 200,000 years. Stress is your body's natural response to potentially dangerous situations, which can include physical danger, emotional danger, and social danger in our modern world. Stress helps you focus on what's in front of you so you can make the best choices. 

But anxiety disorders are different: they take stress above and beyond the normal level. When a person has an anxiety disorder, they may struggle with letting go (still thinking about that weird thing you said two months ago) or feel a high level of stress for VERY long periods of time... like months. Anxiety disorders can also pop up seemingly out of nowhere, when there isn't really something happening right now that's stressful, but you're feeling stressed out anyway.

Anxiety disorders can paralyze people, stop them right where they are and prevent them from moving on.

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What happens in the body during a panic attack/ anxiety attack?

A panic attack, or anxiety attack, is a physical and psychological experience. And it sucks. 

First of all, let's put aside the phrase, "it's just in your head." In fact, let's take it out back and bury it with other ridiculous statements like "not bad for a girl" or "fat-free ice cream". These things don't make sense and we should stop saying them. It's absurd to suggest something isn't real because it doesn't have a physical source and it's "just in your mind." Are memories not real? Things that make you happy/ hungry/ excited/ bored... those aren't real, too? Also, last time I checked, my head is part of my body, so to say something isn't physical because it's in my head is ludicrous. 

Panic attacks can come on at any time, for basically any or no reason. They can happen when you're eating mac and cheese at Panera, writing a blog post, and even when you're sleeping, which is very common. In fact, studies have shown that 50-70% of people who suffer from panic attacks will have at least one while they are asleep (source: Nocturnal Panic Attacks). I can tell you right now that's very understated. My personal experience has been waking up because of a panic attack on average ONCE A WEEK. 

Here is what people commonly experience during a panic attack:
  • headache/migraine
  • shortness of breath
  • tightness in chest
  • "racing" pulse
  • numbness in extremities (fingers, hands)
  • chills
  • intense feeling of foreboding or fear
  • sense of loss of control
  • rumination/ cycling thoughts
General anxiety can also affect digestion and cause stomach problems/ loss of appetite or even trigger food-related soothing/ overeating. And then you get on WebMD (which I honestly don't recommend for someone experiencing anxiety in the moment) and you see a fun list of all the other symptoms of anxiety: Symptoms of GAD

Like I said, this SUCKS.

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Anxiety affects everyday life

Honest story time: I have a stressful job. I love my job, but it stresses me out. I have had days when I've needed to call in sick because of my anxiety. There was one memorable morning when there was a forecast for snow and as I woke up and started planning my day in my head, a level-9000, full-throttle, over-the-top panic attack hit me like Mr. Sandman in Punch-Out. I was freaking out that my then crappy car would crap out on me in the snow and I'm be crap out of luck and stranded somewhere in rural Oregon. My heart was pounding, I was sweating, and I had a loss of time (blacked out). This was a bad one.

There's nothing wrong with taking a mental health day when anxiety or any other mental health disorder is kicking your butt. It happens, it's part of being a human. It's a problem, though, when people start assuming anxiety is "just stress" and don't get treatment or help with it, and they end up calling in sick MANY times because leaving their bed is too terrifying a thought. Just like with any other illness (a cold, the flu, etc.) you would probably take a day off to get well, but if you pretend it's not a problem, never try to get care for it, it's going to be difficult to get better and get back to normal life.

Living with anxiety disorder can also severely affect personal relationships. When you're feeling anxious, you can become irritable and easily overwhelmed. Ever snapped at someone at home, whom you love and maybe they're even trying to do something nice for you, but you're so stressed out about school or work or whatever that you're not being your best self? People can also experience social anxiety, which can cause them to want to avoid friends and family, despite really wanting to hang out. And of course, people living with anxiety can experience such intense fear and shame about their anxiety that their self-image suffers.
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How anxiety is treated

There are a lot of medications and different modes of therapy that have really helped people with anxiety disorders. *Always talk to a doctor or qualified mental health professional before starting ANY medication or therapeutic intervention for ANY mental health disorder*

 I'm not a doctor, and I'm not going to suggest ANYTHING because I'm not a doctor. Here is an abbreviated run down on some of the more common interventions, for information only:

Medications (read more here and here and here):

  • Selective Serotonin Reuptake Inhibitors (SSRIs) - these increase the level of serotonin in the brain which can elevate mood; considered effective interventions for anxiety disorders.
    Brand names: Prozac, Lexapro, Celexa
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) - work just like SSRIs, except they also increase the amount of norepinephrine as well as serotonin.
    Brand names: Effexor, Cymbalta
  • Benzodiazepines - promotes relaxation and reduces muscle tension as well as other physical symptoms of anxiety
    Brand names: Xanax, Klonopin, Ativan
  • Tricyclic Antidepressants - increase serotonin and norepinephrine, and block acetylcholine
    Brand names: Anafranil, Adapin
  • Cannabis - there's not a lot of research to draw reliable conclusions on at this time. Some studies suggest there are receptors in the brains of mice that react to chemicals in cannabis and create a calming sensation; others suggest that the use of cannabis can actually increase anxiety by triggering hallucinations and making sensory intake more sensitive. This is an interesting article with lots of links.
I'll write it again because it's worth repeating: talk to a doctor if you're searching for medications to help with your anxiety or other mental health disorder. DO NOT TAKE MEDICAL ADVICE FROM ANY BLOG. EVER. Even if it's written by your doctor, or by a compelling 30-something woman who pretends to be a unicorn because it makes her feel pretty. 

When considering medications of any kind, make sure you have a clear answer on at least these three questions:
  • How will the medication interact with other medications you're currently taking and your typical lifestyle?
  • What are the short- and long-term side effects of the medication?
  • Does the medication have any risk factor for dependency (i.e. can you become addicted to the medication)?
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Therapy

Go to therapy. Even if you don't think you need to (actually, especially if you don't think you need to). Everyone needs to. Finding the right kind of therapy can be exhausting and disappointing, but it's worth it.

When specifically dealing with anxiety or depression, there are some therapeutic interventions that mental health professionals will suggest:
  • Cognitive Behavioral Therapy (CBT) - "Cognitive behavioral therapy addresses negative patterns and distortions in the way we look at the world and ourselves." (Source: HelpGuide.org) The basic idea here is that thoughts are at the basis of what we feel and experience. And if you can get down to the thoughts and how they affect you in the everyday world, you have a tool to control how you are affected.
  • Acceptance and Commitment Therapy (ACT) - develop skills for accepting situations and events non-judgmentally and while maintaining a sense of "now". Often when a person is experiencing anxiety disorders, they struggle with grounding the current moment, and are focusing instead on what coulda, shoulda, woulda...
  • Dialectical Behavioral Therapy (DBT) - uses strategies for developing mindfulness through individual and group therapy focused on behaviors and identifying the function of those behaviors.
  • Eye Movement Desensitization and Reprocessing (EMDR) - using a guided intervention with a trained professional, EMDR can help people re-frame traumatizing memories or experiences in different context and ease the effect on anxiety. 
The general shared quality of all these therapies is a NON-judgmental approach, which is super important. Modern societies are overly judgmental of people who are experiencing depression or anxiety, as if being full of joy and laughter all the time is not creepy, but should be normal. It's not normal. Feeling anxious and depressed sometimes and happy and silly other times is normal. When looking for support for anxiety, focus on a form of therapy that makes you feel accepted as you are, and meets your needs.

I have personally used EMDR. I admit it's hard. It requires some intentional fluid thinking about memories and that can be tough for someone who, like me, struggles with thinking and talking too much. That's one of the ways I experience my anxiety, too -- becoming overwhelmed with all the thoughts and ideas that buzz around in my head. EMDR has helped me personally discover a lot about myself and the origins of my anxiety.
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Advice for dealing with anxiety

Medications and therapy can be very helpful in the long-run when struggling with anxiety. But when you're in the moment, heart pounding, fingers tingling, blacking out, what should you do? Here are some ideas on simple strategies for dealing with overwhelming anxiety, and they work for people who don't have an anxiety disorder, too!

  • Journal - I am a HUGE fan of journalling. I love to doodle and write and know that whatever I write in my journal is only for me... and for future anthropologists who are researching my very interesting and important life.

    When you journal for anxiety, remember that you can write ANYTHING! You can write about your fears, about your dreams, angry things about people you don't like... WHATEVER! You also don't have to write to make sense. Seriously, forget grammar and spelling, just pick a favorite pen, a comfy spot and go for it!

    If you'd like to try journalling when you're anxious, check out Mari's Journal Writing Power Blog for prompts and ideas.
  • Sensory Intervention/ Care Box - This is my favorite strategy. The whole point of sensory intervention is to refocus on the present moment, bring my mind out of whatever anxious funk it's in and take a moment to chill. It's kind of like getting space from a tough situation, not so that I avoid dealing with whatever is distressing me, but so I can calm down enough to be rational about it.

    Consider the usual 5 senses when using this strategy, and try to think of your favorite ways to stimulate your senses. I like this intervention the best because it allows me to explore things I love and experience them more deeply than usual. I like to keep some of my favorite sensory stimulation items in a box near my bed so they're all ready for me whenever I need them.

    Some ideas:
    • Scent - find a favorite perfume, candle, incense, a shirt that smells like someone you love, flowers, etc. Close your eyes and take slow, deep breaths of the smelly thing and allow your mind to come up with whatever memory or image it will. Try to find different elements of the scent: is your favorite flower kind of *sharp* at the beginning of the scent, but then mellows out? How long does the smell last in your nose?
    • Taste - find something you like to eat, and take small amounts of it. Things like chocolate, dried fruit, cough drops, or gum work really well because they can last a long time on your tongue. Just like with the scent meditation, try to focus all your attention only on what you are tasting. Does the taste change as its in your mouth? Does the food change shape or texture? Bonus points if you can also refocus on any scents from the food you notice. This is a pretty neat guided meditation I've used with groups before: Eating a raisin mindfully
    • Visual - do you have a favorite photograph you love? A special object that you like to admire? Are you into art history and have a small library of art history books in your house like I do? Find something that is pleasing to look at and also somewhat complicated. Try to see everything in the thing. Maybe it's something you've looked at everyday, like a painting in your house, but you've never taken the time to notice the brush strokes that make up waves in the water, or the special colors that blend to make flowers. It's nice to have a book or photo album with lots of images so you can flip around and focus on lots of things.
    • Texture (touch) - try to find things that have interesting shapes or textures for this sensory stimulation. When my sister was a baby, she really liked to rub lace between her fingers as she fell asleep. I find the soft texture of yarn in my fingers as I knit or crochet to be very soothing. Grab a sweater or a stress ball or worry stone you like and close your eyes as you touch it and focus only on how it feels: is it rough, soft, different in different areas? Does it warm as you touch it? How does it feel against your cheek? How heavy is it?
    • Sound - I have a meditation app on my phone that I like to play in groups and I ask all the kids to raise their hands when they can no loner hear it. It's a really calming sound and it helps focus my mind on whatever I'm doing. Some people rely on music to get them through tough times. I've never not felt better after listening to the Beatles. Maybe take the time to make yourself a playlist on whatever device you like to listen to music on, and the playlist can be specifically for songs or sounds you find comforting when you're feeling anxious.
    • Bonus 6th sense! Proprioception (body awareness) - Yes, there is a 6th sense, and no, it's not seeing dead people. It's being aware of where your body is and what it's doing. You can focus on this sense by finding a safe place to stand or sit with your eyes closed and moving your arms and legs carefully. Think about how your body shifts its weight. What do you feel that's different about the air on your hand versus on your face? Can you keep your eyes closed and stretch out a hand, then slowly bring one finger to touch your nose or chin (like you might see in a field sobriety test)?
Extra bonus points if you can focus your attention on one thing that stimulates multiple senses, like an old book that you can feel the rough pages on, look at beautiful pictures or fonts, and smell that musty old book smell. Or a sparkly play-doh (one of my favorites) that also smells amazing and... tastes good (whatever, no one's looking, and it's non-toxic anyway).

Whatever you do, try to focus all your attention on just that one thing or that one sense. This will allow your body to relax and your anxiety and stress levels to even out. It may not work immediately, but it's a good way to retrain your body and your mind to not allow anxiety to drive your actions and thoughts.
  • Safety Plan - A safety plan is a document that lays out ways for you to get help when you need it but are struggling with the right way to get it. This would take some pre-planning, and it includes basic information to help you cognitively understand your experience in an anxiety attack:
    • What causes your anxiety?
      • What thoughts do you think when you're anxious?
      • How does your body feel when you're anxious?
    • What are 3 - 5 things you could do to control your anxiety?
      • What are things you should NOT do? (i.e. hop on FB and look at your ex's page, maybe?)
    • Who are 3 - 5 people you could call or reach out to for support.
It's good to have this safety plan written out and kept somewhere you know where to find it easily.
  • How to help someone else who is experiencing an anxiety attack - So maybe you don't personally experience anxiety attacks, but you know someone who does. And maybe you're not a mental health or medical professional, so witnessing an anxiety attack can be really unnerving and scary.

    STAY CALM.

    That's literally the best thing you can do. One person experiencing an anxiety attack is not helped by another person freaking out. Here are things that do help:
    • Help them deep breathe. Guide them through deep breathing and breathe with them. A nice one to do is "Square Breathing" - trace a square in the air as you and the other person... 
      • Breathe in slowly and deeply for 4 seconds (draw a line going straight up for one side of the square)
      • Hold the breath in for 4 seconds (draw a line going across to make the top of the square)
      • Exhale for 4 seconds (draw a line going down for the other side of the square)
      • Hold the breath out for 4 seconds (draw a line across to where you had started your very first line, to form the bottom of the square)
      • Repeat several times for at least 3 minutes. Don't let either of you pass out.
    • Turn on a show or play them some music to help them get that brain space away from whatever is distressing them.
    • Help them find sensory grounding by giving them a small piece of food they might like, handing them a stress ball to squeeze, or have them hold a toy or ice cube and focus their mind on that.
    • Listen to them and validate their feelings, even if you don't feel the same way. Validation means you can show them that their feelings are real, i.e.: "It makes sense that you're worried about comets plunging to the earth and killing everyone, that would be terrible."
    • DON'T try to argue them out of their anxiety. Believe me, or believe my spouse, arguing with a person on the rationality of their fears WHILE they are experiencing an anxiety attack helps no one. If it's something you have to argue about, do it later, when everyone is calm.
    • DON'T try to resolve their problem. Whatever it is: worry about money, fear of judgement from others, stress about work, etc., don't try to "fix it" for them or make suggestions like "well, what you should do is..." In that moment, the problem isn't the problem, the anxiety is the problem, and it needs to be taken care of first before any rational problem-solving can happen.
    • DON'T tell them to just relax. No one has ever relaxed because someone told them to. That's never happened. Usually people just get more agitated because they feel invalidated and dismissed.
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So that wraps up my exhaustive explanation of anxiety. It's a daily thing for me and for a lot of people... and that's not necessarily a bad thing. I like to remind myself that even the crappy feelings I feel are part of being a human being who has a unique experience of life and the world. No shame, no guilt about it, just acceptance.

Also, I draw comics to deal with my feelings sometimes.

What are your thoughts? What do you like to do when you're feeling anxious? Feel free to add your advice and perspective in the comments!




Sources and further reading



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