Sunday, December 7, 2008

Anxiety and Icebergs

We are all aware, after being inundated for several years with the story and movie of the Titanic, of the dangers of icebergs. What is seen above the surface of the ocean is not what is dangerous. It is what cannot be seen that causes fear in sailors traversing the colder oceans.

Anxiety is often hard to understand, because what we see above the surface just doesn't make sense. The fears are unreasonable and come at random times. But anxiety is like an iceberg. The fears are based not on what can be seen and understood, but on what is under the surface.

Hi Dr. Judi, I have had a stressful few months and in that time I've had 3 anxiety attacks. I went to my PCP and he wants to put me on Paxil, but after reading all the negative information on the internet I don't want to do that. I have had only one prescription of xanax for the past 8 years and I've used it as needed. What should I do? Also, is anxiety associated with menopause? Thank you

Anxiety is very difficult to work with, but that doesn't mean impossible. Sadly, for the most part, it is treated mostly with medication. Medication may work for a while, but in many cases, over time, the anxiety cannot be completely suppressed by the medication and can possibly become very disabling.

General Anxiety Disorder (GAD)
GAD is characterized by excessive, exaggerated anxiety and worry about everyday life events. People with GAD tend to always expect disaster and can't stop worrying about health, money, family, work or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities and relationships.

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well.

Symptoms of GAD may include:
· Excessive, ongoing worry and tension
· An unrealistic view of problems
· Restlessness or a feeling of being "edgy"
· Irritability
· Muscle tension
· Headaches
· Sweating
· Difficulty concentrating
· Nausea
· The need to go to the bathroom frequently
· Tiredness
· Trouble falling or staying asleep
· Trembling, especially the hands, and twitches, especially of the eyes
· Being easily startled
· Rapid or heavy heart beat and/or chest pain
· Stomach and/or abdominal pain
· Diarrhea

In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder and phobias), suffer from depression, and/or abuse drugs or alcohol, or have other addictions.

Panic disorder is a subset of GAD. It is when the nervous system is flashing danger signals at inappropriate times. Without any provocation, they feel the same emotional and physical sensations they would if their lives were in jeopardy. The attacks seem to come out of thin air, in places where there is nothing to fear. Panic disorder typically begins in the late teen years or early-to-mid twenties, but it is now known to exist in children as well. It involves a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes:
· palpitations, pounding heart, or accelerated heart rate
· sweating
· trembling or shaking
· sensations of shortness of breath or smothering
· feeling of choking
· chest pain or discomfort
· nausea or abdominal distress
· feeling dizzy, unsteady, lightheaded, or faint
· derealization (feelings of unreality) or depersonalization (being detached from oneself)
· fear of losing control or going crazy
· fear of dying
· paresthesias (numbness or tingling sensations)
· chills or hot flushes

The anxiety and fear related to the possibility of having another attack can become debilitating and interfere with normal life.

Now, back to the iceberg. Let's compare the brain to an iceberg. The visible part is the conscious mind, and the invisible part is the subconscious mind, that we don't "see," or have conscious awareness of. The conscious mind is the place that deliberate thoughts and actions come from. The thoughts that we can't control tend to come from the subconscious mind.
When we are born and when we are very young we do not have a well-developed conscious mind. Our subconscious mind is like an open bowl, accepting everything that comes into it as truth: every thought, experience, teaching and belief that is poured into it is accepted as truth. Also, when there are traumatic events, such as abuse, illness, accidents, etc., often a piece of the subconscious mind holds onto that traumatic event as if it is the deciding force of our life.
As we grow and begin to develop our conscious mind, we can overcome some of the illogical beliefs of our childhood. We can see that just because a bully beat me up several times, that the world isn't necessarily full of bullies. We may even forget about the bullies, because they don't bother us anymore. But our subconscious mind still functions from its own truth that a bully could beat me up any time. This is where anxiety comes from. I will often refer to it as the child within, that is stuck in the belief system or trauma it experienced.
Suppose the bully was blond with full lips. There may be someone in our life that is blond with full lips. We may not even think about associating this person with the bully, but the "child" within, or the subconscious mind, will, and may trigger anxiety or a panic attack. Or when life is uncertain, when we don't know what is next for us, the "child" within may be triggered because he was daily terrified and uncertain what was going to happen on his way home from school. Or someone may use the same words the bully did, or have the same look or mannerism, and the anxiety is triggered.
Because our subconscious mind was mostly formed when we were young, our reactions to the unknown triggers are often childish. We get upset at ourselves because we "know better." Why would we be anxious about this? Or angry at that? Like a child, the anxious person often seems very selfish. Their mind loops over and over about their anxieties, and they don't have the capacity to be outward focused. Their fears may rule their minds, and they are unable to deal with the concerns of others. The anxiety is magnified because they see often see how selfish they are being, how they are constantly focusing on themselves, how they are so needy, how they are often difficult to live with, and yet they seem unable to change it.
Traditional treatment is generally a combination of medication and cognitive behavioral therapy. This may be adequate for some people, though not for all. Other therapies, less traditional, may be a combination of multiple therapies. Anxiety caused by post-traumatice stress disorder can often be helped with rapid eye movement therapy (Eye Movement Desensitization and Reprocessing, or EMDR). Phobias are often improved with Emotional Freedom Technique, which involves tapping certain acupuncture points while the person is focusing on their fears.
I use a therapy created by Detriech Klinghardt, M.D., called Applied Psychoneurobiology, to access the subconscious mind and discover where the fears are coming from. We also check for hypoglycemia, which can increase anxiety. We also often use neurofeedback to reduce excessive Beta waves, which are associated with anxiety.
We can't always avoid the icebergs, but when we are aware of what is underneath, we can begin to deal with them. Severe, long-term anxiety may take a year or more to work through, because the brain has established pathways over the years that take a lot of effort to break up and change, so it is important to be very patient with yourself or your loved one as treatment is progressing.
Is anxiety associated with menopause? I'll answer that one soon.
Until we meet again,
Dr. Judi


Karen Ahlstrom said...

I have a Generalized Anxiety Disorder coupled with Depression. Often, when the anxiety is especially bad, people will ask me what I've been worried about. Sometimes there are specific things like job stress or whatever, but if there's nothing in my life that really needs to be worried about, my brain will start inventing things. For instance, all the bugs in the world are conspiring against me, and I fear going into the bathroom because they're lying in wait inside the toilet paper tube or something equally silly. It's really odd how these things manefest, but at least now that I know it's just a symptom, I can treat the actual problem rather than trying to figure out why I have a fear of bugs.

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security1 said...
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security1 said...

Hi, I am trying to find answers about herbal meds. Are there any that will work as well as antidepressants for severe anxiety. I cannot find an anti-anxiety med that doesn't make me sick or extremely tired and I have tried many. But I need something that will reall work, and can't find the right info on herbals. It seems they might not work as well?

Dr. Judi said...

Dear Security1,
Some people do see response to natural therapies for anxiety and some do not. It is very individual. Usually there is not "one" herb or product that makes a difference, but more a combination of products and types of products. Some of the things that help: Bach flower remedies, classical homeopathics, GABA, 5-HTP, L-theonine, L-phenylalanine, SAM-e, St. John's wort, kava kava, valerian, etc. A product from the Pain and Stress Center I like is Anxiety Control, along with Brain Link.

It is important to balance blood sugars. Cut out refined sugars and carbohydrates, and eat a balance of proteins and complex carbs at each meal and snack. Eat a healthy snack every 2-3 hours. It's amazing how much difference this makes for many people with anxiety.

Neurofeedback also helps with anxiety.

But the most important natural treatment for anxiety is to recognize that your symptoms are just anxiety, and change the ANTs about anxiety and the things you are anxious about again and again and again and again. And again and again, until the brain starts to change its habits.

Dr. Judi

security1 said...

Thanks so much! I am trying so hard to find out info on naturals. All I'm doing lately is crying as it is frusteration trying all these meds and now turning into depression. They told me at Pain and stress center that the 5htp in brain control may have the same terrible side effects as the paxil did?? I'm scared of that and I don't know what it is safe to mix together. But I am a mess!!Thanks.

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