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

Trauma and the Brain

True love is often carved into a tree because the scar created in the bark will last forever. A couple can return years later and still find their proclaimed love visible for all to see.

Many of us have scars in our skin from childhood cuts and scrapes, or more serious burns or trauma.

But severe trauma, both emotional and physical, can create deeper scars that change the brain and can create chronic physical and/or emotional problems.

For a long time, scientists considered the brain unchanging after a certain age. However, newer research shows that the brain can create new brain cells and change nerve cell connections up until death. The changes are slower with age, but with the right stimulation changes can take place. This is called neuroplasticity.

When we experience physical or emotional trauma, the neural connections in the brain can change so there is a "brain scar," meaning that trauma becomes imprinted in the brain connections and the emotions and/or body keeps reacting as if it is in that trauma.

Consider the millions of inputs into your high-tech computer called the brain. If any of the imputs are flawed through "scarring" of the nervous system, then some of the output may also be flawed. The output may feel very real, and may even cause physical changes, but it is simply a result of the flawed neural input and output.

With emotional trauma, such as abuse, an accident that causes an acute fear of dying, war experiences, sudden death of a loved one, etc., the brain can go into a pattern that keeps reliving that trauma. Sometimes the reliving can be subconscious, resulting in panic attacks. Other times the person is conscious of constantly experiencing the trauma through thoughts, dreams, or "abreactions," which is a flashback of the trauma that actually feels like the person is experiencing it again. This is called post-traumatic stress disorder, or PTSD.

With physical trauma, such as a painful accident, surgery, or even dental procedures, a very low level pathologic impulse can affect the nervous system, and may reflex out at the same or a different level through the brain and autonomic nervous system. This can result in chronic pain, organ dysfunction, or at times an extreme dysfunction of the sympathetic nervous system called Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS).

"I sprained my ankle Dec. 14, 2007 and was diagnosed with RSD/CRPS. I am now 7 1/2 months post-injury and am dealing with the terrible pain of this condition. I would like to know what you know about this condition. "

RSD/CRPS is a chronic, painful and progressive neurological syndrome characterized by severe burning pain, pathologic changes in the skin, muscle and possibly bone, excessive sweating in the area of problem, tissue swelling and extreme sensitivity to touch. The syndrome usually develops in an injured limb, such as a broken leg, or following surgery. However, many cases of RSD involve only a minor injury, such as a sprain. And in some cases, no precipitating event can be identified. The pain becomes disproportionate to the inciting event. There may or may not be evidence of actual nerve injury. Pain may begin in one area or limb and then spread to other limbs.

Millions of people in the United States may suffer from this chronic pain syndrome. RSD/CRPS affects both men and women, and also occurs in children. It can occur at any age, but usually affects people between the ages of 40 and 60 years. RSD/CRPS appears to involve the complex interaction of the sensory, motor, and autonomic nervous systems, and the immune system. It is thought that brain and spinal cord (central nervous system) control over these various processes is somehow changed as a result of an injury.

Traditional western medical treatment often combines physical therapy to maintain mobility, medications to control pain, nerve blocks to block faulty neurological input, and psychosocial support to learn how to live with chronic pain. There is no belief that RSD/CRPS can be cured, though at times there are spontaneous remissions.

There are many alternative treatments that have been shown to have affect on RSD/CRPS. The most common are oxygenation therapies, such as hyperbaric oxygen treatment, hydrogen peroxide intravenously, and ultraviolet blood irradiation. These therapies seem to calm the nervous system and begin to heal the "scar."

Other treatments include specific frequency input, such as colored light, infrared therapy, low level laser therapy, magnetic therapy, and FMS (frequency specific microcurrent). There are studies that show that these therapies increase healing and often, over time, may even cure the problem.

We also use neurofeedback, which is a form of biofeedback that changes brain wave patterns. We perform a test called a Quantitative EEG (QEEG) which showes where brain wave patterns are abnormal, and use that information to create a neurofeedback protocol to change those patterns, which helps to "remove the scar." For more information go to www.vanguardbiofeedback.com.

If you are interested in learning more about healing emotional scars, click on "comments" below and Ask Dr. Judi!

Until we meet again,
Dr. Judi