Peace of mind
If you always feel anxious and stressed, you may have Generalized Anxiety Disorder. Here's how to reclaim a sense of calm.
By Ben Kallen
Two weeks after the World Trade Center was destroyed, Lisa Miller (a pseudonym) began experiencing intense anxiety symptoms. "I went to work, and though I was functional, I was constantly exhausted," the 39-year-old finance manager recalls. "I'd get an anxious thought in my head, and it would get out of control and trigger a panic attack." She eventually left New York for a new job near Durham, N.C., hoping to find calm in a new setting-but the anxiety followed her.
Calm Your Mind
Most stress-reduction techniques will help relieve moderate anxiety, says Edmund J. Bourne, Ph.D., a psychologist practicing in Hawaii and California and the author of Natural Relief for Anxiety (New Harbinger Publications, 2004). This can include abdominal breathing, yoga, tai chi, guided visualizations, or even just taking a break two or three times every day to relax, take a walk, or imagine yourself in a peaceful place.
Relax Your Body
By combining physical relaxation with controlled breathing, yoga can help you deal with both physical and mental stress. A recent study by the Boston University School of Medicine found that any variety of yoga practice may increase brain levels of the neurotransmitter gammaaminobutyric acid (GABA), which is associated with relaxation and lowered anxiety. Magnetic resonance imaging showed a 27 percent increase of GABA in the brains of experienced practitioners following an hour- long yoga session, versus no increase in a group that simply read for an hour. The 2007 study, published in the Journal of Alternative and Complementary Medicine, looked at the effects of yoga on eight practitioners, versus 11 people in the control group.
Thinking Things Through
"For the past 20 years, the standard treatment for all anxiety disorders has been cognitive-behavioral therapy," says Bourne. The term refers to any therapies that teach you how to think more realistically-so fearful thoughts don't build into anxiety. While some psychologists view long-term talk therapy as a more effective solution for deep-seated issues, cognitive-behavioral therapy is most commonly recommended for GAD.
Conquering your anxiety symptoms can be a huge relief. But to be sure they don't come back, Bourne says, it may be helpful to go deeper. "After treating the symptoms, you should look at the underlying causes. And if you have interpersonal problems with your significant others, that might also contribute to anxiety." In addition to cognitive therapy, traditional psychotherapy or family counseling can help with this.
The Anxiety Drugstore
If your symptoms feel overwhelming or are impairing your ability to function, you may need to complement natural treatments with prescription medications. The following drugs are currently available.
While almost everyone feels anxious from time to time, when you worry excessively for six months or more, you may be suffering from Generalized Anxiety Disorder (GAD). Other symptoms can include difficulty relaxing or sleeping, fatigue, headaches, muscle tension, irritability, sweating, nausea, light-headedness, frequent bathroom trips, feeling out of breath, and even hot flashes. It also can be associated with social phobia, depression, or substance abuse. While experts believe GAD may have a genetic component or stem from childhood fears or restrictive parents, the symptoms can be triggered by trauma-like many New Yorkers at the time, Miller felt profoundly affected by the attacks of 9/11-or a difficult life event such as a divorce or a death in the family.
Anxiety is usually accompanied by a heightened state of arousal-the nervous system is constantly over-activated, even when there's no external reason for it. "In the presence of a threat, your body will naturally click into the fight-or-flight response," notes Jeffrey Brantley, M.D., founder and director of the Mindfulness-Based Stress Reduction Program at Duke University's Center for Integrative Medicine in Durham, which offers an eight-week stress reduction course. "Your body can't tell if the threat is outside or inside your head. So if you have a threatening story going on in your own mind, your body will go into the same fear reaction, and you'll feel anxious."
GAD affects almost 7 million Americans-and around twice as many women as men. (This may be because of interactions between sex hormones and brain chemistry, or because women are more likely to have suffered abuse as children.) And a study published earlier this year at the Indiana University School of Medicine by Kurt Kroenke, M.D., found that 7.6 percent of all patients who see a primary care physician have GAD. If your own anxiety is ongoing and affecting the way you live your life, it's important (and possible) to get relief.
Most stress-reduction techniques will help relieve moderate anxiety, says Edmund J. Bourne, Ph.D., a psychologist practicing in Hawaii and California and the author of Natural Relief for Anxiety (New Harbinger Publications, 2004). This can include abdominal breathing, yoga, tai chi, guided visualizations, or even just taking a break two or three times every day to relax, take a walk, or imagine yourself in a peaceful place.
Mindfulness-based meditation, which has proved especially helpful in reducing anxiety, is now being taught in many hospitals and health centers across the country. Studies have found that, among other benefits, it can lower breathing rate, reduce levels of the stress hormone cortisol, and increase activity in the left frontal area of the brain, which is associated with a positive mental state and lowered anxiety levels. In fact, a recent Canadian study of cancer patients who participated in a mindfulness-based stress-reduction program found that levels of cortisol and pro-inflammatory chemicals continued to drop for six months to a year afterward.
Mindfulness practice also helps you notice your thoughts and feelings without judging them. "Mindfulness means accepting whatever you may notice around you and not trying to analyze it," Duke University's Brantley says.
After she left New York for North Carolina, Miller discovered the Duke Mindfulness program and found it to be invaluable. She attended group sessions and learned how to practice the meditations. The time she spent paying attention to her breathing or visualizing something peaceful improved her concentration at work and allowed her to reduce her dose of anti-anxiety medication.
The basics of the meditation (listening to your breath or paying specific attention to various parts of your body) are simple and can be learned from books—such as Full Catastrophe Living (Delta, 1990) and Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life (Hyperion, 2005), both by Jon Kabat-Zinn, Ph.D., founding director of the Stress Reduction Clinic at the University of Massachusetts Memorial Medical Center. "The important thing is to make mindful practice a part of your life so you'll be prepared when a stressful situation arises," Brantley says.
Relax Your Body
By combining physical relaxation with controlled breathing, yoga can help you deal with both physical and mental stress. A recent study by the Boston University School of Medicine found that any variety of yoga practice may increase brain levels of the neurotransmitter gammaaminobutyric acid (GABA), which is associated with relaxation and lowered anxiety. Magnetic resonance imaging showed a 27 percent increase of GABA in the brains of experienced practitioners following an hour- long yoga session, versus no increase in a group that simply read for an hour. The 2007 study, published in the Journal of Alternative and Complementary Medicine, looked at the effects of yoga on eight practitioners, versus 11 people in the control group.
"People with anxiety often have chronic physiological tension in the body, and contracting and releasing muscles can help that," says Bo Forbes, founder of the Boston-area Center for Integrative Yoga Therapeutics. "At the same time, yoga requires mindfulness, which can break the pattern of ruminative thinking." Restorative yoga, in which the body is partially supported by props such as pillows or blankets, is especially helpful in calming the brain and the body, says Forbes.
The practice worked for Ellen Cooper (a pseudonym), a 34-year-old money management executive near Boston whose severe anxiety was triggered by the combination of a stressful job, a divorce, and the loss of a family member, all within one year. She was taking an antidepressant and anti-anxiety medication when she began doing restorative yoga. "From the very first session, yoga allowed me to find the time and space to work through the sadness and find inner peace," she says. After a year of practicing almost every day, either in the studio or at home, she now does restorative yoga regularly, once or twice a week, and has gone off her medication.
Thinking Things Through
"For the past 20 years, the standard treatment for all anxiety disorders has been cognitive-behavioral therapy," says Bourne. The term refers to any therapies that teach you how to think more realistically-so fearful thoughts don't build into anxiety. While some psychologists view long-term talk therapy as a more effective solution for deep-seated issues, cognitive-behavioral therapy is most commonly recommended for GAD.
"What we think about an event affects our feelings more than the event itself," Bourne says. Constant worry can increase your physical symptoms, which in turn can bring about even more worry.
In cognitive-behavioral therapy, you examine the thoughts that underlie those feelings and determine whether or not they really make sense. If not, you can replace them with more realistic thoughts. For instance, you might think, "I am in danger" while walking on a crowded street; the therapist would help you see the situation more clearly, so you instead think something like, "Realistically, the thing I'm most afraid of isn't likely to happen." Therapy sessions are combined with "homework" such as keeping track of your moods and challenging your negative thoughts during the week. The treatment can last from six weeks to several months, with "booster sessions" recommended afterward.
Changing Your Life
Conquering your anxiety symptoms can be a huge relief. But to be sure they don't come back, Bourne says, it may be helpful to go deeper. "After treating the symptoms, you should look at the underlying causes. And if you have interpersonal problems with your significant others, that might also contribute to anxiety." In addition to cognitive therapy, traditional psychotherapy or family counseling can help with this.
You can improve your life further by living in a way that is less stressful. "Allow yourself time for rest, being with loved ones." If you do that, Bourne adds, you'll have less to worry about and more to enjoy.
The Anxiety Drugstore
If your symptoms feel overwhelming or are impairing your ability to function, you may need to complement natural treatments with prescription medications. The following drugs are currently available.
Selective Serotonin Reuptake Inhibitors (SSRIs) are antidepressants that increase brain levels of the calming neurotransmitter serotonin . They include Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline). "Depression and anxiety often go together, and SSRIs can be effective for both," says Mark Goulston, M.D., a psychiatrist in Los Angeles and author of Post-Traumatic Stress Disorder for Dummies (For Dummies, 2007). Side effects, which are often temporary, can include stomach upset, sleep problems, weight gain, and sexual dysfunction.
Tricyclic Antidepressants (TCAs) such as Tofranil (imipramine) and Elavil (amitriptyline) are also prescribed for anxiety. They affect a wider range of neurotransmitters than the newer SSRIs but may cause more side effects and are usually prescribed for people who don't tolerate SSRIs well.
Beta-Blockers prevent adrenaline and noradrenaline from stimulating the sympathetic nervous system, resulting in a slower pulse and lower blood pressure. Originally used to treat heart problems, they're now prescribed for occasional anxiety and post-traumatic stress disorder, as well as for stage fright and performance anxiety. Side effects can include dizziness or a tendency toward depression.
Benzodiazepines such as Xanax (alprazolam) and Ativan (lorazepam) are minor tranquilizers that slow the nervous system by modulating gamma-aminobutryic acid (GABA) receptors, and they're frequently prescribed for serious anxiety. While benzodiazepines are very effective, they can be addictive.
Buspirone (sold as BuSpar and other brands) affects serotonin, dopamine, and possibly other neurotransmitters in the brain. It works more slowly against anxiety than benzodiazepines, but it's less likely to cause side effects or addiction. Side effects can include dizziness or nausea.
Herbal Remedies can provide short-term help for mild anxiety but haven't proven effective against GAD. However, if you're uncomfortable taking pharmaceuticals and your doctor doesn't think prescription drugs are necessary, herbs may be helpful in conjunction with other therapies. (Be sure to discuss with your doctor any herbs or supplements you choose to take-they can cause unwanted effects or interact with drugs.) To deal with symptoms of anxiety, Edmund J. Bourne, Ph.D., recommends valerian, passionflower, chamomile, and theanine, the relaxing component in green tea. While there have been questions about the safety of kava, modern supplements made from only the root are safe for occasional use, according to Bourne.
Develop New Habits
You can reduce anxiety with these simple changes, as recommended by anxiety researchers:
- Get Regular Exercise
Any kind of aerobic workout (or aerobics combined with weightlifting) practiced for 30 minutes four times a week will reduce adrenaline and muscle tension, give you more of a sense of control over your life, and naturally take your mind off things that are bothering you. - Eat A Balanced Diet
A sufficient intake of nutrients such as calcium, magnesium, B vitamins, and omega-3 fatty acids (from fish or flaxseed oil) is associated with lower levels of anxiety. - Get Eight Hours of Sleep Every Night
Adequate sleep allows your nervous system to recover and helps your body to produce hormones that mitigate anxiety. - Avoid Caffeine, Tobacco, and Excess Alcohol
All of these can overstimulate the nervous system and affect your sleep. - Watch Your Drug Intake
Various over-the-counter, recreational, and even prescription drugs can cause or worsen anxiety-including certain cold and allergy medications, diet aids, energy supplements, hormones, caffeine-laced painkillers, steroids, asthma drugs, and ADHD medicines. Discuss with your doctor everything you're taking.
