Anxiety and Stress Protocol


Anxiety and stress are two of the most common types of mental disorders in the United States. The National Institute of Mental Health reports that 19 million Americans per year are afflicted by these illnesses (Narrow et al. 1998). Frequently, they coexist with depression, eating disorders (obesity, bulimia, and anorexia), and substance abuse. In 1990, the direct and indirect costs of these debilitating conditions to the American economy were more than $46 billion. In Britain, the Office of National Statistics reported that approximately one in seven adults has some form of diagnosable mental disorder, with anxiety being the most commonly reported complaint. Conditions associated with anxiety and stress include depression, phobias, and chronic fatigue. Furthermore, accumulated stress and anxiety can predispose patients to medical conditions such as chronic headaches, hypertension, ulcers, and heart disease. Some physicians estimate that stress and anxiety may be a contributing factor in 90% of all illnesses.

Anxiety Disorders

Anxiety disorders are illnesses that cause people to feel frightened and apprehensive for no apparent reason. These conditions are often related to the biological and psychological makeup of the individual and may be familial in nature. If untreated, these illnesses can significantly reduce productivity and inhibit a person's ability to function in daily life. There are five types of anxiety disorders. Many individuals may have more than one type, making then especially difficult to treat.

Women also tend to suffer from these illnesses more than men. Approximately twice as many females have panic disorder, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia (fear of open places or public situations), and other specific phobias. About an equal number of men and women are diagnosed with obsessive-compulsive disorder (OCD) (Bourdon et al. 1988; Robins et al. 1991; Davidson 2000).

Panic Disorder
This disorder is characterized by repeated episodes of intense fear that appear suddenly, often without warning and with varying frequency. Symptoms of panic disorder include chest pains, heart palpitations, sweating palms, dizziness, shortness of breath, a sense of unreality, or an uncontrollable fear of death. Panic disorder affects between three and six million Americans and is twice as likely to occur in women. Onset may occur at any age but generally begins in early adulthood.

Obsessive-Compulsive Disorder (OCD)
OCD is characterized by anxious thoughts and uncontrollable ritualistic behavior: obsessions are the anxious thoughts and compulsions are the rituals used to dispel those thoughts. An example of an obsession would be cleanliness and fear of germs. The compulsion associated with this obsession would be excessive hand washing. No pleasure is derived from performing the rituals; rather, the rituals provide only temporary relief. OCD appears to afflict men and women equally, and approximately one in fifty people may experience some sort of obsessive-compulsive behavior. Onset is typically in early adulthood, although it may occur in childhood or adolescence.

Post-Traumatic Stress Disorder (PTSD)
Common in those who have served in combat, PTSD is a debilitating illness that can result from a traumatic event. Originally defined as battle fatigue or shell shock, this disorder can be precipitated by any traumatic life event such as a serious accident, crime victimization, and natural disasters. People diagnosed with PTSD may relive the event in nightmares or have disturbing recollections of it during waking hours. Ordinary events can trigger flashbacks that may result in a loss of reality, causing the person to believe the event is happening again. PTSD may occur at any age, and although the course of the illness is variable, it can become chronic.

Phobias
These are seemingly inexplicable fears that may be either specific or social in nature. Specific phobias are irrational fears of certain things or situations such as heights; certain animals; or closed-in places, which is known as claustrophobia. This type of phobia may affect one in ten people. Currently, there are no medications for specific phobias. Social phobias are an intense fear of humiliation in a public situation and may be characterized by a feeling of dread beginning weeks in advance of a social event.

Generalized Anxiety Disorder (GAD)
Similar to agoraphobia, which is a fear of open places, GAD is much more serious than the daily anxiety most people feel. It is chronic, excessive worrying about health, personal finances, work, and family. GAD is characterized by difficulty sleeping, trembling or twitching, lightheadedness, irritability, muscle tension, headaches, and other symptoms. Depression may accompany the anxiety. The onset of GAD is gradual, generally occurring in childhood or adolescence, although adult onset is not uncommon. GAD occurs more frequently in women and may be familial in nature.

Stress

Stress is a psychological and physical response to the demands of daily life that exceed a person's ability to cope successfully. Stress is often characterized by fatigue, sleep disorders, irritability, and constant worrying. Depression often accompanies stress. The accumulated effects of stress may lead to more serious medical problems. Stress may be work-related or may stem from personal problems, such as divorce, family conflicts, or financial concerns. Often stress results from a combination of these.

Too much stress is not good and sustained stressors often cause adverse effects. There is ample evidence that living a highly stressful lifestyle damages the heart, raises blood pressure, and can contribute to digestive problems. Not surprisingly, stress can also be damaging to the brain, even leading to premature brain cell aging (Uno et al. 1994; Sapolsky 1996a, 1996b; Lombroso et al. 1998). Most people are familiar with the adrenaline rush response to an emergency. The heart pounds, the muscles constrict, and the lungs expand; and while this is happening, we are capable of greater than normal strength and speed. This response is the body's way of rescuing itself when faced with an emergency. We don't have to think about it to make it happen. It's automatic.

The same can be said of the stress response. Whether we're stuck in traffic, about to give a speech in front of a group, or sitting in the waiting room at a doctor's office, the human stress response happens automatically. The difference between the two is that the adrenaline response in an emergency starts and resolves itself quickly. The response to being stuck in traffic may not. The adrenal glands, located above the kidneys, secrete adrenaline until the emergency passes. Then the body returns to its normal function. However, the stress response is more complex and can last longer. Studies have shown that long-term, chronic stress may cause neural damage (McEwen 1991, 1997, 1999, 2000; Uno et al. 1994; McEwen et al. 1997). Just as prolonged increased levels of adrenaline result in adverse physiological effects, it has been less appreciated that excessive stress can also compromise the nervous system. Lombroso et al. (1998) reviewed the mechanisms by which stress impaired and contributed to brain aging and cognitive impairment.

As stated earlier, physical stress and psychological stress set off a chain of events in the brain and body. Adrenaline is released for quick energy to the muscles. More importantly, a small part of the brain, the hypothalamus, sends a signal to the pituitary gland to start adding a hormone called corticotrophin into the bloodstream. In turn, corticotrophin tells the adrenal glands to release other stress hormones--the glucocorticoids.

In the short term, glucocorticoids are beneficial to the body. Glucocorticoids electrify the hippocampus--the part of the brain related to memory--helping you remember stressful encounters, so you can deal with a similar situation the next time it occurs. This sharpening of memory explains why so many people vividly remember where they were when a certain terrible events occurred, such as the Challenger explosion or John F. Kennedy's assassination. After glucocorticoids flood the bloodstream, the hippocampus signals the hypothalamus to stop releasing corticotrophins, ending the stress response.

However, in those individuals who repeatedly experience stress, this feedback loop degrades. Memory worsens, energy levels diminish, and other health problems emerge (McCraty et al. 1998). The stress response turns on, but does not automatically turn off. A few days of exposure to high levels of stress hormones can weaken hippocampal brain cells, leaving them more likely to die if oxygen is interrupted, such as in a stroke (Lombroso et al. 1998).

Weeks of exposure can wither connections between neurons. Studies on rats indicate that continued stress will eventually destroy brain cells in the hippocampus. The good news is that alterations in dentritic atrophy can return to normal when stress is removed (Sousa et al. 2000). The key is to learn how to deal with daily stress to allow the body to return to its normal state (McCraty et al. 1998).

Conventional Treatments for Anxiety and Stress

Conventional treatments for anxiety and stress include psychotherapy and medication. There are two types of psychotherapy: behavioral therapy and cognitive-behavioral therapy. Behavioral therapy uses several techniques such as diaphragmatic breathing and exposure therapy. Diaphragmatic breathing teaches people how to control anxiety by taking slow, deep breaths. Exposure therapy gradually exposes people to whatever frightens them to help them cope with their fears. Cognitive-behavioral therapy. Modification of thinking patterns that control the thoughts and sensations accompanying anxiety is an integral part of this form of therapy.

Two behavioral techniques, "Cut-Thru" and "Heart Lock-In," are designed to teach the elimination of negative thoughts and to promote a sense of well-being. Research by McCraty et al. (1998) examined the effects of Cut-Thru and Heart Lock-In on healthy adults. These techniques have been designed to develop and maintain shifts in dispositional approach to stressors by changing a person's intrepretive style, breaking negative thought loops, and eliminating unhealthy emotional patterns. Since it has been suggested that recurring negative emotional patterns may lead to adverse physiological effects and decreased general well-being through inappropriate activation of the autonomic nervous system and glucocorticoid secretion, the research of McCraty et al. examined the effects of Cut-Thru and Heart Lock-In techniques on emotions, stress, cortisol/DHEA levels, and autonomic nervous system balance in 45 (15 controls) healthy adults.

After 1 month, participants in the experimental group experienced an increase in positive emotions and a decrease in negative emotions. No significant changes were seen in the control group. The experimental group also experienced a 23% reduction in cortisol and a 100% increase in DHEA levels. McCraty et al. suggest that their study establishes that (1) interpretive styles associated with stress and negative emotions can be changed within a short period of time; (2) changed perspectives influence stress, emotions, and important physiological parameters; and (3) people have greater control over their overall health by controlling their conditioned emotional responses than previously thought.

Often-Prescribed Medications
Often psychotherapy is used in combination with medication. Antidepressants are frequently used in combination with behavioral therapy to mitigate anxiety and stress. The two major classes of antidepressants are selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Zoloft, Paxil, and Luvox, and tricyclic depressants (TCAs), such as Elavil and Tofranil. These medications work by inhibiting the reuptake of neurotransmitters, such as serotonin, resulting in the accumulation of these neurotransmitters. Brain chemicals such as serotonin are thought to be low in conditions such as anxiety and depression. Preventing their reuptake by the nerve cells essentially increases the amount of available chemical. Monoamine oxidase (MAO) inhibitors are also used to treat anxiety and function much the same as SSRIs and TCAs. Antidepressants are among the most widely prescribed medications in the United States.

Less frequently, benzodiazepines such as Valium, Xanax and Serax, may be prescribed to treat anxiety, but they are highly addictive agents that can cause depression if overused. Worse than addiction is the tolerance effect that causes patients to take increasing quantities of the benzodiazepine until the drug stops working altogether. Tolerance to benzodiazepines can occur in as little as a few weeks. Withdrawal symptoms can include hyperanxiety, confusion, anorexia, shaking, memory loss, and reemergence of the original symptoms. There are alternatives to these medications. Doctors sometimes prescribe the beta blocker propranolol (Inderal) to counter performance anxiety. It works by blocking certain actions of the sympathetic nervous system, the part of our chemical make-up that causes us to feel stress. This reduces sensations of anxiety such as racing pulse, speeding thoughts, hand tremors, and nervousness. Potential side effects include slow pulse (less than 50 beats per minute), drowsiness, fatigue, dry mouth, numbness or tingling of fingers or toes, dizziness, diarrhea, nausea, weakness, and cold hands and feet.

Diet
Eating a variety of whole foods will replenish nutrients essential to a healthy nervous system. Some people have hypoglycemia, which are bouts of low blood sugar that can feel much like an anxiety attack. Eating small frequent meals can help, as can avoiding simple sugars (like candy), which produce a blood sugar rush, followed by a nerve-racking bottoming out.

Avoid Stimulants
Many anxious people are sensitive to caffeine. Try to wean yourself off coffee, tea, and anything else containing caffeine, or switch to noncaffeinated varieties of these beverages. Chocolate and herb guarana also contain caffeine. Other stimulants will also produce unwanted anxiety, such as ephedra or ma-huang. Avoid these substances unless directed by a physician.

Supplements
Deficiencies of many vitamins, minerals, amino acids, and fatty acids can imbalance the nervous system. You can take a high-quality multivitamin and mineral formula and consider adding a B-complex supplement along with extra calcium and magnesium at a one to one ratio. This will ensure you are getting enough of these essential nutrients you may not be receiving from your diet alone.

One daily tbsp of flaxseed oil can boost your essential fatty acids or you may choose encapsulated omega-3 oils.

Get Enough Sleep
Of course, this seems like common sense, but studies demonstrate that the consequences of not getting enough sleep are anxiety and irritability, along with a host of other unpleasant side effects. To cope with this, follow a few simple suggestions. The condition of insomnia is examined in great deal in the Insomnia protocol of this book. In summary, try to make your bedroom a place only for sleep. Do not read, eat, or watch TV in the bedroom. This will help train your body to prepare for sleep the moment you lie down. Also avoid stimulating activities before going to bed, like reading a book, or exercising. Some dietary supplements that are helpful in establishing sleep are melatonin and . And although alcohol is technically a depressant, it can greatly interfere with your sleep patterns. Avoid alcohol and cigarettes before going to bed.

Exercise Regularly
Exercising 10 minutes before bedtime is obviously not a good idea, but setting a time of day for regular physical activity is good for your body in many ways, including establishing a normal and healthy sleep pattern (Salmon 2001). It gets you out of your head, releases pent-up emotion, and afterward leaves your muscles toned and relaxed. Pick an activity that you enjoy, so that exercising becomes less of a chore and more of an enjoyment. Try walking, swimming, bicycling, jogging, yoga, tai-chi, skiing, and tennis; even golf burns calories. Interestingly, a study found that leisure-time physical activity buffered people against physical symptoms and anxiety associated with minor stress. What mattered wasn't the person's level of aerobic fitness, but simply the regular participation in an enjoyable physical activity (Carmack 1999). Another study found that although light-intensity exercise lowered anxiety, high-intensity exercise intensified feelings of anxiety (Katula et al. 1999). Some people feel it is necessary to work themselves practically to exhaustion while exercising, while the research indicates that light-impact exercise on a regular basis is actually more effective. As in all things, moderation is the key.

Take a Break
For some people, life tends to go nonstop. Find some way to give the body and mind a break. Light a candle, stare at the aquarium, play with your dog, go for a walk, smell a rose, soak in a warm bath, take a nap, or reward yourself with a massage--anything to break from the relentlessness of your routine.

Massage Therapy
This ancient practice relaxes the body, promotes circulation, and helps you identify and release tense muscles. When your muscles are relaxed, it's hard to maintain an anxious state of mind. In one study, 26 adults were given a chair massage, two times a week for five weeks. A control group simply relaxed in the chair, without receiving a massage. Compared to the control group, the massage group had reduced anxiety, decreased salivary cortisol levels (a measurement of stress), lowered job stress scores, increased EEG patterns consistent with relaxed alertness, and increased speed and accuracy on math tests (Field et al. 1996). Massage also reduces the anxiety, depression, and pain associated with premenstrual syndrome (Hernandez-Reif et al. 2000).

Aromatherapy
Studies on the use of aromatherapeutic massage show it has a mild, transient anxiety-reducing effect (Cook et al. 2000). Aromatherapeutic massage involves adding 10-12 drops of essential plant oil to 1 oz of carrier oil such as almond oil. Calming scents include lavender, neroli, lemon balm, chamomile, geranium, and clary sage. You can also add 10 drops of an essential oil to a warm bath. The benefits aren't sufficient to cure anxiety or stress alone, but regular massage is a good way to relax and reduce stress.

Center Your Mind
Meditation relaxes body, mind, and spirit. A variety of techniques can induce a meditative state: silently repeating a mantra or a prayer, gazing at a lit candle, or focusing on your breathing. Research confirms that two types of meditation can relieve anxiety: Transcendental Meditation (TM) and mindfulness. TM is a simple and effortless way to quiet the mind and deeply relax the body. In a nutshell, you sit in a comfortable position with eyes closed and silently repeat a mantra (a meaningless, simple sound). Ideally, do this for 15-20 minutes morning and evening. Research shows that other benefits of this type of meditation include reduction in blood pressure, pain, and insomnia.

In one study, a group of 83 African-Americans were assigned to learn (1) TM, (2) progressive muscle relaxation, or (3) cognitive behavioral strategies. At follow-up testing one year later, both the meditation and the progressive muscle relaxation groups showed significant increases in overall mental health and decreases in anxiety (Gaylord et al. 1989).

Mindfulness is an ancient Buddhist meditation practice with a goal of full awareness of the present moment, without becoming distracted by thoughts of the past or future. In theory, this sounds simple; in actuality, maintaining this state of mind requires effort and discipline. As noted earlier, the results of McCraty et al. (1998) suggest that people do have greater control over their overall health than previously recognized and that they can learn techniques to "reprogram" how they respond to situations so that they experience lower stress levels, fewer negative emotions, and an increased positive lifestyle. Kabat-Zinn (1990, 1994), author and the founder and director of the Stress Reduction Clinic at the University of Massachusetts Medical Center in Worcester, has conducted studies showing that mindfulness meditation can reduce stress and anxiety.

In 1992, he showed that a mindfulness meditation program reduced anxiety and panic in people with generalized anxiety disorder, panic disorder, and panic disorder with agoraphobia (Kabat-Zinn 1992). In 1995, Kabat-Zinn and colleagues followed up on this original group of 22 patients and found that the majority of them continued the meditation practice and that it had long-term benefits in reducing anxiety and panic attacks (Miller et al. 1995). Shapiro et al. (1998) found that mindfulness meditation reduced stress and anxiety among premedical and medical students.

Breathing
This is the one involuntary body function you can consciously control. The first step is to simply bring your breathing under control:

Exhale completely.
Then slowly take a deep breath in through your nose.
Expand your diaphragm/belly to bring air into the lower portion of your lungs.
As you gradually fill your lungs from bottom to top, expand your chest.
Even lift your shoulders for a last bit of fresh air
Then relax and let the air flow smoothly out of your body.
Pull in your stomach at the end to expel the last bit of stress.
Then begin another breath.
Allen Elkin, program director of New York's Stress Management and Counseling Center, recommends the following breathing technique for rapid relaxation:

You take a deep breath, deeper than normal, and hold it in until you notice a little discomfort. At the same time, squeeze your thumb and first finger together (as if you were making the okay sign) for six or seven seconds. Then exhale slowly through your mouth, release the pressure in your fingers, and allow all your tension to drain out. Repeat these deep breaths three times to extend the relaxation. With each breath, allow your shoulders to droop, your jaw to drop and your body to relax.

Other Relaxation Techniques
Aside from meditation and massage therapy, experience and research show that listening to music, visual imagery (sitting quietly and imaging peaceful scenes), muscle relaxation, biofeedback, yoga, tai chi (a form of moving meditation), and even social support sessions can all decrease symptoms of stress and anxiety (Jin 1992; Field et al. 1997; Malathi et al. 1999).

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These statements have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease