Anxiety is a very real thing. Although it has everything to do with your thoughts and your brain, it's not just something "in your head" that you can easily talk yourself out of. Anxiety is a biochemical reaction to uncertainty, risk, or danger, even when you intellectually understand that there may not be a “logical” reason for such a reaction or perhaps for the intensity of said reaction. Our thoughts, emotions, and physical reactions are all interconnected. When one of them sets off an alarm, the others follow suit. Our survival depends on those three aspects of ourselves working in harmony with each other. So, if you're biochemically reactive brain sends an alarm because it's low on serotonin, then it will spark an emotion of nervousness, anxiousness, fear, or panic, depending on many factors.
Added to that is the fact that life events and stressors can also create anxiety and/or trauma, depending on the circumstances and your perception of the experience(s). When you combine everyday stressors or traumatic events with your natural tendency towards anxiety, you're going to increase your level of anxiety, making it difficult for simply "talking yourself out of it." This is where we going to have to work on specific body relaxation techniques, which when used appropriately and consistently can help adjust the neurotransmitter deficiencies in your brain. That's where practices like yoga, Mindful Breathing or Progressive Muscle Relaxation can be beneficial.
Medication is also a targeted approach to the neurotransmitter/biochemical imbalance. People have different feelings connected with the possibility of adding meds to their “toolbox,” but I would always suggest having a consultation with your medical provider to discuss the approach.
Yoga, meditation, deep breathing, and progressive muscle relaxation imagery may all sound like mushy woo-woo pseudo-psychology, but they really aren't. The research behind the effectiveness of these techniques is solid and plentiful. Consciously practicing relaxation skills trains your mind and creates neurotransmitter "shortcuts" that specifically reduce anxiety.
You can find out more about these techniques simply by googling and checking out the plentitude of free resources available online. There are also DVDs for yoga if you want to do it at home. Here's an article about the proven mental health benefits of yoga: https://www.psychologytoday.com/us/blog/get-hardy/201305/take-stand-yoga-today
For now, though, I’d like to offer a short psychoeducation piece about what is going on in our brains when we’re dealing with anxiety. Some of you may have already gotten this information from me, but a refresher never hurts, either. J
INTRO to Anxiety and Your Brain
Believe it or not, anxiety is a good thing in some situations. In fact, we are all descendants of very anxious people because those were the cavemen that survived. Ha ha ha! I mean, seriously. The risk-takers got eaten by a panther or fell off the cliff or whatever. The anxious folks stayed in the cave and ate berries they already knew were edible. So, anxiety is a genetic trait that we all share, unless we have some kind of mutated gene. Even today, although we don't usually have to run from panthers, we do have to have split second reactions while driving, for instance, or for when the baby starts to roll off the diaper table. Right? In many situations, anxiety is appropriate. But not in every case, obviously, so it might help to understand how anxiety works.
To start with it’s important to understand that the brain has two pathways for anxiety or fear to travel – from the thalamus to the amygdala or from the thalamus to the cortex. Because we’re dealing with two pathways, there will be some differences in treatment approaches, but we will look at those a bit later. Let's start with the amygdala.
Learning about the neuroscience of anxiety, panic, and worry can be really fascinating. I'm not going to get all detailed and scientific, but the short story is that when there is a trigger the anxiety flows into the part of your brain called the thalamus, which is like Grand Central Station. It routes the anxiety to two different places. The first route is going straight to the amygdala, which is a tiny organ in your brain that is responsible for emotions. This route is what I would call fast and fuzzy. It has to be fast because it's a survival adaptation. This is the brain pathways that would protect you if you looked up and saw a panther racing toward you. It's primitive and it does not respond to logic. If a panther is coming at you, you aren't going to be able to reason with your fear. And you wouldn't want to anyway, because what the amygdala does is to immediately prepare your body for the 4Fs-- fight, flight, freeze, or faint. Your body has to respond immediately to the potential danger.
At the same time that the thalamus shoots the igniting spark to the amygdala, it also sends more information over the cortex of the brain, which is the curvy gray part that we usually think of as the brain. This is where the brain can add information to the triggering thought to make better sense out of what might be happening. It's slower than the amygdala because it is gathering information. So, your cortex is what will sort out the fact that the furry black animal racing toward you is a big friendly black lab that wants to kiss your face. (If you're afraid of dogs, this might not help as much but it will still provide you with more information than what you had when you thought it was a panther.) This is the part of the thought process that can and will respond to logic.
So, it might be helpful when we're talking about your anxiety and triggers for you to realize that you're dealing with these two parts of your brain. The amygdala is the part of your brain that responds instinctively and with great intensity to your triggers and, thus, produces panic attacks and high anxiety states. The cortex, which can also be involved in triggering panic attacks, is a slower, more detailed process. It’s the source of worry because your thoughts (arising from and connected to your beliefs) have the capacity to ignite the amygdala also.
That doesn’t seem fair, does it? Your reasoning cortex can’t shut your amygdala down but it can ignite it. Ah, well. So, what does calm your amygdala down? Good question. We will look more at that in the next post. Stay tuned!
More on Amygdala Calming
There are a couple ways to work on calming down the amygdala. Some are more long term, preventative measures and others are in the moment. Long term, preventative methods start with two important health habits: exercise and sleep. Aerobic exercise can calm the amygdala in two ways- in the moment and as a general slow-down of the sympathetic nervous system. During a ramping up of anxiety, aerobics helps complete the circuit, so to speak. Your brain is telling you to run from the panther and when you do aerobic exercise, it tells the brain that you did the thing and it can calm down. Panther problem solved. :) But there are also more general and longer acting results from regular aerobic exercise because it affects a specific kind of serotonin reactor in the amygdala and the endorphins that are released affect the cortex. Lots of good stuff there.
Sleep is another HUGE area that we often completely neglect. I'm terrible at following through with good sleep hygiene as well. The important thing about sleep as far as calming the amygdala is making sure that you're getting enough REM sleep. That's the dreaming state. It's also when memories are solidified and neurotransmitters, replenished. So, it's a very reparative, healing time of sleep. The thing is, the best REM sleep occurs later on in the sleep cycle and if you wake up in the middle of the night, then you end up starting your sleep cycles over from the beginning. 4 hours + 4 hours do not equal 8 hours. They only equal 2 sessions of 4 hours sleep. Kind of a rip off if you ask me, but there you go.
There are also ways of calming down the amygdala during a panic attack. At that time, challenging the thoughts with a previously scripted response will be less than helpful. That's because the amygdala doesn't really listen to the cortex. It doesn't respond the logic. But as I said, there are ways of calming the amygdala that don't involve reasoning with. We'll still need to do cortex work, because even though the amygdala can't (or won't) listen to the cortex, it does watch the cortex for signals of danger. So that's why your thinking can spur on a panic attack (igniting the amygdala) but is ineffective at calming it down. For in the moment calming, the amygdala needs more experiential things like mindful breathing and relaxation or, alternatively, a period of aerobic exercise to complete the loop.
Mindful Breathing
Some excellent methods for promoting relaxation are deep breathing, progressive muscle relaxation exercises, morning prayer and devotions, meditation, and yoga. For Christians or members of other faiths, do you have a regular prayer and devotional time each day? Being intentional about finding quiet, contemplative periods in your day will help you re-center yourself.
Mindful Breathing is a specific breathing technique that helps do a "manual override" of your nervous system. Deep, relaxed breathing helps create a physical state of deep rest that changes your physical and emotional responses to stress (e.g., decreases in heart rate, blood pressure, rate of breathing, and muscle tension). When this happens, your body responds in very specific ways. For instance, your heart beats slower, the oxygen is sent to your muscles and they soften and relax, your breathing becomes slower, your blood pressure decreases, and your levels of nitric oxide increase. All of these things send a message to your amygdala that the danger has passed, and it can stand down. Good stuff there!
It's called Mindful Breathing, also, because it is a way of bringing your attention to the present instead of letting your mind shoot off into the future where all the worries are lurking. (The future is where Uncertainty lives. Regret lives in the past, but that's another story. :) Anyway, Mindfulness is purposely focusing your mind on the Here and Now.
Breathing and Grounding Exercise
Sit in a chair, feet on the ground and hands in your lap. If you are comfortable, close your eyes. If not, just lower them. Let your muscles relax. Concentrate on your breath. Feel it flowing in through your nose. Feel the coolness of it in your nostrils. Feel the warmth as you blow out through your mouth. Follow your breath in and down deep into your lungs. Follow it as it leaves your lungs and exits through your mouth. As you continue to breathe, allow yourself to let comfort and peace flow in on your next breath. Let your worries and fears flow out with your exhale. Comfort and peace in; worries and fear out. As you continue to breathe, turn your focus to your body. Concentrate on where it is pressing against the floor and the chair. Feel the pressure of those contact points. Push your feet against the floor. Settle your backside and the back of your thighs deep into the chair. Press your back against the chair back. Take your time feeling the resistance of your body against these contact points. Then, return your focus to your breath. Let your muscles soften and relax. Feel a sense of connection with yourself and your body.
Rinse and repeat.
Container Exercise
Intrusive worries are exhausting. There is a visualization technique that you might find helpful. It's called the Container Exercise. Find a place to sit down and relax. Take some deep breaths. Ground yourself in the chair and take a few more deep, calming breaths. Then imagine a strong container. It can be whatever you want it to be: a big Acme safe, an old steamer trunk, an armoire, whatever. Really make your container strong and big enough to hold the thing you are worrying or fretting about. Make sure your container has a lock, too. Then picture yourself putting the Worry Thing inside, closing the container and locking it. You can't leave the Worry Thing in there forever -- that would be stuffing your feelings and that never works. So, it's helpful at this point to decide on a time when you can take the Worry Thing out and really look at it. That can be a planning session, a discussion with a person connected to the Worry Thing, or a specific prayer time. The goal here is to recognize that there are times when dealing with the Worry Thing is completely unhelpful to either you or the Worry Thing -- say, 3:00 am or in the middle of a meeting at work. But there are other times when worry needs to be aired out a little. In fact, there are times when worry needs to be faced. Knowing that you will schedule that time will allow you to set the worry aside for those inappropriate or inconvenient times when you can't afford or don't want to ruminate on the Worry Thing. You can't not worry, but you can teach your mind how to manage it in more healthy ways.
Circles of Control and Influence
Another approach to anxiety reduction is to sort out what you can control and that which you can’t. In this exercise, Circles of Control and Influence, you will need to draw out three concentric circles, the smallest in the center, then the next ring, then the last. Make them big enough that you can write legibly in them. The inner circle is the area of life and circumstances that you can control. The next circle is the areas you have influence over, but not complete control. And the outer rim is the areas of things that are just not in your control at all.
For the most part, you are in the very center of control. Now, there may be some aspects that are out of your control, like maybe having some disorder or disease, but how you think about that fact does still lie in the circle of Control. Other people are not in that circle. Not even your own children, if you have them. Other people may exist in the circle of Influence or in the outer circle of No Control. Does that make sense? As you do this exercise, take some time and think about all the things and people in your life and decide where they fall in these three circles. Don't forget to include things of your Inner World, like your depression or anxiety, your attitudes, beliefs, and so on. And then I'd like to know how you felt as you did this exercise. :)