How to Stop Wor­ry­ing

What’s nor­mal… and what’s too much

Reader's Digest International - - Front Page - BY SYD­NEY LONEY

STUDY­ING IN HER DORMITORY ROOM alone one evening at the Univer­sity of Vic­to­ria, stu­dent Jill Tay­lor sud­denly felt a tight­en­ing in her stom­ach and found it dif­fi­cult to breathe. “My heart was rac­ing, my vi­sion tun­neled, “she says. “I was scared. I didn’t know what was hap­pen­ing to me.” It was Novem­ber 2006, and the then sec­ond-year univer­sity stu­dent in Vic­to­ria, Canada, phoned for an ap­point­ment with her doc­tor the next day.

He di­ag­nosed her with “test anx­i­ety”, and be­cause she hadn’t been sleep­ing or eat­ing well, he pre­scribed sleep­ing pills. Hav­ing a diagnosis—a name she could give to her fright­en­ing episodes of anx­i­ety—and the med­i­ca­tion helped Jill.

For the next years, she pushed her­self through univer­sity, grad­u­a­tion, get­ting a job, fall­ing in love and get­ting mar­ried. For a time, things seemed to be on a more even keel. But she con­tin­ued to suf­fer un­man­aged and fre­quent anx­i­ety at­tacks—most of­ten when faced with tests of any kind, talk­ing on the phone, and thoughts of the fu­ture.

Then Jill fell into a se­ri­ous de­pres­sion brought on by her con­tin­ued and un­ad­dressed anx­i­ety. She could no longer func­tion: she quit her job, stopped go­ing out and re­treated into a shell.

Fi­nally, urged by her wife to seek help, Jill went to see her fam­ily doc­tor in Van­cou­ver where she now lived. Her doc­tor re­ferred her to a psy­chi­a­trist at the Mood Disor­ders Clinic of B.C. There, fi­nally, in June 2014, Jill re­ceived an ac­cu­rate diagnosis—she suf­fered from a Gen­eral Anx­i­ety Dis­or­der (GAD). With this diagnosis in hand, her doc­tor pre­scribed some anti-anx­i­ety med­i­ca­tion and en­cour­aged her to find a qual­i­fied per­son with whom she could work to help man­age her dis­or­der.

GAD IS A CON­DI­TION char­ac­ter­ized by per­sis­tent, ex­ces­sive worry—even when there’s noth­ing con­crete to worry about. “Peo­ple with GAD at­tempt to plan for ev­ery even­tu­al­ity, all of the time,” says Dr. Melisa Ro­bichaud, a psy­chol­o­gist in Van­cou­ver. “It’s cog­ni­tively ex­haust­ing.” It can be phys­i­cally tax­ing, too, with symp­toms rang­ing from sleep prob­lems, irritability and dif­fi­culty main­tain­ing con­cen­tra­tion to rest­less­ness or agitation.

At its core, anx­i­ety is the body’s most ba­sic sur­vival mech­a­nism, Ro­bichaud says, the fightor-flight re­sponse you ex­pe­ri­ence when you feel threat­ened. “Anx­i­ety is like the body’s smoke alarm: whether there’s smoke or fire, it makes the same noise.” It can be trig­gered by real dan­ger but also by any­thing we per­ceive as dan­ger­ous.

Peo­ple with GAD think up “what if” sce­nar­ios ex­ces­sively, and this pro­vokes more anx­i­ety. “They can’t stop their wor­ry­ing once it be­gins,” says Ro­bichaud.

GAD CAN BE PHYS­I­CALLY EX­HAUST­ING. SYMP­TOMS IN­CLUDE IRRITABILITY, AGITATION AND FEAR.

WHO IS AF­FECTED?

While sci­en­tists aren’t sure why some peo­ple are more prone to GAD than oth­ers, part of the risk is genetic. GAD also of­ten co­in­cides with other ill­nesses, like de­pres­sion, and women are twice as likely as men to be af­fected.

The World Health Or­ga­ni­za­tion re­ports that the num­ber of peo­ple suf­fer­ing from de­pres­sion and/or anx­i­ety in­creased by nearly 50 per­cent be­tween 1990 and 2013. Mike Ward, a psy­chother­a­pist and founder of the Lon­don Anx­i­ety Clinic in the UK, has seen a 30 per­cent in­crease in pa­tients with GAD clinic-wide in the last two years alone. He says the con­di­tion is in­flu­enced by ev­ery­thing from gene ex­pres­sion and early fam­ily re­la­tion­ships to in­di­vid­ual think­ing styles. “GAD is not a sim­ple fact of cause and ef­fect,” he says.

As anx­i­ety disor­ders go, GAD is one of the most com­mon, es­pe­cially in older adults. “GAD is more com­mon than so­cial anx­i­ety dis­or­der, panic dis­or­der and ma­jor de­pres­sion in se­niors,” says Julie Wetherell, a psy­chol­o­gist at San Diego Health­care Sys­tem and pro­fes­sor of psy­chi­a­try at the Univer­sity of Cal­i­for­nia, San Diego.

The con­di­tion also man­i­fests dif­fer­ently in peo­ple 55 and older, whom Wetherell says, tend to worry less about work and more about per­sonal health and fam­ily is­sues. “Some­times peo­ple have a life­long his­tory of anx­i­ety that they’ve coped with through dis­trac­tion or worka­holism,” she says. “The per­va­sive­ness of the worry only be­comes ap­par­ent when they’re no longer work­ing or are un­able to en­gage in pre­vi­ous cop­ing strate­gies.”

A DIF­FI­CULT DIAGNOSIS

Anx­i­ety symp­toms are as­so­ci­ated with sev­eral health is­sues, which can make diagnosis tricky. Con­di­tions that can cause—or mimic—anx­i­ety in­clude chronic ob­struc­tive pul­monary dis­ease, coro­nary artery dis­ease and hy­per­thy­roidism. “It’s pos­si­ble for a per­son to have both a med­i­cal con­di­tion and anx­i­ety, so when the med­i­cal con­di­tion is di­ag­nosed, the anx­i­ety may re­main over­looked and un­treated,” Wetherell says.

Anx­i­ety-like symp­toms can also be caused by many med­i­ca­tions, in­clud­ing blood pres­sure pills, hor­mones, steroids and an­tide­pres­sants, as well as over-the-counter treat­ments that con­tain caf­feine, like some cough syrups and de­con­ges­tants.

GAD suf­fer­ers will of­ten see a med­i­cal doc­tor first about their phys­i­cal symp­toms and, un­for­tu­nately in some cases, pro­fes­sion­als brush off both phys­i­cal and psy­cho­log­i­cal con­cerns. “Many peo­ple think that worry isn’t a le­git­i­mate men­tal health com­plaint be­cause ev­ery­body frets,” Ro­bichaud says. She’s seen pa­tients who en­dured symp­toms for 15 years be­fore seek­ing help. Luck­ily, Jill’s doc­tor rec­og­nized the signs of a men­tal health is­sue, and re­ferred her to the ap­pro­pri­ate pro­fes­sion­als.

MED­I­CA­TION VS. THER­APY

To­day, af­ter three years of on­go­ing work with her coun­selor, Jill is liv­ing a full life with her wife and baby son. In ad­di­tion to talk ther­apy, she works on Ac­cep­tance and Com­mit­ment Ther­apy (ACT), a mind­ful­ness-based pro­gram, to man­age her anx­i­ety. Jill still has at­tacks, but much more in­fre­quently, and she is cur­rently not on med­i­ca­tion.

How­ever, if her anx­i­ety starts to over­whelm her or she feels her­self sink­ing back into a de­pres­sion, she and her doc­tor work to­gether on a course of med­i­ca­tion to help her through—and she is care­fully mon­i­tored.

Med­i­ca­tions to help treat anx­i­ety can come with se­ri­ous side ef­fects, such as se­da­tion, cog­ni­tive im­pair­ment (over long-term use) and some­times even the de­vel­op­ment of tol­er­ance, which can lead to ad­dic­tion. Wetherell rec­om­mends a non-phar­ma­ceu­ti­cal ap­proach us­ing re­lax­ation and med­i­ta­tion. “Our re­search team is cur­rently us­ing mind­ful­ness-based stress re­duc­tion, which has no side ef­fects,” she says.

MBSR tech­niques in­clude pay­ing at­ten­tion to breath­ing and do­ing men­tal scans of your body to in­crease aware­ness of phys­i­cal sen­sa­tions. “We found that MBSR re­duces cor­ti­sol, a stress hor­mone that dam­ages the brain’s hip­pocam­pus and frontal lobe, so it may have ben­e­fi­cial ef­fects on mem­ory and think­ing, as well as on anx­i­ety.”

An im­por­tant as­pect of mind­ful­ness is to learn to fo­cus on present-mo­ment ex­pe­ri­ence, says Ro­bichaud. “For GAD pa­tients, wor­ries in­volve a stream of thoughts about po­ten­tial neg­a­tive events that might oc­cur in the fu­ture, so be­ing able to fo­cus on the present can be ben­e­fi­cial.”

MAN­AG­ING GAD

For mild cases of GAD, life­style changes may help. One of the most im­por­tant is ex­er­cise. Re­searchers at Prince­ton Univer­sity found that phys­i­cal ac­tiv­ity re­or­ga­nizes the brain in a way that re­duces the or­gan’s re­sponse to stress, mak­ing anx­i­ety less likely to in­ter­fere with nor­mal brain func­tion. Ward says yoga is a good choice, as it helps re­lieve phys­i­cal ten­sion. Mean­while, any type of ex­er­cise that can tire you out, help­ing you sleep bet­ter—and sleep is key. Lack of shut-eye can con­trib­ute to ex­ces­sive wor­ry­ing.

For Jill, walk­ing is a pri­or­ity and she strides out a min­i­mum of 30 min-

“DON’T BE AFRAID TO ASK FOR

HELP. IT IS OUT THERE, AND YOU ARE NOT ALONE WITH YOUR

ANX­I­ETY DIS­OR­DER.”

utes when­ever she can. She plays ul­ti­mate fris­bee once a week, and when she needs quiet but good ex­er­cise, she swims.

Last year, a study pub­lished on­line in Com­put­ers in Hu­man Be­hav­ior showed that us­ing mul­ti­ple so­cial me­dia plat­forms in­creases the risk of both anx­i­ety and de­pres­sion. And, Ward says his pa­tients of­ten use so­cial me­dia to dis­tract them­selves, which may pro­vide short-term re­lief but is ac­tu­ally a cog­ni­tive avoid­ance of anx­i­ety.

There’s also ev­i­dence that what you eat may play a role in your abil­ity to calm your mind. Jill now pays more at­ten­tion to what she eats, and has cut way back on caf­feine and pro­cessed foods. She cooks mostly with fresh in­gre­di­ents, and also drinks more wa­ter. A 2015 study in the jour­nal Psy­chi­a­try Re­search found that eat­ing foods high in pro­bi­otics may pro­tect against symp­toms of so­cial anx­i­ety. And a 2011 U.S. study found that fare high in omega-3s has been linked to lower anx­i­ety.

STAY­ING THE COURSE

Even though you can re­duce—or even over­come—gen­er­al­ized anx­i­ety, main­tain­ing solid men­tal health re­mains an on­go­ing process.

Jill con­tin­ues her mind­ful­ness prac­tice—in­clud­ing breath­ing prac­tises, learn­ing to let go of anx­ious feel­ings, and when in a full-blown at­tack, ground­ing her­self with sounds around her, for ex­am­ple. “These tech­niques are great, but do not hap­pen overnight, it is a prac­tice that has to be dili­gently worked on, but works won­ders in the midst of anx­i­ety,” Jill says.

In ad­di­tion, she has found that be­ing open and forth­com­ing about her con­di­tion and speak­ing hon­estly to friends and fam­ily and even strangers, has been of tremen­dous ben­e­fit.

“The scari­est part of anx­i­ety can be the feel­ing you are the only per­son who feels this way. When I share my story, it helps oth­ers re­al­ize it’s not just them.

“Don’t be afraid to say you need help,” she says. “You are not alone.”

Says Jill, “I now con­sider my anx­i­ety an over­bear­ing and dif­fi­cult room­mate. But I don’t fight it I man­age it, rather than it man­ag­ing me.”

With ad­di­tional re­port­ing by the ed­i­tors

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