Anxiety disorders are the most common psychiatric illness in the United States. Around 40 million people struggle with anxiety that is at debilitating levels. That's one in five people!
So what's going on in anxiety? Basically your sympathetic nervous system, which is designed to help you fight or run from predators (think a bear chasing you in the woods) has gone a bit haywire. Things that should not provoke this response (racing heart, dilated pupils, cold sweat, massive amounts of adrenaline in your bloodstream) have triggered this response. Which feels pretty terrible. Some people experience intense anxiety only occasionally, like before giving a talk in front of an audience, but other people experience anxiety on a daily basis.
Regardless of how much anxiety you have or when it comes on the treatments are essentially the same (except for simple phobias like fear of snakes or fear of flying, which really needs exposure therapy). You can reduce your overall anxiety by following any of these tips:
As always wishing you health and happiness,
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It should be no surprise with the rapid advances in genetics these days that they have identified a gene that may help to explain what a lot of folks call the Highly Sensitive Person. A researcher at the University of California Berkeley, Dr. Levenson, postulates that a variation of the serotonin transporter gene on chromosome 17 may may account for people who feel their emotions very acutely. This serotonin transport gene can have two common variations-- the "short allele" or the "long allele" version. It's the short allele version that seems to be responsible for some people feeling things more intensely. This gene variation also seems to be correlated to higher rates of depression, anxiety and ADHD. Which bolsters what clinicians who work with those populations have noticed for decades-- that if you have anxiety, depression or ADHD, you are likely to have not just one of those but two or even all 3. And that if you have some of those difficulties you are also likely to see those same problems in blood relatives, hinting that there is a genetic linkage.
Dr. Levenson posted a fantastic youtube video that explains his research in a very understandable and fun format (he even uses emojis!). If you resonate with the idea that you tend to feel things more deeply than others you may want to look at other sources of information about this trait such as the wonderful website The Highly Sensitive Person which has books, videos, research links, self-tests and more.
So if you are a highly sensitive person what can be done about it? Well, years ago I encountered a theory in psychology that seemed so completely WRONG to my therapist's ear-- that the goal of therapy should not be to change people but teach people who they already are and how to live the in the world given who they are.
Anyone who reads my blog or does therapy with me knows that I am a huge fan of splitting the difference, finding the middle path or blending opposing ideas. So while at first I balked at what sounded like a completely hopeless perspective-- that we should not try to help people even try to change-- I came to realize that there is room for some of this perspective in my view of personal growth. Whether you are a Highly Sensitive Person, someone with ADHD (you can be both of course), an extrovert or on the spectrum, all of which are known to be highly genetically determined, or have some other genetically linked trait, you CAN make some changes to how you operate in the world. And, at the same time, there WILL be things you cannot change and, as the old 12-step saying goes, it's learning "the wisdom to tell the difference" that is the key to really thriving. So if the idea of a highly sensitive person resonates with you I encourage you to learn more about it and educate those that are close to you so that your behaviors do not get misinterpreted. Then set about learning how you can navigate the world with a little more comfort.
A few examples of HSP that I have known or worked with-- one woman notices that too much noise is very overwhelming for her, so she has skin-colored ear plugs that she wears if she is going out in public (like the mall, a noisy restaurant, etc). They dampen the ambient sound but she can still hear the people she is talking to just fine. If this idea appeals to you I suggest trying the off-the-rack cheap kind first and if you really love them you can order ones that are more high-end or even have them custom made by shops that cater to musicians.
Another HSP I know gets a lot of anxiety when entering into social situations because of the increased complexity of interactions. The combination of more voices, conversations bouncing around, more eye contact, etc. just jangles her nerves and she used to find herself making excuses and not joining into groups. Once she learned that she was an HSP she experimented with different methods of entering into groups that reduced her feeling of exposure to the increased input. She found that when she enters a room, house, venue, etc. if she can wait a minute (she can pretend to check her cell phone, go find a restroom, etc.) her nervous system has time to acclimate to the new environment. Once she has done that if she is still feeling a bit overwhelmed she can stand sideways to the group (this does not have to be too noticeable, the main thing is the have your torso perpendicular to the group but your head can be facing them). This has an interesting impact on the mammalian nervous system. Mammals are most physically vulnerable when their guts are literally exposed. So when one mammal faces another mammal if their torso is exposed the mammalian brain notices this and there is a deep evolutionary alarm that can sound and may feel like anxiety. This is especially likely if the group includes people you don't know or if you are in an environment you have never been in before (a new restaurant, a new friends house, etc). But by simply turning your torso 90 degrees, like you would if you were fencing, your mammalian brain is more likely to ratchet down the threat level and you will relax more.
For this particular person she even had a third level of "defense" for her nervous system if the first two things did not help enough-- she to develop particular imagery that was settling to her nervous system (if you are not familiar with the amazing power of guided imagery I recommend taking a look into it!). For this person imagining standing behind a huge one-way mirror when she was entering a new group was helpful. In the mental image she could see others but they could not see her. This deactivated her fight-flight response that was predicated on the idea of being seen. Again --to go back to how we are just large bipedal animals dressed in clothing-- being seen is the first step to being eaten. So for some HSP just being looked at can trigger a lot of anxiety. Because the brain, while in some ways is extremely sophisticated, in other ways it is very dumb. Sometimes the brain does not always know the difference between a very well rehearsed imagery and reality (just try thinking about biting into a lemon and see what your salivary glands do). So once this person had locked-in to that image as one that reduced her anxiety and she had rehearsed it numerous times she could call it up when under stress in social situations and it would reduce her feelings of being overwhelmed.
Again I am not suggesting that a HSP can turn themselves into a non-HSP. On some level we are who we are. But learning strategies to help modulate one's innate responses can give us more flexibility in our lives and lead to less stress and anxiety.
If you feel you are an HSP therapy can be a wonderful way to learn about yourself and get some help managing your beautiful but slightly tricky nervous system. Our office offers FREE 30-minute consultations so you can see if any of our therapists would be a good "fit" for you. And if you are an HSP in a relationship couples therapy can be a wonderful way not only to learn about yourself but to have your partner also learn about you in ways that can deepen the intimacy and de-personalize some of the problematic things that can crop up with a HSP in partnerships.
As always I wish you well in all of your endeavors and explorations in life, whether you are an HSP or not. The world has room for all of us and we all contribute in meaningful ways to create the rich diversity of the human condition.
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I have written about shame before but wanted to expand on my earlier blog with some new information on how exactly we learn to be shame prone.
James Harper has written about this subject and explains that there are types of families that tend to be shaming. Harper, along with a colleague Hoopes (1990) says that healthy families all contain the following essential qualities to promote optimal emotional development in children-- "accountability"-- the sense that "family members feel and act responsibly towards each other and meet each other's basic emotional needs"; "intimacy"-- family members are "able to share physical touch, be nurturing to each other, and share emotional experiences" in a way that feels supportive and comforting; and "dependency"-- the "ability of family members to rely on each other emotionally for basic needs". This includes parents not being annoyed by the natural dependency of young children and being willing to continue "scaffolding" children well into adolescence as they learn to become more autonomous. Parents who fail to provide enough of these essential qualities inadvertently create shame experiences in children. If repeated often enough this can become part of the child's self-concept and identity. They feel that they are inconvenient to their parents, that their basic feelings are not acceptable, that their world is unpredictable. They learn to despise their natural needs to be dependent and also their normal failures and struggles as they grow and develop. They assume that if only they were "good enough" they would be loved and, therefor, their feeling unloved is somehow their own fault.
When kids experience shame a lot they naturally begin to internalize it. That emotional state gains preference in the nervous system and is more easily accessed. I compare this to driving down a dirt road every day for several week. Over time you will notice grooves getting established in the dirt so that it gets harder to deviate from the path you have been taking each time. This is similar to the way our brains respond-- the more we feel something (or think something, or do something) the more that pathway is reinforced and becomes easier for the brain to find the next time. So numerous experiences with shame as a child make is "shame prone" in adulthood. Research shows that people who are "shame prone" or have "trait shame" learn to expect to be shamed and they learn to hide their flaws from others. This impairs their ability to feel intimately connected with others and can even cause these people to lash out and shame others before they can be shamed themselves. According to studies people high in "trait" shame tend to also be more pessimistic, narcissistic, dependent, emotionally labile, feel victimized and be introverted. In an effort to cope with chronic shame people often turn to substance abuse, addictive behaviors (sex, gambling, eating, work, exercise) and/or chronic interpersonal conflict in an effort to ward off the collapsing into shame they so fear. Mills, Imm, Walling and Weiler (2008) found that children with higher shame experiences also had higher cortisol in their bloodstream, a sign of physiological stress. Remember that the brain does not distinguish emotional versus physical pain in where the information is processed or how the body responds. So shame provokes a stress response in the body that, over time, can lead to chronic stress-related illnesses including more trouble returning to physiological baseline after feeling shamed.
Relationally shame-prone partners tend to have insecure attachment styles (Karos, 2006; Wells & Hansen, 2003) and distressed romantic relationships (Greenberg, 2008). Their sex lives also tend to be problematic/unfulfilling. I am often fond of telling couples that anger and shame are two tried and true arousal killers. Shame-prone partners have trouble communicating in their relationships because they are so guarded and are constantly trying to defend themselves against having shameful parts of themselves discovered. They may perceive attempts to be close as intrusive and an attempt to uncover things that they feel shame about. They may also be aggressive and try to push others away, especially as that person is trying to get closer to them. Sadly in this way shame-prone people often create the situation they are fearing-- being seen as "bad" or "unlovable", which reinforces their feelings of shame.
While all of this is no doubt frustrating to those who are trying to love and be with a shame-prone person it is important to remember that shame-prone people, like all of us, have earned their scars and defenses. Research shows that people who are chronically struggling with shame tend to have histories of abuse, be it sexual (Feinauer, Hilton & Callahan, 2003), physical (Kim, Talbot & Cicchetti, 2009) or other traumas (Lee, Scragg & Turner, 2001). They also are more frequently abandoned by their spouses (Claesson & Sohlert 2002). So they have plenty of reasons to feel vulnerable, victimized and exposed. Empathy and emotional validation are keys to helping a shame-prone person feel more comfortable. Essentially acknowledging their shame and giving it words can be a great weight off of the shame-prone person's shoulders. Of course since those who are shame prone tend to see judgement at every turn it's important to phrase things carefully and let the person know that it makes sense that they feel shame based on their history. It can also be very powerful to share some of your own shame feelings in an effort to normalize their response.
Chronic shame can rob a person of adequate self-worth, goal achievement, fulfilling relationships and feelings of love, joy and satisfaction. If you or someone you love struggles with chronic or intense feelings of shame I recommend that you reach out to a mental health professional to discuss treatment. Psychotherapy, whether it is individual, in groups or as a couple can be a powerful way of healing this toxic emotion.
Wishing you health and happiness,
Many people who contact me are suffering from anxiety. Anxiety can cause a number of problems ranging from irritability, depressed mood, lack of productivity or insomnia.
The first thing I always want to know is are they exercising? Most of my patients who have anxiety find that exercising vigorously most days of the week will reduce their anxiety a considerable amount.
That said exercise is not usually sufficient to remove all anxiety from someone who struggles with it. We almost always need to look at other lifestyle factors (like reducing caffeine and other stimulants) as well as other techniques such as diaphragmatic breathing, guided relaxation practices and mindfulness meditation practices. What follows are some basic videos that people can watch in order to learn how to use these techniques to help with anxiety.
The first link is for teaching diaphragmatic breathing. Some people call it "belly breathing". The reason it's helpful to learn this technique is that if you can fully engage your diaphragm by doing this type of breathing it stimulates the parasympathetic part of your nervous system. That part of the nervous system is what causes your body to relax. If you have been stressed out then your nervous system most likely is sympathetically activated, meaning that the sympathetic branch of the nervous system is dominant. This part of the nervous system (the sympathetic branch) dumps a lot of adrenaline and cortisol (stress hormone) into your bloodstream which causes symptoms of anxiety like shallow breathing, sweating, hot flashes, increased heart rate, stomach upset, headaches, muscle tension, etc. The way to stop this stress response is to activate the parasympathetic nervous system by doing diaphragmatic breathing.
This link will give you a super simple explanation of diaphragmatic breathing :
This link will show you a person doing diaphragmatic breathing so you can follow along and practice it:
This next one is a specific pattern of breathing that also activates the relaxation response and this is another good tool for turning off the stress pattern if you have started to feel anxious:
You can also do the diaphragmatic breathing with a 4-7-8 pattern, or if you prefer you can use any pattern where you exhale longer than you inhale (so for example inhale for 5, hold for 2, exhale for 6, or any other variation as long as the exhale is longer than the inhale).
In order to maximize benefit you should try to practice some form of relaxation breathing at least 2x/day for at least 5 minutes each time. Once you have the hang of it you can increase to up to 10 min each day. Many folks make one of those times when getting ready to fall asleep. It can help you relax and fall asleep if anxiety tends to keep you awake.
The next tool in the anti-anxiety arsenal are mindfulness meditations. These have been shown to reduce anxiety and depression, improve concentration and attention and even improve control over your emotions. Studies show that doing this just 11 minutes each day will produce actual structural changes in the brain (increased activity of the frontal lobe). It helps reduce symptoms of ADHD, depression and anxiety as well as increasing emotional control.
At first you should probably just try 3-4 minutes of mindfulness at a time. Doing too much at once can make it annoying and then you might get turned off to it. Try to start with 3-4 minutes each day and after a few days add another minute, do that for a few days, then add another minute and so on. Eventually you will want to do at least 11 minutes each day of mindfulness meditation.
All of the following videos have good technique so you can try them all and see which ones you like. You can also search yourself on youtube for other ones. But remember even if the video is 20 or 30 minutes just do 3-4 minutes at first. You will not be able to empty your mind, it is totally normal to have thoughts intruding constantly. That's fine. The goal is just to notice the thoughts and then let them go. I think of them like people walking into the room and I notice them and say "hi" and then let them walk away and I let them go. The goal is not really to empty your whole mind because the human brain does not work that way. It's just the process of acknowledging the thoughts and letting them go that builds the brain in the areas that benefit you.
And finally here are links to guided imagery for sleep. These are great to help you fall asleep. You just start playing it when you lay down to sleep and usually folks fall asleep before the whole program finishes.
If you don't like any of these you can search with keywords "guided imagery for sleep" or "hypnosis for sleep" to try some other ones. You can also specify in your search male or female voice, music vs. nature sounds, etc.
If you have other youtube videos that you have found useful for managing anxiety or for falling asleep I would love to hear about it! Send me an email or post your comment below.
Thanks and stay tuned to more ideas on managing symptoms of anxiety without medications.
Krista Jordan, Ph.D.
Dr. Jordan has been in private practice for 20 years in Texas. She is passionate about helping people to overcome hurts and obstacles from their past to find more happiness and health in their current lives.