Friday, August 10, 2012

Putting it All Together; What I've Learned About Anxiety So Far

What sparked this obsessive reading of mine? It probably started with all the comic books I collected as a kid. I read, created, and dreamt of comic stories and cartoonists, 24/7. Our house was filled with science books and magazines. I grew up in a world of art, writing, science, and ideas, since dad was a geologist/landscape artist and mom is a journalist/writer/editor.

Whenever I encounter a topic of interest, I begin an in-depth research and learn all I can, from as many sources as I can. I have a quasi-Aspergian drive to find patterns, underlying order, and solve problems. My OCD tendencies for certainty, control, and completeness fuel my "need to know" and explore. This has presented problems at times. I have to be wary of taking an alarming concept too seriously ("over-valued ideation") without considering that the information may be over-simplified, incomplete, or just wrong. Sometimes, I have to give "health anxiety" topics in particular a rest, by switching to another genre, like crime novels or science books. Balance is called for.

Few topics are as emotionally charged as my senses-shattering struggle with anxiety, which came to a head with a two-week hospitalization in the fall of 2010. I wanted to know how and why this traumatic meltdown happened. In the depths of my despair I resolved to do everything I could to heal, and then get to the bottom of this irrational, self-inflicted suffering. I began by reading everything I could about panic attacks, anxiety, and depression. I never considered that I had OCD per se. The professionals spotted that, and it's a perfect example of how you can't diagnose yourself.

During my hospitalization I learned first-hand about other mental disorders from my fellow patients. Bipolar depression, suicide ideation, eating disorders, cutting, and schizophrenia were common problems. Of course, everyone also had a baseline of anxiety, depression, sleeping problems, addiction, dysfunctional families, job burnout, and in many cases, socio-economic hardships to deal with, as well.

Some of the most insightful and helpful information I've uncovered has come from unexpected sources, not just self-help books or psychology texts. I learned a lot about uncertainty, decision-making, creative thinking, and cognitive hiercharies from popular memoirs, art, investment, and science books.

Here's some of what I've learned.

Many of the anxiety and mood disorders are likely statistical outliers of normal brain functioning. Specifically, the fear mechanisms that evolved for species survival are in overdrive in anxiety disorders.

Chronic stress elevates stress hormones such as cortisol and norepinephrine which, unmitigated, damage your neural connections, cause insomnia, wreak havoc on general health, and intensify overall jitteriness. Chronic insomnia can worsen a wicked feedback loop of more stress hormones, panic, depression, and anxiety. Insomnia should be treated as soon as possible. Sleep medications should be used very judiciously, and if possible, after a time, try to wean yourself off them. Make sure you don't have obstructive sleep apnea or another underlying sleep disorder.

In the case of "comorbid" anxiety and depression, most experts feel the depression should be treated first. SSRIs will treat both anxiety and depression, but it takes a while, and you have to find the right combination and titrate the dosage by trial and error, often feeling like a guinea pig in the process. Oink. Oink.

Anyone who is suicidal should head directly to the Emergency Room "without passing Go," as they say in Monopoly. Feelings of helplessness and desperation are temporary, and you don't want to injure or kill yourself in a rash moment, and leave your family and friends behind, facing "survivor's guilt." Please reach out for help. Every time.

There are countless forms of anxiety -- panic attacks, OCD, social phobia, hypochondria, body dysmorphic disorder, generalized anxiety disorder, anorexia, agoraphobia, hoarding, eating disoders, cutting, and so on. Don't rely on medication alone to solve your problems. Get cognitive-behavioral therapy and exposure and response prevention training from a psychologist, trained in anxiety disorders.

Avoidance is the worst strategy for anxiety as it causes the problem to grow.

Reading special scripts can help you to expose yourself to your fears and uncertainty.

Work on recognizing and accepting uncertainty in all its forms.

Don't let your fear prevent you from enjoying the positive things in life. Accept any uncomfortable feelings you might experience and make yourself do the things anyway. A psychologist can help you with this.

Join a support group so you don't feel alone, and can pick up tips from other peer/consumers.

For heavy-duty problems get both a psychiatrist and a psychologist; they should complement each other. At the very least, get a CBT psychologist.

Remember fear and anxiety are key "marketing tools" exploited by the media, the government, politicians, financial advisors, talk-show hosts, businesses, and others to suck in your attention and push their agendas. Try to limit your eposure to these unneeded sources of "background anxiety" which are omnipresent in modern "connected' society. Living with uncertainty, that's the key.

I'm a big fan of "commercial-free" entertainment like books, CDs, and DVDs. "Unplug" at night.

OCD and panic are biological in basis. The brain is a network of dynamic, ever-changing systems. The limbic system has neural circuits that provide "fast" emotional inputs to the "slow" and higher-thinking cortex. The feedback between these systems is asymmetrical with the lymbic system the more dominant of the two. That's why it's hard to overide our emotions with logic. By being exposed to phobias, or any "conditioned responses," the mind learns gradually to "overwrite" fear triggers and "desensitize," but the triggers are so strongly encoded, they can't be completely erased, only subdued, and a relapse is possible. Expect these lapses and relapses.

In OCD, the brain's biological method of "automatically shifting" away from ruminating thoughts/obesesions is stuck in a brain network/circuit malfunction or "brain lock." SSRIs help the mind override these sticky obsessions, but you can also learn to "manually shift" mental focus away from the obsessions by using Dr. Jeffrey Schwartz's 4-step neuroplastic method. It takes a lot of practice and work, but it should be done. "Neurons that fire together, wire together" (Hebbian learning), and "Neurons that fire apart, wire apart."

How SSRI medications work isn't completely understood. Some think the original "chemical imbalance" or "soup" theory is oversimplified. It's possible that the drug may facilitate "neurogenesis" or the growth of new brain cells in the hippocampus, and this allows for "neuroplasticity" or new synaptic connections to form. This "neural path rewiring" would help explain why SSRIs can take up to six weeks to have a theraputic effect even though they raise seratonin levels within hours.

Even though we don't know precisely how they work, SSRIs have a similar rate of effectiveness as CBT. Using both together is thus optimal. Bear in mind the SSRIs seem to be more effective for OCD than depression, even though they're more widely marketed as antidepressants.

Benzodiazepines are effective for anxiety immediately, but they carry potentially serious risks of tolerance, addiction, memory loss, and dependence. Use them with caution, only as prescribed. I've tried to avoid them entirely as my own treatment has progressed. Try to rely on CBT to deal with most of your feelings of anxiety instead of drugs.

The joy of learning has been a great boon for me. Just as stress can damage neurons, learning can heal and grow synaptic connections. Learning anything at all is therapeutic. Hobbies, games, crafts, art, writing, or even reading fiction. Anything that engages your attention, interest, and keeps your mind active. Learning delivers a shot of dopamine from the "pleasure centers" of your brain.

I believe information/biology networks will be the future of medicine. The brain is a complex network, as are our genome, hormonal system, and cell biology. Then there's epigentics-- wherein the environment affects how and if our genes are expressed. Diet, social interaction, and exercise are all important to mood. More networks, complexity, and feedback systems, all piled atop each other. God knows how long it will take to map and understand all these interconnected networks, the web of life. Every experience changes our unique brains -- this is the "connectome" or neuroplasticty. Use the knowledge that this gift exists to gather hope, change your thought patterns, and heal yourself.

I'm currently interested in exploring overall health, especially in the areas of stress,  diet and supplementation. Corrections in any deficits in these areas will likely help mimimize disease. That makes perfect sense to me. This is the concept of functional medicine. Knowledge and understanding of the mere fact of epigentics can help motivate us to take better care of ourselves and others. Traditional, mainstream "Western medicine" needs to be overhauled with functional medicine. This is a major paradigm and economic shift and will take time. There will be resistance. Self-educate yourself in the meantime as much as possible.

Diet: The Paleolithic/Mediterranean/Zone diet recommendations

Eat mostly low-carb, low glycemic, complex carbs -- vegetables and fruits.
Avoid refined foods, red meat, and sugar.
Eat smaller portions of lean protein -- chicken and turkey.
Eat good only good fats/oils -- olive oil, and flaxseed oil.
Avoid gluten and dairy
Take Omega  RX EPA/DHA concentrate supplements (fish oil).
Take a multivitamin
Use coffee and caffeine sparingly (yum, and no... no...muffins)

Supplements - a topic to eplore:

Other viatmin and herbal supplements: I'm researching this now. There are a lot of pitfalls and expenses. Check my future posts as I try to learn more.

Excercise and Stress recommendations:

Exercise, especially walking, in nature, if possible.
Movement is key. Don't sit around too much. excercise helps your brain as well as your body
Expose yourself to light in the morning to help set your circadian rhythms. Use an eyeshade at night to block out ambient light from outside.
Be aware chronic stress is dangeous -- try to avoid it as much as possible
Reduce stress with meditation.
Get in the "flow" of pleasurable activities
Start a "gratitude journal"
Express bottled-up or painful feelings through a series of written letters (you don't have to send them)
Build social networks and meet new people
Practice the progressive relaxation excercise twice a day
Try self-hypnosis and guided imagery to relax
Use "grounding techniques" in emotional confrontations
Practice deep breathing techniques
Do body stretches
Herbal supplements (needs more research from me)

Now get out there and enjoy art, literature, movies, food, comics, humor, people, pets, nature, and most of all -- yourself.

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