Techniques to Battle Anxiety

I find myself talking about anxiety nearly daily both in my personal and professional life.  Everyone seems to have some form of it impacting their lives.  While I could talk for a very long time about what I think the underlying societal causes are, the thing that people are most interested in is how to manage their worrying.  I do not believe that there in a “one size fits all” solution to the problem.  Anxiety is a sneaky foe that takes many forms and often, when one trigger is neutralized, another emerges.  Therefore, I believe it is important to be confident that you have a toolbox full of techniques for managing your anxiety that will allow you to find relief in any situation or circumstance.  Some of the reliable tools that you should always be aware of are physical elements I have discussed at length in previous blogs: proper sleep, nutrition and exercise.  However, there are plenty of mental tools that you can use as well. 

One such technique is worry restriction.  Anxious feelings often associate themselves with particular experiences or places.  Did you know that you can actually cause insomnia by creating an association between your bed and your anxiety?  While this can be extremely frustrating to many people, causing them to have extreme anxiety about certain places or things, you can also use this association to your advantage when your worry is getting out of control.   Pick a place that is easy to access where you are not needed to perform any other tasks and make it your worry spot.  In order to make the association you may need to be able to go to this place often at first.  Set a timer and place yourself there at regular intervals.  While there you can let your worry happen unchecked.  Allow yourself to cry, stress, and, to the extent possible, come up with a plan for managing future projected worries.  When you leave your worry spot, tell yourself that you are leaving the worries there and can come back to them later. 

The second stage of the plan once you have established a strong association between your anxieties and your worry place is to create a predetermined worry time.  For example, perhaps you would like to allow yourself two “worry sessions” a day in your worry spot and limit them to fifteen minutes each.   As your association with worrying in this place grows, you can extend the time period in between “worry sessions”.  If a concern comes up in between these sessions keep a list to take to your worry spot.  For some people, worrying right after lunch will give them time to come up with a plan for a challenging project you were trying to tackle in the afternoon at work.  For others, worrying at night before they start their bedtime routine will allow them to put the anxiety away and sleep restfully.  Be thoughtful about what time of the day you will have regular access to your space and when it will most benefit you to have this type of contained anxiety.  Many people have used this method with great success to navigate stressful work or personal situations or to help improve sleep. 

It may be a good idea as you go along building your mastery of this type of restriction to also use your worry place as a testing ground for new stress management techniques.  For instance, you could use this time to practice worry journaling, mindfulness, Socratic questioning or thought replacement techniques in a quiet and safe environment.  The good news about worry restriction techniques is that they allow you to regain a sense of control over feelings that often feel out of control and help you create limits on unhealthy habits that have a tendency to increase over time if left unchecked.  You may even find yourself reaching a point where you can skip a session at your worry spot because you have gained an ability to manage your anxiety without it!  If anxiety is impacting your life, don’t just wait, take action to regain control over these feelings. 

Are You Suffering From Insomnia?

In the past, I have talked about matters of sleep hygiene or ways that you can create the best possible chance of getting quality sleep.  However, none of this is particularly helpful in curing true insomnia and the number of sufferers is increasing.  So how can you tell if you might have insomnia?  The first step is always to rule out any underlying medical issues.  Fatigue may be a symptom of many medical problems and should always be addressed with your medical doctor. 

Additionally, there are diagnosable sleep disorders that can wreak havoc on your daily life.  Normally the way to determine whether you have insomnia or a sleep disorder is to consider two factors: your risk factors and the type of symptoms that are occurring.  Risk factors include a tendency to snore, high blood pressure, aged over 50, male gender, body mass index over 35, neck circumference larger than 17 inches (16 inches for women), and whether anyone has observed you stop breathing while sleeping before.  Symptomology is trickier to determine.  The main difference between insomnia and a sleep disorder is that those with insomnia express feeling tired and fatigued while those with a sleep disorder actually doze or fall asleep during the day.  If you suspect a sleep disorder you should seek professional assistance as soon as possible. 

Yet, if you have insomnia, there are many things you can do to work on the problem on your own.  There are two biological factors that work in tandem to help you have quality sleep.  One of those is sleep drive.  The more you are awake and active, the more sleep drive you build up throughout the day.  If you are waking up frequently, or too early in the morning, perhaps you are not accruing enough sleep drive throughout the day.  The answer may be as simple and easy as increasing the amount of hours you are awake or the amount of time you are spending active during the day. 

The other biological system at play is circadian rhythm.  This is the system in your body that notices when light starts to ebb and makes you sleepy.  It is easy for a body’s circadian rhythms to get out of sync when sleep and wake times aren’t consistent throughout the week.  Keeping a sleep diary can be a huge help to determine whether or not you have insomnia and what the underlying causes might be.  While there are many available templates for a sleep diary, the information should at least include what time you get into bed, what time you try to fall asleep, what time you actually fall asleep, how many times you were up and for how long total, what time you wake up for the day, what time you get out of bed, and how you would rate the quality of your sleep.  In order for this information to be useful, it is important to keep track of it for a period of at least a week.  Sleep diaries often help you determine bad habits that may be affecting your sleep and what is the best thing for you to change to improve the quality of your sleep. 

You may notice that you spend a lot of time in bed, but very little of it is time that you are sleeping.  A lot of people have the mistaken idea that every adult requires eight hours of sleep.  This is not always the case.  You may be waking up or not sleeping as well because you are spending too much time in bed.  In that case, you could try restricting the amount of time you are in your bed.  For instance, if you are noticing that you are only sleeping five hours a night, you would wait until you are sleepy to go to bed and allow yourself five and a half hours in bed before your desired wake up time.  Then as you start to see yourself sleeping the full time you are in bed you can increase the amount of hours you are in bed by a half an hour every few weeks until you begin to feel rested.  Note, however, that it is never safe to restrict your time in bed to lower than five and a half hours even if you are actually sleeping less than that.

Another problem you may encounter is that your sleep and wake up times may differ depending on the day.  In that case, you may have to work to try and pick a middle ground sleep and wake up time that would work for the full week.  Once you implement this it is important that you try not to go more than half an hour off of the times you have set for yourself if you truly want to see improvement. 

A final problem that is often encountered is that you may have developed worry about sleep that has caused your body to develop a negative association with your bed.  This may occur in people who have a tendency to be anxious and find themselves stressing while lying awake at night in bed.  A good indicator that this is your problem is that you may be falling asleep on your sofa watching TV but as soon as you are in bed you are wide awake.  The best way to deal with this is to create a “nest”.  The idea is to remove your mind’s negative association with your bed.  So when you cannot sleep, don’t just lay there tossing and turning.  Get up and go to a quiet and calming place.  Engage in a restful activity such as meditation, reading, knitting or even watching non-stimulating TV.  Once you feel sleepy, head back to bed.  Initially this may require you to go to your nest often, sometimes even more than once a night.  However, soon the nest becomes the place that you associate with wakefulness and worry instead of your bed and you will find yourself reclaiming quality sleep.

A combination of the techniques I have suggested may be necessary to solve your insomnia issues.  Also, the problem often feels worse before it gets better.  The first few weeks of change are the hardest, but if you stick with it the results of quality sleep will be well worth the time.  If you want more information about any of these ideas I highly suggest purchasing the book Quiet Your Mind and Get to Sleep by Colleen Carney and Rachel Manber.  Finally, if you notice your insomnia getting worse or have concerns about your ability to stick to any of these techniques, consult a professional and get the help you need.

Dealing with Holiday Depression

It has always been amazing to me that the time between mid-November and the start of January is my busiest period of my professional year.   The holidays are always painted in stories and movies as an idyllic time full of love and happiness.  Even on social media, such as Facebook and Instagram, the highlight reel of everyone’s holiday celebrations displays a skewed representation of the holiday season as a non-stop joyous celebration.  Unfortunately, the truth is far less joyous than you might suppose.  The reality is that many people struggle during this season.  They struggle with feelings of loss and isolation that are only exacerbated by the messages and images of happy family celebration that surround them. 

When you really think about it, there is no surprise that depression rates are higher during this time of year.  Families are often complicated and the holidays can force more time with your extended family than you are accustomed to.  Pair this with an increase of alcohol consumption and there are bound to be hurt feelings and old frustrations bubbling to the surface.  If families are far away and you are unable to spend time with them you may miss them and feel isolated.  In some instances you may be shamed or experience guilt over your inability to participate in family traditions.  For many, this time of year also comes with a reminder of the loved ones they have lost.  Additionally, you may spend time comparing this holiday to previous ones or measuring what actually happened with what you hoped would occur.  Furthermore, omnipresent  social media may cause  you to compare your decorations, gatherings, food, or experiences to those of your acquaintances and friends.  The outcome of such comparisons is often dissatisfaction with something that we might otherwise have found extremely satisfying. 

So the question becomes how can you keep yourself from sinking further into a depressive state this time of year?  There are a few simple ideas that may help you achieve that goal.  First, stay off or limit your exposure to social media.  Spend a few minutes every day instead focusing on what you like about the holidays and thinking about things for which you are grateful.  Learn how to kindly say no to things that consume too much time and energy and take away from the experiences that are important to you.  If you find yourself losing focus of your priorities, ask yourself what you value about this time and stay focused on that.  If you value your children having the experience of being doted on by their grandparents, hold onto the thoughts of that occurring and let go of the parenting criticism that might come with that visit.  Most of all, make time for the people who value you and who you enjoying being around, even if those are not the people with whom you feel obligated to spend time.   Honor anyone you may have lost.  Tell stories about them or create a tradition that keeps them alive in your heart. Remember that nobody has a perfect life or everything that they want but what they are showing you is often their best.  Give yourself (and others) permission to be human and imperfect.  You may be amazed how much more enjoyable the holiday season can be!

The Importance of Exercise for Mental Health

Very rarely do people take into account how their physical health and mental health are connected.  I talk with every patient that seeks my help about setting not just goals for their mental health improvement but goals for their physical health as well. Both our physical and emotional well-being is important for our overall health.  Therefore, it is important to evaluate improvement options as a whole person solution. 

I am never surprised when I hear that someone has gotten into bad sleeping patterns, unhealthy eating patterns, or tapered off on their exercise regimen.  I have written previously about how poor sleep disrupts emotional regulation abilities and how poor nutrition can cause an emotional roller coaster.  However, the importance of exercise is often overlooked in mental health discussions.  We have a tendency to think of exercise in terms of weight loss or cardiovascular health.  However, regular exercise has enormous benefits for our mental health as well.

First, taking time out regularly to exercise is good practice in devoting the time to prioritize your needs before all of the other demands in your life.  Even if it is only twenty to thirty minutes a few times a week, it is a wonderful commitment you are making to your own well-being.  Often for those who struggle with mental health issues, making time for their own well-being is not a habit they have formed, so exercise offers a good reason to form this important habit.

Second, exercise releases endorphins, which help raise your overall sense of happiness and helps combat depressive hopelessness and the overwhelming sensation that comes with anxiety.  The physical activity forces you to be present in the moment giving you practice in keeping yourself focused.  This can be tremendously helpful when combatting mental health issues.  Physical movement helps your body function at its optimal levels, thus enhancing your attention and memory.   Plus, if you stick with it past the initial shock to your body, your energy level will increase.

Finally, exercise opens up new ways to create a sense of mastery.  When you take up a new activity, over time you will see the improvements of practicing that activity such as changes in your body, improved strength, increased endurance, higher energy level, or just strictly the ability to do something better. It makes you feel good about yourself and improves self-esteem. 

Give it a try.  I promise you are worth the 20-30 minutes of your day that it will take to see improvements!

How to Be More Present Focused

Most people who suffer from anxiety have mastered the art of projecting out into the future.  They are often plagued by the “what ifs” that keep them constantly fearing the worst is coming next.  If this is something you struggle with, learning how to be present in the moment could help.  However, it is a skill that can be difficult to master.

Like any skill you build within your life, practice is vital to fully acquiring an ability.  A good way to practice being more present focused is through the use of mindful meditation.  While any meditation is a good way to practice keeping your mind focused, my favorite is one that actually works on being present in a certain space and time.

I suggest you start completing a meditation ten to fifteen minutes a day.  Find a quiet space and take a few minutes to focus on breathing in through your nose and out through your mouth.  When you start to feel your mind wandering, focus on the space around you.  What does it look like?  What sounds do you hear?  What do your surfaces in the area feel like?  Are there any smells you can identify? 

Over time and with practice pull your focus closer to yourself.  How do you feel?  Do you hurt anywhere?  How are you feeling emotionally?  Is anything sore or tired?  Pay attention to those feelings but you don’t need to do anything about it.  Move your focus through your body from your head to your feet noting any issues or feelings you detect along the way. 

Finally, wrap up by stretching or thinking about any issues you noted so that you can move forward with a productive day.  While initially this is going to be difficult and should be kept short, if you practice regularly you will notice that this kind of focus will become easier.  Mastering this ability is a positive step toward removing the constant future focus that becomes exhausting over time.  While this skill will help anxious people, it can also be useful for those who struggle with focus and attention and others who simply want to be better connected to the present.