March 22, 2023
This post is the second part in a two part series. Read part one here.
Cultural expectations here in the USA on anxiety differ greatly. There is vast diversity in the way people approach anxiety or, maybe more often, avoid it. One of the most common responses these days is to treat anxiety with medication. While medication can be helpful in reducing symptoms and is necessary at times, it does not cure disordered anxiety. Sometimes overmedication can actually reduce the symptoms so much that a person is unable to experience appropriate anxiety when it would be useful.
To be clear, I am not anti-medication, nor am I anti-doctor. Medication can be helpful, but it should be something that supports the healing process rather than a mask to cover symptoms. I often have clients who seek services because the medication just isn’t enough. If you happen to be on medication for anxiety right now, I’ll tell you what I tell them - stay on it, and if you want to come off of it over time, do so under the direct guidance of your prescribing physician and therapist.
Healing from disordered anxiety is a process, and it doesn’t happen overnight. Because anxiety is a natural brain and body response, the best and most direct way to heal it is through retraining the brain and the body towards appropriate levels of anxiety rather than trying to eliminate it altogether. We begin this process by focusing on three key areas: intake, output, and rest.
Intake is, of course, what we take into our bodies. Food, drink, substances, but also social interaction. The first, and maybe most important thing I can suggest regarding intake, is that you drink an 8 oz cup of warm water first thing in the morning, even before your coffee. Adding a slice of lemon to your water may help with supporting your liver function and regulating your hormones. Hydrating your brain and body properly is essential to both physical and mental health.
Popular diet trends will insist on cutting out certain types of foods or adding in other foods in order to lose weight. They often cite a better mental health state if you use their diet plans. I am not a nutritionist, I can’t weigh in on the effectiveness of one diet over others. What I can do is encourage you to notice your body before, during, and after you eat.
Pay attention to your cravings and choose healthier options to fill that need. Craving something sweet? Have some fruit or natural fruit juice. Need something salty? Eat some soup, a pickle, or tortilla chips and salsa. Feeling fatigued? Try a small amount of red meat, beans, or a spinach salad with some mandarin orange slices.
If you often feel bloated or have digestive issues, consider your probiotic and prebiotic fiber intake. Consult a nutritionist if you can, or do your own research on how these two things in a healthy combination can enhance the brain-gut connection.
Slow down when you eat and listen to your body to know when you are satisfied so that you don’t over eat which will overtax your body’s digestive system and make you feel sluggish rather than energized.
When you are thirsty, drink water. Save the sweet, sugary drinks for enjoyment and limit your caffeine intake as it increases levels of stress hormones.
Notice how you feel after you eat, and if your body doesn’t feel good and strong within a half hour or so of eating, consider changing something in how you eat or what you take in.
To better help support your nervous system, reduce or eliminate things like caffeine, nicotine, alcohol, and other legal and illegal substances. While they might initially make you feel less anxious, they can increase your body’s anxious responses over time.
The final piece to intake is positive social interaction. Healthy relationships with family, friends, and significant others - even pets, can manage and help balance levels of the stress hormone cortisol. Make certain that you get in quality time with the ones you love, focusing on positive pieces and being a part of a supportive community.
The second part of this three-part foundational work in retraining the brain and body for a healthy anxiety response is output. Just as intake is what we take into our bodies, output is what we do with our bodies. In this case I really am talking about physical exercise. That might sound intimidating at first if you are a person who hated gym class in elementary school, or if you are someone who has physical limitations, but I promise, it doesn’t have to be.
The CDC recommends 150 minutes of moderate-intensity activities or 75 minutes of high-intensity aerobic exercise, and doing muscle strengthening either with resistance or weights two days a week. Anything that gets your heart rate up to 50-60% of its resting heart rate is considered moderate-intensity. An easy bike ride, gardening, washing your car, mowing your lawn with a push-mower, raking leaves, walking 2 miles in 30 minutes, swimming or water aerobics, and many other things you might not think about as exercise all count. You do not need to go out and run a 5k to maintain physical health (although if you can and will enjoy the accomplishment, go for it).
When we talk about output we often talk about heart rate. For a variety of physical health reasons, heart rate is important. But how does having a healthy heart rate help with anxiety? One of the most common side effects of anxiety is an increased heart rate. By intentionally increasing and decreasing your heart rate through exercise, you can actually retrain your heart to reduce it’s heart rate more quickly. Remember that your heart is a muscle - exercising keeps it strong and makes it able to respond to stimulation, including relaxation, more quickly.
Okay, to be honest, I hemmed and hawed about where to put breathing exercises. My smartwatch actually has breathwork on the list of possible exercises I can choose from. I could have put it in the previous section on output, but I decided that it makes more sense in rest because breathing exercises are actually intended to retrain your body and brain to a relaxed default mode rather than an anxious or hypervigilant mode. It is best to work on breathwork when you are already calm. Do it when you wake up, before or after meals, and before bed. There are numerous breathing exercises out there, pick your favorite one to three, and stick to them. When you breathe, make certain that you fill your lungs to capacity, inhaling through your nose to tell your brain you are safe, and exhaling out your mouth to release any old or stale air that might hang out in your lungs.
I get asked by my clients frequently why breathwork is so important. They know it is, they’ve been told to deep breathe for years, but no one ever tells them why it works. I won’t go into all that here, but a quick note on this is that your nervous system has a spot called the vagus nerve. The vagus nerve is the longest of the 12 cranial nerves and is responsible for breathing, heart rate, digestion, and reflex actions like sneezing, coughing and vomiting. When you practice deep breathing it is essentially pushing that nerve like a button which then sends a message to your body that you are safe and can relax. Likewise, rapid shallow breathing can trigger the nerve to send messages to those other parts of the body to trigger an anxious response. This is why breathwork is one of the most important and foundational pieces to having a healthy mind and body.
Rest also includes a healthy sleep cycle. Sleep routines that are calm and relaxing, integrating relaxation exercises through mindfulness or meditative practices are incredibly important to maintaining a healthy balance of stress hormones within your body. Sleep also functions as a regenerative necessity keeping both body and brain cells healthy and active. Deep sleep and REM are necessary for memory processing and strengthening of the immune system. For the best sleep, try shutting off screens at least 30 minutes before you sleep, use white noise machines if that helps, and keep your body as cool as you can manage while you sleep. Drinking warm herbal tea such as chamomile or lavender can also help promote restful sleep. If sleep is a struggle for you even after adjusting nighttime routines, I would encourage you to speak to your doctor to assess if a sleep study might be beneficial.
Input, output, and rest are all essential in the healing process, I won’t pretend that that is all there is to it, but without at least some modicum of these three things in place it is difficult to find long-lasting positive results. Balancing these three things is no guarantee of getting rid of disordered anxiety, although many people report significant gains when they do these three things with consistency. Having these as a solid foundation can help provide a sure footing for further work with a qualified clinician or helper, enhancing the effectiveness of other treatment options.