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Anxiety: It Can Be Managed By Leslie Solomon, M.A., L.P.C.

It's two o'clock in the morning and you're lying in bed. You have something extremely important and challenging tomorrow-a critical meeting, a presentation, or a major exam. You have to get a decent night's sleep, but you are still wide-awake. You try not to focus on having to fall asleep, but keep thinking that unless you fall asleep very soon, you will not be able to function optimally, and your whole future will be "doomed." You become more anxious by the second. It is now 2:30 a.m., and an entirely new disruptive chain of thoughts intrudes.

• "Will my child fit in at school?"
• "Will my senior in high school get into a suitable college?"
• "Is my young adult, who is away at college, still out partying, and will (s)he be up in time for that first class tomorrow morning?"

You tentatively glance at the clock on your bedside table and notice another half hour has gone by. You now begin to think about that pain you are having in your side, that frequent headache, and possibly even, "Oh my goodness, maybe I have a brain tumor!"

If you are a student, your thoughts might include:

• "I have to make an excellent grade on this test."
• "My whole future depends on this score."
• "My career is at stake."
• "Will I meet my parents' expectations or will I disappoint them?"
• What happens to the body when we are worried or anxious?

Imagine a caveman walking back to the comfort of his cave and becoming aware of a saber-toothed tiger crouching in the bush. His body undergoes sudden changes called the "fight-or-flight" response. His brain senses a sudden or severe threat or stress, and releases a flood of adrenaline and body chemicals to muster defenses all over the body.

• His breathing becomes faster.
• His heart pounds.
• His blood pressure rises.
• His muscles tense for action.
• His hands and feet may become cold and sweaty.
• His mouth becomes dry.
• His pupils dilate.
• His digestive system slows down.

His body is prepared to fight that tiger or flee to the safety of his cave. He is determined to survive. Today the tigers are gone, but now man faces different kinds of stressors. People today are bombarded with more anxiety-producing stimuli that demand more of our nervous system than it can handle effectively. These stimuli could be physiological, psychological, or social, yet can still pose a real threat and elicit the anxiety - or "fight-or-flight" response. Everybody worries from time to time. This is perfectly normal, even healthy. Anxiety is a natural response to anticipated future problems. After all, we are animals that have an instinct to survive in the jungle. Anxiety can be a valuable friend and increase our productivity and excitement with life. Some anxiety can motivate or mobilize us to change and accomplish goals. But when worry becomes a full-time preoccupation and accumulates over a period of time, it can lead to anxiety disorders like:

• Migraine and tension headaches
• Irritable bowel syndrome or ulcers
• Insomnia
• Obsessive compulsive disorder, phobias, panic attacks
• Essential hypertension
• Raynaud's disorder (contraction of the arteries, most commonly in hands and feet)
• Anxiety-depressive cycles
• A dependence on drugs or alcohol to relieve our feelings of being uptight

People may differ biologically in their predisposition toward the arousal of anxiety systems and their perceptions of threat. If our parents or grandparents struggled with anxiety, it is likely that they may have passed some of these genes on to us. However, even though anxiety may be genetically influenced, through learning how to modulate emotions, thoughts, and behaviors, anxiety does not have to be genetically fixed.

THE FIGHT / FLIGHT OR FREEZE RESPONSE
Anxiety can be expressed in different ways. The "fight-or-flight" response is the most active defense and can be expressed as "acting out." For example, some children become oppositional and aggressive. Stressed elementary students in grades two through four, tend to show emotional stress behaviors such as crying, throwing tantrums, wetting themselves, and vomiting. The older children, such as those in high school, are more likely to exhibit "rebellious" responses such as refusal to participate, cutting class, and deliberately undermining a test by answering incorrectly. This is a way for these children to actively avoid their uncomfortable feelings of anxiety.

Another way the body reacts to overwhelming stress is the "freeze response." When these children feel anxious, they display passive aggressive behavior, "not doing" or forgetting homework. In a test situation, these children simply shut down, like "deer caught in the headlights." When fighting or fleeing or no longer physically possible, and the child is in a state of helplessness with a sense of not being able to escape, (s)he will frequently enter this freeze, or immobility state. This is a totally instinctual and unconscious reflex that completes the escape response.

• Heart rate decreases.
• Blood pressure drops.
• Muscle tension decreases.
• The focused and alert mind becomes numb and dissociated.
• Cognitive functioning is compromised.
• Memory access and storage are impaired.

HOW DO WE MANAGE THIS "FIGHT / FLIGHT / FREEZE" RESPONSE?
Although anxiety is a natural part of life, it must be managed effectively for our healthy well being. It is not the event that triggers the anxiety, but how we view and then respond to the event, that will determine whether or not we become stressed. Sometimes the slightest thing can trigger an emotional over-reaction in us, completely out of proportion to the event itself. This is more likely to happen when we are under pressure and feel anxious and vulnerable. At other times, we might be able to handle major emergencies with almost no felt sense of effort.

The good news is there are usually many ways of perceiving a particular situation and many possible ways of handling it. It means that the way we see and evaluate our problems will determine how we respond to them and how much anxiety we will experience. We can have much more control over our anxiety response than we generally think. While there are always many possible stressors in our environment which we cannot control, we can change how we think and feel about these stressors, and therefore, change the extent to which we feel threatened.

We, as humans, are biological, psychological, and social beings. We cannot separate the brain, mind, and body. Consequently, comprehensive management may require an interdisciplinary approach of psychotherapy, biofeedback therapy, cognitive retraining, and medication.

BIOFEEDBACK THERAPY is a technique that helps produce a state of relaxation. We learn to reduce our state of anxiety and learn that we do have control over how our body responds to an event. Biofeedback-assisted relaxation training is more than seeing a movie to take our mind off things, or taking a long quiet walk to unwind. Biofeedback training most often includes a combination of deep breathing, muscle relaxation, and visualization skills. Through biofeedback training sessions, we will discover that our racing thoughts will start to slow, and our feelings of fear and anxiety will ease. We learn how to interrupt panic and how to use self-regulation skills to overcome phobias. In fact, when our body is completely relaxed, it is not possible to feel fear and anxiety. Relaxation and anxiety are physiological opposites.

The first step is to deal with physical stress reactions by practicing relaxation exercises. Like the "fight-or-flight" reaction, the relaxation response is innate. At some point in our childhood, we perhaps responded to an event with anxiety. This response was over-learned by repetition. The relaxation response can be over-learned and established as a new pathway in the brain. Acquiring these skills is much like learning to ride a bicycle. We all remember how much initial conscious effort is required in learning balance, coordination, and concentration; but consistent, repetitive practice and commitment to learning this skill paid off, and now most of us can simply sit on the saddle and ride automatically.

COGNITIVE BEHAVIORAL THERAPY
The next step is to address the way we think of, or perceive an event. Thoughts can cause feelings and emotions. Many emotions you feel are preceded by a thought-this thought can often go unnoticed. Change the thought, and we change the feeling. Cognitive retraining teaches you how to recognize, challenge, and then change the thought. A simple example of this is how we respond to being stuck in traffic, especially when we have a time commitment. Our thoughts could be, "I can't stand this traffic. It's impossible to get anywhere on time in this city," and our anxiety increases. We cannot change the traffic, but we can change how we feel about traffic. We could change our thoughts to, "I have no control over this traffic, but I can change how I view it and thus change the way I feel. This gives me time to listen to that new CD I bought, or I could even turn off the music and cell phone and enjoy the silence of my drive."

HYPNOSIS
Hypnosis enables us to deepen our thoughts and feelings. It is a therapeutic skill that allows us to focus our attention and block out distractions. This is called a trance state. While working with someone in trance, the therapist can then effectively communicate ideas that enhance motivation and change perceptions. It is a way to go into our unconscious minds where we are free from self-critical and judgmental thoughts. Hypnosis is most often effective when it is combined with other nonhypnotic interventions and used to further the progress of psychotherapy.

In summary, even though anxiety is a normal, even healthy part of our lives, it can be counterproductive when not managed. Because excessive anxiety is a learned response, effective behavioral and cognitive-behavioral management of anxiety can be accomplished in 8-12 short-term interventions of biofeedback, cognitive retraining, and hypnosis. These practical and concrete approaches focus on specific problems and help to teach emotional self-management skills. The treatment interventions are available to children, adolescents, and adults, and are offered by Lesley Solomon, A Licensed Professional Counselor and Biofeedback Therapist at the Tarnow Center for Self-Management.