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Stress and Anxiety

Is Anxiety the New Norm? Tools to Manage Mental Health in the 21st century:

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Anxiety is affecting more people now than ever [link to thread on scope of the problem below]

How does stress contribute to anxiety? [link to understanding the effects of the stress response below]

What is anxiety at its core? [link to what is anxiety on a physiological level]

Is there hope if you suffer from anxiety? Yes!

Our stress response is one factor that affects anxiety that we can shift [link to conclusions and solutions]

Tools to improve your Anxiety [link to SOLUTIONS section below]:

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We start our days checking our phones for any missed messages. Before we know it, we’re running late for work. Working from home is supposed to give us more time right? But, somehow it seems like less. We rush to get ready and grab our coffee and plop down in front of our computers trying to get through our inbox before the first meeting.

Soon, we’re overwhelmed with feelings of a fast heart rate and sweaty palms, ruminating over and over in our minds, and worrying about the next thing that will go wrong with work or with our family.

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Can you relate?

It seems like feelings of anxiety have become the new norm. Are we doomed to live our days like this? Is there a better way to manage our mental health and day to day emotions? It can seem overwhelming to even start to sort through what is causing everyone to feel so anxious. Fortunately, there are many tools that can help us manage our anxiety and improve our mental health so we aren’t constantly feeling so uncomfortable in our own skin.

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[Link here for Deeper Dive Research based blog on this] Tools to Help with the Epidemic of Stress and Anxiety:

 

Highlights/Thread:

  • Anxiety is extremely common, affecting over 40% of the population in recent years

  • Many of us live in a near constant state of “fight or flight” with ongoing activation of our stress response

  • Too much stress for prolonged periods of time can lead to feelings of anxiety and overwhelm

  • By engaging in stress reduction strategies, it is possible to improve anxiety

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Scope of the Problem:

Anxiety and mental health conditions are occurring at increasing rates. A 2005 survey of over nine thousand people showed close to 30% of those surveyed experienced anxiety during their lifetime. The situation has only worsened in recent years due to the pandemic. A 2021 report by the CDC showed that the percentage of adults who reported recent anxiety or depression in the previous 7 days had reached over 40% of those surveyed. In addition, over a quarter of  those reporting these symptoms were not able to access mental health care. Clearly we need more access to mental health services to address this unmet need. But, in addition to seeking mental health care, what else can individuals do to help themselves cope with the anxiety and stress of life in the 21st century?

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Understanding the effects of the stress response:

Before identifying tools that individuals can use to help themselves, it is important to understand some of the underlying factors that contribute to stress and anxiety. Many of us live in a near constant state of “fight or flight” with ongoing activation of our sympathetic nervous system. This can be due to stressful situations at home or work on a personal level, or events on a global level. Our physiology historically evolved to meet acute temporary stressors (such as running from a tiger) with a sympathetic response that favored survival, and then return to a parasympathetic state. However, with all of the stressful triggers that pile up in day to day life, many are stuck with the gas pedal on, and the nervous system in sympathetic overdrive.

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On a physiologic level, the HPA axis (hypothalamic-pituitary-adrenal axis) is activated when a stressor or threat is detected. The threat can be real (like rushing to catch a flight) or perceived (such as internal rumination and worry). This activation results in the production of more cortisol which helps fuel the energy needed for acute stressors. However, if this system is activated for too long, it can impair various systems in the body. An overactive stress response has been associated with mental health conditions including anxiety.

Overall, while some stress can actually be helpful and improve performance and motivation, too much stress for prolonged periods of time can lead to feelings of anxiety and overwhelm.

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What is Anxiety on a physiologic level?

Now that we’ve discussed the stress response, it would be helpful to examine anxiety more specifically. Some theoriespropose that there is an impairment of vagus nerve activity in mental health disorders like anxiety. The vagus nerve is involved in the parasympathetic or “rest and digest” branch of the nervous system. If vagal nerve activity is impaired, this leads to an imbalance and inflexible nervous system that is unable to inhibit the overactive sympathetic response. In other words, we can get stuck in “fight or flight” and are unable to relax and recover.

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A 2014 meta-analysis explains it well by saying “Anxiety, in all its forms, can be seen as a failure of inhibition involving reduced capacity to inhibit cognitive (e.g., apprehension, vigilance, and worry), affective (e.g., panic), behavioral (e.g., avoidance), and physiological (e.g., increased HR) responses, leading to reduced vagal outflow and lowered HRV.” Once we understand that anxiety is linked to an impairment in these inhibitory pathways, we can consider interventions that would improve these pathways and help individuals achieve improved self-regulation and reduce feelings of anxiety and overwhelm.

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Lifestyle Tips for Alleviating Anxiety:

We’ve talked about the prevalence of anxiety and some underlying causes, now let’s move on to lifestyle changes that can help. For an overview of general lifestyle recommendations we recommend, see our blog on Solutions to Chronic Stress [link to this blog]. Read on for some more specific hacks that could help you reduce anxiety and feel more balanced with your emotions in daily life.

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Food: 

When we are talking about food, there are several different versions of a "healthy" diet but they all consistently include and exclude certain foods. Research has shown that a diet higher in foods like fruits, vegetables and nuts is associated with lower levels of anxiety and stress, and diets higher in sugar and processed foods have been associated with higher levels of anxiety. A whole foods diet that includes a wide variety of colorful fruits and vegetables, clean proteins, healthy fats and healthy carbohydrates would be a great start. It is also important to limit added sugars in the diet and minimize fast food/processed foods. We want to stick with foods that are on the perimeter of the grocery store, and avoid packaged foods with long lists of ingredients.

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Caffeine intake:

While caffeine can be helpful in many ways, like boosting our mood and alertness, sometimes too much caffeine can lead to increased feelings of anxiety. In some sensitive people, even small amounts of caffeine can increase feelings of stress and anxiety. For the average person that is not overly sensitive to caffeine, 250mg of caffeine (which is equivalent to 1 and a half to two cups of coffee or 4-5 cups of black tea; here’s a helpful chart on caffeine in various drinks) is generally considered tolerable and may be beneficial for our mood, whereas more than 400mg can potentially contribute to more anxiety. However, it’s important to remember that we each have our own threshold, some may react negatively to lower amounts and some may tolerate higher amounts. The only way to determine if your current caffeine intake is making you more anxious, is to experiment with cutting back.

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Take home points on caffeine intake and anxiety:

  • If you’re drinking more than the equivalent of 400mg of caffeine a day (check out this chart), consider cutting back to see if your anxiety improves

  • If you’re drinking more like 250mg of caffeine or less, you still may want to experiment with cutting back to see if your anxiety improves as some of us are more sensitive than others

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Alcohol intake:

While it may seem like alcohol temporarily reduces anxiety, it can actually worsen anxiety if used regularly. Alcohol can affect an area of the brain that helps regulate emotions called the amygdala, and this in turn can lead to more anxiety. Alcohol can also affect levels of neurotransmitters in our brain like [GABA, serotonin and dopamine](https://www.candi.nhs.uk/news/unhealthy-mix-between-alcohol-and-mental-health#:~:text=Alcohol stimulates GABA receptors%2C and,overdoses can lead to coma.&text=If there is a constant,adapt by reducing GABA receptors.) which are all important for our mood. If you do use alcohol regularly, you may want to consider working with your physician to determine if cutting back safely can help reduce your anxiety.

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How much alcohol is too much? Well, the CDC recommends no more than 2 drinks a day for men and no more than 1 drink a day for women, but like caffeine, everyone is different. Some individuals may experience a detrimental effect with any amount of alcohol, and others may have a different threshold.

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Stress:

We’ve all felt the effects of stress on multiple areas of our lives, including the effects on our mood and anxiety levels. When it comes to external factors contributing to our anxiety levels, some things are under our control and some are not. We want to both reduce those external factors when possible, and also learn strategies to improve our resilience and mitigate the impact of stress that is unavoidable.

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Controlling External Stressors: One habit worth breaking:

When it comes to avoiding external factors: using electronics before bed is a common habit that many of us have (and have the ability to change!). Scrolling through social media, reading the news on your iphone or sending one last email for work before bed can all activate our sympathetic nervous system. Studies have shown that this can lead to increased feelings of stress and anxiety in both adults and children. It can be helpful to try to stop looking at screens at least an hour or two before bedtime to help down regulate your nervous system. Listening to a podcast or reading a book are some alternatives.

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Improving our Resilience to Stress:

For all of the unavoidable stressors in life, it’s become essential that we build our toolkit for resilience for our overall health and specifically for our mood. If you experience anxiety regularly, there are many choices when it comes to working with our stress response that can help immensely. Gentle yoga, meditation, breathing exercises, and guided imagery are just a few. This CDC website has some useful links to try out for some of these breathing and relaxation techniques. This podcast episode by Stanford professor Dr. Andrew Huberman, PhD also reviews some very helpful breathing techniques for anxiety.

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Here’s a summary of some resources to consider to modulate the stress response:

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Exercise:

Exercise has so many benefits and reducing anxiety is definitely one of them. Any amount of physical activity is better than none. Regular exercise can prevent against future anxiety episodes and can also be used as part of an overall treatment approach for anxiety. A meta-analysis looking at close to 50 studies found that groups using exercise as part of their treatment had significant reductions in anxiety. What kind of exercise should you choose? Strength training, aerobic activity, as well as yoga and tai chi have all been shown to have benefits on mood and anxiety so choose what you like.

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Sleep:

It can be a two way street with sleep and anxiety; poor sleep can contribute to anxiety and anxiety can certainly cause sleeping problems. In addition to working on anxiety with the tips above, take a look at this blog for ideas on how to optimize your sleep to reduce anxiety. [link to blog on Stress and Sleep].

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Summary:

For anyone suffering from anxiety, there is hope. We know that our response to stress and the tools we engage in to modulate this response can have a significant impact on anxiety. By engaging in targeted lifestyle changes, we can change how our body responds to stress and reduce the feelings of anxiety and overwhelm that are all too common.

 

Here’s a summary of the lifestyle tips we discussed above:

  • Watch your intake of processed foods/sugars, caffeine and alcohol

  • Reduce anxiety at bedtime by avoiding electronics 1-2 hours before bed

  • Consider building your stress resilience (meditation, breathing, yoga, etc.)

  • Move daily if you can, any form of exercise will help

  • Optimize your sleep

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Getting Back to the Basics with Breathing

If we know that there is an imbalance in the nervous system in those who suffer from excessive stress, worry and anxiety, how can we intervene on a nervous system level?

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It turns out that individuals with anxiety have been found to have a lower HRV, or heart rate variability. HRV is an important marker of psychological well being that has been studied in those with anxiety. A 2014 meta-analysis that looked at 36 studies showed that anxiety disorders are associated with lower HRV. Because of this association, it would make sense to consider interventions that can help improve HRV as part of an overall comprehensive approach to anxiety and stress related conditions.

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We know that diaphragmatic breathing is one such intervention that can help improve HRV, and we know that a high resting HRV is associated with improved self-regulation and less negative emotion during times of stress. A 2017 meta-analysis examining 24 studies showed that HRV biofeedback training is associated with a large reduction in reported anxiety and stress. This supports the use of HRV biofeedback as a promising therapy to reduce anxiety and stress.

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