Friday, February 27, 2009

Nonpharmacological Treatment of Anxiety

There are many non pharmacological means to treat anxiety. Each of these has true scientific validity and have been shown in a wide variety of studies to have therapeutic value.
The first to consider is exercise. A half hour of aerobic exercise two to three times a week has an equivalent anti anxiety effect to taking the standard anti anxiety medication that most physicians would prescribe. A scientific study compares one group, the test group with the non test, or control group. A measurement for anxiety has been used at the beginning of a study and used again at the end of the study to see which group had changes. It's by this method that exercise has been demonstrated to reduce overall anxiety. Of course, we all might intuitively know this but knowing something doesn't get most of us off the couch. The studies are supposed to be 'convincing' . Even convinced I'd rather be anxious and lie on the couch with the channel changer at times.
Which brings us to cognitive therapies. Aaron Beck, a brilliant researcher in mood and anxiety, demonstrated that what we 'feel' is really a product of what we think. He was the developer of cognitive therapy which is an educational therapeutic process of reprogramming our minds to be more positive and less anxiety prone. His student, Burns, wrote the book, Feeling Good, followed by the blue Workbook of the same name and many well earned international engagements. Simply reading Feeling Good makes people less anxious. It details the work of Aaron Beck and explains not surprisingly that if we don't delete the many 'cognitive distortions' from our mental apparatus we simply won't feel good and we'll continue to shoot ourselves in the mental foot so to speak. Bradshaw an earlier therapist described the ways children learned these negative patterns of thinking which Freud had earlier included in his famous 'repetition compulsion' explanations for how the unconscious programs affected the behaviour of individuals who consciously would not act as they did if they could. Cognitive therapy aims at identifying these anxiety provoking mental 'viruses' and deleting them. My personal favourite is the 'sky's falling', otherwise known as catastrophising or making a mountain out of a molehill. If I hear an unusual noise in my car engine my tendency, possibly learned from my father, is to instantaneously assume the worst, and see myself with a huge car bill for ghastly repairs assuming I don't get killed in a horrible car crash en route to the garage. "Disqualifying the positive" is another of my personal favourites in which I hear dozens of compliments from family and friends but ignore those comments in favour of dwelling on a negative criticism from a stranger who might also be an absolute idiot.
A course in cognitive therapy can be likened to a cleansing enema for the bowels. The difficulty however is to resist returning to the well honed negative patterns of reacting as a constipated personality especially under stress. These negative 'habits' of thinking were once beneficial and adaptive and have a basis in truth so aren't easily let go of and are strangely comforting as one might find the 'devil' we know to the 'unknown'. Consequently modern researchers picking up from where religious scholars left off have looked at how we program our brains on a daily basis.
The Biblical Phillipians 4 states, "whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable - if anything is excellent or praiseworthy -think about such things." Indeed this is the essence of Cognitive therapy but it was writtent 2000 years ago and still needs to be reframed and used. To this end it is best to consider the anxious self as a sick stomach and be very careful and testing about what one feeds the mind. Alternatively one can consider oneself 'allergic' and observe if watching the movie Carrie doesn't just leave you hiding in your room for days. Fatal Attraction might instead of entertaining you make it impossible for you to be in the same room as your girlfriend. There are times for all these things but there's a balance too so that too many vampire movies could make one suspicious and anxious about working in a Transylvania shipping firm. Also reading news of the .000000001% of the planet brutally murdered or anally probed on a daily basis might not bring 'peace of mind'. Alot of changes in what and who one associates with goes along way to reducing overall anxiety.
Drugs and alcohol initially help with anxiety and are often described as 'self medicating' but unfortunately they're a poor substitute for long term means of reducing anxiety and can cause one severe damage in so many ways as they cause one to ignore the message the body might be sending about danger. Consider a drink is like 5 mg of valium and consider that so many people feel they need the equivalent of 20 to 40 mg or more of valium to be with their supposed friends or lovers supposedly some 'safe' place where they insist they're having a good time. Gag me with a spoon! Maybe stopping the booze and waking up to who your real friends are (not the bar tender or drug dealer, for instance) and asking yourself or seeing a counsellor to talk about what life you really want, would be better than increasing the amount of self medication to stay in this definitely unhealthy scenario. The trouble with pain killers of any kind is that pain is a protective response and while morphine can stop the pain it might also result in one continuing to do what causes more damage. Alot of short term gain priorities are simply down right foolish when one considers that the majority of people live to 70 and life is more of a marathon than a sprint. Maybe a job or a girl or guy really isn't worth dying for even if you could do it with just another drink or drug to get you through the immediate 'anxiety'.
Light is very important for reducing anxiety. Seasonal Affective Disorder (SAD) lites have been proven to benefit a wide variety of people who may not have depression but have anxiety. Dr. Seligman whose incredible on line site "Authentic Happiness' years ago showed in his "learned helplessness' models the connection between anxiety and depression. Anxiety was the internal response to an external threat which even if countered over time would use up the resources in the brain for self soothing and lead to a depressive state of 'learned helplessness'.
On his site Seligman shows the association between resentments and anxiety. The essence of Buddhism is that desire leads to suffering and expectations have been the source of much resentment. Reality testing is the means whereby one reviews the facts about the expectations one has and recognises how unrealistic expectations can lead to anxieties.
In relationships Gottman at the famous Love Lab has shown that being in the company of partners who are constantly demeaning, 'cutting the heads off others to make themselves look taller,' naturally leads to feelings of anxiety along with feelings of low self esteem and worthlessness. Homicidal or suicidal behaviour can definitely follow. Assertive behaviour was akin to Gandhi's non violence techniques, not in themselves aggressive but refusing to accept or be in the presence of those who constantly and repeatedly were negative. Unfortunately many social bullies who took assertiveness training turned around and used it to justify their dramatic reactions and refusal to accept any feedback especially constructive feedback.
Not surprisingly new solutions create a new set of problems and alot of anxiety is a product of failure to change in face of new circumstances. Selye, the famous guru of stress management correctly indicated that our brain was developed on a primal mammalian mainframe which was fine tuned for quick reactions to saber tooth tiger attacks and not at all well developed to the seige attacks of governments, beaurocrats and law courts. These institutional threats 'wear' one down like droughts and plagues if one continues to respond to them as if they were 'real' ,as in your 'eviction' is happening tomorrow. More commonly their responses are 'or else' and ' we will take action so you had better panic if you know what's good for you." The aim of these social terrorists is to scare you and yet if you react to every one of their increasingly silly threats which arrive in the mail on a daily basis then you shouldn't be surprised that your body collapses in paralysis and each week you feel like you've fought a dozen saber toothed tigers.
This goes with all the fear mongering messages about 'gloom and doom' and 'the world's going to end' if you don't send a cheque to the "save the world today people." "Don't you care?!" Governments, beaurocracies, institutions and corporations are commonly rude, ignorant, insensitive, grandiose, arrogant, anti social megalomaniacs that routinely make mistakes and threaten all manner of people including the planet itself. It's essential not to take this personally and to recognise that if you responded to all their simultaneous demands you'd die and they wouldn't care at all. They don't care about you, as say your mother might. The key is to realize that you're not alone. Nobody really cares for them and yet we all tolerate them because there's something intrincially addictive about having roads or credit cards or shopping at Wal mart. It's just important not to let them ruin your day with their cacophony of demands and complaints after promising you the world if you used them. Reducing anxiety is keeping things like these monsters in perspective.
Good friends - The philosoper Cicero and many after have emphasized the importance of friends to happiness which itself can also be described as reduced anxiety. Things weren't as valuable in the long run as the company of friends or the power of relationships. Cicero commented on the irritability and general unhappiness of the very rich of Rome. In contrast he pointed to the comfort and joy of non judgemental companions joining for the sharing of tales.
Obviously massage lowers anxiety but the trick is getting someone to do this for you or being able to pay for the service. Making the money for a service or thing might in the long run not be worth the anxiety produced by that process as Thoreau in Walden Pond so critically explored.
Skin to skin contact is anxiety reducing. This alone might explain contact sports. Unfortunately outside of the tropics people are rarely in such close proximity except for sex which itself is anxiety reducing however cuddling, hugging and hand holding without culminating in sex go along way to reducing anxiety. Sex, while definitely reducing anxiety can itself be anxiety provoking if one had expected just to shake hands during the peace in church for instance and the stranger you shake hands with assumes this is a cue for a public orgy. Shaking hands is shaking hands. Hugging is hugging. Taking off one's clothes and their clothes and climbing into beds for purposes other than sleep is sex. And sex between mutually consenting adults, even if it isn't particular good sex, is still in the long run anxiety reducing. Evidence suggests that sex alone may be anxiety reducing even if it lacks a certain 'je ne sais pas.'
Talking therapies, psychodramas, music therapies, body therapies, neurotherapy, bio feedback, acupuncture, yoga, tai chi, 12 step programs and community have alll been shown to be anxiety reducing.
Herbert Benson in the 70's demonstrated the validity of "Relaxation Response" in lowering blood pressure. His work was published in the New England Journal of Medicine and was a cornerstone in the psychosomatic awareness that said, frankly, the toe bone is connected to the head bone. Rahe and Holmes in their classic stress studies showed that major changes good or bad could accumulate rapidly and this could lead to anxiety and stress being experienced organically. Cancer, heart disease, infectious disease, accidents have all be shown to be associated with anxiety. Chronic anxiety can reduce immunological response by at least 30% leaving one vulnerable to all manner of physical disease.
Now, if I were to be a rich doctor with sound business sense I'd encourage you to be anxious about anxiety and say it's going to kill you unless you listen to me and buy whatever product I'm selling this week. Instead , I'd prefer to sit with a begging bowl in some of my favourite spots on the earth but others rarely go there reducing the likelihood of sustenance and eventually government officials would find me and license that part of the earth or say I was trespassing. Being alone and having some time for oneself and time for God or whatever you might call your higher power is as anxiety reducing as prayer or reflecting on what your fundamental belief system is about life, or as Harold Kushner might ask why "bad things happen to good people'. I laughed when I was anxious about a divorce proceeding and a friend said ,"looking for justice in the courts is like looking for love in a brothel." Laugher and good humor are anxiety reducing. For men looking at breasts is too. My fundamental belief system about governments, courts and indeed my 'higher power' had to change or I'd be forever be a 'victim' rather than a 'survivor' and forever fearing death when the classic 'Denial of Death' insists it's coming regardless. There's no need to rush to death as death will find you. Anyday this side of the grass is a good day. Anxiety is real but while Jesus didn't say alot of things people claim he did, he most adamently commanded "Do not be afraid". The song 'Don't Worry. Be happy" may be simplistic but it's nonetheless true. Life is to be worn like a loose robe. Anxiety is to be avoided, used to re direct our lives perhaps, but not to be dwelled on or worse nursed. That said, there are medications which can treat anxiety but even the people who make these medications would prefer you couple their use with healthy living.


detourcy said...

There's the rub..."Even convinced I'd rather be anxious and lie on the couch with the channel changer at times."
Is what we think a product of what we feel or vice versa? CBT is a cognitive program, but Freud talks about "unconscious programs." Isn't that a contradiction?
I think this old fashioned 'sabre toothed tiger" stuff is to simplistic. The brain is also very wired for group & societal behaviour. Man is too puny to fight a sabre-toothed tiger. He needs a team effort. Why does man have so much brain devoted to face recognition & feelings? Not just man but all the societal animals. Even sabre-toothed tigers probably.
But given CBT does help a bit & all help is welcome, I'd think, it is chipping away at the edges isn't it. IZNIT?
I heard Prof J. Stein at Oxford reporting on his clinical trials of giving UK prisoners supplemental vits & fatty acids & so forth. They improved behaviour 40%. Remarkable. Every little bit of help helps.
We don't know do we, really. I suspect words are a late development in mammalian development. Thus we may go back to massage & food & sex & give CBT a miss? Maybe good feelings will lead to better thoughts?

haykind said...

The latest rage is to bypass drugs altogether and go right to the surgical implants.