Dr Pamela Polcyn Phd, MFT

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Anxiety 101


Anxiety is the number one mental health issue for American women according to the National Institute for Mental Health and the number two issue for men after addictions. Only a small percentage of those with this condition receive treatment despite the fact that over 40 million adults suffer from it.

The average person experiences some worry over everyday concerns such as finances, health, work, relationships, or abilities. The anxiety sufferer experiences constant fear and preoccupation with these issues, and avoidance of situations that might trigger further anxiety arousal. The anxiety can range from a mild disturbance to a full blown panic attack.

Why does anxiety seem to be on the rise? Stressors and the resulting stress experienced by the general population has been on the rise in the last 50 years. Americans report an increasingly uncomfortable level of stress in their lives. The pace of life is rapid, the time to adjust and accommodate to changes is diminished.  Different sources estimate that anywhere from 50 – 90 % of adults conclude that they are experiencing stress in at least one area of their life. A period of stress usually precedes a bout of anxiety.

Stress is an arousal response to a situation, distress.  Anxiety is a reaction to the stress response, that includes worry, nervousness and panic. Stress is defined as emotional, physical or mental strain usually precipitated by an external situation or event, a stressor.  Anxiety is a subjective state of tension or uneasiness whose source is unclear, where the focus is internal. When stressed, an individual may experience a gap between what is being demanded of him or her in a situation and the perceived resources he or she has available  to respond to the situation. When anxious, the danger may be unclear, the feeling  that “something bad is going to happen.”

Thoughts, feelings and behavior are affected by stress.  The physiological responses to stress include headaches, muscle tension, fatigue, changes in sex drive, sleep difficulties, chest pains, or digestive problems. Emotional responses include irritability, inability to focus, sadness, or tension.  Behavioral responses include an increase in addictive behaviors such as smoking or drinking, social withdrawal, or angry outbursts.

A major stressor can trigger anxiety. Anxiety affects the body, mind, and emotions and can range in severity from mild uneasiness to severe panic.  The anxiety sufferer gets caught in a worry cycle of constant concern about daily activities, exaggerated focus on possible dangers, or persistent apprehension of a catastrophe. Fears of dying, going crazy or loss of control are common.  The body responds with heart palpitations, trembling, shaking, nausea, dizziness, hot flashes, and shortness of breath. Concerns mount about facing one or more of the feared situations. This worry or anticipatory anxiety leads to persistent avoidance of situations that might trigger or worsen the symptoms.

Anxiety is an integral part of today’s lifestyle. Sometimes when anxiety  arises in response to a specific situation, it is a reasonable reaction. Events that have the potential for loss or failure are challenges frequently faced with some anxiety. The anxiety provoked in these types of situations can provide momentum for facing these situations with increased attention and preparation if it is manageable.

Situational anxiety is a specific type of anxiety that differs from fear in that it is unrealistic and overblown.  Fear of driving on freeways, fear of conflict, fear of dentists or doctors are examples of this type of anxiety. The anxiety has not yet progressed to the phobic stage where anxiety producing situations are consistently avoided but they still induce uncomfortable symptoms for the individual facing the activity.

Even thinking about a particular situation can create distress and uncomfortable physical symptoms.  This is called anticipatory anxiety.  It is on the severe end of the worry spectrum. Thoughts are persistent and have an obsessive quality especially when the sufferer is faced with the feared situation. Anticipatory panic is the label given to a  pattern of the the worsening and intensification of the anxiety symptoms.

These experiences make it difficult for the anxiety sufferer to experience a sense of stability in their everyday life.  Daily life becomes either mildly or extremely unpredictable. Completing everyday chores, work, or even taking care of oneself can become overwhelming. Sleep can be disrupted, as can relationships and careers.

Treatment is about coming home to to a more consistent and manageable response to work, relationship and life challenges. Recovery is about developing an increased ability to cope with the stressors that arise. Finding an internal sense of calm from which one can respond to life in a more relaxed, authentic way is the result of a clear, focused approach to the treatment of anxiety, not as just a collection of symptoms but as a treatable condition reflecting the individual’s lifestyle. Effective treatment addresses the individual, not just the body’s reactions.


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Your body has a mind of its own during a panic attack. A built in fight or flight alarm mobilizes the body to react in an extreme fashion to neutral and sometimes indeterminable triggers. Psychological rather than physical dangers become threatening. You perceive a situation as overwhelming and your body reacts. An argument with your boss, going to a party, driving in a new area, or virtually any situation is seen as dangerous and can lead to a sudden episode of extreme fear and apprehension.

Panic Attacks are a type of anxiety disorder.  They are characterized by out of the blue, recurrent episodes of extreme fear and apprehension.  Fear of death, loss of control, or illness, or more generally fear that something bad will happen accompany these attacks. The attacks can last a few moments or can continue in waves over a few hours. It is estimated that 10-15% of the population experience panic attacks occasionally with about 2% developing a panic disorder.  These panic disordered individuals begins to avoid circumstances that remind them of the prior panic attacks.

The causes of  these frightening attacks are not clear.  Genes appear to have some influence as twin studies show at least a 40% likelihood of occurrence. There are numerous factors that contribute to their onset including biological triggers, environmental triggers, childhood triggers and an accumulation of stressors. Both nature and nurture converge to launch an individual into this pattern. A combination of predisposing factors which occur biologically, environmentally or in lifestyle contribute to the development of  this condition.

Panic attacks occur in the area of the brain called the amygdala which is the fear center of the brain. This area becomes over activated during a panic attack.  When people experience stress, the sympathetic nervous system mobilizes quickly, energy is released and the body prepares for action to cope with predators or other survival threats. When the parasympathetic system , whose job is to to calm the body down, is unable to cope with this sudden arousal and stabilize the body, the individual may experience the heightened arousal state of panic where feelings of choking, a heart attack, fainting, going crazy or dying erupt.

These episodes of panic usually occur rapidly, abruptly and intensely. The adrenals release a large amount of adrenaline which revs ups the body leading to feelings of dread or terror. An individual experiences shortness of breath, excessive sweating, cold hands and feet, shaking or trembling, dizziness, contractions in the chest and throat leading to a sensation of being unable to breathe. The body is jolted into preparation to run or fight even though muscle contractions activated by the sympathetic nervous system can trigger a freeze response and a sense of immobility.

The panicked body triggers a change in breathing which affects carbon dioxide levels in the blood. The amount of carbon dioxide in the body accumulates building up quickly and activating a terror generating system in the body. Carbon dioxide experiments at the University of Iowa indicate that not all individuals with these imbalances in the body experience panic. For those that due, the panic feels unbearable.  Those with panic attacks appear to be more sensitive to carbon monoxide inhalation than those without the condition.

Hyperventilation occurs if you over breathe or breathe through your mouth either causing panic attacks or contributing to them through the aggravation of physical symptoms. The body increases in alkalinity resulting in feeling jittery. The level of carbon dioxide decreases and causes your heart to pump harder and faster. This can  result in lights appearing brighter or sounds appearing louder. Brain vessels constrict  and decrease the amount of oxygen that gets to the brain resulting in dizziness, disorientation, or a sense of unreality.

Due to the multi causality of panic attacks, a multidimensional approach to dealing with them is appropriate.  A few effective approaches include:

1. Reevaluate breathing patterns: Although conventional wisdom has recommended deep, slow purposeful breathing techniques for coping with panic attacks, current research is suggesting something different. Breathing shallowly, as though sipping air, can reverse shortness of breath, dizziness and other panic attack symptoms. Breathing slower and shallower can feel strange at first as though you are not getting enough air. Treatment modalities are available that employ objective mechanical feedback on the level of oxygen in the blood as you get used to this new type of breathing. The daily practice of 15 minutes of breathing twice a day is recommended to develop good breathing habits. There are many other types of breathing whose goal is to regulate the breathing pattern and slow the breath. Practicing these techniques when you are not anxious is of great benefit.

2.Do regular exercise: Exercise contributes to a reduction in muscle tension and stress and therefore all types of anxiety. There is growing evidence that  developing an enjoyable exercise regime that incorporates light aerobic exercise 4 times per week can reduce both anxiety and panic. Exercise has been shown to enhance mood, improve sleep quality, reduce physical and mental tension and improve energy levels. It can reduce stress hormones implicated in the development of anxiety symptoms, produce mood enhancing chemicals such as endorphins which regulate stress reactions in the body. It decreases anxiety sensitivity which is an individual’s sensitivity to the symptoms of stress. Research also indicates that exercise reduces the intensity and frequency of panic attacks.

3. Streamline your diet: Identify and eliminate food triggers through keeping a food diary. Certain foods appear to contribute to either the likelihood of anxiety or the intensification of the symptoms of anxiety or panic, decreasing sleep quality and increasing panic attack frequency. One of the biggest culprits is caffeine. It can trigger feelings of nervousness, irritability, anxiety and panic. Sugar can also lead to panicky feelings in the body.  Research indicates that heavy sugar consumption followed by abstinence can cause a dopamine imbalance that can increase anxiety. Other studies indicate that sugar consumption can affect the body’s ability to fight anxiety. It can cause mood swings, agitation and blood glucose irregularities which can all contribute to anxiety. Monosodium glutamate, a flavor enhancer, can cause dizziness, sweating, nausea and panic attacks. Observing and keeping track of your own reactions to what you eat and drink can assist in deciding what to increase or decrease in your diet to reduce anxiety symptoms.

4. Alcohol: Although many people drink alcohol as a way to calm down and relax, it can increase anxiety.Alcohol consumption causes blood sugar fluctuations and a build up of lactic acid which can increase agitation, stress, and anxiety. Limiting intake can be an effective part of an anxiety reduction program.

5.Observe, problem solve or distract: Catch your symptoms at an early stage: Although panic attacks appear to come from out of the blue, research indicates that changes in  physiology occur about an hour before a full blown attack. Recognizing your own anxiety warning signs and developing a constructive response can alleviate or minimize symptoms. Exit a situation that is increasing tension until the symptoms subside. Talk to someone to distract yourself and to decrease the extra stress that comes from trying to hide the anxiety. Remain in the present moment by noticing the details of external objects preferably using your other senses such as smell, touch and hearing. Use your ability to focus and concentrate on an activity such as a game, planning your day’s activity, solving a puzzle, or counting backwards by 3. Move to a different area.  Go outside or to a different room. Practice breathing along with coping statements such as I can ride through this, all is well and this too shall pass.

Seeing a physician to rule out any physical causes for your symptoms or to discuss the possibility of a short term course of medications is a good initial step to take in beginning your treatment  for panic attacks.  It is a treatable condition.  Many options for treatment are available and can be successful in ameliorating symptoms and in developing a panic free lifestyle.  The right approach can result in much needed relief for this condition.

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Vitamin D3: 10 Reasons your Brain/Body loves it and the dangers of D-ficiency

Your body can produce most of its Vitamin D from sunlight if there is enough.

Vitamin D supplementation is being used to increase longevity, build bones, strengthen the immune system, lower the risk of diabetes, heart disease, kidney disease, Celiac disease,  Depression, Panic,  Seasonal Affective Disorder (SAD), Tuberculosis, Multiple Sclerosis, high blood pressure, cancer and even to fight flu and colds. Research conducted in the past decade suggests that vitamin D takes a more important disease-fighting and preventative role than was once recognized.

Vitamin D deficiencies are more prevalent than previously known. If you live north of  San Francisco, Philadelphia, Rome or Beijing,  chances are that you are not getting enough vitamin D. If you do not get at least a 15-minute daily walk in the sun, are African-American or have dark skin, are elderly, are obese or overweight, or are an adolescent  you are at risk for having lower levels of vitamin D. It has been estimated that worldwide up to one billion people  have a Vitamin D deficiency or insufficiency and the further from the equator you live, the more likely you will be D-ficient.  The elderly have a reduced capacity to synthesize Vitamin D in the skin. Sunscreen reduces the skin’s capacity to synthesize this vitamin by up to 95%.

Regardless of cause, vitamin D deficiency has significant consequences, both medical and psychological. Vitamin D receptors are located in every tissue in the body, and needed  in every bodily function including the heart, brain, muscles, and immune system.

Hundreds of years ago, “Vitamin D” was misrepresented when it was first discovered. By definition, it is not a “vitamin”.  Vitamins are not produced internally, they must be obtained externally from either supplements or dietary food sources. Vitamin D is actually  a hormone. After consumption or skin absorption, Vitamin D is converted to its active hormone form in the liver and kidneys.  As a hormone, it aids in the absorption of calcium used to build strong bones, teeth and muscles and many other bodily functions. When skin is exposed to  ultraviolet (UV) radiation from sunlight, a form of cholesterol in the skin is converted into a precursor of Vitamin D, called “cholecalciferol”. This is the form of vitamin D measured in tests.

Vitamin D controls  between 0. 5% and 5% of the human genome, activating the regulation of the immune system through upregulation or downregulation, by increasing or decreasing  the protein that genes transcribe. Recent research on Vitamin D and gene regulation found that  the gene pathways influenced by Vitamin D intake controlled vital functions in the body such as the immune function, DNA regulation and repair, and cellular response to stress. The D hormone has also been shown to affect brain function and brain development through the controlled release of neurotransmitters such as dopamine and serotonin.

In areas of the brain associated with depression, Vitamin D receptors have been identified. Seasonal Affective Disorder, which is a mood disorder accompanied by symptoms of depression, increases in likelihood with lower sunlight at darker times of the year. It has been linked to lowered levels of Vitamin D which may also affect serotonin levels in the brain.

Vitamin D deficiency and insufficiency are both highly prevalent in adolescents with severe mental illness and depression.  The Vitamin D Council concludes that

According to a recent review, treating vitamin D deficiency in people with depression or other mental disorders may result in improvement in both long-term health and quality of life. Reports confirm that vitamin D has a positive affect on depression:

Women in Washington State increased their vitamin D levels to 47 ng/mL (118 nmol/L) by taking 5000 IU of vitamin D each day during the winter. In some of these women, their depressive symptoms lessened as indicated by the decrease in their scores on a depression test.

Food Sources include Pink Salmon ( 3 ounces) which provides 530 IU’s, Cow’s milk (8 ounces) which provides 98, soy milk (8 ounces) 100, orange juice (8 ounces) 100, egg yolk (large) 21, shitake mushrooms 45, and fortified cereal products.