Tag Archives: anxiety

Anxiety and Elections

Anxiety is an ancient emotion that can help us assess and respond to future risks to our safety and security, a basic human psychological need as Maslow taught us, in his hierarchy of needs.  Anxiety refers to a prolonged state of apprehension brought on by uncertainty about future threats. Past threats logged in our neural memories and unconscious can also influence our view of upcoming risk. As such, anxiety is a natural emotion and vital for survival.

In contrast to anxiety, fear is an acute or phasic response to an immediate and identifiable threat. Anxiety has apparently persisted over human history, indicating that it has an important evolutionary role. Simply put, the evolutionary advantage of anxiety could be that it leads individuals to take fewer risks, seek safety, and focus on doing things well. On the other hand, anxiety can limit the risk-taking that advances mental flexibility, growth, and adaptability.

Interestingly, across the data, anxiety has a curvilinear relationship with behavior. For example, if you are moderately anxious, it can spur action and involvement. However, once over the hump of the curve, when anxiety becomes excessive, it leads to destabilizing and even shutting down of behaviors that are productive.
There are certainly plenty of reasons to be anxious about the state of the nation: the coronavirus pandemic, the economy, climate instability, physician burnout, mental and medical health, homeschooling, and racism, among other societal and personal psychosocial stressors. Some mental health professionals are calling 2020 the most challenging year they’ve ever seen.

Also, partisan political warfare, civil unrest, and terrifying conspiracy theories on TV, news media, and the internet. The actual polls confirm intuition: we are a nervous nation. In May 2020, the US Census Bureau found major depressive disorder at the highest level since they recorded statistics. Earlier this year, my professional organization, the American Psychological Association, conducted a “Stress in America” survey, in which they found more than half (about 56%) respondents identified the 2020 election as a significant stressor. At the end of June, the Centers for Disease Control reported that the highest rising levels of anxiety were among young adults, as well as black and Latinx people of all ages.

The physical and psychological symptoms of anxiety, such as feeling tense or having trouble concentrating, can be so uncomfortable that they cause behavioral changes. Fight or flight stress responses range from avoidance to aggression, as well as self-medicating with alcohol and drugs. One can also have anxiety about one’s very existence and the purpose of one’s life. That is called existential anxiety disorders, as coined by the psychologist, Irvin Yalom.

In terms of evolutionary psychology, anxiety helps us survive. We look for threats. One way that anxiety can do this is to organize our cognitive functions quickly in response to danger. Another body of research indicates that isolation induces anxiety. For most of us, being with community helps alleviate anxiety. we need people. What else helps? Keeping to routines and schedules, self-care, engaged participation, and hope through improved mental well-being. And, when needed, seeking mental health professionals. 

What is social anxiety disorder?

My patient is sobbing in the office, stating she could not order her meal in a restaurant, and felt tongue-tied. She was on a date, which also took immense courage. Social anxiety disorder (also called social phobia) is a mental health condition. It is an intense, persistent fear of being watched and judged by others. Being embarrassed, or feeling foolish becomes a pervasive fear. This fear can affect work, school, and your other day-to-day activities. It can even make it hard to make and keep friends.

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in social situations, such as meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things in front of people—such as eating or drinking in front of others or using a public restroom—also causes anxiety or fear. The person is afraid that he or she will be humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so strong that they feel it is beyond their ability to control. As a result, it sometimes gets in the way of going to work, attending school, or doing everyday things. People with social anxiety disorder may worry about these and other things for weeks before they happen. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them. Avoidance creates comfort, but keeps the person from learning the skills to manage the situation.

Social anxiety disorder is not uncommon; research suggests that about 7 to 10 percent of Americans are affected. Without treatment, social anxiety disorder can last for many years or a lifetime and prevent a person from reaching his or her full potential.

What are the signs and symptoms of social anxiety disorder?
When having to perform in front of or be around others, people with social anxiety disorder tend to:

  • Blush, sweat, tremble, feel a rapid heart rate, or feel their “mind going blank”
  • Feel nauseous or sick to their stomach
  • Show a rigid body posture, make little eye contact, or speak with an overly soft voice
  • Find it scary and difficult to be with other people, especially those they don’t already know, and have a hard time talking to them even though they sometimes wish they could.
  • Be very self-conscious in front of other people and feel embarrassed and awkward
  • Be very afraid that other people will judge them
  • Stay away from places where there are other people

Patients often ask me what causes social anxiety. Social anxiety disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others’ behavior may play a role in causing or worsening social anxiety. For example, you may think that people are staring or frowning at you when they truly are not. Underdeveloped social skills are another possible contributor to social anxiety. For example, if you have underdeveloped social skills, you may feel discouraged after talking with people and may worry about doing it in the future. By learning more about fear and anxiety in the brain, mental health professionals can treat symptoms and help build strategies. 

Social anxiety disorder is generally treated with psychotherapy (sometimes called “talk” therapy), medication, or both. A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT delivered in a group format can also be helpful. Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle and self care can also help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.

Mental health and Corona

Prior to the COVID-19 pandemic, nearly one in five of U.S. adults (47 million) reported having a mental illness in the past year, and over 11 million had a serious mental illness, which frequently results in functional impairment and limits life activities. Please remember that these are only the reported numbers, because many people do not seek help or endorse symptoms.

The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders, who were previously substantial in number. In polls conducted in mid-July, 53% of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation, health worries, evictions, and job loss.

Some takeaways:
A broad body of research links social isolation and loneliness to poor mental health, and data from late March shows that significantly higher shares of people who were sheltering in place (47%) reported negative mental health effects resulting from worry or stress related to coronavirus. In particular, isolation and loneliness during the pandemic may present specific mental health risks for households with adolescents and for older adults. The share of older adults (ages 65 and up) reporting negative mental health impacts has very significantly increased since March. Polling data shows that women with children under the age of 18 are more likely to report major negative mental health impacts than their male counterparts.

Research also shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. Recent polling data shows that more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; and lower income people reported much higher rates of major negative mental health impacts compared to higher income people.

Poor mental health due to burnout among front-line workers and increased anxiety or mental illness among those with poor physical health are also concerns. Those with mental illness and substance use disorders pre-pandemic, and those newly affected, will likely require mental health and substance use services. The pandemic spotlights both existing and new barriers to accessing mental health and substance use disorder services.

In my practice, many people do not have access to consistent Wi-Fi or Internet service. During this unprecedented time of uncertainty and fear, it is likely that mental health issues and substance use disorders among people with these conditions will be exacerbated.

Embolden remains dedicated to providing access and services for medical professionals and front line personnel. The long-term effects that we are experiencing cannot be minimized.

Anxiety Toolkit

1.  Mindfulness Exercise
Start by taking a few deep breaths … breathing in through your nose … and then out through your mouth … in through your nose … and then out through your mouth. Then, while you continue to do so, gradually try to make yourself aware of:

  • 5 Things You Can See:  For example, the table in front of you, the nice painting on the wall, the fridge magnet that your daughter made, the clear blue sky outside, and the leafy green tree across the road.
  • 4 Things You Can Feel:  Once you’ve gotten in touch with five things you can see, then – while you continue breathing in through your nose, and out through your mouth – try to bring awareness to four things you can feel. For example, the chair that’s holding up your weight, your dress against your legs, the soft carpet beneath your feet, or a loose strand of hair brushing against your face.
  • 3 Things You Can Hear:  Next, bring awareness to three things you can hear. For example, the ticking of a clock, a bird chirping outside, or the sound of your children playing in their bedroom.
  • 2 Things You Can Smell:  Then, try to get in touch with two things you can smell. If you try but don’t find yourself able to smell anything, then try to summon up your two favorite smells. For example, the scent of freshly cut grass, or the aroma of a steaming mug of hot chocolate.
  • 1 Emotion You Can Feel:  Lastly, be mindful of one emotion you can feel.

Put all together, this 5-4-3-2-1 grounding exercise is really helpful for when you’re trapped in the “depression fog” and sinking deeper and deeper. It does this by getting you out of your head and in touch with your surroundings – thereby creating some separation between you and your racing thoughts and thus calming you down. Not only that, but it can be used as a preventative exercise too, for the purpose of helping you relax a little bit before something difficult – such as a job interview you’re really nervous about, or meeting someone who’s capable of triggering your depression or anxiety.

2.  Grounding Exercise with Picture Frames
If you find yourself somewhere, where you cannot do a full mindfulness exercise, this is a strategy that works almost anywhere. Find a picture on the wall, or any rectangular framed objects, such as a mirror. In school, and office, classroom, or home, you will usually be able to find something. Walk over to the framed picture. Look at the framed object, and note  the four corners.  While breathing in through your nose slowly, and out through your mouth slowly, mentally count the four corners of the picture. Keep repeating until you find yourself feeling calmer.

3.  Give yourself a timeout
When you’re trapped in the “depression fog”, it’s extremely helpful if you can calm yourself down and put a stop to your racing thoughts. As an alternative to a grounding exercise, another effective way of achieving this is through relaxing self-care practices – for example, by going for a walk, getting lost in your favorite video game, playing with your dog, taking a hot bubble bath, listening to your favorite playlist, reading a good book, watching your favorite series on Netflix, or doing anything else that mellows you out.

4.  Journaling
When you feel yourself suffocated by negative thoughts, worry, fear, or any other difficult emotions associated with “depression fog”, then another way of dealing with them is to try to “release” them. This is not only extremely cathartic – and therefore likely to calm you down – but also, when you have a healthy way to release your pent-up emotions, you’re also able to distance yourself from them, which makes it much easier for you to be able to gain clarity over those thoughts and be able to work through them.

A great way to do this is by journaling. Start with a pen and a blank piece of paper, take a few deep breaths, and then, just write what you feel (you could type your thoughts up on a computer as well, but using a pen and paper is generally recommended since it doesn’t come with distractions like Facebook and your email). Like I said, the process of writing down your thoughts is likely to relax you a little bit, and by “getting them out there” instead of keeping them trapped inside your head, you’ll find it easier to sort them out and gain some control over them.

Write down your thoughts without editing. It’s been shown to be very cathartic.

5.  Talk to an emotion buddy or coach
Just like journalling, talking to someone who you feel comfortable with and trust can also be really cathartic when you’re experiencing “depression fog”. Not only that, but someone you’re close with can also give you a new perspective on the thoughts or the situation that you’re struggling with. This can be particularly helpful, because when you’re in the midst of “depression fog”, your perspective is often negatively distorted, so talking with someone can often result in you seeing things in a more positive or less catastrophic light.  Find one or two trusted people you can talk to in times of trouble.

Relaxation Place

I have anxious clients learn a visual imagery exercise I call the relaxation place. It involves using all of their senses to mindfully recall the details of a place “that you love, that makes your heart peaceful”.

    • What does it smell like
    • Sound like
    • Taste like
    • What are the colors you see and the feelings you have there….

With repeated practice, the place or moment can be visualized with deliberation during times of deep stress and distress. It’s a great tool that you can take anywhere with you.

This is MY relaxation place.

Social Anxiety. It’s More Than Shyness.

16203233 – black woman holding her head in a living room

I have occasional days where it feels overwhelming to leave my house. I just want to have the quiet solitude of no interactions. This is a microcosm of the life of someone with social anxiety disorder. Although I do not suffer from social anxiety, it is the second most commonly diagnosed anxiety disorder. With the average age of onset being the early teenage years, it is a disorder that affects school, work, activities, and social interactions.

Social Anxiety is not shyness. It is an intense fear of being judged, rejected, or embarrassed in a social or performance situation. Symptoms may play havoc with daily routines, work performance, social life, and intimate life.

Social anxiety can be self-perpetuating. For individuals who suffer, avoidance of feared situations is common. The fear then becomes even more entrenched when exposure to anxiety provoking situations is limited. In my work. As part of the therapy process, I frequently meet people in various anxiety provoking settings.

Important facts:

  • A very broad range of interactions can be fear provoking. These might include having to return an item to a store, talk to a server in a restaurant, say hello to a neighbor, or place an order in a fast food drive-through.
  • Signs and symptoms experienced by individuals with social anxiety disorder may include blushing, sweating, racing heartbeat, shaking, avoiding eye contact, or feeling that their mind is going blank.
  • Misreading the behavior of others is a common factor. They might think that another person is frowning at them, angry at them if they don’t return a hello in the hallway, or believe they are being stared at.
  • Emotional distress may be experienced while being introduced to strangers, being teased or criticized, being the center of attention, having to speak in front of others, job interviews, group projects, meeting authority figures, or in classes or conferences that require social participation.
  • “Just face your fears, and they will go away,” does not happen. Therapy includes insight, strategies, practice, exposure, and fine-tuning.
  • Medication has been found to be very helpful, but is not the only solution. These may include antidepressants, beta blockers, and anti-anxiety medications.
Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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