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Tips to Reduce Anxiety

We live in a crazy world. If anything, these past couple of years have taught us that we never know what is going to happen, or what the future holds for us. So why worry and be anxious? 

Easier said than done. In fact, according to the Anxiety and Depression Association of America (ADAA) anxiety disorders are the most common mental illness in the United States, affecting an astonishing number of 40 million adults! Meaning that over 18% of the population experience an anxiety disorder in any given year1.

But what is anxiety exactly?

The ADAA characterizes the Generalized Anxiety Disorder (GAD) as a “persistent and excessive worry about a number of different things1.” While the American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure2.” 

People suffering from anxiety report having recurring intrusive thoughts or concerns, and the constant worry even leads them to totally avoid certain situations that may cause more anxiety. There are also physical symptoms often associated with anxiety, namely sweating, accelerated heart rate, trembling and dizziness2.

Here is a list of common symptoms associated with anxiety:

•  Feeling restless and nervous •  Fatigue
•   Excessive anxiety and worry •   Impaired concentration and cognition
•   Intrusive and repetitive thoughts •   Difficulty sleeping
•   Overwhelming sense of panic or danger •   Experiencing gastrointestinal issues
•   Irritability •   Tendency to avoid situations that trigger anxiety
•   Increased heart rate •   Muscles aches and soreness
•   Sweating  
•   Trembling  
•   Hyperventilating  

Unfortunately, the mental health of the world population has also been widely affected by the recent COVID-19 situation. COVID-19 has been associated with mental health challenges related not only to the morbidity and mortality of the illness, but also due to the mitigation strategies implemented, such as physical distancing and mandatory stay-at-home periods. The Centers for Disease Control and Prevention (CDC) reported that symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019. Statistics show that around 40% of U.S. adults reported at least one adverse mental health concern, including anxiety, depression, substance use, and suicidal ideation3.

The profound changes brought to people’s lives seem to have led to a surge of pandemic-related psychological distress including fear, anxiety, perceived threat, and stress. In a paper published on Psychiatry Research in October 2020, the authors outline the characteristics of what is called the “COVID-19 anxiety syndrome”, which includes symptoms such as avoidance, compulsive symptom-checking, worrying, and threat monitoring, most of the time combined. This syndrome manifests as the inability to leave the house because of COVID-19 fears, frequent checking for symptoms despite not being in a high-risk scenario, and avoiding people or social situation4.

The good news is whether it is related to the current COVID-19 situation or any other situation, present or future, there are things you can do to help reduce your anxiety and related symptoms.

     1.  Sleep Better

Research has found that lack of sleep, which is common in anxiety disorders, can amplify the brain’s anticipatory reactions, which in turn will increase overall anxiety, a ‘worry cycle’ that seems to never end and to feed itself continuously5

Neuroscientists at UC Berkeley identified a neuropathological model in which sleep disruption may contribute to the maintenance and/or exacerbation of anxiety through its impact on anticipatory brain function. Sleep deprivation amplifies anticipatory anxiety by firing up the brain’s amygdala and insular cortex, regions of the brain associated with emotional processing. This brain pattern mimics the abnormal neural activity seen in anxiety disorders. The research also suggests that those who are naturally more worried or anxious and therefore more prone to develop an anxiety disorder are also more vulnerable to the impact of insufficient sleep. Matthew Walker, a professor of psychology and neuroscience at UC Berkeley and senior author of the paper says that “These findings help us realize that those people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation5.” 

The good news is that these results also suggest that sleep therapy may be very beneficial for those suffering from anxiety and stress related disorders, such as generalized anxiety disorder, panic attacks and post-traumatic stress disorder (PTSD). Leading researchers and therapists believe that targeted sleep restoration in anxiety sufferers may contribute to excessive anticipatory response and associated symptom5.

     2.  Deep Breathing

Focusing on your breath can be one of the simplest and most powerful tools to help you manage stress and anxiety. Deep breathing is considered a relaxation technique; one of the easiest and more portable ways of making you feel immediately more relaxed and calmer. 

Research studies have been corroborating the importance of deep breathing techniques as the body’s innate answer to turn off the natural stress response. Studies suggest that deep breathing techniques are capable of effectively improving mood and may help to reduce stress. Promising positive changes were seen in mental health self-evaluations and in certain physical measures, such as cortisol levels and blood pressure6,7.

What is deep breathing?

Deep breathing, also known as diaphragmatic or abdominal breathing, it’s a mode of breathing that requires the diaphragm to contract and relax. During inhalation, the diaphragm is contracted which increases the volume of the lung cavity. During exhalation, the diaphragm is relaxed which decreases the volume of the lung cavity, and the air passively leaves the lungs8

Harvard Health reports that deep breathing encourages full oxygen exchange, which means a beneficial trade of incoming oxygen for outgoing carbon dioxide9. This beneficial exchange contributes to slow the heartbeat and lower or stabilize blood pressure, to ease stress and even relax tense muscles9.

The American Institute of Stress (AIS) recommends 20 to 30 minutes of deep breathing each day to help reduce anxiety and stress. The AIS explains that “deep breathing increases the supply of oxygen to your brain and stimulates the parasympathetic nervous system, which promotes a state of calmness. Breathing techniques help you feel connected to your body—it brings your awareness away from the worries in your head and quiets your mind10.”

What studies show is that slow breathing techniques act by enhancing autonomic, cerebral and psychological flexibility, having found evidence of links between parasympathetic activity and central nervous system activities related to emotional control and psychological well-being11.

How to practice deep breathing?

I.  Choose a quiet place, where you don’t expect to be disturbed. Sit or lay down. Make sure you are comfortable.

II.  Place one hand on your belly and the other on your chest.

III.  Take a normal breath.

IV.  Then try to take a deep breath:

– Inhale slowly through the nose. Allow your belly, ribs and chest area to expand, filling your lungs. Focus your attention on the belly rising.

– Hold the breath for 1 or 2 seconds.

– Let the air out slowly, through the mouth or nostrils. Pay attention on the belly dropping.

V.  Repeat 3 to 5 times or until you feel more relaxed.

The benefits of deep breathing techniques are not just momentary and go beyond punctual stress or anxiety relief. This type of breathing helps to balance the autonomic nervous system, which has long term benefits in terms of prevention and reduction of symptoms in stress-related disorders such as anxiety, stress, depression and post-traumatic stress disorder and other mental health conditions.

     3.  Move More

Physical activity, structured exercise or simple movement can be a great way to protect you from anxiety and reduce associated symptoms. 

Exercise has been shown to be effective in improving anxiety symptoms in healthy people, and in those diagnosed with anxiety and/ or stress-related disorders, and other physical or mental illnesses. Scientists found that regular participation in aerobic exercise has been shown to decrease overall levels of tension, elevate and stabilize mood, improve sleep, and improve self-esteem12,13

Why is exercise good for anxiety?

  • Physical exercise enhances prefrontal cortex activity, responsible for executive function, including emotional regulation. This activation helps control the amygdala, the part of our limbic system related to emotional stress and reaction to threats, real or imagined14.
  • Releases neurochemicals that reduce anxiety, such as serotonin, endorphins, dopamine, brain-derived neurotrophic factor (BDNF), gamma aminobutyric acid (GABA), and endocannabinoids
  • Mental focus goes to the exercise performance, not the worry
  • Helps regulate hormone levels, especially cortisol, the “stress hormone”
  • Improves sleep, essential for anxiety management
  • Uses body energy (humans were made to move!) and decreases muscle tension
  • Increases resilience to stress and develops ‘healthy’ coping mechanisms

How much exercise do I need to practice?

Although a 2019 meta-analysis reported that for those suffering with anxiety disorders, a high-level of physical activity was better at protecting against anxiety symptoms than low physical activity15. Other studies reveal that any activity is good16,17. According to the Anxiety and Depression association of America (ADAA), even just five minutes of aerobic exercise can begin to alleviate symptoms of anxiety, an effect that can be felt almost immediately, although sometimes temporarily18. That is why regular physical activity and having an exercise program is important to achieve long lasting effects. 

Of course, different types of exercise will have different effects on different people, and not any single one of them will be beneficial for all. The main goal here is to choose something you like and that you know you can stick to. From short bouts of exercise to longer aerobic training, from High Intensity Interval Training (HIIT) to yoga, from martial arts to dancing or hiking, exercise is good for anxiety. PERIOD. You just need to do it.

Start now with a 10-minute brisk walk! Invite a friend or loved one, or take your pet with you!

     4.  Meditate

Mindfulness meditation has been found to regulate and relieve anxiety. Studies have found that 20 minutes of meditation reduced anxiety by as much as 22% in healthy individuals, while anxiety medications did not improve anxiety or mood in healthy subjects19. Therefore, the beneficial effect of meditation on people who suffer from generalized anxiety disorder and other mood constructs may even be more pronounced19. Regular meditation practice can highly exponentiate the reduction of anxiety symptoms.

Meditation has the potential to change the brain and neuroscientists have recently discovered that daily meditation may enhance the capacity for joy20. A study led by Dr. Richard Davidson at the University of Wisconsin-Madison researched hundreds of advanced practitioners of meditation. Neuroscientists wanted to find out if years of meditation had changed the brain of an expert monk. They connected 256 electrodes to Matthieu Ricard, a Tibetan monk. Ricard was a French genetic scientist who gave up his career in science 40 years ago and moved to India to study Buddhism and has spent decades meditating in the Himalayas. Dr. Davidson and his colleagues were astonished by Ricard’s brain signature – never seen anything like it before. The activity in his left prefrontal cortex, responsible for subduing negative emotions, and abnormal gamma wave levels, suggesting signs of bliss, led them to dub Ricard as “the happiest man in the world20.”

Besides joy, meditation has many benefits reported in scientific literature:

•  Lowers blood pressure •  Less anxiety
•  Improves blood circulation •  Lowers blood cortisol levels
•  Lowers heart rate •  More feelings of well-being
•  Decreases insulin resistance •  Less stress
•  Less perspiration •  Deeper relaxation
•  Slower respiratory rate •  Increases self-actualization
•  Deep rest •  Reduces psychological stress
•  Increases integration of brain functioning •  Improves immunity
•  Better intellectual performance  

But what is meditation and how do you meditate?

Choose a quiet place where you don’t expect to be disturbed and try this simple exercise:

I.  Sit comfortably (use a cushion or chair). Your eyes can be closed or open with your gaze shifted downward.
II.  Feel your body in the present moment. Notice the sensations within your body.
III.  Start deepening your breath, breathe into your abdomen and chest. Be aware of the breath flowing in and out.
IV.  Then allow your breath to return to normal, breathing through your nose, if possible.
V.  Focus on the breath moving in and out of your nostrils, or on the rise and fall of your chest/belly.
VI.  When you notice your mind wandering, gently bring it back to the breath. No judgement, no strain. Just come back to the breath.
VII.  Continue the practice for 10 to 15 minutes or for as long as you feel comfortable.

That’s it! That was your meditation for today. That simple. Try to do it daily or even twice a day for better results.

     5.  Nature and Grounding

As Hippocrates said, “Nature itself is the best physician.” Indeed, research evidence shows that exposure to nature can have many health benefits, such as lowering blood pressure, reducing respiratory tract and cardiovascular illnesses, improving vitality and mood, restoring attention capacity and mental fatigue and also having a positive effect on mental wellbeing, by relieving anxiety and stress. There is a so-called feeling of “belonging” in nature. This feeling of being a part of nature has been shown to significantly correlate with life satisfaction, vitality, meaningfulness, happiness, mindfulness, and lower cognitive anxiety21

If you add to this beneficial effect of being in nature the actual contact with nature, by being barefoot or laying on the ground, then the benefits of nature exposure rise exponentially with the grounding effect of the planet Earth. Earthing or grounding is putting the body in direct and uninterrupted contact with the earth. This means that skin needs to touch soil, sand, water, or a conductive surface that is in contact with the earth. This allows for a direct physical contact with the vast supply of electrons on the surface of the Earth. The healing benefits of grounding are huge and include decreased levels of inflammation and pain, improved circulation and sleep, and reduced stress and anxiety22,23.

Researchers suggest that the beneficial effects of earthing come from the direct electrical connection with the earth that enables diurnal electrical rhythms and free electrons to flow from the earth to the body. These earth’s diurnal electrical rhythms contribute to setting the biological clocks for hormones that regulate sleep and activity. Free electrons from the earth are proposed to act as natural antioxidants by neutralizing positively charged free radicals, the hallmark of chronic inflammation23,24.

“Beneath your feet outdoors is not just a mere patch of grass, dirt, sand, or concrete. It is an omnipresent source of natural healing energy” – ‘Earthing: The Most Important Health Discovery Ever? 25

     6.  Healthy Nutrition

Here the guidelines are simple:

a.  Living plant-rich diet, raw and vegan as much as possible
b.  Organic, local and in-season
c.  Unprocessed and hormone free
d.  Stay hydrated with pure water
e.  Try periodic fasting
f.  Avoid sugar and processed foods

     7.  Avoid caffeine and other stimulants and alcohol

Avoid or completely remove stimulants from your diet. Alcohol in small doses can be considered a stimulant and should be avoided (although in higher doses is more of a depressant, it still should be avoided).

As with everything in life, the things that will reduce or exacerbate anxiety will be dependent on each individual. Stimulants are not the cause of anxiety per se, but they can exacerbate the symptoms and make anxiety harder to manage.

Stimulants are chemicals that ‘stimulate’ or excite the central and/or peripheral nervous system, or any drug that excites any bodily function. Stimulants induce alertness, elevate mood, cause wakefulness, increase speech and motor activity and decrease appetite. These effects are widely sought out by some but can be very detrimental for anxious people.

Besides prescription amphetamines like ‘Adderall’, ‘Concerta’ and ‘Ritalin’ used for treating ADHD or ADD, stimulant compounds can be found in foods, beverages, and dietary supplements. 

The most common are:

  • Caffeine 
    • naturally in coffee and tea (Camellia sinensis leaves – black, green, and white teas)
    • synthetic in soda pop, energy drinks, dietary supplements, and medications
  • Carnitine
    • naturally produced by the body
    • synthetic in beverages and supplements
  • Ginseng
    • plant native to East Asia. Roots are harvested and used to create herbal supplements
    • ingredient in energy drinks, teas, herbal supplements
  • Guarana
    • plant native to Brazil that produces fruit with edible seeds
    • Ingredient in energy drinks, supplements, and teas
  • Nicotine
    • present in tobacco
  • Taurine
    • naturally in the foods we consume
    • synthetic in energy drinks and supplements
  • Theobromine
    • naturally in cacao plants and tea leaves

Many of these compounds have beneficial effects for health, so your approach to natural stimulants should be individualized. In general, try to avoid them, but if you feel any contribute to your feelings of relaxation and positivity, then it might be good for you.

     8.  Natural Herbs 

Certain herbs and natural supplements have been used for centuries and may help reduce anxiety levels without the unwanted side effects associated with certain medications. 

While we do not recommend you stop or reduce prescribed medications without your doctors’ supervision, there are some herbs known to manage anxiety with “nature’s hand”. Usually, these herbs are used to make infusions, extracts, tinctures, powders, essential oils, tablets and even creams. 

Here are some anti-anxiety natural herbs:

•  Lemon balm (Melissa officinalis)  •  Kava kava (Piper methysticum)
•  Ashwagandha (Withania somnifera)  •  St. John’s Wort (Hypericum perforatum)
•  Valerian (Valeriana officinalis)  •  Passionflower (Passiflora incarnata)
•  Chamomile (Matricaria recutita, Chamomilla recutita)  •  Lavender (Lavandula spp)

Important: Consult with your holistic healthcare provider to find out which herbal supplements may be best for you so that you avoid undesired effects or medication interactions.

     9.  Identify and develop strategies to manage triggers

Being able to identify things or situations that may trigger your anxiety and learning how to reduce your exposure or how to cope with them is one of the best tools you can develop. You can do this work by yourself or with the help of a therapist. 

There are some more obvious and avoidable triggers like alcohol and drugs, which you can reduce your exposure to easily. However, there are other situations, such as work, relationships, social events, or even traumas, that are not as easy to avoid or to minimize the anxiety they bring. These deep rooted or unavoidable triggers may require a deeper work with a specialist and there are many options you can explore in terms of mood disorders therapies, such as cognitive behavior therapy (CBT). 

CBT is a type of psychological treatment that helps a person become aware of ways of thinking that may be automatic but are inaccurate and harmful. It also involves therapeutic development of tools to change thinking and behavior patterns26

     10.  Gratitude

Last but definitely not least, be grateful and make it part of your daily routine. Developing a gratitude practice such as writing down a list of things you are grateful for or telling it to a friend or loved one, can be a great strategy to help you prevent and deal with anxiety.

As Neale Donald Walsch, author of the series Conversations with God, said “The struggle ends when gratitude begins.”

Use this exercise every day or whenever you feel you are getting more anxious:

Are you struggling? What are your real struggles?

Write them down.

Are you grateful? What are you grateful for?

Write it down.

Plant enough gratitude to end the struggle.

Gratitude turns what we have, even our struggles, into enough. When you are grateful, you are enough, your life is enough, what you have and accomplish is enough, others are enough.

Be grateful to be enough.

Know that you are enough.


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