Episode 2: What’s the best way to overcome anxiety?

Anyone who has ever felt anxiety (which pretty much includes all human beings) knows how uncomfortable it can be. In this episode of “Ask a Psychiatrist” we learn about our internal early-warning systems and what it means when our bodies and minds cascade into something more than experiencing the ordinary stressors of everyday life.

Dr. Erik Messamore explains that anxiety usually consists of two separate but intertwined processes – the physiological “fight or flight” reaction AND a host of thoughts that usually involve forecasting something bad in the near or distant future.

The good news for those of us locked in worry, tension, or panic is that scientists have been studying anxiety for over 100 years. We have a lot of knowledge about anxiety – not only how it works but also how to treat it.

Covering both the physiological and psychological elements, Dr. Messamore breaks down the impacts of anxiety on the body as well as the thought patterns that can heighten those symptoms. He provides a framework for examining some of the successful behavioral interventions available as well as thoughts about the role of drug treatment options.

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KEY TAKEAWAYS:

• (01:35) – Anxiety is a normal emotion – even helpful, despite often being uncomfortable.
• (02:56) – Some of the physical symptoms that signal anxiety:
  • An uncomfortable, almost painful feeling of apprehension.
  • Heart racing and difficulty catching one’s breath.
  • Muscle tension and hyper-vigilance (which often extends to interrupting sleep).
  • Feelings of nausea, urgency to urinate or empty one’s bowels.
• (04:26) – About thoughts that can either result from or precipitate anxiety:
  • Ruminating on or catastrophizing about the future.
  • High alert signals reach the brain and start a loop to justify the feeling.
• (07:24) – Anxiety involves two components:
  • Physiological: Preparing the body to fight or flee.
  • Thought: Drives or explains to the brain why this feeling exists.
• (08:00) – Anxiety is relatively easy to study because reliable, inexpensive instruments are available to study symptoms, which are mostly objectively measurable and observable.
• Three strategies for treating anxiety:
  • (10:13) – Cognitive Behavior Therapy (CBT): Offers tools to short-circuit anxious thoughts and physical reactions by redirecting responses that do not serve and tend to get locked into a negative loop.
  • (17:10) – Systematic Desensitization: Some common phobias/anxieties may be hard-wired biologically and can be overcome by systematically titrating exposure to that which is threatening or fear-inducing. (Dr. Messamore shares detailed, vivid examples of this technique.)
  • (22:46) – Exposure and Response Prevention Therapy: A treatment that identifies stressors in the brain and then subtly interrupts any source of reward/relief, initially causing discomfort but incrementally helping to build tolerance and new ways to manage anxiety.
• (27:12) – There are drug treatment options available as an alternative to behavioral therapies. In some cases they can modulate or block reflexive physiological symptoms so that patients can develop adaptive strategies for coping with stressors.
• (31:13) – A bit about SSRIs (selective serotonin reuptake inhibitors) that are sometimes prescribed to get physiological responses in the body under control and opening the possibility of treating underlying psychological/emotional issues.
• (32:05) – Dr. Messamore explains that there are various approaches to treating anxiety, including the effective use of cognitive behavioral and drug treatment programs in combination.   

QUOTABLE:

• “(An anxiety disorder) can begin to take on a life of its own. It goes from something that is really annoying to something that can have the emotional power of a monster that wants to devour you.”
• “When your heartbeat starts to accelerate in response to a thought, then we have a scenario that I call ‘The Feel Makes It Real.’ ”
• “Anxiety is a universal human experience. It’s extremely uncomfortable.”
• “People who are anxiety-prone and suffer from anxiety disorders overwhelmingly … look into the future and provide a negative outcome. And thoughts drive emotions.”
• “Some people find that the physiological response of the body is just so overpowering that using psychological skills has limited value or almost no value at all.”
• “Medicine can be very helpful and the choice to use medicine or the decision about what is the right time is deeply personal.”
• “For most people it’s ideal to use medicines that can control physiological response in combination with proven, evidence-based psychological therapies because the two of them feed from each other … It accelerates the program.”
• “The good news is that anxiety has been studied longer and probably better than any other mood state in humans. We have a lot of techniques that can be very effective and have been proven.”

About the Host:

Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.