By MICHAEL SHAPIRO, PhD

Let me ask you this: have you ever been nervous, anxious, or stressed-out?  Yeah, I thought so. If you had answered “no” to that question, your response would have put you well outside the realm of “normal” humanity (or made you a complete liar).

We all worry. We all get anxious. Anxiety is actually an adaptive response to potentially threatening or dangerous situations.  The theory is that when we were Neanderthals (or cave-dwellers, or primitive men and women, or whatever you wish to call our animal-skin-wearing ancestors), our nervous systems and endocrinological systems developed a complex “circuit” to prepare our bodies for action: when the brain perceived something unusual or threatening, it would send a message (by secreting hormones, which are the chemical messengers of our bodies) to various muscles and internal organs, in order to prepare those bodily systems to either fight the threatening entity or run like heck to get away from it.  This is the legendary “flight or fight” response that you’ve undoubtedly heard about. To this very day, when our bodies secrete these “stress hormones” (particularly adrenalin and cortisol), many things happen: our heart rate and respiration increase, our blood sugar goes up (to “energize” our cells), our pupils dilate, our blood pressure escalates, and nonessential functions (like intestinal activity) are slowed down. You are now prepared for flight or fight.

Having subsequently run from the saber-toothed tiger (or subdued it to create a lovely wall hanging for the cave), the stress hormones in the bodies of our ancestors would then return to normal, and all would be well until the arrival of the next threat…maybe a tyrannosaurus rex or something like that (just kidding…despite what you’ve seen in The Flintstones, the last of the dinosaurs was separated by the first member of homo sapiens by about 65 million years). 

Fast forward to the present. We still face threatening objects and organisms that provoke anxiety and evoke the fight or flight response. No longer a saber-tooth tiger, but maybe an irritable boss that makes too many unfair demands, or a surprise letter from the IRS, or a looming deadline, or a teenage child who is out way past curfew.  Unlike our ancestors and their tiger, we can no longer physically fight these things (at least not without getting in big trouble), nor can we run away from them (try as we might). This is the plight of modern man: the same flood of stress hormones, but no way to work it off!  The result: high levels of cortisol result in heart disease, digestive problems (like irritable bowel syndrome), and a suppressed immune system.

This is why exercise is a critically important first-line treatment for stress and anxiety. Physical exertion serves to dissipate stress hormones. How much exercise? Recent research has shown that burning as few as 350 calories three times per week can be as effective as antidepressant or anti-anxiety medication. This amounts to about 30 minutes of moderately vigorous activity during each session. By “vigorous,” I mean that you have to be exerting yourself to such a degree that you can’t carry on a conversation while you’re doing…well, whatever it is, be it walking, riding a bike, swimming, or playing pickleball. Lifting the TV remote doesn’t count; in fact, it’s been shown that complex exercise (that is, exercise that makes you use your brain, like playing a sport or doing ballroom dancing) may even ward off dementia!

In addition to exercise, there are a host of other activities and techniques that you can do to manage anxiety and stress. Yoga, breathing exercises, progressive muscle relaxation, making time for hobbies, and practicing “mindfulness” (taking a step back from unpleasant thoughts and feelings by focusing on being in the moment) have all been shown to mitigate stress. However, these have to become a “life or death” priority, rather than a “when I get a chance” priority! This is done by making them part of our daily routine.

So, if anxiety and stress are common to all men and women, then why don’t these fixes (exercise, hobbies, vacations, etc.) work for everyone? Sometimes, the “fight or flight” circuit is triggered for no obvious reason, when there’s really nothing to be afraid of. We call this a panic attack. Some people worry all the time, often about things that are very unlikely to happen.  We call this generalized anxiety disorder. Some people, by having bad experiences with very specific things, have learned to fear these things (like spiders or thunderstorms) to an irrational degree. We call this a specific phobia. When someone has been exposed to life-threatening stress and is constantly “on edge” and worried that the stress might re-occur, we call this posttraumatic stress. Any of these anxiety disorders can become so severe that they interfere with normal social or occupational functioning. When that happens, it’s time to seek rofessional

help.

Fortunately, most of these anxiety disorders are manageable with a combination of medication, therapy, and lifestyle changes. I usually tell my patients that medication and therapy are two wings of an airplane: they work best when used together. Certain medications (like Paxil, Prozac, and Zoloft) are particularly effective in dealing with both depression and generalized anxiety. Other medications, like Xanax, are effective for acute episodes of anxiety, but they must be used sparingly—and under the watchful eye of a physician—because of their potential for addiction. Medications help manage both the physical symptoms (sleeplessness, exhaustion, shakiness, shortness of breath) and the mental symptoms (obsessive worrisome thoughts, avoidance, and fear of “losing your mind”) of anxiety.  Then, once these symptoms have been brought under control with medication, therapy is tremendously helpful as a way of learning coping skills and stress management techniques. Some of the therapeutic techniques include Cognitive Behavior Therapy, Mindfulness Therapy, progressive relaxation, and systematic desensitization...each of which may be appropriate for certain types of anxiety disorders. Just ask your primary care provider or qualified mental health professional which of these might be best for you!

So, if you deal with stress or anxiety, welcome to the world of 7.53 humans who currently inhabit the planet. However, if you’re finding hard to manage anxiety on your own, please ask your health care provider for help. Oh…and watch out for those saber-toothed tigers!