January/February 2007

journey in our search for healing

Anxiety: It's All In Your Head...
Or Is It?

By Wendy Underhill

We all know what anxiety is--that jittery, uneasy, fearful feeling that often goes hand-in-hand with physical symptoms, such as shakiness, excessive sweating, heart palpitations, shortness of breath, even gastrointestinal symptoms and insomnia.

Most of us will experience garden-variety anxiety at some time in our lives. “How will I do on that test tomorrow?” “What will my new boss think of my work?” These are typical, low-level responses to potentially stressful situations. But when anxiety gets out of hand, manifesting in the form of phobias, panic disorder and obsessive-compulsive behaviors, it can be debilitating, sometimes even life threatening.

As widespread as anxiety has become, no one knows exactly what causes it. In everyday usage, “anxiety” is often thought of as the outcome of an overwrought personality or character flaw. With an outlook like that, there's not much hope for the anxious except to “buck up” and “be strong” – hardly helpful advice to anyone who is suffering.

In the mental health world, “anxiety disorders,” including phobias, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and others, are thought to be caused by a combination of psychological and biological factors. Not surprisingly, then, the traditional approach to treating anxiety is a combination of talk therapy with psychotropic medications added for moderate to severe cases.

Sometimes talk therapy is enough. Rick, a former Boulderite, began waking up at night with to-do lists racing through his mind. He sought help from a therapist, and with just a few sessions of talk therapy about his job and his responses to it, he was back to sleep. The causes of his anxiety were entirely situational, and the solution was entirely cognitive/ behavioral; in other words, his problem was indeed “all in his head.”

Beyond short term situations such as Rick's, many forms of anxiety can be traced to psychological factors. An obvious example: post traumatic stress disorder. Some people who have witnessed or experienced a life-threatening event (war, sexual assault, natural disasters, and more) continue to have flash-backs, feel detached from loved ones, and, in general, suffer from months or years of anxiety. Long-term exposure to abusive situations can have the same psychological effect, as can negative thinking, poor coping skills, dependency, or learned fears. However, if you've tried therapy and even medication, and you've had little or no relief, your anxiety may not be all in your head.

It's not all in your head
New thinking suggests that many people with the set of symptoms commonly known as anxiety may not have a particular temperament or mental disorder, but rather suffer from physical conditions whose symptoms mimic classically-defined “anxiety.” In other words, anxiety is often not a product of the mind so much as a product of the body.

Take Sharon Heller, Ph.D., for instance. For 12 years, she coped with nearly incapacitating anxiety. Through many visits to health practitioners of many stripes, she learned that she was still experiencing the effects of a head injury suffered 15 years earlier; a chronic GI tract problem; a sensory-processing disorder; and lead poisoning from years of stained-glass crafting. When she had these very physical causes treated, her “anxiety” disappeared.

Heller, a developmental psychologist, has since written a book, The Anxiety Myth: Why Your Anxiety May Not be All in Your Head but from Something Physical (Symmetry, 2006). In a nutshell, the book says that anxiety symptoms are not specific to mental disorders, and may be caused by neurological, structural, sensory or environmental factors.

Heller's book outlines dozens of possible anxiety mimickers, among them:
• Food. Caffeine can trigger anxiety-like symptoms, as can food allergies, food intolerances, leaky gut syndrome and a wide variety of other food-related causes. Even diabetes can mimic anxiety.
• Inner ear difficulties. 90 percent of space-related phobias turn out to be related to inner ear dysfunction. If you had lots of ear infections as a child, and now, as an adult, have phobias, get thee to an ear-nose-throat specialist!
• Chemical sensitivities. People with sensitivity to chemicals, like cleaning products, paint or mold, face a host of symptoms, including shakiness, fatigue, cloudy thinking and worries about going outside the controlled environment of home. Those symptoms sound a lot like anxiety.
• Thyroid problems. Thinning hair, low energy and a surprising weight problem along with “anxiety” symptoms may be a sign that your thyroid– not your brain--is causing your anxiety.
• Sensory processing. If sounds are too loud, lights too bright, and touch seems to be an insult; if you're unusually disorganized; or if focusing on one thing and excluding the multitude of stimulation around is difficult, then any of a variety of sensory processing conditions may be at work, and will almost assuredly make a person “anxious” about everyday living.

The chemistry component
Once these body-based possibilities have been thoroughly ruled out, it's time to look at the brain-based ones. Science is just beginning to understand how neurotransmitters (naturally occurring chemicals within the brain that relay signals between the nerve cells) and mood are interlinked. Some day research may prove that brain-based anxieties are not “all in your head” but rather “all in your chemistry” instead.

Science does know, though, that many mental disorders can be regulated or at least altered by medications targeting neurotransmitters, especially serotonin. For many people, medications called SSRIs, or selective serotonin reuptake inhibitors, have been a lifesaver. And yet, serotonin is only one of many neurotransmitters and SSRIs are relatively blunt instruments in the face of anxiety.

One Wisconsin-based company, NeuroScience, Inc. (www.neurorelief.com) is trying to change that. It has developed urinary and salivary panels that measure levels of serotonin and 12 other neurotransmitters as well. Once levels are determined, the firm suggests supplement-based therapies. (The fact that the company both diagnoses and prescribes may be seen as a conflict of interest.) Since this testing is so new, a client may need to explore this option first and then ask his or her medical provider to consider these tests.

It's all connected
One final anecdote: When Lisa, of Denver, returned after an extended trip to Central America she was sick with gastrointestinal distress that lasted almost two years. Parasites seemed likely, but were never found. As Lisa lost weight, she suffered irritable bowel syndrome and became lethargic. Not surprisingly, she became worried about her condition, too. What was it? Would it ever go away? Where was her true self hiding? While seeking a biological cause, she found a doctor who treated her holistically: he prescribed yoga, meditation and relaxation, all of which helped a bit. But when the right medication for her GI condition was finally prescribed, Lisa became her old self again.

That sounds like physiology at work, but there's more. Now, years later, if Lisa gets too overtaxed with work, family, school and the fate of the world, the medication can't hold back a recurrence. Lisa says her solution has been a combined treatment: “If it weren't for the Western drugs, I'd be in bad shape and if it weren't for the emphasis on relaxation and wholeness, I'd also be in bad shape. It's 50-50.”

That makes sense if brains and bodies are considered as a single unit. If you're incapacitated by a physical cause, psychological ramifications result. If you have a debilitating psychological condition, the body responds chemically, with physical outcomes. So, for anything beyond short-term situational anxiety, treatment must deal with which came first, the physical or the psychological--but not without addressing the other as well.

Wendy Underhill will be appearing at the Nexus Holistic Expo in Boulder, February 10 to 11, 2007. For more information on the Expo, see page 5 or visit www.nexusholisticexpo.com

A Natural Approach
Anyone who is suffering from anxiety-like symptoms has a big job to do to figure out where the trouble lies, in the brain or in the body. While searching, these non-pharmacological techniques or stress-relievers may help:

Herbal remedies for sleep and relaxation
More sex
An exercise regimen
A healthier, more consistent diet
Giving up caffeine and other stimulants
Yoga
Meditation or other relaxation strategies
Keeping a journal
Replacing internal negative self-talk
Counseling
Or, look for a support group on the website of the National Alliance on Mental Illness, www.nami.org. Just remember that these are coping strategies, not solutions, to anxiety symptoms. On the other hand, these strategies are all good advice for everyone, anxious or not.

Resources
For more information, see the following:
• www.adaa.org
• www.recovery-inc.org
• The Anxiety Book: Developing Strength in the Face of Fear by Jonathan Davidson, M.D., and Henry Dreher (Riverhead, 2004) The director of the Anxiety and Traumatic Stress Program at Duke University takes a dead-center look at anxiety, exploring the neuroscience of it as well as the psycho/social aspects. It includes self-assessments, stories from patients, and details on many treatments.
• The Anxiety Myth: Why Your Anxiety May Not be All in Your Head but from Something Physical, Neurological, Structural, Sensory, or Environmental (Symmetry, 2006; available online only at www.anxietymyth.com) reviews dozens of non-psychological causes of symptoms that can easily be misinterpreted as signs of anxiety–and suggests what to do if one of them fits your case.