Powerful Essentials To Overcome Anxiety

I wanted to keep this blog short, simple and manageable, with the intention of not overwhelming people with a whole host of changes that need to be implemented over a short period of time; this is a recipe for failure. However, it would be remiss of me not to mention a few of the most freely available, cost-effective, and important contributors to overall wellbeing and positive mental health: sleep, physical exercise, media diet, and social interaction. These powerful essentials are often discounted or ignored as people look for a shortcut to good mental health or a magic bullet for peak performance. 

Sleep

Getting enough sleep is crucial to both our physical and mental health. We can implement every other mental and physical health strategy to perfection, but if we’re not getting enough sleep we will never be at our best. Research indicates that sufficient sleep has a large positive effect on a whole host of physical and mental aspects of our health, including: emotion regulation, cognitive thinking, decision making, attention, memory, and it also plays a large role in protecting the immune system.

Until recently we have known very little about what happens in the brain when we sleep, and although we still have much to learn, we are starting to understand more about what happens when we go to bed at night.

THE SLEEP CYCLE

We now know we cycle through different periods of sleep several times a night, and in the final stage of each of these cycles we enter Rapid Eye Movement sleep (REM), the period when dreaming occurs.  It’s thought REM sleep is particularly important for our wellbeing, as it’s involved in replenishing our neurotransmitters, cleaning out toxins, and consolidating our memories. Research has also indicated those who have more REM sleep tend to have lower amygdala reactivity, and as a result, less anxiety. So getting a good night’s sleep plays a key role in calming the amygdala and decreasing anxiety. Lack of sleep increases reactivity in the amygdala, raising our general levels of anxiety and making us more sensitive to other emotional states such as anger and irritability.

So how much sleep is sufficient? Eight hours of sleep is normally the magic number suggested to ensure the brain is performing at its best, but recent research suggests it varies from individual to individual, and the optimal time is somewhere between seven to nine hours. However, these recommendations miss out on an important understanding of the sleep cycle.

The full sleep cycle lasts around ninety minutes and goes through five stages, with the REM part of the sleep cycle being the last stage:

• Stage 1 – Light sleep in which we drift in and out of sleep and can be awakened easily.
• Stage 2 – Still in light sleep. Heart rate slows and body temperature drops. The body is getting ready for deep sleep.
• Stages 3 & 4 – These are the deep sleep stages. Difficult to wake up. No eye movement or muscle activity. Waking in these stages feels disorientating.
• REM Stage – Breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, limb muscles become temporarily paralysed. Heart rate also increases and blood pressure rises. We dream in this stage and waking during REM sleep often comes with bizarre and illogical thoughts as dreams are recalled.
   

After completing a full cycle we return to the first stage again and repeat this pattern throughout the night. The first few sleep cycles of the night contain relatively short periods of REM sleep, but long periods of deep sleep. However, as the night progresses, the periods of REM sleep increase in length, while deep sleep decreases. By morning, we spend nearly all of our sleep time in stages 1, 2, and REM.

If we wake up during one of the ninety minute cycles, we start again at the first stage when we go back to sleep, regardless of what stage we woke up in. Then we cycle through the stages until we get to the REM stage again. So two hours of sleep, followed by a period of being awake, and then another five hours sleep isn’t necessarily the same as seven hours of continuous sleep. You don’t carry on where you left off in the cycle, you have to start again at the beginning. Keep this in mind when you’re assessing your quality of sleep.
 

GETTING TO SLEEP WHEN ANXIOUS

Getting a good night’s sleep is often a struggle for people with anxiety because the amygdala is regularly in an aroused state and the sympathetic nervous system is chronically activated. This makes going through the sleep cycles more difficult and is often compounded by worrying thoughts that make it more difficult to drop off. So the key to sleeping well is (1) to try to ensure you’re in as calm a state as possible before going to bed, and also (2) finding a strategy that enables you to fall asleep without too much trouble. You may not always have the time to create a calm environment but it’s important to take some time do so if sleeping is a problem for you. Once you’re able to sleep consistently well, you will be able to be more flexible with your routine.

1. Creating a Calm State

Activities that will help you to enter a calmer state before going to bed include:
 

A consistent and relaxing routine before bedtime – stick to a consistent bedtime on most nights, at least until you start to begin to sleep well. By repeating a regular pattern, you will condition your body and mind to realise it’s time to go to sleep. Begin your routine about 30 to 60 minutes before bedtime and build activities into this time that will reduce stimulation and help you relax; such as reading, having a bath, or listening to music.

Eliminate as much light as possible – avoid television, computers, tablets and smartphones. Numerous studies suggest blue light in the evening disrupts the brain’s natural sleep-wake cycles. If you do go online, use an app or software that eliminates blue light on electronic devices. Many can be found by searching for ‘blue light’ in both iPhone and Android app stores.

Create an environment conducive to sleep – make your bedroom as dark as possible and remove all distractions to sleep out of the bedroom (electronic devices, televisions, work items etc.).

Avoid caffeine, alcohol and spicy foods from early evening onwards – these will stimulate your brain and body.

Exercise earlier in the day – physical activity will help tire your body and make it more ready for sleep, but try to exercise no later than early evening to avoid over stimulating your body before bedtime. This doesn’t have to involve going to the gym or running for miles. A short brisk walk can have an excellent impact.

Avoid napping during the day – this is especially important if you’re not getting a full night of sleep.

Just before you get into bed do some relaxed breathing or a short meditation. - Try the  ‘Panic Attack Exercise 1: Deep Abdominal Breathing’ or the ‘Calming the Mind Exercise 1: Mindfulness Meditation’.

2. Strategies to Fall Asleep

While changing your bedtime routine to maximise the chances of going to bed in a calmer state of mind will definitely help with getting to sleep, people who struggle with anxiety often find as soon as they get into bed and can no longer distract themselves, they start worrying or ruminating. This worrying stimulates the cortex, activates the amygdala, and can make dropping off to sleep very difficult. So what can we do to help us drop off to sleep quickly?

Some of the traditional methods used for getting to sleep, such as counting sheep, are often ineffective. Just knowing we are consciously trying to get to sleep often makes it very difficult, and boredom inducing strategies tend to make our anxious thoughts even more attractive and often keep us awake for longer. However, there are some exercises known to be effective:
 

Cognitive shuffling – This involves mentally picturing a random object for a few seconds before moving onto another: a carton of milk, a car, a castle, a paperclip, and so on. It’s important to ensure the sequence is truly meaningless, otherwise you’ll drift back into rumination.

This method was developed by Canadian cognitive scientist Luc Beaudoin, and described by journalist Oliver Burkeman in his health and wellbeing column in The Guardian newspaper. The exercise is based on the theory the brain tests if it’s safe to fall asleep by checking what our cortex is doing. If the cortex is engaged in rational thinking activity, it determines it may be considering dangers and it would therefore be best for us to stay awake. However, if the thoughts are random nonsense, the brain considers we are relaxed and tired, and sleep should be induced.

Cognitive shuffling also reduces rumination by the simple fact that it’s difficult to focus your attention on more than one thing at a time. It’s hard to ruminate about a problem at work if you’re busy generating images of balloons, cheese, and train carriages.  Beaudoin has an app that provides random words and speaks them into your ear. However, I’d suggest avoiding using an app or headphones in bed, as sleep aids like this, while useful for a time, can act as a crutch, and make sleeping without them difficult in the future. Instead, it would be more effective create these random words yourself by going through the alphabet and naming as many items as you can think of for each letter before going on to the next.
 

Scanning through your day in detail – This exercise involves mentally going through your day in detail, starting from the moment you woke up. So when you get into bed, close your eyes and recall the very first moment of the day you can remember, and then scan through the day as if you’re fast-forwarding a video. Don’t do this too quickly; just do your best to remember all the different parts of the day. It has a certain rhythm to it. So it might be something like this: I woke up – walked to the bathroom – went to the toilet – brushed my teeth – had a shower – woke my child – went into the kitchen – made the breakfast – brushed my teeth – walked to the car – drove to work, and so on. Just work your way through the day remembering all of the different things you did. It should take a few minutes. You may get to parts of the day you’d like to pause and spend a little bit of time thinking about, but don’t pause, just keep going, leave that behind. Let go of the conversation or situation you’d like to focus on and continue to work your way up right up to the present time when you're in bed. Notice when your mind wanders off from scanning the day, and when you realise it's wandered, just gently bring it back to the scanning, starting up again from you left off. 

When you’ve finished scanning through your day, very slowly start to become aware of your breath. Don’t change it, but just be aware of it. Count your breaths until you get to ten. If you lose count or your mind wanders, don’t worry, just bring your attention back to your breath and start again from one. If you’re still awake at this stage, start counting backwards from 100 right the way down to zero, not with the intention of falling asleep but with the intention of getting to zero. If you’re still awake after reaching zero, start again at 100 and count down again, and keep repeating this.

Sleep meditation – there is an extended audio guide version of the above exercise, with a few extra stages in, including a meditation tailored for sleep.  If you find you are still unable to sleep. You can access and download the exercise here: Dr Matt Lewis – Sleep Meditation

https://soundcloud.com/dr-matt-lewis

Physical Activity

I think we all now know physical activity is good for our physical health. There’s growing evidence physical activity can lower the risk of a number of ailments and disorders, ranging from type 2 diabetes, to heart disease, to cancer. However, maybe less well known is the gathering evidence illustrating the positive impact of physical exercise on mental wellbeing,and more specifically, anxiety.

PHYSICAL ACTIVITY REDUCES ANXIETY SYMPTOMS

Research has shown physical exercise can measurably reduce anxiety in around twenty minutes, which is less time than it takes most medications to start working. Physical activity is not only effective at reducing the physiological symptoms of anxiety, but has also been demonstrated to calm the amygdala – reducing its reactivity – meaning anxious feelings and their symptoms are less likely to start, or are much reduced.

This shouldn’t really surprise us, as when anxiety triggers the fight, flight, or freeze response, it prepares our body to move quickly and powerfully. Physical activity uses the emergency response in the way it was intended – by moving and being active. Being physically active lowers the levels of adrenaline pumping through the body and uses glucose released into the bloodstream. So exercise calms the amygdala and reduces anxious thoughts and the physical symptoms. Importantly, it also positively impacts on mental health by producing feelings of wellbeing and exhilaration, prompted by the release of neurotransmitters called endorphins, which also work on reducing pain.

However, exercise is not just an antidote to acute anxiety symptoms, it has also been shown to have a long-term effect on anxiety, with evidence it significantly reduces chronic anxiety, working at least as well as medication over long periods. Regular exercise also has the benefit of providing long lasting muscle relaxation, which, like the muscle relaxation exercises we outlined earlier, reduces muscle tension throughout the body and in turn dampens amygdala reactivity, further contributing to lower levels of anxiety.
 

PHYSICAL ACTIVITY AS EXPOSURE TREATMENT

Exercise can also be particularly beneficial for people who struggle with panic attacks or the strong physiological symptoms of anxiety or stress. Moderate physical activity can act as a type of exposure treatment, helping us to get used to the physical sensations often experienced when anxious or stressed. Experiencing similar sensations while exercising (increased heart rate, rapid breathing, elevated blood pressure) helps us to realise they are not harmful, but we can cope with them and get used to the discomfort.

BUT I DON’T LIKE PHYSICAL ACTIVITY

I’ve read and taught about the benefits of physical activity for a long time, but have also noticed, despite growing evidence of the benefits of exercise and exhortations to get more active from the media, health experts, and government campaigns, most people still don’t exercise regularly. In order for people to be motivated to exercise they must either enjoy what they are doing, or it has to be a part of normal everyday life, whether it be through necessity or choice. My love of walking came from having to walk 25 minutes to the train station from my home and then another 20 minutes after getting off to the train to my place of work every day. If I’d had my own car at the time, I probably would have driven to the train station. However, four years of enforced walking turned into a habit I love, and I’ve long continued to walk everyday despite no longer needing to do the same daily commute.

People often find physical activity difficult to start and maintain because it is seen as a chore. Exercise has become synonymous with going to the gym, and while some people love visiting the gym, for many of us, the gym is a sterile, artificial, and intimidating environment that can be off putting. So the most important criteria for deciding on what type of exercise you should do is enjoyment. If we enjoy what we are doing we are more likely to keep on doing it. Think about what exercise you can do outside of the gym, whether it’s at a club, at home, or outside.

Exercising outside – in nature – known as ‘green exercise’, has been shown to have extra mental health benefits above and beyond physical activity. These include improvements in mood and self-esteem, and reductions in anxiety and depression. I may be biased due to my love of walking, but having taught about the benefits of exercise for many years, I am convinced that if there is a panacea in medicine, it’s walking. So if you do nothing else, start walking for 10 to 20 minutes a day and slowly introduce more walking into your everyday life. The recommended dose is 10,000 steps a day, which is about 4.5 miles. Get a pedometer or activity monitor, such as a Fitbit, to see how far you’re walking. Build up to a level of fitness that allows you to walk briskly for some of the time.

Whatever exercise you do, try to do it with moderate intensity and also make sure your doctor approves it. Think about incorporating it into ‘Foundational Exercise 2: Balancing Life’ outlined in the Calming the Mind part of the blog.

Assess Your Media Diet

Our human negativity bias, a survival strategy inherited from our early ancestors, who lived in very dangerous environments, naturally draws our attention to negative news stories. This is why negative stories dominate the media and why we feel compelled to watch. So it’s natural to want to follow updates of terrorist events, violence, shootings, and war, both on television and social media. However, repeated exposure to trauma by the media can have as similar an impact as experiencing the event first-hand.

HOW CONSTANTLY CONSUMING THE NEWS CAN INCREASE ANXIETY

You may think it is necessary to keep up with the news, and those who follow the media closely are more informed about the dangers of the world, but this isn’t the case. In fact, people who digest more media, grossly overestimate rates of violence. We can compound this and raise our levels of anxiety and helplessness further by reading fearful and angry public comments on what has happened and what action should be taken. Consuming the news in this way makes us far more anxious and afraid because we don’t tend to be very good at assessing risk. We overestimate our chances of being in danger due to a number of irrational ways of thinking. Some of these include:

• If a recent event is particularly dramatic and receives saturation coverage in the media we tend to overestimate the risk of something similar happening to ourselves. We do not see dramatic in-depth media coverage of other causes of death, which are more common, such as road traffic accidents, so we assume the events that receive more coverage are more dangerous to us.

• We lack awareness of the more common positive or neutral events. We don’t focus on the far more common non-events that occur every day, such as the number of flights that safely arrive at an airport, or the number of positive social interactions between people of different religions. These events, which are a far more accurate indicator of reality, do not make the news as they are common and are more likely to occur.

• We succumb to the recency effect. We think a dramatic event is more likely to happen if a similar event happened recently. This is the case after terrorist attacks, virus outbreaks such as Ebola, and aeroplane accidents.

IS THE WORLD BECOMING LESS SAFE?

Although it sometimes feels like the world is becoming less safe, peaceful and united, and therefore more dangerous, violent, and divided, is this actually the case? If you look at the measurements objectively, the world we currently live in is probably more peaceful, safe, and  less dangerous, most of us have never felt as disturbed about the world before, so it feels as if things are worse.

What has changed is how we are getting our information; there are now far more cameras to record both small and large incidents, an internet that helps us to spread information more easily and widely, and also the far reaching effects of social media. So the type of information we now receive has changed, along with the way we get it.

We are living in an attention economy and the information that gets the most attention is extremism and fear mongering. As we’ve discussed before, our negativity bias naturally gravitates towards this type of information, even if it is unbalanced. So extreme views are rewarded with more attention, more shares, and more comments. Social media, some news channels, and the internet in general, have developed a medium in which moderate views, respectful discussion, and reasonable behaviour is considered boring and uninteresting.
 

DISTRACTION AND COGNITIVE OVERLOAD

Continual media exposure also distracts us from getting on with other activities we need to do, or would benefit from, and can also overload our thinking. Endless access to new information easily overwhelms our working memory. When we reach cognitive overload, our ability to transfer learning to long-term memory significantly deteriorates. It’s as if our brain has become a full cup of water and anything more poured into it starts to spill out. So we leave ourselves with little time to do other things properly and are also unable to focus as well on other information.

You also may have noticed once you start looking at news and social media, it’s difficult to stop, it almost becomes an addiction. Our brain craves continual stimulation, is drawn to novelty, and likes to be instantly gratified. Continually watching or reading updates creates a compulsion loop, and like drug addicts, we need more and more ‘hits’ to get the same effect. 

As a personal example, I remember when I used to view social media very frequently. I found sometimes when I closed my eyes at night, went in the shower, or did anything that didn’t take up my full attention, my head would be full of the voices of those I followed on social media. They were constantly swirling around my head. I’d be party to arguments between others that didn’t concern me, engrossed in problems I could do nothing about, and overloaded with so much information I couldn’t process it all.

After a while I realised the thoughts of others were robbing me of any peace or quiet, and were not even allowing my own thoughts to come through. My head was full of well-meaning advice, angry views, outraged voices, stories of injustice, fear, grudges, research findings, funny quips, and many polarised opinions. Meanwhile I realised my life was being lived through the lens of others.

HOW SHOULD WE STAY INFORMED?

This is not to say we should never catch up on the news or engage in social media, or that it always has a negative effect. The internet and social media has also been a vehicle for good and provides some people with a voice and positive connections they previously didn’t have access to. However, we should raise our awareness of how often we access certain types of media and reflect on how we feel after this exposure. We should consider what types of news we digest and what sources we rely on.

Plan times when you want to catch up with the news rather than accessing it continually, and try to notice when you’re automatically checking for updates without being aware of what you’re doing. If, after reflection, you become aware your media diet is problematic and adds to your anxiety, consider how you might change the way you consume the news and any other media, and incorporate it  into ‘Foundational Exercise 2: Balancing Life.’

Looking Outwards: Focusing Away from You and Your Anxiety

When we’re looking to overcome our anxiety, we often focus intensely on ourselves as we try to find a solution. This is understandable, as anxiety is an individual state. When feeling very anxious it seems reasonable to think we should focus our attention inwards in order to ‘work’ on ourselves and assess how effective the strategies and exercises are in helping us.

However, while some self-evaluation is necessary – we do need to know what’s working after all – intense self-focus has also been shown to be harmful to wellbeing. A wealth of evidence has demonstrated anxiety already tends to turn people inwards. It makes us more introspective and therefore less socially engaged and lonelier, and this self-focus can also undermine happiness and cause depression. It’s like a vicious circle; we feel anxious, so we withdraw and become introspective, but this in turn makes us more anxious.

Alongside this, to find out if we’re making progress, we often compare our past levels of anxiety to our current levels of anxiety. This creates a problem: the moment we make that comparison, we shift from experiencing life to evaluating life.

Consider the research on a concept called flow – a state of complete absorption in an activity. Researchers have found when people are in a flow state, they don’t report on any particular emotion – being happy, sad, anxious, fearful – as they’re too busy concentrating on the activity. But afterwards, looking back, they describe flow as a positive emotion. If we become busy assessing each new strategy and evaluation, we can never fully engage in activities, projects, relationships and life in general.  Instead, we can become anxious and depressed and enter a vicious circle. This is documented by psychologists Katariina Salmela-Aro and Jari-Erik Nurmi: anxiety and depression leads people to evaluate their daily projects as less enjoyable, and ruminating about why they’re not fun makes the anxiety and depression worse.

So what can we learn from this research? Firstly, we should start engaging with exercises and projects without constantly evaluating how anxious we are, and focus instead on the exercises or projects themselves. Some reflection on whether the exercises are effective, and which ones work best, can be valuable, but we should avoid constantly evaluating our anxiety and happiness. Secondly, we should be wary of becoming too self-focused or self-absorbed with ourselves and our anxiety, and attempt to also look outwards towards other people.

Some interesting research from the University of British Columbia discovered that encouraging people who suffer from anxiety to engage with others, through acts of kindness, helped reduce anxiety. The researchers recruited participants who reported experiencing high levels of social anxiety, and randomly assigned them to three groups for a four-week intervention. One group performed acts of kindness, another group was simply exposed to social interactions, and the last group was given no instructions except to record what happened each day. The results found those individuals who were asked to perform acts of kindness had the greatest overall decrease in their anxiety about social interactions. That is, they were less scared of, and more drawn to, socialising with others.

The theory behind the results is that by trying to protect themselves from being evaluated negatively by other people, anxious people don’t socially interact. This in turn means any chance to demonstrate their perceptions may be wrong are cut off. The acts of kindness helped to counter this fear of negative evaluation as the anxious people found people responded more positively to them than they expected.

So in the midst of practising all of the exercises we’ve outlined, don’t constantly withdraw into your own world, but also look to how you can help and interact with others.