Surviving Anxiety and Trauma
Surviving Anxiety and Trauma
Unexpected Fall
Dr. Sid drove through the city in the early morning darkness. He'd traveled this route to the hospital for the last 15 years, but the ordinarily busy city was now quiet, a sad reminder of the ongoing pandemic's impact. A shiver crept up his spine at the thought of what lay ahead of him, and he cranked up the heater.
His knuckles turned white as he parked the car and looked up at the gray stone building. Sweat peppered his brow as he walked into the hospital, and his heart raced. He took several deep breaths as he passed the line of patients snaking out the doors and down the road leading to the emergency room. Once in the building, he kept his head down, not wanting to meet the gaze of the frightened people lining the halls in chairs and on stretchers.
Sid's eyes focused on his reflection in the elevator's metal doors. His vision blurred, and he gasped for breath. His lips were dry, and his chest was tight. A memory clouded his mind—horrifying images of death on a battlefield far from home. Bile caught in his throat as he recalled the sea of broken bodies before him and the sickening smell of burning flesh. He awoke in a field hospital with a minor head wound from flying shrapnel. As a medic, he'd lacked adequate medical personnel for the wounded and dying, and he'd watched death come for both friends and enemies. His last memory was trying to find and triage the living and salvage life.
Sid adjusted his face mask and stepped into the empty elevator car, bringing himself back to the present. His knees buckled beneath him as he leaned back against the cold steel wall. Sid clutched his left arm and wished he had paid more attention to the symptoms before now, but work had always been the priority. As a good soldier and doctor, stress and overwork were always part of his life, and over the years, he'd become overweight and ignored signs of heart disease, high blood pressure, and diabetes.
As the elevator climbed to his floor, the pain eased. He stepped off on his floor, loosened his tie, and promised himself he'd start living a healthier life. After grabbing a cup of coffee, he climbed into the protective clothing and mask that would have to sustain him in the next few hours—people were dying.
Sid reached the intensive care unit for rounds, where the nurse and an intern waited for him. They discussed the patients who had died during the night, then Sid examined the weak and dying, changing medications where needed and answering calls from frantic families trying to find out their loved one's status. Suddenly, a sharp pain shot down Sid's arm, and he and his clipboard fell to the floor. Holding his chest and fighting for a breath, darkness closed in around him.
The next thing he knew, he was waking up in the coronary care unit with the familiar beep of a heart monitor reassuring him that he was alive. A cardiology colleague told him that he was in stable condition but had suffered a significant heart attack. He'd gotten a wake-up call—a second chance to change his demanding work schedule, develop a healthier lifestyle, and put his wellbeing first.
As Sid's story shows, life events can contribute to or dramatically increase anxiety, depression, associated diseases, and deaths. Early awareness and care of anxiety-related difficulties or conditions are essential to prevent long-term problems, illnesses, or disabilities.
When Anxiety Conditions Become Adversity for the Mind and Emotions
When well-modulated, fear and anxiety help people stay alert and vigilant. For example, the fear of being ostracized or penalized for rebellious or unlawful activities motivates to follow the laws to maintain civility and safety in the community. On the other hand, excessive fear and anxiety are detrimental to everyday functioning. Too much pressure or stress increases anxiety and fears of failure, weakness, or vulnerability. What can follow is a lowered immunity, a reduced amount of restorative sleep, and increased susceptibility to infection.
Emotional distress and mental impairment related to high anxiety levels or related conditions can also cause work-time loss, disruptions in relationships, drug addictions, overdoses, and suicides. Chronic distress from anxiety can lead to avoidance of activities, social isolation, and illness related to impaired immunity.
When overly anxious, one can seek security by the following advice from friends, advertisements, or the internet—often not the best sources of information. You might become addicted to watching too much TV or consuming news reports that feed fear and worry. The critical point here is to understand and recognize the nature and healthy side of anxiety and be prepared to take action when too much stress or fear is causing impairment, adversity, panic, or obsessiveness.
The initial step may involve implementing helpful self-care or getting outside professional support. Cascading emotional distress needs attention before a person's quality of life declines because of illness or loss of effectiveness and productivity.
Many Do Not Seek or Receive Help
Anxiety disorders affect 40 million adults, or 18.1% of the U.S. population, every year, making it the most common mental/emotional/psychological condition in our country. Anxiety and related disorders account for a significant portion of the U.S. mental health budget.
A considerable number of people with an anxiety disorder have at least one other accompanying psychiatric condition. These disorders can cause overwhelming, debilitating anxiety and fear that can worsen if untreated. And yet, less than 30% of individuals with these problems seek treatment, and a number go undiagnosed by their primary healthcare providers.[2]
Many became overwhelmed in the difficult times of the COVID-19 pandemic with increasing unemployment, losses of businesses and jobs, and the surge in coronavirus cases and deaths in the U.S. Unchecked fear and worry were commonplace, with a growing amount of anxiety, panic, mood disorders occurring, and needing care and help.
Mental Health America (MHA) online screenings over six years, with over 5.5 million United States participants, showed a significantly greater moderate-to-severe depression or anxiety rate than in a similar study before the pandemic. A quarter of study participants cited grief, loss, and financial concerns as contributors to anxiety and depression. According to a two-month survey from the Kaiser Family Foundation in July 2020, more than half of the U.S. population experienced adverse effects from COVID-19-related stress.
Frequently reported difficulties included problems with sleep, poor appetite or overeating, mental health issues, headaches, stomachaches, anger issues, increased alcohol, and drug use, and worsening existing illnesses such as diabetes and hypertension.
Fear and anxiety can dramatically rise when caught in one's inner thoughts and emotions. Levels of fear and anxiety can also become compounded when individuals are in tight quarters with others experiencing fearful states. Avoiding getting help, counseling, or therapy, especially if there is a history of unresolved trauma, will increase the risk of developing future mental health issues or illnesses.
Those having a history of trauma, or living with others who have an unchecked emotional or mental illness, should seek help or guidance early, preferably as soon as they experience growing fear, worry, or anxiety. Early identification of feelings or symptoms of unhealthy emotional or mood states is an initial step in knowing when to get help or support. Prompt attention and early intervention may prevent progression to more severe problems.
Signs of Anxiety-Related Conditions
Being frequently nervous, moody, or on edge
Feeling a sense of impending danger or doom
Increased or rapid pulse/heart rate, palpitations, and dizziness
Fast or troubled breathing and sweating
Increased tiredness, weakness, and desire to sleep more
Muscle tension, fatigue, and trembling
Difficulty concentrating and getting things done
Having trouble sleeping, with more frequent nightmares
Experiencing digestive problems and changes in appetite
Panic attacks, which appear suddenly and increase in intensity over several minutes, then peak and usually go away rapidly
If any of these symptoms persist, please consider seeking appropriate support.
Panic Attacks
Panic differs from fear and other types of anxiety. Panic attacks can occur because of growing stress and fearfulness. These attacks include severe nervousness, muscle tightness, trembling, fast heartbeat, fast or troubled breathing, dizziness, impaired concentration, palpitations, sweating, and sleep disturbances.
Also, panic attacks are often unprovoked, appearing suddenly and increasing in intensity over several minutes, then peaking and then rapidly subsiding over 10 minutes or longer. An episode can occur as a one-time event or repeatedly triggered by something remembered. It can appear without warning and occasionally when awakening from sleep.
These episodes can be alarming, disruptive, and disabling. One explanation for the cause of the panic attacks is that the body's typical alarm system of mental and physical responses to an actual threat, the "fight-or-flight response," gets triggered and activated even when there is no real threat present.
In "normal" times, panic attacks occur in about 20% of the U.S. population at least once in their lifetimes, or 3% of the population at any given time. With the heightened fears over illness and related concerns during a pandemic, major disaster, or community disruption—personal and family safety, work, career, paying the bills, getting needed food, shelter, medications, etc.—panic attacks can occur more frequently.
Contributing factors to panic attacks include:
An actual or transient medical problem such as a middle ear infection, allergies, mitral valve prolapse (often a mild dysfunction of this heart valve closure), hyperthyroidism, or low blood sugar
Earlier life history of significant trauma or post-traumatic stress disorder, with embedded memories of prior trauma, or increased susceptibility for panic episodes in an already highly anxious and hypervigilant person
Medication use or withdrawal, stimulant or substance use or abuse leads to greater vulnerability to panic attacks
Overuse of stimulants like caffeine or non-prescribed or unnecessary stimulant drugs, or drugs of abuse such as methamphetamine or cocaine
Life events involving significant stress, losses, threats of damage, or feelings of increased vulnerability
Panic disorder can become recurrent and disabling. If the panic episode occurs in a specific setting, as in a store or car, irrational fears or phobias about these situations may arise. People that avoid these situations can become increasingly housebound, unable to drive, and develop agoraphobia (fear of public places). If the person doesn't receive effective early treatment, increasing incapacitation in life activities can result.
Holistic Care for Anxiety and Panic
When recurrent fear and anxiety persist and are troublesome, relief may be possible with a mental health care provider's knowledgeable self-care or effective therapeutic intervention. Interventions can help you:
Get unstuck from unhealthy behavior patterns, rigid beliefs, and fearful or painful memories.
Reduce or eliminate anxiety, panic, addictions, and trauma-related symptoms.
Focus more on the present and the here and now, rather than the past or future.
Become more present, mindful, and aware.
Improve energy, focus, concentration, daily functioning, and skills to prevent relapse or recurring symptoms.
Develop greater acceptance and compassion.
Regain the wisdom and balance of personal power, personal needs, and the needs of others.
Reestablish social support and networks.
Therapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) Interventions[3] may prove beneficial for anxiety, mood impairments, and prior trauma.
Therapies commonly employed to benefit anxiety-related conditions include:
Education about the body's physiological reaction to fear and threat
Use of experiential techniques, talk/listening, person to person, and group therapies
Desensitization to the various physical sensations or triggers of panic through the exposure of a person to the actual object, situation, or thought
Catastrophic-thought-reducing techniques
Relaxation, breathing, and stress management techniques
Restructuring dysfunctional thoughts and patterns
Gaining personal insights into one's inner strength and ability to overcome obstacles
Transforming from being the victim of a traumatic experience and memories to a broader perception of life and one's power and potentialities
Recognizing and accepting that the mind is continually moving toward the healing of its own emotional and mental health
Committing to the healing process and therapeutic work as needed
Releasing frozen past traumatic memories and constricting defenses to regain energy flow and vitality
Regaining flexibility from rigid beliefs and attitudes to experience an expanded perspective about life outside the narrow constraints of a limiting mind-ego
Be Aware of Underlying Medical Conditions
Unfortunately, healthcare providers often are not familiar with the potentially devastating and disabling effect of the improper treatment of anxiety-related conditions. Management of anxiety often uses a tranquilizer, an antidepressant, or reassurance by a conventional healthcare practitioner.
A thorough evaluation by a qualified medical and mental health practitioner with skills and expertise in working with anxiety, panic, and mood difficulties is an advised first step when available. Finding caring and valuable help may get at the deeper issues and the roots of anxiety rather than simply suppressing symptoms.
Holistic and natural therapies can add more effectiveness, at times, when combined with conventional treatment.
Positive Complementary Approaches for Consideration:
Lifestyle modifications and life skill enhancements
Mind, body, and spiritual practices such as yoga; chi gong; mindfulness; meditation; or exercise with mindfulness in running, swimming, biking, dance; or active participation in any creative art endeavor
Stress management and relaxation techniques
Acupuncture and massage therapies
Targeted nutritional therapies, botanical medicine, nutritional education about dietary choices, and micronutrients such as herbs, vitamins, minerals, essential fatty acids, and amino acids
If natural treatments have not worked, medication may also be of value in resistant or severe emotional or mental health conditions such as anxiety, panic, post-traumatic stress, or significant mood disturbances. Antidepressants, mood stabilizers, or tranquilizers prescribed by conventional medical practitioners can sometimes bring more immediate relief.
However, the long-term use is controversial because of the possibility of causing other medical issues. Once in use, trying to stop medication can lead to relapse or, with some tranquilizing drugs, can cause withdrawal seizures. Thus, medicines may not have the same lasting effect and benefits as useful therapy programs and natural alternatives.
TIPS:
1. Reduce the time spent watching shows, checking social media, or listening to news stories on your TV, computer, or smartphone when at home or in the workplace during a highly anxious time or when overstimulated. Hearing sensationalized, dramatized news reporting or stories from others repeatedly during the day can lead to increased worry, anxiety, tension, and poor sleep.
2. Instead of too much inactivity, such as passive watching, listening, or obsessing about current worries or events, take frequent time-outs with regular exercise. Active movement includes stretching and eating healthy meals (avoiding sweet binging and over-snacking on high-caloric food or drinks). Enjoy periodic relaxation times with deep breathing, meditation, or yoga. Get adequate restorative rest and sleep.
3. Cut down or stop smoking, vaping, alcohol, and non-prescription drugs, as these adversely affect you.
4. Take more frequent breaks during sitting and work time—stand more, move, or take outside walks.
5. Keep to a regular exercise schedule, such as 30 minutes or 7000 steps per day. Beneficial exercise can take many forms, such as walking, biking, climbing stairs, housework, or an exercise routine with push-ups, lunges, jumping jacks, and running in place. Join an online group exercise program. Do relax, enjoy, and allow any worries and fears to move to the background of your awareness as you fully embrace the physical movement, breathing, and letting go of tension.
6. Get outside and into natural settings. Being in and closer to nature is very calming and healing. Move, breathe, take in the beauty and harmony that abounds around us.
7. Treat yourself to a nice hot bath with two or three cups of Epsom salt and a few drops of essential oils, such as lavender, to melt away any tension and worries.
8. Get involved with enjoyable recreational or artistic activities like art, writing, craftwork, gardening, constructive projects, or volunteer work. Read an inspiring, educational, or fiction book—whichever entertains and relaxes you. Enjoy listening to music, dancing, doing a crossword puzzle, watching a good movie, or a comedy show for some humor and laughs.
9. Stay socially connected with friends, family, and community.
10. Learn yoga, mindfulness practices, meditation, or exercise routines to help with relaxation.
11. During challenging times and travails, take the time to review what is essential and has meaning and purpose for you. Meditate and reflect on what is most important. Witness and let go of fears and self-preoccupation as much as possible. Find some inspirational readings to comfort and inspire you.
12. Allow any crises or stresses to inspire you to live a simpler, more meaningful life and better serve the greater good of the community and the environment. Be encouraged to be socially active to bring about positive change.
13. Be more in the moment, breathe, take it all in—including trouble and worry, along with what is comforting, beautiful, and inspiring for you.
14. Focus on all that for which you can be thankful—taking a time-out to refill your reserves, to regain your resilience and strength to move on with purpose, gratitude, and hope.
Find the best path for yourself to move through fear and anxiety. Caring for your mind, emotions, and spirit is essential for purposeful and healthy living. Be constantly aware and get the help you need at the first signs of distress or ill health. Be open to offering service and support to others with emotional difficulties. Take the time for acceptance and compassion for yourself and others as ever-changing feelings, emotionality, insecurities, and vulnerabilities are a reality of daily life.[4]
I appreciate you and your interest. Please share this article with others or leave comments below.
Be well and do the best you can on your journey of discovery, learning, and healing.
Thanks,
Ron Parks, MD
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ENDNOTES:
Lead-in photo for the article: ©alphaspirit/123rf.com
[1] Sid’s story is not that of an actual person or family but a fictional composite created from my years of clinical and personal experience to heighten your awareness of the importance of the issues discussed
[2] The New York Times (updated August 26, 2020). The U.S. surpasses 5 million cases. nytimes.com/2020/08/08/world/coronavirus-updates.html Halverson, J.L., MD (Bienenfeld, D., MD, Chief Editor) (updated August 6, 2020). Depression, Medscape. emedicine.medscape.com/article/286759-overview
[3] Sharp, J., MD (March 12, 2020). Coping with coronavirus anxiety, Harvard Health Publishing Blog. apa.org/topics/trauma Fader, S. (December 21, 2020). Trauma therapy: What is trauma therapy and how does it work to combat trauma? Better Help. betterhelp.com/advice/trauma/what-is-trauma-therapy-and-how-does-it-work Centers for Disease Control and Prevention (March 19, 2018). Coping with disaster or a traumatic event. emergency.cdc.gov/coping/index.asp
[4] Yasgur, B.S., LSW (August 12, 2020). Supplement plus probiotic may improve depressive symptoms, Medscape Medical News. medscape.com/viewarticle/935603 Brooks, M. (August 3, 2020).
Depression, anxiety in COVID-19 indicators of CNS attack, Medscape Medical News. medscape.com/viewarticle/935019 172
Centers for Disease Control and Prevention (December 11, 2020). Coping with stress: Pandemics can be stressful. cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
Centers for Disease Control and Prevention (September 12, 2019). Take care of your emotional health. emergency.cdc.gov/coping/selfcare.asp
Centers for Disease Control and Prevention (March 19, 2018). Emergency responders: Tips for taking care of yourself. emergency.cdc.gov/coping/responders.asp