The past 18 months have introduced us to many things, like Covid 19, layoffs, vaccines, furloughs, a pandemic, and lockdowns to go along with the constant reminders on the news that the economy is bad and crime is rampant. Add it all together and it is leaving many people with anxious feelings.

What is anxiety?
Psychiatrist Dr. Jenys Allende, Screening and Crisis Intervention and Medical Director for Mental Health Staffing at Legacy Treatment Services, said anxiety is a feeling of worry, nervousness, or uneasiness that is typically about an imminent event or something with an uncertain outcome.

"Anxiety can be normal in stressful situations such as public speaking or taking a test. Anxiety is only an indicator of underlying disease when feelings become excessive, all-consuming, and interfere with daily living," said Dr. Allende. "The thought of being stressed produces anxiety that is adaptive when the individual is able to respond and alter themselves or the environment, but in situations that a satisfactory response is not possible it is maladaptive to remain in a highly activated state for a prolonged period of time."

The connection of anxiety and fear
As Dr. Allende explained, anxiety is a worry, nervousness or unease that does not have a specific object. "Fear however is the same cluster of emotions as anxiety but with a specific object. 'I have a fear of (heights, spiders, or just saying the wrong thing).' However, you could say I am anxious in general."

What came first, the anxiety or the fear? Dr. Allende said it can go both ways. "All of us have a certain level of neuroticism. Some of us get anxious easily while others take things in stride. This is a result of genetics and environment. For example, anxiety could run in your family or you could have a bad experience and become more easily anxious about that situation."

"It is easy to see why fear results in anxiety," explained Dr. Allende. "You are afraid of airplanes for whatever reason, and you get anxious when you are forced to have to fly."

Anxiety can lead to fear
For worriers, those with high neuroticism, they tend to be driven by the possibility of bad consequences rather than good ones, explained Dr. Allende. "You spend your life 'waiting for the other shoe to drop' so it takes little stimulus for you to fear things. Worriers generally make statements like, 'what if the engine fails, a stranger abducts you, or a car is driving erratically?' These potential bad scenarios make people fear certain situations more readily."

Anxiety impacting normal activities
"Anxiety is likely adaptive," according to Dr. Allende. She likened the caveman and his fear of being hurt by an animal, therefore developing a fear of animals like bears to the college student's fear of failing a test. The caveman becomes anxious about bears and stays out of danger and lives. The college student feeling uneasy and spending time thinking about possible failure may drive him to spend more time studying. "These are adaptive positive changes," concluded Dr. Allende.

"Anxiety becomes maladaptive when it starts to interfere with your normal functioning. If that same student became so anxious about the test that every time he opened a book he experienced nausea, sweating and an impending feeling of doom, the anxiety stops him from studying for the exam. That anxiety is maladaptive and is impacting his ability to function at school," said Dr. Allende. "Anxiety disorders begin when the anxiety is severe and/or causes an impairment in functioning."

The "twisties"
Earlier this year the world watched as one of the most accomplished gymnasts in history, Simone Biles, was unable to perform her routine at the summer Olympics because of anxiety or what was referred to as "the twisties." The Washington Post explained, "the twisties" is when gymnasts lose control of their body as they spin through the air. Sometimes they twist when they had not planned to. Other times they stop midway through as Biles did and after experiencing it once, it's very difficult to forget. Instinct gets replaced by thought. Thought quickly leads to worry and worry is difficult to escape. Dr. Allende acknowledged how scary gymnastics can be saying, "Humans can accomplish unbelievable and dangerous things with practice and in the case of gymnastics, with a great deal of natural ability. At the highest levels a tiny misstep, a small miscalculation or doubt could sabotage a maneuver and leave the gymnast paralyzed."

"I wish all of us were at our highest level of self-confidence and ability to pay attention all the time. However, life happens," said Dr. Allende. "People suffer losses and may become less confident in an area of their life because of the understandable distractedness. We may make a minor mistake at work on an email and start to doubt our work skills. Second-guessing yourself and as a result, you do not get much accomplished. But when the stakes are higher and for whatever reason, you have a moment of self-doubt, there can be disastrous consequences. In the case of Simone Biles, she stated she could not tell what was up and what was down."

Dr. Allende said while Biles could rationally tell herself that she had done this routine a million times before without a problem, she had likely activated the fight or flight response. "At that point, the brain is looking for danger. Fear persists because the responses are being run more by the primitive brain than usual.

High-profile people help others with anxiety
When someone we look up to talks about their struggles with mental health it makes it easier to talk about our own struggles, explained Dr. Allende. "This leads more people to ask for help. It also leads to more people offering help. If there is not such a stigma around anxiety, friends may reach out to each other more often to talk about their own anxiety. When Biles spoke out about her anxiety it not only helped people suffering from anxiety, it also helped the general population feel more comfortable about asking, helping with, and understanding anxiety.

When being anxious becomes an anxiety disorder
Anxiety can change into an anxiety disorder, where it impairs an individual from functioning normally, according to Dr. Allende. "It can be one thing or it can build up gradually and result in a fear that may rock an individual to their core and make it difficult to forget. Seeking help with the anxiety is key to moving forward."

The pandemic and anxiety
"Take all the changes with Covid 19. There was the period of time where it was "safer at home" to mitigate the virus," explained Dr. Allende. "At first some took precautions, having things delivered and venturing out less. In this population, some because of their personalities both positive and negative reinforcements began to internalize that "safer at home" mindset and just stopped going out as much. As society began to open up and people began to go out more, some were reluctant due to anxiety about leaving home. "It could be they enjoy having fewer interactions, or they fear getting Covid 19. These people can gradually, selectively gather their own evidence that they are safer at home, become anxious and actually begin to fear going out," said Dr. Allende. "It does not happen to everyone but that gradual worsening course certainly occurs."

Getting past the anxiety
For Biles, getting past her anxiety required her retraining her brain. She went to a gym with soft foam where she would not get hurt if she made a mistake. She had to retrain her brain from an "I could get hurt, to I'm a professional, and I got this." Dr. Allende said, "Improving a particular anxiety involves giving your mature brain evidence that you are safe in order to decrease the response of your primitive brain."

Relating to the teachings of everyone's favorite TV soccer coach, Ted Lasso Dr. Allende said "The coach will tell his players after a tough game, 'be a goldfish,' because goldfish have the shortest memory of all species. That is the ultimate goal of treating anxiety-getting to a point where you can consciously leave your worries behind. Of course, this is only aspirational, but it highlights the difficulty of letting go of anxiety."

In her practice, Dr. Allende said the first thing she does with an anxious person is to retrain their breathing. "I ask them to mimic my breathing and take slow, deep breaths. This actually activates your body's parasympathetic system which is the rest, relax, and sleep system. The slowed breathing quickly results in lowering your heart rate, while having you concentrate on something other than what is making you anxious."

Self-regulation and calming to help relax
Cognitive behavioral therapy for anxiety disorders is highly efficacious and its effects can be long-lasting. According to Dr. Allende, this model helps the individual recognize maladaptive thoughts that lead to anxiety and try to regulate them with different methods. One is the all or none thinking. This maladaptive pattern is rigid, black-and-white thinking. For example, if I go outside I will definitely get anxious and have to come back inside. You can change that to, if I go outside I may get anxious and it might be mild, and I can tolerate that for a while. Dr. Allende added, in the beginning you can also incorporate distraction techniques by consciously concentrating on something else around you, like having a ball in your hand and thinking about how it feels to hold and squeeze it.

Radical acceptance is another technique that puts anxiety and worry into a more convenient time. Dr. Allende said for her hospitalized patients she will tell them when they wake up they must sit with their journal and worry for a specific period of time. They can do it two or three times a day but the caveat is they have to try and worry only in their allotted times. This ultimately results in acceptance of their anxiety and the knowledge they have some control over it.

Seeing more anxiety
Dr. Allende is seeing more patients with anxiety and with more severe symptoms. "It does not surprise me that we are seeing more people with anxiety. The surprise is the magnitude of the problem," said Dr. Allende. "ER's have seen at least a 51% increase in the number of visits for suicide attempts among 12-17-year-olds with girls having a higher incidence than boys. A Centers for Disease Control and Prevention survey showed 11% of all responders had seriously considered suicide in the past 30 days. Among 18-24-year-olds, it was one in four had considered suicide in the last 30 days.

"As a society, we have a shared background level of things that produce anxiety. Climate change, the stock market, the unemployment rate and many others. Covid 19 just increased the background level of anxiety-producing stimulus," said Dr. Allende. "This is a shared traumatic event we are all experiencing. It follows that people are more anxious now than pre-pandemic."

Following Doctor's Orders

Dr. Allende is giving her patients sage advice to help them cope:

1. Turn off the news. Make active changes to decrease the amount of bad news you are subject to each day.
2. Work on life balance. With the drastic change to working from home, people often have a difficult time disconnecting from work, causing them to feel anxious and overwhelmed. Establish "working hours," preferably in a dedicated space that you do not use for other activities. In this manner, you can actually leave the office.
3. Exercise! Exercise causes a natural release of endorphins that reduce anxiety. Think of it as a preventative treatment for anxiety. You do not have to take a pill to reduce your anxiety.
4. Eat well. Have nutritious meals regularly. Sit down to dinner as a family. Improving your general health decreases the stress your body is under, making anxiety less likely.
5. Be a goldfish and go easy on yourself.

When to seek professional help
Dr. Allende advises you to seek professional help when anxiety is interfering with your everyday life at work, in your relationships or keeping you from sleeping at night. If you have suicidal thoughts, seek help. Suicidal thoughts are never a normal part of anxiety and can end in disastrous consequences.

"If you are not sure whether or not to seek professional help and are considering it, seek out professional help. What does the most harm, talking with a therapist who says you are reacting normally or having worsening anxiety interfere in your everyday life? Make the call," concluded Dr. Allende.

To access Legacy Treatment services visit www.legacytreatment.org or call 1-800-433-7365. If you are having thoughts of suicide, please contact the National Suicide Prevention Lifeline available 24 hours a day at 800-273-8255