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Anxiety management can take many different forms
Farm and Ranch Life
Becoming overly alarmed is a common problem for people involved in farming. Last week’s column was about how stress and genetics incline farm people to develop anxiety disorders.

This column is about managing severe anxiety and its accompanying feelings: dreadful thoughts such as death and losing control of our minds, loss of confidence in ourselves, gripping tension, diminished energy, inability to relax, problems sleeping and depression.

Usually we know when fears and panic are reasonable, such as when a threat is real. Anxiety subsides when the threat diminishes. But it is difficult to manage excessive anxiety.

Panic episodes account for almost 30 percent of hospital emergency room visits, according to a University of Pennsylvania study. While chest or abdominal pain are the most common reasons given for ER visits, fear of dying, hyperventilation and other symptoms that are usually manifestations of excessive anxiety are often the underlying real reasons for seeking emergency care.

In the popular 2012 book Zoobiquity: What Animals Can Teach Us about Health and the Science of Healing, the primary author, Dr. Barbara Natterson-Horowitz, describes how sudden overwhelming fear can lead to the death of wild – and occasionally domesticated – animals when they are captured as prey or trapped.

As a psychiatrist and cardiologist, the UCLA professor has observed this in humans as well. The flood of excitatory chemicals released in the body by severe alarm can trigger cardiomyopathy (damage to heart tissue) in both humans and animals. Few humans reach this point, however.

She goes on to say if human death results from anxiety, it is usually gradual, through exhaustion, to the point the body begins to break down muscle tissue that has become overly tense. Protein is released into the bloodstream and eventually, into urine.
This process, called rhabdomyolysis, sometimes occurs in people who overly exert themselves, such as long-distance runners who push themselves too hard. A telltale sign of “rhabdo” is brownish-tinged urine.

It helps anxious people to know they are not likely to die during a panic attack. The bottom line to this discussion about visits to the ER because of panic is that sometimes fears can’t be controlled, no matter how hard we try to tell ourselves it’s unnecessary to be anxious.

It explains why excessive anxiety sometimes leads people to feel like they might die and to fear restraints or have other phobias. People seldom die from anxiety disorders because other symptoms such as pain, “rhabdo” or other stress-related physical illnesses lead them to seek evaluation and treatment.

We do some of our worst thinking at night. It is important to know our production of beneficial chemicals is lowest between midnight and around 4:30 in the morning, assuming we are awake during the day. Awakening during these hours and dwelling on negative thoughts can trigger an alarm reaction.

Perhaps this is what the biblical writer David was referring to in Psalms, verse 91.5: “Do not be afraid of the terrors of the night.” Good advice!

What works to treat excessive anxiety? Behavioral therapy approaches are often sufficient to help anxious people learn how to manage anxiety.

Psychologists and others skilled in behavioral treatments help people to correctly identify feelings of anxiety versus other symptoms, and learn how to manage them through thought control, relaxation exercises and sometimes through relearning how to not respond with fear that has been acquired in the presence of a threat. The latter technique is called desensitization.

Active, but not excessive, exercise, engagement in creative projects, massage and other comforting touches, talking with a trusted partner or friend, prayer and meditation also usually help reduce anxiety. Sometimes what is needed is to learn how to behave more assertively – but not aggressively – in the face of feared individuals or circumstances.

Medications are usually necessary when behavioral approaches to managing anxiety are insufficient. Two families of medications are most often used to treat anxiety disorders: anti-anxiety medications and antidepressants. The most common anti-anxiety mediations are in the benzodiazepine family, such as alprazolam and lorazepam. They inhibit the production of excitatory body chemicals. They are quite addictive.

Buspirone is an alternative that is not known to be addictive. There are several other families of anti-anxiety medications, such as beta-blockers, that have appropriate uses.

Antidepressant medications can help people with anxiety that has become chronic to the point they are not producing sufficient serotonin and other beneficial body chemicals. Several families of antidepressants are available, such as the selective serotonin reuptake inhibitors and norepinepherine reuptake inhibitors.
Usually it takes several days to weeks for antidepressant medications to have their desired effect. Most prescribing physicians are familiar with the common medications for anxiety. They may refer patients to a psychiatrist or psychopharmacology specialist for assistance as necessary.

Anxiety can be terribly uncomfortable, but usually it is not life-threatening. It is treatable through knowledge of how to manage ourselves. Help is available, if needed, from professionals in the behavioral health and medical fields.

Michael R. Rosmann, Ph.D. is a founding partner of the nonprofit network AgriWellness, Inc. Send your thoughts and questions to him by email at mike@agriwellness.org
4/25/2013