Jordyn’s Story

My journey with anxiety has been lifelong, but I didn’t have a vocabulary for it until I was in my mid-twenties. I have always had shy and nervous traits, but the first time I remember feeling anxiety, at its worst, was when I was a freshman in high school. I was going through a relationship crisis that caused me to be so nervous that I threw up every morning before school for weeks. Instead of asking me about my emotional or mental health, I ended up at the doctor, being grilled about possible pregnancy. This was, at the time, impossible, but no one believed me. The doctor herself didn’t even ask about my mental health. Instead, I was given medication for acid reflux and eventually the vomiting stopped, but the underlying problem was never solved or even addressed.

Moving forward, I continued to feel sick during big events like birthdays, vacations and concerts. It was, and still is, a source of frustration not only for me but for my parents. Even though I never knew what caused it and couldn't help it, I heard the phrases "just stop thinking about it" and "I don't understand why you're so nervous" more times than I can count on two hands. It made me feel like I was doing something wrong, or that I could control these symptoms, even though I know now that wasn't the intention. Those who have anxiety know that it isn't a switch that can just be flipped.

On the brink of having my first anxiety attack, I finally scheduled an appointment to see a therapist for the first time. I remember her asking where I feel anxiety in my body. With further explanation, it FINALLY hit me that all the throwing up, the trips to the bathroom, and physical symptoms I experienced due to being “nervous” was actually anxiety. I finally had a word for what I was feeling and that alone made me feel seen and normal. I finally knew that I wasn’t alone and that other people feel like this too, even though it may present in them differently than it does in me.

Anxiety, like everything else, exists on a spectrum. I would not categorize myself as having a major anxiety disorder, but that doesn’t mean that I am not affected by it from time to time. Even though I have not pursued medication, I have considered this as an option for myself. Therapy and other supportive relationships have helped me to feel as though there are people in my corner now who DO get it, will support the side of me that can feel a bit ridiculous at times, and won’t tell me to “just stop thinking about it.”

Options for Treating Anxiety

The treatment options for anxiety are, in part, based on both severity and an individuals baseline versus situational distress. Simply put, symptoms of anxiety associated with a divorce are normal and situational. While medication(s) can be used to decrease distress, effective coping strategies, resources and supportive relationships may be equally, if not more, effective. With the exception of sleep stabilization, I am not quick to recommend medication management for situational anxiety and instead lean into other treatment modalities. The following is an overview of multiple treatment options. This is not an exhaustive list of available options and I respect other options such as prayer, medical marijuana and microdosing.

1. Medication management. There are times when medication is a necessary part of addressing and reducing anxiety. This is especially true for individuals who describe a baseline anxiety level of a 5 or higher on a scale of 1 to 10. Usually by the time people make it into see me, they have been suffering from anxiety for at least a decade and have created maladaptive behavior and thought patterns to support the anxious distress. In some cases, therapy alone is not effective in treating anxiety because the individual is incapable of accessing alternative ways of thinking or coping due to crippling levels of distress. In these cases, medication is the first line of treatment and allows for a decrease in overall anxiety which then allows for therapy to rewire the brain.

2. Individual therapy. Cognitive-Behavioral Therapy (CBT) is a recommended treatment modality for working with individuals struggling with anxiety. The goal here is to reframe catastrophic thinking, replace irrational beliefs, increase distress tolerance and identify adaptive behavior. I find that CBT in conjunction with soothing and healing wounded parts of the self is a highly effective approach to creating relief in most patients.

3. Family therapy/couples therapy. Sometimes our anxiety is triggered or exacerbated by the people in our life. When this happens, a skilled family therapist can assist in exploring the cause and effect of relational dynamics in the family system. My preferred therapeutic modality for resolving anxiety within a family system is Emotion Focused Therapy (EFT). This type of therapy involves an attunement to emotions, identification of emotional triggers and their origins, expansion of emotional distress for processing and reenactment of the emotional distress to create an alternative outcome. The late Sue Johnson posited that, when in distress, couples do not use logic during conflict because they are in the emotional distress areas of their brains. In order for treatment to be effective, the therapist must meet the client in their emotional distress and guide them through the storm to a better outcome.

4. Nutrition. I bet you didn’t know that foods and vitamins can assist in reducing anxiety. Most people know that drinking too much alcohol or caffeine can increase anxious distress, but did you know that eating nuts like almonds and cashews can calm anxiety because they are high in magnesium, healthy fats and Vitamin E. Other recommended foods include salmon, yogurt, dark chocolate, green tea, turmeric, chamomile, eggs and blueberries. Working with a skilled nutritionist or naturopath may be an effective option for treating both long-term and situational anxiety.

5. Exercise. In a prior newsletter, I discussed the benefit of exercise for overall mental health. Not only does movement help to regulate our nervous systems, exercise boosts the release of neurotransmitters, which over time can take the effect of a natural anti-depressant. Light movement such as rocking, swimming, pacing and walking are also highly effective at calming anxious distress. This is why it is instinct for us to rock a crying baby.

6. Genetic testing. The GeneSight Psychotropic test analyzes how your genes may affect your outcomes with medications commonly prescribed to treat depression, anxiety, ADHD, and other mental health conditions. The GeneSight Psychotropic test provides your clinician with information about which medications may require dose adjustments, may be less likely to work for you or may have an increased risk of side effects based on your genetic makeup. The GeneSight test additionally looks for genetic mutations in the brain that may cause mental health conditions like anxiety and may benefit from supplementation.

7. Supplementation. This is used when an individual has a gene mutation with the MTHFR gene (short for methylenetetrahydrofolate reductase variant). MTHFR serves a critical purpose: the production of the MTHFR enzyme. The body has a number of raw materials that must be processed into a new form before they can be used by the body. Folate (Vitamin B9) is one of these raw materials and the MTHFR enzyme is the body’s tool to process it. In perfect circumstances, the MTHFR enzyme transforms folate into an ingredient the body can use – methylfolate. Methylfolate is a crucial element in our biology responsible for building the ingredients that determine how good we feel. It enables our bodies to convert the amino acid homocysteine into another amino acid, methionine. 4 

   Methionine is used to make brain chemicals essential for a number of aspects of our mental health—these include the neurotransmitters serotonin, dopamine, and norepinephrine. The good news is that this gene mutation can be augmented by taking methylfolate.

8. Sleep. Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can worsen anxiety, spurring a negative cycle involving insomnia and anxiety disorders. Simply put, it is not unusual for sleep to become a trigger for anxiety in anxious patients. A sleep stabilization plan is highly recommended in this case and can involve taking medications, setting a bed-time, reducing blue lights, only using your bed for sleep, consuming sleepy time tea, listening to soothing sounds or a guided meditation.

9. Brain training. Neurofeedback aims to decrease anxiety symptoms by teaching people to change their brain wave patterns. Many patients with anxiety have elevated levels of fast beta waves, which can contribute to feelings of fear, insecurity, and panic. Neurofeedback can help reduce these beta waves, while promoting alpha waves associated with relaxation and meditation.

10. Mindfulness. According to Mindful.org, Mindfulness helps you learn to stay with difficult feelings without analyzing, suppressing, or encouraging them. When you allow yourself to feel and acknowledge your worries, irritations, painful memories, and other difficult thoughts and emotions, this often helps them dissipate. Mindfulness also allows you to safely explore the underlying causes of your stress and worry. By going with what’s happening rather than expending energy fighting or turning away from it, you create the opportunity to gain insight into what’s driving your concerns. Finally, Mindfulness helps you create space around your worries so they don’t consume you. When you begin to understand the underlying causes of your apprehension, freedom and a sense of spaciousness naturally emerge.

Recap of Topic: Options for Treating Anxiety

There is no one size fits all approach to treating anxiety. Some individuals prefer to treat their anxiety holistically (i.e. prayer, healthy diet and exercise) and without medication. I respect this approach as much the choice to manage anxiety through medication and therapy. My goal as a therapist is not to dictate a patient’s path but to empower them to choose their best path forward based on all options available. Some widely used and recommended options for treating anxiety include medication management, individual counseling, family counseling, diet, exercise, genetic testing, supplementation, sleep, brain training and mindfulness.

Supporting a Loved One with Anxiety

Living with someone who has anxiety can be sad, frustrating and anxiety inducing. Often times, there is a desire to help or even rescue but an awareness that this is neither appropriate nor possible. Knowing how to sit with a loved one experiencing anxiety can also be uncomfortable especially if you do not suffer from anxiety. A loved one’s anxiety may seem unnecessary and even annoying. If it’s any consolation, most people with anxiety think that too. It is not unusual for a loved one to feel internal pressure to say or do the right thing. Many times, magical words do not exist and the person suffering from anxiety may feel dismissed or judged when neither were the intent. To assist in navigating the complexities of holding space for a loved one with anxiety, I offer the following suggestions. It is important to review these suggestions with your loved one before using them to ensure that they will be welcomed and received.

1. Ask before responding. “What do you need from me here?” Create the habit of asking before responding. Sometimes your loved one may know what they need. They may need reassurance or for you to remind them of facts. Other times, your loved one may not know. If this happens, sit quietly with your loved one and say, “It’s okay not to know. Can I sit here quietly with you?”

2. Co-regulate. Mindfulness, exercise and sensory based coping strategies can be used with your loved one to create a calm state of mind. Examples of sensory based coping skills include going for a walk, giving a massage or taking a bath or shower together. Parents and partners can use this technique to attune to their loved ones dysregulation. Repeated from last week, but still applies.

3. Understand anxiety. Anxious people don’t want to feel anxious. They enjoy peace and joy like everyone else. When anxiety reaches a certain level, it feels impossible to turn it off. It feels like someone has glued a weighted blanket on you. For individuals with chronic and severe anxiety, their thought patterns and emotional regulation system is geared to sustain and perpetuate anxiety. The hard wiring is to a degree that statements like, “Cheer up!”, “Don’t worry so much.”, or “Have you ever considered yoga?” are likely to be offensive.

4. Advocate and encourage. Someone suffering from anxiety, will receive messages both internally and externally that they are deficient and inadequate. You cannot prevent this. Advocating for your child by talking to their doctors and teachers may be necessary as their parent to ensure that the child receives the support he or she needs. Recognizing when your loved one is in need of encouragement is also critical as they will be down on themselves when their symptoms are hard to manage.

5. Hold them. Not every anxious person will want to be held but many do. Research has shown that women holding the hand’s of their husband’s reported less pain and distress during labor and delivery. The physical presence of a loving attachment figure has been shown to reduce the emotional and physical distress in another.

6. Don’t over-function. It will be tempting to fall into this behavioral pattern when living with someone with anxiety. Individuals with anxiety do not like to feel anxious and can create a life around avoiding anxious triggers. When parents and partners rescue their loved one by doing a task for the anxious person that he or she is capable of doing for themselves, you empower the anxious person to remain stuck and reiterate through your actions that they are incapable.

7. Create a calm environment. Individuals with anxiety frequently suffer sensory overwhelm. If you remember that their baseline anxiety is higher than yours, then it makes sense as to how smaller irritants (i.e. a dirty kitchen, a crying child, or a loud television) can stack up fast. Be mindful and respectful of their preferred environmental preferences, when possible.

8. Respect boundaries but create accountability. People suffering from anxiety will reach critical mass sooner than someone who does not experience anxiety. They will be more dysregulated by conflict or overwhelm and may need to call a time out to come back down. As their loved one, it is your job to respect when a time out is called and ask for a reasonable time frame to readdress an issue or topic of conversation.

Recap of Topic: Supporting a Loved One with Anxiety

It is natural to want to support a loved one in anxious distress. It is also natural to feel uncertain and even overwhelmed by the task of doing so. The good news is that, more often than not, your loved one is not looking for you to fix them or their anxiety. They are simply looking for reassurance that they are okay and that you accept them at their worst. When your anxious loved one feels safe enough to become unglued, they can work on releasing the emotional storm versus holding it all inside. While no two individuals are alike and will need different things, some basic things you can do to support an anxious loved one is ask before responding, co-regulate, understand anxiety, advocate, hold them, avoid over-functioning, create a calm environment and respect boundaries.

^{Recommended Product of the Week}

This week’s recommended product(s) is the Breathing Buddha. Daily guided breathing to help calm & focus your mind during the day or promote a peaceful night sleep, improving overall wellness. Continued practice can help manage or reduce stress & anxiety in all ages and can help improve symptoms of depression. A simple & fun meditation tool that can also cultivate mindfulness to help you live in the present moment.