How to deal with anxiety

Many of us experience feelings of worry, fear or anxiety. But when is it time to seek professional help?

Dr. Tyler Van Milligen cares for patients in the MercyOne Psychiatric Residency Program in Des Moines, Iowa. Here we speak with Dr. Tyler to break down the differences between common anxiety disorders and how to determine if your anxiety is interfering with your daily life.

What is anxiety and maybe what are some of the symptoms that people may experience with it? 
Dr. Tyler – “I think a huge misconception is that anxiety is always bad. We have anxiety for a reason. In nature if there's a predator it activates an area of the brain called the amygdala that elicits a response in the systemic nervous system – commonly referred to as “fight or flight.” This is your heart rate, your breathing rate, and it kind of leaves a tattoo on your nervous system so should a similar circumstance present itself you're prepared.

Where it can get disordered is if there's repeated exposure and throws everything off – such as trauma or a genetic predisposition for your brain to linger in that feeling too long. So small things that don't elicit such anxious feelings for others, do bring those feelings for people suffering from anxiety disorders.

What are common symptoms that would be telltale signs that could lead to an anxiety disorder diagnosis?

Dr. Tyler – “A common and consistent way patients have described it is a constant forecasting of worst-case scenarios. It's very hard for patients with anxiety to be in the moment and be present and feel okay. There's an almost irrational fear of what could possibly happen or navigation of various future scenarios or outcomes. These things consume their thoughts and manifests in their bodies with muscle tension, inability to relax, increased heart rate and physical restlessness. It can impact your sleep or appetite. Some patients can experience full blown panic attacks, where it can feel like a legitimate heart attack. GI symptoms or stomach upset, nausea, vomiting, shortness of breath, sweating. It tends to be that sort of feeling like you are being hunted by a lion and you can't explain it.

These physical symptoms are very real. It’s not just in your head.

Dr. Tyler – “100%. The nervous system is responding as if that threat is really, really there it's very real.”

Why do people experience this? What triggers this?

Dr. Tyler – “It looks different for everybody, but it does respond to what we call it psychodynamic therapy. If you have a strong feeling like anxiety and it seems to be persistent in your life, paying attention to what seems to be good for you in terms of relationships, events, and making a correlation to things. Therapy can help patients relate that back to an experience that is causing them to have these feelings today. Sometimes, it can be a traumatic experience. Working with a therapist can help you pin down where it's coming from. There is a genetic component as well - some people are genetically predisposed to have anxiety that never have that stressful event. There are people that don't have the genetic predisposition that end up having anxiety because they have a lot of stress and stressful events that happened in their life.

Let's talk about triggers. Knowing how to handle triggers or stay away from them, might be a big component to somebody’s road to less anxiety in their life.

Dr. Tyler – “I think you hit it spot on. The tendency is to avoid them. If we hate heights, we want to avoid them at all costs - we avoid going on that roller coaster, tall buildings, because we don't want those feelings, which makes total sense! In some cases that might be helpful for a short period of time, but during an assisted therapeutic process exposure to those triggers can help you form a new relationship with them and elicit a different physical or neurological response. It can be very therapeutic. I’m not saying you should go out there and associate yourself with everything that you find triggering but know that subtle exposure in the right environment can actually be very therapeutic and avoidance can actually make it bigger, badder and worse.

We’ve talked about therapy - I think a lot of people have anxiety about getting on a medication for anxiety. 
Dr. Tyler – “Not every anxious person and not every anxiety disorder needs a medication, and there are other options like therapy. There are integrative medicine approaches. Changes in your diet, exercise regimen - all of that will have an impact on the neurochemical balance in your brain. Those are things that can be explored if people have some intense anxiousness about medications. For people on the fence it can really help to have as much education about them as possible and understanding the risks versus benefits.

I think it's important for patients to know – you don’t have to fully commit to long term use of the medicine, if you decide you don't like it, or it's not working. It's a partnership with your provider and you're a team. You’re working on something together, and you can stop if you want to.

How might your family be affected by anxiety? How can the whole family unit heal together? 
Dr. Tyler – “If there’s one thing I’ve learned in parenting, it’s that kids will learn and absorb based on what you're modeling more than anything else. Instead of instruction or teaching them directly, they will replicate what is role modeled in the home. Even though we don't have control over anxiousness, kids will pick up on some of the subtleties and the symptoms. Having the ability to talk about things in the family setting can be really helpful. Sometimes people need to take ‘brain medicine’ just like they take medicines for other things. Creating a discussion about things in the home can instill some level of safety. The role modeling can shift back into a place that fosters open communication.