Anxiety disorders occur when we activate a body system designed to help us deal with emergencies. This "fight or flight" mechanism serves us well when we must confront a tangible danger such as a bear standing in front of us on the trail. We stand ready to do battle or to get out of the bear's way and we do so without taking the time to debate our activity. When we repeatedly activate "fight or flight" our bodies begin to save us even more response time by preparing us for the possibility of danger through complex changes that engage a complex neural circuit. This circuit connects brain structures with our adrenal glands, resulting in a release of hormones nature designed to help us deal with what we call "stress."
Most people living with PD have a pretty good sense of what stress feels like but may not be aware that it can prime a person for anxiety episodes. One aspect of being constantly "battle-ready" is increased vigilance for potential signs that bad things are about to happen. The net result is comparable to a pot of water simmering on the stove. It does not take much additional heat to bring the pot to a boil. Stress provides that "heat" and it often won't take much more energy to set the anxiety pot boiling over.
The treatment of anxiety is a subject too complex for a single blog but for the moment we can talk about broad strategies. Prevention is the key and that is the reason there is such a great focus on stress reduction and stress management in the Parkinson's literature. A second aspect of prevention is to make your physician aware that you are struggling with anxiety. Too often we let shame keep us silent during the office visit, but our anxiety has a nasty habit of reminding us that it might have been a good idea to mention the problem to the doctor.
Anxiety is the most treatable condition accompanying PD. First, there are medications that can be effective for immediately dealing with the uncomfortable symptoms. However, many people try to minimize the size of their already growing medication list, and there is a second line of treatment that can produce enduring changes that help decrease and often eliminate the worst anxiety episodes. One form of psychotherapy known as cognitive-behavioral therapy (CBT) has proven to be very effective for treating anxiety disorders. Call your state psychological association or local mental health department for a referral to a therapist with expertise in this type of treatment.
Anxiety typically builds upon itself. The sense that one is getting anxious makes a person feel even more anxious, increasing the severity of the episode. One of the most effective immediate interventions is to activate the opponent system to "fight or flight." Loosen your clothing, darken the room and lie down on the floor or bed. Take your thumbs and form an inverted "V" with them. Place the point of the "V" at the notch formed by your rib cage and allow you other fingers to lie gently on your belly. Now take a slow deep breath and concentrate on making your belly lift your fingers. Slowly release the breath and concentrate on your fingers sinking as you do this. Repeat as frequently as necessary to feel the anxiety flow away.
The breathing exercise helps to pull one out of an anxiety episode but never underestimate the good effects of a warm soak in the tub, a walk, listening to your favorite music, yoga stretches, or calling a friend. It is important to throw all your resources at anxiety. Living with anxiety drains us of the the energy we need to do the things that are important to us.
If anxiety is dominating your life, be proactive. Take a deep breath (as many as necessary) and reach out to experts who have the skills to help you manage this problem.
The Parkinson's Coach