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Anxiety and Stress Management

with Patricia A. Farrell, PhD

This blog has been retired. We appreciate all the wisdom and support Dr. Farrell has brought to the WebMD community.

Monday, November 17, 2008

SAD: The Demon Beast of Winter

Winter comes this year with a promise of holidays that may not be as bright as we would like. In the middle of a pounding economic downturn with job loss and belt tightening all around, there is another spectre that is there whether the economy is good or bad and it’s Seasonal Affective Disorder, originally called the Winter Blues. Imagine how difficult it is for people with this disorder (SAD) and then add on top of that the problem of lack of money and the stress that brings. It’s a one-two punch no one wants, especially with reduced economic and psychological resources. An estimated 25% of the population suffers from a mild form of SAD and around 5% has a more severe winter depression.

SAD often affects groups who live above certain latitudes. So, it would seem, people often referred to as ‘snow birds’ know what they’re doing when they head south for the winter. It may not be just the cold they’re escaping, it may be depression. The shift that takes place in our biological clocks happens in response to the light that hits our eyes and affects our internal settings.

A small structure in our brains, the pineal gland, produces a substance which can be both problematic and helpful. The substance is melatonin and it has been linked to both SAD and sleep. During the winter months, the decreased exposure to sunlight may stimulate the production of this hormone.

How do you know you have SAD and what can you do about it? First, let’s look at the usual symptoms we see with this winter variety of the disorder. Yes, there’s a summer disorder, too, for some people.

SAD Symptoms

  • January to February is the prime time of year in most Northern climes and we see:
  • Changes in sleeping and eating habits
  • Persistent sad, anxious or “empty” mood
  • Loss of pleasure in activities once enjoyed
  • Depression subsides in the spring and summer months.
  • Symptoms have occurred in the past two years, with no non-seasonal depression episodes
  • Seasonal episodes substantially outnumber non-seasonal depression episodes
  • The individual craves sugary or starchy foods probably because this increases the availability of serotonin which fights depression

As a result of the dietary changes seen, there is weight gain and that further increases depression by lowering self-esteem and intensifying feelings of helplessness. Your clothes don’t fit, you can’t buy new ones and you feel self-conscious. Double whammy there.

Steps You Can Take

  • Light box or visor treatments
  • Dawn simulation devices for morning awakening
  • Antidepressant medications
  • Outdoor or even indoor exercise such as walking for as little as 15 minutes a day

Our thinking about how to treat SAD has changed since 1984 when Dr. Norman Rosenthal first described the disorder. Light boxes aren’t seen as necessary because we’ve discovered that light, from any source, may be beneficial. The most interesting results have come from just plain old exercise several times a week and it can be indoors or outdoors. Walking is one of the exercises that has been found to be both useful and to involve no cost. Leave the car a few blocks away from where you’ve going shopping or at the edge of the parking lot, walk to the stores, take a walk around your neighborhood or in front of the TV. You can probably, if you have a high-tech home, use TV exercise programs such as the virtual tennis, yoga and other programs. This way, you avoid the cold weather and still get your anti-depression exercise fix. In the office, get up and walk things over to your colleagues, walk to the water cooler a few times a day and walk up and down stairs.

You do have resources and you can overcome this disorder, so get walking.

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Posted by: Patricia Farrell, PhD at 12:30 pm

Wednesday, November 12, 2008

Alcohol, Stress and the Holidays

Alcohol has its many advocates in the literature of the past several centuries and it has all those witty phrases we’ve come across. The phrases include, “A day without wine is like a day without the sun,” and “In vino veritas” (In wine there is truth). George Bernard Shaw is reported to have said, “Alcohol is the anesthesia by which we endure the operation of life” and Benjamin Franklin is quoted as saying, “Beer is living proof that God loves us and wants us to be happy.” History tells us that Franklin along with many of the other Founding Fathers, was a great consumer of things alcoholic. Water, after all, was not considered fit to drink, so alcohol filled the bill for daily fluids.

The holidays are around the corner, the economy seems to be headed for a long recovery period and alcohol may play an increasing role in the lives of people in the months to come. Not just a drink for celebration, alcohol, as many of us know, is a powerful non-prescription drug that can lift someone’s mood, temporarily, help with anxiety and may be beneficial to our health. All of this should be taken with a grain of salt, as the saying goes.

Red wine has come into the medical literature as something that can help with a variety of physical disorders or illnesses and, working in nursing homes, I have heard physicians prescribe a “drink” at dinner for some residents. Yes, prescribe. It has to be written into the orders or it can’t be dispensed by the nursing staff. Some residents have their own liquor stored in the nursing station cabinets. I knew of one patient who had champagne for special occasions in her room. She had a terminal illness and champagne was seen as the least of her problems.

Alcohol, unfortunately, also has the ability to cause serious disinhibition with serious, sometimes fatal consequences. We’ve seen the stories about initiations where a bottle of alcohol has to be consumed at one sitting, or in one elongated gulp-session. In these instances, alcohol acts as a fatal poison for the breathing center of the brain. For others, alcohol facilitates actions which result in not a calming effect, but a rage reaction and not Franklin’s “proof.” Statistics on suicide related to the current economic gloom won’t be available for another two years and one wonders what the stats on alcohol consumption will show and if there might be a relationship.

Yes, alcohol has its place in life as we’ve seen from its use in many ceremonies, family gatherings and holiday parties. It can serve as a mild aid to the socially sensitive, but its potential for harm has to be considered, too. The researchers who’ve seen some alcoholic beverages as beneficial are always cautious to say that it has to be used reasonably and, as any drug, with an eye to abuse. What is your limit on alcoholic drinks? You should know what it is and keep yourself within a safe limit. That’s not me preaching, it’s just good sense.

The National Center for Health Statistics (2007) found that 33% of current drinkers had five or more drinks per day in the past year; in 2005 there were 21,634 deaths related to alcohol excluding accidents and homicides. Alcohol deaths were 3.2 times more likely to occur in males as females. One of the major problems with alcohol, in addition to these grim statistics, is that anxiety is related to alcohol abstinence. So, if you drink to help handle your anxiety, trying to cut down on your drinking will result in more anxiety which, in turn, leads you right back to drinking again.

What the National Institute on Alcohol Abuse & Alcoholism Suggests

First, you have to be honest with yourself and answer a few questions:

  1. Do you drink alone when you feel angry or sad?
  2. Does your drinking ever make you late for work?
  3. Does your drinking worry your family?
  4. Do you ever drink after telling yourself you won’t?
  5. Do you ever forget what you did while you were drinking?
  6. Do you get headaches or have a hang-over after you have been drinking?

One “yes” response can indicate you have a drinking problem and you may need professional help to stop. If you do agree that you need help, you can begin helping yourself right now. Steps that are suggested include:

  1. Write down your reasons for cutting down or stopping drinking.
  2. Set a drinking goal. Not a bad idea whether or not you have a problem with alcohol.
  3. Write your drinking goal on a piece of paper and keep it where you can see it.
  4. Keep a daily diary of your drinks that includes the number of drinks, what they were and where you did your drinking.
  5. Take a break from alcohol and make at least one or two days a week alcohol-free days.
  6. Stay active and get involved in something that doesn’t include alcohol.
  7. Seek out support from family, friends or groups.
  8. Remember the places, people and times of great temptation for you. Plan ahead when you are going to social or business events so you can avoid drinking or going over your limit.
  9. Don’t drink when you are upset or angry.
  10. Do not give up. It takes time, like anything else, to reach a goal and along the way there are going to be things that will make you want to toss in the towel.

Remember, there are always going to be “reasons” to drink that don’t include special occasions or ceremonies and you don’t want to take the bait. One of the most unfunny and, potentially disabling remarks I’ve ever heard is, “Well, it’s 5 o’clock somewhere, so we can begin drinking now.” Not funny.

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Posted by: Patricia Farrell, PhD at 6:19 pm

Wednesday, October 1, 2008

Our Economic Crisis and the Role of Fear

Fear is a potent force which nature has provided to help all of us stay out of harm’s way. Unfortunately, it can also cause us to act rashly in situations where restraint rather than a knee-jerk fear response is required. When fear enters, reason leaves the room.

Fear can be used to both push people to action or dissuade them from doing something. It’s something politicians, researchers and patriarchs have known for ages. The research that has been done over the years involved contrived situations of smoke coming into a room, someone falling down onto a subway platform or even horses in a group. The undercurrent of fear was in each one of these and other social psychology scenarios and it illustrated how fear can cause action or keep you glued to your seat.

In addition to actions, fear has its buzzwords such as: layoffs, termination, economic crisis, foreclosure, terrorism and many others that you can think of on your own. The thing to do, however, is to allow yourself not to immediately let that adrenalin kick in and push you to rash into action.

When fear rears its ugly head:

  1. Take time to pull back from the situation and delay immediate action – unless there’s an open artery involved.
  2. Breathe! If you don’t know how to do relaxation breathing, go to my Self-help page
  3. Try to be around people who are calm; it’s infectious in a good way
  4. Sit down and ask yourself to look for the positive side in this or the solution that is currently not being seen. Reach out to others.
  5. Let Scarlet O’Hara be your guide for a moment and remember that “tomorrow’s another day.” Even Annie knew that “the sun will come out tomorrow.”
  6. Understand that FDR was right when he said, “The only thing we have to fear is fear itself.” Don’t let it crush you in its grip.

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Posted by: Patricia Farrell, PhD at 7:24 pm

Monday, September 15, 2008

Ten Rules for Taking Back Your Life

The weather is turning from summer into fall and with it comes cooler days, longer nights and an initial surge of hurricanes. But you don’t have to see this as all bad news even if the the economy hasn’t come back the way most of us would have wanted. Terrorism continues around the world and corporate scandals are still making front page news but I see a positive side.

My personal belief and the belief that you’ll find throughout my book is that for every bad thing that happens, there is a corresponding good thing to be found – if you let yourself see it.

Taking back your life is a matter of deciding that you’re in the driver’s seat, not someone else. It doesn’t matter if the economy’s bad, you can’t go on a super special vacation this year or you are feeling lonely, everything has a positive side. Here are my ‘rules’ for turning things around for yourself, rather than waiting for something or someone to do it for you.

Life ‘Rules’

  1. Challenge yourself to use every ‘bad’ thing in your life as a new beginning.
  2. Find the ‘good’ in everything that you can.
  3. Don’t expect the good things to be readily apparent. It may take a few days, weeks or even months before you finally see them.
  4. Allow yourself to realize your true power. This doesn’t mean pushing people around, but looking for your hidden skills.
  5. Talk to yourself. Talking to yourself is a very powerful tool to use and it can help you increase your motivation and your ability to stick to a task.
  6. Stop expecting others to solve your problems. Even if you lost your job, it’s an opportunity to look in a new direction, to acquire a new skill and to blaze a more pleasurable path in life.
  7. Throw out that ‘yes, but’ expression from your life. It’s just a way of keeping yourself stuck in the mud.
  8. Take a good hard look at what you’d really like in life and sit down and begin making a list that outlines the steps you need to take. Not everyone needs to go to college to be happy. Find out where your happiness lies, if you don’t want to go back to school. Abraham Lincoln did just fine with his self-learning plan.
  9. Beware of the negative people in your life. Pointing out the problems is fine, but some people only see doom and gloom and they can’t be very helpful, unless you find that helpful.
  10. Remember that every road has unexpected turns and that any plan must be one that allows for some give and take. If there’s one word for your plan to take back your life, let it be ‘flexible’ and go from there.

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Posted by: Patricia Farrell, PhD at 5:27 pm

Tuesday, August 26, 2008

Who Said MDs or PhDs Don’t Feel Like Everyone Else?

I had a conversation recently with someone who was doing her job while she talked to me and one statement she made rang out like a loud bell. “Well, you psychologists are trained not to feel grief like the rest of us.” Trained not to feel grief like the rest of you? Did she honestly think that anything in a psychologist’s training could remove the ability to respond like any other human being from any of us so that we’d be immune to feeling emotions like grief? How would they have done that? It certainly wasn’t part of any training I got.

Than I started thinking about the physicians I’ve known and how, when they’re being open and honest with you, they admit to the grief when a patient dies or when they can’t help them with an illness. Not all of them and that’s probably because some have formed a hard mental callus that seems to protect them, but I wonder. Some others see patients as walking, talking bits of anatomy, jobs to be performed, chests to be thumped and meetings to be placed on little white cards. Some are terribly naive about life because they’ve spent their early adulthood in laboratories or writing papers or trying to impress their professors or chiefs of service and missed out on living.

Those are the ones who stand at the doorway to patients’ rooms and announce loudly, “Oh, yes, the test results came back and you’ve got cancer,” and walk away. I’ve seen that happen.

Most of us feel grief and all the normal human emotions the rest of the world experiences. We cry and regret and love and that’s normal. As the famous newspaper letter of many years ago (circa 1897) indicated (I take a bit of license here), “Yes, Virginia, there is a feeling psychologist.”

Well, I should say there is more than one.

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Posted by: Patricia Farrell, PhD at 10:00 am

Monday, August 18, 2008

Making Back to School Less Traumatic

Fall brings with it a return to the work world for adults and to school for children. Whether it’s kindergarten, grade school, high school or college, school has its challenges and so does work. The US Government recognized that school was actually children’s “work” when it permitted Disability allowances for children who couldn’t perform adequately at school. How children perform in school isn’t only a function of their individual abilities, but a part of the equation where parents and community play a major role.

The number of children who will be diagnosed as having anxiety disorders or depression is sufficient for us to recognize that it’s a very real problem that has life-long consequences. I’ve seen estimates of 19 million children diagnosed with anxiety.

An anxious child cannot concentrate sufficiently to absorb what is taught in the classroom and, therefore, that child is at a disadvantage academically. If this goes on for a few years, the child falls farther and farther behind his/her peers and the problems associated with going to school mount as do the behavioral problems associated with poor performance in school. It was once called ‘school phobia,’ but it is more appropriately recognized as much more than one single problem. The anxiety these children feel stems from their social interactions, the school requirements, their preparation for school and the home to which they go each afternoon. All of it must mesh in order for this child to succeed to the best of their abilities.

New Golden Rules

My golden rules for school include:

  1. Read to your young child each evening, if you can and help them to discover the wonder of reading. Reading is probably your child’s most valuable key to learning. If they can’t read well, it is like putting a huge bolder on the road before them and giving them no tools to move it. Reading builds vocabulary and this is one central element in all testing.
  2. Help your child “grow” their vocabulary. If possible, encourage participation in word games or even word-find puzzles. Words can be the key to opening an interest in history and social studies, so use the origin of words to broad their interests.
  3. Teach your child how to organize their activities and their study materials. Anxiety is compounded by not being able to find materials and when deadlines are put off until the last minute. Here we have the beginning of the ‘the dog ate my homework’ scenario.
  4. Set up a schedule for school-related activities and those your child enjoys with friends or family. Remember the saying “all work and no play makes Jack/Jill a dull boy/girl?” Don’t make your child’s day an endless series of “must do” activities.
  5. Remember that later in their school experience critical thinking will be invaluable and it’s in the beginning years of school that you help shape this ability. “Why” questions are a way children begin this search for meaning in their world. Direct them to something that will provide answers they can understand and enjoyment at the same time.
  6. Relaxing is just as an important part of your child’s day as working. How many children are taught how to relax? I don’t think people realize their children may need some help in learning to relax because they still think that a child’s world is one devoid of problems and just packed with fun. If it were, how come so many kids are anxious? What about relaxation breathing that can be done at home or in school when they become tense?
  7. Plan family activities and give your children something to look forward to other than summer vacation. It’s good for them and it’s good for you.
  8. Begin to help them develop problem-solving skills and help them understand that some things take thought and planning and can’t be solved immediately. Build up their ability to control their impulsivity. It’s wonderful to want to do things NOW, but it’s not always the best route. Maze games make this point beautifully.
  9. Encourage skill development in some sport or activity. This helps build self-confidence and acceptance that sometimes mistakes are a part of learning. Whoever shot a hole-in-one the first time they went on the golf course? Why should you expect your child to do something like this the first time they try something? First times are beginnings and you want to let them have as many beginnings as they want or need.
  10. Offer a helping hand, a soft shoulder and a ready ear and you will be giving your child one of the greatest gifts they will ever receive.

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Posted by: Patricia Farrell, PhD at 12:22 pm

Thursday, July 24, 2008

Are you a BlackBerry Addict?

Technology, like stress, is the wily bookkeeper who keeps juggling the books, and not always in our favor. Lately, I’ve been listening to more and more discussion about BlackBerry addiction, so I started giving it some thought. Could you really be addicted to a PDA or wireless device and, if you were, what would be the signs that would tell you? And, is it “addiction” or “dependence?” There are differences. I have a feeling it fits more into the realm of dependence and, like any dependence, it definitely has a down side. BlackBerry is big and the most recent statistics on its sales indicate, according to CNN, that the quarter ending March 2008 saw $1.88 billion in sales and about 2.18 million new subscribers for just that quarter.

Signs of Dependence

When you look for dependence, you want to see if any of the following have been affected by, usually, a substance, but in this case it’s a wireless device.

  1. Are certain activities in your life reduced by your use of this device?
  2. Do you use it excessively?
  3. Do you find it nearly impossible to cut down on your use?
  4. Despite knowing that it causes you stress and tension in your family life, can you not stop using it?
  5. Do you spend large amounts of time using it or in wireless- device-related activities?
  6. If you can’t use it, do you have physical symptoms of sweating, anxiety and even nausea?
  7. Have you developed a tolerance that leads you to use it more and more?

Well, my friend, all of those are signs of dependence and let’s, for one moment, consider what this might do to you. Like an intrusive friend who seems to be helping you, this usage quickly becomes more important than anything else. You NEED it because you HAVE to be available and you NEED to keep up on things. Do you ever have it far from your side and where do you put it at night? Is it ever off? Do you jump when you get a call and does your heart beat increase?

Try one little thing to see how it might be causing you stress. When the signal comes through that you’ve got a message or a call, put your index and middle finger over your left wrist bone (where the pulse is) and count the beats. Record and date it somewhere. Then, at some other time, when you’re doing a relaxing activity, take your pulse. Is there a difference?

Okay, have you developed a dependence and, if so, what might you do about it? Being under constant stress is unhealthy both physically and mentally. The effect won’t be immediate, just like the work of that bookkeeper, but it will be there.

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Posted by: Patricia Farrell, PhD at 12:37 pm

Thursday, July 3, 2008

Stressful Jobs and Depression Risk

Stress is a part of life and when it comes to our jobs and how we make a living, it’s something that requires our constant care and concern. Now a new study of 1,000 workers in Europe found that stressful jobs accounted for 45 per cent of new cases of depression. The factors which the scientists isolated as being especially important were excessive demands on the job and extreme time pressures. Not only did they find that these workers, with an average age of 32, were experiencing a high percentage of job-related stress-induced depression, but there appeared to be a 40 percent increase in reports from workers of job stress.

When economies turn sour, the heat is on in terms of producing the same with less workers or less in terms of resources. What do you do? The easy answer would be, as I’ve seen in some advice columns, to change your job. Not so easily done in an economy that appears to be shrinking, nor is it always possible to fit in a college degree or time to learn additional skills. To preserve your mental and physical health, you have to be the one in charge of your after-work life. How do you do that?

Begin when you get up. If you are going to have breakfast, do some in-place exercises while preparing whatever you’ll have. You can find easy exercises, requiring no equipment, on line. Next, plan something for any free time you might have to break the job-home-job cycle. Give yourself any breaks you can to get out and take a walk, sit in a swing, do some gardening (yes, even on your windowsill). Anything that will break the routine can be helpful.

One local radio station now incorporates a “daily laugh” into their programming where they play jokes from comedy club acts. Put some laughter into your life. I don’t care if you like The Three Stooges or Wayne’s World or whatever, just laugh whenever you can. See the humor in life and, yes, there is humor.

If you need a silly exercise, here’s one I use in my presentations. Wiggle your ears. You can’t? Have you tried? Give it a try and see what happens.

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Posted by: Patricia Farrell, PhD at 8:30 am

Friday, June 13, 2008

The Debt Crunch and Stress-induced Illness

A recent Associated Press-AOL poll, which took another look at the debt-stress crunch now affecting the American consumer, found that 44% of the 1,002 people in the survey indicated migraine headaches, 29% had severe anxiety, 23% suffered from severe depression and half of the study participants had some form of muscle tension or back pain. The results, when compared to a previous study completed in 2004, show significant increases in debt-related stress-induced physical problems. It’s no secret that chronic stress brings on physical problems and the emotional toll is hefty, as well.

Americans have piled up $957 billion in consumer debt, according to the Federal Reserve, and much of it is in the form of credit card debt. Twenty percent of after-tax income is now earmarked to pay this debt and that leaves household budgets with increasingly less money to spend on essentials.

What can be done? My first thought is for professional help in credit card counseling from a reputable service and then consider lifestyle changes to help you weather this credit storm. You will survive, but just as anyone who’s ever been through a tornado knows, you have to begin to sort things out and reorder your priorities.

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Posted by: Patricia Farrell, PhD at 3:05 pm

Thursday, June 12, 2008

Depression for Women, Alcohol for Men

A study which appear in the July issue of Alcoholism: Clinical & Experimental Research has added some interesting new insights into the ways that women and men handle stress. It seems that men seek the stress-reduction method of alcohol consumption while women become depressed.

Why might this be? The researchers think it’s because men, perhaps, have been socialized to use alcohol or that there are, seemingly, gender-specific brain stress pathways that differ in the sexes. One researcher, however, said she thought it was because women tend to think about negative experiences more while men use distraction techniques, such as alcohol, to calm themselves.

So, is it biological or learned? Perhaps, as in most research findings, a little of both and it indicates that we may need to do a better job of helping men and women learn healthier ways to cope.

Is alcoholism or addiction an issue in your family? We’ve got support for you on our Addiction and Substance Abuse support group.

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Posted by: Patricia Farrell, PhD at 7:00 am

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