Holistic Help For Anxiety

Defining Anxiety

Everyone experiences moments of anxiety throughout their lives but for people who suffer from anxiety disorders, these feelings may be uncontrollable and impact their quality of life.

According to the National Institute of Mental Health (NIH) there are several types of anxiety disorders.

Given that this course will be delving into anxiety, please do not continue to read if you suspect you will be triggered.

If you do suffer from mental health disorders, you can contact Lifeline on 13 11 14 or visit lifeline.org.au (Australia only)

Many anxiety disorders are linked, making it possible for an individual to suffer from more than one at various times.

Below is some information on six of the most common anxiety disorders:

  • Generalized anxiety disorder (GAD)
    GAD is usually diagnosed when a person experiences excessive worry on most days for more than 6 months. Triggers may include family, work, financial issues, study and social interactions. Symptoms may include feeling restless, feeling overly alert despite also feeling tired, inability to sleep, feeling angry or easily irritated and muscular tightness especially across the back and neck.
  • Social anxiety
    People who suffer from social anxiety worry that they will be judged in social situations leading them to develop negative emotions about social situations. This may cause them to alter their routines and behaviours to avoid people – such as shopping at quiet times, avoiding parties, events and preferring to stay at home. In severe cases, this can be associated with agoraphobia (fear of leaving the house).
  • Specific phobias (such as a fear of heights)
    Phobias refer to intense fears – not just things that cause discomfort or aversion. For example many people have a fear of heights, but a phobia will manifest in an individual having excessive worry and taking active steps to avoid the situation. If they are in a situation that involves their phobia, they may experience panic attacks (see below).
    Some common phobias include flying, needles, spiders, snakes and enclosed spaces.
  • Panic disorders
    Panic disorders can be unexpected with varying triggers and may present with panic attacks. Often a person may experience a panic attack at random times without a triggering event. Typical signs and symptoms of a panic attack may include heart palpitations, sweating, shaking, feelings of tightness in the chest, inability to breathe, and feeling out of control.
  • Obsessive compulsive disorder (OCD)
    OCD is characterised by the presence of ongoing unwanted thoughts that may result in behavioural changes. While the person may be able to acknowledge that their thoughts may not be realistic, this still does not allow them to move on. For example, a fear of germs may lead to unwanted overthinking concerning cleanliness which may manifest in behaviours of constant handwashing.
  • Post-traumatic stress disorder (PTSD)
    PTSD is most common after a person experiences a traumatic event such as assault, war, accident but can also come on after the loss of a loved one. According to BeyondBlue, up to 12% of Australians suffer from PTSD throughout their lives. Symptoms can include flashbacks, difficulty relaxing and upsetting dreams. PTSD may also affect a person’s personality, leaving them feeling angry, easily irritated, and less interested in doing things that previously resulted in happiness. Feelings of shame and guilt may also be present and may drive behaviours that are reckless or self-destructive.

All of these conditions are serious and should be treated by medical professionals.

Counselling, psychology and medication are options that may help alleviate symptoms and address root causes.

References:

The Impact of Diet on Anxiety

The link between diet and mood is an ever expanding field.

A systematic review of randomised controlled trials was conducted in 2015 and revealed that as far as non-pharmacological approaches go, diet quality was associated with improving depression outcomes.

Unfortunately, many people who suffer from anxiety also have poor quality diets that are high in fats, salt and sugar which apart from being nutritionally deficient also contribute to other health conditions such as hypertension, high cholesterol and diabetes.

In a “chicken vs egg” scenario, one study demonstrated that a 16 week diet that was high in fats actually caused anxiety and disrupted a number of mechanisms that are needed for the immune system. 

Therefore, to use diet as a means to address anxiety therefore makes sense given the effect that many nutrients have on our nervous system.

For example, B vitamins are used to improve mood, memory, digestion, concentration and energy production. Similarly fish oils were shown in a 2011 study to reduce inflammation and symptoms of anxiety by 20% in medical students.

This was further confirmed in a 2012 study that demonstrated dietary intake of fish (in particular DHA) was able to reduce the odds of anxiety disorders by nearly 50% using the General Health Questionnaire 12 (GH12).

In unbalanced diets that are high in processed foods, salt, fat and sugar, the microbiome suffers.

Made up of trillions of bacteria, the internal microbiome is capable of influencing stress and stress-related behaviours through the expression of pathways that impact metabolism, hormones and neurotransmitters. 

Neurotransmitters are chemical messengers that are secreted by nerve cells allowing the nervous system to communicate.

There are many neurotransmitters but those involved in anxiety include acetylcholine, dopamine, noradrenalin, serotonin, gamma-aminobutyric acid and glutamate.

These are greatly impacted by diet.

For example dopamine is responsible for “feel-good” hormones associated with reward behaviours which is why people who withdraw from caffeine and sugar often experience a slump.

Serotonin in particular is associated with mood disorders and is often raised after the consumption of carbohydrates which is why many people gravitate towards high carbohydrate foods such as breads and pasta.

By ensuring a foundation of whole foods that are balanced in nutrients, individuals are better able to regulate neurotransmitter production and support a healthy microbiome.

 This may be challenging for some people with anxiety disorders, as a result of their relationship with food.

For some, food consumption may be linked to comfort which further drives poor eating choices.

The timing and the ritual of eating is also implicated. Mindless eating (eating for comfort without being aware of satiety) at irregular times was related to increased weight gain, decreased social behaviours and impaired sleep quality.

The biggest benefit to ensuring a healthy diet is that it will have multiple positive side effects and minimal negative side effects.

As a foundation of health, a good diet is able to impact all aspects of life by ensuring energy and nutrient needs are met.

The skills involved also impact physiological, psychological and emotional centres.

Furthermore, it can be employed safely to the benefit of all within the home and be used with medications and other support therapies. 

When creating a diet that will support healthy mood and relieve anxiety key nutrients to consider include:

  1. B vitamins
  2. Fish oils
  3. Magnesium
  4. Probiotics

References:

  • Opie, R. S., O’Neil, A., Itsiopoulos, C., & Jacka, F. N. (2015). The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials.Public health nutrition, 18(11), 2074-2093.
  • Kiecolt-Glaser, J. K., Belury, M. A., Andridge, R., Malarkey, W. B., & Glaser, R. (2011). Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial.Brain, behavior, and immunity, 25(8), 1725-1734.
  • Jacka, F., Pasco, J., Williams, L., Meyer, B., Digger, R., & Berk, M. (2013). Dietary intake of fish and PUFA, and clinical depressive and anxiety disorders in women.British Journal of Nutrition,109(11), 2059-2066. doi:10.1017/S0007114512004102
  • Luna, R. A., & Foster, J. A. (2015). Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression.Current opinion in biotechnology, 32, 35-41.

Sampson, T. R., & Mazmanian, S. K. (2015). Control of brain development, function, and behavior by the microbiome.Cell host & microbe, 17(5), 565-576.

  • Dutheil, S., Ota, K., Wohleb, E.et al. High-Fat Diet Induced Anxiety and Anhedonia: Impact on Brain Homeostasis and Inflammation. Neuropsychopharmacol41, 1874–1887 (2016). https://doi.org/10.1038/npp.2015.357

The Link Between Exercise and Anxiety

Like diet, exercise can also play a huge role in the treatment and management of anxiety disorders.

The huge variety of exercises available ensure that there is something for everyone.

Furthermore, many sports, especially team sports, have inbuilt social networks that help to foster good communication which may also help to alleviate symptoms of anxiety.

A systematic review into the use of exercise for anxiety disorders was conducted in 2014 that demonstrated exercise (both aerobic and anaerobic) were able to reduce symptoms of anxiety and was a beneficial adjunctive treatment alongside medication. 

It is believed that exercise is able to impact mood states in a variety of ways including:

  1. Increasing circulation (especially to the brain)
  2. Increasing oxygen intake
  3. Increasing brain-derived neurotrophic factor or BDNF (a brain protein that helps nerves grow)
  4. Regulation of the autonomic nervous system (specifically the parasympathetic nervous system which is responsible for resting and digesting)
  5. Reduction of neuronal arousal
  6. Increasing neurotransmitters – dopamine (reward behaviour) serotonin, endorphins and endogenous opioid neuropeptide transmitters including palmitoylethanolamide (PEA)
  7. Increasing self esteem and confidence via weight loss
  8. Improving pain perception
  9. Increasing energy levels
  10. Provision of distraction
  11. Regulation of sleep

For people unwilling or unable to take medications, exercise may be a viable alternative.

For beginners, start with something simple such as walking.

Any exercise or movement done outside will also increase exposure to fresh air and Vitamin D which is also mood protective.

Gardening may also be therapeutic – not just providing movement and exercise but being surrounded by nature also has mood benefits and may suit people who are less socially inclined. 

Swimming is another physical activity with multiple health benefits – from walking in the water to doing laps and water aerobics, the level of intensity can vary (so can the social interaction). Swimming is ideal for anyone who has joint or mobility limitations as it has the ability to lessen the impact on joints.

An case report published in 2018 that found an immediate improvement in mood following a programme of weekly open cold water swimming.

Cold water therapy is often used in sports for improved recovery and endurance during subsequent high intensity exercise suggesting that it might have impacted on these results. 

While studies on yoga are limited but promising, one systematic review noted that while it was effective for treating anxiety, it was especially beneficial for those suffering from obsessive compulsive disorder.

With its strong focus on breathing and mindfulness throughout movement, it provides a safe and effective outlet for anyone suffering from unwanted thoughts.

For anyone suffering from panic attacks, aerobic based exercise has been shown to be particularly helpful especially for addressing fear of anxiety-related bodily sensations.

This was done using a treadmill for 20 minutes. 

In summary, exercise is a safe and effective treatment option for anyone suffering from an anxiety disorder.

When combined with dietary measures, professional help and medication, outcome measures are greatly enhanced leading to improved quality of life. 

References:

Asmundson, G. J., Fetzner, M. G., DeBoer, L. B., Powers, M. B., Otto, M. W., & Smits, J. A. (2013). Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders.Depression and anxiety, 30(4), 362-373.

Jayakody, K., Gunadasa, S., & Hosker, C. (2014). Exercise for anxiety disorders: systematic review.British journal of sports medicine, 48(3), 187-196.

Marcos de Souza Moura, A., Khede Lamego, M., Paes, F., Ferreira Rocha, N. B., Simoes-Silva, V., Almeida Rocha, S., … & Machado, S. (2015). Effects of aerobic exercise on anxiety disorders: a systematic review.CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 14(9), 1184-1193.

Exercise and Mood: Exercise and mood – Better Health Channel

Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K. (2005). Yoga for anxiety: a systematic review of the research evidence.British journal of sports medicine, 39(12), 884-891.

van Tulleken, C., Tipton, M., Massey, H., & Harper, C. M. (2018). Open water swimming as a treatment for major depressive disorder.Case Reports, 2018, bcr-2018.

Peiffer, J. J., Abbiss, C. R., Watson, G., Nosaka, K., & Laursen, P. B. (2010). Effect of a 5-min cold-water immersion recovery on exercise performance in the heat.British journal of sports medicine, 44(6), 461-465.

Broman-Fulks, J. J., Berman, M. E., Rabian, B. A., & Webster, M. J. (2004). Effects of aerobic exercise on anxiety sensitivity.Behaviour research and therapy, 42(2), 125-136.

The Benefits of Mindfulness and Meditation for Anxiety

Mindfulness practices are becoming increasingly common and for good reason.

They offer a multitude of health benefits and can be practised by all ages and genders safely in most environments.

Even better, they can be used alongside medications and other therapies offering individuals a sense of empowerment and control over their health.

Mindfulness is best described as a state of consciousness which allows individuals to participate and experience situations in a receptive way without judgement.

It can be applied to many situations from physical locations such as work or school to relationships.

For work situations, it has been shown that mindfulness practices resulted in increased productivity and job satisfaction and decreased emotional exhaustion. 

Mindfulness has been associated with the following health benefits:

  1. Increased attention span
  2. Reduction in negative thoughts
  3. Reduction in repetitive thoughts
  4. Improved blood pressure
  5. Improved focus
  6. Better sleep quality

Mindfulness is not something overwhelming or exotic.

It is not designed to “add” to your list of daily things to do, but rather form a framework for how to approach life and deal with situations.

To begin practicing mindfulness, it may be as simple as paying attention to your environment. 

A quick mindfulness practice might begin with you sitting in a chair with your eyes closed.

Begin by noticing what your feet are doing, now move up – what are your legs doing? Move your consciousness further up and pay attention to the posture of your lower back and your posture – try to maintain good posture without being stiff.

Notice how your belly expands when you take a breath, how your chest expands when you take a deeper breath.

Notice how your shoulders will move slightly when this happens.

Relax the muscles of your upper back and neck, bring your consciousness to your jaw – do you feel yourself clenching your teeth throughout the day?

Finally  move your awareness to your face and relax the muscles as you breathe out slowly.

Take a four deep breaths and hold each one for four counts before slowly letting go.

Slowly open your eyes and notice 3 objects that you can see, 2 things you can touch and one thing you can smell. 

References:

Semple, R. J., Reid, E. F., & Miller, L. (2005). Treating anxiety with mindfulness: An open trial of mindfulness training for anxious children.Journal of Cognitive Psychotherapy, 19(4), 379-392.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.Journal of consulting and clinical psychology, 78(2), 169.

Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research.Psychotherapy, 48(2), 198.

Hülsheger, U. R., Alberts, H. J., Feinholdt, A., & Lang, J. W. (2013). Benefits of mindfulness at work: the role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction.Journal of applied psychology, 98(2), 310.

Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction?.Psychosomatic medicine, 64(1), 71-83.

What is Mindfulness? – Mindful https://www.mindful.org/what-is-mindfulness/

Supplements for Anxiety

For the mind and body to function optimally it makes sense that the right fuel is given.

If, after changing diet, increasing exercise and mindfulness symptoms of anxiety are still present, then looking at supplements may be appropriate.

Supplements can be broadly grouped into three different classes:

  1. Vitamins, minerals and nutritionals
  2. Herbal formulas (these may be powders, liquids or capsules) that are based on traditional use (such as Traditional Chinese Medicine) or more current research
  3. Probiotics

It is always a good idea to consider with vitamin and mineral deficiencies.

Before randomly supplementing, it is beneficial to consider doing a blood test or a hair tissue mineral analysis (HTMA) to discover which mineral(s) may be in need of supplementation.

HTMA tests are straightforward and non-invasive tests that may shed light on why a person may be experiencing anxiety.

For example, individuals with high levels of copper have been corelated with symptoms of anxiety.

Other minerals that can contribute to feelings of anxiety if elevated include manganese and iron.

Once imbalances have been discovered, appropriate supplementation can begin.

A good place to start is magnesium as deficiencies can induce anxiety. It also has the ability to affect gut microbiota positively. Calcium, zinc, potassium and selenium should also be considered to ensure proper nerve conduction. 

In terms of vitamins, B vitamins are  crucial for energy production, cognition, memory, learning and mood and should be given as a complex.

Folate and B12 have been shown to have an association with depression and obsessive compulsive disorders.

Vitamin D has also been shown to play a role in mental health.

For people living in areas that experience longer winters, the absence of Vitamin D has led to Seasonal Affective Disorder which is a kind of depression.

Nutritional compounds such as l-theanine may come from herbs or other food sources but are then supplemented in concentrated form.

L-theanine has been shown to help with moderate and severe generalised anxiety disorder and improve feelings of calm as well as sleep quality.

Another nutritional compound with a good body of evidence and safety is N-acetyl-cysteine or NAC.

It has been clinically proven to help treat anxiety, depression, obsessive compulsive disorder and bipolar disorder.

PEA or palmitoylethanolamide is an endogenously produced cannabinoid-like product that has been shown to improve mood and pain states

Herbs have also been shown to be effective for treating anxiety.

The most common herbs include: lemon balm, green tea (specifically L-theanine) withania, kava, lavender, chamomile, St John’s wort, turmeric, saffron, rhodiola and licorice.

Many of these can be mixed safely although great care needs to be taken with St John’s wort as it can interfere with medications.

If in doubt, both turmeric and saffron have been shown to be safe with medications. 

As discussed earlier, the use of probiotics to alter the gut microbiome can have a huge impact on anxiety.

With a good body of evidence suggesting probiotics can increase brain derived neurotrophic factor and reduce inflammation, a broad strain probiotic may be worth considering.

When beginning any new kind of supplement be sure to seek professional advice especially if already on medications. 

References:

  • Sartori, S. B., Whittle, N., Hetzenauer, A., & Singewald, N. (2012). Magnesium deficiency induces anxiety and HPA axis dysregulation: modulation by therapeutic drug treatment.Neuropharmacology, 62(1), 304-312.
  • Bjelland, I., Tell, G. S., Vollset, S. E., Refsum, H., & Ueland, P. M. (2003). Folate, vitamin B12, homocysteine, and the MTHFR 677C→ T polymorphism in anxiety and depression: the Hordaland Homocysteine Study.Archives of general psychiatry, 60(6), 618-626.
  • Türksoy, N., Bilici, R., Yalçıner, A., Özdemir, Y. Ö., Örnek, I., Tufan, A. E., & Kara, A. (2014). Vitamin B12, folate, and homocysteine levels in patients with obsessive–compulsive disorder.Neuropsychiatric disease and treatment, 10, 1671.
  • Islam, M.R., Ahmed, M.U., Mitu, S.A.et al. Comparative Analysis of Serum Zinc, Copper, Manganese, Iron, Calcium, and Magnesium Level and Complexity of Interelement Relations in Generalized Anxiety Disorder Patients. Biol Trace Elem Res154, 21–27 (2013). https://doi.org/10.1007/s12011-013-9723-7
  • Thaler, K., Kaminski, A., Chapman, A., Langley, T., & Gartlehner, G. (2009). Bach Flower Remedies for psychological problems and pain: a systematic review.BMC complementary and alternative medicine, 9(1), 1-12.
  • De Gregorio, D., Manchia, M., Carpiniello, B., Valtorta, F., Nobile, M., Gobbi, G., & Comai, S. (2019). Role of palmitoylethanolamide (PEA) in depression: Translational evidence: Special Section on “Translational and Neuroscience Studies in Affective Disorders”. Journal of affective disorders, 255, S0165-0327(18)31599-4. https://doi.org/10.1016/j.jad.2018.10.117

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