Anxiety
Introduction
Anxiety, in its myriad physical and mental expressions, can be triggered by any internal or external stressor. When the mind perceives or contemplates threats of the past, present or future, stress response systems are activated, releasing neurotransmitters and neurohormones that prepare for fight, flight or freeze behaviors.
Human stress response systems evolved for survival in an era when most days were spent in routine quiet physical activity, punctuated by sudden episodic dangers, and long dark nights were spent in sleep. Today, many people experience long periods of personal and professional stress in an environment that often feels unsafe. Periods of rest and relaxation are not sufficient to rebalance the stress response system.
The result is chronic overactivation of the sympathetic nervous system (SNS). The SNS releases excitatory neurotransmitters. The task of the parasympathetic nervous system (PNS) is to counterbalance these effects by slowing the heart and respiration, calming the mind and emotions, and replenishing the energy consumed by SNS activity. In people who suffer from anxiety disorders, the PNS is underactive while the SNS is overactive. This is a fundamental neurophysiological problem in anxiety disorders.
Mind-body practices can significantly affect the autonomic nervous system. Particular yoga and meditation practices quiet or excite the SNS and PNS. For anxiety disorders, it is important to increase the flexibility of the entire stress response system.
Mind-body techniques that focus on breathing practices can provide rapid reduction in anxiety. Anxious patients are often desperate for the immediate relief they expect to find in a pill, yet yoga breathing practices can alleviate anxiety within minutes. Once people experience this rapid physical relaxation and mental calming, they are more motivated to work with their breath rather than become more dependent on medication. Those who learn to induce a relaxed, calm state through breathing practices are able to meditate more easily.
Adapted from: How to Use Herbs, Nutrients and Yoga in Mental Health
Richard P. Brown, MD, Patricia L. Gerbarg, MD, Phillip R. Muskin, MD
W.W.Norton & Company, 2009
Resources
Finding High Quality Supplements
Purity and quality varies among products because of differences in root stock, soil, climate, harvest time, adulterants and methods of extraction and drying. Lists of high quality herbs and nutrients can be found in How to Use Herbs, Nutrients and Yoga in Mental Health.
Publications
How to Use Herbs, Nutrients and Yoga in Mental Health
Patricia L. Gerbarg, MD., Phillip R. Muskin, Richard P. Brown, MD,
Editors. Complementary and Integrative Treatments in Psychiatric Practice.
Washington D.C., American Psychiatric Association Publishing, 2017.
Websites
Additional resources that help identify high-quality brands are available through the following sites:
Scientific Paper
In the United States, anxiety disorders are among the most prevalent mental health conditions, demonstrating a lifetime prevalence of 20.8%. Anxiety disorders are known to compromise the personal, social and occupational functioning of an individual, as well as their physical health. The ramifications of anxiety disorders extend beyond the individual, to society.
Generalized Anxiety Disorder consists of a multitude of symptoms including chronic worry, muscle pain, headaches, irritability, insomnia, fatigue and restlessness. GAD affects approximately 5% of Americans. The financial cost it places on economies around the world, due to resource expenditure and loss of productivity is substantial.
To date, no treatment demonstrates consistent effectiveness in driving GAD symptoms to remission. Researchers and clinicians are now focusing on meditation and yoga. Mind-body programs for relief of anxiety symptoms offer several advantages over more traditional treatments for anxiety. Mind-body practices have been shown to reduce symptoms of anxiety, depression and PTSD. When administered as a group intervention, treatments are less costly because they require fewer and less expensive health care providers. Unlike anti-anxiety medications, mind-body practices are not associated with habituation, addiction or withdrawal symptoms.
An open-label trial investigated the effects of the Breath-Body-Mind workshop on patients with severe, treatment-resistant GAD with comorbid diagnoses. The goal was to determine whether the addition of this intervention (BBM) to standard pharmacotherapy, would affect symptoms of anxiety and comorbid depression.
Significant symptomatic improvements were noted immediately following participation in a 2-day Breath-Body-Mind training, and improvements were sustained at 6-month follow-up. This pilot study was the first investigation of Breath-Body-Mind to demonstrate significant improvements in symptoms of anxiety and depression in individuals with treatment-resistant GAD. Efficacy and rapid improvements associated with low-risk and low-cost provide support for the BBM approach to be considered as part of the treatment armamentarium of healthcare practitioners managing complicated GAD.
Adapted from: Breath-Body-Mind for GAD Patients
Katzman MA , Vermani M, Gerbarg PL, Brown RP, Lorio C, Davis M, Cameron C, Tsirgielis D.
A multicomponent yoga-based, breath Intervention program as an adjunctive treatment in patients suffering from generalized anxiety disorder with or without comorbidities.
Int J Yoga. 2012 Jan;5(1):57-65. doi: 10.4103/0973-6131.91716.
Phytomedicines for Prevention and Treatment
Phytomedicines (herbs) contain bioactive compounds that can alleviate neuropsychiatric symptoms when used alone or in combinations with other herbs, nutrients, and psychotropic medicines.
Evidence for the beneficial effects of herbal extracts on oxidative stress, mitochondrial energy production, cellular repair, neurotransmission, CNS activation or inhibition, neuroendocrine systems and gene expression is expanding. Understanding the psychopharmacology and the potential clinical effects on anxiety, insomnia, cognitive function and sexual function enables clinicians to evaluate the supplements being taken by patients and to advise them on safety and efficacy.
Herbal medicines for anxiety usually work through gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain. Increasing GABA-ergic action reduces central nervous system stimulation and amygdalar overactivity, as occurs in anxiety disorders.
Adapted from: Phytomedicines for Prevention and Treatment of Mental Health Disorders
Patricia L. Gerbarg, MD, Richard P. Brown, MD
Psychiatr Clin N Am 36(2013) 37-47
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