Archive for April, 2009

Anxiety and Dreams: Related?

Wednesday, April 22nd, 2009
Excessive REM sleep uses up our motivational energy...

Excessive REM sleep uses up our motivational energy...

Dream (REM) sleep is a wonderful mechanism. But, just as two aspirins can be helpful in curing a headache, whereas taking the whole bottle would be harmful, so the right amount of REM sleep accomplishes the emotional repairs required but too much is counter-productive. In addition, if you give the dreaming brain too much work to do, it is forced to up the amount of REM sleep you have each night, which isn’t healthy.

The normal sleep pattern is to start the night with slowwave body-repair sleep, followed about 90 minutes later by our first period of REM sleep, which lasts about 10 minutes.

As the night goes on, we gradually have less slow wave sleep and more REM sleep, culminating in about half an hour of REM sleep just before we wake up in the morning (which is why we sometimes remember the last dream we have had).

As a rule, though, we usually forget our dreams, because they represent expectations that didn’t get completed in real life and therefore we don’t want them stored in memory, as if they had been.

However, research has shown that depressed people who worry a lot and fight anxiety during the days have their first REM sleep just 20 minutes (or at most 50) into the night, and it can last for almost an hour.

They then continue to have more and longer periods of REM sleep (and more intense dreams) until the brain can take no more and they wake in the early hours, even more exhausted than when they went to sleep. Then, once awake, they start all the worrying allover again.

We have an electrical signalling system in our brains – sometimes called the orientation response – that alerts us to sudden changes in our environment. (It is this that would draws our attention to the sound of footsteps or the darting movement in the dark alley.)

This same signal is also set off at the start of and during dreaming, alerting us to the fact that there are undischarged emotional arousals which need de-arousing through dream content.

Unsurprisingly, this signal goes off at an amazing rate in people who worry almost continually. Each time we respond to this signal, however, it draws on our motivational energy, of which we only have a certain amount.

And, as excessive REM sleep pretty well uses this up, it is no surprise, then, than incessant worriers all too often wake in the morning feeling not just exhausted but depressed and lacking in the motivation to get them going.

Quite naturally, this provides something new to worry about.

“Why do I feel like this? I went to bed early. And I know I had quite a bit of sleep. Why don’t I feel refreshed? Why is it such a huge effort just to get out of bed and go and put the kettle on? Perhaps there’s something seriously physically wrong with me?”

If this is you…

Well, yes, something is physically wrong – at the moment.

Your sleep pattern is out of balance, leaving you short on slow-wave body-repair sleep while your dreaming brain is in overdrive, running itself ragged trying to discharge all the arousal caused by your worrying.

No wonder you don’t feel good. And the longer it goes on, the greater the wear and tear on your body, as it is also under siege from all those perpetually circulating stress hormones that try to produce a similar result as anxiety relief.

Quite a dramatic scenario, isn’t it? And it stems entirely from all that fretting, worrying and dread. And although your energy stores gradually fill up somewhat during the day, they quickly become depleted again when the next bout of emotional arousals comes up for discharge in dream form that night.

For dreaming doesn’t solve problems. It isn’t intended to. It merely completes our unresolved emotional expectations so that we can start the day with a fresh I slate’, in terms of emotional arousal. By starting the worry cycle all over again, we undo all that work.

But this needn’t be a permanent state of affairs. Indeed, we have found that simply knowing all this is often the spur that people need to enable them successfully to take the steps which we describe in our newsletter.

How Poor Sleep And Anxiety Lead To Severe Depression

Tuesday, April 21st, 2009
Sleep is not just the brain turning off and resting.

Sleep is not just the brain turning off and resting.

Disturbed sleep is an extremely common feature of generalised anxiety. This is distressing and debilitating enough in itself but it also plays a significant part in the feelings of depression that often accompany anxiety, as we shall explain.

Everybody appreciates a good night’s sleep. But what constitutes a good night’s sleep is much more complex than previously thought.

Sleep is not just the brain turning off and resting. Every night, we need a quota of two kinds – slowwave sleep and dream sleep (also called rapid eye movement or REM sleep because our eyes dart around behind our closed eyelids during this phase).

During slow-wave sleep, the day-to-day wear and tear on our bodily tissues is repaired; brain cells are recharged with sugars and our immune system is refreshed. But, in dream sleep, our brain services our emotional intelligence system. In effect, dreaming is an inbuilt super stress-control mechanism, one of nature’s most incredible developments, without which complex mammals like us could not have evolved. So, to use a computer analogy, slow wave sleep repairs the hardware and dream sleep repairs the software – our thoughts and emotions.

After 12 years of research, trying to puzzle out why we evolved to dream scientists showed that the role of dreaming is to deactivate the emotional expectations and anxiety fighting that we get worked up about during the day and which are still taking up space in our brains when we fall asleep.

They discovered that what needs discharging are not the arousals that were expressed during the day, perhaps by having a heated argument with our partner, or taking evasive action, such as steering round and managing to avoid a dramatic motorway accident; it is the arousals that aren’t expressed or acted out that produce dreams.

These arousals stew away all day below consciousness, waiting to be dealt with, and, if they are still there when we fall asleep, the arousal pattern is completed by being acted out metaphorically in our dreams. This frees up our brains to face the next day’s emotional concerns. In other words, we dream out the emotionally arousing expectations, which, unconsciously, our emotional brain was still expecting to have happen.

This is one of those scientific discoveries that is easy to confirm from your own experience. Every day we generate countless expectations – emotional arousals, positive or negative – that don’t work out. These can range from major ones, such as setting one’s heart on a new house but not knowing if things are going to work out, to minor ones, like considering for a moment taking a proffered piece of cake and then thinking better of it.

Thoughts about the house would keep surfacing, even though we might instantly forget the cake, but both expectations would remain live in the brain at an instinctive, emotional level. This is because a primitive urge has been activated – to move towards something that is desired (the house) or to eat something (the cake) – and, just like other primitive survival urges (for sex, warmth or safety etc.), it has to be discharged in some way or another, once aroused.

This is as true for other mammals as it is for us. If the urges didn’t get discharged, our survival instincts would weaken. For what would be the point of having the instincts that urge us to eat, drink, run away, have sex, etc., if we ignored them most of the time?

Yet we do override them a great deal of the time because we don’t eat every time we see something that whets our appetite or have sex every time we see a person that attracts us.

Clearly, we still need those instincts available to us for the right times and places. So nature’s clever way to keep instinctive programmes intact is to ‘act out’ or complete in our dreams the expectations that were not fulfilled while we were awake.

The brain can only do this when all the senses are shut down, as they are in REM sleep. And, because we can’t fulfil the expectations in ‘real’ time, the brain uses metaphors, patterns drawn from memory, that correspond emotionally to the expectations not acted out.

The unfulfilled expectations that give rise to dreams can be surprisingly varied. For instance, even seeing something on television that makes us angry or alarmed can be sufficient to generate a dream. (As parents are well aware, children often wake up from nightmares generated by something scary seen on the telly.)

More importantly, for our purposes here, an almost bottomless pit of unfulfilled expectations is produced by … constant worrying. And that brings its own special problems.

Let us imagine that Elizabeth, instead of dropping off into a comfortable, soothing sleep when she goes to bed, lies there every night with different worries going round and round in her head – “What if I don’t get the car to the garage the minute it opens. I’ll have to wait in the queue to book it in and then I’ll be late for the train. Then I’ll have no time to get the room prepared for the meeting. And what if I don’t get a seat on the train? I can’t stand with my bad back. But it would be so embarrassing to ask for a seat! Lucy’s got her mock maths GCSE tomorrow. I wonder if she packed her calculator. I’m sure I saw it downstairs, when she was studying. Did she pick it up? I think she must have. Or did she? I must remember to check the table when I get up. Perhaps I should do it now? No, it’s too cold. Oh, I’d better. No, it will disturb the cat, if I go down there. He’ll think I’m going to feed him … ”

By thinking all this, Elizabeth is reliably building up more and more software maintenance for her poor dreaming brain to carry out. And that is added to all the worries that have been whirring around in her head all day that are already in the queue.

Anxiety Emotions Make Us Stupid

Tuesday, April 14th, 2009
Your amygdala doesn't care whether you get embarrassed or not.

Your amygdala doesn't care whether you get embarrassed or not.

If you are going to learn to handle anxiety, this is crucial to understand: when the amygdala is centre stage, excitedly setting off alarms like this to save our skins, it is so powerful that it can actually shut down our higher intelligence completely.

It is as if it has a simple on|off button that it can use to deactivate the thinking part of our brains. When our bodies are in a state of high emotional arousal (whether we are angry, terrified or head over heels in love), we are not thinking straight. High emotional arousal makes us temporarily stupid. Or, to put it more politely, it reduces our options to a simple choice to force us to take action.

It has to be this way.

For example, if from down the street you see a motorbike up on the pavement, accelerating towards you, you don’t want your thinking brain weighing up the odds and wondering, “Surely he knows he shouldn’t be on the pavement? Maybe it’s a film stunt? In that case, where are the cameras? Is that a Harley-Davidson he’s riding? Hmmm … actually he is going very fast. And he is driving straight at me! I wonder if I should just step out of the way in case he hasn’t seen me … ?”

By that time, you might well be dead.

So, in such life-or-death circumstances, we don’t want a highly intelligent system that can carry out reasoned analysis. We want an excitable (and therefore stupid) system that can terrify us and make us dodge the bike and run for it before we even know what we are doing!

So sometimes panic is the right response. In other circumstances, however, the ‘threat’ might tum out to be harmless and, if you have already legged it, you might well feel a prize fool.

But your amygdala doesn’t care whether you get embarrassed or not. It knows that you can get embarrassed a hundred times and it won’t kill you; but fail to act on a genuine life-or-death threat just once, and you are likely to end up never needing this wonderful survival mechanism again.

Our Powerful Emotional Brain

Monday, April 13th, 2009
Strong emotions focus and lock our attention ... everything is simplified to a black-or-white choice...

Strong emotions focus and lock our attention ... everything is simplified to a black-or-white choice...

The ‘thinking’ part of our brains (the neocortex) is relatively new in evolutionary terms. Before our brains developed into the awesome organs they are now, enabling us to plan, imagine, analyse things and make judgements, we relied for our survival on our more primitive ‘mammalian’ brain.

The mammalian brain, a set of structures which lie underneath the neocortex, is often termed the ‘emotional brain’, because it is concerned with instinctive responses involving emotions – most notably the fight-or-flight (anger or fear) response. All instinctive behaviour concerns survival: feeding, mating, fighting or fleeing. And our instincts induce emotions that require us to take action (ideally to carry out the instinctive behaviour so as to lower the arousal again). All emotional needs arise out of this fundamental survival programme.

When the neocortex developed, we had rational intelligence at our disposal, as well as emotional intelligence, and, in the ordinary everyday, the two intelligences work together in partnership, with the rational brain adding subtlety and perspective to the raw feelings of the emotional brain, and the emotional brain tempering the rational brain’s cool clinical judgements. But emotions can often overpower the rational brain, as we shall see.

The emotional brain contains a very small and powerful structure known as the amygdala – so called because it is almond-shaped and amygdala in ancient Greek means almond.

In effect, the amygdala acts as the body’s alarm system. It has access to our store of emotional memories and learned responses and its job is to be alert to any possible danger to us by matching new events to patterns in its store and, from that, judging whether we might be at risk.

For instance, suppose we are walking alone down a dark street late at night and there is a sudden unexpected crunching sound or a quick movement. Our attention is drawn to it instantly and, in less than a split second, our amygdala decides whether the sound or movement could signify danger.

It pattern matches the sound to the crunch of footsteps. It pattern matches the movement to that of a person darting out of an alleyway. Making its best guess, on the basis of what it knows from its memory stores that the sound or movement could signify, the amygdala takes the worst-case scenario and sets off the alarm by making you feel anxiety.

In effect, it concludes, “We are under threat! Or, at least, we might be! So we had better be ready to turn and fight or else run for it.”

Because it needs to make an instant decision to get us out of any potential danger as quickly as possible, the amygdala’s pattern matching is very crude. It is black and white – a situation is either safe or it isn’t. Therefore, it doesn’t have the sophistication of the thinking brain, which can introduce some shades of grey to the situation and might conclude that, yes, the crunch is definitely footsteps but the owner of the feet, far from being a psychopathic killer, is probably only a neighbour from down the street.

And the sense of movement from the alleyway is not a shadowy alien figure with ill intent but merely a black bin bag blowing in the breeze.

But, at this point, the thinking brain hasn’t yet had a look in.

When the amygdala decides that we might be under threat, it takes the steps required (by sending chemical signals) to set the fight-or-flight response in motion without seeking any by your leave from the neocortex.

In fact, this has all already happened by the time the neocortex gets to know what is going on half a second later. Our heart is already pounding, our legs shaking and our breathing coming short and quick by the time we recognise Bob or Nancy from two doors down or identify the bin bag.

We quickly calm down then, of course, and become reasonable people again, instead of gibbering wrecks.

The Fight-Or-Flight Response

Saturday, April 11th, 2009
Taking appropriate action of some kind both relieves the stress and helps us avoid developing anxiety.

Taking appropriate action of some kind both relieves the stress and helps us avoid developing anxiety.

Imagine for a moment that we are our long-ago ancestors, still living in the wild. Our very survival depends on our being ready to react instantly, if a wild boar thunders out of the undergrowth or members of a hostile tribe come over the hill towards us. As soon as we sense a threat, a cascade of bodily events is triggered to help us cope. Almost instantly, the following happens:

Our muscles tense ready for action. Our blood pressure goes up, to increase the circulation to our muscles and heart, which beats faster, to cope with the expected increased demands on it. We breathe faster, to speed up the time oxygen takes to get into our blood, and that makes our anxiety chests hurt and our bodies tremble. To divert as much blood as possible to our limbs to aid action, our digestion is interrupted, making our saliva dry up, and our kidney, intestine and bladder functions stop, causing the muscles at the opening of the anus and bladder to start to relax.

We sweat, to try to cool ourselves. Our bodies are flooded with ‘stress’ hormones that enable all these responses to happen and, as a result, we immediately flee the wild boar or fight the unwelcome tribesmen.

Once the threat is over, if we are still alive to tell the tale that is, our hearts slowly pound less, the shaking gradually stops and the sick feeling passes, as our blood circulation returns to normal and digestion and the other regulatory functions start up again. The stress hormones that were swarming through our body have been burned up during the action we took or else are neutralised as our body maintenance gets back to usual business.

This excellent system has served us well for millions of years. But it was designed to deal with circumstances in which we could take action. The stresses we face today are less often of the life-threatening kind. More usually, we find ourselves in circumstances where we feel psychologically threatened (the boss is critical of our work; someone else is getting our promotion; we’re being bullied at college; a neighbour is continually picking arguments).

Or we feel unsafe (we may fear walking the streets at night or meeting gangs of teenagers; the news is full of gloomy predictions about wars and global warming and deadly diseases).

Or we feel ‘cornered’ – but not by a wild beast that we can flee – we are stuck in a traffic jam; work deadlines are unrealistic; the phone keeps ringing.

The very primitive, early-developed part of our brain (which gives the directions that set our fight-or-flight response in motion) is not able to distinguish between events like those above which it perceives as threatening and those that actually are life threatening. Even worse, it cannot distinguish between real or imagined life-threatening events either. (“I’ll die if I have to get up on that stage and speak!”) Indeed, when the fight-or-flight mechanism first evolved, we didn’t have a ‘thinking’ brain and there was no such thing as imagination. So now, if we imagine ourselves experiencing disaster vividly enough, we can still easily trigger off the fight-or-flight response.

But, when we are being criticised by the boss, sitting stewing in a traffic jam or imagining being trapped in a lift, there is nowhere to run to and no one to fight. And, although the physiological arousal that is switched on when we get stressed in such ways is mopped up quite quickly, an expectation – that something will or should happen – also gets switched on in the brain, and stays switched on, taking up our attention and energy.

This is a cumulative process and, with each additional stress, not only does more and more arousal occur but more and more expectation patterns stay switched on in our brains.

Eventually this puts too much stress on us physically and it is at this point that one person might start to develop anxiety headaches or angina; another will turn to drink; and you may develop an anxiety disorder. Whatever the reaction, it is the body’s message that it has been pushed too far.

Of course, stressful events will always happen. Some will drop out of the blue to scupper our plans, however well we may think we have prepared for every eventuality. At some point, someone we love will die. Companies go bust. Fires, floods and other natural disasters are all out of our control.

But what is within our control is learning how to deal with stress when it arises. By taking appropriate action of some kind, we can dissipate the stress hormones – this both relieves the stress and helps us to avoid developing anxiety.

So, while we can’t prevent a lot of the stressful events we face in life, we can develop psychological robustness.

Anxiety And Stress Are Closely Linked

Thursday, April 9th, 2009
There is an important distinction between being stretched and being stressed ...

There is an important distinction between being stretched and being stressed ...

To understand anxiety, we need to understand about stress, because anxiety and stress are closely connected, though in two different ways. The first, perhaps most obvious, connection, is that very many anxiety problems arise because of chronic levels of stress. The second we will look at shortly.

What is stress?

Stress is any pressure or accumulation of pressures – physical or psychological – that is too much for a person to cope with comfortably. Therefore, what is perceived as a stress will vary from individual to individual.

A marathon runner, for example, will have no difficulty running three miles, yet that might well tax most of the rest of us beyond our endurance.

A stand-up comic may thrive on the ‘rush’ of performing live in front of an audience of hecklers, whereas just giving a short presentation to supportive colleagues will induce extreme panic in someone else.

Throughout our lives we may well have to cope with anxiety in many highly stressful events, ranging from the death of a loved one, relationship breakdown, divorce, job loss, financial difficulties, sex problems and chronic illness to even much longedfor events such as pregnancy, a new child in the family and retirement. And less marked changes in our circumstances, such as a change of job/college/school, a deteriorating relationship with a partner or friend, grown-up child leaving home, more or less responsibility at work or difficulties with a new boss, can all take their toll.

When several events like these happen at the same time or within a short time span, we can be pushed completely beyond our normal coping capabilities. But even lots of small stressful events (or ‘hassles’) that mount up over the day can have a strong negative effect on us.

It is often said that stress can be good as well as bad – getting married, for instance, or setting off on holiday are eagerly anticipated activities, yet they can also be highly
stressful. There is an important distinction, however, between being stretched and being stressed. When we are undertaking new challenges, whether planning a big event or learning a new skill, we are initially stretched beyond our comfort zone but, if we can rise to the challenge, it feels good. We feel excited. Whereas when we are stressed, we can’t rise to the challenge: we feel defeated and negative and that the effort is too much.

It feels bad, and we feel anxious, sometimes develop chronic anxiety. The physiological effects are initially the same (as we will show in a moment) but the outcome very different. In the first scenario, energy is discharged and something is achieved; in the second, there is nothing to show for it.

This is an important difference that needs to be more widely understood.

In other terms, which we will be explaining fully later, all forms of stress arise because, in one way or another (for whatever reason), one or more essential physical or emotional needs are not being met in a person’s life. It may be something that happens gradually – starting, perhaps, with loneliness due to the loss of a loved partner or the inability, because of overwhelming shyness, to make new friends – and then builds and builds in an insidious way, taking the light and enjoyment out of life.

Or it may be something that happens suddenly, as on those tragic occasions when people,
whose lives were working well, are caught up in a natural disaster or become the victims of violence – everything is changed in a flash, and their lives become ruled by fear, making it harder and harder for them to get their essential needs met.

When all of our needs are being met in balance and we are confident about our place in the world and about how we go about in it, we don’t suffer from seriously disabling anxiety and stress.

What role does stress play in causing anxiety and Anxiety Disorders?

Although stress causes anxiety, there is little evidence that it causes Anxiety Disorders, with the exception of Post-Traumatic Stress Disorder and Adjustment Disorder with Anxious Mood. Stressors (stress-provoking factors) such as speaking in public or working under a tight deadline often make people anxious. If the anxiety is not extreme, it usually helps mobilize the person to prepare and perform well. If anxiety rises too high, however, people may become unable to deal with the situation they are in or to act normally. Different people vary in their capacities to tolerate and benefit from anxiety, and each person’s ability to cope with anxiety and danger varies somewhat from time to time.

With the exceptions of Post-Traumatic Stress Disorder, which follows extreme stress beyond a person’s tolerance, and Adjustment Disorder with Anxious Mood, which is an overreaction to a psychosocial stressor, it is not clear that stress is important in causing Anxiety Disorders. Even where the stress seems causative, it is often impossible to specify exactly how this operates. The role that stress plays in causing Anxiety Disorders is undefined at present.

Anxiety Remedy – The Truth Your Doc Isn’t Telling You

Wednesday, April 1st, 2009
Be sure that your doctor is telling everything about anxiety remedy.

Be sure that your doctor is telling everything about anxiety remedy.

A combination of changing life practices, attitude and habits can be used more effectively than any medication as an anxiety remedy to break the cycle of anxious thoughts, feelings and emotions that you are experiencing.

Quick fix drug anxiety treatment for anxiety disorder is not the answer. Many people have experienced temporary relief from such treatments, I am not suggesting that these drugs are not therapeutic in some cases, many people do find some drugs helpful in eliminating some of the unpleasant symptoms experienced, but these drugs are meant for short-term use, to knock the edge off severe symptoms. Many Doctors have ignored the prescription guidelines for these drugs many of which are for use over short term, (2-4 weeks maximum in some cases).

What this means is that patients are becoming addicted to the drugs as if they were the magic anxiety remedy and when dose reduction is attempted, withdrawal symptoms bring back the symptoms for which the drug was originally prescribed, but this time it is much more severe and in addition there can be many more new symptoms.

My belief is that anxiety is manageable without medicinal intervention.

Most drugs, for any illness, are used to mask the symptoms. A medical practitioner will prescribe a drug for a complaint then another to mask the side effects of that drug and so on, to what end? The vicious circle that ensues spirals out of control and before long a cocktail of drugs is causing side effects much worse than the original symptoms. If you are one of those people who read every word on the information pamphlet provided with your medication, you will know that the list of possible side effects can be quite disturbing – far from a real anxiety remedy.

The problem is that the more we rely on these drugs to alleviate the symptoms we experience the more the body and mind becomes reliant on them (physical and psychological dependency). If you broke both of your legs and spent six weeks in bed with both legs in plaster nursing your injuries, would you insist that you kept the plaster casts on indefinitely, even after your bones were mended, just to avoid the unpleasant realisation that taking them off your weakened legs will mean possible discomfort or weakness? No of course not, but many people who get temporary relief from anti anxiety medication become dependent both psychologically and in some cases physically.

The more medication taken to mask the symptoms, the more it is needed to have a therapeutic effect, the dose is increased which gives us temporary relief then the body acclimatises itself at that dose and sends out messages, in the form of returning symptoms, that a higher dose is required. We then increase the dose and the cycle starts again until eventually we are on high doses and not only experiencing our increasing anxiety but side effects and even withdrawal symptoms of the anxiety remedy as the body needs more of it to function normally. It is the fear of returning symptoms of the original illness that stops people from facing their anxieties and reducing their medication, but what must be realised is that increasing drug dose is not the answer, reducing the dose, facing our anxieties and changing our life practices and habits is!