My 3-month plan to overcome anxiety  – Part 2

Link to part 1 here


Exercise

Exercise has never been much of an issue for me, it’s always been a natural part of my life and has always been a supportive habit during many difficult times. As such, I thought I’d include it in the routine as a reminder of the importance of exercise and mental health. As this post is centred around anxiety, I won’t go into the depression benefits (although I’d definitely suggest looking into the connection between exercise and depression if you’re currently battling depression too), but it also seems to have a link with reducing symptoms of anxiety.

Just one bout of moderate intensity exercise, 30 minutes of brisk walking outside found:

“…a significant decrease in self-reported trait anxiety measures when participants [n=36] underwent a single session walking exercise protocol.”

(Clarke et al. 2018)

Furthermore, Ensari et al., 2015, conducted a meta-analysis which included 36 randomised controlled trials. They concluded:

“The cumulative evidence from high-quality studies [n=1233] indicates that acute bouts of exercise can yield a small [yet still statistically significant] reduction in state anxiety.”

(Ensari et al. 2015)

Over the long-term research has shown that regular physical activity and a higher level of cardiovascular health reduces reactivity to stress, and thus a lower overall level’s of anxiety in life. A 2018 systematic review concluded:

“About half of the studies suggested that higher physical activity/fitness levels were associated with an attenuated response to psychosocial stress.”(Mücke et al. 2018). Further “exercise can reduce symptoms of anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder.”

(Kandola A 2015)

It should be noted that currently, it is unclear what the optimal protocol is to elicit an anxiolytic effect. My suggestion would be to do the exercise you enjoy; walking, weights, sport etc. this will boost your adherence and compliance to your routine. As opposed to just committing to running ‘X’ miles a day just to try to induce this response.

I’ve added a couple of templates to give you some ideas on possible routines that I would recommend;

source: http://workoutwaper.co/phul-workout/
source: https://blog.mapmyrun.com/essential-guide-to-running/

Meditation

Meditation (derived from the Latin meditari, meaning to concentrate) involves focusing your mind on a certain object, thought or activity, to achieve clarity and an emotionally calmer state. Meditation has been practised throughout history, mainly in a religious context, however, since the 19th century has spread across cultures. And beginning in the 1970s has moved more into the mainstream. Meditation practice offers; reducing stress, anxiety, depression, and pain, increasing peace, perception, and well-being. Meditation is currently being researched heavily to better define its health (psychological, neurological, and cardiovascular) benefits.

Mindfulness

There are many many types of meditation; transcendental, zen, loving kindness etc. however, the one I want to focus on most is referred to as ‘mindfulness’. A systematic review published in the Journal of the American Medical Association assessed the results of 47 randomised clinical trials (RCT’s) involving a total of 3,515 participants and concluded:

“..mindfulness meditation programs, in particular, show improvements in anxiety, depression, and pain.”

(Goyal M 2014)

Mindfulness, to me, also seems a lot easier to learn and has multiple popular apps that can assist in this. Mindfulness has been characterised as “paying attention in a particular way: purposefully, in the moment, and non-judgmentally.” This is in contrast to traditional cognitive behavioural therapy (CBT) in which negative thoughts are targeted and challenged, the objective of mindfulness is to help people learn, and at times, to become aware of thoughts, feelings and bodily sensations rather than trying to contend with and attempt to modify them.

Evidence of the effects of mindfulness meditation has been studied at length, PubMed shows over 1000 different results, even the US Marines are using mindfulness to decrease stress. Meditation seems to work in multiple ways to improve the practitioners’ mood. One way meditation appears to work is by adjusting the balance of many essential neurotransmitters in the brain; GABA, serotonin, norepinephrine and dopamine. One hour of meditation involving 35 people was shown to produce a 27% increase in GABA and a significant increase in serotonin (meditators also showed a higher resting concentration of serotonin)(Guglietti 2012). Both low levels of serotonin and GABA levels have been linked to mood disorders, which is why we have whole classes of drugs dedicated to their modulation. A 2005 study (n=19) observed that meditation:

“..reduces sympathetic activation [as measured by a reduction of blood norepinephrine concentrations] and improves the quality of life in elderly patients with optimally treated heart failure.”

(Curiati et al., 2005)

A study from Denmark demonstrated a meditative state produced a 65% increase in endogenous dopamine levels. (Kjaer TW 2018). Low dopamine levels have been linked to increased occurrence of social phobia.

Additionally, research is pointing towards structural changes in the brain

“Meditative experiences and mindfulness are rooted not only in psychology but in neuroscience and neurobiology as well. They can be detected at the level of the brain in the area of functional, but also structural changes in grey and white matter, especially in those areas and networks associated with attention and memory, introspection, and sensory processing as well as with self and auto-regulation.”

(Esch 2013)

Hopefully, this can aid in a long-term sustained reduction in anxious thoughts and mannerisms, undoing the result chronic stress has over a lifetime, which has been proven to lead to degenerations in parts of the prefrontal cortex (PFC). This leads to among things, a decreased ability to regulate one’s emotions, and to a deterioration in executive functions and a reduced performance of the working memory in the dorsolateral PFC. As mentioned earlier, there may also be degeneracy in the hippocampus, which is incredibly stress-sensitive, while the amygdala may gain in size, with presumed long-term effects such as raised anxiety, resulting in conditions such as generalised anxiety disorder (GAD).

Apps

After doing some researching and testing out a couple of options for apps to assist in learning mindfulness, I’ve found a few options people might want to look at.

Paid options:
Headspace — is probably the most popular mediation app. The app mainly focuses on mindfulness and has some great little animations to demonstrate some of the points that are raised
10% Happier — Made by NY Times bestselling author it features many of the most well-known meditators in the world. The best bit about this app is variety, there are different methods of meditation and you can usually find someone you like on there.

Free:
Oak — offers a few different styles of meditation and breathing techniques. Nice simple and easy to use. 
Smiling Mind — Smiling Mind is a 100% not-for-profit organisation that works to make mindfulness meditation accessible to all. Their stated vision is to help every mind thrive. With a mission is to provide affordable, lifelong tools to support healthy minds.

Navy SEAL exercise to reduce stress (this technique is also now on Oak)
During my reading on mindfulness, I found a useful breathing exercise the SEALs use to prime themselves and quell stress and anxiety, I thought I’d share too. It’s called ‘box breaths’ or ‘4×4’ and is a simple breathing technique adapted from yoga.

1. Breathe in for 4 seconds

2. Hold for 4 seconds

3. Breathe out for 4 seconds

4. Wait 4 seconds

5. Repeat

When anxiety and panic begin to creep up, it may be useful using this technique and to follow best selling author Tim Ferriss’ advice and “stop everything and take 3 mindful breaths.”

Reading

Lastly, I just want to include a few books which I recommended checking out to help with anxiety, overall mood, and just dealing with adversity.

I’ve found these books all very interesting, in particular, the two stoic texts resonated with me on many levels. 

Conclusion

So that concludes the details of my plan to address long-term anxiety. TL;DR: I’m going to try various supplements and leverage exercise, meditation and reading to reduce my anxiety. If people find this useful let me know in the comments and maybe I’ll come back and add in my experiences/effects or create some journal posts. Hopefully, there’s some information in here that’s helpful, it was definitely informative researching and writing this, I’ve learnt a lot about anxiety and discovered that there’s a lot of treatment options out there extending beyond the usual SSRI’s and CBT. I encourage anyone who’s managed to read all this to explore the research further. My favourite resources to start with are PubMed and Google Scholar then using sci-hub to beat paywalls. Also, the sub-reddits r/depressionregimes and r/nootropics are some excellent places to ask questions and hear some anecdotal experiences.

Best of luck on everyone’s journeys.


If you’ve found this post useful please consider sharing it and/or subscribing to my https://twitter.com/BehindEnemyMind where I share studies I’ve found interesting on mental health issues. 

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