Surviving Anxiety and Trauma

Unexpected Fall

Dr. Sid—endearingly just called “Sid” by his peers, colleagues, and fellow healthcare workers—made his way through the city in the early morning darkness. For fifteen years, he’d traveled this way, but the ordinarily busy city was now quiet, a sad reminder of the pandemic’s impact. He cranked the heater as a shiver crept up his spine at the thought of what lay ahead of him.

His knuckles turned white as he parked the car and looked up at the gray stone building, and as he opened the door, sweat peppered his brow, and his heart raced. He took several deep breaths as he passed the line of patients snaking out the doors and down the road leading to the emergency room. Once in the building, he kept his head down, not wanting to look into the helpless faces all around that reflected his own anxiety as they stared up at him from chairs and stretchers that lined the walls. The COVID-19 pandemic had caught everyone unprepared.

As his eyes focused on his reflection on the metal doors, his breath caught in his throat. His vision blurred as his head dropped to his chest. His hand took his weight as he leaned against the door. Again, he gasped for a breath but his lips were dry and his chest tight.

A memory clouded his mind. Gross images of death on a battlefield far from home: some friends, some enemies—death came for them all. Bile caught in his throat as a depiction of broken bodies lay before him. As a medic, he lacked adequate medical personnel for the wounded and dying. He recalled the sickening smell of burning flesh. His last memory was of him trying to find and triage the living and salvage life, of blacking out, then waking up in the field hospital with a minor head wound from flying shrapnel.

Sid pushed himself back to his feet, adjusted his facemask, and then stepped into the empty elevator car. His knees buckled beneath him as he leaned back against the cold steel wall. As a good soldier and doctor, stress was always in his life, but this was worse. He’d had much taken from him: his wife, child, mother, and so many other things for which he deeply cared. His patients and age put him directly in the firing line for severe illness or even death. He knew the odds were against him. He clutched his left arm and wished he’d reached out for help, but work always came first. Sid would rather work than sit at home, thinking of the past.

As the light climbed to his floor, the pain eased. He loosened his tie and promised himself he’d live a healthier life before it was too late. He’d become overweight and showed early signs of heart disease, high blood pressure, and diabetes.

After stepping off the elevator, he grabbed a cup of coffee before climbing into his protective clothing and mask that would have to sustain him—people were dying.

Sid reached the intensive care unit for rounds where the nurse and new young intern waited for him. They discussed the recent deaths of patients who had died during the night, then by mid-morning, the three had completed rounds. He pushed himself onward, examining the weak and dying, changing medications where he could, and answering calls from frantic families trying to find out their loved one’s status. On his way out of the ICU, Sid grabbed the list with the families’ phone numbers and noted the ones that he hadn’t yet called, promising himself that he’d make the calls. He remembered how he had felt; some news was better than no news.

The clipboard clattered to the ground as a sharp pain shot down his arm. He fell to the ground holding his chest and fought for a breath as darkness closed in all around him. The next thing he knew, he was waking up in the coronary care unit with the familiar beep of a heart monitor reassuring him he’d survived. One of his younger colleagues, a cardiologist, told Sid that he was stable but had suffered a significant heart attack. On the one hand, he was relieved he wasn’t dying of COVID, but deeply saddened about having the major heart attack that he knew was imminent with his high risk and the early warning signs.

Like many of his patients, he had rationalized away the early warning symptoms of heart problems as occasional shortness of breath and left chest pains. Sid had known that he was a prime candidate for a heart attack with all the stress, anxiety, post-traumatic stress from war trauma, residual grieving from the death of loved ones, and the poor lifestyle he was maintaining. But he pushed ahead, not taking any action, living and practicing in very adverse circumstances. The pandemic brought much devastation and loss to those around him, as well as triggering memories of his traumatic war experiences and losing his home, wife, and young son during a hurricane.

Fortunately, Sid survived his heart attack and even experienced a bit of an awakening about changing his lifestyle. Now he could find a more suitable and less demanding work situation and put the pieces of his life back together. Sid’s story ^[1] is a lesson about paying early attention to anxiety and related medical warning signs.

As with Sid, several life events can contribute to or dramatically increase anxiety, depression, associated diseases, and deaths. Early awareness and care of anxiety-related difficulties or conditions are essential to prevent long-term problems, illnesses, or disabilities.

When Anxiety Conditions Become Adversity for the Mind and Emotions

While excessive fear and anxiety are detrimental to everyday functioning, when well-modulated, it helps people to stay alert and vigilant. The fear of being ostracized or penalized for rebellious or unlawful activities is a motivator to follow community laws to maintain civility and safety in the community. During the pandemic, rejecting public health guidelines such as masking or getting vaccinated relates to the fear of tribal or peer groups. Too much pressure or stress increases anxiety and fears of failure, weakness, or vulnerability. What can follow is a lowered immunity, reduced amount of restorative sleep, and increased infection susceptibility.

Emotional distress and mental impairment related to high levels of anxiety or related conditions can also cause work time loss, disruptions in relationships, drug addictions, overdoses, and suicides. Chronic distress from anxiety can lead to avoidance of activities, social isolation, and illness related to impair immunity. When overly anxious, one can seek security by looking for information, often not from the best sources, such as peers, product-promoting business advertising, becoming obsessed and addicted to watching too much TV, or consuming news reports that feed fear and worry while offering limited helpful information. The critical point here is to understand and recognize the nature and healthy side of anxiety and be prepared to take the steps when too much anxiety or fear is causing impairment, adversity, panic, or obsessiveness. Initial action may involve getting help to find the needed information for self-care or outside professional support. Cascading emotional distress needs attention before a person’s quality of life declines because of illness or loss of effectiveness and productivity.

Many Do Not Seek or Receive Help

Anxiety disorders affect 40 million adults, or 18.1% of the U.S. population, every year during typical, non-coronavirus times, making anxiety the most common mental/emotional/psychological condition in our country. Anxiety and related disorders account for a significant portion of the U.S. mental health budget. A considerable number of people with an anxiety disorder have at least one other accompanying psychiatric condition. These disorders can cause overwhelming, debilitating anxiety and fear that could become worse if not treated. And yet, less than 30% of individuals with these problems seek treatment, and a number go undiagnosed by their primary healthcare providers.^[2]

Many became overwhelmed in the difficult times of the COVID-19 pandemic with increasing unemployment, losses of businesses and jobs, and the surge in coronavirus cases and deaths in the U.S. Unchecked fear and worry were commonplace, with a growing amount of anxiety, panic, mood disorders occurring, and needing care and help. Mental Health America (MHA) online screenings over a six-year period, with over 5.5 million United States participants, showed a significantly greater moderate-to-severe depression or anxiety rate than in a similar study before the pandemic. A quarter of study participants cited grief, loss, and financial concerns as contributors to anxiety and depression. According to a two-month July 2020 survey from the Kaiser Family Foundation, more than half of the U.S. population has experienced adverse effects from COVID-19-related stress. Frequently reported difficulties included problems with sleep, poor appetite or overeating, mental health issues, headaches, stomachaches, temper difficulties, increased alcohol and drug use, and worsening existing illnesses such as diabetes and hypertension.

During the pandemic, anxiety and stress increased in essential workers, as with Sid in our story, who had to be on the front lines providing services and witnessing the devastation, tragedies, and deaths of people they served. Problems were even more significant in the days before the vaccine, effective treatments, and safe protective aids were available. Others more vulnerable to the risk of illness, worries, and anxiety states were those in the older age groups, including individuals with medical issues like chronic airway disease, obesity, and diabetes, or adverse practices like smoking, poor nutrition, and sedentary lifestyle. People living in high-risk environments were also at greater risk of anxiety-related difficulties, such as those in nursing homes, crowded spaces, or disadvantaged minority communities with less access to services and essential needs.

As there is the risk of getting a COVID-19 infection when in a closed space with other infected people, fear and anxiety can dramatically rise when caught in one’s inner thoughts and emotions. Levels of fear and anxiety can also become compounded when individuals are in tight quarters with others experiencing fearful states. Avoiding getting help, counseling, or therapy, especially if there is a history of unresolved trauma, will increase the risk of developing future mental health issues or illnesses. Those having a history of trauma, or living with others who have an unchecked emotional or mental illness, should seek help or guidance early, preferably as soon as they experience growing fear, worry, or anxiety. Early identification of feelings or symptoms of unhealthy emotional or mood states is an initial step in knowing when to get help or support. Prompt attention and early intervention may prevent progression to more severe problems.

Be Alert to the Signs of Anxiety Conditions

• Being frequently nervous, moody, or on edge

• Feeling a sense of impending danger or doom

• Increased or rapid pulse/heart rate, palpitations, and dizziness

• Fast or troubled breathing and sweating

• Increased tiredness, weakness, and wanting to sleep more

• Muscle tension, fatigue, and trembling

• Difficulty concentrating and getting things done

• Having trouble sleeping, with more frequent nightmares

• Experiencing digestive problems and changes in appetite

• Panic attacks, which appear suddenly and increase in intensity over several minutes, peak, and usually go away rapidly

If any of these symptoms persist, please consider seeking appropriate support.

Panic Attacks

Panic attacks can occur because of growing anxiety. Panic differs from fear and other types of anxiety. These attacks include severe nervousness, muscle tightness, trembling, fast heartbeat, fast or troubled breathing, dizziness, impaired concentration, palpitations, sweating, and sleep disturbances. Also, panic attacks are often unprovoked, appearing suddenly and increasing in intensity over several minutes, peaking, and then rapidly subsiding over ten minutes or longer. An episode can occur as a one-time event or can repeatedly happen, triggered by something remembered, or it can appear without warning, and occasionally when awakening from sleep. These episodes can be very disruptive, disturbing, and disabling. One explanation for the cause of the panic attacks is that the body’s typical alarm system of mental and physical responses to an actual threat, the “fight-or-flight response,” gets triggered and activated even when there is no real threat present.

In “normal” times, panic attacks possibly occur in 20% of the U.S. population at least once in their lifetimes, or 3% of the population at any given time. With the heightened fears over illness and related concerns as during a pandemic, major disaster, or community disruption—personal and family safety, work, career, paying the bills, getting needed food, shelter, medications, etc.—panic attacks would likely occur more frequently.

Contributing factors to panic attacks include:

• An actual or transient medical problem such as a middle ear infection, allergies, mitral valve prolapse (often a mild dysfunction of this heart valve closure), hyperthyroidism, or low blood sugar

• Earlier life history of significant trauma or post-traumatic stress disorder, with embedded memories of prior trauma, or increased susceptibility for panic episodes in an already highly anxious and hypervigilant person

• Medication use or withdrawal, stimulant or substance use, or abuse thereof, leading to greater vulnerability to panic attacks

• Overuse of stimulants like caffeine or non-prescribed or unnecessary stimulant drugs, or drugs of abuse such as methamphetamine or cocaine

• Life events involving significant stress, losses, threats of damage, or the feelings of increased vulnerability may precede panic attacks

Panic disorder can become recurrent and disabling. If the panic episode occurs in a specific setting, as in a store or car, irrational fears or phobias about these situations may arise. People that avoid these situations, can become increasingly housebound, unable to drive, and develop agoraphobia (fear of public places). If the person doesn’t receive effective early treatment, increasing incapacitation in life activities can result.

Holistic and Effective Care for Anxiety and Panic

When recurrent fear and anxiety persist and are troublesome, help and relief may be possible with knowledgeable self-care or effective therapeutic intervention by a mental health care provider. Interventions can help you to:

• Get unstuck from unhealthy patterns of behavior, rigid beliefs, and fearful or painful memories.

• Reduce or eliminate anxiety, panic, addictions, and trauma-related symptoms.

• Focus more on the present and the here and now, rather than the past or future.

• Become more present, mindful, and aware.

• Improve energy, focus, concentration, daily functioning, and skills to prevent relapse or recurring symptoms.

• Develop greater acceptance and compassion.

• Regain the wisdom and the balance of personal power, self-needs, and the needs of others.

• Reestablish social support and networks.

Therapies may prove to be of benefit to you for anxiety, mood impairments, and prior trauma, such as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) Interventions.^[3]

Therapies commonly employed to benefit anxiety-related conditions often involve:

• Education about the body’s physiological reaction to fear and threat

• Use of experiential techniques, talk/listening, person to person, and group therapies

• Desensitization to the various physical sensations or triggers of panic through the exposure of a person to the actual object, situation, or thought

• Catastrophic-thought-reducing techniques

• Learning relaxation, breathing, and stress management techniques

• Restructuring dysfunctional thoughts and patterns

• Gaining personal insights and the realization of one’s inner strength and vision to overcome obstacles

• Transforming from being the victim of a traumatic experience and memories to a broader perception of life, one’s power, and potentialities

• Acceptance that the mind is continually moving toward the healing of its own emotional and mental health

• A personal commitment to supporting the healing process and therapeutic work as needed

• Supporting the person’s process and strengths to release frozen past traumatic memories and constricting defenses, to regain energy flow and vitality

• Help in regaining flexibility by getting unstuck from rigid beliefs and attitudes, to experience an expanded perspective about life outside of the narrow constraints of a limiting mind-ego

Be Aware of Underlying Medical Conditions

Unfortunately, healthcare providers are often not familiar with the potentially devastating and disabling effect of the improper treatment of anxiety-related conditions. Management of anxiety often uses a tranquilizer, an antidepressant, or reassurance by a conventional healthcare practitioner. A thorough evaluation by a qualified medical and mental health practitioner with skills and expertise in working with anxiety, panic, and mood difficulties is an advised first step when available. Finding caring and valuable help may get at the deeper issues and the roots of anxiety conditions rather than simply suppressing symptoms.

Holistic and natural therapies can be the most effective treatment course when combined with more traditional treatment.

Positive Complementary Approaches for Consideration:

• Lifestyle modifications and life skill enhancements

• Mind, body, and spiritual practices such as yoga; chi gong; mindfulness; meditation; or exercise with mindfulness in running, swimming, biking, or dance; active participation in any creative art endeavors

• Stress management and relaxation techniques

• Acupuncture and massage therapies

• Targeted nutritional therapies, botanical medicine, nutritional education about dietary choices, and micronutrients (as herbs, vitamins, minerals, essential fatty acids, and amino acids)

If natural treatments have not worked, medication may also be of value in resistant or severe emotional or mental health conditions such as anxiety, panic, post-traumatic stress, or significant mood disturbances. Antidepressants, mood stabilizers, or tranquilizers used by conventional medical practitioners can sometimes bring more immediate relief. However, the long-term use is controversial because of the possibility of causing other medical issues. Once in use, trying to stop medication can lead to relapse or, with some tranquilizing drugs or alcohol, can cause withdrawal seizures. Thus, medicines may not have the same lasting effect and benefits as useful therapy programs and natural alternatives.

TIPS:

1. Reduce the time spent watching shows, checking social media, or listening to news stories on your TV, computer, or smartphone when at home or in the workplace during a highly anxious time or when overstimulated. Hearing sensationalized, dramatized news reporting or stories from others repeatedly during the day can lead to increased worry, anxiety, tension, and poor sleep.

2. Instead of too much inactivity, such as passive watching, listening, or obsessing about current worries or events, take frequent time-outs with regular exercise. Active movement includes stretching and eating healthy meals (avoiding sweet binging and over-snacking on high-caloric food or drinks). Enjoy periodic relaxation times with deep breathing, meditation, or yoga. Get adequate restorative rest and sleep.

3. Cut down or stop smoking, vaping, alcohol, and non-prescription drugs, as these adversely affect you.

4. Take more frequent breaks during sitting and work time—stand more, move, or take outside walks.

5. Keep to a regular exercise schedule, such as 30 minutes or 7000 steps per day. Beneficial exercise can take many forms, such as walking, biking, climbing stairs, housework, or an exercise routine with push-ups, lunges, jumping jacks, and running in place. Join an online group exercise program. Do relax, enjoy, and allow any worries and fears to move to the background of your awareness as you fully embrace the physical movement, breathing, and letting go of tension. Get outside and into natural settings. Being in and closer to nature is very calming and healing. Move, breathe, take in the beauty and harmony that abounds around us.

6. Treat yourself to a nice hot bath with two or three cups of Epsom salt and a few drops of essential oils, such as lavender, to melt away any tension and worries.

7. Get involved with enjoyable recreational or artistic activities like art, writing, craftwork, gardening, constructive projects, or volunteer work. Read an inspiring, educational, or fiction book—whichever entertains and relaxes you. Enjoy listening to music, dancing, doing a crossword puzzle, watching a good movie, or a comedy show for some humor and laughs.

8. Stay socially connected with friends, family, and community.

9. Learn yoga, mindfulness practices, meditation, or exercise routines to help with relaxation.

10. During challenging times and travails, take the time to review what is essential and has meaning and purpose for you. Meditate and reflect on what is most important. Witness and let go of fears and self-preoccupation as much as possible. Find some inspirational readings to comfort and inspire you.

11. Allow any crises or stresses to inspire you to live a simpler, more meaningful life, and to serve better the greater good of the community and the environment. Be encouraged to be socially active to bring about positive change. Be more in the moment, breathe, take it all in—including trouble and worry, along with what is comforting, beautiful, and inspiring for you. Focus on all that for which you can be thankful—taking a time-out to refill your reserves, to regain your resilience and strength to move on with purpose, gratitude, and hope.

Find the best path for yourself to move through fear and anxiety. Caring for your mind, emotions, and spirit is essential for purposeful and healthy living. Be constantly aware and get the help you need at the first signs of distress or ill health. Be open to offering service and support to others with emotional difficulties. Take the time for acceptance and compassion for yourself and others as ever-changing feelings, emotionality, insecurities, and vulnerabilities are a reality of daily life.^[4]

I appreciate you and your interest. Please share this article with others or leave comments below.

Be well and do the best you can on your journey of discovery, learning, and healing.
Thanks,

Ron Parks, MD

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ENDNOTES:

Lead-in photo for the article: ©alphaspirit/123rf.com

^[1] Sid’s story is not that of an actual person or family but a fictional composite created from my years of clinical and personal experience to heighten your awareness of the importance of the issues discussed

^[2] The New York Times (updated August 26, 2020). The U.S. surpasses 5 million cases. nytimes.com/2020/08/08/world/coronavirus-updates.html Halverson, J.L., MD (Bienenfeld, D., MD, Chief Editor) (updated August 6, 2020). Depression, Medscape. emedicine.medscape.com/article/286759-overview

^[3] Sharp, J., MD (March 12, 2020). Coping with coronavirus anxiety, Harvard Health Publishing Blog. apa.org/topics/trauma Fader, S. (December 21, 2020). Trauma therapy: What is trauma therapy and how does it work to combat trauma? Better Help. betterhelp.com/advice/trauma/what-is-trauma-therapy-and-how-does-it-work Centers for Disease Control and Prevention (March 19, 2018). Coping with disaster or a traumatic event. emergency.cdc.gov/coping/index.asp

^[4] Yasgur, B.S., LSW (August 12, 2020). Supplement plus probiotic may improve depressive symptoms, Medscape Medical News. medscape.com/viewarticle/935603 Brooks, M. (August 3, 2020).

Depression, anxiety in COVID-19 indicators of CNS attack, Medscape Medical News. medscape.com/viewarticle/935019 172

Centers for Disease Control and Prevention (December 11, 2020). Coping with stress: Pandemics can be stressful. cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Centers for Disease Control and Prevention (September 12, 2019). Taking care of your emotional health. emergency.cdc.gov/coping/selfcare.asp

Centers for Disease Control and Prevention (March 19, 2018). Emergency responders: Tips for taking care of yourself. emergency.cdc.gov/coping/responders.asp