Here’s the understatement of the year: We live in a worrying time. The pandemic, social injustice, civil unrest, and political strife have all combined to make 2020 a year few will forget. Physicians contend with the added burden of the real life-or-death consequences of all of these factors. That’s perhaps why now, more than ever, we need to start taking the mental health of physicians more seriously. Specifically, we’re talking about job-related stress, burnout, and worry. When clinicians say worry, they’re talking about anxiety. The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” According to DSM5, generalized anxiety disorder typically presents as “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).” In adults, diagnosis requires 3 or more of the following symptoms: Restlessness, feeling keyed up or on edge. Being easily fatigued. Difficulty concentrating or mind going blank. Irritability. Muscle tension. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). Luckily, doctors with generalized anxiety disorder have multiple resources they can turn to. There are many effective pharmaceutical options, for example, and/or talk therapy. During the pandemic, talk therapy has embraced telehealth — so there often isn’t a need to venture out. There are even clinically proven interventions that can be done without drugs and without couch sessions. Here are a few. Hiking Your prescription for worry might include a 90-minute nature walk, supported by a 2015 study published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS). Researchers investigated the link between decreased time in nature and increasing levels of urban mental illness. They hypothesized that living in cities may increase “rumination, a maladaptive pattern of self-referential thought that is associated with heightened risk for depression and other mental illnesses.” The PNAS study included 38 participants with no current or past neurologic or psychiatric disorders. Each was assigned a nature walk, or a walk in urban parts of the San Francisco Bay area. Those who went on a nature walk self-reported lower levels of rumination afterward, whereas those who walked in urban areas reported no decrease. The nature-walkers also showed lower neural activity in areas of the brain linked to mental illness risk. “These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world.” Reduce caffeine intake Caffeine has its health benefits, but you can have too much of it. DSM5 even recognizes Caffeine Use Disorder. Caffeine even may be exacerbating your feelings of worry or anxiety. A 2015 Journal of Psychopharmacology study established the stimulant’s anxiety-provoking effect in secondary school children. The study linked increased caffeine intake with increased feelings of anxiety and depression among the children. More than 3,000 children participated in the research, which examined links between diet and school performance, as well as health, stress, anxiety, and depression. Data indicate that weekly caffeine intake was “a significant predictor of anxiety.” “The study also identified very high caffeine intake (>1000 mg/w) to be a risk factor associated with anxiety and depression, although effects were sometimes detected at lower doses,” researchers concluded. Meditation Meditation has been used for centuries for spiritual experiences and cognitive enhancement. But what does the research have to say about the practice and how should physicians counsel their patients on it? A 2014 systematic review published in JAMA Internal Medicine reviewed randomized, placebo-controlled clinical trials through November 2012 in 8 databases, rating evidence strength of each across 4 domains. After filtering through the databases by those criteria, they ended up with 47 trials and about 3,500 participants. They found that mindfulness meditation, when practiced for 8 weeks, showed “moderate evidence of improved anxiety.” Furthermore, no evidence emerged that meditation was any better than drugs, exercise, or behavior therapies. “Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress,” researchers concluded. Exercise Sound body, sound mind. That’s what a 2013 article published in Frontiers in Psychiatry seems to suggest. Those looking to bring feelings of anxiety under control might benefit from regular physical activity. From a physiological standpoint, the article authors point out that regular aerobic exercise lowers sympathetic nervous system activity, as well as hypothalamic-pituitary-adrenal axis reactivity — the dysregulation of which has been commonly implicated in depressive and anxiety symptoms. Exercise also prompts the body to produce endogenous opioids, which may elevate mood and anxiety after exercise. This happens when β-endorphins (endogenous opioids) bind to receptor sites in the brain. From a psychological standpoint, exercise may also help recalibrate the mind and body’s sensitivity to anxiety. “Exposing someone with high anxiety sensitivity to the physiological symptoms they fear, such as rapid heartbeat, in the context of physical exercise increases their tolerance for such symptoms,” the authors wrote. “This exposure reveals that the feared physiological sensations may be uncomfortable, but do not pose a serious threat.” TL;DR Looking for some ways to reduce feelings of worry and anxiety? Go hiking. 90-minute nature walks reduced self-reported rumination. Cut caffeine. Research has shown that increased caffeine intake correlates to increased feelings of anxiety. Mediate. 8 weeks of meditation may cause moderate anxiety reduction. Exercise. You’ll lower sympathetic nervous system activity, produce endogenous opioids, and recalibrate your sensitivity to anxiety. Source
