In one of my previous posts I outlined the basic physiology of the stress response. Today I will examine with you a few of the stress responses you may observe in yourself. In addition, we will examine a technique that is tried and true to alleviate these stress responses or symptoms without the use of medication. This empowers you to be in control of your anxiety rather than your anxiety controlling you. And all you have to do is breathe.
Under ordinary resting conditions we all breathe somewhere in the neighborhood of 14-16 times per minute. With each breath we move about 500 milliliters of air in and out of our lungs. This is called the tidal volume. In addition, we have an inspiratory reserve volume which is the amount of air that can be inspired over and beyond the tidal volume. This equals about 3000 milliliters. There is also an expiratory reserve volume that is the amount of air that can be expelled over and beyond the normal tidal expiration and this equals about 1100 milliliters. There is also a residual volume that averages about 1200 milliliters and is the amount of air remaining in the lungs after the most forceful exhalation. The residual volume is not important to our current discussion. Who knew breathing was so technical? What we see is that under normal resting conditions we move only a fraction of the air that we are capable of moving. We utilize this to our clinical advantage.
In addition to breathing even more shallowly than usual under stressful conditions we also will have cold hands and our shoulder muscles will tend to tense and our shoulders "get up around our ears". Remember, all of this happens unconsciously, that is, you don't have to think about it or even be aware of it. However, in order to break up the stress response we will have to consciously think about our breathing. When we do this we will be tapping into our inspiratory reserve volume and our expiratory reserve volume. This sets off a cascade of physiologic responses that range from warming up those cold hands, relaxing the shoulder muscles, increasing a sense of calmness and decreased anxiety (possibly through the increase in GABA, an inhibitory neurotransmitter in the brain targeted by medication such as Xanax, Klonopin, and Valium), a reduction in resting heart rate, and perhaps even a decrease in inflammatory mediators.
There two things you have to do and one thing you have to not do to have this work.
First, is the posture. Sit in a chair with your back against the chair back and your feet flat on the floor. Align you shoulders square but loosely over your pelvis so you are "sitting straight" but relaxed. Second, you will breathe. Clasp your hands loosely at the bottom of your belly and breathe in, expanding your belly as far as you can, to the count of five. At the end of the inspiration take a brief pause, a beat or two, and then slowly exhale to the count of six. You will want to work your way up to the therapeutic dose of about 20 minuets per day. This will take time. Don't despair if it takes you weeks or months to get to this goal. You do not have to do the 20 minutes all in one sitting. When you get really good at this you will be breathing only about 5 times per minute but moving a much greater tidal volume.
As you do this exercise you will notice a few other things. One thing is that those cold hands will become warm. In fact your whole body may become so warm that you may actually start sweating. Another thing you will notice is that many thoughts will come pouring into or rather out of your head. This brings us to the third thing you must learn to do,or rather not do, do not dwell on these thoughts but let them go. View them as passengers on a passing train, recognize them and wave them on but do not dwell on them. In order to distract ourselves from these thoughts (the cognitive part of this exercise is to flush out our minds not clutter them more) people will use various mantras or repeated short phrases. Simply counting your breath in and out is a simple and easy way to do this, especially as you start the practice. I spent time meditating with a Jesuit monk and one technique he used was to say the Lord's prayer in rhythm with his breathing.
Practice this technique each day. Then when you get into a stressful situation you will be surprised that you can adjust your posture and take a few breaths and markedly reduce your tension and anxiety. Just remember, as one of my patients said, "the time you need it most is when it is the hardest to do".
The conversation usually starts with some variation of, "you'll probably be mad at me, but I was reading on the internet...." No, I will not be mad at you for researching your illness and treatment. Informed consent is the bedrock of medical practice and well informed is better than not informed. However, not all information on the web is created equally. This raises the question for both me and my patients: How do we separate the "good" from the "bad" websites? First, the blogs (other than this one, of course) are on the whole unreliable. Many true stories there but there is also the great risk of bias and idiosyncrasy. There is a tenet in scientific research the one may make inferences about the specific from the general but not about the general from the specific. On the blogs there is not the depth of research, no context, and the discernment used to reach the current state about which one is blogging. Second, the Medical Library Association has compiled an excellent list of reliable websites on which have free public access on which anyone may research any medical topic. Some of the websites I have on my ipad home screen and utilize regularly, e.g., PubMed and Medscape. This list can be found utilizing the search words, "2015 CAPHIS Top 100 List Health Websites You Can Trust"
I will not review all these websites at this time but mention a few highlights. On the medication front the authors have included numerous reliable sources of information including the FDA Drugs Page, LactMed (for nursing mothers), and Medicine Safety: A Toolkit for Families. Much happens with medication that is out of the physician's and pharmacist's control. Once the medication is prescribed and dispensed then the patient takes responsibility for administration, storage, disposal, monitoring effects and side effects, and interactions with other medications that may be clinically noticeable to the patient and/or family. Well informed assessment of these between physician visits will help you receive much better informed recommendations from your physician. In a time of rapidly rising drug prices many patients will require financial assistance in medication purchasing. The list includes Needy Meds, a clearinghouse for various assistance programs.
The lists also includes several reliable sites for general and specific medical information. These include the CDC, The Cleveland Clinic Health Information Center, The Mayo Clinic, MedlinePlus, and Merck Manual Home Edition. These are all useful and reliable.
The list also contains the link to the National Alliance on Mental Illness. This site has valid and reliable information on many psychiatric disorders, treatment and support. The list also gives the link to The American Academy of Child and Adolescent Psychiatry--Resources for Families.
An informative website that exposes health related "frauds, myths, fads, and fallacies" can be found at quackwatch.com.
Many other websites are given that may be of value to you given your specific health concerns. Please take notes and we will discuss any questions that may arise.