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Anxiety and the Body

LukeNotes, January 2024

Anxiety disorders are the most common type of mental illness in the United States, affecting 19% of our population, which is about 40 million adults. Anxiety affects men, women, and children in all age groups. There are a variety of possible causes: genetics, loneliness, learned coping patterns, social inequities, traumatic events, and health issues.

Anxiety is “a feeling of worry, dread, unease or panic, typically about an upcoming event or something with an undetermined outcome”. Anxiety is a normal response for many important life moments, like taking a test, giving a performance, traveling, as well as experiences like getting married, childbirth, or loss. It is usually of short duration and does not cause lasting harm. In fact, a short period of anxiety increases our energy, awareness, and focus so we can attend to the difficulty or excitement that we are facing. However, if the symptoms are excessive when compared to the actual problem, if the stressors are non-specific, or if the symptoms are interfering with normal life, a specific clinical diagnosis might be made, such as Generalized Anxiety Disorder, Social Anxiety Disorder, or Obsessive-Compulsive Disorder.

Common treatments for anxiety disorders are medication, individual therapy, and/or group therapy. However, anxiety is more than our worried thoughts and feelings. It affects every system in our body including muscles and joints, blood pressure, breathing, skin, and digestion. Each of us will have our own personal “anxiety fingerprint” based on our genes and our personalities. Much of the time we are not aware of how our thoughts, feelings, and physical sensations are all part of anxiety.

When someone goes to physical therapy, they will describe physical symptoms of pain and discomfort. They often add their mental complaints as well, but rarely realize that they are connected. Common complaints include: “I’ve been really stressed at work lately” or “I’ve had some family issues to deal with and haven’t gotten much sleep.” The physical symptoms they are feeling is rooted in their sympathetic nervous system or “Fight or Flight” response, which is responding to their stress and directing the body to get ready for action. Heart rate, breathing rate, blood pressure, and muscle tension all increase. Our digestive system and certain immune responses slow down to save body energy. When the sympathetic Fight or Flight response is in a state of high arousal, it can cause sleep disruption and inflammation, which can increase muscle and joint pain.

This is the acute phase of a stress response, and hopefully it only lasts for a few days. Unfortunately, some people are in situations of constant stress that keeps their “Fight or Flight” response on high alert and/or they are self-soothing with unhealthy coping behaviors like isolation, poor sleep, alcohol use, or poor diet. This can cause the “Fight or Flight” response to stay activated. If this cycle is not broken, the stress response can become chronic and begin to affect the health of the body.

Most people will have one or two areas of recurring physical stress. The most common complaints include the amount and quality of sleep, muscle or joint tension, and pain (headaches, neck, and lower back pain), digestive issues (constipation, diarrhea, increased food sensitivity, indigestion, gas, and bloating) and cardiopulmonary issues (chest tightness or pain, racing heart, breathing issues like sleep apnea, asthma, and allergy symptoms).

Other physical symptoms relate to how we are attempting to make ourselves feel better. Soothing with alcohol, sugar, and fatty foods and poor motivation to socialize or exercise are all detrimental to good health. A downward spiral of increased systemic inflammation is created, which can lead to someone feeling less healthy and less in control, causing an increase in anxiety. However, there is an antidote. The sympathetic “Fight or Fight” response can be turned off and the parasympathetic system turned on. This is also known as the “Relaxation Response.”

Our Relaxation Response occurs when we are rested, happy, and feel in control of our body and our lives. This content state of mind tells the nervous system that all is well. An example of this would be when someone has a health problem and goes to the doctor’s office, and suddenly all the symptoms are gone. The mere act of having a plan and letting go of the burden to a professional allowed the body to come out of the stress response and into the Relaxation Response. This is also thought to be why placebos or unproven treatments are sometimes just as successful as real treatment. If people believe something will help, they start to relax, and their body starts to heal. This was named “Remembered Wellness” by Dr. Herbert Benson, the father of the relaxation response.

Our ability to tap into the Relaxation Response may be one of the best ways to stay healthy and anxiety-free. By purposefully engaging in activities, behaviors, places, people, food, and rituals that bring peace, joy, and happiness, we are consistently keeping our nervous system in balance. We are alert yet relaxed, also referred to by athletes to as being in “The Zone.”

Dana Dowd PT, M.S., has been the coordinator of physical therapy and fitness at Saint Luke Institute since 1999.

Read the case study which accompanies this article here.