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The Promise of Tranquility
Why Anxiety Hurts, and How You Can Fix It
IM HAVING round two of PTSD. I havent slept in seven months!
Meeting me for the first time, Catherine slumped in her chair with fatigue, yet her body was so tense and restless that she could not stop moving. What bothered her most was the ceaseless movement of her mind, so locked in activity that it allowed her no rest, not even in sleep. Ive tried everything Ive been told to do, and nothing has worked. Im afraid Ill never come out of this. Is there any hope for me?
Catherines life had been entirely halted by anxiety. Nine years earlier, she had experienced a similar episode that left her paralyzed by fear. Then, too, she couldnt sleep well for months. She found sleeping medications to be helpful at that time. But now, reeling from her diagnosis of cancer just seven months ago, nothing was helping. She had tried half a dozen medications, yet slept only three to four hours per night. She could not turn off the cascade of fear, and despite trips to a sleep center and several doctors, she had lost any hope of improvement.
I know it seems like it will never end, I told her, but this is only temporary. I explained to Catherine that she was actually a very resilient person who normally enjoyed good health. Her fear switch was just locked in the on position right now, and it was keeping her stress hormones so high that she couldnt sleep. We need to find some things to calm that down, and to get you sleeping again, I reassured her. If you can get some sleep, Im confident that youll feel a whole lot better within a few days. Then we can look at ways to keep this from happening again.
And it was true. This bout with anxiety started when she learned that she had cancer, but the cancer was successfully treated and her prognosis was good. Its entirely normal to feel scared when one gets such a diagnosis, but for some reason her body and mind were unable to shut down that automatic stress reaction as they should have. And since she couldnt sleep, there was very little chance that they would do so.
I told Catherine to take a combination of supplements that I thought would calm her nervous system and help her sleep. I believed this to be the key to turning things around for her. She began using B vitamins, magnesium, and 5-HTP twice daily, along with tryptophan and a melatonin complex at night. Sure enough, within five days she clearly began to feel better. Its amazing, the calming feeling these supplements give me. And the antianxiety medications I used before did nothing! she told me, smiling for the first time since I had met her. Her sleep improved quickly and, as I expected, this allowed her mind to calm and her body to relax. The fear switch became unstuck, her stress hormones could return to normal, and she was able to turn her attention to getting her life back on track.
As so often happens, Catherines entire life had been derailed by anxietynot just once but twice. After her cancer diagnosis she had quit her job, left a community and lifestyle that she loved, and moved back in with her parents, who could help care for her. Though she was grateful to have her parents support, she found herself socially isolated, as do so many who live with strong anxiety. She also feared that this spiral of anxiety would happen to her again. What could she do to prevent the cycle from starting all over again?
She decided to enter the Resilience Training Program. I started this program because our usual ways of treating anxiety and mood problems are so often insufficient. People like Catherine are frustrated with medications, want to learn things they can do for themselves, and desperately want to know how to prevent their debilitating bouts of anxiety from coming back again and again. They are looking for relief and are not finding it in the usual places. Resilience Training is a proven eight-week program that incorporates the latest science on diet, exercise, and nutritional supplements along with the best emotional self-care availablewhat I call the psychology of mindfulness. Resilience Training is a step-by-step training in mental calmness and emotional wisdom, designed to help patients recover from and prevent relapse of anxiety, depression, and similar stress related problems. It has been effective even when medications are notand in fact, many of my patients find they dont need to use traditional prescription antianxiety medication at all. In The Chemistry of Calm, I outline my entire approach to stress and anxiety problems, working with body and mind, heart and soul. We humans are complex beings, integrated and whole. When dealing with something as far-reaching as stress and anxiety can be, we need solutions that are as integrated and whole as we are.
Fear, worry, stress, and compulsivity, the unpleasant and unproductive states known collectively as anxiety, are even more common than depression. And anxiety states are increasingly frequent, especially in recent times. Like depression, the effects of anxiety extend beyond the body and mind to the entire being, affecting not only ones sense of well-being but also health, longevity, work productivity, relationshipsthe entire human condition.
As I explained to Catherine, fear itself is a normal, necessary part of being human. Like pain, it is a useful, even indispensable signal that there is something in our environment that is threatening or simply needs our attention. The problem comes when something goes awry in an otherwise normal processwhen the reaction becomes excessive or unyielding. Parts of the body-mind turn off, while other areas get locked in the on position, unable to shut down even after the threat, if there ever was one, is long past. Catherine, for example, had a real scare with her cancer diagnosis. But it was a curable form of cancer that left her at no greater risk than anyone else. The problem was that she could not turn off her fear response.
Genetics plays a role in determining who gets an anxiety disorder, what type it is (e.g., worry, compulsive anxiety, or avoidant anxiety), and its severity. Genetic variability evolves over many millennia, yet we know that the rates of anxiety disorders have skyrocketed in just the last century, not to mention the last decade. I believe this has to do partly with changes in lifestyle, diet, sleep and work patterns, and especially our relationship with stress. Our world is unquestionably complex and in some ways intimidating. Much of the problem, though, lies not with how things have changed outside of us but with our lack of a skillful means for dealing with a challenging world. Catherine, for example, could have spared herself a great deal of suffering if shed had the ability to fully face the sense of vulnerability that washed over her during her first brush with anxiety nine years earlier. Instead, it lodged in her body, ready to pounce again when faced with another overwhelming stress.
The Chemistry of Calm outlines a clear, holistic program for coping with fear and anxiety in much the same way my first book, The Chemistry of Joy, offered steps for overcoming depression. This book focuses on ways to create innate health and resilience as a key to resolving anxiety in everyday lifefrom the ordinary to the extreme. My goal is to help you understand fear and anxiety through a holistic lens and learn practical, integrative solutions that draw from new science, effective self-care, and solid spiritual practices. As I hear from so many of my patients: I dont want to rely on medication for the rest of my life. I just want to know what I can do for myself! This book is meant to give you just thateffective things that you can do for yourself to reclaim the resilience that is your birthright.
The Age of Anxiety
In just a few decades, dramatic changes have occurred in our relationship to stress. There are many illnesses that are now associated with stressand they have become epidemic in scope.
The issue is not that life is so much more stressful now than ever beforea brief look at history may convince us otherwise. Imagine, for example, how stressful it was in times past to routinely lose children to illness; to truly not know whether you and your family would survive the winter; to endure plague, the Civil War, or the Great Depression. But while life has always been stressful, there is something different about how it affects us today, or perhaps how we respond to it.
Likewise, anxiety and its various disorders are nothing new. The ancient Greeks, for example, described agoraphobia (literally fear of the marketplace) even in their day, when some had such severe anxiety that they could not leave their homes. Yet the scientific evidence reinforces our perceptions that modern life is stressful in different ways than before, that anxiety disorders are on the rise, and that other chronic illnesses have become entwined with the stress response. The phrase the age of anxiety has been used before, but perhaps never more aptly than now.
Anxiety disorders are easily the most common mental illnesses, affecting nearly one in five adult Americans in any given year and 30 percent of people in the United States at some point in their lives.1 Thats more than forty million people per year who have a diagnosable anxiety conditionnot to mention those whose suffering doesnt quite cross the threshold into illness. Anxiety disorders are estimated to cost the economy over $50 billion per year, mostly from lost productivity.2 Other consequences include an increased rate of heart disease, suicide, or death by other physical causes.3
At the same time, we have witnessed in the Western world an explosion of other chronic diseases that apparently are affected by the stress response. Heart disease, Alzheimers, chronic fatigue, high blood pressure, asthma, immune system diseases, and even cancer are linked to unhealthy levels of stress and the stress hormones. This problem is highlighted in a recent report by the Greater Boston Physicians for Social Responsibility and Science and Environmental Health Network. Titled Environmental Threats to Healthy Aging, the report notes that while we live longer today than ever before, we are at increasing risk of developing neurodegenerative diseases. The report refers to the Western disease cluster (diabetes, obesity, hypertension, elevated blood lipids, and metabolic syndrome) as factors in the development and progression of various brain disorders.4
Its Not All in Your Head
I dont see the mind, body, and spirit as separate thingsthey are just different reflections of a unified whole. But too often we focus on one and forget the others. The physical and emotional conditions of stress and anxiety have become the scourges of modern life, and they create a huge amount of suffering. What you do to relieve these in the mind also helps the body and spiritand vice versa. Lets take a closer look at some of the different aspects of the stress/fear cycle, all of which we will address in the Resilience Training Program.
The Adrenal/Stress Response
The adrenal/stress response is the key to whether or not fear makes us sick. It is not that stress itself is bad. Studies show that short-term stress can even be good for us. But as the military has discovered, if the amount of stress is great enough, anyone can be broken down by it. Most of us, of course, dont experience severe stress in our day-to-day lives. But if your daily life is filled with constant, unremitting stressif stress is ever present, like background noiseit can be destructive. Still, what determines how well you survive chronic stress is how you react to it and whether you are able to shut it down. Throughout this book you will learn how to protect your body from the corrosive effects of stress.
Brain on Fire: The Destructive Effects of Inflammation
Inflammation is supposed to be one of the ways by which the body protects itself. The redness and swelling that you see with an infection of the skin, for example, are signs that the immune system is doing its job, rallying the troops to the area to fight off the infection. Or if you injure your ankle, it too becomes red and swollen as extra blood and repair cells flow to the area to begin the process of healing.
But your own immune system can turn against you and become the very cause of the damage. Asthma is one example of this; rheumatoid arthritis is another. For reasons that may include genetics, environmental factors, or diet, the immune system is overreacting. Excessive inflammation of the airways causes them to swell and constrict, resulting in difficult breathing for the asthmatic. In rheumatoid arthritis, the joint itself is damaged because of the overdone inflammation response.
Yet there is an even more insidious side to inflammation. When it becomes systemicthat is, when it affects the whole bodythen it causes strain on cells everywhere. And usually we dont even know itit is silent. In recent years, systemic inflammation has been linked to a number of problems, including diabetes, cancer, Alzheimers, Parkinsons, and heart disease.
I address inflammation in the Resilience Training Program because I think that if something is bad for the rest of the body, it is also bad for the brain. Systemic inflammation affects the whole body, after all, and it also puts a strain on brain cells. Indeed, many of my patients show signs of inflammation, and when they take measures to calm it, they also calm their anxiety and improve their mood. The reverse is also truewhen they calm their mind through meditation and awareness practices, the stress response can shut down and so can their inflammation.
Starving in a World of Excess:
Insulin Resistance and Metabolic Syndrome
Most of us in the developed world get an adequate (or excessive) amount of food each day. But from the point of view of the individual cells, there may be a serious lack of what is needed for the cells to do their all-important work. That lack can cause poor communication with other cells, low energy, lack of mental focus, and the inability to shut down the stress response.
There is a spectrum of problems caused by insulin resistance, from very mild trouble processing blood sugar (or blood glucose) to full-blown diabetes requiring the medication insulin. If the mild problems are not heeded and the condition progresses, it may evolve into metabolic syndrome, also known as pre-diabetes. This member of the Western disease cluster includes high blood pressure, elevated triglycerides, low HDL cholesterol, and inflammation.5 It is often evidenced by an increase in belly fat. If the condition is not reversed, it can begin to cause lasting damage to the heart and nervous system. But for most people, it can be reversed.
The frequency of these problems has exploded in recent years, along with the rise in obesity. They are most likely caused by changes in dieteating too much sugar or other highly refined carbohydratescompounded by lack of physical activity. But what does this have to do with anxiety?
Anxiety, depression, and insomnia have all been associated with production of excess insulin.6 The body produces more insulin when cells lose their ability to use the message that insulin gives them. This insulin resistance elevates inflammation and stress hormones.7 In addition, excess insulin deprives the brain of its steady supply of glucose for fuel, so it sends off a strong alarm signal, further heightening the state of stress or anxiety.
But Some of It Is in the Mind
We need to address problems occurring in the physical body because they so strongly impact the brains ability to function well. But we still have to recognize the central importance of the thinking mind, especially in creating stress and anxiety. As Robert Sapolsky, a noted author and stress expert puts it, zebras dont get ulcersthey dont suffer from chronic stress.
But people do, and there are myriad problems associated with long-term stress. Why are we humans so susceptible to stress? Sapolsky says it is because weve evolved to be smart enough to make ourselves sick.8 Since our most obvious survival needs are taken care of, we have too much time on our handstime to turn that intelligent mind against ourselves. In other words, we think, therefore we are stressed.
The Second Arrow
Buddhist psychology would agree with this. In the Buddhist view of the mind, we inadvertently harm ourselves through our own thinking. Buddhists use a battlefield image to describe this. A soldier may be injured in the course of battle, hit by an arrow. That is the risk of being a soldier. Likewise, we will inevitably experience pain or distress in the course of our lives. That is known as the first arrow, and it is largely unavoidable. If were in the game, so to speak, we run the risk of injury.
But imagine that same soldier taking a second arrow and shooting himself with it. Of course that wouldnt happenyet that is just what we do when the thinking mind kicks into gear and we turn the seed of fear into something much larger through worry, regret, rumination, and the like. This is precisely what happened to Catherine. She began to thinkand thats when her real trouble began.
We do not create such troublesome thoughts intentionally. No one really wants to suffer more. We arent aware that we are doing this to ourselves and we dont know how to stop it. But we can become conscious and skilled at breaking out of this cycle, as hundreds of people have learned through the Resilience Training Program, and as you will learn to do, too.
Mind on Fire: The Destructive Potential of Mental Storms
Weve all had themtimes when our thinking takes off down dark alleys and we seem unable to stop it. We all know, from personal experience, that once the brain circuitry heats up, it becomes more intense and unpleasantand increasingly hard to stop. And the storm tends to spread. Soon it is no longer confined to our thoughts. The emotions get involved, and then the rest of the body starts reacting and reinforcing the whole mess.
But while it may seem like we have little control over it, we can actually develop skills that help us to find a calm port in the storm. We can learn to steady the mind and work with the emotions so that they have less destructive force behind them. We cant completely avoid the storms, any more than we can avoid pain or stress. But there is a lot we can learn to do to soften their effects and to hold ourselves steady until the storm passes.
The Constricted Heart: The Tragic Result of Trauma and Fear
What do we do when we feel threatened or, worse yet, become traumatized? We protect ourselves automatically, doing whatever it takes. Very often that involves shutting ourselves down in some way, closing ourselves off from anything that might cause further fear or pain. That might not be such a bad strategy if we knew how to open up again when the threat was gone. But for various reasons, we dont. The emotional heart hardens, shrinks back, or becomes dulledanything not to feel the pain or to be consumed by fear.
There is plenty to feel threatened by in this world. In the past few years, we have witnessed troubled children shooting other children in our schools, fanatical men flying jets into buildings, innocent lives torn apart by war not of their own making, vast economies crumbling under the weight of unchecked greed, soldiers coming home carrying the psychic wounds of war, and women and children the world over suffering the effects of abuse and neglect. What sane person would not feel anxious, stressed, or fearful? Why would you not want to close yourself off from this? What else can we do with these and the other, more personal tragedies that befall us every day?
It is interesting that the word courage comes from the Latin root cor, meaning heart. To have courage is to take heart or, one might say, to reclaim the heart. This may sound vague or soft, yet I find the mindfulness practices that I call cultivating a good heart to be among the most powerful, life-giving, and courageous acts I know. To live with some measure of acceptance, gratitude, forgiveness, and generosity, to find a level of openness and equanimity in the face of such fearful thingsthese are acts of great courage. And it is good medicine, toowe feel better when we live with a more open heart.
Isolation: We Are Not Meant for This
Simply put, we are not built for lives of separation. In my view, feeling disconnected is the number one reason for a loss of vitality, for living a sort of shadow life. And when I think of connection, I look at it in a very broad sense. Yes, it is important to have friends and ties to family and community. But there is also the connection with nature, which can be so life-giving. There is the relationship with ourselves, at all levelscaring enough about our body that we take care of it, accepting ourselves even with all of our past mistakes and present flaws, giving some time and attention to our inner lives. When we do that, we realize that we long for connection to something larger than ourselvesmeaning, purpose, a relationship with the Divine.
Opening ourselves to these and other connections transforms the dynamic of self-care. These are the things that not only keep us afloatthey make us bigger than ourselves. Meaningful connection enlarges our lives.
How to Use This Book
I wish it were otherwise, but millions and millions of people are in a state of depletion today. The Chemistry of Calm is intended as a guide to reclaiming your resilience, to moving from a state of stress, anxiety, or fear to a place of calm, balance, and equanimity. I will show you how to calm the fires of an overactive brain, endocrine system, or immune system. You will learn how to become skilled at working with your own thoughts and feelings so that they are once again allies, and not enemies, in your quest to live a more balanced and serene life. And you are also invited to go beyond good self-care, to begin a process of transformation and to claim for yourself the rich, vital, and courageous life that you long for.
The basis of The Chemistry of Calm is the Resilience Training Program. The program consists of seven steps, what I call the seven Roots of Resilience. In Part One, steps 13, we will focus on the physical body (including the brain) with lifestyle measures and integrative medical therapies. In Part Two, steps 47, we will turn to the inner aspects of resilience, to help you deal with difficult emotional states such as fear and anxiety.
The Roots of Resilience
- 1. Balance your brain chemistry. In chapters 4 and 5, youll learn about proper diet, supplements, and even medications when needed.
- 2. Manage your energy. In chapter 6, youll learn how exercise and moving your body can actually create more energy and better mental health.
- 3. Align yourself with nature. In chapter 7, youll learn how to calm your sleep patterns and recharge your mind.
- 4. Quiet your mind.chapter 8 describes the core practices of mindfulness: awareness of breathing and awareness of thought.
- 5. Face your emotions. In chapter 9 you will learn how to remain steady even if overcome by a mental storm.
- 6. Cultivate a good heart. In chapter 10, youll focus on opening your heartcultivating self-acceptance, loving-kindness, generosity, and gratitude.
- 7. Create deep connections. In chapter 11, youll contemplate the importance of connecting with othersdeveloping a sense of belonging in the larger world.
Part Three gives more detailed background and the scientific underpinnings for the program. This final part of the book focuses on the clinical and scientific aspects of anxiety, including groundbreaking new research that gives hope and inspiration to all who suffer from stress and anxiety.
The suggestions in this book offer a promise that is both authentic and attainable. Over and over again we see people in our program leave behind a lifetime of struggle to find a degree of equanimity and fullness in their lives that they had not dreamed possible. Resilience is indeed within your reach.
Are You Ready?
We know from research on changing healthy behaviors that there is a wide spectrum of readinessranging from not yet ready at all to having already made the changes and simply needing to maintain them. And there is every gradation in between. Wherever you fall on that spectrum, I would encourage you to honestly accept that and be okay with it. There is no right way to do this programor, for that matter, to live ones life. And I believe that there is something in this book for anyone who wants to live a life of greater freedom, fullness, and vitality.
If you are just thinking about it, you may want to start with Part Three to gather more background and understanding. Perhaps you will be informed and inspired enough to shift yourself a bit further toward taking action. If you are ready to make changes but not too sure about your level of commitment, you may want to read chapter 12 to help increase your sense of hope and derive more motivation from that. Then you can return to the program in Parts One and Two.
Some elements of building a foundation are relatively easy to do (such as sleeping more and taking supplements), and others require more committed focus (such as changing diet and exercising). I will provide a full spectrum of healthy options, from simple things you can begin today to profound practices that you can do for a lifetime. Start wherever you can, and build from there.
It is important to begin where you feel the most energy or have the greatest need. You can always go back to earlier sections later onyou will always want to have a firm physical foundation, after all. But whenever you are ready for a process of inner transformation, you may move on to Part Two. There you can learn to tame your mind and emotions and grow more and more fully into yourself.
2010 Henry Emmons
