Sincerely,

Dr. Tina Lepage

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Your Body and Anxiety

Historically, humans survived in a hostile and dangerous environment by remaining alert to life threatening situations. Anxiety in response to a true threat is what we call fear; and it can be life saving. Anxiety in response to day-to-day challenges can also be helpful in improving performance. The hormones released in response to stress are powerful stimulants and can arouse the senses to function at their keenest. When an athlete or actor or speaker anticipates a performance, these stress hormones can help them be alert and function at optimum levels. But, anxiety in response to day-to-day challenge stress can also be harmful. When a person is unable to sleep, or work, or travel due to their response to stress, things have gone awry. Problems arise when the responses to stress are greater than necessary or occur more frequently than actually needed. Over time, the heightened arousal can negatively impact heart function, digestion, metabolism, respiration, immune system, and a person's ability to function.

Current researchers are finding that the biology of fear and anxiety responses are similar, but different. The fight, flight or freeze response of fear involves a cascade of actions in the hypothalamus-pituitary-adrenal (HPA) axis. The result of these actions is the release of powerful hormones into the bloodstream. Cortisol is one of the most critical of these hormones and it is the agent of damage when present in large amounts or over extended periods of time. Once a threat has passed, the body seeks to return to its pre-fearful state. Anxiety, like fear is a powerful response to stress. But with anxiety, the body fails to turn off the stress response when the threat is no longer present. The result is a state of chronic, high alert.

Fear and anxiety are not something to be eliminated from our lives; they have served and continue to serve a valuable protective purpose. But, a response to stress that unnecessarily keeps our bodies in the fight, flight or freeze response must be managed or personal functioning and well-being will be undermined. Today, extreme anxiety can be temporarily managed with drugs that relieve some immediate symptoms, but carry the risk of addiction. New research offers the promise of medications that are more targeted and pose fewer risks. Techniques such as cognitive behavioral therapy (CBT) can help anxious individuals learn to become less anxious by changing how threats are perceived and learning new ways to cope. There is also hope that new developments will lead to earlier detection of anxiety prone individuals so that anxiety treatment can be preventive rather than reactive.

Exercise and Mood  

There is now more evidence than ever supporting the mental health benefits of exercise. A significant link exists between exercise and mood, with the effects of physical activity extending to both the short and long-term. For example, in the short-term going for a run after a stressful day can improve one's mood immediately. In the long-term, there is epidemiological research that suggests people who are active are less depressed than those who are inactive. Further, these data illustrate people who stop being active tend to be more depressed that those who maintain or begin a program of physical activity. When it comes to mood enhancement, exercise is not only a preventative measure, but recent experimental studies (e.g., Blumenthal, 2007) have shown exercise is equally as effective as anti-depressants in treating major depressive disorder and possibly more effective in preventing relapse (Blumenthal, 2010).  

There is also growing evidence to suggest exercise can be helpful in treating anxiety. Anxiety is an experience triggered by activation of the nervous system, which results in physical sensations such as sweating, increased or racing heart rate, and dizziness. Individuals who have a heightened sensitivity to these sensations often respond with fear. Researchers have found exercise can mimic exposure treatment by exposing individuals to anxiety sensations and then associating them with safety (Smits & Otto, 2008). Additionally, activity level has been shown to correlate negatively with likelihood of panic attacks in people who have high anxiety sensitivity.

Researchers are still uncertain about how much and what types of exercise are most beneficial in treating mental health issues. Preliminary research suggests higher dose exercise protocols appear to have the greatest benefit, but family mental health history and gender appear to be moderating variables. Further, aerobic activities have been the focus of most studies in this area. The potential benefits of weight training and mind-body endeavors such as yoga have yet to be fully explored. The mechanism by which exercise exerts its effect on mental health is also still unclear. There are some who suspect exercise works to alleviate depression by increasing serotonin levels (a similar mechanism to antidepressants) and brain-derived neurotrophic factor, or BDNF (a protein related to nerve growth). Another hypothesis is exercise helps to normalize sleep patterns, thereby providing a protective service for the brain. Alternatively, exercise may improve mood as an individual may subjectively feel they have returned to meaningful activity. Most likely, there are multiple mechanisms by which exercise positively affects mental health.  

The most perplexing question, however, is likely why is starting to exercise so difficult, given its various benefits? One potential reason is the tendency to start an exercise session too intensely, which tends to delay its related mood boost. Additionally, many people associate exercise with losing weight or other health-related goals. Often, these goals are long-term endeavors and do not provide the immediate reinforcement needed to maintain the activity. Experts recommend starting an exercise program and individual exercise sessions slowly. In addition, it is recommended one focus on their mental state after exercise (as opposed to long-term goals such as weight loss), which can provide immediate gratification. Further, choosing to not exercise when feeling down prevents one from noticing just how powerful an effect it can have on mood. Experts in this area say skipping a workout at these times is analogous to not taking an aspirin when you have a headache.

Even with so many unanswered questions, it is clear exercise has many benefits, including enhancing one's mental health. Psychologists are experts on behavioral change and can work with clients to begin and maintain an exercise program. Dr. LaFrazza has a unique expertise in working with individuals of all ages and activity levels on incorporating exercise into their wellness regiment, even within the busiest of schedules. Further, Lepage Associates offers outdoor walking trails, which can serve as a vehicle through which physical activity can easily be incorporated into talk therapy.

References:

Blumenthal. J., Exercise and pharmacotherapy in the treatment of major depressive disorder (2007). Psychosomatic Medicine 69:587-596 (2007)