The Three Legs of Anxiety

Have you ever heard of the three legs of anxiety?

Anxiety is not a simple disorder and needs to be treated from a whole system approach.  Anxiety cannot just be treated with cognitive behavioral therapy (CBT) and medication if you want to live a life free of anxiety.

Here is a visual representation of what I’m talking about:

 

Emotional

The Three Legs of Anxiety

Physical                                                                                    Cognitive

Cognitive: This is where CBT comes in.  CBT is a “short-term, goal-oriented psychotherapy that is a hands-on, practical approach to problem-solving. The goal of CBT is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.  CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.”  This is the formal definition.  Where I differ is that with trauma recovery, it is difficult to tell people to change thoughts around some traumas.  For example, the thoughts that come with molestations.  CBT falls short around dealing with emotional problems as they relate to traumas.  Where CBT does come in with traumas is future oriented thinking that includes “what-if” type of thinking.  What-if thinking directly leads to panic attacks.  So, try to eliminate any thought that begins with what-if. Examples of what-if thoughts include – what-if I don’t get that job, what-if the plane crashes, what-if something happens to my kid.

Emotional:  This is all of the emotional work that needs to be done with trauma resolution.  All of the pain is dealt with through different types of therapeutic modalities.  When we resolve the emotional pain around the traumas, the anxiety, PTSD, and depression can ease and, in many cases, resolve entirely.  This process may take some time and a willingness to feel these emotions but is worth doing to have resolution of the trauma and anxiety.

Physical:  Anxiety causes stress on the body and therefore the body will go through chronic stress reactions.  The HPA axis (hypothalamus, pituitary, and adrenal glands) is a system that is responsible for the neuroendocrine adaptation component of the stress response.  The hypothalamus releases corticotropin-releasing hormone (CRF). CRF binds to cell receptors on the pituitary gland causing a release of adrenocorticotropic hormone (ACTH).  ACTH binds to cells on the adrenal cortex and then releases cortisol.  That stress hormone that everyone keeps hearing about.

But why is this bad?

Cortisol lasts for several hours in the body after the body encounters a stressor.  Eventually returning to normal patterns when the stress is eliminated.  With repeated exposure to stressors and with repeated and sustained HPA axis activation this system becomes out of balance and cortisol levels become elevated when they should not be.  Cortisol works in a cyclical nature with melatonin.  Normal levels of cortisol are high in the morning and low at night and melatonin are the opposite with melatonin high in the evening and low in the morning.  High levels of cortisol also cause other hormone disruption including insulin. Insulin resistance is common with abnormal cortisol levels.  In addition, epinephrine and norepinephrine secreted from the adrenal medulla, as well as HPA axis activation persists along with the secretion of CRF, ACTH, and cortisol.  So, it is important to not go into chronic stress patterns that are common with anxiety disorders.

I have so many clients ask me why they have panic attacks in the middle of the night.  They wake up from a deep sleep having an attack while not really thinking of anything.  I call this the “rev-up” cycle.  Once someone has years of panic disorder the body will just rev-up sometimes, and this is why Yoga and meditation are so important in resolution of anxiety disorders. You must teach your body to learn to calm again.

Resolution of anxiety disorder must be worked from all three aspects.  Once that is done living a life free of panic disorder is possible.

Dr. Laura

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