Post on 08-Dec-2021
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Sarah Weaver MSN, FNP-C, HN-BC, IFMCP-Candidate
AHNA National Conference June 2019
CENTERING AND SETTING INTENTION
� •Pause for a moment. Pick a focal point
� •Set aside any concerns regarding the past or the future.
� •These can be picked up later.
� •Gently close your eyes.
� •Breathe deeply and slowly.
� •Set an intention for the situation
� •Breathe mindfully, scan your body for tension and release
� • When needing to be connected with that feeling of love and compassion repeat again, “I am present to the moment.”
OBJECTIVES
�Understand
types of
anxiety and
how it
manifests in
our lives
�Anatomy of
anxiety and
risk factors�Root causes
of anxiety
�Holistic
interventions
ANXIETY IS COMMON
AND
UNTREATED
� 18.1% of adults
have an anxiety
disorder
� Only 36.9% of
those with a
disorder seek
treatment
https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml/index.shtml
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Types of Anxiety
• Acute anxiety is often related to
overwhelming circumstances.
• Chronic
� Generalized anxiety disorder (GAD)
� Obsessive Compulsive
� Panic
� Post-Traumatic
� Social Phobia
National Institutes of Health, 2014
HERE’S WHAT HAPPENS WITH
ACUTE ANXIETY…
� Insomnia
� Irritability
� Withdrawal
� Fatigue
� Nervousness
� Restlessness
� Trouble concentrating
� Muscle tension
� Headaches
� Lasts less than 6 months
CHRONIC
ANXIETY
LOOKS A LITTLE
DIFFERENT…
� Associated with
many mental health issues
� Generalized ill health
� Obsessive/repetitive thoughts and behaviors
� Trouble in
school/work
� Social withdrawal
� Substance abuse
� Depressive/suicidal thoughts
Panic Attacks
• Happens with acute or chronic
• Sense of danger or doom
• Trembling, dizziness, weakness
• Shortness of breath
• Excessive perspiration
• Numbness or tingling in the hands
• Rapid heartbeat, palpitations
• Chest pain
• Rapid breathing, hyperventilating
• Feeling cold or overheated
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Risk factors…
• Usually begins by middle age
• Women are 60% more
likely to develop
• Low self-esteem
• Illness and disease is rated as the “most stressful” life event
• White
• Lower educational attainment
• ACEs
• Parental loss
• Sexual abuse
RISK FACTORS FOR ANXIETY DISORDERS: COMMON AND SPECIFIC EFFECTS IN A NATIONAL SAMPLE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147018/
Functional Medicine Perspective
Institute for Functional Medicine, 2018
The Brain and Anxiety
http://anatomystructure.net/the-anatomy-of-anxiety-diagram/
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FEED YOUR BRAIN � Keep your blood sugar steady
� Water- your brain is made of ¾
water
� Healthy fats- cold water fish,
nuts, avocado, coconut, olive
oil, flax
� Antioxidants- at least 5 cups of
non-starchy vegetables a day
� Anti inflammatory- curcumin,
omega fatty acids
� Eat foods rich in B-vitamins (nuts, seeds, dark green vegetables,
legumes, animal protein,
brewer’s yeast)
� Trial a caffeine wean
Strasser B, Gostner JM, Fuchs D. Mood, food and cognition: role of tryptophan and serotonin. Current Opinions in Clinical Nutrition & Metabolic Care: January 2016;19(1):55-61.
Grosso G, Pajak A, Marventano S. Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLOS One. May 7 2014; http://dx.doi.org/10.1371/journal.pone.0096905
Benton D and Young HA. A meta-analysis of the relationship between brain dopamine receptors and obesity: a matter of changes in behavior rather than food addiction? International Journal of Obesity. 2016;40:S12-S21.
https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamins/vitamin-b/
Creating a Healing Environment
• Think about stimulation- is
there too much or too little?
• Do you have electronics free zone in your life?
• How does it smell?
• Sunlight?
• Noise?
• Clutter?
• Respite Rooms
• Hygge
Effectiveness of Therapeutic Massage for Generalized Anxiety Disorder: A Randomized Controlled Trial: http://psycnet.apa.org/buy/2003-11000-001
CHECK IN
WITH YOURSELF� What do I need right now?
� Sleep
� Hydrate and eat
� Respite room/ A walk outside as a way to calm down and process
� Give yourself permission to do self-care
� Are you empathic?
� Plug into a support system
� Self-massage
� Yoga
� Visit a spiritual place
Marsh, A. (2016). Neural, cognitive, and evolutionary foundations of human altruism. Wiley Interdisciplinary Reviews: Cognitive Science, 7(1), 59-71.
ARE YOU PRACTICING PLAY AND LAUGHTER DAILY?
� Simulated laughter vs spontaneous
laughter
� May improve cortisol,
neurotransmitters, immune system
and inflammation response
� Significant differences in perceived
stress, psychological stress response,
fasting blood sugar, interleukin-6, and
tumor necrosis factor alpha between
the two groups after laughter program
Effect of laughter yoga on salivary cortisol and dehydroepiandrosterone among healthy university students: A randomized controlled trial: https://doi.org/10.1016/j.ctcp.2018.04.005
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Guided Imagery
• Start with eyes closed, breath even
and deep, any comfortable position
• Pleasant
• Imagine being in a calm environment
• i.e., natural setting, fond memory, secure place
• i.e., real or imagined
• Physiologically focused
• Imagine a biologic function
• i.e., WBC eating infected cells, tumor shriveling like a
balloon, circulation coursing through body
• Mental rehearsal/reframe
• Imagine an accomplishment or a
better outcome of current situation
• i.e., see yourself winning a race, hear applause, see yourself calm and smiling talking to a difficult person
• Receptive
• Do a body scan
• i.e., focus on area of pain and imagine it relaxing, warming,
cooling
A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy: https://www.hindawi.com/journals/ecam/2015/270876/abs/
The effects of guided imagery on state and trait anxiety and sleep quality among patients receiving hemodialysis: A randomized controlled trial: https://www.sciencedirect.com/science/article/pii/S0965229918300621
MUSIC
� Music therapy has been
shown to effect NA,
ACTH, IL-6, leptin and
cortisol levels
� Choose music that suits
the patient – it doesn’t
always need to be
instrumental. Try rock,
gospel or oldies
� Meta-analysis shows
music decreases the use
anxiety, pain,
� Care channel, Healing
Arts programs, playing
your instrument
STAND LIKE WONDER WOMAN
� Amy Cuddy,
Harvard Professor
and Social
Psychologist found
that “Power Posing”
for 2 minutes will:
� Decrease Cortisol
by 25%
� Increase
Testosterone by 20%
AFFIRMATION
• A repetitive verbal instrument to produce something in one’s mind, can be considered a form of meditation or prayer. Examples of mantra:
• I am breathing in love and breathing out peace
• I love myself deeply and unconditionally
• It is what it is
• I have compassion for myself and others
Attributions and affirmations for overcoming anxiety and depression: https://www.ncbi.nlm.nih.gov/pubmed/19091166Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814782/
Self-affirmation Reduces Stress and Improves Problem-solving: https://www.healthline.com/health-news/mental-self-affirmation-decreases-stress-increases-problem-solving-050113
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Breathe
• Acts like a natural tranquilizer
• Free and always with you!
• Simple awareness is all that is needed
Relaxation techniques: Breath control helps quell errant stress response: https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-
errant-stress-responseThe Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769199/
Cloud Breathing• Take a moment and focus all of your attention on your
breathing
• Visualize the air you are breathing in as fresh, pure and
energizing air, like white puffy clouds on a beautiful
sunny day
• Breathe in through your nose, allow yourself to feel the
sensation of the air traveling into your body and
energizing you
• Now, exhale and visualize the air that you are expelling is
dark, like that of a smoke stack, this symbolizes any stressors, worries, tension or frustrations you are
carrying with you.
• As you repeat this for a few moments the expelled air will begin to transform from dark to a lighter shade as you let
go of the negative stressors to move into a more relaxed
state.
Benefits of Breathing Techniques
• Relieves physical muscle
tension
• Allows the mental function
to slow and relax
• Body and mind connection
• Calms and centers
• Activates parasympathetic nervous system
• Releases natural wastes,
such as carbon dioxide
• Gives the internal organs a
gentle massage
• Increases the oxygen to all
cells
• Strengthens the lungs
• Slows your heart rate
• Lowers your blood
pressure
• Increases blood flow to muscles
• Improves concentration
• Reduces anger and frustration
• Boosts confidence
MASSAGE THERAPIES
� Effects may derive from stimulation of pressure
receptors leading to enhanced vagal activity and reduced cortisol levels
� Reduces pain, which decreases anxiety
� Self-massage is free and easy
A Meta-Analysis of Massage Therapy Research: http://psycnet.apa.org/buy/2003-11000-001Strine, T.W., Chapman, D.P., Kobau, R., Balluz, L. (2005). Associations of self-reported anxiety symptoms with health-related quality of life
and health behaviors. Soc Psychiatry Psychiatr Epidemiol, 40(8):680.
Massage therapy research review: https://www.sciencedirect.com/science/article/pii/S1744388116300214
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RESTORATIVE YOGA
MINDFULNESS
� A mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations
� Changes brain activity, including in the amygdala
� Mindful eating
� Meditation
� Schedule weekly self-care
An Overview of the Research on Mindfulness‐Based Interventions for Treating Symptoms of Posttraumatic Stress Disorder: A Systematic Review : https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22200
When science meets mindfulness : https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-
mindfulness-may-change-the-brain-in-depressed-patients/
INTEGRATIVE MEDICINE
TOOLBOX
Testing….
Nutrient markers
Thyroid
Adrenals
Food allergies
Organic Acids
Hormones
Neurotransmitters
Treatment….
Psych Meds with genetic
testing
Magnesium, B vitamins
T4/T3
Amino Acids- Theanine, taurine, Inositol
Target NT- GABA, 5HTP
Progesterone, Melatonin
Herbals –Valerian,
Passionflower
MORE TOOLS FOR ANXIETY
� Reduce caffeine, sugar intake
� Weighted blankets- Vasovagal theory
� Essential Oils:
� Lavender- linalool and linalyl acetate inhibition of voltage-gated calcium channels, reduction of 5HT1A receptor activity, and increased parasympathetic tone
� Orange
� Rose
Lavender and the Nervous System: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612440/The Effect of Aromatherapy on Anxiety in Patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111093/
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SUGGESTIONS
� Cognitive Behavioral Therapy and Support Groups are
helpful
� There are many relaxation
apps to use with a smart phone QUESTIONS?