As of Tuesday, October 29, 2013
DEAR DOCTOR K: I’ve always worried a lot. I saw a psychologist, but she said I didn’t have anxiety disorder, so she couldn’t help. I can’t believe there’s nothing to do. Can you help?
DEAR READER: I don’t agree with your doctor. I’ve talked before in this space about how doctors typically define diseases by how they appear in their most extreme form. I call it the “tip of the iceberg” phenomenon. Doctors have certain criteria for what constitutes an anxiety disorder. I assume your doctor has checked those criteria and decided that you don’t have enough of them to “qualify” for the diagnosis.
You may not have an anxiety disorder, but it sounds as though the nagging, worrisome thoughts in your mind may be distracting you from the positive, enjoyable experiences all around you. If so, there are ways to help you.
There’s a newly emerging term for this gray zone that falls between “normal” anxiety and a full-blown anxiety disorder. It’s called “almost anxiety.” In their illuminating new book, “Almost Anxious,” my Harvard Medical School colleague Dr. Luana Marques with Eric Metcalf explore the idea of almost anxiety and introduce a set of skills you can use to keep it at bay. (You can find out more about the book on my website, AskDoctorK.com.)
As discussed in “Almost Anxious,” the first needs that usually go unanswered when people are stressed are the things that actually keep anxiety at bay. These include proper nutrition, sleep and exercise. You may see how these things could be good for your health in general, yet doubt that they could affect anxiety. You shouldn’t doubt it: They can help.
Let’s start with nutrition. People who are a little anxious tend to reach for unhealthy “comfort” food. Or they completely avoid food, skipping meals or even fasting. The healthier road — and one that will also help tame your anxiety — is to eat wholesome foods on a regular schedule. How does nutrition help fight “almost anxiety”? It may be as simple as this: An unhealthy diet contributes to feeling unwell — and then worrying that you may have a serious disease, such as an undiagnosed cancer.
Next on the list is sleep. Being sleep-deprived can significantly raise your anxiety level. But there’s good scientific evidence that good sleep can help control anxiety.
If you have trouble falling or staying asleep, try the following:
— Use your bed for sleep and sex only.
— Get out of bed if you can’t fall asleep after 20 minutes.
— Go to bed and wake up at the same time every day.
— Don’t nap during the day.
— Don’t drink alcohol close to bedtime.
Finally, get regular exercise. Simply moving at a moderate pace has a big effect on anxiety. Aim for 30 minutes of moderate-intensity exercise five days a week. We don’t understand just how it is that regular exercise reduces anxiety, but there is good scientific evidence that it does.
Just deciding to take action to deal with your anxious feelings is itself therapeutic. Being “almost anxious” can interfere with your life, but there are simple and natural (and inexpensive) ways to treat the condition.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)