72 sarah weaver anxiety management ahna 2019 (sarah weaver)

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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?