Reflections From A Chair

This is the fifth post in the series on anxiety.

This post covers the relationship between the 3^rd and 4^th posts. That is, the relationship between some of the stress reduction techniques and the biology of the stress model.

Once more, I need to repeat that this is a tremendous simplification of a highly complex process. In addition, microbiology and neurophysiology are not my strongest points. I welcome all corrections to any of those processes in these posts. References are available at the end of the post for anyone wanting further details. As always, none of the information in this post is intended to replace diagnosis and treatment by a licensed professional. This is for informational/educational purposes only.

During normal times, the body is in a general state of alertness and homeostasis. Even then, "muscle is never completely relaxed-it is in a state of continuous but variable contraction." ( The Nature of the World and of Man, p. 487)

When we need to move or perform some task, we don’t use the whole muscle with all its force for each movement. This is a good thing. Otherwise, you’d smash your teeth and spill the tea into your lap each time you raised the cup to your lips.

Muscles, like the biceps for instance, are separated into smaller groupings or layers by the fascia. The fascia, according to David A. Winter , are sheaths that "enclose the muscles, separating them into layers and groups and ultimately connecting them to the tendons at either end." (p. 166)

A single muscle, then, can have a number of different layers or groupings (motor units).

These layers or units are called into action through a sequence known as "The Size Principle." Winter writes that according to this principle, "the smallest unit is recruited first and the largest unit last. In this manner…movements can be achieved in finely graded steps." (p. 167) The first muscle groups or motor units involved will be the last ones released back to a relaxed state. This allows you to raise a cup gently to your lips and sip, without spilling the tea or splitting your lips.

After getting a drink and returning the cup to the saucer, the task is done. A cortisol message informs the hypothalamus. The hypothalamus then sends out corticotropin-releasing hormone (CRH) to the muscles involved in the task. (This is an oversimplification because there are a number of sub-routines or minor tasks included in the larger goal of taking a sip and placing the cup down. It is the general point that we are interested in.) The muscles in the arm begin to relax, with the largest motor units turned off first and the smallest ones last.

So much for normal daily life.

Now, recall that when we detect a threat, the fight/flight/freeze response starts. The brain initiates a complex series of biological processes that prepares us for the danger.

One way that the body is prepared is an increased tone or readiness of the skeletal muscles. However, in anxiety, there is no clearly identified external threat. Without a specific threat, it is not possible to plan a reaction.

The muscles are tensed, but there is no action to take. A wrong move might get us killed. Yet we have to be prepared to make any move. So long as we believe a threat might be present, the muscles will remain at the ready. CRH is not sent to the muscles to tell them to stand down.

All dressed up in our shiniest battle gear, and no place to go.

To counter this situation, you can give your muscles a direction. Get up and go into the next room. Better yet, go out for a vigorous walk around the block, play catch with one of your children, go for a walk on the beach with a friend, etc. If for some reason you cannot get out, you can do progressive muscle relaxation right where you are sitting.

The point is to give the muscles a useful, conscious goal and to carry it out to completion. Once that is accomplished, the brain, in turn, will send out CRH so that the muscles can go back to their resting point.

It is tempting to sit in the same spot and mull over the worries and anxieties. There has to be a solution to all this worry, stress and anxiety. If only I think harder, longer, I will come up with an answer. That is the wrong response.

You will only generate an increasing level of threat perception and the body will continue to get tense. Remember that the brain calls on increasingly large groups of muscle as the demands of the task get greater (the size principle). As the muscle groups involved become larger and more widespread, the more uncomfortable the body becomes, the more difficult it is to breathe, and so on.

The brain is receiving feedback that the body is under stress and this increases the sense of anxiety/panic. Some people start taking their pulse at this point and get further freaked out because their heart rate is well above normal and they feel short of breath.

All this seems to confirm that one should be anxious. Even if there is no external threat, the brain has in fact found something frightening. It has identified that something is wrong with the body itself. Again, though, I have no idea why my pulse should be 102 and I feel dizzy. That alone makes me anxious. This is now a completely self-fulfilling circle of thought.

Breathing with the diaphragm is so easy that babies do it. However, that simplicity is often an objection to breathing in that fashion. After I tell people about it during a session, I often hear doubt in their voice. "How’s that going to help with dealing with my boss?" It seems too simple to be of any help with real problems, panic and anxiety.

Remember that as the perceived stress/threat grows, more and larger muscle groups are called into service. As my pectoral, trapezius, intercostal, deltoid, and other chest/back/shoulder muscles tighten, they press in against very important items: my ribcage and the lungs. As pressure builds against the ribcage and lungs, it becomes more difficult to take a deep breath.

By the same principle, as the stress/threat level increases, so does the tension in the muscles of my neck. Underneath and around the neck muscles are my throat, spinal cord, major arteries and veins. Pressure on the throat makes it more difficult to breathe. Constricting the arteries causes problems getting blood to the brain.

Understandably, having difficulty breathing is very upsetting to people. It increases the anxiety level. People often start to hyperventilate to compensate for the pressures on the ribcage and throat.

The way out of this is to use the stomach muscles to push out the abdomen and allow the diaphragm to drop, expanding the lungs fully. Pulling the abdominal muscles in pushes the diaphragm up and pushes air out of the lungs. The muscles of the rib cage and shoulders are not used. problems associated with hyperventilating are avoided.

While I was researching this post, I came across a very interesting article that uses a number of the above principles. The article, A quiet hand for microneurosurgery , is by and for neurosurgeons performing microneurosurgery. You don’t want your neurosurgeon to have a shaking hand. The authors found that the following variables are associated with worsened tremors:

Long-term factors include health and age. Intermediate factors are skill, alcohol, nicotine, and caffeine. Short-term factors, which occur during surgery, include limb support, direction of movement, physical fatigue,and anxiety. (p. 542) (I have italicized the elements shared between their article and our discussion.)

The neurosurgeons note that with increasing involvement of more muscle groups, the tremor worsens:

We also became familiar with the size principle of motor unit recruitment; that is, the smallest motor units are recruited first….one should recruit the least number of motor units to perform a task because each contracting muscle fiber adds to the tremor. (p. 542)

For anxiety, the increasing involvement of more and larger muscle groups adds to the anxiety and physical problems associated with anxiety.

These authors found that fatigue was nearly impossible to eliminate in neurosurgeons given their demanding schedule and hours. So they devised a work-around solution. Use only the most energy and movement required for the task-the "quiet hand technique."

Furthermore, avoid alcohol, caffeine and nicotine. Reduce or eliminate anxious thoughts. Focus on the present task. Exercise: " An exercise specific to the quiet hand technique involves taping the four fingers together or placing them together on a tabletop and stretching the thumb in all directions." (p. 543) Finally, they stress the role of breathing. Proper breathing control plays a role in microsuturing:

3) Flex the thumb so that its tip holds the needle holder to the first finger.

4) Inhale with thumb flexion.

5) Position the needle.

6) Extend the thumb .

7) Exhale with thumb extension to ensure smooth rotation. (p. 542)

As you see, many of the principles for stress/anxiety reduction are the same in both our lives and in the practice of neurosurgery. If the principles help physicians working inside a patient’s brain, it would seem like reasonable that the same principles would help with stressful situations in other areas of life.

This post has covered why diaphragmatic breathing, progressive muscle relaxation, light exercise and other factors work to reduce stress and anxiety. Another post will handle good sleep and diet in more depth. A separate post will deal with ways to turn down the dial on anxious thoughts so that the thinking/emotional aspect of anxiety is covered.

The following are references for people who would like more detail on the topics in this post; again they are listed in no particular order.

emedicinehealth.com

Wikipedia-action potential

mcgraw-hill.com Animation: Myofilament Contraction

Mechanism of Tension Generation in Muscle An Analysis of the Forward and Reverse Rate Constants — Davis and Epstein

GetBodySmart.com-action potentials

Wikipedia-muscle contraction

A quiet hand for microneurosurgery: twiddle your thumb

GetBodySmart.com-Skeletal Muscle Fiber Contraction Physiology

This is the third installment on anxiety.

My apologies for the delay in between posts. My previous web host ran into all sorts of difficulties and I had to move the blog and the web site to a new host.

Before going further, let me again say that this site does not substitute in any fashion for treatment or diagnosis by a professional. And this is a good time to mention that whenever someone first experiences anxiety or any other psychiatric illness, a thorough physical examination by your PCP is in order. Many physical illnesses lead to changes in mood, functioning, mental status, etc. Once those illnesses are ruled out, then seeking professional treatment is indicated.

We can now start talking about various anxiety reduction and stress management techniques now that the definitions are in hand.

As a refresher, according to Wikipedia, “Anxiety occurs unconnected to a specific identifiable external stimulus; as such it is distinguished from fear, which occurs in the presence of an identifiable threat.”

One of the first steps in assessing anxiety is to determine if there is any actual external threat. If so, the job of anxiety reduction is made easy. For example, if a person complains of anxiety in the late afternoon, we look to see what may be happening in the late afternoon or evenings that might lead to anxious feelings. If we find that the husband often comes home from work in a foul mood and yells a lot, then this may lead to anxious anticipation of his arrival at home.

The question might arise about why someone would be anxious rather than fearful in these situations. The answer, for better or worse, is lengthy. I will try to devote time to this topic in a later post. For now, let’s simply say that anxiety sometimes seems more bearable than the idea that your life partner is intolerable.

Where there is an external threat, two lines of approach are helpful.

First, anxiety reduction techniques come into play. I’ll get to those in a moment.

Second, if the threat is the husband (or any other external stressor), then more effective ways need to be developed to better deal with the threat. The specific strategies will vary according to the nature of the threat. If it’s the husband, perhaps helping the wife with expressing how his yelling affects her would help. Or perhaps some assertiveness and limit setting is called for. Yet again, it may be that marital therapy would be most beneficial. The list of possibilities goes on. However, the point is to improve the person’s skills for dealing with the situation that threatens them.

Back to anxiety reduction techniques. There are five cornerstones. Each is critical in the reduction of anxiety, although some are harder to achieve than others.

1. Good sleep habits. To keep this post brief, allow me to direct you to a page from the University of Maryland Medical Center. That will help explain the basics of good sleep hygiene.

2. Good diet. Caffeine, sugar, missed meals, highly processed foods are all gasoline to the fires of anxiety. While not exactly a food group, at least for most folks, alcohol and other intoxicants as well as nicotine can also ignite anxiety. For more details on good eating habits, you can go to becomehealthynow.com as well as the glycemicindex.com. It’s hard to overemphasize how much of a role diet plays.

3. Light exercise. This means nothing more than a 20 minute walk around the block. Any kind of physical activity that involves your whole body. But it does not include competitive sports and similar events where there are goals and expectations (read those as stress inducing).

There is a way to cheat on this if you absolutely cannot fit 20 minutes of light outdoor exercise into your day. But it should not be used as a substitute on a regular basis. Again, for the sake of brevity in this post, I’ll direct you to two other sites. The first one is from About.com. The second one comes from RealAge.com. These instructions aren’t quite the same as the ones I use, but they are close enough so that it doesn’t really matter.

4.Fun. This simple word is often the most difficult for people to be able to do. Whatever it is that you consider fun, schedule it in to your week. Fun is an antidote to the build up of stress and anxiety.

5.Get out of the house and socialize, do things with friends and family. Yes, even if you don’t feel like or think that you won’t enjoy yourself or worry that you’ll spoil everything because of your anxieties.

If those are the cornerstones, then the ground upon which they rest is breathing. For a host of physiological reasons, that I will get to in a later post in this topic, breathing is an essential element in both the kindling process of anxiety as well as in reducing anxiety.

Breathing by using your diaphragm is the simplest and most effective anxiety reduction technique that I know (excluding medications). The main problem with this method is that it is so easy, most people don’t think it can be effective. Until I get to the physiological basis of anxiety, you’ll have to trust me on this.

Here are two youtube videos that demonstrate the process. Once you learn how to do it, you can use it everywhere and no one can tell that you are doing. It does not at all need to be as formal as in these videos. They are lying down and being thorough to make a good instruction aide. You can breathe with your diaphragm while walking up the stairs or sitting in a chair at dinner.

I think that’s enough for this post. Next, I’ll try to get to the physical processes involved in stress and anxiety.