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Managing Anxiety

Anxiety and Adrenal Fatigue Syndrome

Managing anxiety and Adrenal FatigueAccording to Lam & Lam (2012), anxiety plays a role in the diagnosing, maintenance, and adrenal fatigue treatment. Beginning from the symptoms stage, anxiety is a commonly experienced symptom of AFS and adrenal disorders that directly impacts the quality of one’s day-to-day life. For those who already suffer from AFS, managing anxiety can be an important yet daunting task.

Decreases in energy and overall functioning can result in anxiety-provoking changes in relationships, work, and daily activities that heighten stress about the present and the future. Such experiences present a significant challenge within recovery efforts, particularly as they are exacerbated by the neurochemical imbalances that occurred in stage 3A and onwards.

For those who have progressed to stage 3C, managing anxiety becomes of even greater concern due to the “wired and tired” (Lam & Lam, 2012, p.128) paradoxical reaction to hormonal axis imbalance.

The Importance of Managing Anxiety

Addressing these concerns first necessitates the understanding that there is no direct causal connection between anxiety and AFS. Anxiety does not necessarily precipitate or follow AFS. Rather, both are intertwined within an overall clinical picture that requires a holistic approach to treatment.

This understanding provides the foundation for approaching adrenal fatigue as a syndrome and not a disease, as there is not one defined cause of AFS symptoms, as the latter would suggest. In the case of anxiety, this rings particularly true as treating anxiety from an AFS perspective is based upon the understanding of how physical, emotional, spiritual, and psychological dysfunction has occurred within a greater life context.

One common area of dysfunction for individuals with AFS is within the perception of one’s ability to recover from AFS and return to a prior, more desirable level of health and wellness. As many individuals with AFS have experienced drastic decreases in their energy and motivation levels from previous times in their lives, the gradual healing of the neuroendocrine system that is required for AFS recovery can be challenging and often feel laborious, tedious, and discouraging, especially if adrenal crashes occur.

In the event that negative attitudes and discouraging appraisals of the future developed as a result of these life changes and remain unresolved, individuals with AFS run the risk of developing health anxiety, which entails the development of dysfunctional beliefs about sickness and health, which leads to misinterpretation of one’s own body sensations and changes (Abramowitz et al., 2010).

Within an AFS framework, anxiety is strongly correlated to the imbalance of norepinephrine and epinephrine within the sympathoadrenal system (SAS) that comprises one part of the autonomic nervous system (ANS). The SAS is a combination of both hormonal and neural systems that utilizes specific hormone messengers (e.g., norepinephrine) to regulate autonomic bodily processes such as blood pressure, body temperature, the force of our heartbeats, and our heart rates (See chapter nine in Lam & Lam 2012 for further information).

Involved in both priming our bodies for simple stressors (e.g., standing up), severe stressors (e.g., public speaking) or even emergencies (e.g., flight, freeze, or fight response) the SAS operates outside of our awareness and is critical for our daily lives.

When experiencing such stressors on a chronic basis, however, the SAS becomes over-activated, leading to the production of larger than normal amount of stress-related hormones. Such imbalance triggers increasingly more intense and longer lasting bodily sensations including increased heart rate, increased energy that does not feel natural, and an increased sense of impending doom. With all of the physical responses taking place, managing anxiety can often seem overwhelming.

Individuals with AFS often experience these sensations as they progress through the AFS stages, particularly in the progression from disequilibrium to adrenal exhaustion in stage 3C. As these symptoms occur more frequently, and/or require more time to dissipate, individuals seeking causal explanations for their experiences begin to focus on their health to find relief and solutions and/or seek increasing social support for perceived health concerns.

Such pursuits, while expected and within the natural range of human reaction to illness, can become problematic and develop into health anxiety when hormonally-induced physical sensations resulting from chronic stress are misattributed to one’s and/or others’ inability to respond to the challenges at hand. Reoccurrences of unwanted physical sensations are thus regarded as signs of failure and/or personal or other ineffectuality, leading to more activity and more stress which further exacerbates an already overloaded SAS.

Managing anxiety may help with chronic painMuch of what we know about health anxiety arises out of research on anxiety and chronic diseases and/or conditions such as diabetes, heart diseases, cancer, and chronic pain. Within each of these medical conditions, greater amounts of health anxiety have been shown to result in more negative views of the future, doubts about one’s ability to affect lifestyle change, fear of becoming gravely disabled, psychological impairment, and high medical utilization (Tang et al., 2009; Poulsent & Pachana, 2014; & Jones et al. 2012).

High levels of health anxiety can result in psychiatric conditions such as Illness Anxiety Disorder (APA, 2013). This disorder is characterized by a preoccupation with seeking reassurance from others, belief that one’s health issues are not taken seriously, performing excessive health-related behaviors (e.g., bodily checking and/or searching the internet for disease-related information), or engaging in avoidant behaviors (e.g., not taking supplements), particularly in the absence of a diagnosed medical illness or condition.

As AFS shares many common features with chronic diseases and/or conditions, such as the existence of a continuum of severity along with prolonged recovery times, it is helpful to examine the impact that health anxiety can have on the healing process. For example, for some individuals with AFS, the gradual progression of healing and/or the waxing and waning of their symptoms could be easily misinterpreted as either complete success or failure in their recovery efforts due to their health anxiety.

Dysfunctional beliefs at either of these polarities could find AFS suffers being either unnecessarily discouraged or overly confident, resulting in inaccurate assumptions, behaviors, and attitudes that can delay the recovery process. For example, the thought of “I am never going to get better” can increase avoidance behaviors, such as failing to adhere to nutritional and supplement protocols that exacerbate feelings of depression or anxiety when no progress is made. On the flip side, unrealistic beliefs or expectations of the recovery process based upon a desire to find a “quick fix” can lead to over-exertion at the moment of first improvement, leading to adrenal crashes and increased difficulties with hormonal axis imbalance.

The premise of addressing maladaptive beliefs about AFS recovery begins with the understanding that health anxiety is a dimensional rather than a categorical construct. It is expected that individuals experience anxiety in relation to changes in health and physical ability, and thus anxious thoughts about one’s recovery process do not equate to having health anxiety. Essentially, it is not the presence of anxiety that is crucial, but rather, how one goes about managing anxiety. Thus, the goal for treating health anxiety and AFS is to address concerns about health and wellness across a variety of dimensions that promote lifestyle change such as:

Managing Anxiety: Breathing as Therapy

Breathing techniques for managing anxietyAs AFS is tied to over-stimulation of the ANS and SNS, which are both involved in activation of the bodily system for action, the utilization of the parasympathetic nervous system (PNS) becomes critical in slowing down bodily processes. Adrenal breathing is an effective way to tap into the stress modulating function of the PNS, as additional oxygen supplied to the body serves to reverse the overuse of the ANS and SNS in response to stress.

Instead, increased oxygen slows down one’s heart rate and lowers blood pressure, which allows for an increased ability to respond to stressors instead of reacting to them through an increased sense of calm and stability. See Lam and Lam (2012) for complete details on adrenal breathing.


Engage in Supportive Relationships

A strong social network of friends and family is a powerful tool to fight negative emotions and for controlling anxiety in adrenal fatigue recoveryContinual engagement in unsupportive relationships poses a risk for individuals with Adrenal Fatigue Syndrome (AFS), as the resulting stress delays the healing process. Research has demonstrated that interpersonal conflicts leading to feelings of social rejection, loneliness, and social isolation have been shown to delay recovery from illness due to increases in inflammation of bodily tissue (Murphy et al, 2012). Furthermore, Dr. Lam details in his book that a cycle of increasing need for cortisol arises in response to stress reactions that result from engaging “toxic relationships” (Lam & Lam, 2012, p. 372). Such increases over time can lead to eventual depletion or imbalance of hormones that result in adrenal fatigue. Finding and developing supportive relationships then becomes critical in controlling anxiety in response to worsening symptoms of AFS. This process can be difficult to engage due to questions on how one develops supportive relationships or how one might change or leave existing toxic relationships. See Dr. Lam’s book for further details.

Grieving Over Multiple Losses

As AFS can dramatically impact one’s ability to engage in everyday activities such as work, school, social relationships, and recreation, it is critical that these changes are acknowledged and explored as losses within the context of one’s total life context. Ignoring or denying the impact of such losses represents an inaccurate perception of one’s reality that forms the basis for issues with controlling anxiety and health.

While it was once proposed that grieving occurred in stages and that individuals processed grief in a sequential manner, alternative approaches have challenged this idea in response to the reality that grieving is not predictable, organized, or formulaic. Each individual experiences grief in different ways, with a range of emotions and behaviors, experienced at different times during the grieving process.

One such model that reflects this approach views grieving as the completion of four tasks: accepting the loss, experiencing the resulting pain, putting the loss into perspective, and adjusting to our changed world (Worden, 2002). Throughout these tasks, individuals may encounter a range of emotions as they engage in the work of grieving, and they alternate back and forth between tasks depending upon life circumstance.

Common emotions include: numbness, disbelief, disorganization, despair, and finally reorganization. It is then critical not only to allow for grieving to occur within one’s recovery from AFS, but also to accept that the grieving process is not linear in nature and that a resolution of grief involves time, hardship, and commitment to adjusting to new perspectives and behaviors.

Controlling Anxiety: Altering Thought Patterns

Try controlling anxietyThe way we think about illness and health can be a pivotal factor in recovery efforts and our experience of controlling anxiety. Specifically, the basic cognitive templates that we employ to organize information and make decisions can determine the degree in which we find an illness to be threatening.

This relationship has been demonstrated within studies that have examined why individuals with similar medical diagnosis have demonstrated variability in their levels of controlling anxiety about their health, as it was discovered that health anxiety levels were dependent upon an individual’s cognitive assessment of the following four dimensions (Hadjistavropoulo, 2012):

  1. Perceived likelihood of contracting or having an illness;
  2. Perceived awfulness of the illness;
  3. Perceived inability to cope with the illness; and
  4. Perceived inadequacy of medical resources for treating the illness.

Controlling anxiety about health issues was found to be more common in those individuals who scored higher across these four dimensions, signaling that perceptions do play a role in the recovery process. For individuals with AFS, the intensity of one’s health anxiety within each of these dimensions thus determines the degree in which one may be experiencing psychological dysfunction.

For example, if one perceives AFS to be highly awful, in addition to feeling unable to cope with the illness, there is an increased risk for the development of detrimental side effects of health anxiety such as depression. The first step in preventing such negative effects is to recognize how our cognitive templates impact our emotions and behaviors in both adaptive and maladaptive ways. The task then becomes to build up our adaptive cognitive templates (e.g., “I am a survivor”) in order to reduce the influence of maladaptive cognitive templates (e.g., “Things never work out”).

Controlling Anxiety: Developing Problem Solving Skills

Preoccupation with one’s health status can interfere with problem-solving because the greater the perceived threat, the more likely one is to limit the range of options or actions in order to avoid a feared outcome, particularly when operating from a position of anxiety.

Having a systematic approach to decision making, however, can help lessen decision-making difficulties in times of high anxiety and provide guidance for many of the decisions faced during AFS recovery that are within our power to control, and can help with controlling anxiety. One such framework is as follows (Wright, Basco, & Thase, 2006):

  1. Slow down and sort it out.
    1. Define the number and magnitude of problems and the urgency of resolving them
    2. Compile a problem list
  2. Pick a target.
    1. Organize the list based on urgency
    2. Eliminate problems that you have no control over or problems that belong to others and cannot be resolved by you
  3. Define the problem accurately.
    1. Be able to describe the problem in few words
    2. Identify how you would know that progress had been made
  4. It helps to break big problems down into easier parts to tackle one at a time, this helps with controlling anxiety and has benefits for adrenal fatigue recoveryGenerate solutions.
    1. Avoid locking in on only one solution
    2. Be creative and consider:
      1. using the assistance of others
      2. doing research
      3. delaying implementation of the plan
      4. considering not solving the problem at all, but learning to live with it
  5. Select the most reasonable solution.
    1. Eliminate solutions that are unrealistic, are not likely to be useful, cannot be easily implemented at present, or could cause more problems than they solve
    2. Choose several possible solutions and weigh the advantages and disadvantages of each
  6. Implement the plan.
    1. Increase the success of the plan by selecting specific day(s) or time(s) the plan will be carried out
    2. Troubleshoot various scenarios that might interfere with the success of the plan and develop alternative options
  7. Evaluate the outcome and repeat the steps if needed.
    1. Sometimes great plans fail
    2. Examine any unforeseen circumstances or elements of the problem that were not fully considered
    3. Correct any inaccuracies or dysfunctional thinking about self or others and try again

Learn to Make Meaning

While problems solving strategies and techniques may be effective in controlling anxiety within situations where the perception of control is high, these same strategies have not been shown to be as effective in situations where the perception of control is low.

Such a situation presents itself when one is diagnosed with a life-altering illness such as AFS, as many individuals feel as if their body has betrayed them and is now responding in ways outside their control. Park (2013) addresses this same dynamic within her work with cancer patients and proposes a meaning-making model of coping for individuals trying to come to terms with a life-changing diagnosis.

This model is built upon the understanding that we construct both global and situational aspects of meaning in our lives, and that stress occurs when we perceive discrepancies between these two aspects of meaning. Global meaning refers to an individual’s general orientation system that includes how one perceives and understands oneself and the world. That includes beliefs concerning fairness, justice, luck, control, predictability, benevolence, and personal vulnerability.

In contrast, the situational meaning is derived from initial appraisals of particular situations that include causal attributions, primary appraisals (threat, loss, and challenge), and one’s perception of his/her ability to cope.

Receiving a diagnosis such as AFS thus presents the potential to violate or even shatter an individual’s global meaning system, which in turn initiates both cognitive and emotional processing (meaning making efforts) in efforts to reconcile situational with global meaning.

This involves understanding and conceptualizing the stressor in a way more consistent with one’s global beliefs and values in order to engage in a process of assimilation and accommodation of events beyond one’s control. If conducted in a sustained and successful manner, such a process has been shown to improve adjustment to life-changing stressors leading to improved mental health outcomes.

Understanding the mental, spiritual, and physical effects of Adrenal Fatigue are important for controlling anxiety about the futureOne way to support meaning-making efforts is to engage and cultivate spiritual pursuits as defined by a “personal or group search for the sacred” (Park, 2013, p. 262). Such sacred encounters have been defined as containing the following elements: a sense of being overwhelmed, a feeling of fascination, a sense of mystical awe, and an experience of intense energy.

These elements inform the understanding of spirituality as being of the nonmaterial world that transports us from the material world that we experience with our five senses (Sperry & Shafranske, 2009). While this is only a brief introduction to an immense topic, the applications to recovery from AFS and health anxiety lies in the need to pursue transcendent, nonmaterial experience in order to fully embrace events outside our control and find meaning in something apart from our physical health.

Such a commitment allows for greater acceptance of the physical changes that accompany AFS, and provides support for the meaning-making process in response to stress and controlling anxiety. An example of this is highlighted in Dr. Lam’s final chapter entitled, “A Return to Simplicity: The Ultimate Solution.” Here, individuals affected by AFS are encouraged to seek a simpler life to promote healing and recovery through strategies that de-clutter and simplify one’s life while also improving personal relationships.

Despite the fact that these recommendations are not directly linked to bodily processes, they are critical within the AFS recovery process as they promote openness and availability to spiritual experiences which have been shown to increase one’s ability to cope with life-changing illnesses, leading to a powerful sense of relief and comfort (Park, 2013).


Dr. Lam's Key Question

Jitteriness and internal anxiety are feelings that a person with advanced AFS may feel. It is a fight and flight reaction to stress.

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