After we ran blood tests and an electrocardiogram to monitor her heart, it was clear that anxiety was driving the spike in her blood pressure and making her feel sick.
How to help her? First by identifying stress as the root cause of her blood pressure flare. Second, by making a plan to unwind the physiological effects of the hormones cortisol and adrenaline that spike with stress — including breathing techniques, exercise, and short-term discontinuation of alcohol and caffeine. Plus, close monitoring of her blood pressures and a follow-up with me next week.
“Am I crazy?” she asked me on the way out of my office. I reassured her that she’s not — she’s merely human.
It’s normal for our bodies to experience the physical symptoms of emotional distress.
We are wired for survival. Whenever we’re faced with a threat to our safety (for example, a lethal virus or images of people scaling the Capitol walls), cortisol and adrenaline hormones are released into our bloodstream and flood our organ systems. As a result, our muscles tense, our breathing becomes rapid and shallow, our heart rate increase, our stomach acid surges, as we enter a state of alertness and “hyper-vigilance.” These bodily changes allow us to run from danger — the proverbial tiger in the wild — but can also pose their own problems.
For example, when we’re repeatedly confronted with threats — when our adrenaline and cortisol levels remain at a constant high level — we can start to feel sick. We can feel wired and tired, overstimulated and irritable, sleepless and anxious at the same time.
Right now in particular, most of us need more than one way to discharge adrenaline and turn off the cortisol spigot. Our mental and physical health hinge on our ability to recognize anxiety when it appears, to connect the dots between our mental and physical states, and to develop techniques to self-soothe when needed.
Here are some ideas:
Limit your media consumption. While it’s tempting to leave the TV news on as background noise and repeatedly check Twitter and Instagram, this overstimulation only amps up our stress hormones. Set a timer. Take breaks. Take a social media hiatus.
Fact-check your worries. It’s important to distinguish between worries that are grounded in reality and worries that stem from false internal narratives. For example, it’s normal to be concerned about the new coronavirus variants. But when you are reassured that the current vaccines will probably work against them (which they should) and you continue to ruminate about vaccine efficacy, we’ve got a problem. Anxiety, when allowed to roam freely through our brains, wastes precious mental and physical energy. Protect your body from being in a constant state of tension by countering your thoughts with facts.
Keep a journal. Writing down our worries can be a wonderful way to sort, categorize, process and demystify anxious thoughts. Seeing our worries on paper can give them less power. The simple act of dumping brain chatter onto paper also frees up brain space for calm, rational thinking.
Prioritize sleep. Sleep is essential for focus, attention, mood, stress management and cognition. Aim for seven to eight hours. (I can hear you laughing.) Make a bedtime routine that promotes a nice, sleepy calm. Turn off Twitter and try a meditation app such as Calm, Insight Timer, Headspace and Ten Percent Happier.
Get exercise. At the risk of beating a dead horse, exercise is one of the best ways to release stress and mitigate anxiety. It doesn’t have to be fancy or formal. Any sort of movement will work. You won’t regret even just getting up from your desk and stretching for five minutes.
Find a mental escape. Get lost in a good book, a TV show, a trashy magazine. Escapism is a wonderful way to “change the channel” in your brain. As long as it’s legal and doesn’t hurt anyone, go for it.
Ask for help. Confer with a therapist, join a support group, engage in AA, talk to your doctor/priest/rabbi/mentor. If not now, when? You don’t have to be in a full-blown crisis to ask for added support. All too often, I see people wait until they are desperate to get the help they need, when getting help early can make all the difference, mentally and physically.
Despite the chaos, uncertainty and ongoing trauma to our collective souls, I remain optimistic. We have been through a lot already, we can continue to learn from our mistakes and we are stronger than we think. And when we are brave enough to address our mental health, we are healthier, more resilient and more capable of making changes for good.
Lucy McBride is an internist based in the District. She writes a blog about health issues at lucymcbride.com/updates.