The world of psychiatry is full of unusual phobias. There’s symmetrophobia, the fear of symmetry, xerophobia, the fear of dryness, and ideophobia, the fear of ideas. But these phobias are exceedingly rare, and in the psychiatric interest on strange phobias, more mundane—and more dangerous—phobias are easily forgotten. Needle phobia is one such fear. There is significant evidence that fear of needles sparks physical changes in the body that can result in cardiac episodes and other health problems when a patient is exposed to needles. But needles are a part of life and are often necessary for medical treatment. Needle phobia, then, can cause a person to avoid life-saving care and, if a needle is forced upon a phobic patient, the results could be disastrous.

Needle Phobia and Cardiac Episodes
Most people dislike needles, but a true needle phobia feels overwhelming and uncontrollable to patients. People who have needle phobia may experience an extremely elevated heart rate and blood pressure immediately before a needle puncture. When the puncture occurs, the heart rate may drop precipitously. This exposes them to significant danger of heart arrhythmias and other cardiac episodes. Dr. James Hamilton, a pioneer in the treatment and study of needle phobia, reports that at least 23 deaths have been caused by a needle puncture that led to a cardiac episode.

Medical Issues
Doctors, nurses, and other people tasked with administering vaccinations and drawing blood are not typically properly educated about needle phobia. They’re accustomed to patients who dislike needles and may reassure them with promises that the puncture won’t hurt or will only take a minute. But with a true needle phobic, these reassurances don’t work. The person isn’t afraid of pain or injury: he or she is afraid of the needle itself. This poses serious obstacles to medical treatment. As many as 10% of people have some degree of needle phobia, and a significant portion of these individuals report that they would rather die than receive a needle puncture. These people tend to avoid medical care because of their fear, allowing their illnesses much more time to worsen than illnesses of nonphobic people.

Causes
Although traumatic experiences with needles such as painful blood draws or blood transfusions can cause needle phobia, people can’t typically trace the origin of the phobia. Needle phobia seems to run in families, but this does not mean the fear is genetic. Children may learn it from watching their parents show fear of needles. Restraining children during vaccinations and blood draws is strongly correlated with the later development of needle phobia. Consequently, parents should strive to ensure that their children’s early experiences with needles are positive and that children are not restrained unless the needle puncture is needed immediately to save the child’s life.

Treatment
Some people have good luck with hypnotherapy, but the most common treatment for needle phobia is counterconditioning. This process can take several years because the mere sight of a needle is sufficient to send many patients into a full-blown panic attack. Treatment providers typically start by asking the person to envision a needle, progress to showing the person a needle, and ultimately move toward getting the person to accept a needle puncture. For people who require needles for medical treatment, it may be necessary to administer general anesthesia to prevent life-threatening reactions. In less severe cases, anti-anxiety medications can lessen the symptoms of needle phobia.

Sources:

1. Hamilton, J. G. (n.d.). Needle phobia: A neglected diagnosis. Needle Phobia. Retrieved from http://needlephobia.info/pages/Hamilton-Needlephobia.pdf.
2. Emanuelson, J. (n.d.). The Needle Phobia Page – fear of needles and needle procedures. The Needle Phobia Page – Fear of Needles and Needle Procedures. Retrieved from http://www.needlephobia.com/
3. The phobia list. (n.d.). The Phobia List. Retrieved from http://phobialist.com/

Related articles:
The Other Side of Normal: An Interview With Jordan Smoller
Three Steps for Dealing with Panic Attacks
Breathing Lessons

Cognitive fusion is a process that involves attaching a thought to an experience. Cognitive fusion is beneficial in many ways. Through the process of cognitive fusion, people can become interested in story lines in movies and books because they attach their emotions to the events. Hobbies that elicit positive feelings can be enhanced as a result of cognitive fusion as well. Even feelings of love can be influenced by cognitive fusion. But this process can also impair behavior in individuals with certain psychological issues. People who struggle with anxiety and depression experience negative thoughts that can prevent them from taking positive actions. For instance, when someone with depression focuses on feelings of worthlessness because they have been unable to overcome their depression, they may continue to avoid seeking help because of the perceived outcome. Individuals who suffer with anxiety also find themselves trapped by cognitive fusion when for instance, they believe they will panic if they are exposed to stressful situations, and therefore avoid all situations that could induce stress, even if they are necessary for recovery.

Understanding how cognitive fusion affects mental health is a relatively new area of research. Acceptance and commitment therapy (ACT) is a mindfulness-based therapeutic approach that teaches clients how to accept negative feelings independently of perceived outcome. Therefore, ACT and other mindfulness techniques aim to teach cognitive de-fusion. Because there is little evidence exploring this, Kristen N. Herzberg of the Department of Psychology at the University at Albany of the State University of New York, recently conducted a study that employed a new tool to measure the effectiveness of ACT on cognitive fusion.

Herzberg and her colleagues developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) and administered it to over 900 individuals, half of whom struggle with extreme anxiety, undergoing 12 weeks of internet ACT treatment. She found that BAFT was quite accurate at identifying levels of cognitive fusion. Specifically, the BAFT was able to measure anxiety sensitivity, avoidance, and cognitive de-fusion in the participants. The results also showed that the anxious participants saw significant reductions in avoidant behaviors after completing the cognitive fusion–targeted ACT program. Herzberg added, “Taken together, these findings suggest the BAFT to be a reliable, valid, and useful measure of cognitive fusion.”

Reference:
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment. Advance online publication. doi: 10.1037/a0027782

We breathe all the time, right? So, what’s the big deal?

Most of us are not breathing properly throughout our days for optimum health and well-being. Most of us have poor posture, we sit at our desks for long periods of time, slump in our seats, stare at screens, move very little… This is a problem for much of the population.

If grief is added on top of those bad habits, our situation becomes even more difficult. Grieving on its own makes us feel like we want to be slumped down, curled into a ball. It makes us want to protect our hearts. The chaotic yet static state sometimes even stops our breath entirely. If you are grieving, you may notice that your breathing is very shallow, or that you are holding your breath without even realizing it. You may suddenly find yourself gasping for a breath, as if you’ve been under water, reaching for the surface. This is not abnormal in grieving. Grief affects every part of us, including our breathing. Here is your chance to learn to breathe through grief.

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Finding a quiet time at any point in your day to simply breathe can be a wonderfully healing tool. Anytime you notice that you are feeling anxious, particularly tired, or that you are holding your breath, take a moment—right then and there—to breathe.

Stoplights make good cues to practice your breathing as well. In addition to helping you notice your breath and serving as reminders to practice your breathing exercises, breathing at stoplights can help to counteract the stress we experience when we are confronted with the stress of the rest of the world—other drivers, traffic jams, errands that must be run—while we are in the midst of our grief. Inside your car, you can create a space of calm and peace simply with your breath. Practicing your breathing, and any other coping techniques, when you are calm, helps you be able to put them to use when you need them, such in the midst of anxiety or a panic attack (also not uncommon in grief).

Additionally, noticing your breath and increasing your use of breathing practices can also help you to become more mindful of your own thoughts and feelings, giving you a sense of control and stability in an otherwise incredibly chaotic time of life. The more you notice how you feel, what your thought patterns are, how your body is affected by your responses to the world around you, your grief experience, your thoughts and feelings, the less out of control you can begin to feel. A greater sense of calm and control can help you along your healing process.

Many people are told, “Take a deep breath.” But in my practice, I have found that when I ask people to show me how they take a deep breath, they often suck in their stomachs and fill up their chests. This is actually the opposite of deep breathing. Breathing this way restricts our lungs’ ability to take in oxygen and to release carbon dioxide. The result is an excess of CO₂ in our bodies. Not inhaling enough oxygen and failing to exhale enough CO₂ can create fatigue, mental fog, and decreased tissue function. For a grieving person, this can intensify many of the normal grief reactions that we go through as part of the grief experience. Breathing deeply and fully can be a helpful tool to decrease stress, increase clarity of thought and help to counteract fatigue. Not only that, but chest breathing stimulates our sympathetic nervous system—our fight or flight stress response. Think about it: When we are startled, what do we do? We open our mouths with a sharp intake of a chest breath. This alerts our brains that there is a danger. Breathing into our chests stimulates the very response we are trying to counteract. Learning to take deep belly breaths is essential to decreasing anxiety and getting more oxygen to the brain.

Read on to learn some simple but truly effective breathing exercises to decrease anxiety, clear your mind, and counteract some of the natural symptoms of grief.

Breathing Exercise: Just Breathe

This is an exercise in simply noticing your breath, helping you to become more aware and mindful of your own breath as it moves in and out of your body.

• To begin, sit in any comfortable position, on the floor or on a chair, with your spine long and straight but not stiff.
• Find a comfortable position for your hands, either folded gently in your lap or resting on your thighs or knees—palms up or down, whichever feels right to you.
• You may close your eyes if that feels comfortable. If not, find a spot on the floor a few feet in front of you and allow your gaze to soften. As you sit, begin to notice the temperature of the air on your skin, notice any sounds you may hear within or outside the room. Begin to notice your body’s weight as it is supported by the chair or the floor. Notice the feel of the floor or the chair under your sitting bones, under your legs. Notice the feel of the floor beneath your feet. Expand your awareness to noticing the sensations of your entire body without feeling the need to change anything, simply notice.
• Now, begin to notice and follow the movement of your breath as it moves in and out of your body, as you inhale and exhale. As you inhale, notice the temperature and the vibration of the air as it flows through your nasal passages, down your throat and trachea, on its way into your lungs. Notice the different sensations of your belly, your ribs, and your chest as they gently expand. As you exhale, notice the temperature of the air, the movement of the tiny hairs of your nose, the feeling of your lungs empty of air as it leaves your body. Simply notice these things and any other sensations that occur as you continue to breathe, easily and naturally, in and out.
• Simply notice your breath as it moves in and out of your body without the need to change anything at all. Just Breathe.

Breathing Exercise: Simple Deep Breathing

For this breathing practice, sit in a comfortable position with your hands relaxed, either in your lap or resting on your thighs or knees. Then begin.

• Relax your shoulders. Pull them up toward your ears, and then roll them back and down, creating space between your shoulders and your ears. Allow your shoulders to relax.
• Breathe normally in and out for a few breaths. Notice how your belly rises and falls easily as you breathe naturally. Your chest should not expand a great deal as you breathe in and out. If you like, you can place a hand on your abdomen to help notice the movement as you breathe in and out.
• When you are ready, breathe in—and on the next exhalation, breathe out slowly from your nose, counting to five. During this exhalation, tighten your abdominal muscles, and pull your diaphragm inward, toward your spine, squeezing all the excess air out of your body. When all the air is squeezed out, pause for two counts, and inhale slowly again, to the count of five, allowing your belly to expand as you breathe in. A very useful tip in learning to breathe deep into your belly is to imagine you are about to take a deep inhalation of your most favorite smell. When we smell something delicious, we almost always instinctively belly breathe.
• If you are comfortable doing so, close your eyes and continue to repeat this easy deep belly breath for 5 to 10 times.
• If you find that your mind wanders during this exercise, don’t worry. Simply bring your focus back to your breathing and begin your counts to 5 again.
• You may find it helpful to think of a happy color (such as yellow or pink) or a calming color (like blue or green) as you breathe in and a dreary color (like grey or tan) as you breathe out. Or, you might choose to imagine breathing in a calming pleasant emotion such as peace or love as you inhale and breathing out stress or anxiety as you exhale.
• As your awareness of your breath increases, it will become easier to practice your deep breathing without focusing so much of your attention on it.

Breathing Exercise: The Three-Part Breath

The three-part breath is a specific breathing technique used in many yoga practices and can be very useful in times of stress or whenever you need to relax. This type of breathing triggers your parasympathetic nervous system or the “relaxation response” (the opposite of the fight/flight stress response) and allows your body and mind to more easily release stress and tension. It is physiologically impossible for your body to be in a stress mode when you practice the deep three-part breath.

Obviously, you can’t breathe this way all the time, but when you do, it can help you think more clearly and decide on another coping skill or something else you can do to move away from the anxiety you may currently be feeling. Or you may decide to use the breath to sit with the pain of grief. This is okay too. Calmness in the midst of pain can help us know that we can survive the next moment, and then the next.

• Again, find your comfortable sitting position, allowing your hands to be relaxed. The three-part breath may also be done lying down. Practicing this breath while lying in bed before sleep is a good choice if you have difficulty clearing your mind and falling to sleep.
• To begin, inhale normally. Then, with your mouth closed, exhale slowly through your nose as you did with the simple deep breathing exercises, using your abdominal muscles to pull your diaphragm inward. Squeeze all the stale, excess air completely out of your lungs.
• As you prepare for your next inhalation, imagine your upper body as a large pitcher. As you inhale, you are filling the pitcher from bottom to top.
• First, fill the diaphragm and lower belly, allowing them to expand and completely fill with air. You can use the “smelling something delicious” tip here as you begin to fill your lower lungs with air, allowing your belly to expand.
• Next, continue to allow your “pitcher” to fill as you notice the lower, and then the upper, parts of the ribcage expanding outward and up.
• Next, fill the upper lungs, noticing the chest expanding, the collar bones and shoulders rising, as your pitcher is filled completely to the top.
• Pause for 2 beats.
• Exhale the opposite way, allowing the “pitcher” to empty from top to bottom.
• Slowly exhale, allowing the shoulders and collar bones to slowly drop, the chest to deflate, the ribs to move inward. Again, pull your diaphragm in, using it to completely empty the air from the bottom of the lungs.
• Repeat the process, refilling the pitcher slowly from bottom to top. Continue with the complete and full exhalations and inhalations, emptying and filling your pitcher.
• The three parts are bottom, middle, top—expanding and contracting as you slowly and completely fill your body with fresh, cell-nourishing, life-giving oxygen and then slowly and completely empty it of carbon dioxide, toxins, and tension held in the body and mind.
• As you increase your practice and the muscle movements become familiar, you may wish to add the counting of your breaths or your color visualizations. Ideally, the exhalations should be about twice as long as the inhalations. Initially, if you count to five as you inhale and exhale, gradually try to make your exhalations to the count of six, then seven, then eight, and so on until you feel more comfortable lengthening your exhalations.

If you feel dizzy or lightheaded while practicing the three-part breath, or any other breathing exercise, stop the practice immediately and allow your breathing to go back to normal. Sometimes if we are not used to a great deal of oxygen, the change can cause lightheadedness or dizziness. Know your own body and be mindful of the changes you notice.

I hope that these breathing lessons may help you through your grief journey and beyond. Just breathe.

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.

New research suggests that stressful events may cause delayed increase in panic symptoms. Because the effect of stress on panic symptoms has not been studied extensively, researchers wanted to determine if people with panic problems experienced immediate increase or a gradual increase in symptoms following a stressful event. “We definitely expected the symptoms to get worse over time, but we also thought the symptoms would get worse right away,” said Ethan Moitra, a postdoctoral researcher in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. But the findings revealed that stress does not always cause an immediate panic attack. Dr. Martin Keller, principal investigator of the research and professor of psychiatry and human behavior, warns family members and clients to watch for signs of panic over the several months following the stressful event. (more…)

Maybe you’ve been struggling with anxiety and panic and you’ve tried everything: medication, progressive relaxation, meditation, exercise, deep breathing, herbs, watching TV till your eyes glaze over in a stuporous fog—and still you’re feeling nervous, irritable, unable to focus, panicky, and tense.

What you’re missing might surprise you: you could be suffering from lack of sleep.

Studies show sleep deprivation to be one of the primary contributors to anxiety problems, depression, and other psychiatric disorders. Sleep appears to be very important for emotional regulation and processing.

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At University of California Berkeley’s Sleep and Neuroimaging Laboratory, assistant professor Matthew Walker’s experiment with sleep deprivation in humans showed that without sleep, the brain reverts back to more primitive patterns of activity. People then become less able to put emotional events into context and respond appropriately.

The amygdala is the part of the brain that prepares the body to protect itself when it perceives danger. When it senses danger, it sends a message to the prefrontal cortex, which then interprets and assesses the situation and decides whether to activate the fight or flight response. Under normal circumstances, the amygdala and prefrontal cortex work together to respond appropriately to danger while also keeping people from overreacting to emotional experiences. Under conditions of sleep deprivation, subjects’ amygdales and prefrontal cortexes stopped working together. Emotional centers were 60% more active, resulting in slower reflexes, increased irritation, problems with focus and concentration, and higher feelings of anxiety.

Other studies suggest that lack of REM sleep causes or worsens psychological problems. REM sleep, also known as dreaming sleep, is very important for processing emotions and memories, clearing the mind of the stressful events of the day, and dreaming. During this stage of sleep, the areas of the brain used in learning and developing new skills are stimulated. About 70 to 90 minutes after falling asleep, the first REM cycle occurs; ideally, people will have three to five REM episodes per night. Getting more and better REM sleep has been shown to boost people’s moods during the day. Fortunately, improving the quantity and quality of REM sleep you get is relatively easy.

Many experts recommend getting seven to nine hours of sleep per night, although some say that the quality of sleep is more important than quantity. Getting six hours of high-quality, uninterrupted sleep is more beneficial than eight hours of restless, interrupted sleep. You can immediately improve the quality of your sleep by making two important changes: change what you put into your body and what you do with your body, both during the day and when getting ready for sleep.

Change What You Put into Your Body

• Eating, drinking, and medication habits may be disrupting your sleep more than you think. Too much food, especially rich, fatty food, can keep your stomach working overtime to digest, and spicy food can cause heartburn. Too much liquid can cause numerous trips to the bathroom at night. Your first step to better sleep is to limit your intake of rich, fatty, or spicy food, especially during your evening meal. Stop eating and drinking fluids several hours before you go to bed for the night.
• Alcohol and caffeine use can also be very disruptive to your sleep cycle. Although you may feel temporarily relaxed after using alcohol, it causes you to wake up later at night, interrupting deep sleep and REM sleep. Caffeine can disturb sleep for up to ten to twelve hours after ingestion, so cut out the caffeine after lunchtime. Nicotine is another stimulant which disrupts sleep, so cut down or eliminate smoking to improve your sleep—although if you’ve been a smoker for a while, nicotine withdrawal may temporarily make it harder for you to sleep.

Change What You Do with Your Body

• Regular exercise can help you fall asleep easier and achieve better rest. It doesn’t even have to be intense or rigorous: a brisk walk or bike ride is plenty. As little as twenty or thirty minutes per day of moderate exercise can be very helpful, and you can even break your activity up into ten- or fifteen-minute segments if you wish. You will want to schedule your exercise in the morning or early afternoon, because your body needs sufficient cool-down time to sleep well.
• Set up a consistent, relaxing routine before bed. This trains your brain to recognize that it is time to wind down, making it easier for you to fall asleep. For thirty minutes to an hour before bed, find peaceful, quiet things to do to relax your body and mind. You might try things such as reading a light, entertaining book or magazine, listening to soft music or audiobooks, enjoying a hobby such as knitting or doing puzzles, or making simple preparations for the next day. A cup of hot tea or a glass of warm milk can also be helpful.
• Although many people use watching TV as a way to relax or fall asleep, television actually stimulates your brain rather than relaxing it. Watching disturbing, violent material on the news or prime-time shows stimulates thinking as well as your physiology. Even if you do manage to fall asleep with the TV on, the continuous flickering of the screen can interfere with your body’s clock, which is sensitive to any light. You will get higher-quality sleep with the TV and computer off. If you have a hard time getting used to sleeping without the television, try turning on soft music, a sleep sound maker, or a fan.
• Avoid napping during the day, which interferes with your body’s clock. Set up your nightly relaxation routine and stick to a consistent sleep schedule, and your quality of sleep will improve.

Getting adequate, quality sleep is extremely important for emotional regulation and processing. Fortunately, it is relatively easy to make changes in this area. Start today, and the effects can be felt almost immediately.

Reference:

1. Yoo, S., Gujar, N., Hu, P., Jolesz, F.A., Walker, M.P. (2007) The human emotional brain without sleep: A prefrontal amygdala disconnect. Current Biology 17: 877-878

Breathing deeply, relaxing your muscles, and staying in the present moment are some of the most common and effective ways to manage anxiety. But did you know that changing your eating habits can also help you feel more calm and balanced?

There are certain foods and substances which tend to trigger stress and anxiety in the body, and in fact, there are several foods that can even trigger panic attacks.

Ingredients of Anxiety

Caffeine, sugar, and alcohol all increase lactic acid levels in the bloodstream. Recent studies show that a high accumulation of lactic acid in the body can increase anxiety and cause panic attacks. Caffeine also blocks adenosine, a neurotransmitter that is believed to play a role in suppressing arousal and promoting sleep. Without adenosine, the pituitary gland produces adrenaline and the increase in adrenaline can either cause or increase symptoms of anxiety. In addition to increasing lactic acid levels in the blood, sugar intake causes a release of insulin which decreases blood glucose, which can result in mood swings and agitation. Alcohol use also causes fluctuations in blood sugar levels, leading to increased anxiety and agitation.

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Seasonings used in cooking can also cause symptoms of stress on the body. Salt depletes potassium in the body. Potassium is important to the proper functioning of the nervous system. Salt also raises blood pressure, which strains the heart and arteries. Monosodium glutamate, commonly known as MSG, can irritate the nervous system causing headaches, tingling, numbness, and chest pains.

Artificial food additives, preservatives, and processed foods can also trigger reactions in people who are sensitive to them. Aspartame, an artificial sweetener, is neurotoxic and should be avoided. Processed foods, those made with refined ingredients such as white flour, white sugar, and white rice, can cause a vitamin B1 (thiamine) deficiency, which can lead to symptoms of anxiety and emotional instability. Refined and processed foods are usually stripped of much of their magnesium as well, and magnesium deficiency may be a factor in symptoms of panic.

People who manage panic disorders should avoid skipping meals. Hypoglycemia, or low blood sugar, can cause the body to release adrenaline in order to prevent fainting, which can trigger a panic attack in susceptible individuals. It helps to eat small meals every three to four hours throughout the day rather than only two or three large meals. It is also important to stay well hydrated.

Food allergies can also be a factor in anxiety and panic disorders for some people. It may help to try eliminating different foods (e.g., wheat or dairy) for two weeks at a time to determine whether a food allergy or sensitivity is aggravating anxiety symptoms.

Certain eating habits can induce symptoms of anxiety. Eating too fast, not chewing enough (15-20 times per mouthful), eating too much, and drinking too much fluid with a meal can all interfere with digestion and the assimilation of food into the body.

A deficiency in several key nutrients can cause symptoms of anxiety:

• B complex vitamins are important for healthy nervous system functioning and in helping the body to relax and recharge. Symptoms of B complex deficiency include fatigue, irritability, nervousness, and insomnia.
• Magnesium is needed for muscle relaxation, healthy heart muscle, and healthy blood vessels. A deficiency of magnesium can cause agitation, anxiety, confusion, cold hands and feet, insomnia, and restlessness.
• Calcium is used by the body for maintenance of electrolyte balance, muscle contractions, and nerve transmission. Calcium deficiency can cause agitation, depression, heart palpitations, insomnia, and irritability.

Although vitamin supplements can help keep B complex, magnesium, and calcium at healthy levels, it is especially helpful to get these nutrients through eating fresh fruits and vegetables, adequate protein, and simple carbohydrates.

Managing anxiety involves changing behavior on several levels. In addition to learning to breathe properly, relax, and use cognitive skills to stop anxious thinking, it is important to keep your body physically healthy. Watching what you put into your body can go a long way in keeping it  healthy and calmly functioning.

* GoodTherapy.org is not intended to be a substitute for professional advice, diagnosis, medical treatment, or psychotherapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental symptom or medical condition.