Synopsis: Anxiety is normal, but too much can be crippling; An author and anxiety sufferer discusses the nature of crippling anxiety and what people can do about it. Host: Nancy Benson.

Guest: Scott Stossel, editor, Atlantic magazine and author, My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind

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Nancy Benson: Anxiety is something we all feel now and then. It’s a natural evolutionary trait, part of the fight or flight response that’s helped humans survive for millennia. Today, we’re not running away from saber-toothed tigers, but it’s still natural to feel anxiety under stress, like before taking a test, for example, or asking your boss for a raise. However, for some people, anxiety is off the charts– overwhelming and debilitating, even when there’s no apparent threat.

Scott Stossel: People who have really severe anxiety disorders suffer from clinical anxiety really badly. There are some of them who have not been able to leave their house for years at a time, or are unable to travel, or are unable if they have severe social anxiety to hold jobs and be in relationships just because the mere act of interacting with other people becomes so anxiety producing.

Nancy Benson: That’s Scott Stossel, editor of the Atlantic Magazine, and author of My Age Of Anxiety: Fear, Hope, Dread And The Search For Peace Of Mind. Stossel has suffered from severe anxiety ever since he was a kid. That’s when most acute anxiety disorders take root.

Scott Stossel: When I was a kid, anytime I was away from my parents I would be convinced that they had abandoned me or had died or had died in a car crash and I literally paced grooves in my carpet in my bedroom, because, you know, even if they weren’t late, if they were 10 minutes before they were supposed to be home, I would be absolutely convinced that I was never going to see them again. As I’ve gotten older, you know, my sort of first and still most long standing phobia is a metaphobia, which sounds idiosyncratic and weird to people who have never heard of it or don’t have it, but many people do we’re now learning from some internet research, but a metaphobia is the pathological fear of vomiting. So you know when I was a kid, and even as an adult, if I’m exposed to someone who’s sick I end up compulsively washing my hands. I have to leave the house if someone in the house is sick. I spend much of my time sort of non-productively analyzing how to avoid contracting stomach viruses.

Nancy Benson: Stossel also has claustrophobia – a fear of enclosed spaces. He’s also afraid of heights, cheese, fainting, flying in an airplane, germs, and speaking in public.

Scott Stossel: Sometimes it can be what they call endogenous panic attacks, and they just sort of strike from nowhere, where suddenly you feel this sense emotionally of overwhelming dread and terror, but physiologically it’s like your body’s going into meltdown. People often think that they’re dying, and turn up in emergency rooms because they think they’re having a heart attack. Because you begin sweating, you get dizzy, you feel nauseous, you have other gastric distress, you start shaking and trembling, you get tingling in your hands and your feet, it’s accompanied with this just overwhelming sense of dread and the kind of need to escape, and I’ve had that happen to me thousands of times over the course of my lifetime and unfortunately sometimes it happens at work, and I have to kind of run and hide in a stairwell or something like that.

Nancy Benson: Researchers don’t know whether clinical anxiety is an emotional, chemical, psychological or spiritual problem. Stossel says it’s probably all of the above.

Scott Stossel: Ultimately it’s impossible to completely disentangle them, but I would say that there is a large genetic component to it we now know this from piles and piles of genetic research that once one or more members of a family tree have generalized anxiety disorder or some other form of anxiety, it’s much much more likely that many other members of that family tree will also develop it, and they’ve now even begun to isolate some of the constellations of genes that lead to anxious temperaments, so partly it is genetic.

Nancy Benson: Clinical anxiety has been documented in the annals of history from Hippocrates and Plato to Darwin and Freud, and every era presumes it’s the most anxious. But Stossel says but people today really are more anxious than ever. We have more potentially paralyzing choices to make in life. Few things are clear-cut, even when we go to the grocery store. What we do about debilitating anxiety has changed, as well. We still often medicate it–for example, Hippocrates suggested drinking wine. In the Victorian age, it was laudanum. But now we have more choices.

Scott Stossel: These days the main treatments are you know there is an array of medications that you can take that that treat it at the source kind of in the brain. But the kind of cutting edge psychological treatments kind of therapies that there’s a lot of evidence to support their efficacy are cognitive behavioral therapy or CBT, which basically involves a sort of form exposure therapy which is you know directly confronting the thing that makes you anxious, but in the company of a therapist that’s sort of guided deep breathing and relaxation and learning that you can confront the thing that scares you without having it overwhelm you, and then reframing (they call it cognitive reframing) changing how you think about things and that can be very effective a lot of research shows it’s as effective as medication but it doesn’t have side effects and dependency issues. And then mindfulness meditation, there’s all kinds of new evidence that this practice which has emerged from the east but is now being adopted in the west there’s lots of evidence that people who are very practiced meditators significantly reduce their levels of anxiety.

Nancy Benson: That’s a long list of possible therapies, and Stossel has tried them all.

Scott Stossel: In my own life I would not have been able to survive and thrive and be as productive as I have without access to various forms of anti-depressants and anti-anxiety medications and there are many people for whom the difference between being completely debilitated and unable to function and being able to be out in the world and being productive is a pill or some combination of pills, so I’m not anti-medication. That said, all things being equal, if you can manage your anxiety without medication your better off because your avoiding the risks of side effects and dependency issues, and it’s still a little bit mysterious what these things are doing to our brains over the long-term. And there are probably a lot of people who are getting medication who don’t really need it just because it’s easy for physicians to get reimbursed by the insurance companies at the same rate for doing what they call a 15 minute psychopharmacology consult rather than a full 50-minute therapeutic hour.

Nancy Benson: But whether one is medicated or not, the good news is that anxiety levels do seem to decrease naturally with age.

Scott Stossel: There’s a lot of research that shows that as you get into your 50’s and into middle age both anxiety and depression tend to decrease for a variety of reasons that researchers theorize either have to do with kind of changing expectations of what your gonna get out of life, and becoming more accepting of yourself. And then maybe actually neurobiological changes to your brain that make you even more even keeled and content, so usually getting older can actually relieve anxiety.

Nancy Benson: Stossel has also had to take a good long look at his anxiety, as well. He says just writing his book has relieved his anxiety levels, at least somewhat.

Scott Stossel: Simply the act of finishing the book and having it come out and having the world not end, you know, I had to wrestle with the shame and stigma of anxiety that was therapeutic. I also have sort of done forced exposure therapy and having to do a lot of public speaking and stuff and that you know I’ve gotten better at managing the medication to do that, and just with practice you get better. So, my overall level of anxiety is moderately reduced. But is it gone or am I cured? No, I definitely still have bad episodes, and you have to resort to medication. But overall on balance it’s been helpful, and I still retain the hope that I’ll continue to you know improve and maybe someday be largely in remission if not fully cured.

Nancy Benson: And it’s also been incredibly gratifying for Stossel to hear from many people who’ve thanked him for bringing the issue of anxiety to light.

Scott Stossel: It’s been quite striking and gratifying to hear from not only friends and colleagues, but also total strangers and including some celebrities who say this is what I’ve suffered with all those years I’m glad to see, you know, it’s like you’re articulating from within my own head and you know thank you for talking openly about this it’s made me feel less alone, or more comfortable, or more comfortable talking about it myself. Including from some psychotherapists who say that, you know, they’ve had a kind of life long coming to terms with their anxiety and that’s the reason the book helped them with that process. And I’ve had other friends write to me or talk to me and say, you know, the book made them feel good because they thought well you know I thought I was anxious but at least I’m not as messed up as he is, so they felt better.

Nancy Benson: You can learn more about Scott Stossel and find a link to his book, My Age Of Anxiety: Fear, Hope, Dread And The Search For Peace Of Mind, through a link on our website at radiohealthjournal. net. You can always find dour shows on iTunes and stitcher. Our writer/producer this week is Polly Hansen. Our production directors are Sean Waldron and Nick Hofstra. I’m Nancy Benson.

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