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We were talking about some of the ways to manage or minimize anxiety in the 2nd part of the series. This last segment continues with some more techniques:

a) Breathe deeply and slowly (inhale for 4 counts, hold for 2 seconds, exhale for 6 counts);

b) Keep your perspective, see the big picture (not only the negative aspect of the situation);
c) Entertain yourself with activities that cheer you up and soothe your nerves.
d) Accept that you have an anxiety problem, tolerate the palpitations/nervousness but continue on with what you are doing.

e) Don’t take things too seriously and learn to laugh at yourself (e.g. so what if you make a mistake in front of the class?)
Really, the major contributor to our anxieties is the kind of thoughts we entertain in our minds! Monitoring and choosing our mindset, therefore, is one of the most effective ways to counter anxiety!!!

We can better manage anxiety by managing our thoughts. Anxiety is often due to a tendency to think negatively whether by: a) anticipating/predicting that what one is about to do will go badly (e.g. I will make a mistake & my classmates will laugh at me!”), b) focusing on the negative aspect of situations (“gosh, I can’t believe I made a mistake twice!” – after a 20-item test) or c) making a problem to be bigger than it really is (“I’ll never forgive myself for making that mistake!”).

Here are some techniques we can use to better manage and even minimize anxiety:

1. a) Reflecting on our thoughts and recognizing how they fall into one or all of these above mentioned negative patterns;
2. b) Depending on the kind of negative thinking one engages in, one can use the appropriate technique to counter the thought;
3. c) Instead of predicting a disaster, visualize the opposite and use the image to predict a more positive outcome;
4. d) Emphasize on the positive rather than on the negative aspects of situations.

More techniques in our 3rd and last installment.

In my work with people with intense feelings of anxiety, I have noticed that one major factor that aggravates their situation is their reaction to their anxiety. That is, when they feel the symptoms of anxiety coming on (e.g. palpitations, cold hands, and nervousness) they react by saying something like this to themselves: “oh no, here it is again! I’m going to make a mistake and make a fool of myself!!!…” They then become overwhelmed by feelings of panic and fear and resort to different behaviors to handle these feelings (many of which are not healthy nor effective). In these cases, the reaction to the condition is more disabling than the anxious condition itself!

One of the healthy ways to handle anxiety is to acknowledge it and accept its presence. Instead of reacting to it with “oh no! I’ll make a mistake!.”, say instead “oh, am being anxious again, these palpitations are just part of my anxious condition and just means I’m reacting to… (it could be a social situation or reporting in front of class). Even though I’m anxious, I know I can do this”.

If a loved one you know (who is age 50years & above) is showing any of the following behaviors, that represent a change from his/her usual behaviors or personality, it may be that she/he is suffering from mild cognitive impairment:

• • Delusions, hallucinations (abnormal perception or thought content).
• • Apathy, aspontaneity, indifference (decreased motivation)
• • Anxiety, dysphoria, changeability, irritability (affective dysregulation)
• • Agitation, disinhibition, gambling, behavioral perseveration, impulsive shopping (impulse dyscontrol)
• • Lack of empathy, loss of insight, loss of social graces or tact, exaggeration of previous personality traits (Social inappropariateness)

In which case, consult a neurologist asap!

I attended the 1st VasCog Philippines conference last February 25 at Seda Hotel in Quezon City. VasCog Philippines is part of the International Society of Vascular Behavioral & Cognitive Disorders and one of its aim is to better “understand the non-physical outcomes of cerebral vascular brain injury like cognitive & behavioral impairments”. Specifically, vascular dementia (as against the dementia of alzheimer’s disease) and behavioral & psychological symptoms of dementia (BPSD)

Several international and local neurologist gave interesting talks on this topic and one take home message is the importance of controlling diabetes mellitus (DM), dyslipidemia (cholesterol level) and hypertension in keeping our brains healthy (and we only have one!).

In particular, hypertension has been found to cause Small Vessel disease which in turn is the leading cause of White Matter Disease (WMD) (seen in our MRIs as white matter hyperintensities). WMD is caused by thickening of the walls of our blood vessels & narrowing of the lumen. These then lead to loosening of our blood vessel walls & microaneurysm formation.

These then set the stage for cerebrovascular accidents and subsequent vascular cognitive impairment!

Control those risk factors and you will do a great favor for your brain and yourself!