Wellness Corner by Dr. Gary Pace M.D. - September 2019

It seems like everyone I come in contact with lately is “stressed.” Why is it that in these modern times, so many feel anxious?

The NYT in April reported that “Americans are among the most stressed people in the world.” This survey of 150,000 people worldwide found that Americans reported feeling stress at the highest levels since the study started in 2005. Now, about 55% of adult Americans said they experienced stress “during a lot of the day,” compared to an average of 35% of adults from other places around the globe.

Gender and Age

It appears that women are “twice as likely to suffer from severe stress and anxiety as men” according to a 2016 study in the Journal of Brain and Behavior. One likely reason is the home responsibilities that women take on. Women do nearly 3 times the unpaid domestic work as men. With so many women in the workforce now, this is in addition to their regular job.

Women also seem to carry an inordinate amount of the “emotional labor,” which can be quite a burden. This is the often unrecognized responsibility for nurturing and caring for the emotional states of others, which can be provided to the detriment of one’s own well-being.

Young people seem to be especially verbal about and aware of their anxieties. A 2016 study showed that 62% of undergraduate college students reported “overwhelming anxiety” during the previous year (up from 50% in 2011). In fact suicide rates among college students has doubled over the last 10 years.

Social media almost certainly has a role in this, due to the constant comparing of self with others. The ways that schools have tried to cope with the increase — safe spaces, trigger warnings-- may help in the short run, but also may make things worse in the long term.

Anxiety Disorder

“A mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one’s daily activities.” Note the important qualifier — “interfere with daily activities.” Panic disorder, general anxiety disorder, obsessive-compulsive disorder all are variations of the voices telling us that something is very wrong, even when there is no actual threat. Now there is a condition called “orthorexia” which is when someone becomes obsessed with healthy and clean food, and becomes extremely limited in what they can eat. It illustrates the fact that there is usually some truth in the fear, but it gets amplified so much that it interferes with normal living.

All of us have anxiety, but for some people, it becomes crippling. Cognitive behavioral therapy (CBT) is a mode of therapy where patients end up confronting their fears directly, and also developing dialogue that can counteract the voices of doom in their minds. A study of anxious youth showed 60% improved using CBT, while only 55% improved using medication alone. Combining the two brought about improvement in 81% of the anxious kids.

External Factors

So, how many of these increases are due to parenting styles, to increase in mental health problems, or to external forces? It is really hard to sort these out, but our society does seem to have a lot of actual problems now.

● Political — the current polarization in our country, and seeming inability of our leaders to even sit down and work to solve problems, is quite striking.

● Climate — a recent study from Yale showed 62% of Americans were worried about climate change, with higher percentages in the younger ages

● Economic — the widening income gap, with 8 billionaires in our country holding as many resources as half of the population and with stagnant wages for middle class workers, contributes to stress for many people.

Conclusions

Anxiety is about avoiding things that may cause harm. Some of the anxiety disorders are telling us to avoid things that really won’t hurt us, and we need to learn to confront these fears and move on. Conversely, some of the external forces can’t be avoided, and anxiety can be a motivation leading to change.

“The goal is to not get rid of the anxiety. The goal is to transform it into what is bearable and useful and motivating.” Dr. Janet Lewis, Psychiatry Professor, University of Rochester.