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In recent years, public figures who openly share their struggles for mental health have helped lift sick comrades from silent shame and stigma.
A few decades earlier, the introduction of new drugs to treat depression and anxiety disrupted the portrayal of mental health problems as a personal failure in favor of an expression of brain chemistry.
Today, new understandings of mutual communication between mind and body make anxiety much more preventable than was previously known.
In “The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response,” holistic psychiatrist Dr. Ellen Vora uncovers the physiological basis of stress and fear and shares pioneering strategies for both prevention and treatment.
This conversation has been edited and condensed for clarity.
CNN: What’s the biggest misconception people have about anxiety?
Dr. Elena Vora: Anxiety is not simply a genetic chemical imbalance. It is largely based on the state of the physical body, which is something we can change.
Recognizing what I call “false anxiety” allows us to take steps to bring our bodies back into better balance, which helps relieve the symptoms of anxiety. This is the message full of hope and power that I want to convey.
CNN: How does the mind-body connection affect anxiety?
Vora: Today, many people recognize that mental health impacts the body. They understand messages from top to bottom: a thought like, “Oh, no, I have a test tomorrow!” it could impact their physical body, say, with a stomach ache.
Less widely recognized is the delicate and deeply interconnected web of back and forth communication between body and mind.
Modern life attacks our digestive tract through chronic stress, processed food and pesticides. The compromised ecosystem of bacteria in our digestive system leads to an unhealthy and inflamed intestinal lining, which triggers a message to the brain: “Things are not good down here.” When our physical body is out of balance, it tells our brains to feel anxious.
CNN: How has your anxiety survey informed your perspective on depression?
Vora: Many patients in my practice have both depression and anxiety. Sometimes they alternate with each other. Other times the two states coexist. Chronic anxiety can deplete us over time, leaving us in a depressive state. Both are manifestations of the brain that say, “I’m not well.”
CNN: What coping strategies can help?
Vora: When our body is stumbled upon a stress response, it can seem synonymous with anxiety and panic. First, we need to eliminate avoidable “false anxiety” by focusing on nourishment and restful sleep, monitoring the effects of technology, caffeine and alcohol.
Often, I like to start with stabilizing my blood sugar because it has such a quick impact on our daily anxious feelings.
The modern American diet is based on refined carbohydrates and smoothies disguised as coffee drinks. We end up on this roller coaster of insulin-chased blood sugar spikes, followed by blood sugar crashes that may seem identical to anxiety. Stabilizing blood sugar offers powerful relief from both anxiety and the sense of doom and discomfort that many people carry in the pit of their stomach.
The ultimate solution, following a blood sugar stabilizing diet with fewer refined carbohydrates and more protein and healthy fats, is a nice strategy. But if that’s 180 degrees from how you’re eating now, here’s a short-term solution: Every few hours, eat a tablespoon of sunflower, almond or other nut butters, ghee, or coconut oil. This creates a safety net that can smooth any blood sugar crash. Many patients have told me that this surgery alone stopped their panic attacks.
CNN: You advise some patients to eat more meat. Why?
Vora: Many patients only come to me eating smoothies, matcha latte, chia seed pudding, or large salads. Their constant tremor comes from their substance-free diet. A semi-vegetarian diet in which meat is not the focus but more of a condiment is probably a weak point for well-being.
Panic attacks and a sense of always feeling on the edge can come from a body that is never grounded with adequate nutrition. A warming, nutritious, well-rounded diet can relieve symptoms of both anxiety and depression.
CNN: If you could wave a magic wand, what nutritional protocols would your patients adopt?
Vora: I don’t want to encourage people on the path to feeling fragile, obsessive, or fearful about food. This doesn’t help anyone’s anxiety. In general, I encourage people to make mistakes by eating real food and avoiding fake and processed foods.
The idea is to approach food the way your great-great-grandmother’s culture did, by eating a balance of healthy, minimally processed proteins, carbohydrates and fats and generally eating what’s local and in season. If you come from a mix of different lineages, choose and then listen to your body.
In general, what works for our body echoes where we came from on the planet. Overall, try to eat real food that has been grown with integrity, ideally on small sustainable farms with humane husbandry practices rather than large intensive ranching and concentrated animal feeding operations.
CNN: What does “completing the stress cycle” mean and why is it important?
Vora: Rebalancing the nervous system is of fundamental importance for regulating anxiety.
Feeling anxious or panicking occurs when the system crosses zero in a stress response. Stress is inevitable, of course. Many of us have accumulated a lifetime of it but fail to complete the stress cycle by releasing pent-up energy.
Animals seem to know instinctively how to release the adrenaline rush they experienced and restore the nervous system. After an antelope has a life or death encounter, it shakes. When a goose comes out of an altercation, it flaps its wings in a particular way.
We, as socialized humans, have no shortage of stressors, but we often lack a practice to release the lingering effects. For some of my patients, exercise is good for you. I am in favor of any kind of creative expression: singing, dancing, singing, drawing, journaling, therapy, elaborating, talking, cuddling, playing with a dog, laughing out loud or crying. All of this restores our body, telling him, “The threat has passed and I am safe now.”
I practice the strangest thing of all: tremble. To restore my nervous system, I play shamanic drumming music, close my eyes and let my body move for about 90 seconds. After that, I’m not carrying the same stress.
It also increases my awareness of what my body is trying to communicate to me. After shaking, I sit down in meditation. Usually something that I have unconsciously ignored, but I have to pay attention to the bubbles.
True anxiety comes from our body’s attempts to communicate. We need to listen.
CNN: What breathing practice do you recommend to calm anxiety?
Vora: My reference point is the 4-7-8 breath. Without straining, gently inhale for a count of four, hold for seven and exhale for eight. With anxiety, it is important to have a free and easy grasp on these structured practices. Feeling like you have to perfectly control your breath is counter-therapeutic.
Typically, our breathing is quick and shallow as we inhale more strongly than we exhale. But if we are on vacation, lying in a hammock with no worries in the world, our breathing will slow down to deep diaphragmatic breathing.
Breathing as if we were relaxed sends a transmission to the brain along the vagus nerve. It tells our brain that the body is calm, causing a neuro-hormonal cascade that helps to relax our whole body.
This practice is easy, free, takes only 30 seconds, and you can do it virtually anywhere.
CNN: How long does the effect last?
Vora: Until real life starts again! Seriously, I think about this, and other relaxation practices, like a multivitamin. The more time in a day you can devote to your body in a relaxation response, the more your body will need to “travel” to cross the zero line in stress.
Relaxing regularly throughout the day creates a habit, establishing a familiarity with a state of calm that we can return to when needed.
It’s like creating a peaceful destination where, at almost any moment, your mind and body can come back to rest and restore.