Emotional Problems

Coping with Stress and Negative Emotions

It's noon in New York City and the yoga class at Crunch Fitness, a trendy Manhattan health spa, is packed. While traffic groans by on 13th Street, two dozen women and men, oblivious to the lunch-hour bustle, quietly follow along as Dana Flynn, the instructor, demonstrates a handstand.

Usually, Flynn says, people sign up for her class because they've heard that yoga can make them more flexible or stronger. But they keep coming back for a different reason, she says.

"People who take the class--and about three-quarters of them are women--notice that they feel less stressed, less anxious and less depressed," says Flynn. "They feel better because yoga cultivates self-acceptance, and a lot of women feel stress, anxiety and depression because they don't accept themselves."

Women, studies show, report considerably more emotional problems than men do--more anxiety, more panic attacks, more phobias, more mood swings and more depression, including seasonal affective disorder, a type of depression common in fall and winter. Some researchers speculate that this is because the hormonal changes that we experience premenstrually, during pregnancy and at menopause widen the arc of our emotional swings.

Other experts say societal factors predispose us to emotional wear and tear. We're still doing most of the work at home and just as much of the work at the office, though for less pay than our male colleagues, they note. Still other researchers say it's possible that men have just as many emotional troubles but are less vocal and less likely to seek help than we are.

DON'T LET NEGATIVE EMOTIONS
ERODE YOUR HEALTH

Whatever the cause of women's angst, emotional problems can exact a heavy toll on our physical health. Research suggests that sustained anxiety and stress, for instance, can trigger physiological changes that raise your blood pressure and heart rate. Too much stress or anxiety over too long a period, it seems, can make you more susceptible to serious conditions like heart disease.

You don't have to let negative emotions get the best of you, however. If you have milder symptoms, an apothecary of nondrug therapies--from yoga, aromatherapy and exercise to meditation, imagery or simple cognitive therapy--can help. If the anxiety or depression or stress that you're feeling is so overwhelming that you no longer enjoy yourself or can't do the things that you need to do, self-help methods may not solve the problem, says Annabelle Nelson, Ph.D., psychologist in Prescott, Arizona, professor at the Fielding Institute in Santa Barbara, California, and author of Living the Wheel: Working with Emotions, Terror and Bliss through Imagery. That's especially true if there's a physical reason for the way you feel.

So if you feel overwhelmed or severely distressed, it's a good idea to consult a medical doctor or professional psychotherapist. She may recommend biofeedback, professional cognitive therapy, breath therapy or light therapy or long-term psychotherapy, alone or in combination with medical treatments.

Whatever route you take, the idea isn't to use these techniques to chase away your bad feelings and forget about them, says Judith S. Beck, Ph.D., director of the Beck Institute for Cognitive Therapy and Research, clinical assistant professor of psychology in psychiatry at the University of Pennsylvania in Philadelphia and author of a textbook on cognitive therapy. Feelings--good and bad alike--can tell you something, says Dr. Beck. "Negative moods may be telling you that there's a problem you need to solve," she explains. If you're depressed, you may need to make some changes in your life. Therapy, whether it's drug therapy or professional psychotherapy, can help you feel better so that you can take a clear-eyed look at your life, decide if and how you might change things and then move on.

ANXIETY, PANIC AND PHOBIAS:
UNFRAZZLE YOUR NERVES

At the Monmouth Medical Center in Long Branch, New Jersey, staff members regularly prescribe personal, portable headset stereos for women awaiting gynecological surgery. The wait before surgery normally makes most women very anxious. But women who listen to music before surgery report less apprehension and worry and have lower heart rates and blood pressures (also a sign of lower presurgical jitters).

Apprehension, worry and rapid heart and breathing rates are all classic symptoms of anxiety. A state of arousal triggered by the threat of danger, anxiety can also bring on stomachaches, restlessness, dizziness and difficulty concentrating.

Sometimes you know exactly why you're anxious--because you have an upcoming job review, for instance. At other times, you may feel anxious, but the danger may not be immediately apparent, says Dr. Beck. You may feel worried and not know why. If you ponder a bit, though, you can usually discover what's triggered your anxiety, she says. You might get anxious awaiting surgery, for instance, because you're afraid there will be complications, or because you're worried that you'll have a great deal of pain and a long recovery after.

Anxiety isn't necessarily bad. Rather, it's a warning that you need to take action, to prepare for, say, an upcoming presentation. When anxiety is ongoing or so intense that it interferes with your ability to concentrate, to sleep or to enjoy yourself, you need relief. Here's what works--and why.

Stop and think. Cognitive therapists like Dr. Beck teach the men and women whom they counsel to identify troubling thoughts and evaluate them. A basic premise of cognitive therapy is that erroneous beliefs contribute to emotional problems and counterproductive behavior. You can try some basic cognitive techniques on your own, Dr. Beck says.

Next time you're feeling anxious, ask yourself, "What thought just went through my head?" Perhaps you thought, "I'll blow the budget presentation, and my boss will fire me!" Ask yourself, "How likely is it that this will happen?" If you've been working diligently on the budget presentation, you probably won't blow it. And if your boss has been happy with your work, it's unlikely that she'd give you the boot even if the presentation didn't go perfectly. Thinking things through this way can help alleviate anxiety and other emotional problems, says Dr. Beck.

See and conquer. Imagining yourself pulling through a difficult situation with ease can help take the edge off your anxiety, says Dr. Nelson. "Imagery talks to the part of your brain called the limbic system, which is the threshold between your mind and body," she explains. "Relaxing imagery affects the limbic system in such a way that your heart rate slows and your blood pressure drops."

Still worried about that budget presentation? Close your eyes and image yourself giving a calm, cool, dazzling presentation. Make it vivid. See the managers' smiling faces, feel the conference room carpet under your feet, smell the coffee in the pot in the middle of the table.

Maybe budget presentations aren't your problem. But mentally rehearsing a positive outcome can help defuse anxiety about other high-pressure situations.

Try yoga. If you're struggling with anxiety, practicing a series of four calming yoga postures can help, says Richard C. Miller, Ph.D., a yoga instructor and psychologist in San Rafael, California, co-founder of the International Association of Yoga Therapists and founder of the Marin School of Yoga.

Start with a forward bend from a standing position posture. Inhaling, raise your arms overhead. As you exhale to a count of eight, bend down at your waist. Then, straighten up slowly, to a count of four or six, as you inhale. Repeat eight times.

Follow with the two-legged table posture. Lie on your back, feet on the floor, knees bent and arms by your side. Inhale to a count of six as you slowly lift your pelvis. Hold the position for a count of one. Then, exhaling, lower your pelvis to the floor to a count of eight. Repeat eight times.

Now try the child posture. Kneel on the floor with your arms overhead and feet straight out behind you. Exhale as you slowly count to six while bending at the waist. Bring your arms down behind you as you lower your buttocks to your heels and bring your forehead to the floor. Relax, then inhale as you straighten up to a count of eight. Repeat eight times.

Finish with yoga Nidra, or quiet contemplation. Shut off the lights, lie on the floor and close your eyes. Spend three to five minutes simply observing how you feel, paying particular attention to your breathing. When you're ready to stop, tell yourself that you're going to resume your day. Then take a deep breath, stretch, open your eyes and get up.

Panic Attacks: Stop Out-of-Control Anxiety

Sometimes, anxiety escalates into a panic attack, a sudden episode of intense anxiety. Symptoms may include heart palpitations and disorientation, along with shortness of breath, dizziness, chest pain, nausea, smothering sensations and bouts of sweating. The experience can be terrifying.

"In the middle of a panic attack, you think that you're facing some kind of catastrophe," says Dr. Beck. "If you're having chest pain, you may think that you're going to have a heart attack. If you feel disoriented, you may think that you're going to go crazy."

Panic attacks can trigger a vicious cycle. Convinced that they're experiencing warning signs of heart attacks or bouts with madness, women who experience panic attacks try desperately to control the symptoms.

"They stop whatever they're doing," says Dr. Beck. "If they're at the mall, they go home. If they're out walking, they sit down. When the symptoms go away--and they usually do--they're convinced that leaving the mall or sitting down was what averted catastrophe. So they stop going to the mall or they avoid going out to walk, to try to avoid repeat episodes."

Some women who experience panic attacks put so many limits on what they can do that they become agoraphobic--irrationally afraid of leaving home and going out in public.

Panic attacks can be treated with intensive therapy--and sometimes medication--with the guidance of a health care practitioner. If you have panic attacks and your doctor has told you that you do not have some other medical problem, remind yourself that they're not warning signs of a catastrophe, says Dr. Beck. The symptoms will go away on their own, usually after less than 20 minutes. You don't have to stop what you're doing or give up the things that you need and like to do, she says.

"If you have panic attacks, you need to stop trying to control the symptoms and prove to yourself that, no matter how bad the symptoms, the ca-tastrophe won't happen," she says. Here's what practitioners suggest.

Calm yourself with self-talk. Cognitive therapy can help you revise the erroneous thinking that contributes to panic attacks, says Dr. Beck. While you're feeling calm, ask yourself, "What catastrophe am I afraid will happen? Why has it never happened?" Then ask yourself, "What can I do to prove to myself that the catastrophe won't happen?"

Say your panic attacks trigger a fear that you're having a heart attack at the mall. Chances are, you've never had a heart attack at the mall and you're not likely to. Rather, you've had panic attacks at the mall. You can prove this to yourself by going to the mall, experiencing the symptoms and coming out of the experience perfectly fine.

Try soothing angelica oil. For panic attacks, Jane Buckle, R.N., a certified aromatherapist and aromatherapy teacher in England and author of Clinical Aromatherapy in Nursing, often recommends the essential oil extracted from the herb Angelica archangelica, available at health food stores. Keep a small bottle handy, add a drop to a hanky and sniff the aroma whenever you feel a panic attack coming on.

Phobias: Rational Solutions for Irrational Fears

So you know what claustrophobia is. But what about agoraphobia? Or acrophobia?

These phobias--irrational fears of enclosed spaces, leaving home, and heights, respectively--are fairly common. But you can have a phobia of virtually any object, activity or situation that frightens you so much that you'll go out of your way to avoid it. Faced with whatever you fear, your heart races, you sweat, blush and want to flee.

Think of a phobia as an intense fear that interferes with daily life. A normal fear--say, a fear of wandering alone into a sinister neighborhood after nightfall--is often well-founded and useful. By contrast, a phobia can keep you from doing perfectly safe things that you want or need to do.

"A phobia is an irrational fear that exerts control over your daily living," explains Eileen F. Oster, registered occupational therapist and meditation instructor from Bayside, New York, and author of The Healing Mind: Your Guide to the Power of Meditation, Prayer and Reflection. "You try to avoid feeling overwhelming anxiety or panic, so you avoid the thing that makes you afraid."

Some phobias stem from past trauma. You might be able to trace your fear of animals, for instance, to the day your neighbor's dog gave you a nasty bite. The origin of other phobias may be more difficult to trace.

Deeply entrenched phobias that interfere with your life require professional help, says Angele McGrady, Ph.D., professor of psychiatry and physiology at the Medical College of Ohio in Toledo and past president of the Association for Applied Psychophysiology and Biofeedback based in Wheatridge, Colorado. For milder phobias, you can try the simple anxiety-relieving techniques described earlier. Here's what else to try.

Imagine yourself victorious. The classic remedy for phobias is a process called systematic desensitization. Basically, you confront the thing that you're phobic of very gradually. To make this easier, imagine yourself confronting the person or thing that you fear before the actual confrontation, says Judith Green, Ph.D., professor of psychology and biofeedback in the Department of Behavioral Sciences at Aims Community College in Greeley, Colorado, and author of The Dynamics of Health and Wellness.

Say you're afraid to ride in elevators. Before you actually set foot in an elevator, imagine yourself approaching the elevator and feeling fine. When you can imagine yourself doing this and actually feel fine, imagine yourself getting into the elevator. And once this mental image no longer makes you uneasy, imagine yourself riding up one floor, without a hitch. Again, when you're able to imagine this without sweating it, imagine yourself riding farther, without incident. Repeat, slowly adding floors, until you can see yourself riding to the top of a tall building without panicking.

Next, approach an elevator while staying calm and relaxed and using positive imagery. First, ride it up one floor, repeating the trip until you're comfortable. Then ride to a second floor and repeat, and so forth. Finally, ride to the top floor. You may want to take a companion with you.

You can use desensitization to gradually overcome other common phobias, such as tunnels, crowded spaces or other close environments.

Think things through. It's often helpful to systematically expose yourself to feared situations, says Dr. Beck. Before you get on the elevator, ask yourself, "What am I so afraid of?" Maybe the answer is, "I'm afraid the elevator will crash." Now ask yourself, "How likely is it that the elevator will crash? How many times has this elevator gone up and down without crashing?" Realistically assessing the risk in this way should help calm your fear, says Dr. Beck.

DEPRESSION: YEAR-ROUND HELP FOR THE BLUES

Everyone gets the blues from time to time, when ambitions fail, for example, or when relationships end. While the blues are relatively short-lived, though, in true depression, individuals suffer moderate to severe symptoms for at least two weeks. If not treated, feelings of sorrow and hopelessness may last weeks, months and sometimes years.

Often, depression is accompanied by other changes: You can't sleep, or you do nothing but sleep. You can't eat, or you overeat. Or you lose interest in sex and other activities that once brought pleasure, have difficulty concentrating, feel restless or tired or develop headaches or back pain. When depression is severe, it can lead to suicidal fantasies, even suicide.

Prolonged depression that won't let up calls for professional help, says Dr. Beck. Your doctor may recommend antidepressants, psychotherapy or a combination of treatments. If you're mildly depressed, and you're not having any thoughts of harming yourself, the following alternatives may help you feel good enough to figure out what's troubling you and how to deal with it.

Talk your way out. When you're depressed, you may tend to have distorted, negative thoughts, like "Nobody cares about me anymore," says Dr. Beck. Ask yourself, "Is there any evidence that this is true?" Odds are, there's little evidence that no one cares. Perhaps you feel this way because family members aren't offering you the help that you need to get everything done. If that's the case, you have to find a solution. "You'll need to ask for help or do less," says Dr. Beck.

"Do less" doesn't mean do less for yourself, however. "When women get depressed, they tend to isolate themselves from others, say no to plans or drop things that they've done that gave them a sense of accomplishment or pleasure. They don't play tennis anymore or ask people to lunch," says Dr. Beck. "Instead of telling yourself, 'Once I feel better, I'll do these things,' tell yourself, 'In order to feel better, I need to start doing these things now.' "

Turn into a cobra. In a German study, women who practiced yoga regularly reported better emotional health--less anxiety and less depression--than nonpractitioners.

When combined with the forward bend from a standing position and the child posture, used to relieve anxiety, the cobra position can stimulate you and lift depression, says Dr. Miller.

First, do the forward bend from a standing position and the child posture, described on page 392. Then do the cobra: Lie on your stomach with your elbows by your sides and your palms flat on the floor by your shoulders. As you inhale, lift your chest to a count of six, keeping your hands on the floor. Now lower yourself back down to the floor as you exhale to a count of eight. Repeat eight times. Then follow with the yoga Nidra, also described on page 392.

Meditate with sound. To boost your energy level and your spirits, Oster suggests "sounding meditation."

Choose any short word that has syllables and consonants in it, like ohm, and repeat it, focusing on nothing but the word. Let the sound of the word vibrate throughout your body, imparting energy, Oster explains. "The act of sounding is putting forth energy. When you're depressed, you have trouble harnessing energy. A sounding meditation helps you gather some energy."

Imagine relief. Visualization is often used to relive physical pain, but it can also be used to heal emotional pain. If you're feeling depressed, Dr. Nelson suggests that you visualize the feeling. "Ask yourself 'Where do I feel pain?' and 'What does it look like?'" she says. "Maybe the image that comes to mind is of a dark blanket that's smothering your heart." Now imagine some relief. "See yourself removing the blanket and freeing your heart," she says.

Try St.-John's-wort. Working with researchers in Germany, a research team at Audie L. Murphy Memorial Veterans Hospital in San Antonio reports that St.-John's-wort (Hypericum perforatum) is effective as a standard antidepressant drug for treating mild to moderate depression--and causes fewer side effects. The researchers based their conclusion on an analysis of 23 trials involving 1,757 men and women. Most of the trials took place in Germany, where herbal medicines are prescribed extensively by psychiatrists, internists, obstetricians and gynecologists for treatment of anxiety, depression and sleep problems.

St.-John's-wort doesn't work overnight. The herb needs two to four weeks to take effect. Follow package directions.

Postpartum Depression: Take It Seriously

It arrives soon after the baby does, but it's no joyous delivery: Postpartum depression leaves many new moms feeling very low.

Roughly three-quarters of new mothers get the postpartum blues. They may feel teary, anxious, tense, moody or angry--or all of the above. Some feel guilty about feeling low when they think that they should be ecstatic. Others worry that they're ill-equipped to care for their infants. In rare but severe cases, new moms begin to toy with the idea of harming themselves or their babies.

A number of things appear to contribute to the postpartum blues, says Dr. Beck. Hormonal changes seem to play a role, as does the stress of adjusting to life with a completely dependent, very demanding new person.

Postpartum depression usually lifts after a week or two, though some women suffer for months if they don't get help. You should see your doctor if you're thinking about harming yourself or your child or if the depression gets worse instead of better, says Dr. Beck. Your doctor may recommend a short course of antidepressants or psychotherapy, or both. For milder postpartum blues, other tactics against depression may help. Practitioners also offer these suggestions.

Foresee good times with your baby. Imagine yourself happy and coping well with your baby, suggests Dr. Green. That way you program yourself for a positive experience.

Help yourself to aromatherapy. If you find yourself feeling blue after delivery, try inhaling the essential oil extracted from Pelargonium graveolens--a species of geranium, suggests Buckle. The aroma affects your adrenal cortex, the part of your brain that is responsible for establishing hormonal balance, she explains. So it can be particularly helpful if you're suffering from postpartum blues, she says.

Seasonal Affective Disorder: Climb with the Light

Stockholm, Sweden, gets less than 12 hours of sunlight a day in early October, a mere 6 hours a day in December and ekes out 8 hours of sunlight a day by the time February rolls around.

That makes Stockholm an ideal place to study seasonal affective disorder (SAD), a type of depression that settles in when days grow short in autumn and doesn't lift until the sunlight hours lengthen in spring. Research finds that SAD is more common in darker, northern climes. It's more widespread in Stockholm than Boston, for instance, but more common in Boston than Miami.

The severity and symptoms of SAD can vary from person to person. But most of those who are affected experience some combination of sadness, crying spells, fatigue, irritability, headaches, difficulty thinking and carbohydrate cravings. Women and men with severe SAD may become suicidal.

Fortunately, a growing body of scientific evidence points to a simple and effective cure. In a study at the Institute of Clinical Neuroscience at St. Göran's Hospital in sun-spare Stockholm, for instance, more than half of a group of 68 male and female volunteers with SAD improved markedly after a short session of light therapy. After just ten sessions of treatment, which involved spending two hours a day in a very brightly lit room, most felt considerably better.

Why does bright light help? Researchers aren't sure. Nor is it clear why some people get SAD in the first place. The hormone melatonin, which regulates many seasonal responses in animals, may play a role, says Brenda Byrne, Ph.D., director of the Seasonal Affective Disorder Clinic at Jefferson Medical College of Thomas Jefferson University in Philadelphia. Bright light suppresses the body's production of melatonin, she explains.

In the Stockholm study, participants spent two hours in bright light. But you may get the same benefit by spending half an hour in front of a light box, says Dr. Byrne. Light boxes are specially designed lamplike devices that emit a wide spectrum of intense light, mimicking sunlight.

"In my experience, about two-thirds of people with definite seasonal affective disorder feel better with light treatment," says Dr. Byrne. (For details on how to use light therapy, see page 210.)

MOOD SWINGS: EVEN OUT
THE HIGHS AND LOWS

"A woman is always a fickle, unstable thing," griped the Roman poet Virgil, one in a long line of men to accuse women of changing their minds and moods too often.

Women do report more mood swings--more dips into depression and more free falls into anxiety--than men. While guys may be just as moody and simply more tight-lipped than we are, the hormonal changes that we undergo after childbirth and before menstruation can affect our moods, says Dr. Beck.

"The trigger may be hormonal," she says. "Or it could be situational--that is, prompted by what is going on in your life."

If you're bothered by mood swings, you may benefit from many of the techniques that help depression and anxiety. Cognitive therapy may also help. When you find yourself slipping into anxiety or depression, ask yourself, "What just went through my mind?" suggests Dr. Beck.

Maybe your mood swing occurred after a friend stood you up for lunch, for example. Perhaps that made you think, 'She doesn't like me anymore. No one does.' Test that hypothesis, says Dr. Beck. Ask yourself if there's any evidence behind that belief. Have all your friends suddenly abandoned you? Probably not. Now ask yourself whether there might be some other explanation for her failure to appear. Maybe she got caught in traffic or her car broke down.

Finally, ask yourself what you might do if the worst scenario were true and your friend didn't like you any longer, she continues. For starters, you could talk to her about the rift. Testing the validity of your thoughts with basic questions like these should help temper your mood swings. (For information on mood swings associated with menopause, see page 437.)

STRESS: ANTIDOTES FOR WHAT LIFE DISHES OUT

Jane Buckle crosses time zones the way most of us cross city limits, jetting between Europe and the United States, teaching and lecturing on aromatherapy. No matter what her destination, Buckle heads for an aromatic bath when