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Anxiety, TIEs, and Faith

Anxiety disorders are the number-one mental
 illness in America, affecting 40 million people over age 18. But not all anxiety is an illness. In fact, there are few people who have not felt highly anxious at some point in life. There is a number of anxiety disorders, including: generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and various panic disorders.

During my psychiatry residency, which I completed in 1978, none of these alphabet soup diagnoses existed. We talked about “anxiety neurosis,” which involves unresolved conflict. Suppose your boss is demeaning, rude, and disrespectful to you. You need the job and are afraid that giving an honest response could get you fired. You’re likely to feel hurt, angry, and afraid, but choose to just “stuff” your emotions. You feel stuck, conflicted, and that can make you feel anxious.

What we call “anxiety” is actually a continuum, starting with concern, then worry, stress, anxiety, panic, fear, and terror. By understanding anxiety as part of this continuum, we can see it less as an illness and more as a larger problem of life. Anxiety is not a new phenomenon. Several years ago I read a quote by Jesus that caught my attention. “Why worry about tomorrow when you have enough to worry about today?” When I read that, I said to myself, “Not much has changed. I thought that a simpler time, with simpler lives would have been less anxiety-producing, but apparently that is not the case.”

Panic Disorders

In panic disorder a person suddenly becomes overwhelmed with anxiety. Their heart races and they feel a sense of impending doom. The first time it happens an individual often goes to an emergency room because he thinks he’s had a heart attack. Lab tests and an EKG don’t show signs of a physical problem. The next panic attack might come a week later or months later. They are unpredictable. As panic disorder progresses, there are more and more attacks without any consistent time frame. Because of their unpredictability, the individual starts feeling anxious in between attacks, experiencing “anticipatory anxiety.” A doctor needs to explain the difference between the sudden panic and the long stretches of anxiety in between because they usually need to be treated separately.


After 60 years use of anti-anxiety medications, we actually don’t know very much about the biology of anxiety. But here is one theory that makes sense. Anxious people tend to be very shallow breathers, so much so that the lowered blood oxygen content can lead to severe muscle spasm and cramps. Persistent muscle cramping can cause a buildup of lactic acid, which makes people anxious. So, it’s a vicious cycle. Anxiety leads to shallow breathing, which raises lactic acid levels, which in turns makes us more anxious.

Many people want the doctor to, “Do something about the anxiety now.” It can take a lot of work to convince someone that learning breath techniques is one of the most important things they can do—now. If a person is only treated with medications, herbs, or nutritional supplements, they are not likely to move through their anxiety. Learning specific mental fitness techniques, including use of the breath, will cut anxiety in half while empowering people. By participating in one’s healing process and practicing specific breath and meditation techniques, the chances of moving through anxiety go way up.

Imagine that your lungs are two large balloons. With deep abdominal breathing you want your lung balloons to fill from the bottom first, and the top second. When you practice abdominal breathing, sit comfortably and place one hand on your abdomen. With a deep breath your hand will move out at least one inch as your diaphragm pulls in the air. When you can see your hand at your waistline moving 1 or 2 inches, you’re breathing deeply.

A second important breath technique is called the “4, 4, and 8 breath.” Inhale slowly to the count of 4. Hold your breath to the count of 4. Slowly exhale to the count of 8. It takes about 20 seconds for one 4-4-8 breath. Two of these breaths will start to relax you right away, moving you out of fight-or-flight physiology. This gets easier with time as you strengthen the muscles involved with breathing.

Because most of us are disconnected from natural breathing, it’s helpful to structure breath techniques into our day. Take two 4-4-8 breaths at the top of the hour, and take several deep abdominal breaths every 15 minutes. In this way you interrupt the buildup of stress and anxiety that occurs for many of us every day. Taking a few conscious breaths every hour is far from what we need but it is definitely enough to decrease anxiety. If people don’t structure healthy breathing into their daily life, 7 days a week, their anxiety may continue to rise until the individual feels out of control.

Change Negative Thought Patterns

Anxiety is about the future, about concerns that things will not work out well tomorrow, next week, or ever. Cognitive Behavioral Therapy identifies the main kinds of cognitive distortions. 1) Worst case scenarios. Given an upcoming event the anxious individual thinks about the worst thing that could happen. 2) All or nothing thinking. There’s no middle ground. 3) What if? 4) Overgeneralization. “This kind of situation always turns out badly.” 5) Seeing only the negative (which makes the positive invisible). If we expect the worst, the worst is likely to happen. Our expectations have a lot to do with how we feel about ourselves and the world. Negative expectations are likely to lead to negative outcomes.

The Vicious Cycle of TIEs

We start with a core negative belief, which leads to a negative “thought-image-emotion (TIE).” TIEs are what your mind “is.” This term “TIE” came to me recently while pondering the close relationship between thought, image, and emotion. Your TIE automatically leads to words and actions. Negative TIES lead to negative outcomes, which reinforce the negative beliefs that lead to ever-increasing anxiety.

Core beliefs are very deep and generally unconscious. Core beliefs are what make up the ego. These core beliefs are the fires that set TIES in motion. These beliefs include: 1) The world is a dangerous place. I need to be on guard. 2) I am an unlovable person. In order to be loved, I must do what the other person wants. 3) I am a flawed person. 4) People are generally hurtful. In order to feel safe, I can’t trust others. 5) Things will never get better.

Six Techniques for Relieving Anxiety

1. Identify and change negative thoughts.

2. Reframe. Switch from thinking that you have anxiety to, “I feel anxious.”

3. Practice a “positive outcome” imagery technique.

4. Breathe. Take two 4-4-8 breaths on the hour and several deep abdominal breaths every 15 minutes.

5. Meditate. There are several main forms of meditation. They all aim at slowing down and quieting the mind. The faster your mind goes the more anxious you are likely to feel. A still mind is free of thoughts, including anxious thoughts.

6. Exercise. If you’re in the midst of feeling severe anxiety, go for a long, brisk walk, or go jogging, cycling, or swimming. If you’re physically healthy, exercise until you are tired. You will feel more peaceful. And with brisk exercise you are breathing deeply the entire time.

Anxiety and Faith

The spiritual issues associated with anxiety are the clearest of any unpleasant mental state. Those issues are lack of faith and lack of inner peace. Anxious people fight to not feel anxious. But it’s more powerful to focus on a positive, such as “attaining inner peace,” rather than fighting a negative. Peace does not come to you because you found the right medication or nutritional supplement.

Faith, the main spiritual issue related to anxiety, almost always involves something greater than yourself. If you believe that God or a Higher Power is deeply involved in your life in a loving, protective way, you have the faith that everything works out. Faith is a core belief. If you’re lacking faith, pray for faith. Lack of faith is the underlying cause of anxiety. Buddhists don’t pray to God, but research shows that their prayers are as effective as those who pray to God. With faith you live with the core belief that everything happens for a reason. Whether life hands you something “good” or “bad,” faith helps you glide through life.

In the next issue we’ll focus on physical approaches that alleviate anxiety.

David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. His book Are You Getting Enlightened Or Losing Your Mind? is now available in bookstores and online.