Controlling Anxiety is Essential in Adrenal Fatigue Recovery
Engage in Supportive Relationships
Continual engagement in unsupportive relationships poses a risk for individuals with Adrenal Fatigue Syndrome (AFS), as the resulting stress delays the healing process. Research has demonstrated that interpersonal conflicts leading to feelings of social rejection, loneliness, and social isolation have been shown to delay recovery from illness due to increases in inflammation of bodily tissue (Murphy et al, 2012). Furthermore, Dr. Lam details in his book that a cycle of increasing need for cortisol arises in response to stress reactions that result from engaging “toxic relationships” (Lam & Lam, 2012, p. 372). Such increases over time can lead to eventual depletion or imbalance of hormones that result in adrenal fatigue. Finding and developing supportive relationships then becomes critical in controlling anxiety in response to worsening symptoms of AFS. This process can be difficult to engage due to questions on how one develops supportive relationships or how one might change or leave existing toxic relationships. See Dr. Lam’s book for further details.
Grieving Over Multiple Losses
As AFS can dramatically impact one’s ability to engage in every day activities such as work, school, social relationships, and recreation, it is critical that these changes are acknowledged and explored as losses within the context of one’s total life context. Ignoring or denying the impact of such losses represents an inaccurate perception of one’s reality that forms the basis for issues with controlling anxiety and health.
While it was once proposed that grieving occurred in stages, and that individuals processed grief in a sequential manner, alternative approaches have challenged this idea in response to the reality that grieving is not predictable, organized, or formulaic. Each individual experiences grief in different ways, with a range of emotions and behaviors experienced at different times during the grieving process.
One such model that reflects this approach views grieving as the completion of four tasks: accepting the loss, experiencing the resulting pain, putting the loss into perspective, and adjusting to our changed world (Worden, 2002). Throughout these tasks, individuals may encounter a range of emotions as they engage in the work of grieving, and they alternate back and forth between tasks depending upon life circumstance.
Common emotions include: numbness, disbelief, disorganization, despair, and finally reorganization. It is then critical not only to allow for grieving to occur within one’s recovery from AFS, but also to accept that the grieving process is not linear in nature and that a resolution of grief involves time, hardship, and commitment to adjusting to new perspectives and behaviors.
Controlling Anxiety: Altering Thought Patterns
The way we think about illness and health can be a pivotal factor in recovery efforts and our experience of controlling anxiety. Specifically, the basic cognitive templates that we employ to organize information and make decisions can determine the degree in which we find an illness to be threatening.
This relationship has been demonstrated within studies that have examined why individuals with similar medical diagnosis have demonstrated variability in their levels of controlling anxiety about their health, as it was discovered that health anxiety levels were dependent upon an individual’s cognitive assessment of the following four dimensions (Hadjistavropoulo, 2012):
- Perceived likelihood of contracting or having an illness;
- Perceived awfulness of the illness;
- Perceived inability to cope with the illness; and
- Perceived inadequacy of medical resources for treating the illness.
Controlling anxiety about health issues was found to be more common in those individuals who scored higher across these four dimensions, signaling that perceptions do play a role in the recovery process. For individuals with AFS, the intensity of one’s health anxiety within each of these dimensions thus determines the degree in which one may be experiencing psychological dysfunction.
For example, if one perceives AFS to be highly awful, in addition to feeling unable to cope with the illness, there is an increased risk for the development of detrimental side effects of health anxiety such as depression. The first step in preventing such negative effects is to recognize how our cognitive templates impact our emotions and behaviors in both adaptive and maladaptive ways. The task then becomes to build up our adaptive cognitive templates (e.g., “I am a survivor”) in order to reduce the influence of maladaptive cognitive templates (e.g., “Things never work out”).
Controlling Anxiety: Developing Problem Solving Skills
Preoccupation with one’s health status can interfere with problem solving because the greater the perceived threat, the more likely one is to limit the range of options or actions in order to avoid a feared outcome, particularly when operating from a position of anxiety.
Having a systematic approach to decision making, however, can help lessen decision-making difficulties in times of high anxiety and provide guidance for many of the decisions faced during AFS recovery that are within our power to control, and can help with controlling anxiety. One such framework is as follows (Wright, Basco, & Thase, 2006):
- Slow down and sort it out.
- Define the number and magnitude of problems and the urgency of resolving them
- Compile a problem list
- Pick a target.
- Organize the list based on urgency
- Eliminate problems that you have no control over or problems that belong to others and cannot be resolved by you
- Define the problem accurately.
- Be able to describe the problem in few words
- Identify how you would know that progress had been made
- Generate solutions.
- Avoid locking in on only one solution
- Be creative and consider:
- using the assistance of others
- doing research
- delaying implementation of the plan
- considering not solving the problem at all, but learning to live with it
- Select the most reasonable solution.
- Eliminate solutions that are unrealistic, are not likely to be useful, cannot be easily implemented at present, or could cause more problems than they solve
- Choose several possible solutions and weigh the advantages and disadvantages of each
- Implement the plan.
- Increase the success of the plan by selecting specific day(s) or time(s) the plan will be carried out
- Troubleshoot various scenarios that might interfere with the success of the plan and develop alternative options
- Evaluate the outcome and repeat the steps if needed.
- Sometimes great plans fail
- Examine any unforeseen circumstances or elements of the problem that were not fully considered
- Correct any inaccuracies or dysfunctional thinking about self or others and try again
Learn to Make Meaning
While problems solving strategies and techniques may be effective in controlling anxiety within situations where the perception of control is high, these same strategies have not been shown to be as effective in situations where perception of control is low.
Such a situation presents itself when one is diagnosed with a life-altering illness such AFS, as many individuals feel as if their body has betrayed them and is now responding in ways outside their control. Park (2013) addresses this same dynamic within her work with cancer patients and proposes a meaning-making model of coping for individuals trying to come to terms with a life-changing diagnosis.
This model is built upon the understanding that we construct both global and situational aspects of meaning in our lives, and that stress occurs when we perceive discrepancies between these two aspects of meaning. Global meaning refers to an individual’s general orientation system that includes how one perceives and understands oneself and the world. That includes beliefs concerning fairness, justice, luck, control, predictability, benevolence, and personal vulnerability.
In contrast, situational meaning is derived from initial appraisals of particular situations that include causal attributions, primary appraisals (threat, loss, and challenge), and one’s perception of his/her ability to cope.
Receiving a diagnosis such as AFS thus presents the potential to violate or even shatter an individual’s global meaning system, which in turn initiates both cognitive and emotional processing (meaning making efforts) in efforts to reconcile situational with global meaning.
This involves understanding and conceptualizing the stressor in a way more consistent with one’s global beliefs and values in order to engage in a process of assimilation and accommodation of events beyond one’s control. If conducted in a sustained and successful manner, such a process has been show to improve adjustment to life-changing stressors leading to improved mental health outcomes.
One way to support meaning-making efforts is to engage and cultivate spiritual pursuits as defined by a “personal or group search for the sacred” (Park, 2013, p. 262). Such sacred encounters have been defined as containing the following elements: sense of being overwhelmed, a feeling of fascination, a sense of mystical awe, and an experience of intense energy.
These elements inform the understanding of spirituality as being of the nonmaterial world that transports us from the material world that we experience with our five senses (Sperry & Shafranske, 2009). While this is only a brief introduction to an immense topic, the applications to recovery from AFS and health anxiety lies in the need to pursue transcendent, nonmaterial experience in order to fully embrace events outside our control and find meaning in something apart from our physical health.
Such a commitment allows for greater acceptance of the physical changes that accompany AFS, and provides support for the meaning-making process in response to stress and controlling anxiety. An example of this is highlighted in Dr. Lam’s final chapter entitled, “A Return to Simplicity: The Ultimate Solution.” Here, individuals affected by AFS are encouraged to seek a simpler life to promote healing and recovery through strategies that de-clutter and simplify one’s life while also improving personal relationships.
Despite the fact that these recommendations are not directly linked to bodily processes, they are critical within the AFS recovery process as they promote openness and availability to spiritual experiences which have been shown to increase one’s ability to cope with life-changing illnesses, leading to a powerful sense of relief and comfort (Park, 2013).
Abramowitz, J.S., Taylor, S.M., Dean, M. (2010). In: Cognitive-behavioral therapy for refractory cases: Turning failure into success. McKay, Dean (Ed.); Abramowitz, Jonathan S. (Ed.); Taylor, Steven (Ed.); Washington, DC, US: American Psychological Association, 327-346.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC.
Jones, S. L., Hadjistavropoulos, H. D., Sherry, S. B. (2012). Health anxiety in women with early stage breast cancer: What is the relationship to social support? Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 44(2),108-116.
Hadjistavropoulos, H. D., Janzen, J. A., Kehler, M. D., Leclerc, J. A., Sharpe, D., & Bourgault-Fagnoue, M. D. (2012). Core cognitions related to health anxiety in self-reported medical and non-medical samples. Journal of Behavioral Medicine, 35, 167-178.
Lam, M., & Lam, D. (2012). Adrenal Fatigue Syndrome: Reclaim Your Energy and Vitality with Clinically Proven Natural Programs. Loma Linda, CA: Adrenal Institute Press.
Park, C. L. (2013). In: The psychology of meaning. Markman, Keith D. (Ed.); Proulx, Travis (Ed.); Lindberg, Matthew J. (Ed.); Washington, DC, US: American Psychological Association, pp. 257-277.
Poulsen, K. & Pachana, N. A. (2012). Depression and anxiety in older and middle-aged adults with diabetes. Australian Psychologist, Vol 47(2),90-97.
Sperry, L., & Shafranske, E. P. (2005). Spiritually Oriented Psychotherapy. Washington, DC: American Psychological Association.
Tang, N., Salkovskis, P.M., Hodges, A.S, Elaina, H., Magdi, H. & Hester, J. (2009). Chronic pain syndrome associated with health anxiety: A qualitative thematic comparison between pain patients with high and low health anxiety. British Journal of Clinical Psychology, Vol 48(1),1-20.
Wright, J. H., Basco, M. R., & Thase, M. E. (2006). Learning Cognitive-Behavior Therapy: An Illustrated Guide, Arlington, VA: American Psychiatric Publishing.
© Copyright 2014 Michael Lam, M.D. All Rights Reserved.