Managing Anxiety and Adrenal Fatigue Syndrome – Part 1
Anxiety and Adrenal Fatigue Syndrome
According to Lam & Lam (2012), anxiety plays a role in the diagnosing, maintenance, and treatment of Adrenal Fatigue Syndrome (AFS). Beginning from the symptoms stage, anxiety is a commonly experienced symptom of AFS and adrenal disorders that directly impacts the quality of one’s day-to-day life. For those who already suffer from AFS, managing anxiety can be an important yet daunting task.
Decreases in energy and overall functioning can result in anxiety-provoking changes in relationships, work, and daily activities that heighten stress about the present and the future. Such experiences present a significant challenge within recovery efforts, particularly as they are exacerbated by the neurochemical imbalances that occurred in stage 3A and onwards.
For those who have progressed to stage 3C, managing anxiety becomes of even greater concern due to the “wired and tired” (Lam & Lam, 2012, p.128) paradoxical reaction to hormonal axis imbalance.
The Importance of Managing Anxiety
Addressing these concerns first necessitates the understanding that there is no direct causal connection between anxiety and AFS. Anxiety does not necessarily precipitate or follow AFS. Rather, both are intertwined within an overall clinical picture that requires a holistic approach to treatment.
This understanding provides the foundation for approaching adrenal fatigue as a syndrome and not a disease, as there is not one defined cause of AFS symptoms, as the latter would suggest. In the case of anxiety, this rings particularly true as treating anxiety from an AFS perspective is based upon the understanding of how physical, emotional, spiritual, and psychological dysfunction has occurred within a greater life context.
One common area of dysfunction for individuals with AFS is within the perception of one’s ability to recover from AFS and return to a prior, more desirable level of health and wellness. As many individuals with AFS have experienced drastic decreases in their energy and motivation levels from previous times in their lives, the gradual healing of the neuro-endocrine system that is required for AFS recovery can be challenging and often feel laborious, tedious, and discouraging, especially if adrenal crashes occur.
In the event that negative attitudes and discouraging appraisals of the future developed as a result of these life changes and remain unresolved, individuals with AFS run the risk of developing health anxiety, which entails the development of dysfunctional beliefs about sickness and health, which leads to misinterpretation of one’s own body sensations and changes (Abramowitz et al., 2010).
Within an AFS framework, anxiety is strongly correlated to the imbalance of norepinephrine and epinephrine within the sympathoadrenal system (SAS) that comprises one part of the autonomic nervous system (ANS). The SAS is a combination of both hormonal and neural systems that utilizes specific hormone messengers (e.g., norepinephrine) to regulate autonomic bodily processes such as blood pressure, body temperature, force of our heartbeats, and our heart rates (See chapter nine in Lam & Lam 2012 for further information).
Involved in both priming our bodies for simple stressors (e.g., standing up), severe stressors (e.g., public speaking) or even emergencies (e.g., flight, freeze, or fight response) the SAS operates outside of our awareness and is critical for our daily lives.
When experiencing such stressors on a chronic basis, however, the SAS becomes over-activated, leading to the production of larger than normal amount of stress-related hormones. Such imbalance triggers increasingly more intense and longer lasting bodily sensations including increased heart rate, increased energy that does not feel natural, and increased sense of impending doom. With all of the physical responses taking place, managing anxiety can often seem overwhelming.
Individuals with AFS often experience these sensations as they progress through the AFS stages, particularly in the progression from disequilibrium to adrenal exhaustion in stage 3C. As these symptoms occur more frequently, and/or require more time to dissipate, individuals seeking causal explanations for their experiences begin to focus on their health to find relief and solutions and/or seek increasing social support for perceived health concerns.
Such pursuits, while expected and within the natural range of human reaction to illness, can become problematic and develop into health anxiety when hormonally-induced physical sensations resulting from chronic stress are mis-attributed to one’s and/or others’ inability to respond to the challenges at hand. Reoccurrences of unwanted physical sensations are thus regarded as signs of failure and/or personal or other ineffectuality, leading to more activity and more stress which further exacerbates an already overloaded SAS.
Much of what we know about health anxiety arises out of research on anxiety and chronic diseases and/or conditions such as diabetes, heart diseases, cancer, and chronic pain. Within each of these medical conditions, greater amounts of health anxiety have been shown to result in more negative views of the future, doubts about one’s ability to affect lifestyle change, fear of becoming gravely disabled, psychological impairment, and high medical utilization (Tang et al., 2009; Poulsent & Pachana, 2014; & Jones et al. 2012).
High levels of health anxiety can result in psychiatric conditions such as Illness Anxiety Disorder (APA, 2013). This disorder is characterized by a preoccupation with seeking reassurance from others, belief that one’s health issues are not taken seriously, performing excessive health-related behaviors (e.g., bodily checking and/or searching the internet for disease-related information), or engaging in avoidant behaviors (e.g., not taking supplements), particularly in the absence of a diagnosed medical illness or condition.
As AFS shares many common features with chronic diseases and/or conditions, such as the existence of a continuum of severity along with prolonged recovery times, it is helpful to examine the impact that health anxiety can have on the healing process. For example, for some individuals with AFS, the gradual progression of healing and/or the waxing and waning of their symptoms could be easily misinterpreted as either complete success or failure in their recovery efforts due to their health anxiety.
Dysfunctional beliefs at either of these polarities could find AFS suffers being either unnecessarily discouraged or overly confident, resulting in inaccurate assumptions, behaviors, and attitudes that can delay the recovery process. For example, the thought of “I am never going to get better” can increase avoidance behaviors, such as failing to adhere to nutritional and supplement protocols that exacerbate feelings of depression or anxiety when no progress is made. On the flip side, unrealistic beliefs or expectations of the recovery process based upon a desire to find a “quick fix” can lead to over-exertion at the moment of first improvement, leading to adrenal crashes and increased difficulties with hormonal axis imbalance.
The premise of addressing maladaptive beliefs about AFS recovery begins with the understanding that health anxiety is a dimensional rather than a categorical construct. It is expected that individuals experience anxiety in relation to changes in health and physical ability, and thus anxious thoughts about one’s recovery process do not equate to having health anxiety. Essentially, it is not the presence of anxiety that is crucial, but rather, how one goes about managing anxiety. Thus, the goal for treating health anxiety and AFS is to address concerns about health and wellness across a variety of dimensions that promote lifestyle change such as:
Managing Anxiety: Breathing as Therapy
As AFS is tied to over-stimulation of the ANS and SNS, which are both involved in activation of the bodily system for action, the utilization of the parasympathetic nervous system (PNS) becomes critical in slowing down bodily processes. Adrenal breathing is an effective way to tap into the stress modulating function of the PNS, as additional oxygen supplied to the body serves to reverse the overuse of the ANS and SNS in response to stress.
Instead, increased oxygen slows down one’s heart rate and lowers blood pressure, which allows for an increased ability to respond to stressors instead of reacting to them through an increased sense of calm and stability. See Lam and Lam (2012) for complete details on adrenal breathing.
© Copyright 2014 Michael Lam, M.D. All Rights Reserved.
Dr. Lam’s Key Question
How do jittery-ness and internal anxiety differ? Is there a cellular difference?
Jitteriness and internal anxiety are feelings that a person with advanced AFS may feel. It is a fight and flight reaction to stress.
Thanks so much Dr. Lam. I really appreciate this information. Somehow I couldn't find any of this in any of my reading material?