Managing Anxiety and Adrenal Fatigue Syndrome – Part 1

By: Jonathan Wong, Psy.D.

Anxiety and Adrenal Fatigue Syndrome

Managing anxiety and Adrenal FatigueAccording to Lam & Lam (2012), anxiety plays a role in the diagnosing, maintenance, and adrenal fatigue treatment. 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.

Managing anxiety may help with chronic painMuch 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

Breathing techniques for managing anxietyAs 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.

Read Part 2 Now!

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Jitteriness and internal anxiety are feelings that a person with advanced AFS may feel. It is a fight and flight reaction to stress.

Managing anxiety
5 - "Thanks so much Dr. Lam"
Thanks so much Dr. Lam. I really appreciate this information. Somehow I couldn't find any of this in any of my reading material?


  • Ryan says:

    I know magnesium can help calm the body, but can it help to de-stress too?

  • Shawna says:

    Is all anxiety curable through natural methods?

  • Pierre says:

    This was a very good read and explains why anxiety can be so much more than just a mental/emotional thing. It’s great that someone understands.

  • Sonia says:

    Anxiety has been so prevalent in my life, I think I have forgotten what it’s like to just feel “normal”. Ever since I was a child, I always noticed I was uncomfortable in crowds and around new people as well as even around people I knew. Now that I’m older, I can’t hardly deal with any stress before going into a full blown panic attack. Are there ways to get rid of this for good??

    • Dr.Lam says:

      Increase parasympathetic tone. Click CD – Adrenal Breathing Exercise for more information.


    • Hannah Tanowitz says:

      I have suffered from Generalized Anxiety for as long as I can remember — and I’m a person of a certain age. My brother was so crippled by anxiety that he received Disability payments. Both parents were over-the-top anxious, too. I’ve tried prescription drugs and herbal remedies of all kinds.I have received acupuncture and Chinese herbs; I have seen shamans, energy healers, medical intuitives, etc. Nothing helped. UNTIL I DISCOVERED CBD (cannabidiol). CBD is an extract of either industrial hemp (usually) or a high-CBD strain of cannibis sativa. If CBD has less than .03% THC, it can be sold over the counter in the US. I take a drop or two under the tongue once or twice a day, and the anxiety disappears. I’m not kidding! I discovered this effect when I took a few drops of CBD for severe gastrointestinal distress. Not only did the CBD allow me to eat again, it reduced the anxiety to almost zero. If you do a search for CBD oil, CBD tincture, CBD pills, CBD cream, you will get the information you need. Be sure to check out the percentage of CBD in the product before buying it, as all CBD products have different amounts of CBD in them.

  • Santiago says:

    Other than diseases, can life stressors also lead to AF and anxiety — for example, college students?

  • James says:

    Is it a good idea to use magnesium for anxiety?

    • Dr.Lam says:

      Magnesium has relaxation properties. In some people it can have an excitation response.


  • Tad says:

    Thanks for this insightful article on the importance of managing anxiety!

  • Blake says:

    Anxiety is a huge factor when it comes to dealing with adrenal fatigue. Thank you for taking the time to explain why in this article!

  • sp says:

    Hi Dr. Lam,

    I recently had surgery to remove my left adrenal gland because of a tumor that was causing high levels of cortisol and cushings syndrome. Now I am taking hydrocortisone and weaning it gradually so as to wake up my right adrenal. But recently I have been feeling a lot of depression and anxiety. What should I do? Should I take any medication for anxiety (don’t want to)? Should I increase hydrocortisone? (but it might delay the recovery process) . Should I try breathing, meditation, therapy? Thanks for any help!

    • Dr.Lam says:

      You will need to talk to your doctor and perhaps look more closely at the medication replacement you are on. Some people may need it longer than others. Everyone is different.

      Dr Lam

      • sp says:

        Dear Dr. Lam, will adrenal breathing help with my anxiety although my remaining adrenal gland is not working yet. Thanks.

  • Heather says:

    Is there any way besides breathing ti help anxiety

    • Dr.Lam says:

      Meditation and supplements also can be helpful. Breathing is one of the best ways if you do it right. My adrenal breathing exercises are very powerful. Be careful not to overdo as it can trigger more anxiety.
      Click CD – Adrenal Breathing Exercise for more information.

  • Kerrie says:

    My doctor just prescribed me Inderal for panic attacks…I am certain I have adrenal fatigue from the anxiety but the doctor basically told me the dizziness, brain fog etc is just in my mind….will the Inderal make me feel worse? My BP doesnt get much more than 100/60 so I’m worried if it gets lowered from the medication i will be passing out. The doctor took my blood pressure before prescribing but said it was “normal”.

    • Dr.Lam says:

      The beta blocker you are prescribed is designed to slow down heart rate and BP. Too low is not good, and your doctor will titrate for you. The problem long term is that once you are on, its very hard to get off, and over time, dosage may increase if the underlying issues are not resolved. Talk to your doctor about an exit plan.

      Dr Lam

  • Karol says:

    You always have the appropriate article that I need at the right time. I am experiencing this health anxiety now even though I know I am healthy and try to disregard it. Can you explain a little bit exactly what an adrenal crash is and how you know that is what it is. I am assuming that what I have been experiencing every year for the last 4 years is an adrenal crash, high blood pressure, cortisol off the charts during 24 hr period, excessive energy etc. Any suggestions on what to do at this time when this happens because doctors can’t tell me anything including the naturopath that I went to for 6 months.

  • Desiree says:

    I have found the breathing exercises to be very helpful!

  • Doug says:

    Why is is so hard to relax after hyperventilating? It seems like it takes way longer to calm down than it does from being scared or nervous or even really angry.

    • Dr.Lam says:

      The body can release excessive amount of adrenaline in that process which prevents relaxation response

      Dr Lam

  • Sarah says:

    Hi Dr Lam
    I started having really bad anxiety after the birth of my baby 7 weeks ago and I’m extremely exhausted, is this related to AFS? I have your book but unfortunately I have no energy or time to read the whole thing now, is there a chapter I can focus on right now to help me?
    Thank you again

  • Gerland says:

    I know anxiety can lead to nervous twitches, but does AF contribute to this at all?

    • Dr.Lam says:

      AF can trigger the autonomic nervous system that lead to release of the neurotransmitter norepinephrine which travels to the brain and trigger anxiety.

      Dr Lam

  • Nicole says:

    Thank you so much for writing this article it was so informative

  • Guenny says:

    I have not read on to the second part of the article, but Im wondering if there are internal and external anxieties. some times I can get anxious from with in, self induced, and some times, it feels that some can trigger the anxiety. Is this the same ? Thanks for your time.

  • Sandi Brown says:

    Hi, have you done any research in conjunction with adrenal fatigue post the gardasil vaccine?

  • Marcus says:

    Are the adrenal breathing exercises okay for someone with moderate asthma?

    • Dr.Lam says:

      It is good for anyone with the intent to reduce sympathetic tone. Because I dont know your body , I could only recommend you check with your doctor first as precaution

      Dr Lam

  • Theresa says:

    how can you tell when you are stage 3C of adrenal fatigue? i feel this level of anxiety consistently but i’m unsure of how to gauge the “wired and tired” symptoms you mentioned.

  • Jeff says:

    As someone who has suffered from anxiety for years, i find this article very helpful. Thank you for the information!

  • Anonymous says:

    What are the benefits to using an air purifier to improve the quality of air when doing breathing as therapy?

    • Dr.Lam says:

      Unpolluted air is always good, regardless of whether it is available during breathing exercise or not.

      Dr Lam

  • Eugene Swanepoel says:

    Dr Lam – God is using you in a mighty way to educate and bring hope to people.
    I am confident that I will be healed from AFS!
    Thank you
    Eugene from Pretoria, South Africa

    • Dr.Lam says:

      To be able to contribute and help is a privilege. We try our best . Anxiety is a big component to AFS. The adrenal breathing exercise can be very helpful if you do it right. I wish you rapid recovery.

      Dr Lam

  • Anonymous says:

    Do you know much about hyperventilation syndrome? Could long term stress lead to this syndrome and in result the patient can’t feel a deep breath or has constant air hunger ? Is this from AFS or the breathing syndrome . My daughter has CFS and Fibro but the main issue continues with her not being able to take or feel a deep breath?

    • Dr.Lam says:

      not being able to take a deep breath is common in AFS. Lab test are normal, and heart function is fine. It usually comes in the form of breathlessness and cannot go up stairs without short of breath. it usually reflect some form of neurotransmitter imabalance if all else is normal. It reflects an underlying cardionomic dysregulation. there is no laboratory test for this. good news is that it usually improves when adrenals get better, but can also get worse if the proper recovery is not deployed and the body gets more decompensated.

      Dr Lam

  • Kellen Grey says:

    I am blessed to have found this information . Thank you Dr Lam.

  • Norman Cramer says:

    Great information explains exactly what I have been going thru in a clear and precise way

    Thank you

  • Ronaldo James says:

    anxiety got to the point where i nearly thought i couldnt take it anymore. once i learned how to really find out what was causing the anxiety, i was able to slowly but surely overcome. great article for anyone who is suffering these symptoms

  • Rochelle P. says:

    I’ve suffered from anxiety for as long as i can remember! So helpful being able to read information that i can relate to.

    • Newsletter says:

      Glad that you find this article helpful. The more advance the AFS, the more anxiety it tends to be. So do take care of it is good. The adrenal breathing exercise is excellent to help out as it reduces adrenaline which is a common cause of anxiety.

      Dr Lam