Episode 31 -- July 30, 2020

A little anxiety can propel you through a happy, successful life, like a motor on a boat. But too much anxiety is a bad thing--even if it's just a little too much. Being "almost" anxious limits your ability to pursue your interests and risk new experiences. This, in turn, drags down your quality of life and well-being. In this era of coronavirus, it's helpful to revisit three essentials in the anti-anxiety toolbox. In this excerpt from her book, Almost Anxious: Is My (or My Loved One's) Worry or Distress a Problem?, Dr. Luana Marques reminds us how good sleep, healthy food, and regular exercise will help us maintain mental health, even in uncertain times.

This excerpt is from Almost Anxious by Dr. Luana Marques and has been edited for brevity.

If there's one thing we all know, it's that Busy Lives Pull People Away from the Basics.
In my work, there are times when I feel stretched so thin that I wonder how anything will get done. My hours are stuffed with the same types of obligations that make modern life so hectic for many people.

You, too, will always have multiple demands competing for the same pool of time:

• your personal needs, including your roles as a family member (mother, father, daughter, son, and so on)
• work needs (scheduled work hours, late nights and weekends on special projects)
• social needs (activities with friends and family
• physiological needs (eating, sleep, and exercise)

Unfortunately, the first needs that usually go unanswered when people are stressed are the activities that actually keep almost anxiety at bay. These needs include proper nutrition, relaxation, and exercise. Researchers have found that people who are asked to complete a stressful task are more likely to snack on unhealthy foods (like candy or chips) than healthy foods (like fruit or nuts), as compared with people who are asked to complete a nonstressful task. Research also confirms that greater stress is associated with a greater drive to eat, including binge eating.

In addition, plenty of research suggests that anxiety and stress are associated with poor sleep quality or insomnia and a sedentary lifestyle. If you neglect any of these needs, you are more likely to become almost anxious (or gain a full-blown anxiety disorder). My own clinical practice experience parallels the scientific data. Several of my patients have trouble differentiating their anxiety from their hunger or fatigue.

People manage to prioritize their schedules enough to get certain things done. So why is it that so many people don't put their physical health into the equation? Why is it that so many take better care of their cars than their own bodies and minds?

In some ways, our needs as humans--eating, sleeping, and exercising--are analogous to the needs of our cars. Your mind can perform nimbly, hopping from task to task and zooming from zero to sixty in an instant. Your car may also handle like a dream, zipping around curves and responding with a burst of speed the moment you need it. But if any of your car's basic needs is left unmet--a leaky tire, a dead battery, or an empty gas tank--you're not going to enjoy its fine-tuned driving abilities. Likewise, if you ignore any of your basic needs, you're not going to be able to race between your obligations with your mind shifting gears smoothly while you operate at peak concentration and just the right level of anxiety.

In this section, I will discuss the three most important bodily needs--good nutrition, sleep, and exercise--that you must address before you can bring your almost anxiety down to an optimal level.

I know that people have been telling you since grade school that you need to eat better, go to sleep earlier, and exercise more. (These steps are seemingly prescribed as the solution for most of our mental and physical health woes!) But they truly are the foundation for taming almost anxiety. Plenty of studies point to a back-and-forth relationship between anxiety and eating, sleeping, and exercise. For example, researchers found that high anxiety predicts the onset of insomnia, and insomnia predicts future episodes of anxiety. I see this relationship in my own office. Patients who are sleep deprived often complain of heightened anxiety. Conversely, patients who are under a lot of stress are more likely to have sleeping problems.

The good news is that making healthy lifestyle choices can help reduce your anxiety. As such, it's time to repair each one of these issues before learning more advanced skills to decrease your almost anxiety.

First, we'll look at the Role of Food in Managing Almost Anxiety.
Sometimes people have trouble knowing whether they're anxious or hungry. This is especially true for those who have lived with moderate levels of anxiety for a while.

These steps for healthier eating have helped many of my patients:

• First, always make sure your pantry, refrigerator, and cupboards are well stocked with a variety of nutritious foods.
• Carry a healthy snack with you.
• Don't wait until you are hungry to eat. Eating small meals and snacks throughout the day helps keep your glucose level steady, which lessens your almost anxiety.
• And find a support person (or people) to help you. If you are trying to change any of your habits, having someone you can call on for encouragement and understanding helps. This is especially true when you are changing your eating habits, as you are likely to often eat with other people. Let your support team know about the changes you're trying to make, and ask for their help.

Next, we'll look at how sleep can be the "Overnight" Method for Dealing with Almost Anxiety.
According to research, being sleep deprived can raise your anxiety level signi¿cantly, and vice versa. Researchers have found that people who have been diagnosed with anxiety disorder have an increased risk for insomnia and shorter sleep duration.

If you are consistently sleeping fewer than six hours a night, if you have trouble falling asleep or staying asleep, or if you wake up feeling tired or sluggish, chances are good that you would bene¿t from better sleep. Practice the following sleep guidelines for at least two weeks while you keep tabs on your almost anxiety symptoms.

Here are the Dos and Don'ts for Better Sleep:

• Do Practice relaxing exercises, such as stretching or calming yoga.
• Do Use your bed for sleep and sex only.
• Do Engage in relaxing activities before going to bed, such as taking a warm bath, reading a novel, or meditating.
• Do Eat a small snack before bed--being hungry can interfere with sleep.
• Do Get out of bed if you can't fall asleep after twenty minutes; then practice relaxing activities.
• Do Maintain a regular sleep cycle, with consistent sleep and wake time.
• Do Get out of bed if you wake up in the middle of the night for fifteen minutes or more.
• Do Keep a comfortable temperature in your bedroom.


• Don't Use stimulating devices (such as a computer, TV, or iPad) before bed.
• Don't Drink alcohol close to bedtime.
• Don't Stare at a clock--this is guaranteed to keep you up worrying.
• Don't Exercise vigorously before bed.
• Don't Smoke close to bedtime--nicotine is stimulating.
• Don't Drink coffee or eat chocolate right before bed--caffeine is stimulating.
• Don't Have disrupting light and noise around while in bed.
• Don't Take worries to bed.

Last, we'll look at how you can Use Exercise to Keep Your Battery Charged,br/> You don't have to be cycling 100 miles a week or bench-pressing your weight to see improvements in your almost anxiety. For most of my patients, one of the major roadblocks to starting an exercise routine is their overestimation of just how much activity they need to do.

The truth is, people will always face challenges when trying to add new commitments to their already busy lives, especially an activity that can trigger negative thoughts (such as "I'm already tired--why wear myself down into sweaty exhaustion?"). But if you don't incorporate exercise into your life, your almost anxiety is likely to continue.

Here's how to make room in your life for more activity:

• Remember that you don't have to go overboard! I hold with the U.S. Surgeon General's suggestion of at least 150 minutes of moderate-intensity physical activity per week for adults; this means as little as 30 minutes a day, ¿ve days a week. Moderate intensity means a level that would allow you to carry on a conversation while you're exercising without gasping for breath.
• Start with activities you like. Exercise can be challenging enough without diving into an activity you don't even enjoy.
• Start small. It's nearly impossible to change your habits overnight.
• Set goals. Most people get their work done, do their grocery shopping, and throw their laundry into the washer and dryer every week, but many have a much harder time staying active. If this sounds like you, a great way to get started is to set measurable goals. Even a little more physical activity is better than none when it comes to reducing your almost anxiety.
• Monitor your progress. Recording your activity helps reinforce your behavior and increases your motivation to stick with it.
• Bring a friend. To help you get your batteries recharged, look for a reliable support person who also wants to get moving.

You can do it. You can manage it. For more information about how to live your life with anxiety, read Almost Anxious by Dr. Luana Marques.

About the Author:
Luana Marques, PhD, is an assistant professor of psychology at Harvard Medical School, the director of psychotherapy research and training at Massachusetts General Hospital and Harvard Medical School, and the director of the Hispanic Clinical Research Program at Massachusetts General Hospital and Harvard Medical School. Her groundbreaking research focuses on the presentation and treatment of anxiety disorders, with a particular focus on cultural differences in the phenomenology of anxiety as well as the dissemination and implementation of empirically supported treatments for anxiety to minority populations. Her research has been funded by the National Institute of Mental Health and the Multicultural Affairs Office at the Massachusetts General Hospital. She has published more than thirty articles and chapters, has served as the program chair of the Anxiety and Depression Association of America (ADAA), and is a member of the American Psychological Association (APA) and the Association for Behavioral Cognitive Therapies (ABCT). She is also actively involved in training and supervising clinical psychology interns at Massachusetts General Hospital. Dr. Marques maintains a private psychotherapy practice in Boston, where she treats individuals with almost anxiety, clinical anxiety, and mood disorders. Connect with her online at www.luanamarquesphd.com or follow her on Twitter at @drluanamarques.

Eric Metcalf, MPH, is a writer and health communicator based in Indianapolis. He has coauthored or contributed to more than a dozen books on health and fitness and written widely for magazines and online publications. He's also a producer and contributor for the weekly Sound Medicine public radio program.

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