Anxiety involves an ongoing feeling of fear, worry, or agitation that negatively impacts your ability to function in various areas of your life such as work, social, or personal life. If you are struggling with moderate to severe and prolonged anxiety/ stress and you have not been able to find a way to resolve it, I strongly encourage you to read the following guidance to reduce or fully resolve symptoms of anxiety. I firmly believe there is always a way out of even the most severe anxiety and I have discovered several keys to escaping or significantly reducing severe anxiety as you will see below.
Below I lay out an outline for resolving anxiety beginning with an assessment and moving through 3 phases resolution process beginning with strengthening, moving to resolving, and ending with expanding/growing. I end by providing additional resources and concluding thoughts. As always please take full responsibility for your own choices and well-being as you engage in this healing journey.
Outline of this page:
- Assessment
- Phase 1: Stabilizing, strengthening, and building capacity.
- Phase 2: Resolving underlying drivers of anxiety.
- Phase 3: Growing, expanding, and living in freedom.
- Additional resources
Assessment:
Let’s begin by assessing what level of anxiety you are facing and what may be some of the primary drivers of it?
To begin with, I recommend you click the following link and take this free anxiety assessment by Mental Health America.
The screener is anonymous free and all demographic questions can be left blank if you prefer not to answer them. You can learn more about the Mental Health America on my page listing free and non-profit mental health organizations here.
I encourage you to take the assessment above and note your score. If your score is anything from moderate to severe I would highly recommend engaging a mental health professional as a critical part of your plan of care AND still taking the actions steps below because I believe they will help you a great deal. If your score is to mild to low moderate, a mental health professional would still be recommended, but you may also get a great amount of traction by completing the following steps on your own while including adequate amounts of non-professional support systems.
Phase 1: Stabilizing, strengthening, and building capacity.
Phase 1 is about stabilizing and strengthening your foundation. Often symptoms of anxiety significantly improve just from engaging in these simple behaviors to resolve it. Two of the often overlooked but critical ingredients I especially want to highlight in Phase 1 are balancing sleep, decreasing excessive cortisol levels, and considering ways to increase testosterone levels. For people struggling with moderate to severe anxiety I strongly recommend engaging professional help as well in the form of a therapist, and potentially an MD or psychiatrist as well.
Below are the topics addressed in Phase 1 Stabilization of symptoms:
- Establishing a professional support system.
- Establishing a non-professional support system.
- Stabilizing sleep.
- Lowering Cortisol and Increasing Testosterone
- Exercise
Establishing a Professional Support System:
Getting a Skilled Supportive Therapist: Having a solid, skilled, well trained mental health professional on your team who can help you navigate the journey through anxiety toward calm and well-being can be a game changer. If you want additional thoughts on finding a therapist, you may consider reading the page on How to Find a Good Therapist. In addition to securing a therapist I strongly encourage you to also take action and incorporate many of the following lifestyle, cognitive, behavioral, nutritional, and other types of interventions to move you along the road to freedom from unhelpful levels of stress and anxiety.
Engaging a Doctor and/or Psychiatrist: Depending on the severity of your anxiety, and how effective the following behavioral, nutritional, and therapeutic interventions prove to be, you may also consider engaging a primary care physician, or psychiatrist in your plan of care who can prescribe and oversee the use of anti-anxiety medication. Below I offer additional thoughts on these options. However, I would not rely on medication alone as a solution to anxiety, but as one small part of a larger and more comprehensive plan to stabilize and then to resolve the deeper roots of anxiety symptoms.
Establishing a non-professional support system:
Having people who come alongside and support us in healthy ways on the journey of growth and healing is very important for stabilizing and reducing symptoms of anxiety, depression, etc. One of the questions our brain needs to know when it is facing a threat or a challenge is, ‘is there anybody with me in this?’ That is, is there anyone who sees, cares, and ideally who can support me in this challenge? These tasks can be divided between a variety of people who offer different types of support. Some people may simply be good listeners, others may have wisdom, others may be good at helping us relax and just have fun for awhile. All together this support community can work together to help us through a challenging time, and in the big picture we will also at various points be part of other people’s support system, and our own experiences may bring great empathy and clarity regarding what is needed.
A support system should ideally include at least a couple of close friends with whom one can be in regular contact, not just to deal with problems, but also to do meaningful, fun, and life giving activities with from sharing a meal to collaborating on a project. If possible it is also ideal to have one or a few support people who are further down the road who can provide wisdom, nurture, encouragement, and strength out of their own experience and maturity. For some thoughts regarding how to build such a support system, please see my post on Establishing support for the journey.
Stabilizing Sleep:
Sleep is probably the most important single ingredient for stabilizing any moderate to severe symptoms of anxiety, depression, PTSD and most other mental health issues.
In the case of extreme anxiety sleep can become exceedingly challenging because a highly anxious body is chronically stuck in a stress state and has difficulty letting down its guard to fall asleep or stay asleep. Sleep absolutely must be brought under control to break up the stress cycle and allow the brain and body a chance to reset themselves and clear out unhelpful neuro-chemical, emotional, and mental residue.
How to improve Sleep:
Getting your circadian clock through your light viewing behavior is key for improving sleep: Recent research has shown that one of the more important behaviors for improving sleep actually what you do right after you wake up. Viewing bright light, especially sunlight within 60 minutes of waking sets off a cascade of positive effects on your hormones including helping to balance cortisol levels, increasing dopamine, which will indirectly result in increases in testosterone and improved mood. Bright morning light also helps your internal organs and deep parts of your brain to what time it is which allows your body to set a bunch of internal clocks to a synchronized time in a process called entrainment. For example, early morning light viewing starts an internal timer for the natural release of melatonin 16 hours late which will help you fall asleep.
The ideal recommendations for early morning light viewing are to wake up at the same time every day, ideally on the early side of the morning, and to go outside within the first hour after waking and look in the direction of the sun for at least 5 minutes on a sunny day and 10-20 mins on a cloudy day.
Additionally, it is critical to avoid screens between 11pm-4am and ideally to avoid all screens for one to two hours before (a decently early) bed time. Dimming overhead lights switching to lamps in the evening is also helpful because screen viewing and bright overhead lights confuse the brain regarding what time it is in ways that cause it to become more alert when it is actually time to wind down and releasing calming neurochemicals. If you feel an early wave of sleepiness, it is recommended to simply follow it and go to sleep rather than trying to push through it.
Adequate exercise is also critical for both good sleep and anxiety/depression reduction. I will say more about exercise below.
Sleep Supplements: Stanford Professor, Dr Andrew Huberman has a series of 4 video podcasts on sleep where he reviews many aspects of improving sleep. The supplements he recommends for adults are outlined below. I recommend discussing this supplementation plan with your primary care physician, particularly if you can connect with a health care provider who has some understanding of the now large body of growing research on the use of supplements and natural treatments. Here is a link to the Huberman Lab Sleep Toolkit for more details. He suggests experimenting with the following supplements one at a time and adding the other supplements on this list if needed.
- 145mg Magnesium Threonate or 200mg Magnesium Bisglycinate
- 50mg Apigenin
- 100-400mg Theanine
- (3-4 nights per week he also takes 2g of Glycine and 100mg GABA.)
Be cautious about the supplement melatonin which is commonly used as a sleep aid. Some professionals such as Andrew Huberman are actually recommending people be more wary of using melatonin may have more powerful effects on the production of other important hormones such as testosterone and estrogen than we realize. He notes that even 1 mg of melatonin is exponentially more than our brain naturally produces.
Sleep medications: If you have tried the above and are still having difficulty sleeping, or if you are in a severely stressed state and have had chronic sleeplessness for a period of months or weeks getting less than, say, 5 or 6 hours a night, sleep medications may well be worth trying out. Extreme anxiety is a case where I have seen sleep medications be of great help at least in the short term to give your brain and body a chance to sleep and reset. Sleep makes it much easier to take helpful action in other areas of your life to improve your situation and symptoms. There are a lot of medications out there to aid in sleep and not all of them are going to be helpful for every person. I have seen some sleep or anti-anxiety medications, for some people, actually have the opposite effect of increasing anxiety and stress while other medications help the same person sleep very well. Thus, if you decide to use sleep medications, I encourage you to be proactive and stay in close communication with your primary care doctor or psychiatrist until you find one or a combination that really works for you. As always, I don’t recommend viewing medications as a final solution, but as part of a larger plan of care that involves developing a lifestyle that promotes good sleep, and resolution of the underlying drivers of anxiety.
Raising Testosterone while Decreasing Cortisol:
Increasing testosterone levels has been shown to reduce levels of fear, increase confidence, increase willingness to face into challenges, and to make effort feel more pleasurable. Testosterone is produced largely in the adrenals which also produce a hormone called cortisol. Cortisol is a stress hormone that we need in the right amounts, but when we are under chronic stress, our adrenals are producing too much cortisol which causes problems. One of the major problems is that if the adrenals are focused on creating cortisol they are not creating enough testosterone. It is therefore key in cases of chronic or ongoing stress/anxiety to reduce cortisol levels and to boost testosterone levels. This seems to be true for both men and women. Men and women both need testosterone and estrogen, but in different ratios. Men have more testosterone than estrogen, women tend to have more estrogen than testosterone. However, both can benefit from increases in testosterone levels. There are natural ways to increase testosterone such as balancing your circadian rhythm through early morning light exposure, standing in power postures, moderate but not extreme exercises such as squats and lunges, or mixing jogging and sprinting. there are also supplements to increase testosterone. Natural activities such as exercise I encourage everyone to do. If you opt to take supplements, I recommend consulting with a holistic health practitioner or doctor about, particularly if you can find a functional medicine or integrative doctor who has some training in the world of supplements and holistic health.
Supplementation:
There are supplements that have been clearly shown to decrease cortisol and increase testosterone levels. A couple of key supplements shown by research are listed below. I am not making particular recommendations to any particular people but I want you to be aware of this as a potentially very helpful option. I strongly recommend getting a holistic or functional medicine doctor on your team who can help you get blood tests to test your testosterone levels and give pre and post supplementation results. You can review for yourself various studies related to nutrition, supplementation, testosterone, anxiety, etc at examine.com.
Supplements to Decrease Cortisol
- Ashwagandha has been shown to have a cortisol lowering effect.
Supplements to Boost Testosterone:
- Zinc, Vitamin D, and Magnesium are three supplements that are proven to boost testosterone IF the person is currently deficient in these. Note that a lot of people are deficient in these key nutrients because it can be hard to get enough of them through typical diets. Zinc Picolinate is one of the easiest for the body to absorb. Vitamin D3 is extremely hard to overdose on and recommendations commonly range from 600-8,000 i.u. I recommend aiming a bit high since your body will clear what it doesn’t need. Magnesium Citrate is shown to have the best bioavailability upper recommended daily dosage is 350mg/day. This information was obtained from examine.com where you can research supplements and dosage recommendations for free. There are additional options which you may consider doing your own research on listed in other places such as this Huberman Lab Podcast on Testosterone and Estrogen lothat are often deficient in people diets which if deficient will decrease testosterone levels. There are Some would argue that reducing cortisol and balancing hormones via adequate sleep, nutrition, and nutrition. Others recommend also adding supplements to boost testosterone. I have not done enough careful research to feel comfortable making particular recommendations on testosterone boosting supplements but if you are interested in some
Lifestyle To Boost Testosterone:
Getting adequate sleep is critical for improving testosterone. Moderate range resistance exercise such as weight lifting, squats, sit ups, etc are shown to increase testosterone. Weight loss is also helpful. Here is a link for ways to boost testosterone naturally from examine.com
Testosterone Replacement Therapy through application of a testosterone cream designed in a medical lab is also an option for males but carries it’s own potential risks and benefits which need to be discussed with your doctor.
Exercise:
It is almost impossible to resolve chronic or acute anxiety without including some amount of exercise. Exactly how much exercise varies some depending on how depleted you are due to chronic intense cortisol levels, but suffice it to say that some exercise is better than none. Even if you only get 5-10 minutes a day of fast walking or jogging, that is far better than nothing. The ideal would be to aim for about 20-30 minutes of elevated cardio at least 4-5 days a week.
Diet
Along with supplementation, eating a healthy diet with enough healthy fats including Omegas such as fish oil, proteins, and vegetables, especially green vegetables is really helpful for testosterone levels as well as getting basic amounts of exercise. These will get easier as your hormones start to get in balance.
What Feels True Now May Not Feel True Once You Are Less Stressed Out:
When we are extremely stressed we tend to simultaneously have extreme negative thoughts about what is happening or could happen. These thoughts can feel completely true, inevitable, and believable even if other people keep telling us that they are exaggerated. The reality is that there is probably some truth in these very large and looming fears, and that there is also probably a significant amount of exaggeration. The reason for this, I believe is that a highly stressed brain is receiving a lot of signals from inside your body that you are in immanent danger. This is due largely to the high levels of cortisol, adrenaline, and other stress hormones flowing through your body. There seems to be a part of our brain that works constantly to explain why we feel or act the way we do which starts generating stories that account for what we are feeling. I have heard this phenomenon referred to by both Dr Andrew Huberman and Dr Karl Lehman. These stories created by our brain tend to feel extremely believable, and probably have parts of reality within them, but they tend to go farther than the reality of the situation merits.
As we dwell on these narratives our brain and body respond to them by activating additional stress hormones to deal with the perceived danger that we imagine may be coming our way. Occasionally there may be cases where this danger could be real. For example, if you are living in a dangerous neighborhood or a warzone, etc. but much of the time even in those areas, the danger is not as immanent as our brain imagines.
While I don’t want to go so far as to simply dismiss the stories that may feel true, I will encourage you to get your sleep on track, reduce cortisol levels, and increase tesosterone and then notice for yourself whether the stories you are telling yourself begin to change or update in helpful ways.
Resolving and Repairing Underlying Causes of Anxiety:
This work is best done in collaboration with a therapist and may involve both present focused work to address the current challenges as well as work to identify and resolve underlying drivers of anxiety that may come from past experiences that are being triggered. Identifying and filling in missing needs from the past may also be key such as resolving early unmet attachment needs, and practicing rhythms of joy and rest in healthy relationships.
Talk To a Doctor or Psychiatrist:
Many people find psychotropic medication to be a helpful aid in coping with symptoms of anxiety. A primary care doctor or psychiatrist can subscribe anti-anxiety medications which may be helpful in reducing symptoms of anxiety. Medications, however, will not resolve the underlying causes/drivers of anxiety symptoms. I would strongly recommend going beyond simply using medications to manage anxiety by taking steps to resolve it such as those listed in this article.
Extra Supports:
If needed, there are also additional options such as outpatient treatment programs as well as anti-anxiety medications that may be of great help.
Footnotes
Modulation of the hypothalamic–pituitary–adrenal (HPA) axis by plants and phytonutrients: a systematic review of human trials. Adrian L. Lopresti, Stephen J. Smith & Peter D. Drummond