March 2007 Columns

Treating Anxiety
By David Gersten, M.D. Anxiety, worry, fear, and panic affect millions of Americans. Some of us are “professional worriers” and some of us have a full-blown disorder, such as “panic disorder with agoraphobia.” A panic attack is an overwhelming mental and physical experience in which one feels a sense of impending doom. Your heart pounds and races; it's hard to catch your breath; you think you're going to die and are pretty sure you're losing your mind. Panic disorder, if not identified and treated, can cripple a person's life. There are a host of anxiety disorders, including anxiety caused by an “existential crisis,” a time when one has lost one's bearings, one's sense of purpose and connectedness. It is important to explore all issues related to anxiety and panic before going for the quick fix, whether that is a medication or a vitamin.

Standard Treatment
How you deal with anxiety and panic reflects how you and your doctor conceptualize what you are struggling with. If your doctor believes that the problem is 100% biological, driven by problems with brain chemistry, then your only treatment will come from approaches that improve brain chemistry. Regarding panic disorder, biological (medication) treatments were fairly well understood more than 30 years ago, and included these components. 1. Anti-depressants, like Elavil and Tofranil (early medications that raised brain norepinephrine levels) were (and are) used to help stop panic attacks. 2. While the effects of anti-depressant medication are waiting to kick in (about 2 weeks), minor tranquilizers (benzodiazepines), such as Valium, Xanax, Klonopin, and Ativan are used to decrease “anticipatory anxiety.” That's the anxiety a person feels in between panic attacks . . . when they are fearfully waiting for the next attack, which cannot be predicted. Largely for political reasons, minor tranquilizers fell into great disrepute, and so they are monitored quite closely by governmental agencies. The fact is that it is nearly impossible to commit suicide by overdosing on this group of medications. On the other hand, the new generations of anti-depressants like Prozac, Paxil, Zoloft, Effexor, and Wellbutrin, are prescribed as if they are totally harmless. These are drugs that will kill you if you overdose. And if you increase them too quickly or suddenly stop them, you may require psychiatric hospitalization. Why the stigma over benzodiazepines? They can and do cause tolerance, meaning that, if you take them every day, their effectiveness will drop from 100% to 75% to 50%, and you will require higher doses. For this reason, it is important, when using these medications, to “hold the line,” avoid increasing dosage, and avoid daily usage. Because people who are serious drug abusers have, among other drugs, abused benzodiazepines, this class of drugs began to be looked at as dangerous and evil in the mid-1980's. While many people prefer non-medical treatments, anti-depressant medications have a long, successful history of alleviating panic attacks, and should not be dismissed as a possible part of the solution. The anxiety experienced in between panic attacks, “anticipatory anxiety,” is qualitatively not different from the anxiety of Generalized Anxiety Disorder, Social Anxiety Disorder, and other anxieties with no name. Therefore, for virtually all forms of anxiety disorders, there are a number of approaches that are universal. I do want to note that the pharmaceutical industry's attempt to portray SSRI anti-depressants as being helpful for most anxiety disorders is, in my opinion, a dangerous marketing strategy. (Actually, it's a great marketing strategy, but dangerous, incorrect information). When I read on one web site that, “SSRI medications are a new class of anti-anxiety drugs,” I was concerned about how successful the drug companies have been in turning their anti-depressant medications into broad-spectrum anti-anxiety drugs. The fact is that, for many people, SSRI's “cause” a great deal of anxiety, rather than curing it. However, they can be useful for panic attacks.

Mind-Body Approaches For Healing Anxiety
1. First, determine if you are dealing with an existential crisis. Medication, or powerful nutritional supplements, will not fill the void of a life in search of meaning. 2. Explore, perhaps with professional help, any immediate causes of conflict. Extreme conflict can precipitate panic and anxiety. Trouble shoot to see if there are practical ways to resolve the conflict in the “real world.” If not, then it is important to use hypnosis or guided mental imagery to quickly get down to core causes of unresolved conflict. You cannot “think your way” out of conflict, since the runaway, ruminating mind causes a great deal of conflict and is not capable of resolving conflict or decreasing anxiety. 3. Look back through your entire life and recall any incidents of severe trauma. I have worked

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March 2007 Columns
3. Look back through your entire life and recall any incidents of severe trauma. I have worked with countless people who “have already done the work” on their trauma issues. The fact is that only a couple of treatment modalities are capable of truly healing the wounds of trauma. Somatic Experiencing, or SE, (created by Dr. Peter Levine) is the most powerful modality for resolving trauma. In my work, I refer to this process as Body-Centered Trauma Resolution (BCTR). Hypnosis and Interactive Guided Imagery can also be quite helpful due to their power to go deep into the subconscious mind, and because of their ability to work with the mind-body . . . and not just the mind. If you want to pursue SE, BCTR, Hypnosis, or Interactive Guided Imagery, do some research. Not all practitioners are created equal. In each of these modalities, you will find people in San Diego (and most cities) with decades of experience. If trauma is the cause of your anxiety, you can find a practitioner of Somatic Experiencing at If you are drawn to Interactive Guided Imagery, you can search for a practitioner a Please understand that someone who spent only a weekend getting a certificate in hypnotherapy is not qualified to assist you in diagnosing your problem. Nor can they help you reconnect to Self, Nature, Others, and Higher Power, if you are dealing with an existential crisis. 4. Various forms of meditation are powerful “anti-anxiety“ remedies. There IS a form of meditation that will work for you. Mantra meditation will work for almost everyone. Focusing on the breath will also help most people, but is not quite as easy as mantra meditation. Mindfulness, both as a meditation technique, and as a way of being in the world, will help bring you into your body and “out of your mind.” People with anxiety, especially Generalized Anxiety Disorder, are trapped in the prison of their mind. Their own mind drives them half crazy, and all attempts to stop the mind prove futile. You need to “get out of your mind” in order to “tame your mind.” Mindfulness techniques help you focus on what is happening in the moment and on the sensations in your body. Mindfulness teaches you to become aware of your surroundings as much as possible, taking in the world through your five senses. The practice of yoga also helps take you into your body. Talk therapy keeps you in your head and is marginally useful and often detrimental. Anxiety and panic are caused by an autonomic nervous system that is in sympathetic nervous system overdrive. Meditation and yoga dampen the sympathetic (fight-or-flight) nervous system and increase the activity of the parasympathetic nervous system, which aids healing and tranquility.

Working with Biochemistry
1. Regardless of the cause of anxiety or panic, neurotransmitters are always involved. GABA chemistry is central to anxiety problems, and most of the anti-anxiety medications work at the GABA receptor site. You can increase GABA in your brain by taking 2,000 to 4,000 mg of GABA per day. Do not take higher doses. The amino acid L-glutamine easily enters the brain and much of it converts into GABA. When you take pure GABA, only a small percentage gets into the brain. GABA combined with L-glutamine will help raise brain GABA levels, which will leave you calmer. 2. Deficiency in the neurotransmitter, norepinephrine, often causes anxiety, as well as depression and insomnia. If your anxiety includes problems with memory and concentration, you are probably dealing with a norepinephrine problem, which can be corrected by taking the amino acid, L-tyrosine. Increasing norepinephrine will help depression and many kinds of anxiety. Many people suffer from both anxiety and depression. Those who have been anxious for months or years, especially those with panic disorder with agoraphobia, often get depressed after awhile. So, it is not uncommon for people with chronic anxiety to also feel depressed, partly due to brain chemistry, and partly due to the fact that chronic anxiety can be debilitating and demoralizing. 3. Brain chemistry requires a few important co-factors, which include: pyridoxal-5-phosphate (the active form of Vitamin B-6), magnesium, SAMe (S-adenosyl-methionine), B Vitamins (especially folic acid and Vitamin B-12), and the proper balance of Omega-3 and Omega-6 fatty acids. 4. The amino acid, Taurine, stabilizes brain tissue, and slows the release of adrenaline, helping to stabilize fight-or-flight physiology. 5. A variety of herbs help with anxiety: including kava kava, valerian, hops, passion flower, and lemon balm.

Healing the Body
1. Do you suffer from hypoglycemia? If so, periodic drops in blood sugar can make you anxious. 2. Part of a medical workup for anxiety should include blood testing for thyroid function. Too much thyroid will cause anxiety, along with heart palpitations. 3. Address adrenal exhaustion. Adrenal function helps you stabilize blood sugar and also

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3. Address adrenal exhaustion. Adrenal function helps you stabilize blood sugar and also produces the hormones that help you cope with everyday, normal stress. With chronic adrenal exhaustion, people become overwhelmed with simple tasks that were once just part of their everyday experience. If your anxiety picture includes hypersensitivity to loud noises, bright light, or sudden changes in movement, and you are also fighting fatigue, you are probably dealing with adrenal exhaustion. These bodily contributors to anxiety are too complex to allow for simple recommendations in this article. Start by getting lab work done.

Healing Your Thoughts
1. Cognitive Behavioral Therapy, or CBT, is the most-researched psychotherapy modality for anxiety and panic disorders. On average, 12 CBT sessions will dramatically improve anxiety disorders. Items 2 — 8 below are some of the techniques used by CBT: 2. Pay attention to all-or-nothing statements, and use of the words “always,” and “never.” Replace these thoughts. A mantra is the easiest and most powerful replacement for incorrect thought patterns. Mantra meditation is an effective tool to help shift out of all-or-nothing, negative thinking. 3. Determine where your negative self-talk comes from. Whose voice is it that speaks so negatively through you and about you? (Mother, father, brother, sister, spouse). Begin to think, speak, and act for yourself, from your core power. 4. Stop automatic negative thinking. CBT teaches techniques for temporarily stopping a runaway mind. 5. Focus on what is calming and positive. 6. Walk and talk slowly. That helps to slow down an overactive mind. 7. Examine perfectionism. The drive for perfection causes anxiety, irritability, anger, and depression. There is no such thing as perfection. Cognitive Behavioral Therapy helps people identify the various facets of unconscious, repetitive, destructive thought patterns. When you learn to strive for excellence rather than perfection, you are freed from the prison your mind creates. 8. Many anxious people are making comparisons all day long, comparing what they do, how they look, how they perform, and what they own . . . to other people. The “comparing mind” is doomed to misery. I have known several excellent musicians who got anxious and depressed because they were not as good as the very best players in the world. Some of these people continued to play their instrument, always making comparisons, and never living fully in the moment with “their own music.” For others the negative comparison was too great and they simply stopped playing their instrument forever. Once you recognize that your mind is making comparisons all day long, you can simply observe each comparison as it arises, and let it go without self-judgment. The “comparing mind” is related to the “perfectionistic mind.” There is no such thing as perfection. ”“The best that you can be” is all there is, and your personal best is diminished by comparing yourself to the greats of the world. On the other hand, great people from all walks of life can serve as role models or inspirations to you, and that is quite different from comparing yourself to them. 9. Redefine setbacks. They are not failures. They are to be expected and accepted.

Pain, Anxiety, and Depression
It is estimated that 15% — 33% of Americans suffer from chronic pain, and for many people that pain is quite debilitating. Over time, people with chronic pain become depressed and anxious. They also develop sleep disorders, and adrenal exhaustion. If your doctor thinks that your main problem is anxiety, rather than physical pain, you will receive a treatment recommendation that will keep you locked into the vicious cycle of pain, anxiety, depression, and insomnia. Almost all pain is caused by inflammation, which is a process in which our immune system turns against us and attacks normal, healthy tissue. If you have chronic pain, you've spent years trying to cope with it. In the next issue of The Light Connection, I will be introducing you to a radical, revolutionary breakthrough in pain reduction.

Spiritual Healing
Many anxious people feel spiritually disconnected. They often don't feel connected to themselves, others, the earth, God or a higher power. It is essential for people to focus their attention on this issue, for without a sense of connectedness, however you define that, a pervasive sense of anxiety is what people live with. Getting reconnected at all levels transforms fear and anxiety into peace and serenity.

Getting Started
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Getting Started
This article has covered most of the key issues related to the treatment of anxiety and panic, but I may have provided so much information that it made you anxious. So, let me simplify the process of healing anxiety and panic. 1. Get an accurate diagnosis, including any physical problems that contribute to anxiety. 2. Work with a clinician to correct your neurotransmitters. 3. Ask yourself if you feel emotionally trapped by a crisis in your life. If you find this to be true, that simple realization will help you. 4. Learn some form of meditation to help tame the “monkey mind.” 5. Take nutrients that produce peace and relaxation in mind and body. Keep your nutritional program simple. 6. Get professional help, and don't spend more than one session simply talking about the anxiety. Review the modalities in this article and commit to a series of about a dozen sessions. Cognitive Behavioral Therapy is effective at correcting destructive thought patterns. Hypnosis and Interactive Guided Imagery will provide techniques for relieving anxiety and resolving conflict. 7. Suspend judgment during your 12-week period of psychotherapy and release the thought, “What if all this does not help?” That “what if” thought is just a shadow, part of old programming that no longer serves a purpose.

No Worry?
A bit of worry and anxiety is normal. If you have absolutely no worry or anxiety, you are either dead or enlightened. David Gersten, M.D. practices Nutritional Medicine, Integrative Psychiatry, and Interactive Guided Imagery out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at


Dear Louise
Dear Louise, My three boys (10, 7, and 4) have all been diagnosed with farsightedness. I know from your books that so much can be done, and that there is a reason for everything, but this has just floored me. Where do I start, and what can I do? O.D., Ireland Dear O.D., Whenever our small children have problems, it's good to begin with clearing our own consciousness. It is safe for me to see would be a good affirmation for you to start with. Repeat this affirmation over and over, and notice areas you don't want to look at or things you don't like to see that might come up. Then repeat: I am safe. Also, do mirror work with your kids. My book The Adventures of Lulu covers this issue among others, and it's specifically geared toward children. Teach your sons to stand in front of a mirror and repeat: I love my eyes. I see everything clearly and lovingly. It is safe for me to see. You can all do it together at first. Many children love mirror work. Your four-year-old will probably take to this first. Do the affirmations will him every day until he enjoys doing it alone. I highly recommend a wonderful book titled Healthy Healing by Linda G. Rector Page, N.D., Ph.D. It's a great source for alternative healing techniques. Look for it in your local health-food store. Dr. Page offers dietary, herbal, and lifestyle support therapies for more than 400 conditions, including eyesight. She recommends vitamin A, C, and D; use of an herbal supplement called Bilberry; and eating mineral foods such as carrots, broccoli, leafy greens, and sunflower seeds.

Dear Louise,

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Dear Louise,

I'm currently experiencing a “grumbling appendix” (chronic appendicitis), and am waiting to hear if I'll need surgery. Although I'm confident that surgery in this instance may be the best solution and could provide me with a brilliant opportunity to heal myself, I'd also like to address the causes. I've had this condition on and off for ten years, although it's only recently been diagnosed, and I'm experiencing unpleasant digestive symptoms more and more frequently. Overanalysis and worry are obviously making my situation worse. How can I heal my health? I am trying to focus on the positive aspects of my life (marriage, happy home), but it seems that this isn't enough. I would appreciate any insights, and thank you profusely for taking the time to read my ramblings! W.F., France Dear W.F., What is it in your life that you cannot stomach? Perhaps it's an old childhood belief that you don't deserve to have so much good in your life? Deserving good is a big issue in many people's lives. But the truth is that we all deserve good experiences just because we exist. It's our divine right. Affirm: I love my stomach. I release all fears. I take in and digest life with joy and ease. I am safe and loved by life!

Dear Louise, My six-year-old daughter constantly complains about earaches, and when I have her checked by a doctor, there is an actual ear infection. It's the right ear mostly. We use medication to cure this, but I wonder if there's another way to handle this? Thank you for your help. M.H., Los Angeles , CA Dear M.H., You'll see a big difference if you remove dairy products from her diet immediately—that is, no milk, cheese, yogurt, or ice cream. So many children are actually highly allergic to dairy, and the first complaint is usually earaches. Rice or almond milk can be substituted, but not soy, as it is usually genetically altered. On the metaphysical level, what does your daughter not want to hear? Is there too much fighting in the house? Does she hear the word no too often, or does she feel that she's not loved enough? Have her affirm: I hear with love. I love my ears. They are happy ears. All is well in my world. Louise L. Hay is a metaphysical teacher and the bestselling author of numerous books, including You Can Heal Your Life , Empowering Women, and I Can Do It! . Subscribe to the Louise Hay Newsletter! Call for a Free Issue: (800) 654-5126. Questions for Louise? Write to: Dear Louise Column, c/o Hay House, Inc., P.O. Box 5100, Carlsbad, CA 92018-5100 (letters may be edited for length and clarity). Visit Louise and Hay House at: or

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