How To Help Your Anxious Patient

Anxiety can mess up patient care. Some patients can’t get an MRI, others struggle to tolerate radiation and some never make it to the specialist because they are afraid of bad news.

For patients with generalized anxiety disorder SSRIs/SNRIs can help, but not completely, and they take time to work. Benzodiazepines don’t solve the problem either. They have significant risks (e.g., falls, delirium, tolerance and addiction), and they don’t work on the underlying issues so they can’t create lasting change.

Non-pharmacologic approaches to anxiety are safe, effective, inexpensive and easy to teach. Here are some simple techniques to teach your patients:

Emergency exercise. When our stress response gets activated, our body prepares to run. We learned this when being eaten by animals with big teeth was a possibility. When we ignore this biological need and sit on the couch with our stress, we don’t give our nervous system the opportunity to complete the stress cycle.

When feeling agitated or anxious, do 30-60 seconds of intense aerobic exercise (as tolerated/safe, of course). You can run up and down the stairs, do jumping jacks or run in place. Catch your breath and do it again until you feel your body relax.

Tactile tools. Our attention can only be in one place at a time – either in the past, the future or the present. People may ruminate about the past and worry about the future, but in the present moment things aren’t usually that bad. Tools that focus attention in the actual moment that we are living in can reduce the stress response. Many people use a focus on the breath to relax, but for others it can actually make them more anxious.

Try a tactile approach. Rub two fingers together firmly enough that you can feel the ridges of your fingertips. Focus all your attention on this sensation, and when your mind wanders just gently bring it back to your fingertips. Any sensation will work: a stone in your pocket, a piece of nubby fabric, the feel of your toes in your shoes, etc.

Thought labeling. There is a huge difference between “I’M GOING TO DIE IN THE MRI MACHINE!” and “my anxious mind is telling me that I’m going to die in the MRI machine.” Realizing that your anxiety is a just a liar and you don’t have to listen to their drama can make a huge difference. Just label the thought and emotion rather than getting swept away by it.

Name Your Anxiety. Let’s say you name your anxiety Walter. You goal is to get to the point when you can say to yourself “Walter says that I’m going to die in the MRI machine, but I know he’s a liar so I’m not going to listen to him.”

Here’s a tip: if you practice these techniques yourself, you will become skilled at teaching them to your patients. And you know what else might happen?

Wellness is for everyone – even you!

I’m in your corner.

Delia

Delia Chiaramonte, MD