Health Matters Blog

Anxiety in the Primary Care Setting

By John Todd, APRN, FNP

Anxiety is an emotional and physical health problem. It is marked by feelings of fear, unease, and worry that can sometimes be so severe as to make us feel physically unwell. The source of these feelings is not always known. Sometimes it involves past trauma or injury; sometimes it involves fear about something uncertain in the future.

A patient might say to me, “I need something for my anxiety.” They might have had prescriptions in the past for quick-acting medicines such as Xanax, Ativan, Valium, or Klonopin. Those are benzodiazepines, medicines that should only be prescribed with great caution and awareness of the risk for tolerance and dependence. In some cases these medications are good solutions but they have limitations. As a primary care nurse practitioner I want to move beyond what seems like a quick-and-easy “fix” but doesn’t heal over time. The use of these quick-acting medications is an example of seeking an external locus of control over one’s emotional state. Making a lasting and effective change in the dynamic of anxiety is neither easy nor quick, like taking a pill might be.

John Todd, APRN

John Todd, APRN

Your primary care provider might decide to prescribe a short duration of the quick-acting anxiety medications for an acute issue such as grief or a stressful life transition, yet we understand that those medications are rarely the best long-term solution. Thankfully, some daily medications that work for depression can also, for some patients, help settle anxiety on a long-term basis, but it can take 2–3 weeks to determine whether a medicine will be effective.

Some people may turn to self-medication—attempting to soothe or numb their worries with substances or activities. Most anxiety rescues (activity, food, drink, quick-acting medicines) help people disconnect from their bodies. What do you use to settle your anxiety? A tall drink of spring water or a shot of vodka? Mindful yoga or a first-person shooter game with Internet friends? Is it a breath of fresh air during a walk in the woods or a puff on a cigarette during your commute? A double-chocolate brownie or a dose of medication?

Don’t get me wrong; we all need a time-out from the hectic pressure that can build around us. In an acute state of anxiety these short term rescues may seem like a good enough solution. But a more successful treatment for anxiety is to seek an internal locus of control: become more aware of yourself, your inner dialogue, and the connection between your body and both the voluntary and involuntary nervous systems. Thankfully, that time-out is already available within each of us by becoming more connected, more mindful, by listening to our inner talk and cultivating an inner voice that is kind to ourselves.

When we develop the ability to recognize harmful self-talk, we can practice changing the way we speak to ourselves; each of us can exert powerful restorative effects on our emotional and physical well-being.

Here’s one simple method (of many) to start to learn body awareness and calm the inner voice: the 4-7-8 breath work technique from Dr. Andrew Weil. Count to 4 while you breathe in through your nose (or mouth if you’ve got a stuffy nose); count to 7 while you hold your breath, count to 8 while you breathe out through your mouth. After trying this once; then do the whole 4-7-8 pattern with your tongue touching the roof of your mouth just behind your teeth; then use this tongue position each and every time you do the 4-7-8 breathing. The first time you try this breathing technique, repeat it just 4 times, as it might make you feel a little lightheaded. Work up to 8 repetitions of this, twice daily, upon awakening and before sleep. It will take about a month of regular daily use of this 4-7-8 method for it to feel natural and more deeply beneficial.

Your primary care provider (PCP) can guide you towards understanding your anxiety through education and therapy. Any person who is dealing with anxiety from week to week, month to month, will benefit greatly from regular visits with a mental health therapist. Your PCP can help get that routine established.

Additionally, your PCP can use screening tools to assess the severity of your anxiety and to determine if other mood disorders such as depression or bipolar disorder are present. Some patients with prolonged and debilitating anxiety might require a referral to a psychiatrist, but even then, the essential act of learning to listen to one’s own body and inner dialogue is central to successfully controlling anxiety.

John Todd is a Family Nurse Practitioner with Brattleboro Internal Medicine and Putney Family Healthcare, members of the BMH Physician Group. He can be reached at 802-257-2611 or 802-387-5581.

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