BodySense Blog

How to Handle Panic Attacks

It may seem hard to get a grip on anxiety during a panic attack, but learning the right techniques can help you get your anxiety back under control.

Panic attacks can be terrifying. These attacks stem from profound anxiety that can make your heart pound and your knees go weak. Panic attacks can make it difficult to catch your breath and can also cause chest pain and dizziness — you may even think you're having a heart attack. A panic attack may only last a few minutes, but it can leave you feeling frightened and uneasy.

Understanding Panic Attacks

A panic attack and its symptoms of tremendous anxiety can strike suddenly, out of the blue. While a panic attack itself may be brief, it can lead to a lasting fear of having another episode. When panic attacks and the fear of having attacks occur repeatedly, people are said to have a panic disorder, a type of anxiety disorder.

"People have these panic attacks under various circumstances,” explains Martin N. Seif, PhD, a clinical psychologist in New York City and Greenwich, Conn. They constantly worry about having an attack and may avoid certain situations as a result. Eventually, people with panic disorder may realize that they aren't actually afraid of the situation they're avoiding, but rather of experiencing additional panic attacks, notes Seif.

Fortunately, you don’t have to live in fear of panic attacks. There are specific strategies you can use to help manage your anxiety and control your physical symptoms as well.

Panic Attacks: How to Take Control

The best way to stave off future panic attacks is by learning how to control your anxiety so that if you do start to notice symptoms of a panic attack, you can calm your mind and body until the symptoms fade.

"People who experience panic attacks have to learn how to cope with their feelings of panic," says Seif. While medication can be effective, cognitive-behavioral therapy is one of the best techniques for managing panic and anxiety. "It involves recognizing that the panic-producing process is fueled by future-oriented, catastrophic thinking," explains Seif. People with panic disorder have to become aware that their thoughts trigger a physical reaction, which results in a panic attack.

To gain control over panic disorder, it's important to learn and practice anxiety management techniques, says Seif. Strategies that you can use to help you curb a panic attack include:

• Breathing slowly and deeply. Anxiety can cause you to breathe very quickly, which makes both the mental and physical symptoms of a panic attack even worse. When you start to feel panicky, be sure to take slow, deep breaths to soothe your mind and body.
• Stop and think. When your thoughts start spinning out of control, simply tell yourself to stop. Organize your thoughts and decide what you need to do to get yourself calm again.
• Think positively. Push negative thoughts out of your mind, and remind yourself that you are in control. Think about times when you've been able to manage situations successfully and reduce anxiety.
• Stand up for yourself. If you need to leave a situation, do so or tell someone you need to leave. Don't be afraid to ask for help. Allowing yourself to become more upset will not help if what you really need is to take a walk and blow off some steam.
• Relax your muscles. Anxiety causes your entire body to tense up, so make a conscious effort to relax each muscle from your toes all the way up to your neck and face.

Don't wait for a panic attack to begin to try these techniques. Seif notes that it's important to use these strategies regularly and learn to manage your anxiety in gradual stages. As you become more confident that you can rein in a panic attack, you can walk out the door each day breathing easier.

By Diana Rodriguez

Medically reviewed by Niya Jones, MD, MPH

Coping With Anxiety and Depression

Anxiety disorders are often linked to depression. It's important that both conditions are treated simultaneously.

People with anxiety disorders, like social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, or phobias, spend most of their lives in an agitated state. After a while, that can take a huge emotional toll, and depression often sets in. But relief from both anxiety and depression can be achieved.

Why Anxiety Leads to Depression
Anxiety disorders are much more than just nervousness and worrying. They can cause terrifying fear about things that other people wouldn't give a second thought to. Many people with anxiety disorders understand that their thoughts are irrational, but they still can't stop them.

"It's a cycle. Because when you get anxious, you tend to have this pervasive thinking about some worry or some problem and you feel bad about it. Then you feel like you've failed, and you move to depression," says Sally R. Connolly, LCSW, a therapist at the Couples Clinic of Louisville in Kentucky.

The two conditions have a complicated relationship:

• The incidence of developing depression in addition to an anxiety disorder is high — a little more than half of all people with major depression also suffer from severe and persistent anxiety, notes Connolly.
• "People who are depressed often feel anxious and worried, so one can trigger the other. Anxiety often comes before depression," she says.
• Some of the research indicates a biological predisposition to both anxiety disorders and depression. A family history of these mental health conditions may also help explain the connection between anxiety disorders and depression.

"Especially with anxiety, more so than depression, there often is some family history, and so therefore we think that there may be some genetic predisposition to this," says Connolly. "Some people are just worriers and pass it down."

Symptoms of Anxiety and Depression
These are warning signs that a person may suffer from both anxiety disorder and depression:

• Constant, irrational fear and worry
• Physical symptoms like rapid heartbeat, sweating, and difficulty breathing
• Insomnia
• Constant feelings of sadness or worthlessness
• Disinterest in hobbies and activities
• Feeling tired and cranky
• Panic attacks

Treating Anxiety and Depression
Both anxiety and depression need to be treated, and treatment should be focused on both conditions together.

• Cognitive-behavioral therapy (CBT) is often used to treat anxiety disorder with depression. CBT can teach people to manage their fears, anxieties, and depressive symptoms by figuring out what's really causing them; they also learn how to take control of their emotions.
• Antidepressant medications may also be prescribed to help treat both conditions; they are often used in conjunction with CBT.
• Exercise can also help both anxiety disorders and depression. Exercise releases chemicals in the body that make you feel good, and it can help you relax.

Treatment for anxiety disorders and depression needs to be administered and managed by a psychiatrist, Connolly says. "It's really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder," she says. Bipolar disorder, a condition in which emotions can swing from very low to very high levels of mania and depression, is treated much differently than anxiety disorder with depression.

No one has to suffer from anxiety disorder or depression, and certainly not both. People with anxiety disorder should speak with a psychiatrist, therapist, or other health-care professional about their symptoms, and start treatment before depression has a chance to set in.

By Diana Rodriguez

Medically reviewed by Pat F. Bass III, MD, MPH

Living With Anxiety

A blog about trying to keep calm and carry on.

by AdrienneR

The Medication Game

Anyone living with an anxiety disorder has grappled with the subject of medication at some point in their lives. Do I take it, stay on it, reduce it, increase it, avoid it, or get off it? Then there are those pesky side effects — fatigue, changes in sexual desire, and dizziness are common with antidepressants  — and the adjustment period with getting both on and off medications for anxiety can be very difficult.

 

I'm not advocating one way or the other, I just know what works for me. And, yes, medication has been a part of what's gotten me through some very anxious periods. At the time of my initial diagnosis, going even as far as the supermarket or to a friend's house was panic-inducing. I only truly felt safe in my home, when my family members were there. Within weeks of starting medication (I take sertraline, but at the time it was only available in its brand-name form, Zoloft) I started to open up my world again. Of course, I did so in combination with weekly therapy sessions and the support of friends and family, but I also felt a drastic physical change. I can't say that would have happened without medication.

 

How else do I know that medication has been helpful? Because I've stopped taking it, more than once. With Zoloft, neither time did I experience the painful withdrawal period that many people speak about. Medication just kind of silently came and went out of my life. I'd come to a point where I didn't feel like it was doing much for me anymore — I still had anxiety from time to time, but overall I was managing. And I managed off of medication too, but as time passed, I realized I just wasn't managing as well. I started replaying aggravating events over and over in my head, waking up feeling anxious, and feeling more hesitant about trying new things. Let me reiterate: medication never took away my anxiety completely, but getting off of it showed me that it did, in fact, bring the anxiety down to a baseline level. So will I stay on medication for my anxiety for the rest of my life? That I can't say for sure. All I know is that as long as it's something that's helping me to live my life, I'm not going to deny myself of it.

Everyday Health - Emotional Health

Emerging Courageous

Walking Through Your Fear

The situations, activities, and individuals that frighten us remain static. Their relative intensity does not change. Fear, on the other hand, self-magnifies. It is when you are afraid and envisioning all that might go wrong that the energy underlying your fear grows. A tiny flicker of anxiety can easily develop into a terror that manifests itself physically and eventually paralyzes you into inaction. Though frequently, in walking through that fear, we discover that the strength of our fright was out of synch with reality. And we learn that doing what frightens us can lead to great blessings. Confronting your trepidation head-on will help you accept that few frightening scenarios will ever live up to the negative disasters that we sometimes play out in our minds.

Though fear is literally an evolutionary gift meant to sharpen your senses and energize you during times of great stress, it can nonetheless become a barrier that prevents you from fulfilling your potential by causing you to miss out on rewarding, life-changing experiences. During the period before you face your fear, you may have to deal with a barrage of negative thoughts and emotions. Walking through it, whether your fear is public speaking, taking part in an activity that makes you nervous, or asserting yourself when the odds are against you, may be equally as difficult. But once you have emerged unscathed on the other side, which you will, you will likely wonder why you assumed the worst in the first place. As you spend time worrying about what might happen, it’s good to know that your fear probably won’t happen at all. It may feel like a great weight has been lifted from your shoulders, and you will likely feel a sense of passionate pride. Walking through your fear can mean taking risks and can require both practice and patience. Since it is challenging to act when you are gripped with fear, start small.

Each step you take into fear will strengthen you and help you confront future fears with poise, courage, and confidence. You will also find that when you are willing to stare your fear in the face, the universe will always offer you some form of aid or support. When you see the heights of accomplishment and personal evolution you can attain when you walk through your fears, your faith in yourself will grow, allowing your next step to be easier.

DailyOM

Cultivating The Seed Within

Peace

In our noisy world, we often find ourselves longing for peace and searching to find it somewhere else. While it’s true that there are places we can visit where we can experience peace, such as sacred sites or buildings, we do not need to wait until we get to one of these places to feel at peace. Instead, we can learn to locate the seed of peace inside ourselves and cultivate it so that it grows into a reliable source of serenity that we can always access, no matter where we are.

We experience peace when we are in a state of mental calm and serenity. It might surprise you to notice how infrequently you allow yourself to be free from anxiety. Realizing this is the first step to inner peace. If you wait until all the details of your life are taken care of to allow yourself to experience peace, you will never feel peaceful because there is always something that your mind can grab onto to create anxiety. It is important to consciously set aside your worries and make time to cultivate inner peace.

Ideally, you could schedule time each day to meditate on peace and experience what it feels like to be calm and serene. It takes practice to learn how to let go of your worries, so give yourself some time. Inhale deeply, and feel your worries dissolve with every exhale. Remind yourself that soon enough you will be able to take care of everything you need to, but right now you are taking a break. As the clutter of your thoughts and concerns clear away, you will start to feel more serene. Allow yourself to move deeper into this state with each inhale. Realize that you have the power to free yourself from anxiety simply by deciding to do so. The more you practice feeling peaceful, the easier it will be for you to feel at peace.

DailyOM

Creativity, Productivity, and Leisure

The nerve-jangling pressure of lengthy daily "to do" lists can leach away energy. The thought of adding more items to the list may fill you with more dismay than delight, even if the addition is relaxation, creativity, or time with a loved one. Yet when you refresh yourself in ways that are meaningful to you, you add to your stock of energy and joy.
 
What does "creativity" mean to you? Writing a short story? Sculpting clay? Designing a retreat? Pulling out a paint box? Dancing around the room? Building a deck? Cooking up a feast? Landscaping a garden?
 
If you have a dream you’ve never explored, find small and big ways to follow through. Sing in the shower, take lessons from a pro, or try out a song in front of friends. If you have no idea where to turn, sign up for a class you think you might enjoy. Give yourself the opportunity to try a variety of options. Don’t give up if the first one fails to captivate you or if the results of your effort don’t meet your expectations. Discover what creative work you love and do it.
 
Productive work forges links between you and the world and invests life with meaning. It matters little whether these tasks are performed via a paid or volunteer job or while digging in the garden. They offer pleasure and sometimes the chance to be creative.
 
If you’re retired or find that the work that pays your bills offers few opportunities for satisfaction, indulge your productive side elsewhere. The simplest task, such as slicing vegetables for dinner or scrubbing a floor, may be less tedious and more joyful if you approach it mindfully. Jobs that involve other people can spark connections that nurture you in other ways. Work that benefits others often offers special satisfactions. Such volunteer opportunities abound for people of every age and level of ability. Check with VolunteerMatch or SeniorCorps or call your local chapter of the United Way for tasks that fit your talents and available time.

The job many of us find hardest is setting aside time for pursuits defined as leisure. Reading a novel, playing a game of tennis, soaking in a hot bath, or spending a half-hour meditating may seem like selfish activities. Productive and even creative pursuits are more likely to meet with accepting nods. Yet playfulness invites joy back into your life. And relaxation enhances "flow," a state described by psychologist Mihaly Csikszentmihalyi in which creative juices are freed and their full expression is directed to all pursuits.
 
So, stretch out on a hammock for a nap. Enjoy a massage. Carve out 20 minutes during your busy day for breath focus or progressive muscle relaxation. Soak in the sounds of music you find calming or invigorating or simply pleasurable. Taking this time for yourself helps ward off exhaustion and burnout, allowing you to focus more attentively and less resentfully on the tasks of your day. Consider it a gift to yourself that also pays dividends to others.

From the Harvard Health Publications Special Health Report, Stress Control: Techniques for Preventing and Easing Stress

With Depression, Vets Face Higher Suicide Risk

About a third of the veterans treated in Veterans Affairs hospitals suffer from depression, putting them at much greater risk of suicide than non-depressed veterans, University of Michigan researchers report.

But is that risk greater at certain times, and might it be related to their use of antidepressants, the researchers wondered?

Their five-year study of veterans with depression revealed a spike in suicide risk after discharge from a psychiatric hospital and a relatively short-term increase in risk after beginning treatment with an antidepressant. The findings were published in the January issue of the Journal of Affective Disorders.

"The goal of this study was to determine suicide rates during potentially high risk periods for patients with depressive disorders," said lead researcher Dr. Marcia Valenstein, a clinical psychiatrist at the VA Ann Arbor Healthcare System and an associate professor of psychiatry at the University of Michigan Health System.

Valenstein's research team collected data on 887,859 VA hospital patients being treated for depression from April 1999 to September 2004. They calculated the suicide rate for several 12-week periods, including after the start of treatment with antidepressants, after treatment changes, and upon discharge from a psychiatric hospital.

"The possibility of increased suicide risks with antidepressant use has received much media attention, and there have been governmental recommendations for close clinical monitoring during these periods," Valenstein said.

The study confirmed what others have shown: that the first 12 weeks after starting antidepressants is a higher risk period for patients, with 210 suicides per 100,000 person-years, but that the risk returns to normal thereafter.

"However, patients were at very high risk for suicide immediately following psychiatric hospitalizations, where the suicide rate was 568 per 100,000 person-years," Valenstein said. The risk for suicide after psychiatric hospitalization does not return to normal for a year, she said.

Veterans 61 to 80 years of age were found to have the highest risk of suicide, the researchers noted.

There are currently no governmental recommendations for close monitoring after someone is discharged from a psychiatric hospital, although one widely used protocol suggests one visit in the first seven days after discharge, Valenstein said.

"To have the greatest impact on suicide, health systems should prioritize suicide prevention efforts following psychiatric hospitalizations," she said. "If resources allow, closer monitoring during the first 12 weeks after an antidepressant start may be warranted."

Valenstein said that to help stem the tide of suicide among veterans, the Department of Veterans Affairs is spending $300 million for suicide prevention and other mental health services.

Simon Rego, associate director of psychology training at Montefiore Medical Center and an assistant professor at Albert Einstein College of Medicine in New York City, agreed that there's a need for better monitoring of depressed patients after they leave the hospital.

"Although the results of this study are limited, in that they are based on a largely male and older VA population of depressed patients, they still provide an important contribution to an area of extreme importance to the entire mental health system in the United States: suicide prevention," Rego said.

The study highlights the importance of moving some of the responsibility traditionally placed on clinicians to the entire mental health care system in order to shift the focus of prevention efforts from individual patients to entire at-risk populations, he added.

"In terms of suicide prevention, the results indicate that there are readily identifiable high-risk periods following specific events, such as being discharged from an inpatient psychiatric stay or starting a new antidepressant medication, and contrary to previously held notions, that these risk periods are not just for younger patients," Rego said.

In addition, the finding that suicide risk is highest in the first 12 weeks after discharge from a psychiatric hospitalization calls into question current policies that require minimal contact after a patient has been discharged, Rego said.

"The data from this study would suggest that the current monitoring is neither intense enough nor long enough in duration, and that the best use of our mental health resources would be to target efforts at frequent reassessment of suicide risk, offering of support, and establishing a connection to outpatient services during the entire 12-week period after discharge from a psychiatric hospitalization," Rego said.

Everyday Health - Emotional Health on 12/30/2008

Anxiety Linked to Heart Attack Can Raise Death Risk

Post-traumatic stress disorder (PTSD) linked to a heart attack can raise the long term risk of death for people with implanted cardiac defibrillators, a new study suggests.

Surviving a heart attack or cardiac arrest can cause significant distress. As a result, many patients later develop PTSD, which includes intense anxiety, flashbacks and "hyperarousal," according to background information in the article.

The German study, published in the November issue of Archives of General Psychiatry, found that almost 70 percent of the 211 recipients of the heart-shocking devices experienced some PTSD symptoms. About 31 percent of the recipients died within five years of the attack, and those with PTSD were about 2.4 times more likely to be among the deceased.

"Our findings provide direct evidence for an independent influence of PTSD symptoms on fatal outcome in these patients," wrote the authors of the study, led by Dr. Karl-Heinz Ladwig of Technische Universitaet Muenchen, Munich.

While patients with PTSD in the study reported more cardiac symptoms (such as chest pain) than those without the disorder, the clinical experiences in such patients -- for example, the frequency at which their defibrillator administers shocks -- were similar between the two groups.

"Therefore, the perceived severity rather than the objective severity of a cardiac condition as determined by cardiac criteria may be associated with PTSD," the authors wrote.

They called for further studies to determine whether behavioral and biological factors affect the death rates in these patients, but in the meantime, they called for screening for PTSD in patients with implantable cardiac defibrillators, as it is "likely to be clinically beneficial, and treatment in selected patients should be attempted."

Health Day

Work-life balance: Ways to restore harmony and reduce stress

Finding work-life balance in today's frenetically paced world is no simple task.

Spend more time at work than at home, and you miss out on a rewarding personal life. Then again, when you face challenges in your personal life, such as caring for an aging parent or coping with marital problems, concentrating on your job can be difficult.

Whether the problem is too much focus on work or too little, when your work life and your personal life feel out of balance, stress - along with its harmful effects - is the result.

The good news is that you can take control of your work-life balance - and give yourself the time to do the things that are most important to you. The first step is to recognize how the world of work has changed. Then you can evaluate your relationship to work and apply some specific strategies for striking a healthier balance.

How work invades your personal life

There was a time when employees showed up for work Monday through Friday and worked eight- to nine-hour days. The boundaries between work and home were fairly clear then. But the world has changed and, unfortunately, the boundaries have blurred for many workers. Here's why:

• Global economy. As more skilled workers enter the global labor market and companies outsource or move more jobs to reduce labor costs, people feel pressured to work longer and produce more just to protect their jobs.
• International business. Work continues around the world 24 hours a day for some people. If you work in an international organization, you might be on call around the clock for troubleshooting or consulting.
• Advanced communication technology. Many people now have the ability to work anywhere - from their home, from their car and even on vacation. And some managers expect this.
• Longer hours. Employers commonly ask employees to work longer hours than they're scheduled. Often, overtime is mandatory. If you hope to move up the career ladder, you may find yourself regularly working more than 40 hours a week to achieve and exceed expectations.
• Changes in family roles. Today's married worker is typically part of a dual-career couple, which makes it difficult to find time to meet commitments to family, friends and community.

Married to your work
It can be tempting to rack up the hours at work - especially if you're trying to earn a promotion or some extra money for a child's education or a dream vacation. For others, working more hours feels necessary in order to manage the workload.

But if you're spending most of your time at work, your home life will likely pay the price. Consider the pros and cons of working extra hours on your work-life balance:

• Fatigue. Your ability to think and your eye-hand coordination decrease when you're tired. This means you're less productive and may make more mistakes. These mistakes can lead to injury or rework and negatively impact your professional reputation.
• Family. You may miss out on important events, such as your child's first bike ride, your father's 60th birthday or your high-school reunion. Missing out on important milestones may harm relationships with your loved ones.
• Friends. Trusted friends are a key part of your support system. But if you're spending time at the office instead of with them, you'll find it difficult to nurture those friendships.
• Expectations. If you regularly work extra hours, you may be given more responsibility. This could create a never-ending and increasing cycle, causing more concerns and challenges.

Sometimes working overtime is important. If you work for a company that requires mandatory overtime, you won't be able to avoid it, but you can learn to manage it. Most importantly, say no when you're too tired, when it's affecting your health or when you have crucial family obligations.

Striking the best work-life balance

For most people, juggling the demands of career and personal life is an ongoing challenge. With so many demands on your time - from overtime to family obligations - it can feel difficult to strike this balance. The goal is to make time for the activities that are the most important to you.

Here are some ideas to help you find the balance that's best for you:

• Keep a log. Track everything you do for one week. Include work-related and non-work-related activities. Decide what's necessary and what satisfies you the most. Cut or delegate activities you don't enjoy and don't have time for. If you don't have the authority to make certain decisions, talk to your supervisor.
• Take advantage of your options. Find out if your employer offers flex hours, a compressed workweek, job-sharing or telecommuting for your role. The flexibility may alleviate some of your stress and free up some time.
• Learn to say no. Whether it's a co-worker asking you to spearhead an extra project or your child's teacher asking you to manage the class play, remember that it's OK to respectfully say no. When you quit doing the things you only do out of guilt or a false sense of obligation, you'll make more room in your life for the activities that are meaningful to you and bring you joy.
• Leave work at work. With today's global business mentality and the technology to connect to anyone at any time from virtually anywhere, there's no boundary between work and home - unless you create it. Make a conscious decision to separate work time from personal time. When with your family, for instance, turn off your cell phone and put away your laptop computer.
• Manage your time. Organize household tasks efficiently. Doing one or two loads of laundry every day, rather than saving it all for your day off, and running errands in batches are good places to begin. A weekly family calendar of important dates and a daily list of to-dos will help you avoid deadline panic. If your employer offers a course in time management, sign up for it.
• Rethink your cleaning standards. An unmade bed or sink of dirty dishes won't impact the quality of your life. Do what needs to be done and let the rest go. If you can afford it, pay someone else to clean your house.
• Communicate clearly. Limit time-consuming misunderstandings by communicating clearly and listening carefully. Take notes if necessary.
• Fight the guilt. Remember, having a family and a job is OK - for both men and women.
• Nurture yourself. Set aside time each day for an activity that you enjoy, such as walking, working out or listening to music. Unwind after a hectic workday by reading, practicing yoga, or taking a bath or shower.
• Set aside one night each week for recreation. Take the phone off the hook, power down the computer and turn off the TV. Discover activities you can do with your partner, family or friends, such as playing golf, fishing or canoeing. Making time for activities you enjoy will rejuvenate you.
• Protect your day off. Try to schedule some of your routine chores on workdays so that your days off are more relaxing.
• Get enough sleep. There's nothing as stressful and potentially dangerous as working when you're sleep-deprived. Not only is your productivity affected, but also you can make costly mistakes. You may then have to work even more hours to make up for these mistakes.
• Bolster your support system. Give yourself the gift of a trusted friend or co-worker to talk with during times of stress or hardship. Ensure you have trusted friends and relatives who can assist you when you need to work overtime or travel for your job.
• Seek professional help. Everyone needs help from time to time. If your life feels too chaotic to manage and you're spinning your wheels worrying about it, talk with a professional, such as your doctor, a psychologist or a counselor recommended by your employee assistance program (EAP).

Services provided by your EAP are usually free of charge and confidential. This means no one but you will know what you discuss. And if you're experiencing high levels of stress because of marital, financial, chemical dependency or legal problems, an EAP counselor can link you to helpful services in your community.

Remember, striking a work-life balance isn't a one-shot deal. Creating balance in your life is a continuous process. Demands on your time change as your family, interests and work life change. Assess your situation every few months to make sure you're keeping on track.

Balance doesn't mean doing everything. Examine your priorities and set boundaries. Be firm in what you can and cannot do. Only you can restore harmony to your lifestyle.

MayoClinic.com

Music therapy

What is music therapy?

Music therapy is the use of music to gain physical and emotional healing and wellness. A trained and certified music therapist, dance/movement therapist, or creative arts–expressive therapist can provide music therapy. Therapy sessions can involve listening to music, music-making, or both.

Research is beginning to reveal how music works to heal the body and mind.

• The rhythm and tone of music can excite you or relax you. Music therapy can help reduce your heart rate and blood pressure and increase your ability to think, learn, reason, and remember.
• Music-making is a healthy way of expressing yourself.

What is music therapy used for?

You can use music therapy to help your mental and physical health. It helps people express themselves, find new memories, and calm the body and mind through its rhythm, order, and predictability. Music therapy is sometimes combined with movement therapies, such as dance.

Music therapy:

• May improve forgetfulness (dementia) by:
  • Improving your connection to others.
  • Helping the brain produce a calming substance (melatonin).
  • Improving how well you speak.
  • Improving long-term and medium-term memory.
• May help babies born too early to deal with necessary but painful procedures. Crying is often affected by music.
• Is used to reduce the pain of cancer treatment.

Is music therapy safe?

Music therapy is considered safe.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Jeannette Curtis; Caroline Rea, RN, BS, MS
Content provided by Healthwise

Try yoga to treat anxiety and depression

To me, yoga is a way of manipulating the nervous system, just like drugs are. And so it can be useful for people with anxiety and depression. It certainly won’t hurt, so I recommend that you try to practice daily in some form in addition to whatever medications or psychotherapy your doctor recommends.

First, I’d focus on your anxiety, using restorative yoga — or positions of deep rest with the support of blankets and bolsters — to stimulate the parasympathetic nervous system, which encourages the body to relax and renew. This might include supported reclining, bridge and child’s poses as well as savasana, or corpse pose. Chest-opening positions like the cat-cow stretch and cobra pose are also beneficial.

For your depression, I suggest active poses like sun salutations in order to get the body moving and fluid and to counter any feelings of being trapped or weighted down. Standing poses that require balance (like mountain and tree poses) can help center the mind, too.

Deep, uneven breathing (such as an inhale of 3 breaths and exhale of 6 breaths) done lying on the ground with your chest propped open also stimulates the parasympathetic nervous system and helps you relax.

Whenever you’re feeling particularly down, I encourage you to return to these tools.

Judith Hanson Lasater, Ph.D., P.T., yoga teacher and author of 6 books, including Living Your Yoga: Finding the Spiritual in Everyday Life

Stressed? Skip TV and look out the window

If you're feeling stressed, rather than wallow in front of the television try looking out of the window, with a U.S. study finding scenes of nature can alleviate minor stress levels.

Researchers at the Human Interaction with Nature and Technological Systems Lab at the University of Washington set out to look at whether nature, either the real thing or depicted technologically, can impact on minor stress levels.

The study involved measuring people's heart recovery rate from minor stress when they were exposed to a natural scene through a window and when exposed to the same scene shown on a high-definition plasma screen, or a blank wall.

"The heart rate of people who looked at the scene through the window dropped more quickly than the others. In fact, the high-definition plasma screen had no more effect than the blank wall," the researchers said in a statement.

They also found that when people spent more time looking at the natural scene their heart rates tended to decrease more. That was not the case with the plasma screen.

The study, involving 90 college students, is published in the Journal of Environmental Psychology.

"Technology is good and it can help our lives, but let's not be fooled into thinking we can live without nature," Peter Kahn, who led the research team, said in a statement.

He said people were losing direct experiences with nature and instead experiencing nature represented technologically through television and other media with children growing up watching Discovery Channel and Animal Planet.

"But as a species we need interaction with actual nature for our physical and psychological well-being," he said.

Reuters

7 Questions to Ask Your Doc If You Have a Major Decline in Sex Drive

1. Could it be caused by medications I'm taking? Loss of libido is a common side effect to some prescription medications.

2. I'm angry/stressed/tired/overwhelmed — could this be part of the problem? Emotions can wreak havoc with hormone levels and the endocrine system, and that can put a damper on your desire.

3. Am I overweight? High cholesterol and insulin resistance — two common medical conditions associated with being overweight — can affect sexual performance.

4. Could I be suffering from depression? Depressed people are rarely interested in sex.

5. Could I have a hormonal problem? Imbalances of testosterone in men and estrogen in women can lower libido.

6. I experience pain during sex — enough that I don't want to have sex much anymore. What's causing it? The problem could range from the relatively easy to correct (such as not enough foreplay) to a more severe underlying condition (such as an estrogen deficiency).

7. I haven't been able to achieve an orgasm in a while. What's happening to me? The problem could be related to medication you're taking, or it could be a harder-to-pinpoint psychological issue. Either way, your doctor will be able to help.

Revolution Health Group

Helping Kids Cope With Stress

Kids get to play and they don't have jobs, but they still have plenty to worry about. Stress from things like school and social situations can feel overwhelming for kids, particularly if they don't have healthy strategies to cope with strong feelings and solve everyday problems.

A recent KidsHealth® KidsPoll showed that kids deal with stress in both healthy and unhealthy ways, and while they may not initiate a conversation about what's bothering them, they do want their parents to reach out and help them cope with their feelings.

But it's not always easy for parents to know how to connect with a child who's feeling stressed.

Here are a few ideas:

Notice out loud. Tell your child when you notice something he or she might be feeling. ("It seems like you're still mad about what happened at the playground"). This shouldn't sound like an accusation (as in, "OK, what happened now? Are you still mad about that?") or put a child on the spot. It's just a casual observation that you're interested in hearing more about your child's concern.

Listen to your child. Ask your child to tell you what's wrong. Listen attentively and calmly -- with interest, patience, openness, and caring. Avoid any urge to judge, blame, lecture, or say what you think your child should have done instead. The idea is to let your child's concerns (and feelings) be heard. Try to get the whole story by asking questions like "And then what happened?" Take your time. And let your child take his or her time, too.

Comment briefly on the feelings you think your child was experiencing. For example, you might say "That must have been upsetting," "No wonder you felt mad when they wouldn't let you in the game," or "That must have seemed unfair to you." Doing this shows that you understand what your child felt, why, and that you care. Feeling understood and listened to helps your child feel connected to you, and that is especially important in times of stress.

Put a label on it. Many kids do not yet have words for their feelings. If your child seems angry or frustrated, use those words to help him or her learn to identify the emotions by name. Putting feelings into words helps your child communicate and develop emotional awareness -- the ability to recognize his or her own emotional states. A child who can do so is less likely to reach the behavioral boiling point where strong emotions get demonstrated through behaviors rather than communicated with words.

Help your child think of things to do. Suggest activities your child can do to feel better now and to solve the problem at hand. Encourage your child to think of a couple of ideas. You can get the brainstorm started if necessary, but don't do all the work. Your child's active participation will build confidence. Support the good ideas and add to them as needed. Ask, "How do you think this will work?" Sometimes talking and listening and feeling understood is all that's needed to help a child's frustrations begin to melt away. Other times try changing the subject and moving on to something more positive and relaxing. Don't give the problem more attention than it deserves.

Just be there. Sometimes kids don't feel like talking about what's bothering them. Respect that, give your child space, and still make it clear that you'll be there when he or she does feel like talking. Even when kids don't communicate, they usually don't want parents to leave them alone. You can help your child feel better just by being there -- keeping him or her company, spending time together. So if you notice that your child seems to be down in the dumps, stressed, or having a bad day -- but doesn't feel like talking -- initiate something you can do together. Take a walk, watch a movie, shoot some hoops, or bake some cookies. Isn't it nice to know that your presence really counts?

Be patient. As a parent, it hurts to see your child unhappy or worried. But try to resist the urge to fix every problem. Instead, focus on helping your child, slowly but surely, grow into a good problem-solver -- a kid who knows how to roll with life's ups and downs, put feelings into words, calm down when needed, and bounce back to try again.

Remember that you can't fix everything, and that you won't be there to solve every problem as your child goes through life. But by teaching healthy coping strategies, you prepare your child to manage whatever stresses come in the future.

KidsHealth

Group urges heart test before kids get ADHD drugs

Children with attention deficit hyperactivity disorder should get their hearts checked before starting treatment with Ritalin or other stimulant drugs, experts recommended on Monday.

The American Heart Association called for these children to undergo an electrocardiogram, a test that detects and records the heart's electrical activity, before taking such drugs.

The group said it is not clear that these medications increase a child's risk of sudden cardiac death, but issued the new recommendations out of an abundance of caution.

"There's been concern that these drugs might be associated in a very small number of individuals' sudden cardiac arrest or sudden cardiac death," said Dr. Victoria Vetter of the University of Pennsylvania School of Medicine in Philadelphia, who led the panel that drafted the recommendations.

"There's no registry in the country to determine how many young people are dying from sudden cardiac arrest and what they might have causing that -- and similarly how many of those who die might be on these medications. So there's no causal information," Vetter added in a telephone interview.

Ritalin, Novartis AG's brand name for the generic drug methylphenidate, is a central nervous system stimulant prescribed to calm and focus children with ADHD, a condition marked by inattention, hyperactivity and impulsive behavior.

ADHD appears to be more common in children with heart conditions, the American Heart Association said in the recommendations, published in its journal Circulation.

The group said U.S. Food and Drug Association data showed that between 1999 and 2004, 19 children taking ADHD drugs died suddenly and 26 children had cardiovascular events such as strokes, cardiac arrests and heart palpitations.

MILLIONS TREATED

Millions of U.S. children are taking ADHD drugs.

Research has indicated that stimulants like Ritalin can raise the heart rate and blood pressure. While these side effects are unimportant for most children with ADHD, they can be relevant for those with a heart condition, the American Heart Association said.

Some heart conditions can raise the risk for sudden cardiac death, which can happen when heart rhythm becomes erratic.

The association's recommendations call for a child to get an electrocardiogram before starting ADHD stimulant medications because the test may identify conditions like heart rhythm abnormalities that can trigger sudden cardiac death.

"It won't pick up every one. There will be some false positives. But it's a relatively inexpensive and simple test that doesn't hurt the children in any way and it will let us identify some of these children and know that they have heart conditions," Vetter said.

"We particularly don't want to scare people or to alarm them," Vetter said.

The group also urged doctors to evaluate the heart health of children already taking ADHD medications if they were not evaluated before they began treatment. If the electrocardiogram turns up trouble, that does not necessarily mean the child should not get ADHD medications, Vetter said.

"We would monitor those children more carefully -- start them on lower doses of drugs and see how they do," she said.

Two U.S. health agencies said last year they were launching a two-year assessment of potential heart risks from ADHD drugs.

Reuters

Adaptive Equipment and Sensory Integration

There's a lot your body will sense form these bright and fun-shaped aromatherapy toys.  They provide gentle pressure to any part of the body.  Contains a blend of carefully selected spices and herbs.  Helps with relaxation and focus while bringing a sense of calmness to children.  Plus, it's a great way to provide olfactory and proprioceptive stimulation.

5 Ways to Ward Off Anxiety

Anxiety disorders are the most common form of mental illness in America, affecting more than 40 million Americans ages 18 and older, according to the Anxiety Disorders Association of America.

As with most mental health problems, people experience degrees of anxiety ranging from the normal situational variety — which arises from financial, work, health or relationship problems — to more severe panic or post-traumatic stress disorders and specific debilitating phobias. 

Some anxiety is healthy, appropriate and motivating (e.g., when studying for a test or preparing for an athletic competition). This type of anxiety has been called eustress. But anxiety becomes a problem when it is crippling or sends you into a state of distress. If left unaddressed, even milder levels of anxiety can take a physical toll and cause fatigue, insomnia, drug and alcohol problems, and the corrosive effect of the fight-or-flight hormone cortisol.

Here are five things you can do daily to better manage your day-to-day anxiety. If your feelings of anxiety become debilitating or don’t respond to these interventions below, seek help from a trained professional.

1. Have a cup of tea. For centuries, herbalists have touted the calming action of chamomile. This gentle herb soothes the stomach as well as the mind, so brew up a cup and let its warmth and aroma melt away your mild anxiety. Green tea also calms the mind, most likely because it contains significant amounts of L-theanine, an amino acid that increases the brain’s production of gamma-aminobutyric acid (GABA). A 2006 study published in the journal Biofactors described GABA as a natural relaxant that diminishes anxiety. Be aware that green tea contains caffeine, albeit in small amounts compared to coffee. So if you’re sensitive to caffeine, look for decaffeinated green tea.

2. Get some aerobic exercise. Raising heart and breathing rates can help people to burn off nervous energy and to reduce generalized anxiety. A study published in the February 2004 edition of Behavior and Research Therapy found that both low- and high-intensity treadmill workouts (20 minutes) reduced anxiety in subjects with elevated anxiety  scores. In this case, more was better — high-intensity workouts brought about more rapid reductions of anxiety and a higher number of positive responses.

3. Practice yoga. Regular yoga practitioners often say that they feel more self-assured and positive about themselves after class, and numerous studies have identified physiological proof (reduced blood pressure, heart rate and respiraton) to these improved emotional and mental states. Studies have shown that yoga can help people with cancer and AIDS to overcome disease-associated anxiety. In fact, Peter M. Wolsko, M.D., M.P.H., of Harvard Medical School has a National Center for Complementary and Alternative Medicine-funded study underway that is examining yoga’s effect on generalized anxiety disorder. While almost any type of yoga and series of poses can help to relieve symptoms of anxiety, restorative yoga — which uses bolsters, blankets and other props to support the body and encourage relaxation — may offer beginners an easy way to get started. More adept practitioners should try forward bends, supported chest openers or even upside-down poses like headstands.

4. Breathe. As anxiety takes hold, our breathing becomes more rapid and shallow — a natural reaction that is linked to our nervous system’s adaptive “fight or flight” response. This instinctual response helps us to calculate and manage the risk of any potential danger, either real or imagined. A study in the February 2005 issue of The Journal of Complementary Medicine reports that “a sequence of specific breathing techniques … can alleviate anxiety, depression, everyday stress, post-traumatic stress and stress-related medical illnesses.” Similar studies have shown that any kind of rhythmic or conscious breathing — whether it’s linked to yoga (pranayama) or religious ritual (saying the rosary) — can have a beneficial effect on stress and anxiety levels.

Linda Sparrowe, author of A Woman’s Book of Yoga and Health (Shambhala Publishing, 2002), suggests these simple breathing techniques:

•    Breathe to relax. Find a comfortable position (sitting or lying down) and breathe deeply into your belly. As you inhale, say the words “I am” to yourself. As you exhale, silently say the word “relaxed.” Repeat this mantra with each complete breath and feel yourself relax.

•    Count your breaths. Focus on your breath and count each complete cycle (inhale and exhale) until you reach 10. Don’t fret if you lose count. That’s normal. Simply start again.

5. Take your B’s. A number of studies conducted from the 1980s to the present have demonstrated that various B vitamins have a positive effect on anxiety. Naturopathic doctor John Neustadt, medical director of Montana Integrative Medicine in Bozeman, suggests taking 50 milligrams of vitamin B complex one to three times a day. He also says that additional supplementation with the following four Bs may also help:

•    Inositol. In an article published in the June 2001 issue of the Journal of Clinical Psychopharmacology, Israeli researchers found that inositol (up to 18 grams a day for a month) produced improvements in various anxiety measures that were comparable to fluvoxamine (Luvox), a drug prescribed for obsessive compulsive disorder (OCD), and it didn’t have unwanted side effects.

•    Thiamine. Prolonged vitamin B1 deficiency can produce elevated levels of lactate and symptoms of anxiety. Take 50 milligrams three times a day with meals.

•    Vitamin B6. This is a key nutrient involved in the synthesis of GABA, a neurotransmitter that helps regulate anxiety. Also, the body cannot convert tryptophan to serotonin (another anxiety-related neurotransmitter) without B6. Take 50 milligrams three times a day.

•    Niacinamide. A more bioavailable (absorbent) form of vitamin B3, niacinamide compares with benzodiazepine drugs (Valium, Xanax) in alleviating anxiety, according to a number of studies completed during the last two decades. Recommended doses vary from 100 to 1,000 milligrams three times a day, or just below the amount that produces nausea.

According to Neustadt, the best way to take B vitamins is orally — except for B12, which is best taken under the tongue in an easy-to-dissolve tablet or liquid form.

He says he tests for vitamin B deficiencies “when stress starts manifesting itself clinically with insomnia, fatigue or depression,” but that he also looks at amino acids, minerals and fats “because biochemistry is a web of interaction, and you need more than just B vitamins.”

Not everyone needs testing, however. Neustadt says it’s OK if someone experiencing anxiety or stress takes a high-quality and high-dose B complex supplement to see if it helps bring relief. Besides, he says: “My assumption is that the majority of people need a good multivitamin with high doses of B’s just as an insurance policy.”

What now?
What if the above interventions do not work, or if they only provide temporary relief?  Symptoms of anxiety are multidimensional and can range from shortness of breath and nausea to a feeling of dread, panic or losing one’s mind. Anxiety is like the mind’s fever, an indication that something is not well.

In order to treat a fever correctly, the doctor must determine the underlying cause of the condition, and the same principle holds true for anxiety. Some fevers go away on their own relatively quickly or with anti-inflammatory medication — while some do not. If your anxiety persists, you will do well to seek the appropriate help.

A good place to start always is with your primary care doctor.  He or she will be able to evaluate you and make sure that you are in good physical health and not suffering from an underlying thyroid problem or an undiagnosed medication reaction or medical  condition that has anxiety as a primary symptom. If you have not had a checkup in a while, it’s a good idea to do this anyway.

If you are medically healthy, your primary care doctor will be able to refer you to see a psychiatrist or a therapist. Sometimes taking an antidepressant medication that also treats anxiety can help in the short term, as can an immediate-acting  anti-anxiety medication or sleeping aid. 

However, more than anything else, taking the leap of faith to see a trained professional can endow you with a sense that you are taking this problem seriously and are trusting someone safe with a burden you may have been carrying for some time. If this is so, talking therapy might do wonders for you — with or without any kind of anxiety medication. When in doubt, play it safe and go see a trained professional.

Revolution Health Group

Relaxation Techniques

Relaxation techniques are a great way to help you beat stress and sustain good health.

Try these suggestions to help you unwind, courtesy of AARP:

• Invigorate muscles with a visit to a massage therapist.
• Meditate. Sit quietly or listen to soft music.
• Practice deep breathing.
• Imagine yourself in a relaxing place, such as in the mountains or on the beach.
• Stop stressful thoughts before they spin out of control.
• When you feel stress, your muscles tense up. Learn to relax your muscles to release stress.
• Practice yoga or tai chi.

Health Day

Beat Stress, Live Longer

Over the past decade or so, it's become increasingly clear that stress can harm our health. But now a study shows the damage is even more profound than we'd thought: Stress, it seems, can actually make your cells age quicker.

The study, from researchers at the University of California at San Francisco, shows that prolonged high stress speeds up age-related cellular changes by a decade or more. These changes have been associated with serious health problems, including heart attacks and increased vulnera-bility to infection.

All 58 women in the study were mothers between 20 and 50 years old -- certainly a group that knows stress. But the 39 women in the highest-stress group were also caring for a chronically ill child, and the scientists found a direct correlation between the number of years the child had been ill and the extent of premature aging in the mother's cells.

While researchers look for "treatment interventions" -- doctorspeak for ways to chill out -- do yourself a favor and start taking breaks now.

Alternative Medicine Magazine

Humor Therapy

What is humor therapy?

Humor therapy (sometimes called therapeutic humor) uses the power of smiles and laughter to aid healing. Humor therapy helps you find ways to make yourself (or others) smile and laugh more. When you think of humor therapy, picture clowns in the children's ward of a hospital cheering up sick children. Some hospitals now have humor carts that provide funny materials for people of any age. Many nurses have learned the value of providing a good laugh to those they care for.

Scientists have been researching the relation between the mind and the body, especially in connection with the body's ability to heal (a field called psychoneuroimmunology). Laughter appears to change brain chemistry and may boost the immune system.

Humor may allow a person to feel in control of a situation and make it seem manageable. It allows people to release fears, anger, and stress, all of which can harm the body over time. Humor improves the quality of life.

What is humor therapy used for?

Anyone can use humor therapy, either preventively or as part of treatment for any disease. People commonly use it in the treatment of long-term (chronic) diseases, especially those that are made worse by stress (such as heart disease and asthma). Chronic diseases can often have a negative effect on mood and attitude, which can make the disease worse. Humor therapy helps decrease the negative effects of feeling unhealthy, out of control, afraid, or helpless, which are common problems for those with cancer or chronic diseases.

Humor therapy is also valuable as a preventive measure for the caregivers of people with chronic diseases. Caregivers are at high risk of becoming sick themselves, and humor therapy can help release the stress that comes from being a caregiver. Caregivers and those they care for can practice humor therapy together, and they both are likely to have better health as a result.

Is humor therapy safe?

Humor therapy is completely safe. Your doctor is likely to approve of any efforts you make to use humor therapy, even if he or she is not aware of any medical benefits that may result. Since it is also inexpensive, risk-free, and readily available, there is little reason not to try practicing humor therapy.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Healthwise

Yoga: Not Just for Chilling Out

Many people think of yoga as a wonderful way to relax. But any true yogi knows the practice can also be quite energizing. In fact, a new study suggests it might help a group of people even more in need of a boost than the average person: those fighting multiple sclerosis, a disease that often comes with bone-crushing fatigue.

Researchers at the Health & Science University in Portland, Oregon, discovered that people with MS who took a yoga class every week for six months -- along with doing poses at home -- reported being considerably less tired than a group who did nothing out of the ordinary. The study is the first in-depth trial of yoga for MS patients. Lead researcher and neurologist Barry Oken says that people whose symptoms are mild should be able to manage in a gentle class designed for seniors; those with more severe symptoms might prefer a class geared to people with MS.

Alternative Medicine Magazine

Dealing With Anxiety

For some people, anxiety can be so severe that it is difficult to function.

The American Academy of Family Physicians offers these suggestions for dealing with anxiety:

• It's OK to worry about some things -- but try not to let anxiety consume your day. Set aside a certain amount of time each day to consider all of the things that are concerning you, and come up with ways to deal with them. Once your time is up, try to move on.
• Try relaxation techniques such as yoga, meditation, deep breathing and stretching.
• Get regular exercise and plenty of sleep. Avoid caffeine and alcohol.
• Take care of issues that caused you to worry in the past.
• Talk to your doctor about your anxiety and concerns.

Health Day

Depression and anxiety: Exercise eases symptoms

If you have depression or anxiety, you might find your doctor or mental health provider prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.

"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.

When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. See how exercise can ease depression symptoms and anxiety symptoms. Plus, get realistic tips to get started and stick with exercising.

How exercise helps depression and anxiety

Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes and other diseases. A growing volume of research shows that exercise can also help improve symptoms of certain mental health conditions, including depression and anxiety. Exercise may also help prevent a relapse after treatment for depression or anxiety.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve depression symptoms. But smaller amounts of activity - as little as 10 to 15 minutes at a time - can improve mood in the short term. "Small bouts of exercise may be a great way to get started if it's initially too hard to do more," Dr. Vickers-Douglas says.

Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Some evidence suggests that exercise raises the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release muscle tension, help you sleep better, and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety.

The benefits of exercise for depression and anxiety

Exercise has many psychological and emotional benefits when you have depression or anxiety. These include:

• Confidence. Being physically active gives you a sense of accomplishment. Meeting goals or challenges, no matter how small, can boost self-confidence at times when you need it most. Exercise can also make you feel better about your appearance and your self-worth.
• Distraction. When you have depression or anxiety, it's easy to dwell on how badly you feel. But dwelling interferes with your ability to problem solve and cope in a healthy way. Dwelling can also make depression more severe and longer lasting. Exercise can shift the focus away from unpleasant thoughts to something more pleasant, such as your surroundings or the music you enjoy listening to while you exercise.
• Interactions. Depression and anxiety can lead to isolation. That, in turn, can worsen your condition. Exercise may give you the chance to meet or socialize with others, even if it's just exchanging a friendly smile or greeting as you walk around your neighborhood.
• Healthy coping. Doing something positive to manage depression or anxiety is a healthy coping strategy. Trying to feel better by drinking alcohol excessively, dwelling on how badly you feel, or hoping depression and anxiety will go away on their own aren't helpful coping strategies.

Tips to start exercising when you have depression or anxiety

Of course, knowing that something's good for you doesn't make it easier to actually do it. With depression or anxiety, you may have a hard enough time just doing the dishes, showering or going to work. How can you possibly consider getting in some exercise?

Here are some steps that can help you exercise when you have depression or anxiety. As always, check with your health care provider before starting a new exercise program to make sure it's safe for you.

• Get your mental health provider's support. Some, but not all, mental health providers encourage exercise as a part of their treatment plan. Talk to your doctor or therapist for guidance and support. Discuss concerns about an exercise program and how it fits into your overall treatment plan.
• Identify what you enjoy doing. Figure out what type of exercise or activities you're most likely to do. And think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening or go for a jog in the pre-dawn hours? Go for a walk in the woods or play basketball with your children after school? Do what you enjoy to help you stick with it.
• Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think about what you may be able to do in reality. Twenty minutes? Ten minutes? Start there and build up. Tailor your plan to your own needs and abilities rather than trying to meet idealistic guidelines that could just add to your pressure.
• Don't think of exercise as a burden. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or antidepressant medication - as one of the tools to help you get better.
• Address your barriers. Figure out what's stopping you from exercising. If you feel intimidated by others or are self-conscious, for instance, you may want to exercise in the privacy of your own home. If you stick to goals better with a partner, find a friend to work out with. If you don't have extra money to spend on exercise gear, do something that's virtually cost-free - walk. If you think about what's stopping you from exercising, you can probably find an alternative solution.
• Prepare for setbacks and obstacles. Exercise isn't always easy or fun. And it's tempting to blame yourself for that. People with depression are especially likely to feel shame over perceived failures. Don't fall into that trap. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you're a failure and may as well quit entirely. Just try again the next day.

Sticking with exercise when you have depression or anxiety

Launching an exercise program is hard. Sticking with it can be even harder. One key is problem solving your way through when it seems like you can't or don't want to exercise.

"What would happen if you went out to your car and it wouldn't start?" Dr. Vickers-Douglas asks. "You'd probably be able to very quickly list several strategies for dealing with that barrier, such as calling an auto service, taking the bus, or calling your partner or friend for help. You instantly start problem solving."

But most people don't approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide against the walk and don't even try to explore alternatives. "With exercise, we often hit a barrier and say, 'That's it. I can't do it, forget it,' " Dr. Vickers-Douglas says.

Instead, problem solve your way through the exercise barrier, just as you would other obstacles in your life. Figure out your options - walking in the rain, going to a gym, exercising indoors, for instance.

"Some people think they need to wait until they somehow generate enough willpower to exercise," Dr. Vickers-Douglas says. "But waiting for willpower or motivation to exercise is a passive approach, and when someone has depression and is unmotivated, waiting passively for change is unlikely to help at all. Focusing on a lack of motivation and willpower can make you feel like a failure. Instead, identify your strengths and skills and apply those to taking some first steps toward exercise."

MayoClinic.com