Ashlee Williams, MD (Host): Anxiety doesn't just mean feeling nervous or overwhelmed. It has physical effects, causing headaches, muscle tension, difficulty sleeping, and more. And while anxiety is a natural response to stress, it can sometimes interfere with how we feel, think and go about our daily lives. Welcome to The Healthier You Podcast.

I'm Dr. Ashlee Williams, and today I'm joined by Dr. Jessica Reddy, a Board Certified Psychiatrist here at Kaiser Permanente. We'll be talking about some of the most common signs of anxiety and more importantly, practical steps you can take to start feeling better. Thank you so much for joining us today, Dr. Reddy.

Jessica Reddy, MD: Thank you for having me.

Host: So excited about this important conversation. Okay, Dr. Reddy, let's just start with the basics. We always like to start with the basics. What is anxiety and how common is it?

Jessica Reddy, MD: So anxiety can look like a lot of different things. For example, it can look like worry. So having thoughts about the future, about things that we can't control. It can also manifest physically like having increased heart rate or feeling like your palms are sweaty, or breathing faster. It can look like a lot of different things. It's very common to feel anxious. I think it's part of normal life and daily life, but we start to look into it further when these physical and psychological effects start to interfere with daily life. And up to 20% of people in the US have been diagnosed with anxiety disorders.

Host: Wow, that's a pretty large percentage. So can you talk about what are common causes or triggers for anxiety?

Jessica Reddy, MD: So when I think about somebody, a patient who comes into the clinic, with symptoms and signs of anxiety, I think about four different areas of life. First of all, the environment. So one's stressors. So if there's a, a loss of a loved one or trauma or a loss of a job, or, any sort of stressor that interrupts from

daily life can cause the anxiety response. Another thing is, anxiety is known to run in the family. So there is a genetic basis to at least a part of anxiety and anxiety disorders. Another factor could be what we call motivated behaviors. So, this is really looking at substances. So alcohol and marijuana, for example, are very common and use of these substances can contribute to anxiety in the long term. And then there are always medical conditions that we have to rule out prior to saying that somebody has, is suffering from a primarily, psychiatric basis for anxiety. And, and these include thyroid issues, diabetes, as well as heart disease.

Host: So it sounds like there's some factors that we have control over and some that we don't. Can you talk about the physical manifestations of anxiety in our body?

Jessica Reddy, MD: The anxiety response, actually, if you look down the list of organ systems in the body, it can affect pretty much every single one of those. So if you just go head to toe. You know, we talked about worries. Some people will describe feeling cognitively slow or you know, not being able to think clearly, feeling like their heart is beating really fast or, breathing really quickly. Some people will say that their muscles start to shake. Some people will have GI issues that are, is triggered by anxious distress. And then we want to think about if this response goes on for a while, so chronically, for example, it can actually lead to some physical conditions such as headaches, migraines, back pain, neck pain. So some really common presenting symptoms that, you know, if you look, deeper, we can attribute it to at least in part anxious distress and anxiety that is untreated.

Host: I do think my patients are always surprised, like how many parts of the body that anxiety can actually affect. I mean, nausea, diarrhea. It's always important to rule out other causes, but also to know that our mental health can have such an impact on our body. So how can anxiety affect someone's daily routine or decision making?

Jessica Reddy, MD: This question comes up a lot. Oftentimes I'll have patients who I meet who are experiencing profound difficulties with focus and concentration, and short term memory. And actually anxiety can be the cause of that, or at least contributing heavily to those symptoms. This can lead to underperforming at work and, you know, frustration that that might cause. Another thing that is very common is, anxiety can be very distressing for people and very uncomfortable and painful at times. And that can be associated with avoidance. So avoiding to go places, certain places or avoid being around certain people or, and that can really prevent people from engaging in things that make their life worth living and really have subsequent effects, with that. And then a lot of people experience anxiety at night in particular, and that can manifest as, anxious rumination. So having anxious thoughts, questions, having thoughts of what will happen next or having catastrophic thoughts like thinking that the worst thing possible is going to happen.

Those are just some examples of anxious thoughts and those sorts of thoughts kind of spinning in one's head can affect their ability to sleep. And then of course, there's the domino effects when we're having difficulties with sleep.

Host: As a psychiatrist, do you have any practical tips on how to manage anxiety?

Jessica Reddy, MD: Yeah, so this is probably one of the most common things that I encounter in my practice and I try to talk about this with everybody. And it really comes down to sleep. That is probably the number one most important thing from a behavioral standpoint in order to help ourselves to manage anxiety.

And we just mentioned that, anxiety can impair sleep. So it's like a chicken or the egg situation. But at some point it really is worthwhile in investing in sleep because if we're not sleeping or we're not getting good enough quality or a good enough length of sleep, or, you know, if it's interrupted, then that's going to have effects on our mood, anxiety, on concentration, on frustration tolerance, and, and all of those kind of interplay.

Now, when I talk to somebody about sleep, I really try to identify, you know, if there are issues. Really identify where in the whole sleep cycle we're having the biggest problem. So is it going to sleep, having difficulty falling asleep, or staying asleep or feeling like, you know, somebody's a light sleeper.

And then really trying to optimize environmental and behavioral factors and sometimes with medications to help, really optimize sleep. Another evidence-based, recommendation includes exercise. So regular exercise, at least 30 minutes of aerobic exercise, per day has been associated with decreased anxiety and, and greater resilience to anxiety provoking stressors.

I love to talk to patients about mindfulness and meditative activities such as yoga, because not only can that be cardiovascularly intensive, but it also can help soothe the nervous system to help promote calmness and sleep. And then the last part is diet. You know, there's a lot that can be said about diet, but I, like to start with helping patients understand the idea of glycemic index and how we want to focus on eating things that don't make our blood sugars rapidly rise and fall, because those sorts of acute changes can contribute to, psychiatric issues like sleep.

So things with whole grains, leafy vegetables, whole foods, fruits and vegetables can help regulate emotion and, and anxiety.

Host: These are great tips. I agree sometimes getting a good night's sleep and building a exercise routine are much easier said than done. Luckily, we have a couple of podcasts, one on getting a good night's sleep and also one on building an exercise routine that our listeners can check out if interested. So what about grounding techniques? Is this a way to counteract anxiety?

Jessica Reddy, MD: Yeah, so grounding is really a powerful way to counteract anxiety in the moment. So what this means is, focusing on our senses. It's our senses that receive inputs that trigger anxiety. So for example, hearing a loved one who's upset or seeing something particularly stressful.

What we want to do with grounding is to essentially co-opt or, distract our senses in a different way. So what are our senses, right? So, seeing things, so maybe going outside and taking a walk, looking at nature, will help distract from the anxiety provoking trigger and help calm the nervous system.

Pets. Having a pet and playing with them or petting them can be very helpful, through physical touch. I recommend, you know, if there's a, if you have a candy or, an orange, for example, biting into an orange some, anything that can engage the senses in a different way will help calm the nervous system.

Host: That's really great advice. What type of advice would you give someone who's hesitant or embarrassed to ask for help managing their anxiety?

Jessica Reddy, MD: Yeah. So I think with this I really like to think about information and education. You know, oftentimes I'll have people who are experiencing physical symptoms, and when all the tests are done and everything medically comes back normal and they get referred to me; our conversation looks a lot like, how we started this podcast, which is understanding that it can manifest in a variety of different ways, and that it is extremely common and it can affect anybody, no matter who you are or what you do or anything. I always try to really convey this message of hope because it is very treatable. The first step is recognizing it and building self-awareness of how it manifests in each one of our bodies. Because we're all going to be different and how anxiety looks like will look different depending on the body.

And then, figuring out what would be, if needed, what kind of either behavioral techniques or medication or psychotherapy, any sort of treatment that we have available to help the patients ultimately feel better.

Host: Thanks for the insight, Dr. Reddy. Here are some key takeaways from today's episode. One. Anxiety can affect both the mind and the body, and it's the most common mental health condition in the United States. Two. Causes include genetics, stressful life events, and certain health conditions or substances.

Three. Symptoms may be physical, muscle tension, headaches, digestive issues, as well as emotional. Four. Sleep, exercise and a healthy diet are powerful tools for managing anxiety. Grounding exercises can also help to relieve anxiety and bring you back to the present moment.

And five, if anxiety's interfering with your daily life, don't hesitate to seek help. Support is available and recovery is possible. For more expert advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you found this episode helpful, don't forget to subscribe and share it with others.

Thank you, and from all of us at Kaiser Permanente, be well.