Mental Health Training

Why Do I Feel More Anxious at Night?

The quiet hours can bring a lot of internal chatter, and here’s how to deal with it.

Whenever you try to fall asleep at night, many anxious thoughts and embarrassing memories come racing into your mind, preventing you from drifting off. Why does this happen, and can you do anything about it?

Experts say that whether you’re throbbing through tomorrow’s to-do list or dwelling on past regrets, it’s normal for worries and fears to surface at night.

According to an October 2022 survey of 3,192 adults in the United States, 34 per cent of respondents reported feeling anxious or nervous within the past month. And 32 per cent said that their stress had led to changes in their sleeping habits, including difficulties with falling asleep.

However, there is an evolutionary purpose to evening anxiety, said Dr. Rafael Pelayo, a clinical professor of psychiatry and behavioural sciences in sleep medicine at Stanford Medicine and author of the book, “How to Sleep.”

“Sleep is the most dangerous thing we can do,” he said, and being hyper-aware of our surroundings allowed our ancestors to spot any incoming threats.

But when your anxiety keeps you awake, you not only miss out on the health benefits of sleep, you might kick off a vicious cycle of poor sleep routine and increased stress that can be hard to break.

“Sleep loss is often a precursor for anxiety disorders, and anxiety leads to sleep loss,” said Dr. Sarah Chellappa, a neuroscientist at the University of Cologne in Germany.

Here’s what the experts say you can do if your overactive mind keeps you awake.

The cruel connection between anxiety and sleep

Anxiety can surface at any time, but there are a few reasons it may feel more intense at bedtime, said Candice Alfano, director of the Sleep and Anxiety Center at the University of Houston. “Most of us are incredibly busy during the waking hours; our attention is pulled in many different directions, so we have limited time to think about our worries,” she said. 

“But at night, while we lie in bed, there are few distractions from the thoughts that make us anxious.”

This can lead to a frustrating problem: We can’t sleep because those anxious thoughts make us think we are unsafe, making us more alert by raising our heart rates and tightening our muscles.

Essentially, the body can’t quite tell if the source of our troubles is a physical threat, like a tiger about to pounce, or an upcoming presentation you’re nervous about making at school — it just gets the memo to stay awake.

At a basic level,” Dr. Pelayo said, “feeling in danger or under stress is the same mechanism in the brain.”

Worse, sleep loss has been shown to produce more anxious thoughts. In a 2019 review published in the journal Sleep Medicine Reviews, researchers concluded that insomnia was a significant predictor of anxiety, among other mental health conditions. 

The researchers explained that sleep helps us distinguish between threatening and safe, so we aren’t as good at responding to stress, fear and anxiety, without adequate sleep. This could, in turn, mean more negative thoughts that can interfere with shut-eye.

The good news is that solid sleep can also make your anxiety better over time, experts say.

How to slow anxious thoughts at night

Since better sleep helps decrease anxiety, general good sleep hygiene practices — like going to bed and waking up at the exact time every day and avoiding any blue light technology before bedtime — can help on both fronts, Dr. Alfano said.

The tips below, however, might help you reduce anxious bedtime thinking.

Caffeine is a stimulant. Caffeine’s half-life is approximately five hours, meaning if you have an eight-ounce cup of coffee at 4 p.m., you’ll still have half that cup’s caffeine in your system by 9 p.m. That’s a problem because caffeine keeps you awake and is known for making anxiety symptoms worse,

The torrent of personal revelations that has poured from Prince Harry of late has been met with a range of reactions, from sympathy through to fury. But quite why he has pressed the nuclear button and blown up all before him, in such a public, uncompromising fashion, has remained a puzzle to some. One possible explanation, suggested earlier this month by Philip Ingram, a former colonel in the British Army, is that Harry is suffering from post-traumatic stress disorder (PTSD). 

Ingram pointed out in a newspaper article that what Harry went through in childhood - the loss of his mother in a car crash, amid overwhelming media interest - “would break many normal people,” and that his deployment to Afghanistan with the Army brought additional stresses (even if Harry claims military service “saved” him) . Is it possible, then, that trauma lies behind his current behaviour, which from the outside appears more self-destructive than healing? 

That soldiers can suffer PTSD after leaving the battlefield is by now well established. In the First World War, it was dubbed shell shock, and has since been recognised as a medical condition, a type of anxiety disorder. But it is one that can also be caused by any situation a person finds traumatic, from road accidents and sex attacks to domestic or child abuse, health problems and even childbirth. PTSD can result from grief, too, says psychotherapist Julia Samuel. 

While in most cases, traumas are processed relatively quickly (in weeks rather than years), in a minority of cases, the trauma remains “locked in the brain, untouched and unresolved, as if it were in the present,” which can lead the sufferer to see the world differently, says Samuel, who was a close friend of Diana’s and is godmother to Prince George, Harry’s nephew. “You can have it on the brain decades after the event. It has no sense of time, it is present in the body. Trauma then heightens your sense of fear and response to the world: the world seems more dangerous.”

Multiple studies have pointed to changes in the brain associated with PTSD. The condition is typically diagnosed by a psychiatrist via a mental health assessment, not a brain scan, but research shows the amygdala - the part of the brain that deals with emotional responses - is more active in those who suffer from it. 

“The trauma is stored in the amygdala, which is the part of the brain that’s always looking for threats,” says Samuel. “It can’t cognitively be processed.”

Symptoms of PTSD can include vivid flashbacks, intrusive thoughts, nightmares, becoming easily upset or angry, extreme alertness, disturbed sleep, irritability and aggressive behaviour, poor concentration and, indeed, carrying out self-destructive or reckless acts, according to an extensive list from mental health charity Mind. 

You will learn more about what developmental disabilities are, the associated risk factors, and different interventions that can help individuals with developmental disabilities reach their goals.

Developmental disability 

Developmental disability is a term used to describe physical or mental impairments caused by particular disorders or illnesses. It includes conditions such as Autism, now called an autism spectrum disorder (ASD), cerebral palsy, Down, and Fetal Alcohol Syndrome. Individuals with developmental disabilities often experience physical, psychological and communication difficulties and usually last throughout a person’s lifetime.

What is child development?

Child development is an exciting process! It refers to how babies and children grow, learn, and master different skills. Four key areas cover physical, cognitive, language, and social-emotional development. Physical development looks at strength and physical abilities; cognitive growth involves thinking and problem-solving. Language development focuses on communication and understanding. Social-emotional development deals with how children interact with others and handle their feelings.

Development milestones

Development milestones mark typical growth stages and are achieved by most children around the same age. However, each child develops individually, making their own timeline.

What Are Developmental Disabilities?

Developmental disabilities are delays in their physical or cognitive development that adversely affect a person’s ability to function in daily life. These delays may affect motor skills, speech, learning and other vital areas of functioning. Depending on the severity of impairments and limitations of the disability, individuals may have difficulties performing tasks independently (such as taking care of oneself) or interacting with others (for example, speaking).

Risk Factors & Causes Associated With Developmental Disability

Risk factors and causes associated with developmental disability vary by diagnosis. Common risk factors include a family history of intellectual disability/developmental delay; advanced parental age; maternal drug use/exposure; premature birth or low birth weight; prenatal exposure to toxins such as alcohol or lead; exposure to environmental toxins such as lead paint; infections during pregnancy; genetics plays a role in some cases; lack of access to routine medical care in early childhood years before symptoms become more pronounced​​ from the age of twelve​.

Seek Support

Reaching out to other people who also have family members affected by a developmental disability can provide you with valuable support in dealing with your own situation. A child psychologist or a developmental-behavioural paediatrician is dedicated to assisting and advising those taking care of individuals with various developmental disabilities, including national organisations and online forums.

Developmental disabilities make it difficult for people to do everyday activities and gain the skills to reach their full potential. Developmental disabilities can range from mild to severe, depending on the individual’s abilities and the support they have around them. 

Everyone seems to be on psychedelics except me.

People will go to the unlikeliest of places to sort their heads out, be it the internet,

the rainforests of the Amazon, or even suburbia in London, UK.

Like noticing the first grey hairs, I suppose there comes a time in midlife when many of us think: is everyone on drugs but me? These rude awakenings of ageing are inevitable – I just hadn’t counted on them coming to me exactly the same time. There I was, at the hairdresser’s for my biannual root touch-up, when the nice woman charged with making me blonde again – let’s call her Claire,

announced that she would have to use a more “icy” blonde tone to help mask the proliferation of greys coming through.

Perhaps noticing the shock on my face, she changed the subject and asked how my Christmas was. I mumbled some platitudes about it being lovely, thank you very much, before asking how hers was. “Eventful,” smiled Claire. “I went on a guided ayahuasca trip as a present to myself.

Now she really had my attention.

“It’s a South American psychoactive plant that gives you this intense spiritual experience,” she continued. “It was mind-blowing. Eye-opening. It takes you into another dimension and lets you see how connected we are.

“Goodness,” I said. “Where did you go to do it? Peru? Brazil? Chile?” “Oh no!”, she replied. “I went to see a shaman in Croydon.”

Regular readers will know that I’m no prude when it comes to drugs, having tried a fair few before giving them up several years ago. And yet, even this reformed drug addict is shocked by how normal it seems to have become for people to announce that they have spent the weekend casually taking psychedelics.

Anyone with even a passing interest in the news will have noticed that Prince Harry has admitted to taking ayahuasca and magic mushrooms. In California, where I went at the beginning of January to interview him, I felt very old indeed as I saw the number of high-end shops selling fancy clutch bags that would have been just the thing had they not been a) 600 dollars and then monogrammed, with words such as “WEED”, “GUMMIES” and “EDIBLES”.

Back in the UK, I relayed this information to a similarly middle-aged, middle-class friend, who laughed at me patronisingly. “Bryony,” he said, pouring himself a glass of merlot, “everyone does edibles nowadays, honey”.

“Well, I don’t!” I said haughtily, clutching my glass of water. “You may not, but I can assure you that people are microdosing their way through life’s drudgery with chocolate-covered mushrooms they have ordered off the internet all over the country.”

As someone who had to give up drugs for their mental health, I found all this a bit much. But I was obviously taking the wrong drugs. Last week, a study reported that a single dose of DMT – the psychedelic found in ayahuasca – might effectively treat people with severe depression.

The 34 subjects in the trial were given an I V drip of DMT, causing them to experience a 20-minute psychedelic “trip”. They were then given therapy to help them make sense of the process. Six in 10 were declared depression-free three months later.

This kind of study is fascinating because, for decades, most research into treatment for depression has been sluggish, to say the least, slowed down by the unstoppable march of mass-marketed antidepressants. As Dr David Erritzoe, a clinical psychiatrist at Imperial College London and the study’s chief investigator noted: “For patients who are unfortunate to experience little benefit from existing antidepressants, the potential for rapid and durable relief from a single treatment, as shown in this trial, is very promising.”

What does this mean? Should we all be out picking mushrooms? Or taking guided ayahuasca trips with so-called shamans on the outskirts of south London?

Aphasia.

Aphasia is a communication disorder that results from damage or injury to the language parts of the brain. It's usually caused by a stroke but can also be caused by other brain injuries, such as a tumour or head injury. People with aphasia may have difficulty understanding spoken and written language, speaking, reading and writing. They may also find it challenging to communicate effectively with others to express their needs.

Imagine that you're trying to talk, but you can't get the words out — and then, if you finally do, no one understands what you're saying. And you don't know what others are saying to you. That's what it's like to live with aphasia.

Aphasia results from damage to the brain that affects speech and language comprehension. Frequently, aphasia follows a stroke, but it can also result from a traumatic brain injury; in my case, I suffered a "coup contrecoup injury, which had occurred by the jolting of the brain against the skull and the shearing forces on the brain caused by direct contact from, acceleration-deceleration forces.

The latter type is more common in paediatric traumatic brain injury and more generally caused by motor vehicle accidents associated with high-velocity acceleration-deceleration forces, and, consequently, aphasia. This occurred when a drunk driver ploughed into a parked car I was sitting in one Tuesday morning in 2006.

I'm sharing my story not because I think it is exceptional but because I know it is not. If anything, the telling makes it unusual because so few of us with aphasia can speak about our difficulties.

At least 180,000 Americans are diagnosed with aphasia yearly, and it's estimated that some 2 million Americans have it; it's more prevalent than Parkinson's disease, cerebral palsy, multiple sclerosis, muscular dystrophy and Lou Gehrig's disease combined.

Yet, the condition remains mainly in the shadows, maybe partly because so few of us with it, can tell others about our challenges.

Actor Bruce Willis and former congresswoman Gabrielle Giffords are perhaps the most famous people to publicly acknowledge their aphasia. (Willis's diagnosis, it was recently announced, has now progressed to frontotemporal dementia).

In research from the National Institutes of Health, aphasia had the most considerable negative impact on the quality of life of the 60 measured conditions, even more than cancer and Alzheimer's disease.

I'm sharing my experience to give hope to others with aphasia and their families.

A brain stuck in static.

Within days of my injury, I could unstick my tongue from the roof of my mouth and create an odd sound occasionally, but I couldn't communicate in any traditional sense. I felt like a human radio pumping out static — with sporadic bursts of clarity.

When I was asked to point to a picture of a teapot, an apple, or an elephant, my adrenaline kicked in, my breathing got faster, my heart rate got faster, and I started to sweat. Sometimes I just pointed to my head. The odds of a sinkhole opening within me were approximately equal to the odds that I'd find the right word at the right time, something I'd done with ease before the accident as a professional freelance writer.

Gun-control activist Gabrielle Giffords is the star of the new documentary.

I couldn't navigate the smallest space or the slightest thing. None of the tools I had used before made any sense. Not words or places or names or directions or signs on bathroom doors. It's hard to navigate when you can't decipher anything on your desktop or phone and can't tell anyone that you can't.

I pointed to a chair because I couldn't say "chair." I mimed drinking from a bottle because I couldn't find the word "bottle" or "water" "thirsty" or "drink." If I spoke at all, I spoke with an urgency bordering on panic. In the first year after the accident, once I began to put words together, I said things like "white stuff sky," which meant snow, or "cow thing pants," which meant belt.

We’re all looking for that elusive, ‘spark’ – but what really ignites a long-lasting relationship? There is good news, Science is closing in on the answers.

For centuries, our romantic fates were thought to be written in the stars. Wealthy families would even pay fortunes to have a matchmaker foretell the success, or failure of a potential marriage.

Despite the lack of any good evidence for its accuracy, astrology still thrives in many lifestyle magazines, while the more sceptical among us, might hope to be guided by the algorithms, of websites and dating apps.

But are these programs any more rigorous than the signs of the zodiac? Or, should we put our faith in love languages, and attachment theory? (That’s to name just two fashions in pop psychology).

The world of matchmaking, is riddled with myths, and misunderstandings that recent science, is just starting to unravel. From the inevitably messy data, a few clear conclusions, are emerging that can help guide us in our search for true love.

If you are looking for the secrets of romantic success, the most obvious place to start, would seem to be the science of personality.

If you are an outgoing party animal, you might hope to find someone with a similar level of extraversion; if you are organised, and conscientious, you might expect to feel a stronger connection, with someone who enjoys keeping a rigid schedule.

The scientific research does offer some support for the intuitive notion, that “like attracts like”, but in the grand scheme of things, the similarity of personality profiles, is relatively unimportant.

“Yes, it is true that people are more likely to experience chemistry, with someone who is similar to them, in certain ways,” explains Prof Harry Reis, at the University of Rochester, New York. “But if I brought you in a room with 20 people, who are similar to you in various ways, the odds that you’re going to have chemistry, with more than one of them, are not very good.” It is only the extreme differences, Reis says, that will matter, in your first meetings. “It’s not likely, that you would have chemistry,with somebody who is very dissimilar to you.”

The rest is just noise. The same goes for shared interests. “The effects are so tiny,” says Prof Paul Eastwick at the University of California.

Eastwick found similarly disappointing results when he looked at people’s “romantic ideals” – our preconceived notions, of the particular qualities we would want in our dream partner. I might say that I value kindness above all other qualities, for instance, and you might say you are looking for someone who is adventurous, and free-spirited.

You’d think we’d know what we want – but the research suggests otherwise. While it’s true, that certain qualities, such as kindness, or adventurousness, are generally considered to be attractive, experiments on speed-daters, suggest that people’s particular preferences tend to matter very little, in their face-to-face interactions.

Someone who stated that they were looking for kindness, for example, would be just as likely to click, with someone who scored high on adventurousness, – and vice versa.

Despite our preconceptions, we seem open, to a wide variety of people, showing generally positive attributes.

“We can’t find evidence that some people really weigh some traits over others,” Eastwick says. He compares it to going out to a restaurant, ordering a specific dinner, then swapping food with the table next to yours. You’re just as likely to enjoy the random dish, as the one you’d originally ordered.

Given this growing body of research, Eastwick is generally very sceptical that computer algorithms can accurately match people for chemistry, or compatibility. Working with Prof Samantha Joel at Western University in Canada, he has used a machine learning program, to identify any combinations of traits, that would

Micro-dosing psychedelics and mental health.

Continuing with the psychedelic theme, and the potential benefits to mental health have been covered in a previous article and podcast. The key issues were the potential therapeutic benefits of using these compounds.

After all, there was a 40-year pause on psychedelic research following the prohibition of these substances.

There are some cynics and concerns about this method due to the unpredictability of each subject, and one size fits all isn’t available.

The drug’s potency has increased over time, and psychedelics are illegal, so there’s no quality control on supply, and some nasty contaminants, have been found within illicit street products.

There have been reports of adolescents experiencing nightmares or flashbacks after taking psychedelics, which could be attributed to traumatic experiences during a bad psychedelic experience.

Psychedelic drugs may also negatively affect adolescents' brain development, who are still growing and learning to cope with life’s challenges.

Beginning in the 1960s, scientists thought that depression resulted from having low levels of the neurotransmitter serotonin in the brain. Traditional antidepressant drugs, such as selective serotonin reuptake inhibitors, worked by correcting that chemical imbalance.

But there were holes in this hypothesis. Most notably, antidepressives medication could raise serotonin levels immediately, but symptoms of depression typically don’t alleviate until several weeks after starting the treatment. Unfortunately, this drug had unsavoury side effects, such as "emotional blunting" .

A new theory emerged in the early 2000s that depression, anxiety, and Post-traumatic stress disorder may stem from the loss of synapses in the brain.

It turned out that antidepressant drugs could regrow those lost synapses — a process known as plasticity.

It’s possible that by forging new connections in the brain, people can start to change negative thought patterns and regain control over anxious or depressive impulses.

The brains of Buddhist monks and other expert meditators — people intimate with mystical experiences — also undergo changes.

There’s even research suggesting that talk therapy works, in part, by altering patterns of brain activity.

Psychedelics are thought to confer therapeutic benefits by inducing plasticity in the brain.

Micro-dosing psychedelics has long been a subject of fascination to people looking for non-traditional methods of mental health treatment.

But what is micro-dosing?

Could it offer an effective alternative to traditional therapies?

This article will discuss the potential benefits and drawbacks of micro-dosing psychedelics and how to experiment with them safely.

What Is Micro-dosing?

Microdosing involves taking small doses (often around one-tenth of a whole amount) of psychedelic drugs, such as lysergic acid diethylamide, LSD or psilocybin mushrooms, over extended periods. People who use this method report improved mental clarity, focus, creativity, and mood states. It’s often referred to as ‘micro-dosing’ because such tiny amounts are used.

Micro-doses say the substances help them overcome emotional barriers and increase productivity; others claim the experience helps reduce anxiety or depression symptoms.

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Have you ever wondered what the secret to overall good health is? 

Turns out, it all starts with your gut.

The gut microbiome is an ecosystem of hundreds to thousands of microbial species living within the body. These populations affect our health, fertility, and even our longevity.

There is increasing evidence that the mixture of microorganisms found in the gut and intestinal tract plays a key role in regulating health. It is central to the digestion of food but has also been linked to the functioning of the immune system, mood and brain function, as well as to a range of conditions, including cancers and neurodegenerative diseases.

How Your Gut Flora Impacts Health

Gut health is a term that describes the balance of microorganisms in the digestive tract. These microorganisms, which consist of bacteria, fungi, and viruses, help break down food and promote digestion. A healthy gut contributes to proper immune function and overall health.

Poor diet, stress, and antibiotics can all negatively impact gut health by destroying beneficial bacteria. Antibiotics will alter the gut flora for up to 12 months.

Eating a healthy diet rich in prebiotics (foods that feed the good bacteria) and probiotics (live organisms found in foods like yoghurt), getting adequate sleep, exercising regularly, and managing stress are some ways to support good gut health.

Good gut health plays an essential role in our body’s performance. It has been linked to various physical and mental health conditions, including obesity, depression, allergies, asthma, diabetes and cancer. It’s no wonder that many experts are now claiming that having a healthy gut could be the key to overall well-being.

Brighten up your meal

Adding colour to your meal provides essential vitamins and minerals to your overall diet.

By rotating the variety of your fruit and vegetables weekly, you will feed different microbes in the gut and ensure you achieve your five-a-day target. Your goal is to hit 30 Different plant-based foods per week.

Eat more fibre

Fibre feeds the good gut bacteria, and they consume it and then produce short-chain fatty acids (known as postbiotics), which help reduce inflammation in the body. It also helps maintain bowel health because it increases the bulk in stools, increasing bowel transit time. Therefore, avoid laxatives, enemas, and other medicines that change how your bowels function.

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The term “psychedelic” is derived from the Ancient Greek words “psyche” (meaning “mind”) and “delos” (which means “to manifest”). The British-born Canadian psychiatrist Humphry Osmond coined it in a letter to author Aldous Huxley in 1956.

Psychotropic medication definition. Is any drug prescribed to stabilise or improve mood, mental status, or behaviour?

It’s an umbrella term for many medications, including prescription and commonly misused drugs.

If you want to discuss the benefits of psychedelic drugs, then according to McKenna’s 1992 book on Food of The Gods. He proposed the Stoned Ape Hypothesis. He explained that ingesting psychedelic plants may have encouraged social bonding and consciousness, responsible for doubling the brain capacity of our ancestors two million years ago. 

Unfortunately, it is only a theory with very little proof or support. There’s possibly some truth in what McKenna enunciates, said the palaeontologist Dr Martin Lockley, author of a book called How Humanity Came Into Being. 

However, perusing this theory and being an optimist, could our village cokehead be the next Einstein? 

On the other hand, research has shown that psychedelics may genuinely spark the creation of new neurons and synapses, a process known as neurogenesis within the Petri dish. 

Perhaps in the future, treatments for neurodegenerative diseases like dementia could stimulate the formation of new neurons without sending patients on any mind-bending cosmic adventure.

For the baby boomers, a psychedelic experience is somewhat déjà vu, sending you back to the summer of love.

It is indeed a trip down memory lane for some (pun intended). Still, it doesn’t mean it’s all a bed of roses, and it’s no exaggeration that these substances can harm in the wrong hands or be abused. 

Albeit a popular and mainstream topic for generations, it has been immortalised in history books, folk law and music with positive and negative correlations.

Psychoactive substance

A psychedelic drug is a psychoactive substance whose primary action is to produce hallucinations or other sensory distortions, with secondary effects that are either less prominent or more desirable.

Because of this dual action, the correct term for these drugs is entactogens (entheogens if the primary product is spiritual). Psychedelics include a variety of hallucinogenic compounds like LSD, and mescaline and primarily act on the serotonergic system in the brain.

Psilocybin causes visual and mental distortions, such as dysphoria, stress, and anxiety. While amphetamines like cocaine, crystal meth, ketamine and MDMA cause feelings of euphoria.

Phencyclidine, also known as PCP or angel dust, is an NMDA antagonist and induces symptoms that can mirror those observed in schizophrenia.

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Experiencing occasional anxiety is a normal part of life, but you are not alone if you have experienced a mental health challenge over the past few years.

We were already in an epidemic of anxiety before the pandemic, and those rates have continued to climb. The international prevalence of anxiety and depression increased by 25 per cent in the first year of the pandemic, according to the World Health Organization.

Faced with this crisis, the mental health field offers a few suggestions. The presiding agreement is that our mental health struggles are the result of a chemical imbalance written in our DNA. 

The implication is that our anxiety is chemical, and our serotonin level, the feel-good hormone, is determined by our genetic destiny. Mental healthcare professionals offer medications and therapy to change our cognitive rituals to lift our suspected serotonin deficiency.

But what if these options don’t work for you?

While our current offerings help some people, the inaccessibility of therapy is at an all-time high. Far too many people were struggling with their mental health and experiencing disappointing results with medication.

Focusing on brain chemistry has led us to overlook what impacts our mood and behaviour; the body plays a critical and often overlooked function in mental health. This can come as good news for those who have not found satisfactory relief from medication and therapy.

The determinants of our mental well-being go beyond our genes and brain chemistry to include inflammation, gut health, sleep, nutrition, hormones, chronic limbic hyperarousal because of unresolved trauma, and even having our fundamental human needs for community, nature, meaning, and purpose go unmet. 

If we do have what is known as a chemical imbalance, it is probably a downstream consequence of these other states of imbalance.

In other words, anxiety is not all in your head; it’s based mainly on the body, where it should first be addressed.

I believe there are two types of anxiety: genuine anxiety (or purposeful anxiety) and avoidable anxiety.

Genuine anxiety is our inner compass nudging us to pay attention to what’s not right in our personal lives, our communities and the world. It’s not something to suppress or pathologise, and it’s not what’s wrong with us — it’s what’s right with us when we can viscerally connect to what’s wrong in the world.

With genuine anxiety, our symptoms communicate something to us that should be heard and honoured. Instead of asking, “how can I stop feeling so anxious,” we should ask, “what is my anxiety telling me?” There’s often a call to action baked into our genuine anxiety, and when we let our uneasiness fuel purposeful action, we don’t feel so mired in our anxiety.

On the other hand, avoidable anxiety is often as simple as our body getting tripped into a stress response, which transmits a signal to the brain telling us something is wrong. 

And the human brain worries and fears everyday situations.

Your anxiety checklist.

When I work with patients, I start with avoidable anxiety — the low-hanging fruit. We come up with an avoidable anxiety inventory. In a moment of peak anxiety, this list can cue them to reflect on possible causes of a sudden stress response taking over their body, help them identify the particular avoidable anxiety that might be occurring, and understand its straightforward remedy.

An avoidable anxiety inventory could include the following:

• Hunger
• Sleep deprivation
• Being over-caffeinated
• A hangover (what is known as “hang-xiety”)
• Gut issues
• Inflammation
• Long stretches of being sedentary
• Chemical fallout after consuming highly processed food
• Late luteal phase (the days before the bleeding phase of the menstrual cycle)
• Inter-dose withdrawal (the pharmacologic low-point when you’re due for your next dose of a psychiatric medication)

Ellen Vora is an integrative psychiatrist in New York City, and the author of “The Anatomy of Anxiety.”