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Friday, August 17, 2018

Mental Health Series Part II: Anxiety

This is Part II of a brief synopsis of the impact health professionals, other than mental health specialists, can have on athletes and other patients alike who struggle. Anxiety, itself, is normal from time to time. But uncontrollable, physical, and constant anxiety which hinders one's performance, mental well being, or life in general is not and should be addressed medically. The following contains some warning signs and facts about anxiety and exercises and methods you can provide someone who is struggling with anxiety. Let's stop the stigma and create conversations about mental health.

Disclaimer: I am in no way, shape, or form a mental health specialist. I am student physical therapist  relaying on knowledge garnered from experience, research journals, and professors during my undergrad and graduate career. I do, however, care about the well-being of others and feel mental health is an overlooked aspect in many aspects. If a case is encountered that you may presume to include a mental health disorder it is important to speak to the client/athlete/patient about this and consider including mental health professionals in the treatment plan.

The NCAA reports that 18% of those over 18 had a mental disorder diagnosed in 2011, with 9 million of those people having it affect their day to day living greatly. 75% of those diagnosed have their first onset by 24 y.o.. That brings us to college students (see image below). This data from the ACHA, indicates a slight decreased level of student athlete mental health involvement compared to non-student athletes. However, it was also discovered that student athletes are more reluctant to report mental health history and a decreased willingness to seek help of mental health professionals in the future. This is where it becomes important for those surrounding athletes (especially student-athletes) to be aware of mental health struggles of those athletes.


Part II: Anxiety 

Types & Definitions: 
  • Generalized Anxiety Disorder: often described as 'free floating' due to no particular cause. Those affected often find it difficult to sit still or relax. Constant worrying interferes with concentration and daily activities. 
  • Performance Anxiety/Athletic Performance Anxiety: worry and fear about an upcoming practice, game, etc. 
  • Social Anxiety Disorder (SAD): a fearful, sinking, etc. feeling when performing or interacting in public (ex: public speaking, interacting at a party, encounters with those you feel are more 'powerful' than you)
  • Panic Attack/Disorder: a feeling of terror that may occur without warning and is usually accompanied by a racing heart and/or shortness of breath
  • Obsessive Compulsive Disorder (OCD): recurrent irrational thoughts or behaviors that those affected feel compelled to perform; an inability to perform the behavior can worsen the anxiety
  • Phobias: irrational fear of a specific object or situation
  • Post-Traumatic Stress Disorder: reliving a traumatic event or threat of injury, especially during the night. This can also cause emotional withdrawals and emotional outbursts. 
Prevalence: 31.9% of adolescents in the US; college students (see chart above)
Cause: Not totally understood but thought to be an altering of brain chemistry due to trauma, stress, medications, and/or drugs/alcohol.
Signs and Symptoms (Emotions): 
  • Apprehension 
  • Feeling Powerless
  • Having a sense of impending danger, panic, or doom
  • Increased Heart Rate
  • Having the urge to avoid things that trigger anxiety symptom
  • Trouble concentrating or thinking about anything than the present worry
  • Unable to control worrying
Signs and Symptoms (Physical):
  • Breathing Rapidly 
  • Sweating
  • Trembling
  • Feeling Weak/Tired
  • Sleeping Trouble
  • Gastrointestinal Problems
Our Role:
We as healthcare professionals need to be aware of the stress level and what is going on that may cause the symptoms of our patient's distress; i.e. their 'emotional construct'. Dr. Scott Goldman breaks anxiety into two categories: performance anxiety and general anxiety disorder; but, the emotional constructs between the two remain similar. He states that the anxious thoughts and behaviors are often about the future which may be perceived as a threat or danger. Further breaking down anxiety, he describes two threats: a threat to safety (that person is going to hurt me) and a threat to ego (if I don't perform well, I am a loser).

In today's world, there is an utmost pressure to succeed and the fear of failure is instilled early in life. It is not uncommon to find someone struggling with depression and anxiety, together. The NCAA reports that nearly 85% of athletic trainers believe anxiety is currently an issue with athletes on their campus.As a diagnosis of anxiety is difficult to pin-point from observation, it is important if you suspect a mental health disorder to take the patient/athlete into private and have a meaningful conversation with them.  Let them talk about their feelings, be an outlet for them, LISTEN. This is a time for you to figure out their emotional construct. This step is often the hardest as it is difficult to get others to open up, especially if you are not particularly close. Furthermore, it is important to ask them if they would like resources to pursue mental health providers whether you work in a hospital or a campus, there should be a card you can hand them that has information for them to pursue. You need to understand your department's mental health referral protocols as everyone is different.

Those who suffer from OCD or PTSD should be encouraged to entertain the idea of a mental health professional as the disorders are often very complex. SAD and Performance Anxieties are the more common situation that we as regular health professionals will encounter and will therefore these self-help strategies will be focused on those diagnoses. Since everyone is different and not one technique, or even set of techniques, will be perfect for everyone. Below are several links that I thought provided really sound self-help strategies you can provide to your struggling athlete/patient or even yourself.

What does exercise do for Anxiety?
Besides exercise being a way to enhance mood, energy levels, and sleep quality; it can be a way for those suffering from anxiety to release tension, feelings of fear/worry, and help ease symptoms of other co-existing conditions such as depression. Exercise also releases endorphins (the feel good chemical in the body) and reduces the production of stress hormones which both help fight pain and stress. It has also been discovered that exercising regularly can help decrease a person's sensitivity to stress/anxiety. Remember, it is important to start small, develop a routine, and be consistent with that routine. Even if it is performing a breathing technique upon waking up or running 10 miles, doing something consistently is the most important.

Again, I have posted links to various help-lines, links, etc. that one may find useful if they are struggling with tough times. 

For everyone: be an active listener to your friends, family, teammates, etc. and be true to yourself and don't try to 'tough it out', help is only one call away and it is NOT something to be ashamed about. 

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Depression Clinics Help Line: 1-888-771-5166
UW-L Counseling Center608-785-8073

Note from Mayo Clinic: "If you exercise regularly but depression or anxiety symptoms still interfere with your daily living, see your doctor or mental health professional. Exercise and physical activity are great ways to ease symptoms of depression or anxiety, but they aren't a substitute for talk therapy (psychotherapy) or medications.
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