Are We in an Anxiety Epidemic? Dr. Rachel Abrams Says Yes

Dr. Rachel Abrams is a family practice physician who is board certified in Integrative Medicine. Founder of the award-winning Santa Cruz Integrative Medicine Clinic, she has been voted "Best Doctor" in Santa Cruz County from 2009 – 2018. Dr. Rachel dedicates her practice, teaching, and writing to helping each person learn to listen to their body's innate intelligence.

1440: Let's talk about anxiety—which you call a lifestyle-borne illness. Is this something you encounter often in your patients?

Dr. Rachel: I see anxiety and insomnia (which is a result of anxiety typically) in my office more commonly than any other issue. Anxiety is rampant, and I am not alone in seeing that. It is an epidemic. Anxiety, I believe, is caused by taking this human body of ours with its physiology that is almost 10,000 years old and putting it in a modern culture, where there's a variety of things that are not friendly to our stress response. I often elaborate on this point by talking about a wonderful book by Robert Sapolsky called Why Zebras Don't Get Ulcers. If you ever go on safari in Africa, you notice that all the animals that eat each other actually coexist. It's this crazy thing when you see it and think, "What? The lions are over here, and the giraffes are grazing right next to them." The thing is that the giraffes know when the lions are hungry, so though they live alongside the creature that could kill them all the time, they are not stressed all the time. Zebras have a stress response, and when it kicks in, they run. The lions run after them. The stress response spikes. The zebras get adrenaline. They get cortisol. Their blood rushes to their limbs, and they run for their lives, literally. If one of the lions gets a zebra, then the herd moves away. The lion takes the kill and, within five minutes, the zebras start to graze again. If a zebra has narrowly escaped attack, it shakes (a natural and healthy stress response) but then goes back to grazing. So, the zebras are anxious and stressed when the stressful incident happens and then over it and back to normal after a fairly short transition period.

1440: Five minutes? Wow. Can people bounce back from acute stressors that quickly?

Dr. Rachel: We rarely do. Humans have these giant forebrains, and that means that if I narrowly missed being hit by a car this morning, I might shake afterwards like the zebra, but I'm likely to think, "Oh my god. I almost died. What would've happened if I died? What would happen to my children?" I might then rehearse this, especially if I'd been in a car accident before, which amplifies my stress response. I'm likely to think about it repetitively in a way that persists in my body so my adrenaline level does not drop. It stays high all day long, and if I've had several car accidents in the past, maybe it stays high for a month. Humans have an anxiety response that perpetuates—and unfortunately that anxiety response, which is a normal, natural, and necessary response, becomes a chronic response. And when you have chronic high cortisol and adrenaline, it does a lot of damage in the body. It does a lot of cellular damage. It increases fat and reduces muscle. It impacts metabolism. It makes us feel anxious and have a short fuse—none of which is good for us. Add to that the fact that we live in a culture where we are exposed to stressors at a much higher rate than we were created for. Human animals were supposed to live in groups of 150 to 1,000 people—and those would be all the people you knew. All the births and deaths and tragedies within that group, that's what you knew about, as opposed to what we're aware of today, which is an entire world of tragedy and death. Humans are also designed to go to sleep when it gets dark and get up when it becomes light. We are meant to be physically active all day. In that scenario, our built-in stress response is appropriate. But that is not how we live. Now, we are bombarded by information. Bombarded by tasks. We are not gathering in the woods. We are not farming. We are typically multitasking all day long. Multitasking is not necessarily a bad thing. Mothers and fathers have multitasked for millennia, but the current circumstances are pushing too many boundaries. For instance, if I'm driving a car and I'm trying to feed the children in the backseat and one of them is crying and then another driver honks at me and my cell phone goes off—that is not a natural human animal experience.

1440: That scenario you mention—driving and phones and kids and honking—sounds perfectly normal to many of us. Short of removing ourselves from those situations, what can we do to support our overstimulated stress response in a life that inevitably includes moments like that?

Dr. Rachel: I talk a lot about the necessity of adrenal downtime. We need more opportunities than we typically have to relax our system. Now, bear in mind that not all stress is bad. What we call challenge stress, as in—I have this project at work I'm really excited about that's pushing me. It's a little bit difficult, but it's very fulfilling—that sort of stress is not bad for us. Challenge stress helps us grow. It is actually good for the heart and good for our cells. It's the other kind of stress that's really hard on us. We need to counteract all stress, whether it's productive or destructive, with downtime, in which the adrenal gland that makes cortisol and adrenaline can actually stop working—or it can work at a much lower level for a while. What does that look like? It looks like lying on a couch, going for a walk, swimming in a pool, reading a book, or listening to music. Even better, it involves looking at nature, which has this amazingly calming effect on us, because human animals are meant to live in nature. That's what we're created for. Seeing trees and grass and greenery has a dramatic effect on cortisol and adrenaline levels. People in cities who live in buildings that look out on a tree as opposed to a wall have lower rates of heart attacks. It's remarkable.

1440: Why is sleep such an issue? Why is that where anxiety shows up so often?

Dr. Rachel: Sleep is an issue for the same reason that anxiety is an issue, which is that our culture is so unfriendly to the sleep of the human animal. We have too much light. We have electricity, but we also have computer screens—which produce a type of light that looks like sunlight. It's full-spectrum light, and when you encounter full-spectrum light, your body thinks it's daytime. There are great studies showing that teenagers who are in front of screens—computer screens or pads or phones—for two hours in the evening have something like 30 to 60 minutes less sleep at night. It has a profound effect, because that light suppresses melatonin production. We naturally produce melatonin at nighttime. As the sun goes down, our pineal gland notes that and begins to produce more melatonin. That higher level of melatonin eases us into sleep. You interrupt that process if you have all this light exposure before sleep. That is true for adults and adolescents—it's just more intense in adolescents. So, we have too much light and too much stress. People watch the news in bed. They're getting light from the television, and they're lying in their bed watching the latest horrible thing that's happening, and then they expect to close their eyes and go to sleep? It's not logical, because we really are animals. If you are sleep training your baby, you're not going to hand the infant your cell phone in the crib, right? That's a terrible idea. The cell phone is stimulating. And yet, people sleep with their phones by their beds—with all the work they do in their emails and texts sitting literally right next to them, psychologically. It makes it very hard for us to settle. This interview was conducted by Kate Green Tripp, Managing Editor for 1440 Multiversity.