Do you have the Sunday Morning Blues?

Dr Mrabet Jihene, Assistant professor and Director of the Office of counselling and disability at the American University in Emirates, says: “Work or school is a place where we face challenges; where we learn and improve ourselves; it gives us a purpose in life and it should increase our self-confidence.

"It should also feed us with ambition and creativity. When we do something that we are passionate about, stress will just be a provider of motivation and energy to meet our responsibility and achieve our goal, but if the anxiety turns to being a constant feeling of overwhelmed, oppressed and behind in our responsibility then we have to start thinking responsibly about ourselves and our environment.”

“Normal is a relative word in psychology.... However I can say that it’s not ideal or typical to feel anxious about returning to school /office,” adds Dr Dr Valeria Risoli, Clinical Psychologist at Dubai-based Dubai Physiotherapy & Family Medicine Clinic.

Here’s a look at some factors that may be contributing to that feeling of dread, she explains:

My child doesn’t want to go to school – what’s wrong?

Dr Daniela Graf, Child & Adolescent Psychiatrist and Psychotherapist at the Dubai-based German Neuroscience Center, suggests a conversation with a professional if your child is trying to get out of going to school. “In case children and young adolescents show such anxieties especially with consecutive avoidance to go to school or complete school refusal the underlying causes or triggering factors might be a shy primary personality, a separation anxiety or a school phobia e.g. due to bullying,” she explains.

Talk to a professional to gauge if there is an underlining bigger issue such as anxiety about own abilities, low self-esteem, or if it just a temporary emotional response to something that is happening at work/ school that could be quickly addressed.

What’s normal, what’s not?

Remember, there are different levels of anxiety – and most people experience it sometimes. But if it begins to leech from your quality of life, you need to access the situation and treat what’s causing it. Dr Jihene; Shorouk Nafie, Counselor at German Neuroscience Center; and Dr Valeria Risoli, Clinical Psychologist, Dubai Physiotherapy & Family Medicine Clinic weigh in on the signs and symptoms of anxiety and how alternative therapy can help.

Signs and symptoms:

Changes in body: Trembling, muscle tension , headaches, sweating, dry mouth, difficulty swallowing, abdominal pain

Panic attack: dizziness. Rapid or irregular heart rate and breathing

Bladder and stool issues: Frequent diarrhea or need to urinate

Mood: Generalized upset, irritability

Sleeping difficulties: Insomnia, nightmares

Focus level: low. Sometimes, with adults, it extends [to] sexual problems

Why me?

Genetics: It could be an inherited trait. Or the gene associated with Serotonin, which is responsible for the regulation of moods, is not working properly.

Circumstances: Past riddled with trauma, childhood abuse, insecurity. Stress.

Low self-esteem/poor-coping skills/insecure attachment with caregiver.

Drugs: Anxiety can be a side effect of a medicine.

Organic disease: If you have a tumour, especially of the adrenal gland.

What’s happens to my body?

Here’s what happens when you are faced with a trigger. The thalamus will receive stimulus – visual or auditory - and send it to amygdala and hippocampus. Then the amygdala will register the danger and will trigger fast response. The hippocampus attaches emotional baggage to oncoming data. So that it can be filed under ‘threat’ and you can have an automatic response the next time you are faced with the same stimulus.

The Pituitary gland release acetylcholine – a neurotransmitter- that will release corticosteroid. These will provoke arousal and fear reactions.

Then the sympathetic nervous system will trigger also the adrenal medulla [the inner part of an adrenal gland] and will release endorphin, provoking fear or fight responses.

Does age make it better or worse?

Worse. Health, family, losses can stress out an older person more than a younger person. Also, there is the fear of one’s mortality.

Trigger target areas

Professional sphere: relates to the fear of job loss, which may mean leaving the country.

Identity: Careers and relationships have also become a crucial in how we define ourselves.

Relationships: These are becoming more and more complex, which can trigger uncertainty. We assume the worst about ourselves, our partners and the future.

Anxiety or depression – which came first?

Anxiety and depression often come together. While the order may be unique to the individual, they are usually trapped in the vicious circle.

“When people are anxious they constantly worry about something so they have difficulty [in] enjoying life and be happy. It is very common to feel depressed when we have these views. People will inevitably lose interest and motivation for what they do and will feel easily trapped in a state of depression,” says Dr Valeria Risoli, Clinical Psychologist, Dubai Physiotherapy & Family Medicine Clinic.

Most common complaints in UAE?

Anxiety and stress.

What can I do to feel better?

Pills and therapy: Dr Risoli explains, “It is proven that the combination of medication and psychotherapy such as CBT [cognitive behavioural therapy] approach can be very effective for anxiety disorders.

Talk and re-prioritize: Sometimes it can be handled easily by just reorganising your life and learning to deal with your triggers, says Dr Jihene.

Alternative line: Acupuncture. Relaxation techniques, sport, yoga, listening to music, practicing activities and hobbies that we enjoy, spending time with family and friends, being active, eating healthy.

Can you die from anxiety?

Panic attacks might give you the sensation of having a heart attack but you will not die from it.

It can affect the well-being of an individual and his immune system might get weaker, causing physical problems. Associated disorders such as severe depression can also be a factor that might affect the quality of life to the point of being a cause of death (extreme cases of suicide).

Alternative ways to deal with anxiety

Try some yoga – it can do you a world of good when trying to control your anxiety.

Marjariasana: Or the cat-pose stretch. Get down on all fours. Breathe out and as you do, contract your core and hunch, dropping your head down. Next, breathe and arch the back, contracting the back muscles and lifting your head up. Focus on the movement of the back and spine from the tail bone to the neck and the breathing. Continue 5 to 10 reps. This is very good for back and neck issues. This is “one of the best asanas to work on the spine and the central nervous system. The asana draws blood towards the back, spine and spinal cord, relieving stress from the neck, upper, middle and lower back,” says Gokul Ram K, owner of Trance Yoga UAE.

Shirshasana: or the headstand pose. Practice only under expert guidance unless you are pro. “It supplies each brain cells with surplus blood for it to function better eliminating stress and anxiety,” explains Ram K.

Savasana: This one is meant to relax. Lie flat on your back with heels spread as wide as the yoga mat. Spread your arms, palms facing upwards. Let go of the body weight onto the floor and allow your muscles, joints and organs to relax. Focus on the breathing.

Kapalbhati: Sit in a posture you're comfortable in. Preferably, crossed legged or lotus posture. Exhale forcefully through the nose by pushing the stomach in on every exhalation. Inhaltion should be easy and normal. Do a minimum of 20 and max according to lung capacity. Focus on the breathing and/or the eyebrow centre.

“This focuses on pumping up oxygen more towards the forehead area which is home for your thoughts. This relaxes the frontal brain area,” says Ram K.

Bhramari pranayama: or the Humming Bee. Get into the Kapalbhati posture. Sit on the floor crosslegged and with your back straight. Close your ears using your fingers. Breathe out deeply while making the humming sound as loud as possible. Focus at the throat and the vibration you feel at the centre of your head. Repeat 3 to 5 times.

AUM chanting and meditation: “This is said to be food for the soul. There are numerous benefits by practicing chanting and meditating regularly. And this works as the ultimate practice for all types of anxiety disorders,” says the yoga instructor.

Put a needle on it

“The understanding of anxiety is the level of stress [a person is suffering from]. What acupuncture does it helps them to relax,” says Dr Tingting Tang. “To improve their stress level, to improve their sleep quality.”

What it does: “According to scientific research, they believe that when the needle [is] inserted into a particular point in the body, the body starts to release the ‘happy chemicals’ that are equivalent to the anti-depressant medication,” explains the doctor.

“We believe that there is a relation between the digestion system and the brain. So when some patients get indigestion or gastric disorders, they are more likely to develop issues like anxiety and depression. So what acupuncture does is help to fix the digestion system as well.”

What you can expect: There will be one [needle] between the eyebrows, there will be a few points on the tummy, and there will be one or two points in the arms and the legs.

First-person account

‘I let the people I love give me anxiety’

I am lucky enough not to suffer from anxiety every day. I am lucky that I can go out by myself, meet people at parties. I speak up at work and I give my opinions with family. When I am with friends, I’m usually happy and comfortable. I believe that is when I am the happiest, if I’m being honest. That said my anxiety comes from specific people in my life. People who mean a lot to me.

All it takes is one comment from them, or for them to pull away or become distant, even unintentionally, to turn my entire mood around.

For example, one day, I wake up and start my day with a smile, my mood is great, and life is good, one word or comment from those particular people inexplicably messes up my mood. It is not as if they insulted me, or made fun of me, but they said something ... something that triggered a reaction.

After reading a book about the science of adult attachment, I learned that I am, what you would call, an ‘anxious attached’ person, which means that I thrive off supportive relationships that are stable and long lasting.

And certain people that I love, intensify my worries instead of pacifying them. So when they are in a terrible mood, it becomes contagious and I become affected by their negativity until I myself start to feel down and uncomfortable. What is the one thing that would make me feel better? When they are better again.

When someone has a little bit of power over your emotions, it’s easy for their words to influence your state of mind. I always tried so hard to change people’s actions, so that I wouldn’t get upset. It didn’t exactly work out. Do you know how hard it is to change someone? Quite hard. I learned it the difficult way.

It’s not like I let every single person that I know affect me. Just the ones I love. On the contrary, the people you don’t love are the ones that don’t affect you, because you simply don’t care enough about them. For years, I have allowed myself to go through life dwelling and letting these people ruin my mood and give me anxiety. If someone still does not realise that behaving a certain way with you, upsets you, then you simply have to change your perception. Start caring less about things that they have to say. Sounds a little extreme, I know. But you have to work on a plan to detach yourself.

Because my mood influencers are still an important part of my life, I can’t actually completely pull away. I just distract myself with work and think about doing something new. Engaging in new activities sends feel-good hormones to your brain that make you feel happier. So I would give that a try. In those moments of annoyance and upset, I try to live and breathe positivity. “Be positive” it sounds so lame, I know, but it actually works. Forcing yourself to think about the good things actually makes you feel happier and a bit distracted from the upsetting comments.

Finally, treat yourself the way you want to be treated. If you believe you deserve loving friendships and relationships without, then stop taking it. Don’t bring yourself down, walk away from disrespect and think of yourself as the most important person in your life. True love is peace of mind. If only I would take my own advice.

-Y.Z

‘I was scared of the world’

The world went sideways before it blurred. Age 10. My long affair with social phobia had just begun.

I’ve grown up being told stories of how as I child if I saw more than the four faces I loved – mum, dad, brother and the maid – I would cry and flail hysterically. But it was when I walked into that room with people I did not know - even now I cannot say how many there were – did I seriously think something was wrong.

In India – as I am sure elsewhere – there is no such thing as a people phobia; there are only ‘stubborn people who are not trying hard enough’.

It was especially odd to think of it as a medical anything because out of the four of us, only my father seemed to like people; the others, like me, were reclusive. When it got too bad, they advised me to see a therapist; I saw a few a few times - never went back to the same one.

Quiet. Gloomy. Haughty. Snob. The words would filter through the cobwebs of my ears and settle with hammer-like hits on my ear drums. If I sat with more than one person, thoughts would dissipate. I would not allow myself to be a good student – it may mean speaking up in class. I gave back the prefect badge when it was given to me; why on earth would anyone want that kind of spotlight on them? Mediocrity and I became best friends. Oh and we had our solitude.

Making it to work wasn’t much better. For some reason when you are getting career advice no one tells you about that awful, obnoxious person who will take pleasure in your misery, or the one who likes to hear you stutter. The only thing constant has been the words – I have known I want to write since I was six. But the lack of confidence - a common side-effect I later found out –meant erratic pieces submitted with bone crushing doubt and a sense of general self-loathing that would make wading through a septic tank seem clean.

Years passed in this gloom.

Finally, prodded by feelings of depression – at one point I lay in my bed for two days under the blankets not wanting to see light – rage (coupled with some substance abuse) and thoughts of death, I ventured into a doctor’s office. He decided to call me a ‘client’.

I suppose an alarm should have gone off in my head, but at this point, I just really needed help. I was making excuses to not talk to people; not eat with people. I was making excuses to not look at people. I had at this point met my future husband – and the thought of losing that anchor was crippling.

I could not stand him so much as helping a friend to a drink without my anxiety taking over. I would have out-of-body experiences, watching myself doing things I would hate but seemingly have no control over.

And so I went off to the doctor and became a ‘client’. I was immediately given a pill. A magic dose that suddenly made the world stop shaking just because someone was addressing me. I could write and show my work to people. Everything was good except one teeny little annoyance…the weighing scale kept twitching up, up and away (this apparently is a common side-effect).

I put on about 8kgs in two months. Mortified, I asked for a change in prescription. The third time I complained and refused to eat any more of it, I was given another pill. This one made me giddy and zoned out. Not taking it for a day meant withdrawal symptoms such as queasiness and the inability to speak a sentence straight. And a sense of vertigo that was frightening. Unfortunately, it didn’t do a thing to the weighing machine.

It was in the grip of this fear – that without the pill came nothingness, worse than the fear of people - that I decided to go to another doctor. My sentences, looking back, must have astounded him. They came slowly, one word at a time and basically added up to this: Help.

He helped me wean off that disaster and get onto another pill. At this point I spoke to my mum –otherwise my best friend – about what I was going through. It took about six months and some hard self-searching to be ok. To just be ok with being me. To even consider that it is ok to not be ok.

I’m still figuring out what comes next. But at least I can walk into a room with my head up now. And smile.

K.N.

'I am a sponge for other people’s stress'

This bubbling pile in me is just there; not as part of a particular situation or event, or connected to an incident or relationship. It’s just simmering away, not at the brim, but not a tickle either. Sometimes it’s that feeling you used to get in school when you didn’t finish your homework – a feeling of some fear and trepidation. At other times it is this dam of sadness that threatens to break out if I let loose, a second away.

Anxiety to me has always been a novel concept to attach to something I feel – it’s always sounded like an extreme thing to have, something for the crazies and something you don’t say out loud. However, at 27, I know that anxiety – like many other mental health issues – constitutes a spectrum and what I feel possibly falls in the lower end of it.

Who trigger it, you may ask. Who wouldn’t – I would reply.

As I have grown older, life has become fuller and definitely harder – the cycle of life is that way. I have also noticed that as we grow older, it’s harder to deal with people. It has also become difficult to get understanding and meaningful deep friendships – most of us are usually reduced to one strong relationship. I had a friend in every face I saw regularly when I was 22 – 5 years later, I have none that I want to see regularly.

So what is the trigger? It’s from the few I have let in to my life.

Stress: Each person handles stress a different way and for me, while I handle my own stress very well, I am a sponge for other people’s stress. If an important person in my life is stressed out, I get anxious and can’t sleep – even if said person is sound asleep and dealing with it. I don’t bring it up because I am one of those people who don’t want to add to stress – so it festers and builds in me, while I keep the calmest façade. I am quite an expert at it if I may say so myself.

How I deal with it: When this happens, the only way I can handle it is by trying from my level for a solution. I have noticed that even if that solution is rejected by the person, the fact that I tried my level best to change something helps me calm down and let go.

Acceptance

From a very young age, I have been given a set of… guidelines, if you will. All of them start with “You are a girl and so…”

As someone from India, raised by traditional parents, there was a lot of pressure on me to do the right things, to say the right things, to be extremely diplomatic, to hide my emotions and more. All of this conditioning has in some ways left me incapable of saying exactly what I mean or forces me to apologise for things I shouldn’t have to.

The anxiety builds when someone important to me refuses to make things right, or refuses my views – but I still have to be the diplomatic one, the one who behaves well and the one who lets it rest. I do let it rest but it doesn’t rest in my mind – it goes to the back of mind and sits there waiting for the next time and the next one.

How I deal with it: I do forget things and forgive things – I just can’t forget the way I felt which is what builds into anxiety over time. Sometimes I save conversations or write things down on my phone because I want to deal with it and not let my mind forget while my heart remembers.

I then bring it back up when I am feeling down and ask myself if that incident has gone away – a game of omission until I get to the root of why I feel the way I feel. Processes of introspection like these help me a lot and help me gain confidence in myself

Another fact I have found is that to me, I am my best confidant, supporter and critic. I have built up my list of strengths and flaws – I know exactly who I am. Unapologetically I pick at myself because when these periods of introspection come in I am not confused about who I am and what I stand for. That gives me courage to say the things I need to and let go of the things I need to.

D.C.