• Social isolation is both a contributing factor to anxiety and also a result of it.
• When you are suffering, it is challenging to reach out to others in a meaningful way.
• The physiological effects are devastating, with significant mental and physical consequences.
• It even affects the expression of your genome (DNA) in forming aggressive inflammatory cells that destroy your own tissues.
• The loneliness and isolation that many people experience is one of the worst aspects of the whole experience of dealing with chronic illness.
• Conversely, reconnecting with your family, friends, and colleagues is a powerful force for healing.
• The catch-22 is feeling good enough to begin reaching out. It is one of the reasons that there is a sequence to the healing journey. Each person is ready at a different point along the way.

Loneliness and social isolation may some of the worst aspects of suffering from any chronic illness. Over 50% of Americans are socially isolated regardless of where they live or the size of the town or city. It is ironic in that social isolation is such a significant contributing factor to poor health in this modern era. It is also dangerous. It is estimated that the effects on one’s health is equivalent to smoking about 15 cigarettes/ day.¹ Sadly, the age group that is the most affected are those in college and in their 20’s. This stage of your life has the potential to be the best of times.

 Consumed by suffering

When suffering from crippling anxiety and other physical symptoms, you spend a lot of your conscious hours looking on the Internet, seeking medical care, trying different treatments, and discussing your problems with anyone who will listen. Why wouldn’t you? Your life has been consumed and you want it back. Unfortunately, in spite of your best efforts to move forward, from a brain development and physiological perspective, you are moving the wrong direction. Here are some of the effects:

• Unpleasant circuits in your brain are reinforced.
• Pleasant one become less active with disuse.
• You drive people away that you used to have fun with and bond with others who are in a similar condition.
• Eventually, many people are so drained from the endless battle with their suffering, they become isolated, even in the midst of their own family.
• Oxytocin is a hormone that causes social bonding and is also powerfully anti-inflammatory. Lack of connection drops it down and your inflammatory state becomes even higher.

Some data

The effects of social isolation are deep. They go right down to the expression of your DNA directing the production of proteins that are the essence of life. There are about 20-30 genes that effect the production of certain white blood cells called monocytes. White blood cells are at the core of fighting foreign material in your body, including cancer cells, viruses, and bacteria. There is an over-active form of them called, “warrior monocytes” that are too aggressive and also attack your body’s own tissues creating many diseases states and symptoms. Anxiety is one of these inflammatory states. The most powerful factor causing the creation of these cells is social isolation. The second factor was chronic stress (anxiety).²

Dr Dantzer wrote an extensive review paper³ looking at the social influences on inflammation. There are many factors that affect inflammatory markers, and he presented the top four factors that lowered inflammation.

• A sense of control
• Hope/ optimism
• Positive affect/ attitude
• Social connection

Humans evolved by having language and being able to cooperate through social connection. It is the reason we are so tribal, and unfortunately, we haven’t evolved enough as a species to view every person as part of the human tribe. There is an evolutionary basis for excluding groups of people, as we compete for resources. That being said, social connection is a deep need, and it is expressed in your physiological state.

Another paper out of UCLA reported on a study where a volunteer was placed in a special MRI scanner called a functional MRI (fMRI). It highlights area of increased brain activity. The volunteer then played a computer-based video game where he or she was in a game of three-way catch. The computer was programmed at a certain point to exclude the volunteer and the ball was “tossed” between the remaining two players. The volunteer did not know the other two players were just the computer. Guess what? Even though it was just a computer game, and the volunteer could not physically see the other players, the centers of the brain that are active in chronic physical pain lit up. In other words, emotional pain is processed in a similar manner. ⁴

The catch-22 of social isolation

I will only say that becoming socially isolated and feeling lonely was one of the worst aspects of my 15 years of suffering. The only word that slightly described the feeling was, “crushing.” I began to experience deep self-deprecating thoughts that revolved around, “why would anyone want to hang around with me?”, and “I don’t have anything interesting to say.” These thought patterns were endless. This occurred despite me generally being very social person. Just the feeling of being lonely felt like an Abyss and was paralyzing with regards to re-engaging. I really could not see an end to it.

Healing

I noticed very early on that my patients would check off, “re-engaging with family and friends” as part of their healing. Social interactions are tricky in that you be rejected sometimes and hence one of the reasons people have social anxiety. It is greatly magnified when you are already experiencing chronic mental and/or physical pain. So not only do you not have the energy to reach out to others, feeling inadequate may also contribute. Here are some suggestions.

• Be kind to yourself. You are doing the best you can.
• People who you used to be friends with may not have as much in common with you and you may be rejected.
• Others you have bonded with through your pain may also reject you as you heal. You are no longer validating their suffering, and as you heal, they are confronted with their own inability or unwillingness to pursue the same journey.
• So, the first step in returning to a normal life, is to be prepared for these kinds of interactions.

Then just move forward in any way that you can.

• Call old friends or family members. Many of them are in the same condition you are. It is remarkable how common it is to be trapped by anxiety and pain. However, as mentioned many times, conversations around these topics are counterproductive for all parties.
• Re-engage with old skills such as art, music, and hobbies.
• Read interesting books or watch inspiring movies. They are great topics for conversation.
• Join a club. You don’t need to be an expert. There are numerous choices such as birdwatching, Scrabble, ping pong, book, movie, and history clubs, walking with friends, and music.
• Find ways to give back and there are endless options. One of my successful patients was “trapped” in a nursing home and spiraling back down into the Abyss. She decided to become an advocate for other patients who had dementia. Within a few weeks, her whole mood and outlook dramatically improved.

Recap

Loneliness is crushing and both a contributing factor to chronic illness and also a result of it. A significant aspect of healing is reengaging with those around you. What makes this all the more difficult is that while you are suffering, you may not have the interest or energy to reach out to others. Then if you are still in the mode of discussing your troubles, you will push people away who can nurture you, or attract others who are also frustrated with their suffering, and they will pull you deeper into The Abyss. This cycle is deadly.

That is why you must empirically make decisions to keep reaching out and connecting regardless of how you feel. You will feel awkward, especially when you have taken medical conversations and complaining off of the table as topics. The connections can be as simple as a phone call, reaching out to old friends, or joining a book club. The key is doing something – anything to reach out and break out of your patterns.

Humans and language evolved through language and social connection. It is one of the most basic of needs. Actively reaching out and giving back is a powerful move to stimulate your brain to rewire and heal. To have a good life, you must live a good life. It requires practice.

 Questions and considerations

1. You might be sitting here and feeling overwhelmed by the thought of even trying to reach out. That is OK and understandable. You can’t just flip this one around on a dime.
2. Just do something. Anything. You have heard the term, “baby steps” many times.
3. The problem is that when your brain has been barraged with negative thought patterns, you may feel people may not want to be around you. That is a classic common cognitive distortion of, “mind reading.” Maybe they don’t and you also have to be OK with that. Maybe they are in the same situation as you are and don’t have the energy to engage.
4. I can personally vouch for how distorted thinking patterns become from my own experience. For a long time, even after I was much better, I was still quite self-conscious.
5. Humans evolved by interacting with other humans. Somehow, re-engaging with life has to be part of your healing journey.

References

1. Cigna US Loneliness Index 2018. Report published by Cigna Insurance Company.
2. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189

3. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42. https://doi.orgl/10/1016/j.bbi.2018.08.010
4. Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosom Med (2012); 74: 126-135.

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It’s the sensation created by elevated levels of stress chemicals.

• Adrenaline – increases sensitivity and alertness
• Cortisol – mobilizes energy stores/ inflammation
• Histamines – immune system/ inflammation
• Endorphins – modulates the stress response

Anxiety is an automatic survival response. The unconscious brain is estimated to process 11 millions bits of input per second whereas the conscious brain deals with 40 per second. It is a huge mismatch. That is why it’s not subject to rational psychological interventions alone.

Decreasing your body’s level of stress hormones causes anxiety to drop.

There are two ways of accomplishing this:

• Relaxation strategies
  • Mindfulness, meditation, “active meditation”, forgiveness, play, medical hypnosis, biofeedback and many more.
• Stimulating the brain to change (neuroplasticity), so there is less reactivity to stress.
  • Learning to “be with your pain”.
  • Not discussing it with anyone.
  • Expressive writing
  • Moving forward with your life with or without your pain.
  • “An enjoyable life”

There are two more critical concepts:

Since anxiety is a unpleasant deeply seated core survival reaction, you’ll do almost anything to avoid it. Essentially, anxiety is the pain. The basic intent of it is to cause you to act in a manner to diminish a threat (control) and move on.  When you can’t escape a mental (thoughts) or physical threat, your body will secret more stress hormones to increase your chances of survival. The sensation generated is anger. Anger is anxiety with a chemical kick. It’s even less subject to rational interventions.

Not only are there strategies to decrease the stress hormones, there are powerful ways, to stimulate increased levels of relaxation (play) chemicals, such as:

• Oxytocin – bonding, the “love” drug
• Dopamine – reward
• Serotonin – mood elevator
• GABA hormones (the body’s equivalent of Valium).

This dramatically different chemical environment generates a deep sense of well-being.

Your capacity to enjoy your life depends on your skills in minimizing your levels of stress hormones and stimulating your “play” chemicals. Modern neuroscience has documented why “Laughter is the best medicine”.

Explanation of anxiety: Converstion with David Elaimy

Wake the fun up

Listen to the Back in Control Radio podcast Anxiety Basics.

The post Anxiety Basics first appeared on Back in Control.

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