Anxiety is everywhere in the air these days. Anxiety and Depression Association of America, anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States or 18.1% of the population every year. But despite how common it is, there’s still a huge stigma around the disorder and what it actually means—and how to treat it. Dr. Ellen Vora, MD is a holistic psychiatrist who has done extensive research into anxiety disorders and how it manifests in the body and mind.
In her book, The Anatomy of Anxiety, Dr. Vora offers a holistic approach to treating anxiety, guiding readers to listen to their bodies to identify what their anxiety is trying to tell them. Frenshe sat down with Dr. Vora to talk about how to adjust our relationship to our anxiety and what her book covers.
What is anxiety and how does it commonly manifest?
Anxiety is a feeling of worry, nervousness, fear, or unease, typically about everyday situations or something with an uncertain outcome. It shows up differently in all of us—from a chronic and constant sense of worry accompanied by rumination and the inability to relax, all the way to a calm baseline interrupted by intense anxiety in social situations or panic attacks out of the blue.
You mention in “The Anatomy of Anxiety” that anxiety isn’t just in the head, it’s also in the body. Can you expand more on that?
We’ve been taught that mental health issues are a genetically determined chemical imbalance in the brain. This has two problems: first, by focusing on anxiety from the neck-up, we overlook the role that the physical body has on our mental health. Inflammation, blood sugar, hormones, and the ecosystem of bacteria in our digestive tract are all aspects of the physical body that directly impact our mood. In fact, the chemical imbalance we’re so myopically focused on is sometimes a downstream effect of these other issues.
The other issue with thinking of mental health as exclusively genetic is that it suggests that our mental health issues are a fixed trait or a destiny. In functional medicine, we say: genes load the gun and the environment pulls the trigger. Genes are only ever a predisposition to mental health struggle, never a destiny. And the environmental piece—how we sleep, how we eat, whether we move our bodies, whether we have community or purpose in our lives—is a primary determinant of our mental health. Focusing on the environmental determinants of our mental health, AKA the part we have some control over, is a more hopeful and empowering message.
What is true anxiety and false anxiety?
False anxiety is the anxiety caused by imbalances in the physical body. It’s avoidable anxiety. It’s often the result of some state of physiologic imbalance that trips our body into a stress response, causing unnecessary suffering.
True anxiety is not something to pathologize, and it’s not something we can gluten-free or decaf-coffee our way out of. True anxiety is purposeful anxiety. It’s our inner compass nudging us to slow down and pay attention to what’s out of alignment in our personal lives, our communities, and the world at large. True anxiety often has a call to action baked into it, and when we translate the anxious feeling into purposeful action, the feeling of helplessness and anxiety transforms into a feeling of purpose.
What is the difference between anxiety and intuition? How can our readers separate the two?
True anxiety and intuition generally register as a more substantial feeling. I like the way Glennon Doyle draws the distinction between fear and intuition. She explains, “My anxiety is high, it’s like a shaky hovering, it’s a high frequency . . . it’s buzzing. . . But . . . there is something below it that is heavier, that is more grounded, that is not shaking, that is solid, that is the Knowing. And I actually now am at a time in my life—at 45 years old—where I can tell the difference.”
In other words, even as true anxiety and intuition might be communicating to you that something is not right, they feel different from false anxiety. We can practice discerning the difference between fear and false anxiety, and our intuition and true anxiety. Instead of feeling like a threat, intuition comes from a place of clarity and compassion.
Should we ever listen to our anxiety?
Yes, our true anxiety is here with an important message baked into it. In fact, I think the sensitive, intuitive, anxious folks are sometimes here in a prophetic capacity—their anxiety is here to help us course correct as a society.
What is the effect of technology (especially social media) on our anxiety? How can we fix our relationship with our tech?
Technology impacts our anxiety across multiple dimensions. Most of us are familiar with the ways that social media gins up our anxiety through compare-and-despair as we look at the highlight reels of other peoples’ lives, the ways it creates FOMO or makes it grossly apparent when we were left out of a social gathering, and the impact filters have on setting unattainable beauty standards that might leave us feeling less than when we see our perfectly human reflections in the mirror.
I believe social media, while allowing us to connect with our niche around the globe, also creates an opportunity cost where we don’t feel as motivated to connect with others in real life. The physical position we hold when we crane our neck down to look at our phones may be impacting our capacity for healthy breathing and smooth blood flow to the brain. The blue spectrum light from our screens impairs our melatonin secretion in the evening and disrupts our circadian rhythm, making it harder to sleep well. And social media apps don’t have a natural stopping point, so they never cue us to pause, preventing us from going to sleep at a healthy hour.
A large part of how technology has exacerbated our anxiety is by way of the attention economy–that media companies are competing for our attention, and they know that if they prey on our fear response, instill uncertainty or doubt, or when the algorithm favors controversy, we will give them an increasingly large share of our attention. They get more clicks and more ad revenue, but our mental health is the collateral damage.
There’s so much in the world that’s anxiety-inducing and out of our control. Especially now, how can we manage our anxiety when it feels like it’s one crisis after another?
We evolved in communities of about 100-120 people. For thousands of years, we had no way of being aware of the problems plaguing communities outside of our own. These days, we are surrounded by news of everything wrong in all corners of the world at all times. It’s too much. In the words of Britney Packnett Cunningham, “We need rested warriors.”
While we want to stay informed and participate in the public conversation, by setting limits, making conscious choices as we navigate the information landscape, and keeping our phones out of the bedroom at night, we can protect our sanity and our rest, and therefore show up creative and energetic when it’s time for us to make our contribution to righting the wrongs of the world.
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