WHAT ARE WE PREPARING FOR?

Many of my patients tell me that they have to worry a lot so that they are "prepared." If I am quiet after they tell me that they feel they need to be prepared, often they will say that they don't know what they are preparing for. However, they still feel that they need to prepare in case something bad happens. So, why do we feel a need to be prepared? Is it so that we will know what to do if something bad happens? What does feeling stessed and anxious and worried prepare us to do? Doesn't it prepare us to continue to be stressed and anxious and worried? What good is that? Well, you will know what is going to happen [you will be stressed, anxiious and worried] and that can be reassuring as you don't have to face the unknown.

Many of the people who need to be prepared also fear the unknown and can't imagine just seeing what happens every day [every moment?]. They anticpate bad things happening frequently and if they worry about this they feel that they will not be surprised and will be more prepared. Are they more prepared? Research suggests that they are not preparing to manage stress but are actually creating stress by their preparation. In his book: Why Zebras Don't Get Ulcers, Robert Sapolsky indicates that when Zebras are stressed it is brief as they are either rapidly killed by a predator or they are not. Apparently, Zebras do not walk around worrying when the next predator attack might come, so their stress is over quickly. Humans however, have the ability to instruct their brains to be on guard in case we are threatened as we recall past threats as if they will reoccur. Thus, we are intermittantly stressed as we anticipate repeat of past stresses [constant stress would be something like a full body second degree burn with constant severe pain]. This activation of our brain's stress reponse mechanism is frequent enough that our brain's immune system can not recover before the next stress activation. This compromises our immune sytem's ability to respond to stress and is one of the reasons that autoimmune disorders are increasing as our compromised immune systems are more likely to attack our own body as if it were a foreign body. 

But if it clearly hurts us, why do we keep worrying? It gets back to the fact that our brains take instructions from us. How can it be that our brains are merely following orders [instructions if that sounds better than orders]. Why would we give our brains instructions that hurt us? Well it might be that at one time in the past those instructions to worry helped to temporarily reduce our fears and anxieties. These worries are not helpful now but we keep telling our brains that we need them as we continue to worry. In fairness, our brain's stress response happens in one nanosecond [a billionth of a second] so we are feeling stressed before we are actually aware that we are stressed. 

So, it is clearly better to not prepare ourselves to control stress by worrying but what alternatives do we have. There are specific cognitive behavioral treatments that can help us to not have to prepare by being stressed utilizing a technique called EMDR. This stands for Eye Movement, Desensitization and Reprocessing allows you to process past traumas while your brain is occupied by eye movements so that you can avoid or reduce stress being connected to the memory. There are also medications that can separate stress from past memories. These include: propranolol, low dose lithium, ketamine and a number of hallucinogens that have yet to receive FDA approval. There are also some supplements that might turn out to be helpful but it is to soon to tell.