November/December 2009, Volume 2, Issue 6
“I have been practicing psychiatry for 40 years, but I’ve never seen this much stress and worry about economic well-
being and the future. There is a sense that the ground is no longer solid, that a system we all thought would sustain us no longer works as we were told it would.”

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Coping with Uncertainty: Some
Simple Steps for the Stressed Out

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Coping with Uncertainty:
Some Simple Steps for the Stressed Out
Dr. James S. Gordon, a Health Insights Today editorial board member, is the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression and several other books. The former chair of the White House Commission on Complementary and Alternative Medicine Policy, he is a clinical professor of psychiatry and family medicine at Georgetown Medical School and director of the Center for Mind-Body Medicine in Washington, DC.

A PBS special on Dr. Gordon’s work will air in late November or early December 2009. Check local listings for dates and times.

The following article is published with permission from the author. It was first published in the Washington Post.

A middle-aged, working-class woman recently came to my medical office complaining that her back had “seized up.” Her husband had lost both his jobs and was feeling quite disheartened; not long after, her blood pressure had “jumped though the ceiling” and she began sleeping poorly.

Another patient came to see me suffering from crippling anxiety attacks. He had lost the better part of his considerable fortune in the economic collapse. Now he was waking in the middle of each night feeling his chest crushed, unable to breathe, half fearing and half wishing he would die.

I have been practicing psychiatry for 40 years, but I’ve never seen this much stress and worry about economic well-being and the future. There is a sense that the ground is no longer solid, that a system we all thought would sustain us no longer works as we were told it would. In the past, when patients reported job-related stress, it was from unfulfilling work and the anxiety of making choices. “Should I stay in this job that I can’t stand and keep feeling so unhappy?” they would say. Now, I hear about unmeetable mortgages, months without work, fears of ending life in a low-paying, entry-level job. “What went wrong?” my patients say. “What could I have done?” “How can I manage?”

In this uncertain time, symptoms of chronic illnesses – hypertension, back pain, diabetes – that were controlled or dormant are erupting. Low-level depression, whose hallmarks are feelings of helplessness and hopelessness, is endemic.

Large numbers of people across the country are trying to quiet their apprehension with drugs or drink, or have turned to antidepressants, anti-anxiety medications and sleeping pills. But after decades working not only in Washington but also with war-traumatized populations overseas, I’ve found there are simple strategies for helping people cope that are easy to learn, practice at home and, in these stressful times, free.

1. Begin a simple meditation practice. Loss – of jobs or economic security, as well as of a beloved person – is perhaps the greatest and most common of stressors, and the most frequent cause of anxiety and depression. Slow, deep breathing – in through the nose, out through the mouth, with the belly relaxed and soft, and the eyes closed – is a sure “evidence-based” antidote to the stress response that uncertainty provokes. Practicing this “soft belly” technique several times a day for several minutes each time quiets the “fight-or-flight” response that makes people anxious and agitated, and brings us what cardiologist Herbert Benson famously called “the relaxation response.” Financial advisers, child-care workers and soldiers back from a second tour in Iraq with whom I’ve worked have all found, in this simple practice, a source of calm.

2. Move your body. With the possible exception of talking with a sympathetic, skilled human being, physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Exercise has been shown in animal studies to increase cells in the hippocampus, a region of the brain concerned with memory and emotion, which can be depleted by significant psychological trauma (and financial stress is one of the most significant traumas) or chronic depression. Exercise increases mood-enhancing neurotransmitters in our brains, and decreases the levels of stress hormones that exacerbate chronic illness.

It may not be easy to get moving when you’re feeling defeated, but every step you take, literally as well as figuratively, will encourage you to take the next one. Make sure you do something physical that you enjoy or once did enjoy. Aerobics or yoga classes may feel overwhelming or too expensive. Don’t worry: Dancing at home by yourself works just as well, and so does walking. Exercise is often the first item on my prescription pad.