Carlo Carandang, MD, FAPA, a leading expert in anxiety and depression, has opened a private practice in psychiatry in Seattle. To book an appointment in Dr. Carandang’s Seattle office, please visit his practice website here.
There’s a quiet revolution occurring in psychiatry. The mental illness burden is felt worldwide, yet psychiatry has not been able to help millions of people who suffer from mental illness, as access to psychiatry and mental health services is at a crisis (Fields and Corbett-Dooren, 2014). Psychiatry is fast becoming trivialized due to its inability to deliver treatment to the population. But gone are the days when doctors had the monopoly on medical knowledge. With the advent of the internet, people can now research their symptoms, possible illnesses, and treatment options before even seeing the doctor. When people are suffering from mental illness and can’t access psychiatry, they still need help. As a result, people naturally look to the internet and research their ailments online. For people with anxiety, this book, Anxiety Protocol, and its affiliated website, AnxietyBoss.com, represent a new option for those who suffer from anxiety but are not able to receive help. This is an online solution that is based on self-help and natural remedies for anxiety. It is for the newer generations who are not pill-poppers and seek a natural, self-reliant way of getting rid of their anxiety. It is for the new generation who are more health-conscious and looking for healthy living options to treat and prevent anxiety. What we offer here is the latest evidence-based program to help eradicate your anxiety. These are evidence-based services and products that have research showing they are effective at eradicating anxiety…all from the comfort of your laptop, tablet, or smartphone. Imagine: a treatment for anxiety that does not involve going to a doctor’s office or hospital. This is the quiet revolution in psychiatry, where a treatment for anxiety can be effective and delivered without a doctor or therapist, without prescription medications (that have multiple and sometimes severe side effects). Certainly, I’m not advocating you ditch your psychiatrist if you already have one. If you have severe anxiety disorder, then you do need to see a psychiatrist. However, for milder forms of anxiety, this online, natural, and self-reliant intervention will signal the beginning of the quiet revolution in psychiatry, where treatment is delivered virtually, online.
But psychiatry still has much to offer people who have mental illness. These are important and exciting times for the profession, as it tries to figure out the neurobiological underpinnings of mental illness. Currently, clinical psychiatry does not have objective, biological tests to help confirm mental illness. Rather, mental illness is diagnosed based on history and clinical presentation. However, psychiatry is fast becoming a specialty of medicine based on the brain. The mind, and the various problems and illnesses that are from disorders of the mind, can basically be explained at a molecular level, with neurons communicating with each other via synapses, and these synapses connect to one another via neurotransmitters. These neurotransmitters are the chemicals which carry out the message between neurons, and the receptors of these neurotransmitters are the targets of the psychiatric medications prescribed for mental illness…this is the so-called “chemical imbalance” of mental illness. But mental illness is much more complex than a chemical imbalance. In the brain on a macro level, mental processes have specific circuitry, which connect different parts of the brain, and this circuitry is comprised of the neurons which conduct the message between brain areas. Functional neuroimaging is already revealing preliminary evidence that mental illness is associated with disruptions of these brain circuits, and that treatment can normalize these circuits. It is hypothesized that psychotherapy and other alternative treatments can also normalize these disruptions in brain circuitry. In addition to neuroimaging research, genetics research is on the verge of finding the constellation of genes responsible for transmission of mental illness in families. In the next few years, psychiatry should have objective, biological tests to help diagnose mental illness, and cures may be possible. These are exciting times in psychiatry, given it is at the brink of finding the cause (and cure) of mental illness.
On the other hand, it is also the worst of times for psychiatry, given so many people with mental illness suffer without treatment. This book, Anxiety Protocol, and its affiliated website, AnxietyBoss.com, respond to those individuals who often go unheard. It’s been developed to deliver treatment online and virtually. It is our sincere hope that we can reach the millions who suffer from anxiety, and provide them with a natural, online, and self-reliant solution to their ailment.
Carlo Carandang, MD
Author, Anxiety Protocol
Anxiety Protocol, The Foundation: Understanding Anxiety, Author: Carlo Carandang, MD
Book Reviewer: Sheik Hosenbocus, MD
A large and ever growing number of people suffer daily from the debilitating effects of anxiety affecting their quality of life. A majority suffers in silence. Without the appropriate tools and in their attempts to cope, they often resort to maladaptive strategies. Many find solace in the use of various substances including alcohol, cigarettes, marijuana, to mention a few. This goes on for years and years as anxiety is a life-long condition. The lack of user friendly, down to earth tools out there has been a major perpetrator of this problem. The Anxiety Protocol will undoubtedly now addresses this gap. A major strength of this book is its encouragement on the use of modern technology to enable people young and old to research and manage their ailment on line where they will learn self-help skills and alternative strategies. This is an easy to read book that offers a comprehensive, up to date and holistic exploration of the different anxiety disorders backed by the latest research and is extremely well referenced. The affiliated website AnxietyBoss.com enables those who do not have timely access to a family doctor or specialist to find out about the latest evidence-based solutions that can help them deal more effectively with their anxiety.
The book contains six sections divided into 22 chapters. Each chapter is a comprehensive review in its own right. Section 1, Chapter 1 presents a general overview and classification of anxiety disorders citing a comprehensive list of symptoms to characterize each disorder. Each subsequent chapter (2-9) provides a thorough exploration of a separate anxiety disorder, illustrated by specific detailed case examples containing the presenting symptoms, full case history, diagnosis and clinical course. For each disorder there is a comprehensive list of management strategies including self-help, psychotherapy, pharmacotherapy and goes beyond the traditional treatment strategies for each disorder by expanding on a variety of natural remedies and providing research based information on a variety of herbal and nutritional products. This in itself is a unique and welcomed feature of this book making it very appealing to many. Section 1, chapter 10 provides a brief up to date account of the neurobiology of anxiety disorders to demystify misconceptions and provide a better understanding of the “chemical imbalance” in the brain usually referred to by many but only few can comprehend.
Section 2 expands on the treatment of anxiety with chapter 11 focusing on the psychotherapeutic approach to anxiety disorders. The emphasis here is placed on cognitive behavioral therapy (CBT) as the first line treatment for all anxiety disorders, citing a higher level of evidence of effectiveness than any other type of psychotherapy. Chapter 12 explores the various classes of medications used to treat specific anxiety disorders and provides the reader with a helpful table listing all the medications, the type of anxiety they treat and the mechanisms of action. In this chapter the author refers to prescription medication as a “last resort treatment” reserved for the most severe cases or those who have failed psychotherapy. This may sound controversial to those who consider medication in association with or as an adjunct to psychotherapy. According to the author this statement has been explicitly written to educate, raise awareness and encourage physicians to avoid the indiscriminate use of psychotropic medications for anxiety before even trying other strategies especially CBT whose beneficial effects have also proven to be longer lasting than any medication as well as self–help and/or alternative interventions. The book is meant not only to educate about anxiety but also hopes at the same time to change the way physicians think about treatment or resort too quickly to medication.
Section 3, Chapter 13 and 15 deal exclusively with alternative treatments for anxiety with a comprehensive list of practical self-help interventions. Chapter 14 covers an extensive list of various natural supplements that have proven useful in anxiety disorders. Each is described in detail backed by recent studies and placebo controlled RCTs. including positive effects, dosages and adverse effects. Section 4 provides an extensive coverage of anxiety disorders resulting from trauma and stress including adjustment disorders complete with case examples and treatment strategies. Section 5 is important as it deals specifically with anxiety disorders in special population including children (chapters 18 &19) and the elderly (chapter 20) focusing on the special criteria, clinical course and treatment of anxiety disorders in these population with well written case examples.
In conclusion Anxiety Protocol is a creative, innovative and comprehensive book on anxiety. The author presents his readers with a vast array of self-help skills and alternative methods of managing their anxiety including online support via its websites, AnxietyProtocol.com and AnxietyBoss.com. This is quite unique and in keeping with the type of treatment that people usually aspire to but have not been able to access so far. Anxiety Protocol has broken the ice and now makes it easily and readily accessible. A weakness of the book is with regards to children namely, a lack of specificity of the disorders and specifically the ages that some of the techniques could be most helpful and that could also serve as a guide to parents and clinicians. The book’s greatest achievement is the provision of comprehensive alternate strategies including natural remedies and self-help strategies as well as the provision of an affiliated website AnxietyBoss.com to provide specific management strategies and tools putting these at easy reach of most people. The information contained in the book is well researched and referenced and aimed at those who for different reasons may not have access to a well-qualified therapist or physician or those sitting on a wait list. This book now provides hope for them and as such should be made widely available and easily accessible to the population at large as well all mental health practitioners and physicians. There is a lot of knowledge to be gained by reading the Anxiety Protocol. Overall this book is highly recommended as a useful resource in many different ways.
Sheik Hosenbocus, MD, FRCPC
Clinical Assistant Professor
Department of Psychiatry
University of British Columbia
Note from the author, Dr. Carlo Carandang: Dr. Sheik Hosenbocus kindly reviewed the 1st book of Anxiety Protocol, The Foundation: Understanding Anxiety, but did not review the 2nd book of Anxiety Protocol, Moving Forward: Treatment Plan, as the 2nd book was not completed at the time of his review. The 2nd book, Anxiety Protocol, Moving Forward: Treatment Plan, is a concise yet comprehensive, 8-chapter self-help course designed to help you eradicate your anxiety quickly, while the 1st book of Anxiety Protocol, The Foundation: Understanding Anxiety, is a comprehensive reference for increasing your knowledge of everything related to anxiety.
Anxiety affects millions of people, but not everyone with anxiety needs prescription medications. Prescription medications for anxiety include antidepressants and benzodiazepines. However, antidepressants and benzodiazepines have multiple, significant side effects, and are expensive. Indeed, a recent study has questioned the efficacy of antidepressants for anxiety, as their effect may have been overestimated due to publication bias, where journals tend to only publish positive studies, while not publishing the negative ones (Roest et al., 2015).
Fortunately, there are alternatives to prescription medications for anxiety. Herbal and dietary supplements (natural supplements) are gaining popularity for mental health problems like anxiety, as they are associated with less side effects and are less expensive. A novel natural supplement for anxiety has recently been formulated, called KalmPro, at KalmPro.com. What is different about this natural supplement for anxiety is that the ingredients were formulated from studies showing effectiveness and safety for the treatment of anxiety.
KalmPro has multiple ingredients which have been combined into a 750mg pill, with the recommended daily dosage being 1 to 2 pills daily. The all-natural ingredients include a carbohydrate (inositol), an amino-acid (l-theanine), and three herbs (lemon balm, passionflower, and lavender).
Only two natural supplements have several placebo-controlled randomized controlled trials (RCTs) showing effectiveness for anxiety: kava and inositol (Hofmann, 2012). However, kava is associated with liver toxicity and liver failure, so kava is not recommended for treatment of anxiety. However, KalmPro has inositol, which has multiple studies showing effectiveness for panic disorder and obsessive compulsive disorder (OCD) (Palatnik et al., 2001; Fux et. al., 1996). Inositol is a sweet-tasting carbohydrate. It is a natural compound with virtually no side effects.
KalmPro also has l-theanine, an amino acid found in green tea. L-theanine reduces anxiety symptoms in healthy subjects, decreases anxiety in people with psychosis, and improves concentration while decreasing anxiety (Unno et al., 2013; Ritsner et al., 2011; Kobayashi et al., 1998). Green tea has been associated with anxiety reduction for centuries, and l-theanine is the responsible ingredient.
KalmPro has several herbs, one of which is lemon balm. Lemon balm is an herb in the mint family. Lemon balm combined with Valerian led to decreased anxiety in healthy subjects, and was effective for mild to moderate anxiety disorders and sleep problems (Kennedy et al., 2006; Cases et al., 2011). Another herb in KalmPro is passionflower, a flowering plant. Passionflower was as effective as oxazepam for generalized anxiety disorder, and reduced anxiety in surgery patients pre-operatively (Akhondzadeh et al., 2001; Movafegh et. al., 2008). The last herb in KalmPro is lavender, a flowering plant in the mint family. Lavender was more effective than placebo for generalized anxiety disorder, had less side effects than paroxetine, had a side effect profile comparable to the placebo, was as effective as lorazepam for generalized anxiety disorder, and does not have the sedative or addictive potential of benzodiazepines (Kasper et al., 2014; Woelk and Schläfke, 2010). Lavender has a few RCTs which are positive for anxiety, and with more positive studies, it may eventually have the type of evidence backing kava and inositol for anxiety treatment.
In summary, KalmPro has natural herbs and dietary supplements which have research studies showing effectiveness for generalized anxiety disorder, panic disorder, obsessive compulsive disorder, mild to moderate anxiety disorders, stress in healthy people, stress before surgery, and sleep problems. In addition to treating anxiety effectively, KalmPro is safe and well tolerated, according to the studies showing the safety of each natural ingredient. KalmPro can be considered for mild to moderate cases of anxiety. However, severe cases of anxiety need medical attention, preferably from a psychiatrist.
The martial arts are ancient forms of combat in Eastern cultures, which utilizes mind-body exercises, spiritual practices and physical exercises. Martial arts include kung fu, tai chi, judo, karate, and taekwondo. Yoga and qigong are derived from the martial arts and quite popular worldwide, with yoga especially popular amongst women. In modern times, marital arts are utilized for self-improvement. Martial arts foster competition, physical fitness, and mental and spiritual health. Although physical exercise in martial arts has been the focus in Western cultures, there is the added benefit of developing the mental and spiritual being. However, martial arts practitioners from the East view the physical, mental, and spiritual development as all part of the same process (Bu et al., 2010).
Martial arts can be helpful for relief of anxiety and stress. Tai chi, a martial art, and qigong and yoga, martial art derivatives, are also categorized as mind-body exercises and have evidence that they may be helpful for anxiety (Wang et al., 2014). Another study revealed that 28 weeks of yoga meditation was more effective than the control group for anxiety disorder with mixed anxiety and depression (Srivastava et al., 2011). Mind-body exercises help one to be mindful of posture, movement, muscle tone, relationship of body parts to one another, and breathing. This helps to distract one from distressing thoughts and removes one from their stressful environment.
In addition, martial arts develop mental sharpness, alertness, and concentration, as these are necessary attributes to help one in self-defense from enemies. Without alertness and concentration, one would not be able to defend oneself, even if one were well-endowed physically. Directed breathing, meditation, and directing the energies of the psyche are part of martial arts practice, which helps to develop mental focus and concentration (Bu et al., 2010). As a case in point, Bruce Lee was physically smaller than many of his opponents, but where he lacked in physical size, he made up for in focus, concentration, and execution. Martial arts give you a sense of mastery and fulfillment, which also contributes to your well-being.
In summary, martial arts can help to reduce anxiety and stress. Martial arts help by giving you a sense of mastery over an ancient practice and a sense of fulfillment to improve your self-esteem. In addition, martial arts can help you improve mental focus, concentration, and general well-being. For more information and help on anxiety, please visit AnxietyBoss.com.
Effects of martial arts on health status: a systematic review.
Bu B, Haijun H, Yong L, Chaohui Z, Xiaoyuan Y, Singh MF.
J Evid Based Med. 2010 Nov;3(4):205-19.
Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials.
Wang CW, Chan CH, Ho RT, Chan JS, Ng SM, Chan CL.
BMC Complement Altern Med. 2014 Jan 9;14:8.
Meditation for the management of adjustment disorder anxiety and depression.
Srivastava M, Talukdar U, Lahan V.
Complement Ther Clin Pract. 2011 Nov;17(4):241-5.
Anxiety disorders are characterized by extreme fear, nervousness, or worry on exposure to a feared stimulus, which can be an object, person, or situation. Fear is differentiated from anxiety, in that fear is a reaction to a current stimulus, whereas anxiety is fear of some future stimulus or anticipation of one. Anxiety becomes a problem when one becomes fearful, nervous, or worried out of proportion to the feared stimulus, or becomes nervous or worried about some future stimulus or anticipated event.
Fear is a normal response, and is a necessary component of survival. When presented with danger in the environment, a physiological reaction is triggered where adrenaline is released into the bloodstream. Adrenaline is a fear-response hormone which causes several physical changes in the body, including increased heart rate, increased rate of breathing, and dilated pupils. In addition, there is shunting of the blood flow from the digestive system and the skin to the skeletal muscles, which can be felt as having the “butterflies” in the stomach or having numbness and tingling sensations of the extremities. These physical changes allow the person to prepare to fight the danger, or to run from it, the so-called “fight-or-flight” response. The increased heart rate and breathing rate allows the blood to supply more oxygen to the skeletal muscles needed to fight or run, and the blood shunting to the skeletal muscles further aids this process. The dilated pupils allows for improved vision to assess the danger, and the brain becomes more alert and hypervigilant for danger, allowing one to scan their environment in order to deal with the external danger. However, this fear response goes awry when one starts to anticipate danger, or starts to have thoughts about events which overestimate the danger and underestimate one’s ability to cope with the danger. In this situation, the fear response is heightened by one’s thoughts about the event or future event, where the overestimation of danger and underestimating of one’s coping leads to anxiety. Unfortunately, the body perceives fear and anxiety the same way, where the adrenaline response is triggered with either fear or anxiety. So when one has anxiety, the fight-or-flight response is activated, and serves no purpose as the danger is more in one’s head and the way they think or give meaning to the situation.
Anxiety becomes an anxiety disorder when the anxiety symptoms cause impairment of functioning in relationships and work/school, and the person has significant distress and is unable to control the anxiety. The major anxiety disorders include generalized anxiety disorder, specific phobia, social phobia, panic disorder, post traumatic stress disorder, and obsessive compulsive disorder. Other anxiety disorders include substance induced anxiety disorder, anxiety due to a general medical condition, acute stress disorder, adjustment disorder with anxiety, separation anxiety disorder, and selective mutism. Each disorder is associated with a specific core anxiety symptom:
- Generalized anxiety disorder- generalized worries
- Specific phobia- fear of an object or situation (ie fear of heights)
- Social phobia- fear of social scrutiny (ie stage fright)
- Panic disorder- panic attacks
- Post traumatic stress disorder- flashbacks and nightmares of trauma
- Obsessive compulsive disorder- intrusive thoughts and ritualistic behaviors
Anxiety treatment involves psychotherapy, with cognitive behavioral therapy (CBT) having the most evidence for efficacy. CBT works on the premise that events or situations do not directly cause the anxiety; rather, the thoughts we have or the meaning we give the events causes the anxiety. CBT works by identifying the maladaptive thoughts, working on more adaptive thoughts, and suppressing/distancing oneself from the maladaptive thinking. In addition, CBT addresses the avoidant behaviors which serve to sustain the anxiety over the long term; this can be a difficult task, as the avoidant behaviors serve to relieve anxiety in the short term. Other forms of psychotherapy include depth or insight oriented psychotherapy, which addresses the causes and the proximal determinants of the anxiety. If psychotherapy is not effective, or if the anxiety symptoms are severe, then pharmacotherapy with anxiety medications can be considered after a psychiatric assessment. Other treatments for anxiety include self-help treatments, natural supplements, and alternative interventions for anxiety like exercise, meditation, and relaxation. Please see AnxietyBoss.com for more information and help on anxiety.