Dan’s Top 10 Stress and Anxiety Book Picks

There’s a wonderful piece in todays New York Times MagazineThe Manic in Me: If I Couldn’t Conquer my Anxiety, the Least I Could do was Understand It by Daniel Smith.  He writes:

“There are two types of anxiety sufferers: stiflers and chaotics. Stiflers are those who work on the principle that if they hold as still, silent and clenched as possible, they will be able to cut the anxiety off from its energy sources, the way you cinch off the valve from a radiator.  Chaotics, by contrast, work on no principle whatsoever.  Although chaotics are sometimes stiflers when alone, when they are around other people, and especially intense interpersonal situations, they are brought into a state of such high psychological pressure that all the valves pipes open of their own accord, everything is released in a geyser of physicality and verbiage, and what you get is a kind of shimmery, barely stable equilibrium between internal and external states, like in those rudimentary cartoons where the outlines of the characters continuously squiggle and undulate”.

Smith captures some of the panicked nature of anxiety sufferers.  But he’s not describing the anxiety that’s a normal part of life.   Anxiety can even be useful when it alerts us to danger. But for some people, anxiety is a persistent problem that interferes with daily activities – – just as depression does – – such as work, school or sleep. This type of anxiety can disrupt relationships and enjoyment of life, and over time it can lead to serious health concerns and other problems.

Scientists know there is a high degree of comorbidity (i.e. the presence of a disease in addition to the primary disease) with anxiety and depression:  up to 60% of patients whose primary diagnosis is anxiety also suffer from depression and vice versa.  Check out my earlier blog, How Stress and Anxiety Become Depression.

All this being said, and without further adieu, here are my top 10 picks. Feel free to suggest your own.

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.

Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do? In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.

This book is a primer about stress, stress-related disease, and the mechanisms of coping with stress. How is it that our bodies can adapt to some stressful emergencies, while other ones make us sick? Why are some of us especially vulnerable to stress-related diseases and what does that have to do with our personalities?”

Sapolsky, a neuroscientist, concludes with a hopeful chapter, titled “Managing Stress.” Although he doesn’t subscribe to the school of thought that hope cures all disease, Sapolsky highlights the studies that suggest we do have some control over stress-related ailments, based on how we perceive the stress and the kinds of social support we have.  Watch this fantastic National Geographic Documentary featuring Dr.Sapolsky explaining Stress and Anxiety.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness – John Kabat-Zinn, M.D.

As a busy lawyer, I was immediately attracted to the title Full Catastrophe Living. It literally leapt of the bookshelf and cracked me on the head.  Who doesn’t live a life so jammed with stuff to do that it feels like a catastrophe?

Chronic stress saps our energy, undermining our health, and making us more vulnerable to anxiety, depression, and disease.  The heart of the book is based on Kabat-Zinn’s renowned mindfulness-based stress reduction program at the University at Massachusetts Medical Center.  Check out this video clip of Dr. Kabat-Zinn.  The author takes the phrase “full catastrophe living” from book and movie Zorba the Greek.  If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town.  To help him restore it, he hires  a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”

The Mindful Way through Anxiety: Break Free From Chronic Worry and Reclaim Your Life – Susan M. Orsillo, Ph.D.

Anxiety isn’t the same thing as stress. You can’t just “get over” anxiety. In fact, the very things most people do to try to feel better–avoiding feared situations, pushing worry out of mind–only make the problem worse. This book presents a powerful new alternative that can help you break free of anxiety by fundamentally changing how you relate to it. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, seems like it is everywhere these days and being offered as a solution to much of the mental distress that ails modern society.  Yet, in my own limited experience, it is worthy of such attention because it works.

Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness – Richard O’Connor, Ph.D.

Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression.   This was the first book I read that made clear to me the connection between stress, anxiety and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry.  This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating.  If you’re looking for a quick read and pick-me-up, this isn’t it.  Read the Book Review.

The 10 Best-Ever Anxiety Management Techniques – Margaret Wehrenberg, Ph.D.

Medication, once considered the treatment of choice, is losing favor as more and more sufferers complain of unpleasant side effects and its temporary, quick-fix nature. Now, thanks to a flood of fresh neurobiology research and insights into the anatomy of the anxious brain, effective, practical strategies have emerged allowing us to manage day-to-day anxiety on our own without medication. Addressing physical, emotional, and behavioral symptoms, Margaret Wehrenberg, Ph.D., a leading mental health clinician, draws on basic brain science to highlight the top ten anxiety-defeating tips. Everything from breathing techniques to cognitive control and self-talk are included.   I really like that the 10 chapters are highly readable and short. Dr. Wehrenberg is also a frequent blogger at the Psychology Today website.  Here’s one of her blogs, The One-Two Punch of Negativity and Fear.

Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety – Troy DuFrene

This book approaches the problem of anxiety a little differently than most. Instead of trying to help you overcome or reduce feelings of anxiety, it will help you climb inside these feelings, sit in that place, and see what it would be like to have anxiety and still make room in your life to breathe and rest and live, really and truly live, in a way that matters to you.  This approach is based upon a research-supported form of psychotherapy called Acceptance and Commitment Therapy, also known as ACT which starts with the assumption that the normal condition of human existence is suffering and struggle, ACT works by first encouraging individuals to accept their lives as they are in the here and now. This acceptance is an antidote to the problem of avoidance, which ACT views as among the greatest risk factors for unnecessary suffering and poor mental health

Get Out of Your Mind and Into Your Life – Steven C. Hayes

This is another book that uses the ACT approach. It’s different than the book above because it offers a five-step plan for coping with painful emotions such as anxiety and depression.  How I love plans!  I also liked the wisdom contained here: the recognition that painful feelings cannot be controlled will open you to the possibility of fully emotional living.  When anxiety arises in our bodies and minds, we erroneously believe that we have the power to rein these in, stop them and thus effectively eliminate it.  However, this approach only leads us further down into the well of panic.  Anxiety is not the problem.  It is our attempts to squash and control it that strengthen anxiety and prevent us from coping with it effectively.  Learn what steps you can take to approach anxiety differently.

The Worry Cure – Robert L. Leahy

For “highly worried people,” or those who suffer from the “what-if disease,” this book presents a systematic, accessible self-help guide to gaining control over debilitating anxiety. Leahy is an expert in changing thought processes, and he walks worriers step-by-step through problems in the way they think, with pointers on how to change these biases. The author then outlines a seven-step worry-reduction plan (remember, I love plans!) beginning with identifying productive and unproductive worry, progressing to improving skills for accepting reality, challenging worried thinking and learning to harness unpleasant emotions such as fear or anger.

The Anxiety and Worry Workbook – David A. Clark, Ph.D.

Like many of the other books I’ve recommended, this one is also grounded in cognitive behavior therapy.

I like this book because included in it are carefully crafted worksheets, exercises, and examples that reflect the authors’ decades of experience helping people who really, really struggle with anxiety. Learn practical strategies for identifying your anxiety triggers, challenging the thoughts and beliefs that lead to distress, safely facing the situations you fear, and truly loosening anxiety’s grip–one manageable step at a time.  Like depression, coping effectively with anxiety involves learning  helpful new and constructive ways of thinking about the problems we all face.  So often, it isn’t the reality of a situation that makes us anxious, but the stories we tell ourselves about the events that happen moment-to-moment.  

Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.

This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality.  So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement and affirmation.  Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons.  This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.

Healing Anxiety and Depression — Daniel Amen, M.D.

Dr. Amen is a true pioneer in uncovering the connections between the brain and behavior.  In this excellent book, he provides an overview of how the brain works and how medication, diet, supplements, exercise and social and therapeutic support can help anxiety.  Check out this video clip of Dr. Amen talking about his comprehensive approach. As science’s understanding of how anxiety and depression work has grown, there is an emerging picture that both of these conditions are “whole body” problems that demand whole body solutions.  Like depression, we can’t just take a pill.  Rather, we need to look at every aspect of our lives so that we can address anxiety on multiple levels.





Lawyers and Anxiety — The Fault of the Person, the field or law school?

I have a friend named Matt. He was one of the most popular students at my high school. A bit of a nerd, he was excellent at basketball, good enough at football, and not too bad with the ladies. He and our group of mutual friends would go out regularly, getting into shenanigans and living it up like young people are supposed to live.

As we got older, not much changed. While our shenanigans matured, we were still a group of outgoing companions that found ways to make life more enjoyable while still remaining as responsible as possible. We were the ideal – outgoing people with adult lives who continued to enjoy each other’s company.

Then Matt got into law school.

During law school he suffered from some general life stresses. His mother was diagnosed with cancer, and he and his girlfriend had their ups and downs. It was hard on him, certainly, but his mother was getting treatment and he and his girlfriend were still together, so it seems like something the average emotionally healthy person would cope with.

But he couldn’t because law school didn’t allow him to. His first year was brutal, without even the smallest break for some type of school/life balance. He was placed into a law student group in which he spent the vast majority of his time. He had no social life, he had no free time, and he certainly didn’t have the opportunity to cope with the stress he was experiencing in his personal life.

Not long after that he became a different person. He became socially withdrawn, “flaky,” and took to drinking. He was past the age when most people suffer from major personality changes and yet there he was, becoming a different person right in front of me, with very little I could do as most of his time was still spent on his law degree.

Learning to Cope in Law School

There’s an excellent article on this website about the personality of lawyers. In it, the author found that lawyers tended to be more naturally pessimistic, and that the practice itself often contributed to their depression and anxiety.

But I submit that law schools are also creating students that haven’t had an opportunity to learn to cope with the stresses of both the job and life. Many of them appear to be cutting their students off from the outside world – and even from fellow law students – and breeding young lawyers that haven’t had an opportunity to take a breath for several years.

Once they graduate, many of these students will be defending hardened criminals, helping companies dodge taxes, or even burying their faces in paperwork as they try to help companies and individuals avoid prosecution or take advantage of legal loopholes. Some of them will win their cases. Others will lose, often. It’s a lot of high stress work.

And yet few of these students will have had an opportunity to relax or cope since their first year of law school. These high stress students are being thrown into high stress careers, and the one payoff (money) isn’t enough to make up for what they’re being forced to experience.

The career is to blame for a lot of this stress. It’s a career that is prone to numerous failures, and one that expects a great deal of anyone that chooses to pursue it. But the universities that are training these students are also to blame. They’re preventing their students from coping with their daily life, only to throw them into a career with greater stress and no coping strategies.

Law schools need to start taking mental health into far greater consideration with all of their programs. The intensity of each program is believed to be valuable to training future leaders in the field of law, but if 20% of those lawyers are suffering from severe anxiety and depression, these programs have failed, as all they’ve created is another individual suffering from stress in their life. This needs to change.

About the Author: Ryan Rivera is an author and speaker on anxiety and depression, and often meets with lawyers whose jobs are the leadingcause of anxiety. He has more information on anxiety and depression at www.calmclinic.com.


My Desk, My Enemy: 6 Helpful Ways to Get Organized

I spend time – too much it – trying to keep my desk in check.

Like a taciturn child, it erupts with tantrums of disorganization. The fact that it’s a mess today seems unfair, as if a hole suddenly formed in the ceiling above me and dropped a cache of briefs, case opinions and half-used legal pads onto my workspace.

I shuffle the papers that lay before me. They look back at me.  Ten minutes go by.  I reshuffle everything all over again. Sound familiar?

Mind you, on the Clutter-o-Scale, my desk is only a 4 out of 10.  If so, why the grief?

Some of my angst comes from having trouble finding things.  But an equal measure comes from the sense that I should be more organized. We have made a religion out of organization in this country which has sprouted temples of crazed worship like The Container Store or Organize.com.  Maybe this growth industry is in reaction to how much stuff/junk/information we like or have to obtain and perpetually reorganize.  This mania has even spawned an inane reality T.V. show “Hoarders.”

Too many things compete for lawyers’ attention besides the usual culprits of returning phone calls, court appearances and last minute deadlines.  When you add a messy desk to an already stressed-out life, well, it becomes the enemy.

Desks are the pedestals of our productivity.  How we organize the stuff on them has a big effect on how well or if we get things done in a timely fashion.  But just as important as these practical concerns is the impact it has on our mental health.

What is your Organizational Style?

According to Kelly Lynn Anders in her book The Organized Lawyer, “Not everyone prioritizes about what the eye needs to feel relaxed. Some ideas work for some and not for others. That’s why it’s important to know your type.” She identifies four types of organizers:

Stackers organize by topic in stacks. They are visual and tactile and like to give the appearance of order. The busier these people are, the more stacks they have.

Spreaders are visual like stackers, but must be able to see everything they’re working on.

Free Spirits keep very few personal belongings around the work area. They like new ideas and keep reports, books, articles and magazines near.

Pack Rats have emotional ties to things. They like the feeling of fullness around them and like to tell stories about what’s in the office.

Which type are you?  She has a lot of useful suggestions, among them is color coding files. On her own desk, she keeps commonly used files close at hand. Because she identifies herself as a “stacker,” Anders avoids cabinets and other hidden spaces for her files.  “The reason I don’t have a lot of hidden storage is stackers have a tendency to squirrel things away,” she said. Check out some of her other suggestions at her website.

A Contrarian Point of View

Einstein considered his cluttered desk a help rather than a hindrance to his prodigious creativity.

While we don’t have his brain’s elephantine computing power, it’s worth considering that your desk mess might not be so bad after all.

Dr. Jay Brand, a psychology professor, argues that a squeaky clean desk doesn’t always equate with a productive employee. It can actually hinder personal efficiency because a person’s desk is an extension of his/her mind. That’s because our human memory has a limited capacity, or finite ‘cells’ available for storage and since most people do multiple things at once they almost immediately ramp their working memory to capacity. They need a place to park some of the information from their working memory into the environment and what more logical place than their desks?

According to Dr. Brand, “these cluttered desks that people use to store information from their working memory are called ‘cognitive artifacts’, and they expand a person’s capacity to think and utilize the environment”. He argues that companies with clean desk policies waste time by requiring workers to clean up their cognitive artifacts every night and re-clutter them the next morning. He points out that everyone has a different working style and piles can be organized topically, chronologically, or according to an individual system. As long as the pile means something to the person who made it, it is effective.

I’ve known plenty lawyers in this group.  But I ain’t one of them.  Maybe it has to do with my own depression over the years.  Or, as Kelly Anders suggests, it’s just my type that determines how I lay out the work space in front of me.

The Depressed Desk

When a lawyer has depression, motivation and organization are BIG problems.  A lack of energy blunts motivation.  We already know that it’s a good idea to keep our desk together, but there simply isn’t much neurochemical juice to get it done.    But, time or a court’s scheduling order waits for no one.  If we don’t keep the paperwork on the conveyor moving, we end up a casualty of our work days and add to the stress/anxiety/depression mix.

In her book Get it Done When You’re Depressed, Julie Fast writes:

“Many people equate depression with the inability to work. In reality, the problem is often the inability to feel like working.  People who are depressed assume that their lack of motivation is a sign of weakness, and if they could just buck up a bit, they would be more productive. But waiting until you feel like doing something is the single biggest mistake you can make when you’re depressed and need to get things done.”

Yes, we need to start working in spite of our desire not to.  Dr. John Preston, in the same book, elaborates further:

“Depressed people find it very hard to ignite this self-generated action due, in large part, to decreased metabolic functioning in the frontal lobes of their brain, which are responsible for initiating behavior.  So if a person waits a long time and not only not accomplish the non-rewarding tasks but also miss out on the big projects that can bring big rewards.”

So it appears that folks who aren’t depressed and are motivated people have ramped up brain metabolism.  I’m envious.  Yet, there is something we can do about it.  As I’ve written about before, consistent exercise helps boost the happy chemicals in our brains, jacks up metabolism and improves our motivation and focus.  Moving is motivating.

We must outfox depression.  It would have us do nothing.  So we must do something.   When I apply this simple wisdom to my day, I’m always pleasantly surprised at how my feelings catch up with my doing and how my doing affects my feelings.

My experience during bogged down moods, was that I’d get most things done, but it would take lots of energy.  When I’d come home from work, I’d be spent.

Six Simple Solutions

I agree with an observation made by Leo Babauta on his blog Zen Habits: “The most important thing to remember is that you must have a system in place, and you must teach yourself to follow the system.  Otherwise, you just clean your desk, and it gets messy again”.

Here are a couple of tried and true tips that have helped me:

1.   Get rid of all those pens. Only keep three or four.  More than that, and there’s too much ink in your work space.  If you love pen, keep your stash at home.  I often troll the pen aisle at Office Max — strange, but true. So I know how difficult it is to part with them.

2.   Take home any books that you don’t use on a regular basis. It’s just more clutter and keeps you from easily putting your hands on the important stuff you need to do your job.

3.   Hide cords – these are like a floating octopi with tenticles that seemingly go everywhere.  Use twist-ties or coil your cords up.

4.   Only keep on your desk what you need for that day. Then section off your desk and workspace so that everything has a specific space.

5.   Have a dump day.  Take everything off your desk and out of your drawer and then put it in a big pile. Then, sort through what is garbage and what you really need throughout the workday.

6.   Schedule a date and time to clean your desk.  Ideally, at the end of a workday.  Weather permitting, do it on Friday’s around 4 so that I start my Monday fresh.

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