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How to Deal With Anxiety

Neeta Hillman
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Neeta Hillman is a wife of 7 years to her beloved, Jim. Her burden has been to empower people with God's plan for physical and spiritual restoration, in the context of their individual culture. She is board certified in Internal Medicine and worked in the NEWSTART program at Weimar for 3.5 years then at Wildwood Lifestyle Center for 9 months. She currently works as a part time hospitalist while traveling overseas and locally in mission outreach. 

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  • June 18, 2015
    4:30 PM
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This topic specifically tonight is one that's actually pretty dear to my heart upon anxiety and dealing with things I had and and what are the what are the studies behind it some of them you've seen already and we're just going to kind of combine some of what we've talked about with some of the other data and I apologize. I just recently went from A to Shiva to a mac computer and not all of my presentations are compatible I guess between Powerpoint and keynote but so I posted that I have a little chance but I am happy to send you the the Powerpoint version of my anxiety notes if you if you want them if you just let me know but then why don't we go ahead and start with a word of prayer then Father in heaven. We just want to thank you again so much for the privilege of being able to come together to work together to learn together. We thank you for the abundance of information that you've given to us to teach us to help us to grow with and I pray that as we touch upon this issue of anxiety there's a lot that you have this say concerning that. And I pray that you teach us how to be able to take what we learn and put it into practice. And I pray that we would be able to maybe even encourage others that struggle with this is because there are many more out there than we realize that struggle with the issue of anxiety and I just pray again. May your words be lifted up in your principles be lifted up in Jesus' name we pray him and anxiety why why picking this this topic recently over the last two years. I've seen an increasing number of patients professionals they're working professionals who have become the ability to buy citee and it's interesting Leah working professionals especially those in ministry been doing ministry for a long period of time that are really significantly impacted by anxiety. More so women than men but that's mainly by diagnosis. I don't know if the prevalence because one of the questions is whether the prevalence may actually be a little higher in men than it is in women but definitely more so in women. What really bothered me was seeing women who had accomplished quite a bit in life for a long time but just all of a sudden it seemed like like they could not function because of severe anxiety. You kept wondering what is the common denominator in going back and reviewing charts and looking at things trying to figure out I don't understand these are people these are people people with strong faith like this in church reading the Bible praying I mean from what they've they've told me people who are eating plant based diet. What is it that is the difference. I'll tell you some interesting things are going to start with some of the lifestyle issues. There are there are two. There are three in particular common denominators that I found in every single one of the charts of my women who were struggling with anxiety. Now among the men that I had in the charts in the last four years among men and two of these apply to a little bit more so than than two that among women but the number one can anyone think of the number one lifestyle factor that across the board men and women struggle with that contributed to increased anxiety or inability to deal with. Yes yes yes. This is the biggest denominator and I'm talking about. Tell you you know this then. Last week I saw a university professor who had come after years of treatment for anxiety. OK intelligent brilliant woman able to do. I mean has been able to do so many projects finished her Ph to be accomplished quite a bit and all a sudden now she's paralyzed and can't function in what used to be so active in ministry and just gone done just everything worries and become to become very anxious in the process. But consistently I asked her you know it's funny because you know you went through everything and you're doing the plan doing everything he's thanking me and in this you know what on earth is going on and they look on there. When I asked her how much exercise is she doing. Because I asked two questions. It's important to be able to recognize cause to effect right because anxiety severe anxiety oftentimes is associated with depression also there's they can be a lack of motivation with that and so and it's not motivation because they just are lazy per se but that the just the depressed level the third one especially in the brain does that lead you to plan ahead and to move in to do things just isn't there and you know I'm it's two questions that I ask one are you consistently exercising are what is your exercise routine right now but two when you last remember being able to be functional How much did you exercise and what I find consistently is that people either were you know used to exercise they may have had a lot of stressors growing up during the time that they were doing or P.P.T. and some of these other things you know prior to that they were exercising consistently but then whenever they became got more intensely involved in ministry or in business process or whatever it was exercise diminished and maybe sometimes that it could have been underlying before from other things we're going to talk about. Really became more profound when they when their exercise dropped and this is actually one of the things that more consistently and I wish I wish I could show you some of the data though there from it but. One of the one of the things that we know about exercise exercise we mentioned increases beta endorphins rate that's one of your moody or feel good hormones. So one of the other things that exercise does is it improves the efficiency of your neurotransmitters. OK the officially especially the availability of your nerve transmitters such as their opponent and and dopamine. OK. The ability to to be able to sense pleasure and satisfaction especially long term. That's one thing but remember we talked about exercise and that interesting little thing molecule called B.D.N.F. brain the right of nurture OPEC's factor your ability to learn and unlearnt certain things we're going to talk about cognitive behavioral therapy a little bit towards the end but one of the challenges that we found is that when people are not exercising regularly regularly and they're trying to fix issues especially with the thought processes that come with anxiety it is very very difficult for them to do so because of the decreased elasticities of the brain to be able to rely on learn and we learn some of the behaviors of the past. So extra exercise is one of the things that is very very critical. The other reason exercise makes a big difference we believe because this improves circulation especially to the frontal lobe. And what we found is that in again interval training is a one of those things that maximizes an improved circulation to the frontal lobe of our brain the one that allows the executively plan and to look at information in a. In a in an inappropriate or in a. I guess consistent and in a more realistic picture. OK. Whenever we when I talk to patients about the lifestyle aspects concerning anxiety many times I'll think one you know will want to deal with the thought that we do need with a media life a program with anxiety. You need to deal with the pot aspect of it also in order to talk about cognitive behavioral therapy just a bit. But one of the things that has helped us and why does lifestyle make a difference the way I look at it is this. You're trying to fight and combat a disease you want everything in your arsenal every tool you can to be able to maximize your ability to deal with that issue in a problem while the thought may be that one of the main underlying issues anything that inhibits your ability to be able to improve your mood. Anything that inhibits your health in general is going to increase your anxiety long term because one of the things that actually we find more consistently people is because anxiety in general but there's also helpings I.T. they have health issues that have come up and now they're not able to do as much as they did before. And it becomes very frustrating and challenging for them as they're able to incorporate lifestyle factors in one at a time and their health improves the anxiety also starts to improve and one factor contributing to the anxiety starts to be able to be taken care of which is this their overall health an improvement. The exercise is one of those things. So we mentioned exercise what is the number two and I think I found I get in this one I'm not. We know that it's exaggerated in the data but as far as the numbers this is just one thing that I've consistently seen over the last four years. Sun and sunshine does affect it will talk about sunshine in a bit but but more consistently than that. Water water intake you know I never believed or understood. I mean I knew water was important but such a simple molecule such a simple molecule and what they found at this there are vast numbers of studies that are done concerning water and mood. Something as simple let me mention that the initial studies that were done concerning mood and exercise were done in athletes and soldiers. OK. People are aggressively active and of course they have them in more confined that you ations where they could measure water loss temperature and temperature raising in their body. I was such things but one of the things that they found of this as little as a one to two percent. The hydration as little as a one hundred two percent dehydration and people reported when they were at when they had to do any kind of tasks that are quite a little bit more thinking or a task that would require them to resist something that they couldn't otherwise they were significantly more felt more confused agitated irritated and then shows if they had one to two percent the adoration if instead they would hydrate then and then have them is the one thing they will first be hydrate them have them do the task then they'll rehydrate them and then repeat the task that they began to feel actually more refresh and able to face the task again without much difficulty and it was just. Replacing literally one to two percent improvement in volume. Ok water. How simple that is. I'm telling you you know one of the interesting things that they found is that they would take they would take students who were faced with with an exam or with something that the testers know that they had they had to complete and they looked again at the hydration status they were more likely to make mistakes and become very frustrated at the mistakes and then make further mistakes repeatedly on during those exams. If they were again the hydrated ones they rehydrated them again you would see the improvement they would report a subjective improvement but then there would be an objective improvement also in being able to focus and to be able to look at the situation differently. Please do not under underestimate the effectiveness of something as simple as staying well hydrated and for whatever reason and when I would look at the charts of my patients especially the women this is the one that was a little bit more consistent among the women more so than the men but when I would consistently look at the charts many of them were drinking at the most maybe three ounce glasses of water a day consistently on a good day they would maybe hit about four to six but that was rare pretty rare that they would do that they would be hydrate and they'd start another day and then and then it would worsen. OK So hydration whether the other lifestyle factors that came into play. What was the third lifestyle factor that seemed to worsen anxiety and this one of one of those chicken and egg things that unfortunately go back and forth one worse than the other which wars and the other that yours and the other. Yes yes. Leap is a person was not able to get consistent regular efficient sleep. Their levels of anxiety to be to deal with stress are to signal significantly decline. This was found actually even with them with it. Among those that were done with the residents and in medical residents in residency and also even medical students during periods of sleep deprivation inability to be able to to deal with stressors when on rounds or in team rounds or in dealing with issues with patients. If they were sleep deprived post call vs after they'd had a weep and then had been able to come back and be restored after after sleep. But here's the thing you know we talked about hydration and how do you know how to hydrate before we talked about exercise. What of this what are the things that need to be put into place to be able to manage sleep appropriately. How many of you have heard of something called sleep hygiene. Yeah like I once did that what is sleep hygiene said bathing before my sleep. I like actually you know that's like that the thought I was a bit bad but we've hygiene sleep hygiene specifically is talking about the activities that we do surrounding our sleep and during our sleep. OK so this means that the consistency of getting to bed on time at a regular time every night and waking up at the same time every day was one significant factor in being able to help a person who is dealing with sleep regularly. We as much as possible. Even if the sleep was interrupted if they could consistently get to bed at the same time around the same time no more than thirty minutes off of their regular time they were able to do or function get their more efficiency out of their sleep. OK What was the other thing that we mentioned that improves efficiency of sleep. We had just talked about it. Exercise rate hundred fifty minutes of exercise regularly a week OK in the aerobic moderate to vigorous range with significantly improved sleep again and non-pharmaceutical alternative is the way the National Sleep Foundation described it. People consistently regularly exercise their quality and quantity of sleep significantly improve. Other things that helped. We talked about this in the nutrition aspect. That late night meal. If the last meal of the evening is a very light meal. Keeping it very simple as much as possible. Three hours before you actually go to sleep again your quality of sleep is much improved you know with our patients who are struggling with sleep. Often I will recommend for them to be on a two meal a day plan at least for a short period of time while they're trying to get their sleep back into back into gear and what they find is this their sleep actually significantly improve their quality of sleep initially. Many of them are worried that they're going to wake up hungry. But the interesting thing is they're actually able to sleep through the night consistently specially if they can even if they eat an evening meal but keep it very light for the duration of time until sleep actually makes a difference to other aspects of sleep hygiene. OK The bed is only first sleeping. OK One other thing that will leave that one alone. That is a homely first sleeping OK. That means you don't work in bed. You don't read in bed. You don't have the T.V. on in bed. You don't sit and worry about the day in bed it is only for sleeping. The bed is also not for staying awake wondering why you're not sleeping. What does that mean. What that practically means and sleep hygiene is a part with somebody is dealing with anxiety. We really go into sleep heighten and detail meaning that if they have not been able to fall asleep for Rossley we would say about twenty minutes away and we're going to talk about the alarm of the time and looking at the clock. But if they're not able to fall asleep within about twenty minutes they cannot stay in the bed. Patients that practice good sleep hygiene do significantly better than those who would sit there in the bed worried and wondering because let me tell you anxieties start to have to actually worsen as they come to think about getting back in the bed. Even just the thought of fear of seeing the bed starts to get them anxious as they worry about not sleeping. So again once you get into the bed here here's the other thing. Part of sleep hygiene is not looking at the clock at all. How many of you usually pretty much know what time you get the bed every night. Right. Ideally if you're struggling with sleep you don't want to look at the clock once you're headed to bed. You don't look at the clock again. Even if you know that it's late. All that doesn't increase the anxiety of Oh my goodness I was wanting to get to bed at nine thirty tonight and it's a lot. And o'clock at night you know one of the most consistent things we find people struggling with sleep if they know what the time is one when they go to bed if they know what the time is when they when they are not falling asleep if they know what the time is when they waken from sleep in the middle of the night. They get more anxious if it is if they are say they haven't slept they haven't fallen asleep they haven't slept and they and it's they they went to bed at ten o'clock and now it is twelve o'clock. OK It's twelve o'clock and they haven't fallen asleep. They look at the clock Oh my goodness it's twelve o'clock. What are they start to get worried about. I've been in bed for two hours and I haven't fallen asleep and they start to get worried and anxious thoughts are usually the thing that will keep them from falling asleep through the night. What if they've been able to sleep that they have what is often associated with more with depression and anxiety and depression concurrently with early morning awakenings. I always mention the patients you should I I ought not to tell him to be or not to look at the clock at all through the night away the next day I'll ask them how did you sleep. Oh I woke up and they what time did you wake up. Oh about two o'clock and I left them I did you know questioning you should not know you should not look at the clock set an alarm that five alarms if you have to set five alarms but set the alarm such that you do not no matter what you do not look at the clock. If you are if you have not fallen asleep yet OK once you get into bed and you are in bed you haven't fallen asleep. You say you need to lie and still after trying to position and lie is still a possible one of the worst things for someone who is not falling asleep well is slipping back and forth back and forth in bed. It will do more to agitate and worsen belief if they do that. I encourage humans again is that they pick a position and try to lay as still as possible. After you've taken care of these issues of sleep hygiene grade your You're going to bed at the same time waking up at the same time and part of sleep hygiene interestingly is a consistency and regularity of the time you eat. What we've actually found is for people who work night shifts if they can maintain as relatively close to the same times that they eat when they're not on the night shift they actually do better and if they shift everything around just to fit the fit the night shift meaning that when they come off the night shift if they actually eat breakfast at that time. Wait about an hour and then actually go to sleep and then and then wake up and have their second meal before they go to work without eating anything else. During the work time they'll actually do a function a lot better be able to have a more regular pattern of sleep when they come back to when they go back to their they time when they're not on their night schedule. So once you're doing all that you're eating regularly you're going to bed at the same time waking at the same time you're not looking at the clock. You're using the bed only for sleep for nothing else. The next thing to keep in mind is like OK life on. We thought you mentioned sunlight sunlight. Take the trip to found that we consume in our diet and converts it from trip to fantasy or tone and daytime light does that they time light will increase that then nighttime darkness converts that their tone in to melatonin melatonin event pulsed out of the pineal gland in a rhythmic fashion that peaks toward the middle of the night. And we can. It is very difficult for people to mimic that in a medication you just cannot get the same effect that you do if you get it naturally if you have lights on and we're talking about lights from an incandescent bulb if you're talking about lights from the T.V. from an i Pad from a fold from whatever it is for in it depends on your circadian rhythm it's somewhere I have to look and gauge when that is roughly from about eight thirty to ten o'clock sometime in that period of range. Everybody has a little bit different. If you have the lights on after that period of time where is that. That's a gator than it is for up to forty five minutes past that time. You have the police your melatonin levels by fifty percent or fifty percent. It's hard when we're a society constantly engaged in everything that we're doing and to be able to put that aside about an hour or two hours before bedtime. And sadly getting that light out you don't want to deplete the the tone and that you had just made in conversion from the sun in your body. OK consistency and regularity of sleep. What about anxious thoughts and sleep. Sometimes people cannot sleep because they're constantly thinking this is I mean this is a very common very very very common thing to happen. Interestingly those who exercise regularly and stay active throughout the day are less likely to suffer from constant thoughts throughout the night. We don't know the path of their own. Or the in the mechanism behind that when things that have again found as a consistency in regularity that is just what it would help with out with preventing those anxious repeated repetitive thoughts. Part of the reason may be because there's more fish and they're able to fall asleep faster they can't worry about things longer that could be a possible mechanism of action. One of the things that I found is to is to write down whatever it is that you are thinking about the keeping a notepad and a paper beside the bed and whatever it is it is wearing you see a thing that you need to do things you're worried about forgetting. If there are things that you've got to take care of it's writing down those things that you have that you're consistently worrying about once you've written them down. The next thing to do is to encourage a person to pray about them and this is where I'm going to tie in both both cognitive behavioral therapy with sleep together for for anxiety. For the life of me I could not understand I remember sitting there and thinking there were two verses in the Bible that really really bothered me especially when it came to helping my patients with dealing with anxiety because it almost looks like a mockery in their faith and I did not know how to be able to help them with it. Can anyone guess what those two verses were in the Bible. Oh no no no that's not I'm sure you're approaching seventy cents or something. Actually that's what that is the one that was better but there were those that was instruction to not worry. But but there was there were two in particular that bothered me because there was a promise concerning these if you do have it. We had a Bible if you have an i Pad or whatnot one of them was actually Isaiah twenty six verse three. And some of you probably have memorized if you know this one very well. They had twenty six verse three. Twenty six and verse three. He will keep him in perfect peace whose mind is stayed on the because he trusts in the. I have prayed that prayer for my patience. So many times and I'm sitting there and I'm thinking either God is a liar in the Bible or something is not going on right now with how I am instructing and helping my patient. I don't know what to do because according to this verse it says you were keep him in perfect peace whose mind is stayed on the because he trusts in the. It didn't even say you know there will be more peaceful. They will be a little less anxious. It actually says perfect peace. It is very difficult to be in perfect peace and have constant consistent anxious thought what. Where did the two of them collide and I did not know what to do with the other verse I actually was in Philippians and if you're going to or if you're going to Philippians four verse six. Some of you might have a version there if you have a King James and so be careful for nothing but it's the audience for verse six. Some of you if you are looking to be careful for nothing in other versions it says Do not be anxious about anything you do NOT being. It's about anything her be careful for nothing but in everything by prayer and petition or supplication depending on your translation. With thanksgiving let your no request be made known to God and the peace of God which passes all understanding. Will keep your hearts and your minds through Christ Jesus. Why did those two verses frustrate me. There are lots of hours of the talked about not being anxious and keep your peace that those to the physically said Don't be anxious. And there was a promise of peace that was associated with it but I couldn't seem to I didn't know how to help my patients get to that point. It wasn't until I started talking to my patients and I thought OK I've got to follow them around because you know it was so challenging for me to encourage patients I would give them promises to look at and I would ask them pray those promises and they would tell me. Dr Hillman you don't understand how many times I have prayed for peace and to not be anxious. And they got to the point where they're feeling like God is hearing their prayers. And then what is the point of praying and I don't want to pray and I don't believe the Bible anymore or maybe I am a bad person because these promises aren't coming and that's a very challenging the only There's a physician and trying to explain to somebody well look the Bible is not lying but I can tell you what's going on. So I started to do is to hang out with my patients. They get anxious lately started specifically praying and it's easier to do in a lifestyle program. Not as easy when you've got an outpatient to go with them but you know I thought what I would I would specifically pray for one thing I would pray that something would go wrong for them during the program and I would tell my patients at the beginning I'm not going to let you know I was going to pray that something should come it doesn't go right well you're the program hopefully it's not that. Program I went on the program every every or what not but are to go wrong for you but that even if it was another patient that's frustrating or something else that's frustrating for them. You know something from home but why would I print because I want to see their thought process as they were going through any difficult situation because I wanted to kind of understand what is happening when they approach the circumstance and situation and the interesting thing is that consistently when I would pray this prayer something would happen and no I didn't make it happen. OK something that would happen with a patient. And so I would tell them you need to let somebody know and immediately you know some to come and get me. When this happens well they would come and they would get me and then we would. Then I would sit with them and I'd say OK why don't you go through you know by the time I developed a bit of a report with them so it's not like with a weird person a sitting member they never met before sitting there and listening and watching them. So it's over walking we're talking and I and I ask them why don't you why don't we pray why don't we pray and turn this over to God will do exactly what it says in Philippians four verse six and seven that we're going to pray and we're going to ask God concerning the circumstance of the situation and we're going to do it with Thanksgiving so we're going to start by by listing things that we're thankful for where God has been faithful even if it's the same thing and that's all we can think about for a period of time. We're going to do that and then and then we're going to see what happens. OK here's the thing that I found would consistently happen at my patients after can. What can you tell me maybe some of you who have who tend to be more anxious about how you might personality with such struggles both depression and anxiety for quite a while. What usually happened after they prayed about the circumstance of the situation. What would be the first words out of their mouth usually after they prayed they would start talking about the problem back over again and how terrible it was and how difficult it was and then the interesting thing is you would find that they would not only tell me but then you would find them about five ten minutes later talking to another patient about the problem of the difficulty and then they would go and they would talk to one of the the lifeguard counsellors about the diet in the issue in the problem and they would repeatedly be mentioning and talking about the issue and the problem now. I am all for people to have one or two people with whom they can talk with and pray with concerning circumstances and situations that are going on with that one of the child as we consistently found with a patient that almost especially those of the most severe anxiety almost immediately after praying about the circumstance of the situation they would be worrying about that situation and they couldn't stop doing it. So now I'm stuck with a situation like OK so now now I'm can see what's happening but But what do you do about that. It's hard to not be anxious but by everything I turn to fission with thanksgiving present these requests and the peace that God has given to them would be given to then I would pass a law understanding go back to and actually during the time of prayer they actually felt a lot less anxious. I think immediately that within about two to three minutes later they would still feel pretty at peace. It was once I started talking about a problem again that they started to get anxious. OK Go back twenty six three with me OK and then we're going to grow and hold your place and so at the end of it. I they had twenty six verse three what Isaiah twenty six verse three says that I would keep in perfect peace. Who what is what is that next phrase say mind is. They'd be one of the key things that we found. This is actually something that is a learned behavior and that is to continually dwell on subjects and situations even after we've prayed and turned it over to God But the challenge was they didn't have something else to think about in that period of time so they would go back to doing with thinking about the problem again and then repeatedly talking concerning that the promise was this the person would be kept in perfect peace whose mind with They'd on God How easy is it to think on heavenly things and be worried about what you're worried about at the same time I can't think about two things at the same time I think I could multitask I don't even multi task that well but. But being able to keep the mind on Christ not let me show you something interesting because go back to the Philippines for verses six and seven I knew Philippians four vs six and seven I had memorized it multiple times. OK I was doing a a lecture on stress for some of my patients and I happened to go down to verse eight because when I was when I was doing a summer between my first and second year of medical corps done on the hundredth and someone to challenge me there to memorize the fourth chapter Philippians and all of a sudden I went through that next verse. What is the verse that immediately follows verse seven. I know it's very fate might have been a favor saved by somebody read for me the in the verse that says immediately follows verse eight. So at first I had to not be anxious about anything but by everything with prayer and petition present your requests or you know doing that with things giving a list of all the things things you're thankful for that your courage for. With God you have presented them to God You've asked them to take that they've laid before that cares for him get good good births per state. So the prescription was given to not think about. So don't be anxious about X. Y. and Z. whatever that circumstance may be and this is the exact same principle that Isaiah shared before right. They're not contradictory things. You're anxious about something you presented to God and then you give up their right to continue dwelling on that issue and that matter again. But the only way to I'm learned that is to do what follows next. So what I said you know you keep him in perfect peace of mind it's stayed on the is similar to that that thing in Philippians four Verse eight after telling us that the peace that passes understanding will keep our hearts and minds are crazy that tells us finally brother and whatever is true honest just pure lovely of good report if there be any virtue of any praise think on these things that has to be the next step that follows. So with my patience I added another thing to their prescription for the sleep if they started to have anxious. What they would write down the list of things that they were worried about whether they were it was with the things that they needed to do tomorrow things that they were worried about that were currently going on where it was the issue that I prayed about it would happen to me while they were there the program they would write that down they would actively pray about it and they would claim a promise from scripture concerning that. But it was not their own power that was going to fix the situation or the circumstance but they had to do a very next step immediately they needed to start to think about something else because what was happening is this we talked about brain the right nerve trophic factor for and this laying down of synopses. When we learnt to repeatedly go back to that thing it is a learned behavior that we reinforce over and over again in a thread that was redundant but we reinforce that behavior. Our thinking on those things that we worry about the funny thing is this it happens at a very young age and consistently with all of my patients. They would tell me you know what I've been doing this for a long time long before I even realize I struggled with severe anxiety. I tend to purse that way to worry about it I would tell my girlfriends about the problem I would call whoever would listen to me and I would I would tell you No I would I would call my parents I would tell them about it they would write about it I would read it and it's Oh my goodness. Nowadays with them with our with Facebook and Twitter and whatever you can not only tell your friend about you can tell five hundred other people about the problem and then whatever what then happens is that they respond to you and keep you thinking and Welling about the problem and going on over and over again you know and it was challenging because people think that what they're doing is being helpful by listening to us repeat that issue and that circumstance over and over again. Remember in these two verses what isn't pot is this one to be given the issue. Our mind has to be diverted to something else and not just something else that tells us this is what. So what are our MY needs to go through what is found of this consistently. Initially it is hard. Let me tell you how this occult it is. If you struggle with repeatedly anxious thoughts to choose to not dwell on that matter is a challenging thing very very challenging thing. But if you start to put in the habit of immediately choosing something else to think about it becomes more and more the strength the part you're strengthening the synapse that you start to strengthen is actually turning to something positive. But here's the thing. What we found is that if there is a work that is involved in trying to figure that out initially finding out that they need to think about because then I remember patients helping me. I think I don't know what I was supposed to think about was looking for other things to think about I don't know what to do if you know you have a tendency towards anxiety towards worrying about something over and over again this is where carrying scripture cards with you in your back pocket in your ear wherever you are. OK Because what you want to do is you want to take the element of having to think about what to think about. So that immediately the very next thing that you do is you have you pull out this you pull out that thoughts that certain that whatever it is and you start to think about it that verse that scripture that promise whatever it is. If you worry about this. Two ation maybe it is it is you know I had gotten all bit anxious last week with you know that I still struggle with anxiety and I have to work at doing it this is a behavior pattern I used to be a very positive person somewhere and I believe it was especially with the lack of sleep and lack of exercise during the years of residency. I turned into a very pessimistic person I remember distinctly people used to always say oh you're so positive you're third but recently a friend came to visit me and then my sister I'm not on Facebook very often and folks this should put a picture on there my sister said oh really funny. Someone posted that picture of you and they were they were talking about about you and you know about oh there's a someone back in college even talking about how well you know you used to always stay positive and one of my friends back in the beginning of medical school actually said oh how are things going how is how is life going with you. Oh but you know it's probably could be going in the dumps but you're always positive about it and I'm sitting there thinking wow there was a time when I used to actually stay positive and somehow that turned and let me tell you build lifestyle factors the things we eat the lack of exercise the lack of the water that we're taking in. They predispose our brain to not being able to dwell on positive things they predispose that and then once we continue to choose to dwell on the negative thing it becomes a habit and a pattern and it has to be a pattern that is on the line. My encouragement to you. You know I've looked for that magic pill that comes with anxiety you know the most consistent thing that I found and I seen people and I found that even consistently in myself I can't. Do anything about it. I can't fix the situation. I have tried for a long time to fix people and it just doesn't work. They don't want me to fix them. I have great ideas of how they can be fixed but they don't want to hear it and they're not going to turn her out of the race. So what happens when you are in a circumstance and a situation there are what we call in called the vehicle therapy distorted thoughts OK. Some things are easy to recognize of the sort of thought I'm ugly I'm stupid that I am. I miss your goal nothing good will ever come out of the situation. Some of those things are just very plain and blatant the sort of thoughts. But we don't recognize how in everyday life the way that we we tend to go toward the negative very quickly. We're late for work we come up to a stoplight and it turns red. And we think to ourselves. Every time I come to a stop light it always turns red never green. And the funny thing is that that attitude it seems like it's a small things of pop like mother to get a deal right. But we repeatedly do this over and over again what we find is that we end up actually. We end up actually repeating a pattern in the rest of our lives in the other things that are going on now it's a sort of there's a situation with a person because a Jewish network with a financial issue with whatever it may be. There's a consistency to think and to dwell on that problem and take it out of proportion to what it is what happens when a person really is doing something that is aggravating you that is not right. They are actively hurting you and you've tried. They help you try to talk them you've gone through the system you've gone through a maybe was it was on a co-worker you'd gone to the system. Talk to them talk the boss talk to whoever else to try to figure out to work out the situation and knowing where you think they are going to change you can change your job at the time. What are you going to do in that circumstance and in that situation. Often times when you've had a pattern of repeated consistent negative thoughts or dwelling on the thoughts the pattern the think is I am angry because they I am not doing well or are not able to succeed at doing something because he because she because the circumstance the situation and the question is in the midst of that are we able to look through the promises look through the things that are going on and to be able to say wait a second this isn't right. Lying would be saying Oh that's right it's OK for them to treat me badly. That's that's a distorted thinking of its own. Look at the situation a different way from Heaven's Light is a look at you know I don't know how the circumstance of the situation is going to work out. I know that God can work it out and I will do the things I know to do and trust and to take care of the situation and circumstance and to actively do that. The difference that it will make from day to day and with those well you know it's funny I was sharing with a patient you know in the intellect you were going through this and and the first thing they said was Well it's never going to work nothing has ever worked before and I told him I said look you don't know you haven't tried it. It's consistently going through this and real learning the pattern because the very thought the very easy thing to think about the pattern of thinking has been to look at the impossibility of that rather than looking at what can be done in the circumstances in the situations that are going. I'm with my patients a struggle with sleep want what I ask them to do with the start praying for people. OK During the time when they're having the anxious thoughts they're not allowed to think about the parts list are praying for people and they list every family member they can think about and they pray through that list and then if they can't think about any more family member than they prefer the for the staff on campus or they pray for the people of their church or they pray for whatever they consistently start to pray through the list. You know the interesting thing is that most people never make it through their entire lives before they're back to sleep again. And I've seen it consistently the ones who have not been able to put it through. Either one could just say oh I didn't want to bother with praying I want to really do that and I think the time that the interesting thing is when they consistently do it there they are huge. I have not yet had a person make it through their lists and the other thing that I encourage them to do is doing that is actually getting out of the bed and doing that if they've been in bed for a while when they're when they're struggling with it. My final thing that I wanted to share with you concerning anxiety over work is another one of those things taking on of responsibilities that are not your own to take on this is one thing that I find consistently happening with with people that struggle with anxiety. What is the thing that people oftentimes recommend to someone who has been struggling with anxiety if they've been taking on too much what are they normally recommend for them to do is to tell the Learn to say no but that they say that they don't want to take it to an extreme learn to say no. Just stop everything done do everything just say no you know just say no to everything you know and let me try something it actually doesn't work very well to do it that way. Well I encourage you to do instead is to look one of the reasons that oftentimes the God the math of having multiple things on our plate that we're not ours to handle. As someone once said not every need out there is mine to fix or meet. God hasn't called me to fix every person's problem that is out there. And oftentimes we find the solution in the sense that we we try to solve the problems for other people. Let me give you a very good example of my own recently that I think the after years of struggling with this finally getting some control of the situation I had to come in with planning and putting together the presentation for the and and last week there was a young lady who was getting married on the campus of getting married and I remembered what it was like preparing for a wedding and all the work that went into preparing for the wedding and all my goodness my poor husband I the number of those we tied on invitations and things I can't even remember we just were just how they were and I was sitting and thinking oh poor thing. All that work that she has to do. You know I should offer her my help notwithstanding that I had a new set of patients coming in and the first three days are always intense and late because we have to do our our initial intake and I knew that was coming up. I knew that I had the presentations this finished for this week and I. For it to put together one hundred fifty of her invitations. The interesting thing was that she even said Aren't you too busy to do that. She asked the question twice. I was like I don't know it's going to be so carefully Don't worry I'll take over it'll be a nice distraction away for a little bit to do something that doesn't require a lot of thought and thinking. I came to Saturday night and I thought I was going to pull my hair out if I put one more bamboo stick on a piece of paper and it was not that I didn't want to help but here's the thing I did not know how to prioritize and I found myself and I remember asking my husband how do I get myself into these things. And I remember because this is something that I've been struggling with for a long time is choosing priorities. One of the things that I would encourage if you're a person who tends to take on things that are not yours you see problems that you want to fix. Give yourself a minimum of twenty four hours before you offer help or commit to actually doing something. The interesting thing is that if you really need to do that usually the issue will still be around or someone else will have taken care of it. The head of time and they didn't need you to do that. What ends up happening is that the obligations to which you are committed that God is called You will suffer as a result of that and will end up making you more anxious in the situation in the circumstance. So here's the principle I wanted to take away. The principle is not to say no to everything. The principle is not even to say yes to everything. The principle is to take time and to ask God what are his priorities for you that day. Is this something he desires for you to actually take on. And even one of the things that I found I specifically asked God Can you please let there be a situation that is that that comes up because you help me it said to recognize that it's OK for things to not be fixed they weren't fixed long before I came into the picture and not the hero to save everything that he can manage that without my help and then manage those things that I do need to take care of help me man the things I need to take care of with excellence. Because the one thing you do not want to do is to be busy doing so many other things that you end up with using the word failing or not completing those things that you know that you are called to do. When you think on these things that are pure and good and true and virtuous I think that what is my ministry what it meant. What are your priorities for me and heard you as you do that. This is what it means to seek first when it said you know in those in the Matthew verse straight Matthew Don't worry about this don't worry about that don't do it and then it says to seek first the Kingdom of God This is what it meant when Martin Luther said that on the day that he was a busy had the most to do that he got up earlier to pray to find out what was God's priority in insufficiency for him those that were the most successful consistently unable to maintain despite the challenges. Life they spent and kept that communion time with God so that they knew as they went through the day to be able to look at situations and circumstances through God's eyes and you know what I've even found myself doing when someone comes and asks me for help and I'm staying there and feeling her ran like I can't hold my goodness I'm about to tell them no and making me or isn't and I'm just going to be I'll usually let them know you know I have a lot on my plate right now. I mean this isn't something I can take on but can we take a moment to pray together that God would help you find a solution concerning this sort of them and find some help for this. Interesting way to put them at ease puts me at ease and nine times out of ten God finds a solution that never involved me to begin with. With my patients that struggle with anxiety the most those are the things that seem to consistently hit them over and over again to be able to find those things that God has called you to be able to consistently exercise and take care of the things because that is one of the things recognize that taking care of your body is one of the things that God has prioritized for you. People oftentimes are worried about something it's funny they'll tell me I don't know what God's will for me is concerning the situation or the circumstance. And I'll ask them you don't know what to do in this situation or circumstance but are there things that you know you should be doing that you're not doing right now. Are you getting your sleep. Are you exercising regularly. Be faithful to the things you know you need to do and God will reveal those things that you don't know about in the time that he needs to reveal them. And he has never failed in doing. I thank you very much you have any questions at all any. Any thing that the issue of anxiety is something that is very it's quite it's pretty extensive but I'll tell you people that consistently put these things in their perspective and and continue to apply them consistently other things to help your brain increasing omega three fatty acids vitamin D. will help you also with being able to prime the function of your brain to have any other questions. All right here we end with a word of prayer. Father in heaven I just want to thank you so much for the privilege of being able to come before you. I thank you for the promises that are in Isaiah twenty six three and the promises in Philippians four versus six seven and eight. And I thank you that you didn't leave us in darkness concerning what to do when it came to anxious thoughts. I thank you for the victory through the repeated injunctions especially through Spirit of Prophecy and the Bible that have told us to keep our minds date on you to abide in you to spend time with you. I thank you that we are promised that the fruit of the Spirit includes peace and that fruit can be a big come out as we abide in you so I am asking you this for each person here including myself. Help us learn what it means to abide in you to take on your priorities your desires your will for our life that we may truly be in perfect peace because we trust in you. Thank you again for these things in Jesus' name. 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