Stellate Ganglion Block (SGB) can also be effective for non-PTSD anxiety
2020 has brought an onslaught of new stressors for all of us. Many of us are now feeling a form of chronic anxiety that I think of as “stealth anxiety.” Stealth anxiety is ever-present, but hard to pin down. It comes from a thousand little cuts and continual disruptions to the life we had prior to COVID-19. Rather than being caused by a “capital T” trauma, stealth anxiety is corrosive. It often impacts us outside of our own, and others’, awareness.
Here are a few examples of how “stealth anxiety” can operate.
Lasting changes in our landscape
- The changes I’m referring to include the loss of businesses we normally frequent. For some of us, a local coffee shop, fitness gym, or eatery was our “third place.” A “third place” is based on a concept developed by sociologist Ray Oldenberg who described this as the places that are neither home nor work, where people connect to exchange ideas and have a good time. Many of these “third places” in our lives have been closed for months or have gone out of business entirely. To be constantly reminded that we do not have access to places of comfort and social connection creates “stealth anxiety.”
Peak levels of collective social stress
- High levels of social stress might show up in obvious ways – for example, the bitter attacks people wage on each other in social media forums like Nextdoor or by unfriending/blocking someone on Facebook. But it also shows up in subtle ways. For instance, when we encounter each other on walking paths, with half our face covered now, do we still make an effort to say “hello?” Or do we look down, or look away, and stay lost in our thoughts? With half of our faces covered, and less in-person social interaction, there is the sense of being more “invisible” these days. This kind of invisibility can heighten feelings of disconnection with people around us.
Difficulties meeting the needs of people we care about
- Many of us are now learning just how challenging it is to achieve work-life balance as a telecommuter. Having children in "virtual" school classes while parents are working from home all but guarantees a new level of parental guilt. As children seek the attention they want and need, they find parents are continually occupied with work responsibilities, or attending back to back Zoom meetings. And we may be pressed into new roles that we are not prepared for. To give a specific example, the ways that children are taught math in school now (the “Common Core”) is not how we were taught. As a result, it can be a serious challenge to help them with their math homework. We may worry that our children’s long-term learning will be impacted – or that their social development will be stunted. These kinds of concerns often create continual “stealth anxiety.
So, what do we do? Here are some coping strategies that may help.
Some sense of routine – or “rhythm” – in life, can help us manage anxiety. Confronting “stealth anxiety” means becoming fully aware of it and reckoning with it directly. Acknowledging that this is NOT a normal time and that our routines have been totally disrupted for a lengthy period of time is the first step. This then allows us to think about the elements we benefited from in our previous routine. Once we have identified these things, we can mindfully create a new routine for this altered time. For instance, one of the “new normal” elements in my life is to join some friends, including some groups of Marines, for “virtual fire pits” on a fairly regular basis.
For this challenge, the best defense is a friendly offense. If we can be the person to reach out to others with a friendly “hello” and a direct, kind gaze, we can create a little protection for ourselves, and maybe even others. We have no idea what kinds of stressors – or “capital T” traumas – those we encounter may be going through. I recently had to make multiple visits to my local post office over several weeks. One of the postal employees looked really beaten down one day, so I asked her how she was doing, really. She told me that she had lost two family members, one to COVID, and one who was shot and killed in the line of duty as a police officer. At the same time, I was grieving the loss of a special person, a former patient who had died of a heart attack. She and I had a brief moment of connection around these losses that helped both of us.
As my children well know, I have nothing to offer when it comes to teaching common core math programs. However, I see my limits very clearly and have been able to bring in a little virtual help from a college aged student. It didn’t break the budget to hire this support a few hours a week, especially now that we are not paying for after-school care. She was able to relate to our kids and the types of learning methods that are taught nowadays. Right now, as I write this, there are LOTS of very talented people sitting unoccupied in their homes, with skills to offer to others. Being creative about finding them and supporting them might bring mutual benefit to you and to them.
What if you continue to struggle with anxiety symptoms, even when applying consistent wellness practices?
For some of us, stealth anxiety may cause changes in our “fight or flight” system. Why? Because the continual onslaught of life stressors can cause long-lasting biological changes. As I mentioned in an earlier article, extreme stressors can shift and lock us into a higher gear, where we may remain for years or even decades. This happens all the time for people in certain high stress occupations – for example, military service members, firefighters, emergency medical professionals, and police officers.
Many of my patients have described this state as “feeling constantly revved up and being unable to throttle down.” Common indicators of this altered biological state that I call “chronic threat response” include symptoms like disrupted sleep, anger attacks, overwhelming panic, difficulties concentrating, a feeling of constantly being on “high alert”, and a strong startle response - in other words, the “hyper-arousal” cluster of trauma symptoms. Since the start of the COVID crisis, I have frequently spoken about the state of “chronic threat response,” for example, in this CNN article.
In the past several months, work has advanced on an innovative approach to treat these “hyper-arousal” symptoms. This approach – Stellate Ganglion Block – involves injecting an FDA-approved pain medication into a cluster of nerves in the neck, which appears to reboot the adrenaline system. SGB (as it is commonly called) sets the optimal conditions for talk therapy. For those stuck in a state of “chronic threat response,” SGB has played a critical role in helping my patients set and maintain a new normal – especially those suffering from PTSD.
We have treated a wide spectrum of individuals, unified by a continual challenge of feeling “stuck” with an overactive fight or flight system. Some of our patients meet criteria for a PTSD diagnosis and some do not. Some are warfighters who would not meet criteria for a diagnosis of PTSD, but who suffer from the specific symptoms associated with “chronic threat response.” Others are corporate leaders and executives who “can’t downshift” whose family relationships have suffered because of their sudden flashes of irritability. We have also successfully treated firefighters, EMTs, frontline emergency health care workers, and police officers who may not meet criteria for PTSD, but whose quality of life and ability to downshift from work to home has been impacted by continual stress exposure. In the same way that SGB has been used in the war zone to treat medics and flight nurses, we have treated frontline healthcare workers who are the warriors in our current healthcare crisis.
The psychological toll of COVID is real, and it will persist for many of those who have been impacted by trauma. Whether trauma has had an impact this year, or at some other time prior, if you find that you have persistent symptoms of “chronic threat response” like continually disrupted sleep, surges of panic or anger, difficulties concentrating, or an acute startle response, you may want to consider SGB as a treatment.
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Date of original publication: October 29, 2020