Doug Berger: Tokyo Psychiatrist on Soothing Anxiety

With global anxiety and depression rates at an all-time high, what can people do to combat these mental health issues?

Since 1940 the amount of people suffering from anxiety and depression has been steadily increasing. Classified as a spectrum disorder, anxiety can manifest in various forms and severity, and no one is immune to this mental health issue that plagues millions of men, women, youth and even children.

Thanks to the prevalence of digital culture, anxiety is even getting catchy buzzwords and anagrams, like FOMO, better known as Fear of Missing Out, which has been associated with social anxiety and guilt. Not only does this indicate the changing face of anxiety, it is proof that anxiety which was once considered a mental health issue for older people is increasingly becoming an issue amongst all demographics and cultures.

A 2013, mental health report published in the Australian journal Psychological Medicine, found that as many as 1 in every 10 people suffer from some type of anxiety, which can present as panic attacks, heart palpitations, sweats, lightheadedness and a host of other ailments.

The report went on to state that clinical anxiety and depression are serious health issues all around the world, however, anxiety disorders are more commonly reported in Western societies than in non-western societies.

This presents a unique problem for Westerners living abroad in need of anxiety treatment, as well as people in countries where discussing mental health is still considered taboo.

Dr. Doug Berger, a psychiatrist in Tokyo, is working to help erase the stigma associated with anxiety and mental health, while simultaneously using his American and Japanese expertise to treat a diverse array of people living in and around Tokyo.

We asked Dr. Doug Berger about his thoughts around the steady increase of anxiety and depression, as well as some tips to combat anxiety in various age groups.

Thank you for your time Dr. Doug Berger. What do you think is behind the growing number of patients suffering from anxiety?

Anxiety has always existed in various forms, but the ability of mental health professionals to understand anxiety-related conditions is greater due to increased professional awareness. Romantic troubles, economic uncertainty, and other factors including worry how one is viewed by many others on social media, as well as greater access to the news media that continually barrages us with scary stories can all contribute to increased anxiety.

Can you describe what spectrum disorder means and why it applies to anxiety?

The term “spectrum disorder” is just a complicated term to express that the severity of a symptom like anxiety may go from transient to chronic, and mild to severe. It may be part of another problem such as adjusting to a life stressor, it may be a symptom of another psychiatric problem such as depression, or it might be a stand-alone problem as is seen in Generalized Anxiety Disorder, Social Anxiety, Panic Disorder, and others.

What separates general anxiety from an anxiety disorder?

“General anxiety” may refer to anxiety from everyday life problems; i.e., fear of losing one’s job, a romantic relationship, being ostracized from friends, etc., or it can mean Generalized Anxiety Disorder which includes constant worry, muscle tension, possible insomnia etc., that has no specific obvious cause. Sometimes Generalized Anxiety Disorder can be genetic.

What are the types of maladaptive defense mechanisms that can limit a person who is suffering from anxiety or an anxiety disorder?

Persons with anxiety may shrink from social interaction as a reaction or defense to ward off anxiety. They may have mild social fears causing them to seem introverted and quiet, or they may have more severe anxiety in social situations limiting health social and occupational functioning. Mildly introverted persons may be liked because of their non-confrontational demeanor in spite of having significant subjective distress. “Binding one’s anxiety” is another form of defensive reaction wherein a person engages in specific activities or behaviors to decrease tension. For example, a person anxious about an upcoming surgery may begin to organize their affairs and take care of many tasks they fear will be difficult to do after surgery. Persons with anxiety disorder and no specific feared event may show the same behaviors.

In general, what can people do to calm an anxious mind?

Avoiding anxiety-provoking situations may not be a maladaptive behavior depending on the situation or severity as described above. Avoiding, caffeine (which can provoke anxiety), tobacco and alcohol (which can make persons anxious when they come off the substance), drugs (especially drugs with stimulant effects, i.e., drugs for ADHD, cocaine, etc.) is a good idea. Some persons prefer sports, meditation, or yoga to help them, although these may have limited effect if the severity and chronicity of anxiety is great and they should also receive medical help.

Do you have advice for parents whose children suffer from anxiety?

This really depends on the age of the child. For children under five or six years old it is very difficult to pinpoint what is an anxiety disorder from normal or transient developmentally-related anxiety that usually shows up as anxiety on separation from parents. Generally, I would advise providing as much love and care as possible while gently training the child that the parents can not be continually be by their side. Social introversion and avoidance should also patiently be followed over the years by giving both love along with nudging children to take steps to be friendly and social with others. Night terrors and panic in children requires a nuanced evaluation of family dynamics, genetic, and medical/psychiatric issues.

For older children, social-skills training and integrating into peer-group activities if possible is important. Some children really do better with more solitary hobbies such as musical instruments, programming, math, etc., and there is a grey zone where we worry about the child on the one hand, but need to foster acceptance of socially-hesitant children on the part of the parents. Older children with panic, generalized anxiety, social anxiety disorder, and other disorders need to be evaluated by a professional.