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Section 13
Diet and Exercise Intervention

Question 13 | Test | Table of Contents

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In the last section, we discussed three steps to help clients overcome their anxiety over travel. These three stages are motivation; pleasurable tie-ins; and lessening anticipatory anxiety.

As you know, a client’s daily life can affect the frequency and intensity of their panic attacks. 

In this section, we will examine four aspects of exercise and diet to help reduce the severity of panic attacks. We will discuss the benefits of exercise; aerobic exercise; anaerobic exercise; and diet tips.

♦ Benefits of Exercise
First, we will discuss the benefits of exercise. Besides the obvious benefits of higher self-esteem, many health experts agree that exercise reduces stress because of the endorphins released during such activity. Immediately after physical activity, clients experience a euphoric feeling. 

In addition, exercise reduces muscle tension that accumulates during periods of high stress.  Much like a massage, the movement of muscles and tendons releases extra strain brought on by anxiety. Ruth, an anxiety ridden 27 year old client of mine, continuously complained of muscle tension in her neck, legs, and back.  Ruth decided to take up regularly exercising at the gym. 

Ruth stated, "I started going to the gym during my lunch hour. My boss was a wonderful guy really, but sometimes he’d frazzle my nerves and I would feel the normal muscle tension start up again. I’d come back to the office feeling so wonderful and so relaxed. I’d also feel so kindly to my boss, I’d forget how he was in the morning." As you can see, Ruth could easily release her stress through just an hour of exercise in the middle of her day.

♦ Exercise #1- Aerobic
Second, we will discuss how certain types of exercise can be used for certain symptoms of anxiety in clients. Tiffany would begin to feel faint and hyperventilate when faced with stress.  To increase the flow of oxygen to her brain and reduce her panic attacks, I suggested that she take up aerobic exercise.  As you already know, aerobic exercise trains one’s body to deliver more oxygen to the brain and other parts. 

As the body adjusts to this new strain, it learns to deliver the oxygen more quickly and efficiently. Tiffany decided to take up jogging. At first, she only did about fifteen minutes a day. Eventually, her tolerance for high aerobic exercise became such that she could go for thirty minutes, four times a week.

Tiffany stated, "When I do get panic attacks, which is rare now, I don’t hyperventilate as badly as I used to. Not only that, I seem to be able to keep my head about myself during the attacks. When I start to feel my chest tighten, my mind goes into ‘coping’ mode, kind of like how I function during running: to get past these few minutes as painlessly as possible." 

As you can see, aerobic exercise has benefited Tiffany in two ways:  mentally and physically.  Think of your Tiffany.  Could he or she benefit from aerobic exercise?

♦ Exercise #2- Non-Aerobic
The second type of exercise is, obviously, anaerobic. I find this type of activity is more beneficial for clients who are concerned about inducing an attack with a heightened heart rate.  Lily, a 31 year old client of mine, stated, "I know I should exercise more. I’m not that out of shape, but I know it would make me feel better. It’s just that when I do anything that makes my heart beat faster, I get scared because that’s what happens when I’m having an attack. So, instead of reducing my attacks, it feels like I’m having one right then." 

I suggested that Lily try yoga, which raises a heart rate minimally, but not enough to cause a panic.  Not only is yoga non-cardiac, the many varied positions are designed to increase metabolism and reduce muscle tension and stress. Lily stated, "I love yoga now. I take a class three times a week and I also do my own routines on the weekends. I’m so relaxed after doing any of the positions, plus it’s helped me to meet people and make friends in my class. I have a social life again!"

For men, yoga is not always an appealing choice. Weight lifting is another alternative. Like yoga, it works the muscles with minimal increased heart rate. Also, it can increase self-esteem about one’s body. Think of your Lily, who is concerned about inducing a panic attack. Could he or she benefit from anaerobic exercise?

♦ Effective Diet Tips
In addition to exercise, we will also discuss the importance of a healthy diet. For those clients susceptible to anxiety, a balanced diet is essential to maintain a low stress environment. Clients who consume foods high in sugar and caffeine are putting unnecessary carbs into their bodies.  These ingredients could induce a panic attack and cause worse anxiety symptoms. 

Diets that are high in fat and sodium, which are ingredients most prominent in fast food restaurants, can also have a negative effect on an anxiety-prone client.  According to research, frequent consumption of these types of foods causes a slight addiction in the brain’s opiate receptors. When this happens, the client feels slightly depressed and apathetic until he or she consumes their favorite fatty foods.

When a client is on a diet that is most likely hurting their chances of recovery, I give them a list of "Healthy Diet Guidelines" that will help reduce their stress:

  1. Increase your intake of fruits and vegetables.  Packed with nutrients and fiber, they also have disease-fighting properties.  Ideally, you might want to eat more vegetables than fruits, because they tend to be more nutrient-packed.
  2. Eat whole grains.  These are rich in B-Complex nutrients, of which the milling process can remove over 75 percent.
  3. Eat more foods from the bean family.  Tofu, green beans, lentils, and split peas, as well as regular beans are good sources of protein when combined with a grain product such as whole wheat bread.
  4. Cut down on sugar.  Reading food labels is essential as corn syrup, sucrose, and dextrose are just fancy names for sugar and can sneak into almost any food.  Products marked as "no fat" generally contain more sugar than they ordinarily would.
  5. Spread out your eating so you have four or five mini-meals a day instead of three large ones.  This will reduce the risk of low blood sugar, which can cause fatigue.  Try not to go more than four hours without eating.
  6. Avoid caffeine.  Gradually wean yourself off coffee with decaf or tea. According to Dr. Thomes Udhe, a former researcher at the National Institute of Mental Health, "Caffeine can cause panic attacks in panic disorder patients and, in sufficient quantities, can also trigger panic attacks in normal controls."
  7. Drink six to eight glasses of water a day. 
  8. Go easy on fats.  This means reducing the intake of meat and poultry.  Use olive or canola oil for cooking.  Switch to fat free milk.  Avoid products that contain partially hydrogenated oils, which cause trans-fatty acids that are harmful to the arteries.
  9. Reduce sodium intake.  Fast food, canned goods, processed meat, and hard cheese are very high in salt.  Try using more natural herbs and spices for flavoring.
  10. Eat a varied diet.  Try new vegetables or fruits so you don’t get tired of one thing.

Think of your anxiety-prone client.  Could he or she benefit from a slight change in diet?

In this section, we discussed four aspects of exercise and diet to help reduce the severity of panic attacks. We went over the benefits of exercise; aerobic exercise; anaerobic exercise; and diet tips.

In the next section, we will present five breathing exercises that you might consider teaching or recording for your anxious clients, which are 1-to-8 count; 1-to-4 count; 5-to-1 count; three-part breathing; and alternate nostril breathing. 

- Mason, J. L., Ph.D. (1980). Guide to Stress Reduction. Los Angeles, CA: Peace Press.
Reviewed 2023

Peer-Reviewed Journal Article References:
Aschbrenner, K. A., Mueser, K. T., Bartels, S. J., & Pratt, S. I. (2013). Perceived social support for diet and exercise among persons with serious mental illness enrolled in a healthy lifestyle intervention. Psychiatric Rehabilitation Journal, 36(2), 65–71.

Brown, C., Read, H., Stanton, M., Zeeb, M., Jonikas, J. A., & Cook, J. A. (2015). A pilot study of the Nutrition and Exercise for Wellness and Recovery (NEW-R): A weight loss program for individuals with serious mental illnesses. Psychiatric Rehabilitation Journal, 38(4), 371–373. 

Brydges, C. R., Liu-Ambrose, T., & Bielak, A. A. M. (2020). Using intraindividual variability as an indicator of cognitive improvement in a physical exercise intervention of older women with mild cognitive impairment. Neuropsychology. Advance online publication. 

Chen, R., Niehorster, D. C., & Li, L. (2018). Effect of travel speed on the visual control of steering toward a goal. Journal of Experimental Psychology: Human Perception and Performance, 44(3), 452–467.

Erceg-Hurn, D. M., & McEvoy, P. M. (2018). Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome. Psychological Assessment, 30(11), 1512–1526. 

QUESTION 13
What type of exercise helps reduce a client’s symptom of hyperventilation? To select and enter your answer go to Test.

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