Category: Anxiety

What Research Data Says About Food Allergy Anxiety

10/30/2022

One of the most common reasons people reach out to allergy-informed therapy providers is for help managing food allergy anxiety. It's easy to understand why allergic individuals and families may feel anxious, but it's also useful to learn more about food allergy anxiety itself - the data and insights behind the emotion.

What Have We Learned About
Food Allergy Anxiety So Far?

Therefore, this Food Allergy Counselor post offers an overview of key points from a 2020 research article entitled, "Anxiety and Food Allergy: A Review of the Last Two Decades". As the research article is 22 pages long with lots of data, this serves as a highlight of key information.

Anxiety Basics:

Anxiety is often triggered by unpredictability, uncertainty, unknowns, new experiences, and change/transition.
Experiencing anxiety or anxious feelings is not the same as being diagnosed with an anxiety disorder, which requires meeting a specific set of criteria.
Symptoms of anxiety typically include thoughts of future-focused worry and apprehension, as well as physical sensations such as rapid heartrate, sweating, and nausea, especially if in the presence of perceived or actual danger (i.e. fight, flight or freeze response).
Anxiety symptoms can be short-lived and situation-specific, or ongoing and over-generalized.
At lower levels, anxiety can be useful, motivating us to prepare and make safe choices. Higher levels of anxiety, especially if ongoing in nature, tend to lead to unhelpful actions, distress, and interference in daily functioning.
Anxiety disorders are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health.

Food Allergy Anxiety (FAA):

A predominant theme that came to light in this article was anxiety that results from the experience of the first severe reaction.
FAA tends to be focused on specific fears and/or FA-related phobias, and is often related to (or as a result of) specific events.
Similar to general anxiety, lower levels and short-lived FAA can actually help us be appropriately cautious, whereas higher levels and ongoing FAA tend to lead to life-impacting avoidance and distress.
High levels of FAA around the time of diagnosis can motivate us to gather information that leads us to effectively manage the FA, which also helps decrease FAA. With time and practice, FAA levels tend to stabilize.
(3) key events typically trigger increased/renewed FAA: New accidental exposures, new information about potential risks, and developmental transitions leading to increased threats of risk. These triggers can motivate some to make improvements in their FA management approaches.
Those experiencing ongoing and high levels of FAA may perceive allergen risks to be more elevated than they truly are, which can lead to over-avoidant and life-limiting behaviors.
Heightened allergen risk perception is associated with higher levels of anxiety.

FAA and Oral Immunotherapy (OIT) / Oral Food Challenges (OFC):

After an OFC, study data showed that mothers experienced a reduction in FA parental burden, but not in general stress and anxiety levels.
Research shows OIT has a general positive effect on some aspects of quality of life, particularly relating to food anxiety, and social and dietary limitations, but not the emotional impact.
A recent study showed that quality of life improves significantly with OIT, including emotional impact and food anxiety upon reaching OIT maintenance, and with additional improvement 6 months later.

FAA and Parents/Families:

Anxiety and fear are parental instincts that intensify when their child has been diagnosed with a FA.
It's not uncommon for parents to feel anxious when introducing new foods to their allergic child and younger siblings.
Differences in parental FAA may be reflective of anxiety fluctuations in different stages on the FA journey and/or the child's development, as well as differentiations in families’ adaptation and resilience.
Research has led to the development of patterns relating to how families adapt to FA that are based on levels of anxiety, balanced psychosocial functioning, and effectiveness of FA management. This can help practitioners understand the direction of therapeutic goals for each allergic family.
Cultural aspects, personalities, and previous trauma regarding FA events are factors associated with differences in how families cope with FA.
For nut allergic kids and their mothers, prescribing epinephrine autoinjectors is associated with reduced anxiety.
Self-reported compliance regarding carrying epinephrine autoinjectors was associated as a burden among food allergic teens and their parents.

FAA and Adults:

Adults experiencing the psychological burden of FA may notice increased stress levels and negative moods on days with more allergy issues/anxieties.

Interventions and Approaches for FAA Management:

The overall goal for managing FAA is finding that "just right" level of FAA that allows you to cautiously manage your FA without leading to maladaptive hypervigilance and potentially dangerous risk-taking behaviors.
Allergy-informed therapists can provide psychoeducation, psychotherapy, counseling, and teach skills and relaxation/coping techniques to help allergic individuals and families develop the skills to find that balance.
Coping with FAA isn't a simple, one-size-fits-all strategy; it requires emotional and behavioral adaptations.
Clear, concise and reputable educational materials, especially for newly-diagnosed families, may reduce stress/anxiety levels and improve QoL since it can increase a sense of control (Added FAC note: These FA Stages Handouts are great examples)
Messaging and modeling matter: Using a calm, matter-of-fact approach to FA management, which focuses on safety routines and modeling the use of adaptive coping, may convey the message within the family that FA is manageable.

Final Thoughts and Takeaways

The hope is that this information has helped you gain a new perspective on food allergy anxiety, better understood your own anxiety, gained more self-compassion, and/or guided you in a useful direction. And if you're a healthcare and/or behavioral healthcare provider reading this, the hope is that this information helps you approach your allergic patients with a much deeper picture of their food allergy anxiety, which is useful in guiding them through the development of anxiety management skills.

So, what are the main takeaways of this two decade food allergy anxiety research article, and how can you apply them?

Anxiety is a common aspect of life with food allergy, but it isn't all-or-nothing - it exists on a continuum. There are times on the food allergy journey where anxiety may be more present and intense, and times when we feel we're managing it well.

Because anxiety is a normal human emotion, it's not a realistic goal to aim to completely get rid of anxiety (even food allergy anxiety), especially as it can actually be motivating and purposeful if we learn how to manage (and use) it effectively. Therefore, it's helpful to focus our attention on developing approaches, skills, and tools that help us find our "just right" balance with food allergy anxiety.

Use these final thoughts as a general guide to help you work towards that "just right" balance:

It's helpful to remember my food allergy anxiety feels bad, but can be useful
I can notice my food allergy anxiety, yet not let it tell me how to live my life
My food allergy anxiety may be making me feel the risk is higher than it is
Just because my food allergy anxiety feels big doesn't mean I can't handle it
What information and tools can I learn to help me turn down my FA anxiety?
What aspects of life does my food allergy anxiety hold me back from?
How can I do very meaningful things in life even WITH my FA anxiety?

Please don't hesitate to reach out to an allergy-informed clinical therapy provider if you'd like more support with managing your FAA!

And if you'd like more content focused on food allergy anxiety and the management of it, check out this FAC content:

The FAC Blog Category: Anxiety
The FAC Blog Category: Allergy Anxiety Tools
The FAC Blog Category: Fears
Exploring Food Allergy Families podcast - Ep. 10: The Data About Our Feelings with Dr. Ruchi Gupta and Dr. Lisa Lombard (available on all podcast apps)

Do You Find Content & Resources on
The FAC Useful For Yourself or Patients?

The Food Allergy Counselor (The FAC) exists to offer insightful information and practical approaches for navigating the daily overwhelm and anxiety often associated with food allergy life. From evidence-based information, experiential insights, practical tools, and links to additional resources/supports useful for those managing allergies and providers supporting them, The FAC is your allergy psychosocial hub!

Therefore, please consider sharing your feedback about how The FAC has helped you via this brief, 3-question feedback form. Thank you in advance!

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Fear-Based Messages About Food Allergy Mistakes

8/7/2022

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[This is one of those articles that may stir up feelings of anxiety. But remember - anxiety isn't the bad guy (even though it makes us feel uncomfortable) - and it can actually push us towards meaningful change. So harness any anxious feelings you may feel as you read this, and focus on exploring why they're there and how the information presented may help you create a more workable approach to anxiety].

Scrolling through allergy social media accounts, you may have come across posts with the following kinds of messages:

You can't make any mistakes when managing food allergies
There are no do-overs if you DO make mistakes
Be careful - don't make wrong choices because results will be catastrophic
You need to be 100% on the mark every moment of every day

[Image Source: AmberMB on Pixabay]

Do these messages raise your anxiety levels? Do they flip on the pressure to be perfect? Or make you want to curl up in a ball and hide (so you don't have to deal with the possibilities of making mistakes)?

These are normal emotional responses to those kind of statements.

While messages with these themes mean well - encouraging people to exercise caution and take food allergies seriously - the reality is that they may do more harm than good.

Let's explore (3) reasons why these fear-based messages may not be the best approach to relaying the seriousness of food allergies, particularly within the food allergy community itself.

1. They Can Lead To Excessive Anxiety & Worry

Increased anxiety has already been noted, but let's expand on the potential "allergy anxiety domino effect" that fear-based allergy messaging may give way to.

Excessive anxiety and worry can lead to avoidance of experiences in order to seek safety. Avoidance of experiences can then lead to even more anxiety due to a lack of confidence in one's ability to manage their allergy without avoiding things. This then reinforces the narrative that life with food allergies is too scary to navigate. And, you guessed it - that tends to translate to even more avoidance.

Experiencing some anxiety can actually be useful, often motivating us towards action and change. However, when it becomes excessive, our stress levels rise and our confidence in our ability to manage situations decreases. This is when we tend to feel scared, stuck, and without any control or impact on situations and their outcomes.

Therefore, when messages use extreme language and themes, they're likely overshooting their target, leading readers to feel less empowered and more trapped by allergy fears.

2. They Can Lead To Setting Unrealistic Expectations

Simply put, no one is perfect! That means that mistakes WILL happen. I know that's a scary thought when managing life-threatening food allergies, but it's a thought that is better addressed than avoided. With that said, not every mistake leads to a reaction or anaphylaxis, and that's an important thing to remind yourself.

When messages lead us to believe that every mistake ends in catastrophe, our brain interprets that as a threat - we must keep ourselves and/or our child from having an allergic reaction at all costs (including costs to our own well-being). This then triggers a feeling of panic and fight/flight/freeze response. And understandably, that primes us to seek safety by creating an unrealistic safety bubble for fear of making mistakes.

That's why fear-based messaging does more harm than good. When we're in fight/flight/freeze mode, our focus is safety, not learning to live with food allergies. If we stay in that mode, we will expect ourselves (and others) to be perfect, never making a mistake - telling ourselves that this an achievable goal. And if a reaction does happen, we may then deal with intense guilt that is fed by this unachievable goal.

Yes, our overall goal is to prevent reactions, but it's unhelpful to believe that this is achieved through perfection. It's more useful to accept that there will likely be mistakes - maybe even made by ourselves - and focus on learning how to navigate reactions, should they happen.

3. They Can Lead To Overparenting Behaviors

While parenting a food allergic child does require additional stressors that non-allergy parents don't deal with, it's still possible to overparent an allergic child.

Overparenting is paved with good intentions, but can result in a child experiencing increased anxiety, inadequate life skills, and a lack of resilience. There's data exploring how maternal distress is an identified risk factor for psychosocial difficulties in youth with food allergy, and restrictive parenting practices can lead to poorer health-related quality of life in this population. And even with allergic children, parents' goals are still to work themselves out of a job. This means that allergy parents should focus on helping themselves grow through each stage of an allergic child's development in order to raise a self-sufficient allergic young adult.

Connecting this with the first two points, fear-based messaging tends to lead to the exact opposite by opening the door to excessive anxiety, which then sets the stage for avoidance of experiences, aiming for unrealistic perfection, and overparenting children in order to achieve safety - none of which is helpful.

So then how can people express the seriousness of food allergies with less fear-based messaging?

Below are (2) helpful tips for developing messages that evoke action and empowerment rather than paralyzing worry and fear:

Focus The Message on Building Confidence:

Encouraging allergic individuals to build confidence in their ability to manage an allergic reaction is a more useful message, as it motivates people towards action. In order to grow confidence, we must first build competence through practice. Yes, that means that you'll be stepping outside of your comfort zone, but you can do so at your own pace. Without practicing allergy management skills and preparing for the possibility of anaphylaxis, competence and confidence will not develop - and instead, anxiety and fear may continue to be the main drivers in your decision-making. Therefore, encouraging action towards building confidence helps people feel more capable of managing food allergies and less like they have no control at all.

Strike a Balance Within The Message:

When living with food allergies, we do need to take them serious. But overly-focusing on the seriousness of allergies can lead to the belief that every aspect of allergy life will be hard, if not impossible, to navigate. Therefore, it's helpful to aim to strike a balance between the seriousness and workability of the message. Yes, we want to encourage people to take allergies seriously and make mindful choices, but it's equally important to encourage finding workable ways to live life with allergies that isn't rooted in daily fear.

Tips For Navigating Fear-Based Messages:

If you haven't already, you'll likely come across fear-based allergy messaging online, because, let's face it - food allergies can feel scary! But don't let these kinds of narratives have the power to make you feel inadequate about how you're navigating life with allergies.

Here are helpful reminders as you come across fear-based messaging:

Look beyond the words & interpret what the message is trying encourage
Notice what it triggers & focus on actions that help address the worries
Set realistic expectations of self and others - no one can be perfect!
Be selective in who/what accounts you follow online - if they often leave you feeling triggered, they aren't useful for you

[It's important to note that if you and/or your child has experienced an allergic reaction, it may feel harder to disengage from these fear-based messages. Monitor how you're coping after reactions, and if you find it hard to regain daily functioning, discuss this with your allergist and consider reaching out for therapeutic support].

Remember, support is there if you need it! Don't forget to check out the Food Allergy Counselor Directory, the Exploring Food Allergy Families podcast, the Food Allergy Behavioral Health Resource section, and the allergy-specific therapeutic worksheets. And if you're an allergy-informed therapy provider, then visit the Provider page!

Don't be shy - reach out and say hi! I look forward to hearing your thoughts on this post and other FAC content.

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Unhelpful Allergy Beliefs

5/21/2022

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Ever notice that we live by rules? I'm not talking about societal rules such as laws, but internal rules, or beliefs and guidelines we've created for ourselves to live by. We typically develop these internal rules/beliefs through experiences we've had, or to help us achieve or avoid things.

You'll likely identify these internal rules by the language you use when thinking of them. "Should, ought to, must, right or wrong, good or bad, always or never" are common words and phrases that let us know that we're connecting with these internal rules/beliefs.

But internal rules and beliefs are useful, right?

Maybe. They can be useful, guiding us towards things that matter to us in life. BUT, they can also be unhelpful, leading us to veer off track. It's this unhelpfulness that I want to explore - with a simple, practical strategy to help navigate these unhelpful internal rules and beliefs.

Credit: johnhain on Pixabay

Quality of Life Impacts of Unhelpful Internal Beliefs

Our internal rules and beliefs can act as guides for how we navigate life. Let's look at some non-allergy examples first:

Belief: "I shouldn't do that because I'm not smart" ---> This internal belief may lead to avoiding taking risks where the outcome may make result in giving wrong answers, extending ourselves academically or professionally, or anything else that reinforces this belief
Belief: "I'm a bad cook" ---> This may lead to avoiding cooking, trying new recipes, or letting others taste what you've made
Belief: "The world is always unsafe" ---> This may lead to limiting experiences in life or not believing that there is safety and kind people out there in the world

Just like the rules of the road that guide us in driving, these internal rules/beliefs guide our behaviors and how we navigate life. Think of them like guard rails on the highway. When the internal rules/beliefs are helpful, they're like guard rails separated by many lanes - there's so much space to move around, and there may even be portions of the road where there aren't any guard rails limiting us!

But when these internal rules/beliefs are unhelpful, they can feel like guard rails on a one-lane highway - keeping you confined to a very small space.

Before we explore examples of unhelpful allergy-specific internal rules/beliefs and what to do with them, I need to cover one more topic: How rigid or flexible our internal beliefs are.

How Rigid Or Flexible Are Your Internal Beliefs?

Credit: Memory Catcher on Pixabay

Using the guard rail metaphor, let's apply it to bowling. Have you ever gone "bumper bowling" with the guard rails up so that the bowling ball doesn't go into the gutter?

In my experiences with bumper bowling, sometimes I've played with hard, rigid metal bumpers and other times with softer, inflatable-looking bumpers. With the hard, rigid metal bumpers, my ball would typically bounce off of them so much so that it would overcorrect itself, bounce to the other side of the lane, and then bounce back again. It looked like it was erratically bouncing back and forth with no real hope of hitting a pin! But when I've played with the softer, more flexible bumpers, while my ball would still bounce off of the bumpers, it actually seemed to have a chance to actually move down the lane with hope of hitting a pin.

What this example is getting at is that our internal rules/beliefs (guard rails) can be rigid or flexible, which impacts the actions we take and our quality of life.

With rigid internal rules/beliefs, we often find ourselves avoiding experiences and limiting ourselves because they don't leave much room for exploration, possibilities, and other perspectives. Things need to be a certain way and align with these internal rules, otherwise it's too risky, scary, uncomfortable, and likely unattainable (or so we believe). The rigid nature of these rules is MEANT to help us feel less anxious and more certain about things, but often times, it ends up doing the opposite and creating more discomfort in our lives.

When our internal rules/beliefs are more flexible, we're more willing to test the waters outside of our comfort zone to see what happens. We're also more willing to see things from more than one perspective, which potentially leads to changing our internal rules/beliefs to be more workable ones for ourselves, our goals, and our lives in general. While the flexibility of these rules/beliefs may initially scare us because it feels so uncertain, the flexibility helps us to develop life skills that get us through the discomfort and uncertainty life throws our way - and that helps us develop competence and confidence in ourselves!

Now, let's put this all together with allergy-specific examples!

Noticing Your Unhelpful Allergy Beliefs

Many of the internal allergy rules/beliefs we've developed are likely rigid ones, which doesn't leave much room for anything less than perfection.

Let's look at these examples of unhelpful allergy rules/beliefs and potential outcomes of living by these rules - and as you read them, I encourage you to think about the rigid rules/beliefs you may have developed:

Rigid Allergy Belief: "Feeling anxious is always a sign it's unsafe or that I'll react"

This rigid belief will likely lead you to avoid anything that makes you feel anxious because you'll interpret everything uncomfortable as something that will lead to a reaction. However, this is unhelpful because anxiety is a normal part of life, especially when managing allergies. Anxiety also doesn't only show up when it has to do with safety - it often shows up when something is new to us! So this rigid belief reinforces the unrealistic internal rule that living safely with an allergy looks like a very precise math equation: Allergy + Avoidance = Total Safety. However, allergy life ISN'T a precise math equation, and living like it is will likely negatively impact your quality of life.

Rigid Allergy Belief: "If I'm not doing everything other allergic individuals or allergy parents that I see in support groups are doing to stay safe, then I'm not being safe enough/aren't being a good enough allergy parent."

This rigid belief sets you up for unhelpful comparisons! These comparisons are based on the internal belief that how others navigate allergy life is right, and how you're doing it is wrong. Says who?! We're all different. We have different allergy specifics, values, and goals in life. What works for one person may not work well for another. So taking information learned from others as a verbatim map you're supposed to strictly follow in order to be safe enough or a good enough allergy parent only pushes you even further from learning the skills that will help YOU feel confident in allergy management!

Now, let's use these rigid allergy belief examples above and turn them into more flexible internal beliefs.

A Practical Tool For Changing Unhelpful Beliefs

So what's the simple, practical tool that helps us change our rigid rules/beliefs into more flexible and workable ones?

LANGUAGE, or the words we choose to use, even in our own mind!

You'll see we can turn a rigid belief into a more flexible one by simply changing the words or phrases used - because language matters when it comes to how we internal rule-making!

Rigid Allergy Belief: "Feeling anxious is always a sign it's unsafe or that I'll react"
Flexible Allergy Belief: "Feeling anxious may be a sign it's unsafe or that I'll react"

Did you notice a difference in how it felt when you read the rigid version versus the flexible version of this internal belief? While it still leaves room for thinking about the potential or uncertainty of a reaction (because we truly can't eliminate ALL uncertainty in life), it hopefully felt less uncomfortable. The flexible allergy belief will open you up to looking at other perspectives and potential outcomes, such as anxiety just being an uncomfortable feeling that doesn't always mean something is unsafe. And this adjusted internal belief will allow you to choose new actions, which may positively impact your quality of life!

Rigid Allergy Belief: "If I'm not doing everything other allergic individuals or allergy parents that I see in support groups are doing to stay safe, then I'm not being safe enough/aren't being a good allergy parent."
Flexible Allergy Belief: "I can choose to do what other allergic individuals or allergy parents that I see in support groups are doing to stay safe, but not doing so doesn't mean I'm not being safe enough/aren't being a good enough allergy parent."

By changing the phrasing used in this rigid allergy rule/belief, it literally changes the meaning of it! So, which of those statements feels most workable for you? (I'm putting my money on the flexible one). Instead of falling in line with an internal rule you created based off of the fear you're feeling, you can choose to make that belief work better for you. Then, the next time you're reading through online posts and that rigid allergy rule/belief pops back up (because it most likely still will for awhile), you can remind yourself of your more workable, flexible rule/belief!

Final Takeaways....

While there is a lot of room for very calculated and precise rules in allergy life (and life in general), not EVERY internal allergy rule/belief has to be so rigid. And in fact, the more rigid we tend to be, the more potential there is that these rules/beliefs will negatively impact our quality of life.

Therefore, remember:

It's helpful to start noticing your internal rules/beliefs and their impact on life
Our internal rules/beliefs can be helpful AND unhelpful
It's important to assess which of our rules/beliefs are unhelpful vs. unhelpful
Explore whether your unhelpful internal rules/beliefs are too rigid
It IS possible to make our internal rules/beliefs more workable with flexibility
Making our internal rules/beliefs more flexible starts with adjusting language
When the rigid rules/beliefs pop back up, remind yourself of the flexible ones
Navigating allergy life with some flexible internal rules/beliefs can positively impact the ability to learn how to confidently live with allergies and positively impact your quality of life

Other FAC posts that may help:

Remember, support is out there if you need it! Don't forget to check out the Food Allergy Counselor Directory, the Exploring Food Allergy Families podcast, the Food Allergy Behavioral Health Resource section, and the allergy-specific therapeutic worksheets. And if you're an allergy-informed therapy provider, then visit the Provider page!

----> And don't forget to sign up to receive helpful allergy psychosocial tips and updates via email! Subscribers also get the free "Allergy Anxiety and Overwhelm Mini Guide".

Don't be shy - reach out and say hi! I look forward to hearing your thoughts on this post and other FAC content.

Do you value the Food Allergy Counselor Directory and the support it provides to the allergy community? Want to see it expand with additional providers? Contact founder Tamara Hubbard, LCPC for sponsorship opportunities!

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<<Previous

What Research Data Says About Food Allergy Anxiety

What Have We Learned About
Food Allergy Anxiety So Far?

Final Thoughts and Takeaways

Do You Find Content & Resources on
The FAC Useful For Yourself or Patients?

Fear-Based Messages About Food Allergy Mistakes

1. They Can Lead To Excessive Anxiety & Worry

2. They Can Lead To Setting Unrealistic Expectations

3. They Can Lead To Overparenting Behaviors

Focus The Message on Building Confidence:

Strike a Balance Within The Message:

Tips For Navigating Fear-Based Messages:

Unhelpful Allergy Beliefs

Quality of Life Impacts of Unhelpful Internal Beliefs

How Rigid Or Flexible Are Your Internal Beliefs?

Noticing Your Unhelpful Allergy Beliefs

A Practical Tool For Changing Unhelpful Beliefs

Final Takeaways....

Archives

Categories

FAC Resources

For THERAPY Providers

About

What Research Data Says About Food Allergy Anxiety

What Have We Learned About​Food Allergy Anxiety So Far?

Final Thoughts and Takeaways

Do You Find Content & Resources onThe FAC Useful For Yourself or Patients?

Fear-Based Messages About Food Allergy Mistakes

1. They Can Lead To Excessive Anxiety & Worry

2. They Can Lead To Setting Unrealistic Expectations

3. They Can Lead To Overparenting Behaviors

Focus The Message on Building Confidence​:

Strike a Balance Within The Message:

Tips For Navigating Fear-Based Messages:

Unhelpful Allergy Beliefs

Quality of Life Impacts of Unhelpful Internal Beliefs

How Rigid Or Flexible Are Your Internal Beliefs?

Noticing Your Unhelpful Allergy Beliefs

A Practical Tool For Changing Unhelpful Beliefs

Final Takeaways....

Archives

Categories

FAC Resources

For THERAPY Providers

About

What Have We Learned About
Food Allergy Anxiety So Far?

Do You Find Content & Resources on
The FAC Useful For Yourself or Patients?

Focus The Message on Building Confidence: