What is Your Worst Essential Tremor Fear?

Without question, being diagnosed with essential tremor raises worries: Will it get worse? How bad can it get? Will I have to take drugs for the rest of my life? What if there are side effects? How will other people see me? How many doctor appointments will there be? What if I can’t drive?

Essential tremor, the most common movement disorder, can progress to the point where daily personal and professional tasks become challenging. Sometimes even impossible. Thus, a certain amount of worry is justified. The physical aspects of ET require that a person must be prepared for long-term problem solving, and be adaptable to what can’t easily be solved. As life goes on, one worry may begin to stand out as the ultimate consequence of having ET. It is the worst fear of all, unique to each person:

I will lose my job and we’ll end up in poverty…

One or more of my children will inherit ET from me…

I will end up in an institution unable to feed, bathe, or toilet myself…

…or many other fears.

Usually the worst fear never comes to pass, but many daily worries still pop in. It’s important to learn to manage these since constant anxiety can affect the body and the brain. Let’s take a closer look.

Worry and anxiety stem from our most basic need to survive. In the presence of danger—whether real or imagined, external or internal—the brain immediately prepares us to react by rallying what is called the fight-or-flight (or stress) response. Numerous physical processes rapidly increase our resources and energy. This biochemical surge equips and compels us to either run away or fight back. This is the state of anxiety. However, with ET you can neither walk away from it nor punch it in the face. If you could, all that biochemical anxiety would be discharged and your body would subside back to normal. This is the problem. The inability to discharge frequent ET-related worries by fleeing or fighting establishes a state of constant low-grade anxiety which in turn maintains a low level of the same biochemistry. This builds up biochemical residue from living in the constant shadow of fear.

A vicious circle

When the first alarm bell sounds (e.g., the diagnosis of ET), a part of the brain called the amygdala goes into overdrive and “memorizes” details of the negative threat, storing them so the brain will recognize signs that the threat may be about to occur again. The brain then uses these details as predictors of danger which triggers another biochemical surge. For example, if you were listening to a particular song on the car radio when you pulled into the doctor’s parking lot, you may find that in the future when you hear that song, you start feeling anxious and you don’t even know why. Now it becomes a vicious circle: details raise anxiety, anxiety records more details, leading to future raising of anxiety, etc.

ET can easily create this vicious circle. As a new challenge appears (e.g. the medication didn’t work and your doctor puts you on a new drug that makes you sleepy) it fulfills the expectation posed by your worry (there will be side effects). Now, each time you feel tired, it brings up another worry (I’ll be on drugs for the rest of my life). If anxiety and fear become more frequent or chronic, over months and years the body and mind suffer from the biochemical build-up:

  • Physical health – The immune system is weakened. Organ systems (cardiovascular and digestive) may develop symptoms, and we may look and feel older than our years.
  • Memory – The formation of long-term memories may become fragmented and distorted, compromising rational thought. We develop negative expectations, leading to more anxiety.
  • Brain processing and reactivity – Fear can derail logical processing of information, leading to being ruled by emotions rather than reflection, making impulsive or inappropriate decisions.
  • Mental health – Fear can lead to fatigue and even depression.i

Taking charge of fear

It’s important to identify the worries, anxiety and fears that accompany life with ET. Once you know what they are—including your very worst fear—it’s easier to cope with them in advance using logic and common sense. Use a journal or a trusted friend to help you list your fears and sort them from least to worst. Once you know what they are, here are some tips:

  • Lower your expectations – rather than aim for perfection, be proud of however close you get
  • Maintain a positive attitude
  • Limit alcohol and caffeine (helps stabilize your internal chemistry)
  • Take deep breaths and slowly count to ten
  • Take a time out when you need it
  • Talk things out with someone to generate practical solutions to problems
  • Read self-help or inspirational books that help you put your fears in perspective
  • Do what you enjoy (follow your passion)
  • Maintain a sense of humor

On the most practical level, remember that the biochemical surge can make tremors worse. While it seems unfair that tremors cause anxiety, and anxiety causes tremors, at least you CAN learn to control anxiety. Over time, you can break the vicious circle. Here are some more suggestions on managing anxiety.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Neurosurgery Associates.

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