Managing Anxiety
Unraveling Anxiety
Introduction to Anxiety
Richard Dismukes, LPC
Anxiety is the most common mental health condition that people struggle with today. It is estimated that one-third of Americans have or will suffer from an anxiety disorder throughout their lifetime. Social isolation, increased involvement with technology and digital media, school shootings, community violence, global warfare, false news, climate change, and extreme political division are a few of the global issues that rest in the background. Add these to the personal problems that often wreck our world, and it is easy to see how our nervous system can spiral out of hand. This translates to teachers who lie awake at night worrying about their students, police officers chronically on higher states of alert, healthcare workers who are overworked and who put their health at risk, young parents who both work but still have a hard time making ends meet and who worry about their children’s future, and young people who are concerned about their safety and the future of the world. For these reasons, we all need to learn more about stress and anxiety and develop skills to help us cope. In this section, we will provide insight into how works anxiety and introduce positive strategies to help manage this condition. Topics in this section include:
Understanding Anxiety
Anxiety is a common condition that can be overwhelming and can drive many unhealthy behaviors, yet it can also be thought of as helpful in some ways. To understand these very different effects, it is necessary to understand what anxiety is and how it works.
The nervous system maintains a delicate yet ever-changing balance. It monitors our status and sends signals to different organs and glands to maintain this balance. When something goes wrong, or we perceive real or imagined danger, the nervous system responds and sends signals to the organs and glands to release chemicals to help the body respond. Your body's reaction to these chemicals is experienced as stress. Usually, the nervous system helps us cope with external or internal stressors; they are dealt with, and the body returns to balance or homeostasis. The body's physiological reactions (stress response) can range from mild to severe, depending on the threat.
The problem is that we cannot always tell if the signals from the body (feelings) represent a real or a perceived threat. If the threat is real, we adapt or cope as best we can, and our system returns to homeostasis. In this scenario, these feelings of fear or worry are protective and help us cope. If the threat is based on a false perception or excessively negative narrative about the threat, there is no resolution, and these feelings can become overwhelming. Our system stays on constant alert, and we can’t bounce back. This is when we develop high levels of fear or worry, and anxiety begins to creep into the picture. Anxiety is not just a psychological or mental state, as many think; it becomes a very real physical condition, and it has many nuances.
Anyone can experience anxiety or have a panic reaction, and everyone who experiences anxiety is triggered differently. The underlying physiological stress response system is biologically similar from person to person, but anxiety varies due to intensity, biological and environmental differences, and triggers. How safe we feel is critical to our mental and physical health. Anxiety occurs when we do not feel safe, but it is more than fear. It develops into a dysregulated state of the nervous system. It can be chronic, as in Generalized Anxiety; or specific, as in Social, Performance, and Separation Anxiety; or specific, as in fears or phobias, or it can be triggered automatically by any type or stimuli associated with previous traumatic events.
Anxiety can be overwhelming, completely debilitating, mildly problematic, or even adaptive and beneficial, depending on how you look at it. Some people are only anxious at certain times or situations, so it might come and go with some, yet be there constantly with others.
Stress can be healthy and is often beneficial as we prepare for challenging situations. The physiological “stress response” helps us cope and adjust when we face threats. We would not survive without this system. Stress—this feeling of fear or alarm—is beneficial when it motivates us to take positive action.
Anxiety builds when we are unable to bounce back or calm down after highly stressful events. It is a state of constant or high involuntary arousal of the autonomic nervous system. Anxiety is complicated when the individual attempts to consciously regulate their autonomic system, which is not under conscious control. This creates a conflict between the conscious and unconscious brain, which leads to conflict between the conscious brain and the body, and moves the person’s system further out of balance.
In the words of Stephen Porges, author of Our Polvvagal World, How Safety and Trauma Change Us
“While we evolved to be occasional tourists to the state of fear and alarm, some of us have become full-time residents.”
Anxiety is a complex emotion, and there are many ways to look at it. If you view anxiety as a part of our survival system, it becomes a good thing because the entire system is beautifully designed to protect us and help us cope with the struggles of life. The challenge is not getting stuck in a state of fear or alarm. When we trust our system, listen, and move forward, we can avoid getting caught up in a state of anxiety. The story we tell ourselves is separate from real-life danger; this narrative can maintain feelings of fear, panic, or dread, and this internal language usually sets into motion the condition of anxiety. Once it gets started, the anxiety tends to maintain itself because we feel panic or fear in the body and then cognitively struggle with repetitive thoughts that the threat must exist because we are feeling this way. As long as we keep feeling anxious, we keep thinking something is wrong, and as long as we keep thinking something is wrong, we keep feeling anxious. The body and the mind are in conflict, and we need to address this problem from a cognitive (top-down) and a physical (bottom-up) perspective.
Dr. David Hanscom takes it a bit further, “We must learn to love anxiety.”
“With our language ability, we possess what I call ‘cognitive consciousness,’ which is the capacity to describe these sensations. Meaning is given to our feelings, generated by these neurochemical reactions that reflect danger and safety.”
“Realistically, we’re always on some degree of alert for trouble, and there can be an endless stream of repetitive unpleasant thoughts. We call them RUTs, which are repetitive, unpleasant thoughts. And with physiology, how your body functions, RUTs can affect every cell in your body.”
So we are left with this paradox that anxiety can be terrifying because of the nature of the emotions or thoughts that come with extreme anxiety and the knowledge that anxiety is not our enemy; anxiety is just anxiety; it is part of our design, and it can be our friend. The idea is to not look at anxiety as something to fight with or a bad thing that needs to go away. This sets up an internal conflict that creates more anxiety. Anxiety results from the story we tell ourselves when our body is speaking to us; if we listen and respect what our body is telling us, we can change the narrative and learn to live with occasional anxiety. If we resist, try to control, panic or even push back against anxiety, we create an internal struggle that can take us into our darkest hours.
Stress vs. Anxiety
We’ve all felt stress before—it’s generally experienced physically in the body, like tension or discomfort. Sometimes, people mistake stress for anxiety, but they’re different. Everyone experiences stress, but not everyone experiences anxiety. However, excessive stress can lead to anxiety. Let’s take a closer look at this.
Stress is normal. It happens when we are threatened or in danger or perceive something as difficult, challenging, or more than we can manage. Stress is usually not a problem; it is the body's natural defense system. A reasonable level of stress is healthy. It helps motivate us into action and helps us cope with difficult situations.
Stress comes in many forms and may be caused by external things that happen to us, like unexpected bills, loss of relationships, job changes, bad weather, an argument with a friend, a big deadline, or a story we tell ourselves. Stress is also caused by internal conditions like negative thoughts, low blood sugar, allergies, tiredness or lack of sleep, toxins that get into our system, or medical conditions. Some people see stress caused by internal conditions as “false anxiety” because the stress response is a “normal” reaction under these circumstances, but these things can trigger anxious thoughts, which trigger anxiety when this condition is present.
If you have adequate skills to manage stress, it usually comes and goes, and everything is fine.
Anxiety is an internal condition that develops over time. The defense system becomes activated by excessive worry or fear associated with threatening experiences that can be real or imagined. Trauma or an extremely high-stress level can contribute to anxiety, but inadequate or unhealthy coping skills and the meaning we make of these experiences also play a critical role.
Anxiety is related to uncertainty about what we think might happen in the future rather than what is happening in the present. The brain typically tries to predict what will happen in the future based on past experiences. According to Justin Brewer in Unwinding Anxiety, Anxiety is born when the prefrontal cortex doesn't have enough information to predict the future accurately. When information is lacking, our pre-frontal cortex (PFC) can spin out endless versions of what might happen and what you should do, and you begin to feel nervous about the future. The PFC might shut down entirely, creating the conditions for panic. Anxiety is fueled by questioning thoughts, fears, and an overactive imagination, but actual environmental events usually trigger it. Anxiety can be mildly challenging or intensify into a highly uncomfortable physiological state.
Anxiety and stress share many common physiological characteristics, such as an increased heart rate and respiration, difficulty concentrating, gastrointestinal problems, difficulty sleeping, fatigue, restlessness, moodiness, muscle tension or pain, uneasiness, or even headaches.
When a person has an anxiety condition, it can be triggered automatically even though there is no real external threat; the threat is generated internally. Anxiety can cause an acute biological stress response, and in this way, it feeds itself. We play a role when we react to the biological stress response and interpret or make meaning that is not accurate. For example, a person might have a natural ache or pain. For various reasons, they go into a pattern of worry and rumination, a RUT (repetitive internal thought) that something terrible is wrong. This perception or story activates the body's defense systems, and we feel like we would if our thoughts were accurate.
Anxiety and stress are different. Stress is commonplace and adaptive. Anxiety can be all over the place, chronic, overwhelming, or mildly problematic on occasion. Physiological stress or “false anxiety” can be your body signaling you that something is off, which can be beneficial, but actual anxiety is a physical change in a person’s nervous system, which results in the person quickly and more easily going into or getting stuck in highly activated states of physiological arousal.
The autonomic nervous system reacts autonomically (unconsciously) when we are threatened. This can be a real threat when we make meaning or create a narrative in response to triggers or stimuli associated with previous stressful experiences. Triggers can be anything associated with a prior traumatic experience: thoughts, sounds, smells, places, a movie or TV scene, being in a crowd, a time of day, month, or year, or simply a feeling in the body. The anxiety-producing narrative is usually a very negative story that something is wrong, that something terrible is happening or is going to happen, that the person is losing control of themselves, or that they have made a mistake from which they cannot recover. These and similar narratives set the nervous system in motion. The body goes into flight or flight or the immobilized shut-down response. The person's narrative or the meaning the person makes of the trigger can intensify the feeling of threat. Sometimes, however, there is no narrative; the trigger automatically activates the nervous system due to previous learning or associations, as in post-traumatic stress responses.
How Anxiety Strengthens:
Anxious people often read into or make meaning of events that may be coincidental. This is usually a form of catastrophizing or overthinking. A person struggling with anxiety might notice a slight pain in their body, a strange feeling in the stomach, a slight from a friend, or they might have a very distressing thought. They begin to worry or ruminate, ‘What does this mean? They create a story that something terrible is happening. They wonder if something is wrong with them or if something bad is going to happen, and their anxiety causes a deep gut-level feeling that something is off. They look for an explanation, thoughts spiral, they must have done something wrong, bad things happen, things do not work out …!!!’ The person becomes miserable because they had a simple ache or pain. When the same thing happens to someone not prone to anxiety, they might blow it off. “Well, the person who snubbed me is in a mood.” Oh, well, the pain is nothing; I must have slept wrong, and they go on to think about different things. They don’t make meaning out of a minor irritation. The less anxious person does not experience the uneasy feeling and is not driven to interpret or try to make meaning out of the situation; they think realistically, ‘Life is difficult sometimes’ and accept that you can’t know what is happening with others or we all have aches and pains. Either mindset may have a grain of truth. Still, if you have a history of trauma or past negative and stressful experiences, then you are more prone to negatively interpret, need control, or make meaning of things, and you feed the anxiety. If you borrow from the non-anxious and ignore the need to figure things out, stop overthinking the situation, and trust your body, you are less likely to create a false narrative. Being in a state of anxiety increases the chances that you will generate a negative narrative, which feeds the anxiety that builds up over time.
Letting go and not trying to create meaning or overthink situations will reduce fear and arousal. When something triggers an automatic fear or threat reaction, figuring out what it means and why it happened is unnecessary. Instead, recognize that you have anxiety, which causes strong reactions, and try to let go. Say to yourself, ‘That doesn’t mean anything. I think it does, but thoughts are just thoughts. It is just a scary feeling, and it will soon pass. Become aware of your tendency to overly interpret or make meaning out of scary feelings, and challenge your thoughts and feelings. When you say, ‘I don’t know what that means,’ ‘It may not mean anything. It may just be a random feeling.’ you may feel a little vulnerable or exposed, but over time, you learn to be comfortable with a little discomfort, which brings anxiety down to a point where you can feel safe and learn to live with mild anxiety. Choose to drop the habit of ‘figuring out what things mean.’ Don’t let your mind dwell on that process. Tell yourself, “It doesn’t help to think about that.” After you try this for a few weeks, if you are more anxious than ever, you can go back to figuring out what everything means.
A person’s response to stress or anxiety is determined by many factors: genetics, environment, coping skills, and the intensity of a person’s experiences. We cannot control genetics or environmental experiences. Still, we can develop and implement better coping skills and knowledge of how the nervous system works, which helps us regain balance when our nervous system reacts. Learning to calm the nervous system, question the story, or move the narrative in a positive direction can be helpful. Let’s look at a one widely accepted theory of how the nervous system works.
Polyvagal Theory
Dr. Stephen Porges, Polyvagal Theory, From Our Polyvagal World, How Safety and Trauma Change Us.
According to polyvagal theory, there are three rather than two primary nervous system states. One system (rest and digest) is about safety, the green or the safe zone, associated with social engagement, compassion, clear thinking, calmness, and regulation of the body. This system is the foundation for mental and physical health; it is where we want to stay. A second system, the yellow zone, is the traditional sympathetic response, which is associated with fight-flight, panic, restlessness, reactive, rage, and anxiety. This system activates when we feel threatened. A third system, the red zone, is a shutdown or dissociative state involving blacking out, numbing, hopelessness, helplessness, and inability to engage socially. This third system helps us cope when we feel severe danger or are in a life-threatening crisis. Sympathetic arousal and vagus nerve shutdown (and possibly two other systems, fawning and appeasement) are natural defense strategies when we feel threatened. We respond automatically and viscerally (according to Dr. Porges, neuroceptively) before we are consciously aware. These systems take over depending on our perception of safety or threat, regardless of whether there is any real threat. One of these systems is always primarily in control, depending on what is happening, and the other two systems provide background support. When we are in the green zone, we are more capable of learning new skills, remembering, and interacting with others; the yellow or red zones take over when we are stressed or overwhelmed.
Polyvagal Theory contributes to understanding how we cope with severe trauma or a life-threatening situation. This third component of our nervous system is associated with immobilization, feeling numb, and going into an ancient state of paralysis. This happens literally in real life-threatening situations, but it also occurs metaphorically in many other situations in which a person feels overwhelmed. After trauma, people often shut down or become unable to cope with the demands of life. They may not be able to make decisions, go to certain places, or do certain things that were typical behaviors before the trauma. This shift occurs as a result of the trauma and often leaves people feeling stuck or unable to move forward in life. When we are threatened, the sympathetic nervous system goes into hyperarousal (fight or flight), or the dorsal vagus nerve shutdown system is activated, and we feel variations of anxiety and other emotions like fear, hatred, and anger. If we can regulate our system, we return to the green zone where we feel calm, safe, and friendly.
We need all three of these systems to survive, but it is more difficult to shift back into the green or safe system after the red system is activated. Being aware of these systems helps us understand what is happening inside. Getting stuck in the yellow or red systems is highly uncomfortable and creates a need for relief. Many people try to cope with these nervous system states by turning to addictive behaviors like drugs, overeating, overspending, relationship dependencies, porn or sexual addictions, or obsessive ruminations and unhealthy thinking patterns. Understanding how the nervous system works helps us create a safe space where we can learn coping skills that help us avoid these unhealthy coping patterns.
How Anxiety Disorders Develop
Chronic or high levels of anxiety can lead to an anxiety disorder. Healthy pathways or circuits in the brain designed to help us manage danger (yellow and red systems) become more easily triggered and activated frequently. Anxiety becomes wired into your brain, and learning about quick fixes, developing cognitive strategies, or taking medication may help, but they won’t unwire it.
The brain changes and adapts or learns in response to our experiences. When you experience extreme stress, high anxiety, or a panic attack, the way neurons communicate in the brain is altered. Circuits that are part of our natural defense system, which are activated often, become stronger and more easily triggered going forward. The more they are triggered, the stronger they become, and they are more easily triggered. In this way, structures and networks in the brain strengthen just like muscles in the body strengthen when used often. This “anxiety disorder” becomes a very real physical condition of the brain and the body, and it can be difficult to correct.
Common Anxiety Disorders:
The underlying problem is anxiety, but the triggers or conditions that elicit the anxiety are different:
Social Anxiety: Anxiety associated with being with groups of people, talking to someone new, or in social situations. Thoughts might be that you embarrass yourself or come across badly.
Performance Anxiety occurs when you are about to take a test, when called on in class or when you must perform for others. Thoughts may be about failing, falling short, embarrassment, or disappointing someone.
Separation Anxiety: When you leave, or someone leaves you. Thoughts might be that someone might be hurt, die, never come back, or something terrible might happen to you while separated.
Generalized Anxiety: Worry about various things, but worry is out of proportion to the actual impact of the event: negative thoughts, hypervigilance, chronic concern.
Specific Fears or Phobias: like Agoraphobia (fear of leaving a safe zone) or Claustrophobia
Panic Disorder: Excessive concern about additional panic attacks along with specific worries such as going crazy, heart attack, and losing control.
Anxiety due to addictions or medical problems.
Trauma and Stress-Related Disorders:
PTSD, Post Traumatic Stress Disorder
Acute Stress Disorder
OCD (Obsessive Compulsive Disorder) and related disorders.
Hoarding Disorder
Excoriation Disorder (picking skin)
Hair Pulling Disorder
Conditions that may cause anxiety
Adrenal tumor
Asthma
Alcoholism
Angina pectoris
Cardiac arrhythmia
CNS degenerative diseases
Cushing’s disease
Coronary insufficiency
Delirium
Hypoglycemia
Hyperthyroidism
Meniere’s disease (early stages)
Mitral valve prolapse
Parathyroid disease
Post-concussion syndrome
Premenstrual syndrome
Drugs that may cause anxiety
Amphetamines
Appetite suppressants
Asthma medications
Caffeine/energy drinks
CNS depressants (withdrawal)
Cocaine
Nasal decongestants
Steroids
Stimulants
Anxiety Driven Behaviors (Obsessive Compulsive Behaviors)
An anxious thought can lead to maladaptive behavior, like “need to tell” or “need to know” behaviors. A person who becomes anxious because they think their spouse may have cheated will frequently ask questions about where their spouse is, or they might become obsessed with tracking or checking up on their spouse. They feel reassured and less anxious once they find out what they need to know or when they say what they need to say, and their anxiety is temporarily reduced because they feel less threatened, but long-term anxiety is strengthened. Let me explain.
Compulsive behaviors temporarily quieten the (obsessions) thoughts that lead to the behavior. However, engaging in compulsive behaviors also increases the probability that the person will ask or engage in the compulsion again. What you practice grows stronger. Obsessive-compulsive behavior does not deal with the underlying problem of anxiety, but it is one way of coping with anxiety. The person may become convinced that their anxiety level is tied to knowing or being reassured, so behaviors of asking or telling become more likely in the future. A bad feeling (anxiety) going away is a net positive experience (negative reinforcement), so many behaviors, like arranging, straightening, or cleaning, are reinforced and strengthened by slight reductions in anxiety. Similarly, anxiety drives behaviors such as excessively apologizing or frequently seeking reassurance.
Anxiety and especially panic reactions become connected to the environmental situation in which they are experienced or with thoughts or feelings that become triggers. It seems natural to avoid the situation or engage in compulsive behaviors (that may be irrational) to reduce or cope with obsessions. Obsessions are thoughts, and compulsions are behaviors that help us cope with obsessions. This leads to obsessive-compulsive behavior patterns like checking, washing, ordering, arranging, cleaning, picking, avoiding, or hoarding, all of which reduce anxiety in the short run. Importantly, when reductions in anxiety reinforce these compulsive behaviors, the obsessive thoughts that lead up to the behavior are also reinforced. Understanding how this works can be very helpful in managing OCD.
This is complex, so let me repeat. When anxiety goes away or is reduced, this is experienced as a net positive (negative reinforcement), which strengthens the compulsion (behavior) and the obsession (thought) that occurred just before the behavior. These thoughts or obsessions are also reinforced (along with the compulsive behavior) as the compulsive behavior drives anxiety down temporarily. Hence, the obsessions become stronger and lead to increased anxiety because the compulsive behavior reinforces (helps to lower) the obsession or rumination. These increased obsessions actually strengthen the anxiety that the compulsive behaviors temporarily lower. Reductions in anxiety drive or strengthen compulsive or irrational behaviors, and various anxiety disorders emerge. A useful caveat is that this only works if anxiety is experienced as a negative or bad thing that we want to go away. The worse anxiety becomes, the more we want it to go away, and the stronger the obsessive thoughts and compulsive behaviors become.
This process changes the brain and becomes an automatic thinking pattern over which we may have little control. Take, for example, Hoarding, perhaps one of the easiest forms of OCD to understand. The person has the obsession (thought) that they will at some point need or want the thing that needs to be thrown out so they keep it (compulsive behavior), but now, going forward, they are more likely to keep things in the future, which reinforces the obsession that they may need or want that thing. Every time they repeat this behavior, the brain becomes more wired in this way and it can get out of control, all driven by anxiety.
Panic Reactions
When a person experiences extreme anxiety or a panic attack, the nervous system goes into full-throttle survival mode, and people may think they are going ‘crazy’ or having a ‘nervous breakdown.’ They typically do not understand what is happening and create a story or narrative about the experience and why. They might engage in bizarre, extreme, or superstitious behavior to cope or relieve themselves. Many people go to the ER thinking they are dying or having a nervous breakdown. Others go into a shutdown or dissociation that can immobilize them (Polyvagal Theory).
Anxiety can be terrifying to a person because, at that moment, the person is experiencing the same emotions or level of distress as if they were having a heart attack, dying, or having a “nervous breakdown.” If you believe this is happening, there is little difference between your perceptual experience and the real thing. In these situations, people become desperate and will say or do whatever they can to relieve or cope with this feeling. This level of anxiety is a severe condition that can and usually does have a devastating impact on the individual.
When anxiety is triggered and the person goes into a panic, this strengthens the biological cascade within the body. When this becomes severe or happens often, the person begins to dread or fear it will happen again. This develops into a cycle or pattern that feeds itself. People struggle with all sorts of thoughts associated with their anxiety experiences. As thoughts become more dysfunctional, the panic response becomes even more intense, and the overt behavioral impairment becomes more significant. The emergency defense networks in the brain become triggered and activated in the absence of a biological threat, and this pattern is strengthened each time the person goes into panic mode.
Therapist primarily focus on nonmedical approaches to anxiety. This does not suggest that we do not support medical approaches to managing these conditions; this is often necessary, but we are not trained or qualified in these areas. We highly recommend consulting with a physician or a psychiatrist when symptoms of anxiety are creating acute distress or interfering with daily function. Preventative medications to reduce anxiety and medicines that you take when anxiety becomes unmanageable (known as rescue medications) can be very helpful. We highly recommend consulting with medical professionals if you are struggling with anxiety. We also acknowledge that nonmedical approaches may be beneficial, but they are not always adequate stand-alone treatments for severe anxiety.
Tools for Managing Anxiety
There are various natural ways to calm down and reduce stress and anxiety. These methods involve deactivating the sympathetic or aroused part of the system and activating the parasympathetic or calm part. Although we have less control over the red zone, strategies still exist to mitigate it. These strategies are powerful and can be developed into healthy coping and stress management skills that can be utilized during times of excessive anxiety. However, dealing with anxiety and especially trauma can be challenging and usually requires personalized treatment interventions from a therapist, and these conditions often require medical as well as behavioral treatment. If the non-medical interventions are not helping, it is important to see a psychiatrist or a physician to discuss medical therapy options. Non-medical strategies for re-regulating the nervous system are briefly listed below.
Some people benefit more from the “top-down” approaches, which focus more on cognitive skills to help calm the system and increase safety by changing your thoughts (see our thoughts section). Examples of "top-down" strategies include:
Cognitive re-appraisal of unhealthy belief systems
Manage irrational thoughts or cognitive distortions
Expressive writing or journaling
Understanding anxiety and developing more awareness of triggers
Learning about how the nervous system works
Stress reduction strategies and increased positive internal dialogue or Attitudes about Gratitude, Forgiveness, Acceptance
Developing a more growth-oriented mindset
Building self-compassion
Developing Attitudes of Mindfulness and learning to be more present in the moment
Improving communication and Problem-Solving Skills
Other approaches focus more on “bottom-up” strategies for training the body to slow down, relax, and feel safe, along with strategies to generate more natural positive chemistry to counteract the effects of high stress. Strategies like breathing, meditation, yoga, discovering hobbies or activities that create “flow,” or increasing feel-good chemistry fall into the second category.
Some examples of "bottom-up" strategies include:
Breathwork (a powerful way to reset or hack your nervous system)
Meditation
RAIN (Recognize, Accept, Investigate, Note)
Prayer
Allowing yourself to experience Grief and Loss
Yoga or Mindful Movement Skills
Exercise (Increasing Heart Rate Variability) helps cope with panic
Diet/Nutrition/Sleep
Opening eyes wider to let more light in in the morning and open up curiosity (Judson Brewer: Unwinding Anxiety)
To manage anxiety, we need to focus on the variables that we can control.
Tools to Help Manage Anxiety
These strategies can help you remember and integrate calming practices into your daily routine. If you practice them when you are calm, they will be there when life becomes more difficult.
The acronym STOP is helpful when you struggle with stress or want to check in and deepen awareness in the middle of a task. It can apply to any task you don’t want to do, one you enjoy, or a moment of neutrality in the day.
S = Stop what you're doing
T = Take a few breaths
O = Observe what's happening internally and externally
P = Proceed with intention (choosing what would be best to do next)
These daily practices involve noticing and accepting while monitoring and strengthening control over your system. These are ways to bring yourself into the present moment by asking: What is my current experience? What is happening in my heart, body, and mind? Breathe. Expand the field of your awareness around and beyond your breathing to include a sense of the body as a whole, your posture, and facial expression, and then further outward to what is happening around you. These strategies help you calm your system and lower the chance of a panic attack due to a false signal of danger or threat.
Note the "stopping—choosing—starting—doing—finishing" task sequence.
Dr. Tara Brach suggests the acronym RAIN to help people work through difficult emotions without becoming overwhelmed.
R = Recognize and label the feeling
A = Accept the feeling without criticizing yourself
I = Investigate your experience by noticing the sensations that accompany the feeling and your reactions to the feeling
N = Non-identify: We are more significant than our thoughts and feelings; they are part of us, not us.
Other people use the acronym SLOW to remind themselves to SLOW down or to STOP and reaccess. These strategies are about pausing or slowing down to help reestablish control over your nervous system.
S = Slow down and take several full breaths
L = Listen to your body
O = Open yourself up to all possibilities
W = Work to be as calm as possible
Small Habits That Help You Fine Tune
Your Feel-Good Chemistry
Oxytocin
Doing Something for someone else
Hugging a pet or playing with an animal
Holding hands, cuddling, or looking into another person’s eyes
Yoga
Love and Kindness Meditation or notes to friends or loved ones.
Massage or self-massage of shoulders and temples
Socializing with friends
Chamomile Tea, Vitamin C, Sunshine, Warmth
Oxytocin is available as a nasal spray
Dopamine
Completing a task
Physical contact, like a big hug.
Listening to music
Spending 30 minutes a day in the sunshine
Physical Activity: Exercise will be different depending on how much you enjoy it – if you enjoy exercise, it will increase dopamine 2x above baseline).
Good night’s sleep
Chocolate will increase dopamine by 1.5x
Nicotine (when smoked) increases dopamine by 2.5x
Sex (pursuit and act) increases dopamine 2x
Amphetamine increases dopamine 10x
Close social connections that release oxytocin have been found to trigger dopamine release.
Take a cold shower. A cold plunge (the water temperature will depend on cold adaptation) can boost dopamine up to 2.5x above baseline and is sustained for up to three hours post-exposure!
Drink green tea
Deep breathing
Meditation
Create art like painting, writing, photography, or cooking
Eat fruit to increase tyrosine
Doing something new and interesting
Serotonin
Spend 5 minutes in nature
15 to 20 minutes in the sunshine
Eat bananas for the amino acid tryptophan
20 to 30 minutes of exercise each day
Smell lemon or lavender essential oils
Recall pleasant, positive memories
Get a massage
Laugh by calling a funny friend or watching a comedy
Practice gratitude
Supplement with probiotics to increase tryptophan
Eat good carbohydrates like apples, sweet potatoes, and carrots
Listen to music
Dance to music
5 to 10 minutes of mindfulness every day
Managing Panic Attacks
Managing a panic attack requires special strategies because of the extreme nature of the experience. Understanding what is happening and not fighting the panic helps to reestablish balance. Anxiety cannot be eliminated or controlled; fighting it gives it more power. When you try to get rid of anxiety, this equates to fighting your own body, which only creates more stress. It is difficult to remain calm and accept anxiety when alarms go off throughout your system, particularly when they are ringing at maximum capacity.
The critical question is whether there is any evidence of a real threat. We often have thoughts or beliefs that are not true. To determine whether there is a real threat, we need to get the higher cognitive areas of the brain involved. This is difficult when the brain's emotional and threat control areas are gobbling up all of the glucose (energy) in the brain. Awareness that you are having anxiety or a panic reaction allows you to try to respond in ways to relax and help your system calm down. Notice that you have anxiety and try not to react with more fear or by hyper-focusing on the trigger; instead, shift your focus on the recovery of control physiologically.
Several coping strategies can be helpful in the immediate recovery process. Because anxiety or panic can be so overwhelming, it is essential to plan and practice techniques to prepare if you think you might go into a panic reaction. Breathing strategies and approaches supported by acronyms like RAIN, STOP, and RESET outline a process of acceptance that immediately starts to diffuse or reduce neurological arousal and bring anxiety down. These approaches have multiple renditions or variations, but they all share common characteristics and help you regulate your physiology. They help, but they will not always prevent a panic attack.
Panic-Attack Strategies
It helps to move your body to reduce adrenaline and other stress hormones, walk outside or into wide open spaces, hold an erect posture and breathe slowly and naturally, or sit and place your hand over your heart or abdomen, feel the rising and falling sensations, and try to normalize or lower your breathing rate.
Shift your attention to sensory information in the present moment by counting, naming, noticing, or doing something specific and intentional like:
Count five things you can see,
Name three things you can hear.
Do three 4-7-8- Breath cycles ((Inhale to the count of four, hold for a count of seven, and exhale to eight.)
(Repeat)Name three things you can hear
Notice four things you are touching
Repeat the breathing cycle, try to slow breathing, and have a longer exhale.
Try to box breathe (inhale to count 4, hold to count 4, exhale to count 4, pause count if 4). Repeat three cycles
Notice something you can smell
Notice something you can taste
Count slowly to 100, or make it challenging and count by 3s
Cold water helps calm anxiety. Run your hands under cold water or wash your face. You can take a cold shower for 30 seconds, fill a bowl with cold water, hold your breath while plunging your face in for 30 seconds, or place a few cubes of ice in a ziplock bag and place it against your face.
If capable, write about whatever you are going through.
Expressive Writing
One of the most powerful ways to cope with anxiety and other challenging emotions is through expressive Writing. Suppressing thoughts and feelings can cause our body to enter “fight or flight” mode. Dr. David Hanscom has a website and a podcast in which he writes about strategies for managing anxiety and emotions that get trapped inside our bodies. He is an orthopedic surgeon who advocates for more non-surgical interventions to help reduce and eliminate physical pain. He uses expressive Writing as a preferred strategy for coping with emotions held inside the body. He writes t, “We need excellent tools in our coping skill toolbox that help us to express or process our thoughts and emotions, and expressive writing is a tool no box should be without.”
The Curse of Consciousness (By Dr. Hanscom)
Unpleasant thoughts are sensory inputs that our nervous system identifies as threats. So, the body’s response is “fight or flight.” Unpleasant, repetitive thoughts become rooted in our brains and aren’t subject to reason, and the more attention you spend on them, the stronger they become. They can cause phantom brain pain and multiple other symptoms like chronic pain. The thoughts are the threat, and uncomfortable emotions are the feelings this stress physiology creates.
Stress is a Whole Body Response to Threats
Stress and pain work both ways. Intense feelings can trigger, amplify, or even create sensations of pain where there is no apparent cause, and pain can often cause stress in our everyday lives. Many people who suffer from chronic pain complain of severe pain after a personal loss, like a family death or job loss. Often, a patient’s pain will resolve once they begin healing from their loss— even when a severe structural problem is causing it.
How to Do Expressive Writing:
Step 1: Write your thoughts on paper and try to lose yourself completely. Don't filter, censor, or overthink aloud! Don’t stop thinking or choosing words. Write and see what comes out.
Step 2: When you’re done, destroy it. Rip it up into itty bitty pieces and throw them away, burn them (safely), bury them, or shred them.
Step 3: Do this once a day for 5-15 minutes. Make it a habit, like taking a shower or washing your face. Even when your pain goes away, continue the expressive writing practice. This is just good emotional hygiene, like physical or bedtime hygiene.
Why Am I Supposed to Destroy It?
First of all, remember we can’t escape our unpleasant thoughts. Writing in this manner allows you to separate from your thoughts. As you write, many different things will come to the surface. These are not issues. They are just thoughts, and any time spent reviewing them reinforces them.
The second reason to write this way is that when your thoughts are not discovered, your genuine thoughts and feelings are more likely to emerge. You have broken up the need for mental control, the underlying problem, and the driving power behind them. You can write the thoughts down and then let them go.
Important!
Don’t force yourself to do more than you are comfortable with! However, some emotional
discomfort is normal. This is a long-term commitment so that small steps will work best.
View this process as just an exercise and an essential starting point and not as the only answer to breaking up obsessive thought patterns. Natural healing happens when our nervous systems shift into more pleasant circuits; they can’t do that without first letting go.
Why Do People Resist Engaging in this Simple Process?
It seems too easy to have enough impact on such a big problem.
• “I happened on it by accident without any idea it would have any effect on my prolonged suffering. Within two weeks after starting, I sensed a definitive mood shift, and six weeks later, I was beginning to feel much better. This after 15 years of struggling without any success. And If I stop for a few weeks, I am reminded of its power every time. About 3-5 of my symptoms consistently reappear and quickly resolve when I re-engage.”Humans need mental control. Writing breaks through this. “Letting go” can be troubling, and writing is a defined action that moves you forward. This need for control causes disturbing and disruptive thought patterns. Only write about what you can tolerate. If you start developing increased anxiety and agitation, you should immediately stop writing until you feel ready to start again. When you restart, start slowly and be gentle with yourself.
Your suffering isn’t being acknowledged. How can something so simple help heal your most intense pain? Research has shown that the impact of chronic pain on the quality of your life is similar to that of having terminal cancer.
• But Remember, this is just an exercise and a starting point. The healing process has other layers.
Precautions
Expressive Writing physically affects your nervous system activity, alters your metabolism, and changes the profile of your stress chemistry regulated through the autonomic nervous system, which is the nerve supply to internal organs.
Recap
We can’t unlearn old pain circuits, but you can build new ones and alter them to more pleasant ones that go past the pain circuits.
Expressive Writing helps your brain relearn and rewire its response to the experience that triggers the threat response and pain.
Other Strategies:
• Meditation
• Sleep
• Anger processing• Breathwork
• Exercise and dietMedicine
• Identify triggers“I have seen few patients deeply heal without engaging in this core exercise. The journey out of chronic mental and physical pain begins the day you start to write.”
Other Writing Techniques:
• Verbal Expression
• Switch to the 3rd Person
• “Air Writing” and other approaches
What To Say To Help A Child With Anxiety
1. It is ok to feel anxious. Validate or support their emotions and remind them it is normal to feel anxious and not anything to feel ashamed about.
2. I am here for you no matter what. Remind them that you are on their team and will listen or provide whatever support they need to feel safe and secure.
3. Let’s Breathe together. Remind them of their coping skills and put them into practice. Deep breaths can help calm our mind and our body. Inhale peace, exhale worry. Inhale safe, exhale fear.
4. Do you need a break? Go for a mindful walk, do an art project, or assemble a puzzle.
5. You can do hard things. Remind them of their strength and capabilities, and celebrate small wins.
6. These feelings will Pass. Feelings come and go like waves in the ocean. They are not permanent. Remind your child that this feeling will not last forever.
Megan K. Stack Posted on Instagram: At bedtime, the 8yo told me his teacher said: “Think of your mind like a pond full of fish, and each fish is a feeling. Try to be the pond and not the fish.” All I can say is that primary school has significantly improved.
