Anxiety is a debilitating condition which affects many people (around 40 million adults in the USA alone). It often feels like a run-away train which is on a collision course with something immovable. People who suffer from anxiety frequently question their own sanity. Equally they may question their ability to survive beyond the attack. Many different areas of life can be affected by anxiety. It can quickly degenerate into a mechanism for habitual self-loathing. It is also important to recognize that there are different sorts of anxieties. For example, thought they share some common ground, social anxiety is different than Agoraphobia. Discussing each type is beyond the scope of this article. Therefore, this article focusses upon more generalized anxiety techniques.
Although anxiety is often equated as being stressed, it differs in an important way. Stress typically is a normal response to a threatening situation. For example, immediately before a sporting event, athletes may feel some stress. That the sporting event will take place is something real and immediate. The chemical reactions due to stress can have a benefit to the person. For instance, it primes them to do well.
Anxiety by way of contrast is closer to undue worry about the sporting event. An athlete may have a full-blown anxiety attack believing that when the event takes place they may have a heart attack – even though they are in peak physical condition. Anxiety typically has a lot of fear thrown in, whereas stress usually has an anticipatory element which does not overwhelm the person. Additionally, anxiety is usually future orientated. If I see a lion who looks like they are about to pounce on me, I would experience stress. If, however I imagined that a lion is going to pounce on me when I visit Africa, then that is much more likely to be anxiety.
The difficulty in separating out the two is that there often is significant overlap. An incident which stresses a person can quickly turn into anxiety. This is particularly true if the stress is not managed well. Stress can serve as a trigger for psychological fear and worry to set in. When someone is constantly bombarded by stress signals it is relatively easy for the body to respond with anxiety. The human body stress response is on hyper-alert. As such the body is flooded by stress hormones. In the sporting example presented earlier this flooding of stress hormones can be a good thing if it is situational and appropriate to what is going on in life. A way to think about anxiety is that a person’s nervous system becomes over sensitive due to being constantly flooded by stress hormones.
Anxiety disorders are real disorders which can cause extreme fear in a person. They affect:
|Common Physical Symptoms
||Common Cognitive Symptoms
||Common Behavioral Symptoms
- Chest pain,
- Heart palpitations,
- Shortness of breath,
- Stomach discomfort,
- Muscle tension,
- Sleeping difficulties.
- Exaggerated worry,
- Fear of dying,
- Repeated unwanted thoughts,
- Trouble focusing,
- Emotional numbing,
- Distorted thinking,
- Fearing the worse outcome.
- Unwanted ritualized behaviors,
- Heightened startled response,
- Avoidance of people,
- Avoidance of things or places,
- Being snappy with others,
“Anxiety is love’s greatest killer. It makes others feel as you might when a drowning man holds on to you. You want to save him, but you know he will strangle you with his panic.” ~Anais Nin
Anxiety is often left untreated which is part of the reason why so many in the population suffer from it. The reality is that anxiety is highly treatable. This cannot be emphasized enough. Granted it does take a commitment to heal from the person experiencing anxiety. But given a firm commitment anxiety can be managed to the point of being non-existent. If people would recognize that the stigma to seek professional help is unwarranted that would go a long way towards people seeking help. If you do suffer from anxiety particularly if its reasonably severe please seek some help. Usually, the therapy for anxiety is relatively short term and typically well worth the effort and expense.
What follows should not be viewed as a substitute for seeking professional help if warranted. I do hope that the material presented here does help people to combat anxiety and gives them a few more options and tools to work with.
Grounding Techniques for Anxiety
One of the hallmark features of anxiety is its ability to overwhelm a person. Anxiety with its future orientation spins the person out of control. The anxiety sufferer frequently feels ungrounded and for all intents and purposes is projecting negatively into the future with excessive worry.
Consequently, one of the first things a person can do is to bring themselves back into the present moment while grounding themselves. A technique which is highly amenable to doing so is called the
5-4-3-2-1 anxiety coping technique. It is a sensory awareness exercise which has helped many anxiety sufferers – it is also helpful in other situations as well.
The technique consists of the following;
Name 5 things which you can see.
Acknowledge 4 things you can touch.
Pay attention to 3 things you can hear.
Name 2 things you can smell.
Focus on 1 thing you can taste.
To help memorize the technique I have created an infographic linked below. Please feel free to download it, print it off and share it. Additionally, if you would like the infographic in a higher resolution please contact me and I will arrange for that to occur.
Another technique I often recommend to my psychotherapy clients is to place one hand over their heart and one hand over their lower stomach.
Allow the hand over the stomach to rise and fall as much as possible with each breath.
Pay attention to how your hand moves with the breath.
Fill and empty the stomach as much as possible.
At the same time, try and keep the hand over the heart as relatively still as possible.
Focus on your breathing, focus on your hands. Simply pay attention to them.
Do not worry about the thoughts, let them go, just focus on the above.
If you find yourself distracted by thoughts, gently return the mind to the breath and hands as soon as you notice you have become distracted.
Why these techniques are so effective is that it helps a person to immediately ground themselves in the present. A simple technique like holding an ice cube can also work wonders for the same reason. The extreme change in temperature forces the mind to focus on what is happening physiologically in the present moment.
Where Mindfulness Can Help
“Smile, breathe, and go slowly.” ~Thich Nhat Hanh
While we are discussing being more present and becoming grounded it might be beneficial to discuss how a mindfulness practice may help reduce anxiety. But first a bit of a cautionary note:
I do think that frequently mindfulness is over prescribed by practitioners. It is not the panacea it often is made out to be and in some cases, has been demonstrated to have negative effects with people. It is increasing popularity is not necessarily indicative that all is well on the mindfulness front.
Despite my reservations, there are aspects of mindfulness which to my way of thinking helps eradicate anxiety. At its roots mindfulness is a simple meditative technique:
It asks the person to observe their experience as it occurs in the moment without resistance.
For example, what is your current thought? Can you allow that thought to be? Can you allow that thought to pass? Watch the thought come and go. Keep doing this as each thought enters consciousness. When the mind gets caught up in a story (and it will) just return to observing the thoughts as they occur.
It is not uncommon for people to watch the breath as they begin a practice of mindfulness meditation. Simply watch each breath come and go. When the mind wanders and yes it will wander, return your attention to the breath. Another common method is to watch the sensations of the body as they occur in real time. Anything that can be focussed upon in the present moment is fair game.
Why mindfulness meditation is particularly useful in combatting anxiety is that it helps bring a person back to the present moment. One of anxieties features is one of a condition based in fear. This fear takes the mind away from the present moment and creates unnecessary worry about some future event which realistically is unlikely to happen. It is a mind which has run away with it itself out of fear.
It makes sense then that bringing attention back to the present moment is a good counter to the future orientation of anxiety. But there is another often-overlooked component to mindfulness which is equally important. It is the ability to fully accept the experience as it is.
Initially the above may sound counter intuitive – after all do we not want to be rid of anxiety? The paradox is that in fully accepting anxiety many of the secondary symptoms of anxiety dissipate. Anxiety has a trigger point which usually triggers our bodies to become tense, our breathing to become shallow and laboured and so on. If we follow the pattern of anxiety as it appears we notice that we almost immediately tense up in anticipation of what is to follow.
In fully accepting anxiety the normal apprehension of an anxiety attack is cut off. It is an effort to help the body to do the opposite of what it would typically do during an anxiety attack. A mindfulness practice helps to quieten down our brains which in turn gives us the opportunity to observe ourselves as we perform our daily functions.
Observing ourselves is an important aspect of dealing with anxiety. When we are observing ourselves as is often the case in a mindfulness practice it gives us room to create a little breathing space. For example, rather than getting caught up in the anxiety attack and having a fear that a heart attack is imminent, observing allows us to recognize that it is an anxiety attack and not a heart attack. The fear is reduced considerably.
Thus, a mindfulness practice has many of the right ingredients to deal with anxiety. Mindfulness is something that does require a continual practice. Its benefits work over a period as a person becomes more efficient at reducing the arousal and becoming more adept at relaxing into the moment. It is worth noting that like many worthwhile things some determination and persistence is required.
The Importance of Beliefs
When working with people in a therapeutic setting I like to take the acceptance one step further. Rather than seeing the initial stress signals of anxiety as a handicap, we can view them as something which is preparing us to perform at our best. Again, it may initially sound counter intuitive, but our beliefs about stress and in turn anxiety typically make matters worse. As noted earlier, stress can be a great signal to enhance performance under certain circumstances. It turns out that it is our belief and approach to stress which greatly influences how we are going to react to the stressor.
Psychologist Kelly McGonigal has an excellent TED talk entitled how to make stress your friend. While she is specifically talking about stress, the same phenomena seem to apply to anxiety (for instance, see this recent study http://www.apa.org/pubs/journals/releases/xge-a0035325.pdf)
This is a very informative video which I encourage people to view. More importantly try and put some of the things discussed into practice.
Challenging the Thoughts
As we are now moving into the cognitive realm of anxiety it is important to have some means of dealing with the cognitive distortions which accompany anxiety. Remembering that in its essence anxiety is irrational fear. Dealing with the irrationality which goes on in the mind becomes an integral part of healing. The link below is an article I wrote a while back that displays some common irrational beliefs.
If a person can recognise that they are experiencing anxiety, then it is easier for them to also see that there are likely to be irrational thoughts going on in the mind. One trick is to learn that having a thought does not necessarily mean that the thought is going to be true. In fact, in the case of anxiety, thoughts are frequently going to be misleading and often outright untrue. Hence a person is under no obligation to believe a thought – more so in conditions where anxiety is present.
A good approach to dealing with thoughts ties in nicely with the earlier discussion on mindfulness. Allow the thoughts to come in to consciousness but equally allow them to pass. Observe the thoughts as they come and go. As a side note this method tends to work well with ruminations which often accompany anxiety.
Another approach comes from the field of cognitive behaviour therapy. In this approach a more confrontational approach is taken towards the cognitive distortions. For example, a person can challenge the irrational fear of having a heart attack or fainting on the spot or going insane. A question that could be asked is how likely is it to be a heart attack as opposed to an anxiety attack? What is the evidence that insanity is about take over? Or is it more likely that the thought of going insane is a symptom of anxiety? Have I confused a thought with a fact?
Something which helps a person ease back into a more realistic cognitive framework works well. Often it is a good idea to do homework and be more prepared to deal with the anxiety attack. A person may identify the trigger to anxiety and then identify the sequence which follows. It may be that a certain thought triggers some emotion which then triggers some unwanted behaviour. Once the pattern is identified than a person can work out alternate responses to the trigger. Writing more appropriate responses down and memorizing them helps a person to deal with the unwanted thoughts. It also helps to write down easy to remember responses. Clients often remark how much difference the simple technique of writing down pre-made responses to anxiety has made.
While discussing thoughts, it is important to remember to not supress the thoughts. Several studies have demonstrated that suppression ultimately makes the anxiety worse. Instead of running away via suppression, use some of the acceptance techniques outlined thus far. Acceptance does not mean that a person should live a life full of anxiety. It only means that resistance to the initial onset of anxiety is minimized. As mentioned a few times now, allow the thought to enter consciousness but equally allow it to dissipate. This can be accomplished by developing some observation skills.
One of the keys to handling the negative thoughts comes in the form of reframing them into something more manageable – ideally they would be reframed into something more positive. For example, I once had a client who experienced a lot of anger in her life. In sessions, she would make a tight fist. I suggested to her, that she had a strong determined fist. Some of her ability to change then revolved around how she could best put that strength and determination to work. A person who is stubborn could just as well be thought as someone who persists.
The following are a few examples to help consolidate the idea of reframing;
Negative thought – I cannot handle this.
Reframed version – I have faced obstacles before and gotten through it. I will again.
Negative thought – I am sure something terrible is about to happen.
Reframed version – I am not sure what the future will bring, but there is a good chance it will turn out fine.
Negative thought – What if I have a panic attack?
Reframed version – I am going to attack the panic!
It is a good idea to practice reframing by writing down alternate positive statements. The more a person gets into the routine of reframing, the easier it gets. Keep at it is the take away message here. A couple of final points to leave you with.
Eat well. The impact of nutrition should not be underestimated when learning to deal with anxiety. Food impacts our mood. A good healthy diet should be maintained by anxiety sufferers. A visit to a nutrition expert may pay dividends in this regard.
Get outside. Some studies have demonstrated a link between vitamin D deficiency and anxiety. Sunlight is one of the best ways to obtain some vitamin D. As a side note, vitamin D deficiency is reaching epidemic proportions in many modern countries. Consider visiting your doctor and getting tested for vitamin D.
Relax. I can’t stress the importance of learning to relax. This applies not only to anxiety suffers but for the general population as well. A good way to learn to relax is to learn a progressive muscle relaxation technique. The video below demonstrates the technique.
Progressive Muscle Relaxation
I hope this article helps to some small degree. If you have some feedback or have some questions on this article please leave me a comment.