Tuesday, 19 Mar 2019
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How to Manage Anxiety: Sound Advice from a Mental Health Expert

We all know what anxiety can feel like; it can be utterly debilitating and soul-destroying. Many of us are familiar with the pounding chest where you feel your heart is about to explode. Your face flushes or goes suddenly quite pale. You can feel the blood draining from your face.

The panic inside you says: “People are going to notice you experiencing this. Get out of here!” And the stinging fear of embarrassment and humiliation can overwhelm you to the point of tears.

Such experiences can be completely terrifying. We often want to stop feeling these symptoms altogether, however we need to recognize that in many cases, experiencing anxiety actually serves us well.

Our brains are biologically wired to help us survive. What’s happening here however, is our innate fear response has become hyper vigilant in a way that no longer serves us. It’s working in overdrive when we perceive (often subconsciously) there is a threat to our safety but there may not actually be a physical and real threat.

There are strategies you can use to regain control but you will need to consciously learn how to manage anxiety and reduce the emotional, mental and physical experiences you’re suffering.

1. Work with a Professional to Identify and Get Familiar with Your Triggers

Your experience of anxiety will be different to the next person and the next person after that. It’s important to recognize that the specific prescription of tools and techniques that work for you will be different to how they work for someone else.

Spending time to recognize patterns and common features of your anxiety should be a primary step in your management and recovery plan.

Despite popular belief that we need to go back to the root cause of how and why your anxiety started, it’s important to know that sometimes significantly traumatic events and/or experiences are better contained in the box with the lid on. In other cases, accessing the catalyst can be a lengthy and experience and near impossible.

Working with a qualified and trained mental health professional can greatly help you to gently and safely assess and determine things which can derail you. Doing so will not only help you protect your emotional and mental health, but add a greater sense of control in mapping and identifying graduated steps to work through as a treatment plan.

Look to partner with a supportive, empathetic trained professional in your corner who can see risks and help you develop suitable tailored action plans to manage and reduce symptoms that trigger your symptoms. You’ll increase control of your own progress, and your growing confidence can exponentially increase your recovery than trying to go it alone.

If you can’t access face to face or group workshops, online therapy (e.g. Better Help or Talk Space) is becoming much more widely available. There are options available for everyone.

2. Have Breathing Techniques up Your Sleeve

The mistake often made by those in the throes of experiencing heightened symptoms, is trying to recall specific ‘helpful’ thoughts to eradicate the unhelpful ones in that moment. This doesn’t work very often. It’s like trying to open the door of a front loader washing machine just commencing a spin cycle to put more laundry inside!

If your symptoms are highly intense, such strategy is unlikely to succeed. Your mind is the washing machine, by the way.

The way we breathe has incredible power beyond simply inhaling oxygen and expelling it from our lungs. The rhythm, pace and depth all have significant calming and healing effects on us.

Neuroscience documents that by switching focus to managing your breath halts certain neurons sending panic signals throughout your body.((American Psychological Society: Breathing above the brain stem: volitional control and attentional modulation in humans)) The result is calmer physiology.

Making it your job to calm your breath first helps reduce intensity of those tangible symptoms screaming at you.

We breathe in two ways: through our thoracic region and through our diaphragm. The latter is the one you want to focus your attention to:

  1. Place your non-dominant hand, palm down flat over your chest and place the other just under your ribs on your diaphragm.
  2. Either close your eyes or drop your gaze to a 45° angle and choose a spot to loosely focus on.
  3. Draw a breath in through your nose, gradual, slow and smooth as silk for three counts.
  4. Hold the breath for a split second.
  5. Purse your lips and expel your breath again for 4 or 5 counts, slow, smooth as silk. Control the exhalation.

The next breath cycle, you may want to breathe in for three counts and exhale for five counts. Practice this for at least 5 cycles or at least till you start to notice you are physically calmer in some respects.

If you suffer from panic disorder,((Beyond Blue: Panic Disorder)) you can initially feel increased panic or anxiety doing this technique. Stop and practice again a little while later. You need to switch focus from thoracic (chest) breathing which is common during panic attacks, to diaphragmatic breathing.

Don’t wait until you’re in the heat of the moment to try putting the technique into effect. Practice during a time when you are calmer so your brain and body develop a familiarity of the process and what a reduction in your symptoms feels like.

Like a competitive sport, you practice off the court so that when you get on the court, you’re well familiar with what you need to do. You only need to press the proverbial button and let a more automatic, practiced process wield its magic. Practice.

3. Learn Grounding and Distraction Techniques Which Give Your Mind Something to Do

Such techniques are distractions. Do they get rid of your anxiety? Unlikely. Do they help to cope with and reduce the intensity of your symptoms? Yes, so that you can recalibrate yourself to a more organized mental state from which you can engage cognitive exercises that challenge and reframe unhelpful thoughts.

If you’re never thought games such as eye-spy would ever come in handy in your adult years, here is news for you!

Start with the letter ‘A’ and look to name everything you can see around you starting with ‘A’. Move on then to the letter ‘B’ then ‘C’ and so on. Search as far, wide and deep as you can looking for objects that start with your letter of focus.

Or, use colors. Work your way through the colors of the rainbow sequentially identifying as many things as you can that showcase that color. Fully immerse into the exercise and give your mind something to focus on. Spend a few minutes to do this.

A tangible grounding technique is to focus on what you have physical contact with. Pay attention to the sensations; how your bottom touches and squishes into the chair or your back muscles press into the back of your seat.

How do your feet feel in your shoes? How do your clothes feel against your skin? You’re tasking your mind with an activity which decreases capacity for it to focus on your present symptoms of anxiety.

4. Try Cognitive Behavioral Therapy (CBT)

Professor Jasper Smits and Professor Stefan Hofman have conducted extensive research into the most effective treatments for managing adult anxiety. They published findings in the Journal of Clinical Psychiatry from an extensive meta-analysis which revealed CBT to consistently have strong impact in the treatment and management of anxiety.((J Clin Psychiatry: Cognitive-Behavioral Therapy for Adult Anxiety Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials))

CBT involves addressing, challenging and reframing negative thoughts and re-shaping unhelpful behavior. A task-based, practical approach is applied to help clients recognize maladaptive thinking and habits, learn more helpful and positive ways to behave and think; and in turn, transform their symptoms.

For individuals to really experience benefit, undertaking regular applications of doable homework exercises is most effective. CBT is highly effective but requires individuals’ regular commitment.

Expect to work with a mental health professional on a weekly basis for three to four months. Find someone who won’t just give you homework sheets (that’s lazy therapy) but is closely attuned to providing you with good education, comfortably assess any resistance to change, and be able to modify and adjust exercises that best enable you to do them.

You won’t just experience a reduction in your symptoms because you develop such strong self-awareness and self-monitoring skills. You’ll learn mental skills that will strengthen your resilience and propel you further forward toward goals of how you want to feel, think and behave.

5. Try the Emotional Freedom Technique (EFT)

EFT which involves applying light repetitive pressure to meridian points, is becoming increasingly documented as an effective symptom reduction technique for anxiety.((Good Therapy: Emotional Freedom Technique)) Also known as ‘tapping,’ anyone can learn to self-administer it with the guidance of a practitioner.

In collaboration with professional associate Gary Craig, Clinical psychologist Dr Roger Callahan((Roger Callahan: About Thought Field Therapy | Meridian Energy Tapping | Tapping Therapy)) developed a simple yet effective self-administered process where individuals self-apply pressure to acupressure points on their body.

Using techniques from neuro linguistic programming and thought field therapy, individuals consciously lean into degrees of discomfort concerning their thoughts, feelings and physical symptoms.

Best learned under instruction and support of an EFT practitioner or trained professional, you initially apply mindfulness to consciously become aware of your anxiety symptoms – thoughts, feelings and physical sensations.

As you tap, you gradually start to experience relief and reduction in your symptoms. However, remember the level of impact felt will differ and progress at different rates from one person to the next.

Research shows that the positive effect of tapping is long lasting, particularly for anxiety disorders and post traumatic stress. It is becoming used more widely for other mental health challenges including weight loss, grief and loss, low self-esteem and confidence.

6. Use Imagery to Help Manage Anxiety

This is such an under-utilized but very powerful mechanism of our brain when it comes to directing our thoughts and behavior in a way to serve us, particularly in the context of anxiety.

Our brains are neuroplastic. We can train and rewire them to work better in our favor, yet we often live the majority of our day unconsciously by default.

Think about how many times you have day-dreamed today. When your tummy starts growling just before lunchtime, can you easily hook into images of what you want to satiate your hunger?

Often we engage imagery without thinking, but guided imagery is a key technique that helps with the reduction of anxiety with diagnoses of PTSD, social phobia and performance anxiety.((Front. Behav. Neurosci.: Coping changes the brain))

Your brain’s amygdala plays a key role in emotional regulation((Elizabeth A Phelps: Human emotion and memory: interactions of the amygdala and hippocampal complex)) and hence those emotions connected with perceived fear responses when you feel anxious.

Imaginal exposure therapy (vividly imagining the feared object, situation or activity) works to dampen amygdala activity and reduce the intensity of emotions experienced in anxiety. You have the advantage of visiting memories in a safe, controlled space interspersed with grounding/relaxation, and gently exposing your mind’s eye to that which you feel anxious about. Starting this process should be done with a trained professional.

7. Ensure Relaxation Techniques Are in Your Toolkit

Being anxious is exhausting. For those who suffer from general anxiety, your stress response mechanisms are constantly running, so you need to learn how to tell your body to relax.

Having a couple of meditative instructional relaxation apps you can instantly access through your phone should be on your list of essential management strategies.

In your choice of apps and relaxation techniques. consider choosing one which engages as many of your senses as possible. The more physical feedback you’re directed to notice a reduction in your physical symptoms throughout the relaxation exercise, the more likely you will stick to it and be motivated to repeat it.

Progressive muscle relaxation should be in your anxiety management toolkit. This method directs you to focus on noticing the different feeling between active tension and resulting relaxation when you release the tension of a muscle. Sequentially working through muscle groups in the body from head to toe, your mind is directing and telling your body to become calmer.

You need to be sensible with this one where you might be recovering from an injury or be at risk of developing a physical injury. Certainly avoid this exercise (and meditation) whilst driving.

Again, practicing this one at regular times throughout the day gives your brain and muscles a mental blueprint to relax such that it will be more effective in anxiety-provoking situations. Because you can also feel immediate tangible differences, it can boost your confidence earlier than starting with exercises that are purely cognitive.

The Bottom Line

Reviewing your diet and exercise regime is a given. Reducing caffeine intake, processed food and improving physical movement you engage in daily has incredibly strong impact and makes the strategies above even more effective when you do them.

However, for you to get a strong handle on how to manage and reduce your experience of anxiety, you’re going to have to develop a commitment to regularly applying changes.

If you don’t know where to start, get in touch with a therapist. Your first step is to develop a strong awareness of what you’re experiencing and what could be triggering it.

When you know and understand more, you can do far more in the pilot seat to land your anxiety back on the tarmac and potentially never let it take off from that runway again.

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