Confronting anxiety with skills and support

Last month I wrote about anxiety disorders and the range of symptoms that can be involved with problems such as panic attacks, post-traumatic stress, phobias or generalized anxiety. Most of us have some stressful times when we experience what would be considered a normal level of worry or nervousness, but when anxiety reaches a level where it starts to interfere with our day-to-day functioning or causes us intense distress that’s not going away, then we need to think about seeking help.

For many, their first step might be to ask their primary care physician about medication options, and there are certainly situations when that is entirely appropriate. But even if the short-term use of prescription medication is recommended, in the long run we are best served by learning some new skills for dealing with anxiety symptoms when they arise. Medication is only one tool for the alleviation of anxiety, and I always recommend that we try to have as many tools as possible in our toolboxes so that we increase the likelihood of finding relief.

Psychotherapy for anxiety

Since anxiety symptoms can be physical (like your heart racing), mental (negative thoughts) and emotional (fear, embarrassment), the treatment for these disorders may focus on all three of these realms. The physical symptoms may be addressed with relaxation training or breathing exercises. The mental symptoms can be aided by learning to be more aware of what are called “self-talk” statements and then developing the ability to refute them when they are overly negative. The counseling approach that’s most commonly used is called cognitive-behavior therapy, or CBT. CBT is meant to be relatively short-term and focuses on mastery of specific skills that gradually enable the individual to return to activities that they’ve been avoiding due to anxiety.

Minding your internal dialogue

One of the underlying principles of CBT is that your emotional responses stem from your thought patterns. If what you are saying to yourself is something like, “I can’t give this presentation at work – what if I faint or can’t keep my words straight? Everyone will think I’m incompetent and I’ll probably lose my job!” then you are likely to feel anxious, upset, and scared. The CBT approach would have you examine those thoughts and see the element of irrationality. You might be able to generate a response like, “Yes, I don’t like giving presentations, but I’ve done them a few times before and they went OK. My coworkers actually seem to like working with me and respect the job I do. Truth is, I’ve never fainted in my life, so that probably won’t happen now.” The ability to be more rational does not mean that your anxiety immediately vanishes, but it is likely to have the effect of reducing its intensity and enabling you to feel more hopeful about getting through the situation.

Looking for red flags

I think that the most common start to an anxious thought is, “What if. . .?” What if I miss my plane? What if it rains on my outdoor wedding? What if I have cancer? What if I don’t get this promotion? We work ourselves up into a frenzy over events that are not actually happening. I’m not saying that they’re not possibilities, only that it often serves absolutely no useful purpose to “pre-worry” about all the negative possibilities. The response that I often teach for this is to see that “what if” as a red flag, as a signal to yourself to come back into the present moment. Right here, right now, things are usually just fine. Sure, making a back-up plan is sometimes a good idea, but then let go of running ten steps ahead of yourself, and know that you’ll cope with the feared situation if and when it comes up.

The only way over it is going through it

Another key principle of anxiety treatment is that the very response that we have when we’re extremely anxious – that is, to avoid the situation – makes it worse. If I’m afraid to ride in an elevator and my response is to always take the stairs, I might be quite fit from all that climbing, but my fear of elevators will remain. CBT makes use of exposure therapy, meaning that I have to repeatedly expose myself to the feared situation in order for the anxious response to go away. Yes, I’ll probably be pretty nervous the first several times I do it, but I’m also learning strategies for coping with those nerves in order to tolerate the ride. Every time I’m able to successfully get through the feared situation, I’m building evidence for myself that it’s not so awful that I can’t manage it.

Self-help strategies for managing anxiety and stress

There are plenty of things that we can do on our own to reduce anxiety, even if we don’t seek professional help. Frankly, I think that even the most laid back among us would benefit from these pointers.

  • Exercise regularly – we should all do this for our general health and fitness, but it can also serve as a great stress reliever.
  • Limit (or eliminate) alcohol, caffeine, and tobacco use, which can aggravate anxiety.
  • Breathe! Focusing on the rhythm of your own inhale and exhale can act as kind of an anchor, helping to dissipate some of the physical symptoms of anxiety. Practices such as yoga, meditation, and tai chi often incorporate breathing as a focus of attention.
  • Stay connected socially. Talk to friends, family, or trusted coworkers. Get out and have fun in your free time. Volunteer or participate in an activity that you enjoy with others. Social relationships are good for our physical and mental health.
  • Laugh! A sense of humor can help us through the most difficult challenges in our lives. The ability to laugh at our own foibles makes them seem a lot less worrisome.