As we slowly inch our way towards the end of 2020 and enter the winter period with colder and shorter days - not to mention the emotional rollercoaster that has, for many, placated the last couple of weeks - anxiety seemed like an appropriate topic to address this time around.
Anxiety has been an ongoing theme within this blog, particularly in terms of its correlation to diet and behavioral modification - which are great, albeit long term, solutions. What I haven't talked about, though, is what to do in the moment when acute anxiety strikes.
Anxiety is a tricky one. It can appear in many different forms, is experienced differently by everyone, and can be triggered quite easily - and by things we wouldn't necessarily expect. It's not an easy thing to control, and we can quickly spiral with catastrophic thinking - I know I definitely do! In fact, according to the World Health Organization, their 2017 report estimated that 264 million people globally suffer from some form of anxiety disorder - keeping in mind that: 1. many cases are unreported, 2. this percentage has likely peaked in this last year, 3. that anxiety disorders range from mild to severe, and 4. you don't have to have an anxiety disorder to experience anxiety.
Full disclosure: anxiety is something I've struggled with a lot, for as long as I can remember. I actually don't have a recollection of a time where I wasn't feeling anxious, almost like it has become a part of me. Which, I'm assuming, is why I say I'm anxious rather than I'm feeling anxious - thus distinguishing myself from my emotions - when I speak out loud about anxiety and am not mindful about my words.
My anxiety took a really big toll on my quality of life. I self-medicated through a lot of unhealthy habits for a really long time. It's only been in the last year & odd months that I've started getting a better grip on my anxiety, through a combination of the correct SSRI (selective serotonin reuptake inhibitor) & NDRI (norepinephrine-dopamine reuptake inhibitor), having a routine that includes weekly therapy, daily cardio (shout out to PopSugar Active for getting me through this second lockdown), yoga and work, and using a mix of mindfulness, CBT (Cognitive Behavioral Therapy) and DBT (Dialetical Behavior Therapy) exercises. I still have a long way to go, but things are rolling off my shoulders with a lot more ease and my catastrophic thinking is becoming a lot less frequent and lasts for shorter periods of time.
That little tidbit of personal information is two-fold: to underline the fact that I'm not trying to talk about something that I know nothing about, and to remind you that you're not alone. In fact, writing it down was a bit anxiety provoking ("What if this causes people to question my abilities as a therapist? What if people start thinking less of me?"... you get the drift.) but that just goes to show you - we're all a work in progress.
Anyways... Let's get to the good stuff. How do we deal with anxiety without unhealthy coping mechanisms? What are some ways to alleviate the bodily sensations that accompany anxiety, to calm down that tornado of thoughts in our head?
The idea here is not to stop anxiety completely. It's to achieve better emotional regulation - so that when our anxiety flares up, it goes away a lot faster.
Ways To Relieve Anxiety (Almost) Immediately
Have you ever noticed how, in some movies and TV shows, when there is a particularly emotional scene, the actor/actress will go and splash cold water on his or her face? Well, there's actually good reason for that, and the science behind it is pretty interesting.
When we're stressed & anxious, the amygdala (the part of the brain within our temporal lobes that plays a primary role in emotional responses and decision making) sends the hypothalamus (the area of the brain that controls the autonomic nervous system) SOS signals. The autonomic nervous system is comprised of two parts: the sympathetic nervous system and the parasympathetic nervous system. When SOS signals are sent to the hypothalamus, the sympathetic nervous system gets thrown into what we call "fight or flight". This creates a surge of energy (also known as adrenaline), allowing us to respond adequately to the perceived danger. Our heart starts beating fast, our breathing becomes quicker, our blood pressure skyrockets, our pupils dilate, we may even begin to sweat... simply put, we are on high alert, ready to take on the threat. The parasympathetic nervous system, on the other hand, has a completely opposite function. Also known as "rest and digest" (in comparison to "fight or flight"), the parasympathetic nervous system allows us to recover from stress, bringing everything back to normal.
Ice activates the parasympathetic nervous system when our sympathetic nervous system is in high gear, hitting the breaks on our physical and psychological response to anxiety.
Splashing your face with or dunking your hands in ice cold water, taking a cold shower, holding an ice-cube or letting it melt in your mouth, or holding an ice-pack can immediately bring your cortisol levels down. Not only does it distract you (lets face it, an ice cold shower isn't the most comfortable thing), it helps ground us through stimulating our senses, and activates our parasympathetic nervous system. A study done in 2015 found that cold-water immersion had a positive effect in stress and psychological fatigue reduction.
Act Like Everything Is Fine (DBT Technique)
Have you noticed any bodily changes when you feel a sudden wave of anxiety? Maybe your jaw clenches, maybe your muscles tense. There are certain ways that we react when we are in a state of emergency - some are unique to us, while others are more or less universal, such as quick & shallow breathing.
Acting as you would in a "normal" situation when stressed sends signals to the brain that everything is okay, that you're okay, and therefore the "fight or flight" response is not needed in this moment. As Mark Tyrrell explains it, by opening up our body posture, smiling, talking softly and calmly, breathing deeply and/or producing saliva (yep, we stop salivating when we're in fight or flight mode!) by chewing gum or popping a tic-tac in our mouth, we are changing the feedback loop to our sympathetic nervous system. We're telling it we're not in real danger, because if we were, we wouldn't be doing any of the above! As a result, by changing the feedback loop, our anxiety can be turned off a lot more quickly. Anxiety is rarely rational, so it's important to rationalize it through behavior changes when our mind isn't necessarily cooperating.
Note: even just doing one of these behavior modifications when acute anxiety strikes will help!
Jot It Down
One of the things that I value the most from this line of work is the wisdom and insight that my clients share with me on a regular basis. They have their own innate and innovative ways to manage their stress outside of our sessions together. While writing/journaling is something I'm a big advocate for, and is usually one of my first suggestions when managing mood disorders, I hadn't necessarily thought of the creative ways to implement writing in anxiety management - until some of my clients starting bringing up their own versions of journaling:
One of my clients recently told me how she was having anxiety about a specific topic during the week, and wrote it down on a list of things to bring up in our upcoming session together. As soon as it was written down, it was compartmentalized in her brain as something to work on in therapy, and the anxiety she was feeling in that moment went away until we were able to work on it together.
Another client of mine recounted writing negative thoughts on pieces of paper and burning them. She described the feeling of a weight being lifted off of her shoulders after having done that.
However you like to do it, whether that be through bullet points, single words, or full paragraphs - writing can help you get those anxious thoughts out of your head and onto paper. In fact, a study done by Dr. Schroder in 2018 showed that expressive writing reduced "error related negativity" (ERN) - a brainwave that is part of the electrical brain activity called event-related potential (ERP), and is significantly enlarged in people with anxiety. Offloading, as Schroder calls it, frees up mental space.
5-4-3-2-1 Grounding Technique
Grounding techniques are great to "snap" ourselves out of our anxieties - which are typically related to the past or the future - and to connect us with the present moment. It's a really versatile skill to have, as it helps with anything from panic attacks to dissociation and can be used anytime, anywhere.
The 5-4-3-2-1 technique engages all of our senses and taking in the details of our environment. With each step, either write, think or say out loud what you're observing:
List 5 things you can see right now
List 4 things you can hear
List 3 things you can feel
List 2 things you can smell
List 1 thing you can taste (or, if you don't have anything you can pop into your mouth, like a tic-tac, think of 1 thing that you're grateful for)
Cognitive Restructuring (CBT Technique)
This exercise can be a bit difficult, especially at first. It's definitely worth a few tries and, in my opinion, is well worth the effort.
Cognitive Behavioral Therapy is based off of the idea (dare I say fact?) that thoughts affect our emotions and actions. One way to tackle this issue is through cognitive restructuring - or, to put it simply, taking the time to pause and challenge our thoughts. The American Psychological Association defines cognitive restructuring as a technique used to help identify "self-defeating beliefs or cognitive distortions, refute them and then modify them so that they are adaptive and reasonable". This is a great technique to use in the therapy room (virtual or otherwise), but we can also do it outside of the session. There are a lot of different ways to approach cognitive restructuring, but I'll just mention the one that I think is the easiest to do on our own:
Note: it's important to focus on one cognitive distortion at a time. Don't try to tackle all of your anxious thoughts at once!
Decastrophizing (also known as the "What If" technique)
The two key elements here are to 1. identify the catastrophic thought (e.g.: A family member doesn't pick up the phone: something awful must have happened; if my partner leaves me, I'll be alone forever...), 2. challenge the catastrophic thought with evidence: remember relevant past experiences and, from there, judge whether or not it is likely for your fear to come true (e.g.: My father hasn't answered the phone before, and nothing was the matter. He's probably busy and will call me back later; Nothing in my relationship points towards my partner wanting to leave me, and even if my partner did leave, I've had prior relationships - if I've been able to find past partners, I can absolutely find future partners).
Other questions you can ask yourself if your thought is still causing distress: How frequently does this catastrophe occur in real life? What would the worst possible outcome look like? What would the best possible outcome look like? In the worst case scenario, how would you cope? Would you eventually be okay?
How do you deal with anxiety? Do you feel like you have a good grasp on it? Let me know through the comments below or by email!