Managing Anxiety

Managing anxiety levels in the longer term takes time and may require application of specific techniques, such as Cognitive Behavioural Therapy (addressing the underlying excessive negativity associated with anxiety and depression), Compassion Focused Therapy (developing the capacity to self-soothe), Dialectical Behavioural Therapy (drawing on mindfulness and learning to tolerate emotions), Emotional Freedom Technique (tapping therapy combined with facing the challenge and affirmations), mindfulness (being present and accepting in the moment) and visualisation techniques. These forms of therapeutic practices take time to understand and persistence to apply consistently before they will be effective in the moment. Sometimes, there is a wish to relieve anxiety in the moment, without recourse to active long-term management techniques.

Activities which are successful in lowering anxiety will vary from person to person and the situation.

As anxiety is experienced physically (via the fight-or-flight system), mentally (through rumination) and emotionally (the distress associated with anxiety), activities to alleviate anxiety can operate in any of these modalities. Maintaining social connections, effective self-care and learning to tolerate strong emotions are also key to managing anxiety.

Physical activities

• Sleeping sufficiently is one of the most important ways to combat anxiety. Lack of sleep will impair the capacity to manage emotions effectively, make decisions and control impulses.

• Exercise has benefits on both the body and the mind. Specifically, bilateral stimulation, through activities which alternately activate each side of the body, has been shown to help with processing distressing thoughts and memories to lower anxiety, e.g. walking, running, swimming, dancing, climbing, cycling and some forms of gym exercise.

• Soothing rhythm breathing is a practice in which the person focuses on the in-breath (sometimes to a count or an app) and pauses momentarily before taking a slightly longer, slower out-breath, then pauses momentarily before returning to the in-breath. This practice slows down the body and mind and invokes the parasympathetic (rest-and-digest) system to counteract the stimulation from the activated sympathetic nervous system (fight-or-flight).

• Being in nature can lower anxiety, e.g. walking in a park or the countryside and gardening.

• Engaging in a ‘flow’ activity, in which the mind is fully focused and immersed in an active, challenging, satisfying experience, can act to temporarily block out anxiety, e.g. art, crafting and creative activities, constructing/renovating/fixing/DIY, gaming, solving puzzles, playing an instrument or singing, learning a new skill, reading, gardening, sports, planning a trip or event and, in some circumstances, work can be a flow activity.

• Challenging yourself with a novel activity can break a fixed mindset and bring about a sense of achievement and a change of mood.

• Tapping on points on the body can lower anxiety in the moment, e.g. two fingers of one hand tapping on the back of the wrist or the fleshy area which makes a V between the thumb and first finger on the other hand. Another area to tap is the point between the bones of the third and fourth fingers, half way along the hand.

• Certain tastes and scents may bring the mind back to focusing on the present, e.g. sucking a strong tasting mint, sweet or lozenge or using lavender or other calming herbal oils, candles or body scent.

Mental activities

• Meditation can be practised as simply focusing on the breath, bodily experience and an awareness of being present in the moment or by following a guided meditation as a more supported experience.

• Visualisation, calling to mind a safe and calming scene can take the mind out of the present distress to a less anxiety-inducing place. Guided meditations often use visualisation techniques.

• Mindfulness is being aware of one’s lived experience in the present moment. It is a practice of fully experiencing both the current internal emotions, thoughts and physical states and the external environment and situation. It encourages a sense of perspective that we are thinking, feeling beings who interact with others and the physical world around us in an ever-changing way from moment to moment. If we are ruminating on past events or imagining future situations, we become aware that these are thoughts in our minds, which lead to certain emotional reactions, but they are fleeting and do not define everything about us or our experience. The practice of mindfulness can be initiated simply by examining, in detail, what is currently being experienced internally and externally.

• Journaling (keeping a record of thoughts and feelings with a sense of curiosity and open reflective awareness) can support exploration of issues, facing up to difficult truths and may be actively used to foster a sense of self-care, self-compassion and mindfulness.

• Therapists use a technique called chairwork, in which the person is asked to adopt two or more personas, which are aspects of themselves, such as the Vulnerable and Anxious Self, the Vulnerable and Sad Self, the Angry Self, the Caring Self or the Rational Self and debate the issue which is giving rise to distress. The person imagines these personas as each sitting on a chair, discussing the issue with the other persona. It is possible to be in two minds over an issue and internal conflicts tend to drain energy. For example, a person may want to press forward with an activity (the Rational and Capable Self), but anxiety is holding that person back (the Vulnerable and Anxious Self). The two aspects ask each other questions and explore what the perspectives are, uncovering the negative beliefs in the process and working towards understanding and acceptance.

• Distraction from anxiety through watching a film, series or engaging in online activities may offer temporary relief.

• Resting, through simply stopping all activities and relaxing somewhere calm and comfortable is a self-caring activity.

Emotional activities

• Checking in on your emotional state is a way of acknowledging the validity of your current feelings. This practice is particularly important to develop for those who have been raised in or are currently living in an environment where emotions were or are denied, discounted and invalidated. Examples of this might be being told: “Big boys don’t cry!”, “The sooner you get on with it, the sooner it will be over!”, “There’s nothing to be upset about!”, “You’re over-sensitive”, “You’re overthinking this!”, “You’re upsetting yourself!”, “Calm down!”, “You’ve nothing to be upset about!”, “So many people have it worse than you!”, etc. Living with someone who is absorbed largely by their own needs can leave those around them struggling to recognise their emotions and address them.

When emotional states have been ignored or invalidated, planning regular, scheduled check-ins over the day may help. These may be supported by asking questions, such as: “How am I feeling in this moment: Anxious, distressed, upset, hurt, embarrassed, ashamed, guilty, grieving, low, frustrated, annoyed, angry or calm and content?” “Is there an association with  thoughts about something in the past which I’m struggling to work through and either resolve or accept”? “Am I anxious about a possible outcome in the future?” “Is how I feel affecting my behaviour towards myself or my situation or others”? “What do I need to do to support my capacity to care for myself and also meet my responsibilities, over time”?

• Self-compassion and self-soothing are important skills to develop in addressing anxiety. This could take the form of a visualisation of giving and receiving a hug and comforting words with someone trusted and caring (real or imaginary). It could, alternatively, take the form of saying a phrase out loud in a soft, gentle, warm and caring tone of voice, accompanied with a slight smile e.g. “I won’t always get everything right, but I care about myself,” “I’m feeling low and I’m giving myself a hug” (this can be accompanied by gently squeezing opposing upper arms), “I’m annoyed with myself, but I’m going to care for myself,” “I’m going to let this go for the sake of my well-being,” “I’m offering myself warmth and kindness to get me through this moment”, “This moment is hard, but I’m supporting myself through,” “I’m my own support team and will encourage myself through this challenge,” “I’m giving myself all the love and care that I need to go forward”. Self-compassionate phrases are personal and take a little thought to develop and practise to be effective in infusing them with the right positivity and caring sentiments.

• Humorous online clips, podcasts, television productions and audiobooks may lift a negative mood and mindset.

• Listening to music which either matches or opposes the current mood may allow fuller expression of emotions and shift mood.

Connection

• Feeling isolated is a factor in provoking anxiety and unfortunately, anxiety can lead to social withdrawal. Building social connections into daily life is a way to manage anxiety. Social activities may include physical contact with loved ones and animals, in person conversations with and video or voice calls to trusted, connected others. Online connections and cultural social events can also give a sense of being bonded to others in specific ways. When none of these options are available, helplines may offer the opportunity to discuss feelings and issues with another person. When feeling totally isolated, it is important that the internal dialogue is positive, in a caring and supportive way as sometimes the only person that you have to bond with is yourself.

Self-care and life choices

• When anxiety is a constant in everyday life and affects sleeping, eating, performance at work/study and relationships, it may be that more active management is required. Targeted techniques, such as CBT, CFT, DBT and EFT, as listed above, may help to reduce anxiety in the longer term. Where these are insufficient to manage anxiety effectively, medical assessment is indicated.

• Experiencing anxiety may be a signal that something is out of balance and that life choices need to be reassessed with a view to possible change. Effective self-care requires planning life in such a way as to support the need to meet essential responsibilities, while ensuring adequate physical, mental and emotional care. This may mean assessing the balance between well-being and responsibilities in order to make choices and compromises which are the best fit to maximise longer term well-being.

Tolerance

• Anxiety is both an evolved and learned response to environmental challenges and experiencing anxiety is part of the human condition. It can be seen as a signal to reassess the current activity to see whether it is still appropriate to the situation or whether changing the response or investing more effort would be of benefit. In this light, tolerating anxiety is the path to becoming resilient to life’s challenges, through building confidence that we can experience anxiety, along with challenges, and survive to live another day. It is not anxiety in the moment which is harmful in itself, rather our negative response to feeling anxious, which perpetuates the cycle – the fear of your own fear. This perpetuation of anxiety is based on our perception of the magnitude of the challenge and our capacity to meet that challenge effectively. So, the answer to managing anxiety is, at least in part, in facing life’s challenges head on and accepting that anxiety will be present and that we will get through. When we develop a positive, self-supportive and self-soothing inner voice to approach life’s problems, we are able to care for the more vulnerable, anxious self. This caring self is the key to managing anxiety.