Anxiety Management

Anxiety and your body

When we feel anxious a chain of automatic events occurs in our bodies, which prepares us for action. This reaction is often termed the “fight or flight” response and can be traced back into our evolutionary past. Imagine the primitive caveman threatened by a wild animal. He needs to be prepared for vigorous action: either to run or to fight. We still possess this survival reaction, although it is now triggered by more subtle situations – some of which we are not even consciously aware of.

The reaction itself consists of the brain sending a message to pump adrenalin into the bloodstream and into the large skeletal muscles of the arms and legs. The heart beats faster as it is working harder. Because it is working harder, it need more fuel so we breathe in more oxygen. To cool down the body, sweat and blood capillaries come to the surface. The body ideally needs to be as light as possible so a visit to the toilet might be necessary. When this chain of events occurs in a normal situation, for example if we are pushing a trolley around a supermarket or sitting in a business meeting, it can be very frightening. The important thing to remember is that the physical symptoms are natural and not harmful, but are appearing in an inappropriate situation.

The three systems of anxiety

Anxiety is often referred to as if it is a single phenomenon, but this is not the case. There are three parts to the feeling of anxiety:

a) Bodily sensations. These have already been mentioned – they include irregular breathing, churning stomach, sweating, trembling, racing heart and the need to visit the toilet.

b) Behaviour. This means the way you behave – that is what you do when faced with the situation you fear. Especially important is the behaviour of avoiding the situation, either not going into the situation, or getting out of it as quickly as possible.

c) Thinking. This includes your ideas and beliefs, your mental comments to yourself, or our mental pictures about what might happen to you in the situation you fear.

Looking at these parts separately, and learning new skills in each area, is an important part of anxiety management.

A. Managing Bodily Sensations

Meditation

This is discussed here. Provided it is done regularly, meditation induces relaxation during the meditation session and more generally.

Controlling Hyperventilation

Catch it early

If it has happened to your before, you may be able to identify the warning signs, e.g. a stifling feeling as if the window should be open, tightness in the chest, or noticing your breathing is fast. These should be your cue to:

1. Stop whatever you are doing and try to find a quiet place to sit down.

2. Close your eyes and focus on the word “calm” in your mind.

3. Try to release some of the tension in the upper body. Sitting in a tense hunched-up position increases the possibility of hyperventilation. Dropping shoulders in a sideways widening direction makes hyperventilation more difficult since the chest and diaphragm muscles are stretched outwards.

4. Breathe slowly from the stomach, not the chest. Breathe in to a count of four slowly and out to a count of four slowly. Or visualize your breathing-in as going up one side of a hill, experiencing a plateau at the top, and then breathing out as though going down the other side.

5. It may also help to place your hands with your fingertips together on your stomach; make sure that each time you breath in, your fingertips come apart.

6. Concentrate on breathing out.

The re-breathing technique

If your symptoms don’t go away after a few minutes it is likely that you haven’t caught it quickly enough, and you will need to use the re-breathing technique. This involves breathing in the air you have just breathed out. This air is richer in carbon dioxide and will thus quickly replenish the carbon dioxide you have been exhaling.

• Make a mask of your hands, put them over your nose and mouth, keep them there.
• Breathe in through your nose (if possible).
• Breathe out hard through your mouth.
• Breathe your own exhaled air.
• This should be done slowly and without holding your breath. Repeat four or five times (no more).
• All the time try to stay calm and relaxed.

It is even better to use a paper bag (not polythene) over your nose and mouth instead of your hands, if circumstances allow. Adjust your posture so that your elbows are on a level with or above your shoulders (this makes it difficult to over-breathe).

B. Managing Behaviour

Dealing with Avoidance and Facing Fear

Avoiding anything that makes us anxious is in some ways a natural reaction. However, avoiding some situations that create anxiety can lead to the development of phobias and loss of confidence. Once we begin to avoid things, we may find our mobility increasingly restricted.

When you either stay in the situation you fear, or deliberately put yourself in that position, your anxiety will go up, reach a plateau and then go down again. The first time you do this the anxiety will take time to subside. The second time you face the situation you fear, your anxiety will be less severe and fall in a shorter time. Each time you put yourself into that situation your anxiety will progressively be less severe and fade more quickly.

The best way of overcoming avoidance and loss of confidence is by tackling your fears one step at a time in easy stages. This technique is called graded practice or systematic desensitization. By identifying situations that you avoid, and gradually confronting them time and again, you can reduce the anxiety associated with those situations. It is important to practice easier tasks first, so as to build up your confidence before tackling more difficult situations.

Graded Practice

1. List a number of situations that you avoid because of your anxiety.

2. Describe the situations in as much detail as possible. Be specific. Rather than saying, “Going on a bus,” say, “Travelling, alone on the number 29 bus, into town, on a weekday afternoon.”

3. Rate how much anxiety you anticipate each situation will create on a scale of 0 – 10 where 0 = low anxiety, 5 = moderate anxiety and 10 = extreme anxiety.

4. Rearrange the situations in ranked order with the most difficult at the bottom.

5. Start with the easiest situation and practice it. If practice is to be helpful it must be (a) regular, (b) frequent, and (c) prolonged – you must go on practising until the anxiety has died down.

6. If something is too hard, look at ways of breaking it down into intermediate stages.

7. Do not be put off by feeling anxious. Remember you are learning to master anxiety rather than avoid it.

8. Reward yourself for your successes.

Examples

• Catching the no. 29 bus to the station, on my own, on Saturday morning. 5
• Going into a lift in a department store, on my own, on a weekday afternoon. 6

Overcoming a Specific Phobia

A specific phobia refers to an isolated experience of anxiety attached to a particular object or situation. It is different from a complex phobia where there are multiple fears and anxieties. Specific phobias are often of animals, such as spiders, snakes, cats and dogs; or illness and blood; or natural phenomena such as thunderstorms, lightening, wind, or heights; more unusually they can be of situations such as eating or even going to the toilet in a public space.

The characteristics of a specific phobia

1. An intense fear of an object or situation, which is out of all proportion to the situation that evokes it.

2. The person recognizes that it is unreasonable and irrational but cannot do anything about it.

3. The sufferer avoids the feared situation as much as possible and this process of avoidance interferes with the smooth running of their everyday life.

It is estimated that the incidence of phobia in the general population is between 2-3 percent. The specific phobias often have their origins in childhood fears that have failed to diminish with time. When looking at the development and maintenance of phobias, a number of factors appear relevant. There is often a family history of fear, phobia and avoidance; parents can often act as models for their children. If they are not acting as direct models, it is possible that they are subtly supporting the child’s avoidance behaviour. Often there is a traumatic experience that acts as a nucleus for the subsequent phobia. But the main factor that keeps phobia going is a marked pattern of avoidance behaviour. Avoidance reduces the immediate feeling of anxiety, which strengthens the likelihood of avoidance in future.

The treatment of choice for a specific phobia

1. Understand the process, development and maintenance of the phobia.

2. Gain some control over physical reactions of fear and anxiety, through relaxation training, breathing exercises, distraction and positive self-talk.

3. Construct a desensitization hierarchy of situations that you are afraid of. This is done by rating specific situations on a scale of 0 to 10, where 0 = no anxiety and 10 is equal to the worst possible anxiety. Be as specific and concrete as possible in describing situations.

4. Once a hierarchy is established, start at the top and work down by exposing yourself to the situation. The golden rule is that ultimately the only way to overcome a phobia is to face it directly. Stay in the situation of fear until you notice your anxiety going down. Once you feel comfortable with one situation move on to the next most difficult one.

Example of a desensitization hierarchy

C. Managing Thoughts

Positive Self-Statements for Coping with Anxiety

Preparation

• It’s not going to be as bad as I think.
• It won’t last long and I can cope with it.
• I might enjoy it if I go.
• If I do get bad feelings, I know they won’t last long and I can cope with them.
• It’s better to go than not to go. Worry doesn’t help.
• I am getting better and need to go to rebuild my confidence.

Coping

• Concentrate on what is going on.
• Concentrate on what I have to do.
• Remember to relax and think positive.
• This is just anxiety; it is an unpleasant feeling but I’ve never been ill.
• I can tolerate anxiety; I’ve managed it many times before.
• I know I’m going to be OK.
• The feelings are unpleasant but not harmful or dangerous.
• One step at a time.
• The feelings always pass away.

Praise

• I coped with that.
• I achieved that; I’m getting better.
• I handled that; it should be easier next time.
• I can be pleased with the progress I’m making.
• I did that well.
• If I keep this up I’m going to get really good at this.

Distraction

Thinking about unpleasant symptoms will tend to make them worse. We begin the “fear of fear” cycle, provoking further symptoms and preventing existing ones from disappearing.

It is difficult to simply turn your attention away from unpleasant feelings. To do so, two things are necessary.

• Be determined not to think about or dwell on the symptoms.
• Fill your mind with other things; distract yourself.

Distraction techniques

1. Mental Games. Do puzzles, crosswords or other word games, recite a poem, sing a song or count backwards from one hundred — all are useful distraction exercises. The important thing is that they take your attention away from the panic thoughts.

2. Environmental Focus. Concentrate on a specific detail of the world around you, for example, make words out of the number plates of cars or guess what people do for a living. Focusing on the outside world will prevent you thinking about what is going on inside.

3. Use a bridging object. This might be a photograph or a special brooch or a souvenir from a happy time. Looking at the object generates positive anxiety-reducing thoughts.

4. Physical Activity. Give yourself a task to do. This takes your mind off worrying thoughts. For example, hand drinks out at a party, change the music, or wash up after a meal. On a more general level, keep yourself physically active and mentally distracted from worrying thoughts by pursuing sporting activities — this is one of the best insulators against stress.

Mental Rehearsal

Mental rehearsal involves imagined, mental practice of performing a task effectively and it improves actual performance. Research shows that a combination of “imagined practice” and actual practice often results in better performance of difficult activities than if preparation relies only on actual practice. This applies to a wide range of activities, including those of sport, work, social and psychological coping skills.

As mental practice is perfect practice, it also boosts confidence as the experience of success increases confidence even if the experience is imagined. Mental practice should supplement other forms of skill development, not replace them. For instance, role playing effective listening skills and getting feedback on performances helps to develop those skills in ways that mental rehearsal cannot. Nonetheless, mental practice assists the skill learning process and provides the extra edge for those who have reached sufficient levels of skill development.

Just a few seconds to visualize successful performance can be helpful. More elaborate mental rehearsal, like the following, is even more useful.

A mental rehearsal procedure

1. Find a time and place where you won’t be interrupted.

2. Recline or lie down, and close your eyes.

3. Relax, concentrate, and focus. Take deep breaths and exhale slowly. As you exhale, imagine that stress is leaving your body. Start at your feet … feel all the stress leave your feet … then your legs … then your chest … all the way to the top of your head … feel all the stress leave your body.

4. Once relaxed, focus on the specific challenging task.

5. Mentally tell yourself that you are confident and that you have the ability to perform this task successfully. Repeatedly tell yourself, with confidence, that you will be successful.

6. Imagine what you will see just before you begin the task. Visualize yourself as an active participant, not as a passive observer. For example, to mentally rehearse putting a golf ball, imagine that you are standing on the green rather than watching yourself from the gallery.

7. While relaxed and focused, mentally rehearse successful performance of this task. Imagine going through the process and seeing successful results.

8. Repeat step 7 several times.

9. Finally, open your eyes and smile. You have successfully performed in your mind, which is great preparation for actual performance. You should now be confident that you will perform successfully in the real situation. Remember to praise yourself for being successful. Self-reinforcement is another a key to self-motivation.