Reilly's Therapy Blog

Anxiety

Anxiety, like water, takes many forms. Water can just be water. But that same H2O can manifest as steam or as ice. It can be life-saving for a person who is dehydrated, or fatal for one who is lost at sea. But what of anxiety? Anxiety too takes many forms. It might raise its head as crushing panic. It might manifest as the sickening flashbacks of post traumatic stress. Then again, it might hang around like an unwelcome houseguest as generalised anxiety or trip us up as a baffling yet powerful phobia. Depression, too, is often fueled by unresolved anxieties.1,2 And certainly anxiety seems to be at the root of OCD of at least some people’s descent into addiction or compulsion as ‘self-medication’. Yes, anxiety is a many-headed SNAKE. In this piece, though, I want to focus specifically on discrete episodes of heightened anxiety. I’ll give you some really useful behavioural tips to help you minimize and control specific bursts of anxiety, such as panic ‘attacks’. The multi-pronged approach to treating anxietyIt goes without saying that we need to learn to relax more often. Relaxation is the antidote to fear and stress. Our behaviour is so often a reflection of what we feel and think, but because we exist in feedback loops, what we do also influences how we feel and think. There are many things we can do to help overcome anxiety, or at least align it so that it’s only there when it needs to be (to motivate us to fight or fly during an actual physical threat). Here we’ll focus on some behavioural interventions. 1. The mysterious power of chewing gumWhy is it, they wanted to know, that chewing gum helps them feel calmer in situations that would usually send them into a spiral of panic? I thought about this. Fear, of course, is a survival instinct. We need it to help protect us from physical threats. You don’t cure anxiety. You help align it, so that it behaves itself and works for you only when it’s really needed. Our instincts, at least in part, are blind. They take their lead, so to speak, partly from what we do and experience. To a degree we train our instincts the way we might train a pet or guard dog. Anything we do that sends the message to the fear instinct that we are not facing a present and immediate threat will cause the fear instinct to back down. Fear is a big investment of energy, and our bodies know that we need to conserve energy and not waste it. So our answer for the friend who sent the chewing gum question becomes clearer. One of the first things to switch off when your fight-or-flight response kicks in is salivation, because you don’t need to be eating if you’re trying not to be eaten! If you are in a tricky situation and you chew gum, the gum makes you salivate. This salivation feeds back to your fear instinct that all must be well, and so all the other symptoms of fear get reduced in a domino effect. By chewing gum in a usually stressful situation, our friend was sending the message to his instinctual mind that “this is so unthreatening that I can afford to chew and salivate!” Any behavior that contradicts the fear narrative, whether it’s salivating, talking, acting normally or staying instead of running, will start calming things down pretty quickly. So let’s look at what behaviours we can encourage in our anxious clients to help them tame their anxiety response. 2. Name the anxietyA 2015 study found that putting feelings into words can reduce physiologic symptoms of anxiety. In fact, the study found that the more words people used to describe their anxiety, the more their symptoms of anxiety reduced. This is really interesting, and something we can communicate to our clients. We can also tell ourselves that subjects in the research study didn’t expect that putting their anxiety into words would reduce their anxiety. But physiological testing showed that it reduced all the same. What’s more, the reduction in anxiety occurred regardless of whether the ‘labels’ people used for their anxiety were spoken or written down. So we might write down in a notebook, in some detail, the way they are feeling when they become anxious. We are encouraged to use as many extreme, even exaggerated, fear words as possible with the assurance that this can help dilute the actual anxiety. We human beings have an innate need to express ourselves. Putting experience into words can dilute its impact, as we have to use the left prefrontal lobe of the brain to verbalize in this way. Since anxiety is essentially an emotion expressed through the right hemisphere of the brain, this activation of the left hemisphere can reduce the experience of anxiety. But in order to show their instincts there is nothing to fear. 3. Face the anxietyIn nature we avoid what might be deadly. But in a more complex world, what we avoid starts to feel threatening even if it most certainly is not. To live a life of avoidance is to live a life of fear. A diminished life. If you want to convince your fear instinct that something is dangerous, it’s simple: just avoid it or avoid it when you come across it. If you happen to panic, for example, in a particular shop, and then run from that shop, as far as your fear instinct is concerned there is something deadly in that shop. Now, simply because you ran away from the shop, it might feel overwhelming, terrifying even, to go back into it. Had you stayed in the shop until you had calmed down, the instinctive conditioning might well have been different. If nothing had happened in the shop and you had regained a sense of calm while you were still in that shop, then the fear instinct would have had no cause to tag that store as a deadly threat. If you stay in a situation rather than run from it, then eventually fear switches off, because if the situation was really life threatening you’d run away. So you train your instincts partly by how you behave. Run away and the fear builds; stay and the fear diminishes. And it works the other way around too. People who make themselves calmly and repeatedly do something that is life threatening are communicating to the fear instinct that what they are doing is not deadly. Think old-time lion tamers putting their heads in lions’ mouths, those fearless souls shooting themselves from the mouths of cannons, or people repeatedly doing parachute jumps. Because they are voluntarily going towards these experiences, the fear response gets the message these experiences are not threatening. Of course, staying in a situation when you are panicking, or going towards a situation you are frightened of, is much easier said than done. But we can help ourselves to do this by: explaining why it is necessary to go towards what we fear, not away from it Using the other feedback alteration strategies in this piece Visit the feared place or situation in your mind while very relaxed and calm. As far as the fear instinct is concerned, to imagine a feared place or time is to experience it for real. 4. Breathe out the anxietyYour body, everybody’s body, seeks balance, or ‘homeostasis’. It is positively looking for a reason to calm down again. Fear is essentially the ‘exercise response’. If you are breathing hard, sweating, gasping and, after a time, shaking with exertion while on the treadmill in the gym, we do not call this panic. We call it exercise. But if your breaths are shallow, your brow is sweaty and your heart is racing when you are, say, sitting down during a meeting, this we don’t call exercise. We call it panic. Actually, the second example is effectively the body preparing for exercise. The symptoms of panic are so close to the symptoms of heavy exercise for a reason: because panic wants you to act in purely physical ways. No one is ‘attacked’ by panic, which is why I don’t like the disempowering metaphor of panic ‘attacks’. Rationalise it call it a panic of thoughts and this should instantly get you thinking why? Again, anything we do to let our instincts know this is not actually a situation that requires a massive investment of our energy will tend to balance out feelings of anxiety pretty fast. 5. Every breath you take.Now, one of the first responses to shift when we tag something as threatening is our breathing. We need to pump around more oxygen for all the heavy exercise our survival requires. What panickers (that is, inappropriate exercise responders) tend to do is gulp air. This is also what we do during heavy exercise, because our muscles need all the oxygen they can get. When we breathe in we activate the sympathetic nervous system – the part that has to do with fight or flight, heavy exercise and arousal. When we breathe out we activate the parasympathetic nervous system – the part that relaxes and calms us. People will often sigh (slowly breathe out) when they are stressed as their body seeks to balance out their arousal levels. We can teach ourselves, what I call, 5/7 breathing, which they can do as soon as they feel at all anxious. This method involves breathing in to the quick count of 5 (not 5 seconds), pausing for a moment, breathing out to the quick count of 7, pausing for a moment again, and repeating. The numbers don’t matter so much. The important thing here is that the out breath is slower and longer than the in breath. And this technique has a ripple effect. There are benefits beyond just directly and quickly calming the person: The focus on breathing is a distraction. The fear response, if it could think, might conclude: “I wouldn’t be focusing on my breathing if there really were an immediate threat!” But even before they focus on their exhalations, we can ask our clients to do something that will help them start to stand aside from the anxiety. 6. Grade the anxietyA year ago I was asked to present to around 20 people, I’d never presented to more than or 3, and suddenly, just before walking out to speak, I started to feel much more anxious than was useful for the situation. I decided to grade the anxiety on a scale from 0 to 10, 0 being no anxiety at all (which would be just plain silly before giving a big talk) and 10 being the most terror I could possibly experience. I decided I was at a 6. Already I’d done a few things to dilute the anxiety. I had reframed it from a feeling to a number. Thinking about numbers is not nearly as scary as thinking about fear. This diluted the fear and also forced me to use the cognitive or thinking centres of my brain, which so often become locked out or ‘hijacked’ by fear. I had put a limit on it. Rather than letting the fear escalate to terror, I had given the fear an upper limit. I had also taken back a sense of control. I had gone into a mindful, observing state. A part of me was outside of the anxiety, watching it. I was not in the anxiety now, I was ‘watching’ it. I then picked a number I’d be happy starting my presentation at. I decided a 3 would be fine. I began to breathe out slowly, and for longer than I breathed in (see tip two). When I’d breathed myself down to a 3, I walked on and began the talk. This took perhaps 20 to 30 seconds. As none of the audience tried to kill me or even screamed or yelled in my direction (amazing!), my fear instinct soon got the message this wasn’t, in fact, a deadly encounter. I began to relax, get into a flow, and even enjoy the experience. This may seem like a really simple intervention, but it can be incredibly effective. The vast majority of panickers can be helped through clinical hypnotic strategies and/or these behavioral ones. For some, however, discharging the energy might be the way forward. 7. Discharge the anxietyApart from being a powerful antidepressant, exercise is a way of switching off panic. When we, for example, sprint or perform push-ups or squats to the point we can’t do any more, we have in effect completed the fight-or-flight response circuit. A 2011 study found that “people with ‘high anxiety sensitivity’ – an intense fear of the nausea, racing heart, dizziness, stomach aches and shortness of breath that accompany panic reacted with less anxiety to a panic-inducing stressor if they had been engaging in high levels of physical activity.” So exercising more intensely, more often, will tend to lower anxiety generally. People who exercise regularly tend to be healthier mentally and less anxious than sedentary types. But sometimes we can prescribe some kind of exercise to do even as anxiety rises in the moment. In a similar case, a woman who felt unduly anxious before making a presentation at work was asked to do (out of sight of her audience) 50 star jumps as fast as she could. She found that once she had got her breath back she was ready to talk and felt “weirdly calm”. Her body had gone through the whole cycle of intense exercise. It now felt like she had survived an emergency, and she couldn’t help but feel calmer. Of course, all the usual sensible checks into health need to apply here. If we exercise intensely to the point we can’t exercise anymore then, as far as our instincts know, we have gone into the fight-or-flight response, and because we are alive at the end of it, we have survived the threat! It can be really hard then to panic. It’s as though some people need to complete the arousal circuit of fight or flight through exercise. This kind of intervention certainly doesn’t have to be as dramatic as the examples above. Simply doing 20 star jumps, or as many push-ups as you can manage (even if it’s not quite one!), will help de-potentiate panic. And that can be effective even some hours before the feared situation. Okay, lastly, we can encourage our clients to be AWARE. Lastly, Teach yourself the AWARE techniqueI sometimes give anxious clients a little card they can get out and use as a prompt whenever they start to find themselves feeling panicky. Create your own or for someone you know. AWARE, of course, is an acronym: Accept that you are feeling anxious, and also name it. Watch the anxiety, and even grade it. Act normal! Breathe as described in tip three, and carry on acting as though there were absolutely no threat. (If you talk, breathe calmly, and stay in the situation, you are showing your fear instinct it doesn’t need to tag the situation as threatening.) Repeat the previous three steps if necessary. Expect the best. You are taking control of the fear instinct and taming and training it. You can see that focusing on these steps, by reading them from a small card if necessary, incorporates many of the principles of the tips given here. In summary…To reduce anxiety quickly and effectively, teach your clients to: Understand how the fear instinct is led in part by what we do. We can train this powerful ‘guard dog’. Avoidance will build fear, while staying or approaching the feared situation will diminish it. Remember, this ‘approach’ can be done psychologically during deep relaxation to quickly retag the situation as non-threatening. Name the feeling, either out loud (if appropriate), internally, or by writing it down. Explain that this has been shown to lessen anxiety even in people who didn’t believe it would! Breathe out longer and more slowly than they breathe in. This will quickly turn off anxiety (which requires that we breathe in rapidly in preparation for heavy exercise). Grade their anxiety, then decide what number they would be happy with in this situation and ‘breathe their way down’ to that level. Utilize regular exercise as a way of minimizing stress and anxiety. You could even have them do short intense bursts of exercise before a stressful event if it’s practical to do so. Use the AWARE technique and carry a card with the steps if need be. Anxiety is there as an occasional power to be utilized in the (hopefully few) times it may really be necessary. To return to my water analogy, we can learn to swim or even surf the waves of adaptive stress – not sink into an abyss of fear. Just as we can use and harness water, we can use the alternating currents of stress and relaxation to build satisfying and meaningful lives. Helping a UPTV client overcome feelings of inferiorityThis client works as a hypnotherapist and knows she is good at what she does. She has helped people overcome terrible phobias and extreme PTSD, but whenever she speaks with academics or people she feels are highly qualified and “clever” she becomes tongue tied and feels inferior. She says she was constantly told she couldn’t learn throughout her childhood but is reluctant to talk about this. Mark reframes different kinds of knowledge (and tells a story about this during hypnosis). He helps her access times when she feels mostable and natural and seeks to link that feeling to times when she communicates with “clever people.” He also encourages her to communicate reassuringly and calmly with her younger self during one of those times she was “lied to” that she couldn’t learn.

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