Recovering from Anxiety

Everyone experiences anxiety at one time or another. It is a normal reaction to a stressful situation such as having to give a speech, first day on a new job, a performance review, wondering why a loved one isn’t home yet and so forth. In such cases, anxiety can even be helpful to spur us to solve a problem or take positive steps to be prepared. Anxiety like this usually resolves once the situation passes.

But sometimes anxiety becomes ongoing, excessive or severe. We become locked into concerns arising from the past or fears about the future. At this point anxiety becomes a problem that leaves us living with paralyzing doubts and fears that disrupt our everyday life.

This type of steady, all-over anxiety is called a Generalized Anxiety Disorder (GAD). Other anxiety-related problems include panic attacks, separation anxiety, social anxiety and post-traumatic stress that happen in response to specific triggers. Obsessive-compulsive disorder, another type of anxiety, is marked by persistent invasive thoughts or compulsions to carry out specific behaviors (such as hand-washing).  Frequently anxiety in any form is accompanied by depression.

Children, teens, and adults, including seniors, can suffer from anxiety, although sometimes it is easy to over look the symptoms as “moodiness” of a particular stage of life. Generally, the overwhelming, persistent types of anxiety first appear during childhood. Evidence suggests both biological and environmental factors contribute to their onset. Some people may have a genetic predisposition to anxiety or early traumatic experiences can reset the body’s normal fear-processing system to be hyper-reactive to stress. Neither means anxiety is an inevitable condition, however.

If you believe you or a love one are suffering from chronic anxiety, ask for a short complimentary screening survey.

Steps to Recovery

Disabling forms of anxiety are a complex mix of mental, physiological and emotional ingredients that become entrenched as mental habits. Fortunately like other habits, these habits can be broken. Behavioral therapies, with or without medication, provide many tools that have been proven effective to re-train our brain to control anxiety symptoms. This is especially true in helping children who have anxiety.

If you or a loved one is suffering from serious anxiety, you can use the steps below to consider where you or they are along the road to recovery and which tools might be most useful at this time. When your anxiety is mild in nature or related to a transient circumstances or setbacks, you may find using this material on your own to be helpful.  If your anxiety is severe, long-lasting, or recurring and you can’t find your way out, counseling offers support and specific tools that enable you to take these steps successfully.

In some cases you may also want to talk with your medical doctor, if you have not already, about whether medication in combination with counseling would be helpful. Many studies show medication and counseling using CBT methods is the most reliable and effective approach to treating anxiety.

1. Understand the dynamics.

The emotion of anxiety produces an intense energy that is designed for taking action. The dictionary definition reflects its two-sided role. The first: “an uneasiness of the mind caused by a concern for the future.” The second: “an eager earnestness or intense desire.” This two-sided role of anxiety means that if we don’t use its intense energy to act on our concerns, the energy turns inward and builds up and we begin to feel a lot of pressure. If we still fail to take action, we soon feel as if we’re living in a pressure cooker.

As with all emotions, anxiety is a “bundle” of thoughts, feelings, bodily sensations and impulses to act. To better understand the dynamics of these bundles, try this experiment. When you experience either a pleasant or unpleasant emotion, check with chart below to see what’s going on. Notice the interplay of the different aspects of the bundle. You’ll discover that, as this chart illustrates, each element of the bundle affects the others. Change any one and the others will change.

 Often when we feel anxious we’re not aware of the presence of one or more of these elements. The most uncomfortable one(s) are the one’s we’re most likely aware of, but they are also the most difficult to change because we’re locked into what we’re experiencing most intensively. That is why, despite the urging of friends and family, it is rare that we can “Just relax.” or “Calm down” through willpower alone. But by bringing all four elements into awareness, we can use tools to change a more accessible element and thereby change the others more easily.

2. Recognize your physical symptoms of anxiety. Recognizing our physical reactions and using tools to change these reactions is often the quickest doorway to changing anxious feelings early before they intensify. Here are examples of common physical symptoms. Add any other physical symptoms you experience

• Rapid heart beat
• Rapid breathing
• Short of breath
• Indigestion or stomach achesSurge of energy
• Dizziness or feeling faint
• Restlessness
• Headaches
• Weakness
• Sweating or perspiring
• Trembling or shaking
• Muscle tension
• Confusion or fogginess that makes thinking or problem-solving harder

2. Recognize your feelings. Many words are used to describe the feelings associated with anxiety, although not everyone uses the same words to describe the same level of anxiety. Some words are commonly used to represent mild forms while others are more to describe intense forms. For example, we might say we feels concerned, frustrated or uneasy to describe a mild sense of anxiety. To describe a more elevated sense of anxiety we might say we feel worried, distressed or scared. At a very intense level of anxiety we might say we are feeling panicked or freaked out.

My husband Paul and I have created an Anxiety Meter to identify the particular words you use to describe mild, moderate or intense anxiety. By taking note of the words you use at the earliest signs of anxiety, the sooner you can choose specific tools to circumvent anxiety from escalating to more intense feelings that are harder to manage.

3. Recognize your thoughts.  Feelings of anxiety are accompanied by thoughts. Sometimes the most bothersome symptoms of anxiety are brought on by thoughts that won’t stop racing through our mind, by frightening mental images that keep flashing over and over like a movie  in our mind or by fearful possibilities we dwell on endlessly.

These stubborn tangled thoughts can leave us distracted. We may have difficulty concentrating or remembering details of daily life. Thoughts can also trigger an anxious episode or they can be a reaction to one or more of the other elements.  For example recalling an especially frightful memory might trigger a feeling of panic that in turn triggers further thoughts like “I can’t stand this.” “I can’t handle this.” “I’m falling apart.” These thoughts in turn might produce even more intense anxious feelings and bodily sensations.

If you are suffering from anxiety you know that simply “thinking positive” is rarely enough to shift your anxious feelings. But if you listen to and take note of the thoughts that accompany your anxiety, you can draw on many helpful tools to analyze, evaluate and change our thoughts in more truthful, realistic ways that reduce anxious physical symptoms and enable you to return to a sense of calm.

4. Recognize your impulses. Feelings of anxiety also trigger certain impulses to act. We might have an impulse, for example, to:

• Pace about
• Run away
• Hide in bed with the covers over our head
• Wring our hands
• Bite our nails
• Twist our hair
• Slam our fist on the table or into the wall
• Throw something
• Lash out verbally to whoever is around.
• Harm ourselves (i.e. cutting, scratching, pulling out hair)
• Entertain or act on suicidal thoughts

Of course impulses are not actions; they are mental precursors to action. We do not need to act on our anxious impulses. We can use them to alert ourselves to the fact that we are feeling anxious and need tools to reduce our anxiety level so we can think more clearly, make better choices and take useful action to address our concerns.

5. Establish and verify your safety.  Anxiety is fear generated by the mind.  We are not anxious in the midst of a real threat. Imminent danger produces fear, not anxiety. If we see a tornado bearing down on our home, if a brush fire is creeping down the hill side toward our office, if someone pulls a loaded gun on us, we don’t feel anxious. In situations like this we feel fear. Anxiety occurs in our mind when we imagine or foresee a possible danger.

Fear is a very helpful emotion for dealing with imminent danger. It charges us to right act NOW to protect ourselves. Anxiety is helpful only as warning from a mental construction of some possible danger. It can feel just like the real thing, but it is not. So, of course the first thing to do when anxiety arises is to check out the reality of your safety in the here and now moment. If you are actually in imminent danger you must take immediate action to protect yourself.

Because anxiety feels so much like fear, assurance of safety is very important to an anxious person. You can quickly assure your safety by bringing your attention into the present moment.  Focus on where you are physically in the moment. If there is a real potential for physical danger, such as an abusive boyfriend who has threatened your life or a child who has threatened suicide previously, you need to actively undertake precautions and protections. Reliable protections can greatly reduce feelings fear. But if you continue to worry and fret despite any actual imminent danger or once all possible safeguards are taken, you are suffering on-going anxiety – a mentally constructed fear-based habit that involves contemplating possible negative futures, of “what if’s, “could be’s,” “might be’s” or replays of frightening memories – that you need to free yourself from.

6. Bring anxiety habits into consciousness. Usually our anxiety cycles follow a habitual pattern. The cycle consists of a series of conscious or unconscious choices, beginning with a trigger of some kind. You might be anticipating an upcoming event such as having to make an important speech, the possibility of losing your job or a boyfriend cheating on you. Or the trigger might be your wife hasn’t arrived when expected, not having enough money in the bank to make the upcoming rent payment, a pending performance evaluation at work or an upcoming job interview. Or it could be a memory that pops up, the refrain of a song, a loud noise that reminds you of something bad that occurred. Or perhaps you or someone else is expecting more of you than is humanly possible and these impossible demands are piling up unbearably.

Sometimes we don’t know what the trigger is at first. The anxiety is just a vague feeling, a strange thought or an undesirable impulse. With or without awareness of a trigger, you can still notice the pattern of thoughts, feelings, body sensations and impulses that you habitually slip into when you’re anxious. Noticing the pattern takes anxiety off of automatic pilot and lets you see where you’re headed. We can think of the pattern something like a silver ball bouncing around a pinball machine, pinging wildly from one element to the other, lighting up one element after another, again and again.  By noticing your reactions, though, you can see the pattern for how each element of the bundle is setting off the others. Here’s an example:

In this example, the anxiety habit was triggered by feelings when making plans for a holiday trip. The pattern was feeling, thought, sensation, then impulse. Then round and round the feelings, thoughts, sensations and impulses went as this person grew more and more anxious.

Here’s how the pattern unfolded. “I started planning another holiday trip to visit my mother out of town (trigger) when I began to feel really nervous (feeling). My immediately remembered (thought) the typically unpleasant arguments my mother and I had on our last visit. I could feel my chest tighten up (body sensation). I thought to myself ‘I can’t do this.’ I wanted to pick up the phone right then and tell her I wasn’t coming this year (impulse). The thought of how disappointed my mother would be made me feel really guilty. Then I became short of breath (sensation). I was telling myself “Mother will be crushed. I have to go.” (thought). I wanted to cry.” (Impulse).  Tears started to sting my eyes (sensation) and I felt terribly sad (feeling). I had to go (thought). My stomach ached and my hands were shaking (sensations) as I nervously (feeling) started packing (impulse).”

7. Master tools to make new choices and shift old habits.

 There are two parts to recovering from anxiety. One is immediate; the other is long term. First we need to have tools for getting out of an anxiety episodes as early as possible when you have one and then we need tools for how to avoid having future episodes. The most helpful tools provide us with a means to choose to specifically alter one of the elements of the anxiety bundle – physical sensations, feelings, thoughts or impulses – because that will alter the others. Each is a doorway to awareness and point of power where we can intervene. Later we can use them to respond differently to triggers without becoming anxious.

Here are several examples of specific tools we can learn to draw on, first to get out of a state of anxiety and later to avoid getting anxious in the first place.

Avoiding or escaping (temporary)

Relaxation skills for managing arousal and escalations
Sensory awareness
Visualizations

Cognitive restructuring
Appraising the situation
Pattern labeling
Reality checking
Predicting outcomes
Self talk

Interpersonal communication and life management skills 
Active listening
Assertiveness
Conflict resolution
Chunking, prioritizing and organizing

Problem-solving skills 
Clarify the situation
Generating alternatives
Decision-making

Here are examples of how our anxious traveler might use some of these tools:

Sensation. Often noticing the body sensations associated with anxiety is the quickest and easiest way to escape a habit pattern.  As soon as our traveler noticed the tightness in her chest she could have taken a deep belly breath. This is a relaxation tool that brings oxygen to the brain, eliminates physical tension and clears the mind to figure out the next steps we need to take.

Feeling. When we are anxious we do not feel safe so one valuable tool is to create a visualization of a safe place where we can go in our mind to settle nerves and see things more clearly. At the panicky moment when our traveler remember the awful events of her last visit and wanted to rush to the phone, she could have calmed herself by traveling in her mind to a time and place where she was most safe and at peace.

Thought. When our traveler heard herself saying “I can’t do this.” she could have recognized it as a common thought that accompanies her feelings of anxiety and labeled it as part of her Anxiety Habit. By labeling the anxiety pattern she can then choose to shift to any other aspect of that bundle she wishes. For example, she might calmed herself by using self talk to remind herself that as an adult she has a choice whether to go our not and can take steps to be OK either way.

Impulse. When our traveler felt so anxious that she had a sudden impulse to call her mother and cancel the trip right on the spot without further thought, she was acting impulsively out of fear and might quickly shift her focus to the present moment by using sensory awareness. Concentrating, for example, on where she is sitting or standing, noticing the colors, shapes sounds, temperature and images of the room or other surroundings. Bringing our consciousness into the sensory present usually triggers one to take a breath (new body sensation) and notice that we are just fine, right here, right now, and can safely decide what we wish to do next.

These are only a few examples of how we can use the many proven tools to free ourselves from an anxiety habit. Sometimes they sound simple but when used consistently with adequate support they have been proven to be helpful even when anxiety has already become intense, long standing or severe. Many helpful tools can be learned through the Mindfullness Cognitive Behavior Therapy, a 10-week evidence-based program for recovering from anxiety, depression and bipolar mood swings.

Please contact me if you have questions, need additional information or would like help with recovering from anxiety.