Have you ever experienced that rush of adrenaline? A sense of your heart pounding? Maybe a sense that you can’t quite catch your breath, a tightness or pain in your chest, feeling dizzy or faint? Maybe these symptoms are accompanied by a sense of dread or a sense that you are going to die?
Me too! You may question, a clinical psychologist that has struggled with anxiety? Yes, I am human first and foremost, with my own experience of adversities which have meant I have some vulnerabilities to mental health difficulties. I have experienced those sudden states of intense fear, my heart beating so fast that I thought it would just stop and/or explode. I would experience an “impending sense of doom” and truly believed that I was going to die. It was terrifying and exhausting.
But, anxiety can be tamed. Let's have a think about what anxiety is.
What is anxiety?
Anxiety is typically understood as a feeling of unease, such as worry or fear. It is a very important defensive emotion, focused on threats, motivating us to do something. It is crucial for our survival. Anxiety is a normal and healthy reaction to a sense of danger and/or in a stressful situation.
When our threat system is activated, it is like a fire alarm in the brain, alerting and prepping the body for the perceived danger. It activates the sympathetic nervous system, known as the body's danger response. This then instructs the kidneys to release two chemicals, adrenaline and noradrenaline to serve get the body ready. This is usually understood as flight, fight, freeze, fawn, flop.
There are a variety of ways in which anxiety can then be experienced:
Heart palpitations: Blood pressure and pulse increases to move blood to the muscles to be able to "run or attack".
Visual changes: Eyes become alert to danger.
Breath faster and/or shallower: Allowing us to breathe in more oxygen to be transported around the body. As a result, you may feel short of breath or a sensation of "not being able to catch a breath".
Sweating: Adrenaline heats up the body, thus we need to sweat to cool down.
Tense muscles: Blood flow is prioritised to the limbs, ready to run or attack.
Racing thoughts: Our thoughts become threat focused, our logical and rational mind gets switched off! We can begin to feel detached or being unreal.
Dry mouth and digestion difficulties: When we are in danger, we do not need to be digesting food. That would only slow us down. Adrenaline diverts the blood flow from the stomach and intestines to the limbs (again, ready to run or attack!). This means we can develop a dry mouth, nausea, butterflies and/or cramps.
When anxiety becomes a problem
What about when we experience anxiety and there is no real danger? That is when anxiety can become a real problem and impact your daily life.
The World Health Organisation reports that anxiety related disorders are the most common mental health problem in the world. So, if you are struggling with anxiety, please know that you are absolutely not on your own.
Experiences of trauma have been linked to anxiety (e.g., The Unholy Trinity: Childhood Trauma, Adulthood Anxiety, and Long-Term Pain - PMC (nih.gov)). Perhaps this makes sense, given that traumatic experiences can lead you to be hypervigilant to threat, activating and prolonging your threat system. If you have experienced trauma and find yourself experiencing anxiety, please take a look at my blog that explores trauma and the different ways in which to help you manage.
Prolonged activation of our threat system can lead to "toxic stress". This is whereby the body fails to recover fully. Toxic stress can impact the body's ability to recover, and can lead to weakening of the immune system.
Understandably, a common response to anxiety is to "run away" or avoid a situation. These are examples of "safety behaviours". These behaviours offer short term relief however, longer term consequences include loss of confidence, increase in anxiety about said situation and an increase in safety behaviours.
Managing anxiety
Remember - You are not going crazy. Anxiety is a healthy response to danger. If it is becoming overwhelming and/or debilitating, then it's time to take action.
Here are some tips to try out if you are finding that anxiety is beginning to have power over you.
Get to know your anxiety.
Before you can begin to learn how to manage anxiety, you really must get to know your anxiety.
Everyone's anxieties are different, from triggers, to how they experience anxiety, to how they cope with anxiety.
It can be helpful to ask yourself:
What are the situations and/or things that trigger my anxiety?
How does my body feel when I am anxious?
What are my anxious thoughts?
What do I do when I am anxious? Does this help?
You may find it best to keep a record for one-two weeks. With the knowledge, comes the power.
Manage bodily symptoms.
As discussed above, anxiety can manifest with a variety of physical sensations. This is because of the sympathetic (threat) nervous system. You can "activate" your parasympathetic nervous system, bringing about a calming effect on your body.
Diagrammatic breathing. When we are stressed or anxious, we tend to breathe more rapidly, known as "hyperventilation", which can cause frightening symptoms in itself. By engaging in diagrammatic breathing, you can bring your parasympathetic nervous system online. To do this, place one hand on your chest and one hand on your stomach. Breathe out as much as you comfortably can and then take a slow and deep in-breath, allowing your stomach to rise. Slowly and evenly, breathe out through your mouth. Repeat this cycle for as long as you can comfortably manage. At first, you may feel that this is a little weird and uncomfortable however, with practice, you should begin to find this soothing and relaxing.
Progressive muscular relaxation. We know that when we are anxious or stressed, our muscles tense. However, sometimes they can become too tense and cause uncomfortable sensations. Progressive muscular relaxation is a technique aimed at relieving this tension. Start with tensing your hands, making a tight first, noticing the tension that arises. Hold for about five seconds before you let go. Notice how your muscles feel when you relax. Then repeat with your arms, face, shoulders, chest and abdomen, legs and then whole body. You can find a helpful script here: https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Panic/Panic---Information-Sheets/Panic-Information-Sheet---05---Progressive-Muscle-Relaxation.pdf
Move your body. There is an abundance of research that suggests that exercise improves depression and anxiety. Exercise can "use up" some of the adrenaline that is released when we are stressed or anxious. If you are physically occupied, you are less likely to ruminate on anxious thoughts, serving as an excellent distraction! Another good reason to exercise, it releases "feel-good" endorphins. Next time you are feeling stressed or anxious, move your body!
Practice Acceptance - The Unwanted Party Guest.
The unwanted party guest is a metaphor from Acceptance and Commitment Therapy (ACT). When anxiety shows up, the experience can be like having an unwelcome party guest arrive. It may make you feel uncomfortable. What options do you have? You could kick them out and guard the door, making sure the door is locked. However, they may sneak through the back door or through an open window. Or you may allow them to stay at the party, but watch them like a hawk. You may try your hardest to avoid and forget about them. Yet, this takes you away from enjoying the party.
This metaphor encourages us to recognise that avoiding unwanted thoughts and emotions can only get us so far. Instead, it encourages us to make room for these thoughts and emotions without attempting to ignore or suppress. By practicing acceptance, we are better able to enjoy the party that is life.
Here is a helpful video explaining this metaphor: https://www.youtube.com/watch?v=VYht-guymF4
Try "Dropping Anchor". A technique developed by Russ Harris:
Acknowledge your thoughts and feelings. Notice with curiosity your thoughts, emotions, memories, urges. Label your experiences, for example, "I am having the thoughts of x", "I am noticing anxiety in my chest".
Come back into your body. Connect with what is going on in your body. Ground your body, you could try pushing your feet into the ground, holding out your arms, holding yourself, or placing a kind hand on the place of discomfort.
Engage in the present. Notice what is occurring around you. Connect with the present moment. It can be helpful to use your senses, alternatively, engage with an activity that matters to you.
Try the Butterfly Hug.
The butterfly hug is a form of bilateral stimulation and is a highly effective tool in soothing your emotional state and to come back in to your body. Cross your arms over your chest, so that the middle finger on both hands is placed just below the collarbone, with your hands pointing towards the neck (it should look like a butterfly's body). Closing or partially closing your eyes (looking to the top of your nose), alternate moving your hands, like flapping the winds of a butterfly. Try to breathe slowly and deeply, whilst observing what appears in your mind and body almost as if you are observing clouds in the sky passing by.
Here is a helpful link to the skill: The Butterfly Hug (youtube.com)
Identify and examine your thoughts.
Anxious thinking can drive and trigger anxious feelings, which in its self can trigger anxious thinking. What a trap!
Once you have begun to understand your anxiety, you can begin to review the worrying thoughts.
We are all prone to a degree to exaggerated thinking. Here is a list of common biases in thinking. It may be helpful for you to consider how many apply to you and how they might affect your anxiety:
All-or-nothing: missing the range of possibilities that lie in-between, for example, everything is either good or bad, black or white.
Catastrophisation: predicting the very worst case scenario. This used to be a default of mine, it takes work but you can break free!
Emotional reasoning: assuming that how you feel is how the situation really is. For example, if you feel bad, assuming that you must be bad.
Jumping to conclusions: forming interpretations in the absence of facts to support your conclusion. For example, predicting the future or mind reading.
Disqualifying the positives: rejecting or dismissing something positive about yourself or life.
Unrelenting standards: using exaggerated expectations/ criteria for yourself and/or others. For example, using “shoulds” in your expectations of yourself.
Name calling: applying a negative label to yourself.
You can read more about common biases in thinking here: Unhelpful thinking Overview (health.wa.gov.au)
When reviewing the content of your worrying thoughts, it can be helpful to ask yourself the following questions:
Do they include any of the above thinking biases?
Are there reasons for having these worrying thoughts?
Are there reasons against holding these thoughts?
What is the worst thing that could happen and how would you cope? (Yes go there, be brave!)
What is a more constructive way of viewing this situation?
Is there anything you can do now? Can you test out your new conclusions?
Face your fears.
When we begin to avoid or escape a situation that causes our anxiety, we become less confident about being able to manage it in the future. Assess your fears. You can then proceed with tackling your fears one step at a time, known as graded exposure. This approach can help you to overcome your fear by giving you the opportunity to learn that you can cope in situations that typically cause you anxiety. By practising this, and remaining in the situation that makes you feel uncomfortable, you will find that your anxiety will reduce over time. Remember to set graded tasks.
Here is a step by step guide on creating your own graded exposure ladder for facing fear: https://www.therapistaid.com/therapy-worksheet/creating-an-exposure-hierarchy
Practice, practice, practice!