Anxiety Management 101

This post will be quite long and yet it won’t go deep below the surface. The topic is simply too complex to fit into text unless we call that one text a book. I will outline different levels at which anxiety management makes sense and provide examples that can jumpstart your own exploration. Patience and self-compassion will be your allies on this journey and readiness to experiment a prerequisite for starting it.

Unfortunately, there are no quick and easy solutions when it comes to human psychology.

Who needs anxiety management and who needs more than that? 

We all feel anxiety from time to time and there’s nothing we can do about it. Like sadness, anger, shame, but also joy and happiness - anxiety is a part of life. Managing anxiety is a life skill so anyone can benefit from it. There are situations where seeking psychotherapy or psychiatric care might be more important than learning management strategies on your own or working with a life coach who doesn’t have appropriate training to responsibly help you. Some of these situations are the following:

• You feel like anxiety is crippling and is interfering meaningfully with your work, relationships, or other parts of your life.

• Your anxiety is extremely difficult to control, and it overwhelms you frequently.

• You’re turning to drugs or alcohol to cope with anxiety.

• Anxiety is leading you to have thoughts about suicide (if this is the case, seek treatment ASAP).

• You suspect that anxiety may be caused by another health issue such as a thyroid disorder: psychological techniques are all well and good, but first eliminate any physical causes, otherwise they make no sense.

• Anxiety has severely affected your quality of life.

If you don’t meet any of the criteria above, please proceed! If you do, you can certainly benefit from everything I’m about to write, but you might want to consult someone for face-to-face therapy or medical treatment. 

1.  Get to know your anxiety

Anxiety – and, indeed, anxiety disorders – come in many shapes and forms. You have your generalized anxiety, your phobias, panic disorder, social anxiety. Anxiety is the fundamental symptom underlying BFRBs (body-focused repetitive behaviors) and OCD. Anxiety often comes into play with mood disorders too. When it comes to psychopathology, pretty much wherever you turn, you’ll find anxiety just around the corner.

In addition, anxiety is one word that covers a plethora of different manifestations. Precisely because of this, it’s important to get to know your anxiety well before you decide how to manage it. Why? If you were struggling with a somatic problem, you’d want a precise diagnosis to determine what therapy you need, instead of your doctor prescribing a random drug that they feel might be helpful… correct? Well, the same applies here. If you want to work with your anxiety effectively, you’ll need to know exactly what you’re dealing with. 

Sometimes, anxiety is more of a mental thing. For example, your brain can be hyperactive, and you might struggle to stop worrying. This can lead to additional symptoms like insomnia, or even panic. You might have a sense of impending doom, or you might experience very difficult and repetitive thoughts that distract you from whatever it is that you want to focus on. These thoughts could deal with practically any topic, but it’s fair to say that generally, they tend to feed into out fears. If you are afraid of failing, you might have a ton of thoughts about all the possible ways in which you could fail, eventually making you so anxious that you actually do fail. If you’re afraid of rejection, you might become hyper-perceptive to all the little gestures or subtleties of other people’s behaviors to validate your fear. You might experience problems focusing. Behind the scenes, your fears and insecurities fine tune your perception and your thinking to further amplify themselves. 

Anxiety can also be quite physical, and it can affect nearly all of your systems. Here’s a brief overview.

Skin: itchy skin, sweating

Digestive system: altered bowel function, nausea, dry mouth, abdominal pain

Uro-genital system: frequent urination

Muscular system: tremors, fatigue, tension, twitching

Respiratory system: shallow fast breathing, sighing 

Neurological system: tension headaches, vertigo

Cardio-vascular system: tachycardia, palpitation, chest pain.

Get to know your anxiety (questions/ journaling prompts)

• What is your anxiety like in your mind?

• What are the dominant physical symptoms of anxiety?

• How does your anxiety evolve – is it (or: when) slow and gradual or sudden? 

• What is the first symptom that you become aware of?

• What is the opposite of anxiety for you, and when do you feel that way? 

• What typically triggers your anxiety? Take a step further: when are you triggered by internal experiences (thoughts, memories, etc.) and when are you triggered by external circumstances?

• Take a step further: do different triggers trigger different types of anxiety? 

 2. Have first aid tools ready

If your anxiety is mainly related to your thoughts, you may want to consider some of the following techniques:

• Focusing exercises or mindfulness – for beginners, I recommend an app called Meditation & Relaxation by Fitness22; they are short and well times, and they have specific meditation that deal with concentration. 

• Cognitive defusion – there is no use in arguing with your thoughts. Think of that as just feeding them additional energy, energy that you’re losing and that they are gaining. Instead, it’s much more practical to “unglue” yourself from your thoughts. When we take our thoughts as true or real and when we understand them literally instead of metaphorically, that’s when anxiety and fears arise. There are many ways to defuse thoughts, some include saying them out loud in a funny voice, or singing them to a funny tune, or embedding the thoughts in the lyrics of a song you like. Sometimes it’s sufficient to simply thank your mind. This may sound silly, but it will make the thoughts either go away or seem less intense. 

• Ask for evidence – take a few moments to ground yourself and then ask yourself: “How do I know that this is true?”

• Meditation practices that involve mantra repetitions – by “mantra” I don’t mean affirmations, I mean actual mantras, those meaningless phrases like “ram” or “lam” or if you like longer ones “gate gate paragate parasamgate bodhi svaha”. You can choose a random word and repeat it. You can count to 5 over and over again. You can learn to sing some minimalist opera and use that. For our purpose here, we can say that mantra repetition works by filling up your mind-space, leaving no space for those annoying and difficult thoughts. 

When physical symptoms dominate, you may consider some of the following:

• Breathing exercise – they work quite well to regulate your breathing and slow down your heart rate. It takes about 4-5 minutes of repetition, and they might relax tense muscles too. Click here to download a free handout with breathing exercises. 

• You can try this audio exercise for acute anxiety. 

• Try grounding exercises - 5-4-3-2-1 grounding, light stretching, etc.

• Put your right hand on the left side of your chest and your left hand on your abdomen. When the palms of your hands touch your skin, warmth will be generated. Focus on that warmth as you try to slow down your breathing.

• Give yourself a hug.

• Do 10 minutes of yoga

• Try progressive muscle relaxation

How to choose your first aid techniques?

Based on how your anxiety presents, you can choose a starting point, a few techniques that make sense to work with. However, there are no recipes that work without failing or that work for everyone. You will have to rely on your experience. Give these techniques a fair trial and then assess where they work and where they don’t, and see if you can improve on them or combine them into one. 

In general, it’s best to be as minimalist as possible with first aid techniques. If you have 10 things that work, it’s not very likely that you’ll make the right choice when you feel intensely anxious. One or two techniques are just fine. The simpler the protocol the greater the chance of success. 

Another important thing to keep in mind is that first aid doesn’t have to clam you down completely, just to reduce the intensity of anxiety to what’s manageable. 

3. Understanding anxiety

Anxiety is not random, just like other emotions aren’t random either. However, it’s much easier to understand what other emotions mean. When you feel guilty, you know that means you did something wrong, and in most cases it’s easy enough to understand the situation well to learn your lesson and not do it again. Anxiety is different because it usually feels very vague and seemingly isn’t telling us anything more than “somehow something isn’t as it should be” and, to be fair, this isn’t quite useful.

In constructivist psychology, emotions are always seen as information. In that sense, they don’t differ much from thoughts except that they use different symbols to convey their messages. Thoughts use words, emotions use sensations or other non-verbal elements. My favorite constructivist, George Kelly, adds another twist. In his theory, he never uses the term emotion at all, which led many prominent psychologists to criticize him for seeing people as machines. The trouble with that criticism is that many prominent psychologists didn’t bother to read his book other past the preface. Instead of the term emotions he uses another one, broader and more useful, although unlikely to replace the word emotion in the popular imagination any time soon. Kelly talks about transitions or transitional states, whatever you prefer. 

What does this mean? Transitions are specific states when our personality (“system of constructs” in Kelly’s words) is in some kind of motion, some kind of change. Different transitions point to different processes. Understanding transitions means understanding ourselves knowing the direction of our growth. Anxiety is also a transition and it’s telling us that we’re experiencing a failure to properly attribute meaning to an event. Meaning-making is the most fundamental psychological mechanism, and it’s not working well. Put simply, what anxiety is telling you is: wtf?! If we wish to look at this from a more useful point of view, we can say that anxiety invites us to create a narrative around the objects of anxiety. And not just any narrative, but one that gives us useful tools to act.

Creating a narrative psychologically speaking isn’t quite the same as just coming up with a story, especially because anxiety sometimes feels untriggered, as if it came out of nowhere. Even though constructivism does tell us that we don’t have immediate access to truth and must satisfy ourselves with utility instead, it doesn’t mean that you can go around telling yourself any story you like to hear. Oh, how I wish we could do that! Even though we can never know what reality is in itself (if anything), we can check if our stories about reality pan out. Whenever you interact with the world, you get some kind of feedback and that feedback, when honestly assessed, tells you everything you need to know about any potential holes in your narrative. 

This is a process that takes time and it’s a process that goes beyond the intellectual, as it’s never enough to just tell the story to yourself. Instead, you must embody it. I recommend journaling ad nauseam because it is useful to pick up on any elements of old or new emerging narratives. If you journal about what’s making you anxious (and what’s making you relaxed!) you will start noticing emerging themes and once you notice them, you’ll be able to improve them further. 

Obviously, I am not talking about quick fixes anymore, but that doesn’t mean that you can’t do anything in the moment. 

• Ask people for advice – you never know what they might come up with!

•  Practice mindfulness informally by being more present in everyday life; this will give you more details and more information. It will be easier to grow from your anxiety because you won’t miss as much of your in-the-moment experience.

• If you’re anxious about how people see you – ask them directly! There’s no need to sit and project your worst fears onto others. Ask them and they will tell you. 

• Building on the previous one: ask people to tell you their versions of your stories or the events that are making you anxious. That’s a chance to open yourself up to alternative narratives. Whenever you feel resistance to something they’re saying, that’s a direct indication that you have some unfinished business in that area, that there is growth to be done. 

4. Tolerating anxiety

I mentioned this before, but it’s worth repeating there is no way around a degree of anxiety in certain situations, so we have no choice but to learn how to tolerate it while it’s there. By “tolerating” I mean being with it, but not reacting impulsively to it. It’s what we call equanimity in the world of mindfulness.

• Consciously expose yourself to anxiety-inducing situations. Make a list, rank them in order of intensity/threat and then start from those that are less safe and work your way up slowly. Expose yourself to a few minutes of discomfort and observe it. In particular, be mindful of your body and where anxiety arises.

• Talk about difficult topics with people you trust and then with people you don’t know as well. 

• Intentionally do something embarrassing.

• Get out of your comfort zone or speak up freely.

• Talk politics with someone who has the exact opposite beliefs to yours and learn to stay with the internal outrage, be mindful of it, but don’t react to it.

• Practice mindfulness formally and daily.

5. Lifestyle changes

There are many things to consider here, but they all share one common quality: it’s all hard and none of it is quick. At the same time, all of it is crucial.

This last category is truly vast so documenting every little instance isn’t possible and if it is possible, it’s certainly useless. It’s perhaps better to think in broader strokes so that you can find those aspects of your life that need to be changed. It’s likely different for everyone. The goal is to understand what the overall place of anxiety is in your life and to address those patterns of thinking and doing that make it worse or that generate it with some regularity.

Most of my clients are willing to do quite literally everything except make changes in this last category. Adults can make decisions for themselves even if these decisions produce more suffering in the long run, so I’m not the one to oppose an adult’s informed decision, although it must be said that without making overall lifestyle changes everything else in this long post is just a temporary solution. It’s like using chewing gums to plug holes in a sinking ship. 

Here are some things to consider:

• Make sure that you’re physically healthy: a number of somatic conditions can cause anxiety and the way to get rid of that anxiety or keep it under control is to deal with the physical issue.

• Regular physical activity – regular doesn’t mean daily, but it certainly means weekly. Cardio is preferable but even gentle activities like yoga or Pilates will be beneficial and will reduce your baseline anxiety levels and likely also improve your mood.

• Make appropriate dietary changes – starting from the obvious such as reduce coffee intake and avoid energy drinks, less green or black tea and more beverages that don’t contain stimulants. This may not be the same for every person, but it helps to reduce sugar intake and to overall have healthier diet. We know from research that even your gut bacterial flora affects your mood and emotions!

• Journal regularly and think of journaling as the equivalent of washing your face and taking a shower. Especially if you don’t have a therapist or a counselor to talk to, journaling is a great way to keep track of your own emotions and thoughts, as well as a private, safe space to vent.

• Start a regular meditation practice – 20 minutes every morning and after 8-10 weeks of regular practice you can expect a reduction in baseline anxiety, you will likely see your mood improve and you’ll learn how to relate to both thoughts and emotions in a healthier way. 

• Good sleep hygiene is important and helpful to maintain.

Those were the easy ones, now onto the difficult stuff:

• Make sure that your work/life balance is actually balance, not just work with a touch of life when work gives you some free time.

• Don’t invest yourself emotionally in things that aren’t meaningful, and that especially applies to work.

• Check where your limitations are. Maybe you are taking on more than you can handle. Not more than you “should” handle, but more than you can actually handle. If you continuously fail at something it could be that it’s just not something you can do right now. And that’s OK. Learn to forgive yourself, learn to set more realistic goals, and move on. (All easier said than done.)

• Don’t neglect your social life and carefully choose the people around you. Take a good, long, hard look at your closest and most intimate relationships and see how satisfying and fulfilling they are. Balance them as best as you can.

• Learn how to say “no”. Recognize when you need to.