Living With Anxiety
Over 40 million adults in the U.S. (19.1%) have an anxiety disorder. Living in today’s world of pandemics, climate change and political unrest certainly isn’t helping! What can you do to better understand and manage your anxiety? Fortunately there are many short and long-term techniques that can help.
Research on anxiety shows us that a little helps improve performance in most situations but too much will cause us to be less effective. For example, if I am trying to parent my 2-year-old, a little bit of anxiety about wanting to be a good parent may motivate me to read some parenting books that are helpful. But too much anxiety could cause me to lose sleep at night and feel super stressed out which could actually cause me to yell at my 2 year-old next time they are melting down. In general our brains function best when we have a moderate amount of “activation” in our system. Too little activation can cause us to be bored, checked-out, disinterested or lethargic and too much can cause us to go into a fight-or-flight response, which not only causes us physiologic damage but also causes our brains not to function very well in that moment. The parts of the brain that have the high-powered skills and processing capacity literally are taken “off line” during very high levels of stress. This is because those brain areas, while very powerful, are slower and require more energy to run. In a situation that your body perceives as an emergency (aka high anxiety situation) the nervous system will shut down the slower, more fancy processing areas of the brain in favor of the “quick and dirty” processing areas in the lower structures. While these parts of the brain can operate quickly they lack nuance and are error prone. So you won’t do your best thinking, and therefore won’t do your best behaving, when under very high levels of stress.
Anxiety resides first in the body so the fastest and most reliable way to reduce anxiety is to go to the body. Our diaphragm connects to our sympathetic nervous system via the vagus nerve and so controlling your breathing is a fantastic “hack” to help you move out of a stress/anxiety response state (which is a state of sympathetic dominance). Generally breathing slowly and spending longer on the exhalation portion will bring your nervous system back into balance. However since humans have some variation in their systems it’s important to try different breathing techniques to figure out which ones work for you. The basic breath that I teach as a first place to start is inhaling for 4 counts, holding for 2 counts and exhaling for 6-8 counts. It should not feel too forced so find a rhythm that works for you, for example you don’t have to hold for 2 counts or you could inhale for 3 and exhale for 5. The general idea is to emphasize the exhalation as that is the part of the cycle that kicks in the parasympathetic system which is the system that calms us down. It’s also helpful to breathe deep into the lower lobes of the lungs/diaphragm, so focusing on feeling your lower lungs (sometimes referred to as “belly breathing”) filling up as you inhale is helpful. Most adults go through their day breathing higher up in the chest and this does not induce the relaxation response. So getting deeper into the bottom of the lungs is an important part of switching the gears of the nervous system. Other tools to deal with anxiety can be doing a short guided meditation. Even 5 minutes of following a meditation on an app, podcast or Youtube video can re-route the stress response. Being in nature can also reduce anxiety. Some people find taking a shower or bath helps to move out of sympathetic activation. Every person is different so what works for one may fall flat for another, but everyone can find some tools to help them take control of their nervous system and shut down the anxiety/fight-or-flight response.
For more long-term help with anxious thoughts it can be helpful to engage in psychotherapy. Cognitive-behavioral therapy can help you challenge anxiety- producing thoughts or re-frame them in a more neutral manner. Deeper insight-oriented psychotherapies like psychoanalytic psychotherapy can help you uncover possible roots of anxiety that lie in earlier experiences. Trauma reprocessing techniques like EMDR, Somatic Experiencing or Sensory Motor Psychotherapy can help you uncouple the physiological anxiety response from particular triggers like specific memories, locations or people. Anxiety can be both a symptom and a signal, so sometimes we are just trying to reduce the symptom and sometimes we are trying to understand what the signal is trying to teach us. If anxiety is a long-standing, recurring problem for you it may be helpful to not only take a symptom approach but to also understand the underlying meaning of the anxiety itself.
In addition to using breathing to manage anxiety, distraction of various kinds can also help. So for example going for a walk and noticing all of the different people, plants, animals, etc. that you encounter (to take your mind off of your anxiety). Or watching an engaging program. Or listening to music. For some people relaxing music, especially things that are melodic, can help. Melodic music stimulates the ventral vagus nerve through connections in the inner ear and that can help bring on the relaxation response. For other people, more up-beat music works better. Again you can experiment to see how you can reduce anxiety using other types of sensory input, be it muscular, through going for a walk, or auditory, through music, or visual, through looking at nature or even a TV program. There is some research to show that inhaling essential rose oil helps reduce circulating levels of cortisol, which is a marker for the stress response. So you can keep some rose oil on hand and smell it when you feel stressed. Other people find that other fragrances like vanilla, lavender or cinnamon work well so experiment with olfactory stimulation and see if you feel more calm.
In addition to the psychotherapies already mentioned I think it is critical for people who are prone to anxiety to look at their lifestyle factors. Getting proper sleep is absolutely key to keeping our nervous systems balanced. You need 7-8 hours of good quality sleep every night, no exceptions. Make that a priority even if it means changing your routines to get to bed on time. If you struggle with persistent anxiety I always recommend getting off of all stimulants. This means caffeine in coffee, tea, colas and even chocolate. Also beware of energy drinks that have taurine, B vitamins and other stimulating ingredients. In general if it’s marketed to “boost energy” or even “boost alertness” it probably has a stimulant in it. Be aware that it takes your body 9 hours to get rid of caffeine once you have ingested it, so in general make sure you don’t have any caffeine after noon to prevent it from disrupting your sleep. And since caffeine is going to bias your system towards sympathetic activation it’s actually a good idea to avoid it entirely if you struggle with anxiety frequently.
Exercise is a super powerful way to help manage frequent anxiety since it re-sets our nervous system and bleeds off excess energy. For anyone struggling with daily anxiety I recommend 30-60 minutes of moderate exercise EVERY day. This intervention alone has significantly reduced many of my client’s problems with anxiety. I especially like exercises that emphasize slow, deliberate breathing like yoga, Pilates and swimming. But since every person is different you should experiment and find the one that works for you. Consistency is the most important thing.
Meditation is also an amazing tool to help with anxiety. The research is strongest on mindfulness meditations and mantra-based meditations. Fortunately there are a lot of aps these days and even more Youtube videos that have meditations you can follow along with. I find that the most important thing about meditation is making sure that you have reasonable expectations going in. Meditation is NOT about “emptying” your mind. You cannot empty a mind! Our minds are designed to generate thoughts whenever we are conscious and even during some portions of sleep. The goal of meditation is only to be aware of what the thoughts are, not to stop having them. Imagine you are sitting in a room and people keep walking through the door. These are your thoughts. You greet them– “oh hello there, anxiety about my taxes!”– and let them go. Another thought will almost immediately replace that one and that’s fine. That does not mean that you are doing meditation wrong! If you are acknowledging the thoughts but letting them go then you are absolutely doing it right, even if you have a constant stream of thoughts the whole time. I think it’s sadly ironic that people turn to meditation to help with anxiety and then get anxious that they are doing it wrong. So be clear that having a constant stream of thoughts is fine and part of the process.
Whatever techniques you try, remember to be patient with yourself. Don’t make yourself stressed about being perfect at stress-management techniques! And don’t be afraid to reach out for help. Anxiety can be very difficult to live with so you deserve to get support and education from a mental health professional to make the process a bit easier.
