Anxiety is something that plagues nearly one in five adults in the US. Unwarranted fears, worries, uneasiness, unwarranted sense of urgency, panic, and “what-if” thoughts are hands-down the most common ailments of the adults, teens, and kids that I see in therapy.
These thoughts and feelings are scary, often-relentless, and seemingly insurmountable. What to do when anxiety strikes?
1) Prepare your physiology (because the next steps are hard, and not to be tried when you are in fully-charged, “anxiety mode.”)
Here are some ideas for calming yourself:
Breathe deeply and slowly, taking five seconds on the inhale and five seconds for the exhale.
Do isolated muscle compressions, tightening and loosening one muscle at a time (when you unclench a muscle, it becomes even more relaxed than baseline.)
Listen to calming music or a progressive relaxation.
Practice a mindfulness exercise for five minutes (Focus on your breathing, and practice simply observing and visualizing letting go of your thoughts without adding anything to your thoughts (I visualize the thought floating away on a cloud or a hot air balloon.) Don’t judge yourself if this mindfulness exercise is difficult; It takes a lot of practice. At first the thoughts will bombard you, and you will be visualizing thoughts going away in rapid succession. I will get easier though.
Exercise for 5-10 minutes.
Ground yourself to the neutral present (also works as an intentional distraction from relentless thoughts.). Focus on the mundane and oridnry aspets of your surroundings for three to five minutes. Intentionally tell yourself things like, “The floor is brown and smooth; there are 25 tiles in the ceiling; the air is about 70 degrees; I notice a tear on this sofa about one centimeter in length….”
2) Check your thoughts. Now is the hard part….People with anxiety have TWO fundamental thought problems. One is that they worry about things that are not likely to happen/unrealistic and the other is that they tell themselves that they cannot possibly sustain the discomfort that a feared scenario may bring about. It is important to check your thoughts to address both of these thinking errors.
-What am I really afraid of? Specifically. (For example, it’ s not that I simply fear talking to new people; it’s that I fear that I will feel rejected. )
-What is the evidence that my fear will come true? (Are there any CLEAR and TRUSTED sources I can check for more information/evidence? NOT THE INTERNET OR the all-roads-lead-to-cancer that is Web MD. Do I need to have a conversation with someone to get to the bottom of this without making any assumptions?)
–What is the evidence that it will not come true? (Are there any CLEAR and TRUSTED sources I can check for more information/evidence? NOT THE INTERNET. Do I need to have a conversation with someone to get to the bottom of this without making any assumptions?)
-When you have established whether or not your fear is grounded in reality, commit yourself to acting accordingly. If it’s not a realistic fear, proceed as if you did not fear it. If the fear is grounded in reality (the evidence that it will happen is stronger than the evidence that it will not happen), what will actually happen? Often times people with anxiety are simply avoiding embarrassment, emotional pain, or other discomfort that is temporary and not catastrophic. In this case, it also helpful to add this question: If I am especially sensitive to discomfort, what could I do to endure this more easily in the event that it my feared scenario occurred? Self soothe? Talk to someone? Have a pleasant distracting activity plan in place?
-Or, if my feared scenario is likely, is there something I can do to actually prevent or address it? (#3)
– And occasionally, people with anxiety hold onto their mindsets because they benefit more from not getting better than they do from getting better. Ask yourself, do I have anything to gain from being fearful or tightly wound? Do my parents or my partner or my peers attend to me in a way that is absent if I am not anxious? Do my parents have something to talk about and keep them together if I am “sick” (sounds cliché, but it often happens.)? Do I get out of school or home obligations because of my condition? Does my unrealistically high expectation of myself, others, and the world give me a sense of superiority that I enjoy on some level? Does my anxiety absolve me of guilt for not being involved or proactive with the lives of my family, friends, or self? (Barriers to “recovery” are often explored in family therapy.) More often than not, there is no secondary gain for anxiety, and if there is, it is almost always unconscious and not deliberate. In any case, it doesn’t hurt to explore these possibilities, even if the answers end up being “no.”
3) Try new behaviors.
Now here is something no one wants to hear: The best way to surmount anxiety is to go toward your fear. Sometimes that requires participating in scary thoughts (# 2 was all about that.), and sometimes that requires participating in “scary” behaviors.
Some examples of behaviorally moving toward your fears include:
If you worry about finances, make a plan or call a financial advisor.
If you are afraid people won’t like you, go out of your way to sit at a crowded lunch table.
If you fear driving, ask a friend to help you practice in a parking lot.
If you worry about your relationship, talk to your partner or possibly seek counseling..
If you worry about what life will be like after you have kids, consult friends who have kids, take opportunities to babysit, and talk to your partner.
If you are nervous about asking for a raise, plan out what you are going to say, and commit yourself to having that conversation.
And often times, changes in behavior are required to alleviate realistic “what if’s.” If your scary thought in #2 was What if my husband leaves me?” and you realize that he is supremely unhappy and you are extremely disconnected as a couple, the first line of defense would be to actually change behaviors to improve the relationship, not just shore up your idea that you will be able to handle it when he does leave you.
If your scary thought in #2 was, “What if my son fails Algebra and doesn’t finish high school?”, and you conclude that this is likely, your best course of action would be to hire a tutor and consult with your son, not just remind yourself that the world will not end if your son does not finish school. Action (and sometimes conversation) is often the best defense against anxiety.
But what if you are super, super terrified. What if it is simply not that simple, even if you have done all the calming exercises in the world in #1? Make a list of small, gradually more anxiety-provoking behaviors, and then get to getting.
Maybe you are terrified to have the conversation about the raise with your boss, but you could actually go through the gradual steps of: 1) Write down a script. 2) Practice in front of the mirror. 3) role-play with your therapist 4) Actually talk to your boss.
Or maybe you are scared to death of loosening up your grip on your husband’s “horrific” parenting (I mean if he lets the kids watch too much TV, they’ll definitely never get into college and be living in a cardboard box on the side of the road.)…BUT maybe you CAN go through the gradual steps of: 1) Negotiate TV, bed, discipline, and meal procedures with your husband (loosening your grip by meeting him halfway instead of trying to convince him that to you with how you want it). 2) Have your husband make the kids’ lunches for a week and watch how the world doesn’t end just because Johnny had Pringles instead of whole wheat crackers. 3) Intentionally sit back while your husband is the activity director one weekend. Manage your sense of urgency when he turns on the TV for two hours, and consciously notice how he played catch in the afternoon. 4) Go away for an afternoon, and notice how the kids are still standing and happy when you get home. 5) Start seeing your husband’s parenting choices as not so abysmal.
Or maybe you are scared to death of using a public bathroom, but maybe you CAN go through the gradual steps of: 1) Walking into the bathroom without using it until that is no longer scary 2) Walking into the actual bathroom stall until that is not longer scary 3) touching the top of the seat and the flusher until that is no longer scary 4) Actually using the bathroom.
Anyway, this is all a very simplified explanation of how to “bust anxiety.” There is much more to this topic, including post-traumatic reactions, obsessions and compulsions, fighting familial anxiety, panic symptoms that seemingly have nothing to do with your thoughts, and medication management. Since it is so prevalent, and affects parenting, romantic relationships, and every other relationship a person could have, it is a topic that I will continue to address in this blog. And I hope it goes without saying that I encourage anyone who suffers from anxiety to not simply look to the internet for guidance, but to seek in-person, personalized, professional guidance.
And since women are 60% more likely than men to experience anxiety, and I love me some couples therapy, just for fun, here are the top three ways that a woman’s anxiety affects her relationship:
– Anxious attachment. (He doesn’t really love me; He’s going to leave me. I can’t stand to be apart, because I’m always thinking of all the bad things that are going to happen. I interpret every little thing as evidence that he does not consider me or care about me.)
– Control complex. (If he does it his way, the world will end –or the kids will die, or the house will fall apart, or we will reach financial demise, etc. etc.)
– Fear of intimacy. (emotional or otherwise) (It’s too scary to tell him how I really feel or what I really need , so I’ll just act like everything is fine for the most part with random bouts of passive aggression or explosiveness.)