Mental Health Matters

You feel anxiety bubbling up inside you. You become tense, fearful, and perhaps jittery. Dread overtakes you. Feeling sweaty, nervous, and sick at your stomach, your thoughts swirl in your brain like a cyclone. You are sure you are going to explode. Despite repeated efforts to ignore your heart pounding in your chest and increased difficulty in breathing, the awful dread and sense of urgency that has overtaken you persists. You tell it to go away and try to refocus your thoughts. Resistance is futile. It seems the more you fight this anxiety monster the stronger it becomes. It doesn’t back off, but instead beats you up with even more furor than before. Unable to fight back any longer, you run and hide, finding the nearest escape and isolate yourself, waiting it out, and feeling like you are going to die.

If you are not one who is prone to anxiety, then this scenario probably sounds unreal to you. But it is very real to the 40 million people diagnosed with anxiety disorders. Anxiety can have such a paralyzing impact on a person’s life that living a normal life doesn’t seem possible. You may wish to avoid being around people or in uncertain or unpredictable environments, preferring routine and staying close to home. You avoid stressful situations because you never know if it will ignite your anxiety and create an embarrassing situation for you or one in which you have to stop what you’re doing and go home. 
Anxiety for many is a fact of life. It is in the DNA, the hardwiring, but it does not have to be the ruler of one's life. Though managing anxiety can be difficult, frustrating, and challenging, it can be done. With practice and patience you can learn to manage your anxiety and expand the perimeters of your life’s reach. It does not have to be debilitating. 

In this article I will show you steps you can take immediately to reduce the episodes of anxiety you have and the intensity of each. Most likely, you will not use one of the steps, move on to the next step, then the next. It's not necessarily a linear progression through the steps. Instead, you may use several steps at once. Or you may use a step, go on to others, then come back to that initial one again, maybe even several more times. 

One of the basic principles underscoring anxiety is that the more you obey it, the more it grows, expanding into every corner of your life and making your world smaller and smaller. As long as you obey your anxiety, you will not be able to shrink it to a more manageable size. I often suggest to clients to take on a mission of defying their anxiety: disobeying it. If that can't be done full out, then do whatever amount that can be done at the moment and build on that. You can also substitute whatever your anxiety is telling you to do as a symbol of your defiance as well. For example, your anxiety tells you to pick at a scab? Resist the urge. Scratch a freckle instead. Your anxiety tells you it's too uncomfortable for you to go out in public? Do it anyway. Or water down anxiety's demand and substitute it with a form of its demands that you stay home, isolated from others and walk down the street. Or to the end of your driveway. Do whatever form of rebellion that you are able to do that can substitute for anxiety's demands. So even if you can't do it wholly, do it partly. If you are able to, get in your car, and drive to the store. Park. Then go back home if you must and count it a win. Your anxiety tells you to repeatedly ask questions? Don't do it. Maybe instead of making a question about what you feel the urge to ask, form it into a sentence and state it as though you are thinking aloud. "Hmmm, trying to decide if I should go out tonight..." Overall, try to resist complying with your anxiety (either by using substitution or blatant disobedience) for 5 minutes. Then 5 minutes more. Then another 5. By the end of the 15 minutes you may discover that the urge to submit to your anxiety has lessened.
Another basic principle to understand is that anxiety is energy. It often manifests itself in picking, pacing, popping knuckles, angry outbursts, crying, and countless other ways. Exercise is a phenomenal energy drainer and can take the edge off so your anxiety doesn't explode quite as quickly or hugely. I recommend daily exercise of some form: walking, yoga, swimming, whatever the activity, just move and deplete that energy.

It's important to rate your anxiety when you are experiencing it as well as monitoring it on a day to day basis.When you begin feeling anxious, quickly make a mental note of its severity on a scale of 1-10. Think about its intensity and how much its disrupting your usual activities. On a scale of 1-10 – with 1 representing minimal, and 10 representing maximum, how would you rate its severity? The number you assign to it is very specifically your own assessment. It’s a number that reflects your perception of how intense the anxiety is. One of the advantages to self rating is that it gives you feedback on the progression or regression of your anxiety. To get that feedback though, you will need to periodically rate your anxiety throughout its life cycle. Once you have mentally rated your anxiety several times you will develop your own definition of what each number represents in terms of your symptoms. Rating your anxiety will take only a couple of seconds. Although I list it as a 'first' step, it isnt  done in isolation of the other steps. Each of the steps, though listed in order, will likely be used and reused in various orders and in conjunction with each other throughout your episode of anxiety. 
In addition to rating your anxiety on the spot when it occurs, I suggest each night you rate your day based on the level of anxiety you experienced in general that day. It is best to record this number in perhaps a notebook for this purpose.  Just as already described, you will use the numbers 1-10 to reflect the degree of severity of the anxiety you experienced throughout the day in general. The severity of your anxiety can be assessed by recalling its duration- how long it lasted- and intensity- how much it disrupted your thoughts, feelings, and activities.

 Rating your anxiety will help you gain control over a situation in which you feel you have no control. It will also help you recognize that there are different degrees to your anxiety. It will help you pay more attention to how you successfully prevent it from escalating. It will help you learn to ‘catch it while it’s little.’ It creates an awareness that anxiety ebbs and flows, expands and shrinks, and that when you are experiencing severe anxiety it will not stay that way permanently. It will also help you to see improvement in the long run. If you typically rate your anxiety between 6 and 9, for example and over a period of time you find that your highest rating is rarely an 8 or a 9, then you know you are making gains. Sometimes its hard to notice improvement in ourselves and writing down your ratings will document your progress, giving you confidence and providing you with information to help you determine what works and what doesn’t. Over a period of days, weeks or month, however long you choose, you might want to graph these numbers to show the ebb and flow of your anxiety and to point out progress.
Below you will find a partial graph of a client of mine. She rated her anxiety each night. She preferred though rather than rating the degree of anxiety, to rate her sense of control, peace, and what she identified as a good day. We also used percentages instead of the 1-5 or 1-10 rating scale. Whether you use percentages, numbers, or whether you rate your anxiety at its worst or at its best really isnt important. What is important is that it makes sense to you. I drew a line at 50% which would represent a half good half difficult day. We felt like if she could achieve anywhere above 50% that is significant progress. You will note the highs and lows. This representation opened the door for us to begin to try to figure out what was contributing to these numbers. What helped to achieve above 50%? What happened that caused it to fall below 50%? Awareness of a problem is half the solution. Rating increases awarenss of your anxiety from every angle! 

YOUR BRAIN ON ANXIETY
The sweaty hands, the difficulty breathing, nervousness, racing thoughts… these are not imaginary symptoms and they do not mean you are crazy! When you experience these kinds of symptoms, what you are experiencing is your brain on anxiety. It is important to remember you are not your anxiety! Anxiety has a way of convincing you that what you are feeling is very real and true when in reality, it isn’t! Say to yourself or aloud, “This is anxiety making me feel like Im going to explode. But I am not really going to explode it just feels that way because anxiety is changing my perception of things.” In some ways your brain is trying to protect you from whatever danger or threat it perceives exists. Most people will have a red flag thought pop in their head, they can objectively assess its validity, discard it, and move on. But the brain of someone who has anxiety, works differently. Their brain alerts them with a red flag thought and when they begin to assess its validity the brain doesn’t let them move on from it. It stays stuck on it and simmers in their thoughts. It persists until they feel panic, and then things begin to snowball. Really, your brain is showing you love. It thinks its doing a good thing by warning you to protect you. You must tell your brain, “Thank you for trying to protect me but I can handle it from here." 

  Thanking your brain is one step in the direction of waving the white flag of surrender, which will be discussed next.When you thank your brain, you don't argue with or try to make it stop. Instead, you embrace it, thank it, show it some love, then firmly tell it, 

When you feel anxiety bubbling up inside you, there’s one important first step you must do but you aren’t going to want to do it and that is,wave the white flag of surrender. It may seem contrary to surviving an episode of anxiety but I have found that the more someone fights anxiety, the more it fights back. And the more it fights back, the stronger it becomes! It beats you up with even more furor than before, relentlessly badgering you in your thoughts. When we give up the fight, anxiety tends to begin to dissipate.
You will feel terribly helpless and there may be an increased sensation of anxiety. Try to flow with it. Lay down if you can or sit in a relaxed position, try to consciously relax your mouth and jaw, close your eyes, and imagine you are floating in it and you are okay with it. If your fists are clenched, unfold them. This not only jumpstarts your body into a relaxed state but is symbolic that you are truly surrendering. 
Don't forget to do your  4-7-8 breathing and repeat it for a long as you need to. You are not afraid of it. It cannot actually hurt you. Say aloud, This is not me. This is anxiety. I am not my anxiety. This is my brain reacting to perceived danger. Speak to it statements of truth, described next.

speak truth!

You have rated your anxiety, waved the white flag of surrender, thanked your brain for trying to protect you, distrated yourself, you are breathing long and slow inhales and exhales, and you are speaking truth to it. Now what? 
 Now it is time to ask the WHAT IF and the SO WHAT question. 
The purpose of asking the what if and the so what questions is to put anxiety in its place, to let it know that nothing it says to you will intimidate you. These questions also help to put things into perspective for you: to see that its not the end of the world, though it may feel like it. You will notice the answers to these questions do not exaggerate or lie.They are grounded in truth. It's important to be truthful and admit pain and suffering but to also state the opposite side of that coin: that you will some how get through this. I find that blending the two sides of the coin- the good and the bad- is much more realistic and effective. Rarely are things truthfully all of one side or the other. Here are examples of what I am talking about. 

Anxiety: your head is pounding, something must be terribly wrong with you!
Client: So what if my head is pounding? That's a natural physiological response to stress. I'm human and my body will respond in human ways.
Anxiety: Your stomach is hurting and its never going to stop!
Client:So what? I won't like it but I will deal with it if that happens!
Anxiety: You're going to vomit!
Client: What if I do? What's the big bad thing about that? It will be unpleasant for a few minutes and I might be embarrased but hey human beings vomit sometimes. 

Whatever the answers are to the questions what if and so what, it will not be your untimely death.

Learning to manage and shrink the level of anxiety in your life requires a comprehensive approach. In addition to the strategies described above, self care is extremely important. Self care truly is the foundation necessary for all the other strategies to be effective. Self care can include, eliminating as much processed, packaged foods as you can from your diet, appropriate and regular exercise, getting enough sleep, getting outdoors, engaging in activities that bring you happiness, and avoiding unhealthy and dangerous habits and addictions. Appropriate medication and therapy are also a huge part of the equation. Collaboration between your doctor, your therapist, and any one else who is a vital part of your life is important as well.
A final suggestion of something you can do as you reflect on your anxiety in general is to develop a life cycle of it.

THE LIFE CYCLE OF YOUR ANXIETY

Reflect on a recent anxiety episode you have had. Break it into blocks of time where any transitions occurred (such as eating breakfast, turning on tv, changing the baby's diaper, etc... It might be 15 minute, 30 minute, even a few hours increment of time. That is fine. There is no wrong way to do this. Rate your level of anxiety for each increment of time. Plot on a line graph numbered 1-5.  Examine what was going on then. Look at the time frame it began to recede. What made it recede? When was the anxiety at its peak? How long did it last? What were you telling yourself at that time?
The following illustration shows a life cycle for an episode of anxiety one of my clients had. She was 12 years old at the time and experienced anxiety about going to school. The life cycle of an anxiety episode…helps you to identify what you did that helped to alleviate it and it reassures you that it will subside. There is a beginning, middle, and an end. I would encourage you to rate your anxiety noting precipitating factors and then diagram its life cycle.
In the following illustration of a 12 year old client, you can see her anxiety occurred in the early morning. I had her tell me her morning routine for getting ready for school. The time blocks I used were transitional times in her routine. Also, I had her rate it on a scale of 1-5 which can sometimes be easier for people, especially children. She reflected on her morning from the moment she awoke at 5:50 AM. I asked her to rate her level of anxiety for each time block and she indicated it on the graph with a dot. Then I connect the dots to provide a visual of the rise and fall of her anxiety episode. This gave us valuable information. For one, it let her see that there is an end to anxiety. For another, we were able to go back for each time block and analyze what was going on during that time frame, what she was telling herself, what symptoms of anxiety she began to notice initially, and most importantly, what she did to address it, if anything. When she couldnt remember, I asked for her best guess. You can see from the image that at 7:40 is when her anxiety (referred by her as worry) was at his highest, or prime time. This was the time when she had to get out of the car to go into school. We were able to talk about strategies she used such as distraction, breathing, telling herself the truth about the matter, using humor, & surrendering, that helped her to shrink the intensity of her anxiety.