Treating Anxiety

• Problematic anxiety affects approximately 15% of the population.
• Suffering from intense anxiety can feel overwhelming and depressing.
• Within the mental health profession, anxiety is generally recognized as a very treatable problem. It is quite possible to overcome your anxiety.
• Remember, a “quick fix” doesn’t exist. Overcoming anxiety requires effort.
• There are effective strategies that individuals can use to decrease or eliminate problematic anxiety.
• To overcome anxiety, you will need to work on several skills at once.
• As you address problematic anxiety, predict a temporary increase in anxiety. You can learn some skills to help you manage this.
• Many practitioners who specialize in working with anxiety disorders rely on a cognitive-behavioral approach because of its proven effectiveness. This approach is primarily educational in nature and teaches strategies that, with regular practice, help reduce anxiety.
• Key treatment strategies include the following:
  • shifting your attitude about anxiety
  • identifying and eliminating catastrophic thinking
  • exposure therapy
  • cognitive-behavioral therapy is likely to remain an effective treatment for anxiety problems well into the future

Types Of Anxiety

Difficulties with anxiety are typically the result of a combination of factors, including life experiences and gentic make-up. Factors that may contributed stuggles with anxiety:

1. Family experiences - Early loss of a parent, overprotective parents, highly critical parents, growing up in a chaotic family or one where emotion is discouraged or abuse occurred can contribute to anxiety problems (Bourne, 2000).
   
   
2. Stressful life events - Problems with anxiety can develop following periods of significant loss (e.g., serious illness or death of a family member), during periods of life change (e.g., starting university, having a baby) or after experiencing traumatic events (e.g., assault, car accident) (Bourne, 2000).
   
   
3. Heredity - Having relatives who suffer from depression, alcoholism or other anxiety problems may leave you more susceptible to anxiety (Beckfield, 1994).
   
   
4. Temperament/Personality Were you born shy, cautious or introverted? Being born with a temperament characterized by discomfort with unfamiliar situations may increase your vulnerability to anxiety later in life. In addition, personality features, such as the following, are typical of anxiety sufferers:
   • Attach deeply to others; extra-sensitive about separation
   • Frequent worries about death and disaster
   • Excessive concerns about illness
   • Strong need for control
   • Feelings of inadequacy
   • Lack of assertiveness
   • Avoidance of emotion (Beckfield, 1994)
     
     
5. Biology - Symptoms of anxiety can arise from certain medical conditions (inner ear problems, hyperthyroidism). Also, research shows that people with problematic anxiety have sensitive and reactive nervous systems. They tend to have “anxiety sensitivity” (perceive anxiety as harmful) and have heightened awareness of, or ability to detect, bodily sensations of arousal (Craske and Barlow, 2001).
   
   
6. Society - The rise in anxiety over recent decades may be partially attributable to an increase in “environmental threats” and the decline in “social connections” (Davidson, 2003). There can be an increase the amount of stress people feel with heightened uncertainty about the safety of our world. For some people, this heightens anxiety symptoms.

What maintains anxiety

How people think has a significant impact on anxiety. Below are some examples of cognitive distortions that contribute to increased anxiety.

All-or-nothing thinking - Seeing things in black and white or right and wrong categories. Example: Only 85% or better is acceptable.

Disqualifying the positive - Rejecting positive experiences because they “don’t count” for some reason. Example: He did talk to me at the party, but it wasn’t until the end.

Jumping to conclusions - You draw a negative conclusion even though there isn’t sufficient evidence for it. Example: My prof yawned during my presentation. I’m sure I failed.

Mind reading - You arbitrarily decide you know what negative conclusions someone else has made about you. Example: I was late for the group meeting to work on the project. I doubt they want me in their group now.

Catastrophizing - You assume extreme and horrible consequences of events. Example: I made a mistake at work. I’ll get fired and never find another summer job.

“Shoulds” - You try to motivate yourself by telling yourself what you “should” do. Example: I should be able to decide on a career by now.

Mental filtering - You focus on a single negative detail and dwell on it. Example: I just keep thinking about that exam question that I couldn’t answer. Now I’m really worried about how I did.

Avoiding - You avoid anxiety-provoking situations

Avoiding

Avoidance does not work... the most effective way to overcome anxiety is to face and embrace it

How Avoiding “Works”

Avoiding anxiety-provoking situations “saves” people from re-experiencing anxiety. Avoidance behavior is reinforced (so continues to happen) because it “works” (i.e., it reduces anxiety).

Why avoidance works ONLY in the short-term.

Avoidance robs people of the opportunity to learn that:

• anxiety can be tolerated
• anxiety will diminish over time
• disasters rarely occur
• Without an opportunity to learn that one can cope and that anxiety will decrease, anxiety problems are perpetuated. AVOIDANCE DOES NOT WORK.

Eliminating Avoidance Through Exposure

• When you repeatedly remain in feared situations long enough to allow your anxiety to subside, your anxiety WILL decrease and disappear.
• Exposure works automatically. You don’t need to do anything but stay and let yourself feel anxious.
• The effectiveness of exposure has been confirmed repeatedly and powerfully in research and clinical settings. 
• The process of exposure is extremely predictable. You’ll see for yourself.

1. Get a medical examination. Have your physician rule out cardiovascular (e.g., heart arrhythmia), respiratory (e.g., asthma), hormonal (e.g., hyperthyroidism), and drug-related (e.g., side effects of drugs) problems.
2. Learn the facts about anxiety.
3. Understand your symptoms.
4. Understand potential causal factors.
5. Develop a new perspective (i.e., face and embrace your anxiety).
6. Use effective anxiety-management strategies such as the following:
   • Respiratory training
   • Healthy lifestyle:
     • Diet
     • Exercise
     • Sleep
     • Substance Use
     • Leisure Time
     • Support
   • Cognitive strategies
   • Behavioral strategies
7. Work to better understand, accept and express all of your feelings.

Make Lifestyle Changes

Eating

• Eat regularly. Don’t go longer than 4-6 hours between meals (Whitney and Rolfes, 2002).
• Have mixed meals that include protein, carbohydrate and fat (i.e., include foods from at least three of the four food groups at each meal). This helps meet the body’s nutritional needs and keeps you feeling full/satisfied (Whitney and Rolfes, 2002).
• Avoid dieting (women need between 1900-2200 kcal/day and men between 2300-2900/day, depending on activity level) (Whitney and Rolfes, 2002). Mood may be affected even with modest restriction (Somer, 1999).
• Limit caffeine. As little as 1 cup of coffee can bring on anxiety in an anxiety-prone individual (Bourne, 2000).

Exercise

• 30+ minutes of moderate exercise (e.g., walking across campus, walking home etc.) on most, preferably all days of the week. 10 minute segments count (Health Canada, 1998).
• How exercise helps:
  • Reduces muscle tension. This helps you feel less tense and uptight.
  • Brings about the more rapid metabolism of excess adrenaline. As a result, the arousal and vigilance associated with anxiety are diminished.
  • Enhances the oxygenation of your blood. Increased oxygen to your blood and brain increases concentration and alertness.
  • Stimulates the production of endorphins. In turn, this promotes a sense of well-being, leaving you less likely to feel anxious. 
  • Lowers the acidity of the blood. This increases energy levels.
  • Helps you to discharge pent-up frustration. Releasing this emotion can help alleviate feelings of anxiety.
  • Increases subjective feelings of wellbeing. This buffers you from feelings of anxiety.
  • Reduces insomnia. When you sleep better you feel better and have more energy available to devote to anxiety management strategies.
  • Helps increase self-esteem. When you feel better about yourself you experience improved confidence in your ability to overcome anxiety

Get a Good Night’s Sleep

• Keep a regular sleep schedule (go to bed and wake up at same time each day, including weekends).
• Only use your bed for sleeping and sex.
• If you can’t sleep after 15 minutes, get up and do something quiet (e.g., read a book); when tired, go back to bed; repeat as many times as necessary. Don’t nap the next day.
• Count random numbers (e.g., “1, 27, 67, 14…”). This distracts from worries, but is not demanding enough to keep you awake.
• Don’t watch the clock.

Alcohol Use

• Alcohol acts on the central nervous system very much like a sedative. Some individuals with anxiety problems may attempt to utilize alcohol to promote relaxation or to increase self-confidence in social situations. Over time, however, problematic use of alcohol results in increased anxiety, reduced self-confidence, physical health problems and stress related to relationship, academic or work difficulties. In turn, these problems serve to further increase anxiety

Drug Use

• Cannabis – increases heart rate and can distort senses; some people feel paranoid and less in control when “high”; heavy use can lead to feelings of depersonalization (Addiction Research Foundation, 1997).
• Ecstasy – increases sweating, heart rate, blood pressure, nausea, blurred vision; can result in panic attacks (Addiction Research Foundation, 1996).
• Cocaine – increases heart rate, respiration rate, blood pressure and body temperature; can lead people to feel anxious or panic-stricken (Addiction Research Foundation, 1997).

Caffeine 

• Too much caffeine can leave you feeling nervous and restless, and can contribute to insomnia, gastrointestinal disturbance, increased heart rate and muscle twitching. If you conclude that caffeine use is contributing to or exacerbating your anxiety, you may decide to reduce the amount of caffeine you consume.  An abrupt reduction can produce unpleasant withdrawal symptoms (e.g. fatigue, headaches) so reduce gradually.
• Experiment to find out what your own daily caffeine limit is in order to help reduce feelings of tension. For many people, this is approximately 100 mg/day. Drip coffee 146 mg per cup, Tea bag (5 min. brew) 46 mg per cup, Coca-Cola 65 mg per cup, Pepsi 43 mg per cup

Nicotine

• Nicotine is a strong stimulant that increases physiological arousal and stresses the cardiovascular system. Cigarette smoking causes an increase in blood pressure and raises your heart rate (as you know, a common symptom of anxiety).
• While some smokers report that cigarettes help to calm them, research actually indicates that smokers tend to be more anxious than nonsmokers. 

Leisure Time

• Students who experience difficulties with anxiety often feel that they cannot afford time away from studying for leisure activities. However, engaging in enjoyable activities on a regular basis promotes relaxation, reduces stress and lowers susceptibility to anxiety. Having fun everyday is a legitimate and important self-care activity.

Support

• Seeking and accepting the support of trusted family and/or friends is key to better managing anxiety. Everyone needs someone who will listen, cheer them on, offer ideas and care.

Practice Abdominal Breathing (Respiratory Training)

When you become anxious you automatically breathe in a more rapid and shallow way. “Over-breathing” results in a decreased proportion of carbon dioxide to oxygen in the blood. The heart pumps faster, muscles feel weak and shaky, you start to feel dizzy, hands become clammy and tingling sensations occur in the hands and feet. Many of the physical symptoms of anxiety can be a direct result of rapid and shallow breathing. Anxiety symptoms can be reversed or prevented by altering your breathing.

Take time to relax

Research has documents the benefits of practicing relaxation strategies on a regular basis. Individuals who experience difficulties with anxiety may especially benefit from the following:

• reduction in overall level of anxiety
• prevention of the build-up of stress
• improved ability to identify and then more easily address anxiety and tension in one’s body
• less frequent anxiety attacks 
• increased energy level and productivity
• improved concentration and memory
• increased self-confidence

Some common ways to promote relaxation include:

• respiratory training (also called abdominal breathing)
• guided imagery
• progressive muscle relaxation
• meditation
• visualizing a peaceful scene

• Mindfulness

Develop a new perspective

As you start using the above specific strategies to better manager your anxiety, it will be equally important to develop a new attitude toward anxiety. Your beliefs about anxiety are key to making lasting change.

Consider the following:

Anxiety does not need to be a secret

Many individuals who experience problems with anxiety hide this from others, feeling ashamed or embarrassed. These feelings erode self-esteem and make you even more vulnerable to anxiety. When anxiety is no longer a secret, you can better make decisions to help yourself (instead of working to protect yourself from the opinions of others) and access the support you deserve. This strengthens self-worth and guards against anxiety. Anxiety does not need to be a secret. You can tell people about your anxiety.

Anxiety is not an enemy

It is natural to want to fight against the anxiety that disrupts your life and makes it difficult for you to live more peacefully. However, rejecting and resisting anxiety requires your time and energy. Ultimately, it increases feelings of tension and frustration, making you more vulnerable to anxiety. Tension is reduced and a sense of calm can develop when you acknowledge and accept your anxiety as a legitimate part of your life experience. Instead of investing your energy into fighting anxiety, you are freed up to better use your coping strategies. Anxiety is not the enemy. You can welcome anxiety.

It's OK to let down your guard

Individuals who experience difficulties with anxiety are vigilant and on-guard for something to go wrong. This constant surveying consumes time and energy, causes stress and increases feelings of anxiety. Letting down your guard and paying less attention to what might happen frees you to better enjoy your life. In addition, you are better able to focus on what you need in the moment if you aren’t worrying about the future. You don’t have to watch and wait for anxiety. You can move forward with your life.

Avoidance reinforces anxiety

As you know, one of the most successful ways of overcoming anxiety is to directly face the physical symptoms and situations you fear. By choosing to attend to frightening symptoms and to enter feared situations, you ask for anxiety to happen and discover you can cope. When you invite anxiety instead of running from it, the balance of control shifts to you. By consciously choosing to face fears, you increase your sense of self-confidence and build your resistance to anxiety. You do not have to hide from anxiety. You can choose to face anxiety.

Uncertainty comes with daily life

Problems with anxiety often relate to a fear of uncertainty. Much time and energy can be consumed in attempting to predict and control the outcome of events. Worrying about the possibility of negative outcomes increases tension and promotes chronic anxiety. The truth is that living involves risk. Certain circumstances are beyond your control. Accepting the uncertainty that comes with daily life puts you in a strengthened position to deal with what actually occurs. You can accept that some events are predictable and some are not, and that some events will have a positive result and others will not. You can accept risk.

Imperfection is acceptable

Sometimes, people who learn specific anxiety management techniques become convinced that their strategies must work each time they are used in order for them to cope. In reality, life is complicated and magical solutions don’t exist. While the techniques you learn are effective, they are not perfect. It is likely that there will be times when you feel less successful in your efforts to manage anxiety. This, however, does not mean that you have failed or are unable to cope. Accepting the likelihood of minor setbacks (and choosing to see these as learning experiences) will release you from the pressure that comes with believing that the techniques SHOULD work and that you MUST always cope. You can accept imperfection.

Managing underlying feelings

Better understand, accept and express all of your feelings.

What feelings have to do with anxiety:

• Sometimes anxiety masks other feelings (particularly anger and grief)
• Dealing with underlying or unresolved feelings may decrease anxiety
• When anxious, learn to ask yourself, “What else am I feeling?”
  • Look for one-word descriptors such as: sad, angry, resentful, embarrassed, humiliated, frustrated, etc.
• If you are not sure what feelings might be behind your anxiety, ask:
  • “What just happened?”
  • “What’s going to happen?”
  • “How might someone else in this situation feel?”
  • “What might be affecting me that’s not so obvious?”
  • “Am I feeling stressed about something?”
  • “Did something just happen to trigger a painful memory/feeling?”
• Find healthy ways to deal with feelings (e.g., let yourself have the feelings, go for a walk, talk to a friend, seek therapy if necessary)
• Seek help if you are struggling to better identify, accept and express your feelings

Where to go from here

Remember the foundations:

• Understanding your anxiety (e.g., symptoms, causes)
• Shifting your attitude
• Implementing stategies disucssed
  • Using respiratory training
  • Taking time to relax
  • Lifestyle management
  • Managing underlying feelings

Download the workbook

As you think about the different ways you can better manage anxiety, download and work through the workbook.

• Download Understanding Anxiety workbook

Remember

• You are not alone. Problematic anxiety affects approximately 15% of the population (Bourne, 2000).
• Suffering from intense anxiety can feel overwhelming and depressing.
• Within the mental health profession, anxiety is generally recognized as a very treatable problem. It is quite possible to overcome your anxiety.
• There are effective strategies you can use to decrease or eliminate problematic anxiety.
• To overcome anxiety, you will need to work on several skills at once.
• As you address problematic anxiety, predict a temporary increase in anxiety. You can learn some skills to help you manage this

Remember, a “quick fix” doesn’t exist. Overcoming anxiety requires effort.