We all deal with anxiety, in fact if we did not have anxiety, we would be dead. Anxiety is meant to be a survival state for the body, warning us of danger and preparing us to survive it. However, when there is not actual and immediate threat to our life, then anxiety is not only not useful, but unpleasant and makes the situation more difficult. Therefore, it is imperative that we not just accept anxiety as a part of our lives, but explore it and manage it. There are immediate ways to do this for some relief and there are long term methods to eliminate the triggers for our unnecessary anxiety.
I often have clients ask me “what do I do?” As a therapist this is a difficult question, as I do not know what is best for each individual, but only have suggestions based off knowledge and experience. So this is a breakdown of what I would recommend as a short and long term management plan for anxiety and all that comes with it. This includes racing thoughts, shakiness, body tension, negative thoughts, and cognitive difficulties.
Immediate Symptom Management - CBT/DBT
Cognitive Behavioral Therapy (CBT) uses challenges to how we think, or to our perception of events, to change the way we feel and behave in a given situation. Dialectical Behavior Therapy (DBT) incorporates mindfulness and grounding techniques to supplement CBT even further. These are great techniques to turn to for some immediate relief and action against anxiety when it is unwanted or unwarranted. The first thing you should do when you feel anxious but you are not actually in danger in that specific moment of time, is get out of the mind and into the present. A combination of CBT and DBT techniques can assist with this.
Our awareness must be always on something and can only be on one thing at a time. Therefore, if your awareness is in your mind then the possibilities include focusing on future unknowns, increasing anxiety, or past worries and regrets, increasing depression. Anxiety when there is not immediate threat in your way is a perceived threat. For example, if you were to turn around and see a lion behind you, you would have a specific fight or flight response. If I were able to convince you, without even looking, that there is a lion behind you, then you would have a similar response. The threat only needs to be perceived, not real. Therefore, we first want to show our mind there is not a real threat to life and then shift our body's nervous system.
First, you want to learn coping strategies to get your awareness out of the chaos of the mind and into the safety of the present. We rely on our senses to pull this off. Focus your attention on something you can see and describe it in every detail and nuance, listen to identify the most dominant sound and describe it, then listen beyond to the sound underneath it and describe to yourself. If all else fails, get a big bowl of cold water, add ice for good measure, and dip your face right in there. Put your attention on how the cold water feels on your ears, nose, eyelids, and any differences. Notice the difference in temperature where the water line meets your face. This will help pull your attention into the present, as we can only experience our senses in the present moment.
Next is the body. Take in a deep breath through your nose as you count to four, hold for four seconds, then breathe out of your mouth as you count to four and notice how the air feels leaving your lungs and crossing your lips. This will start to control your breathing and trigger the nervous system to shift to the parasympathetic and ventral vagal, triggering the vagus nerve which will help regulate breathing and heart rate. Add in a body tension exercise. Tense your entire body as though you are trying to make yourself as small as possible, hold for 3-5 seconds with a breath in, then release the breath forcibly and let every muscle in your body release and go flaccid. This will also trigger the nervous system to shift, put your attention on the sensations in the moment, and the body will signal to the brain that it is relaxing.
Identify Root Cause(s) - Internal Family Systems (IFS) / Parts Work
When beginning to focus on the long-term healing process and not just coping strategies, I tend to focus on parts work next. This is my approach and can be altered, just like the suggested coping skills above. Coping skills are to focus on immediate relief of symptoms, kind of like putting medicine on a wound, IFS (and similar modalities) are like researching the wound to understand how it happened and why it is there. IFS is best done with a trained therapist, however you can do parts work on your own. There is an IFS Workbook I put together form the Internal Family Systems Training Manual available HERE. You can also research and look for IFS self-help books online. Basically, we have parts that arise when certain internal and external conditions exist, and some of these parts are wounded from past events/trauma. This is a lengthy discussion, so I will suggest you check out an episode I did on the podcast HERE. After applying medicine and examining the wound, the last phase is to sew it up and have it heal; which helps the symptoms to no longer exist or be much more manageable.
Remove the Root Cause(s) – EMDR
Continuing the analogy, now that we have put medicine on the wound so it doesn’t hurt as much and identified where and how the wound occurred, we close the wound so it can permanently heal. I usually approach this with EMDR, as it is often the fastest way to clear trauma wounds. There are many other methods that you can work with a therapist to use for healing trauma, somatic experiencing, psychotherapy, an more, but EMDR seems to work the best and fastest in my practice. I suggest you attempt EMDR with a trained therapist, as this approach requires specific training before the therapist is allowed to use it.
If you are working with a therapist you can also get workbooks that can help you to do EMDR at home. A book I often suggest for my clients is Getting Past Your Past by Francine Shapiro, the creator of EMDR. There are also many other self-help EMDR books available on the market. There are also a few EMDR apps for the phone and online. But again, I recommend you at least expose yourself to EMDR with a trained therapist first. For self-work I tend to recommend Emotional Freedom Technique (EFT), or “tapping”, for my clients. There is book and an accompanying app called The Tapping Solution available through most phone app stores.
So to summarize, we begin by trying to provide some immediate relief and increase self-efficacy by identifying coping skills. These coping skills often use CBT and DBT techniques to manage symptoms in the mind and body. Next you identify the root cause of the trauma or part that is driving some of the symptoms or behaviors that are unwanted. Finally you remove the root issue so the symptoms do not serve a purpose any longer using EMDR, EFT, or other methods. This is a comprehensive approach to healing trauma, but not the only way. If you would like to book a session then go HERE to reach out for a free 15 minute consultation.