Anxiety Management

By Stuart Sorensen - RMN


There are many types of anxiety disorder ranging from mild feelings of 'worry' at one end of the scale to complete panic attacks at the other. Although these extremes are very different in severity the basic 'process' of anxiety is the same for both. It is the awareness of this process which forms the basis of anxiety management techniques.

Let's begin by understanding what anxiety is not. ANXIETY IS NOT OUR ENEMY. In fact, we all need a certain amount of anxiety in our daily lives just to keep us going. It's the little 'worries' and trivial concerns of everyday life that motivate us to get out of the bed in the morning.

Sigmund Freud divided anxiety into two broad areas which are still accepted today. These are 'appropriate' and 'inappropriate'. Let's look at what this means.

When we are faced with threatening situations we need to be aware of the dangers they represent. The way we recognize them as dangerous is by our feelings of anxiety. It can be thought of as a call to action warning us that something is wrong and prompting us to act. This is called appropriate anxiety because it helps us to stay safe.

Sometimes however people become anxious inappropriately. They perceive or imagine a threat which isn't actually there. This is called inappropriate anxiety because it prompts us to act inappropriately, running away or losing control of ourselves for example.

The way to decide whether or not anxiety is appropriate is to carefully weigh up all the information logically. Also see if other people think the situation is actually threatening or dangerous. If not it's likely that your anxiety is inappropriate. Later we'll look at ways of combating anxiety but for now it's enough just to learn how to recognize it. Below are some questions you can ask yourself about your anxiety.
What's the worst that can happen?

What can I do to cope if the worst were to happen?

How likely is it that the worst will happen?

What's most likely to happen?

Am I worrying about a problem (which can be solved) or a fact which can't be altered?

If it can't be altered (something in the past perhaps) is it appropriate to worry about it or should I just move on?

If the situation can be altered isn't it better to act instead of just worrying?

Let's look at how anxiety works - the fight or flight mechanism.

Anxiety is part of our natural defence system. If we didn't get anxious about dangerous situations we probably wouldn't live very long. The process of anxiety triggers the 'fight or flight' response - a vital defence system which is common to all mammals and most other animals as well. Let's look at how the fight or flight system works.
Imagine you're walking along a dark street at night. Suddenly from out of the shadows a large man appears with a knife and tries to stab you. You have two choices - to run away or to fight. Fight or flight.
Whatever you decide to do it's important that your body works as well as it can if you are to survive. You need to be able to rely on your muscles to run or to fight back and you must stay alert to other possible dangers - the man may have an accomplice for example. Whether you choose fight or flight you need to be at your best in order to survive.
The body's way of preparing us for peak performance is what we call anxiety. It involves a lot of physical changes which can seem frightening and confusing until we learn to understand their meaning. Let's look at some of the more usual symptoms of anxiety. These can be divided into two categories - physical and psychological.

Muscle tension is one of the most common physical symptoms. It is the body's way of storing up energy in the muscles in readiness for action. The more energy is stored the greater the tension we feel. Sometimes people experience aching muscles or a trembling sensation. This can result in uncontrollable shaking as the muscles store up more and more energy. Imagine the tension in a heavy spring as it gets pressed down. In many ways the tension in our muscles is just like that.

Of course all that energy uses fuel and the more tense we become the more fuel we need. The body's fuel supply is controlled by breathing and blood flow or circulation. Blood is pumped around the body by the heart to provide nutrients and oxygen to the muscles and tissues. At times of anxiety more fuel is needed so the heart rate speeds up and often it feels as though the heart will 'explode' as it fights to keep the muscles properly fuelled. Also breathing speeds up and becomes more shallow so people begin to 'gasp' for breath. All this extra physical exertion provides heat and so the body begins to sweat - our natural cooling mechanism.

In order to get enough energy to the large muscles of the body such as legs, arms and the abdominal muscles blood supply to the less important areas is reduced. That's why some people experience a tingling sensation (pins and needles) in their hands or feet. It also explains the churning stomach or butterflies sensation. That simply means that the system is working efficiently in order to keep us safe. Incidentally the need to use the lavatory is just another part of the same process. It is no more than a sign that things are working as they should.

Remember the attacker in the street. You'd have a much better chance of escaping or defeating him and his cronies with all that energy stored up in preparation for fight or flight.

Of course the man with the knife may not be the only problem you have. It may be that there's another assailant or some other danger lurking just around the corner. It's important that you stay alert and keep a constant check on your surroundings. That's why your mind begins to hop from one topic to another. It's checking for danger so you can have as much warning as possible if something else crops up. Sometimes we experience this constant checking as paranoia but it's actually an important part of the fight or flight mechanism. This constant searching for things which may become a threat to us is what we call worrying. It's also why some people seem unable to concentrate on any one thing when they're anxious. They have to keep reviewing a large number of things in order to make sure they're still safe. This is what we call racing thoughts.

The fight or flight mechanism is rather like an electric circuit. It can only be 'on' or 'off'. When we get anxious and our body changes in the ways described above the system is 'on'. That's because of the action of the SYMPATHETIC NERVOUS SYSTEM. It's just like flicking a switch which sets the whole system in motion.

The other side of the coin is the PARASYMPATHETIC NERVOUS SYSTEM. That's the part which calms us down again. It's the off switch. Once the danger is passed the parasympathetic nervous system is triggered to restore normal function to our minds and bodies.
Remember we compared the system to an electrical circuit. That's because it can only be either 'on' or 'off'. The trick is to learn how to switch the system off. That's what we'll look at next.

Because the system can only be on or off we don't need to control all the symptoms of anxiety at once. In fact we can't - that would be impossible. Fortunately for us all we need to do is control one or two key symptoms and the rest will fall into line. Remember - we can't be half anxious any more than an electric light can be half on.

The easiest thing to control is breathing. When we are anxious we breathe rapidly and shallowly. Combat this by making a special effort to breathe slowly and deeply. This will slow your heart rate at the same time, reduce the flow of blood and nutrients to your muscles and begin to reduce the anxiety. At the same time concentrate on counting as you breathe. Slowly breathe in as you count four - slowly. Then slowly breathe out as you count four. Every time you exhale let the muscles in your shoulders drop and relax your arms as much as possible. You should find that your arms, neck and shoulders will become a little more relaxed with each breath. Do this as many times as you need to until you feel the anxiety disappear.

This technique is called quick relaxation and with a little practice you'll find it can be done anywhere at any time without anyone else noticing. It's also helpful to lie down for twenty minutes or so each day and either listen to a taped relaxation exercise or relaxing music. Music which has sixty beats per minute in 4:4 time such as baroque is most effective as it mimics the rhythm of a relaxed heartbeat.

Other excellent techniques which may take a little longer to learn include progressive muscular relaxation which is also known as Jacobson's relaxation and the more advanced transcendental meditation

The easiest thing to control is breathing. When we are anxious we breathe rapidly and shallowly. Combat this by making a special effort to breathe slowly and deeply.

I think, therefore I am,

And all that I am is dictated by my thoughts.

Thought breeds opinion, opinion belief,

Belief engenders attitude,

And attitude, behavior.

Therefore in order to live well,

A man must first strive to think well.

His thoughts must be as a strong fortress

To withstand the onslaught of derision and dogma

And yet welcoming enough to admit the arguments of reason.

Thought must be fluid and well conceived,

Though must not be fixed but its' foundations must be firm.

And thought belongs to us all.

In this, the second anxiety management handout, we will consider the psychological or cognitive symptoms of anxiety. Although it isn't possible to cover all the cognitive aspects of anxiety in such a short document this should help you gain some understanding of the thoughts which give rise to anxiety (anxiogenic thoughts).

Before we begin to study the thoughts themselves it's worth spending a little time thinking about the nature of thought itself and the effect thought has upon behaviour. Actually psychologists believe that thoughts are a form of behaviour themselves. They can be described as mental behaviours and as we all know behaviours can be changed.

The idea of thought as behaviour is central to anxiety management. It is through taking control of and changing our thinking style that we develop the skills we need to cope with our worries. In the end it comes down to personal choice. We can choose which thoughts to accept and work with and which thoughts we'd rather ignore. Actually everyone already chooses their beliefs, no matter how unlikely or unsupportable they may be. That's how we protect our Ego and self-esteem. That's why two perfectly reasonable and intelligent people can draw completely different conclusions from the same evidence. Political differences or religious beliefs are classic examples of this ability we all have to choose what we want to believe. Sometimes we become so entrenched in our opinions that we ignore every piece of evidence that doesn't fit in with our preconceived notions about 'reality'. At the same time we emphasize the evidence that does fit. Psychologists call this selective abstraction.

What follows is a series of statements or beliefs which either create or destroy anxiety. Each is followed by a short summary of its' effect upon anxiety and, where appropriate an alternative belief is suggested. Please bear in mind that people usually decide what they want to believe first and then look for evidence to support it afterwards. That's why lovers can do no wrong in each other's eyes and the actions of enemies are generally considered to be malicious. It's selective abstraction' again. Why not use the system to your advantage by making it conscious (within your control) instead of unconscious.


I can predict the future
Most people deny holding this belief absolutely. They think of fortune telling as the realm of cranks and weirdoes. However many people spend their entire lives worrying about future predictions they have made which never come true. They have wrongly predicted the future with such conviction that they ruin any chance they may have had of finding peace of mind. Think about the things that have worried you over the years. The things you got most worked up about? How many of them actually came true no matter how convinced you were that they would? Anxiety is almost always based upon unconscious fortune telling.

A more helpful belief may be:
I can make an educated guess - a projection about what is likely to happen and then make plans to avoid catastrophe. Then I can stop worrying about it.

If I think it then it has to be true.
Once again most people deny holding this belief. On a conscious, rational level they know that thoughts are only thoughts. Unconsciously however anxious people become so convinced of the 'truth' of their thoughts that they stop being able to rationalize at all.

A more helpful belief may be:
I can measure my thoughts objectively against the evidence and decide whether to accept or reject them. I don't have to believe everything I consider.

It is unbearable when things go wrong.
This is called catastrophic thinking and it's one of the fastest ways there is to destroy your peace of mind. After all, let's fact it, things go wrong on a very regular basis. If you hold this belief then of course you're going to worry. You may be very objective in your assessment of the situation - the fact that things do often go wrong - but the way you interpret that likelihood will give rise to anxiety. It's important to get things into perspective.

A more helpful belief may be:
Things often don't turn out the way I'd like them to. However it's the little adversities in life that help me grow. Problems can be used to make me better - not bitter. I'm a resourceful human being with the ability to deal with most things so long as I think clearly about the problem and keep my anxiogenic thoughts under control.

It's a good idea to avoid stressful situations.
Most people are surprised to learn that avoiding stress is one of the worst things we can do. Anxiety management is a skill and it takes practice. If we avoid stress we miss out on the practice and so we never learn to deal with it. What's worse, we actually lose the coping skills we already have and so, over time we become more and more anxious.

A more helpful belief may be:
Life is full of stress but this can be overcome by thinking about it logically and taking positive action to change things for the better.

I have to be in control to be safe.
This belief is not only wrong it's dangerous. Total control is impossible for anyone to achieve. There are always too many possibilities, too many things which may go wrong. If your peace of mind depends upon control you'll never stop worrying.

A more helpful belief may be:
I can control my own actions and responses to the world. That's as much as anyone can ever do. It's enough because if I can control myself (and my thoughts) I can survive and actually grow from just about anything.

I can change things that cannot be changed.
Unless you're superhuman you can't. Remember that anxiety is part of our natural defence mechanism. It's a call to action. It alerts us to the fact that something is wrong and gives us the opportunity to change it. It has no place in situations which cannot be changed. Nevertheless how many of us worry about things which happened in the past for example - things which can never be changed. If you worry about past events instead of planning to overcome future problems you're not only wasting your time you're destroying your quality of life and, on one level at least, asking the impossible of yourself - to change what cannot be changed.

A more helpful belief may be:
There are some things which I cannot change. It's better to concentrate upon what I can achieve instead of worrying pointlessly about the things I cannot. To put it another way:

God grant me the serenity to accept the things which cannot be changed; The courage to change the things which can be changed and the wisdom to know the difference.

Of course this has been no more than a taster and there are many more cognitive aspects to anxiety. If you've found this information of use you may well benefit from counseling or a course in anxiety management. Whether you go on to learn more or not I hope you've enjoyed what we've covered here.

Remember - you are responsible for your own quality of life. What are you going to do about it?

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