Managing and treating anxiety

Anxiety disorders can affect a person’s ability to work, study and take part in everyday activities. They can be distressing and debilitating, and may contribute to lost educational and employment opportunities and to difficulties in family and social relationships. The good news is that recovery is possible with appropriate treatment.

Treatment may include exposure therapy, attention training and a range of anxiety management techniques that help you manage your symptoms. You can learn many of these strategies yourself, for example through books or courses, or with the help of a trained professional.

Learning about anxiety#

The old saying that knowledge is power applies here: learning about anxiety is central to recovery. Education includes understanding the physiology of the fight-or-flight response, which is the body’s way of dealing with impending danger. In people with anxiety disorders, this response is triggered inappropriately by situations that are generally harmless. Understanding what is happening in your body is an important way to gain a sense of control over your symptoms.

Mindfulness#

When feeling anxious, a person can spend a great deal of time caught up in anxiety-provoking thoughts. Mindfulness is becoming more popular as people recognize how helpful it can be for a range of issues, and many resources are available to help you develop a mindfulness practice.

Relaxation techniques#

A person who feels anxious most of the time often has trouble relaxing, but learning how to release muscle tension can help. Relaxation techniques include:

• Progressive muscle relaxation.
• Isometric relaxation exercises.

Correct breathing techniques#

Some physical symptoms of anxiety can be triggered by hyperventilation, which raises oxygen levels and reduces the amount of carbon dioxide in the blood. Carbon dioxide helps regulate the body’s reaction to anxiety.

It can help to learn to breathe from your diaphragm rather than your chest, to guard against hyperventilation. The key is to let your belly expand as you breathe in. You can check this by placing one hand on your lower abdomen and the other on your chest: when you breathe correctly, your abdomen moves rather than your chest.

It also helps to slow your breathing when you feel anxious. Some people find abdominal breathing difficult, and there are many other breathing techniques you can try. You can also try holding your breath for a few seconds, which helps to boost carbon dioxide levels in the blood.

Cognitive therapy#

Cognitive therapy focuses on changing the patterns of thinking and beliefs that are linked to, and trigger, anxiety. For example, a person with social anxiety may worsen their anxiety with negative thoughts such as, “Everyone thinks I’m boring.”

The basis of cognitive therapy is that beliefs trigger thoughts, which then trigger feelings and produce behaviors. For example, if you believe (perhaps unconsciously) that you must be liked by everyone to feel worthwhile, then someone turning away from you mid-conversation might lead you to think, “This person hates me”, which makes you feel anxious.

Cognitive therapy strategies include rational self-talk, reality testing, attention training, cognitive challenging and cognitive restructuring. This involves monitoring your self-talk, challenging unhelpful fears and beliefs, and testing the reality of negative thoughts.

Behavior therapy and exposure#

A major part of behavior therapy is exposure. Exposure therapy involves deliberately confronting your fears in order to desensitize yourself, so you can retrain yourself to redefine the danger or fear in a situation or trigger. The steps may include:

• Analyze your fears: what exactly are you afraid of?
• Rank your fears in order, from most to least threatening, and choose to work first on one of your least threatening fears.
• Think about the feared situation and imagine yourself experiencing it.
• Work out a plan with a number of small steps. For example, gradually decrease the distance between yourself and the feared situation or object, or gradually increase the time spent in the feared situation.
• Resist the urge to leave. Use relaxation, breathing techniques and coping statements to manage your anxiety.
• Afterwards, recognize that nothing bad happened, and repeat the exposure as often as you can to build confidence that you can cope.

When you are ready, tackle another feared situation in the same step-by-step way.

Dietary adjustments#

The mineral magnesium helps muscle tissue relax, and a magnesium deficiency can contribute to anxiety, depression and insomnia. Inadequate intake of B vitamins and calcium can also worsen anxiety symptoms. Make sure your daily diet includes foods such as wholegrain cereals, leafy green vegetables and low-fat dairy products.

Nicotine, caffeine and stimulant drugs prompt your adrenal glands to release adrenaline, one of the main stress chemicals, so these are best avoided. Other things to limit include salt and artificial additives such as preservatives. Choose fresh, unprocessed foods whenever possible.

Exercise#

The physical symptoms of anxiety are caused by the fight-or-flight response, which floods the body with adrenaline and other stress chemicals. Exercise burns up these stress chemicals and promotes relaxation, so physical activity is another helpful way to manage anxiety. Aim to be physically active at least three to four times each week, and vary your activities to avoid boredom.

Learning to be assertive#

Being assertive means communicating your needs, wants, feelings, beliefs and opinions to others in a direct and honest way, without intentionally hurting anyone’s feelings. A person with an anxiety disorder may find it hard to be assertive because they fear conflict or believe they have no right to speak up. However, relating passively to others lowers self-confidence and reinforces anxiety, so learning to behave assertively is central to building stronger self-esteem.

Building self-esteem#

People with anxiety disorders often have low self-esteem. Feeling worthless can make anxiety worse in many ways: it can trigger a passive style of relating to others and foster a fear of being judged harshly. Low self-esteem may also be related to the impact of the anxiety disorder on your life, including:

• Difficulties functioning at school, work or in social situations.
• Isolation, and feelings of shame and guilt.
• Depressed mood.

Community support organizations and counseling may help you cope with these problems, and you can take steps to learn about and improve your self-esteem.

Structured problem solving#

Some people with anxiety disorders are worriers, who fret about a problem rather than actively solve it. Learning how to break a problem down into its parts and then decide on a course of action is a valuable skill. This approach, known as structured problem solving, can help manage generalized anxiety and depression.

Medication#

It is important to see medication as a short-term measure rather than the solution to an anxiety disorder. Research has shown that psychological therapies, such as cognitive behavior therapy, are much more effective than medication in managing anxiety disorders over the long term. Your doctor may prescribe a brief course of tranquillisers or antidepressants to help with your symptoms while other treatments are given a chance to take effect.

Support groups#

Support groups allow people with anxiety to meet in comfort and safety, and to give and receive support. They also provide an opportunity to learn more about anxiety and to build social networks.

If you ever feel overwhelmed, or have thoughts of harming yourself, seek help straight away by contacting a doctor, a local emergency service or a crisis support line in your area.

Types of anxiety disorders#

There are different types of anxiety disorders, including:

• Obsessive compulsive disorder.
• Panic disorder, including panic disorder with agoraphobia.
• Social anxiety disorder.
• Specific phobias.
• Post-traumatic stress disorder.
• Generalized anxiety disorder.
• Body-focused repetitive behaviors, such as trichotillomania or dermatillomania.
• Hoarding.

Key points#

• Recovery is possible with appropriate treatment.
• Education is an important way to promote control over symptoms.
• The key to correct breathing is allowing your belly to expand as you breathe in.
• Inadequate intake of B vitamins and calcium can also exacerbate anxiety symptoms.

Where to get help#