Treating Anxiety Part 3: reactive elements and body awareness

In parts 1 and 2 of this series, I examined the nature and course of anxiety as it occurs and techniques to break the escalation of anxiety in the comfort of your home or in a clinical setting. Because anxiety is cumulative, there is some benefit to seeking a reduction at anytime we feel overwhelmed with stress, even after a long day. It gives us an opportunity to "reset" and reverse the mounting pressure that our rigorous activity brought forth and put us in the proper state of mind to truly enjoy our recreational and leisure portion of the day. But addressing stress as it occurs, in the social milieu, presents an even greater challenge. When suddenly confronted with a profound external stressor, we often lose that part of us that is the most grounded and pragmatic. So the question becomes, how can I maintain control when I am at my absolute worse?

In part one, I mentioned taking "stress breaks" throughout the active part of your day, utilizing the lunch or personal time appropriated to you. You have developed some stress reduction techniques at home, but because you lack the privacy and resources to fully implement these techniques in a work, school or community setting, it is beneficial to bring SRT into play by creating "portable" versions of these techniques to implement when you have a few moments or even seconds to yourself in these settings.

Meditation and positive visualization are possible anywhere. The most important element here is being well practiced enough at home to jump quickly into the technique in more formal settings, if even for just a brief period of time. Someone who is well-practiced at home can quickly let their mind "empty out," if for just briefly before regaining focus. And break time is an opportunity to take stress on for an even more extended period of time.

Recently a client with and anxiety disorder had some moderate success with deep breathing and meditation in the clinic setting and home. The panic attacks continued at school, however. These attacks included increased heartbeat and profuse sweating. I told him he needed to take time out during the school day and deep breathe and relax. He stated he thought this impossible because he would become self-conscious, aware that others were observing him taking deep breaths. My rational response was what did he find more embarrassing, him taking deep breaths or his shirt becoming soaking wet from perspiration? In fact, there is nothing embarrassing or impractical about breathing in this manner when sedentary or involved a moderately paced activity. And there is absolutely no benefit to displaying tension to others by taking short breaths and speaking in a pressured tone. People respond positively to those that exude calmness and confidence in any formal setting.

In order to claim this calm and confident persona, we need to examine our everyday physical orientation and movement in the workplace. How you sit at your desk chair and get up from it, for example can set the tone for the way you react to stressful situations. Are the muscles of your neck and spine overly tensed? Or do you sit slouched with your shoulders slumped in a submissive manner? Either one will contribute to anxiety when exposed to a stressful situation. Extreme muscle tension causes bodily discomfort, which in turn makes our mind even more confused and less adept to deal with adversity. Slouching passively is cause for unpreparedness and ambush when we our suddenly challenged. The happy medium is a healthy orientation of your head, neck and spine. Sitting upright, shoulders pronounced but not locked square as if at attention, is the correct stress reducing posture. Your neck should allow your head to be slightly forward, but not tilted downward or fixed upright. You should feel a widening in your lower back, as the orientation of head and neck allow the muscles along your spine to relax.

The movement from office chair to copying machine or from classroom to classroom should be scrutinized also. Anxious people tend to move about in a twisting, herky-jerky fashion. They think in terms of function, quickness and utility as opposed to their physical well being and comfort. Do you pop up out of a chair suddenly and automatically with a focus on your destination or the next task at hand? If so, you are reinforcing stress. You are placing unneeded tension on your joints and spine, and once again experiencing that discomfort that is cause for even more confusion and anxiety.

Take on the task of improving the most fundamental physical ergonomics in your day to day activities. Concede that these debilitating repetitious movements are taken for granted and never scrutinized. Resolve to partake in a deliberate and fluid physical motion. Unlearn the repetitious motor movements of your body that are cause for physical and mental tension. Reinvent your physical orientation and increase your awareness in those places were you experience the most stress. Both mind and body will be that much better for it.

This concludes my clinical insight on the practical treatment of the infliction of stress and the experience of anxiety. Hopefully you have achieved an awareness and knowledge of how anxiety manifests itself, the tools and techniques to keep it at bay and the means to take it on where it is most likely to have it most profound effect, in the places where you struggle everyday for achievement, income and recognition.

Treating Anxiety Part 2: stress reduction techniques

Empowerment is the key to a stress reduced life. I say reduced as opposed to free because we all experience stress on some level. Deadlines from work, difficulties with significant relationships and financial dealings to name a few. It's more the way we react to these situations than the content or magnitude of the challenge that makes it debilitating. A former friend of mine's favorite saying was "it is only a big deal if you make a big deal out of it." And although I wanted to slap him upside the head when he evoked this after my pet died, there is some truth to it.

We need to control and quantify our reactions to challenges and setbacks as they occur. So developing a repertoire of stress reducing and controlling techniques is a valuable weapon in the battle against anxiety disorders. Being comfortable and well practiced with them is probably the most difficult facet in being successful with them. When we feel overwhelmed with problems our narrow focus becomes the problem itself, not our disposition as we take them on. So appreciate the importance of your mind-set in dealing with your anxiety related problems.

Listed below are a few SR techniques I have had success with clinically. It is important to experiment around and find the one or many that work for you. You must gain some mastery of the technique in a comfortable setting, and then be able to implement it when you first feel the anxiety coming on, anywhere, anytime anyplace.

Deep Breathing Technique: This is the most basic and widespread of SR techniques. It is frequently ridiculed in the media and movies as a desperate measure when someone is overwhelmed. I don't know how many movies or comedy sketches I have seen wherein someone is breathing into a paper bag in the most inappropriate of settings (you don't really need the paper bag).

The most important element of DBT is control. You chose a slow deliberate pace to breathe. When you inhale, you do not let your abdominal muscles expand, as if you are filling up with air. Instead, you tighten your abdominal and diaphragm muscles. When you exhale you can slowly relax the abdominal and diaphragm and control the stream of air. Performers, particularly singers, woodwind and brass players use this technique to enhance execution when reciting.

Although the easiest to master, DBT is highly effective. It is also the most feasible to combine with other techniques. The increase in oxygen to the brain and vital organs gives one a sense of well-being. One of the main symptoms of anxiety disorders is a feeling of loss of control, in particular body functions. An increased pulse, or sweating, for instance, makes us feel even more anxious. In taking complete control of our breathing, we resume command over our bodies. We gain a calmness that lets us address these uncomfortable sensations.

Positive Visualization: When overwhelmed with disturbing thoughts, simply imagine a time and place when you were completely relaxed. A vacation at the beach, the warm breeze and the sound of the surf. Even a romantic encounter, one you truly enjoyed and does not invoke other insecurities. We all have memories that when vividly recalled will elicit the same calming sensations when the experience occurred. They can serve as a distraction when we feel on the brink of an anxiety episode.

Meditation: This technique really utilizes the power of the mind. Mediation, in a transcendental sense, is the "art of think of nothing." You position yourself seated in a quiet, non-stimulating setting. You can start with a mantra, a 2 or 3 syllable nonsense phrase or word. Keep repeating it in your mind till all meaning is lost. Eventually you can drop the mantra and jump to thoughts of nothing. When you loose the internal dialogue associated with a conscious state, all of the physical symptoms associated with stress vanish. Muscle tension in the neck, a rapid pulse, acid stomach, will slowly melt away.

Thought Stopping: This is effective for anxiety related disorders related to repetitive disturbing thoughts. It is a procedure used to stop thoughts that are cues to thinking obsessively or acting compulsively. The key is to hear “stop” literally or figuratively whenever a negative or unhealthy thought arises. You can yell it to yourself when you are at home or alone, then replace it with the imagined audible in your head when in a more formal setting. Another method entails making a tape recording of your voice by repeating the unhealthy thought, i.e, "I think my hands are dirty," over and over again for 2 minutes, then yelling "stop" loudly and repeating the cycle over and over. Then lie down in a semi-conscious state and listen to the looped tape.

The idea is to "jar" the negative thoughts and feelings out. Once you are redirected you can shift your thinking and activities to more healthy ones. Hopefully, over time, the repetitive thoughts will vanish.

Biofeedback: Biofeedback is not a SRT per se. It is a method of measuring physical responses associated with stress. A SRT is implemented and then the effectiveness of that technique is measured by the biofeedback instrument, as it looks for a decrease in a stress related physical response. It gives the client the ability to confirm the effectiveness of the technique. The client no longer will have to say "I think I am relaxing," because there is measurable confirmation to the relaxation. Once the sensation is confirmed and quantified, the client has learned to relax.

There are several biofeedback instruments available to measure stress. Some are quite inexpensive. I have found a Galvanic Skin Response instrument quite effective in practice. I paid $25 for it on ebay. Here are some definitions:

Pulse and Variable Heart Rate: When stressed, the heartbeat not only increases, but becomes more arrhythmic or uneven. Breathing does too. The "Stress Eraser, " measures both of these and keeps a diary to monitor improvement. It will even tell you when to breathe in a healthy cadence. It is portable and made of i pod style polished metal. It measures from your index fingertip. Might be an overkill on price but very stylish and effective.

Galvanic Skin Response: As mentioned above, very effective and inexpensive. Measures moisture at your fingertips, the minute "perspiration response." It emits a theramin-like tone that lowers as you relax. PC software is also cheap and attainable. These will create graphs to illustrate response over time and offer games that encourage you to relax. Time proven and effective biofeedback instrument.

Muscle Tension Instruments: Not highly commercialized, these measure tightening muscles, particularly in the neck. Highly effective in treating migraines and muscle tension-related headaches. Not very practical in terms of comfort (hard to cope with electric diodes placed on the neck).

Brain-Wave Machines: These are also used mostly in clinical settings, but are gaining popularity via the portability of the microchip. These directly measure the beta waves that are associated with a relaxed, conscious state. They are potentially the most effective way of measuring anxiety, but are also the most expensive, with the alpha-beta-wave machines of any real value topping $1k.

External Skin Temp- As we become stressed, blood rushes out of our extremities to our vital organs. These instruments measure body temp at your finger tips and scrutinize temps slightly below the normal 98.6. These are the most inexpensive in the biofeedback realm, but as you might have guessed, the least effective because there is a delay between the anxious response and the change in skin temperature, analogous to the delay in change in room temperature after you turn the thermostat down. It is therefore hard to get a feel for the cause and effect relationship of anxiety and this physical response. A mood ring is a simple example of an external skin temperature biofeedback instrument.

Stress reduction techniques do work. This is supported by research. It is difficult to find the time to implement them and find the right one that works for you. Biofeedback gives you an opportunity to confirm your progress and accomplishments and makes the dedication to anxiety reduction that much easier.

This blog has covered valuable information regarding controlling anxiety. In part one, we gained an understanding of how anxiety manifests itself and relates to our daily living and cycles. Part two has given us background on tools and techniques we can use to combat this illness. In part three, we will examine how to use stress reduction in the most practical settings, when and where it occurs in our work, travels and at home.

Treating Anxiety Part 1: cycles and patterns

Anxiety is by far the most addressed issue in clinical therapy. It is the big kahuna of psychiatric treatment. The 3 largest selling prescription drugs in the U.S. for all ailments of body and mind are approved to treat anxiety. These drugs usually produce moderate to excellent initial success, but are known for profound side-effects and increased tolerance. That's why learning to manage it on your own is so important.

Although anxiety manifests itself in many ways, there are some common elements we can identify that help us gain an understand of the cause-effect relationship and behavior chains that make it an obstacle to enjoy and function in our daily lives. Here are a few commonalities:

The Tension Mounts: Anxiety accumulates through stress. Most people report anxiety heightening by the end of the day. Panic attacks occur far more often in the PM then AM. It is therefore very important for sufferers to take stress breaks during the day. If you have an anxiety problem and you are spending your lunch or coffee break surfing the net, calling family or friends or some other activity that requires significant attention and concentration, then you are making poor use of your time. Take a few minutes periodically during the day implement a stress reduction technique (much more on them later). This will at least slow the accumulation of stress during the day and make it more manageable as it peaks.

Domino Effect: When we are under stress, we often make hasty and impulsive decisions. The consequences of these decisions are often cause for more stress and anxiety. Like a bad lie made from a politician, things start to unravel and we experience chaos and a loss of control. The saying or song "one thing leads to another," probably alludes to this phenomena. This dynamic once again points to the need to keep stress at a minimum and reset periodically during the day.

The Mind-Body Relationship: There are several measurable physical response directly associated with anxiety: increased and variable heart rate, adrenalin being dumped in the blood stream, increased muscle tension to name a few. These will be further addressed in the discussion of biofeedback in part 2. When we experience uncomfortable physical sensations the result is generally, you guessed it, more anxiety. Someone's heartbeat increases and palpitates and they wonder if they need to go to ER. Or someone begins to perspire in a social setting and they become more self-conscious and less confident.

The common theme between these 3 elements of anxiety disorders is one of mounting and accumulating stress. We see a chain of events and behaviors that help feed the anxiety. The preventive or proactive element of treating this disorder is vital. The onus is on you to identify these maladaptive trends as they happen and try to subvert them. Then the therapist or other resource can give you a repertoire of techniques to help you tame this debilitating beast.

up next: Treating Anxiety Part 2: relaxation techniques