Techniques to Battle Anxiety

I find myself talking about anxiety nearly daily both in my personal and professional life.  Everyone seems to have some form of it impacting their lives.  While I could talk for a very long time about what I think the underlying societal causes are, the thing that people are most interested in is how to manage their worrying.  I do not believe that there in a “one size fits all” solution to the problem.  Anxiety is a sneaky foe that takes many forms and often, when one trigger is neutralized, another emerges.  Therefore, I believe it is important to be confident that you have a toolbox full of techniques for managing your anxiety that will allow you to find relief in any situation or circumstance.  Some of the reliable tools that you should always be aware of are physical elements I have discussed at length in previous blogs: proper sleep, nutrition and exercise.  However, there are plenty of mental tools that you can use as well. 

One such technique is worry restriction.  Anxious feelings often associate themselves with particular experiences or places.  Did you know that you can actually cause insomnia by creating an association between your bed and your anxiety?  While this can be extremely frustrating to many people, causing them to have extreme anxiety about certain places or things, you can also use this association to your advantage when your worry is getting out of control.   Pick a place that is easy to access where you are not needed to perform any other tasks and make it your worry spot.  In order to make the association you may need to be able to go to this place often at first.  Set a timer and place yourself there at regular intervals.  While there you can let your worry happen unchecked.  Allow yourself to cry, stress, and, to the extent possible, come up with a plan for managing future projected worries.  When you leave your worry spot, tell yourself that you are leaving the worries there and can come back to them later. 

The second stage of the plan once you have established a strong association between your anxieties and your worry place is to create a predetermined worry time.  For example, perhaps you would like to allow yourself two “worry sessions” a day in your worry spot and limit them to fifteen minutes each.   As your association with worrying in this place grows, you can extend the time period in between “worry sessions”.  If a concern comes up in between these sessions keep a list to take to your worry spot.  For some people, worrying right after lunch will give them time to come up with a plan for a challenging project you were trying to tackle in the afternoon at work.  For others, worrying at night before they start their bedtime routine will allow them to put the anxiety away and sleep restfully.  Be thoughtful about what time of the day you will have regular access to your space and when it will most benefit you to have this type of contained anxiety.  Many people have used this method with great success to navigate stressful work or personal situations or to help improve sleep. 

It may be a good idea as you go along building your mastery of this type of restriction to also use your worry place as a testing ground for new stress management techniques.  For instance, you could use this time to practice worry journaling, mindfulness, Socratic questioning or thought replacement techniques in a quiet and safe environment.  The good news about worry restriction techniques is that they allow you to regain a sense of control over feelings that often feel out of control and help you create limits on unhealthy habits that have a tendency to increase over time if left unchecked.  You may even find yourself reaching a point where you can skip a session at your worry spot because you have gained an ability to manage your anxiety without it!  If anxiety is impacting your life, don’t just wait, take action to regain control over these feelings. 

Choosing Therapeutic Activities

In my practice, I am always connecting with other professionals who offer services that my clients may also need.  In a recent conversation with one of these professionals, a wonderful occupational therapist that I often refer appropriate cases to, she happened to bring up a question she often hears from parents: are there activities I should be doing with my child that will enhance the therapeutic process?  In this world of overscheduled children, it is often difficult for parents to narrow down the activities with which they should get their children involved.  This leads to a desire to “kill two birds with one stone” and focus energy on activities that will be enjoyable but may also work on issues that the child is facing.  This discussion with the occupational therapist caused me to take a deeper look into what other activities could be used to help kids work on the issues that bring them to my office.

For my colleague, her answers are straightforward.  Any activities that involve fine or gross motor skills and offer sensory input are great.  If you have a child with fine motor issues, enroll them in piano, guitar, art class or rock climbing, for example.  All of these activities require the use of pressure and muscles within your hands and strengthen those things.  For balance issues, yoga, gymnastics, karate or dance might be a good recommendation.  But what can I offer as suggestions to parents whose kids have ADHD, social anxiety or poor self-esteem? I began to look at what skills I was trying to build and what activity would help build those same skills.

So if your child has social anxiety or low self-esteem, you would be looking for an activity that builds confidence and allows them to build comfort with being part of groups and builds leadership skills.  Girl or Boy Scouts seem like a great way to achieve these things.  Volunteering is also great for this.  Look for opportunities for your child to become a part of the community at large.  Work at a soup kitchen or food drive. 

If your child has ADHD, you will likely be looking for activities that promote working memory and executive functioning skills.  In order to accommodate their need for stimulation and activity, you might steer your child toward active things that are more solitary in nature such as running or swimming.  As an added bonus, you could involve them in things that are active but involve strategy such as fencing or rock climbing.  Activities that require thinking ahead or anticipating an opponent’s next move will help them train their brain to slow down and organize information.  Chess is a fantastic game for these kids.

Instead of just signing our kids up for whatever activities in which they express an interest, given the limitations on everyone’s time these days, I think it is smart to think about how an activity might help them learn the life skills they need in a fun and natural way.  Instead of having to fight with them to practice skill building activities that seem like work, they can be building the same skills in a way that they enjoy.  While this doesn’t replace the need for therapeutic intervention, it certainly could lessen the time that is required and build skills that could grow with your child throughout their lives.   Using these methods can help you incorporate these interventions into your child’s activities in a more time efficient and enjoyable manner. 

Matters of Sleeplessness

In my practice, I’ve noticed sleep deprivation effecting patients with increasing frequency.  Sleep is closely linked to your emotional state and your ability to control and regulate emotions.  A lack of sleep, especially for an extended period of time, can cause extreme mood swings and allow anxiety to run unchecked.  While I encounter a lot of people who struggle to fall asleep, I encounter just as many who wake up often throughout the night and struggle to stay asleep.  Unfortunately, waking during the night affects the quality of your sleep because it does not allow you to complete your body’s natural sleep cycles.  While quantity of sleep is important (the National Institutes of Health states that an average adult requires 7.5-9 hours of sleep each night), quality is even more important.  Without quality sleep your body cannot do the maintenance that is required for overall health and happiness.

If you are a poor sleeper, chances are this habit has developed over an extended period of time, but don’t despair.  There are things that you can do to improve the quality, and quantity, of your sleep.  Many doctors are now suggesting that people with sleep deprivation issues try melatonin to improve their sleep.  The problem with using melatonin long term is that it is possible that the use of artificial melatonin can decrease our body’s natural production of sleep hormones.  So while melatonin can be a useful tool to help reset our sleep clocks, it is my opinion that it should not be used for more than two weeks.  It is far better to try and reset naturally and create better long term sleep habits.

First, make sure that the place where you sleep is cool, comfortable, quiet and dark.  Use black out shades/curtains, and invest in a comfortable mattress and pillows.  For those that struggle to ignore outside noises a sound machine may be a good investment.  Second, avoid screen time within an hour of bedtime.  While we don’t always recognize it, the back lighting from screens is stimulating to our brains and can prevent quality sleep even when our bodies are obviously tired.  Third, avoid alcohol within an hour of bed time.  Studies have proven that we do not sleep as soundly when we drink alcohol right before bed.  If possible, it is good to try and keep your bedtime the same time throughout the week as well. Finally, create a good bedtime ritual.  A bedtime ritual can be anything that relaxes you and sends the signal to your brain that it is time to release sleep hormones.  A good bedtime routine is one that you can take with you no matter where you go.  Maybe you like to read a good book before bed, or have a cup of decaffeinated tea.  Perhaps you like to journal or do a mental breakdown of your day.  My favorite habit is a short meditation to clear your mind and relax your body.  Hopefully, if you make your sleep a priority you can improve your overall health and happiness.

A Happiness Journal to Combat Unhappiness

The mindset that leads people to seek therapy is often a result of a habitual negative pattern of thinking.  Interestingly, the amount of change required to make a large impact in the way you feel is often minimal.  The hard part is having the motivation to make an initial change and then maintaining that change until it becomes a new permanent habit.  Therefore, I normally suggest that people start with a tiny insignificant change such as changing their morning coffee to tea.  While this seems like such a minor shift, it is a building point to prove to yourself that you can make change, and a very easy way to break out of your mental rut.

If you are capable of making a minor change, which everyone is despite what they may believe, I often suggest the implementation of a “happiness journal”.  Most people who feel unhappy struggle to even find the smallest positives in their day-to-day life.  They have become adept at seeking out every negative experience throughout the day and ruminating on how “unlucky” their lives have become.  I have discovered that journaling is a powerful tool in many ways.  A happiness journal is a tool that anyone can use to teach themselves how to recognize all the positive things that do occur in their day-to-day life. 

At the end of every day I suggest that people sit down and write a list of at least three things that were positive about their day. Believe it or not, this is often a struggle for people who are unhappy.  They often seek guidelines for what is acceptable as a positive item for the list and I refuse to give any.  I want them to be forced to expand their thinking to allow for all of the wonderful things that happen in their lives.  Maybe a stranger complimented your shoes. Maybe a coworker who is notoriously difficult for you to deal with was out of the office or, even better, suddenly kinder that day.  Maybe it is just that you are grateful for your spouse sticking by you even though you have not been the most pleasant person to be around lately. Maybe you saw a beautiful sunset while stuck in traffic on your way home.  I don’t really care what it is that made you feel a moment of cheer that day, I just want you to be able to recognize the positive events.

In response to this requested task, I often get complaints that people are tired and don’t want to “waste” the time at the end of their day.  Ironically, these are often the same people who struggle to fall or stay asleep.  Doing it at the end of the day is important because it allows you to go into sleep with a happier and more relaxed mindset.  It may actually help you sleep better so that you are less tired the next day.  It will also help you have a more positive feeling about a day that may have seemed overwhelmingly awful.  Another complaint is that people feel silly writing these things down.  While the goal may be that you can eventually do this in your head as you are drifting off to sleep, it is vitally important that it begin as a written exercise for two reasons.  First, writing something down will solidify it in your mind, which will have a larger emotional impact and cement something in your memory.  Second, if you have a written record, when you are feeling extremely low you can look back over previous entries to recapture some of the happiness that does exist in your life.

I know that initially this may be a difficult and time consuming task.  However, I have yet to meet someone who doesn’t find it easier in a very short amount of time and love the effect that it has on their emotions.  As you become adept at this exercise you can utilize it to boost your self-esteem by simply changing it to three things that you did well every day.  Or use it to help a marriage by coming up with three things your spouse did that made you happy that day. So pick up a pen or pencil and get started.  The only thing you have to lose is your negative viewpoint.

To Medicate Or Not To Medicate?

In the course of my time treating individuals with mental health issues, I have often been asked whether or not I believe in the benefits of psychotropic medication.  The answer is not a simple one.  Mental health treatment is a mutifaceted endeavor.  I have certainly been part of treatment teams for individuals who need medication in order to live healthy lives. 

Let's first examine medication for the treatment of anxiety or depressive disorders.  There are many factors in a person's life that can contribute to them feeling anxious or depressed.  Eating habits, sleep habits and exercise are factors that are often overlooked.  Poor coping mechanisms, a propensity for negativity, self-destructive behavior patterns and poor social support are also major contributing factors.  None of these factors will be addressed through the use of psychotropic medications.  However, often genetics and biology also play a part in the development of these issues.  If your brain chemistry is a contributing factor in your anxiety or depression it is unlikely that you will be able to combat these problems without the help of medications.

If we are talking about issues such as ADHD, the determination becomes murkier.  A lot of people with this issue are able to be successful in altering undesirable behaviors through the use of structure and behavior planning.  Medication is often warranted in cases where other options have been exhausted.   Sometimes, non-medicated interventions are unsuccessful in helping the individual to overcome behaviors or impulses that lead to unhappiness and a lack of self-confidence in their lives.

My ultimate answer is always that it is important that you weigh all of your options.  Having a good team of helping professionals guiding you to make decisions will often lead to your happiest and healthiest outcomes.  Sometimes medication can be a temporary solution until new coping mechanisms and behavior patterns or healthier lifestyle choices can be learned.  The world is full of many different professionals who proclaim to want to help individuals sort through these issues.  Ask questions and find the one who you feel understands your concerns and can answer your questions fully and appropriately.