Anxiety Relief: How to Treat Anxious Symptoms and Thoughts Effectively?
If you are struggling with anxious symptoms, you are not alone.
According to the Anxiety and Depression Association of America (ADAA) one out of every five people has trouble with anxiety ranging from generalized to situation-specific. (1)
In this article, you’ll learn how to treat anxious thoughts and symptoms using MBCT, CBT, and ERP.
Ready? Let’s get started!
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How We Develop Anxiety Disorders?
1. Excessive Worrying
Just like all our other behaviors, we worry because we think it will benefit us.
Worrying serve a purpose: it helps us prepare for or prevent danger. For example, worrying about our health helps us make changes in our diet and lifestyle.
However, when that worrying becomes excessive and irrational, it becomes unproductive.
This is especially true when our valuations are unrealistic – we over- or undervalue one of the factors in worrying.
Our amygdala (responsible for processing fearful and threatening stimuli) tells our body to produce adrenaline when we encounter a stressor.
This adrenaline gives our muscles and organs a boost in energy and causes all of the anxious symptoms associated with adrenaline, such as rapid heart rate, shallow breathing, dilated pupils, etc.
The amygdala dials down its response over time, and our body releases excess adrenaline.
However, when we consciously worry about the anxious symptoms we’re experiencing, this causes more adrenaline production, which leads to a panic attack.
In practice, it looks like this:
1. You experience an anxious symptom like elevated heart rate.
2. You mind creates a suggestive thought about that symptom, like “Am I having a heart attack?”
3. You begin to worry about that thought and consider your options, “What if my heart fails?” or, “Will I need to call an ambulance?”
4. This worrying signals to the amygdala that you are in danger, causing it to produce even more adrenaline. This intensifies the symptoms, creates a loop, and brings you back to step one.
Treating Anxiety: MBCT, CBT, and ERP
Some of the main therapies used in treating anxiety include:
1. Mindfulness-Based Cognitive Therapy (MBCT)
MBCT helps in reducing anxious symptoms and panic attacks.
Panic happens when we worry about an anxious symptom.
MBCT helps us stop the loop by changing our response to suggestive thoughts about our anxious symptoms and choosing not to worry about them, cutting off the release of more adrenaline.
In practice, the initial symptoms will show up, but instead of intensifying and turning into panic, they will remain at the same level then slowly go down. As you practice more, the anxious symptoms will appear less often and will be less intense.
CBT helps you challenge suggestive thoughts so you can see exactly what thoughts are unrealistic, and enables you to adopt new helpful ones.
In the long term, CBT helps reduce our unhealthy valuations and reduce excessive worrying, which in turn, helps reduce adrenaline production and anxious symptoms.
3. Exposure and Response Prevention (ERP)
ERP targets the amygdala (responsible for processing fearful and threatening stimuli) using exposure to fearful situation. This induces positive experiences for the amygdala so that it desensitizes and changes its response to some situations.
However, no matter how often we expose ourselves to a stressor, the amygdala will still count the experience as negative if we panic.
This is why ERP is only effective when we couple it with a therapy that prevents panic and ensure every exposure ends positively, like MBCT.
In short, MBCT targets short-term panic, CBT address long-term worrying, and ERP helps reduce the strength of anxious symptoms.
An ideal approach would be using just MBCT for a few weeks. Then, add CBT and once you are used to practicing both, you can add ERP.
Mindfulness-Based Cognitive Therapy (MBCT)
Techniques such as deep breathing and progressive muscle relaxation, while can offer relief, it doesn’t stop us from worrying.
MBCT teaches you how to experience anxious symptoms without worrying about them, allowing the body to release all of the leftover adrenaline without making more.
When we change our behavior (worrying), our anxious thoughts will out and slowly go away.
How Can You Stop Worrying?
By minimizing the benefits and maximize the costs of worrying in your head, so you can choose not to worry about the suggestive thoughts arising.
The MBCT method consists of four steps: recognize, respond, return, and remind.
1. Identify Your Anxious Thoughts
When a suggestive thought about an anxious symptom arises, begin by identifying that thought.
Identifying here means spelling out the exact thought you are having about your anxious symptom.
While this might seem obvious to people who have practiced doing so in therapy or while meditating, for people who have been worrying for most of their lives, it feels like they are worrying about nothing.
Start by asking yourself, “What am I worrying about right now?”
You might be worrying about having a heart attack, or fainting, or going crazy.
Be specific about your anxious thought.
2. Respond to Your Anxious Thoughts
Once you have identified the thought you are worrying about, you can respond to it in a way that helps you decide not to worry.
It’s easier to come to that decision when you can see that the costs outweigh the benefits of worrying and that you don’t really need to worry.
Start by examining your history with anxious symptoms.
Despite having panic attacks in the past, you never had a heart attack, stopped breathing, or gone crazy.
Examining your past experiences with panic can help you realize that anxious symptoms are harmless and that you don’t need to worry about them.
It’s also important to consider the costs of worrying.
Worrying about your anxious symptoms has not actually protected you from danger, quite the opposite – it made you even more anxious.
Respond to your anxious thoughts in a helpful way.
You can tell yourself something like, “Whatever. I know I’ll be fine,” or, “Let it be. I felt this way a hundred times before. I know this will also pass.”
3. Distract Yourself From Self-Checking
Once you have responded to the anxious thought, you need to avoid checking whether the original symptom has gone away.
One way to distract yourself from self-checking is to return your attention to the task at hand, or focus on something that grabs your attention and shuts down the urge to check in.
If you are having a conversation with someone, recall the last thing they said.
If we are not in the middle of anything, choose an engaging activity, such as solving a problem, writing, or playing an instrument.
4. Remind Yourself Why You Do Not Need to Worry
When you bring your attention back to the present moment, your anxious symptoms will begin fade away.
However, some small suggestive thoughts might arise. The final step here is to answer small thoughts without having to repeat the first three steps.
Say to yourself something like, “Whatever. I don’t care,” and go back to the task at hand.
Dealing With Anxious Symptoms
1. Adrenaline Rushes and Trembling
Usually adrenaline rush feels like a cold flush throughout our body. It can be followed by trembling as our body is trying to release and dispense of that adrenaline. (1)
So you don’t need to worry about it as it goes away on its own. the shaking and trembling is a sign that your adrenaline levels are going down.
2. Shortness of Breath
Shortness of breath is another symptom of high adrenaline.
We feel like we need to breathe manually or else we will stop breathing.
Fortunately, the part of the brain responsible for our breathing is out of our control and will keep working without our conscious intervention. (2)
In fact, the best way for our breathing to return to normal is to let the brain and lungs do their job without trying to intervene. This is why you don’t need to worry about this symptom.
3. High Heart Rate
Having a heart attack is one of the main things we worry about when we experience anxious symptoms.
Fortunately, no amount of adrenaline will ever cause a heart attack or stroke. This is mainly because a heart attack or stroke occur when our arteries become blocked by deposits, which has everything to do with our diet and nothing to do with our brain or adrenaline levels. (3)
4. Nausea and Other Stomach Issues
Nausea is another uncomfortable anxious symptom. It can cause us to worry we might throw up.
However, our body is usually capable of handling it without our conscious intervention and without any consequences. Vomiting is exceedingly rare when experiencing anxious symptoms.
Other stomach issues include cramps and irregular bowel movements, caused by adrenaline. These too should go away as you calm down by your doctor is the best one to advise you in the interim.
Adrenaline can also cause feelings of dizziness. We may even feel like we could faint, which can be scary, especially when we are in a social situation.
Fortunately, adrenaline cannot cause us to faint.
This is because fainting occurs when our blood vessels expand rapidly, like when we stand up too quickly. Whereas adrenaline causes our blood vessels to contract, not expand, which means adrenaline actually prevents us from fainting. (4)
6. Worrying In Bed
Some people would spend hours in bed going over the event of the day or worrying about an upcoming event or project.
One way to deal with this is to ask yourself, “Should I worry about this right now?” If there’s something you can do about it, you can write it down and take care of it the next day.
If worrying about it now won’t lead you to take action, it’s a waste of time and energy. In response, try telling yourself, “I will take care of it tomorrow.”
You can shift your focus by listening to a soothing story or meditating.
Many people would also worry about not getting enough sleep, which causes them to stay up more, creating a loop and making their anxiety even more intense.
It helps to know that, some nights of poor sleep are not enough to cause significant lasting damage. (5)
That’s why the best thing you can do is to be at peace with the idea of getting a only a few hours of sleep or even not sleeping at all. This will give your body the chance to finally relax and actually get to sleep.
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Cognitive Behavioral Therapy (CBT)
Worrying is not always unhelpful. Worrying about life choices and decisions can be helpful and lead us to act productively.
CBT can help you identify what worrying is helpful and what is unhelpful.
How to differentiate between healthy and unhealthy worrying?
Healthy worrying is when you spend no more than a few minutes considering an issue and that consideration leads to taking meaningful action. For example, briefly worrying about money can lead you to start saving and budgeting.
But when we constantly worry about the same issue without taking action or solving a problem, worrying becomes unhealthy.
1. Identify Anxious Thoughts
Just like MBCT, we begin by identifying what we are worrying about.
Ask yourself “What am I worrying about?” and be specific.
2. Identify The Valuation Behind The Anxious Thought
Once you identified the anxious thought, ask yourself, “Why am I worrying about this?”
3. Examine The Logic In Your Valuation
In this step you’re looking for cognitive distortions.
Cognition is a fancy word for a thought – the way we interpret everything happening around us.
Sometimes our thoughts become distorted. We might think in ways that are illogical that don’t reflect reality.
Ask yourself the following question, “How many times have you worried about something that didn’t end up happening, but you keep worrying about it each time?“
Once you can identify the distortion in your way of thinking, you can challenge your old valuation and think of a more realistic thought.
Since it is more complex than MBCT, CBT is best practiced using a journal or a workbook.
The following are some common cognitive distortions:
1. Black-and-White Thinking
Black-and-white thinking means assuming that all situations have only two outcomes: good or bad.
Life is too complex to be thought of in such simplistic terms. For example, we cannot say eating food is good or a facing a challenge is bad.
To correct this distortion, you can think to yourself, “Feeling uncomfortable is not the end of the world. I can still tolerate that feeling while doing what I need to do.”
Catastrophizing means overvaluing the worst-case scenario.
For example, if you’re having a test, catastrophizing would mean worrying about what would happen if you fail.
Catastrophizing is problematic because these worst-case scenarios almost never happen. So focusing on it is unrealistic.
It’s important to remind yourself of the in-betweens. The outcome might be bad, but it’s almost never as horrible as you expect.
3. Jumping to Conclusions
Jumping to conclusions means assuming something is true without evidence.
For example, you might assume that a angry is angry with you based on her tone of voice.
Ask yourself, “Is it possible I’m not the reason she is acting this way?” and consider evidence to the contrary. Her initiating conversations can be a sign that she’s happy to talk to you.
Filtering means discounting the positive and valuing only the negative. We might also filter out our positive experiences but not others’.
For example, spending so much time on social media can lead us to feel less attractive and see others as so much more attractive than us, ignoring the fact that people are positing their best pictures, which often are edited and filtered.
Overgeneralization is when you assume that one event is part of a larger trend, when it is not.
For example, you might encounter a setback after weeks or month of behaving healthily, leading you to mistakenly take it as a sign that you are losing all of your progress.
Remind yourself that now that you’ve been practicing for a while, getting back on track will be much easier than when you first started.
6. Emotional Reasoning
Emotional reasoning is when we use our emotions to justify our actions.
For example, we might wake up feeling depressed and decide to stay in bed, even though we have things we need to do.
Using our emotions to make decisions is illogical because emotions come and go, sometimes, out of our control. You can feel sad and still do the things you need to do. You can feel angry, but decide not to act on it.
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Exposure and Response Prevention (ERP)
Two main reasons our amygdala produces adrenaline are conscious worrying and unconscious threat detection due to the amygdala’s own internal programming.
This internal programming is based on experiences. When we have an experience that ends in discomfort, the amygdala dials up its response. This is why making our experiences more positive can help reduce the intensity of our anxious symptoms.
The purpose of ERP is to expose our amygdala to a stressor that activates it, then desensitize our amygdala by preventing ourselves from engaging in a negative response.
Rules of ERP
1. We need to expose ourselves to a stressor for longer than we are used to (at least ten or fifteen minutes after the most intense symptoms have passed).
2. Exposure needs to be gradual, starting with the least feared situations, then increasing the frequency, time, or volume of exposure and working our way up to the most feared ones as we get more comfortable.
3. To help our amygdala retain these experiences, we need to expose ourselves constantly and over time.
4. Exposure works best when we had plenty of experience practicing MBCT and CBT so we do not worry.
1. Direct ERP
Direct ERP is when we expose our amygdala to its stressors is directly.
For example, if socializing at work causes you anxiety, direct ERP means regularly attending work functions, making small talk and then extending the conversation gradually, all while using MBCT to prevent panic.
The more you expose yourself to these situations, the more your amygdala’s response weakens and over time anxious symptoms will hardly come up at all.
2. Indirect ERP
Indirect ERP is when you expose yourself to a similar but less intense situation than the one that activates your anxiety.
This is especially useful when the feared situation is not accessible to practice frequently, like airplane flights or group presentations.
The goal here is to stimulate a similar sensation in an activity that is more accessible. For example, for those who fear air flights, riding an elevator or a roller coaster can simulate a similar sensation.
If you fear public speaking, joining a public speaking group can create a similar sensation.
Indirect ERP can also be a lead-in to direct ERP. If you’re not comfortable with direct confrontation yet, you can choose to practice mock interviews with a friend.
3. Imaginal ERP
Imaginal ERP is especially useful when it’s a thought rather than a situation that activates our amygdala, such as the thought of going crazy.
Imaginal ERP is usually done through role-play with a talk therapist. The therapist gives you a thought that activates your amygdala and you begin to imagine how you would act, all while using MBCT to manage anxious symptoms.
Imaginal ERP can also be used as a preparation to direct or indirect ERP when we don’t feel comfortable yet to expose ourselves to a feared situation. For example, you can imagine yourself socializing and interacting with other people.
When practicing imaginal ERP, make sure you visualize the situation in a realistic way. Avoid setting high expectations by imagining yourself succeeding without experiencing anxious symptoms.
Imagine yourself experiencing all the uncomfortable thoughts and symptoms you are used to but being able to deal with them like you always have.
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Lifestyle Changes to Help Reduce Anxiety
1. Exercise More
Exercising three to five times a week for a period of a half hour or more boosts our mood and helps with overall health.
Exercise is also helps reduce anxiety: it gives our body a chance to get rid of adrenaline excess.
2. Pay Attention These Aspects of your Diet
Dehydration increases the chance we will experience anxious symptoms.
There are four main factors that impact dehydration: water, electrolytes (essential minerals), alcohol and caffeine.
The body needs a certain balance of electrolytes and water to function. Without enough water or salts, our blood vessels constrict, which causes the heart and lungs to go into overdrive. (6)
Make sure you drink enough water and get enough salts in your diet.
This would also mean that you need to avoid substances that dehydrate you, like caffeine and alcohol. Bothe are diuretics, which means they make us urinate more.
Caffeine also causes our blood vessels to constrict, which can amplify the strength of our anxious symptoms. (7)
3. Maintain Good Sleep Quality
Sleeping well might not do much to reduce anxious symptoms, but sleeping poorly is proven to increase these symptoms. (8)
Studies show that meditation has positive effects on all kinds of bodily processes, including our mood.
If you’re not familiar with meditation, you need to keep in mind that it’s impossible to make our brain stop thinking so the goal is not to fight your thought.
Rather, the goal is to create a distance between you and your thoughts by noticing your thoughts without engaging in them, and to simply shift your attention to something else (like your breath or your pulse in your hand and feet) each time your mind wanders.
5. Have a Healthy Support System
A nonjudgmental support system can make a world of difference when recovering from anxiety.
It’s important to keep in mind that it’s our responsibility to request their help and communicate with them what’s helpful and what’s unhelpful.
Is Anxiety Curable?
Some people believe that anxiety is curable, while others believe it’s only manageable.
The fact is, anxiety serves a purpose: it’s our body’s way of giving us a boost when we are in danger or when we need to focus. So it is not something we want to eliminate completely.
Anxiety could be compared to physical pain. While physical pain can cause great discomfort, it’s just a symptom. The real issue isn’t the physical pain, but what causes it.
Similarly, anxious symptoms are a sign that we need to address whatever is triggering that anxiety, be it certain situations, or unhelpful thinking patterns. In that sense, anxiety disorders can be curable.
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- Portions of this article were adapted from the book The Anxiety Encyclopedia: Your Path to Recovery, © 2021 by Jotham Sadan. All rights reserved.