It was post-holiday-deep-winter January. For the first time in my life I was living alone. That previous August my youngest moved out for her first year of college. I had been pretty busy during the fall season with travel and work — a welcome distraction. But now, a few months later, it was hard to ignore the deafeningly quiet house.

Morning after morning I woke up with a hard-to-describe feeling that started deep in my abdomen and swelled through my chest. I would lay in bed, miserably waiting for this unwelcome and never-tardy intruder to show up and temporarily paralyze me with a mixture of fear, dread, and self-recrimination.

Eventually I would start my day — quiet, shut down, mechanically moving through all the tasks ahead of me.

Even for me—a therapist—it took longer than you’d think to recognize this as anxiety. (It seems so obvious now as I describe it, but when you’re in the middle of it, it’s difficult to be objective.)

I waited for the feeling to subside (“It’s winter, everybody feels this way…”) but when it didn’t, I knew I needed a more intentional approach.

I think of one of my favorite scenes from the movie Silver Linings Playbook when Dr. Patel tells Pat, “So get a strategy. You need one.”

I know I’m not alone. Nearly every day I talk with friends, clients, family members and co-workers about anxiety. We know that around 30% of individuals in the US will be diagnosed with an anxiety disorder throughout their lifetime, and that does not account for the likely thousands of people who never seek professional help for their symptoms.

Fighting anxiety takes more than one strategy of course. Lengthy books have been written about this, so it is impossible to distill a one-size-fits-all anxiety-fighting strategy into a blog post.

However, if you are one of the millions of individuals who struggle with anxiety, here are three practical steps you can take to get on the path to feeling calmer and more at peace.

CBT & DBT

Some quick background: Cognitive Behavior Therapy (CBT) teaches that your thoughts, feelings and behaviors are all related to one another. If you change one thing, it will impact the others.

A close cousin to CBT is Dialectical Behavior Therapy (DBT) which integrates the concepts of non-judgmental validation and radical acceptance as a way to open the door to new thoughts, behaviors and feelings.

Both in my personal life and in my practice, I have found that a combination of the two can be especially useful in fighting the sometimes debilitating symptoms of anxiety.

The following strategies are adapted from DBT and CBT principles. They are not the only things that work, but if you are looking for something you can try right now to decrease your feelings of anxiety, this is a good place to start.

Step One: Start with Mindfulness

The first step is to work on becoming more aware of how you experience the physical symptoms of anxiety.

When we are anxious, the brain and the body are like two worried friends who get each other all worked up.

For example, let’s say you experience the feeling of your heart racing.

The brain says, “Oh no, our heart is racing. That means something terrible is happening!”

Then it sends your eyes out to look around for Something Terrible.

(Something Terrible is always there when we look for it.)

As soon as you find it, your heart races even more, which confirms that this is indeed Something Terrible.

Or let’s say a thought pops into your head that something terrible is happening. Now your heart starts racing — which confirms to your brain that something terrible is happening, which causes your heart to race even more. (And it will probably throw in some shallow breathing for good measure.)

If you have experienced this, you understand the vicious cycle.

Whatever the physical symptoms are, try to work on noticing them without judging them or attaching meaning. Rather than saying, “Oh no, my heart is racing for no reason. I must be going crazy,” you might just say, “I notice my heart is racing. I can feel it pounding.” Then follow that up with some self-validation. “The body is complicated. Sometimes our hearts race. This is a part of being human. It doesn’t have to mean anything.”

People have devoted their lives to practicing this mindful awareness and validation, so don’t be surprised if it doesn’t come naturally. I do recommend practicing it regularly — daily if you can.

Once you notice the physical feelings and are more aware of them and can work on validating yourself without judgment, you can move into the next stage.

Step Two: Distress Tolerance

Practice distress tolerance. One problem with anxiety is that it makes situations seem more dire than they actually are. Since anxiety is often first felt in the body, actively taking steps to reduce the physical symptoms of anxiety can make you feel like your situation is more manageable.

Distress tolerance skills are DBT skills that help us manage difficult moments without doing anything to make the problem worse. When using these skills try not to expect dramatic improvement — just think of them as turning down the heat a bit.

Here are a few things to try:

1. Practice parasympathetic breathing. When you are anxious, your body is in a state of fight or flight. The sympathetic nervous system is in charge and you are wired to run away, fight hard or freeze up. This breathing technique sends the message to your brain that things are okay and helps get the parasympathetic nervous system back on board. The goal is to be more aware of your breathing as you exhale longer than you inhale. Try it: Inhale for 4 counts, exhale for 8 counts
2. Change your temperature. A sudden change in temperature can also help restore the body to a parasympathetic state. Try splashing cold water on your face, taking a cool or cold shower, or submersing yourself into cold water (like a pool). If you are really brave, you can put your face in ice water for about 30 seconds. (This activates what is known as the mammalian dive reflex which can “reset” the nervous system.)
3. Try a grounding skill. Have you ever felt so anxious that it seemed like you weren’t even present in your surroundings? When this happens, a grounding skill can work. Try looking around the room for 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. If any of these things are inaccessible to you, you can just imagine smelling, tasting or touching something soothing.
4. Connect with someone you trust. Sometimes it just helps to speak our anxieties out loud. If you have a trusted friend or family member, call them and say, “I’m feeling anxious right now. I just need to hear your voice.” You don’t need to go into it — sometimes just knowing a caring person is near can help us settle.

Step Three: Get into Problem-Solving Mode

So you’ve noticed, you’ve validated without judgment, you’ve calmed a bit. Now is the time to roll up your sleeves and get into problem-solving mode. These are the more CBT-oriented practical steps you can take to really start feeling better over the long term.

Anxiety often makes us feel paralyzed, so taking action (which is the opposite of what you might feel like doing) can remind the brain that it is indeed capable of moving forward.

1. Tend to your basic routines. My anxious phase followed a busy holiday season. I was staying up too late, eating foods that weren’t good for me, not exercising. It really helped to shore up my sleeping, eating and exercise habits. What we do with our bodies and what we put into them has a profound impact on our mood and behavior. If you are anxious, make sure you’re getting enough sleep, eating healthy foods (and avoiding drugs and alcohol) and are moving a little every day. If you don’t believe me, keep doing what you’re doing and keep a mood log for one week. Then try to improve on the eating, sleeping and exercising and keep a mood log for the next week. Notice where you feel better.
2. Look for ways to challenge and change negative thinking. Are you catastrophizing? Thinking in an all-or-nothing way, or focusing only on the worst case scenario? Perhaps you are taking on problems that aren’t yours to solve or making everything your fault when it isn’t. When you catch yourself thinking in an overly negative way, try to challenge and change those negative thoughts. In CBT we call this “reframing.” Cognitive reframes are essential to reducing anxious thoughts.
3. Try a problem-solving strategy. I have found that we humans have a tendency to put more effort into worrying about the things we can’t change than we do working on changing the things we can. A simple shift of focus can help us feel more productive and less worried. This problem-solving strategy can help clarify where you should direct your energy.
   1. Define the problem like a newspaper headline – try to leave all the emotion and judgment out and just state the facts.
   2. Write down both your feelings and your thoughts about this problem.
   3. Write down your goal related to this problem. Be careful with this one — it’s easy to choose a goal that we can’t accomplish. The goal “I just need my boss to stop asking me to work late” is not realistic because you physically can’t stop your boss from doing this. Shifting your goal to “I want to be more direct with my boss when he asks me to stay late” is something you can work on.
   4. What are the things that ARE in your control? What things are NOT in your control? Make a commitment to focusing your time and energy on the elements of the problem that you DO have control over, and try to consciously work on letting go of the things you don’t.
   5. What are you willing to do? What are you not willing to do? This section speaks to setting limits and boundaries. With your boss — you might be willing to stay late once a week, but you are not willing to stay late every day. Once you determine your boundaries, it will help you figure out how to communicate more effectively with the people in your life.

When should I seek help from a professional?

It is very difficult to be objective about our anxiety. Talking with a qualified professional can help us apply these skills in a much more efficient and effective way. While not everyone with anxiety symptoms needs to see a therapist, here are some situations where it would be especially helpful:

1. You have tried these techniques but they do not seem to work.
2. You feel overwhelmed or unable to even begin to use these strategies.
3. Your anxiety symptoms seem out of proportion to the event. (Other people in your life are not as anxious as you are about the same problems.)
4. You find that your anxiety symptoms interfere with your life and make it difficult to function.
5. You suspect your anxiety symptoms are related to past trauma.

A good therapist can help guide you through these strategies, model for you what it’s like to be validated, help you identify places where you get stuck in your thinking, and help you brainstorm practical solutions.

It’s been a few years now since my anxious winter, and I can confidently say that the changes I made continue to work today. None of these are overnight or instant solutions, but a consistent practice can make the difference between being anxious and stuck or peaceful and thriving.

If you are in the Greenwood/Indianapolis, Indiana area and are interested in learning more about how the therapy process works, give us a call at 317-743-8202 or email [email protected]. Even if you’re not in the area and have questions, we would be glad to help if we can.