Dealing with Anxiety

This month’s Atlantic magazine’s cover boldly announces the lead story: “SURVIVING ANXIETY,” an article written by the magazine’s editor, Scott Stossel. His anxiety is so debilitating that the only way he can speak in public, or fly on a plane, or undertake numerous other activities is to swallow a combination of heavy tranquilizers and a quantity of alcohol (needless to say a potentially dangerous combination).

Fortunately, most people afflicted with debilitating anxiety (and up to 1/3 of us will suffer from that at some point in their lives) can utilize less drastic techniques and still achieve good results. This post will identify and elaborate on some of them.

There are several “clusters” of anti-anxiety treatments, each focused on a different aspect of anxiety’s genesis and a different aspect of its treatment. No single one of them is generally capable of reducing anxiety in all circumstances, but acquiring a “toolbox” of techniques that can be utilized at different times and in different situations can certainly be effective.

1. Bringing yourself into the present

“Most anxiety is about the future: What’s going to happen? When will it happen? What steps can I take to make it happen (or to prevent it from happening)? But there’s also anxiety about the past (Did I make the right decision? Could I have done more? Where did I screw up?), although the anxiety there relates to trying to discover the thing that “went wrong” so that it can be avoided in the future. The one place that anxiety does not exist is in the present (you can be worrying in the present, but not about anything that is presently happening – you simply have an experience of whatever is going on).

Ways of bringing yourself into the present include concentrating on your breathing (the feeling of air filling your lungs or passing through your nostrils), implementing progressive relaxation (a succession of tensing and then relaxing muscle groups), listening to music, observing nature (anything from watching clouds to noticing the pattern in the bark of a tree) playing with a child or animal, or on the feeling of your muscles as you stretch.

2. Distracting yourself

When you find your thinking is in a loop, ruminating on a past or future incident or outcome, consider the possibility of shifting your attention to something that will engage your mind and shift its focus, like a slapstick comedy or a page-turner of a book or a crossword or jigsaw puzzle. Don’t turn on CNN, MSNBC or Fox News (or listen to talk radio): they intentionally program anxiety-producing topics (“Next up: What new threat has the Pentagon worried?”).

3. Cognitive techniques

Just as thinking creates anxiety, it can be harnessed to combat it. Question your anxious thoughts: Is it likely that I will run out of money and find myself homeless? Ask if your anxious thoughts are in any way serving a valuable purpose (i.e. if as a result of worrying is there some step you can take to diminish its likelihood). If not, think about the waste of time and energy involved in that anxious line of thinking. Are you concentrating on your weaknesses or mistakes and overlooking strengths and correct decisions (or, in general, focusing on the half-empty rather than the half-full glass?) Is perfectionism at work? For a particularly `detailed discussion of these techniques, read “The Anxiety and Phobia Workbook”; or “Learned Optimism” or “Authentic Happiness” by Martin Seligman.

Another valuable tool is visualization: close your eyes and conjure up a situation in which you felt calm (either one that actually happened or an imaginary one). A walk in a piney forest, perhaps, or a drowsy afternoon on a tropical beach. The more detailed you can make this visualization the more effective it will be: imagining the crunch of the leaves underfoot in the forest, or the smell of the salt air on the beach.

4. Spiritual techniques

I will classify meditation as a spiritual technique, although one certainly does not need to be spiritually oriented in order to benefit from it. Fifteen or twenty minutes sitting quietly, noticing your racing thoughts almost from the perspective of an outsider, and not attaching to any of them, can build the mental focusing muscles necessary to implement other anti-anxiety techniques. Furthermore, meditation has both an immediate and a cumulative effect, so even if you don’t feel you had a “good” meditation, simply attempting to has value. N.B.: when meditating it is not necessary to “empty the mind” (which is just about impossible for most people, especially beginners).

Prayer is another technique that works well for quite a few people. It can be a prayer of supplication (“God, help me to lift these worries and put my faith in you”) or a prayer that others be comforted (“May all those in pain or suffering feel relief”).

5. Pharmaceuticals and other substances

There are several classes of drugs marketed to reduce anxiety. Some designed for short-term, fast relief (e.g. Ativan or Klonopin). Others are intended to provide a longer-lasting effect (e.g. Valium and Buspar). Beta block regulate blood pressure and have been found to reduce “performance anxiety” such as that often present before speaking in public.

Several plants/herbs have been touted for their ability to reduce anxiety: chamomile and lavender for example, and warm milk or hot cocoa is recommended by some.

Finally, alcohol is undoubtedly the most widely-used treatment for anxiety. While a glass of wine or a cocktail can facilitate relaxation, it’s easier than might be imagined to develop dependence.