Generalized Anxiety - Part two
Second session: Checking in
You have come back for a second session. Congratulations. So let’s sit with a cup of herbal tea or a glass of water and briefly revisit what you learned about yourself last week and what your next steps can be.
First lets check on how you managed with your homework. You most likely have gone down one of several paths since our last visit around the homework assignment.
One of several things has happened to you because of your actions.
1. You did the homework that we talked about last week and you are feeling slightly better but not quite trusting that good feeling or yourself.
2. You did the homework for awhile but self doubt has crept in and you still feel awful. The anxiety has told you that you are hopeless and nothing that you do will help you...the anxiety has gotten bigger and puffed up so that you remain scared of it and it maintains control.
3. You did not attempt the homework because you were afraid that you would fail. You started to live in the what if’s...
What if it you do the homework and you still feel awful?
What if the breathing, exercise and increasing your consciousness does not work and you realize that your situation is hopeless and lastly?
What if you are beyond help?
The what if’s can go on at length and for some time?
This is much too hard and I just want to be magically better
So...your anxious brain comes up with what seems to be the most logical conclusion that it is better to do nothing than have your worst fears confirmed.
I learned a long time ago that living a good life is a bit like trying out a series of scientific experiments on yourself… you try a new behaviour or way of thinking, analyze your results and either keep practicing it, or if that technique does not work the first time you either try it again to test your hypothesis or set it aside for the time time being and try something new.
As we move on in our second session we are building your toolbox which will include; some education about anxiety, cognitive behavioural therapy (which when done properly helps you connect both mind and body), and several new skills that you can practice between sessions. The real work of counselling is done by you in the spaces in-between our hour together.
More checking in:
The intention of this is to help you feel a sense of trust and that you are in not just safe but competent hands.
The other thing we do in the second session is check in to see how you are. This part is not just about anxiety about how you are. So as we sit and sip our decaffeinated tea we can have a little conversation about your life. I might ask you what has stayed with you since our last session and if you are curious about anything in particular. Questions that people will ask include:
· Is my anxiety the worst case you have ever seen?
· Is there hope for me?
· Why me?
· Will I get better so that I never have to deal with anxiety again?
· Does anxiety have a purpose?
I will address that last question first.
Can anxiety be purposeful? (a piece of education)
The short answer is yes!
Keep in mind I always have a long answer too, so here it is.
We are supposed to feel anxious sometimes. For example if you don’t feel some anxiety around exams you might not study or wake up in time for an important exam. So in lots of ways anxiety is purposeful, it is telling us that some event, situation or even a group of people are important to us. Anxiety can be a natural response to abnormal situations. For example almost everyone I know is worried about COVID. Unless its consuming every waking moment it is fine to be concerned about your loved one’s well being at this time.
Even if the fear is telling us to avoid a situation we still might choose to move forward. If we use the example of bungee jumping, although, I personally think that no one in their right mind would go bungee jumping. Yet many people enjoy that rush of adrenalin that they feel when doing something that appears dangerous but in the right circumstances can be very safe and dare I say, even fun. I think that most people who go bungee jumping for the first time, no matter how adventuresome they are, feel some fear the first time but less fear the second time. The people who work at a bungee jumping station probably feel little or no fear because the act has become normalized.
So... my point is that anxiety can be purposeful in telling us to pay attention, go slowly, and have a second think about our actions but in many instances does not stop people from seeking adventure.
When and how do we overrule this natural response
It is essential to acknowledge the anxiety but then make decisions around your behaviour and thinking that might seem counterintuitive: overrule anxiety and its travel companion fear. Notice that I said overrule not ignore. By trying to ignore fear we somehow make it significantly greater in our brain and body. We may not be able to control our emotional response but we can control our thinking and our behaviour. At any moment we can make choices to engage ion behaviours that are consistent with our goals. Often that requires a bit of bravery on our part. People who address their own anxiety/bully are indeed brave people.
When we start to address the anxiety in my office you need to know that it is not my intention to help you to become reckless in your daily affairs but rather to help you have some choices about how you make those choices.
Two types of anxiety that our brain produces (a little bit more education)
There are two separate pathways to anxiety: through the cortex or the amygdala. Cortex-based anxiety is different than amygdala-based anxiety. Cortex based anxiety is from our imagination and that triggers anxiety but amygdala based anxiety is a chemical reaction in the brain.
For instance, if you are worrying about an exam or a social situation you will know that that anxiety originates in the cortex. If you tense up for no apparent reason you will know that your amygdala has been activated.
Learning how and why these pathways create anxiety is important. Once you can identify where your anxiety or similar emotions are coming from, you can use tactics to help reduce the anxiety and work through it quicker.
Tools to help soothe anxiety, fear, panic and worry
Its all well and good to know where your anxiety begins in your brain but you also need the right tools to work on anxiety wherever it originates. You learn how to identify what path your anxiety is coming from and then how to tackle it with various exercises.
Counselling and other treatments are helpful when:
You feel yourself getting anxious often and don’t where it comes from.
You have a hard time calming yourself down when anxiety strikes.
Find yourself tense, unable to breathe, and wanting to escape in certain situations.
You have weird fears and moments of anxiety that most people don’t have and want to understand how to get rid of them.
Have obsessive thoughts.
Catastrophize things in your mind.
Feel a lot of guilt and shame over past experiences.
You beat yourself up over not being perfect.
You get a lot of insight into why these things happen along with the exercises to help you overcome these issues.
Medication:(An additional tool if needed)
I am not against the use of medication in treating anxiety. Generally I find that as adults we can be very stoic, and sometimes people feel ashamed if they need medication to help them address anxiety and practice the skills they will learn in counselling. If your doctor recommends medication then take it as prescribed and keep in contact with your doctor and pharmacist about the effect that the medication is having on you. The key message here is keep in touch with your doctor and pharmacist ,and take the medication as prescribed, but also do the cognitive and behavioural work involved in getting better.
How Breathing ‘Wrong’ Can Worsen Anxiety Symptoms (Rapid and Shallow breathing gets us into trouble)
Thinking about something as simple as the act of breathing regarding correct and a incorrect way to do it just makes people feel even more anxious. However, even though breathing is a natural act sometimes we get into bad habits around breathing. I remember reading that is because most of us talk so much so that we stop breathing properly which takes a bit of time. I am not sure if that is always right but it can be, especially in my case because I get so excited. Rapid and shallow breathing is a recipe for anxiety.
Mindfulness and intentional exercises can help you get out of those bad habits so that breathing can become the natural and healing act. I think of mindfulness as simply being present in this particular moment.
When you breathe from high in your chest, your chest muscles begin to tighten, causing you to feel increased chest pain and heaviness. If you breathe rapidly without any physical exertion, your blood does not oxygenate properly, leading to the following symptoms:
Dizziness/lightheadedness
Rapid heartbeat
Shortness of breath
Tingling or numbness in your hands and feet
Hyperventilation
Physical pain and
Exhaustion
All of these symptoms together are part of your body's "Emergency Response." Your shallow, rapid breathing signals the presence of danger, and your body prepares itself to take action which leads to anxiety and panic
Tools (Skills to practice)
Journaling - helps you learn your own patterns and identify your triggers,
Breathing - always a good idea and there are new ways to do it that will help you. We look more at breathing in the next section
Mindfulness: Is becoming aware of what is happening in your body as well as your brain,
Mediation: Can help you let some of the stuff go away
Tools: More Skills in Detail (more to practice)
The Calming Response
Take deeper, slower breaths See if you can breath into your diaphragm. Pretend you are a singer.
You do have the power to reverse this harmful Emergency Response and invite your body into a calming place.
First, the oxygenation of your blood improves. This, in turn, causes your breathing and heart rate to slow down. As you take deeper, slower breaths, the muscles in your body become less tense.
Dr. Edmund Jacobson, an early pioneer of relaxation techniques, once famously said:
"An anxious mind cannot exist in a relaxed body."
The mind-body connection is so powerful that once relaxation is achieved through proper breathing, your mind also becomes calm. The thought patterns which caused you to feel anxious in the first place become more manageable.
While the Calming Response takes a bit longer than the Emergency Response, it is still one of the most efficient and natural ways to combat anxiety.
Steps To Abdominal Breathing
Abdominal breathing is also referred to as ‘natural" breathing. That's because it's the way newborn babies breathe.
If you observe an infant, you will see that their bellies rise and fall with their breathing. Their chests, however, do not move up and down at all.
By nature, humans breathe from their bellies. It's only when we encounter a "fight or flight" response to danger that we begin to breathe from our chest instead.
Shallow, rapid breathing from the chest (also known as "thoracic breathing") is the kind of breathing to be used during physical exertion. It gives us what we need to survive, but does not allow fully for the intake of oxygen and the exhale of carbon dioxide needed for our long-term health and comfort.
Next time you take a breath, place one hand on your waist and the other on your chest and pay attention to what happens. Which hand rises the most when you inhale? For the natural breathing which best supports day-to-day activities, the hand on your waist should rise and fall. The hand on your chest should rise very little, if at all.
If you find that you are chest breathing, a simple exercise can help.
Follow these steps:
Slowly inhale through your nose while keeping your shoulders relaxed. Keep your hand on your belly and note that it rises while your chest remains still. You don't have to fill your lungs completely; just take in a normal amount of air.
Close your mouth and silently count to three.
Gently exhale through your mouth. Purse your lips, but keep your jaw relaxed.
Take another break for a few seconds. The point of these pauses is to slow down your breathing deliberately.
Repeat these steps for a few minutes as needed, until you notice that your body feels relaxed and calm.
To that end, do a practice of engaging in this breathing exercise several times throughout the day. Fortunately, you can do this exercise at any time, whether you're standing or sitting, in any venue.
Other Exercises That May Be Helpful
Countdown To Calm
This exercise takes more time than the abdominal breathing exercise described above. While it may not be as convenient, it forces you to spend more time focusing on relaxation, making it easier for you to tame those anxious thoughts.
Take a deep breath and exhale slowly while repeating a mantra such as ‘This too shall pass, or even just the word ‘relax. A mantra does not have to be a complicated Sanskrit word. I have a client who just tells himself ‘you’ve got this’
Close your eyes.
Take ten gentle breaths and slowly count down from 10 to one on each exhale.
Open your eyes when you get to one
Visualize each part of your body relaxing.
Carbon Dioxide Rebreathing
This exercise is best used if you are in the midst of a panic attack or you are hyperventilating. It rebalances levels of oxygen and carbon dioxide so you can calm down quickly.
Slowly breathe into a paper bag. If you don't have one, breathing into your cupped hands can also do the trick.
Take 5-10 slow natural breaths.
Deep Breathing For Anxiety
This exercise won't help you when you're already in the throes of a panic attack, but if you engage in it regularly, it yields a greater sense of calm which can reduce the likelihood of an attack.
Sit up straight with your arms and back supported, ideally in a chair with armrests.
Breathe slowly and deeply through your nose for 5-6 seconds.
Hold for 2-3 seconds.
Slowly breathe out for 6-7 seconds, with lips pursed to make a slight whistling sound.
Repeat ten times.
The Bottom Line
People with anxiety disorder often don’t breathe properly and one of our jobs is the help you become very aware of your breath. The other habit that people who live with anxiety disorder have is that when anxiety is not with them they ignore it and stop opening the toolbox that they have developed or practicing the skills that they have learned. In order to control this bully you have to practice your new habits every day. In future weeks we will look at how you can begin to speak to yourself differently and frankly more kindly.
Endnotes
Rethinking anxiety: Learning to face fear Dawn Huebner
Therapy in a nutshell; https://www.therapynutshell.com/
Rewire Your Anxious Brain : Catherine M Pittman PhD and Elizabeth M Karle, LLIS
Hope and Help For Your Nerves: Dr. Claire Weekes
The 10 Best-Ever Anxiety Management Techniques: Margaret Wehrenberg
