Anxiety Really Sucks!

Why so angry?

I can be an incredibly irritable person from time to time. I get annoyed when people walk too slowly in front of me, when the fridge won’t close properly, and when I keep dying in Resident Evil at the same point. Usually, I’m able to control my anger and let it diffuse. But sometimes, I’m not. Like yesterday – when I tore off my running shoes and launched them with such force that they both left permanent dents in the wall, all while screaming obscenities at a volume that left my throat feeling raw.

There is a definite link between anger and anxiety. While they clearly feel different, they’re both states of heightened arousal. Both emotions often involve cognitive distortion and a biased evaluation of a situation. They both seem to involve the release of adrenaline and thus are manifestations of the fight-or-flight response. And from my personal experience, sometimes very acute anger can feel like a panic attack – the loss of control, the fear of going crazy, the shame that comes after you cool down.

Anger naturally would have us act aggressively. Perhaps our ancestors could lash out at a threatening foe, but our modern society does not grant us the outlets for acting aggressively (outside the realm of organized activities like sports). Instead, we have to learn to either suppress our rage or calm ourselves down. Suppressed rage can be a source of anxiety in itself, and sometimes it’s simply not possible to calm down (much as it’s impossible to calm down during a panic attack). Waiting until you lose control of your anger is probably not the best method. Instead, try thinking ahead.

How can you control your anger? There are no quick fixes, but here are some techniques I’ve picked up that help in the long run to deal with my anger and keep me more grounded and easygoing.

• Try relaxation. Whether it’s light stretching or mindfulness meditation, relaxation techniques are a good thing to pick up if you’re prone to anxiety or anger. From my experience with mindfulness, I can truthfully say that the more you practice being calm, the easier it gets. Learning the proper breathing techniques and tricks for keeping your mind focused on the present are great ways to keep yourself calm. Learn to do this while you’re feeling okay, and it will become easier to do when you’re not.
  
• Develop better communication skills. A passive-aggressive style of communication is a major source of anger and frustration for most anxious people. A common example of unhealthy passive-aggressive thinking is assuming that someone else should know what you want without actually telling them, and then feeling angry or cheated when they fail to meet your (silent) demands. Try to work on being more assertive – this way you will get your point across in a healthy way. I struggle immensely with being assertive, but I’ve been trying to work on it. It helps to start small: try buying a product and then returning it immediately. If you can master being assertive with strangers, move on to being assertive with your close friends and family. Getting your point across in a polite but direct fashion will save you hours of frustration.
• Use your journal. A great way to overcome your anger rationally is simply to document the things that make you upset and take a look at them once you’ve calmed down. Maybe you’ll be able to see patterns in the sorts of things that make you angry. Better yet, you may see that your anger is irrational and come up with a solution. Try restructuring the way you see the situation. For example, rather than honking and screaming at a driver who cuts you off, try asking yourself whether that person may be in some sort of emergency. Challenging your anger with rational thinking is a productive, healthy way to modulate your emotions.
• Exercise more often. Anger, like anxiety, is the product of pent-up emotional energy. Exercising is a great way to diffuse some of that energy. Go out for a jog or hop on your bike.

These are simply a few of the ways that you can learn to control your anger. Anger can strike out of the blue, sometimes in situations where you can’t easily diffuse it. Practice these techniques when you do have the ability to control your situation and it will get easier to handle situations that you can’t control.

How do you cope with anger? I would love to hear your own techniques.

[As a post-script, I just want to apologize for the sparse posting over the past week. My goal is to post at least twice a week, but I’ve been busy lately writing guest posts. You can read my guest post for Summer Beretsky’s blog Panic About Anxiety here, and you can read my two guest posts for the Free Your Mind Projects here and here. I will resume posting more regularly! I hope you’ve all had a fantastic week.]

Is your life a daily catastrophe?

Today marked the end of my 7-day free trial at a local gym I have been meaning to join. Gyms have always deterred me because I feel awkward exercising around people who are much more athletic than I am. I finally worked up the courage to try one, and I had been enjoying it all week. So naturally, as my free trial was over, I walked in the door this morning and declared that I was going to officially get a membership. I went through all the paperwork, only to realize that the gym does not offer memberships on a month-by-month basis, but rather on a yearly basis. Realizing that I am only going to be staying with my parents for another two months, I was forced to leave the gym without signing up.

Doesn’t sound so bad, right? I bet you’re wondering why I’m even telling you this story. Unfortunately for me, my tendency to catastrophize turned this neutral situation into a spiral of emotions. I think I’m getting a little ahead of myself here – let’s back it up.

One of the hallmarks of cognitive behavioral therapy (CBT, aka the kind of therapy that will most likely be prescribed to you) is the idea of cognitive distortions – exaggerated and maladaptive ways of thinking that perpetuate false beliefs about the self and cause unwanted emotions. Whereas cognitive biases are both helpful and harmful at times, cognitive distortions are always bad. One prominent example of a cognitive distortion is catastrophizing, where a regular situation gets blown out of proportions and becomes the end of the world. You may catastrophize about present events (“I missed that light – now I’m going to be late for work and get fired!”) or future events (“If I choke up while presenting, everyone will think I’m a freak and no one will like me!”). Catastrophizing the past and present is a sign of depression, while catastrophizing the future is a sign of anxiety (although it’s not always a clear distinction).

Now back to my gym situation. When I realized I’d made a mistake by failing to ask the policies of the gym, I immediately felt overwhelmingly embarrassed. I had to pick up my things and walk out – and then the catastrophizing began. “Everyone will notice me leaving and will realize why I had to leave. Because I’m stupid and didn’t read up on gym policies before trying to get a membership. Now everyone in that gym will think I’m the most idiotic person alive because I couldn’t even sign up for a gym membership properly. Maybe this is why I didn’t do well in human genetics last semester – because I’m stupid. I’ll never be able to make it back to college; I’m bound to just fail out as soon as I go back anyway. I’ll never get fit like I wanted to, and I’ll never get any smarter, and I’ll just sit in my room for the rest of my life eating Doritos and getting fat while everyone around lives a happy life.” …Phew. That was a lot of distorted thinking.

We all catastrophize. Every day seems like the end of the world for some reason or another. But when catastrophizing brings you to the brink of mental illness, it becomes a real problem. It’s very difficult to lift yourself out of catastrophic thinking when you’ve become accustomed to it over the years. Nevertheless, there are ways you can tackle the issue. Here’s what I’ve learned to do:

• Notice when you’re catastrophizing. The obvious first step.
• Break out the journal. In order to overcome your catastrophic thinking, you have to challenge it. It’s hard to do this in the moment, so write down all the details of the situation that is causing you to catastrophize. It’s important to stay as objective as possible here.
• Record your catastrophic thoughts on a separate page. This will help you later. 
• Once you’re calm, go back and compare notes. Try to look for discrepancies between your thoughts and the actual situation. If you scored below average on an exam, is that really proof that you’re unintelligent? Or could it have been more a product of your lack of studying, the structure of the exam, your interest in the material, or your state of mind in taking the exam?

Only in challenging your cognitive distortion with rational thinking will you learn to overcome it. It certainly takes time – you’ve probably had decades of practice with this sort of thinking. Sometimes it may be hard to accept that your thoughts are not fact. I still find it hard to accept that a grade below what I’d hoped for is not always reflective of my (un)intelligence. I find it hard to accept that people may still like me despite the fact that I’m not as articulate as I’d like or not as extroverted as I could be. With time, you will begin to accept these things. You are a great person – millions of people can tell you that, but you have to learn it yourself.

What do you catastrophize? I would love to here your take on the concept of cognitive distortions. Are there any other ways you’ve been able to cope?

Start by taking a walk around the block to overcome agoraphobia.

As I’ve mentioned before, I’ve struggled with agoraphobia for the past couple months. If you’re not familiar with agoraphobia, it’s the fear of being in situations where escape is difficult. Agoraphobia is typically lumped together with panic disorder because it usually begins with panic attacks (with your PD diagnosis, you’ll get a label of “with agoraphobia” or “without agoraphobia”). The rationale is simple: you have a panic attack in a particular situation, it scares you, so you start avoiding that situation. Over time, you may have so many panic attacks in so many different settings that you’re pretty much scared of going anywhere. At its extreme form, agoraphobia may prevent you from ever leaving your home (although I want to emphasize that agoraphobia is not simply a fear of leaving the house).

We all avoid things to a certain extent. Whether it’s shopping, going to the gym, attending social gatherings, or getting behind the wheel of a car, there’s probably something that makes you uncomfortable that you avoid when possible. That certainly doesn’t make you agoraphobic. It’s only once you’ve started altering your behavior in destructive or otherwise dramatic ways to avoid things that you may consider yourself agoraphobic. Trust me, it’s not pleasant.

How can you prevent agoraphobia? There are no surprises here – if you catch your avoidance behavior early enough, you may be able to prevent agoraphobia from setting in. It’s important to keep note of your anxiety triggers and watch for signs of panic attacks. If you do have a panic attack while you’re out somewhere, try not to run. Use coping techniques to overcome the panic attack without avoiding the situation. If you’re having your first panic attack or if you’re in a situation that is particularly scary for you, it may be hard to stay put. Running away is of course your initial instinct when you panic (hence the term “fight-or-flight”). If you have to run, make sure you come back to that situation when you’re more calm. Avoidant behavior is a way of training your brain to fear things. Let’s say you have a panic attack in the mall. If you run out of the mall as soon as the panic attack begins, your brain will interpret your surroundings as dangerous since it is in a state of hypervigilance and is looking for any cues that may signal danger.

My quick and easy advice: Don’t let your brain learn to associate external cues with internal anxiety. Unfortunately, that is much easier said than done. I know how hard it is to remain in situations that cause anxiety. But take it from me: it’s much worse to end up stuck at home, scared to venture outside.

How is agoraphobia treated? The primary method of treatment is exposure therapy. Yep, it’s not any more complicated than you’d think. Exposure therapy involves exposing you to the feared situations and encouraging you to stay there until your initial anxiety abates. At first, you may have supportive people there like spouses or close friends to help you, but eventually you should be able to face the situations on your own. The idea here is to undergo graduated exposure, where you develop a hierarchy of feared situations and start with the least scary, rather than flooding, where you would jump right into the deep end and face your most feared situation. Flooding can actually be harmful and just further enforce your agoraphobia.

For my agoraphobia exposure plan, I started by taking my dog for a walk around the neighborhood. I realized pretty quickly that I had just built up my fears in my head, and I was not actually afraid to leave the house after all. So, I decided to take it a step further and leave the house for a therapy appointment. It was a little scarier because I had to stay in one place, but I knew it was for my benefit in the end so I managed to get through it. The third thing was going to get a haircut, which was a bit of a leap. I find haircuts quite awkward on a good day, so with the added threat of a looming panic attack in the mix, I thought it was a recipe for disaster. I got through the appointment without a panic attack (and with a nice new ‘do). It was a great accomplishment, but left me feeling exhausted (even though I never quite reached the panic attack threshold, I wanted to run out of that hair salon the entire time I was there). Over the past week, I’ve managed to go out for dinner, join a gym and workout in public several times, and sit through two anxiety group sessions. Even just a month ago I never thought I’d be able to do any of that without having a panic attack. The exposure therapy really works well if you can stick to it.

If you’re having troubles with the exposure, maybe take it a little bit slower. I was lucky because my agoraphobia is quite the recent development, so I didn’t have too much trouble re-training my brain to feel comfortable in potentially inescapable situations. For many people, their agoraphobia has gone on for years, and thus can be quite difficult to overcome. If you fall into this category, then take things slow. Start by going out around the block with a loved one. Keep doing this for a couple weeks, at least until it no longer elicits a strong anxiety response. It may take months, but it will be worth it in the end when you have the freedom and control to engage in a variety of activities at your leisure. It’s worth noting that exposure therapy will not necessarily “get rid” of your anxiety. There may be situations that will always cause you some anxiety. Treating your agoraphobia will not eliminate your anxiety, but rather will allow you to regain control of your life.

If you want a more detailed overview of exposure therapy, I will be doing a longer post on the subject in the coming weeks. For now, it’s suffice to say that exposure is the only tried-and-true method for overcoming agoraphobia without medication. (If you are interested in medication, antidepressants and benzodiazepines can be of great help in your exposure plan. The only problem is the potential interference with the associative learning that you’re trying to overcome. Psychoactive medications can interfere with normal memory processes and interrupt the effectiveness of the exposure therapy – your brain may fail to learn that there’s nothing to fear. Talk to a doctor to weigh the pros and cons of medication.)

How have you overcome your agoraphobia? As always, I would love to hear your story. Leave me a line!

Today, I want to share a story. The year is 2012, and I’m back at school living a “normal” life. In order to move forward with my thesis project, I have to defend my thesis proposal in front of my professor and my fellow honors students. Like the procrastinator I am, I leave the presentation to put together the night before I’m scheduled to present. The following morning, I wake up and I instantly know it’s going to be a tough day. I gather all my stuff together, stuff a piece of toast in my mouth, and run out the door. In my bag is a little bottle filled with propranolol, a medication that calms me down and stops my physical anxiety symptoms from manifesting. I get to the psychology building forty minutes early, just to be sure I’m not late for my proposal defense. As my hands start to shake and my heart rate speeds up at the thought of speaking in front of my peers and professor, I pop one 20 mg dose of propranolol to calm down. Of course, unlike Xanax and other benzodiazepines, the propranolol does nothing to calm my racing thoughts and feelings, it just paralyzes my body a little bit so that other people can’t tell how out-of-control anxious I am.

Time is ticking by, and the other students in my seminar begin to show up. I laugh when they ask if I’m nervous, trying my best to avoid the question. I wouldn’t say I’m nervous – I’m freaking out! The metaphoric bell rings, and we all file in to the seminar room. The propranolol has slowed my heart, so I feel a little bit of relief, but my thoughts are racing and I have a crippling sense of dread. I stand up in front of the class and start talking. It feels like the room is narrowing in around me, as if the world is dissolving away and I’m left alone with my fear. My speech begins to feel automated, as if I’m on autopilot and the words are just spewing out on cue. I speak with adequate intonation, I have a good blend of hand gestures and eye contact; all in all, the presentation goes well enough. But inside my mind, a war is being waged.

After the presentation, I sit down and receive the usual reassurances – you did great, you spoke well, you seemed calm. (I laugh a little bit at the notion that I could ever “seem calm.”) As I sit back in my chair and listen to the next presentation, I can feel my chest burning up, and sure enough, I’ve developed a rash. It feels like I just ran a marathon. I can barely pay attention to what’s going on around me; my body is in recovery mode, trying to reach a state of equilibrium again.

On the surface, I wasn’t any more nervous to give that presentation than anyone else. In fact, I probably looked more calm than my peers thanks to the propranolol slowing my heart and calming my breathing. And that is the hardest part of living with a mental illness: the semblance of normalcy. The appearance of health. Mental illness isn’t something that you wear on your sleeve, it doesn’t come with canes or walkers, it leaves no blemishes or bruises. To the outside world, I’m no different than anyone else. But if there’s anything I’ve learned through this process, it’s that no one can tell me what I’m feeling. I know the difference between normal nervousness and crippling anxiety. For other people who can’t see inside my head, my illness is only as real as I say it is.

It comes as a surprise to most people when I tell them I have an anxiety disorder. Some are empathetic, some indifferent, and some would like to think they can cure me. If you’ve ever had to “come out” with a mental illness, then you know the interesting reactions you can get. Sometimes you hear things like…

“But you’ve never seemed anxious before.” Well, thanks. I’ve had anxiety for 8 years. It surely doesn’t take 8 years to learn how to hide something from other people.

“Everyone has anxiety.” Thank you, I wasn’t aware. I guess I’ll just have to stop being such a baby, right?

“Stop worrying about it so much and just get over it.” Great advice. I would be ecstatic if it were that easy. It’s not. I’ve tried.

To other people’s credit, it can be hard to hear that someone you know well is sick, especially if it’s not immediately apparent. Everyone loves giving advice – myself included – so it can be difficult to bite back the comments that spring to mind and listen. It is true that everyone experiences some level of anxiety (anxiety is normal, healthy even, in small doses), so of course everyone feels like an anxiety expert of sorts. Thanks to the laundry list of cognitive biases that plague our minds, everyone has their own take on how the world works and what people need most.

I spend a lot of my time pretending to be perfectly normal. It’s a choice I make, because I want to live a normal life without letting my disorder get the best of me. Sometimes, I’m forced to lie. From colds to stomach flus, I get a lot of mystery illnesses. It’s a lot easier to tell someone I can’t leave the house because I have a heavy fever than to admit I’m too scared of having a panic attack to sit through a meeting. I would rather say that I’m hungover from last night than admit the real reason I can’t go to brunch is that I’m too anxious to sit at a table with other people.

However, in the past couple months I’ve learned that sometimes, opening up and talking about how you’re feeling can do a lot more good than you’d think. Talking my anxiety out can sometimes help me get to the root of the problem and feel better much quicker than hiding it. It’s a tough route to go though; if you’re anything like me, you can fill entire conversations with how you’re feeling. It can be difficult to get across how you’re really feeling without being overly wordy. You might leave out some important parts of what’s going on in your head and give the wrong impression of your general state of being. Taking those first steps – admitting to someone that you suffer from anxiety – can be incredibly beneficial on its own. 

Yes, sometimes there are empty smiles. Sometimes I laugh when I really want to scream and throw things. Sometimes I respond with vague one-word answers when I’m not really listening because I’m fighting back the urge to race out of the room. But that isn’t to say I’m not really here. I’m me, just as I’m me when I’m not ill. Hiding your illness doesn’t make you a bad person. Neither does opening up about it. Those are just two of the options we have as sufferers of so-called “invisible” illnesses. You may choose to let some people know and not others. Some situations demand that you explain your erratic behavior, while other situations permit you to avoid the topic. In the end, you control how other people perceive you, and there is no right or wrong way to approach (or avoid) the subject of your illness.

How do you cope with your invisible illness? Are you open about it, or do you prefer to hide it? Leave me a comment; I would love to hear your answers.

We’d all like to believe that we think  in an objective, rational manner. Unfortunately, our minds are hardwired to see the world in an egocentric frame of reference, and thus information tends to get distorted, lost, or invented. Over the course of evolution, the human brain has evolved many mechanisms for extracting the most relevant information out of the surrounding environment without having to overload its senses.

One broad category of such mechanisms is the cognitive bias. Cognitive biases have evolved to speed up judgment times and make decisions easier to come by. However, by decreasing judgment time, your brain often sacrifices objectivity and precision. Decision-making mechanisms that speed up reaction time (while sacrificing accuracy) are referred to as heuristics, and there have been many identified in cognitive psychology. Cognition can also be persuaded by goals or motivational states (we often perceive things as we’d like to see them).

Cognitive biases not only interfere with your day-to-day perception of the world, but can also affect the way you see your illness and when you choose to seek treatment. In today’s post, I want to go over four basic cognitive biases that could be hindering your anxiety treatment plan.

Confirmation Bias. 

What is it? Humans have an overwhelming tendency to confirm their own beliefs. Hence, it shouldn’t come as a surprise that we’re hardwired to do just that. The confirmation bias is the tendency to collect information from our surroundings that supports ideas or beliefs that we have already formulated.  It’s hard to think objectively when your brain is constantly searching for information that validates your beliefs.

How can it disrupt treatment? If you think that your biggest anxiety trigger is the smell of perfume, then you’ll notice every time you feel anxious around someone wearing a heavy scent. Unfortunately, the confirmation bias may lead you to miss other obvious triggers. The confirmation bias will make it difficult for you to pinpoint your anxiety triggers because you will likely already have an idea of what’s causing your anxiety. Overcoming the confirmation bias is an essential part of cognitive therapy.

Hindsight Bias. 

What is it? The hindsight bias is closely related to the confirmation bias; both are examples of how overconfident we can be in our own thoughts and beliefs. The hindsight bias is the tendency to overestimate how predictable something was after it has occurred (“I knew it all along!”). For example, when you get an A on a midterm, you “knew” it would happen because you studied so hard.   Cognitive biases like the hindsight bias probably derive from cognitive dissonance: the discomfort we feel when we hold two or more conflicting ideas. “I thought I was going to get an A on that midterm, but I got a B.” These two conflicting thoughts make you feel quite uncomfortable; so you rectify them. “Well, it wasn’t a fair exam. I have an unfair professor.” Hindsight bias is one of the many ways we can reduce the amount of cognitive dissonance we feel. Obviously, when I’m right I knew it all along. When I’m wrong, something happened that was completely out of my control.

How can it disrupt treatment? You may find yourself overly confident in your ability to predict panic attacks or sudden onset of anxiety. Over time, you may become so confident in your ability to predict your panic attacks that you stop following your treatment plan. The ability to predict when we’ll feel anxious is falsely comforting, sometimes encouraging us to think we’ve “conquered” our illness. From time to time, I’ve found that I become so confident in my ability to deal with and predict my anxiety that I stop doing the things that keep me calm. Eventually, falling off my treatment plan comes back to bite me, and the anxiety gets worse again.

Availability Heuristic. 

What is it? The availability heuristic occurs when we make decisions or judgments based on how easily information comes to mind. For example, if you’re out buying a new car, and you remember your uncle telling you about how much he loves his new Honda, you may be persuaded to buy a Honda. When memories are available to us, they can be quite persuasive. Many students unknowingly use this tactic to answer multiple choice questions; read the question, and whatever comes to mind is probably the right answer. Professors can take advantage of this mental short-cut to trip up their students and make misleading questions. This heuristic can be used to make a lot of false assumptions, and can enhance the effects of an illusory correlation (a situation where two things seem related, but are not). For example, say you have two friends from Belgium. Both of them happen to be fans of the show Friends. If asked whether most Belgian people like the show Friends, you’ll probably say yes. Hopefully you can see how irrational that is; two individuals are hardly a representative sample of a population of 11 million. We use the availability heuristic in many different areas of our lives to make decisions, both trivial and important.

How can it disrupt treatment? Like the confirmation bias, the availability heuristic can distort the way you see your anxiety triggers. If the last time you felt anxious happened to be while giving a presentation in class, you may become convinced that presentations are your biggest problem, while this may not be the case. This can lead you to start solving problems that aren’t really problematic – while ignoring problems that are severely impacting your life.

Anchoring Effect. 

What is it? Anchoring occurs when we base decisions on deviations from a set piece of information we’re given. For example, if you’re told a watch normally costs $100, but you can get the watch for $80, it will sound like you’re getting a deal – even if the watch is only worth $50. The first piece of information we receive surrounding a decision will anchor how we approach that decision.

How can it disrupt treatment? Labels can act as anchors to disrupt your perception of your illness. If you’re initially told you may be suffering from obsessive compulsive disorder, that label will act as an anchor to guide the way you see your illness, and can influence the treatment you decide to undergo. The anchor may dissuade you from exploring alternative diagnoses like post-traumatic stress disorder or generalized anxiety disorder.

The human brain is an incredible organ, capable of astounding feats that (as of yet) are not reproducible in the lab. We are constantly being bombarded with a daunting amount of sensory information, and it’s a wonder that any of us can make it out the door in the morning without being overwhelmed. Our brains do their best to keep us living happy, healthy lives free of decision fatigue, sensory overload, and debilitating stress. But sometimes, the very mechanisms our brains use to lighten our cognitive loads can also be those obstacles preventing us from overcoming illness. Being more aware of the various cognitive biases that plague the human race can have a noticeable impact on your treatment outcomes.

What cognitive biases are affecting you? Leave me a comment if you have stories of your own cognitive bias.

You may be asking yourself, “How could I possibly be breathing incorrectly? I’ve been breathing since I was born, how could I screw it up?” Well, for those of us who have joined the anxiety club, breathing may be something that we just can’t get right. It has been known for a long time that anxiety sufferers tend to hyperventilate more often than the average person (see, for example, this scholarly article or this one). While researchers haven’t really distinguished the directionality of the association (does anxiety cause hyperventilation, or vice versa?), it is clear that a frantic state of breathing exacerbates underlying anxiety.

Let’s go into a brief explanation of what hyperventilation does to you. When you breathe faster than normal, you are expelling carbon dioxide at a much quicker rate, which would be okay if you were running a marathon and creating more carbon dioxide than usual, but chances are that’s not the case. What happens is that the concentration of CO2 in your blood falls drastically, sending you into a state of respiratory alkalosis – where your blood is more basic (less acidic) than it should be. This increase in pH is interpreted as a signal that you have too much oxygen in your blood (which isn’t true), so your blood vessels constrict and less oxygen makes it to your brain. Low oxygen levels in your brain give you the characteristic symptoms of labored breathing: numbness/tingling, lightheadedness, dizziness, headache and fainting. You might notice that these symptoms sound a bit like a panic attack. Cue the “Aha!” moment.

So how can you avoid hyperventilation, you might ask? Here are some simple steps you can take to reduce your anxiety through proper breathing techniques.

• Monitor your breathing during periods of increased anxiousness. Make the effort to start noticing your breathing patterns – do you hyperventilate more when you’re anxious? If you don’t, then maybe you are already breathing correctly. Chances are that either way, you’ll benefit from learning proper technique.
  
• Does your stomach expand or retract when you breathe? If your stomach is expanding, then you’re breathing correctly. If not, then you need to work on your technique. Correct, deep breathing is about expanding your diaphragm to get the most air you can. Slow, deep breathing will actually activate your parasympathetic nervous system (the so-called “rest and digest” system) that will calm you down. Incorrect “chest” breathing will not help.
• Try some breathing exercises every day. Make room in your day for 10 minutes of deep breathing. You can train your body to breathe more effectively if you just take the time to do so. Here is a resource that I found helpful when I was learning proper breathing technique.
• Take deep breaths when you feel anxiety coming on. Remember that deep breathing will calm you down. It certainly won’t eliminate all of your anxiety, but I’ve generally found that if I focus on my breathing when I feel a panic attack coming on, I can calm myself down in time to get through whatever situation I’m stuck in.

Diaphragmatic breathing is an important tool for anyone suffering from anxiety or high stress levels. Deep breathing even feels calmer, and sometimes the difference between labored breathing and calm breathing can be all it takes to ward off panic attacks or drag you out of a state of prolonged anxiousness.

Picture yourself riding a wave when you’re accepting your panic attack.

For many of you, the most troubling aspect of your anxiety is the thought that it might strike when you can’t take the time to deal with it. Maybe you’re sitting in a meeting. Maybe you’re in the middle of a final exam. Maybe you’re at a party with some friends that don’t know you very well. Whatever the situation, it puts you on edge to think that a panic attack could overwhelm you at any moment. 

In today’s post, I want to go over some simple ways that you can reduce the acute fear that surrounds panic attacks, and how you can deal with panic attacks when they happen.

Before the panic attack:

• Accept that a panic attack could strike. Let go of the notion that having a panic attack in public would be the end of the world. Come to terms with the fact that you could panic in an inconvenient situation. What’s the worst that could happen? Maybe you have a panic attack during a meeting, and you have to step out to the bathroom for a little while. Maybe you have to head home to take a sick day.
• Remember that a panic attack can’t kill you. You are in no danger of dying, having a heart attack, suffocating, or being harmed in any other way. Panic attacks are certainly real, but the physical sensations they cause are not. Another good thing to remember is that the typical panic attack will reach its peak in about 10 minutes, so if it does happen, it won’t last as long as you think.
• Ignore other people’s perceptions. For many of you, your real fear is that people will judge you. From my experience, most people are quite understanding when it comes to panic attacks. Reaching out and telling someone you are at risk of having a panic attack may actually do more good than you’d think. If you’re not comfortable talking about your anxiety, that’s okay too. Just tell others you’re not feeling great and asked to be excused. Think about how concerned you are with other people’s perceptions of you, and then imagine that everyone else is thinking the same thing. Most people are so concerned with what other people are thinking that they don’t take the time to notice what others are doing.
• Think calming thoughts. If you feel a panic attack on its way, there’s no point building it up in your head. Try to think calmly and positively about it. When I feel a panic attack coming on, oftentimes I’ll start laughing to myself. I find it funny that my brain is still convinced that a rising heart rate is a sign of danger, so I laugh at myself. Maybe you’re not at the point of humor, but at least you can try to avoid the catastrophic thinking. “I feel a panic attack coming on, but I know I’ll be okay.” “I only have to sit through 10 minutes of panic, and then I’ll start to feel better.”

During the panic attack:

• Accept that it’s happening. There’s no point trying to ignore it – chemicals have started coursing through your blood, readying your body for action. You can’t hide from a panic attack.
  
• Think coping thoughts, ignore negative ones.  Like I mentioned before, try not to build the panic attack up in your head. Think things like “This will be over soon” or “I’m going to be okay, nothing bad can happen to me.”
• Take deep breaths. Diaphragmatic breathing is very important here – take in deep breaths, making sure your stomach is expanding (not retracting), and let them out slowly. You want to signal to your body that there’s no danger. Slow, deep breathing is a way of activating the relaxing mechanisms in your body to override the panic attack. Hyperventilation, which is the default panic state for most, decreases the carbon dioxide concentration in your blood, which triggers mechanisms that reduce the amount of oxygen flowing to your brain – increasing your anxiety.
• Distraction. Once you’ve accepted that the panic attack is happening, you may want to keep your mind engaged. I find that doing mental arithmetic helps keep my brain focused on something other than the anxiety. I keep doubling numbers until I can’t keep track anymore (2, 4, 8, 16, 32, and so on).
• Feel new sensations. Exposing your senses to new stimuli can be a powerful force to combat your anxiety. However, everyone has different triggers, so there isn’t one way to accomplish this. Sometimes I want to see a familiar face or be hugged by someone I feel close to, other times I want everyone to get the hell away from me .  Sometimes I find that smelling lavender oil helps, but other times it gives me a headache which just makes me feel worse. It takes some time to figure out what sensations can help you while you’re panicking, so don’t use this as a first line of defense.
• Advanced tip: Stay put. When you have a panic attack, I know the first thing that comes to mind is: “Get me the hell outta here!” It’s hard to stay put during a panic attack, but there’s an important reason for it. Anxiety is largely a result of faulty learning: instead of learning that a tiger or bear is a sign of danger, you’ve learned that a phone call or a group presentation is a sign of danger. Avoiding the things that make you panic is like telling your brain “Yes, you’re right, sitting through a meeting could kill me.” Once you’ve found your anxiety triggers, you will want to try to expose yourself to them without running away.

Panic attacks really sucks, huh? If there’s any take-home message I can emphasize here, it’s to learn to accept the panic. Don’t let it rule your life, or you’ll end up housebound. If you’re new to this whole anxiety stuff, then take the time to deal with it now before it gets any worse. The longer you leave your anxiety unacknowledged, the harder it will be to overcome later on.

How do you survive your panic? I’d love to hear from you. Leave a comment below!

Are crowded places making you anxious?

You’re sitting on a crowded bus, and suddenly your heart rate spikes, your breathing becomes irregular, and you get an overwhelming sense of dread. You’re going for a nice long run, and then suddenly you feel like the world is closing in around you and you can’t breathe. You’re at a party having fun, and then your ex walks in and you feel your hands trembling, your palms sweating, and your temperature spiking.

In all of these cases, you are experiencing some form of anxiety. It seems like the anxiety came out of the blue, but something must have caused it, right? Most certainly. Anxiety triggers will be very different for most of you. If you have social anxiety, you might get anxious when you have to give a presentation or when you’re forced to be assertive. If you’re a panicker like me, you may get anxious when your heart rate rises or your breathing becomes irregular. If you’re obsessive-compulsive, you might find that intrusive thoughts are causing anxiety.

Here is a simple step-by-step guide to help you identify your anxiety triggers. I suggest that you keep a small journal handy to document your experiences.

1. Be vigilant. Stay focused on your feelings, and try to pinpoint exactly when a wave of anxiety starts. Note your heart rate, your breathing, your trembling, and your emotions. The first step to identify your anxiety triggers is to notice the exact moment when your anxiety starts (this can be harder than it sounds).
   
2. Record your surroundings. Have a journal or notebook handy. Write down everything you can about your physical environment. Where are you? What are you doing? Are you alone or with friends? Are you in public?  Be as objective as you can.
3. Record your thoughts. Much of your anxiety comes from your false beliefs and assumptions. Take some time to write down what you’re thinking about when the anxiety starts. Are you having negative thoughts? Are you worrying about a future event? Are you overly conscious of other people around you? Try to figure out what it is that’s making you fear the situation.
4. Keep recording for a week. Every time you start feeling anxious for the next week, record everything you can about the situation (remember to look internally as well!). The biggest obstacle you’ll face here is hypothesis myopia: you will start to develop an idea of what’s causing your anxiety, and only notice evidence that supports your hypothesis (this is called a confirmation bias – we’ll talk more about that later). Keep being objective! Record everything, not just what you think is important.
5. Go back and analyze your records. Remember to start looking at your findings without a prior hypothesis. Sometimes, I’m surprised to see that every time I get anxious, I happen to be thinking about something I never imagined could be a trigger. Look for commonalities in your journal: were most of your anxious episodes surrounding public transportation? Was a certain person around? Were you having recurring, intrusive thoughts? Was it a smell, a particular sensation, a bright light? Triggers can be very general (like open areas) or incredibly specific (like the smell of pine needles on a cold day in the dark). You may be surprised by what seems to be causing your anxiety.
6. Take note of your triggers. This isn’t an exact science (well, it’s not really science at all), so you may not be able to find all your triggers. You may have some triggers that you rarely come across (I’m terrified of heights, but I’m not usually dangling over the side of a building so I don’t think about it very often). You may even have some triggers that you never experience anymore because you’re avoiding something (I hate answering the phone, so I avoid it at any cost). The more triggers you can identify, the more control you will develop over your symptoms. The scariest part of anxiety is the not knowing; the times when the anxiety strikes for no apparent reason. Develop a list of your triggers, and see whether or not they persist over time. The ones that do persist are probably the ones closer to the root of your problem.

To give you an example to get you started, I will describe a recent anxiety-provoking situation of my own. I was down in my basement running on the treadmill, and I suddenly noticed I was panicking. I’m certainly not new to this whole anxiety-tracking business, so I took note of everything around me and everything I was thinking and feeling. I realized that there were two main things causing the panic: superficially, it was the strained breathing signalling to my brain that I was under stress; but really, the trigger was my own negative thinking. I was worrying that because my breathing was becoming strained after only 10 minutes of running, I was severely out of shape and I would never build up the endurance I wanted to. My thoughts wandered over to Failureland, that part of your mind that loves to tell you that you’re failing at something. Over the past two years, I’ve realized that most of my triggers surround my perfectionism.

Keep in mind that your triggers will probably change over time. If you’re anywhere near as suggestible as I am, you may find that reading about other people’s triggers will cause you to develop new triggers. The biggest step you can make in your journey to recovery is to identify what is making you anxious. Then, you can take the steps to figure out why a particular situation, thought, or feeling is making you that way. We are really trying to get to the why. There’s a reason we’re anxious. I hope that in finding that reason, it will help us get better.

Leave me a comment! I would love to hear what your triggers are. If you have any questions for me, feel free to leave them below! I love answering questions (seriously).