Recovering from Anxiety: How to face what you fear

So you have decided you want to tackle your anxiety.  It has simply taken up too much of your life.  Whether your anxiety manifests as uncontrollable thoughts that put you on edge, physical symptoms like shortness of breath and crushing chest pain, or a combination of the two, anxiety robs a person of being in the moment, and of being themselves.   Instead, anxiety throws you forward into an uncertain but definitely horrible future, backwards into regret and self-loathing, or has you glued in the present overanalyzing what can be done now to make the past better or to avoid the next catastrophe. 

Here is what you need to know:

Panic symptoms and panic attacks that are occurring inappropriately (ie not adaptive to the situation) do not physically harm you and are not physically dangerous.  They feel terrifying, like you are losing control or dying.  It is important to disarm panic of this threat. No matter how severe the anxiety in the moment, you are physically safe. 

To know you are physically safe is the foundation upon which you can then go on to recover from anxiety.  If this sounds too difficult, we may be dealing with a trauma response which I address briefly at the end of this article.

The main treatment for anxiety is to confront what it is you are anxious about.  Avoidance teaches you psychologically that something is unsafe when it is not.  Therefore approaching that that makes you anxious with the proper tools can recalibrate your fear response to be more appropriate.  This is called an exposure exercise.

 Exposure exercise 101:

Step 1)  Start with low-anxiety exposure exercises.  Do not flood yourself with the worst-case scenario right off the bat.  This will lead to worsened anxiety over the short-term and people dropping out of therapy or giving up.  Create an anxiety exposure hierarchy where specific situations are listed in a pyramid formation from lowest anxiety-inducing (1/10) to highest (10/10).  The clinician will start where you feel you have anxiety that is slightly uncomfortable but manageable (usually in scenarios where the anxiety is between 3-5/10).

 Step 2)  Complete exposure exercises of mild/moderate anxiety 1-3 times daily (e.g. Riding the bus).  Use relaxation techniques to help increase your tolerance in the situation and to help you more objectively observe what is happening for you physically and mentally in the situation.  Relaxation exercises should be taught to you previously by your clinician before your first exposure.  Some examples of these are deep breathing and the body scan. 

Step 3) Cognitive behavioral therapy (CBT) is often paired with exposure exercises so that automatic negative thoughts that arise can also be addressed.  For example, in social settings, should a person avoid eye contact with you, it is common to have the automatic thought that the person does not like you.  CBT teaches you to challenge these thoughts and to come up with alternatives.  For examples, the person may have gotten a text on his phone, or he may be heading to the bathroom.

Over time, your anxiety will decrease as your body and mind learns the situation is safe. 

 Step 4) Move up one level on your anxiety pyramid (e.g. Tackling scenarios that bring on 5-6/10 anxiety).  Repeat steps 1-3 with that scenario until the anxiety level comes down to a 2-3/10, then move up one step of the pyramid etc.

 Lastly, a few words about Post Traumatic Stress Disorder (PTSD).  PSTD often masquerades as other anxiety disorders and should always be screened for in assessment.  Anxiety that is a result of trauma requires a different treatment approach.  In instances of pure anxiety without a history of trauma, patients can feel vulnerable and relaxed at the same time, their symptoms of anxiety are more clearly episodic and often relate to very specific situations.  In PTSD, patients can feel anxious and hypervigilant all the time.  Their bodies and minds do not know how to feel safe anymore and this is because these are adaptations the body and mind have made, without conscious awareness, to endure and survive.   So trauma work prioritizes helping the body feel physically safe before addressing what is being avoided.  This also means there must be more attention paid and active work done on the part of the therapist to develop and nurture trust and safety within the therapeutic alliance.  When treating pure anxiety disorders without a history of trauma, trust and safety is important, but it is not at the forefront of care.

 So if you have been given a diagnosis of an anxiety disorder, but you have not responded to treatment as you or your clinician would have expected, it is worth revisiting the initial diagnosis to make sure something has not been missed.