Anxiety has been described as “living in tomorrow instead of today.” This gets to the heart of the problem—anticipating the worst for the future instead of engaging with life fully in the present moment. In this section, you’ll get some strategies for turning that situation around.
As explained earlier in this book, anxiety has several sources. Some of them, such as genetics or the behavior of family members, are outside your control. But there are two important factors that you can control—your thinking and your behavior.
A self-help plan for anxiety includes strategies that you use on a daily basis. Their purpose is to help you to release anxiety-driven thoughts and behaviors.
If you’re getting professional treatment for anxiety, your therapist may also give you “homework” to do between sessions—additional tasks to complete or specific techniques for changing habits. Those are additional tools for reclaiming your life from anxiety.
There’s a saying: “Don’t believe everything you think.” This expresses a key element in managing anxiety. Instead of viewing our beliefs as absolute truths, see them as mental events to observe and evaluate. This gives you the power to challenge thoughts that create anxiety.
One powerful tool for challenging anxiety-based thinking is Rational Emotive Behavior Therapy (REBT). This is a specialized form of cognitive-behavioral therapy that helps us see the relationship between thinking, emotion, and behavior.
Albert Ellis (1913–2007) created REBT. He was a psychologist who started training to become a psychoanalyst—an old-school therapist like Sigmund Freud. Ellis quickly broke with psychoanalysis, however. He concluded that Freud’s method takes years, costs a lot of money, and produces few results. Ellis wanted to work with people in a way that leads to dramatic change in a relatively short period of time. So he stopped doing psychoanalysis and created REBT. The result was an approach that changed the entire practice of psychotherapy.
Look for Three Irrational Beliefs
An earlier section of this book explained six types of thinking that help to fuel anxiety: negative predictions, focusing on the negative aspects of past events, perfectionism, self-judgment, recycling thoughts, and suppression. Ellis reduced this list to just three thoughts that lead to many forms of emotional disturbance, including anxiety:1
Ellis called these three thoughts irrational beliefs. (And since each of them includes the word must, Ellis also referred to the beliefs as examples of “musterbation.”) Why call them irrational? Because they are extreme. Because they lack even a shred of evidence. And because trying to live by these beliefs is guaranteed to make us suffer.
Each of the three statements listed earlier is a dogmatic demand—a rigid expectation that you must always perform perfectly, that people must always do what you want them to do, and that events in life must always be to your liking. None of these demands is realistic, however. In making them, we forget several key points:
Challenge Those Beliefs
One way to free yourself of the three core irrational beliefs is to challenge them with all your might. Look for certain “weasel words” that make these beliefs so absurd and anxiety producing. These include
Whenever possible, replace these words with expressions such as
Using these guidelines, you can rewrite the three main irrational beliefs. Turn them into more flexible, rational thoughts that help to reduce anxiety:
Note: Nothing in REBT or any other form of cognitive-behavioral therapy suggests that we have to passively accept incompetent, aggressive, shaming, manipulative, or illegal behavior from other people. It’s true that we cannot always expect people to act with perfect wisdom and compassion. However, we can assert our rights to be treated fairly, set appropriate boundaries, and enforce consequences when people harm us.
The point of REBT is simply that punishing ourselves with negative emotions such as anxiety does not change other people—it simply makes us suffer. Instead of issuing dogmatic demands, we can make reasonable requests. We are much more likely to get what we want in life when our interactions with other people are grounded in rational thinking and emotional health.
Another technique for dealing with anxiety-based thoughts is not to challenge them or replace them, but to simply detach from them.
Imagine that each anxiety-creating thought is written out on an index card that you can hold in your hand. In your mind’s eye, see yourself shuffling through those cards, examining them, turning them over, crumpling them up one by one, and tossing them in the trash. This is an image that perfectly expresses the nature of detachment—observing a thought and then calmly letting it go.
Detaching might be a little easier if you learn to use some defusion techniques drawn from Acceptance and Commitment Therapy, another form of cognitive-behavioral therapy.2 (To “defuse” from a thought means to detach from it.)
One such technique is to precede an anxiety-based thought with these words: I’m having the thought that … For example, I’m having the thought that I should always appear calm, confident, and in control.
You can also experiment with other “front-end” words:
Notice the effect of using such statements. Adding the extra words puts a little space between you and your thoughts. In a subtle way, these statements remind you that you are more than your thoughts. Thoughts come and go a million times each day. But the essential you—that is, the capacity to simply be aware of thoughts—always remains.
Moreover, not all thoughts are created equal. Some thoughts serve you, and you get to keep those. But other thoughts only create anxiety, and those are thoughts that you get to release.
In addition to challenging anxiety-based thinking and detaching from thoughts, you can practice mindfulness. This is a simple approach to meditation that’s practiced by people of many religions, as well as people with no religious affiliation. The aim is to watch thoughts, physical sensations, and behavioral urges come and go. With time and practice, you can learn to simply observe these internal events without getting caught up in them.
The main things to remember about mindfulness practice are these:
Devote a few minutes every day to mindfulness practice. Gradually increase the time to twenty minutes. As your practice deepens, you’ll learn to view thoughts as neutral and natural events, like changes in the weather.
You’ll also experience urges to behave and learn that you do not have to act on them. This is a powerful way to release the links between anxiety-based thinking, physical sensations, and self-defeating behaviors.
In terms of physical sensation, the feeling of being relaxed is the opposite of feeling anxious. Relaxation is a learned skill. If you practice it enough, you can use this skill even in the most challenging conditions.
Take relaxing breaths. The most direct route to relaxation in any given moment is your breathing. Feeling anxious often leads us to breathe in short, shallow gulps. To relax, make your breathing deeper, slower, and more regular. See if you can make your exhalations last longer than your inhalations. Also breathe all the way down into your diaphragm, so that you can actually see your belly rise and fall as you breathe in and out. If your attention wanders to anxiety-based thoughts, then gently refocus on the sensations associated with deep breathing.
Scan your body. Another relaxation technique is the body scan (also called progressive muscle relaxation). This is a technique to practice in a quiet place where you can be alone. Lie down on a firm bed or mat, and place a pillow underneath your head and another pillow under your knees. Then contract the muscles in your face by wrinkling your forehead and arching your eyebrows. Hold the contraction for ten seconds and then release the tension. As you release, pay close attention to the sensation of relaxation. Do the same pattern of contraction and release with each of your muscle groups in turn: shoulders, hands and forearms, buttocks, legs, and ankles and feet.
Once you learn how to do the body scan, you can experiment with relaxing on cue. This is something you can do just about any time, any place. When you feel upset, just mentally scan your body for areas of tension. Then say the word relax to yourself as you release the tension in each area.
Use guided imagery. You probably have vivid mental images of something or someone who you associate with feelings of serenity. This might be a special vacation spot, a peaceful spot in nature, or the face of a loved one. Whatever it is, see if you can bring the image to mind. Close your eyes and conjure up all the details related to this image—sights, sounds, smells, tastes, and sensations of touch. Imagine that you’re actually walking into this safe, comforting space. This technique will become more effective if you practice it on a daily basis, even when you’re not feeling anxiety or another upsetting emotion.
Make time for simple pleasures. Finally, choose a few simple self-soothing activities that you can do on a regular basis. For example:
So far, this section has given you several techniques for managing anxiety. But in moments when anxiety peaks—like when you’re in the midst of a panic attack or flashback—these techniques might seem too complex or hard to remember. What can you do then?
One answer is just to remember the “three Ps”:
Step 3 will be more effective if you take time in advance to make a list of options. To create this list, first imagine the worst that could happen in specific situations where you tend to feel anxiety. Then write down what you could do to cope with each situation.
Following is an example adapted from Bemis and Barrada’s book, Embracing the Fear. This is a plan for responding to anxiety surrounding shopping for groceries, but the same type of plan could be used for any number of situations.
Notice that the example follows a common format. It includes a list of “what if” questions, answers to those questions, and ideas for other helpful strategies.
Example: Shopping in a supermarket
Q: What if I can’t get out to do my grocery shopping?
A: I could wait and do it later, or ask someone else to do it with me (or for me).
Q: What if I panic on the way?
A: I’ll try to just let it happen. It’s only a feeling. I won’t be in any danger.
Q: What if I have to wait in line?
A: I could go at a time when it isn’t busy.
Q: What if my hand shakes when I’m writing a check?
A. I could write part of the check before I get there. I could also use cash.
Q: What if I faint?
A: I’m only dealing with a thought about fainting. Chances are that won’t happen.
Q: What if I get to the back of the store and I can’t leave?
A: My legs will carry me to the door, even if it doesn’t feel that way.
Q: I’m feeling really strange. What if this time it isn’t anxiety?
A: It is only anxiety. I’m not in any danger. It will help if I just try to go with the feeling.
Q: What if I panic and have to leave my cart?
A: It really is okay to walk away from the cart and leave the store.
Other helpful strategies:
While you’re in the process of changing your responses to anxiety in specific situations, you can also benefit from reducing stress in other areas of your life.
Take care of your health. Members of Alcoholics Anonymous (and other groups based on the Twelve Steps of AA) often remind each other not to HALT—that is, not to get hungry, angry, lonely, or tired. This is sound advice for managing anxiety. Getting professional treatment for anxiety can help with angry and lonely. Preventing hungry and tired means eating well, getting plenty of rest, and staying physically active.
Physical activity is especially important. Regular exercise changes your body chemistry by reducing levels of stress hormones, such as adrenaline and cortisol. If you exercise at a sufficient level of intensity, you also trigger the release of endorphins. These are brain chemicals that reduce physical pain, elevate your mood, and prevent anxiety.
In addition, exercise contributes to weight loss, which can change your appearance and alter your self-image for the better. Success at losing weight gives you a feeling of mastery and control. It demonstrates that you can set a goal and achieve it. When you make a habit of exercise and enjoy the resulting benefits, this offers a powerful inducement to make other changes in your behavior as well.
Share what you’re thinking and feeling. Talk to a trusted family member or friend about your experiences with anxiety and strategies for managing it. The act of describing your emotions can reduce anxiety and give you a fresh perspective on how to respond to it more effectively.
When you talk about anxiety, remember that not everyone will respond in a skilled way. Some people may trivialize your experiences, insist on giving simplistic advice, or expect immediate change. As an alternative, seek out people who understand the complexity of anxiety—those who will listen in a nonjudgmental way and help you find professional help when that’s appropriate.
Structure your time. A life that’s marked by anxiety sometimes looks messy. For example, you might be afraid to say no when someone asks you to volunteer your time or take on extra tasks at work. As a result, you can feel anxious and overcommitted. The solution is to reduce chaos. Structure your life by sticking to a regular weekly schedule and saying no to extra demands whenever possible.
One common effect of anxiety is that it shuts us off from the life that we want to live. Most of us say that we value things such as health, fun, relationships, learning, and meaningful work. Unfortunately, anxiety often undercuts our efforts to actually translate values into daily activities.
Your values are your top priorities in life—the things that, for you, make life worth living. Values are things that you desire for their own sake. They are ends in themselves, not means toward some other end that you consider more important.
When asked to define their values, many people respond with a list of abstractions such as health, love, and wealth. These are certainly worthwhile. They are also abstract concepts, however, and hard to define in ways that guide our behavior.
As an alternative, consider defining values as domains of activity. An exercise included earlier in this book (Discovering the Costs of Anxiety—and Your Desire to Change) offers these examples:
Stating values this way makes them easier to translate into action. You can refer to any domain of activity and ask yourself this question: What should I be doing on a daily, weekly, or monthly basis to make this value a reality?
For example, developing a strong network of supportive friends could translate into any of the following actions:
These are just a few possibilities. The point is to actually live your values by using them to choose specific behaviors. Values are invisible, but behaviors are visible, and they lead to concrete results.
As you define your values and translate them into behaviors, remember that you can act independently of your feelings. In other words, you can feel anxious about calling an old friend and still do it. You can feel nervous about introducing yourself to a co-worker and still extend your hand. You can feel worried about becoming a block leader and still follow through on your commitment.
Although applying this strategy may be difficult and stressful, over time you will find yourself more able to tolerate the anxiety. And, after a while, the anxiety will slowly dissipate altogether.
There’s a slogan that expresses this idea—act “as if.” Changing your thoughts and behavior might feel strange at first. But is that any surprise? After all, you’re planning to think and act in direct opposition to anxiety-based habits that you’ve developed over many years.
Acting “as if” means taking it easy and giving yourself time to go through the process of healing. With sustained practice, your new habits will feel less odd. The new attitudes and behaviors will start to take hold.
You’ll probably find that your behavior is easier to change than your beliefs or emotions. This is logical: You have more direct control over the movement of your muscles than over your thoughts and feelings. Over time, however, sustained changes in behavior can lead to major shifts in your beliefs and emotions as well.
If you wait to become completely free of anxiety before you take action on your values, then you could be waiting for a long time. Start acting “as if” today.
You can use a journal to take a written inventory of your emotional life. Journaling helps you to understand the sources of your anxiety, your coping strategies, and the consequences of your behaviors. Based on this self-awareness, you can choose to make changes in your thinking and behavior—and monitor the results over time.
To get started with journaling, consider the following suggestions.
Run a “mood meter.” Keep track of how your moods change. At the end of the day, for example, assign a number on a scale of one to five that indicates your overall level of anxiety for the previous twenty-four hours (one means “no anxiety” and five means “lots of anxiety”).
List anxiety triggers. Go back and reread the exercise titled Discovering Anxiety Triggers. Repeat this exercise periodically. See if your list of triggers as a whole is getting bigger or smaller. Also look for new and recurring items on the list. Aim to get a precise picture of when and where you feel the most anxiety.
Challenge anxiety-based thinking. Single out specific thoughts that are especially challenging for you. Then develop a bank of written arguments against those beliefs.
Develop anxiety action plans. Start with the format used in the previous examples—questions, answers, and other helpful strategies. This is just one option, however, so feel free to experiment with other formats.
Anxiety can coexist with addiction to alcohol and other drugs. These conditions can get closely intertwined, and for several reasons:
If you’re experiencing anxiety, it’s understandable that you might seek relief through a strong drink, a joint, or an extra sleeping pill. Drugs can change your mood instantly. They can flood your body with pleasant physical sensations. They can turn down the volume of negative thoughts or even drown them out.
However, using drugs to medicate yourself for anxiety is risky. Drugs can mask the symptoms of anxiety without treating their underlying causes.
If you use drugs consistently, you can also develop tolerance to them. This means that you need to consume increasing amounts of the drug in order to experience the anxiety relief that you seek.
In addition, using drugs to mask anxiety creates a risk of drug abuse or dependence. Abuse leads to negative consequences, such as strained finances, job loss, or loss of key relationships. Dependence leads people to become so preoccupied with getting and using drugs that little else in life matters.
Suppose that you’ve depended on alcohol or other drugs for years as a way to cope with anxiety. Then someone tells you that in order to recover from addiction, you have to stop using your drug of choice for the rest of your life. Faced with this fact, what alcoholic or addict would not feel anxious?
Fortunately, anxiety is a condition that’s highly treatable. So is addiction.
As a first step, take an honest look at your current relationship with alcohol and other drugs. One option is to ask the “CAGE questions”:
Answering yes to even one of the previous questions signals a possible problem with drug abuse or dependence.
Of course, the CAGE questions are no substitute for a medical evaluation and diagnosis. If you’re concerned about your own drug use, then get professional help right away.
Broadly speaking, there are two possible links between anxiety and addiction. Anxiety is called a “primary” condition under two conditions: when it occurs before addiction, or when it persists after you’ve abstained from drugs for at least six months. Primary means that the condition requires its own treatment. Left untreated, in fact, anxiety could hamper your recovery from addiction.
If your first experience of anxiety came after you started drinking or using drugs, then the anxiety is probably “secondary.” This does not mean that anxiety is something to ignore; it means that the anxiety developed as a consequence of addiction. If your anxiety decreases within a few months of quitting drugs, that’s an additional sign that the anxiety is secondary.
Getting professional treatment for both anxiety and addiction will help you avoid two common mistakes. One is hoping that a primary anxiety will go away on its own if you just work hard enough at your Twelve Step program or treatment plan for drug addiction. The second is trying to treat anxiety when your use of alcohol or other drugs is still out of control. Both of these scenarios can lead to disappointing results.
Fortunately, many of the skills you learn in order to cope with anxiety can also strengthen your recovery from addiction. Treatment for both conditions calls for making changes in your thinking and behavior and getting appropriate medical care.
There’s a story about a mountain climber who stumbles off the edge of a cliff. He manages to break his fall by grabbing a branch on a tree that overlooks the ravine. Hanging on for his life, he calls up to heaven: “If there’s anybody up there, help me—please!”
A thunderous voice booms from the clouds: “Let go, and I will protect you.”
The man pauses for a moment to think. Finally he shouts, “Is there anyone else I can talk to?”
Perhaps you’re having a similar reaction to the suggestion that you accept anxiety. You might be wondering if there’s something else you can do. The answer is yes. You can use all the other self-help techniques suggested earlier. At the same time, consider the possible benefits of acceptance. Ironically, some people find that accepting anxiety is one of the most powerful tools for reducing it.
To understand this point, get clear about what acceptance really means. It does not mean resigning yourself to a life filled with anxiety. Rather, acceptance means giving yourself permission to have the problem for right now. It means giving up your dogmatic demand that life be free of anxiety, other unpleasant emotions, and other problems. One woman with an anxiety disorder put it this way: “When I no longer cared whether I had a panic attack, I quit having them.”
Remember that a key feature of anxiety-based thoughts is the presence of absolute demands—those that include words such as should, have to, never, always, and must. The same words can creep into your thoughts about experiencing anxiety. For example:
Thoughts like these make acceptance much more difficult. Remember that an effective self-help program for managing anxiety is flexible, forgiving, and realistic. It allows for mistakes. Consistent effort is required; absolute perfection is not.
It took years for you to develop the patterns of thinking and behavior that create and reinforce anxiety. Those patterns are not going to disappear overnight. Just keep practicing your new habits for reducing anxiety, realizing that long-term gains count more than short-term slips.
As another slogan reminds us, what counts is “Progress, not perfection.” That’s acceptance in a nutshell.