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  • Monika La Nuez, LCSW

Managing Anxiety: Effective Physiological, Cognitive, and Behavioral Techniques

Updated: Jan 25



Anxiety Therapy and Anxiety Treatment Boca Raton


If you experience anxiety, then you know the all-consuming and debilitating impact it can have on every aspect of your life, whether it’s advancing in your career, trying to socialize and form meaningful relationships, feeling limited in your choices and actions due to crippling fear, or avoiding any number of significant situations and events.  Living with constant anxiety is emotionally excruciating and if you’re reading this, I’m guessing you are wishing for relief from the limits that anxiety is creating in your life.


It is absolutely possible to manage and find ways to cope with your anxiety. You CAN begin living a life where your fear no longer consumes you and you’re able to find ways to move forward with your life goals. In this post, I want to focus on several approaches to coping with anxiety in order to begin living the life you’ve always wanted.


It’s important to note that anxiety itself is not fundamentally problematic. Just as with all other emotions, anxiety is an adaptive emotion that serves to alert you to justified threats in your environment and successfully navigate perilous situations. Anxiety becomes problematic and impairing, though, when it becomes all-consuming and starts to limit your quality of life, your ability to engage comfortably in the world, and your ability to function through important daily events.  


Anxiety is also a whole-body experience. It manifests physiologically, cognitively, emotionally, and behaviorally. On the physiological level, you may notice rapid breathing and heart rate, or tension in your jaw and in your muscles. On a cognitive level, you likely experience fear-inducing thoughts that make the world around you feel threatening and unsafe. And on a behavioral level, there’s a chance you respond to these worry thoughts by isolating, avoiding, and limiting your experiences and interactions with your surroundings.  


It helps to look at your anxiety holistically, and to focus on reducing your anxiety by utilizing a combination of physiological, cognitive, and behavioral interventions.  Let’s look at some of the tools you can use in each of these areas to start feeling relief from your anxiety and reclaim your life. 


Physiological interventions


You’ve possibly noticed that your anxiety is accompanied by physiological symptoms, like a racing heart, muscle tension, tightness in your chest or throat, feeling hot and clammy, or having an upset stomach. Symptoms like a fast heart rate or tense muscles signal to your brain that there must be something threatening in your environment, and that you must remain vigilant of your surroundings.  One way to reduce anxiety and bring relief is to calm those physiological symptoms that are signaling to your brain to stay on high alert. Some tools that help on the physiological level include:


Exercise

If you notice yourself feeling anxious, exercise is an incredibly powerful tool you can use to relieve some of your anxiety.


Physical activity, and specifically intense exercise, activate the parasympathetic nervous system, which cues your body to relax and settle down.


If you are anxious, your heart rate or blood pressure are likely elevated, telling your brain to remain in fight-or-flight mode. If you engage in something like a brisk run or heavy lifting, your heart rate and blood pressure should soon go down after workouts such as these, activating your body’s relaxation response and helping you to feel more calm afterward.


Paced breathing 

One of the most powerful tools for anxiety relief is right at your fingertips and always readily available. It is your ability to breathe and particularly, to actively become aware of your breathing patterns in order to consciously activate a relaxation response. 


During anxious times, your breathing is likely quick and shallow, which again, causes your body to remain in fight-or-flight mode.  Learning to pace your breathing and engage in deep, rhythmic breathing patterns once again activates your body’s “rest” response, lowering your heart rate, blood pressure, loosening your muscles, and helping you achieve that sense of calm you so desire.


One of the most beautiful things about learning to use your breathing as a relaxation tool is that you can use it anywhere, in a work meeting, in the moment as you’re coping with anxiety in a social situation, or when confronting a difficult event. While other interventions can’t necessarily be used in all contexts and situations, you always have your breath with you, and can easily and subtly access your ability to take deep, slow, mindful breaths to achieve an increased sense of calm. 


If you’re wondering how you can begin to engage in mindful breathing, apps like Calm and Headspace offer a multitude of breathing and mindfulness exercises to guide you along. You can also find an abundance of options on YouTube, as a way of practicing paced breathing more regularly and to reap the benefits of this habit. 


Temperature

Our body temperature tends to go up when we are anxious, angry, nervous, or afraid, which signals to the body to remain on high alert. One intervention that is often utilized in DBT therapy is the use of cold water or ice to help lower your body temperature and activate your parasympathetic nervous system.


You can try dunking your head in ice water for several seconds or holding ice in both hands to help relieve your anxiety or other intense emotions that lead you to feel dysregulated. This is a strategy many clients have tried over the years on their own and within my DBT therapy groups, and have been happily surprised to see how this intervention helps with reducing anxiety quickly and effectively. 


Stretching 

A common physical symptom of anxiety is muscle tension and tightness. What do you notice if you scan your body right now? Is your brow furrowed? Are you clenching your jaw? Do you feel tightness in your neck, shoulders, or hips? By engaging in stretching or exercises like progressive muscle relaxation, you can increase serotonin levels in your body, which helps improve your mood and produce a relaxing effect.  You can check out a helpful guided progressive muscle relaxation exercise here.



Cognitive interventions


Your brain is an incredible organ, churning out tens of thousands of thoughts a day.  These thoughts are forming so quickly and automatically that most of us are only aware of a handful of thoughts we experience a day.  Whether we are aware of these thoughts or not, they are impacting our mood, outlook, and approach to situations around us all the time.  


Anxious thoughts can appear in all kinds of ways and tend to be future oriented.  Here are a few categories and examples of anxious thoughts people tend to experience.


Negative predictions

A hallmark characteristic of anxious thinking is the tendency to make negative predictions, or fortune tell, about the future. Fortune telling can look something like this:


“I’ll never pass that exam and I won’t graduate college.”

“I’m going to bomb the interview. I’ll never find a job and won’t be able to make any money.”

“I won’t know anyone at the party and will just end up standing there looking like an idiot.”

“I won’t be able to survive on my own if I ask for a divorce.”

"She's going to realize I'm no good and is going to break up with me."


Do you notice whether you regularly make negative predictions? What do you notice about how you feel if this is something you find yourself doing? My guess is that thoughts like these amplify your anxiety and feelings of worry about the future. 


“What if?” worries

Similar to making negative predictions, “what if?” worries are future oriented. These thoughts, however, tend to be about scenarios that aren’t guaranteed to happen, far off in the future distance, or are sometimes hypothetical. They can look like:


“What if my anxiety comes back?”

“What if I get cancer and die young?”

“What if I never fall in love?”

“What if I never have children?”

“What if the plane crashes?” "What if my child gets mixed up with the wrong crowd when he's older?"


These kinds of thoughts are so burdensome because they create anxiety about situations and scenarios over which you have no control of in the present moment, thus causing you anxiety, fear, and worry as your life unfolds about something that may not end up actually occurring or that you simply cannot get an answer or resolution to at this very moment.


Magnifying

Magnifying is the act of amplifying a detail so that it takes on more relevance or power than it needs to. 


Perhaps you stumbled over your words during a presentation. As you mull over the presentation afterward, you notice yourself overly focusing on and ruminating about that moment when you misspoke. You may notice yourself reviewing this moment over and over again, negatively judging yourself and imagining that everyone listening to your presentation walked away only thinking about your mistake.


As you can see, this process of magnifying is a recipe for increased anxiety and inner turmoil. Do you notice whether this is something you do? If you do magnify, how does it affect you physically and emotionally?


Catastrophizing

Catastrophizing also tends to be a future-oriented concept. When we catastrophize, we imagine worst case scenarios unfolding about situations that may occur in the future. Of course, if you notice yourself catastrophizing, you likely also notice that your anxiety spikes up and your fears about the future amplify.


Reframes and Remedies

If any of the above thinking patterns feel relatable to you, and you notice that these kinds of thoughts are contributors to your anxiety, you might be wondering what to do to help reduce these thoughts or change your perspective. Here are some tools:


Increase Awareness

Awareness is a vital part of the change process. Without awareness, we cannot change patterns that aren’t serving us. This also applies to our thinking patterns. Because our thoughts are so abundant and automatic, they tend to occur without our conscious awareness, all the while wreaking havoc on our mental health and sense of well-being. So the first step toward changing your relationship to your thoughts is to become aware of them in the first place.


I encourage you to set up and practice daily mental health check-ins, in which you actively ask yourself to check in on your thoughts. If you happen to notice physiological sensations like a rapid heartbeat, shortness or breath, or butterflies in your stomach, this is an excellent opportunity to focus on your thoughts and see if you are experiencing anxious thoughts that are contributing to your anxiety in the moment. 


Bring yourself back to the present moment

As mentioned before, anxiety primarily tends to be a future-oriented condition. We tend to get anxious about situations and issues that feel uncertain or unfamiliar.


As you begin to check in on your thought patterns and become more aware of your anxious thoughts, try to notice if you are worrying about something that isn’t happening yet, or may not happen at all.


If this is the case, I encourage you to use some strategies to bring yourself back to the present. Some interventions that can help include:


Connect with your senses

When we are anxious, we tend to be disconnected from our surroundings and the present moment. We may be physically present somewhere, and are likely so consumed by our thinking that we are in no way engaged with what is going on around us. One way to get back to the present moment is to slowly connect with each of your senses. 


  • Use your sense of sight to become aware of your surroundings - really study the colors, textures, and details of the objects around you. 

  • Pay attention to all the different sounds you can hear. 

  • Notice if there are any pleasant or unpleasant scents around you, or perhaps just notice how your nostrils feel cool as you breathe in the air around you. 

  • Use your sense of touch to connect with the textures and temperatures of surrounding objects, really taking in whether something is rough or smooth, soft and warm, or cold and sleek to the touch. 

  • Notice your sense of taste and the sensations within your mouth. 


By focusing on your senses, you can detach or defuse from the thinking mind, offering you solace from your anxious thoughts and at the same time helping you engage in your actual life as it is unfolding.


Reframe worries

Reframing is the act of taking a thought or concept and looking at it from a different, more effective perspective.  Here are a few examples of reframes:


Original thought: “I’ll never pass that exam and I won’t graduate college.”

Reframed thought: “This material is difficult but if I join a study group, work with a tutor, and study every night leading to the exam, I have a chance of passing it.”


Original thought: “I won’t know anyone at the party and will just end up standing there looking like an idiot.”

Reframed thought: “Okay, maybe I won’t know anyone at the party. I’ll try to find someone or a group of people who look friendly and introduce myself.  No matter what, no one is going to remember the details of this party in a few days, weeks, or years.”


Original thought: “What if the plane crashes?”

Reframed thought: "Air travel is the safest form of travel. I don’t get scared each time I drive my car, and that’s more dangerous than flying. Things like turbulence are normal and the pilots know what they’re doing.”


Create a Thought Record

A thought record is a tool often used in CBT Therapy and can be a very helpful way of becoming increasingly aware of your thinking patterns. A thought record also allows you to write down reframes and get in the pattern of challenging unhelpful thoughts quickly and more automatically. The Beck Institute provides a helpful Thought Record on its website if you want to check out this tool.


Behavioral Interventions


The physiological and cognitive symptoms of anxiety often lead us to behavioral patterns of avoidance and isolation.  Avoidance feels comforting in the moment because you don’t have to confront whatever you’re afraid of. It can provide immediate relief in the short-term and a sense of escape from the things you fear.


What can become problematic in the long-term when you constantly avoid situations that you fear is that your life starts to become deeply limited.  And by avoiding most situations, you are most likely to miss out on participating in events and situations that make life fulfilling, enriching, exciting, and joyful. Here are some tips to help challenge your urge to avoid when experiencing unwarranted anxiety:


Avoid avoiding

“Avoiding reality does not change reality.” I remember reading this statement years ago and was struck by its significance.  You may avoid opening the mail or bills because of financial anxiety, however this does not change the reality that you owe money.


You may avoid studying because you’re sure you’ll fail your exam, but this won’t stop the exam from taking place and affecting your GPA or ability to remain enrolled in school.  By avoiding situations you fear regularly, you are essentially guaranteeing that you will experience negative consequences and outcomes.


In order to reduce your tendency to avoid, ask yourself the following questions:


  • What is one thing I can do that doesn’t feel overwhelming?

  • What is the worst case scenario? Can I survive it? Have I been able to cope with similar situations in the past?

  • What are some positive consequences that can actually occur?

  • How often do my negative predictions come true? And when they have come true, how have I coped and survived?

  • How will I feel if I confront the thing I avoid? Is it possible I will feel empowered? Will I be surprised that the thing I was fearing wasn’t so scary at all?


Expose yourself

Find ways to safely expose yourself to the thing you fear. If you are afraid of driving after experiencing a traumatic car accident, start off by sitting in the car in your driveway. Then, over the course of the next days or weeks, drive around the block of your apartment community or neighborhood. Then, you can have someone drive you to a nearby commercial parking lot and practice driving around there. Once you feel ready, drive yourself to a nearby store or other location. Expose yourself so that each time you confront the thing you fear, you overcome some of your worry, realize you are capable, and eventually get to a point where you can calmly engage in that once feared activity.


Do your research

A common fear people experience is the fear of flying, even though this is one of the safest ways to travel on record. It’s understandable, you’re suspended 30,000 feet up in the sky at the mercy of someone else’s skills and capabilities. It can feel so frightening! Now, learning about and reading about what’s normal when flying can be an excellent way to assuage your fears. Finding out that turbulence is normal and something pilots are perfectly capable of navigating can allay this common fear, for example.


Remember the Spotlight Effect

Perhaps you experience social anxiety. When imagining yourself in social situations, you imagine that everyone is criticizing, judging, and making fun of you in their heads. Going to social events, parties, get togethers, work outings, or networking opportunities feel monumental, life-threatening, and impossible.  One of the most helpful tools is to remember the Spotlight Effect, which essentially debunks the notion that we are in the spotlight of other people’s lives.  In fact, most people are concerned about their situations and themselves, and are likely not to spend much time thinking about you as they navigate their own challenges and day-to-day responsibilities. 


Final thoughts


Anxiety can create a true stranglehold on your life, robbing you of significant personal and professional opportunities. It can make your life small and colorless - perhaps creating an illusion of safety but robbing you of all the wonders, joys, and pleasures of life. You deserve to lead a life where anxiety isn’t in the driver’s seat, and you feel free and capable of pursuing the things that matter to you.


I encourage you to try some of the tools I’ve mentioned in this post to see if any of the skills above help relieve some of your anxiety. I also encourage you to grant yourself compassion, patience, and gentleness as you try new approaches to reduce your anxiety.  It can take a lot of time and practice for new skills to feel effective and beneficial. Afterall, your anxiety has probably been around for quite some time and become deeply entrenched. It is normal for the process of feeling relief to take some time.


I truly hope that some of the ideas in this post resonate with you, and that practicing some of these skills begins to offer you emotional freedom from your anxiety, so you can lead the life you’ve always wanted and so deeply deserve.



Seeking anxiety therapy and treatment in Boca Raton or the South Florida area? Feel free to reach out to schedule a free 15-minute phone consultation to see how I can help you with your mental health therapy goals. Call me at 917-843-7803 or at therapy@monikalanuezlcsw.com

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