11 Tips to Skillfully Manage Anxiety

Anxiety can be a very common experience for most of us and can be extremely unpleasant. It is a feeling of worry, nervousness, or unease, often times about a situation or event that has an uncertain outcome. It can also happen when we’re dealing with more stressors than we’d like, especially at this time of year.  Anxiety can become a ‘disorder’ when it lasts more than 6 months and interferes with your functioning, such as your career, self-care and/or relationships. Based on 2020 data from the Depression Association of America, anxiety is the most common mental disorder in the US, affecting about 40 million adults [1].

Many people have noticed that their anxiety has gone up due to the increasing COVID numbers and the ramifications of all of the unknowns. As we prepare to move into a new year, people’s anxiety also arises as we can feel pressure to start making changes and to work on ourselves, which can also lead to feelings of sadness, despair and overwhelm. If you feel anxious when thinking about the upcoming new year, you are not alone. When you notice your anxiety is present, there are specific and intentional things you can do to relieve the feelings. Anxiety loves overwhelm and hates specificity, so it throws things off when we create a specific proactive plan in terms of how we’re going to cope. If you deal with anxiety every day, strategies can be applied to your lifestyle that help you reduce the anxiety or keep it at bay. Here are 11 key ways to managing anxiety so that it doesn’t manage you:

1. Stop and Breathe

Without stopping to breathe, your breath will likely become shallow and fast -- a breathing pattern associated with anxiety and overwhelm. Simply remember to intentionally pause, name ‘Ah the feeling of anxiety is here’ and then consciously let your breathing slow down to a relaxed pace. Taking longer, slower, deeper breaths can help you start feeling calmer within seconds and it's often recommended to quell panic attacks. Inhale for about four to five seconds, hold your breath for a few seconds, and then exhale slowly longer than the inhale (around six to seven seconds). The numbers don’t matter as much as slowing, pacing and lengthening the breaths and having a longer exhalation than the inhalation (this stimulates the parasympathetic nervous system).

2. Get Regular Exercise

Staying fit isn't just about weight loss/maintenance and muscle strength. Exercise is critical for regulating your hormones and emotional health. A 2018 study found that high intensity exercise is more effective than low intensity exercise in improving symptoms for people with anxiety [2].

According to Harvard Health, elevating your heart rate promotes the release of feel-good hormones, including serotonin, endorphins, gamma aminobutyric acid (GABA) and brain-derived neurotrophic factor (BDNF). Elevated levels of these anti-anxiety hormones cause stress hormone levels to drop [3].

3. Write Down Your Thoughts

Keeping a journal to regularly stop and express your thoughts on paper, or in the notes section of your phone, can help you process your emotions and paradoxically ease anxiety. When you put ‘dump’ the thoughts that are in your mind onto paper, you can string apart the thoughts that are racing in circles and see them from new perspectives. This is a skill called “cognitive defusion” whereby, with practice, we can develop a witness or observer perspective to our thoughts.  From a mindfulness perspective, we call this ‘decentering’, one of the skills thought to be one of the mechanisms of change.  This also builds our meta-cognition skills - the ability to think about our thinking - which develops cognitive flexibility, a hallmark of mental fitness.  A 2018 study published in JMIR Mental Health looked at the effect of journal writing on 70 adults with anxiety. After 12 weeks, those who wrote 15 minutes 3 days a week had fewer symptoms compared to those who didn't write.

4. Question Your Thoughts

Sometimes the anxiety builds up through unconscious thoughts, just below the surface of awareness. Once we can step back and see our thinking from a more conscious and rational perspective, the fear-based narratives lose ground and fall apart.
Maybe what you're worrying about is rooted in something deeper that you can't control. Ask yourself what's really bothering you when intense emotions come up, because unchallenged thoughts can cause you to gloss over reality and reason purely from our emotional mind, which is often irrational. By questioning the validity of your anxious thoughts, you can find out if your worry is based on distorted truths or total unknowns. Ask yourself ‘Is this thought 100% true, 100% of the time’ and ‘What’s one other way I can interpret this situation’ as this will increase your psychological flexibility.

5. Track Your Anxiety Triggers

Anxiety “triggers” are situations or events that trigger your anxiety. They're often things out of your control. Start noting patterns in your feelings and write down any triggers you can identify. When you become aware of your triggers, you identify the early warning signs of anxiety as it arises and then we can take steps to mitigate it. On the other hand, if you don't know the external factors that trigger you to feel anxious, it's difficult to see events without the habitual lens of anxiety.

6. Try Meditation

In a 2-month study on 174 participants with anxiety and chronic pain, daily meditation was found to lower symptoms and improve well-being [5]. The researchers defined formal meditation exercises as sitting in meditation, doing mindful movements and body scans. Body scan meditations involve closing your eyes and focusing your awareness on one body part at a time, moving from head to toe. By being aware of physical sensations in our body, we turn on a part of our brain responsible for interoception and we turn off the wandering mind (also known as the ‘default mode network’). Meditators learn how to turn off the wandering mode, which is often responsible for anxiety, by intentionally bringing awareness into the body.
Another way meditation works is by teaching the ability to release muscle tension you weren't aware of. Awareness is powerful as it creates options and opportunities that wouldn’t be possible if we were in mindless mode, or autopilot mode. It's also good for brain health and lowering stress hormone levels. In fact, meditation is even shown to lower blood pressure and inflammation.

7. Declutter Your Space

The look of your environment can affect the way you feel. Clutter around your home may creep up on you subconsciously as a source of anxiety. If you make it a habit to declutter and tidy up each day or on a weekly basis, you can avoid the level of clutter that contributes to anxiety, fear and procrastination.

By keeping your stuff organized, you can also reduce the stress and anxiety that comes with not being able to find things. Plus, organizing and tidying up can help you clear your mind and refresh your mood.

8. Make Time for Leisure Activities

Regularly prioritizing and setting time aside to engage in leisure activities that are in alignment with your values is one of the healthiest ways to cope with anxiety in the long-term. Whether you enjoy painting, cooking, baking, gardening, writing, walking, spending time with friends or family or something else, be sure to prioritize it. Don’t only participate in leisure activities if you ‘have time’ for it.  Make it a mandatory part of your overall health and wellness. As an OT and Registered Psychotherapist, clients are often encouraged to make time for leisure to enhance the balance in their life. When we’re out of balance, we feel unwell. So many people feel a stronger pull to productivity and can even feel guilty for making time for leisure pursuits, but there is a significant amount of scientific backing for the health benefits of increasing one’s life balance.  Developing a skill or taking up a new leisure interest gives you the chance to use your tap into your sense of curiosity and break your mind from its habitual patterns of overthinking and getting stuck in the same old, same old. If you google Interest Checklist, you can generate some ideas of what to try out.

9. Get Enough Sleep

Sleep deprivation and anxiety can become a vicious cycle. If you aren't getting enough sleep, you're more likely to experience symptoms of anxiety and low mood. With your body and mind in a state of anxiety, getting sleep, in turn, becomes more difficult.
If you have trouble falling asleep at night, dedicate the last hour before bed to relaxing activities and avoid using screens. Doing some relaxation and/or mindfulness exercises as part of your winding down routine is highly recommended. Rather than ruminating about your day or thinking about the to-dos of tomorrow, it helps to calm and stabilize your attention and body. If you tend to wake up in the night and feel unrested, try taking melatonin supplements to increase your levels of sleep-promoting hormones before bed. Vitamin D and omega-3 supplements are also associated with better sleep in people with insomnia, because of the role these nutrients play in regulating the sleep-wake cycle. Mindfulness practice while awake in the middle of the night is also helpful to sidestep the mind’s tendency to overthink and react about the fact that we’re awake.  Play a sleep meditation, do a body scan while you’re in bed and choose not to catastrophize about being awake.  Remind yourself that all that’s happening is that you’re awake. If you’ve been awake for more than 20 minutes, get up and do a quiet activity until you feel more tired and return to your bed. Practice self-compassion if you’re awake because that can also reduce the stress hormones and self-criticism that many people experience with middle of the night wakings.

10. Drink Herbal Tea

Drinking tea to soothe your nerves has existed in culture for centuries. Some plants have anti-anxiety properties that work by regulating stress hormone levels and reducing physical measures of stress like heart rate and blood pressure.
In one study, people who took 220 mg of chamomile capsules up to five times a day saw improvements in their anxiety symptoms compared to those who took a placebo [6]. In a study involving 60 elderly participants, those who drank lavender tea daily experienced less anxiety after just 2 weeks [7]. Other promising herbs for anxiety are peppermint, valerian root and lemon balm teas.

11. Try Therapy

Working with a mental health professional can help you get savvy on how to respond to your anxiety when it strikes hard. Therapy provides a safe place to express yourself with a trained third party who's uninvolved in your life. Going to therapy doesn't mean getting a diagnosis, and you don't need to be mentally unwell to try therapy. The main objective is to talk through the things you're struggling with, get a better understanding of your feelings, and learn better methods for coping.

Making Peace with Anxiety

Doing away with anxiety is a counterproductive goal since we’re equipped with anxiety to survive actual danger situations. These days, it’s more just our thoughts that create and maintain anxiety rather than true dangers. Having some anxiety is normal, as it helps with responding to events life throws at you. When it becomes chronic, however, it can be paralyzing and snowball into other problems in life. Managing your anxiety gets easier when you put habits in place that ease stress and help balance your body and mind. Journaling, therapy and meditation are just a few proven options to try, though it's also important to cover your bases by trying your best to get some good quality sleep and regular exercise and physical activity.  

Wishing you luck and remember that these skills take practice and patience to start to realize the benefits.


References:

1. adaa.org/understanding-anxiety/facts-statistics
2. bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3313-5
3. health.harvard.edu/blog/can-exercise-help-treat-anxiety-2019102418096
4. ncbi.nlm.nih.gov/pmc/articles/PMC6305886/
5. pubmed.ncbi.nlm.nih.gov/17899351/
6. ncbi.nlm.nih.gov/pmc/articles/PMC5650245/
7. pubmed.ncbi.nlm.nih.gov/32444033