10 strategies to build your anxiety toolkit


Anxiety takes many forms – you probably have your own agonizing version – but it is usually a feeling of extreme fear or worry, often accompanied by catastrophic thoughts and physical symptoms.

When it’s problematic, anxiety can undermine your mental and physical health and contribute to a number of serious conditions, including burnout, heart disease, gastrointestinal problems, hypertension, migraines, and dementia.

The environment plays a role, but so does your legacy. Anxiety runs in families: 30 to 50 percent or so of your anxiety is because of your genes.

Forty-one percent of people with anxiety disorders go untreated, which is tragic considering there are scientifically proven strategies to help you feel better.

“Everyone feels anxious sometimes,” says Elizabeth Hoge, director of the Anxiety Disorders Research Program at Georgetown University School of Medicine. “It’s the intensity and frequency of symptoms that make it problematic.”

It’s hard to tame fear if you repress it, hate it, or worse, fuel it. Approach fear like any other surmountable problem.

To quell your anxious mind, befriend it. Put your arm around that part of yourself that gets anxious and get curious.

Consider these tactics to address your anxiety. And make sure you prioritize sleep, everything is harder when you’re exhausted.

When you begin to feel anxious, pause and try to identify your feelings as precisely as possible. Maybe it’s something like: I have a feeling of dread about going to work today. Labeling feelings helps your prefrontal cortex turn chaotic emotions into rational thoughts, dampening their effect, according to research by Matthew Lieberman, a neuroscientist and professor at the University of California, Los Angeles. Then confide in someone you trust so you feel less alone. Explain that you don’t need help, you just want to share your emotions.

Find out what’s behind the feeling. Perhaps your job anxiety is fueled by the fear of being fired or being judged harshly by a boss. Tune in to your triggers. Also practice what’s known as cognitive reappraisal, which means reframing the meaning of an emotion to change its impact. For example, getting fired is scary, but it can also be an opportunity to find a better job where you feel more secure. Reappraisal is associated with reduced anxiety, while suppressing emotions is associated with increased symptoms.

“Relaxation is important,” says psychologist Edmund Bourne, author of “The Anxiety & Phobia Workbook.” “It’s the first thing I teach my patients.” Taking a few deep breaths, inhaling through your nose and exhaling through your mouth, can reduce your body’s stress response, which is especially helpful if your anxiety is accompanied by physical symptoms such as shallow breathing, a racing heart, or a spinning stomach. Make it a habit to take breathers throughout the day. An app like Breathwrk and the Breathing App can help you with that.

Several studies have shown that music can reduce anxiety in critically ill patients. Experiment with different types of music to see what makes you feel calmer.

“A single exercise can improve your mood,” says Kristin Szuhany, a clinical psychologist at New York University Grossman School of Medicine. Walking outside while focusing on your surroundings can help you feel more connected to your current experience and away from the anxious thoughts in your head.

A recent study by Hoge found that people who took an eight-week, personalized course in mindfulness-based stress reduction (MBSR) experienced a decrease in anxiety similar to those who were prescribed escitalopram, an anti-anxiety medication. Participants in both groups started with moderate anxiety; after eight weeks, their anxiety had dropped to a level that was considered mild. Anxiety levels continued to drop even after the study was over. Developed in 1979 by Jon Kabat-Zinn, MBSR teaches skills such as mindfulness meditation, yoga, and breath awareness.

Cognitive behavioral therapy (CBT) teaches you to challenge your irrational thoughts and behaviors. It is a short-term therapy, about 8 to 16 sessions that has been proven to help with anxiety and help you manage anxiety spirals. You will be given homework assignments to complete between sessions and after therapy. “Patients tend to see a lot of progress in a short period of time,” says Szuhany, who uses CBT with her patients.

Research into the relationship between diet and mood is still in its infancy, but making your diet healthier can’t hurt. A journal review found more anxiety in people whose diets included high intakes of sugar, refined carbohydrates and high-fat foods and low levels of tryptophan and protein. A recent study revealed that the artificial sweetener aspartame caused anxiety-like behavior in mice.

Anxiety can become an addiction. “You can get so used to worrying that it becomes who you are,” says Judson Brewer, author of “Unwinding Anxiety.” “It fills the space and gives your mind something to do.” Brewer, an associate professor at Brown University, says it’s vital to become aware of your troubling habits. Let’s say you are anxious every time you give a presentation. Your mind makes a habit of worrying in the days leading up to the event. Worrying fuels your fear. And then the anticipation of the next presentation becomes more loaded and a negative loop ensues. Instead, you could stay with the original fear and get used to the feeling, rather than worry about it. To try keeping track of your anxious habits, download Brewer’s free habit mapper.

There are many medications that have been proven to reduce anxiety. Talk to your healthcare provider about your specific symptoms to determine which medication will work best. Selective serotonin reuptake inhibitors (SSRIs) (such as escitalopram, brand name Lexapro) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed for both anxiety and depressive disorders. They take a week or more to fully work and then lead to a reduction in symptoms. Benzodiazepines such as lorazepam are prescribed to treat short-term symptoms and take effect within hours. Beta blockers also work quickly and can help if you experience uncomfortable symptoms such as rapid heartbeat, sweating and tremors, according to the National Institute of Mental Health.

The more you understand your fear – what causes it, what helps to tame it – the better you can manage it and the healthier you will feel.

Lesley Alderman is a psychotherapist based in Brooklyn.

We welcome your comments on this column OnYourMind@washpost.com.

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