How To Cope With Anxiety
A trite answer is to do the things that decrease anxiety and avoid the things that increase it. While it seems to make sense to avoid something that brings on anxiety caused by an Anxiety Disorder (and some well-meaning friends and even doctors may say, “If it bothers you, just stay away from it”), avoiding the things that make us anxious usually makes the Anxiety Disorders worse. Two studies have shown that phobics who avoid the things they fear may get worse, yet the same people improve if they face the things they fear and improve their anxiety coping skills. The same is true for people with Obsessive-Compulsive Disorder or people having anxiety about swallowing.
Anxiety Coping Skills
There may be three exceptions to the rule that facing their anxiety fear makes it better. First, about 3 percent of people with Anxiety Disorders do not improve their anxiety coping skills when they expose themselves to the things they fear. The reasons why this very small proportion of patients fail to respond to exposure and have anxiety setbacks are not known at this time.
Second, some individuals suffering from chronic Post-Traumatic Stress Disorder may find that exposure to the scene of their trauma—or even exposure to similar scenes in television shows, movies, magazines, or newspapers—will recreate feelings of great anxiety and thus negate any anxiety coping skills they might have and induce anxiety anger. This is very unlike the experience of people with Phobic and Obsessive-Compulsive Disorders who are pleasantly surprised that their anxiety actually decreases when they face the thing they fear.
Third, anxiety about a real danger (such as being the victim of a mugging in a neighborhood in which such attacks are common) should not be treated by exposure. This is an example of anxiety that aids survival. Exposure to this situation would increase the risk of actual harm and is obviously not appropriate way to teach how to cope with anxiety.
It is not known why exposure is so successful for the large majority of patients with Anxiety Disorders yet apparently ineffective for a small minority (about 3 percent of persons with Phobic or Obsessive-Compulsive Disorders and a larger proportion of persons who suffer from chronic Post-Traumatic Stress Disorder)
Therefore, most people with phobias and obsessive-compulsive, like worrying about sleep, rituals can “fight” them by facing the things they fear and by remaining in contact with them until their anxiety coping skills increase and becomes manageable. Repeated exposure sessions are very effective treatment for these people and teaching them how to cope with anxiety.
Before you begin to practice exposure, make a list of situations you avoid. If there are many places you avoid, it is helpful to rank them in the order of the intensity you feel about them. Start practicing in situations where you will have the most chance of success, and later move to more difficult situations. Regular practice is essential. Your first attempts can be regarded as experiments to explore your present limits, so try not to be too hard on yourself or discouraged if this exercise is very difficult at first.
At first, try to identify what tends to raise your anxiety level and cause anxiety hyperventilation. Then see which coping strategies are most helpful for you. Remember: the goal is to face and tolerate some anxiety without escaping from the situation. Even if you leave, it will help you if you experience the anxiety and decrease its level to some degree. Although you can escape a feared situation at any time, if you leave while your anxiety level is high, it’s best to return and reenter the situation as soon as you can to get more practice.
If you have trouble getting back into a situation in which you’ve panicked on a previous occasion, you may want to do some “imaginary exposure” first. Imagine yourself back in the situation and review those parts that make you most nervous, for instance, all the associated physical sensations and thoughts. Practice your rational responses and slow, gentle breathing as you imagine the situation. Continue to imagine coping until these strategies lower your anxiety to manageable levels. You might want to tape record these exercises. If so, after you describe each panic situation, leave room on the tape to imagine using your coping skills.
Another useful strategy for reentering avoided situations, like when you have travel anxiety, is to break the task of going back into small steps. For example, if you’ve had a bad time in elevators, you might just want to look at the elevator on the first try, and the next time press the buttons to call the elevator, and later actually get on the elevator. For others, getting on the elevator right away seems to work best. Going with a partner you trust or a therapist may also help you.
Another strategy involves exposure only to internal fear cues — the rapid heartbeat, shortness of breath, difficulty of breathing, etc. Even if you’re in a safe place, imagining a feared internal symptom can lead to a panic attack. It’s very possible that you don’t realize that what you actually have is a strong, illogical aversion to your own bodily sensations. If you can learn to bring the scary symptom to a therapist or a trusted companion in a safe situation, you can practice turning the symptom on and off using coping strategies. When the scary symptoms are under your voluntary control, a change in your heartbeat or your breathing, for example, will no longer lead to a panic attack.
