The Basics of Overcoming Anxiety Through Cognitive, Behavioral, Mindfulness Approaches
Anxiety feels paralyzing, overpowering, and can take control of one’s life. I typically see people develop anxiety at it’s peak in their late teens/early 20’s, and also for women during pregnancy and/or postpartum. If you do a literature review on the research examining the effectiveness of anxiety treatment via therapy versus medication, the research will tell you that therapy (education, learning and applying skills) exceeds long term benefits over medication (calms your body down, but doesn’t teach you tools, and can cause dependence and other physical issues). Keep in mind that everyone and every situation is different, thus warranting a different approach.
Three general approaches I use for treating anxiety: 1) Cognitive, 2) Behavioral, 3) Mindfulness
1) Cognitive Approach (changing your thought process about the situation)
Just because you think something, doesn’t mean it’s true.
Don’t believe what you think.
Just because you feel anxious, doesn’t mean something bad is going to happen.
To understand this approach, keep in mind of the Cognitive Behavioral Therapy framework. This framework comes from Aaron Beck and David Burns (Check his book out - “The Feeling Good Handbook”). The CBT model posits that: a situation occurs, we come up with an interpretation about it, which determines how we will emotionally feel, which then causes us to behave a certain way. Therapeutically, we teach people to intervene either on the cognitive and/or behavioral domain of that model (nobody can just magically change their emotion).
In the cognitive domain as it relates to anxiety (or depression), the hardest part is to actually catch yourself as you are creating that interpretation about the distressing situation. Name it. What are you saying to yourself exactly that is causing the anxiety -
“Tomorrow is my job presentation, Im not going to be prepared, going to blow it, and people won’t see me as the successful person I’ve tried to work so hard to be”.
Now really examine this interpretation to determine if this is accurate or distorted. It’s most likely distorted at least in one way. Here are some cognitive techniques that will help determine the accuracy/inaccuracy of your thought:
Examine The Evidence Technique:
What’s the evidence that shows you will, in fact, bomb the presentation and show people you’re not that successful person?
What’s the evidence that this WONT happen?
Worst Case Scenario: Identify the worst case scenario (i.e. You do bomb the presentation):
what’s the worst thing that could happen?
what’s the probability that this will actually occur?
if it does in fact occur, how will you survive it?
Reality Check: This is when you need to remind yourself a few things:
did anyone catch on fire as a result?
will this situation impact you three months from now?
will this one situation overshadow EVERYTHING else that has defined you in others’ eyes?
Act As if: This can be a helpful approach in “accepting” the possibility that what you’re telling yourself is in fact true, and how to grab it by the horns and carry on with life:
identify the tasks that need to be done in order to maintain “damage control” as a result.
identify exactly what you need to do to move on in your life from this.
Identify the Cognitive Distortion: we have so many distorted thoughts, theres actually specific names for them:
https://psychcentral.com/lib/15-common-cognitive-distortions/ for the list, but the common ones:
Catastrophizing
All or Nothing Thinking
Negative Filtering
Overgeneralization
Cost Benefit Analysis: A different approach all together, because this technique doesn’t actually bother with determining whether your thought/perspective is accurate or not. It’s examining how thinking this way is actually serving you. If the cons are outweighing the pro’s, take yourself out of that rabbit hole. The pros and cons of thinking this thought:
what are the advantage of thinking you’re going to bomb the interview and end up homeless?
keeps you on your toes to make sure you’re accurately prepared for the presentation
…..crickets….
what are the DISADVANTAGES of thinking this:
stresses you out
causes insomnia
you’re worrying about something that hasn’t even been proven true or not
it’s raising your blood pressure, heart rate, cortisol, tension in your body
takes away your mental energy that could otherwise be spent for someone or something else
takes away from the present moment
2) Behavioral Approach (using behaviors to manage the situation)
Actions can be extremely powerful. For anxiety in particular, because of how physiological the anxious state can be, as well as the power of a Corrective Experience that corrects our thinking:
Physical Outlet: Anxiety is a very intense physiological state. A person with anxiety walks around in life at around a “4” or “5” on the 1-10 Anxiety Scale, compared to a non-anxious person who’s baseline is around a 1 or 2 most of the day. As such, the anxious body, dealing with Fight-or-Flight states, cortisol, adrenaline, and general tension, needs a physical outlet to rid all of this out. A walk, gardening, yoga, running, weight lifting. Whatever fits your lifestyle. Also, give yourself permission to cry. You’re allowed.
Scheduled Worry Time: So often people will attempt to remain busy throughout the day without giving very much time to process the things on their mind in the background. These things then pop up in the forefront of the mind when one is in idle, usually when trying to sleep. So, I prescribe worry time - literally find a time during the day to check in with yourself. Set 20 minutes on your phone and give yourself the space to process, think, journal, worry yourself blue in the face. Once the 20 minutes is up, walk away from the thoughts. This has been shown to allow the brain to clear up some of the worrisome thoughts that can pop up during unwanted times.
Breathing Retraining: Again, pertaining to the overactive physiological state, our breathing plays a significant role in how our central nervous system functions. Breath sloooowly and deeeply. Particularly, prolong the exhale as long and as deep as you can. This literally slows your heart rate down. Concentrate, because I know this is hard, especially in those anxious moments.
Relaxation: Same premise, calm the system down. Get yourself back down to a functional level on that 1-10 Anxiety Scale so that you can begin thinking rationally again. Some helpful techniques:
Body Scan
Progressive Muscle Relaxation
Meditation exercise
Stretch
Internalizing the Corrective Experience: This is BY FAR, my most powerful technique I like to use. DONT AVOID. It only feeds the anxiety and makes your world smaller. Approach the feared stimulus and afterwards digest what you learned from doing it. You’ve heard the phrase “face your fears”. Perfect example is from a patient of mine whom was invited to a party to see friends she had isolated herself from for quite some time after she endured a trauma. She catastrophized that if she went to this party, the friends would not make her feel welcomed or understood. Nonetheless, she went, and was literally overwhelmed with joy from the amount of love and support she received from them.
Most of the time, the thing that we are anxious about happening, really isn’t going to be the case. Once you witness that experience that corrects your faulty thinking, really hold that experience in your mind and internalize the positive from it. Our brains are wired to think the worst and it’s not until we actually experience the truth and internalize this truth, that we begin to rewire our brains to think in more accurate ways.
3) Mindfulness - Author and professor Jon Kabat-Zinn is one of the gurus of this concept
This is a completely different approach all together. Where CBT aims to catch the thoughts in order to deem them positive/negative or true/false and to change them, Mindfulness just simply acknowledges the thought as just what it is. A thought. That’s it. Our thoughts come and go out of our minds and really don’t require much more from us except to be aware of them. It’s an Eastern approach and says that we don’t need to actually DO anything with a given thought. Paradoxically, by simply acknowledging to yourself that you have a thought that is causing you anxiety, it loses it’s power over you. One of my patient’s described it best by saying to herself, “ok anxiety, I feel you right here with me. You can hang out here, but I’m going to just continue on with my day”. Just because you feel anxious, doesn’t mean you necessarily have to do anything with it. Acknowledge it and keep moving. Empowerment. Some basic mindfulness techniques:
Leaves on a Stream: One of my favorite Mindfulness meditations. A play on words, it’s our stream of consciousness that we are working with in our minds. Imagine yourself sitting comfortably by a stream of water. Really put yourself there in your mind with as many details as possible (what do you hear, smell, see, feel, etc). On top of this stream of calm, running water are a bunch of leaves. Observe this stream of water. And for every thought the enters your mind, just simply place each thought on one of those leaves and watch the leaf float by down that stream of water. Every thought. Don’t do anything else with the thought. Don’t judge it, don’t try to prove it true or false, just simply acknowledge it and place it on a leaf and watch it float by. Try this technique for 5 minutes at night and I guarantee you will fall asleep.
Tug of War : A favorite analogy that can help people keep things in mindful perspective is the Tug of War example: imagine you must play the game Tug of War with a monster that you know is much bigger and stronger than you. The two of you must tug a rope and in between you is a deep, dark hole that if, you fall in, you will no doubt become injured. So, what do you do with this rope? You LET THE ROPE GO. Stop fighting the anxiety. Acknowledge what is, give up the fight, and gain control back in your life.
Grounding: when you feel the anxiety coming over you, perhaps even a panic attack inching it’s way in, grounding can be a powerful tool to take you out of your head and into your present surroundings, by using your five senses to anchor you. In your mind:
Sight: describe in detail one or two things you see in front of you
Smell: describe what you can smell. Have lotion, flowers, or anything fragrant in front of you? Use that to mindfully smell.
Sound: describe some sounds you hear right now.
Touch: what does your sweater feel like? What does the current temperature feel like?
Taste: describe any aftertaste in your mouth, or, pop in a mint or take a sip of your coffee and be mindful of the taste.
Loving Kindness: you are having a hard time. Stop giving yourself a hard time for thinking and feeling the way you are in this moment. Being critical of yourself will only make you feel worse. Take a loving, compassionate stance for yourself instead, as you simply acknowledge what your mind is going through. Breath. Maybe place a hand on your heart and remind yourself that no feeling is ever final and this intense emotion too shall pass.
Whatever techniques you choose, remind yourself that you are not alone on this journey. Anxiety can feel overwhelming, but with time and patience, your persistence and self commitment will overpower it’s strength over you and give you your life back.
Ladies - join my colleague ChansLogic & I in our Cognitive Behavioral Therapy based online class to help overcome depression and anxiety: