Productive Ways to Manage and Reduce Anxiety Symptoms

In this article published in the Smarter Living Section of the New York Times on December 21, 2017,  Jen Doll discusses the prevalence of anxiety disorders, the difference between situational anxiety and anxiety disorders, and effective ways to manage and reduce ongoing anxiety symptoms.

How to Combat Your Anxiety, One Step at a Time

By Jen Doll

Earlier this year, I suffered my first major panic attack. For days afterward, my heart would race and my mind would fill with doomsday visions as I worried about everything around me, including whether I’d have more panic attacks and if I’d ever be able to stop them.

Knowing that it wasn’t just me, however, was strangely reassuring.

“Anxiety disorders are the most common condition in psychiatry,” said Dr. Naomi Simon, professor of psychiatry at N.Y.U. School of Medicine and director of the Anxiety and Complicated Grief Program at N.Y.U. Langone Health. Some 40 million people aged 18 or older in the United States, or 18 percent of the population, will suffer from an anxiety disorder each year, according to the Anxiety and Depression Association of America. In the course of a lifetime, that rate goes up to 28.8 percent of the American public.

Dr. David Rosmarin, the founder and director of the Center for Anxiety and an assistant professor in the department of psychiatry at Harvard Medical School, added, “We’ve seen a massive increase in services in New York City in the last six months.”

“From North Korea to hurricanes, we live with a greater degree of uncertainty,” he said. “What it boils down to is: How much can people tolerate it when they don’t know what’s going to happen next?”

Being anxious vs. having a disorder

There’s an important distinction between anxiety and an anxiety disorder, Dr. Simon said.

“Anxiety is a natural reaction to stress — it’s not necessarily pathological or dangerous,” she said. “There’s the point where it becomes a condition, and the way we separate those has to do with the level of persistence, severity, distress, and if it’s impacting day-to-day function.”

So, for example, if you feel anxiety while watching the news, you probably don’t need to do anything about that (except maybe turn off the TV, go for a walk or take some deep breaths). But if your anxiety is interfering with your concentration, ability to focus or sleep — and, according to the DSM-5, if you have worry for more days than not for at least six months — that points to a disorder and you should seek a professional diagnostic assessment. But, Dr. Simon said, “For anyone who has some nervousness, anxiety or stress, there are many coping strategies you can try on your own.”

She added that, even at extreme levels, “anxiety is uncomfortable but generally does not result in death.” (Even if it doesn’t feel like that at the time.)

Consider what makes you feel in control

“Anxiety is an excessive focus on something that might happen in the future,” said Bea Arthur, a licensed mental health counselor in New York and founder of the mental health machine learning start-up The Difference.

“This is always related to a perceived lack of control, so add back things that you do feel in control of,” she said. “Think about how you can contribute, do things, make progress. Just walk outside — even that does wonders.”

Ms. Arthur also suggested “editing your life” to help bring back a sense of empowerment. This means giving up things that don’t make you feel in control. The book “Essentialism: The Disciplined Pursuit of Less” by Greg McKeown is a great place to start, she said.

Yes, medication can have its place

Talk therapy is rarely a bad thing. Many doctors urge caution, however, with regard to prescriptions, as well as indulging too heavily in “self-medicating” with beers or rosé with friends.

“They do have a role for some patients either short or long term as they are generally safe under the care of a doctor,” Dr. Simon added.

“We would encourage a person to use them only so far as they help deal with the problem,” Dr. Rosmarin said. “Ultimately, people have to face their fear. To get a person to that place, that’s the art of therapy.”

Ms. Arthur agreed. “Pills don’t make you feel better, they reduce the intensity of the episode,” she said. “But so does talking to someone about it.”

As for alcohol, moderation is the key. “If you’re drinking with people you like and enjoy,” she said, “I think that’s a good thing.” Keep in mind, however, that there’s an increased association between anxiety and alcohol and other substance abuse, Dr. Simon pointed out. And drinking too much can ultimately make you feel even more anxious. So turn to rosé cautiously.

Yes, you should start a meditation practice

Meditating doesn’t have to be scary. Aaron Dias, a meditation coach and yoga instructor, encourages people to create “a very simple daily practice in the beginning of the day. Keep it to five minutes, or do five breath cycles if five minutes causes anxiety. For example, breathe out anxiety, breathe in goodness, strength, or whatever you’re trying to cultivate.”

A meditation practice, she said, will help you start to feel more empowered.

“If I sit down and enter a space I’ve decided is safe and healthy and healing, it sends a message to the rest of my system that I’m not just at the whim of all these other things that are going on,” she said.

Dr. Simon recommended “going to nature and attending to the trees and beautiful weather, taking your attention away from the worries and appreciating and noticing something around you.” You might also try “volunteering in your community or donating to fund-raising” as a way to do something positive while accepting that some things can’t be controlled, she said.

Your phone is not your B.F.F.

I sleep with my phone, or right next to it. It’s generally the first thing I look at in the morning, and the last thing I look at before I go to bed. And I know that’s bad; it makes me feel bad. I started turning off my ringer so I wouldn’t immediately respond to texts or calls, including those that woke me in the middle of the night.

I also installed an app called Moment, which told me I should spend less time looking at apps on my phone. I have to admit, when I do this I feel more able to handle the world around me, including my Twitter feed, which I ultimately removed from my phone. (This really did wonders, not least because reading the news was no longer the very first thing I did each morning.)

“It is important that you get off the devices and try to spend time with people you care about and not only be interacting around these topics,” Dr. Simon said.

Getting sweaty is great

“The gym and exercise is one of the few bastions where you have to put your phone away,” said Natalia Mehlman Petrzela, an associate professor of history at the New School who teaches Intensati, a workout combining interval training, martial arts, dance and yoga. “I no longer see it as a guilty pleasure, I see it as a way of taking care of myself so I can engage more meaningfully.”

I plod to the gym regularly, and it’s true: Even if I don’t feel great when I’m there, I feel much better once I’ve gone — especially when I’m engaging in exercises like yoga or SoulCycle, where I can’t watch CNN or glance at my phone. The endorphins are nice, but also, it’s a chance to regain a sense of control, if only of your own body. (As always, check with a doctor before beginning any new or intense exercise regimens.)

Dr. Simon is engaged in a research study sponsored by the National Institutes of Health and the National Center for Complementary and Integrative Health that’s looking at how yoga compares with cognitive behavioral therapy in coping with stress.

“The reason we’re doing it is that anecdotally, and through some growing data, there’s evidence it may be helpful for some people,” she said. Plus, unlike medication, not only can exercise “help reduce stress and anxiety, it’s also good for your cardiovascular health,” she said.

It feels really good to say no …

Packing our schedules with activities and obligations takes a toll, no matter how much we want to do them. Cory Nakasue, a somatic therapist and astrologer, told me she’s getting over her “FOMO issues” — Fear of Missing Out — and instead enjoys missing out on things.

“Anxiety creeps up when I’ve let demands — even fun distractions — from the outside have their way with me,” she said. “When I ‘miss out’ on things, it feels like I’m reshuffling the decks so that I’m a priority and not ‘the things.’”

If you want to do that, too, “work backward,” Ms. Arthur said. “What do you want your life to look like? What do you want your day to look like? Whenever you keep coming up against that dread, instead of saying ‘I have to do this,’ say ‘I GET to do this, what will this GET me?’ If it still doesn’t align, then stop doing that.”

Inspired, I canceled several plans. It felt great.

… but say yes to the right things

“I think self care has become a bad word because it’s often a marketing strategy for things that feel frivolous,” Ms. Mehlman Petrzela said. “But I don’t think we should throw the baby out with the scented bath water.”

Need some ideas? When I asked a handful of people what they were doing to care for themselves in these times, they mentioned taking time out roughly three times a week to do a sheet mask (which requires the maskee to lie down motionless); adopting an anti-inflammatory diet; sleeping at least eight hours a night; “so much fitness”; reading poetry or fiction and “not reading all the articles”; and watching an impressive variety of non-news TV, including escapist favorites like “30 Rock,” “The Great British Baking Show,” “The Real Housewives” and HGTV.

Spike Friedman, a writer who lives in Los Angeles, shared perhaps the most extreme method: “The weirdest thing I’m doing to take care of myself is going to ride roller coasters every couple of weeks so my body can line up with my brain more in terms of how I’m perceiving the danger of the world. North Korea is beyond my comprehension/perception … being upside down at 60 miles per hour is not.”

Spend quality time with friends, both furry and human

Sarah Miller, a writer in Nevada City, Calif., said one of her anxiety releases is to sob into the soft fur of her elderly blue heeler, Merle.

“Also, I remind myself people have been through worse,” she said. And Maris Kreizman, an author and a pug owner, told me, “When we adopted Bizzy, I didn’t even think about how ironic it would be to rely on an animal who is very anxious herself to help allay my own anxiety.”

She added: “But when the world overwhelms me, cuddling with her while reading a book makes me feel human again. And when she’s all snorts and panic, I know I can rub her belly or give her ear scratchies (or maybe slip her a Xanax) and offer her relief, too.”

Kids, yours or borrowed, can also really help put things in perspective. “Hanging out with my children has been a huge reprieve,” Ms. Mehlman Petrzela said. “In a moment of anxiety, I find them and immerse myself in whatever kind of childlike universe they’ve created.”

Ask for help

During my last panic attack, I remember blinking at my phone through tears, ashamed that I needed to call someone. But as Dr. Simon said, “Spending time with people who you find supportive is one of the most protective things.”

I eventually texted a friend, who came over immediately. She brought packets of Natural Calm, a magnesium supplement you add to water (I don’t know if it calms me, but it tastes good); advice on dealing with stress (watch “Golden Girls” reruns!); and reassurances that she’d stay until I fell asleep.

The next day, I made an appointment with a doctor and got a prescription for Klonopin, just in case. So far, I haven’t had to take too many of the pills, thanks to diligently incorporating several of the tips above into my life. But I’m still drinking Natural Calm, every day.

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