10 Strategies to Build Your Anxiety Toolbox


Anxiety takes many forms – you probably have your own tormented version – but it’s usually a feeling of extreme fear or worry, often associated with catastrophic thoughts and physical symptoms.

When problematic, anxiety can become debilitating to your mental and physical health, contributing to a number of serious conditions including burnout, heart trouble, gastrointestinal problems, hypertension, migraines and dementia.

The environment plays a role, but so does your heritage. Anxiety is hereditary: about 30-50% of your anxiety is due to your genes.

Forty-one percent of people with anxiety disorders go untreated, which is tragic because 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 the symptoms that makes it problematic.”

It’s hard to tame anxiety when you repress it, hate it, or worse, feed it. Approach anxiety as you would any other surmountable problem.

To ease your anxious mind, make friends with him. Put your arm around that part of you that gets anxious and gets curious.

Consider these tactics for dealing with your anxiety. And be sure to focus on sleep, everything is harder when you are exhausted.

When you start to feel anxious, pause and try to identify your feelings as precisely as possible. It might be something like: I’m afraid to go to work today. Labeling feelings helps your prefrontal cortex organize chaotic emotions into rational thoughts, mitigating 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 to feel less alone. Explain that you don’t need any help, you just want to share your feelings.

Find out what’s behind the feeling. Perhaps your anxiety at work is fueled by the fear of being fired or judged harshly by a boss. Tune into your triggers. Also, practice what’s called cognitive reappraisal, which means reframing the meaning of an emotion to change its impact. For example, being laid off is scary, but it can also be an opportunity to find a better position where you will feel more secure. Reappraisal is associated with decreased 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 belly 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, heart racing or a churning stomach. Make a habit of taking breathing breaks throughout the day. An app such as Breathwrk and Breathing App can guide you.

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

“A single session of exercise can improve your mood,” says Kristin Szuhany, a clinical psychologist at New York University’s 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 worrying thoughts in your head.

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

Cognitive-behavioral therapy (CBT) teaches you to question your irrational thoughts and behaviors. It is a short-term therapy, around 8-16 sessions, which has been shown to be effective against anxiety and helps you learn how to deal with anxiety spirals. You will be given homework to do between sessions and after the therapy is over. “Patients tend to see a lot of progress in a short time,” said Szuhany, who uses CBT with her patients.

Research on the relationship between diet and mood is in its infancy, but making your diet healthier can’t hurt. A diary review found higher levels of 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 found that aspartame, an artificial sweetener, produced anxious behavior in mice.

Anxiety can become an addiction. “You can become 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 keeping your worrying habits in mind is key. Let’s say you feel anxious every time you give a presentation. Your mind gets used to worrying in the days leading up to the event. Worrying fuels your anxiety. And then the anticipation for the next presentation becomes more tense and a negative loop sets in. Instead, you could sit with the original fear and get used to the feeling, rather than worrying about it. To try tracking your anxiety habits, download Brewer’s free Habit Mapper.

There are many medications that have been shown to be effective in reducing anxiety. Talk to your health care provider about your specific symptoms to determine which medication might be most effective. Selective serotonin reuptake inhibitors (SSRIs) (such as escitalopram, brand name Lexapro) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed for anxiety as well as for depressive disorders. They take a week or more to work fully and then lead to a decrease in symptoms. Benzodiazepines such as lorazepam are prescribed to treat short-term symptoms and work within hours. According to the National Institute of Mental Health, beta-blockers are also fast-acting and can help if you suffer from uncomfortable symptoms such as rapid heartbeat, sweating, and shaking.

The more you understand about your anxiety – what triggers it, what helps tame it – the better you’ll be able to manage it, and the healthier you’ll feel.

Lesley Alderman is a Brooklyn-based psychotherapist.

We welcome your feedback on this column at OnYourMind@washpost.com.

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