Overcoming Anxiety and Panic, Part 1

An anxious woman looking out through window blinds

If life were a long train ride and you are given the choice to be a passenger or the engineer, which would you choose? As the passenger, you can just sit back, relax and look out the window. As the engineer, you can turn at junctions, choose when to speed up, slow down and stop. In short, you would have some control. In principal, the choice is not very different in your brain. You can choose to be a passenger allowing thoughts, worries and past experience to determine your everyday experience or you can begin to assume the role of engineer.

Although it may sound incredible, it has been shown that by changing the way we think, we can physically change our brains. This phenomenon is possible because the brain has “neuroplasticity,” i.e., it can reorganize itself and grow new connections. The Science Journal of the Wall Street Journal reported that long time meditators had indeed altered the structure of their brains (Begley, 2007)

That is not to say that gaining control of your thinking is easy. It is not. It presupposes that you are ready to change, not merely ready to think about changing. It means adjusting your lifestyle, developing a commitment to follow through and an expenditure of effort.

Meditation is just one technique to reduce anxiety and panic. There are many more.

Where to start

In the last newsletter, "the Roots of Anxiety and Panic" we learned that many factors can that contribute to anxiety and panic. This newsletter is about techniques to manage and ultimately overcome anxiety and panic. To be clear, this is not meant as a treatment suggestion, as that is best done by consulting with a qualified therapist. Rather, it is meant to provide an overview of clinically reviewed and anecdotal treatment techniques for anxiety and panic.

Physical changes

Please note that you should consult with your physician before initiating any of these physical changes, especially if you are considering a new exercise regimen.

Exercise

The exact mechanism is not yet understood but studies show that exercise can lessen anxiety. Some possible mechanisms that create those beneficial effects are the release of the endorphins (associated with positive mood), a reduction in muscle tension, an increase in parasympathetic nervous system activity (this part of the nervous system returns your body to a calm, normal state after experiencing an excited state) and a reduction in the excitability of your central nervous system (Taylor, 2000, p. 32). Exercise techniques such as Yoga, Tai Chi and Qi Gong are especially helpful because they also emphasize breathing as part of their training.

Diaphragmatic breathing

Another physical change that you can make is to do deep, diaphragmatic breathing. The goal here is to consistently draw in the kind of breath that causes your stomach to expand. Studies have shown that anxious people tend to employ shallow chest breathing. This kind of breathing can result in overbreathing, an increased heart rate and dizziness. Since these are also the symptoms of panic, they may be interpreted as the onset of an attack (Bourne, 2005, pp. 76-77).

Research indicates that slower, deeper breathing causes the central nervous system to instruct the heart to slow down (Glenn, Ditto, 2004) and that “regular practice of breathing exercise [...] increases parasympathetic tone, decreases sympathetic activity, improves cardiovascular and respiratory functions, decreases the effect of stress and strain on the body and improves physical and mental health” (Pal G, Velkumary, S, 2004, p. 115). In simpler terms, breathing can decrease the fight or flight response (the sympathetic nervous system) and increase the calming effects, e.g. lower heart rate and blood pressure (the parasympathetic nervous system). Both of these physiological effects are be beneficial when coping with anxiety.

See the recommended reading section for suggested readings on proper breathing.

Progressive muscle relaxation

A third physical technique is to use progressive muscle relaxation. This technique involves gently tightening a group of muscles and then holding them tight for about 7 seconds. This is followed by 20 seconds of relaxing that same muscle group. If the muscle group is still tense, repeat the tense/relax cycle one or two more times. To enhance the benefits, say something calming to yourself as you relax your muscles. Some ideas are “Letting go,” “relax” or “goodbye tension.”

Research shows that muscle relaxation training can have other benefits as well, including lower blood pressure, decreased pulse rates and improved sleep (Kim D, Lee G, 1989)

Changing habits

Watch the nicotine and caffeine

The first and simplest habit you can change is to eliminate or sharply reduce your nicotine and caffeine intake. The Harvard Mental Health Letter puts it plainly:

Smoking and caffeine both can promote anxiety and may trigger a panic attack in someone with panic disorder. Smoking interferes with breathing and reduces oxygen flow to the brain. The automatic physiological response is more rapid breathing and faster pumping of the heart. In people who are susceptible, the result may be a panic attack.
The stimulant effect of caffeine may also promote anxiety. Caffeine can set off a panic attack in someone who is susceptible by activating the sympathetic nervous system, which mediates the body’s response to stress or danger. (2008).

Viewing and listening habits

Another habit change that can reduce anxiety is carefully choosing what you watch (TV & movies) and what you listen to. For example, if you watch violent or otherwise anxiety provoking movies and TV, you might be interested in this NY Times article: “when children watched violent television programs, mirror neurons, as well as several brain regions involved in aggression were activated, increasing the probability that the children would behave violently” (Blakeslee, 2006). If you like loud, agitating music, you should know that a recent French study linked loud music with increased alcohol consumption. One theory is that loud music increases arousal, which then leads to increased alcohol consumption (Guéguen N, Jacob C, Le Guellec H, Morineau T, Lourel M, 2008).

Every time you choose images to put in front of your eyes or sounds to pipe into your ears, you are affecting your emotional state. Choose wisely.

Time management

Time management habits can also increase or decrease your levels of anxiety. For example, by planning to arrive at 7:59 for the 8 AM train, you will likely increase your anxiety. There is no margin for error, no provision for traffic or the myriad of other possible delays. Another time management habit is giving yourself downtime. Stress can be cumulative and there is a need to take breaks during the day and vacations during the year. Although the media often glorifies the always connected, 24/7 worker, it is a recipe for high stress, anxiety and burnout.

Starting a new habit – meditation

The benefits of meditation for stress reduction are well known. But recently studies have also shown that meditation can improve social interactions. A 2008 study of college students has shown that “meditation-based stress-management practices reduce stress and enhance forgiveness among college undergraduates” (Oman D, Shapiro S, Thoresen C, Plante T, Flinders T). Another 2008 study has found that “just a few minutes of loving-kindness meditation increased feelings of social connection and positivity toward novel individuals on both explicit and implicit levels” (Hutcherson C, Seppala E, Gross J). So not only can meditation help you focus and clear your mind, it can also improve your social interactions. And the importance of social interaction and social support cannot be understated. A University of Michigan study cites previous research suggesting that:

[…] forming social bonds creates positive emotions, whereas breaking social bonds creates negative emotions; that people think a great deal about actual and potential relationship partners; and that deficits in belongingness are associated with both physical and mental health problems (Crocker, Canevello, 2008)

If the idea of starting a meditation practice is daunting, take a look at “The Three Minute Meditator” in the recommended reading section. It is easier than you think.

Changes in the way you think

Your thinking habits strongly affect the way you feel. There are many ways of thinking that can make you feel more anxious. I’ll review a few here.

Imagining disastrous scenarios

Imagine that you are sleeping and you hear a creak in the floorboards. If your thoughts are “Someone has broken in. It’s a murderer who has come to kill me”, odds are you will feel some anxiety (I would!). Alternatively, if you think that it may be a pet or family member walking around, you will likely feel curious about whom it is.

Take another case, where your spouse is late coming home from work. Think of what you would feel if you assumed that the delay the a result of traffic as opposed to envisioning a terrible accident. You get the idea. If you imagine the worst, you will feel the worst.

If you believe that worrying keeps you safe, remember that you can retain an appropriate sense of caution while changing your thinking. It will just serve better if you begin to imagine benign scenarios and outcomes rather than disastrous ones.

“I must” “It has to” (rigid thinking)

There is a great difference between working toward a goal and believing that it must be attained. You can demand that life give you specific outcomes but the problem is, life may not cooperate. By seeing the world in terms of demands, instead of preferences, you can add a great deal of stress and anxiety to your life.

Similarly, if you think that if you don’t get an A on an exam, it is the same as getting an F, you put yourself in another stressful dilemma. By converting the full spectrum of possibilities into just two (success or failure), you will increase your anxiety. Also, your self esteem will likely suffer as you will tend to view more of your efforts as failures.

“The world is a dangerous place”

This belief deserves to be challenged. Billions of people interact peacefully and respectfully every day. Only a rare few act to harm others. In addition, safety improvements are constantly being made in every area of our lives, from travel to products and services. Of course there is danger, but it is comparatively rare. The mindset that life is as dangerous as a soldier living behind enemy lines is as stressful as it is untrue. In fact, one of the features of an anxious person is their attentional focus on danger cues (see the “Attentional Focus” section of the August, 2008 newsletter for more on this). Just shifting your focus to safety cues can lessen your anxiety.

“I won’t be able to cope”

Believing that you do not have the resources to deal with situations that may come up will increase your fear and anxiety. But if you think back on your life, there were many challenges and difficulties that you did overcome. You would not have made it this far if you had not. Remember this as you think of future situations. The same strength and inner resources that helped you manage in the past will still be there to help you manage and navigate through the future.

“I’m not doing as good as ...”

If you frequently compare yourself to others, it can be harmful to your self esteem. There will always be someone more attractive, more learned, more athletic or more something. And when you “fall short” it will likely increase your anxiety that you feel, particularly social anxiety. If you want to benchmark your performance, compare your current achievements against previous achievements that you have made. One study of athletes found that those who had successfully rehabilitated after serious injuries engaged in this type of self to self comparison (Andreas, Faulkner, 1994).

References

Andreas, S. Faulkner, C. (1994). NLP: The New Technology of Achievement. New York: HarperCollins Publishing.
Begley, S. (2007, January 19). How Thinking Can Change the Brain: Dalai Lama Helps Scientists Show the Power of the Mind To Sculpt Our Gray Matter. The Wall Street Journal online. Retrieved October 9, 2008 from http://online.wsj.com/article_email/SB116915058061980596-lMyQjAxMDE3NjI5MTEyNTEwWj.html
Blakeslee S (January 10, 2006). Cells That Read Minds. NY Times.
Bourne, E. (2005). The Anxiety & Phobia Workbook. California: New Harbinger Publications.
Crocker J, Canevello A (2008). Creating and undermining social support in communal relationships: The role of compassionate and self-image goals. Journal of Personality and Social Psychology. 95(3), pp. 555-575.
Glenn D, Ditto B (2004). Vagal Tone Biofeedback: Respiratory and Non-Respiratory Mediated Modulations of Vagal Tone Challenged by Cold pressor Test. McGill Journal of Medicine 7(2).
Guéguen N, Jacob C, Le Guellec H, Morineau T, Lourel M (2008). Sound level of environmental music and drinking behavior: a field experiment with beer drinkers. Alcoholism: Clinical and Experimental Research 32(10):1795-8.
Hutcherson C, Seppala E, Gross J (2008). Loving-Kindness Meditation Increases Social Connectedness. Emotion. 8(5), pp. 720-724.
Kim D, Lee G, (1989). The effect of muscle relaxation training on patients with insomnia complaints. The Journal Of Nurses Academic Society 19(2), pp. 191-202.
Oman D, Shapiro S, Thoresen C, Plante T, Flinders T, (2008). Meditation Lowers Stress and Supports Forgiveness Among College Students: A Randomized Controlled Trial. Journal of American College Health; 56 (5), pp. 569-578.
Pal G, Velkumary S (2004). Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian Journal of Medical Research 120(2), pp. 115-121.
Taylor A (2000). Physical activity, anxiety and stress. In S Biddle, K Fox & S Boutcher (Eds.) Physical Activity and Psychological Well-being (pp. 10-45). London: Routledge.

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