Hello and welcome to ‘Managing anxiety’, Week 4, Session 1, our penultimate session! Can you believe it?

If this is the first time you are reading this, welcome! We’re so happy to have you here. However if you’re just starting out please do head back to the first session. We build on material throughout the weeks, and we don’t want you to miss anything!

The goals for this session are:

• Understanding the importance of having strategies to manage anxiety
• Learning the ways we can put the breaks on and stop the amygdala response

But of course first, we start with a grounding exercise. 

**Today’s grounding exercise is…
**If you feel comfortable, close your eyes. Now think about a calming colour, and as you take a deep breath in, imagine the air that is coming into your body is that colour and it’s calming every part of your body inside you. Now as you exhale, imagine a strong colour like red or orange coming out along with your stress, anxiety, fears. Do this 3 times.

Fun question: What is your favourite smell?

The plan for today's session is to look at ways to manage our anxiety in a more focused way. The intention is to zoom into anxiety management techniques that can help us feel more in control when anxiety comes to visit.

But firstly, let us address an important question: why do we need to have strategies to manage anxiety?

We need these strategies because we need to find ways of not being on “out in the wild” mode all the time - that sympathetic nervous system response we introduced in the first week with the 3F fear response. As we mentioned before, this 3F response, the fight-flight-freeze, is meant to be a short-term response; so, if we feel this is becoming a very frequent state for us, we need to do something about it. Our sympathetic nervous system is meant to work in balance with our parasympathetic nervous system - that “rest and digest” system that restores our system to a state of relaxation and rebuilding. 

And another thing: stress in and of itself isn’t bad! While we’re not meant to enter the 3F state very many times a day as we might with anxiety, we’re also not meant to be totally relaxed all the time. Often, as people who experience anxiety, this is a huge pressure that we place on ourselves, that we should never experience stress of any kind, and any time we enter into the 3F state or a mode of panic, that it is our failing as a human being. No. We don’t have to place this pressure on ourselves: we’re not supposed to feel like a cat purring while its belly gets rubbed every second of the day. As we go through our anxiety strategies today, keep this in mind; we do not want these suggestions to make you feel guilty for all the time you spend in a state of anxiety. We just want to give you the tools to manage the anxiety so you can live the more peaceful, less stressed life you deserve. Today, we’re going over strategies you can use in these exact moments of the fear state, while next session we’ll look at longer-term strategies which will help us not enter that fear state quite as frequently.

So why do we spend so much time in the 3F state? It might be that we have chronic stressors in our lives that are making us constantly anxious, such as the COVID-19 pandemic or caring for someone with a chronic disease, or maybe we experience high periods of anxiety without a clear cause. Either way, when we are in a state of chronic anxiety, we can start suffering physical difficulties such as trouble sleeping. This will make us feel unprepared to cope with the demands of our day, including when we feel anxious, and create more anxiety- like a vicious cycle. So, attending to our anxiety is a priority.

Another reason why we need to learn ways of coping with our anxiety is because otherwise we might experience that we feel very emotionally exposed. If you are constantly on fight or flight mode, you will probably take that comment from your partner or friend or colleague in the worst possible way because your system is ready to attack. Anxiety - based in the fear of uncertainty - will read the most stressful, fearful interpretation out of an uncertain or ambiguous remark. Or maybe you might burst into tears. Our emotions will feel uncontrollable and we can feel like our relationships are deteriorating. If we are able to deal with our anxiety consistently and if we have an awareness of it, we will be able to stop ourselves from reacting this way.

And like we said, some levels of stress are normal, and can be helpful to keep us motivated and productive. For example: there is a hormone called cortisol which is involved in regulating the stress response. In addition to stressful situations, there is another time our cortisol levels peak. When? First thing in the morning! Cortisol helps us wake up and get out of bed. This is normal; mild stress reactions have a function in helping us get through the day and respond to everyday demands. Nevertheless, if we are living under constant fear or anxiety, our physical health can start to suffer. Like we said in our last session, our immune system can get compromised and we can be more vulnerable to suffer physical symptoms and getting ill (this decreased immune reactivity is in part attributable to increased levels of our friend, the stress hormone cortisol!). And because of the physical effects of anxiety, a lot of people struggle to identify anxiety as the main cause of their discomfort because they might see the symptoms in their bodies. This can result in endless consultations with the doctor to report a variety of pains and health problems. Whilst these are not unreal, not addressing the source of our immune system being compromised will not allow us to start feeling better.

So, before we go on to discuss some coping strategies that can be of help, we want to give you some tools to help you manage anxiety whilst it is happening. We know this is the most difficult part of suffering from anxiety so we want to focus on this first. When we are feeling anxious, we just want something to make it go away. And whilst the preventative things we have been looking at and the coping mechanisms that we want to install will be the key to reducing our anxiety in the long run, it's also important to have some tools at hand to use on the spot:

• Remove the focus from the anxiety: we know that if we are feeling anxious and someone, or even ourselves, tells us “don't be anxious” we will end up feeling even more anxious. What we are doing is focusing more on the anxiety, which feeds into it and makes us feel worse. Whilst being able to identify anxiety is present is a good skill, staying there thinking about it will make us panic. Now you know it's there, it is time to do something about it.
• Relaxation is the antidote to anxiety: you cannot be relaxed and anxious at the same time. Remember the parasympathetic and sympathetic systems: they don't cohabitate. You can put on the breaks but give your body exactly the opposite of what it is having: a relaxed state. This sounds impossible. We know. But it is not. We promise. We need to get you to trigger the relaxation response and then you let your body do its thing. Here are a couple of options that can help you do this:
  • Rely on things that make you feel relaxed: that song you love? Have it on your phone. That video of your nephew, that guided meditation: have things at hand that will make it easy for your body to enter the relaxation state. Just push play and go with it.
  • Guided body relaxation: do some guided relaxation exercises (lots on youtube!) and practice them. If you do this, your body will be able to learn body relaxation and will be able to automatically connect to that when you need it. It's amazing like that.
  • Find a distraction: put on that show you like and makes you laugh. The best thing for your body will be to concentrate on something else and forget about the anxiety for the time being. Some laughter will be an incredible adrenaline boost. Or maybe read a book. Call a friend to discuss something different. Practice some yoga.
    And an important note: distraction is not avoidance. The idea is that you are working on addressing and managing your anxiety (which you are certainly doing, as you are here!) but you do not need to think about that whilst you are feeling distressed.
  • Grounding exercises: you know the ones that we do at the beginning of each session? These are amazing to try to when you are feeling anxious. They can help you connect with the here and now and allow your mind to disconnect from the anxiety.
  • Practice your breathing: when the emergency response starts, our breathing will get faster. If we can contrast it by making our body breathe slower, this will bring us back to a relaxed state. The key with deep breathing is to exhale for longer than inhaling. Try inhaling through your nose counting until 4, then retaining the air in your belly for 2, and then releasing the air through your mouth counting until 5. Try this a few times when you are feeling anxious, and even practice it when you are not.
  • More generally to do with relaxation: take a quick break, and do something physical. Of course, this may not always be possible. However, likewise, there are situations where we might not feel that it’s possible to step away, that there’s something that we have to address right then and there, but actually if we take a 15-minute quick walk around the block, get some fresh air, regulate our breathing like we describe above - you’ll come back calmer and in a better state to deal with the situation. So walking, taking a moment to stretch, going to get a snack at the shop down the road - anything physical that will give our body the chance to reset just a little bit. 
    Just a note at this point though: It’s important that this doesn’t become an avoidant habit, that whenever we feel stressed we hit the escape button and go away to do something else. But stepping away for a moment can help if we acknowledge that we’re in too heightened a state of anxiety to really manage the situation in that moment, and we make a conscious effort to do something that will help our bodies relax. It’s all about why we’re doing it - are we stepping away to fulfill our need for rest and calm? Or are we doing it to just delay our anxiety, as opposed to actually addressing the root need? Hopefully as this course has gone on, you have been able to learn to listen to yourself and your needs honestly, and without self judgment. Like we always say, self-knowledge is the first step.
  • If it’s an anxiety-inducing situation that you don’t know how to react to - and you have the chance to take a moment to think - use your thought diary! Spend 5 minutes writing out everything that is making you anxious about this situation - the catastrophising of the worst possible outcomes that could happen, what you’re worried other people will think of you or say because of this situation, anything and everything. Don’t worry about writing full sentences or correct grammar, just release it onto the page. The more you write, the more you may get to the heart of what’s concerning you, and the thoughts or worries that weren’t consciously accessible to you at the beginning may emerge. It also may help you to realise what you do have the power to do to help this situation - those things that you can control - and which worries about things that you cannot control that you want to consciously discard. Maybe add these to your columns from the last homework.

Important information: none of these will work unless you practice them! You need to apply yourself and practice them beforehand and be prepared just in case. Have that song that makes you feel calm on your playlist. Or the podcast that will distract you on your phone. Or have that bracelet that connects you to a special place with you so you can hold it and go back there with your mind. You will then have your resources ready to use if you start feeling anxious.

Finally, just a note on coping mechanisms. As we’ve gone through this list, you might also have been reminded of ‘on the spot’ techniques you used in a moment of anxiety, which may not have been as nourishing. They provided a quick sense of relief, but in the long-term created more problems for you. Do not judge yourselves for these behaviours - easier said than done, we know. But the point of going over these techniques isn’t to silence those parts of ourselves that are reaching for relief in a moment of panic, or to shame ourselves for what we did for that relief. We just want to provide you with techniques that address your needs more nourishingly - that bring calm, rest, and ease, and foster your relationship with yourself long-term. Make room for discomfort, but also peace. 

The homework for this week is… We have two techniques for you to practice! 

Firstly, we’d like to ask you to try an exercise called Spiral Technique. This technique is part of a set of techniques developed by Francine Shapiro, who is the creator of a particular trauma therapy called EMDR.

To use this technique, Identify something that bothers you at about a 3 level on a scale 0-10.

1. Bring up an image that represents it for you
2. As you think of the image that represents it, notice where you feel the disturbance in your body.
3. Now pretend that the feeling is “energy”. If it was a spiral of energy, which direction is it moving in: clockwise or counter-clockwise?
4. Now, with your mind, gently change the direction of the spiral in your body. For instance, if it was originally moving clockwise, gently change it to counterclockwise.

Notice what happens with the feelings in your body. For many people, the feelings start to go away when they change the direction of the spiral. If you notice this happening, then continue until you feel comfortable. If that direction didn't work, try the other one and see if the disturbance feels less.

Maybe you’d like to apply this technique to some of those aspects of anxiety from the last homework, the things you cannot control. While it doesn’t make us able to control these techniques, it may provide a kind of release or catharsis of some of the built-up frustration we have, that we have to deal with this bothersome or stressful thing out of our control.

The second technique we’d like you to do is to practice your Safe Place again. But, this time, we want you to pay attention to your breathing whilst you do it. Bring up the image of your safe place and the word that best defines it. Once you start feeling the positive emotions emerge, place your hand in your stomach or chest-where you feel your breathing starts. That is the breathing pattern you feel when you are calm and safe. The breathing you feel when you are relaxed. This is the breathing that brings to life our parasympathetic nervous system, brings down our stress hormones, and brings a feeling of rest.

And with both of these techniques, practice makes perfect. As we mentioned earlier, practicing the techniques we have been learning together is key to teach your body how to respond to anxiety. If you don’t manage to memorize them and practice them regularly, then unfortunately they will not work in times of feeling anxious. These techniques may not work for you, that is fine, but practising them will not only help you acknowledge whether they’re working for you but will also bring you closer to understanding what kinds of techniques you are looking for overall.