The Washington Post

10 strategies to build your anxiety tool kit. They’ll give you some valuable relief.

- Lesley Alderman is a psychother­apist based in brooklyn. We welcome your comments on this column at

Anxiety takes many forms — you probably have your own tormenting version — but it’s typically a feeling of extreme fear or worry, often paired with catastroph­izing thoughts and physical symptoms.

When it is problemati­c, anxiety can become debilitati­ng to your mental and physical health, contributi­ng to a number of serious conditions, including burnout, cardiac disorders, gastrointe­stinal problems, hypertensi­on, migraine headaches and dementia.

Environmen­t plays a part, but so does your legacy. Anxiety runs in families: 30 to as much as 50 percent or so of your anxiety is because of your genes.

Forty-one percent of people with anxiety disorders are not treated, which is tragic, since there are scientific­ally proven strategies to help you feel better.

“Everyone feels anxious at times,” says Elizabeth Hoge, director of the Anxiety Disorders Research Program at Georgetown University School of Medicine. “It’s the intensity and frequency of symptoms that makes it problemati­c.”

It’s hard to tame anxiety when you suppress it, hate it or, worse, stoke it. Approach anxiety like you would any other surmountab­le problem.

To quell your anxious mind, make friends with it. Put your arm around that part of you that gets anxious and become curious.

Consider these tactics for addressing your anxiety. And be sure to prioritize sleep, everything is harder when you’re exhausted.

When you start to feel anxious, pause and try to identify your feelings as precisely as possible. Perhaps it’s something like: I feel a sense of dread about going to work today. Labeling feelings helps your prefrontal cortex organize chaotic emotions into rational thoughts, dampening their effect, according to research by Matthew Lieberman, a neuroscien­tist and professor at the University of California at Los Angeles. Next, confide in someone you trust so you feel less alone. Explain that you don’t need help, you just want to share your emotions.

Explore what’s behind the feeling. Maybe your work anxiety is fueled by fear of being laid off or judged harshly by a boss. Tune into your triggers. Also, practice what’s known as cognitive reappraisa­l, which means reframing the meaning of an emotion to alter its impact. For instance, being laid off is scary, but it could also be an opportunit­y to find a better position where you feel more secure. Reappraisi­ng 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 turn down your body’s stress response, which is particular­ly helpful if your anxiety is accompanie­d by physical symptoms such as shallow breathing, a racing heart or churning stomach. Make it a habit to take breathing breaks throughout the day. Apps such as Breathwrk and the Breathing App can help guide you.

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

“A single bout of exercise can improve your mood,” says Kristin Szuhany, a clinical psychologi­st at New York University Grossman School of Medicine. Walking outside while focusing on your surroundin­gs can help you feel more connected to your present experience and away from the worried thoughts in your head.

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

Cognitive Behavioral Therapy (CBT) teaches you to challenge your irrational thoughts and behaviors. It’s a short-term therapy, about eight to 16 sessions, that has been proved to help with anxiety and help you learn to manage anxiety spirals. You’ll be given homework assignment­s to do between sessions and after therapy has ended. “Patients tend to see a lot of progress in a short amount of time,” said Szuhany, who uses CBT with her patients.

Research about the relationsh­ip between diet and mood is in its infancy — but making your diet healthier can’t hurt. A journal review found higher levels of anxiety in people whose diets included high intake of sugar, refined carbohydra­tes and high-fat foods, and low levels of tryptophan and protein. One recent study revealed that the artificial sweetener aspartame produced anxiety-like 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 it’s vital to become mindful of your worrying habits. Let’s say you feel anxious every time you give a presentati­on. Your mind gets in the habit of worrying in the days leading up to the event. Worrying stokes your anxiety. And then anticipati­ng the next presentati­on becomes more fraught and a negative loop becomes establishe­d. Instead, you could sit with the original fear and get used to the feeling, rather than fretting about it. To try tracking your anxious habits, download Brewer’s free habit mapper.

There are many medication­s that have been proved effective at reducing anxiety. Talk to your health-care provider about your specific symptoms to determine which medication might work best. Selective serotonin reuptake inhibitors (SSRIS) (such as escitalopr­am, brand name Lexapro) and serotonin and norepineph­rine reuptake inhibitors (SNRIS) are commonly prescribed for anxiety as well as depressive disorders. They take a week or more to work fully, and then lead to a lessening of symptoms. Benzodiaze­pines such as lorazepam are prescribed to treat short-term symptoms and take effect within hours. Betablocke­rs are also fast-acting and can help if you struggle with uncomforta­ble symptoms such as rapid heart rate, sweating and tremors, according to the National Institute of Mental Health.

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

 ?? CELIA JACOBS for The Washington POST ?? Challenge your habits
CELIA JACOBS for The Washington POST Challenge your habits

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