Six steps to managing anxiety

My battle with anxiety

Anxiety sucks. In many seasons of my life, anxiety has completely dominated and even overwhelmed me. Anxiety has woken me on a morning, jumped all over my chest, and implored me to hide beneath the duvet. In the grip of anxiety, it’s hard to imagine your stomach ever being still, your muscles ever being relaxed, or your mind ever being calm.

I’ve had major bouts of anxiety when I’ve been assailed night and day with post-traumatic symptoms, leading to breakdown. I’ve been overwhelmed by anxiety when life has become overwhelming with too many things, or too many of them out of my control. And I’ve been frantic with anxiety due to the hormonal tectonic shifts of menopause. Anxiety has looked different in me at different stages of my life. It looks different for different people. The main commonality? That it sucks.

But anxiety can be manageable. For it to be so, we need to understand what it’s trying to achieve; we need to collaborate with our bodies; we need to avoid the doom-loop of being anxious about being anxious; we need a personalised approach; and we need a long-term view. Here’s what I mean.

1. Understand that anxiety is trying to keep us safe

I think it’s natural to think that anxiety is a problem – because it feels so awful. But without anxiety, we’d likely be dead. Ultimately we have evolved to feel anxious, as part of a fear response, in order to promote our survival: to stay safe and therefore to stay alive.

This to me is an important first step in tackling anxiety. Because if we think of it as the enemy, or as a malfunction of our brain, then we’ll approach the whole thing awry. We’ll try to eradicate it or at least suppress it. And we’ll spend a lot of time beating ourselves up for being anxious, rather than being grateful for anxiety as a messaging mechanism, and being curious about what that message actually is. We need to hear that message so we can do something about it – or the klaxon of anxiety will continue to sound.

After trauma, anxiety is a perfectly reasonable response. Anxiety whispers – and sometimes shouts – to us, ‘You’re not safe!’ And so it’s little wonder that we experience so much anxiety after trauma – because the reality for us so often was, and still is, that we’re not safe.

When our brain perceives us not to be safe (even if we are), it activates a cascade of neurobiological responses. Our survival-based back brain takes over, shutting down clever, rational, front-brain-based thought. And physiologically, with an alarm sounding in our body, we move out of the green zone of calm and collected (technically the ventral vagal circuit) into the amber zone of fight and flight – of anxiety (technically the spinal sympathetic circuit). All of it is an attempt by our brain and body to get us to do something to reach safety. The horrible, restless, agitated feeling that is anxiety operates to get us up off our backsides, to mobilise us into action, to keep us safe.

And so, evolutionarily, anxiety is not a feeling that we should try to suppress or eradicate. It’s a signal that we don’t feel safe, and its aim is to motivate us to move towards safety. The key to dealing with anxiety is to listen to the signal, to hear the message it’s giving us, and to do something to become safe.

‘Safety’ though can mean a million different things. There are obvious threats to safety such as abuse or violence, or dangers such as heights or accidents. But as homo sapiens our greatest safety is to be in a ‘tribe’: we have evolved to be safe in close-knit communities and relationships, including in attachment relationships. So anything that threatens our sense of belonging or acceptance in the group can spark feelings of unsafety and hence anxiety. Our neurobiology screams at us: ‘Don’t be rejected! Stay part of the group!’ because to be alone on the prehistoric savannah meant almost certain death. Our anxiety is triggered therefore by primal causes, not just by threats that make conscious sense.

Sometimes we feel anxious and hence unsafe when there is no actual threat to us, when we are actually, objectively safe. This false alarm is a product of our back brain, which bases its assessment of threat on old data of when we were unsafe in the past, rather than on data from the here-and-now. This is the fingerprint of trauma in our lives – the inability to accurately assess threat with our front brains, because we are continually hijacked by the oversensitive back brain. As such, persistent and crippling anxiety is a signal to us to address our underlying trauma, and to begin to rewire the back brain’s threat assessment processes. Anxiety with no specific immediate cause, therefore, is still a signal to action – to deal with the root cause.

It’s also why ‘being present’, ‘grounding’, ‘focusing on the here and now’ are the inverse of anxiety. These actions or states are based in the front brain. By ‘being present’, and taking in accurate data around our surroundings from the here-and-now, our front brain is better able to assess if we’re safe or not, and strategise to take appropriate action. Background anxiety – that low hum of dread that pools in our tummy – is often a sign that our back brain has been triggered and that it’s not assessing ‘the present moment’ but is distracted by signals from the past. ‘Being present’ requires full immersion in only what is, not what we imagine (future) or remember (past).

My relationship with anxiety has been much more comfortable now that I equate anxiety with a perceived sense of unsafety. When anxiety hits, I try to be curious: ‘Hmm, what’s going on here? Why do I feel unsafe? Why do I feel under threat? What’s really happening?’ I don’t jump to conclusions that there’s something wrong with me, and I don’t simply try to suppress the anxiety. I listen instead to what it’s saying to me, and I get curious. This means that I start looking, with my front brain, for what is. I orient to the present, to the here-and-now, to assess whether or not I’m actually safe right here, right now.

Sometimes the anxiety is warranted, because I really am in danger. In that case, I’m grateful for it, as it’s a guide for action, to do whatever I need to do to get to safety. When however it’s a false alarm, I know now that I need to soothe my back brain with the sensible rationality of the front brain, to accept that my oversensitive smoke alarm is sounding the alarm, but there’s no actual fire. Either way, anxiety leads to action. The worst response is simply to muffle the signal – then anxiety will keep sounding, because we haven’t heard and responded. Either get to safety, or soothe and reassure your back brain that you are actually safe – this is the key to responding to the signalling of anxiety.

2. Plan our response

Anxiety is a bodily phenomenon. It starts in the body, it’s felt in the body and to a large extent it can also be managed in the body. When we’re anxious, we may have a racing heartbeat and shallow breath, and we may feel shaky and even light-headed. It’s impossible to relax and all our muscles may bunch up, or jiggle in agitation.

None of this is the body gone wrong. When we feel anxious, it can be helpful to realise that anxiety is an instruction to the body to gear up for action. It sends messages through the body to prepare us for that action. There’s a mismatch though when we feel anxious but we don’t act: we have a body that’s ready to do but we’re not doing. It’s this discrepancy that feels so physically uncomfortable and keeps the klaxon sounding.

But the answer isn’t simply to do whatever anxiety is prompting us to do – this can lead to reactive, back-brain-drive responses. The most unhelpful response to anxiety is to do something that makes us even less safe, which will counter-productively increase our anxiety. Instead, we need to figure out if the alarm is real or not, and if it’s not immediately obvious (flames licking at the door!), we can usually assume that our back brain is jumping to conclusions. And if so, we need to bring online our more perceptive front brain to do a proper risk assessment and to gather all the facts.

This is where we often get stuck: how can we calm down when we need to be calm enough to know how to calm down? Here a pre-prepared mantra of responses can be helpful, where we drill ourselves to talk ourselves through the anxiety trigger in a certain way.

Mine looks something like this: ‘I’m feeling anxious … I probably feel unsafe … let’s pause a moment and take a breath … let’s get the front brain online to see if I am actually safe or not …’ I repeat these phrases like a list, working my way through a sequence of responses, which I’ve committed to memory when I’ve not been anxious.

I find it helpful because it controls the flow of my thoughts – away from catastrophising (either ‘Something bad is about to happen!’ or ‘What is wrong with me that I’m feeling anxious again!’) and into a pre-planned response where (in the words of Daniel Siegel) I ‘name it to tame it’, and then take charge of my thoughts and actions:

• Acknowledge that I’m anxious
• Make the link that the anxiety is signalling that I feel unsafe
• Pause and breathe to re-regulate my nervous system
• Remind myself to get my front brain online
• Assess for threat with the front brain
• Choose my action based on my front brain, not my triggered back brain.
• Once you grasp this natural sequence, it’s not hard to remember it, although to start with I wrote it down and kept it with me for quick reference – because sometimes the anxiety is so overwhelming that we lose touch with memory and coping strategies and front brain rationality altogether. It’s a case of doing whatever we need to do to equip ourselves to deal with anxiety in the moment, and, for me, having a response framework is essential.

3. Collaborate with our bodies

But as well as anxiety leading to stages of physiological agitation and distress, there are also bodily states and experiences which can sensitise us to anxiety. It’s a two-way process. If we can address these ‘vulnerability pathways’, it can help us to stay more often in the green zone of calm and collected, and make the bumps of anxiety less severe.

Sleep

After a night of short sleep (under 6 hours), the amygdala, the brain’s danger-detecting smoke alarm, becomes significantly more reactive and biased towards threat. We literally see everything through a negative, dangerous filter the next day. Therefore, if even neutral stimuli are experienced as threatening, we will feel less safe. And in turn feeling unsafe makes us anxious. So sleep matters. Annoyingly, feeling anxious can also stop us sleeping, and therefore lead to a vicious cycle of becoming more anxious because we’re underslept, and sleeping less because we’re anxious.

Diet

Less obviously, the bugs in our gut determine our default levels of anxiety. Recent studies show a link between ultra-processed foods (UPFs) and an increase in anxiety and depression. With up to 80% of young people’s energy intake coming from UPFs, there’s a corresponding negative impact on their mental health. What we eat (and drink) matters – far more than we have previously realised. A diet high in UPFs will increase our baseline of anxiety, whereas a diet low in UPFs and high in whole foods will lower it. And yet the more anxious we are, the less capacity we may have to avoid the temptations of addictifying UPFs – another vicious cycle.

Environment

We evolved on the savannah and in the forests of Africa. We lived in nature, in small groups or tribes, without the hyperstimulation of screens and cities and a million strangers in close proximity. Our brains didn’t evolve for the hyper-connected world of social media and moving images and dopamine-hitting apps. In modern life, we’re increasingly overstimulated – and when we’re overstimulated (hyperarousal), our ancient neurobiology expresses that through anxiety. Conversely, being in nature has a directly calming, anxiolytic effect, as numerous studies now show. And yet for many people a cactus on their desk may be their only daily exposure to nature. Both the ‘too much’ of hyper-stimulation and the ‘too little’ of calming nature have a huge effect on raising our baseline levels of anxiety.

Movement

Anxiety is a message for us to move, to do something to deal with threat. Our bodies, again, evolved for movement. Not ‘exercise’ as we frame it in our modern lifestyles: we didn’t evolve to do spin classes. But we evolved to move throughout the day, outdoors, with sunlight streaming into our eyeballs. Instead, after trauma we may have a deeply embedded freeze response that often makes it feel unsafe to move. Added to this are often multiple accumulated disabilities from the inflammatory effects of trauma, rendering movement painful or impossible. And so our lives become increasingly sedentary, and we are unable to access the movement that anxiety is asking us to do. We live with the pent-up energy of anxiety pooled in our bodies.

Substances

When faced with anxiety, it’s natural for us to ingest substances which will take the edge off. But so many of them actually, at least in the long-run, make the anxiety worse. Alcohol is the most obvious culprit. As a depressant, it relaxes and calms us down – so far, so good. But simultaneously it actually increases activation of our sympathetic nervous system, which is the pathway for our amber zone fight-and-flight system. Therefore, especially with heavier drinking, in the long-term we may increase our baseline of anxiety. So too with caffeine, which can feel essential to counter the impacts of short sleep, but which stimulates our amber zone fight-and-flight response, further increasing our baseline of anxiety.

Avoidance

When we’re anxious, it’s a natural response to avoid whatever we’re anxious about. We can do this consciously and purposefully, using distraction as a strategy to manage anxiety in the moment. But there’s a downside: when we avoid an anxiety trigger in this way, we send a message to our brain that what we’re avoiding is in fact dangerous. For proof, just look at our behaviour: it must be dangerous, because we’re avoiding it! And so the more we avoid it, the more anxious we become. Hard though it is, we have to train ourselves to tackle low-level anxieties before they grow bigger, and recognise the long-term cost of avoidance (including dissociation and denial) despite the short-term relief they bring.

4. Cognitive reframes to avoid being anxious about being anxious

Being anxious about being anxious makes sense. It feels awful to feel anxious, so it’s natural to be concerned about it. Do I have a mental health problem? Will I always be like this? What’s wrong with me?

The problem is that it can lead to a self-reinforcing feedback loop: I’m anxious about being anxious, and that increases my anxiety overall, which makes me even more anxious about being anxious. How we frame anxiety impacts our brain’s perception of how easy or difficult it is to manage. If we big it up into a significant problem (‘I have a mental health problem!’, ‘I’m going mad!’, ‘I’ll never be able to cope with life!’) and we believe that our life will only get worse because of it, then that in itself will cause anxiety. Instead, we need to think differently about anxiety, and not take it quite so seriously – difficult though that is when it’s screaming, ‘We’re all going to die!’

Here are some cognitive reframes that might help.

a. Seeing anxiety as normal, natural and useful

Anxiety is increasingly framed as a mental health problem. But what if we frame it as something that’s normal, and natural, and that it has a useful point to it? Would that make us feel any differently about it?

Anxiety is the outward expression, through the physical manifestation of symptoms of anxiety such as butterflies in our tummy, agitation, a racing heartbeat, or catastrophic thoughts, that we don’t feel safe. So rather than saying to ourselves, ‘There’s my anxiety again!’ or ‘I’m having a really bad day with my anxiety’ – which describes the predicament we’re in, but doesn’t solve it – instead we can say, ‘Aah, look. I’m feeling unsafe again. That’s why I’m feeling anxious. This is normal. This is natural. And it might even be useful. What is it saying to me?’

This is a helpful reframe because it’s showing us what’s really going on (feeling unsafe) rather than focusing just on the messaging (the anxiety). And so we can start therefore to address it, to ask ourselves, ‘What do I need to do to feel safe?’ – which makes anxiety useful.

b. Seeing anxiety as a message, not who I am

The second reframe is to understand that the anxiety we’re feeling is just a message – it’s not who we are. Firstly, it’s a message and only a message. And sometimes the message is wrong. Sometimes it’s a false alarm. So we need to assess the message it’s bringing to us, rather than assuming that it’s automatically true. Because it’s just a message. It’s not a description of reality. It’s a guess.

And it’s not who we are. We can blur this truth when we start talking about ‘my anxiety’, or that ‘I have anxiety’, which risks giving anxiety an inflated place in our life. For sure, it can feel like anxiety dominates us, and therefore is a fair reflection of reality. But in order to manage anxiety, we need to knock it down a peg or two. We need to put it in its place – ‘You’re just a message. However loud or persistent you are, you’re just a message. You’re not a statement about who I am as a person.’

c. Anxiety as a notification

We can also reframe anxiety by viewing it as a notification. I often set reminders for myself on my phone (‘PUT BIN OUT!’ on Mondays), and when the notification pings into awareness, I use it as a prompt for action. We can use anxiety in this way as well, as a prompt to ask ourselves what’s going on with ourselves right here, right now: ‘What do I need? Something has fired off this message of anxiety. Why? What’s going on?’ So we welcome it rather than being afraid of it.

If we can stop and notice the anxiety, rather than simply reacting to it (and getting anxious that we’re getting anxious) then it can be a super-helpful way of spotting what triggers anxiety, and what our brain and body really need. Anxiety therefore becomes a notification, rather than an error message. We don’t need to panic at it, and nor do we need to suppress it. Instead: ‘Notification incoming! – What do I need?’

d. Develop skills rather than trying to ‘get better’

It takes skills to manage anxiety. We weren’t born with those skills, and if no-one taught them to us as we were growing up, then in all likelihood we don’t have them now. That, to me, is a more compassionate way of looking at anxiety compared to seeing it as a ‘sickness’. We’re not unwell. We just don’t yet have the skills. So our reframe is to see the ping of anxiety as simply a prompt for us to learn how to manage our feelings and to keep ourselves safe. It’s not something we need to ‘recover from’ – it’s just something we can learn, with skills, to manage.

5. Find the right management techniques for you

How do we develop these skills? First, we need to understand the limitation of techniques. Taking the edge off the anxiety is a good thing – so that we have the brain space to listen to its message. But techniques shouldn’t be there simply to shush or eradicate anxiety entirely. If we do that, we’ll be deaf to its message – and that could lead us into more danger or difficulty down the line.

The problem with only using medication to ‘deal with’ anxiety is its inference that there’s just something wrong with your head, and that the drugs are necessary to fix your head. It doesn’t accept that perhaps there’s nothing wrong at all with your head, and there’s everything wrong with your circumstances, your environment, or the people in it. So I’m not against medication or other techniques, as long as we’re using them to calm the anxiety sufficiently to be able to focus on and deal with whatever is causing it. It’s looking to these things as sole solutions to eradicate the anxiety that can be dangerous.

Second, it’s vital that we find techniques that work for us. Within the self-help literature, there are a multitude of options for managing anxiety. Breathing, meditating, art, yoga, colouring, journalling, nature, exercise, a bath or shower, distraction – the list is endless. But I never found someone chucking ideas at me helpful. ‘I don’t want to go for a walk’, ‘I don’t want a warm bath’, ‘I don’t want to phone a friend.’ It always felt like a mismatch with how bad (anxious) I was feeling, and the off-the-shelf advice I was being given. It usually made me feel unseen and unheard and unfelt. That in itself then dysregulated me further and exacerbated the anxiety.

But that doesn’t mean to say that those approaches don’t work. My resistance was usually triggered by someone trying to fob me off, to fix me, rather than being willing to hear how distressed I felt. I didn’t want a solution from them – in that moment, I wanted their support. And I also wanted to feel that they had seen me – seen me clearly enough to tailor a suggestion that works for me rather than a cookie-cutter solution.

It’s taken me many, many years to know what works for me, and what doesn’t. I find breathing incredibly powerful, partly because it makes sense to me, having researched how the breath sits on the interface between the back brain (responsible for our amber zone anxiety) and the front (responsible for conscious thought and choice). It was only through understanding the science of the breath that I felt like I wasn’t being fobbed off or patronised.

Similarly, although I struggle with many forms of formalised mindfulness, I found the Headspace app really useful. I had to overcome multiple obstacles in learning mindfulness: a fear of failing; perfectionism to ‘do it right’; a mind that resembled a ferret in a fire; an inability to locate my body let alone my breath; a terror of what I might feel if I was still for ten seconds. I know how difficult this journey can be. So for many people, it’s not the right next step. This is the point: do what’s right for you, not what’s on a ‘list’. And certainly don’t feel a failure if the prescribed suggestions don’t work for you. Most of them don’t work for me either.

For me, to manage anxiety, I need to plan, I need to be organised, and I need to live as far as possible free of chaos. I live by routines and rituals. I crave familiarity and peace and quiet. I need to reduce external stimulation and prevent overload in my mind. So I use noise cancelling earphones when in busy, public spaces. I am ruthlessly protective of my time and energy, and have learned to say no to situations or people that will take me out of the green zone. I have focused on the interventions that I need, rather than trying to be a ‘good girl’ by following the recommendations of others. I’ve figured out, through trial and error and a lot of reflection, what works for me, and I am dismissive to the point of rudeness about interventions that I’ve tried and I know don’t work for me. Sometimes the best thing we can do to manage our anxiety is to learn to be assertive, and to defend our right to do what we need to do, and not what we’re expected to do.

I only made progress in managing anxiety once I started dealing with the root. I tried for years to simply suppress it, mainly by berating and even threatening myself: ‘Calm down’, ‘Get a grip’, ‘Don’t be such a wuss’, ‘Get over yourself.’ It didn’t work. It just increased my anxiety. I had to learn to take this anxiety seriously, to get to the bottom of it, to listen to what it was saying, and do what I needed to do for myself to calm it. I had to stop blaming myself and start helping myself, and instead of feeling shame about getting anxious, I had to learn to actively manage it in ways that are unique for me.

6. Focus on berries, not bears

‘What would living with minimal anxiety actually look like? Can you even imagine it? Or has it become so much a part of your identity and how you see yourself that you cannot imagine life without it?’

This was a challenge I had some years ago in which I was encouraged to develop a vision for life beyond anxiety. Trauma gets us focused on the ‘bears’, the danger lurking in the bushes. A life beyond anxiety and trauma helps to reorient our attention again on the ‘berries’, the luscious fruity rewards that make life worth living, and then sustain that life.

The ‘bears’ will be different for everybody – they may represent real people (‘my mother’), or certain types of people (‘angry’, ‘narcissistic’), or emotions (‘abandoned’) or situations (‘in trouble’). So too we all have different types of ‘berry’ in our life – the things we’re pursuing, that bring us joy and nourishment and wonder.

For many years after trauma, my focus was solely on avoiding the bears, dealing with the bears, recovering from the bears … But there came a time when I was sufficiently safe from the bears that I was able to actively switch my focus instead to pursuing the berries. I had to find things in my life that I wanted to do, goals that I wanted to achieve, dreams that I wanted to attain. Having spent my whole life just attuned to the danger of bears, there was a gaping void when I tried instead to direct my attention towards berries. I didn’t know what they were, what they looked like, where to find them, how to harvest them. It was a whole set of new skills that I felt ill-equipped for.

But in order to live beyond trauma, or anxiety, it’s imperative that we train our brain to stop looking for bears behind every bush, and instead start to zoom in on the juicy clusters of berries. If we don’t, we will continue to live anxious … and we will miss out on the rewards and reality of a berry-ful life. That life sounded mythical to me while I was busy fighting off the bears. But it’s actually very real.

This has been my journey, from persistent, crippling anxiety and overwhelm, to a life where I can still get anxious sometimes – but it’s normal, it’s natural and I can say now with absolute sincerity that it’s useful. It helps me to figure out what’s going on for me, what I need to do to be safe, and how to correct any imbalances in my life that have crept in, of fearing rejection and abandonment, or striving for perfection, or simply hanging out with a troop of bears. And I’ve had to learn to become comfortable with anxiety – to be able to shrug at it, to acknowledge it, to listen to it, but not to be scared by it.

This is anxiety. It sucks. But it’s just a message. It’s not who I am.