dealing with anxiety attacks

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Question: I get these anxiety attacks and I just can't stop thinking. Sometimes I can't sleep. Sometimes it even happens when I'm driving, once I had to pull over. I feel my heart racing and I feel like the whole world is closing in on me. I hate it. Still I don't want to take any medication, I don't want to feel like I am dependent on something. What can I do?

Answer: Before we remove something we need to figure out what its function is. Instead of just eliminating this anxiety we need to figure out what they are doing for you. Then we teach you to bring your anxiety down to a level that is useful without being debilitating or even really annoying.

If we remember one of the key Maigler assumptions: all feelings have a function in helping us to survive, then we must ask what could this anxiety be doing for you? Chances are it is preventing you from relaxing and letting your guard down. If you have more anxiety than seems appropriate for the situation it suggests that you don't trust yourself spot dangers.

I would guess that in your past you have been surprised by something awful and you would do anything to never be shocked with a negative like that again. That means these anxiety attacks are something that you are choosing because you would rather live with them than the fear of emotional ambush. The bad news is there is no safe place from emotional ambush. The good news is since they hyper vigilance you get from anxiety isn't really helping you anyway we lose nothing but reducing it.

But why, you may ask, are you having anxiety attacks when the trigger is as trivial as how clean the house is before Thanksgiving, or that presentation to your Spanish class, or if your boyfriend's sister hates you?

We worry about these more trivial issues because the big issues that really produce our fear seem impossible to deal with. If we tried to answer the questions: will anyone ever love me for me, or what is my purpose on earth, do I deserve to be happy? We would not be able to get down to firm yes or no answers, and the ambiguity is scary. If I instead freak myself out about whether or not everyone will like the pasta sauce I made, and I end up with negative results, I can probably survive that.

So what do we do about it? Step 1: in the middle of an anxiety attack control your breathing, there are many great techniques for that, pick any one that works for you. I know, I know deep breaths, it sounds like such a cliche. Well it is a cliche for a reason, it works. That anxiety attack is chemical in nature and a faucet of of adrenaline is rushing to your heart. We turn off the flow by slowing your breathing which will in turn slow your heart rate, and send a signal to your brain that you have things under control.

Step 2: remind yourself that you will get through this, and it is not life threatening. It may sound silly but eventually anxiety attacks can lead to panic attacks, where people believe they are going to die. One key is remembering that you have survived this before and you will be fine.

Step 3: focus on something else: If you can call someone you like and ask them to talk to you about THEIR life, not your anxiety. If it is late and you cannot get anyone else guided visualizations (aka day dreaming about something pleasant or soothing) can work.

Step 4: start dealing with the REAL issue. whether it be in therapy or through journaling or artwork devote some time to thinking about the fear that is producing the anxiety. Not the surface trigger issue, but the real issue. If you are not sure what that is, start working with a therapist. But the point is unless you do this anxiety attacks will keep coming back no matter what you do to manage them.

Step 5: Engage in stress prevention techniques: Yoga, Tai Chi, and marital arts are my three most highly recommended strategies because they combine exercise and controlled breathing techniques with a set of principals to live by. Other forms of exercise are okay but are hard to access when you are driving or trying to sleep and they usually qualify more as stress management than prevention.

Step 6: Talk to your doctor. Even if you do not want to explore medication there may be some physical issues that are leading to your anxiety and stress and if you try these other steps and anxiety attacks are still coming this may be a health issue.

Anxiety responds well to treatment but it can take a really long time and most of my clients continue having bouts of anxiety attacks even though they are engaged in therapy and often take medication. A lot of this is because they are afraid to let go of their anxiety, afraid that if they do they will get hurt again. They are right that there is danger out there, but anxiety is warning system not a shield and it works much better when you use it the way it was intended.