Anxiety refers to our experience of fearful distressing thoughts which are often accompanied by physiological responses, such as adrenaline and cortisol release, increased heart rate, increased respiration rate, elevated blood pressure, slowed digestion, dry mouth, as well as heightened activity in the amygdala and reduced activity in the prefrontal cortex (see Arnsten, 2009).
Anxiety is fed through what is known as a positive (or self-reinforcing) feedback loop. For example, a person with health anxiety may become aware of their heart beating harder or faster than normal, and this awareness may lead them to worry about their heart; intense worry causes the body to release adrenaline, and adrenaline causes the heart to beat even faster / pump even harder; for the person who is already concerned about their heart, these palpitations cause even more worry, which then causes the body to release even more adrenaline…and so on.
When you get stuck in a vicious cycle like this, you may go on to experience extremely acute anxiety — what is commonly known as an anxiety attack or panic attack.
(Note: One should be checked out by a qualified medical professional should they fear something is wrong with their body — but in some cases health anxiety persists even after the individual is reassured that their body is functioning normally. An individual might go on to develop an anxiety disorder if they don’t address their anxiety — either by learning methods like those described here, and / or by getting help from a professional.)
Regardless of what the ultimate cause of your anxiety is, the best way to stop anxiety is to think of it like a fire, and to cut off its fuel source.
Awareness of the fact that anxiety is necessarily associated with, and fed by a cascade of physiological effects, allows one to break the positive (self-reinforcing) feedback loop of anxiety. With this knowledge, we come to realize that our highest priority should be on stopping the physiological cascade, rather than on trying to wrestle with our thoughts — since we likely won’t be able to address our runaway thoughts until we have attenuated our sympathetic nervous system response (our body’s freeze, flight, or fight system) which decreases activity in the part of our brain we use for reasoning (the pre-frontal cortex). Returning to our fire analogy — you can’t put out a gas fire until you shut off the gas.
We can stop the vicious cycle of anxiety through using the ARMOR mnemonic below:
A) Awareness
Developing awareness involves training yourself to become aware of when you are starting to feel anxiety, so you can learn to break the self-reinforcing cycle of physiological effects before they really get going. Think of triggers beforehand so you can prepare for them or avoid them (for example, hypoglycemia triggers anxiety in some individuals). These triggers might be internal (distressing thoughts) or external (events in the world — what others do, what happens in our environment).
One way to help develop awareness is to journal about what caused your anxiety, what it felt like when you first started to notice it, etc. Be especially attentive to chemical triggers. For example, pay attention to if anxiety starts after taking a drug (for example, caffeine and marijuana use can trigger anxiety for some), or after that drug starts wearing off (withdrawal from depressant drugs, like alcohol or benzodiazepines, can precipitate anxiety).
Awareness also entails being aware of what is going on in your body — Are you clenching your jaw? Are you holding tension in your muscles? Are you breathing in a rapid, shallow manner? When you learn to have an awareness of your body you can learn to stop the anxiety cycle before it has a chance to really get going.
R) Relax
When we feel anxiety coming on we need to start counteracting the process that is feeding it by relaxing.
One of the best things you can do to start winding down is to engage in slow / deep breathing. Inhale through the nose for 4 seconds, then exhale through the mouth for 6 seconds (purse your lips like you are breathing through a straw to slow your exhale). Engaging in slow / deep breathing, where we exhale longer than we inhale, for several minutes often helps to stop the anxiety cycle by engaging the parasympathetic nervous system (our body’s rest and digest system). The parasympathetic nervous system dampens the sympathetic system (our body’s freeze, flight, or fight system) response — which will get our physiological functions closer to baseline.
If slow / deep breathing doesn’t seem to help, or if you would like to supplement it, there are other techniques that can help, such as self-massage, grounding, utilizing healthy distractions, etc. See our stress management page for more information on ways to manage stress and anxiety.
M) Make Distance
While we cannot control most of what happens in the world or the thoughts or emotions that enter our minds, we can control how we respond to them. Cognitive distancing, also known as objective detachment, involves changing our perspective, so that we can step outside the bubble of our experience; in doing so we think of ourselves as outside observers of our mind, taking note of what is going on. In viewing things in an objective and detached way, we are learning to accept distressing thoughts and emotions, rather than automatically reacting to them, identifying with them, or trying to suppress them.
Awareness, relaxation, and cognitive distancing are all aspects of mindfulness practice. In developing mindful awareness, you will learn to view your thoughts and emotions as transient phenomena, like passing clouds in a sky — to acknowledge and observe them objectively — as a scientist would observe phenomena in the world — and to refrain from responding to them automatically (for example, by trying to suppress them), or to engage in judgement about them (e.g., “I’m a horrible person for thinking this;” “I must be going crazy;” etc.).
O) Observe
While we are practicing mindful awareness, we should observe our thoughts and emotions and note whether they are entrenched in our consciousness — that is, are they being reinforced by beliefs that we either consciously or unconsciously hold. If we find that our thoughts and emotions are a common part of our conscious landscape, and we have successfully de-escalated our anxiety response to a level where we can think calmly and rationally, we should proceed to R below.
R) Reflect, Reframe and Use Rational Emotive Behavior Therapy (REBT)
We all feel anxious at times. Anxiety is a signal that can be helpful if it is directed appropriately. When we start to feel anxious, and we persist in that anxiousness, we are simply being fearful. We all feel fear occasionally, but if we do not learn to overcome our fear it is paralyzing and not helpful.
To start the process of reflection we should ask ourselves what our anxiety is signaling. Is it related to something we can control? If so, we should redirect our anxious energy into what is actionable in the situation we are in. This might be taking some action to better our situation or to engage in preparation. If our anxiety is related to something we cannot control, it would benefit us to reframe our thinking by choosing to accept that which we cannot control and focus on what we can control (e.g., our reactions, our thinking).
While reflecting we also want to consider our values and our goals. Existential therapy is helpful for highlighting our values and our sense of meaning or purpose in life. Focusing on our values and what we find meaningful will help us to overcome the fears and struggles we must face in life.
It benefits us to rationally scrutinize all of our thoughts and beliefs, but we should especially scrutinize those that lead us to experience distressing emotions and / or to engage in problematic or self-defeating behavior. When we find ourselves experiencing distressing emotions, or engaging in problematic behaviors, we should use the ABCDE model used in rational emotive behavior therapy (REBT) to discover the beliefs that are linked to these emotions or behaviors. When we find the beliefs that cause these distressing emotions and / or problematic behaviors we should challenge or dispute them.
We don’t have to believe everything we think or feel, or everything others have told us. Instead, we should think very carefully and rationally about what we choose to believe. The ABCDE model of REBT allows us to challenge beliefs or ways of thinking that cause or reinforce anxiety. Once you have identified these irrational or self-defeating beliefs/ways of thinking using the ABCDE model, you can learn to rationally dispute them, and develop new effective beliefs or ways of thinking.
A therapist trained in REBT or other forms of cognitive behavioral therapy (CBT) can help with learning disputation of irrational / self-defeating beliefs by pointing out common thinking errors, and by demonstrating how to correct them. Learning to self-dispute irrational / self-defeating beliefs is one of the best ways we can prepare ourselves for things that would usually trigger anxiety or other distressing thoughts / emotions.
* Notes: Anxiety could be related to an issue with how your body is functioning, where cognitive (e.g., thoughts, perceptions) or affective (emotional) processes do not play a major direct role. For example, substance use — whether over-the-counter medications, prescription medications, or recreational “street” drugs — can disrupt the normal functioning of your brain. If you have consumed too much caffeine, or other stimulant drugs, you may experience anxiety. Likewise, if you have recently used depressant drugs (e.g., alcohol, benzodiazepines), your body will respond by ramping up excitatory neurotransmitters (e.g., norepinephrine, glutamate) to counteract the depressant effects of these drugs; when you stop using depressant drugs you may experience acute anxiety during the withdrawal process — due to the excess of excitatory neurotransmitters in your body. In these cases, the physiological effects related to substance use might be the ultimate cause of your anxiety.
Health disorders can also cause anxiety. Hyperthyroidism — where the body produces an excess of hormones — is one example of a medical condition that can cause anxiety, and there are many others. Because of this it is important to look at the basic things that play a role in your physiology. Examples: What kind of substances (drugs / alcohol) are you consuming, and how much are you using them? Are you getting enough sleep? Are you eating healthy?
References:
Arnsten A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature reviews. Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648