Here I sit, on a beautiful Sunday morning, outside on the floating ‘zen’ deck my husband helped me build. The air is still cool. The birds are singing lovely melodies. The warmth of the sun peeking through the trees is warm on my face. I am surrounded by the green leaves of trees in my backyard, the pink flowers planted around my deck, and the light blue sky filled with white, whispy clouds. So why is my body still in such a state of panic?
My anxiety manifests physically most of the time. My body knows that I am anxious before my brain does. I may be able to get my mind to a state of peace, but often my body has not yet caught up. I wake up in the morning, I lie still, and I take a long, slow, deep, satisfying breath in. I enjoy the feeling of breathing, so often taken for granted, before I get out of bed. I know that it’s possible my body will not stay calm for long.
When my body is experiencing moderate to severe anxiety, it is easy for both the mind and body to feel out of control, which exacerbates the physical symptoms further. In this past round of partial-hospitalization, I focused on mental health management through my anxiety disorder lens. After learning from others in the group and living with this for some time, I have developed some ‘go-to’ strategies that work for me when my body is in distress. Maybe they will be helpful for you too.
Calm your mind.
Use mindfulness. Observe your lower body to ground yourself. Describe your surroundings to move your mind away from worry thoughts and rumination. To do this, I describe what I see, hear, smell, taste, or feel. You might even consider saying those descriptions out loud. It might sound like this: “Pink flower moving in the wind, slightly to the right.” “Tall tree, brown and tan bark flaking off, small green leaves, some lighter than others.” “My dog lying at my feet, white and black hair, eyes closed, chest moving up and down.” The first time I practiced by stating my observations aloud outside of a therapy setting was with my husband. We were taking a walk around the neighborhood, like we often do, and I told him I wanted this one to be a ‘mindfulness walk’ which was code for ’don’t talk to me right now.’ This particular day, I felt my mind constantly drifting back to the sensation of breathlessness, and I felt the frustration building. I knew I was escalating toward a severe panic attack, filled with gasping for breath, severe lightheadedness, and repetitive vomiting. I started verbalizing each observation out loud and continued to do so for the whole walk. My husband stayed quiet. By the end of the walk, I said with optimism, “did you notice how much better my breathing is now?” And he replied, “yes, but I didn’t want to draw your attention back to it by saying something.” And just like that we both truly understood the benefits of mindfulness.
Flash forward to the day we were biking and I was having my third full-on, terrifying panic attack. We were alone on a bike trail, with no one in sight. I was wheezing with every inhale, trying to find my breath, calm the panic of my mind, and slow the tears running down my face. I was looking around, but I couldn’t speak; I didn’t have the breath for more than a word or two at a time. My husband started pointing out observations of our surroundings out loud. “Hey, look there, a butterfly just landed on that plant.” “Woah, look at how that field of grass looks blowing in the wind.” I couldn’t smile, or thank him at the time, but I knew what he was doing. By helping me with mindfulness, he was figuratively holding my hand, walking me out of the depths of this panic attack, to safety on the other side.
Calm your body.
Use progressive/paired muscle relaxation. This is a practice in which you tense muscles of the body while you breathe in, then relax those muscles while you breathe out. I often use this to help me calm my body before going to sleep. It can take 2 minutes or 20 minutes, it is totally up to you. You can find many scripts or narrations on the internet. YouTube alone has hundreds of guided progressive muscle relaxation options.
Distract your mind.
Do an activity that you enjoy, do only that activity, and do it mindfully. For me, this means I need to make sure I don’t have the TV on in the background, and I avoid the temptation of multi-tasking. I find it most helpful to choose activities that require attention and light physical effort. This list will vary significantly by person, but I will share the activities I use that have been most effective.
- Working on a jigsaw puzzle
- Playing the ukulele and singing
- Creative activities, such as writing or painting
- Taking a walk outdoors
- Challenging my husband to a game of Scrabble (and I usually win, so double bonus)
Distract your body.
There is a skill I learned in dialectical behavioral therapy (DBT) that I have found to be incredibly effective when facing severe distress, such as panic attacks, emotional distress that will not subside, or self-harm or suicidal thoughts. You dip your face in cold water and you hold it for 30 seconds, or as long as can be tolerated. This scientifically calms down your body for a short period of time by decreasing your heart rate. You can also achieve similar results by holding an ice pack on your face, splashing cold water on your face, or walking outside on a cold day. This skill works fast, but doesn’t last for a long time, so must be used in combination with other strategies. Your body can get used to this and thus decrease the effectiveness of the skill, so I use it sparingly, only when facing distress that cannot be calmed by other means.
**This should be considered carefully if you have a heart condition or other condition in which decreasing heart rate at a fast pace could be harmful.
Help your mind.
Develop a phrase or mantra to encourage yourself. Repeat it to yourself over and over again. Say it over and over again until you believe it. I like to keep my mantras simple so I can easily remember and access them when I need to. These are some of the mantras I use:
- This too shall pass.
- Breathe in. I feel very anxious. Breathe out. And I can tolerate this feeling.
- I will survive. (Maybe add ‘I have survived this before’ and reflect on previous successes)
- I have the skills I need to manage this.
- Breathe in. You will get through this. Breathe out. So relax.
Help your body.
Use medication if it is part of your treatment plan. Use only as recommended and prescribed by your mental health care team. Medication is a sensitive and stigmatizing topic. While I believe medication should be used when needed, I also understand that medications in the U.S. can be over-prescribed, or used as a sole treatment for mental health disorders. I take medication. I take many medications, actually. I have medications on stand-by for severe anxiety episodes and I use them in combination with many other skills, like the ones stated above. I work closely with my therapist and psychiatrist to continue to refine my treatment plan for severe anxiety episodes and to build and maintain healthy behaviors around medication use.
It’s okay if all you did today was survive.
As I take a moment to attend to my body again after writing this post, I notice my inhalations are less strained, my chest feels less tight, and I am breathing more comfortably again. I don’t know how long it will last. But for now, my body is calm.
What other strategies work for you when you are experiencing anxiety? We can never have too many tools in our anxiety toolbox, so comment below with your ‘go-to’ skills. Together we can learn and grow stronger. We are not alone.