Calming the Anxiety Response Guide

Throughout the course of the book we’ve talked about what anxiety is, how it develops, when it is useful, and when it becomes a problem. Most of the strategies so far have centred on exercises that change our relationship with anxiety; helping us to manage our anxious thoughts, uncomfortable feelings, and resultant behaviours. We’ve focused on not allowing anxiety to keep us stuck, hold us back, or stop us from living a meaningful life.

However, what if we’re particularly panicked, anxious, angry, or stressed, and really need help right at that very moment? Maybe we feel like we’re losing it in a situation in which we feel trapped: sitting at an exam feeling overwhelmed, panicking before a job interview, feeling faint when waiting for a medical appointment, or waking in the middle of the night to a feeling of dread.

This section contains some short and simple exercises that are focused on reducing the physiological symptoms of anxiety. You won’t be surprised to learn these exercises are designed to help us switch from the sympathetic nervous system, which we should all know by now, is very aggressive, to the parasympathetic nervous system, which is much calmer.

We described the role the amygdala plays in anxiety in Chapter 3. We said it is involved in both pathways, and is the part of the brain that initiates the emergency arousal system: the fight, flight, or freeze response. Once the challenge or emergency response has kicked in, whether it is through the thought-based cortex pathway telling the amygdala to react, or directly through the reactive pathway of the amygdala itself, our ability to think and respond to the anxiety reaction in a logical way is very limited. So recognising the arousal response and understanding what is about to happen before it occurs, or just after it starts, is vital to responding to it appropriately and reducing anxiety quickly.

Once the emergency response is up and running, the chances of strategically thinking our way out of it are very limited. Indeed our cortex can misinterpret why these symptoms are occurring and convince us something dangerous is happening or going to happen. This can heighten our anxiety response further and we can become trapped in a negative feedback loop.

Remember, when our emergency arousal system is activated, the sympathetic nervous system is energised and stress hormones such as cortisol and adrenaline are released. This produces a rapid number of physiological responses that include: increased heart rate, elevated blood pressure, rapid breathing, blood flowing to the extremities, slowed digestion, and increased sweating. This response is extremely useful to us when we’re in danger, providing us with extra strength and alertness, giving us a better chance to escape more swiftly, fight more powerfully, or freeze and hide away more effectively.

All of this happens within a fraction of a second, before we consciously know what is happening. It’s wired this way to help save our lives, and so can’t be based on any higher thinking; there is no time to ponder strategies of how and best to react. It’s a vital, life saving, hardwired system that we need when we’re in genuine danger, but it’s not so helpful when we react in this way when giving a presentation in front of an audience, noticing our neighbour’s car is parked on our grass, or opening a letter from our bank telling us our account is overdrawn.

So when we are experiencing the physiological symptoms of anxiety, triggered by the fight, flight or freeze response, we need to be aware of this, and target the amygdala directly. We’re going to look at two different categories of the physiological anxiety response and suggest exercises that can help both; firstly the aggressive fight or flight response; and then the freeze response to anxiety.

Fight or Flight Exercises

The following exercises are intentionally short and simple. Remember, they are designed to help you switch quickly from a defensive and aggressive state, to a much calmer one. These exercises should be practised if you’re feeling particularly panicked, anxious, angry, or stressed, and you don’t want to behave or feel that way. As with all of the other exercises included in the book, the more you practise them, the quicker they will work and the more effective they will be. Just read through the exercises, try each one out, and then pick one or two that work best for you and use them when needed.

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Fight or Flight Exercise 1: Three Deep Breaths
 

This exercise is quick and effective. By slowing down breathing and taking deep breaths we can direct our body to switch from the sympathetic system’s stress response to the parasympathetic system’s relax response.

Step 1

Take a short, strong, but gentle, inward breath through your nose for two seconds and then breath out slowly through your mouth for 5-7 seconds.

Step 2

Repeat step 1 another two or three times. The response is almost immediate and surprisingly powerful.  If you find you’re still experiencing powerful physical anxiety symptoms, try to breathe normally for about a minute and then repeat the exercise again.

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Fight or Flight Exercise 2: Getting Present

This exercise is designed to bring you into the present moment and out of thoughts and feelings of panic:

Step 1

Sounds: For one minute notice what sounds you can hear in the environment around you. Rather than striving to hear sounds, allow the sounds to come to you. Each time your attention wanders away from the sounds and back to your thinking, gently and with compassion, bring your attention back to the sounds.
 

Step 2
Objects: For one minute notice up to three objects you can see in your environment in as great a detail as possible (shape, colour, texture etc.). Imagine you are a visitor from another planet and have never seen these objects before.  Each time your attention wanders away from the objects and back to your thinking, gently and with compassion, bring your attention back to the object.

Step 3

Now try to engage in the present moment and focus on what is happening in your immediate environment.

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Fight or Flight Exercise 3: The Pause
 

This exercise is useful when we feel like we are losing control of our emotions, particularly when we’re getting lost in our reaction to a person, situation, or event. This exercise calms the amygdala and gives us greater access to our prefrontal cortex, enabling us to act more calmly and effectively. 

An audio version of this exercise can be found here: Dr Matt Lewis: The Pause

https://soundcloud.com/dr-matt-lewis/the-pause-mp3

The Angry Sergeant

Before outlining the steps, I’ll summarise a true story told by Tara Brach, a psychologist and meditation teacher, that illustrates the power and effectiveness of the exercise.

She describes how a Sergeant in United States Army called into a supermarket on his way home from a mindfulness-based anger management course. He was in a rush to get home and got very irritated as he stood waiting in a queue to pay for his groceries. There was a woman in front of him who was holding a baby, waiting to pay for only a few items. The Sergeant thought the woman should have gone to one of the express checkouts and not clogged up the queue he was in. To make matters worse, when the woman was being served, she handed the baby to the cashier and they stood chatting for a while. He felt his irritation and anger growing, but then remembered one of the exercises from his anger management course.

He paused and then asked himself what was going on inside his head at that moment; he tried to be aware of the story that was playing in his mind, and observe what he was thinking and feeling. He noticed anger, and underneath the anger he noticed anxiety about being late, and underneath the anxiety he became aware of a fear of losing control. He stayed with this anger and discomfort for a while and found a little space. In that small gap he had created he noticed how lovely the baby was and how much the two women were enjoying her.

When he got to the front of the queue he remarked to the cashier that the baby was adorable. “Oh thank you.” the cashier said,  “Actually that’s my little girl. My husband was killed in Afghanistan last year so my mother brings her by a few times a day so we have a little time together.”

This illustrates if we sometimes don’t pause and deepen our attention, we can find ourselves constantly caught up in the stories in our head, living out patterns that separate us from our best selves and from others, and often make difficult situations worse.

Step 1

Pause. Stop for a moment. Breathe. Notice your breathing for 10 to 20 seconds.

Step 2

Notice what is going on inside your mind and body. What stories are you telling yourself? What emotions are there? What is happening in your body? Observe your thoughts and emotions and look for some space. Are you tense? Notice how your body feels.

Step 3

Now bring your attention to the present moment. What is happening around you in your environment. What can you see and hear? Try to engage with what is happening around you without judging.

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Fight or Flight Exercise 4: The Bell Hand
 

This exercise involves focusing intently on your dominant hand while opening and closing it. It’s an effective exercise for focusing your attention away from unhelpful thoughts and on to the present moment, activating the calming parasympathetic nervous system.

The movement involves softening the palm of the hand by drawing the fingers inward toward the palm, but neither closing the hand into a fist, nor totally stretching out the palm and fingers. Instead the focus is on the gentle opening and closing movement of the fingers and softening of the palm, which can be coordinated with breathing.

Step 1

So start with the palm of your dominant hand open and flat. Exhale and slowly and gently draw your fingers and thumb inward, whilst keeping them straight (so you’re not making a fist), until your fingers and thumb meet. See the photo below. Focus your attention intently on the movement and how it feels.

Step 2

Then as you inhale, slowly open your hand again. Repeat this until you start to feel calm. If you attention wanders away, just gently bring it back to focusing on the movements of your hand.

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Fight or Flight Exercise 5: Focus on the Soles of Your Feet
 

You can do this exercise standing or sitting down. If sitting on a chair, adjust your spine so it is straight but not rigid. Your eyes can be open or shut (eyes shut is normally best but if you’re unable to do this as you’re not in private, keep your eyes open and lower your gaze).

Focus on the Feet

Focus your attention on the sensation of your feet on the ground. Notice the exact sensations, the weight, temperature, tingling, the feeling of your shoes, or nothing at all if that is the case. Notice when your mind takes over with its commentary and as soon as it does, note where it took you, and then bring your focus back to your feet. Keep bringing your attention back to your feet until about two minutes has gone by.

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Fight or Flight Exercise 6: R.A.I.N

We can use the acronym R.A.I.N. to help us find some space when dealing with difficult emotions. 

Step 1
Recognition  – When feeling overwhelmed it’s difficult to think clearly, it feels as if your head is full of red mist. Firstly, just recognise whatever you can within the swirling mist; such as anxiety, fear, rage or sadness. Just merely identifying an emotion means you’re regulating it; you’re using your prefrontal cortex to calm the aroused limbic system.
 

Step 2

Acceptance – All emotions are okay, the harm is done in the way you think about them. Whatever the feeling is, it is just a feeling, you don’t have to act on it. Let it pass through, because in the next second it changes anyway. Let go of the shame and blame, it will never get you anywhere other than back to being locked into unhelpful thinking.
 

Step 3

Investigation – Focus your attention into wherever the emotional pain is in your body. As soon as you tune into the sensation in the body, the story inside your head changes. Investigate inside: is your chest tight? Your stomach churning? Your jaw clenched? If you register nothing, that’s fine too.

Step 4
Non-Identification – Step away from the emotions and give them space knowing this will pass too. Stop the struggling. With this distancing, you’re developing self-regulation, reducing the intensity. You’re focusing on the raw sensations rather than the thoughts behind them and the ‘whys’ and ‘wherefores’. You won’t immediately snap out of your anger, anxiety, or stress, but you will give yourself a small gap, enabling you to reflect in the midst of it all. The more you practise, the faster you get at identifying and exploring your emotions.

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The Freeze Response

When discussing the fight, flight, or freeze response, the ‘freeze’ part of the arousal system is often overlooked. If the brain assesses, accurately or not, fighting or fleeing the situation is not an option, or the traumatic threat is on-going, the limbic system can simultaneously activate the parasympathetic nervous system (the more calm state), causing a state of freezing called 'tonic immobility' – like a deer caught in the headlights, or a rabbit playing dead when spotted by a hunting dog. This can happen in situations in which you don’t have enough hormone-assisted strength or speed to respond to an overwhelming emergency by fighting or running away. 

When this happens we can sometimes dissociate from being in the present moment; this can help us not to feel the overwhelming enormity of what is happening; and hormones, including endorphins, can be released, acting as an analgesic, reducing the pain of mental or physical injuries.  Additionally, if you’re not putting up a fight or running away, the person or animal attacking you might lose interest in continuing their attack, or if you can’t make the attacker stop by fighting or fleeing, the brain thinks it is a better option to disappear within itself and block out what is too overwhelming and frightening to take in.

Just as with the fight or flight response, the freeze response can also be triggered in relatively safe situations. Some people seem more prone to the freeze response and are more likely to be withdrawn and avoidant rather than experience feelings of panic. However, research has indicated if we use an active coping strategy when we feel frozen, withdrawn, and immobilised like this, we can undo the freeze response and train our brains to respond in this way in similar situations in the future.35

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Freeze Response Exercise: Do Something Active

Do Something Active

This exercise may seem very simple, but it can be difficult to start in the middle of a freeze response. Research suggests you should find something active you can do during the moment you feel frozen, almost anything active: do a jigsaw puzzle, tidy up, or call someone on the phone. Social activities can be particularly helpful when feeling frozen, indeed anything that involves pleasurable interactions with others. The key is to do something that interrupts the freeze response of the  amygdala.

Often when experiencing the freeze response, people feel too anxious to do anything, they may often stay in bed, avoiding work or other commitments, but by shifting the amygdala to a more active response, they find the interruption creates some momentum and allows them to engage in activities that may have seemed overwhelming beforehand.

Plan Ahead

It can be difficult to think of something active to do while in the middle of a freeze response, so plan ahead. When you are functioning well and feel in control, think of activities you could easily do, are readily available, and make a list. Then, when you do feel immobile, it will be easier to choose something active without having to think too much about it. Try to raise your awareness of experiencing the freeze response, notice when it is happening and then take action.

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