When anxiety shows up uninvited – how to prevent it from taking control

“Anxiety can be defined as the response of an organism to a threat, real or imagined. It is a process that, in some form, is present in all living things.”

— Murray Bowen

Everyone experiences varying degrees of anxiety at different points in their life. If you meet someone that says they haven’t, they may not be aware of how anxiety shows up for them. Bowen theorists tend to use terms such as tension and/or discomfort interchangeably with anxiety, I find that most people can relate to the experience of discomfort/tension but often do not attribute that to anxiety. In the end, what we label it doesn’t actually matter – what matters is an ability to observe it in ourselves and to become acquainted with how it shows up in our body, thoughts, behaviours and emotions - and further, what automatic patterns of behaviour we have developed in order to manage it. These behavioural strategies for managing the discomfort are often so automatic that we have no idea we’re doing them – a lot of them having made their appearance in childhood. The problem with this disconnection from self-awareness is that those strategies, although perhaps providing some immediate temporary relief from the symptom and tension, may be causing more distress (e.g. increasing intensity of symptoms) in the long run. I believe that the most effective treatment for anxiety in the long term is thinking about it systemically, which means understanding it from a relational perspective (*see below quote).

“Bowen defined anxiety as the response of the individual to real or imagined threat. Anxious people become more sensitive to others and more focused on relationships. As anxiety and its more general partner, tension, increase, people become more emotionally reactive to one another.”

- Dan Papero, 2014, p387

If treatment is only focused on symptom management but the underlying relational sensitivities and unresolved attachments are not identified and addressed the symptoms may be better managed, but they may continue to emerge as we go about life and potentially even increase in their intensity (frustrating, no?). This is the work I most enjoy doing with clients, but it’s slow going and takes ample amounts of courage to face the discomfort that has typically been avoided. Because of the high level of anxious intensity involved when unpacking and facing relational tensions/sensitivities (both past & present), it’s not a common therapeutic pathway chosen – a symptom focus is often less confronting & therefore a more popular treatment choice.

All of this said, sometimes the symptoms of anxiety can be so intense that they interfere with day-to-day functioning, and the mere thought of accessing clear and calm thinking in relation to family relationships just feels too far out of reach. Fair enough! When clients come to me in this state, jumping straight into facing relational discomfort or exploring their family of origin may not always be the most useful place to begin. I like to ask the question of – what right now is going to help me access clearer thinking in relation to the underlying challenges I’m facing and the capacity to be able to address them? For a lot of people, the answer would be something related to ‘please just help me get a handle on reducing the severity of these symptoms so that I can get through each day!’.

The DSM (*Diagnostic and Statistical Manual of Mental Disorders) describes ‘Generalised Anxiety’ as anxiety that occurs over an extended period (at least 6 months) and the experience of being unable to control or manage the worry. They outline some of the symptoms as being:

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

*https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/

In my opinion this list is only just scratching the surface! Some examples of other common symptoms are:

• Gut disturbances and/or nausea
• Intrusive thoughts (unwanted or distressing thoughts or images that pop up in your mind)
• Avoidance - inability to complete tasks or show up to places such as work/school/appointments etc.
• Panic attacks (e.g. shortness of breath, rapid heartbeat, sweating, chest pain, physical trembling or loss of feeling, sense of impending doom).

So, if you’re experiencing any of these and feeling at a loss for how to manage them, I’m going to use the rest of this post to run through some ways to consider doing that. It’s a lengthy post so strap in!

I recommend having a look through and having a think about how you could incorporate some of these into your daily routine – in a realistic & manageable way. A lot of people think that symptom management strategies are only useful when they are experiencing symptoms but I disagree, if you’re able to be proactive and include some of these strategies each day regardless of what your symptoms are doing, then you will be much more likely to calmly face stress and triggers when/if they arise.

*These have not been written in any particular order of significance.

 Mindfulness 

Google AI helpfully generated this definition of mindfulness: Mindfulness is a state of mental focus where you're present in the moment, intentionally observing your thoughts, feelings, and sensations without judgement or reaction. It's about being fully aware of your current experience, whether it's an internal state like a feeling or an external one like a sensory input, without getting carried away by your thoughts or emotions.

For those in a chronic state of anxiety or panic, the thought of being still with your thoughts can sound just downright awful and to some impossible! I get it. However, that is precisely why it’s so important to try it – acknowledging that it may take lots of practice & that’s to be expected. Avoiding or battling against anxious thoughts can only serve to make someone feel more distressed and defeated overtime. Learning how to manage yourself calmly in the face of anxious thoughts can be such a game changer. Adopting the belief that thoughts are in fact, just thoughts, and do not determine who you are, what you will do or what will happen can gently remove their power over us – enabling a sense of freedom to reconnect with your own guiding values and focusing your behavioural choices around who you want to be rather than the anxious thoughts running the show.

Mindfulness has gained increasing traction in the mental health field over the years due to its effectiveness and as a result there are many resources at your disposal – how good! I’d recommend finding one that specifically assists with noticing and accepting anxious thoughts, enabling you to tolerate their presence and overtime reduce your reactivity to them. Personally, I think that the resources provided by Headspace are very good and although they charge a fee for use of their app, they have provided many free resources on their youtube channel. 

Here is an example of one you could try: https://www.youtube.com/watch?v=Hvs_49dikDQ&t=16s

An Australian app that provides similar resources is Smiling Mind - https://www.smilingmind.com.au/

Breathwork 

Breathwork is often included in the practice of mindfulness which is a double benefit! But I wanted to single it out as a strategy in its own right because there is an increasing amount of research out there to support its effectiveness in managing and reducing symptoms of anxiety. Google AI once again has helpfully defined it as: a breathing exercise or technique where you consciously control and alter your breathing pattern to influence your mental, emotional, and physical state. It involves techniques to change the way you breathe, aiming to achieve a specific outcome, often related to well-being or healing.

When the body flicks into a state of fight/flight/freeze (otherwise known as ‘the stress response’) due to a perception that we are under some kind of threat, the brain sends a whole bunch of commands around the body to get ready for survival. Some of these commands can cause the heart to begin racing, sweating, trembling, inability to access clear thought (shutting off from our prefrontal cortex - our thinking brain), but perhaps most importantly it can cause shortness of breath. Shortness of breath is useful if we truly are needing to escape danger fast - think about when you have done a high intensity workout, you’ll notice your breath and heart rate change to match the intensity of the work out and access another level of physical ability. However, experiencing this when we are sitting at our desk, driving our car, giving a presentation, responding to our child’s tantrum and so on is rarely helpful, if not quite unpleasant! Giving attention to slowing and deepening our breath sends a counteracting message to the brain to say, “hey brain, I’m not actually under any real threat right now – you can relax!”.

My favourite breath technique is a very simple one – box breathing. The reason I like it is because you can find a square or rectangle shape almost anywhere and if you can’t then you can draw one (even on your hand) – so it can be used at almost any moment or location. Example, find a doorway or a window, focus on it and as your eyes move up one side of the door breathe in, across the top part of the door hold that breath and then release it slowly down the other longer side, again hold as your eyes follow the shorter bottom line and repeat – aiming to lengthen and deepen your breath on each cycle by counting as you go. As you do this, observe any changes in the body – hopefully noticing a reduction in muscle tension and/or trembling.

Here is a link to a video example of the activity: https://www.youtube.com/watch?v=tEmt1Znux58
Other breathing exercises: https://www.healthline.com/health/breathing-exercise#faq

In a similar way awareness of your heart rate can also be very useful. For those who have smart watches which can monitor heart rate, keep an eye on yours – especially in moments of stress and find somewhere to sit down, take some deep breaths and see if you can bring that heart rate down to a resting state by using your breath.

 

Engaging Your Thinking Brain  

Often when it comes to anxiety our pre-frontal cortex (the part of our brain where we do our best thinking and decision making) doesn’t get a look in – the limbic system, most notably our Amygdala (can be understood as our brain’s alarm system for perceived danger) tends to call the shots! So, finding ways to keep our pre-frontal cortex online can be extremely useful – we need to keep our ability to reason & make clear decisions engaged and not allow it to check out.

The most prolific approach to keeping our thinking engaged is one you will likely have heard of - CBT (Cognitive Behaviour Therapy). Among other techniques this therapy utilises ‘thought challenging’ which encourages us to identify the negative (anxious) thought and then question its validity, asking questions such as:

 

• What evidence do I have to support this thought? What are the facts?
• Is there another way I could look at/understand this?
• What would you say to a friend in this situation?
• Am I catastrophizing (to view a situation worse than it is)?

Bowen therapists will encourage clients to engage their thinking brain by practising the art of ‘zooming out’, observing self and getting curious about what data you can find. Like a researcher whose project is to learn everything you can about self, especially when it comes to automatic responses to discomfort and moving away from a cause-and-effect way of thinking.

I often ask clients questions like these:

• What is in and out of my control? How can I focus my energy into what is in my control?
• How can I get curious about what’s happening for me right now? What can I observe – what do I notice myself automatically doing in response to this discomfort?
• How do I want to be able to manage myself in this? How can I make choices that align with what I value?
• Is what I’m wanting or choosing to do reasonable/unreasonable?
• Are the symptoms I’m experiencing understandable given the circumstances I’m up against?
• How can I better set myself up to manage myself more calmly next time I’m faced with these symptoms/discomfort?
• Who can I talk to about what I’m experiencing who will be a resource to me without trying to fix/take responsibility for my problems? How can I resist the invitations from others to make me a project to fix and stay responsible for myself? How will I know when it is appropriate for me to seek help and ask another to step in (e.g. matters of safety)?
• Have I observed anxiety anywhere else in my family system before? How have they typically responded to times of stress/anxiety? Does this help me to understand my sensitivities?

Once again, this is an area with extensive resources available to you. Apps like MindShift & MindDoc include CBT activities to assist with identifying and challenging anxious thoughts. I've found that my clients tend to prefer writing certain stand out questions down on their phone or in their notebook and pulling them out in moments of need until they get to a point where they no longer need to look because they’ve memorised them and the process occurs naturally. And of course, accessing counselling is a great way to keep that mind engaged in a thoughtful way.

If not with me, here are some other therapists I would recommend: https://www.thefsi.com.au/fsi-network/

 

Chase Those Happy Hormones!  

Endorphins - often referred to as the brain’s natural pain reliever, endorphins are wonderful! They are the hormones which block the perception of pain, improve mood, lower stress and increase a sense of well-being. Often endorphin releasing activities are encouraged for women in labour as a way of managing pain, so that’s a pretty good argument for its usefulness, right? Another hormone worth highlighting is Serotonin, if you’ve had any contact with anti-depressant medication before you may know that this medication is known as selective serotonin reuptake inhibitors (SSRIs), which as the name suggests, increase serotonin levels in the brain. So, it makes sense that tapping into these helpful feel-good friends could be useful for reducing the severity of anxious symptoms, right?

Exercise:
The most well-known endorphin producing activity is exercise, most known for its effectiveness for treating depression. If you’re not an athletic type, that’s okay because studies show brisk walking and dancing are just as effective – personally I love a lights off disco dance party with my kids at the end of the day. So, get creative and find what gets your heart rate up (in the way it’s supposed to!). 

Laughter:
I think most people have that one trusty go-to tv show that can always make them laugh, or at least smile in the worst of times - cue The Office for me). Seek out things/people/content that will give you a chuckle.

• 
  Music:
  Get those headphones in and get the volume up on your favourite tunes. My husband listened to opera while running the other night and came back elated! Opera doesn’t quite do it for me, but a bit of Beyonce will always do the job.
  
  Dark chocolate:
  Did we need more excuses to eat chocolate? If so, here’s a good one.
  
  Sex:
  Sexual activity & orgasm not only produce endorphins but it’s lovely friends' dopamine and oxytocin as well. A wonderful trio of happy hormones.
  
  Get out in nature:
  Especially if there’s sunlight involved! Some studies show that low levels of vitamin D can be linked with low mood, depression and anxiety – so when the sun is out, soak it in (with sunscreen on of course).
  
  Volunteer:
  Or find a way to engage in acts of kindness and generosity e.g. drop a meal over to that friend who’s just had a baby or some flowers to that friend who lost their job last week.
  
  - Social interaction
  - Massage
  - Create art
  
  The list could go on, but I’ll stop it there.

Gratitude  

Something that can ever so quietly sneak away when experiencing anxiety is the practice of gratitude - thankfulness. The mind begins to focus so deeply on what it is worried about, what is not going well and how awful we may be feeling that in this process it forgets what may still be good. If we do not spend any time reflecting on what is good and expressing thankfulness for those things the more space that is left for the worry to take up residence. It seems simple but actually this can be a very difficult thing to do when it feels as if nothing in life is good, so like mindfulness it requires practice, and an ability to look beyond the expected to things like a beautiful flower you saw opening up in the garden, that first sip of hot tea/coffee in the morning, the feel of the sun on your neck as you step outside at lunch, the text from a friend checking in, the beauty of a new song you heard recently and so on. The more we can spend time in gratitude the more we can gently shift our focus from the worry over to what is life-giving. It is known to improve mood, reduce stress and build resilience.

Physical Health (nutrition & sleep)

Most people have heard of Maslow's hierarchy of needs which places physiological needs as the most basic and fundamental needs a person has. If a person is experiencing illness, pain, lack of sleep, gut disturbances and so forth, being able to reduce the intensity of anxiety is likely to be even more challenging. Some of these health difficulties can be exacerbated or even kicked off as a result of high levels of anxiety - a bit of a chicken or egg situation! With this in mind, it's good to remember that as anxiety is reduced the physical symptoms should also calm down, however in some cases the physical difficulties could also use a bit of support and for that I recommend connecting with a good GP.

I want to highlight two key areas that I believe to have strong links to the severity of anxious symptoms - nutrition (gut health) and sleep.

Sleep perhaps is an obvious one, we all know we need it and it's generally accepted that a lack of it contributes to higher levels of irritability and difficulty concentrating. I recommend taking some time to observe your sleep hygiene (habits and practices that promote healthy and restful sleep).

• How consistent is your sleep schedule? Consistency helps to set a natural rhythm for your body clock.
• Does your bedroom environment promote sleep? E.g. is it a dark, comfortable, relaxing space free of unhelpful mess & distractions?
• How do you wind down before sleep? Do you allow time for activities that are calming prior to sleep? (e.g. warm shower, reading, listening to relaxing music etc.)
• Have screens found their way into your bed/room? Screens within an hour from the time we go to bed have been linked with poor sleep quality and difficulty falling asleep.
• Have you considered support from sleep aids such as white noise or bedtime meditations?
• If sleep is becoming a significant issue talk to your GP about whether melatonin supplements may be a helpful short term option.

Nutrition. For a lot of people high levels of stress and/or anxiety can be closely linked with their gut... cue running to the toilet before a big presentation at work! Studies have shown that people diagnosed with IBS (Irritable Bowel Syndrome) are significantly more at risk of experiencing anxiety than someone without. My curiosity is peaked here to ask which came first! There's plenty of material out there to read on this but I am mentioning it because I believe paying attention to what we put in our bodies, particularly in times of stress, is a useful support in managing the intensity of symptoms. Does your experience of anxiety have you on a special diet of high sugar, highly processed, package convenience foods? Often it does! I'm not suggesting cutting that comfort right out but just taking a moment to consider if it's helping. Alcohol begs a mention here too, as it is a very popular way for many to 'treat' their anxious symptoms, which can easily lead to dependence and worsening symptoms over time.

Medication

As I mentioned at the beginning of this post, sometimes the symptoms of anxiety can feel unbearable, particularly in the case of those experiencing debilitating panic attacks preventing them from being able to function day to day. In these circumstances, considering some short term help from medication can be useful. I often say to my clients who are considering this, that its purpose would be to assist in reducing the intensity of anxious symptoms while you work to develop your own non-medical strategies for managing it longer term. Although not a long term solution, medication for a time can be very useful to allow a little more space for someone to work on the broader challenges they are facing and develop their own skills for managing it with the intent to come off the medication when ready and continue management more holistically. Talk with your GP about what options are available and if it's the right pathway for you at this time.

If you want to consider herbal options before going down the medication route then talk to your pharmacist about what is available. Vitamin B and St Johns Wort are popular herbal supplements for assisting with managing stress and low mood.