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MENTAL HEALTH

Clinically Approved: Self-Help Tools For Anxiety

August 16, 2019

Symptom Guides > Mental Health > Clinically Approved: Self-Help Tools For Anxiety

by

Dr. Ross Nelson

Dr. Ross Nelson is a licensed clinical psychologist and entrepreneur in Palo Alto, CA. He received his doctorate from the California School of Professional Psychology, and has professional expertise in cognitive behavioral therapy. He has worked in outpatient services at Kaiser Permanente, and as a psychologist for the startup, Crossover Health. Today, Dr. Nelson runs a private practice and is also the founder of Welleo Health. He is passionate about evidence-based therapy and addressing the global mental health crisis.

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Currently, 18% of US adults are diagnosed with an anxiety disorder every year. And the majority of us have likely experienced the emotional state of anxiety, even if only for just a few brief moments— maybe when you got lost on your way to an interview, couldn’t find your keys before work, or looked out over the edge of a high building. Despite its prevalence, it’s estimated that only 37% of those suffering from an anxiety disorder actually receive treatment.

 

While many people are at least somewhat familiar with the basic strategies for improving their anxiety (e.g. deep breathing, exercising, talking to a friend, and practicing mindfulness and/or yoga), there are many more techniques and interventions people can apply to help themselves overcome their anxiety.

 

In this article, we will review some key Cognitive Behavioral Therapy techniques you can use to help you manage your anxiety. These self-help methods were drawn from the books, Feeling Good and When Panic Attacks, both written by world-renowned psychiatrist, Dr. David Burns.

 

Topics we will explore include:

• Anxiety Advantages
• Check Your “Cognitive Distortions”
• Ditch the Double Standards
• Balance Your Perspective
• Face Your Fears
• Gradual Exposure and Flooding
• Cognitive/Imaginal Exposure
• Shame Attacking and Rejection Practice:
• Bonus Self-Help Tips for Anxiety

Anxiety Advantages

Interestingly, little attention has been placed on the advantages and positive attributes anxious thoughts and feelings show about us. Anxiety is often something we try to suppress, ignore, or get rid of because it’s an uncomfortable feeling. However, anxiety may bring certain positive outcomes. An initial self-help exercise you can try is to write out the advantages of your negative, worrisome, or anxious thoughts and feelings. Ask yourself how they might help you, protect you, or benefit you. For example, what are the benefits of: “If I make a mistake, I’m going to lose my job?” The thought could motivate you. It could help you feel accomplished if you do well and are promoted rather than fired. It could also allow you to prepare for the worst.

 

Additionally, make a separate list of positive attributes the negative thoughts and anxiety show about you, and how they reflect what you care about most. For example, the negative thought above would show that you care about doing great work, maintaining a job and a reasonable reputation, and your future.

 

This isn’t just a prescription to “look on the bright side.” It’s a powerful tool that can help make your anxiety seem less threatening. The exercise can also expose any ambivalence you have about letting go of your anxiety that may be getting in the way of your recovery. Once you’ve written down your answers, talk through them with a therapist, a trusted family member, or a friend.

Check Your “Cognitive Distortions”

Have you ever heard the expression “Don’t believe everything you think?” Our beliefs are sometimes inaccurate, flawed, or distorted. When you feel anxious, take a closer look at what it is you are saying to yourself and check your thoughts against the list of “cognitive distortions” below. Do you notice any flaws in your thinking? The most common cognitive distortions amongst those who experience anxiety are: jumping to conclusions, assuming what others are thinking, and fortune-telling or predicting that things will turn out badly (typically with questionable evidence).

 

1. All-or-Nothing Thinking. You think about things in absolute, black-and-white categories. You are either a success or a failure. Your performance was totally good or totally bad. If you are not perfect, then you are a failure. This binary approach does not account for shades of gray.

 

2. Overgeneralization. You view a single negative event as a never-ending pattern of defeat. You draw faulty conclusions about something based on just one example. After interviewing for and not getting a job, you may overgeneralize by thinking you’ll never be able to get a job.

 

3. Mental filter. You focus and dwell on the negative aspects of a situation and filter out all of the positive ones.

 

4. Discounting Positives. You insist that your positive qualities and experiences don't count.

 

5. Jumping to Conclusions. You jump to conclusions not warranted by the facts. There are two ways people often do this:

 

  • Mind-Reading: You assume you know what other people think. Commonly, people inaccurately think others will react negatively to them.

 

  • Fortune Telling: You predict or assume that things will turn out badly.

 

6. Magnification or Minimization. You blow things way out of proportion or shrink the importance of a positive or negative event.

 

7. Emotional Reasoning. You reason from your feelings. For example: “I feel like an idiot, so I must be one.” Or "I feel hopeless. This means I'll never get better."

 

8. Should Statements. You criticize yourself or other people with “shoulds,” “shouldn'ts,” “musts,” “oughts,” and “have-tos.”

 

  • “I Should” Statements: Lead to feelings of guilt and inferiority.

 

  • “Others’ Should” Statements: Lead to feelings of bitterness, anger, and frustration.

 

9. Labeling (Ourselves or Others). We take one narrow characteristic about ourselves or someone else and globally apply it to the whole person. Rather than objectively considering the behavior, we engage in “labeling” (and often ignore information that doesn’t fit under the umbrella of the label). “Because I didn’t do well on a test, that makes me a failure,” or “Because she is frequently late to work, she is irresponsible.”

 

10. Blame. You focus on finding fault instead of solving the problem. There are two ways this is done:

 

  • Self-Blame: You blame yourself for something you weren't entirely responsible for.

 

  • Other-Blame: You blame others from a “victim perspective” and overlook ways you contributed to the problem.

Ditch the Double Standards

There is growing evidence of a correlation between niceness and anxiety, as people who are anxious are more commonly very nice and caring individuals. On one hand, anxious people typically present to others as kind and caring, but on the other hand, internally, they may be preoccupied with cruel and critical feedback about themselves that they would never actually say to someone else.

 

When experiencing a negative belief, ask yourself if you would say such harsh things to a friend or family member—and if not, what would you say to them? At that point, it’s a good idea to begin to take your own brilliant advice! For example, if a friend had an upcoming interview for a job, would you tell them “You are going to blow it. You will make an absolute fool of yourself, and there’s no chance they will hire you.” I’m guessing not! Take a moment and rethink what you would tell someone who had an upcoming interview for example.

Balance Your Perspective

Instead of outright buying into your negative belief, consider a perspective that incorporates healthy acceptance and self-defense (against the negative belief). For example, if you were thinking, “ I will fail my big presentation,” a balanced perspective could be: “It’s possible that I will fail the presentation, but I would survive and learn from the mistake” (healthy acceptance).

 

On the other hand, I can’t predict the future, so saying I am going to fail the presentation is not fair. In reality, it’s possible I’ll do a pretty good job (or maybe even a great job!), and I have evidence of doing well on presentations in the past (self-defense).

 

Try this 50/50 balanced perspective technique out with your own anxious thoughts and discuss the changes you’re implementing with a therapist or trusted family member or friend

Face Your Fears

One of the hallmark behaviors of individuals experiencing anxiety is avoidance. Over the course of time, humans have learned that dangerous things are to be avoided. That said, when feeling anxious, the things that are being avoided (asking someone out on a date, public speaking, heights, interviews, etc) are perceived to be dangerous, but are not actually dangerous. Given such, one of the most important things you can do to help yourself overcome anxiety is to face your fears! Running away and avoiding the things we fear actually helps keep the anxiety alive. The clinical term for this method is “exposure therapy” because you work to expose yourself to the events, people, or items you fear most. People often find that the things they feared were not nearly as scary or negative as they imagined.

 

Below are some examples of how you can begin practicing exposure therapy to improve your anxiety.

Gradual Exposure and Flooding

When you use Gradual Exposure, you expose yourself to the thing you fear in small steps so that it won't be so terrifying.

 

  • Example: If you have an elevator phobia, you could first look at photos of elevators, then watch YouTube videos of people riding in elevators, then stand in front of an elevator, then briefly stand in an elevator with the door open, then ride the elevator for a few minutes.

 

In contrast, when you use Flooding, you expose yourself to the thing you fear most, all at once.

 

  • Example: If you have an elevator phobia, you could force yourself to ride up and down an elevator and stay there, no matter how anxious you feel, until your fear disappears.

Cognitive/Imaginal Exposure

Sometimes we aren’t able to practice in-person exposure techniques, but we can do so in our imaginations. Close your eyes and visualize your worst fears in your “mind’s eye.” Try to endure the anxiety for as long as you can. If you become panicky, tell yourself, "Don't fight it!" Instead, try to make it even worse. Eventually, your anxiety will burn itself out, because your body simply cannot create anxiety indefinitely.

 

  • Example: If you have a fear of flying, you can’t expose yourself to an actual airplane crash, but you could overcome your anxiety by confronting your fear in your mind’s eye.

Shame Attacking and Rejection Practice:

Many people struggle with social-related anxiety, where we may fear judgment or rejection. If you are fearful of being rejected or fear looking foolish in front of others, it is recommended that you actually accumulate rejections and embarrass yourself in public on purpose. Here are some examples:

 

  • Ask for food from a restaurant that they obviously would not have.

  • Purposefully trip while walking on a busy street.

  • Sing or dance in public or in a store (by yourself).

  • Ride a crowded elevator standing backward.

  • If single and avoiding dating due to anxiety, approach and talk to 25 strangers in 48 hours. (For those that seem interesting, ask if they would want to hang out sometime.)

Bonus Self-Help Tips for Anxiety

In addition to the CBT technique we listed above for anxiety, here are a few other self-help techniques and lifestyle changes to consider:

  • Practice assertiveness (that is, express your thoughts and feelings)
  • Practice mindfulness/meditation
  • Practice deep breathing
  • Exercise consistently
  • Engage in hobbies and play
  • Ensure you are satisfied with your job/career
  • Maintain good work-life balance and use your paid time off
  • Ensure your relationships are healthy
  • Get quality sleep
  • Eat a balanced diet
  • Avoid alcohol, caffeine, cigarettes, and other drugs.

Like developing any new skill, all of these techniques and lifestyle changes take practice and time. If you are not finding relief from your anxiety on your own, it’s a good idea to seek out assistance from a trained mental health professional. You can also read about anxiety treatment options or download K Health to chat with a doctor about your symptoms, get help with prescriptions, or receive a referral to other doctors who can help

Anxiety is often something we try to suppress, ignore, or get rid of because it’s an uncomfortable feeling. However, anxiety may bring certain positive outcomes.

Chat with a doctor about your anxiety. Download K Health.

by

Dr. Ross Nelson

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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