Anxiety, Stress, and Panic Toolkit
Learn strategies to use during moments of extreme stress, anxiety, and panic, as well as regular lifestyle modifications to reduce stress and anxiety overall.
We live in an epidemic of stress. In fact, most Americans are stressed, burned out, and/or anxious. Fortunately, there is hope for relief from these issues. This blog post will provide some practical tools you can use when you're having an episode of stress, anxiety, or panic. It will also provide some lifestyle modifications that can help you reduce stress overall.
Coping Skills for Anxiety, Stress, and Panic
These coping skills can help you in the moment when you're caught up in anxiety, stress, or panic to calm down your nervous system.
Cyclic sighing: One extremely powerful and easy tool is called "cyclic sighing." Cyclic sighing helps you breathe more deeply, use your diaphragm, oxygenate your body, and dispel carbon dioxide. Cyclic sighing can have a very positive impact with just a small handful or a few minutes of breathing. To do it, breathe in quickly and briefly through your nose twice and then take a nice long sigh as an exhale. Repeat for 30 seconds to 5 minutes. Here's a brief lecture and demonstration of cyclic sighing. This can help in an episode of panic, anxiety, stress, insomnia, or even after a workout. This tool is one of my top recommendations.
Deep breathing with elongated exhales: Deep breathing helps engage the parasympathetic (commonly known as "rest and digest") branch of your nervous system. Elongating your exhale (for example, breathing in for 4 counts and out for 6) further helps you relax. To practice deep breathing, make sure you're breathing deeply into the bottom of your rib cage. You should be able to feel your ribcage fan out to the sides. If you're having an anxiety or panic attack, you could try a few minutes of cyclic sighing and then do this exercise to deepen further into relaxation. Try this meditation that I recorded for guidance and instruction.
Use ice and cold water: Another technique is to use temperature to calm your nervous system. You can do this by dunking your head in bowl with cold or ice water for 30 seconds, putting a cold pack over your eyes, or taking a cold shower. This activates the "mammalian diving reflex," which causes your heart rate to drop and your nervous system to soothe naturally. While this technique may seem strange or uncomfortable, don't knock it until you try it. Some people swear by this!
Recognize impermanence: Everything is impermanent, including moments of suffering. This idea comes from Buddhist psychology and can be helpful in moments of extreme anxiety or panic. Remember that this, too, shall pass.
Use mantas: Mantras are short phrases that you can use to anchor you and give you hope during moments of suffering. One I particularly like for anxiety and panic is "this is scary but not dangerous." Other examples could be "I can do hard things," "this is impermanent," or "I can be calm in the storm." Choose one that you resonate with, or create your own.
Get out of your head and into your body: When you are anxious or panicked, anxious thoughts interact with physiological body sensations of anxiety in an infinity loop. Anxious, worried thoughts keep the felt body experience of anxiety going. Therefore, it's helpful to get out of your head and focus, instead, on your body. Some focal points could be the surface underneath you, your breath, or places in your body that feel pleasant or neutral. Notice what sensations you feel in these places. You might be surprised to notice that, even if anxiety and panic feel all-consuming, there are places in your body that feel calm.
Use guided visualization: Close your eyes and connect to something that feels like a resource for you. If you are a therapy client of mine, you may know how to connect to your inner guidance. You may also visualize a safe, calming place in nature, such as floating in the ocean or walking through the forest. Focus all your attention on this visualization to help yourself calm down.
Widen your field of vision: When we get anxious, we get tunnel vision. You can help relax your nervous system by widening your field of vision, and noticing what you can see at the periphery. Do not dart your eyes back and forth. Rather, relax your eyes and simply notice what you can see at the edges.
Ground in your senses: Engage your sense of sight, hearing, smell, taste, or touch. One simple exercise is to notice 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
TRE: TRE stands for Trauma and Tension Releasing Exercises. This is a somatic (body-based) method that helps you literally shake out stress, tension, and trauma. TRE is something I can teach you how to do in a handful of sessions that will equip you with a coping tool that you can use in moments of anxiety or panic.
Let it out: Your body has natural intelligence within. In moments of extreme anxiety or panic, you may feel the urge to cry, run, punch, flail, scream, pound your feet or fists on a pillow or bed, or dance. As long as you are in the proper space to do so, and it is safe, it can be very helpful to let your body move your anxious energy out and through.
Connect to your core self: Your "core self" is your innate healing intelligence, according to the Internal Family Systems model. It is something I help my clients connect to in therapy. This can be very grounding in the midst of a panic or anxiety attack. You could try this meditation or this meditation to connect. Another thing you can do is to journal back and forth between your core self and the anxious part of you, which helps the anxious part feel heard and soothed.
Progressive muscle relaxation: PMR is a well-studied technique that guides you to engage and release the various muscle groups in your body. It can help with anxiety, stress, insomnia, and even chronic pain. It is particularly helpful if you have body tension due to stress.
You can combine these strategies together. For example, one option would be to do 3 minutes of cyclic sighing, then take deep, full breaths while recognizing impermanence and saying "I can be calm in the storm." When you feel calmer, you can open your eyes and ground in your environment. Another option would be to "let it out" by crying and punching a pillow, then taking deep breaths, and then visualizing yourself in nature while feeling your core self energy inside of your body.
Regular Strategies to Reduce Anxiety, Stress, and Panic Overall
The following strategies detail changes you can make to your overall lifestyle and wellness routine that will help reduce stress, anxiety, and panic overall. These things will help you "even out" your nervous system as a baseline and help you feel calmer. For example, if you regularly experience general anxiety or stress at a level 4/10 most of the time, using regular strategies could* help bring this number down to a 1.
Therapy to address underlying causes: It's important to note that the above coping tools do not heal underlying causes. Attending therapy will help you find, address, and heal the root causes of stress, anxiety, and panic. This is necessary so you're not having to constantly cope when you get triggered. Unresolved trauma lies at the core of many people's chronic anxiety and panic. Think of coping skills as a life ring, and therapy as learning how to swim so you won't feel like you're drowning anymore.
Address underlying health conditions: Make sure to tell your doctor about your anxiety, stress, and panic. Explore the possibility of underlying health conditions. While the causes of high stress include unresolved trauma, lifestyle, relationship issues, and everyday stressors, underlying health issues can also contribute.
Expose yourself to cold temperatures: In addition to being a coping technique for in-the-moment anxiety, regular cold exposure is a practice that can help train and calm your nervous system as a baseline, working to build resilience and reduce or prevent anxious episodes. This can be done through cold showers or baths, splashing cold water on your face, or going to a cryotherapy chamber. This activates the vagus nerve and the parasympathetic nervous system, which calms you down. As someone who has been cold-phobic for most of my life, I was hesitant to try this myself for a long time. But I have grown to love it for the amazing benefits!
Exercise: Regular exercise helps release feel-good endorphins, decreases muscle tension, helps you build up resilience, and draws your attention away from whatever you're anxious about. It improves your overall health, making all of your body systems more resilient to stress.
Nutrition: Eating a healthy, well-rounded, colorful diet improves your overall health. Try to eat whole foods over processed foods. Specifically, eating a diet rich in magnesium, zinc, omega 3s, probiotics, antioxidants, and B vitamins can help with anxiety. Some people will choose to have bloodwork done with their doctor to check their levels and supplement accordingly.
Supplement: Some people will choose to supplement the above vitamins and nutrients. Additionally, ashwaganda, St. Johns Wort, l-theanine, and vitamin D have all been shown to help with stress, panic, and/or anxiety. Talk to your doctor about these supplements and research them yourself before adding them to your routine. As a mental health professional, I am not qualified to prescribe or recommend specific supplements for you. This does not constitute medical advice.
Connect to your core self: See above. Connecting to your core self on a regular basis helps you build trust in yourself and grounds you. This helps you feel more resilient and capable of handling whatever comes your way.
Mindfulness meditation: Mindfulness means "paying attention, on purpose, in the present moment, without judgment" according to John Kabat-Zinn. Mindfulness meditation involves focusing on one thing in the present, such as your breath. When combined with deep belly breathing, regular mindfulness meditation trains your focus, calms your nervous system, and trains you to stay present. It also builds up the muscle to redirect your attention away from anxious thoughts when needed.
Mindfulness in the moment: Mindfulness is helpful outside of formal meditation practice, as well. When you notice yourself getting carried away in worried thoughts, you can redirect your attention to what you are doing in the present moment. Examples include washing the dishes, playing with your dog, drawing, etcetera. It's important to stay grounded in your body and what you're experiencing with your senses while doing your everyday activities. Developing a practice of staying present in general helps you stay "here and now" instead of getting carried away into worries about the future.
Cyclic sighing and deep breathing: See the above list for more details. Developing a regular daily practice of cyclic sighing and deep breathing helps calm your nervous system as a baseline, in addition to helping you in particularly anxious or panicked moments.
Reduce unnecessary stressors and obligations: In our culture, many people see it as a "badge of honor" to work 60+ hours a week, feel tired, or "do it all." However, this impacts health and wellbeing negatively. You can choose to step out of this narrative. Consider your regular to-dos. Are they necessary? Do you enjoy them? Cut down on unnecessary responsibilities. Learn to say "no." Create more space to be, breathe, and relax.
Do one thing at a time: Multi-tasking leads to a scattered, chaotic mind and nervous system. Breathe, slow down, and do one thing at a time. Recognize when you complete tasks, celebrate, breathe, and then move onto the next thing.
Listen to your body: Your body gives you signals about what it needs all day. It will tell you when you're thirsty, hungry, tired, or when something just "doesn't feel right." Learn to listen to these signals and take good care of yourself. This meditation can teach you how.
Mindful movement: Yoga, mindful walking, tai chi, TRE, and other forms of mindful movement can help train you to be present in the "here and now." It's important to stay grounded in your body while you're doing these activities to reap the full benefits.
Progressive Muscle Relaxation: See above for a description. Like TRE, PMR helps relieve and release built-up tension.
Thanks for taking the time to read this blog post. Hopefully, you've found a handful of tools that you think will work for you. It is not necessary to use all of these tools in order to benefit. Start with what you can reasonably do now and build up over time. I recommend writing down your favorites, practicing them, and making a plan to do them when you need to.
*Disclaimer: The strategies contained in this blog post do not constitute medical advice. It is not possible to deliver personalized medical advice in a public blog post. Results of these methods are not guaranteed. Always speak with your medical and mental health providers before beginning the use of any new strategies, and discontinue the use of any strategies that are not helping you or worsen your symptoms. Specifically, trauma can complicate the use of these tools and it is best to speak with a therapist or other mental health provider to ensure the tools work for your body and symptoms. If you are a client of mine, please speak with me about these strategies before using them. Thank you!