5 Tips for Managing Intense Anxiety using Dialectical Behavioural Therapy Skills

By: Sharon Girgis, Registered Psychotherapist

We have all experienced anxiety before, whether it be that nagging feeling that something bad is going to happen or that general sense of dread and apprehension. Anxiety can also manifest in physical symptoms, such as an upset stomach, dizziness or a racing heart beat. In some cases, these symptoms subside on their own and other times they require some form of intervention.

There are some skills that one can use when trying to manage low to moderate levels of anxiety but what happens when anxiety is extreme and leads to a crisis situation? Over the years, many of my clients have reported that when their anxiety is extremely high, what they have learned in previous therapy sessions has not really worked for them.  This is when I often turn to a type of therapy called Dialectical Behavioural Therapy (DBT) which takes the core concepts of Cognitive Behavioural Therapy and builds on them. DBT teaches an entire skill set dedicated to surviving a crisis, for those situations where the problem cannot be solved in the moment but finding a way to get through it is essential.

When you are experiencing high anxiety, your fight or flight sympathetic nervous system has been activated. This is because your body believes it is under threat and goes into survival mode. The sympathetic nervous system is responsible for the adrenaline coursing through your blood, your elevated heart rate and feelings of anxiousness. By activating your parasympathetic nervous system, (the body system that calms the physical symptoms after they have been activated) you can reduce your intense feelings of anxiety.

The following 5 tips are skills that you can try the next time you notice your anxiety is extremely high:

1. Paced Breathing:

Deep breathing can trigger the effects of the parasympathetic nervous system.  In order to do this, you want to focus on your breathing by taking a deep breath in through your nose as you feel your stomach expand with air, and breathe out through your mouth, feeling your stomach deflate. You want to stay focused on your breathing and if it helps, visualize yourself breathing in one colour and breathing out another. If you feel your thoughts starting to wander, simply bring them back to your breathing no matter how many times it takes. Picturing the different colours can help focus your attention.

2. Progressive Muscle Relaxation:

Sitting in a comfortable position, gently tense a small group of muscles at a time, working your way up from your feet, all the way to your head, while making sure you’re breathing. Gently tense your muscles and hold for 5-7 seconds and then release. As you release the muscles, note the difference between tension and relaxation while you release. There are many guided relaxations online that can lead you through this process.

3. TIP your body temperature:

This can be done by submerging your face in cold water or placing an ice pack between your eyes for 20 seconds. This simulates the dive reflex, a body system in mammals that functions to slow breathing and heart rate to preserve energy, if we were to be submerged in cold water. This tends to work quickly but provides a short window so it is usually best paired with another skill.  (This should not be attempted with a heart condition or if taking any heart medication).

4. Distraction:

Choose something that you can get into that will act as a distraction from the anxiety, such as: reading, watching TV, colouring, doing crosswords puzzles or calling a friend. Contribute by doing something nice for someone else that will take your mind off of what you are feeling. Change your emotions by watching a funny movie or listening to very upbeat music. Push away your anxious thoughts by counting backwards from 1000, listing your favourite TV shows and movies, or all the cities that start with the letter A. By focusing on listing things, it is hard to maintain and focus on your anxious thoughts.

5. Self-Soothe:

Do something that brings you comfort in the moment by pleasing your 5 senses. Take a bath, smell some scented candles, look at pictures of your pet or loved ones, listen to soothing or calming music, or eat something you really enjoy and savour every bite.

Often it is the combination of these skills that are most effective. It is also important to note that these skills do not solve the reason why you are anxious, they are simply tools for reducing your anxious feelings in the moment. The best way to figure out which work for you would be to try each and see which give you the best result.

Source: DBT Skills Manual for Adolescents (Rathus & Miller).

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