Managing Anxiety

Why is it so important to stay calm?

Managing your anxiety: Our body has two systems, the sympathetic nervous system (which we often call the fight or flight system) and the parasympathetic nervous system (sometimes referred to as the ‘rest and digest’ system). These systems inhibit each other so we are usually in either ‘fight or flight’ or ‘rest and digest’ mode. The image below explains what this means for our bodies and minds.

When we are threatened by something, we go into fight or flight mode so that we are ready to protect ourselves. Coronavirus represents a threat to our physical health, our loved ones and our wellbeing, so a lot of us will be in fight or flight mode more often at the moment, which is what underlies feelings of anxiety.

In the short term, like if we’re crossing a very busy street, or trying to avoid coughing people on public transport, it can be helpful to be in fight or flight mode so that we will spot danger quickly and be able to move quickly to safety if needs be.

However, in the long term fight or flight mode is exhausting. As all of our blood flow is going to our muscles in readiness to run, it’s not going to our digestive system so we don’t get the nutrients or calories we need from our food so easily. It’s hard to sleep, so our bodies don’t repair and recover as well. Blood flow to the brain isn’t prioritised so we can become a bit scatty and forgetful, and find it hard to rationalise our emotions. All of these things will in time make our immune function lower, and reduce our mental resilience.

Therefore, in these times of coronavirus, staying on top of anxiety is key to getting into the ‘rest and digest’ mode more so we can stay healthy and get through this period of uncertainty. Below are some ideas to help with managing your anxiety while maintaining social-distancing or in self-isolation. It is important to remember that not all techniques work for all people, so try out the ideas below and see which work best for you!

Practical tips for managing anxiety

Breathing exercises

In fight or flight mode our breathing speeds up, so to flip back into rest and digest mode, we need to slow our breathing down. On top of this when we’re in fight or flight we focus on getting oxygen in, and not on getting waste gases out, so breathing out for longer than we breathe in can help to counter-balance this.

Slow it down and use your diaphragm Try breathing in through your nose for 6 seconds and then out through your mouth for 8*. You can do this sat in a chair or lying down.

Once you’ve got that then focus on making each breath really deep. Try putting your hands near the top of your stomach, just at the bottom of your rib cage where your diaphragm is, and concentrate on making your abdomen expand as you breathe in. Then as you breathe out let it relax to normal again. For each breath focus on this movement until you are naturally breathing slower and deeper.

*If you have the virus or aren’t used to practicing slow breathing you might need to adapt these exercises as you won’t be able to breathe as deeply. Perhaps breathe in for 4 and out for 5 instead. Do what feels comfortable- if the breathing exercises make you cough or if it hurts to breathe deeply then make your breathing slightly lighter and reduce the length of the breaths.

Focus your attention

Next you can try counting down your breathing as a meditative practice. Focus on what each breath feels like- the movement of your stomach, and your shoulders, the sounds you make breathing, the feel of air rushing in through your nose and out of your mouth. Notice the change in temperature between air coming in and out. See if you can trace the feeling of the air through your wind pipes. As you focus all of your attention on your breathing start to count down from 30 with each breath. If you lose focus and your mind wonders, or if you forget what number you were on then just return to 30 and try again. You will find it is very difficult to get down to 0 but it will help focus your attention away from your worries and slow your heart-rate and breathing! This exercise can be particularly helpful when trying to get to sleep.

Add imagery to boost the calming effects! Alternatively you could try ‘colour breathing’. To do this think of the colour that to you symbolizes whatever you want to feel more of. For example, if you are feeling very anxious you might want to feel cool and calm, and for you a light blue colour might represent that feeling. Now return to your slow deep breathing, and with each breath imagine the colour you have chosen filling up your body a little more. With the first few breaths imagine it filling your chest, cooling you down and relaxing your muscles there. Then with another three or four breaths imagine it filling your head, then your abdomen, then one arm and then the other, then moving down into your thighs until eventually it reaches all the way to your toes. Let the calm that the colour represents fill your whole body, and remember to keep that breathing slow.

Progressive Muscle Relaxation

When we are anxious and in fight or flight mode we tend to tense our muscles, often without even noticing. In order to shift back into rest and digest mode we might need to purposefully relax our muscles. One very effective way of doing this is to work through each muscle group in your body clenching those muscles as much as you can for 10-20 seconds and then completely releasing them. If you try this with your shoulders now you will probably find that they drop lower than they were before you clenched them! Try lying down and work through your muscles in the order below. Do just one area at a time but tense as much as you can, this may help with managing your anxiety.

Toes and feet (curl toes)

Lower legs (flex feet)

Upper legs (try lifting your whole legs of the ground a little while flexing your feet)

Buttocks (clench)

Lower back and abs (tense all muscles in this area)

Upper back and shoulders (pull shoulders up and forwards and tense)

Fingers and hands (clench hands into fists)

Lower arms (flex hand towards lower arm)

Upper arms (clench fist and pull lower arm towards upper in a bicep curl) • Neck (look upwards and clench muscles)

Head (close eyes, furrow brows, clench teeth)

Grounding exercises for managing anxiety

Grounding is a term for bringing ourselves back into the present when we start to feel emotionally overwhelmed and out of control. Anxiety can often make us feel like this, and it often goes with thoughts like ‘I can’t cope with this anymore’ and ‘I don’t know what to do’. It also often goes hand in hand with tearfulness, breathing very quickly, or starting to feel nauseous. If you find yourself feeling like this it can be really scary, so make sure you know what your most effective grounding strategies are early on and then write it on a post-it note to remind you if you start to get overwhelmed. Below are some ideas of things that other people find work for them:

A strong smell like smelling salts, or essential oils. The part of the brain related to smell is really close to the part of the brain associated with fear and emotional memories. If we are imagining bad things that could happen in the future, or remembering something upsetting that has already happened, a strong smell that wouldn’t be present in those imagined/remembered situations can help bring us back into the present. If you’re in self-isolation you might use spices that you already have in the cupboard, or ask a friend or neighbour if they could pick you up a bottle of essential oils and drop them through your letterbox!

A strong taste- by the same logic taste can help us to ‘snap out of’ memories or imagined situations that are upsetting. Sour sweets or a hot chili sauce can work.

A tactile object- having a stress ball to squeeze, beads on a string that you can move up or down, a bouncy ball to throw and catch, a soft blanket to stroke, or any other tactile object that you can interact with to keep you focussed on the present can help. It can be particularly helpful if the object is associated with positive memories, i.e. a shell from a beach where you went on holiday, or a gift from a friend.

A photograph- sometimes it can be helpful to ground ourselves by remembering what we have in the present. During self-isolation you might not get to see all of your favourite people, but remembering that they’re there and they still love you is important. Keep a photo of the people you can’t be with right now to focus in on if you start to feel overwhelmed, and once you’ve got your breathing in order and are feeling a bit better, why not pick up the phone to them or give them a video call?

5, 4, 3, 2, 1- this is a simple grounding exercise that can be done anywhere and there are five steps:

Notice 5 things you can see right now- things close to you, further away, out of the window. Notice them in detail, name their shapes and colours in your head.

Notice 4 things you can hear- again some things might be outside, some might be inside, some might even be in your own body.

Notice 3 things you can feel- it might be the pressure of your back and bum on your seat, or feet on the ground (this can be helpful as it’s a reminder that we are always physically grounded). You might notice the feel of clothes on your skin, or your temperature, or the feel of air moving in and out of your lungs.

Notice 2 things you can smell- this can be difficult, but often our own clothes keep a smell, or we might smell food or an air freshener.

Notice 1 thing you can taste- this can be very hard as we rarely focus on taste unless we’re eating, but have a go at just focusing on your taste sense for a bit and see what you notice.

Physical grounding- when we are really overwhelmed we often feel a bit nauseous and weak and want to sit down and shut our eyes, but if we can make ourselves use our muscles and have to focus our physical energy on something in the present, this can be a very effective way of grounding. Two helpful ways to do this are planking, or a wall-sit (see pictures below).