I’ve been talking with my clients a lot recently about how to manage anxiety and stress. We’re all experiencing probably a higher level of anxiety than what we’re used to. Some people have a lot of skills for managing that and some of us don’t
Increased stress with job loss, lack of finances, kids home from school, and social isolation can create an even more volatile home environment for victims and survivors of domestic violence.
Our need for human connection is so powerful that it is essential to our physical and mental well-being.
As a therapist, people tend to look to me for answers. We ask the questions to gain understanding and help guide and walk with people on their journeys. In the midst of a pandemic, how does that work though?
Feelings of increased stress, anxiety, and depression are now a new “normal baseline” for a population finding themselves faced with fear and uncertainty.
Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms.
Many people with panic attacks may have difficulty breathing, sweat profusely, tremble, and feel their hearts pounding.
Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they make think they’re having a heart attack. Others have reported feeling like they are having a stroke.
Panic attacks can be scary and may hit you quickly. Here are 11 strategies you can use to try to stop a panic attack when you’re having one or when you feel one coming on:
While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack.
If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms — and the panic attack itself — worse.
Focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four:
By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK.
Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms.
Some panic attacks come from triggers that overwhelm you. If you’re in a fast-paced environment with a lot of stimuli, this can feed your panic attack.
To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.
Focus on the physical sensations you are familiar with, like digging your feet into the ground, or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on.
Some people find it helpful to find a single object to focus all of their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible.
For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Focus all of your energy on this object, and your panic symptoms may subside.
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.
Consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.
Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.
What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains?
Picture yourself there, and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees.
This place should be quiet, calm, and relaxing — no streets of New York or Hong Kong, no matter how much you love the cities in real life.
At the same time, it can be hard to know if the worries and racing heart you experience at the thought of, say, meeting new people, is run-of-the-mill stress, or if you’re actually experiencing some level of anxiety and could benefit from seeing a professional.
“I can’t tell you how many people I see who say, ‘I don’t know if I should be coming in here,’” clinical psychologist Robert Duff, Ph.D., author of Hardcore Self Help: F**k Anxiety., tells SELF. “On a broad scale, [talking about anxiety] is positive, but I don’t blame anyone for the confusion.”
Figuring out how serious your anxiety is can be tough because anxiety is a normal and essential part of being a human.
“Anxiety is a reaction to a situation we perceive as stressful or dangerous,” Monique Reynolds, Ph.D., licensed clinical psychologist at the Center for Anxiety & Behavioral Change in Rockville, Maryland, tells SELF. This produces a stress response in your body—specifically, your brain’s hypothalamus triggers your sympathetic nervous system to release norepinephrine (aka adrenaline) and cortisol (a stress hormone) to get you out of harm’s way.
This is actually a good thing when there is a real threat of danger present. “A major part of our brain’s job is to keep us alive, and fear and anxiety are a big part of that,” Reynolds says. For example, the anxiety you would feel at seeing a truck hurtling towards you would make you move from its way more quickly.
But if you have anxiety, that stress response can kick in when it shouldn’t. “You feel very much the way you do when in a dangerous situation…[but] there’s no real danger there,” Duff says. Instead of being helpful, this misfiring of your fight or flight reaction can hinder you.
While a little anxiety can also help you to perform at an optimal level under stress, giving you a burst of adrenaline and hyper-focus to finish a business proposal before deadline or nail that dance number at a performance, living in a constant heightened state of anxiety can be distracting at best and debilitating at worst. When anxious thoughts are interfering with your life and causing you significant distress, that isn’t something you should just chalk up to nerves and push through. That’s something you can get help with.
Anxiety is the most prevalent mental illness in the United States, and it comes in various forms.
Anxiety affects about 40 million American adults each year, according to the Anxiety and Depression Association of America (ADAA). But it’s not as cut-and-dry as saying that anxiety is simply when you feel nervous all the time. This mental health condition comes in many forms.
Generalized anxiety disorder (GAD) is characterized by having excessive worries and fears for months, according to the National Institute of Mental Health (NIMH). Per the ADAA, GAD affects 6.8 million U.S. adults each year. Panic disorder involves spontaneous bouts of debilitating fear known as panic attacks, along with intense worry about when the next attack will come, according to the NIMH. Per the ADAA, it affects 6 million American adults each year. Social anxiety disorder (also known as social phobia) happens when you have a marked fear of social situations in which you might be judged or rejected, as well as avoiding these situations or experiencing symptoms like nausea, trembling, or sweating as a result.
Then there are other issues that are closely related to anxiety, like obsessive-compulsive disorder, which involves intrusive thoughts and urges, and posttraumatic stress disorder, which happens when people have a prolonged stress response to harrowing situations.
These are just some of the various anxiety and anxiety-adjacent disorders out there. That these issues can present in myriad ways can make it even harder to know if what you’re experiencing is anxiety that could benefit from outside help.
“Some people feel they can control their anxiety, some feel it’s something they ‘should’ be able to manage, some feel shame, some fear they might be ‘crazy,’ and others downplay how much their anxiety is impacting them,” Reynolds says.
If anxiety interferes with your daily life—whatever that might look like to you—that’s reason enough to see a mental health professional.
“When your world starts to become limited because of anxiety, that is a good signal that it’s time to seek treatment,” Reynolds says. “What is it doing to your life, your relationships, your sleep, health, work, and ability to learn and pursue things that are important to you?”
This “functional impairment,” as Reynolds calls it, can show up in different ways in different people. Is anxiety making you avoid doing things with loved ones because you’re too nervous to go outside? Do you skip school or work out of fear of what people may think of you? Can you not get enough sleep because you’re up all night worrying about the next day? Is your anxiety over certain tasks, like paying bills, leading to procrastination so extreme it comes with consequences, like getting your lights turned off?
Keep tabs on whether you’re blowing up at people, too. Anger and irritability can sometimes be a sign of anxiety. “We often forget that fight or flight includes ‘fight,’” Reynolds says. “If you have a shorter fuse or are always on edge for triggers, it could be related to anxiety.”
So, too, could physical issues. “We think of ourselves as these disembodied heads floating around,” Reynolds says. “We forget that there is a big feedback loop between the nervous system and the body.” Every part of you, from your head to your stomach to your feet, has nerves to regulate important processes, which is why your sympathetic nervous system’s stress response can be so far-reaching. You even have an entire nervous system reserved for gastrointestinal function, known as your enteric nervous system, which may help explain why there’s such a strong link between issues like irritable bowel syndrome and anxiety.
Constant fatigue can also kick in if your anxiety is in overdrive. “The physical reaction to anxiety, by nature, is supposed to be short-term. The body is supposed to come back down to baseline,” Duff says. “But a prolonged period of anxiety depletes your resources and exhausts you.”
“If your anxiety is bothering you and you are suffering, you deserve to get help,” Duff says. That’s true whether or not you think your anxiety is serious, whether or not you think you meet diagnostic criteria you read online, and whether or not your friends and family treat your anxiety with the weight it deserves. And if your anxiety is getting to the point where you’re worried for your safety, call 9-1-1 or the National Suicide Prevention Lifeline (it’s available 24 hours a day, seven days a week at 1-800-273-8255), or go to the emergency room, Reynolds says.
Seeing a therapist can be anxiety-inducing on its own, but it’s worth it. Here are a few ways to make it easier.
Knowing what to expect at your first therapy session may make the experience less scary. Although every professional is different, you’re likely to get a lot of questions at the first visit. Ultimately, your psychologist or therapist’s goal is to learn what troubles you’re having so that they can create a plan to help you build the skills you need to address your anxiety.
They’ll also want to figure out which kind of therapy best matches your needs. Different forms, like cognitive behavioral therapy, which aims to help people change negative thought patterns, work for different people.
Since the cost of therapy can be prohibitive, know that there are resources to help you find affordable treatment, like the National Alliance on Mental Health’s HelpLine at 1-800-950-6264. The HelpLine is available Monday through Friday, from 10 A.M. to 6 P.M., and you can explain your specific situation to the staffer or volunteer who answers. They may be able to refer you to local organizations that offer more affordable treatment. You can also try the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator tool, which can help you find mental health providers who take various forms of insurance, offer payment assistance, or use a sliding scale. Resources like GoodTherapy also allow you to limit search results to therapists who use sliding scales.
And don’t stress about meeting some arbitrary threshold of anxiety for your appointment to be worth the effort. “Somebody with anxiety [may] think there is a risk to seeing someone. ‘If I go and don’t have an anxiety disorder, there’s something bad about that,’” Duff says. “That’s not true. If you are suffering and seeing some of these signs, that’s enough.”
It may be that all you need is a few sessions, or you may meet weekly for months or years based on your goals. Your psychologist or therapist might decide medication would help you live your healthiest, happiest life, or just having someone to talk to might work for you. Also, if you decide you’re not really into the person you’re seeing but you still want help, there’s absolutely nothing wrong with trying someone else, Duff says.
Ask yourself what kind of life you want to live and what’s holding you back from achieving it, Reynolds says, adding, “If there’s anything related to fear and anxiety, it’s a great sign that maybe you need support around those things.”
Someone experiencing smiling depression would — from the outside —appear happy or content to others. On the inside however, they would be experiencing the distressful symptoms of depression.
Depression affects everyone differently and has a variety of symptoms, the most distinguished being deep, prolonged sadness. Other classic symptoms include:
- changes in appetite, weight, and sleeping
- fatigue or lethargy
- feelings of hopelessness, lack of self-esteem, and low self-worth
- loss of interest or pleasure in doing things that were once enjoyed
Someone with smiling depression may experience some or all of the above, but in public, these symptoms would be mostly — if not completely — absent. To someone looking from the outside, a person with smiling depression might look like:
- an active, high-functioning individual
- someone holding down a steady job, with a healthy family and social life
- a person appearing to be cheerful, optimistic, and generally happy
If you’re experiencing depression yet continue to smile and put on a façade, you may feel:
- like showing signs of depression would be a sign of weakness
- like you would burden anyone by expressing your true feelings
- that you don’t have depression at all, because you’re “fine”
- that others have it worse, so what do you have to complain about?
- that the world would be better off without you
A typical depressive symptom is having incredibly low energy and finding it hard to even make it out of bed in the morning. In smiling depression, energy levels may not be affected (except when a person is alone).
Because of this, the risk of suicide may be higher. People with major depression sometimes feel suicidal but many don’t have the energy to act on these thoughts. But someone with smiling depression might have the energy and motivation to follow through.
Depression doesn’t just affect adults, it also affects millions of children and adolescents.
Some of the symptoms that accompany childhood depression include irritability, social withdrawal, and low energy. Children with depression may also struggle to manage their behavior.
In 2013, 11 percent of 12- to 17-year-olds experienced a major depressive episode. Many younger children are also diagnosed with depressive disorders, such as persistent depressive disorder or disruptive mood dysregulation disorder, every year.
Children with depression may require a slightly different approach to discipline. Here are seven tips for disciplining a depressed child.
Work With Your Child’s Treatment Team
If you suspect your child has depression, speak to his pediatrician or a mental health professional. Depression is treatable, but without appropriate intervention, it may get worse. Treatment may include therapy, parent training, or medication.
Work with treatment providers to learn about the steps you can take to best support your child’s mental health. Inquire about the specific strategies you should use to address behavior problems like non-compliance and disrespect.
Establish Healthy Rules
All kids need rules, but children with depression sometimes require specific rules that support a healthy lifestyle. A depressed child may want to stay up late and sleep all day, or he may want to spend all of his time playing video games because he lacks the energy to play outside.
Set limits on electronics and discourage your child from sleeping during the day. You may also need to create rules about personal hygiene as children with depression sometimes don’t want to shower or change their clothes. Keep your household rules simple, and emphasize the importance of being healthy.
Provide Structure to Your Child’s Day
Kids with depression often struggle to fill their time with meaningful activities. For example, a child may sit in his room all day, or he may put off doing his chores as long as possible.
Create a simple schedule that provides structure to your child’s day. Set aside time for homework, chores, and other responsibilities and allow him to have limited electronics time once his work is done. Children with depression sometimes struggle with sleep issues, so it’s important to establish a healthy bedtime routine as well.
Catch Your Child Being Good
Positive discipline is most effective for children with depression. Look for opportunities to praise your child by saying things like, “You did a great job cleaning your room today,” or, “Thank you for helping me clean up after dinner.” Praise will encourage your child to keep up the good work.
Create a Reward System
Rather than focus on taking away privileges for misbehavior, emphasize to your child that he can earn rewards for good behavior. A behavior chart or a token economy system can motivate depressed kids.
Choose one or two behaviors to work on first—like taking a shower before 7 p.m. If he follows through, let him earn a token or sticker that can be exchanged for bigger rewards, like a trip to the park. Or, provide small, immediate rewards for compliance, like 15 minutes to play on the computer.
Separate Your Child’s Emotion from the Behavior
Discipline your child’s child’s behavior, not his emotions. Don’t scold him for being angry or lecture him about being in a bad mood. Instead, send the message that emotions are OK, it’s what he chooses to do with those emotions that matters. Teach him healthy coping strategies so he can deal with uncomfortable feelings, like anger, frustration, embarrassment, or sadness.
Consider the Implications of Negative Consequences
Children with depression need negative consequences for breaking the rules, but you should choose those consequences carefully. Taking away your child’s ability to socialize with friends, for example, could make his depression worse.
Short-term consequences, like time-out, can be very effective for younger children with depression. Consequences that take place over several days, like being grounded for a week, can backfire because children with depression may lose their motivation to earn their privileges back.