Reducing the Symptoms of Anxiety

Excerpted from
Anxiety, Phobias, and Panic
By Reneau Z. Peurifoy

The four skills for reducing the symptoms of anxiety described in this lesson take time to develop. Plan for only modest results at first. However, once these skills are mastered and you combine them with the ideas and skills presented in the following lessons, they become a mighty force for managing stress and anxiety.

Four Common Roadblocks

You probably already use some, if not all of the skills described in this lesson. However, it is likely that you have also found they do not always work well. The four main roadblocks that prevent people from using these skills effectively are described below along with suggestions for overcoming them.

Inappropriate use

Skills for reducing anxiety often fail because they are used inappropriately. This roadblock can be overcome by studying the explanations provided in this lesson for how and why each skill works and following the suggestions which art' made.

Over-reliance on one or two skills

If you only have one or two methods for reducing the symptoms of stress and of anxiety, inevitably there comes a time when these methods do not work very well.

Overcoming this roadblock requires the use of several different skills to cope with stress and anxiety. Each skill reinforces the others and becomes more effective.

Failure to use at the first signs of distress

If you treat a wound as soon as it occurs, it usually heals without any problems. If you do not attend to it and allow it to become infected, it causes much discomfort and requires more extensive treatment to heal. The same principle applies to the skills described in this lesson. They work best when used at the first signs of stress and anxiety'. When you ignore your body, behavior, and thoughts until you are experiencing severe stress or anxiety, the approaches work poorly. The key to overcoming this roadblock is to use these skills as soon as you notice yourself becoming anxious.

Over-reliance on just reducing the symptoms of anxiety

It is not enough to work only at relieving the symptoms of anxiety. You also need to learn how to eliminate the mistaken beliefs and habitual thinking patterns that cause them. The skills presented in this part of die program are, in a sense, a kind of Band-Aid designed to help you feel more comfortable and regain some control over your body. They are much like medications to relieve the pain of a broken leg. While this is important, it is also essential to repair the damage and learn how to avoid injury in die future. This is not meant to minimize die importance of the skills you are developing this week. They are an essential part of overcoming severe anxiety. In fact, as you progress through die program and become better able to minimize the sources of stress and anxiety you have control over, the skills described in this lesson become even more powerful.

Four Basic Skills for Reducing the Symptoms of Anxiety

Take your time as you develop the four skills presented in this section. Plan to return to this lesson and work with these skills many times before they are mastered.

Cue-Controlled Relaxation

At the turn of the century, a Russian scientist named I. P. Pavlov conducted a classic experiment. He presented a neutral stimulus to hungry dogs, such as ringing a bell, then followed it by giving the animal food. The food caused the dog to salivate. With repetition, the neutral stimulus (the bell) eventually would trigger salivation. When a response is triggered by a stimulus as a result of this type of conditioning, it is called a conditioned response.

Many human reactions and behaviors are a type of conditioned response learning. Consider the saying, "Moms cooking tastes best." Mom could be a terrible cook and this would still be true because her children would have been conditioned to her cooking. This is why food in foreign countries often tastes "funny." The same is true with clothing fashions. Pictures of clothes worn ten years ago look funny because we have been slowly reconditioning ourselves to the fashions of today.

When a person experiences high anxiety, the various sensations and events present during the time that the person is anxious tend to become a conditioned response stimuli. For example, if a person has panic attacks while driving, simply being in a car may trigger mild anxiety symptoms. Anxiety generated by this form of conditioned response learning plays a very subtle but important role in maintaining panic disorder Even though a person may consciously understand the dynamics that caused the original symptoms and is confident that there is no danger, he or she will still continue to experience anxiety generated by conditioned response learning. This type of conditioned response learning can be reversed through a process called desensitization explained in detail later in the program or by using cue-controlled relaxation.

Cue-controlled relaxation refers to relaxation triggered by a cue in a conditioned response manner just as Pavlov's dogs were conditioned to salivate to a bell. The actual cue can be anything. Commonly used cues include a word such as "relax," an imaginary scene, or a simple physical cue such as putting your thumb and finger together.

The first step in developing cue-controlled relaxation is to learn a method that enables you to produce a relaxation response like those described in Appendix 1. The second step is to decide on a cue and begin associating it with the relaxation response you are practicing. For example, you might place your thumb and two fingers together while practicing your relaxation response exercise. With time, the act of placing your thumb and fingers together would act as a cue or trigger for the relaxation response. Sometimes this type of cue is called a relaxation response anchor because the response is anchored to it.

At first, the anxiety triggered by conditioned response learning will be much stronger than the relaxation generated by your relaxation response training. This is to be expected since you have been unconsciously reinforcing the conditioned response anxiety for a long time. Even with practice, your cue-controlled relaxation will, by itself, probably not eliminate anxiety but only reduce it. However, when used in combination with the other skills in this lesson, cue-controlled relaxation becomes a powerful tool for reducing anxiety. With time and practice, you can desensitize yourself and eliminate the conditioned response anxiety.

Diaphragmatic Breathing

Hyper (too much) ventilation (air movement) is simply over-breathing. It occurs when a person breathes more rapidly, more deeply, or a combination of both than is needed to meet the body's demands for oxygen and removal of carbon dioxide. Breathing in this fashion causes the level of carbon dioxide to drop in the bloodstream. Forceful hyperventilation can reduce the carbon dioxide level in the blood by 50% in as little as 30 seconds. Most people would think this is good since they were taught in school that carbon dioxide is a "waste" product. However, carbon dioxide is very important in maintaining a proper acid-base or pH level in the blood and is the chemical used by the body to regulate breathing.

Hyperventilation raises the pH level in the nerve cells making them more excitable, and it also tends to activate the fight or flight response. This sets off a chain reaction of activity in the body that can produce any of the following symptoms:

• Heart palpitations, tachycardia (racing heart), heartburn or chest pain

• Numbness or tingling of the mouth, hands, or feet

• Dizziness, faintness, lightheadedness, poor concentration, blurred vision, or a sense of separateness from the body (depersonalization)

• Shortness of breath, "asthma," or choking sensation

• Difficult)' swallowing, lump in the throat, stomach pain, or nausea

• Tension, muscle pains, shaking, or muscle spasms

• Sweating, anxiety, fatigue?, weakness, poor sleep, or nightmares

Most of the above symptoms will develop in under a minute. While they can be uncomfortable, none of the symptoms causes lasting harm. Most people who hyperventilate do not realize they are hyperventilating. Instead of reporting a problem with hyperventilation, they complain of various specific or vague symptoms from the above list. Hyperventilation can occur with any of the following:

• When at rest, you breathe with your upper chest instead of with your diaphragm.

• When you breathe through your mouth because of either habit or because of physical or medical problems.

• When you sigh or yawn because you have been holding your breath.

Let's look at each of the above individually.

Humans have two basic breathing patterns. In thoracic or upper-chest breathing the chest lifts upward and outward and breathing tends to be shallow and rapid. In diaphragmatic breathing the inhalation tends to be deeper and slower. When the lower lungs fill with air, they push down on the diaphragm and cause the abdominal region to protrude, making the stomach appear to be expanding and contracting with each breath.