How Do You Manage Anxiety in Your Patients?

It is difficult and usually not a realistic goal to completely eliminate anxiety for most people. Therefore, I try to help my clients decrease the amount of time in the day that they worry. One way to do this is to schedule specific 'worry time.' If anxious thoughts come into your head before your scheduled worry time, gently tell yourself you will address those thoughts later and try to focus on what you are doing in the present moment.

I recommend a great book, Needing to Know for Sure by Martin Seif, and teach some of the concepts discussed in that book. One concept is the idea of tolerating the discomfort of not knowing for sure. I teach clients to sit with that feeling and really get comfy with discomfort.

My approach to supporting clients suffering from anxiety is two-fold. First, using Mindfulness-Based Cognitive Therapy (MBCT) principles, I help them develop greater self-awareness to catch early signs of anxiety and practice self-regulation skills. Then, I use Eye-Movement Desensitization and Reprocessing (EMDR) to help them target the challenges in life causing anxiety, or sometimes the anxiety itself, making space to process, desensitize, and rehearse more adaptive ways of coping. I've used this approach for years with clients and have seen amazing results!

I find the strategy that works best for anxiety depends on which symptoms of anxiety are causing the most distress. If you are someone who gets stuck in your thoughts, then holding your breath as you place your face in cool water for 30 seconds can help to get you out of fight-or-flight mode, reduce your heart rate, and get you out of your head.

Another tool that can help with worrisome thoughts is to write down these thoughts (writing helps to process thoughts) and ask yourself, 'Is this something I have control over, and is this helpful for me to focus on right now?' If the answer is yes to both, then you can go into problem-solving mode. If you answer no to either question, then try to distract yourself from the problem, as either there is nothing you can do about it for now, or it is simply not helpful to focus on it in this moment. Try coming back to the problem later.

If the physical symptoms of anxiety are causing you the most distress, you can try exercise to use up the excess adrenaline, followed by slow, deep breaths paired with muscle relaxation. Try breathing in to the count of 4 while simultaneously tensing your muscles, then slowly breathe out to the count of 6 while releasing the tension in your body, and repeat deep breathing and progressive muscle relaxation as needed until you are feeling calmer.

I often find that at the core of anxiety disorders is a difficulty tolerating uncertainty. This can manifest in frequent worry and “what if” thoughts, as well as avoidance of both the actual feared event and the experience of anxiety itself. Therefore, one of the greatest tools for managing anxiety and worry thoughts is “cognitive restructuring,” or identifying and challenging our negative thought patterns. Our thoughts, feelings, and behaviors all work in a cycle.

For example, when we experience a negative worry thought, “What if I fail this test,” we feel increased anxiety and are more likely to engage in unhealthy behaviors (e.g., procrastinate and avoid studying for the test). By becoming a better observer of our thought patterns, we can look at the evidence for and against these thoughts and better challenge them. Instead of “what if I fail this test,” this person can identify this as a catastrophic "what if" thought, and identify evidence against the fear of failing (e.g. I studied hard for this test, I attended office hours, I did well on the practice quizzes). By challenging these negative thoughts, this person will likely feel a reduction in anxiety and increased motivation, encouraging healthier behaviors such as reducing procrastination and creating better study habits.

I find that anxiety is best managed by approaching the fear. Patients usually avoid and obsess when they don't have safety to confront it. I help patients establish safety so we can approach the situation together, helping them grow in confidence and security.

As a psychiatrist, I've seen firsthand the usefulness of grounding techniques in managing anxiety for my patients. One method that stands out is the "5-4-3-2-1" exercise, where we use our five senses to bring ourselves back to the present moment. It's as simple as identifying five things we can see, four things we can touch, three things we can hear, two things we can smell, and one thing we can taste. By engaging our senses, we can shift our focus away from anxious thoughts and fully immerse ourselves in the here and now.

Another helpful exercise I teach my patients is diaphragmatic breathing. It's a simple method where you take slow, deep breaths to activate your body's relaxation response. You breathe through your diaphragm, and it can really help reduce stress and anxiety symptoms.

An interesting technique I have also tried is progressive muscle relaxation. It's basically when you tense up some muscles and then let them go, one by one. It helps to bring attention to any tension you might be holding onto and can also help you relax and feel less anxious.

One final suggestion I offer to my patients is to take a brief walk. This can help to relax and refocus their minds.

These methods are practical and easy to use, making them valuable tools for any psychiatrist to have.

As a licensed clinical social worker, I have witnessed firsthand how useful mindfulness-based stress reduction (MBSR) can be for managing anxiety. When you practice MBSR, you learn to focus on the present moment, which helps break the cycle of anxious thoughts. This method combines mindfulness meditation and gentle yoga to teach you how to respond to stress with awareness rather than reactivity.

Research from Georgetown University shows that MBSR can be just as effective as medication for treating anxiety disorders. This makes it an excellent option if you're looking for a non-drug approach or haven't had success with medication.

In MBSR, you'll attend weekly sessions and engage in daily mindfulness exercises, often including a day-long retreat. This structure offers a supportive environment where you can develop skills to manage anxiety better. Clients often find that MBSR not only reduces anxiety but also improves their overall quality of life by enhancing emotional regulation and resilience.