What should you do when you have anxiety

People who are prone to anxiety, or are suffering from anxiety disorders don’t always have access to resources and professional help. It has been even harder for them as they come to terms with an unprecedented situation in the form of a pandemic.

The spread of the coronavirus has unleashed a calamitous impact on people around the world which goes beyond health. The social and economic fallout from the pandemic—job losses, social distancing, drop in incomes—is impacting the mental and physical well being of people. Experts believe that it is leading to people feeling more scared, anxious, and depressed.

Femoai spoke to Bengaluru-based psychotherapist and adjunct faculty at Christ University Michelle Manasseh about what can people do if they have anxiety and no access to professional help. She also talks about what people are feeling as they deal with the pandemic.

• How can people who have anxiety disorders deal with it? What if they aren’t able to seek professional help?
• What about exercise, that is often recommended for people to help overcome anxiety.
• How do we help our friends who may come to us when they are anxious?
• Could you also talk about the anxiety that people are feeling because of the pandemic?

How can people deal with anxiety if they don’t have immediate access to professional help?

A simple relaxation technique is deep breathing. When we are anxious and our heart is beating faster, breathing is shorter and less oxygen is going to the brain. Deep breaths force more oxygen to the brain and help you think from a more rational perspective. At most times, anxiety is driven by irrationality and irrational thoughts. If it is anxiety about rational things, it can be justified to a certain extent.

A tool that I sometimes use with my clients is the grounding technique. Grounding technique is used to ground you to the present. Anxiety often happens when people are thinking about things that haven’t even occurred. They are not in the present moment.

If a person is in a room, the grounding technique will let them observe things in the room. They will identify the fact that their mind has wandered off which is why they are feeling anxious. They have to consciously bring the mind to the present and try to forcefully have it think of the things in the room.

Using this technique, we focus on the characteristics of objects in the room, like there is a nice chair or a nice table in the room, this is the colour of the chair, or that the chair has four legs. These are nuanced observations of objects near us. The intention is that we are working towards bringing our attention and our mind back to the present. And pulling it away from the anxiety-driven thoughts. We have to do it repeatedly, there has to be an intention of wanting to be conscious.

The other technique people use when they feel anxious is to list out things in their mind and write them down, like a list of their favourite books or songs. This also brings about control and stops our mind from wandering off to places that we don’t want it to go.

Sometimes when people feel anxious, they start telling themselves to stop being anxious, but the more they do that, the more anxiety they have. We can get anxious about being anxious. Instead of telling ourselves to not do something, we should be asking our mind to do something else. The trick is that if our mind is telling us to think of a pink elephant, we tell it to think of a blue tiger instead. The mistake we make with our emotions is that we tell ourselves don’t feel like this or don’t do this, we are being judgemental of ourselves or being critical of ourselves. The more we are being critical, the worse the emotions become.

Sometimes when people feel anxious, they start telling themselves to stop being anxious, but the more they do that, the more anxiety they have. We can get anxious about being anxious. Instead of telling ourselves to not do something, we should be asking our mind to do something else. The trick is that if our mind is telling us to think of a pink elephant, we tell it to think of a blue tiger instead.

What about exercise? It is often recommended for people to help overcome anxiety

Exercising helps as well. It helps the body use a specific kind of energy and in letting go of some anxious energy. From a physiological perspective, when the mind is in a fight or flight mode, there is a large amount of adrenaline in our system. The part of the brain that is causing the fight and flight reaction is called the amygdala. This communicates to our adrenaline glands to release adrenaline.

Amygdala developed a million years ago, as part of evolution, to protect us from actual physiological danger. It developed in a way that it reacts to anything that is a threat to us. It’s job is to react. But in this day and age, we are not necessarily in physiological danger, our anxiety is not externally driven but internal, it is because of what we are thinking about; it could be something that is a threat to our emotional self, a threat to our ego, and it activates the amygdala. The adrenaline in our system makes us feel restless, makes our heart beat fast. Therefore, physical exercise helps us get rid of that anxious energy and allows the logical part of the brain to function.

Physical exercise helps us get rid of anxious energy and allows the logical part of the brain to function.

How do we help our friends who may come to us when they are anxious? How do we deal with the situation as we are not professionals?

We should not advise, we should just listen. We all have a tendency of advising and telling them what to do based on what worked for us. That usually never works because all of us have different things that work and ones that don’t. For instance I can tell my client to exercise, but I cannot tell them which form of exercise will work for them. It is important to tell them that they can do some form of exercise, it could be walking, jogging or zumba, depending on what works for them.

Someone who is not a therapist may suggest something like zumba, for example. So the person, who is suffering from anxiety, is going to take a class thinking that zumba will help them get rid of it. It is, therefore, important to not advise but to listen. And, if someone is struggling with it for a long time, if they are struggling with concentrating or managing their anxiety, suggest that they go and see a professional. Try not to solve the problem yourself, try not to be the rescuer.

If there is stigma, if they are struggling with going to a therapist, try to normalise it for them, let them know that it’s like going to a doctor when you have a stomach ache or other physical ailments. Similarly if your brain is hurting, you need to go see somebody who can help you with that.

It is important to not advise but to listen. If someone is struggling with it for a long time, if they are struggling with concentrating or managing their anxiety, suggest that they go and see a professional. Try not to solve the problem yourself, try not to be the rescuer. If there is stigma, if they are struggling with going to a therapist, try to normalise it for them, let them know that it’s like going to a doctor for a stomach ache.

Infact, the first couple of sessions I do with my clients, it’s them just talking and me listening. So many realisations come to them while they are talking, and they have their moment of catharsis. They often don’t have someone who would listen to them attentively. All you have to do is set your phone aside and listen. Try to be as understanding of what they are going through without judgement.

Could you also talk about the anxiety that people are feeling because of the pandemic?

It depends on what their anxiety revolves around. The one thing I have realised is that, to a large extent, what we are experiencing is not necessarily anxiety. David Kessler, a therapist who works with grief, spoke about it on a podcast; he said that what we are dealing with right now is not anxiety but grief as the future is uncertain. It is grief about losing the freedom that we had, it’s grief over ambiguity, grief over the fear of losing people that we love dearly. That made so much sense to me. We are all dealing with it. I am equally struggling with it, but just being able to define it as grief helps.

David Kessler, a therapist who works with grief, spoke about it on a podcast; he said that what we are dealing with right now is not anxiety but grief as the future is uncertain. It is grief about losing the freedom that we had, it’s grief over ambiguity, grief over the fear of losing people that we love dearly.

We can put it under a broad idea of anxiety, but once you define it as grief, it makes it okay to feel. We are not going to be able to go back to our normal lives. It is not going to be the same normal, and allowing ourselves to be angry is okay. It’s okay to be upset. We didn’t ask for it. It’s a situation we feel we are not in control of, we feel we don’t have certainty, everybody is trying to make sense of it. And it’s okay to be angry and upset, have moments of being sad. This is the new norm and we have to work around it.

At this time, the resources are available but the way you reach out is different. You can still seek help for mental health, but you probably can’t go to the therapist’s office, you may have to do it over the phone.

We can put it under a broad idea of anxiety, but once you define it as grief, it makes it okay to feel. We are not going to be able to go back to our normal lives. It is not going to be the same normal, and allowing ourselves to be angry is okay. It’s okay to be upset.

However, the one worrying aspect has been the rise in domestic violence mainly with women. We really don’t know the restrictions, the challenging situations that these women are in and whether they have access to reach out to anybody. It is something we need to plan for in the future. 

It is difficult for therapists as well. The only way even we get to know of these situations is if the violence has been so bad that they have been taken to the hospital or they have managed to put out something or the other (a call or a message to a friend etc), found an opportunity. But there needs to be consistency in terms of how we can reach out to these women. It is still a challenge for us.

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