Fran Miller, Ph.D. ©
In 2008 I wrote an article on Managing Stress and Reducing Anxiety. I was living in Bend and we were in the midst of the national financial crisis. Five housing developers committed suicide in Bend that year. Bend was hit very hard. Many of my clients were’t even able to pay their copays, and I developed anxiety myself because I feared I could go “under water” in my own house. As a consequence, I decided to move back to Portland in 2011. Fortunately, I had maintained a practice of psychology here, and many of my clients welcomed me back.
The causes of anxiety are varied. Financial anxiety is felt with extreme severity because the consequences of financial difficulty can be so severe. That is also true with health concerns or serious illness. I have dealt with clients of every age who have received a serious diagnosis, and who struggle to return to health or to survive. There are three other types of concerns that cause anxiety. One is the sort of background issues that we hear about in the news – war, terrorism, global warming, weather crises, and random crime events. The second one is the personal issues that cause us anxiety on a daily basis – minor injuries or health issues, work stresses and concerns, and family and relationship problems. In addition, there are very individual and personal psychological issues and issues related to our identity and self esteem. All of these varied circumstances are sources of anxiety.
According to psychological diagnostic criteria, there are several types of anxiety: panic anxiety, generalized anxiety, and social anxiety, among others. One of them seems to be increasing in recent years – social anxiety. It seems that the widespread use of technology, social media, smart phones, and texting is really causing an increase in social anxiety. This is especially true for young people – high school and college age. It used to be that mild or moderate underlying depression was more common in a psychology practice. Now we see much more panic anxiety, generalized anxiety, and social anxiety.
It’s possible to help ourselves and deal with moderate anxiety by doing some research, reading, and implementing healthy activities. But most clients tell me that they find this individual effort to be frustrating, and that moderate or severe anxiety doesn’t usually get resolved that way. I am a psychologist so I may be biased, but I find that by implementing a combination of efforts including psychotherapy, anxiety can be greatly minimized. Unlike depression, I don’t think anxiety can be completely eliminated. There will always be some issues, setbacks, problems, or even crises that will contribute to anxiety throughout our lives. But if we are aware of our anxiety, and make an effort to work with it on an ongoing basis, with the help of a therapist we can keep anxiety to a minimum. Here are some of the things that can really produce results:
Psychotherapy: Psychotherapy is beneficial in very many ways and each benefit contributes to the reduction of anxiety. There is usually a very individual component to anxiety related to our identity, self esteem, history, or personality. It’s very difficult to figure these elements out on our own. It’s possible ….maybe, but difficult. For example, it’s very hard to discern what role our own individual personality style plays in our circumstances. For example, are we passive, accommodating, arrogant, self centered, sensitive, controlling, fearful, impatient, shy, aggressive, or lacking in self esteem? Are we confident, self assured, thoughtful, modest, considerate, energetic, motivated, optimistic, accepting, grateful, generous, or compassionate? All of these characteristics, and many others, affect our lives and our anxiety level. Working on anxiety in psychotherapy consists of addressing the issues that underlie anxiety such as issues related to your identity and self esteem, your personality formation, and relationships. Therapy can also be helpful in looking at options, decision making, priorities, and career direction.
Another aspect of therapy that can be especially beneficial is the relationship itself. It is very difficult to try to work on our own growth and development by ourselves. However, a good therapy relationship is meant to provide a safe and protective environment for looking at ourselves, developing the courage to make changes, and for sharing the joy and sense of accomplishment with our progress. A good therapist will provide a caring and non-judgmental unconditional positive regard. I think the effectiveness of psychotherapy depends on the skill of the therapist as well as the effort of the client.
In therapy we also address the methods that will help you to release stress, strengthen your body, increase relaxation, and calm and free your mind. Here are nine other methods that, if you practice them regularly, will reduce your anxiety. The problem is — you have to actually do them!
Exercise: I have learned that exercise is the second most important factor next to therapy in reducing anxiety. Aerobic and weight bearing exercise, biking, boating, as well as yoga, tai chi, martial art, running, hiking, and strenuous walking, increase your strength, produce endorphins, and contribute to the reduction of anxiety.
Progressive Muscle Relaxation Exercise: – This is an exercise that you do lying down in a relaxed position. I won’t give extensive directions here because you can get them on the internet or we can go over them in a therapy session. But basically you go through all of the muscle groups of the body and tense and relax each one. After 15 or 20 minutes, you will experience an increase in relaxation and a reduction in anxiety. That’s partly because you can’t be relaxed and anxious at the same time! They have physiologically opposite manifestations!
Lying Still: Lying still is a method that I observed myself. It makes sense that when we lie still that our heart rate naturally decreases, that we will begin to feel more relaxed – and that consequently our anxiety level is reduced. It’s the most helpful if we can find a place that is silent and calming. It’s obviously not helpful to watch the news or other TV or to listen to upbeat music. Calming music can be helpful. If you practice the breathing and mindfulness techniques listed below while lying still, that also increases relaxation.
Breathing Techniques: There are several specific breathing techniques that we can go over in therapy that are helpful in reducing anxiety and increasing relaxation. Some breathing techniques are the same ones recommended for sitting meditation.
Visualization Exercise: Visualization exercises can be done in several different ways. Here are two of them. I recommend this one for times like when you are sitting in a dentists chair or trying to go to sleep. Imagine that you are at your favorite vacation place — at the coast or in the mountains. Imagine what it looks like. Imagine yourself there relaxing in a chair or laid out in the sun. Imagine what you hear – the wind blowing through the trees, birds chirping. Imagine what you smell – the fragrance of the pines. Imagine what you see – clouds floating by in the blue sky. Enjoy the warmth of the sun. My previous Zen teacher, Robert Aitken, recommended forgetting the self while uniting with something else. Forget your worries and preoccupations and focus your attention on the sounds, fragrance, and comfort of your imaginary surroundings.
Another way to do a visualization exercise is to lie down where it is calm and quiet. Take a few deep breaths and take a few minutes to relax your body. With your eyes closed, imagine a blank screen in front of you. Stay focused on the blank screen until something appears on the screen and you start to imagine something taking place. If you do this exercise in therapy there can be some dialogue during the visualization. One time a client said during his visualization that he saw the Dalai Lama. I suggested that he ask the Dalai Lama a question. Silently he asked his question, and was then surprised to hear an answer. The answer turned out to be personal, meaningful to him, and very helpful. I’ve never done a visualization with a client that did not have a significant meaning. However, it helps to do this in a therapy session because sometimes we cannot discern the full meaning of a visualization by ourselves.
Journaling: I recommend journaling during the course of psychotherapy because it can provide topics for therapy sessions, provide relief when therapy is not available, and it can help us to organize and explore our thoughts and feelings. It has been found that expressing our own narrative in writing and/or in therapy reduces stress and actually changes activity and even the structure of the brain (Siegel, The Mindful Brain). Journaling doesn’t have to be in the form of essay writing, although that can definitely be beneficial. We can also use a journal to develop goals, list priorities, write out pros and cons, facilitate decision-making, and provide for a therapeutic expression of our feelings. Journaling sounds elementary or minimalistic, but, in fact, it is extremely beneficial and therapeutic.
Mindfulness Practice: I won’t go into a description here of mindfulness practice because I have an article on my website called Beginning Mindfulness Practice. Mindfulness practice is different from mindfulness meditation. Mindfulness meditation is one of the three classic methods of meditation, whereas mindfulness practice is “taking meditation off the cushion” and being aware, thoughtful, and mindful while we are doing the various activities of our day. The predominant characteristic is that we make an effort not to focus on the future or the past, but keep our mind focused on our sensory input in the present moment.
Short Sitting Meditation: Sitting meditation is when you assume a meditation posture on a chair, bench or cushion. The defining characteristic is to maintain a straight, unsupported back. Meditation postures were described historically by Siddhartha Gautama, The Buddha, in around 500 B.C. The classic instruction is from Dogen Zenji in Japan in around 1200 A.D., and is familiar to all Zen students. Most descriptions of meditation posture follow his instruction. When just beginning to practice a sitting meditation, I recommend just a short period of time — 5, 8, or 10 minutes. Trying at first for a short period of time helps you to have a positive experience and allows you to adjust to, or acclimatize to, what is a rigorous technique.
Longer or Regular Length Sitting Meditation: The recommended length for sitting meditation is 20, 25, or 40 minutes. At the Honolulu Diamond Sangha, Robert Aitken recommended 25 minute sittings. At the San Francisco Zen Center, 40 minute sittings are regularly practiced. I recommend short sittings until you are able to naturally sit for longer periods, and then I think for daily sitting at home that 25 minutes is a reasonable length. The posture is even more important in longer sittings which is what the posture was designed for. Formal posture is the most comfortable for longer periods of time, creates stillness and quiet, and increases focus. To have a chance in our busy days to sit in quiet, to process our day, to observe our thoughts and feelings, to quiet our minds, and to simply focus on our breath – is exceedingly refreshing and beneficial. Perplexing circumstances can sort themselves out. The tensions in our bodies can fall away. We can enjoy a restful, silent break in our day.
With a daily meditation practice it’s possible that anxiety can fall away. But more than that, if we choose to follow a more serious practice that includes meditation, study, and training with a teacher, not only can anxiety fall away, but surprisingly other positive qualities can manifest — and also other positive experiences. It is part of Zen Buddhist tradition and teaching that four great wisdoms, or the Brahma Viharas, can develop. These are loving kindness, compassion, sympathetic joy, and equanimity. With the methods described above, we can reduce anxiety. And with silence and serenity, with study and insight, with effort and practice, our best selves can manifest – and we can find peace.