When I look back on all these worries, I remember the story of the old man who said on his deathbed that he had had a lot of trouble in his life, most of which had never happened.” – Winston Churchill
We all recognize the signs of anxiety. The sweating, nausea, shortness of breath, trembling, and dizziness that comes on suddenly and seemingly out of nowhere. If our anxiety response is particularly overwhelming, we may feel heart palpitations, a sense of choking, chest pain, numbness, chills or hot flashes, and we may even fear that we are dying. If you are experiencing four or more of the above symptoms, you might be experiencing a panic attack. If you experience panic attacks on recurring basis and fear future attack, you may be suffering from a panic or anxiety disorder. 
The good news is that we understand anxiety better than we every have. Anxiety is a psychological, physiological, and behavioral state created by a threat to well-being or survival. This threat can be either actual or potential. It is characterized by increased arousal, expectancy, autonomic and neuroendocrine activation, and specific behavior patterns. The function of these changes is to facilitate coping with an adverse or unexpected situation and, above all else, increase the chances of survival. 
Paradoxically, the repeated activation of this anxiety response, and the “fight or flight” response it creates, interferes with our ability to cope in a healthy way. It also predisposes us to a wide range of chronic conditions. At its worst, uncontrolled anxiety can even disable someone and leave the unable to function effectively in day to day life.
Most interventions or treatments for anxiety focus on the ability to get away from the situations that are triggering the stress response. This is the “flight” aspect of “fight or flight.” You see a threat? Get away and run in the opposite direction. You can’t stop fighting with someone? Leave them and don’t come back. These are oversimplifications, of course, but what do we do when leaving isn’t an option? What if you are feeling anxiety in the only place that you can be?
This is a challenge that many of us are facing as people social distance and states go into lockdown or quarantine in response to COVID 19. This global pandemic has brought on a great deal of reasonable and justifiable fear and anxiety. Issues such as physical health, the health of loved ones, loss, maintaining financial security, caring for children have all been combined with the increased responsibilities at home along with decreased options in terms of maintaining personal mental health by actually being able to leave that home from time to time. The really bad joke about this pandemic is that it will benefit divorce lawyers above all else!
Now consider those increased stressors while thinking about those who suffered from anxiety disorders prior to COVID 19. Imagine dealing with that condition but with every coping skill that involves mobility or “flight” eliminated. How can we deal with the “normal” amount of stress and anxiety that this pandemic has produced? How can we even begin to deal with those stressors if we are already burdened by panic attacks, panic disorder, or an overactive sympathetic nervous system that is particularly adept at identifying threats…most of which will never happen? Here are some recommendations:
You’re Grounded! – I would like you to acknowledge FIVE things you see around you. It could be a pen, a spot on the ceiling, anything in your surroundings that is physical and could be perceived by others. Now, I want you to acknowledge FOUR things you can touch around you. It could be your hair, a pillow, or the ground under your feet. Really focus on the sensations that touch creates. Once that is complete, pleas acknowledge THREE things you hear. This could be any external sound. Focus on things you can hear outside of your body. Listen to those sounds as if you are going to describe them to someone who has never heard them before. After that, acknowledge TWO things you can smell. Maybe you are in your office and smell pencil, or maybe you are in your bedroom and smell a pillow. If you need to move around to find a scent you could smell, that is perfectly ok. Lastly, acknowledge ONE thing you can taste. What does the inside of your mouth taste like—gum, coffee, or the sandwich from lunch? If you’d like to introduce a preferred taste, now is the time.
Congratulations! You have just completed a grounding exercise. Grounding is a form a mindfulness and research has shown that it can be very effective at reducing anxiety and helping people cope with feelings of stress.  Best of all, it can be done right where you are at any moment. You can write these answers out or say them quietly to yourself. Experiment with methods of expression to find what works best for you.
Just Breathe – Would you be interested in a pill that can reduce stress levels in your body, lower your heart rate, lower your blood pressure, improve diabetic symptoms, reduce depression, manage chronic pain, regulate your body’s reaction to stress and fatigue, and reduce the possibility of burnout?  Great? Just take a deep breath and……that’s it. Mindful breathing has shown the ability to produce all the above effects in people dealing with anxiety and other chronic illnesses.
So how to practice mindful breathing? The easiest way to mindful breathing is simply to focus your full attention on your breath, the slow inhale and controlled exhale. You can do this while standing, but its better if you sit or even lie down in a comfortable position. Your eyes may be open or closed, but you may find it easier to maintain your focus if you close your eyes. Feel free to play any soothing or ambient music/sounds as your practice. It can help to set aside a designated time for this exercise, but it is even more helpful to practice it when you’re feeling particularly stressed or anxious. This can shift your anxiety from something happening “to” you to an opportunity to improve your mindful breathing.
Sometimes, especially when trying to calm yourself in a stressful moment, it might help to start by taking an exaggerated breath: a deep inhale through your nostrils (3 seconds), hold your breath (2 seconds), and a long exhale through your mouth (4 seconds). Otherwise, simply observe each breath without trying to adjust it; it may help to focus on the rise and fall of your chest or the sensation through your nostrils. As you do so, you may find that your mind wanders, distracted by thoughts or bodily sensations. That’s OK. Just notice that this is happening and gently bring your attention back to your breath.
Write this down – Sometimes, anxiety and stress can feel like a flood overwhelming your mind and body. With no place to go, no way to take flight, you may feel helpless against this flood. It seems guaranteed to come crashing down. But then you remember, people throughout history have dealt with actual floods and uncontrollable waters and they didn’t do so by simply abandoning the lands where the waters might reach. They rechanneled the waters so that safe living became possible.
You can do the same thing with your anxious thoughts through journaling. Journaling has shown to be effective at reducing anxiety and helping individuals cope with panic attacks. The way journaling helps is much like the dams, and canals, and bridges that have helped humans deal with overflowing waters. Thoughts and feelings aren’t avoided, they are rechanneled to the pages of your journal where they are harmless. This frees you to focus on more manageable emotions while empowering you to actively engage the triggering thoughts.
There are a million ways to journal, but they tend to fall into 1 or 2 approaches. In the first, you embrace your anxious thoughts. Pushing these thoughts away can work in the short term but this only suppresses stress and it will surface even stronger later. According to research, writing down your worries can make them go away — almost as if you are transferring them out of your head and onto the paper. This is an active engagement of these negative thoughts so write whenever you feel the stress or anxiety. Grab your journal and vent all those negative thoughts into the page. You will immediately feel lighter, happier, and more relaxed.
The second strategy is not one of avoidance but of creation. Instead of passively waiting for stress to be dealt with, your journal can be used to flood your mind with positive, empowering thoughts. Many people remember Stuart Smalley from Saturday Night Live looking in his mirror and saying, “I’m good enough, I’m smart enough, and doggone it, people like me!” Well, doggone it, he was right. If we flood our consciousness with positive messages such as “you can do this!” or “you are strong”, eventually you will believe you. So load that journal up with positive messages, read them back to yourself, and you will train your brain to pay more attention to the positive empowering messages and less to the anxious, self-defeating worries.
As with any advice, these tips are not a cure all or a guaranteed solution to everyone’s anxiety. They are simple ideas that have proven effective for others and can be attempted, right now, where you are, with or without a stay at home order. If you, or a loved one, feels that they cannot cope with the anxiety or stress they are facing, you should always feel empowered to connect with Behavioral Health professional who are essential and still working during this crisis. There are many to choose from and helpers like those at PATH Integrated Healthcare  stand ready to assist you as you cope with your anxiety and work to build a better tomorrow.
 Kabat-Zinn, J. (2005). Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. Hyperion.
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