In this historical and cultural moment, sadly, anxiety has become a part of our everyday lives. Many of us experience nervous system “red alert” more often than we would like. I know I do, and I consistently see it in my clients. I am intellectually aware of the ways in which our bodies and minds try to protect us from threats. I also have a decent understanding of the ways in which these protection mechanisms often go haywire and end up creating or at least perpetuating a sense of threat instead. (Read here and here for two blog posts I wrote about trauma and the mind-body connection.) However, rational thought doesn’t help us when we get into a spiral of worry, panic and fear. For me, it can easily feel like my body and mind are betraying me, since I know I am not in danger and yet I FEEL like the world is caving in on me. I have been working on reframing this, so that my body is instead my best friend, a safe haven, the only little sanctuary that truly belongs to me on this earth. The idea is to calm the physiological signals using the body, so I can get myself out of sympathetic nervous system activation and realize that I am safe.
It is worth mentioning that anxiety is complex and multi-factorial. There are many systems in the body that could be experiencing a disturbance or pathology: musculoskeletal, neurological, biochemical, electrical, energetic and others. However, in my experience I have found the following to be true for many people: anxiety disturbs our mind-body connection, scrambling our interpretations as to what is actually happening at the moment. Mindfulness and body awareness, in my experience, are some of the natural enemies of anxiety. The more we can connect to our bodies and truly pay attention to what we are feeling, the more we can understand our bodily processes and even use them in our favor. Using our bodies to self-soothe is obviously not a new idea – as children we did this all of the time. In many photos of me as a little girl, I am staring distrustingly into the camera, either twirling my hair or sucking my thumb. As an adult, however, I clearly needed smarter tactics! Somatic therapy, yoga and massage help, but what about tools to help in a pinch during a stressful moment? Here are a few that work for me – I hope you find one or two that are helpful.
BREATHING TECHNIQUES
Breathing is a fundamental part of any discussion about anxiety. It’s a cliche for a reason! The breath is the life force. At the onset of stress, we might find ourselves momentarily freezing in place, interrupting breathing altogether. As the heart rate quickens, the breath returns but at a faster pace in the form of shallow breathing. As we continue to respond to stress, our muscles tighten, including the thoracic diaphragm and other muscles responsible for inspiration and exhalation. Our stomach muscles often tense up in order to protect our organs, making a full inhale and exhale even more difficult. Most of us, unless we have specifically done some type of breathing practice, do not take full breaths as we brace ourselves against discomfort. This, of course, leads to more panic and anxiety. So the first and best line of defense against anxiety is full, deep breathing.
In order to take a full breath, we must fill our lungs to the sides and down into the thoracic diaphragm as well as the upper part of our chest. I find it helpful to put my hands around myself in a sort of “self hug”, but down around my ribs. You can simply put your hands on your ribcage on the same side of your body, too; I just like the “swaddled” feeling I get with my arms wrapped around my middle. (It looks less conspicuous if you are in public, too.) Once your hands are on the ribcage, apply the slightest pressure and slowly breathe out into your hands as much as you can and then fully exhale. Take a few seconds each for the inhale and exhale and really pay attention to how you feel. Imagine the stress leaving your body with each exhale. Visualization is another great tool to aid in breathing. I learned these visualization techniques from Carole Osborne, one of the most respected educators in the field of perinatal massage:
Imagine your torso as a folded umbrella with the edge of the umbrella at your lower ribcage. As you inhale, see the umbrella opening. Exhaling, imagine it closed against the center pole. Continue to open and close the umbrella in your imagination as you breathe for another several minutes.
Once you are able to fill up the lungs out to the sides, place your hands on your belly OR one hand on the belly and one hand on the chest. Again slowly breathe into your hands so they are rising and then allow a full exhale. For those of us who grew up on Jane Fonda … this is not the time to be sucking in your stomach. Allow your belly to look big and round!
The visualization (again, from Carole Osborne):
Imagine that your torso is a beach and that your hands are driftwood on that beach rising and falling with the water’s peaceful movements. With your inhale, watch in your mind’s eye as your “driftwood hands” rise with a gentle wave touching the shore. Let your abdomen swell more extensively than your chest. Feel your hands sink on your torso when you exhale, as you imagine the wave retreating. Continue to watch the rising and falling of the driftwood on the gently surging and retreating water as you continue to breathe fully for several minutes.
Full, slow breathing practices are generally great for me and easy to do in public, but there are many different types of breath exercises out there. Andy Caponigro’s book “The Miracle of the Breath: Mastering Fear, Healing Illness, and Experiencing the Divine” is full of good suggestions, including a “Tarzan” breath, a rapid breath of fire and some grounding exercises.
FINGERHOLD PRACTICE FOR MANAGING EMOTIONS AND STRESS*
I learned this from a wonderful woman who works for the National Center on Domestic Violence, Trauma & Mental Health. She gave me this handout (printable version here), and I would like to share the fingerhold practice in case it is helpful for some of you. I find it calms me, combined with breathing.
Practicing fingerholds can help to manage emotions and stress. Hold each finger, in turn, with the other hand, holding for as long as it feels comfortable. Hold gently, but firmly. As you hold your finger, breathe in a way that feels comfortable. Many adults feel relief after 2-5 minutes per finger, and children often need to hold their fingers for much less time (30 sec. – 1 min.) for it to feel useful. You can work with either hand, and you can also work with just one or two fingers if that feels most helpful (or you don’t have a lot of time).
Key:
Thumb – tears, grief, emotional pain, feeling upset
Pointer/Index finger – fear, panic, feeling scared
Middle finger – anger, rage, resentment, feeling mad
Ring finger – worry, anxiety
Little finger – having self-doubts, not feeling good about ourselves or feeling bad
* This handout was adapted from Capacitar’s Emergency Tool Kit by Jen Curley, National Center on Domestic Violence, Trauma & Mental Health.
USING YOUR SENSES
Aromatherapy and music therapy are two quick and easy ways to ameliorate anxiety. Both affect the brain. Our olfactory system directly affects the limbic system (“the emotional brain”), which affects those parts of the brain that control heart rate, blood pressure, breathing, memory, stress levels, and hormone balance. There is a reason why you inhale bergamot oil and instantly feel happy! I have used essential oils to make inhalers for friends that they can carry around with them. The inhaler essentially looks like a lipstick; inside is a cotton wick that holds the essential oils. They are inexpensive and the wick can be swapped out to use a different recipe. The recipes can be modified to be safe for children, as well. A very basic recipe using oils that many people already have is: 5 drops each of bergamot, lavender and frankincense. Here and here are two other great blends from Aromatics International, and here is a video of Aromatherapist Andrea Butje making her Anxiety Away Blend.
Another trick is to sneak headphones on and play music that you find calming. Every once in a while I wake up at 2:30am worrying about something and I can’t go back to sleep. When this happens, I put on music: whale sounds, nature sounds, singing bowls or soothing music. Even if I can’t fall back to sleep, at least I am awake and calm as opposed to awake and freaking out. Music has been used as therapy for ages. Research shows that listening to music stimulates more areas of the brain than any other human function. Among many other things, music lowers levels of the stress hormone cortisol, so it has a powerful effect on stress. According to a large scale McGill University review, listening to music prior to surgery was more effective in reducing patients’ anxiety than prescription medication. Music therapy is currently being successfully used to alleviate anxiety in patients with dementia, cancer, chronic pain and depression.
VAGUS NERVE STIMULATION
The vagus nerve plays an important part in the parasympathetic nervous system, or the “rest and digest” system. It runs from the brainstem through the neck to the heart, lungs and other internal organs – it’s amazing how many body systems this nerve is involved with (it’s name derives from the Latin word for “wandering”, if that tells you anything). It keeps the body in balance through neurendocrine-immune axis activity and the regulation of metabolic homeostasis. This nerve mediates sensory information to the brain and has direct and indirect connections to the neural circuit which pertains to emotional and cognitive functions. People with low vagal tone often suffer from depression and/or anxiety (among other things), since the ability to get into “rest and digest” is compromised. Research has been mixed, but the concensus seems to be that stimulating the vagus nerve may offer benefits, including stress reduction.
Vibration in the throat is the easiest way to stimulate this nerve. All of the below would do the trick, plus most are fun:
- gargling
- chanting
- singing
- laughing
You all know I love doing the “horselips” and it’s even better if I combine it with a low guttural noise before or after. Laughter, in this case, truly can be the best medicine. I keep a few “bloopers” style seconds-long videos on my phone for moments of panic. These videos make me belly laugh every single time and the anxiety magically lifts.
The vagus nerve responds to cold exposure, so to possibly alleviate anxiety in a pinch, you could splash cold water on your face. I haven’t tried this one specifically for anxiety, but I do enjoy a cold shower post-run and have noticed uplifting effects on my mood (which could have been the run, too).
MUSCLE DECOMPRESSION FOR TENSION RELEASE
JAW
Those of us who hold tension in our jaws will find relaxing the mouth and jaw works wonders in combatting worry and anxiety. My first step is normally to flap my lips in “raspberries” or “horse lips” fashion. I look ridiculous but I can’t believe how much doing this calms me down. I then place my hands on the sides of my cheeks, apply pressure and slowly drag down, allowing my mouth to open if necessary as my hands glide down my face. I know most people are accustomed to pulling the cheek skin up rather than down for vanity purposes, but the point is to traction the masseter muscle away from its origin. In other words, we want to apply pressure in the opposite direction of normal contraction.
SHOULDERS
It can be helpful to exaggerate a tensed posture first in order to get a better release of tension. With the shoulders, you can tense up and shrug your shoulders for three seconds and then drop the shoulders dramatically as you exhale, sighing audibly if that feels good. This one does not work for me, personally, but I have friends and clients who swear by this method of tension release. I have modified the idea in a way that works better for me: I tense my shoulders back rather than up, squeezing the rhomboids for 3 seconds, which also allows the chest to open up, and then I drop the shoulders into relaxation.
CHEST
Tightness in the chest is a common complaint accompanying feelings of anxiety. The breathing techniques above are all great for decreasing this tightness. In addition to breathing, however, I like to externally manipulate the chest (which helps to facilitate the breathing). One way to do this is to stretch the pectoralis muscles in something like a doorway stretch (blog on that here). However, when I am feeling anxious, I find that feeling contained feels better, again like swaddling. Anxiety is individual, so you can experiment and see what feels best for you. I like to put one or both hands over my sternum. I can feel my heart and lungs, which makes me feel very safe. This also connects me to my heart center, reminding me of my gratitude practice. I then put the slightest pressure on my sternum, just enough to get good traction on the skin, and I move the skin around in slow big circles, or sometimes just move the skin laterally and hold for a few moments and then do the other side.
I will admit that I do not fully understand the mechanism through which this might work, but it does (for me). As skin stretch is the major modality used in dermoneuromodulation, I suspect the answer may be found here. A very simplified version of this theory is that by engaging mechanoreceptors in the skin through skin stretch, we are giving the nervous system input that helps it downregulate nociception. By providing the cutaneous nerves with novel stimuli, we are affecting the nervous system in a broader sense. I have only begun to scratch the surface of Diane Jacobs pivotal work, so forgive the crude explanation. All I can say with certainty is that a slow gentle skin stretch on the sternum greatly reduces a sense of panic in me personally, and I use it often. You can try it and decide for yourself if it helps.
GROUNDING YOURSELF
Making ourselves feel “safe” appears to be a big factor in alleviating anxiety. One way to do this is to feel that we are on solid ground, bringing us back to “earth”. Connecting with the natural earth, if it’s available to you, is best, but even feeling the floor in your office beneath you can be reassuring. A few suggestions for feeling grounded:
- walk on grass, barefoot if possible (watching out for dog poop, glass, etc)
- stomp your feet on the ground to feel how solid it is beneath you, knowing you are supported
- put your back up against a wall, again so you feel supported, with something to “lean” on
SUPPLEMENTS
As supplements are outside of my scope of practice, I asked genomics expert and functional medicine practitioner Ryan Frisinger if he had any safe over-the-counter supplements to combat anxiety. He gave me a GABA spray (that included things like L-Theanine, L-Carnosine, and pterostiblene) that worked great for me, taken before bed to wind down or anytime I felt stressed, but he cautioned me that it was not for everyone. The spray worked with my particular genetics, but could be harmful to someone else. He suggested Hyland’s Biochemic Phosphates, which are specifically formulated for anxiety and nervous system exhaustion and generally safe for everyone.
However, he was clear that anxiety is complicated and deserves a more thorough examination. Here is what he said:
A lot of anxiety is driven by foods that are excessive in tyrosine, tryptophan, sulphur and methione. All of those have the potential to activate the fight or flight response and imbalance neurotransmitters. The first step is to eat an anti-inflammatory diet: no grains, dairy or sugar. Additionally, many things in our modern medicine toolkit cause antibodies to the GAD enzymes, which make it hard for the body to change glutamate into GABA to help move the brain from a state of excitation to inhibition. We must also look at broad scale nutrient deficiencies (B-vitamins, magnesium, zinc, vitamin D, lithium orotate, vitamin C), because the biochemistry of the brain is downstream and if there is an insufficient supply of nutrients, we have uneven production of neurotransmitters. There are lots of supplements on the market that propose cures for anxiety like nervines (passionflower or Kava), or GABA sprays and capsules (Kavinace). Most of those are too generalized to treat anxiety effectively as the problem is always multifactorial in nature. It is also important to draw a distinction between anxiety and depression. Monitoring sleep quality is crucial because that will undermine the neurotransmitter system’s function and the circadian biology of the cells and organs. Finally, we need to be mindful not to overstep energetic boundaries, as some of this anxiety is caused by lifestyle choices that lead to chronic exhaustion of the nervous system.
I couldn’t agree more: diet, sleep and lifestyle are the areas to target when thinking about optimum functioning, which includes nervous system and emotional states. Until we have these dialed in, however, we need little tools to get us through stressful times. When I pressed him for a short-term suggestion to combat acute stress, he emphasized the importance of reengaging the brain to stop the spiral of anxiety. (That will be the subject of another post in the near future.) He agreed with all of my suggestions above, with the walk in nature being his top go-to, but added that 10 minutes of Tetris is HIS quick way to halt anxiety/panic attacks in their tracks. (If you are intrigued and want to hear more about Ryan’s work, I have listed some podcasts in the resources below).
These are just a few of the tricks I have learned along my journey of self-knowing. When I start to go down the spiral of worry, fear and panic, I try to be as compassionate with myself as humanly possible. None of these tricks works for me EVERY time, except for maybe the breathing techniques, but the more I develop body awareness, the more I find I can handle my stress with equanimity.
ADDITIONAL RESOURCES:
Vagus Nerve Stimulation Study
Vagus Nerve Stimulation Article
Ryan Frisinger Podcasts:
There is some controversy as to the function of this muscle, and it is hard to separate the upper fibers’ function from the rest of the muscle. All of the fibers work together, although during different actions some areas of the muscle work harder than others. The standard anatomy answer is that the upper trapezius is a prime mover of scapular elevation, which means it raises the shoulder blade. However, there is some excellent research (see resources below) to suggest that, due to the transverse direction of the upper trapezius fibers, its main function is to move the clavicle medially, thereby transferring compression loads from the cervical spine to the sternoclavicular joint (where the collarbone meets the sternum). This essentially means that the weight of the arm and anything it carries is transferred to the chest and mid-body rather than the neck. Pretty important! It would make sense then that if this muscle is weak, we might have some neck pain. This also makes the case for strengthening.
Neck and shoulder pain are among the most common complaints reported by new clients. Recent developments in pain science have largely debunked purely structural models as explanations for pain. However, structural analysis is still relevant as a piece of a larger paradigm, particularly when it comes to the neck and shoulders. So while biomechanics may not be everything, in most cases of neck and shoulder complaints, consistent forward head posture greatly contributes to the root cause of the pain. In some of these cases, there is an accompanying uncomfortable “dowager’s hump” at the base of the neck that forms when the vertebrae become compressed. Neurological overstimulation can also result from sustained tension in the 
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