Anxiety Reduction Techniques

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Anxiety Reduction Techniques

Definition

Purpose

Description

Aftercare

Risks

Normal results

Abnormal results

Resources

Definition

Anxiety reduction techniques are learned skills that can be used by an individual to help overcome anxiety and its associated mental and physical symptoms, including tension, worry, and nervousness. These techniques include relaxation, visualization and imagery, diaphragmatic breathing, stress inoculation, and meditation.

Relaxation or progressive relaxation

This anxiety reduction technique is based on the premise that anxiety and stress are associated with muscle tension. When one achieves deep muscle relaxation, muscle tension is reduced, and this relaxed state is incompatible with anxiety.

Visualization and imagery

This anxiety reduction technique aids the person in making a mental image of what he or she wants to accomplish. For example, an individual might wish to release worries or concerns, or create a relaxing image to escape momentarily from a stressful event.

Diaphragmatic breathing

This technique involves teaching a person to breathe sufficient amounts of air to help his or her blood fill with oxygen and be purified properly. In this technique, the individual breathes deeply from the diaphragm, which is located low in the chest, near the abdomen.

Stress inoculation

Self-talk, or the things that people tell themselves about stressful situations, can be habitual. For example, a person may take an ordinary event and automatically magnify its importance. Stress inoculation training is a type of therapy that teaches clients to cope with anxiety and stressful situations by learning more functional patterns of self-talk.

Meditation

In this anxiety reduction technique, an individual is trained to focus his or her attention on one thing at a time.

Purpose

The goal of learning and implementing anxiety reduction techniques is to help reduce the intensity of anxiety that an individual feels. These techniques are also helpful in teaching people how to relax and manage stress. Many of the techniques are used in combination with each other. For example, a person may be taught diaphragmatic breathing while also engaging in relaxation techniques, a visualization and imagery exercise, and/or meditation.

Relaxation or progressive relaxation

Relaxation has been used to help women during childbirth and people with chronic pain. Relaxation has also been used to treat muscle tension, muscle spasms, neck and back pain, and to decrease perspiration and respiratory rates. Furthermore, relaxation can help with fatigue, depression, insomnia, irritable bowel syndrome, high blood pressure, mild phobias, and stuttering.

Visualization and imagery

Visualization and imagery techniques have been helpful in treating general or specific anxiety, headaches, and muscle tension and spasms. They are also useful in reducing or eliminating pain, and in the recovery from illnesses and injuries. Visualization and imagery techniques have also been used by athletes to help them achieve peak performance.

Diaphragmatic breathing

Diaphragmatic breathing has been found to help people reduce anxiety, depression, irritability, muscle tension, circulation, and fatigue.

Stress inoculation

Stress inoculation has been helpful in reducing interpersonal and general anxiety. For example, these techniques may be used when a person has an upcoming job interview, speech, or test. Stress inoculation has also been used to treat phobias, fear of heights, and chronic anger problems.

Meditation

Meditation has been used to treat and prevent high blood pressure, heart disease, strokes, migraine headaches, immunization diseases, obsessive thinking, attention problems, anxiety, depression, and anger difficulties.

Description

These various techniques are often practiced and demonstrated in therapy sessions with a trained professional. In addition, the person learning the techniques would need to continue to practice them on a regular basis, outside of the therapy sessions.

Relaxation or progressive relaxation

In progressive relaxation, an individual is instructed to tighten and then relax various muscles. He or she either lies down or sits in a chair with his/her head supported. Each muscle group (such as face muscles, arm muscles, leg muscles, etc.) is tensed for five to seven seconds and then relaxed for 20 to 30 seconds. This helps the person recognize the feeling of tense and relaxed muscles. This entire procedure is repeated one to five times, and usually starts with the face muscles and moves downward to the foot muscles. When relaxation is used with chronic pain and childbirth, the techniques focus the person’s attention on breathing and relaxing muscles as a distraction from the pain. For mastery, relaxation techniques are typically practiced every day for one to two weeks. A person may engage in these techniques anywhere from 15 minutes to an hour per session. Sometimes, the individual will record and replay instructions on tightening and relaxing various muscle groups until he or she becomes familiar with the muscle groups and establishes a comfortable routine.

Visualization and imagery

The basic premise behind visualization and imagery is that one’s thoughts become reality. For example, if an individual thinks anxious thoughts, then he or she will become tense. The principle of visualization and imagery is that a person can use his or her imagination to be persuaded to feel a certain way or do anything that is physically possible to do. There are three basic types of visualization: programmed, receptive, and guided visualization.

In programmed visualization, the person creates a vivid image including sight, taste, sound, and smell. The individual then imagines a goal he or she wants to attain or some type of healing that is desired. In the visualization, the goal is achieved, or the healing occurs.

An idea underlying both receptive visualization and guided visualization is that the person is seeking an answer to a life question or resolution to an issue, and the answer or resolution is within the person, but is buried or inaccessible because of fear, doubt, or anxiety. These techniques are similar to dream interpretation and free association techniques used in psychoanalysis or psychodynamic therapy. For example, an individual may wonder whether he should remain in his current job. A proponent of these techniques would maintain that “deep down,” below the level of conscious thought, the man knows what he really wants to do, but he is not allowing himself to listen to his desires or to act—he is blocking the message his subconscious is sending him. The goal of these techniques is to enable the person to relax and focus enough to receive that message, so that he or she can do what needs to be done. In receptive visualization, the individual creates a peaceful scene in his or her mind. After the image is formed, the person asks a question and waits for the answer. To continue the example above, the man imagines a beach, and he asks himself the question, “Should I leave my job?” He continues to relax and remain in the scene, and he may “hear” an answer blowing in the breeze or “see” a boat sailing away, which may be symbolic of his wish to leave his job.

In guided visualization, the person creates a very vivid image, as in programmed visualization, but omits some important elements. The person then waits for the subconscious to supply the missing pieces. For example, a computer programmer may wonder if she should stay in her present job or return to school for an advanced degree. In engaging in guided visualization, she may visualize her cubicle at work, the pictures on her desk, the feel of her desk chair, the sounds of people outside her cubicle typing and talking, but she will omit an element from the scene. In this case, she may omit her computer. She will then wait to see what her subconscious uses to replace her computer. This woman may find in her visualization that her computer has been replaced by books, which may represent her desire to return to school.

Visualization and imagery exercises work best when a person is relaxed. Visualization and imagery exercises are typically practiced two to three times a day for 10 to 20 minutes at a time. How quickly an individual will see results can vary. Many times people report immediate symptom relief. However, the personal goals a person sets, the power of a his or her imagination, and willingness to practice can all influence how rapidly benefits can be obtained. Some people find it helpful to tape record and replay detailed descriptions of what they want to visualize or imagine.

Diaphragmatic breathing

Diaphragmatic breathing can typically be learned in minutes; however, the benefits may not be recognized until after several months of persistent practice. When breathing from the diaphragm, clients are often told to lie down on a rug or blanket, with their legs slightly apart, arms to the sides not touching the body, with their eyes closed. Attention is brought to the breathing by placing one hand on the chest and the other hand on the abdomen area. The client is then instructed to breathe in through the nose and exhale out the mouth. Each time the client breathes in, he or she should try to breathe deeper. This should be practiced for a minimum of five minutes once or twice a day. Over a few weeks of practice, the time period engaged in diaphragmatic breathing should be increased to 20 minutes and the activity can be performed while lying down, sitting, or standing.

Stress inoculation

As people go about their daily lives, they often have thoughts in which they are talking to themselves. Stress inoculation involves this self-talk in helping clients decrease their anxiety and stress. Stress inoculation therapy works on the basis of turning the client’s own thought patterns into a “vaccine” against stress-induced anxiety. The first step is to develop a list of stressful situations and arrange them from least to most stressful. Once anxiety-producing situations are identified, the client is taught to curb the anxiety-provoking thoughts and replace them with more positive coping thoughts. Once these new thoughts are learned, they can be tried out in real situations. The time it takes to replace old habitual thoughts with new thoughts can vary depending on the amount of practice and commitment to make this change.

Meditation

There are various forms of meditation. Depending on the type used, the individual focuses his or her attention in slightly different ways. For example, Zen meditation focuses on breathing, whereas in transcendental meditation, the person makes a sound or says a mantra selected to keep all other images and problems from intruding on his or her thoughts. With practice, a person can reach a meditative state and obtain its benefits within a few minutes.

Aftercare

After a person has learned and practiced anxiety reduction techniques, he or she may need additional instruction from a trained professional. Having a trained professional review these techniques can help reinforce what the person has already learned and been practicing. Furthermore, the person may identify aspects of the techniques that he or she is doing incorrectly, areas that need more attention or focus, and alternative methods of engaging in the techniques.

Risks

There are minimal risks associated with these techniques, but some physical problems have occurred. For example, precautions should be taken when doing progressive relaxation and tensing the neck and back. Excessive tightening can create muscle or spinal damage. Additionally, tightening various muscle groups, such as the toes or feet, could result in muscle cramps. If physical problems occur, such as difficulty taking deep breaths, unusual muscle pain, or an increased level of anxiety, then the individual should seek assistance from a physician.

Normal results

In general, after engaging in these anxiety reduction techniques, many people report an increased sense of well-being and relaxation. People have a greater sense of control, and confidence in their coping abilities. This results in a decreased need to fear or avoid stressful situations.

Relaxation or progressive relaxation

Progressive relaxation can be useful in reducing muscle tension. Engaging in relaxation may help to improve a person’s energy level, depression, and anxiety, as well as the ability to retrieve information from memory.

Visualization and imagery

By engaging in the positive thinking often associated with visualization and imagery, a person can create a clearer image of what he or she wants to accomplish. By repeating the image again and again, the individual comes to expect what he or she wants will occur. As a result, the person will often begin to act in a way more consistent with accomplishing the goal.

Diaphragmatic breathing

Sufficient amounts of air reach the lungs, which purifies and oxygenates the blood. Waste products in the blood are removed, and organs and tissues become nourished.

Stress inoculation

A person will have more realistic views of stressful and anxiety-producing situations in his or her life. The individual will be able to relax away tension by effectively thinking useful coping thoughts rather than negative interpretations of situations.

Meditation

As people learn to meditate, they often discover that they have some control over the thoughts that come to their minds, as opposed to feeling as though thoughts “pop” into their heads. Many people begin

ROLLO MAY (1909-1994)

Rollo May was the second of six children and the eldest son of Earl Tuttle, a Young Men’s Christian Associations field secretary, and Matie Boughton May, a homemaker. May grew up in Michigan in a family that had “more than its share of troubles.” He later described his parents as “austere disciplinarians and anti-intellectuals” and portrayed their relationship as “discordant” and the precursor for his interest in psychology and counseling. His oldest sister was frequently psychotic and spent time in mental hospitals.

His lectures on counseling and personality adjustment were published as his first book, The Art of Counseling: How to Gain and Give Mental Health (1939), which was well regarded. May studied psychology at Columbia University in New York City. While working on his dissertation in 1942 and still counseling, May was diagnosed with tuberculosis. His personal struggle against death solidified his views on existentialism. While recuperating in upstate New York for almost two years, May wrote The Meaning of Anxiety (1950), which he considered the “watershed” event of his career. He stressed that anxiety can be a positive, motivating force for social and personal development, and that people can use their inner resources for life choices. In 1953 May published his second book, Man’s Search for Himself. Written in laymen’s terms, it was a popular and critical success and established May as a leader of American existentialism.

By the early 1960s May had become a leader in challenging behaviorism and psychoanalysis. He “defected” from biological determinism by stressing unique conscious elements in individual psychology. After moving to California in 1975, he resumed his private practice as a therapist. He also served in various capacities at the Saybrook Institute of the California School of Professional Psychology. More books and ideas followed: Power and Innocence: A Search for the Sources of Violence (1972), The Courage to Create (1975), My Quest for Beauty (1985), and The Cry for Myth (1991). May was a prolific writer and thinker who wrote more than fifteen books, many of which are directly related to his personal life and growth as a person. He was the recipient of the American Psychological Association’s Gold Medal for his distinguished career in psychology, Phi Beta Kappa’s Ralph Waldo Emerson Award, and the Whole Life Humanitarian Award.

to recognize dysfunctional patterns of thought and perceptions that have influenced their lives. Additionally, many people report a greater ability to manage their emotions and gain a greater sense of stability. When a person meditates, he or she often suppresses the activity of the sympathetic nervous system, the part of the nervous system that activates the body for emergencies and activities. Meditation also lowers a person’s metabolism, heart, and breathing rates. Additionally, meditation decreases the chemical in the body often associated with stress.

Abnormal results

Once a person begins to implement these anxiety reduction techniques effectively, he or she may discover old or hidden psychological pain. The individual may feel angry, frightened, or depressed, and it may be beneficial for him or her to talk to a friend, mental health professional, or meditation teacher.

Some people have difficulty with various aspects of the different techniques. For example, an individual may feel restless when first learning how to meditate, ormay feel as though a thousand thoughts are running through his or her mind. However, with practice and assistance from a trained professional, these difficulties will subside. People who feel frustrated or discouraged may simply need to find ways to make the practice of these techniques more comfortable. As is the case with many other skills, effectively reducing anxiety with these techniques requires patience and practice. If an individual does not consistently practice these techniques, the benefits will probably not be obtained.

Resources

BOOKS

Bourne, Edmund J. The Anxiety and Phobia Workbook. 4th ed. Oakland, CA: New Harbinger Publications, 2005.

Donaghy, Marie, Rosemary A. Payne and Keith Bellamy. Relaxation Techniques: A Practical Handbook for the Health Care Professional. Oxford: Churchill Livingstone, 2005.

Smith, Jonathan C. Stress Management: A Comprehensive Handbook of Techniques and Strategies. New York: Springer Publishing Company, 2002.

Veeraraghavan, Vimala and Shalini Singh. Anxiety Disorders: Psychological Assessment and Treatment. Thousand Oaks, CA: Sage Publications, 2002.

Wolpe, Joseph. Practices Without Principles. Washington D.C.: American Psychological Association, 2006.

PERIODICALS

Arch, Joanna J. and Michelle G. Craske. “Mechanisms of Mindfulness: Emotion Regulation Following a Focused Breathing Induction.” Behaviour Research and Therapy 44.12 (December. 2006): 1849–58.

Bornas, Xavier, and others. “Changes in Heart Rate Variability of Flight Phobics During a Paced Breathing Task and Exposure to Fearful Stimuli.” International Journal of Clinical and Health Psychology 6.3 (September 2006): 549–63.

Hunt, Melissa, and others. “The Role of Imagery in the Maintenance and Treatment of Snake Fear.” Journal of Behavior Therapy and Experimental Psychiatry 37.4 (December 2006): 283–298.

Lundgren, Jesper, Sven G. Carlsson, and Ulf Berggren. “Relaxation Versus Cognitive Therapies for Dental Fear—A Psychophysiological Approach.” Health Psychology 25.3 (May 2006): 267–73.

Meuret, Alicia E., Thomas Ritz, Frank H. Wilhelm, and Walton T. Roth. “Voluntary Hyperventilation in the Treatment of Panic Disorder—Functions of Hyperventilation, Their Implications for Breathing Training, and Recommendations for Standardization.” Clinical Psychology Review 25.3 (May 2005): 285-306.

Rausch, Sarah M., Sandra E. Gramling, and Stephen M. Auerbach. “Effects of a Single Session of Large-Group Meditation and Progressive Muscle Relaxation Training on Stress Reduction, Reactivity, and Recovery.” International Journal of Stress Management 13.3 (August 2006): 273–90.

Roth, Walton T. “Physiological Markers for Anxiety: Panic Disorder and Phobias.” International Journal of Psychophysiology 58.2-3 (November-December 2005): 190–98.

ORGANIZATIONS

American Psychiatric Association, 1400 K Street NW, Washington, DC 20005. <http://www.psych.org>.

American Psychological Association, 750 1st St. NE, Washington, DC 20002. Telephone: (202) 336–5500. <http://www.apa.org>.

Anxiety Disorders Association of America. 11900 Parklawn Drive, Suite 100, Rockville, MD 20852. Telephone: (301) 231–9350. <http://www.adaa.org>.

The National Institute of Mental Health, 5600 Fischers Lane, Room 15C05, Rockville, MD 20857. Telephone: (301) 443–4513. <http://www.nimh.nih.gov/>.

The National Mental Health Association. 1201 Prince Street, Alexandria, VA 22314–2971.

Keith Beard, Psy.D.

Ruth A. Wienclaw, PhD