Practical Techniques for Coping with Anxiety and Panic

Dr. David L. Kupfer, Ph.D.

All effective coping techniques aim to teach you that anxiety is a normal, natural, manageable psychophysiological state. In other words, anxiety is OK.

1. Focus on the present.

When anxious, be aware if your attention is on the future (“I’m going to have a heart attack if I stay this nervous”) or the past (“This is just like that last time”). If so, return your focus to the present (“My heart is beating, the steering wheel is blue, etc.”).

2. Focus on the physical.

Anxiety may worsen if you focus on your mental worries about the bad things that might happen. Reassurances can come from returning your attention to whatever it is that is happening physically; for example, “Hmm, now that I notice it, my heart isn’t really beating that fast.”

3. Give yourself a relaxation break.

One quick way to lower your anxiety level and increase your sense of control is to take three deep, slow abdominal breaths. Extend your stomach out while you inhale, pause for a moment, and then exhale slowly and fully. Pause and take two more breaths like this one, each one slower and deeper than the last.

4. Re-thinking without judgment

If you notice self-criticism or negative judgments about yourself in your thinking, interrupt those thoughts. Try out more realistic self-supportive thoughts, such as, “It’s OK to be anxious, I can still do things even if I’m nervous… Nothing is urgent, I can take my time…I can trust my mind and body to handle some discomfort; God didn’t make junk.”

5. Paradoxical techniques.

If you are scared that anxiety will lead to a loss of control, you might be able to reassure yourself by trying on purpose to make your anxiety symptoms worse. You will probably fail to make them worse, which will truly reassure you. For example, you can focus your mind on a physical anxiety symptom like your hands sweating. Tell yourself to sweat more. When you notice that your symptoms don’t get worse even when you try to increase them, you will be learning faith in your body’s natural ability to regulate itself. Mental paradox is useful for people who just can’t get their minds off a catastrophe they fear. You may fear fainting, losing control of your car, going crazy, or having a heart attack. If you can’t get your mind off these fears, try thinking only about these disasters for several minutes. You probably won’t be able to do this. You can also try following your catastrophic fears to their endpoints, by asking yourself “And then what?” after focusing on your worst fear. For example, “I’ll pull over to the side of the road and pass out.” “And then what?” “I guess someone would stop and help me after a while.” This type of internal dialogue usually leads to a reassuring laugh at yourself, or an awareness that nothing terrible is very likely to happen.