Contact with the Present Moment: Acceptance and Commitment Therapy Series

Imagine with me that you’ve been in therapy for a while.  You’ve been addressing the faulty thinking patterns of shame and self-doubt that led you into depression.  Or you’ve been working through panic and crippling fear that propelled you into treatment for anxiety.  Perhaps addiction and its lasting effects on you and your family led you to seek counseling, and you’re beginning to experience healing.  Or you’ve learned strategies to cope with some of the worst of your chronic pain. 

Yet, in spite of these gains you’ve been making, you find that you still get stuck.  Whether you wish you could just make the anxiety go away, or you are hit with triggers of addiction at the most inopportune times, the lasting impact of these experiences might never disappear.  You wonder to yourself, “will I ever just be happy and not have to deal with this anymore?”

Enter the game-changing principles of acceptance and commitment therapy, or ACT.  ACT is based around the concept of psychological flexibility: an openness to your present experience that allows you to adapt your response to any circumstance in service of your personal values.  Rather than attempting to change or eliminate negative thoughts or alter emotions, ACT focuses on utilizing mindfulness to recognize and separate who we are from our negative internal experiences (acceptance) and focus instead on implementing value-based actions (commitment).  It acknowledges that suffering is a universal and inevitable reality, and the goal of “being happy” isn’t always realistic to life.

Often where we get stuck in our work through varied mental health and life struggles is wishing they would disappear entirely.  But when that is not an option, ACT provides another path that can enrich and deepen your life.

In this series, we’ll be covering the six components of psychological flexibility that make up the foundation of ACT.  These include contact with the present moment, acceptance, defusion, values, self as context, and committed action. 

Contact with the Present Moment

Consider the thoughts you’ve had in the past hour.  How many of them have been about something that’s coming up in the future?  What about past experiences and events?  Or have any of them been focused on what’s happening right now?

The majority of our thoughts are focused on recalling past events or planning for the future, rather than being in the present.  Therefore, we don’t accurately observe what we’re experiencing in the moment.  Our lack of connection to present experience causes us to feel confused when we react in a way we don’t expect to certain situations.  We don’t often understand the cause and effect of our actions because we are distracted by our thoughts.

Contact with the present moment requires you to “be here now.”  Be present with your thoughts.  Be aware of what is happening in your body.  Notice the sensations you feel, the ways in which your five senses are interacting with the world around you.  Be conscious of your emotional landscape.  In essence, this component invites you to bring attention to your current experience without the filter of your thoughts and judgments. 

Principles

Nonjudgmental awareness

What does it mean to bring attention to your experience without a filter?  It requires you to contextualize your emotions, sensations, thoughts, and urges as data of which to take note, rather than interpreting those events with certain labels or assumptions.

We tend toward these judgments naturally.  Have you ever had thoughts like, “This is bad,” “I am stupid,” or “That would be perfect”?  Most commonly, we label things as “good” or “bad.”  For example, you might feel excitement about an upcoming event and label that experience as “good,” but fear about driving through rush hour traffic is labeled as “bad.”  On the way, a car could cut you off in traffic, and you automatically have a negative thought about someone else, label the thought as “bad,” and become angry with yourself for having that thought. 

Instead of jumping to judge, this component encourages you to approach those thoughts and emotions differently.  Notice what happens and occurs in your body instead of instantly moving to label or assume something about yourself or someone else.

Let go of the “why”

We often seek to make meaning out of our experiences, whether consciously or not.  We have a natural tendency to try to figure out why things work the way we do, including our minds and our bodies.  However, that can sometimes backfire and prove unhelpful, particularly in situations that have many factors outside of your control.

Attempting to find the meaning behind an accident or sudden death can keep you stuck in pain much longer than is needed.  Similarly, wondering why you’ve been hit with chronic pain or illness simply intensifies the experience.  Staying with the present moment and experience without venturing into the “why” of it is another way to prevent losing contact with the present.

Mindfulness as an access point

Mindful awareness in ACT is intended to help you come to know and understand yourself more fully.  The purpose of mindfulness here, moreso than relaxation, is to recognize our minds, feelings, urges, body sensations, and experiences in a way that helps us come to terms with our reality.  Mindfulness is not emptying the mind, controlling the mind, or focusing concentration. Mindfulness can happen even if you aren’t sitting still or you struggle to focus on your body.  Any moment can provide an opportunity to check in and become more aware of your internal landscape.

There is no right or wrong way to approach mindfulness.  In fact, the way in which we approach mindful awareness can often teach us something about how we are living our lives and the challenges we experience.  Have trouble connecting with your body? That’s a piece of data you can take away and learn about yourself.  Find yourself falling asleep when you try to do a mindful breathing exercise? That could hint at some clues about your pace of life or your needs for sleep.  Let the process of mindfulness be another source of learning about yourself.

Practices

Create intentional space for mindful awareness

In your busy day, you might find it difficult to devote an extended period of time to a guided meditation or mindfulness exercise.  Instead, look for opportunities to create a moment or two where you pay attention to your thoughts, emotions, and experiences in the present moment in a different manner than you would normally.  I’ve written previous articles about quick meditations or simple grounding exercises that may provide helpful strategies or ideas to implement this.

Use formal or informal practice

You might be someone who is well served by setting aside a specific time each day for a mindfulness meditation or grounding exercise, like those listed in the article above.  If that describes you, find a time in your day where you can slot 10-15 minutes to sit quietly, breathe, and bring awareness to your internal experience.  Meditation apps like Headspace or Calm may help you if guidance would feel supportive.

But what if you don’t have the time to set aside for mindfulness meditation?  Remember what we discussed earlier – you can be mindful at any moment throughout your day.  Bring awareness to the warm water on your hands and the smell of dish soap as you wash the dishes.  Notice the thoughts that are running through your mind while you’re out for a walk.  Pay attention to the feelings that arise in you while you’re having a conversation with your spouse or a friend.  Any moment can be a mindful moment if you choose to bring present awareness to your thoughts, emotions, sensations, and urges.

Build in a daily pause

Create a time each day where you can slow down and observe or describe your experiences.  This might be first thing in the morning before you hop out of bed or as you prepare to fall asleep.  You may want to set an alarm for some point during the day as a reminder to check in with your internal experience.  Focus on what’s happening, rather than interpreting what is happening through a label of judgment.  What’s more important for you is the growing awareness of what is happening internally, not the mind’s interpretation of what is happening.

Make it work for you

Don’t allow someone to tell you, “you need to meditate every day for 15 minutes or else you’re doing it wrong.”  As mentioned earlier, there is no right or wrong way to be mindful!  Adapt what works for your circumstances at this point in your life.  Allow for flexibility as you seek to connect more with the present moment, and let go of any rigid expectations or needs for the time.  Often you’ll find that it’s challenging to become aware of the present moment, or your experience doesn’t go how you would expect.  Resist the urge to label that as a “bad” experience and instead remember that it is all normal, part of the learning process, and also providing you with helpful information about yourself.

Keep an eye out in future weeks as we continue to explore the different components of psychological flexibility found in ACT that can help you get unstuck in your healing process.

How to Cope With a Trauma Response: Part 1

Your day is progressing just like any other.  Waking up, getting the kids ready for school, going to work, preparing dinner…when all of a sudden, out of nowhere, you’re hit with a flashback of the event.  You feel a pit in your stomach, sweat breaks out on your forehead, and you feel your heart rate spike.  You’re having trouble breathing, and you feel the urge to escape. 

If you have post-traumatic stress disorder (PTSD) or symptoms related to PTSD, you probably know this experience well.  Memories of the trauma or triggers that remind you of the event can send you into a tailspin: you’re fine one moment, then in a panic or shut down the next.  For partners who have experienced betrayal trauma, this response arises with triggers related to their addicted spouse’s behaviors.

The experience of a trauma response can be scary, as it often comes on suddenly and feels impossible to stop.  It can be exhausting to go through one of these experiences as your body goes into overdrive, trying to protect you from a threat that (often) isn’t there.  To cope with your response, you might shut down into a depression, lash out in anger or irritation at the people around you, collapse into grief and sadness, or turn inward with shame.

How do I know I’m having a trauma response vs. pure anxiety or panic?

There are several common symptoms of post-traumatic stress disorder that may come up when trauma resurfaces:

• Flashbacks to traumatic events (re-experiencing the memory as if it were happening now)

• Mood swings and emotional volatility

• Exaggerated startle response

• Avoiding certain triggers or activities that you used to find enjoyable

• Low self-esteem

• Isolation and withdrawal from others

Trauma shares symptoms with anxiety and/or panic attacks.  Anxiety often includes worries that are more future-oriented than trauma.  While it is true that some anxiety centers around worry about events from the past, trauma responses are different in that they can be traced back to a specific memory of a traumatic event.

Panic attacks can also arise as a result of trauma, with symptoms such as racing heart rate, sweating, feeling faint, nausea, and worry that you’ll die (often related to the heart rate symptoms).  If you experience these symptoms, be sure to meet with your doctor to rule out any underlying medical causes.  However, if there is no obvious medical cause, see if you can connect your reaction to a specific reminder of trauma (as in a trauma response), or notice if the panic arises seemingly out of nowhere (as in panic disorder).

How to Manage Trauma Responses

There are two stages to handling trauma responses.  First, you need strategies to bring yourself back into your window of tolerance by calming the physical and emotional reactions you’re having.  Once you’ve been able to calm and self-soothe, the next step involves exploring the cause of the traumatic response and some options for processing and addressing that trauma.  Today, in Part 1, we’ll talk about the first step: reducing the intensity of your initial response. 

Reduce the physical and emotional overwhelm caused by the initial hit of trauma.

You can’t think straight when you’re in the middle of a trauma response, as your body and mind take you out of your prefrontal cortex (the part of your brain involved with decision-making, impulse control, and executive thinking) and move you into your limbic system (the emotional center; the fight-flight-freeze response).

In order to bring your thinking brain back online, it is necessary to calm down your nervous system enough to communicate to yourself that you don’t need to run from a threat, as the adrenaline response is prompting you to do.  Deep breathing, guided meditations, progressive muscle relaxation, grounding exercises, and other ways of calming down the nervous system are useful during these moments.

Use coping thoughts to calm your emotions.

Often, the traumatic event happened in the past and is not currently occurring, as in an experience of a car accident or a past experience of sexual assault.  In these cases, you can use words to remind yourself of your current distance from that painful experience.  They can help you ease the initial intensity of the trauma response.  These might include phrases like:

• I’m safe now, in this moment.

• I’m no longer in that situation.

• I can get through this.

• This too will pass.

• That was a painful experience, and I am not living it now.

But what if the trauma is ongoing?  When you are in a relationship with a sex or love addict who has betrayed you and are working the process of recovery, the traumatic experience may feel more present and real due to broken trust.  In those cases, it may be more helpful to use self-encouraging statements to affirm the strengths you have that are carrying you through.  These might include words like:

• I’ve been through painful moments before, and I’ve survived.

• I’m strong enough to handle this.

• I can’t control other people’s actions, but I can control my decisions and how I respond.

• I can handle this one day at a time.

• This is hard now, but in the long-term, I’m going to be okay.

Use a distraction technique.

If meditations and coping thoughts aren’t cutting it, use a distraction technique.  These are not meant to create unhealthy dissociation from your feelings or events, but instead are meant to help calm the intensity of your experience so that you aren’t as overwhelmed by it and can approach it with more curiosity.  It helps to think of this distraction as temporary, meant to bring your level of intense emotion down so that you can make sense of your reaction and respond differently. 

Using strategies popularized by dialectical-behavioral therapy (DBT) can help create this distraction.  Find an enjoyable activity that you can engage in for a period of time that takes your mind off the trigger.  Engage in a self-soothing behavior that helps you connect to your five senses.  Use the acronym ACCEPTS to help you connect with ways you can distract yourself from the distress. 

In Part 2, we’ll delve into how to explore and process the trauma response, creating tools to help you navigate its impact differently in the future.

Creating Hope in Chaos: A Therapist's Guide to Thriving During the COVID-19 Crisis

The current upheaval to many of our daily lives as a result of the COVID-19 outbreak is something we as a society have never experienced before.  Every person is affected directly or indirectly, by stay-at-home orders, closures of stores and restaurants, financial shifts, and the spread of the illness.  It’s easy for those who do not typically struggle with anxiety or depression to feel the stress of this moment in the world.

This makes the call to care for our mental health that much more important.  But how can we do that when many of us are stuck at home?  Here are a few ideas that may help you not only to get through this crisis, but perhaps to begin to thrive in the midst of and as a result of it.  Engaging in items on this list can create opportunities to change the way you approach your life for the long-term.

Reducing Anxiety

Limit your media intake. The public health crisis is constantly changing.  Every news media outlet is producing massive amounts of coverage of anything and everything having to do with the coronavirus.  It makes sense that many of us would want to follow these updates through the news.  But this can easily turn into constantly checking headlines or social media, feeling our anxiety rise with the second.

Create a limit for yourself on how much time you’ll spend on social media, news websites, or even watching TV coverage of coronavirus.  Choose a certain time of day when you will check and set a boundary to limit how long you’ll read or watch.

Incorporate deep breathing and meditation practices. Breathing and meditation can be a helpful way to calm the panic response that surfaces with anxiety.  If you notice yourself experiencing physical symptoms of anxiety, focus on taking a few deep breaths, allowing the air to move down into your abdomen.

Guided meditations, which can be found on YouTube or through various apps, can be helpful to direct your mind to focus on your breath.  Many of these resources offer options for children as well.  For example, many mobile guided meditation apps such as Headspace and Sanvello are offering free access to services during the crisis. 

Practice gratitude. One of the greatest protections against anxiety is to focus on appreciating what you currently have.  Spend time daily reflecting on areas of your life for which you can be grateful.  If this crisis has allowed you more time to spend with family or focusing on tasks at home, find thankfulness in that.  Begin a list or a gratitude journal that helps you consistently keep track of the positives in your circumstance. 

Self-Care

Go outside. Even if you are in a community that has required its citizens to stay at home during this crisis, those orders often allow for physical activity outside.  Use this extra time to go for a walk or run.  Take your kids out on a bike ride or walk around the neighborhood.  Play or relax in your yard together.  Spending time in nature offers a multitude of mental health benefits, so why not take advantage of those now?

Practice active rest. Much of the reaction I’ve seen from people who have the privilege of being able to work from home is to rejoice in the fact that they get to catch up on their Netflix queues.  While there’s nothing wrong with watching a good show from time to time, spending a whole day bingeing on TV can lead to feelings of guilt or lethargy.  You might not have done anything during the day, but you still feel exhausted, whether from staying up too late watching your shows or the strain of so much screen time.

Instead of doing those things that seem like rest but are actually draining, lean into habits that provide actual rest for you.  Allow yourself to sleep in or take a nap.  Read a good book.  Pray, spend time reading the Bible, or practice other spiritual self-care.  Spend lazy hours talking with your loved ones or playing board games.  Letting your mind and body catch up on rest from the frenzied pace of normal life can be an incredible blessing during this season.

Exercise. As mentioned earlier, walking or running outside is an easy way to get out of the house while still following guidelines for health and safety of others.  Get into the practice of taking a short walk daily.  If you’re used to a commute to work, “walking” to work by strolling around the block can be an easy way to set boundaries at the start and end of your work-from-home day. 

What if you usually go to the gym to get in your exercise?  Look for opportunities to do those same exercises from home.  Free videos on YouTube (like Yoga with Adriene) or subscription programs (like OpenFit) offer at-home workouts that you can do from the safety of your living room.

Social Connection

Call a loved one every day.  Just because we’re “social distancing” doesn’t mean that we have to cut off all connection with the people we love.  I was inspired by a recent blog post by Marnie Ferree to get out my phone and call one of my loved ones on a daily basis.  This can be a family member, friend, coworker, or other member of your community that can help you feel connected within the craziness. Reach out to someone you haven’t connected with for some time and catch up on how they’re doing, offering your empathy and support in response.

Write notes of encouragement. Have you ever received a handwritten note in the mail?  It can be heartwarming to receive words of encouragement.  Why not spread the love during this time with the extra minutes we may have in our day?  Write notes to medical professionals who need support, friends who you know are feeling financial strain, or just to maintain connection with those you love. 

Have a family game night or scavenger hunt. The busy pace of life can prevent families from being able to spend quality time together on a more regular basis.  This period of extended time at home creates an opportunity for family members who don’t often get to see one another to spend quality time together.  As tempting as it may be to all sit in front of your individual screens, coordinate an evening where you play a game together or create a scavenger hunt through the yard or neighborhood for different items.

Use technology creatively to connect.  Video messaging platforms have allowed people to continue to connect when they are thousands of miles apart, so of course they can be used to connect with people who are just down the street.  Have a coffee date with a friend by brewing your own cups and then sitting down to chat.  “Go out” for drinks with your friends virtually.  Play a cooperative game with friends on a video gaming console or with various apps that allow you to connect in different locations.

Volunteer or donate. As a follow-up to the gratitude practice, you  may find yourself recognizing how blessed you are in comparison with others.  Although it may seem like you can’t do much while you are cooped up at home, there are plenty of ways you can serve and bless those who are dealing with more difficult circumstances.  Many local charities are accepting financial or material donations to support those in need.  Hospitals and medical facilities are accepting donations of certain medical supplies.  Many food pantries are still open and collecting dry goods.  If you have extra disinfecting wipes, hand sanitizer, or even toilet paper to share, consider offering it to neighbors of yours who may not have those supplies.

Notice the Positive

Reflect on what you’re learning. Ask yourself what you may be learning or observing during this drastic change in circumstances.  Can this new perspective or knowledge impact the way you live your life in the future?  How might you want to change our daily habits as a result?  For instance, perhaps you’ve enjoyed having extended time with your household and want to make that a priority in the future.  Perhaps you’ve discovered a new hobby or interest that will shape how you spend your leisure time once this crisis has passed.  

Focus on others. Often, this goes hand-in-hand with the suggestion of volunteering time or donating supplies.  When you shift your gaze to others who are in need, you are more likely to feel grateful for what you have and relieved of anxiety.  Pray for those in your community specifically, and ask others who you might pray for them.  Identify ways you can love or bless the people in your community using a strategy listed above.

Search for acts of kindness. The moments that have floored me most throughout this crisis have been the acts of kindness I’ve witnessed that offer hope and joy to others in the midst of chaos.  Keep your eyes open for ways in which your community might be carrying out some of these gestures. Brainstorm ways you might be able to participate in those acts of kindness.  Search for lists of ideas or become inspired by news coverage of these choices people are making to bring hope. 

Understanding the Window of Tolerance and How Trauma Throws You Off Balance

Have you ever felt out of control of your emotions?  Overtaken by anger or rage?  Swarmed by anxious thoughts and worries? Confused by the intensity of your emotional reactions?

What about feeling shut down emotionally? No matter how hard you try, you can’t seem to feel anything.  You’re disconnected from relationships and others, and you coast through your day feeling numb.

Chances are, if you’ve had this happen to you, you’ve been outside of your window of tolerance. 

What is the window of tolerance?

Coined by Dr. Dan Siegel, the term “window of tolerance” describes the space where your level of arousal (how alert you are) matches up with what is required for you to do.  This window is the space where you can approach day-to-day life most effectively, handling emotions without losing control and making clear-headed decisions with rational thought.

Imagine an average day where you aren’t troubled by too much stress, but you’re still alert and able to focus on your tasks.  Typically, this would place you right in the center of your window of tolerance: you’re not facing anything beyond what you can handle.  You can experience emotions without being overtaken by them and feel safe in general.

Let’s say a minor stressor comes up: you get a phone call from your boss that requires you to do additional work, or an email comes in from your child’s teacher about misbehavior in their class.  That stressor will increase your level of arousal, maybe even to put you at the edge of your window of tolerance, but if you’re still within that window you can handle the stress without getting too out of sorts.

Our brains are designed to handle the ups and downs of emotions and experience by remaining within this window of tolerance.  We may have unconscious coping mechanisms in place that help us handle that stress, or the passage of time brings us back to the center of that window.

The National Institute for the Clinical Application of Behavioral Medicine (NICABM) has provided this infographic to help you visualize the window of tolerance.

What happens when I go outside the window?

When a circumstance, stressor, or trigger is enough to throw you outside the window of tolerance, you enter into survival mode.  Outside the window of tolerance, the prefrontal cortex of your brain (involved in impulse control, decision-making, and regulating emotions) shuts down.

If your level of arousal is too high and jumps above the window of tolerance, you’re experiencing hyperarousal.  Usually this is the initial response when a stressor throws you off balance.  Hyperarousal comes from your fight-or-flight adrenaline response, which can show up with increased heart rate, racing thoughts, digestive issues, or hypervigilance in your surroundings.  You might feel an intense wave of anxiety, panic, or anger.  Your emotions can be overwhelming and out of control.

If your level of arousal is too low and dips below the window of tolerance, this is hypoarousal.  This comes from a freeze and shut-down response, often as a reaction to the adrenaline rush of hyperarousal.  Hypoarousal can look a lot like depression.  You might notice lack of motivation, exhaustion, and feeling numb and disconnected from emotions.

How Trauma Affects the Window of Tolerance

If you’ve experienced trauma, whether big T (like a natural disaster or prolonged abuse) or little t (like gaslighting or emotional manipulation that adds up over time), you know that reminders of those experiences can bring you back to how it felt then.  These triggers happen out of nowhere.  A sound, smell, or location can send you into a negative spiral.  Often, these triggers go unnoticed and you’re left feeling anxious, depressed, or some combination of the two without really knowing why.  Other times, these are obvious reminders that trigger flashbacks or physical reactions in your body.

If you have experienced trauma, your window of tolerance shrinks.  The traumatic experience has likely taught you that the world is unsafe and unpredictable.  Triggers related to the trauma also increase emotional response, skyrocketing you out of your window of tolerance before you’re even aware of what’s happening.

Because the window of tolerance is smaller, you’re likely to fluctuate more often through hyperarousal and hypoarousal.  Something as simple as that call from your boss or email from your child’s teacher could send you into an anxious spiral. 

In some cases, when you’ve been outside of your window of tolerance for a long period of time, clinical levels of anxiety or depression can develop. Survivors of trauma may learn to adapt to fluctuations between hyperarousal or hypoarousal by moving toward unhealthy behaviors, such as addictions, to manage their discomfort.

How can I stay in my window of tolerance?

There are healthy alternatives to addictions or other destructive ways of coping that can help you to return to your window of tolerance.

• Breath work and grounding. Bring yourself into the present moment by taking a few deep breaths.  Use a breathing technique like four-square breathing or the 5-4-3-2-1 grounding exercise to help you remember that you’re in the present.

• Check your thoughts. Talk to yourself about what’s going on in the present.  Question whether the feelings of panic or lack of safety are based in factual reality, or if they’re an echo of the past trauma.  Affirm yourself for changes you’ve made and work you’ve done or are doing to heal from the trauma.

• Self-care. When you notice your emotions getting out of control, think of that as a red flag indicating your need for self-care.  This can include things like going for a walk, taking a hot shower, giving yourself a few minutes to breathe, or calling a friend.  Look for self-soothing actions that help you not to be overcome by the emotion and ground you in the present

• Connection with loved ones.  Feeling supported and cared for by your loved ones can serve as an important part of self-care when you’re reeling from a trauma-related trigger.  Connect with your loved ones via phone call, text, or in-person meeting to remind you of their present role in your life. 

Expanding Your Window of Tolerance

The solutions above can be great in an emergency when you find that you’re already outside of the window of tolerance.  But if you’ve experienced trauma and are coping with a smaller window of tolerance, these will only provide a temporary fix.  Luckily, it is possible to grow that window of tolerance with focused work.

• Therapy. Creating space to process and deal with the impact of trauma on your everyday life with a professional counselor or psychologist can help create a buffer for your emotional reactions.  Your relationship and connection with your therapist is the most valuable part of any therapy relationship, moreso than what technique that therapist uses.  Find someone with whom you feel comfortable and safe and who can help you stay within the window of tolerance in your sessions, as healing can’t occur when you’re outside of that window.

• EMDR. As an EMDR-trained clinician, I have seen EMDR change the game with clients who have survived trauma.  EMDR (eye movement desensitization and reprocessing) helps process and reorganize the traumatic memories in your brain such that they aren’t creating such strong emotional reactions.  This technique replaces the negative narratives and emotions from those memories with a more grounded and centered perspective coupled with positive, affirming words.

• Regular meditation practice.  While the short version of meditation and breathing mentioned above can help in a pinch, regular meditation practice can do wonders for extending the window of tolerance.  Doing regular breath work over time can create a habit that develops into a reflex to react to stress with conscious breathing.

Rescue Meditations for Anxiety and Panic

Have you ever experienced high levels of anxiety bordering on panic?  Symptoms like shortness of breath, chest pain or pressure, sweating, heart pounding, dizziness, and racing thoughts can be overwhelming when they arise.  And if it’s ever developed into a full-blown panic attack, you know the paralyzing fear that comes with that experience. 

When these symptoms arise for you, it’s a good idea to consult your medical doctor.  Some symptoms are shared in common with heart or lung issues, so you want to be sure there’s not an underlying medical concern that’s causing the symptoms.  But if you check with your doctor and you are otherwise physically healthy, your doctor might recommend psychological treatment and/or “rescue medications.”

Rescue medications, such as Xanax or Ativan, are anti-anxiety medications that help to bring your symptoms down to a manageable level when you are facing a high level of panic or anxiety.  I believe these medications can be helpful in crisis scenarios.

But if you don’t have these rescue medications or prefer a more natural approach, there are ways in which you can harness your body’s natural calming systems to relieve that anxiety.  Below are some suggestions for rescue “meditations” that you can do when you’re experiencing panic or even just feeling overwhelmed and stressed. 

If you find that these strategies aren’t effective or you’re continuing to experience symptoms, seek out help from your medical doctor or a mental health professional to address what is causing the panic.

Deep Breathing

When you’re panicked or anxious, breathing patterns are more shallow.  If you place a hand on your chest while you’re feeling stressed, you’ll likely find it rises and falls in short bursts.  The goal in taking deep breaths is to engage your diaphragmatic muscles in your abdomen.  This triggers your body’s natural calming system that helps you relax. 

To do this exercise, sit comfortably in a chair or lay on your back in a comfortable position.  Place one hand on your chest and one on your abdomen.  Take a few breaths and notice which hand moves.  Focus your breath so that your hand on your abdomen is rising and falling more with each breath.

Next, take a series of breaths with one of the following patterns:

• 4-square breathing: breathe in for 4 counts, hold at the top for 4 counts, breathe out for 4 counts, and hold the exhale for 4 counts

• 4-2-6 pattern breathing: breathe in for 4 counts, hold at the top for 2 counts, and breathe out for 6 counts

Do 10 repetitions of one of these patterns.  Using a breathing pattern that focuses on a longer exhale helps regulate the body. It activates the parasympathetic nervous system, the part of your body that calms the fight-or-flight response associated with anxiety and panic.

Guided Meditation for Anxiety (Yoga With Adriene)

On her YouTube channel, Adriene of Yoga with Adriene offers a playlist of short, guided meditations that can help you when your’e in a crisis.  She also has yoga practices designed to help you ground yourself or deal with anxiety on her YouTube channel.  If you have the time to do a longer workout or yoga practice, this might be a good fit for you.  Moving your body is a great way to deal with anxiety or panic.

Headspace or Other Meditation Apps

Headspace is a great app teaching the basic skills of meditation.  They include short videos describing how to approach meditation, and they offer their first 10 basic meditations for free. 

While you can only access those 10 meditations without a subscription, I’d recommend looking into their subscription, especially if you’d like to make meditation a more regular practice.  If you do have a subscription, here are a few of their “SOS” meditations I’d recommend:

SOS for Panicking

SOS for Feeling Overwhelmed

SOS for Flustered

There are plenty of other meditation apps that exist, such as Calm and 10% Happier. Try a few apps and decide which one you like best to use as a resource.

Visualize a Calm and Peaceful Place

Spend a few minutes thinking of a place you’ve been or that you create in your imagination where you can feel calm and peaceful. Identify what you see, hear, feel, taste, and smell in that image. Envision yourself there and notice what emotions it evokes. Pay attention to the pleasant feelings in your body and allow yourself to enjoy them.

5-4-3-2-1 Grounding Exercise

Start out by taking a few deep, abdominal breaths, as described above. 

Begin by noticing 5 items in the room around you that you see.  Say them out loud.  Describe the colors you see, Identify any textures you’re aware of on those items.

Next, notice 4 things you can feel without moving your body: it could be your clothing on your skin, the feel of the chair in which you’re sitting, or your feet on the floor.  Say these out loud as well.  Describe the sensation of those feelings. 

Then notice (aloud – catching a pattern?) 3 things you can hear.  Describe the sounds: whether they are consistent or intermittent, loud or soft, familiar or unfamiliar. 

Notice 2 things you can smell or two things of which you like the smell (as sometimes in a sterile environment there aren’t many smells).  Describe what these things smell like.

Finally, notice 1 thing you can taste or of which you like the taste.  Describe that taste to yourself. 

Regular Meditation Practice

What I’ve shared above are short, quick meditations that you can do in a crisis.  However, the strongest benefits of meditation have been shown when you implement a daily meditation practice over the long-term.  Daily meditation actually changes the structures of your brain associated with stress and calm.  If you find you like these strategies for calming yourself, I suggest that you try meditation daily.

These “rescue meditations” are a way to distract yourself from the symptoms of anxiety and calm your body down so you aren’t so overwhelmed.  However, they are not meant to completely resolve the anxiety.  The panic will continue to come back until you recognize the source of the anxiety and resolve it.  If you notice the panic continuing, consult a mental health professional to begin examining the potential sources of your distress.

Take a Deep Breath: Five Mindful Strategies for Dealing with Anxiety

During my first year of my master’s program, I saw how anxiety, stress, and lack of time would hit me with intense experiences of overwhelm.  I was working close to full time hours at a nanny job, attending class 4 nights a week, and serving in my church in my “free time.”  Any extra time I had was filled with studying and attempting to navigate my way through our massive textbooks.   With a temperament that errs on the side of anxiety and perfectionism, it was easy to talk myself into a state of stress that would make it difficult for me to function.

My school was a commuter school about 30 minutes away from where I lived, so I began listening to podcasts in my car.  (Cue the beginning of my obsession with podcasts).  One of those podcasts interviewed a life coach and therapist who gave tips on dealing with anxiety.  She taught a technique involving deep breathing, which I’d never tried before.  I decided to give it a go in the 10 minutes I sat in my car before class.  Let me tell you: it was like magic.  I felt like I could enter into the classroom in a completely different and relaxed state of mind.

Everyday anxiety is something many people experience, especially during stressful seasons in their lives.  Anxiety engages our internal fight-and-flight response, which pumps up our body with adrenaline and cortisol, a stress hormone.  By practicing deep breathing and other techniques below, you can take control over your body’s instinctual reaction.  As you slow down your breathing and your thoughts, you’re essentially reminding your body that you aren’t in danger.  This calms your fight-or-flight response.

Here are some tips on how you can respond with mindfulness when you feel yourself becoming anxious, nervous, and overwhelmed.

Daily Meditation

As the foundation of all the exercises that follow, daily meditation helps you become attuned to your body.  Spend time in a quiet room in silence for a few minutes to start.  Gradually increase to more time as you become more comfortable.  Pay attention to the way your body feels, noticing each part of your body, any emotions that arise, or any physical sensations. 

Oftentimes meditation is associated with “clearing your mind,” which can discourage you if you feel as though you can’t turn your thoughts off.   Instead, accept the likelihood that thoughts will cross your mind, and allow yourself to notice them, but not shame yourself for having them.

There are several apps that offer guided meditations, if you’re someone like me and are too easily distracted to sit quietly.  I’m a particular fan of Happify and Headspace, but there are many out there you can try and find the best fit for you.

Progressive Muscle Relaxation

Progressive muscle relaxation is the practice of mentally becoming aware of each part of your body by isolating one muscle group at a time, tensing and flexing the muscles.  Pay attention to the feeling of holding tightness in your muscles as you tense them, and notice how it feels to release and relax them afterwards.

This practice can also help you fall asleep at night or re-energize yourself during the day.   In the morning or throughout your day, start by tensing and releasing your toes and work your way upward through different muscle group such as your legs, knees, stomach, chest, arms, shoulders, neck, jaw, and forehead.  At night, do the opposite - start with the muscles in your forehead and work your way down through your body. 

Deep Breathing Exercises

Deep breathing was the technique that I heard Dr. Jennifer Degler speak about on that podcast all those years ago.  She introduced four-square breathing: a technique where you breathe in for 4 counts, hold the breath for 4 counts, breathe out for 4 counts, and hold for 4 counts.  Completing about 10 cycles of these deep breaths allows you to begin to feel the anxiety melt away.

As you’re practicing these breathing exercises, you’ll want to breathe from your diaphragm or abdomen.  In order to do that, it can be helpful to imagine that there is a balloon in your stomach, just behind your belly button.  Breathe in through your nose, trying to make that balloon expand.  As you breathe out through your mouth, imagining the balloon deflating.  Another helpful strategy involves laying on the ground or on a sofa, placing your hands on your stomach, and feeling your stomach rise and fall as you breathe.

5-4-3-2-1 Senses Grounding Exercise

This is a personal favorite of mine, especially when I’m feeling particularly triggered by thoughts or emotions.  Begin taking a few deep breaths, noticing the rise and fall of your abdomen.  Next, take a look around you and notice 5 things that you see.  Notice the colors, textures, and other characteristics of those objects.  Next, move on to identifying 4 things you can hear, noticing the quality of the sound, whether it is loud or soft, repeating or one-time.  Continue down through this pattern by noticing 3 things you can touch/feel, 2 things you can smell, and 1 thing you can taste.  You’ll feel yourself becoming grounded in the present reality around you, and emotions will likely become less distracting and more manageable.

Breath Prayer

Often when we talk about Christian meditation practice, it is accompanied by reading or memorizing Scripture and seeking to understand truth about that passage.  While that can be helpful to engage your mind, when you’re feeling stressed or overwhelmed, this isn’t always the quickest way to address that anxiety.  Instead, integrate some of the earlier mentions of breathing exercises and Biblical truth through breath prayer.  Breath prayer involves identifying a short phrase or sentence of truth about God or prayer to God.  Examples might be phrases such as, “Lord, have mercy,” “God, I need you,” or “Holy Spirit, come.”  You could also use short Bible verses that are meaningful to you, such as “I can do all things through [Christ] who strengthens me.” (Philippians 4:13 ESV).  Repeat those words to yourself out loud or in your mind while you are practicing deep breathing.  Breathe in on the first part of the phrase, and release your breath on the second half of the phrase.

While these mindfulness strategies didn’t immediately fix my stress levels or perfectionism, they did provide a way for me to calm my body down and remind myself of truth.  Test out some of these strategies for yourself when you’re feeling stressed or overwhelmed, and see which ones help you to lower those levels of stress.

This article was originally posted on May 4, 2017.

Take a Deep Breath: 5 Mindful Strategies for Managing Day-to-Day Anxiety

During my first year of my master’s program, I saw how anxiety, stress, and lack of time would hit me with intense experiences of overwhelm.  I was working close to full time hours at a nanny job, attending class 4 nights a week, and serving in my church in my “free time.”  Any extra time I had was filled with studying and attempting to navigate my way through our massive textbooks.   With a temperament that errs on the side of anxiety and perfectionism, it was easy to talk myself into a state of stress that would make it difficult for me to function.

My school was a commuter school about 30 minutes away from where I lived, so I began listening to podcasts in my car.  (Cue the beginning of my obsession with podcasts).  One of those podcasts interviewed a life coach and therapist who gave tips on dealing with anxiety.  One of those techniques involved deep breathing, which I’d never tried before.  I decided to give it a go in the 10 minutes I sat in my car before class.  Let me tell you: it was like magic.  I felt like I could enter into the classroom in a completely different and relaxed state of mind.

Everyday anxiety is something many people experience, especially during stressful seasons in their lives.  Anxiety engages our internal fight-and-flight response, which pumps up our body with adrenaline and cortisol, a stress hormone.  By practicing deep breathing and other techniques below, you can take control over your body’s instinctual reaction.  As you slow down your breathing and your thoughts, you’re essentially reminding your body that you aren’t in danger.  This calms your fight-or-flight response.

Here are some tips on how you can respond with mindfulness when you feel yourself becoming anxious, nervous, and overwhelmed.

Daily Meditation

As the foundation of all the exercises that follow, daily meditation helps you begin to become attuned to your body.  Spend some time in a quiet room in silence for a few minutes to start.  You can gradually increase to more time as you become more comfortable.  Pay attention to the way your body feels, noticing each part of your body, any emotions that arise, or any physical sensations. 

Oftentimes meditation is associated with “clearing your mind,” which can discourage you if you feel as though you can’t turn your thoughts off.   Instead, accept the likelihood that thoughts will cross your mind, and allow yourself to notice them, but not shame yourself for having them.

There are several apps that offer guided meditations, if you’re someone like me and are too easily distracted to sit quietly.  I’m a particular fan of Happify and Headspace, but there are many out there you can try and find the best fit for you.

Progressive Muscle Relaxation

This is the fancy therapist term for the practice of mentally becoming aware of each part of your body by isolating one muscle group at a time, tensing and flexing the muscles.  Pay attention to the feeling of holding tightness in your muscles as you tense them, and notice how it feels to release and relax them afterwards.

This practice can also help you fall asleep at night or re-energize yourself during the day.   In the morning or throughout your day, start by tensing and releasing your toes and work your way upward through different muscle group such as your legs, knees, stomach, chest, arms, shoulders, neck, jaw, and forehead.  At night, do the opposite - start with the muscles in your forehead and work your way down through your body. 

Deep Breathing Exercises

Deep breathing was the technique that I heard Dr. Jennifer Degler speak about on that podcast all those years ago.  She introduced four-square breathing: a technique where you breathe in for 4 counts, hold the breath for 4 counts, breathe out for 4 counts, and hold for 4 counts.  Completing about 10 cycles of these deep breaths allows you to begin to feel the anxiety melt away.

As you’re practicing these breathing exercises, you’ll want to breathe from your diaphragm or abdomen.  In order to do that, it can be helpful to imagine that there is a balloon in your stomach, just behind your belly button.  Breathe in through your nose, trying to make that balloon expand.  As you breathe out through your mouth, imagining the balloon deflating.  Another helpful strategy involves laying on the ground or on a sofa, placing your hands on your stomach, and feeling your stomach rise and fall as you breathe.

5-4-3-2-1 Senses Grounding Exercise

This is a personal favorite of mine, especially when I’m feeling particularly triggered by thoughts or emotions.  Begin taking a few deep breaths, noticing the rise and fall of your abdomen.  Next, take a look around you and notice 5 things that you see.  Notice the colors, textures, and other characteristics of those objects.  Next, move on to identifying 4 things you can hear, noticing the quality of the sound, whether it is loud or soft, repeating or one-time.  Continue down through this pattern by noticing 3 things you can touch/feel, 2 things you can smell, and 1 thing you can taste.  You’ll feel yourself becoming grounded in the present reality around you, and emotions will likely become less distracting and more manageable.

Breath Prayer

Often when we talk about Christian meditation practice, it is accompanied by reading or memorizing Scripture and seeking to understand truth about that passage.  While that can be a helpful practice, when you’re feeling stressed or overwhelmed, this isn’t always the quickest way to address that anxiety.  Instead, integrate some of the earlier mentions of breathing exercises and Biblical truth through breath prayer.  Breath prayer involves identifying a short phrase or sentence of truth about God or prayer to God.  Examples might be phrases such as, “Lord, have mercy,” “God, I need you,” or “Holy Spirit, come.”  You could also use short Bible verses that are meaningful to you, such as “I can do all things through [Christ] who strengthens me.” (Philippians 4:13 ESV).  Repeat those words to yourself out loud or in your mind while you are practicing deep breathing.  Breathe in on the first part of the phrase, and release your breath on the second half of the phrase.

While these mindfulness strategies didn’t immediately fix my stress levels or perfectionism, they did provide a way for me to calm my body down and remind myself of truth.  Test out some of these strategies for yourself when you’re feeling stressed or overwhelmed, and see which ones help you to lower those levels of stress.