When Anxiety Makes it Difficult to Work on Your Anxiety

It's possible to be so anxious that you can't focus on what you need to do to decrease your anxiety or, sometimes, even remember what to do. Every once in awhile, I see a person like this: He or she just can't seem to settle down enough to follow even very basic instructions. So, what can be done?

Most of the people who see me in my anxiety counseling/psychotherapy practice are distressed due to generalized anxiety, PTSD, past childhood trauma, agoraphobia or another phobia, panic disorder or panic attacks, obsessive compulsive disorder (OCD), an OCD-spectrum eating disorder, social anxiety or some other form of anxiety. Yet, most people with these disorders do follow through with what can help, whether it's meditation, exercise, problem-solving, sleep tips, cognitive behavioral therapy (CBT), exposure response prevention (ERP) or other forms of therapy and help for anxiety. This is all work that a very anxious person may not be able to take on, though. Many people take antidepressants for anxiety, other medications for panic and some take benzodiazepines, but they don't help everyone, benzodiazepines can be addictive and some people refuse to take medications.

It's important to see a doctor and have a physical with lab tests done to make sure something isn't physically wrong, such as a thyroid issue. If there are other symptoms, the doctor may refer the person to a neurologist or other specialist. I often recommend seeing a naturopath too: Food reactions, vitamin deficiencies and menopause, as examples, can cause what seem to be symptoms of an anxiety or other mental health issue. If these measures don't reveal a physiological cause, then basic behavioral changes might well be the answer.

When the mind won't be calm, the highly anxious person can often find some relief in slowing down and simplifying life as much as possible. I've found that helping people learn to write down only the real priorities in their lives in a schedule book can help. Then, they don't have to go over these things time and again, worrying about when to do them and that they'll forget. This means writing down only the priorities and letting everything else go for awhile.

I talk with them about how to simplify their lives to the degree possible and teach them to breathe from the diaphragm. It helps to have a friend who can be a coach, to check in every other day or so to ask if they're following the schedule and remind them to slow down and keep things simple. It also sometimes helps to have them put up reminder notes around the house and in the car to take it easy, simplify and breathe. The mind will usually find some comfort with a very simple daily structure.

Simple acts like taking a warm shower or bath, repeating a short mantra, such as "I wish myself peace," or having a warm bowl of oatmeal for breakfast are excellent ways to calm the self. All but the most distressed person in a life-threatening crisis -- who may need to go an emergency room or call 911 for an ambulance -- can usually do this. Going to bed at the same time every night and getting up at the same time each morning may even be very challenging, but helpful for the person.

Once a simple daily structure, some easy self-soothing, eating and any other self-calming the person can do is accomplished for awhile, then gradually adding exercise, breath awareness meditation, and later, CBT, and whatever other methods may be indicated for the individual, become possible. Day by day, step by step, the mind will become increasingly at ease as the brain changes.