More threads by Daniel E.

Daniel E.
Getting a grip on anxiety

Fight back against all the reasons we have to lose control

By Heidi Moore
Special to the Chicago Tribune

August 5, 2007

Crowded "L" trains, drug-resistant infections, global warming, terrorism -- there are so many things to stress out about, it's amazing anyone sleeps through the night. But just because we're not running around screaming doesn't mean anxiety isn't getting the better of us.

About 40 million Americans 18 and older have an anxiety disorder, ranging from generalized anxiety disorder to social phobia, according to the National Institute of Mental Health.

If anxiety is interfering with your daily life, talk to your doctor or a mental health professional. But for most people who handle life's stresses more or less successfully but could use some help at times, here are some tips for letting go of periodic anxiety.

Don't go with your gut. "People often assume they should trust their instincts, but that's exactly the opposite of what they should do when faced with anxiety," said David Carbonell, a psychologist and the director of the Anxiety Treatment Center, with offices in Chicago, Rolling Meadows and Oak Park. "Our gut instincts tend to be the opposite of what would be useful because we're gearing up to treat this [situation] like an actual threat."

First, he suggests, slow down and try to clarify what you're up against. Ask yourself: "Is there a problem to solve? Is this useful, or some kind of threat or problem I need to deal with, or is this unhelpful worry?" If you don't need to take immediate action, anxiety is probably not a useful response.

Breathe like a baby. When anxiety sets in, take a cue from a baby: Breathe with your diaphragm. "Newborns are world-class belly breathers, and that's a relaxing way to breathe," Carbonell said.

But don't forget to exhale first, he added. Omitting this important first step may actually make breathing shallower and cause a panic response.

Be here now. Mental health professionals echo this mantra from the psychedelic era. Simply existing in the moment and not worrying about the future or dwelling on the past helps you let go of tension, suggested Mark Pfeffer, a licensed psychotherapist and director of the Panic-Anxiety Recovery Center in Chicago.

Skip that triple espresso. It might be unwelcome news in this grande-no-foam-latte society, but stimulants such as caffeine can increase anxiety. And although sugar isn't technically a stimulant, it can have similar effects. Pfeffer tells clients to cut down on or eliminate caffeine, sugar and alcohol, all of which can worsen anxiety symptoms.

Although maintaining a balanced, healthful diet can help you deal better with anxiety, there's no easy diet fix. "Many clients look for the anxiety diet or supplements, and I really try to steer them away," Pfeffer said. "Broccoli does not help reduce anxiety. It would be nice if it did."

Exercise. People rarely look tense after completing a marathon. When your fight-or-flight response kicks in, try going for a run, hitting the basketball court or even taking a long walk with a friend or loved one. Cardiovascular exercise is best, Pfeffer said, for boosting the endorphins that "get your chemistry going the other way."

Schedule worry time. For many, managing anxiety means dedicating a specific time of the day to accumulated worries. "We're all juggling so many things in life, we let them pile up and have arguments with a spouse or kick the cat," Pfeffer said. "It's helpful to take a little time in the day -- a session with yourself and a significant other -- and have a worry time. Come up with a list of the worries that are occurring in your life, and try to respond to each of them. Then come up with a plan of action."

Don't beat up on yourself. It's OK to be anxious sometimes, health professionals say. "Anxiety is a natural part of our lives. Sometimes we think it's the enemy, but there's a primitive purpose for us having this anxiety," Carbonell explained. "Our species evolved as prey, not predators, so our central nervous system is designed to watch for trouble and be suspicious. We're top dog now, but we have the same nervous system of a scared little animal chased by tigers."

And there's another reason not to get mad at yourself for giving in to anxiety. "Then you have worry about worry," Carbonell said, "which is even worse than the original worry."


Breathe like a baby.

How To Breathe With Your Diaphragm - An Exercise

There are a number of different ways to do breathing exercises and to learn to breathe properly. This exercise takes you through careful steps, designed to help you learn to breathe with your diaphragm, in a slow and helpful process.

Difficulty: Average
Time Required: 10 minutes, 2 times per day

Here's How:
I try to practice this 2 times a day for 10 minutes. It is not easy, and it takes a lot of practice. I am getting better and better the more I practice. Do not get angry or stressed out with yourself because I did at first; just give it time.

I place one hand on my chest and my other on my stomach with my little finger just a little above my naval. The movement should come from your lower hand (stomach).

I was one of those chest breathers and had to do this exercise on the floor to be able to breath from my diaphragm area. I would lay flat on my stomach on the floor.

At first do not try to take too much air in and to not slow your breathing down too much. Just breathe smoothly and easily. Do not hold your breath.

I count on my "in" breaths. When I breath in, I think "one" to myself.

As I breath out, I think the word "relax" and I try to let my body go limp a little.

Then "two" on next breath, and on the out breath think "relax."

I do this until I get to 10 then start back at 1.

Gradually begin to slow your counting day by day (I would not start this until about 5-6 weeks later) until you can breathe at a rate of 10 breaths per minute at rest. This is where I am at now. I'm still having some problems with this, but I am doing a lot better each day.

  • Remember: do not gulp in a big breath and then let it out at once. Keep it smooooth.
A checklist:
  • Comfortable, quiet location.
  • Count "1" on breath in and think "relax" on breath out.
  • Focus attention on breathing and counting.
  • Expand diaphragm on breath in and keep chest still.
  • Count up to 10 back to 1.
  • Practice twice daily, 10 minutes each time
  • Monitor your practice.


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Hey Daniel,

Interesting article. I agree with most of it exept the "don't trust your gut" advice. My gut has never steered me wrong as its that calm inner knowing in me. Its my head that gets me into trouble because if I over analyze the panic worsens.

With the breathing I rely on just as simple exercise of focusing on my natural breathe. Simply feeling the natural inhale and exhale can calm me down. Dealing with anxiety has changed drastically for me over the years as I always do the basics - make sure I've eaten, go for a walk, turn on lights...its usually when I have done all that is when I need that extra support.

Thanks for the article



Does anyone know if there is a certain level of cardiovascular exercise that is shown to reduce stress (e.g. how many times per week for how long?) I know the recs. for health but I was wondering if there were any specific recs. for the most anxiety reduction benefits...


Daniel E.
I know the recs. for health but I was wondering if there were any specific recs. for the most anxiety reduction benefits...

I think it's basically the same. In my experience, more is better, at least to a certain point, though even a 5-minute walk can help.

For example, in a study published in 2005 about depression and exercise, people who exercised more -- exercising aerobically to burn about 175 calories a day for someone weighing 155 pounds (17.5 calories/kg/week) -- felt better than those who exercised at less than half that rate:

Using a reduction in HAM-D score of 7 as a criterion for 'remission' (i.e. a temporary cure of the depression symptoms), the remission rate for high-dose aerobic exercise was 42%. (It was 26% for low-dose exercise...)

How much exercise had to be done? The target - 17.5 kcal/kg/week - was based on recommendations established by public health authorities. The lack of difference between the 3-day and 5-day results shows that it's the amount of exercise done each week, rather than the frequency, that's important. As a very rough guide, 17.5 kcal/kg/week would be equivalent to using a treadmill to expend 175 calories every day if you weigh 70 kg (i.e.155 lbs); most good treadmills and stationary bikes give the number of calories expended.

BTW, for reference:

A 140-pound person can burn 175 calories in 30 minutes of moderate bicycling, and 322 calories in 30 minutes of moderate jogging.
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Thanks a lot for the information Daniel. That's really helpful and reassuring. That sounds very reasonable. Thank you again. :)
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