by Dr. Denise Renye, Licensed Clinical Psychologist and Sex Therapist, PsyD, MA, MEd, in San Francisco, CA

How to Cope with Anxiety If You Can’t Go to Therapy

I spoke with a friend of a friend recently who said he copes with anxiety solely through medication because that’s all he’s been exposed to. It got me thinking about how some people don’t know what else to try for anxiety other than pharmacological interventions because they may not have considered therapy as an option. And even many people who have considered therapy may not be able to afford it. Learning how to cope with anxiety in healthy ways can make such a difference.

This is quite the conundrum because anxiety disorders are the most common mental illness in the US, according to the Anxiety and Depression Association of America (ADAA). Anxiety affects 40 million adults in the U.S. ages 18 and older —  about 18.1% of the population. Also, anxiety disorders are highly treatable, but only 36.9% of people receive treatment.

Therapy and medication are two ways to manage treatment, but they’re not the only ways. What follows are strategies to cope with anxiety without going to therapy or taking drugs.

7 Non-Pharmacological Strategies for Anxiety

1. Exercise

You knew this one was coming, didn’t you? Anxiety is associated with energy; it’s why we have expressions like “fidgeting nervously,” or “a nervous tic.” Exercise is an outlet for that anxious energy. In addition, there are numerous studies that show exercise and regular activity are beneficial for anxiety, meaning exercise reduces it.

2. Change Your Diet

Did you know 95% of your serotonin receptors reside in your gut? It stands to reason then what you feed your gut affects your mood. That’s true and in fact, a 2016 study found healthy eating can alleviate anxiety. Is your diet high in processed foods such as frozen dinners, shelf-stable cookies, and potato chips? If so, those foods could be exacerbating your anxiety. What happens if you try eating differently?

3. Journaling

It’s not uncommon for a person to experience swirling thoughts when they’re anxious. Thinking about the future in a negative way can promote anxiety such as repeating to yourself: “I don’t look good in pictures,” “No one will come to my party,” “Everyone hates me,” or “What if I lose my job?” Writing those thoughts down, letting all your worst fears become expressed, can help release them from your brain and soothe the anxious parts of yourself. This is also helpful if you experience insomnia that may stem from anxiety.

4. Breathing

It seems so simple because we breathe all day long, but conscious breath can go a long way in alleviating anxiety. I’m a proponent of breathing into your belly, alternate nostril breathing, and circular breathing. I also have a free, guided, breathwork meditation. To start, set a timer for 30 seconds (and work up to three minutes) and see how you feel after breathing with intention and awareness. What I love about breathwork is it encourages a pause. Many of us are conditioned to fear a pause, to fear silence. With anxiety, your brain can run off without you, imagining ten steps into the future. Pausing, sitting in silence, brings your brain back to where your feet are, here, in this present moment. Noticing the present moment, being with the pause, the silence, you may notice things aren’t as terrible as they first seemed.

5. Yoga & Meditation

There are numerous kinds of yoga and meditation in the world, but nearly all of them help with anxiety. Experiment with different kinds until you found one that works for you. Yoga and meditation incorporate many of the characteristics I listed above: pausing, breathwork, and focusing the mind.

6. Spirituality

I view a spiritual practice as complementary to therapy and depth coaching because it can help provide access to the internal world. Spirituality can be defined simply as a sense of connection to something greater than yourself and can offer meaning as well as purpose in your life. Cultivating a meaningful connection with something bigger than yourself just may result in emotions such as peace, awe, and contentment. In other words, a spiritual practice — tailor-made for you — can help you cope with anxiety.

7. EFT/Tapping

Emotional Freedom Technique (EFT), also known as tapping, combines cognitive therapies with acupressure for the treatment of psychological distress. A 2016 study found EFT demonstrated a significant decrease in anxiety scores, even when accounting for the effect size of control treatment. More recently, in 2019, researchers found EFT helps physiologically, meaning not only did study participants self-report that they felt better, but their bodies also showed a decrease in resting heart rate and blood pressure and an altering of cortisol levels.

Adult Children of Alcoholics (ACA)

Sometimes it’s really hard to manage anxiety on your own and you just may need support. If money is an issue, Adult Children of Alcoholics (ACA) meetings are a great option. The meeting is open to not only children raised in alcoholic homes, but anyone raised in a dysfunctional environment. The program functions like other 12-step groups in that members share for a limited time and there’s a sponsor or fellow traveler to help a person through the steps. That means there’s a community of people to support you as you learn how to cope with anxiety. However, what’s unique about ACA is that it also addresses post-traumatic stress disorder (PTSD) and has literature devoted to nurturing an inner loving parent. Creating a strong, secure, attachment figure within yourself could help calm anxious parts of yourself, especially if the anxiety is arising from your inner child.

If you’re struggling with anxiety, you don’t have to suffer through it. Anxiety is treatable with a multitude of drugs, therapy, and any of the methods I mentioned above. If one method doesn’t work, try another. And try it for some time as it may take a while. Just know, relief is possible. Start your search for a therapist today.

References

Anderson, Elizabeth; Shivakumar, Geetha. “Effects of Exercise and Physical Activity on Anxiety.” Front Psychiatry. 2013;4:27. doi: 10.3389/fpsyt.2013.00027

Anxiety and Depression Association of America. “Facts and Statistics.” https://adaa.org/understanding-anxiety/facts-statistics, accessed November 18, 2021.

Bach, Donna; Groesbeck, Gary; Stapleton, Peta; et al. Clinical EFT (Emotional Freedom Techniques) Improves Multiple Physiological Markers of Health. J Evid Based Integr Med. 2019;24:2515690X18823691. doi:10.1177/2515690X18823691

Carpenter, Dr. Siri. “That Gut Feeling.” American Psychological Association. September 2012; 43(8): 50. https://www.apa.org/monitor/2012/09/gut-feeling

Clond, Morgan. “Emotional Freedom Techniques for Anxiety: A Systematic Review With Meta-analysis.” J Nerv Ment Dis. 2016;204(5):388-395. doi: 10.1097/NMD.0000000000000483.

Null, Gary; Pennesi, Luanne; Feldman, Martin. “Nutrition and Lifestyle Intervention on Mood and Neurological Disorders.” J Evid Based Complementary Altern Med. 2017 Jan;22(1):68-74. doi: 10.1177/2156587216637539.

Food is an important element of every culture; the less of it available, the more important the meaning surrounding it. From holiday and traditional celebrations to the ritual of Sunday dinners, almost everyone has memories—happy, comforting memories—tied to food. So it is no surprise that people who are experiencing difficulties sometimes turn to food to try to evoke pleasant feelings.

Everyone is familiar with the idea of self-soothing through food. Eating a pint (or more!) of ice cream after a romantic breakup is a cliché. A cup of tea and a biscuit is an equally iconic response to an upset in English culture. However, this usually harmless form of self-soothing can become a problem for people with serious and persistent emotional challenges such as those occurring as the result of posttraumatic stress (PTSD). These problematic reactions may include:

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• Binge eating
• Anorexia
• Bulimia

What Is Posttraumatic Stress?

Briefly stated, PTSD is the result of experiencing a “shocking, scary, or dangerous event” (Post-Traumatic Stress Disorder, 2016). While not everyone will develop persistent symptoms as the result of such events, some people will go on to feel afraid or anxious even though they are no longer in danger. Symptoms may include flashbacks (intrusive memories), nightmares, avoiding places or things which trigger bad memories, being easily startled, or having difficulty sleeping. Sometimes symptoms don’t appear until months or even years after the experience.

Binge Eating

According to Dr. Cynthia Bulik, an expert on eating disorders at the University of North Carolina, “Binge eating is not just a lot of overeating … there’s this sense of loss of control. You start eating and you feel like you just can’t stop” (When Food Consumes You, 2017). This is the most common eating disorder in the United States. People with this condition eat past the point where they are full; they often feel compelled to go on eating. This may lead to obesity and the problems that come with it.

What is the link between the two? Most of the time, the trauma comes first and binge eating later (Brody, 2017). Research shows both PTSD and binge eating are related to production of stress hormones and mood-boosting brain chemicals. About one in four people who binge eat is believed to have PTSD; about 35% of women with a binge eating disorder have been sexually assaulted. PTSD and binge eating are linked in the body.

Bulimia

Sometimes, people who have indulged in binge eating will follow with an attempt to rid themselves of the excess calories. This may be done through self-induced vomiting; the use of laxatives to help food pass quickly through the body; prolonged exercise; or, paradoxically, periods of fasting. People with this condition (known medically as bulimia nervosa) may be able to maintain a normal weight because of their efforts to counteract the high caloric intake of an eating event. However, the cycle of overeating and purging may cause other health issues, including problems with the digestive system or heart irregularities, along with problems from a poorly balanced diet.

One study found about 25% of women with this condition have PTSD. (Blinder, et al., 2006), In a study of women in a residential treatment program for eating disorders, almost three-quarters had experienced significant trauma, and more than half reported symptoms typical of PTSD (Brewerton, 2008).

Anorexia

The least common eating disorder, but potentially the most deadly, is known as anorexia nervosa medically. People who have this condition typically think of themselves as overweight, leading to chronic under-nutrition. People literally starve themselves to death, thinking the whole time that they are obese. People with anorexia are six times more likely to die prematurely than members of the general population (DeNoon, 2011). People who are diagnosed with anorexia in their 20s are 18 times more likely to die prematurely.

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture.

Causes and Treatment Options

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture. Physical and emotional health, particularly PTSD, are additional factors which may offer opportunities to influence the course of this condition (When Food Consumes You, 2017). Early diagnosis and treatment are critical.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes five evidence-based treatments for PTSD: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PET), eye movement desensitization and reprocessing (EMDR), and accelerated resolution therapy (ART). However, prolonged exposure therapy may increase the risk of binging at least temporarily (Brody, 2015).

Recent research has suggested that accelerated resolution therapy may be most effective. Walden Behavioral Care, which specializes in treating people with eating disorders, psychiatric conditions, and other comorbid issues, conducted an informal study for purposes of self-improvement. The study, which included 28 people, showed a significant reduction in self-reported levels of stress following treatment with ART. Before intervention, participants reported a mean level of distress of 7.62 (out of 10); after treatment, the level had dropped to 3.16, a reduction of more than half.

For help with problematic eating patterns, contact a therapist.

References:

1. Blinder B. J., Cumella E. J., & Sanathara V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68, 454-462.
2. Brewerton, T. D. (2008, May 8). The Links Between PTSD and eating disorders. Psychiatric Times, 25(6). Retrieved from http://www.psychiatrictimes.com/articles/links-between-ptsd-and-eating-disorders
3. Brody, B. (2015, January 24). The link between trauma and binge eating. Retrieved from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/ptsd-binge-eating#1
4. DeNoon, D. J. (2011, July 12). Deadliest psychiatric disorder: Anorexia. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia
5. Post-traumatic stress disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
6. Walden Behavioral Care reports aggregate quality assessment information on patients treated with ART. (n.d.). Retrieved from http://acceleratedresolutiontherapy.com/walden-behavioral-care-pilot-study-art/
7. When food consumes you. (2017). Retrieved from https://newsinhealth.nih.gov/2017/11/when-food-consumes-you

Self-soothing is as natural to people as breathing. Even as infants, we quickly learn the soothing results of sucking our thumb when our mother’s nipple isn’t available. As we grow, our repertoire expands as our world expands. The soft touch of a flannel blanket or a plush toy may be our next source of comfort and emotional support. For many of us, food and drink are the go-to sources of comfort beyond our bodies.

How many happy memories are attached to good times with family and caregivers? As adults, many of the ways we make ourselves feel better are by invoking those memories through the powerful sense of smell, cooking or consuming old favorites whose aromas awaken a multisensory memory. Holidays and special occasions are built around re-creating many of these old favorites, amplifying the current experience by invoking the past.

Sometimes, however, self-soothing can become a problem. It often seems to happen when there is posttraumatic stress (PTSD) in the background, such that self-soothing behaviors are over-used and become a source of difficulty in and of themselves. Some of the ways people try to cope with the symptoms of PTSD are:

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• Eating
• Substance use
• Exercise
• Self-mutilation

1. Eating

Eating is a way that most of us self-soothe. An ice cream binge is a stereotyped way to deal with a major disappointment. Actually, both over-indulgence and over-abstention can lead to health issues.

While we’re all familiar with overeating as a possible problem, anorexia and bulimia are other ways people can use food to self-soothe. It may seem counterintuitive for someone to restrict the amount of food they take in (or keep in) as a source of self-soothing, but many experts believe this is a way of exercising control over an area of their lives which many people find satisfying as a way of combating PTSD which otherwise leaves them feeling overwhelmed and out of control. Specialists who treat eating disorders have consistently confirmed this observation (Brewerton, 2007).

2. Substance Use

Like eating, drinking to “drown our sorrows” is a well-established cultural meme. While it’s certainly not condoned by health professionals, we all know of mature individuals who have dealt with a major disappointment by overindulging in alcohol. While this can be a slippery slope toward dependency, use of other substances can be even more dangerous. The addictive nature of marijuana is widely overlooked. Drugs such as cocaine, methamphetamine, and opiates are highly addictive, and almost everyone is aware of those dangers. Tobacco use is usually initiated through cigarette smoking, which in addition to the effects of nicotine provides reinforcement through the sucking reflex, the life-giving behavior which supports our earliest efforts to sustain life. (This is why nicotine patches alone often fail to provide relief to people who want to stop smoking.)

What many people do not recognize is that these dangerous methods of self-soothing are usually turned to by people experiencing severe symptoms of PTSD who feel the need for greater comfort. It is believed that 50% to 66% percent of those who experience PTSD symptoms may also have addictive behaviors. There is a tendency to stigmatize people who have this kind of problem as being somehow morally deficient. The truth is, many have undiagnosed and untreated PTSD, usually experienced in childhood.

Running when our knees hurt, lifting weights despite an injury, not giving our bodies time to recover (like exercising seven days a week) are all ways in which we can hurt ourselves while appearing to be pursuing “health.”

3. Exercise

Everyone recognizes the importance of exercise to good health. The more the better, right? Scientists have told us there is almost no limit to the amount of exercise which is good for us—the benefits just keep adding up. However, what they are addressing is healthy, nondestructive exercise: a variety of types of exercise, including stretching, aerobic, and anaerobic exercise like that found in cross-fit regimens and yoga. This type of exercise lowers our blood pressure and improves our cholesterol and sense of well-being. It is frequently prescribed as a component of a complete PTSD recovery program. The latter is supported by the generation of endorphins when we exercise—those hormones which make us feel good after we’ve been exercising for about 20 minutes.

Like anything else which makes us feel better, it’s possible to become dependent on those endorphins and thus exercise to extremes in order to enjoy the benefits. Running when our knees hurt, lifting weights despite an injury, not giving our bodies time to recover (like exercising seven days a week) are all ways in which we can hurt ourselves while appearing to be pursuing “health.” Often, people who exercise in this way may appear to have some sort of obsessive compulsion; my experience with people who behave this way strongly suggests they are dealing with some overwhelming and irrational fear, almost always tied to some childhood trauma which resulted in PTSD.

4. Self-Mutilation

Among the many self-soothing behaviors are various forms of nonlethal self-mutilation. Usually, this takes the form of cutting behaviors. People who do this may repeatedly cut themselves with a sharp instrument, such as a knife or razor. Others may stick themselves with pins or burn themselves.

The explanation given by many people who engage in self-harm is that the pain is a distraction from the extreme emotional discomfort they are feeling. Explanations from those who do this include “to distract from painful feelings” and “to punish themselves” (Gibson & Crenshaw, 2015). Cutting or other self-mutilation gives them a way to exert control, like eating disorders, and distract themselves from their emotional pain. Several studies have found that the vast majority of people who engage in such behaviors have trauma in their background.

Finding Support

There are five types of treatment for PTSD which are recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA) as being “evidence-based”: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PET), eye movement desensitization and reprogramming (EMDR), and accelerated resolution therapy (ART). The first three use a combination of education, discussion, and homework to work through the effects of PTSD. They generally require 12 to 20 sessions and are about 70% successful, on average. EMDR uses eye movements and suggestions to deal with trauma; it generally requires eight to 10 sessions and is also about 70% successful, on average. ART uses eye movements and suggestions, requires three to five sessions, and appears to be about 90% successful. As with any treatment, your mileage may vary; there is no one-size-fits-all treatment approach.

If you know someone who is indulging in extreme self-soothing, consider whether they might benefit from one of these types of treatment.

References:

1. Brewerton, T. D. (2007). Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. The Journal of Treatment & Prevention, 15(4).
2. Gibson, L.E., & Crenshaw, T. (2015). Self-harm and trauma: Research findings. Retrieved from https://www.ptsd.va.gov/professional/pages/self-harm-trauma.asp
3. Kim, S.H., Kravitz, L., & Schneider, S. (2012). PTSD & Exercise: What Every Exercise Professional Should Know. IDEA Fitness Journal, 9(6).
4. The Link Between PTSD and Substance Abuse/Addiction. (n.d.). Retrieved from https://americanaddictioncenters.org/ptsd/