Calm Your Nerves and Combat Anxiety
 From The Anxiety & Phobia Workbook By Edmund J. Bourne, Ph.D.,
Learn Deep Relaxation Techniques
Deep relaxation refers to a distinct physiological state that is the exact opposite of the way your body reacts under stress or during a panic attack. This state was originally described by Herbert Benson in 1975 as the relaxation response. It involves a series of physiological changes including:
• Decrease in heart rate
• Decrease in respiration rate
• Decrease in blood pressure
• Decrease in skeletal muscle tension
• Decrease in metabolic rate and oxygen consumption
• Decrease in analytical thinking
• Increase in skin resistance
• Increase in alpha wave activity in the brain
Regular practice of deep relaxation for twenty to thirty minutes on a daily basis can produce, over time, a generalization of relaxation to the rest of your life. That is, after several weeks of practicing deep relaxation once per day, you will tend to feel more relaxed all the time.
Numerous other benefits of deep relaxation have been documented over the past twenty years. These include:
• Reduction of generalized anxiety. Many people have found that regular practice also reduces the frequency and severity of panic attacks.
• Preventing stress from becoming cumulative. Unabated stress tends to build up over time. Entering into a state of physiological quiescence once a day gives your body the opportunity to recover from the effects of stress. Even sleep can fail to break the cumulative stress cycle unless you've given yourself permission to deeply relax while awake.
• Increased energy level and productivity. (When under stress, you may work against yourself and become less efficient.)
• Improved concentration and memory. Regular practice of deep relaxation tends to increase your ability to focus and keeps your mind from "racing."
• Reduction of insomnia and fatigue. Learning to relax leads to sleep that is deeper and sounder.
• Prevention and/or reduction of psychosomatic disorders such as hypertension, migraines, headaches, asthma, ulcers, and so on.
• Increased self-confidence and reduced self-blame. For many people, stress and excessive self-criticism or feelings of inadequacy go hand in hand. You can perform better, as well as feel better, when you are relaxed.
• Increased availability of feelings. Muscle tension is one of the chief impediments to an awareness of your feelings.
How can you achieve a state of deep relaxation?  By teaching yourself abdominal breathing exercises.
Exercise: Learn how to breathe from your abdomen
Your breathing directly reflects the level of tension you carry in your body. Under tension, your breathing usually becomes shallow and rapid, and occurs high in the chest. When relaxed, you breathe more fully, more deeply, and from your abdomen. It's difficult to be tense and to breathe from your abdomen at the same time. A few benefits of abdominal breathing include:
• Greater feelings of connectedness between mind and body. Anxiety and worry tend to keep you "up in your head." A few minutes of deep abdominal breathing will help bring you down into your whole body.
• Abdominal breathing by itself can trigger a relaxation response.
Abdominal Breathing
1. Note the level of tension you're feeling. Then place one hand on your abdomen right beneath your rib cage.
2. Inhale slowly and deeply through your nose into the "bottom" of your lungs -- in other words, send the air as low down as you can. If you're breathing from your abdomen, your hand should actually rise. Your chest should move only slightly while your abdomen expands. (In abdominal breathing, the diaphragm -- the muscle that separates the lung cavity from the abdominal cavity -- moves downward. In so doing it causes the muscles surrounding the abdominal cavity to push outward.)
3. When you've taken in a full breath, pause for a moment and then exhale slowly through your nose or mouth, depending on your preference. Be sure to exhale fully. As you exhale, allow your whole body to just let go (you might visualize your arms and legs going loose and limp like a rag doll).
4. Do ten slow, full abdominal breaths. Try to keep your breathing smooth and regular, without gulping in a big breath or letting your breath out all at once. It will help to slow down your breathing if you slowly count to four on the inhale (1-2-3-4) and then slowly count to four on the exhale. Remember to pause briefly at the end of each inhalation. Count from ten down to one backward, one number with each exhalation. The process should go like this:
Slow inhale... Pause... Slow exhale (count "ten")
Slow inhale... Pause... Slow exhale (count "nine")
Slow inhale... Pause... Slow exhale (count "eight")
and so on down to one. If you start to feel light-headed while practicing abdominal breathing, stop for 15-20 seconds, and then start again.
5. Extend the exercise if you wish by doing two or three "sets" of abdominal breaths, remembering to count backward from ten to one for each set (each exhalation counts as one number). Five full minutes of abdominal breathing will have a pronounced effect in reducing anxiety or early symptoms of panic. Some people prefer to count from one to ten instead. Feel free to do this if it suits you.
Calming Breath Exercise
The Calming Breath Exercise was adapted from the ancient discipline of yoga. It is a very efficient technique for achieving a deep state of relaxation quickly.
1. Breathing from your abdomen, inhale through your nose slowly to a count of five (count slowly "one... two... three... four... five" as you inhale).
2. Pause and hold your breath to a count of five.
3. Exhale slowly, through your nose or mouth, to a count of five (or more if it takes you longer). Be sure to exhale fully.
4. When you've exhaled completely, take two breaths in your normal rhythm, then repeat Steps 1 through 3 in the cycle above.
5. Keep up the exercise for at least three to five minutes. This should involve going through at least ten cycles of in-five, hold-five, out-five. As you continue the exercise, you may notice that you can count higher when you exhale than when you inhale. Allow these variations in your counting to occur if they do, and just continue with the exercise for up to five minutes. Remember to take two normal breaths between each cycle. If you start to feel light-headed while practicing this exercise, stop for thirty seconds and then start again.
6. Throughout the exercise, keep your breathing smooth and regular, without gulping in breaths or breathing out suddenly.
Practice the Abdominal Breathing or Calming Breath Exercise for five minutes every day for at least two weeks. If possible, find a regular time each day to do this so that your breathing exercise becomes a habit.
By extending your practice of either breathing exercise to a month or longer; you will begin to retrain yourself to breathe from your abdomen. The more you can shift the center of your breathing from your chest to your abdomen, the more consistently you will feel relaxed on an ongoing basis.

Next Step: Find out how regular exercise can greatly reduce your anxiety
Start an Anxiety-Reducing Exercise Regime One of the most powerful and effective methods for reducing generalized anxiety is a program of regular, vigorous exercise.  Exercise is a natural outlet for your body when it is in the fight-or-flight mode of arousal.  Regular exercise has a direct impact on several physiological factors that underlie anxiety. It brings about:
• Reduced skeletal muscle tension, which is largely responsible for your feelings of being tense or "uptight"
• More rapid metabolism of excess adrenaline and thyroxin in the bloodstream, the presence of which tends to keep you in a state of arousal and vigilance
• A discharge of pent-up frustration, which can aggravate phobic or panic reactions
Exercise: Design a Plan Exercise needs to be of sufficient regularity, intensity, and duration to have a significant impact on anxiety. The following standards can be viewed as goals to aim for:
• Ideally exercise should be aerobic
• Optimal frequency is 4-5 times per week
• Optimal duration is 20-30 minutes or more per session
• Optimal intensity for aerobic exercise is a heart rate of (220- your age) x .75 for at least 10 minutes.
The table below indicates aerobic pulse ranges for various ages:
Age
20-29
30-39
40-49
50-59
60-69 Pulse (Heart) Rate
145-164
138-156
130-148
122-140
116-132

Avoid exercising only once per week. Engaging in infrequent spurts of exercise is stressful to your body and generally does more harm than good (walking is an exception).
Eliminate Anxiety-Provoking Foods from Your Diet
 What you eat has a very direct and significant impact on your body's internal physiology and biochemistry.
 

In the last twenty years the relationship between diet, stress, and mood has been well documented. It's known that certain foods and substances tend to create additional stress and anxiety, while others promote a calmer and steadier mood. Certain natural substances have a directly calming effect and others are known to have an antidepressant effect. Many of you may not yet recognize connections between how you feel and what you eat. You simply may not notice that the amount of coffee or cola beverages you drink aggravates your anxiety level. Or you may be unaware of any connection between your consumption of sugar and anxiety, depression, or PMS symptoms. 
Low Stress/Anxiety Dietary Guidelines
Although all of the guidelines below are important, they are listed in order of their direct relevance to anxiety reduction.
1. Eliminate as far as possible the stimulants and stress-inducing substances -- caffeine, nicotine, other stimulants, salt (down to one gram or teaspoon per day), and preservatives. (Caffeine and nicotine are the most critical for reducing anxiety.)
2. Eliminate or reduce to a minimum your consumption of refined sugar, brown sugar, honey, sucrose, dextrose, and other sweeteners such as corn syrup, corn sweeteners, and high fructose. Replace desserts, sugary beverages, and sweet snacks with fresh fruit and sugar-free beverages. Moderate alcohol consumption, since your body converts alcohol to sugar.
3. Reduce or eliminate refined and processed foods from your diet as much as possible. Replace with whole and fresh foods (preferably organic).
4. Eliminate or reduce to a minimum any food that you establish as an allergen.
5. Reduce consumption of red meat as well as poultry containing steroid hormones and other chemicals. Replace these with organic poultry and/or seafood (fish such as halibut, salmon, snapper, sole, trout, and turbot are recommended).
6. Increase your intake of dietary fiber by eating foods such as whole grains, brans, and raw vegetables. (Note, though, that too much fiber can cause gas and bloating and interfere with the body's ability to absorb protein.)
7. Drink the equivalent of at least six 8-oz. glasses of bottled spring water or purified water per day.
8. Increase your intake of raw, fresh vegetables. A mixed-vegetable salad every day is an excellent idea.
9. Include one fresh (not frozen or canned) cooked vegetable in your diet each day.
10. Reduce animal fat and cholesterol-containing foods such as red meat, organ meats, gravy, cheeses, butter, eggs, whole milk, and shellfish to no more than 20 percent of the calories you eat. Polyunsaturated vegetable-based fats contained in cooking and salad oils should also be taken in moderation. Monounsaturated oils such as unrefined olive oil or canola oil are preferred.
11. To avoid excessive weight gain, consume only as much energy (calories) as you expend. Decrease caloric intake and increase exercise if you're already overweight.
12. Select foods from the four major food groups: 1) fruits and vegetables (four to five servings daily); 2) whole grains, including whole-grain rice, cereals, and whole-grain breads (three to four servings daily); 3) animal proteins, emphasizing organic poultry, seafood, and eggs or legume equivalents if you are vegetarian (two to three servings daily), and 4) dairy products, emphasizing low-fat or nonfat dairy products (one or two servings daily). Your diet should emphasize the first two categories and moderate amounts of the latter two. In general, it's a good idea to move your diet in the direction of vegetarianism and away from excess consumption of animal-based foods.
Monitor what you eat for at least three days. In what ways might you improve your dietary habits? What would you actually be willing to change in the next month?
Learn to Control Your Inner Thoughts
Imagine two individuals sitting in stop-and-go traffic at rush hour. One perceives himself as trapped, and says such things to himself as "I can't stand this," "I've got to get out of here," "Why did I ever get myself into this commute?" What he feels is anxiety, anger and frustration. The other perceives the situation as an opportunity to lay back, relax and put on a new tape. He says such things to himself as "I might as well just relax and adjust to the pace of the traffic," or "I can unwind by doing some deep breathing." What he feels is a sense of calm and acceptance. In both cases, the situation is exactly the same, but the feelings in response to that situation are vastly different because of each individual's internal monologue, or self-talk.
What's Your Sub personality?
Not all negative self-talk is the same. Human beings are not only diverse but complex, with multifaceted personalities. These facets are sometimes referred to as "sub personalities." Our different sub personalities each play their own distinct role and possess their own voice in the complex workings of consciousness, memory, and dreams. Below are four of the more common sub personality types that tend to be prominent in people who are prone to anxiety: the Worrier, the Critic, the Victim, and the Perfectionist.
1. The Worrier (promotes anxiety)
Characteristics: The Worrier creates anxiety by imagining the worst-case scenario. It scares you with fantasies of disaster or catastrophe when you imagine confronting something you fear. The Worrier's dominant tendencies include: 1) anticipating the worst, 2) overestimating the odds of something bad or embarrassing happening, and 3) creating grandiose images of potential failure or catastrophe.
2. The Critic (promotes low
self-esteem)
Characteristics: The Critic is that part of you which is constantly judging and evaluating your behavior (and in this sense may seem more "apart" from you than the other sub personalities). It tends to point out your flaws and limitations whenever possible. It jumps on any mistake you make to remind you that you're a failure.
3. The Victim (promotes depression)
Characteristics: The Victim is that part of you which feels helpless or hopeless. It generates anxiety by telling you that you're not making any progress, that your condition is incurable, or that the road is too long and steep for you to have a real chance at recovering. The Victim also plays a major role in creating depression. The Victim believes that there is something inherently wrong with you: you are in some ways deprived, defective, or unworthy.
4. The Perfectionist (promotes chronic stress and burnout)
Characteristics: The Perfectionist generates anxiety by constantly telling you that your efforts aren't good enough, that you should be working harder, that you should always have everything under control, should always be competent, should always be pleasing, should always be (fill in whatever you keep telling yourself that you "should" do or be). It has a tendency to try to convince you that your self-worth is dependent on externals such as vocational achievement, money and status, acceptance by others, being loved, or your consistent ability to be pleasing and nice to others regardless of what they do.
Exercise: What Are Your Sub Personalities Telling You?
Take some time to think about how each of the above sub personalities plays a role in your thinking, feelings, and behavior. First, estimate how much each one affects you by rating its degree of influence from "not at all" to "very much" on a six-point scale. Which sub personality is strongest and which is weakest for you? Then think about what each sub personality is saying to you to create or aggravate anxiety in each of four different situations.
1. Work (in other words, on your job, at school, or in other performance situations)
2. Personal Relationships (with your spouse or partner, parents, children, and/or friends)
3. Anxiety Symptoms (on occasions where you experience panic, anxiety, or obsessive-compulsive symptoms)
4. Phobic Situations (either in advance of facing a phobia or while actually confronting the phobic situation)

Here is an example for The Worrier:

Work: "What if my boss finds out that I have agoraphobia? Will I get fired?"

Relationships: "My husband is getting tired of having to take me places. What if he refuses? What if he leaves me?"

Anxiety Symptoms: "What if they see me panic? What if they think I'm weird?"

Phobic Situation: "What if I get into an accident the first time I try to drive on the freeway?"
Now, write down on a piece of paper the anxiety-provoking statements your sub personalities are using in each of the above situations. You don't need to do this for all four sub personalities or for all four types of situations in each case. Only include those sub personalities and situations which you suspect are a problem for you.
Exercise: Countering Negative
Self-Talk
After you have identified negative statements you typically tell yourself for your various sub personalities, you are ready to counter them with positive, supportive statements.
If you're creating anxiety and other upsetting emotional states through negative mental programming, you can begin to change the way you feel by substituting positive programming. Doing this will take some practice.
Perhaps you're strongly attached to some of your negative self-talk. You've been telling yourself these things for years and it's difficult to give up both the habit and the belief. The validity of your negative self-statements has nothing to do with how attached you are to them or how ingrained they might be. Rather, it has to do with whether they stand up under careful, objective scrutiny. You can weaken the hold of your negative self-statements by exposing them to any of the following Socratic questions. (These questions are Socratic because, like Socrates, they expose a negative argument to rational investigation.)
1. What is the evidence for this?

2. Is this always true?

3. Has this been true in the past?

4. What are the odds of this really happening (or being true)?

5. What is the very worst that could happen? What is so bad about that? What would I do if the worst happened?

6. Am I looking at the whole picture?

7. Am I being fully objective?

Consider the following example:

Worrier: "What if I have a heart attack the next time I panic?"

Questioning: "What is the evidence that panic attacks cause heart attacks?"  (Answer: None.)

Counterstatement: "A panic attack, however uncomfortable, is not dangerous to my heart. I can let panic rise, fall, and pass, and my heart will be fine."

Try this yourself. Write down counterstatements corresponding to each negative statement you created. (Note: The Anxiety & Phobia Workbook contains helpful worksheets for this exercise.)
Next Page: Work with your positive counterstatements
Once you've completed writing out positive self-talk for each sub personality in each situation, there are several ways you can work with your positive counterstatements.

1. Read through your list of positive counterstatements slowly and carefully for a few minutes each day for at least two weeks. See if you can feel some conviction about their truth as you read them. This will help you integrate them more deeply into your consciousness.

2. Make copies of your statements and post them in a conspicuous place. Take time once a day to carefully read through your positive counterstatements.

3. Put your counterstatements on tape, leaving about five seconds between each consecutive positive statement so that it has time to sink in. You can significantly enhance the effect of such a tape by giving yourself 10-15 minutes to become very relaxed before listening to your counterstatements. You will be more receptive to them in a relaxed state.

Practice Your New Skills Daily
The initial motivation and enthusiasm you have when you first decide to do something about your problem is usually sufficient to get you started. The real test is in following through.   On a practical level, this means going out and exercising, or working on your self-esteem even on those days when you don't feel like it. It means that you get up and keep going even after you've had a setback which makes you wonder whether you'll ever feel better. While your motivation may wax and wane, a personal commitment to follow through with your program is what is going to make the difference.   Here’s to practicing “going with the flow”, and staying on your “surfboard”!  We can’t control life’s ups and downs but we can control our reaction to it.  And that is powerful stuff!