Anxiety Management

Anxiety management involves learning several skills that will help you cope better with PTSD symptoms. People usually try all of these anxiety management techniques to determine what helps most. When PTSD symptoms strike, anxiety management techniques are used to reduce the intensity of symptoms and the distress they create. But it is not enough to understand the principles behind these techniques; they must be practiced repeatedly until they can be employed easily and automatically—almost without thinking about them. Some people use anxiety management techniques to help control anxiety while they do exposure therapy. Five different techniques for anxiety management are:

• Breathing training
• Relaxation
• Assertiveness training
• Positive thinking and self-talk
• Thought stopping

Breathing training

When we feel frightened or anxious, a natural part of our "fight or flight" response is to breathe rapidly and deeply, which can often result in hyperventilation. Hyperventilation produces uncomfortable or even frightening sensations that make you feel even more anxious. In fact, some describe a "vicious cycle" in which anxiety or fear provokes hyperventilation, which in turn increases anxiety and fear. Breathing training can help stop this cycle before it gets out of control. back to top

Relaxation

When frightened or anxious, we tighten our muscles so that we are ready to fight, flee or freeze. While this reaction is appropriate in the face of imminent danger, PTSD symptoms are a reaction to past danger and are inappropriate in the present. back to top

Assertiveness training

Assertive communication is a direct and honest expression of your feelings, preferences, needs or opinions that does not offend or threaten another person. It means standing up for your legitimate rights without violating the rights of others. Unassertive communication occurs when you do not directly express your feelings, needs or opinions. For those with PTSD, unassertive communication can accentuate distress and dysfunction. back to top

Positive thinking and self-talk

In this technique, the goal is to replace negative or destructive thoughts with positive thoughts. For example, instead of thinking, "I can never control my emotions," we can learn to say to ourselves, "No one can control all their emotions all the time, but is it really true that I can never control my emotions? No. I can think about times when I have had better control over my emotions..." One popular book that provides more detail about constructive thinking is entitled Feeling Good by David Burns (see Reading List). back to top

Thought stopping

Thought stopping asks you to stop thinking distressing thoughts. A therapist may ask you to think a distressing thought and when you indicate that the thought is clearly in mind, the therapist shouts "Stop." This startles you and interrupts the thought. You can learn to first shout, later say and finally whisper, "Stop," whenever a distressing thought occurs.

This anxiety management technique is controversial because it is the opposite of what exposure therapy requires. Exposure therapy, which has been shown to be very effective in treating PTSD, requires long periods of confronting the triggers of PTSD discomfort to allow habituation to occur. Thought stopping, by contrast, maintains that one should stop, or turn off, discomforting thoughts. While this may provide short-term relief for some individuals, it seldom provides lasting benefit because the distressing thoughts and feelings almost always come back. In fact, thought stopping before habituation has time to work may make the person more sensitive to the very thoughts being stopped.

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