What tools might therapy offer someone who struggles with social & professional performance anxiety?

Good Morning and Thank You!  I hope this information is helpful and if you decide to get therapy, please allow me the opportunity. 

When you’re having an anxiety or panic attack, it is difficult to reach the skills in the brain when physically the body is compromised. It is best to do some breathing skills or temperature change skills to take care of the physical needs first and bring the body to homeostasis. Once you are to that level, you can access more of the logical and reasonable part of the brain which can include challenging yourself with questions.

One is called diaphragmatic breathing. It’s where you breathe deeply from your diaphragm. Before you can access any skills from your mind, you first need to calm the body. We can calm that in two ways and one of them is by breathing. When you diaphragmatic breath, set up as straight as you can. Put your hand on your belly. You will take a long deliberate deep breath in through your nose. When you exhale, take a long deliberate breath out. You might even want to do an extra push to push out any extra bad air in the body. Do this for as long as you need to. You should feel your heart rate start to go back to normal and you’re sweating us start to be under control.

Another way is another breathing skill called squared breathing. This is where you breathe to the count in a square pattern. So you breathe in for a count, hold for a count, breathe out for a count, and hold for a count. Typically people start with the number four and see how it works for them. If you’re a deeper breather, you may need to increase the number to six or so. If you are not able to hold your breath for that long, you can keep the holding number at four. The important thing is that you breathe in and out the same number, and you hold your breath for the same number. But the concept of controlling the breath is the same. People have actually been able to control their blood pressure by using the skill. It is pretty awesome!

The third and final way I would like to share with you is change in temperature. This is a DBT skill and works very well also. Basically, you put your face into a bowl of cold ice water for about 30 seconds. That will intensely bring the temperature in the body down which will slow down the heart rate. I know most of us start with a bowl of ice water. One way to revise that is to use an ice pack and put it on your face. You can also splash cold water on your face but it will take longer without the ice.

Another tool is to YouTube meditation for anxiety, stress, anger etc and listen to a playing as you're going to sleep.  You will fall asleep but your subconscious will remember everything.  It helps sublimely.  Therefore, load it up, listen, and fall asleep.  

Additionally, here are some questions to challenge negative thinking. Am I falling into a thinking trap? Am I catastrophizing or awfulizing? What evidence do I have that this thought is true? What evidence do I have this thought is not true? Have I confused a thought with a fact? What would a friend say about my thought? If this thought was a friend’s thoughts, what would I say to them? Am I 100% sure that this thought will happen? How many times has this thought happened before? Is this thought so important that my future depends on it? What is the worst that could happen? If that worst thing happens, what could I do to cope with it or handle it? Is my judgment based on the way I feel instead of facts? Am I confusing possibility with certainty? Is this a hassle or something horrible?

So there are three states of mind: emotion mind, reasonable mind, and wise mind.

Emotion mind is where we are 100% full of an emotion. It could be any emotion. It could be joy, fear, anxiety, happiness, anger, worry, just about anything. When full in emotion mind, we have no reason or thoughts that are sensible. We are just full of that emotion and cannot see out of it. It is not a good place to make good decisions because we are not using logic or reason.

Another state of mind is reasonable mind. When we are full in reasonable mind, we have no emotion. It’s very factual, give me the data kind of mind. It is a place of only looking at the facts. People that are accountants or actuaries will spend a lot of time in reasonable mind. Where those two minds come together is called wise mind. This is where you want to try to go and most certainly this is where you want to make your important decisions. If we make decisions in emotion mind, they usually become hasty decisions and we later regret it. If we make decisions in reasonable mind, we don’t always take into the account of other peoples feelings and what they would like.

Wise mind takes into account both. A lot of people ask, how do you know when you are in wise mind? The thing is, there’s no one specific indicator. It’s kind of a gut feeling. It feels right and you go back and forth with emotion and reason and you feel right about the decision. I would encourage you to be aware of these states of mind and try to put yourself in wise mind. Please don’t expect perfection. That is not reasonable.

When you have some time, google "urge surfing." You can do this when you are experiencing something like you are and it’s hard to get out of your head with negative intense thinking. It helps you walk through what you are experiencing. It does it without using judge mental terms like this will never go away. It helps you be mindful and stay in the present. But it also allows you to just experience what you are by describing and not using awfulizing words. 

Another tool and after you are able to regulate yourself physically, you can start using additional skills. One of those skills has called the stopp skill. This is probably one of my favorites. I love the stopp skill because you can use it for so many different things. It is an acronym. 

The S stands for stop. You need to actually tell yourself and your thoughts stop. 

T stands for take a breath. I will take a good deep diaphragmatic breath. Slowly and intentionally. This will slow down the elevation in the body and allow you to access what you need to in your mind. 

O is observe. Observe what is happening around you. What am I really reacting to? Is this going to be helpful? What is happening with my body at this time? 

The first P is to pull back and put into some perspective. Is there another way to look at the situation? If somebody was coming to me with this, what would I say to them? What meaning am I giving this event? That is a question that I ask myself a lot and then I further challenge that by asking do I need to have an air rational or intense reaction in order to handle this the best way possible? Ask yourself if the reaction you have is proportion to the actual event and what are the consequences to those actions? 

The final P is to practice what works. Ask yourself what is going to be most helpful. Will it be effective? Will it be appropriate? Does it keep within my value system? What is the best thing for me to do not only for myself but for others in the situation as a whole? I tried to raise my kids always thinking about the golden rule which is do unto others as you would have done onto you. So that is a question I ask myself is with my response be a response I would want to hear or deal with? I know at first we have to think about these skills intentionally. However, once you do them a few times, it becomes easier to do. After a while, you will just do the scale without even thinking about it. I just like everything in life, it takes practice and at first it’s definitely intentional thinking. 

I hope this is helpful.  Dr. Paula