Addressing Anxiety and the Negative Feedback Loop

Man holding headDo you often feel anxious or have times of panic? Does your anxiety overwhelm you or interfere with your work, friends, or family? If so, you’re far from alone. According to the National Institute of Mental Health (NIMH), approximately 19 million adults in the United States experience ongoing anxiety. It cuts across all ages, ethnicities, education levels, and socioeconomic levels. Most of us feel it at some point. Anxiety comes in many flavors; it may erupt only in social situations, manifest as an obsession or compulsion, as a specific phobia, or it may be generalized.

Below are signs of two types of anxiety:

  1. Generalized anxiety symptoms: irritability/restlessness/worrying, muscle tension/fatigue, problems concentrating, sleep difficulties.
  2. Panic symptoms: racing heart/trembling, fear of losing control or dying, shortness of breath/chest pains, chills/hot flushes (not due to peri- or menopausal phase), dizziness/light-headedness/nausea, numbness/tingling/sweating.

It’s common to feel embarrassed about your anxiety, to feel alone, and to keep it a secret. It’s scary to think of asking for help. You may have been feeling anxious for long enough that it’s hard to remember a time when you didn’t live with it. Your anxiety may feel like an unpleasant but “normal” part of you. You do not have to live with this ongoing pain: You’ll be reassured to know anxiety can be effectively treated.

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Anxiety is caused by three overlapping events: a trigger or environmental cue (public speaking or party), mental reactivity (a negative thought/self-talk), and physical reactivity (breathing rapidly, clenching fists, etc.). These form a negative feedback loop, where one begets the other. In order to cope with their anxiety, most people avoid the trigger. Though avoidance helps in the immediate moment, it makes anxiety worse in the long term. Why? Two reasons: 1) It reinforces your belief that you’re helpless to deal with it, and 2) you don’t get positive experiences as basis for further success. Below are some basic strategies to help reverse the direction of the feedback loop, turning the dial from negative to positive:

  • Consult your physician for a physical exam, including blood work, to rule out physiological causes—e.g., endocrinological imbalance such as hyperthyroidism.
  • You need not suffer alone. Weighed down by anxiety, the burden of trying to deal with it alone makes it worse. Visiting a psychotherapist for guidance is optimal. If you cannot do this, confide in a trusted friend or family member. This will help ease any shame you may feel.
  • Examine your thoughts about anxiety-provoking situations, such as going to a party.  What are your thoughts and how do they make you feel? “They might not like me”; “I won’t know anyone”; “I won’t have anything to say.” Do you notice they’re negative, harsh, or critical? Ask yourself, “If a friend was voicing these doubts, asking for reassurance, what would you say to them?” You’d be encouraging, kind, empathic, positive, and balanced. “Even though this is hard for me, I’m not quitting; instead, I’m moving forward.” “I can meet new people and maybe make a friend.” “I can ask people about themselves.” “It’ll make me feel good to know I tried something new.” “I’m glad I’m trying my best—that’s the most I can ask of myself.” Apply this compassion to yourself. Repeat these thoughts aloud; write them as bullet points and read them throughout the day, record them on your smart phone as voicemail, or simply review them mentally. Remember: Keep your tone of voice soft and supportive, caring, patient, and kind!
  • Pay attention to your physical sensations. Is your heart beating fast? Are your hands trembling? Do you feel hot? Are you sweating? To calm yourself, find a quiet place to sit. Place your hands on your thighs. Imagine a cooling breeze on your face and body. Visualize being pleasantly fanned. Murmur to yourself, “I’ll be OK, I’m doing the right thing and helping myself.” Closing your eyes, breathe deeply to a silent count of 10. Repeat. And again, until your diaphragm feels consistent. Your pulse will slow to a rhythmic beat. If you’re in a public space, excuse yourself to visit the restroom to practice these strategies. If you’re in a place without privacy, simply concentrate on your inhale and exhale. Repeat counting over and over. Nobody will guess you’re actively self-regulating your inner state!
  • For mild/moderate anxiety, you can use a mindful approach. If you fight your anxiety, you’re making it the enemy, which builds a hostile energy between you and your symptom. Instead, befriend your anxiety. Try to be OK with its existence, and “sit” with the feeling. Hold it in your conscious awareness; you’re learning to observe it at a safe distance. By not participating in it, you’re not losing yourself. In doing this, most people report, “Whew, what a relief not to be held hostage to it; I don’t feel like a prisoner of it!” Where you were once in turmoil and anguish, with practice you’ll find oasis—soothing, peace, and calm.
  • If you need more help, consult a psychiatrist for medication assessment. You may choose to use medications occasionally for severe anxiety, supplementing other therapy techniques.

© Copyright 2013 by Ranjan Patel, Psy.D., MFT, therapist in Burlingame, CA. All Rights Reserved.

Permission to publish granted to GoodTherapy.org. The preceding article was solely written by the author name above. The view and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Aleta

    January 24th, 2013 at 11:17 AM

    “Examine your thoughts about anxiety-provoking situations, such as going to a party.”

    This is what gets to me! I dread being in a place where I do not know the people. I feel uncomfortable and so completely avoid situations where such an issue might arise.

    Funny thing is I am pretty good at reassuring and advising friends myself. But when it comes to me I don’t know, I just don’t share it and suffer alone in silence. Why is it that I am able to help others but not to my own self?

    Anyway, I will try the techniques you have mentioned and I hope it turns out good. Thank you for this useful share.

  • Ira Bindman

    January 24th, 2013 at 12:23 PM

    Good article. I work with many patients who suffer from anxiety and this spells information clearly and non-judgment ally. Thanks.

  • emilie r

    January 24th, 2013 at 1:34 PM

    I have always been sort of embarassed to admit my fears and anxieties especially given that I am from afamily that nothing ever seems to stop or intimidate. They are all go getters who, when something that I perceive as bad, they just shake it off and keep on going and that is what I have been told to do too. But I can’t. I am sometimes paralyzed with fear where they all seem fearless, and that is when I run into the most trouble. I don’t know how to ask them for help because they have never told me that it is okay to need it.

  • Tilak Rishi

    January 24th, 2013 at 5:18 PM

    A very helpful article, in fact, the finest and most practical piece of advice to those passing through anxiety phase. The best part of the article, which I could instantly put to practice with immediate remarkable relief, I found in advice on ‘mindful approach’ method. Thank you Dr. Ranjan Patel, I’m going to get my positive energy back sooner than I could ever expect, and at no extra cost, which I could hardly afford. God bless you and the goodtherapy.org.

  • alice

    January 24th, 2013 at 11:21 PM

    just running away from the problem by avoiding the trigger is not going to help. I used to do this but learned that it wasn’t helping.. my fear was stepping out of my comfort zone, meeting new people.. it has changed now though. I am no more afraid of such an instance and can confidently step out. and what a relief it has been!

  • Melissa

    January 25th, 2013 at 3:54 AM

    Sometimes if you can just pinpoint the triggers that cause you so much anxiety it is super easy to fix. But when you don’t know what causes it it would be best to seek the help of a therapist who can help you work through all of that, deal with your emotions, and hopefully reach a conclusion about what could cause this generalized sense of panic in life. The meds can help too, but if you know what causes it to be worse then that’s even better for recovery.

  • ROBIN

    January 25th, 2013 at 12:59 PM

    Could a person have more than a single trigger? A friend of mine has this weird behavior of backing out of situations that most of us would consider normal. Sometimes it’s at the last moment and I’m left wondering what went wrong. I’m suspecting it has to be his fears and triggers, but could there be more than one for him to have them as often as he does?

  • ALAN

    January 25th, 2013 at 11:55 PM

    This is one rut that is tough to break out of! It can become a cycle that takes an automated course with no change ever happening. I was into this kind of a cycle and it took me a lot of encouragement from family and friends and my own efforts to get out of it.

    Also informing them of this ‘weakness’ was not easy at all. It took me some time but I’m glad I did that. I can see now how chained I was in this loop!

  • Robinm

    January 26th, 2013 at 8:25 AM

    Thank you for pointing out the endocrinological imbalance points. This can be for some THE reason for the anxiety and yet the furthest from their minds. Such suffering and such simple solutions.

  • Beth

    January 26th, 2013 at 9:00 AM

    Wow, I can completely relate to it: I would get very anxious to go to parties, even Thanksgiving dinners within family and close friends. This progressed into multiple phobia of flying, elevators, germs, … you are absolutely right about the embarrassment, making excuses to walk up twenty flights of stairs in a downtown building to avoid an elevator panic attack, was excruciating. I feel much better nowadays, with proper medication and therapy regiment. In addition, I have been trying to “pay attention to my physical sensations” which helps demystify the fear and brings me into the present moment instead of panicking about what might happen next. I am also eager to try “mindful approach” which I recently heard on NPR, can alter brain structure for a persistently calm life. Thank You, for such a thoughtful, sensitive, non-judgmental, and informative article!

  • Jamie

    January 26th, 2013 at 1:50 PM

    Thank you for some wonderful advice. I have this problem myself and I hope I am able to overcome it gradually with the advice you have provided.

    Never has this been explained to me in this way by which I am able to related and understand completely. Many thanks for publishing this.

  • Peg Haust-Arliss

    July 20th, 2013 at 1:52 PM

    Good article. I also work with folks with anxiety challenges. I especially like the second to last point. Whatever you resist persists.

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