Principles of handling anxiety

Anxiety is an alarm that goes off too easily

Anxiety is your body's alarm system, and its job is to protect you. Picture a car swerving into your lane. Before you have time to think, your heart pounds, your muscles tense, and you jerk the wheel. That's anxiety working the way it's supposed to. It noticed danger and got your body ready to act.

The trouble starts when the alarm goes off too easily. Instead of going off for a swerving car, it goes off for an email from your boss, a bill you haven't opened, a noise your car is making, or a thought like "what if something happens to my kids?" Your body reacts as if you're in danger, even though you're sitting at your kitchen table.

When the alarm keeps going off like this, it wears you down. You might feel on edge most of the day, have trouble sleeping, snap at people you love, or feel worn out from worrying about things that haven't happened. Some people have felt this way for so long that they think it's just their personality.

If that sounds familiar, you aren't weak and you aren't broken. Anxiety is one of the most common mental health problems, and it usually gets better with the right approach. The tools in this guide are the same ones therapists who specialize in anxiety teach their patients. They take practice, and they work for a lot of people.

What anxiety does to your body

When the alarm goes off, your body releases adrenaline and gets ready to fight or run away. Doctors call this the fight-or-flight response. It happens within seconds, and it causes a lot of physical feelings at once.

These feelings can be scary when you don't know where they come from. Each one has a job, though. Your body is getting ready for action:

None of these feelings are dangerous. They're uncomfortable because they're meant to get your attention. Knowing what each one is doing can take some of the fear out of it. A pounding heart is a lot less frightening when you know it's your body getting ready to move.

Anxiety also shows up in your thoughts and in what you do. In your thoughts, it looks like worry: your mind jumps to what could go wrong and replays the same what-ifs over and over. In what you do, it looks like putting things off, avoiding situations, checking things again and again, or asking other people whether everything is okay. That last part, what you do when you're anxious, turns out to matter most for whether anxiety sticks around.

Why anxiety keeps coming back

Think about the last time you avoided something because it made you anxious. Maybe you let a phone call go to voicemail, put off opening a letter, or skipped an event you were dreading. What happened to your anxiety right after you avoided it? It went down. You felt relief.

That relief is what keeps anxiety going. Your brain notices that avoiding made the bad feeling go away, so the next time you feel anxious, avoiding is the first thing it reaches for. Your brain also decides that the situation must have been dangerous and that you got away just in time. So the next time the same situation comes up, the alarm goes off faster and louder.

Over time this turns into a cycle. The more you avoid, the more things feel scary, and the smaller your life gets.

The sneaky kind of avoidance

Some avoidance is easy to spot, like not going at all. Other avoidance is harder to see: you go, and you do something extra to get through it. Therapists call these safety behaviors. Here are some common ones:

• Asking someone "are you sure it's okay?" again and again
• Checking things over and over, like the stove, the locks, your bank account, or where your kids are
• Over-preparing, like rereading an email ten times before you send it or writing out everything you plan to say
• Researching a decision for hours before you can make it
• Only doing something when a certain person comes with you
• Staying busy or distracted so you don't have to feel the anxiety

Safety behaviors feel helpful, and in the moment they do help. The problem is what your brain learns from them. When everything turns out fine, your brain gives the credit to the safety behavior. It never finds out that you would have been fine without it, so you feel like you need it every time.

What happens when you stay

Anxiety doesn't keep climbing forever. If you stay in an anxious situation, the anxiety rises, reaches a peak, and then starts to come down on its own, even if you don't do anything to make it go away. Most people with anxiety have never seen this happen, because they leave before it does.

Staying also teaches your brain something important. You expected something bad to happen, you stayed, and you saw for yourself that it didn't happen, or that it happened and you handled it. That experience is what calms the alarm down over time.

This is also why reassurance doesn't help much. When someone tells you "don't worry, it'll be fine," you might feel better for a few minutes. The alarm doesn't change much from being told something is safe. It changes when you go through the situation yourself and come out okay.

The way out: face your fears in small steps

The most effective treatment for anxiety uses this idea on purpose. It's called exposure. It means facing the things you've been avoiding, a little at a time, and staying long enough to learn that you can handle them.

That might sound scary. It works a lot like getting into a cold pool. If you jump into the deep end, the shock is so strong that you might climb right back out. If you start on the first step, wait until your body gets used to the water, and then go down one more step, you end up all the way in without panicking.

Exposure is a main part of cognitive behavioral therapy (CBT), one of the best-studied treatments for anxiety. You can start practicing it on your own, and a therapist can help if you get stuck.

To show how it works, this section follows one person. Sam worries about money constantly, even though his bills get paid. To keep the worry down, he avoids looking at his bank account, leaves bills unopened for weeks, and asks his wife several times a week whether they're okay financially. Every time he avoids, he feels a little better for a moment, and every month the worry grows.

Step 1: Make a list of what you avoid

Write down the situations you avoid because of anxiety, and the safety behaviors you use to get through things. Be specific. "Money stuff" is too vague to practice. "Open my credit card bill and read the whole thing" is specific enough that you could do it tonight.

Sam's list includes checking his bank balance, opening bills, reading his credit card statement, calling the credit card company about a charge, and going a day without asking his wife if they're okay.

Step 2: Rate how hard each one would be

Next to each item, write a number from 0 to 100 for how anxious you'd feel doing it. Zero means totally calm. A 50 means uncomfortable, but you could get through it. A 100 is the most anxious you can imagine. Don't worry about getting the numbers exactly right. They're only there to help you put the list in order.

Step 3: Put the list in order

Sort your list from easiest to hardest. Therapists call this a fear ladder, because you climb it one step at a time, starting at the bottom. Here is Sam's:

If there's a big jump between two steps, add a step in between. You can make almost any step easier by doing a shorter version, doing it at an easier time of day, or doing it with someone else before you try it alone.

Step 4: Pick a starting step

Start with a step you rated somewhere around 30 to 50. It should feel uncomfortable and still doable. If you start too high, you'll probably bail out partway through, and leaving early teaches your brain that the situation really was dangerous. If you start too low, you won't learn much. Sam decides to start with reading his whole credit card statement, which he rated a 40.

How to practice a step

Each time you practice, you're testing what your anxiety says will happen. Every practice has three parts: before, during, and after.

Before: write down what you're afraid will happen

Right before he starts, Sam writes one sentence about what he's afraid of: "I'll find out we're in serious trouble, and I'll be so upset I won't be able to do anything for the rest of the night." Then he writes down how sure he feels that it will happen, from 0 to 100%. Right now it feels about 70% likely.

Writing this down matters. Once it's over, it's easy to forget how sure you were, and then you miss what the practice taught you.

During: stay with it, and skip the safety behaviors

Then Sam does the step and stays with it. He reads the whole statement, line by line. He doesn't close it halfway, and he doesn't go ask his wife if everything is okay. When he sees the total, his anxiety jumps to about 65. His heart speeds up and his shoulders get tight.

He doesn't try to make the feeling go away. He notices it, keeps reading, and lets it be there. After about ten minutes, his anxiety has dropped to around 35. It's still there, and it's a lot smaller.

How long to stay depends on the step. For something that takes a minute, like opening a bill, repeat it several times in a row. For something longer, stay until you've found out whether your fear came true, and until your anxiety has started to come down if you can.

After: write down what happened

When he's done, Sam writes down what happened: "The bill was higher than I wanted, and it was a normal month. I felt upset for a few minutes, then I made dinner." Then he rates his original fear again. Now it feels about 20% likely.

The gap between what Sam expected and what happened is what teaches his brain that this situation is safer than it thought. Each time he practices, he sees that gap again, and the alarm gets a little quieter.

You can keep track with three simple questions. Fill in the first one right before you start, and the other two right after you finish:

How often to practice

Practice most days if you can, and at least three or four times a week. Once a week usually isn't enough for the new learning to stick.

Keep practicing the same step until it feels noticeably easier. A good sign is when your anxiety during the step is about half of what it was the first time, or when it's clear that the thing you feared isn't happening. Then move up to the next step on your ladder.

Progress won't be a straight line. Some days a step will feel harder than it did the day before, especially when you're tired, stressed, or sick. That's normal, and it doesn't erase what you've learned. Go back down a step for a few days, then keep climbing.

If it isn't getting easier

If you've been practicing for a couple of weeks and a step still isn't getting easier, one of these is usually the reason:

• A safety behavior is sneaking in. Maybe you repeat "it's fine, it's fine" the whole time, or you only practice when someone is with you. Find it and drop it.
• The step is too big. Break it into a smaller step and come back to this one later.
• You aren't practicing often enough. Aim for most days.

Cut back on safety behaviors

Safety behaviors, like checking, asking for reassurance, and over-preparing, keep anxiety going in the same way avoiding does. Cutting back on them is one of the most helpful things you can do, and it's often an easier place to start than your biggest fears.

Start by writing down the safety behaviors you use. Pick the one that seems easiest to give up. You can stop it completely, or cut it down in stages. If you check your bank account ten times a day, go down to five a day for a week, then two, then once each morning. When that feels normal, pick the next one.

Expect your anxiety to go up at first when you drop a safety behavior. That means it's working, because your brain is finally getting the chance to learn that you're okay without it. Just like with exposure, the anxiety comes down if you stick with it.

Reassurance

Asking other people for reassurance is one of the most common safety behaviors, and one of the hardest to give up. It helps for a few minutes. Then the doubt comes back, often with a new question. Over time, it teaches you that you can't handle not knowing unless someone else tells you it's okay.

If there's someone you usually go to for reassurance, talk about it together at a calm moment. Agree that answering is feeding the worry, and plan to cut back together, a little at a time. Decide ahead of time what they can say instead of answering, such as:

The worry usually pushes back hard for the first week or two, with more questions and more upset. It tends to settle if you both stick with the plan.

Tools for worry

Worry is the thinking part of anxiety. It feels like you're solving a problem or preparing for something bad, which is why it's so hard to stop. Most worry goes in circles, though. You think about the same what-if again and again and end up just as anxious as when you started, with nothing solved.

Worry also takes credit it doesn't deserve. When the thing you worried about doesn't happen, part of you feels like the worrying kept it from happening. That makes you more likely to worry the next time.

These tools help you sort out the worries you can do something about, deal with those, and give the rest a set place in your day.

Tool 1: Ask, "Can I do something about this in the next 48 hours?"

When a worry shows up, ask yourself that one question. If the answer is yes, there's a problem to solve. Use Tool 2 to make a plan, put the first step on your calendar, and let the worry go for now.

If the answer is no, there's nothing to solve right now, no matter how much you think about it. Worries like "what if I get sick someday?" or "what if my kids don't turn out okay?" fall into this group. They can wait for your worry time in Tool 3. Most people find that most of their worries land in the "no" group.

Tool 2: Solve problems on paper

Worrying about a problem and solving it can feel alike, and they're very different. Worry circles the problem over and over. Problem-solving goes through it once and ends with something you can do. Grab a piece of paper and:

1. Write the problem in one sentence.
2. List at least five possible solutions. Don't judge them yet. Silly ones are fine.
3. Pick one that seems good enough. It doesn't have to be perfect.
4. Plan the first step: what you'll do, when, and where.
5. Do it.
6. Check how it went. If it didn't work, pick another solution from your list.

For example, "My car inspection is Friday, and the brakes might need work I can't afford" could lead to a plan to call two repair shops for prices during lunch on Wednesday. Once that call is on the calendar, the worry has a plan, and you can set it down.

Tool 3: Give worry its own time

This tool can sound strange at first. Instead of trying to stop worrying, you schedule it. You pick a time each day to worry on purpose. The rest of the day, when a worry shows up, it has to wait for that appointment. Psychologist Thomas Borkovec developed this approach. It cuts down the time you spend worrying, and it shows you that you have more control over worry than it feels like you do.

1. Pick a time: 15 to 30 minutes, at the same time and place every day. Choose a time at least a couple of hours before bed, and a spot that isn't your bedroom.
2. Start a worry list, either a note on your phone or a small notebook.
3. When a worry shows up during the day, write it down in a few words. Tell yourself, "Not now. I'll think about this at 6:30." Then bring your attention back to what you were doing.
4. At worry time, set a timer and go through your list. Ask the 48-hour question about each worry. Make a plan for the ones you can do something about, and let yourself worry about the rest on purpose.
5. When the timer goes off, stop, even if you're in the middle of a worry. Anything left over goes on tomorrow's list.

One day of worry time might look like this:

The first week usually feels clumsy, and you'll often forget to put a worry off. That's okay. Put it off as soon as you notice, even if you've already been worrying for a while. For many people it starts to click after a couple of weeks of practice. You may also notice that a lot of the worries on your list don't seem important anymore by the time worry time comes around.

Tool 4: Check worry's track record

Anxiety can feel very sure about what's going to happen, and it's wrong most of the time. You can check this for yourself. During worry time, write down what you're afraid will happen and how likely it feels. A few days later, go back and write down what happened. When a worry does come true, write down how you handled it, too.

In a 2020 study, people with generalized anxiety disorder tracked their worries this way, and about 9 out of 10 of their worries didn't come true. Seeing that in your own handwriting is much more convincing than someone telling you not to worry.

Tool 5: Practice not knowing

A lot of worry comes from how hard it is to not know how things will turn out. Checking, researching, and asking for reassurance are all ways of trying to feel certain. Life doesn't come with guarantees, though, so the need for certainty never gets satisfied, and the worry keeps asking for more.

You can get more comfortable with not knowing the same way you'd build up a muscle, with small, safe practice. Try two or three of these each week:

• Pick a restaurant without reading the reviews
• Make a small choice, like what to order, in under a minute
• Go out without checking the weather
• Send an email after reading it over only once
• Let someone else plan an evening, and don't ask for the details
• Watch a movie you know nothing about

Before each one, notice what you're afraid will happen. Afterward, notice what happened and how you handled it.

Tools for anxious thoughts

Anxious thoughts often show up as questions, like "What if I mess this up?" or "What if something's wrong?" They feel urgent, and they're hard to argue with. These tools help you look at them more clearly.

Turn the what-if into a prediction

Rewrite the what-if as a plain sentence about what you're afraid will happen, and rate how likely it feels. "What if the meeting goes badly?" becomes "I'll stumble over my words, and my boss will think I'm bad at my job. 60% likely." Now it's something you can look at, instead of a vague cloud of dread.

Ask two questions

First, ask: how likely is this? Think about the other times you predicted something like this and what happened. Think about what you'd say to a friend who was worried about the same thing.

Second, ask: if it did happen, how would I cope? Anxiety tends to stop the story at the worst moment, so keep the story going. If you stumbled over your words in the meeting, what would happen next? Probably an awkward moment, a little embarrassment for a day or two, and then your life would go on. Having a plan for the bad outcome is often more calming than trying to convince yourself it won't happen.

Talk to yourself like a good coach

Many people with anxiety are very hard on themselves. They think being harsh keeps them in line, and mostly it keeps them tense and scared. A good coach still expects you to do hard things, and stays on your side while you do them.

When you catch yourself thinking "You idiot, you blew it," try "That went badly. What will I do differently next time?" Instead of "Why can't you just be normal?" try "This is hard for me, and I'm working on it one step at a time." If you're stuck, ask what you would say to a friend in the same spot, and say that to yourself.

Notice the thought without believing it

Sometimes arguing with a thought keeps you stuck on it. Another option is to step back from it. Instead of "I'm going to fail," say to yourself, "I'm having the thought that I'm going to fail." The thought is still there, and now you're watching it instead of getting pulled along by it. This skill comes from acceptance and commitment therapy (ACT).

Call it excitement

Anxiety and excitement feel almost the same in your body: a fast heart, a burst of energy, butterflies. Before something nerve-racking, like a presentation or a first date, trying to calm down often doesn't work, because calm is a long way from how you feel. Excitement is much closer. In a 2014 study, people who said "I'm excited" before singing karaoke, giving a speech, or taking a math test did better than people who tried to calm down. So right before the moment, say "I'm excited," and think of one good thing that could come out of it.

When anxiety comes out of nowhere

Sometimes anxiety shows up on an ordinary day for no clear reason. When that happens, stop asking "what if?" and ask "what happened?" Look back over the last day or two. Did someone upset you? Did you agree to something you didn't want to do? Is there something you're sad or angry about that you haven't let yourself feel? Anxiety sometimes shows up in place of another feeling. Naming that feeling, even just to yourself, can take a lot of the pressure off.

Tools for a tense body

These tools help calm your body. Use them every day to lower your overall anxiety, or during a hard moment to help you stay where you are. Try not to use them as a way to escape. If a breathing exercise turns into something you feel you have to do to get through every anxious moment, it has become a safety behavior.

Slow breathing with a long breath out

Your heart slows down a little each time you breathe out, so breathing with a long, slow exhale helps settle your body. One simple version is called cyclic sighing. Breathe in through your nose, take one more small sip of air at the top, and then let it all out slowly through your mouth. In a 2023 study, people who did this for five minutes a day for a month had a bigger improvement in mood than people who meditated for five minutes a day.

Press start and follow the circle for five minutes:

Try it once a day for a few weeks. If you feel lightheaded or tingly, make your breaths smaller and slower.

Count your breaths

If meditation feels like too much, try this instead. Count "one" as you breathe in and "two" as you breathe out, and keep counting up to 50. If you lose count, your mind has wandered off into a worry. Noticing that is the skill you're building, so start again at one. You can do this in a waiting room, in line, or in bed when your thoughts won't settle.

Relax your muscles

Anxiety keeps your muscles tight, often without you noticing. To practice letting go, tense one group of muscles, like making tight fists, for about 5 seconds. Then let them go loose for 15 to 20 seconds and notice how different they feel. Work your way through your hands, arms, shoulders, face, stomach, and legs. Over time, you'll get better at noticing tension early and letting it go.

Move your body

Regular exercise is one of the best ways to lower anxiety. Aim for 20 to 30 minutes of something that raises your heart rate, like brisk walking, biking, or swimming, on most days. Exercise also gets your body used to a fast heartbeat and heavy breathing, so those feelings seem less scary when anxiety causes them. If you have a heart problem or another health condition, check with your doctor before starting a new exercise routine.

Everyday things that turn anxiety up

Some anxiety comes from parts of your daily routine that are easy to change.

Sleep

Anxiety and poor sleep feed each other. A bad night makes the next day more anxious, and anxiety makes it harder to fall asleep. One of the most helpful changes is getting up at the same time every day, even on weekends. Our Insomnia Basics guide has a full plan.

Caffeine

Caffeine speeds up your heart and can make you jittery, which feels a lot like anxiety. If you're anxious, try cutting back, especially after noon. Cut down slowly over a week or two, since stopping all at once can cause headaches and tiredness. Energy drinks, soda, and some teas have caffeine too.

Alcohol

Alcohol can calm anxiety for a few hours, and then the anxiety often comes back stronger as it wears off, usually the next morning. It also makes your sleep worse. If you drink heavily every day, don't stop suddenly on your own, because withdrawal can be dangerous. Talk to a doctor first.

Cannabis

Cannabis, especially strong products and edibles, can trigger anxiety and panic, and using it regularly can make anxiety worse over time.

News and your phone

What you watch and read affects your alarm. Hours of scary news, true crime, or scrolling teach your brain that the world is dangerous. For one week, try checking the news once a day at a set time, keep your phone out of the bedroom at night, and notice how you feel.

Your first two weeks

You don't need to do everything in this guide at once. This is a simple way to start:

After that, keep climbing your fear ladder one step at a time, and keep using the tools that help you most. There will be good days and bad days. Many people notice a real difference within a few months of steady practice, and steps that once felt impossible start to feel ordinary.

Guides for specific kinds of anxiety

This guide covers anxiety in general. Some kinds of anxiety have their own patterns and their own tools. If one of these sounds like you, read that guide next:

• Panic attacksSudden waves of fear with a racing heart, dizziness, or trouble breathing, and worry about when the next one will hit.
• Social anxietyFear of being judged or embarrassed, avoiding people, and replaying conversations afterward.
• Health anxietyWorry about having a serious illness, checking your body, and searching your symptoms online.
• Intrusive thoughts and OCDDisturbing thoughts that won't leave, and things you feel driven to do over and over, like checking or washing.
• InsomniaTrouble falling asleep or staying asleep, which often comes along with anxiety.

One more kind of anxiety needs a different approach. If your anxiety started after a traumatic event and comes with nightmares, flashbacks, or always feeling on guard, look for a therapist who offers trauma-focused therapy, such as prolonged exposure, cognitive processing therapy, or EMDR. The VA's National Center for PTSD explains each one.

Books and apps

If you'd like to go further, these are good places to start:

• When Panic Attacks by David Burns. Despite the title, it covers many kinds of anxiety, including worry, shyness, and phobias. It teaches more than 40 CBT techniques for anxious thoughts, with lots of examples.
• Dare by Barry McDonagh. It teaches the DARE response, a four-step way to stop fighting anxiety and let it pass. It covers everyday anxiety and panic attacks.
• MindShift CBT, a free app with a fear ladder planner, thought tools, and daily check-ins.

The book links are Amazon affiliate links. As an Amazon Associate, Psychofarm earns from qualifying purchases, at no extra cost to you. See our disclosures.

Counting breaths to 50, talking to yourself like a good coach, and calling anxiety excitement come from Dr Thomas Smithyman's video "20 Years of Anxiety Treatment in 15 Minutes", retold here in our own words. The treatment methods are based on cognitive behavioral therapy research, including Thomas Borkovec's work on worry postponement and Michel Dugas's work on uncertainty. Psychofarm has no financial relationship with any app or program mentioned on this page.