Anxiety is one of the most uncomfortable emotions, and so common for those of us in marginalized communities. Whether we are LGBTQ, Kink/BDSM/Leather, engaged in sex work or living some form of non-monogamy, we are exposed to potential judgement from others and ourselves, and thus experience extra opportunities for anxiety to be a problem.
As a therapist who specializes in working with these communities, I like to stay current with the evidence-based treatments for reducing and eliminating anxiety.
Anxiety Intensity Conditions
I tend to break down my approach to anxiety by how severe the anxiety seems to be. I will call them Anxiety Intensity Conditions and rank them on a scale of 1-5. Think of it as AXCON, similar to the military’s use of DEFCON (Defense Condition) for determining the scale of response to situation.
Let’s apply the AXCON scale to a scenario where my car is almost out of gas, and I’m running late for work. Suppose I have also been “counseled” by a supervisor about previous lateness. I notice that I am feeling anxious and rate how strong the feeling is, to determine the best way to focus and calm myself.
No anxiety - enjoy your day :-)
“It’s going to be okay. I’m sure the gasoline will last until I get to the appointment. And even if it doesn’t, I know I can communicate with people and cope with them being upset with me.”
And when the intensity of the anxiety is low enough, this works just fine.
At this level of increased anxiety, I use the “worst case scenario” approach. With this approach, I imagine the worst possible outcome and reassure myself that even if it comes to that, I will be able to cope with it and recover.
“Okay, what’s the worst case scenario? I could get fired for being late. I don’t want that to happen, but if it did, I know I have enough money saved or support from other people to get by until I get another job. It’s not the end of the world.”
If using this technique increases your anxiety, then you are already at AXCON 2.
When I feel like I’m at AXCON 2, I use some of the techniques from a book called Stopping the Noise in Your Head by Dr. Reid Wilson. Dr. Wilson also has a free video series about these techniques on his website. These techniques are called Exposure and Response Prevention. This is the gold standard for anxiety treatment (more on this later.)
I imagine my anxiety as another person who is harassing me. I visualize myself getting up in Anxiety’s face and essentially saying, “Really? Is that all you got?”
“Hello Anxiety! I’m glad you’re here. Because you know what? I want to feel anxious! In fact, this isn’t enough anxiety for me. I want more. Make the wheels fall off my car! Then I surely won’t make it to the appointment. You’re not going to do that for me? Okay, make the car run out of gas right here, and make the cell service go out so I can’t call anybody. Go ahead! I’m waiting! Okay, have my boss call me right now and fire me for no reason. I want a vacation anyway! Come on!”
It sounds completely counterintuitive, but it has really worked for me and some of my clients! However, I have found that some people need to build up their inner resources and resiliency before using these techniques. Which brings me to the highest intensity level for anxiety.
AXCON 1 is a panic attack. Imagine those scenes in Star Trek when Red Alert kicks on. Weird lighting, whooping siren, the bridge tipping this way and that. It’s overwhelming, complete with physical sensations and a sense of urgency demanding your full attention RIGHT NOW.
With a panic attack, the only thing to do is address the panic attack. Use whatever works to calm yourself and end the panic attack.
I use, and have taught clients to use, a breathing technique where I extend each exhale a little more each time. In an anxiety attack, the impulse is to breathe fast and shallow, which increases your feeling of being completely out of control. Your heart races and it’s hard to think clearly because short breaths bring less oxygen to the brain.
Because we have some control over breathing, we can use it to literally trick the heart into slowing down. Try counting how long you can extend the exhale. Then increase that length of time by 1 with each breath. I’ve seen clients pull themselves out of a panic attack in less than 30 seconds using this technique.
Additional Strategies for Dealing With Panic Attacks
Additional strategies that can help you calm yourself when you feel super anxious:
Close your eyes
Focus on a single object
Apply ice or cold pack to your face or armpits
Pet your friendly cat, dog, horse, rabbit, guinea pig, or other cuddly creature, if you have one (or piece of fur, or soft micro fleece blanket....)
Use a grounding technique, such as:
--Name three things you see
--Name three things you hear
--Name three things you feel
--Name three things you smell
You can do this with any series of things you can identify to yourself that makes you focus on something. Some people use a prayer or a mantra. In the TV series Jessica Jones, Jessica would calm herself by saying the names of the streets that she lived on while growing up.
Once a panic attack has subsided, you’ll want to return to addressing the source of the anxiety with the AXCON 2 approach. In my next post, I will explain Exposure and Response Prevention in more detail and how to use these techniques for a longer term approach to healing entrenched anxiety.