I wrote this post for something else, but thought I'd share it here. Use it as much as you like, share it if it's helpful. This is not the definitive cure to anxiety by any means, but hopefully at least some people find it useful.

I thought I'd talk you through the basic steps I use in therapy with young people. This method uses CBT and has a strong evidence base for most forms of anxiety (including phobia). It can also be adapted for things like OCD. 


Step 1. Understanding anxiety

Feeling anxious is essential for survival. Without it, humans would have died out thousands of years ago. That scared feeling is what keeps us from getting too close to the cliff edge and falling, or going into a dark cave and getting trapped. We needed those nervous people to hang back from fighting that mammoth, in case it all went horribly wrong. If you're a nervous person, then know that you are important and humanity would never have survived without people like you. 

But sometimes anxiety can get in the way of us doing things we want. 

Long ago, the world was a very dangerous place so we needed to protect ourselves. If we came across a huge bear, our bodies had a mechanism to help us survive, called the fight or flight response (there is also the freeze response, but I'm going to focus on the main two). When that alarm bell is set off in your brain as that bear comes running towards you, your brain sets off a bunch of signals to your body to get ready. You have two options - stay and fight, or run away (flight). You breathe quicker and your heart beats faster, to make sure you have enough oxygen in your system to fuel your muscles for fighting or running. You might start sweating, to make sure your body doesn't overheat in the process. Your brain might start to block out what's going on around you to help you focus. You might feel nauseous, dizzy, or need the toilet - all a response to everything going on inside your body.

All of that is helpful if you're fighting a wild animal. Less so if you just want to just get through the day at school (unless your school is in the middle of the tiger enclosure at the zoo, I suppose).

So why do people still get anxious? Our brains are really good at wanting to protect us, with good reason. So if something happens, such as a bad experience, or we see someone else's nervous behaviour, our brains start to go into panic mode. For example, my mum was very scared of spiders growing up, so I learnt from a young age thar spiders were something to be feared (even though I'm in the UK and spiders here are safe). My brain wanted to keep me safe, so it learnt to set off its alarm bell every time I saw a spider. 

The problem is, the more we avoid the things we fear, the harder it gets to unlearn that behaviour. We don't ever get the chance to find out that we can cope fine with the thing we fear (in my case spiders), and so it turns into a vicous cycle.

To break this cycle, we need to create a new pathway in our brain that avoids the panic button completely. Literally. Our brain is filled with these literal pathways, made up of neurons and synapses and whatever else goes on in there, and we need to make a new one. Imagine it as a field of long grass - there is a well-trodden path that you know very well, that takes you through the field. We need to make a new path. The first time is going to be tough. There will be bumps and challenges along the way. But the more you walk along the new path, the easier it will become. The temptation to use your old path will be there in the beginning, but with time the new route will get easier, and with even more time the older, panic-filled route will grow over and eventually vanish. As long as you stick to the new path. 

So how do we do that?

Step 2. Learn some strategies

Anxiety feels really uncomfortable. There's no doubt about it. But there are things you can do to help with this.

One of the quickest ways to trick your body into calming down is by controlling your breathing. Remember that extra oxygen for the fight/flight situation? You can trick your body into thinking you're calm by breathing out for LONGER than you breathe in, to get rid of the extra oxygen. If people tell you to take a deep breath, don't do it. The timings don't matter hugely, for example you could breathe in for 5, hold it for 5, and breathe out for 7. You decide.

Another helpful strategy is noticing. Notice other things around you. You might count how many square things you can see, find something for every colour of the rainbow, pay attention to the textures you can feel. Really channel into that bird you can hear, that breeze through the window, or what someone is saying. One technique is called 54321 - 5 things you can see, 4 you can hear, 3 feel, 2 smell, 1 taste. 

Other things include hand massage, listening to/imagining your favourite song, drawing... whatever makes sense for you. 

The other main strategy is around remembering the evidence and taking control of your anxious voice. Think about what is realistically going to happen, and separate that from the alarm bell in your brain. For example, with my fear of spiders, I might say "I know this is just my anxiety talking, I know that spiders can't hurt me". You might come up with positive affirmations or coping sentences to remind yourself that you can do this. One of my favourite examples was a little boy I worked with who was afraid of going out at night in case he got bitten by a wolf. There are no (wild) wolves in England.

Step 3. Create your plan:

Now we need to make a step-by-step plan for how to overcome the anxiety. I like to do this by drawing it out on a ladder or as steps, to really help visualise the process. You can have as many steps as you like on your plan, but roughly 10 is a good number to aim for. 

At the top of your steps/ladder, you will put your target. It's probably something that feels impossible right now, but it's the thing that if you could wave a magic wand, you wish could be different. Then fill in the rest of your steps with gradually smaller and smaller challenges/changes until you get down to a first step, which is something that feels uncomfortable but doable.

Here is an example based on social phobia, where the person is anxious about awkward interactions with strangers at a bus stop (imagine the thing on the left is a ladder!):

|-| Have a 5 minute conversation with a stranger
|-| Have a 1 minute conversation with a stranger
|-| Ask a stranger at the bus stop a question 
|-| Say hello to a stranger at the bus stop
|-| Smile at and make eye contact with a stranger 
|-| Stand next to a stranger at a bus stop for 1 min
|-| Stand 2 metres from a stranger at a bus stop
|-| Stand at a bus stop when someone else is there
|-| Walk past the bus stop if someone else is there
|‐| Stand alone at a bus stop

Step 4. Put it into action!

For each step of the plan (starting from the bottom and working up), arrange how you're going to do that thing. If you notice your alarm bell starting to go off in your brain, use the coping strategies you've come up with. It's up to you how quickly you work through this - one step per week is a reasonable target, but do each one a few times if need be. Keep pushing through any uncomfortable feelings. 

If you achieve that step, you've earned yourself a reward! Keep the rewards in line with the point in the ladder, for example lower down might be a chocolate bar, or another tasty treat. In the middle might be a new piece of clothing or going out to do something. At the top should be the big reward - the latest video game, or a day out to somewhere cool (this doesn't need to be expensive). 

Well done, you've conquered the anxiety! Keep reinforcing that pathway in your brain - don't just stop using all your new skills.

You are awesome!

Tips:

This should feel uncomfortable but manageable. If it's too easy, you need to challenge yourself more. If it's too hard, practice the current step more or add in an extra step.

It's normal to have some parts of the plan that go easily and smoothly. It's normal to have tougher patches that make you want to give up. Remind yourself that you are strong and are fighting to make your life better than how you feel it is now. Don't feel bad for the tough times - it's the sticking at it that proves how awesome you are.

When speaking to other people, try really hard to focus on them. Social anxiety forces us to focus on ourselves, but really zone into the other person and how they look, sound, what they are saying.