cartoon of a black woman struggling to cope with anxiety thoughts
DBT

Coping Skills for Anxiety Management

Many of us might argue that 2020 was the “year of the coping skills.” Others might argue that 2020 was the “year of anxiety.” I will argue the “both/and” and tell you that they often go hand in hand.

Throughout the past year, all the way to present day, many of us have felt an increase in intense emotions. This has given us a metaphorical shove into a very common reality: “How do I deal with this?” Others may have realized that we have been using coping skills all along but now have the thought “wow, I have to practice these daily for them to be effective?!”

Spoiler alert: as humans, we ALL need coping skills.

Building coping skills into our regular practice is key! We need coping skills to deal with lack of connection. We need coping skills to navigate difficult conversations. We need them for when we feel intense emotions. And we need them at work, at school, at home, and at play. We need coping skills in life!

Dialectical Behavior Therapy offers a very specific set of coping skills that help with a wide variety of intense emotions, also known as emotion dysregulation.

For those of us who experience intense anxiety, we know that anxiety, indeed, can trigger both emotional and behavioral dysregulation. This is not uncommon! There are three modules in DBT that are particularly helpful when addressing anxiety, and if you have ever been in a DBT skills group, or are interested in joining a DBT skills group, “getting to know” our thoughts and emotions, and our reactions to our thoughts and emotions, is a big part of the process. The mindfulness, distress tolerance and emotion regulation module help us get there. 

Before we get to the skills to use when we feel anxiety at that intensity, we first need to learn to be mindful of it, to bring awareness to the emotion. Skills to help with this process are our “What” and “How” skills of mindfulness. What do we do, and how do we do it?

Mindfulness skills are crucial when beginning to address our anxiety.

Bringing awareness (mindfulness) to our anxiety will help us “get to know it a little better” and recognize when we are feeling triggered. We want to pay particular attention to observing, describing, and participating. Ask yourself some of these questions:

  • Where does it show up in my body?
  • How does it feel?
  • What physiological sensations does it trigger?
  • What thoughts am I noticing? 

In addition to our “what” skills of observing describing and participating, we want to practice our “How” skills by being nonjudgmental, one-mindful, and effective.

  • Are there judgments coming up related to your anxiety? Notice them.
  • Are you doing six things at once when experiencing anxiety? Bring your focus to the present moment.
  • Do you know what helps with your anxiety but are avoiding it? Focus on what works.

Intense emotions like anxiety can trigger us to engage in unhelpful behaviors. This could be substance use, self-harm, avoidance, and isolation. This happens because anxiety is uncomfortable and we’d just rather not engage with it! By becoming more mindful of our anxiety, however, we can increase our ability to make skillful decisions in those uncomfortable and challenging moments.

Sometimes our anxiety can trigger crisis thoughts, and the belief that the present moment is actually a crisis.

When we are feeling like we are in a crisis, a helpful coping skill to try is TIPP. This stands for Temperature, Intense Exercise, Paced Breathing and Paired Muscle Relaxation. TIPP works on activating both our sympathetic nervous system (our “fight or flight” response), AND our parasympathetic nervous system, which cues a relaxation response. The idea is that by using one of the four skills within TIPP, you will lower your emotional intensity enough to make an adaptive choice: ask for help, call your therapist, or use any of the other distress tolerance or emotion regulation skills.

cartoon of ice melting, excersize bike, lungs breathing, and biceps muscle contracting to symboling the 4 steps of the anxiety coping skill TIPP

Temperature challenges you to TIP your face forward into a bowl of cold water (make sure your eyes and nose are in the water), and hold your breathe for about 30 seconds. This will trigger the mammalian dive reflex, which will then cue a relaxation response.

Intense exercise challenges you to do short bursts of high intensity exercise, like sprinting for 30 seconds, doing a wall-sit, push-ups, jumping jacks, or jump squats.

Paced breathing challenges you to breathe in deeply which activates your sympathetic nervous system. And then breathe out slowly, specifically longer than your in-breath. This will then activate your parasympathetic nervous system: relaxation response!

Lastly, paired muscle relaxation challenges you to tighten and release your muscles in your body slowly and mindfully. You might try this in your toes, your hands, or even your face. When you release, say to yourself “relax.” This will help you mindfully release tension and, again, cue a relaxation response that will lower your emotional intensity. 

Once we have lowered our emotions with short term coping skills, it is also important to use long term coping skills that help us manage our anxiety.

For many of us, anxiety is a consistent presence. Learning to regulate it and accept it is very important. ABC PLEASE is a skill that is very effective when learning to regulate emotions long-term. Not only does it have multiple skills within a skill, each of those skills are so important and helpful! Accumulating positives challenges us to engage in activities that will “accumulate” positive experiences. This offsets anxiety emotions. Building Mastery challenges us to engage in activities that make us feel masterful, competent, and proud. And coping ahead is pretty self explanatory. It challenges us to cope ahead of time for when we know anxiety will be high. You can by create either a mental or a physical “tool-kit” in preparation to help you through the moment.

The “PLEASE” part of this skill challenges us to take care of our physical health (did you take your medication today?), eat balanced meals, avoid mood altering substances, get adequate sleep, and exercise. All of these contribute to our physical AND emotional health: remember, they are all connected!

These anxiety coping skills are life skills!

Whether you are currently engaged in dialectical behavior therapy or not, these skills are important for any and everyone! Through individual, group or family therapy, we will learn how to use these skills in order to address anxiety. It is also important to remember that anxiety, just like all emotions, has a function. Learning the skills to regulate it and manage it effectively is what keeps us safe! 


About the Author

Adam Friedfertig

Adam Freidfertig, LGPC is a licensed graduate professional counselor at Montgomery County Counseling Center in Rockville, MD. He obtained his bachelors degree from University of Delaware and his master’s degree in clinical Mental Health Counseling at Johns Hopkins University.

Adam has extensive training in DBT and in IFS (Internal Family System). He has worked in wilderness therapy settings, intensive outpatient settings, and now private practice settings. He specializes in work with teens and young adults. Adam see telehealth clients in Maryland.


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