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One popular method for handling stress, panic attacks, and anxiety attacks is cognitive behavior therapy (CBT). In CBT, a therapist helps you identify and change negative thoughts (i.e., cognitions) and behaviors that are contributing to your anxiety.
For instance, imagine that every time you go to work, you experience stress symptoms because of the traffic. By the time you reach the office, you’re so wound up that you have an anxiety attack. Pretty soon, you’re scared to go to work because you associate it with anxiety and panic.
A CBT therapist’s job would be to help you first identify this pattern, then make changes to break it. You might learn deep breathing exercises you can use during traffic jams or you might simply learn to accept that delays are unavoidable and that you will get there when you get there. More deep breathing can be helpful to break the connection between panic and the office setting. You might also learn to avoid that morning coffee and instead do two minutes of meditation at your desk before starting your day.
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Exposure therapy goes hand-in-hand with CBT. Frequently, certain situations or things become associated with fear so intense that it’s impossible to simply face it head-on. In fact, doing so can make things worse. To continue the example from above, you might have panic attacks or anxiety attacks at work that are so severe that you become afraid to go to work. Forcing yourself through the door only produces wave upon wave of panic that leaves you dizzy, nauseous, and trembling.
In such a case, exposure therapy can be helpful to gradually re-introduce you to the office environment with little or no fear. You might start simply by talking about the office. At the same time, you would practice breathing and deep relaxation techniques that counteract the anxiety this causes. Once you’re comfortable talking about the office, you might look at a picture of it, or start the drive over to it. Again, you push yourself only as far as you can cope, all the while practicing strategies that reduce your fear. After a few weeks, you should be able to walk through the door with levels of anxiety that you can manage, and eventually you should be able to go there anxiety-free.
Interpersonal Therapy (IPT)
IPT aims to unpack the interpersonal issues that may be contributing to your stress or anxiety. Perhaps you never felt cared for by your parents, leading to a lifetime of feeling unsafe. Perhaps your relationship with your spouse is unstable and leading to constant stress. These are the kinds of things an IPT therapist can help you uncover and work through.
Acceptance and Commitment Therapy (ACT)
ACT therapy borrows from Buddhist tradition to help you learn to accept how things are and live in the moment. That doesn’t mean that you should not make an effort to change—only that change is not possible without first seeing and accepting reality as it is.
For instance, before you can repair a troubled relationship with your mother, you must first accept feelings you may have that she failed to care for you properly as a child. Denying those feelings actually impedes positive change, and it serves no purpose to beat yourself up about them. An ACT therapist will help you first to recognize and accept your thought and feelings without judgment and then commit to making positive changes in your life.
Dialectical Behavioral Therapy (DBT)
Like ACT, DBT also incorporates Buddhist principles of mindfulness and acceptance. A DBT therapist will help you learn to recognize and tolerate negative thoughts and feelings without judgment. You will also learn skills to improve your interpersonal relationships and regulate your emotions. While on the surface ACT and DBT sound quite similar, the techniques and approaches used to achieve results are often very different.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR can be very effective to reduce the fear and anxiety associated with a specific memory or thought. An effective therapy for uncomplicated PTSD, a person makes very specific, rapid eye movements with the guidance of a professional while remembering a distressing event. These eye movements appear to help the brain process the distress, eventually reducing it.
There are several other approaches to managing stress and copying with anxiety attacks that you might want to explore. Biofeedback, for instance, involves learning to control your body’s own response to stress and relaxation in order to calm yourself.
Biofeedback techniques include listening to your own heart rate and trying to slow it down. You can also use a device that measures how much sweat your fingers are producing (known as electrodermal activity or EDA), as sweating is a sign of arousal.
A newer form of biofeedback is called neurofeedback, in which you are hooked up to a computer that measures your brain waves. The computer produces signals that indicate when your brain waves are reaching a state associated with relaxation, and you then try to reproduce this state. For instance, the computer might show a still image of an airplane while you’re anxious, and the airplane might begin to move as your brain waves transform toward a more relaxed brain state. Your job would then be to keep that airplane moving.
If you have severe anxiety attack and stress symptoms that do not respond to standard treatment, including medication, there are some brain stimulation techniques that are showing promise. Some of these techniques involve implanting electrodes directly into the brain while others require only that the stimulation be placed on the scalp in order to reach the brain. While these techniques can be very effective, they are generally reserved for severe cases that cannot be effectively treated any other way.
Originally published in May 2016 and updated.