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Clients Cope
24 Dec 2021 by Laura Wells, DClinPsy
We have all experienced anxiety at some point, whether it’s hearing a bump in the
night or preparing for an exam.
However, over-activation of the anxiety response can have a debilitating impact, and
anxiety difficulties are one of the most commonly presented mental health problems
(Stansfeld et al., 2016). Thankfully, there are many evidence-based anxiety
management tools available.
This article provides key information for practitioners, with over 20 helpful anxiety
tools to help clients cope with and overcome anxiety difficulties.
Before you continue, we thought you might like to download our three Strengths
Exercises for free. These detailed, science-based exercises will help your clients
realize their unique potential and create a life that feels energizing and authentic.
Anxiety is the activation of the body’s fight, flight, or freeze response, which is often
experienced as restlessness, trembling, poor concentration, sweating, heart
palpitations, shortness of breath, and irritability (Clark & Beck, 2011).
Beck, Emery, and Greenberg’s (2005) cognitive theory suggests that anxiety
difficulties stem from an overestimation of danger and underestimation of coping
ability. In this theory, negative cognitions (e.g., predictions and appraisals) start the
vicious cycle of anxiety, triggering associated physiological responses and safety
behaviors (e.g., avoiding or escaping feared situations).
Although safety behaviors alleviate anxiety in the short term, they can lead to anxious
predictions never being challenged, which maintains or worsens anxiety in the long
term (Wells, 1997).
This brief TED Talk video introduces anxiety and the fight, flight, or freeze response.
1. Psychoeducation
It is important to normalize anxiety initially and provide information about the brain’s
threat response (Donker, Griffiths, Cuijpers, & Christensen, 2009).
Normalizing anxiety helps to reduce a client’s sense of shame or feeling that there’s
something wrong with them (Welford, 2010). Here’s an example of an anxiety
psychoeducation video.
For further reading about psychoeducation, this article offers 48 Ways to Apply
Psychoeducation as a Coach, while our article Coaching for Anxiety offers podcasts
and techniques that you can use with your clients.
2. Anxiety monitoring
Keeping track of experiences of anxiety can help clients identify patterns of thoughts,
feelings, and behaviors. They can write down triggers or keep an anxiety diary as a
way to gain a deeper understanding of these patterns (Leahy, Holland, & McGinn,
2011).
Psychological formulation (Johnstone & Dallos, 2014) can help clients understand
maintenance cycles of anxiety (i.e., how their anxious thoughts, feelings, and
behaviors interlink to keep anxiety going). For example, the Cognitive-Behavioral
Therapy situational formulation cycle can be used as part of psychoeducation.
There are different types of tools that target different areas of the anxiety cycle.
Relaxation strategies calm bodily sensations, cognitive skills aim to shift anxious
thinking, and behavioral strategies help to reduce safety behaviors.
Different tools work for different people in different situations. It can be helpful for
clients to develop a written list or toolkit of strategies that work for them.
1. Controlled breathing
Progressive muscle relaxation aims to relax the muscles to ease the bodily sensations
of anxiety, such as muscle tension. You tense and relax each muscle group in turn,
working progressively throughout the body.
3. Calming imagery
Visualization is the idea of building an image in your mind of a calm, safe place (e.g.,
beach, forest, familiar place). This soothes the anxiety response and distracts from
anxious thinking (Hart, 2008; Welford, 2010).
4. Distraction
You can distract your brain from anxious thoughts by refocusing on another activity.
This strategy can also help clients feel empowered to use their existing strengths and
interests as helpful anxiety tools, for example, doing an enjoyable hobby.
5. Thought challenging
Thought challenging involves identifying evidence for and against anxious thoughts.
The aim is to weigh up this evidence and then reframe the thought as a more balanced
view of the situation, moving away from anxious predictions. Use this Questions for
Thought Challenging worksheet to get a balanced view on a situation.
6. Compassionate self-talk
Anxiety partly stems from self-criticism, such as believing that you do not have
the skills to cope (Welford, 2010).
Compassionate self-talk can help reduce anxiety and self-criticism. For example, “I’ve
coped before, I can get through this.”
7. Worry time
This involves allocating specific worry time (e.g., 5–10 minutes per day). If worries
pop up, these can be written down and saved until worry time. This reduces the
amount of worrying and rumination. Use our Worry Bank worksheet for further
practical guidance on this tool.
These involve facing your fears by reducing safety behaviors. Behavioral experiments
involve writing down the initial anxious prediction, facing the feared situation, and
then reflecting on what actually happened.
This often provides evidence against the initial anxious belief. Use this Behavioral
Experiment to Test Beliefs worksheet to plan out experiments. Build up to facing
fears through graded exposure by breaking down the task into small steps.
9. Exercise
Physical activity can be an effective way to reduce anxiety levels. It helps burn off the
adrenaline caused by the fight, flight, or freeze response and serves as a distraction
(Kennerley, 2014) and also helps with sleep (Kredlow, Capozzoli, Hearon, Calkins, &
Otto, 2015).
10. Sleep
Feeling anxious can negatively impact sleep, and lack of sleep can mean a lower
threshold for feeling anxious. It is important to strive for a good night’s sleep, through
a relaxing bedtime routine, regular sleep pattern, and using other sleep hygiene
strategies.
1. Mindful breathing
This involves bringing your attention to your breathing, which refocuses your
brain away from anxious thoughts to solely attending to the present moment
and the physical sensations of the breath.
2. 5-4-3-2-1
This strategy helps you to connect to your environment using all senses. It
involves naming five things you can see, four things you can touch, three things
you can hear, two things you can smell, and one thing you can taste.
3. Grounding object
It can be helpful to carry a grounding object, such as a stone or fidget toy.
When anxious, you can hold the object and focus your attention on it, such as
the textures and colors, to bring your attention back to the present.
4. Ground through the feet
Place your feet on the ground and focus on the sensations this connection
brings. This simple tool aims to foster a sense of feeling centered, present, and
grounded to the earth.
5. Body scan
Bring your awareness to each part of your body in turn. The aim is to notice
different sensations in your body, either internally or how the body feels when
in contact with the external environment (e.g., touching a chair).
Focusing on the breath can help to anchor you initially and lay the foundations for
other grounding skills.
Tip 2: Create a grounding box
Also called a self-soothe box, this pre-made collection of grounding objects and
reminders can make it easier to use grounding strategies when you’re very anxious. It
helps to have multi-sensory tools, for example, a grounding object or something
pleasant to smell/taste. You can also have written reminders of other grounding skills.
It is normal for your mind to wander during mindfulness and grounding techniques,
and it is important not to fall into self-critical thinking.
We can use the mindfulness concepts of nonjudgmentally noticing when our mind
wanders and refocusing back to the grounding exercise. It may help to use a cognitive
defusion tool (Harris, 2009), such as seeing thoughts as leaves on a stream floating by
while doing mindful grounding. You can access the Leaves on a Stream exercise as
part of this free Mindfulness Tools pack.
Biological changes
Fast, shallow breathing (associated with anxiety) can result in hyperventilation, which
disrupts the blood’s oxygen and carbon dioxide levels, leading to feeling faint and
dizzy.
Mindful breathing helps with the cognitive effects of anxiety. Instead of focusing on
anxious thoughts, the mind focuses on the breath, helping to ground in the present and
shift focus away from anxious thoughts about the past or future.
Example ideas include our Deep Breathing for Kids worksheet, as well as this anxiety
psychoeducation video for kids.
When supporting children with anxiety, parents and carers play a vital role. Here are
five additional anxiety management tools for parents/carers to implement (Creswell &
Willetts, 2019):
Parents can use tools such as graded exposure and set goals with their children to
reduce safety behaviors.
Children often seek reassurance from adults when feeling anxious. Although parents
will naturally want to ensure the child is okay, too much reassurance can actually
make anxiety worse in the long term (Creswell & Willetts, 2019).
Instead of giving reassurance, it can help to empower the child to manage their
anxiety by using strategies from their toolbox.
4. Talk time
Parents can allocate a specific time to discuss worries with children. This helps to
reduce the amount of focus on worries and reassurance seeking, making them less
dominant in day-to-day life.
5. Encourage independence
Parents can help children overcome anxiety by empowering them to manage and
problem-solve anxiety-provoking situations themselves, to help build
independent coping skills.
It is also important to reinforce positive and brave behaviors using praise and rewards.
Adults:
2. Glasgow Anxiety Scale for People with an Intellectual Disability (Mindham &
Espie, 2003). This 27-item tool is included in Mindham and Espie’s
(2003) original article.
Children:
The aim of this article was to give practitioners a summary of the key advice and
strategies available for anxiety management. The hope is that this can be used to
foster clients’ confidence to use their inherent strengths and build new skills in order
to overcome anxiety difficulties and live the life they choose.
We hope you enjoyed reading this article. Don’t forget to download our three
Strengths Exercises for free.
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