Is this feeling normal? How can I cope with these thoughts? How do I feel at peace moving forward?

Dear Klaus,

First of all, I am impressed that you are reaching out for help. It is a brave first step, and I want to congratulate you on dipping your toe in the water here at BetterHelp to see if meeting with a therapist here will help you. You have raised several different issues here, and it is clear that you have a lot on your mind. Anxiety becomes a serious problem when it starts to inhibit you from doing activities you enjoy, from succeeding at school or work, or from general happiness.

What to do about it?

- Speak to your medical health care provider about whether anti-anxiety medication may be a good fit for you. Anxiolytics are safe and effective, and they can help increase the effectiveness of one on one talk therapy.

- Learn about the links between anxiety and cognition. From what you wrote, it sounds like overwhelming feelings are not new for you (but certainly much more problematic right now). A few decades of social science research have helped us understand that our thought patterns and how we consider the world and events lead to specific emotions. Your therapist can teach you more about the cognitive model and describe some practical tools to change the maladaptive thought patterns (in other words, the ways of thinking that keep bringing you down). There are so many practical ways to get started with this work, and it can help strengthen you throughout your life. In the mean time, you can learn more by watching a Groupinar on BetterHelp about Cognitive Behavioral Therapy to start learning about the links between anxiety and cognition.

- Learn more about anxiety in general. Physical sensations like increased heart rate, sweating, feeling overwhelmed and panicked are signs of your fight or flight response. This is an evolutionary function of our sympathetic nervous system that helps our bodies prepare for dealing with predators (either to fight or flee). In addition, you may feel your muscles tense up and a surge of energy as glucose and adrenaline are released into your bloodstream. The fight or flight response makes a lot of sense if you are dealing with a physical threat, but it does not help us much when our threat is a work deadline, being late for an appointment, meeting a new person, poor internet connection, or other modern stressors. Indeed, too much of the fight or flight response causes stomach upset, muscle tension, bad mood, trouble sleeping, and eventually even lowered immunity (do you ever notice how college students always get sick right after final exams?).

- Disrupt intense fear or the fight or flight response with deep breathing. Learning deep belly breathing (or “diaphragmatic breathing) is a great tool to add to effective stress management. Taking time to breathe deeply for a few minutes is a free and easy to learn method to take you out of the fight or flight zone and into a zone where you can think more clearly and not experience those side effects. You can Google “deep breathing” or “diaphragmatic breathing” to start learning a technique that really helps most people. You can find mobile apps to help (for example the Breathe2Relax or the Virtual Hope Box app – both are free and evidence-based) or watch videos online that can walk you through it. These are skills that not only help you now, but can assist you throughout your entire life (for example, dealing with road rage, poor customer service, annoying family). You can also disrupt the fight or flight response in the moment with just a minute or two of intense exercise (for example, push-ups, jumping jacks or walking up and down a flight of stairs). This helps use some of the adrenalin and glucose that are released into your blood stream when you have encountered a stressor and leaves you thinking a bit more clearly.

- Try to identify triggers. We are creatures of habit, and we tend to be afraid of consistent things. Unfortunately, the more we avoid a fear, the stronger that fear gets (avoidance is like fuel for fear). As such, it is important to start learning about the common themes of what makes you anxious. Is it a fear of being judged? A fear of failure? A fear of not being loved or admired? Everyone is different. The best way to do this is to start keeping a log of the times you experienced the fight or flight response. Jot down in a journal or in an app like Google Keep these times, including:

-- What was the triggering event?

-- How long did it take to calm down?

Over time, your therapist will likely recommend that you also track “what was the automatic thought,” or the instant thought that just popped in to your mind that might have made you feel even worse (such as “everyone here is going to hate me.” Or “They all think I’m stupid.” Or “I need to determine my life’s purpose or else I’m a failure.”) Your therapist can help you identify themes and come up with alternative cognitions or thoughts to battle these automatic thoughts.

- Learn more about social anxiety. It is completely normal to feel anxiety around new people or people we already know. Often this stems from a worry about being judged or about being disliked. It seems like social anxiety has increased dramatically since the onset of the COVID 19 Pandemic since many of us have had more limited interaction and spending time with strangers was *literally* unsafe prior to vaccines (and even since then for some). As such, it is important to know that you are not alone in this. When you see people walk into a social situation with a smile and a warm handshake, often they are employing the “fake it ‘til you make it” approach. Further, we live in a society that makes us all feel like we need to be extroverts, whereas it is just fine to be a person who only needs a few close friends instead of a large group. Oftentimes when we are in our 20s we start to recognize whether we are the kind of person who feels recharged after spending time with others (extrovert) or who feels recharged after spending time alone (introverts). There is no one right way.

I see good things in your future. Again, I’m so impressed that you have reached out for help and I’m confident that working with your therapist will help you in several areas of your life!

Best,

Julie

Note: If you are in crisis and feeling like hurting yourself, please call 911, go to your closest emergency department, or call the suicide hotline (the National Suicide Prevention Lifeline) immediately at 800-273-8255. You could also go to their website to chat at https://suicidepreventionlifeline.org/.