Although psychotherapy along with medication management (if warranted) are the mainstays of treating anxiety and obsessive-compulsive disorders, there are a number of other interventions that you can be doing in order to help enhance and even expedite your progress.
1) Maintain your normal schedule to the greatest possible extent you can manage
Why: All too often, I see patients who have decreased their activities and reduced their contact with other people because of their symptoms. They may have done so for a variety of reasons, such as feeling too anxious, worrying about their ability to manage their symptoms in public, feeling exhausted and overwhelmed by their symptoms, etc. The tendency to withdraw from one’s typical lifestyle patterns often makes anxiety worse because the lack of engagement with regular life activities leaves the person with more time to focus on their symptoms and creates more open space for anxiety to take up residence. Also, mental health trends show time and time again that less engagement in enjoyable/meaningful activities and an absence of interaction with others can exacerbate clinical presentations
How: Although it may not be feasible to keep the same level of activity as you once did when you are in the throes of an anxiety disorder, that does not mean that you should cease participation in all of your normal patterns. Modify what you can — try consolidating your errands into one trip, maintain contact with friends even if it is just a quick meeting for a walk, take more breaks as needed, etc. Work with your mental health provider to identify ways to maintain variations of your activities. Don’t let your anxiety bench you from your life!
2) Manage your stress
Why: Stress and anxiety manifest rather similarly in a physiological sense and they certainly have the potential to reinforce and increase one another. If your baseline level of stress is heightened, that will surely show up in your experience of anxiety. Therefore, if you can find ways to better manage your stress, you will also be better managing your anxiety or OCD.
How: While there are many ways to manage stress, it is important to make sure that your methods are constructive and do not result in a higher level of stress in the big scheme of things. Remember, it’s not an effective coping strategy if it is causing more issues in the long run. Here are a few stress management suggestions:
- Strategically disengage from those stressors that are unnecessary — turn off the news if you feel anxious about all the gloom and doom featured in the news stories. We are constantly bombarded (particularly for the last 1.5 years) by bad news and limiting our viewing of such material would be beneficial. Seek to minimize your interactions with people who sap your energy, manage your time so you don’t have to rush, make time for rest, etc.
- Limit your exposure to upsetting information, people who are intentionally pushing your buttons, and stop saying “yes” when you want to say “no.”
- Alter stressful situations when possible, whether that involves becoming more organized, compromising with your friends, or assertively managing your boundaries.
- Stress management also involves learning how to adapt to stressors and to become more flexible by using cognitive restructuring skills, employing a big-picture perspective, setting reasonable expectations for yourself, and practicing acceptance.
- Create a self-care routine for yourself and make it a priority to be consistent with it. A good self-care routine will go a long way in helping to buffer the impacts of stress. Remember, self-care is not indulgent. It is necessary for optimal health and is as critical as good nutrition, restful sleep, and regular exercise for maintaining wellness.
3) Spend time outdoors
Why: Studies have shown that spending time outdoors decreases anxiety and depression and increases feelings of happiness. Research has found the being outside decreases cortisol levels (primary stress hormone)
How: Make a point to get outside each day, even if it’s just for 10 minutes, and yes, even if it’s cold.
- Open your windows and let fresh air inside
- Garden outside or take care of some indoor potted plants
- Use a sound machine to create nature sounds inside
- Walk around your work or school building before heading indoors
- Take your breaks outside, even if it is just sitting on your front stoop
- Eat outdoors when you can.
4) Use your social supports
Why: The benefits of social connectedness are numerous and have been linked to increased longevity, better immune system functioning, lower rates of anxiety and depression, and increased self-esteem – just to name a few. In regards to anxiety and OCD treatment, family members, roommates, teachers, significant others (and of course your therapist or psychologist!) can all help to further the treatment process by constructively supporting you and encouraging you to fight through your anxiety and overcome your fears
- Make a point of socializing regularly (the “regular” frequency and duration may differ from person-to-person). Find and spend time with others who share your interests. Strike up conversations with neighbors, cashiers, baristas, etc. Join a group at the gym, library, church, etc.
- If you feel comfortable, tell trustworthy others about your anxiety. There is nothing to be ashamed of in admitting your struggles with anxiety. Anxiety thrives in the darkness so the more you can bring it into the light and normalize it, the less power it has over you. You may also be surprised to find that others in your life may also be grappling with anxiety of their own from time to time.
- Different people in your life will be more helpful for certain things than other things. Some people may be more instrumental supporters, meaning that they can assist with getting things done (running errands, addressing tech issues, delegation of tasks), while other people in your life may be excellent listeners who can serve as an empathetic sounding board, while still others may offer help in the form of respite by being the ones you call when you want to engage in enjoyable activities.
- Remember, connectedness is subjective. Therefore, it does not matter how many friends you have or how many nights you spend out socializing. What actually matters is that you feel connected
5) Decrease your consumption of sugar, caffeine, and alcohol
- Caffeine is classified as a minor stimulant that revs up your nervous system, causing an uptick in heart rate and blood pressure. Typically, the nervous systems of people who are struggling with anxiety already tend to be overactive and do not need the further acceleration provided by caffeine. Caffeine essentially primes the system or sets the stage for you to feel more anxious.
- Sugar consumption spikes your blood sugar levels and is then followed by a crash. The ups and downs in blood sugar level can trigger the release of adrenaline and cortisol, which promote anxious feelings
- Some people self-medicate with alcohol, which is a central nervous system depressant, meaning that it slows down your nervous system (opposite of caffeine). It also temporarily increases the pleasure chemical (dopamine) in the brain. However, such self-medicating does not actually resolve anxiety. Your worries will still be there once your body has processed out the alcohol. Alcohol has the potential to worsen anxiety due to its ability to disrupt the balance of brain chemicals. Alcohol is also disruptive to sleep, which increases anxiety levels
- Make a plan to start cutting back on your caffeine little by little. If it is not possible for you to forgo the caffeine all together, try to be strategic about when you have it. For example, if you know that you have a stressful event happening in your day, try to wait until afterwards before having caffeine. Keep in mind that caffeine has a half life (time it takes for your body to process out half of the caffeine consumed) of five to seven hours.
- Ditch the white sugar and opt for natural sugars, such as honey, maple syrup, coconut sugar, molasses. These natural sweeteners have a lower glycemic index (coconut sugar = 35 and white sugar = 65) and therefore cause a more modest rise in blood sugar as compared to white sugar
- Do not use alcohol as a way to avoid or cope with your anxiety/OCD. Make sure to inform your mental health provider if you believe your drinking patterns have become problematic
6) Establish and maintain a bedtime routine that allows you to obtain between seven and nine hours of sleep per night
Why: Sleep is our system’s time to rest and repair. Obtaining good sleep enhances our abilities to learn, memorize, and make good decisions. Sleep also improves our immune system functioning, reduces inflammation and stress, regulates our metabolism, lowers our blood pressure, and aids emotional regulation. With adequate sleep we are better able to maintain the balance between our emotional gas pedal (amygdala – responsible for fight or flight) and the emotional brake pedal (prefrontal cortex—responsible for executive functioning capabilities, such as planning, initiation, impulse control, decision making, etc.).
- Keep a regular sleep and wake schedule
- Do not nap during the day (if you must nap, do not exceed 20 minutes)
- Do not engage in other activities (reading, watching tv, social media) from your bed
- Stop using screens at least two hours before going to bed
- Have a pre-bedtime routine that will build associations of upcoming sleep and signal to your system that it is time to wind down. Wash your face, brush your teeth, make yourself tea (caffeine-free), read in a comfortable chair, meditate, etc.
- Manage your sleeping environment – keep it dark, quiet, and cool (around 65 degrees)
7) Keep track of things you are grateful for, things that are going well, and positives in your day
Why: Did you know that on average, people have around 60,000 – 70,000 thoughts each day? While we may not register each and every thought that crosses our minds, all thoughts have the power to impact our moods. In other words, although we may not be consciously taking stock of each thought, our emotions are nonetheless impacted by the content. When we choose to focus on the positives and practice gratitude our brains release neurotransmitters including serotonin, dopamine, and oxytocin (all the feel-good brain chemicals) and decreases cortisol. Research has shown that positivity and gratitude increase self-esteem and empathy, decrease anxiety and depression, enhance relationships and quality of sleep, and improve health and mental resilience.
How: If you don’t already have one, start a gratitude practice. You have the power to choose where you direct your thoughts and those thoughts that we pay attention to (negative or positive) will grow.
- Identify three things that went well today before you go to sleep at night or identify three things that you are looking forward to when you wake up in the morning
- Keep a gratitude journal
- Set alerts for yourself throughout the day to take a minute to pause and list five good things in your life
- Say “thank you” whenever possible
- Challenge yourself to select one day a week in which you cannot make any complaints
8) Decrease consumption of inflammatory foods and take care of your gut
Why: As we become increasingly aware of factors that contribute to overall health, information is rapidly growing that links gut health to overall well-being. More and more evidence is coming to light on just how significant of a role the gut plays in our overall health. Our gastrointestinal system is so complex that it has been labeled as the “second brain” and the gut actually contains part of our nervous system, called the enteric nervous system. Additionally, a whopping 95% of our serotonin receptors are located in the gut. The gut is also home to around 70% of our immune system. Research has shown that certain foods inflame the gut, preventing it from operating as effectively as it could be. Inflammation refers to our immune system’s response to what it perceives to be a threat to our system. This is an adaptive response when there actually is a threat to the system, like injury or infection. However, sometimes the immune system is responding this way when we are not technically under-attack, such as when we are chronically stressed (excessive cortisol), struggling with autoimmune disorders, and eating inflammatory foods. Inflammation is linked has been linked to a variety of health issues. Therefore, it is important to reduce inflammation where we can, and one way is by eating healthy. Certain foods are known to increase inflammation, while others are known to decrease it.
How: According to Harvard Medical School “doctors are learning that one of the best ways to reduce inflammation lies not in the medicine cabinet, but in the refrigerator. By following an anti-inflammatory diet, you can fight off inflammation for good.”
- According to Dr. Robynne Chutkan, a preeminent gastroenterologist (and other sources) we should decrease our consumption of:
- Refined carbohydrates (white bread, pasta, cereal, baked goods)
- Fried foods
- Processed and red meats (hot dogs, meat jerkies, some deli meats)
- Corn/corn products
- Artificial sugars and food additives (aspartame, stevia, sorbitol, food coloring/dyes)
- Refined oils (canola, corn, safflower, peanut)
- According to Dr. Robynne Chutkan, a preeminent gastroenterologist (and other sources) we should increase our consumption of:
- Nuts, seeds, and nut/seed butters (almonds, walnuts, pecans, flaxseeds, pumpkin seeds)
- Fruits (berries, citrus fruits, apples)
- Legumes (beans, peas, chickpeas)
- Healthy fats (avocado, olive/olive oil, coconut oil, salmon)
- Leafy greens (spinach, kale, collards)
- Fiber foods
- Focus on consuming organic and seasonal foods when you can and foods that are free of preservatives, anti-biotics, and hormones. Also, make sure to stay well hydrated!
9) Engage in regular physical exercise
Why: Research has consistently shown that exercise has countless benefits for our health and has been directly tied to decreasing symptoms of anxiety and depression. Physical activity promotes the release of endorphins, which are natural brain chemicals that relieve pain and increase feelings of happiness. Engaging in regular exercise can also help to improve sleep and decrease muscle tension, both of which buffer the effects of anxiety. Exercise has been shown to increase energy levels and is a healthy outlet for emotional release.
- Experts recommend engaging in 30 minutes of exercise five times a week
- If you do not exercise regularly, consult with your doctor and start off slowly
- You don’t have to spend hours at the gym to get a good workout. There are so many available options for exercising. Keep going until you find one that appeals to you
- Exercise when your energy is at its highest point, but be sure to discontinue exercise at least two hours prior to going to bed so that it does not interfere with your sleep
- Make your exercise social — join a class at the gym, go for a walk with your dog, do your yoga at the park, or pair up with a friend to keep each other motivated
- Sneak in extra exercise where you can: take the stairs instead of the elevator, get off the bus or train one stop early and walk the rest of the way, walk to the other room to talk to a family member (don’t just text them), stretch or use free weights while watching tv, etc.
10) Find a reason to laugh every day
Why: We’ve all heard the expression “laughter is the best medicine” and I think we can all agree that it’s the most fun “medicine” to take! In addition to numerous physical benefits of laughter (improved immune system functioning, lowering blood pressure, cardiac protection, muscle relaxation, decreased pain, etc.), humor has also been shown to ease anxiety and stress, boost mood, diffuse tension and anger, facilitate social bonds, and strengthen existing relationships.
- Follow a funny meme account
- Recall funny memories
- Find comical tv shows, movies, and/or YouTube videos to watch
- Listen to a funny podcast or standup comedians
- Spend time with animals
- Host a game night for your friends and/or family
- Surround yourself with people who are playful and have a good sense of humor
11) Take some time off from technology
Why: The constant pressure to be electronically connected and the volume of information that we are bombarded with on a daily basis can become very overstimulating to our nervous systems. Additionally, devices are generally disruptive to our ability to concentrate and frequent disruptions to our attention can lead to falling behind on your work, which is associated with feelings of stress, anxiety, and overwhelm. Device use prior to bed has been directly linked to sleep dysregulation, which causes us to miss out on the restorative benefits of sleep that might otherwise have served to buffer anxiety. Excessive device use has blurred boundaries between work and non-work time (the same goes for school) since most people connect their accounts to their home laptops and cell phones. Finally, there are growing trends indicating that social media increases the tendency to compare ourselves to unrealistic standards, promotes worries that we are missing out, and amplifies negative beliefs that we are not doing as well as the highlight reels displayed on others’ social media pages.
- Turn your phone on airplane mode when you are working to minimize distractions
- Move your devices so that they are not accessible from your bed and silence them during times when you are sleeping
- Log out of your accounts during non-work times
- Unfollow those pages that are negative or critical, lead you to engage in negative self-comparisons, or are simply not bringing you enjoyment
- Value in-person connection over electronic connection — have a no-phone policy (when possible) when spending time with family and friends
12) Stop comparing yourself to others
Why: It has been said that “comparison is the thief of joy.” Comparisons are also typically subjective and biased. There is no such thing as a fair comparison between two people because there is never an equal playing field. We all have different starting points, stumbling blocks, strengths and weaknesses, resources, and supports. Therefore, no two people’s trajectories for moving through life are exactly the same. Consequently, comparing with unequal variables is bound to be unfair and will likely to lead to feelings of stress. Furthermore, comparison wastes time and energy and detracts attention from focusing on important relationships and activities.
- One way to stop comparing is to remind ourselves that we are doing the best we can with what we have available to us at any given moment. The things that are accessible to us —- time, money, energy, resources, support system, etc. — are highly variable and can cause shifts in what constitutes our “best” from day-to-day.
- Focus on your own strengths and celebrate your wins
- The only fair comparison is to compare yourself to yourself. Make note of the areas in which you’ve made progress or grown
- Remember that no one has it together all of the time. We are all works-in-progress
13) Swap critical and judgmental self-talk for supportive and compassionate self-talk
Why: The relationship you have with yourself is one of the most important relationships you will ever have because you will always be with you! As the saying goes, “we are our own worst critics.” People often tend to focus on their mistakes or shortcomings, while filtering out the things that they are doing well or dismissing the areas in which their strengths are on display. Most people would never dream of talking to others in the manner in which they speak to themselves. Can you imagine what would happen if you continually spoke to your best friend, your spouse, or your children in a critical or judgmental way? If the relationship did not end, it would most certainly be damaged. The same negative impacts occur when we speak this way to ourselves. The consequences of self-criticism include increased anxiety, feelings of inadequacy, and isolation. Self-compassion, on the other hand, occurs when we treat ourselves with warmth and empathy, which increases our motivation, resilience, and feelings of empowerment.
- Stop the “shoulds.” Everyone seems to have a list of shoulds for themselves about things that they believe they ought to be doing. If you notice a lot of shoulds in your thinking, you may notice that your mood is negatively impacted. Shoulds are a pretty sure-fire way to feel bad about yourself because they imply that you ought to be doing something, but you’re not and therefore, you’re bad. Re-evaluate your shoulds and determine whether or not they are actually useful. If they are, figure out how you can put them into practice bit by bit. Your therapist or psychologist can help you set realistic goals around these targets. My first suggestion would be to change your language — instead of “I should…,” try “I would like to…,” “I plan to…,” or “I am working on…” The words that we say to ourselves can make a big difference.
- Cut yourself some slack. Shift your mindset to one of encouragement rather than criticism. Doing this consistently will help you to focus on opportunities rather than failures, improve your performance, and help you to be more productive
- Take note of your self-talk. Literally, write it down. Notice the tone. If you deem it to be unhelpful, practice making adjustments to a more supportive tone. Channel the way that you would speak to someone you really care for and use that as your target for how you will speak to yourself
- Engage in regular self-care. Make a routine of asking yourself “What do I need right now?” Listen and follow through on the answers that come to the surface
- Check out Dr. Kristin Neff’s (the leading researcher on self-compassion) website
14) Reward yourself
Why: Behavioral psychology principles tell us that any behavior that is rewarded is far more likely to continue. In fact, even those tasks that we dread can be made more tolerable if we know that we can anticipate a forthcoming reward once the task is completed. The expectation of a reward can help us to push through a task that is challenging and will help us to grow in a positive direction. Rewards are certainly helpful in the course of anxiety treatment, no matter the age of the patient. The use of rewards can also increase willingness to approach the same or other challenging tasks in the future, thereby helping us strengthen our learning and increase our mastery. Rewarding and motivating yourself throughout the course of your treatment can help you to expedite your gains and can increase your confidence in approaching difficult challenges.
- Work with your therapist to develop a rewards system that will help keep you motivated while facing your anxiety
- Start with frequent rewards to help you gain your momentum. Once you have hit your stride, start to space the rewards a bit further apart
- Come up with a variety of rewards that you are interested in earning. Rewards can be things like getting yourself a special treat, going on an outing, Facetiming someone you don’t see often, engaging in some sort of self-care activity, allowing yourself 30 extra minutes of sleep, etc. What motivates you is personal, and your rewards system should be tailored as such
15) Adopt an attitude of progress over perfection
Why: Perfection is unattainable and setting unreasonable expectations will only increase your anxiety. Perfectionistic standards can actually curtail progress and immobilize efforts because the person believes that he/she will fall short of the unattainable standard. The truth of the matter is that we are all works-in-progress and we will all always be works-in-progress. Some days we will feel like we have it all together and other days, we will feel like it’s all coming apart. THIS IS NORMAL! Keep in mind that in the context of anxiety and OCD treatment, success is not the absence of anxiety. Success is overcoming anxiety step-by-step and realizing that this is not a linear process. Partial accomplishment is still accomplishment. Making an effort is an accomplishment. Showing up is an accomplishment.
- Notice and seek out the things that are going well. Write them down
- Replace every criticism with two positive remarks about yourself. Retrain your brain with this corrective experience
- Celebrate each and every one of your wins (even the tiniest of wins)!
- Revisit this resource as often as you need
- Consider setbacks as opportunities to learn and become stronger for the future
- Acknowledge that therapy is hard work and accept that there will be some bumps in your therapeutic journey
- Stay the course and communicate with your mental health professional. You can do this!