Coping With Physical Symptoms of Anxiety

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Relaxation-Related Exposure:   Fight or Flight Anxiety Symptoms

As you probably know, a primary strategy in all of the empirically-supported treatments for anxiety disorders is “exposure” i.e., helping patients tolerate graduated exposure to the anxiety-related cues or triggers that trouble them.  For example, these triggers or cues are always experienced by persons struggling to overcome past traumatic events (PTSD), as well as panic attacks.   For the past 12 years, I have worked to refine an exposure procedure that helps patients better manage the “fight or flight” symptoms of anxiety or panic attacks.   I can report that in every case in which patients have reliably practiced the technique at home, daily, for 3-4 weeks, they have reported an improved sense of control over the onset or early symptoms of their anxiety reaction.  In this procedure, we want to have patients simulate or replicate a couple of the key “fight or flight” symptoms i.e., rapid heart rate and breathing.  

If you have been cleared by your primary care provider to engage in exercise and especially, aerobic activity, you can then consult with them about doing the activity described below.  That is, you should obtain their opinion and endorsement. You may want to double-check with them about what your max heart rate should be during aerobic activity, etc. 

In this fight or flight simulation procedure, we coach typical anxiety patients to take a short walk, maybe only around the block to start with.  If they can engage in running, so much the better.  If walking is a problem due to joint pain or high body weight, the symptom simulation exercise can be done on stair-step machine, elliptical, or in a swimming pool as part of a water aerobics class.   It is important to get warmed up through slow, gradual exercise (walking, swimming, water aerobics, treadmill etc.). 

The procedure is quite simple.  During the final minute of your exercise (e.g., last 100 yards of your walk), pick up the pace of the activity dramatically.   At the point your heart rate and breathing are quite rapid, it is you would be finishing your walk or run.  You are now entering the door of your home, or situated next to an exercise mat at the gym, next to a comfortable chair, or sitting/lying at the edge of the swimming pool.  We want you to immediately lie down and close your eyes. 

The next step only takes about 3-4 minutes.   Lie very quietly, eyes closed and focus all of your concentration on your breathing and heart rate.  Do NOTHING selse, except allow your body to naturally breath in/out as you recover from the stress of your exercise.  Do not try to control or regulate your breathing (e.g., by taking deep breaths).  After a minute or so, we want you to pay close attention to the point in time when you notice things slowing down e.g., your breathing becoming just a bit less rapid, your heart rating starts to slow.  You’ll want to identify the very moment this is starting to occur.   Once you have detected this change, we want you to engage in an internal dialogue (yes, we all talk to ourselves…..).  You might say something to yourself such as, “O.K., I can tell my heart rate has slowed just a bit”, “I’m breathing a tiny bit more comfortably”;   “I can tell things are just now starting to ‘slow down’”.   Next, add in a few self-assurance statements to yourself:  “When my heart rate is going fast, I know it will eventually slow down on its own; my body will take care of itself if I just allow it”; or,  “If I just pay full attention to my breathing, I will notice exactly when it  will slow down on its own; I just need to calmly wait it out”.  Or, “ I can trust my body to calm itself when my breathing and heart rate are going too fast”

Again, the goal here is graduated exposure.  Your activity level can become more vigorous over time, as you strive to more realistically replicate the breathing and rapid heart rate of an anxiety attack.  A key aspect of the procedure is to be able to reassure yourself that you need do nothing but monitor them.  You can tell yourself that every time you exercise your body will regulate itself if you simply allow it.  

This procedure is certainly not a “cure” for anxiety reactions or anxiety attacks.  However,  were you to seriously practice this daily for 3-4 weeks, you would begin to develop the perception that whenever your heart rate and breathing become uncomfortably rapid, you experience gradual, increasing confidence that you now have a technique for gaining a sense of control, by “doing nothing” but self-monitoring, talking reassuringly to yourself, and waiting for your body to take care of itself.   It is a tool you’ll eventually begin to use at the earliest stages of an anxiety or panic attack, or when you know you are going to have to face some anxiety triggers or cues.  I have emphasized that this procedure takes practice, but if you do any form of aerobic activity or walk regularly, let me remind you that adding the procedure only takes 3-4 minutes at the very end of your activity. 

At this point, I can tell you that some patients with severe anxiety attacks or panic agree to try the exposure activity, but fail to follow through because they are afraid that exercising to increase their heart rate or breathing will “cause” them to fall into a panic or anxiety attack.   In these cases, we want to break the activity down into smaller, simpler steps.  For example, we might have them simply walk around the block without speeding up during the final minute, and prompt them to simply practice the 3-4 minute period of lying down, focusing on breathing and heart rate right after they arrive back home.   After becoming comfortable doing this for say, a week, we would have them pick up the pace of walking just a bit, during the final 30 seconds of their walk. 

I want to reiterate how important it is to make sure that symptoms that you believe are “fight or flight” in nature are truly due to an anxiety attack or panic attack.   Some health conditions produce symptoms that are similar to anxiety reactions and need to be ruled out or treated by appropriate medical procedures.  Thus, having an accurate diagnosis is very important.  In addition, it is important to be cleared by your doctor or primary care provider to engage in aerobic activity and that you know whether he or she has placed some constraints or limits on what you can do.

Copyright 2019  David M. Stein, Ph.D.  Readers are welcome to link to this article.   Copying this article without the written permission of the author is not permitted.  Copying the article and presenting it on another website without appropriately crediting the present author is considered plagiarism.  This action will be reported to state or provincial licensing boards as an ethical violation.