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A useful tip to help manage anxiety and panic

There's one really helpful and specific tip to manage panic attacks and anxious thinking that I use frequently in sessions. It's a good one because it's tied very much to an industry process that many clients are familiar with, however they have not considered it in relation to their own feelings. I have found that for some clients, this tool can often lead to a big a-ha moment in the therapy process, and is one of several helpful skills that can move a client out of chronic worry, and/or debilitating panic.

One of the biggest features of panic and worry, is the overestimation of threat. When we worry, things that could happen, suddenly seem pretty likely. The what ifs become whens. And when something is threatening, our nervous system reacts strongly, and rightly so. The whole point is to keep us safe. What we need to do when we are trying to manage chronic worry or panic, is to help our mind and body to re-evaluate the risk, and assess threats more accurately. We need to reassure ourselves, our bodies, and our emotional responses.

There are several ways to do this, however I found that using the visual tool of a risk assessment matrix can be really helpful. Here is an example of one, you may have seen it before:

These have so many applications. I first came across one when I worked in the events industry and was required to produce a risk assessment for each event that I produced. I know teachers use them a lot when planning school excursions. Builders and contractors use them frequently to assess and manage hazards onsite.

However, put all that aside, the risk assessment matrix is a fantastic visual tool for understanding what our minds are doing when we panic or worry. Basically we are committing two different emotion-driven errors of thinking. Our emotion (the fear) is overestimating both the likelihood that something will happen, and the impact that will occur as a result. Our mind and body have us in the red zone, when chances are the reality is probably more green to yellow.

Here's an example:

Jane feels crippled by anxiety for the first couple of hours after she drops her daughter at day-care. She can't shake from her mind the image that her daughter might be missed/ignored for a period which could mean she'd suffocate under a bean bag and die. She'd read an article about that happening to a child one time in the States and has never been able to shake the image. This feels very real and she struggles to concentrate at work, and repeatedly fights the urge to phone the daycare to check that her daughter is ok. Eventually this eases as the day progresses.

Now there are few things going on here, and there would be several skills Jane and I would cover in our sessions together. The risk assessment matrix is one of those. I'd be hoping to help Jane realise that her worry and the associated anxiety is causing her to overestimate both the likelihood and severity of her daughter being ignored at daycare.

Together we'd look at the matrix and firstly think about how likely is it that her daughter may be ignored for a length of time, or go missing. We'd probably talk a little about teacher ratios, how large the space is, how many opportunities there are to hide or go missing, how much her child's personality is in line with a child that would hide. After all of this we'd probably end up somewhere around unlikely, or possible (at a stretch).

Then we'd move on to the impact. Let's say her daughter is missing for a few minutes. How catastrophic could that be. Chances are she would be found and would rejoin the group. Maybe she'd injure herself, but given there aren't many hazards in a daycare centre, chances are the impact would be low. Minor, at most. This leaves Jane in light-green range for risk (low-medium). This is important because her emotions are screaming red!

Jane might argue that the feared beanbag situation may occur. Then we'd return to likelihood. How frequently does this happen that a child is undetected under a bean bag? The fact that a single occurrence of this tragedy was international news puts it squarely in the very unlikely category. Even if her child were to disappear under a beanbag (unlikely), we'd need someone to sit on it at the same time (very unlikely) and not hear or feel a child underneath (very unlikely). That puts us in dark green very low likelihood territory.

But let's say the absolute worst occurs and the impact is severe. Rationally speaking, this still puts us at a medium risk according to the matrix, which is significantly lower that what Janes anxiety is leading her to believe in the moment she thinks about it.

When Jane is experiencing the anxious worry, her emotions are taking her straight into that red zone. Without thinking it through, her anxiety is telling her that the worst outcome is very likely and catastrophic. On evaluation, we can see that the risk is far lower, Jane's emotions are not evaluating threats fairly.

What next?

We'd reflect on this in session, and Jane would practice applying the risk matrix to her worries between sessions. Over time, Jane might start to catch her worries jumping in to the red-zone and be able to successfully pull herself back into the green/yellow zones. With enough practice, her emotions will follow.

This skill alone may not eliminate Jane's anxiety, but it would likely be a significant step on her path to recovery.

Try it and see how it works for you.

Article author:

Elizabeth Talbot

Clinical Psychologist

B Psych (Hons), M Psych (Clin), MAPS

Elizabeth Talbot is a Clinical Psychologist and the Principal Psychologist at Clinical Therapy. Whilst Elizabeth enjoys her clinical work, she is also a lover of behavioural science and has a keen research interest in the psychology of decision making, moral reasoning, cognitive biases, magical thinking, and conspiratorial beliefs.

Content note: Unless otherwise labelled, all blog posts are intended as discussion pieces, and are not academic texts. Articles pertaining to research or making an academic argument will be labelled as such and include supporting evidence/references. All examples (including client names) are fictitious, to illustrate a point, and are not based on actual clients.