Coping Skills

CBT also often involves training in anxiety-­management skills. The idea is that if you struggle with anxiety problems, it can be useful for you to have a few tools you can use to calm yourself down when your anxiety becomes overwhelming. Some of the most common skills include breathing retraining and progressive muscle relaxation. Breathing retraining involves changing how you breathe: instead of breathing shallowly, drawing your breath by arching your shoulders and moving your chest, in breathing retraining you draw air in deeper through your abdomen or diaphragm area. By doing this, you can reduce your heart rate and other symptoms of anxiety, and change the ratio of carbon dioxide to oxygen in your bloodstream. Progressive muscle relaxation is another common skill taught in CBT for anxiety disorders. This skill involves systematically tensing and relaxing your muscles and is designed to help you feel calmer and notice the difference between holding tension in your muscles and having loose, relaxed muscles. Both breathing retraining and progressive muscle relaxation are parts of most treatments for anxiety disorders and can be quite helpful.

Exercise 2.1 Try Diaphragmatic Breathing Right Now!

You can practice diaphragmatic breathing right now if you’d like: Put one hand on your chest and one hand on your abdomen. Now, slow down and deepen your breathing, and when you breathe, try your best to make your hand on your abdomen move up and down more than your hand on your chest. Just focus on your breathing and how it feels to draw in the air and exhale it. You can even say to yourself inhale with each inhalation, and exhale with each exhalation. Try this for ten minutes and see what it feels like. Do your best, while you’re doing this, just to let anxious thoughts come and go, and simply focus on your breathing. Rate your anxiety on a scale from 0 to 10 (where 0 means no anxiety and 10 means extreme anxiety) before and after this exercise, and see if you notice any difference.

Anxiety before: ___________ Anxiety after: ___________

Even though our focus in this book is on DBT, we bring up CBT for a couple of very important reasons. Perhaps the most important reason is that you will be much better able to help yourself with your anxiety problems if you know about available treatments that work. If you had asthma and knew nothing at all about its treatments, you could go to a doctor who prescribes bananas and omega-­3 fatty acids, and go merrily on your way, only to find yourself wheezing, gasping, and wondering why this “prescription” isn’t helping you, as you scarf down a half-­dozen bananas and a can of salmon in a desperate attempt to open your airways. Well, okay, we’re exaggerating a bit! But we have seen many people who had no idea what types of treatments really work for anxiety disorders. As a result, they have sometimes spent time and money on treatments that simply did not work. Beyond knowing what treatments to seek, once you know a bit about effective treatments for anxiety disorders, you might have a clearer idea of what DBT adds to these treatments and how, even if you are already in a treatment that helps you, DBT may give you some added benefits.