Episode transcript, extended show notes, and video can be found here.

#69 Hello from Denmark (though I’m actually editing and releasing this 2 weeks later back at home) which is statistically the happiest country in the world. I dive into the Danish practices that contribute to such strong mental health and how you can implement these in your life. Onto the main episode, I dive into everything you need to know to navigate ANXIETY as a teen! I give a complete overview on all things anxiety, tips and tricks from my own experience, how to support someone struggling, and answer some listener questions! 

I dive into the following topics...

+ Anxiety vs. feeling anxious 

+ Navigating panic attacks + supporting others

+ Reducing and recovering from anxiety long term

+ Working through nightmares/nighttime anxiety

+ Resources for anxiety

+ Your questions about anxiety

+ So much more!

Mentioned in this week's episode...

+ Ep. 47 DBT Education: TIPP, Crisis Survival Skills, + Riding the WAVE (Distress Tolerance)

+ My instagram: stalk the Europe trip 

+ Podcast recommendation on Danish life: https://drchatterjee.com/episode-32-science-happiness-meik-wiking/

+ Ep. 68 How Our Mental + Physical Health Are Connected feat. Laura Martin

+ Ep. 56 OCD + Exposure Therapy

+ Ep. 39 Your Foolproof Guide to a Good Night's Sleep

+ Resources for anxiety 

+ Crisis text line: TEXT ‘connect’ to 741741

+ Teenline: text TEEN to 839863

+ Headspace, guided meditations on YouTube, podcast apps, etc

+ https://panicandanxiety.org/find-help/emergency-help-lines/ 

+ https://www.nimh.nih.gov/get-involved/education-awareness/shareable-resources-on-anxiety-disorders

Episode Sponsors

🍓This week's episode is brought to you by Sakara. Sakara is a nutrition company that focuses on overall wellness, starting with what you eat. Use code XOSADIE at checkout for 20% your first order!

🛋This week's episode is sponsored by Teen Counseling. Teen Counseling is an online therapy program with over 14,000 licensed therapists in their network offering support with depression, anxiety, relationships, trauma, and more via text, talk, and video counseling. Head to teencounseling.com/shepersisted to find a therapist today!

🤍This week's episode is brought to you by Sadie's Socials! For GIF creation, website design, podcast production, social media management, and more services head to shepersistedpodcast.com/workwithme!

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© 2020 SHE PERSISTED LLC. This podcast is copyrighted subject matter owned by SHE PERSISTED LLC

Welcome to she persisted.

I'm your host Sadie Sutton.

Every Friday, I post interviews about mental health dialectical

behavioral therapy and teenage life.

These episodes break down my mental health journey, teach skills to

help you cope with life and showcase testimonials from individuals,

including teens, just like you.

Whether you've struggled yourself or just want to improve your mental fitness.

This podcast is your inspiration to live a life you love and keep persisting

this week's DBT scale is the tip scale.

We've covered this before, but it is so relevant to coping with anxiety

that I wanted to bring it up again.

Tip T P IPP is an acronym that stands for temperature, intense exercise, paced,

breathing, and paired muscle relaxation.

The tip scale lowers physiological symptoms of distress, whether that's

increased heart rate, increased breathing, clenched muscles, pretty much what

happens when you go into fight or flight.

And when you bring down these physical reactions, you're able to get out of fight

or flight mode, be in a more rational Headspace and start to emotionally

calm down and bring your body back to its normal level of functioning.

So temperature for this part of the scale, you're submerging your

face in a bucket of ice water.

You can also use an ice pack, cold water underneath your eyes on your face, on

your wrist, on the back of your neck.

And what you're doing is you're stimulating your vagus nerve.

Your vagus nerve is part of something called your mammalian diving reflex, which

lowers your heart rate and lowers your breathing rate so that when you're in

cold water and swimming, you don't end up drowning from an excess of carbon dioxide.

So when you're in intense distress, your heart rates really high,

your breathing rates really high.

If you submerge your face in water, if you put ice packs underneath your eyes,

your body lowers your heart rate and your breathing rate to keep you alive.

But also it takes you out of that fight or flight mode.

Similar with intense exercise.

When you are having a panic attack, having lots of anxiety or really

angry, emotionally distressed, and your heart rate's really high.

Your breathing rate is really high.

If you do sprint squats, wall sits, anything that is like 110% of an exertion.

Running is really great boxing, jumping up and down.

All of those are amazing when you do those, you're increasing your heart rate

past its normal threshold and past what it is when you're in distress and your body

works to lower your heart rate because it can't maintain that level aroused overlap

of arousal for a long period of time.

So your body brings down your heart rate.

It brings down your breathing rate, passed a threshold at which it was at

when you are in fight or flight mode.

Next is paced breathing.

This is pretty simple.

. You're breathing out for longer than you're breathing in and you're breathing

in and out with counts and you're working to, again, lower your breathing

rate and in turn lower, your heart rate, lower those symptoms of distress.

So what I like to do is inhale one, two, hold for a moment and exhale 1, 2, 3.

And I repeat that over and over again for a few minutes, until I

noticed my heart rate going down, my breathing is leveled out and I'm able

to ground myself with that sensation.

Last part of this acronym is.

Paired muscle relaxation.

What you're doing is again, taking away the physiological

symptom of clenched muscles.

So you're going through doing a bit of a body scan, clenching your fists,

as you inhale and releasing your muscles and your breath on your exhale.

Same thing with your thighs, arms back, all of that.

You're going through your body, doing a scan, clenching your muscles on your

inhale and releasing them on your exhale.

So that's the tip scale, a little bit more information to throw at you

than your normal TBT skills, but a super useful one that is completely

backed by science by evidence.

You can't say well, no, my body won't do its mammalian diving reflex.

I will still have a high heart rate.

That's just not how it works.

And that's why I love this skill from DBT so much.

So I will like a full episode all about the tips, kale in today's show notes.

If you want to learn more about it and understand in more detail, how you can

implement each part of the acronym.

Hello.

Hello.

Hello.

And welcome back to another episode of she persisted.

I am podcasting to you today for Munich Germany.

I'm actually in Europe right now.

I am tagging along on a business trip with my dad, right before I go off

to college in a few weeks, we can spend some time together, hang out.

And it's, it's been really fun if you are following me on Instagram

at actually persisted podcast.

You've been seeing all of my stories.

As we're traveling, I've been having a lot of fun with those and taking photos

and videos and just documenting the trip.

So I definitely recommend you head over there.

But I bring this up because I was in Copenhagen yesterday.

And if you don't know, Denmark is statistically the

happiest country in the world.

And my mom suggested this a while ago that I do a podcast episode

where I really did a deep dive here.

Why is Denmark the happiest country what's going on there?

How can we implement similar topics?

I want to bring on a guest that can help me dive into that more.

But in this week's intro, I wanted to give you a couple of tips, tricks practices

that you can implement that are very common and prevalent with Danish people

that contribute to their livelihood, wellness, happiness, and all of that.

So a couple of things, and again, I'm no expert.

I was over 24 hours, listened to podcasts about it, read a little bit,

but again, no expert by any means.

The first thing worth mentioning, is there key value of humility?

I was walking around the town with a couple of people that lived locally

and we walked by the different palaces that the Danish royalty lifted.

And yes, that does not sound humble at all, but she was talking about the

different families and how they have four kids and all the kids go to public

schools and you always see them biking around the town and walking around the

town and hanging out with everyone and getting to know everyone very well.

And it's a very different approach to Royal family than we would typically see.

So, this is a really common theme throughout Danish society is to really,

really implement practices of humility, not boasting, not bragging, and really

creating a sense of equality for everyone and really embodying and understanding

that you are not better or more deserving than anyone else on this planet.

And we're all here to try and make relationships and connections and

live a happy fulfilled life.

And there's nothing that, that makes you more deserving or

superior or better in any way.

So that's the first thing worth mentioning.

And the next thing I want to mention is a huge emphasis on outdoor activity, getting

outside exercise, the number one form of transportation that many, many people

use in Copenhagen is biking and walking.

They have these amazing bike paths all around the city that are paved

they're right next to the road.

There's like a huge law that if a car hits a bike, this woman was joking.

She was like, they will literally go to prison because bikes are so prevalent.

They get the right away, all of that kind of thing, because everyone bikes

to work, they bike around the city.

It's the easiest way to get around.

so will, this might not necessarily work with your schedule or your lifestyle,

getting outside, getting active, getting some vitamin D is something

that you can implement in your schedule.

And there's a huge connection to getting outside, getting active, increasing your

endorphins, getting vitamin D and lower levels of depression, anxiety, mental

health struggles, all of these things.

And the next thing worth mentioning is something that's very common and prevalent

from my perspective in the United States, which is living to work your, your life,

your day, your routine, your community is dictated by getting up, going to your

job, you are, you are living to get to this next point in your life to work,

to save, to, to meet your retirement fund, all of these different things.

And so in Copenhagen, it's really a different approach.

You are working to live.

You are working to have a steady income and to be able to support

yourself and your family, but it's not, it's not your life.

It's not your number one focus instead.

You're really shifting your attention to your relationships your community.

And as a result, they, they take summers off.

They have less work hours.

They have a lot better paid vacation and leave plans than

we do in the United States.

But it's really making a shift of optimizing these things that bring

you a lot of joy outside of work and having that sense of purpose.

And yes, using work as a way to be able to function, maintain your life.

But really your goal is living not working.

And the last thing that I'm going to mention is community.

When I was talking to a woman who's lived in Copenhagen for many years

of her life, she was talking about how there's a couple of things that

are really unique about Copenhagen.

One is the huge, huge, huge sense of community.

People are constantly hanging out.

She was talking about how her and 50 of her other friends, they do

this little biking trip and they all bike to each other's houses

and eat different courses of meals.

And there's 50 of them.

They go and sit in their backyards and they eat food and they all hang out and

laugh and they do this every single year.

Another big shift is fabbing going out.

It's going into other people's homes and to these communities really

fostering these relationships.

So there's just a huge sense of connection to connection and community.

And we know that connection is so vital to mental health, mental

wellness, your, your ability to live and thrive as a human, right.

The evolutionary need was to stay in tribes, to stay in communities

so that you could together fight off a, a saber tooth tiger because

you couldn't do that by yourself.

But if you had a community that could be aware of your surroundings,

somewhat hunt, someone gather someone, make sure that the cave was okay.

You would be able to protect yourself.

And so communication is vital to our functioning and it's so important.

So to recap those different Danish principles, connect yourself with

others, get outside, get active, practice, humility, and work to

live instead of live to work.

So I hope that was a fun, little brief tangent and just random

mental health trivia for you.

But with that being said, let's dive.

So yeah, I will update you guys on the podcast next week.

But, yeah.

So let's dive into this episode, all about anxiety now, shifting from this little

intro moment to really going in deep here.

My hope is that you come away with this with a really good understanding

of what anxiety is how to cope with it yourself, how to support someone else

coping and really differentiating how you can cope with anxiety in the moment

and then work towards long-term recovery.

Dive into anything about coping with anxiety, we have

to talk about what anxiety is.

So anxiety as an emotion, you feel anxious, right?

Anxiety is a sense of fear, unease, apprehension, and it's

your body's way of telling you that there's a potential threat.

So again, going back to why we evolved as humans, your body would feel anxiety

and fear when there was a saber tooth tiger around that you had the urgency

to get out of that situation, to protect yourself that you would say safe, you

would stay alive survival of the fittest.

Right?

So what makes anxiety a mental illness as a classification and a

mental health challenge is when the threat and your level of emotional

intensity is not justified.

Those feelings are so valid.

What you're feeling when you feel the fear and apprehension and anxiety

and unease, that is totally bowed.

That's real, that's authentic.

That is your emotion.

However, your fear is not justified given the threat.

So if you're throwing up every time you go to school, because you're so nervous

about what people are thinking about you, that is a totally valid emotion

and fear and uneasy and apprehension to feel, but your response, the level

of emotional intensity that you're feeling to your trigger, which is being

at school and being around others, isn't justified given the situation.

So when you're noticing that your emotional reaction isn't justified,

that's when a lot of times people will be like, Hmm, I kind of want to shift this.

I want to get curious here.

I really don't want to feel this emotional discomfort so often.

And again, going back to this idea of anxiety as a mental illness, when it

starts to severely impact your daily functioning, your quality of life,

your ability to engage in your, your relationships, work school, all of that.

That's when it becomes a mental illness, that's when it's really

interfering with your quality of life.

And you're no longer in your state of your life worth living.

So not a doctor, not a psychiatrist, not diagnosing you, just giving you kind

of that clarification between what is anxiety as an emotion, as a feeling, as

a sensation versus as a mental illness.

So if you're listening to this and you're like, wait a minute,

like, this sounds like me.

It's really difficult for me to get to school work, engage in my relationships

because I'm constantly anxious.

I'm constantly having panic attacks.

Talk to your doctor, talk to a psychiatrist, talk to a school counselor,

talk to your parents and kind of explore what your options could be

because you don't have to live that way.

It's I don't want to say that it's not normal because that's not what I

mean by that, but it doesn't have to be your normal is what I'm saying.

Your normal doesn't have to be filled with anxiety and apprehension.

You can live a life of, of feeling calm and at ease and and not necessarily

in control because there we get to the other end of the spectrum there.

But, but yeah, you you're.

You're okay.

You're balanced.

You're grounded and you're ready for what life throws at you.

So that is having anxiety as a diagnosis versus feeling anxious.

Again, it's having it severely impact your quality of life, your

ability to function on a daily basis versus having feelings of fear,

apprehension, unease which sometimes they're just defied and sometimes

are not justified given the trigger.

So another thing that I have found since I started talking about

depression and anxiety on the podcast is that it can really be boiled

down to a spectrum of emotions.

And I know it's not the most clinically accurate way to explain it.

I'm sure this is totally 100% correct, but it's something that I really do believe to

be true and I found that explaining it in this way, makes it really easy to connect

and relate to others when your experiences with depression and anxiety are different.

So with parents, with teachers, all of those things, so a

great way to explain it.

So anxiety, when we think about it, it's a spectrum of fear.

We all feel normal anxiety and fear.

When we're going to give a big presentation or someone jumps in

scares us, or we're watching a horror movie, that's fear, that's anxiety,

what's something exciting is coming up.

Fear, anxiety, apprehension on the other end of the spectrum.

We have those emotions at a much larger scale.

And we get put into fight flight or freeze mode, which is your

body's reaction to a threat.

And so if you come face to face again, going back to the caveman

days, you come face to face with a saber tooth tiger your body.

Your brain is either going to fight.

It's going to stand there.

It's going to start throwing rocks at the tiger, shy and scared away.

It's going to freeze, which is something that we're exploring a lot more recently.

The original theory was fight versus flight.

Now we've added in this freeze element where you go into complete panic mode.

You're not able to process through and make decisions and be able to figure out

an effective way to proceed and get out of this dangerous situation with the Teicher.

And then the last one is flight.

So you're running away.

You're getting out of there as quickly as possible.

You're going back to your cave to save yourself and make sure

you're away from the threat.

So this same three reactions are true with things like an upcoming school

presentation or a meeting new pupil.

Or navigating a big change in your life.

And so going back to this idea of your spectrum of emotions,

when you're having panic attacks.

You're experiencing extreme fear when the trigger does not justify that fear.

Like you're having saber tooth tiger level fear over an

assignment that's due tomorrow.

Or you're in fight flight or freeze mode.

Very, very, very frequently.

That's the end of the spectrum where we get into anxiety, it's

impacting your functioning.

So we can really empathize and connect and be able to explain what that sensation

is like because people experience fear, they experience unease, they

experience feelings of anxiousness.

And so we can say, remember when you had that really big, final exam that your

grade was resting on and you were just an absolute rack and you were nervous.

Imagine what that would be like every minute of every single day.

And that's what life is like for me.

So we're able to explain this because we all experience emotions because they

have these evolutionary functions for us.

We can, we can connect.

We can validate, we can empathize.

We can be sympathetic.

We can support others because we felt these emotions, even if it's

not the same intensity to the same trigger, to the same degree, to

the, with the same coping skills.

Right?

So that is kind of understanding anxiety from another angle, which

is the spectrum of emotions.

So next topic I want to dive into.

This is a lot of me talking this week.

I'm going to dive into a couple broad topics here, which is

anxiety versus panic attacks.

I want to dive into all of the different things that you need to know about panic

attacks, coping through one, supporting someone else dealing with long-term

anxiety, dealing with nightmares and having anxiety at night, which

was something I struggled with for a really long time resources for anxiety.

And then I'm going to dive into all the questions that

you guys asked me on Instagram.

So we just kind of talked about what anxiety is it, a very boiled down emotion

level, fear, apprehension, unease, anxiety as a mental illness, or as a mental health

challenge that interferes with your life.

a lot of the time presents in different ways.

For many people.

I remember for me, it was a lot of racing.

Thoughts, thoughts, spirals, physical symptoms, like nauseousness.

Increased heart rate, really shaky and fidgety, lots of legs

bouncing, all that kind of stuff.

It does tend to impact your sleep.

Concentrating is hard.

You get really fatigued from constantly being in this state

of arousal and awareness.

Shameless plug, listen to last week's episode with Laura because she explains

this so well, what happens when you're in the state of arousal for a really long

period of time and how to heal from that?

So I'll link that in today's show notes, but going back to what

anxiety looks like, long-term.

Sometimes you have dizziness, headaches, all of these different physiological

symptoms when your body's in this state of arousal and fear and concern,

because we're not meant to be in that state for a really long time.

We're meant to get out of a threat, the saber tooth tiger

and move on with our lives.

But for many of us in the day and age we're living in and the way that

we have developed our belief systems and, and relationships and, and our

lives, anxiety is something that isn't just a feeling that's there.

When the saber tooth tiger pops up and instead it's really impacting

your ability to, to function and live your life worth living.

Yeah.

Anxiety recap, just lots of worrying, racing, thoughts by roles.

There can be physiological symptoms.

And I'm not gonna give you a whole list, cause I'm not trying to diagnose you.

Just kind of differentiate to what, having anxiety as an emotion and an, a

sensation versus having a panic attack.

So panic attacks, so blown fight or flight mode, you are reacting and often a very

physiologic Common symptoms are sweating.

You sometimes you're dizzy or your heart rates increased.

Your givingness increased.

You're shaking, you're trembling.

I remember I would get really tearful and I would be crying and feel like my skin

was crawling or things were closing in.

I feel really trapped and out of control and overwhelmed.

A lot of people will describe panic attacks the first time that they have

them, that you feel like you're dying and you don't know what's going on.

Sometimes people get chest pain, they think you're having a heart attack.

It, your body is physiologically responding to a very real threat that

it's feeling again, the threat isn't justified, but it's valid and your

body is responding to that threat.

And that response is, is, is a very, very real response.

And it's very overwhelming.

It's very scary and it's, it's difficult to rationalize through it, to navigate,

to work through what's going on because it's such a polarizing sensation.

So that's the difference between anxiety and panic attacks.

What I'm going to do now is dive into panic attacks and I'm going to

walk you through what worked for me, recovering from anxiety long-term rather

than the short-term coping skills.

So.

Panic attacks.

We just talked about what they are, what they can look like, there's tons and

tons of different ways they can present.

But it's a physiological attack due to anxiety.

One thing that I wrote down that I wanted to talk about is how to know

if you're having a panic attack.

And I can't sit here and tell you what it's gonna look like when it's going to

pop up for you, because I don't know that it's a very subjective experience.

My triggers aren't the same as your triggers.

Your body's responses to different stimuli is completely different from mine, as well

as your emotion regulation and your coping skills and all of these different things.

So the way that I would kind of flag that you're having a panic attack and

these skills might be helpful is the symptom that is the anxiety that I

talked about, which is thoughts, racing, increased heart rate, increased breathing.

And you're getting to a point where you feel out of control.

You're feeling very overwhelmed.

Your ability to rationalize is kind of decreasing.

You are feeling out of control helpless and.

It's very overwhelming again, that like attack, sensation.

So being aware of your bodily sensation, what thoughts are going through your head?

What emotions are popping up, what's going on?

Do a bit of a body scan and are you feeling overwhelmed?

You think it would be helpful to get through this?

So coping with a panic attack, the first skill that I always do when

having a panic attack is the stop scale.

This is an acronym that stands for stop.

Take a step back, observe and proceed mindfully.

It's the first thing you're going to do.

You notice something?

That's not what great you're feeling out of control.

You're like something is wrong here.

Red flags going up.

What are you going to do?

You're going to physically stop.

You're going to mentally stop.

Of course you might still be having physical symptoms.

Your mind might still be racing, but you're not going to try

and continue a conversation.

You're not going to try and continue to have that argument with here, your

parent or friend or whatever it is.

You're going to physically stop here, going to try and stop.

Th the, the thoughts, the conversations, these things you're

having in the situation, you're going to take a step back to, if

you can, you're going to remove yourself from the fiscal environment.

You're going to try and take a step back from the emotions, the thoughts

you're going to observe what's going on.

What are your physical sensations?

What emotions are popping up?

What are the thoughts going through your head?

And then you're going to proceed mindfully and that's not going to be,

I know that's, you're like really sick.

Like I'm going to proceed mindfully while I feel like I'm dying.

Okay, great.

Yeah.

Let me just pull out my Buddha.

No, what you're going to do is you're going to figure out your coping.

And I'm going to give you a bunch of tips and tricks that you can

easily implement in the moment.

You don't need to do all of these.

If you can just remember to take deep breaths.

you've got something out of this episode.

There's value provided here.

So you're eating mindfully in this situation is not going back and

working through this conflict.

It's not going back and going back into the concert that just

gave you panic attack because your senses were on overload.

Your proceed mindfully is my next step.

And the next two seconds is I'm going to take a deep breath and

then I'm going to let it out.

My next step in the next few seconds is that I'm going to drink some water and

I'm going to focus on that sensation as it goes through my mouth and down my throat,

rather than the sensation of how it feels like the walls are closing in on me.

So that's your proceed mindfully.

Part of your observe in this is really being mindful of your

current thoughts and emotions.

And I bring up this mindfulness because I don't, I'm not necessarily asking

of you to sit there and be like, wow, I'm feeling some anxiety right now.

I want the mindfulness piece to let go of the judgments.

I want you to let those thoughts and emotions come in Without labeling them

as good or bad, or this needs to go away.

I need to fix this.

I need to make it stop.

They're just, They're coming in.

They're going out.

There are waves of thoughts.

There are waves of emotions.

There are waves of urges without judgments.

They're not good.

They're not bad.

They're just there.

So next step again, I'm not expecting you to do all of these things in the moment.

If you can pick one or two of these where you're like deep breathing is great for

me, or, you know what, getting outside is great for me, that's all, these are just

lots of tips and tricks of things that could be helpful that might work for one

person and might not work for another.

So the next thing is radical acceptance, which is 100% and truly accepting that

you're having a panic attack right now.

If you are in your head saying this isn't a panic attack, I'm fine.

I'm just going to get through this.

If I just sit here for a couple of minutes more, my emotions will go away.

You are creating more distress for yourself by fighting against that

emotion, suppressing it when it will bubble up and come back in a larger way.

So if you can radically accept and say, I'm having a panic attack

right now, I'm feeling overwhelmed.

I don't know what to do.

You're able to accept those emotions and then figure out a plan to cope

with that rather than fighting against herself, your sensations, your emotions.

Right?

So we talked about the tip scalp.

That's my next item on the list, which is to lower your physiological

sensations on breaking that down, making it a lot or simple, deep breaths.

If you can remember to breathe when you're having a panic attack, that's

a super common symptom is shortness of breath, not being able to breathe.

If you can remember, okay, I'm going to inhale for two.

I'm going to pause and I'm going to exhale for three.

If you could have tremor those counts, that is something for you to focus

on other than these physiological sensations, which can be fairly stressful.

Again, breaking down this tip skull again, cold ice water, changing the temperature.

You get really hot when you're having a panic attack.

You're overheating.

You're overwhelmed.

If you can switch up that sensation, drink some ice water, put some cold ice on

your face, on your neck, on your wrists.

Take a shower.

That's another really great thing.

If that's possible, really switching up those physiological sensations,

getting yourself out of your head.

Next thing, getting fresh air and getting outside.

This was my go-to when I be having a panic attack, which for me was a lot

of times at school, freshman year, I would be outside and I was a mess.

I was like sobbing on the street, like walking around, like pulling my hair out.

Like I was a disaster, but I was outside and I was no longer in the situation

that was adding to the anxiety.

I was able to lower my distress because there was wind in my face.

I was outside.

I was grounding getting fresh air and out of the situation causing you distress.

The next thing is a grace enemy tip.

I remember there's this one episode that I watched years and years and years ago.

And it was a doctor, she was on the spectrum.

I don't remember exactly what her diagnosis was, but she was having

a panic attack at one point.

And she was like, I need someone to compress my nervous system.

And I think Christina was there and she was like, what does that mean?

What am I supposed to do?

Because she's trying to learn from this doctor.

And this doctor is having this anxiety attack.

So you see the doctor trying to pull her white medical lab coat

around herself, make it tighter.

And she's doing that because when you compress your nervous system,

your lowering your heart rate, you're lowering your breathing rate.

You're calming down.

So I know this isn't for everyone, because if you're feeling like the walls are

closing and you're feeling out of control, you're feeling really trapped a hug from

someone isn't necessarily going to help.

But sometimes for me, depending on what I'm feeling panic about, what I'm feeling,

anxiety about, being able to just really hug someone and know that they're there

and I'm not alone, and they can support me and just cry into them and really

just give a giant hug and know that they're supporting me is really helpful.

So if that doesn't add to your stress, that's another tip.

the next thing is remembering that everything is impermanent and this

panic attack is to this emotion.

This thought, this urge, this shortness of breath is increased.

Heart rate can't last forever.

It won't last forever because it cannot.

You're going to ride the waves of the emotions, the sensations, the thoughts,

the urges, and that's something for me.

Now, when I feel distressed, when I feel a lot of depression or anxiety, I

repeat to myself, life is impermanent and this impermanence will be on my side.

These sensations can't last forever.

These emotions can't last forever.

At some point, the tide will change.

I won't be feeling this level of distress anymore and it'll get better.

It'll lift and I will no longer feel this burden.

My next coping skill is a grounding tip.

And this is a super common one, but you're doing the rule of five, which is great

to remember because to have five fingers on your hands, you looked out ease.

Remember, you can count with your fingers.

You're looking around you for five things.

You can see four things.

You can touch three things.

You can hear two things.

You can smell.

One thing you can taste.

So if I was doing this right now, I can see the lamp next to me.

I see the podcast microphone right in front of me.

I see some city lights outside.

I see my notes in front of me.

And I see the little like audio bar on my audio recording going up and down

as I'm speaking, I might've been six.

Not totally sure for things I can touch.

I can feel my Palm on my thigh.

I can feel my elbow on the table, feel my lips and my teeth coming together.

As I'm talking, I can feel my hair resting on my shoulder.

Three things I can hear.

I can hear my own voice.

I can hear my little microphone.

I'm not my friend.

I can hear my little headphone moving as I'm talking.

And this is kind of weird, but I can feel here.

My mouth noises, not me speaking, but like my lips moving.

If that makes sense, two things I can smell, I can smell the perfume I'm

wearing and I can smell the hotel room.

Those are two significant smells.

And one thing I can taste just my mouth.

I don't know what else I could taste, but I, another one for this

one, cause sometimes it's difficult.

You look around you, maybe you're near fruit tree.

Maybe there's a drink in front of you.

Maybe there's food near you.

That's something that you could taste.

Next tip is tapping on opposite sides of your body.

I learned this one in an IOP program and it's a little bit hard to

explain post a video on Instagram, a little real, but you're going to

put your hands on opposite shoulders.

So your arms are crossed on your chest.

Kind of like you're about to like lay into the coffin position.

So the best way I can describe it and you're going to tap alternating hands.

You can do the same thing on your leg, which is more discreet, which is you're

crossing your arms over so that your, your forearms are on top of each other.

And your right hand is on your left thigh.

Your left hand is on your right thigh and you're tapping 1, 2, 1, 2, just like when

you brush your teeth with your left hand, it uses the opposite side of your brain.

Same thing here, you're tabbing with opposite sides.

You're rewiring the the neurons firing the cognition going on your brain.

You're breaking up that pattern of your amygdala, going crazy,

setting out fight or flight signals.

You're breaking up that messaging.

Another great tip is repetition.

Whether this for you is counting, repeating a mantra, prayer

just counting like 1, 2, 3, 1, 2, like something like that.

It's very grounding.

It gives you something to focus on that gets you out of your head.

That's not the distress.

Another big thing, like I mentioned, I used to struggle a lot with feeling

like my skin was itching or wanting to like pull on my hair, tactile

distractions, whether it's a fidget.

If you can put your hands into the grass, if you're sitting on the

ground doing something with your hands, other than taking it out on

your body, which for me was something that I struggled with scratching.

Cause I felt like my skin was crawling or really just hugging

out my hair because I felt trapped.

So tactile distractions is huge imagery.

Imagining a place that brings you calm a sense of home, a sense of Just

feeling good and not the emotion that you're feeling now is a great one.

The next one is pretty much what we've been talking about this

whole time, but it's distraction.

It's distracting from your current thoughts, emotions, sensations,

and getting out of your heads.

You can get through this moment and then you can cope through it.

Then you can process what happened, but you're just surviving through this moment.

I'm in the last thing meant I'm going to mention, as far as coping through your

own panic attack is being near someone.

If someone's next to you, if someone sitting outside with you, even if they're

not hugging you or touching you or anything like that, someone is there.

You're not alone.

You're not again.

I talked about how it can feel like you're, you're dying.

This sensation is really, really scary.

You're not alone in this experience.

You aren't alone in these feelings of distress.

You're going to be okay.

And someone is there to support you.

Be there as a shoulder to cry on and make sure that you're okay.

So someone in your life, whether it's a stranger, a friend, a family

member is having a panic attack.

How can you support them?

The first thing is to make coping really easily accessible.

Whenever I see someone having a panic attack, I don't care

if I know them or if I don't.

When I was back at school in person, I've done this multiple times, but there

was a girl in my mock trial team on.

Then she was having a panic attack.

Cause we were about to go into a competition.

Notice the science and I go into my little like mom mode.

I like to pretend I'm like a doctor in emergency room.

I'm like crisis mode.

Let's manage it.

Follow her to the bathroom, immediately getting wet paper

towels, and I'm handing them to her.

And I remember she was like, oh, like it's okay.

She was trying to go in the bathroom, stall and cry.

I wanted to be alone.

And I was like, just put these under your eyes.

I promise I've been here a day.

You can do whatever you want.

Just trust me, put these under your eyes.

I'm not going to leave her to go find her own ice pack.

I'm not gonna leave her to wet her own paper towels to put them under her

eyes, handing her the coping skill, making it super easily accessible.

This is similar with a glass of water, cold water.

Don't let them make them go get it.

Let them do it.

Tank them.

Hey, I just want, I need you to breathe.

Okay.

Inhale, exhale, making these resources, these tips and tricks

easy, and they can just take up your suggestions and implement them

rather than having to ration through.

What's my best option here.

Yeah.

Going right off of that with making their resources accessible is to talk calmly.

Encourage them.

You're going to be okay.

You got this.

I'm right here.

Let's keep breathing.

You're okay.

I got you.

You're safe.

This is going to pass calm voices.

Oh my God.

What's her.

Are you okay?

Like what's happening?

Why are you like, like what's going on?

Like what happened?

All boys encouraging.

You're getting them through this moment.

They're just trying to survive.

And building right off of that is to not force a huge processing moment.

You're just getting them out of crisis mode.

You're not going to be like, Hey, like I saw you talking to your friend over there.

It seemed like you got in a really big argument.

Like what just happened?

Wallace burst is having panic attack.

You're helping them survive through this moment.

You're not processing.

They are just surviving the physical sensations.

The thoughts, the urge is the emotions that are arising.

And the last thing is to not leave them alone.

I think that people will have different perspectives on this.

If you experienced panic attacks a lot, you know how to cope, you

know, that it's better to be alone.

You can advocate for yourself.

If that's possible in that moment or let your friends know beforehand, Hey,

if you see me having panic attack, I just want you to know that I totally

have been through this rodeo before, and I know how to cope with it,

and it's best for me to be alone.

But if someone's having a panic type for first time again, we talked about

how people describe this as feeling like you're dying, being left alone

when you're scared and overwhelmed and don't know what's happening, can be

like just even more fear and anxiety.

So being there and just knowing that they're not alone, there's someone

to support them that will check in on them and not leave them to be

in this experience by themselves.

So that is all of my panic attack, tips, tricks, education, or talking

long-term anxiety, recovery to decrease your your emotions, your symptoms that

pop up and frequency of panic attacks.

So the first thing worth mentioning is exposure therapy.

I will, I think a full episode on this, it kind of dives more into OCD,

but it totally is applicable here too.

So when we have say a panic attack, because we're scared

about giving a presentation and we don't give the presentation that

day because we're so overwhelmed.

And then we get school the next time and we feel even more anxiety because

now it's been two days since you were supposed to give the presentation.

And last time, when you were supposed to give the presentation,

you had this terrible.

Experience, which was a panic attack.

And so your anxiety builds, it keeps getting worse and worse.

The longer you avoid emotions, it bubbles up, it gets more overwhelming.

So exposure therapy is exposing yourself to the things that bring on anxiety

in small manageable amounts, pushing yourself outside of your comfort zones.

That next time you encounter that, trigger it, that stimuli

you are not as overwhelmed.

You know how to cope, you're prepared.

So if you are scared of flying, you're going to do exposure therapy

by first thinking about what it's like, you're going to walk herself

through mentally what it's like to fly.

Next thing you might watch a YouTube video going through

security and getting on the plane.

Next thing after that, maybe you will actually get to the airport and you'll

walk around and go through that process.

Another thing is to bring on physical sensations.

When you have panic attacks a lot, you sometimes get scared of having a panic

attack, and that brings on a panic attack.

So doing exercise, which increases your heart rate increases your

breathing rate gets you comfortable with the sensation of being physically

in a state of arousal without tying that sensation to this is bad.

This is a panic attack.

This is terrible.

If that makes sense.

So linking an episode on that, but exposure therapy long-term is

huge for managing your anxiety.

Mindfulness is another big thing.

Again, really, not being judgmental of when you're feeling anxiety,

what you're feeling anxiety about and being super aware of when these

emotions and thoughts come up again.

We're avoiding avoidance.

Okay.

We are aware of our emotions so that we're not suppressing them because when

we suppress them, they bubble up, they get bigger and then they implode a little bit.

So what you're doing is instead being really aware of these emotions, these

thoughts, virals, getting curious around what's going on there is set up avoiding

and having it bubble up into a panic attack, emotion, regulation skills.

I have a question about this and which I'm going to answer it later

in the episode, but making sure you're taking care of your physical

health, your sleep is on track.

You're eating balanced, you're exercising.

You're taking your medications regularly.

All of these things, decrease your emotional vulnerability and decrease

your likelihood of a panic attack.

Making sure that you're regularly building healthy relationships,

you're accumulating positives.

You're building mastery over something in your life.

Those are all things that will help again, decrease your emotional vulnerability,

decrease your chances of feeling anxiety and feeling anxiety as strongly.

Another skill and emotion regulation module from DVT is coping ahead.

And this skill is when you write down the who, what, when, where, why of a

situation and you walk through exactly how you're going to cope with with your

worst case scenario, what you think is going to happen, what could happen?

So say you're anxious about a presentation you're going to give,

you're going to do who, what bummer?

Why about this presentation?

What classroom is it in?

Who might you encounter as you walk to the classroom?

Who's your teacher, what's the presentation about all of that.

And then you're going to mentally walk through what that's going to be like.

You're going to at each moment when you would feel anxiety.

So when you walked in the classroom, you feel that sense

of dread you feel butterflies.

Okay.

I'm going to do deep breathing.

So really knowing how you're going to cope in this situation ahead of time.

And somewhere to expose your therapy, just continuing to get curious about

what's bringing up anxiety, what was that thought pirate triggered by and why did

that trigger those emotions and building a sense of mastery over your anxiety?

Because you are you're stronger.

And so this is something that's done a lot of times.

this is when I would recommend advocating to your parents or a school counselor

for professional support on with anxiety.

And you can do that by saying, Hey, feeling a lot more stress

recently with school or with life.

And I'm wondering if I could meet with someone about it or just being

super open and being like I've been having a lot of panic attacks or a

lot of anxiety that started to impact my mental health or my ability to do

schoolwork engaged in my relationships.

Didn't really want to talk to someone about it and build my toolbox so that

I can navigate this more effective.

And the last thing that I'll mention for long-term anxiety,

recovery is chain analysis.

Chain analysis is a DBT scale where you break down every single step

of what happened when a problem of emotional or behavior occurred.

So if you had a panic attack, you're going to walk yourself backwards back.

Okay.

What thoughts happened?

What was my trigger?

What interactions happened?

Where was I, what emotions came up and then you're going to go

in and be like, okay, this is when I would have coped this way.

This is what I would've done.

Some deep breathing.

This is what I would have asked for help.

And another tip that I'll add for this is to be cognizant of what is valid

as far as emotions and what is not justified as far as a reaction or an

intensity or duration of the emotion.

So subs is getting long guys, you're getting all the tips and tricks.

I'm sorry of this is helpful to someone.

So.

Second to last section I'm going to cover is nightmares in nighttime anxiety.

I think something that makes nighttime anxiety really a whole other burden to

tackle is it's really isolating your loan.

A lot of the times of the people are sleeping.

And also if you're having nightmares, everything feels really real.

The stimuli that your senses it's like, like loosening it's really, really scary.

So my tips for that, that worked for me, honestly, my nightmares and

my nighttime anxiety went away as I improved my mental health together

as my sleep got on track as my anxiety throughout the day decreased.

So it did as well at night, same thing with depression

throughout the day, nightmares decreased as well, sleep improved.

So my first tip is to have a solid sleep routine and sleep hygiene on.

So this means you're not drinking coffee super late in the day.

You're not napping.

You're getting out.

You're exercising.

You're taking care of your physical health, you're unplugging before bed.

And I will link an episode all about sleep hygiene, but you're making sure that you

are setting yourself up for success when it is time to go to sleep, rather than

being like, oh, I'm not tired because I slept for six hours during the day to day.

Right.

Another tip is when you're really at a point where you're like, I need support.

I am asking for help.

And I, I need other people in my corner to help me navigate this.

I slept on my parents' bedroom floor for about six months when I was a freshman.

And it was a combination of having a lot of nightmares, a lot of anxiety,

insomnia, and my parents not really trusting that I would be physically safe.

I was at a really tough point.

And at the time knowing that they were there and that I wasn't sleeping alone

and by myself and I, wasn't gonna wake up from a nightmare, having anxiety and

being like I'm by myself, I'm terrified to move was really, really reassuring.

And so sleeping over with a friend, a sibling a parent, if you can advocate

for that and say, I think it'd be helpful for me for a couple of days, just for

tonight to have someone else in the room.

So I'm not waking up alone.

That's another great tip.

Next tip all of the panic attack tips and tricks and coping

skills that I just mentioned.

You can use these when you wake up from a nightmare.

When you're having anxiety before you're going to bed, especially

grounding, getting yourself out of your, your head and realizing, okay,

I'm here, I'm in my room, I'm in bed.

I'm not in this crazy situation.

That was in my dream.

I am in this place that is safe.

And I know well, and I'm okay.

So grounding is huge.

And that again, mindfulness of your current thoughts, what emotions are

justified, what what emotions are valid and what thoughts, reactions, emotional

duration and intensity are not justified.

Given the situation resources, all of this will be linked in today's show

notes, but if you are struggling with anxiety on, there are two crisis text

lines that I want to recommend to you.

The first one is just the United States crisis.

Textline you text connect to 7 4 1 7 4 1, and you can talk to a licensed

counselor about the anxiety that you're feeling what's coming up for you and

how you can cope more effectively.

The next one is physically specifically 14th.

It's called teen line, and you can text teen 2 8 3 9 8 6 3.

Again, licensed counselors, helping you walk through the anxiety you're

feeling, navigate the situation and figure out a coping plan.

I am going to link to other links on all about anxiety resources.

One is from panic and anxiety.org.

And the other one is from the national Institute of mental health.

So you can read all of those for more comprehensive resources.

And the last things I'll mention Headspace for guided meditation

for anxiety, same thing.

You can look it up on YouTube, just say, guided meditation for panic attack for

anxiety before bed, or about an event that's coming up, that kind of thing,

tons and tons and tons of resources for someone to walk you through.

Step-by-step how to cope.

Same thing with podcast apps, having someone to listen, to walk you

through your deep breathing, rather than having to do it yourself.

Super helpful, great resource.

So onto the questions favorite coping skills for panic attacks.

I gave you so many earlier in this episode, I'm going to give you my

top three that work the best for me.

Tip is an amazing one, but I'm not going to include that because I haven't

had to use it as often because I'm not having full blown panic attacks.

My top three favorite ones that really work for me deep reading

they're really leaning into the idea of this is impermanent and that

impermanence will be on my side.

And radical acceptance of this is what I'm feeling.

This is the emotion that's coming up right now, and that's what I'm

going to cope through and navigate.

Next question is testing anxiety.

My first thing that I would say is take care of you.

Please skills, make sure you're getting enough sleep.

You're eating well.

You are exercising.

You're taking care of your physical health.

You want to reduce your emotional vulnerability as much as possible.

We know that when you haven't slept the night before your performance on

tests and assessments, not as good.

So you're going to sleep.

You're going to make sure that you're physically in the best possible state

to take this test and reducing your likelihood of having a panic attack.

The next thing I would do is cope ahead again.

Who, what, when, where, why, as far as the task, what coping skills can

use it, all of those different points.

What's the worst case scenario?

How would I cope through that?

What's the best case scenario?

How would I cope through that?

What's a realistic prediction.

How would I cope through that?

And I would also.

Say for that one, keeping coping skills on hand, come to your classroom with

a bottle of water, you have cold water to drink, to ground yourself.

If you're feeling anxiety and overwhelmed, you're going to have

a fit that you can put on your desk.

If you're a teacher allows, that kind of depends on the, the teacher,

but that you could play with tactile distraction if necessary.

You have your five fingers to do your five things.

I can see five things.

I can touch three things.

I can hear two things I can smell.

One thing I can taste.

So your coping skills are an hand.

You're not going to have to stress about how you can cope through this

because you have planned that before.

And those coping mechanisms are super easily accessed.

The next question is how to prevent panic attacks at school.

I would really say similar thing which is coping ahead, having your coping skills

super easily accessible in your backpack, make a little coping skill pack, whether

it's fidgets and ice pack, you know, those ones they put in first aid kits

where you pop it and then it's cold.

You could use that in the bathroom, a water bottle.

A, I said fidget a little deep breathing reminder card.

And the other thing that I would do is really exposure therapy.

We're avoiding the avoidance avoiding school, avoiding the triggers

will make your anxiety worse.

So really pushing herself to overcome those challenges and using your coping

mechanisms that you've prepared for yourself, how to support someone,

having a panic attack covered this lot.

But my quick tips to recap is to not leave them alone.

You're there to support them.

You are not going to have them emotionally process in the moment you are helping

them survive through this crisis.

And that is your goal.

Not understanding what happened.

You are going to talk calmly and slowly.

You're going to say it's okay.

I'm here.

Let's breathe.

You're okay.

You're having a panic attack.

I got you.

I'm not leaving.

You're you're okay.

It's going to be okay.

And making coping skills easily, easily accessible, Haring them a cold

compress to put under their eyes.

Ho holding their hands, looking them in the eyes and saying we're inhaling.

We're exhaling or inhaling, exhaling, guiding them outside for some fresh air,

making those coping skills accessible.

Next question.

Similar how to help someone feel more comfortable in anxiety inducing spaces.

I would say really let them kind of lead you on this one.

I feel like this is a situation where if someone is having anxiety about

being at a concert or being at school or something that brings anxiety for them,

they'll come to too, they'll come to you.

It kind of became kind of nervous about this.

Not really sure how this is going to go down.

And then from there it came back, okay, what can I do?

How can I help?

Rather than a panic attack where it's kind of difficult for them to

rationalize and plan through how they're going to get through the situation.

If it's an anxiety inducing environment, they can kind of plan

beforehand and recruit you as a resource if they need that support.

Next question.

How to help a friend out with anxiety?

Like what are helpful versus harmful things, helpful?

Being there as a nonjudgmental support system?

Not being overly nosy, I guess would be the word about like

what causes panic attack.

Why are you feeling anxiety about that?

That doesn't make sense, but just validating, say, yeah, that's

like really anxiety provoking.

Oh my gosh.

Like, yeah, that's a really scary, that's really crazy.

Like, I totally understand where your stress that's a lot to deal

with validation, empathy, support, without judgment harmful things

being like that's not stressful.

Where are you feeling that way?

Being judgmental about their emotions.

I remember one time when I was at boarding school, there was a staff member.

Girl was having a really bad panic attack and the staff member gave

her warm water, turned on the hot air conditioning and play the radio.

All three of those things would not be helpful.

So really just being nonjudgmental, validating, empathetic, and making

coping skills easily accessible.

And last question is, can you talk about how you use emotion, regulation

skills to keep anxiety at bay?

I struggle with this me too.

And what I would say there is, again, first things first decrease your

emotional vulnerability, please.

Skills number one.

The next thing is kind of improving your baseline of your life worth living.

So you're going to be accumulating positives.

You're building mastery, you're building healthy relationships, all of

these things that make your baseline higher and give you more resilience.

When you do feel moments of anxiety and stress.

And then coping ahead, really being strategic and thoughtful about how

you're going to navigate situations that might bring up anxiety.

I know it's work.

It takes effort.

It takes more thought than you probably would like.

But, but it works.

If you can say, okay, if I feel anxiety at the center,

I'm going to do deep breathing.

And that's my one skill that I'm committing to.

It will help you for the moment in a big way.

Okay.

Okay.

That's the episode?

My throat hurts.

I feel like I just, I literally did just talk for an hour.

And I went through so much information, but I just had so much that I wanted to

make available to you guys and accessible.

So if you made it this far, I'm sorry, I just dumped so much information at you.

Hopefully something stuck with you.

If there's one skill that you took away from it.

It's a success in my book.

That's all you need is one thing to get you for the moment.

One thing that you can latch onto and say, I'm breathing for the next five

minutes and that's what I'm focusing on, or I'm counting as high as I

can go until I'm out of this crisis.

And that's how I'm going to survive this.

That's that's all I can hope for.

So with that being said, I hope you enjoyed this as

always tag me on social media.

If you listen to this episode, let me know it's helpful.

Let me know what you want to see in the podcast.

Email DMA.

If you have more questions and share this episode with a friend or

family member, if it was helpful.

So thanks for listening and I'll see you next Friday

to recap this week's episode, I talked all about anxiety versus feeling anxious,

navigating panic attacks, and supporting others who are having panic attack.

Reducing and recovering from anxiety, long-term working through nightmares

and nighttime anxiety, great resources for anxiety, especially for teens.

And I entered a whole bunch of your questions about anxiety.