Introduction

Anxiety is a term used to describe the unpleasant feeling we get when we are in a stressful, threatening or difficult situation. Most of us will experience anxiety at some point in our lives for various reasons. 

Often, anxiety is a normal emotion and will go away either over time or once the situation that was causing the anxiety has resolved. In case of Generalised Anxiety Disorder, severe anxiety is more frequent. If the feeling of anxiety is persistent, it can negatively impact one’s quality of life.¹

However, it is possible to reduce anxiety levels with certain techniques and lifestyle changes.² If you are someone who is struggling with anxiety but wants to discover ways to manage it without the use of prescription medications, then carry on reading. In this article, we delve into the diverse array of options that can help you manage your anxiety.

Understanding anxiety and stress

You've probably heard the idea that stress and anxiety are left over from the time when our ancestors were pursued by animals or other human predators. The idea is that whenever we are anxious, our body often reacts to a modern-day stressor, such as an exam, a breakup, or a problem at work, in a way similar to how it would react if we were being attacked by a bear or a lion.³

In our daily lives, we often encounter things that cause stress to our bodies. These stressors can be both physical and mental. For example, swimming in extremely cold water would be considered a physical stressor, while going through a breakup would be considered a mental stressor. Our bodies cannot distinguish between mental and physical stressors in terms of how they react. 

When we are anxious or stressed, the immediate stress response involves our autonomic nervous system, which comprises the parasympathetic and sympathetic nervous systems. Stress activates the sympathetic nervous system and deactivates the parasympathetic nervous system.²

It’s useful to have a brief understanding of these systems in order to understand how you can influence them when you are feeling anxious.

The nervous system

When we’re relaxed, neurons, or nerve fibres, in our bodies release a chemical called acetylcholine (ACh), normally used to move muscles. However, when stressed, these neurons release epinephrine (a.k.a. adrenaline), which acts on specific receptors in the body.

This system activates certain systems, like the muscles of your legs and heart (sympathetic - “fight or flight”) and deactivates others, like those involved in digestion and reproduction (parasympathetic - “rest and digest”).³ 

This stress response causes a feeling of agitation that makes you want to move, so you might feel an urge to act or speak when stressed. Controlling stress involves learning how to work with this feeling of agitation.

First, we’ll discuss a few ways to help manage acute stress, such as that you might feel before an exam.

Breathing techniques

Breathing techniques can help us tap into our body’s nervous system and activate the parasympathetic (rest and digest) response when we’re feeling anxious. 

The first thing to note about breathing techniques for anxiety is that naturally when we breathe in, our heart rate increases slightly, and when we breathe out, our heart rate slows slightly. Simply, by increasing the length of our exhales in comparison to the length of our inhales, we can lower our heart rate and help ourselves feel more relaxed. However, there are a few more specific techniques we can use.⁴

Cyclic physiological sighs

The so-called “physiological sigh” is a breathing pattern that we naturally do when we’re about to fall asleep.⁵ It consists of two consecutive inhales through the nose, the first being a deep inhale followed immediately by a second, smaller inhale; this is followed by a long, full exhale through the mouth.

But how does this reduce anxiety?

• Carbon dioxide regulation: The double inhale maximally inflates the lungs, including the small air sacs known as alveoli. Alveoli may not get fully inflated during regular breathing, but if they are fully inflated, they help us expel carbon dioxide more efficiently during the prolonged exhale
• Autonomic nervous system adjustment: By enhancing the removal of carbon dioxide gas, the physiological sigh helps balance the levels of oxygen and carbon dioxide in the blood, which directly influences the parasympathetic branch of the autonomic nervous system and calms us down

Box breathing

Box breathing is a structured breathing technique that involves:

1. Inhaling for a set time/count (e.g. four seconds)
2. Holding the breath for the same time
3. Exhaling for the same time
4. Holding the breath again for the same time

This technique helps regulate the autonomic nervous system, reducing physiological arousal and promoting a sense of calm. It's particularly useful for managing stress in real-time situations, such as before public speaking or performances.⁶

Progressive muscle relaxation (PMR):

Progressive Muscle Relaxation is a technique that involves sequentially tensing and then relaxing different muscle groups throughout the body.⁷ This method is designed to help individuals become more aware of physical tension and learn to release it, thereby reducing stress and promoting overall physical relaxation. It’s particularly good if you’re in bed and struggling to fall asleep due to stress.

How to perform PMR

1. Sequential muscle engagement

Tensing: You start by deliberately tensing a specific muscle group, such as the muscles in your right hand, and hold the tension for about 5-10 seconds.

Relaxing: After the tensing phase, you slowly release the tension and focus on the sensation of relaxation that follows. This relaxation phase typically lasts for about 20-30 seconds.

2. Full body relaxation

This process is repeated systematically for different muscle groups, typically starting from the feet and moving up to the head. By the end of the session, the entire body should feel more relaxed.

There are some other things we can focus on in our lifestyles that may have a positive benefit on anxiety. 

Exercise

Regular physical activity is crucial for reducing anxiety.⁸ Exercise helps by:

• Reducing stress hormones: Physical activity lowers levels of stress hormones like cortisol
• Boosting mood: It increases the production of endorphins, which are natural mood-lifting hormones
• Improving sleep: Regular exercise can help you fall asleep faster and enjoy deeper sleep, which is essential for anxiety management​ . We’ll discuss this more in a bit

In particular, exercises such as yoga⁶ have been found to have a beneficial effect on anxiety levels. It’s important to choose the type of exercise that is most enjoyable and sustainable for you. 

Nutrition

Nutrition has been shown to be of great importance in many mental health conditions, including anxiety.⁹

• Balanced diet: Consuming a balanced diet rich in essential nutrients supports overall brain health. Nutrients like omega-3 fatty acids, vitamins B and D, and minerals such as magnesium can help reduce anxiety
• Avoiding excessive stimulants: Limiting caffeine¹⁰ and sugar intake can prevent spikes in anxiety levels. Staying hydrated and maintaining a steady intake of complex carbohydrates helps stabilise blood sugar levels, which can affect mood and anxiety

Sleep

There’s no downplaying the importance of good sleep in mental health and wellbeing.¹¹ Good sleep helps to improve anxiety in two main ways:

• Regulating the autonomic nervous system: Quality sleep helps balance the body's responses to stress and promotes a state of calm
• Improving mood and cognitive function: Good sleep hygiene practices, such as maintaining a regular sleep schedule and creating a restful sleeping environment, are essential. Things such as avoiding caffeine and electronic devices before bedtime can improve sleep quality​

Mindfulness and meditation

Mindfulness and meditation practices help regulate the autonomic nervous system, which controls the body’s stress response. By engaging in these practices, individuals can shift from a state of sympathetic activation to parasympathetic dominance, promoting relaxation and reducing anxiety​.¹²

There are a few different forms of this you can try. 

• Mindfulness meditation involves paying attention to the present moment without judgement. It can be practised through body scans, breath awareness, or focusing on sensations
• Focused attention meditation: Directing attention to a single focus point, such as breathing, to cultivate concentration and reduce distracting thoughts
• Guided meditation: If you’re a complete beginner to meditation, you might find it helpful to use audio or visual guides to lead you through meditation sessions. There are plenty of free online resources for this

Cognitive behavioural therapy (CBT)

CBT is a kind of therapy that teaches you more helpful ways of thinking and reacting to everyday situations. It aims to improve your state of mind by teaching you to spot the links between your thoughts, actions and feelings.¹³

There are a few different forms of CBT, including:

1. Cognitive therapy - spots unhelpful thoughts and beliefs and helps us to adapt how we think about them
2. Behaviour therapy - helps us to change unhelpful behaviours such as checking or getting reassurance. Helps us to gradually face situations, thoughts or memories that we’ve been avoiding
3. Compassionate mind therapy - teaches us to be be less critical of ourselves and others to help us feel more safe and content
4. Acceptance and commitment therapy - teaches us to accept unpleasant thoughts and feelings rather than fighting them or getting upset 
5. Dialectical behaviour therapy - teaches techniques to manage strong feelings and sudden mood changes
6. Cognitive analytical therapy - helps us understand the past causes of current difficulties and find new ways of managing them

You can do some CBT at home yourself, but it’s best to work with a trained therapist if possible. You should be able to access this via your GP.

Other activities

There’s a lot to be said for engaging in activities that we enjoy to decrease anxiety levels. Simply hanging out with friends and having meaningful social interactions has been shown to decrease anxiety levels. 

Additionally, activities such as art therapy, music and dance have all been shown to help with anxiety.¹⁴ 

Nature and environment

Spending time in nature has also been consistently shown to have a beneficial impact on anxiety and stress levels.¹⁵ 

It could be worth trying activities outdoors, such as walking the dog or even sitting and reading a book in the garden or the park, rather than inside. Other things to try include

• Growing or picking food
• Buying flowers or potted plants to bring inside
• Surrounding yourself with photos of your favourite places in nature 
• Watching the stars
• Going beachcombing or geocaching
• Pet sitting or dog walking
• Birdwatching

Summary

Hopefully, this article has given you some tools to help manage both acute and chronic anxiety more effectively, without medications. However, if anxiety persists, it is important to seek professional help as soon as possible so that you can get the most appropriate support for you.