Here are some things to say and do instead
Keep calm and carry on. Should this be our mantra in this world full of danger, strife, and stress? Tell that to our overly anxious, overthinking brains.
As I lay in my bed, tossing and turning in that witching hour between 3:30 and 4:30 AM this morning, I contemplated my own anxieties. Trying to solve all of the world’s problems during this time of night is never successful, but I can’t seem to turn off the intrusive thoughts.
By experience, I know that upon wakening, the catastrophes my brain was creating during my restless attempt at slumber will never seem as insurmountable in the daylight hours.
I hate that I have anxiety, but I do believe that we all have it to some degree. If you don’t, you’re lying. At least, I tell my patients and family this.
See, sometimes I look at my own trials with anxiety as a gift. Even though at times I struggle to manage my own thoughts, I have a gift for talking others out of theirs. Overwhelming anxiety, panic attacks, and fear of falling all come down to the feeling that you are not in control of your life, and initiating a fight or flight response.
With my family members who suffer, I try to get them to break down their anxieties into manageable tasks. We look at all of the problems, list them out, and tackle them one by one, starting with the easiest or most pertinent problems to solve.
With the recent death of my father, in those moments after his heart stopped, my mom was understandably overwhelmed. But she had some decisions to make and needed to decide pretty quickly. My dad had never discussed his wishes upon his death, and he left the choices to her. So I was able to get her to talk to me about her own wishes. And then she could reach a comfort level about making choices for him.
My daughter has a predictable response to end-of-semester deadlines every fall, without fail. She’s a perfectionist and has maintained a 4.0 throughout her college career. I’ve been able to help her figure out how to manage every time. Sometimes it’s asking a professor for an extension. Sometimes it’s being her editor for papers. Sometimes it’s simply reminding her that she is loved and safe.
And I’ve encountered friends during panic attacks as well. The best phrase to hear when you are in fight or flight mode is you are safe. That’s it. That’s the primary message. If they will let you, hold their hand. This grounds them. Give them something to focus on besides their sense of panic. Tell me five things you can see, four things you can hear, and three things you can smell.
I needed to do this as a coach on one of my group runs. I talked one of my team members through a panic episode when she was harassed by someone on our route. These tactics really helped.
With my patients, my approach is a bit different. I try to address the emotional response to healing with all of the people in my care. As a physical therapist in inpatient rehabilitation, I often spend over an hour at a time with my patients, providing lots of opportunities to address their fears and concerns.
I try to anticipate anxieties. I imagine how I would feel in their situation. It’s especially challenging for those who are experiencing a major medical event for the first time. Feeling vulnerable on that level is supremely humbling.
The witching hour is definitely something we address. I kind of joke about it, talking about the things that race through their mind at 4:00 AM. It’s surprising how many of my patients give me this shocked look when I do, as if I exposed their little secret. I educate them about discharge planning, stages of healing, fears of loss of independence, and typical patterns in recovery from their illness or injuries. These are the thoughts that often run through your brain in rehab.
Granting as many ways to control their situations is one element of care that can make a big difference in the anxiety level of my patients. It can be as simple as asking them which side of the bed they would like to get out of, showing them how they can adjust their hospital bed themselves, or choosing what part of their therapy they would like to tackle first.
Sometimes my patients are so overwhelmed by a fear of falling that it makes participating in therapy difficult. I rely on a mantra my favorite running coach told my team: Breathe, relax, believe. First, I get my patient to look me in the eyes, as often they need something to focus on. Hi there! Good. Next, I ask them to breathe. We take a deep breath together. Exhale. And then I ask them to relax. We are going to get through this together. I promise I won’t let you fall. I know it’s hard for you to trust someone you just met. But I’m here to help you get your life back, and this is how we start. Your job is simply to show up and do the work. My goal is not to make you miserable in the process, so if we start getting out of bed, and it’s terrible for you, we’ll stop. And I keep my promises.
Breaking down big tasks into parts, once again, is another element of managing anxiety in mobility training. Getting out of bed, for example, becomes a more complicated endeavor when you’ve taken inventory of your body, and nothing seems to work like it used to. I help my patients problem-solve based on their new to them bodies. And as we work on the skills, they begin to restore what was once lost.
Sometimes my patients are dealing with side effects of medications that they don’t understand. For example, pain medications can alter thought processes, and other drugs like albuterol used in breathing treatments can increase your heart rate and make you feel anxious. Explaining these effects to my patients, letting them know that I understand and that they are not crazy, goes a long way in earning their trust so that we can get on with the therapy for the day.
The one thing I’ve learned that doesn’t help my family, friends, or patients when they are burdened with anxiety is telling them to calm down. A brain in fight or flight does not respond well to this. People simply need to know that they are safe, that someone cares, and to be given things they can control. An anxious brain often can’t do this. This is when an objective person can help.
Do you deal with anxiety? Do you have people in your life that do? I’d love to hear about your experiences.
As always, I hope you all are safe and healthy.