Anxiety: it’s so physical. Anxiety activates your body’s fight or flight response, which changes how your body functions so that you can better respond to danger (details here– worth reading first). When the fight/flight response is chronically switched ‘on’ as a result of anxiety, in the absence of danger, it causes a range of problems such as difficulty sleeping, concentrating, or winding down. There are, however, a number of ways that you can actively change your physiology to help down-regulate the fight/flight response, and this blog outlines just a few of the physiological methods that can help with this. As follows:
The fight or flight response is fuelled by rapid and shallower breathing, and anxiety is generally characterised by shallower chest breathing. Slowing your breathing right down disrupts the fight/flight response, producing physiological changes- such as decreased heart rate, correcting the ratio of oxygen to carbon dioxide coming into your body, and helping slow down your heart rate. There are several ways to breathe differently:
i. Controlled breathing is helpful for really high anxiety. Try breathing in for a count of 4, holding your breath for a count of 1, exhaling for a count of 6, and holding for a count of 1. Do this on repeat for several minutes. Counting helps distract your mind from the worry or panic it has been focused on; slowing your breathing helps change how your body is functioning, and the long exhalation can help to relax you.
ii. Practice long, deep exhalations- ideally breathing out for twice as long as you inhale. If you’re gulping air in quickly (say, one second), then work on breathing out twice as long (i.e., for two seconds)- as long as the ratio of 1:2 is consistent. If you can slow your inhalation down further, say, to three seconds, then your exhalation would be six seconds. Making your exhalation longer is thought to prevent hyperventilation and increase the amount of carbon dioxide in your body. The fight/flight response relies on increased oxygen (and decreased carbon dioxide), and longer exhalations prevent the increased oxygen intake.
iii. Use a consistent pace of breathing that approximates a slowed normal breathing rate: breathing in for a count of 3, and out for a count of 3.
Any of the above can be used when anxiety or panic is looming. Most research studies indicate that there is a marked benefit when breathing retraining is undertaken- this is when breathing skills are practised daily (usually for at least 20 minutes), for several weeks. This is particularly helpful when you have chronically shallow breathing due to anxiety, as you are retraining your body to breathe in a more relaxed way. Additionally, you then have a well-practiced skill to use if anxiety starts escalating. Research has indicated that breathing retraining can decrease anxiety, heart rate, breath rate, temperature , negative feelings, as well as improve attention .
- Diving Reflex
When you dive into cold water, your body makes several physiological changes to protect itself from the potential dangers of low oxygen and cold temperatures. Your heart rate slows, the amount of oxygen in your blood decreases, and blood flow to your limbs reduces to ensure your vital organs (think heart, lungs, and brain) have more blood and oxygen. The dive reflex physiology works in a directly opposite way to the fight/flight response, and can be activated in several ways, such as:
i. Exposure to cold on your face, such as:
- cold water splashed on your face
- applying a cold wet towel over your face
- putting your face in a bowl of cold water
- having a cold shower
- putting cold/ice packs on your face
ii. And, by holding your breath at the same time (as if you were diving).
The water used however, has to be cold to activate the dive reflex- think around 10°C as ideal.
- Vigorous Exercise
Vigorous exercise changes your body’s functioning in several ways. You sweat; breath faster, but also more deeply (unlike in the fight/flight response); heart rate increases; and parts of your brain that are underactive when you’re anxious are stimulated. Further, stress hormones that maintain the fight/flight response reduce, and endorphins and your ‘feel-good’ neurotransmitters (such as serotonin and dopamine) are also released. Not to mention, exercise can distract from your anxiety, and help you burn off that nervous energy or restless tension (ever felt the urge to pace or move when you’re anxious?).
When exercise is regular, it has ‘anti-anxiety’ properties, but it also has this effect when used on an ‘as-needed’ basis . Research has indicated that it can help reduce panic attack frequency and intensity  when used as needed. There is often a significant reduction in anxiety shortly after exercise, and this benefit persists for several hours after exercising . The best type of activity for anxiety is high-intensity aerobic exercise (cardio) for 20-30 minutes . There is also evidence that even 10 minutes of high-intensity interval training (using sprinting) can reduce anxiety . Try any of the following:
ii. Fast-paced walking
iii. Treadmill use
v. Sprinting interval training
Aim to break a sweat and increase your breathing and heart rate- think of these as positives to reduce anxiety!
A range of studies have indicated that listening to relaxing music can help relieve anxiety and its physiological symptoms , including for both chronic anxiety  and temporary anxiety (such as anxiety linked to medical procedures ). These studies, and others, have indicated that music can decrease heart rate, anxiety, blood pressure, and the amount of cortisol (a stress hormone) in the body.
Principles to use:
i. The music must have a slow tempo, close to resting heart rate: think around 60 beats per minute.
ii. Instrumental music tends to perform better, rather than music with lyrics. Research studies have used a variety of soothing instrumental music, including piano, jazz, orchestral, and synth.
iii. Some studies where participants self-selected their own music had better outcomes than those that were provided relaxing music. Think about developing a playlist that you find soothing.
Here are some suggestions to get you started:
 Chen, Y., Huang, X., Chien, C., & Cheng, J. (2016). The Effectiveness of Diaphragmatic Breathing Relaxation Training for Reducing Anxiety. Perspectives In Psychiatric Care, 53, 329-336. DOI: 10.1111/ppc.12184
 Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., … Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874. doi:10.3389/fpsyg.2017.00874
 Ströhle, A., Graetz, B., Scheel, M., Wittmann, A., Feller, C., … & Dimeo, F. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. Journal of Psychiatric Research, 43, 1013-1017. https://doi.org/10.1016/j.jpsychires.2009.02.004
 Martinsen, E. W. (2008). Physical activity in the prevention and treatment of anxiety and depression. Nordic Journal of Psychiatry, 62, 25-29. Doi: 10.1080/08039480802315640
 Aylett, E., Small, N. & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18, 559. doi:10.1186/s12913-018-3313-5
 Mason, J. E. & Asmundson,G. J. G. (2018). A single bout of either sprint interval training or moderate intensity continuous training reduces anxiety sensitivity: A randomized controlled trial. Mental Health and Physical Activity, 14, 103-112. https://doi.org/10.1016/j.mhpa.2018.02.006
 de Witte, M., Spruit, A., van Hooren, S., Moonen, X., & Stams, G. (2019) Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses. Health Psychology Review, Advance online publication. DOI: 10.1080/17437199.2019.1627897
 Flores Gutiérrez, E. O., & Terán Camarena, V. A. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy, 44, 19-24. https://doi.org/10.1016/j.aip.2015.02.003.
 Wu, P., Huang, M., Lee, W., Wang, C., & Shih, W. (2017). Effects of music listening on anxiety and physiological responses in patients undergoing awake craniotomy. Complementary Therapies in Medicine, 32, 56-60. https://doi.org/10.1016/j.ctim.2017.03.007
 Kühlmann A. Y. R., de Rooij A., Kroese L. F., van Dijk M., Hunink M. G. M., & Jeekel, J. (2018). Meta-analysis evaluating music interventions for anxiety and pain in surgery. British Journal of Surgery, 105, 773-783. doi: 10.1002/bjs.10853