Here's a rather long discussion of stress reduction and anxiety management.
I'd recommend printing it and reading at some leisure time.

Dr.Hat

Stress reduction and anxiety management

Here we're going to talk about stress management and anxiety reduction. Most of us probably don't have to worry about this much, right? NOT!
We're all stressed to some degree; that has become part of our daily lives.
So everyone here can probably benefit from some of this material, whether we have OCD or not. However, those of us with an anxiety disorder are more likely to be bothered by acute or persistent anxiety than the rest of us, and hopefully the material we present here will be especially helpful to you.
Whole body health. First of all, we're going to address the concept of something we call "whole body health." Stress is probably the worst thing that can happen to your body, after disease. It wears down your resistance, depletes your immune system, robs your body of energy, vitamins and minerals, and tends to make everything that is functioning either marginally or poorly function even worse. Managing anxiety means not only learning how to reduce stress (and we'll get to this in a minute, so don't get anxious), but also learning how to help the body operate at higher efficiency all the time. That way, when the stress dragon rears it's ugly head, your body will be in better shape to deal with it. You can think of it as building up your body's savings account so that you'll be in a better position to manage future bodily expenses. One of the very first things we can do to start our body's savings plan is to learn good nutrition. An article by Liana Beckett published in the OCF newsletter entitled "OCD and Nutrition" is a brief introduction to this area, and it's something for you to take home and read. Most of us don't even know what a healthy diet is anymore. Isn't that something? When our ancestors were foraging for food, eating nuts and berries and whatever they could kill, they probably ate better than most of us do now. Some of you are very conscious of your diet, and may even know how many grams of fat and protein you eat every day. Great! The rest of us should do as well. Basically, the arithmetic looks like this for fat: out of a 2500 calorie per day diet we should get no more than 30% of those in fat, which means about 750 calories. But every gram of fat has nine calories, so that means only about 83 grams of fat. That really isn't very much when you consider all the places you get fat (even bran muffins are about 60% fat by calories, mainly from the oil or shortening used for baking).
Getting enough fruits and vegetables is probably equally hard for most of us. How many of us really eat six servings of fruits and vegetables per day? Most of us don't. All of these considerations make a difference when it comes to managing anxiety. But one big factor that a lot of us overlook is caffeine (see Figure 5). Does anyone notice that when they drink caffeine the feel a little more nervous, jumpy or hyper? And if you're already anxious, caffeine can make it much worse. Each cup of regular coffee has about 100 mg of caffeine in it, while an equal volume of tea or soda has about half that much. Decaf coffee has about 5 mg caffeine per cup, depending on the brand. Chocolate is another source of a caffeine-like drug called theobromine - fancy name, does the same.
A five-ounce piece of chocolate has the same caffeine-equivalent as a cup of regular coffee. Drinking cocoa, however, has only about as much caffeine as decaf. The bottom line is that caffeine makes anxiety worse; the more caffeine you drink, the worse your anxiety will be. Sometimes people ask what an optimal amount of caffeine is, and that is pretty hard to answer. The real answer is somewhere between none and half a cup of decaf per day. But don't go out and quit drinking caffeine cold-turkey, or you will be setting yourself up for very bad withdrawal headaches. The best rule is moderation: if you drink a lot of caffeine now, try to cut down, not cut out.
Another item that's near and dear to many of us is sugar. What does sugar have to do with anxiety? Well, as any of you that have ever seen kids eat breakfast cereal know, sugar gives you a burst of energy. If you eat a cookie or candy bar in the late afternoon, you get a lift. How come? Sugar is immediately used by the body as energy; it doesn't even have to be converted into anything else the way complex carbohydrates or proteins do. That lift can be just enough to get you through the day; however, one problem with eating lots of sugar (which is also a problem with caffeine, by the way) is that when the lift is over, we crash. The crash from sugar is similar to what we feel when we're hungry, commonly called "low blood sugar." This is one of the feelings that is frequently mistaken for anxiety. So it's best if you can moderate your sugar consumption if you're eating lots of it now.
One other area that we need to discuss is the relationship between OCD and alcohol (or many other drugs, for that matter). It's not uncommon for people who are stressed or who suffer from anxiety to drink when they're feeling anxious. We often rationalize that "it calms my nerves" or "it helps me unwind." This may be true, but there are two problems with this approach. First, alcohol "disinhibits" us, which means that is reduces the effectiveness of the parts of the brain that put the brakes on our thoughts and emotions. So the parts of your brain that are already poorly controlled due to your OCD will be under that much less control - some people experience a worsening of their obsessions when they drink. Second, if alcohol reduces your anxiety, you may have a rebound of anxiety when it starts to wear off. That means that either your anxiety could be worse than before, or you will have to continue drinking to keep the anxiety at bay. Here again, the best approach is moderation. We would never tell you that you can't have beer with your pizza again - you all would probably leave now! But if you can cut down, it will help.
Any questions about OCD and nutrition? Let's talk about anxiety itself for a few minutes. First of all, what is anxiety? Well, besides being uncomfortable and a pain in the, well, it's also a signal that your body needs to react to something, usually a danger. It's really a good thing that we have some anxiety, because some dangers need responding to. But sometimes we get false alarms, feelings of anxiety when there is no real danger. How do you know when you feel anxious? It can be a mixture of dread, nervousness, impatience, irritability and a bunch of other feelings that many of us are aware of. We may feel that we're breathing a little fast, that we perspire more than normal or that our stomach feels odd. But sometimes those feelings can result from other things as well. There is a quick mnemonic to help find out if you might be mistaking something else for true anxiety. The key word is HALTE, and the letters stand for the first letters of the words Hungry, Angry, Lonely, Tired and Exercise (see Figure 6). If you think you may be feeling anxious, do a quick check: is it possible that I'm just hungry? When was the last time I ate anything substantial? This is a big one for me - if it's around 4:00pm and I'm getting grouchy, I can be pretty sure that it's because it's feeding time, not because I'm anxious. Once I eat, I feel much better, much calmer and less annoyed. You can also ask yourself other key questions using this approach. Am I really angry? Am I really lonely? Do I need to rest? Or do I need to burn off some extra energy, to exercise? You may be surprised at how often one of these other feelings gets mistaken for anxiety.
OK, let's suppose you've done your HALTE check and none of that applies. There's a good chance that you're experiencing real anxiety. Some anxiety is real and for good reason; for instance, if you were in danger you would want you body alarms to be activated. Sometimes anxiety is real but only based on the perception of danger. For instance, public speaking is the number one most feared activity in this country. As Jerry Seinfeld said, "When going to a funeral, most people would rather be the guy in the box than the one delivering the eulogy." For now, let's assume that there is no real danger nor any perception of danger. You're dealing with an awful feeling that may be acute or chronic. And very few things can stimulate that anxiety more than stress. The more stress, the more anxiety. So one thing we can do to alleviate anxiety is to manage stress. Stress can be either internal or external. External stress is often defined by demands, deadlines, requests and desires of your environment, your job, school, families, mates and other people. It can leave us feeling tired or overwhelmed. Managing external stress may include things like taking fewer classes, asking for help with the kids, educating your family to be more supportive and therefore less demanding. To some of us this may sound like copping out, taking the easy way. And if our anxiety is mostly internal, dealing with the causes of external stress will not reduce the internal problems. But it may help us feel a little less tired, a little less overwhelmed and a little more able to face the challenges of our internal anxiety. Plus, this feeling of copping out reflects on the way we view ourselves, and that is a big part of what internal stress is all about: we are not often as disturbed by things as we are by the view we take of them. This is what makes anxiety so subjective: you may think, "So I'll take one less class this term, no big deal." On the other hand, I might think, " Oh boy, that means I'm not competent, not successful and will probably never succeed at anything." Of course this is an example of a distorted form of thinking, and there are others listed in this handout called the Ten Cognitive Distortions (see Figure 7). Managing internal stress is partly learning non-distorted thinking, like not thinking that everything is a catastrophe or that things are only black-and-white. Cognitive distortions are involved in a lot of other problems, most notably depression, and are part of the focus of Cognitive Therapy.
Another part of learning to manage internal stress is to lessen worry. Worry is concern about things over which you have no control, interest paid on a debt before it comes due. The difference between worry and obsession is partly a matter of degree, but also that worry is more often a rational concern, while an obsession is by definition irrational. Lessening worry is not easy, but there are two simple rules (from a book title) to remember about worry. Rule 1: Don't sweat the small stuff. Rule 2: It's all small stuff. Actually this is pretty true: usually the "worst that can happen" is not only not very bad, but also pretty unlikely. It often helps to lessen worry if you share your worries with someone you trust.
Sometimes just listening as they come out of your mouth can make them seem not quite so overwhelming, and the brain actually processes information that you hear or speak differently from information that stays in your head or that you read. It seems that reaching out, or even speaking out, makes the obsession more "out there someplace," and less part of us.
There are a couple of other things that fit into the "whole body management" concept of anxiety. One is exercise. How many people exercise regularly, meaning at least 20 minutes a day three times a week? Not many of us. There's nothing like exercising to get the blood flowing, to get your lungs working and increase the exchange rate of carbon dioxide for oxygen in your bloodstream. Even walking up the stairs instead of taking the elevator, going for a 15-20 minute walk at lunchtime or running in place at home for just a few minutes is helpful. After exercise it's usual to feel tired, but it's not that exhaustion you feel after being anxious all day. It's the kind of feeling that says "I'm ready to rest now."
Great - that feeling means that you are relaxed enough to rest. There are a couple of other activities that can make you feel this way as well, and they include anything that sends the brain primarily into alpha rhythms.
These include daydreaming, watching TV, yoga and meditation. There are nearly an infinite number of ways to do meditation, which is simply learning to focus your mental energies on one thing, like a chant or on your breathing. All of these things send the message to your brain: "I'm relaxed enough to rest."
We'll some simple techniques for getting to this feeling, but first I want to mention one more thing about anxiety. I mentioned that anxiety is subjective, and your attitude about things really determines your reactions to them. We can demonstrate this by using what we call a "stress-gauge diagram" (see Figure 8). This triangle is our stress gauge, and this wavy line near the bottom is our baseline level of stress. We all have some stress in our daily life, and it can be so constant that we don't even recognize it until it moves up from the baseline. The rest of the triangle above the baseline represents our reserve, our capacity to deal with stress. You can see that under "normal conditions," we have a large reserve. Now let's assume that some stressful event happens, like it's your turn to teach the OCD group here. Now the wavy line representing our stress goes up. What does that do to our reserve? It gets smaller, so that we will have less reserve to deal with any other stress going on in our lives. Now let's look at someone who is suffering from an anxiety disorder, say OCD for example. We have the same triangle, but the wavy line that represents the background stress level is already way up. They don't have much reserve, even under "normal conditions." And if a similar stressful event occurs and their stress level goes way up here, well, you can see that this person may be feeling that they just can't take much more. In fact, this is a pretty common feeling for OCD sufferers. "I just don't know how I can handle any more." "I'm at the end of my rope." For those of us who have never had an anxiety problem to call our own, this may be a little difficult to comprehend. But let me give you an example of the kind of feeling that OCD sufferers may have when they're having a particularly bad day. Close your eyes, and imagine that you're in a sky diving plane, the kind with a big open cargo bay and one big square door in the side. Now you're 5000 feet above the ground, and the houses look like dots and the highways look like string. Now imagine that you're at the mouth of the door with both hands holding on very tightly to the edges of the door. The instructor is trying to push you out the door, into ... empty space. But there's one problem - you have a parachute that can't be guaranteed to open. And the instructor is saying, "Just let go!" Even though you have never actually fallen from this height without a parachute, you probably feel that you know this: if you don't hold on, you might die.
Now open your eyes. That is often what people with OCD say about their rituals or their obsessions: "if I don't do it (think it), I might die."
Or sometimes, "someone else might die." This is the level of anxiety that we are talking about here, a level at which it may really be impossible to "just" do something.
[Anxiety management] Now that we know what we've got, what can we do about it? Not to worry, we won't leave you hanging. The first and easiest thing to do about anxiety is to change the way you breathe. Yes, change the way you breathe. I bet you didn't know that all of us learned the wrong way to breathe. We breathe like this, with our chests expanded. You know, "breathe like a man," "suck in that gut," "you won't look good in a bikini with your tummy sticking out." What happens when we breathe this way? Well, we have to expand a lot of chest muscles and rib bones, and in reality they don't move very far. There is an easier way, and we call this diaphragmatic breathing. Try this: put one hand on your chest, and the other on your tummy. Now when you breathe the usual way, your chest hand moves and your tummy hand doesn't. Try to reverse that, so your tummy hand moves and your chest hand doesn't. First, stick your tummy out all the way without breathing. Now take a breath. Do you notice how all of the air automatically goes into your stomach? The thin muscle called the diaphragm just below the bottom of your ribs offers almost no resistance to breathing, so breathing in and out through your tummy takes much less energy. Also there's more room to expand your lungs this way, so you get more air with each breath. And you can't do this kind of breathing very fast, so you naturally slow down your inhalation. This limits the tendency to hyperventilate, and actually makes the exchange of oxygen in your lungs more efficient. Try this five or six times. This is the type of breathing that your body automatically does when you are about to fall asleep.
So what you are doing is fooling your body into thinking that you are relaxed enough to go to sleep. Try doing this just before dealing with a stressful situation. Better still, try doing this several times during the day when you're not particularly stressed, with the idea that eventually you will change over to breathing this way as a matter of habit. But at the very least, take 5-6 breaths like this when you're feeling stressed - you'll feel better fast. By the way, after you get this down, you don't need to use your hands anymore. We'd look pretty funny up here in front of you with our hands on our tummies for 90 minutes.
Now stand up. If you're holding anything, please put it on the floor.
Reach up toward the ceiling, standing on your toes, stretching your back muscles back and forth, wiggling your fingers as you really try to touch the ceiling. Now in one smooth slow movement, bend back down and point toward the floor. If you can touch the floor fine, but you don't have to get all the way there to get the benefit of this stretch. As you're down here, rock slowly at your hips, and remember not to lock your knees. One more time, reach up toward the ceiling, on your toes and wiggling your back muscles. Now, slowly back down toward the floor, keeping your knees slightly bent and all your other joints as loose as possible.
OK, let's stand up straight again just for a minute to check that no one feels dizzy from this exercise, and then let's sit down.
What you did just now was exercise. How about that! It wasn't so painful after all, huh? Stretching is a great way to loosen up those stiff muscles and joints where most of us keep our stress locked up. It's much harder to feel stressed when you're limber and loose. Think for a minute: where do you hold your stress? In your neck, or maybe your lower back? Some of us may hold it in our stomach muscles, or in our facial muscles.
We'll discuss an exercise in a minute that will get at all your muscular-stress hiding places. But if you know where you keep your stress and can develop a stretching exercise to loosen those muscles, that might be enough. Many of us don't know right away where our stress is, so this kind of overall stretching is better to start out with. You can develop other overall stretches, some standing up, some sitting, and some lying down, depending on your specific needs. Try this a couple of times a day; you may even be able to develop stretches that no one else can see (if you started doing our toes-to-ceiling stretch in the supermarket, you run the risk of having the stock person asking you "do you need some help reaching something?").
But especially, if you are planning to do some exercise like running, walking or something else, always include at least 5 minutes of stretching both before and after your exercise. You don't want to start out working cold muscles too hard, and stretching afterward is a good way to "cool down;" both things help prevent injury to muscles. Remember: stretching is to muscles as Slick 50 is to your car's engine.
Progressive muscle relaxation. We want to demonstrate one more stress/anxiety reduction technique for you; this one is called progressive muscle relaxation. We'll show you how to concentrate on one muscle group after another, first tightening and then relaxing them, until you've done this with all your major muscle groups. When we do this here, we will actually combine the muscle relaxation with two other things: the first is the diaphragmatic breathing that we talked about already, and the second is mental imagery. As we do this exercise, I'll describe a scene for you, and I'd like you to try to imagine the scene as you see it, not necessarily as I describe it. This should take us about 20 minutes; you can turn out some of the lights for this if you wish.