A clinical psychologist explains what happens in the mind and body when someone is experiencing anxiety, and offers practical strategies to help manage anxiety.
In this episode of Health Matters, Dr. Courtney DeAngelis, a clinical psychologist at NewYork-Presbyterian and Columbia discusses what happens in the mind and body during anxiety, distinguishes between anxiety attacks and panic attacks, and shares effective strategies and practical advice for managing anxiety.
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Courtney DeAngelis, PsyD, is an Assistant Professor of Medical Psychology (in Psychiatry) within the Division of Child and Adolescent Psychiatry at Columbia University. She also serves as a licensed clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders-Westchester (CUCARD-Westchester).
Dr. DeAngelis specializes in the assessment and treatment of children, adolescents, and young adults with anxiety, mood, habit, posttraumatic stress, and disruptive behavior disorders. She has expertise in treating OCD, generalized, separation, and social anxiety disorders, specific phobias, posttraumatic stress disorder, and childhood externalizing disorders (ADHD, Oppositional Defiant Disorder, and Conduct Disorder).
Throughout her career, Dr. DeAngelis has received specialized training in the provision of several evidence-based treatments, including cognitive behavioral therapy (CBT), exposure and response prevention (EX/RP), functional family therapy (FFT), and trauma-focused cognitive behavioral therapy (TF-CBT). Dr. DeAngelis has more recently received specialized training in the treatment of complicated grief. She is accepting patients of all ages who may be experiencing traumatic stress and/or grief during the COVID-19 pandemic.
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Dr. Courtney DeAngelis: … because anxiety's not a fun feeling to experience, the more that we fight against it or struggle with it, you're like, ugh, I'm so mad at myself. Why am I anxious again? Or like, why can't I just kick this? The more that we, kind of, struggle with those emotions, then the more often we experience them intensely.
Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.
For Mental Health Awareness Month this May, we’re tackling a topic that many of us struggle with to some degree: Anxiety. Whether it’s everyday worries or more prolonged stress, anxiety can have a negative impact on our health and quality of life if we don’t find ways to better manage it.
This week, I'm joined by Dr. Courtney DeAngelis, a Clinical Psychologist at New York-Presbyterian and Columbia. She helps explain what's happening in our bodies when we're feeling anxiety and offers effective strategies to deal with it so that anxiety doesn't get in the way of living a healthy life.
Courtney: Hello. Thank you so much for joining us today.
Dr. Courtney DeAngelis: Of course. Yeah. Thanks so much for having me.
Courtney: So, Dr. DeAngelis, I feel like anxiety is such a commonly used word these days, and it's thrown around a lot and many people are feeling it, whether it's a nagging feeling or something that's truly distressing. Can you help define anxiety and what's happening in our bodies when we feel it?
Dr. Courtney DeAngelis: Yeah, absolutely. So, the way that I try to break it down usually to people is that we are hardwired as humans to have this fight or flight system in our body that really was meant, from an evolutionary standpoint, to protect us from danger. So this idea that if, you know, there's the cavemen had to fight a bear or some kind of, like, animal, right? This idea that your body wants you to be able to run successfully from that dangerous stimulus or to be able to fight against it.
So now in our current stage of life, that anxiety, that fight or flight system really tends to kick in when there's something that we perceive as just stressful in our everyday life. When that system kicks in, it really activates a lot of those uncomfortable physical sensations. So your body kicks on the system thinking that you have to fight a bear in front of you or run from this bear when really it could be a text message that you're trying to send.
Courtney: So what is the first step to kind of telling yourself the text message isn't a bear?
Dr. Courtney DeAngelis: Yeah.
Courtney: Like, I can respond to this text or I can send this text?
Dr. Courtney DeAngelis: I'm a CBT psychologist, so cognitive behavioral therapist. So I do focus a lot on, like, how we, like, talk to ourselves essentially. So I might myself try to, like exactly what you just said, be like, not a bear, not dangerous. I'm cool. Got it, Courtney.
Courtney: Right.
Dr. Courtney DeAngelis: So something that’s kinda like short, sweet to the point. Sometimes I also land on humor too, is like, if I know that there's something for me actually, I do notice that like the stomach sensations and that kind of, you know, gut feeling, that's off, that happens when I'm anxious personally. So if I notice that and I try to pull back to be like, all right, so wait, what's going on here? What's throwing me off right now? I can say to myself, “Hey, uncomfortable, not dangerous.”
So trying to, kind of, like, reframe in that situation that whatever's happening around me, I can handle something that's uncomfortable, different than being in a situation that would be dangerous, technically speaking.
Courtney: Can you explain the difference between an anxiety attack and a panic attack?
Dr. Courtney DeAngelis: A panic attack happens where we suddenly experience a lot of intense sensations in our body. Without warning, without a trigger, we can't identify what's going wrong, so to speak. Almost as if you're losing control of your body. And that could be those textbook examples people give of, you know, my heart's racing, I'm short of breath, I feel dizzy, I'm sweating. Even worrying like I'm losing control, I'm gonna die. Like very worst case scenario thoughts. So those symptoms peak and pass within 10 to 20 minutes, at most an hour. They're usually not long lasting in duration because it's that fight or flight system kicking on. Your body's doing the right thing at the wrong time.
So that panic attack happens, uncued, unprompted and you feel this intense experience. An anxiety attack is when something triggers us. We're worried about something coming up and we're anxious, on edge. It can be more of like a gradual buildup. Sometimes it's quick, too. That intensity varies, I would say, more for, like, these anxiety attacks. So, people can describe feeling anxious for hours at a time.
Courtney: I feel like avoidance can feel like the go-to way to deal with anxiety. It's making me anxious. I just won't do it.
Dr. Courtney DeAngelis: Yep.
Courtney: So why is this a bad move?
Dr. Courtney DeAngelis: I think it's an unhelpful response long term. So, we really talk a lot in our clinic and team about this model or cycle of avoidance and anxiety that happens where people feel anxious about something. Their urge is to avoid, as you said, and by avoiding their brain learns: Okay – The best way to feel better is to not do that thing, to not think about that thing. I can't even tolerate saying it, thinking about it, imagining it. That creates a lot of distress. And it reinforces or strengthens this belief that we can't handle whatever that thing is.
So avoidance helps us in the short term to alleviate that stress that pops up when we think about or picture that stimulus.
In the long term, it just maintains our anxiety because it really, again, kind of reinforces that belief system that that thing should be avoided, that we can't tolerate it.
Courtney: I've heard anxiety described as a wave we can learn to ride. Can you elaborate on that metaphor a bit?
Dr. Courtney DeAngelis: Yeah. I imagine a lot of times that our anxiety is like a wave that will peak and pass. And so what I mean by that is, I've never in my clinical work met somebody that has felt anxious, you know, every hour of every day for a week at a time.
That even when we have very acute anxiety, our bodies really are not hardwired to carry that indefinitely. We talked about that fight or flight system – if we can trust that our body has these systems to also turn that off and to self-regulate that that anxiety will pass.
And the paradox here is that so often, because anxiety's not a fun feeling to experience, the more that we kind of, like, fight against it or struggle with it, you know, something's happening, you're like, Ugh, I'm so mad at myself. Why am I anxious again? Or like, why can't I just kick this? The more that we kind of struggle with those emotions, then the more often we experience them intensely. So it's this paradox that if we can say like, all right, this is a wave, it's gonna peak and pass, or I'm riding that wave of anxiety, it's essentially that you're accepting anxiety's here, it's showed up, it's gonna calm back down.
And everybody can typically figure out for themselves, like, what that looks like. So maybe you're somebody that – I'm just gonna go do some crossword puzzles and probably 10, 15 minutes I'll likely feel a little bit more calm and relaxed.
Maybe you're somebody that likes to practice mindfulness or meditation, so throwing on a quick audio, going for a walk – that helps to regulate your nervous system. Maybe exercise for some people, that's another good way and strategy. Yeah, so that could be something that if I do that, change gears a little bit, then I will feel much better.
So if you know like one or two go-to skills that can help to regulate you and calm you down then we're kind of reinforcing this narrative that, hey, I can handle my anxiety.
Courtney: Right. Well, and I feel like a lot of these thoughts can get, like, sticky. Can you explain what a sticky mind means?
Dr. Courtney DeAngelis: Yeah, absolutely. So a sticky mind to me means that somebody whose thoughts jump from one worry to the next. So people that describe that they're anxious about something happening, and it's like they can't shut it off. So if you had a tough conversation at work and, you know, it's after five and you're like, I know the day's done, you know, I'll deal with it tomorrow. But you're just sitting there doing the dishes and you keep thinking about what your boss said. And it's really hard for people to let go of those thoughts or almost feel as if they have control over those thoughts. That's like what anecdotally a lot of people describe.
Courtney: It's like the thoughts can replay even though it's over. How do you stop the tape?
Dr. Courtney DeAngelis: Yeah, so, different ways for different people. Just kind of labeling or calling out that anxious thought. So we're kind of trying to like catch that thought that's coming up. Then we check it, then we change it. Three C's is my way to remember that. So like what is it that we're worried about happening? Is that something that's likely to come true? What would a friend say about this situation? Would they expect it to go wrong too? Is there really any evidence? Is this something we can handle? And then try to change that thought. So yeah, that more balanced example that a friend might give, reminding ourselves like, I might not like this, I can handle it. It's uncomfortable, not dangerous. So finding another way to move through it will create less distress.
Sometimes that's one response to stop the tape. Other people might picture a conveyor belt, like a grocery store. But so you picture a conveyor belt and your thoughts are kind of going down that conveyor belt. We're letting them go past us as opposed to keeping them stuck with us.
Leaves on a stream, clouds in the sky, we want to create distance from our thoughts.
Courtney: Could you share some specific grounding techniques or exercises that you think could be helpful to someone if they're in a really anxious moment?
Dr. Courtney DeAngelis: Yeah, absolutely. So we can also practice mindfulness and by grounding ourselves in our sense – through our five senses. So a common like trick or tip that I'll talk about is the 5, 4, 3, 2, 1 skill. So we're using our five senses to guide us through a situation.
A lot of times when we're anxious, we're focusing on how awful our body feels, or we're focusing on that, you know, worst case scenario coming true.
We want to, instead, focus on what's happening around us in that current moment. So find five things that you can see around you and just in your head, call them out while you're in that room. Then shift to four things that you can feel or touch. And to be clear, that might be, I can feel the tag on the back of this sweater.
You know, it doesn't have to be that you're holding all these objects or items and they're falling outta your hands. That, so we're kind of going from, you know, sight to then also feel or touch. Then three things that you can hear around you. Two things that you might be able to smell. One thing that you can taste. The goal is really just to help you get outta your head in that cliche, and instead more focus on what's happening around you.
Courtney: Dr. DeAngelis, thank you so much for being with us here today and sharing these tips to reframe anxiety and better manage it. And I know I'll be thinking of you next time. A text feels like a bear. Thank you.
Dr. Courtney DeAngelis: Oh, yeah! I'm so happy to do it!
Courtney: Our many thanks to Dr. Courtney DeAngelis. I’m Courtney Allison.
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