In this post, you’ll learn about lasting treatments for anxiety vs. coping skills.
Have you tried a bunch of stuff to manage anxiety and depression, but you’re still struggling?
This might be why: Some strategies that work great for the short term, don’t help in the long run. They might make you feel better in the moment, but they do nothing to resolve your anxiety in the long run.
Gwen had anxiety and she’d spent a lot of time in therapy, and quite a bit of time on the internet, trying to learn how to make her anxiety go away. She’d learned breathing techniques, she tried grounding exercises, she talked with her therapist about stuff that made her anxious and she tried to avoid triggers–but her anxiety just kept coming back. Her life didn’t feel any more manageable now, than it did before. I mean maybe a little, but she still struggled to function in college. When she felt anxious she’d leave class–which happened a little too often. She didn’t really make friends and spent a lot of time alone in her room, feeling completely overwhelmed with life and not knowing where to start on her huge class load. “Maybe” she told herself “I just have to cope with anxiety for the rest of my life”. And this thought made her more anxious and depressed.
Can You Relate?
A lot of articles, books, your friends, and even therapists recommend over and over that you learn “coping skills” to deal with anxiety. But coping skills only work in the short term.
It’s like you’re in a small boat out in the middle of the ocean. Suddenly, you notice water leaking into the boat. Anxiety is like that rising water—it feels overwhelming and threatens to sink you.
- Coping skills are like using a bucket to bail out the water. They’re quick and effective in the moment. If you’re panicking and the boat is filling fast, the bucket is essential—it keeps you afloat and prevents you from sinking. I’m going to give you a nice list of these types of skills, but you can’t bail water forever. This is why most advice on the internet about anxiety fails or it can even make things worse, because if all you’re doing is bailing water, you’re going to get exhausted eventually.
The most common problem for people like Gwen is they haven’t been taught how to implement the long-term skills that actually make your anxiety go down over time, instead of just coping.
- Long-term treatments can help you get out of crisis mode and into fixing mode. Fixing the leak in the boat takes more effort and time up front, but it addresses the root cause. Instead of endlessly bailing water, you’re working to repair the hole so you won’t keep ending up in the same situation. This is where cognitive treatments, therapy, or even medication come in—they help you change your relationship with anxiety or reduce its intensity over time. But here’s the thing about these long-term treatments–they often don’t help in the short term. They sometimes even make you feel worse–at first.
After long-term treatments, there’s one more type of skills:
- Maintenance skills keep you healthy, they set your life up for success and low drama. These skills keep you healthy when you’re no longer in therapy.
You need all three types of skills: The bucket helps you survive in the short term, but fixing the leak ensures you won’t always have to rely on the bucket. If you only bail, if you just rely on coping skills over and over, the leak keeps coming back, the anxiety keeps coming back. If you stop bailing and only fix, you might sink before the repairs are done. And if you don’t do maintenance, then you’re going to keep repeating the cycle of ending up in the middle of the ocean with a hole in your boat.
So let’s explore what these three types of skills are:
Short-term skills are for when you’re in Crisis Mode. What might help me calm down, feel a little better, or not hurt someone? How are you going to keep your boat from sinking?
Cognitive
- Brain dump
- Meditation
- Gratitude practice
- Gritting your teeth and getting through it
- Thought suppression, avoidance skills, distraction, (stuffing, numbing, etc.). These skills are really important if you’re in a dangerous situation- like war, or you’re a first responder. But they can’t be your only skill, or you’ll end up with a huge bottle of bottled up emotions.
Somatic (Body Based)
- Grounding skills, EFT, Vagus nerve exercises
- Breathing
- Stretching
- Vigorous exercise
- Progressive Muscle Relaxation
- Hugging someone, petting an animal
- Washing face in cold water
Behavioral
- Managing triggers (sometimes you have to leave)
- Talking it through with someone
- Getting support – seeing a doctor or a therapist, perhaps some other interventions
- Venting, relying on others to help regulate you
- Benzodiazepines (like valium; they manage the anxiety symptoms in the short term, but can actually make anxiety worse in the long run)
- Hospitalizations
If you’re suicidal- stuff that keeps you alive- fast acting medications, hospitalizations, suicide watch, 24/7 support, these are all good short-term treatments, you can’t get better if you’re dead. But few of these actually provide long-term treatment.
A quick note about hospitalization for mental health crises. With physical emergencies, like surgery for a burst appendix, a hospitalization can diagnose and fix the root of the problem. But with most mental health conditions– a hospitalization is intended just to help you stabilize. They will keep you alive, try to get you an accurate diagnosis (which can be really helpful), adjust your meds (usually add some) and then build a care plan. Sometimes there’s individual therapy and group therapy, but usually people leave the hospital feeling like “Now what?” Hospitalization served its role as a short-term treatment, but not a long-term treatment.
So Gwen actually had a lot of these short-term skills. She could avoid her triggers and calm down in the moment, but she wasn’t really doing anything to resolve her anxiety.
Each of these coping skills can help your boat stop sinking but they don’t get you out of the middle of the ocean. And that’s where some of these long-term strategies come in.
Gwen switched up therapists, and she started seeing progress. She learned that there were two big things fueling her anxiety. The first was worrying. When we worry, our brain brings to mind the perception of danger, which triggers that fight/flight/freeze response in our bodies, it fuels anxiety. But trying to “Just stop worrying” didn’t work. Fortunately, her new therapist taught her the skill of Scheduled worry. She retrained her brain to worry on purpose for 30 minutes a day, and that freed her from most of her anxiety and worry the other 23.5 hours of the day.
The second thing she learned was about “Safety behaviors”. Gwen learned that anxiety is also fueled by avoidance, and when we learn to stop the habit of avoiding, we can stop the cycle of anxiety. But Gwen wasn’t avoiding all social interactions, she would go to parties but just feel anxious the whole time. What was causing this? Her new therapist helped her explore the underlying beliefs that were keeping her scared, like “I have to be perfect or no one will like me” along with the avoidance behaviors that were fueling her anxiety. Safety behaviors like “needing to get drunk” or “needing to have a friend go with you” or “making sure to talk a lot to avoid awkward silence”–these were all sneaky forms of avoidance that fueled Gwen’s social anxiety. So with the help of her therapist and some practice, she was able to drastically reduce her social anxiety when she replaced her safety behaviors with some new social skills.
Just like Gwen, when you get out of crisis mode, you can get into learning mode–or as I like to say, “Let’s solve some of this crap.” It’s like you’ve made it back to shore, and now you’re finding the holes in your boat and figuring out what’s causing them. What is making the boards rot or why is the navigation making us hit rocks?
Now we’re starting to fix the things that are causing our boat to sink.
Cognitive:
- Active learning in therapy, replacing negative beliefs with more helpful ones.
- You’re learning how to Process emotions- how to notice them, name them, explore them, and then make good choices about your actions.
- Becoming aware of cognitive distortions and actively replacing those negative thoughts with more helpful ones.
- Catastrophizing
- Black and white thinking
- Emotional reasoning
- Mind reading
- Selective focus, discounting the negative.
- Learn about the patterns that fuel the disorder. (Avoidance, Worry)
- And the skills that help, like Scheduled worry
- Journaling paired with gratitude/noticing the good
- Using mindful practice to retrain your brain to separate from negative thoughts and redirect attention to what’s important or the present moment.
- Instead of reacting to big stressors or avoiding them, you sit down and write about them, you get curious and explore them.
Somatic: You’re helping your body regulate emotions with:
- Healthy diet,
- Sleep,
- Exercise
- Medication, supplements
- A regular practice of checking in with the nervous system and re-regulating multiple times throughout the day- this retrains your nervous system to be parasympathetically dominant.
Behavioral
- Learning to replace unhealthy behaviors with healthy behaviors
- Setting boundaries
- Saying no to too many commitments, taking time for self care.
- Facing your fears and solving problems
- Building up a positive mutual support network – improving relationships, building friendships, cutting people off, group therapy
If you’re consistently seriously struggling, then medication management, or more serious mid-term interventions might include RTCs or IOPs.
So, the goal of all of these longer term treatments is to find the holes in your boat, and to repair them, so that your boat is solid and sturdy, ready to face the waves that come.
Now, let me ask you a question- when you have a headache- do you take a painkiller? I was recently in a huge conference room where someone asked that question and 90% of the hands went up. But do you exercise every day and eat right? About 10 percent of the hands went up. Many of us are willing to do the thing that makes our pain go away in the moment, (like coping skills) but it takes a little more discipline to do the daily practices that foster long-term health.
It’s silly to think that managing thoughts and emotions is an action instead of a life practice. If we truly want to have a really healthy relationship with life and our emotions, we need to learn how to implement healthy habits daily, weekly, and monthly.
And that’s where Maintenance Skills come in.
We’re maintaining the boat- painting it regularly, removing the barnacles, making sure the maps and navigation are up to date so you don’t keep hitting rocks. Of course storms come in occasionally, but because your boat is sturdy you can ride it out and get back to shore safely.
At this point the daily crises are gone, and you’ve gotten really good at facing your fears. That means that a lot of the dramatic anxiety has resolved in your life. You don’t buy into cognitive distortions, so your emotions are more level overall. Now you’re going to implement the tiny changes that make your life sustainable, purposeful, and wonderful.
I’m happy to say that Gwen has slowly and gradually built up the ability to attend all of her college classes, her anxiety has decreased a ton, but when it does flare up she feels really confident that she can handle it. And she also has a lot of good practices in place that help her feel healthy and strong.
Here are some of the skills that sustain mental health:
Cognitive
- Gaining confidence in your ability to resolve problems
- Shifting your beliefs about yourself from “broken” to resilient
- Having a reasonable calendar, with downtime scheduled in
Somatic
- Sticking to healthy routines – like sleep, eating healthy, and exercising,
- You have systems to maintain your health- for example, once a week you sit down and journal about how you’re doing.
Behavioral
- You’re building the skills to function well at work and be productive in life
- You’re building communication skills and conflict resolution skills
- You’re getting really clear on your life purpose and your values, and you’re putting your energy toward that purpose
- You’re gradually building up a group of people who support you and you contribute to them
- You’re RESPONSIVE instead of reactive. You can honestly say “I plan ahead to manage and resolve problems, but when they come up I handle them with confidence.”
Instead of focusing all your energy on staying afloat, at this point you have the ability to think about the maps and compass, where do I want to sail? Where am I going in this boat and how will I get there?
You get really clear on what you want your life to be about. You know your purpose, and your actions line up with that purpose. When storms come, you have people who help you, you have the skills to navigate safely, and your boat is solid and ready to get you to your destination.
Gwen is on the other side of her anxiety issues. She is dating a super nice guy, she’s almost done with her degree in speech language pathology, and she’s looking forward to working in elementary schools helping kids. She’s got a supportive group of friends and she feels pretty darn optimistic about the future because she knows she can handle what life throws at her, and keep learning when things get tough.
I hope this video helps you think about why you still have anxiety after trying a bunch of coping skills. If you find yourself getting stuck, make sure you’re moving up from coping skills to resolving skills and maintenance skills. I promise it’s possible to get unstuck and live a purposeful life in which your problems don’t sink you.
If you want to learn some of these skills, check out my membership where I’ll walk you through each of these skills in short video lessons.
Thanks for watching and take care.
