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Episode 13: The Best Way to Handle Holiday Stress

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Put down the Xanax. This week, MedShadow Founder Su Robotti and Content Manager Jonathan Block talk about using easy forms of meditation to manage stress during the holidays.

Su Robotti: Hello and welcome to MedShatowTV. My name is Sue Robotti, and I’m the founder of MedShadow.

Jonathan Block: And I’m Jonathan Block. I’m the content manager for MedShadow.

SR: Today, we’re going to talk to you about stress. We’ve been feeling a lot of stress. The holidays are coming, and stress is caused by too much food, too many relatives, too much pressure, too much gift shopping, too much drinking.

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The key here is too much. Today, we want to help you take it down a notch, calm down, and we want to help you do that through meditation.

First of all, what is stress? The physical response to a stressful situation is adrenalin and cortisol enter your bloodstream. It increases your blood pressure, and your heart rate starts to go stronger. And if this isn’t dealt with easily or quickly, and it continues for a period of time, it can lead to gastrointestinal problems. It can lead to heart disease. It can lead to brain dysfunction like I’m having now. It can lead to a lot of long-term issues with heart disease and gastrointestinal problems among other things.

But Jonathan, what do you suggest we do? Should we pop a pill? That would be very quick.

JB: Absolutely, don’t. You’ve actually alluded to it, and that was through meditation, which is the main part of an idea known as mindfulness, which is defined as being aware of the present. I mean, I know what a lot of people are thinking — the same thing that I was thinking when I heard the word mindfulness. That just sounds like a whole bunch of new age hooey.

SR: Hooey?

JB: Hooey.

SR: Okay.

JB: I’m going old school. I can tell you from a personal experience as somebody who’s dealt with stress, and anxiety, and depression. Meditation associated with mindfulness actually does work. It works well.

And why don’t you take a pill? Because pills have side effects.

Mindfulness meditation — and we’ll be discussing this in a little bit — there are clinical studies that have demonstrated that mindfulness meditation can be used for a number of different conditions avoiding these sort of drugs, which as our MedShadow audience knows, most of which — if not all — are associated with side effects, drug interactions, or other nasty effects.

SR: In fact, is meditation as effective as antidepressants?

JB: Yes, it is. There’s been, I want to say, 40 to 50 clinical studies done just on comparing mindfulness and meditation with antidepressants. They’ve all come to the same conclusion. Mindfulness meditation is as effective as antidepressants.

So why — I know what you’re going to say. I’m going to read your thoughts. But why not just take a pill, right?

SR: Why not?

JB: I know that’s the easy way to go out. The thing is is that as I just mentioned, antidepressants and other antianxiety pills like the Xanax or the Valium that some people in our audience may be taking, have taken, or thinking about taking.

Mindfulness meditation is something that you can teach your brain how to think. It helps you relax without the use of drugs, and therefore you can learn how to deal with stress and anxiety over the long term. It’s actually much better for you, because you’ll actually train your brain how to better handle stress and anxiety but without the nasty side effects of a pill which means it is harder work.

But in the long term, the long-term efficacy of it has been demonstrated whereas with antidepressants, we know that people develop problems, and they lose their efficacy. And for some people taking antidepressants and anti-anxiolytic drugs, they just aren’t even effective anymore.

SR: So let’s take a breath.

JB: Yes.

SR: And how do you meditate? Do you have to sit cross legged? Do you have to hold your fingers in the air? Do you have to say, “Ohmm”?

JB: No, you’re thinking of some of the Buddhist meditation. But this type of meditation like the meditation that pretty much busy people or people that don’t want to go, “Ohmm,” want to do — can take as little as 10 minutes.

That’s what I do a day. I only do 10 minutes. I do some breathing exercises. There are also ways which if you learn more about mindfulness and we’ll provide you with some information about that in a second — the mindfulness, actually, you train your brain to relax. I know this sounds weird, because I didn’t believe it until I started doing it. And then in the words of a great Monkees song, “I’m a Believer,” and I’m a believer now about how effective mindfulness is and how effective mindfulness meditation is as well.

SR: So do you take classes? How do you learn to do this?

JB: I do a combination of things. I have read some books. There’s an excellent website that is operated by the fine people at UCLA known as the UCLA Mindfulness Awareness Research Center. That address is http://marc.ucla.edu. They actually have free relatively short meditations that you can download and listen to, and you can start on your own.

There’s another resource that I use a lot. This is a paid resource. It’s an app, and you can also do on your computer called Headspace. But I pay — I find it particularly effective. I looked at a lot of them, and I find Headspace — just to let the audience know, neither Headspace nor UCLA has asked us to mention them. This is just from my own personal experience.

SR: And then I’ll add one that’s free that I use; it’s called Breathe. But there are many, and you’ll find the one that you like if you just Google guided meditations, and you’ll find it.

I started meditating by simply becoming quiet and not using guided meditation — just setting a timer and trying to still my thoughts calmly for 3 minutes at a time. I got up to 5 minutes. And honestly, guided meditation is much easier.

JB: Oh, yes.

SR: And I would like to graduate to regular quiet meditation. But for now, I’m finding that I become more calm and happy using the guided meditation.

JB: And if you’re a novice — I still consider myself a novice — I find that the guided meditation works a lot better.

Just one other point because I know we’re talking a lot about this. It’s that mindfulness meditation is actually good not only for — works well, I should say — works not only well for depression, anxiety, and stress, but it’s been shown that people that want to lose weight through practice of mindfulness meditation, they can actually teach themselves to eat less.

SR: Eat less during meditation?

JB: No, afterwards, because they train their brain.

SR: You mean through their mindfulness.

JB: Right, because they think — like they ‘think before.’ You’ve heard the term, “Think before you act.”

SR: Uh-hum.

JB: You teach yourself how to think before you eat, and you’re more careful at what you eat. But just by taking a few — by doing 10 minutes of meditation every day and then when you go and decide to have your meal, people who have done meditation and mindfulness, they train their brain to think, “Maybe I don’t need that side of French fries. Maybe I should get a side of quinoa or something of that nature, something of a more healthy starch.”

SR: Yes. My downfall is more of when I’m in a family situation, and there’s cheese, and crackers, and nuts, and all these good stuff in front of me, and I find I’m eating without thinking. I think you’re going to tell me that that’s not mindful.

JB: It’s not mindful, but everybody is allowed during the holidays to cheat a little bit. The thing is not to make it a regular part of your life. And even if you just have a few — if you — let’s say you cut out — maybe you only eat nuts, but instead of reaching for the Ferrero Rocher chocolate, maybe in parties you might have had 3. Now, maybe you’ll only have 1. That’s even mindfulness just like making even a slight change. And then as you get better and better at mindfulness and meditation, you’ll learn to control yourself better.

SR: Okay. So instead of taking a pill, instead of eating chocolate, instead of taking a long hot soak in the tub, what we’re going to do is try meditating to de-stress.

JB: Actually, taking a long hot soak in the tub is actually very good.

SR: Soak in the tub — we’re saying yes to this.

JB: We are saying yes to that.

SR: What about taking a walk or a jog?

JB: Also excellent.

SR: Okay.

JB: Just lose the medications and go easy on the chocolate.

SR: Okay. Do that and have a great holiday.

JB: Yes. From all of us here at MedShadow, thank you for making MedShadowTV, which just premiered this year, such a wonderful success, and a happy holidays to you and your family. Take care.

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How Meditation Helps My Patients Heal

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By Jamie Zimmerman, MD
Doctors. When you think of them, what comes to mind? Stethoscopes, white coats, pills?  What if there were a new kind of doctor? One who prescribes meditation, yoga, and other contemplative practices, rather than (or in addition to) doling out medication? More and more doctors are taking an integrative approach in their practices, offering patients alternative therapies to address a multitude of health problems. Here’s how meditation has helped my patients and suggestions on how it might help you.

The words meditation and medication sound suspiciously similar, and this is no coincidence.  These words, along with the term medicine, come from the same Latin root, mederi, which means “to heal.”  So, although many people think of meditation as an Eastern tradition, with  roots in Vedic, Hindu, or Buddhist practices, it seems as though the ancient Romans also recognized the healing powers of this introspective practice. Indeed, Catholicism’s rosary beads come from the same root as the beaded necklace or mala many Hindu or Buddhist practitioners carry, and the idea is the same:  Repeating the same holy words again and again is thought to infuse the mind with their spiritual essence. Modern science has developed and substantiated the idea of neuroplasticity, or the ability of the brain to change and reshape itself through the lifespan. This understanding lends a secular twist to these ancient, sacred chanting practices.

Jame Zimmerman at TEDxBushwick, March 21, 2015

Nearly every culture around the world has developed some silent and/or introspective practice.  Vision quests among indigenous Americans, centering prayer in the Christian faith, yogic postures, breathing exercises, chanting and silent meditation in Hindu traditions, and of course the sitting, walking and other meditations in Buddhism permeate communities around the globe. If the Latin language assumes these practices hold a healing quality, what exactly is the healing potential of meditation, and how can it be harnessed?

As a physician expert on “meditation medicine,” one who lectures and writes widely on this topic, I’d love to answer this question with a personal story. Currently, I work with several clients for whom I prescribe meditation. About a year ago, I met Linda (name and some life details changed to protect her identity). She had recently gone through a breakup and was living in the US, far from her family in Canada.  In the months before we met, Linda started experiencing severe anxiety, which grew so strong she was unable to ride the subway in New York City, as the crowds would spark panic attacks. This anxiety often kept her up at night. Linda also found herself crying uncontrollably at times, and she had less motivation to go to her graduate school classes and cancelled most of her social engagements.

Before seeing me, she had seen a psychiatrist who prescribed a medication commonly used to treat both anxiety and depression. This medication takes some time to take root, however, and also only works for about one-third of patients. During our first session, I carefully listened to Linda’s history, asking clarifying questions like any health care practitioner. It was clear that Linda had many external circumstances that added to her anxiety and sadness, which were now interfering with her work and quality of life.

Linda’s nervous system had clearly hit a bump in the road. I decided to teach Linda the “relaxation response,” a standardized technique based on transcendental meditation. During my first session with Linda, I guided her through the relaxation response meditation, and offered instructions on how to begin a twice-daily meditation practice. In the first week, Linda experienced less anxiety and began to sleep better. By the end of the second week, she noticed her sadness had begun to fade. Of course, some of this could be attributed to time, or the effects of the medications her psychiatrist prescribed. However, over time, Linda was able to work with her psychiatrist to taper off the medication and still feel fine, as long as she maintained her regular meditation practice.

When Marcus had difficulty sleeping after a cancer diagnosis, the relaxation response was also beneficial. Just like with pills, however, different meditations help with various ailments. When Virginia faced relationship difficulties, and felt overwhelmed by her growing resentment and emotional tension, compassion meditations helped her rewire her brain to feel greater empathy for her partner and also treat herself more kindly.

Of course individual patient stories aren’t randomized trials, and there are many variables at play that could also factor into Linda’s recovery, Marcus’ ability to rest and Virginia’s increased empathy and ease. However, each did improve rapidly after beginning a meditation practice, and many peer-reviewed studies support the role of meditation, including the relaxation response, in treating depression and anxiety, improving sleep, and building compassion. Unlike medications, these practices have essentially no gnarly side effects.

Harvard cardiologist Herbert Benson, MD, became a proponent of meditation after he was approached repeatedly by practitioners of transcendental meditation who claimed their practice had profound health benefits. After numerous requests, Dr. Benson finally acquiesced, but insisted upon replacing the Sanskrit mantras (meaningless sounds that people repeat during this practice) with the bland word “one.”

He then studied the effects on his patients, many of whom had high blood pressure, and was floored by the results. Time after time, he saw that his patients’ heart rates and blood pressure dropped, their breathing rate slowed down, and their brain needed less energy — these were all signs they were experiencing the “relaxation response,” the opposite of the body’s fight or flight stress response. Dr. Benson began to ask some patients to practice this technique regularly and, one by one, many of them were able to reduce or eliminate their blood pressure prescriptions and other medications. Dr. Benson and his Harvard colleagues have published numerous studies on the benefits of meditation in leading journals, which can be found at this site: http://www.relaxationresponse.org/. Dr. Benson’s New York Times best-selling book The Relaxation Response is one of the first efforts to systematically study meditation. Convinced of meditation’s benefits, Dr. Benson meditates twice a day and has seen his health improve.

If you’d like to test drive the relaxation response meditation yourself, visit my website, www.jamiez.tv, and click “free meditations” to download a 10-minute guided relaxation response meditation. There are many different types of meditation teachers; if you’re interested in finding a course near you, this website may help: http://www.mindful.org/resources/

These days, I’m grateful to share meditation medicine with audiences, individual clients and readers internationally. My hope is that Western medicine will embrace a future dedicated to building, restoring and promoting health, rather than merely treating disease, and I believe contemplative practices will play a large role in this endeavor.

Jamie Zimmerman, MD, a physician, meditation teacher and author, died in an accident in October 2015. She lectured internationally on “meditation medicine” and living your calling. A meditator since age 16, she studied with many of today’s leading instructors and was featured on ABC.com, Yahoo News, MindBodyGreen, Yoga Journal, SONIMA, and Huffington Post Live. She was a health and wellness reporter at ABC National News, where she taught her colleagues to meditate and hosted a digital series called “Make Your Passion Your Paycheck.”

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How Mindfulness Meditation Can Help Reduce Meds

A growing number of American doctors are looking East as science seems to confirm that mindfulness meditation can play a role in reducing a need for meds for some patients. A 2015 study in JAMA Internal Medicine, for example, concluded that mindfulness meditation improved sleep quality in older adults, and mounting evidence suggests that a meditation practice can ease stress, chronic pain, anxiety, depression and even improve outcomes in treatments for addiction and cancer.

More recent studies have come to similar conclusions. For example, a meta-analysis — a study of studies — published in JAMA Psychiatry in June 2016 found that mindfulness meditation is effective in treating people whose depression has relapsed after trying several antidepressants.

Danielle Hark knows this first-hand. “For years, I suffered from insomnia, anxiety and severe depression — and took multiple medications to address all of those health concerns,” says the 34-year-old professional photographer in Millburn, New Jersey. Then, her doctor told her about mindfulness meditation and its potential to ease her symptoms. She started attending a meditation study group in her area twice a month and listened to short, guided mindfulness meditations every night before bed. And within a few weeks, she was able to stop taking Klonopin (her anti-anxiety medication) as well as reduce her sleeping medication to half doses or skip it entirely.

Check out a discussion of mindfulness meditation and its benefits for many ailments on MedShadow TV.

“I started feeling less anxious as soon as I started attending the meditation group and even more noticeable changes occurred when I started meditating every day at home,” says Hark. “I always thought I couldn’t meditate because it meant I’d have to sit silently on a pillow — and my mind is just too busy for that,” she says. “But as soon as I turned off the TV at night and started listening to 10- or 20-minute guided meditations, I noticed a huge change, and the benefits have stuck.”

What is Mindfulness Meditation?

While the phrase “mindfulness” has gotten a lot of buzz in recent years, touted as a way to help us do everything from lose weight to stress less, mindfulness meditation has been practiced for centuries. According to most definitions, it’s an adaptation of Buddhist breath work, aimed at helping those who do it learn to focus on emotions, thoughts and sensations occurring in the present moment with full acceptance and without judgment. The simplest way to start practicing mindfulness meditation is as follows: Sit on the floor or a chair with your back straight and get as comfortable as possible; then, focus on your breathing and as thoughts come up, notice that your mind has wandered and simply return your focus to your breaths.

How is this different from any other meditation? While mindfulness meditation trains the mind to be in the present moment and involves passive attention to breathing and any sensations, thoughts and emotions that may surface, basic meditation (sometimes called transcendental meditation) uses a mantra as a vehicle to let the mind settle down naturally and ultimately to transcend thought.

Essentially, the main difference is that the goal of mindfulness meditation is to anchor your thoughts in the present moment, whereas transcendental meditation aims to experience a state of awareness without an object of thought, says Eva Selhub, MD, a clinical instructor in medicine at Harvard Medical School and a Clinical Associate of the Massachusetts General Hospital and author of Your Health Destiny: How to Unlock Your Natural Ability to Overcome Illness, Feel Better, and Live Longer.

“I like to think of transcendental meditation as vertical meditation, with the goal being to go down as deep into yourself as possible,” says Dr. Selhub. “Whereas mindfulness meditation is horizontal — you’re still having observations and you’re encouraged to use your mind to observe your surroundings nonjudgmentally. In my experience, mindfulness meditation can be much easier to learn and implement right away, making it accessible to everyone and anyone willing to sit quietly even for just a few moments and simply focus on their breath.”

This accessibility and approachability is what led Bill Dinker, a 32-year-old director of a drug and alcohol rehab center in Nashville, to turn to mindfulness meditation 3 years ago, when he felt like he was suffocating under the weight of drug addiction and bipolar disorder.

“Prior to beginning my practice, I was severely addicted to heroin and taking lots of medication for bipolar disorder,” says Dinker. “I was taking so many prescriptions that I gained 60 pounds and finally decided something had to change.” So Dinker sought help for substance abuse and was introduced to mindfulness meditation while in treatment. The benefits of adding mindfulness meditation to other therapeutic treatments he received while in rehab were immediate.

“The first thing I noticed was how relaxed and at ease I felt,” he says. “In fact, the feeling was so foreign to me that at first, I thought something was wrong.” As he continued to practice, Dinker found he was not only able to stay sober and stay off the cocktail of medications he was previously taking, but he was promoted at work and started sleeping better, too.

Conditions Mindfulness Meditation Can Help

An increasing body of scientific research supports mindfulness meditation’s effectiveness in in relieving symptoms and reducing medication for a variety of health conditions. 3 illnesses for which the most solid evidence exists that mindfulness meditation can help include:

Stress, Anxiety and Depression

As Hark learned firsthand, quieting the mind and learning to tune in to the present moment can be a powerful vehicle for reducing anxiety — something that researchers from Johns Hopkins University in Baltimore, Maryland, found when they reviewed nearly 19,000 studies on meditation. Their findings, published in JAMA Internal Medicine, suggest that mindfulness meditation eases anxiety, depression and pain. Even better, more research indicates that you don’t have to commit a lot of time to the practice. One recent study from Carnegie Mellon University in Pittsburgh, published in the journal Psychoneuroendocrinology, found that a brief mindfulness meditation practice — just 25 minutes for 3 consecutive days — helps alleviate psychological stress.

Cancer

Considering the stress, anxiety and depression a cancer diagnosis can cause, it’s no wonder the research specifically looking at mindfulness meditation as a complement to cancer treatments has shown tremendous benefits. In one study of breast and prostate cancer patients, published in Integrative Cancer Therapies, mindfulness intervention done in a clinic-based group setting showed consistent benefits, including improved psychological functioning, reduction of stress symptoms, enhanced coping mechanisms and overall well-being in cancer outpatients. Another study, published in Psychosomatic Medicine, found similar results, showing cancer outpatients who receive mindfulness meditation intervention have significantly more vigor and less total mood disturbance, depression, anxiety, anger and confusion than those cancer outpatients not practicing mindfulness meditation. Still more research (pdf) found that mindfulness meditation significantly improved the quality of sleep in women with breast cancer.

Addiction

Once again, the power of mindfulness meditation to reduce stress and anxiety comes into play in relation to addiction, as the link between stress and substance is well-documented. Countless studies echo Dinker’s real-life experience: Mindfulness meditation creates a change in one’s relationship to the present moment, creating a “reperceiving” or “attentional control” that can help facilitate more mindful behavioral choices. To wit: Researchers from Yale University found that a 4-week mindfulness meditation training program was more effective as a treatment for smoking cessation than the American Lung Association’s “gold standard” treatment, with participants experiencing a 90% reduction in the number of cigarettes they smoked from 18 a day to 2 a day and 35 percent of participants quitting smoking completely. Other research found that just 5 20-minute sessions of mindfulness meditation prompted increased blood flow to the area of the brain vital to self-control with 11 hours of practice creating actual physical changes in the brain around this area.

Research supporting the benefits of mindfulness meditation when it comes to easing the symptoms of a host of other health conditions, including chronic pain, insomnia, irritable bowel syndrome, high blood pressure and even HIV/AIDS is still emerging.

“I’m convinced that we’ll continue to see more evidence of the benefits of mindfulness meditation in easing symptoms of a range of health conditions and helping people reduce their medication intake,” says Selhub. “And until that happens, we still have enough proof that starting a meditation practice can only help you get healthier and feel better.”

Getting Started: How to Start a Mindfulness Meditation Now

Maybe you’re suffering from one of the health conditions mentioned in this article and hoping to reduce symptoms and your medication intake. Or perhaps you’re simply intrigued by the power of mindfulness meditation to reduce stress and help you sleep more soundly. Whatever your reasons for wanting to try mindfulness meditation, Martha Hackett, MD, an integrative family physician in Mentor, OH, who teaches group meditation classes, wants you to know it’s easier than you might think to start.

“While you can certainly find a local meditation center to take classes or even consult with an integrative doctor or other practitioner for advice, most of us can quite simply carve out just a few minutes to sit in a quiet space and just breathe,” says Dr. Hackett. If you’re having trouble, relax — frustration and anxiety about not being able to sit for even a short amount of time is very normal. If this happens and you can’t seem to quiet your mind and body enough to sit through a few minutes of mindfulness meditation, you might try a guided meditation online or via an app for your smartphone. “There are so many wonderful sources with free guided meditations that can support you as you start this practice, says Hackett. A couple to try: UCLA’s Mindful Awareness Research Center, which has countless guided meditations you can download on iTunes, or HeadSpace, a popular app that offers 10-minute guided meditations.

If you start to wonder whether or not you’re doing it “right” or “wrong” or how good you are at the practice, it’s time to simply quiet those thoughts and bring your attention back to your breath. “The best part about mindfulness meditation is that there truly is no right or wrong way to do it,” says Dr. Selhub. “Simply stay in the present moment, tap in to what you’re sensing rather than what you’re thinking, and drop any judgment about yourself. If you can do that, true healing can happen.”

Like many holistic, alternative and integrative approaches, most insurance companies don’t cover mindfulness meditation classes or groups, says Dr. Hackett, though that may change in the future. “As more research emerges on the health benefits of this practice, I think insurance companies will have no choice but to cover meditation classes,” she says. In the meantime, there are plenty of resources — and scientific proof providing good reason — to give mindfulness meditation a try.

“I truly feel like in a lot of ways, I owe my life to mindfulness meditation,” says Dinker. Hark has similar sentiments. “Mindfulness meditation has helped me live a happier, more balanced life,” she says. “I believe it’s something anyone could try — and everyone could benefit from incorporating into their lives.”

Meghan Rabbitt is a freelance writer whose work is published in national magazines and websites, including Women’s Health, Dr. Oz The Good Life, Prevention, Redbook, Refinery29, LearnVest, Canyon Ranch and more.

For more information:

Brief Summary of Mindfulness Research (pdf) (UCLA Mindfulness Awareness Research Center)
Can meditation top medication? (Boston Globe)
Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances (JAMA)

Additional resources:

American Mindfulness Research Association
Guided Mindfulness Meditation Practices with Jon Kabat-Zinn (YouTube)
Insight Meditation Society (Insight Meditation Society)
UCLA Mindful Awareness Research Center

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Therapy, Meditation, Sleep and Exercise Can Help Lessen Anxiety

When Lisa Jones was in college, her once-manageable anxiety became overwhelming.“I was having three or four panic attacks a day,” she says. “My hands were shaking. I felt I needed to run and hide. I would hyperventilate sometimes to the point of blacking out. I knew I needed help.”

Lisa’s doctor referred her to Frances P. Thorndike, PhD, an Assistant Professor in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia Health System, in Charlottesville, who also has a private practice. Lisa’s doctor had prescribed medication, and Thorndike recommended that she also start a program of Cognitive Behavioral Therapy (CBT), a technique that gives patients tools to control their own anxiety. Lisa also began meditating, starting with 10 minutes a day, on her own.

Lisa very quickly started to see results. “Even though the treatment didn’t immediately cut down the number of panic attacks, I felt better,” she says. “I felt like I had control, and I didn’t have to let the panic attack take over my life.”

Lisa, who wasn’t opposed to medication, decided to hold off and try the therapy alone first. Still, knowing the medication was available gave her comfort. “It was helpful to know that it was OK to take it if I needed it,” she says. There is ample evidence that techniques including CBT, meditation, sleep strategies and exercise can help people with anxiety disorder. People who try these techniques may still need medication, however, to manage extreme symptoms, help get them through the first stages of therapy, or, like Lisa, to keep on the shelf for a “break-glass-in-case-of-emergency moment.”

CBT: Tools for Living

Many studies show that Cognitive Behavioral Therapy (CBT) can teach people with anxiety disorder to manage their condition. Recently, a November 2013 study, published in Behavior Research and Therapy, tracked 361 people with panic disorder as they completed an 11-session course of CBT. The study showed “strong evidence” that CBT reduced panic symptoms. “Medications for anxiety disorder can certainly be helpful,” explains Thorndike. “But CBT actually changes thought patterns and behaviors that cause anxiety and keep it going.”

If you choose this type of therapy you will learn techniques to cope with your situation and feelings, and those techniques will be tailored to your unique situation, Thorndike says. You will learn techniques to deal with anxiety, including relaxation and deep breathing, as well as cognitive tools – things you can say to yourself to challenge and control your fears. Eventually, you will practice using these techniques when exposed to your trigger, the situation that produces anxiety. “We start gradually,” Thorndike says. For example, if someone is afraid of dogs, “we may start by looking at pictures of dogs, and then going to a park and watching them from a distance,” she says.

To find a therapist who practices CBT ask your doctor or the Therapist Directory of the ADAA. While one-to-one therapy is ideal, you can also try to learn some of these techniques on your own. Thorndike recommends starting with The Anxiety and Phobia Workbook by Edmund J. Bourne (New Harbinger Publications, 2011). In addition, a review in the January 2014 issue of Current Opinion in Psychiatry found that “recent studies have confirmed the utility of computerized psychotherapy for anxiety” although more research is needed. If you want to try an online program, Thorndike recommends you use Beacon 2.0, to search for the right program.

Mindfulness Meditation: Living in the Moment

Another technique that has been proven to control anxiety is mindfulness meditation. This is a type of meditation that teaches you to be aware of the present moment—your thoughts, emotions, and sensations—with an attitude of acceptance.

Elizabeth Hoge, MD, an Assistant Professor of Psychiatry at Harvard Medical School in Boston, is a psychiatrist with a specialty in anxiety disorders. Her study on mindfulness meditation was published in the August 2013 issue of the Journal of Clinical Psychiatry (view a summary here). For this study, 93 people were asked about their symptoms and put through a stress test both before and after training. Half had training in mindfulness meditation, and half attended an education class. Those who learned to meditate had less stress on the second test than those who didn’t, says Dr. Hoge, who is also affiliated with the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital.

Why does meditation help? “Mindfulness meditation starts with a practice of focusing on your breath,” says Dr. Hoge. “As your thoughts arise, you are taught to just notice them there, like a cloud passing in the sky, and not react to them.” With practice, people with anxiety disorder can use these techniques to control their reactions to negative thoughts in daily life.

While any form of meditation will help, she says, her research study used mindfulness meditation, which is derived from Vipassana or Insight, meditation. You can find information on Insight meditation at the website of the Insight Meditation Society, www.dharma.org. There are also many books on meditation technique, including Wherever You Go, There You Are by Jon Kabat-Zinn (Hyperion, 2005).

Get Your Rest

Sleep and anxiety are intertwined, says Thorndike. “People who are anxious may struggle with falling asleep or wake up during the night,” she says. Being overtired can make people more prone to anxiety and less able to cope with its symptoms as well, she adds.

Try some simple steps to improve your sleep at night. “Your bed should be saved only for sleep or sex,” she says. “If you are awake for more than 15 or 20 minutes, leave the room. Don’t lie in bed and worry.”

It is also important to keep screens, phones, and TV out of the bedroom, maintain consistent bed and wake times, avoid caffeine in the afternoon and avoid exercising late in the evening. If you want help doing this, consider trying an online program. A 2013 study in the Journal of Clinical Psychology, co-authored by Thorndike, found that adults using an online sleep program saw improvements in both sleep and anxiety. Thorndike has helped develop one called SHUTi.

Get Moving

Exercise can help as well, Thorndike says. Researchers at Princeton University recently found that mice who exercised were calmer than those who were more sedentary — and had developed more new brain cells as well. Even if you are out of shape, “start wherever you can, depending on your fitness level,” Thorndike says. “It is only important to do it regularly and consistently.” Eventually, try to build to a program of exercise of at least 30 minutes 3 times weekly.

For Lisa, a little more than a year of therapy gave her the tools she needs to manage her anxiety daily. Today, she meditates daily, practices yoga, and uses the skills she learned from Thorndike. “I still get the symptoms of panic attacks,” she says. “I still have all the same triggers. But when I feel the attack coming on, I can use these tools to squash it.“

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.

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