Easy Practice

I often find myself talking with patients about behavioral strategies for dealing with life’s challenges. We discussions on the benefits of meditation, and breathing techniques for managing anxiety. We discuss the benefits of exercise on mood, or how regular sleep helps with managing anxiety symptoms. We will discuss different ways of coping with stress in our lives. We have conversations to help people learn how to name and identify strong emotions (a learnable skill that is not taught enough).

The challenge is that what usually prompts these conversations is a crisis— or at least a situation that is overwhelming. Really strong feelings have come up for someone who struggles to identify basic emotions. Someone is having full-blown panic attacks, not mild anxiety every once in a while. These overwhelming situations are what prompt the conversation, so we talk about strategies for managing anxiety or ways of recognizing emotions. But there’s a disconnect— the reason that prompted the conversation, the cause of the conversation— is often not going to be addressed by the skills I am discussing. At least, not yet.

When we are in crisis, or struggling mightily, it’s often because we are running up against the limit of what we know how to manage. After all, if we knew how to manage the situation, it would not be a crisis! If we were good a dealing with loss, stress, anxiety, whatever it was— we would probably not be having the conversation in the first place. Crises, or significant struggle, is almost by definition because what is on our plate, what is facing us, is more than we know how to handle. In and through that struggle we are then prompted to learn, to grow, to find new ways of managing.

But the new skills we need to master are often challenging. For example, there is a highly effective breathing technique called Square Breathing (or box breathing). In it, one breathes in slowly for a count of four, holds it for a count of four, exhales for a count of four, and then pauses for a count of four. The cycle then begins again. It is an excellent technique for managing anxiety and stress, for bringing a rebellious nervous system back into control. Part of its beauty lies in its simplicity. It is helpful in managing low levels of anxiety and panic attacks. And yet for someone just learning how to do it, using it for the first time during a panic attack is likely to fail. Why?

First, in the middle of a panic attack, we are in fight-or-flight mode. Simply remembering to do the technique is unlikely. It is difficult to focus on breathing when the voice inside your head is streaming HELP! HELP! I’M GOING TO DIE! Perhaps some tiny part of your brain is able to respond, Let’s focus on breathing. To which the panicked voice answers, I DON’T NEED SOME STUPID BREATHING TECHNIQUE. DIDN’T YOU HEAR ME? THE WORLD IS ENDING!

Next, while it is effective, it takes practice and discipline to control the breath. Breathing slowly when the heart is beating fast and the world feels like it is closing in is hard. The mechanics of using the technique are simple to understand and easy to implement when things are calm (like you are reading this, or in my office), but not so simple or easy when the kids are crying the phone is ringing and there’s someone at the door and we’re on a zoom call with the boss and a client. In other words, simple in ideal circumstances– but if we always lived in ideal circumstances, there would be no need for the technique to begin with.

So, how do we bridge the gap? How do get to the place where something like a breathing technique can be helpful when we are feeling anxious? The answer is practice. Lots of practice. Low-stakes practice. Easy practice.

Trying to use a breathing technique for the first time to manage a panic attack (or a super stressful situation) without ever practicing it when calm is like showing up to baseball opening day without ever having picked up a bat, and expecting to hit a home run. It takes more than just knowing how to swing a bat to connect with the ball. Moreover, the time for practice is before the technique is needed. The time for practice is in low-stakes, easy situations.

The time to first start practicing a new breathing technique is when running a couple of minutes late, when sitting in traffic, or when worried about a phone call. The time to practice, in other words, is at times the anxiety is already manageable. The goal is lots of practice in easy situations— so that when difficult situations arise, the techniques are easier to recall and easier to implement. There is already a muscle memory of how to do it.

I have talked about this in terms of a breathing technique for anxiety, but the underlying idea is much more broad. If you are trying to quit smoking, for example, and use smoking as a form of stress relief, the time to practice is probably not in the middle of a stressful situation. If we are trying to make different food choices, we are probably not going to choose an apple over a doughnut if the doughnut is sitting right in front of us. If we are trying to manage anger better, there will probably be more success in trying to work with minor irritations rather than big problems. Get practice with the small tasks, gain confidence, practice, and build momentum. This can be challenging though (and feel frustrating) because working on a small scale does not feel like it is addressing the issue that prompted the change. It is only with time and practice that the change becomes more apparent, and the implications of tackling the large problem snap into sharper focus.

How do you start small? What can you do to gain practice, so that tackling the big stuff becomes more within reach?


-Dr. Justin