Many of us live with persistent anxiety. If our doctor recommends stepping away from medicine, what are some ways to cope without medicine?
Q. I’ve been taking Xanax to help with anxiety for a few years. Now my physician is telling me I’m using it too much and need to get off it. I have tried breathing meditation but it doesn’t work for me. I just want a happy life without this constant anxiety. What are some other ways besides drugs and breathing to get rid of anxiety?
A. To begin healing anxiety, we need to stop treating it like a termite in the temple of the soul. If I had termites in my house, I’d definitely want them gone, every last one! But anxiety is trickier than termites. Treating anxiety like a pest to eradicate tends to make it persist. It’s easy to get stuck in: Oh no! Here’s the anxiety again! When we’ve struggled with anxiety for a while, we start getting anxious about getting anxious.
Your physician is likely wanting you to get off Xanax because you’re developing a tolerance to it. She or he knows that people can get addicted to Xanax and other benzodiazepines. Doing better with anxiety starts with a different kind of tolerance—an acceptance that anxiety is an inevitable part of life for us all. When your ability to accept anxiety increases, your need for anxiety medicine will decrease.
You said you’ve tried breathing meditation and it didn’t work. I invite you to let go of thinking of meditation as a technique that works or doesn’t work and start imagining it as a tool for moving toward a new way of living.
You might think: But my problem isn’t ordinary anxiety, it’s intense daily anxiety. Am I supposed to just accept it? I consulted on a case in which a patient had attempted suicide because of unrelenting anxiety. After weeks in a psychiatric hospital, she went to a renowned $50,000-per-month treatment program for further rehabilitation. What did they teach her there? How to practice mindful awareness and acceptance of anxiety to be less dependent on anxiety medication.
When people are in an overwhelming life crisis, medicines like Xanax can be helpful. It's possible, though, that your anxiety has been persisting for years. This may indicate that something in your current life needs to change, or that your whole mind-body system was set on “anxiety” at an early age—or both. If there are big-T traumas in your life story or years of little-t traumas (a childhood with chronic emotional abuse or invalidation, for example), you may benefit from finding a therapist who knows how to work with trauma. You can get a good start on understanding the lasting effects of trauma by reading Bessel van der Kolk’s bestselling-book The Body Keeps the Score.
There’s a reason that many approaches to calming anxiety without medicine start with the breath. When we consciously slow and deepen the breath, the whole autonomic nervous system gets a message to calm down. You said you’ve tried breathing meditation and it didn’t work. I invite you to let go of thinking of meditation as a technique that works or doesn’t work and start imagining it as a tool for moving toward a new way of living.
I might be a bit like you. I find breathing alone, without any other focus for meditation, not as helpful as other approaches. I have two suggestions for you. First, try putting on the mind of a little child who’s playing a game with her breath. Let your child mind say I’m pretending that my breath is my spiritual umbilical cord. I can take in all the energies I need for my life with every breath! I say “pretend” to dodge the adult mind that’s always assessing whether something is valid or productive. When I breathe playfully in this way, I take in peace, compassion, acceptance, non-judgment—whatever I need to deal with life in the moment.
Here’s a second suggestion. Try sitting in a chair or on the floor and putting your hands palms-up on your knees. Psychologist Marsha Linehan calls this the “willing hands” posture. For me it symbolizes an open receptivity to life as it is. It also signifies my willingness to receive the energies I need to deal with life. Just say out loud the things that are making you anxious; after each one say, “I accept.” If the anxiety is about some future thing you think might happen, you can say, “I’m afraid ____ might happen. I accept that it might happen. I accept my anxiety about it possibly happening. I accept that being anxious about it happening cannot give me complete control over whether it happens.”
“I accept” has two effects. First, it signals a willingness to stop fighting with anxiety and move toward acceptance that life is difficult for everyone. Saying “I accept” does not mean I have already accepted 100%. It signals my intention to meet anxiety with acceptance rather than with more anxiety. Second, “I accept” puts us in touch with what I call the “large I” that is capable of accepting difficult things (versus the small i that is afraid of anxiety). When you say “I accept,” it’s important to realize you’re not saying you like it, you approve of it, you want it. You’re just saying that given that it’s already here, the highest version of you accepts that it’s here.
If you do try breathing in higher energies or the willing hands/"I accept" approach, the minimum effective dose of these practices is several times per day for the rest of your life. Unlike Xanax and other medicines, the best dose of mindful acceptance is usually more, more, more!
Read more The Soul of Therapy.
For your reflection or journal time:
What problems in my life do I tend to approach with “How can I get rid of this?” instead of “I accept that this is here—now how do I choose my best path forward?”
Send your questions to [email protected] Questions may be edited for clarity or length. Dr. Anderson cannot respond to all letters. Sending a letter, whether answered in this column or not, does not create a doctor-patient relationship. Information in this column is for general psychoeducational purposes and is not a substitute for assessment and care provided in person by a medical or mental health professional.