ANXIOUS CLIENT? FORGET RELAXATION, GET THEM MOVING!
Therapist and author, Courtney Armstrong discusses how light physical activity can be a more effective tool for reducing anxiety than relaxation techniques.
Did you know that one of the best ways to reduce anxiety is to move your body? Most therapists are taught to teach their anxious clients relaxation techniques. But, if a client is really keyed up or panicky, inviting her to walk or move with you for a few minutes can bring her tension down more quickly than having her sit on your couch attempting to relax. Sometimes the body needs to work out the excess adrenalin generated by a stress response before it can slow down.
How Movement Helped Me Stop a Panic Attack
I personally learned that movement could be a more effective antidote for anxiety when I experienced my own panic attack several years ago. I awoke suddenly at 3 a.m. breathless, sweating profusely, with my heart racing at about 120 beats per minute. Being a therapist, I understood what was happening and initially responded by slowing my breathing, redirecting my thoughts, and attempting a few rounds of progressive muscle relaxation. To my dismay, these interventions didn’t decelerate the rush of adrenaline coursing through my veins one bit and, as a result, I began to feel frustration as well as panic.
Fortunately, I recalled a story from psychiatrist David Burns’ book Feeling Good (1980) in which he suggested that one of his patients do jumping jacks as a way to distinguish a panic attack from a heart attack. Burns told the man that if he could do just one jumping jack he could be fairly certain he wasn’t having a heart attack. So I got out of bed and started doing jumping jacks. Surprisingly, I felt better within minutes. It wasn’t so much that exercising allayed my fears of having a heart attack, but that the cardiovascular activity itself provided relief. Exercising my body was matching what my nervous system wanted: to move, to run, and do something!
Because I’m not too fond of jumping jacks, I decided to continue exercising to an aerobic dance DVD. Within 10 minutes, my heart rate felt normal and I was able to finish with a few stretching and deep breathing exercises. Since having this experience, I often recommend clients try 10 minutes of brisk walking to reduce anxiety and quiet panic symptoms instead of trying relaxation techniques. They tend to agree that incorporating several minutes of light physical activity is more effective than using breathing or relaxation techniques alone.
Research by psychology professor Robert Thayer bears this out. In his book Calm Energy (2001) he talks about an experiment he conducted in which he measured the energy and tension levels of research participants after they walked briskly for 10 minutes. Results showed that participants reported a significant decrease in tension and an increase in energy level for up to 60 minutes after a 10-minute walk. Thayer explains that tension is caused when we inhibit our body’s desire to take action when we are feeling stressed. Moving the body releases and tempers the emotional response the brain is urging us to take.
Likewise, in her book 8 Keys to Safe Trauma Recovery (2010), Babette Rothschild recommends engaging in light physical movement to discharge the “fight-flight-or-freeze response”. Rothschild reports that 4% of the general population becomes more anxious when they attempt to relax. This can be especially true for those who’ve experienced trauma. For a trauma survivor, relaxing can feel like she is leaving her body vulnerable to danger whereas moderate physical activity regulates stress hormones and increases feelings of containment, strength, and self-control.
How Using Movement in a Session Helped Calm a Client with PTSD
Movement proved to be a more effective way for Jeanette to reduce anxiety. She was a 45-year-old client who had been raped by someone at her workplace. Jeanette said her most troubling symptoms were insomnia and nightmares and asked me to teach her relaxation techniques. As I led her into a “calming breath” exercise, I noticed she took fast, short inhalations and held her breath for several seconds as if she was reluctant to exhale; she looked very uncomfortable. On her fourth inhalation, Jeanette clenched her fists and closed her eyelids tightly as though she were fighting back tears. I felt compelled to reassure and coach her:
Therapist: Jeanette, let’s pause for a moment so I can check in with you. What are you noticing within your body as you do this?
Jeanette: My heart is racing. I can’t seem to calm down.
Therapist: Okay, that’s the kind of feedback I’m looking for. That’s actually a physiological response designed to strengthen you. After a trauma, your mind can confuse relaxation with letting your guard down and so it defends against that. Your heart is beating fast to prepare you to run from a situation that seems weird. It feels even weirder because you’re sitting still when your body wants to move. Standing and stretching might feel better right now.
I modeled this for Jeannette by standing up and stretching my arms over my head and twisted from my waist, side to side.
Jeanette: [Standing and stretching] Yes. That does feel better.
Therapist: Good. What sensations are you noticing within your body right now?
Jeanette: My heartbeat has slowed down. It feels lighter in my chest. I don’t feel on the verge of tears. Ugh, I hate crying. It makes me feel weak.
Therapist: Well, I don’t see anybody waving a white flag here. You’re standing up to this thing. Emotion is energy trying to get you to do something. The emotion of fear is asking you to move away from something that seems strange or dangerous. Sadness and tears are asking you to pull back, reflect, and express compassion for yourself. No wonder you’ve been feeling confused. It’s like your body is shouting “Run!” but your heart is saying, “Slow down, protect me, take care of me.”
Jeanette: Yes. I feel so conflicted. I want to fight and run, but I also feel like I could break down at any moment. I hate it. I’m not a crier.
Therapist: Well, if you don’t like crying, you can shake that energy off, too, like this. [I shake my body around then start shuffling my feet like a boxer as I punch my arms out into the air.]
Jeanette: [Laughs, stands, and mimics my shuffling]
Therapist: Crying is a lot easier and it looks less ridiculous, but it’s up to you.
Jeanette chuckled and actually shuffled around with me before her laughter segued to tears. I offered her my hand and she squeezed it as she let herself cry.
Before my own experience of using movement to quell anxiety, I might have encouraged Jeanette to explore what felt scary about crying and why it made her feel weak. Not only would that have increased Jeanette’s self-consciousness, but it would also have encouraged more intellectualization. I needed to build more rapport with her before pursuing deeper emotional exploration. I also didn’t want her to escape back into her head by attempting to analyze her feelings. My intention was to give Jeanette a little education about emotion to appeal to her intellectual side, then model dealing with intense emotion by using movement and humor. Goading Jeanette to laugh and play with me discharged the emotional energy in a way that felt less daunting to her and helped her feel less vulnerable.
I’ve also helped clients discharge anxiety by tossing a beach ball back and forth during the session, taking a short walk around the office, or even “running” in place while seated in our chairs by moving our legs up and down quickly and pumping our arms.
Keep the Activity at a Light to Moderate Level
When selecting an activity to discharge anxiety symptoms, I find its best to keep it at a light to moderate level of intensity for just 10 to 20 minutes. Prolonged or intense physical exercise is contraindicated for people dealing with depression, post-traumatic stress, and severe anxiety. Not only can extended exercise increase pain and fatigue but some people are also prone to panic or flashbacks when their heart rate increases dramatically because the body associates this with the fight-or-flight response. Therefore, it is better to start with lower intensity activities like walking, strength training, yoga, dancing, Tai Chi, or Qi Gong.
In sum, physical movement and activity can relieve anxiety more quickly than relaxation techniques. First of all, light to moderate activity may be necessary to discharge the adrenalin and muscle tension before a person can comfortably relax his or her body. In addition, physical activity modulates the production of stress hormones and can increase a person’s sense of strength and empowerment.
The physical activity doesn’t have to be long or intense. In fact, 10 minutes of brisk walking, stretching, or dancing is enough to bring the anxiety down to a manageable level and clear the mind enough to allow you to relax effectively.
Have you used movement or physical activity to assist clients in reducing anxiety? Please share your experiences and thoughts about this in the comment box below.
Courtney Armstrong LPC
25th June 2015
Burns, D. D. (1980). Feeling Good: The New Mood Therapy. New York: Avon Books.
Rothschild, B. (2010). 8 Keys to Safe Trauma Recovery: Take Charge Strategies for Reclaiming Your Life. New York: W. W. Norton & Company.
Thayer, R. E. (2001). Calm Energy: How People Can Regulate Mood With Food And Exercise. New York: Oxford University Press.