Helping Clients Overcome Anxiety with Effective Strategies to Face Growing Challenges
Anxiety has been on the rise in many different ways for many different people during the past two years. It is not surprising considering that life has been forced to change in ways no one could have expected, for longer than anyone could have predicted. As mental health workers, we have increasingly found ourselves facing these situations with our clients, and we might not always know exactly how to deal with clients with severe clinical anxiety in our sessions with horses.
The pandemic has created a critical situation in regards to stress and anxiety. Some ways this has really affected us is in facing the unknown. While we may have figured out ways to live our lives now two years into the pandemic, we never really know what is coming around the corner. This can place us in a constant state of high alert, waiting for the next bad news. In addition, we have lost our physical connection with other people. No more handshakes or hugs, and decreased physical exercise, can build stress in our body with little opportunity for release. Many people are finding themselves unemployed or underemployed, creating anxiety about how to pay their next month’s rent. The wearing of face masks, while necessary, builds on our stress by taking away our reflexive ability to connect to other people while going about our daily activities. We are finding these factors are contributing to hyperarousal in the nervous system. This results in our clients experiencing Chronic Threat Response, which mimics the symptoms of PTSD. While there may not have been any specific trauma suffered, living under fear of a constant threat has made treatment of our clients more complicated.
Simple Tools to Begin Behavioral Changes
One of the most important tools to introduce to your client is breathwork. Many times, when someone is experiencing stress and anxiety, they find themselves breathing very shallowly and only into their shoulders. This does not allow the blood in the body to become fully oxygenated. Our goal is to create the habit of deep breathing. One of the most effective ways to do this is to have your client lay down and place their hands on their belly. Have them feel how their belly will rise with a deep inhale, and fall as they exhale. Have your client bring a yoga mat to their horse sessions, and practice this prior to your session. This does not need to be a half hour meditation, but should be practiced regularly to encourage the habit in your client. Another beneficial habit to instill in your client is exercise. Many of us have taken to simply sitting and waiting for time to pass, as days run into each other in lockdown. Moving the body encourages people to breathe more deeply naturally, and can help a client to feel “unstuck”.
Speaking of being stuck, it is extremely important to release emotions. Think of a pressure cooker. The steam builds and builds inside of it; if there is no steam let off, it will explode. This is what happens with anxiety and depression in our clients, which can result in a full blown panic attack. It is very important to channel these growing negative emotions into a healthy release. Some activities that may help include something as simple as getting outside, breathing fresh air and going for a walk. Again, moving the body and a change of location can really help. Screaming at the top of your lungs, or punching a pillow can be a huge release as well. Putting on your favorite music, and really dancing, losing yourself in the music, moving as quickly and as wildly as feels good to your body. These activities don’t cause damage or harm to anyone or anything and can go a long way to letting off steam from that internal pressure cooker.
It is important to validate anger in your clients. Beneath anxiety is always anger, whether it is about losing one’s job or simply feeling out of control. Trying to always deal with anxiety with a calm approach will not provide your client the opportunity to release this anger inside them. One very simple activity that I like to recommend is the “Towel Smash”. It is suitable for all ages and really easy to do. You take several small hand towels or kitchen towels and soak them in a bucket of water. Then you go outside and throw them against a plain wall. It makes a wonderful sound, it doesn´t hurt anyone, it requires physical strength, and might even get the angry person laughing after a while. When throwing the towel the person can say what he or she is angry about or just make a grunting sound.
It is important to have privacy for this activity, so the client feels more comfortable to have an authentic release.
A few more basic tools that can help with our anxiety clients include limiting the intake of coffee and sugar. Caffeine and sugar are excellent at ramping up our anxiety when consumed to excess. Maybe it feels good in the moment, but in the long term, it will make someone feel exponentially worse. But make sure they don’t avoid it completely! This can result in headaches and lack of focus, which could exacerbate anxiety issues. While limiting coffee and sugar intake, it is also important to consume less social media, and reduce screen time as a whole. More time spent on social media can make us feel inferior because of all the perfect lives presented to us. Your client’s anxiety might grow because they think everyone is “doing better” than them. This isn’t true, as many people depend heavily on filters and staged photos to present to their followers an idyllic life. Reducing screen time can also limit the amount of bad news we consume. These days, it seems as though the next crisis is lurking around every corner, and we are just waiting for it to show itself. The stress of expectation is not something your client needs at this moment. Turning off the phone can also result in better sleep.
Lack of sleep is a huge factor when it comes to managing our anxiety. How many of us have found ourselves short tempered and grumpy after a night of bad sleep? Compound that with feelings of stress, anxiety, and often, feelings of impending doom, and this is a recipe for trouble. Reducing consumption of emotional irritants, such as caffeine, sugar, and screen time, can be a huge help in creating a better night’s sleep. Another important tool is the creation of daily routines in our clients lives. Waking up at the same time, eating breakfast at the same time, going to sleep at the same time – these are very important to help in stabilizing a client’s mood and help cope with anxiety. Hold your client accountable to making these changes. Have them check in with you each night and track the amount of coffee drank, sugar eaten, and hours of screen time that day. Having you as an accountability partner can act as a huge motivation in making, and maintaining, these changes.
Advanced Tools for behavioral change
After you have experienced some compliance with your client, it is good to introduce some positive behavioral reinforcements to maintain the changes made. One very fun activity is creating a gratitude jar. Each day, your client can write down one thing they are thankful for, and put it in the jar. These can be as simple or as complex as your client wants them to be. They can start by simply being happy the sun came out today, and work up from there. Thinking of the positive things in their life can help them to recognize that life is good. It is also important to make sure your client is reaching out to other people and offering help to others in any way they can. Helping other people in simple ways, such as a text just checking in on a family member or friend, can help raise our clients dopamine levels. We know anxiety and depression can cause a client to seek isolation. I tell my clients to make a list of 10 people they would feel comfortable reaching out to, and have them choose someone daily to speak with. They can call them on the phone or simply send a text letting them know they are thinking of them. This will help your clients to build their own support group, and not only rely solely on you. It is important they have a group of family and peers of their own to discourage dependency on you. (As an aside, many of these tools have also been proven in the 12 step community as a treatment for substance abuse addiction.)
Panic Attacks: Bringing Our Clients Back down to Earth
I think it is important here to spend a moment talking about panic attacks. When our clients are in the grips of a profound panic attack, it can be difficult at the moment to think of ways to bring them back to us. Our patients can honestly think they are dying. They feel as though they are having a heart attack, complete with chest pain and blurry vision. They can end up in the emergency room, only to be sent out saying they are fine, it is “only a panic attack.” How invalidating! To our clients, this is a true moment of life or death. We have to provide them with first aid, as with any health emergency.
The first thing we want to do is encourage their deep breathing, which they have already been practicing with you. Remind them to breathe into their belly, not into their upper chest and shoulders. An activity we do with the horses which might benefit us here, is to put something solid into your clients hands. With the horses, we use a thick rope. Away from the horses, your client can hold onto a chair or bench, anything that is available.Have them be aware of the texture, if it is hard or soft, rough or smooth. Encourage your client to look around and tell you what they see. Notice the color of the sky, feel the ground beneath their feet. Our goal is to bring them back into the moment. Anxiety is about something in the past or something in the future. It is never about something in that exact moment. The worst thing a client can do is curl up away from the world and spin out mentally. It is very beneficial to begin this practice with the horses: deep breath, look at the horses, describe what you see, feel the ground under your feet, what do they smell? Make sure the client understands that this is a practice they can bring with them and use at any time to aid in bringing down anxiety.
It is important to do something that is a direct sensory experience as well. A quick way to do this is to have your client prepare a non alcoholic drink for themselves. Drinking ice water or hot tea will allow your client to feel a different temperature that can shock them back into the moment. Our goal is to help ground your client and keep them from being fully consumed by the panic and losing themselves. Another sensory experience is to clench their muscles tightly and make a fist. Clench, inhale; release, exhale. This can bring your client back into the moment as well.
Once your client has calmed down a bit, finding a safe person to ask for an extra long hug can help them feel real and present. It would be helpful to practice this ahead of time. Have your client decide who would feel safest to ask, and have a conversation before they come to them in a panicked state. This can be practiced with the horses as well. Your client can have an experience of physical connection with horses that can mimic an extra long hug from a family member. This can be an excellent way of practicing contact with clients that are perhaps a little shy or timid to reach out to a family member. They may then see the benefit to physical contact and be less afraid to ask for it from a family member. There are many ways we can utilize horses to aid a client with clinical anxiety.
Activities with and Benefits of Horses with Anxiety Clients
Therapy with horses can be very beneficial for anxiety clients because of sensory stimulation. Once we have a client working with the horses, they can truly feel the world around them, the earth under their feet. This can be so much more helpful than sitting in an office setting. For anxiety clients, they might be dealing with profoundly hidden emotions and problems. What we want to do is have our clients project these hidden emotions onto the horses so that we can figure out what is going on inside our clients, and eventually get to a diagnosis. We don’t want to simply talk about anxiety, we want to engage our clients and our horses with different activities. Take a picture of a client in a calming moment interacting with the horses. Send it to them. Have them tell you how they are feeling in that moment, what do they feel, what do they smell? This is a tangible, sensory experience that they can remember during moments of panic. The horses are naturally a calming presence.
It is very important when working with horses for a client with anxiety is to remain in close body contact. Anything you can do to get the client and the horses’ heart as close as possible is ideal. This can open up the heart chakra, and allow the energy to between client and horse. If you have a horse that can be ridden, it can be very beneficial for a client with anxiety to lay on the horse’s back, and just completely release and relax. One position is face down, with the clients’ head resting on the highest point of the horse’s back. An even more beneficial stretch for releasing trapped emotions can be the psoas stretch. This involves your client laying down on their back atop the horse, which gently opens the hips to its maximum amount, stretching the psoas nerve. In this pose, you must monitor for emotional symptoms, as this release can be dramatic. It is sufficient to hold this pose for only a few minutes, and you never want to force this position. Just hold a safe space for your client, and work with them to deal with any feelings that may come up.
Protecting yourself and your Clients
Dealing with patients with clinical anxiety can be quite scary. What are some things you should always keep in mind while moving through these sessions? One experience I have witnessed personally time and again, are clients coming to me already on prescription medications to control their symptoms. We want to make sure we work with our clients to understand that what we are offering is not an instant replacement for their medication. We need to encourage them to continue to take their medication as prescribed, while also offering them tools to help cope with their anxiety on their own. If a client is starting to feel better and expresses to you the desire to stop taking their medication, please direct them to speak with their doctor first, and then offer them help to wean themselves off the medication. A client on these prescriptions can experience very dangerous side effects if they take themselves off these medications “cold turkey.” Our work is a piece of the puzzle, not the entire picture. With time, hard work, and collaboration with their doctor, we do offer a holistic alternative to medication.
As difficult as working with clients with clinical anxiety can be, we have a host of tools at our disposal that we can employ and teach to our clients. We will not see change with these clients over night, and we wouldn’t want to. Anxiety disorders are manifested as a sort of addiction, where the clients become accustomed to – and actually come to depend on – feeling a certain way most of the time. Our goal is to chip away at these unhealthy responses to stressors and to replace them with healthy coping mechanisms that our clients feel comfortable reaching for, whether they are in session with the horses, or alone in their home. This is a time of fear and uncertainty for us all, and recognizing and validating our clients’ anxiety while also providing them proper channels for releasing these emotions is not only beneficial for them, but highly rewarding for us as well.
Helping people become anxiety-informed is dear to me. My own life has been affected by multiple traumata, I was exposed to high levels of anxiety in my childhood and I have worked with hundreds of clients who would have struggled SO MUCH LESS if just someone understood what was going on with them.
Below are some helpful free worksheets you can print out and share with your clients to help remind them of the healthy tools you are teaching them.
I wish you all the best on your journey towards understanding and healing.
With care, Christina
