Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist

Anxiety Management Techniques





























Though anxiety can cause significant impairments, hopes for long-term recovery are very good. Through rigorous research studies, the National Institute of Mental Health has identified cognitive behavioral therapy as being highly effective in treating anxiety disorders. There are usually four parts to the cognitive behavioral treatment of anxiety disorders: education, cognitive skills training, behavioral strategies, and somatic management skills. Education regarding the causes and treatments for anxiety can provide peace of mind, a sense of control, and motivation for treatment. There should be no mystery or complexity in the explanations and treatment. Cognitive skills training involves identifying and challenging the thoughts that increase anxiety and can include self-monitoring thoughts and developing an alternative perspective regarding feared outcomes. This is why the education component is important. Behavioral strategies include exposing you to situations that induce anxiety in a controlled manner allowing you to challenge your fears and develop confidence in your coping skills. Somatic management skills refers to relaxation, breathing, and mindfulness meditation strategies that are used to calm general physiological arousal or to help you tolerate the discomfort of the situation. The specific strategies will differ depending on the source of your anxiety. 



Biofeedback is a therapeutic technique that can be used to help manage symptoms related to anxiety, stress, insomnia, and chronic pain. By using a specialized heart rate monitor, you will be able to see a visual representation of your heart rhythm patterns and learn how to create heart rhythms associated with focused attention, calm relaxation, and positive emotions. Biofeedback is not a cure or a treatment but rather a training technique that is, in a sense, a short-cut to learning deep relaxation and meditation. By getting immediate feedback on a monitor, you will quickly learn how your body responds to stress so that in the future you are more aware of your internal sensations association with stress allowing you to catch it earlier in the cycle. In addition, you will be able to learn how to implement various relaxation techniques and get feedback that it is having a positive impact on your body system. 


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Essentially, your heart rate speeds up and slows down in a rhythmic pattern leading to variability in your heart rate (HRV). Heart rhythm patterns associated with stress, anxiety, and anger are shallow, jagged, and irregular whereas heart rhythm patterns associated with calmness, focused attention, and positive emotions are smooth and wave-like indicating that your heart rate is increasing and decreasing in a rhythmic fashion. These smooth waves appear when your breathing and your heart rate (two powerful systems in your body) are in coherence with each other. This in turn, leads to more coherence in your other physiological systems, particularly the autonomic system that is associated with the stress and relaxation responses. The smooth waves have also been found to be an indication of health and wellness, particularly cardiac functioning. In my practice, I utilize a simple heart monitor attached to your earlobe to give you feedback about your heart rate patterns and to optimize breathing techniques.  


Click here for a more detailed explanation of heart rate variability biofeedback.


Click here for research publications on the relationship between heart rate variability and both physical and mental health.


MINDFULNESS MEDITATION Mindfulness refers to the nonjudgmental acceptance of one's thoughts, feelings, and physical sensations. Mindfulness meditation can help increase awareness and appreciation of the present moment, improve clarity of thinking, and calm physiological arousal. Mindfulness teaches us to sit with and observe our thoughts and feelings with compassion and prevents a secondary anxiety response where we become anxious about our anxiety. Mindfulness also allows anxiety to dissipate on its own via the parasympathetic nervous system and gives the prefrontal cortex (our thinking brain) the opporunity to calm our amygdala (feeling brain). MIndfulness meditation is a skill that can be improved with practice. Mindfulness meditation often starts with a focus on the breath. By learning to shift your attention to your breath, you can learn to sit with your anxiety which will allows your breathing to become slow and rhthmic which will then encourage your body to engage in a relaxation response as opposed to a stress response.


Click here for a thorough description of mindfulness based cognitive therapy for anxiety disorders.



A medical professional should be consulted regarding the use of medications in the treatment of anxiety, but an understanding of the pros and cons of the medications would be helpful. 


Click here for information regarding the use of medications for the treatment of anxiety

Click here for information regarding the use of medications for specific anxiety disorders. 



There are many wonderful self-help books out on the market, but most people seem to benefit from the individualized coaching they receive in therapy.


Click here for more information on anxiety disorders from the National Institute of Mental Health

Click here for more information on anxiety disorders from the Anxiety Disorders Association of America


Click here for a workbook that is used by many therapists in the treatment of panic disorder

Click here for a workbook that is used by many therapists in the treatment of chronic worrying

Click here for a workbook that is used by individuals more as a self-help workbook.