How to Manage Anxiety

For some, anxiety comes and goes. For others, it lingers, feeling like a revving engine that never slows. Anxiety can show up as racing thoughts, a pounding heart, or the sense that something terrible is approaching. For many people, anxiety is anticipatory—sometimes called the "Sunday scaries" before the workweek—and the same grounding and breathing strategies described here can help.

Anxiety is not only a mental experience, explains Melissa Nunes‑Harwitt, LCSW, a clinical social worker with UR Medicine. It’s in your body, too. But with the right tools and support, it’s possible to regain a sense of control.

“When anxiety gets strong enough that it becomes its own issue, the first thing to address isn’t the source of the stress—it’s the anxiety itself,” Nunes-Harwitt says. “And that starts by tuning into the body.”

What Does a Panic Attack Feel Like?

Anxiety can take many forms, and is usually accompanied by physical sensations, like:

• Racing heartbeat
• Shallow breathing
• Tightness in the chest
• Unsettled stomach
• Muscle tension

When anxiety reaches the level of a panic attack, symptoms intensify and may include:

• Nausea
• Sweating
• Body shakes
• Tunnel vision
• Disorientation
• Hyperventilating

Anxiety Coping Techniques

Two of the most effective techniques Nunes-Harwitt teaches are grounding and controlled breathing. These methods work by engaging the senses and shifting attention away from overwhelming thoughts.

The 5‑4‑3‑2‑1 Grounding Method

One popular strategy is the 5‑4‑3‑2‑1 grounding method, which uses each of your senses to bring attention to your surroundings.

To practice this method, turn your attention to what is happening in the present moment by listing the following things, preferably out loud:

• Five things you see.
• Four things you hear.
• Three things you feel with touch.
• Two things you smell.
• One thing you taste.

Attaching words to sensations activates regions of the brain that help regulate emotional responses.

“It puts the sensations you’re having—like a racing heart—into context,” says Nunes-Harwitt. “Your heart is pounding, and the sun is shining. The fan is whirring, you can smell your coffee. You’re safe.”

Breathwork: Focus on the Exhale

Breathing techniques are another powerful tool. Contrary to popular advice, Nunes-Harwitt says taking a “deep breath” isn’t always helpful. Instead, the key is to focus on slowing your exhale. “When we breathe out, our heart rate slows down a little. That’s where the calming effect comes in.”

Techniques like box breathing or the 4‑7‑8 method can guide this process, but what matters most is making the exhale the same length or slower than the inhale. It’s best to breathe in through the nose and out through the mouth.

Acknowledging the Anxious Sensations

Another simple step to shift your experience with anxiety is to acknowledge the feeling itself. Instead of fighting or avoiding the sensation, acknowledge what’s happening. Try saying to yourself: ‘I’m feeling anxious right now. I am worrying that someone is mad at me. There is tightness in my chest.’

This shift—from being in the experience to observing it—creates space. It gives you the chance to respond more intentionally.

When you’re not only experiencing it, but also becoming an observer to your own experience, that’s a huge step in managing any mental health condition."

Understanding Therapy Approaches

Anxiety can be addressed through two major therapeutic pathways between the mind and the body: bottom-up and top-down. For many people, the most effective way to treat anxiety includes a combination of the approaches.

Anxiety Myth Busting

Despite how common it is, anxiety is often misunderstood. Nunes-Harwitt regularly hears myths from patients who feel stuck, ashamed, or confused about their experiences.

Myth #1: Anxiety Will Go Away

One common misconception is that anxiety will go away if the stressor is resolved. While this is true with situational stress, it is not the case with clinical anxiety. The body and mind stay in a heightened state even when the situation changes.

Myth #2: Medication Is Enough

Another myth is that medication or therapy alone will cure anxiety. In truth, a treatment plan that uses both often leads to the best outcomes. “Medication can turn the volume down so therapy techniques can land,” Nunes-Harwitt explains.

Myth #3: Anxiety Makes Me Productive

Some people worry that without their anxiety, they won’t have the same drive and motivation to achieve. What most discover in therapy is that they can still perform successfully—just without the constant sense of urgency that accompanies anxiety.

Myth #4: Everyone Feels Like This

“People with chronic anxiety sometimes don’t realize how much it colors their day-to-day life,” says Nunes-Harwitt. “They assume everyone scans the room when they walk into a restaurant. But not everyone does. And you don’t have to, either.”