What To Do When Anxiety Comes Back

What do you actually do when anxiety comes back after you thought you'd put it behind you? In this episode I talk about why recovery was never a straight line to zero, and why I measured my own recovery by "widening the gaps" between panic attacks instead. I get into why a single anxious moment usually isn't the "setback" you think it is (and what a real setback actually is), the science of why anxiety can resurface even years later, and a story from a trip well into my recovery when panic showed up at the worst possible moment. Plus the exact response that keeps a hard day from snowballing, and why taking care of your basics is maintenance, not a safety behavior. If you've ever thought "I'm right back where I started," this one's for you!

SOURCES:
-Reinstatement of extinguished fear by an unextinguished conditional stimulus. https://pmc.ncbi.nlm.nih.gov/articles/PMC3343277/
-Enhancing Inhibitory Learning: The Utility of Variability in Exposure. https://pmc.ncbi.nlm.nih.gov/articles/PMC6884337/ (Why practicing across varied situations helps the new learning generalize and stick.)
-Delayed Extinction Attenuates Conditioned Fear Renewal and Spontaneous Recovery in Humans. https://pmc.ncbi.nlm.nih.gov/articles/PMC2749460/ (Repeated, spaced practice reduces the return of fear over time.) 

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Transcript

SPEAKER_00 0:25

Welcome to the 18 Minutes Podcast. I'm Amanda, and this is the show where we take everything that's confusing, isolating, and scary about disordered anxiety, and we turn it into something you can actually work with. I want to start today with a story. A few years ago, well into my recovery, I went on a weekend trip with some friends. The moment that I got into my room at this Airbnb, before I had even set my bags down, I had a full-blown panic attack out of nowhere. Now, a little bit of context so you understand the full picture of what's going on. Um, traveling used to be one of my biggest triggers when I was in the throes of panic disorder. For years, going anywhere that wasn't my home was a threat to my nervous system. So walking into this Airbnb and having a panic attack within 60 seconds of being there, years after I thought I had put all of that behind me, was really scary. And it wasn't really the panic attack itself that scared me so much. It was the thought I had immediately when those feelings came on. What if I'm right back where I started? I'll tell you how that weekend went a little later on because how it went is the whole point of today's episode. Because today we're talking about what happens when anxiety comes back. When you've had a good stretch of feeling like yourself for weeks or months or even years, and then it shows up like it never left. We're going to talk about why that happens, why a single moment of panic is hardly ever the setback you think it is, what setbacks actually are, and most importantly, what to do in that difficult moment so that it stays a moment and doesn't snowball into something bigger. Before we dive in, I am not a medical professional or a therapist. Everything I share on this show comes from my own experience with disordered anxiety, my recovery journey, and the research I do for the show. This is not a replacement for therapy. Please take only what's helpful to you, leave what isn't, and listen to your medical and mental health professionals first. If you're new here, welcome. Thank you for being here. I'm so glad you found this resource. Please follow or hit subscribe wherever you're listening because new episodes drop every Friday and I don't want you to miss them. If you're a regular listener, thank you for being here and welcome back. If you haven't already, head to the18minutes.com and grab your free recovery guide. It's one page, it's a consolidated version of how I recovered from panic disorder with some extra tips sprinkled in based on how maybe I would do things differently if I were starting over. Grabbing the recovery guide also adds you to my weekly newsletter that comes out every Monday morning. I love starting my week writing this letter to you, and I've heard from other people that they really enjoy the motivation, the encouragement to start their week off as well. Okay, let's talk about what to do when anxiety comes back. Before we can actually talk about what to do when it comes back, I want to get really clear on what recovery looks like. Because I think a lot of us are carrying around this picture of what recovery has to look like that sets us up to feel like failures. The picture most of us have is a straight line. You're anxious, you do the work, and then at some point you cross a finish line and you're just done, cured. Anxiety never comes back. So the first time anxiety does show up again, it feels like proof that you failed or that the work didn't work and that you're just as broken as you thought you were. That is not what recovery is. For me, recovery was about widening the gaps. When I was at my worst, I was having multiple panic attacks a day. Then as I started doing the work, it became once a day, usually during a scheduled intentional exposure. And then it was multiple times a week, and then once a week, and then a couple times a month, and then once a month. And I want you to picture what that feels like. The panic did not disappear all at once. I was still having panic attacks, but the gap between them was getting wider. And that's how I knew I was recovering. My metric wasn't, oh, I never panic anymore. I'm recovering now. It was the gaps between my adrenaline surges are getting wider. So my brain is changing. I was building up my tolerance for my triggers, and I was able to do more and more all the time. I'm always honest with you about where I am right now. And the gap between panic attacks is really, really wide. I'm not having regular panic attacks anymore, not even close. But every once in a while, I still do get a surge of adrenaline. Like that rush of anxiety that comes out of nowhere. And what I want you to hear is that that is not a sign that my recovery failed. For a lot of us, that's just what recovered looks like. Because the truth that people don't put in their aspirational Instagram carousels is that the goal was never zero anxiety and 100% peace and tranquility in Zen. Anxiety is a normal human experience. Even people who have never had a panic attack their entire lives have anxious days. The goal of recovery was never to feel anxiety zero times for the rest of your life. The goal was for anxiety to stop running your life. And by that standard, an occasional adrenaline surge years into recovery isn't a problem at all. It's just being a person with a normal nervous system. So if you're measuring your recovery by whether you ever feel anxious again or not, I want you to throw that out. We're gonna use a better metric. Are the gaps getting wider? And are you doing more things than you used to do? That's how we measure recovery. Okay, so now I want to talk about the word setback because I think it gets thrown around a lot and sometimes in ways that actually hurt us. Here's my take on this: if you are recovered or well into your recovery and you have a single panic attack or anxious day or um a random adrenaline surge that comes out of nowhere, I don't think that's a setback. I think you should call it what it is, which is feeling anxious. Because that's going to happen from time to time, especially for people like us who are maybe a little bit prone to anxious patterns. It's not a relapse or a backslide, it's just a Tuesday where you felt anxious. And the reason I'm so particular about this language is because the labels we use have real consequences. I've talked about this before. The words we use matter. The moment you think, oh gosh, I'm having a setback, you've added a layer of fear on top of the anxiety you're already feeling. Now you're not just feeling anxious, you're afraid of what that anxiety means. And if you've listened to the Fear of Fear episode, you know that that second layer, the fear of fear, is what turns a small anxiety wave into a big one. That second fear, that second layer is the fuel. So when you continuously label an anxious moment after you're you know into recovery or recovered as a setback, you can actually make it turn into one. But when you handle it well, like you've learned how to do and you're completely capable of doing, and you don't pour that fuel on it, it typically passes and you can move on. This all comes down to something that I think is really important. It comes down to the meaning we assign. When the anxiety shows up again, we get to choose between I'm back to square one and I know what this is, I've felt this before, I know how to handle this. Those two sentences move your nervous system in two completely different directions. One says danger and signals alarm, and the other says, I've got this, things are cool. Same physical sensations, two completely different reactions, and two completely different outcomes. Now, I'm gonna be honest with you because I'm not trying to just make you feel good about all this, I'm trying to help you recover. The word setback does have a real meaning, and it does really happen sometimes. Sometimes a person goes months or even years without a single panic attack, and then the whole thing comes back full force, like full-blown anxiety disorder back again. And I mean weeks or months where the anxiety is running the show just like it did before. That is a real setback, and I'm not going to tell you that that doesn't happen and that everything's fine because it does happen to some people. But I'm naming it because it has a way through and a way from preventing it from happening in the first place. It's the same way through that we always talk about on this show. So whether you're having an anxious afternoon after being recovered, or you're having a genuine return of disordered anxiety, the tools are the same. Before I get into more detail on that, I want to answer a question you might be asking, which is why does this happen in the first place? If I put the work in, why would the anxiety come back? I'm gonna give you a quick overview of the science, which I actually find really reassuring. Your nervous system has a memory. When you recover from disordered anxiety, especially through exposure, your brain is not going in and deleting that old fear. What it actually does is build a new pathway on top of it. The I'm safe, this isn't dangerous pathway. And over time, that connection, that path gets stronger and stronger. But the old wiring is still there underneath. It doesn't get erased. So, under the right conditions, like a lot of stress, lack of sleep, illness, that old pattern, that old connection can resurface for a little bit. The original fear memory actually stays intact and it can re-emerge over time, after a stressful event, or in a new setting. I'll put links to these studies in the show notes if you're like me and want to read up a little more on the neuroscience. One really important note that I want you to hear the more you practice building that new pathway, that new connection, the less likely that old pattern will be able to re-emerge. A lot of people I've talked to tell me a story that goes something like: I had a panic disorder, I was panicking multiple times a day, I did some exposure work, and I got my life to a point that was manageable for me. I did exposures to driving and being at work. So now I can go to work, which is a huge deal for me, and my life is in a situation where I feel more in control. The exposure work kind of stops there because they're relieved that they're getting, you know, major parts of their life back. Then, maybe months later, they're at a restaurant with friends and they have a major panic attack seemingly out of nowhere, and they get freaked out. Then the next morning, on their way to work, they have another panic attack, and now they believe they're in a setback. What the research says is that the more we practice these new patterns and these new associations, that is, anxiety trigger does not equal danger, the less likely the old pattern is to show up. What the research says is that the more we practice new patterns and new associations, that is, anxiety trigger does not equal danger, and especially in different contexts, not just the same situation over and over again, the less likely that old pattern is to show up. We create a stronger pattern by repeating it more often in a variety of contexts. So that person who practiced exposure and response prevention on and off for a couple of months just so that they could get back to work is likely going to experience that reappearing of disordered anxiety because the new pattern of anxiety symptoms do not equal danger, is not nearly as strong as it could be. And I want you to really hear what this means. When anxiety comes back, it is not evidence that your recovery failed or that you didn't actually get better. It's just how the memory of these connections work in every human brain. The new pathway, regardless of how weak or strong, is still there. The skills are still there. You haven't lost anything. The old pattern just reappeared for a minute. Okay, so I promise I'd tell you how that weekend went. So here's the rest of the story. So I'm standing in this Airbnb. I've just started to have a major panic attack, and catastrophic thoughts are running through my head. What if this ruins the whole weekend? What if my friends notice me panicking and they think I knew she wasn't as normal as she was saying? What if my recovery was never going to last? And I felt that fear for a while. I laid down in the bed and I grabbed my phone to distract myself. I was considering grabbing my husband, who's in another room, to come in and reassure me that I was okay. I'm not gonna pretend that I was totally chill about it because I wasn't. I was very afraid. But then I did what I know how to do. I practiced acceptance. I got up out of bed, I walked into the kitchen where all my friends were, and I had conversations with them while I was actively having an adrenaline surge without fighting it or trying to get the feelings to stop. I stopped using safety behaviors to try to get myself to calm down. And here's the part that I think is the most important. I made room for it to happen again. I told myself, if I panic again this weekend, then I panic again. I know how to handle it. I was genuinely willing for it to come back. And you know what happened? I didn't panic again the entire trip. Not even a little bit. I didn't panic again for months, maybe even years after that trip. And looking back on that panic experience, I realized something that I think is really interesting. I was getting sick that weekend. After we got home, I got a nasty cold. So I had barely had any sleep. I was getting sick. Um, I had a bunch of caffeine that day because I was so tired from the lack of sleep. And if you were going to design a recipe for feeling anxious, that is essentially it. Underslept, run down, overcaffeinated in a situation that used to be a major trigger of mine. Of course, my nervous system got a little loud. Nothing had gone wrong with my recovery at all. My body was just doing what bodies do under that kind of strain. So let me pull the actual tools out of that story because everything I did is something that you can do too. First, name it accurately. Not I'm having a setback, my disorder is back, but I'm feeling anxiety, I know what this is, I can handle it. You're telling your brain the truth instead of a worst-case scenario story. Second, don't add that second layer of fear. Feel the anxiety without panicking about the anxiety and redirect if you have to, like I did. I have a whole episode called How to Practice Acceptance. So if this is the part that you struggle with the most, you can listen to that one after this. The short version is you let it be there. You stop fighting against it and trying to make it leave. Third, and I do I do think this one is really important, and a lot of people skip this, but practice being willing for it to happen again. I know that can sound backwards to be willing for anxiety to come back, but that's exactly what takes the fuel out of the situation. As long as you're bracing against the next wave, you're feeding it. The moment you really make peace with, okay, if this if this happens again, I will handle it, you've taken away the exact thing that it runs on. Fourth, don't run back to your old safety behaviors. The temptation when anxiety comes back is to reach for the things that make you feel comfortable in the moment, like I did in that Airbnb. Laying down, distracting yourself, whatever it is. But every time you do that, you're teaching your brain that the crutch that you're using is what saved you from a really dangerous situation. You're feeding that old pathway instead of the new one. So keep living your life, stay on the trip, engage with the present moment. That's how we keep that difficult situation just a difficult situation. And fifth, look for the physical setup. Before you decide that your anxiety is back, ask yourself, how's my sleep been? Am I getting sick? How much caffeine have I had? Where am I at in my hormone cycle? Have I been under a lot of stress lately? Nine times out of ten, there is a plain, boring, logical reason for feeling anxiety that is not your recovery falling apart. You couldn't get that old anxious pattern, that old wiring to go away no matter how hard you tried, and you're not going to cause the new pathways and connections you've created to fall apart either. And that leads me into the last thing I want to talk about today, which is maintenance. In the recovery framework I use, there's a phase called regulate. And while some of the regulating happens during active recovery, I think it's even more important afterwards. Because once you get your life back, you still have a nervous system to take care of. Getting enough sleep, eating in a way that nourishes you, controlling your caffeine intake, moving your body every day, practicing mindfulness and gratitude. These things are good for our mental health. And as people who run a little more anxious than average, who still have that old wiring underneath, I would argue that it's even more important that we take care of our mental health. Not out of fear, but out of hope. If we take care of ourselves, we can live the lives we've always dreamed of. In recovery, we move from fear to freedom. And after recovery, we get to maintain that freedom. Now, I have to add an important caveat here because I know my audience and I know how our brains work. There is a difference between maintenance and a safety behavior, and the difference is in your intention. If you are practicing good sleep hygiene because being well rested makes you feel good, it makes you function better, that's maintenance. If you are clinging for dear life to your sleep routine because you do not want to feel anxious and you're terrified of a relapse, that's a safety behavior and it will keep you anxious. If you're going for a walk because movement clears your head and you enjoy it, that's maintenance. If you are compulsively exercising because you think it's the only thing standing between you and a panic attack, that's a safety behavior. Same action, totally different relationship to it. One comes from care and the other comes from fear. I want you to keep an eye on which version you're coming from. And this really is just the flip side of my Airbnb story, right? When the basics slip, when you're running on little sleep, when you're getting sick, when you're overcaffeinated, you're going to feel more anxious. That's not any recovery practice failing. That's just your body asking for some care that it hasn't been getting. So when anxiety does show up, one of the kindest and most practical things you can do is check in with your basic needs and get things back in order. Not in a panic, just as a person taking. Care of yourself. Okay, so here's a quick overview of everything we talked about today. First, recovery was never about hitting zero anxiety. It's about those gaps getting wider and anxiety taking up less of your life. An occasional wave, even years in, does not erase any of your progress. Second, a single anxious moment is just an anxious moment, not a setback. Name it for what it is, let it be there, and be willing for it to come back. Keep living your life while it passes. The more you practice exposure in different contexts, the less likely breakthrough panic will happen in the future. And three, take care of your basic needs. Sleep, food, movement, mindfulness, all as maintenance and not as a way to outrun panic. And when anxiety does show up, check the physical setup before you decide it means anything. Most of the time, your body is just tired. And that's all for today's episode on what to do when anxiety comes back. I want to say one more thing before we go. The reason that weekend matters to me, why I tell that story, is because it's one of the clearest points I have of what freedom from disordered anxiety actually is. Because for years I thought that freedom meant never feeling anxiety again. That if I ever had another panic attack, that would mean that I hadn't recovered and that this is just the way that I'm wired permanently. But standing in that house, feeling the panic, freaking out for a minute, coming back to what I know and accepting it, letting it be there, and being willing for it to come back, and then watching it pass and going on to have a great weekend with my friends, that was a pivotal experience for my understanding of freedom. It was never about never feeling anxious. It was about not fearing my own body anymore. I can feel it, not let it run the show, and keep doing the things I love. That's what fear to freedom actually means. If today's episode spoke to you, I have a few other episodes that pair really well with this one. Fear of fear, if you want to understand that second layer we talked about, how to practice acceptance, which I mentioned earlier, it's my most popular episode, and it's the how-to for letting anxiety be there. And how to prepare for a panic attack to help you plan ahead for when this inevitably happens again in the future. If you have questions about anything we covered today, or there's a topic you want me to go into on the show, send me an email at amanda at the18minutes.com or send me a DM on TikTok and Instagram at the 18 Minutes. I read every single thing and I love to hear from you. If today's episode was helpful to you, please follow or subscribe so you don't miss the next one. And if you have a second, please consider leaving a rating or review so that other anxious people can find this show. Thank you so much for being here today, and we'll see you next time.