Anxiety Coping Skills: 14 Techniques Grouped by Their Target

About this tool

Anxiety coping skills are the techniques a person uses to lower anxiety in the moment or to reduce how often and how strongly it returns. The term covers a lot of ground, from a sixty-second breathing pattern to a ten-week exposure plan, and lists of them online tend to be long and unsorted. A more useful way to organize them is by what each skill acts on. Anxiety runs through four channels: the body's arousal, where attention goes, what the mind predicts, and what the person does next. Every skill worth keeping works on one of those four, and knowing which one tells you when to use it.

Body skills lower physical arousal. Paced breathing with a long, slow exhale engages the parasympathetic braking system within a minute or two. Progressive muscle relaxation, tensing and releasing muscle groups in sequence, teaches the body the difference between held tension and release. The DBT skill set TIPP, which stands for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation, is the emergency version: cold water on the face, a burst of hard exercise, a slow exhale, then relaxation, for moments when arousal is near the top of the scale. The first two need a medical check first. Linehan's handout says to consult a health care provider before using cold water or intense exercise if you have a heart or other medical condition, a lowered heart rate from medication such as a beta-blocker, an allergy to cold or an eating disorder, and to avoid ice water if you are allergic to the cold; if any of that applies, start with paced breathing and muscle relaxation and ask about the other two. Ordinary movement, a brisk walk or a run, does the same job more slowly and has good evidence for anxiety that is chronic rather than acute.

Attention skills move the focus from the inside of the head to the outside world, or change the relationship with a thought without arguing with it. Grounding, including the 5-4-3-2-1 senses sequence, gives attention a concrete job. Cognitive defusion, from acceptance and commitment therapy, treats a thought as a thought rather than a fact: noticing "I am having the thought that I will fail" instead of "I will fail." Single-task attention, doing one ordinary activity with full attention, is the everyday form of mindfulness and is easier to keep up than formal meditation.

Thought skills work on the prediction. Cognitive restructuring, the core CBT procedure, writes down the anxious thought and tests it against the evidence. Decatastrophizing asks what would actually happen if the feared thing occurred, how likely that is, and how the person would cope, which usually shrinks the catastrophe to a problem. Worry postponement, from Thomas Borkovec's stimulus control research, sets a fixed daily worry period and defers every worry that arrives outside it. The worries lose their urgency when they are written down and given an appointment.

Behavior skills change what the person does, and over weeks they do the most to reduce anxiety for good. Graded exposure means approaching feared situations in a planned order and staying long enough to learn that the feared outcome does not happen or can be handled. Dropping safety behaviors means letting go of the small rituals that quietly confirm the danger, such as checking your pulse repeatedly or always sitting near the exit. This is about rituals, not about prescribed medication, medical supplies or an accessibility aid: keep those, and work out with your prescriber or therapist which habits are worth changing and in what order. Activity scheduling keeps a life going when anxiety wants to shrink it. Problem solving takes the worries that are about a real, solvable situation and turns them into a plan.

If one idea organizes the whole list it is this: avoidance-based coping maintains anxiety, and approach-based coping reduces it. Avoidance works instantly, and that is exactly the problem. Leaving the party, canceling the appointment, not opening the letter, checking one more time: each gives relief, the relief rewards the avoidance, and the person never gets to learn that the situation was survivable. Paul Salkovskis described this cycle in 1991, and it is the reason a skill that feels like coping can be making things worse. The test for any skill is simple. Does it help you move toward the thing you fear, or does it help you keep away from it? Breathing before a presentation is approach. Breathing so you can get out of the room is avoidance wearing a coping skill's clothes.

The evidence behind these skills is solid at the level of the therapies they come from. Cognitive behavioral therapy for anxiety disorders has decades of trials behind it, with exposure and cognitive work as the components that carry the effect. Transdiagnostic programs such as David Barlow's Unified Protocol pull together the same four targets. Relaxation and breathing on their own help with symptoms but do not reliably resolve an anxiety disorder, and the research on single techniques used alone is thinner than their popularity suggests. Expect the behavior and thought skills to do the heavy lifting and the body and attention skills to make that work bearable.

The attention skills suit almost everyone. The body skills need one check first: the DBT temperature and intense-exercise techniques are not for everyone, and Linehan's own handout says to check with a health care provider first if you have a heart or other medical condition, a low heart rate from medication such as a beta-blocker, an allergy to cold or an eating disorder, and to avoid ice water if you are allergic to the cold. The thought and behavior skills suit anyone willing to practice between episodes rather than only during them. The common mistakes are using a skill for the first time mid-panic, collecting skills instead of practicing two, using breathing as a way to flee, and treating grounding as a substitute for exposure. If anxiety has lasted more than a few months, is interfering with work, sleep or relationships, or comes with panic attacks you cannot predict, a therapist can build the exposure and restructuring plan with you. Psychology.com's directory lets you search for one by specialty at no cost. The Grounding Techniques, 4-7-8 Breathing and Scheduled Worry Time pages on this site cover three of the skills here in more depth, and the Coping Skills Library covers the wider set.

Reviewed by Michael Callans, MSW
Reviewed the four-target grouping, the TIPP expansion, and the avoidance-versus-approach framing for accuracy against CBT, DBT and ACT practice.

References

1. Salkovskis PM. The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy. 1991;19(1):6-19.
2. Barlow DH, Farchione TJ, Sauer-Zavala S, et al. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. 2nd ed. Oxford University Press; 2018.
3. Linehan MM. DBT Skills Training Manual. 2nd ed. Guilford Press; 2014.
4. Borkovec TD, Wilkinson L, Folensbee R, Lerman C. Stimulus control applications to the treatment of worry. Behaviour Research and Therapy. 1983;21(3):247-251.
5. Clark DA, Beck AT. The Anxiety and Worry Workbook: The Cognitive Behavioral Solution. Guilford Press; 2012.

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