Anxiety may be a key driver for the use of substances, or anger/violence. High levels of anxiety are incompatible with accurate Mentalization.

This is a well evidenced behavioural relaxation technique used in Cognitive Behavioural work to reduce anxiety.

Another acute behavioural technique worth considering (particularly if there are odd sensations of tingling, or the person feels breathless in a panic state) is Re-breathing.

PsychoEducation

• Explain the "vicious circle" of anxiety (see below). Use diagrams to help. Give the diagrams to the young person at the end of the session.
• Emphasise that this is a very powerfully evidenced technique, that has been tested with thousands of people and is known to be effective.
• There are plenty of other methods, but it is best to adopt one and stick with it than to flit from thing to thing without ever really mastering any of them.

The problem - a vicious circle:

1. Anxiety in the brain sends messages to the ADRENAL glands (above the kidneys) which release ADRENALINE. This raises the heart rate, and quickens the breathing, preparing the body for "fight or flight".
2. At the same time, adrenaline increases the likelihood of MORE anxious thoughts and worries in the mind (this is useful if there is a real threat out there, but can be unhelpful if it just increases panicky feelings.)
3. The more anxiety you feel, the more messages the brain sends down to the muscles, teling them to "tense up" in case of the need for "fight of flight".
4. At the same time, "stress sensors" in the muscles send messages BACK to the brain, telling it how tense the muscles are - the more tense they are, the more stressful messages are sent back to the brain - and this makes the brain (and your mind!) even more more stressed - a classic vicious circle!

The solution - switching off the circle:

Be a scientist about this!

BEFORE YOU START - you want to know that whatever you do is WORKING. So give your anxiety a SCORE (0 = totally chilled out, 100 = complete panic)

Now start:

1. Find a quiet spot if you can, but you can even do a version of this on a bus if you have to...
2. Now, just as the more tense your muscles become, the more anxious you become, so the more relaxed and soft you can make your muscles, the more this calms the system down, because those "stress sensors" send reassuring messages back to the brain ("Dunno what's going on up there, but we're all mellow down here!"
3. By tensing a muscle as hard as you can, and then relaxing it slowly, you can't help but leave it more relaxed than it was before you started.
4. Sit comfortably. Feel the level of tension in your muscles. Try to focus on the physical feelings of tension in your body.
1. Start at the toes; clench them, count slowly to ten, then relax them slowly.
2. Do the same with each group of muscles; - calves, thighs, buttocks (remind the young person that this and the face muscles are the only muscle groups that you might want to avoid tensing in a public place - the rest you can do without anyone noticing!), stomach muscles, then fists, arms, then jaw, then facial muscles (screw your face up as tight as you can then relax.) Count slowly in your head (or aloud if you wish) to ten for each muscle group, and then relax them slowly.
5. At the same time you can use another useful fact - which is that the conscious mind can only really host one thought at a time. So, if you fill it with reassuringly boring methodical thoughts, there is less room for panicky anxious ones to keep stirring you up and triggering the vicious circle:
1. Each time you relax a group of muscles, slowly repeat something reassuring to yourself, such as: "My arm muscles are starting to feel really relaxed and soft now."
2. Even though this feels a bit odd/silly at first, because it is rather a dull and methodical thing, it will be blocking those anxious thoughts from filling your head...
3. So you are now going about the business of stopping the vicious circle from the top down (your thoughts) and the bottom up (your muscles).
6. Go from the toes to the facial muscles in strict order three times (takes less than 5 minutes.

Be a Scientist about this!

When you stop, give your anxiety another SCORE (0 - 100, just as before)... it may not have reduced down to zero, but it is very unlikely to have increased.

1. Just knowing that you have some control over your anxiety can itself be very reassuring.
2. PRACTICE MAKES PERFECT - this exercise works like any athlete works - the more you train, the better you get at it. Set yourself a target to do this twice a day - by all means more if you wish, or need to. It is useful to try to use it when you are not too panicky to start with, so that you can get into a pattern.