American Association for Physician Leadership


How to Manage Your Anxiety

Charlotte Lieberman

November 21, 2023


We all feel anxiety at times. It becomes problematic when it feels unmanageable, which means different things for different people.

When I was nine, I was diagnosed with anxiety disorder by my first-ever therapist. My parents dragged me into treatment after repeatedly catching me cleaning their bathroom. I didn’t mind, but I was confused. I didn’t see anything wrong with what I was doing: organizing their medicine cabinet by color and size, throwing out expired antibiotics and sticky bottles of cough syrup. My favorite part was wiping down the sink with warm water, feeling my worries wash away with stubble and soap scum. Cleaning gave me the sense that I could find inner order among the outer chaos — our cramped New York apartment, murmurs of my parents’ struggling marriage, the growing pains of adolescence.

Now, two decades later, I still rely on cleaning as a coping mechanism for my anxiety. My current therapist encourages me to “sit with the feeling” instead, and sometimes I can tolerate it. There are mornings when I can wake up, take a shower, and go about my day with relative ease. There are also mornings, like today, when I feel imprisoned in a labyrinth of negative thoughts. Taking walks helps. Placing a heating pad on my stomach does too. For now, I am sitting with my anxiety, drinking my morning coffee, reminding myself to be grateful for my support system and the tools that help me manage.

It’s all a practice.

Based on my personal experience and research, I’ve learned there’s no one-size-fits-all when it comes to determining when anxiety becomes maladaptive and when to get help. The fact is that anxiety exists at different levels and in different ways in each of us, depending on our brain chemistry, genetic makeup, backgrounds, environments, social relationships, and so on.

Across the board, anxiety becomes problematic when it feels unmanageable — which also means different things for different people. Perhaps its intensity gets in the way of your day-to-day functioning. Maybe the feeling is so diffuse and unspecific that you feel at a loss for how to address it, and wondering only sucks you deeper into a quicksand of anxious thoughts. You might find yourself fixating on something that you know isn’t a cause for worry, but you still can’t help it. These are just some of the signs that you might benefit from professional mental health support. I know I have.

Whether on your own or alongside a therapist (I recommend both), the key to managing anxiety is learning to identify it, understand it, and respond to it with self-compassion. With that, I’ll share a few research-based practices that can, hopefully, help you cope more skillfully with anxiety, no matter what it looks like for you.

Identify and get to know your anxiety. From the wellness industry to tech and beyond, capitalism has influenced how we think about even our most mortal problems. Hunger, thirst, fatigue, boredom: There’s an app for all of it. But framing anxiety as “a problem” that needs a quick fix can kickstart a vicious cycle you may know as “fight or flight.” When we view our own painful emotions as a “threat” to fight or flee from, we turn ourselves into the enemy. So, rather than working against ourselves and trying to resist or run away from negative feelings, what if we simply said hello to them?

Research shows that mindfulness techniques like breath work can reduce anxiety and improve cognition. They help us tap into the region of our brains responsible for awareness, concentration, and decision-making (the prefrontal cortex), and put us in a calmer, more focused state. We are able to think more clearly and make better, more thoughtful decisions, rather than relying on the part of our brains that view anxiety as a threat (the amygdala).

The next time you’re spiraling — whether about work or your partner or nothing at all — pause and imagine anxiety knocking at your front door. Tell it, “One minute!” Then give yourself a moment to pause and try this breathing cycle: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds. This technique is known as “box breathing,” and it is a fast, effective way to calm the nervous system by “tricking” the mind into believing that the body is relaxed.

Once you’ve calmed down, imagine opening your front door and saying, “Ah, anxiety. Thanks for coming, but I’m not free right now.”

The goal is to gently create distance between yourself, your thoughts, and your emotions. Pinpointing where in your body the uncomfortable feelings reside can also help. Is it a tightness in your chest, or a churning in your stomach? Simply notice. By taking a step back from your discomfort, you may be able to relate to it with a bit more clarity. You gain the relief of perspective: This is an uncomfortable experience. This is not me.

Choose an anchor. Routines help reduce general feelings of anxiety, and are often effective antidotes for those with more serious mental health disorders. Doing the same thing at regular intervals signals to our brains that we are safe. Call it a routine, a ritual, an anchor — whatever resonates.

What you choose to do is up to you. It can even be laughably simple. I know that every day I take a walk at 12 pm before I eat lunch. I drink a glass of water upon waking up. I read the newspaper before I check my email.

For me, writing three pages in my journal every morning is a non-negotiable. This means I do it whether I feel like it or not, and knowing that I can follow through on this task — no matter what — gives me a reliable well of self-trust that I can dip into whenever anxiety tugs. Plus, writing down my thoughts is a cathartic, grounding exercise in and of itself. And it’s not just true for me: Journaling is often used as a therapeutic tool for anxiety and other mental health conditions.

Whatever routine you choose, make it a formal commitment. If it helps to keep you accountable, tell your partner, friend, or colleague about your routine, and ask them to check in with you weekly. Maybe write it on a sticky note and put it on your laptop. But don’t make it a chore.

You may find you feel a greater sense of safety and comfort once you apply this practice. And when you fall off the wagon, try to forgive yourself and move on.

Reframe self-discipline as a form of kindness. We are often conditioned to believe that feeling like our “best selves” results from maintaining a laundry list of #selfcare #goals. But for those of us with anxiety, self-care can actually be a major source of stress. My anxiety lends itself to perfectionism, which means I instinctively shudder at the thought of adding anything to my plate.

I long resisted the benefits of exercise, avoided having a social life, and dismissed my hobbies simply because I felt overwhelmed by the idea not just of having more “to do,” but also having to do it perfectly. After work, I’d come home, eat takeout, and scroll on Instagram until my eyes fluttered shut. This, I rationalized, was self-care. Except that it made me feel terrible.

With time and the help of my therapist, I eventually learned to adopt a different attitude. Yes, self-care requires a degree of discipline. But discipline can be kind.

Yoga and meditation are two ways to practice what I call “supportive discipline.” Focusing on the breath — and gently releasing distractions as they arise — requires both kindness and discipline. In Buddhism, this key tenet is roughly translated as “right effort.” As a meditation teacher once explained to me, you can think of your breath like a fragile object. If you grip it too tightly, it will break. But if you completely slacken your hand, it will fall. This practice of finding and maintaining that careful balance, to me, is a great image of supportive discipline.

Of course, meditation doesn’t feel great for everyone — and that’s okay. There are an infinite number of ways to practice being kinder to yourself and tuning into the present moment. You could try new hobbies like brewing beer, crocheting, rollerblading, bee-keeping. Exercising, drawing, and listening to music are evidence-based ways to reduce anxiety and regulate emotions. Find what works for you. Then do it. Period.

Visualize positive change. In the midst of anxiety, motivation to do anything can be the trickiest part. Try to connect to the positive feeling that will result from taking the action that feels “hard,” whether that’s going for a run or getting out of bed in the morning. Simply imagining success is correlated with motivation and the achievement of goals.

When you’re imagining how good it will feel, whatever “it” is, encourage yourself as you would a good friend. There is a robust body of recent research on the mental health benefits of “self-distancing,” which researchers compare to “the experience of seeking out a friend’s counsel on a difficult problem.” Rather than become “immersed” in the painful, often paralyzing feeling of anxiety, we can momentarily envision ourselves offering guidance to a good friend. Stretch. Make fruit salad. Watch a romantic comedy.

Anxiety is stubborn, so you’ll likely try to wriggle out of the good advice your “distanced” self is giving. But try to engage in the mental role play as best as you can. “Whereas it is often challenging for the person experiencing a personal dilemma to reason objectively about their own circumstances,” researchers explain, “friends are often uniquely capable of providing sage advice because they’re not involved in the experience.”

Imagine that! What would it feel like not to be involved in the experience of anxiety? Be creative.

Simple as these tips are, they may not always feel easy. They certainly don’t for me. If anxiety is good for anything, it is succeeding at making simple things feel complicated and insurmountable.

The bottom line? We can choose to be kinder, patient, and more compassionate with ourselves. Uncomfortable feelings will persist and subside — then persist again. The most productive thing any of us can do is show up to ourselves and others with open minds and hearts. It may not be the first priority on your to-do list, but let it be enough.

Editor’s Note: The opinions expressed here are for general informational purposes only. If you have concerns about an anxiety disorder, we recommend you consult with a medical professional.

Copyright 2020 Harvard Business School Publishing Corporation. Distributed by The New York Times Syndicate.

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Charlotte Lieberman

Charlotte Lieberman is a writer, marketing consultant, and certified life coach/hypnotist. You can find her work in The New York Times, The Harvard Business Review, Marie Claire, and elsewhere. Follow her on Twitter @clieberwoman.

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