Perhaps you have heard that somatic techniques are the answer—diaphragmatic breathing, nervous system regulation, grounding exercises. These are incredibly helpful, and I teach them on my YouTube channel. But they are only part of the solution.

Or perhaps you have been told that cognitive behavioral therapy (CBT) is the answer—stop ruminating, change your thoughts, identify your cognitive distortions. Again, enormously valuable work, which can create real change. But still, only part of the solution.

There are two other essential components that rarely get discussed—components that tie everything together and create the lasting change you are seeking.

In this article, I will share why the somatic and cognitive approaches help, what critical piece ties them together, and the missing piece that actually retrains your ancient brain to respond differently. By the end, you will understand the complete approach to anxiety recovery.

Anxiety is both a physiological event, rooted in the body, and a cognitive event (cognitions=thoughts).

Additionally, it is a natural emotion! In some situations, a small and manageable amount of anxiety can genuinely help us focus, stay on target, and get things done. It can provide the motivation to address a problem once we have identified it.

Further, much of our anxiety is rooted in our ancient survival responses—our fight-flight-freeze responses. All of this makes anxiety complex.

But the good news is that recovery from anxiety is absolutely possible. I want to emphasize this: in my work as a psychotherapist with clients over 20 years, helping people with their anxiety was deeply satisfying because they could make substantial progress when they integrated all the components and committed to practicing the techniques.

Somatic techniques work bottom-up. This means they start in the body and will eventually calm your cognitions. When you regulate your nervous system through breathing, movement, or grounding, you are calming your body and eventually, thoughts begin to settle.

Cognitive techniques work top-down. You begin to think about things differently, identifying cognitive distortions and reframing your thoughts. This helps your body respond with less anxiety. Even simply naming the emotions you are having has been clinically proven to lower your anxiety.

Both of these approaches are valuable. But there is something crucial that ties them together.

There is a part of your brain that can step back and look at your thoughts and your physical feelings.

It is the part that thinks about your thoughts. It is not consumed by them. It does not believe every one of them. 

It can detect patterns and unhelpful spirals in your thoughts. 

It can also observe your physical symptoms and identify them: this racing heart is because you are anticipating something that you don't like, but it isn't needed. 

Eventually, this part of the brain will see how your thought patterns and physical symptoms impact each other - and how they can spiral you into more anxiety OR they can spiral into a better state of mind. Helping one will help the other. 

I call this part of the brain the "observer brain." 

You might have an anxious story going in your head. If you are in an anxious state, you could be totally in that thought, and your body is responding to the dramatic story, to the catastrophizing. You are almost fully living it.

But the observer brain can look at that and see what is going on: "Hey, I am doing that again. I am making up a story. My body is responding and it is not actually happening."

This observer brain also helps with the somatic piece. The observer brain might notice: "Okay, you are having palpitations and nausea. You already know this is not a medical problem. You have already had it checked out, so something triggered this. I may not know what exactly triggered it right now, but I know something triggered it. So I know I need to begin to utilize those somatic techniques."

This observer brain is extremely important for anxiety recovery.

Right now, even as you are reading this, your observer brain is developing.

 Psychotherapy helps you become more aware of your thought patterns and helps develop the observer brain.

Mindfulness meditation is one of the best techniques to develop the observer brain. I know this is challenging for many people, but it is possible even if you have anxiety. When you sit in mindfulness meditation, you become acutely aware of your habitual thought patterns and how those patterns impact you somatically. Or if you tend to experience things somatically first (which many people do), you will begin to see how those somatic feelings trigger anxious thoughts.

Essentially, anything that helps you observe your patterns in a non-critical way will strengthen this observer brain.

The second thing that gets left out of the conversation a lot is this: it is actually changes in your behavior that retrain your old brain, your amygdala.

Your amygdala does not really respond to logic. Even your emotional brain—you can think of it like a puppy's brain. If you talk to a puppy and tell it to calm down, it is not going to respond well. If you get down on the floor and hug it, it will respond better. However, if you are guiding it and teaching it the behaviors that will help it be calmer, that will be the most effective.

Cognitive behavioral therapy does incorporate behavior change, but it seems—particularly in popular media—that everybody has translated CBT into cognitions and forgotten that behavior piece.

But the research shows that with almost all anxiety types, changing behavior is the most important element.

Using your cognitive brain and your observer brain (which is much less judgmental), identify what behaviors contribute to any kind of compulsive anxiety cycle you might have.

If you have health anxiety, you might compulsively research different somatic symptoms and health issues. It might give you temporary relief to do that, but that temporary relief maintains a cycle of anxiety and compulsive behavior. That would be a behavior to identify and begin to say, "Okay, cannot go there."

If you have agoraphobia, you begin to avoid leaving your house. I know this sounds challenging, and I do not mean to minimize the difficulty, but long-term change and recovery will require you to gradually leave your house. That is why exposure therapy is so critically important for panic attacks, agoraphobia, and other anxiety disorders.

The gold standard for OCD treatment is ERP—exposure and response prevention. This focuses on increasing the person's tolerance for feeling the anxiety gradually and then preventing the response which tends to give the person relief.

A classic example is somebody who washes their hands too much and is worried about germs or disease or giving somebody else a disease. The anxiety builds and builds until the person engages in the compulsive action (hand-washing), which gives them relief. But this simply maintains the cycle.

The concept of gradually increasing your tolerance for feelings of anxiety is also incorporated into one of the most effective therapy techniques for panic attacks, called interoceptive exposure.

Interoceptive means looking inside and identifying your sensations—how your stomach feels, how your heart is feeling, all of those uncomfortable panic symptoms that can lead somebody into a complete panic attack and spiral. And instead of reacting to them, one increases one's tolerance of them. The observer brain kicks in to say, "Okay, we know this is not dangerous. We do not like it. It is very uncomfortable. But we do not have to keep spiraling, and we can tolerate it".

I am mentioning these different disorders because even if you have generalized anxiety disorder, these concepts can be incorporated into how you think about what you are tolerating (in a positive sense). What can you tolerate without jumping right into the behavior that comes out of your anxiety?

I have a free webinar called Rewire Your Brain for Joy and Confidence that goes into more detail about how we develop this observer brain and how we bring behavior change into our lives to create lasting change in our mood. Many people have told me it is a very helpful webinar, and I invite you to join.

Keeping in mind that anxiety is a full mind-and-body issue, here is how to organize your approach to anxiety recovery:

These include grounding techniques and diaphragmatic breathing, along with overall means of relaxing and calming your physiology. These are the foundational tools to use.

The more you practice these grounding techniques and diaphragmatic breathing, the easier they become to access when you are anxious. If you do not practice them regularly, they will not be available when you need them.

I recommend practicing diaphragmatic breathing three times a day, five minutes at a time, and not when you are particularly anxious. This repeated practice is also a behavior that helps retrain your old brain to breathe calmly on a regular basis. Practicing the somatic techniques regularly will help you access them when you most need them.

Understand what the cognitive distortions are. Begin to look at your anxious thoughts and analyze them as you step back from those thoughts. When you recognize "that is catastrophizing" or "that is black-and-white thinking," you diminish that thought's power, and you are strengthening that observer brain.

Remember that the observer brain is not fixed. It is not like you either have one or you do not. It is something that you develop. As you develop it, the physiology of your brain actually changes.

The true rewiring of the neurobiology of your brain is going to happen through changing those behaviors that maintain your anxiety cycles. This is where the most profound and lasting change occurs.

Recovery from anxiety is absolutely possible when you take the complete approach. By integrating somatic techniques, cognitive work, developing your observer brain, and—most importantly—changing the behaviors that maintain your anxiety, you create lasting change.

Please share in the comments which of these elements you would like me to expand upon. Which items would you like to hear more about, and what questions do you have? This helps me tremendously as I develop future content. And stay tuned for a more extensive piece on the behavioral component.