By Heather L. Corwin, PhD, MFA, Certified Rolfer

The pandemic is impacting our lives in ways we could never have anticipated. While everyone experiences anxiety, some of us have levels of anxiety that require medical or psychological intervention. When working with people as we do through Rolfing® Structural Integration (SI), being able to detect symptoms of anxiety will help support your client while working together to achieve a wellness  goal.  Some of our clients know when they have diagnosable anxiety. Some are seeking our help because they have not been able to sleep well due to pain that might coexist with anxiety. Others might just feel vaguely agitated and not be able to identify why. The  Diagnostic  and  Statistical   Manual  of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013), describes generalized anxiety disorder (GAD) as “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance), and may involve restlessness, fatigue, difficulty

concentrating, irritability, muscle tension, and sleep disturbances . . . that cause impairment in social, occupational, or other important areas of functioning.”

Whether their anxiety is acute or chronic, our clients can benefit from our ability to identify how that anxiety may be contributing to their overall experience of themselves at this time. What has been true during my time practicing Rolfing SI is the type of support we offer through our work usually feels good to receive regardless of a formal diagnosis of anxiety. This point is important right now because of the threat we are facing throughout our global community. In this article, we will explore some of the common affects and effects of anxiety, psychological tools to consider, and introduce some practical exercises you might adopt in your practice to facilitate emotional regulation and anxiety management.

Present fears are less than horrible imaginings

William Shakespeare

Common Elements of Anxiety

Having undoubtedly experienced anxiety, we can, ideally, understand and even magnify our own experiences to empathize with people who suffer more acute levels. For the purpose of hands-on therapy, physical manifestations of anxiety are listed below. Physical symptoms of general anxiety disorder (GAD) might include:

• Irritability
• Trouble sleeping
• Muscle tension and aches
• Trembling, feeling twitchy
• Nervous, easily startled
• Sweating
• Nausea
• Irritable bowel syndrome

Many of these symptoms involve nervous system arousal, which can have many causes. When working with clients, these symptoms are something we usually look for to ensure the pace of our sessions    is tolerable and enjoyable. With clients who have GAD, a slower pace is ideal. I allow for time between strokes to check  in with the client visually or verbally. Pausing gives the client time to accept the input and prevents the nervous system from overload. Some nervous system responses that indicate anxiety: sweating, short and shallow  breaths, eyes darting around even when closed, and  more.  Attention  and  sensitivity   are required to monitor arousal in your client as well as to avoid stimulating any anxious reaction. Environmental factors might include temperature in the room, surface/table comfort,  lighting,  sounds.  A weighted blanket (with a washable cover) and aromatherapy may help to support some clients. Any one of these sensory assists may help soothe and bring an anxious person back into the moment. Anxiety often involves flights of thought, forecasting into the future or getting stuck in a past event. If our clients communicate with us verbally around such content, we can help interrupt the cascade of anxiety by redirecting them back into their bodies. Some clients may feel less anxious receiving work clothed.

At the root of anxiety is a perceived or real unresolvable conflict. If the person has no ability to solve the problem or conflict, anxiety is produced, and other behaviors will likely pop up to avoid or alleviate the stress and discomfort. As you might expect, anxiety shows up in

Powerlessness is a powerful agent of anxiety.

the body as tension causing a variety of discomforts that can become habits and evolve to protective postural armor or possibly painful holding in the soft tissue. The psychologist and medical doctor Wilhelm Reich was the first to propose we have several bands  of  tension  in the body that require release which are aligned with typical stressors. Today, many health-care providers understand the relationship between tension in the body and psychological well-being.

I have noticed in my mental health practice that anxiety is often inflamed when a person is put in a position where they have little power but are expected to make a change or impact in a situation. This is a ripe situation for anxiety to flourish. Most children understand this position because adults have the power. Think back to when you were a child when an adult reprimanded you for something you did not do. How did that feel? Powerlessness is a powerful agent of anxiety. The more a person is exposed to this type of interaction, the more likely that person will develop symptoms of generalized anxiety. This can also happen in the workplace with adults. When leadership is weak or does not support ‘outside the box’ approaches to solving problems, the person who follows her own path can become a source of ridicule without ever knowing why. This could most certainly cause anxiety. Having little control  over  your  environment  (which  is so much the case for all of us at this time) is likely to produce anxiety. It is easier to normalize anxiety amidst shared experiences, such as what is happening now with the pandemic.

There are moments when all anxiety and stated toil are becalmed in the infinite leisure and repose of nature. 

Henry David Thoreau

Let us take a moment to look at the brain and its role in anxiety. The area of our brain that is responsible for emergencies is the amygdala. This area of the brain is responsible for fear and joy. To borrow a metaphor from anxiety expert Bessel Van der Kolk, the amygdala is like a smoke detector. The smoke detector goes off when we have burnt toast and when the house is burning down, it does not discern the difference, it just tells the body that there is a threat. The amygdala gives the message, Emergency!

This is true even when we have a small worry; our stress  response  has  grown to blow up what may actually be a small worry into a big, anxious moment. This   is a fundamental operational process of how anxiety operates in the amygdala. What can help us manage the moment   is to take a pause to identify our fear reaction. For example, there may be a moment when we are spinning in our minds and we have noticed our belly is starting to ache and we have begun to tremble (common sensations of anxiety). Let us introduce the tool of a ‘fear thermometer’ (Walker, 2017). If we have a fear thermometer that goes up to ten

• ten being the highest or most fear – we may be at a nine (house is burning down). Now insert the fear thermometer for a check on reality. If the thermometer reading is a two or three – more like toast burning – that information can help regain emotional

Another example: your spouse or child expresses displeasure with  your  view  on a subject. That conflict might activate your amygdala (which has  no  capacity  for nuance) to warn: “Ten! House  is burning down!” Insert  fear  thermometer:  “I know that so-and-so is crabby today.” Temperature reading is actually two. Triggers for anxiety have very little to do with what is actually happening. It’s simple but not easy. Managing emotions requires awareness, practice, and patience. With the right skills, a person can learn to modulate the response of the amygdala to engage the neocortex, which is the logical/thinking part of your brain. When a person is able to get logic involved, this gives enough space to recognize the anxiety for what it is. This sounds like a simple process, but it is not. Our fears are hard-wired and so is our body’s response to keep us safe. When our systems have become highly sensitized, managing the response to match the event requires time, awareness, patience, and sometimes professional help that goes beyond a Rolfer’s scope. Nevertheless, just as we help our  clients  foster  awareness in bodies and sensations, expanding awareness of how anxiety shows up  in  the body can be profoundly eye-opening for our clients. Simply naming the fact that anxiety might be present gives the person an opportunity to recognize and even choose how to respond to their experience.

Clients who present with diagnosed conditions such as fibromyalgia or an autoimmune disorder may have been experiencing an exacerbation in their condition during this pandemic. Often, inflammation is involved, which makes tissues more tender and sensitive. We must adjust our input accordingly. It is entirely possible that some clients long-depended on Rolfing SI as a way to cope with anxiety prior to any sheltering-in- place. Then, when they most needed us, we were, as non-essential workers, unable to help them. Notably, this may have inspired anxiety within our own Rolfing SI community. Some worries may have included or continue to include worry over being unable to help others because we need to remain safely isolated, not being able to pay bills, and not being able to support our clients in ways we have for years.

Working with children around anxiety  may involve a different repertoire of intervention. Anxiety does not present differently in children; they simply lack awareness to be able to express or identify many of the elements of what’s happening. For example, acknowledging anxiety in daily life includes identifying when the reaction is out of proportion to the event. While an adult client may be able to make use of the (aforementioned) ‘fear thermometer’, a child may respond more to a visual and metaphorical representation of personal anxiety, such as a ‘creature’.

We might help the child to identify this creature’s characteristics: what  does  it look like? Is the creature prickly? Soft? Big? Small? What color or colors is it? Temperature? Does it have special powers? Does it breathe fire? Does it spit water? Can it be invisible? Can it fly? What is the creature’s language? When the creature/ anxiety communicates, what does it sound like? A nickname for the creature can also be helpful. Creating a creature can help the child to separate herself from her anxiety: “Look, there’s ‘Calamity Creature’ knocking on the door again!” We are helping her develop a capacity for observation, thus engaging the neocortex/logic part of brain, which can give her a sense of having some control rather than only feeling highjacked by anxiety. See Figure 1, this is an example created by a girl age 9; Cordelia  is  the bad fairy who represents anxiety. And see

Figure 2, Clara, the good fairy who helps identify the appropriate fear response.

To be  clear,  identifying  the  anxiety  does not necessarily take it away. Our reaction to anxiety can change because we can learn to expect our anxious reaction, make it normalized, and then the amygdala will interrupt the anxiety loop (Wilson and Lyons, 2013). What we are doing is finding a way to manage our response to it.

Breath is the bridge which connects life to consciousness, which unites your body to your thoughts. Whenever your mind becomes scattered, use your breath as the means to take hold of your mind again.

Thich Nhat Hanh

For many clients who experience anxiety, the hands-on element of Rolfing SI alone can help calm them. (Exceptions to this are clients with histories of physical abuse or post-traumatic stress disorder; such clients require specific considerations which we will not explore in this article). During hands-on work, we may ask clients to focus on their experience of physical sensation. Similarly, when the focus is on the breath, the mind’s redirection can help to calm them (Telles et al., 2019).

Nervous system down-regulating has an effect on the breath, which may become slower and deeper. You might  ask your clients to notice if their breath has changed, as opposed to asking them to change their breath. The role of the breath in managing anxiety cannot be overstated. Taking slower, deeper breaths from the abdomen or diaphragm can lower heart rate can induce relaxation. [See Leyba (2020) for more information about deeper breaths.] Following are some directive breathing exercises I have developed to incorporate into our sessions. Italics indicate directions to the client.

1. Slowing the Breath

– Notice how you feel and find an adjective for that feeling.

• Inhale on a count of seven, pause for two, then exhale on a count of seven, pause for two
• Do this for three
• Inhale on a count of six, pause for two counts, exhale for a count of
• Repeat for three
• Rest and notice if your breath feels like it is moving in more places in your

– Notice if you feel any different in your sensations than you did before you did this breath work. 

Note:  When  making  any   adaptations to the breath, the nervous system can become aroused rather than calm. If this happens, say to your client: “If you begin to feel agitated, take a break. Sometimes the body is not used to getting so much oxygen. This might make you a little lightheaded or dizzy..”

To help your clients build up their capacity, you can slowly introduce these ideas at the beginning of your session and at the end.

2. The ‘K’ Breath

When you are ready for your next inhalation, make a ‘K’ sound (the same sound as the end of the word ‘duck’) before you fill your lungs, pause when full, then ‘K’ sound before you

Play with the duration of the breath and where you are filling your For example, I may focus on my low back ribs to open as I inhale, pause, and then think of that area to empty on the ‘K’.

• I may suck in as much air as I can in four seconds, pause and then ‘K’ out nine seconds.
• The application of this exercise can build breath capacity, which brings more oxygen into the body while it calms/ down-regulates the nervous

Invite your clients to consider:

• The great thing about breath work is you can play with it and at any point, you can let it go if you feel like you are squeezing your ribs or
• What “squeezing your ribs” means is you have run out of breath and you are then forced to push air

We want to avoid force. The ‘K’ will help with the ease of breath.

3. The ‘Raspberry’ Breath

• This is one kids do all the time to make a fun sound, or to imitate a horse’s
• Gently press your lips together and send a steady stream of air through, just enough to be able to vibrate the

This action does not allow a person to go at any rate other than steady, or the lips stop vibrating.

• You can play with how much you purse the lips.

More pursing elongates the breath and might heighten the pitch of the sound (less like a motorboat and more like a blender sound).

Your lips will feel tingly after this, which is normal.

4. Bubbles
– Let’s blow some bubbles! This will definitely remind you to breathe.
Keep a supply of bubbles in your office to give as a gift to practice between sessions. Plus, bubbles are beautiful to look at floating in the world.

5. The ‘Huh’ Breath
The Huh is a similar sound to a sigh and usually is used with a minimum of three huh’s on one exhalation.
– Breathe in normally and offer as many huh’s on the exhale as you are naturally able to do.

– This may be three times or more.
– Keep in mind, the goal is not laughing, it is to relieve tension in the breathing areas, the throat, and facilitate ease with the sound.
– Try this lying down, seated, and standing to see if one of the ways gives you more access to your breath.

6. Counting Your Breaths in a Minute

– Simply to notice how many breaths you take in a minute.
– Don’t try to achieve a certain number.
– Just count.
Since there are cell phones everywhere with a stopwatch app, most people have the ability to do this easily. If they do this a few times a day, they might notice patterns. For instance, during transitions from one part of the day into another, or in tense situations. This type of engagement also helps manage anxiety immediately as long as the focus remains on counting rather than the thought that is causing the anxiety.

7. Alternate-Nostril Breathing
– Breathing only through your nose, cover your right nostril with your thumb on a count of four, pause and uncover right while using your index finger to cover your left nostril and exhale for six counts.
– Repeat four times.
– Rest and breath normally.
– Reverse and use left hand to do the same (left thumb to left nostril, etc.).
– Gently blow your nose as needed.
– Notice what you notice.
In a study looking at how yogic alternate-nostril breathing impacts anxiety, the conclusion found “breath awareness and sitting quietly with eyes closed, also practiced for eighteen minutes each, reduce(s) state anxiety” (Telles et al., ‘2019, p. 121).

8. Balloons and Straws
If the previous exercises sound like they might be on the edge of where some clients might be willing to go, you can use a good old-fashioned balloon to help remind a person how to access lung capacity. A warmup to the balloon can be using a straw to blow a piece of cotton across a table.

The essence of great breath work is often engaging, simple, and clear.
Feelings come and go like clouds in a windy sky. Conscious breathing is my anchor.
Thich Nhat Hanh

There is no limit to the complementary therapy we can incorporate in our work to help our clients address anxiety. A client can be taught to practice breathing using any one of the exercises above as a mindful meditation. We can suggest at- home practices to empower and deepen the results of our work. Discover what is appropriate for each client. ‘Thinkers’ might prefer work that is more intricate and detailed; ‘feelers’ might prefer more sensory-led practices. Since anxiety exists in everyone, stress-management tools that calm the body are valuable and useful with all people.
To sum up, we all have some levels of worry that are more heightened when we are under threat. If you, your loved ones, and your clients have been feeling more overwhelmed these days, that is perfectly normal and to be expected. We are living in unprecedented and uncertain times, involving possible economic insecurity and personal health threats.
As Rolfers, our ability to work may be restricted, and may come and go with the pandemic curves. Conflicting information only adds to the uncertainty. Living with our families around the clock can breed its own levels of frustrations and conflict. If you have young children, you face the additional challenge of at-home schooling. Online technology may be difficult to maneuver. Our lives do not look like they did, which may involve grief. No matter what has fueled your or clients’ anxiety, there is comfort in identifying and using tools to manage the feelings, arousal of the nervous system, and runaway thoughts.

I find the words of Paolo Coelho helpful: “Anxiety was born in the very same moment as mankind. And since we will never be able to master it, we will have to learn to live with it — just as we have learned to live with storms.”

Heather L. Corwin holds a PhD in clinical psychology with a somatic concentration from The Chicago School of Professional Psychology and a MFA in acting from Florida State University/Asolo Conservatory. Currently, Heather practices as a clinical fellow at Blackbird Behavioral Health and she runs her Rolfing studio, both located in Oak Park, Illinois. As an actor for over twenty years and theatre arts professor at places like Roosevelt University, Pasadena City College, and Northern Illinois University, Heather’s research and work examines behavior through the lens of psychology, allowing the flaws of being human to unite us through creative expression. Heather is a Certified Rolfer, a belly laugher, a talk therapist, married to the love of her life, mom to an energetic nine- year-old, and fan of historical romance. To read more publications and learn more about her, please visit BodybyHeather.com or CorwinCounseling.com.

References
American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders. Arlington, Virginia: American Psychiatric Association.
Leyba, E. 2020, May/June. “8 Simple ways to soothe an anxious child,” Psychology Today, 53 (3), 32-33.
Telles, S., B. Vishwakarma, R.K. Gupta, &
A. Balkrishna 2019. “Changes in Shape and Size Discrimination and State Anxiety After Alternate-Nostril Yoga Breathing and Breath Awareness in One Session Each.” Medical Science Monitor Basic Research 25:121.
Walker, B.F. 2017. Anxiety Relief for Kids: On-the-Spot Strategies to Help Your Child Overcome Worry, Panic, and Avoidance. Oakland, California: New Harbinger Publications.
Wilson, R., & L. Lyons 2013. Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children. Deerfield Beach, twenty years and theatre arts professor at places like Roosevelt University, Pasadena City College, and Northern Illinois University, Heather’s research and work examines behavior through the lens of psychology, allowing the flaws of being human to unite us through creative expression. Heather is a Certified Rolfer, a belly laugher, a talk therapist, married to the love of her life, mom to an energetic nine- year-old, and fan of historical romance. To read more publications and learn more about her, please visit BodybyHeather.com or CorwinCounseling.com.

Anxiety, Psychological Tools, and Breath[:]