My Thoughts

Thanks for the question! This is a very common issue with anxiety, so thank you for asking about it. One thing I hear in this question is that you went to a cardiologist about this issue. That’s awesome. That’s always a good step to rule out significant health issues that could be contributing. Obviously, there is a difference between feeling in the pit of health anxiety and going to the doctor for every single little odd sensation that you might have and getting something concerning checked to give you some peace of mind. Essentially, your goal in going to the doctor is to give yourself permission to approach this issue rather than avoid it for fear of some serious health consequence. If your cardiovascular situation is such that it is actually a bad idea for you to exercise vigorously due to risk of having a heart attack or something, then you actually will want to avoid it. Now we know that’s not the case, so what can we do here?

Understanding Anxiety

There are a few anxiety fundamentals that I need to throw out there. I also need to take my obligatory moment to remind you about my online course, because I go into a lot of detail about these things in there.

So first off, physical sensations play a huge role in a lot of people’s anxiety experience in a couple of ways. One of the things that anxiety causes us to do is to misinterpret the sensations in our bodies. Anxiety wants to protect us from danger, so it causes us to be hypervigilant about the sensations happening within ourselves. Something that might be innocuous normal bodily change suddenly has a huge magnifying glass held up to it. And in a super fun way, anxiety placing all the focus on that sensation can cause the sensation to actually get bigger and more obvious. There is also a pattern that happens, often in people that have a panic attack, where the first time something like this happens, it’s really about your body thinking it noticed a sign of danger and ramping up your fight or flight response to deal with it. Let’s say that elevates to a level that you end up in the hospital because you think you’re having a heart attack or a stroke. After that, you might actually get anxious about the fact that you might be anxious. This is a little hard to explain, but it’s like your body is hypervigilant to signs of anxiety, so you can actually make yourself anxious by worrying about anxiety.

As I said, the body does misinterpret physical sensations. You can probably find situations that cause you to experience very similar sensations that you don’t interpret as anxiety. For example, let’s say you are about to see your favorite band. The lights go down, you hear the amps turn on, and stuff is about to take off. you probably have a lot of physical sensations that are very similar to anxiety. But you don’t interpret it that way. You interpret it as excitement.

So that’s a little bit about how physical sensations work in anxiety and it sounds like that’s definitely going on here. Rather than interpreting the heart rate elevation as just a sign of normal cardiovascular stress, you are interpreting it as a sign that something is wrong. This isn’t necessarily a conscious process – you can intellectually understand that nothing is wrong, but you still feel this ramp up and elevation. Another anxiety fundamental is that avoidance is the fuel of anxiety. since anxiety is trying to keep you safe, even if it’s inappropriate or overzealous in its attempts, anxiety will try to keep you away from things that it interprets as a danger. This can be a literal situation or even avoidance of a particular thought or physical sensation. The thing is that when you avoid something because your anxiety tells you to, you are rewarding your anxiety and making it bigger. You are saying “Thank you for keeping me safe. You were totally right.” When you know that something is not a true risk, avoiding it just gives it too much credit. So what you want to do is the opposite. You want to approach the anxiety-induing situation. This is a process that we call exposure.

One last really important fundamental thing is that recovery from anxiety does not mean that you find some magical way to reduce your anxiety down to zero. Truly it means that you learn to make your anxiety less relevant. It’s about becoming better at being an anxious person. About calling BS on your anxiety and doing what you intend to do even if anxiety occurs. So for you, this is probably a very predictable and basic response, but you are most likely going to want to keep up the exercise and gradually expose yourself to the sensation. Rather than working toward being able to exercise without feeling any odd cardiovascular symptoms, your job is to get better and better at exercising with those sensations there. As your doctor said, even though they may be uncomfortable or concerning, they are not signs of danger. You can do this gradually if you like, but it’s important to remember that there isn’t a wrong way to do this. If you accidentally go too hard, you are still okay. The anxiety is not going to hurt you, it’s just uncomfortable. So, it’s not even a mistake, truly. But as I said, you can attack this gradually. If you get some of the sensations you are talking about from walking vigorously, then start there.

Exposure, Anxiety, and Exercise

When doing exposure work, the most important factors to consider are duration and frequency. What we do not want is for you to go take a quick walk around the block and then quickly get back home because the sensation is too strong. That would again be giving it too much credit and actually reinforcing the anxiety. Instead, we want you to be engaging with the activity for a significant amount of time. I’m talking more like walking for 30 minutes straight. This gives your body a chance to both feel and adjust to the sensation. And then when it comes to frequency, the more the better. If you could be walking every day, that would be awesome. But at the very least, shooting for 3-4 times a week would be productive. This will allow your body to acclimate and for you to develop a better tolerance for the anxiety that you are experiencing while exercising.

Once you feel that you have gained some mastery over these steps, you can ramp it up in terms of the intensity. You can jog. Or you can experiment with interval training, which is actually a really great way to have a lot of exposure to the sensation of your pounding heart because you are forcing your heart to adjust to the faster and slower pace. Remember when you experience anxiety symptoms that you expected them. You are inviting them. So you win. You are standing up to them and that’s the whole point. Not to escape them. To endure them. Keep this up over time and you may find that the things that once challenged your anxiety are now easy. That your standard has changed.

Obviously, this doesn’t only apply to walking and running. You can also play around with other types of exercise including lifting, swimming, and sports. Sports would actually be an interesting one to try if you haven’t already. Sometimes when you are so engaged in a competitive activity, especially with other people, you don’t even notice the same sensations. They are probably still there, but they don’t worry you as much as they do in the other context. That’s basically what I have for you. This is a pretty basic nuts and bolts situation. Avoid avoidance. Remember that the sensations are expected and that you don’t HAVE to get rid of them.

It’s probably a great idea to find some good deep breathing exercises that you practice often to have in your back pocket when you need to bring things down a few notches, but just remember that the point of this sort of exposure work is not to run with no physiological elevation. You want to get better at tolerating it. And you will.

Good question!