Physiological Techniques
1Relaxation TechniquesCBT
A family of techniques — including progressive muscle relaxation (PMR), autogenic training, and guided imagery — designed to shift the body from sympathetic (fight-or-flight) to parasympathetic (rest-and-digest) activation. Work by releasing muscular tension that accumulates below conscious awareness and directly fuels anxiety.
PMR: starting at the feet, tense each muscle group firmly for 10 seconds, then release for 20 seconds. Notice the contrast. Work upward through calves, thighs, abdomen, hands, arms, shoulders, face. Full sequence: 20–25 minutes. Abbreviated versions: 5 minutes.
2Deep BreathingCBT/DBT
Diaphragmatic breathing activates the vagus nerve and parasympathetic nervous system, directly counteracting the physiological panic response. The key mechanism is the extended exhale: exhaling longer than inhaling increases heart rate variability and signals safety to the nervous system. Practice daily when calm to make it effective under stress.
Box breathing: inhale 4, hold 4, exhale 4, hold 4. Or 4-7-8: inhale 4, hold 7, exhale 8. Practice 5 minutes daily when calm — this builds the neural pathway that makes it accessible during actual distress.
3MindfulnessCBT
Mindfulness-based practice trains deliberate, non-judgmental attention to present-moment experience. Regular practice restructures the default mode network (associated with rumination) and strengthens prefrontal regulation of the amygdala. Both a formal practice (meditation) and an informal approach to daily activity.
5-minute body scan: lie down, close eyes. Slowly bring attention to each area of the body from feet to crown. Notice sensation without trying to change it. When the mind wanders — and it will — gently return without judgment. The returning is the practice.
4Distress ToleranceDBT
A set of skills designed specifically for riding out a crisis without making it worse. Core skills include TIPP (Temperature, Intense exercise, Paced breathing, Progressive relaxation), ACCEPTS (structured distraction), and self-soothe. Distress tolerance is not about solving the problem — it is about surviving a crisis moment intact.
TIPP in crisis: hold your face in ice-cold water for 30 seconds — this activates the dive reflex and immediately slows heart rate. Or do 60 seconds of intense exercise to metabolize adrenaline. These are physiological interventions, not psychological ones.
5Chain Analysis (Physiological Focus)DBT
Map every link in the chain from vulnerability through crisis, with particular attention to physiological signals. Chain analysis reveals that behavioral escalation is typically preceded by identifiable somatic cues — shallow breathing, chest tightness, physical restlessness — that arrive before thoughts or emotions are conscious.
Work backward from the crisis behavior: ‘Just before, I felt my chest tighten and my breathing shallow. Before that: thought Y. Before that: event Z. Vulnerability: I hadn’t slept.’ The chest tightening is the earliest signal — and the best physiological intervention point.
6Gratitude PracticesACT
Regular, intentional attention to what is working, present, or appreciated counteracts the negativity bias built into human threat-detection systems. Not toxic positivity — it trains attentional balance. Research shows it increases positive affect, reduces stress hormones, and improves sleep quality with consistent practice.
Each evening, identify three specific things that went well — not generalities (‘my family’) but specific events (‘my daughter laughed at breakfast’). Write them down. Notice what consistent practice does to the default direction of your attention over 2–3 weeks.
7MetaphorsACT
Use concrete analogies to make psychological concepts tangible and memorable. Metaphors work because experiential understanding transfers more effectively to real-world behavior than conceptual explanation. A well-chosen metaphor can shift a person’s relationship to inner experience in ways that verbal explanation alone cannot achieve.
‘Passengers on the Bus’: you are the driver, and your thoughts and feelings are passengers shouting directions. You don’t have to obey them or throw them off — you can acknowledge them and keep driving your chosen direction. The passengers are loud, but they don’t hold the wheel.
8Interpersonal EffectivenessDBT
DBT’s DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate) and GIVE/FAST skills provide specific behavioral scripts for getting needs met while maintaining relationships and self-respect. Most valuable when emotional intensity has historically derailed effective communication.
DEAR MAN: ‘When you interrupt me in meetings (Describe), I feel dismissed (Express), and I’d like you to let me finish before responding (Assert). That would help me contribute more confidently (Reinforce).’
The body keeps the score. No amount of cognitive reframing fully resolves distress that is held in the nervous system. The techniques on this sheet work at the level of physiology — which is where anxiety lives, and where it can most directly be addressed.