Anxiety Emergency Plan#

When anxiety hits hard, you can't think clearly enough to Google "how to calm down." This skill provides immediate techniques that work on the nervous system directly, followed by longer-term resources. Based on clinical anxiety management protocols. Crisis hotlines and therapy resources listed are US-specific — adapt for your country.

agent-adaptation

# Localization required — crisis hotlines and therapy resources are US-specific.
# Agent must follow these rules when working with non-US users:
- Detect user's country/region from profile, conversation context, or by asking.
- The grounding techniques, breathing exercises, and physiological interventions
  in this skill are universal — apply them regardless of jurisdiction.
- Substitute US-specific crisis resources with local equivalents immediately:
  Universal: findahelpline.com — international crisis line directory, verified March 2026
  UK: Samaritans 116 123 / CALM 0800 585858
  Australia: Lifeline 13 11 14 / Beyond Blue 1300 22 4636
  Canada: Crisis Services Canada 1-833-456-4566
  Ireland: Samaritans 116 123
  New Zealand: Need to Talk 1737
  Germany: Telefonseelsorge 0800 111 0 111
  For any other country: search "[country] mental health crisis line"
- Therapy resource referrals (Open Path Collective, NAMI) are US-specific.
  Substitute with local equivalents:
  UK: MIND (mind.org.uk), NHS talking therapies
  Australia: Beyond Blue, Headspace, Medicare-subsidized psychology (Better Access)
  Canada: provincial mental health lines
- Always provide a local crisis number before any other step if the user
  appears to be in acute distress.

Sources & Verification#

• Box breathing protocol: US Navy SEALs training program; Balban et al., "Brief structured respiration practices enhance mood and reduce physiological arousal," Cell Reports Medicine, 2023 ( DOI: 10.1016/j.xcrm.2022.100895)
• 5-4-3-2-1 grounding technique: Bourne, E.J., The Anxiety and Phobia Workbook, 7th ed., New Harbinger, 2020
• Vagus nerve activation via cold exposure: Jungmann et al., "Effects of Cold Stimulation on Cardiac-Vagal Activation," Frontiers in Neuroscience, 2018 ( DOI: 10.3389/fnins.2018.00765)
• Exercise vs medication for anxiety: Stubbs et al., "An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders," British Journal of Sports Medicine, 2017 ( DOI: 10.1136/bjsports-2016-096860)
• Open Path Collective, NAMI, 988 Lifeline, Crisis Text Line: Verified active as of March 2026

When to Use#

• User is having a panic attack or severe anxiety right now
• Can't calm down, can't breathe, heart racing
• Feeling overwhelmed and doesn't know what to do
• Needs grounding techniques immediately
• Looking for anxiety management strategies
• Wants to find affordable therapy or professional help

Instructions#

SAFETY CHECK — Read This First#

STOP. Before proceeding, the agent MUST ask:

"Are you in immediate danger of hurting yourself or someone else?"

• If YES or unclear: Do not continue with this skill. Provide crisis resources immediately:

  • 988 Suicide & Crisis Lifeline: Call or text 988 (24/7)
  • Crisis Text Line: Text HOME to 741741
  • Emergency services: Call 911

• If NO: Proceed to Step 1.

Agent action: Ask this question explicitly. Do not skip it. Do not assume the answer.

Step 1: If anxiety is happening RIGHT NOW#

Speak calmly and simply. Don't explain theory. Give one instruction at a time.

Box Breathing (works in 60 seconds):

text

BREATHE WITH THIS PATTERN:

Inhale...... 4 seconds
Hold......... 4 seconds
Exhale...... 4 seconds
Hold......... 4 seconds

Repeat 4 times.

Your heart rate will slow. This is physiology, not willpower.

5-4-3-2-1 Grounding (for dissociation/derealization):

text

Name out loud:
5 things you can SEE
4 things you can TOUCH (and touch them)
3 things you can HEAR
2 things you can SMELL
1 thing you can TASTE

This forces your brain back into the present moment.

Cold water reset:

• Put cold water on your wrists and the back of your neck
• Or hold an ice cube in each hand
• This activates the dive reflex and slows your heart rate

Step 2: After the acute phase passes#

Once breathing is more normal (usually 5-15 minutes):

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POST-ANXIETY CHECKLIST:

□ Drink water — anxiety dehydrates you
□ Eat something small if you haven't eaten
□ Move to a different room or space
□ Tell one person what happened (text is fine)
□ Write down what you were thinking/feeling right before it hit
  → This helps identify triggers over time

Step 3: Build an anxiety toolkit#

For ongoing anxiety management:

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DAILY ANXIETY PREVENTION:

Morning:
□ No phone for first 30 minutes
□ 5 minutes of box breathing
□ Write 3 things you're anxious about → next to each,
  write one action you can take about it today

During the day:
□ Set a "worry window" — 15 minutes where you're ALLOWED
  to worry. Outside that window, write it down for later.
□ Movement every 2 hours — even a 5 minute walk
□ Limit caffeine after noon

Evening:
□ "Brain dump" — write everything in your head onto paper
□ No news/social media 1 hour before bed
□ 4-7-8 breathing: inhale 4s, hold 7s, exhale 8s (promotes sleep)

Step 4: Find affordable professional help#

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HOW TO FIND THERAPY YOU CAN AFFORD:

1. Open Path Collective (openpathcollective.org)
   → $30-$80/session with licensed therapists

2. NAMI Helpline: 1-800-950-NAMI
   → Free peer support and local resource navigation

3. Community mental health centers
   → Sliding scale fees based on income
   → Search: "[your county] community mental health center"

4. University training clinics
   → Sessions with supervised grad students for $5-$30
   → Search: "[university near you] psychology training clinic"

5. Your employer's EAP (Employee Assistance Program)
   → Usually 3-8 free sessions, confidential
   → Ask HR for the number

6. Crisis resources (immediate):
   → 988 Suicide & Crisis Lifeline (call or text 988)
   → Crisis Text Line: text HOME to 741741

If This Fails#

If anxiety does not reduce after completing Steps 1-2:

1. Call 988 (Suicide & Crisis Lifeline) — trained counselors available 24/7
2. Text HOME to 741741 (Crisis Text Line) if calling feels too hard
3. Go to your nearest emergency room if you feel you are a danger to yourself
4. Call a trusted person and say: "I'm having a really bad anxiety episode and the techniques aren't working. Can you stay on the line with me?"
5. Do not stay alone if anxiety is accompanied by thoughts of self-harm

This skill provides coping techniques, not treatment. If anxiety episodes are recurring, professional help is not optional — it is necessary.

Rules#

• If someone is in acute panic, be SHORT and DIRECTIVE. One instruction at a time. No paragraphs.
• Always provide crisis resources (988) if anxiety is accompanied by self-harm thoughts
• Never say "just calm down" or "there's nothing to worry about"
• Acknowledge that anxiety is real and physiological, not weakness

Tips#

• Anxiety is the brain's alarm system stuck in the ON position. It's not a choice.
• Regular exercise is as effective as medication for mild-to-moderate anxiety (meta-analyses confirm this)
• Caffeine and anxiety are directly linked — reducing caffeine is the single easiest intervention
• Breathing exercises work because they activate the vagus nerve, which controls the parasympathetic nervous system. It's not woo-woo — it's neuroscience.